Trauma Care Systems in Urban Areas: Our Thoughts on the Contrasting Approaches in South Korea and Japan.

Trauma is a major global health issue, causing significant mortality, disability, and healthcare expenses. Since 2012, the Ajou Trauma Center in South Korea has been at the forefront, providing centralized severe trauma care for a population of 9.5 million. In 2022, the center managed 3,500 cases of severe trauma, including 500 helicopter transports, and conducted 2,800 surgeries, with 450 addressing torso trauma. Its exceptional performance has garnered global recognition, solidifying its position among the top advanced trauma centers. In Tokyo, critically ill and major trauma patients are currently transported to the nearest emergency and critical care centers, each serving a population of approximately 0.5 to 0.6 million people. Due to the low incidence of trauma per facility and an aging population, implementing a high level of trauma care and a comprehensive training framework within Japan's existing system poses significant challenges. A comparative analysis of South Korea's centralized system and Tokyo's decentralized approach indicates that the centralized system may lead to the establishment of a more advanced trauma center with ethical and equity considerations, compared to the decentralized approach. Therefore, consolidating major trauma cases in Tokyo shows promise for establishing exceptional trauma centers. This emphasizes the urgent need for Japan to take immediate steps towards a more robust future in trauma care. This assertion aligns with the global discourse on improving trauma care practices and could make a valuable contribution to the scholarly literature on trauma care systems.

Utilisation of public healthcare services by an indigenous group: a mixed-method study among Santals of West Bengal, India.

A barrier to meeting the goal of universal health coverage in India is the inequality in utilisation of health services between indigenous and non-indigenous people. This study aimed to explore the determinants of utilisation, or non-utilisation, of public healthcare services among the Santals, an indigenous community living in West Bengal, India. The study holistically explored the utilisation of public healthcare facilities using a framework that conceptualised service coverage to be dependent on a set of determinants - viz. the nature and severity of the ailment, availability, accessibility (geographical and financial), and acceptability of the healthcare options and decision-making around these further depends on background characteristics of the individual or their family/household. This cross-sectional study adopts ethnographic approach for detailed insight into the issue and interviewed 422 adult members of Santals living in both rural (Bankura) and urban (Howrah) areas of West Bengal for demographic, socio-economic characteristics and healthcare utilisation behaviour using pre-tested data collection schedule. The findings revealed that utilisation of the public healthcare facilities was low, especially in urban areas. Residence in urban areas, being female, having higher education, engaging in salaried occupation and having availability of private allopathic and homoeopathic doctors in the locality had higher odds of not utilising public healthcare services. Issues like misbehaviour from the health personnel, unavailability of medicine, poor quality of care, and high patient load were reported as the major reasons for non-utilisation of public health services. The finding highlights the importance of improving the availability and quality of care of healthcare services for marginalised populations because these communities live in geographically isolated places and have low affordability of private healthcare. The health programme needs to address these issues to improve the utilisation and reduce the inequality in healthcare utilisation, which would be beneficial for all segments of Indian population.

Assessment of asbestos-cement roof distribution and prioritized intervention approaches through hyperspectral imaging.

The discernment of asbestos-cement (AC) roofs within urban areas stands as a pivotal concern pertinent to communal well-being and ecological oversight, particularly in emerging nations where asbestos continues to be extensively employed. Conventional methodologies entailing the recognition of asbestos-cement roofs and the characterization of their degradation status, such as tangible examinations and laboratory assays, prove to be temporally protracted, financially demanding, and arduous to extrapolate comprehensively across expansive urban domains. In this paper, it is presented a novel approach for identifying asbestos-cement roofs in urban areas using hyperspectral airborne acquisition and carry out a diagnosis that allows to identify the state of asbestos-cement roofs and thus provide a tool for the competent authorities to develop and prioritize intervention strategies to mitigate the problem. Four different methodologies were implemented and compared, three of which are new in the literature, to identify the deterioration of asbestos-cement (AC) roof state in large urban areas. This, in turn, furnishes a tool for competent authorities to identify the state of AC roofs, develop and prioritize intervention strategies to mitigate the problem. The control points in field allowed validating the classification and the proposed methodology for the prioritization of intervention in AC roofs. Some neighborhoods in the city showed peaks in the area of asbestos-cement roofs of 47% of the total area of the neighborhood, representing practically all of the roofs present in the neighborhood. On average around 20% of the total area of a neighborhood in Cartagena is covered by AC. Furthermore, it was found a total area of AC roofs throughout the city of more than 9 km2 (9 million square meters). On the other hand, two of the 4 methods used showed encouraging results that demonstrate their ability to identify covers in poor and good condition at a large scale from hyperspectral images. This academic novelty suggests that there is a possibility of practical application of these methods in other urban contexts with high concentrations of AC roofs, helping in the planning and optimization of intervention strategies to mitigate the risk in public and environmental health due to the presence of asbestos.

