Health Infrastructure Research Articles

2.M. Scientific session: Economics of Mental Health in the interplay between health systems and public health

Abstract Mental health systems and services are essential components of the public health infrastructure, serving as frontline for prevention and intervention for health overall. Despite this, access to mental health services remains largely inadequate, with the OECD calculating that only about one in three people with mental health problems has access to quality treatment across 19 EU Member States. The economics of mental health play an important role in determining the allocation of resources, the accessibility of services and the overall effectiveness of interventions. Effective planning requires an understanding of population needs, service gaps and utilization patterns, in order to ensure equity and health improvement. In fact, the conceptualisation of the economic dimensions of mental health enables policymakers, practitioners, and stakeholders to make informed decisions that optimize resource utilization and maximize societal benefits. The proposed workshop will build on previous activities of the EUPHA Section on Public Health Economics at EPH, including the recent establishment of a working group on the economics of mental health. The aim of the meeting is to promote the adoption of best practices and methodologies in the conduct of economic studies on mental health. As such, the workshop will provide an opportunity to discuss the unique challenges of economic evaluation in this field and to present relevant ongoing activities by members of the Section and other invited experts. Key messages • Mental health, its distribution and at-risk populations influence resource allocation and policy decisions within mental health systems. • Tackling inequalities in mental health is essential for promoting health equity and social justice, requiring evidence-based interventions and policy initiatives to empower marginalized communities.

Future actions and a call for ongoing support

Abstract The EUVABECO project is currently piloting a suite of innovative tools, including decision support systems, targeted screening tools, electronic vaccine leaflets, disease simulators, and cross-border vaccination cards. These tools have shown great promise in transforming vaccination practices within individual healthcare settings, contributing to building vaccine confidence and increasing protection against vaccine-preventable infections across the life course. As EUVABECO progresses to the crucial phase of implementing these pilots, active collaboration and sustained support from the multiple actors of the vaccine ecosystem in the implementing countries are essential. To ensure these tools are effectively adapted across different MS, they must be customised to meet local needs and the specific requirements of diverse healthcare environments. This involves integrating feedback from initial deployments. More than just a technical implementation, this phase is about fostering and maintaining robust partnerships with key stakeholders such as healthcare providers, policymakers, and National Immunization Technical Advisory Groups (NITAGs). The success of the EUVABECO project depends on continuous engagement and the sharing of knowledge and resources among all partners involved. This presentation seeks to reinforce the call for ongoing commitment and collaboration from existing stakeholders and to encourage new partners to join this transformative effort. This will foster a more harmonized approach to vaccination policies. Together, we aim to build a more resilient public health infrastructure, enhancing the preparedness and responsiveness to current and future vaccination challenges, ultimately improving resilience to health threats across the European Union.

Factors influencing protective gear use in crisis-affected Afghanistan during COVID-19

Abstract Background Afghanistan has faced considerable challenges in healthcare delivery during the COVID-19 pandemic. These challenges were compounded by limited health literacy, shortages of skilled health workers, and fragile health infrastructure, which increased the country’s double burden of disease. The World Health Organization (WHO) recommended the use of masks as part of a comprehensive strategy to mitigate the spread of SARS-CoV-2. Nevertheless, research on mask-wearing practices in Afghanistan is limited. This study aims to investigate the factors influencing the wearing of protective gear, including masks, during the COVID-19 pandemic in Afghanistan. Methods This study analyzed 16,058 households from the 2020 Afghanistan Multi-Sector Needs Assessment (MSNA) survey data. This survey was conducted between August and September 2020 by the Racial and Ethnic Approaches to Community Health (REACH) Initiative. Sampling weighted multivariable binary logistic regression analysis was performed. Results Recent internally displaced persons (IDPs) and returnees in Afghanistan were more likely to wear protective gear to prevent COVID-19 compared to non-recent IDPs. Factors such as household sizes, household income, knowledge of humanitarian support, and the distance to healthcare facilities were significantly associated with the likelihood of wearing protective gear. Conclusions The study suggests that certain factors place crisis-affected populations in Afghanistan at high risk in COVID-19 preventive behaviors, especially in wearing protective gear. The findings in this study indicate that public health interventions should focus on improving healthcare accessibility and enhancing information dissemination while considering socioeconomic factors. Additionally, this study highlights the need for access to personal protective gear during outbreaks of infectious disease, such as the COVID-19 pandemic. Key messages • Socioeconomic factors and accessibility on health services and information can affect COVID-19 preventive behaviors in crisis-affected populations. • This study can inform public health professionals to develop adequate interventions during infectious disease outbreaks.

