THE FIRM GEOGRAPHY OF CENTRAL AND EASTERN EUROPE AND THE WESTERN BALKANS

Since the dissolution of the USSR and advent of market relations, small and medium-sized Russian cities have experienced many economic and social problems due to their peripheral status. At the same time, they form the main framework for the settlement of the northern territories. The research aims to reveal the importance of small and medium-sized cities in the set- tlement system of 13 regions of the Russian North by studying their demographic dynamics. We examined the hypothesis that the demographic sustainability of these cities depends on the time of their formation. A proposed methodology for assessing the demographic sustainability of cities is based on five groups: demographically sustainable, relatively sustainable, unsustainable, critically unsustainable, instability. Four periods of the formation of small and medium-sized cities are defined: colonisation of the Russian North (1584–1917); industrialisation and urbanisation of the northern territories (1918–1959); from coercion to encouragement — northern romance (1960–1989); from settlement to abandonment — depopulation (1990–2020). For each period, the cities were assessed in terms of their demographic sustainability. The current sustainability of the cities was shown to be dependent on the period of their formation. Compared with the rest of Russia, the structure of settlements in the North revealed both similarities (concentration of the population in large cities) and differences (the proportion of the population living in small and medium-sized cities is higher, but lower in rural areas). Future research will focus on developing a methodology for assessing the «saturation» of small and medium-sized cities in the Russian North.

To combat global warming, advancing the shift from extensive traditional urbanization to intelligent, green, and low-carbon new urbanization is essential for the high-quality and sustainable development of the Chinese economy. This paper considers the comprehensive pilot policy for new urbanization as a ‘quasi-natural experiment,’ and assesses the current status of carbon emissions using panel data from 139 small and medium-sized Chinese cities between 2006 and 2019. The direct effects of the new urbanization pilot policies on carbon emissions in small and medium-sized cities were assessed using the difference-in-differences (DID) method. The robustness of the findings was further validated through parallel trend tests and propensity score matching DID methods. Subsequently, the mediating effect model was employed to explore the mechanisms by which the new urbanization pilot policies affect carbon emissions in Chinese small and medium-sized cities. The findings are as follows: (1) In recent years, there has been a significant increase in the level of carbon emissions in China’s small and medium-sized cities, with emissions in the western and northeastern regions notably lower than those in the central and eastern regions. (2) Compared to non-pilot regions, the new urbanization pilot policies have significantly reduced carbon emissions in pilot regions. (3) The new urbanization pilot policies reduce carbon emissions in small and medium-sized cities by optimizing the industrial structure and enhancing green innovation.

