Integrating the Physical Environment Within a Population Neuroscience Perspective

Population neuroscience recognises the role of the environment in shaping brain, behaviour, and mental health. An overview of current evidence from neuroscientific and epidemiological studies highlights the protective effects of nature on cognitive function and stress reduction, the detrimental effects of urban living on mental health, and emerging concerns relating to extreme weather events and eco-anxiety. Despite the growing body of evidence in this area, knowledge gaps remain due to inconsistent measures of exposure and a reliance on small samples. In this chapter, attention is given to the physical environment and population-level studies as a necessary starting point for exploring the long-term impacts of environmental exposures on mental health, and for informing future research that may capture immediate emotional and neural responses to the environment. Key data sources, including remote sensing imagery, administrative, sensor, and social media data, are outlined. Appropriate measures of exposure are advocated for, recognising the value of area-level measures for estimating exposure over large study samples and spatial and temporal scales. Although integrating data from multiple sources requires consideration for data quality and completeness, deep learning and the increasing availability of high-resolution data present opportunities to build a more complete picture of physical environments. Advances in leveraging detailed locational data are discussed as a subsequent approach for building upon initial observations from population studies and improving understanding of the mechanisms underlying behaviour and human-environment interactions.

Does aquatic performance predict terrestrial performance: a case study with an aquatic frog, Xenopus laevis

The physical properties of the environment impose strong selection on organisms and their form-function relationships. In water and on land, selective pressures differ, with water being more viscous and denser than air, and gravity being the most important external force on land for relatively large animals such as vertebrates. These different properties of the environment could drive variation in the design and mechanics of the locomotor system of organisms. Animals that use multiple environments can consequently exhibit locomotion conflicts between the demands imposed by the media, leading to potential trade-offs. Here, we tested for the presence of such locomotor trade-offs depending on the environment (water or land) in a largely aquatic frog, Xenopus laevis. We focused on terrestrial and aquatic exertion capacity (time and distance swum or jumped until exhaustion) and aquatic and terrestrial burst capacity (maximal instantaneous swimming velocity and maximal force jump) given the ecological relevance of these traits. We tested these performance traits for trade-offs, depending on environments (water versus air) and locomotor modes (i.e. exertion and burst performance). Finally, we assessed the contribution of morphological traits to each performance trait. Our data show no trade-offs between the performance traits and between the environments, suggesting that X. laevis is equally good at swimming and jumping thanks to the same underlying morphological specialisations. We did observe, however, that morphological predictors differed depending on the environment, with variation in head shape and forelimb length being good predictors for aquatic locomotion and variation in hindlimb and forelimb segments predicting variation in jumping performance on land.

A systematic review on the relationship between the built environment and children's quality of life

BACKGROUND

Evidence of the effects of the built environment on children has mainly focused on disease outcomes; however, quality of life (QoL) has gained increasing attention as an important health and policy endpoint itself. Research on built environment effects on children's QoL could inform public health programs and urban planning and design.

OBJECTIVE

We aimed to review and synthesize the evidence of the relationship between built environment features and children's QoL.

METHODS

Five research databases were searched for quantitative peer-reviewed studies on children between 2 and 18 years, published in English or German between January 2010 and August 2023. Only primary research was considered. Included studies (n = 17) were coded and methodologically assessed with the Joanna Briggs Critical Appraisal Checklists, and relevant data were extracted, analyzed, and synthesized, using the following built environment framework: (1) neighborhood green and blue space, (2) neighborhood infrastructure, and (3) neighborhood perception.

RESULTS

Green space was positively associated with children's QoL. Infrastructure yielded inconclusive results across all measured aspects. Overall neighborhood satisfaction was positively correlated with higher QoL but results on perceived environmental safety were mixed.

CONCLUSIONS

Most studies are correlational, making it difficult to infer causality. While the positive findings of green space on QoL are consistent, specific features of the built environment show inconsistent results. Overall perception of the built environment, such as neighborhood satisfaction, also shows more robust results compared to perceptions of specific features of the built environment. Due to the heterogeneity of both built environment and QoL measures, consistent measures of both concepts will help advance this area of research.

A review on factors related to patient comfort experience in hospitals

The creation of a welcoming hospital atmosphere is necessary to improve patient wellbeing and encourage healing. The goal of this study was to examine the variables affecting hospitalised patients' comfort. The study procedure included a thorough search of the Web of Science and Scopus databases, as well as the use of software analytic tools to graphically map enormous literature data, providing a deeper understanding of the linkages within the literature and its changing patterns. Insights from a range of disciplines, including engineering, psychology, immunology, microbiology, and environmental science, were included into our study using content analysis and clustering approaches. The physical environment and the social environment are two crucial factors that are related to patient comfort. The study stress the need of giving patient comfort a top priority as they heal, especially by tackling indoor air pollution. Our research also emphasises how important hospital care and food guidelines are for improving patient comfort. Prioritising patients who need specialised care and attention, especially those who have suffered trauma, should be the focus of future study. Future research in important fields including trauma, communication, hospital architecture, and nursing will be built on the findings of this study. To enhance research in these crucial areas, worldwide collaboration between experts from other nations is also advised. Although many studies stress the significance of patient comfort, few have drawn conclusions from a variety of disciplines, including medicine, engineering, immunology, microbiology, and environmental science, the most crucial issue of thoroughly researching the improvement of patient comfort has not been addressed. Healthcare workers, engineers, and other professions will benefit greatly from this study's investigation of the connection between hospital indoor environments and patient comfort.

