Geographical Context Research Articles

Unravelling spatial scale effects on elevational diversity gradients: insights from montane small mammals in Kenya

BackgroundMontane ecosystems play crucial roles as global biodiversity hotspots. However, climatic changes and anthropogenic pressure increasingly threaten the stability of montane community dynamics, such as diversity-elevation interactions, creating a challenge in understanding species biogeography and community ecology dynamics in these crucial conservation areas. We examined how varying sampling spatial grains influence small mammal diversity patterns within Kenya’s tallest montane ecosystems.MethodsEmploying a combination of multidimensional alpha diversity metrics and multisite beta diversity characteristics (species richness, phylogenetic and functional diversity and divergence, and multisite beta diversity) alongside spatial generalized additive multivariate regression analyses, we tested how spatial scaling influences elevational diversity gradient patterns and their associations with environmental and human activity variables.ResultsThe diversity-elevation associations were generally homogeneous across spatial grains; however, idiosyncratic patterns emerged across mountains. The total (taxonomic, phylogenetic, and functional) beta diversity, nestedness, and turnover resultant components monotonically increased or decreased with varying spatial grains. The associations between the diversity patterns and the environmental and human footprint variables increased with spatial grain size but also presented variations across mountains and indices. Species richness and phylogenetic and functional richness indices were more strongly influenced by spatial scale variations than were the divergence and community structure indices in both the diversity distribution patterns and their associations with the environmental and human variables.ConclusionsThe diversity-elevation and diversity-environment (including human activity pressure) relationships across spatial grains suggest that montane small mammal diversity patterns portray subtle but systematic sensitivity to sampling spatial grain variation and underscore the importance of geographical context in shaping these elevational diversity gradients. For improved effectiveness, conservation efforts should consider these spatial effects and the unique geographical background of individual montane ecosystems.

Impact of Mobile Health Interventions on HIV Testing Rates among At-Risk Youths: A Review

HIV remains a significant global public health challenge, particularly among at-risk youths aged 15–24, who accounted for over 30% of new infections in 2022. Barriers such as stigma, socioeconomic disparities, and limited access to healthcare contribute to low HIV testing rates within this demographic. Mobile health (mHealth) interventions, which leverage the widespread use of mobile devices, offer innovative solutions to address these barriers by providing confidential, accessible platforms for HIV testing and care. This review explored the impact of various mHealth interventions, such as SMS-based reminders, mobile apps, and telehealth platforms, on HIV testing rates among at-risk youths in different regions. Several studies demonstrate significant increases in testing rates, with mHealth tools reducing barriers related to confidentiality, stigma, and geographical access. However, challenges remain, including digital access disparities, privacy concerns, and the sustainability of interventions. A comprehensive literature review of studies on mHealth interventions targeting at-risk youth populations were utilized in compiling this educating paper. Future research should focus on refining mHealth strategies, incorporating emerging technologies like AI, and ensuring interventions are tailored to specific cultural and geographical contexts. mHealth has the potential to play a crucial role in combating the HIV epidemic by empowering at-risk youths to access testing and care. Keywords: Mobile health (mHealth), HIV testing, At-risk youths, Digital health interventions. HIV prevention.

Exploring the Impact of Artificial Intelligence on Healthcare Management: A Combined Systematic Review and Machine-Learning Approach

The integration of artificial intelligence (AI) in healthcare management marks a significant advance in technological innovation, promising transformative effects on healthcare processes, patient care, and the efficacy of emergency responses. The scientific novelty of the study lies in its integrated approach, combining systematic review and predictive algorithms to provide a comprehensive understanding of AI’s role in improving healthcare management across different contexts. Covering the period between 2019 and 2023, which includes the global challenges posed by the COVID-19 pandemic, this research investigates the operational, strategic, and emergency response implications of AI adoption in the healthcare sector. It further examines how the impact of AI varies across temporal and geographical contexts. The study addresses two main research objectives: to explore how AI influences healthcare management in operational, strategic, and emergency response domains, and to identify variations in the impact of AI on healthcare management based on temporal and geographical contexts. Utilizing an integrated approach, we compared various prediction algorithms, including logistic regression, and interpreted the results through SHAP (SHapley Additive exPlanations) analysis. The findings reveal five key thematic areas: AI’s role in enhancing quality assurance, resource management, technological innovation, security, and the healthcare response to the COVID-19 pandemic. The study highlights AI’s positive influence on operational efficiency and strategic decision making, while also identifying challenges related to data privacy, ethical considerations, and the need for ongoing technological integration. These insights provide opportunities for targeted interventions to optimize AI’s impact in current and future healthcare landscapes. In conclusion, this work contributes to a deeper understanding of the role of AI in healthcare management and provides insights for policymakers, healthcare professionals, and researchers, offering a roadmap for addressing both the opportunities and challenges posed by AI integration in the healthcare sector.

