This article examines the role of coworking and flexible workspaces in promoting sustainable spatial development in the non-metropolitan areas of Bulgaria. A mixed-method approach was applied, combining inventory enumeration, spatial classification, SDG-based sustainability assessment, and qualitative coding (open, axial, selective). A total of 74 coworking and flexible workspaces were identified across the six national planning regions, evaluated according to six analytical criteria (accessibility, seasonality, specialization, municipal administrative district, urban planning zone, building function) and assessed against five SDG-aligned dimensions (SDG 8, 9, 11, 12, 13). The results reveal uneven territorial distribution, strong concentration in major cities outside the capital, and emerging sustainable models in peripheral areas. Comparative SDG scoring and typological interpretation demonstrate three recurring models—Sustainable Reuse, Nature-Oriented, and Innovative/Experimental—each associated with distinct spatial and environmental characteristics. A metropolitan benchmarking exercise further contextualizes the strongest sustainability profiles. Based on these findings, a conceptual sustainable coworking model is developed for a nationally significant spa and climatic resort, illustrating how coworking can address regional disparities, support green transition policies, and reinforce territorial cohesion. The article concludes by outlining research directions related to digitalization, circular construction, environmental performance indicators, and feasibility assessments for non-metropolitan coworking development.
Xucheng Fred Huang, Qingyang Zhu, Rebecca Zhang
et al.
Abstract Ambient air pollution and seasonal influenza both contribute to respiratory morbidity, yet their potential synergistic effects remain unclear. Understanding how these two exposures interact is crucial for developing integrated health protection strategies. We conducted a time-series analysis to assess whether community-level influenza activity modifies the short-term associations between air pollution and respiratory emergency department (ED) visits. We acquired daily ED visits for all respiratory illnesses, pneumonia, asthma, and chronic obstructive pulmonary disease (COPD) from six U.S. metropolitan areas (2005–2017). Weekly influenza activity was measured by laboratory-confirmed influenza hospitalization rates from hospital surveillance system. We used quasi-Poisson models to estimate associations between PM2.5 and NO2 levels and ED visits during the influenza season. Effect modification by influenza activity was examined through quartile level and spline-based interaction terms. PM2.5 was consistently associated with all respiratory outcomes, while NO₂ associations were more variable across locations. Adjustment for influenza activity slightly attenuated air pollution and ED visit associations. We observed evidence of positive effect modification by influenza activity, which varied by pollutants, outcomes and locations. For example, in Atlanta the relative risk for respiratory ED visits per interquartile range increase in PM2.5 was 1.035 (95% CI: 1.020, 1.051) during peak influenza periods (4th quartile) versus 0.998 (0.975, 1.021) during low influenza periods (first quartile). In San Francisco, the corresponding relative risks were 1.013 (95% CI: 1.006, 1.024) versus 0.999 (0.993, 1.006). Highest NO2 associations were also during peak influenza periods in pooled analyses of pneumonia and COPD ED visits. Influenza activity modifies short-term associations between air pollution and respiratory ED visits in complex, non-linear ways, with amplification during moderate or high influenza circulation. These findings highlight the need for integrated air quality and infectious disease surveillance to mitigate seasonal respiratory health burdens.
Harsh G Kamath, Tzu-Shun Lin, Naveen Sudharsan
et al.
To simulate realistic impact of rooftop-based heat mitigation strategies (HMS), we introduce a new capability in the Weather Research and Forecasting model coupled with the building effect parameterization urban physics module. This enhancement allows the model to ingest two dimensional fields of grid aggregated roof albedo and fractional rooftop area availability for HMS implementation. By incorporating these spatially varying inputs, the model overcomes previous limitations that relied on idealized scenarios. Using Austin, Texas, as a testbed metropolitan area, we assessed the realistic potential for cooling the city by reducing the 2 m air temperature ( T _2M ) and universal thermal climate index (UTCI) through various HMS. Specifically, we evaluated cool roofs, green roofs, and solar photovoltaics under two scenarios: (i) complete roof area coverage and (ii) realistic implementation based on the available flat (non-pitched) roof area. Additionally, we implemented urban gardens and street trees and assessed their effectiveness in reducing T _2M and UTCI. All experiments, including a control scenario without any HMS, were conducted during clear-sky days in August 2020, which was one of the hottest months recorded in Austin. The results indicate that while cool and green roofs are effective, their effectiveness is obfuscated in the city-wide mean T _2M and UTCI reduction. Further, the realistic implementation of HMS had a negligible impact on city-wide mean T _2M and UTCI. Nevertheless, these realistic rooftop simulations demonstrated potential for localized cooling in some areas of the city. Combining realistic rooftop-based HMS with urban gardens and street trees similarly resulted in limited city-wide cooling while yielding noticeable cooling in some grid cells. Street trees showed a large potential for locally reducing UTCI. These findings have direct implications for urban planning and heat mitigation approaches, as they highlight the need for evaluating HMS based on local (e.g. urban-block-scale) impacts using realistic implementation constraints, rather than emphasizing city-wide reductions in T _2M or UTCI.
