The document summarizes the current state of traffic-related health impacts in urban areas and how we have arrived at this point. It describes a significant burden of disease associated with current transport practices, driven by rapid car-centered urbanization, mass motorization, policies favoring car mobility, and the influence of the car industry lobby. Traditional transport appraisal methods like cost-benefit analysis are limited and favor short-term economic benefits over long-term health and environmental impacts. There is a need for more health-aware perspectives in transport planning and policies to guide more sustainable development.
Ministerial lunch: Migration and health in the WHO European Region - presentation delivered by Dr Zsuzsanna Jakab – WHO Regional Director for Europe, on 14 September 2015, at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
Presentation delivered by Prof. Dr. István Szilárd, University of Pécs Medical School, Chair of Migration Health, at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
CEO of Infinitum Humanitarian Systems Eric Rasmussen, MD, MDM, FACP helped the Medical Devices Group understand the depth of the challenges to global health.
You really have to watch his talk (some of the images will take your breath away) for the full impact of the presentation and please share it on social media and with your colleagues.
Visit http://medgroup.biz/future-global-health for the video recap and transcript and consider the 10x Medical Device Conference to meet speakers like Eric.
For 10x information, see http://medgroup.biz/About-10x
Ministerial lunch: Migration and health in the WHO European Region - presentation delivered by Dr Zsuzsanna Jakab – WHO Regional Director for Europe, on 14 September 2015, at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
Presentation delivered by Prof. Dr. István Szilárd, University of Pécs Medical School, Chair of Migration Health, at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
CEO of Infinitum Humanitarian Systems Eric Rasmussen, MD, MDM, FACP helped the Medical Devices Group understand the depth of the challenges to global health.
You really have to watch his talk (some of the images will take your breath away) for the full impact of the presentation and please share it on social media and with your colleagues.
Visit http://medgroup.biz/future-global-health for the video recap and transcript and consider the 10x Medical Device Conference to meet speakers like Eric.
For 10x information, see http://medgroup.biz/About-10x
Global health trends and lessons learned towards better advocacy and develo...Farooq Khan
Written from the perspective of a Canadian Emergency Medicine Resident in July 2013 as a presentation to peers and colleagues for academic purposes only.
Part 1: Advocacy in Emergency Medicine
- Patients, communities and the world at large
Part 2: Global Health trends
- Political, social, economic and environmental determinants
- Emergency Medicine as a global priority
Part 3: Examples of Emergency Medicine development and activism
- Global Emergency Care Collaborative - Uganda
- International Emergency Medicine research at WHO
- Getting involved without leaving the country
A review of global health issues, highlighted by the COVID-19 pandemic and suggestions for improvement of health in a post pandemic world. Presentation for the Mongolian National University of Medicine School of public Health, April 16th 2021
210415 long version middleton j mongolia ph conference
In recent times, an enormous amount of people have been migrating to various places. Migration has its impacts on various sectors such as economic, political and social; it also has an impact on the health of individuals and on the community. The various public health issues due to migration have been discussed in this presentation. I hope it provides new information to the readers.
Presentation for the Grand European Symposium: Training, Research and Innovation in the Europe of Health”, on September 30th 2021, The Sorbonne Grand Amphitheater
210923 middletonj sorbonne vr2
Die Zukunft ist rosig, die Zukunft ist die öffentliche GesundheitJohn Middleton
The future's bright, the future is public health. Presentation to the MPH students introductory course Bielefeld University School of public Health, October 11th 2021. 211011 2 middleton j bielefeld main
A 2013 paper (with minor edits) presented at the Australian Social Policy Conference. Yet another piece on the relationships between the social, the spatial and policy responses to complex and dynamic phenomena.
Public health systems and the health of the public (full)John Middleton
A combined slideshow comprising two presentations made by John Middleton, President of the Uk Faculty of Public Health, at the 2nd Arab Public Health Conference , Casablanca, April4-6th 2019. this includes the short plenary presentation on the future role of public health and slides of the role of the UK faculty of public Health from a lunchtime workshop, April 4th 2019.190405 ar pha middletonj vr 3 full final
STEP Annual Conference 2018 - Adrian Davis, How Far Should We Go to Improve A...STEP_scotland
STEP 2018 Conference. Adrian Davis. Presentation on barriers to progress in tackling poor air quality beyond issues around the science itself. It addresses ideological barriers, the meanings of evidence across professions, and asks questions about past failures to implement effective interventions to improve urban air quality.
Ubuntu 14.04 merupakan salah satu versi ubuntu yang telah hadir pada 17 April 2014. Ubuntu versi ini merupakan distribusi linux yang paling populer yang menggunakan user interface unity yang khas dan disesuaikan. Versi ubuntu ini memiliki kode nama atau codename yatiu Trust Tahr. Dimana dalam versi ini juga merpakan edisi dengan dukungan jangka panjang “Lng Term Support” selama 5 tahun.
Global health trends and lessons learned towards better advocacy and develo...Farooq Khan
Written from the perspective of a Canadian Emergency Medicine Resident in July 2013 as a presentation to peers and colleagues for academic purposes only.
