Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study.

Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(ß) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(ß) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion.

Bridging therapeutic landscapes to architecture. International experience-based design strategies for healthcare infrastructures.

BACKGROUND AND AIM: in Italy, many cases studies of therapeutic green spaces are built into healthcare infrastructures, but only some of these follow the principles of healing gardens. Scientific literature and international case studies offer many contributions of evidence relating to how therapeutic green spaces can support traditional treatments. The paper analyze the relationship between indoor and outdoor spaces and healing gardens' features; the main research questions were: "Can we synthetize experience-based design strategies for therapeutic green spaces and healing gardens? How can we prioritize the most relevant ones for the healthcare infrastructures?" METHODS: Research Method is divided into three different steps: 1st case studies' selection; 2nd case studies' analysis, and 3rd quali-quantitative comparative matrix. RESULTS: ten case studies were identifiedfour of them have the therapeutic green space on the ground floor,despite of the other six having the healing garden on the rooftop.The best experience-based design strategies for the therapeutic green spaces or healing gardens development were identified from the previous comparison matrix, and divided into A.Safety, Security and Privacy; B.Accessibility; C.Physical and Emotional Comfort; D.Positive distraction; E.Engagement with Nature; F.Maintenance and Aesthetics; and G.Sustainability. CONCLUSIONS: The results obtained from the comparative matrix are qualitative and quantitative design elements in terms of type of element / space, percentage, perimeter, area, number, materiality, shape, color, among others. The quali-quantitative matrix is a useful and practical tool that allows the designer to have a base of design guidelines that can be later applied to the proposal of new therapeutic gardens.

Covid-19 emergency management and preparedness in cross-border territories. Collection of experiences, needs and public health strategies in the framework of interreg GESTI.S.CO. project.

BACKGROUND AND AIM: The Covid-19 pandemic highlighted management difficulties in neighboring territories. The aim of the paper is to report the needs of different stakeholders during, before and after Covid-19 emergency with specific regard to challenges faced by public administrators in confined territories. METHODS: In the framework of Interreg GESTI.S.CO. project the study has been designed with two methodological steps: i) a co-design workshop and ii) a web-based survey. The workshop includes both an audience interaction session and focus groups. Then, starting from the focus group results, the survey has been designed with 30 questions and submitted to the 227 municipalities located between Italy and Switzerland to understand the implementation of Public Health strategies in local emergency planning. RESULTS: The interactive session highlighted that most of the critical issues are related to the lack of communication and planning in Public Health policies. The survey highlighted that the local emergency plans rarely integrate a section on health emergencies (30% Italy and 50% Switzerland). Only 20% of the respondents dedicated a section for Covid-19 emergency management. Most of them did not activate initiatives to support mental health. 90% of the municipalities did not cooperate with the neighboring country, but half of them think that it would have been much more useful. The 55% of the Italian respondents are currently updating their emergency plan and will implement it with some Public Health input. CONCLUSIONS: The study provides insights that can support policy makers in improving their strategy in responding to future pandemic. (www.actabiomedica.it).

Can Homes Affect Well-Being? A Scoping Review among Housing Conditions, Indoor Environmental Quality, and Mental Health Outcomes.

The purpose of the scoping review is to explore the relationship between housing conditions, indoor environmental quality (IEQ), and mental health implications on human well-being. In fact, time spent at home increased due to the recent COVID-19 lockdown period, and social-sanitary emergencies are expected to grow due to the urbanization phenomenon. Thus, the role of the physical environment in which we live, study, and work, has become of crucial importance, as the literature has recently highlighted. This scoping review, conducted on the electronic database Scopus, led to the identification of 366 articles. This, after the screening processes based on the inclusion criteria, led to the final inclusion of 31 papers related specifically to the OECD area. The review allowed the identification of five housing conditions [house type, age, and floor level; housing qualities; household composition; neighborhood; green spaces] that, by influencing the IEQ parameters, had impacts on the mental health outcomes addressed. By synthesizing the contributions of the review, a list of design recommendations has been provided. These will serve as a basis for future researchers, from which to develop measures to reduce inequalities in housing by making them healthier, more resilient, and salutogenic.

