As urbanization accelerates in China, more and more rural elders are moving to cities to live with their children. However, they face challenges in overcoming cultural, social, and economic disparities and maintaining health in urban life, and health is important human capital that may have a significant impact on the urban adaptation of rural elderly migrants (REMs). Based on the 2018 China Health and Retirement Longitudinal Study (CHARLS), this paper constructs an indicator system to measure the level of urban adaptation of REMs. The health level and urban adaptation of REMs are studied in depth, and how to better help them adapt to urban life in order to provide a healthy living environment and a good lifestyle is explored. The empirical analysis finds the following: (1) good health helps REMs achieve a better level of urban adaptation. (2) REMs with good health status are more likely to go to community clubs for activities and do physical activities and thus improve their urban adaptation level. (3) There are significant differences in the effects of health status on urban adaptation among REMs with different characteristics. REMs with better health status in the central and western regions have significantly higher levels of urban adaptation than those in the eastern regions, and men have higher levels of urban adaptation than women. Therefore, the government should construct classification measures according to the differentiated characteristics of rural elderly migrants’ urban adaptation, and guide and support their stratified and orderly adaptation to urban society. Rural elderly migrants (REMs) in China are a special vulnerable group in the context of rapid aging, rapid urbanization and mobile China. REMs are those who have an agricultural household registration (hukou), have followed their children to live in the city for more than half a year, and have reached the age of 50 , with paREMs generally face difficulties in urban adaptation , which bHealth is an important influencing factor for REMs in their adaptation to urban areas. REMs face various challenges in the process of new urbanization, and one of the most important factors is health status, which is also a very basic human freedom . The heaNot many studies have been conducted on REMs in China, a special group arising from the dualistic structure of China, while most of the concerns about migrants are aimed at younger rural migrants, often known as “rural migrant workers who come to city for more money and better life”. There are very few studies that combine the triple attributes of rural household registration + mobility + old age and focus on this group in terms of policy care and academic concern. The current studies have mainly investigated the current situation of social adaptation and its influencing factors of REMs ,16, but With the acceleration of urbanization in China, more and more elderly people in rural areas are moving to cities with their children, and this population movement brings challenges to REMs. In this context, it is important to explore the role of health status on the urban adaptation of REMs for the development of elderly health policies and urban planning. The health capital model provides a theoretical framework for exploring this issue. This paper will analyze the role of health status on the urban adaptation of REMs based on the health capital model. The adaptation status of REMs is not only a reflection of their own welfare level, but also determines the speed of their transition to citizenship.The health capital model was proposed by Grossman in 1972 to explore the complex trade-offs in health management . GrossmaFirst, health status has a direct impact on the urban adaptation of REMs. Physical health is the foundation for REMs’ adaptation to urban life. REMs with good health and physical fitness are better able to adapt to the pace and pressure of urban life. Urban living conditions are relatively better, and older adults have access to better medical services and health care resources. However, at the same time, the urban living environment may also have negative effects on the health of REMs, such as air pollution and irregular diet. Therefore, REMs need to maintain good health by following a healthy diet, enhancing physical exercise, and avoiding risky behaviors. On the contrary, REMs with poor health status may encounter more health-related problems during the urban adaptation process, which in turn affects their quality of life and urban adaptation. Studies have shown that health is an important factor influencing the willingness of mobile populations to stay . Health H1: Health status affects the urban adaptation of REMs.Second, health status has an indirect effect on the urban adaptation of REMs. Health status can not only directly affect individuals’ urban adaptation, but can also improve their urban adaptation ability by improving their social interactions and social resource access . The cogH2: REMs with good health are more likely to have stronger social connections in the urban environment.The data in this paper come from the China Health and Retirement Longitudinal Study (CHARLS) database. The survey is a large-scale interdisciplinary project hosted by the National Development Institute of Peking University and jointly implemented by the Social Science Survey Center of Peking University and the Peking University Youth League Committee. Using a scientific PPS sampling method, the household survey was conducted in 28 provinces  of mainland China among middle-aged and older households and individuals aged 45 or older, covering 150 counties and 450 villages (communities), and as of the 2018 follow-up, there were 12,400 households and about 19,000 respondents, which is a high-quality set of micro data with universal representation of Chinese residents that can be used for comprehensive and in-depth analysis of China’s aging problem and promote interdisciplinary research on aging in China. Because unified resident hukou cannot determine whether they are rural hukou or not, which affects the determination of the status of rural elderly people who move with them, a small number of unified resident hukou are excluded from this paper. The sample selection of this paper is based on the following criteria: from the 2018 data, this paper screened out the sample of elderly people with agricultural hukou, aged 50 years or older, who had lived in their children’s city for more than half a year, and after removing the sample with missing important variables, a final sample population of 790 individuals was used for this study.Urban adaptation. H. Entzinger  argues tUrban life adaptation refers to the fact that the REMs have to change their original living habits and concepts to adapt to “modern” urban life after entering the city. Therefore, this paper draws on existing research and selects ① Urban living conditions, which are divided into objective and subjective housing conditions. Many REMs living with their children live in industrial communities in the city; some of the housing is still relatively old, and the housing conditions are not ideal. The measurement of the objective condition of urban living is based on several factors. Firstly, the presence of rental housing indicates the existence of housing costs, which can negatively impact the adaptation of REMs by limiting their expenses in other areas. This is represented by assigning a value of 0 to renting a house and a value of 1 to no rental house. Additionally, the availability of certain amenities determines the objective living conditions. Factors such as the presence of electricity, running water, bathing facilities, separated bathroom, and natural gas are evaluated. Each affirmative response (“yes”) to these items contributes 1 point. Furthermore, the age of the housing where REMs reside is considered, with a higher value assigned to newer houses (ranging from 0 to 5). The subjective conditions of urban living are also taken into account. For instance, the indoor temperature of the house is assessed. If the temperature is deemed appropriate, 2 points are assigned. Colder or hotter temperatures receive 1 point, while very cold or very hot temperatures receive 0 points. Studies have indicated that better objective housing conditions correlate with higher subjective well-being among older individuals. Living in newer homes is associated with a greater subjective sense of well-being. On the other hand, older houses tend to have older infrastructure, potentially leading to poorer living conditions compared to newer houses . ② HygieSocial interaction adaptation measures the extent to which older people communicate, interact, and establish good relationships with others in the city, i.e., social interaction . In thisPsycho-cultural adaptation, i.e., the degree to which the elderly can adapt to different ideas, concepts, and various cultures, mainly reflects REMs’ adaptation to modern urban culture, changes in values, and the overall evaluation of their inner feelings towards urban life. In this paper, with reference to existing studies, we selected ① Digital cultural adaptation and found that Internet use was positively related to social adaptation , measureIn order to comprehensively evaluate the level of urban adaptation of REMs, this paper follows the methodology and steps of Zhang Chen et al.  to calcuAfter determining the weights of each indicator in the urban adaptation index system according to the entropy weighting method, the indicators are weighted and averaged based on the weights to obtain the comprehensive evaluation index of urban adaptation degree, with higher scores indicating a higher urban adaptation degree of REMs. At the same time, the same method is used to measure the scores of urban life adaptation, social interaction adaptation, and psycho-cultural adaptation. The composition and descriptive statistics of the urban adaptation index system of the rural migrant elderly in their place of migration are shown in As shown in Based on different definitions of health, investigators have used a variety of different ways to measure the true health status of respondents. In this paper, objective health is used as a measure of health based on the approach of the literature and the availability of primary data. The objective health indicator uses the instrumental activities of daily living (IADL) indicator , which mCommunity activities (Cclub) and moderate physical activities (Modpa) are the two mechanism variables in this article. Cclub was measured by whether REMs attended activities in the community activity room in the past month. Modpa was measured by whether REMs had undertaken moderate physical activity more than 10 min each time every week. Both community activities and moderate physical activities were treated as dichotomous variables, where “1” represents the presence of the activity and “0” indicates the absence of the activity.Based on existing studies ,40, thisTo examine the relationship between health status and urban adaptation of REMs, we estimate the following equation:The characteristics of the variables we chose are shown in In order to determine whether the characteristics of the REM population are either similar to or significantly different from the non-migrant elderly and make us believe the REM population are a quite different group, we conducted a comparison with the main characteristics among the rural elderly, the urban elderly, and REM through the grouping T-means test, and significant differences were found among the rural elderly, the urban elderly, and REM in terms of personal characteristics. Compared to the rural elderly, REM showed significantly better objective physical health, objective mental health, more perceived social support, a better education level, more financial assets, and likelihood of going to community activity rooms, while, when compared with the urban elderly, it was found that there were no significant differences in objective physical health between the two groups. REM had significantly poorer objective mental health and self-rated health compared to the urban elderly. The education level and financial assets of REM were also lower than those of the urban elderly. The probability of participating in community activity rooms was significantly lower for REM compared to the urban elderly. However, REM had a lower prevalence of chronic diseases compared to the urban elderly. The test results are not included in the body due to space constraints, so they are placed in the attachment Prior to conducting the regression model for empirical analysis, a multicollinearity test and Pearson/Spearman correlation coefficient was performed to test whether there is multicollinearity among independent variables that could distort the model estimates. The results show that see  the inflThe urban adaptation effects of health status are all significant at the 1% significance level, which indicates that REMs with higher levels of