Search Results (30)

In response to public health emergencies, the importance of resilient medical facilities—such as large exhibition centers and sports venues that can be rapidly converted into temporary emergency hospitals—has become increasingly evident. This study focuses on these potential medical resources within megacities, using Shanghai as a case study. Employing advanced analytical tools including the kernel density two-step floating catchment area method, Lorenz curves, and Gini coefficient, we systematically evaluated the spatial allocation of 36 resilient medical facilities in Shanghai. The findings indicate that Shanghai’s resilient medical facilities ensure 4.5 emergency beds per thousand residents, with large exhibition centers and sports venues demonstrating exceptional conversion capabilities far surpassing those of ordinary public venues. However, the study also uncovers significant disparities in spatial allocation: these facilities are predominantly concentrated in the city center, leading to notable deficiencies in accessibility and equity for suburban areas. The opportunity for residents to access emergency medical services decreases progressively from the city center outward, a trend consistent across various travel time scenarios. The calculated Gini coefficient underscores an extremely uneven spatial configuration of resilient medical facilities, well beyond the warning threshold, suggesting substantial service disparities between different regions during emergencies, which poses potential risks to public health. Our research provides valuable insights for megacities aiming to more effectively address future public health challenges and enhance societal resilience. Full article

Detection and quantification of disease-related biomarkers in wastewater samples, denominated Wastewater-based Surveillance (WBS), has proven a valuable strategy for studying the prevalence of infectious diseases within populations in a time- and resource-efficient manner, as wastewater samples are representative of all cases within the catchment area, whether they are clinically reported or not. However, analysis and interpretation of WBS datasets for decision-making during public health emergencies, such as the COVID-19 pandemic, remains an area of opportunity. In this article, a database obtained from wastewater sampling at wastewater treatment plants (WWTPs) and university campuses in Monterrey and Mexico City between 2021 and 2022 was used to train simple clustering- and regression-based risk assessment models to allow for informed prevention and control measures in high-affluence facilities, even if working with low-dimensionality datasets and a limited number of observations. When dividing weekly data points based on whether the seven-day average daily new COVID-19 cases were above a certain threshold, the resulting clustering model could differentiate between weeks with surges in clinical reports and periods between them with an 87.9% accuracy rate. Moreover, the clustering model provided satisfactory forecasts one week (80.4% accuracy) and two weeks (81.8%) into the future. However, the prediction of the weekly average of new daily cases was limited (R² = 0.80, MAPE = 72.6%), likely because of insufficient dimensionality in the database. Overall, while simple, WBS-supported models can provide relevant insights for decision-makers during epidemiological outbreaks, regression algorithms for prediction using low-dimensionality datasets can still be improved. Full article

Modeling non-point source pollution dynamics in inland lake basins is essential for safeguarding water quality, maintaining ecosystem integrity, protecting public health, and advancing long-term environmental sustainability. This study explores non-point pollution dynamics in the Sapanca Lake basin, Turkey, in association with the basin’s land use, land cover, hydrology, pollutant sources, and water quality parameters. The required data were gathered via a three-year monitoring program, which was carried out at 12 sampling stations around the lake, as well as using the collecting field measurements and GIS databases. Stepwise multiple regression analysis was employed to determine the best relation between non-point pollutants and land features. The results showed that urbanization and population density have significant correlations with the total nitrogen (TN) and total phosphorus (TP) in the study areas. Rivers crossing pristine areas, such as forests and uncultivated lands, demonstrated better water quality, thereby positively contributing to the lake ecosystem conservation. The highest nutrient loads were observed in streams that flow through highly urbanized sub-basins, followed by predominantly agricultural areas. This is likely due to runoff from urban environments, leaching from cultivated land, and contributions from livestock and tourism facilities. Conversely, densely forested regions exhibited the lowest levels of nutrient loads, highlighting their capacity for nutrient retention. The peak levels of non-point source pollution (TN = 5.22 mg/L and TP = 0.53 mg/L) were recorded in catchments with the highest degree of urbanization, whereas the lowest values (TN = 0.28 mg/L and TP = 0.04 mg/L) were found in the least urbanized areas. These findings emphasize that nutrients primarily impact water quality because of increasing urban and agricultural activities, while forested land plays a vital role in preserving lake water quality. To ensure sustainable water quality in lake basins, it is essential to strike a careful balance between protective measures and utilization policies, prioritizing conservation efforts. Full article

