Green workspace and urban health: exploring the impacts of industrial robotics in pollution emissions and public health.

Introduction: This study addresses a critical gap in understanding how technological advancements, specifically industrial robots, influence urban pollution emissions and public health. The rapid evolution of technology and changing working conditions significantly affect these areas, yet research has not extensively explored this domain. Methods: Utilizing 2018 China Labor-force Dynamic Survey (CLDS) dataset, this study examines the impact of industrial robots on public health. An analytical framework is employed to assess the correlation between the adoption of eco-friendly industrial robots and improvements in worker health, attributed to the reduction of pollution emissions. Results: The findings reveal that the adoption of industrial robots significantly enhance both public physical and mental health. This study also identifies potential demographic heterogeneity in the effects of industrial robots. The benefits are more pronounced among non-insured manual female workers who are older, have lower education levels, and hold rural hukou. These benefits are closely linked to improvements in the quality of the production environment and reductions in pollution emissions at both macro and micro levels. Discussion: The study underscores the significant potential of industrial robots to positively impact urban health, advocating for strategies that promote the development of safer, greener environments.

Trypanosoma spp. infection in urban and wild ecotopes of the caribbean region in Colombia. / Infección por Trypanosoma spp. en murciélagos capturados en ecótopos urbanos y silvestres de la región Caribe en Colombia.

Motivation for the study. The role of bats as hosts of Trypanosoma spp. in the Atlantic department in Colombia, as well as its taxonomic diversity has been poorly studied. Main findings. This is the first report of frequency of infection by Trypanosoma spp. in bats in the Atlántico Department in Colombia. Implications. The great adaptive capacity of bats to different ecological niches and its role as hosts of Trypanosoma spp. for wild and urban ecotopes represents a risk factor in transmission cycles of epidemiological importance. We conducted a study to evaluate the frequency of infection by Trypanosoma spp. in bats captured in wild and urban ecotopes in the Department of Atlántico in the Caribbean region of Colombia from March 2021 to May 2022. Bats were taxonomically identified, and sex, relative age, and reproductive conditions were determined. A blood sample was used for parasitological analysis and DNA extraction to amplify a region of the 18S rRNA. 125 bats were collected, with the most abundant families being Molossidae (62/125; 49.6%) and Phyllostomidae (43/125; 34.4%). Molossus molossus collected in wild habitats showed an infection frequency of 8.1% (5/61) and 4.1% (3/61) through parasitological and molecular analysis, respectively. In comparison, Noctilio albiventris collected in urban habitats showed an infection frequency of 16.6% (2/12) for both analyses. These findings represent the first records of M. molossus harboring trypanosomes for the Department of Atlántico and of N. albiventris harboring trypanosomes in Colombia.

Se evaluó la frecuencia de infección por Trypanosoma spp. en murciélagos capturados en ecótopos silvestres y urbanos del Departamento del Atlántico, en la región Caribe de Colombia, entre marzo de 2021 y mayo de 2022. Se identificaron taxonómicamente los murciélagos y se determinó sexo, edad relativa y condiciones reproductivas. Se utilizó una muestra de sangre para análisis parasitológico y extracción de ADN para la amplificar una región del ARNr 18S. Se capturaron 125 murciélagos, siendo las familias más abundantes Molossidae (62/125; 49,6%) y Phyllostomidae (43/125; 34,4%). Molossus molossus capturado en ecótopos silvestres mostró una frecuencia de infección del 8,1% (5/61) y 4,1% (3/61) mediante análisis parasitológico y molecular, respectivamente. En comparación, Noctilio albiventris capturado en ecótopos urbanos mostró una frecuencia de infección del 16,6% (2/12) para ambos análisis. Estos hallazgos representan los primeros registros de M. molossus albergando Trypanosoma spp. para el Departamento del Atlántico y de N. albiventris albergando Trypanosoma spp. en Colombia. Motivación para realizar el estudio. El rol de los murciélagos como hospederos de Trypanosoma spp. en el Departamento del Atlántico en Colombia, así como su diversidad taxonómica ha sido poco estudiada. Principales hallazgos. Este es el primer reporte de frecuencia de infección por Trypanosoma spp. en murciélagos en el Departamento del Atlántico en Colombia. Implicancias. La gran capacidad de adaptación de los murciélagos a diferentes nichos ecológicos y su rol como hospederos de Trypanosoma spp. en ecótopos silvestres y urbanos representa un factor de riesgo en ciclos de transmisión de importancia epidemiológica.

