Search Results (9,894)

Urban green spaces are increasingly recognized as cooling infrastructure for climate resilience, environmental health, and spatial equity. However, their planning value depends not only on where green spaces are located but also on whether cooling supply is translated into lower thermal pressure and aligned with heat-sensitive demand. This study examines blue–green–gray infrastructure cooling supply, thermal regulation, human-relevant thermal pressure, and supply–demand mismatch across 1385 census tracts in Maryland, USA. An Infrastructure Cooling Supply Index (ICSI) was constructed from green, blue, and gray infrastructure components and evaluated against maximum land surface temperature (LSTmax), Heat Index, extreme heat days, and a Human-Relevant Thermal Pressure Index (HTPI) integrating ambient heat intensity and recurrent extreme heat exposure. Explainable machine learning was used to identify the relative contributions of individual infrastructure components, and cooling supply was compared with socially differentiated heat-sensitive demand. The results show that higher ICSI is significantly associated with lower LSTmax, Heat Index, and HTPI. The association was strongest for surface thermal conditions, remained significant for Heat Index and integrated human-relevant thermal pressure, and was comparatively weaker for recurrent extreme heat days, indicating that infrastructure cooling supply affects thermal outcomes through distinct pathways. Cooling supply was also spatially uneven, with stronger provision generally associated with greater vegetation and tree-canopy coverage, higher park provision, larger water-area proportions, and lower gray-infrastructure pressure. Explainable GeoAI results identify impervious cover, tree canopy, water-area proportion, road density, and park provision as the principal contributors to tract-level thermal pressure. The mismatch analysis identifies 433 census tracts, or 31.3% of all Maryland tracts, as low-supply–high-demand priority areas. These tracts reveal substantial spatial convergence among elevated heat-sensitive demand, insufficient cooling infrastructure, and persistent thermal pressure. This study provides a tract-level approach for targeting cooling interventions where thermal pressure, vulnerability, and infrastructure deficits converge. Full article

With rapid population aging in China, the age-friendly upgrading of rural public spaces has become central to both rural revitalization and active aging. Existing evaluation frameworks are constrained by urban-oriented indicators, linear utility assumptions, and static assessments that overlook rural contextual needs. In response to these limitations, this study develops and validates a rural age-friendly public space evaluation system by coupling the Kano model with the Capability Maturity Model (CMM). Evaluation indicators were derived from in-depth interviews with rural older adults through three-level grounded-theory coding. The Kano model was then used to identify demand attributes and Better–Worse coefficients, while indicator weights were determined using an AHP–entropy method adjusted by Kano coefficients. Finally, a Kano–CMM correlation matrix was constructed to generate a five-level maturity evaluation model and applied to Xinan Village, Xiancun Town, Zengcheng District, Guangzhou. Results identify seven core dimensions: safety and protection; accessibility and mobility continuity; comfort and health friendliness; health and wellness support; social interaction and psychological belonging; environmental sanitation and quality; and maintenance, renewal, and durability. Rural older adults’ needs are dominated by must-be attributes, followed by attractive attributes, whereas one-dimensional attributes are comparatively less prominent. Safety- and accessibility-related indicators show the highest negative risk sensitivity, indicating that rural age-friendly design should prioritize risk reduction over experiential enhancement. The proposed framework moves beyond checklist-based assessment and provides an evidence-based, dynamic, and auditable tool for diagnosing and improving rural age-friendly public spaces. Full article

Background/Objectives: Herbal medicine is one of the most widely used forms of complementary medicine worldwide. Although traditionally associated with rural populations and older generations, its use among urban adolescents and young adults and the factors associated with its use remain insufficiently understood. This study aimed to evaluate herbal medicine knowledge, use, recommendation practices, and their associations with family-based recommendation, social media exposure, and previous experience using herbal medicine together with conventional medical treatment among urban adolescents and young adults in western Mexico. Methods: A cross-sectional study was conducted among 144 urban high school students in western Mexico. A structured questionnaire was used to assess sociodemographic characteristics, herbal medicine knowledge, use, recommendation practices, family-based recommendation, social media exposure, and self-reported concurrent use with conventional medical treatment. Bivariate and multivariable logistic regression analyses were performed to identify factors independently associated with herbal medicine use, recommendation, and self-reported knowledge. Results: Herbal medicine use was reported by 36.8% of participants, whereas 31.9% reported knowing what herbal medicine is. Family-based recommendation was independently associated with herbal medicine use (OR = 8.04; 95% CI: 2.99–21.61; p < 0.001), followed by self-reported herbal medicine knowledge (OR = 4.56; 95% CI: 1.97–10.58; p < 0.001). Recommendation behavior was independently associated with family-based recommendation (OR = 3.70; 95% CI: 1.45–9.44; p = 0.006) and previous herbal medicine use (OR = 4.16; 95% CI: 1.75–9.93; p = 0.001). Among herbal medicine users, all participants reported previous experience using herbal medicine together with conventional medical treatment, suggesting the coexistence of both therapeutic approaches within this study population. Social media exposure was associated with self-reported herbal medicine knowledge (OR = 2.97; 95% CI: 1.06–8.27; p = 0.038) but was not associated with herbal medicine use or recommendation. Conclusions: Among this study population, herbal medicine was commonly reported and appeared to be part of complementary healthcare practices among urban adolescents and young adults. Family-based recommendation was independently associated with herbal medicine use and recommendation, whereas social media exposure was associated primarily with self-reported knowledge rather than behavioral outcomes. These findings highlight the importance of considering herbal medicine use during clinical communication and adolescent health education while recognizing the coexistence of herbal and conventional healthcare practices. Full article