Resumo Dados do Censo Demográfico de 2022, já disponibilizados, permitiram uma leitura das principais evidências da metropolização no País, percebidas na evolução da distribuição da população, do grau de urbanização, na consolidação das grandes concentrações urbanas, metropolitanas e não metropolitanas, e em seus vetores de expansão. Tal leitura se complementa apontando as principais características, em 2022, dos domicílios e suas condições de saneamento, e das pessoas residentes, em sua composição por cor ou raça, perfil etário e razão de sexos. Foram considerados quatro recortes de análise, que abrangem os 5.570 municípios brasileiros, minuciosamente cobertos pelo Censo. Como resultado da exploração desses dados, além de um retrato sucinto dos processos populacionais, pode-se apontar grandes desafios para a pesquisa, formulação de políticas públicas e gestão urbana.
This study proposes a holistic, principle-based approach to Istanbul’s transportation problems instead of fragmented solutions. A three-stage analytical methodology was developed to evaluate Istanbul’s transportation system from a principle-oriented perspective. In the first stage, 12 principles shaped by a sense of stewardship were identified based on current literature and expert insights. These principles were grouped under four thematic pillars and prioritized using the Analytic Hierarchy Process (AHP). In the second stage, the current transportation policies of the Istanbul Metropolitan Municipality (IMM) were evaluated by experts. These evaluations were then clustered using the K-Means method, and the resulting clusters were interpreted to prioritize the identified problem areas. In the final stage, strategic documents and project proposals were assessed through a principle-alignment analysis and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method, respectively. In this way, the strategies and projects most closely aligned with the identified principles were systematically revealed. By integrating qualitative and quantitative analyses (expert judgments, AHP, K-Means, TOPSIS) within a mixed-methods framework, the research aims to provide decision-makers with a viable and objective basis for transportation policy development.
Artika Archana Kumari, Tafheem Ahmad Wani, Michael Liem
et al.
BackgroundDisparities in health equity between metropolitan and rural areas are a global concern, especially in vast countries such as Australia, Canada, and the United States. Virtual care models in health care settings are promising in reducing inequalities, with virtual hospitals (VHs) potentially bridging the gap for isolated or underserved regions. However, evidence-based strategies and the complexities of VH implementation necessitate further research.
ObjectiveThis rapid review aims to examine the role of VHs in enhancing regional and remote health care by focusing on accessibility, patient and health care provider experiences, and implementation barriers and facilitators. It provides tailored recommendations for large-scale implementation in communities with access issues, contributing to the discussion on equitable health care.
MethodsA rapid review was conducted in accordance with the World Health Organization guidelines. A systematic search was performed across PubMed, MEDLINE, CINAHL, and the La Trobe University Library for peer-reviewed articles published between January 2015 and March 2023. Additional gray literature was identified through Google searches and snowballing from relevant web articles. Studies were included if they focused on regional or remote populations and addressed VHs or virtual care. Studies that solely discussed hybrid models of care were excluded. Data were systematically extracted using a customized Microsoft Excel template. A mixed methods thematic analysis was conducted to identify recurring themes, barriers, facilitators, and recommendations related to VH implementation as well as patterns in clinical outcomes and stakeholder perspectives.
ResultsA total of 35 articles were included in this review, comprising 23 (66%) peer-reviewed studies and 12 (34%) gray literature sources. Positive clinical outcomes were reported in 9 (26%) articles, highlighting outcomes such as reduced disease transmission, improved patient safety, fewer admissions and readmissions, lower mortality, shorter hospital stays, and better adherence to clinical best practices. Health system outcomes were identified in 15 (43%) articles, including reduced costs, enhanced patient experience and safety, improved care delivery and health care provider support, greater efficiency, broader geographic coverage, and better integration of services. Patient and health care provider perspectives were discussed in 12 (34%) articles, with positive views attributed to convenience, time and cost savings, and improved service quality. Barriers and facilitators were the most frequently discussed themes, appearing in 27 (77%) and 26 (74%) articles, respectively, with challenges and enablers commonly linked to people, processes, technology, and financial sustainability.
