BackgroundIncreased urbanization in the developing world parallels a rising burden of chronic diseases. Developing countries account for ∼80% of global cardiovascular (CV) deaths, but contribute a paucity of systematic epidemiological data on CV risk factors.ObjectiveTo estimate the prevalence of CV risk factors in rural and urban cohorts attending general practice clinics in the Africa and Middle East (AfME) region.MethodsIn a cross-sectional epidemiological study, the presence of CV risk factors (hypertension, diabetes mellitus (diabetes), dyslipidemia, obesity, smoking and abdominal obesity) were evaluated in stable adult outpatients attending general practice primary care clinics. A rural population was defined as isolated (>50 km or lack of easy access to commuter transportation) from urban centers.Results4,378 outpatients were systematically recruited from 94 clinics across 14 AfME countries. Mean age was 46±14 years and 52% of outpatients were female. A high prevalence of dyslipidemia (70%) and abdominal obesity (68%) were observed, followed by hypertension (43%) and diabetes (25%). The vast majority of outpatients (92%) had at least one modifiable CV risk factor, many (74%) had more than one, and half (53%) had 3 or more. These findings were observed in both genders and across urban and rural centers. Among outpatients with pre-existing hypertension or dyslipidemia, many were not at their target blood pressure or LDL-cholesterol goals.ConclusionCardiovascular risk factors are highly prevalent among relatively young, stable outpatients attending general practice clinics across AfME. The findings support opportunistic screening for CV risk factors whenever outpatients visit a general practitioner and provide an opportunity for early identification and management of CV risk factors, including lifestyle interventions.

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In order to be able to forecast the weather and estimate future climate changes in the ocean, it is crucial to understand the past and the mechanisms responsible for the ocean variability. This is particularly true in a complex area such as the Mediterranean Sea with diverse dynamics like deep convection and overturning circulation. To this end, effective tools are ocean reanalyses or reconstructions of the past ocean state. Here we present a new physical reanalysis of the Mediterranean Sea at high resolution, developed in the Copernicus Marine Environment Monitoring Service (CMEMS) framework. The hydrodynamic model is based on the Nucleus for European Modelling of the Ocean (NEMO) combined with a variational data assimilation scheme (OceanVar). The model has a horizontal resolution of 1/24° and 141 unevenly distributed vertical z* levels. It provides daily and monthly temperature, salinity, current, sea level and mixed layer depth as well as hourly fields for surface velocities and sea level. ECMWF ERA-5 atmospheric fields force the model and daily boundary conditions in the Atlantic are taken from a global reanalysis. The reanalysis covers the 33 years from 1987 to 2019. Initialized from SeaDataNet climatology in January 1985, it reaches a nominal state after a 2-years spin-up. In-situ data from CTD, ARGO floats and XBT are assimilated into the model in combination with satellite altimetry observations. This reanalysis has been validated and assessed through comparison to in-situ and satellite observations as well as literature climatologies. The results show an overall improvement of the comparison with observations and a better representation of the main dynamics of the region compared to a previous, lower resolution (1/16°), reanalysis. Temperature and salinity RMSD are decreased by respectively 14 and 18%. The salinity biases at depth of the previous version are corrected. Climate signals show continuous increase of the temperature and salinity, confirming estimates from observations and other reanalysis. The new reanalysis will allow the study of physical processes at multi-scales, from the large scale to the transient small mesoscale structures and the selection of climate indicators for the basin.

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Madden-Julian Oscillation (MJO)-like disturbances with features similar to observations, although slightly weaker. Conclusions The Saudi-KAU CGCM ability to simulate the ENSO and the MJO suggests that it is capable of making useful predictions on subseasonal to seasonal timescales.