Psychosocial factors of work-life balance and resilience among Malaysian working women: A qualitative approach

Regardless of cultural or geographical contexts, women worldwide often bear the primary responsibility for childcare and household management. For women pursuing careers, these responsibilities are amplified, creating a challenging dynamic as they strive to balance professional duties with domestic obligations. The onset of COVID-19 profoundly disrupted lives, with working women being particularly impacted. The pandemic necessitated a rapid transition to a "new normal," where remote work became the standard. This shift required women to juggle childcare, household chores, and professional tasks within the confines of the same physical space. Work-life balance refers to the equilibrium between personal, family, and professional responsibilities, while resilience is defined as an individual's capacity to cope with and recover from adversity. This paper examines the psychosocial factors contributing to work-life balance and resilience, which are vital for achieving a balanced and fulfilling life among working women in Malaysia. Data was collected through a qualitative approach using focus group discussions with eleven working women from diverse professional backgrounds, and the data was analyzed using thematic analysis. The findings reveal that the psychosocial factors affecting work-life balance and resilience are deeply interconnected. Three major themes emerged from the analysis: social support, individual factors, and spirituality. These factors enable working women to adapt, persevere, and thrive despite challenges, especially with the support of their families, including spouses and parents. This study underscores the critical role of psychosocial factors in enhancing work-life balance and resilience among working women, highlighting their importance in navigating the complexities of modern life.

The Exergo-Economic and Environmental Evaluation of a Hybrid Solar–Natural Gas Power System in Kirkuk

The increasing environmental challenges posed by the widespread use of fossil fuels and the fluctuating nature of renewable energy have driven the need for more efficient and sustainable energy solutions. Current research is actively exploring hybrid energy systems as a means to address these issues. One such area of focus is the integration of Organic Rankine Cycles (ORCs) with gas and steam turbines, utilizing both natural gas (NG) and solar parabolic trough collectors (PTCs) as energy sources. This study examines the performance of a hybrid system implemented in Kirkuk, Iraq, a region known for its substantial solar radiation. Previous research has shown that hybrid systems can effectively enhance energy conversion efficiency and reduce environmental impacts, but there is still a need to assess the specific benefits of such systems in different geographical and operational contexts. The analysis reveals a thermal efficiency of 59.32% and an exergy efficiency of 57.28%. The exergoeconomic analysis highlights the optimal energy cost at USD 71.93/MWh when the compressor pressure ratio is set to 8 bar. The environmental assessment demonstrates a significant reduction in CO2/emissions, with a carbon footprint of 316.3 kg CO2/MWh at higher compressor pressure ratios. These results suggest that integrating solar energy with natural gas can substantially improve electricity generation while being both cost-effective and environmentally sustainable.

Levelling up in a ‘decentralised’ England: place-based or ‘one-size-fits-all’ strategies?

ABSTRACT English policymaking has traditionally been centralised, assuming homogenous needs across regions and contributing to economic inequalities. The Levelling Up Agenda aims to address these disparities through a place-based approach using devolved Combined Authority (CA) organisations. Despite being the first national strategy with an extensive place-based focus, it faces criticism as a potentially centralised political tool. Concerns also exist about whether Combined Authorities can deliver regional economic development as they have centrally controlled aspects. If regional planning approaches are identical, decentralisation through Combined Authorities would essentially be futile. This paper uses a novel quantitative method with Strategic Economic Plans to determine if regional planning inhibits a place-based or ‘one-size-fits-all’ approach, contributing data-driven insights to the debate regarding the efficacy of Combined Authorities. Through exploratory text analysis, hierarchical and K-means clustering, findings indicate regions adopt place-sensitive planning with varying sector priorities. A northern-southern and an inland-coastal distinction emerge, with London as an outlier. This suggests Combined Authorities are fit for purpose at this quantitative clustering level and do consider their geographical context in planning despite a devolved yet centrally controlled oxymoronic landscape. Collaborations like an inland and a coastal CA network are recommended to potentially maximise place-based growth.

