[The territorial nature of the Primary Health Care of Brazil's Unified Health System (SUS): the proliferation of community medical clinics in the Metropolitan Region of Belém, State of Pará, Brazil]. / A territorialidade da Atenção Básica à Saúde do SUS: a difusão das clínicas médicas populares na Região Metropolitana de Belém, Pará, Brasil.

The scope of this article is an analysis of the proliferation of community medical clinics in the municipalities that comprise the Metropolitan Region of Belem. An investigation was conducted into the performance of the primary health care network of Brazil's Unified Health System, with a view to getting a better understanding of the reasons for, and origins of, the proactive stance of the community health sector. The discussion is based on the review of primary and secondary data, obtained via fieldwork in 119 community clinics in the Metropolitan Region of Belem, and information from Brazil's Unified Health System data center. It was revealed that the community health clinic sector has benefited extensively in recent years from the intensification of underfunding of Brazil's Unified Health System, especially the primary health care network, which is undergoing a process of fragmentation. This is directly responsible for the reduction and disruption of multiprofessional primary health care teams, in addition to the losses suffered in the supplementary health sector. The community clinics adopt an spontaneous and contradictory care model created by the private sector to meet the repressed demand of Brazil's Unified Health System.

O artigo apresenta uma análise sobre a difusão das clínicas médicas populares nos municípios que compõem a Região Metropolitana de Belém (RMB). Com o propósito de compreender as razões e as origens do avanço do setor de saúde popular, promoveu-se uma investigação sobre a atuação da rede de atenção básica à saúde (ABS) do Sistema Único de Saúde (SUS). A discussão se fundamenta na revisão de dados primários e secundários, captados via trabalho de campo nas 119 clínicas populares da RMB e via informações do DATASUS. Constatou-se que o setor das clínicas de saúde popular foi beneficiado amplamente nos últimos anos, mediante a intensificação do subfinanciamento do SUS, em particular da rede de ABS, que passa por um processo de fragmentação, responsáveis pela redução e pela desarticulação das equipes multiprofissionais de ABS, além das perdas apresentadas no setor de saúde suplementar. As clínicas populares seguem um modelo assistencial inacabado e contraditório, criado pela própria iniciativa privada para o preenchimento da demanda reprimida do SUS em razão de o acesso a essas instituições não garantir uma assistência universal e gratuita ou assegurar um tratamento continuo, motivo pelo qual uma ampla parcela destes usuários é devolvida ao SUS.

Climate change and health: The case of mapping droughts and migration pattern in Iran (2011-2016).

INTRODUCTION: Migration and mobility of population have been reported as a common reaction to drought. There is historical evidence to suggest the health effects of droughts and human migration linkage in Iran. This study aimed to map the drought and migration patterns in Iran in 2011 and 2016 and explore their possible health impacts. METHODS: This sequential explanatory mixed-method study was done in two stages of spatial analysis and qualitative study. Data mapping was conducted through the equal interval classification and using drought, migration, and agriculture occupation data based on provincial divisions in Iran in 2011 and 2016. This qualitative study was conducted using the content analysis approach. RESULTS: The in-migration rate was higher in 2011 rather than 2016. Migration to cities was much higher than migration to villages in both years. The frequency of male migrants was higher than females in all provinces in 2011 and 2016. Physical and mental diseases as well as economic, sociocultural, education, and environment effects on health were extracted from the qualitative data. CONCLUSION: A holistic picture of droughts and migration issues in Iran and their health consequences were achieved by the present research. Further research is needed to explore the determinants of health impacts of climate change in vulnerable groups. Public health problems can be prevented by adaptive and preventive policy-making and planning. This can improve the coping capacity of the population facing droughts and enforced migration.

Exploring the adoption of water quality trading as an alternative stormwater regulatory compliance strategy for land development projects: A case study for Roanoke, Virginia.

Urban stormwater runoff is a significant source of nutrient pollution that is very costly to treat. Water quality trading (WQT) is a market-based strategy that can be used to lower the costs associated with meeting stormwater quality regulations. While many WQT programs have experienced low participation, Virginia's program has seen high participation due to the inclusion of land developers and other regulated stormwater dischargers. However, the extent to which WQT is used as a compliance option by regulated stormwater dischargers is not well understood, particularly when compared with the adoption of traditional compliance options. To address this knowledge gap, we collated a novel dataset comprising site characteristics and stormwater compliance methods for all development projects in the City of Roanoke, Virginia from December 2015 to March 2022. We analyzed this dataset to characterize the adoption of nutrient offset credits and other compliance methods being used, including best management practices (BMPs) and improved land covers associated with reduced nutrient export. Results show that credits are the preferred compliance option in Roanoke and were used as the only treatment compliance method for 59% of projects with treatment requirements. Projects using credits corresponded with a lower median disturbed area (1.36 acres) and lower median nutrient load reduction requirement (0.69 pounds of total phosphorus per year) compared with other compliance methods. Furthermore, we found that 58% of the projects that used credits achieved stormwater quantity compliance using methods other than implementing stormwater control devices. By mapping buyers and sellers of credits, we found that all credit sellers are downstream of the development projects. We discuss how this downstream trading could be a cause for concern, as part of a larger discussion of the advantages of tracking stormwater compliance methods, drawing on Roanoke as a case study.

