Selection of Matching Variables in Community Health Intervention Trials

In a matched experimental design, the effectiveness of matching in reducing bias and increasing power depends on the strength of the association between the matching variable and the outcome of interest. In particular, in the design of a community health intervention trial, the effectiveness of a matched design, where communities are matched according to some community characteristic, depends on the strength of the correlation between the matching characteristic and the change in the health behavior being measured. We attempt to estimate the correlation between community characteristics and changes in health behaviors in four datasets from community intervention trials and observational studies. Community characteristics that are highly correlated with changes in health behaviors would potentially be effective matching variables in studies of health intervention programs designed to change those behaviors. Among the community characteristics considered, the urban-rural character of the community was the most highly correlated with changes in health behaviors. The correlations between Per Capita Income, Percent Low Income & Percent aged over 65 and changes in health behaviors were marginally statistically significant (p < 0.08).

Rural water system sustainability : a case study of community-managed water systems in Saramaka communities

Worldwide, rural populations are far less likely to have access to clean drinking water than are urban ones. In many developing countries, the current approach to rural water supply uses a model of demand-driven, community-managed water systems. In Suriname, South America rural populations have limited access to improved water supplies; community-managed water supply systems have been installed in several rural communities by nongovernmental organizations as part of the solution. To date, there has been no review of the performance of these water supply systems. This report presents the results of an investigation of three rural water supply systems constructed in Saramaka villages in the interior of Suriname. The investigation used a combination of qualitative and quantitative methods, coupled with ethnographic information, to construct a comprehensive overview of these water systems. This overview includes the water use of the communities, the current status of the water supply systems, histories and sustainability of the water supply projects, technical reviews, and community perceptions. From this overview, factors important to the sustainability of these water systems were identified. Community water supply systems are engineered solutions that operate through social cooperation. The results from this investigation show that technical adequacy is the first and most critical factor for long-term sustainability of a water system. It also shows that technical adequacy is dependent on the appropriateness of the engineering design for the social, cultural, and natural setting in which it takes place. The complex relationships between technical adequacy, community support, and the involvement of women play important roles in the success of water supply projects. Addressing these factors during the project process and taking advantage of alternative water resources may increase the supply of improved drinking water to rural communities.

How Insecurity impacts on school attendance and school drop out among urban slum children in Nairobi

This paper discusses how perceptions of personal security can impact on school enrolment and attendance. It mainly focuses on threats to physical harm, crime, community and domestic violence. These security fears can include insecurity that children suffer from as they go to school, maybe through the use of unsafe routes; insecurity that children feel at school; and the insecurity they suffer from in their homes. Although poverty is an indicator of insecurity, this paper does not focus solely on poverty as it is well covered elsewhere in the literature. The paper relies on qualitative data collected in Korogocho and Viwandani slum areas in Nairobi, Kenya between October and November 2004. The paper analyses data from individual interviews and focus group interviews and focuses on the narrative of slum dwellers on how insecurity impacts on educational attainment. The conclusion in this paper is that insecure neighbourhoods may have a negative impact on schooling. As a result policies that address insecurity in slum neighbourhoods can also improve school attendance and performance.

Patient satisfaction and nursing staff work satisfaction in an urban public teaching hospital