Background and Aims Despite huge efforts to accomplish equitable access to high-quality healthcare, large disparities in kidney care delivery remain across Europe. Economic factors are considered to be the driving force behind differences in access to kidney replacement therapy (KRT), with lower access in lower-income countries. There is a sparsity of epidemiological data on KRT in Central and Eastern Europe. Therefore, we aimed to examine time trends in incidence and prevalence of KRT in Central and Eastern Europe from 2010 to 2021. Method We included incidence and prevalence data on patients starting or receiving KRT between the years 2010 and 2021 from 18 Central and Eastern European countries participating in the ERA Registry. Albania, Belarus, Bulgaria, Cyprus, Czech Republic, Latvia, Lithuania, Northern Macedonia, Poland, Russia, Slovakia, Turkey, and Ukraine provided data on aggregated level, whereas Bosnia and Herzegovina, Estonia, Greece, Romania and Serbia provided individual patient data. General population data were reported by the collaborating registries or extracted from Eurostat. Most registries had full coverage of the general population. We expressed incidence and prevalence per million population (pmp) and time trends were studied with Joinpoint regression and expressed as Annual Percentage Changes (APCs). Results Incidence of KRT varied largely across Central and Eastern European countries (Fig. 1). In 2010, it ranged from 23.0 pmp in Ukraine to 190.5 pmp in Greece, and in 2021 from 53.0 pmp in Ukraine to 283.0 pmp in Cyprus. In 7 countries the KRT incidence increased significantly between 2010 and 2021 (APC; 95% CI): Albania (+8%; 5-10%), Cyprus (+6%; 4-9%), Greece (+3%; 3-4%), North Macedonia (+4%; 3-5%), Romania (+3%; 1-5%), Russia (+9%; 7-10%), and Ukraine (+7%; 4-9%). Serbia was the only country in which KRT incidence decreased: from 188.6 pmp in 2010 to 65.9 pmp in 2021 (APC: −8%; −10 to −6%), whereas for other countries KRT incidence remained stable over the study period. Except for the Baltic States, the age of incident KRT patients increased in all countries during the study period, also reflected by a temporal increase in the proportion of patients initiating KRT at ages of 65 years and older. The KRT prevalence also showed large variation across countries, ranging from 123.6 pmp to 1080.0 pmp in 2010 in Ukraine and Greece (Fig. 1). In 2021 it ranged from 303.6 pmp (Ukraine) to 1445.4 pmp (Greece). In all, but five countries (Belarus, Bosnia and Herzegovina, Czech Republic, North Macedonia, and Serbia) the prevalence of KRT increased annually with 2-9% between 2010 and 2021. This increase was mainly driven by an increase in prevalent patients with a functioning kidney transplant. If, however, the period prior to the COVID-19 pandemic was considered (2010 to 2019) there was also an increasing trend in the KRT prevalence for Bosnia and Herzegovina, Czech Republic, and North Macedonia. In all countries, prevalent KRT patients became older during recent years. Conclusion Large variation exists in the number of incident and prevalent patients treated with KRT across Central and Eastern Europe. In the majority of countries the incidence of KRT remained stable between 2010 and 2021, whereas in about one third of countries the incidence of KRT significantly increased. On the other hand, in most countries the number of prevalent KRT patients significantly increased over the study period, especially prior to the COVID-19 pandemic. This increase was mainly driven by an increase in prevalent kidney transplant recipients. Patients on KRT tended to become older in the entire region, reflecting both the aging population, as well as the increasing willingness and capacity to treat elderly patients. Nevertheless, large country variations in the epidemiology of KRT remain and this study is a first important step to define country-specific priorities for the optimization of kidney care and to create further public awareness for kidney diseases in the Central and Eastern European region.

Introduction: Ischemic stroke accounts for approximately 80% of all stroke cases and remains a major cause of morbidity and mortality among adults. At the beginning of the 21st century, the age-standardized incidence of stroke in Europe ranged from 95 to 290 cases per 100,000 population. Objective: Our aim was to examine trends in the incidence of ischemic stroke in Europe between 1991 and 2021, by country group, gender, and age group. Method: In our retrospective, quantitative study, we analyzed data from 44 countries in three European country groups (Eastern, Central, and Western Europe) per 100 000 people based on the Global Burden of Disease 2021 database. Descriptive statistics, time series analysis and Kruskal–Wallis test were performed. Results: Between 1991 and 2021, the age-standardized incidence per 100 000 population in men decreased from 206.7 to 147.1 (−28.8%) in Eastern Europe, from 172.1 to 123.8 (−28.1%) in Central Europe, and from 120.7 to 62.3 (−48.4%) (p<0.05) in Western Europe. In women, during the same period, it decreased from 169.8 to 113.9 (−32.9%) in Eastern Europe, from 142.4 to 106.0 (−25.6%) in Central Europe, and from 89.5 to 47.2 (−47.3%) in Western Europe (p<0.05). Significant differences were found between Eastern and Western European countries and between Central and Western European countries for both sexes (1991, 2001, 2011, 2021: p<0.05). The incidence was higher in men than in women every year, especially in the age groups over 55. The largest decrease for both sexes was observed in the 65–69 age group. Based on the analysis by country, the largest decrease was in Portugal (men: –71.1%; women: –69.9%), while in Montenegro, increases of +4.1% for men and +6.3% for women were observed. Conclusion: During the study period, the incidence of ischemic stroke decreased in all three country groups, but the improvement was greater in the Western European country group, which had lower (more favorable) baseline values, than in Central or Eastern Europe. Nevertheless, in 2021, the incidence in Eastern and Central Europe still exceeded the level measured in Western European countries in 1991. Orv Hetil. 2025; 166(42): 1642–1652.

