OBJECTIVE: The influence of rurality on the duration of untreated psychosis (DUP) in first-episode psychosis (FEP) is poorly understood. We investigated factors associated with FEP in rural/urban settings and whether there are rural/urban differences in DUP and the mode (speed) of onset of psychosis.
METHODS: We used the Cambridgeshire and Peterborough NHS Foundation Trust Research Database (CPFTRD) to identify all persons presenting to an early intervention for psychosis service with FEP between 2013 and 2015. We performed descriptive statistics and multivariable linear and multinomial regression to assess the relationships between the study outcomes and the independent variables.
RESULTS: One hundred and fifty-five FEP patients were identified, with a mean age of 23.4 (SD, 5.3) years. The median DUP was 129.0 (IQR: 27.5-524.0) days. In rural areas, FEP patients were more likely to be employed and live with family than those in urban areas. A longer DUP was observed among patients with an insidious onset of psychosis compared with an acute onset (619.5 (IQR: 333.5-945.0)) vs. (17.0 (IQR: 8.0-30.5)) days respectively, p < 0.0001. We found evidence that the mode of onset of psychosis differed by employment status and living circumstances. There was insufficient evidence of rural/urban differences in DUP and mode of onset of psychosis.
CONCLUSIONS: Our results suggest that the mode of onset of psychosis is an important indicator of treatment delay and could provide vital information for service planning and delivery. Sociodemographic variations in FEP exist in rural populations, and our findings are similar to those observed in urban settings.

Grave\'s disease affects numerous patients globally, but its impact on health-related quality of life (HR-QoL) in relation to geographical disparities remains under-explored. This cross-sectional study aimed to assess the influence of urban versus rural residence on HR-QoL among patients diagnosed with Graves\' Disease in Rajasthan, India. One hundred seven Graves\' disease patients from rural and urban endocrine centers were analyzed. The rural group included 52 patients (24 males, 28 females), averaging 38.9 ± 10.9 years of age, while the urban group had 55 (13 males, 42 females) with an average age of 39.1 ± 14.2 years. We found differences between rural and urban patients in terms of gender ratio, BMI, smoking habits, and obesity. Multivariable linear regression was used in both groups to determine the association between the baseline characteristics of Graves\' patients from both areas and HR-QOL. Health-related quality of life, assessed via the SF-36 questionnaire, indicated higher general health and role emotional scores among urban patients. Our study found that the duration of Graves\' disease in rural centers negatively impacted physical health scores. In urban patients, age and BMI influenced physical health, while gender and disease duration affected mental health scores in rural patients. Age impacted mental health in urban patients. Rural patients had a poorer quality of life compared to urban patients. Differences in gender distribution, BMI, smoking habits, and obesity rates revealed disparities in Graves\' disease between rural and urban patients in India, highlighting the need for better healthcare infrastructure and awareness in rural areas.

Non-native species have the potential to detrimentally affect native species through resource competition, disease transmission, and other forms of antagonism. The western honey bee (Apis mellifera) is one such species that has been widely introduced beyond its native range for hundreds of years. There are strong concerns in the United States, and other countries, about the strain that high-density, managed honey bee populations could pose to already imperiled wild bee communities. While there is some experimental evidence of honey bees competing with wild bees for resources, few studies have connected landscape-scale honey bee apiary density with down-stream consequences for wild bee communities. Here, using a dataset from Maryland, US and joint species distribution models, we provide the largest scale, most phylogenetically resolved assessment of non-native honey bee density effects on wild bee abundance to date. As beekeeping in Maryland primarily consists of urban beekeeping, we also assessed the relative impact of developed land on wild bee communities. Six of the 33 wild bee genera we assessed showed a high probability (> 90 %) of a negative association with apiary density and/or developed land. These bees were primarily late-season, specialist genera (several long-horned genera represented) or small, ground nesting, season-long foragers (including several sweat bee genera). Conversely, developed land was associated with an increase in relative abundance for some genera including invasive Anthidium and other urban garden-associated genera. We discuss several avenues to ameliorate potentially detrimental effects of beekeeping and urbanization on the most imperiled wild bee groups. We additionally offer methodological insights based on sampling efficiency of different methods (hand netting, pan trapping, vane trapping), highlighting large variation in effect sizes across genera. The magnitude of sampling effect was very high, relative to the observed ecological effects, demonstrating the importance of integrated sampling, particularly for multi-species or community level assessments.

BACKGROUND: Non-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra.
METHODS: A convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion.
RESULTS: Out of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55-118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden.
CONCLUSIONS: The economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions.

