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Standards for designing, improving, and maintaining the built environment have conceptual and practical value for health. Yet, their importance runs the risk of being subsumed in tangential discour...

The aim of this meta-analysis and systematic review is to summarize and critically analyze the influence of surgery-related factors in lumbar interbody fusion for degenerative spine diseases. A systematic review of the literature was carried out with a primary search being performed on Medline through PubMed. The 2009 PRISMA flowchart and checklist were taken into account. Sixty-seven articles were included in the analysis: 48 studies were level IV of evidence, whereas 19 were level III. All interbody fusion techniques analyzed have proved to reach a good fusion rate. An overall mean fusion rate of 93% (95% CI 92–95%, p

Networks are increasingly important for advancing urban science, policy and practice. The complexity that cities present to stakeholders of all kinds demands systems-based and networked approaches to solving sustainability challenges. This article analyses the contemporary rise of global networks of urban science, policy, and practice. We provide an overview of urban science, policy, and practice networks followed by a detailed case study of the emerging Future Earth Urban Knowledge Action Network (Urban KAN), highlighting its vision, initial activities and impacts, and challenges and remaining tasks. Findings from the case study reveal that a network across science, policy and practice can make significant contribution in cutting-edge knowledge generation, global research agenda setting, timely contribution to global policy processes, catalyzing the formation of new national and thematic research-action networks, among others. In contrast, such a network also faces challenges, in terms of attraction and representation of the composition, maintaining initial momentum, turning the science-policy integration and collaboration into reality, and obtaining strong and continued financial and institutional support. We conclude that networks across the boundaries of science-policy-practice are still in their infancy, and deeper collaborations across sector, scale, and networks that enable the implementation of effective new actions will be key indicator in measuring the success of these networks.

Experiences with a systems approach to urban health and well-being in the Asia-Pacific region underline the need to: Understand and underscore the centrality of health in development by formalizing links between health and other sectors. Move beyond simple indicators to a recognition of the consequences of complexity, and particularly of the dynamics of causal feedback loops.

CITY KNOW-HOWHuman health and planetary health are both influenced by city lifestyles, city leadership, and city development. For both, worrying trends are leading to increasing concern. It is imperative that both become core foci in urban policy. Changing the trajectory will require concerted action. The journal Cities & Health journal is dedicated to supporting the flow of knowledge, in all directions to help make this happen. We want to support communication between researchers, practitioners, policy-makers, communities and decision-makers in cities. This is the purpose of this City Know-how section of the journal. ‘Research for city practice’ disseminates lessons from research, explaining the key messages for city leaders, communities and the professions involved in city policy and practice. ‘City shorts’ provide glimpses of what is being attempted or achieved. ‘Case studies’ are where you will find evaluations of interventions and ‘Commentary and debate’ helps extend the conversations we are having a...

Complexity is the hallmark of our habitats, our livelihoods and our health. These objects of analysis, understanding and intervention extend from our homes to our streets and neighbourhoods...

The sustainable development of cities is increasingly recognized as crucial to meeting collectively agreed sustainability goals at local, regional and global scales, and more broadly to securing hu ...

