Exploring Regional Reduction Pathways for Human Exposure to Fine Particulate Matter (PM2.5) Using a Traffic Assignment Model.

An exposure-based traffic assignment (TA) model is used to quantify primary and secondary fine particulate matter (PM2.5) exposure from on-road vehicle flow on the Chicago Metropolitan Area regional network. PM2.5 exposure due to emissions from light-duty vehicles, heavy-duty trucks, public transportation, and electricity generation for electric vehicle charging and light-rail transportation is considered. The model uses travel demand data disaggregated by time-of-day period and vehicle user class to compare the exposure impacts of two TA optimization scenarios: a baseline user equilibrium with respect to travel time (UET) and a system optimal with respect to pollutant intake (SOI). Estimated baseline PM2.5 exposure damages are $3.7B-$8.3B/year. The SOI uses exposure-based vehicle rerouting to reduce total damages by 8.2%, with high-impacted populations benefiting from 10% to 20% reductions. However, the SOI's rerouting principle leads to a 66% increase in travel time. The model is then used to quantify the mitigation potential of different exposure reduction strategies, including a bi-objective optimization formulation that minimizes travel time and PM2.5 exposure concurrently, adoption of a cleaner vehicle fleet, higher public transportation use, particle filtration, and exposure-based truck routing. Exposure reductions range between 1% and 40%, but collective adoption of all strategies would lead to reductions upward of 50%.

A tutela do direito à saúde na jurisprudência da Corte Interamericana de Direitos Humanos / The protection of the right to health in the jurisprudence of the Inter-American Court of Human Rights / La tutela del derecho a la salud en la jurisprudencia de la Corte Interamericana de Derechos Humanos

Objetivo: discutir os efeitos da autonomia do direito à saúde decorrentes do desenvolvimento do art.26 da Convenção Americana na jurisprudência da Corte Interamericana de Direitos Humanos. Metodologia: utilizou-se a base jurisprudencial das decisões da Corte que apresentam o reconhecimento indireto da saúde como um direito plenamente justiciável e aquelas que reconhecem a justiciabilidade direta de tal direito. Resultados: a primeira parte da investigação analisou os quase 20 anos de evolução histórica da justiciabilidade indireta dos direitos econômicos, sociais, culturais e ambientais na jurisprudência interamericana, seja via conexão com o direito à vida ou com o direito à integridade pessoal. Na sequência, a segunda parte do artigo lança luz sobre as decisões dos anos de 2018 a 2022, inauguradas pelo caso paradigmático Poblete Vilches y otros vs. Chile (2018), nos quais houve a consagração do direito à saúde como direito plenamente justiciável perante a Corte. Conclusão: a análise detida do arcabouço jurisprudencial interamericano permite concluir que a tutela direta do direito à saúde não frustra quaisquer expectativas legítimas dos Estados em razão de as obrigações estatais terem sido desenvolvidas progressivamente por via de conexidade. Além disso, os principais resultados dessa pesquisa apontam para as duas principais inovações decorrentes da autonomia do direito à saúde: a presença recorrente das vulnerabilidades interseccionais nas violações de direitos humanos dessa natureza e as obrigações estatais referentes a atos cometidos por prestadores privados de serviços de saúde. Tais aprofundamentos são essenciais para delinear a leitura sistemática da jurisprudência interamericana e efetivar o direito humano à saúde no continente americano.

Objective: to discuss the effects of the autonomy of the right to health resulting from the development of article 26 of the American Convention in the jurisprudence of the Inter-American Court of Human Rights. Methods: we used the jurisprudential basis of decisions of the Court that present the indirect recognition of health as a fully justiciable right and those that recognize the direct justiciability of such right. Results: the first part of the investigation analyzed the nearly20 years of historical evolution of the indirect justiciability of economic, social, cultural, and environmental rights in Inter-American Court case-law, whether throughconnection with the right to life or to personal integrity. The second part of the paperfocuses on the decisions delivered by the Court from 2018 to 2022, beginning with the paradigmatic case Poblete Vilches y otros vs. Chile (2018), in which the right to health was established as a fully justiciable right before the Inter-American Court. Conclusion: a careful review of the jurisprudence leads to the conclusion that direct protection of the right to health is not inconsistent with any legitimate expectations of States because State obligations have been developed progressively by means ofthe connection principle. Furthermore, this research indicates two significant innovations resulting from the autonomy of the right to health: the persistence of intersectional vulnerabilities in such human rights violations, as well as State obligations concerning acts committed by private healthcare providers. This level of sophistication is required to outline the systematic reading of Inter-American Court case-law and for implementing the human right to health on the American continent.

Objetivo: discutir los efectos de la autonomía del derecho a la salud resultantesdel desarrollo del artículo 26 de la Convención Americana en la jurisprudencia de la Corte Interamericana de Derechos Humanos. Metodología: se utilizó la base jurisprudencial de las decisiones de la Corte que presentan el reconocimiento indirecto de la salud como un derecho plenamente justiciabley aquellas que reconocen la justiciabilidad directa de tal derecho. Resultados: la primera parte de la investigación analizó casi 20 años de evolución histórica de la justiciabilidad indirecta de los derechos económicos, sociales, culturales y ambientales en la jurisprudencia interamericana, ya seapor conexión con el derecho a la vida o con el derecho ala integridad personal. A continuación, la segunda parte del artículo presenta las decisiones de los años 2018 a 2022, desde el paradigmático caso Poblete Vilches y otros vs. Chile (2018), en el que se reconoció el derecho a la salud como plenamente justiciable ante la Corte Interamericana. Conclusión: el análisis en profundidad del marco jurisprudencial interamericano permite concluir que la tutela directa del derecho a la salud no frustra ninguna expectativa legítima de los Estados, pues las obligaciones estatales se han desarollado progresivamente por vía de conexidad. Además, los principales resultados de esta investigación señalan las dos principales innovaciones derivadas de la autonomía del derecho a la salud: la presencia recurrentede vulnerabilidades interseccionales en las violaciones de los derechos humanos de esta naturaleza y las obligaciones del Estado en relación con los actos cometidos por los agentes privados en servicios de salud. Tales investigaciones en mayor profundidad son esenciales para hacer una lectura sistemática de la jurisprudencia interamericana y para lograr la efectividad del derecho humano a la salud en el continente americano.

Sanitary and environmental conditions related to food poisoning among informal street vendors in downtown Medellín, Colombia, 2016.

Introduction: Although studies with informal workers have been conducted in Latin America and the Caribbean, there is still scarce evidence on the prevalence of food poisoning among workers with subsistence jobs on the streets and sidewalks of cities and on the factors that influence its presentation. Objectives: To determine sociodemographic, labor, sanitary, and environmental conditions that influence the prevalence of food poisoning in informal workers in downtown Medellín, Colombia. Methods: This is a cross-sectional study using a workers' survey as the primary source. A total of 686 workers aged ≥18 years who had been working for ≥ 5 years were surveyed. An assisted survey was initially applied as a pilot test for training purposes and to obtain informed consent. Results: We identified several associations and explanatory factors of food poisoning using chi-square tests and prevalence ratios, with unadjusted and adjusted 95% confidence intervals (95%CI). A higher prevalence of food poisoning (p < 0.05) was observed in workers with lower frequency of waste collection (PR = 2.09; 95%CI = 1.04-4.19), who left cooked food (PR = 6.40; 95%CI = 2.34-17.8), beverages or chopped fruits uncovered at their workplace (PR = 3.92; 95%CI = 1.40-10.48), with inadequate waste management (PR = 4.84; 95%CI = 2.12-11.06), exposure to polluted water (PR = 3.00; 95%CI = 1.20-7.50) and acceptable water supply (PR = 5.40; 95%CI = 1.60-17.8). The factors that explained higher rates of food poisoning were not having a waste collection service (PRadjusted = 5.58; 95%CI = 3.38-13.10), inadequate waste management (PRadjusted = 6.61; 95%CI = 1.25-34.84), and having sanitary services next to worker's stall (PRadjusted = 14.44; 95%CI = 1.26-165.11). Conclusions: The conditions that are associated with and explain the higher prevalence of food poisoning in this working population can be addressed with health promotion and disease prevention interventions.

