The impact of introducing alcohol-free beer options in bars and public houses on alcohol sales and revenue: A randomised crossover field trial.

AIMS: The study aimed to estimate the impact of introducing a draught alcohol-free beer, thereby increasing the relative availability of these products, on alcohol sales and monetary takings in bars and pubs in England. DESIGN: Randomised crossover field trial. SETTING: England. PARTICIPANTS: Fourteen venues that did not previously sell draught alcohol-free beer. INTERVENTION AND COMPARATOR: Venues completed two intervention periods and two control periods in a randomised order over 8 weeks. Intervention periods involved replacing one draught alcoholic beer with an alcohol-free beer. Control periods operated business as usual. MEASUREMENTS: The primary outcome was mean weekly volume (in litres) of draught alcoholic beer sold. The secondary outcome was mean weekly revenue [in GBP (£)] from all drinks. Analyses adjusted for randomised order, special events, season and busyness. FINDINGS: The adjusted mean difference in weekly sales of draught alcoholic beer was -20 L [95% confidence interval (CI) = -41 to +0.4], equivalent to a 4% reduction (95% CI = 8% reduction to 0.1% increase) in the volume of alcoholic draught beer sold when draught alcohol-free beer was available. Excluding venues that failed at least one fidelity check resulted in an adjusted mean difference of -29 L per week (95% CI = -53 to -5), equivalent to a 5% reduction (95% CI = 8% reduction to 0.8% reduction). The adjusted mean difference in weekly revenue was +61 GBP per week (95% CI = -328 to +450), equivalent to a 1% increase (95% CI = 5% decrease to 7% increase) when draught alcohol-free beer was available. CONCLUSIONS: Introducing a draught alcohol-free beer in bars and pubs in England reduced the volume of draught alcoholic beer sold by 4% to 5%, with no evidence of the intervention impacting net revenue.

The difference in the elderly's visual impact assessment of pocket park landscape.

As an important part of urban public open space, pocket parks have become an important activity place for the elderly in the context of the aging society in China. With the pocket parks in Nanjing, Jiangsu province, China as research object, this paper set six landscape features to be studied, namely, Height of trees, Green color richness, Stratification of green landscapes, Green space ratio, Leisure facilities, and Water landscape. The elderly respondents with different demographic characteristics, such as age, gender, education level and residential type, were subjected to the picture stimulation experiment whose results were then statistically analyzed. The results indicate that gender and residential type exert certain influence on the elderly's visual impact assessment of pocket park landscape. To be specific, the male elderly prefer the pocket park landscape with 3-6 m high trees, medium green space ratio, and more leisure facilities; the female elderly are in greater favor of pocket park landscapes with 0-3 m high trees, five or more colors, three or more layers; the elderly who live with their families prefer pocket park landscapes with medium green space ratio and more leisure facilities; to the elderly who live alone, pocket park landscapes with trees which are 0-3 m high, five or more colors, and medium leisure facilities are more attractive. This study can provide valuable reference for pocket park design in China.

Equity assessment of maternal and child healthcare benefits utilization and distribution in public healthcare facilities in Bangladesh: a benefit incidence analysis.

