Changes in migration patterns that have occurred in recent decades, both quantitative, with an increase in the number of immigrants, and qualitative, due to different causes of migration (work, ...family reunification, asylum seekers and refugees) require constant u pdating of the analysis of how immigrants access health services. Understanding of the existence of changes in use patterns is necessary to adapt health services to the new socio-demographic reality. The aim of this study is to describe the scientific evidence that assess the differences in the use of health services between immigrant and native populations.
A systematic review of the electronic database MEDLINE (PubMed) was conducted with a search of studies published between June 2013 and February 2016 that addressed the use of health services and compared immigrants with native populations. MeSH terms and key words comprised Health Services Needs and Demands/Accessibility/Disparities/Emigrants and Immigrants/Native/Ethnic Groups. The electronic search was supplemented by a manual search of grey literature. The following information was extracted from each publication: context of the study (place and year), characteristics of the included population (definition of immigrants and their sub-groups), methodological domains (design of the study, source of information, statistical analysis, variables of health care use assessed, measures of need, socio-economic indicators) and main results.
Thirty-six publications were included, 28 from Europe and 8 from other countries. Twenty-four papers analysed the use of primary care, 17 the use of specialist services (including hospitalizations or emergency care), 18 considered several levels of care and 11 assessed mental health services. The characteristics of immigrants included country of origin, legal status, reasons for migration, length of stay, different generations and socio-demographic variables and need. In general, use of health services by the immigrants was less than or equal to the native population, although some differences between immigrants were also identified.
This review has identified that immigrants show a general tendency towards a lower use of health services than native populations and that there are significant differences within immigrant sub-groups in terms of their patterns of utilization. Further studies should include information categorizing and evaluating the diversity within the immigrant population.
On 12–15 March 1993, a severe winter storm (SC93) formed over the Gulf of Mexico, affecting the Caribbean Islands and the eastern coast of the United States (US) and Canada with a notable amount of ...precipitation, snow and severe local storms. In this study, we investigate the origin of the precipitation generated by SC93 by applying a widely used Lagrangian moisture source diagnostic method. Our findings revealed that most of the moisture came from the western North Atlantic Ocean, the Caribbean Sea and the Gulf of Mexico. Moreover, the eastern US and Mexico acted as notable terrestrial moisture sources. Overall, the moisture contribution from the oceanic origin was higher than the terrestrial counterpart, and the moisture sources progressively shifted northward as the storm moved. In addition, the moisture uptake mainly occurred in the cyclone–anticyclone interaction region.
Abstract
Global warming and associated changes in atmospheric circulation patterns are expected to alter the hydrological cycle, including the intensity and position of moisture sources. This study ...presents predicted changes for the middle and end of the 21st century under the SSP5-8.5 scenario for two important extratropical moisture sources: the North Atlantic Ocean (NATL) and Mediterranean Sea (MED). Changes over the Iberian Peninsula—considered as a strategic moisture sink for its location—are also studied in detail. By the end of the century, moisture from the NATL will increase precipitation over eastern North America in winter and autumn and on the British Isles in winter. Moisture from the MED will increase precipitation over the southern and western portions of the Mediterranean continental area. Precipitation associated with the MED moisture source will decrease mainly over eastern Europe, while that associated with the NATL will decrease over western Europe and Africa. Precipitation recycling on the Iberian Peninsula will increase in all seasons except summer for mid-century. Climate change, as simulated by CESM2 thus modifies atmospheric moisture transport, affecting regional hydrological cycles.
The urban-breeze circulation is a mesoscale response of the atmospheric flow that is related to horizontal variations in temperature associated, for dry conditions, with gradients in sensible heat ...flux densities. This local circulation is difficult to observe with a simple observational deployment, and the 3D numerical simulations needed to model it are very demanding in computer time. A theoretical approach scaling the daytime urban heat island and urban-breeze characteristics has been developed and provides a simple set of equations that depend on measurable parameters. Three-dimensional high-resolution numerical simulations, performed with the Nonhydrostatic Mesoscale (Meso-NH) atmospheric model, were used to generate a set of urban-breeze circulations forced by an idealized urban environment. The pertinent forcing parameters chosen were the size of the city, the height of the thermal inversion topping the mixed turbulent air layer, and the difference (urban – rural) of surface heat flux. Scaling laws are presented that describe the shape of the urban heat island and the horizontal and vertical wind intensity and profiles.
