Today more than half of the world’s population lives in urban areas. Children spend about 40 h a week in the school environment. Knowing the influence of school exposure to green/blue spaces could improve the children’s health, creating healthier environments and preventing exposure to legal/illegal drugs. This systematic review summarized the main results of published studies on active or passive exposure to green or blue spaces in different domains of child neurodevelopment. In August 2022, five databases were searched and twenty-eight eligible studies were included in the analysis. Cognitive and/or academic performance was the most frequently studied (15/28). Most studies evaluate passive exposure to green/blue spaces (19/28) versus active exposure (9/28). Only three studies addressed the relationship between blue space and neurodevelopment. The main results point toward mixed evidence of a protective relationship between green/blue space exposure and neurodevelopment, especially in improving cognitive/academic performance, attention restoration, behavior, and impulsivity. Renaturalizing school spaces and promoting “greener” capacities for school environmental health could improve children’s neurodevelopment. There was great heterogeneity in methodologies and adjustment for confounding factors across studies. Future research should seek a standardized approach to delivering school environmental health interventions beneficial to children’s development.

Childhood and adolescent cancer survivors (CACS) are a high-risk population for non-communicable diseases and secondary carcinogenesis. The Environmental and Community Health Program for Longitudinal Follow-up of CACS in the region of Murcia, Spain, is an ongoing pioneering program that constitutes a model for social innovation. This study aims to present the program tools and protocol as a whole, as well as a profile of the incidence, survival, and spatiotemporal distribution of childhood cancer in the region of Murcia, Spain, using 822 sample cases of cancer diagnosed in children under 15 years of age (1998–2020). While the crude incidence rate across that entire period was 149.6 per 1 million, there was an increase over that time in the incidence. The areas with a higher standardized incidence ratio have shifted from the northwest (1998-2003) to the southeast (2016–2020) region. Overall, the ten-year survival rate for all tumor types was 80.1% over the entire period, increasing the five-year survival rate from 76.1 (1998–2003) to 85.5 (2014–2018). CACS living in areas with very poor outdoor air quality had lower survival rates. Furthermore, integrating environmental health into clinical practice could improve knowledge of the etiology and prognosis, as well as the outcomes of CACS. Finally, monitoring individual carbon footprints and creating healthier lifestyles, alongside healthier environments for CACS, could promote wellbeing, environmental awareness, and empowerment in order to attain Sustainable Development Goals for non-communicable diseases in this population.

The complex interactions between heat and public health in tropical environments are not well understood, limiting the integrated understanding of heat-related impacts on the sustainability and resilience of the affected populations. To provide evidence on the impact of heat stress on mortality in Puerto Rico by means of indices that are based on physiologically relevant environmental factors. Daily data on non-accidental mortality for the period of 2015-2020 were obtained from the Puerto Rico Department of Health. We obtained 2 meter ambient air temperature data across the whole geographical extent of Puerto Rico and for the 2015-2020 period at an hourly step from the ERA5 climate reanalysis dataset. We employed two indices derived from thermo-physiological models: the Universal Thermal Climate Index (UTCI) and the Heat Index (HI). Poisson regression models were fitted to explain the total number of deaths as a function of UTCI and HI while adjusting for sex and age. We observed an increase in overall non-accidental mortality in the days categorized as the highest tertile of both HI (IRR: 1.23, 95% CI: 1.21; 1.25) and UTCI (IRR:1.47, 95% CI: 1.44; 1.49) in the adjusted model. Myocardial infarction, ischemic heart disease, heart failure, and cerebrovascular disease were some of the primary causes of death. Results will provide local decision-makers with sufficient evidence on heat stress impacts and valuable information on vulnerability that can be translated into heat adaptation strategies in Puerto Rico.

