Baseline Survey on Reproductive Health Needs in Preparation of a CBD Program in Lushoto Division,Lushoto District

\ud This community based household study was designed to collect baseline data on reproductive health Lushoto division of Lushoto District, selected as a pilot area for a community Based Distribution program. The study focused on main reproductive health indicators (fertility, fertility regulation, maternal health and on knowledge about sexually transmitted diseases). The study design originates from the MoH-GTZ project on reproductive health in Kenya where rapid assessment tool was adapted according to the needs of the field of reproductive health. 478 randomly selected women in reproductive age (15-49) from 6 villages were interviewed with a questionnaire. The main findings are: In Lushoto division the contraceptive prevalence is 29%. 77% of the study population know at least one modern method of family planning. Regarding provision of services 79% of women preferred women of their or any age 18% did not mind at all who offers the service. 86% of the women could at least name one STDs. Asked what they currently do not prevent themselves or their partner from being at risk for STDs 60% answered “nothing”. The percentage of institutional deliveries (in Health Centre, Dispensary or Hospital) was 22% however 98 % of the women had received antenatal care including tetanus vaccination. The survey revealed that 47% of the women had initiated to live with a male partner before attaining 19 years of age. The final conclusion is that there is a considerable unmet need for family planning services in Lushoto division. Out of those who do not want a pregnancy in the following years only 33% prevent pregnancy 30% with modern methods. \u

Maltrato en el entorno familiar a las personas mayores en las Islas Azores

Objetivos: dimensionar el maltrato a personas mayores vulnerables en el entorno familiar y comunitario de las Islas Azores, identificar factores de riesgo de maltrato y definir el perfil del anciano maltratado. Método: estudio descriptivo de corte transversal. Muestreo aleatorio. Los instrumentos utilizados fueron: historias clínicas de los usuarios, Mini-Examen Cognitivo, test de autonomía para las Actividades Básicas de la Vida Diaria, Test de APGAR Familiar, Índice de Sospecha de Maltrato hacia Personas Mayores y Formulario de Evaluación de Trabajo Social. El análisis estadístico fue descriptivo para las variables cualitativas y cuantitativas y una regresión logística múltiple para identificar los factores asociados al maltrato. Resultados: se identificó sospecha de maltrato en el 24,5% de los ancianos participantes. El maltrato psicológico fue el tipo de maltrato más común y los desencadenantes de ese maltrato fueron principalmente los hijos. Conclusión: se asocia ser mujer y pertenecer a familia disfuncional con mayor probabilidad de padecer maltrato; el alto nivel de la violencia domestica a los ancianos en las Islas Azores sigue la línea que en el resto de Portugal.Objetivos: dimensionar os maus-tratos contra as pessoas idosas vulneráveis no ambiente familiar e comunitário nas Ilhas dos Açores, identificar fatores de risco para maus-tratos e definir o perfil do idoso maltratado. Método: estudo descritivo transversal. Amostragem aleatória. Os instrumentos utilizados foram: prontuários dos usuários, Mini Exame do Estado Mental, teste de autonomia para as Atividades Básicas da Vida Diária, Escala APGAR Familiar, Índice de Suspeição de Abuso no Idoso e Formulário de Avaliação de Trabalho Social. Análise estatística descritiva foi usada para as variáveis qualitativas e quantitativas e regressão logística múltipla foi usada para identificar os fatores associados aos maus-tratos. Resultados: suspeita de maus-tratos foi identificada em 24,5% dos idosos participantes. O abuso psicológico foi o tipo de maus-tratos mais comum e os responsáveis por esses maus-tratos foram principalmente os filhos. Conclusão: ser mulher e pertencer a uma família disfuncional está associado com uma maior probabilidade de sofrer maus-tratos; o alto nível de violência doméstica contra os idosos nas Ilhas dos Açores segue o mesmo padrão do resto de Portugal.Objectives: to dimension abuse against vulnerable adults within the family and community environment in the Azores Islands, identify risk factors for abuse and describe the profile of an abused elder. Method: descriptive cross-sectional study. Random sampling. The instruments used were: clinical histories of the users, Mini-Mental State Examination, Index of Independence in Basic Activities of Daily Living, Family APGAR Scale, Elder Abuse Suspicion Index and Social Work Assessment Form. Descriptive statistical analysis was used for qualitative and quantitative variables and multiple logistic regression was used to identify factors associated with elder mistreatment. Results: abuse suspicion was identified in 24.5% of elderly participants. Psychological abuse was the most common type of abuse and sons were the main abusers. Conclusion: being a woman and belonging to a dysfunctional family is associated with an increased risk of becoming a victim of abuse; the high level of domestic violence against the elderly in the Azores Islands is in line with the rest of Portugal

Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

BACKGROUND: The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. METHODS: A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002) were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. RESULTS: The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. CONCLUSION: Extrapolating the observed cost-savings of$59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to$3.7 million