First report of an acute case of chagas disease in the municipality of Miraflores, Guaviare, Colombia. / Primer caso agudo de enfermedad de Chagas en el municipio de Miraflores, Guaviare, Colombia.

We present a case of acute phase Chagas disease in a 40-year-old male patient from Vereda Buenos Aires, Municipality of Miraflores, Department of Guaviare. The patient attended the emergency department with fever, headache, asthenia, adynamia and dysuria. The blood smear and urinalysis were positive for symptomatic urinary tract infection, but negative for malaria. Five days later the diagnosis of acute phase Chagas disease was confirmed after a positive result for Trypanosoma cruzi. The patient was treated with nifurtimox and benznidazole, his contacts and risk areas were investigated, an active entomological community and institutional search was carried out, as well as in the reservoirs, finally, laboratory surveillance for possible cases of infection in the community was conducted. Five cases with similar symptoms were identified, but parasitological tests were negative. Health education measures were implemented to prevent the spread of the disease.

Se presenta un caso de enfermedad de Chagas en fase aguda en un paciente masculino de 40 años, procedente de la Vereda Buenos Aires, Municipio de Miraflores, Departamento del Guaviare. El paciente acudió a urgencias con fiebre, cefalea, astenia, adinamia y disuria. Se realizó un frotis de sangre y un análisis de orina, con resultados positivos para infección urinaria sintomática, pero negativos para malaria. Cinco días más tarde se confirmó el diagnóstico de enfermedad de Chagas en fase aguda tras recibir un resultado positivo para Trypanosoma cruzi. El paciente recibió tratamiento con nifurtimox y benznidazol, y se llevó a cabo una investigación de contactos y zonas de riesgo, búsqueda activa comunitaria e institucional, entomológica y de reservorios, y una vigilancia de laboratorio para detectar posibles casos de infección en la comunidad. Se identificaron cinco casos con síntomas similares, pero las pruebas parasitológicas fueron negativas. Se aplicaron medidas de educación sanitaria para prevenir la propagación de la enfermedad.

Erectile dysfunction among men with chronic kidney disease undergoing hemodialysis in a Brazilian Amazon urban setting: an epidemiological study.

INTRODUCTION: Erectile dysfunction (ED) is a common sexual problem among men with chronic kidney disease (CKD). The severity of sexual dysfunction tends to worsen with kidney damage. This study aims to evaluate the erectile function and sexual quality of life of adult male CKD patients undergoing hemodialysis (HD) in a hospital located in the Brazilian Amazon. METHODS: A cross-sectional quantitative study was performed within the HD Sector of the Nephrology Unit including men with CKD aged ≥ 18 years, undergoing ≥ 3 weekly HD sessions for ≥ 3 months who had been sexually active for ≥ 6 months. We used the Male Sexual Quotient (MSQ) to measure sexual satisfaction and the International Index of Erectile Function (IIEF5) to establish erectile function. Statistical analysis was performed with SPSS 21.0 using appropriate tests, such as Mann-Whitney and Kruskal-Wallis (P < 0.05). RESULTS: Ninety-eight patients (51.68 ± 15.28 years) were evaluated. They were primarily married/or living with a partner (60.20%), with HD time between 1 to 5 years (55.10%), and an average KTV of 1.17. ED prevalence was 66.30%, and it was associated with a higher age group (p = 0.01), lower family income (p = 0.02), diabetes (p = 0.01), lower mean corpuscular hemoglobin (p = 0.04), higher total calcium (p = 0.04), and lower albumin (p = 0.03). Around 75% classified their sex life as regular to excellent. CONCLUSION: Despite the high ED prevalence, most men with CKD in HD reported experiencing regular to excellent sex life. The study underscores the importance of establishing effective screening and conducting routine evaluations regarding sexual issues in these men.

Comprehensive evaluation of global health cities development levels.

