Regions Of World Research Articles

Educational boundaries explain strength and variation in global fertility convergence

This paper shows that the level and timing of fertility are converging strongly over different measures of educational attainment using 65 years of data from 146 countries. Global convergence patterns are primarily driven by high-income societies, while sub-Saharan Africa is the world region that is converging most slowly, if not converging at all. Most importantly, levels of education matter heavily for explaining strength and variation in global fertility convergence, with two intersecting educational gradients suggesting: (i) stronger convergence over tertiary education followed, in turn, by secondary and primary; (ii) stronger convergence over education completed relative to education attended. Our findings provide important insights for addressing key challenges in global development and demography, and for informing policymakers as they evaluate the suitability of specific educational policies aimed at further narrowing inequalities between societies—such as supporting higher education as well as the successful completion of targeted educational cycles.

Frequency and clinical characteristics of children and young people with type 2 diabetes at diagnosis from five world regions between 2012 and 2021: data from the SWEET Registry.

The diagnosis of type 2 diabetes is increasing in young people worldwide. This study evaluated the frequency and clinical characteristics of young people presenting with type 2 diabetes from the multinational SWEET e.V Registry 2012-2021, including the first years of the COVID-19 pandemic. This is a longitudinal observational study based on the SWEET Registry, which collects demographic and clinical data on children and adolescents with diabetes from centres worldwide, with the diagnosis and classification of diabetes provided locally by each centre according to International Society for Paediatric and Adolescent Diabetes definitions. By July 2022, the SWEET Registry included 96,931 individuals from 130 centres with a total of 1,154,555 visits. Data were analysed by region: Europe (EU), Australia and New Zealand (AU/NZ), South America (SA), North America (NA) and Asia/Middle East and Africa (AS/AF). Trends in proportions for the two-year periods, calculated as cases with type 2 diabetes diagnoses over all cases with diabetes diagnoses, were estimated using logistic regression models adjusted for age at onset and sex. Overall, there were 2819 of 58,170 new cases (4.8%) with type 2 diabetes: 614 in EU, 293 in AU/NZ, 79 in SA, 1211 in NA and 622 in AS/AF. The proportion of type 2 diabetes increased from 3.2% to 6.0% from 2012/2013 to 2020/2021, a relative rate of increase of 9% per two-year period (95% CI 5.9, 12.3; p<0.001). In the two-year period of the COVID-19 pandemic, type 2 diabetes continued to follow the observed trend, with a proportion of 6.0% in 2020-2021 compared with 5.4% in 2018-2019. High variability in the proportion of type 2 diabetes was observed across regions, with the lowest values observed in EU and the highest in NA. A significant increase in the proportion of type 2 diabetes was observed in EU, AU/NZ and NA. The median HbA1c was not uniform and was highest in AS/AF (85 mmol/mol [9.9%]; IQR 55-111 [7.2-12.3%]) and lowest in EU (63 mmol/mol [7.9%]; IQR 48-99 [6.5-11.2%]), and the difference between EU and NA (median value 73 mmol/mol [8.8%]; IQR 50-105 [6.7-11.8%]) was statistically significant (p=0.047). There was also a difference in BMI SD score by region: the lowest median BMI SD score was 2.2 (IQR 1.4-2.7) in AS/AF and the highest was 3.1 (IQR 2.5-3.6) in AU/NZ. The multinational SWEET data from the years 2012 to 2021 inclusive support recent findings of a worldwide increase in type 2 diabetes in young people, albeit with regional differences. This increase highlights the need for ongoing preventive measures and available advanced treatment modalities worldwide.

