The importance of interdisciplinary frameworks in social media mining: An exploratory approach between Computational Informatics and Social Network Analysis (SNA)

Social media content is one of the most visible sources of big data and is often used in health studies to draw inferences about various behaviors. Though much can be gleaned from social media data and mining, the approaches used to collect and analyze data are generally strengthened when examined through established theoretical frameworks. Health behavior, a theory driven field, encourages interdisciplinary collaboration across fields and theories to help us draw robust conclusions about phenomena. This pilot study uses a combined computer informatics and SNA approach to analyze information spread about mask-wearing as a personal mitigation effort during the COVID-19 pandemic. We analyzed one week’s worth of Twitter data (n = 10,107 tweets across 4,289 users) by using at least one of four popular mask-support hashtags (e.g., #maskup). We calculated network-measures to assess structures and patterns present within the Twitter network, and used exponential random graph modeling (ERGM) to test factors related to the presence of retweets between users. The pro-mask Twitter network was largely fragmented, with a select few nodes occupying the most influential positions in the network. Verified accounts, accounts with more followers, and those who generated more tweets were more likely to be retweeted. Contrarily, verified accounts and those with more followers were less likely to retweet others. SNA revealed patterns and structures theoretically important to how information spreads across Twitter. We demonstrated the utility of an interdisciplinary collaboration between computer informatics and SNA to draw conclusions from social media data

Does It Work for Everyone? The Influence of Demographic Variables on Statistical Reliability.

Recent developments have highlighted the importance of tailored health education efforts. However, little research has explored differential functioning of survey items for diverse populations. This work explores differences in statistical reliability for multiple scales across demographic groups. Understanding such differences is important in health research, given the rapid shifts occurring in global demographics. Study data were collected from eight years of the National College Health Assessment (n = 885,084), a large-scale annual survey of U.S. university students. Meta-analytic reliability generalization was used to compare reliability of two scale measures for multiple demographic groups. In nearly all cases, there were statistically significant differences in reliability across demographic groups. Researchers should consider relative functioning of any scale employed in their work. For certain demographic groups, various scales may not be sufficiently reliable. However, this may be obfuscated in larger samples, containing large numbers of individuals for whom the scale is sufficiently reliable. We suggest a thorough subsets analysis of data to ensure uniform functioning of items prior to use. Just as health interventions should be tailored to populations of interest, so too must research methods and tools

Diseño de cubierta y puente grúa para la Mini Central Hidroeléctrica de la parroquia San José de Ayora, cantón Cayambe

El actual proyecto está dirigido a la rehabilitación estructural de la casa de máquinas de la mini central hidroeléctrica, además de la propuesta de diseño de un puente grúa que permita el mantenimiento de los equipos existentes. Una vez realizada la visita al lugar del proyecto, se evidenció el deterioro de la estructura principalmente de la cubierta. Posteriormente se realizó el levantamiento de la estructura existente mediante la utilización de herramienta manual, con el fin de obtener los datos necesarios para llevar a cabo este proyecto, debido a que no existía registro alguno de información por parte del gobierno parroquial sobre la casa de máquinas de la mini central hidroeléctrica. Una vez obtenida la implantación de la estructura, se procedió a realizar la evaluación de los elementos principalmente de la cubierta, para dar un diagnóstico inicial de la estructura en cuanto a conocer si los elementos existentes cumplen con los requisitos de resistencia estipulados en la normativa vigente. El análisis estructural fue el siguiente paso para poder determinar todas las cargas que actúan sobre la estructura planteada y en conjunto con el levantamiento obtenido de la estructura existente poder realizar el modelamiento mediante la herramienta computacional SAP2000. Antes de realizar el diseño de los elementos que conforman la estructura, se verificó que el modelo planteado cumpla con los requisitos sismorresistentes de acuerdo con la Norma Ecuatoriana de la Construcción con el fin de garantizar el correcto funcionamiento de la estructura planteada. Finalmente, se realizaron diseños tipo de placas base, conexiones y cimentación, además de planos estructurales para posteriormente poder realizar el cronograma valorado y presupuesto referencial del proyecto.The current project is aimed at the structural rehabilitation of the powerhouse of the mini hydroelectric power station, in addition to the design proposal for a crane bridge that allows maintenance equipment to be maintained. Once the visit to the project site has been made, the displacement of the structure, mainly of the roof, is evident. Subsequently, the existing structure was surveyed using the manual tool, in order to obtain the necessary data to carry out this project, since there is no record of information by the parish government about the house of machines of the mini hydroelectric power station. Once the implantation of the structure is obtained, a procedure is carried out to carry out the evaluation of the elements of the structure, mainly the roof, to give an initial diagnosis of the structure in terms of knowing whether the elements are difficult with the resistance requirements stipulated in current regulations. The structural analysis was the next step to be able to determine all the loads acting on the proposed structure and together with the lifting obtained from the existing structure to perform modeling using the SAP2000 computational tool. Before carrying out the design of the elements that make up the structure, verify that the proposed model complies with the earthquake resistant requirements in accordance with the Ecuadorian Construction Standard in order to protocols the correct operation of the proposed structure. Finally, type designs of base plates, connections and foundations, in addition to structural planes were used to later be able to carry out the valued schedule and the project's reference budget