Developing a Geriatric Emergency Department: People, Processes, and Place

Older patients' ED visits rose 30% over 5 years and EDs are now examining geriatric emergency department (GED) models of care. The 3 Ps model focuses on the GED's People, Processes, and the Place to provide a framework for GED development. Key resources include the: GED Collaborative, GED Guidelines, and Geriatric Emergency Department Accreditation process. Core to a GED's operation is its care processes including: (1) General approaches; (2) Screening for high-risk conditions; (3) Enhanced assessment; (4) Workflow alterations; and (5) Transitions. This article provides practical guidance to EDs seeking to enhance the ED experience of older people and improve the quality of their outcomes.

Surface tension in biological systems - a common problem with a variety of solutions

Water is of fundamental importance to living organisms, not only as a universal solvent to maintain metabolic activity but also due to the effects the physical properties of water have on different organismal structures. In this review, we explore some examples of how living organisms deal with surfaces covered with or in contact with water. While we do not intend to describe all possible forms of interactions in every minute detail, we would like to draw attention to this intriguing interdisciplinary subject and discuss the positive and negative effects of the interaction forces between water molecules and organisms. Topics explored include locomotion on water, wettability of surfaces, benefits of retaining a film of air while submerged (Salvinia effect), surface tension of water inhibiting air-breathing, accumulation of water in small tubes, surface tension in non-mammalian and mammalian respiratory systems. In each topic, we address the importance of interactions with water and the adaptations seen in an organism to solve the surface-related challenges, trying to explore the different selective pressures acting onto different organisms allowing exploring or compensating these surface-related interactions.

Mobile app impulsive buying: A situational factors dataset analysis

This dataset examines the empirical model of situational factors for impulsive buying on mobile apps. The model presents factors driving impulse buying based on situational factors consisting of the physical environment, social environment, time perspective, and hedonic and utilitarian exploration. The data collection technique in this study used a questionnaire distributed online according to predetermined criteria, namely mobile device users who accessed online market board applications and made regular purchases in the last six months. The data were tested statistically using Structural Equation Modeling to ensure the model's fit.

Urban design and cardio-metabolic risk factors

Accumulating evidence suggests that the built environment may be associated with cardiovascular disease via its influence on health behaviours. The aim of this study was to estimate the associations between traditional and novel neighbourhood built environment metrics and clinically assessed cardio-metabolic risk factors among a sample of adults in Canada. A total of 7171 participants from Albertas Tomorrow Project living in Alberta, Canada, were included. Cardio-metabolic risk factors were clinically measured. Two composite built environment metrics of traditional walkability and space syntax walkability were calculated. Among men, space syntax walkability was negatively associated with systolic and diastolic blood pressure (b = -0.87, 95% CI -1.43, -0.31 and b = -0.45, 95% CI -0.86, -0.04, respectively). Space syntax walkability was also associated with lower odds of overweight/obese among women and men (OR = 0.93, 95% CI 0.87, 0.99 and OR = 0.88, 95% CI 0.79, 0.97, respectively). No significant associations were observed between traditional walkability and cardio-metabolic outcomes. This study showed that the novel built environment metric based on the space syntax theory was associated with some cardio-metabolic risk factors.

Performance Regulation of Single-Atom Catalyst by Modulating the Microenvironment of Metal Sites

Metal-based catalysts, encompassing both homogeneous and heterogeneous types, play a vital role in the modern chemical industry. Heterogeneous metal-based catalysts usually possess more varied catalytically active centers than homogeneous catalysts, making it challenging to regulate their catalytic performance. In contrast, homogeneous catalysts have defined active-site structures, and their performance can be easily adjusted by modifying the ligand. These characteristics lead to remarkable conceptual and technical differences between homogeneous and heterogeneous catalysts. As a recently emerging class of catalytic material, single-atom catalysts (SACs) have become one of the most active new frontiers in the catalysis field and show great potential to bridge homogeneous and heterogeneous catalytic processes. This review documents a brief introduction to SACs and their role in a range of reactions involving single-atom catalysis. To fully understand process-structure-property relationships of single-atom catalysis in chemical reactions, active sites or coordination structure and performance regulation strategies (e.g., tuning chemical and physical environment of single atoms) of SACs are comprehensively summarized. Furthermore, we discuss the application limitations, development trends and future challenges of single-atom catalysis and present a perspective on further constructing a highly efficient (e.g., activity, selectivity and stability), single-atom catalytic system for a broader scope of reactions.

Effects of the physical environment on children and families in hospital-based emergency departments: A systematic literature review

Every year, millions of children seek care in emergency departments (EDs) for various conditions. Though the physical environment of the ED provides the context and setting for care delivery, influences workflows, and shapes interactions between users, the noisy, sterile, stimulating nature of the ED can be counter-therapeutic to pediatric patients and families. This systematic literature review investigates this complex dynamic and asks how the physical environment of emergency departments affects children and their families or guardians. Using PRISMA methods, this review searched four databases to identify and analyze twenty-one peer-reviewed articles that explored the impacts of the physical environment of hospital-based EDs on children or family members. Several themes emerged from the literature - concerning control, positive distractions, family and social supports, and designing for a safe and comfortable experience - that illustrate opportunities for future ED design and highlight knowledge gaps and avenues for future research.

Effect of the Physical Environment on Health and Well-Being of Nursing Homes Residents: A Scoping Review

OBJECTIVES

In what way the physical environment of nursing homes (NHs) influences the health and well-being of nursing residents is not well codified. The authors aimed to review scientifically based knowledge on this topic.