Development of an Index System for Public Toilets Based on HRWS-PS Theory and Improvement Strategies

As an integral part of the urban public health infrastructure, public toilets play a significant role in shaping a city’s image. With the advancement of the economy, people have increasingly higher expectations for public toilets. While existing standards primarily focus on physical indicators, there is still room to incorporate measures that prioritize humanistic care. Therefore, based on the Human Rights to Water and Sanitation in Public Spaces (HRWS-PS) standards, this study develops a comprehensive index system for public toilets with a specific emphasis on humanistic care, utilizing expert questionnaires and employing methods such as the analytic hierarchy process (AHP) and entropy weight, and highlights safety and quality as paramount concerns for users, followed by usability and accessibility as secondary needs. Acceptability, which encompasses additional amenities, depends on meeting these secondary needs through solid basic design and construction practices. Affordability, related to consumer costs, is comparatively less demanding. By applying this framework, an analysis of the current state of upgrading urban public toilets in Shijiazhuang was conducted, leading to recommendations for improvements across four key areas: environmental sanitation, architectural design, infrastructure development, and urban planning. The final results provide practical insights for evaluating and suggesting enhancements to ongoing toilet revolution initiatives and urban basic service facilities while also informing urban renewal efforts and designs.

Institutional Discrimination in Health Security Policies against Immigrants in South Korea

Abstract Background South Korea is poised to become Asia’s first mult-iethnic society with over 5% of its population, totaling more than 2.5 million, being immigrants. This demographic shift presents significant public health challenges linked to widespread, and even intensifying, institutional discrimination in healthcare services. Methods This study reviews discriminatory practices across ten essential health security programs, including National Health Insurance (NHI) system, disability assistance, occupational health services, maternal and child care services, national immunization program, health screening program, and assistance for catastrophic medical expenses. Government data and personal narratives were also reviewed to identify the discriminatory elements that can have significant consequences, including increased disease prevalence, higher incidence of occupational injuries, and broader socio-economic instability among migrants. Results Discriminatory elements were found in most programs, with the exception of emergency medical services. These programs commonly provide fewer benefits or impose stricter eligibility criteria for migrants compared to nationals. In particular, the Korean NHI system demands migrants to pay higher premiums and more rigorous maintenance requirements. Conclusions The findings emphasize the need for urgent reforms to equalize health insurance costs, simplify eligibility criteria for migrants, and broaden the scope of benefits to encompass all residency statuses. Implementing these changes will enhance public health infrastructure, improve occupational safety, and foster better integration of the diverse population, ultimately promoting social cohesion and a fairer health system for all. Key messages • A number of discriminatory elements against migrants have been identified in South Korea’s social security policies that can exacerbate health disparities. • Reforms are needed to expand benefits and relax eligibility criteria for migrants in key healthcare policies, including the National Health Insurance system.

Semmelweis University’s innovative Center of Preventive Services in support of healthy ageing

Abstract Issue/problem Europe’s aging population presents substantial hurdles for healthcare sustainability. To alleviate the social and economic impacts of age-related diseases, promoting healthy aging is imperative. However, motivating individuals to adopt a healthier lifestyle proves challenging. Description of the problem Semmelweis University, a leading institution in medicine, health sciences, and health care in Hungary and Central Eastern Europe, has addressed this challenge by establishing the Center of Preventive Services (CPS), serving 12,500 Semmelweis University employees. The CPS conducts comprehensive health risk assessments and offers consultations with specialists in preventive medicine, public health, dietetics, physiotherapy, and health psychology. Motivational interviewing is used to enhance patient engagement and commitment to healthy lifestyle changes. Results The CPS has effectively integrated preventive services into the university’s healthcare system, reaching a significant number of employees. Early results show improvements in participants’ lifestyle and health behaviors due to the effective use of motivational interviewing. According to the first preliminary result, a study on step count conducted within the CPS found that those taking part in motivational interviewing session were able to increase their average daily step count by 1074 (95% Confidence Interval: 116-2033) steps more than controls. Lessons The Semmelweis University’s CPS provides valuable lessons for integrating healthy aging-focused preventive care into healthcare systems: 1. Effective preventive care requires targeted interventions based on detailed risk assessment and motivational interviewing; 2. Embedding preventive services within existing health infrastructure improves accessibility and utilization; 3. Collaborative and multidisciplinary approaches are essential to comprehensively address the needs of ageing populations. Key messages • Motivational interviewing boosts the effectiveness and engagement of preventive health services, which is essential to meet the challenges of ageing populations. • The Semmelweis University’s model program shows that embedding preventive services into the infrastructure of existing institutions like universities is scalable for better public health.

