Public Health-Led Insights on Electric Micro-mobility Adoption and Use : a Scoping Review

Altres ajuts: acords transformatius de la UABUnidad de excelencia María de Maeztu CEX2019-000940-MThe advent of electric micro-mobility (EMM) has transformed the urban mobility landscape, with projections indicating a 5-10% increase in its modal share in European cities by 2030. In this scoping review, we aimed to comprehensively examine the key determinants of EMM adoption and usage from a public health perspective. Sixty-seven articles were included in the analysis, primarily covering e-bikes and e-scooters. The determinants were categorised into two broad categories: (1) contextual determinants that encompass enabling and hindering factors related to legal frameworks, transportation systems and infrastructure, and technology, and (2) individual-level determinants that pertain to intrinsic motivations and deterrents of individuals. Our findings reveal that EMM vehicles are widely perceived as a cost-effective, flexible, ad hoc, and fast mode of transportation within urban areas, augmenting accessibility and connectivity. Additionally, the lightweight, foldable, and transportable nature of these vehiclesis highly appreciated by users. However, several barriers have also been identified, including inadequate infrastructure and end-of-trip facilities, limited capability to traverse diverse terrains and trip scenarios, acquisition and maintenance costs, limited carrying capacities, technical failures, and accident risks. Our results suggest that the interplay of contextual enablers and barriers and personal motivations and deterrents drive the emergence, adoption, and usage of EMM. Hence, a comprehensive understanding of both contextual and individual-level determinants is crucial for ensuring a sustainable and healthy uptake of EMM

Large-scale citizen science protocol provides high-resolution nitrogen dioxide values while enhancing community knowledge and collective action

We present an already tested protocol from a large-scale air quality citizen science campaign (xAire, 725 measurements, see Ref. [1]). A broad partnership with 1,650 people from communities including 18 primary schools in Barcelona (Spain) provided the capacity to obtain unprecedented high-resolution NO2 levels. Communities followed the protocol to select measurement points and obtain NO2 levels from outdoor locations n=671, playgrounds n=31, and inside school buildings (primarily classrooms) n=23. Data was calibrated and annualized with concentration levels from the city´s automatic air quality monitoring reference stations [2]

Large-scale citizen science provides high-resolution nitrogen dioxide values and health impact while enhancing community knowledge and collective action

We present outcomes from a large-scale air quality citizen science campaign (xAire, 725 measurements) to demonstrate its positive contribution in the interplay between advances in exposure assessment and developments in policy or collective action. A broad partnership with 1,650 people from communities around 18 primary schools across Barcelona provided the capacity to obtain unprecedented high-resolution NO2 levels and an updated asthma Health Impact Assessment. It is shown that NO2 levels vary considerably with at some cases very high levels. More than a 1,000 new cases of childhood asthma could be prevented each year by lowering NO2 levels. Representativity of site selection and the minimal number of samplers for land use regression modelling are considered. Enhancement of community knowledge and attitudes towards collective response were observed and identified as key drivers for successful large-scale monitoring campaigns. The results encourage strengthening collaboration with local communities when exploring environmental health issues

Jardins als terrats per la inclusió, salut i benestar de col·lectius vulnerables

Unidad de excelencia María de Maeztu MdM-2015-0552Investigadors del Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNUEJ) de l'ICTA-UAB, amb l'Institut de Salut Global de Barcelona (ISGlobal), coordinaran i realitzaran un estudi per l'Institut Municipal de Persones amb Discapacitat de Barcelona (IMPD) amb l'objectiu d'avaluar els beneficis del programa municipal de jardins als terrats per a persones amb discapacitat. Aquest estudi també ajudarà a avaluar la possibilitat de replicar els jardins ja existents, estenent un projecte que ajuda al benestar de grups socialment vulnerables alhora que ofereix beneficis ecològics a la ciutat.Investigadores del Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNUEJ) del ICTA-UAB, junto con el Instituto de Salud Global de Barcelona (ISGlobal), coordinarán y realizarán un estudio para el Instituto Municipal de Personas con Discapacidad de Barcelona (IMPD) con el objetivo de evaluar los beneficios del programa municipal de jardines en azoteas para personas con discapacidad. Este estudió ayudará también a evaluar la posibilidad de replicar los jardines ya existentes, extendiendo un proyecto que ayuda al bienestar de grupos socialmente vulnerables a la vez que ofrece beneficios ecológicos a la ciudad.Researchers from the Barcelona Laboratoy for Urban Environmental Justice and Sustainability (BCNUEJ) from the ICTA-UAB, in partnership with the Barcelona Institute for Global Health (ISGlobal), will coordinate and conduct a study for the Barcelona Municipal Institute for People with Disability (IMPD) to assess the benefits of the municipal rooftop garden program aimed at people with disabilities. This study will also help assess the opportunities for replicating the gardens that the city currently has, extending a project that provides well-being for socially-vulnerable groups while delivering ecological benefits to the city

