Abstract
Background
As the global burden of disease evolves, lower-resource countries like Nepal face a double burden of non-communicable and infectious disease. Rapid adaptation is required for ...Nepal’s health system to provide life-long, person-centred care while simultaneously improving quality of infectious disease services. Social determinants of health be key in addressing health disparities and could direct policy decisions to promote health and manage the disease burden. Thus, we explore the association of social determinants with the double burden of disease in Nepal.
Methods
This is a retrospective, ecological, cross-sectional analysis of infectious and non-communicable disease outcome data (2017 to 2019) and data on social determinants of health (2011 to 2013) for 753 municipalities in Nepal. Multinomial logistic regression was conducted to evaluate the associations between social determinants and disease burden.
Results
The ‘high-burden’ combined double burden (non-communicable and infectious disease) outcome was associated with more accessible municipalities, (adjOR3.9495%CI2.94–5.28), municipalities with higher proportions of vaccine coverage (adjOR12.4995%CI3.05–51.09) and malnutrition (adjOR9.19E10395%CI19.68E42-8.72E164), lower average number of people per household (adjOR0.3295%CI0.22–0.47) and lower indigenous population (adjOR0.2095%CI0.06–0.65) compared to the ‘low-burden’ category on multivariable analysis. ‘High-burden’ of non-communicable disease was associated with more accessible municipalities (adjOR1.9395%CI1.45–2.57), higher female proportion within the municipality (adjOR1.69E895%CI3227.74–8.82E12), nutritional deficiency (adjOR1.39E1795%CI11799.83–1.64E30) and malnutrition (adjOR2.17E13195%CI4.41E79-1.07E183) and lower proportions of population under five years (adjOR1.05E-1095%CI9.95E-18–0.001), indigenous population (adjOR0.3295%CI0.11–0.91), average people per household (adjOR0.4495%CI0.26–0.73) and households with no piped water (adjOR0.2195%CI0.09–0.49), compared to the ‘low-burden’ category on adjusted analysis. ‘High burden’ of infectious disease was also associated with more accessible municipalities (adjOR4.2995%CI3.05–6.05), higher proportions of population under five years (adjOR3.78E995%CI9418.25–1.51E15), vaccine coverage (adjOR25.4295%CI7.85–82.29) and malnutrition (adjOR4.29E4195%CI12408.29–1.48E79) and lower proportions of households using firewood as fuel (adjOR0.3995%CI0.20–0.79) (‘moderate-burden’ category only) compared to ‘low-burden’.
Conclusions
While this study produced imprecise estimates and cannot be interpreted for individual risk, more accessible municipalities were consistently associated with higher disease burden than remote areas. Female sex, lower average number per household, non-indigenous population and poor nutrition were also associated with higher burden of disease and offer targets to direct interventions to reduce the burden of infectious and non-communicable disease and manage the double burden of disease in Nepal.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This paper documents the tropospheric chemical mechanism scheme used in the TOMCAT 3-D chemical transport model. The current scheme includes a more detailed representation of hydrocarbon chemistry ...than previously included in the model, with the inclusion of the emission and oxidation of ethene, propene, butane, toluene and monoterpenes. The model is evaluated against a range of surface, balloon, aircraft and satellite measurements. The model is generally able to capture the main spatial and seasonal features of high and low concentrations of carbon monoxide (CO), ozone (O3), volatile organic compounds (VOCs) and reactive nitrogen. However, model biases are found in some species, some of which are common to chemistry models and some that are specific to TOMCAT and warrant further investigation. The most notable of these biases are (1) a negative bias in Northern Hemisphere (NH) winter and spring CO and a positive bias in Southern Hemisphere (SH) CO throughout the year, (2) a positive bias in NH O3 in summer and a negative bias at high latitudes during SH winter and (3) a negative bias in NH winter C2 and C3 alkanes and alkenes. TOMCAT global mean tropospheric hydroxyl radical (OH) concentrations are higher than estimates inferred from observations of methyl chloroform but similar to, or lower than, multi-model mean concentrations reported in recent model intercomparison studies. TOMCAT shows peak OH concentrations in the tropical lower troposphere, unlike other models which show peak concentrations in the tropical upper troposphere. This is likely to affect the lifetime and transport of important trace gases and warrants further investigation.
