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Introduction: Given worsening youth mental health over the past years, mobile medical units are a potential avenue to increase access to mental healthcare services.Methods: This 1-year retrospective study examined a self-administered psychosocial assessment, and referrals made to mental health services for adolescent patients served by a mobile medical unit. We extracted psychosocial assessment responses, Patient Health Questionnaire (PHQ-9) scores, and mental health referral information for patients seen by the mobile medical unit in 2022 and examined rates and predictors of depression and referral to mental health services.Results: Of the 326 patients who completed the psychosocial assessment, one in five had moderate to severe depression symptoms based on PHQ-9 scores. Factors associated with referral to mental healthcare included female gender identity, LGBTQ+ identity, and several factors from the psychosocial assessment. Additionally, 13.8% wanted a mental health referral, and 16.6% were referred to mental healthcare. Patients who desired to see a mental health provider had higher odds of being referred (p < 0.0001). All patients with moderate to severe depression who were not already connected to mental healthcare and wanted a referral were referred.Conclusion: This study documents the impact of a mobile medical unit programme in identifying adolescent patients with mental health needs and referring them to mental healthcare. [ABSTRACT FROM AUTHOR]

Strongyloides stercoralis is a soil‐transmitted helminth which is distributed predominately throughout tropical and subtropical regions and is considered a neglected tropical disease. Due to low larval output, traditional microscopic methods lack sensitivity, especially in areas of low endemicity. Serological assays present an opportunity to study the epidemiology of S. stercoralis in areas of low endemicity such as Jamaica. The current study evaluated the seroprevalence of S. stercoralis in a selected subpopulation in Jamaica. An analysis was conducted on 311 archived serum samples previously submitted for investigating viral infections during a fever epidemic between 2014 and 2015. Randomly selected, anonymized sera were tested for the presence of S. stercoralis IgG antibodies using the AccuDiag Strongyloides IgG ELISA Kit. Data including age, sex, clinical diagnosis, and the geographic location of sample submission were recorded to delineate trends in demographic variables. The seropositivity rate of S. stercoralis was 15.43%. The rate among females and males was 16.45% and 14.47%, respectively (χ2 = 0.2339, p = 0.629). The highest rate was found in middle adulthood (31–50 years) (26.53%; 13/49). The seroprevalence of S. stercoralis was significantly highest in a rural Regional Health Authority (33.33%; 14/42) and least within an urban Health Authority (9.71%; 17/175). Exposure to S. stercoralis appears to be highest in the rural Regional Health Authorities with an island‐wide exposure rate of 15.43%. The rapid ELISA testing method for the detection of IgG antibodies to S. stercoralis used in this study may be useful as part of a combined approach to elucidate the epidemiology of this soil‐transmitted parasite in Jamaica. [ABSTRACT FROM AUTHOR]

Introduction Methods Consumer and community consultation Results PLAIN LANGUAGE SUMMARY The Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC) is a goal‐setting tool designed to measure therapy outcomes with First Australians. It was originally developed and validated for use with First Australian children as a culturally responsive alternative to traditional western outcome measures. This research explored the applicability, responsiveness and clinical utility of the ATOMIC when used with First Australian adults attending an urban health service.Separate parallel studies investigated responsiveness and clinical utility. The first employed quantitative methods to investigate change over time via pre‐ and post‐intervention data. The second employed a qualitative phenomenological approach to determine the clinical utility of the tool. Semi‐structured interviews and focus groups were used, respectively, to understand the experience of using the ATOMIC from a client and clinician perspective. Client perspectives on the purpose of the tool and its alignment with their views on health care and therapists' perspective on the ease of use and applicability of the tool to the health service setting were explored. These data were analysed using reflexive thematic analysis.The methodological approach followed National Health and Medical Research Council (NHMRC, 2018) guidelines in considering cultural continuity, reciprocity and equity. This project was initiated and guided by Aboriginal and Torres Strait Islander leaders (the advisory group) as a prioritised need for a robust way of reporting outcomes to complement existing statistical and narrative data within a large community‐controlled health service. The advisory group provided high level governance from project conception to conclusion and were involved in yarn‐backs about research findings.Responsiveness: Wilcoxon test showed a statistically significant increase (P = 0.00) in ATOMIC scores pre‐ (mean = 1.8) and post‐ (mean = 8) intervention. Effect size (Cohen d) was deemed significant calculated at 2.1.Clinical utility: Findings included: First Australian clients are adept at self‐managing their conditions; the ATOMIC is a clinically useful outcome measure, which reflects this; ATOMIC is an acceptable tool to First Australian clients and clinicians and supports culturally responsive goal setting and occupational therapy practice.The Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC) was created to measure how well therapy works for First Australian children. This research investigates whether it also works with adult First Australians.Two studies were undertaken: a quantitative study to see whether ATOMIC scores changed before and after therapy and a qualitative study, which asked people what they thought about using the ATOMIC.ATOMIC scores went up after therapy, indicating it is sensitive to change, and both clients and therapists liked using the ATOMIC and found it useful. It matched well with how First Australian adults see health care and helped set goals for therapy.The results of the study show that the ATOMIC is helpful for both clients and therapists in understanding how well therapy works and helps to set goals that make sense culturally. This study looked at one health service in one regional area, so more research is needed to establish whether it works elsewhere. Overall, the results indicate the ATOMIC is a promising step towards better therapy for Indigenous Australians. [ABSTRACT FROM AUTHOR]

Urban sprawl and the shortage of proper sanitary infrastructures significantly jeopardize public health and urban sustainability. The problem is further aggravated as a result of the rapid urbanization and urban sprawl. This study investigated the relationship between urban sprawl and sanitation risk conditions in a rapidly growing city in India. This was accomplished by investigating changes in urban sprawl areas between the periods 2000–2020 using multispectral satellite images and Shanon's entropy model and studying the pattern of spatial variations in basic sanitation services derived from the 100 household‐based surveyed WASH (water availability, sanitation, and hygiene) data collected in 2018 before COVID‐19 from 45 sprawl regions. Spatial statistical techniques, namely, the inverse distance weighted (IDW) interpolation and the multicriteria decision technique, were employed for neighborhood analysis and assessing sanitation risks inside the sprawl region. Results showed that Raipur exhibited urban sprawl and around 93.68% of the sprawl area was classified between high (6.47%)‐ and medium (80.52%)‐risk zones. [ABSTRACT FROM AUTHOR]

Urban development often generates noise and light pollution, reduces green space, produces heat islands, and increases population density that can exacerbate crime, disease transmission, anxiety, and stress. This article argues that individuals and communities have rights to not have their space impinged upon by urban plans, designs, or development. This negative right means governments have ethical obligations to develop infrastructure that mitigates adverse health consequences, preserves natural environments, safeguards ecological well-being, and promotes peace and public health. [ABSTRACT FROM AUTHOR]

Introduction: The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program. Methods: Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse–Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]). Results: Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms. Conclusions: Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services. [ABSTRACT FROM AUTHOR]

