Exploring the Relationship Between Air Quality and Ischemic Stroke Admissions During the COVID-19 Pandemic.

OBJECTIVES: Amongst all the global catastrophe due to Coronavirus disease 2019, a significant bright spot is a reduction in air pollution as countries undergo lockdowns to limit the spread of infection. Another reduction that has been reported is in the number of strokes presenting to hospitals, despite the virus implicated in causing a hypercoagulable state. Acute exposure to air pollution has been linked to increase in stroke incidence and the improvement in air quality may be responsible for the decrease in stroke presentations. MATERIALS AND METHODS: To explore this hypothesis, we compared the air quality index (AQI) of Karachi, the largest cosmopolitan city of Pakistan, during the lockdown period in 2020 to the same period in the previous year. RESULTS: We found a significant drop in AQI depicting an improvement in air quality. Simultaneously, we identified a drop in number of stroke admissions to less than half from 2019 to 2020 at one of the largest tertiary care hospitals of the city, during this period of interest. CONCLUSION: We hypothesize that one important reason for this drop in stroke admissions, may be an actual reduction in stroke incidence brought about by an improvement in air quality.

Infant Mortality in the Metropolitan Region, Chile 2005-2014. / Mortalidad Infantil en las comunas de la Región Metropolitana, periodo 2005-2014.

INTRODUCTION: Infant mortality depends on the economic, social, and cultural level of development of the place of residence. OBJECTIVE: To describe the infant mortality rates (IMR) and the late infant mortality rates (LIMR) of the Metropolitan Region (MR) communes and to evaluate their trend between 2005 and 2014. MATERIAL AND METHOD: Ecological study that describes the rates of the 52 communes of the MR. For the analysis, the IMR and LIMR were elaborated for each year and com mune and were compared using population attributable risk (PAR), attributable risk percent (AR%), and rate ratio (RR). Trends were analyzed through the Prais-Winsten model. A value p < 0.05 was considered a statistically significant trend. RESULTS: The commune 'Independencia' presented the hig hest IMR and LIMR with 12.7 and 4.05 per 1000 live births respectively, 1.75 and 2.05 times more compared with the IMR and LIMR of the MR. The commune 'Las Condes' and 'Vitacura' presented the lowest IMR and LIMR respectively. The IMR trend regarding 2005 increased in Lo Barnechea, Lo Espejo, and Recoleta, and decreased in Las Condes, Macul, Pudahuel and San Bernardo. The LIMR decreased in Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Tala- gante, Pedro Aguirre Cerda, and Quilicura, and increased in Peñaflor. CONCLUSION: The regional IMR and LIMR hide the slight increase in rates and the persistence of heterogeneity among communes. This forces us to explore the causes of these inequities through future analytical studies.

Time Trends in First-Episode Genital Herpes Simplex Virus Infections in an Urban Sexually Transmitted Disease Clinic.

BACKGROUND: Genital herpes simplex virus type 1 (HSV-1) has emerged as the leading cause of first-episode genital herpes among specific populations in the United States, such as adolescents, young adult women, and men who have sex with men (MSM). We examined trends in the etiology of first-episode genital herpes diagnoses over time in a sexually transmitted disease (STD) clinic population. METHODS: Using an electronic database, we identified persons diagnosed as having first-episode genital herpes at Public Health - Seattle & King County STD Clinic from 1993 to 2014 and compared risk factors for genital HSV-1 versus herpes simplex virus type 2 (HSV-2) infection. RESULTS: Of 52,030 patients with genital ulcers, 3065 (6.15%) had first-episode genital herpes infection: 1022 (33.3%) with HSV-1 and 2043 (67.7%) with HSV-2. Overall, 1154 (37.7%) were women, the median age was 28 years (interquartile range, 24-36 years), 1875 (61.2%) patients were white, and 353 (11.5%) were MSM. The number of patients diagnosed as having first-episode genital HSV-2 declined on average by 5.5 persons per year, from 208 in 1993 to 35 in 2014 (change of -5.6 per year; 95% confidence interval [CI], -6.9 to -4.1), whereas HSV-1 diagnoses remained stable at approximately 50 per year (change of 0.2; 95% CI, -0.4 to 0.9). In a multivariate model, persons diagnosed as having first-episode genital HSV-1 rather than genital HSV-2 infection were more likely to be younger (age <30 years [relative risk {RR}, 1.38; 95% CI, 1.22-1.55]), white (RR, 3.16; 95% CI, 2.57-3.88), and MSM (RR, 1.50; 95% CI, 1.31-1.71). CONCLUSIONS: We observed a significant decrease in the frequency of first-episode genital HSV-2 and a stable number of first-episode genital HSV-1 infections in a STD clinic over the last 2 decades.