Many measles endemic countries with suboptimal coverage levels still rely on vaccination campaigns to fill immunity gaps and boost control efforts. Depending on local epidemiological patterns, national or targeted campaigns are implemented, following which post-campaign coverage surveys (PCCSs) are conducted to evaluate their performance, particularly in terms of reaching previously unvaccinated children. Due to limited resources, PCCS surveys are designed to be representative at coarse spatial scales, often masking important heterogeneities in coverage that could enhance the identification of areas of poor performance for follow-up via routine immunization strategies. Here, we undertake geospatial analyses of the 2021 measles PCCS in Nigeria to map indicators of coverage measuring the individual and combined performance of the campaign and routine immunization (RI) at 1 × 1 km resolution and the ward and district levels in 13 states. Using additional geospatial datasets, we also produced estimates of numbers of unvaccinated children during the campaign and numbers of measles-containing vaccine (MCV) zero-dose children before and after the campaign at these levels and within health facility catchment areas. Our study revealed that although the campaign reduced the numbers of MCV zero-dose children in all the districts, areas of suboptimal campaign and RI performance with considerable numbers of zero-dose children remained. Our analyses further identified wards and health facility catchment areas with higher numbers of unvaccinated children within these areas. Our outputs provide a robust evidence base to plan and implement follow-up RI strategies and to guide future campaigns at flexible and operationally relevant spatial scales. Full article

Accessibility is an important indicator for measuring the level of medical facility services in cities. Traditional studies on healthcare accessibility for the elderly have typically focused on the capabilities of emergency services while overlooking the daily independent healthcare needs of the elderly. Taking Wuhan City as an example, the Gaussian two-step floating catchment area method is used in this study to measure the accessibility of urban elderly residents with respect to general hospitals, specialized hospitals, and community health service centers. It also analyzes the appropriateness of the medical facility layout for the elderly in Wuhan City. The research findings indicate the following: (1) The accessibility evaluation method for urban medical facilities established with the Gaussian two-step floating catchment area model can accurately assess the supply–demand relationship between the elderly and various levels of medical facilities. (2) The overall coverage of medical service facilities in Wuhan City is relatively high, but there are significant differences in accessibility for elderly residents in different areas. (3) The appropriateness of daily healthcare access for elderly residents in the central urban areas of Wuhan City is mainly influenced by the layout of general hospitals, while, in the peripheral areas, it is mainly influenced by the layout of specialized hospitals and community health service centers. (4) Improving the appropriateness of urban medical facilities for elderly individuals requires differentiated improvement measures tailored to the characteristics of different zones. Full article

Ensuring the spatial equity of health service facilities (HSFs) is crucial for the well-being of residents. However, previous research has predominantly focused on the accessibility and equity of single-type facilities, neglecting the residents’ demand for diversified types of health services. This study proposes a multi-type, Gaussian-based, two-step floating catchment area method (MT-G2SFCA) to assess the comprehensive accessibility and equity of multi-type HSFs in different age groups in the Hedong District of Tianjin, with the Gini coefficient and the bivariate local Moran’s I. Furthermore, the key factors affecting the accessibility were explored through a geo-detector. The results indicate the following: (1) Neglecting the health benefits of facility type diversity can result in an underestimation of the accessibility and equity; (2) neglecting the differences in walking ability of the elderly can result in an overestimation of the accessibility and equity; and (3) the Pedestrian Route Directness is the key factor affecting the accessibility and equity in high-density urban areas, and especially that the facility density is the key factor for the elderly. This research emphasizes the impact of facility type diversity on the accessibility and equity of HSFs, which can offer more precise and holistic technical assistance and policy recommendations for optimizing the allocation of HSFs. Full article