Background/Objectives: Chronic non-communicable diseases remain one of the main public health problems. Increasing multimorbidity and the importance of health literacy (HL) emphasize the need for a comprehensive assessment of health indicators. The aim of this study was to assess the main health indicators of the Lithuanian population and trends in the use of healthcare services and to discuss the relevance of these indicators in the context of HL, based on the links between HL and these indicators described in the scientific literature. Methods: A retrospective longitudinal descriptive study was performed using publicly available Lithuanian population health statistics of 2005–2024. Mortality, morbidity, avoidable hospitalizations, subjective health assessment, and utilization of healthcare services and preventive programs were analyzed using descriptive statistical analysis. HL was not directly measured but was used as a conceptual framework for interpreting the findings. Results: In Lithuania, the highest mortality rate is due to cardiovascular diseases (CVDs) (~50.8%). CVD and infectious diseases also dominate the structure of avoidable hospitalizations, and their rates vary greatly across municipalities, being higher in less urbanized areas. The assessment of the population’s health is improving over time, but gender differences remain in the use of healthcare services and preventive programs. Conclusions: The findings demonstrate a high burden of chronic diseases and regional disparities in healthcare utilization in Lithuania. HL may provide a useful context for interpreting these findings, although it was not directly assessed. Future studies should directly evaluate HL and its association with health indicators in the Lithuanian population. Full article

Unsafe water sources contaminated with fecal bacteria and antibiotic-resistant pathogens represent a critical public health challenge in rapidly urbanizing regions. This study investigates the occurrence, distribution, and antimicrobial resistance (AMR) patterns of Escherichia coli across interconnected water sources in Guwahati, India, including river water, wells, municipal supply, and groundwater. A total of 87 samples were analyzed using membrane filtration, biochemical identification, and automated confirmation, followed by antibiotic susceptibility testing and phenotypic detection of β-lactamase production. Total coliforms were detected in 64.4% of samples, while E. coli was confirmed in 51.7%. According to World Health Organization risk thresholds, 93.3% of river water samples and 50% of groundwater samples fell within the very-high-risk category (>1000 CFU/100 mL), indicating widespread fecal contamination in sources used for domestic purposes. Antibiotic-resistant E. coli was identified across all water types, with 14.1% of isolates exhibiting multidrug resistance (MAR index > 0.2). Notably, 20.6% of isolates produced β-lactamases, including one extended-spectrum β-lactamase (ESBL) producer, while no carbapenemase-producing strains were detected. The co-occurrence of multidrug-resistant E. coli across surface and groundwater systems is consistent with the interconnected nature of urban water contamination and suggests the potential for widespread exposure through drinking water pathways, though direct transfer between water systems was not experimentally confirmed in this study. These findings underscore the urgent need for improved wastewater management, protection of groundwater resources, and strengthened antibiotic stewardship within a One Health framework to mitigate the environmental dissemination of AMR. Full article

