Summary Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective ...medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions ( r =0·83), and human resources for health per 1000 ( r =0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation.
This paper investigates commercial displacement in the context of tourism gentrification. Tourism gentrification refers to the process by which tourism-related activities result in the displacement ...of long-term residents in favour of capital investment focused on tourism. While research on displacement induced by tourism gentrification has mainly focused on the residential displacement of long-term inhabitants, its impacts on local shops are poorly understood. Yet, commercial displacement is key to tourism gentrification as it involves the displacement of local shop owners and acts as a pressure of displacement on residents. This paper aims to measure the extent of shop displacement and to explore its causes and effects on shop owners by examining the experiences of shop owners as a category of those displaced, using Marcuse’s theoretical framework on displacement and the city centre of Reykjavík (Iceland) as a case study. It combines the quantitative measurement of commercial displacement with interviews with displaced shop owners. It argues that understanding commercial displacement, which is inherently much more visible than residential displacement, can provide urban geographers with valuable insights into understanding broader processes of gentrification-induced displacement.
The 2014–2015 Holuhraun eruption in Iceland, emitted ∼11 Tg of SO2 into the troposphere over 6 months, and caused one of the most intense and widespread volcanogenic air pollution events in ...centuries. This study provides a number of source terms for characterisation of plumes in large fissure eruptions, in Iceland and elsewhere. We characterised the chemistry of aerosol particle matter (PM) and gas in the Holuhraun plume, and its evolution as the plume dispersed, both via measurements and modelling. The plume was sampled at the eruptive vent, and in two populated areas in Iceland. The plume caused repeated air pollution events, exceeding hourly air quality standards (350 μg/m3) for SO2 on 88 occasions in Reykjahlíð town (100 km distance), and 34 occasions in Reykjavík capital area (250 km distance). Average daily concentration of volcanogenic PM sulphate exceeded 5 μg/m3 on 30 days in Reykjavík capital area, which is the maximum concentration measured during non-eruptive background interval. There are currently no established air quality standards for sulphate. Combining the results from direct sampling and dispersion modelling, we identified two types of plume impacting the downwind populated areas. The first type was characterised by high concentrations of both SO2 and S-bearing PM, with a high Sgas/SPM mass ratio (SO2(g)/SO42−(PM) > 10). The second type had a low Sgas/SPM ratio (<10). We suggest that this second type was a mature plume where sulphur had undergone significant gas-to-aerosol conversion in the atmosphere. Both types of plume were rich in fine aerosol (predominantly PM1 and PM2.5), sulphate (on average ∼90% of the PM mass) and various trace species, including heavy metals. The fine size of the volcanic PM mass (75–80% in PM2.5), and the high environmental lability of its chemical components have potential adverse implications for environmental and health impacts. However, only the dispersion of volcanic SO2 was forecast in public warnings and operationally monitored during the eruption. We make a recommendation that sulphur gas-to-aerosol conversion processes, and a sufficiently large model domain to contain the transport of a tropospheric plume on the timescale of days be utilized for public health and environmental impact forecasting in future eruptions in Iceland and elsewhere in the world.
•Holuhraun eruption impacted aerosol chemistry and air quality 100 s km downwind•Volcanic aerosol size and chemistry has implications for health impacts.•Two types of plume, primitive and mature, impacted populated areas in different ways.•Mature plume was an ‘unseen’ hazard, dispersion not forecast during the eruption.•Recommendation for improved plume hazard forecasting during future eruptions.
•Traction bronchiectasis (TB) is noted within interstitial lung abnormalities (ILA) on CT.•TB is associated with shorter survival in ILA.•ILA with dilation of bronchioles (bronchiolectasis) without ...TB also shows shorter survival.•Bronchiolectasis may be an earlier sign of fibrotic lung disease including ILA.•Traction bronchiectasis/bronchiolectasis index (TBI) predicts shorter survival in ILA.
To investigate if the presence and severity of traction bronchiectasis/bronchiolectasis are associated with poorer survival in subjects with ILA.
The study included 3,594 subjects (378 subjects with ILA and 3,216 subjects without ILA) in AGES-Reykjavik Study. Chest CT scans of 378 subjects with ILA were evaluated for traction bronchiectasis/bronchiolectasis, defined as dilatation of bronchi/bronchioles within areas demonstrating ILA. Traction bronchiectasis/bronchiolectasis Index (TBI) was assigned as: TBI = 0, ILA without traction bronchiectasis/bronchiolectasis: TBI = 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion: TBI = 2, ILA with mild to moderate traction bronchiectasis: TBI = 3, ILA and severe traction bronchiectasis and/or honeycombing. Overall survival (OS) was compared among the subjects in different TBI groups and those without ILA.
The median OS was 12.93 years (95%CI; 12.67 – 13.43) in the subjects without ILA; 11.95 years (10.03 – not reached) in TBI-0 group; 8.52 years (7.57 – 9.30) in TBI-1 group; 7.63 years (6.09 – 9.10) in TBI-2 group; 5.40 years (1.85 – 5.98) in TBI-3 group. The multivariable Cox models demonstrated significantly shorter OS of TBI-1, TBI-2, and TBI-3 groups compared to subjects without ILA (P < 0.0001), whereas TBI-0 group had no significant OS difference compared to subjects without ILA, after adjusting for age, sex, and smoking status.
The presence and severity of traction bronchiectasis/bronchiolectasis are associated with shorter survival. The traction bronchiectasis/bronchiolectasis is an important contributor to increased mortality among subjects with ILA.
A considerable part of the seismic risk to the capital area of Iceland is provided by a series of strike-slip faults at the mid-Atlantic plate boundary within a distance range of 15–35 km. About two ...thirds of the Icelandic population lives within this distance range from the source areas of M 6–6.5 earthquakes. The structure of the plate boundaries in SW-Iceland is relatively complex. Three branches meet in the Hengill Triple Junction, the oblique rift of the Reykjanes Peninsula, the South Iceland Seismic Zone (a transform zone) and the Western Volcanic Zone (a rift zone). The Reykjanes Peninsula oblique rift has an over-all trend of 70°, highly oblique with respect to the spreading direction, 101° in this region. It contains both volcanic systems and seismogenic strike-slip faults. The fissure swarms of individual volcanic systems contain normal faults and fissures, with a NE-trend, also quite oblique to the plate boundary. The fissure swarms fade out towards the NE and SW as they extend into the plates on either side. Overprinting this pattern of volcano-tectonic structures are sets of parallel, northerly striking transcurrent faults that generate the largest earthquakes in this zone. Their surface expressions are en echelon fracture arrays and push-up structures. The sense of displacement is right-lateral. In the 15 km long section of the rift studied here we find evidence for at least six faults of this type. The length of individual faults may exceed 12 km. The distance between them varies from 1 to 5 km, and together they form a bookshelf-type fault system taking up the left-lateral component of plate movements across the oblique rift zone.
•Surface expressions of at least 6 strike-slip faults are identified and mapped along the eastern part of the Reykjanes Peninsula Oblique Rift.•The faults are transverse to the plate boundary and parallel to each other.•The faulting is right-lateral, and the faults take up the left-lateral motion across the rift by bookshelf faulting.•The faults are the main sources of seismic hazard for the Reykjavík metropolitan area, including geothermal power stations.•The maximum magnitude of earthquakes on these faults is estimated to be around 6.5.
objectively measured population physical activity (PA) data from older persons is lacking. The aim of this study was to describe free-living PA patterns and sedentary behaviours in Icelandic older ...men and women using accelerometer.
from April 2009 to June 2010, 579 AGESII-study participants aged 73-98 years wore an accelerometer (Actigraph GT3X) at the right hip for one complete week in the free-living settings.
in all subjects, sedentary time was the largest component of the total wear time, 75%, followed by low-light PA, 21%. Moderate-vigorous PA (MVPA) was <1%. Men had slightly higher average total PA (counts × day(-1)) than women. The women spent more time in low-light PA but less time in sedentary PA and MVPA compared with men (P < 0.001). In persons <75 years of age, 60% of men and 34% of women had at least one bout ≥10 min of MVPA, which decreased with age, with only 25% of men and 9% of women 85 years and older reaching this.
sedentary time is high in this Icelandic cohort, which has high life-expectancy and is living north of 60° northern latitude.
To investigate the incidence and progression of age-related macular degeneration (AMD) and associated risk factors.
Population-based, prospective, cohort study.
We included 2868 participants from the ...Age Gene/Environment Susceptibility-Reykjavik Study with retinal data at baseline and 5-year follow-up.