City health examinations are integral to China’s urban planning, construction, and management. They effectively identify potential risks and vulnerabilities in urban development, ensuring safety resilience—a critical component. This resilience enhances the city’s ability to withstand internal and external shocks, promoting the safety of urban residents and fostering sustainable city development. Drawing on the Japanese disaster prevention strategy, the disaster prevention life circle emerges as a rescue and protection system during urban disasters, fortifying urban safety resilience. However, smaller and mid-sized cities, constrained by limited resources, significantly need to catch up in disaster prevention planning. Consequently, bolstering safety resilience in these cities becomes a pressing concern. This study focuses on Lindian County in Heilongjiang Province as the urban area under consideration for resilient city objectives. Leveraging the ArcGIS network analysis tool, we optimize the placement of emergency shelters, aligning with urban disaster assessments and the equilibrium of disaster prevention facility supply and demand. Accessibility analysis of emergency shelters was conducted using the Gaussian two-step floating catchment area method. Ultimately, we integrate the range of demand points assigned to each shelter, along with the effective land area reflecting the supply of shelters, as weights into a weighted Voronoi diagram. This diagram is combined with a reference to the entire region to delineate the disaster prevention life circle. Findings reveal that, under the premise of minimizing government construction costs while maximizing coverage and evacuation utilization rates, the optimal resident emergency congregate shelters in the study area are 8, with 98 emergency evacuation and embarkation shelters. Striking a balance between disaster prevention facility supply and demand and regional accessibility, the urban area of Lindian County is segmented into 3 resident disaster prevention life circles and 24 emergency disaster prevention life circles. The objective of this study is to optimize shelter siting and establish disaster prevention life circles in diverse urban areas. This endeavor aims to bolster urban resilience and foster sustainable urban development. Full article

Increasingly, health professionals are recognizing the need for a more holistic, or One Health, approach to wellness. Companion animals share the lives and homes of many Americans, and yet little research exists on the intersection of disparities of access to veterinary care and access to human health care. This research aims to fill that gap by exploring the use of a spatial model that identifies the relationship of supply and demand while also considering reductions as a function of travel time to a care facility. Four counties in Alabama were analyzed at the census tract level to determine the supply of primary care physicians and veterinary care providers. This research provides a unique application of the Enhanced Two-Step Floating Catchment Area model by independently examining access to each type of care and then comparing both access supply values at the census level. Results indicated a statistically significant positive relationship between access to both types of care, implying areas with lower access to primary care have concomitantly low access to veterinary care. Implications for practice include the introduction of this methodological approach, identification of future parameter specification research to improve the approach, and identification of an area of significant concern in the One Health framework. Further, the results can inform solution strategies such as offering integrated care interventions for both humans and their companion animal household members with direct use for policymakers aimed at increasing equitable access to health care across the One Health spectrum. Full article

We conducted a cluster randomized trial of two models for integrating HPV self-collection into family-planning (FP) services at 16 health facilities in Malawi between March 2020–December 2021. Model 1 involved providing only clinic-based HPV self-collection, whereas Model 2 included both clinic-based and community-based HPV self-collection. An endline household survey was performed in sampled villages and households between October-December 2021 in the catchment areas of the health facilities. We analyzed 7664 surveys from 400 villages. Participants from Model 2 areas were more likely to have ever undergone cervical cancer screening (CCS) than participants from Model 1 areas, after adjusting for district, facility location (urban versus rural), and facility size (hospital versus health center) (adjusted odds ratio = 1.73; 95% CI: 1.29, 2.33). Among participants who had ever undergone CCS, participants from Model 2 were more likely to report having undergone HPV self-collection than participants from Model 1 (50.5% versus 22.8%, p = 0.023). Participants from Model 2 were more likely to be using modern FP (adjusted odds ratio = 1.01; 95% CI: 1.41, 1.98) than Model 1 participants. The integration of FP and HPV self-collection in both the clinic and community increases CCS and modern FP uptake more than integration at the clinic-level alone. Full article