In this study, we investigated the changes in the origin of moisture for the precipitation associated with tropical cyclones (TCs) after extratropical transition (ET) over the North Atlantic Ocean ...basin from 1980 to 2018. We analyzed the 24 hr before and after the occurrence of ET events. By applying a TC‐centric methodology we found that the moisture uptake (MU) occurred predominantly in the south and southwest sectors within ∼2,000 km of TC center before ET and from the southwest and west sectors after ET. In addition, the development of the cold front and the warm conveyor belt after ET induces changes in the moisture transport pattern. Overall, the secondary circulation of TCs favored the moisture flux inward for TCs precipitation, while the large‐scale baroclinic environment controlled the MU after ET.
Plain Language Summary
Tropical cyclones (TCs) are one of the weather systems that often cause fatalities and strong damage to socioeconomic infrastructures in tropical and subtropical latitudes. During the poleward movement, they can undergo an extratropical transition (ET), experiencing notable changes in their structure, such as the replacement of the warm core with a cold core and an increase in the area of the precipitation pattern. In this study, we investigate the changes in the moisture sources' contribution to the precipitation within the TCs' outer radius before and after ET over the North Atlantic Ocean basin. Our results show that the moisture sources were mainly located in the south and southwest sectors within ∼2,000 km of the TC center before ET and in the southwest and west sector after ET. Additionally, the large‐scale baroclinic environment modulated the moisture transport pattern after ET. These findings contribute to improving our knowledge about the changes in a TC during the ET event.
Key Points
The west North Atlantic Ocean was identified as the main moisture source, accounting for ∼44%–69% of total moisture uptake
The moisture was predominately originated from the south and southwest sectors during PRE‐extratropical transition (ET) and from the southwest‐west during POST‐ET
The large‐scale baroclinic environment controlled the moisture transport for tropical cyclones precipitation after ET
The aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of ...the associations found in each pattern.
A cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex.
Seven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI), chronic obstructive pulmonary disease (COPD), rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns). Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors-such as hypertension or dyslipidemia-were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents). Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern.
The present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical patient guidelines to patients with multimorbidity who are taking multiple drugs.
Physical activity (PA) has been shown to improve the general health of patients with chronic diseases and to prevent the onset of such conditions. However, the association between multimorbidity and ...PA has not been investigated in detail, and recent studies of this topic yield dissenting results. The objective of this study was to examine whether PA levels were associated with multimorbidity, self-rated health and functional limitation.
This was a cross-sectional study based on data from the 2009 European Health Interview Survey for Spain. The sample population included 22,190 adults over 15 years of age. The independent variables were multimorbidity (measured as the number of chronic diseases), activity limitations, and self-rated health status. The dependent variable was PA level, measured as a) a continuous variable in metabolic equivalents (METs) and b) a dichotomous variable based on international recommendations (</≥500 MET-minutes per week). The associations between the dependent and independent variables were evaluated across sex and age groups (16-24, 25-44, 45-64, 65-74, >74 years), using multivariate linear and logistic regression models that were adjusted for age, educational level and employment status.
An inverse association was found between PA and multimorbidity among older males and young females between 16-24 years. This negative association was also observed among males aged 25-44 years when analysing PA as a dichotomous variable. Self-rated health status was directly related to the achievement of minimum PA levels among middle-aged and older individuals, but the opposite happened among the youngest group of females. Significant associations between the existence of activity limitations and the performance of lower volumes of PA were consistently observed among subjects over 44 years.