Lokale Soziale Ökonomie: Lern- und Studienmaterial ; ein Europäisches Curriculum für Praktiker, Unterstützer und Multiplikatoren in Sozialen Unternehmen

Obwohl in einigen europäischen Ländern durchaus eine ganze Reihe von Lehr- und Lernmaterialien für Praktiker und Unterstützer in der Sozialen Ökonomie verfügbar sind, besteht ein wachsender Bedarf an spezialisiertem Lern- und Studienmaterial. Das vorliegende Curriculum zeichnet sich in erster Linie dadurch aus, dass es sich methodisch von traditionellen Formen durch eine explizit partizipative Arbeitsweise unterscheidet und sich inhaltlich vor allem auf jene Aspekte oder Spezifika konzentriert, welche für soziale Unternehmen und die weitere Lokale Soziale Ökonomie typisch sind

The first multi-model ensemble of regional climate simulations at kilometer-scale resolution, part I: Evaluation of precipitation

Here we present the first multi-model ensemble of regional climate simulations at kilometer-scale horizontal grid spacing over a decade long period. A total of 23 simulations run with a horizontal grid spacing of ∼ 3 km, driven by ERA-Interim reanalysis, and performed by 22 European research groups are analysed. Six different regional climate models (RCMs) are represented in the ensemble. The simulations are compared against available high-resolution precipitation observations and coarse resolution (∼ 12 km) RCMs with parameterized convection. The model simulations and observations are compared with respect to mean precipitation, precipitation intensity and frequency, and heavy precipitation on daily and hourly timescales in different seasons. The results show that kilometer-scale models produce a more realistic representation of precipitation than the coarse resolution RCMs. The most significant improvements are found for heavy precipitation and precipitation frequency on both daily and hourly time scales in the summer season. In general, kilometer-scale models tend to produce more intense precipitation and reduced wet-hour frequency compared to coarse resolution models. On average, the multi-model mean shows a reduction of bias from ∼ −40% at 12 km to ∼ −3% at 3 km for heavy hourly precipitation in summer. Furthermore, the uncertainty ranges i.e. the variability between the models for wet hour frequency is reduced by half with the use of kilometer-scale models. Although differences between the model simulations at the kilometer-scale and observations still exist, it is evident that these simulations are superior to the coarse-resolution RCM simulations in the representing precipitation in the present-day climate, and thus offer a promising way forward for investigations of climate and climate change at local to regional scales.Fil: Ban, Nikolina. Universidad de Innsbruck; AustriaFil: Caillaud, Cécile. Université de Toulouse; FranciaFil: Coppola, Erika. The Abdus Salam. International Centre for Theoretical Physics; Italia. The Abdus Salam; ItaliaFil: Pichelli, Emanuela. The Abdus Salam; Italia. The Abdus Salam. International Centre for Theoretical Physics; ItaliaFil: Sobolowski, Stefan. Norwegian Research Centre; NoruegaFil: Adinolfi, Marianna. Fondazione Centro Euro-Mediterraneo sui cambiamenti climatici; ItaliaFil: Ahrens, Bodo. Goethe Universitat Frankfurt; AlemaniaFil: Alias, Antoinette. Université de Toulouse; FranciaFil: Anders, Ivonne. German Climate Computing Center; AlemaniaFil: Bastin, Sophie. Universite Paris-Saclay;Fil: Belušić, Danijel. Swedish Meteorological and Hydrological Institute; SuizaFil: Berthou, Ségolène. Met Office Hadley Centre; Reino UnidoFil: Brisson, Erwan. Université de Toulouse; FranciaFil: Cardoso, Rita M.. Universidade Nova de Lisboa; PortugalFil: Chan, Steven C.. University of Newcastle; Reino UnidoFil: Christensen, Ole Bøssing. Danish Meteorological Institute; DinamarcaFil: Fernández, Jesús. Universidad de Cantabria; EspañaFil: Fita Borrell, Lluís. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones del Mar y la Atmósfera. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmósfera; Argentina. Instituto Franco-Argentino sobre Estudios del Clima y sus Impactos; ArgentinaFil: Frisius, Thomas. Helmholtz Gemeinschaft; AlemaniaFil: Gaparac, Goran. Croatia Control Ltd.; CroaciaFil: Giorgi, Filippo. The Abdus Salam. International Centre for Theoretical Physics; Italia. The Abdus Salam; ItaliaFil: Goergen, Klaus. Centre for High-Performance Scientific Computing in Terrestrial Systems; Alemania. Helmholtz Gemeinschaft. Forschungszentrum Jülich; AlemaniaFil: Haugen, Jan Erik. Norwegian Meteorological Institute; NoruegaFil: Hodnebrog, Øivind. Center for International Climate and Environmental Research-Oslo; NoruegaFil: Kartsios, Stergios. Aristotle University Of Thessaloniki; GreciaFil: Katragkou, Eleni. Aristotle University Of Thessaloniki; GreciaFil: Kendon, Elizabeth J.. Met Office Hadley Centre; Reino UnidoFil: Keuler, Klaus. Brandenburg University of Technology Cottbus-Senftenberg; AlemaniaFil: Lavin Gullon, Alvaro. Universidad de Cantabria; EspañaFil: Lenderink, Geert. Royal Netherlands Meteorological Institute; Países Bajo