Impacts of changes in environmental exposures and health behaviours due to the COVID-19 pandemic on cardiovascular and mental health : A comparison of Barcelona, Vienna, and Stockholm

Responses to COVID-19 altered environmental exposures and health behaviours associated with non-communicable diseases. We aimed to (1) quantify changes in nitrogen dioxide (NO2), noise, physical activity, and greenspace visits associated with COVID-19 policies in the spring of 2020 in Barcelona (Spain), Vienna (Austria), and Stockholm (Sweden), and (2) estimated the number of additional and prevented diagnoses of myocardial infarction (MI), stroke, depression, and anxiety based on these changes. We calculated differences in NO2, noise, physical activity, and greenspace visits between pre-pandemic (baseline) and pandemic (counterfactual) levels. With two counterfactual scenarios, we distinguished between Acute Period (March 15th – April 26th, 2020) and Deconfinement Period (May 2nd – June 30th, 2020) assuming counterfactual scenarios were extended for 12 months. Relative risks for each exposure difference were estimated with exposure-risk functions. In the Acute Period, reductions in NO2 (range of change from −16.9 μg/m3 to −1.1 μg/m3), noise (from −5 dB(A) to −2 dB(A)), physical activity (from −659 MET*min/wk to −183 MET*min/wk) and greenspace visits (from −20.2 h/m to 1.1 h/m) were largest in Barcelona and smallest in Stockholm. In the Deconfinement Period, NO2 (from −13.9 μg/m3 to −3.1 μg/m3), noise (from −3 dB(A) to −1 dB(A)), and physical activity levels (from −524 MET*min/wk to −83 MET*min/wk) remained below pre-pandemic levels in all cities. Greatest impacts were caused by physical activity reductions. If physical activity levels in Barcelona remained at Acute Period levels, increases in annual diagnoses for MI (mean: 572 (95% CI: 224, 943)), stroke (585 (6, 1156)), depression (7903 (5202, 10,936)), and anxiety (16,677 (926, 27,002)) would be anticipated. To decrease cardiovascular and mental health impacts, reductions in NO2 and noise from the first COVID-19 surge should be sustained, but without reducing physical activity. Focusing on cities’ connectivity that promotes active transportation and reduces motor vehicle use assists in achieving this goal

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

An urban green space intervention with benefits for mental health: A health impact assessment of the Barcelona “Eixos Verds” Plan

Background: Mental health disorders account for over 30% of the global burden of disease. There is a positive association between green space exposure and better mental health, and therefore urban greening can be an effective public health tool. Barcelona is a compact city with one of the highest population and traffic densities in Europe, with limited green spaces. Under the umbrella of the Superblock model, the Barcelona City council is implementing the Eixos Verds Plan for extensive street greening. We estimated the potential mental health benefits of this plan. Methods: We performed a quantitative health impact assessment at the Barcelona grid-cell level (n = 1,096). We compared the baseline green space situation (2015) with the proposed plan and translated the increase in green space into a) percentage of green area (%GA) and b) NDVI. We combined exposure data with Barcelona-specific mental health risk estimates, adult population (n = 1,235,375), and mental health data, and calculated preventable cases. Findings: Under the Eixos Verds Plan, we estimated an average increase of 5·67 %GA (range: 0·00% − 15·77%) and 0·059 NDVI (range: 0·000 − 0·312). We estimated that with the Eixos Verds Plan implementation, 31,353 (95%CI: 18,126–42,882) cases of self-perceived poor mental health (14·03% of total), 16,800 (95%CI: 6828–25,700) visits to mental health specialists (13·37% of total), 13,375 (95%CI: 6107–19,184) cases of antidepressant use (13·37% of total), and 9476 (95%CI: 802–16,391) cases of tranquilliser/ sedative use (8·11% of total) could be prevented annually, along corresponding to over 45 M € annual savings in mental health costs annually. Interpretation: Our results highlight the importance of urban greening as a public health tool to improve mental health in cities. Similar results for green interventions in other cities could be expected