health are more likely to achieve higher levels of urban adaptation. An increase of one unit of health increased the urban adaptation of REMs by 0.007, and the increased urban score accounted for 3.3% of the mean urban adaptation score (0.2134).In terms of the social support received by REMs, the coefficient of the type of medical insurance was signified positive, indicating that the more comprehensive the type of medical insurance in which REMs participated, the higher the level of their urban adaptation. The economic support given by their children’s families had a significant positive effect on the urban adaptation of REMs, indicating that the economic support relaxes the labor time requirement for REMs and facilitates their interaction with urban residents, thus facilitating their urban adaptation. The amount of perceived social support had a significant positive effect on the urban adaptation of REMs, indicating that the social support felt by REMs gave them spiritual encouragement and psychological comfort when they faced the “unfamiliar” social environment in the city. The coefficient of children’s emotional support was negative but not statistically significant, indicating that children’s emotional support had no significant effect on urban adaptation. Regarding the individual characteristics of REMs, the coefficient of education level is significantly positive and significant at 1% significance level, indicating that higher education levels contribute to the urban adaptation of REMs. The age factor also has a significant effect on the urban adaptation of REMs: the older they are, the weaker the urban living ability, interaction ability, and adaptation ability, so the urban adaptation level decreases with incremental age, and aging is not conducive to the urban adaptation of REMs. The healthy aging and active aging measures are imperative. Household characteristics of REMs also have a significant impact, such as property income and financial asset income, with both contributing to urban adaptation of REMs.The KHB model, which is currently used more frequently, was used for the intermediate effect test ,44. REMsIn terms of the exclusion of the problem of omitted variables, a natural question is whether the health of REMs varies based on other unobservable characteristics. That is, are there unobserved family and child characteristics, and do these characteristics affect the health of REMs as well as their urban adaptation? To verify that the results are not affected by omitted variables, the Oster  test forOster pointed out that there are three ways to perform the robustness test: (1) the range of to Zhang , the ranTo define health as an independent variable more specifically and purely, health was replaced with self-rated health  and treated as a dichotomous variable and regressed again by means of a replacement model. The explanatory variables in the robustness test section are integrated urban adaptation, in which column (1) is an OLS regression, column (2) is a robust regression with M-estimation model, which further removes the effect of extreme values on the regression results, and column (3) is an IPWRA regression model, which is doubly robust ; that isp < 0.1). Therefore, the positive effect of health status on urban adaptation was greater for REMs in the Midwest than those in the East. As previous studies showed, migrant workers in the more affluent southeastern coastal cities feel less accepted, have greater social and economic externalities, and cultural and customary differences, and group differences in migration are latent mechanisms [There are large differences in REMs’ life course, education level, gender, region of migration, and the length of time in receiving cities, so regression in groups were conducted based on these characteristics, and a suest test was conducted on two groups of samples; the test results rejected the original hypothesis of no significant differences except for the age group and region group, that is, there were significant differences between different groups, as shown in chanisms , the latThere are three dimensions of urban adaptation of REMs, namely, urban life adaptation, social interaction adaptation, and psycho-cultural adaptation. Previously, we only analyzed the impact of health status on the urban adaptation of REMs, but the impact on specific dimensions is unknown, so it is necessary to investigate the impact of health status on different dimensions and to determine whether there are differences in the impact. From the OLS regression results in While there have been some studies focusing on the determinants of urban adaptation among REMs, few of them have considered the role of health status, let alone how health status influences the level of urban adaptation. This research paper aims to investigate the impact of health status on the urban adaptation of REMs in cities. Drawing on classical theories and the relevant literature, we propose hypotheses regarding the relationship between health status and the level of urban adaptation among REMs, and we utilize a national dataset from China to test these hypotheses. The primary objective of our study is to provide insights into the factors influencing the urban adaptation of REMs and to contribute to their integration into cities and the establishment of an inclusive society.The findings of this study highlight the significance of REMs’ health status as a crucial factor in enhancing their urban adaptation. Our research has shed light on a previously understudied and less explored aspect of REMs’ urban adaptation. The results align with other studies that have focused on internal migrants’ settlement intentions and social integration in China, which have demonstrated the importance of physical health in influencing migrants’ intentions to permanently move to the city and their social integration, among other factors. When REMs experience poor health, their access to physical activities and community clubs may be restricted, impeding their interaction with the urban environment. Additionally, increased healthcare costs and difficulties in caring for their grandchildren may further exacerbate the challenges they face, potentially leading to their children viewing them as burdens. Consequently, REMs with a poor health status may exhibit lower levels of urban adaptation.As previous studies have shown, the health of migrants has affected the social integration of migrants , and socFurthermore, the results of our study show that REMs with better physical health may have a higher urban adaptation level in terms of urban life adaptation, social interaction adaptation, as well as psycho-cultural adaptation. One of the most important findings is that REMs with different characteristics showed considerably different urban adaptation outcomes; thus, different measures for different characteristic groups constructed by the government are highly needed.Our results have important theoretical implications for the study of internal elderly migrants from rural households because previous studies have generally ignored the health of elderly rural migrants when discussing factors affecting urban adaptation. In this study, physical health was discussed to provide a comprehensive understanding that is important not only for relevant research, but also for the government. Traditional theories and research usually consider health as an important factor influencing the willingness of internal migrants to settle but ignore the impact on the level of social integration, or consider the impact of health on migrants, but ignore the impact of health on the urban adaptation of special groups such as REMs. This study highlights the impact of health on the urban adaptation of REMs and elucidates the mechanisms of community clubs and physical activities in this process.Concisely, in previous studies, institutional barriers, such as the hukou system and medical service, have been broadly discussed as key factors in migrants’ urban adaptation. This paper emphasizes the impact of an individual’s health on urban adaptation, which is more relevant and should not be overlooked when discussing elder migrants’ urban adaptation. As China’s urbanization advances, more rural elderly will move to urban areas to live with their children, and the Chinese government should implement targeted polices for protecting REMs’ health for family happiness, for inclusive urbanization, and for a harmonized society.Due to the limitations of the data, there are some limitations in this paper. First, there are no specific tracking survey data for REMs, and the sample size selected from the CHARLS database is limited; thus, the analysis using cross-sectional data has difficulties dealing with endogeneity well on the one hand, and it cannot dynamically analyze the impact of time point changes on the other hand. The health status of REMs is a continuous and uncertain process, so the health of REMs cannot be judged only on the basis of a certain point in time. Second, this paper establishes a simple causal framework and attempts to explore how health affects the urban adaptation of REMs, but due to the lack of richer information , it is not possible to explore the influence mechanism in more depth. Finally, the reverse causality between community activity and physical activity and health status was also not addressed in this paper due to the lack of appropriate instrumental variables. The above limitations are the next step to try to alleviate or the problem to solve.Based on data from the fourth China Health and Retirement Longitudinal Study in 2018, this study constructed urban adaptation indicators for REMs, measured urban adaptation scores for REMs, and portrayed the adaptation status of REMs. The OLS regression model, robust regression M estimation, IPWRA regression, and KHB mediated effects model were used to explore the effect of health status on urban adaptation of REMs. The basic conclusions drawn were the following:First, according to the results of descriptive statistics and urban adaptation measures, REMs have a fair level of health, lower education, and a high proportion of spouses accompanying them. The level of urban adaptation was extremely low, and men had a slightly higher level of urban adaptation than women. REMs with high education levels and spouses accompanying them had a higher urban adaptation level.Second, according to the results of the empirical analysis, the research hypotheses of this paper all held true. That is, health status does have a significant positive effect on the urban adaptation of REMs, and the mechanism analysis indicates that REMs with good health status have a higher possibility of going to community clubs for activities, engaging in physical activities, interacting with urban residents, expanding the scope of interaction, and thus promoting urban adaptation.Third, there were significant differences in the effects of health status on urban adaptation among REMs with different characteristics. Health status had a more significant effect on urban adaptation among REMs in the central and western regions. The effect of increased urban adaptation level due to health of REMs with high education levels was greater than that of REMs with low education levels.The role of health status on the urban adaptation of REMs is multifaceted. It can not only directly affect urban adaptation of the elderly, but also influence their urban adaptation by affecting their community activities and physical activities. There are many factors affecting health, and different subjects play different roles in promoting the health of REMs. Therefore, in the process of urbanization, relevant subjects should work simultaneously to strengthen health protection and social support for REMs to promote their urban adaptation. First, children should care about the health of their parents who have moved with them. They can also make full use of green areas, parks, and community rooms in urban communities, so that the REMs can get in touch with the natural environment and the humanistic environment and gradually adapt to modern urban society. Since REMs are lonely and isolated, children should take the initiative to communicate with their migrating parents and provide psychological guidance to ease the discomfort of REMs due to the change of environment and cultural systems. Second, the community should establish a health monitoring and treatment system. The community is the “second environment” for REMs, and it is also the most important activity space. Thirdly, the city government can pay attention to the changes in the health status of the elderly and help them stay healthy in various ways, such as organizing public welfare activities and building health service platforms to help REMs adapt to urban life better. Finally, REMs should take the initiative to engage in physical and social activities, practice self-direction of negative emotions, and enhance physical and mental health.