Background: Gestational anemia represents a major public health challenge in Peru, with a national prevalence ranging from 20% to 27.9%; however, the northern regions remain insufficiently studied. This study aimed to explore the multidimensional structure of clinical and sociodemographic characteristics among pregnant women with gestational anemia treated in northern Peru. Methods: A cross-sectional study was conducted among 70 pregnant women diagnosed with gestational anemia and treated at the Chicama micro-network in the La Libertad region during 2024. Sociodemographic, territorial, reproductive, and nutritional variables were obtained from medical records. Principal Component Analysis for Categorical Data (CATPCA) was applied to identify multidimensional patterns associated with anemia severity. Results: The CATPCA identified a two-dimensional structure explaining 38.47% of the total variance. Dimension 1 (sociodemographic–territorial profile; 22.55%) included health facility (−0.925), educational level (0.887), maternal age (0.878), and district of origin (−0.871). Dimension 2 (reproductive–biological profile; 15.91%) included number of previous pregnancies (0.909), interpregnancy interval (0.909), and body mass index classification (0.589). Multivariate profiles showed that mild anemia (n = 49) was predominantly associated with pregnant women younger than 20 years, lower educational attainment, and rural settings. In contrast, moderate/severe anemia (n = 21) was more frequently associated with women aged 20–35 years, secondary or higher educational attainment, and urban healthcare settings, contrary to the conventional expectation that higher educational attainment acts as a protective factor against anemia. Additionally, mild anemia was associated with multiparity and overweight/obesity, whereas moderate/severe anemia was linked to primiparity and normal BMI. Conclusions: Gestational anemia in northern Peru follows a two-dimensional pattern in which sociodemographic and territorial characteristics showed greater explanatory contribution than reproductive–biological factors. Distinct anemia severity profiles were identified, highlighting the need for context-specific prenatal care strategies and targeted public health interventions. Full article

Rapid urbanization and climate change have intensified environmental pressures and social inequalities, making the integration of urban resilience and sustainable development a critical global challenge, with Nature-based Solutions (NbS) emerging as a promising pathway; however, the knowledge structure, collaboration patterns, and evolutionary trends of NbS research remain fragmented and insufficiently understood. This study conducts a comprehensive bibliometric analysis of 1261 publications from the Web of Science Core Collection (2005–2025), employing tools including VOSviewer 1.6.20, CiteSpace 6.4.R1, and Bibliometrix 4.1.3 to map publication trends, collaboration networks, knowledge bases, and thematic evolution. The results reveal a rapid expansion of NbS research since 2013, characterized by strong interdisciplinarity and a multicentric yet uneven geographical distribution dominated by China, the United States, and Europe. Four major research clusters are identified, encompassing policy governance, environmental benefits, ecosystem services, and social equity, reflecting a shift from ecological performance to integrated socio-ecological frameworks. Additionally, thematic evolution indicates growing emphasis on governance mechanisms, public health, and environmental justice. Overall, NbS research is transitioning toward a multi-scale, multi-objective, and governance-oriented paradigm. These findings highlight the need for strengthened international collaboration, standardized evaluation frameworks, and inclusive policy design to enhance the effectiveness and global applicability of NbS in advancing urban sustainable development. Full article

The aggregation behavior of microplastics is often assumed to facilitate their removal during water treatment; however, this assumption has not been systematically evaluated for low-density polyethylene (LDPE) particles. This study aims to experimentally distinguish the effects of aggregation and dispersion on the coagulation–flocculation behavior and filterability of LDPE microplastics in the context of urban water treatment. Surface modification using two non-ionic surfactants (Tween 20 and Tween 80), combined with ultrasonic dispersion, was applied to induce controlled changes in particle aggregation behavior. Optical microscopy was used to characterize aggregation and dispersion behavior. Subsequent jar tests and filtration experiments were conducted to assess how these distinct particle states influence separation performance. Rather than presuming improved removal, the study focuses on identifying the conditions under which aggregation or dispersion governs microplastic breakthrough and filterability. By addressing process-related factors that may influence microplastic passage into treated water, the findings contribute to understanding short-term exposure risks within the urban water and health nexus. Full article

The Anning River, traversing the mineral-rich Panxi region, is highly susceptible to contamination by potentially toxic elements (PTEs). This study systematically investigated the contamination profiles, source apportionment, and probabilistic human health risks of eight PTEs in the surface sediments of the basin. Index-based evaluations revealed that Cd acts as the dominant ecological threat, exhibiting extreme enrichment, whereas V, Cr, and Ni reflect natural background signatures. Receptor modeling via Positive Matrix Factorization (PMF) successfully decoupled four distinct sources: mining and smelting emissions (Cd, Zn), natural lithogenic weathering (V, Cr, Ni), mixed traffic/urban inputs (Pb, Cu), and a Tl-specific mixed source. Crucially, while deterministic approaches suggested safe exposure levels, probabilistic Monte Carlo simulations uncovered hidden vulnerabilities: children face a striking 60.51% probability of exceeding the acceptable total carcinogenic risk (TCR) threshold of 1.0 × 10⁻⁴, primarily governed by Cr and Ni. These findings underscore the urgent need for differentiated environmental management in similar mining-impacted basins. Specifically, stringent source controls for Cd must be implemented alongside exposure pathway interruptions to safeguard vulnerable demographics from Cr and Ni. Full article