Buildings as reflectors of societal values: what features of psychiatric wards reveal about stigma

Abstract Built Environment (BE) features bearing domestic attributes align with the concept of psychosocial re-integration. To understand the level of de-institutionalisation in relation to mental health infrastructure, a series of 29 case studies occurred in four countries from 2000 onwards. We collected data from Europe, the UK, New Zealand and more recently in the US: England (n = 15), France (n = 5), New Zealand (n = 4) and the US (n = 5). This included five acute wards in England and five in France in 2000-2004, two further acute wards in England in 2015-2017, four facilities in New Zealand in 2017-2020 (catering also for the Māori population), six further wards (older adult rehab, older adult dementia, acute, rehab, PICU, older adults) and two forensic wards in England and five wards in the US in three different hospitals (one mental health and four mental health wards in general hospital: two adult and two adolescent) in 2023-2024. An architectural checklist was developed to evaluate the traits of the exterior and interior and measure the degree of institutionalisation vs homelikeness for mental health buildings. Cross-country comparison revealed recent case studies to be closer to the institutional end with increased anti-ligature features. Most NZ and the US samples were the most institutional ones. The checklist revealed that acuity was potentially not a determinant of institutional versus domestic buildings. Data shown that very few features were universally present, questioning what is the absolute minimum in relation to the illness rather than the policies. The US sample provides further food for thought, especially in relation to the location of psychiatric wards inside general hospitals and the reasons that lead to this. Finally, by looking at the BE for mental health, we uncover issues regarding the service provision and institutional prejudices connected to stigma. This questions the adequacy of de-institutionalisation policies in certain contexts. Key messages • The study of the architecture of healthcare facilities can depict aspects related to the health service provision and raise questions about the effectiveness of rehabilitation strategies. • The architecture of psychiatric wards questions the success of some de-institutionalisation decision-making in a cross-country comparison.

Global health

Abstract Global health emphasizes the importance of addressing health challenges that transcend national borders and require strong international collaboration and governance. This concept is grounded in collaborative transnational actions aimed at promoting health for all, reducing disparities, and protecting against threats. Strengthening health systems, public health infrastructure, improving health service delivery, and ensuring equal access to healthcare for all are key focus areas in global health. This plenary will address several major health challenges and critical issues, such as the rising burden of non-communicable diseases, re-emerging pandemics, environmental threats, and the suboptimal responses of national healthcare systems to manage these challenges. The need to focus on vulnerable and marginalized populations, particularly those affected by migration and ethnicity, will be highlighted. The discussion will also showcase the importance of including ethnic minority and Indigenous people’s perspectives in health policy and decision-making processes, as well as addressing the social determinants of health that disproportionately affect these communities. Central to the discussion on global health is the role of global health policy and diplomacy, focusing on how countries can collaborate to address health threats and challenges, shaping international strategies and frameworks. Innovation, including reverse innovation and the development of evidence-informed policies and effective public health strategies that can be implemented globally and is relevant also in resource-constrained contexts, is another critical aspect in addressing the intersection of health and development. Finally, strong public health leadership is needed to shape practices and policies, as well as fostering the next generation of global health leaders. The multifaceted nature of global health calls for a comprehensive approach to health—one that integrates policy, leadership, and equity into the core of public health strategies. The integration of health into all policies at the global level is vital for creating supportive environments, policies, services, and communications that promote better health for all. Moderators Iveta Nagyova President EUPHA Henrique Barros President ASPHER Speakers/Panellists Emma Rawson Te Patu President World Federation of Public Health Associations Charles Agyemang Professor of Global Migration, Ethnicity & Health, University of Amsterdam, Netherlands Agnès Buzyn Former Minister of Health and Social Affairs, France Moredreck Chibi Public Health Innovation Lead, WHO Regional Office for Europe

