Evaluation of statistical process control charts for infant mortality monitoring in Brazilian cities with different population sizes.

OBJECTIVES: The control chart is a classic statistical technique in epidemiology for identifying trends, patterns, or alerts. One meaningful use is monitoring and tracking Infant Mortality Rates, which is a priority both domestically and for the World Health Organization, as it reflects the effectiveness of public policies and the progress of nations. This study aims to evaluate the applicability and performance of this technique in Brazilian cities with different population sizes using infant mortality data. RESULTS: In this article, we evaluate the effectiveness of the statistical process control chart in the context of Brazilian cities. We present three categories of city groups, divided based on population size and classified according to the quality of the analyses when subjected to the control method: consistent, interpretable, and inconsistent. In cities with a large population, the data in these contexts show a lower noise level and reliable results. However, in intermediate and small-sized cities, the technique becomes limited in detecting deviations from expected behaviors, resulting in reduced reliability of the generated patterns and alerts.

A local-to-global emissions inventory of macroplastic pollution.

Negotiations for a global treaty on plastic pollution1 will shape future policies on plastics production, use and waste management. Its parties will benefit from a high-resolution baseline of waste flows and plastic emission sources to enable identification of pollution hotspots and their causes2. Nationally aggregated waste management data can be distributed to smaller scales to identify generalized points of plastic accumulation and source phenomena3-11. However, it is challenging to use this type of spatial allocation to assess the conditions under which emissions take place12,13. Here we develop a global macroplastic pollution emissions inventory by combining conceptual modelling of emission mechanisms with measurable activity data. We define emissions as materials that have moved from the managed or mismanaged system (controlled or contained state) to the unmanaged system (uncontrolled or uncontained state-the environment). Using machine learning and probabilistic material flow analysis, we identify emission hotspots across 50,702 municipalities worldwide from five land-based plastic waste emission sources. We estimate global plastic waste emissions at 52.1 [48.3-56.3] million metric tonnes (Mt) per year, with approximately 57% wt. and 43% wt. open burned and unburned debris, respectively. Littering is the largest emission source in the Global North, whereas uncollected waste is the dominant emissions source across the Global South. We suggest that our findings can help inform treaty negotiations and develop national and sub-national waste management action plans and source inventories.

GIS-based assessment of spatial and temporal disparities of urban health index in Shenzhen, China.

Purpose: To explore the inter-regional health index at the city level to contribute to the reduction of health inequalities. Methods: Employed the health determinant model to select indicators for the urban health index of Shenzhen City. Utilized principal component analysis, the weights of these indicators are determined to construct the said health index. Subsequently, the global Moran's index and local Moran's index are utilized to investigate the geographical spatial distribution of the urban health index across various administrative districts within Shenzhen. Results: The level of urban health index in Shenzhen exhibits spatial clustering and demonstrates a positive spatial correlation (2017, Moran's I = 0.237; 2019, Moran's I = 0.226; 2021, Moran's I = 0.217). However, it is noted that this clustering displays a relatively low probability (90% confidence interval). Over the period from 2017 to 2019, this spatial clustering gradually diminishes, suggesting a narrowing of health inequality within economically developed urban areas. Conclusion: Our study reveals the urban health index in a relatively high-income (Shenzhen) in a developing country. Certain spatially correlated areas in Shenzhen present opportunities for the government to address health disparities through regional connectivity.

Income inequality and healthcare utilization of the older adults-based on a study in three provinces and six cities in China.