Is the Urban Child Health Advantage Declining in Malawi?: Evidence from Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

In many developing countries including Malawi, health indicators are on average better in urban than in rural areas. This phenomenon has largely prompted Governments to prioritize rural areas in programs to improve access to health services. However, considerable evidence has emerged that some population groups in urban areas may be facing worse health than rural areas and that the urban advantage may be waning in some contexts. We used a descriptive study undertaking a comparative analysis of 13 child health indicators between urban and rural areas using seven data points provided by nationally representative population based surveys-the Malawi Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Rate differences between urban and rural values for selected child health indicators were calculated to denote whether urban-rural differentials showed a trend of declining urban advantage in Malawi. The results show that all forms of child mortality have significantly declined between 1992 and 2015/2016 reflecting successes in child health interventions. Rural-urban comparisons, using rate differences, largely indicate a picture of the narrowing gap between urban and rural areas albeit the extent and pattern vary among child health indicators. Of the 13 child health indicators, eight (neonatal mortality, infant mortality, under-five mortality rates, stunting rate, proportion of children treated for diarrhea and fever, proportion of children sleeping under insecticide-treated nets, and children fully immunized at 12 months) show clear patterns of a declining urban advantage particularly up to 2014. However, U-5MR shows reversal to a significant urban advantage in 2015/2016, and slight increases in urban advantage are noted for infant mortality rate, underweight, and stunting rate in 2015/2016. Our findings suggest the need to rethink the policy viewpoint of a disadvantaged rural and much better-off urban in child health programming. Efforts should be dedicated towards addressing determinants of child health in both urban and rural areas.

The Urban Liveability Index: developing a policy-relevant urban liveability composite measure and evaluating associations with transport mode choice.

BACKGROUND: Designing healthy, liveable cities is a global priority. Current liveability indices are aggregated at the city-level, do not reflect spatial variation within cities, and are often not aligned to policy or health. OBJECTIVES: To combine policy-relevant liveability indicators associated with health into a spatial Urban Liveability Index (ULI) and examine its association with adult travel behaviours. METHODS: We developed methods to calculate spatial liveability indicators and the ULI for all residential addresses in Melbourne, Australia. Associations between the address-level ULI and adult travel behaviours from the 2012-2014 Victorian Integrated Survey of Travel and Activity (VISTA) (n = 12,323) were analysed using multilevel logistic regression. Sensitivity analyses to evaluate impact of methodological choices on distribution of liveability as assessed by the ULI and associations with travel mode choice were also conducted. RESULTS: Liveability estimates were calculated for 1,550,641 residential addresses. ULI scores were positively associated with active transport behaviour: for each unit increase in the ULI score the estimated adjusted odds ratio (OR) for: walking increased by 12% (95% Credible Interval: 9%, 15%); cycling increased by 10% (4%, 17%); public transport increased by 15% (11%, 19%); and private vehicle transport decreased by 12% (- 9%, - 15%). CONCLUSIONS: The ULI provides an evidence-informed and policy-relevant measure of urban liveability, that is significantly and approximately linearly associated with adult travel behaviours in the Melbourne context. The ULI can be used to evaluate progress towards implementing policies designed to achieve more liveable cities, identify spatial inequities, and examine relationships with health and wellbeing.

21st century research in urban WASH and health in sub-Saharan Africa: methods and outcomes in transition.