This study examined the level of patient satisfaction and nursing staff work satisfaction at an urban public hospital in the Southwestern United States. The primary objectives of this study were to determine: (1) the level of overall patient satisfaction and satisfaction with specific dimensions of hospital care; (2) the differences in patient satisfaction according to demographic characteristics (age, gender, ethnicity, and education completed) and predispositional factors (perceived health status, perceived level of pain, prior contact with the hospital, and hospital image) and the relative importance of each variable on patient satisfaction; (3) the level of overall work satisfaction and satisfaction with specific dimensions of work experienced by the medical/surgical nursing staff; (4) the differences in work satisfaction experienced by the nursing staff based on demographic variables (age, gender, ethnicity, and marital status) and professional factors (education completed, staff position, the number of years employed with the hospital, and number of years employed in nursing) and the relative importance of each variable on work satisfaction; and (5) to determine the effect of the nursing work milieu on patient and staff satisfaction.^ The study findings showed that patients experienced a moderate to low level of satisfaction with the dimensions of hospital care (admission process, daily care, information, nursing care, physician care, other hospital staff, living arrangements, and overall care). Of the eight dimensions of care, patients reported a relatively positive level of satisfaction (75 percent or better) with only one dimension: physician care. Ethnicity, perceived health status, and hospital image were significantly related to patient satisfaction. Hispanic patients, those who were in good health, and those who felt the hospital had a good image in their community were most satisfied with hospital care. Patients also reported areas of hospital care that needed the most improvement. Responses included: rude staff, better nursing care, and better communication.^ Findings from the nursing satisfaction survey indicated a low level of satisfaction with the dimensions of work (autonomy, pay, professional status, interaction, task requirements, and organizational policies). Only one dimension of work, professional status, received a mean satisfaction score in the positive range. Additionally, staff members were unanimously dissatisfied with their salaries. Frequently mentioned work-related problems reported by the staff included: staffing shortages, heavy patient loads. and excessive paperwork.^ The nursing milieu appeared to have had a significant effect on the satisfaction levels of patients nursing staff employees. The nursing staff were often short staffed, which increased the patient-to-nurse ratio. Consequently, patients did not receive the amount of attention and care they expected from the nursing staff. Crowded patient rooms allowed for little personal space and privacy. Dissatisfaction with living conditions served to influence patients' attitudes and satisfaction levels. These frustrations were often directed toward their primary caregivers, the nursing staff. Consequently, the nursing milieu appeared to directly affect and influence the satisfaction levels of both patients and staff. (Abstract shortened by UMI). ^

Community participation in health services

This study critically analyzes and synthesizes community participation (CP) theory across disciplines, defining and beginning to map out the elements of CP according to a preliminary framework of structure, process, intermediate outcomes, and ultimate outcomes. The first study component sought to determine the impact of Sight N' Soul, a CP project utilizing neighborhood health workers (NHWs), on appointment missing in an indigent urban African-American population. It found that persons entering the vision care system through contact with an NEW were about a third less likely to miss an appointment than those persons entering the system through some other avenue. While theory in this area remains too poorly developed to hypothesize causal relationships between structure, process, and outcomes, a summary of the elements of Sight N' Soul's structure and process both developed the preliminary framework and serves as a first step to mapping these relationships. The second component of the study uncovered the elements of structure and process that may contribute to a sustained egalitarian partnership between community people and professionals, a CP program called Project HEAL. Elements of Project HEAL's structure and process included a shared belief in the program; spirituality; contribution, ownership, and reciprocation; a feeling of family; making it together; honesty, trust, and openness about conflict; the inevitability of uncertainty and change; and the guiding interactional principles of respect; love, care, and compassion; and personal responsibility. The third component analyzed the existing literature, identifying and addressing gaps and inconsistencies and highlighting areas needing more highly developed ethical analysis. Focal issues include the political, economic, and historical context of CP; the power of naming; the issue of purpose; the nature of community; the power to muster and allocate resources; and the need to move to a systems view of health and well-being, expanding our understanding of the universe of potential outcomes of CP, including iatrogenic outcomes. Intermediate outcomes might include change in community, program, and individual capacity, as well as improved health care delivery. Ultimate outcomes include increased positive interdependencies and opportunities for contribution; improved mental, physical, and spiritual health; increased social justice; and decreased exploitation. ^

