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The Surface Cool Island (SCI) refers to localized reductions in land surface temperature (LST) produced by features that enhance evapotranspiration, shading, and energy flux regulation. In arid urban areas, vegetated parks play a key role in mitigating heat through these mechanisms. This study evaluates how park vegetation structure and spatial configuration influence SCI intensity (ΔTmax) and extent (Lmax) using multi-seasonal, day–night satellite observations in Mexicali, Mexico. A total of 435 parks were analyzed using Landsat 8/9 TIRS (30 m) for LST and Sentinel-2 MSI (10 m) for vegetation mapping via NDVI thresholding and supervised random forest (RF) classification. On average, parks lowered daytime LST by 0.81 °C (max: 6.41 °C), with a mean Lmax of 120 m; nighttime cooling was weaker (avg. ΔTmax: 0.37 °C; Lmax: 48 m). RF-derived metrics explained SCI variability more effectively (R2 up to 0.64 for ΔTmax; 0.48 for Lmax) than NDVI-based metrics (R2 < 0.35), highlighting the value of object-based land cover classification in capturing vegetation structure. This remote sensing framework offers a scalable method for assessing urban cooling performance and supports climate-adaptive green space design in hot-arid cities.

With the rapid development of urbanization, the ecological environment is being degraded. Taking the Barcelona Metropolitan Region as an example, this paper developed an ecological environment quality-assessment system suitable for different times and regions, based on remote sensing, to evaluate the quality of the ecological environment from 2006 to 2018. We also built various ordinary least squares models to analyze multiple variables affecting the ecological environment. Finally, the characteristic triangular spatial structure was used to explain the interaction between the two key variables. The results showed that the ecological quality was unevenly distributed. The largest green space contributed the most benefits but was decreasing and becoming fragmented. NDVI (normalized difference vegetation index) was the most significant natural variable related to the distribution of green space. Precipitation was the most closely related climate factor to NDVI. There was a complex two-way interaction mechanism between the two, and its boundary value was getting higher and higher. In conclusion, the environmental quality of the BMR needs improvement. The characteristic triangle can effectively explain the interaction mechanism between precipitation and NDVI. This study deeply analyzes how various factors affect environmental quality from both the global and internal perspectives and provides a scientific basis for urban ecological management and sustainable development.

The objective of this study was to analyze the climate change experienced in Spain between 1971 and 2022 and to estimate the future climate (2050). The main objectives were as follows: (1) to analyze the temporal evolution of temperature from 1971 to the present, to quantify the warming process experienced in the case study and to evaluate the increase in extreme heat events (heatwaves); (2) to study the evolution of the precipitation regime to determine whether there is a statistically representative trend towards a drier climate and an increase in extreme precipitation; (3) to investigate the interaction between annual precipitation and the continuous increase in temperature; and (4) to estimate the future climate scenario for mainland Spain and the Balearic Islands towards 2050, analyzing the trends in land aridity and predicting a possible change from a Mediterranean climate to a warm steppe climate, according to the Köppen classification. The aim of this study was to test the hypothesis that the increase in temperature resulting from the global warming process implies a tendency towards progressive drought. Given the extreme annual variability of the climate, in addition to the ordinary least squares methodology, the techniques mainly used in this study were the Mann–Kendall test and the Kendall–Theil–Sen (KTS) regression. The Mann–Kendall test confirmed the very high statistical significance of the relationship between precipitation (RR) and maximum temperature (TX). If the warming trend experienced in recent years (1971–2022) continues, it is foreseeable that, by 2050, there will be a reduction in precipitation in Spain of between 14% and 23% with respect to the precipitation of the reference period (understood as the average between 1971 and 2000). Spain’s climate is likely to change from Mediterranean to warm steppe in the Köppen classification system (from “C” to “B”).