Purpose: The objective of this study is to gain a more nuanced understanding of the specific impact of income inequality on the utilization of healthcare services for older adults. Additionally, the study aims to elucidate the moderating and mediating roles of public transfer income and psychological health in this context. Methods: A systematic examination of the impact of income inequality on healthcare utilization among older adults was conducted through field questionnaire surveys in six cities across three major geographical regions (West, Central, and East). The analysis employed baseline regression, as well as mediating and moderating effect tests. Results: First, there is a negative relationship between income inequality and the use of therapeutic healthcare services (ß1 = -0.484, P < 0.01) and preventive healthcare services (ß2 = -0.576, P < 0.01) by older adults. This relationship is more pronounced in the low- and medium-income groups as well as in the western region. The mediating effect of psychological state is significant (ß3 = -0.331, P < 0.05, ß4 = -0.331, P < 0.05). Public transfer income plays a significant role in regulation. The moderating effect of public transfer income on therapeutic services was more significant in low-income groups (ß5 = 0.821, P < 0.01). The moderating effect of public transfer income on preventive services was more significant in middle-income groups (ß6 = 0.833, P < 0.01). Conclusion: The study clearly demonstrates a significant negative correlation between income inequality and the utilization of healthcare services by older adults. Furthermore, the study reveals that this relationship is particularly pronounced among older adults in low- and medium-income and Western regions. This detailed analysis of regional and income level heterogeneity is of particular value in this field of research. Secondly, this study attempts to integrate the two pivotal dimensions of public transfer income and psychological state for the first time, elucidating their moderating and mediating roles in this relationship. The findings indicate that public transfer income serves as a moderating factor, exerting a notable "reordering effect" on income inequality and resulting in a "deprivation effect." Such factors may impede the utilization of medical services, potentially influencing the psychological state of older adults.

Impact of Ambient Temperature on Mortality Burden and Spatial Heterogeneity in 16 Prefecture-Level Cities of a Low-Latitude Plateau Area in Yunnan Province: Time-Series Study.

Background: The relation between climate change and human health has become one of the major worldwide public health issues. However, the evidence for low-latitude plateau regions is limited, where the climate is unique and diverse with a complex geography and topography. objectives: This study aimed to evaluate the effect of ambient temperature on the mortality burden of nonaccidental deaths in Yunnan Province and to further explore its spatial heterogeneity among different regions. Methods: We collected mortality and meteorological data from all 129 counties in Yunnan Province from 2014 to 2020, and 16 prefecture-level cities were analyzed as units. A distributed lagged nonlinear model was used to estimate the effect of temperature exposure on years of life lost (YLL) for nonaccidental deaths in each prefecture-level city. The attributable fraction of YLL due to ambient temperature was calculated. A multivariate meta-analysis was used to obtain an overall aggregated estimate of effects, and spatial heterogeneity among 16 prefecture-level cities was evaluated by adjusting the city-specific geographical characteristics, demographic characteristics, economic factors, and health resources factors. Results: The temperature-YLL association was nonlinear and followed slide-shaped curves in all regions. The cumulative cold and heat effect estimates along lag 0-21 days on YLL for nonaccidental deaths were 403.16 (95% empirical confidence interval [eCI] 148.14-615.18) and 247.83 (95% eCI 45.73-418.85), respectively. The attributable fraction for nonaccidental mortality due to daily mean temperature was 7.45% (95% eCI 3.73%-10.38%). Cold temperature was responsible for most of the mortality burden (4.61%, 95% eCI 1.70-7.04), whereas the burden due to heat was 2.84% (95% eCI 0.58-4.83). The vulnerable subpopulations include male individuals, people aged <75 years, people with education below junior college level, farmers, nonmarried individuals, and ethnic minorities. In the cause-specific subgroup analysis, the total attributable fraction (%) for mean temperature was 13.97% (95% eCI 6.70-14.02) for heart disease, 11.12% (95% eCI 2.52-16.82) for respiratory disease, 10.85% (95% eCI 6.70-14.02) for cardiovascular disease, and 10.13% (95% eCI 6.03-13.18) for stroke. The attributable risk of cold effect for cardiovascular disease was higher than that for respiratory disease cause of death (9.71% vs 4.54%). Furthermore, we found 48.2% heterogeneity in the effect of mean temperature on YLL after considering the inherent characteristics of the 16 prefecture-level cities, with urbanization rate accounting for the highest proportion of heterogeneity (15.7%) among urban characteristics. Conclusions: This study suggests that the cold effect dominated the total effect of temperature on mortality burden in Yunnan Province, and its effect was heterogeneous among different regions, which provides a basis for spatial planning and health policy formulation for disease prevention.