Risk assessment for hurricane-induced pluvial flooding in urban areas using a GIS-based multi-criteria approach: A case study of Hurricane Harvey in Houston, USA.

As one of the most destructive nature hazards, hurricane-induced flooding generates serious adverse impacts on populations, infrastructure, and the environment globally. In urban areas, complex characteristics such as high population and infrastructure densities increase flood disaster risks. Consequently, the assessment of flood risks is becoming increasingly important for understanding potential impacts on an urban area and proposing disaster risk mitigation strategies. After conducting a comprehensive literature review, this study finds that most urban flood risk assessments often overlook urban ecosystem elements, focusing more on social and economic aspects. Hence, the role of urban ecosystems cannot be fully understood. To address this gap, this study proposes a social-ecological systems (SES) flood risk assessment framework for urban areas. Based on this framework, a comprehensive list of indicators collected through a literature review is provided for urban flood risk assessments. A comparative study of flood risk during Hurricane Harvey (2017) in Houston, Texas, USA, is carried out using the improved analytic hierarchy process (IAHP) weighting method and the equal weighting method for indicator weighting. Results are then compared with the damage data of Hurricane Harvey published by the U.S. Federal Emergency Management Agency (FEMA). The analysis identifies that the western part of Houston had the highest flood risks, while the center of Houston was at lower flood risk. Comparisons between the results from the IAHP and equal weighting methods show that the latter produces a broader range of high flood risk areas than the former. This study also highlights the role of urban ecosystems in mitigating flood risks and advocates for more holistic, social-ecological assessments of flood risk. Such assessments could utilize the proposed framework and the indicator list but contextualize these to the specific urban area's contexts being investigated.

Socioeconomic inequalities in COVID-19 incidence during the first six waves in Barcelona.

BACKGROUND: The emergence of SARS-CoV-2 affected urban areas. In Barcelona, six waves of COVID-19 hit the city between March 2020 and March 2022. Inequalities in the incidence of COVID-19 have been described. However, no studies have examined the daily trends of socioeconomic inequalities and how they changed during the different phases of the pandemic. The aim of this study is to analyse the dynamic socioeconomic inequalities in the incidence of COVID-19 during the six waves in Barcelona. METHODS: We examined the proportion of daily cases observed in the census tracts in the lower income tercile compared with the proportion of daily cases observed in the sum of the lower and higher income terciles. Daily differences in these proportions were assessed as a function of the epidemic waves, sex, age group, daily incidence and daily change in the incidence. A logistic regression model with an autoregressive term was used for statistical analysis. RESULTS: A time-dynamic effect was found for socioeconomic inequalities in the incidence of COVID-19. In fact, belonging to a lower-income area changed from being a risk factor (Waves 1, 2, 4 and 5) to being a protective factor in the sixth wave of the pandemic. Age also had a significant effect on incidence, which also changed over the different waves of the pandemic. Finally, the lower-income areas showed a comparatively lower incidence during the ascending phase of the epidemic waves. CONCLUSION: Socioeconomic inequalities in COVID-19 changed by wave, age group and wave phase.

Assessment of exposure, coping and adaptation strategies for elements at risk to climate change-induced flooding in urban areas. The case of Jangwani Ward in Dar es Salaam City, Tanzania.