Tackling global inequalities in access to Water, Sanitation and Hygiene (WASH) remains an urgent issue - 58% of annual diarrhoeal deaths are caused by inadequate WASH provision. A global context of increasing urbanisation, changing demographics and health transitions demands an understanding and impact of WASH on a broad set of health outcomes. We examine the literature, in terms of health outcomes, considering WASH access and interventions in urban sub-Saharan Africa from 2000 to 2017. Our review of studies which evaluate the effectiveness of specific WASH interventions, reveals an emphasis of WASH research on acute communicable diseases, particularly diarrhoeal diseases. In contrast, chronic communicable and non-communicable health outcomes were notable gaps in the literature as well as a lack of focus on cross-cutting issues, such as ageing, well-being and gender equality. We recommend a broader focus of WASH research and interventions in urban Africa to better reflect the demographic and health transitions happening. Abbreviations: CBA: Controlled Before and After; GSD: Government Service Delivery; IWDSSD: International Drinking-Water, Supply and Sanitation Decade (IDWSSD); KAP: Knowledge, Attitudes and Practices; IBD: Irritable Bowel Diseases; MDG: Millennium Development Goals; NTD: Neglected Tropical Diseases; PSSD: Private Sector Service Delivery; SDG: Sustainable Development Goals; SSA: Sub Saharan Africa; SODIS: Solar Disinfection System; STH: Soil Transmitted Helminths; RCT: Randomised Control Trial; WASH: Water Sanitation and Hygiene; WHO: World Health Organization.

Perception of Urban Environmental Risks and the Effects of Urban Green Infrastructures (UGIs) on Human Well-being in Four Public Green Spaces of Guangzhou, China.

Cities face many challenging environmental problems that affect human well-being. Environmental risks can be reduced by Urban Green Infrastructures (UGIs). The effects of UGIs on the urban environment have been widely studied, but less attention has been given to the public perception of these effects. This paper presents the results of a study in Guangzhou, China, on UGI users' perceptions of these effects and their relationship with sociodemographic variables. A questionnaire survey was conducted in four public green spaces. Descriptive statistics, a binary logistic regression model and cross-tabulation analysis were applied on the data from 396 valid questionnaires. The results show that UGI users were more concerned about poor air quality and high temperature than about flooding events. Their awareness of environmental risks was partly in accordance with official records. Regarding the perception of the impacts of environmental risks on human well-being, elderly and female respondents with higher education levels were the most sensitive to these impacts. The respondents' perceptions of these impacts differed among the different green spaces. The effects of UGIs were well perceived and directly observed by the UGI users, but were not significantly influenced by most sociodemographic variables. Moreover, tourists had a lower perception of the impacts of environmental risks and the effects of UGI than residents did. This study provides strong support for UGIs as an effective tool to mitigate environmental risks. Local governments should consider the role of UGIs in environmental risk mitigation and human well-being with regard to urban planning and policy making.

Development of a spatial sampling protocol using GIS to measure health disparities in Bobo-Dioulasso, Burkina Faso, a medium-sized African city.

BACKGROUND: Many cities in developing countries experience an unplanned and rapid growth. Several studies have shown that the irregular urbanization and equipment of cities produce different health risks and uneven exposure to specific diseases. Consequently, health surveys within cities should be carried out at the micro-local scale and sampling methods should try to capture this urban diversity. METHODS: This article describes the methodology used to develop a multi-stage sampling protocol to select a population for a demographic survey that investigates health disparities in the medium-sized city of Bobo-Dioulasso, Burkina Faso. It is based on the characterization of Bobo-Dioulasso city typology by taking into account the city heterogeneity, as determined by analysis of the built environment and of the distribution of urban infrastructures, such as healthcare structures or even water fountains, by photo-interpretation of aerial photographs and satellite images. Principal component analysis and hierarchical ascendant classification were then used to generate the city typology. RESULTS: Five groups of spaces with specific profiles were identified according to a set of variables which could be considered as proxy indicators of health status. Within these five groups, four sub-spaces were randomly selected for the study. We were then able to survey 1045 households in all the selected sub-spaces. The pertinence of this approach is discussed regarding to classical sampling as random walk method for example. CONCLUSION: This urban space typology allowed to select a population living in areas representative of the uneven urbanization process, and to characterize its health status in regards to several indicators (nutritional status, communicable and non-communicable diseases, and anaemia). Although this method should be validated and compared with more established methods, it appears as an alternative in developing countries where geographic and population data are scarce.

