Urban Settings Research Articles

Environmental and geographical determinants of tuberculosis distribution in Sidi Kacem province, Morocco: a three-year retrospective study (2018–2020)

ABSTRACT This retrospective study analysed 1,506 tuberculosis cases (2018–2020) in Sidi Kacem province, Morocco, to investigate environmental and geographical determinants of disease distribution. Results revealed higher prevalence in rural areas (55%) than in urban settings (45%), with significant seasonal variations. Environmental factors, including housing conditions and geographical location, strongly correlated with disease patterns. Findings emphasise the need for environment-specific interventions in tuberculosis control strategies.

Evaluating maternal drug use disparities, risk factors and outcomes in Northeast Arkansas: a pre, during, and post-COVID-19 pandemic analysis

IntroductionThe use of addictive substances remains a major health problem in the U.S. An increase in drug overdose and mortality was observed during the COVID-19 pandemic, especially in underserved populations. This surge also impacted pregnant women especially with the use of marijuana (THC) and opioids.MethodsRetrospective study analyzing mother-infant dyads with reported Meconium Drug Screen (MDS) results, from January 2018 through April 2023 at a reference hospital serving an urban and rural area of Arkansas. Due to the absence of universal screening, the prevalence of drug use was variable during the study period. An adjusted monthly positive rate (AMPR) was calculated by considering the expected number of positive MDS screenings per month and adjusting it based on the screening rate per month and the monthly birth count.ResultsAmong 8,030 live births, 957 dyads were included in the analysis, with 47% (N = 450) of infants testing positive for at least one substance. Of these, 64.2%, 11.1%, and 6.7% were positive for THC, amphetamines, and opioids, respectively; and 17.8% tested positive for more than one substance. Infants with a positive MDS (MDS+) had significantly lower weight, height and head circumference with higher preterm rates and longer hospital stays. Mothers who smoked during pregnancy were more than twice as likely to have an MDS + result than those who did not (OR 2.39 (95% CI: 1.34–3.02), and most were from metropolitan areas (73%) or white (67%). The adjusted MDS + rate or AMPR significantly increased over the study period from 6.8% (January 2018) to 7.4% (April 2023). However, the COVID-19 pandemic did not significantly impact these rates. Compared to amphetamines and opioids, THC usage significantly increased during the study period and this increase was more pronounced after the state’s legalization of THC.ConclusionMaternal substance use, predominantly THC, continues to increase, particularly following its legalization. Infants who were MDS + presented adverse neonatal outcomes, with the majority of the mothers being white and from urban settings. Maternal self-reported smoking was associated with increased usage of other substances. Racial disparities were observed during the study, underscoring the need for universal drug testing and targeted interventions.

Effect of nutrition education on hemoglobin level of pregnant women in Southeast Ethiopia: a cluster randomized controlled trial

BackgroundMaternal hemoglobin (Hgb) is considered an essential, modifiable risk factor for adverse pregnancy outcomes (APOs). Evidence for the effect of nutrition education on the Hgb levels of pregnant women in low-income countries, including Ethiopia, is inconclusive. This study aimed to assess the effect of nutrition education on the Hgb levels of pregnant women in urban settings in the Bale Zone, Southeast Ethiopia.MethodsA community-based two-arm parallel cluster randomized controlled trial was carried out among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control groups) at health facilities from February to December 2021. A multistage cluster sampling technique followed by systematic sampling was used to select the pregnant women. Pregnant women who took part in the intervention arm received six nutrition education sessions, whereas pregnant women in the control group received routine standard care. We used a pretested, interviewer-administered, structured questionnaire to collect the data. The Hgb level of pregnant women was measured by collecting a finger-prick blood sample using a HemoCue Hb 301. A generalized estimating equation (GEE) model was used to isolate the net effect of the intervention on Hgb, accounting for the clustering. Beta coefficients (β) along with a 95% confidence interval (CI) were used for interpretations.ResultsThe mean difference in Hgb levels between the intervention and control groups was 0.12 ± 0.04 (P value < 0.002). The multivariable GEE linear model revealed that nutrition education significantly improved the Hgb levels of pregnant women [β = 0.36, 95% CI: (0.30, 0.43)]. An increase in the consumption of a cup of coffee or tea decreased Hgb levels by 0.14 g/dL [β = -0.14, 95% CI: (-0.23, -0.06)].ConclusionThe findings showed that a comprehensive nutrition education intervention using the health belief model (HBM) and theory of planned behaviour (TPB) designed to improve dietary diversity substantially improved hemoglobin (Hgb) levels among pregnant women. While we found no single dietary factor to be significant, in this group of pregnant women in Ethiopia, an increase in the daily consumption of a cup of coffee or tea decreased Hgb levels. As a consequence, pregnant women should be advised to limit their coffee or tea consumption. The study was registered on Clinicaltrials.gov retrospectively with the registration number PACTR202201731802989 on 24/01/2022.