Their official documents were compared, including newspapers andprograms, as well as fieldnotes and letters by social scientists engaged infieldwork in favelas in the period.An analysis is presented of the work of three international entities in Brazilianfavelas in the 1960s: Brasil-Estados Unidos Movimento, Desenvolvimento eOrganização de Comunidade; Ação Comunitária do Brasil; and the United Nations.These entities conveyed the ideal of developmentalism through technicalcooperation with countries deemed underdeveloped, drawing on the pure andapplied social sciences through community development. Documents from theAnthony Leeds archive at Casa de Oswaldo Cruz were used to analyze theseentities’ actions in the  Clearances of this kind had begun in the 1950s, with the ParquesProletários (Proletarian Parks), intensifying in the 1960s under the administration ofthe then Guanabara state governor, Carlos Lacerda , not tomention the social services  andAção Comunitária do Brasil . Similarly, the UnitedNations (UN) had also turned its sights to the issue of low-income housing around theworld, including the situation inside favela s.As of 1965, Encontrosetnográficos e antropologia em rede: a favela do Jacarezinho e a pesquisa de Anthonye Elizabeth Leeds na década de 1960 (Ethnographic Encounters and NetworkedAnthropology: the favela of Jacarezinho and the Research of Elizabethand Anthony Leeds in the 1960s)   .favela s where ACB worked in the 1960s to be identified. Accordingto the letters and reports written by a community agent, the agency intended to choosefour favela s to work in, cooperating with the Companhia de Habitação(Cohab), a state housing company, in the urbanization of Gardênia Azul and Vila Isabel.The favela s visited included Fernão Cardim, Parque União, Morro dosUrubus, Vila Cândido, Guararapes, Morro do Sossego, and Pavão Pavãozinho . For these thinkers, this theory, linked to the ideas of development andsocial change, was grounded on the assumption that the expansion of modern societyyielded the same social effects, albeit at varying paces and along differenttrajectories . For their part, the theories of development anddependence were based on the idea of “center versus periphery,” using the categoriesof “mass marginality” and “reserve army of labor” to draw links between dependence,marginality, and informality   .In the development theories from the 1960s, a correlation can be seen betweendevelopment, modernization, industrialization, and the incorporation of new values.Under the Point Four program, established in 1949 by President Harry Truman, USinternational technical cooperation with Latin American countries covered areas suchas health, education, administration, and nuclear energy   . This pCombining anthropology and technical cooperation through the promotion of developmentand social change, Point Four also marked the invention of the concepts ofdevelopment and underdevelopment, favoring different anthropological proposals asthey sought legitimacy and vied over the same agenda   . These favela s and in their internal composition, be it by bringingthe leading proponents of these debates on board or by propagating their visions ofdevelopment to favela dwellers. As for the uses they made ofanthropology, these were also varied, ranging from drawing connections between pureand applied anthropology to the involvement of anthropologists with the politicaldemands of favela dwellers. At that time, anthropologists werelooking for new meanings for their professional practice beyond scholarly work perse: they might embark on addressing the political demands of the state or of otherparties with whom they came into contact, or they could engage with internationaltechnical cooperation agencies to put the techniques of community organization anddevelopment they advocated into practice.In the wake of these anthropological disputes and the theories that ran through them,the international technical cooperation agencies that emerged in this contextmirrored the same disputes. While they championed the promotion of development astheir raison d’être, they articulated these narratives in their activities inFrom the 1940s to the 1960s, US anthropology was very much linked to the Point Fourdevelopmentalist policies  , which Community development emerged in the 1930s   , but waIn the 1950s, community development was associated with an ideal of economic-basedmodernity by both the UN and the OAS, putting it at the heart of their technicalassistance policies in the Americas and a means of aligning the population withnational plans for economic and social development   .ActualIn 1960, community development incorporated the demands of progressive socialmovements, especially those of the Catholic Church. Social workers were beginning tocall for the participation of the local people in order to help raise awareness andfoster politicization   .GettinAccording to favela s, COD was materialized in the creation ofsocial centers and projects for the eradication or urbanization of thesecommunities, being channeled into the improvement or creation of urbaninfrastructure through mutual assistance   . Combinistance   .Chief among the criticisms made of community development are its conservative bias orthe limited nature of the reforms it proposed, leaving intact the capitalist,inequality-perpetuating structures of social relations. Some authors emphasize itsrole in reinforcing capitalist hegemony and the developmentalist ideal, whereby thenotion of integration operates with a quest for consensus and the control of groups,sometimes conditioning it on a passive stance   . HoweveThe key players in the spread of community development in Brazil included thesociologist José Arthur Rios and the social worker Josephina Albano. Rios, who hadacquired experience in health education campaigns in rural parts of Brazil in theprevious decades , in conjunction with ActionInternational, which engaged in private-sector community action programs in theAmericas . The idea behind ACB wasthat it should study, arrange, and systematize the “problem,” galvanizing existinglocal resources. Like Acción en Venezuela, the agency was part of ActionInternational, a private entity created in New York in June 1965 that took aid toimpoverished areas . Bemdoc was a technical cooperation projectof the Agency for International Development (AID), funded by the US government,geared towards promoting the methodology of community action in partnership withwhichever accredited governments requested technical assistance .favela dwellers to be produced. Theyalso covered the payroll costs of the technical and administrative staff involved inthe projects, their training and capacity building, the preparation of reports andinternal newssheets, and the infrastructure for the operation of the programs, suchas rental costs, office supplies, etc. While the ACB was supported by privatefunders, Bemdoc was maintained by the US Agency for International Development(USAID) and the Alliance for Progress.The volume of financial capital invested in the agencies allowed publicity materialsand educational pamphlets for favela s were essentially aproblem. For ACB, the range of factors they felt should be addressed – migration,isolation, and disorganization – were also “problems” . Meanwhile, they also saw favela s as placeswhere actions should be taken, namely, the provision of assistance for the residentsand, ultimately, providing their “solution.” These elements resulted in theconsolidation of the theories of the culture of poverty and marginality, both ofwhich spread in the period , it recommended that the “problem” of housing and urban development should bea priority for governments and international agencies, as should studies on theexperiences of programs in this field . Bemdoc (s.d.b) did notmention favela s as problematic per se, seeking, rather, toidentify problems in the local areas, indicating that favela s werea cluster of problems whose solution was down to the residents themselves, mediatedby the agency. If development was predicated on finding a solution forfavela s and their problems, then identifying them was centralto the agencies’ work. This ensured it was better adapted to the prevailing idealsof development, modernization, and social change . The other agencies’ perspectives on social changecan be inferred by the objectives stated in their documents.The factors of social change explicated by the UN were access to basic socialservices and housing. In other words, it saw housing policies as an antidote tounderdevelopment   . Thisefavela dwellers. As for Bemdoc, its objectives werethe to get the residents into the labor market; to provide technical assistance tosolve the problems identified by the residents; to prepare leaders to be Bendocintermediaries in the favela ’s political organization; andcommunity unification through shared awareness of its problems and the promotion ofCOD .The goals of ACB were: the creation of civic centers to host its communityactivities, community building, and the development of leaders and representativeorganizations capable of meeting their needs and getting the more influential socialclasses to participate in solving the problems of COD was understood as a set of assumptions: the community as the main source ofresources for its own improvement; solutions to problems through the voluntaryparticipation of residents; and integration of the community with society as theresponsibility of local governments and society through its institutions . Both ACB and Bemdoc saw an association between community andintegration, sometimes interlinked with the ideas of isolation and rurality. Theseelements were presented in community development and the theory of marginality inassociation with urban informality as categories that were interdependent in theircauses and the way they operated   .favela s with migration,rurality, and consequently backwardness. This association was important in theshaping of a meaning for development to which the social sciences could contribute .Problem and solution were articulated interdependently to justify the existence ofACB and the understanding that social services were a venture. Bemdoc  did not see social services as a venture; rather, it had a complexbureaucratic internal organization that it endeavored to reproduce in thefavela s.The discourse permeating the documents echoed the debates in the social sciences andsocial services that also associated tribute  . ACB saIf ACB saw social services as its function, UN and Bemdoc had more diverse, lessinterventionistic roles and functions. The UN proposed to provide host governmentswith consultancy in the preparation of their programs, in addition to technicalstaff, information, and the evaluation of methods and results .Bemdoc was