Part 1: Advocacy in Emergency Medicine
- Patients, communities and the world at large
Part 2: Global Health trends
- Political, social, economic and environmental determinants
- Emergency Medicine as a global priority
Part 3: Examples of Emergency Medicine development and activism
- Global Emergency Care Collaborative - Uganda
- International Emergency Medicine research at WHO
- Getting involved without leaving the country
A review of global health issues, highlighted by the COVID-19 pandemic and suggestions for improvement of health in a post pandemic world. Presentation for the Mongolian National University of Medicine School of public Health, April 16th 2021
210415 long version middleton j mongolia ph conference
In recent times, an enormous amount of people have been migrating to various places. Migration has its impacts on various sectors such as economic, political and social; it also has an impact on the health of individuals and on the community. The various public health issues due to migration have been discussed in this presentation. I hope it provides new information to the readers.
Presentation for the Grand European Symposium: Training, Research and Innovation in the Europe of Health”, on September 30th 2021, The Sorbonne Grand Amphitheater
210923 middletonj sorbonne vr2
Die Zukunft ist rosig, die Zukunft ist die öffentliche GesundheitJohn Middleton
The future's bright, the future is public health. Presentation to the MPH students introductory course Bielefeld University School of public Health, October 11th 2021. 211011 2 middleton j bielefeld main
A 2013 paper (with minor edits) presented at the Australian Social Policy Conference. Yet another piece on the relationships between the social, the spatial and policy responses to complex and dynamic phenomena.
Public health systems and the health of the public (full)John Middleton
A combined slideshow comprising two presentations made by John Middleton, President of the Uk Faculty of Public Health, at the 2nd Arab Public Health Conference , Casablanca, April4-6th 2019. this includes the short plenary presentation on the future role of public health and slides of the role of the UK faculty of public Health from a lunchtime workshop, April 4th 2019.190405 ar pha middletonj vr 3 full final
STEP Annual Conference 2018 - Adrian Davis, How Far Should We Go to Improve A...STEP_scotland
STEP 2018 Conference. Adrian Davis. Presentation on barriers to progress in tackling poor air quality beyond issues around the science itself. It addresses ideological barriers, the meanings of evidence across professions, and asks questions about past failures to implement effective interventions to improve urban air quality.
Ubuntu 14.04 merupakan salah satu versi ubuntu yang telah hadir pada 17 April 2014. Ubuntu versi ini merupakan distribusi linux yang paling populer yang menggunakan user interface unity yang khas dan disesuaikan. Versi ubuntu ini memiliki kode nama atau codename yatiu Trust Tahr. Dimana dalam versi ini juga merpakan edisi dengan dukungan jangka panjang “Lng Term Support” selama 5 tahun.
Taller sobre recursos en la nube para investigadores. Google Scholar y Mendeley
Taller básico sobre el gestor de referencias bibliográficas Mendeley, gestor bibliográfico institucional de la Universitat Politècnica de València. Permite organizar fácilmente sus documentos, leer e insertar anotaciones en sus archivos PDF, colaborar en grupos privados o abiertos, y acceder de forma segura a su investigación tanto en versión local (escritorio) como en la nube.
Desarrollado en 9 videos (Polimedia, http://bit.ly/29tD3Pi):
Gestión de referencias bibliográficas: Mendeley:
1.Los gestores bibliográficos. Estándares en la gestión de referencias bibliográficas. Formatos RIS, BibTex
2.Introducción a Mendeley: gestor de referencias, gestor documental y red social 3.Crear una cuenta en Mendeley. Versión gratuita vs versión institucional. 4.Mendeley. Versión web.
5.Mendeley. Versión escritorio (Mendely Desktop).
6.Complementos: Web Importer y plug-in para citar en un procesador de texto 7.Importar referencias: importación directa, Web Importer.
8.Importar referencias: importación indirecta.
9.Citar y escribir desde un procesador de texto
Buenas Practicas de Construcción Manual de Construcción de Casas Segura.Publicarnic
Guía para la construcción de viviendas siguiendo las normas de seguridad recomendadas para la construcción. Elaborado por Cámara Nicaragüense de la Construcción.
DotNetFringe presentation about .NET assemblies.
Abstract:
If there's a fringe practice with .NET, it's opening the hood of the .NET binaries, aka assemblies, and tinkering directly with the metadata and the IL bytecode.
Interested in compilers? Profilers? IDEs? Virtual Machines? Developer tools in general? On .NET, all of those share a common form of data: assemblies. What better way is there to learn more about the platform than by manipulating its data? While it’s sometimes viewed as some form of black magic, it’s really no rocket science.
This session will be the opportunity for .NET developers to learn how to analyze and manipulate the very data they consume and produce every day, and how to pick the right tool for the job.
제 1회 '새 광고' 컨퍼런스 [어느 광고대행사의 고백]에 이어서 2번째 [지속가능 브랜드: 다시 쓰는 브리프]로 만나뵐 수 있는 시간을 준비했습니다. 광고대행사 고백은 여전히 광고, 마케팅이 욕망을 다루는 것이 아니라 가치를 다룰 수 있음을, 사회와 시장에 불필요한 소음을 더하는 것이 아니라, 문제 해결 활동이 될 수 있음을 믿고 있습니다. '새 광고' 그 두번째 시간, [지속가능 브랜드: 다시 쓰는 브리프]로 함께 상상해 보고픈 분들의 많은 참여를 기대합니다.
One Minute Tips, Take Two! Student Perceptions of Videos Used for Teaching In...Lucinda Rush
Presentation at the Virginia Library Association Annual Conference, October 22, 2015
Lucinda Rush, Rachel Stott, Topher Lawton, Megan Smith
Digital learning objects are all the rage, but what does the YouTube generation think? We will discuss student perceptions of videos used for information literacy instruction and methods for incorporating short videos into assessable learning activities.