Characteristics of Diseases in Developing Countries

In the urgent realm of global health, it is imperative to acknowledge and promptly address the distinct characteristics of diseases that afflict developing countries. These nations face a unique set of challenges that contribute to the burden of illness and significantly impact the quality of life for their populations. By promptly exploring the key features of diseases in developing countries, we can better understand the complex interplay between socioeconomic factors and health outcomes [1]. One of the primary characteristics of diseases in developing countries is their disproportionate impact on vulnerable populations. Socio-economic disparities, limited access to healthcare, inadequate sanitation infrastructure, and poor nutrition contribute to the heightened susceptibility of marginalized communities to preventable infectious diseases such as hydatid cysts, malaria, tuberculosis, and diarrheal illnesses. The lack of resources and infrastructure further exacerbates the spread of these diseases, creating a cycle of sickness and poverty [2,3]. Furthermore, the prevalence of neglected tropical diseases (NTDs) is a defining feature of the disease landscape in developing countries. These illnesses, which include dengue fever, Chagas disease, and schistosomiasis, predominantly affect populations in low-resource settings and often go unnoticed on the global health agenda. The burden of NTDs is compounded by limited funding for research and treatment, leaving affected communities without adequate support and interventions [4]. In addition to infectious diseases, non-communicable diseases (NCDs) are on the rise in developing countries, posing a dual burden of illness alongside contagious diseases. Factors such as urbanization, lifestyle changes, and an aging population contribute to the increasing prevalence of conditions like cardiovascular diseases, diabetes, and cancer. The inadequate healthcare infrastructure in many developing countries further hinders NCDs' prevention, diagnosis, and management, leading to poorer health outcomes for those affected [5]. Addressing the characteristics of diseases in developing countries requires a multi-faceted approach that encompasses strengthening the healthcare system, investing in public health infrastructure, and, most importantly, providing equitable access to essential medicines. By ensuring fair access to these medicines, we can work towards achieving health equity and reducing the burden of disease in developing countries.

Lived experiences of women with uterine rupture who were managed at Nekemte specialized hospital: a qualitative study

BackgroundUterine rupture is a rare but severe obstetric complication that poses significant risks to maternal and fetal health. Understanding the lived experiences of individuals who have undergone uterine rupture is crucial for improving care and support for those affected by this condition. This qualitative phenomenological study aimed to explore the experiences of individuals who have experienced uterine rupture.MethodThe study employed a qualitative phenomenological approach, conducting 12 in-depth interviews and four key informant interviews with individuals who had experienced uterine rupture. Data analysis was conducted thematically using Atlas ti software to identify patterns and themes within the participants’ narratives.ResultsThe analysis of the interviews highlighted six key themes: experience during diagnosis and initial symptoms, perceived predisposing factors of uterine rupture, challenges faced by individuals with uterine rupture, impacts on their lives, and coping and resilience strategies. The findings revealed that women often failed to recognise the initial symptoms of uterine rupture due to a lack of preparation, a preference for home deliveries, husband refusal, and a general lack of awareness. This delay in seeking care resulted in severe consequences, including the loss of their babies, infertility, fistula, psychological trauma, and disruptions to daily life and relationships. To cope, many women resorted to accepting their situation, isolating themselves, and using traditional healing techniques.ConclusionsThis study’s findings provide valuable insights into the complex and multifaceted nature of uterine rupture, shedding light on the experiences of those affected by this condition. To address the challenges, it is essential to enhance awareness and education through community education programs and comprehensive antenatal classes. Additionally, improving access to healthcare by strengthening health infrastructure and deploying mobile health clinics can ensure better prenatal care. Furthermore, encouraging hospital deliveries through incentives and the support of community health workers can reduce risks. Providing psychological counselling and establishing support groups can help affected women cope with the consequences. Moreover, engaging men in maternal health through educational programs and involving them in antenatal care can foster better support. Finally, promoting safe traditional practices by integrating traditional healers and respecting cultural sensitivities can increase acceptance and adherence.