limited to offering technical assistance and, when it could, the physicalresources needed to execute developments, such as water tanks, sewers, or accessroads. Bemdoc’s technical assistance varied according to what problems the residentsraised  and the way the work was organized within thecommunity, which made it as fluid as the meaning of development itself.Although none of the agencies offered a stated definition of development, the set ofactions they fostered to render it possible indicates the basis of their ideas. Itcan be inferred that development was a category under construction within theseagencies’ work, which meant that as it was constant and set in various contexts, itcould take various forms according to the social and political context of the placesin question.favela s in the promotion of development . Sometimes they included sanitation, installingfacilities such as septic tanks for sewage and means of ensuring a water supply, aswell as incinerators for domestic waste, drainage for rainwater, and the remediationof the damage caused by these factors .In line with the redemptive view of housing   , the thfavelas: the legal status of land uses and houses, and the improvement of socialconditions through, for example, school building, the provision of literacy classes,primary education, and a better standard of life . In addition to educational opportunities, Bemdoc also arrangedrecreational activities, such as film screenings, public festivities, excursions,and the formation of recreation committees. ACB’s actions included classes inliteracy and dressmaking, childcare, children’s theater, and film screenings.Other factors arise in the endeavors to bring development to favela dwellers. Assuming migration to be the root cause of thefavela s, they concluded that the city was unable to absorb themigrants and the migrants lacked the ability to adapt to urban living . Its other assumptions, alongside the theories of the culture of poverty andmarginality, were that there was something abject about poverty and thefavela s were isolated from the rest of the city. Although ACBidentified standard of living as a key aspect of what it understood development tobe, it did not propose any cultural activities to address this or to attempt tochange the local residents’ mindset.References to social and cultural factors and standard of living are more evident inACB’s documents, which express their views and discourses aboutfavela problem” led ACB to make capital investments and offertechnical assistance to farmers and sugarcane growers in the north of Rio de Janeirostate. As for Bemdoc, even though it did not point to migration as a direct cause ofthe favela s, it also operated in rural areas .The UN’s and ACB’s identification of migration as the cause of the “favela dwellers were mostly from rural backgrounds wasunfounded . ACB took technical incapacity vis-a-vis urbanservices into account, but also felt it was possible for residents of rural originsto adapt to city living and train for the urban workforce through its educationalprogram . For the UN, migration was what explained the ruralovertones of social and cultural life in the favela s, withsupposed isolation potentially occurring in the rural or urban environment. Based onthis, the UN set goals to get community residents into the housing market and morequickly assimilated into the city. This would be achieved in stages, according tothe types of rural-urban migration, with each stage presenting its own specificchallenges . The associations between migration and isolation andbetween urban living and integration were added to the characteristics of thenotions of development and modernization these agencies held by. However, theseassociations had some nuances.Although statistics from before the 1960s showed that the idea thatfounded   , ACB anfavela s,” an article published inJornal do Brasil newspaper, the changes rendered in the placeswhere they operated can be seen. They were places that, one deduces, must have beenfavela s before the arrival of the agency, which brought aboutthe ideal of associative life. For ACB, ceasing to be a favelameant adhering to this associative ideal and not just changing the local physicalconditions or assuring the right to land ownership and use. Redemption anddevelopment went beyond housing alone.For ACB, the notion of isolation had to do with an indifference on the part of theresidents in relation to each other. The fact that they did not know each other, didnot engage in any shared activities besides soccer, and showed little interest inthe lives of their neighbors constituted their isolation, as far as it was concerned. As some authors have pointed out, workers’ free time should beoccupied, resulting in their being disciplined and controlled, which was importantfor the ideal of development and modernization to be achieved   . In “Cofavela s with the local middle class through communityactions, such as the offer of donations and labor. The residents from throughout thefavela would be integrated through their engagement inassociative life, understood to mean the participation of residents in the variousorganized groups and committees created by the agency. Isolation was understood asdisunity in groups or lack of interaction among existing groups . The idea that housing would foster moderate consumption habitsand political behavior was stressed  saw the government’s approach as paternalistic and claimed that forcedevictions benefitted only the wealthier classes.On the other side of the rural explanation of favela was considered suitable for (semi-)urban development,ACB did not advocate eviction. For some employees, urbanization was a betterapproach than eradication. However, the eviction policy was justified in theinstitutional discourse, despite the conditions considered by the agency in itspilot project.According to the ACB (19 jun. 1969), evictions were paternalistic because residentsreceived new housing without having to fight for it or being prepared to receive it.They only advocated eviction provided that residents received advance preparation sothat they did not reproduce the same behaviors in their new community and that asurvey was done of the new area to ensure it was equipped to receive the evictees,meeting their needs and ensuring their access to employment. If thefavelas, it put more emphasis on urbanization than “slum clearance” .As for Bemdoc, despite the absence of any explicit mention of eviction in itsdocuments or official institutional position, the debate about eviction versusurbanization still influenced its work, at least in Borel, whose residents thoughtits staff were promoting their eviction. The absence of any debate in Bemdoc’sdocuments may explain why one of the criteria for choosing new sites was that theyfell outside the government’s eviction plan . In the case ofthe UN, while it did not completely neglect the debate, it took a weak stance.Pointing to actions designed to improve existing and future favela s in the SouthZone of Rio to housing projects in the North Zone of the city . In addition, self-help had, ACB felt, the effect of changing the residents’patterns of thought and behavior both to realize its ideal of community and toprevent the housing projects to which they would be removed from deteriorating intonew favela s . Like ACB, Bemdoc was about helping residents toidentify their community’s needs and plan ways to address them. According to theagency, “the full participation of residents in overall planning develops in them abroad vision of their problems and solutions, equipping them for future initiatives,defining their responsibilities and that of Bemdoc” .For Bemdoc (nov. 1965c), self-help was a way for residents to work according to itsown organizational logic, namely, splitting up into committees and subcommittees,and was also seen as a vehicle for the notion of integration it championed.As for the UN, the improvement of living conditions and local social and economicconditions was to be achieved by local participation and by self-improvementorganizations. This notion is reinforced in the stated objective: to promote actionsusing the people’s ability to invest and work. The actions would be chosen accordingto the felt needs, while understanding that not all actions taken by governmentagencies would need to coincide with these for their success . As self-help and task forces were fundamental for communitydevelopment and the agencies’ ideal of developmentalism, their function was todiscipline residents. Not only would they occupy idle time   , but thfavela s where it operated: Borel, Turano, andNova Brasília . ACB, for its part,did not have it as a goal for its project, although some vocational training wasprovided where it operated , which meant they knew how to settheir own priorities. This therefore begs the question as to how much the residents’priorities coincided with those identified by the agency and what disparities theremay have been between them.It should be noted that task forces had already been set up infavela dwellers, which is onlyaddressed in the Bemdoc documents. These bear witness to both an idealization ofthis relationship on the part of the agency in relation to what was actually seenand experienced. According to the pilot program, the agency expected residentparticipation in all the project’s groups and phases. Their involvement was designedto bring in representatives of existing local groups. The relationship with theresidents can be observed in the intention to get them involved in the entity’soverall planning. The goal was to get them to study the problems and find thesolutions together with the Bemdoc team. For the agency, this collaboration wouldneutralize conflicts among local groups and prevent Bemdoc’s direct involvement.This position of neutrality in relation to the conflicts already existing in thefavela s was, however, something that did not please theresidents . As the teams came into contact withpre-existing groups, interests, and conflicts, they had to deal with conflicts ofinterest among the residents in relation to the project, all of which was compoundedby the prevailing political environment under the military dictatorship, whichprevented residents from engaging in political activities.No less frequent, but much overlooked, is the discussion about the relationshipbetween these agencies and the The first conflict was over the nature of the project. The residents expected toobtain material support from the agency for the execution of building works toimprove the local area, but this sometimes fell short of their expectations.Meanwhile, Bemdoc’s main objective was to develop leaders to mobilize residents inself-help actions and projects, in addition to training workers. According to agencydocuments, the