BACKGROUND: The distribution of healthcare services should be based on the needs of the population, regardless of their ability to pay. Achieving universal health coverage implies first ensuring that people of all income levels have access to quality healthcare, and then allocating resources reasonably considering individual need. Hence, this study aims to understand how public benefits in Bangladesh are currently distributed among wealth quintiles considering different layers of healthcare facilities and to assess the distributional impact of public benefits. METHODS: To conduct this study, data were extracted from the recent Bangladesh Demographic and Health Survey 2017-18. We performed benefit incidence analysis to determine the distribution of maternal and child healthcare utilization in relation to wealth quintiles. Disaggregated and national-level public benefit incidence analysis was conducted by the types of healthcare services, levels of healthcare facilities, and overall utilization. Concentration curves and concentration indices were estimated to measure the equity in benefits distribution. RESULTS: An unequal utilization of public benefits observed among the wealth quintiles for maternal and child healthcare services across the different levels of healthcare facilities in Bangladesh. Overall, upper two quintiles (richest 19.8% and richer 21.7%) utilized more benefits from public facilities compared to the lower two quintiles (poorest 18.9% and poorer 20.1%). Benefits utilization from secondary level of health facilities was highly pro-rich, while benefit utilization found pro-poor at primary levels. The public benefits in Bangladesh were also not distributed according to the needs of the population; nevertheless, poorest 20% household cannot access 20% share of public benefits in most of the maternal and child healthcare services even if we ignore their needs. CONCLUSIONS: Benefit incidence analysis in public health spending demonstrates the efficacy with which the government allocates constrained health resources to satisfy the needs of the poor. Public health spending in Bangladesh on maternal and child healthcare services were not equally distributed among wealth quintiles. Overall health benefits were more utilized by the rich relative to the poor. Hence, policymakers should prioritize redistribution of resources by targeting the socioeconomically vulnerable segments of the population to increase their access to health services to meet their health needs.

The optimal spatial delineation method for the service level of urban park green space from the perspective of opportunity equity.

Urban park green spaces (UPGS) constitute a vital component of urban ecosystems, and the unequal distribution of UPGS can significantly impact the well-being of residents. Therefore, investigating the spatial delineation methods of UPGS service levels from the perspective of opportunity equity contributes to enhancing people's quality of life and promoting social harmony. Taking the Yingze District of Taiyuan City as an example, this study uses a modified accessibility measurement method of UPGS with the smallest clustered unit (building) as the service demand point and the UPGS entrance/exit as the service provision point, to establish a micro-scale evaluation framework for spatial equity considering the service radius and service quality of UPGS. The findings are as follows: after setting different service radius for UPGS at different levels, additional areas not covered by UPGS service were identified compared to setting the same service radius uniformly, which could prevent these areas from being overlooked in urban plans. After considering the quality of UPGS services, additional areas with low and high UPGS service levels were identified. Accurate spatial delineation of UPGS service level can avoid wasting public resources by including areas with high service levels in the scope of new UPGS requirements, while areas with low service levels lose opportunities for consideration in future urban infrastructure planning. This study emphasizes the residents' demand for both the quantity and quality of UPGS, facilitating an accurate assessment of whether urban residents can enjoy UPGS, the number of UPGS options available to them, and evaluate the quality of UPGS services experienced. Overall, this research provides new insights for evaluating the spatial equity of urban public facilities.

[The use of sports facilities for physical activity: a public health and equity perspective]. / El uso de instalaciones deportivas para promover la actividad física: una perspectiva de salud pública y equidad.

Introduction: Background: despite multimillion-dollar investments in sports facilities, there is little information on their contribution to energy expenditure of the population. In this study, participation in 71 physical activities (PAs) and 31 different types of spaces was examined. Objectives: to evaluate which types of spaces are more effective from a public health perspective. Methods: a cross-sectional sample was designed, stratified and proportional to the adult population of Gran Canaria (n = 3,000, ≥ 18 years). PA was evaluated using a validated questionnaire. The spaces used were grouped into two categories: public open spaces and sport facilities. Descriptive statistics and multiple logistic regression were used to analyze the data. Results: the open public spaces accumulated a volume of hours for PA between 1.6 and 28.4 times higher than the sport facilities depending on the socio-demographic group analyzed. The indoor sport facilities were the ones that expressed the greatest associative strength with the achievement of PA recommendations (OR = 5.45, 95 % CI: 4.01; 7.40). Conclusion: a dilemma was posed from a public health perspective because the urban open public spaces reached more population and supported most of the population's energy expenditure, particularly in the groups with the highest health risk, but the indoor sport facilities were the ones that best contributed to achieving a healthy level of physical activity. This study suggests changes in the polices of construction and management of sport facilities and open public spaces to increase PA in groups at higher health risk.