Abstract Background Limb muscle dysfunction is prevalent in chronic obstructive pulmonary disease (COPD) and it has important clinical implications, such as reduced exercise tolerance, quality of life, and even survival. Since the previous American Thoracic Society/European Respiratory Society (ATS/ERS) statement on limb muscle dysfunction, important progress has been made on the characterization of this problem and on our understanding of its pathophysiology and clinical implications. Purpose The purpose of this document is to update the 1999 ATS/ERS statement on limb muscle dysfunction in COPD. Methods An interdisciplinary committee of experts from the ATS and ERS Pulmonary Rehabilitation and Clinical Problems assemblies determined that the scope of this document should be limited to limb muscles. Committee members conducted focused reviews of the literature on several topics. A librarian also performed a literature search. An ATS methodologist provided advice to the committee, ensuring that the methodological approach was consistent with ATS standards. Results We identified important advances in our understanding of the extent and nature of the structural alterations in limb muscles in patients with COPD. Since the last update, landmark studies were published on the mechanisms of development of limb muscle dysfunction in COPD and on the treatment of this condition. We now have a better understanding of the clinical implications of limb muscle dysfunction. Although exercise training is the most potent intervention to address this condition, other therapies, such as neuromuscular electrical stimulation, are emerging. Assessment of limb muscle function can identify patients who are at increased risk of poor clinical outcomes, such as exercise intolerance and premature mortality. Conclusions Limb muscle dysfunction is a key systemic consequence of COPD. However, there are still important gaps in our knowledge about the mechanisms of development of this problem. Strategies for early detection and specific treatments for this condition are also needed.

The Barcelona Metropolitan Area (AMB) has implemented various policies to reduce car use and promote more sustainable mobility. Initiatives such as superblocks, Low Emission Zones (LEZs), and the Bicivia network aim to transform the urban model in response to environmental and congestion challenges. However, the high reliance on private vehicles for intermunicipal travel, uneven infrastructure, and social resistance to certain changes remain significant issues. This study examines the evolution of mobility patterns and assesses the effectiveness of the above policies in fostering real and sustainable change. A mixed-methods approach was adopted, which combined an exploratory factor analysis (EFA) of 2011–2024 data, trend linear regression, and a comparative international analysis. The EFA identified four key structural dimensions: traditional transport infrastructure, active mobility and bus lines, public bicycles and mixed use, and transport efficiency and punctuality. The findings reveal a clear reduction in private car use and an increase in sustainable modes of transport. This indicates that there are prospects for future transformation. Nonetheless, challenges persist in intermunicipal mobility and the public acceptance of the measures. This study provides empirical and comparative evidence and emphasizes the need for integrated metropolitan governance to achieve a resilient and sustainable urban model.

Innovative digital health tools are increasingly being evaluated and, in some instances, integrated at scale into health systems. However, the applicability of assessment methodologies in real-life scenarios to demonstrate value generation and consequently foster sustainable adoption of digitally enabled health interventions has some bottlenecks. We aimed to build on the process of premarket assessment of 4 digital health interventions piloted at the Hospital Clinic de Barcelona (HCB), as well as on the analysis of current medical device software regulations and postmarket surveillance in the European Union and United States in order to generate recommendations and lessons learnt for the sustainable adoption of digitally enabled health interventions. Four digital health interventions involving prototypes were piloted at the HCB (studies 1-4). Cocreation and quality improvement methodologies were used to consolidate a pragmatic evaluation method to assess the perceived usability and satisfaction of end users (both patients and health care professionals) by means of the System Usability Scale and the Net Promoter Score, including general questions about satisfaction. Analyses of both medical software device regulations and postmarket surveillance in the European Union and United States (2017-2021) were performed. Finally, an overarching analysis on lessons learnt was conducted considering 4 domains (technical, clinical, usability, and cost), as well as differentiating among 3 different eHealth strategies (telehealth, integrated care, and digital therapeutics). Among the participant stakeholders, the System Usability Scale score was consistently higher in patients (studies 1, 2, 3, and 4: 78, 67, 56, and 76, respectively) than in health professionals (studies 2, 3, and 4: 52, 43, and 54, respectively). In general, use of the supporting digital health tools was recommended more by patients (studies 1, 2, 3, and 4: Net Promoter Scores of -3%, 31%, -21%, and 31%, respectively) than by professionals (studies 2, 3, and 4: Net Promoter Scores of -67%, 1%, and -80%, respectively). The overarching analysis resulted in pragmatic recommendations for the digital health evaluation domains and the eHealth strategies considered. Lessons learnt on the digitalization of health resulted in practical recommendations that could contribute to future deployment experiences.