Introduction: How to scientifically assess the health status of cities and effectively assist in formulating policies and planning for health city development remains a profound challenge in building a global "health community." Methods: This study employs the Building Research Establishment's International Healthy Cities Index (BRE HCI), encompassing ten environmental categories and fifty-eight indicators, to guide and support the scientific development of healthy cities. The entropy weight-TOPSIS method and the rank sum ratio (RSR) method were applied to comprehensively rank and categorize the health development levels of fifteen global cities. Furthermore, through cluster analysis, this research identifies universal and unique indicators that influence the development of healthy cities. Results: The results indicate that: (1) Within the scope of 58 evaluation indicators, the precedence in weight allocation is accorded to the kilometres of bicycle paths and lanes per 100,000 population (0.068), succeeded by m2 of public indoor recreation space per capita (0.047), and kilometres of bicycle paths and lanes per 100,000 population (0.042). (2) Among the ten environmental categories, the top three in terms of weight ranking are transport (0.239), leisure and recreation (0.172), and resilience (0.125). Significant disparities exist between different cities and environmental categories, with the issue of uneven health development within cities being particularly prominent. (3) The study categorizes the development levels of healthy cities into three tiers based on composite scores: it classifies Singapore, Shanghai, and Amsterdam at an excellent level; places Dubai and Johannesburg at a comparatively poor level; and situates the remaining ten cities at a moderate level. (4) The analysis identifies 53 international common indicators and 5 characteristic indicators from the 58 indicators based on the significance of the clustering analysis (p < 0.05). Discussion: The study proposes four strategic recommendations based on these findings: establishing a comprehensive policy assurance system, refining urban spatial planning, expanding avenues for multi-party participation, and augmenting distinctive health indicators. These measures aim to narrow the developmental disparities between cities and contribute to healthy global cities' balanced and sustainable growth. However, due to existing limitations in sample selection, research methodology application, and the control of potential confounding variables, further in-depth studies are required in the future.

Reinternaciones psiquiátricas: Determinantes clínicos, sociales ydemográficos en un hospital de la Ciudad de Buenos Aires.

OBJETIVO: Este trabajo busca determinar las variables asociadas a las rehospitalizaciones múltiples en una sala de internación de mujeres, del Hospital de Emergencias Psiquiátricas "Torcuato de Alvear" de la Ciudad de Buenos Aires, Argentina. Método: El presente es un estudio analítico, de tipo transversal, en el que se incluyeron consecutivamente 350 pacientes de entre 18 y 65 años, hospitalizadas desde 2013 hasta diciembre de 2017 en la sala de internación de mujeres de dicho hospital. Al momento del alta se recabaron datos sociodemográficos, clínicos y sobre las condiciones de externación de todas las pacientes. Se definió internaciones múltiples al haber tenido 3 o más internaciones previas al momento de la actual internación. Para variables continuas se realizó test t o el análisis de varianza (ANOVA) en casos de distribución normal, y test de Mann- Whitney y Kruskal-Wallis en casos de distribución asimétrica. Las variables cualitativas se analizaron a través del test de chi-cuadrado con corrección de continuidad. La asociación entre variables se evaluó a través de los coeficientes de correlación de Pearson o Spearman según corresponda. RESULTADOS: Las variables asociadas con reinternaciones múltiples fueron: el diagnóstico de Trastorno Bipolar, encontrarse realizando tratamiento al ingreso, así como la precariedad habitacional, la falta de trabajo y de autonomía económica. Conclusión: Las variables representativas de vulnerabilidad social y económica se asociaron con la utilización de camas de  internación psiquiátrica. Son necesarias políticas públicas que permitan interrumpir la relación entre pobreza y patología mental.

Urban Scaling Functions: Emission, Pollution and Health.

Urban scaling is widely used to characterize the population dependence of city indicators including greenhouse gas emission. Here we analyze the population dependence of CO 2 and PM2.5 emissions and concentrations across all European cities. Our analysis reveals considerable variations in emissions among cities of comparable population size which are not captured by conventional urban scaling. We thus characterize these fluctuations by multi-parameter scaling functions and multifractal spectral analysis. We find that the distribution of emissions and population is multifractal while that of air pollution is not, leading to non-trivial relations between emission and pollution in some large cities. We also analyze the impact of forests in curbing emission and the impact of air pollution on health. Our work provides a detailed picture of the fluctuations in the scaling of urban metabolism in Europe and suggests a general strategy that goes beyond conventional urban scaling laws.

Healthy city evaluation based on factor analysis-Taking cities in the Guangxi Zhuang Autonomous Region as an example.