Topology-aware mamba for crack segmentation in structures

CrackMamba, a Mamba-based model, is designed for efficient and accurate crack segmentation for monitoring the structural health of infrastructure. Traditional Convolutional Neural Network (CNN) models struggle with limited receptive fields, and while Vision Transformers (ViT) improve segmentation accuracy, they are computationally intensive. CrackMamba addresses these challenges by utilizing the VMambaV2 with pre-trained ImageNet-1 k weights as the encoder and a newly designed decoder for better performance. To handle the random and complex nature of crack development, a Snake Scan module is proposed to reshape crack feature sequences, enhancing feature extraction. Additionally, the three-branch Snake Conv VSS (SCVSS) block is proposed to target cracks more effectively. Experiments show that CrackMamba achieves state-of-the-art (SOTA) performance on the CrackSeg9k and SewerCrack datasets, and demonstrates competitive performance on the retinal vessel segmentation dataset CHASE_DB1, highlighting its generalization capability.

The 2024 Public Health Emergency of International Concern: A Global Failure to Control Mpox.

On August 14, 2024, following a regional declaration by the Africa Centres for Disease Control and Prevention, the World Health Organization declared mpox a Public Health Emergency of International Concern, marking the second such declaration in two years. A series of outbreaks involving the more virulent clade I virus (compared to clade II, which caused a global outbreak in 2022), has now spread in 13 African countries, exposing the inadequacies of the public health infrastructure in these settings. There was significant investment during the 2022 global outbreak, but these efforts failed to address vaccine access and treatment in the Global South. Regulatory delays, unequal access to vaccines, and a lack of compassionate use treatments for severe cases have resulted in preventable cases and deaths, especially among vulnerable populations such as pregnant women, children, and the immunocompromised. The current outbreak also underscores critical knowledge gaps in our understanding of mpox, including its transmission, pathogenesis, and viral evolution. We join intensified calls for global solidarity and action to control mpox, emphasizing immediate containment measures and long-term local and international investment in African public health systems, to prevent future epidemics.

Navigating the global health seas: A personal odyssey through the depths of COVID-19

This study offers an extensive perspective on the COVID-19 pandemic through a unique lens, blending personal narratives with informative analysis. Owing to strained public health systems, individuals faced emblematic struggles – such as awaiting medical attention in overwhelmed emergency rooms and securing testing appointments–which symbolized universal experiences. Through depersonalized yet interconnected stories, this study elucidates systemic vulnerabilities in global health infrastructures. An examination of socioeconomic disparities through third-person narratives reveals communities grappling with layoffs and limited health-care access. This study seeks to offer an analytical yet empathetic exploration of the broader socioeconomic impact of COVID-19. The objective portrayal of the pursuit for equitable vaccine access mirrors global challenges in scheduling and supply shortages. Furthermore, the personal narratives highlight the connections forged, the information shared, and the resources pooled, emphasizing a shared commitment to overcoming challenges together. This study concludes with a collective call for adopting a resilient, equitable, and united approach to global health in which informed perspectives of collective struggle converge for a better future.

Commerce and Health Management: Analyzing the Intersections of Public Health Policies and Economic Development

This study investigates the critical relationship between public health policies and economic outcomes. Through a mixed-methods approach that includes quantitative analysis of survey data and qualitative insights from stakeholder interviews, the research identifies key themes such as the integration of health and economic policies, the role of health investments in fostering economic resilience, challenges in policy implementation, and the significance of innovation in health management. Findings indicate a strong positive correlation between effective public health measures and perceived economic development, highlighting the necessity for cohesive strategies that align health initiatives with economic planning. The study further reveals that barriers such as funding constraints and varying perceptions hinder effective implementation, suggesting the need for enhanced cross-sector collaboration and targeted communication. Recommendations include prioritizing health infrastructure investments and embracing technological innovations to improve healthcare access and efficiency. As societies face ongoing global challenges, this research emphasizes that effective health management is not only a public health concern but also a crucial element of economic strategy. By recognizing the interconnectedness of health and economic systems, stakeholders can work towards creating a more resilient and prosperous future.

