Wildfire, deforestation and health in tropical rainforest areas: a scoping review protocol

INTRODUCTION

Wildfires and deforestation potentially have direct effects on multiple health outcomes as well as indirect consequences for climate change. Tropical rainforest areas are characterised by high rainfall, humidity and temperature, and they are predominantly found in low-income and middle-income countries. This study aims to synthesise the methods, data and health outcomes reported in scientific papers on wildfires and deforestation in these locations.

METHODS AND ANALYSIS

We will carry out a scoping review according to the Joanna Briggs Institute's (JBI) manual for scoping reviews and the framework proposed by Arksey and O'Malley, and Levac et al. The search for articles was performed on 18 August 2023, in 16 electronic databases using Medical Subject Headings terms and adaptations for each database from database inception. The search for local studies will be complemented by the manual search in the list of references of the studies selected to compose this review. We screened studies written in English, French, Portuguese and Spanish. We included quantitative studies assessing any human disease outcome, hospitalisation and vital statistics in regions of tropical rainforest. We exclude qualitative studies and quantitative studies whose outcomes do not cover those of interest. The text screening was done by two independent reviewers. Subsequently, we will tabulate the data by the origin of the data source used, the methods and the main findings on health impacts of the extracted data. The results will provide descriptive statistics, along with visual representations in diagrams and tables, complemented by narrative summaries as detailed in the JBI guidelines.

ETHICS AND DISSEMINATION

The study does not require an ethical review as it is meta-research and uses published, deidentified secondary data sources. The submission of results for publication in a peer-reviewed journal and presentation at scientific and policymakers' conferences is expected.

STUDY REGISTRATION

Open Science Framework (https://osf.io/pnqc7/).

Nationwide equity assessment of the 20-min neighbourhood in the scottish context: A socio-spatial proximity analysis of residential locations

The 20-min neighbourhood (20 MN) is a method of designing neighbourhoods in such a way that individuals can meet the majority of their daily needs within a 10-min walk (therefore a 20-min return trip) of their home. The Scottish Government have committed to apply the 20 MN concept nationwide, focusing on disadvantaged communities. The aims of this study were to: (1) create 20 MN catchment areas for health, transport, education, social and recreational domains; (2) describe the number of residential locations within 20 MN domain catchment areas; and (3) describe variation in access to 20 MN domains by area-level socioeconomic status and urbanicity. 20 MN catchment areas (800-m) were created for 10 domains using road and path network analysis. All Scottish residential locations (n:146,190) were plotted, assigned area-level socioeconomic status and urbanicity. A dichotomised (yes/no) variable was created to identify whether it was within a 10-min walk of individual 20 MN domains. One in five residential locations had access to all 10 20 MN domains (Urban: 28%, Rural: 5%). There was variation in proportion of residential locations that has access to at least one facility by domains; 91% had access to at least one public transport stop and 84% a public open space. There was poorer access to primary care services (42%) and healthy food retailers (50%). Across all domains, access to at least one facility was greater within the most deprived areas. Access to 20 MN domains was greatest in areas where individual health status tends to be worse. A policy focusing solely on improving access to key facilities and amenities for deprived areas may be ineffective in reducing health inequalities. Future studies should assess the quality of facilities and co-location with health damaging facilities, particularly within more deprived areas. Alternative policy approaches may be required for improving access to facilities and amenities for rural communities.

Neighbourhood natural space and the narrowing of socioeconomic inequality in years of life lost: a cross-sectional ecological analysis of the Scottish Burden of Disease

BACKGROUND

Natural space is associated with reduced risk of, and narrower socioeconomic inequalities in, diseases that affect older populations, and some contributors to premature mortality in younger individuals. Burden of disease measures such as years of life lost (YLL) are influenced by premature poor health and death. We hypothesised some association between natural space and both rates of and inequalities in YLL might be present.

METHODS

The outcome data were the YLL component from Scottish Burden of Disease 2016, provided at small-area level (datazone) for males and females under 65 years of age in Scotland, UK. Exposure variables were the percentages of land cover within each datazone defined as 'natural space' (NS), and 'natural space and private gardens' (NSG). Together with a measure of area income deprivation, these were fitted in a multilevel Poisson model accounting for intra-datazone level variation, and spatial autocorrelation between datazones.

RESULTS

An increased percentage cover of NSG was associated with lower YLL in males (incident rate ratio (IRR) 0.993, 95% credible interval (CrI) 0.989 to 0.997) and females (IRR 0.993, CrI 0.987 to 0.998); each 10% increase of natural space cover was associated with a 7% decrease in the incidence rate. An increased amount of natural space within local areas was associated with reduced disparity in YLL between the most and least income deprived areas.

CONCLUSIONS

The health benefits of natural space also apply when indicators sensitive to health events at younger ages are used. An increased amount of natural space within local areas has the potential to reduce the disparity in YLL between the most and least income deprived areas-the 'equigenic' effect.

Trends and inequalities in distance to and use of nearest natural space in the context of the 20-min neighbourhood: A 4-wave national repeat cross-sectional study, 2013 to 2019

The 20-min neighbourhood is a policy priority for governments worldwide; a key feature of this policy is providing access to natural space (NS) within 800 m of home. The study aims were to (1) examine the association between distance to nearest NS and frequent use over time and (2) examine whether frequent use and changes in use were patterned by income and housing tenure over time. Bi-annual Scottish Household Survey data were obtained for 2013 to 2019 (n:42128 aged 16+). Adults were asked the walking distance to their nearest NS, the frequency of visits to this space and their housing tenure, as well as age, sex and income. We examined the association between distance from home of nearest NS, housing tenure, and the likelihood of frequent NS use (visited once a week or more). Two-way interaction terms were further applied to explore variation in the association between tenure and frequent NS use over time. We found that 87% of respondents lived within 10 min walk of a NS, meeting the policy specification for a 20-min neighbourhood. Greater proximity to NS was associated with increased use; individuals living a 6-10 min walk and over 10 min walk were respectively 53% and 78% less likely to report frequent NS use than those living within a 5 min walk. Housing tenure was an important predictor of frequent NS use; private renters and homeowners were more likely to report frequent NS use than social renters. Our findings provide evidence that proximity to NS is a strong predictor of frequent use. Our study provides important evidence that time-based access measures alone do not consider deep-rooted socioeconomic variation in use of NS. Policy makers should ensure a nuanced lens is applied to operationalising and monitoring the 20-min neighbourhood to safeguard against exacerbating existing inequalities.