Purpose: To describe program characteristics and outcomes of a residential substance use recovery program serving pregnant and parenting women in a rural and urban location. Description: This assessment of administrative records from April 1, 2020 through March 31, 2022, included women in a rural (n = 140) and urban (n = 321) county in Kentucky. Assessment: This retrospective case study used descriptive and non-parametric analyses to assess the population and examine differences between locations, race, and ethnicity for women served. Logistic regression tested predictors of goal achievement by community. Of 461 women served, 65 (14.1%) delivered a baby while in treatment; 62 of which were considered healthy. 13% of the women were Black, 83.1% non-Hispanic (NH) white, and 3.7% were other races/biracial; 1.3% were Hispanic. The mean age was 30.92 years (SD 6.23) and treatment duration was 90.11 days (SD 67.70). Program goals were achieved by 312 (67.7%). There were no differences in rates of goal achievement or treatment duration by race, ethnicity, or age and no difference in the rate of achievement by location in univariate analyses. However, treatment duration was positively associated with program success in both communities. In the urban community, Black women were 8% more likely to successfully complete the program compared to NH white women (OR = 9.77 [95% CI 1.21,79.18; p = 0.033]) after controlling for confounders. Insufficient sample size for non-white women in the rural community prohibited evaluation. Conclusions: Duration of time in the program best predicted successful completion for women in recovery. These findings have policy implications. Significance: Women having difficulties with substance use are typically of childbearing age. Integrated programs are needed to address the multi-factorial needs of these women. Models suggest that optimal care involves services that are co-located or closely aligned. The current evaluation contributes to the literature by examining outcomes for women in recovery. This case study examines client outcomes at a community-based residential treatment program and found evidence that the length of stay was associated with achievement of program goals. Lastly, contrary to previous reports, Black women in an urban community had an 8% greater probability of successful completion compared to white women. [ABSTRACT FROM AUTHOR]

Objective: To determine the influence of arterial hypertension (AHT), sex, and the interaction between both left- and right ventricular (LV, RV) morphology, function, and tissue characteristics. Methods: The Hamburg City Health Study (HCHS) is a population-based, prospective, monocentric study. 1972 individuals without a history of cardiac diseases/ interventions underwent 3 T cardiac MR imaging (CMR). Generalized linear models were conducted, including AHT, sex (and the interaction if significant), age, body mass index, place of birth, diabetes mellitus, smoking, hyperlipoproteinemia, atrial fibrillation, and medication. Results: Of 1972 subjects, 68% suffered from AHT. 42% with AHT and 49% controls were female. Females overall showed a higher ejection fraction (EF) (LV: regression coefficient +2.4% [95% confidence interval: 1.7; 3.1]), lower volumes and LV mass (−19.8% [−21.3; −18.5]), and prolonged native septal T1 (+22.1 ms [18.3; 25.9])/T2 relaxation times (+1.1 ms [0.9; 1.3]) (all p < 0.001) compared to males. Subjects with AHT showed a higher EF (LV: +1.2% [0.3; 2.0], p = 0.009) and LV mass (+6.6% [4.3; 9.0], p < 0.001) than controls. The interaction between sex and AHT influenced mapping. After excluding segments with LGE, males (−0.7 ms [−1.0; −0.3 |) and females with AHT (−1.1 ms [−1.6; −0.6]) showed shorter T2 relaxation times than the sex-respective controls (p < 0.001), but the effect was stronger in females. Conclusion: In the HCHS, female and male subjects with AHT likewise showed a higher EF and LV mass than controls, independent of sex. However, differences in tissue characteristics between subjects with AHT and controls appeared to be sex-specific. Clinical relevance statement: The interaction between sex and cardiac risk factors is an underestimated factor that should be considered when comparing tissue characteristics between hypertensive subjects and controls, and when establishing cut-off values for normal and pathological relaxation times. Key Points: There are sex-dependent differences in arterial hypertension, but it is unclear if cardiac MR parameters are sex-specific. Differences in cardiac MR parameters between hypertensive subjects and healthy controls appeared to be sex-specific for tissue characteristics. Sex needs to be considered when comparing tissue characteristics in patients with arterial hypertension to healthy controls. [ABSTRACT FROM AUTHOR]

Rapid Acceleration of Diagnostics–Underserved Populations (RADx-UP) Kansas worked with 10 Kansas counties from November 2020 through June 2022 to form local health equity action teams (LHEATs), develop COVID-19 testing strategies, foster communication about COVID-19, and share best practices through a learning collaborative. Participating counties documented 693 distinct COVID-19 testing and 178 communication activities. Although the intervention was not associated with changes in the proportion of positive COVID-19 tests, LHEATs in the learning collaborative implemented new testing strategies and responded to emerging COVID-19 challenges. (Am J Public Health. 2024;114(11):1202–1206. https://doi.org/10.2105/AJPH.2024.307771) [ABSTRACT FROM AUTHOR]

This paper studies if information on radiation from uranium and radon is capitalized into housing prices and tests if homeowners sort vertically to avoid increased ground-level radiation. Using detailed measurements on the level of radiation, I estimate housing price elasticities with respect to radiation among both single-family detached homes and apartments in multi-story buildings. The results for the single-family homes show that both uranium in the bedrock and indoor radon levels are negatively correlated with the housing price. While the estimates for the single-family homes might be biased due to omitted geographical variables that are correlated with the level of radiation, the capitalization of radiation among apartments in multi-story buildings can be estimated using only within-building variation in the level of radiation. I use building-fixed effects to test for the existence of a vertical pollution price component to the vertical rent curve. Radon gas is heavier than average indoor air and higher concentrations are mostly found on lower floors in areas with high uranium concentrations in the bedrock. Theory predicts that apartments on higher floors will be priced higher relative to the first floor in more polluted areas. The results show that vertical price difference between the first floor and the fifth floor or above is on average 0.7 percent higher due to the uranium in the bedrock while the price effect for the indoor radon measurements is close to zero. [ABSTRACT FROM AUTHOR]

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Amidst the intersecting crises of the COVID-19 pandemic and ongoing police brutality against Black people, jurisdictions across the United States declared racism to be a public health crisis in the summer of 2020. According to the American Public Health Association (APHA), 233 jurisdictions have published such declarations as of January 2022, with 92% of declarations being made at the city or county level. What does it mean to frame racism as a public health crisis? This paper explores and compares theoretical and practical definitions of disasters and crises from the planning field through a review of the literature. The author concludes that racism can be conceptualized as a slow-onset disaster. With the understanding that racism can be understood as a disaster, the author demonstrates the utility of leveraging a disaster recovery framework to drive a comprehensive response to address racism as a public health crisis. [ABSTRACT FROM AUTHOR]

Urban planning significantly influences the physical and health profile of urban environments. This paper explores the critical nexus between urban planning and public health, emphasizing the urgent need to integrate health considerations into the urban planning curriculum in India. Current urban planning courses often overlook public health aspects, resulting in a disconnect that could hinder the ability of urban environments to meet the health and well-being needs of their populations. Through a comprehensive review and analysis of curriculum data from selected Indian institutions of national importance—including the School of Planning and Architecture, Indian Institute of Technology Kharagpur, and National Institute of Technology, Bhopal—this study identifies significant gaps in the inclusion of health-related content in urban planning education. The analysis reveals a low occurrence of health-related themes within the planning curriculum, with essential topics like public health history, environmental health, and health impact assessments seldom addressed. To bridge these gaps, the paper suggests incorporating mandatory health-focused courses, such as Health Impact Assessments and public health fundamentals, into the curriculum. It also recommends interdisciplinary collaboration with public health professionals to enrich planning education. By restructuring the curriculum to include more comprehensive health-related education, future urban planners can be better equipped to create healthier and more sustainable urban environments, ultimately enhancing public health outcomes in rapidly urbanizing spaces. This research not only sheds light on current educational inadequacies but also proposes actionable steps towards a more holistic integration of health and urban planning disciplines. [ABSTRACT FROM AUTHOR]