Struggles of Fatherhood: A Prospective Study on the Incidence of Paternal Postpartum Depression and Associated Factors.

To investigate the incidence and the factors associated with paternal postpartum depression amongst new fathers in Singapore. A prospective repeated measures study was conducted from September 2023 to March 2024. A total of 200 fathers aged 21 years and above who had a neonate born at full term and no serious health events for both mother and neonate were recruited from a local hospital via convenience sampling. Fathers completed questionnaires at the third trimester of pregnancy (baseline) and 1 month postpartum. Multiple regression analyses were used to identify significant factors associated with postpartum depression in fathers. The incidence of paternal postpartum depression was 5.26% at 1 month post-childbirth, using the Edinburgh Postpartum Depression Scale (EPDS). Using the Gotland Male Depression Scale (GMDS), 7% of the fathers were identified with high risk of depression and 14.3% of the fathers had moderate depressive symptoms. Paternal postpartum depression at 1 month post-childbirth could be predicted by paternal postpartum depression scores at baseline measured by EPDS and GMDS, as well as by baseline perceived social support and parental self-efficacy at 1 month post-childbirth. This study found that a considerable number of fathers in Singapore are at risk of postpartum depression. There is an urgent need for the development of more comprehensive tools to measure postpartum depression in fathers that are culturally adapted to the local context. Early screening during antenatal visits enables timely intervention and access to support, benefiting the entire family. Nurses could help fathers to be more involved by extending patient education and teaching infant care skills to both parents. When counselling patients, the involvement of extended family members and navigating new roles as caregivers of a new baby and breadwinners are important considerations for new parents. This study is the first of its kind to measure the incidence of postpartum depression amongst new fathers in an urban multicultural Asian setting, like Singapore. The study found that the incidence of postpartum depression in fathers were 5.26% when measured using EPDS and 14.3% when measured using GMDS at 1 month postpartum. These findings could inform future family-centred and father-specific interventions to improve the mental health outcomes of new parents. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. No patient or public contribution.

Investigating the effects of local climate zones on land surface temperature using spectral indices via linear regression model: a seasonal study of Sapanca Lake.

The formation of urban heat islands is a widespread issue in cities. However, the impact of spectral indices on land surface temperature (LST) with various urban forms, climates, and functions has not been sufficiently examined. Currently, the prevalent method for analyzing complex urban areas is the classification of local climate zones (LCZs). In this study, we aim to explore the urban thermal environment by utilizing GIS-based spatial analyses and statistical methods. We also examine LCZs and the temporal-spatial changes of LSTs in Sapanca Lake and its surroundings. A comparative analysis was conducted on the relationship between the normalized difference vegetation index (NDVI), the modified normalized difference water index (MNDWI), and the normalized difference built-up index (NDBI) spectral indices in different LCZs and LST using a linear regression model. The results showed that all LCZs experienced a warming effect with an increase in NDBI, while they exhibited a cooling effect with the influence of NDVI and MNDWI. Notably, NDVI demonstrated a strong cooling effect in LCZ A (Dense trees) during the summer season, with an R2 coefficient of 0.73. Similarly, MNDWI had an R2 coefficient of 0.73 in LCZ A during spring. Values calculated as a result of regression are found as MAE:0.72 and MSE:0.75. These findings indicate the cooling effect of urban areas characterized by dense trees and water surfaces, highlighting their role in reducing LST. As a result, the research revealed the role of urban green systems and water surfaces in reducing the heat island effect, which is a problem, especially in urban centers. Overall, the study's results contribute to a better understanding of the thermal environmental characteristics in complex urban settings.

Swasthya Pahal (Health for All) Using a Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored Informatics Framework in Rural and Urban Areas of Chennai, Tamil Nadu: Protocol for a Quantitative Study.

Noncommunicable diseases (NCDs) require a longer period of care, for which health care systems must acquire technologically advanced solutions to enhance patient care. Swasthya Pahal (health for all) is an innovative, interactive, multilingual, stand-alone, internet-enabled computer-based program that aims to improve the self-management of NCDs. This study aims to enhance the self-management of chronic NCDs (diabetes, hypertension, high cholesterol, and obesity) by determining the usefulness, acceptance, and effectiveness of the Swasthya Pahal program in hospital and community settings in both rural and urban areas of Chennai, Tamil Nadu. This objective can be met by generating risk factor profiles of individuals enrolled and enhancing their self-management of NCDs using a portable health information kiosk that uses the Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored (SMAART) model. A quantitative study will be conducted on a convenient sample of 2800 individuals from selected hospital and community settings in rural (n=1400) and urban areas (n=1400) in Chennai, Tamil Nadu. Data will be collected on sociodemographics, health behaviors, and clinical status, as well as knowledge, attitudes, and practices. Objective assessments such as weight, blood pressure, and random blood sugar levels will be measured. In addition, the usefulness, acceptance, and effectiveness of the Swasthya Pahal program will be determined. Results will be summarized using descriptive analysis. Appropriate bivariate and multivariate regression analysis will be performed to determine the predictors of the outcome variables of usefulness, acceptance, and effectiveness of Swasthya Pahal in wider settings. All analyses will be performed using SAS (version 9.1; SAS Institute), and the results will be reported as 95% CI values and P<.05. The study proposes to enhance the self-management of NCDs in both rural and urban community settings through the implementation of the Swasthya Pahal program based on the SMAART informatics framework. The study aims to understand the implementation, acceptability, and usability of Swasthya Pahal among a diverse sample of people in urban and rural settings. PRR1-10.2196/39950.

Analysis of acute non-pharmaceutical toxic exposures in children: a 5-year retrospective study

ObjectiveThis study aims to systematically analyze the epidemiological characteristics, clinical interventions and outcomes of children with acute non-pharmaceutical toxic exposures.MethodsThis retrospective study included all children with acute non-pharmaceutical toxic exposure admitted to the emergency department of the Capital Institute of Pediatrics between January 1, 2019, and December 31, 2023. Eligible patients were triaged into red, yellow, and green groups according to their severity condition. Clinical information including demographics, exposure details, clinical manifestation, laboratory results, treatments, and outcomes were extracted from electronic medical records. Univariate and multivariate logistic regression analyses were conducted to identify risk factors associated with hospitalization.ResultsOverall, a total of 718 patients with acute non-pharmaceutical toxic exposures was included in this study, infants and toddlers accounting for 57.9%. The male-to-female ratio was 1.16:1. The majority exposure events occurred at home (89.3%) and in urban settings (78.4%). Accidental poisoning was the predominant cause, accounting for 94.7%, and the primary route of exposure was oral (93.6%). Mercury was the most common exposed substance, representing 18.8% of cases, particularly among preschool-aged children (31.7%). Patients triaged to red zone had a higher proportion of clinical manifestation and required more aggressive treatments. Although most patients discharged without treatment (78.4%), 19.1% need emergency observation, and 2.5% required hospitalization. Logistic regression analysis showed that corrosive household products exposure (OR = 42.747, 95% CI[5.041–362.520]), skin and mucosal damage (OR = 37.052, 95% CI[5.339–257.153]), pesticides exposure (OR = 33.322, 95% CI[3.863–287.423]), heavy metals exposure (OR = 31.636, 95% CI[1.471–680.210]), neurological manifestation (OR = 22.656, 95% CI[4.766–107.711]), positive toxicology results (OR = 15.105, 95% CI[6.584–34.656]), industrial products exposure (OR = 10.294, 95% CI[1.144–92.641]), and intentional poisoning (OR = 3.060, 95% CI[1.733–5.405]) associated with hospitalization.ConclusionPediatric patients exposed to some specific toxicants like industrial products and corrosive household products might associated with a higher risk of severe clinical outcomes. Advocating for enhanced safety regulations or educations and public health initiatives to mitigate the incidence of such exposures is still important for protecting children's health.

Impact of Climate Change on Informal Street Vendors: A Systematic Review to Help South Africa and Other Nations (2015–2024)