Communities, Sport, Inclusion. Strategies for Parish Complexes Social Reactivation Through Sport Practice Promotion.

The following contribution presents some findings deriving from the research project "Sport is Society" by Politecnico di Milano. The research reflects on the built heritage and its ability to be accessible and usable for different users with different needs in its structures and offer of services, focusing on sports activities and spaces. The study refers to collective ecclesiastical structures in the contemporary city. The research in this area demonstrates the possible degrees of innovation regarding the increase in the inclusiveness of private facilities with a public vocation, where sport represents a driver of social inclusion for the community. The research proposes advice to guarantee inclusive sports facilities for the community, highlighting the strict relationship between the inclusive city and the ecclesiastical heritage, as an emerging issue to be investigated and solved. Starting from its relevance and the potential of the structures to become a truly "accessible patrimony", the tool suggests strategies for policymakers and ecclesiastical administrations to make them become "open services" - usable and accessible by all - for and inside the urban community.

Association between Urban Greenspace and Health: A Systematic Review of Literature.

The current review aimed to explore the association between urban greenspaces and health indicators. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure and two selected health outcomes (objectively measured physical activity (PA) and mental health outcomes (MH)). Two electronic databases-PubMed/Medline and Excerpta Medica dataBASE (EMBASE)-were searched from 1 January 2000 to 30 September 2020. Only articles in English were considered. Out of 356 retrieved articles, a total of 34 papers were included in our review. Of those, 15 assessed the association between urban greenspace and PA and 19 dealt with MH. Almost all the included studies found a positive association between urban greenspace and both PA and MH, while a few demonstrated a non-effect or a negative effect on MH outcomes. However, only guaranteeing access is not enough. Indeed, important elements are maintenance, renovation, closeness to residential areas, planning of interactive activities, and perceived security aspects. Overall, despite some methodological limitations of the included studies, the results have shown almost univocally that urban greenspaces harbour potentially beneficial effects on physical and mental health and well-being.

COVID-19 and Living space challenge. Well-being and Public Health recommendations for a healthy, safe, and sustainable housing.

BACKGROUND AND AIM OF THE WORK: The ongoing pandemic of COVID-19 is a strong reminder that the lockdown period has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the built environment, both outdoor and mainly the indoor spaces: housing, workplaces, public buildings, and entertainment facilities. How can we re-design the concept of Well-being and Public Health in relation to the living places of the future? METHODS: According to the previous statements and scenario, this paper aims to integrate the building hygiene and well-being, focusing the possible responses, both existing and for the new buildings, taking home a strong message from this "period" of physical distancing. RESULTS: The Well-being and Public Health recommendations for a healthy, safe, and sustainable housing are framed into the following key points: 1. Visible and accessible green elements and spaces; 2. Flexibility, adaptability, sharing, and crowding of living spaces, and compliant functions located into the buildings; 3. Re-appropriation of the basic principles and archetypes of sustainable architecture, thermal comfort and Indoor Air Quality (IAQ); 4. Water consumption and Wastewater Management; 5. Urban Solid Waste Management; 6. Housing automation and electromagnetic fields; 7. Indoor building and finishing materials. CONCLUSIONS: The Well-being and Public Health recommendations for a healthy, safe and sustainable housing may provide a useful basis for Designers, Policy Makers (fostering tax incentives for building renewal), Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform living places in healthier and Salutogenic spaces.

COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities.

BACKGROUND AND AIM OF THE WORK: The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the systems and local capacities to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities? METHODS: According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the "period" of physical distancing.  Results. Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism.  Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities. CONCLUSIONS: The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments. (www.actabiomedica.it).

New competences to manage urban health: Health City Manager core curriculum.