Background Population-based Health Risk Assessment (HRA) tools are strategic for the implementation of integrated care. Various HRA algorithms have been developed in the last decades worldwide. Their full adoption being limited by technical, functional, and economical factors. This study aims to apply the Adjusted Morbidity Groups (AMG) algorithm in the context of an Italian Region, and evaluate its performance to support decision-making processes in healthcare programming. Methods The pilot study used five Healthcare Administrative Databases (HADs) covering the period 2015–2021. An iterative semi-automated procedure was developed to extract, filter, check and merge the data. A technical manual was developed to describe the process, designed to be standardized, reproducible and transferable. AMG algorithm was applied and descriptive analysis performed. A dashboard structure was developed to exploit the results of the tool. Results AMG produced information on the health status of Marche citizens, highlighting the presence of chronic conditions from age 45 years. Persons with high and very high level of complexity showed elevated mortality rates and an increased use of healthcare resources. A visualization dashboard was intended to provide to relevant stakeholders accessible, updated and ready-to-use aggregated information on the health status of citizens and additional insight on the use of the healthcare services and resources by specific groups of citizens. Conclusion The flexibility of the AMG, together with its ability to support policymakers and clinical sector, could favour its implementation in different scenarios across Europe. A clear strategy for the adoption of HRA tools and related key elements and lessons learnt for a successful transferability at the EU level were defined. HRA strategies should be considered a pillar of healthcare policies and programming to achieve person-centred care and promote the sustainability of the EU healthcare systems.

The heterogeneity and complexity of symptom presentation, comorbidities and genetic factors pose challenges to the identification of biological mechanisms underlying complex diseases. Current approaches used to identify biological subtypes of major depressive disorder (MDD) mainly focus on clinical characteristics that cannot be linked to specific biological models. Here, we examined multimorbidities to identify MDD subtypes with distinct genetic and non-genetic factors. We leveraged dynamic Bayesian network approaches to determine a minimal set of multimorbidities relevant to MDD and identified seven clusters of disease-burden trajectories throughout the lifespan among 1.2 million participants from cohorts in the UK, Finland, and Spain. The clusters had clear protective- and risk-factor profiles as well as age-specific clinical courses mainly driven by inflammatory processes, and a comprehensive map of heritability and genetic correlations among these clusters was revealed. Our results can guide the development of personalized treatments for MDD based on the unique genetic, clinical and non-genetic risk-factor profiles of patients. Major depressive disorder is a heterogeneous condition with varied presentation of symptoms, comorbidities, and related genetic factors. This study aimed to identify clusters of major depressive disorder-related longitudinal multimorbidity trajectories and to characterize the clusters using genetic and risk factor data.

Background As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers). Methods Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery. Results Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery. Conclusions We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.

Over the past decades, health care systems have significantly evolved due to aging populations, chronic diseases, and higher-quality care expectations. Concurrently with the added health care needs, information and communications technology advancements have transformed health care delivery. Technologies such as telemedicine, electronic health records, and mobile health apps promise enhanced accessibility, efficiency, and patient outcomes, leading to more personalized, data-driven care. However, organizational, political, and cultural barriers and the fragmented approach to health information management are challenging the integration of these technologies to effectively support health care delivery. This fragmentation collides with the need for integrated care pathways that focus on holistic health and wellness. Catalonia (northeast Spain), a region of 8 million people with universal health care coverage and a single public health insurer but highly heterogeneous health care service providers, has experienced outstanding digitalization and integration of health information over the past 25 years, when the first transition from paper to digital support occurred. This Viewpoint describes the implementation of health ITs at a system level, discusses the hits and misses encountered in this journey, and frames this regional implementation within the global context. We present the architectures and use trends of the health information platforms over time. This provides insightful information that can be used by other systems worldwide in the never-ending transformation of health care structure and services.