DESIGN

A systematic scoping review of research into the effect that physical environment in nursing homes has on residents' health.

SETTING AND PARTICIPANTS

Search for relevant English-language articles in PubMed and the Cochrane database before April 15, 2022. Article selection and data extraction were performed by 2 researchers. Studies were included if conducted on nursing home residents and if they examined associations between components of the physical environment and health outcomes.

MEASURES

The review was performed in accordance with the PRISMA statement.

RESULTS

Of 1347 articles retrieved, 59 met the inclusion criteria-40 observational, 1 survey, and 18 interventional studies, of which 5 were randomized controlled trials. Certain environmental features repeatedly show significant positive effect on resident's health, such as noise reduction, tuning of lighting, natural light, easy access to garden, dining environment, and resident-centered interior renovation. Nursing home size was not found to have a direct relationship to resident health and well-being, although it is related to more than only the physical environment (eg, social environment).

CONCLUSIONS AND IMPLICATIONS

This review provides guidance in selective areas of the physical environment for the design of nursing homes, with potential benefits for the health and well-being of residents.

The role of physical environmental characteristics and intellectual disability in conduct problem trajectories across childhood: A population-based Cohort study

BACKGROUND

The paucity of research investigating the role of the physical environment in the developmental progression of conduct problems and the potential moderating effects of intellectual disability (ID) is surprising, given the clinical relevance of elucidating environmental determinants of disruptive behaviours.

AIMS

To use data from a large UK cohort study to assess associations between physical environmental exposures, ID, and conduct problem trajectories.

METHOD

The sample included 8168 Millennium Cohort Study children (1.9% with ID). Multilevel growth curve modelling was used to examine the role of physical environment characteristics in the developmental trajectories of conduct problems after adjustments for ID status.

RESULTS

Exposure to external environmental domains was not associated with differences in children's conduct problems across development. Alternatively, internal aspects of the household environment: spatial density (b = 0.40, p < .001) and damp problems (b = 0.14, p < .001) were both significantly associated with increased trajectories. Various individual and familial covariates were positively associated with conduct problems over time, including: presence of ID (b = 0.96, p < .001), autism spectrum disorder (b = 1.18, p < .001), male sex (b = 0.26, p < .001), poverty (b = 0.19, p < .001), maternal depression (b = 0.65, p < .001), and non-nuclear family structure (b = 0.35, p < .001). Positive ID status appeared to moderate the effects of internal household spatial density, reporting a non-linear negative association with spatial density and conduct problems across development (b = -1.08, p < .01).

CONCLUSIONS

Our findings highlight the potential harmful consequences of poor internal residential conditions on children's development of disruptive behaviours.

The association between Geographic Information System-based neighborhood built environmental factors and accelerometer-derived light-intensity physical activity across the lifespan: a cross-sectional study

Background

Evidence on associations between environmental factors and accelerometer-derived light-intensity physical activity (LPA) is scarce. The aim of this study was to examine associations between Geographic Information System (GIS)-based neighborhood built environmental factors and accelerometer-derived LPA, and to investigate the moderating effect of age group (adolescents, adults, older adults) on these associations.

Methods

Objective data were used from three similar observational studies conducted in Ghent (Belgium) between 2007 and 2015. Accelerometer data were collected from 1,652 participants during seven consecutive days, and GIS-based neighborhood built environmental factors (residential density, intersection density, park density, public transport density, entropy index) were calculated using sausage buffers of 500 m and 1,000 m around the home addresses of all participants. Linear mixed models were performed to estimate the associations.

Results

A small but significant negative association was observed between residential density (500 m buffer) and LPA in the total sample (B = -0.002; SE = 0.0001; p = 0.04), demonstrating that every increase of 1,000 dwellings per surface buffer was associated with a two minute decrease in LPA. Intersection density, park density, public transport density and entropy index were not related to LPA, and moderating effects of age group were absent.

Conclusions

The small association, in combination with other non-significant associations suggests that the neighborhood built environment, as classically measured in moderate-to-vigorous intensity physical activity research, is of limited importance for LPA. More research is needed to unravel how accelerometer-derived LPA is accumulated, and to gain insight into its determinants.

Preceptors' and nursing students' experiences of using peer learning in primary healthcare settings: a qualitative study

BACKGROUND

Due to the need for students to integrate theory with practice, current research seeks the best learning and teaching models in primary healthcare settings. The aim of this study was to explore preceptors' and nursing students' experiences of using peer learning during clinical practice in primary health care.

METHODS

A qualitative research approach was used based on semi-structured interviews with seven preceptors and ten nursing students. The interviews were transcribed and analyzed by using content analysis based on an inductive reasoning.

RESULTS

Preceptors and students perceived peer learning as an educational model to be beneficial for learning in primary care settings. They found the model to be stimulating, challenging, and leading to development of professional identity and nursing skills. All informants were positive towards the peer learning experience, with students reporting they were seen as individuals, despite working in pairs. However, the physical environment was demanding with regards to telephone counseling issues, limited opportunities for using computers, and the use of small examination rooms.

CONCLUSION

This study shows that, despite the complex learning environment, peer learning as an educational model appears to work well in a primary healthcare setting. However, much improvement is needed to facilitate the students' learning process. Consequently, conditions for clinical practice and learning beneficial to both students and preceptors should be prioritized by management.