The Superblock model: a review of an innovative urban model for sustainability, liveability, health and well-being

Introduction. Current urban and transport planning practices have significant negative health, environmental, social and economic impacts in most cities. New urban development models and policies are needed to reduce these negative impacts. The Superblock model is one such innovative urban model that can significantly reduce these negative impacts through reshaping public spaces into more diverse uses such as increase in green space, infrastructure supporting social contacts and physical activity, and through prioritization of active mobility and public transport, thereby reducing air pollution, noise and urban heat island effects. This paper reviews key aspects of the Superblock model, its implementation and initial evaluations in Barcelona and the potential international uptake of the model in Europe and globally, focusing on environmental, climate, lifestyle, liveability and health aspects. Methods. We used a narrative meta-review approach and PubMed and Google scholar databases were searched using specific terms. Results. The implementation of the Super block model in Barcelona is slow, but with initial improvement in, for example, environmental, lifestyle, liveability and health indicators, although not so consistently. When applied on a large scale, the implementation of the Superblock model is not only likely to result in better environmental conditions, health and wellbeing, but can also contribute to the fight against the climate crisis. There is a need for further expansion of the program and further evaluation of its impacts and answers to related concerns, such as environmental equity and gentrification, traffic and related environmental exposure displacement. The implementation of the Superblock model gained a growing international reputation and variations of it are being planned or implemented in cities worldwide. Initial modelling exercises showed that it could be implemented in large parts of many cities. Conclusion. The Superblock model is an innovative urban model that addresses environmental, climate, liveability and health concerns in cities. Adapted versions of the Barcelona Superblock model are being implemented in cities around Europe and further implementation, monitoring and evaluation are encouraged. The Superblock model can be considered an important public health intervention that will reduce mortality and morbidity and generate cost savings for health and other sectors.We acknowledge support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program”. The SUPERBE project (“Potenziale von Superblock-Konzepten als Beitrag zur Planung energieeffizienter Stadtquartiere”) has received funding from the Austrian research funding programme “Stadt der Zukunft”. “Stadt der Zukunft” is a Funding Programme of the Republic of Austria, Federal Ministry for Transport, Innovation and Technology. The Austrian Research Promotion Agency (FFG) has been authorised for the Programme Management. The TuneOurBlock project (“Transforming urban quarters to human scale environments: applying superblock concepts for different urban structures”) has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 875022. The authors also acknowledge financial support from the Slovenian Research and Innovation Agency (H6-8290) under agreement no. 1000-23-0618 and research core/project funding Geography of Slovenia (P6-0101). Strategic research and innovation program for the development of Medical University – Plovdiv” № BG-RRP-2.004-0007-C01, Establishment of a network of research higher schools, National plan for recovery and resilience, financed by the European Union – NextGenerationEU. Angel M. Dzhambov's and Mark J. Nieuwenhuijsen's time on this publication is partially supported by the “Strategic research and innovation program for the development of Medical University – Plovdiv” № BG-RRP-2.004-0007-C01, Establishment of a network of research higher schools, National plan for recovery and resilience, financed by the European Union – NextGenerationEU". This project has received funding from the European Union's, Horizon Europe Framework Programme (HORIZON) under GA No 101094639 - THE URBAN BURDEN OF DISEASE ESTIMATION FOR POLICY MAKING (UBDPolicy)

Mobility and COVID-19 : Time for a mobility paradigm shift

Urban mobility and the COVID-19 pandemic have had significant impacts on each other and on health. Urban areas are particularly hit by COVID-19, where moving around while social distancing is challenging because public space is often limited and mostly designated for motorized traffic. Urgent actions need to be taken by cities and citizens that bring longer-term changes towards healthy, equitable and sustainable mobility