Gesundheitliche Bedeutung blauer Stadtstrukturen

Wasser hat zentrale Bedeutung für Genese und Gestalt menschlicher Siedlungen. Das stadtblaue Inventar aus überformten natürlichen und künstlichen Gewässern ist divers zusammengesetzt und unterliegt einem stetigen Wandel, der aus geänderten Nutzungsansprüchen resultiert. Besonders markant sichtbar ist dieser Prozess derzeit am Niedergang innerstädtischer Hafenanlagen und an deren postindustrieller Revitalisierung. Positive Wirkungen urbaner Blauräume auf die Gesundheit haben im Diskurs um waterfront revitalization bislang kaum eine Rolle gespielt, obwohl für blaue Stadtstrukturen inzwischen durchaus spezifische, Gesundheit schützende und fördernde Wirkungen nachgewiesen werden konnten. Gesundheitsschutz bezieht sich dabei etwa auf innerstädtische Kühlung, Durchlüftung, reduzierte Lärmwahrnehmung, Belichtung und Vorhaltung von Trinkwasserressourcen; Gesundheitsförderung umfasst Möglichkeiten zu körperlicher Aktivität, sozialer Interaktion oder Kontemplation an Gewässern. Zur Durchsetzung gesundheitsbezogener Ziele bedarf es angepasster Governance-Strukturen, welche die gesundheitsrelevanten Potenziale blauer Stadtstrukturen berücksichtigen und entwickeln.Water plays a central role for the formation and the form of human settlements. The urban blue inventory of natural and artificial water bodies is diverse and subject to continuous change. Currently, this is particularly visible for abandoned inner-urban harbour sites and their post-industrial revitalisation. The positive impacts of urban blue spaces have not played a major role in the discourse about waterfront revitalisation so far, although specific health-protecting and health-promoting effects of urban blue have been proven. In terms of health protection such effects include urban thermal stress reduction, ventilation, reduction of noise perception, insolation and drinking water provision, while health promotion effects include options for physical activity,social interaction and contemplation near urban blue. Sensitive governance structures are essential to recognise and develop the health-relevant potential of urban blue spaces and to achieve health-related targets

Vielfältige Instrumente in der städtebaulichen Planung zur Gesundheitsvorsorge und Gesundheitsförderung - ein zusammenfassender Überblick

Planerische Instrumente für gesunde Lebensverhältnisse existieren spätestens seit der dynamischen Periode der Industrialisierung ebenso wie städtebauliche Leitbilder. Sie sind auf örtlicher und überörtlicher Ebene mit unterschiedlichen Zuständigkeiten angesiedelt. Dabei hat räumliche Planung im Kern die Aufgabe, zwischen unterschiedlichen Raumansprüchen und Nutzungskonflikten einen Abwägungsprozess zu gestalten, um die politische Entscheidungsfindung vorzubereiten. Die gesetzlichen Grundlagen und institutionellen Rahmenbedingungen für räumliche Planung und Gesundheitsrecht sind unterschiedlich, weisen aber über das aktuelle Präventionsgesetz Schnittstellen auf. Diese gilt es kooperativ auszugestalten.Planning tools for healthy living conditions have existed at least since the dynamic period of industrialisation, as have urban development visions. They are assigned to local and regional levels with different responsibilities. The crucial element of spatial planning is the task to develop procedures to consider and weigh up different spatial demands and conflicts of use in order to prepare political deliberation and decisionmaking processes. The legal and the institutional frameworks for spatial planning and health differ, but they are interlinked through the current Prevention Act. This presents an opportunity for a co-operative approach