Delineating the geographic context of physical activities: A systematic search and scoping review of the methodological approaches used in social ecological research over two decades

BACKGROUND

The social ecological approach suggests that the spatial context among other factors influence physical activity behavior. Ample research documents physical environmental effects on physical activity. Yet, to date inconsistent associations remain, which might be explained by conceptual and methodological challenges in measuring the spatial dimensions of health behavior. We review methods applied to measure the spatial contexts in the social ecological physical activity literature.

METHODS

Online databases and selected reviews were used to identify papers published between 1990 and 2020. A total of 2167 records were retrieved, from which 412 studies that used physical activity as a primary outcome variable, included measures of the physical environment and applied the main principles of the social ecological approach, were included.

RESULTS

Subjective approaches were the dominant method to capture the spatial context of physical activities. These approaches were applied in 67% (n=279) of the studies. From the objective approaches an administrative unit was most prevalent and was applied in 29% (n=118) of the studies. The most comprehensive objective spatial methods that capture the true environmental exposure, were used only in 2% (n=10) of the studies.

CONCLUSIONS

Current social ecological physical activity research applies simple conceptualizations and methods of the spatial context. While conceptual and methodological concerns have been repeatedly expressed, no substantive progress has been made in the use of spatial approaches. To further our understanding on place effects on health, future studies should carefully consider the choice of spatial approaches, and their effect on study results.

Characteristics of nursing home units with high versus low levels of person-centred care in relation to leadership, staff- resident- and facility factors: findings from SWENIS, a cross-sectional study in Sweden

BACKGROUND

The context of care consists of factors that determines the extent to which staff can offer person-centred care. However, few studies have investigated factors that can explain variation in levels of person-centred care among nursing home units. The aim of this study was to explore factors characterizing nursing home units with high and low degree of person-centred care, with focus on leadership, staff, resident and facility factors.

METHODS

Cross-sectional data from residents, staff, and managers in 172 randomly selected nursing homes in Sweden were collected in 2014. Activities of Daily Living Index, Gottfries' cognitive scale, Person-centred Care Assessment Tool together with demographic information and estimations of leadership engagement was used. Independent samples t-test and Chi2 test were conducted.

RESULTS

Highly person-centred units were characterised by leaders engaging in staff knowledge, professional development, team support and care quality. In highly person-centred units' staff also received supervision of a nurse to a larger extent. Highly person-centred units were also characterised as dementia specific units, units with fewer beds and with a larger proportion of enrolled nurses. No differences in degree of person-centred care were seen between public or private providers.

CONCLUSIONS

This study provides guidance for practitioners when designing, developing and adapting person-centred units in aged care contexts. Managers and leaders have an important role to promote the movement towards a person-centred practice of care, by supporting their staff in daily care, and engaging in staff knowledge and professional development. Targeting and adjusting environmental factors, such as provide small and dementia adapted environments to match the residents' personal preferences and capacity are also important when striving towards person-centredness.

A GIS based approach to neighbourhood physical environment and walking among adults in Colombo municipal council area, Sri Lanka

BACKGROUND

Physical Activity (PA) promotes health and wellbeing and walking is one of the easiest and commonest way to incorporate activity into everyday life. This study examined the association between the objectively measured neighbourhood physical environment and walking among the adults in Colombo Municipal Council (CMC) area in Sri Lanka.

METHODS

A cross sectional study was carried out and primary data collection carried out to assess walking, socio-demographic characteristics and geo location of residence. Secondary data was obtained to assess neighbourhood environment from existing spatially referenced data from the survey department of Sri Lanka. Geographic Information Systems (GIS) was used to calculate density measures (residential density, land use, connectivity and access) and distance measures, which were then correlated with walking.

RESULTS

A sample consisted of 284 adults aged 29-59 years with a mean age of 40.6 (SD,10.9) years. The total mean minutes walked a week was 175.8 min with a standard deviation of 214.0. The mean and the standard deviations of walking per week for transportation and leisure were 158.4 (SD,196.6) and 17.5 (SD,70.1) respectively. Residential density measures, building foot print area, length of major roads, number of intersections, number of bus stops, and distance to nearest major roads showed significant moderate degree of correlations with total minutes of walked per week, (p < 0.001). These results were similar with walking for transportation.

CONCLUSION

There is indication that neighbourhood features are associated with walking among the adults in the CMC area using secondary data on physical environment. This paves way for further exploration to understand the relationship between neighbourhood physical environment and walking which could be used for effective interventions to promote walking.

Relationship Between the Physical Environment and Physical Activity Levels in Preschool Children: A Systematic Review

PURPOSE OF REVIEW

The aim of this study was to understand the influence of the physical environment on the physical activity (PA) behavior of preschool children (aged 2 to 6 years), in order to provide an overview of these influences from the perspective of the ecological model.

RECENT FINDINGS

PA is of great importance for the prevention of obesity and cardiovascular diseases since childhood. The physical environment has a direct relationship with the different domains, where people can spend their time being physically active. Nonetheless, despite the importance of the physical environment to engagement in PA, very few reviews have focused on this relationship in the context of the growing problem of physical inactivity among preschool children. Studies that had analyzed the school domain had found that greater availability of a wider variety of portable play equipment, presence of certain fixed playground equipment, and presence of open spaces had favored PA levels. Furthermore, different studies had shown that the natural environment and the presence of hills were important for children's PA. Thus, despite the associations with PA we were able to identify in this review, new studies will still be needed to link the physical environment with PA levels, especially regarding transportation and leisure time. In conclusion, promoting studies on this subject from an early age will allow us to obtain information that could allow the adaptation, design, and construction of healthier homes, neighborhoods, and schools that promote children's health.