Background: Greenspace is an important modifiable environmental factor that is associated with health and well-being. Although previous research has shown that exposure to greenspace is beneficial for cardiovascular diseases, studies have rarely focused on early subclinical health outcomes such as electrocardiogram (ECG) abnormality. Methods: We developed a longitudinal study using data from the China National Stroke Screening Survey (2013–2019). Monthly exposure to greenspace was assessed by the Normalized Difference Vegetation Index (NDVI) values. ECG abnormality was diagnosed by physicians based on the results of the 12-lead electrocardiogram. We used fixed-effects logistic regression with participant-specific intercepts to estimate the association between exposure to greenspace and ECG abnormalities. Results: A total of 132,108 visits from 61,029 participants with ≥ 2 ECG measurements were included. At baseline, the lag-1 month average NDVI value was 0.29 (SD = 0.15). In the fully adjusted model, per 0.1-unit increment in lag-1 month average NDVI value was associated with a 3.0% (95% CI -1.6 ∼ 7.4%) decreased risk of ECG abnormality. In urban areas, the decreased risk associated with per 0.1-unit increment in NDVI was 14.81% (95% CI 9.38 ∼ 19.92%). Conclusion: Our study found that higher exposure to greenspace was associated with a decreased risk of ECG abnormality, especially in urban areas. Our findings suggested that monthly exposure to greenspace might be beneficial to cardiovascular health, and greenspace provision and maintenance could be considered an important public health intervention in urban planning. [ABSTRACT FROM AUTHOR]

Water scarcity is a critical issue affecting numerous regions, including Addis Ababa, Ethiopia. The city's growing population and rising water consumption place significant pressure on its existing water infrastructure. This study evaluates the impact of water loss due to leakages in the distribution system on the demand–supply gap in Addis Ababa, utilizing the WB EasyCalc software for analysis. Data analysis from 2023 indicate that monthly water loss contributes to an additional unmet demand of 5 million cubic meters (MCM), emphasizing the urgent need for effective water loss reduction strategies to enhance supply reliability. Currently, the city achieves only 42% water supply coverage, with an average loss of 300 L per connection per day and approximately 25,000 L lost per kilometer of pipeline daily. Furthermore, non-revenue water (NRW) accounts for 41.8% of total production, with real losses constituting 64%. The Infrastructure Leakage Index (ILI) score of 27 underscores the critical need for targeted leakage management interventions. The significance of this research lies in its quantification of water loss and its direct correlation with unmet demand in Addis Ababa. The findings provide essential insights for policymakers and stakeholders, highlighting the necessity for improved infrastructure management and strategic interventions to bolster water supply reliability. Implementing effective leakage reduction measures could substantially mitigate water scarcity challenges, thereby supporting sustainable urban development and enhancing public health outcomes in a city where access to clean water is vital for economic and social stability. Article Highlights: Addis Ababa's water system suffers from a 41.8% water loss, significantly impacting supply reliability. Physical infrastructure issues like leaks and bursts contribute to 26.3% of the total water losses. Reducing water loss could close the demand–supply gap, ensuring a more sustainable and efficient water supply system. [ABSTRACT FROM AUTHOR]

More than one in ten Americans are food insecure, with significantly higher rates in minority communities. Most of the extensive research on food insecurity focuses on food deserts and the accessibility to well-stocked supermarkets, with much less known about the role of dollar stores in the urban environment. We draw on retail redlining as a conceptual framework because of its utility in describing the interaction of race/ethnicity, poverty, and profit-seeking in the spatial distribution of food outlets in urban areas. Specifically, we examine how race/ethnicity and poverty predict differential access to dollar stores and supermarkets in Chicago. We find that race and ethnicity remain significant predictors of access to retail outlets, even when controlling for a variety of additional factors. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has spread through pre-existing fault lines in societies, deepening structural barriers faced by precarious workers, low-income populations, and racialized communities in lower income sub-city units. Many studies have quantified the magnitude of inequalities in COVID-19 distribution within cities, but few have taken an international comparative approach to draw inferences on the ways urban epidemics are shaped by social determinants of health. Methods: Guided by critical epidemiology, this study quantifies sub-city unit-level COVID-19 inequalities across eight of the largest metropolitan areas of Latin America and Canada. Leveraging new open-data sources, we use concentration indices to quantify income- and vulnerability-related inequalities in incidence, test positivity, and deaths over the first 125 weeks of the pandemic between January 2020 and May 2022. Results: Our findings demonstrate that incidence, deaths, and test positivity are all less concentrated in low-income sub-city units than would be expected, with incidence ranging concentration in lower income neighbourhoods in Toronto (CI = -0.07) to concentration in higher income neighbourhoods in Mexico City (CI = 0.33). Drawing on relevant studies and evaluations of data reliability, we conclude that the best available public surveillance data for the largest cities in Latin America are likely not reliable measures of the true COVID-19 disease burden. We also identify recurring trends in the evolution of inequalities across most cities, concluding that higher income sub-city units were frequent early epicentres of COVID-19 transmission across the Latin America and Canada. Conclusions: Just as critical epidemiology points to individuals biologically embodying the material and social conditions in which we live, it may be just as useful to think of cities reifying their material and social inequities in the form of sub-city unit-level infectious disease inequities. By shifting away from a typical vulnerability-based social determinants of health frame, policymakers could act to redress and reduce externalities stemming from sub-city unit-level income inequality through redistributive and equity-promoting policies to shift the centre of gravity of urban health inequalities before the next infectious disease epidemic occurs. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusion This study was an open‐label single‐arm clinical trial evaluating the fidelity, feasibility, acceptability, and clinical signal of abbreviated mindfulness‐based cognitive therapy (MBCT‐brief) delivered either via telephone (MBCT‐T) or by video conferencing (MBCT‐V) for people with migraine and comorbid depressive symptoms.Migraine is commonly comorbid with elevated depressive symptoms. MBCT reduces depressive symptoms and shows promise to reduce migraine‐related disability. An abbreviated and remotely delivered version of MBCT could increase access to care.People with migraine and elevated depressive symptoms were recruited from a large urban health system. Participants were assigned in blocks of eight to receive an evidence‐based MBCT‐brief treatment, including eight weekly group classes and home practice delivered via telephone (MBCT‐T) or video (MBCT‐V); MBCT‐T was randomly selected for the first block. Sessions were recorded and coded for treatment fidelity. Feasibility was assessed via session attendance (primary), homework completion, recruitment rate, and survey completion rate. Acceptability was assessed via the eight‐item Client Satisfaction Questionnaire (CSQ‐8; primary), the Credibility/Expectancy Questionnaire (CEQ), the System Usability Scale (SUS), and items assessing survey acceptability. Participants completed the Headache Disability Inventory (HDI) and Quick Inventory of Depressive Symptomatology‐Self Report 16‐item (QIDS‐SR16) at baseline, mid‐treatment, and post‐treatment. Feasibility and acceptability rates were compared to a priori benchmarks.Participants (n = 16) were all female with a mean (standard deviation [SD]) age of 45 (13) years, the majority of whom identified as White (13/16, 81%) and non‐Hispanic (14/16, 88%). The intervention met the a priori criteria set for therapist fidelity to treatment protocol (mean [SD] MBCT‐Treatment Acceptability and Competence Scale Adherence score 2.9 [0.2]), feasibility (mean [SD] session attendance was 7.9/8 [0.3]), and acceptability (mean [SD] CSQ‐8 score 28.8 [3.3]) for the entire sample and for each treatment arm. The usability of the remote‐delivery system was high across study participants (mean [SD] SUS score 84.8 [11.0]). Survey procedures were broadly deemed acceptable, with at least 80% participants either endorsing “Agree” or “Strongly Agree” across all items. Using Wilcoxon tests, we observed significant reductions in both the HDI (pre‐treatment median [interquartile range] score 63 [40, 70] vs. post‐treatment 36 [26, 54], p = 0.004) and the QIDS‐SR16 (pre‐treatment median [interquartile range] score 8 [5, 13] vs. post‐treatment 4 [3, 6], p = 0.003).We found that remotely delivered MBCT‐brief for migraine and depressive symptoms was feasible and acceptable to patients in both the telephone and video modalities. Intervention was associated with significant post‐treatment reductions in headache‐related disability and depressive symptomatology, findings that must be interpreted cautiously in the absence of a control group. [ABSTRACT FROM AUTHOR]