Climate change poses significant challenges to informal street vendors, particularly in urban settings where they operate in vulnerable environments. These challenges include economic instability, health risks, and sociopolitical exclusion, which are further exacerbated by extreme weather events and inadequate policy support. This review focuses on understanding these impacts by synthesizing lessons and exploring potential solutions from South Africa and other regions that could be implemented by governments and street vendors. A systematic review was conducted, following PRISMA guidelines, to synthesize findings from 48 studies published between 2015 and 2024. This review employed qualitative and quantitative analysis using thematic coding in ATLAS.ti and Microsoft Excel version 2024. Comparative analyses across regions and time periods were conducted to identify differences in impacts and adaptation strategies. Among the 48 studies, 52% were conducted in Africa and 50% in Asia, making these the most frequently represented regions in research on climate change and informal street vendors. Most of the publications were between 2021 and 2024 (52%). This review further highlights that climate change has led to significant economic losses, reduced working hours, and increased operational costs for informal vendors. Health impacts, such as respiratory illnesses and heat stress, are prevalent, particularly among vendors exposed to air pollution and extreme temperatures. Gender-specific vulnerabilities were noted, with women facing compounded challenges due to caregiving responsibilities and inadequate access to sanitation facilities. While Asian vendors have adopted technological solutions like mobile payment systems and cooling devices, these may not be currently feasible for South African vendors. Instead, tailored interventions that consider the local context and available resources are necessary to effectively support South African street vendors. Key recommendations include integrating vendors into urban resilience planning such as encouraging the use of cleaner and more sustainable transportation, improving access to healthcare, and providing financial support. Additionally, governments and communities should pilot the solutions identified in this review and publish their findings to inform future policies and practices.

Perceived urban environment elements associated with momentary and long-term well-being: An experience sampling method approach

Well-being (WB) extends beyond physical health, as defined by the World Health Organization and encompasses two aspects: (1) long-term WB (LWB), such as overall life satisfaction; and (2) momentary WB (MWB), such as immediate mood. While research has demonstrated a positive association between one’s environment and LWB, limited studies have explored the association between environmental characteristics and MWB. We applied the experience sampling method (ESM) to collect data on location, perceived environmental characteristics, MWB, and LWB of adult participants living in Kashiwa-no-ha area, Kashiwa City, Japan. Structural equation modeling was used to calculate the correlation coefficients between different environments and both MWB and LWB. LWB was positively associated with MWB (standardized coefficient=0.24) and urban elements—cafés/restaurants/bars (0.11), cultural/sports/education facilities (0.04), and public spaces (0.11). Meanwhile, relaxing/clean (0.56) and natural environments (0.14) were associated with higher MWB. Conversely, vibrant environments (−0.14) and being on the move (−0.11) were linked to lower MWB. LWB was positively associated with being at cultural/sports/educational facilities (0.06), and vibrant (0.15) and communicative (0.13) urban settings. MWB was associated with various built environments, emphasizing the need for places like parks and cafés that promote a positive mood, and well-designed transportation and roads. These elements are important for developing urban areas that meet the physical requirements of residents while supporting their emotional and psychological well-being.

Feasibility of HIV self-test implementation among Mizo youths: a field investigation from Northeast India bordering Myanmar

IntroductionThis study investigated the potential of HIV self-test (HIVST) to reach individuals who otherwise might not access testing or antiretroviral therapy (ART). The study had two main objectives: (a) to develop an HIV self-test implementation plan based on the findings from qualitative inquiries with local stakeholders and (b) to examine HIVST uptake among youths in the urban setting of Aizawl district in Mizoram.MethodologyIn the first phase, qualitative in-depth interviews (IDI) were conducted with HIV program officials, religious leaders, community influencers, youths, and key population groups. These inquiries guided the planning of strategic communication, community engagement, HIVST delivery, and linkages with HIV confirmatory testing services in phase two. Factors associated with the non-uptake of HIV confirmatory tests by youths following HIVST were analyzed quantitatively. Additionally, secondary data collected from attendees of the “Integrated Counselling and Testing Centre” (ICTC) were also analyzed.ResultsThe in-depth interviews underscored the need to introduce HIVST among Mizo youths. The respondents emphasized the importance of diverse outreach approaches and communication strategies, including the use of social media platforms, as critical components for successful HIVST implementation. They also provided valuable insights on the optimal locations and methods for making HIVST kits accessible. Among the youths who used HIVST, the majority were first-time testers (1,772/2,101; 84.3%). Those diagnosed with an undiagnosed HIV infection were started on ART. The preference for the blood-based HIVST format (1,162/2101; 55%) was noted to be slightly higher than the saliva-based format. Confirmatory test uptake was significantly higher among those with sero-reactive HIVST results (χ2 23.89; p &amp;lt; 0.001). Factors independently associated with (adjusted odds ratio; AOR with 95% CI) “no-show for HIV confirmatory tests,” which hold significant programmatic implications, included “age &amp;gt; 20 years (1.47; 1.18–1.82),” “gender (men)” (1.25; 1.01–1.55), “education below 10th standard” (5.16; 2.66–10.01), “no prior HIV testing experience” (2.12; 1.61–2.81), and “unwillingness to undergo HIV confirmatory testing” (2.85; 2.05–3.96). Individuals who opted for the blood-based HIVST were 23% less likely (AOR 0.77; 95% CI; 0.62–0.96) to drop out of the HIV confirmatory testing process. Additionally, only 1% of respondents perceived HIVST as having self-harm potential.ConclusionSustained community engagement, effective networking with HIV program officials, and strategic communication were three critical pillars supporting the successful implementation of HIVST. There was a significant increase in HIVST uptake among young first-time testers.