Smart Cities have been around as a concept for quite some time. However, most examples of Smart Cities (SCs) originate from megacities (MCs), despite the fact that most people live in Small and Medium-sized Cities (SMCs). This paper addresses the contextual setting for smart cities from the perspective of such small and medium-sized cities. It starts with an overview of the current trends in the research and development of SCs, highlighting the current bias and the challenges it brings. We follow with a few concrete examples of projects which introduced some form of “smartness” in the small and medium cities context, explaining what influence said context had and what specific effects did it lead to. Building on those experiences, we summarise the current understanding of Smart Cities, with a focus on its multi-faceted (e.g., smart economy, smart people, smart governance, smart mobility, smart environment and smart living) nature; we describe mainstream publications and highlight the bias towards large and very large cities (sometimes even subconscious); give examples of (often implicit) assumptions deriving from this bias; finally, we define the need of contextualising SCs also for small and medium-sized cities. The aim of this paper is to establish and strengthen the discourse on the need for SMCs perspective in Smart Cities literature. We hope to provide an initial formulation of the problem, mainly focusing on the unique needs and the specific requirements. We expect that the three example cases describing the effects of applying new solutions and studying SC on small and medium-sized cities, together with the lessons learnt from these experiences, will encourage more research to consider SMCs perspective. To this end, the current paper aims to justify the need for this under-studied perspective, as well as to propose interesting challenges faced by SMCs that can serve as initial directions of such research.

In the last decade, substantial differences in the epidemiology of, antiretroviral therapy (ART) for, cascade of care in and support to people with HIV in vulnerable populations have been observed between countries in Western Europe, Central Europe (CE) and Eastern Europe (EE). The aim of this study was to use a survey to explore whether ART availability and therapies have evolved in CE and EE according to European guidelines. The Euroguidelines in Central and Eastern Europe (ECEE) Network Group conducted two identical multicentre cross-sectional online surveys in 2019 and 2021 concerning the availability and use of antiretroviral drugs (boosted protease inhibitors [bPIs], integrase inhibitors [INSTIs] and nucleoside reverse transcriptase inhibitors [NRTIs]), the introduction of a rapid ART start strategy and the use of two-drug regimens (2DRs) for starting or switching ART. We also investigated barriers to the implementation of these strategies in each region. In total, 18 centres participated in the study: four from CE, six from EE and eight from Southeastern Europe (SEE). Between those 2 years, older PIs were less frequently used and darunavir-based regimens were the main PIs (83%); bictegravir-based and tenofovir alafenamide-based regimens were introduced in CE and SEE but not in EE. The COVID-19 pandemic did not significantly interrupt delivery of ART in most centres. Two-thirds of centres adopted a rapid ART start strategy, mainly in pregnant women and to improve linkage of care in vulnerable populations. The main obstacle to rapid ART start was that national guidelines in several countries from all three regions did not support such as strategy or required laboratory tests first; an INSTI/NRTI combination was the most commonly prescribed regimen (75%) and was exclusively prescribed in SEE. 2DRs are increasingly used for starting or switching ART (58%), and an INSTI/NRTI was the preferred regimen (75%) in all regions and exclusively prescribed in SEE, whereas the use of bPIs declined. Metabolic disorders and adverse drug reactions were the main reasons for starting a 2DR; in the second survey, HIV RNA <500 000 c/ml and high cluster of differentiation (CD)-4 count emerged as additional important reasons. In just 2 years and in spite of the emergence of the COVID-19 pandemic, significant achievements concerning ART availability and strategies have occurred in CE, EE and SEE that facilitate the harmonization of those strategies with the European AIDS Clinical Society guidelines. Few exceptions exist, especially in EE. Continuous effort is needed to overcome various obstacles (administrative, financial, national guideline restrictions) in some countries.