ConclusionsVHs have the potential to revolutionize regional and remote health care by overcoming barriers, using facilitators, and following recommended practices, leading to better clinical outcomes and increased satisfaction for patients and health care providers.
Saad Ahmed Waqas, Dua Ali, Taimor Mohammed Khan
et al.
ABSTRACT Background Recent research has shown that type 2 diabetes mellitus (T2DM) has increased the burden of Alzheimer's disease (AD) in the US aging population. However, trends in mortality from this comorbidity among adults aged ≥ 65 years have not been investigated. Objectives This study examined trends and disparities in AD‐related mortality among older US adults with T2DM from 1999 to 2019. Methods Data from the CDC WONDER database were analysed to assess AD‐related mortality in patients with T2DM aged ≥ 65 between 1999 and 2019. Age‐adjusted mortality rates (AAMRs) per 100,000 people and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, age, urbanisation and geographical region. Results From 1999 to 2019, there were 71,550 deaths with T2DM and AD among adults aged ≥ 65. AAMRs rose from 4.12 in 1999 to 11.65 in 2019, with the sharpest increase between 2014 and 2017 (APC: 10.81; 95% CI: −3.20 to 13.43). Women had slightly higher AAMRs than men, with rates increasing from 4.71 in 1999 to 11.61 in 2019 for women, and from 4.08 to 11.70 for men. Hispanic individuals saw the highest increase in AAMR (11.15), followed by non‐Hispanic Black (9.30) and White populations (7.92). AAMRs were highest in the West (10.91) and the Midwest (9.62), while the Northeast (4.70) had the lowest. Nonmetropolitan areas had consistently higher AAMRs (10.74) than large metropolitan areas (6.68) and small/medium metropolitan areas (9.25). States in the top 90th percentile for T2DM–AD mortality included California, South Dakota and Kentucky, where rates were approximately eight times higher than in states in the lowest 10th percentile. Conclusions This study reveals a significant rise in T2DM–AD comorbidity‐related mortality among older adults, especially among Hispanics, women and rural residents. These findings underscore the need for targeted interventions to reduce the burden in vulnerable populations.
Diseases of the endocrine glands. Clinical endocrinology
Rural homestays have emerged as pivotal drivers of rural socioeconomic revitalization, particularly in metropolitan peripheries characterized by intensified urban–rural dynamics. However, their spatiotemporal distribution patterns and underlying mechanisms remain underexplored. This study employs Geodetector and related analytical methods to examine rural homestays in Beijing, aiming to decipher spatial heterogeneity and driving factors. The results reveal a distinct “large-scale dispersion with small-scale clustering” pattern marked by pronounced agglomeration in northern mountainous areas and sparse distributions in southern suburban regions. Temporally, the sector currently exhibits a notable expansion–contraction phase influenced by external factors, alongside spatial centroid migration toward resource-rich zones. Geodetector quantification identifies the proximity to transportation nodes and vegetation coverage as primary spatial determinants, while socioeconomic factors demonstrate comparatively limited influence—contrasting sharply with urban contexts. Rural homestay concentration zones are classified into high-, medium-, and low-intensity categories based on the homestay density, with high-intensity zones leveraging apex advantages of scenic resources, cultural heritage, and infrastructure. These findings underscore the interplay of natural environmental factors, tourism resources, transportation accessibility, and socioeconomic conditions in shaping agglomeration dynamics, providing actionable insights for optimizing spatial planning and promoting sustainable development in rural regions adjacent to megacities.
Valeria Vitulano, Giulio Gabriele Pantaloni, Antonio Bocca
et al.
In a context of environmental and socio-economic challenges, metropolitan areas represent a fundamental territorial scale for addressing cohesion, competitiveness, and sustainability, key priorities in European territorial development. Accessibility to services is crucial, as it reflects the right to full citizenship, particularly in territories where attractive urban centres coexist with peripheral areas. Balancing these dynamics is a major challenge for metropolitan governance and planning, especially in Italy, where Metropolitan Cities (MCs) have been institutionalised for over a decade. This paper examines spatial structure, accessibility, and governance through a comparative analysis of three Italian MCs in the Po Valley macro-region, a polycentric system along the Mediterranean Corridor of the Trans-European Transport Network. Despite overall interconnections, the MCs display different settlement and accessibility patterns. The Metropolitan City of Turin is selected as a case study for its territorial diversity, metropolitan-mountainous character, misalignment between administrative and functional boundaries, and accessibility limitations. The research examines current planning instruments and governance-government arrangements of the case study in addressing these challenges. Findings, framed within the decadal review of Italian MCs, emphasise the need for greater coordination between plans, policies and programmes, combined with strengthened inter-municipal collaboration and territorial representation, to support a multi-level governance framework capable of coherent, effective, and balanced metropolitan development.