residents saw it as an executor and financier of works but recognizedthat this stemmed from their own interpretation at the launch of the program.favela s, among other facets of their work. Their appropriationof these methods and techniques occurred differently according to how they conceivedof the favela s, or squatter settlements, and were often broughtinto play, despite the lack of comprehensiveness of the information collected.Techniques from the social sciences were also instrumental in entering thefavela s, even if there was no concern with aligning this withthe field of applied anthropology, development anthropology, or action anthropology.It is questionable how much the agencies appropriated pure science with anytheoretical or methodological rigor to develop their methodologies. In addition,there was some identification with functionalist structural anthropology in thecommunity development programs  –also demonstrates this concern prior to the preparation of any program. After all,low-income housing was a priority of the agency, as witnessed by the existence of aresolution addressing this topic specifically. Also, and no less importantly, theprofessional exchange observed at these entities, as in the case of Anthony Leeds,shows recourse to the social sciences was commonplace.favela s was guided by a procedure similar to that used bysocial scientists: establishing a gateway before spending time there. The process ofcoexisting with the residents involved getting its staff involved in the daily lifeof the favela and its residents. Their resistance was disarmed bythe collaboration of “key people from the favela ,” such asreligious leaders, barkeepers, soccer teams, and water controllers .Although ACB openly adopted the principles and methods of community action, alsodefining criteria for choosing where they would work, its method for enteringfavela s. Anthony Leeds, Josephina Albano, andJosé Arthur Rios were invited to run the basic course in Communal Action held byACB’s training department in 1967. The anthropologist Anthony Leeds and thepolitical scientist Elizabeth Leeds had been researching favela swith methods and techniques from the social sciences since 1965  drew on the social sciences for its institutional purposes. The presenceof these intellectuals in an ACB course illustrates not only how much of a referencethey were in community development, but also the links between social scientists andsocial workers, and between the pure and applied social sciences. This intersectionin community development was not only due to initiatives of this kind, but also toconstant efforts in methodology-building based on recorded experiences .The similarity between ACB and Bemdoc was their previous contact with the regionaladministration and the forging of associations before entering thefavela s with field observation, they alsoadministered sociometric tests to selected leaders and to select candidates forBemdoc I . According to the department’s work plan, the creationof a permanent center for documentation and research on favela swould generate better information, as it would be based on pure science for theformulation of action programs.The work plan devised by an experienced anthropologist for its Department ofScientific Studies lent Bemdoc a more robust scientific basis for its actions. Afterstudying the Such cases of interaction with the social sciences illustrate the context in whichthe adoption of these sciences and the associated ethical impacts were questioned.In view of the counterinsurgent and anti-communist nature of the US’s internationaltechnical cooperation policy   , it is favela s, sometimes on an ad hoc basis. Inmost cases, this occurred more to help the agencies enter thefavela s than to meet the demands of their residents or tobring about any ideal of development they may have intended to further. The mostconcrete attempt to expand the uses of social sciences was the proposal to makeBemdoc’s research department a reference center on favela s.If the circumstances of the Cold War and the demands it spawned led to a newappreciation of the social sciences on the part of international agencies based inthe US, including the employment of social scientists, in Brazil the process wassimilar. It is not possible to gauge how many Brazilian social scientists worked forthe agencies or to compare such numbers with those from the USA, but there wasprofessional interchange between the agencies, such as in the case of Anthony Leeds,and the social sciences were also called upon, sometimes providing a basis for theagencies’ actions in the favela dwellers.However, the agencies did not go so far as to mobilize any material or politicalaction, as they felt that solving their problems and addressing their felt needs wassomething the residents should be responsible for. Getting the authorities involvedwas not even mentioned in these agencies’ principles or agendas. If development wasto be promoted by individuals, then any obstacles were also down to them. Despitethe community-oriented discourse, favela s and the promotion ofdevelopment in them were seen through an individualizing lens. Articulated with thenotions of felt needs and integration, self-help effectively obliterated the role ofthe authorities and to some extent absolved them from their responsibilities towardsthe residents. Self-help, individual in nature, was deeply embedded in thedevelopmental ideal of these agencies and went towards reinforcing the theories ofthe culture of poverty and marginality, as well as integration, isolation, andrurality, which also operated together and in connection with these theories.This knowledge made it possible for the agencies to identify leaders, share the ideaof felt needs, or select the priorities of favelaresidents had done previously, as was the setting of priorities , the international agencies were actually superfluous. It is also worthconsidering whether the residents and agencies may have operated at cross-purposes,since the constant threat of eviction would have made the urbanization of thefavela s and the legalization of the residents’ housing morepressing demands. From the point of view of the agencies, the redemptive perspectiveof education and work justified their presence in the favela s andtheir actions as if they were the felt needs of the residents. Somehow, the idea ofsocial degeneration and the organizational incapacity of the residents wasreinforced.If self-help in the form of task forces was something favela s’ development. The residents were already organized andknew what their priorities were. The agencies’ ideal of integration assumed that thefavela s were enclaves or that their isolation was down to theindividual residents themselves, not long-term historical and sociological processespermeating society, such as the intersections between race relations and labor.With regard to theories of social change and development, there can be seen a degreeof articulation with the imprecise ideals of COD disseminated by the agencies, seenas vehicles of social change. The ideas of felt needs and self-help operatedtogether with integration, forming the core of the promotion of development.However, without the action of the residents there could be no action by theagencies, although it was supposedly they who would promote thefavela s were local, with many organizations and an activepolitical life, it would be enough for agencies to trigger existing resources,including workers. While their performance depended on existing residents’associations and organizations, political and institutional restrictions preventedthem from satisfying the residents’ primary demands: the urbanization of thefavela s and resistance to eviction. Forced evictions had beencarried out since 1952 and gained strength throughout the 1960s, justified by theassumptions of marginality, the culture of poverty, and the view offavela s as a problem  decisions and actions.Consistent with a vision that held residents accountable for the material andphysical conditions of the favela s and helping their residents gainemployment. The concepts of development did not encompass sanitation or even touchon any idea of law or citizenship. From the perspective of this hegemonic,economic-oriented notion, in which the living standards of a given middle class weretaken as a reference, their actions cannot be deemed successful. If the elasticityand multiplicity in the interpretations of development are considered, then somesuccess can be admitted. Considering that the fight against marginalization includeda set of actions aimed at getting favela residents into the laborand housing markets and adopting the same consumption habits as the middle classes,the developmentalist ideal and community development advocated by the internationalagencies saw popular education and work as redemptive in this respect.Even though the agencies may have diverged in their understanding of key categoriesof developmentalism, they were one in taking actions addressing the physicalconditions in the The conservative nature of community development was associated with the fact thatexisting social structures were maintained and the conceptions of developmentalismwere reductive. Yet at this time there were already some more progressiveunderstandings of community development being developed. Even though there was noconsensus on the concept, there was some common ground, even if slightly differentapproaches were used. In this context, potential divergences can be observed withinthe entities, especially in their approach to evictions and the diversity ofemployees and staffers. Attempts to articulate more consistently with the puresocial sciences and technical staff training initiatives are factors that can beunderstood as part of the move towards the reconceptualization of the socialservices, discussions about the strategic uses of anthropology, and the obsolescenceof the theories of marginality and the culture of poverty. In this period, despitethe critical movement in anthropology and the social services, the institutionaldiscourse of the agencies did not follow suit, except in the case of some staff fromthe Peace Corps   .As the reconceptualization of social services and the discussion about ethics inanthropology showed, questions were already in the air about how effective communitydevelopment was in fostering social change and development. The institutions’ambiguity towards such topics as urbanization and eviction already pointed in thisdirection. Their overall orientation may have been conservative, but they also hadsome ideas that did not chime with what the US felt it needed in the context of theCold War – actions to fight insurgency and curb the spread of communism – whichended up sparking other disputes in the heart of developmentalism.