Urban areas are the engines of socioeconomic growth and the homes of billions of people around the globe. In a changing climate, urban areas are inexorably from vulnerability to climate hazards including flooding which deters their social, economic, and environmental sustainability. The main objective of this paper was to explore exposure to elements at risk due to climate change-induced flooding in urban areas. In addition, the paper analyses the coping and adaptation strategies practiced at the community and national levels and recommends appropriate policy measures for enhanced climate resilience in urban areas. The study adopted purposeful sampling in which n = 95 households were selected for the study. Data collection methods involved household interviews with structured questionnaires, focused group discussions, documentary reviews, transect walks, surveys, and observations. Data analysis was done with a statistical package for social sciences. The results revealed that the elements at risk of exposure to climate change-induced flooding in the study area were physical infrastructures, socio-economic activities, livelihoods, and ecosystems. The study recommends enhancing resilience of elements at risk to climate change-induced flooding at national and local levels in urban areas. This is through promoting flood policies, strategies, laws, planning and management measures; enhance non-structural actions including flood forecasting, mapping, emergency evacuation plans and land use zoning and structural measures namely dams, dikes, storm surge barriers for adaptation to urban flooding.

How has COVID-19 changed private car use in European urban areas? An analysis of the effect of socio-economic characteristics and mobility habits.

The private car has been identified as the main winner among transport modes in urban areas during the COVID-19 pandemic. The fear of contagion when using public transport or the decrease in road congestion are likely to have induced changes in citizens' travel habits with respect to cars. This work investigates the impact of the pandemic on individuals' habits and preferences regarding their car ownership levels and car usage in the European urban context, with a special focus on the role played by individual socio-demographics and urban mobility patterns. For this purpose, a Path Analysis approach has been adopted to model car ownership and use before and after COVID-19. The main data source employed in this research is an EU-Wide Urban Mobility Survey that collects detailed information (individual and household socio-economic characteristics, built environment attributes and mobility habits) of 10,152 individuals from a total of 21 European urban areas of different sizes, geographical locations, and urban forms. The survey data has been complemented with city-level variables that account for differences across the cities that may explain changes in car-related behaviour. The results show that the pandemic has induced an increase in car use among socio-economic groups that are generally associated with low car-dependent behaviour, revealing that policy instruments that discourage the use of the private car in urban areas are needed to avoid reversing past trends in the reduction of urban transport emissions. High-income, well-educated teleworkers are observed to be the ones that have reduced their car use to a larger extent. On the contrary, low-income individuals are mostly maintaining similar levels of car mobility. Finally, frequent public transport users are more likely than occasional users to have substituted this mode by the private car.

Courage to Quit® rolling group: Implementation in an urban medical center in primarily low-income Black smokers.

BACKGROUND: Continuous "rolling" tobacco group treatments may help reduce cessation disparities by increasing access among underserved people who smoke cigarettes. We evaluated the implementation of a rolling enrollment adaptation of an evidence-based tobacco treatment group intervention, Courage to Quit®-Rolling (CTQ®-R). METHODS: The 4-session CTQ®-R incorporating psychoeducation, motivational enhancement, and cognitive behavioral skills was evaluated by examining feasibility and preliminary program outcomes with a pre-post design using the SQUIRE method in a sample of 289 primarily low-income, Black people who smoke. Feasibility was measured by examining program retention. Paired t-tests evaluated changes in behavioral intentions and knowledge about smoking cessation and differences in average daily cigarettes smoked from first to last session attended. RESULTS: CTQ-R was feasible to implement in an urban medical center program enrolling primarily low-income Black people who smoke, with 52% attending at least 2 sessions and 24% completing the full program. Participants demonstrated improvements in knowledge of smoking cessation strategies and confidence in quitting (ps < .004). Preliminary effectiveness analyses showed a 30% reduction in average daily cigarette use, with group completers reporting greater reduction than non-completers. CONCLUSIONS: CTQ®-R is feasible and showed preliminary effectiveness for increasing knowledge about stop smoking skills and reducing cigarette smoking. IMPLICATIONS: A rolling enrollment smoking group treatment is feasible and may be effective among people who smoke who face historical and systemic barriers to tobacco treatment engagement. Evaluation in other settings and over longer periods of time is needed.

[Psychosocial mediators between socioeconomic status and oral health among urban-dwelling older adults].

