Cancer risk associated with radionuclide exposure in urban radiological dispersal events varies by target organ, sex, and age at exposure, so whole-body average dose metrics underestimate the heterogeneity of individual risk. This study quantified organ-specific excess relative risk (ERR) in a hypothetical urban radiological dispersal scenario, stratifying simultaneously by distance from the release point, Pasquill-Gifford (PG) atmospheric stability class, and demographic profile. The study population comprised 90 individuals distributed across three locations (0.3, 1.0, and 2.0 km) and three PG classes (D, E, and F), yielding nine independent combinations. Anatomical correspondence between the HotSpot nomenclature for 23 organs and the Biological Effects of Ionizing Radiation (BEIR) epidemiological categories was established through direct equivalence, functional grouping, and residual classification. For committed equivalent doses to organs below 100 mSv, the BEIR VII model was applied; above that operational threshold, an organ-specific extension based on BEIR V parameterizations was adopted. The Collective Risk Index (CRI) was synthesized through a demographically weighted index. Under severe atmospheric stability (PG F), the 0.3 km location had a CRI of 146.519, equivalent to 91.3% of the total burden across all three locations. The female-to-male ratio exceeded unity in all scenarios, ranging from 1.109 to 1.639. Under extreme-dose conditions, non-monotonic reordering of aggregate risk by age group was observed. Operational prioritization in urban radiological emergencies based solely on whole-body average quantities is insufficient: locations with comparable mean doses exhibit distinct risk hierarchies when anatomical resolution and demographic composition are explicitly incorporated into the decision model.
Urban orthopaedic practice in India is undergoing profound organisational change driven by population ageing, an increasing burden of musculoskeletal disease, expanding subspecialisation, technological advances, and growing regulatory and quality-reporting requirements. These developments have renewed interest in organisational models capable of supporting coordinated, high-quality musculoskeletal care while maintaining clinical efficiency and professional sustainability. This structured narrative review evaluates contemporary organisational models of orthopaedic practice, with particular emphasis on structured group practice, within the Indian healthcare context. A structured narrative review was undertaken using PubMed as the primary database, supplemented by targeted Google Scholar searches and manual reference screening. Forty-five publications meeting predefined eligibility criteria were included in the final narrative synthesis. Evidence relating to orthopaedic practice organisation, subspecialisation, volume-outcome relationships, multidisciplinary care, clinical governance, registry participation, workforce wellbeing, health-system organisation, and practice sustainability was synthesised. The available literature suggests that structured group practice may facilitate subspecialty-focused care, multidisciplinary collaboration, standardisation of perioperative pathways, registry participation, continuous quality improvement, and equitable workload distribution. However, direct comparative evidence demonstrating superiority over well-organised solo or small-group practice remains limited, particularly in India. Many reported advantages appear to arise from effective evidence-based organisational processes rather than organisational size alone. The available evidence suggests that organisational models capable of supporting multidisciplinary care, clinical governance, and evidence-based organisational processes are increasingly important for contemporary orthopaedic practice. Structured group practice represents one context-dependent organisational approach that may be particularly relevant to urban India. The review identifies important evidence gaps, particularly the lack of comparative Indian studies, and highlights priorities for future research.
Daylight exposure is an environmental determinant of human health, yet measuring real-world exposure at scale remains a major challenge. Large population studies frequently rely on self-reported time spent outdoors as a proxy for daylight exposure, although the validity of this measure remains uncertain. We evaluated the agreement between daily self-reported outdoor daylight exposure and objective light measurements obtained from wearable sensors and investigated whether depressive symptoms influence this agreement. A total of 172 adults living in two Brazilian metropolitan regions were monitored for up to 44 consecutive days, yielding over 5,800 matched days of subjective and objective exposure data. Objective measures included device output illuminance, photopic illuminance, and melanopic equivalent daylight illuminance (EDI). Agreement was assessed across the light exposure thresholds and durations using Lin's concordance correlation coefficient and ROC analyses. Moderate agreement was observed between self-reported and actigraphy-based daylight exposure. The highest concordance occurred at light levels consistent with outdoor daylight (>1000 l× for photopic illuminance and melanopic EDI; >750 l× for device illuminance). A minimum of 30 min of outdoor daylight exposure was the duration most accurately self-reported. Depressive symptoms did not affect these agreement patterns. These findings support the use of simple self-report questionnaires to estimate outdoor daylight exposure in clinical applications and in studies examining how environmental factors shape health.