Day-to-day intrapersonal variability in mobility patterns and association with perceived stress: A cross-sectional study using GPS from 122 individuals in three European cities

Many aspects of our life are related to our mobility patterns and individuals can exhibit strong tendencies towards routine in their daily lives. Intrapersonal day-to-day variability in mobility patterns has been associated with mental health outcomes. The study aims were: (a) calculate intrapersonal day-to-day variability in mobility metrics for three cities; (b) explore interpersonal variability in mobility metrics by sex, season and city, and (c) describe intrapersonal variability in mobility and their association with perceived stress. Data came from the Physical Activity through Sustainable Transport Approaches (PASTA) project, 122 eligible adults wore location measurement devices over 7-consecutive days, on three occasions during 2015 (Antwerp: 41, Barcelona: 41, London: 40). Participants completed the Short Form Perceived Stress Scale (PSS-4). Day-to-day variability in mobility was explored via six mobility metrics using distance of GPS point from home (meters:m), distance travelled between consecutive GPS points (m) and energy expenditure (metabolic equivalents:METs) of each GPS point collected (n = 3,372,919). A Kruskal-Wallis H test determined whether the median daily mobility metrics differed by city, sex and season. Variance in correlation quantified day-to-day intrapersonal variability in mobility. Levene's tests or Kruskal-Wallis tests were applied to assess intrapersonal variability in mobility and perceived stress. There were differences in daily distance travelled, maximum distance from home and METS between individuals by sex, season and, for proportion of time at home also, by city. Intrapersonal variability across all mobility metrics were highly correlated; individuals had daily routines and largely stuck to them. We did not observe any association between stress and mobility. Individuals are habitual in their daily mobility patterns. This is useful for estimating environmental exposures and in fuelling simulation studies.

Socio-economic patterning of food and drink advertising at public transport stops in Edinburgh, UK

OBJECTIVE

Outdoor advertisements for food and drink products form a large part of the food environment and they disproportionately promote unhealthy products. However, less is known about the social patterning of such advertisements. The main aim of this study was to explore the socio-economic patterning of food and drink advertising at bus stops in Scotland's capital city, Edinburgh.

DESIGN

Bus stop advertisements were audited to identify food/drink adverts and classify them by food/drink category (i.e. 'advert category'). This data were then linked to area-based deprivation and proximity measures. Neighbourhood deprivation was measured using the bus stop x/y co-ordinates, which were converted to postcodes to identify the matching 2012 deprivation level via the Scottish Index of Multiple Deprivation. Distance to schools and leisure centres were also collected using location data. Generalised estimating equations and linear regression analyses were used to assess associations between the promotion of advert categories and deprivation and proximity to schools/leisure centres, respectively.

SETTING

Edinburgh city, United Kingdom.

RESULTS

561 food/drink advertisements were identified across 349 bus stops, with 8 advertisement categories noted and included in the final analysis, including alcohol, fast food outlets and confectionary. The majority of adverts were for 'unhealthy' food and drink categories, however there was no evidence for any socio-economic patterning of these advertisements. There was no evidence of a relationship between advertisements and proximity to schools and leisure centres.

CONCLUSIONS

While there is no evidence for food and drink advertising being patterned by neighbourhood deprivation, the scale of unhealthy advertising is an area for policy evaluations and interventions on the control of such outdoor advertising.

Do neighbourhood characteristics matter in understanding school children’s active lifestyles? A cross-region multi-city comparison of Glasgow, Edinburgh and Hong Kong

Many studies have explored the influence of individual and neighbourhood factors on active school travel (AST), this novel study is the first to examine how AST and formal extracurricular activities are associated with children’s active lifestyles. The aims of this study were to (a) create an active lifestyle variable (ALIFE) measured in terms of total weekly minutes of AST and extracurricular activities, and (b) explore how ALIFE is associated with different attributes at the individual, household and neighbourhood levels, and how these relationships differ for children aged 10 and 11 years old across the three cities: Glasgow, Edinburgh and Hong Kong. We found environmental factors to be important indicators of lower AST, for example greater parking facility density. The most substantial contribution to children’s overall ALIFE was household income, those from the lowest household group having almost 2 h less ALIFE per-week than those from the highest income.

Change in time spent visiting and experiences of green space following restrictions on movement during the COVID-19 pandemic: a nationally representative cross-sectional study of UK adults

OBJECTIVES

Green space positively influences health and well-being; however, inequalities in use of green space are prevalent. Movement restrictions enforced due to the COVID-19 pandemic could have exacerbated existing inequalities regarding who visits green space. Therefore, this study aimed to explore how movement restrictions have changed the time spent visiting green space and experience of green space in the United Kingdom (UK) and how these differed by individual-level demographic characteristics.

DESIGN AND OUTCOME MEASURES

A nationally representative cross-sectional survey administered through YouGov between 30 April and 1 May 2020. Data were collected on the time spent visiting green space and change in the experience of green space, including missing social interaction, increased physical activity and feeling greater mental health benefits in green space. Demographic information was collected on sex, age, ethnicity, social grade and dog ownership. Associations between specific outcome variables and predictors were assessed using logistic regression.

SETTING

UK, with population weights applied.

PARTICIPANTS

2252 adults aged 18 years and over.

RESULTS

Overall, 63% of respondents reported a decrease in time spent visiting green space following movement restrictions. Lower social grade respondents were less likely to visit green space before and after restrictions were enforced (OR: 0.35 (95% CI 0.24 to 0.51); OR: 0.77 (95% CI 0.63 to 0.95)). Female respondents were more likely than male respondents to agree that green space benefited their mental health more following restrictions (PP: 0.70 vs 0.59). Older (65+ years) respondents were less likely than middle-aged (25-64 years) respondents to have visited green space following the restrictions (OR: 0.79 (95% CI 0.63 to 0.98)).