Introducción: Introducción: pese a las inversiones multimillonarias en instalaciones para la actividad física-deportiva, hay poca información acerca de su contribución en el gasto energético poblacional. En este estudio examinamos la participación en 71 actividades físicas (AF) y 31 tipos de espacios diferentes. Objetivo: valorar qué tipos de espacios son más eficaces desde una perspectiva de salud pública y equidad. Método: muestra transversal aleatoria, estratificada y proporcional en género y edad a la población de adultos de Gran Canaria (n = 3.000, ≥ 18 años). La AF fue evaluada mediante cuestionario validado. Los espacios de AF fueron agrupados en dos categorías: espacios públicos abiertos (EPA) e instalaciones deportivas. Para analizar los datos se emplearon estadística descriptiva y regresión logística múltiple. Resultados: los EPA acumularon un volumen de horas de AF entre 1,6 y 28,4 veces mayor que las instalaciones deportivas dependiendo del grupo sociodemográfico analizado. Las instalaciones deportivas cubiertas fueron las que expresaron la mayor fuerza asociativa con el logro de las recomendaciones de AF (OR = 5,45, IC 95 %: 4,01; 7,40). Conclusiones: se planteó un dilema desde una perspectiva de salud porque los EPA urbanos llegaron a más población y dieron soporte a la mayor parte del gasto energético poblacional, particularmente, en los grupos de mayor riesgo de salud, pero las instalaciones deportivas cubiertas fueron las que mejor contribuyeron a lograr un nivel saludable de actividad física. Este estudio sugiere cambios en las políticas de construcción y gestión de instalaciones deportivas y EPA para aumentar la AF en los grupos de mayor riesgo de salud.

How can public open spaces contribute to physical activity promotion? / Como os espaços públicos abertos podem contribuir para a promoção da atividade física?

Public open spaces (POSs) are means to ensure one's right to recreation and health. The objective of this essay is to present reflections and evidence on how these spaces contribute to promoting physi-cal activity (PA). Understanding how to access (proximity/distance), quantity and diversity, and the surrounding and internal conditions of places (quality, structure, aesthetics, safety) can affect the use of POSs is imperative for public management actions. Thinking of POS use beyond PA by recog-nizing its social, economic, and cultural benefits can be fundamental to reduce inequalities regarding access to these places. POS-related actions and demands are intersectoral, multiprofessional, and interdisciplinary, thus requiring political, academic, and community involvement and commitment for PA promotion

Espaços públicos abertos (EPA) são equipamentos que promovem o direito à recreação e à saúde. O objetivo deste ensaio é apresentar reflexões e evidências sobre como esses espaços contribuem para a promoção da atividade física (AF). Compreender como o acesso (proximidade/distância), a quantidade e diversidade, as condições do entorno e internas dos locais (qualidade, estrutura, estética, segurança), podem afetar o uso dos EPA é fundamental para ações da gestão pública. Pensar o uso do EPA para além da prática de AF, reconhecendo seus benefícios sociais, econômicos e culturais pode ser fundamental para diminuir as iniquidades de acesso a esses locais. Ações e demandas relacionadas aos EPA são intersetoriais, multiprofissionais e interdisciplinares, necessitando com isso envolvimento e comprometimento político, acadêmico e comunitário, a fim de promover AF

Inequality of public facilities between urban and rural areas and its driving factors in ten cities of China.

Urban development continues to face the dilemma of spatial inequality of public facilities, particularly educational and medical facilities. Identifying inequalities in various types of public facilities and their driving mechanisms is crucial in reducing social inequality. However, information on this topic is limited. This study took 10 typical cities in China as cases. We used the methods of the Gini coefficient and hedonic price model as bases in evaluating the equality of nine types of education and medical facilities, focusing on the differences between urban and rural areas. Moreover, we further analyzed the driving factors of facility equality. Results showed that equality of public facilities in urban areas was significantly higher than that in rural areas. Primary schools, middle schools, and health service centers were relatively equal, and kindergartens and pharmacies were unequal only in rural areas. However, the equality of facilities with large-size or commercial attributes was not optimistic. Furthermore, there remained a significant gap among counties (or districts), which was mainly driven by population, economy, and building density in the form of logarithm and logarithmic linear models. Our research contributes to an in-depth understanding of the inequality of public facilities and further supports decision-making to improve social equality.

