Residential green space and child intelligence and behavior across urban, suburban, and rural areas in Belgium: A longitudinal birth cohort study of twins.

BACKGROUND: Exposure to green space has beneficial effects on several cognitive and behavioral aspects. However, to our knowledge, no study addressed intelligence as outcome. We investigated whether the level of urbanicity can modify the association of residential green space with intelligence and behavior in children. METHODS AND FINDINGS: This study includes 620 children and is part of the East Flanders Prospective Twin Survey (EFPTS), a registry of multiple births in the province of East Flanders, Belgium. Intelligence was assessed with the Wechsler Intelligence Scale for Children-Revised (WISC-R) in 620 children (310 twin pairs) between 7 and 15 years old. From a subset of 442 children, behavior was determined based on the Achenbach Child Behavior Checklist (CBCL). Prenatal and childhood residential addresses were geocoded and used to assign green space indicators. Mixed modeling was performed to investigate green space in association with intelligence and behavior while adjusting for potential confounding factors including sex, age, parental education, neighborhood household income, year of assessment, and zygosity and chorionicity. We found that residential green space in association with both intelligence and behavior in children was modified by the degree of urbanicity (p < 0.001). In children living in an urban environment, multivariable adjusted mixed modeling analysis revealed that an IQR increment of residential green space (3,000-m radius) was associated with a 2.6 points (95% CI 1.4-3.9; p < 0.001) higher total intelligence quotient (IQ) and 2.0 points (95% CI -3.5 to -0.4; p = 0.017) lower externalizing behavioral score. In children residing in a rural or suburban environment, no association was found. A limitation of this study is that no information was available on school location and the potential for unmeasured confounding (e.g., time spend outdoors). CONCLUSIONS: Our results indicate that residential green space may be beneficial for the intellectual and the behavioral development of children living in urban areas. These findings are relevant for policy makers and urban planners to create an optimal environment for children to develop their full potential.

Who receives naloxone from emergency medical services? Characteristics of calls and recent trends.

Background: With the rapid rise in opioid overdose-related deaths, state policy makers have expanded policies to increase the use of naloxone by emergency medical services (EMS). However, little is known about changes in EMS naloxone administration in the context of continued worsening of the opioid crisis and efforts to increase use of naloxone. This study examines trends in patient demographics and EMS response characteristics over time and by county urbanicity. Methods: We used data from the 2013-2016 National EMS Information System to examine trends in patient demographics and EMS response characteristics for 911-initiated incidents that resulted in EMS naloxone administration. We also assessed temporal, regional, and urban-rural variation in per capita rates of EMS naloxone administrations compared with per capita rates of opioid-related overdose deaths. Results: From 2013 to 2016, naloxone administrations increasingly involved young adults and occurred in public settings. Particularly in urban counties, there were modest but significant increases in the percentage of individuals who refused subsequent treatment, were treated and released, and received multiple administrations of naloxone before and after arrival of EMS personnel. Over the 4-year period, EMS naloxone administrations per capita increased at a faster rate than opioid-related overdose deaths across urban, suburban, and rural counties. Although national rates of naloxone administration were consistently higher in suburban counties, these trends varied across U.S. Census Regions, with the highest rates of suburban administration occurring in the South. Conclusions: Naloxone administration rates increased more quickly than opioid deaths across all levels of county urbanicity, but increases in the percentage of individuals requiring multiple doses and refusing subsequent care require further attention.

Climate change, urbanization and disease: summer in the city .

Climate change and urbanization can alter the burden of human diseases. The tropics, a region that includes the poorest populations and highest disease burdens, are expected to get slightly hotter and substantially more urban. Studies have projected changing burdens under different climate or urbanization scenarios, but it remains unclear what will happen if both happen at once. Interactions could amplify disease burdens, improve health overall, or shift burdens around. Social planners need better data on contemporary seasonal disease incidence patterns across the spectrum of climate, urbanicity and socio-economic status. How climate change, urbanization and health interact must be understood to adequately plan for the future.

Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009.

