Recent Submissions

  • Journal Article

    Distributional Regression Techniques in Socioeconomic Research on the Inequality of Health with an Application on the Relationship between Mental Health and Income 

    Silbersdorff, Alexander; Schneider, Kai Sebastian
    International Journal of Environmental Research and Public Health 2019; 16(20): Art. 4009
    This study addresses the much-discussed issue of the relationship between health and income. In particular, it focuses on the relation between mental health and household income by using generalized additive models of location, scale and shape and thus employing a distributional perspective. Furthermore, this study aims to give guidelines to applied researchers interested in taking a distributional perspective on health inequalities. In our analysis we use cross-sectional data of the German socioeconomic Panel (SOEP). We find that when not only looking at the expected mental health score of an individual but also at other distributional aspects, like the risk of moderate and severe mental illness, that the relationship between income and mental health is much more pronounced. We thus show that taking a distributional perspective, can add to and indeed enrich the mostly mean-based assessment of existent health inequalities.
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  • Journal Article

    The effect of bigger human bodies on the future global calorie requirements 

    Depenbusch, Lutz; Klasen, Stephan
    PLOS ONE 2019; 14(12): Art. e0223188
    Existing studies show how population growth and rising incomes will cause a massive increase in the future global demand for food. We add to the literature by estimating the potential effect of increases in human weight, caused by rising BMI and height, on future calorie requirements. Instead of using a market based approach, the estimations are solely based on human energy requirements for maintenance of weight. We develop four different scenarios to show the effect of increases in human height and BMI. In a world where the weight per age-sex group would stay stable, we project calorie requirements to increases by 61.05 percent between 2010 and 2100. Increases in BMI and height could add another 18.73 percentage points to this. This additional increase amounts to more than the combined calorie requirements of India and Nigeria in 2010. These increases would particularly affect Sub-Saharan African countries, which will already face massively rising calorie requirements due to the high population growth. The stark regional differences call for policies that increase food access in currently economically weak regions. Such policies should shift consumption away from energy dense foods that promote overweight and obesity, to avoid the direct burden associated with these conditions and reduce the increases in required calories. Supplying insufficient calories would not solve the problem but cause malnutrition in populations with weak access to food. As malnutrition is not reducing but promoting rises in BMI levels, this might even aggravate the situation
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  • Journal Article

    TWENTY‐FIRST‐CENTURY TRADE GOVERNANCE: FINDINGS FROM THE COMMONWEALTH COUNTRIES 

    Khorana, Sangeeta; Martínez‐Zarzoso, Inmaculada
    Contemporary Economic Policy
    To investigate the factors contributing to pioglitazone-induced edema, we analyzed sodium excretion and several clinical parameters before and after administration of pioglitazone. We analyzed these parameters before and after 8 weeks of administration of pioglitazone to female subjects with type 2 diabetes. When we evaluated whether a significant correlation was found between salt excretion and blood pressure, six patients showed such correlation and 20 patients did not. After 8 weeks of pioglitazone administration, five patients had developed edema, and, surprisingly, such correlation was not found in all five subjects. Salt excretion after administration of pioglitazone was significantly lower in subjects who developed edema and those who showed the correlation, and the hematocrit was significantly lower after administration in the subjects who showed the correlation, but not in the edema group. Pioglitazone-induced edema would be caused not only by fluid retention, but also by other factors, such as vascular permeability.
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  • Journal Article

    The Presentation of Self as Good and Right: How Value Propositions and Business Model Features are Linked in the Sharing Economy 

    Wruk, Dominika; Oberg, Achim; Klutt, Jennifer; Maurer, Indre
    Journal of Business Ethics 2019; 159(4) p.997-1021
    The sharing economy as an emerging field is characterized by unsettled debates about its shared purpose and defining characteristics of the organizations within this field. This study draws on neo-institutional theory to explore how sharing organizations position themselves vis-à-vis such debates with regard to (1) the values these organizations publicly promote to present themselves as “good” sharing organizations and (2) the business model features they make visible to appear as having the “right” organizational model. This study examines the online self-representations of 62 prototypical sharing organizations in Germany with regard to value propositions and business model features. A semantic network analysis of the features reveals two distinct categories of sharing organizations: grassroots initiatives and platform-based organizations. By showing how value propositions and business model features are linked in the sharing economy, the findings indicate the different legitimation strategies of grassroots initiatives and platform-based organizations, which we term “sustainability by model” and “sustainability by feature.” These findings broaden our understanding of the strategies that organizations apply to cope with societal expectations in the emerging sharing economy.
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  • Journal Article

    Prevalence and factors associated with underweight children: a population-based subnational analysis from Pakistan 