Should We Be Confident in Published Research? A Case Study of Confidence Interval Reporting in Health Education and Behavior Research

Confidence intervals (CIs) have been highlighted as “the best” reporting device when reporting statistical findings. However, researchers often fail to maximize the utility of CIs in research. We seek to (a) present a primer on CIs; (b) outline reporting practices of health researchers; and (c) discuss implications for statistical best practice reporting in social science research. Approximately 1,950 peer-reviewed articles were examined from six health education, promotion, and behavior journals. We recorded: (a) whether the author(s) reported a CI; (b) whether the author(s) reported a CI estimate width, either numerical or visual; and (c) whether an associated effect size was reported alongside the CI. Of the 1,245 quantitative articles in the final sample, 46.5% (n = 580) reported confidence interval use; , and 518 provided numerical/visual interval estimates. Of the articles reporting CIs, 383 (64.2%) articles reported a CI with an associated effect size, meeting the American Psychological Association’s (APA) recommendation for statistical reporting best-practice. Health education literature demonstrates inconsistent statistical reporting practices, and falls short in employing best practices and consistently outlining the minimum expectations recommended by APA. In an effort to maximize utility and implications of health education, promotion, and behavior research, future investigations should provide comprehensive information regarding research findings

Estado del arte sobre la utilización de Materiales Poliméricos para las construcciones

Objectives: Nowadays there is a growing demand for construction materials that are durable and sustainable, in order to improve the long-term performance of houses and buildings, as well as to improve the resistance and strength over time of the different civil infrastructures. Thanks to the advance of technology and innovation in materials engineering, modification processes have been developed in different polymers, and this modification is a well-known method that has improved the properties of construction materials. Methodology: The present research analyzed the different investigations that focus on the types of polymers that exist, based on composition and use, considering different factors such as climate, bacterial agents, among others that influence the deterioration of polymeric materials. Results: The present study identifies some knowledge gaps related to the understanding of the functionality of polymers, especially those that can be fused with construction materials. Conclusion: Establishing these gaps facilitates the generation of applications for polymeric materials that are generally waste, thus promoting the conservation and sustainability of non-renewable resources.Objetivos: En la actualidad existe una demanda creciente de materiales de construcción que sean duraderos y sostenibles, esto con la finalidad de mejorar el rendimiento a largo plazo de las casas y edificios, así como para mejorar la resistencia y firmeza con el pasar del tiempo de las distintas infraestructuras civiles. Gracias al avance de la tecnología y la innovación en la ingeniería de materiales se han desarrollado procesos de modificación en diferentes polímeros, esta modificación es un método bien conocido, y que ha logrado mejorar las propiedades de los materiales de construcción. Metodología: la presente investigación analizó las distintas investigaciones que se enfocan en los tipos de polímeros que existen, basados en la composición y uso, considerando diferentes factores como el clima, agentes bacterianos, entre otros que influyen en el deterioro de los materiales poliméricos. Resultados: El presente estudio identifica algunas brechas de conocimiento relacionadas con el entendimiento de la funcionalidad de polímeros, en especial de aquellos que pueden ser fusionados con los materiales de construcción. Conclusión: establecer estas brechas facilita la generación de aplicaciones para materiales poliméricos que generalmente son desechos, consiguiendo con esto promover la conservación y sostenibilidad de recursos no renovables. Área de estudio general: ciencia de los materiales, Área de estudio específica: resistencia de los materiales, Tipo de estudio: revisión bibliográfica