Determinants of Low Coverage of the Free Surgical Care Programme for Trachomatous Trichiasis in Rural Guinea in 2022.

This study aimed to describe the experiences of healthcare personnel and patients in the organization of free surgical campaigns and care for trachomatous trichiasis in the health district of Siguiri in Guinea, including challenges experienced in providing surgical care. This was an explanatory qualitative study conducted in 2022 in the health district of Siguiri. A total of 20 participants were interviewed including patients (n = 7; 35%), community health workers (n = 4; 20%), health services managers, and healthcare providers (n = 8; 40%). Two main data collection technics were used: documentary review and in-depth individual interviews. All interviews were transcribed and manually coded using an Excel extraction spreadsheet. Data were analysed using inductive and deductive approaches. The results showed several organizational, structural, and community challenges that underlined the low surgical coverage of trachomatous trichiasis in the health district of Siguiri. Organizational challenges included the low involvement of local actors in planning activities, the limited timeframe of the campaigns, and the lack of logistics for activities supervision and patients' transportation to surgery sites. Structural challenges included the inadequacy of health centres to provide surgical services, poor health infrastructures, and sanitation conditions in some areas. Individual challenges included remoteness of surgical sites and costs associated with services provision including medicines. Community challenges included fear of surgery and the coincidence of the campaigns with agricultural and mining activities. The results of the study call on the national neglected tropical disease program and its partners to adopt and promote micro-planning of trachomatous trichiasis surgical activities, with the effective participation of local stakeholders in endemic health districts. They should also envision integrating the management of surgical treatment including costs associated with care (transportation, food, rehabilitation support for patients who have undergone surgery) and complications of surgical procedures for an expansion of the trachomatous trichiasis free surgical care coverage in endemic health districts in Guinea.

Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review

Background The coronavirus disease (COVID-19) pandemic has underscored the need for resilient health systems. However, Ghana does not seem to achieve commensurate results, suggesting potential gaps in critical interventions. This study examines these gaps by drawing on global experiences to guide Ghana's preparedness for future emergencies. Methods A scoping review based on the synthesis of published journal articles and grey literature was used to gather relevant evidence to address the study’s objective. Peer-reviewed literature searches were conducted in databases, including Medline, Scopus, and Health Sources, supplemented by searches on organizational websites to identify grey literature. We adopted the Organization for Economic Co-operation and Development (OECD) framework to explore how health systems responded to the COVID-19 pandemic globally and draw lessons for strengthening Ghana's health system resilience. We analyzed policy responses in three main areas: pandemic preparedness, crisis management, and response and recovery. Results Ten strategies emerged from the study as critical in strengthening health system resilience against future pandemics. These strategies include whole-of-government engagement, financing for preparedness, community engagement and trust, robust surveillance systems, emergency medical care, diverse workforce development, digital health integration, critical health infrastructure, well-planned commodities/products, and social capital. Each strategy plays a vital role in enhancing preparedness, response, and recovery efforts, highlighting the multifaceted approach needed to mitigate the impact of future pandemics on health systems. Conclusions The identified strategies align with the attributes of a resilient healthcare system. By adopting these strategies, Ghana can build a resilient healthcare system that effectively addresses future challenges, guided by global insights and experiences.

Association between greenness exposure and depression rate among Bangkok residents: An ecological longitudinal study

This ecological study aimed to examine the relationship between greenness exposure and depression among Bangkok residents, using the district as a unit of analysis. This study utilized data on depression (ICD-10 F32, F33), environmental parameters, and demographic and health infrastructure variables in 50 districts in Bangkok recorded from 2018 to 2020. The Excellence Center for Depressive Disorder provided information on the number of new depression cases, including only those who had registered permanent residence in Bangkok. Greenness was measured using the normalized difference vegetation index (NDVI), which was extracted from a Terra-MODIS sensor. Then, the association between greenness exposure and depression was evaluated using descriptive statistics, bivariate analysis, and generalized additive mixed models with adjustment for covariates. From 2018 to 2020, a mean of 4.57 ± 6.45 cases was recorded per 100,000 population annually, and the mean NDVI was 0.33 ± 0.09. Adjusted for all covariates, as well as considering the smooth terms basis, an increase in one unit of NDVI value would contribute to depression rate reduction by up to 77.7 % (risk ratio = 0.223, 95 % CI = 0.200 – 0.248). PM2.5 exhibited an insignificant positive association with depression incidence rate. Additionally, temperature and humidity were associated with depression rate in the final model (p < 0.05). Living in greener areas would contribute to a lower depression incidence rate in Bangkok. However, the study is subject to limitations, including the impact of the COVID-19 pandemic, which may have influenced both depression rates and access to green spaces during the study period. Policies that can increase environmental greenness should be promoted to enhance social interactions and physical activities.