Objectives　This study examined the psychosocial mediators that most effectively mediate the socioeconomic status (SES)-based differences in oral health (OH) among urban-dwelling older adults.Methods　A representative sample of individuals aged ≥65 years living in two areas with different residential SES in Tokyo produced 739 effective participants. OH was based on the total score of subjective sense of health, number of remaining teeth, and oral function. SES was evaluated by education and income. Based on the socioecological model, mediators were assessed using self-esteem, social support, and depression.Results　 Based on the multiple mediation analysis, no significant effects were observed for specific psychosocial factors. However, the overall psychosocial factors showed significant effects as the mediating factor between income and OH. The mediating effect of overall psychosocial factors was not significant regarding years of education and oral health.Conclusion　A hybrid of life-stage preventive activities and overall reduction of psychosocial risk factors may eliminate the differences in OH by SES.

Women's perception of urban insecurity in the Monterrey metropolitan area during COVID-19 / Percepción femenina de la inseguridad urbana en el área metropolitana de Monterrey en tiempos de COVID-19 / A percepção das mulheres sobre a insegurança urbana na área metropolitana de Monterrey em tempos de COVID-19

The purpose of this paper it to explore women's perception of urban insecurity prevailing during the COVID-19 pandemic in the Monterrey metropolitan area (MMA) in Mexico. In recent decades, large cities have grown and with them, so has crime increased. As a result, the issue of urban insecurity has become important, particularly during this COVID-19 pandemic. For this purpose, a cross-sectional, descriptive, non-probabilistic study was conducted involving 69 women aged 18 to 58, with Universidad Autónoma de Nuevo León being taken as the sample frame. Our findings show that 74% of the participants indicate that urban safety near their homes, ranges fair to very bad, while 81% feel the same about safety near their workplaces. Ninety-three per cent say that crime has increased. Meanwhile, 55% say that the situation has affected their quality of life severely to very severely, denoting the MAM population's transition from one of social well-being to one of vulnerability, which has been further aggravated by the health contingency.

Este artículo investiga la percepción femenina de la inseguridad urbana que prevalece durante la pandemia de COVID-19 en el área metropolitana de Monterrey (MAM) en México. En las últimas décadas las grandes urbes han crecido y con esto también se favorece la delincuencia. Por lo tanto, el tema de inseguridad urbana se ha tornado pertinente y, particularmente, ha sido de interés abordarlo durante esta pandemia de COVID-19. Para esto, se realizó un estudio de carácter transversal y descriptivo, no probabilístico, en 69 mujeres de 18 a 58 años, y se consideró la Universidad Autónoma de Nuevo León como el sitio de muestreo. En el presente documento los hallazgos muestran que 74% de las participantes indica que la seguridad urbana cercana a sus casas es regular a muy mala. Similar situación se presenta en sus lugares de trabajo, según afirma el 81%. El 93% asevera que los actos delictivos aumentaron. Entre tanto, el 55% dice que esta situación afectó de grave a muy gravemente su calidad de vida. Esta situación denota la transición de la sociedad en el MAM de bienestar social a otra de vulnerabilidad, que se ha incrementado por el escenario de la contingencia sanitaria que ha padecido.

Este artigo investiga a percepção das mulheres sobre a insegurança urbana prevalecente durante a pandemia COVID-19 na área metropolitana de Monterrey (MMA), no México. Nas últimas décadas, as grandes cidades cresceram e, com isso, a criminalidade também aumentou. Portanto, a questão da insegurança urbana tornou-se relevante e, particularmente, tem sido de interesse abordá-la durante esta pandemia da COVID-19. Para este fim, foi realizado um estudo transversal, descritivo e não-probabilístico entre 69 mulheres de 18 a 58 anos, e a Universidade Autônoma de Nuevo León foi considerada como o local de amostragem. Neste documento, os resultados mostram que 74% dos participantes indicam que a segurança urbana perto de suas casas é justa a muito ruim. Uma situação semelhante é encontrada em seus locais de trabalho, de acordo com 81%. Noventa e três por cento dizem que a criminalidade aumentou. Enquanto isso, 55% dizem que esta situação tem afetado seriamente a qualidade de vida deles. Esta situação reflete a transição da sociedade no MMA de uma situação de bem-estar social para uma situação de vulnerabilidade, que tem aumentado devido ao cenário de contingência de saúde que experimentou.

Investigating the combined effect of ALAN and noise on sleep by simultaneous real-time monitoring using low-cost smartphone devices.