Equity Measurement of Public Sports Space in Central Urban Areas Based on Residential Scale Data.

Urban public sports facilities have captured much public attention because of their close ties to public health. However, few studies have comprehensively assessed the equity of accessibility to various types of public sports space with a fine scale. This study proposed a spatial equity measurement method based on multi-source urban data and GIS network analysis. Residential buildings were taken as the minimum research unit to investigate the equity differences of residents' enjoyment of urban public sports space accessible by walking and public transportation. Taking Harbin, China, as an example, this study calculated and visualized the proximity of more than 12,000 residential buildings to a variety of public sports space in the central urban area. The results showed that: (1) urban centers enjoy more public sports space resources than border areas, that is, the developed area has more advantages than the emerging area; (2) according to the classification of sports space, their spatial distribution pattern and measurement results are obviously different; (3) the areas with a low walking equity degree also had a low bus equity degree. This study integrated multi-source data into the traditional spatial computing models and provided an important reference for the equitable planning of urban public sports space.

Psychosocial and environmental determinants of physical activity in a Brazilian public university employees - ELDAF: A prospective cohort study protocol.

BACKGROUND: Increased physical activity levels and their determinations are essential issues worldwide. The Longitudinal Study of Physical Activity Determinants (ELDAF) aims to understand the roles of psychosocial and environmental factors in workers' physical activity levels. METHODS: A prospective cohort study of non-faculty civil servants from a public university (approximately 1,200 individuals) will start in 2022 (baseline). The primary measurements will be accelerometer- and questionnaire-based physical activity, social support, social network, socioeconomic status, bereavement, job stress, body image, common mental disorders, depression, and neighborhood satisfaction. Additional measurements will include necessary sociodemographic, physical morbidity, lifestyle and anthropometric information. Participants' places of residence will be geocoded using complete addresses. All participants will furnish written, informed consent before the beginning of the study. Pilot studies were performed to identify and correct potential problems in the data collection instruments and procedures. ELDAF will be the first cohort study conducted in Latin America to investigate physical activity and its determinants.

The enduring pursuit of public science at U.S. land-grant universities.

Since the 1990s, universities have faced a push toward output commercialization that has been seen as a potential threat to the public science model. Much less attention has been given to the enduring nature of internal organizational features in academia and how they shape the pursuit of traditional scholarly activities. This article exploits four waves of representative, random-sample survey evidence from agricultural and life science faculty at the 52 major U.S. land-grant universities, spanning 1989-2015, to examine faculty attitudes/preferences, tenure and promotion criteria, output, and funding sources. Our findings demonstrate that faculty attitudes toward scientific research have remained remarkably stable over twenty-five years in strongly favoring intrinsic and public science goals over commercial or extrinsic goals. We also demonstrate the faculty's positive attitudes toward science, an increased pressure to publish in top journals and secure increasingly competitive grants, as well as declining time for science. These trends suggest a reconsideration of university commercialization strategies and a recommitment of universities and their state and federal funders toward fostering public agricultural and life science research.

Spatial equity in the layout of urban public sports facilities in Hangzhou.

This paper proposes a framework for a layout evaluation of urban public sports facilities. First, the buffer analysis method is used to measure the service level of public sports facilities. The study findings indicate that the overall service level of public sports facilities presents the spatial characteristics of a central agglomeration, and the value of the service level diffuses outward from high to low. There is evident spatial heterogeneity in the layout of public sports facilities in Hangzhou. Second, the Gini coefficient, Lorenz curve, and location entropy are employed to measure the equity of the distribution among spatial units and the intradistrict disparity. The results show a mismatch between the spatial distribution of the facilities and the distribution of the permanent population. The patterns of distribution of the location entropy classes of Hangzhou can be divided into three types: balanced, alternating, and divergent districts. The method in this paper is effective in measuring spatial equity and visualizing it. it has a certain degree of systemicity, universality and operability. At the same time, this method can compare the diachronic characteristics of the same city and the synchronic characteristics of different cities, which has universal application value.

Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York.