Bridging the AI Divide: Human and Responsible AI in News and Media Industries

Artificial intelligence (AI) is revolutionizing media and journalism, reshaping processes, content, and audience relationship. This editorial report discusses the opportunities and challenges AI brings to these industries raised by this collection of studies, emphasizing the importance of integrating ethical principles and human-centric approaches to its development. These articles examine how AI reshapes content creation, distribution, and audience interaction while addressing the ethical, political, and economic implications of its integration. Key contributions include discussions on the ethical challenges posed by AI—such as bias, transparency, and accountability—and the need for robust governance structures to foster trust and fairness in AI-driven media systems. A recurring theme in this issue is the AI divide, highlighting the disparity in access to AI technologies between the Global North and South. The special issue offers insights into how this divide exacerbates existing inequalities in media production and consumption. It also advocates for interdisciplinary approaches and collaborative efforts to ensure AI's benefits are equitably distributed across geographical and socio-economic contexts. By exploring both the opportunities and perils of AI adoption in media and news industries, this special issue serves as a comprehensive examination of the evolving relationship between AI, media, and society, offering pathways for responsible innovation and inclusive AI adoption worldwide.

What is the “best” way to measure the relative location variables in the market value assessment? An econometric method applied to an Italian case study

The present research is dedicated to investigating the explanatory power of relative location variables in assessing and forecasting market values. Here, relative location refers to the spatial position (geographical context) of a building or property in relation to a given Point Of Interest (POI). Specifically, a methodological approach is proposed for identifying the most suitable quantification modality based on statistical performance and consistency with the market mechanisms of the specific reference context. For a case study in Northern Italy, we collected data on 615 residential properties and 2673 POIs, including cultural facilities, school and education institutions, commercial services, sports, entertainment, and leisure facilities, health and care services, public transport systems, urban parks, and green areas. The relative location between the collected properties and the POIs is assessed using an automated calculation procedure developed in the Python programming language, in conjunction with Geographic Information Software (GIS). This automatism allows the assessment of relative location in terms of different Units Of Measure (UOM), such as straight-line distance, travel time by car, travel time on foot, travel time by public transport, and the number of POIs in a 400 m/1 km ring buffer. Since 615 residential buildings and 2673 POIs were analysed, with their relative locations measured using six different UOMs, a database of 9'865'215 data was produced. Furthermore, for each category of POI, a feature importance analysis guides the selection of the best UOM, i.e., the most statistically significant one. Considering the chosen UOM, an optimised econometric technique is finally implemented to analyse the functional relationships between the market values of residential properties and the set of identified relative location variables.

Image-Based Quantitative Analysis of Epidermal Morphology in Wild Potato Leaves

The epidermal leaf patterns of plants exhibit remarkable diversity in cell shapes, sizes, and arrangements, driven by environmental interactions that lead to significant adaptive changes even among closely related species. The Solanaceae family, known for its high diversity of adaptive epidermal structures, has traditionally been studied using qualitative phenotypic descriptions. To advance this, we developed a workflow combining multi-scale computer vision, image processing, and data analysis to extract digital descriptors for leaf epidermal cell morphology. Applied to nine wild potato species, this workflow quantified key morphological parameters, identifying descriptors for trichomes, stomata, and pavement cells, and revealing interdependencies among these traits. Principal component analysis (PCA) highlighted two main axes, accounting for 45% and 21% of variance, corresponding to features such as guard cell shape, trichome length, stomatal density, and trichome density. These axes aligned well with the historical and geographical origins of the species, separating southern from Central American species, and forming distinct clusters for monophyletic groups. This workflow thus establishes a quantitative foundation for investigating leaf epidermal cell morphology within phylogenetic and geographic contexts.