Secular trends in dietary patterns of young children in Brazil from 1996 to 2006.

OBJECTIVE: To describe dietary patterns (DP) from 1996 to 2006 and in the first 5 years of life and to explore individual and contextual characteristics associated with each DP. DESIGN: DP were defined by principal component analysis. The association between DP and individual (sociodemographic, maternal and child) and contextual (geographic regional and year) characteristics was analysed by multilevel analysis. SETTING: Two complex probabilistic Brazilian Demographic and Health Surveys (BDHS 1996, 2006). SUBJECTS: Brazilian children under 5 years of age. RESULTS: DP1 included yoghurt, vegetables, fruits, tubers, red meat. DP2 included liquids, milk, fruits, egg/chicken/fish, red meat, breast milk (negative loading). DP3 included fruit juices, 'papilla', yoghurt, red meat (negative loading). DP4 included formulas, milk, enriched 'papilla', egg/chicken/fish (negative loading). DP prevalence within the age range from 1996 to 2006 remained constant for DP1; increased after 12 and 6 months, respectively, for DP2 and DP3; and decreased for DP4. DP1 was explained by higher maternal education, wealth, lower number of children at home; DP2 by living in rural area and younger mothers; and DP4 by lower maternal education and wealth. The total variance of the model attributable to geographic region was 30·2, 20·7 and 54·2 % for DP2, DP3 and DP4, respectively. CONCLUSIONS: DP trends observed from 1996 to 2006 show positive aspects, such as: maintenance of DP1 as the main DP after 12 months; an increase in the prevalence of DP2 and DP3 followed by a decrease of DP4 after 6 months. DP1 is explained mainly by socio-economic factors, regardless of contextual characteristics, and DP2, DP3, DP4 are partially explained by contextual effects.

Infant Deaths and Mortality from Gun Violence: Causal or Casual?

OBJECTIVE: Describe trends in non-Hispanic black infant mortality (IM) in the New York City (NYC) counties of Bronx, Kings, Queens, and Manhattan and correlations with gun-related assault mortality. METHODS: Linked Birth/Infant Death data (1999-2013) and Compressed Mortality data at ages 1 to ≥85 years (1999-2013). NYC and United States (US) Census data for income inequality and poverty. Pearson coefficients were used to describe correlations of IM with gun-related assault mortality and other causes of death. RESULTS: In NYC, the risk of non-Hispanic black IM in 2013 was 49% lower than in 1995 (rate ratio: 0.51; 95% CI: 0.43, 0.61). Yearly declines between 1999 and 2013 were significantly correlated with declines in gun-related assault mortality (correlation coefficient (r) = 0.70, p = 0.004), drug-related mortality (r = 0.59, p = 0.020), major heart disease and stroke (r = 0.85, p < 0.001), malignant neoplasms (r = 0.57, p = 0.026), diabetes mellitus (r = 0.63, p = 0.011), and pneumonia and influenza (r = 0.78, p < 0.001). There were no significant correlations of IM with chronic lower respiratory or liver disease, non-drug-related accidental deaths, and non-gun-related assault. Yearly IM (1995-2012) was inversely correlated with income share of the top 1% of the population (r = -0.66, p = 0.007). CONCLUSIONS: In NYC, non-Hispanic black IM declined significantly despite increasing income inequality and was strongly correlated with gun-related assault mortality and other major causes of death. These data are compatible with the hypothesis that activities related to overall population health, including those pertaining to gun-related homicide, may provide clues to reducing IM. Analytic epidemiological studies are needed to test these and other hypotheses formulated from these descriptive data.

Public health and urban planning: a powerful alliance to be enhanced in Italy.

Urban planning has played and still plays a key role in improving urban health and indoor health. The authors sketch out the historical evolution of the relationships between Public Health and urban planning, in particular to what happened in Italy during the past 150 years. The authors suggest some lines for further research, but also describe some interventions that could obtain practical results in terms of health gains for the population.

Population Impact and Effectiveness of Monovalent Rotavirus Vaccination in Urban Malawian Children 3 Years After Vaccine Introduction: Ecological and Case-Control Analyses.