CONCLUSIONS

Inequalities in green space use were sustained, and possibly exacerbated, during movement restrictions. Our findings emphasise the importance of green spaces remaining open globally in any future 'lockdowns'/pandemics. Further investigation is required to determine how visit patterns and experiences change through the different stages of the COVID-19 pandemic in the UK.

Exposure to unhealthy product advertising: Spatial proximity analysis to schools and socio-economic inequalities in daily exposure measured using Scottish Children's individual-level GPS data

This study aimed to understand socio-spatial inequalities in the placement of unhealthy commodity advertisements at transportation stops within the Central Belt of Scotland and to measure advertisement exposure using children's individual-level mobility data. We found that children who resided within more deprived areas had greater contact with the transport network and also greater exposure to unhealthy food and drink product advertising, compared to those living in less deprived areas. Individual-level mobility data provide evidence that city- or country-wide restrictions to advertising on the transport network might be required to reduce inequalities in children's exposure to unhealthy commodity advertising.

Neighbourhood natural space and the narrowing of socioeconomic inequality in children's social, emotional, and behavioural wellbeing

INTRODUCTION

The natural environment may benefit children's social, emotional and behavioural wellbeing, whilst offering a lever to narrow socioeconomic health inequalities. We investigated whether immediate neighbourhood natural space and private gardens were related to children's wellbeing outcomes and whether these relationships were moderated by household income.

METHODS

A nationally representative sample of 774 children (55% female, 10/11 years old) from the Studying Physical Activity in Children's Environments across Scotland study. Social, emotional and behavioural difficulty scores (Strengths and Difficulties Questionnaire) represented wellbeing outcomes. Percentage of total natural space and private gardens within 100m of the child's residence was quantified using Ordnance Survey's MasterMap Topography Layer®. Linear regression, including interaction terms, explored the two main research questions.

RESULTS

A 10% increase in residential natural space was associated with a 0.08 reduction (-0.15, -0.01; 95%CI) in Emotional Problem scores and a 0.09 improvement (0.02, 0.16; 95%CI) in Prosocial Behaviour scores. Household income moderated the associations between % natural space and private gardens on Prosocial Behaviour scores: for natural space, there was a positive relationship for those in the lowest income quintile (0.25 (0.09, 0.41; 95%CI)) and a null relationship for those in the highest quintile (-0.07 (-0.16, 0.02; 95%CI)). For private garden space, there was a positive relationship for those in the highest quintile (0.15 (0.05, 0.26; 95%CI)) and negative relationship with those in the lowest quintile (-0.30 (-0.50, -0.07, 95%CI)).

CONCLUSION

The natural environment could be a lever to benefit those from less advantaged backgrounds, particularly the development of prosocial behaviours.

Active commute to school: does distance from school or walkability of the home neighbourhood matter? A national cross-sectional study of children aged 10-11 years, Scotland, UK

OBJECTIVES

To study the extent to which home-to-school distance and neighbourhood walkability were associated with self-reported active travel to school (ATS) (eg, walking, cycling), and to explore how distance moderates the effect of walkability on ATS, among 10-11 years old.

DESIGN

Cross-sectional study.

SETTING

Data were collected between May 2015 and May 2016 in partnership with the Growing Up in Scotland Study, a nationally representative longitudinal cohort study.

PARTICIPANTS

713 children (male (n=330) and female (n=383) 10-11 years old) from Studying Physical Activity in Children's Environments across Scotland.

PRIMARY AND SECONDARY OUTCOME MEASURES

Children who actively travelled to/from school categorised as active all (100% of ATS) and active 60%+ (at least 60% of ATS); home-to-school road/path network distance (<0.5 km, 0.5 to <1 km, 1 to <1.5 km, 1.5 to <2 km, 2 km+); home neighbourhood walkability (i.e., composite measure of road/path intersection density and dwelling density) (in quintiles).

RESULTS

Distance and walkability were both associated with ATS. The likelihood of ATS for all or most journeys decreased with increasing distance. Compared with 'most' walkable areas (Q1), the odds of active all were significantly lower within least walkable areas (Q5 OR 0.45, 95% CI 0.21 to 0.99), and odds of active 60%+ were significantly less in Q2-Q5 (lowest odds Q5 OR 0.20, 95% CI 0.07 to 0.47). Regarding walkability and distance interactions, for all distance categories, higher walkability increased the probability of ATS (for most school journeys).

CONCLUSION

Walkability was positively associated with ATS within all distance categories, with the relationship between walkability and ATS more complex than the clear-cut association between distance and ATS. A more walkable environment had a larger effect on the probability of reaching the 60% threshold of school journeys using ATS than the probability of always travelling in an active manner. Investment is needed in existing less walkable neighbourhoods to provide infrastructure to support opportunities for children's ATS.

Which urban land covers/uses are associated with residents' mortality? A cross-sectional, ecological, pan-European study of 233 cities

​OBJECTIVES: The study aim was to determine whether the range and distribution of all, and proportions of specific, land covers/uses within European cities are associated with city-specific mortality rates. ​SETTING: 233 European cities within 24 countries. ​PARTICIPANTS: Aggregated city-level all-cause and age-group standardised mortality ratio for males and females separately and Western or Eastern European Region. ​RESULTS: The proportion of specific land covers/uses within a city was related to mortality, displaying differences by macroregion and sex. The land covers/uses associated with lower standardised mortality ratio (SMR) for both Western and Eastern European cities were those characterised by 'natural' green space, such as forests and semi-natural areas (Western Female coefficient: -18.3, 95% CI -29.8 to -6.9). Dense housing was related to a higher SMR, most prominently in Western European cities (Western Female coefficient: 17.4, 95% CI 9.6 to 25.2). ​CONCLUSIONS: There is pressure to build on urban natural spaces, both for economic gain and because compact cities are regarded as more sustainable, yet here we offer evidence that doing so may detract from residents' health. Our study suggests that urban planners and developers need to regard retaining more wild and unstructured green space as important for healthy city systems.