Combining the pieces: identifying key determinants of export diversification in Africa amidst model uncertainty

AbstractExport diversification can be a driver of economic growth. Policies to diversify exports attempt to defy an existing comparative advantage in low-value-added goods to promote transformation. Many structural, general policy, and trade-related variables have been identified as important drivers of diversification. This article reviews the literature on the determinants of export diversification and applies Bayesian Model Averaging (BMA) to empirically tackle model uncertainty stemming from many possible determinants. It assesses the relevance and impact of up to 46 drivers of export diversification for up to 47 African countries and 123 trading partners from 1995 to 2018. It finds that African countries’ structural features are especially influential in determining export diversification, a potential explanation for Africa’s more concentrated export baskets compared to other world regions. Furthermore, trade policies, like tariffs and regional integration, are critical in promoting export diversification. These findings underscore the AfCFTA’s potential to foster export diversification across African economies. A diverse set of non-trade-related policy variables also significantly affect export diversification. Factors such as institutions, education, service sector, resource rents, financial development, FDI and exchange rate stability are relevant determinants in different settings. Moreover, the analysis shows that whom you trade with is also important for diversification, and that context-specific differences, such as specific regional integration contexts or type of commodity-dependence, matter. The results suggest that the goals to diversify exports at the extensive margin for structural change and the intensive margin to tackle volatility, seem often not achievable via the same policies.

Carbon omission and financial market sustainability via government effectiveness: a cross-culture comparison of OECD and Asian emerging economies

PurposeFinancial market sustainability is gaining attention as investors and stakeholders become more aware of environmental, social and governance issues, pushing demand for responsible and ethical investment practices. Therefore, this study aims to investigate the impact of carbon (CO2) emissions from three sources, oil, gas and coal, on the stock market sustainability via effective government policies.Design/methodology/approachThe eight countries belong to two different regions of world: Asian economies such as Pakistan, India, Malaysia and China, and OECD economies such as Germany, France, the UK and the USA are selected as a sample of the study. The 22-year data from 2000 to 2022 are collected from the DataStream and the World Bank data portal for the specified countries. The generalized methods of movement (GMM) and wavelet are used as the econometric tool for the analysis.FindingsOur findings show that the CO2 emission from coal and gas significantly negatively impacts stock market sustainability, but CO2 emission from oil positively impacts stock market sustainability. Moreover, all the emerging Asian economies’ CO2 emissions from coal and gas have a much greater significant negative impact on the stock market sustainability than the OECD countries due to the critical situation. However, the government’s effective policies have a positive significant moderating impact between them, reducing the effect of CO2 emission on the stock market.Research limitations/implicationsThis study advocated strong implications for policymakers, governments and investors.Practical implicationsEffective government policies can protect the environment and make business operations suitable, leading to market financial stability. This study advocated strong implications for policymakers, governments and investors.Originality/valueThis study provides fresh evidence of the government’s effective role to control the carbon environment that provide the sustainability to the organizations with respect to OECD and emerging economy.

International survey of bimodal hearing and bilateral cochlear implant service provision for adults

Objectives As cochlear implant (CI) criteria widen, more candidates with usable residual hearing are being considered for a CI. Unlike children, adults mostly receive only one implant. The aim of this survey was to determine bimodal-hearing and bilateral CI service provision for adults around the world. This survey offers the backdrop against which future clinical practice and service delivery can be considered. Methods CI professionals from across the world were invited to participate in an international multicentre survey. The online questionnaire was circulated to CI professionals in 75 countries. There were 64 respondents, representing 25 countries across five world regions. Results In this sample, adult CI users most had unilateral CI (74.5%) and only 25.5% were bilateral CI users. Some 54% of unilateral CI users used a hearing aid (HA) in the non-implanted ear. Funding for a second implant or HA was not well supported for adult unilateral CI users, and there was no clear practice guidance for fitting and maintaining the contralateral HA in most regions. Conclusions CI professionals recognised the value of fitting contralateral HAs at CI services, with audiology departments and private HA dispensers playing an ongoing role in general maintenance and support.