A core curriculum is an essential step in development knowledge, competences and abilities and it defines educational content for the specialized area of practice in such a way that it can be delivered to new professional job. The Health City Manager core curriculum defines the strategic aspects of action to improve health in cities through a holistic approach, with regard to the individual, and a multi-sectoral approach, with regard to health promotion policies within the urban context. The Health City Manager core curriculum recognizes that the concept of health is an essential element for the well-being of a society, and this concept does not merely refer to physical survival or to the absence of disease, but includes psychological aspects, natural, environmental, climatic and housing conditions, working, economic, social and cultural life - as defined by the World Health Organization (WHO). The Health City Manager core curriculum considers health not as an "individual good" but as a "common good" that calls all citizens to ethics and to the observance of the rules of civil coexistence, to virtuous behaviours based on mutual respect. The common good is therefore an objective to be pursued by both citizens and mayors and local administrators who must act as guarantors of equitable health ensuring, that the health of the community is considered as an investment and not just as a cost. The role of cities in health promotion in the coming decades will be magnified by the phenomenon of urbanization with a concentration of 70% of the global population on its territory.

Healthy Design and Urban Planning Strategies, Actions, and Policy to Achieve Salutogenic Cities.

Starting from a previous experience carried out by the working group "Building and Environmental Hygiene" of the Italian Society of Hygiene and Preventive Medicine (SItI), the aim of the present work is to define new strategic goals for achieving a "Healthy and Salutogenic City", which will be useful to designers, local governments and public bodies, policy makers, and all professionals working at local health agencies. Ten key points have been formulated: 1. climate change and management of adverse weather events; 2. land consumption, sprawl, and shrinking cities; 3. tactical urbanism and urban resilience; 4. urban comfort, safety, and security perception; 5. strengths and weaknesses of urban green areas and infrastructures; 6. urban solid waste management; 7. housing emergencies in relation to socio-economic and environmental changes; 8. energy aspects and environmental planning at an urban scale; 9. socio-assistance and welfare network at an urban scale: importance of a rational and widespread system; and 10. new forms of living, conscious of coparticipation models and aware of sharing quality objectives. Design strategies, actions, and policies, identified to improve public health and wellbeing, underline that the connection between morphological and functional features of urban context and public health is crucial for contemporary cities and modern societies.

[Hygienic and sanitary aspects in urban planning: contradiction in national and local urban legislation regarding public health]. / Aspetti igienico-sanitari in ambito urbanistico: conflittualità nelle norme urbanistiche nazionali e locali in tema di sanità pubblica.

Nowadays, the majority of world population lives in urban areas and this portion is going to increase in the coming decades. The health impact of urban areas is well established and described in scientific literature. Italian health and hygiene legislation dealing with urban health is fragmented and not coordinated with the regulation about environment and city planning. The overlapping of legal competences between different authorities and the conflict of attribution between the Central State and Regional Governments deeply contributed to generate uncertainty. The authors here analyse the Italian regulatory framework and depict its lacks in terms of public health protection.

Indoors and health: results of a systematic literature review assessing the potential health effects of living in basements.

A new law approved in March 2017 in the Lombardy Region makes it possible to live in basements. Basements are defined as buildings partly below curb level but with at least one-half of its height above the curb. Basements' features and structural characteristics might pose risks to human health. In this paper we adopt a multidisciplinary approach to assess the potential health effects of living in basements. In particular, we define a conceptual framework to describe basements' structural characteristics which are risk factors, as well as the mechanisms through which they impact on human health. We also conduct a systematic review on the scientific databases PubMed,Embase, DOAJ, Proquest and EBSCO to retrieve, pool and critically analyze all available research that quantified the risk of living in basements for different health outcomes. Available evidence suggests living in basements increases the risk of respiratory diseases (asthma and allergic disorders); more heterogeneous data are available for cancers and cardiovascular diseases. As more quantitative data need to be prospectively retrieved to assess and monitor the risk of living in basements for human health, clear minimum requirements for light, air, sanitation and egress are to be defined by technical experts and enforced by policy makers.