Technology integration in complex healthcare environments: A systematic literature review

To support safety and efficient care, effective integration of technology into the timepressured, high-risk healthcare environments is critical. This systematic literature review aimed to highlight the impact of technology on the physical environment as well as the facilitators for and barriers to technology integration into complex healthcare settings, including operating rooms and trauma rooms. PsycINFO, Web of Science, and PubMed databases were utilized, along with a hand search. PRISMA and MMAT guidelines were used for reporting and quality appraisal. Out of 1,001 articles, 20 were eligible. Identified categories included hybrid and integrated environments, technological ambiance, and information technologies. Technology integration has implications for direct patient care, efficiency, throughput, patient safety, teamwork, communication, and the perception of care. The facilitators for and barriers to technology integration included layout design, equipment positioning, and decluttering. The physical environment can improve the impact of technology on factors such as patient safety and efficiency.

Do parenting practices moderate the association between the physical neighbourhood environment and changes in children's time spent at various physical activity levels? An exploratory longitudinal study

BACKGROUND

As many children do not meet the recommended daily physical activity (PA) levels, more research is needed towards environmental determinants of children's PA levels. The aims of this longitudinal study were to investigate whether the physical environment and parenting practices have an impact on changes in children's weekday time spent at various PA levels and whether associations between physical neighbourhood environment and changes in children's PA are moderated by parenting practices.

METHODS

We performed a secondary data analysis of longitudinal data collected at three timepoints (baseline, 6, and 18 months) from 10 control schools of the Active Living study, a quasi-experimental study, which took place in South Limburg, the Netherlands. In total, 240 children aged 8-12 years were included in the analyses. PA levels were measured using accelerometry (ActiGraph GT3X+). The physical environment was assessed at baseline through neighbourhood audits of the school environment, and PA parenting practices were measured at baseline via validated parental questionnaires. Multivariate multilevel regression analyses were conducted to determine the main effects of the physical environment and parenting practices on changes in children's time spent in sedentary behaviour (SB), light PA and moderate-to-vigorous PA (MVPA) over 18 months. Additionally, moderation of the association between the physical environment and children's PA levels by parenting practices was examined by adding interacting terms to the regression equations.

RESULTS

Walkability of the physical environmental was associated with a decrease in SB at 18 months (B = -5.45, p < .05). In addition, the parenting practice logistic support was associated with an increase in MVPA (at all time points, B = .68, B = .73 and B = 1.02, respectively, all p < .05) and a decrease in SB (at 18 months, B = -1.71, p < .05). Stratified analyses (based on significant interaction terms) showed that the effect of specific physical environmental features (e.g., sports facilities) on children's improvements in PA levels were strengthened by favourable parenting practices.

DISCUSSION

Besides the main effects of walkability and logistic support, there were indications that several parenting practices moderate the association between the physical environment and changes in children's time in various PA levels. The current findings are exploratory, and need to be confirmed in further research.

Risk factors associated with mortality of COVID-19 in 3125 counties of the United States

BACKGROUND

The number of cumulative confirmed cases of COVID-19 in the United States has risen sharply since March 2020. A county health ranking and roadmaps program has been established to identify factors associated with disparity in mobility and mortality of COVID-19 in all counties in the United States. The risk factors associated with county-level mortality of COVID-19 with various levels of prevalence are not well understood.

METHODS

Using the data obtained from the County Health Rankings and Roadmaps program, this study applied a negative binomial design to the county-level mortality counts of COVID-19 as of August 27, 2020 in the United States. In this design, the infected counties were categorized into three levels of infections using clustering analysis based on time-varying cumulative confirmed cases from March 1 to August 27, 2020. COVID-19 patients were not analyzed individually but were aggregated at the county-level, where the county-level deaths of COVID-19 confirmed by the local health agencies. Clustering analysis and Kruskal-Wallis tests were used in our statistical analysis.

RESULTS

A total of 3125 infected counties were assigned into three classes corresponding to low, median, and high prevalence levels of infection. Several risk factors were significantly associated with the mortality counts of COVID-19, where higher level of air pollution (0.153, P < 0.001) increased the mortality in the low prevalence counties and elder individuals were more vulnerable in both the median (0.049, P < 0.001) and high (0.114, P < 0.001) prevalence counties. The segregation between non-Whites and Whites (low: 0.015, P < 0.001; median:0.025, P < 0.001; high: 0.019, P = 0.005) and higher Hispanic population (low and median: 0.020, P < 0.001; high: 0.014, P = 0.009) had higher likelihood of risk of the deaths in all infected counties.

CONCLUSIONS

The mortality of COVID-19 depended on sex, race/ethnicity, and outdoor environment. The increasing awareness of the impact of these significant factors may help decision makers, the public health officials, and the general public better control the risk of pandemic, particularly in the reduction in the mortality of COVID-19.

Risk factors associated with mortality of COVID-19 in 3125 counties of the United States

BACKGROUND

The number of cumulative confirmed cases of COVID-19 in the United States has risen sharply since March 2020. A county health ranking and roadmaps program has been established to identify factors associated with disparity in mobility and mortality of COVID-19 in all counties in the United States. The risk factors associated with county-level mortality of COVID-19 with various levels of prevalence are not well understood.

METHODS

Using the data obtained from the County Health Rankings and Roadmaps program, this study applied a negative binomial design to the county-level mortality counts of COVID-19 as of August 27, 2020 in the United States. In this design, the infected counties were categorized into three levels of infections using clustering analysis based on time-varying cumulative confirmed cases from March 1 to August 27, 2020. COVID-19 patients were not analyzed individually but were aggregated at the county-level, where the county-level deaths of COVID-19 confirmed by the local health agencies. Clustering analysis and Kruskal-Wallis tests were used in our statistical analysis.

RESULTS

A total of 3125 infected counties were assigned into three classes corresponding to low, median, and high prevalence levels of infection. Several risk factors were significantly associated with the mortality counts of COVID-19, where higher level of air pollution (0.153, P < 0.001) increased the mortality in the low prevalence counties and elder individuals were more vulnerable in both the median (0.049, P < 0.001) and high (0.114, P < 0.001) prevalence counties. The segregation between non-Whites and Whites (low: 0.015, P < 0.001; median:0.025, P < 0.001; high: 0.019, P = 0.005) and higher Hispanic population (low and median: 0.020, P < 0.001; high: 0.014, P = 0.009) had higher likelihood of risk of the deaths in all infected counties.

CONCLUSIONS

The mortality of COVID-19 depended on sex, race/ethnicity, and outdoor environment. The increasing awareness of the impact of these significant factors may help decision makers, the public health officials, and the general public better control the risk of pandemic, particularly in the reduction in the mortality of COVID-19.

Heat and fraud: evaluating how room temperature influences fraud likelihood

Despite the considerable amount of research devoted to understanding fraud, few studies have examined how the physical environment can influence the likelihood of committing fraud. One recent study found a link between room brightness and occurrence of human fraud behaviors. Therefore, the present study aims to investigate how temperature may affect fraud. Based on a power analysis using the effect size observed in a pilot study, we recruited 105 participants and randomly divided them into three temperature groups (warm, medium, and cool). We then counted fraud behaviors in each group and tested for potential significant differences with a Kruskal–Wallis test. Additionally, we used a correlation analysis to determine whether the perceived temperature affected fraud. As a result, regardless of participants’ subjective sensory experience or their physical environment, we did not find that temperature-related factors influence the incidence of fraud. We discussed the potential reason for the results and suggested directions for future research.

MR Imaging Safety: Siting and Zoning Considerations

Although comparatively much younger as a discipline, these early decades of the structure of practice of MR imaging safety have developed in an alarmingly ad hoc manner, particularly when contrasted with contemporary ionizing radiation safety. This absence of structure and metrics for MR imaging safety has impaired the direct safety best practices for the recognizable domains of clinical and operational MR safety. If the built environment of MR imaging is effectively the hardware of the mechanism of health care delivery, then the appropriateness of this hardware to the software (clinical and operational practices) is of great importance.

Different neighborhood walkability indexes for active commuting to school are necessary for urban and rural children and adolescents

BACKGROUND

Literature focusing on youth has reported limited evidence and non-conclusive associations between neighborhood walkability measures and active commuting to and from school (ACS). Moreover, there is a lack of studies evaluating both macro- and micro-scale environmental factors of the neighborhood when ACS is analyzed. Likewise, most studies on built environment attributes and ACS focus on urban areas, whereas there is a lack of studies analyzing rural residential locations. Moreover, the relationship between built environment attributes and ACS may differ in children and adolescents. Hence, this study aimed to develop walkability indexes in relation to ACS for urban and rural children and adolescents, including both macro- and micro-scale school-neighborhood factors.

METHODS

A cross-sectional study of 4593 participants from Spain with a mean age of 12.2 (SD 3.6) years was carried out. Macro-scale environmental factors were evaluated using geographic information system data, and micro-scale factors were measured using observational procedures. Socio-demographic characteristics and ACS were assessed with a questionnaire. Several linear regression models were conducted, including all the possible combinations of six or less built environment factors in order to find the best walkability index.

RESULTS

Analyses showed that intersection density, number of four-way intersections, and residential density were positively related to ACS in urban participants, but negatively in rural participants. In rural children, positive streetscape characteristics, number of regulated crossings, traffic calming features, traffic lanes, and parking street buffers were also negatively related to ACS. In urban participants, other different factors were positively related to ACS: number of regulated crossings, positive streetscape characteristics, or crossing quality. Land use mix acted as a positive predictor only in urban adolescents. Distance to the school was a negative predictor on all the walkability indexes. However, aesthetic and social characteristics were not included in any of the indexes.

CONCLUSIONS

Interventions focusing on improving built environments to increase ACS behavior need to have a better understanding of the walkability components that are specifically relevant to urban or rural samples.

What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature

BACKGROUND

Research aiming to improve the hospital experience for patients with dementia and their informal carers is strongly recommended. The present review aimed to describe the research on interventions to meet the needs of people with dementia in acute hospital settings regarding physical environment, organization of care, and staff knowledge of dementia and competence in person-centred care. An integrative review design was applied. We searched for studies in PubMed, Ovid Medline, Cinahl, Embase, Swemed+, and Cochrane databases using the Mixed Methods Appraisal Tool (MMAT) for quality evaluation. Twenty-seven articles were included, describing the perspectives of people with dementia, informal carers, and professional carers. The MMAT score ranged from two to four. Twelve studies described needs and experiences, mostly using a qualitative design. Common themes and results were synthesized. The studies identified a need to enhance staff competence regarding dementia and person-centred care. Fifteen studies described interventions: two were qualitative; three used mixed method, and 10 were quantitative, of which two were randomized controlled trials and eight were observational studies. Five types of interventions were identified. Three types could positively impact staff knowledge about dementia and person-centred care. One type was experienced as positive regarding organisation of care for patients with dementia. None of the intervention studies found evidence for effects on the identified needs regarding physical environment.