Executive summary: Over the past four decades, rapid urbanisation in China has brought unprecedented health benefits to its urban population, but has also created new challenges for protection of and promotion of health in cities. With the shift from rural to urban living, more people than ever enjoy the health advantages that cities can provide, such as better access to health services and improved sanitation. For example, the average life expectancy of male urban residents in 2010 was estimated to be 7·09 years longer than that of of their counterparts in rural China; urban females lived 6·64 years longer.1 Other changes associated with rapid urbanisation– including large-scale migration, ageing, pollution, shifts in diet and lifestyle, and social inequality–have created new health challenges.2 For example, about 52% of people over 60 years old lived in urban areas in 2015 compared with 34% in 2000,3 thus increasing the burden of senior care in Chinese cities. Non-communicable diseases have replaced infectious diseases as the leading cause of death among urban residents; the percentage of years of life lost because of such diseases as a fraction of all-cause years of life lost increased from 50·0% (95% CI 48·5–53·0) in 1990 to 77·3% (76·5–78·1) in 2015.4 Health inequality also increased in urban areas.5 China has acted to address urban health challenges by passing strict environmental regulations and investing heavily in urban infrastructure. Major reforms have been passed to increase the transparency of environmental governance to control pollution over the short term, while moving to reform whole industries and thus provide long-term solutions. Programmes like the Hygienic Cities movement have invested heavily in urban infrastructure to promote health, including major improvements in urban sanitation.6 China has also increased coverage of and accessibility to health services in urban areas. In 2016, around 93·8% of the urban population was covered by urban medical insurance programmes, a substantial increase from 4·1% in 1998 when the programmes started.7,8 Meanwhile, cities in China are also testing new strategies for urban health management, such as China’s pilot Healthy Cities project.9 Management of chronic diseases and mental disorders in cities has improved dramatically and major progress has been made regarding access to preventive and primary health services. All these efforts have contributed to the reduction of exposure to health risks and health improvement in urban China. However, despite these successes, major gaps remain, including but not limited to an over-reliance on a top-down-approach to environmental management, a narrow focus on health care in urban health management, and a scarcity of intersectoral action. Given that the urbanisation rate in China is predicted to reach 71% by 2030,10 urban health challenges will continue to emerge and expand. If innovative strategies are not used to address these issues, they will become major obstacles to the achievement of improved health and development for millions of people. It has also become clear that the health sector alone, with its traditional piecemeal approach, cannot effectively resolve the modern challenges to urban health in China. The country is now in a transitional period in which the pursuit of economic growth at any cost is being replaced by sustainable development. In 2013, President Xi Jinping declared China’s intention to develop a so-called ecological civilisation (ecocivilisation), the core principles of which involve balancing the relationship between humanity and nature. During this transition, health is recognised as the centrepiece of sustainable development in China, as highlighted in the Healthy China 2030 plan that was adopted in 2016.11 As a result, people-centred and health-oriented urban development will hopefully prevail in China; however, major efforts, political will, and investments will be needed to put this vision into practice. The Tsinghua–Lancet Commission on Healthy Cities in China aimed to characterise, understand, and address urban health challenges in the unique context of China’s rapid and dynamic urban development. Experts from a wide range of disciplines examined environmental and social determinants of health, identified key stakeholders,and assessed actions for the prevention, management, and control of adverse health outcomes associated with the country’s urban experience. We conclude that key efforts are needed to combat urban health challenges in China and these should be unified with the Healthy Cities movement, which uses a systems approach to urban health management and provides a clear path to the realisation of the Healthy China 2030 plan. Actions taken to build healthy cities in China have contributed to global knowledge on the development of healthy cities in other parts of the world. China’s strategic, simultaneous rollout of diverse trials in different cities— in areas such as health education and promotion—and its rapid adoption of effective approaches at the national scale is a valuable lesson for other countries facing rapid urbanisation. Despite such successes, we believe that there is room for substantial improvement and make the following five key recommendations. Integrate health into all policies China should take advantage of new, human-centred urbanisation strategies. For example, cities should integrate health into urban planning and design as a first step towards the integration of health into all policies. Increase participation Cities should increase participation by residents, the private sector, non-governmental organisations (NGOs), and community groups in health management. This increase can be achieved through investment in community capacity building and engagement with the private sector. Promote intersectoral action To motivate and sustain intersectoral action in the design, building, and management of healthy cities, cities should develop ways to assess the health effects of urban management by use of measures that span multiple and diverse sectors. Set local goals for 2030 and assess progress periodically Cities should view the health goals specified in the Healthy China 2030 plan as long-term goals that are achieved through the building of healthy cities. Indicator systems should be put in place to assess progress and inform the public. Enhance research and education on healthy cities To develop new theories and practical solutions, cities should increase investment and form partnerships with universities, research institutes, and the private sector to support research and education on the best ways to create healthy cities.