Local health rules and building regulations: a survey on local hygiene and building regulations in Italian municipalities.

INTRODUCTION: WHO has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Local Health Rules (LHRs) and Building Regulations (BRs) are tools which provide safety and building hygiene in construction practices. Currently the Italian Government is considering to establish a National Building Regulation and, related to the following purpose, this paper presents a survey on the status of adoption and updating of LHRs and BRs in Italian municipalities. METHODOLOGY: The current Italian state of LHRs, BRs and Municipal Development Plans (MDPs) have been examined by a survey considering a sample of about 550 cities, with different demo graphic and geographic features, starting from the previous research work by Signorelli et al. (1999). RESULTS: The analysis underlines a serious shortage of updated LHRs, especially in small and medium-sized municipalities whereas BRs and MDPs are widespread. Only 30% of them are previously approved and validated by Local Health Authorities. CONCLUSION: Starting from a survey, the present scenario of Building Regulations requires the introduction of further performance guidelines instead of normative ones and, therefore, the current actions to give rise to a National Building Regulation could be integrated by building hygiene contents of LHRs.

2015-2018 Regional Prevention Plan of Lombardy (Northern Italy) and sedentary prevention: a cross-sectional strategy to develop evidence-based programmes.

Cross-sector, life-course, and setting approaches are identified in the 2015-2018 Regional Prevention Plan (PRP) of Lombardy Region (Northern Italy) as valuable strategies to ensure the efficacy and sustainable prevention of the non-communicable disease (NCDs). The involvement of non-health sectors in health promotion activities represents a suitable strategy to affect on social, economic, and political determinants and to change environmental factors that could cause NCDs. A dialogue among communities, urban planning, and prevention know-how is a prerequisite to develop a system of policies suitable to promote healthy lifestyle in general and, specifically, active lifestyles. The 2015-2018 Lombardy PRP pursues its aims of health promotion and behavioural risk factors for NCDs prevention through programmes that implement their own setting networks (Health Promoting Schools - SPS; Workplace Health Promotion - WHP) and develop new networks. Sedentary lifestyle prevention and active lifestyle promotion are performed through the approach promoted by the Healthy Cities Programme (WHO), encouraging two main processes: 1. creating integrated capacity-building among health and social prevention services, academic research, and local stakeholders on different urban planning and design issues; 2. promoting community empowerment through active citizens participation. Through this process, Lombardy Region aims to orient its services developing evidence-based programmes and enhancing advocacy and mediating capacity skills in order to create a profitable partnership with non-health sectors. This paper reports the main impact data: 26,000 children that reach school by foot thanks to walking buses, 57% of 145 companies joining WHP are involved in promoting physical activity, 18,891 citizens who attend local walking groups.

Social sustainability in healthcare facilities: a rating tool for analysing and improving social aspects in environments of care.

INTRODUCTION: Nowadays several rating systems exist for the evaluation of the sustainability of buildings, but often their focus is limited to environmental and efficiency aspects. Hospitals are complex constructions in which many variables affect hospital processes. Therefore, a research group has developed a tool for the evaluation of sustainability in healthcare facilities. METHODOLOGY: The paper analyses social sustainability issues through a tool which evaluates users' perception from a the quality and well-being perspective. It presents a hierarchical structure composed of a criteria and indicators system which is organised through a weighing system calculated by using the Analytic Network Process. RESULTS AND DISCUSSION: The output is the definition of a tool which evaluates how Humanisation, Comfort and Distribution criteria can affect the social sustainability of a building. CONCLUSION: Starting from its application, it is evident that the instrument enables the improvement of healthcare facilities through several design and organisational suggestions for achieving healing and sustainable architectures.

Humanisation and soft qualities in emergency rooms.