The functional microclimate of an urban arthropod pest: Urban heat island temperatures in webs of the western black widow spider.

Urbanization alters natural landscapes and creates unique challenges for urban wildlife. Similarly, the Urban Heat Island (UHI) effect can produce significantly elevated temperatures in urban areas, and we have a relatively poor understanding of how this will impact urban biodiversity. In particular, most studies quantify the UHI using broad-scale climate data rather than assessing microclimate temperatures actually experienced by organisms. In addition, studies often fail to address spatial and temporal complexities of the UHI. Here we examine the thermal microclimate and UHI experienced in the web of Western black widow spiders (Latrodectus hesperus), a medically-important, superabundant urban pest species found in cities across the Western region of North America. We do this using replicate urban and desert populations across an entire year to account for seasonal variation in the UHI, both within and between habitats. Our findings reveal a strong nighttime, but no daytime, UHI effect, with urban spider webs being 2-5 °C warmer than desert webs at night. This UHI effect is most prominent during the spring and least prominent in winter, suggesting that the UHI need not be most pronounced when temperatures are most elevated. Urban web temperatures varied among urban sites in the daytime, whereas desert web temperatures varied among desert sites in the nighttime. Finally, web temperature was significantly positively correlated with a spider's boldness, but showed no relationship with voracity towards prey, web size, or body condition. Understanding the complexities of each organism's thermal challenges, the "functional microclimate", is crucial for predicting the impacts of urbanization and climate change on urban biodiversity and ecosystem functioning.

[A survey on the current situation of serum vitamin A and vitamin D levels among children aged 2-<7 years of 20 cities in China].

Objective: To investigate serum vitamin A and vitamin D status in children aged 2-<7 years in 20 cities in China. Methods: A cross-sectional study was conducted. A total of 2 924 healthy children aged 2-<7 years were recruited from September 2018 to September 2019 from 20 cities in China, categorized by age groups of 2-<3 years, 3-<5 years, and 5-<7 years. The demographic and economic characteristics and health-related information of the enrolled children were investigated. Body weight and height were measured by professional staff members. The serum vitamin A and vitamin D levels were detected by high-performance liquid chromatography-tandem mass spectrometry. Chi-square test and Logistic regression were applied to analyze the association between vitamin A and vitamin D deficiency and insufficiency as well as their underlying impact factors. Results: The age of the 2 924 enrolled children was 4.33 (3.42, 5.17) years. There were 1 726 males (59.03%) and 1 198 females (40.97%). The prevalences of vitamin A and vitamin D deficiency in enrolled children were 2.19% (64/2 924) and 3.52% (103/2 924), respectively, and the insufficiency rates were 29.27% (856/2 924) and 22.20% (649/2 924), respectively. Children with both vitamin A and vitamin D deficiencies or insufficiencies were found in 10.50% (307/2 924) of cases. Both vitamin A (χ2=7.91 and 8.06, both P=0.005) and vitamin D (χ2=71.35 and 115.10, both P<0.001) insufficiency rates were higher in children aged 3-<5 and 5-<7 years than those in children aged 2-<3 years. Vitamin A and vitamin D supplementation in the last 3 months was a protective factor for vitamin A and D deficiency and insufficiency, respectively (OR=0.68 and 0.22, 95%CI 0.49-0.95 and 0.13-0.40, both P<0.05). The rates of vitamin A and D insufficiency was higher in children with annual household incomes <60 000 RMB than in those with annual household incomes ≥60 000 RMB (χ2=34.11 and 10.43, both P<0.01). Northwest and Southwest had the highest rates of vitamin A and vitamin D insufficiency in children aged 2-<7 yeas, respectively (χ2=93.22 and 202.54, both P<0.001). Conclusions: Among 20 cities in China, children aged 2-<7 years experience high rates of vitamin A and vitamin D insufficiency, which are affected by age, family economic level, vitamin A and vitamin D supplementation, and regional economic level. The current results suggest that high level of attention should be paid to vitamin A and vitamin D nutritional status of preschool children.

Understanding the Integrated Health Management System Policy in China From Multiple Perspectives: Systematic Review and Content Analysis.