The association between artificial light at night (ALAN) and noise, on the one hand, and sleep, on the other, is well established. Yet studies investigating these associations have been infrequent and mostly conducted in controlled laboratory conditions. As a result, little is known about the applicability of their results to real-world settings. In this paper, we attempt to bridge this knowledge gap by carrying out an individual-level real-world study, involving 72 volunteers from different urban localities in Israel. The survey participants were asked to use their personal smartphones and smartwatches to monitor sleep patterns for 30 consecutive days, while ALAN and noise exposures were monitored in parallel, with inputs reported each second. The volunteers were also asked to fill in a questionnaire about their individual attributes, daily habits, room settings, and personal health, to serve as individual-level controls. Upon cointegration, the assembled data were co-analyzed using bivariate and multivariate statistical tools. As the study reveals, the effect of ALAN and noise on sleep largely depends on when the exposure occurred, that is, before sleep or during sleep. In particular, the effect of ALAN exposure was found to be most pronounced if it occurred before sleep, while exposure to noise mattered most if it occurred during the sleep phase. As the study also reveals, the effects of ALAN and noise appear to amplify each other, with a 14-15.3% reduction in sleep duration and an 8-9% reduction in sleep efficiency observed at high levels of ALAN-noise exposures. The study helped to assemble a massive amount of real-time observations, enabling a robust individual-level analysis.

Multi-level policy responses to tackle socioeconomic inequalities in the incidence of COVID-19 in a European urban area.

BACKGROUND: Spain has been hit hard by COVID-19 since March 2020, especially in its metropolitan areas. We share experiences from Barcelona in measuring socioeconomic inequalities in the incidence of COVID-19 in the different waves, and in implementing coordinated and equity-oriented public health policy responses. METHODS: We collected daily data on confirmed COVID-19 cases, geocoded the address of residence to assign each case to one of the 73 neighborhoods and 1068 census tracts, and calculated the cumulative incidence of COVID-19 by neighborhood and five income groups (quintiles of census tracts) by sex across four waves of the pandemic. We adjusted hierarchical Bayesian spatial models to obtain the relative risk (RR) of cumulative incidences in each quintile compared with the richest areas. A variety of public health policies implemented to tackle the pandemic and especially these inequalities in COVID-19 incidence and vaccination are selected and described. RESULTS: Area-level income inequalities in the incidence of COVID-19 were present at different degree in all four waves. In the second wave (10/1/2020 to 12/6/2020), RR for the poorest income quintile census tracts compared with the richest was 1.43 (95% credible interval-CI-: 1.22-1.67) for men and 1.58 (95% CI: 1.35-1.83) for women. Later, inequalities in vaccination coverage also arose. Equity-oriented policy responses included: "health hotels" or home delivery of basic products for individuals with COVID-19 and without adequate conditions for isolation; new emergency facilities for homeless people, including those with active drug use; mass screening in high incidence areas; contingency plans for nursing homes and schools; adapting community health programs for their early reactivation; digital self-appointment support points and community vaccination days. CONCLUSION: COVID-19 hit Barcelona neighborhoods unequally, with variations between waves. The rapid availability of geolocalized data and by socioeconomic level helped public authorities to implement targeted policies and collaborative interventions for the most vulnerable populations. Further studies would be needed to evaluate their impact.

Environmental risk assessment of the potential "Chemical Time Bomb" of ion-adsorption type rare earth elements in urban areas.

Ion-adsorption type rare earth elements (REEs) located in tropical and subtropical zones have abundant movable and bioavailable ion-exchangeable REEs and could be an environmental hazard. However, our understanding of their environmental risk in urban areas is limited. We aimed to determine whether ion-adsorption type REEs in Guangzhou represent a kind of potential "Chemical Time Bomb" (CTB) and assess the environmental risk. We conducted a comprehensive survey of REEs in 181 samples including regolith (n = 70), surface water (n = 55), sediment (n = 25), vegetables (n = 22) and rhizosphere soil (n = 9), collected from five regions around Guangzhou, as a representative city of ion-adsorption type REEs in tropical and subtropical zones. The existing environmental risk was assessed by calculating the estimated daily intake (EDI) of REEs through vegetable consumption, and leaching simulation experiments were used to discuss the factors affecting the long-term stability of REEs. The average REEs concentrations (ΣREEs) in the regolith and sediment were 458.5 and 218.6 µg·g-1, respectively, which were higher than the background values of regolith (197.3 µg·g-1) and sediment (173.3 µg·g-1), and large proportions of ion-exchangeable REEs were observed in regolith and sediment, indicating that ion-adsorption type REEs in Guangzhou are a kind of potential CTB. The average ΣREEs in surface water (3.9 µg·L-1), rhizosphere soil (466.9 µg·g-1) and vegetables (25.0 µg·g-1·dw) suggest that REEs have migrated to the supergene environment even organisms. The average EDI (55.4 µg·kg-1·d-1) close to the safety limitation (70 µg·kg-1·d-1) suggests that the existing health risk is very worrisome. Human factors, including acid rain, mining and farming, probably ignite the CTB, causing the release of REEs to the urban environment on a large scale. This prospective study demonstrated that REEs exposure problems in urban areas of ion-adsorption type REEs should not be ignored.

