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Background: The impact of climate change on public health may occur through a number of main pathways including increased temperature, ground-level ozone levels and ultra-violet radiation, which have a range of consequences for human health. One strategy for adaptation to the predicted effects of climate change on health that has been proposed, is to ‘green’ urban areas, essentially by increasing the abundance and cover of vegetation. This protocol is for an update of a systematic review which aimed to address the question: How effective is ‘greening’ of urban areas in reducing human exposure to ground-level ozone concentrations, UV exposure and the ‘urban heat island effect’?
Methods: A sensitive search of multiple databases and relevant journals for relevant published articles will be conducted. A search for relevant unpublished articles will be undertaken through an internet search and of websites of relevant organisations. Inclusion criteria will be applied at title, abstract and full-text. Repeatability checks of this screening process will be undertaken. Articles included at full-text will be critically appraised using a standardised checklist. A repeatability check will be made of this process. Pre-defined data items will be extracted from included articles. If appropriate, quantitative synthesis will be undertaken through meta-analysis and/or a narrative synthesis will be undertaken.
BACKGROUND: Geographical variation of the general practitioner (GP) workforce is known between rural and urban areas. However, data about the variation between and within urban areas are lacking.
METHOD: We analyzed distribution patterns of GP full time equivalents (FTE) in German cities with a population size of more than 500,000. We correlated their distribution with area measures of social deprivation in order to analyze preferences within neighborhood characteristics. For this purpose, we developed two area measures of deprivation: Geodemographic Index (GDI) and Cultureeconomic Index (CEI).
RESULTS: In total n = 9034.75 FTE were included in n = 14 cities with n = 171 districts. FTE were distributed equally on inter-city level (mean: 6.49; range: 5.12-7.20; SD: 0.51). However, on intra-city level, GP distribution was skewed (mean: 6.54; range: 1.80-43.98; SD: 3.62). Distribution patterns of FTE per 10^4 residents were significantly correlated with GDI (r = -0.49; p < 0.001) and CEI (r = -0.22; p = 0.005). Therefore, location choices of GPs were mainly positively correlated with 1) central location (r = -0.50; p < 0.001), 2) small household size of population (r = -0.50; p < 0.001) and 3) population density (r = 0.35; p < 0.001).
CONCLUSION: Intra-city distribution of GPs was skewed, which could affect the equality of access for the urban population. Furthermore, health services planners should be aware of GP location preferences. This could be helpful to better understand and plan delivery of health services. Within this process the presented Geodemographic Index (GDI) could be of use.