Are urban landscapes associated with reported life satisfaction and inequalities in life satisfaction at the city level? A cross-sectional study of 66 European cities

With more than half the world's population residing in urban areas and this proportion rising, it is important to understand how well-planned urban environments might improve, and reduce inequalities in, quality of life (QoL). Although studies suggest city-level characteristics hold independent influence on QoL, they generally lack a theoretically informed approach to understanding how the whole city landscape might be implicated, have paid scant attention to inequalities in QoL and often focus on small numbers of cities or countries. We applied theory and methods from landscape ecology to explore associations between cities' land cover/use, residents' reported life satisfaction and within-city socio-economic inequalities in life satisfaction. We joined individual-level responses to the European Urban Audit (EUA) Perception Surveys (2012, 2015) with city-level data from the European Urban Atlas classifying land cover/use into 26 different classes. Our sample included 63,554 people from 66 cities in 28 countries. Multilevel binary logistic models found that specific land use measures were associated with life satisfaction, including the amount of a city which was: residential (OR:0.991, 95%CI 0.984–0.997); isolated structures (OR:1.046, 95 CI 1.002–1.091); roads (OR:0.989, 95%CI 0.982–0.996); pastures (OR: 1.002, 95% CI 1.002–1.003) and herbaceous vegetation (OR:0.998, 95%CI 0.997–0.100). A more even distribution of land cover/use (β: 1.561, 95%CI -3.021 to −0.102) was associated with lower inequality in life satisfaction. This is the first study to theorise and examine how the entire urban landscape may affect levels of and inequalities in wellbeing in a large international sample. Our finding that more equal distribution of land cover/use is associated with lower levels of socio-economic inequality in life satisfaction supports the idea that city environments could be equigenic – that is, could create equality. Our findings can aid urban planners to develop and build cities that can contribute to improving, and narrowing inequalities in, residents' life satisfaction.

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It is important to understand how urban environments might improve quality of life.

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We explored associations between land covers and life satisfaction.

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We also explored within-city socio-economic inequalities in life satisfaction.

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Specific land use measures were associated with life satisfaction.

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Land cover evenness was associated with lower inequality in life satisfaction.

Children's mobility and environmental exposures in urban landscapes: A cross-sectional study of 10-11 year old Scottish children

Research into how the environment affects health and related behaviour is typically limited in at least two ways: it represents the environment to which people are exposed using fixed areal units, and, it focuses on one or two environmental characteristics only. This study developed a methodology for describing children's mobility and the complexity of their environmental exposure across a 1934 km2 study area, including urban, suburban and rural zones. It conceptualised and modelled this area as a landscape, comprised of spatially discrete amenities, infrastructure features, differing land covers/use and broader environmental contexts. The model used a 25 m2 grid system (∼3 million cells). For each cell, there was detailed built-environment information. We joined data for 100 10/11-year-old children who had worn GPS trackers to provide individual-level mobility information for one week during 2015/16 to our model. Using negative binomial regression, we explored which landscape features were associated with a child visiting that space and time spent there. We examined whether relationships between the features across our study area and children's use of the space differed by their sociodemographic characteristics. We found that children often used specific amenities outside their home neighbourhood, even if they were also available close to home. They spent more time in cells containing roads/transportation stops, food/drink retail (Incidence rate ratio (IRR):4.02, 95%CI 2.33 to 6.94), places of worship (IRR:5.98, 95%CI 3.33 to 10.72) and libraries (IRR:7.40, 95%CI 2.13 to 25.68), independently of proximity to home. This has importance for the optimal location of place-based health interventions. If we want to target children, we need to understand that using fixed neighbourhood boundaries may not be the best way to do it. The variations we found in time spent in certain areas by sex and socio-economic position also raise the possibility that interventions which ignore these differences may exacerbate inequalities.

Magnetic Resonance Image-Guided Radiotherapy (MRIgRT): A 4.5-Year Clinical Experience

AIMS

Magnetic resonance image-guided radiotherapy (MRIgRT) has been clinically implemented since 2014. This technology offers improved soft-tissue visualisation, daily imaging, and intra-fraction real-time imaging without added radiation exposure, and the opportunity for adaptive radiotherapy (ART) to adjust for anatomical changes. Here we share the longest single-institution experience with MRIgRT, focusing on trends and changes in use over the past 4.5 years.

MATERIALS AND METHODS

We analysed clinical information, including patient demographics, treatment dates, disease sites, dose/fractionation, and clinical trial enrolment for all patients treated at our institution using MRIgRT on a commercially available, integrated 0.35 T MRI, tri-cobalt-60 device from 2014 to 2018. For each patient, factors including disease site, clinical rationale for MRIgRT use, use of ART, and proportion of fractions adapted were summated and compared between individual years of use (2014-2018) to identify shifts in institutional practice patterns.

RESULTS

Six hundred and forty-two patients were treated with 666 unique treatment courses using MRIgRT at our institution between 2014 and 2018. Breast cancer was the most common disease, with use of cine MRI gating being a particularly important indication, followed by abdominal sites, where the need for cine gating and use of ART drove MRIgRT use. One hundred and ninety patients were treated using ART in 1550 fractions, 67.6% (1050) of which were adapted. ART was primarily used in cancers of the abdomen. Over time, breast and gastrointestinal cancers became increasingly dominant for MRIgRT use, hypofractionated treatment courses became more popular, and gastrointestinal cancers became the principal focus of ART.

DISCUSSION

MRIgRT is widely applicable within the field of radiation oncology and new clinical uses continue to emerge. At our institution to date, applications such as ART for gastrointestinal cancers and accelerated partial breast irradiation (APBI) for breast cancer have become dominant indications, although this is likely to continue to evolve.

Do 'environmental bads' such as alcohol, fast food, tobacco, and gambling outlets cluster and co-locate in more deprived areas in Glasgow City, Scotland?

This study utilised an innovative application of spatial cluster analysis to examine the socio-spatial patterning of outlets selling potentially health-damaging goods/services, such as alcohol, fast food, tobacco and gambling, within Glasgow City, Scotland. For all categories of outlets combined, numbers of clusters increased linearly from the least to the most income deprived areas (i.e. one cluster within the least deprived quintile to ten within the most deprived quintile). Co-location of individual types of outlets (alcohol, fast food, tobacco and gambling) within similar geographical areas was also evident. This type of research could influence interventions to tackle the co-occurrence of unhealthy behaviours and contribute to policies tackling higher numbers of 'environmental bads' within deprived areas.

