The present qualitative research explores the factors that have influenced the use of urban green spaces (UGS) in Mexico City during the COVID-19 pandemic and the implications of their usage on residents’ well-being. This study was conducted using a combination of solicited audio and written diaries, photography, and in-depth interviews with 16 participants, aged 22 to 58. The article provides a critical reflection on the incentives and deterrents to the UGS use of participants while social distancing measures were in place. The results show that in Mexico City: (1) participants’ lack of access to UGS has hampered their use, mainly among those of low-income neighborhoods; (2) UGS size did not directly impact participants’ UGS use during the pandemic; and (3) women were deterred from accessing UGS due to safety concerns related to the fear of violence. Overall, the results suggest that UGS use has served as a coping mechanism to decrease the effects of stress and isolation caused by the pandemic, increasing users’ physical and mental well-being. This study’s conclusions can help develop future citizen participation tools that are useful for resilience in urban design, as they provide interesting insights into the perceptions of residents, such as the most valued characteristics of UGS.

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BackgroundThere is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy).MethodsA retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years).ResultsMortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47–0.94; OR age > 75 years 0.72, 95% CI:0.54–0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58–0.93).ConclusionsAmong patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.

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Objetivos. Identificar los factores asociados con la dependencia funcional futura de las personas mayores en México, así como con recibir o no apoyo para la realización de actividades básicas de la vida diaria (ABVD), y proyectar la prevalencia de la dependencia funcional en 2026. Métodos. Se utilizaron los datos del Estudio Nacional de Salud y Envejecimiento (ENASEM) del 2001 y las rondas de seguimiento de 2012 y 2015. Se estimó un modelo de regresión logística multinomial para analizar los factores asociados con la dependencia futura y un modelo de regresión logística para los factores asociados con recibir o no apoyo. Para las proyecciones de personas mayores en situación de dependencia en 2026 se utilizaron los datos del ENASEM del 2015 y los coeficientes estimados del modelo de dependencia futura. Resultados. Las personas de más edad, las que tenían un nivel de educación más bajo, las que padecían de hipertensión, artritis, diabetes, las que habían sufrido una embolia cerebral o alguna caída, y las que tenían algún nivel de dependencia funcional previa presentaron un riesgo significativamente mayor de dependencia (leve o severa) y de fallecer en los 11 años siguientes respecto a sus referencias. Las personas de mayor edad o con dependencia severa tuvieron mayores probabilidades de recibir apoyo respecto a sus referencias. Para el año 2026, se estima que el 18,9% de las personas mayores en México tendrá dependencia leve y el 9,3% dependencia severa. Conclusiones. Los factores asociados con la dependencia futura y con fallecer fueron la edad, el nivel educacional, algunas enfermedades crónicas, haberse caído y tener dependencia funcional previa; los factores asociados con recibir apoyo para la realización de ABVD fueron tener dependencia severa y la edad. Se estima que la prevalencia de la dependencia aumentará 2,1 veces en 25 años (2001-2026).

BackgroundEquity, financial sustainability, and quality in healthcare are key goals embraced by universal health systems. However, systematic performance management strategies for achieving equity are still weaker than those aimed at achieving financial sustainability and quality of care. Using a vertical equity perspective, the overarching aim of this paper is to examine how improving equity in quality of care impacts on financial sustainability. We applied a simulation to indicators of the heart failure clinical pathway in Tuscany (central Italy), in order to quantify the equity gaps and financial resources that could be reallocated in the absence of performance inequities.MethodsThe analysis included all patients hospitalized for heart failure as a principal diagnosis in 2014. We selected five indicators: hospitalization rate, 30-day readmission, cardiology visits, and the utilization of beta-blockers, and ACE inhibitors and sartans. For each indicator, the simulation followed three steps: 1) stratification by socioeconomic status (SES), using education as a proxy for SES; 2) computation of the vertical equity indicator; and 3) assessment of the financial value of the equity gap.ResultsAll indicators showed performance gaps regarding inequities across SES-groups. For the hospitalization rate and 30-day readmission, resources could have been reallocated, if the performance of patients with a low SES had been equal to the performance of patients with a high SES, which amounted to €2,144,422 and €892,790 respectively. In contrast, limited additional resources would have been required for prescriptions and cardiology visits.ConclusionsReducing equity gaps by improving the performance of low-SES patients may be a crucial strategy to achieving financial sustainability in universal coverage healthcare systems. Universal healthcare systems, which aim to pursue financial sustainability and quality of care, are thus urged to develop performance management actions to improve equity. This approach should not only include the measurement and public disclosure of equity indicators but be part of a comprehensive evidence-based strategy for the management of chronic conditions along the clinical pathway.

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