Medium-sized cities are in the population range of between 500,000 and one million inhabitants. Despite the importance of large cities, the greatest urban growth occurs in medium and small cities. During the last century these cities enjoyed acceptable air quality, however from the last years of the last century and the two decades of this century the atmospheric health has deteriorated, generating problems. The dynamics of population growth faced by these cities represent a serious threat to the environment, as well as to the health and quality of life of its inhabitants, since it generates new economic processes, accompanied by an increase in industrial activities, motorization rates, greater fuel consumption and higher emissions of air pollutants.&#x0D; Objective: To carry out an analysis of the air quality condition and to show the trends of the criteria pollutants for 10 medium-sized Mexican cities with the highest population growth.&#x0D; Materials and Methods: The data for the analysis of air quality of medium-sized cities were downloaded from the consultation system of Air Quality Indicators-SCICA through the http://scica.inecc.gob.mx/exec/addl website. The downloaded data are hourly concentrations of the six criteria pollutants PM10, PM2.5, O3, SO2, NO2 and CO for the monitoring stations of the cities of Aguascalientes (863 893 h), Mexicali (854 186 h), Ciudad Juárez (1 501 551 h), Chihuahua (925 762 h), León (1 579 803 h), Morelia (743 275 h), Puebla (1 542 232 h), Querétaro (794 789 h)), San Luis Potosí (854 186 h) and Torreón (690 193 h), indicators were calculated of the daily, monthly and annual trend, averages, percentages of days with concentrations above the norm and number of days per year in which any of the norms is exceeded during the period 2000-2020. Compliance with environmental health NOMs (at one hour, 8 h, 24 h and annually) was evaluated depending on the pollutant criterion.&#x0D; Results and Discussion: Medium-sized cities have grown between 21 and 55% in the last 20 years, some surpassing the category of medium cities. The concentrations of PM10, PM2.5 and O3 in all medium-sized cities are almost always above the normativity which represents a risk to the health of the population. The concentrations of CO, NO2 and SO2 are below the limits of the regulations, so these pollutants currently do not represent a risk to the population of medium-sized cities. Most cities present less than a third of the year with days out of the norm, only Torreón, Puebla and León present values of one third to two thirds of the year above the norm.&#x0D; Conclusions: The pollutants PM10, PM2.5 and O3 represent a risk to the health of the population of medium cities in Mexico, while the concentrations of CO, NO2 and SO2 currently do not represent a risk for the population of medium cities.

Urban resilience has evolved in the last time into a wider scope, related not only to facing major challenges or risks but to managing the complexity of urban systems and their “metabolism”, looking for more sustainable strategies. Consequently, it can be a very useful concept for both big and smaller cities, which are facing everyday urban life challenges. In a global context in which the urban phenomenon continues to spread, this paper aims to set a concept of “low regime”, “low intensity” or “daily” resilience as a specific and essential strategy for medium-sized cities in order to fulfil their role in the global concert of cities, through the historical analysis along the last five decades of three medium-sized inner Spanish cities: Vitoria, Zaragoza and Valladolid. These three cities, the most populated and complex among the medium-sized inner Spanish cities, are also capitals of their respective regions (the Basque Country, Aragon and Castile and Leon), and they represent the transition from an expansive model, in particular in their respective urban fringe, to the “urban resilience agenda”. In the sixties and seventies, they experienced an impressive growth, both physical and demographic. Later, in the eighties and nineties, the moderation in the population growth rates did not also moderate their physical expansion, which moved to the surroundings of the cities, until this growth came to an abrupt end in 2007 due to the economic crisis. Coming from a quite similar and homogenous cultural and urban context, Vitoria, Zaragoza and Valladolid have been developing undifferentiated peripheries, disrespectful with the conditions of the territory, until they started to adopt tailored strategies so as to guarantee a sustainable growth in the future and avoid eventual menaces for their urban territory. These new strategies aim to ensure the resilience of their respective urban fringe, because this is where the urban development tensions concentrate, and consist of composing an own profile of action, learning from the history of the city itself and from the natural values of their surrounding territory, and also keeping in mind the scarcity of economic resources in these medium-sized cities compared to bigger ones. Step by step, the singular history of each city, its “genius loci”, emerges as a solid foundation for these new strategies. This paper concludes that this idea of own identity seems to be resilient, and reveals that it can express itself through different tools (green infrastructure, urban regeneration and territorial planning) which in these three cities have found a useful topic to articulate a new integrated strategy for the “metabolism” of urban fringe in water systems: the Salburua wetlands and Zadorra river in Vitoria, protagonists of its greenbelt; the Ebro river in Zaragoza, recovered for the city after Expo 2008; and the network of rivers, canals and irrigation ditches in Valladolid, which stand as axes of a better relationship with the territory. All of them represent low cost smart and natural strategies that emerge as replicable examples of what “daily resilience” means and offers to these kind of medium-sized cities.