Study on the development characteristics and spatial and temporal patterns of population ageing in 31 central cities in China.

Background: Population ageing is inseparable from technological innovation, social progress and the development of human civilization, and constitutes a new element in the development of contemporary human history. Objective: To dynamically analyses the developmental, structural and growth characteristics of population ageing in 31 provincial capitals and municipalities in China, using the data of the fifth national census in 2000 and the seventh national census in 2020. Methods: The development characteristics and spatial and temporal patterns of population aging in the 31 cities were measured using the population aging index growth model, Theil's index, coefficient of variation, population aging index and other analytical methods. Results: (1) From 2000 to 2020, the population aging rate of the 31 central cities generally increased, and the population aging level of the cities showed the characteristics of "East-Central-Northeast-West" to "Northeast-East-Central-West" decreasing. (2) Regional differences in the ratio of old to young are relatively high, while regional differences in the level of population ageing are relatively small. The level of population ageing is classified with the indicators of size structure, family structure and age structure in the first and third quadrants, and with the geographic concentration rate in the second and fourth quadrants. (3) China's population ageing has a T-shaped spatial distribution characteristic pointing along the coast - along the Yangtze Rivers. Conclusion: The 31 central cities are the center of gravity of China's economy and have strong economic power in dealing with the challenges of population ageing, but how to make population ageing compatible with the economy and society, and then promote sustainable population development, is a topic that needs further attention in the study.

Police shootings, violent crime, race and socio-economic factors in municipalities in the United States of America.

BACKGROUND: Both police shootings and violent crime remain high in the United States of America compared to other developed nations but debates continue about whether race, mental health or other social factors are related to them. AIMS: Our aim was to test relationships between community factors indicative of socio-economic status, racial demographics, police shootings, and violent crime. METHODS: Data on police shootings, violent crime and community sociodemographic factors were drawn from two publicly accessible datasets: health and police records of 100 US municipalities and relationships between them explored using regression analyses. RESULTS: Data were from the 100 largest US municipalities as designated by the mapping police violence database. The median per capital violent crime rate was 5.94 and median killings by police per 10 thousand arrests was 13.7. Violent crime was found to be related mainly to income inequality and lower academic achievement in the community. Race was unrelated to violent crime after controlling for other factors. Police shootings were found to be related to community level mental health concerns, food insecurity and the municipality's violent crime rate. CONCLUSION: The evidence suggests that socio-economic factors are the primary drivers of both violent crime perpetration and police shootings. Policy approaches aimed at improving education and reducing poverty are likely to mitigate both violent crime and police shootings. However, it is important to recognise that being Black is an indicator of particular disadvantage within this context. This underscores the need for comprehensive strategies that address the systemic issues of racial disparities and socio-economic inequality, while also acknowledging the complex interplay of race, poverty and policing in the context of violent crime and police shootings.

Disappearing cities on US coasts.

The sea level along the US coastlines is projected to rise by 0.25-0.3 m by 2050, increasing the probability of more destructive flooding and inundation in major cities1-3. However, these impacts may be exacerbated by coastal subsidence-the sinking of coastal land areas4-a factor that is often underrepresented in coastal-management policies and long-term urban planning2,5. In this study, we combine high-resolution vertical land motion (that is, raising or lowering of land) and elevation datasets with projections of sea-level rise to quantify the potential inundated areas in 32 major US coastal cities. Here we show that, even when considering the current coastal-defence structures, further land area of between 1,006 and 1,389 km2 is threatened by relative sea-level rise by 2050, posing a threat to a population of 55,000-273,000 people and 31,000-171,000 properties. Our analysis shows that not accounting for spatially variable land subsidence within the cities may lead to inaccurate projections of expected exposure. These potential consequences show the scale of the adaptation challenge, which is not appreciated in most US coastal cities.