BACKGROUND: The integrated health management system (IHMS), which unites all health care-related institutions under a health-centered organizational framework, is of great significance to China in promoting the hierarchical treatment system and improving the new health care reform. China's IHMS policy consists of multiple policies at different levels and at different times; however, there is a lack of comprehensive interpretation and analysis of these policies, which is not conducive to the further development of the IHMS in China. OBJECTIVE: This study aims to comprehensively analyze and understand the characteristics, development, and evolution of China's IHMS policy to inform the design and improvement of the system. METHODS: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to collect 152 policy documents. With the perspective of policy tools and policy orientation as the core, a comprehensive 6D framework including policy level, policy nature, release time, policy tools, stakeholders, and policy orientation was established by combining the content of policy texts. These dimensions were then analyzed using content analysis. RESULTS: First, we found that, regarding the coordination of policy tools and stakeholders, China's IHMS policy was more inclined to use environment-based policy tools (1089/1929, 56.45%), which suggests a need for further balance in the internal structure of policy tools. Attention to different actors varied, and the participation of physicians and residents needs further improvement (65/2019, 3.22% and 11/2019, 0.54%, respectively). Second, in terms of level differences, Shanghai's IHMS policy used fewer demand-based policy tools (43/483, 8.9%), whereas the national IHMS policy and those of other provinces and cities used fewer supply-based tools (61/357, 17.1% and 248/357, 69.5%, respectively). The national IHMS strategy placed more emphasis on the construction of smart health care (including digital health; 10/275, 3.6%), whereas Shanghai was a leader in the development of healthy community and healthy China (9/158, 5.7% and 4/158, 2.5%, respectively). Third, in terms of time evolution, the various policy tools showed an increasing and then decreasing trend from 2014 to 2021, with relatively more use of environment-based policy tools and less use of demand-based policy tools in the last 3 years. The growth of China's IHMS policy can be divided into 3 stages: the disease-centered period (2014-2017), the e-health technology development period (2017-2019), and the health-centered period (2018-2021). CONCLUSIONS: Policy makers should make several adjustments, such as coordinating policy tools and the uneven relationships among stakeholders; grasping key policy priorities in the context of local characteristics; and focusing on horizontal, multidimensional integration of health resources starting from the community. This study expands the objects of policy research and improves the framework for policy analysis. The findings provide some possible lessons for future policy formulation and optimization.

Optimal site selection for construction and demolition waste disposal using GIS-FAHP: a case study from Kafr El Sheikh City, Egypt.

The increasing number of building and demolition projects results in huge amounts of construction and demolition wastes (CDWs) that are illegally dumped. However, these wastes must be disposed of in appropriate legal sites to protect the environment and human health. After reviewing the literature, no prior research examined optimal site selection for dumping or recycling CDW in an Egyptian city. Furthermore, the absence of field surveys did not offer a holistic understanding of the specific criteria used in the model for this region, nor did it permit an assessment of the suitability of existing dumpsites, thereby revealing certain limitations in the final results. In this regard, this research aims to apply a multi-criteria geographic information system (GIS)-based framework to identify an optimal site for CDW disposal in Kafr El Sheikh City. The criteria affecting the site selection are identified and categorized from prior literature, which are further refined using field surveys and focus group to evaluate their applicability in the context of an Egyptian city. After conducting questionnaire surveys, the trapezoidal interval type II fuzzy analytic hierarchy process is applied to compute the weights of the identified criteria from the perspective of each group of experts. The entropy-based aggregation approach is employed to identify the compromise weights taking into account the preferences of different groups. GIS is a powerful tool for geoprocessing and analyzing spatial big data. The result is a scenario map for the optimal site locations with varying suitability scales (i.e., excellent, very good, good, average, poor, and very poor). The proposed methodology provides what-if scenarios based on a selected set of criteria. According to the results of the multi-criteria decision analysis models, the suitability varies based on the weights of the criteria. For the equal-weighted criteria model, the excellent category covers 5.96% of the study area, increasing to 6.48% for the weighted criteria model. These areas primarily lie in the northeast direction. Conversely, the majority of the study area, 41.80% under equal-weighted criteria and 32.39% under weighted criteria, falls within the average and poor suitability categories, respectively. In general, the most suitable areas are located on the outskirts of the city, and the suitability decreases near the central business district. To bridge the gap between research findings and practical applications, a land use analysis employing satellite imagery is conducted to pinpoint suitable locations for CDW disposal. Existing CDW dumpsites predominantly fall within the range of poor to very good for the equal-weighted criteria model, while the weighted criteria model categorizes them into the poor (16.66%) and average (83.33%) categories. The findings demonstrated the applicability of the proposed framework for CDW disposal management and planning.