CONCLUSION

The included studies suggest that staff need more knowledge regarding dementia and person-centred dementia care and that training interventions implemented to enhance staff competence had promising results. However, there is a need for research on the needs of patients with dementia in acute hospital settings regarding physical environment and effect of design elements. There is also a scarcity of intervention studies focusing on the effect of models of care that support the psychosocial needs of patients with dementia.

Innovative solutions to enhance safe and green environments for ageing well using co-design through patient and public involvement

BACKGROUND

There is a need to develop innovative solutions to enhance safe and green physical environments, which optimise health, wellbeing and community participation among older adults. To develop solutions that meet the needs of a diverse ageing population, an interdisciplinary approach is needed. Our aim was to identify the needs of older people in relation to ageing well in the environment by bringing together knowledge from different perspectives using Patient and Public Involvement.

METHODS

An international consortium (Retrofit living For ageing well through Understanding and Redesign of Built environments consortium: ReFURB) was established in April 2018, including ten core members, to (i) explore cutting-edge solutions to safe living for ageing populations and (ii) develop innovative approaches to everyday physical environments, which bring about health benefits. We used a co-design, interdisciplinary framework involving older adults, carers, physiotherapists, geriatricians, engineers, human movement experts, geographers and psychologists from the UK and Australia. This engaged people in a 1 day workshop that comprised a series of presentations from international speakers on urban design, social connectedness, hazards and injury prevention, and the physical environment. Small group discussions (facilitated by consortium members) followed presentations to consider the opportunities, challenges and barriers encountered with ageing, which included the use of creative engagement activities (LEGO® Serious Play, mind maps, poster gallery walk), to help participants share personal stories and reflect on the issues raised. Thematic coding was used to synthesise the outputs of the small group work.

RESULTS

Five themes were identified across the workshops: access and transport; involvement of the whole community; restoration rather than redesign; assistive and digital technology; and intergenerational approaches. These dimensions related to the physical, social and nature-based qualities of everyday environments, as they pertain to ageing well.

CONCLUSIONS

Co-design was a valuable tool that helped understand the perceptions of participants and essential to develop effective interventions and solutions. Participants highlighted several issues affecting people as they age and key environmental considerations to promote wellbeing, activity, and participation. The consortium identified gaps in the existing evidence base and are now planning activities to further develop research ideas in collaboration with our co-design participants.

The effect of blue dishware versus white dishware on food intake and eating challenges among residents living with dementia: a crossover trial

Objective

Residents living with dementia (RLWD) often experience changes in their visual perception, which could reduce food intake. Inadequate food intake is known to cause malnutrition, which increases the risk of hospitalization, morbidity, and mortality. This study evaluated the effectiveness of using blue dishware compared to white dishware to improve food intake and mitigate eating challenges among 18 RLWD (mean age 84.6 ± 7.9 years, 72.2% female).

Results

A within-within person crossover design determined differences in food intake and eating challenges between blue and white dishware conditions. Five participants responded to the blue dishware and increased their average food intake by ≥ 10%. Responders were not different from non-responders in terms of demographic or health characteristics. The proportion of eating challenges experienced was not significantly different between the blue and white dishware conditions. Percent food intake was significantly greater at lunch (83.5 ± 19.0%) compared to dinner (75.8 ± 22.1%; p < 0.0001), regardless of dishware condition. However, there were no significant differences for food intake between the dishware conditions, even after matching food choices. Promoting food intake and reducing eating challenges in RLWD likely needs multi-component interventions targeting meal quality, meal access, and mealtime experience.

Trial registration ClincialTrials.gov Identifier: NCT04298788. Retrospectively registered: 6 March 2020, https://clinicaltrials.gov/ct2/show/NCT04298788?term=NCT04298788&draw=2&rank=1.

A quantitative assessment of school environment as viewed by teachers

Background

There is evidence suggesting that the school environment does have prominent contributions to the rise of childhood obesity.

Aim

The objective of this study was to assess the school environment by interviewing the teachers and compare the school environment score between rural and urban schools in Terengganu, Malaysia.

Methods

Thirty-two teachers from 16 primary schools in Terengganu were interviewed using a set of validated Malay version “School Environmental Mapping” questionnaire. A total of 76 items consisting of four domains of school environment factor: physical (what is available) with 41 items; economic (what the costs are) with nine items; political (what the rules are) with nine items; and socio-cultural (what the attitudes and beliefs are) with 17 items. Every item was questioned using an initial closed question followed by an open question when the criteria were not met or need further information regarding those particular items.

Results

The present study revealed that the school environment of school in state of Terengganu is still low and not satisfied. Based on the schoolteacher's information and observation, there are significant barriers to promoting healthy eating and physical activity at school e.g. limited financial and budget allocation; lack of school facilities; lack of manpower to organise and monitor the programme; lack of participation and cooperation from parents; and no enforcement and serious action from authorized personnel on street hawkers near the school. This is reflected by the score achieved for 16 schools in Terengganu was only 63.05%. The political environment indicated the highest score among the domains, which was 77.78%, whereas, the lowest score was an economic environment (50.00%). Upon comparing between the urban and rural areas, the present study reported that there was a significant difference between school settings (p < 0.001) for an overall school environment, in which the rural areas had a significantly higher score than urban counterparts (64.86% vs 59.34%, p < 0.001). For each domain of the school environment, the findings showed that only two domains (physical and political environment) were significantly different between school settings.