Making cities mental health friendly for adolescents and young adults.

Urban life shapes the mental health of city dwellers, and although cities provide access to health, education and economic gain, urban environments are often detrimental to mental health1,2. Increasing urbanization over the next three decades will be accompanied by a growing population of children and adolescents living in cities3. Shaping the aspects of urban life that influence youth mental health could have an enormous impact on adolescent well-being and adult trajectories4. We invited a multidisciplinary, global group of researchers, practitioners, advocates and young people to complete sequential surveys to identify and prioritize the characteristics of a mental health-friendly city for young people. Here we show a set of ranked characteristic statements, grouped by personal, interpersonal, community, organizational, policy and environmental domains of intervention. Life skills for personal development, valuing and accepting young people's ideas and choices, providing safe public space for social connection, employment and job security, centring youth input in urban planning and design, and addressing adverse social determinants were priorities by domain. We report the adversities that COVID-19 generated and link relevant actions to these data. Our findings highlight the need for intersectoral, multilevel intervention and for inclusive, equitable, participatory design of cities that support youth mental health.

Ethnic disparities in cancer mortality in the capital and northeast of the State of São Paulo, Brazil 2001-17.

PURPOSE: There is a paucity of studies investigating cancer disparities in groups defined by ethnicity in transitioning economies. We examined the influence of ethnicity on mortality for the leading cancer types in São Paulo, Brazil, comparing patterns in the capital and the northeast of the state. METHODS: Cancer deaths were obtained from a Brazilian public government database for the Barretos region (2003-2017) and the municipality of São Paulo (2001-2015). Age-standardized rates (ASR) per 100,000 persons-years, by cancer type and sex, for five self-declared racial classifications (white, black, eastern origin (Asian), mixed ethnicity (pardo), and indigenous Brazilians), were calculated using the world standard population. RESULTS: Black Brazilians had higher mortality rates for most common cancer types in Barretos, whereas in São Paulo, white Brazilians had higher rates of mortality from breast, colorectal, and lung cancer. In both regions, lung cancer was the leading cause of cancer death among white, black, and pardo Brazilians, with colorectal cancer deaths leading among Asian Brazilians. Black and pardo Brazilians had higher cervical cancer mortality rates than white Brazilians. CONCLUSION: There are substantial disparities in mortality from different cancers in São Paulo according to ethnicity, pointing to inequities in access to health care services.

Human mobility networks reveal increased segregation in large cities.

A long-standing expectation is that large, dense and cosmopolitan areas support socioeconomic mixing and exposure among diverse individuals1-6. Assessing this hypothesis has been difficult because previous measures of socioeconomic mixing have relied on static residential housing data rather than real-life exposures among people at work, in places of leisure and in home neighbourhoods7,8. Here we develop a measure of exposure segregation that captures the socioeconomic diversity of these everyday encounters. Using mobile phone mobility data to represent 1.6 billion real-world exposures among 9.6 million people in the United States, we measure exposure segregation across 382 metropolitan statistical areas (MSAs) and 2,829 counties. We find that exposure segregation is 67% higher in the ten largest MSAs than in small MSAs with fewer than 100,000 residents. This means that, contrary to expectations, residents of large cosmopolitan areas have less exposure to a socioeconomically diverse range of individuals. Second, we find that the increased socioeconomic segregation in large cities arises because they offer a greater choice of differentiated spaces targeted to specific socioeconomic groups. Third, we find that this segregation-increasing effect is countered when a city's hubs (such as shopping centres) are positioned to bridge diverse neighbourhoods and therefore attract people of all socioeconomic statuses. Our findings challenge a long-standing conjecture in human geography and highlight how urban design can both prevent and facilitate encounters among diverse individuals.

Global evidence of rapid urban growth in flood zones since 1985.