Urban tree canopy is known to mitigate ambient heat and improve physical and mental health but the longitudinal interactions and impacts of tree canopy, temperature, and mortality are not well understood. Using high resolution tree canopy estimates, temperature, mortality, and demographic data from 2011 to 2021, we implemented negative binomial generalized estimating equations to model all-cause and disease-specific mortality based on tree canopy cover, year-to-year changes in tree canopy cover, and maximum temperature, adjusting for area-level demographics in Chicago, IL. We used K-means clustering to identify patterns of canopy, temperature, and mortality disparities across Chicago community areas. There were 220,711 decedents during the study period (115,974 male, 104,734 female; mean age at death: 69.4 ± 19.9 years). Existing canopy coverage was not statistically significantly associated with mortality (incidence rate ratio [IRR] = 0.995, 95% confidence interval [CI] = 0.984-1.007). However, each year-to-year percent increase in canopy was associated with around a 10% reduction in mortality (IRR = 0.902, [0.871-0.935]) with significant associations for cause-specific cardiovascular (IRR = 0.908, [0.869-0.948]), mental health (IRR = 0.836, [0.784-0.892]), musculoskeletal (IRR = 0.907, [0.832-0.989]), and respiratory (IRR = 0.887, [0.833-0.945]) diseases. Cluster analysis identified that neighborhoods on Chicago's South and West sides were characterized by high temperatures, greater absolute canopy loss despite elevated baseline canopy levels, and increased mortality. Among the hottest neighborhoods, canopy-temperature interaction models demonstrated that areas experiencing larger year-to-year canopy losses had higher yearly mortality. Protecting tree canopy cover from losses over time, particularly in vulnerable areas with higher temperatures, may present a key opportunity to reduce mortality and mitigate impacts of climate change. Trees in cities do more than provide shade, they can also protect health. Many studies have looked at how one measurement of tree canopy cover relates to health. But few have examined how year‐to‐year changes in tree canopy affect mortality over time. We studied Chicago from 2011 to 2021 to see how tree canopy cover, summer heat, and deaths were connected. Using data on temperature, tree canopy cover, demographics, and mortality, we found that neighborhoods with increasing year‐to‐year tree canopy had lower associated death rates. We also found that these increases in tree canopy cover were associated with less risk of dying from heart, lung, mental health, and musculoskeletal diseases. In addition, we found that within the hottest neighborhoods, which clustered on Chicago's South and West sides, mortality increased more as year‐to‐year tree canopy losses increased. Therefore, planting and maintaining trees, particularly in hotter neighborhoods, could lower mortality and make communities more resilient to rising temperatures.
In Uganda, 1 in 4 girls has been pregnant by 18 years. This was worse during the COVID 19 pandemic. We determined risk factors for pregnancy among rural and urban dwelling adolescents in Uganda. We conducted a mixed-methods study among girls aged 13 to 19 years in a rural and urban district in Uganda. Quantitatively, we used an unmatched case control design involving 200 adolescents with pregnancy experience and 400 controls with no pregnancy experience. Quantitative data was analyzed using STATA version 14. Qualitative methods included 17 focus group discussions, 10 in-depth interviews and 20 key informant interviews with key stakeholders. Transcribed audio recordings were analyzed using a content thematic approach using Nvivo. Of the 600 girls, mean age was 16.9 years (SD 3.84). Independent risk factors for pregnancy were age, out-of-school, a friend with teenage pregnancy, cigarette smoking, working for money and correct contraceptive knowledge. Protective factors included positive personal attitudes, father's education and larger household size. Qualitatively, inadequate information on sexual and reproductive health, early sexual debut, alcohol and drug abuse, absence of parental supervision, negative peer influence and poverty were reported. Overall, individual characteristics, behaviors and inadequate information increased the risk of pregnancy.