Are Changes in Neighbourhood Perceptions Associated with Changes in Self-Rated Mental Health in Adults? A 13-Year Repeat Cross-Sectional Study, UK

The aim of this study was to examine changes in neighbourhood perceptions on self-rated mental health problems over time, and to explore demographic, geographic and socio-economic factors as determinants of increased or decreased anxiety and depression symptoms. We conducted a repeat cross-sectional study of individuals (N: 4480) living in the same areas of west central Scotland in 1997 and 2010. Individuals were asked to complete a questionnaire at both time-points, containing 14 questions relating to neighbourhood perceptions and the Hospital Anxiety and Depression Scale (HADS). A three-level linear regression model was fitted to HADS scores and changes in neighbourhood perceptions over time; controlling for a number of individual and area-level variables. Overall, area-level mean HADS scores decreased from 1997 to 2010. When adjusted for individual and area-level variables, this decrease did not remain for HADS anxiety. Applying an overall 14-scale neighbourhood perception measure, worsening neighbourhood perceptions were associated with small increases in depression (0.04, 95% confidence interval (CI) 0.01 to 0.07) and anxiety (0.04, 95% CI 0.00 to 0.08) scores over time. This highlights a need for local and national policy to target areas where neighbourhood characteristics are substantially deteriorating in order to ensure the mental health of individuals does not worsen.

Population levels of, and inequalities in, active travel: A national, cross-sectional study of adults in Scotland

This study aimed to describe active travel (walking or cycling) in Scotland and explore potential demographic, geographic, and socio-economic inequalities in active travel. We extracted data for the period 2012-13 (39,585 journey stages) from the Scottish Household Survey. Survey travel diaries recorded all journeys made on the previous day by sampled individuals aged 16 + living within Scotland, and the stages within each journey. Descriptive statistics were calculated for journey stages, mode, purpose and distance. Logistic regression models were fitted to examine the relationship between the likelihood of a journey stage being active, age, sex, area deprivation and urban/rural classification. A quarter of all journey stages were walked or cycled (26%, n: 10,280/39,585); 96% of these were walked. Those living in the least deprived areas travelled a greater average distance per active journey stage than those in the most deprived. The likelihood of an active journey stage was higher for those living in the most deprived areas than for those in the least deprived (Odds Ratio (OR) 1.21, 95% CI 1.04-1.41) and for those in younger compared to older age groups (OR 0.44, 95% CI 0.34-0.58). In conclusion, socio-economic inequalities in active travel were identified, but - contrary to the trends for many health-beneficial behaviours - with a greater likelihood of active travel in more deprived areas. This indicates a potential contribution to protecting and improving health for those whose health status tends to be worse. Walking was the most common mode of active travel, and should be promoted as much as cycling.

Effect of a new motorway on social-spatial patterning of road traffic accidents: A retrospective longitudinal natural experimental study

Background

The World Health Organisation reports that road traffic accidents (accidents) could become the seventh leading cause of death globally by 2030. Accidents often occur in spatial clusters and, generally, there are more accidents in less advantaged areas. Infrastructure changes, such as new roads, can affect the locations and magnitude of accident clusters but evidence of impact is lacking. A new 5-mile motorway extension was opened in 2011 in Glasgow, Scotland. Previous research found no impact on the number of accidents but did not consider their spatial location or socio-economic setting. We evaluated impacts on these, both locally and city-wide.

Methods

We used STATS19 data covering the period 2008 to 2014 and describing the location and details of all reported accidents involving a personal injury. Poisson-based continuous scan statistics were used to detect spatial clusters of accidents and any change in these over time. Change in the socio-economic distribution of accident cluster locations during the study period was also assessed.

Results

In each year accidents were strongly clustered, with statistically significant clusters more likely to occur in socio-economically deprived areas. There was no significant shift in the magnitude or location of accident clusters during motorway construction or following opening, either locally or city-wide. There was also no impact on the socio-economic patterning of accident cluster locations.

Conclusions

Although urban infrastructure changes occur constantly, all around the world, this is the first study to evaluate the impact of such changes on road accident clusters. Despite expectations to the contrary from both proponents and opponents of the M74 extension, we found no beneficial or adverse change in the socio-spatial distribution of accidents associated with its construction, opening or operation. Our approach and findings can help inform urban planning internationally.

Changes over time in population level transport satisfaction and mode of travel: A 13 year repeat cross-sectional study, UK

AIM

The aim of the study was to examine changes over time in satisfaction with usual transport mode, explore individual and area level characteristics as mediators in the likelihood of transport satisfaction, and whether any changes in transport satisfaction varied by these factors over time.

METHODS

Adults from West Central Scotland, United Kingdom, who participated at both waves of the repeat cross-sectional 'Transport, Health and Well-being Study' conducted in 1997 (n=2735) and 2010 (n=2024) were assessed. Individuals completed a detailed postal questionnaire at both time points including self-rated satisfaction with usual transport mode (using a seven point scale subsequently dichotomised to a binary outcome of satisfied (1-2) and other (3-7)). Participants reported usual transport mode for travel to various destinations. A multilevel logistic regression model was used and individuals were nested within areas (c. 4000 population).

RESULTS

At the 2010 sweep, two thirds (n=1345) of individuals were satisfied with their transport choice. Those with fair/poor health were less satisfied with their usual transport compared to those in better health (Odds Ratio (OR) 0.49, p<0.001). Access to a car was associated with overall transport satisfaction (OR 2.63, p<0.001) and the effect of deprivation on transport satisfaction was mitigated when adjusted by household car access. Transport satisfaction increased more from 1997 to 2010 for retired individuals compared to those in employment (OR 1.40, p=0.032), and for those who travelled by public transport (OR 2.39, p=0.005) and using multiple modes (OR 2.19, p<0.001) compared to those who travelled by car.

CONCLUSIONS

The proportion of those who travelled using public transport, active modes or by multiple mode increased journey satisfaction over time at a greater rate than those who travelled by car, highlighting that continued efforts should be made to promote these more active transport modes which have potential to impact on health.

Health impacts of the M74 urban motorway extension: a mixed-method natural experimental study

Background

Making travel easier can improve people’s access to opportunities, but motor transport also incurs substantial undesirable health and social impacts.

Aims

To assess how a new urban motorway affected travel and activity patterns, road accidents and well-being in local communities, and how these impacts were experienced and brought about.

Design

The Traffic and Health in Glasgow study, a mixed-method controlled before-and-after study.

Setting

Glasgow, UK.

Participants

Repeat cross-sectional survey samples of 1345 and 1343 adults, recruited in 2005 and 2013, respectively. Of these, 365 formed a longitudinal cohort, 196 took part in a quantitative substudy using accelerometers and global positioning system receivers and 30, living within 400 m of the new motorway, took part in a qualitative substudy along with 12 other informants. Complementary analyses used police STATS19 road traffic accident data (1997–2014) and Scottish Household Survey travel diaries (2009–13).

Intervention

A new 5-mile, six-lane section of the M74 motorway, opened in 2011 and running through predominantly deprived neighbourhoods in south-east Glasgow, with associated changes to the urban landscape.

Main outcome measures

Differences in self-reported travel behaviour (1-day travel record), physical activity (short International Physical Activity Questionnaire) and well-being [Short Form 8 Health Survey (SF-8) and a short version of the Warwick–Edinburgh Mental Well-being Scale], and in the incidence of road traffic accidents.

Methods

A combination of multivariable cohort, cross-sectional, repeat cross-sectional and interrupted time series regression analyses comparing residents of the ‘M74 corridor’ intervention area and two matched control areas, complemented by novel qualitative spatial methods. Graded measures of the proximity of the motorway to each participant’s home served as a further basis for controlled comparisons.

Results

Both benefits and harms were identified. Cohort participants living closer to the new motorway experienced significantly reduced mental well-being (mental component summary of the SF-8 scale) over time compared with those living further away [linear regression coefficient –3.6, 95% confidence interval (CI) –6.6 to –0.7]. In the area surrounding an existing motorway, this association was concentrated among those with chronic conditions. In repeat cross-sectional analyses, participants living closer to a new motorway junction were more likely to report using a car at follow-up than those living further away (odds ratio 3.4, 95% CI 1.1 to 10.7). We found weaker quantitative evidence of a decline in physical activity participation and no quantitative evidence of an overall change in either active travel or accidents associated with motorway exposure. Qualitative evidence suggested that, although the new motorway improved connectivity for those with dispersed social networks and access to motor vehicles, the impacts were more complex for others, some of whom found the motorway to be a cause of severance. Changes in community composition and cohesion, and perceptions of personal safety, were widely perceived as more important to local people.

Limitations

A key limitation of natural experimental studies is that the risk of residual confounding cannot be eliminated.

Conclusions

Overall, these findings highlight the potential for urban infrastructural projects of this kind to add further burdens to already disadvantaged communities, exacerbating inequalities and contributing to poorer health outcomes. The health and social impacts of such initiatives should be more fully taken into account in planning and research.

Funding

The National Institute for Health Research Public Health Research programme.

Effects of new motorway infrastructure on active travel in the local population: a retrospective repeat cross-sectional study in Glasgow, Scotland

Background

Promoting active travel is an important part of increasing population physical activity, which has both physical and mental health benefits. A key benefit described by the then Scottish Government of the five-mile M74 motorway extension, which opened during June 2011 in the south of Glasgow, was that the forecast reduction in motor traffic on local streets would make these streets safer for walking and cycling, thus increasing active travel by the local population. The aim of the study was to evaluate the impact of new motorway infrastructure on the proportion of journey stages made actively (cycling or on foot) by individuals travelling in and out of the local area.

Methods

Data for the periods 2009–10 and 2012–13 were extracted from the Scottish Household Survey (SHS) travel diaries, which record each journey stage made during the previous day by a representative sample of the Scottish population aged 16 and over. Each individual journey stage was assigned to one of the following study areas surrounding existing and new transport infrastructure: (1) an area surrounding the new M74 motorway extension (n = 435 (2009–10), 543 (2012–13)), (2) a comparator area surrounding an existing motorway (n = 477 (2009–10), 560 (2012–13)), and (3) a control area containing no comparable motorway infrastructure (n = 541 (2009–10), 593 (2012–13)). Multivariable, multi-level regression analysis was performed to determine any between-area differences in change in active travel over time, which might indicate an intervention effect. Reference populations were defined using two alternative definitions, (1) Glasgow City and (2) Glasgow and surrounding local authorities.

Results

The results showed an increase in the proportion of journey stages using active travel in all study areas compared to both reference populations. However, there were no significant between-area differences to suggest an effect attributable the M74 motorway extension.

Conclusions

There was no clear evidence that the M74 motorway extension either increased or decreased active travel in the local area. The anticipation by policy makers that reduced motorised traffic on local streets might increase journeys walked or cycled appears to have been unfounded.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0403-9) contains supplementary material, which is available to authorized users.

Effects of new urban motorway infrastructure on road traffic accidents in the local area: a retrospective longitudinal study in Scotland

BACKGROUND

The M74 motorway extension, Glasgow, opened in June 2011. One justification for construction was an expectation that it would reduce road traffic accidents (RTAs) on local non-motorway roads. This study evaluated the impact of the extension on the number of RTAs, stratifying by accident severity.

METHODS

Data for the period 1997-2014 were extracted from a UK database of reported RTAs involving a personal injury. RTA severity was defined by the level of injury: minor, severe or fatal. RTAs were assigned to (1) the local area surrounding the motorway extension, (2) a comparator area surrounding an existing motorway or (3) a control area elsewhere in the conurbation. Interrupted time-series regression with autoregressive integrated moving average (ARIMA) errors was used to determine longitudinal between-area differences in change in the number of RTAs, which might indicate an intervention effect.

RESULTS

Glasgow and surrounding local authorities saw a 50.6% reduction in annual RTAs (n: 5901 to 2914) between 1997 and 2014. In the intervention area, the number of recorded RTAs decreased by 50.7% (n: 758 to 374), and that of fatal/severe RTAs by 57.4% (n: 129 to 55), with similar reductions in the comparator/control areas. The interrupted time-series analysis showed no significant between-area differences in temporal trends. The reduction of pedestrian casualties was attenuated in the intervention area relative to Glasgow and surrounding authorities.

