GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study.

Purpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality. Patients and Methods: We followed 1300 participants with COPD aged ≥40 years who participated in the HUNT Study (1995-1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications. Results: Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (ptrend=0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7-66.9), 60.9 (56.1-64.4), and 56.1 (54.0-58.1), respectively, at 20-years' follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8-59.1), 54.1 (52.1-56.0), and 52.6 (51.0-54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time. Conclusion: The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.

Policy Coherence and Interplay between Climate Change Adaptation Policies and the Forestry Sector in Nepal.

Least Developed Countries are likely to be hit the hardest by climate change and need focused efforts towards adaptation. Nepal recognizes that it needs to integrate climate change adaptation into various policies, but limited understanding of how to make these policies coherent is among the factors that hinder effective adaptation action. This can lead to wasted resources and lost opportunities. This paper applies concepts from policy coherence for development frameworks and policy content analysis to examine coherence in Nepal's climate and forest policies-and discusses the factors hindering effective implementation. The policies are analyzed at the horizontal/external level at three layers-motivation, measures, and planned implementation process. The paper finds that policies are more consistent on motivation level and adaptation measures, but are less coherent on implementation. The National Adaptation Programme of Action (NAPA) is more explicit in identifying institutions, organizations, roles and responsibilities, resource allocation (financial), and a monitoring and evaluation plan for climate change adaptation while other policies such as Climate Change Policy 2011, National Biodiversity Strategy and Action Plan 2014-2020, Forest Policy 2015, and Forest Sector Strategy 2016 have critical gaps in this area. This paper conclude that formulation of a policy, articulating targets, and mobilizing financial resources are in themselves not sufficient to effectively address climate change adaptation. Policy-based legislation is required, together with development of a supportive collaborative multi-stakeholder approach at different levels of governance, backed up by effective, collaborative monitoring and enforcement.

The socio-economic determinants of infant mortality in Nepal: analysis of Nepal Demographic Health Survey, 2011.

BACKGROUND: Infant mortality reflects not only the health of infants but societal well-being as a whole. This study explores distal socioeconomic and related proximate determinants of infant mortality and provides evidence for designing targeted interventions. METHODS: Survival information on 5391 live born infants (2006-2010) was examined from the nationally representative Nepal Demographic Health Survey 2011. Bivariate logistic regression and multivariate hierarchical logistic regression approaches were performed to analyze the distal-socioeconomic and related proximate determinants of infant mortality. RESULTS: Socio-economic distal determinants are important predictors for infant mortality. For example, in reference to infants of the richest class, the adjusted odds ratio of infant mortality was 1.66 (95% CI: 1.00-2.74) in middle class and 1.87 (95% CI: 1.14-3.08) in poorer class, respectively. Similarly, the populations of the Mountain ecological region had a higher odds ratio (aOR =1.39, 95% CI: 0.90-2.16) of experiencing infant mortality compared with the populations of the Terai plain region. Likewise, the population of Far-western development region had a higher adjusted odds ratio (aOR =1.62, 95% CI: 1.02-2.57) of experiencing infant mortality than the Western development region. Moreover, the association of proximate determinants with infant mortality was statistically significant. For example, in reference to size at birth, adjusted odds ratio of infant dying was higher for infants whose birth size, as reported by mothers, was very small (aOR = 3.41, 95% CI: 2.16-5.38) than whose birth size was average. Similarly, fourth or higher birth rank infants with a short preceding birth interval (less than or equal to 2 years) were at greater risk of dying (aOR =1.74, 95% CI: 1.16-2.62) compared to the second or third rank infants with longer birth intervals. A short birth interval of the second or the third rank infants also increased the odds of infant death (aOR = 2.03, 95% CI: 1.23-3.35). CONCLUSIONS: Socioeconomic distal and proximate determinants are associated with infant mortality in Nepal. Infant mortality was higher in the poor and middle classes than the wealthier classes. Population of Mountain ecological region and Far western development region had high risk of infant mortality. Similarly, infant dying was higher for infants whose birth size, as reported by mothers, was very small and who has higher birth rank and short preceding birth interval. This study uniquely addresses both broader socioeconomic distal and proximate determinants side by side at the individual, household and community levels. For this, both comprehensive, long-term, equity-based public health interventions and immediate infant care programs are recommended.