Introducción: Aunque se han realizado estudios con trabajadores informales en América Latina y el Caribe, aun es escasa la evidencia con respecto a la prevalencia de intoxicaciones alimentarias en trabajadores con empleos de subsistencia en las calles y aceras de las ciudades y a los factores que influyen en su presentación. Objetivos: Determinar las condiciones sociodemográficas, laborales, sanitarias y ambientales que influyen en la prevalencia de intoxicación alimentaria en trabajadores informales del centro de Medellín. Métodos: Estudio transversal con fuente primaria de información en un censo de 686 trabajadores, ≥18 años y con ≥5 años en su oficio. Se aplicó encuesta asistida previa realización de prueba piloto, estandarización de encuestadores y toma de consentimiento. Resultados: Se identificaron asociaciones y factores explicativos de intoxicación alimentaria, con pruebas del chi-cuadrado y razones de prevalencia (RP), con intervalos de confianza del 95% (IC95%) crudos y ajustados. Mayor prevalencia de intoxicación alimentaria (p < 0,05) en trabajadores con menor frecuencia de recolección de residuos (RP = 2,09; IC95% = 1,04-4,19), en quienes dejaban alimentos preparados (RP = 6,40; IC95% = 2,34-17,8), bebidas o fruta picada descubiertos en el puesto de trabajo (RP = 3,92; IC95% = 1,40-10,48), con inadecuado manejo de residuos (RP = 4,84; IC95% = 2,12-11,06), exposición a agua contaminada (RP = 3,00; IC95% = 1,20-7,50) y de aceptable calidad (RP = 5,40; IC95% = 1,60-17,8). Explicaron mayor intoxicación alimentaria no tener servicio de recolección de residuos (RPajustada = 5,58; IC95% = 3,38-13,10), inadecuado manejo de residuos (RPajustada = 6,61; IC95% = 1,25-34,84), y tener servicios sanitarios al lado del puesto de trabajo (RPajustada = 14,44; IC95% = 1,26-165,11). Conclusiones: Las condiciones que se asocian y explican mayor prevalencia de intoxicación alimentaria en esta población trabajadora, pueden ser revertidas con acciones de promoción de la salud y prevención de la enfermedad.

Relations between personal exposure to elevated concentrations of arsenic in water and soil and blood arsenic levels amongst people living in rural areas in Limpopo, South Africa.

Exposure to arsenic even at low levels can lead to adverse health outcomes, however, there is a paucity of research from South Africa in relation to human exposure to arsenic. We investigated long-term exposure of residents in Limpopo province, South Africa, in a cross-sectional study by analysing water, soil and blood arsenic concentrations from two arsenic-exposed (high and medium-low exposure) villages and one non-exposed (control) village. There were statistically significant differences in the distribution of arsenic in water, soil and blood amongst the three sites. The median drinking water arsenic concentration in the high-exposure village was 1.75 µg/L (range = 0.02 to 81.30 µg/L), 0.45 µg/L (range = 0.100 to 6.00 µg/L) in the medium- / low-exposure village and 0.15 µg/L (range = < limit of detection (LOD) to 29.30 µg/L) in the control site. The median soil arsenic concentration in the high-exposure village was 23.91 mg/kg (range = < LOD to 92.10 mg/kg) whilst arsenic concentrations were below the limit of detection in all soil samples collected from the medium-/low-exposure and control villages. In the high-exposure village, the median blood arsenic concentration was 1.6 µg/L (range = 0.7 to 4.2 µg/L); 0.90 µg/L (range = < LOD to 2.5 µg/L) in the medium-/low-exposure village and 0.6 µg/L (range = < LOD to 3.3 µg/L) in the control village. Significant percentages of drinking water, soil and blood samples from the exposed sites were above the internationally recommended guidelines (namely, 10 µg/L, 20 mg/kg and 1 µg/L, respectively). Majority of participants (86%) relied on borehole water for drinking and there was a significant positive correlation between arsenic in blood and borehole water (p-value = 0.031). There was also a statistically significant correlation between arsenic concentrations in participants' blood and soil samples collected from gardens (p-value = 0.051). Univariate quantile regression found that blood arsenic concentrations increased by 0.034 µg/L (95% CI = 0.02-0.05) for each one unit increase in water arsenic concentrations (p < 0.001). After adjusting for age, water source and homegrown vegetable consumption in multivariate quantile regression, participants from the high-exposure site had significantly higher blood concentrations than those in the control site (coefficient: 1.00; 95% CI = 0.25-1.74; p-value = 0.009) demonstrating that blood arsenic is a good biomarker of arsenic exposure. Our findings also provide new evidence for South Africa on the association between drinking water and arsenic exposure, emphasising the need for the provision of potable water for human consumption in areas with high environmental arsenic concentrations.

Telemedicine as an environmental ally - The social, financial, and environmental impact of virtual care in the otolaryngology clinic.

PURPOSE: Synchronous virtual care rapidly expanded worldwide amid the COVID-19 pandemic to provide remote medical assessment, minimizing contact and disease transmission risk. Despite its benefits, such an abrupt expansion has shed light on the need to address patients' level of satisfaction with this service delivery. The purpose of this study was to investigate patients' satisfaction, travel cost, productivity loss, and CO2 emissions involved with synchronous virtual care and in-person assessments in rhinology and sleep apnea clinics. MATERIALS AND METHODS: This prospective comparative study included patients managed via virtual care, or in-person clinic visit at St. Joseph Hospital, London, Canada, from December/2020 to April/2021, with rhinology pathologies or sleep apnoea. Patient satisfaction questionnaire (PSQ-18) scores were assessed. The overall scores of respondents were recorded including cost implications. RESULTS: A total of 329 patients were invited, 28.5 % responded (n = 93). 33 virtual care (age 48 ± 6), and 60 in-person (age 51 ± 19). There was no statistical significance in PSQ-18 scores. However, under a diagnosis-based subgroup analysis, allergic rhinitis patients on virtual care presented a significantly lower PSQ-18 scores on the general satisfaction (3.28 vs. 4.25, p = 0.04). The time spent with the doctor was directly correlated with age for patients seen in-person (r = 0.27; p = 0.037). The estimated loss of productivity for the Virtual care group was CAD 12, patients assessed in-person presented an average loss of productivity about six times higher (CAD 74 ± 40). CONCLUSIONS: Overall patients' satisfaction did not depend on whether they were seen virtually or in-person. However, time spent with the doctor contributed to higher satisfaction levels, but only among older patients who were seen in person. Nonetheless, allergic rhinitis patients seemed less satisfied with the virtual care option. Virtual care demonstrates economic benefits.

[Relationship of demographic and dietary hygiene factors with the pathology found in outpatient colonoscopies performed in a Castilla y León Health Service center]. / Relación de los factores demográficos e higiénico-dietéticos con la patología hallada en las colonoscopias ambulatorias realizadas en un centro del Servicio Castellano y Leonés de Salud.