With the unprecedented growth of the elderly population in China, elderly-care facilities (ECFs) are in a fast expansion process. However, limited attention has been paid to the imbalance at the actual utilization level of ECFs. This research aims to reveal the spatial inequity of ECFs and to quantitatively examine the effect of accessibility and institutional service capacity on utilization. Taking Chongqing, China, as the study area, we measured the spatial accessibility of different travel modes by the Gaussian Two-Step Floating Catchment Area (G2SFCA) method and investigated distribution differences in spatial accessibility, service capacity, and utilization of ECFs by the Dagum Gini Coefficient and its decomposition. Then, the impact of spatial accessibility and service capacity on the utilization of regional ECFs was quantified by multiscale geographically weighted regression (MGWR). The study findings can be summarized as follows. (1) Walking accessibility has the most significant impact on the utilization of ECFs and shows geographic heterogeneity. Developing a pedestrian-oriented network of pathways is essential to enhance the utilization of ECFs. (2) Accessibility by driving and bus-riding does not correlate with regional ECFs utilization, and relevant studies cannot rely on them alone for assessing the equity of ECFs. (3) In the utilization of ECFs, since the inter-regional difference is more significant than the intra-regional difference, efforts to reduce the overall imbalance should be oriented toward inter-regional variation. The study’s findings will assist national policymakers in developing EFCs to enhance health indicators and quality of life for older adults by prioritizing financing for shortage areas, coordinating ECFs services, and optimizing road systems. Full article

Disparities in access to health services in rural areas represent a global health issue. Various external factors contribute to these disparities and each root requires specific remedial action to alleviate the issue. This study elucidates an approach to assessing the spatial accessibility of primary care, considering Malaysia’s dual public–private system specifically in rural areas, and identifies its associated ecological factors. Spatial accessibility was calculated using the Enhance 2-Step Floating Catchment Area (E2SFCA) method, modified as per local context. Data were secondary sourced from Population and Housing Census data and administrative datasets pertaining to health facilities and road network. The spatial pattern of the E2SFCA scores were depicted using Hot spot Analysis. Hierarchical multiple linear regression and geographical weight regression were performed to identify factors that affect E2SFCA scores. Hot spot areas revolved near the urban agglomeration, largely contributed by the private sector. Distance to urban areas, road density, population density dependency ratios and ethnic composition were among the associated factors. Accurate conceptualization and comprehensive assessment of accessibility are crucial for evidence-based decision making by the policymakers and health authorities in identifying areas that need attention for a more specific and localized planning and development. Full article

Sustainable development goal (SDG) 3 promotes well-being and healthy lives for people of all ages. However, based on the literature, one of the main challenges to achieving SDG 3 is inequality in access to health care. In order to support the efforts of the local government of the province to contribute to the achievement of SDG thru equitable access to health care, this study measured the spatial accessibility of healthcare facilities in Marinduque, Philippines. It used distance-based (i.e., travel-time) and area-based (i.e., enhanced two-step floating catchment analysis or E2SFCA) metrics. The distance from each healthcare facility to different villages in the province was established using QGIS and Google Maps. The distance traveled was measured using three (3) modes of transportation: tricycle, jeepney, and private vehicle. The E2SFCA scores were calculated for different population groups: the general population, women, children, and the elderly. Based on the results, island villages and those areas in the inner portion of the province lack physical access to healthcare facilities. Such a limitation was apparent in the distance- and area-based accessibility metrics. Among the population group considered in this study, the women population showed the lowest accessibility scores. Full article