As urbanization speeds up, the concept of healthy cities is receiving more focus. This article compares Chongzuo and Nanning in Guangxi with Beijing to assess the development gaps in cities in Guangxi. An indicator system for healthy cities was designed from six dimensions-healthy economy, healthy population, healthy healthcare, healthy environment, healthy facilities, and healthy transportation-and 26 secondary indicators, which were selected from 2005 to 2022, and an improved factor analysis was used to synthesize a healthy city index (HCI). The number of factors was determined by combining characteristic roots and the variance contribution rate, and the HCI was weighted using the entropy-weighted Topsis method. A comprehensive evaluation of the urban health status of these cities was conducted. The results showed that extracting six common factors had the greatest effect, with a cumulative variance contribution rate of 93.83%. Chongzuo city scored higher in the field of healthcare. The healthy environment score of Nanning was relatively high, which may be related to continuous increases in green measures. In terms of the healthy economy dimension, Beijing was far ahead. However, in recent years, the healthy economy level in Chongzuo has increased, and the GDP growth rate has ranked among the highest in Guangxi. In addition, the growth rate of healthy facilities in Nanning was relatively fast and has been greater than that in Chongzuo in recent years, which indicates that the Nanning Municipal Government believes urban construction and municipal supporting facilities are highly important. In terms of healthy transportation, Chongzuo and Nanning scored higher than Beijing. This may be because the transportation in these two cities is convenient and the traffic density is more balanced than that in Beijing, thereby reducing traffic congestion. Chongzuo had the highest score for a healthy population, and a steadily growing population provides the city with stable human resources, which helps promote urban economic and social development. Finally, relevant policy recommendations were put forwards to enhance the health level of the cities.

Heat exposure impacts on urban health: A meta-analysis.

The escalating health risks posed by warm weather in urban areas have become a pressing global public health issue. This study undertakes a meta-analysis to evaluate the impact of warm weather on health in urban settings. We comprehensively searched PubMed, Embase, Scopus, and Web of Science for literature published before September 6, 2023, evaluating evidence quality using the Navigation Guide Criteria. We included original studies utilizing high temperatures or heatwaves as exposure metrics and employing observational designs. A meta-analysis was carried out to assess the relative risk (RR) of the association between high temperatures (or heatwaves) and disease outcomes. Out of 12,893 studies identified, 188 met the inclusion criteria for meta-analysis. Results demonstrate a statistically significant association between a 1 °C temperature increase and a 2.1 % elevation in disease-related mortality (RR 1.021 [95 % CI 1.018-1.023]), alongside a 1.1 % increase in morbidity (RR 1.011 [95 % CI 1.007-1.016]). Heatwaves also showed associations with increased total mortality (RR 1.224 [95 % CI 1.186-1.264]) and morbidity (RR 1.038 [95 % CI 1.010-1.066]). Subgroup analyses for diseases, sex, age, climatic zones, countries, and time periods consistently indicated heightened disease-related mortality and morbidity linked to high temperatures. Notably, China's urban population faced an elevated mortality risk (RR 1.027 [95 % CI 1.018-1.036]) compared to other countries (RR 1.021 [95 % CI 1.019-1.024]). Mortality associated with high temperatures after 2007 (RR 1.022 [95 % CI 1.015-1.029]) was higher than before 2007 (RR 1.017 [95 % CI 1.013-1.021]), reflecting increased health risks as the global warming accelerates. Our findings underscore the positive association between rising temperatures and/or heatwaves and adverse health outcomes in urban populations. The widespread exposure to high temperatures amplifies health risks across various diseases, demographics, climates, and countries, with potential exacerbation under ongoing global warming. Further research is imperative to delineate factors influencing altered heat exposure impacts.

From COVID-19 to a "new normal": could we support a "healthy renaissance" for our cities?

BACKGROUND: At the beginning of 2020, worldwide public debate focused on the fight against the climate crisis. Many challenges are ahead of us, from health emergencies, with the pandemics underway, to the exhaustion of natural resources, to major climate change. DISCUSSION: Many cities face health threats related to urban and land use planning, while infectious diseases thrive in overcrowded cities: living in unhealthy environments killed 12,6 million people in 2012 and air pollution killed 7 million people in 2016. Urbanization is one of the major global trends of the 21st century and has a significant impact on health. Over 55% of the world's population lives in urban areas, a percentage that is expected to increase to 68% by 2050. CONCLUSIONS: Developing new and more sustainable ways of living, moving, utilizing resources, and accessing services including healthcare and education, is crucial to preserve our future and the future of the next generations.

Exploring the nexus of urban form, transport, environment and health in large-scale urban studies: A state-of-the-art scoping review.

BACKGROUND: As the world becomes increasingly urbanised, there is recognition that public and planetary health relies upon a ubiquitous transition to sustainable cities. Disentanglement of the complex pathways of urban design, environmental exposures, and health, and the magnitude of these associations, remains a challenge. A state-of-the-art account of large-scale urban health studies is required to shape future research priorities and equity- and evidence-informed policies. OBJECTIVES: The purpose of this review was to synthesise evidence from large-scale urban studies focused on the interaction between urban form, transport, environmental exposures, and health. This review sought to determine common methodologies applied, limitations, and future opportunities for improved research practice. METHODS: Based on a literature search, 2958 articles were reviewed that covered three themes of: urban form; urban environmental health; and urban indicators. Studies were prioritised for inclusion that analysed at least 90 cities to ensure broad geographic representation and generalisability. Of the initially identified studies, following expert consultation and exclusion criteria, 66 were included. RESULTS: The complexity of the urban ecosystem on health was evidenced from the context dependent effects of urban form variables on environmental exposures and health. Compact city designs were generally advantageous for reducing harmful environmental exposure and promoting health, with some exceptions. Methodological heterogeneity was indicative of key urban research challenges; notable limitations included exposure and health data at varied spatial scales and resolutions, limited availability of local-level sociodemographic data, and the lack of consensus on robust methodologies that encompass best research practice. CONCLUSION: Future urban environmental health research for evidence-informed urban planning and policies requires a multi-faceted approach. Advances in geospatial and AI-driven techniques and urban indicators offer promising developments; however, there remains a wider call for increased data availability at local-levels, transparent and robust methodologies of large-scale urban studies, and greater exploration of urban health vulnerabilities and inequities.

The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities.

AIMS: To assess the association between sociodemographic and clinical factors with body mass index (BMI) in a population at risk of type 2 diabetes (T2D) in Bogotá and Barranquilla, Colombia. METHODS: This cross-sectional study used data from the PREDICOL Study. Participants with a FINDRISC ≥ 12 who underwent an Oral Glucose Tolerance Test (OGTT) were included in the study (n=1166). The final analytical sample size was 1101 participants. Those with missing data were excluded from the analysis (n=65). The main outcome was body mass index (BMI), which was categorized as normal, overweight, and obese. We utilized unadjusted and adjusted ordinal logistic regression analysis to calculate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: The prevalence of overweight and obesity was 41 % (n=449) and 47 % (n=517), respectively. Participants with a 2-hour glucose ≥139 mg/dl had 1.71 times higher odds of being overweight or obese (regarding normal weight) than participants with normal 2-hour glucose values. In addition, being a woman, waist circumference altered, and blood pressure >120/80 mmHg were statistically significantly associated with a higher BMI. CONCLUSION: Strategies to control glycemia, blood pressure, and central adiposity are needed in people at risk of T2D. Future studies should be considered with a territorial and gender focus, considering behavioral, and sociocultural patterns.

Sociodemographic and reproductive risk factors associated with metabolic syndrome in a population of Brazilian women from the city of Ribeirão Preto: a cross-sectional study.

Objective: To identify sociodemographic and reproductive risk factors associated with MetS in women in their fourth decade of life. Methods: Cohort study conducted on women born from June 1978 to May 1979 in Ribeirão Preto, Brazil. Sociodemographic, clinical, and obstetric data were collected by interview and clinical evaluation. Univariable and multivariable binomial logistic regression models were constructed to identify the risk factors of metabolic syndrome and the adjusted relative risk (RR) was calculated. Results: The cohort included 916 women, and 286 (31.2%) of them have metabolic syndrome. MetS was associated with lack of paid work (RR 1.49; 95% CI 1.14-1.95), marital status of without a partner (RR 1.33; 95% CI 1.03-1.72), low educational level (less than 8 years of schooling [RR 1.72; 95% CI 1.23-2.41], 8 to 12 years of schooling [RR 1.37; 95% CI 1.06-1.76], when compared with more than 12 years of schooling), and teenage pregnancy (RR 2.00; 95% CI 1.45-2.77). There was no association between MetS, and the other covariates studied. Conclusion: Metabolic syndrome in a population of women in the fourth decade of life was associated with lack of employment, lack of a partner, low educational level, and teenage pregnancy.

Perinatal mortality in the municipality of Panchimalco, San Salvador: a case series. / Mortalidad perinatal en el municipio de Panchimalco, San Salvador: una serie de casos.