Communication dynamics and media interactions of young adults who have attempted suicide: a qualitative thematic analysis

ObjectiveThe study examines the potential effects of communication processes and media consumption habits on suicide ideation among male and female young adults aged 18–29 who have attempted suicide at least once.MethodsIn-depth interviews were analyzed using MAXQDA Analytics Pro 2024, and thematic analysis was applied according to Braun and Clarke’s model.ResultsFour themes emerged: (1) Family-related factors, (2) sociopsychological factors, (3) sociocultural factors, and (4) media-related factors. Regarding family-related factors, most participants come from broken family structures and commonly report issues with family communication and experiences of violence. Regarding sociopsychological factors, anger issues, despair, and addictions among participants were observed to increase suicide tendencies. Regarding sociocultural factors, most participants expressed difficulties in conforming to society and feeling pressures from cultural or religious expectations. Regarding media-related factors, it was noted that a vast majority of participants spend long hours consuming media daily and frequently interact with content that leads them into adverse emotional states, primarily for time passing on social media platforms.DiscussionThis research not only reinforces information in the literature but also presents unique findings compared to similar studies, particularly in cultural and geographical contexts. The results uniquely highlight the diversity in perceptions of the relationship between religion and suicide. While literature generally notes religion as a deterrent to suicide, this study reveals that intense religious pressure could increase suicidal tendencies through effects like rejection and hatred of religious values. Media also plays a reinforcing role in this context.ConclusionIn conclusion, this study elucidates the complex interactions underlying suicide attempts among young adults and provides a solid foundation for policies and interventions aimed at better managing media interactions, which play a critical role in suicide prevention efforts.

Initial upper Palaeolithic on the Iranian Plateau: Sorheh Rockshelter, Southern Alborz mountains

The Late Pleistocene of southwestern Asia witnessed hominin diversification, admixture, and adaptation to new environments. The Iranian Plateau in southwestern Asia lies at the crossroads between Africa, Europe, Central Asia, and the Far East, and therefore, has contributed substantially to the history of hominin migration. On the Iranian Plateau, the Middle to Upper Palaeolithic transition is a puzzling phase that lacks chronological precision and stratified archaeological materials. The timing and geographical context of this transition are essential for understanding the spread of modern humans and their interactions with other species, including the Neanderthals. Sorheh Rockshelter in the southern piedmonts of the Alborz Mountains on the northern Iranian Plateau is a newly discovered site on high altitude of 1903 m asl., with the potential to answer some of these questions. In 2019 and 2022, excavations at Sorheh revealed distinct hominin behavioural and settlement systems, falling under the description of the Initial Upper Palaeolithic in the Levant, eastern Europe, Siberia, and Mongolia. In the chronological window covered at Sorheh (∼50–35 ka), the Upper Palaeolithic cultures had already been developed in other regions of the Iranian Plateau. The new data we obtained from Sorheh determines, for the first time, a physiogeographic, chronostratigraphic, and anthropogenic picture of the Initial Upper Palaeolithic on the Iranian Plateau, filling the gap in the distribution of this techno-complex between the Levant and eastern Eurasia. Deciphering the Initial Upper Palaeolithic in Sorheh indicates the complex and diverse nature of hominin behaviours during the transitional Middle-Upper Palaeolithic phase and reveals the critical role of the northern Iranian Plateau in hominin expansion towards Central Asia.

Unravelling the Dynamics of Necessity-Driven Entrepreneurs (NDEs) and Opportunity-Driven Entrepreneurs (ODEs): A Study of Immigrant Micro Enterprises (IMEs) in the Hospitality Industry

The purpose of the study is to investigate the notion of Necessity-driven Entrepreneurs (NDEs) and Opportunity-driven Entrepreneurs (ODEs) among IME (Immigrant Micro Enterprise) owners in the hospitality industry and how changes in motivational traits influence business practices, innovation, and growth aspirations. In many geographical contexts, the ever-challenging hospitality industry is dominated by businesses that are immigrant-owned and of micro sizes that experience additional challenges compared to their native and large counterparts. Through qualitative research and interviews with 18 owners of restaurants and eateries in the IME category in eastern Norway, the study found that while NDE traits are dominant during start-ups, ODE traits also exist, revealing a dynamic relationship between the two and thus problematic to classify hospitality IMEs as either NDE or ODE. Experiences and close customer interactions rather than formal R&D activities inspire changes and innovations in business practices, growth aspirations, and perceptions of success. This study offers new insights into hospitality IME owners’ motivations and goals, which may be relevant in other similar industries and geographical contexts. It underscores the importance of understanding the interplay of NDE and ODE traits among IME owners and their impact on business success in the challenging industry in which they operate.