Disaster losses are increasing and evidence is mounting that climate change is driving up the probability of extreme natural shocks1-3. Yet it has also proved politically expedient to invoke climate change as an exogenous force that supposedly places disasters beyond the influence of local and national authorities4,5. However, locally determined patterns of urbanization and spatial development are key factors to the exposure and vulnerability of people to climatic shocks6. Using high-resolution annual data, this study shows that, since 1985, human settlements around the world-from villages to megacities-have expanded continuously and rapidly into present-day flood zones. In many regions, growth in the most hazardous flood zones is outpacing growth in non-exposed zones by a large margin, particularly in East Asia, where high-hazard settlements have expanded 60% faster than flood-safe settlements. These results provide systematic evidence of a divergence in the exposure of countries to flood hazards. Instead of adapting their exposure, many countries continue to actively amplify their exposure to increasingly frequent climatic shocks.

Analysis of the spatial-temporal distribution characteristics of hepatitis E in Jiangsu province from 2005 to 2020.

Objective: This study attempts to analyze the spatial clustering and spatial-temporal distribution characteristics of hepatitis E (HE) at the county (city and district) level in Jiangsu province to provide a scientific basis for the prevention and control of HE. Method: The information on HE cases reported in the Chinese Center for Disease Control and Prevention Information System from 2005 to 2020 was collected for spatial autocorrelation analysis and spatial-temporal clustering analysis. Result: From 2005 to 2020, 48,456 HE cases were reported in Jiangsu province, with an average annual incidence rate of 3.87/100,000. Male cases outnumbered female cases (2.46:1), and the incidence was highest in the 30-70 years of age group (80.50%). Farmers accounted for more than half of all cases (59.86%), and in terms of the average annual incidence, the top three cities were all in Zhenjiang city. Spatial autocorrelation analysis showed that Global Moran's I of HE incidence varied from 0.232 to 0.513 for the years. From 2005 to 2020, 31 counties (cities and districts) had high and statistically significant HE incidence, and two clustering areas were detected by spatial-temporal scanning. Conclusion: HE incidence in Jiangsu province from 2005 to 2020 was stable, with age and gender differences, regional clustering, and spatial-temporal clustering. Further investigation of HE clustering areas is necessary to formulate corresponding targeted prevention and control measures.

The global wildland-urban interface.

The wildland-urban interface (WUI) is where buildings and wildland vegetation meet or intermingle1,2. It is where human-environmental conflicts and risks can be concentrated, including the loss of houses and lives to wildfire, habitat loss and fragmentation and the spread of zoonotic diseases3. However, a global analysis of the WUI has been lacking. Here, we present a global map of the 2020 WUI at 10 m resolution using a globally consistent and validated approach based on remote sensing-derived datasets of building area4 and wildland vegetation5. We show that the WUI is a global phenomenon, identify many previously undocumented WUI hotspots and highlight the wide range of population density, land cover types and biomass levels in different parts of the global WUI. The WUI covers only 4.7% of the land surface but is home to nearly half its population (3.5 billion). The WUI is especially widespread in Europe (15% of the land area) and the temperate broadleaf and mixed forests biome (18%). Of all people living near 2003-2020 wildfires (0.4 billion), two thirds have their home in the WUI, most of them in Africa (150 million). Given that wildfire activity is predicted to increase because of climate change in many regions6, there is a need to understand housing growth and vegetation patterns as drivers of WUI change.

Exploring the effect of city size on carbon emissions: Evidence from 259 prefecture-level cities in China.