Perinatal mortality is an indicator that reflects the impact of maternal and infant care in a country. This study presents nine cases of perinatal mortality that occurred in the municipality of Panchimalco, El Salvador. The information was obtained from audit reports. The mothers of the deceased infants were aged between 17 and 43 years, did not use contraceptive methods, had incomplete prenatal controls and averaged a gestational age of 31 weeks. Three deliveries were attended in the community. Most perinatal deaths occurred before delivery due to unknown causes, and live births were preterm. We identified factors such as deficits in comprehensive care for women. Further studies are needed to determine the main factors influencing perinatal deaths in El Salvador. Motivation for the study. It is necessary to understand the maternal and infant characteristics of perinatal deaths. Additionally, it is required to generate evidence that contributes to a better understanding of these events. Main findings. Nine cases of perinatal deaths with maternal-fetal risk characteristics were identified. Most deaths occurred before delivery, with prematurity predominating in the neonates. Implications. Understanding the maternal and infant characteristics of perinatal deaths is essential for developing preventive strategies aimed at reducing risk factors related to perinatal mortality.

La mortalidad perinatal es un indicador que refleja el impacto de la atención materno-infantil de un país. Este estudio presenta nueve casos de la mortalidad perinatal ocurridos en el municipio de Panchimalco, El Salvador. La información se obtuvo de los informes de auditorías. Las madres de los fallecidos tenían edades entre 17 a 43 años, sin uso de anticonceptivos, con controles prenatales incompletos y un promedio de edad gestacional de 31 semanas, tres partos fueron atendidos en la comunidad. La mayoría de muertes perinatales ocurrieron antes del parto de causa desconocida y los nacidos vivos fueron prematuros. Se identificaron factores como el déficit en la atención integral a la mujer. Se requiere de nuevos estudios para determinar los principales factores que influyen en las muertes perinatales en El Salvador. Motivación para realizar el estudio. Es necesario conocer las características maternas e infantiles de las muertes perinatales. Además, es fundamental generar evidencia que contribuya a una mejor comprensión de estos eventos. Principales hallazgos. Se identificaron nueve casos de muertes perinatales y con características materno-fetales de riesgo. La mayoría de las muertes ocurrieron antes del parto y predominó la prematurez en los neonatos. Implicancias. El comprender las características materno-infantiles de las muertes perinatales, es esencial para desarrollar estrategias preventivas orientadas a disminuir los factores de riesgo relacionados con la mortalidad perinatal.

Advancing Health Equity through 15-min Cities and Chrono-urbanism.

Implementing the 15-min city and chrono-urbanism aims to improve sustainability and quality of life by ensuring residents' proximity to essential services. The 15-min city model is gaining global traction, with localized adaptations to suit communities' needs. Beyond environmental motivations, 15-min cities can benefit public health through enhanced walkability, social cohesion, and universal accessibility. However, research examining the intersection of health and equity among chrono-urbanism and the 15-min city remains limited. This study aims to develop a framework to integrate health and equity into chrono-urbanism and 15-min city plans. We describe the potential benefits and risks of the 15-min approach for urban planning, daily behaviors, and health outcomes. Potential benefits of 15-min cities for health equity include proximity to destinations, increased physical activity, strengthened social capital, reduced emissions, and traffic calming. Risks that must be mitigated include gentrification, variable proximity definitions, infrastructure upgrades, and inadequate cultural sensitivity. Recommendations to integrate 15-min cities into planning activities include conducting comprehensive baseline assessments, aligning goals with sustainability, economic development, flexible zoning, inclusive public spaces, and diverse community engagement tactics. We recommend interventions targeting marginalized communities and developing standardized measurement tools for comparison, monitoring, and evaluation. A nuanced, equitable approach to implementing 15-min cities can help urban plans support health equity across diverse populations.

Effectiveness of hierarchical medical system and economic growth: based on China's urban vs. rural health perspectives.