Profile of oral health in students from 06 to 07 and 11 to 13 years of the school Manuel Scorza, Villa María del Triunfo, Lima-Perú

Objetivo: Determinar el perl de salud bucal que incluye prevalencia de caries dental, índice de higiene oral, prevalencia de enfermedad periodontal, maloclusiones, uorosis, lesiones bucales y la localización de estas, en escolares de 06 a 07 y de 11 a 13 años de edad, del colegio estatal Manuel Scorza. Materiales y método: Estudio descriptivo transversal. Se tomó una muestra no probabilística por conveniencia de 151 estudiantes, a los cuales se examinó, previa calibración de los examinadores. Resultados: Se encontró que el índice de caries CPOD es de 3,05, y el COD de 4,29, el IHOS fue regular en 75,3 %, el nivel de uorosis fue muy leve en 9,2 %, 53 % presentó gingivitis leve, la maloclusión ligera fue la más observada con 72.8 %, las lesiones más prevalentes fueron abscesos de origen dental en 7,9 % y locali-zadas en surco vestibular. Conclusiones: El índice de caries en dentición permanente es moderado y en dentición decidua es moderado con tendencia a alto, la higiene oral es regular, presentan gingivitis leve y maloclusión ligera, el grado de uorosis es leve y la lesión más frecuente fue absceso de origen dental en el surco vestibular.Objective: Determinate the oral health prole including dental caries prevalence oral hygiene index , prevalence of periodontal disease, malocclusion , uorosis and oral lesions and the location of these, in students of 06 to 07 and 11 to 13 years old from Manuel Scorza Public School. Materials and method: A cross sectional study, took a nonrandom sample of convenience; 151 students, which examined them, previ-ously calibration of the examiners. Results: We found that the rate of caries CPOD is 3,05 and the COD is 4,29, the IHOS was regular in 75,3 %, the level of uorosis that was slight in 9,2 %, and the level of prevalence of slight gingivitis was 53 %, slight malocclusion had 72.8 %, the most prevalent lesions were dental abscesses in 7,9 % and located in vestibular sulcus. Conclusions : e rate of c aries in permanent teeth is moderate and in deciduous dentition is moderate tends to be high, oral hygiene is regular, students presented slight gingivitis and light malocclusion, the degree of uorosis is low, and the most frequent lesion was abscess dental located in the vestibular sulcus

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings In 2017, cirrhosis caused more than 1.32 million (95% UI 1.27-1.45) deaths (440000 [416 000-518 000; 33.3%] in females and 883 000 [838 000-967 000; 66.7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2.4% (2.3-2.6) of total deaths globally in 2017 compared with 1.9% (1.8-2.0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21.0 (19.2-22.3) per 100 000 population in 1990 to 16.5 (15.8-18-1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32.2 [25.8-38.6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10.1 [9.8-10-5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3.7 [3.3-4.0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103.3 [64.4-133.4] per 100 000 in 2017). There were 10.6 million (10.3-10.9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33.2% for compensated cirrhosis and 54.8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases snore than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.Peer reviewe

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations