Immigrant's use of primary health care (PHC) services differs from that of native's, but studies are non-consistent, and the importance of individual explaining variables like socio-economic status, ...morbidity burden and length of stay in the host country is uncertain.
Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration Database for all immigrants and natives ≥ 15 years registered in Norway in 2008 (3 739 244 persons), applying the Johns Hopkins ACG® Case-Mix System. Using multivariate binary logistic and negative binomial regression analyses, respectively, we compared overall use of PHC and number of visits to PHC between immigrants and natives, and investigated the significance of socio-economic, immigration and morbidity variables.
A significantly lower percentage of immigrants used the general practitioner (GP) compared with natives. Among GP users, however, most immigrants used the GP at a 2-15% significantly higher rate compared with natives. Older immigrants used their GP less and at lower rates than younger immigrants. A significantly lower percentage of immigrants from high-income countries, but a higher percentage of all other immigrants used emergency services compared with natives, with no differences in use rates. Morbidity burden and length of stay were essential explaining variables.
Lower use of PHC among immigrants could be due to better health or to access barriers, and should be further studied, especially for the oldest immigrants. Adjusted high frequency of use may be appropriate, but it might also be a signal of non-effective contacts.
The rapidity and synchrony of the African Humid Period (AHP) termination at around 5.5 ka are debated, and it is unclear what caused a rapid hydroclimate response. Here we analysed the hydrogen ...isotopic composition of sedimentary leaf-waxes (δD
) from the Gulf of Guinea, a proxy for regional precipitation in Cameroon and the central Sahel-Sahara. Our record indicates high precipitation during the AHP followed by a rapid decrease at 5.8-4.8 ka. The similarity with a δD
record from northern East Africa suggests a large-scale atmospheric mechanism. We show that northern high- and mid-latitude cooling weakened the Tropical Easterly Jet and, through feedbacks, strengthened the African Easterly Jet. The associated decrease in precipitation triggered the AHP termination and combined with biogeophysical feedbacks to result in aridification. Our findings suggest that extratropical temperature changes, albeit smaller than during the glacial and deglacial, were important in triggering rapid African aridification during the Holocene.
As the flows of immigrant populations increase worldwide, their heterogeneity becomes apparent with respect to the differences in the prevalence of chronic physical and mental disease. Multimorbidity ...provides a new framework in understanding chronic diseases holistically as the consequence of environmental, social, and personal risks that contribute to increased vulnerability to a wide variety of illnesses. There is a lack of studies on multimorbidity among immigrants compared to native-born populations.
This nationwide multi-register study in Norway enabled us i) to study the associations between multimorbidity and immigrant origin, accounting for other known risk factors for multimorbidity such as gender, age and socioeconomic levels using logistic regression analyses, and ii) to identify patterns of multimorbidity in Norway for immigrants and Norwegian-born by means of exploratory factor analysis technique.
Multimorbidity rates were lower for immigrants compared to Norwegian-born individuals, with unadjusted odds ratios (OR) and 95% confidence intervals 0.38 (0.37-0.39) for Eastern Europe, 0.58 (0.57-0.59) for Asia, Africa and Latin America, and 0.67 (0.66-0.68) for Western Europe and North America. Results remained significant after adjusting for socioeconomic factors. Similar multimorbidity disease patterns were observed among Norwegian-born and immigrants, in particular between Norwegian-born and those from Western European and North American countries. However, the complexity of patterns that emerged for the other immigrant groups was greater. Despite differences observed in the development of patterns with age, such as ischemic heart disease among immigrant women, we were unable to detect the systematic development of the multimorbidity patterns among immigrants at younger ages.
Our study confirms that migrants have lower multimorbidity levels compared to Norwegian-born. The greater complexity of multimorbidity patterns for some immigrant groups requires further investigation. Health care policies and practice will require a holistic approach for specific population groups in order to meet their health needs and to curb and prevent diseases.
A Lagrangian analysis is applied to identify the main moisture source areas associated with atmospheric rivers (ARs) making landfall along the west coast of South Africa during the extended austral ...winter months from 1980 to 2014. The results show that areas that provide the anomalous uptake of moisture can be categorized into four regions: (1) the South Atlantic Ocean between 10°S and 30°S, (2) a clear local maximum in the eastern South Atlantic, (3) a continental source of anomalous uptake to the north of the Western Cape, and (4) over South America at a distance of more than 7000 km from the target region. It emerges that the South American moisture source can be linked to a particular phase of the South American low‐level jet, known as a no Chaco jet event (NCJE), which transports moisture to the western and central South Atlantic basin. Concisely, we provide strong evidence that the two margins of the South Atlantic Ocean appear connected by two meteorological structures, with the NCJE playing a key role of transporting moisture from South America to the western and central South Atlantic basin, feeding the AR that transports some of the moisture to the west coast of South Africa.
Using Lagrangian analysis, performed over the extended austral winter months from 1980–2014, we provide strong evidence that the two continental margins of the South Atlantic Ocean appear connected by two meteorological structures. A no Chaco jet event plays a key role in transporting moisture from South America to the western and central South Atlantic basin, feeding the atmospheric river that transports some of the moisture to the west coast of South Africa.
This work examines the main sources of moisture over Central Brazil and La Plata Basin during the year through a new Lagrangian diagnosis method which identifies the humidity contributions to the ...moisture budget over a region. This methodology computes budgets of evaporation minus precipitation by calculating changes in the specific humidity along back‐trajectories for the previous 10 d. The origin of all air masses residing over each region was tracked during a period of 5 years (2000–2004). These regions were selected because they coincide with two centers of action of a known dipole precipitation variability mode observed in different temporal scales (from intra seasonal up to inter decadal timescales) and are related to the climatic variability of the South American Monsoon System. The results suggested the importance of the tropical south Atlantic as a moisture source for Central Brazil, and of recycling for La Plata basin. It seems that the Tropical South Atlantic plays an important role as a moisture source for Central Brazil and La Plata basin along the year, particularly during the austral summer. The north Atlantic is also an additional source for both regions during the austral summer.
A major risk factor of COVID-19 severity is the patient's health status at the time of the infection. Numerous studies focused on specific chronic diseases and identified conditions, mainly ...cardiovascular ones, associated with poor prognosis. However, chronic diseases tend to cluster into patterns, each with its particular repercussions on the clinical outcome of infected patients. Network analysis in our population revealed that not all cardiovascular patterns have the same risk of COVID-19 hospitalization or mortality and that this risk depends on the pattern of multimorbidity, besides age and sex. We evidenced that negative outcomes were strongly related to patterns in which diabetes and obesity stood out in older women and men, respectively. In younger adults, anxiety was another disease that increased the risk of severity, most notably when combined with menstrual disorders in women or atopic dermatitis in men. These results have relevant implications for organizational, preventive, and clinical actions to help meet the needs of COVID-19 patients.
In this study, we conducted a global assessment of the sensitivity of vegetation greenness (VGS) to precipitation and to the estimated Lagrangian precipitation time series of oceanic (PLO) and ...terrestrial (PLT) origin. The study was carried out for terrestrial ecosystems consisting of 9 biomes and 139 ecoregions during the period of 2001–2018. This analysis aimed to diagnose the vegetative response of vegetation to the dominant component of precipitation, which is of particular interest considering the hydroclimatic characteristics of each ecoregion, climate variability, and changes in the origin of precipitation that may occur in the context of climate change. The enhanced vegetation index (EVI) was used as an indicator of vegetation greenness. Without consideration of semi-arid and arid regions and removing the role of temperature and radiation, the results show the maximum VGS to precipitation in boreal high-latitude ecoregions that belong to boreal forest/taiga: temperate grasslands, savannas, and shrublands. Few ecoregions, mainly in the Amazon basin, show a negative sensitivity. We also found that vegetation greenness is generally more sensitive to the component that contributes the least to precipitation and is less stable throughout the year. Therefore, most vegetation greenness in Europe is sensitive to changes in PLT and less to PLO. In contrast, the boreal forest/taiga in northeast Asia and North America is more sensitive to changes in PLO. Finally, in most South American and African ecoregions, where PLT is crucial, the vegetation is more sensitive to PLO, whereas the contrast occurs in the northern and eastern ecoregions of Australia.
The Intra–Americas Seas region is known for its relevance to air–sea interaction processes, the contrast between large water masses and a relatively small continental area, and the occurrence of ...extreme events. The differing weather systems and the influence of variability at different spatio–temporal scales is a characteristic feature of the region. The impact of hydro–meteorological extreme events has played a huge importance for regional livelihood, having a mostly negative impact on socioeconomics. The frequency and intensity of heavy rainfall events and droughts are often discussed in terms of their impact on economic activities and access to water. Furthermore, future climate projections suggest that warming scenarios are likely to increase the frequency and intensity of extreme events, which poses a major threat to vulnerable communities. In a region where the economy is largely dependent on agriculture and the population is exposed to the impact of extremes, understanding the climate system is key to informed policymaking and management plans. A wealth of knowledge has been published on regional weather and climate, with a majority of studies focusing on specific components of the system. This study aims to provide an integral overview of regional weather and climate suitable for a wider community. Following the presentation of the general features of the region, a large scale is introduced outlining the main structures that affect regional climate. The most relevant climate features are briefly described, focusing on sea surface temperature, low–level circulation, and rainfall patterns. The impact of climate variability at the intra–seasonal, inter–annual, decadal, and multi–decadal scales is discussed. Climate change is considered in the regional context, based on current knowledge for natural and anthropogenic climate change. The present challenges in regional weather and climate studies have also been included in the concluding sections of this review. The overarching aim of this work is to leverage information that may be transferred efficiently to support decision–making processes and provide a solid foundation on regional weather and climate for professionals from different backgrounds.
Abstract South Africa (SA) is highly vulnerable to the effects of drought on the environment, economy, and society. However, its effect on human health remains unclear. Understanding the mortality ...risk associated with different types of droughts in different population groups and by specific causes would help clarify the potential mechanisms involved. The study aims to comprehensively assess the effect of droughts of varying time scales on cause-specific mortality (all; infectious and parasitic; endocrine, nutritional, and metabolic; cardiovascular; respiratory) in SA (from 2009–2016) and identify more vulnerable profiles based on sex and age. We also evaluated the urbanicity and district-level socioeconomic deprivation as potential risk modifiers. We used a two-stage time-series study design, with the weekly standardized precipitation-evapotranspiration index (SPEI) calculated at 1, 6, 12, and 15 months of accumulation to identify droughts of different duration (SPEI1, 6, 12, 15, respectively). We applied a quasi-Poisson regression adjusted by mean temperature to assess the association between each type of drought and weekly mortality in all district municipalities of SA, and then pooled the estimates in a meta-regression model. We reported relative risks (RRs) for one unit increase of drought severity. Overall, we found a positive association between droughts (regardless the time scale) and all causes of death analyzed. The strongest associations were found for the drought events more prolonged (RR 95%CI: 1.027 1.018, 1.036 (SPEI1); 1.035 1.021, 1.050 (SPEI6); 1.033 1.008, 1.058 (SPEI12); 1.098 1.068, 1.129 (SPEI15)) and respiratory mortality (RRs varied from 1.037 1.021, 1.053 (SPEI1) to 1.189 1.14, 1.241 (SPEI15)). An indication of greater vulnerability was found in younger adults for the shortest droughts, in older adults for medium-term and long-term droughts, and children for very long-term droughts. However, differences were not significant. Further evidence of the relevance of urbanicity and demographic and socioeconomic conditions as potential risk modifiers is needed.
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