Novartis Foundation

Social networking is an essential feature of hunter-gatherer societies. It fosters the circulation of goods and information and enables kinship ties across different scales, including long-distance contacts. While such behaviors are known since at least the Upper Palaeolithic, evidence for geographically extensive social networks remains scarce. This evidence is limited to indirect inferences based on shared cultural traits, “art” styles, and symbolic items, while lithic raw material movements are mostly local and regional, with few cases exceeding 300 kilometers. We provide geochemical evidence for the largest confirmed distance between the source and discard location of a knapped lithic object in Palaeolithic Europe. Solutrean artifacts discarded at Peña Capón, Central Iberia, were sourced in Southwest France, 600 to 700 kilometers away. This demonstrates social networks of unprecedented geographic scale maintained during ∼1400 years during the Last Glacial Maximum. It also suggests that stone tools were exchanged as symbolic items to solidify social contacts and sustain far-reaching networks as risk-buffering mechanisms among widely dispersed hunter-gatherers.

ObjectivesHypertension is a major cardiovascular risk factor in Brazil and globally, requiring effective healthcare system strategies. This study examines how the health system in São Paulo manages hypertension, identifying patterns and connections that influence patient outcomes and resource use.MethodsUsing literature reviews and participatory discussions with experts, we developed a systems map, causal loop diagram, to illustrate dynamic complexity underpinning hypertension management. Thematic analysis of qualitative data informed the model, highlighting key interactions that shape screening, treatment, and long-term care.ResultsThe analysis reveals critical dynamics at individual, community, and system levels. Early diagnosis and expanded treatment access improve adherence and reduce complications. However, these improvements also increase the number of patients needing long-term care. This creates a challenge where healthcare gains today can raise future demands if prevention efforts are underfunded.ConclusionUnderstanding these interconnections is crucial for balancing treatment expansion with sustainable prevention strategies. By mapping system-wide challenges, this study offers a framework to help policymakers allocate resources more effectively and strengthen urban health systems. Future research will focus on using simulation modeling to test policy interventions and improve hypertension outcomes.

IntroductionCardiovascular disease is a leading cause of morbidity and mortality globally and in New York City. Significant disparities in prevalence and risk factors persist across city neighbourhoods and among populations of varying socio-economic status, racial and ethnic backgrounds. These disparities are shaped and sustained by the complex interplay of social determinants of health, including housing, employment, access to healthcare and structural inequities. This study builds on prior quantitative research conducted under the AI4HealthyCities initiative, which applied machine learning to identify spatial clusters of cardiovascular vulnerability and social disadvantage. This research addresses key gaps in that work by generating disaggregated, qualitative data on underrepresented populations. The study also aims to explore the mechanisms through which specific social determinants may contribute to cardiovascular risk, including the role of behavioural and demographic mediators. By combining lived experiences and system-level perspectives, the research will provide contextualised insights to support local stakeholders in designing more effective, equity-oriented interventions.Methods and analysisThis mixed-method ethnographic study will collect data in three phases: expert interviews, community roundtables and vulnerability assessments across three New York City boroughs (Brooklyn, the Bronx and Queens). Qualitative data will be analysed using a combination of deductive and inductive approaches. Thematic synthesis will be used to identify patterns across and within boroughs. Study design and interim findings will be reviewed in collaboration with community stakeholders, a research steering group and the AI4HealthyCities Global Expert Council.Ethics and disseminationThis study has received ethical approval from the Ethics Committee of Weill Cornell Medicine (code number: 23-04025988). The findings of the project will be disseminated via conferences, speaking engagements and peer-reviewed publications.

Optimal diagnosis and management of acute coronary syndrome (ACS) is essential to improve clinical outcomes and prognosis. Sex disparities in ACS care have been reported in the literature, but evidence gaps remain. This review aims to map and to summarize the global evidence on sex differences in the provision of care across the ACS continuum. A systematic literature search was conducted in Pubmed, EMBASE, and the World Health Organization Global Index Medicus. The search was restricted to original research articles published between January 1, 2013, and August 30th, 2023, and with a full-text available in English, Spanish, Dutch, or French. The search terms and key words covered five aspects of the ACS care continuum: pre-hospital care, diagnosis, treatment, in-hospital events, and discharge. Of the 15,033 identified articles, 446 articles (median percentage of women per study: 29%), reporting on 1,483 outcomes, were included. Most studies were conducted in high-income regions (65%). Studies reported on pre-hospital care (8%), diagnosis (9%), treatment (45%), discharge (14%) and events (24%). For 45% of outcomes, results favored men, 5% favored women, and 50% showed mixed results or no sex difference. ACS care aspects with the largest sex differences were pre-hospital care (58% of the outcomes favored men vs 7% favored women) and diagnosis (70% favored men vs 2% favored women). Studies on sex differences in ACS mainly come from high-income regions. Sex differences in ACS management are widely reported and mainly unfavorable to women, especially in the early phases of pre-hospital care and diagnosis.

Abstract The National Institute for Public Health and the Environment (RIVM) has assessed the current effects of climate change on health as part of a national sector-wide process towards updating the Dutch National Adaptation Strategy. Besides health, this process includes assessing the risks of climate change for water management, agriculture, the built environment, nature and other sectors. It will provide a basis for policy, for prioritising the most urgent risks and for long-term risk monitoring. Six climate-related health topics were assessed for this update: heat, air quality, mental health, UV radiation, pollen allergies and infectious diseases. To allow comparison of the impact and likelihood of the climate-related risks across sectors, a format for factsheets on climate risks had been provided. Following this format, for each climate-related health topic we considered the climate threat, secondary effects, exposure, vulnerability, adaptive capacity, impact and cascading effects. The magnitude of the health impacts was categorised per topic as low (< 10,000 people affected; 0 - 10 seriously injured/dead), medium (10,000 - 100,000 people affected; 10 - 100 seriously injured/dead) or high (>100,000 people affected; >100 seriously injured/dead). The likelihood of these impacts was then described as well as possible black swan events or tipping points. Finally, the policy context was outlined, including possible maladaptation, lock-ins, and equity aspects, followed by quality assurance considerations. For all topics, negative health impacts are already occurring. However, the magnitude of the impacts cannot yet be accurately quantified. In this presentation, we will discuss the results of this assessment and explore the pros and cons of being part of a sector-wide process.

A functional and reliable Health Information System (HIS) is vital for data-based decision-making in public health. Here we describe the assessment of data processes and general HIS principles by adapting a global approach to three cities. The assessments supported the data strategy of the CARDIO4cities initiative in each city aiming to improve urban population health by increasing the use of cardiovascular disease (CVD) data to inform decision-making. We aimed to explore data collection processes and entities, data availability and quality as well as data ownership and sharing regarding a set of identified key performance indicators (KPIs). KPIs were based on a global theory of change (ToC) and a global evaluation and indicator framework and were tailored to each location. By first assessing existing sources and processes regarding data, recommendations for changes and improvements are sure to build on current circumstances. To map the data, existing data collection, analysis and storage processes were investigated. A flow chart was created to visualize the data pathways and challenges for each system and findings were compared across cities to document differences and similarities. Data quality and interoperability of various separate systems were the most prominent challenges for all HISs. The observed dvata quality issues originated from incorrect, missing and incomplete data and were connected to the misunderstanding of indicators, incomplete data input forms or the lack of a systematic data routine in the workflow. Harmonization of the HISs to ensure interoperability can facilitate data collection and analysis of health data and can provide a solid basis for health management decision-making. Based on the presented HIS cases, we recommend to examine, map and verify current processes when conducting a HIS assessment, to visualize findings and to gauge the interest of government entities to ensure political support.