Urban shrinkage, characterised by long-term demographic, socio-economic and spatial changes, has been studied extensively, including via research into causes, typologies, and planning responses. However, while understanding and measuring urban shrinkage processes is crucial if policymakers are to respond adequately to cities’ challenges, multi-criterion studies on shrinkage trajectories are still required for the spatiotemporal complexity to be captured correctly. This study reviews methods by which urban shrinkage is studied and concludes with a selection of multi-criterion methods that offer more in-depth insight than population-based methods. Finally, a multicriteria analysis, adapted from Milbert (2015), is applied to measure urban shrinkage in Poland in the years 2006 to 2021. This incorporates six variables with a view to shrinking and growing cities being assessed and assigned to one of five categories.
The research provides insights into Poland’s most recent urban shrinkage processes. Results show that, over the analysed period, urban shrinkage was a phenomenon that increased and intensified in Poland, affected a growing number of urban centres of medium size, and was to be noted on the peripheries of metropolitan areas. Such research outcomes contribute to a better understanding of urban shrinkage in Poland, provide a basis for further research, and inform policymakers as they seek to formulate more-targeted strategies to address the specific challenges that urban shrinkage raises.
Pedro Luis Barbosa de Almeida, Flávia Noronha Dutra Ribeiro
Abstract The Urban Heat Island (UHI) effect, where urban regions experience higher temperatures than their rural counterparts, is a well-observed phenomenon with consequences such as health issues and increased energy consumption. In the Metropolitan Area of São Paulo (MASP), a dense urban zone with over 20 million inhabitants, the UHI effect is intensified due to rapid and unplanned urbanization. This research utilized meteorological data from MASP's weather stations and employed the k-means clustering algorithm to identify regions with pronounced UHI intensity. The study revealed four distinct clusters, with Cluster A exhibiting the most significant UHI effect. This effect was related with land use patterns, particularly the dominance of residential and commercial areas and a lack of green spaces. Seasonal variations in the UHI effect were also observed. The findings highlight the impact of urban development on localized climate change and provide valuable insights for urban planning and policy-making in MASP. Future studies could expand on these findings by including more variables and examining other global urban regions.
Despite the high symbolic and political values granted to Jerusalem, the city’s net migration balance has been negative for several decades, within the Israeli as well as within the Palestinian population. Similarly, despite the fact that Jerusalem is designated as capital city by the Hebrew State, and claimed as capital by the Palestinian Authority, the migration’s movements affecting Jerusalem are not exclusively political, even if political grounds may explain part of the flow. Indeed, “classical” economic factors, such as the cost of housing, unemployment and job search, might play a significant role in the dynamics of demographic attraction and repulsion to and from Jerusalem. In addition, two metropolitan areas have gradually developed around Jerusalem, one concerning the Israeli population, the second concerning the Palestinian population. Within these metropolitan areas, suburbs are attracting more and more inhabitants, expressing an urban spread process that nowadays affect most of the metropolitan cities in the world.
Abstract Objective To explore the relationship between distance traveled and rurality to clinical timepoints and 2‐year disease free survival (DFS) in newly diagnosed HNC patients. Methods This study was conducted through retrospective analysis, with key independent variables including distance to academic medical center and rurality score. To better understand delays in care, the sample was divided into two groups based on an optimal treatment timeline. We then assessed for the impact of distance traveled. Results A higher proportion of patients in the optimal treatment timeline group resided in metropolitan areas, which also had a lower mean index of medically underserviced score. Patients in this group had a shorter duration from first presentation for HNC to presentation to an academic medical center and a shorter duration from referral to presentation. However, there was no significant difference in 2‐year DFS between the groups. Those who lived closest to Upstate were more likely to identify as Black. Those who live in suburban communities around Upstate were most likely to initiate treatment within 1 month of presentation. Those who live farthest from Upstate were the least likely to have an HPV‐negative cancer of the head and neck, and more likely to receive surgery as part of treatment and to receive a biopsy prior to presenting to Upstate. Conclusions Despite differences in distance traveled and rurality between communities, there was no impact on 2‐year DFS. Together, we suggest that these findings support that socioeconomic and patient factors, instead of travel distance alone, impact HNC workup patterns. Level of Evidence Level III.