CONCLUSIONS

Reduction in RTAs was not associated with the motorway extension. Our findings suggest that in planning future investment, it should not be taken for granted that new road infrastructure alone will reduce RTAs in local areas. Urbanisation is proceeding rapidly worldwide, and evidence of infrastructure changes is lacking; this novel study provides important findings for future developments.

Quality of life impact of childhood skin conditions measured using the Children's Dermatology Life Quality Index (CDLQI): a meta-analysis

BACKGROUND

The Children's Dermatology Life Quality Index (CDLQI) is the most widely used instrument for measuring the impact of skin disease on quality of life (QoL) in children.

OBJECTIVES

To provide a meta-analysis of all published QoL scores for a range of childhood skin conditions.

METHODS

Studies using the CDLQI questionnaire to measure QoL in skin conditions were identified by searching Medline and Embase from January 1995 (CDLQI creation) to December 2014. Studies were grouped according to condition and baseline scores were combined using meta-analysis.

RESULTS

Sixty-seven studies using the CDLQI met the inclusion criteria. The overall estimated CDLQI scores for conditions reported more than once were [point estimate (95% confidence interval, CI), number of studies (n), score range]: atopic eczema [8·5 (7·1-9·8), n = 38, 0-29], acne [5·3 (1·9-8·5), n = 5, 0-30], alopecia [3·1 (0-7·7), n = 2, 0-6], molluscum contagiosum [3·5 (0·6-6·7), n = 5, 0-27], psoriasis [8·0 (3·9-12·1), n = 6, 0-29], scabies [9·2 (0·0-20·3), n = 2, 1-26], urticaria [7·1 (0-15·4), n = 2, 0-22], vitiligo [6·5 (0·7-12·2), n = 2, 0-20] and warts [2·9 (0-5·8), n = 4, 0-16]. Overall, the mean effect on QoL [weighted average CDLQI score 4·6 (95% CI 3·9-5·4)] for children with these conditions was small. However, many children were found to experience a very large impact on QoL (34% of children with atopic eczema, 10% with molluscum contagiosum and 1-5% with acne) in studies where the distributions of scores were provided.

CONCLUSIONS

Most skin conditions in children have a 'small' mean effect on QoL. However, the range is large and a significant proportion of children with many common skin conditions will experience a very large effect on quality of life.

Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: a prospective community cohort study

BACKGROUND

Molluscum contagiosum is one of the 50 most prevalent diseases worldwide, but scarce epidemiological data exist for childhood molluscum contagiosum. We aimed to describe the time to resolution, transmission to household child contacts, and effect on quality of life of molluscum contagiosum in children in the UK.

METHODS

Between Jan 1, and Oct 31, 2013, we recruited 306 children with molluscum contagiosum aged between 4 and 15 years in the UK either by referral by general practitioner or self-referral (with diagnosis made by parents by use of the validated Molluscum Contagiosum Diagnostic Tool for Parents [MCDTP]). All participants were asked to complete a questionnaire at recruitment about participant characteristics, transmission, and quality of life. We measured quality of life with the Children's Dermatology Life Quality Index (CDLQI). Participants were prospectively followed up every month to check on their recovery from molluscum contagiosum and transmission to other children in the same household, until the child's lesions were no longer visible.

FINDINGS

The mean time to resolution was 13·3 months (SD 8·2). 80 (30%) of 269 cases had not resolved by 18 months; 36 (13%) had not resolved by 24 months. We recorded transmission to other children in the household in 102 (41%) of 250 cases. Molluscum contagiosum had a small effect on quality of life for most participants, although 33 (11%) of 301 participants had a very severe effect on quality of life (CDLQI score >13). A greater number of lesions was associated with a greater effect on quality of life (H=55·8, p<0·0001).

INTERPRETATION

One in ten children with molluscum contagiosum is likely to have a substantial effect on their quality of life and therefore treatment should be considered for some children, especially those with many lesions or who have been identified as having a severe effect on quality of life. Patients with molluscum contagiosum and their parents need to be given accurate information about the expected natural history of the disorder. Our data provide the most reliable estimates of the expected time to resolution so far and can be used to help set realistic expectations.

FUNDING

Wales School of Primary Care Research (WSPCR) and Cardiff University.

Epidemiology of molluscum contagiosum in children: a systematic review

BACKGROUND

Molluscum contagiosum (MC) is a common skin condition that primarily affects children, a common reason for presenting in primary care and is commonly seen in children presenting with other conditions in primary and secondary care. It is usually asymptomatic but can present with pain, pruritus, erythema and bacterial superinfection. Aim. To synthesize the current epidemiology of MC. Design and setting. A systematic literature review of bibliographical databases on the prevalence, incidence, risk factors, age distribution and association with other conditions for MC in children.

RESULTS

Data on the epidemiology of MC is largely of poor quality. The largest incidence is in children aged between 0 and 14 years, where the incidence rate ranged from 12 to 14 episodes per 1000 children per year. Incidence rates in the UK were highest in those aged 1-4 years. Meta-analysis suggests a point prevalence in children aged 0-16 years of between 5.1% and 11.5%. There is evidence for an association between swimming and having MC and MC is more common in those with eczema; however, there is little evidence for other risk factors.

CONCLUSIONS

MC is a common condition, with the greatest incidence being in those aged 1-4 years. Swimming and eczema are associated with the presence of MC, but the causal relationships are unclear. There is a lack of data regarding the natural history of MC and published data are insufficient to determine temporal or geographic patterns in incidence, risk factors, duration of symptoms or transmission between family members.

Accessibility of sexual health services in teenage sexual health service users: local area geospatial analysis

BACKGROUND

Teenage pregnancy rates in the UK are the highest in Western Europe. Causes of teenage pregnancies are multifaceted with complex interplay of social, lifestyle and wider determinants influencing risk. Improving access to sexual health services through community services is an important factor in attempting to tackle this issue, but few studies have examined factors that influence this.