Temporal variation of allergenic potential in urban parks during the vegetation period: a case study from Bratislava, Slovakia.

Park greenery represents an oasis for urban residents; however, during the flowering period of trees that produce allergenic pollen grains, these areas threaten individuals suffering from seasonal allergic respiratory diseases. In this study, we evaluated the temporal distribution of the allergenic potential of three most important urban parks in Bratislava over the vegetation period, using a modification of the Urban Green Zone Allergenicity Index (IUGZA) and Individual-Specific Allergenic Potential Index (IISA) designed as a running index - rIUGZA and rIISA. We found that rIUGZA gives better information for park management and revitalization, since it considers the potential size of woody plants, while rIISA, considering the actual size of the vegetation, provides more relevant information for pollen-allergy sufferers. Based on rIISA, the allergenic potential was highest in May for the Grassalkovich Garden (formal baroque garden) and Janko Král Park (English landscape park) and in April for the Medic Garden (repurposed baroque garden). We also found differences in the duration of the period of increased allergenic potential in these parks, ranging from 1 to 3 months. Based on the total annual sums of rIISA, we found the highest allergenic potential in the Medic Garden and lowest in the Janko Král Park. This variance is caused mainly by the different density of trees and percentage of allergenic species. The biggest contributors to the allergenic potential were Platanus, Acer and Tilia. Based on the information on temporal variation of the allergenic potential during the vegetation period provided by the running indices, it is possible to improve the planning of park revitalization based on the flowering period of allergenic species and provide better information to the pollen-allergy sufferers for minimizing the allergenic effect of urban green areas on their health during a particular month.

Transplanted Ginkgo growth rates indicate common Chinese nursery techniques may severely limit urban ecosystem services.

China has experienced history's largest rural-to-urban migration. The social, economic, and environmental challenges brought about by urbanization are diverse and complex. Given China's national goal to achieve carbon neutrality by 2060 and commitment to urban sustainability, large cities have focused on urban greening initiatives. Yet, studies seeking to quantify ecosystem services and disservices only assess healthy, mature trees, rather than those with severe damage, declining health, or lack of vitality due to poor management. In this short communication, we conducted a case-study in one of China's major nursery stock-producing cities, Chengdu, on a common street tree, Ginkgo biloba, to assess the long-term impact of one of the most common yet extreme nursery transplant practices on tree growth (traumatic root-cutting of 'super-large' nursery stock). We used tree-ring data collected in a typical urban greenspace from 23 Ginkgo trees, including 18 trees transplanted as 'super-large' nursery stock and a control group (5 trees) transplanted as small-caliper trees. We found the trees transplanted as 'super-large' nursery stock experienced declining tree growth with decades of lost landscape potential likely due to traumatic root-cutting at the time of transplant from nursery to landscape. The control group allowed contrast between the growth patterns of 'super-large' transplanted trees with those that remained healthy, being transplanted as smaller-caliper trees. For the 'super-large' trees, we found a decrease in carbon sequestration from 7.6 kg C yr-1 on average per tree in 2001 to about 1.5 kg C yr-1 on average per tree in 2021, while no decreasing trends were observed among the control trees. This implies a negative impact on multiple expected ecosystem services including carbon sequestration, shade, canopy coverage, and pollutant mitigation. These results highlight the unrecognized costs of common Chinese nursery and transplant techniques on urban landscape trees, necessitating more research, science-based policies, and better management techniques.

Predicting coastal harmful algal blooms using integrated data-driven analysis of environmental factors.

Coastal harmful algal blooms (HABs) have become one of the challenging environmental problems in the world's thriving coastal cities due to the interference of multiple stressors from human activities and climate change. Past HAB predictions primarily relied on single-source data, overlooked upstream land use, and typically used a single prediction algorithm. To address these limitations, this study aims to develop predictive models to establish the relationship between the HAB indicator - chlorophyll-a (Chl-a) and various environmental stressors, under appropriate lagging predictive scenarios. To achieve this, we first applied the partial autocorrelation function (PACF) to Chl-a to precisely identify two prediction scenarios. We then combined multi-source data and several machine learning algorithms to predict harmful algae, using SHapley Additive exPlanations (SHAP) to extract key features influencing output from the prediction models. Our findings reveal an apparent 1-month autoregressive characteristic in Chl-a, leading us to create two scenarios: 1-month lead prediction and current-month prediction. The Extra Tree Regressor (ETR), with an R2 of 0.92, excelled in 1-month lead predictions, while the Random Forest Regressor (RFR) was most effective for current-month predictions with an R2 of 0.69. Additionally, we identified current month Chl-a, developed land use, total phosphorus, and nitrogen oxides (NOx) as critical features for accurate predictions. Our predictive framework, which can be applied to coastal regions worldwide, provides decision-makers with crucial tools for effectively predicting and mitigating HAB threats in major coastal cities.