Sustainable Active Travel in Environmentally Challenging Cities: A Systematic Review of Barriers and Strategies

Active travel modes, such as walking and cycling, are essential for fostering sustainable urban transportation. However, their adoption in environmentally challenging areas—characterised by steep slopes, extreme weather, and rugged terrain—presents significant obstacles. This study addresses these challenges by conducting a systematic literature review of studies published between 2000 and 2024 to identify strategies that promote active travel in such contexts. Using a structured five-step methodology, 62 relevant articles were selected and analysed to explore common challenges and propose tailored solutions. The findings highlight critical barriers, including topographical difficulties, harsh climatic conditions, and adverse weather, all of which hinder walking and cycling. To address these barriers, this study identifies a range of solutions, including infrastructure enhancements such as bike lifts, e-bike systems, shaded walkways, and heated pavements, as well as policy measures like financial incentives and disincentive regulations. Importantly, this study makes a deliberate effort to avoid overgeneralised solutions by emphasising the need for interventions that are context-sensitive and tailored to specific environmental challenges, urban scales, and local conditions. By providing options for actionable strategies, this research offers a comprehensive foundation for developing inclusive and sustainable policies that encourage active travel in diverse and environmentally constrained urban settings.

Mushroom Growing and Wealth Creation in Mbarara Municipality, A Case of Selected Mushroom Farmers.

The study was set out to explore whether mushroom growing create wealth among participating households in Mbarara Municipality. This study was guided by the following objectives: to explore whether the participating households generate income from the mushroom enterprise; to examine various investments created out of the income from the mushroom enterprise for diversified earning; and to investigate the saving capacity of the participating households for future investment and enterprise sustainability. A retrospective-prospective study design was used to investigate the aspects within the period that took place in the past so as to understand the present situation and use it to predict the future. The study population included group leaders and members. From this population the researcher sampled 50 respondents using purposive and simple random sampling techniques. The study used both questionnaire and interviews to gather field data; qualitative data was arranged according to themes and quantitative data was analyzed using Statistical package for social scientists (SPSS). From the study, it was found out that farmers generate income from mushroom growing; In addition, respondents mentioned that mushroom presents growers with high nutritional value as well as income. The study also revealed the distribution of income as positively skewed, implying that farmers ought to obtain skills and improve on the technology they use to produce more and earn much. The study concluded that mushroom growing can contribute to wealth creation in an urban setting context due to its low set-up cost, high price margin and quick returns. The study recommends that Higher Institutions of learning like Bishop Stuart University should develop outreach programmes to equip such enterprises with basic skills to enhance their efficiency and high returns leading to wealth creation and sustainable transformation.

Transformer-based travel time estimation method for plateau and mountainous environments.

Travel time estimation (TTE) is a critical function in intelligent driving systems. Current research and applications related to TTE primarily focus on urban environments. The objective of this study is to develop TTE methods that are applicable to wilderness areas characterized by plateau and mountainous topography. We selected Transformer, which has greater robustness in capturing long-distance dependencies than LSTM, to develop a Transformer-based model. The model simultaneously integrates positional encoding and multi-head self-attention mechanisms with the objective of enhancing the accuracy of travel time predictions based on a substantial number of trajectory points in wilderness settings. A meta-learning strategy was employed to improve the model's generalization ability, thereby ensuring its applicability for accurate travel time estimation across a range of challenging environments. Two datasets were constructed based on measurements from two selected areas in eligible plateau and mountainous regions of western China. For each dataset, two categories of features were defined: terrain-weather features and spatio-temporal features. These categories were established in accordance with the influence of seven specific features on traffic conditions in both urban and wilderness areas. Experiments were conducted on both datasets utilizing terrain-weather features. When evaluated alongside the five models that are most commonly utilized in urban settings, the mean absolute percentage error (MAPE) of our model exhibited a 14.89% improvement in plateau environments and a 12.20% improvement in mountainous environments in comparison with the most effective model, namely MetaTTE-GRU. These findings substantiate the assertion that the proposed model is an effective means of estimating travel times in complex environments, and that it exhibits superior accuracy compared to existing LSTM-based estimation models.