This study explores governance strategies and community responses to the COVID-19 pandemic in Bengaluru and Shanghai. It builds on recent evidence showing China centers on territorial institutions to respond to the pandemic, whereas democratic India relies on associational politics, including alliances with different stakeholders. The study argues that increased community involvement in Shanghai arose from the state’s inadequacies during the crisis, while resident welfare associations (RWAs) in Bengaluru primarily served the middle class and had limited impact on vulnerable populations. Using a mixed-methods approach, the study highlights key lessons that contributed to effective responses in both cities, offering policy recommendations for building resilient cities with stronger leadership. Community reactions in India and China surpassed the normal during the pandemic. Despite differences in urban regimes and political systems, Shanghai’s territorial institutions contrasted with Bengaluru’s associational approach; however local governance and community efforts significantly shaped their pandemic outcomes during the health disaster. [ABSTRACT FROM AUTHOR]

Background: Urban neighborhood environments play an important role in facilitating or hindering residents to engage in active mobility and social participation. However, while there is much quantitative research, in-depth knowledge that contextualizes residents' subjective perceptions of barriers and facilitators of active mobility and social participation is still insufficient. Therefore, a qualitative approach was used to collect subjectively perceived barriers and facilitators of active mobility and social participation of residents from different neighborhoods with objectively determined high vs. low walkability. Furthermore, to better understand (non) concordance of objective environmental characterizations and actual levels of behavior, low and high walkability neighborhood-specific barriers, proposed improvements, and particularities that determine (non) engagement in active mobility and social participation were explored. Methods: Three focus groups (N = 6, N = 6, and N = 5) with 17 participants (7 women, 10 men) aged 21–64 (mean age 43.4 ± 14,6 years) were conducted utilizing a pre-structured interview guideline. Participants lived in 11 different neighborhoods with either high or low objectively determined walkability. The focus groups were transcribed verbatim, followed by a thematic analysis of the content with deductive and inductive code categories, utilizing the MAXQDA software. Results: Notable was the consensus of many perceived barriers and facilitators of active mobility and social participation along with their assignability to the same context (points-of-interest, infrastructure; safety, communication, community; topography, physical compositions, weather, aesthetics; personal / individual attitudes, influences, evaluations). Another main finding was that high and low walkability neighborhood-specific particularities were revealed that are in contrast to some objective characterizations of walkability: For example, too high density can inhibit active mobility, and too many options can inhibit social participation. Conclusions: The consensus of many barriers and facilitators of active mobility and social participation suggests that valuable synergies could be created by coordinating interventions aiming to promote both active mobility and social participation in urban neighborhoods. Also, considering subjective perceptions of residents helps to identify neighborhood-specific factors that determine (non) engagement in active mobility and social participation. The findings can help city planners and public health officials improve the promotion of active mobility and social participation in the creation of health-enhancing urban neighborhoods. [ABSTRACT FROM AUTHOR]

There are many pollutants in the air that can be harmful to human health. Their impact varies based on factors such as the kind of pollutant, duration of exposure, and concentration levels. Volatile organic compounds are particularly significant carcinogens among the various pollutants present in the air. Consequently, people who are exposed to these harmful airborne pollutants suffer permanent consequences. This study examines the properties of BTEX compounds—benzene, toluene, ethylbenzene, and xylene—as well as their sources and risk assessments throughout a one-year period from March 21, 2019, to March 20, 2020, in Karaj, Iran's largest industrialized city. First, utilizing a geographical information system that covered the entire city, 17 locations within Karaj were chosen for this purpose. Then, samplings were carried out in the spring, summer, autumn, and winter months with the NIOSH 1501 method. During the research period, 68 samples of BTEX compounds were collected. The adsorption of these contaminants on the activated carbon adsorbents was performed using an environmental sampling pump with a flow rate of 0.2 L/min for 1 h. The samples were subsequently prepared using a carbon disulfide solution and injected into a GC-FID for analysis. In this research, the average annual concentration of BTEX compounds in the air of Karaj city was obtained at 33.01 µg/m3. Autumn and spring had the highest and lowest average concentrations of BTEX compounds, respectively. In addition, sites 5 and 8 had the highest average annual concentrations of these pollutants. The sourcing conducted in this study showed that transportation and fuel consumption, as well as industries, were the primary sources of pollution in the city. In addition, the excess lifetime cancer risk was higher than the guideline value in some sites and lower in others. Furthermore, the Hazard Quotients were lower than 1, but in general, the citizens of Karaj were at serious risk from exposure to this group of pollutants. [ABSTRACT FROM AUTHOR]

This paper uses the China Migrants Dynamic Survey (CMDS) in 2017 to investigate the relationship between inter-city tier migration and health and explores the mechanism and heterogeneity. The results show that migration from low-tier to higher-tier cities positively correlates with health, and the greater the span between the city tiers of inflow and outflow, the better the health. The revenue effect and institutional effect are mediating factors related to upward migration and health, and the mediating role of the institutional effect is more potent than that of the revenue effect. There is intergenerational heterogeneity between the revenue effect and the institutional effect. Among the old generation of migrants, the explanatory power of the institutional effect is stronger than the revenue effect, while the revenue effect and the institutional effect have similar roles among the new generation of migrants. This study suggests that migrating to high-tier cities protects health status through revenue and institutional effects. However, with the intergenerational replacement of migrants, the mediating factors for maintaining good health in high-tier cities that migrants rely on will change. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a leading contributor to global morbidity and mortality rates, particularly in urban areas where lifestyle and socioeconomic factors significantly influence its prevalence. Understanding these factors is crucial for developing effective public health interventions. Methods: This cross-sectional study involved 200 urban adults to assess the prevalence of hypertension and identify its associated risk factors. Participants underwent blood pressure measurement and completed questionnaires on lifestyle behaviors and socioeconomic status. Statistical analysis was conducted to evaluate the relationships between hypertension and various risk factors. Results: The prevalence of hypertension increased with age, with the highest prevalence (25%) observed in individuals over 60 years. Lifestyle factors such as smoking and obesity were significantly associated with hypertension, with odds ratios of 1.7 and 2.2, respectively. High stress was also a notable risk factor, with an odds ratio of 1.9. A strong correlation was found between lower socioeconomic status and higher prevalence of hypertension (odds ratio of 2.3 for lowincome groups). Conclusion: The study highlights the significant impact of age, lifestyle, and socioeconomic status on the prevalence of hypertension among urban adults. These findings suggest that public health strategies focusing on lifestyle modifications and socioeconomic improvements could be effective in managing and preventing hypertension in urban populations. [ABSTRACT FROM AUTHOR]