A presentation by Ebele Mọgọ, DrPH
“Sustainable African Cities: Debating Current Challenges and Exploring Future Pathways”
Ghana Academy of Arts and Sciences, Accra, Ghana
How urban planner can play a role to control communication disease?
Healthy homes promote good physical and mental health. Good health depends on having homes that are safe and free from physical hazards.
Role of urban planner to control the communication disease.momal
How urban planner can play a role to control communication disease?
“A city always contains more than any inhabitant can know, and a great city always makes the unknown and the possible spurs to the imagination.” – Rebecca Solnit
Routes to Clean Air 2016, Prof. Stephen Holgate, University of SouthamptonIES / IAQM
Talk Title: Every breath we take: the lifelong impact of air pollution
Routes to Clean Air is a two-day conference from the IAQM where academics, professionals and policy makers share their experiences of improving traffic emissions.
This event highlights the importance of public communication and behavioural change surrounding road transport and air quality issues.
Inclusive health and fitness education for sustainable developmentoircjournals
Health and fitness is viewed as both an enabler and an
End for sustainable development.Health and fitness
is a rapidly growing area of focus for people across the
world. The popularity of health services on media news
and talk shows,high tech health and fitness tracking
devices and stress management workshops are
just but a few of the indicators of a growing interest in whole
person well-being. For individuals with intellectual and
developmental disabilities, the benefits of quality health
and fitness areas great as those experienced by the rest of the
human population. However,the opportunities to access
quality health and fitness information and resources are not necessarily
as available. There are many options for engaging in health and
fitness activities in communities, and disability should not exclude a person from
participation. However, in reality there are too few fitness
opportunities that are of high quality and truly inclusive.
This paper therefore aims to help readers advocate for inclusive
Health and fitness opportunities in their communities by providing a list of key characteristics of quality, inclusive programs, as well as a set of tips for
individuals with disabilities.The paper has reviewed well researched sources
in Kenya and the world over highlighting how and why health must be more present, more integral, and more influential.Despite a broad agenda and steep competition for attention health and fitness remains a prominent and vital component of the development agenda and this can only be possible through inclusive quality
health and fitness education.The results will be focus on health and fitness
for individuals with physical, social, vocational, spiritual, emotional, and psychological disabilities. It offers ways in which disability service providers, health and fitness professionals, community fitness and recreation programs and employers among others can help ensure what opportunities to choose and engage in health and fitness activities through inclusive education is achieved.
Presentation at 3rd GRF One Health Summit 2015
Poverty and Health - One Health Approaches for Sustainable Development
Sumitra SITHAMPARAM, Malaysian Medical Association, Malaysia
Globalization, Global Health and Public Health.
Changing Concepts of Public Health.
Causes, Aspects and Types of Globalization.
Social Changes due to Globalization.
How Globalization affects Public Health.
Globalization of Public Health.
Threats to Global Health.
Creating a Healthy Environment: The Impact of the Built Environment on Public Health
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For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
How do air quality models perform with different validation datasets and diff...Haneen Khreis
This paper explores the performance of two commonly used air quality models: dispersion models and land-use regression models. Both models are widely used in air pollution epidemiological studies and in health impact assessment studies. In this work, we looked at how the choice of the validation dataset impacts the performance of air quality models and the insights gleaned from their validation. We also looked at whether the spatial resolution for the models' setup impacts the performance of air quality models and the insights gleaned from their validation. We saw that R-squared almost halved when the air quality models' estimates were made at the centroid of the 100x100m grid in which the validation point fell, instead of at the exact location of the validation point. We also saw that the different validation datasets give very different insights.
Dispersion models and land-use regression models are widely used in air pollution epidemiological studies and in health impact assessment studies. As such the performance of these air quality models have implications on the ability of epidemiological studies to pick up associations between the exposures and the health outcomes of interest, and the ability of health impact assessment studies to quantify the impacts accurately. This work demonstrated the value of validating modeled air quality data against various datasets to obtain a better understanding of the performance of models and the value of reporting these validation results. Also, the work suggested that the spatial resolution of the models’ estimates has a significant influence on the validity at the application point. These results should be considered when air quality models are used to assign human exposures and study the health effects/impacts of these exposures. Significant work is still needed to improve the performance of air quality models and their ability to pick up the variations of air pollution levels and especially the higher and more variable levels that are related to traffic. Significant work is also still needed to account for the factors that underlie this variation in epidemiological and health impact assessment studies, especially time activity patterns of the exposed populations
Traffic-related air pollution and the local burden of childhood asthma in Bra...Haneen Khreis
Background/aim Asthma is a burdensome disease which has been cited as the most common chronic disease in children. Traffic-related air pollution (TRAP) may be an important exposure in its development. Bradford, UK, is a multi-ethnic deprived city suffering from asthma rates higher than national and regional averages. TRAP is of concern to local communities and is thought to contribute to the asthma burden. Methods We estimated childhood population exposure to traffic-related NOx and NO2 at the smallest census tract level in Bradford using three validated exposure assessment methods: two novel full-chain models linking transport, two different emission models and air dispersion models and one land-use regression (LUR) model, which was developed as part of ESCAPE and which also provided estimates for other pollutants including PM2.5, PM10 and black carbon. We extracted national and local childhood asthma incidence rates and used meta-analytic exposure-response functions. We calculated the relative risk and population attributable fraction of childhood asthma attributable to each pollutant. We estimated asthma cases attributable to each pollutant and exposure combination. Results Depending on the exposure assessment method used and the pollutant studied, the estimated TRAP-attributable asthma cases varied between 279 and 687 annually, representing between 15% to 38% of all asthma cases in the city. The health impacts estimated were sensitive to the exposure assessment method used, the pollutant selected in the analysis but, differently from the initial hypothesis, not to the vehicle emission factors used in the full-chain models. Conclusion TRAP is estimated to cause a large, but preventable, childhood asthma burden. This study is the first study undertaking full-chain health impact assessment that considers the full-chain from source, through exposure pathway to outcome. The study also adds to the scarce literature exploring the impacts of different exposure assessments on the estimated burden of disease.