The smart glasses were implemented as an innovative communication tool to enhance effectiveness in the field. The traditional mode of communication for Emergency Medical Services (EMS) was radio, which had significant restrictions, primarily that they were unable to transmit any visual data. To enhance efficiency, the smart glasses were used for a more accurate assessment of the condition of patients during transportation. At this time, however, no prior study has shown significant benefits of employing smart glasses into EMS.The primary objective of this study is to compare the duration of patient care in an ambulance between the use and non-use of smart glasses. The secondary objective is to identify the characteristics of data communication between the ambulance and the hospital.This retrospective study utilized data gathered from closed-circuit television (CCTV) in ambulances at Srinagarind Hospital, Thailand. The data were collected over a six-month period, specifically from July through December 2021. The study included two groups: the smart glasses group and no smart glasses groups, both used during EMS operations. The primary data collected focused on the duration of patient care in the ambulance. Additionally, the type and characteristics of data transfers via smart glasses during EMS operations were also recorded.Out of the 256 EMS operations included in this study, 53.1% (N = 68) of the participants in the smart glasses group were male. The majority of operations were performed during the afternoon shift in both groups. The average patient care time in the smart glasses group was 10.07 minutes, while it was 5.10 minutes in the no smart glasses group (P <.001), indicating a significant difference. Visual data communication between the ambulance and the hospital via smart glasses predominantly involved vital signs (100.0%), physical examination (56.3%), and neurological examination (42.2%). The use of audio data from the hospital to the ambulance primarily included taking additional patient history (26.6%) and performing physical examinations (19.5%).The implementation of smart glasses in EMS operations resulted in an increase in patient care time in the ambulance. Furthermore, the use of smart glasses facilitated an effective channel of real-time two-way communication between the ambulance and the hospital. In the case of an emergency patient being put in an ambulance, the assessment and treatment process starts with taking into account patient history, measuring vital signs, giving physical examinations, and providing necessary treatment. Once the standard of emergency care has been implemented, the patient will be transported to the designated hospital via an emergency ambulance.Thailand’s Emergency Medical Services (EMS) are initiated with a call to the 1669 national emergency hotline from patients or other individuals; after that, the medical call center will dispatch either the nearest or most appropriate EMS units to provide emergency care. The collected information is then communicated via radio to the destination hospital or the hospital command center. This communication serves to provide crucial information about incoming patients to the emergency department (ED). As a result, the ED can prepare the necessary personnel and medical equipment to promptly initiate treatment upon the patient’s arrival at the hospital.During the journey, the medical personnel on board the ambulance, such as doctors or nurses, are responsible for continuously assessing the patient’s condition. This involves observing the patient’s symptoms, conducting periodic questioning, and monitoring vital signs. The data can be visible from the ambulance to the hospital with real-time information. This means that EMS staff do not have to take their eyes off patients. Furthermore, smart glasses are used to get the orders directly from the hospital to the ambulance members in case of time-sensitive conditions of the patients, such as cerebrovascular disease, multiple traumas, and cardiac arrest. Doctors on duty at the destination hospitals can see the process of care on an ambulance and provide additional history directly to the team in the ambulance. The suggested treatment can also be provided to ambulance personnel in cases whose symptoms were not clear. The use of smart glasses in EMS is recognized as a form of online medical oversight, aimed at enhancing the efficiency and safety of services delivered to emergency patients. By enabling real-time communication and video streaming, smart glasses allow remote medical professionals to provide guidance, support, and oversight to EMS personnel on the scene.However, the process of transferring information from an ambulance to the destination hospital takes a lot of time. During this period, the EMS members who are responsible for reporting the information must take their eyes off the patient assessment due to the radio base station on Thai ambulances that are designed to be mounted on the front of the vehicle so that the reporter cannot continuously see and assess the patient’s condition. As a result, the diagnosis of changing symptoms of patients is sometimes delayed, resulting in worsening clinical conditions. Therefore, to shorten that period, smart glasses play an important role in emergency medical operations.The primary objective of this study was to compare the duration of patient care in the ambulance between smart glasses and no smart glasses used. The secondary outcome was to identify the type and characteristics of data transfers via smart glasses during EMS operations.This retrospective study was carried out utilizing various EMS units at Srinagarind Hospital, Thailand. The hospital is the primary center in the region for training emergency physicians and EMS technicians with 1,500 EMS (basic level) and 1,000 EMS (advanced level) operations carried out annually. In the EMS unit, there is a dispatch center which operates and controls six ambulances. The smart glasses were implemented in the EMS units starting in 2021. This equipment was new in the health care system. The EMS providers who used smart glasses were well-trained in the instruction of this equipment and no motion sickness was reported during the operations.All data on patients treated with an EMS ambulance during the study period and recorded in a closed-circuit television (CCTV) database were collected. Cases with incomplete data and cases where the patients were not found were excluded from this study. Furthermore, cases in which EMS members experienced motion sickness while wearing smart glasses were excluded from this study.Data were collected from July through December 2021. The data were extracted from four CCTVs, which were provided in the ambulances. In each EMS operation, the data were reviewed on a case-by-case basis in the process of EMS transport being carried out. The EMS practitioners proceeded to transfer the patient to a hospital via ambulance for specialized care and provided medical care during transportation. The primary data obtained were the duration of patient care in the ambulance, which was overseen by three emergency physicians, each with over ten-year experience in EMS. The type of data communication between ambulance and hospital via smart glasses was divided into visual and audio data.Transport time is defined as the period of time from when the patient has been placed in the ambulance and ends when the patient’s care is transferred to the destination hospital.Patient care time is the sub-period of the transport time, defined as the duration during which EMS providers provide medical attention and care to a patient while they are only in the ambulance. It includes the time spent assessing the patient, administering treatments or interventions, monitoring vital signs, and addressing any immediate medical needs or emergencies. Thus, the authors determined that a sample size of 256 would be required. The statistical analysis was performed with Khon Kaen University’s  license for IBM SPSS for Windows version 27.0 . The categorical data obtained are presented as frequencies and percentages. Continuous data are presented using the means and standard deviations (SD). The chi-square test was used to assess the relationship between categorical variables. A two-tailed P <.05 was considered statistically significant.The sample size was calculated based on previous studies.The smart glasses were manufactured by The Real Wear Company . It was the HMT-1 model. Android 10.0 was the operating system, and it was connected via Wi-Fi 2.4 GHz and 5 GHz or Bluetooth Low Energy 4.1. The data were from smart glasses including visual and audio with real-time two-way communications. The EMS members who responded to those wearing smart glasses were the team leaders . Requirement for informed consent from the patients was waived since patient confidentiality protection had been guaranteed, as patients were not identified by name, but by a unique study number.Over the period of the six-month study, 256 EMS operations were collected from the EMS CCTV database, the characteristics of which are shown in Table The average time from dispatch to vehicle en route (activation time) for the smart glasses and the no smart glasses groups were 1.02 minutes and 1.00 minutes, respectively , physical examinations 56.3%), and neurological examinations (42.2%). In Table %, and ne The Faculty of Medicine, Khon Kaen University has been using smart glasses on ambulances since 2021.This study focused on the implementation of smart glasses, a new technology that will increasingly be employed in Thailand’s EMS, in order to improve the efficiency of patient care while in the ambulance, and to assist in the capacity of doctors stationed at destination hospitals to transmit patient information and analyze symptoms. This has been found to have many limitations, such as unclear radio communication, requiring a long time to make contact, confusion over codes used to communicate via radio communication, and no visual aids to help in the assessment of the patient’s physical examination. For these reasons, smart glasses technology has been adopted to solve such problems. The expectation is to more effectively convey information from ambulances, both audio and visual, to accurately assess symptoms and prepare for treatment at the ED.The traditional method of transferring information from ambulances to hospitals in Thailand without telemedicine systems is radio.According to the study, using smart glasses in ambulances increased patient care time more than not using them. The main reason was that the use of smart glasses required personnel stationed in the ambulance to monitor the patient at all times, as well as observe changes and transmit data of vital signs utilizing equipment installed on the ambulance. As a result, when there was a change in the patient’s condition, the personnel in the ambulance were able to assess the condition in a timely manner. Furthermore, the increased period of care for patients in the ambulances demonstrated that unnecessary time was effectively reduced because EMS members no longer had to rely solely on radio communication to report patient information, which was prone to errors. Therefore, the adoption of smart glasses technology in EMS will support more effective patient evaluation, diagnosis, and treatment with reduced duration of time. Moreover, the use of smart glasses did not affect the delay of the scene time and transport time due to the EMS members wear the equipment during the moving ambulance.Types of communication data transmitted through smart glasses can be divided into two categories: visual and audio data. In the field of visual information, referral of information from the ambulance to the destination hospital with patient vital signs and physical examinations are provided to doctors stationed at the destination hospitals. In addition, if necessary, specific medical equipment at the ED will be prepared ahead of patient arrival.In the field of audio data, there is a two-way communication route; from the ambulance to the hospital, and from the destination hospital is also transferred to the personnel in the ambulance. In accordance with the standards of EMS operations in Thailand, personnel on board the ambulance will report preliminary patient information consisting of gender, age, chief complaint, and onset, which is important information to the hospital. There is also a provisional diagnosis from EMS members in an ambulance. In the case where initial diagnosis is not possible, further medical examination will be required, which has a positive effect. This allows the patient to be diagnosed quickly. In addition, in cases where resuscitation is needed, the doctor stationed at the destination hospital can also order immediate treatment in the ambulance. The procedure in the ambulance , with the guidance and monitoring from the staff at the hospital, will allow the EMS members to have more confidence to perform these procedures.The use of smart glasses in EMS creates an additional channel for the transfer of essential information from the destination hospital to the ambulance, especially for medical history, physical examinations, and treatment.Development of Thailand’s EMS by using modern technology has always and will continue to play an important role in public health policy. Efficient communication equipment and communication networks will change the treatment guidelines in ambulances to be more convenient, faster, and more efficient in response to the ever-growing needs of society, ensuring sustainable development, and increasing service safety records.This study analyzes operational data in the EMS through a CCTV database recorded through cameras installed on ambulances. It relies on experienced doctors who make judgment calls and analyze the duration time of EMS operations. In addition, efficient databases with clear audio and visual aids are an important factor in the data analysis.The characteristics of EMS in each country vary in terms of personnel, vehicles, and treatment guidelines, so the use of information depends on such key factors.The implementation of smart glasses increased patient care time in EMS ambulances and created effective channels of real-time two-way communication between ambulance and hospital.