Frequent severe heat waves have caused a series of health problems for urban dwellers. Swimming, an exercise that combines both cooling off and moderate to vigorous physical activity (MVPA), is one solution for alleviating the conflict between urban heat problems and public health. Therefore, the distribution and spatial accessibility of swimming pools are worth examining. Using open-source data we scraped from the Baidu Map API (Application Programming Interface), we designed and constructed a grid-based accessibility index. We analyzed pool accessibility in three aspects: distribution of pools, catchment area of pools, and spatial disparities of the accessibility index. The results are as follows. (a) The pools are clustered, dense in the central area, and sparse in the peripheral areas. (b) 53.16% of the residents can access a pool within 5 minutes by cycling, and the number is only 12.03% when they travel on foot. The poor situation is highly improved with the extension of time, these figures are up to 97.62% and 70.71% when the time cost is 15 minutes. The overall circular buffer significantly mismatches the real catchment area of the pools. (c) The spatial disparity in accessibility is significant and shows a sharply decreasing trend outward from the center. (d) Pool accessibility is mainly influenced by the distribution of pools and ground obstacles such as rivers, mountains, and elevated roads. The method used here has high precision and can be used for accessibility assessments of other facilities in the city. Full article

Park green space (PGS) is an important part of urban ecosystem and green infrastructure, and the ease of access to PGS is closely related to the health of residents. A growing number of studies have attempted to identify accessibility disparities, but results have varied because of the travel mode choice and the measurement method. This study proposes a dynamic Huff two-step floating catchment area (H2SFCA) method based on map service API (Application Programming Interface) to assess the accessibility of PGS, with the Gini coefficient and bivariate local Moran’s I used to analyze accessibility equity. Results show that: (1) driving and biking modes have more significant spatiotemporal compression effects than dynamic modes, public transit, and walking mode. (2) The accessibility values and spatial patterns vary significantly by travel mode. The PGS availability pattern at the local level is more uneven than the distribution of accessibility at the regional level. In comparison with dynamic travel modes, the accessibility values for the single travel mode are more likely to be overestimated or underestimated. (3) The PGS accessibility by the dynamic modes generally has better spatial equity and residents can select suitable travel tools to acquire more equitable park services. In addition, there is a significant accessibility difference between dynamic driving-based mode and dynamic transit-based mode in four subdistricts, which are mainly located in the south of Tianhe District. The public transport facilities linking parks in these areas need to be optimized. This study further improves the accessibility evaluation method, with the findings conducive to the implementation of refined PGS planning and management. Full article

The primary healthcare facilities are among the most basic needs of the residents, huge in quantity and widespread. Their distributions are directly related to people’s health, which affects the sustainable development of cities. The accessibility calculation of primary level healthcare facilities and the equity evaluation of accessibility from the perspective of medical service category and urban population is very important for the decision-making of layout and configuration but has been ignored for a long time. This study took the primary healthcare facilities of Fukuoka city in Japan as research objects; it first used the variable two-step floating catchment area (V2SFCA) method to calculate the healthcare catchment areas (HCAs) of medical service providers and the population catchment area (PCAs) of medical demand locations, and then obtained the accessibility to primary healthcare facilities. Finally, the spatial disparities of accessibility were evaluated from three aspects: overall space distribution by using Global and Local Moran’s I, service quality, and the population to be served. The results showed that HCAs were from 500 m to 6400 m, PCAs ranged from 500 m to 3000 m, the use of variable catchments can improve the accuracy of accessibility assessment results; the accessibility of primary healthcare facilities was clustered and had significant spatial differences, which were high in urban center and low in suburban area; the obvious differences in the accessibility distribution characteristics of clinics in differential diagnosis and treatment departments led to different degrees of unsaturation in the types of medical services obtained by residents; although the elderly’s demand for basic medical care was many times higher than that of other age groups, the accessibility in high-demand areas was generally low, and the situation in severely high-demand areas was more serious. This work puts forward a multi-dimensional realistic evaluation system for equality accessibility of primary healthcare facilities, providing the data support for the medical resources and facilities’ allocation and the intensive land use. Full article