    Kumar, Ramesh; Abbas, Faisal; Mahmood, Tahir; Somrongthong, Ratana
    BMJ Open 2019; 9(7): Art. e028972
    OBJECTIVES: This study aims to determine the prevalence of and factors associated with underweight children under the age of 5 in Punjab, Pakistan. DESIGN: We analysed cross-sectional household-level subnationally representative Multiple Indicator Cluster Survey. SETTINGS: Punjab province, Pakistan. PARTICIPANTS: 24 042 children under 5 years of age. DATA ANALYSIS: Multilevel multivariate logistic regression analysis. RESULTS: Prevalence of moderately and severely underweight children was found to be (33.3% and 11.3%, respectively). Multivariate multilevel logistic regression results show that as the child grows older the likelihood of the child being underweight increases significantly (eg, children between 12 and 23 months are one and half times more likely to be underweight, whereas children between the ages of 36 and 47 months are two and a half times more likely to be underweight). Gender was found to be another significant factor contributing to underweight prevalence among children under the age of 5. The likelihood of a girl child being underweight is more than that of a boy child being underweight (OR 0.92, 95% CI 0.8 to 1.0). Similarly, a child whose birth order is three or more is two times more likely to be underweight (OR 1.96, 95% CI 1.5 to 2.5) relative to a child of a lower birth order. Moreover, diarrhoea also significantly increases the likelihood of the child being underweight (OR 1.31, 95% CI 1.1 to 1.5). Child size is another determinant for underweight prevalence among children under 5, for example, a child with a size smaller than average at the time of birth is 2.7 times more likely to be moderately underweight than a child with an average or larger than average size at the time of birth. CONCLUSION: Rigorous community-based interventions should be developed and executed throughout the province to improve this grave situation of underweight prevalence in Punjab. Mother's education should be uplifted by providing them formal education and providing awareness about the importance of proper nutrition for children.
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  • Journal Article

    Public good provision by large groups – the logic of collective action revisited 

    Weimann, Joachim; Brosig-Koch, Jeannette; Heinrich, Timo; Hennig-Schmidt, Heike; Keser, Claudia
    European Economic Review 2019; 118 p.348-363
    The organization of collective action is extremely important for societies. A main reason is that many of the key problems societies face are public good problems. We present results from a series of laboratory experiments with large groups of up to 100 subjects. Our results demonstrate that large groups, in which the impact of an individual contribution ( MPCR ) is almost negligible, are able to provide a public good in the same way as small groups in which the impact of an individual contribution is much higher. Nevertheless, we find that small variations in MPCR in large groups have a strong effect on contributions. We develop a hypothesis concerning the interplay between MPCR and group size, which is based on the assumption that the salience of the advantages of mutual cooperation plays a decisive role. This hypothesis is successfully tested in a second series of experiments. Since Mancur Olson’s “Logic of collective action”it is a commonly held belief that in large groups the prospects of a successful organization of collective actions are rather bad. Our results, however, suggest that the chance to successfully organize collective action of large groups and to solve important public good problems is much higher than previously thought.
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  • Journal Article

    Too cold for warm glow? Christmas-season effects in charitable giving 

    Müller, Stephan; Rau, Holger A.
    PLOS ONE 2019; 14(5): Art. e0215844
    This paper analyzes seasonal effects and their potential drivers in charitable giving. We conduct two studies to analyze whether donations to the German Red Cross differ between the Christmas season and summer. In study 1 we find that in the pre-Christmas shopping season prosocial subjects almost donate 50% less compared to prosocials in summer. In study 2 we replicate the low donations in the Christmas season. In an extensive questionnaire we control for several causes of this effect. The data suggest that the higher prosocials' self-reported stress level, the lower the donations. The higher their relative savings, the lower the giving. Our questionnaire rules out that "donation fatigue" matters. That is, donations do not depend on the number of charitable campaigns subjects are confronted with and their engagement in these activities during Christmas season outside the lab.
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  • Journal Article

    Public provision of emergency obstetric care: a case study in two districts of Pakistan 