Extreme heat poses growing health risks in tropical regions, yet public perception of this threat remains understudied in the Caribbean. This study examines how residents in Puerto Rico perceived heat-related health risks and how these perceptions relate to vulnerability and protective behaviors during the extreme heat events of the summer of 2020. We conducted a cross-sectional telephone survey of 500 adults across metropolitan and non-metropolitan areas of Puerto Rico, using stratified probability sampling. The questionnaire assessed heat risk perception, sociodemographic characteristics, health status, prior heat exposure, and heat-related behaviors. While most participants expressed concern about climate change and high temperatures, fewer than half perceived heat as a high level of personal health risk. Higher levels of risk perception were significantly associated with being male, aged 50–64, unemployed, and in fair health, having multiple chronic conditions, and prior experience with heat-related symptoms. Those with symptoms were nearly five times more likely to report high levels of risk perception (OR = 4.94, 95% CI: 2.93–8.34). In contrast, older adults (65+), despite their higher level of vulnerability, reported lower levels of risk perception and fewer symptoms. Nighttime heat exposure was widespread and strongly associated with heat-related symptoms. Common coping strategies included the use of fans and air conditioning, though economic constraints and infrastructure instability limited access. The findings highlight the disparity between actual and perceived vulnerability, particularly among older adults. Public health strategies should focus on risk communication tailored to vulnerable groups and address barriers to heat adaptation. Strengthening heat resilience in Puerto Rico requires improved infrastructure, equitable access to cooling, and targeted outreach.

Puerto Rico is experiencing anomalous heat episodes. The year 2023 was marked by unprecedented extreme heat events with negative impacts in Puerto Rico’s learning environments. This study aimed to understand the context, barriers, knowledge, risks, vulnerabilities, perceptions, employees’ profiles, attitudes, and symptoms related to extreme heat in learning environments. We employed a mixed-methods approach combining: (1) Earth Observation Data and geospatial analysis, (2) an online survey for teachers, administrative staff, and other school employees from diverse educational settings and levels and (3) a series of participatory activities with stakeholders, practitioners and decision makers that led to knowledge co-production and adaptation strategies. 36 % of schools were exposed to land surface temperatures exceeding 41.4 °C. The southern region showed the highest proportion (50.7 %) of schools in high or critical risk areas for heat and had insufficient A/C infrastructure. Survey results indicated significant disparities in A/C conditioning availability between private (17.28 %), public schools (2.93 %) and educational regions. Students and school employees in non-air-conditioned environments showed significantly higher odds of experiencing heat-related symptoms. Fatigue (OR=2.53), irrationality (OR=2.40), lack of attention (OR=2.14), dizziness (OR=2.62, 95 % CI: 1.91–3.65) were some of the most reported symptoms. This assessment of extreme heat impacts in tropical learning environments reveals significant disparities in heat exposure and adaptation capacity across Puerto Rico's educational system. The findings highlight the urgent need for targeted interventions. This research contributes to the improvement of learning environments and serves as a model for adaptation efforts in educational settings in tropical islands.

Human-induced climate change is increasing extreme precipitation events, potentially affecting respiratory health and healthcare access in urban areas. This study examined the relationship between precipitation-driven flooding events and emergency department (ED) visits for acute respiratory illnesses in New York City (NYC) communities. We conducted a retrospective ecological study across 14 postal ZIP codes in New York City's five boroughs from October 2020 to November 2022. Using NYC Micronet sensor network data, we analyzed ED visits for influenza-like illness and pneumonia (n=53,534), categorizing flooding events as minor (2.5 inches). Associations between flooding exposure and ED visits were analyzed using Poisson mixed effects models with a 6-day lag, controlling for socioeconomic status and COVID-19 rates. Precipitation-driven flooding was associated with an average 2.8% decrease in respiratory ED visits after 6 days (IRR 0.972, 95% CI 0.955-0.989). Minor flooding showed a 2.4% reduction in visits, while moderate and major flooding were associated with 17.9% and 12.9% reductions, respectively. These associations remained significant after controlling for confounders. Acute urban flooding events were associated with decreased respiratory ED visits, suggesting possible disruptions to healthcare access or deferred care. These findings affect climate change adaptation and infrastructure planning to ensure continued healthcare accessibility during extreme weather events.