Modelling study of soil C, N and pH response to air pollution and climate change using European LTER site observations

Current climate warming is expected to continue in coming decades, whereas high N deposition may stabilize, in contrast to the clear decrease in S deposition. These pressures have distinctive regional patterns and their resulting impact on soil conditions is modified by local site characteristics. We have applied the VSD+ soil dynamic model to study impacts of deposition and climate change on soil properties, using MetHyd and GrowUp as pre-processors to provide input to VSD+. The single-layer soil model VSD+ accounts for processes of organic C and N turnover, as well as charge and mass balances of elements, cation exchange and base cation weathering. We calibrated VSD+ at 26 ecosystem study sites throughout Europe using observed conditions, and simulated key soil properties: soil solution pH (pH), soil base saturation (BS) and soil organic carbon and nitrogen ratio (C:N) under projected deposition of N and S, and climate warming until 2100. The sites are forested, located in the Mediterranean, forested alpine, Atlantic, continental and boreal regions. They represent the long-term ecological research (LTER) Europe network, including sites of the ICP Forests and ICP Integrated Monitoring (IM) programmes under the UNECE Convention on Long-range Transboundary Air Pollution (LRTAP), providing high quality long-term data on ecosystem response. Simulated future soil conditions improved under projected decrease in deposition and current climate conditions: higher pH, BS and C:N at 21, 16 and 12 of the sites, respectively. When climate change was included in the scenario analysis, the variability of the results increased. Climate warming resulted in higher simulated pH in most cases, and higher BS and C:N in roughly half of the cases. Especially the increase in C:N was more marked with climate warming. The study illustrates the value of LTER sites for applying models to predict soil responses to multiple environmental changes

Attribution of the heavy rainfall events leading to severe flooding in Western Europe during July 2021

In July 2021 extreme rainfall across Western Europe caused severe flooding and substantial impacts, including over 200 fatalities and extensive infrastructure damage within Germany and the Benelux countries. After the event, a hydrological assessment and a probabilistic event attribution analysis of rainfall data were initiated and complemented by discussing the vulnerability and exposure context. The global mean surface temperature (GMST) served as a covariate in a generalised extreme value distribution fitted to observational and model data, exploiting the dependence on GMST to estimate how anthropogenic climate change affects the likelihood and severity of extreme events. Rainfall accumulations in Ahr/Erft and the Belgian Meuse catchment vastly exceeded previous observed records. In regions of that limited size the robust estimation of return values and the detection and attribution of rainfall trends are challenging. However, for the larger Western European region it was found that, under current climate conditions, on average one rainfall event of this magnitude can be expected every 400 years at any given location. Consequently, within the entire region, events of similar magnitude are expected to occur more frequently than once in 400 years. Anthropogenic climate change has already increased the intensity of the maximum 1-day rainfall event in the summer season by 3–19 %. The likelihood of such an event to occur today compared to a 1.2 ∘ C cooler climate has increased by a factor of 1.2–9. Models indicate that intensity and frequency of such events will further increase with future global warming. While attribution of small-scale events remains challenging, this study shows that there is a robust increase in the likelihood and severity of rainfall events such as the ones causing extreme impacts in July 2021 when considering a larger region

Attribution of the heavy rainfall events leading to severe flooding in Western Europe during July 2021

In July 2021 extreme rainfall across Western Europe caused severe flooding and substantial impacts, including over 200 fatalities and extensive infrastructure damage within Germany and the Benelux countries. After the event, a hydrological assessment and a probabilistic event attribution analysis of rainfall data were initiated and complemented by discussing the vulnerability and exposure context. The global mean surface temperature (GMST) served as a covariate in a generalised extreme value distribution fitted to observational and model data, exploiting the dependence on GMST to estimate how anthropogenic climate change affects the likelihood and severity of extreme events. Rainfall accumulations in Ahr/Erft and the Belgian Meuse catchment vastly exceeded previous observed records. In regions of that limited size the robust estimation of return values and the detection and attribution of rainfall trends are challenging. However, for the larger Western European region it was found that, under current climate conditions, on average one rainfall event of this magnitude can be expected every 400 years at any given location. Consequently, within the entire region, events of similar magnitude are expected to occur more frequently than once in 400 years. Anthropogenic climate change has already increased the intensity of the maximum 1-day rainfall event in the summer season by 3–19 %. The likelihood of such an event to occur today compared to a 1.2 $$^{\circ }$$C cooler climate has increased by a factor of 1.2–9. Models indicate that intensity and frequency of such events will further increase with future global warming. While attribution of small-scale events remains challenging, this study shows that there is a robust increase in the likelihood and severity of rainfall events such as the ones causing extreme impacts in July 2021 when considering a larger region