When we think of "climate change," we think of man-made global warming, caused by greenhouse gas emissions. But natural climate change has occurred throughout human history, and populations have had to adapt to the climate's vicissitudes. Anthony J. McMichael, a renowned epidemiologist and a pioneer in the field of how human health relates to climate change, is the ideal person to tell this story. Climate Change and the Health of Nations shows how the natural environment has vast direct and indirect repercussions for human health and welfare. McMichael takes us on a tour of human history through the lens of major transformations in climate. From the very beginning of our species some five million years ago, human biology has evolved in response to cooling temperatures, new food sources, and changing geography. As societies began to form, they too adapted in relation to their environments, most notably with the development of agriculture eleven thousand years ago. Agricultural civilization was a Faustian bargain, however: the prosperity and comfort that an agrarian society provides relies on the assumption that the environment will largely remain stable. Indeed, for agriculture to succeed, environmental conditions must be just right, which McMichael refers to as the "Goldilocks phenomenon." Global warming is disrupting this balance, just as other climate-related upheavals have tested human societies throughout history. As McMichael shows, the break-up of the Roman Empire, the bubonic Plague of Justinian, and the mysterious collapse of Mayan civilization all have roots in climate change. Why devote so much analysis to the past, when the daunting future of climate change is already here? Because the story of mankindâs previous survival in the face of an unpredictable and unstable climate, and of the terrible toll that climate change can take, could not be more important as we face the realities of a warming planet. This sweeping magnum opus is not only a rigorous, innovative, and fascinating exploration of how the climate affects the human condition, but also an urgent call to recognize our species' utter reliance on the earth as it is.

This paper revisits the emission scenarios of the European Commission's 2005 Thematic Strategy on Air Pollution (TSAP) in light of today's knowledge. We review assumptions made in the past on the main drivers of emission changes, i.e., demographic trends, economic growth, changes in the energy intensity of GDP, fuel-switching, and application of dedicated emission control measures. Our analysis shows that for most of these drivers, actual trends have not matched initial expectations. Observed ammonia and sulfur emissions in European Union in 2010 were 10% to 20% lower than projected, while emissions of nitrogen oxides and particulate matter exceeded estimates by 8% to 15%. In general, a higher efficiency of dedicated emission controls compensated for a lower-than-expected decline in total energy consumption as well as a delay in the phase-out of coal. For 2020, updated projections anticipate lower sulfur and nitrogen oxide emissions than those under the 2005 baseline, whereby the degree to which these emissions are lower depends on what assumptions are made for emission controls and new vehicle standards. Projected levels of particulates are about 10% higher, while smaller differences emerge for other pollutants. New emission projections suggest that environmental targets established by the TSAP for the protection of human health, eutrophication and forest acidification will not be met without additional measures.

This paper analyses factors that contributed to the evolution of SO2, NOx and CO2 emissions in Europe from 1960 to 2010. Historical energy balances, along with population and economic growth data, are used to quantify the impacts of major determinants of changing emission levels, including energy intensity, conversion efficiency, fuel mix, and pollution control. Time series of emission levels are compared for countries in Western and Eastern Europe, throwing light on differences in the importance of particular emissiondriving forces. Three quarters of the decline in SO2 emissions in Western Europe resulted from a combination of reduced energy intensity and improved fuel mix, while dedicated endof- pipe abatement measures played a dominant role in the reduction of NOx emissions. The increase in atmospheric emissions in Eastern Europe through the mid-1990s was associated with the growth of energy-intensive industries, which off-setted the positive impact of better fuel quality and changes in fuel mix. A continuous decrease in energy intensity and higher conversion efficiencies have been the main factors responsible for the moderate rate of growth of European CO2 emissions.