Access to safe, clean water and sanitation is globally recognized as essential for public health. Public toilets should be accessible to all members of a society, without social or physical barriers preventing usage. A public toilet facility's design and upkeep should offer privacy and safety, ensure cleanliness, provide required sanitation-related resources, and be gender equitable, including enabling comfortable and safe management of menstruation. Menstrual hygiene management (MHM) refers to the need to ensure that girls, women and all people who menstruate have access to clean menstrual products, privacy to change the materials as often as needed, soap and water for washing the body as required, and access to facilities to dispose of used materials. Challenges around menstruation faced by people experiencing homelessness, which tend to be greater than those facing the general population, include inadequate toilet and bathing facilities, affordability issues around menstrual products, and menstrual stigma. Public toilets are a vital resource for managing menstruation, particularly for vulnerable populations without reliable access to private, safe, and clean spaces and menstrual products. This mixed-methods study sought to: 1) understand the lived experiences of MHM among people experiencing homelessness in New York City with respect to public toilets; 2) describe general and MHM-related characteristics of public toilets in high need areas of Manhattan and analyze their interrelationships; and 3) examine the associations among neighborhood-level demographics and the public toilet characteristics in those areas. Qualitative methods included key informant interviews (n = 15) and in-depth interviews (n = 22) with people with experience living on the street or in shelters, which were analyzed using Malterud's 'systematic text condensation' for thematic cross-case analysis. Quantitative methods included audits and analyses of public toilet facilities (n = 25) using traditional statistics (e.g., Spearman's correlations) and spatial analyses (e.g., proximity buffers). Qualitative findings suggest cleanliness, access to restrooms, and availability of resources are critical issues for the participants or prospective users. Quantitative analyses revealed insufficiently provided, maintained, and resourced public toilets for managing menstruation in high-needs areas. Findings also suggest that toilets with more MHM-related resource availability, such as menstrual products and toilet stall disposal bins, were more difficult to access. Neighborhood-level characteristics showed a potential environmental injustice, as areas characterized by higher socioeconomic status are associated with more access to MHM-specific resources in public restrooms, as well as better overall quality.

Facility-level determinants of quality routine intrapartum care in Afghanistan.

BACKGROUND: Although there have been notable improvements in availability and utilization of maternal health care in Afghanistan over the last few decades, risk of maternal mortality remains very high. Previous studies have highlighted gaps in quality of emergency obstetric and newborn care practices, however, little is known about the quality of routine intrapartum care at health facilities in Afghanistan. METHODS: We analyzed a subset of data from the 2016 Afghanistan Maternal and Newborn Health Quality of Care Assessment that comprised of observations of labor, delivery and immediate post-partum care, as well as health facility assessments and provider interviews across all accessible public health facilities with an average of five or more births per day in the preceding year (N = 77). Using the Quality of the Process of Intrapartum and Immediate Postpartum Care index, we calculated a quality of care score for each observation. We conducted descriptive and bivariate analyses and built a multivariate linear regression model to identify facility-level factors associated with quality of care scores. RESULTS: Across 665 childbirth observations, low quality of care was observed such that no health facility type received an average quality score over 56%. The multivariate regression model indicated that availability of routine labor and delivery supplies, training in respectful maternity care, perceived gender equality for training opportunities, recent supervision, and observation during supervision have positive, statistically significant associations with quality of care. CONCLUSIONS: Quality of routine intrapartum care at health facilities in Afghanistan is concerningly low. Our analysis suggests that multi-faceted interventions are needed to address direct and indirect contributors to quality of care including clinical care practices, attention to client experiences during labor and childbirth, and attention to staff welfare and opportunities, including gender equality within the health workforce.

Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda.

BACKGROUND: Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. METHODS: Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers' sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. RESULTS: The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01-1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02-1.17)] favoured facility delivery while a higher parity of 3-4 [APR = 0.93, 95% CI (0.88-0.99)] was inversely associated with health facility delivery as compared to parity of 1-2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05-1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04-1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78-0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08-1.19)]. CONCLUSION: Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

[COVID-19 and elderly people in nursing homes: Impact according to the modality of residence]. / COVID-19 y personas mayores en residencias: impacto según el tipo de residencia.