Discarded tires remain a significant public health problem in tropical urban environments, serving as high-risk breeding sites for Aedes aegypti, the mosquitoes which transmit dengue, chikungunya, and Zika viruses. Identifying these habitats using ground-based surveillance methods can be resource-intensive and often misses fenced-off areas and tires on roofs. This study presents a novel approach using unmanned aerial vehicle (UAV) imagery combined with deep learning to automatically detect discarded tires across the Tallo sub-district of Makassar, Indonesia, an area with historically high dengue incidence. We trained and compared U-Net++ and DeepLabV3++ convolutional neural network architectures for tire segmentation. We evaluated the models' ability to identify the locations, shapes, and spatial distribution of discarded tires in the study area. Both models demonstrated high prediction accuracy, with F1 scores of 0.87 and 0.82, respectively, with modestly superior performance by the U-Net++. The strong detection performance was largely attributable to the distinctive circular morphology and spectral characteristics of tires in aerial imagery, though this same characteristic occasionally led to false positives when encountering tire-mimicking objects such as outdoor air conditioning condenser units, water tank lids, and similar circular items. Identifying, locating, and eliminating potential larval breeding sites is a primary strategy for the control of Aedes aegypti -transmitted viruses. Accurate, rapid detection of high-risk Aedes aegypti breeding sites from UAV imaging is a promising new tool to improve vector control.
The first three years are critical for foot development, yet standardised assessments are lacking. This study aimed to establish sex-specific reference percentiles for key foot dimensions in Chinese children under three years of age. We recruited 6,284 children aged 9-36 months from a child health clinic in Xi'an, China. Foot length, width, calcaneal eversion angle, and the arch index were measured from static, weight-bearing images. Sex-specific percentile curves were constructed using the Generalised Additive Model for Location, Scale, and Shape (GAMLSS). Foot length, width, and arch index increased with age, whereas the foot width/length ratio and calcaneal eversion angle decreased. Median (P50) foot length increased from 11.29 cm to 15.07 cm in boys and from 10.95 cm to 14.76 cm in girls. Corresponding values for foot width were 5.37-6.50 cm (boys) and 5.15-6.30 cm (girls). The arch index rose from 0.04 to 0.18 (boys) and 0.06 to 0.23 (girls), while the foot width/length ratio declined from 47.45% to 43.04% (boys) and 47.03% to 42.51% (girls). This study provides the first foot morphology reference standards for urban Chinese children under three years of age, offering essential data for early foot structure assessment in this population.
Against the backdrop of climate warming and intensifying extreme heat, urban heat stress not only elevates health risks but also disrupts the continuity of health promotion and public service provision by compressing the Meteorological feasibility of time resources for safely conducting outdoor physical activity. However, prior research has largely focused on linear changes in single heat indicators, with limited efforts to characterize-within a unified and comparable framework-the dual-pathway process of hazardous exposure-time expansion and safe activity-window contraction. Existing studies also rarely provide systematic quantification and validation of intra-warm-season risk reallocation, such as increasing late-season concentration and shifts in average peak timing. To address these gaps, we propose an Outdoor activity opportunity window framework that shifts the object of analysis away from observed physical activity behaviors-which are difficult to obtain continuously over long periods-toward a reproducible measure of Meteorological feasibility of time resources. Using Universal Thermal Climate Index (UTCI) statistics for 31 provincial capital cities and municipalities in China from 2010 to 2024, we developed a dual-metric system comprising Heat Risk Hours (hours under high-risk heat-stress conditions) and Physical Activity Opportunity (PAO) Rate (the share of time within the safe activity window). We applied robust trend estimation and standardized composite metrics to quantify the rate of deterioration in the