Car free cities bmdc meeting 9th september 2016 haneenHaneen Khreis
Background: Many cities across the world are beginning to shift their mobility solution away from the private cars and towards more environmentally friendly and citizen-focused means. Hamburg, Oslo, Helsinki, and Madrid have recently announced their plans to become (partly) private car free cities. Other cities like Paris, Milan, Chengdu, Masdar, Dublin, Brussels, Copenhagen, Bogota, and Hyderabad have measures that aim at reducing motorized traffic including implementing car free days, investing in cycling infrastructure and pedestrianization, restricting parking spaces and considerable increases in public transport provision. Such plans and measures are particularly implemented with the declared aim of reducing greenhouse gas emissions. These reductions are also likely to benefit public health.
Barriers to Active TravelHow hard can it be?Haneen Khreis
Alison delivered a short presentation detailing the ‘journey’ she has undertaken over the last few years in her quest to get more people travelling actively. On the face of it, this seems like a fairly easy objective to achieve, but Alison has learned (sometimes the hard way) that things are not as simple as they seem. This presentation will detail some of the barriers present to achieving this - the conflicting aims and interests, and how she has managed to overcome some of them.
For questions: Send email
Alison.Millbourn@kirklees.gov.uk
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. The Health Impacts of Traffic-related Exposures in Urban
Areas: Understanding Real Effects, Underlying Driving
Forces and Co-producing Future Directions
Haneen Khreis, 2nd International Conference on
Transport and Health, San Jose, 13-15 June, 2016
Session: Collaboration for a Healthy Change in Transport Planning, Advocacy, and Policy
2. Acknowledgements
Karyn Warsow, Health Policy
Management and Leadership
Ersilia Verlinghieri, public
participation in transport planning
Alvaro Guzman, power in
transport planning
Luc Pellecuer, Incorporation of Environmental
Impacts into engineering
Antonio Ferreira, Governance
and Transport Policies
Ian Jones, Urban and Transport
planning
Eva Heinen, Active travel behavior David Rojas-Rueda, Epidemiology and
public health
Natalie Mueller, Public health Paul Schepers, Traffic safety Karen Lucas, Transport and
social analysis
Mark Nieuwenhuijsen, Epidemiology and
public health
3. Background
■ The world is witnessing its largest
surge of urban growth in history
■ e.g. 75% of the European
population live in urban areas
■ Urbanization being shaped by step
changes in transport connectivity
and related land-use practices
■ Transport often envisioned as a
driver for urban development and
a contributor to economic returns
■ But has negative impacts on the
health of a population
exacerbated in urban areas
Rydin et al. 2012
4. Background
■ Each year, > 1.3 million deaths and 78 million
injuries warranting medical care result from motor
vehicle crashes
■ Air pollution and decreases in physical activity
associated with annual estimates of 7 million and
2.1 million global deaths, respectively
■ Current land-use planning and policy patterns are
reinforcing excessive use of motorized transport
modes
■ Health impacts are disproportionately distributed,
contributing further to gross inequalities in health
5. Background
■ Sustainable transport infrastructure/modes
effective in promoting active travel; increasing
physical activity and reducing exposures
■ Can reduce health inequalities through
modifying some of the pathways by which low
socioeconomic position can lead to diseases
■ This evidence reinforces the need to develop
and implement effective policies that define and
address health consequences
6. Rationale
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?