There is an inverse association between multimorbidity and PA in the youngest and oldest age groups. In addition, both low self-rated health status and the presence of functional limitations were related to lower PA in most of the examined population groups. These features should be considered in the design and implementation of community-based approaches to promoting PA, if further corroborated in longitudinal studies.
Iran is a semi-arid to arid country that faces a water shortage crisis. Its weather is also influenced by various air masses and moisture sources. Therefore, applying accurate stable isotope ...techniques to investigate Iran’s precipitation characteristics and developing Iran meteoric water lines (MWLs) as an initial step for future isotope hydrology studies is vitally important. The aim of this study was to determine the MWLs for Iran by considering air masses and dominant moisture sources. The Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model backward analysis was used to determine the trajectories of various air masses in 19 weather stations in Iran and the areas covered by them. δ18O and δ2H contents were obtained for precipitation events from 32 stations in Iran and four in Iraq. Stable isotope samples were gathered from different sources and analyzed in various laboratories across the world. Three MWLs for north of Iran, south Zagros, and west Zagros, were determined based on the locations of dominant air masses and moisture sources. The proposed MWLs were validated by comparison with fresh karstic spring isotope data across Iran. In addition, Iran main moisture sources MWLs were used to determine dominant moisture sources role in karstic springs and surface water resources recharge.
BackgroundChagas disease has spread beyond its original borders on the American continent with migration. It can be transmitted from mother to child, through organ transplantation and transfusion of ...blood and blood products. It is necessary to determine when to screen for this infection.AimOur objective was to evaluate the appropriateness of screening for
infection in Latin American migrants and their descendants.MethodsWe reviewed the literature using rigorous criteria. The quality of evidence was ranked according to the GRADE classification. An evidence to decision framework was adopted to provide information on the most relevant aspects necessary to formulate recommendations.ResultsThe 33 studies evaluated revealed a prevalence of
infection among Latin American migrants in Europe of 6.08% (95% confidence interval (CI): 3.24-9.69; 28 studies). Vertical transmission occurred in three of 100 live births (95% CI: 1-6; 13 studies). The prevalence of cardiovascular disease was 19% (95% CI: 13-27; nine studies), including only 1% severe cardiac events (95% CI: 0-2; 11 studies). The overall quality of evidence was low because of risk of bias in the studies and considerable heterogeneity of the evaluated populations. The recommendations took into account economic studies on the value of screening strategies and studies on acceptability of screening and knowledge of the disease in the affected population.ConclusionsWe identified five situations in which screening for
infection is indicated. We recommend screening persons from endemic areas and children of mothers from these areas.
Understanding the drivers of precipitation and their changes in a non-stationary climate is crucial for effective climate adaptation and water resource management, as it helps us anticipate and ...respond to shifting precipitation patterns and their impacts. Here, analysing simulations from the Coupled Model Intercomparison Project Phase 6 (CMIP6) we show that the conditional probability of extreme daily precipitation given joint extremes of two drivers (precipitable water and vertical velocity) will be stable in a 3 °C warmer future. Consistent with earlier work, we find that the near-global increase in precipitable water (thermodynamic influence) is the baseline for changes in extreme precipitation, which are modulated by changes in vertical velocity (dynamic influence). Thus, in regions where vertical velocity increases, the effect of the two drivers is additive and their changes contribute to an increase in extreme precipitation. The changes of the two drivers are opposite where vertical velocity decreases, resulting in only small increases in extreme precipitation or even a decrease. Furthermore, we reveal that there are moderate changes in the dependence between the drivers, which are larger over the ocean than over landmasses, but they contribute only little to the overall changes in extreme precipitation. We conclude that the use of two very simple drivers that are readily available from climate models can be of great utility for evaluating precipitation extremes in models and understanding their projected changes.
•Changes in precipitable water are the baseline for changes in extreme precipitation.•Changes in extreme precipitation are modulated by changes in vertical velocity.•Changes in driver dependence have minor impact on extreme precipitation changes.
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