opportunity window and to produce a tiered ranking of cities. We further conducted an external consistency validation of September UTCI risk hours using station-based observations of daily maximum temperature hot days (≥33°C/≥35°C). In addition, monthly data from May to September were used to test intra-warm-season risk reallocation and average peak timing: at the national scale, the late-season peak share (August-September) increased over time (≥33°C: 0.0076/year; ≥35°C: 0.0055/year), and the mean timing of peak risk shifted later overall (≥33°C: 0.0096 months/year; ≥35°C: 0.0071 months/year). In this study, PAO refers to the meteorology-constrained feasibility opportunity for outdoor physical activity and is intended to represent constraints on time resources; it is not equivalent to the amount of activity that actually occurs, nor is PAO Rate derived from survey-based participation data. Our results show that: (1) a pronounced Dual-pathway squeeze exists at the national scale, with rising heat-risk exposure and shrinking safe activity windows occurring in parallel; (2) cities exhibit substantial heterogeneity in the "speed of worsening," forming an identifiable tiered structure; and (3) warm-season risk undergoes structural reallocation along the time axis, with many cities showing signs of greater late-season concentration, although city-specific trajectories remain heterogeneous. As an application-oriented translation, we incorporated the rate of change in the share of the population aged 65 years and older as a dynamic vulnerability indicator, and coupled opportunity-window deterioration with aging dynamics to identify priority scenario cities. We quantified the magnitude of between-group differences using Cliff's delta (δ), a distribution-free effect size. Priority scenario cities displayed systematic differences in late-season structural indicators, suggesting that the temporal focus and resource prioritization of adaptation-oriented governance can be further refined. This study offers a reproducible dual-metric diagnostic framework linking urban heat risk and the Outdoor activity opportunity window, enabling the identification of priority contexts and supporting targeted investments in age-friendly cooling infrastructure, indoor substitute activity spaces, and late-warm-season warning-scheduling management for more precise resource deployment.
Myopia has become an increasingly important vision health concern among children and adolescents in China. However, longitudinal surveillance data from less-developed coastal regions remain limited. This study aimed to investigate temporal trends and demographic differences in myopia prevalence among school students in Qinzhou, Southern China, using three consecutive years of school-based screening data. A repeated cross-sectional study was conducted from 2022 to 2024 in 40 primary and secondary schools in Qinzhou, China. A total of 90,072 screening records from students aged 6-18 years were included. Uncorrected visual acuity and non-cycloplegic autorefraction were assessed using standardized examination procedures. Myopia was defined according to spherical equivalent refraction. Differences in myopia prevalence by sex, educational stage, residential region, and age group were analyzed using chi-square tests and binary logistic regression models. Overall myopia prevalence increased from 43.17% in 2022 to 48.21% in 2023 and remained high in 2024 (47.51%). Female students consistently showed higher myopia prevalence than male students across all years (all p < 0.001). Myopia prevalence increased significantly with advancing educational stage and age, particularly after 12 years of age. Within matched educational stages, urban students demonstrated persistently high prevalence rates, whereas larger year-to-year fluctuations were observed among rural and township students. In addition, the proportions of moderate and high myopia increased with age. Although a slight decrease in prevalence was observed in 2024, the overall burden of myopia remained substantial. Myopia prevalence among school-aged children and adolescents in Qinzhou remained high during the study period, with significant disparities across sex, age, educational stage, and residential region. These findings highlight the need for early preventive interventions and region-specific myopia control strategies, particularly for younger students and underserved populations.