Background: The hierarchical medical system is an important measure to promote equitable healthcare and sustain economic development. As the population's consumption level rises, the demand for healthcare services also increases. Based on urban and rural perspectives in China, this study aims to investigate the effectiveness of the hierarchical medical system and its relationship with economic development in China. Materials and methods: The study analyses panel data collected from Chinese government authorities, covering the period from 2009 to 2022. According to China's regional development policy, China is divided into the following regions: Eastern, Middle, Western, and Northeastern. Urban and rural component factors were downscaled using principal component analysis (PCA). The factor score formula combined with Urban-rural disparity rate (ΔD) were utilized to construct models for evaluating the effectiveness of the hierarchical medical system from an urban-rural perspective. A Vector Autoregression model is then constructed to analyze the dynamic relationship between the effects of the hierarchical medical system and economic growth, and to predict potential future changes. Results: Three principal factors were extracted. The contributions of the three principal factors were 38.132, 27.662, and 23.028%. In 2021, the hierarchical medical systems worked well in Henan (F = 47245.887), Shandong (F = 45999.640), and Guangdong (F = 42856.163). The Northeast (ΔDmax = 18.77%) and Eastern region (ΔDmax = 26.04%) had smaller disparities than the Middle (ΔDmax = 49.25%) and Western region (ΔDmax = 56.70%). Vector autoregression model reveals a long-term cointegration relationship between economic development and the healthcare burden for both urban and rural residents (ßurban = 3.09, ßrural = 3.66), as well as the number of individuals receiving health education (ß = -0.3492). Both the Granger causality test and impulse response analysis validate the existence of a substantial time lag between the impact of the hierarchical medical system and economic growth. Conclusion: Residents in urban areas are more affected by economic factors, while those in rural areas are more influenced by time considerations. The urban rural disparity in the hierarchical medical system is associated with the level of economic development of the region. When formulating policies for economically relevant hierarchical medical systems, it is important to consider the impact of longer lags.

Policy impact pathways of climate-related urban health vulnerability - A retrospective analysis.

Climate change-related health risks are likely to become more prevalent in cities. Cities are also key actors in adaptation to these risks. Adaptation can take place through intentional measures to reduce vulnerability or exposure and unintentionally through other urban policy processes and outcomes. However, complex and dynamic relations between urban policy impacts and vulnerability development are an understudied phenomena. This limits the understanding of how urban climate-related health risks emerge and evolve. We examine urban policy pathways that influence vulnerability to climate-related health impacts with a most similar - most different case study. With a qualitative retrospective analysis of four urban areas in Finland we unveil the mechanism of how urban policy affects urban environment over time and how these impacts and changes shape vulnerability. Contrasting the most different cases, we show that urban policy impacts set differing preconditions to adaptation between local districts. We conclude by suggesting that to adapt to future challenges in cities with respect to social and ecological justice, it is necessary to mainstream adaptation into urban policies with continuous cross-sector and multi-level dialogue about the development of vulnerability.

Impact of Smokeless Tobacco on Cardiovascular Disease Risk in a Nigerian Metropolitan City.

The use of smokeless tobacco products (STP) as a substitute for tobacco smoking is driving increasing consumption of these products especially in developing countries. The study sought to make comparison of cardiovascular risk profile between chronic STP users and suitably matched tobacco-naïve controls. This is a preliminary report from the cross sectional part of a two-arm prospective study of Smokeless Tobacco Products Composition and Exposure Outcome in Enugu metropolis, Nigeria. Consecutively recruited current Smokeless tobacco users, who had no history of cigarette smoking, aged 18 years and above, residing in selected communities in Enugu metropolis, Nigeria were recruited for the study from October 2022 to July 2023. Age and sex matched non-tobacco users from same localities as the study subjects served as controls. Written informed consent to participate in the study was obtained from all study participants. All participants were screened by the investigators, using the study case report forms, to obtain data on medical history, demographic, clinical, laboratory, and electrocardiographic evaluation. Data from 54 STP-users and 54 non-STP-users (mean age 56.58 ± 8.15 years) were analyzed. Anthropometric parameters were similar in both groups. Smokeless tobacco users had higher erect and supine blood pressure indices as well as greater postural drop in systolic blood pressure. The occurrence of diabetes mellitus (20.37% versus 5.56%) and hypertension (25.93%; 11.11%) was significantly higher in the STP-users than in the non-user population, (p = 0.02192 and 0.04751 respectively). Electrocardiographic evaluation showed significantly increased QTc and dispersions of P-wave, QRS and QT intervals as well as reduced PR interval in STP users. Electrocardiographic abnormalities observed in STP users include left ventricular hypertrophy, left atrial enlargement, ST-segment elevation, short PR interval and long QTc. Use of smokeless tobacco products is associated with increased risk burden of diabetes mellitus and hypertensive heart disease. Electrocardiographic findings linked to STP-use in this study are features consistent with arrhythmia, ventricular repolarization abnormality, myocardial hypertrophy and ischaemia, suggesting that smokeless tobacco products are not safe substitutes for tobacco smoking.