Leitbilder einer gesundheitsfördernden Stadtentwicklung

Leitbilder bieten die Möglichkeit, gesellschaftliche Interessen zu bündeln und in Prozesse der Stadtentwicklung einzubringen. Gesundheitliche Ziele nahmen in der Stadtplanung bereits früh, beispielsweise in der Gartenstadtbewegung oder auch in der Charta von Athen, eine wichtige Rolle ein. Aufbauend auf der Ottawa-Charta zur Gesundheitsförderung der WHO werden in Stadtplanung und Städtebau zunehmend menschliche Gesundheit und Wohlbefinden in den Mittelpunkt öffentlicher Entscheidungsprozesse gerückt. Dieser Artikel geht insbesondere der Frage nach, ob Gesundheitsförderung als Leitbild des Städtebaus und der Stadtentwicklung geeignet oder bereits etabliert ist. Hierzu wird zunächst auf die Begriffe "Leitbild" und "Gesundheitsförderung" eingegangen. Im Anschluss werden historische und aktuelle Berührungen beider Bereiche diskutiert sowie praktische Umsetzungsansätze exemplarisch vorgestellt. Als konsekutive Herausforderungen schließlich werden gesellschaftliche Legitimation und politische Realisierbarkeit angesprochen.General principles offer the opportunity to bundle societal interests and to integrate them into processes of urban planning and development. Health targets already played an important role in urban planning at an early stage, such as in the Garden City Movement or in the Athens Charter. Based on the WHO Ottawa Charter for Health Promotion, human health and well-being are increasingly considered as part of public decision-making processes in urban development and planning. The main objective of this article is to explore the extent to which health promotion is appropriate or has already been established as a general principle for urban development and planning. For this purpose, the terms "general principle" and "health promotion" need first to be considered. In the following, historical and current interrelations of both areas are discussed and examples of practical implementation approaches are presented. Finally,societal legitimacy and political feasibility are addressed as consecutive challenges

Coping with ill-health: health care facility, chemist or medicinal plants? Health-seeking behaviour in a Kenyan wetland

Background: Sub-Saharan African wetlands, settlement areas to growing populations, expose their users to diseases as necessary health infrastructure remains underdeveloped. Methods: Mixed methods were adopted to assess the health-seeking behaviour of different exposure groups (farmers, pastoralists, service sector workers) in a Kenyan wetland community. Based on a cross-sectional survey (n = 400), syndromic surveillance was linked to health-seeking event analysis. In-depth interviews with community members (n = 20) and experts (n = 8) enabled the integration of healthcare user and provider perspectives. Results: Health-seeking behaviour in the wetland was determined by physical/infrastructural, natural/environmental, financial/socioeconomic and social/demographic factors, as well as human/cultural aspects such as traditional preferences rooted in health beliefs. Community members had different strategies of coping with ill-health and few symptoms remained untreated. Whether via a health care facility admission, the visit of a chemist, or the intake of pharmaceuticals or medicinal plants: treatment was usually applied either via a healthcare service provider or by the community members themselves. An undersupply of easy-to-reach healthcare options was detected, and healthcare services were not available and accessible to all. The widely-practiced self-treatment of symptoms, e.g. by use of local medicinal plants, mirrors both potential healthcare gaps and cultural preferences of wetland communities. Conclusions: Integrated into an overall health-promoting wetland management approach, widely accepted (cultural) realities of health-seeking behaviours could complement health sector service provision and help ensure healthy lives and promote well-being for all in wetlands

High Zika Virus Seroprevalence in Salvador, Northeastern Brazil Limits the Potential for Further Outbreaks.

During 2015 to 2016, Brazil reported more Zika virus (ZIKV) cases than any other country, yet population exposure remains unknown. Serological studies of ZIKV are hampered by cross-reactive immune responses against heterologous viruses. We conducted serosurveys for ZIKV, dengue virus (DENV), and Chikungunya virus (CHIKV) in 633 individuals prospectively sampled during 2015 to 2016, including microcephaly and non-microcephaly pregnancies, HIV-infected patients, tuberculosis patients, and university staff in Salvador in northeastern Brazil using enzyme-linked immunosorbent assays (ELISAs) and plaque reduction neutralization tests. Sera sampled retrospectively during 2013 to 2015 from 277 HIV-infected patients were used to assess the spread of ZIKV over time. Individuals were georeferenced, and sociodemographic indicators were compared between ZIKV-positive and -negative areas and areas with and without microcephaly cases. Epidemiological key parameters were modeled in a Bayesian framework. ZIKV seroprevalence increased rapidly during 2015 to 2016, reaching 63.3% by 2016 (95% confidence interval [CI], 59.4 to 66.8%), comparable to the seroprevalence of DENV (75.7%; CI, 69.4 to 81.1%) and higher than that of CHIKV (7.4%; CI, 5.6 to 9.8%). Of 19 microcephaly pregnancies, 94.7% showed ZIKV IgG antibodies, compared to 69.3% of 257 non-microcephaly pregnancies (P = 0.017). Analyses of sociodemographic data revealed a higher ZIKV burden in low socioeconomic status (SES) areas. High seroprevalence, combined with case data dynamics allowed estimates of the basic reproduction number R0 of 2.1 (CI, 1.8 to 2.5) at the onset of the outbreak and an effective reproductive number Reff of <1 in subsequent years. Our data corroborate ZIKV-associated congenital disease and an association of low SES and ZIKV infection and suggest that population immunity caused cessation of the outbreak. Similar studies from other areas will be required to determine the fate of the American ZIKV outbreak.IMPORTANCE The ongoing American Zika virus (ZIKV) outbreak involves millions of cases and has a major impact on maternal and child health. Knowledge of infection rates is crucial to project future epidemic patterns and determine the absolute risk of microcephaly upon maternal ZIKV infection during pregnancy. For unknown reasons, the vast majority of ZIKV-associated microcephaly cases are concentrated in northeastern Brazil. We analyzed different subpopulations from Salvador, a Brazilian metropolis representing one of the most affected areas during the American ZIKV outbreak. We demonstrate rapid spread of ZIKV in Salvador, Brazil, and infection rates exceeding 60%. We provide evidence for the link between ZIKV and microcephaly, report that ZIKV predominantly affects geographic areas with low socioeconomic status, and show that population immunity likely caused cessation of the outbreak. Our results enable stakeholders to identify target populations for vaccination and for trials on vaccine efficacy and allow refocusing of research efforts and intervention strategies