BACKGROUND: In highly populated African urban areas where access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions. This study aims to analyze the association between topographic elevation and the distribution of cholera cases in Harare during the cholera epidemic in 2008 and 2009. METHODS: We developed an ecological study using secondary data. First, we described attack rates by suburb and then calculated rate ratios using whole Harare as reference. We illustrated the average elevation and cholera cases by suburbs using geographical information. Finally, we estimated a generalized linear mixed model (under the assumption of a Poisson distribution) with an Empirical Bayesian approach to model the relation between the risk of cholera and the elevation in meters in Harare. We used a random intercept to allow for spatial correlation of neighboring suburbs. RESULTS: This study identifies a spatial pattern of the distribution of cholera cases in the Harare epidemic, characterized by a lower cholera risk in the highest elevation suburbs of Harare. The generalized linear mixed model showed that for each 100 meters of increase in the topographical elevation, the cholera risk was 30% lower with a rate ratio of 0.70 (95% confidence interval=0.66-0.76). Sensitivity analysis confirmed the risk reduction with an overall estimate of the rate ratio between 20% and 40%. CONCLUSION: This study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Furthermore, elevation information, among other risk factors, could help to spatially orientate cholera control interventions during an epidemic.

Adolescent suicide attempts in Bærum, Norway, 1984-2006.

BACKGROUND: There are presently few international studies that examine adolescents' own experience of both triggering and the underlying reasons behind their suicide attempts. AIMS: To present the rates, triggering factors, and underlying reasons for such behavior. METHODS: The 23-year (1984-2006) surveillance study reported includes all general hospital-treated suicide attempters aged between 13 and 19 years (n = 254) living in the municipality of Bærum, a suburb on the outskirts of Oslo, Norway. RESULTS: Suicide attempt rates for both sexes decreased during the period of study. The female suicide attempt rate was on average 3.5 times higher than the male rate. An average of 8.2% of the suicide attempters made a repeat attempt within the following year. Overall, the most commonly reported trigger was a relational conflict (50.2%), and the most commonly reported underlying reason was a dysfunctional family situation (43.6%), followed by mental health problems (22.8%). The main gender difference for both triggers and underlying reasons was that relational conflicts were reported significantly more often by girls than by boys as triggers (55.0% versus 32.7%), and dysfunctional family issues were reported significantly more often by girls than by boys (47.1% versus 30.8%) as underlying reasons for the attempt. Mental health problems were reported less frequently as an underlying reason by girls than boys (21.2% versus 28.8%). CONCLUSIONS: A family-oriented intervention embracing the extended family system seems warranted in a majority of the cases in our study.

Educación superior y participación en el marco del presupuesto participativo en la comuna uno de medellín / Higher education and participation in the frame of the implementation of the participative budget in the commune 1 in medellin

Este texto es un producto de los desarrollos del proyecto “Evaluación y seguimiento al trabajo social y comunitario de los beneficiarios del fondo de presupuesto participativo destinado a cursar estudios de educación superior “Comuna Uno, Medellín”, en asocio con la Secretaría de Educación de la ciudad de Medellín, el cual pretende ir más allá de una evaluación de procedimientos, objetivos y resultados y profundizar en algunas dimensiones de la participación ciudadana, en la toma de decisión y beneficios comunitarios que esto trae para el caso específico del proyecto de Educación superior en la comuna Uno.

This text is the product of the developments of the project entitled: "Evaluation and Monitoring of the Social and Community Work of the Beneficiaries of the Participatory Budget Fund Aimed At Pursuing Higher Education Studies Belonging to Commune One, Medellin," in Partnership with the Secretariat of Education in the City of Medellin. It is aimed at going beyond an assessment of procedures, objectives, and outcomes, and in doing so; explore some dimensions of citizen participation in decision making and community benefits that this brings to the specific case of the Higher Education Project in the Commune One.

Prevalence of stroke and transient ischemic attack in three elderly populations of central Spain.