Healthcare systems face increasing challenges due to the impacts of climate change. The number of weather-related natural disasters has tripled since the 1960s, and temperature records have been ...broken worldwide. These changes threaten the health, environment, and food security of billions of people. The burden of climate change impacts will disproportionately affect children and low- and middle-income countries. Climate change also acts as a risk multiplier, exacerbating existing health inequities and placing vulnerable populations at higher risk. To increase healthcare system resilience, targeted interventions in maternal and early life care are crucial. By improving awareness, diversity, self-regulation, integration, and adaptability within healthcare systems, we can mitigate the effects of climate disruption and empower future generations to thrive. These interventions include incorporating planetary health into medical education, expanding access to mental health care for pregnant women, and implementing programs that support vulnerable mothers and their children. By focusing on maternal care, we can improve overall healthcare system resilience and better prepare for the challenges of climate change.
We present an optimal-estimation (OE) retrieval scheme for stratospheric sulfur dioxide from the High-Resolution Infrared Radiation Sounder 2 (HIRS/2) instruments on the NOAA and MetOp platforms, an ...infrared radiometer that has been operational since 1979. This algorithm is an improvement upon a previous method based on channel brightness temperature differences, which demonstrated the potential for monitoring volcanic SO2 using HIRS/2. The Prata method is fast but of limited accuracy. This algorithm uses an optimal-estimation retrieval approach yielding increased accuracy for only moderate computational cost. This is principally achieved by fitting the column water vapour and accounting for its interference in the retrieval of SO2. A cloud and aerosol model is used to evaluate the sensitivity of the scheme to the presence of ash and water/ice cloud. This identifies that cloud or ash above 6 km limits the accuracy of the water vapour fit, increasing the error in the SO2 estimate. Cloud top height is also retrieved. The scheme is applied to a case study event, the 1991 eruption of Cerro Hudson in Chile. The total erupted mass of SO2 is estimated to be 2300 kT ± 600 kT. This confirms it as one of the largest events since the 1991 eruption of Pinatubo, and of comparable scale to the Northern Hemisphere eruption of Kasatochi in 2008. This retrieval method yields a minimum mass per unit area detection limit of 3 DU, which is slightly less than that for the Total Ozone Mapping Spectrometer (TOMS), the only other instrument capable of monitoring SO2 from 1979 to 1996. We show an initial comparison to TOMS for part of this eruption, with broadly consistent results. Operating in the infrared (IR), HIRS has the advantage of being able to measure both during the day and at night, and there have frequently been multiple HIRS instruments operated simultaneously for better than daily sampling. If applied to all data from the series of past and future HIRS instruments, this method presents the opportunity to produce a comprehensive and consistent volcanic SO2 time series spanning over 40 years.
Rhea's exosphere is thought to originate from sources of carbon, water ice and other volatiles that arrived at Rhea by bombardment. Its seasonal variability is directly driven by polar surface ...temperatures allowing surface adsorption, and the persistence of source volatiles require that seasonal temperatures remain sufficiently cold to retain them. Cassini CIRS detected temperatures in Rhea's winter polar region of 23 K, amongst the coldest measured in the Solar System, but with a relatively large footprint we seek to add value to these observations by modeling sub field-of-view (FOV) temperature distribution and examining how the coldest scenes evolve on a seasonal basis.
A simple, rough surface 1-dimensional thermal model is developed using a digital elevation map as input to a thermal model. We compared averaged rough and flat modeled FOVs to CIRS temperatures for a set of case study observations in the south polar region in winter darkness and found they both agree within expected CIRS error in all cases. We develop an asymmetric estimate of CIRS FOV temperature uncertainty, which is particularly important for very cold spectra to accurately represent the sensitivity of the instrument. This approach provides a conservative upper temperature limit to spectral fits whilst highlighting there is often little information to constrain the lower bound of temperature uncertainty in these cases.