Mosquito nets in a rural area of Western Kenya: ownership, use and quality

<p>Abstract</p> <p>Background</p> <p>Insecticide-treated nets (ITNs) are regarded as one of the most effective strategies to prevent malaria in Africa. This study analyses the use and quality of nets owned by households in an area of high net coverage.</p> <p>Methods</p> <p>A structured questionnaire on ownership and use of nets was administered to the households of individuals sampled from a local health centre in south Kisii district, Kenya. A physical inspection of all the nets in the households was done and their conditions recorded on spot check forms designed for that purpose.</p> <p>Results</p> <p>Of the 670 households surveyed, 95% owned at least one net. Only 59% of household residents slept under a net during the night prior to the survey. 77% of those who slept under a net used an insecticide-treated net (ITN) or long-lasting insecticide-treated nets (LLIN). Out of 1,627 nets in the survey households, 40% were deemed to be of poor quality because of holes. Compared to other age groups, children aged 5-14 years were most likely to have slept under nets of poor quality (odds ratio 1.41; <it>p </it>= 0.007).</p> <p>Conclusions</p> <p>Although net ownership was high following increased delivery of ITNs, continuous promotion of effective maintenance and routine use is needed and efforts to replace damaged nets must be implemented.</p

Therapeutische Landschaften – Schlüsselkonzept einer post-medizinischen Geographie der Gesundheit

Kistemann T, Claßen T. Therapeutische Landschaften – Schlüsselkonzept einer post-medizinischen Geographie der Gesundheit. Berichte zur Deutschen Landeskunde. 2012;86(2):109-124

Contamination Landscapes: Spatio-Temporal Record and Analysis of Pathogens in Clinical Settings

Nosocomial outbreaks require quick epidemiological clarification of possible chains of infection, since the pathogen usually has a head start that has to be caught up. Identification of people and areas at risk is crucial for efficient confinement. This paper describes a concept which can be applied to healthcare settings. The application skips the time-consuming and imperfect reconstruction of direct and indirect contacts. Indoor mobility of people and devices are instead measured precisely, and the mobility history is used to construct a spatio-temporal &lsquo;landscape of infection&rsquo;. This landscape allows for the calculation of a modelled &lsquo;contamination landscape&rsquo; (CL) adding location-based prolongation of infectivity. In that way, the risk per person can be derived in case of an outbreak. The CL concept is extremely flexible and can be adapted to various pathogen-specific settings. The combination of advanced measurements and specific modelling results in an instant list of possible recipients who need to be examined directly. The modelled, pathogen-specific parameters can be adjusted to get as close as possible to the results of mass screenings