Structural transformation is widely considered a key driver of economic development; however, its contribution to multidimensional well-being remains unclear. This study analyzes the relationship between structural transformation and well-being using an unbalanced panel of 150 countries from 2000 to 2023. A multidimensional well-being index is constructed through principal component analysis, combining indicators of health, education, physician density, and security. The empirical strategy combines fixed-effects models with time controls and dynamic panel estimations using the System Generalized Method of Moments (System GMM) to address unobserved heterogeneity, persistence, and potential endogeneity. Fixed-effects estimates show that education and urbanization are positively associated with well-being, whereas industrialization and GDP per capita are not statistically significant. However, once dynamic persistence is incorporated, the significance of all structural variables disappears, while the lagged well-being indicator remains strongly significant, indicating a high degree of path dependence, although the overidentifying-restrictions test raises some concerns about the validity of the instruments used in this dynamic specification. These results suggest that the influence of structural transformation on well-being may be overstated in static specifications and that long-run well-being trajectories show a high degree of persistence. The findings highlight the importance of accounting for persistence and endogeneity when evaluating development outcomes. The dynamic estimates point to high persistence in well-being, but given the diagnostic concerns regarding instrument validity, these results should be interpreted as suggestive evidence of specification sensitivity rather than as conclusive evidence of path dependence or absence of structural effects. Full article

Complete neighbourhoods, places where residents can meet their daily needs on foot, have become a central component of healthy and sustainable urban planning. Yet most assessment frameworks are calibrated for dense metropolitan environments, leaving rural and peri-urban municipalities without operational tools suited to their territorial needs. This article presents MilieuxVie, an open-source, browser-based interactive mapping application developed for the Laurentides health region of Québec (76 municipalities, 11 land-based unorganised territories, 2 indigenous territories and 4 aquatic administrative units; 93 territorial units in total; ~680,000 inhabitants). The tool evaluates the spatial accessibility of 12 service categories drawn from the Vivre en Ville (2026) complete-neighbourhood framework and OpenStreetMap data, using 2026 residential parcels from the provincial property assessment roll as origin points and weighting results by number of dwelling units. Three adaptive radius tiers (dense, intermediate, rural), based on residential dwelling-unit density (dwellings per km² of residentially designated urban land), scale the distance standards to settlement density. Because thresholds are scaled to settlement density, scores express context-relative service proximity rather than a uniform pedestrian standard and should not be read as directly comparable absolute accessibility across rural, peri-urban, and urban settings. A dedicated urban perimeter mode further disaggregates analysis to sub-municipal built-up zones, aligning the tool with Québec’s provincial Government land-use planning guidelines (GLPG). Gap analysis outputs identify which service types fall below the 70% coverage target, helping elected officials and planners identify where to focus further analysis. Results illustrate the scope of accessibility deficits across the region and highlight the analytical limits of uniform distance thresholds when applied beyond metropolitan contexts. Scores differ significantly across different settings (Kruskal–Wallis p = 0.006); the adaptive radius tiers narrow but do not close the structural gap, with rural municipalities scoring significantly lower than dense ones. The tool is freely available and requires no software installation, making it directly deployable by local planning offices. Full article

Although the Mediterranean diet (MD) is widely recognized as a healthy dietary pattern, its potential role as a framework for sustainable urban gastronomy has received limited attention. This narrative review synthesizes evidence from nutrition, environmental studies, gastronomy, tourism, and urban food systems. The review explores MD’s sustainability dimensions, food waste and urban food systems, cultural heritage, and trends in urban gastronomy. The findings suggest that the MD is a strong model for sustainable urban food futures, combining nutritional adequacy, relatively low environmental impact, and socio-cultural legitimacy. Evidence indicates that Mediterranean-style dietary patterns are associated with lower greenhouse gas emissions, land use, energy use, and water consumption than Western diets, while also remaining comparatively affordable when based on staple plant foods. However, important challenges remain, including affordability, especially across vulnerable social groups; dependence on local supply systems; authenticity under tourism pressure; and the need for effective governance. Overall, the evidence suggests that the MD provides a useful framework for integrating health, sustainability, and cultural heritage objectives within urban food systems. Future research should focus on city-level implementation strategies, food service and restaurant sector practices, and hotel meal planning within urban MD frameworks. Full article