ADAPTATION STRATEGIES TO HUMAN PHYSIOLOGICAL DISCOMFORT AMONG ELDERLY PEOPLE IN KATSINA URBAN, KATSINA STATE, NIGERIA

Information on adaptation strategies to human physiological discomfort is very important for individuals, groups of people, planners, and policymakers in the world's tropical regions where thermal stress poses a significant threat to life, especially among elderly people. Based on this, the aim of the study, therefore, is to assess adaptation strategies to human physiological discomfort among elderly people due to temperature and humidity extremes in residential areas and workplaces during the hot and cold seasons in Katsina. A total of 100 copies of a questionnaire were administered to the elderly people to obtain information on their adaptation strategies. A stratified random sampling method was used to select the respondents in the study area. Descriptive statistics were then used to describe their perception of adaptation strategies to human physiological discomfort. Results obtained revealed that in the hot season, the majority of the respondents at residence areas and working places perceived outdoor and indoor with fans "respectively" as their best-adapting strategies to human physiological discomfort due to temperature and humidity extremes. However, in the cold season, the study revealed that the majority of the respondents in residence areas and workplaces perceived thick dress as their best-adapting strategy for human physiological discomfort due to temperature and humidity extremes. Adapting strategies to human physiological discomfort depends primarily not only on environmental conditions but relaxing in natural environments and using customized clothing materials. People are encouraged to continue planting trees in and around their homes, working workplaces and to adequately prepare to adapt to extreme hot and cold seasons.

The Role of Environment Social and Governance (ESG) Score To Cost of Debt: Evidence From ASEAN Countries*

ABSTRACTEnvironmental social governance (ESG) disclosure has become an increasingly important component in determining a company's financing cost (cost of debt‐CoD). This phenomenon could be attributed to company reputation development and the rise of socially responsible investing. We contribute to the existing literature by investigating further the causality process of ESG scores to the reduction of CoD particularly in nonfinancial companies in one of the most dynamic world regions: Association of Southeast Asian Nations (ASEAN). To meet our research objective; we applied difference‐in‐difference analysis to a dataset of 135 nonfinancial companies (that published ESG score in Bloomberg) from 6 ASEAN countries, using annual frequency data from 2012 to 2021 (1350 observations). We found that ESG does reduce CoD in the range of 21.3% (measured by interest expense) to 27.7% (measured by credit spread). Our finding is quite solid under an array of robustness checks.

Predictors of adolescent well-being around the globe: are students from Confucian East Asia different?

PurposeUsing rich data from nearly 400,000 15-year-olds across 70 middle- and high-income countries and economies participating in PISA 2018, this study investigates (1) global predictors of adolescent subjective well-being (SWB), and (2) differences in adolescent life satisfaction, its predictors and endowments with predictors across world regions and cultures. A particular focus lies on comparing Confucian East Asia (CEA) with other world regions.MethodsData were analyzed using multiple linear regressions and Blinder-Oaxaca decomposition. As measures of adolescent well-being, this study employs life satisfaction, affective well-being, and meaning in life.ResultsGlobally, adolescent well-being outcomes are found to be most strongly linked to gender, personality, relative SES, relationship quality, peer SWB, autonomy and the learning environment, as well as local cultural factors. Estimations by world region reveal several culture-specific explanations for interregional well-being gaps. In particular, notoriously low levels of life satisfaction among students from CEA countries are found to be associated with low self-efficacy, low peer well-being, as well as with high emotional interdependence compared to other world regions. Emotional interdependence is more strongly experienced among CEA adolescents compared to adolescents from any other world region. Moreover, it is found to be more strongly associated with life satisfaction in the CEA region than in any other region. In line with the former, CEA students show stronger links between other relational factors (parents’ emotional support; sense of belonging at school) and life satisfaction compared to most other regions.ImplicationsThis study suggests that among the environmental factors that shape the experience of adolescent lives, relationship and cultural factors play key roles and are closely intertwined. Parents, educators and policymakers around the world should focus on creating a positive school environment that promotes well-being, student self-efficacy, a sense of belonging, and a safe space in which failure is accepted as part of the learning process. This is particularly needed in Confucian East Asian countries.

