Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Svengi ja groove rytmimusiikissa : Rytmiikkaan ja hienorytmiikkaan keskittyvä vertaileva musiikkianalyysi

Käsitteillä svengi ja groove viitataan useimmiten kappaleen tietyn tulkinnan eli esityksen pääasiallisesti rytmisten ominaisuuksien laatuun. Tutkimuksen tavoitteena on kehittää musiikin rytmiikkaan ja hienorytmiikkaan keskittyviä musiikkikognitiivisia analyysimetodeja, joita soveltamalla nämä ominaisuudet voitaisiin tavoittaa. Käsitteiden monitulkintaisuus, joka tuodaan esiin tutkimuksen alussa aiheuttaa tälle monenlaisia haasteita. -- Tutkimuksen rytmiikkaan keskittyviä analyysimetodeja sovellettaessa musiikkia tarkastellaan tietystä esityksestä tehdyn nuottiesityksen, transkription välityksellä. Hienorytmisiä analyysimetodeja käytettäessä musiikkia tarkastellaan esitysten instrumenttiosuuksien sävelten alukehetkien tarkkojen sijaintien kautta. Alukehetket poimitaan erilaisin automaattisin ja manuaalisin tietokoneavusteisin menetelmin äänitteiltä. Tutkimuksessa tarkastellaan musiikissa esiintyviä ilmiöitä myös laajemmalla, musiikin havaitsemiseen ja tuottamiseen yleisesti liittyvällä musiikkikognition tasolla. Tärkeänä näkökulmana musiikin rytmiikan esitetään jakautuvan kognitiivisesti karkeampaan tekstuaaliseen rytmiikkaan ja tätä hienoisesti varioivaan ei-tekstuaaliseen hienorytmiikkaan. Analyysiosuudessa kehitettyjä metodeja sovelletaan seuraavien kappaleiden soolo-osuuksiin: Miles Davis – 'Freddie Freeloader' (1959), James Brown – 'Doing it to Death' (1973) ja Led Zeppelin – 'Stairway to Heaven' (1971). Kappaleet edustavat tutkimuksessa jazz-, funk- ja rock-tyylilajeja. Analyysi tarkastelee ja vertailee kappaleiden metristä stabiiliutta, instrumenttiosuuksien suhdetta pulssin iskuihin, rytmiikan kolmimuunteisuutta, soolojen metrisiä painopisteitä, soolojen rytmistä tiheyttä sekä tempojen muutoksia. -- Kehitetyt menetelmät osoittautuvat kaikki käyttökelpoisiksi. Kappaleille yhteiseksi piirteeksi paljastuu instrumenttiosuuksien säännönmukainen sijoittuminen pulssin iskuihin nähden kappaleiden sisällä. Kappaleiden välillä eri instrumentit sijoittuvat kuitenkin pulssin ympärille eroavin tavoin, jonka oletetaan johtuvan ennen kaikkea tyylilajien eroista. Tempot pysyvät kappaleissa varsin muuttumattomina. Jatkotutkimuksen kannalta mielenkiintoisia näkymiä ovat muun muassa metodien laajempi soveltaminen, automaattisten menetelmien kehittäminen