Background: General practice training in outer metropolitan (OM) areas contributes to patients' access to care. Differences in clinical practice and training in rural versus urban areas have been established, but less is known about OM versus inner metropolitan (IM) differences – whether they offer a trainee learning experience of populations with distinct demographics and healthcare characteristics. This study sought to identify the characteristics and associations of general practice training in New South Wales and Australian Capital Territory OM areas, compared to IM and rural areas. Methods: Cross-sectional analyses of data (2016–2020) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours, were performed. Multinomial logistic regression assessed associations of rural/OM/IM practice location with registrar and practice factors, patient factors, consultation content factors and consultation action factors. Results: Overall, 1308 registrars provided data from 177,026 consultations. For several variables, there was a pattern in the differences of associations across rural/OM/IM areas. Experience of care of older patients and Aboriginal and/or Torres Strait Islander health were more likely in OM than IM areas. Care of patients from non-English speaking background was more likely in OM than in rural areas. Possible markers of healthcare access (specialist referrals, and pathology and imaging requests) were less likely in OM than in both IM and rural areas. Conclusions: OM areas are distinct (and educationally rich) clinical learning environments, with distinct demographic characteristics and seeming healthcare access limitations. This finding has implications for workforce support and health resource allocation. General practice in outer metropolitan regions is unique. In GP registrars' practice in these regions, fewer specialist, pathology and imaging referrals were generated, and care of older patients and Aboriginal and Torres Strait Islander patients was more likely than in inner metropolitan areas. Care of patients from non-English speaking backgrounds was more likely than in rural areas. A gradient (from inner metropolitan to outer metropolitan to rural regions) existed for many characteristics of registrars, practices, patients and clinical care. [ABSTRACT FROM AUTHOR]

This article critically reviews the literature on urban informality, inequity, health, well-being and accountability to identify key conceptual, methodological and empirical gaps in academic and policy discourses. We argue that critical attention to power dynamics is often a key missing element in these discourses and make the case for explicit attention to the operation of power throughout conceptualization, design and conduct of research in this space. We argue that: (a) urban informality reflects the exercise of power to confer and withhold advantage; (b) the dominant biomedical model of health poorly links embodied experiences and structural contexts; (c) existing models of accountability are inadequate in unequal, pluralistic governance and provision environments. We trace four conceptual and empirical directions for transformative approaches to power relations in urban health equity research. [ABSTRACT FROM AUTHOR]

This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. Population data were obtained from Census Bureau and New York City Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45–64 years in the wealthiest quintile). A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower. [ABSTRACT FROM AUTHOR]

Background and Objectives Walking enhances the health, quality of life, and independence of older adults. However, a global decline in urban walking necessitates a re-evaluation of segmented, quantitative approaches to policies and theoretical frameworks in geriatric medicine for promoting walking among older adults. This study conceptualized the perceptions, experiences, and behaviors regarding walking, from a health promotion perspective, among older urban adults. Research Design and Methods Pedestrian-friendly communities were explored for older adults in Seoul, South Korea, using a grounded theory. Thirty-eight older adults actively engaged in walking were recruited between July and December 2020. A qualitative multimethod approach was used, and the collected data were analyzed using open, axial, and selective coding, with axial coding integrating textual and spatiobehavioral information. Results The open-coding process yielded 92 concepts, 47 subcategories, and 19 categories. Using axial and selective coding principles, a conceptual framework was developed to explain how walking shaped the daily lives of older urban adults and provided multidimensional health benefits. Walking perception attributes were characterized by "embodied subjectivity as a healthy older adult," "autonomy of movement," and "walking as a way to enrich or sustain life." Active walking facilitated interactions between older adults and their neighborhood environment within the context of compact and accessible urban living. Discussion and Implications A healthy and age-friendly community encourages interactions between older adults and their neighborhood environment by providing opportunities for daily walking for several purposes, such as providing a sense of autonomy, increasing health-promoting behaviors, and creating a sense of community. [ABSTRACT FROM AUTHOR]

The impacts of climate change have been recognized as a global health emergency. Worsening climate stressors are resulting in injury, illness and death. As this threat to health grows, so does the need to adapt. Climate change adaptation has been noted to reduce the risk of disease transmission, chronic illness exacerbation, physical trauma, and the mental health impacts associated with climate change. Cities across Western Canada have initiated the process of implementing health-focused climate change adaptation; however, progress has been slow, leaving communities vulnerable to health threats. Exploring five case study communities in Western Canada, this research sheds light on factors that enable and constrain progress on health-focused climate change adaptation. Research objectives are addressed through analysis of 16 key actor interviews (with experts in public health, planning, local governance, and other related fields), and a scan of relevant strategic planning documents. Results indicate that political will, expertise, and awareness has resulted in the development of health-focused climate change adaptation policy/ plans. However, implementation of these plans lags in practice. This lag stems from a lack of implementation detail in climate change adaptation plans, limited understanding of the impact of climate change on health, and jurisdictional confusion. Key policy insights: In Western Canadian communities, implementation of health-focused climate change adaptation policy and plans lags in practice. Health-focused strategies within climate change adaptation plans are often vague. Plans must be revised to include implementation and monitoring details, to help facilitate their actualization. The impact of climate change on health is not broadly recognized by community residents. Reframing public understanding of climate change from an environmental issue to a public health issue will translate into increased support for action. Jurisdictional blurriness significantly impedes efforts. Role clarification and improved delineation of responsibilities via enhanced multi-level government coordination will help to resolve action hesitancy at the local level. [ABSTRACT FROM AUTHOR]

Background: Use of immune checkpoint inhibitors is growing, but clinical trial data may not apply to Indigenous patients or patients living in remote areas. Aims: To provide real‐world incidence of immune‐related adverse events (irAE) in the Top End of the Northern Territory and compare incidence between demographic subgroups. Methods: This retrospective, observational, cohort study collected data from electronic records of patients living in the Top End with solid organ cancer treated with immunotherapy between January 2016 and December 2021. The primary outcome was cumulative incidence of any‐grade and severe irAE. Secondary outcomes were overall survival, treatment duration and reason for treatment discontinuation. Results: Two hundred and twenty‐six patients received immunotherapy. Forty‐eight (21%) lived in a remote or very remote area, and 36 (16%) were Indigenous. Cumulative incidence of any‐grade irAE was 54% (122/226 patients); incidence of severe irAE was 26% (59/226 patients). Rates were similar between Indigenous and non‐Indigenous patients of any‐grade (42% vs 56%, P = 0.11) and severe (11% vs 18%, P = 0.29) irAE. However, Indigenous patients had shorter treatment duration, more frequently discontinued treatment due to patient preference and appeared to have shorter median overall survival than non‐Indigenous patients (17.1 vs 30.4 months; hazard ratio (HR) = 1.5, 95% confidence interval (CI) = 0.92–2.66). There was no difference in mortality between remote and urban patients (median overall survival 27.5 vs 30.2 months; HR = 1.1, 95% CI = 0.7–1.7). Conclusions: Rates of irAE in our cohort are comparable to those in the published literature. There was no significant difference in any‐grade or severe irAE incidence observed between Indigenous and non‐Indigenous patients. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the practice of physical activity (PA) among adolescents and its association with characteristics of the urban environment of Brazilian capitals. Study with adolescents from the 26 Brazilian capitals and the Federal District participating in the National School Health Survey, 2015 edition. The association between regular practice of PA (≥300 minutes/week) and the dimensions of urban well-being (urban mobility, urban environmental conditions, urban housing conditions, urban collective services, and urban infrastructure) was examined using multilevel logistic regression. A total of 50,904 adolescents were evaluated, among which 20.7% were active. It was observed in the multiple model that adolescents who live in capitals with better urban environmental conditions, such as the presence of tree coverage, less open sewage, and less accumulated garbage around the houses, are more likely to be active (OR = 1.06; 95% CI:1.01;1.12). Adolescents who live in cities with less urban disorder are more likely to be active. [ABSTRACT FROM AUTHOR]