BACKGROUND: Rotavirus vaccines have been introduced in many low-income African countries including Malawi in 2012. Despite early evidence of vaccine impact, determining persistence of protection beyond infancy, the utility of the vaccine against specific rotavirus genotypes, and effectiveness in vulnerable subgroups is important. METHODS: We compared rotavirus prevalence in diarrheal stool and hospitalization incidence before and following rotavirus vaccine introduction in Malawi. Using case-control analysis, we derived vaccine effectiveness (VE) in the second year of life and for human immunodeficiency virus (HIV)-exposed and stunted children. RESULTS: Rotavirus prevalence declined concurrent with increasing vaccine coverage, and in 2015 was 24% compared with prevaccine mean baseline in 1997-2011 of 32%. Since vaccine introduction, population rotavirus hospitalization incidence declined in infants by 54.2% (95% confidence interval [CI], 32.8-68.8), but did not fall in older children. Comparing 241 rotavirus cases with 692 test-negative controls, VE was 70.6% (95% CI, 33.6%-87.0%) and 31.7% (95% CI, -140.6% to 80.6%) in the first and second year of life, respectively, whereas mean age of rotavirus cases increased from 9.3 to 11.8 months. Despite higher VE against G1P[8] than against other genotypes, no resurgence of nonvaccine genotypes has occurred. VE did not differ significantly by nutritional status (78.1% [95% CI, 5.6%-94.9%] in 257 well-nourished and 27.8% [95% CI, -99.5% to 73.9%] in 205 stunted children;P= .12), or by HIV exposure (60.5% [95% CI, 13.3%-82.0%] in 745 HIV-unexposed and 42.2% [95% CI, -106.9% to 83.8%] in 174 exposed children;P= .91). CONCLUSIONS: Rotavirus vaccination in Malawi has resulted in reductions in disease burden in infants <12 months, but not in older children. Despite differences in genotype-specific VE, no genotype has emerged to suggest vaccine escape. VE was not demonstrably affected by HIV exposure or stunting.

Consolidating the social health insurance schemes in China: towards an equitable and efficient health system.

Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes.

Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities.

BACKGROUND: In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996-1998 and 2005-2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. METHODS: Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996-1998 and 2005-2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). RESULTS: For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12-1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09-1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05-1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02-1.06 in the 2nd period). CONCLUSIONS: In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities.

Early days of life are crucial for child survival in Gamo Gofa Zone, Southern Ethiopia: A community based study.

BACKGROUND: Though, Ethiopia has shown progress in the reduction of under-five mortality in the last few years, the problem of neonatal and under-five mortality are still among the highest in the world and that warrants continuous investigation of the situation for sustained interventions to maintain the reduction beyond the millennium development goals. Therefore, this study was conducted with the objective of determining the magnitude of childhood mortalities in the designated community. METHOD: A census of 11 kebeles (lowest administrative units in Ethiopia) of Arba Minch Town and 11 kebeles of Arba Minch Zuria District, which were not part of Arba Minch Demographic Surveillance System (DSS), had been done in order to identify all children (alive and dead) born between September 01, 2007 and September 30, 2014. Besides, all children born after July 01, 2009 were tracked from the data base of the Arba Minch DSS. Descriptive analyses with frequency and cross tabulation with the corresponding confidence interval and p-value were made using SPSS 16 and STATA 11. Extended Mantel-Haenszel chi-square for linear trend was also performed to assess presence of linear trend through the study period using open-Epi version 2.3. RESULT: A total of 20,161 children were included for this analysis. The overall weighted under five, infant and neonatal mortalities with their corresponding 95 % confidence intervals were: 42.76 (39.56-45.97), 33.89 (31.03-36.76) and 18.68 (16.53-20.83) per 1000 live births, respectively. Majority of neonatal deaths occurred within the first 7 days of life. Under-five mortality was found to be significantly higher among non-DSS rural kebeles, overall rural kebeles and females. CONCLUSION: Significant number of children died during their early days of life. Strengthening of maternal and child health interventions during pregnancy, during and immediately after birth are recommended in order to avert majorities of neonatal deaths.

Longitudinal Trends in the Prevalence of Diabetes Mellitus in an Urban Emergency Department.