7. ■ Initial meeting at the 1st International Conference of
Transport and Health 2015 – London
■ Bring together expertise in transport engineering, transport
and urban planning, research and strategic management,
epidemiology and health impact assessment
■ Built on/led to recent reviews on this topic by some authors
■ Arrange meetings amongst the authors. Full collaboration
has been made possible through the use of online tools
such as Google Docs and emails
■ Organize (4) workshops around the key synergies between
transport and health
■ Concepts presented were developed further and discussed
amongst the authors, and others attending
■ this paper emerged from a collective rather than a
solitary exercise
Methods
8. Where are we now?
Adverse health
impacts associated
with traffic
Motor vehicle
crashes
Physical inactivity
Air pollution
exposure
Noise exposure
Temperature
(rises) exposure
Green space
reduction
exposure
9. Motor vehicle crashes
■ One of the earliest recognized traffic-related health
issues (obvious effects…)
■ Vulnerable populations and road users including the
elderly, children, the economically disadvantaged and
pedestrians and cyclists are the most impacted
■ Half of the world’s road traffic deaths occur amongst
motorcyclists, pedestrians and cyclists, with 31% of
deaths amongst car occupants (rest is unspecified)
■ Low-income and middle-income countries account for
over 90% of the world’s roads fatalities despite having
48% of the world’s registered vehicles
■ Have received more policy attention partly due to the
attention to crash severity and loss of life
■ Incidence rates for active travel depend on the number
of active travellers resulting in a rapid decline in MVC
when the number of these users increase
10. Motor vehicle crashes
“I'm listening to a live streaming of the
US Department of Transportation 50th
Anniversary ceremony. The overwhelming
theme is automotive safety. t is ingrained
in the culture not specific to people. This
perspective requires a cultural shift at
the policy level, which is happening
slowly in the US ”
“Perhaps mention safety concerns
were raised soon after ww2. At least
in NL in the ’60 and ’70. As a
consequence there cars were
banned and it was one of the
reasons to stimulate bicycling”
11. Physical inactivity
■ The biggest public health problem of the 21st century
■ 2.1 million global deaths/year attributable
■ Physically inactive people have a 20% to 30% increased
risk of all-cause premature mortality
■ Increased physical activity associated with a reduction in
risk of chronic diseases e.g. cardiovascular disease,
dementia, Alzheimer's and Parkinson's disease, type-2
diabetes, breast cancer, colon cancer depression and
anxiety symptomatology
■ Emerging evidence for a role in delaying cognitive
decline/improving brain health
■ Positive effect on pulmonary function, which can have a
role in reducing the negative health effects of traffic-
related air pollution
12. Active travel and physical activity
■ 20% to 50% of population do not meet physical activity
guidelines
■ Active travel could provide means to build physical
activity into daily routines
■ Active travel associated with higher levels of objective
and self-reported physical activity
■ Countries with higher levels of active travel have lower
obesity levels suggesting
■ Providing for active travel will boost its levels, although
the effects of new infrastructure may not be
immediate
■ Available resources for physical activity participation
including parks and walking and biking trails vary by
neighbourhood socioeconomic status with the pattern
of fewer options for the more deprived
13. Traffic-related
air pollution
■ In urban areas, ambient air pollution is
dominated by motor vehicles traffic
■ Associated with all-cause mortality,
childhood asthma incidence,
cardiovascular disease incidence,
cardiovascular mortality and morbidity,
cerebrovascular mortality and
morbidity, decreased lung function in
children, infant mortality, lung cancer,
low birth weight, pregnancy-induced
hypertensive disorders, preterm birth,
respiratory infections, and respiratory
mortality and morbidity
■ Contributing to an estimated 370,000
premature deaths and on average a 9
month reduction in life expectancy in
Europe
■ Source models not widely available
■ TRAP disproportionately distributed
amongst socio-economic and
vulnerable groups e.g. low-income
groups and minorities, as their schools
and residences are often located in
high traffic exposure areas
14. Traffic-related noise
■ Ambient noise are associated with the road
network, junctions, traffic flow, speed and load
■ Health effects of traffic-related noise are
increasingly being recognized as attributable to a
large burden of disease that may be comparable
to that of air pollution
■ One million healthy life years are lost every year
from traffic-related noise in the western part of
Europe alone
■ Ambient noise has been associated with all-
cause mortality, cardiovascular mortality and
morbidity, annoyance and sleep disturbance,
adverse reproductive outcomes, cognitive
problems in children, diabetes type-2, high blood
pressure in children, mental health and well-
being problems and stroke
■ Cardiovascular effects by ambient noise have
been shown independent of air pollution
exposures
■ Low-income individuals and visible minorities
tend to be located in the areas most polluted by
road traffic noise
15. Urban Heat Islands
and Greenhouse
Gases
■ High density urban settlements
and roads heat absorbing
concrete and asphalt structures
dominate the landscape = heat
island effect
■ Traffic also release anthropogenic
heat by way of tailpipe emissions
(black carbon, carbon dioxide,
methane, nitrous oxide) and can
amplify urban temperatures
■ High ambient temperatures have
been associated with all-cause
mortality, cardiorespiratory
morbidity, children’s mortality and
hospitalization, heat stress,
hospital admissions, increased
health service use for chronic
diseases, including respiratory
diseases, hypertension and
diabetes, preterm birth, reduced
lung function in children and MVC
16. Green infrastructure
■ Associated with a number of beneficial health effects,
including decreased premature mortality, reduced
cardiovascular disease, higher birth weight, improved
mental health, improved sleep patterns, recovery from
illness, reduced children's behavioural problems, reduced
incidence of childhood asthma, increased social contacts
■ Other beneficial effects on cognitive development, physical
activity and obesity
■ Possible mechanisms for health benefits are due to
increased physical activity, more space to enable social
interaction, psychological restoration and stress reduction,
and mitigation of environmental exposures including air
pollution, noise and heat
■ Distribution of (access to) green spaces can be differential
by socioeconomic status in favour with those with resources
to move to greener areas
■ Amount of green space is often limited in cities
■ Varies considerably between and within cities, European
cities average around 18.6% green space
■ Transport and utilities use significant amounts of land
which could arguably be or be used for green infrastructure
17. Results
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?