The world is undergoing a massive urban transition, which is now both the greatest driver of global environmental change and the most significant influence on human health. Cities offer real opportunities for improving health, but managed poorly, they can also create or reinforce significant health deficits while putting severe stresses on the natural systems which support human civilization. Management of urban problems is rarely straightforward, as complexity across scales and sectors, in causal structures, actors and incentives, can lead to ineffective policies and unintended consequences. Systems thinking offers a promising way forward in its ability to deal with non-linear relationships and simultaneous actions and outcomes. Encompassing, on the one hand, analytic frameworks and methods that can provide important causal insights and a test bed for urban policy, and on the other, broad processes of inter- and trans-disciplinary engagement to better define problems and feasible solutions, systems approaches are critical to the current and future design and management of sustainable healthy cities.

It has become evident that our planetary ecosystem is changing rapidly in response to human activities. This has led scientists to recognize the present-day era as a new geological epoch, the Anthropocene, in recognition of the substantial effect of man on the Earth’s systems. Human health is better today than at any other time in history. Yet the flourishing of civilization has come at the cost of an unsustainable exploitation of nature’s resources. As we look toward the future, it has become clear that we now face substantial health risks from the degradation of the natural life support systems which is critical for human survival. Global environmental change, including climatic change, ocean acidification, land degradation, water scarcity, overexploitation of fisheries, and biodiversity loss, poses serious challenges to the global health gains of the past several decades.

This article describes the origins and characteristics of an interdisciplinary multinational collaboration aimed at promoting and disseminating actionable evidence on the drivers of health in cities in Latin America and the Caribbean: The Network for Urban Health in Latin America and the Caribbean and the Wellcome Trust funded SALURBAL (Salud Urbana en América Latina, or Urban Health in Latin America) Project. Both initiatives have the goals of supporting urban policies that promote health and health equity in cities of the region while at the same time generating generalizable knowledge for urban areas across the globe. The processes, challenges, as well as the lessons learned to date in launching and implementing these collaborations, are described. By leveraging the unique features of the Latin American region (one of the most urbanized areas of the world with some of the most innovative urban policies), the aim is to produce generalizable knowledge about the links between urbanization, health, and environments and to identify effective ways to organize, design, and govern cities to improve health, reduce health inequalities, and maximize environmental sustainability in cities all over the world.

El proceso de adopción de la siembra directa (SD) en Uruguay comenzó a fines de los 80. En el sector lechero, donde la degradación de los suelos ha sido producto principalmente del excesivo laboreo, la SD representa una ventaja para la conservación del potencial productivo. La encuesta realizada en el año 2000 detectó una fase decreciente en el proceso de adopción, proyectándose un máximo para el período 2000-2005. En el 2005, se realizó una nueva encuesta con el objetivo de elaborar un diagnóstico actualizado de la SD en los establecimientos lecheros. Los resultados muestran que un 46% han adoptado la SD, de los cuales el 58% la realiza sistemáticamente (nunca hacen laboreo). Los productores que realizan SD poseen mayor superficie lechera y productividad. El principal cambio detectado en los adoptantes de la SD fue la presencia de la maleza Poa annua, mientras que, por el contrario, se detectó una disminución del engramillamiento. Entre los productores que realizan SD, la falta de maquinaria y la huella por pastoreo fueron las razones más importantes para realizar laboreo ocasional. La falta de maquinaria fue la razón de mayor peso para no adoptar el sistema. De los productores que en el 2000 no realizaban siembra directa, el 48% la han comenzado, mientras que sólo un 8% de los que la realizaban la han abandonado.