The assessment of an extended set of socio-economic determinants to explain anxiety and uncertainty, insufficient quality and food intake of Afghan refugees.

OBJECTIVES: In this study, socio-economic factors associated with Afghan refugee households' food insecurity, anxiety and uncertainty, insufficient quality and food intake were determined. DESIGN: Household Food Insecurity Assess Scale measurement was applied to assess food insecurity, anxiety and uncertainty, insufficient quality and insufficient food intake. Descriptive analysis and multivariable regression models were used to determine the associated factors. SETTING: The study was carried out in urban areas of Tehran province in Iran. PARTICIPANTS: To collect data, interviews were conducted among 317 Afghan households. The questionnaire was administered via face-to-face interviews to either the breadwinner of the selected households or a member who could respond on behalf of the household. RESULTS: About 11·3 % of Afghan households who resettled in Tehran province were food secure, while 11·7 % were marginally, 40·7 % moderately and 36·3 % severely food insecure. Economic and financial factors were inversely and significantly associated with food insecurity. Employment, income, distance from the central market and personal saving were inversely associated with food insecurity, while other determinants, including the length of living time in Tehran, house type and the number of male and female children, had a direct association with food insecurity. CONCLUSIONS: The associations of socio-economic factors with three categories of food insecurity differed. Elimination of occupation bans that the Iranian government imposes on refugees provides simple access to financial supports like long-term loans, and opening a bank account for refugees will benefit both Iranians and refugees.

Clinical application of the fracture risk assessment tool in the general population and its correlation with bone turnover markers.

Objective: To compare the risk of osteoporotic fractures between the urban and urban-rural fringe populations in southern China and to explore the effect of bone turnover markers on fracture risk. Methods: Epidemiological investigations were conducted in the urban and urban-rural fringe areas of southern China in June 2018. Residents aged 40 years and over who signed informed consent forms were included. Physical examination and questionnaire collection were completed. Bone turnover markers (BTMs) including osteocalcin (OC) and beta cross-linked C-telopeptide of type 1 collagen (ß-CTX) were tested. Bone mineral density (BMD) of the femoral neck and lumbar vertebrae 1-4 were measured using dual energy X-ray absorptiometry. Fracture risk assessment tool (FRAX) values were calculated to show the probability of major osteoporotic fracture (PMOF) and probability of hip fracture (PHF) over the next 10 years. Results: A total of 1,051 participants were included in this study, including 553 in the urban areas and 498 in the urban-rural fringe areas. The average PMOF and PHF were 3.4 (2.3-5.4) % and .6 (.3-1.5) %, respectively. Compared with that in the urban populations, the femoral neck BMD in the urban-rural fringe populations was lower and FRAX values were generally higher, especially for women. FRAX values in various populations were mainly negatively correlated with lumbar and femoral neck BMD and were positively correlated with ß-CTX; meanwhile, only PHF was negatively correlated with OC. After adjusting for sex, elevated ß-CTX levels significantly increased the risk of high PMOF in various populations and increased the risk of high PHF in the urban-rural fringe populations. In particular, the risks of increased PMOF and PHF could increase by as much as 33 times and 19.5 times, respectively, in the urban-rural fringe areas. Conclusion: The urban-rural fringe populations in Southern China may be at risk of osteoporotic fracture. In addition to being related to BMD, the FRAX value also correlates with some BTMs. Combining FRAX with BMD, and BTMs may better predict the fracture risk.

Urban-Rural Gaps in Breastfeeding Practices: Evidence From Lao People's Democratic Republic.