We aimed to determine whether preferred language influences follow-up for patients diagnosed with nephrolithiasis in the emergency department (ED). We retrospectively reviewed patients referred from an ED to our clinic for symptomatic nephrolithiasis from 12/2021 to 6/2024. Patients were stratified by preferred language (English speakers [ES] vs. Non-English speakers [NES]) and compared across time to office visit, time to surgery, 24-hour urine collection, ED revisits, and failure to undergo surgery. Multivariate linear regression of log-transformed time to follow-up determined factors influencing time from ED to office visit. We identified 255 ES vs. 112 NES. Mandarin (44%), Cantonese (21%), and Spanish (18%) speakers comprised most of the NES cohort. NES experienced longer time to office visit (32.6 vs. 20.9 days, p < 0.001) and more ED revisits (16.1% vs. 7.8%, p = 0.02). There were no differences in time to surgery (24.8 vs. 22.3 days, p = 0.10), collection of 24-hour urine sample (22.3% vs. 17.3%, p = 0.25), or failure to undergo surgery (12.3% vs. 12.2%, p = 1.0). On multivariate regression, NES was independently associated with delayed follow-up (β = 2.49, 95% CI [1.63, 3.80], p < 0.001). On subgroup analysis, Spanish speakers had significantly longer follow-up delays than English (p < 0.001) and Chinese speakers (p = 0.003), while Chinese and English speakers did not differ (p = 0.57). After an ED presentation for nephrolithiasis, NES have delayed urologic follow-up and more ED revisits than ES, with subgroup analysis identifying Spanish speakers as the most affected group. Targeted interventions and language-concordant care models may reduce these disparities.
BackgroundCervical cancer significantly impacts sexual and family functioning, yet limited evidence exists on addressing these issues in sub-Saharan Africa.ObjectivesThis study examined the prevalence and associations of sexual and family function among women diagnosed with cervical cancer in Kumasi-Ghana.DesignA concurrent mixed-methods study design.MethodsThis study was conducted at the Komfo Anokye Teaching Hospital from 2020-2021. The quantitative component employed a cross-sectional design using 181 women with histologically confirmed cervical cancer. Sexual functioning was assessed using the Female Sexual Function Index, while family functioning was evaluated using the APGAR Family Functioning Scale. Systematic sampling was used for participant selection. Associations between predictors were examined using Firth penalized logistic regression. Analysis tool was STATA version 16.0. The qualitative component utilized purposive sampling to recruit 15 participants for in-depth interviews. Thematic analysis was performed for qualitative data using NVIVO software version 14.ResultsParticipants had a mean age of 57.5 years (SD=12.85). Almost all (96.1%) women with cervical cancer had sexual dysfunction, despite majority (93.4%) reporting a frequent sexual desire as a relational dimension rather than an indicator of preserved sexual health. Family dysfunction was prevalent, with 65.7% classified as severely dysfunctional families. The study revealed that women with 8-13 children had significantly lower odds of family functioning (AOR = 0.12, 95% CI: 0.01-0.59, p = 0.006). Qualitative findings revealed that, despite higher family dysfunction, meaningful support from spouses and children provided substantial practical and emotional support even as extended family involvement remained limited.ConclusionSexual and family functioning challenges are highly prevalent among Ghanaian women with cervical cancer despite a maintained sexual desire and support from nuclear family. Integration of culturally-appropriate, holistic sexual health counselling and family-centered interventions into routine cervical cancer care is essential for survivorship support in resource-limited settings. Cervical cancer significantly affects family and sexual funtioning. However the contextual explanation makes a difference.
Indoor volatile organic compounds (VOCs) require treatment technologies that remain effective at low concentrations and high airflow rates without generating persistent secondary waste. This structured narrative review evaluates VOC removal by microalgae and algal-bacterial consortia using an evidence hierarchy that distinguishes direct gas-phase studies, gas-liquid reactor studies, and aqueous mechanistic studies. Formaldehyde and benzene, toluene, ethylbenzene, and xylenes (BTEX) are identified as the principal indoor VOC targets, whereas studies on phenols, polycyclic aromatic hydrocarbons, and other aqueous organic contaminants are considered mainly as mechanistic evidence. Direct evidence at indoor-relevant gas-phase concentrations remains scarce, and removal efficiencies obtained from liquid batch cultures cannot be extrapolated to indoor air without considering gas-liquid partitioning, biomass loading, reactor configuration, airflow, and abiotic losses. Quantitative comparison is further limited by inconsistent units, inadequate controls, incomplete carbon balances, and insufficient data on energy demand, byproducts, long-term stability, and bioaerosol containment. Future studies should therefore report standardized performance indicators and verify mineralization through mass-balance or isotope-based approaches. Current evidence supports microalgal systems primarily as application-specific biological polishing processes rather than established replacements for conventional air-cleaning technologies.
