RESUMEN
Annually, an estimated 152000 people in the UK have a stroke, accounting for 11% of all deaths in England and Wales, but for those that survive, nutrition is key to the body's recovery. Consequences of malnutrition can include increased susceptibility to infection, delayed healing, impaired cardiovascular function, decreased muscle strength and depression. Given the complex nature of post-stroke dysphagia, it may not be possible that simple screening tools sufficiently identify those at risk of aspiration. If a patient is deemed unsafe or unable to meet their nutrition and hydration needs orally, guidelines recommend they should be considered for nasogastric feeding within 24 hours and a referral for dietetic/nutrition team input should be made accordingly. Speech and language therapists can predict early in a patient's journey whether or not prolonged dysphagia is likely. In turn, the need for long term artificial feeding can then also be anticipated.
Asunto(s)
Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Apoyo Nutricional , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Enfermedad Aguda , Gastrostomía , Humanos , Intubación Gastrointestinal , Calidad de VidaRESUMEN
With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.
RESUMEN
Cities produce more than 70% of global greenhouse gas emissions. Action by cities is therefore crucial for climate change mitigation as well as for safeguarding the health and wellbeing of their populations under climate change. Many city governments have made ambitious commitments to climate change mitigation and adaptation and implemented a range of actions to address them. However, a systematic record and synthesis of the findings of evaluations of the effect of such actions on human health and wellbeing is currently lacking. This, in turn, impedes the development of robust knowledge on what constitutes high-impact climate actions of benefit to human health and wellbeing, which can inform future action plans, their implementation and scale-up. The development of a systematic record of studies reporting climate and health actions in cities is made challenging by the broad landscape of relevant literature scattered across many disciplines and sectors, which is challenging to effectively consolidate using traditional literature review methods. This protocol reports an innovative approach for the systematic development of a database of studies of climate change mitigation and adaptation actions implemented in cities, and their benefits (or disbenefits) for human health and wellbeing, derived from peer-reviewed academic literature. Our approach draws on extensive tailored search strategies and machine learning methods for article classification and tagging to generate a database for subsequent systematic reviews addressing questions of importance to urban decision-makers on climate actions in cities for human health and wellbeing.
RESUMEN
Transformational change is urgently needed to address planetary health challenges in cities. Through an interdisciplinary overview of the literature, we consider how to frame and unpack city-level transformation towards synergistic benefits for urban health and environmental sustainability. By describing the characteristics of a 'healthy sustainable city' and by bringing together the ideas underlying frameworks for health and sustainability, we develop a conceptual understanding of how cities may progress towards achieving significant improvements in health and the environment. We investigate how urban change works, and build a theoretical understanding of how urban change may be directed to integrate health and sustainability. We conclude that urban transformation needs to be a multi-scalar process across city sectors to meet the scale, speed and form of change required. We propose that this can best be achieved in practice through a composition of mechanisms, including strengthening city governance, enabling technological and social innovations, applying sustainable urban planning and infrastructure development, and impelling social behaviour change; supported by systems-driven policy and practice-focused scientific evidence.
Asunto(s)
Planificación de Ciudades , Salud Urbana , CiudadesRESUMEN
This paper describes a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods the Complex Urban Systems for Sustainability and Health (CUSSH) project will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperatives for planetary health in the 21st Century. CUSSH's core components include: (i) a review of evidence on the effects of climate actions (both mitigation and adaptation) and factors influencing their implementation in urban settings; (ii) the development and application of methods for tracking the progress of cities towards sustainability and health goals; (iii) the development and application of models to assess the impact on population health, health inequalities, socio-economic development and environmental parameters of urban development strategies, in order to support policy decisions; (iv) iterative in-depth engagements with stakeholders in partner cities in low-, middle- and high-income settings, using systems-based participatory methods, to test and support the implementation of the transformative changes needed to meet local and global health and sustainability objectives; (v) a programme of public engagement and capacity building. Through these steps, the programme will provide transferable evidence on how to accelerate actions essential to achieving population-level health and global climate goals through, amongst others, changing cities' energy provision, transport infrastructure, green infrastructure, air quality, waste management and housing.