PURPOSE: To find out whether elements such as public expenditure, the coverage ratio, public or private ownership, and the size of Nursing homes relate to the number of deaths in residences per COVID-19. MATERIAL AND METHODS: A total of 15 variables are analyzed in 17 Autonomous Communities (n = 17), where the following stand out: public expenditure per dependent person; incidence of COVID-19 in each Autonomous Community; deaths in Nursing homes by COVID-19; and analysis of places in Nursing homes. Reliability of r = 0.613. Regression analyses are carried out with the different variables, and ANOVA tests. RESULTS: Percentages of deaths by COVID-19 in Nursing homes, between 40% and 88%, of the total of (p < 0.001, X2 = 0.975). A relationship is established between the number of deaths from COVID-19 in Nursing homes, and the higher number of private Nursing homes (p < 0.001, X2 = 0.633). The larger the size of the Nursing home, the more deaths by COVID-19 were recorded (p < 0.001, X2 = 0.787), with private Nursing homes having +100 places, and public Nursing homes having +100 places (p < 0.001, X2 = 0.808). CONCLUSIONS: It was found that there is a relationship between the number of deaths from COVID-19 in Nursing homes, and the fact that there are a greater number of private Nursing homes in that autonomous community. It was detected that the model of Nursing home best prepared to face the COVID-19: public Nursing homes with less than 25 places.

Trends in and determinants of visiting private health facilities for maternal and child health care in Nepal: comparison of three Nepal demographic health surveys, 2006, 2011, and 2016.

BACKGROUND: Maternal and child health care services are available in both public and private facilities in Nepal. Studies have not yet looked at trends in maternal and child health service use over time in Nepal. This paper assesses trends in and determinants of visiting private health facilities for maternal and child health needs using nationally representative data from the last three successive Nepal Demographic Health Surveys (NDHS). METHODS: Data from the NDHS conducted in 2006, 2011, and 2016 were used. Maternal and child health-seeking was established using data on place of antenatal care (ANC), place of delivery, and place of treatment for child diarrhoea and fever/cough. Logistic regression models were fitted to identify trends in and determinants of health-seeking at private facilities. RESULTS: The results indicate an increase in the use of private facilities for maternal and child health care over time. Across the three survey waves, women from the highest wealth quintile had the highest odds of accessing ANC services at private health facilities (AOR = 3.0, 95% CI = 1.53, 5.91 in 2006; AOR = 5.6, 95% CI = 3.51, 8.81 in 2011; AOR = 6.0, 95% CI = 3.78, 9.52 in 2016). Women from the highest wealth quintile (AOR = 3.3, 95% CI = 1.54, 7.09 in 2006; AOR = 7.3, 95% CI = 3.91, 13.54 in 2011; AOR = 8.3, 95% CI = 3.97, 17.42 in 2016) and women with more years of schooling (AOR = 1.2, 95% CI = 1.17, 1.27 in 2006; AOR = 1.1, 95% CI = 1.04, 1.14 in 2011; AOR = 1.1, 95% CI = 1.07, 1.16 in 2016) were more likely to deliver in private health facilities. Likewise, children belonging to the highest wealth quintile (AOR = 8.0, 95% CI = 2.43, 26.54 in 2006; AOR = 6.4, 95% CI = 1.59, 25.85 in 2016) were more likely to receive diarrhoea treatment in private health facilities. CONCLUSIONS: Women are increasingly visiting private health facilities for maternal and child health care in Nepal. Household wealth quintile and more years of schooling were the major determinants for selecting private health facilities for these services. These trends indicate the importance of collaboration between private and public health facilities in Nepal to foster a public private partnership approach in the Nepalese health care sector.

Exploring country-wide equitable government health care facility access in Uganda.

BACKGROUND: Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor. METHODS: An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models. RESULTS: The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents. CONCLUSIONS: The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a "pro-poor" tool to increase health access equity.

Codesigning Parks for Increasing Park Visits and Physical Activity in a Low-Socioeconomic Community: The Active By Community Design Experience.