UNASSIGNED: Recent studies showed increased mortality risks after hot nights, but their effect on hospitalizations, especially in vulnerable populations, remains under-studied.
UNASSIGNED: Daily hospitalization, meteorological (including hourly), and air pollution data were collected for the hot seasons (May-October) of 2000-19 in Hong Kong. We derived three hot-night metrics: HNday28 °C, daily minimum temperature ≥28 °C, the governmental definition of hot nights; HNe, hot night excess calculated by summing heat excess of hourly temperatures above 28 °C at night; and HNday90th, hot nights classified using the 90th percentile HNe (17.7 °C⋅h) as a cutoff. We fitted time-series regression with distributed lag nonlinear models to examine the associations of hot-night metrics with various hospitalizations.
UNASSIGNED: During the 3680 study days, 5,002,114 non-cancer non-external (NCNE) hospitalizations were recorded. Half (1874) of the days experienced excess nighttime heat (HNe>0) with a mean (SD) of 8.0 (6.8) °C⋅h; 499 and 187 hot nights were identified by HNday28 °C and HNday90th, respectively. Extreme HNe (99th percentile vs 0 °C⋅h) was significantly associated with increased NCNE hospitalizations over lag 0-4 days by 3.1% [95% confidence interval: 1.5%, 4.8%] overall, with enhanced effects in elderly (5.3% [3.2%, 7.4%]), low-SES individuals (5.3% [2.8%, 8.0%]), and circulatory admissions (3.4% [0.2%, 6.8%]). HNday90th, reflecting extreme HNe, better identified hazardous hot nights than the official HNday28 °C.
UNASSIGNED: Excessive nighttime heat is significantly associated with increased hospitalizations, particularly affecting the elderly and socioeconomically disadvantaged individuals. Nighttime heat intensity should be incorporated in defining hot nights with public health relevance.
UNASSIGNED: British Heart Foundation.

UNASSIGNED: Low levels of physical activity in high- to low-income countries, including South Africa, pose a great risk of cardiovascular-related diseases.
UNASSIGNED: This study aimed to assess and compare the physical fitness profile among children.
UNASSIGNED: The study setting comprised rural and urban primary school learners in the Eastern Cape province, South Africa.
UNASSIGNED: A cross-sectional study was adopted utilising a randomly selected sample of boys and girls aged 9-14 years. Physical fitness measures were assessed using the Euro-fit test battery. Some parametric tests were used for mean comparisons of the various anthropometric measurements and physical fitness characteristics across demographics.
UNASSIGNED: The sample consisted of 870 primary school learners. The average weight and height of the sample were 39.29 ± 10.34 kg and 144.06 ± 10.81 cm, respectively, with a mean body mass index (BMI) of 18.80 ± 4.11 kg/m2. The results showed that boys reported significantly high levels of physical fitness. Sit-ups (p ≤ 0.001) and VO2 max (p ≤ 0.001) significantly increase with age, while all the physical fitness measures were significantly higher among rural-based learners.
UNASSIGNED: Rural-based learners and boys generally had better physical fitness performance than their peers. The effect of gender and place of residence should be considered when designing physical fitness interventions.
UNASSIGNED: This study adds to the existing body of knowledge about the effect of demographic factors on the physical fitness profile of children, where boys and rural-based learners are reported to be more physically fit than their counterparts.

UNASSIGNED: Waist-based indicators of obesity are being used to detect central obesity and are predictive for metabolic syndrome (MS). The aim of the study is to assess the basic anthropometric indices in children, to determine the prevalence of overweight and obesity, and to determine the association between various waist-based measurements and body mass index (BMI).
UNASSIGNED: A cross-sectional study was conducted among children aged 10 to 15 years attending government corporation schools in Chennai. Basic anthropometric measurements were taken. BMI, waist circumference/height ratio (WHtR), and waist circumference/hip circumference ratio (WHR) were calculated. The percentiles (Indian reference cutoffs) were determined for waist circumference (WC) and BMI. The prevalence of overweight and obesity was determined and compared to waist-based parameters.
UNASSIGNED: Of 820 children, males constituted 47.1%. Stunting was seen in 9.8% and 7.8% were underweight. 8.2% had BMI less than the 3rd percentile. The prevalence of overweight and obese children was 9% and 3.2%, respectively, with female predominance. The majority had WC less than the 5th percentile. The prevalence of children under risk for MS based on WC >70th percentile was 4.5% and based on WHtR >0.5 was 8.2%. A significant association was identified between all waist-based anthropometric measurements to detect children at risk for MS and overweight/obese children as per BMI category. WHtR >0.5 was an indicator of overweight/obese children in logistic regression analysis.
UNASSIGNED: Early identification of children at risk of MS would require a combination of BMI to detect general obesity and waist-based anthropometric measurements to identify central obesity.

Artificial light at night (ALAN) is an increasingly pervasive pollutant that alters animal behaviour and physiology, with cascading impacts on development and survival. Recent evidence links exposure to ALAN with neural damage, potentially due to its action on melatonin synthesis, a powerful antioxidant. However, these data are scarce and taxonomically limited. Here, we used micro-CT to test the effects of short-term ALAN exposure on brain volumes in the Australian garden orb-weaving spider (Hortophora biapicata), a species commonly found in urban areas and, specifically, around street lights. We found that short-term ALAN exposure was linked to reductions in the volumes of brain structures in the primary eye visual pathway, potentially as a consequence of oxidative stress or plastic shifts in neural investment. Although the effects of ALAN were subtle, they provided new insights into potential mechanisms underpinning the behavioural and physiological impacts of ALAN in this important urban predator.