Classifying and mapping the urban transition in Vietnam

The urban transition almost always involves wrenching social adjustment as small agricultural communities are forced to adjust rapidly to industrial ways of life. Large-scale in-migration of young people, usually from poor regions, creates enormous demand and expectations for community and social services. One immediate problem planners face in approaching this challenge is how to define, differentiate, and map what is rural, urban, and transitional (i.e., peri-urban). This project established an urban classification for Vietnam by using national census and remote sensing data to identify and map the smallest administrative units for which data are collected as rural, peri-urban, urban, or urban core. We used both natural and human factors in the quantitative model: income from agriculture, land under agriculture and forests, houses with modern sanitation, and the Normalized Difference Vegetation Index. Model results suggest that in 2006, 71% of Vietnam's 10,891 communes were rural, 18% peri-urban, 3% urban, and 4% urban core. Of the communes our model classified as peri-urban, 61% were classified by the Vietnamese government as rural. More than 7% of Vietnam's land area can be classified as peri-urban and approximately 13% of its population (more than 11 million people) lives in peri-urban areas. We identified and mapped three types of peri-urban places: communes in the periphery of large towns and cities; communes along highways; and communes associated with provincial administration or home to industrial, energy, or natural resources projects (e.g., mining). We validated this classification based on ground observations, analyses of multi-temporal night-time lights data, and an examination of road networks. The model provides a method for rapidly assessing the rural–urban nature of places to assist planners in identifying rural areas undergoing rapid change with accompanying needs for investments in building, sanitation, road infrastructure, and government institutions.

The utility of rapid participatory appraisal for community assessment, diagnosis, and policy development

The selection of a model to guide the understanding and resolution of community problems is an important issue relating to the foundation of public health practice: assessment, policy development, and assurance. Many assessment models produce a diagnosis of community weaknesses, but fail to promote planning and interventions. Rapid Participatory Appraisal (RPA) is a participatory action research model which regards assessment as the first step in the problem solving process, and claims to achieve assessment and policy development within limited resources of time and money. Literature documenting the fulfillment of these claims, and thereby supporting the utility of the model, is relatively sparse and difficult to obtain. Very few articles discuss the changes resulting from RPA assessments in urban areas, and those that do describe studies conducted outside the U.S.A. ^ This study examines the utility of the RPA model and its underlying theories: systems theory, grounded theory, and principles of participatory change, as illustrated by the case study of a community assessment conducted for the Texas Diabetes Institute (TDI), San Antonio, Texas, and subsequent outcomes. Diabetes has a high prevalence and is a major issue in San Antonio. Faculty and students conducted the assessment by informal collaboration between two nursing and public health assessment courses, providing practical student experiences. The study area was large, and the flexibility of the model tested by its use in contiguous sub-regions, reanalyzing aggregated results for the study area. Official TDI reports, and a mail survey of agency employees, described policy development resulting from community diagnoses revealed by the assessment. ^ The RPA model met the criteria for utility from the perspectives of merit, worth, efficiency, and effectiveness. The RPA model best met the agencies' criteria (merit), met the data needs of TDI in this particular situation (worth), provided valid results within budget, time, and personnel constraints (efficiency), and stimulated policy development by TDI (effectiveness). ^ The RPA model appears to have utility for community assessment, diagnosis, and policy development in circumstances similar to the TDI diabetes study. ^

Community Trails in Community Context: GIS Analysis of Associations between Trail and Neighborhood Characteristics

This research examines the site and situation characteristics of community trails as landscapes promoting physical activity. Trail segment and neighborhood characteristics for six trails in urban, suburban, and exurban towns in northeastern Massachusetts were assessed from primary Global Positioning System (GPS) data and from secondary Census and land use data integrated in a geographic information system (GIS). Correlations between neighborhood street and housing density, land use mix, and sociodemographic characteristics and trail segment characteristics and amenities measure the degree to which trail segment attributes are associated with the surrounding neighborhood characteristics.

Has the development of a New Urbanist community affected the physical activity levels of residents in surrounding neighborhoods?