The purpose of the Active By Community Design (ABCD) project was to engage residents in the redesign of two public open spaces to increase park visits and park-based physical activity (PBPA). It was anticipated that by adding local preferences to park design considerations along with collected data and available evidence, the study would achieve increased levels of community engagement and subsequent increases in park visits and PBPA. This study summarizes two case studies outlining the community engagement and research translation process. Utilizing a pre-post evaluation design, baseline measures were completed with a series of validated tools for park use and park quality. Baseline data, evidence, community and stakeholder input were synthesized and presented to a "design subcommittee" to translate into "real-world" park redesigns. Park audits, a household survey, and park open days identified the spaces were not designed for the activities residents wanted, while park observations identified usage was low, and those observed were mostly children and adults walking. Park redesigns focused on maximizing access, infrastructure to enable physical activity (PA), PA programs and enhancements to improve aesthetics and safety concerns. The ABCD project successfully demonstrated a process of combining data and community and stakeholder engagement input to translate evidence into the creation of more supportive environments for PA. Stakeholder and resident input to the redesign processes contributed to satisfaction and ownership that residents reported on the redesigned parks, which may increase the likelihood of increased park usage and park-based physical activity.

Preparedness of health facilities providing HIV services during COVID-19 pandemic and assessment of their compliance to COVID-19 prevention measures: findings from the Tanzania Service Provision Assessment (SPA) survey.

INTRODUCTION: the increased demands of health facilities and workers due to coronavirus overwhelm the already burdened Tanzanian health systems. This study evaluates the current capacity of facilities and providers for HIV care and treatment services and their preparedness to adhere to the national and global precaution guidelines for HIV service providers and patients. METHODS: data for this study come from the latest available, Tanzania Service Provision Assessment survey 2014-15. Frequencies and percentages described the readiness and availability of HIV services and providers. Chi-square test compared the distribution of services by facility location and availability and readiness of precaution commodities and HIV services by managing authorities. RESULTS: availability of latex gloves was high (83% at OPD and 95.3% laboratory). Availability of medical masks, alcohol-based hand rub and disinfectants was low. Availability of medical mask at outpatient department (OPD) was 28.7% urban (23.5% public; 33.8% private, p=0.02) and 13.5% rural (10.1% public; 25.4% private, p=0.001) and lower at laboratories. Fewer facilities in rural area (68.4%) had running water in OPD than urban (86.3%). Higher proportions of providers at public than private facilities in urban (82.8% versus 73.1%) and rural (88.2% versus 81.6%) areas provided HIV test counseling and at least two other HIV services. CONCLUSION: availability of commodities such as medical masks, alcohol-based hand rub, and disinfectant was low while the readiness of providers to multitask HIV related services was high. Urgent distribution and re-assessment of these supplies are necessary, to protect HIV patients, their caregivers, and health providers from COVID-19.

Equity to Urban Parks for Elderly Residents: Perspectives of Balance between Supply and Demand.

As population ages, ensuring that the elderly get their due rights has become a common concern of scholars in many fields. However, as an important public service facility in daily life of elderly, the research on the equity of urban parks is mostly based on the evaluation of accessibility. The equity of the elderly's access to urban parks services has been rarely discussed from the perspective of supply and demand balance. In the context of the concept of spatial equity, we used urban parks in the main city of Harbin as a case study, the actual travel mode of the elderly was considered in the evaluation, adopted an Integrated Spatial Equity Evaluation (ISEE) framework, quantitative evaluation of the equity of different levels of urban park under multiple traffic modes. In this study, the results showed that under the three modes of travel, the degree of spatial equity was higher for non-motorized trips than for the other two modes. In terms of urban parks hierarchy, the spatial equity of urban parks at district level were much higher than those at the neighborhood level and street level. The inequity between supply and demand for urban park for elderly people was significant and varies between administrative districts. The empirical evidence in this research may provide references and suggestions for urban parks planning and decision-making. In cities where the scale of land use is basically stable, such as Harbin, we can start from the spatial configuration of park green space system and public transportation system to improve the efficiency of urban parks provision. Thereby promoting the construction and development of an "old age-friendly" society.