Introduction: Background: colorectal cancer (CRC) is one of the most frequent tumors in terms of incidence and mortality. Several elements, both inherited and environmental, have been related with its pathogenesis. Aims: to analyze the influence of age, gender and nutritional factors on the diagnosis of colonic polyps and CRC. Methods: a prospective, descriptive study over outpatients from the Health Area of León who took a colonoscopy between 09/09/2012 and 06/30/2013. Patients were asked to fill a semiquantitative food frecuency questionnaire with data such a sociodemographic, toxic and dietetic facts. Differences in diagnosis according to sociodemographic and hygiene-dietetic data were analyzed with a multivariate analysis by forward stepwise logistic regression. Results: data were collected from 1390 patients. Mean age was 57.88 (15.17) years and 47.8 % were male. CRC was diagnosed in 5 % of colonoscopies, and polyps in 20.4 %, with 9.4 % of them being HRA. Risk of polyps and HRA was higher in males (26.9 % vs 14.5 %) and (12.6 % vs 6.3 %), respectively (p < 0.001). Mean age was significantly higher in patients who presented polyps (56.51 (15.45) vs 63.22 (12.69) years; p < 0.001). Among the group who reported intake of smoked and salted food, the risk of polyps doubled (2.9 % vs 6.7 %, p = 0.002). In relation to alcohol intake we found that subjects with daily alcohol consumption showed a higher incidence of polyps whe compared to occasional drinkers and teetotallers (32 % vs 20 % vs 18.6 %, p = 0.002) Conclusions: age correlated with higher risk of polyps, HRA and CRC. Moreover, male gender also was associated with a high risk of polyps and HRA. Alcohol and red and processed meat intake increased polyp risk.

Introducción: Introducción: el cáncer colorrectal (CCR) es un tumor muy frecuente en términos de incidencia y mortalidad. Su patogenia se ha relacionado con diversos factores ambientales y hereditarios. Objetivos: analizar la asociación de edad, sexo y factores dietéticos con el diagnóstico de adenomas y CCR. Métodos: se realizó un estudio descriptivo prospectivo con los pacientes del Área Sanitaria de León que se sometieron a una colonoscopia ambulatoria entre 09/09/2012 y 30/06/2013. Mediante un formulario autoadministrado se recogieron datos sociodemográficos, tóxicos y dietéticos usando un cuestionario alimentario de frecuencia semicuantitativo. Se analizaron las diferencias en el diagnóstico según los datos sociodemográficos e higiénico-dietéticos, con análisis multivariante mediante regresión logística por pasos hacia delante. Resultados: se recogieron datos de 1390 pacientes cuya edad media fue de 57 (15) años; de ellos, el 47,8 % eran varones. Se diagnosticaron CCR en el 5 % de los pacientes y pólipos en el 20,4 % (9,4 % de adenomas de alto riesgo (AAR)). El hallazgo de pólipos y AAR fue más frecuente en los varones (26,9 % vs. 14,5 % y 12,6 % vs. 6,3 %, respectivamente (p < 0,001)). La edad media fue significativamente superior en los pacientes que presentaban pólipos (56.51 (15.45) vs. 63.22 (12.69) años; p < 0,001). En la población que refirió un consumo diario de carnes procesadas se duplicaba la proporción de pólipos detectados (2,9 % vs. 6,7 %; p = 0,02). Aquellos pacientes que consumían alcohol diariamente tenían mayor incidencia de pólipos frente al consumo ocasional y los abstemios (32 % vs. 20 % vs. 18,6 %; p = 0,002). Conclusiones: la edad se relacionaba con un mayor riesgo de pólipos, AAR y CCR. Los varones también tenían más riesgo de pólipos y AAR. El consumo de alcohol, carnes rojas y procesadas incrementaba el riesgo de pólipos.

Environmental Impact of Ambulatory Telehealth Use by a Statewide University Health System During COVID-19.

Objective: Several studies before the COVID-19 pandemic documented the positive impact of telehealth on patients' travel distance, time, out-of-pocket costs, and greenhouse gas emissions. The objective of this study was to calculate these outcomes following the increased use of ambulatory telehealth services within five large University of California (UC) health care systems during the COVID-19 pandemic. Methods: We analyzed retrospective ambulatory telehealth data from the five UC health care systems between March 1, 2020, and February 28, 2022. Travel distances and time saved were calculated using the round-trip distance a patient would have traveled for an in-person visit, while cost savings were calculated using Internal Revenue Services' (IRS) 2022 standard mileage reimbursement rates. In addition, we estimated the injuries and fatalities avoided using the national motor vehicle crash data. Greenhouse gas emissions were estimated using the 2021 national average vehicle emission rates. Results: More than 3 million (n = 3,043,369) ambulatory telehealth encounters were included in the study. The total round-trip distance, travel time, and travel cost saved from these encounters were 53,664,391 miles, 1,788,813 h, and $33,540,244, respectively. These translated to 17.6 miles, 35.3 min, and $11.02 per encounter. By using telehealth, 42.4 crash-related injuries and 0.7 fatalities were avoided. The use of telehealth for ambulatory services during this time eliminated 21465.8 metric tons of carbon dioxide, 14.1 metric tons of total hydrocarbons, 212.3 metric tons of exhaust carbon monoxide, and 9.3 metric tons of exhaust nitrogen oxide emissions. Conclusions: Telehealth use for ambulatory services in a statewide academic Health System during COVID-19 had a positive impact on patient travel distance, time and costs, injuries and fatalities in motor vehicle accidents, and greenhouse gas emissions. These significant advantages of telehealth should be considered when planning future health services.

Motivos de derivación y características epidemiológicas de los pacientes atendidos en una consulta monográfica de dermatoscopia de un hospital terciario español / Reasons for Referral and Epidemiological Characteristics of Patients Seen at a Dedicated Dermoscopy Unit in a Spanish Tertiary Care Hospital

Las consultas monográficas de dermatoscopia digital están dirigidas a la población con alto riesgo de melanoma. Conocer los motivos de derivación a estas consultas, así como las características epidemiológicas de los pacientes permite optimizar los recursos sanitarios, y determinar qué pacientes se benefician más de esta técnica. Se analizaron los motivos de derivación y las características epidemiológicas de 413 pacientes atendidos en una consulta monográfica de dermatoscopia en un período de 10 años, y que presentaban al menos un criterio de alto riesgo de melanoma. También se analizó el número necesario de extirpaciones (NNE) por cada melanoma diagnosticado, sus características histológicas y las variables no ambientales se asociaron con su diagnóstico. Los motivos de derivación más frecuentes fueron: antecedentes de melanoma previo (21,5%), cambios detectados por el paciente o su familia (20%), hallazgos clínicos y/o dermatoscópicos sospechosos de malignidad (19,4%) y antecedentes familiares de melanoma (17,4%). Setenta y seis de las 178 lesiones extirpadas fueron melanomas, obteniendo un NNE de 2,34. La edad avanzada fue el único factor de riesgo que se asoció de forma estadísticamente significativa con el desarrollo de melanoma (AU)

Dedicated dermoscopy units assess individuals at high risk for melanoma. Understanding the reasons for referral to these units and the epidemiological profile of referred patients can help optimize health care resources and determine who benefits most from dermoscopic evaluation. We analyzed reasons for referral and epidemiological characteristics of 413 patients with at least 1 high-risk factor for melanoma seen at a dedicated dermoscopy unit over a period of 10 years. We also analyzed the number of necessary excisions (NNE) for each melanoma diagnosed, histologic features, and associations between nonenvironmental factors and diagnosis. The main reasons for referral were a past history of melanoma (21.5%), changes detected by the patient or a relative (20%), clinical and/or dermoscopic findings suggestive of malignancy (19.4%), and a family history of melanoma (17.4%). Seventy-six of the 178 excised lesions were melanomas (NNE per melanoma detected, 2.34). Older age was the only risk factor significantly associated with the development of melanoma (AU)