OBJECTIVE: Our aim was to assess prevalence rates of cerebrovascular disease (CVD; stroke and transient ischemic attacks) according to age and gender in three populations in central Spain using data from the Neurological Disorders in Central Spain (NEDICES) study, a population-based survey of elderly participants. METHODS: Individuals from one suburban municipality of Greater Madrid (Las Margaritas neighborhood, Getafe), one urban district of Madrid (Lista) and one rural site (Arévalo county, Avila) were evaluated at baseline (n = 5,278). The evaluation included a screening questionnaire and a neurological assessment when possible. We used point prevalence with a reference date of May 1, 1994. RESULTS: Of the 5,278 subjects, there were 186 prevalent stroke cases and 71 cases of transient ischemic attacks. Prevalence rates, adjusted to the standard European populations, were 4.9% for CVD (95% confidence interval [CI] = 4.3-5.4), 3.4% for stroke (95% CI = 2.9-3.9) and 1.3% for transient ischemic attacks (95% CI = 1.0-1.6) in the total population. Age-specific prevalence rates of CVD, stroke and transient ischemic attacks increased exponentially with advancing age. The prevalence rates of CVD, stroke and transient ischemic attacks were higher for men than for women. Prevalence figures were higher in the suburban area of Margaritas compared to the rural region. CONCLUSIONS: In this study, the prevalence of stroke and transient ischemic attacks were higher in men and in urban areas. Central Spain would be a medium stroke prevalence zone.

Population puzzle. Suburban sprawling.

What's a hospital to do when hundreds and even thousands of new residents move into its formerly quiet little community every month? That's the predicament that Dixie Regional Medical Center in Utah and many other boom-town hospitals are in; they must decide how to transform themselves to meet the needs of a rapidly changing marketplace. City hospitals face a similar challenge: affluent young professionals and empty-nesters revitalize certain neighborhoods while other areas lose their long-time- and well-insured-population base to the suburbs.

Evaluation of the impacts of dock structures and land use on tidal creek ecosystems in South Carolina estuarine environments.

Tidal creeks and their associated salt marshes are the primary link between uplands and estuaries in the southeastern region. They are also critical nursery and feeding grounds. In addition, the uplands surrounding creeks are preferred sites for homebuilding because of their natural beauty and the ability to access the estuary from a personal dock structure. The objective of this study was to evaluate the cumulative impacts of docks on tidal creek nursery habitats for both small and large tidal creeks. The number of docks was associated with the amount of impervious cover in both small and large creeks. The presence of docks had little measurable effect on sediment metal concentrations at the scale of small and large creeks. In small and large creeks, sediment polycyclic aromatic hydrocarbon (PAH) concentrations were related to the human activity in the upland that includes the presence of docks at the scale of small and large creeks. Some impacts on the benthic community were associated with docks and human activity in small creeks but not in large creeks. Suburban development may reduce fish and crustacean abundances, but the dock may potentially mediate the development effect. Individually, the harm to the marine environment resulting from dock shading, chrominated copper arsenate leachates, and PAH contamination was small at the scale of tidal creeks. However, impacts from dock structures could not be separated from anthropogenic watershed-scale effects. These results demonstrate that suburban development with its accompanying dock construction does represent a major source of environmental degradation to tidal creeks and associated salt marsh habitats.

"They're too smart for that": predicting what children would do in the presence of guns.

OBJECTIVES: We examined parents' beliefs about how children would react to finding guns, with particular emphasis on how parents reasoned about children's actions. METHODS: Based on a randomized telephone survey of Northeast Ohio residents, we focused on the 317 urban and 311 rural respondents who had children 5 to 15 years old in their homes. Respondents were asked about gun ownership and their expectations of how children would react to finding guns. Analysis examined responses in relation to various demographic and socioeconomic variables. RESULTS: All respondents--regardless of gun ownership, geography, race, gender, education level, income, or child age--were equally likely (approximately 87%) to believe that their children would not touch guns they found. Fifty-two percent of those reasoned that children were "too smart" or "knew better." Only 40% based their predictions on specific instructions they had given their children. Only 12% (15/122) of owners stored guns locked and unloaded. Only 3 of 13 variables tested were positively associated with safe storage: having a child 5 to 9 years old, having at least a 4-year college education, and having an income >or=65,000 dollars per year. CONCLUSION: Results indicate that parental beliefs may effectively relieve adults of responsibility and place the burden on children to protect themselves. The implication for injury prevention is that caregivers' unrealistic expectations of children's developmental levels and impulse control may influence storage decisions or the inclination to address gun safety issues with children or other adults with whom children spend time (relatives, playmates' parents).

The relationship between population density and cancer mortality in Taiwan.