A system dynamics model and analytical hierarchy process: an integrated approach for achieving sustainable solid waste management system.

Waste management in low-income countries faces challenges with an average cost of $35/ton approximately 51% collection efficiency. Despite investments in treatment, processing, and recycling, the system remains unsustainable owing to poor planning and policies. The current analysis of Lahore's solid waste management (SWM) system, selected as a major city of a low-income country as a case study, focuses on collection efficiency and waste generation. However, it neglects the complex and dynamic nature of SWM systems. To capture the complexities and dynamic nature of the SWM system, system dynamic (SD) modeling is proposed for its effectiveness in modeling complex and dynamic systems. Unlike previous attempts at SD modeling that mostly consider only some components of the SWM system with varying success, this study attempts to use a holistic approach by considering all aspects of an integrated SWM system. In addition, this study explores different financial and management policies, highlighting the weaknesses of the system through a quantitative comparison of three scenarios: (1) business-as-usual (BAU) which considers the current trends in waste generation and practices of collection and disposal to landfill, (2) waste treatment system (WTS) in which various waste treatment systems are included to reduce burden on landfill, and (3) introduction of user fee with awareness campaigns (UFAC) which encourages community participation towards reduction in waste generation and financially supports the SWM. All three scenarios use four indices: waste generation, waste ending up in landfill, uncollected waste, and annual budget deficit as performance indices. These scenarios were simulated over a 25-year period using an SD model, covering all six components of the SWM system. The BAU scenario shows a 16% increase in waste generation, a 173% increase in landfill waste, an 11% reduction in uncollected waste, and a 64% increase in the budget deficit over the simulation period, indicating an unsustainable SWM system. The WTS scenario exhibits a 16% increase in waste generation, a 155% increase in landfill waste, an 11% reduction in uncollected waste, and a 61% increase in the budget deficit, showing a significant reduction in landfill waste and a slight reduction in deficit but it remains unsustainable. The UFAC scenario, however, results in a 40% reduction in waste generation, a 67% decrease in uncollected waste, an 8% decrease in landfill waste, and a 59% decrease in the budget deficit. These results demonstrate that instituting user fees for SWM services and incentivizing community participation towards waste reduction and segregation can make the SWM system of Lahore sustainable. This SD model provides insights for policymakers, aiding what-if analyses and long/short-term waste management plans for metropolitan cities in low-income countries. To validate the sustainability judgments based on performance indices, the analytical hierarchy process (AHP), a multi-criteria decision analysis (MCDA) tool commonly used for ranking policy decisions based on competing criteria, was employed. It considered the same four criteria as in the SD model. The results of the AHP analysis aligned with those of the SD model, ranking the UFAC scenario as the most sustainable option.

Knowledge, attitude, and perceptions of healthcare professionals towards complementary and alternative medicine: a cross-sectional survey from twin cities of Pakistan.

BACKGROUND: The growing popularity and use of complementary and alternative medicine (CAM) products among the general public worldwide has been well documented. This study aimed to investigate the knowledge, attitude, and perceptions (KAP) of Pakistani healthcare professionals (HCP) toward CAM and to document their views on integrating CAM education with the curriculum of undergraduate health science programs. METHOD: A cross-sectional study using simple random sampling was conducted for a duration of ten months among HCPs from Pakistan's twin cities: Islamabad and RawalpindiThe data were collected using a self-administered and validated (Cronbach's alpha: 0.71) questionnaire. This questionnaire consisted of five sections, namely; demographic, attitude, perception, integration and knowledge. RESULT: The response rate was 91.20% (500/456). The participants included 160 physicians, 155 nurses,and 141 pharmacists. The majority of the respondents were females, 67.50%, and unmarried (60.50%).The majority of HCPs participating in this study agreed that CAM modalities may benefit conventional medicine system. Likewise, most HCPs perceived different CAM therapies aseffective treatment options. More than 50% HCPs suggested CAM elective courses in the curriculum of the health sciences program.Overall, 79.17% of the HCPs have poor knowledge of CAM. Physicians have the highest knowledge score 25.63%, followed by pharmacists 21.99%, and nurses 12.26%. Knowledge status was significantly associated with age, profession, and experience of practice (p = 0.001,0.001 & 0.019). CONCLUSION: This study revealed that despite the overall positive attitude of HCPs toward CAM, the score of knowledge is low. Therefore, the survey recommends evidence-based guidelines for the rationale use of CAM and updated syllabi of undergraduate health programs which will assist the future HCPs in increasing professionals' knowledge toachieve better health outcomes for the general public.