Background Telehealth has been used in the treatment of different diseases, and it has been shown to provide benefits for patients with amyotrophic lateral sclerosis (ALS). Due to the social distancing measures put into effect during the coronavirus disease 2019 (COVID-19) pandemic, there was an urgent need for telehealth to ensure the provision of healthcare.Objective To evaluate the feasibility of telehealth for the provision of multidisciplinary ALS care, and to assess its acceptability among patients and caregivers.Methods We conducted a retrospective cohort study in which multidisciplinary evaluations were performed using the Teleconsulta platform. The patients included had ALS and at least one in-person clinical evaluation. The patients and the caregivers answered satisfaction questionnaires.Results The sample was composed of 46 patients, 32 male and 14 female subjects. The average distance from their residences to the reference services was of 115 km. Respiratory adjustment was the most addressed topic.Conclusion The strategy is viable and well accepted in terms of satisfaction. It was even more positive for patients in advanced stages of the disease or for those living far from the referral center. Telemedicine uses technological tools to provide healthcare as well as the exchange of information between the physician and the patient, while telehealth is a broader concept involving support groups, health professionals, and information.Technology has been used in healthcare for several years through different tools ,The telestroke was one of the first telehealth services used to perform remote clinical evaluations and make therapeutic decisions.Patients with ALS and their caregivers deal with several issues as the disease progresses. The treatment for ALS is based on controlling symptoms and improving quality of life and survival, since it currently has no cure.Therefore, this study aimed to evaluate the viability of teleconsultations for patients with ALS and the level of satisfaction of patients and caregivers at a referral center in northeastern Brazil.The present was a retrospective cohort study with ALS patients treated at the Motor Neuron Diseases outpatient clinic of Hospital Universitário Onofre Lopes, at Universidade Federal do Rio Grande do Norte (HUOL/UFRN), from March 2020 to March 2021.We included patients diagnosed with ALS according to the El Escorial criteria with at least one in-person consultation. Published in 1994, the criteria include categories such as suspected, possible, probable, and definite. Cases that presented during the COVID-19 pandemic were evaluated in person before the follow-up through teleconsultation. Patients without internet access or who refused to participate in teleconsultations were excluded from the study. Teleconsultation was offered to all 71 patients regardless of the stage of the disease. Caregivers and patients could contact the group coordinator by phone or text message to schedule a teleconsultation. In total, 46 (64.7%) patients participated in the teleconsultations.A member of the multidisciplinary team contacted the patients through phone calls, usually one day before the teleconsultations, to apply a brief screening questionnaire. Then, synchronous teleconsultations were conducted.Caregivers were invited to the teleconsultations when needed to help the patient communicate with the multidisciplinary team and clarify possible doubts and demands. The revised ALS Functional Rating Scale (ALSFRS-R)The patients were divided into 2 groups according to the ALSFRS-R score (≥ 39 and < 39) and ranked according to the rate of progression, calculated through the following equation: 48 ‒ ALSFRS-R score at diagnosis/duration from onset of symptoms to diagnosis (in months). Rate of progression was classified as fast (> 1), intermediate (0.5 to 1.0), or slow (< 0.5).The Teleconsulta platform was developed by the information technology team of the Laboratory of Technological Innovation in Health at HUOL/UFRN. It is a private virtual consultation room for health professionals and patients, accessed using a smartphone or computer with internet access. When the patients could not access this platform, the teleconsultation occurred using the Google Meet platform.Two questionnaires were applied to assess the level of satisfaction after each teleconsultation using a Likert scale (one for the patient and the other for the caregiver).The protocol for the present study was reviewed and approved by the Ethics Review Board of UFRN (under numbers CEP HUOL/UFRN 4.152.889).The spinal-onset classic phenotype was the most frequent among ALS patients. The probable (35%) and definite (30%) categories of the El Escorial criteria and stage 4b (59%) on the King's Staging were predominant among the studied patients.The ALSFRS-R was applied during all evaluations, except to patients evaluated in less than three months. The patients were also investigated for signs of hypoventilation, weight loss, need for non-invasive ventilation using the bilevel positive airway pressure, gastrostomy, advanced respiratory life support, and tracheostomy .Respiratory adjustment  was the most addressed topic in the teleconsultations, followed by medication adjustments .Due to instability in the internet connection or difficulties accessing the Teleconsulta platform, some consultations were performed using the Google Meet platform. In case of limited internet access, patients were individually consulted through phone calls. The lack of limited internet access, computer or smartphone incompatibility with the platform, illiterate patients, difficulty in properly accessing the platform, and poorly-positioned smartphone cameras  were the most common problems.A total of 33 caregivers  and 36 Patients with ALS and caregivers evaluated well the teleconsultations. They highlighted the convenience of receiving assistance and maintenance of multidisciplinary care at home. However, the patients and caregivers reported the lack of physical contact and difficulties with technology as negative issues. The teleconsultation promoted engagement among the multidisciplinary team to discuss and evaluate patient and exchange information with professionals the city of origin of the patient. Drug prescriptions and exam requests were delivered to a caregiver at the referral center one week after the teleconsultation.Before the COVID-19 pandemic, a small portion of patients were submitted to telehealth, and patients, caregivers, and health professionals reported a perception of satisfaction and safety.Teleconsultation benefits the follow-up and revaluations of patients with end-stage diseases, since they are not exposed to the hospital environment, and do not have to wait for consultations and suffer from fatigue, and have no need for transportation to a distant referral center. Some patients in the present study lived 354 km away from our center, which could represent a high cost for the family and public health system of the city. There have been reports in the literature of significant reductions in cost for patients, families, and the public health system due to teleconsultation.Patients and caregivers reported the lack of privacy to discuss intimate issues or talk exclusively with the health professional as the main negative point. Another limitation was the lack of physical evaluation, which is relevant in cases in which the possible diagnosis requires regular physical revaluations to monitor new signs and symptoms. To minimize this limitation, the patients were asked to show and make some movements with their hands, arms, feet and legs so that the multidisciplinary team could better assess disease progression. In addition, patients were systematically asked about fasciculation and cramps.Most patients in the present study had advanced ALS ,Clinical emergencies were often addressed through phone calls or text messages (depending on each case). In these moments, instructions and changes in clinical approaches were performed to avoid negative outcomes. Thus, the Teleconsulta platform recorded a small number of emergency approaches.Patients and caregivers reported teleconsultations as positive and satisfactory Also, teleconsultation enabled multidisciplinary care with lower risks and costs regarding transportation to reference centers. Thus, teleconsultation should be prioritized for patients with advanced diseases to discuss their cases with caregivers and the care team from the patient's city.The main limitation of the present study was the lack of a control group to compare the level of satisfaction between in-person consultations and teleconsultations.


In this study, using data from 2010 to 2021, and by utilizing the stochastic impacts by regression on population, affluence, and technology (STIRPAT) theory, and system generalized method of moments, the effect of green financing and deployment of renewable energy on carbon dioxide emissions in China and its provinces were analyzed. The results show that green financing reduces environmental pollution at the country level. Moreover, with a 1% increase in renewable energy consumption, carbon dioxide emission can be expected to decrease by 0.103%. It also demonstrates that green financing has a statistically significant coefficient only in provinces located in the eastern and western regions. Chinese policymakers should incentive policies for provinces in the eastern region of China in order to have a cleaner environment. The central region should be under supportive and pressure policies to move faster along the path to sustainable development. Climate change is a complex concept in the literature on environmental economics and human challenge in the global context. Undoubtedly, climate change causes disturbances in agricultural production (risk to food security), global warming, droughts, and geopolitical tensions related to water. Some scholars believe that the threat of climate change is unsolvable in the short term because of its global nature; therefore, it requires global unity and policy to be solved. Li et al.  have argHowever, it should be noted that efforts have been made, albeit small and integrated, to deal with climate change. These efforts  have included international agreements to implement integrated and aligned policies to reduce the threat of climate change. Huang and Zhai  have menCountries have implemented various policies to combat climate change. As a roadmap for implementing such policies, countries must have a long-term plan or clear vision of their sustainability goals. For example, in 2020, China announced its plans to achieve peak carbon by 2030 and carbon neutrality by 2060; in 2020, Japan declared its plan to implement net-zero emissions by 2050. Other plans have included CanREA’s 2050 Vision, UAE’s National Energy Strategy 2050, Qatar’s National Vision 2030, Turkish renewable energy vision 2023, Korea’s Energy Master Plan 2035, Germany’s landmark Renewable Energy Act 2021, and Singapore’s Green Plan 2030; all of these roadmaps have clear targets and set out intermediate, operational, and final goals.Under these long-term plans, countries are implementing deterrent and incentive policies and tools based on their economies’ systems, weaknesses, and strengths. The most important policies are listed in Table The critical point for implementing the policies listed in Table This study primarily examines the relationship between green finance, renewable energy deployment, and climate change in China. China is a leading Asian country in terms of establishing various plans to develop green energy consumption across various industries. As shown in Table i.It conducts a regional study of China that does not consider China’s country-level data. China has more than 1.4 billion people and a relatively wide geographical area . Therefore, it should be regionally investigated. Therefore, in this study, data analysis of different regions of China was conducted as a panel data framework.ii.It uses the stochastic impacts by regression on population, affluence, and technology (STIRPAT) theoretical framework to explain the research problem and econometric modeling.iii.It uses carbon dioxide emissions per capita as a proxy for climate change and issued green bonds as a proxy for the green financing variable.Given the importance of studying the case of China regarding how green finance and renewable energy deployment can affect climate change, this research makes the