Study Aims. The neighborhood environment has been shown to influence physical activity levels, but little is known about how far-reaching these effects are. This study sought to determine whether or not the development of a New Urbanist community in Austin, Texas affected the physical activity levels of residents in surrounding neighborhoods. The results were stratified by demographic characteristics, residential distance from the New Urbanist community, and type of physical activity to determine if any observed changes varied by these factors.^ Methods. Self-report questionnaires were mailed to a random sample of households located within one mile of the New Urbanist development. The questionnaire included questions about physical activity behaviors before and after the community was constructed in 2006. Changes in reported levels of physical activity between the two time points were examined.^ Results. The prevalence and average minutes per week of total physical activity did not change. Significant increases in the frequency and quantity of moderate-intensity leisure-time physical activity were observed. The amount of time spent walking and biking for recreation outside of the neighborhood increased significantly among those living close to Mueller. The weekly time spent in vigorous-intensity activity increased significantly, especially among those living closer to Mueller. There were significant decreases in the prevalence of and time spent walking for transport. The use of Mueller parks and trails was highest among participants living close to Mueller.^ Conclusions. The nearby Mueller development does not appear to have encouraged sedentary members of the surrounding population to become physically active, but might be associated with increased weekly physical activity among those who were already active. The increase in vigorous-intensity physical activity and recreational walking/biking outside of the neighborhood among those subjects living closer to Mueller may be attributed to the use of Mueller parks and trails, which was also considerably higher among this group. People may be substituting the time they spent walking for transport before the Mueller development with moderate-intensity leisure-time physical activity. Future research should seek to identify barriers that may be preventing more nearby residents from using Mueller facilities for physical activity. ^

Charity care and community benefits by hospital type in Texas

Hospital care is the largest component of the health care sector. This industry is made up of for profit hospital (FPH) organizations, not for profit (NFP) hospitals, and government (GOV) run hospital facilities. Objectives of this analysis were: (a) to conduct a literature review on NFP hospital legislation at the state level in Texas and at the federal level in the broader U.S.; and (b) to describe the types of charity care and community benefits currently being provided: by NFP hospitals compared to FPH hospitals and GOV hospitals; by hospitals geographic proximity to the Texas-Mexico border; and by hospital community type (rural, suburban, and urban); and (c) propose specific policy changes that may be needed to improve the current Texas State statute. Methods. In describing the historical and current policy context of NFP hospital legislation in the United States, federal legislation was reviewed from 1913 to the present and Texas State legislation was reviewed from 1980 to the present. In describing the provision of charity care, data from the 2008 Annual Cooperative Hospital Survey were examined by hospital organizational type, size, proximity to the border, and community type using linear regression and chi-squared tests to assess differences in charity care and community benefits. Results. The data included 123 NFP hospitals, 114 GOV hospitals, and 123 FPH. Results. Small sized (p<0.001) and medium sized (p<0.001) NFP hospitals provide a greater percent of total charity care when compared to FPH hospitals and to both GOV and FPH hospitals respectively; however, no significant difference in total charity care was found among large sized NFP hospitals when compared to FPH hospitals alone (p=.345) and both GOV and FPH facilities (p=.214). The amount of charity care provided was not found to be different based on proximity to the border or community type. Community benefit planning and budgeting was found to be similar regardless of community type and proximity to the border. Conclusion. No differences in charity care in Texas were found for large sized NFP hospitals compared to FPH and GOV hospitals. Contrary to widely held beliefs, this study did not find the border region to provide a greater amount of charity care or bad debt. Charity care also did not vary by community type. These findings underscore the need for continued collection of transparent data from all hospitals in order to provide policy makers and consumers with information on utilization trends to ensure benefits are being provided to the community. Policy changes or revoking tax-benefits may occur as charity care utilization declines with the implementation of health reform in the next few years.^