Intensified discrimination against tenants and its health effects during the COVID-19 pandemic in large Chinese cities.

The COVID-19 pandemic in many senses reconstructs social norms and reshapes social behaviour, which typically assumes a close correlation between mobility with a higher risk of COVID-19 infection. This may intensify the pre-existing discrimination against tenants and widen tenure-based health inequalities. Drawing on an online questionnaire survey conducted in five major cities in China in 2020, we employ multi-level regression models to examine the intensified discrimination against tenants during COVID-19 and its impacts on residents' physical and mental health inequalities. Results show that the pre-existing inequalities have been intensified during COVID-19 and the perceived discrimination has rendered worsened self-rated health and mental health and enlarged health inequalities. The discrimination particularly affected tenants with better economic profiles or worse health conditions; by contrast, despite being exposed to more tenant-related discriminatory experiences, rural hukou holders suffered from less severe health inequalities. A clear linkage is found between renting in poorly-managed and larger health gaps generated by discrimination. The negative health impact of intensified discrimination is found to be more significant in communities with lower infection risk, which points to the necessity of understanding the long-term health impact of discrimination against tenants in a more holistic way. In terms of community environment, we discover a positive effect of community social capital, i.e., higher level social capital helps mitigate the health threat of discrimination against tenants during COVID-19. Besides, public housing tenants reported better health outcomes and were less exposed to intensified discrimination during COVID-19 than private housing tenants. These findings provide a nuanced understanding of variations determined by individual and territorial factors, thus present timely policy implications for promoting healthy and inclusive urban development in the post-pandemic era.

Using the Doughnut Economics framework to structure whole-system thinking in socioecological wellbeing with multidisciplinary stakeholders: an applied case study in Glasgow, Scotland.

BACKGROUND: Human and environmental health are inseparable and interdependent. Doughnut Economics is a conceptual framework combining the Sustainable Development Goals with Planetary Boundaries, thereby simultaneously considering human and planetary wellbeing. The vision is to "meet the needs of all people within the means of the living planet, for the benefit of both current and future generations". Glasgow City Council has committed to becoming a Green Wellbeing Economy, with a socially just transition to Net Zero by 2030. Through our City-University partnership, we are exploring whether Doughnut Economics can drive transformative action towards a sustainable, healthy, and equitable future. METHODS: Glasgow is a pilot site for the C40 Cities' Thriving City Portrait methodology that downscales Doughnut Economics to cities. The Portrait process combined desk-based research and policy review (from January to April, 2022) with participatory workshops to enrich initial findings. The five participatory workshops took place between April, 2022, and February, 2023, and involved about 130 stakeholders. Participants included civil servants, politicians, scientists, community representatives, employees and representatives of private and third-sector organisations, and social enterprises, identified through an iterative stakeholder mapping process with City Council partners. Workshop aims were to create pluralistic definitions of what thriving means for each of the Doughnut's social and ecological dimensions. Ethics approval for the study was granted by The University of Glasgow, College of Medical Veterinary and Life Sciences. FINDINGS: The workshops produced a shared, holistic vision for Glasgow's future as a thriving city. The Doughnut demonstrated potential as a tool for both understanding the city's socioecological impacts, and as a compass by which the city might set its policy agenda. It allows the multiple goals and priorities of a city system to congregate around a cohesive goal. The Portrait process led to a widening of stakeholders' perspectives, applying systems thinking to policy priorities, cross-sector discussion and collaboration, and significant buy-in from a diverse range of changemakers. INTERPRETATION: The Doughnut framework offered a starting point for Public and Planetary Health researchers to understand connections, co-benefits and trade-offs across different parts of the policy and intervention system. Applying this framework in cities could generate support for whole-system interventions and sustainable solutions to the complex and interconnected climate and social challenges we face. One of the limitations is that we do not yet know whether stakeholders can translate support for this co-created framework into tangible whole-systems action. FUNDING: UKRI Natural Environment Research Council and University of Glasgow.

Variations of pollen concentration in urban alleys of park city and the transmission pattern during the period of high allergenic risk: Taking Qingyang District of Chengdu City as an example.