There are many reservoirs, ponds and Korotoa River in the capital of ancient Pundranagar, Bangladesh, which is an intensive agricultural region. Since different industries are operated for the preparation of different agricultural instruments and agrochemicals are extensively applied to the agricultural soils which mix with the river and pond water and these water bodies may be contaminated with trace elements. In this study, levels of nine trace elements (Cr, As, Cu, Ni, Zn, Cd, Fe, Mn and Pb) and physicochemical properties in surface water from one river and five ponds were measured and compared with water quality guidelines. In addition, health risks, pollution status and possible sources of trace elements were assessed. The mean concentrations of As, Cd, Pb, Cr, Ni, Cu, Fe, Mn and Zn in pond water were 0.059, 0.033, 0.067, 0.136, 0.133, 0.280, 0.733, 0.127 and 0.266 mg/L and river water were 0.055, 0.037, 0.054, 0.104, 0.120, 0.230, 0.702, 0.125 and 0.200 mg/L, respectively. Except Cu and Zn, the mean concentrations of trace elements were above the water quality permissible standards indicating water from these sources is not safe for human use. The WQI values suggested that the water quality is excellent to poor water quality class. Health risk indices indicated that As in water via ingestion exposure pathway may pose both non-carcinogenic and carcinogenic health risks to the residents where the non-carcinogenic risk to the residents is raised from ingestion of As, Cd, Cr and Pb from water. [ABSTRACT FROM AUTHOR]

Objective This study aimed to compare rehospitalization rates, diagnoses, and well-baby nursery (WBN) length of stay (LOS) among rehospitalized infants born during the COVID-19 pandemic to those born prior. Study Design A retrospective comparison of 215 infants rehospitalized from March 1, 2019, to March 1, 2021, was performed in an urban academic center. Rates of readmission were determined for all infants using an unadjusted odds ratio. Among infants rehospitalized at ≤30 and ≤7 days, key cohort characteristics were analyzed using chi-square analysis, Fisher's exact test, independent t -test, and nonparametric testing as applicable. Differences in readmission diagnoses determined by International Classification of Diseases (ICD) code and chart review were evaluated with multivariable logistic regression comparing infants born during the pandemic to the year prior. Results Pandemic infants had a 51% increased odds of rehospitalization ≤7 days of discharge from WBN compared with prepandemic infants (95% confidence interval [CI]: 1.09–2.09). Rehospitalized infants born during the pandemic had shorter WBN LOS; infants rehospitalized ≤30 days had LOS of 54.3 ± 18.6 versus 59.6 ± 16.2 hours (p = 0.02) and infants rehospitalized ≤7 days had LOS of 53.8 ± 17.8 versus 60.8 ±17.0 hours (p = 0.02). The pandemic group of infants had a 3.5 increased odds of being readmitted for hyperbilirubinemia compared with other diagnoses after adjusting for biological sex, ethnicity, percent weight lost at time of discharge, gestational age, and mode of delivery (CI 1.9, 6.4). Conclusion Rehospitalization ≤7 days post-WBN discharge was more common in infants born during the pandemic. Infants rehospitalized during the pandemic were more likely to have shorter WBN LOS and to be rehospitalized for hyperbilirubinemia. Retrospective analyses limit conclusions about causation but suggest that being born during the pandemic increased risk of rehospitalization for hyperbilirubinemia among infants in urban, under resourced setting warranting further investigation. Key Points Newborns rehospitalized during the pandemic had a shorter newborn nursery stay. Newborns in the pandemic had a higher rate of rehospitalization within 7 days of birth compared to year prior. More infants who required readmission during the pandemic were hospitalized for hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Current literature on internal bordering has suggested understanding health care as a key migration control field. This article takes a closer look at the humanitarian medical offices in Frankfurt am Main, Germany, and patients from Romania and Bulgaria in precarious life circumstances. It addresses the strategies identified in the accounts of frontline workers beyond the mere provision of access to free and anonymous medical attention. Based on 16 interviews with medical staff, social workers and administrative officers, two approaches emerged. One clearly strives for the formalisation of the human right to health care in close collaboration with, or by challenging the local bordering actors; the other insists on bypassing any point of contact with them, focusing exclusively on informal and direct solutions. The interviews showcase how the resulting strategies can contribute to internal bordering and debordering on an urban scale, and affect the individuals' trajectories as patients and as migrants. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore the prevalence of depressive disorders in very old adults over time, in rural/urban environments, between men/women, as well as to explore other factors associated with depressive disorders. This study was conducted utilizing the GERDA-database data, which consists of four cohorts of 85, 90 and 95+ year olds living in Northern Sweden. Participants could reside independently or in residential care. Data collections took place between 2000 and 2017. Descriptive data and logistic regression models were utilized to explore data. The prevalence of depressive disorders increased between 2000/02 and 2015/17 in all age groups, with the highest percentages observed in the 95+ age group, reaching 53.6 % in 2015/17. The prevalence varied from 20.3 % in those without dementia to 65.1 % in those with dementia. Sex or living in an urban/rural environment was not associated with an increased risk of depression in the fully adjusted models. Dementia and reduced capacity in activities of daily living were associated with depressive disorders among 85 and 90-year-olds, while living alone was associated with depressive disorders in the 95+ age group. Potentially limited generalizability, as this study took place in northern Sweden. The prevalence of depressive disorders among very old adults increases with age and the prevalence also increases throughout cohorts and time. These alarming rates of depressive disorders among the very old require immediate measures and further investigation. Future studies are needed to explore and monitor trends and to plan and design tailored interventions. • Depressive disorders increased with age among very old people in Northern Sweden. • Depressive disorders increased between all four cohorts from 2000 to 2017. • Depressive disorders are underdiagnosed and only half of them received treatment. • Depressive disorders are associated with dementia disorders and reduced ADL-capacity. [ABSTRACT FROM AUTHOR]

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Nature-based solutions have been promoted as an effective strategy to address climate impacts, including urban temperature reduction. In this paper, we analyze the impacts of the introduction of street trees on temperature (Universal Thermal Climate Index, UTCI) for three different dates, 2000, 2023, and 2050. A 3D model was developed in Rhinoceros software for a part of George Town, on Penang Island. Four different sections of streets were simulated after integration of the model with the Grasshopper plug-in, where a parametric system was built for temperature measurements based on simulations in the Ladybug and Honeybee plug-ins. The tree species used were selected from a pool of tree species commonly planted in urban settings in Malaysia that have low and medium sensitivity to climate impacts. The results show a maximum reduction of 7 °C between 2000 and 2050, achieved on a street with an NW–SE orientation that was planted with three rows of trees. The minimum UTCI reduction achieved was 3 °C, between 2023 and 2050, in a street with NW–SE orientation that was planted with one tree row. The two streets with a SW–NE orientation showed a 5 °C temperature reduction between 2023 and 2050. Both streets have only one row of trees but different species and sizes, with the bigger trees reducing the temperature in a slightly larger area. The results show the importance of introducing and safeguarding street trees to reduce urban temperatures in the country, potentially keeping temperatures below life-threatening levels, thereby safeguarding urban health, while also reducing costs of energy consumption. Solar orientation, the number of tree rows, and their distribution impact the outcomes. The findings provide useful guidance for climate-conscious urban planning practices in Malaysia. [ABSTRACT FROM AUTHOR]

The article presents a study on an intervention to increase code status conversations for emergency department patients aged 75 years and above being admitted to the hospital. Topics discussed include the objectives of the study, details on the study's participants, and the association of a teaching intervention combined with email reminders with increases in documented code status discussions and do-not-attempt-resuscitation code status for the patients.