Digital macular photographs were graded for presence of AMD. Participants completed a questionnaire and extensive clinical battery. Biomarkers were assessed. Risk factors for AMD were analyzed using multivariate regression analysis with odds ratios (ORs) and 95% CIs.
We assessed AMD, defined as early or late.
Among 2196 participants free of AMD at baseline, 14.9% developed incident AMD. In multivariate models, incident AMD was significantly associated with age (OR per year, 1.14; 95% CI, 1.11-1.17), current smoking (OR, 2.07; 95% CI, 1.38-3.11), former smoking (OR, 1.36; 95% CI, 1.04-1.79), plasma high-density lipoprotein (HDL) cholesterol level (OR, 1.62 per mmol/L; 95% CI, 1.19-2.22), and body mass index (BMI; OR, 1.04 per kg/m(2); 95% CI, 1.01-1.07). Among 563 participants with early AMD at baseline, 22.7% progressed to late AMD (11.0% pure geographic atrophy GA and 11.7% exudative AMD). On multivariate analyses, age was significantly associated with progression to GA (OR 1.14; 95% CI, 1.07-1.21) and exudative AMD (OR, 1.08; 95% CI, 1.01-1.14). Adjusting for age, female sex was associated with exudative AMD (OR, 2.10; 95% CI, 1.10-3.98) and plasma HDL cholesterol with GA (OR, 2.03 per mmol/L; 95% CI, 1.02-4.05).
By age 85, 57.4% of participants had signs of AMD. Age, smoking, plasma HDL cholesterol, BMI, and female sex are associated with AMD. Elevated HDL cholesterol is associated with GA development.
to examine the relationships between impairments in hearing and vision and mortality from all-causes and cardiovascular disease (CVD) among older people.
population-based cohort study.
the study ...population included 4,926 Icelandic individuals, aged ≥67 years, 43.4% male, who completed vision and hearing examinations between 2002 and 2006 in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) and were followed prospectively for mortality through 2009.
participants were classified as having 'moderate or greater' degree of impairment for vision only (VI), hearing only (HI), and both vision and hearing (dual sensory impairment, DSI). Cox proportional hazard regression, with age as the time scale, was used to calculate hazard ratios (HR) associated with impairment and mortality due to all-causes and specifically CVD after a median follow-up of 5.3 years.
the prevalence of HI, VI and DSI were 25.4, 9.2 and 7.0%, respectively. After adjusting for age, significantly (P < 0.01) increased mortality from all causes, and CVD was observed for HI and DSI, especially among men. After further adjustment for established mortality risk factors, people with HI remained at higher risk for CVD mortality HR: 1.70 (1.27-2.27), whereas people with DSI remained at higher risk of all-cause mortality HR: 1.43 (1.11-1.85) and CVD mortality HR: 1.78 (1.18-2.69). Mortality rates were significantly higher in men with HI and DSI and were elevated, although not significantly, among women with HI.
older men with HI or DSI had a greater risk of dying from any cause and particularly cardiovascular causes within a median 5-year follow-up. Women with hearing impairment had a non-significantly elevated risk. Vision impairment alone was not associated with increased mortality.
Der Sammelband bietet einen systematischen Überblick über Grundlagen, empirische Erkenntnisse und Reflexionen zur Umsetzung inklusiver Bildung im Bildungssystem Islands und regt so den ...internationalen Dialog an. Neben dem Fokus auf die gesellschaftliche Diskussion von Herausforderungen in Island im Vergleich zu deutschsprachigen Ländern werden von isländischen und deutschen Expert*innen Forschungs- und Qualifizierungsprojekte vorgestellt, Beispiele inklusiver Schulen und Lernprozesse erläutert sowie Erkenntnisse zur Gestaltung inklusionsorientierter Lehrer*innenbildung beschrieben.
As a part of the EU-funded CarbFix2 project, Climeworks and Reykjavik Energy have partnered to combine direct air capture (DAC) technology with the injection of CO2 into basalts, for permanent ...storage by mineralization of the injected carbon. This is the world’s first DAC installation that is combined with mineral storage of CO2. There is large potential for further optimization and substantial scale up of this joint operation. The organizations are developing an integrated CO2 removal solution that may be expanded and applied globally. This type of solution has been recognized as a crucial component in efforts to mitigate global warming.
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