Sociodemographic and Psychosocial Factors Influencing Coronavirus Disease 2019 Testing Uptake: Insights from Urban and Rural Communities in South Africa.

Access, demand, and acceptance of coronavirus disease 2019 (COVID-19) testing have varied globally. This study explored the sociodemographic and psychosocial risk factors that contribute to the uptake of COVID-19 testing in community settings in South Africa. This paper presents a cross-sectional secondary analysis using data from a cluster randomized controlled trial and a nested perception survey of COVID-19 antigen testing in communities located in urban (eThekwini, KwaZulu-Natal) and rural settings (Worcester, Eastern Cape) in South Africa. Individuals who were reluctant to get tested participated in the perception survey. Data were analyzed using descriptive statistics and multivariable logistic regression to assess linear associations and estimate adjusted odds ratios (ORs). The analysis was conducted on 3,074 individuals, of whom 2,509 (81.6%) provided consent for COVID-19 testing. Among those, 2,505 (81.5%) tested negative, and 4 (0.1%) tested positive for COVID-19. The mean age of participants was 38 (SD = 14.61), and 57% were male. Females (OR: 1.27; 95% CI = 1-1.6), individuals older than 56 years (OR: 1.95; 95% CI = 1.24-3.07), and those who were vaccinated (OR: 1.99; 95% CI = 1.53-2.60) were more likely to consent. Individuals who had previously tested positive for severe acute respiratory syndrome coronavirus 2 were less likely to consent to testing (OR: 0.64; 95% CI = 0.11-0.46). No link was found between depression, anxiety, substance use, and willingness to undergo COVID-19 testing. A perceptions survey involving 704 participants, which explored factors influencing testing willingness, found that older adults, and urban populations were less likely to undergo COVID-19 testing. Targeted health campaigns may improve testing rates. Larger-scale implementation research is required to explore best practices for improving testing rates and confidence in population-level detection within South Africa.

Premature Mortality and Health Inequality among Adult New Yorkers with Serious Mental Illness.

Although numerous studies have documented excess mortality and health inequality among individuals with serious mental illness (SMI), none has been done among individuals in a large, diverse urban setting, such as New York City (NYC). We used referral data for adults aged 18 and older referred to the NYC Department of Health and Mental Hygiene public mental health services between January 2004 and December 2018 and matched it to the NYC death registry. Age at death, leading causes of death, years of potential life lost (YPLL), and standardized mortality ratios (SMRs) were calculated for this population. We found individuals with SMI in NYC died at younger ages and had higher rates of YPLL compared to the total population (147.4 YPLL vs. 66.8 YPLL per 1000 population). Age and gender-adjusted SMRs show these individuals have more than twice the mortality rate of the total NYC adult population (overall SMR 2.2 [95% CI 2.1-2.2]). Cause-specific SMRs show an increased risk of death among SMI from diabetes (SMR 2.8 [95% CI 2.4-3.10]), heart disease (SMR 2.7 [95% CI 2.6-2.9]), psychoactive substance use and accidental overdose (SMR 4.5 [95% CI 4.1-4.9]), and suicide (SMR 6.7 [95% CI 6.0-7.4]). Our results highlight the need to implement effective, preventive, and rehabilitative measures that integrate physical and behavioral healthcare services and address upstream drivers of health to achieve health equity and eliminate health disparities. In order to achieve gains in life expectancy, specific considerations for reducing excess mortality in the SMI population must be accounted for.

Prevalence of communicable, non-communicable diseases, disabilities and related risk factors in Khyber Pakhtunkhwa Pakistan: Findings from the Khyber Pakhtunkhwa Integrated Population and Health Survey (2016-17).