Background: Patients with type 2 diabetes (T2D) are at an increased risk of genital urinary (GU) infections, with the risk increasing with higher A1Cs. Given the broad adoption of sodium-glucose co-transporter 2 inhibitors (SGLT2is) in patients with T2D, both providers and patients need to be aware of common adverse effects associated with these medications, specifically GU infections. However trials involving SGLT2is looked at patients with an average A1C of less than 9%, and thus, the incidence of GU infections may not truly reflect the general diabetic population. Objective: The purpose of this study is to assess the association between GU infections in patients started on SGLT2is and A1C levels. Methods: A retrospective study was conducted on patients seen in an adult, primary care clinic, at New York City Health and Hospitals, South Brooklyn Health. Men and nonpregnant, nonlactating women >18 years old with a diagnosis of T2D who were initiated on an SGLT2i between January 2018 and January 2023 were included in the analysis. The primary endpoint is to compare the risk of GU infections in patients with T2D who were started on SGLT2is, regardless of dose, with hemoglobin A1C of >9% to those with hemoglobin A1C <9% at baseline. Results: Three hundred and twenty-eight patients were eligible based on specified inclusion and exclusion criteria. Overall, there was a statistically significant difference in the number of GU infections that occurred in patients with a baseline A1C >9% compared with those with an A1C <9% (95% confidence interval [CI] = 1.05-2.88; P = 0.041). Conclusions and Relevance: Type 2 diabetes patients initiated on SGLT2is may experience an increased risk of GU infection, especially in those patients with an A1C of 9% or greater. Further research is necessary to validate and expand upon these findings. [ABSTRACT FROM AUTHOR]

Time-varying characteristics of particulate matter (PM) pollution play a crucial role in shaping atmospheric dynamics, which impact the health and welfare of urban commuters. Previously published studies on the diurnal patterns of PMs are not consistent, especially in the context of field experiments in central China, and most field studies have only focused on particles with a single particle size. This study conducted regional-scale studies across 72 street canyon sets in Wuhan, China, investigated diurnal and seasonal PM concentration variations while also evaluating various PM size and the key driving factors. During summer (July, August, and September), evergreen tree-lined street canyons maintained a stable linear trend for smaller dp particulates (i.e., PM1, PM2.5, and PM4), while deciduous street canyons exhibited a bimodal distribution. In winter (January and February), fine particulates (i.e., PM1 and PM2.5) remained a linear trend in evergreen street canyons, while deciduous street canyons show a slightly wavy fluctuating pattern. Meanwhile, it exhibited quadrimodal-peak and triple-trough patterns in both PM7, PM10, and TSP concentrations. The lowest PM concentrations were observed between 14:00 and 16:00 for all particle sizes, with decreased summer pollution (7.81% lower in PM2.5, 53.47% lower in PM10, and 50.3% lower in TSP) noted in our seasonal analysis. Among the various meteorological factors, relative humidity (RH) was identified as the dominant influencing PM factor in both summer and winter. Results from this study will help us better understand field-based air pollutant dispersion processes within pedestrian spaces while laying the groundwork for future research into street PM experiments. [ABSTRACT FROM AUTHOR]

Urban wildlife faces unique physiological and behavioral challenges compared to conspecifics which live in less altered natural habitats. Animals in urban habitats are also exposed to urban stressors and commonly make use of inappropriate food sources from trash bins and dumpsters, which may affect their heath status. The goals of this study were to evaluate overall health of an urban population of eastern gray squirrels (Sciurus carolinensis) and to assess seasonal changes in several health parameters. Squirrels (N = 45) were trapped in Durham, North Carolina, USA and briefly anesthetized with inhalant anesthetic for physical examination, body mass collection, and venipuncture via the femoral vein. Collected blood was analyzed for several health parameters via hematology and biochemistry analyses including assessment of lipids and kidney and liver values. Physical examinations were clinically unremarkable and similar across seasons. Females had higher cholesterol values and lower creatinine values compared to males. Seasonal differences occurred in few parameters and were detected only between summer and either fall or spring. Potassium and monocytes were higher in summer compared to spring, and creatinine, BUN and monocytes were higher in summer compared to fall. Overall, health parameters of urban eastern gray squirrels fell within published reference ranges for the species. Together, these results suggest that urban squirrels in this study population can maintain good health in an anthropogenic habitat. [ABSTRACT FROM AUTHOR]

Urban lakes serve as vital ecological and recreational anchors within built environments, essential for enhancing urban resilience. Evaluating lake health predominantly focuses on water quality, assessing indicators such as nutrient levels, toxicity, pH balance, and water clarity to monitor changes. This study proposes a comprehensive evaluation framework that systematically describes specific spatiotemporal manifestations and periodic exogenous regulation characteristics across five dimensions: physical structure, water quality, shoreline dynamics, external regulation, and social service. Furthermore, it introduces an urban lake health assessment model based on synergistic development to evaluate the integrated development and interaction between water environments and social services. This model is applied across urban lakes in various developmental stages in China. Key findings include: 1) Urban development often impacts lake health disparately, with varying degrees of synergy observed between water environments and social services across different urban lakes. However, shifts in urban ideologies and improvements in governance, along with protective policies and project implementations, have contributed to improving water quality to some extent. 2) Engineering interventions do not consistently correspond with improvements in water quality, and governance measures sometimes yield mixed outcomes, underscoring the necessity for systematic solutions to lake health. Restoring hydrological processes emerges as crucial for enhancing sustainability. [ABSTRACT FROM AUTHOR]

Due to very high mobility in the environment and penetration ability into living organisms, nanoparticles (NPs) of urban dust pose a potential threat to human health and urban ecosystems. Currently, data on the chemical composition of NPs of urban dust, their fate in the environment, and corresponding risks are rather limited. In the present work, NPs of deposited urban dust have been comprehensively studied for the first time; NPs isolated from 78 samples of dust collected in Moscow, the largest megacity in Europe, being taken as example. The elemental composition, potential sources as well as environmental, ecological, and health risks of NPs of urban dust are assessed. It is found that dust NPs are extremely enriched by Cu, Hg, Zn, Mo, Sb, and Pb, and can serve as their carrier in urban environments. No regularities in the spatial distribution of elements have been found, probably, due to high mobility of dust NPs. High ecological and health risks caused by dust NPs are demonstrated. Source apportionment study has evaluated one natural and two anthropogenic sources of elements in NPs of urban dust; the contribution of natural and anthropogenic sources being comparable. It is also shown that dust NPs may be considered as an important carrier of trace elements in urban aquatic systems. Additionally, the risks associated with NPs and bulk samples of dust have been compared. The observed risks associated with NPs are significantly higher. [ABSTRACT FROM AUTHOR]