INFANT MORTALITY IN THE MEXICAN AMERICAN COMMUNITY: AN ANALYSIS OF DIFFERENTIALS IN INFANT, NEONATAL, AND POSTNEONATAL MORTALITY BY ETHNICITY AND PARENTAL NATIVITY, 1974-75 SINGLE LIVE BIRTH COHORT, HARRIS COUNTY, TEXAS

The paradoxically low infant mortality rates for Mexican Americans in Texas have been attributed to inaccuracies in vital registration and idiosyncracies in Mexican migration in rural areas along the U.S.-Mexico border. This study examined infant (IMR), neonatal (NMR), and postneonatal (PNMR) mortality rates of Mexican Americans in an urban, non-border setting, using linked birth and death records of the 1974-75 single live birth cohort (N = 68,584) in Harris County, Texas, which includes the city of Houston and is reported to have nearly complete birth and death registration. The use of parental nativity with the traditional Spanish surname criterion made it possible to distinguish infants of Mexican-born immigrants from those of Blacks, Anglos, other Hispanics, and later-generation, more Anglicized Mexican Americans. Mortality rates were analyzed by ethnicity, parental nativity, and cause of death, with respect to birth weight, birth order, maternal age, legitimacy status, and time of first prenatal care.^ While overall IMRs showed Spanish surname rates slightly higher than Anglo rates, infants of Mexican-born immigrants had much lower NMRs than did Anglos, even for moderately low birth weight infants. However, among infants under 1500 grams, presumably unable to be discharged home in the neonatal period, Mexican Americans had the highest NMR. The inconsistency suggested unreported deaths for Mexican American low birth weight infants after hospital discharge. The PNMR of infants of Mexican immigrants was also lower than for Anglos, and the usual mortality differentials were reversed: high-risk categories of high birth order, high maternal age, and late/no prenatal care had the lowest PNMRs. Since these groups' characteristics are congruent with those of low-income migrants, the data suggested the possibility of migration losses. Cause of death analysis suggested that prematurity and birth injuries are greater problems than heretofore recognized among Mexican Americans, and that home births and "shoebox burials" may be unrecorded even in an urban setting.^ Caution is advised in the interpretation of infant mortality rates for a Spanish surname population of Mexican origin, even in an urban, non-border area with reportedly excellent birth and death registration. ^

Health outcomes, quality improvement and cost-effectiveness of the Community Diabetes Education (CoDE) program: Results of a randomized controlled trial

The objectives of this dissertation were to evaluate health outcomes, quality improvement measures, and the long-term cost-effectiveness and impact on diabetes-related microvascular and macrovascular complications of a community health worker-led culturally tailored diabetes education and management intervention provided to uninsured Mexican Americans in an urban faith-based clinic. A prospective, randomized controlled repeated measures design was employed to compare the intervention effects between: (1) an intervention group (n=90) that participated in the Community Diabetes Education (CoDE) program along with usual medical care; and (2) a wait-listed comparison group (n=90) that received only usual medical care. Changes in hemoglobin A1c (HbA1c) and secondary outcomes (lipid status, blood pressure and body mass index) were assessed using linear mixed-models and an intention-to-treat approach. The CoDE group experienced greater reduction in HbA1c (-1.6%, p<.001) than the control group (-.9%, p<.001) over the 12 month study period. After adjusting for group-by-time interaction, antidiabetic medication use at baseline, changes made to the antidiabetic regime over the study period, duration of diabetes and baseline HbA1c, a statistically significant intervention effect on HbA1c (-.7%, p=.02) was observed for CoDE participants. Process and outcome quality measures were evaluated using multiple mixed-effects logistic regression models. Assessment of quality indicators revealed that the CoDE intervention group was significantly more likely to have received a dilated retinal examination than the control group, and 53% achieved a HbA1c below 7% compared with 38% of control group subjects. Long-term cost-effectiveness and impact on diabetes-related health outcomes were estimated through simulation modeling using the rigorously validated Archimedes Model. Over a 20 year time horizon, CoDE participants were forecasted to have less proliferative diabetic retinopathy, fewer foot ulcers, and reduced numbers of foot amputations than control group subjects who received usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life-year gained was estimated for CoDE intervention participants over the same time period. The results from the three areas of program evaluation: impact on short-term health outcomes, quantification of improvement in quality of diabetes care, and projection of long-term cost-effectiveness and impact on diabetes-related health outcomes provide evidence that a community health worker can be a valuable resource to reduce diabetes disparities for uninsured Mexican Americans. This evidence supports formal integration of community health workers as members of the diabetes care team.^