Integrating livestock with cotton (Gossypium hirsutum L.) offers profitable alternatives for producers in the southeastern USA, but could result in soil water depletion and soil compaction. We conducted a 3-yr field study on a Dothan loamy sand (fine-loamy, kaolinitic, thermic Plinthic Kandiudult) in southern Alabama to develop a conservation tillage system for integrating cotton with winter-annual grazing of stocker cattle under rainfed conditions. Winter annual forages and tillage systems were evaluated in a strip-plot design where winter forages were oat (Avena sativa L.) and annual ryegrass (Lolium mutiflorum L.). Tillage systems included moldboard and chisel plowing and combinations of noninversion deep tillage (none, in-row subsoil, or paratill) with or without disking. We evaluated forage dry matter, N concentration, average daily gain, net returns from grazing, soil water content, and cotton leaf stomatal conductance, plant populations, and yield. Net returns from winter-annual grazing were between US$185 to US$200 ha - yr - . Soil water content was reduced by 15% with conventional tillage or deep tillage, suggesting that cotton rooting was increased by these systems. Oat increased cotton stands by 25% and seed-cotton yields by 7% compared with ryegrass. Strict no-till resulted in the lowest yields-30% less than the overall mean (3.69 Mg ha -1 ). Noninversion deep tillage in no-till (especially paratill) following oat was the best tillage system combination (3.97 Mg ha -1 ) but deep tillage did not increase cotton yields with conventional tillage. Integrating winter-annual grazing can be achieved using noninversion deep tillage following oat in a conservation tillage system, providing producers extra income while protecting the soil resource.

Extreme events, both natural and anthropogenic, increasingly affect cities in terms of economic losses and impacts on health and well-being. Most people now live in cities, and Asian cities, in particular, are experiencing growth on unprecedented scales. Meanwhile, the economic and health consequences of climate-related events are worsening, a trend projected to continue. Urbanization, climate change and other geophysical and social forces interact with urban systems in ways that give rise to complex and in many cases synergistic relationships. Such effects may be mediated by location, scale, density, or connectivity, and also involve feedbacks and cascading outcomes. In this context, traditional, siloed, reductionist approaches to understanding and dealing with extreme events are unlikely to be adequate. Systems approaches to mitigation, management and response for extreme events offer a more effective way forward. Well-managed urban systems can decrease risk and increase resilience in the face of such events.

Measuring and mapping apparent soil electrical conductivity (ECa) is a potentially useful tool for delineating soil variability. The “Old Rotation,” the world's oldest continuous cotton (Gossypium hirsutum L.) experiment (ca. 1896), provides a valuable resource for evaluating soil spatial variability. The objectives of this study were to determine the relationship between soil chemical and physical properties and ECa in the Old Rotation, to determine spatial differences in these properties, and to relate differences in these properties to long‐term management effects. Soils at the site classified as fine, kaolinitic, thermic Typic Kanhapludults. Soil ECa was measured at 0–30‐ and 0–90‐cm depths (ECa‐30 and ECa‐90) using a Veris® 3100 direct contact sensor with georeferencing. Soils were grid sampled (288 points) at close intervals (1.5×3.0 m) for chemical properties and grid sampled (65 cells, 7.5×6.9 m) for soil texture. Soil organic carbon (SOC) and total nitrogen (N), extractable phosphorus (P...

Despite evidence that they play similar but independent roles, maternal education and household wealth are usually conflated in studies of the effects of socioeconomic status (SES) on malaria risk. Demographic and Health Survey and Malaria Indicator Survey data from nine countries in sub-Saharan Africa were used to explore the relationship of malaria parasitemia in children with SES factors at individual and cluster scales, controlling for urban/rural residence and other important covariates. In multilevel logistic regression modeling, completion of six years of maternal schooling was associated with significantly lower odds of infection in children (OR = 0.73), as was a household wealth index at the 40th percentile compared to the lowest percentile (OR = 0.48). These relationships were nonlinear, with significant quadratic terms for both education and wealth. Cluster-level wealth index was also associated with a reduction in risk (OR = 0.984 for a one percentile increase in mean wealth index), as was urban residence (OR = 0.59). Among other covariates, increasing child’s age and household size category were positively correlated with infection, and sleeping under an insecticidetreated bednet the previous night (OR = 0.80) was associated with a moderate reduction in risk. Considerable variation in parameter estimates was observed among country-specific models. Future work should clearly distinguish between maternal education and household resources in assessing malaria risk, and malaria prevention and control efforts should be aware of the potential benefits of supporting the development of human capital.