[Translated article] Reasons for Referral and Epidemiological Characteristics of Patients Seen at a Dedicated Dermoscopy Unit in a Spanish Tertiary Care Hospital / Motivos de derivación y características epidemiológicas de los pacientes atendidos en una consulta monográfica de dermatoscopia de un hospital terciario español

Dedicated dermoscopy units assess individuals at high risk for melanoma. Understanding the reasons for referral to these units and the epidemiological profile of referred patients can help optimize health care resources and determine who benefits most from dermoscopic evaluation. We analyzed reasons for referral and epidemiological characteristics of 413 patients with at least 1 high-risk factor for melanoma seen at a dedicated dermoscopy unit over a period of 10 years. We also analyzed the number of necessary excisions (NNE) for each melanoma diagnosed, histologic features, and associations between nonenvironmental factors and diagnosis. The main reasons for referral were a past history of melanoma (21.5%), changes detected by the patient or a relative (20%), clinical and/or dermoscopic findings suggestive of malignancy (19.4%), and a family history of melanoma (17.4%). Seventy-six of the 178 excised lesions were melanomas (NNE per melanoma detected, 2.34). Older age was the only risk factor significantly associated with the development of melanoma (AU)

Las consultas monográficas de dermatoscopia digital están dirigidas a la población con alto riesgo de melanoma. Conocer los motivos de derivación a estas consultas, así como las características epidemiológicas de los pacientes permite optimizar los recursos sanitarios, y determinar qué pacientes se benefician más de esta técnica. Se analizaron los motivos de derivación y las características epidemiológicas de 413 pacientes atendidos en una consulta monográfica de dermatoscopia en un período de 10 años, y que presentaban al menos un criterio de alto riesgo de melanoma. También se analizó el número necesario de extirpaciones (NNE) por cada melanoma diagnosticado, sus características histológicas y las variables no ambientales se asociaron con su diagnóstico. Los motivos de derivación más frecuentes fueron: antecedentes de melanoma previo (21,5%), cambios detectados por el paciente o su familia (20%), hallazgos clínicos y/o dermatoscópicos sospechosos de malignidad (19,4%) y antecedentes familiares de melanoma (17,4%). Setenta y seis de las 178 lesiones extirpadas fueron melanomas, obteniendo un NNE de 2,34. La edad avanzada fue el único factor de riesgo que se asoció de forma estadísticamente significativa con el desarrollo de melanoma (AU)

Características actuales de la población pediátrica asistida en un centro de salud del primer nivel de atención en 2020-2021: Montevideo, Uruguay / Characteristics of the pediatric population assisted at primary care level in Montevideo, Uruguay / Características da população pediátrica assistida no nível de atenção primária em Montevidéu, Uruguai

Introducción: alrededor del 30% de las enfermedades infantiles responden a factores sociofamiliares y ambientales, asociados a condiciones de vida, dinámica familiar y exposición a sustancias tóxicas. Conocer las características de la población pediátrica que asiste este centro de salud nos ayudará a identificar factores que pueden estar influyendo en su salud. Objetivos: Describir las características clínico-epidemiológicas de la población menor de 15 años que recibió asistencia en el Centro de Salud Badano Repetto en el período 2020-2021. Conocer diferentes variables que pueden influir en la salud de esta población Identificar asociación de variables familiares y socioculturales con el desarrollo en las diferentes edades. Metodología: estudio descriptivo, retrospectivo, corte transversal. Se incluyó una muestra por conveniencia del 15% del total de los niños y adolescentes menores de 15 años asistidos en el centro de salud desde 1/10/2020 hasta 31/3/2021. Variables estudiadas: del niño: sexo, edad, antecedentes perinatales, crecimiento y desarrollo, controles en salud, inmunizaciones, escolarización, actividades extracurriculares. De los padres: edad, nivel educativo, consumo de sustancias psicoactivas, antecedentes patológicos, empleo, privación de libertad. Familia y vivienda: estado civil de los padres, antecedentes de violencia doméstica, convivientes, características de la vivienda, servicios básicos, transferencias directas de ayuda, intervención de equipos de territorio. Fuente de datos: historias clínicas y vía telefónica. Registro en planilla prediseñada. Los resultados se expresan en frecuencias absolutas, relativas y medidas de tendencia central con su rango. Se utilizó test de Chi cuadrado o exacto de Fisher. Nivel de significación: 0,05. Programa Epi Info™ versión 7.2. Consentimiento informado telefónico a padres y asentimiento a adolescentes. Aprobado por el Comité de Ética del CHPR. Resultados: consultaron 2.826 menores de 15 años, se incluyeron 426 (15%), pero solo 263 (62%) fueron analizados, dado que 163 (38%) no pudieron ser contactados telefónicamente. El 52% eran de sexo femenino. Media de edad: 4 años (5 días-14 años), 69% ≤5 años. 83% de los pacientes tenían adecuados controles de salud y 91% estaban al día con sus inmunizaciones. 12% tenían sobrepeso/obesidad. El desarrollo neurológico fue adecuado en 93% en los menores de 5 años y en 56% de los mayores de 5 años de edad. En el caso de aquellos con trastornos del neurodesarrollo mayores de 5 años, 46% tenían trastornos del aprendizaje, 39% trastorno de conducta, 32% trastornos del lenguaje, 10% déficit intelectual. 56% estaba escolarizado, todos en escuelas públicas. En el caso de aquellos que no asistían a la escuela, 4 estaban en edad de asistencia obligatoria (6, 7, 9 y 10 años de edad). 20% de los niños/adolescentes había repetido por lo menos un año en escuela o liceo. Datos perinatales: 14% de las madres consumieron drogas; las más frecuentes fueron tabaco y pasta base de cocaína (PBC). 85% fueron recién nacidos de término, 10% presentaron depresión neonatal. 15% de niños/ adolescentes estuvo expuesto a violencia doméstica y 32% de ellos (12/38) tenía por lo menos un padre con uso de drogas psicoactivas en el domicilio. 21% de los niños/adolescentes expuestos a violencia doméstica tenía una dificultad de aprendizaje. 8% de estos pacientes tenía por lo menos un padre que no había terminado educación primaria y 28% que no había terminado ciclo básico. Se encontró una relación significativa entre uso de drogas psicoactivas, declarada por uno o ambos padres, y violencia doméstica. No se encontró una relación significativa entre alteración del neurodesarrollo y violencia doméstica. Conclusiones: estos hallazgos muestran una población social y económicamente vulnerable, padres con baja escolaridad, uso de pasta base de cocaína durante el embarazo en un porcentaje mayor al reportado nacionalmente, y 15% de niños/adolescentes expuestos a violencia doméstica, pero con un buen número de controles de salud. La mayor fortaleza encontrada por este estudio es la importancia de mantener una buena conexión con estas familias, que mostraron un alto nivel de compromiso con el centro de salud. Esto nos desafía a priorizar la prevención y promoción en salud como herramientas valiosas para adquirir salud de calidad para estos niños/adolescentes. Nuevos estudios, con otras metodologías, serán necesarios para analizar estas variables encontradas.