    Brückmann, Peter; Hashmi, Ashfa; Kuch, Marina; Kuhnt, Jana; Monfared, Ida; Vollmer, Sebastian
    BMJ Open 2019; 9(5): Art. e027187
    Objectives Pakistan is one out of five countries where together half of the global neonatal deaths occur. As the provision of services and facilities is one of the key elements vital to reducing this rate as well as the maternal mortality rate, this study investigates the status of the delivery of essential obstetric care provided by the public health sector in two districts in Khyber Pakhtunkhwa in 2015 aiming to highlight areas where critical improvements are needed. Setting We analysed data from a survey of 22 primary and secondary healthcare facilities as well as 85 community midwives (CMWs) in Haripur and Nowshera districts. Participants Using a structured questionnaire we evaluated the performance of emergency obstetric care (EmOC) signal functions and patient statistics in public health facilities. Also, 102 CMWs were interviewed about working hours, basic and specialised delivery service provision, referral system and patient statistics. Primary outcome measures We investigate the public provision of emergency obstetric care using seven key medical services identified by the United Nations (UN). Results Deliveries by public health cadres account for about 30% of the total number of births in these districts. According to the UN benchmark, only a small fraction of basic EmOC (2/18) and half of the comprehensive EmOC (2/4) facilities of the recommended minimum number were available to the population in both districts. Only a minority of health facilities and CMWs carry out several signal functions. Only 8% of the total births in one of the study districts are performed in public EmOC health facilities. Conclusions Both districts show a significant shortage of available public EmOC service provisions. Development priorities need to be realigned to improve the availability, accessibility and quality of EmOC service provisions by the public health sector alongside with existing activities to increase institutional births.
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  • Journal Article

    Production logistics and human-computer interaction—state-of-the-art, challenges and requirements for the future 

    Klumpp, Matthias; Hesenius, Marc; Meyer, Ole; Ruiner, Caroline; Gruhn, Volker
    The International Journal of Advanced Manufacturing Technology p.1-19
    Current concept, development, and testing applications in production concerning Cyber-Physical Systems (CPS), Industry 4.0 (I40), and Internet of Things (IoT) are mainly addressing fully autonomous systems, fostered by an increase in available technologies regarding distributed decision-making, sensors, and actuators for robotics systems. This is applied also to production logistics settings with a multitude of transport tasks, e.g., between warehousing or material supply stations and production locations within larger production sites as for example in the automotive industry. In most cases, mixed environments where automated systems and humans collaborate (e.g., cobots) are not in the center of analysis and development endeavors although the worker’s adoption and acceptance of new technologies are of crucial relevance. From an interdisciplinary research perspective, this constitutes an important research gap, as the future challenges for successful automated systems will rely mainly on human-computer interaction (HCI) in connection with an efficient collaboration between motivated workers, automated robotics, and transportation systems. We develop a HCI efficiency description in production logistics based on an interdisciplinary analysis consisting of three interdependent parts: (i) a production logistics literature review and process study, (ii) a computer science literature review and simulation study for an existing autonomous traffic control algorithm applicable to production logistics settings with the specific inclusion of human actors, and (iii) a work science analysis for automation settings referring to theoretical foundations and empirical findings regarding the management of workers in digital work settings. We conclude with practical implications and discuss avenues for future research and business applications.
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  • Journal Article

    Consumer Preferences for Different Designs of Carbon Footprint Labelling on Tomatoes in Germany—Does Design Matter? 

    Meyerding, Stephan; Schaffmann, Anna-Lena; Lehberger, Mira
    Sustainability 2019; 11(6): Art. 1587
    The climate impact of tomato production is an important issue in the sustainability of tomatoes, especially in northern European countries, such as Germany. Communicating the climate impact of products to the consumer is difficult and the design of the label might be the key to its success. For this reason, the present study compares the utilities of six different carbon footprint labels to evaluate which label design works best for the consumer. 598 consumers were surveyed in a representative online choice-experiment. The participants had to choose between tomatoes with different product characteristics, such as origin, price, organic label, and carbon footprint label. A split sample approach was used where each sub-sample with around n = 100 saw a different carbon footprint label design in the choice-experiment. The results suggest that qualitative carbon footprint labels using color-coded traffic light labelling are superior to those that claim climate impact reduction or neutrality, including those that provide more details regarding the climate impact of the product and the company. The latent class analysis with four consumer segments shows that a significant proportion of consumers in Germany would consider a carbon footprint label as an important characteristic.
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  • Journal Article

    Unterstützendes Führungsverhalten schulischer Leitungskräfte für die Arbeit professioneller Lerngemeinschaften im Kollegium 