RESUMEN
The data presented in this article were used to estimate the impacts of air pollution policies on population health and health inequalities within a spatial microsimulation model, MicroEnv [1]. They provide a basis for comparison with similar models and allow researchers to integrate additional model components without duplication of effort. Relative risk estimates for the association between air pollution and rates of ischaemic heart disease (IHD) incidence, IHD case fatality and all-cause mortality were taken from a review of the epidemiological literature and meta-analyses [2]. Modelled small area air pollution data (PM2.5) for Greater London, UK were obtained from an environmental consultancy. All other data were collected from open source Governmental or Non-Government Organisation (NGO) data repositories. These include all-cause mortality rates; IHD incidence, prevalence and mortality rates; general fertility rates; small area socio-economic deprivation data; and relative risk estimates for the association between deprivation and all-cause mortality.
RESUMEN
The Sustainable Development Goals (SDGs) recognise the critical need to improve population health and environmental sustainability. This paper describes the development of a microsimulation model, MicroEnv, aimed at quantifying the impact of environmental exposures on health as an aid to selecting policies likely to have greatest benefit. Its methods allow the integration of morbidity and mortality outcomes and the generation of results at high spatial resolution. We illustrate its application to the assessment of the impact of air pollution on health in London. Simulations are performed at Lower Layer Super Output Area (LSOA), the smallest geographic unit (population of around 1500 inhabitants) for which detailed socio-demographic data are routinely available in the UK. The health of each individual in these LSOAs is simulated year-by-year using a health-state-transition model, where transition probabilities from one state to another are based on published statistics modified by relative risks that reflect the effect of environmental exposures. This is done through linkage of the simulated population in each LSOA with 1â¯×â¯1 km annual average PM2.5 concentrations and area-based deprivation indices. Air pollution is a leading cause of mortality and morbidity globally, and improving air quality is critical to the SDGs for Health (Goal 3) and Cities (Goal 11). The evidence of MicroEnv is aimed at providing better understanding of the benefits for population health and health inequalities of policy actions that affect exposure such as air quality, and thus to help shape policy decisions. Future work will extend the model to integrate other environmental determinants of health.
Asunto(s)
Contaminación del Aire/efectos adversos , Simulación por Computador , Política Ambiental , Disparidades en el Estado de Salud , Salud Poblacional , Exposición a Riesgos Ambientales , Humanos , Londres , Material ParticuladoRESUMEN
There is growing recognition of the need to improve protection against the adverse health effects of hot weather in the context of climate change. We quantify the impact of the Urban Heat Island (UHI) and selected adaptation measures made to dwellings on temperature exposure and mortality in the West Midlands region of the UK. We used 1) building physics models to assess indoor temperatures, initially in the existing housing stock and then following adaptation measures (energy efficiency building fabric upgrades and/or window shutters), of representative dwelling archetypes using data from the English Housing Survey (EHS), and 2) modelled UHI effect on outdoor temperatures. The ages of residents were combined with evidence on the heat-mortality relationship to estimate mortality risk and to quantify population-level changes in risk following adaptations to reduce summertime heat exposure. Results indicate that the UHI effect accounts for an estimated 21% of mortality. External shutters may reduce heat-related mortality by 30-60% depending on weather conditions, while shutters in conjunction with energy-efficient retrofitting may reduce risk by up to 52%. The use of shutters appears to be one of the most effective measures providing protection against heat-related mortality during periods of high summer temperatures, although their effectiveness may be limited under extreme temperatures. Energy efficiency adaptations to the dwellings and measures to increase green space in the urban environment to combat the UHI effect appear to be less beneficial for reducing heat-related mortality.