Pollen (spores and pollen) allergy caused by green areas is one of the most serious environmental epidemics endangering urban public health. The pollen allergy rate in China reached 17.8% in 2022, characterized by a wide age range of onset, severity and diversity of symptoms. The aims of this study were to verify the consistency of the prediction results of pollen concentration and the index of allergenicity of urban green zones (IUGZA) equation, and to clarify the dispersal pattern of tree pollen in the urban alleys of cities with high density of static wind. We selected representative high, medium and low allergenic areas based on the allergenic stress in urban alleys of Qingyang District, Chengdu calculated by IUGZA equation, and monitored the pollen concentrations by selecting points and indicator species within the three allergenic areas. There was a consistency in the variation of pollen concentration in urban alleys of the three areas, with the highest pollen concentration in March. Mean pollen concentration showed a pattern of spring > autumn > summer > winter. The main pollen sources belonged to Ginkgo, Platanus, Firmiana and Cedrus, accounting for 42.4%, 16.3%, 9.0% and 6.5% of the total pollen, respectively. Wind speed had the greatest effect on pollen concentration and its dispersal distance in the urban alley. The horizontal dispersal distance of pollen was up to 260 m, and the number of pollen showed a significant negative linear correlation with the distance away from the pollen sources. The concentration of exotic pollen collected at the high site (4.5 m above ground) was much lower than that at the near-ground site (1.5 m above ground), but without difference in the types of pollen. The results of allergenic risk predicted by the IUGZA equation were consistent with the actual measured pollen concentration, which could be used in high-density static wind city.

Descriptive study of reported cases of sexual violence and specialized care services in the state of Minas Gerais, Brazil, 2019.

OBJECTIVE: to describe the sociodemographic profile of reported cases of sexual violence (SV) and the distribution of care services for this health condition in the state of Minas Gerais, Brazil, 2019. METHODS: this was a descriptive study of the cases of sexual violence reported on the Notifiable Health Conditions Information System and care services registered in the National Health Establishment Registry. RESULTS: a total of 4,418 notifications of SV were identified during the study period, representing more than 12 notifications per day; the majority of notifications were among females (87.0%) and among children and adolescents (72.0%); the distribution of care services showed care gaps in four of the 14 health macro-regions of the state of Minas Gerais; the maximum distances traveled to access referral services ranged from 93 to 327 km. CONCLUSION: the scarcity of care services for people subjected to sexual violence in the micro-regions and macro-regions of Minas Gerais highlights the need for planning public policies aimed at increasing access to these services. MAIN RESULTS: Over 12 notifications of sexual violence were reported per day in the state of Minas Gerais in 2019, with a higher prevalence in females, children and adolescents, mixed-race/Black people. Care gaps were identified in four macro-regions of the state. IMPLICATIONS FOR SERVICES: There was a need for victims to travel long distances to receive care in municipalities with referral services for comprehensive care for sexual violence, which may hinder access and timely care. PERSPECTIVES: It is expected that the results can contribute to improving public policies, considering the need to strategically plan the location of specialized services for people subjected to sexual violence.

Diet, lifestyle and contaminants in three east Greenland Inuit municipalities.

Persistent organic pollutants (POP) are environmental contaminants transported over long distances to the Arctic where they biomagnify in marine mammals subsistence hunted by Inuit and may therefore affect human health. Marine mammals in east Greenland are known to have the highest POP concentrations in the circumpolar Arctic area. Due to high intake of marine mammals, east Greenlandic Inuit likewise have the highest POP body burdens across the Arctic. This cross-sectional study aims to investigate the levels of POP and metals in Inuit with a high intake of top predatory species including killer whales and polar bears. Study participants include 37 men and 21 women from Kulusuk, Tasiilaq and Ittoqqortoormiit during year 2013-2015. Lipophilic POP (11 organochlorine-pesticides, 14 polychlorinated-biphenyls (PCB), 10 polybrominated diphenyl ethers), polyunsaturated fatty acids (PFUA) and cotinine were determined in plasma. Fifteen perfluoroalkylated substances (PFAS) were measured in serum and urine and the renal clearance was estimated. Finally the concentration of 10 metals were measured in whole blood. The median age was 38 years, Ittoqqortoormiit Inuit being the oldest. The smoking rate was around 70%, and Kulusuk participants had the lowest PFUA concentrations. Significant municipality differences were observed for lipophilic POP, serum PFAS, mercury, arsenic and selenium with highest concentrations in Ittoqqortoormiit Inuit. Males had higher blood concentrations of PFAS and lead. The estimated PFAS renal clearance and ratio of urine to serum were significantly higher for females, suggesting a sex difference in excretion via the kidney, maybe partly because men had higher serum PFAS concentrations. We observed that Inuit with intake of >200 g polar bear per week had significantly higher levels of PCB, PFAS, arsenic and selenium. In summary, the level of blood POP and heavy metals seems to relate to sex and the frequency intake of meat from marine mammals.

Exploring the role of nature-based typologies and stewardship schemes in enhancing urban green spaces: Citizen perceptions of landscape design scenarios and ecosystem services.