    Warwas, Julia; Helm, Christoph; Schadt, Christian
    Zeitschrift für Bildungsforschung
    Ergänzend zu einer primär outcome-orientierten Erforschung von Professionellen Lerngemeinschaften wendet sich der Beitrag günstigen innerschulischen Entwicklungsbedingungen für die Arbeit dieser Gemeinschaften zu. Dabei interessiert vor allem, welche prädiktive Kraft unterstützende Führungspraktiken der Schulleitung für variierende Ausprägungen konstitutiver Merkmale von Professionellen Lerngemeinschaften besitzen und worin diese Führungspraktiken konkret bestehen. Um diesen Fragen nachzugehen, werden im Theorieteil des Beitrags sowohl Kerndimensionen von Professionellen Lerngemeinschaften als auch mögliche Ansatzpunkte ihrer gezielten Förderung durch eine Synopse vorliegender Systematisierungen und Einzelstudien beschrieben. Die Literatursichtung lässt u. a. erkennen, dass sich eine unterstützende Führung nicht auf die Bereitstellung struktureller Ressourcen beschränkt, sondern zudem die Stärkung vertrauensvoller Beziehungen, inhaltliche Impulse für die Unterrichtsentwicklung sowie die Teilung von Führungsverantwortung beinhaltet. Die Ergebnisse von Mehrebenen-Strukturgleichungsmodellen (N= 395 Lehrkräfte) dokumentieren erwartungskonform praktisch bedeutsame Zusammenhänge zwischen wahrgenommenem Führungsverhalten und Kerndimensionen professioneller Gemeinschaften im Kollegium, auch wenn die Einschätzungen der Lehrkräfte die theoretisch angenommene Differenzierung von vier Facetten des Führungsverhaltens nicht exakt widerspiegeln.
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  • Journal Article

    Gender and job satisfaction in German horticulture 

    Meyerding, Stephan G.H.; Lehberger, Mira
    International Food and Agribusiness Management Review 2018; 21(7) p.1003-1022
    There is little known about the links between gender and job satisfaction in the agricultural sector. Considering the ongoing shortage of agricultural staff in Germany, gaining insight into this issue is valuable, in particular, if one is interested in retaining workers in the business and in identifying gender-specific strategies to recruit new staff. For this reason, a survey among employees (N=218) of German horticultural companies was carried out. The results indicate that, while there are no significant differences for job satisfaction between the two genders in general, the determinants of job satisfaction differ substantially in their importance between the genders.
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  • Journal Article

    Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017 

    Lozano, Rafael; Fullman, Nancy; Abate, Degu; Abay, Solomon M.; Abbafati, Cristiana; Abbasi, Nooshin; Abbastabar, Hedayat; Abd-Allah, Foad; Abdela, Jemal; Abdelalim, Ahmed; et al.
    Abdel-Rahman, OmarAbdi, AlirezaAbdollahpour, IbrahimAbdulkader, Rizwan SuliankatchiAbebe, Nebiyu DerejeAbebe, ZegeyeAbejie, Ayenew NegesseAbera, Semaw F.Abil, Olifan ZewdieAboyans, VictorAbraha, Haftom NiguseAbrham, Aklilu RobaAbu-Raddad, Laith JamalAbu-Rmeileh, Niveen MeAbyu, Gebre Y.Accrombessi, Manfred Mario KokouAcharya, DilaramAcharya, PawanAdamu, Abdu A.Adebayo, Oladimeji M.Adedeji, Isaac AkinkunmiAdedoyin, Rufus AdesojiAdekanmbi, VictorAdetokunboh, Olatunji O.Adhena, Beyene MeressaAdhikari, Tara BallavAdib, Mina G.Adou, Arsène KouablanAdsuar, Jose C.Afarideh, MohsenAfshari, MahdiAfshin, AshkanAgarwal, GinaAghayan, Sargis AghasiAgius, DominicAgrawal, AnuragAgrawal, SutapaAhmadi, AlirezaAhmadi, MehdiAhmadieh, HamidAhmed, Muktar BeshirAhmed, SayemAkalu, Temesgen YihunieAkanda, Ali S.Akbari, Mohammad EsmaeilAkibu, MohammedAkinyemi, Rufus OlusolaAkinyemiju, TomiAkseer, NadiaAlahdab, FaresAl-Aly, ZiyadAlam, KhurshidAlam, TahiyaAlbujeer, AmmarAlebel, AnimutAlene, Kefyalew AddisAl-Eyadhy, AymanAlhabib, SamiaAli, RaghibAlijanzadeh, MehranAlizadeh-Navaei, RezaAljunid, Syed MohamedAlkerwi, Ala'aAlla, FrançoisAllebeck, PeterAllen, Christine A.Almasi, AliAl-Maskari, FatmaAl-Mekhlafi, Hesham M.Alonso, JordiAl-Raddadi, Rajaa M.Alsharif, UbaiAltirkawi, KhalidAlvis-Guzman, NelsonAmare, Azmeraw T.Amenu, KebedeAmini, ErfanAmmar, WalidAnber, Nahla HamedAnderson, Jason A.Andrei, Catalina LilianaAndroudi, SofiaAnimut, Megbaru DebalkieAnjomshoa, MinaAnsari, HosseinAnsariadi, AnsariadiAnsha, Mustafa GeletoAntonio, Carl Abelardo T.Anwari, PalwashaAppiah, Lambert TettehAremu, OlatundeAreri, Habtamu AberaÄrnlöv, JohanArora, MonikaAryal, Krishna K.Asayesh, HamidAsfaw, Ephrem TsegayAsgedom, Solomon WeldegebrealAsghar, Rana JawadAssadi, RezaAtaro, ZerihunAtique, SulemanAtre, Sachin R.Atteraya, Madhu SudhanAusloos, MarcelAvila-Burgos, LeticiaAvokpaho, Euripide F. 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A.Awasthi, AshishAyala Quintanilla, Beatriz PaulinaAyele, Henok TadesseAyele, YohanesAyer, RakeshAzarpazhooh, Mahmoud RezaAzzopardi, Peter S.Azzopardi-Muscat, NatashaBabalola, Tesleem KayodeBabazadeh, ArefehBadali, HamidBadawi, AlaaBalakrishnan, KalpanaBali, Ayele GeletoBanach, MaciejBanerjee, AmitavaBanoub, Joseph Adel MattarBanstola, AmritBarac, AleksandraBarboza, Miguel A.Barker-Collo, Suzanne LynBärnighausen, Till WinfriedBarrero, Lope H.Barthelemy, Celine M.Bassat, QuiqueBasu, ArindamBasu, SanjayBattista, Robert J.Baune, Bernhard T.Baynes, Habtamu WondifrawBazargan-Hejazi, ShahrzadBedi, NeerajBeghi, EttoreBehzadifar, MasoudBehzadifar, MeysamBéjot, YannickBekele, Bayu BegashawBelachew, Abate BekeleBelay, Aregawi GebreyesusBelay, Saba AbrahamBelay, Yihalem AbebeBell, Michelle L.Bello, Aminu K.Bennett, Derrick A.Bensenor, Isabela M.Benzian, HabibBerhane, AdugnawBerhe, Abadi KidanemariamBerman, Adam E.Bernabe, EduardoBernstein, Robert S.Bertolacci, Gregory J.Beuran, MirceaBeyranvand, TinaBhala, NeerajBhalla, AshishBhansali, AnilBhattarai, SurajBhaumik, SoumyadeepBhutta, Zulfiqar A.Biadgo, BeleteBiehl, Molly H.Bijani, AliBikbov, BorisBililign, NigusBin Sayeed, Muhammad ShahdaatBirlik, Sait MentesBirungi, CharlesBisanzio, DonalBiswas, TuhinBitew, HelenBizuneh, HailemichaelBjertness, EspenBobasa, Eshetu MulisaBoufous, SoufianeBourne, RupertBozorgmehr, KayvanBragazzi, Nicola LuigiBrainin, MichaelBrant, Luisa C.Brauer, MichaelBrazinova, AlexandraBreitborde, Nicholas J. K.Briant, Paul SvitilBritton, GabrielleBrugha, TraolachBukhman, GeneBusse, ReinhardButt, Zahid A.Cahuana-Hurtado, LuceroCallender, Charlton SKHCampos-Nonato, Ismael R.Campuzano Rincon, Julio CesarCano, JorgeCar, JosipCar, MateCárdenas, RosarioCarrero, Juan J.Carter, AustinCarvalho, FélixCastañeda-Orjuela, Carlos A.Castillo Rivas, JacquelineCastro, FranzCausey, KateÇavlin, AlanurCercy, Kelly M.Cerin, EsterChaiah, YazanChalek, JulianChang, Hsing-YiChang, Jung-ChenChattopadhyay, AparajitaChattu, Vijay KumarChaturvedi, PankajChiang, Peggy Pei-ChiaChin, Ken LeeChisumpa, Vesper HichilombweChitheer, AbdulaalChoi, Jee-Young J.Chowdhury, RajivChristensen, HanneChristopher, Devasahayam