The distribution of modeled sub-FOV facet temperatures is explored for the full range of azimuth angles and slope gradients. More extensive and cooler temperatures were found in the rough model, complemented by fewer but warmer areas than the flat model. We find temperature contrasts of individual model facets of up to 15 K warmer and 11 K colder within some CIRS FOV when the rough model was compared flat, in a case study of scenes in winter darkness. This is due to the persistence of the seasonal thermal wave beneath the surface. We tested model sensitivity to thermal input parameters (thermal inertia and bolometric Bond albedo). These values are challenging to constrain due to limited observations and measurement noise and are expected to vary with subtle changes in surface characteristics. We found that within 20° of the pole, temperatures do not rise significantly above 80 K all year, implying that a variety of simple organic molecules, linear amides and other carbon-containing compounds would remain stable on a quasi-permanent basis, potentially until photolytic or radiolytic mechanisms liberate by-products which provide a source for exospheric constituents. The simple rough model indicates that some facets experience very different summer/winter season lengths than a flat model can represent, which is important in terms of the exospheric sequestration process.
We use threshold temperatures of 55 K for CO2 and 30 K for O2 ice as proxies for their relative stability at the surface. The surface coverage of these temperatures with time was compared to modeled exospheric abundance by Teolis and Waite (2016). They are anti-correlated which is expected, but with slight differences in timings of minima and the equinoctial maxima. We find that the rough model suggests larger areas able to adsorb these species than the flat model, and that the cumulative influence of topography would have a direct relationship on the timing and abundance of the exosphere.
We place Rhea's polar environment in context with other icy moons in the Saturnian system using the flat model. The satellites Tethys, Dione and Enceladus experience similar polar thermal regimes to Rhea (with exceptionally cold winters) and would potentially benefit from the consideration of topography in relation to exospheric modeling.
•We characterize new asymmetrical temperature errors for the coldest CIRS measurements (< 30 K).•Rhea’s polar regions remain < 80 K, preserving many volatile species that could interact with the seasonal exosphere.•Several of Saturn’s icy satellites are as cold as Rhea.
We present an optimal-estimation (OE) retrieval scheme for stratospheric sulfur dioxide from the High-Resolution Infrared Radiation Sounder 2 (HIRS/2) instruments on the NOAA and MetOp platforms, an ...infrared radiometer that has been operational since 1979. This algorithm is an improvement upon a previous method based on channel brightness temperature differences, which demonstrated the potential for monitoring volcanic SO2 using HIRS/2. The Prata method is fast but of limited accuracy. This algorithm uses an optimal-estimation retrieval approach yielding increased accuracy for only moderate computational cost. This is principally achieved by fitting the column water vapour and accounting for its interference in the retrieval of SO2. A cloud and aerosol model is used to evaluate the sensitivity of the scheme to the presence of ash and water/ice cloud. This identifies that cloud or ash above 6 km limits the accuracy of the water vapour fit, increasing the error in the SO2 estimate. Cloud top height is also retrieved. The scheme is applied to a case study event, the 1991 eruption of Cerro Hudson in Chile. The total erupted mass of SO2 is estimated to be 2300 kT ± 600 kT. This confirms it as one of the largest events since the 1991 eruption of Pinatubo, and of comparable scale to the Northern Hemisphere eruption of Kasatochi in 2008. This retrieval method yields a minimum mass per unit area detection limit of 3 DU, which is slightly less than that for the Total Ozone Mapping Spectrometer (TOMS), the only other instrument capable of monitoring SO2 from 1979 to 1996. We show an initial comparison to TOMS for part of this eruption, with broadly consistent results. Operating in the infrared (IR), HIRS has the advantage of being able to measure both during the day and at night, and there have frequently been multiple HIRS instruments operated simultaneously for better than daily sampling. If applied to all data from the series of past and future HIRS instruments, this method presents the opportunity to produce a comprehensive and consistent volcanic SO2 time series spanning over 40 years.
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