Pakistan is facing a triple burden of diseases: communicable diseases (CDs), non-communicable diseases (NCDs) and disabilities. There is limited evidence on the patterns of these diseases in Pakistan, specifically Khyber Pakhtunkhwa. Additionally there remains limited study on the impact of sex-, age and setting-stratified morbidities in Khyber Pakhtunkhwa. The objective of this study was to present the demographic characteristics and the burden of locally-specific CDs (hepatitis B and C, TB, AIDS), NCDs (diabetes, renal diseases, asthma, epilepsy, coronary heart diseases, cancer, hypertension, cholesterol, thalassemia), and disabilities (congenital, post-disease, post-injury, paralysis) stratified by sex, age and setting in the Khyber Pakhtunkhwa province of Pakistan. The Khyber Pakhtunkhwa Integrated Population and Health Survey (KP-IPHS) was conducted in 2016-17 to gather comprehensive information about the demographic characteristics and locale-specific health-related issues of the people of Khyber Pakhtunkhwa, Pakistan. This cross-sectional survey was conducted in 24 districts across all 7 divisions of Khyber Pakhtunkhwa on population ageing ≥18 years. A total of 20704 respondents were taken from primary (n = 1061) and secondary sampling units (n = 15724), designed with considerations for urban/rural and socio-economic status. Each primary unit included 250-300 households. The sample selection utilised a multi-staged stratified systematic cluster sampling technique, involving the inclusion of every 16th household in rural areas and every 12th household in urban areas. Observations were recorded on demographics, quality of life, physical activity, BMI, disabilities, CDs and NCDs. Among all NCDs, hypertension has the highest prevalence (29.2%), showing a significant difference between females (32.7%) and males (25.0%). The proportion of males and females with diabetes is 7.4% and 5.2%, respectively, with a more substantial percentage (11.2%) observed in the ≥50 years' age group compared to 2.5% in the 18-29 years' age group and 5.0% in the 30-49 years' age group. Among the included CDs, hepatitis B and C (0.5% and 0.8%, respectively) are most prevalent. Hepatitis B is more common in females (0.8%) and in rural settings (0.6%) compared to males (0.3%) and urban settings (0.2%), respectively. The prevalence of congenital disabilities is the highest of all disabilities, with a significantly high prevalence in females (5.3%) and rural settings (3.5%) compared to males (0.9%) and urban settings (0.6%) respectively. Furthermore, post-injury, post-disease disabilities, and paralysis significantly increase with age (P < 0.001). Our findings show that the prevalence of CDs, NCDs and disabilities varies across sex, age and settings, with a notable prevalence in females and the old-age population (≥50 years). The results emphasise the necessity of public health efforts, such as screening, prevention, and treatment, to tackle the triple burden of CDs, NCDs, and disabilities in Khyber Pakhtunkhwa Pakistan.

Effectiveness of a resilience, gender equity and mental health group intervention for young people living in informal urban communities in North India: a cluster randomized controlled trial

ABSTRACT Background Mental health problems are the leading cause of disease burden among young people in India. While evidence shows that youth mental health and resilience can be improved with group interventions in school settings, such an intervention has not been robustly evaluated in informal urban settings. Objective This study aimed to evaluate whether the Nae Disha 3 group intervention could improve youth resilience, mental health and gender equal attitudes among disadvantaged young people from low-income urban communities in India. Methods This cluster randomised controlled trial used an analytic sample of 476 adolescents and young adults aged 11–25 years from randomised clusters in urban Dehradun, India. The 251 intervention group participants were 112 boys and 139 girls, and the 225 young people in the wait-control group were 101 boys and 124 girls. Five validated tools measuring resilience gender equity and mental health were filled by participants at three different points in time. Results Difference in difference (DiD) analysis at T2 showed that scores improved among girls in intervention group, for adjusted model, resilience (DiD = 4.12; 95% CI: 2.14, 6.09) and among boys, for resilience (DiD = 5.82; 95% CI: 1.57, 9.74). Conclusions The Nae Disha 3 intervention among disadvantaged urban youth moderately improved resilience for both young men and women, though it did not significantly impact mental health, self-efficacy, or gender-equal attitudes. We establish potential merit for this approach to youth mental health but recommend further research to examine active ingredients and the ideal duration of such group interventions.

Transforming Urban Façade Condition Assessments with Semantic Data Visualizations and 3D Spatial Layouts from BIMs

Safety inspection of building façades in urban settings is critical for public safety, as many incidents/accidents frequently occur due to falls from façades. This inspection is required for condition assessment of current states and their comparison to assessments conducted in a previous inspection cycle. The current practice of façade condition assessment relies on static, scattered, and textual depictions, which prevents inspectors from having a comprehensive view of façade condition and comparing it to the previous inspection cycle’s findings. Integrated visualization of spatial and semantic data and providing this data based on the preferences of the decision makers are proven to be effective in various decision domains. This study builds on previous research efforts on integrated visualization techniques to identify façade inspectors’ preferences in comprehending inspection findings. Through the design of low-fidelity visualization prototypes, this study first identifies highly frequently preferred visualization techniques by inspectors. Based on these, this study then quantifies the impact of these identified visualization preferences on accuracy and efficiency of decisions in relation to condition assessment of building façades though a set of high-fidelity prototypes and user studies. The results show that integrated visualization of façade conditions has the potential to bring the efficiency of capturing a holistic view of the façade conditions up to 65% and increase the accuracy of decisions up to 41%. The findings of this study directly benefit inspection companies and city agencies who can deploy visualization techniques that are impactful for façade condition assessment in order to holistically assess building façades.