J.Chung, Sheng-ChiaCicuttini, Flavia M.Ciobanu, Liliana G.Cirillo, MassimoClaro, Rafael M.Claßen, Thomas Khaled DwayneCohen, Aaron J.Collado-Mateo, DanielCooper, CyrusCooper, Leslie TrumbullCornaby, LeslieCortinovis, MonicaCosta, MeganCousin, EwertonCromwell, Elizabeth A.Crowe, Christopher StephenCunningham, MatthewDaba, Alemneh KabetaDadi, Abel FekaduDandona, LalitDandona, RakhiDang, Anh KimDargan, Paul I.Daryani, AhmadDas, Siddharth K.Das Gupta, Rajatdas Neves, JoséDasa, Tamirat TesfayeDash, Aditya PrasadDavis, Adrian C.Davitoiu, Dragos VirgilDavletov, KairatDayama, Anandde Courten, BarboraDe Leo, DiegoDe Neve, Jan-WalterDe Steur, HansDegefa, Meaza GirmaDegenhardt, LouisaDegfie, Tizta TilahunDeiparine, SelinaDellavalle, Robert P.Demoz, Gebre TeklemariamDemtsu, BalemDenova-Gutiérrez, EdgarDeribe, KebedeDervenis, NikolaosDessie, Getenet AyalewDey, SubhojitDharmaratne, Samath D.Dhimal, MeghnathDicker, DanielDinberu, Mesfin TadeseDing, Eric L.Djalalinia, ShirinDo, Huyen PhucDokova, KlaraDoku, David TeyeDouwes-Schultz, DirkDriscoll, Tim RobertDuan, LeileiDubey, ManishaDubljanin, EleonoraDuken, Eyasu EjetaDuncan, Bruce B.Duraes, Andre R.Ebrahimpour, SoheilEdvardsson, DavidEl Bcheraoui, CharbelEldrenkamp, ErikaEl-Khatib, ZiadElyazar, Iqbal R. F.Enayati, AhmadaliEndries, Aman YesufEshrati, BabakEskandarieh, ShararehEsteghamati, AlirezaEsteghamati, SadafEstep, KaraFakhar, MahdiFakhim, HamedFanzo, JessicaFaramarzi, MahbobehFareed, MohammadFarhadi, FarzanehFarid, Talha A.Farinha, Carla Sofia e SáFarioli, AndreaFaro, AndreFarvid, Maryam S.Farzadfar, FarshadFarzaei, Mohammad HoseinFarzam, HosseinFazaeli, Ali AkbarFazeli, Mir SohailFeigin, Valery L.Feigl, Andrea B.Fekadu, WubalemFeldman, RachelFentahun, NetsanetFereshtehnejad, Seyed-MohammadFernandes, EduardaFernandes, Joao C.Feyissa, Garumma ToluFijabi, Daniel ObadareFilip, IrinaFinegold, SamuelFinger, Jonas DavidFischer, FlorianFitzmaurice, ChristinaFlor, Luisa SorioFoigt, Nataliya A.Foreman, Kyle J.Frank, Tahvi D.Franklin, Richard CharlesFukumoto, TakeshiFukutaki, KaiFuller, John E.Fürst, ThomasFurtado, João M.Gakidou, EmmanuelaGallus, SilvanoGankpe, Fortune GbetohoGansevoort, Ron T.Garcia, Ana CristinaGarcia-Basteiro, Alberto L.Garcia-Gordillo, Miguel A.Gardner, William M.Gebre, Abadi KahsuGebre, TeshomeGebregergs, Gebremedhin BerheGebrehiwot, Tsegaye TeweldeGebremedhin, Amanuel TesfayGebremichael, BereketGebremichael, Teklu GebrehiwoGelano, Tilayie FetoGeleijnse, Johanna M.Geramo, Yilma Chisha DeaGetachew, SefoniasGething, Peter W.Gezae, Kebede EmbayeGhadami, Mohammad RasoulGhadimi, RezaGhadiri, KeyghobadGhasemi-Kasman, MaryamGhiasvand, HesamGhimire, MamataGhoshal, Aloke GopalGiampaoli, SimonaGill, Paramjit SinghGill, Tiffany K.Giussani, GiorgiaGnedovskaya, Elena V.Goldberg, Ellen M.Goli, SrinivasGona, Philimon N.Goodridge, AmadorGopalani, Sameer ValiGorman, Taren M.Goto, AtsushiGoulart, Alessandra C.Goulart, Bárbara Niegia GarciaGrada, AymanGriswold, Max G.Grosso, GiuseppeGugnani, Harish Chander C.Guillemin, FrancisGuimaraes, Andre Luiz SenaGuo, YumingGupta, Prakash C.Gupta, RahulGupta, RajeevGupta, TanushHa, Giang HaiHaagsma, Juanita A.Hachinski, VladimirHafezi-Nejad, NimaHaghparast Bidgoli, HassanHagos, Tekleberhan B.Haile, Michael TameneHailegiyorgis, Tewodros TesfaHailu, Gessessew BugssaHaj-Mirzaian, ArvinHaj-Mirzaian, AryaHamadeh, Randah R.Hamidi, SamerHankey, Graeme J.Harb, Hilda L.Harikrishnan, SivadasanpillaiHaririan, HamidrezaHaro, Josep MariaHasan, MehediHassankhani, HadiHassen, Hamid YimamHavmoeller, RasmusHawley, Caitlin N.Hay, Simon I.He, YihuaHedayatizadeh-Omran, AkbarHegazy, Mohamed I.Heibati, BehzadHeidari, BehnamHeidari, MohsenHendrie, DeliaHenok, AndualemHeredia-Pi, IleanaHerteliu, ClaudiuHeydarpour, BehzadHeydarpour, FatemehHeydarpour, SousanHibstu, Desalegn T.Híjar, MarthaHoek, Hans W.Hoffman, Daniel J.Hole, Michael K.Homaie Rad, EnayatollahHoogar, PraveenHorita, NobuyukiHosgood, H. 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    The Lancet 2018; 392(10159) p.2091-2138
    BACKGROUND: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. FINDINGS: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. INTERPRETATION: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. FUNDING: Bill & Melinda Gates Foundation.
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  • Journal Article

    Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. 

    GBD 2017 Risk Factor Collaborators
    The Lancet 2018; 392(10159) p.1923-1994
    BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations. METHODS: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. FINDINGS: In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. INTERPRETATION: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. FUNDING: Bill & Melinda Gates Foundation.
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  • Journal Article

    Laboratory Experiments of Tradable Development Rights: A Synthesis of Different Treatments 

    Proeger, Till; Meub, Lukas; Bizer, Kilian
    Sustainability 2018; 10(6): Art. 1972
    Tradable development rights (TDR) are considered by scholars and regulators in various countries as a means of reducing land consumption efficiently. Similar to the development of CO2-certificate trading schemes, the methodology of experimental economics can be used to derive empirical evidence on the core parameters and problems of TDR schemes, thus extending theoretical modelling and evidence from case studies. Building on a common laboratory experimental framework, we discuss results from five distinct experiments that consider mechanisms of allocation, resilience against external shocks, political business cycles, communication and collusion, and risk. These results provide initial empirical directions for the further study and introduction of TDR schemes for managing and reducing environmental issues related to land consumption for building projects.
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  • Journal Article

    Health care service provision in Europe and regional diversity: a stochastic metafrontier approach 

    Schley, Katharina
    Health Economics Review. 2018 May 31;8(1):11
    In the last decades, demographic change coupled with new and expensive medical innovations have put most health care systems in developed countries under financial pressure. Therefore, ensuring efficient service provision is essential for a sustainable health care system. This paper investigates the performance of regional health care services in six West European countries between 2005 and 2014. We apply a stochastic metafrontier model to capture the different conditions in the health care systems in the countries within the European Union. By means of this approach, it is possible to detect performance differences in the European health care systems subject to different conditions and technologies relative to the potential technology available. The results indicate that regional deprivation plays a key role for the efficiency of health care provision. Furthermore, a pooled model which assumes a similar technology for all countries cannot sufficiently account for differences between countries. Surprisingly, the Scandinavian regions lag behind other regions with respect to the metafrontier.
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  • Journal Article

    Model selection in semiparametric expectile regression 

    Spiegel, Elmar; Sobotka, Fabian; Kneib, Thomas
    Electronic Journal of Statistics 2017; 11(2) p.3008-3038
    Ordinary least squares regression focuses on the expected response and strongly depends on the assumption of normally distributed errors for inferences. An approach to overcome these restrictions is expectile regression, where no distributional assumption is made but rather the whole distribution of the response is described in terms of covariates. This is similar to quantile regression, but expectiles provide a convenient generalization of the arithmetic mean while quantiles are a generalization of the median. To analyze more complex data structures where purely linear predictors are no longer sufficient, semiparametric regression methods have been introduced for both ordinary least squares and expectile regression. However, with increasing complexity of the data and the regression structure, the selection of the true covariates and their effects becomes even more important than in standard regression models. Therefore we introduce several approaches depending on selection criteria and shrinkage methods to perform model selection in semiparametric expectile regression. Moreover, we propose a joint approach for model selection based on several asymmetries simultaneously to deal with the special feature that expectile regression estimates the complete distribution of the response. Furthermore, to distinguish between linear and smooth predictors, we split nonlinear effects into the purely linear trend and the deviation from this trend. All selection methods are compared with the benchmark of functional gradient descent boosting in a simulation study and applied to determine the relevant covariates when studying childhood malnutrition in Peru.
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  • Journal Article

    Updated Nomogram Incorporating Percentage of Positive Cores to Predict Probability of Lymph Node Invasion in Prostate Cancer Patients Undergoing Sentinel Lymph Node Dissection. 