Concepts and Object-Oriented Knowledge Representation

Tutkielma käsittelee nykyisiä kognitiotieteen teorioita käsitteistä ja niiden mallintamista oliokeskeisillä tietämyksen esittämisen menetelmillä. Käsiteteorioista käsitellään klassinen, määritelmäteoria, prototyyppiteoria, duaaliteoriat, uusklassinen teoria, teoria-teoria ja atomistinen teoria. Oliokeskeiset menetelmät ovat viime aikoina jakautuneet kahden tyyppisiin kieliin: oliopohjaisiin ja luokkapohjaisiin. Uudet olio-pohjaiset olio-ohjelmointikielet antavat käsitteiden representointiin mahdollisuuksia, jotka puuttuvat aikaisemmista luokka-pohjaisista kielistä ja myös kehysmenetelmistä. Tutkielma osoittaa, että oliopohjaisten kielten uudet piirteet tarjoavat keinoja, joilla käsitteitä voidaan esittää symbolisessa muodossa paremmin kuin perinteisillä menetelmillä. Niillä pystytään simuloimaan kaikkea mitä luokkapohjaisilla kielillä voidaan, mutta ne pystyvät lisäksi simuloimaan perheyhtäläisyyskäsitteitä ja mahdollistavat olioiden dynaamisen muuttamisen ilman, että siinä rikotaan psykologisen essentialismin periaatetta. Tutkielma osoittaa lisäksi vakavia puutteitta, jotka koskevat koko oliokeskeistä menetelmää. Avainsanat: käsitteet, käsiteteoriat, tekoäly, komputationaalinen psykologia, olio-ohjelmointi, tiedon esittäminen

Luke, The Friend of Sinners

I examine the portrayal of Jesus as a friend of toll collectors and sinners in the Third Gospel. I aim at a comprehensive view on the Lukan sinner texts, combining questions of the origin and development of these texts with the questions of Luke s theological message, of how the text functions as literature, and of the social-historical setting(s) behind the texts. Within New Testament scholarship researchers on the historical Jesus mostly still hold that a special mission to toll collectors and sinners was central in Jesus public activity. Within Lukan studies, M. Goulder, J. Kiilunen and D. Neale have claimed that this picture is due to Luke s theological vision and the liberties he took as an author. Their view is disputed by other Lukan scholars. I discuss methods which scholars have used to isolate the typical language of Luke s alleged written sources, or to argue for the source-free creation by Luke himself. I claim that the analysis of Luke s language does not help us to the origin of the Lukan pericopes. I examine the possibility of free creativity on Luke s part in the light of the invention technique used in ancient historiography. Invention was an essential part of all ancient historical writing and therefore quite probably Luke used it, too. Possibly Luke had access to special traditions, but the nature of oral tradition does not allow reconstruction. I analyze Luke 5:1-11; 5:27-32; 7:36-50; 15:1-32; 18:9-14; 19:1-10; 23:39-43. In most of these some underlying special tradition is possible though far from certain. It becomes evident that Luke s reshaping was so thorough that the pericopes as they now stand are decidedly Lukan creations. This is indicated by the characteristic Lukan story-telling style as well as by the strongly unified Lukan theology of the pericopes. Luke s sinners and Pharisees do not fit in the social-historical context of Jesus day. The story-world is one of polarized right and wrong. That Jesus is the Christ, representative of God, is an intrinsic part of the story-world. Luke wrote a theological drama inspired by tradition. He persuaded his audience to identify as (repenting) sinners. Luke's motive was that he saw the sinners in Jesus' company as forerunners of Gentile Christianity.

Early life determinants of atopy : A 20-year prospective follow-up study on unselected, healthy newborns