following contributions to the existing literature:The results showed that green financing reduces environmental pollution at the country level. Additionally, with a 1% increase in renewable energy consumption, carbon dioxide emission can be expected to decrease by 0.103%. Therefore, green financing has a statistically significant coefficient only in provinces located in the eastern and western regions. Chinese policymakers should institute incentive policies in provinces in the eastern region of China. The central region should be under supportive and pressure policies to move faster along the path to sustainable development.The remainder of this paper proceeds as follows. Section “Literature review” provides a brief literature review and clarifies the literature gaps this study tries to fill. The section “Green policies in China” provides information on green policies in China. Section “Data and model specification” discusses the data and model specifications, and the section “Empirical results” presents the empirical findings. The last section presents the concluding remarks, a discussion of practical policies, and recommendations for further research.Several earlier studies have drawn attention to the impacts of green finance and renewable energy deployment on climate change in China.2 emissions reduction in China from 2007 to 2018. A dynamic spatial Durbin model has confirmed that green finance in China is efficient and can lower carbon dioxide emissions. Zhang et al.  was established because of a flood disaster that became a national crisis. From its establishment in 1998 to 2002, the current administration has carried out essential actions in the environmental field. The SEPA policy of converting fields into forests in China during this period caused more than 7.7 million hectares of agricultural land to be converted to forest land. From 2002 to 2015, various green policies were developed in China, most of which were ineffective because of the need for fossil fuels to support China’s manufacturing industries. The signing of the Paris Agreement on December 12, 2015, by China and 195 other countries set a suitable road map for China to pay more attention to environmental issues. Additionally, the introduction of the Sustainable Development Goals by the United Nations on January 1, 2016, doubled China’s motivation to achieve sustainable development. In April 2019, China promoted the Belt and Road Initiative International Green Development Coalition as the first Chinese regional sustainable plan. In 2020, China launched its vision of peak carbon by 2030 and carbon neutrality by 2060 as two major projects aimed at improving air quality and environmental protection in the global context. China is a pioneer in implementing green financing to support green projects. Since March 2016, according to China’s 13th Five-Year Plan for Economic and Social Development, the country has established a green financing system that includes green credit, green bonds, and green development funds. The Agricultural Bank of China issued its first green bonds in late 2015. Recently, the Chinese government has supported these policies. In 2021, China’s green bond market was the second largest after that of the U.S. The country issued over 1643 green bonds valued at USD 270 billion in 2021. Regarding green loans, Chinese banks provided nearly USD 2.5 trillion in 2021, compared to around 1.8 trillion in 2020. China’s economic sector targets for developing green financing markets are green transportation, emerging industries, and industrial energy savings. In February 2021, the Chinese State Council published a roadmap for the transition pathway toward green and recycling development by 2025, and enhanced environmental protection in pursuit of the target of a “beautiful China” by 2035 , affluence (income per capita as proxy), and technology proxy with green finance.In Eq. , carbon According to the theoretical framework, Eq.  can be tEquation  in the lX), can be written as Eq.  were gathered from 2010 to 2021 for 25 Chinese provinces. The data were collected from China’s National Bureau of Statistics, the Statistical Yearbook of each province, and the China Statistical Yearbook on the environment. It should be noted that China’s first green bonds were printed in 2015, which is why we extracted the green financing variable of Chinese provinces since 2010 using the weighted average of green loans and green bonds.y is the dependent variable, yt−1 represents the lag term, and X represents the independent variables. It should be mentioned that the before–after estimation tests are conducted to explore the appropriate estimation technique and ensure the validation of the empirical findings.To estimate the coefficients in Eq. , the sysIn the first stage, it is necessary to perform tests to determine the most appropriate estimation technique. Accordingly, a first-generation panel unit root test (ADF test) is conducted. Table It is argued that, in panel data studies, there may be cross-sectional dependency among the samples; therefore, it was necessary to carry out the second generation of panel unit root tests (CIPS and C.Z. tests). The results of the two tests are presented in Table Based on the results of the first- and second-generation panel unit root tests, it can be concluded that all variables were stationary and stable processes.Next, the coefficients were estimated using the system GMM technique. The results of the estimations are presented in Table 2 emissions by 0.103%.Table Given the vast geographical area of China and the difference in the level of development across its provinces, the effectiveness of green financing and consumption of renewable energy varies from province to province. To obtain more practical findings, we categorized 25 selected provinces based on their geographical location into the following three regions: west, east, and center. The three-panel frameworks for these three regions were analyzed using the system GMM, as reported in Table 2 emissions impacted only the provinces in the central and western regions of China, while the coefficient of lagged CO2 emissions was not statistically significant for the eastern region’s provinces. The labor force across all three regions of China positively and significantly affected carbon dioxide emissions. The magnitude of this effect in the central region was greater than that in the other two regions, a major reason for which is the existence of many heavy industries in the provinces of the central region of China. Regarding income per capita, the estimation results showed that the effect of this variable on carbon dioxide emissions was positive in the central and western regions, and only the states located in the eastern region of China had a negative effect coefficient. This may be because the eastern provinces of China are more developed, and the higher the income levels in these provinces, the more the people are willing to change their lifestyles in a green way to protect the environment. Green financing had a statistically significant coefficient only in provinces in the eastern and western regions. Moreover, this variable’s influence on reducing carbon dioxide emissions was more significant in the eastern region of China. An important reason for this is that the eastern regions of China are more developed. Therefore, people in these regions have greater potential to participate in the green financing market and green projects. The use of renewable energy across all regions of China has had a positive effect on reducing carbon dioxide emissions. However, its influence in the eastern region has been greater than that in the other two regions. The CPI also had a significant coefficient and positive sign for all three regions. Therefore, in all provinces of China, an increase in the CPI is an obstacle to developing sustainable development policies.Lagged CO2 emissions per capita) was substituted using greenhouse gas emissions. The empirical model was re-estimated using the system GMM approach for Chinese regions. The results, as reported in Table To ascertain the validity of the empirical findings, a robustness check was employed. Accordingly, the dependent variable  are more developed; therefore, the people in these regions have more potential to participate in the green financing market and green projects. The use of renewable energy across all regions of China has had a positive effect on reducing carbon dioxide emissions. However, the influence in the eastern region has been greater than that in the other two regions.The threat of climate change has become a topic of concern for the international community in recent decades. Despite several meetings and discussions with experts and politicians, humankind has not been able to remove the shadow of this threat from life on the planet. Given its high volume of fossil fuel use, China has made a significant contribution to the creation and persistence of this threat. In this study, using data from 2010 to 2021, the STIRPAT theory, and the econometric method of panel data, the effect of green financing and deployment of renewable energy on the carbon dioxide emissions of China and its provinces have been analyzed and interpreted. The findings show that green financing has a slight negative impact coefficient on environmental pollution at the country level. By increasing the volume of green financing in China, carbon dioxide emissions can decrease by 0.015%. Moreover, renewable energy consumption has a coefficient of 0.103. This indicates that by increasing renewable energy consumption by 1%, COAccording to the obtained results, the issue of clean energy policies at the provincial and country levels in China is worth mentioning. The Chinese government should pay more attention to encouraging leading provinces in the field of renewable energy and supporting lagging provinces in the fight against environmental pollution. Chinese leaders must make strong decisions about the future of their country by supporting sustainable development. On September 22, 2020, the president of China announced that, in line with the Sustainable Development Goals, his country would try to reach peak emissions before 2030 and carbon neutrality before 2060. To achieve these two important targets, China should formulate and approve two separate policy groups at the national and provincial levels. At the macroeconomic level, China’s policymakers should try to create green jobs (to create a positive effect where increasing the labor force reduces carbon dioxide emissions), increasing the green basket of consumption in society , better development of the green financing market, wider financial support for green projects , and make more efforts to increase the consumption of renewable energy. However, at the regional and provincial levels, China’s policymakers should institute more incentive policies for the provinces in the eastern region so that they can move more easily along the path of sustainable development. Conversely, the central region should be under supportive policies (granting green loans and green subsidies) and pressure policies (carbon tax) to move faster toward sustainable development. The uniformity of applied policies toward different provinces and regions can become a factor in their ineffectiveness and the creation of inequality in the sustainable development of regions in the long term Chen, .This study provides practical findings and innovative management policies for experts and policymakers in China and worldwide. It is important that China, as the largest contributor of greenhouse gas emissions and a major consumer of fossil fuels, creates a managed balance in its provinces in the field of sustainable development. The results of this study significantly contribute to achieving this goal. However, there were limitations  in conducting this research. It is suggested that, in future research, field research and survey methods be used to obtain complementary results. Given the spread of COVID-19 since the end of 2019 and its transformation into a worldwide pandemic, future research should investigate the effect of this pandemic on the relationship between green financing and climate change. More advanced econometric methods, such as artificial neural networks, could be used to predict the relationships between variables in the future. Such research can help China reach its goals of peak carbon by 2030 and carbon neutrality by 2060.