    Winter, Alexander; Kneib, Thomas; Wasylow, Clara; Reinhardt, Lena; Henke, Rolf-Peter; Engels, Svenja; Gerullis, Holger; Wawroschek, Friedhelm
    Journal of Cancer 2017; 8(14) p.2692-2698
    Objectives: To update the first sentinel nomogram predicting the presence of lymph node invasion (LNI) in prostate cancer patients undergoing sentinel lymph node dissection (sPLND), taking into account the percentage of positive cores. Patients and Methods: Analysis included 1,870 prostate cancer patients who underwent radioisotope-guided sPLND and retropubic radical prostatectomy. Prostate-specific antigen (PSA), clinical T category, primary and secondary biopsy Gleason grade, and percentage of positive cores were included in univariate and multivariate logistic regression models predicting LNI, and constituted the basis for the regression coefficient-based nomogram. Bootstrapping was applied to generate 95% confidence intervals for predicted probabilities. The area under the receiver operator characteristic curve (AUC) was obtained to quantify accuracy. Results: Median PSA was 7.68 ng/ml (interquartile range (IQR) 5.5-12.3). The number of lymph nodes removed was 10 (IQR 7-13). Overall, 352 patients (18.8%) had LNI. All preoperative prostate cancer characteristics differed significantly between LNI-positive and LNI-negative patients (P<0.001). In univariate accuracy analyses, the proportion of positive cores was the foremost predictor of LNI (AUC, 77%) followed by PSA (71.1%), clinical T category (69.9%), and primary and secondary Gleason grade (66.6% and 61.3%, respectively). For multivariate logistic regression models, all parameters were independent predictors of LNI (P<0.001). The nomogram exhibited a high predictive accuracy (AUC, 83.5%). Conclusion: The first update of the only available sentinel nomogram predicting LNI in prostate cancer patients demonstrates even better predictive accuracy and improved calibration. As an additional factor, the percentage of positive cores represents the leading predictor of LNI. This updated sentinel model should be externally validated and compared with results of extended PLND-based nomograms.
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  • Journal Article

    Supermarket purchase contributes to nutrition-related non-communicable diseases in urban Kenya. 

    Demmler, Kathrin M.; Klasen, Stephan; Nzuma, Jonathan M.; Qaim, Matin
    PloS one 2017; 12(9): Art. e0185148
    BACKGROUND: While undernutrition and related infectious diseases are still pervasive in many developing countries, the prevalence of non-communicable diseases (NCD), typically associated with high body mass index (BMI), is rapidly rising. The fast spread of supermarkets and related shifts in diets were identified as possible factors contributing to overweight and obesity in developing countries. Potential effects of supermarkets on people's health have not been analyzed up till now. OBJECTIVE: This study investigates the effects of purchasing food in supermarkets on people's BMI, as well as on health indicators such as fasting blood glucose (FBG), blood pressure (BP), and the metabolic syndrome. DESIGN: This study uses cross-section observational data from urban Kenya. Demographic, anthropometric, and bio-medical data were collected from 550 randomly selected adults. Purchasing food in supermarkets is defined as a binary variable that takes a value of one if any food was purchased in supermarkets during the last 30 days. In a robustness check, the share of food purchased in supermarkets is defined as a continuous variable. Instrumental variable regressions are applied to control for confounding factors and establish causality. RESULTS: Purchasing food in supermarkets contributes to higher BMI (+ 1.8 kg/m2) (P<0.01) and an increased probability (+ 20 percentage points) of being overweight or obese (P<0.01). Purchasing food in supermarkets also contributes to higher levels of FBG (+ 0.3 mmol/L) (P<0.01) and a higher likelihood (+ 16 percentage points) of suffering from pre-diabetes (P<0.01) and the metabolic syndrome (+ 7 percentage points) (P<0.01). Effects on BP could not be observed. CONCLUSIONS: Supermarkets and their food sales strategies seem to have direct effects on people's health. In addition to increasing overweight and obesity, supermarkets contribute to nutrition-related NCDs. Effects of supermarkets on nutrition and health can mainly be ascribed to changes in the composition of people's food choices.
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  • Journal Article

    A Conceptual Framework for the Integration of Corporate Social Responsibility and Human Resource Development Based on Lifelong Learning 

    Ketschau, Thilo
    Sustainability 2017; 9(9): Art. 1545
    Companies often see themselves as actors in a process of sustainable development that takes place in society. With this self-conception comes the challenge to act in a socially responsible way. The following paper presents a framework to integrate the concepts of Corporate Social Responsibility and Human Resource Development to create an approach that can address this responsibility. The concepts of Corporate Social Responsibility and Human Resource Development are linked by the idea of lifelong learning, incorporating concepts and ideas from the field of education into the framework, which makes it possible to examine the issue of promotion and social advancement irrespective of an individual’s social background. The article lays a foundation for the framework by describing the concepts named above and later on conceptualizes a three-part framework that helps to analyse the development of entrepreneurial structures that enable social commitment through company education. With this framework, an innovative approach to link a corporation’s social and educational engagement for mutual benefit is given an applicable form, with the immanent potential for the development of social sustainability. The research presented in this paper is purely theoretical and its results offer a connection point for practical interventions.
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