Imagining and implementing healthy city interventions: Combined results from parallel concept mapping exercises in Montreal with community members and stakeholders.

OBJECTIVE: Built environment interventions provide structural solutions to complex urban challenges. Though community voices are part of municipal decision-making, planners and public health professionals need tools to better integrate their perspectives for desired changes (what) when implementing built environment interventions (how). We present two simultaneous concept mapping exercises conducted in Montréal, Canada, to facilitate the consideration of these dimensions. METHODS: Community members were prompted about neighbourhood changes that could improve their quality of life; stakeholders were prompted about factors that contribute to successful implementation of interventions. Through each exercise, items were generated, grouped, and rated on importance and feasibility. Concept maps were produced using multidimensional scaling and hierarchical cluster analysis. The clusters identified by community members and stakeholders were combined into a Community × Stakeholder Matrix, which supported discussions on interventions with the research's Advisory Committee. RESULTS: Thirty-two community members generated 41 responses, which resulted in 6 clusters: (1) strengthen public transportation, (2) reduce space dedicated to cars, (3) foster local social connections, (4) develop quality cycling infrastructure, (5) improve pedestrian accessibility, and (6) green the city. Thirty-seven stakeholders generated 40 items, which resulted in 5 clusters: (1) collaboration with stakeholders and citizens, (2) planning and evaluation, (3) common vision for the future, (4) regulatory framework and funding, and (5) context-informed approach. CONCLUSION: Capturing the collective vision of our urban environments and the processes underlying change through concept mapping can lead to more successful changes. We propose combining understandings of the what and how into a matrix to support evaluation and strategic planning of interventions and better integrate community voices into operational planning.

RéSUMé: OBJECTIF: Les interventions sur le cadre bâti peuvent offrir des solutions structurelles aux défis urbains complexes. Bien que les communautés fassent partie du processus décisionnel municipal, les urbanistes et les professionnels de la santé publique ont besoin d'outils pour mieux intégrer leurs perspectives sur les changements souhaités (le quoi) dans la mise en œuvre réussie des programmes et des interventions sur l'environnement bâti (le comment). Nous présentons deux exercices simultanés de cartographie conceptuelle menés à Montréal, Canada, visant à capter ces dimensions de mise en œuvre. MéTHODES: Les membres de la communauté ont été sondés sur les changements dans leur quartier qui seraient susceptibles d'améliorer leur qualité de vie, tandis que des acteurs municipaux ont été sondés sur les facteurs qui contribuent à la réussite de la mise en œuvre des interventions urbaines. Pour chaque exercice, des items ont été générés, regroupés et notés en fonction de leur importance et de leur faisabilité. Des cartes conceptuelles ont été produites à l'aide d'analyse multivariée d'étalonnage multidimensionnel et d'une analyse hiérarchique ascendante. Les regroupements identifiés par les membres de la communauté et les acteurs municipaux ont été combinés dans une matrice communauté × acteurs municipaux, qui a encadré une discussion sur les interventions sur le cadre bâti avec le comité consultatif du programme de recherche. RéSULTATS: Trente-deux membres de la communauté ont généré 41 réponses uniques, qui ont formé 6 regroupements : (1) renforcer les transports en commun, (2) réduire l'espace dédié aux voitures, (3) favoriser le lien social local, (4) développer des infrastructures cyclables de qualité, (5) améliorer l'accessibilité piétonne, et (6) verdir la ville. Trente-sept acteurs municipaux ont généré 40 éléments uniques, qui ont mené à 5 regroupements : (1) collaboration avec les parties prenantes et les citoyens, (2) planification et évaluation, (3) vision commune pour l'avenir, (4) cadre réglementaire et financement, et (5) approche contextuelle. CONCLUSION: En captant la vision collective sur nos environnements urbains et la compréhension des processus sous-jacents au changement avec la cartographie conceptuelle, les transformations urbaines peuvent être plus réussies et plus inclusives. Nous proposons de combiner les perspectives sur le quoi et le comment dans une matrice pour soutenir l'évaluation et la planification stratégique d'interventions, tout en promouvant l'intégration des voix de la communauté dans la planification opérationnelle de l'aménagement urbain.