As a gathering place for human production activities, cities are the main places where energy consumption and carbon dioxide emissions occur. How to accurately measure city size and test the impact mechanism of city size on carbon emissions of different city levels is still controversial. This study uses the global nighttime light data to identify urban bright areas and built-up areas, and accordingly constructs the city size index of 259 prefecture level cities in China from 2003 to 2019. It avoids the problem of only considering the single index of population size or space size, and makes the measurement of city size more reasonable. We use a dynamic panel model to study the impact of city size on urban carbon emissions per capita, and discuss the heterogeneity of various cities under different population levels and economic development levels. The empirical results indicate that in the scale of cities in China showed a fluctuating growth trend in recent years. The city size index of most cities is clustered at medium and high values. The city size index of cities with different economic development levels and different population-scale levels shows obvious gradient differences but maintains an upward trend. The expansion of supercities (with a population of more than 5 million) introduces a drastic increase in carbon emissions. The carbon emissions growth caused by the expansion of cities that are classified as third tier and below is the smallest, while that caused by the expansion of cities that are classified as first-tier is the largest. The findings suggest differentiated emissions reduction suggestions for cities with different sizes.

Japanese Local Governments' Dissemination Activities for Advance Care Planning: A Descriptive Analysis of a Nationwide Survey during the COVID-19 Pandemic.

This study aims to compare the awareness-raising activities between municipalities with and without focused anti-infection measures during the 2019 coronavirus disease (COVID-19) pandemic. Descriptive analysis was conducted using a nationwide self-administered questionnaire survey on municipalities' activities for residents and for healthcare providers and care workers (HCPs) in October 2022 in Japan. This study included 433 municipalities that had conducted awareness-raising activities before 2019 Fiscal Year. Workshops for residents were conducted in 85.2% of the municipalities, and they were more likely to be conducted in areas with focused anti-infection measures than those without measures (86.8% vs. 75.4%). Additionally, 85.9% of the municipalities were impacted by the pandemic; 50.1% canceled workshops, while 26.0% switched to a web-based style. Activities for HCPs were conducted in 55.2-63.7% of the municipalities, and they were more likely to be conducted in areas with focused anti-infection measures. A total of 50.6-62.1% of the municipalities changed their workshops for HCPs to a web-based style. Comparisons between areas with and without focused anti-infection measures indicated that the percentages of those impacted for all activities were not significantly different. In conclusion, awareness-raising activities in municipalities were conducted with new methods during the COVID-19 pandemic. Using information technology is essential to further promote such activities for residents.

External Factors Impacting Residents' Participation in Waste Sorting Using NCA and fsQCA Methods on Pilot Cities in China.

Recycling waste is important as it can help to reduce environmental pollution caused by "waste siege". Source classification is an important part of the municipal solid waste (MSW) sorting process. The factors that prompt residents to participate in waste sorting have been debated by scholars in recent years; however, there are not many papers that focus on the complex relationships between them. This study reviewed the literature that concerns residents' participation in waste sorting, and it summarized the external factors that might influence residents' participation. Then, we focused on 25 pilot cities in China, and we analyzed the configuration impact of external factors on residents' participation using a necessary condition analysis (NCA) and a fuzzy-set qualitative comparative analysis (fsQCA). We found no consistency between variables, nor was there one single condition that caused residents to participate in waste sorting. There are two main methods (environment-driven and resource-driven) that can help achieve a high participation rate, and three methods that can cause a low participation rate. This study provides suggestions for the implementation of waste sorting in other cities in China, as well as developing countries, with an emphasis on the importance of public participation.

Religious Afterlife Beliefs Decrease Behavioral Avoidance of Symbols of Mortality.

An astonishing cultural phenomenon is where, far away from or close to a city center, people in different societies localize cemeteries that function as both sites of memory of lost ones and symbols of mortality. Yet a psychological account of such differences in behavioral responses to symbols of mortality is lacking. Across five studies (N = 1,590), we tested a psychological model that religious afterlife beliefs decrease behavioral avoidance of symbols of mortality (BASM) by developing and validating a word-position task for quantifying BASM. We showed evidence that religious believers, including Christians, Muslims, Hindus, and Buddhists, exhibited decreased BASM relative to nonbelievers. We also provide evidence for a causal relationship between religious afterlife beliefs and reduced BASM. Our findings provide new insight into the functional role of religious afterlife beliefs in modulating human avoidance behavior in response to symbols of mortality.