Displaced by nature, driven by choice: Exploring the factors influencing environmental migrants' habitat preferences in coastal Bangladesh

This study examines the factors influencing environmental migrants’ habitat preferences in southwestern Bangladesh. Using a multi-stage sampling technique, we selected 408 households in rural and urban areas, who had moved to their current locations due to climatic extremes. We applied relevant regression models to analyze the complex interplay of socioeconomic, environmental, and institutional factors shaping migration decisions. Our empirical results suggest that, despite having greater access to services in cities, migrants reported lower levels of well-being than their rural counterparts, which could be attributed to reduced social cohesion and limited opportunities for participation in decision-making. Disaster preparedness, early warning access, and prolonged exposure to environmental hazards significantly influence migration decisions and well-being. Protracted post-disaster suffering increases the likelihood of migration to urban slums, emphasizing the vulnerability of rural populations. Men are more likely than women to migrate to urban areas, possibly due to perceived employment opportunities. Surprisingly, while slum dwellers have better service access, their well-being scores are lower than rural residents. Access to education, healthcare, safe drinking water, and early warning systems are all crucial determinants of well-being. Policy recommendations include improving disaster preparedness and early warning systems in rural areas, developing targeted interventions for urban slum migrants focused on social cohesion and income diversification, and implementing gender-specific support programs. This research contributes to understanding environmental migration dynamics in Bangladesh and informs policymakers about sustainable resettlement strategies. Future studies should explore non-linear relationships and expand to diverse geographical contexts.

Dynamic Programming Implementation for Delivery Route Optimization in E-Commerce Logistics

The rapid growth of e-commerce has created new challenges in logistics optimization, particularly in terms of delivery route efficiency. This research develops a dynamic programming model to optimize delivery routes in the context of e-commerce in Indonesia. Using a modified Vehicle Routing Problem with Time Windows (VRPTW) approach, we implemented an algorithm that considers various factors such as distance, time, and cost. Simulations using synthetic datasets showed efficiency improvements of 18.7% in travel distance and 22.3% in delivery time compared to conventional methods. Field trials with an e-commerce partner resulted in a 21.5% reduction in travel distance and an increase in on-time delivery rate from 87% to 94%. Sensitivity analysis revealed that the algorithm's performance is most affected by demand fluctuations and changes in traffic conditions. Implementation challenges include integration with existing systems and consideration of workforce impact. This research opens avenues for further development in algorithm scalability, integration of sustainability factors, and adaptation to various geographical contexts, demonstrating significant potential for improving e-commerce logistics efficiency in the future.

The Hungarian fossil record of the Pliocene pig Sus arvernensis (Suidae, Mammalia)

Sus arvernensis is a Pliocene species that occupies a key position in the evolution of suids (Suidae, Artiodactyla, Mammalia) in Eurasia, and besides, it is considered important for biochronological correlations and paleoecological inferences. However, our knowledge on S. arvernensis is largely based on fossil remains from southwestern Europe. Here, we present a revision of the Hungarian fossil record of S. arvernensis. Up to now, the species was known from only two localities of Hungary, Gödöllő (central Hungary) and Süttő (northwest Hungary), and the latter occurrence has even been questioned. After the comparison with other relevant samples of S. arvernensis, of the Early Pleistocene S. strozzii, and of the extant wild boar S. scrofa (motivated by previous attributions and the chronology of the localities), the presence of S. arvernensis from Gödöllő and Süttő is confirmed, and more material of the species is described from Beremend (southern Hungary) and Kisláng (western Hungary). Collectively, the results of the revision carried out herein reveal a relatively widespread distribution of S. arvernensis in Hungary, hence providing an important link from the eastern to western European fossil record of the species. The specimens from Gödöllő and Süttő are slightly larger than the other material of S. arvernensis from France and Italy included in the biometric comparison, although the paucity of the material precludes to evaluate whether these differences are significant and to relate them to a chronological and/or geographical context. The occurrence of S. arvernensis in the Hungarian localities considered in this work is a biochronological indication of an age older than at least 2.6 Ma, since the species is not recorded after the Pliocene–Pleistocene transition. This in agreement with the age estimates available so far for some of the localities or provides new insights. At Süttő, in particular, the identification of S. arvernensis reinforces the view that travertine deposition started already in the Pliocene.