This research investigates the UK citizens' perceptions of the ecosystem services (ES) created using a range of Nature-Based Solutions (NBS) in urban green spaces (UGS). The longevity of the ES derived from UGS is dependent on the effective on-going maintenance of urban landscapes, therefore this paper also gathers data on direct UGS participation specifically through the lens of civic stewardship to assess the impact of such schemes upon ES. NBS typologies were created and used, in the mixed methods study, to gauge perceptions of and preferences for alternative urban landscape design. The UGS survey collected data from 345 respondents on ES and the NBS typologies. Twelve semi-structured interviews provide qualitative data on NBS typology preferences, perceptions, and understanding of ES as well as motivations behind civic engagement in UGS in the UK. Stewardship programmes were found to increase community resilience by providing additional ES. The results showed a preference for integrating complex, multifunctional UGS into the fabric of urban centres to ensure accessibility and to maximise engagement. More complex NBS typologies were perceived to provide additional ES when compared with traditional monoculture mown grass and shrub amenity planting. Mixed native planting and Tiny Forest NBS typologies were perceived as providing more provisioning, cultural, regulating, and supporting ES. Considering both UK citizens' perceptions of the ES gained from alternative NBS and stewardship schemes in UGS represents a holistic approach that can improve the design and management of NBS in cities. This study is the first to explore both concepts in the UK and suggests a holistic UGS approach to address urban challenges, including those related to Climate Change.

Use of complementary and alternative medicine by cancer patients in Colombia.

BACKGROUND: The use of complementary and alternative medicines (CAM) among cancer patients varies greatly. The available data suggest an increasing use of CAM over time and a higher prevalence in low- and middle-income countries. However, no reliable data are available from Latin America. Accordingly, we examined the prevalence of CAM use among cancer patients from six Colombian regions. METHODS: We conducted a survey on cancer patients attending comprehensive cancer centres in six capital cities from different regions. The survey was designed based on a literature review and information gathered through focus groups on CAM terminology in Colombia. Independent random samples of patients from two comprehensive cancer centres in every city were obtained. Patients 18 years and older with a histopathological diagnosis of cancer undergoing active treatment were eligible. The prevalence of CAM use is reported as a percentage with the corresponding confidence interval. CAM types are reported by region. The sociodemographic and clinical characteristics of CAM users and non-users were compared using Chi square and t tests. RESULTS: In total, 3117 patients were recruited. The average age 59.6 years old, and 62.8% were female. The prevalence of CAM use was 51.7%, and compared to non-users, CAM users were younger, more frequently women, affiliated with the health insurance plan for low-income populations and non-Catholic. We found no differences regarding the clinical stage or treatment modality, but CAM users reported more treatment-related side effects. The most frequent types of CAM were herbal products, specific foods and vitamins, and individually, soursop was the most frequently used product. Relevant variability between regions was observed regarding the prevalence and type of CAM used (range: 36.6% to 66.7%). The most frequent reason for using CAM was symptom management (30.5%), followed by curative purposes (19.5%). CONCLUSIONS: The prevalence of CAM use among cancer patients in Colombia is high in general, and variations between regions might be related to differences in cultural backgrounds and access to comprehensive cancer care. The most frequently used CAM products and practices have little scientific support, suggesting the need to enhance integrative oncology research in the country.

Telecoupled urban demand from West African cities causes social-ecological land use transformation in Saharan oases.

Little is known about the long-distance telecoupling effects of urban food demands on land use changes (LUCs) in remote oases of the Southern Sahara. Using the example of two typical oasis settlements on Mont Bagzam in the southern Aϊr Mountains of Niger which are linked to regional and global markets by an unpaved road since 2015, this study aimed at analyzing time trajectories of LUCs and related changing agricultural production patterns. LUCs were quantified for 1955 to 2022 using GIS-based mapping of agriculture and natural vegetation based on historical aerial photographs, CORONA and multi-spectral satellite images, and high resolution drone-based surveys. The results show a major increment in actively used agricultural land in the 850 ha watershed of the two oases from 11 ha in 1955 to 13 ha in 2003 and 68 ha in 2022 as well as the addition of 92 irrigation wells to 16 existing ones between 2003 and 2022. LUCs and evapotranspiration calculated from climatic data of a local weather station allowed to estimate changes of irrigation water needs in the selected watershed. While annual precipitation averages only 214 mm, local reference evapotranspiration may reach 1,476 mm year-1. Therefore, the additional annual irrigation water needs for the newly established fields between 2003 and 2022 cultivated to cash crops rose by 696 million l. To detect LUC effects on soil quality, soil samples of onion and garlic fields of different ages were collected employing a false-time-series approach. Results reveal increasing soil pH and salt concentrations and falling ground water tables, which reflects a negative water balance and ground water extraction above recharge levels. Our study provides evidence that the newly established telecoupled production systems on Mont Bagzam threaten the sustainability of existing local agricultural production and related livelihoods of agro-pastoralists.