METHODS

Geospatial analysis was conducted on community sexual health service users and teenage conceptions from local sexual health services were recorded. Univariate and multinomial regression was performed to test associations between service type and socio-economic status.

RESULTS

No significant differences in accessibility of services between teenage girls who have conceived and those seeking sexual health services were found. Females aged 17 and under were more likely to use a young people's sexual health service than mainstream services (P < 0.001). However, a young person living in the most deprived quintiles was more likely to use a mainstream service if it was closer to their home address (adjusted odds ratios: 2.154, 95% confidence intervals: 1.533-3.027).

CONCLUSIONS

Service type and socio-economic status impact upon the choices young people make when accessing community sexual health services. The study supports policy for locating young person services within the most deprived areas of a community.

An automated method for adaptive radiation therapy for prostate cancer patients using continuous fiducial-based tracking

Electromagnetic tracking technology is primarily used for continuous prostate localization during radiotherapy, but offers potential value for evaluation of dosimetric coverage and adequacy of treatment for dynamic targets. We developed a highly automated method for daily computation of cumulative dosimetric effects of intra- and inter-fraction target motion for prostate cancer patients using fiducial-based electromagnetic tracking. A computer program utilizing real-time tracking data was written to (1) prospectively determine appropriate rotational/translational motion limits for patients treated with continuous isocenter localization; (2) retrospectively analyze dosimetric target coverage after daily treatment, and (3) visualize three-dimensional rotations and translations of the prostate with respect to the planned target volume and dose matrix. We present phantom testing and a patient case to validate and demonstrate the utility of this application. Gamma analysis of planar dose computed by our application demonstrated accuracy within 1%/1 mm. Dose computation of a patient treatment revealed high variation in minimum dose to the prostate (D(min)) over 40 fractions and a drop in the D(min) of approximately 8% between a 5 mm and a 3 mm PTV margin plan. The infrastructure has been created for patient-specific treatment evaluation using continuous tracking data. This application can be used to increase confidence in treatment delivery to targets influenced by motion.

Comparison of controlled internal drug release device and melengesterol acetate as progestin sources in an estrous synchronization protocol for beef heifers

The objectives of this experiment were to compare estrous synchronization responses and AI pregnancy rates of beef heifers using protocols that included either CIDR or MGA as the progestin source. The hypotheses tested were that: (1) estrous synchronization responses after (a) progestin removal, and (b) PGF(2alpha); and, (2) AI pregnancy rates, do not differ between heifers synchronized with either progestin source. At the start of the experiment (Day 0) in both years, heifers were assigned randomly to receive, MGA supplement for 14 days (MGA-treated; n=79) or CIDR for 14 days (CIDR-treated; n=77). On Day 14 progestin was removed and heifers were observed for estrus up to and after PGF(2alpha) on Days 31 and 33 for CIDR-treated and MGA-treated heifers, respectively. Heifers that exhibited estrus within 60h after PGF(2alpha) were inseminated by AI 12h later; the remaining heifers were inseminated at 72h after PGF(2alpha) and given GnRH (100mug). More (P<0.05) CIDR-treated heifers exhibited estrus within 120h after progestin removal than MGA-treated heifers. Intervals to estrus after progestin removal were shorter (P<0.05) for CIDR-treated heifers than MGA-treated heifers. More (P<0.05) CIDR-treated heifers exhibited estrus and were inseminated within 60h after PGF(2alpha) than MGA-treated heifers. Pregnancy rates did not differ (P>0.10) between MGA-treated (66%) and CIDR-treated (62%) heifers. In conclusion, the use of CIDR as a progestin source in a 14-day progestin, PGF(2alpha), and timed AI and GnRH estrous synchronization protocol was as effective as the use of MGA to synchronize estrus and generate AI pregnancies in beef heifers.

Long-term follow-up of upper extremity implanted venous access devices in oncology patients

PURPOSE

To evaluate function and assess incidence of complications relating to upper extremity implanted venous access devices placed in oncology patients primarily for chemotherapy.

MATERIALS AND METHODS

The authors retrospectively evaluated the clinical course of 205 upper extremity implanted venous access devices placed with fluoroscopic and sonographic guidance in 204 patients during a 2-year period. All patients had a diagnosis of malignancy for which chemotherapy was planned. Follow-up data were collected by patient examination, direct evaluation of device function, as well as chart review and review of relevant imaging procedures. A modified technique for device placement is described.

RESULTS

The devices were placed successfully on the initial attempt in all cases. Clinical follow-up was obtained for 195 devices (95.1%) for a total device service period of 33,619 days (mean service interval = 169 days). Seventy-eight devices (40%) had service intervals greater than 180 days. Thirty-seven devices (19% of total devices) led to 39 complications (0.116 event/100 days). No immediate procedural complications were incurred. Eight complications occurred after 180 days of port service. Nineteen devices (9.7% of total devices followed) required removal as a result of complication. Common complications included port malfunction requiring urokinase to clear (n = 10; 0.030 event/100 days), ipsilateral upper extremity deep venous thrombosis (n = 9; 0.027), and local infection (n = 7, 0.021). A comparison of these results relative to other published series of similar devices placed for mixed indications is presented.

CONCLUSIONS

Implanted venous access devices are an effective means of long-term venous access in oncology patients. Complication rates in this large series compared favorably to other published radiologic and surgical series. Analysis of complications in a subgroup of extended use implanted venous access devices (greater than 180 days follow-up) showed no statistically significant (P < .05) difference from the larger group of devices.

Improved liquid chromatographic determination of riboflavin in milk and dairy products

Reported here is a simple liquid chromatographic (LC) method for the determination of riboflavin in milk (liquid, evaporated, and dry), yogurt, and cheese. The method involves passing liquid samples or filtrates of semisolid and solid samples through a C18 cartridge. Retained riboflavin is then eluted with an aliquot of 50% methanol in 0.02M acetate buffer of pH 4. A volume of the eluate is injected into the LC system consisting of a C18 column, a solvent of water-methanol-acetic acid (65 + 35 + 0.1, v/v) with a flow rate of 1 mL/min, and a UV detector set at 270 nm. The method is precise and accurate and compares favorably with the present AOAC method. Moreover, it involves fewer sample preparation steps and has a total analysis time of less than 1 h.