Many investigators have examined urbanization gradients in cancer rates. The purpose of this report was to identify urban-rural trends in cancer mortality rates (1982-1991) for municipalities in Taiwan. For this purpose, Taiwan's municipalities were classified as rural, suburban, urban, or metropolitan, using population density as an ordinal indicator of the degree of urbanization. Average annual age-adjusted, site-specific cancer mortality rates were calculated for both sexes within each population density group. Significant increasing trends with more urbanization were observed in mortality rates for cancers of the lung, pancreas, and kidney among both males and females, as well as male prostate cancer, and female breast and ovary cancer. In addition, this study revealed a significant rural excess for nonmelanoma skin cancer among both males and females, as well as male non-Hodgkin's lymphoma, and cancers of the female bone, and female connective tissue. Analytic studies for sites with consistent urban-rural trends may be fruitful in identifying the aspect of population density, or other unmeasured factors, that contribute to these trends.

PIP: Almost all studies which have reported variation in cancer incidence and mortality rates across urbanization gradients have found higher rates in urban populations than in rural areas. Findings are presented from a study conducted to identify urban-rural trends in cancer mortality rates during 1982-91 for municipalities in Taiwan. The countries municipalities were classified as rural, suburban, urban, or metropolitan, using population density as an ordinal indicator of the degree of urbanization. Average annual age-adjusted, site-specific cancer mortality rates were calculated for both sexes within each population density group. Significant increasing trends with more urbanization were observed in mortality rates for cancers of the lung, pancreas, and kidney among both men and women, as well as male prostate cancer and female breast and ovary cancer. The study also found a significant rural excess for non-melanoma skin cancer among men and women, as well as male non-Hodgkin's lymphoma and cancers of the female bone and connective tissue.

Cryptosporidiasis: estudio de un brote diarreico en una zona suburbana de ciudad La Habana / Cryptoporidiasis: study of a diarrheia epidemy in a suburban ares of the city of La Habana

En marzo de 1994 se estudio un brote de criptosporidiasis en una comunidad suburbana de ciudad de La Habana. se investigaron 162 personas por examen de heces, al inicio del brote y semanalmente durante 7 semanas, para determinar el momento en que desaparecian los ooquistes y la aparicion de casos nuevos, las tecnicas cronologicas empleadas fueron: directo, Ritchie y Ziel Nelsen Modificados; tambien se estudiaron las heces de los cerdos. Se hallo cryptosporidium sp en el 21.6 por ciento de las personas encuestadas, la mayor tasa se hallo en niños de 0 a 4 años (57.8 por ciento) (p<0,005). Se hallo el antecedente de contacto con cerdos en 32 de 35 casos. La diarrea afecto a 20 de los 35 casos; todos los niños entre 0 y 4 años. Solo 8 personas adultas fueron asintomaticas. En 10 de los 20 niños con diarrea se requirio hospitalizacion. El brote se controlo con la erradicacion de la cria de cerdos, los ooquistes desaparecieron entre 7 y 14 dias despues de diagnostico el brote y no aparecieron casos nuevos a los 21 dia de diagnosticado el brote

En los márgenes: estudio de población en riesgo social en el Partido de La Plata / In the periphery: study on social risk population in the La Plata District

Estudio sobre focalización de la pobreza estructural en el Partido de La Plata (Bs. Aires). Se utilizó un método de tareas que relevó información sobre aspectos tales como trabajo, salud y participación social. Para ello se diagramó un censo de hogares y personas que habitan en asentamientos poblacionales conocidos como villas miseria, ubicados en los márgenes de la ciudad

The changing concentration of the older nonmetropolitan population, 1960-90.

Changes in the absolute and relative size of the elderly population since 1960 are decomposed into the underlying demographic components for metropolitan and nonmetropolitan areas and for subregions of the United States. Specifically, we examine the components of net migration and natural increase for those aged 0-64 and those 65 or older. Generally, the natural increase component for those 65 and over has increased since 1960, whereas that for those under 65 has declined. Metropolitan areas have consistently lost, and nonmetropolitan areas gained elderly migrants. Trends in elderly population change are far from uniform across nonmetropolitan America. In general, the "aging" of the nonmetropolitan population was predominantly due to elderly migration during the 1970-80 decade, and to the loss of young people both before and afterward. Recent trends give little support for the view that the 1970s was the beginning of a new phase of deconcentrated settlement, even for elderly persons.