Systematic review of ethical/methodological issues in transgender youth participative research

Abstract Background Understanding the experiences of transgender and gender-diverse (TGD) youth is essential for developing appropriate support services. However, studies focusing on TGD youth under 18 outside clinical settings are scarce, limiting effective support development. The requirement for parental consent in participatory research poses ethical and logistical challenges, impacting the safety, well-being, and privacy of adolescent participants. This dynamic complicates the balance between adolescents’ rights to autonomy and privacy and parental duties to protect their children. This review aims to illuminate the ethical and methodological challenges in participatory research with TGD youth. Methods A systematic review of bibliometric databases from 2006 to 2022 was conducted, focusing on transgender and gender non-conforming identities, adolescence, qualitative and participatory research methods, and consent issues. This review was registered with PROSPERO in November 2022 (CRD42022368360). Results Of 3,794 articles initially identified, 291 met the inclusion criteria, and 48 were extensively reviewed. Research with TGD youth commonly faces ethical tensions including parental inclusion in the consent process, safeguarding participant safety and privacy, ensuring confidentiality, and creating environments that allow TGD youth to express themselves and feel empowered. Methodological challenges include engaging public and stakeholders, recruiting participants, data collection, and maintaining research integrity. Conclusion & Implications The literature on participatory research with young transgender and gender-diverse individuals reveals intricate and often conflicting issues related to consent procedures, power dynamics, and the researcher’s role. These findings are applicable in various legal and geographical contexts, providing insights that can guide practices globally. Key messages • Research reveals ethical dilemmas in participatory research with transgender young people, highlighting difficulties around consent and the need for tailored support. • Understanding the complexities of research ethics enables better support for transgender and gender-diverse young people during research.

Health Impact Assessment in Personalized Prevention: three applications on pharmacogenomic testing

Abstract Background In recent years, literature on the efficacy of genetic and genomic tests has expanded, yet the impact of personalized prevention programs that include such tests remains understudied. Our study aims to test the use of the Health Impact Assessment (HIA) framework, traditionally applied in non-health policy evaluation, to assess the impacts of personalized prevention policies. Methods We selected a policy mandating dihydropyrimidine dehydrogenase (DPYD) genetic test use before prescribing fluoropyrimidine for colorectal cancer (CRC) patients. Three HIAs are being conducted in Italy, Portugal, and Finland to assess the applicability across different contexts. The assessment involves literature review, comparative risk modeling, and stakeholder interviews. Three national steering committees, comprising representatives from key interest groups and experts, will evaluate evidence to gauge policy impacts and offer recommendations. Results The potential impacts identified include CRC patients’ outcomes, economic, organizational, patient experience, clinician workload, and equity. Preliminary results show a consensus in literature and national guidelines on the ability of the DPYD test to reduce adverse events and enhance the quality of life of CRC patients. However, the assessment reveals context-specific effects regarding equity, influenced by the prevalence of ethnic groups and variations in access to health services across regions. Differences also emerged on organizational aspects like the availability of resources such as laboratories and personnel. A lack of literature was observed on patient acceptability and clinician attitudes towards the test. Conclusions The use of HIA in personalized prevention might assist in identifying policy impacts often overlooked through the involvement of key interest groups in the assessment process. Such effort can further emphasize the significance of evaluating these programs while considering the geographical context. Key messages • Our study innovatively applies the Health Impact Assessment framework to evaluate personalized prevention programs in pharmacogenomic, addressing a critical research gap. • Preliminary findings underscore the importance of considering geographical factors in public health policy evaluation, highlighting nuanced context-specific effects.

Urban Exposome and Health

Abstract Background The environment in which we live is thought to explain 70% of the non-communicable disease burden. The aim of EXPANSE project (funded from the European Union Horizon 2020 research and innovation programme under grant agreement No 874627) is to evaluate the optimal strategies for maintaining health in the context of contemporary urban environments. As a component of the project, Urban Labs allow deep phenotyping of the urban exposome and assessing its use and perception. The Urban Labs aim to improve exposure assessment, identify mediating and modifying lifestyle factors, and link the urban exposome to intermediate endpoints relevant for cardiometabolic and pulmonary health. Methods By monitoring the activities of 4,000 individuals in five distinct urban areas, Urban Labs provide a comprehensive understanding of the urban exposome, which can be compared with residential address-based model estimates. The participants complete a baseline questionnaire, repeated bi-monthly questionnaires and exposure-specific questionnaires over a period of 2 years using mobile phone application (ExpanSeeker). Two-week personalized measurements including spatial-temporal activity patterns, sensor-based environmental and behavioral measurements, and minimally invasive biological sample collection are performed covering different seasons. Results The Baseline Questionnaire (BQ) and two-weeks measurement campaigns (MC) were completed in European cities as follows: Athens BQ = 379, MC = 232; Barcelona BQ = 1040, MC = 303; Basel BQ = 731, MC = 655; Lodz BQ = 634, MC = 100; The Netherlands (multicity) BQ = 1033, MC = 326. Data collection process is ongoing. Conclusions The collection of novel data on individuals activities and perceptions within temporal and geographical contexts in Urban Labs will contribute to a more comprehensive understanding of how the urban dwellers are exposed to and interact with their environment, thereby supporting healthier urban engineering and policy making. Key messages • Urban Labs will provide a more comprehensive understanding of the impact of the urban environment on individual’s behavior, their exposome, enabling more accurate prediction of non-communicable risk. • Urban Labs will provide a base to support healthier urban engineering and policy making.