Objectives: Breastfeeding rates are decreasing rapidly in many low and middle-income countries, disproportionately affecting urban residences. We use data from Lao People's Democratic Republic to identify primary mechanisms underlying the urban-rural gap in breastfeeding practices. Methods: We used data from the 2017 Lao Social Indicator Survey II. Residence was categorized as large-urban (>1 million), small-urban (<1 Million), and rural. Multivariable logistic regression provided odds ratios and 95% confidence intervals (CI) to identify factors attributing to the urban-rural differences in complying with World Health Organization's breastfeeding recommendations for children <24 months. Results: Mothers in large-urban residences had 3.78 (95% confidence intervals: 1.19, 11.95) and 4.67 (95% CI: 2.30, 9.46) higher odds of non-compliance with exclusive and complementary breastfeeding recommendations, respectively, than mothers living in rural areas in bivariate models. Breastfeeding differentials between small urban and rural residences were largely explained by differences in maternal education and household wealth. Conclusion: Results of our paper suggest large disparities in breastfeeding practices between large-urban, small-urban, and rural residences.

Do Current Measures of Social Exclusion Depict the Multidimensional Challenges of Marginalized Urban Areas? Insights, Gaps and Future Research.

According to the United Nations, 70% of the world's population will live in cities by 2050, increasing the proliferation of areas of social exclusion and thus polarization and segregation. The establishment of multidimensional measures seeks to identify such situations of social exclusion to inform social policies and interventions. However, some concerns emerge: Are these measures catching the needs of people living in particularly disadvantages areas? Do they offer a human-centred approach or a territorial focus? Is the multidimensionality of such measures reflecting nonmaterial aspects such as health, access to liveable environments or political participation? To analyse how the scientific literature is addressing the measurement of social exclusion to tackle such urban challenges, a systematic review following the PRISMA guidelines was performed in the Web of Science database. After screening following the inclusion criteria, 28 studies were identified that analysed systems of indicators that multidimensionally examined social exclusion at the individual and/or family level in urban contexts. Despite studies being eminently limited to some Western countries, the results revealed a broad diversity. However, very few of them fully focused on the specific characteristics of marginalized urban areas, and most found serious difficulties in overcoming a material approach.

Is Living in a U.S. Coastal City Good for One's Health?

BACKGROUND: Evidence suggests that living close to "blue spaces" (water features), particularly coastlines, has salutary effects on human health. METHODS: We analyzed five years of annual, self-reported general health and unhealthy days data from the Behavioral Risk Factor Surveillance System of the U.S. Centers for Disease Control and Prevention for 165 urban areas across the contiguous U.S. We compared health self-reports for people living in coastal vs. non-coastal urban areas and for residents of the disaster-prone Gulf of Mexico region vs. other locations. Coastal urban areas were defined as those having ≥50% of their population living within 20 km of a coast. RESULTS: We found no overall health advantage of residing in a coastal urban location when all urban areas were considered. However, residents from non-Gulf of Mexico coastal urban areas reported modestly better health than residents from non-coastal areas. In contrast, self-reported health of Gulf coastal urban residents was significantly poorer than that of residents from other urban areas. CONCLUSIONS: The frequency of disasters and history of health and socioeconomic disparities in the Gulf region may be responsible, at least in part, for the apparent lack of health promoting effects of coastal location there.

Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession.

OBJECTIVE: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. METHODS: This is an ecological study of trends in three periods of time: two before (2000-2003 and 2004-2008), and one after (2009-2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. RESULTS: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. CONCLUSIONS: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.

Development a new index for littered waste assessment in different environments: A study on coastal and urban areas of northern Iran (Caspian Sea).

The coastal pollution has been evaluated using indexes like Clean Coast Index (CCI) in many countries. In this study, several coasts and urban areas in northern of Iran along the Caspian Sea, were assessed in terms of number and composition of litters. Furthermore, Clean Environment Index (CEI) was used for the first time to interpret the results. The results indicated that 60% of the coasts and 50% of the urban areas were in a dirty status and only 22% of the total surveyed areas were found to be in a clean status. The highest number of litters observed in the study areas was cigarette butt. Due to the impact of risk factor of different types of littered waste, it was obviously clear that CEI offers a more realistic and rigorous interpretation than CCI. Therefore, this new index can be considered to evaluate litters pollution in various areas.