Atopy-related allergic diseases, i.e. allergic rhinoconjunctivitis, atopic dermatitis and asthma, have increased in frequency in the industrialized countries. In order to reverse this trend, effective preventive strategies need to be developed. This requires a better understanding of the early-life events leading to the expression of the atopic phenotype. The present study has aimed at defining early-life factors and markers associated with the subsequent development of allergic diseases in a cohort of 200 healthy, unselected Finnish newborns prospectively followed up from birth to age 20 years. Their mothers were encouraged to start and maintain exclusive breastfeeding as long as it was nutritionally sufficient for the infant. Consequently, all the infants received some duration of exclusive breastfeeding, 58% of the infants were on exclusive breastfeeding for the first 6 months of life, and 18% received this feeding at least for the first 9 months. Of the infants, 42% had a family history of allergy. After the first year of follow-up, the children were re-assessed at ages 5, 11 and 20 years with clinical examination, skin prick testing, and parental and personal interviews. Exclusive breastfeeding for over 9 months was associated with atopic dermatitis and symptoms of food hypersensitivity at age 5 years, and with symptoms of food hypersensitivity at age 11 years in the children with a familial allergy. Subjects with allergic symptoms or a positive skin prick test in childhood or adolescence had lower retinol concentrations during their infancy and childhood than others. An elevated cord serum immunoglobulin E concentration predicted subsequent atopic manifestations though with modest sensitivity. Children and adolescents with allergic symptoms, skin prick test positivity and an elevated IgE had lower total cholesterol levels in infancy and childhood than the nonatopic subjects. In conclusion, prolonging strictly exclusive breastfeeding for over 9 months of age was not of help in prevention of allergic symptoms; instead, it was associated with increased atopic dermatitis and food hypersensitivity symptoms in childhood. Due to the modest sensitivity, cord serum IgE is not an effective screening method for atopic predisposition in the general population. Retinol and cholesterol concentrations in infancy were inversely associated with the subsequent development of allergic symptoms. Based on these findings, it is proposed that there may be differences in the inborn regulation of retinol and cholesterol levels in children with and without a genetic susceptibility to atopy, and these may play a role in the development of atopic sensitization and allergic diseases.

Non-industrial private forest landowners’ choices of timber management strategies and potential allowable cut.

In the study, the potential allowable cut in the district of Pohjois-Savo - based on the non-industrial private forest landowners' (NIPF) choices of timber management strategies - was clarified. Alternative timber management strategies were generated, and the choices and factors affecting the choices of timber management strategies by NIPF landowners were studied. The choices of timber management strategies were solved by maximizing the utility functions of the NIPF landowners. The parameters of the utility functions were estimated using the Analytic Hierarchy Process (AHP). The level of the potential allowable cut was compared to the cutting budgets based on the 7th and 8th National Forest Inventories (NFI7 and NFI8), to the combining of private forestry plans, and to the realized drain from non-industrial private forests. The potential allowable cut was calculated using the same MELA system as has been used in the calculation of the national cutting budget. The data consisted of the NIPF holdings (from the TASO planning system) that had been inventoried compartmentwise and had forestry plans made during the years 1984-1992. The NIPF landowners' choices of timber management strategies were clarified by a two-phase mail inquiry. The most preferred strategy obtained was "sustainability" (chosen by 62 % of landowners). The second in order of preference was "finance" (17 %) and the third was "saving" (11 %). "No cuttings", and "maximum cuttings" were the least preferred (9 % and 1 %, resp.). The factors promoting the choices of strategies with intensive cuttings were a) "farmer as forest owner" and "owning fields", b) "increase in the size of the forest holding", c) agriculture and forestry orientation in production, d) "decreasing short term stumpage earning expectations", e) "increasing intensity of future cuttings", and f) "choice of forest taxation system based on site productivity". The potential allowable cut defined in the study was 20 % higher than the average of the realized drain during the years 1988-1993, which in turn, was at the same level as the cutting budget based on the combining of forestry plans in eastern Finland. Respectively, the potential allowable cut defined in the study was 12 % lower than the NFI8-based greatest sustained allowable cut for the 1990s. Using the method presented in this study, timber management strategies can be clarified for non-industrial private forest landowners in different parts of Finland. Based on the choices of timber managemet strategies, regular cutting budgets can be calculated more realistically than before.

Non-industrial private forest landowners’ choices of timber management strategies.