18. How did we get here?
■ A significant burden of disease associated with
transport practices
■ Suggest that transport design, planning and policy are
operating separate from health at some level
– Trends of development,
– (lack of) Public policies
– Public’s perceptions and awareness,
– The state of the transport investment appraisal
– and the influence of powerful actors in leading to
the current state and maintaining it
19. Rapid and car-centred urbanization
■ Advanced a car-centred planning approach
dominated urban and transport planning since
post-Second World War
■ The car has become socially, culturally,
economically, politically, ethically and
environmentally ingrained in westernised
countries
■ The very nature of urbanization enhances
exposure to heat, air pollution, and radiation via
street canyons, heat island effects, depleting
green space
■ Given the global trends towards a more
urbanised world population, impacts are
forecasted to continue and intensify
■ The car has become socially, culturally,
economically, politically, ethically and
environmentally ingrained in westernised
meaningful public transport system and a
gradual abandonment of these urbanised areas
■ Reinforces policy focus on ‘economic centres of
agglomeration’
■ Fosters a self-reinforcing cycle of car
dependence by creating a system of ‘auto-
mobility’
■ Auto -mobility systems
– increased the fraction of the exposed
population living and working in close
proximity to highways and roads
– decreased physical activity
– and reduced the feasibility and
convenience of active travel and of public
transport provision
■ The very nature of urbanization enhances
20. Rapid and car-centred urbanization
■ Car-centred urbanisation increases the physical
separation of activities and the need for
motorized transport
■ Increased spatial separation of activities lowers
urbanised population densities, and results in
lower commuter numbers needed to support a
meaningful public transport system and a
gradual abandonment of these urbanised areas
■ Reinforces policy focus on ‘economic centres of
agglomeration’
■ Fosters a self-reinforcing cycle of car
dependence by creating a system of ‘auto-
mobility’
21. Rapid and car-centred urbanization
■ Auto -mobility systems
– Increased the fraction of the exposed
population living and working in close
proximity to highways and roads
– Decreased physical activity
– Increased the need and convenience for
motorized transport
– and reduced the feasibility and
convenience of active travel and of public
transport provision
22. “The transport sector is susceptible
to long term effect on design
decisions. Urban form does not
change as rapidly (or even at all) as
building or roads are built or
demolished, for example many roman
road still exist in the landscape or still
serve as roads”
In regard to transport policy measures : “Why
land use policy measures seem to receive the
least attention whilst they could be most
effective?” – “I agree with you! Is true, there are
the most effective because there are the cause
of the cause. But at the same time is the harder
to be changed from a politician perspective, is a
change of model. But is the most important and
effective intervention”
23. Mass Motorization and
Ethical Positions Towards
Human Life
■ Increasing the number of vehicles and infrastructure
priorities
■ Manifested most clearly in the substantial deaths due to
MVC, and less clearly in the rise of chronic diseases related
to traffic exposure and practices over the same periods
that car traffic undergone large changes
■ Systems approach; such as the Vision Zero initiated by
Sweden and Sustainable Safety in the Netherlands
based on an ethical position in which it is unacceptable to
have people seriously injured or killed on the network
■ Transport infrastructure design is inherently conceived to
drastically reduce crash risk
■ This clarity in policy and guidance may have led to a
substantive influence for human life in the transport design
agenda
24. The Car Lobby
■ Acknowledge car industry as a powerful and diffuse
force in advocating for mass motorization through
marketing strategies to increase uptake and
maintenance of driving
■ Opposing measures that may reduce car use, e.g.
fuel duty increases, reduction in parking supply,
proposals for car-free zones, improvements in traffic
safety and delayed EU emissions regulations
■ Little public support for measures to rectify the
impact
■ The car industry with its economic reach to provide
jobs including manufacturing, dealerships, hire
companies, parking garages, motoring organizations,
oil and gas companies, construction and engineering
firms, insurance industry and others, make it difficult
to regulate
■ It is moving into new markets in low and middle-
income countries
25. Public Policy Favouring Car Mobility
“For national and local policy makers, I suggest the following ranking of priorities in
transport policy: (1) stimulate the economy by facilitating the smooth flow of goods and
people, (2) ensure social equity by facilitating access to mobility for disadvantaged
groups (especially via public transport), and (3) addressing negative externalities in the
following order of importance: (a) congestion, because it has negative social and
economic implications, (b) local ‘quality of life’ problems such as air pollution, parking
and spatial problems, (c) safety (traffic deaths and injuries), and (d) environmental
sustainability such as climate change. This externality ranking explains why most
transport policy programs address congestion (via congestion charging, dynamic traffic
management, and demand management)” (Geels 2012)
26. Public Policy Favouring Car Mobility
■ Historic strong association between economic development and an increase in the demand
for transportation and number of road vehicles
■ Infrastructure banks and governmental agencies have funded road construction for several
decades
■ Motorized mobility remains a criterion for measuring country-level economic success
■ Economic investment in roads is seen as an important determinant of economic growth
■ Traffic optimization and travel time savings remain the lead principles in transport planning
■ Technical-orientation in practice (mainly an engineering and economic focus) underestimate
the negative externalities of transport infrastructure decisions
■ Even solutions supposedly aimed at alleviating car use such as transit and bus rapid transit
are directly measured by travel time savings
■ Road investment strategies continue to support motor vehicle travel, thereby attracting more
cars whereas considerably less is allocated to active and public transport modes or mobility
management strategies
29. The State of the Practice of Transport
Appraisal ■ Cost Benefit Analysis (CBA) is the most commonly used
instrument to determine whether a certain transport project
is to be preferred over another
■ A project that has the highest positive monetary value, or
the highest benefit to cost ratio is the preferred project by
decision-makers
■ Monetized items include (changes in) travel times,
consumer surplus, (changes in) employment, business
activity and earnings, MVC, casualties, carbon and air