Reversible Urban Entities. Improving public-to-private continuity.

The aim of this paper is to call into question those typologies conventionally used in developing the post-industrial urban fabric (streets, cityblocks, slabs, etc.), often catering to urban designs based on speculative interests and completely overlooking community interests. By defining the concepts of ?postpublic space? and ?reversible urban entities? and illustrating them with an exemplary case of Spanish residential architecture from the 1960s, we establish one possible way of tackling contemporary urban-residential projects. This alternative approach considers the relationship between residential systems and open space systems and promotes the continuity and/or alternation of scales between house and city in an effort to improve the urban quality of life for residents and external users.

Assessing urban mobility through participatory scenario building and combined utility-regret assessment

La planificación de la movilidad sostenible urbana es una tarea compleja que implica un alto grado de incertidumbre debido al horizonte de planificación a largo plazo, la amplia gama de paquetes de políticas posibles, la necesidad de una aplicación efectiva y eficiente, la gran escala geográfica, la necesidad de considerar objetivos económicos, sociales y ambientales, y la respuesta del viajero a los diferentes cursos de acción y su aceptabilidad política (Shiftan et al., 2003). Además, con las tendencias inevitables en motorización y urbanización, la demanda de terrenos y recursos de movilidad en las ciudades está aumentando dramáticamente. Como consecuencia de ello, los problemas de congestión de tráfico, deterioro ambiental, contaminación del aire, consumo de energía, desigualdades en la comunidad, etc. se hacen más y más críticos para la sociedad. Esta situación no es estable a largo plazo. Para enfrentarse a estos desafíos y conseguir un desarrollo sostenible, es necesario considerar una estrategia de planificación urbana a largo plazo, que aborde las necesarias implicaciones potencialmente importantes. Esta tesis contribuye a las herramientas de evaluación a largo plazo de la movilidad urbana estableciendo una metodología innovadora para el análisis y optimización de dos tipos de medidas de gestión de la demanda del transporte (TDM). La metodología nueva realizado se basa en la flexibilización de la toma de decisiones basadas en utilidad, integrando diversos mecanismos de decisión contrariedad‐anticipada y combinados utilidad‐contrariedad en un marco integral de planificación del transporte. La metodología propuesta incluye dos aspectos principales: 1) La construcción de escenarios con una o varias medidas TDM usando el método de encuesta que incorpora la teoría “regret”. La construcción de escenarios para este trabajo se hace para considerar específicamente la implementación de cada medida TDM en el marco temporal y marco espacial. Al final, se construyen 13 escenarios TDM en términos del más deseable, el más posible y el de menor grado de “regret” como resultado de una encuesta en dos rondas a expertos en el tema. 2) A continuación se procede al desarrollo de un marco de evaluación estratégica, basado en un Análisis Multicriterio de Toma de Decisiones (Multicriteria Decision Analysis, MCDA) y en un modelo “regret”. Este marco de evaluación se utiliza para comparar la contribución de los distintos escenarios TDM a la movilidad sostenible y para determinar el mejor escenario utilizando no sólo el valor objetivo de utilidad objetivo obtenido en el análisis orientado a utilidad MCDA, sino también el valor de “regret” que se calcula por medio del modelo “regret” MCDA. La función objetivo del MCDA se integra en un modelo de interacción de uso del suelo y transporte que se usa para optimizar y evaluar los impactos a largo plazo de los escenarios TDM previamente construidos. Un modelo de “regret”, llamado “referencedependent regret model (RDRM)” (modelo de contrariedad dependiente de referencias), se ha adaptado para analizar la contribución de cada escenario TDM desde un punto de vista subjetivo. La validación de la metodología se realiza mediante su aplicación a un caso de estudio en la provincia de Madrid. La metodología propuesta define pues un procedimiento técnico detallado para la evaluación de los impactos estratégicos de