Background/Objectives: Iron deficiency anemia (IDA) remains the most prevalent nutritional deficiency worldwide and a leading cause of years lived with disability, particularly in low-income countries. In Egypt, the burden is substantial and compounded by regional socioeconomic, nutritional, and parasitic factors. Despite this, the predictors of diagnostic delay within the Egyptian healthcare system remain poorly characterized. This study aimed to quantify the extent of diagnostic delay among Egyptian patients with IDA and to identify the sociodemographic and clinical risk factors independently associated with prolonged time to diagnostic confirmation. Methods: A single-center retrospective cohort study was conducted at Al-Minia University Hospital, Egypt, between March and April 2026, enrolling 350 adults with confirmed IDA diagnosed between 2015 and 2025. “Diagnostic delay” was defined as the interval in days from the index date (the first documented abnormal complete blood count) to laboratory confirmation of iron deficiency by serum ferritin and/or transferrin saturation. Secondary outcomes included patient delay, system/testing delay, and etiology work-up delay. Time-to-event analysis was performed using Kaplan–Meier curves and Cox proportional hazards regression. All analyses were conducted in R version 4.4.0. Results: The cohort comprised 213 females (60.9%) and 137 males (39.1%), with a median age of 39 and 36 years, respectively. The median primary diagnostic delay was 76.0 days (IQR: 38.0, 182.8), with patient delay accounting for a median of 26.5 days and system/testing delay for 21.0 days. Overall, 155 patients (44.3%) experienced a diagnostic delay of more than 90 days. In the multivariable Cox model, urban residence (aHR = 0.69, 95% CI [0.53, 0.99], p = 0.045) was independently associated with a slower rate of diagnostic confirmation. Conclusions: Diagnostic delay in IDA is substantial in Egypt, driven by both patient-level symptom normalization and counterintuitive systemic bottlenecks. Urban residence was independently associated with prolonged time to diagnostic confirmation; ordering of iron studies at the first visit was associated with delay in bivariate analysis only and was not an independent predictor after multivariable adjustment. Targeted public health education, restructured primary care pathways, and improved laboratory turnaround times are essential to reduce this burden. Full article

Background: Equitable and adequate access to primary care services is essential for reducing healthcare disparities and advancing social justice. In developing countries like China, achieving a balanced primary care provision across urban–rural divides, regions, and population groups represents a critical strategy for improving public health outcomes. Methods: This study integrates high-resolution population data, nationwide point of interest (POI) data, and aggregated individual survey data to analyze the spatial distribution of primary care facilities in China, evaluate their accessibility and equity, and examine the relationships among primary care accessibility, socioeconomic factors, and public health outcomes using geographic analysis and machine-learning methods. Results: (1) Primary care facilities in China exhibit significant spatial clustering and pronounced urban–rural disparities, with 23% of the urban population having access within walking distance; (2) while horizontal equity in primary care accessibility is relatively well-maintained for China’s aging population, vertical equity requires substantial improvement; and (3) primary care accessibility demonstrates significant but nonlinear associations with key socioeconomic indicators, including urban population size, GDP, built-up area, health insurance coverage, and public expenditure. Conclusions: These findings provide valuable insights for health resource allocation and urban planning policies aimed at achieving equitable primary care access. Full article

As China shifts from expansion-oriented urbanization to stock-based renewal, cities need diagnostic tools that can identify built-environment deficiencies and translate them into spatially targeted renewal priorities. Building on China’s official urban physical examination system, this study develops a land-renewal-oriented diagnostic workflow across four spatial scales: housing, community, block, and urban area. The framework integrates top-down objective assessment of land, facilities, infrastructure, environment, and safety conditions with bottom-up resident satisfaction evaluation. It then converts composite health scores, problem concentration, and safety relevance into three renewal priority categories: Priority Level III (critical renewal), Priority Level II (general renewal), and Priority Level I (long-term optimization). Using Wu’an, a resource-dependent county-level city in Hebei Province, as a case study, the results show that Priority Level III problems are concentrated mainly at the housing scale, especially corridor safety hazards, while widespread pipeline aging and age-friendly retrofitting needs are classified as Priority Level II medium-term renewal issues. Community and block scales mainly show facility, governance, and functional mismatches. The contribution of this study is not the four-tier scale structure itself, which is derived from existing policy, but the operational translation of urban physical examination results into spatial diagnosis for land renewal, renewal priority classification, and action-plan formulation. The workflow offers a transferable methodological reference for county-level stock renewal, while local indicators, thresholds, and implementation pathways require contextual adaptation. Full article