The main purpose of the study is to examine the impact of drastic and proactive forest fire interventions, which are applied to avoid the risk of loss of life and property close to urban areas, on the continuity of plant species with fire-adapted characters and the potential to cause species loss. In this context, the basic assumption of the study is that the reduced frequency of fires caused by suppressed fires in natural areas in order to avoid the risk of forest fires that may affect residential areas, will lead to the reduction of various plant species that sustain their lives thanks to their fire-adaptive characters. As a qualitative data analysis method, the rates of urban and forest areas, the number of forest fires, the amount of burned area and plant species diversity data were used to deal with the study data with document analysis. In the selection of the 10 metropolitan cities that constitute the sample area of the study, the criteria of being in the Mediterranean ecosystem, containing plant species adapted to fire, and being metropolitan (where natural and built environment elements are intertwined) were taken as basis. The study will create an ecological perspective in fire prevention policies and strategies to be developed through the determination of plant species characteristics in large cities located in the fire-prone Mediterranean ecosystem.
AbstractInvestigating the impact of social support on elderly well-being during the COVID-19 pandemic is crucial, given its absorptive potential in mitigating the adverse effects of distressful circumstances. This study examines the influence of socio-demographic characteristics and social support on the well-being of older adults (aged 50+) in Ghana. The study utilized a cross-sectional survey with a quantitative approach to collect data from 400 older adults residing in the Accra and Kumasi metropolitan areas. Purposive and snowball sampling techniques were used to recruit the participants. Categorical regression analysis was employed to estimate the associations between socio-demographic factors, social support dimensions, and the well-being of older adults. Of the eleven variables used, six were significant predictors of well-being. In their order of importance, enacted social support (β = 0.496), social integration (β = 0.252), perceived social support (β = 0.149), educational level (β = 0.121), gender (β = 0.074), and employment status (β = -0.017) were the predictors of well-being among the sample. The strongest and weakest predictive factors of well-being within the sample are enacted social support and employment status, respectively. The study emphasizes that focus should not solely be on socio-demographic factors when addressing the well-being of older adults during distressful situations like the COVID-19 pandemic. Instead, it highlights the paramountcy or primacy of social support in mitigating the harmful impact of the pandemic on their well-being. Interventions should prioritize strengthening older individuals’ access to diverse social support options for enhanced well-being.
Rahnee A. Karge, Colin M. Curtain, Mohammed S. Salahudeen
<i>Background and Objectives:</i> Schizophrenia, a debilitating mental illness, is often associated with significant physical health risks. Many second-generation antipsychotics increase the risk of metabolic syndrome and cardiovascular disease. Community pharmacists are highly accessible and could play a role in monitoring cardiometabolic adverse drug events in people with schizophrenia. However, it remains uncertain whether mental health professionals perceive this as valuable. This study aimed to explore the opinions of mental healthcare professionals regarding the role of community pharmacists in reducing the incidence of cardiometabolic adverse events in people with schizophrenia and their integration into a multidisciplinary mental health team. <i>Materials and Methods:</i> Qualitative semi-structured interviews were conducted with Australian psychiatrists, mental health nurses and mental health pharmacists. Transcription of the interviews underwent thematic analysis using an inductive approach. <i>Results:</i> Eleven mental healthcare professionals from metropolitan and regional areas across Australia were interviewed, leading to the identification of five overarching themes. These themes encompassed the following aspects: the benefits of community pharmacists’ involvement in managing cardiometabolic adverse drug events in people with schizophrenia, improving communication pathways with community pharmacists, defining roles and responsibilities for monitoring cardiometabolic parameters and managing adverse cardiometabolic drug events, fostering collaboration between community pharmacists and mental health care professionals, and recognising the acceptance of community pharmacists’ integration within a multidisciplinary team. Mental health professionals believed that community pharmacists could play a role in reducing the incidence of cardiometabolic adverse events in schizophrenia. However, they underscored the need for enhanced communication and collaboration pathways with other healthcare professionals, emphasised the importance of more comprehensive mental health first aid training, and identified potential barriers for community pharmacists such as remuneration, workload, and staff resources. <i>Conclusions:</i> Mental health professionals acknowledged the benefits of incorporating community pharmacists into multidisciplinary teams as a strategy to reduce the incidence of adverse events among individuals with schizophrenia. They recognise the competence of community pharmacists in monitoring cardiometabolic adverse events. However, these professionals have also highlighted specific perceived barriers to the complete integration of community pharmacists within these teams. Notably, there are concerns related to remuneration, staff resources, time constraints, acceptance by other healthcare professionals and patients, and the need for improved communication pathways. Addressing these barriers and providing targeted training could facilitate the valuable inclusion of community pharmacists in the comprehensive care of people with schizophrenia.