Sexual harassment among higher education students: a worldwide review

Abstract Introduction Sexual harassment is an uprising problem in higher education systems worldwide with major impacts on students. The aim of this study was to describe and meta-analyze quantitative data on sexual harassment prevalence among higher education students. Methods We searched in seven databases and included studies published in English and French from 2000 until 2023 if they measured sexual harassment prevalence on students attending higher education, and they were quantitative cross-sectional studies. Prevalence estimates disaggregated by gender identity, and world region were meta-analyzed using a random-effects model and reported following PRISMA guidance. Results We identified 53 articles, from 6 different regions of the world, with highly variable sample sizes, ranging from 164 to 779,170. 45% of the samples were from the United States. 32% of studies used convenience or purposive sampling and 39% random sampling. The meta-analyzed prevalence of sexual harassment was globally 36.9% (95% CI [30.6, 43.6], 43.7% for women, 16.8% for men, 33.4% for non-binary. In additional, variations in prevalence were observed across the different world regions. In particular, the Eastern Mediterranean region presented the highest prevalence estimates for sexual harassment among women, reaching 67.5%, while the Americas region presented the highest prevalence estimates for sexual harassment among men, at 18.8%. Discussions Higher education institutions, especially in low- and middle-income countries, should commit to the conduct of surveys to monitor the prevalence of sexual harassment, and policymakers should allocate specific funds and resources to support the implementation of sexual harassment prevention and intervention initiatives in higher education, prioritizing the safety and well-being of students. Key messages • High prevalence of sexual harassment in higher education underscores urgent need for proactive measures to ensure student safety and well-being. • Policymakers should allocate specific funds and resources to support the implementation of SH prevention and intervention initiatives in higher education.

Using marketing strategies to promote maternal health: an international students’ collaboration

Abstract Purpose About 1 in 8 birth parents experience symptoms of perinatal mood and anxiety disorders (PMADs). The purpose of this collaborative project was to create a social media deliverable to lower the risk of postpartum depression in pregnant and postpartum parents in Georgia, USA. Methods Using the SM 10-step model, Master of Public Health Students from Georgia Southern University (GSU), Georgia in collaboration with Creative Business students from Breda University of Applied Science (BUas), the Netherlands, designed an evidence-based SM product. They were mentored by public health and media faculty from both institutions. Roles and responsibilities according to the skill sets were divided, but briefly: students 1) identified a target audience; 2) conducted tertiary data collection; 3) set goals and objectives; 4) developed 4 P’s (product, price, place, and promotion) 5) developed marketing strategies.; 6) and used the strategy to create a specific social media deliverable. Results Utilizing the 10-step model social marketing strategy used state-of-the-art marketing and digital media techniques and evidence-based strategies to create a digital electronic booklet that focused on reducing the stigma associated with help seeking behaviors with the ultimate goal to reduce the incidence and prevalence of PMADs. The digital interactive booklet will be pilot tested in selected OBGYN offices and health departments in Southeast Georgia in July 2024. Conclusions This collaborative project demonstrates effective collaboration between disciplines from different world regions utilizing strengths from both teams: public health and digital media skills to create an SM product that will be utilized to promote social engagement among postpartum parents. Key messages • Students utilized social marketing strategies to create an electronic booklet to address postpartum depression using state-of-the-art digital media techniques and evidence-based strategies. • This collaborative project demonstrates effective collaboration between disciplines from different world regions and utilizes strengths from both teams.

The prevalence, patients characteristics and risk factors of hyper-Lp(a)-emia in the Polish population. The first results from the PMMHRI-Lp(a) Registry