OBJECTIVE: The objective of this study was to examine the longitudinal trends in diabetes mellitus (DM) in emergency department (ED) patients and evaluate the factors associated with those trends. METHODS: We conducted a retrospective analysis of all patients who presented to the ED from 2006 to 2011. The presence of DM, height, and weight were recorded prospectively. The study was conducted in the ED of an urban, academic hospital with an average yearly volume of approximately 62,000 patients. Inclusion criteria were age 16 years and older; presentation to the ED for any reason; and documentation of height, weight, and history of DM. Data were analyzed in 1-year blocks, then examined for trends using linear regression analysis. Data also were examined by obesity class: normal (body mass index [BMI] 20-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), obese (BMI 30-39.9 kg/m(2)), and extreme obesity (BMI >40 kg/m(2)). RESULTS: There was a statistically significant increase in the prevalence of type 2 DM during the study period. The percentage of type 2 DM for all patient visits increased progressively from 10.7% to 16.1% (r(2) 0.97). Progressive increases in yearly type 2 DM prevalence were observed for all BMI classes. The rate of change in the increase of DM was related directly to the degree of obesity. For the normal weight category, the percentage of patients with DM increased 0.5%/year (r(2) 0.92), overweight 0.7%/year (r(2) 0.88), obesity 1.0%/year (r(2) 0.90), and extreme obesity 1.4%/year (r(2) 0.94). Patient age increased slightly for all obesity groups, accounting for a 0.2% to 0.4%/year increase in the prevalence of DM in the population. CONCLUSIONS: In this longitudinal analysis, we found an increase in the prevalence of patients with DM and an increase in ED visits by patients with DM. Our results indicate that these increases are influenced most significantly by the obesity level of the patient.

Then and now: a revision of the city health profile of the city of Pécs, Hungary.

The City of Pécs, a founding member, has participated in the World Health Organization European Healthy Cities Network (WHO-EHCN) since 1986. Each WHO-EHCN city prepares a city health profile (CHP) through which it supports local health-related activities. The first CHP of Pécs was carried out in 1996. The aim of more recent research has been to implement a comprehensive review of the first CHP and to make a comparative analysis between the results of the former and the updated CHPs. The data were received from different databases and a telephone survey. The review showed improvement in those areas that can be influenced through the measures of the city authorities. The survey showed that both the ratio of smokers and the amount of cigarettes smoked had decreased so that the ratio of regular smokers became the lowest among the youngest age group. The number of alcohol consumers increased, while the amount of alcohol consumed dropped slightly, meaning that alcohol consumption per capita decreased overall. The comparative analysis highlighted unhealthy diets, insufficient sleep duration and physical inactivity becoming significant health risk factors. To avoid a 'reinventing the wheel' situation, it would be worth comparing the results of health and lifestyle surveys of other WHO-EHCN cities and eventually jointly devise the best solutions.

Comparisons in childhood obesity and cardiometabolic risk factors among urban Saudi Arab adolescents in 2008 and 2013.

BACKGROUND: We aimed to compare the prevalence of childhood obesity and other cardiometabolic risk factors from two independent cohorts (2008 and 2013) in Riyadh, Saudi Arabia. METHODS: A total of 4549 adolescents aged 12-18 years [2454 boys, 2095 girls], taken from two independent cohorts, 5 years apart (2008 and 2013), were included. Anthropometrics were measured, and fasting blood samples were taken to ascertain glucose and lipid profile. RESULTS: The overall prevalence of obesity was significantly higher in 2013 [15.3 (95% confidence interval 13.7-16.9)] than 2008 [12.6 (11.3-13.9)] (P = 0.012). Stratified by sex, the prevalence of obesity among boys was significantly higher in 2013 than 2008 [2008 = 12.0 (10.3-13.7) versus 2013 = 17.4 (15.1-19.7); P < 0.001]. The age groups 13 and 15 years had a significantly higher mean triglycerides in 2013 than 2008 (P-values 0.003 and <0.001, respectively) and lower mean HDL-cholesterol also in the 13 years old age group (P < 0.001). CONCLUSIONS: The prevalence of childhood obesity in Saudi Arabia has increased in particular age groups (13-15 years) during a 5-year span. Special attention is warranted in these vulnerable age groups, particularly in boys, as cardiometabolic risk factors appear to worsen.