The factors affecting the non-industrial, private forest landowners' (hereafter referred to using the acronym NIPF) strategic decisions in management planning are studied. A genetic algorithm is used to induce a set of rules predicting potential cut of the landowners' choices of preferred timber management strategies. The rules are based on variables describing the characteristics of the landowners and their forest holdings. The predictive ability of a genetic algorithm is compared to linear regression analysis using identical data sets. The data are cross-validated seven times applying both genetic algorithm and regression analyses in order to examine the data-sensitivity and robustness of the generated models. The optimal rule set derived from genetic algorithm analyses included the following variables: mean initial volume, landowner's positive price expectations for the next eight years, landowner being classified as farmer, and preference for the recreational use of forest property. When tested with previously unseen test data, the optimal rule set resulted in a relative root mean square error of 0.40. In the regression analyses, the optimal regression equation consisted of the following variables: mean initial volume, proportion of forestry income, intention to cut extensively in future, and positive price expectations for the next two years. The R2 of the optimal regression equation was 0.34 and the relative root mean square error obtained from the test data was 0.38. In both models, mean initial volume and positive stumpage price expectations were entered as significant predictors of potential cut of preferred timber management strategy. When tested with the complete data set of 201 observations, both the optimal rule set and the optimal regression model achieved the same level of accuracy.

Ekotuotteet kuluttajan arjessa – vastuullisuutta, puhtautta ja arjen luksusta

Tutkielmassa tarkastellaan kuluttajien näkemyksiä ekotuotteiden valintaan vaikuttavista tekijöistä. Analysoin ekotuotteiden hankintaa kolmen teeman kautta. Ne ovat vihreys ja vastuullisuus, puhtaus tuotevalinnoissa sekä niin sanottu arjen luksus. Tutkimukseni empiirinen osa koostuu 10 teemahaastattelusta. Tutkimuskohteena on ekokauppa Ruohonjuuressa ostoksiaan tekevät kuluttajat. Haastateltavia etsin ilmoituksella ekokauppa Ruohonjuuresta sekä kaupan Facebook-sivuilta. Lisäksi oma haastattelupäivä Ruohonjuuren myymälässä tuotti haastateltavia mukaan tutkimukseen. Kirjoitin haastatteluista yhteenvedon ja analysoin aineistoa teemoittelun avulla. Nykyiset ympäristöongelmat vaikuttavat siihen, millaisena koemme arjen tulevaisuudessa. Vihreä ja vastuulllinen kuluttaja ottaa huomioon kulutuspäätöksiensä vaikutukset ympäristöön. Vihreät kulutuspäätökset tarkoittavat kestäviä kulutustapoja kuten jätteiden lajittelua, kirpputorikierrättämistä ja ympäristöä säästävien ekotuotteiden valintaa. Aineiston perusteella voi todeta, että ekotuotteiden ympäristömyönteisyyteen liitetään läheisesti luomutuotanto ja luomutuotteet. Ekotuotteet nähdään myös eettisinä ja moraalisina valintoina, joiden avulla halutaan vaikuttaa myös muiden hyvinvointiin. Ekotuotteisiin kohdistuu siten monenlaisia odotuksia, mutta myös epäilyjä. Aineistoni perusteella tuotetta ei välttämättä koettu ekotuotteeksi, jos sen valmistamiseen on käytetty paljon resursseja. Kuluttajat ovat kiinnostuneita ruoan alkuperästä ja sen aitoudesta. Ekotuotteet koetaan muita tuotteita päinvastoin puhtaiksi vaihtoehdoiksi. Puhtaus ekotuotteissa mielletään laadultaan turvallisiksi ja terveellisiksi tuotteiksi, jotka maistuvat hyvältä. Haastatteluaineiston perusteella voi todeta, että ekotuotteet koettiin myös arjen ostosten erikoisuudeksi. Arjen luksus lisää käyttäjälleen mielihyvän elämyksiä. Ekotuotteita ostamalla rakennetaan myös omaa elämäntyyliä ja erottaudutaan muista. Aineiston perusteella ekokauppaan mennään kiertelemään, tekemään heräteostoksia ja etsimään uutuuksia. Shoppailu ekokaupassa voi olla nautinnollista ja miellyttävää toimintaa, vaikka ostamista vain harkitaan. Ekotuote lahjana kertoo lahjan antajasta ja tuo lahjan saajalle palan luksusta vaikkapa luomusuklaan muodossa.