UNLABELLED: Scenario. Currently, there are few evaluation methods that analyse social aspects in healthcare issues, especially humanisation and well-being, as perceived by users in emergency departments which are places in which patients' psycho-physical well-being is decisive. For this reason, research was conducted to create a tool to improve the quality of these areas. METHODOLOGY: In order to conduct the research, the work was structured in three phases: the first, based on the analysis of State-of-the-Art and the current studies on the interactions established between the physical and emotional conditions of the structure and the users; the second, through the definition of a questionnaire which explores humanisation and comfort aspects; the third, through the application of the instrument. RESULTS: The paper presents and analyses data collected from the application on a case study in Milan, analysing the responses and proposing design suggestions for increasing the quality of emergency environments. CONCLUSIONS: In anticipation of future works, the application of such a tool can provide the opportunity to improve and enhance quality and staff efficiency in emergency department spaces.

Water use and water saving in Italian hospitals. A preliminary investigation.

AIM: The aim of this work is to investigate about water use, wastage, saving and reuse in hospitals. METHODS: An anonymous ad hoc questionnaire was tested in a sample of 36 public hospitals of Lombardy Region (21% of total public hospitals). Daily water consumption reported is on average equal to 481 m3, ranging from 30 to 2280 m3. There is a strong correlation between water consumption and number of hospital beds (p < 0.005). In 33 hospitals (92%) water consumption is measured and, among them, in about 48% more than one flow meter is installed; 86% consider "important" the reduction of water consumption and about 55% recognize that wastewater could be minimized within the structures. DISCUSSION: There is consensus about the need to train health personnel and to implement technical measures to improve the water resources management, but initiatives to raise knowledge and awareness of health personnel have been promoted only in 10% of hospitals. RESULTS: Results show not only a lack of awareness regarding water use and saving among the personnel in general, but also among heads of the hospitas' technical office and energy managers as well. For this reason, it will be of interest to carry out this investigation at national level and also to develop recommendations to support and promote a safe reuse of water in all the hospitals.

Healthcare for all in emerging countries: a preliminary investigation of facilities in Kolkata, India.

INTRODUCTION: India is one of the five countries with the lowest public health spending levels: the private medical services are one of the most developed fields, meanwhile public health ones are totally inadequate with the most number of health facilities concentrated in cities, where only the 25% of the population lives. Public facilities are mainly made up of primary level and not well distributed on the territories, so they do not guarantee accessibility to a wide sample of population, who live in rural areas of India. METHODOLOGY: Starting from the analysis of three different health care levels in the Indian context, the research team developed a meta-project that considers all the current criticisms and the Indian customs through a flexible layout that responds to the healthcare needs of population. RESULT AND DISCUSSION: The research work is aimed to develop a meta-project that considers all the current criticisms and the Indian customs through flexible layouts that responds to the healthcare needs of population. CONCLUSION: The innovation of the research work is to develop the hygienic aspects, the layout and the distribution, the sub-division of the medical functions through the Indian culture and the needs of the country. The choice of lowly technologies permits to promote the usage of local materials, their maintenance and skills for creating a virtuous economic system.

Green areas and public health: improving wellbeing and physical activity in the urban context.

INTRODUCTION: The green areas play an important role in improving the environmental quality and climate of the city. However, despite the undoubted importance of these areas, the benefits to public health are still under investigation. RESULTS: The Authors perform a review of studies on the relationship between health and green areas and describe the main areas for which evidence on this relationship is currently available. They include: effects on air quality, on social cohesion, on mental health, with particular reference to the stress, and on physical activity. CONCLUSIONS: Most of the evidence comes from cross-sectional and descriptive studies and the approaches used to measure the association show themselves to be often unsatisfactory. The Authors conclude the review stressing the need for greater integration between the different professionals involved in urban planning and in health care analysis in order to identify research approaches more appropriate to understand such complex issues, striving toward a planning design of green areas that will satisfy both environmental sustainability and health requirements.