Head injury (HI) places a significant burden on survivors, leading to long-term disability. However, limited studies have investigated its prevalence in South Asian countries. Perform a systematic review to identify community-based surveys reporting the prevalence of HI in South Asia and to conduct a meta-analysis to derive pooled prevalence estimates for the region. A comprehensive literature search was conducted in EBSCOhost, Google Scholar, Ovid, PubMed, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality and risk of bias were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology and Risk of Bias Tool for Prevalence Studies, respectively. The analysis was carried out using the latest version of R software (4.4.0). Twenty-one studies assessing general, pediatric, and older adult populations were included; the overall prevalence of the general population of HI in South Asia was estimated to be 12/1000 persons. Sri Lanka had the lowest prevalence score for HI (0.6/1000 persons), whereas India had the highest (16.1/1000 persons). Prevalence of HI in the pediatric population was 60/1000 persons and in older adults was 47.2/1000 persons. The prevalence of HI was higher in males than in females, and urban residents scored higher than rural residents. The study sheds light on the current status of HI prevalence in South Asia. Therefore, improvement in community awareness and treatment facilities is needed to be implemented to control HI fatalities.
Despite the potential of nanofibers to reinforce poly(methyl methacrylate) (PMMA) denture base resins, no consensus exists regarding their effects on material properties. This systematic review and meta-analysis aimed to evaluate whether the incorporation of nanofibers into PMMA denture base resins improves flexural strength and other physicomechanical properties when compared with unmodified PMMA. This study followed PRISMA guidelines and was registered on the Open Science Framework (<osf.io/3g9pn>). Searches were conducted on Medline/PubMed, Scopus, Cochrane Library, Web of Science, EMBASE, Lilacs, and SciELO. Eligibility criteria included in vitro or in vivo studies comparing nanofiber-reinforced PMMA to conventional PMMA. The meta-analysis was conducted for flexural strength (the only property assessed in all studies). A subgroup meta-analysis was performed to explore heterogeneity between studies. From the 1,893 initially screened articles, six were included. The investigated nanofibers included carbon, acrylonitrile-butadiene-styrene, polyamide-6, polystyrene, cellulose, PMMA-cerium, and polyvinyl alcohol at concentrations from 0.1 to 23%. The evaluated properties included impact strength, flexural strength, fracture resistance, hardness, elasticity, toughness, surface roughness, contact angle, and spectrophotometric color analysis. While the qualitative analysis showed divergent findings regarding property improvement, the quantitative analysis revealed no significant differences in flexural strength between nanofiber-reinforced PMMA and conventional PMMA at the evaluated concentrations: PMMA vs. 0.5% PMMA (p=0.554), PMMA vs. 1% PMMA (p=0.847), PMMA vs. 3% PMMA (p=0.9825), and PMMA vs. 5% PMMA (p=0.222). However, subgroup analysis indicated higher flexural strength for the conventional PMMA when compared with nanofiber-reinforced PMMA, particularly at higher nanofiber concentrations (p<0.0001). Incorporating nanofibers into PMMA resulted in no significant increase in flexural strength, showing inconsistent effects on other physicomechanical properties. Therefore, further standardized laboratory and clinical studies are needed to clarify its efficacy and clinical applicability.
Disease profiles and access to care differ between rural and urban populations. The aim of this study is to examine the association of rurality with electronic health record-derived disease profiles and heart failure risk. We conducted a retrospective observational study of 242 758 participants enrolled in the All of Us Research Program. Rurality status was estimated using 2010 Rural-Urban Commuting Area codes from participant home 3-digit zip code prefixes, and participants were grouped into rural, mixed, and urban arms. We compared the disease profiles with phenome-wide association studies and the risks of heart failure between arms. The final cohort included 5581 participants in the rural arm, 62 287 in the mixed arm, and 174 890 in the urban arm. Compared to the urban setting, 70 phecodes were significantly enriched in the rural arm including obesity (odds ratio [OR], 1.42, 95% confidence interval [CI], 1.34-1.51) and related diagnoses. Cancer screening-, dermatological-, and eye care-related diagnoses were significantly depleted in the rural arm. The rural arm also showed a greater risk of heart failure (adjusted hazard ratio [HR], 1.20, 95% CI, 1.10-1.31). With the national dataset in All of Us, we found that rural participants had significantly higher risks for obesity-related diseases and heart failure in this study. Depleted phecodes in the rural participants suggested a lack of access to cancer screening, stressing the potential importance of targeted cancer disease management in rural communities.