quality emissions and noise impacts
30. The State of the Practice of Transport
Appraisal
■ But many inherent limitations:
– CBA accept transport users’ willingness-to-pay as an appropriate indicator factored in the
calculations
– CBA are embedded in an econometric ontology that associates lower economic benefits and costs
to events taking place in the future due to economic depreciation rates. As a result, short-term
economic benefits (e.g. higher accessibility to jobs, lower travel costs) are likely to be overvalued
when measured against more complex and distant costs such as long-term environmental and
health impacts
– CBA assumes the outputs of transport planning models in the calculations
– It is acceptable to consider the time savings for existing travellers that use the services of a new
transport project as benefits. It also establishes that it is valid to sum time savings to the time
spent by travellers that were induced to travel by the new project (induced demand)
– CBA logic assumes that time savings are a benefit when time spent travelling can be positively
valued by transport users, especially those using transit and active travel modes
– Impacts on morbidity are not addressed
31. The State of the Practice of Transport
Appraisal
“Would it be the solution to conduct
an overall appraisal/evaluation of a
plan/intervention. Not just health or
economic benefits, but as wide as
possible? I guess that is the main
problem at the moment that
evaluations/appraisals are mostly
done by domain”
32. Results from transport practitioners
Economic Growth
Travel Time Savings
Cost Effectiveness
Land-use
Accessibility
Noise Reductions
Equality
Providing for Cars
Efficiency
SafetySustainability Policy Integration
Connectivity
Economic Growth
Travel Time Savings
Cost Effectiveness
Accessibility
Carbon ReductionsNoise Reductions
Equality
Providing for Cars
Efficiency
Safety Policy Integration
Connectivity
Sustainability
AirQuality
33. Public Perceptions and Awareness
■ Historically, societal acceptance and preference toward private
car ownership was celebrated as a process of democratization
fulfilling individual desires of flexibility and self-determination
■ It also symbolized the idea of freedom and independence as
well as, power, superiority, and social status
■ Behind public perceptions are driving forces of this
development such as “the leading industrial sectors and the
iconic firms within 20th-century capitalism (Ford, GM, Rolls-
Royce, Mercedes, Toyota, VW and so on), and the industry from
which the definitive social science concepts of Fordism and
Post-Fordism have emerged.” (Urry 2004)
■ These forces are behind a persistent car-mobility paradigm
making car dependence a phenomenon that operates societally
■ Cultural norms reinforced by public policy and institutions that,
although should represent the public interest and are oriented
around sustainability tend to exercise power to protect special
interests
34. ■ Health impacts of transport were not widely recognized until the 1990s
■ Lack of public awareness of these impacts, even those which have been receiving
increasing media coverage such as air pollution; reinforce the lack of political
commitment and initiative to address these problems
35. Results
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?
36.
37. Where do we want to go?
■ Mitigating or preventing adverse health impacts will have a long run benefit to
society in terms of overall well-being, productivity, economic prosperity, reduction in
healthcare costs societal investments rather than societal costs
■ An integrated cross-disciplinary planning effort to move away from a car-based
society to high quality and equitable public and active travel systems
■ More importance to health in the development and transport agenda
■ Knowledge transfer and collaboration in research, policy, and practice will play a
fundamental role in promoting healthy transport practices
38. Results
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?
39. What will guide us?
■ Example of good practice emerging from a collaborative
and open-ended project bringing together expertise in
health, environmental sciences, air pollution, transport
planning, economics, practice and advocacy and policy
making
■ HEAT aims at making the health benefits of regular cycling
and walking visible to transport and urban planners
■ Whilst addressing the importance of CBA in transport
design and planning decisions
■ The tool offers economic estimates of health benefits of
walking and cycling by estimating the economic value of
reduced mortality that results from specified amounts of
walking or cycling in a defined population
■ Been used in research, policy making recommendations,
advocacy and in practice
■ Was recommended in the official toolbox for transport
investment appraisal (WebTAG) in England and in the
Action Plan for Improving the health of Londoners by
Transport for London
40. What will guide us?
■ iConnect study aimed at measuring and evaluating the
changes in travel, physical activity and carbon emissions
related to Sustrans' Connect2 programme
■ Connect2 an ambitious UK-wide project that transformed
local travel in more than 80 communities creating new
crossings and bridges to overcome barriers increasing
physical activity
■ Initial funding for this programme came from a non-
transport source, the UK Big Lottery Fund (£50 million),
in which public vote demonstrating the huge amount of
public support for this programme was essential
■ This funding was used to unlock other sources of funding
necessary to complete the programme at an overall value
of £175 million
41. What will guide us?
■ Bradford Metropolitan District Council recently undertaken
a low emission zone feasibility study
■ Involved stakeholders, researchers and practitioners from
different disciplines including transport planning,
environmental sciences, public health and health
economics alongside collaboration with other city councils
in the West Yorkshire
■ The relative impact of several transport interventions
scenarios beyond the ‘business as usual’ case were
modelled
■ The impact that these scenarios may have on projected
air quality concentrations, health of the local population
and the costs and benefits associated with each
intervention measure were calculated and presented
■ Was used to provide strong evidence in support of two
funding bids at an approximate value of £1 million that
aim at improving air quality in the region
42. Results
– A clear scoping of traffic-related
health impacts (in urban areas)…
– Understanding and discussing the
underlying driving forces behind
where we are now…
– Is there a need for a new health-
aware perspective in the
transport/development agenda?
– Examples of good practice and
lessons learned from case studies
– Consider stakeholders involved and
make recommendations
Where are we now?
How did we get here?
Where do we want to go?
What will guide us?
How will we get there?
43. What action
and from who?
■ No “one size fits all” approach and policy
transfer is a highly politicised process
justifying preferred solutions
■ Technological improvements are not it!