Human rights in education implication schema based on the study of the UN Economic and Social Council’s 2030 agenda

Human rights in education are an essential area that needs to be the highest priority for improving almost the entire world, especially for the 2030 agenda. This research analyzed the human rights in education values inside the UN Economic and Social Council’s declaration goal 4 of the official document entitled “Building back better from the coronavirus disease (COVID-19) while advancing the full implementation of the 2030 Agenda for Sustainable Development”. The data are analyzed through a critical discourse approach in qualitative design and discourse organization analysis method. There are nine main human rights in education found inside the declaration including ensuring and protecting education equality, education, and learning development acceleration, preparing and providing sufficient education funding, cultural diversity in education, providing a safe environment for physical and mental health, providing safe, modern and convenient infrastructure and teaching-learning facilities, gender equality in education, internet literacy in education, involving every country as to the world’s global meeting and cooperation of education. The focus of improvement on human rights in education is concluded to be dynamic, which is influenced by economic, welfare, politics, IT, and other integral aspects of development and depends on the world’s and a country’s needs and future desire.

Role of North Atlantic warming in the extremely hot summer of 2023 in North China

Abstract A deadly heatwave hit North China in the summer of 2023, causing severe damage to human health and public infrastructure. However, the underlying physical mechanism is still unknown completely. In this study, we explore the causative role of anomalous sea surface temperatures in three oceans using observation and reanalysis data, as well as partial regression and correlation methods. This heatwave exhibited the longest maximum duration of the past 50 years. According to the probability density function, the maximum temperature also reached an unprecedented high. A long-lived anticyclone dominated North China, causing persistent downward motion and adiabatic heating, enabling the heatwave to form and continue for more than 20 d. The Indian, Pacific, and North Atlantic oceans all experienced extreme warming. However, our results indicate that North Atlantic warming played a decisive role in the occurrence of this heatwave by exciting a Rossby wave train that propagated eastward, generating the long-lived anomalous anticyclone and inducing heatwaves. In comparison, the other two oceans exhibited weak or negative contributions to the heatwave. As the North Atlantic shows an obvious warming trend with increasing global warming, more attention should be paid to its relationship with heatwaves in North China.

The Use of Remote Presence Robotic Tele-Presentation in Rural and Remote Canada: A Systematic Review.

Objective: One potential solution to limited health care in rural and remote regions is remote presence robotic tele-presentation to allow health care providers to care for patients in their home community via a robotic interface. We synthesized evidence regarding the use of remote presence robotic tele-presentation in rural and/or remote Canadian health settings. Methods: Medline, PubMed, and Embase were searched up to August 2023. Remote presence robotic tele-presentation refers to any robotic device used for the purpose of presenting and/or collecting patient information. Primary research was included if the patient was located in remote and/or rural Canada, featured remote presence robotic tele-presentation, and assessed patient, family, or clinician satisfaction, patient transport to nearby regional or urban center, health care costs, clinical outcomes, infrastructure outcomes, adverse events, or telementoring. Results: Six studies were included. Patients, nurses, and physicians all reported high levels of satisfaction when using the remote presence robotic tele-presentation. Fifty to sixty-three percent of patients were managed in their home community and did not require transfer to another center. Remote presence robotic sonography resulted in adequate imaging in 81% of first trimester ultrasound limited exams but was less useful for second trimester complete obstetric ultrasounds (20% adequate imaging). Two of eight laparoscopic colorectal surgeries had to be converted to open surgeries. Telerobotic ultrasound clinics resulted in a diagnosis in 70% of cases. Conclusions: Evidence suggests remote presence robotic tele-presentation is a safe and cost-effective approach to providing care in distant communities and can prevent some transfers and evacuations to tertiary hospitals.