Mifepristone versus Foley balloon catheter for outpatient cervical ripening at term: A non-inferiority randomised controlled trial.

To evaluate whether the success rate of oral mifepristone was not inferior to that of Foley balloon catheter for outpatient cervical ripening of term pregnancies, and whether there were differences in side effects for mothers and newborns. Open-label, non-inferiority randomised controlled trial. A tertiary care European university hospital in an urban setting. A total of 101 women with a Bishop's score<6 and with an indication for outpatient cervical ripening at term. Participants were randomly allocated to receive either mifepristone 200mg per os, or an intracervical Foley catheter balloon. Women going into labour in the first 24h after the intervention or with a favourable Bishop's score (≥6) at the first re-evaluation, conducted 18-24h after the intervention. We hypothesized that the incidence of the main outcome in the mifepristone group would be similar to that of the Foley balloon catheter group, within a margin of 10%. Onset of labour or favourable Bishop's score were achieved in 33.3% of women receiving mifepristone and 30.2% of those receiving the Foley balloon catheter (risk difference 0.03, 95% confidence intervals -0.15 to 0.21). This confidence interval indicates that mifepristone can be 21% superior but can also be 15% inferior to the Foley catheter balloon, therefore not meeting our non-inferiority target of less than 10%. Similar rates of onset of labour or favourable Bishop's score were achieved with mifepristone and Foley balloon catheter in outpatient cervical ripening at term, but mifepristone could not be shown to be noninferior.

Dual Clinical Practice (DCP) policy to improve the retention of human resources for health in Rwanda: a mid-term review using a cross-sectional and retrospective study design

BackgroundDespite the high demand for public services globally, ensuring the quality of services provided by public health facilities is challenging. Poor remuneration of public sector health care providers (HCPs) drives their migration to private health facilities. The Dual Clinical Practice (DCP) Policy in Rwanda represents a strategic initiative aimed at retaining healthcare professionals in public health facilities, allowing them to engage in private practice concurrently. This study assesses the implementation challenges and identifies opportunities for potential reformulation of DCP schemes.MethodsThis study employed a mixed methods approach, incorporating both cross-sectional and retrospective designs across six Rwandan public hospitals. Quantitative and qualitative data were collected through key informant interviews (KIIs) and joint interviews (JIs), as well as through the analysis of health facility records obtained from the Health Management Information System (HMIS) and the Electronic Medical Record (EMR). Qualitative data were analyzed using Atlas.ti software, while quantitative data were analyzed using Microsoft Excel.ResultsThe study involved participants from six Rwandan hospitals, including 20 healthcare providers and 32 patients. Qualitative results revealed that a substantial majority of health care providers supported the DCP policy, with a high patient satisfaction rate of 81% regarding DCP services. However, challenges emerged, including limited awareness of the policy and difficulties in tracking DCP engagements. Quantitative data from the HMIS and EMR indicated an increase in patient enrollment across most facilities, with DCP outpatient visits accounting for a significant percentage of total visits in some hospitals. While the DCP contributed positively to hospital revenues, concerns about the sustainability of the scheme and the adequacy of health care remuneration were highlighted, calling for a review of DCP policy involving stakeholders beyond the Ministry of Health.ConclusionThis study found that the DCP policy in Rwanda positively impacted healthcare provider retention, patient satisfaction, and hospital revenues. Providers expressed strong support for the policy, and patient satisfaction was high, with 81% of patients reporting positive experiences with DCP services. The scheme contributed to increased patient enrollment and hospital revenue, particularly in urban facilities. However, challenges, such as limited awareness of the policy among healthcare providers and difficulties in tracking DCP engagements, were noted. Additionally, concerns about the sustainability of the DCP and the adequacy of healthcare remuneration highlighted the need for policy revisions. To address these challenges, a collaborative approach involving stakeholders such as tax authorities, hospital administrations, and health insurance companies is necessary. Additionally, our study highlights the critical role of investments in physical infrastructure to support the long-term success of DCP. Enhancing infrastructure would not only ensure better healthcare quality but also support the retention of providers in both urban and rural settings.