UNASSIGNED: Health-focused research funders increasingly support multi-country research partnerships that study health, urban development and equity in global settings. To develop new knowledge that benefits society, these grants require researchers to integrate diverse knowledges and data, and to manage research-related aspects of coloniality, such as power imbalances and epistemic injustices. We conducted research to develop a transdisciplinary study proposal with partners in multiple middle and high income countries, aiming to embed equity into the methodology and funding model.
UNASSIGNED: Parallel to literature review, we used participatory and social research methods to identify case study cities for our primary study and to inform our study design. We conducted semi-structured interviews with informed and consented sustainable urban development experts in the USA (n=23). We co-developed our research approach with our global advisory group (n=14) and conducted a participatory workshop (n=30) to identify case study sites, also informed by conversations with international academic experts in sustainable development (n=27).
UNASSIGNED: Through literature review we found that there is a need to study the contextual pre-conditions of urban transformation, the influence of coloniality on understandings of how cities can change and the failure of standard development practices to meet the needs of all residents and the planet. Through expert input and literature we found that decolonial and storytelling methods may help us show the complexities behind stories of urban transformation, particularly the role of marginalized populations in creating long-term change.
UNASSIGNED: There are multiple benefits of conducting research to develop an equitably designed multi-country research collaboration. We built new partnerships and co-developed our research approach, creating new understanding of diverse collaborators\' disciplinary perspectives and institutional requirements. By investigating the informational needs of U.S. sustainable development actors and designing our study to meet these needs, we have increased the likelihood that our research will create impact.
Project title: Mobilizing knowledge about urban change for equity and sustainability: developing ‘Change Stories’, a multi-country transdisciplinary study. Our team initially included researchers in London and later expanded to include international collaborators with expertise in urban development, public health and anthropology. This project was primarily conducted through online workshops and interviews (May – Dec 2022), with one in-person workshop in Valencia, Spain (Oct 2022). Research funders have recently increased support for multi-country partnerships that study urban health equity. However, there is often a lack of funding to develop these studies in a way that supports integration of diverse fields and manages research-related aspects of coloniality, such as power imbalances and devaluing certain forms of knowledge. We conducted research to develop a transdisciplinary study proposal with partners in multiple countries, aiming to embed equity into our approach. We used literature review alongside social research methods (94 participants) to develop case study cities and our study design. We found that community involvement in urban governance is important for achieving equity and health, yet it remains under-valued in status quo development models, undermining the potential for cities to support people and the planet. We believe that our approach offers valuable learning for other multi-country transdisciplinary studies.

BACKGROUND: Vitamin D deficiency (VDD) is conventionally associated with inadequate sunlight exposure. Ironically, recent evidence suggests a rising prevalence in urban areas of tropical regions like Sri Lanka, where comprehensive data are unavailable. This study aimed to estimate the prevalence of low vitamin D status in urban adults and its impact on serum calcium.
METHODS: A population-based cross-sectional study was conducted among 1260 adults aged 35-74 years, living in Colombo, the most urban district in Sri Lanka. They were recruited from 63 administrative divisions, using multi-stage, probability-proportionate-to-size, cluster sampling. Non-fasting venous blood was collected without tourniquet. Low vitamin D (< 30.0 ng/mL), VDD (< 20 ng/mL) and vitamin D insufficiency (20.0-29.9 ng/mL) were determined using chemiluminescence assay method, and serum calcium using Calcium Gen2 reagent.
RESULTS: Among the population (53.3% females; mean age = 51.8 years), the prevalence of low vitamin D was 93.9% (95% CI: 92.5-95.2). This was primarily due to VDD (67.5%; 95% CI: 64.9.0-70.1%), with some insufficiency (26.4%; 95% CI: 24.0-28.9%). Most VDD cases (53.9.0%) were \'mild\' (10.0- < 20.0 ng/mL) in severity, with fewer \'moderate\' (12.8%) and \'severe\' (0.8%) cases. Prevalence of VDD was highest in females, aged 35-44-years, living in \'highly urban\' areas and of Tamil ethnicity. Further, VDD showed a decreasing trend with older age groups, while it was significantly more prevalent in females than males (72.6% vs. 61.7%; p < 0.01), across all age groups. Low serum calcium levels were observed in 9.8% of adults with low vitamin D, compared to 22.4% with normal vitamin D, implying that there could be factors other than vitamin D in maintaining serum calcium levels.
CONCLUSIONS: Colombo District, representing urban settings in Sri Lanka faces a high prevalence of low vitamin D, primarily VDD, with higher rates in females, younger individuals and highly urban areas. These findings challenge assumptions about tropical regions being guaranteed of optimal vitamin D levels; and underscore the need for national vitamin D supplementation and food fortification programs, especially in high-risk urban settings in South Asian countries like Sri Lanka.