Introduction: around 30% of childhood diseases are caused by social, environmental and family issues, as well as by life conditions, family dynamics and exposure to toxic substances. Understanding the characteristics of the pediatric population assisted at this Health Center, will help us identify health-threatening factors. Objectives: Describe the clinical and epidemiological characteristics of the population under 15 years of age assisted at Badano Repetto Health Center between 2020 and 2021. Understand the different variables that could influence this population´s health. Identify the link between family, social and cultural variables and neurological development at different ages. Methodology: descriptive, retrospective cross-sectional study. Convenience sampling of 15% of the total number of children and adolescents under 15 years of age, assisted at the Health Center from 10/01/2020 to 3/31/2021. Variables: children: sex, age, perinatal history, growth and neurological development, health checkups, vaccines, school attendance, extracurricular activities. Parents: age, education, psychoactive substance use, pathological background, job, prison. Family and household: parent`s marital status, domestic violence history, cohabitants, housing characteristics, basic household services, government aids, community interventions. Data source: medical records and telephone conversations. Data was recorded on template charts. We used results in absolute and relative frequencies, and their measures of central tendency measures and their range, Chi-square test or Fisher´s exact test. Significance level 0,05. Epi Info Program, version 7.2. Informed parent and adolescent consent. Approved by the CHPR Ethics Committee. Results: out of the 2826 patients under 15 years of age assisted at the clinic, we included 426 (15%), but only 263 (62%) were analyzed, since we were not able to reach 163 (38%) by phone. 52% were female. The average age was 4 years of age (5 days-14 years old). 69% of children were under 5 years old. 83% of patients had adequate number of checkups and 91% had an updated vaccination chart. 12% were overweight/obese. Neurodevelopment was adequate in 93% of those under 5 years of age, and 56% of those over 5 years of age. Regarding those with neurodevelopmental difficulties and over 5 years of age, 46% had learning disabilities, 39% had behavioral disorders, 32% language disorders, 10% intellectual deficit. 56% attended school, all of them public schools. For those who did not attend school, 4 of them were old enough to attend mandatory school (6, 7, 9 and 10 years of age). 20% of the children and adolescents had failed at least one year in school or high school. Perinatal findings: 14% of mothers had substance use during pregnancy, mainly tobacco and cocaine base paste. 85% of them had been born to term, 10% had neonatal depression 15% of children/adolescents had been exposed to domestic violence and 32% of them (12/38) had one parent with psychoactive drug use at home. 21% of children/adolescents exposed to domestic violence had a learning disability. 8% had at least one parent who did not finish primary school and 28% who did not finish middle school. Statistically, a significant link was found between psychoactive substance use, declared by one or both parents, and domestic violence. No statistically significant link was found between neurodevelopmental difficulties and domestic violence. Conclusions: these findings show a socially and economically vulnerable population, parents with little formal education, higher cocaine paste base use during pregnancy than the national statistics and 15% of children/adolescents exposed to domestic violence, even though they a high number of them had received their health checkups. The biggest strength shown by this study is the importance of maintaining a good bond with these families, who showed a high level of commitment with the health center. This leads us to prioritize health prevention and promotion as a valuable tool to achieve health quality standards for these children and adolescents. New studies, using other methodologies, will be necessary to analyze this data.

Introdução: cerca de 30% das doenças infantis são causadas por questões sociais, ambientais e familiares, bem como por condições de vida, dinâmica familiar e exposição a substâncias tóxicas. Compreender as características da população pediátrica atendida neste Centro de Saúde, nos ajudará a identificar fatores de risco à saúde. Objetivos: Descrever as características clínico-epidemiológicas da população menor de 15 anos de idade atendida no Centro de Saúde Badano Repetto no período 2020-2021. Compreender diferentes variáveis que podem influenciar a saúde dessa população. Identificar uma relação entre as variáveis familiares e socioculturais e o desenvolvimento em diferentes idades. Metodologia: estudo descritivo, retrospectivo, transversal. Foi incluída uma amostra por conveniência de 15% de todas as crianças e adolescentes menores de 15 anos atendidos no Centro de Saúde entre 01/10/2020 e 31/03/2021. Variáveis estudadas: da criança: sexo, idade, história perinatal, crescimento e desenvolvimento, controles de saúde, imunizações, escolaridade, atividades extracurriculares. Dos pais: idade, escolaridade, consumo de substâncias psicoativas, histórico médico, emprego, privação de liberdade. Família e habitação: estado civil dos pais, história de violência doméstica, coabitantes, características da moradia, serviços básicos, transferências de ajuda de custo, intervenção das equipes no território. Fonte de dados: prontuários e enquetes telefônicas. Cadastro em planilha padrão. Os resultados são expressos em frequências absolutas e relativas e medidas de tendência central com sua amplidão. Utilizou-se o teste do qui-quadrado ou exato de Fisher. Nível de significância 0,05. Programa Epi Info™ versão 7.2. Consentimento informado por telefone pais e consentimento dos adolescentes. Aprovado pelo Comitê de Ética do CHPR. Resultados: 2.826 crianças menores de 15 anos consultadas, 426 (15%) foram incluídas, mas 263 (62%) foram analisadas, pois 163 (38%) não puderam ser contatadas por telefone. 52% eram do sexo feminino. Idade média 4 anos (5 dias -14 anos), 69% ≤ 5 anos. 83% dos pacientes possuíam controles de saúde adequados e 91% estavam com suas imunizações em dia. 12% com sobrepeso/obesidade. O desenvolvimento neurológico foi adequado em 93% dos menores de 5 anos e em 56% dos maiores de 5 anos. No caso dos portadores de transtornos de neurodesenvolvimento com mais de 5 anos, 46% apresentavam transtorno de aprendizagem, 39% transtorno de conduta, 32% transtorno de linguagem, 10% déficit intelectual. 56% estavam na escola, todos em escolas públicas. No caso dos que não frequentaram a escola, 4 deles estavam em idade em idade escolar obrigatória (6, 7, 9 e 10 anos). 20% das crianças/adolescentes repetiram pelo menos um ano na escola ou no ensino médio. Dados perinatais: 14% das mães usavam drogas; pasta base de tabaco e maiormente pasta base de cocaína (PBC). 85% eram recém-nascidos a termo, 10% tinham depressão neonatal. 15% das crianças/adolescentes foram expostos à violência doméstica e 32% deles (12/38) tinham pelo menos um dos pais que usava drogas psicoativas em casa. 21% das crianças/adolescentes expostas à violência doméstica tinham dificuldade de aprendizagem. 8% desses pacientes possuíam pelo menos um dos pais com escola primária incompleta e 28% com ensino médio incompleto. Encontrou-se relação significativa entre o uso de drogas psicoativas, declarado por um ou ambos os pais, e a violência doméstica. Não foi encontrada relação significativa entre transtornos do neurodesenvolvimento e violência doméstica. Conclusões: esses achados mostram uma população social e economicamente vulnerável, pais com baixa escolaridade, uso de pasta base de cocaína durante a gravidez em porcentagem superior ao reportado a nível nacional, e 15% de crianças/adolescentes expostos à violência doméstica, mas com um alto número de controles de saúde. A maior fortaleza encontrada por este estudo é a importância de manter um bom vínculo com essas famílias, que demonstraram alto nível de comprometimento com o centro de saúde. Isso nos leva a priorizar a prevenção e promoção da saúde como ferramentas valiosas para a aquisição de saúde de qualidade para essas crianças/adolescentes. Novos estudos, com outras metodologias, serão necessários para poder analisar essas variáveis encontradas.

Economic and Environmental Impact of Digital Health App Video Consultations in Follow-up Care for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial.