Asunto(s)
Calor/efectos adversos , Vivienda , Mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Cambio Climático , Planificación Ambiental , Humanos , Lactante , Persona de Mediana Edad , Temperatura , Reino Unido , Adulto JovenAsunto(s)
Contaminantes Atmosféricos , Contaminación del Aire Interior , Contaminantes Atmosféricos/análisis , Contaminación del Aire Interior/efectos adversos , Conservación de los Recursos Energéticos , Monitoreo del Ambiente , Vivienda , Humanos , Material Particulado/análisis , Reino Unido , VentilaciónRESUMEN
Typical polycyclic aromatic hydrocarbon mixtures are established lung carcinogens, but the quantitative exposure-response relationship is less clear. To clarify this relationship we conducted a review and meta-analysis of published reports of occupational epidemiologic studies. Thirty-nine cohorts were included. The average estimated unit relative risk (URR) at 100 Mu g/m (superscript)3(/superscript) years benzo[a]pyrene was 1.20 [95% confidence interval (CI), 1.11-1.29] and was not sensitive to particular studies or analytic methods. However, the URR varied by industry. The estimated means in coke ovens, gasworks, and aluminum production works were similar (1.15-1.17). Average URRs in other industries were higher but imprecisely estimated, with those for asphalt (17.5; CI, 4.21-72.78) and chimney sweeps (16.2; CI, 1.64-160.7) significantly higher than the three above. There was no statistically significant variation of URRs within industry or in relation to study design (including whether adjusted for smoking), or source of exposure information. Limited information on total dust exposure did not suggest that dust exposure was an important confounder or modified the effect. These results provide a more secure basis for risk assessment than was previously available.
Asunto(s)
Contaminantes Ambientales/envenenamiento , Neoplasias Pulmonares/etiología , Exposición Profesional , Hidrocarburos Policíclicos Aromáticos/envenenamiento , Estudios Epidemiológicos , Humanos , Neoplasias Pulmonares/epidemiología , Proyectos de Investigación , Medición de RiesgoRESUMEN
Since 1993, all new gasoline-engine automobiles in the United Kingdom have been supplied with three-way vehicle exhaust catalytic converters (VECs) containing platinum, palladium, and rhodium, to comply with European Commission Stage I limits on emissions of regulated pollutants: carbon monoxide, hydrocarbons, and oxides of nitrogen. We conducted a physical and economic evaluation of the environmental and health benefits from a reduction in emissions through this mandated environmental technology against the costs, with reference to urban areas in Great Britain. We made both an ex post assessment--based on available data to 1998--and an ex ante assessment--projected to 2005, the year when full penetration of VECs into the fleet is expected. Substantial health benefits in excess of the costs of VECs were indicated: By 1998 the estimated net societal health benefits were approximately 500 million British pounds, and by 2005 they were estimated to rise to as much as 2 billion British pounds. We also found through environmental surveys that although lead in road dust has fallen by 50% in urban areas, platinum accumulations near roads have risen significantly, up to 90-fold higher than natural background levels. This rapid accumulation of platinum suggests further monitoring is warranted, although as yet there is no evidence of adverse health effects.
Asunto(s)
Ambiente , Modelos Teóricos , Salud Pública , Emisiones de Vehículos/efectos adversos , Emisiones de Vehículos/prevención & control , Catálisis , Análisis Costo-Beneficio , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Paladio/análisis , Platino (Metal)/análisis , Salud Pública/economía , Rodio/análisis , Reino Unido , Población UrbanaRESUMEN
Acinetobacter baumannii is an opportunistic Gram-negative bacterium which is a common cause of hospital-acquired infections. Numerous antibiotic-resistant strains exist, emphasizing the need for the development of new antimicrobials. Alanine racemase (Alr) is a pyridoxal 5'-phosphate dependent enzyme that is responsible for racemization between enantiomers of alanine. As D-alanine is an essential component of the bacterial cell wall, its inhibition is lethal to prokaryotes, making it an excellent antibiotic drug target. The crystal structure of A. baumannii alanine racemase (AlrAba) from the highly antibiotic-resistant NCTC13302 strain has been solved to 1.9â Å resolution. Comparison of AlrAba with alanine racemases from closely related bacteria demonstrates a conserved overall fold. The substrate entryway and active site of the enzymes were shown to be highly conserved. The structure of AlrAba will provide the template required for future structure-based drug-design studies.