la aplicación de medidas de gestión de la demanda en el transporte, que se considera que constituye una herramienta de planificación útil, transparente y flexible, tanto para los planificadores como para los responsables de la gestión del transporte. Planning sustainable urban mobility is a complex task involving a high degree of uncertainty due to the long‐term planning horizon, the wide spectrum of potential policy packages, the need for effective and efficient implementation, the large geographical scale, the necessity to consider economic, social, and environmental goals, and the traveller’s response to the various action courses and their political acceptability (Shiftan et al., 2003). Moreover, with the inevitable trends on motorisation and urbanisation, the demand for land and mobility in cities is growing dramatically. Consequently, the problems of traffic congestion, environmental deterioration, air pollution, energy consumption, and community inequity etc., are becoming more and more critical for the society (EU, 2011). Certainly, this course is not sustainable in the long term. To address this challenge and achieve sustainable development, a long‐term perspective strategic urban plan, with its potentially important implications, should be established. This thesis contributes on assessing long‐term urban mobility by establishing an innovative methodology for optimizing and evaluating two types of transport demand management measures (TDM). The new methodology aims at relaxing the utility‐based decision‐making assumption by embedding anticipated‐regret and combined utilityregret decision mechanisms in an integrated transport planning framework. The proposed methodology includes two major aspects: 1) Construction of policy scenarios within a single measure or combined TDM policy‐packages using the survey method incorporating the regret theory. The purpose of building the TDM scenarios in this work is to address the specific implementation in terms of time frame and geographic scale for each TDM measure. Finally, 13 TDM scenarios are built in terms of the most desirable, the most expected and the least regret choice by means of the two‐round Delphi based survey. 2) Development of the combined utility‐regret analysis framework based on multicriteria decision analysis (MCDA). This assessment framework is used to compare the contribution of the TDM scenario towards sustainable mobility and to determine the best scenario considering not only the objective utility value obtained from the utilitybased MCDA, but also a regret value that is calculated via a regret‐based MCDA. The objective function of the utility‐based MCDA is integrated in a land use and transport interaction model and is used for optimizing and assessing the long term impacts of the constructed TDM scenarios. A regret based model, called referente dependent regret model (RDRM) is adapted to analyse the contribution of each TDM scenario in terms of a subjective point of view. The suggested methodology is implemented and validated in the case of Madrid. It defines a comprehensive technical procedure for assessing strategic effects of transport demand management measures, which can be useful, transparent and flexible planning tool both for planners and decision‐makers.

Bioaccessibility of heavy metals and risk assessment in urban gardens of Madrid

Human health problems and solutions. Urban gardening has spread worldwide in recent years as it enhances food security and selfsupply and promotes community integration. However urban soils are significantly enriched in trace elements relative to background levels. Exposure to the soil in urban gardens may therefore result in adverse health effects depending on the degree of contact during gardening, infant recreational activities and ingestion of vegetables grown in them. In order to evaluate this potential risk, 36 composite samples were collected from the top 20 cm of the soil of 6 urban gardens in Madrid. The aqua regia (pseudototal) and glycine-extractable (bioaccessible) concentrations of Co, Cr, Cu, Ni, Pb and Zn were determined by atomic absorption spectrophotometry. Additionally, pH, texture, Fe, Ca, and Mn concentrations, and organic matter and calcium carbonate contents were determined in all urban gardens and their influence on trace element bioaccessibility was analyzed.