SummaryThe genetic structure of Sicily was analysed through the distribution of surnames of 758,793 users registered in the Italian Telephone Company, corresponding to 371 communes of the island. Estimates of the coefficient of consanguinity due to random isonymy, of Fisher'sa, an indicator of abundance of surnames, and of Karlin–McGregor'sv, an indicator of immigration rates, were obtained for each commune. Four different estimates of genetic distance between all possible pairs of communes within each province were also obtained, and their relationship with geographic distance was studied. The logarithmic transformation of Lasker's coefficient of relationship showed correlations with the log of geographic distance which range between −0·78 and −0·40; the strongest, for the province of Catania, was attributed to the presence of Mount Etna, and the weakest, for Palermo, to the high population density of this province.

Malaria occurrence is lower in urban versus rural areas of sub-Saharan Africa for a variety of reasons, including limitation of suitable mosquito habitat, generally improved housing standards and access to prevention and treatment, and a relative decrease in the ratio of vectors to humans. Nonetheless, empirical observation confirms that malaria cases, whether locally transmitted or imported, are frequently observed in cities in endemic areas. Theoretical considerations imply that local transmission will decrease as a city grows, transitioning from a relatively malaria-permissive state to one that encourages reduction or extinction. Using a simple deterministic systems dynamic model based on traditional malaria models, we simulate scenarios for the evolution of local transmission rates and acquired immunity in a homogenous urban area with respect to population size, growth rate, and level of suppression of mosquito breeding. In particular, we consider how the timing and extent of decreases in local transmission are mitigated by travel by city dwellers to endemic rural areas and their resulting exposure to infected mosquitoes. We explore the generalizability and sensitivity to assumptions of our results using microsimulation and analytic methods to account for various aspects of environmental (urban/rural) and demographic heterogeneity. The results of these simulation models should inform projections for long-term urban malaria trends, and have implications for the targeting of malaria prevention efforts in urban and peri-urban areas of sub-Saharan Africa.

Cephalic vein (CV) approach is preferable to subclavian vein when technically feasible. Aim of the study was to describe a technique to extend the use of CV for lead implantation. This technique was applied every time the lead didn't proceed through the CV. Methods After the isolation of the CV as usual a Terumo straight wire was advanced under fluoroscopy control through the subclavian vein up to the right atrium. Then an appropriate-size dilator and sheath with a peel-away system was slipped over the wire. In case of dual-chamber pacemaker the wire was kept in place for the second lead. Results All patients (Pts) (77±8 years) were implanted with tined bipolar atrial and ventricular leads. Our technique was applied in 64 pts (9% single-lead VDD, 55% dual-chamber and 36% single-chamber). No complications were reported in these pts neither in acute nor at follow-up (1 and 3 months). The subclavian approach was used only in 11% pts, when both the standard cephalic approach and this technique failed. Conclusion Our technique is feasible in the majority of patients and always safe.

A clinical case of splenosis recently observed in a young man subjected at the age of 8 to splenectomy for rupture of the spleen and operated at 19 for intestinal occlusion is reported. The pathogenetic aspects of the condition, characterised by the presence of nodules of splenic tissue in the abdominal cavity, are examined through a review of the literature.

A case of cystic neoplasia with a cephalopancreatic localization, arising in a young woman aged 26 and derived from the beta-insular elements, is presented. The tumour had invaded the porto-mesenteric tract, and hence duodenopancreatic demolition had to be followed by venous repair by prosthesis. On the basis of the literature the biological complexity of this exceptional tumour is disscussed (especially in relation to prognosis), as well as the surgical treatment adopted in this patient, who is in excellent conditions more than three years later.