Abstract Background Based on the recent data and existing guidelines Lp(a) is recognized, independent CVD risk factor. However, the knowledge on the prevalence of elevated Lp(a) levels, patients characteristics as well as non-genetic risk factors is scarce from some world regions including from Poland, the largest CEE country. Purpose We aim to present the first results from the Lp(a) registry established in the 2nd largest hospital in Poland - Polish Mother’s Memorial Hospital Research Institute (PMMHRI). Methods The PMMHRI-Lp(a)-Registry was established in 2022. The indications for Lp(a) measurement in the registry are based on the 2021 Polish Lipid Guidelines and new Polish recommendations on the management with elevated Lp(a) (2024). The PMMHRI-Lp(a)-Registry is a part of the being founded Lp(a) National Registry of the Polish Lipid Association. Results Based on the data from 302 consecutive patients (mean age 52.18 years; women 53%) the mean Lp(a) level was 30.3±39.4 mg/dl; it was numerically higher in woman (32.8 mg/dl), but there were no significant sex differences (men: 27.5 mg/dl; p=0.245). There were also no significant differences between those with and without CAD, stroke, HF, cancer, diabetes, kidney disease, and thyroid disease. The significant Lp(a) level difference was observed in those with diagnosed dyslipidemia in comparison to those without (31.9±40.6 vs 17.7±25.8 mg/dl, p=0.044) and in those with the history of myocardial infarction (MI) vs those without (50.1±50.3 vs 28.1±37.5 mg/dl, p=0.004). However, when we divided those with MI on premature vs no premature, no significant difference in Lp(a) level was observed (41,6±41.9 vs 57.6±56.7 mg/dl, p=0.39). Lipid lowering therapy did not significantly affect Lp(a) level, with only significant differences in those treated with ezetimibe (as a part of the combination therapy; 39.5±47.6 vs 27.5±36.3 mg/dl, p=0.027). For selected patients (n=31; 10.3%) with two Lp(a) measurements (mean time distance: 7±5 months) we did not observe any significant visit-to-visit variability (mean difference: 0.81 mg/dl; z=0.256, p=0.262) (Fig. 1). We did not also observe any percentage differences in variables (besides MI history, p=0.017) for different Lp(a) risk groups: 0-30, &amp;gt;30-50, &amp;gt;50-180 and &amp;gt;180 mg/dl. While dividing the population on those with Lp(a) ≤30 mg/dl vs &amp;gt;30 mg/dl, the only differences were seen for dyslipidemia diagnosis (p=0.044) and MI occurrence (6.98 vs 17.24%; p=0.007). Similar pattern was observed while dividing the whole population on those with Lp(a) ≤50 vs &amp;gt;50 mg/dl (Fig. 2). Conclusions These results strongly emphasize that Lp(a) should be measured commonly, as its high level is highly prevalent in patients at the risk both in primary and secondary prevention, what require risk re-stratification and treatment optimization. This is especially important in the regions that characterize of baseline high CVD risk, what refers to most of the CEE countries, including Poland.

Analysis of patterns and trends in competition manipulation in sport global data: 2018–2023

ABSTRACT Competition manipulation in sports has evolved from a localized issue to a global concern. Advances in technology and the growth of sports betting markets have attracted criminal networks that manipulate sporting events for financial gain. The aim of this study was to examine patterns and trends in competition manipulation in sport from a global dataset over a 6-year period. Manipulation of sports competition investigations and sanctions were assessed across world regions and sports. The Macolin Convention typology was also employed to categorize manipulation types and instigators. Results showed an increase in investigations and sanctions year-on-year, with Europe consistently having the highest numbers annually. The majority of investigations and sanctions were consistent across the sports of football, cricket, and tennis, and also an emerging trend in sanctions in esports. Investigation types have mostly been due to direct interference of a sports competition or use of external means. The instigator of manipulation trends shifted from opportunistic types to the exploitation of power or influence. The patterns and trends reported can help inform the work of sport management professionals.