Urban green spaces provide vital restorative benefits for public mental health, yet traffic noise widely undermines these effects, with existing studies predominantly focused on sound pressure level rather than temporal and frequency characteristics of traffic noise. An outdoor experiment was conducted with 33 participants to investigate traffic noise impacts on urban green space restorative effects, assessing objective attentional restorative effects and subjective restorativeness (Perceived Restorative Soundscape Scale) under varied sound pressure levels, temporal discontinuity, and frequency conditions. Results showed that traffic noise consistently reduced subjective restorativeness, with negative effects intensifying as sound pressure level increased and weakening with greater temporal discontinuity. Medium-low frequency noise produced stronger detriments than medium-high frequency noise for both subjective and objective restoration. Objective restoration shifted from impairment to improvement as temporal discontinuity rose and showed a significant interaction between sound level and time-domain characteristics. Effect sizes further indicated that subjective restorativeness was more sensitive to sound pressure level, whereas objective restoration responded more to temporal characteristics. These findings clarify multi-dimensional traffic noise impacts on green space restorative effects, offering scientific support for urban noise management and green space soundscape optimization.
Household locations of pedestrian injuries and fatalities are disproportionately concentrated in lower socioeconomic neighborhoods, reflecting deep-rooted disparities in urban infrastructure, pedestrian exposure, and traffic safety. This study analyzes the relationship between socioeconomic levels and pedestrian incidents in Cali, Colombia, focusing on both the residential locations of injured individuals and the physical locations of fatalities. By separately examining injury residences and fatality locations, we begin to investigate how socioeconomic disparities influence both who is affected and where incidents occur. Residential injury data (2009-2010) and pedestrian fatality data (2008-2010) were analyzed using spatial mapping and Poisson regression modeling. Our preliminary findings reveal individuals injured in pedestrian incidents predominantly reside in lower socioeconomic neighborhoods, where inadequate infrastructure and increased exposure to traffic hazards are likely contributing factors. In contrast, fatal incidents tend to cluster in specific high-risk zones, particularly in middle-high socioeconomic neighborhoods characterized by dangerous road conditions and high vehicle speeds. Poisson regression identified socioeconomic levels and proximity to health centers were significant predictors of pedestrian fatalities, while road and population density showed weaker or nonsignificant associations. These findings provide an initial foundation for hypothesis generation and future research on urban safety disparities. They suggest socioeconomic context and access-related infrastructure together influence pedestrian risk, underscoring the need to integrate equity-focused and built-environment strategies into pedestrian safety planning and policy. By examining both socioeconomic context and physical risk, this study offers early, but critical insights for creating safer, more equitable urban environments.