Gesundheitliche Belastungen durch Extremwetterereignisse

Gesundheitliche Belastungen durch Extremwetterereignisse: Die Auswirkungen von Extremwetterereignissen wie Überschwemmungen, Starkregen, Stürme, Dürren und Temperaturextreme beeinträchtigen die menschliche Gesundheit auf verschiedene Weise. Unmittelbare Auswirkungen sind die Zunahme der Mortalität und Morbidität durch Unfälle und Verletzungen, extreme Hitze, Kälte und Wassermangel. Sekundäre Auswirkungen sind die durch Umwelt- und Ökosystemveränderungen geänderten Muster vektorübertragener und wasserbezogener Krankheiten sowie die Exposition gegenüber toxischen Substanzen. Tertiär können Extremwetterereignisse gesundheitsrelevante Versorgungsinfrastrukturen (Gesundheits- und Nahrungsmittelversorgung, Transport-, Elektrizitäts- und Kommunikationsinfrastruktur) beeinträchtigen. Neben kurzeitigen Gesundheitseinschränkungen können sich Extremwetterereignisse auch langfristig auf die Gesundheit auswirken. Die natürliche Exposition gegenüber Wetterextremen ist ebenso bedeutsam wie der Einfluss von anthropogenen Faktoren, welche sich auf die Vulnerabilität sowie Anpassungs- und Erholungskapazität einer Bevölkerung auswirken. So sind soziale und kulturelle Faktoren wie auch ökonomische, politische und technologische Determinanten von Bedeutung. Art und Ausmaß von Extremwetterereignissen führen jeweils unterschiedliche Risiken mit sich, welche die Gesundheit von Individuen oder ganzen Bevölkerungsgruppen beeinflussen können. Neben der physikalischen Kraft von Extremwettereignissen, wodurch körperliche Verletzungen und Todesfälle sowie Beschädigungen an kritischer Infrastruktur und Gebäuden resultieren, sind Extremwetterereignisse auch für Veränderungen des Auftretens von Infektionskrankheiten verantwortlich. Die Klimaelemente Wasser (Abwesenheit oder Überschuss) und Temperatur spielen bei verschiedenen Extremwetterereignissen eine entscheidende Rolle, indem sie Einfluss auf das Überleben, das Wachstum, den Transport und die Transmission von Krankheitserregern nehmen. Auch auf das Auftreten von nichtübertragbaren Krankheiten wirken sich Extremwetterereignisse aus. Um die gesundheitlichen Belastungen durch Extremwetterereignisse zu reduzieren, gilt es, Anpassungsstrategien und Schutzmaßnahmen zu etablieren. Health burdens due to extreme weather events: Extreme weather events, such as, floods, heavy rainfall, storms, droughts and temperature extremes can affect human health in various ways. Direct impacts may include an increase in mortality and morbidity due to accidents and injuries, exposure to extreme heat or cold, or due to water scarcity. Secondary impacts may include changes in vector-borne and water-borne diseases, as a result of environmental and ecosystem change, as well as exposure to toxic substances. Some tertiary effects of extreme weather events may include disruptions to health-related supply infrastructure, such as health care, food supply, transportation, electricity and communications infrastructure. In addition to the short-term consequences of extreme weather on health, extreme weather events can have longer lasting impacts. In an effort to understand how extreme weather events may affect populations, it is important to consider the interplay of anthropogenic factors that influence the overall vulnerability, adaptability and recovery capacity of populations. Therefore socio-economic, political, cultural and technological conditions must be considered. The type and extent of extreme weather events can trigger a variety of different associated risks, which may affect the health of only a group of individuals or the entire population. In addition to injury, death or damage to critical infrastructure, extreme weather events are also associated with the incidence of infectious diseases. Temperature and the absence or excess of water during or after extreme weather events, play crucial roles by influencing the survival, growth, transport and transmission of pathogens. Extreme weather events also have an impact on the occurrence of noncommunicable diseases. In order to reduce the impacts on health by extreme weather events, adaptation strategies and protective measures must be established

Der Einfluss urbaner Hitze auf die menschliche Gesundheit

Die Zunahme langer Episoden extremer Hitze in den vergangenen Jahrzehnten hat einen Anstieg hitzeassoziierter Morbidität und Mortalität zur Folge, insbesondere in Verbindung mit den Charakteristika des städtischen Klimas, die zur Ausbildung urbaner Hitzeinseln führen. In Städten und Kommunen steht daher zunehmend neben dem Klimaschutz die gesundheitsbezogene Klimaanpassung im Fokus. Gemäß den Empfehlungen der Weltgesundheitsorganisation (WHO) spielt dabei die Entwicklung von Hitzeaktionsplänen eine wichtige Rolle. Urban Heat as a health burden: The characteristics of cities are generating urban heat islands. The increase of episodes of extreme heat during the last decades is a major health burden. Heat waves in populated areas are accompanied by an increase of morbidity and mortality. Preparedness for climate change includes mitigation as well as health-related adaptation. Heat-Health Action Plans as recommended by World Health Organization (WHO) play an important role