Counter-productive in instances such as
the failure of the massive technology
change from petrol towards to mitigate
climate change
■ Public transport and active travel
provision and behavioural and societal
transformations are needed
■ Active involvement and collaboration of
engineers, planners, economists,
epidemiologists, and medical providers to
ensure health is at the top of the list of
competing priorities
44. How will we get there?
■ Transport Engineers and Planners
■ Try and bridge the gap between design, planning,
economics and health
– Bring the health agenda to the table
– Consider the health impacts of engineering and
planning decisions as more explicit outcomes of the
transport design and appraisal process
– Expand transport planning curriculums beyond the
functional quality of infrastructure
– Engage more with the public
– Consider health through transport design as an
additional objective
– Adopt tools and methods that would enable
assessing health impacts of transport design and
planning (e.g. Health Impact Assessment tools
45. How will we get there?
■ Health practioners
– Improve understanding of the urban and transport planning agenda
– Play a proactive role to include health as a transport project objective
– Advocate for effective policies that encourage active travel and reduce car use
– Partner with urban and transport planners from the start of design and
planning process to ensure that health is a recognized objective
– Support transport engineers and planners in conducting health impact
assessments for possible transport scenarios
– Develop innovative and usable health economic assessment tools to be added
to existing or novel transport design and planning tools
46. How will we get there?
■ Researchers
– Start appraising tools that are being used in transport planning to provide a holistic
point of view in regards to impacts on health
– Advocate for co-production and cross-disciplinary work
– Increasing the outreach and communication between the research community and
transport practitioners, local governmental entities and the public constituency
– Epidemiologists and health researchers can contribute to resolving open scientific
issues and improving the evidence base for health impact assessment
– Follow-up to how policy guidance/recommendations will be interpreted or altered
– Increase public outreach and awareness of health impacts of transport choices
and practices
47. How will we get there?
■ Policy makers
– Include long-term health impacts that are difficult to grasp or measure on the
short term
– Reallocate funding streams at the policy level to include health impact
assessment
– Expand CBA and similar appraisal methods
– Set operational goals and indicators in a transparent and non-sectorial manner
– Have strict legislation for integrated transport planning with land-use
– Clear policy and guidance to transport professionals to include health in the
development and transport agenda
“This is difficult to ask to people
who are already under pressure
to do their job as fast as
possible and whose boss does
not recognise the importance of
integrating health impact”
48. Changing perspectives?
■ “Economic investment in roads is seen as an important determinant of economic growth. It is
important to break this cycle and think about economic development rather than growth”
■ “It might be worth a quick thought experiment around what a health oriented approach to
transport planning might look like. Stated differently, from an engineer’s perspective,
accounting for black spots and reducing fatalities is health. From an urban designer
perspective, designing places for human interaction is health. From an urban planning
perspective (at least land use), separating land uses like residential from commercial or
industry (like pig slaughter houses) is health. As such, contemporary urban planning reflects
a variety of different perspectives and aims, which are often tied to specific pots of monies
and constrained and constituted via specific professional remit and duties”
■ “As my focus is more on design, I don’t think I’m the best person to contribute to the sections
about policy. In my role as policy advisor for the ministry I am of course involved in policy, but
this papers helps me realize how lucky road safety experts are”
■ “Neoliberalism and CBAs as wrong instruments at two levels: technical and fundamental”
■ “Yes CBAs are based on reducing travel time see article you sent me. While increasing travel
time may be beneficial in case of active transportation”
49. Conclusions
“Citing Frank and Engelke's 2001 literature review, the very first sentence in Northridge et
al. (2003) article is "While it has been stated before, it nonetheless bears repeating that the
connections between urban planning and public health are not new. Clearly, though such
connections are not new, they have been inadequate to generate consensus towards a more
sustainable, healthy and ethical urban and transport systems. There is probably several
articles you can point to which have sought to make similar points and cross disciplinary
boundaries. That being said, whereas such examples evidence Karen's point, I remain
unconvinced they evidence practice. There remains a gap between the academic and
professional circles. Again, this is not to pick on professionals or civil servants, who for the
most part do or at least strive to do a good job, but if things were different, you wouldn't
have a paper. They're aren't different, and thus, you still have valid points and a paper”
50. A few learning experiences
■ “The big questions will only be answered by cooperation of multiple disciplines”
■ “Transport and Health seem to have quite different histories, experiences and (vested)
interests and we need to develop a common narrative and close collaboration to tackle
the transport and health problems”
■ “Collaboratively writing this paper helps me to put my own discipline (road safety in my
case) in the broader context of health. For instance, some safety measures are helpful
for road safety only while other measures contribute to other health benefits as well.
This stimulates thinking”
■ “The one major lesson learnt is that although health has made significant advances in
demonstrating effects from car-oriented planning (which I was not aware of), such work
has yet to contribute to a more evidence-based approach to urban policy and practice”
■ “Collaborative efforts of both sectors are needed to provide healthy and sustainable
transport policies”
■ “…How to combine both interest in a sustainable manner will be the challenge of the
near future”
51. A few learning
experiences?
■ “It will take a lot of time and effort to develop
principles for designing the road system that are
helpful for all important health aspects. And
even more difficult (or impossible), principles
that work in different contexts. Having such
principles (e.g. the Sustainable Safety principles
in the Netherlands) were extremely helpful for
road safety policy. It would be great to have such
principles for transport and health in general. It
seems we have a long way to go to develop such
principles”
■ “What a pleasant surprise to realise we were so
many, with so different backgrounds, thinking
that health should be taken into account while
planning transport systems. Joining our forces is
definitely a promising avenue towards a more
integrated way of thinking transport issues”