BACKGROUND: Following the Riyadh Declaration, digital health technologies were prioritized in many countries to address the challenges of the COVID-19 pandemic. Digital health apps for telemedicine and video consultations help reduce potential disease spread in routine health care, including follow-up care in orthopedic and trauma surgery. In addition to the satisfaction, efficiency, and safety of telemedicine, its economic and environmental effects are highly relevant to decision makers, particularly for the goal of reaching carbon neutrality of health care systems. OBJECTIVE: This study aims to provide the first comprehensive health economic and environmental analysis of video consultations in follow-up care after knee and shoulder interventions in an orthopedic and trauma surgery department of a German university hospital. The analysis is conducted from a societal perspective. We analyze both economic and environmental impacts of video consultations, taking into account the goal of carbon neutrality for the German health care system by 2030. METHODS: We conducted a prospective randomized controlled trial comparing follow-up care with digital health app video consultations (intervention group) to conventional face-to-face consultations in the clinic (control group). Economic impact included the analysis of travel and time costs and production losses. Examination of the environmental impact comprised the emissions of greenhouse gases, carbon monoxide, volatile hydrocarbons, nitrogen oxides, and particulates, and the calculation of environmental costs. Sensitivity analysis included calculations with a higher cost per ton of carbon dioxide equivalent, which gives equal weight to the welfare of present and future generations. RESULTS: Data from 52 patients indicated that, from the patients' point of view, telemedicine helped reduce travel costs, time costs, and production losses, resulting in mean cost savings of €76.52 per video consultation. In addition, emissions of 11.248 kg of greenhouse gases, 0.070 kg of carbon monoxide, 0.011 kg of volatile hydrocarbons, 0.028 kg of nitrogen oxides, and 0.0004 kg of particulates could be saved per patient through avoided travel. This resulted in savings of environmental costs between €3.73 and €9.53 per patient. CONCLUSIONS: We presented the first comprehensive analysis of economic and environmental effects of telemedicine in the follow-up care of patients in orthopedic and trauma surgery in Germany. Video consultations were found to reduce the environmental footprint of follow-up care; saved travel costs, travel time, and time costs for patients; and helped to lower production losses. Our findings can support the decision-making on the use of digital health during and beyond the COVID-19 pandemic, providing decision makers with data for both economic and environmental effects. Thanks to the pragmatic design of our study, our findings can be applied to a wide range of clinical contexts and potential digital health applications that substitute outpatient hospital visits with video consultations. TRIAL REGISTRATION: German Clinical Trials Register DRKS00023445; https://tinyurl.com/4pcvhz4n.

Environmental impact of telehealth use for pediatric surgery.

BACKGROUND: The healthcare sector is responsible for 10% of US greenhouse gas emissions. Telehealth use may decrease healthcare's carbon footprint. Our institution introduced telehealth to support SARS-CoV-2 social distancing. We aimed to evaluate the environmental impact of telehealth rollout. METHODS: We conducted a retrospective cohort study of pediatric patients seen by a surgical or pre anesthesia provider between March 1, 2020 and March 1, 2021. We measured patient-miles saved and CO2 emissions prevented to quantify the environmental impact of telehealth. Miles saved were calculated by geodesic distance between patient home address and our institution. Emissions prevented were calculated assuming 25 miles per gallon fuel efficiency and 19.4 pounds of CO2 produced per gallon of gasoline consumed. Unadjusted Poisson regression was used to assess relationships between patient demographics, geography, and telehealth use. RESULTS: 60,773 in-person and 10,626 telehealth encounters were included. This represented an 8,755% increase in telehealth use compared to the year prior. Telehealth resulted in 887,006 patient-miles saved and 688,317 fewer pounds of CO2 emitted. Demographics significantly associated with decreased telehealth use included Asian and Black/African American racial identity, Hispanic ethnic identity, and primary language other than English. Further distance from the hospital and higher area deprivation index were associated with increased telehealth use (IRR 1.0006 and 1.0077, respectively). CONCLUSION: Incorporating telehealth into pediatric surgical and pre anesthesia clinics resulted in significant CO2 emission reductions. Expanded telehealth use could mitigate surgical and anesthesia service contributions to climate change. Racial and linguistic minority status were associated with significantly lower rates of telehealth utilization, necessitating additional inquiry into equitable telemedicine use for minoritized populations. LEVEL OF EVIDENCE: Level IV.

Changes in Health and Quality of Life in US Skilled Nursing Facilities by COVID-19 Exposure Status in 2020.

Importance: During the COVID-19 pandemic, the US federal government required that skilled nursing facilities (SNFs) close to visitors and eliminate communal activities. Although these policies were intended to protect residents, they may have had unintended negative effects. Objective: To assess health outcomes among SNFs with and without known COVID-19 cases. Design, Setting, and Participants: This retrospective observational study used US Medicare claims and Minimum Data Set 3.0 for January through November in each year beginning in 2018 and ending in 2020 including 15 477 US SNFs with 2 985 864 resident-years. Exposures: January through November of calendar years 2018, 2019, and 2020. COVID-19 diagnoses were used to assign SNFs into 2 mutually exclusive groups with varying membership by month in 2020: active COVID-19 (≥1 COVID-19 diagnosis in the current or past month) or no-known COVID-19 (no observed diagnosis by that month). Main Outcomes and Measures: Monthly rates of mortality, hospitalization, emergency department (ED) visits, and monthly changes in activities of daily living (ADLs), body weight, and depressive symptoms. Each SNF in 2018 and 2019 served as its own control for 2020. Results: In 2018-2019, mean monthly mortality was 2.2%, hospitalization 3.0%, and ED visit rate 2.9% overall. In 2020, among active COVID-19 SNFs compared with their own 2018-2019 baseline, mortality increased by 1.60% (95% CI, 1.58% to 1.62%), hospitalizations decreased by 0.10% (95% CI, -0.12% to -0.09%), and ED visit rates decreased by 0.57% (95% CI, -0.59% to -0.55%). Among no-known COVID-19 SNFs, mortality decreased by 0.15% (95% CI, -0.16% to -0.13%), hospitalizations by 0.83% (95% CI, -0.85% to -0.81%), and ED visits by 0.79% (95% CI, -0.81% to -0.77%). All changes were statistically significant. In 2018-2019, across all SNFs, residents required assistance with an additional 0.89 ADLs between January and November, and lost 1.9 lb; 27.1% had worsened depressive symptoms. In 2020, residents in active COVID-19 SNFs required assistance with an additional 0.36 ADLs (95% CI, 0.34 to 0.38), lost 3.1 lb (95% CI, -3.2 to -3.0 lb) more weight, and were 4.4% (95% CI, 4.1% to 4.7%) more likely to have worsened depressive symptoms, all statistically significant changes. In 2020, residents in no-known COVID-19 SNFs had no significant change in ADLs (-0.06 [95% CI, -0.12 to 0.01]), but lost 1.8 lb (95% CI, -2.1 to -1.5 lb) more weight and were 3.2% more likely (95% CI, 2.3% to 4.1%) to have worsened depressive symptoms, both statistically significant changes. Conclusions and Relevance: Among skilled nursing facilities in the US during the first year of the COVID-19 pandemic and prior to the availability of COVID-19 vaccination, mortality and functional decline significantly increased at facilities with active COVID-19 cases compared with the prepandemic period, while a modest statistically significant decrease in mortality was observed at facilities that had never had a known COVID-19 case. Weight loss and depressive symptoms significantly increased in skilled nursing facilities in the first year of the pandemic, regardless of COVID-19 status.

[Health Economic-Industrial Complex: the economic and material basis of the Brazilian Unified National Health System]. / Complexo Econômico-Industrial da Saúde: a base econômica e material do Sistema Único de Saúde.