From text to allegory: ideological turns in Shamel Abatha’s translation of Animal Farm in the socio-political context of Egypt’s Pre-Arab Spring

ABSTRACT The influence of ideology on the process of translation has been one of the most controversial debates among scholars and translators who may undergo multiple challenges due to certain ideological demands, whether they be political, cultural or religious. In the Arab world, the socio-political scene has been dominated by ideological shifts since the outbreak of the Arab Spring. These shifts have influenced Arab scholars and translators in many possible ways, one of which is the reproduction of incisive narratives that not only account for the causes and effects of revolutions that swept different regions in the Arab world but also provoke political reform. In this vein, this article investigates Shamel Abatha’s translation of George Orwell’s Animal Farm (1945) to Arabic. It specifically explores Abatha’s political orientations which result in daring textual manipulations of Orwell’s text before the Arab Spring in Egypt in 2011. Following Mona Baker’s narrative theory, the article demonstrates how Abatha’s target text turns into a socio-political national allegory that embodies critical ideological implications. The corpus consists of selected comparisons between Orwell’s Animal Farm and Abatha’s مزرعة الحيوانات [mazraat alḥywānāt] (2009) to show how translation strategies expound the impact of the latter’s political environment on his translation.

Beyond natural language: an ontology-based description of a new Scarabaeus dung beetle from Madagascar (Coleoptera, Scarabaeinae).

The dung beetle genus Scarabaeus (Coleoptera, Scarabaeinae, Scarabaeini), predominantly found in the arid regions of the Old World, includes three endemic species inhabiting the dry ecosystems of western and southern Madagascar. These species are presumed to form a monophyletic clade nested within the African Scarabaeus.Semantic modelling of phenotypes using ontologies represents a transformative approach to species description in biology, making phenotypic data FAIR and computable. The recently developed Phenoscript language enables the creation of semantic, computable species descriptions using a syntax akin to human natural language (NL). However, Phenoscript has not yet been tested as a tool for describing new taxa. In this study, we test the utility of Phenoscript by describing a new species, Scarabaeus (sensu lato) sakalava sp. nov. from Madagascar. The initial description is composed directly in Phenoscript, replacing the traditional natural language format. This Phenoscript description is then translated into a human-readable form using the Phenospy tool for publication purposes. Additionally, the Phenoscript description is converted into an RDF graph, making it understandable by computers using semantic technologies.Scarabaeussakalava sp. nov. is found in western central Madagascar and is closely related to S.viettei (Paulian, 1953) from north-western Madagascar. We provide an updated identification key and distribution map for all Malagasy Scarabaeus and discuss their systematic placement.

Observations indicate regionally misleading wetting and drying trends in CMIP6

We evaluate trends in terrestrial water storage over 1950–2100 in CMIP6 climate models against a new global reanalysis from assimilating GRACE and GRACE-FO satellite observations into a hydrological model. To account for different timescales in our analysis, we select regions in which the influence of interannual variability is relatively small and observed trends are assumed to be representative of the development over longer periods. Our results reveal distinct biases in drying and wetting trends in CMIP6 models for several world regions. Specifically, we see high model consensus for drying in the Amazon, which disagrees with the observed wetting. Other regions show a high consensus of models and observations suggesting qualitatively correctly simulated trends, e.g., for the Mediterranean and parts of Central Africa. A high model agreement might therefore falsely indicate a robust trend in water storage if it is not assessed in light of the observed developments. This underlines the potential use of maintaining an adequate observational capacity of water storage for climate change assessments.

Social inequality and news media repertoires in seven MENA countries

Social inequality shapes peoples’ chances and strategies to keep informed about current affairs. We study citizens’ news media repertoires – individual patterns of combining selected news media – in a world region of extreme social inequality within and between countries: the Middle East and Northern Africa (MENA). We report a secondary analysis of a large-scale survey in seven MENA countries to develop news user typologies. We explore how digital forces shape news media repertoires to determine the influence of social inequality on the population’s information routines regarding current affairs, and investigate the diversity of the inhabitants’ media repertoires.