We sought to assess the impact of dietary risk on the worldwide burden of stroke, focusing specifically on ischemic stroke. Utilizing information from the Global Burden of Disease Study 2021 (GBD2021), we evaluated the age-standardized death rate (ASDR), the age-standardized disability-adjusted life years (DALYs) rate, and the age, sex, and regional distribution of the estimated annual percentage change (EAPC) of the stroke burden linked to dietary risk from 1990 to 2021. The global overall ASDR and the age-standardized DALY rate per 100,000 population for stroke linked to dietary risk from 1990 to 2021 exhibited a declining trend [EAPC = -1.95; EAPC = -1.70, respectively]. The reduction in ASDR was statistically more pronounced in female (EAPC = -2.42) compared to males (EAPC = -1.60). The dietary factor exerting the most significant impact on stroke in 2021 was a high sodium diet, succeeded by a diet deficient in fruit. The regions and countries most affected by a high-sodium diet on the ASDR for ischemic stroke are Central Europe (9.86 per 100,000 population) and North Macedonia (33.13 per 100,000 population), respectively; the regions and countries with the most substantial influence on the age-standardized DALY rate are East Asia (187.15 per 100,000 population) and North Macedonia (477.26 per 100,000 population). The ASDR and age-standardized DALY rates across 5 Socio-Demographic Index (SDI) regions, 20 regions, and over 170 countries worldwide demonstrated a notable downward trend, with the regions experiencing the most significant decline being High SDI (EAPC: -3.64; EAPC: -2.74, respectively). The sole increase in ASDR was recorded in southern sub-Saharan Africa. The worldwide toll of stroke linked to dietary risks may have diminished from 1990 to 2021. Nevertheless, the most significant dietary contributors are diets rich in sodium and deficient in fruit, with the stroke burden associated with dietary risks remaining especially elevated in Central Europe, East Asia, and Eastern Europe. Lowering sodium consumption and enhancing fruit intake can aid in alleviating the global disease burden.

The systems of public complaints on environmental noise were reviewed in seven countries of Central and Eastern Europe (CEE), South-East Europe (SEE), and Newly Independent States (NIS). Public complaints remain an important issue due to differences in public sensitivity to noise and due to several cases where a measurement of noise intensity does not give a satisfying solution to the problem. The unresolved problem remaining in the residential neighborhoods is the noise from pubs and restaurants that are open until late in the night. In our review, we compiled information on the institutions responsible for the implementation of environmental noise legislation and organizations that are responsible for dealing with public complaints. Information on activities for increasing public awareness on hazards rising from environmental noise and the role of civil initiative was explored. In seven countries, and among them, Slovenia, Lithuania, Latvia, Slovakia, The Former Yugoslav Republic of Macedonia, Serbia, and Poland, the responsibilities and duties are shared among different institutions at national and regional levels, depending on the noise source. The problem of gathering information on complaints and using it for improving the wellbeing and health of citizens remains often difficult and unsolved.

Researches on noise and performance in central and Eastern Europe and South-East Europe countries and Newly Independent States have been performed in last 40 years in Bulgaria, Czechoslovakia, Former Yugoslav Republic of Macedonia, Hungary, Lithuania, Poland, Romania, Union of Soviet Socialistic Republics, Russia, Serbia and Yugoslavia, mainly at universities in the capitals. In laboratory studies the effects of noise have been studied on vigilance, visual performance, attention, information perception and processing, reaction time, short term memory and spatial reasoning. The field studies focused on the relation between chronic exposure to community noise and children's behavior and executive functioning (EF) and between industrial noise and occupational injuries. These studies were mainly complementary to the studies in Western Europe.