The article aims to make a theoretical and political discussion of the concept of the Health Economic-Industrial Complex (CEIS), updating the concept to a contemporary context of technological transformation and of challenges for universal health systems, particular the Brazilian Unified National Health System (SUS). In a context of asymmetric globalization, of emergence of a technological revolution, and of the (re)placement of structural barriers that keeps Brazilian society in its historical movement of inequality, vulnerability, and exclusion, we need to rethink healthcare by resuming and updating an agenda that privileges the historical-structural factors of Brazilian society, the international insertion of the country, and its relationship with an extremely asymmetric diffusion of technical progress, knowledge, and learning, dissociated from local social and environmental needs. With a methodology that involves the analysis of the brazilian response to COVID-19, the commercial balance of the CEIS, and the access to COVID-19 vaccines, the study shows that health is a central part of the economic and social structure and reproduces the characteristics of the national development pattern within it. An equitable society, with quality of life, committed to social rights and the environment is structurally conditioned by the existence of an economic and material basis that supports it. This systemic and dialectical view is the main theoretical and political contribution intended by our study, which seeks to contribute to a collective health approach integrated with a political economy view.

O artigo tem como objetivo fazer uma discussão teórica e política do conceito do Complexo Econômico-Industrial da Saúde (CEIS), atualizando a visão para o contexto contemporâneo de transformação tecnológica e dos desafios para os sistemas universais de saúde e do Sistema Único de Saúde (SUS), em particular. Em um contexto de globalização assimétrica, de emergência de uma revolução tecnológica e de (re)colocação de barreiras estruturais que trancam a sociedade brasileira em seu movimento histórico de desigualdade, vulnerabilidade e exclusão, necessitamos repensar a saúde, retomando e atualizando uma agenda que privilegia os fatores histórico-estruturais da sociedade brasileira, a inserção internacional do País e sua relação com uma difusão extremamente assimétrica do progresso técnico, do conhecimento e do aprendizado, dissociados das necessidades sociais e ambientais locais. Mediante uma metodologia que envolve a análise da resposta brasileira à COVID-19, da balança comercial do CEIS e do acesso a vacinas para COVID-19, o artigo evidencia que a saúde é parte central da estrutura econômica e social e reproduz as características do padrão de desenvolvimento nacional em seu interior. Uma sociedade equânime, com qualidade de vida, comprometida com os direitos sociais e o meio ambiente é condicionada pela existência de uma base econômica e material que lhe dê sustentação. Essa visão sistêmica e dialética é a principal contribuição teórica e política pretendida pelo artigo, que procura contribuir para uma abordagem de saúde coletiva integrada com uma visão de economia política.

Este artículo tiene como objetivo plantear una discusión teórica y política del concepto de Complejo Económico-Industrial de la Salud (CEIS), actualizando la visión para el contexto contemporáneo de transformación tecnológica y de los desafíos para los sistemas universales de salud y el Sistema Único de Salud (SUS), en particular. En un contexto de globalización asimétrica, de emergencia de una revolución tecnológica y de (re)colocación de barreras estructurales que encierran a la sociedad brasileña en su movimiento histórico de desigualdad, vulnerabilidad y exclusión, necesitamos repensar la salud, retomando y actualizando una agenda que privilegia los factores histórico-estructurales de la sociedad brasileña, la inserción internacional del País y su relación con una difusión extremadamente asimétrica del progreso técnico, del conocimiento y del aprendizaje, disociados de las necesidades sociales y ambientales locales. Por medio de una metodología que implica el análisis de la respuesta brasileña a la COVID-19, la balanza comercial del CEIS y el acceso a las vacunas contra la COVID-19, este artículo pone de manifiesto que la salud es parte central de la estructura económica y social y reproduce las características del estándar de desarrollo nacional en su interior. Una sociedad equitativa, con calidad de vida, comprometida con los derechos sociales y el medio ambiente está condicionada estructuralmente por la existencia de una base económica y material que la sustente. Esta visión sistémica y dialéctica es el principal aporte teórico y político pretendido por el artículo, que busca contribuir a un abordaje de la salud colectiva integrado con una visión de economía política.

Aplicación de indicadores ambientales para la planificación del uso del suelo en una zona costera de Buenos Aires, Argentina / Application of environmental indicators for land use planning in a coastal area of Buenos Aires, Argentina

RESUMEN El objetivo de este trabajo fue aplicar indicadores e índices ambientales en una zona costera localizada en el noreste de la provincia de Buenos Aires (Argentina). El área de estudio se ubica en el sector de la planicie costera del Río de la Plata, correspondiente al partido de Ensenada. La misma es un área con alto valor para la biodiversidad regional y brinda numerosos servicios ecosistémicos. Además, está expuesta de manera recurrente a inundaciones y anegamientos, los cuales, determinan fuertes condicionantes para el uso del suelo. Se identificaron y seleccionaron indicadores que aportan información sobre características estructurales y funcionales del medio natural, respecto de su fragilidad frente a intervenciones, a partir de los criterios: vulnerabilidad natural, valor patrimonial y condicionamientos naturales frente a intervenciones antrópicas; estos indicadores fueron integrados para obtener un Índice de Fragilidad Natural Territorial (IFNT). Se generaron mapas temáticos de índices parciales y un mapa final correspondiente al IFNT, mediante el uso de Sistemas de Información Geográfica (SIG). Los resultados obtenidos establecen que el 15,1 % de la superficie del partido presenta una fragilidad natural entre muy alta (2,1 %) y alta (13 %) y un 20,2 %, con valores medios, asociados a ambientes de escasa pendiente del centro, W y E-SE del territorio, así como al sector más próximo a la ribera rioplatense, donde se asientan áreas urbanas. Se observó tendencia de crecimiento urbano avanzando sobre sectores identificados con fragilidad entre muy alta y media. Este índice se considera una herramienta útil para la planificación territorial sostenible.

ABSTRACT The objective of this paper was to apply environmental indicators and indexes in a coastal area located in the northeastern province of Buenos Aires (Argentina). The study area is located in the sector of the coastal plain of the Río de la Plata corresponding to the Ensenada district. It is an area of high regional biodiversity value and provides numerous ecosystem services. In addition, it is exposed to frequent flood events and waterlogged soils, which determines strong conditioning factors for land use. In this paper, the application of environmental indicators and indexes developed ad hoc is presented in order to assist in the sustainable land use planning of the territory. Indicators were identified and selected to provide information on structural and functional characteristics of the natural environment regarding its fragility in front of anthropic interventions. These indicators were made following these selection criteria: natural vulnerability, patrimonial value and natural conditioning to anthropic interventions. These indicators were integrated to obtain a Natural Territorial Fragility Index (NTFI). Thematic maps of intermediate indexes were generated, as well as a final map corresponding to the NTFI, integrated in a GIS. The results obtained from the NTFI calculation establish that 15,1 % of the area of the district presents a natural fragility with values very high (2,1 %) and high (13 %) and 20,2 % medium value. In the center, W and E-SE of the territory, as well as in the sector closest to the rioplatense riverbank, the NTFI presents very high to medium values mainly associated with low slope environments. Urban areas are developed in this location. There is an urban growth trend advancing on sectors identified with very high to moderate fragility. This index is considered a useful tool for sustainable territorial planning.

Health benefits from cleaner vehicles and increased active transportation in Seattle, Washington.