Background: Evidence is needed to understand factors that influence child development and caregiving experiences, especially in marginalized contexts, to inform the development and implementation of early childhood development (ECD) interventions. This study explores caregiving practices for young children in an urban informal settlement with Kenyans and embedded refugees, and identifies factors shaping these caregiving experiences, to inform the design and development of potentially appropriate ECD interventions. Methods: A qualitative formative study, which included 14 focus group discussions (n = 125 participants), and 13 key informant interviews was conducted between August and October 2018. Purposive sampling approaches were used to select a diverse range of respondents including caregivers of children below three years of age and stakeholders of Kenyan nationality and refugees. Data were analysed using a thematic approach and the Nurturing Care Framework was used as an interpretative lens. Results: There was a fusion of traditional, religious and modern practices in the care for young children, influenced by the caregivers' culture, and financial disposition. There were mixed views/practices on nutrition for young children. For example, while there was recognition of the value for breastfeeding, working mothers, especially in the informal economy, found it a difficult practice. Stimulation through play was common, especially for older children, but gaps were identified in aspects such as reading, and storytelling in the home environment. Some barriers identified included the limited availability of a caregiver, insecurity, and confined space in the informal settlement, all of which made it difficult for children to engage in play activities. Physical and psychological forms of discipline were commonly mentioned, although few caregivers practiced and recognized the need for using non-violent approaches. Some overarching challenges for caregivers were unemployment or unstable sources of income, and, particularly for refugee caregivers, their legal status. Conclusion: These findings point to the interplay of various factors affecting optimal caregiving for young children in an urban informal settlement with Kenyans and refugees. Integrated ECD interventions are needed for such a mixed population, especially those that strive to anchor along caregivers' social support system, co-designed together with community stakeholders, that ideally focus on parent skills training promoting nurturing care and economic empowerment. [ABSTRACT FROM AUTHOR]

Asthma is one of the most prevalent chronic conditions in the United States and is particularly sensitive to environmental changes in urban areas. While it is known that traffic congestion contributes to increased vehicle emissions and poorer air quality, its direct association with asthma incidence has not been thoroughly explored. This study aimed to address this void by analyzing 148 city-level observations from 2016 to 2020 in Texas, using data from the Texas A&M Transportation Institute and Definitive Healthcare. We investigated the association between traffic congestion, measured by the travel time index, and annual city-level asthma hospital discharges, while adjusting for refinery productivity, minority groups, and education levels through multivariate regression. Our findings revealed a significant positive correlation between the travel time index and asthma visits, indicating that higher traffic congestion is associated with increased hospital visits for asthma. This finding remains consistent across different models, regardless of whether control variables are included. For the control variables, we found that higher refinery productivity was linked to elevated risks of asthma-related hospitalizations, aligning with previous research findings. Although correlations with Black or African American and Hispanic or Latino populations, as well as those with less than a high school education, were not statistically significant, a positive trend was observed. These results emphasize the impact of traffic congestion on asthma prevalence and the necessity for targeted public health interventions and urban planning strategies. [ABSTRACT FROM AUTHOR]

Purpose: This scoping review aims to understand the extent and attributes of literature evaluating differences between rural and urban populations' utilization of health services in upper-middle and high-income countries. Method: The review was conducted in line with established scoping review methodology guidelines. We used the "Participants, Concept and Context" framework to guide the inclusion criteria and determination of the review's scope. Studies published over a 15-year period (2008–2022) were identified using Embase, Medine, PubMed, and Scopus databases. Study attributes, areas of focus and findings were reviewed and extracted. Results: The search identified 179 studies. The number of studies published looking at rural–urban differences in health service utilization has increased over time. The focus of these studies is relatively evenly split between primary and secondary sectors. The majority of studies observed less service utilization by rural populations than urban—especially so in primary-sector services. When higher rural utilization of secondary services was observed this was frequently attributed to poor access to other services that would have had the potential to mitigate the secondary demand. Studies were not commonly grounded in principles of equity or fairness and rarely offered value judgements on observed differences in utilization. There were limited system-level studies – the vast majority being disease- or service-specific analyses. We consider this a notable gap in the literature. Conclusion: This scoping review identifies key parameters of studies on rural–urban variation in health service utilization. The finding that most studies observed rural populations utilized comparatively less services is concerning, in the context of general evidence about high levels of health need in rural communities. Future system-level research considering the combined variations in need and utilization appears a priority. [ABSTRACT FROM AUTHOR]

This study examines psychosocial and environmental factors affecting diabetes management in Morocco, where prevalence increased from 3.3% in 1992 to 7.3% in 2019. A survey of 116 diabetic patients at an urban health centre in Kenitra assessed self-esteem, psychosocial factors, medication adherence, traditional medicine use, and lifestyle habits. The predominantly female sample (72.4%), averaging 50.47 years old, showed high rates of low self-esteem (66.38%), significantly linked to poorer medication adherence (p = 0.007). Elevated stress and anxiety levels also negatively impacted adherence. Traditional medicine use (86%) showed no correlation with adherence. Environmental changes included frequent fast food (27.6%) and sugary drink consumption (41.4%), with low physical activity (19.8%). The study highlights the pivotal role of psychosocial factors, in managing diabetes in Morocco, amidst rapid environmental changes. It stresses the need for a culturally sensitive approach to diabetes care, integrating psychological support, traditional medicine, and addressing challenges from the modern obesogenic environment. [ABSTRACT FROM AUTHOR]

Background: Rapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria. Methods: This community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants' perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment. Results: The prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently. Conclusion: Food insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers. [ABSTRACT FROM AUTHOR]

Physical fitness is considered an important indicator of health in adolescents. Despite the recognized benefits of regular physical activity, recent studies indicate a decline in physical fitness among adolescents, including agility, a key component of fitness often overlooked in research. This study aimed to investigate trends in agility among urban Catalan adolescents over two decades. A total of 1439 students, aged 13–15 years, participated in the 8 × 10 m shuttle run test between 2002 and 2022. The results revealed a significant decline in agility performance across both boys (F(3,839) = 392, p < 0.001, ηp2 = 0.584) and girls (F(3,593) = 414, p < 0.001, ηp2 = 0.677) over time, with notable differences observed between consecutive five-year periods. The findings underscore the urgency of addressing declining physical fitness among adolescents and advocate for enhanced physical education programs and community-based interventions to promote regular physical activity. Recognizing the importance of agility and other aspects of physical fitness in adolescent health, policymakers, educators, and healthcare professionals are urged to collaborate on initiatives to mitigate the risk of future health issues. Further research is recommended to explore the multifaceted influences on adolescent physical fitness and develop targeted interventions to improve overall health outcomes in this population. [ABSTRACT FROM AUTHOR]

Secure and scalable group communication environments are essential for many IoT applications as they are the cornerstone for different IoT devices to work together securely to realize smart applications such as smart cities or smart health. Such applications are often implemented in Wireless Sensor Networks, posing additional challenges. Sensors usually have low capacity and limited network connectivity bandwidth. Over time, a variety of Secure Group Communication (SGC) schemes have emerged, all with their advantages and disadvantages. This variety makes it difficult for users to determine the best protocol for their specific application purpose. When selecting a Secure Group Communication scheme, it is crucial to know the model's performance under varying network conditions. Research focused so far only on performance in terms of server and client runtimes. To the best of our knowledge, we are the first to perform a network-based performance analysis of SGC schemes. Specifically, we analyze the network impact on the two centralized SGC schemes SKDC and LKH and one decentralized/contributory SGC scheme G-DH. To this end, we used the ComBench tool to simulate different network situations and then measured the times required for the following group operations: group creation, adding and removing members. The evaluation of our simulation results indicates that packet loss and delay influence the respective SGC schemes differently and that the execution time of the group operations depends more on the network situations than on the group sizes. [ABSTRACT FROM AUTHOR]