Countries from South-East Europe (SEE), Central and Eastern Europe (CEE) and Newly Independent States (NIS) are in the process of harmonization with European environmental noise legislation. However, research work on noise and health was performed in some countries independently of harmonization process of adoption and implementation of legislation for environmental noise. Aim of this review is to summarize available evidence for noise induced sleep disturbance in population of CEE, SEE and NIS countries and to give directions for further research work in this field. After a systematic search through accessible electronic databases, conference proceedings, PhD thesis, national reports and scientific journals in English and non-English language, we decided to include six papers and one PhD thesis in this review: One paper from former Yugoslavia, one paper from Slovakia, one paper from Lithuania, two papers from Serbia and one paper, as also one PhD thesis from The Former Yugoslav Republic of Macedonia. Noise exposure assessment focused on road traffic noise was mainly performed with objective noise measurements, but also with noise mapping in case of Lithuanian study. Sleep disturbance was assessed with the questionnaire based surveys and was assumed from dose-effect relationship between night-time noise indicator (Lnight ) for road traffic noise and sleep disturbance (for Lithuanian study). Although research evidence on noise and sleep disturbance show to be sufficient for establishing dose response curves for sleep disturbance in countries where studies were performed, further research is needed with particular attention to vulnerable groups, other noise sources, development of laboratory research work and common methodology in assessment of burden of diseases from environmental noise.

The nationwide COVID-19 epidemic ended in 2020, a few months after its outbreak in Wuhan, China at the end of 2019. Most COVID-19 cases occurred in Hubei Province, with a few local outbreaks in other provinces of China. A few studies have reported the early SARS-CoV-2 epidemics in several large cities or provinces of China. However, information regarding the early epidemics in small and medium-sized cities, where there are still traditionally large families and community culture is more strongly maintained and thus, transmission profiles may differ, is limited. In this study, we characterized 60 newly sequenced SARS-CoV-2 genomes from Anyang as a representative of small and medium-sized Chinese cities, compared them with more than 400 reference genomes from the early outbreak, and studied the SARS-CoV-2 transmission profiles. Genomic epidemiology revealed multiple SARS-CoV-2 introductions in Anyang and a large-scale expansion of the epidemic because of the large family size. Moreover, our study revealed two transmission patterns in a single outbreak, which were attributed to different social activities. We observed the complete dynamic process of single-nucleotide polymorphism development during community transmission and found that intrahost variant analysis was an effective approach to studying cluster infections. In summary, our study provided new SARS-CoV-2 transmission profiles representative of small and medium-sized Chinese cities as well as information on the evolution of SARS-CoV-2 strains during the early COVID-19 epidemic in China.

A significant amount of people live in small and medium-sized cities. In the context of smart cities and their further development, these are still often neglected in scientific considerations. We present a maturity model developed by a design science approach on the basis of theory and practice, specifically for the needs of small and medium-sized cities, in order to support them in their development into a fully comprehensive smart city. We derived requirements from the literature on the one hand and on the basis of expert interviews on the other hand. We evaluated our model using the example of the medium-sized town of Bad Hersfeld. Our maturity model can be easily applied by those responsible in small and medium-sized cities and provides a means of comparison with other cities of a similar size. It can further help city leaders to plan the next step in their smart city.

Economic sustainability plays an important role in shaping conditions for economic growth and social development. The importance of answering the question about the level of sustainability of family farms results from the fact that the countries of Central and Eastern Europe, apart from exceptions (e.g., the Czech Republic and Slovakia), are characterized by a fragmented agrarian structure. Hence, the main goal of this article was to answer two questions: (1) whether the countries of Central and Eastern Europe differ in the level of economic sustainability of small family farms; and (2) whether the same socioeconomic factors impact similarly on the level of economic sustainability of small family farms from countries of Central and Eastern Europe. The study was based on surveys conducted in small family farms: in 2018 from Poland (672 farms) and in 2019 in four other countries (Lithuania; 999 farms, Romania; 834 farms, Serbia; 523 farms, Moldova; 530 farms). The publication includes a critical analysis of the literature, structure analysis and correlation analysis. The results show the occurrence of large differences between the economic sustainability of small family farms from the countries of Central and Eastern Europe. The research indicates that the larger the area of a small-scale family farm, the greater its economic sustainability. The productivity of these farms increases with their economic sustainability. The results also prove a negative relationship between the age of the farmer and the economic sustainability of their farm in all analysed countries. These trends were found in all analysed countries of Central and Eastern Europe. The results of the analyses support the conclusion that agricultural policy instruments aimed at increasing the economic sustainability of small family farms should lead to: land consolidation, a decrease in the age of farm owners through generational changes, and a decrease in employment in agriculture, which would lead to a reduction in labour input in the agricultural sector.