Prevalence and prognostic relevance of non-obstructive coronary atherosclerosis in MINOCA: a meta-analysis of 35 studies

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) can result from a variety of pathological mechanisms, not always associated with atherosclerosis. It has been suggested to distinguish between patients without obstructive coronary artery disease (NObs-CAD, stenosis diameter 1-49%), and patients with smooth coronary arteries (NCA), but differences in terms of prognosis or therapeutic approaches have not been clearly elucidated. Objectives The aim of this study is to evaluate the prevalence and prognostic impact of NObs-CAD as assessed by invasive coronary angiography (ICA) in MINOCA. Methods A meta-analysis was performed including studies reporting the prevalence of NObs-CAD versus NCA in MINOCA patients. Data on prognosis stratified by the presence of NObs-CAD were collected. Random-effects models were used to estimate the prevalence of NObs-CAD. Pooled risk ratios (RR) with 95% confidence intervals (CI) for all-cause death, myocardial infarction (MI), and the composite of both outcomes of patients with NObs-CAD compared to NCA were calculated at short-term (<1 month), 1-year and long-term follow-up (more than 1 year). Results Thirty-five studies were analysed. The pooled prevalence of NObs-CAD estimated by ICA was 53% [95% CI 47-60%]. Heterogeneity was high (I2=98.0%), but none of the clinical and instrumental characteristics tested in meta-regression analyses had a significant impact on the I2, except for age (residual I2=97.2%, p=0.014) and geographical context. Specifically, studies conducted outside Europe reported a higher prevalence of NObs-CAD with lower I2 values. Thirteen studies provided prognostic data. The presence of NObs-CAD was associated with an increased risk of death or MI compared to NCA, as well as the risk of MI at 1-year follow-up (RR = 1.49 [95% CI 1.17-1.90] and RR = 1.80 [95% CI 1.26-2.59], respectively), whereas the risk of death was comparable. Similar results were observed at long-term, but not at short-term follow-up. Out of 13 studies, 4 provided information regarded the medications at discharge stratified by the presence or absence of NObs-CAD. NObs-CAD patients received more often aspirin (89% vs 69%; p<0.01), P2Y12-inhibitors (52% vs 29%; p<0.01), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53% vs 40%; p<0.01), beta-blockers (70% vs 57%; p<0.01), and statins (86% vs 60%; p<0.01) compared to NCA. Conclusions Stratification of patients according to the degree of coronary stenosis has prognostic implications in the setting of MINOCA, since NObs-CAD patients present a higher risk of reinfarction. Further dedicated trials are needed to clarify whether these patients may benefit from a tailored approach in terms of secondary prevention strategies.Central illustration

Family Vulnerability: From concept to a scale validity and application

Abstract This activity will last 20 minutes. An interactive presentation will be structured at three steps. First, a debate will be facilitated to engage participants on the following questions: i. What is family vulnerability? ii. Why should we measure family vulnerability at the context of Primary Health Care (PHC)? Second, once concepts are aligned, a brief presentation about the Vulnerability Family Scale for Brazil (EVFAM-BR) will be performed. At this time, participants will have the opportunity to know about the process of development, validation and the final version of EVFAM-BR (Souza et al., 2023, available at https://doi.org/10.1371/journal.pone.0280857). Third, presenters will share step by step how EVFAM-BR can be implemented into PHC, considering two real-world experiences in Brazil, Southeast and North regions, and will discuss about possible strategies to tailor it at different cultural and geographic context, from settings with higher vulnerability and low resources to high technology settings.