The impact of social determinants of health on international migrants’ health outcomes: a bibliometric analysis

Purpose The aim of this study is to conduct an in-depth exploration of the research landscape concerning the impact of social determinants of health (SDH) on the health outcomes of international migrants. Design/methodology/approach Leveraging the extensive Scopus database, this study retrieved a total of 2,255 articles spanning the years 1993–2023. The framework for analysis used the SDH categories outlined by the World Health Organization. Findings The research landscape exhibited an apparent increase in the number of publications, but not a net increase in the research productivity. The USA emerged as the leading contributor to research output, with the Journal of Immigrant and Minority Health emerging as the most prolific publication venue, and the University of Toronto ranking as the most prolific institution. The SDH category that received the highest number of publications was the “community and social context”. Migrants from different regions in Asia (East, Central and South Asia) and those from Latin America and the Caribbean region appeared to be the most commonly researched. Highly cited articles predominantly delved into mental health outcomes arising from discrimination and migration policies. Research limitations/implications The findings proffer valuable insights for shaping future research endeavors, accentuating the imperative for diversified studies encompassing underrepresented domains, broader health outcomes and the inclusion of migrant populations from different world regions in investigative pursuits. Originality/value This study delivers a comprehensive analysis of the research landscape, unveiling critical trends in the realm of SDH and migrant health outcomes.

Millets: The Sustainable Super-Food with Anti-aging Properties

Millets, a type of cereal from the Poaceae family, are among the earliest crops still produced today. They are a customary staple meal in the world's arid regions. It is a drought-resistant crop that needs minimal upkeep. This paper examines the possible anti-aging benefits of many millet species, including finger millet, foxtail millet, and pearl millet, as well as their diverse nutritional profiles. Rich in vital minerals like vitamin E, selenium, and amino acids, as well as antioxidants like polyphenols and flavonoids, millets assist tissue repair, improve collagen synthesis, and lessen oxidative stress on the skin. Their low glycemic index also helps to stabilize blood sugar levels, which lowers the risk of age-related illnesses including diabetes and heart disease. Additionally, millets support intestinal health, which is essential for absorbing nutrients and maintaining general vitality. Millets are an environmentally friendly crop that promotes agricultural sustainability because they demand little in the way of resources to grow. By integrating millets into the diet, individuals can benefit from a natural approach to longevity, promoting both personal health and environmental well-being.

Risk of Developing Multimorbidity among Previously Healthy Immigrants and Long-term Ontario Residents

Background Multimorbidity is an important health issue associated with a greater risk of adverse health outcomes, more frequent hospitalizations, greater healthcare needs, and premature death. This study examined patterns of and the risk of developing multimorbidity between immigrants and long-term residents of Ontario. Methods We used a 1:1 matched retrospective observational open cohort design from 1995 to 2016, using routinely collected population-based administrative data at ICES. Multimorbidity was defined as two or more and three or more co-occurring chronic conditions. Chronic disease frequencies of dyads and triads were examined. Stratified multivariate Cox Proportional Hazard models examined the risk of developing multimorbidity and further by world regions of origin for immigrants compared to long-term residents. Results Hypertension and diabetes, in combination with chronic obstructive pulmonary disease, were the leading multimorbidity dyad and triad groups. After controlling for age, sex, and neighborhood income quintiles, immigrants from the Caribbean and South Asia had a greater risk of developing 2+ multimorbidity, compared to long-term residents. Refugees from North Africa and the Middle East (HR = 1.22 [95% CI: 1.03-1.42]) as well as refugees (HR = 1.78 [95% CI: 1.59 – 1.98]) and family immigrants from South Asia (HR: 1.08 [95% CI: 1.02-1.14]), had a higher risk of 3+ multimorbidity compared to long-term residents of Ontario. Conclusion These findings highlight the importance of routine population-based data collection on immigration status and world regions of origin to inform public health research. Investments in preventive health services and management of multimorbidity are needed for specific population groups.

Toward Centrality Evaluation of Yearning Symptoms for Prolonged Grief Disorder: A Cross-Cultural Approach

Background: The new ICD-11 diagnosis of prolonged grief disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions. Methods: Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirmatory factor analyses, followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearning were performed. Results: Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the other Europe-Israel region as well as China, it tended to fall into the middle or lower rankings of symptom centrality. Sensitivity values were consistently high, while specificity values indicated moderate levels. Discussion: In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensitive) symptom for individuals in high-risk states for PGD, although it has only moderate specificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cultural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.