Colorectal cancer (CRC) remains a leading cause of cancer morbidity and mortality in the United States and shows substantial geographic variation. Socioeconomically disadvantaged communities experience elevated CRC incidence, yet few studies have analyzed multi-decade poverty measures for long-term structural disadvantage. We analyzed CRC incidence from 2017 to 2021 across Texas using Texas Cancer Registry data. Age-sex-race/ethnicity standardized cases were incorporated as offsets in Bayesian spatial models to generate tract-level posterior mean relative risks. We evaluated four tract-level poverty measures (high poverty in 2021; persistent poverty since 1990; enduring poverty since 1980 and 1970), Rural-Urban Commuting Area (RUCA) classifications, and CRC screening rates among adults aged 50-75 years. Long-term poverty and rurality were independently associated with elevated CRC risk. Compared with urban tracts, micropolitan and rural tracts had 7-8% higher risks. Poverty measures defined over longer durations showed stronger associations with CRC incidence: high poverty in 2017-2021 (RR = 1.04, 95% CrI: 1.01-1.07), persistent poverty since 1990 (RR = 1.04, 1.00-1.08), enduring poverty since 1980 (RR = 1.06, 1.01-1.11), and enduring poverty since 1970 (RR = 1.09, 1.04-1.15). Higher tract-level CRC screening prevalence was inversely associated with CRC incidence (RR per 1% increase = 0.99). Long-term poverty and rural residence were associated with elevated CRC risk in Texas, even after adjusting for screening prevalence. Multi-decade poverty measures and updated RUCA classifications identified geographic disparities not captured by single-year poverty indicators and supported geographically targeted screening, prevention, and resource allocation efforts. These results can inform geographically targeted, efficiency-focused screening and prevention strategies, particularly in communities experiencing decades of structural disadvantage.
Cancer pain management depends partly on patients' knowledge, attitudes, and practices (KAP), but evidence from Southwest China remains limited. This study assessed cancer pain-related KAP, identified factors associated with Practice, and explored whether Attitude statistically accounted for the association between Knowledge and Practice. A two-center cross-sectional study was conducted among 523 patients with cancer-related pain at two tertiary hospitals in Southwest China. Data were collected using a self-developed KAP questionnaire, and domain scores were standardized to a 0-100 scale. Preliminary psychometric properties were assessed using internal consistency, item-level analyses, and confirmatory factor analysis. Factors associated with Practice were examined using multivariable linear regression. Exploratory indirect-effect analyses were performed using the PROCESS macro. The mean standardized scores were 61.3 ± 32.6 for Knowledge, 62.0 ± 21.1 for Attitude, and 53.3 ± 28.9 for Practice; 51.6% of participants had poor Practice scores. Higher Knowledge score and peri-urban or urban residence were associated with higher Practice scores, whereas greater current pain intensity, age ≥60 years, and female sex were associated with lower Practice scores. Stage IV disease was positively associated with Practice after adjustment and remained generally consistent in the education-adjusted sensitivity model, although unadjusted analyses showed the opposite direction. Neither unadjusted nor covariate-adjusted exploratory indirect-effect analysis supported a statistically significant indirect association through Attitude. Among tertiary-hospital patients with cancer pain in Southwest China, Practice was comparatively lower than Knowledge and Attitude. Improving cancer pain-management practice may require attention to knowledge-to-action translation, symptom burden, and care-context factors rather than knowledge or attitudes alone. Future prospective, multicenter, and community-based studies are needed to validate the questionnaire and clarify temporal relationships among KAP domains.
Antimicrobial resistance (AMR) is a major global public health threat, particularly in low- and middle-income countries. In Ecuador, AMR research has expanded during the last two decades, but evidence remains fragmented and largely restricted to the human health sector. We systematically reviewed studies reporting laboratory-confirmed bacterial resistance in Ecuador between 2000 and 2024, including evidence from human, animal, food, and environmental sources. Eighty studies met the inclusion criteria. Most were hospital-based and conducted in urban areas, with limited evidence from rural, Amazonian, and insular regions. Gram-negative bacteria accounted for the greatest resistance burden, particularly Escherichia coli (56.6%), Klebsiella pneumoniae, Salmonella spp. (22.3%), the Acinetobacter baumannii complex, and Pseudomonas aeruginosa, together with resistant Staphylococcus aureus and Mycobacterium tuberculosis. Resistance to beta-lactams and fluoroquinolones predominated, whereas carbapenem resistance was especially notable among WHO priority pathogens. Evidence from animal, food, and environmental sectors was scarce and heterogeneous, and molecular characterization was inconsistently reported. These findings highlight important surveillance gaps beyond hospital settings and underscore the need for integrated multisectoral surveillance to strengthen public health policy, antimicrobial stewardship, and AMR prevention in Ecuador.