BACKGROUND: Climate mitigation policies that focus on the transportation sector yield near-term health co-benefits that could motivate policy action. OBJECTIVE: We quantified CO2 emission reductions as well as the air pollution and health benefits of urban transportation policies promoting electric vehicles (EV) and walking and bicycling in Seattle, Washington. METHODS: We compared a business-as-usual scenario projected to 2035 with intervention scenarios in which 35% of gasoline vehicles were switched to EV, and 50% of car trips less than 8 kilometers were replaced by walking or bicycling. We modeled changes in primary traffic-generated oxides of nitrogen (NOx) and fine particulate matter (PM2.5) as well as walking and bicycling activity, CO2 emissions from traffic, and fatal traffic injuries due to the transportation policy scenarios. We estimated the impacts of these changes on annual cases of asthma and premature mortality in the Seattle population. RESULTS: Increasing the use of EV, walking, and bicycling is estimated to reduce CO2 emissions by 744 tons/year (30%) and lower annual average concentrations of primary traffic-generated NOx and PM2.5 by 0.32 ppb (13%) and 0.08 µg/m3 (19%), respectively. In Seattle, the lower air pollutant concentrations, greater active transportation, and lower fatal traffic injuries would prevent 13 (95% CI: -1, 28), 49 (95% CI: 19, 71), and 5 (95% CI: 0, 14) premature deaths per year, respectively and 20 (95% CI: 8, 27) cases of asthma per year. SIGNIFICANCE: Moving towards cleaner vehicles and active transportation can reduce CO2 emissions, improve air quality, and population health. The resulting public health benefits provide important motivation for urban climate action plans. IMPACT STATEMENT: Using key components of the health impact assessment framework, we quantify the environmental and health benefits of urban transportation policy scenarios that promote electric vehicle use and replace short car trips with walking and bicycling as compared with a business as usual scenario in 2035. Our findings demonstrate that transportation scenarios promoting cleaner vehicles and active transportation can reduce CO2 emissions, improve air quality, and increase physical activity levels, resulting in significant public health benefits.

Medical Waste from COVID-19 Pandemic-A Systematic Review of Management and Environmental Impacts in Australia.

The coronavirus (COVID-19) pandemic has created a global medical emergency. The unforeseen occurrence of a pandemic of this magnitude has resulted in overwhelming levels of medical waste and raises questions about management and disposal practices, and environmental impacts. The amount of medical waste generated from COVID-19 since the outbreak is estimated to be 2.6 million tons/day worldwide. In Australia, heaps of single-use gowns, facemasks/face shields, aprons, gloves, goggles, sanitizers, sharps, and syringes are disposed everyday as a result of the pandemic. Moreover, the establishment of new home/hotel quarantine facilities and isolation/quarantine centres in various Australian states and territories have increased the risks of transmission among people in these facilities and the likelihoods of general waste becoming contaminated with medical waste. This warrants the need to examine management and disposal practices implemented to reduce the transmission and spread of the virus. This study reviews the various management and disposal practices adopted in Australia for dealing with medical waste from the COVID-19 pandemic and their impacts on public health and the environment. To achieve the aims of this study, prior studies from 2019-2021 from various databases are collected and analysed. The study focuses on generation of medical waste from COVID-19, management and disposal methods, current problems/challenges and environmental and public health impacts. Considering the enormous risks involved and the significance of appropriate handling and disposal of medical waste from COVID-19, this study provides insights on short and long term responses towards managing COVID-19 waste in Australia. The study contributes to Australia's efforts against the transmission and spread of COVID-19 and provides recommendations for the development of workable and sustainable strategies for mitigating similar pandemics in the future.

Assessment of medical waste generation, associated environmental impact, and management issues after the outbreak of COVID-19: A case study of the Hubei Province in China.

COVID-19 greatly challenges the human health sector, and has resulted in a large amount of medical waste that poses various potential threats to the environment. In this study, we compiled relevant data released by official agencies and the media, and conducted data supplementation based on earlier studies to calculate the net value of medical waste produced in the Hubei Province due to COVID-19 with the help of a neural network model. Next, we reviewed the data related to the environmental impact of medical waste per unit and designed four scenarios to estimate the environmental impact of new medical waste generated during the pandemic. The results showed that a medical waste generation rate of 0.5 kg/bed/day due to COVID-19 resulted in a net increase of medical waste volume by about 3366.99 tons in the Hubei Province. In the four scenario assumptions, i.e., if the medical waste resulting from COVID-19 is completely incinerated, it will have a large impact on the air quality. If it is disposed by distillation sterilization, it will produce a large amount of wastewater and waste residue. Based on the results of the study, we propose three policy recommendations: strict control of medical wastewater discharge, reduction and transformation of the emitted acidic gases, and attention to the emission of metallic nickel in exhaust gas and chloride in soil. These policy recommendations provide a scientific basis for controlling medical waste pollution.

Ultrafine particle exposure for bicycle commutes in rush and non-rush hour traffic: A repeated measures study in Copenhagen, Denmark.

Ultrafine particles (UFP), harmful to human health, are emitted at high levels from motorized traffic. Bicycle commuting is increasingly encouraged to reduce traffic emissions and increase physical activity, but higher breathing rates increase inhaled UFP concentrations while in traffic. We assessed exposure to UFP while cycling along a fixed 8.5 km inner-city route in Copenhagen, on weekdays over six weeks (from September to October 2020), during morning and afternoon rush-hour, as well as morning non-rush-hour, traffic time periods starting from 07:45, 15:45, and 09:45 h, respectively. Continuous measurements were made (each second) of particle number concentration (PNC) and location. PNC levels were summarized and compared across time periods. We used generalized additive models to adjust for meteorological factors, weekdays and trends. A total of 61 laps were completed, during 28 days (∼20 per time period). Overall mean PNC was 18,149 pt/cm3 (range 256-999,560 pt/cm3) with no significant difference between morning rush-hour (18003 pt/cm3), afternoon rush-hour (17560 pt/cm3) and late morning commute (17560 pt/cm3) [p = 0.85]. There was substantial spatial variation of UFP exposure along the route with highest PNC levels measured at traffic intersections (∼38,000-42000 pt/cm3), multiple lane roads (∼38,000-40000 pt/cm3) and construction sites (∼44,000-51000 pt/cm3), while lowest levels were measured at smaller streets, areas with open built environment (∼12,000 pt/cm3), as well as at a bus-only zone (∼15,000 pt/cm3). UFP exposure in inner-city Copenhagen did not differ substantially when bicycling in either rush-hour or non-rush-hour, or morning or afternoon, traffic time periods. UFP exposure varied substantially spatially, with highest concentrations around intersections, multiple lane roads, and construction sites. This suggests that exposure to UFP is not necessarily reduced by avoiding rush-hours, but by avoiding sources of pollution along the bicycling route.

Occurrence and concentration of 20-100 µm sized microplastic in highway runoff and its removal in a gross pollutant trap - Bioretention and sand filter stormwater treatment train.

Microplastic pollution of stormwater can be a serious threat to the environment. Gross pollutant trap (GPT) - bioretention treatment trains have been shown previously to treat (inter alia) particulate stormwater pollutants including microplastic particles larger than 100 µm. This study was carried out to investigate whether such stormwater treatment trains also remove smaller 20 to 100 µm sized microplastic particles from highway runoff. Further, it investigates occurrence and concentration of 20 to 100 µm sized microplastic particles in highway runoff and which polymer types they can be assigned to. Volume proportional samples from nine rain events were taken from the incoming highway stormwater, from the gross pollutant trap effluent and the outflow from a bioretention system as well as a non-vegetated sand filter. The microplastic analyses were carried out using µFTIR and FTIR-ATR, which made it possible to detect particles where carbon black was present. It was found that 20 to 100 µm sized microplastic particles are abundant in highway runoff and that their concentrations are highly variable, with a median of 230 particles/L, a minimum of 42 particles/L and a maximum of 8577 particles/L. The dominant polymer types in highway stormwater were Polypropylene (PP), Ethylene Propylene Diene (EPDM) rubber and Ethylene-vinyl acetate (EVA). The treatment train with the bioretention system treated 20 to 200 µm sized microplastic particles significantly better than the treatment train with a non-vegetated sand filter, with median effluent concentrations of 26.5 particles/L and 121 particles/L, respectively. The GPT had no significant impact on the treatment of 20 to 100 µm sized microplastic particles.