Conclusion

This study revealed that the level of a healthy school environment among schools in both settings is still not satisfied. Addressing the obesogenic elements of school environments is one of the strategies in prevention since the school environments exert a great influence on children's behaviour.

Triangulating School Climate: Areas of Convergence and Divergence Across Multiple Levels and Perspectives

Students often have differing perceptions of their school's climate. Although these subjective perceptions can be meaningful outcome predictors, discrepancies create challenges for those seeking to globally characterize or intervene to improve the climate of a school. Trained, independent  observers can provide insights on perceptible and ostensibly malleable aspects of the school; however, the extent to which these observations help us to understand differences in students' report of school climate has not been examined. To study this, we assessed convergence and divergence between independent observers' assessments and students' perceptions of school climate at the classroom and school levels. Data come from the Maryland Safe and Supportive Schools Initiative (MDS3), which included 20,647 students and observations of 303 teachers in 50 high schools. Students responded to survey items regarding safety, engagement, and environment; independent observers assessed teachers' classroom practices and the school physical environment. A three-level model partitioned variance to the individual, classroom, and school levels. The variance in students' climate perceptions was primarily between students, with most classroom and school intraclass correlation coefficients (ICCs) ranging from 0.01 to 0.08, though one was as high as 0.20; however, observations explained large percentages of between-school variation in climate (58%-91%). Findings suggest the potential utility of outside observations for explaining school-level variation in school climate to inform decision-making and future research.

How Can Autonomy Be Maintained and Informal Care Improved for People With Dementia Living in Residential Care Facilities: A Systematic Literature Review

Background and Objectives

For people with dementia living in residential care facilities, maintaining autonomy and receiving informal care are important. The objective of this review is to understand how caregiving approaches and physical environment, including technologies contribute to the maintenance of autonomy and informal care provision for this population.

Research Design and Methods

A literature review of peer-reviewed articles published between January 1995 and July 2017 was performed. Realist logic of analysis was used, involving context, mechanism and outcome configurations.

Results

Forty-nine articles were included. The improvement of the relationship between residents and formal/informal caregivers is important. This increases the knowledge (sharing) about the resident and contributes to their autonomy. A social, flexible, and welcoming attitude of the formal caregiver improves the provision of informal care. Specially designed spaces, for instance, therapeutic gardens, create activities for residents that remind them of themselves and contribute to their autonomy. Use of technologies reduces caregiver’s time for primary tasks and therefore enables secondary tasks such as interaction with the residents.

Discussion and Implications

The results revealed how residential care facilities could maintain autonomy of their residents and improve informal care delivery using caregiving approaches and the physical environment including technologies. The results are supporting toward each other in maintaining autonomy and also helped in enhancing informal care provision. For residential care facilities that want to maintain the autonomy of their residents and improve informal care delivery, it is important to pay attention to all aspects of living in a residential care facility.

Multilevel analysis of the impact of neighborhood environment on postpartum depressive symptoms

BACKGROUND

About one in ten mothers experience postpartum depression (PPD) in Japan. Although the individual and social risk factors of depression have been reported, few studies have focused on the neighborhood environmental features. In this study, we examined the association between neighborhood environmental features and PPD symptoms among Japanese women.

METHODS

Questionnaire survey including women who participated in 3- or 4-month health checkup in Nagoya City, Japan in 2012 was used. PPD symptoms were evaluated using Edinburgh Postnatal Depression Scale (EPDS). As the neighborhood places where postpartum mothers often visit, we measured availability of grocery stores, community centers and asobiba (playground for children) within residential neighborhood unit using geographic information system. A multilevel analysis was conducted on 2,298 individuals nested within 388 school districts using Stata 15.1 software.

RESULTS

Mothers who live in the neighborhood with more number of asobiba had lower EPDS score, even after adjustment for individual factors (B: -0.12, 95%CI: -0.24, -0.01), and additional adjustment for other neighborhood environmental factors (B: -0.14, 95%CI: -0.27, -0.02).

LIMITATION

Our cross-sectional design limits to draw causal inferences. As for the evaluation of PPD symptoms, no diagnosis has been made. Moreover, we do not have the information on the accessibility to transportation, and the exact residential location of the survey respondents.

CONCLUSION

Our findings suggest that the availability of asobiba in the community has a protective effect on PPD symptoms. Providing more asobiba in the neighborhood for new mothers may be a viable preventive strategy for PPD symptoms.

Distinct aspects of the early environment contribute to associative memory, cued attention, and memory-guided attention: Implications for academic achievement

Childhood socioeconomic status (SES) is associated with numerous aspects of cognitive development and disparities in academic achievement. The specific environmental factors that contribute to these disparities remain poorly understood. We used observational methods to characterize three aspects of the early environment that may contribute to SES-related differences in cognitive development: violence exposure, cognitive stimulation, and quality of the physical environment. We evaluated the associations of these environmental characteristics with associative memory, cued attention, and memory-guided attention in a sample of 101 children aged 60-75 months. We further investigated whether these specific cognitive abilities mediated the association between SES and academic achievement 18 months later. Violence exposure was specifically associated with poor associative memory, but not cued attention or memory-guided attention. Cognitive stimulation and higher quality physical environment were positively associated with cued attention accuracy, but not after adjusting for all other environmental variables. The quality of the physical environment was associated with memory-guided attention accuracy. Of the cognitive abilities examined, only memory-guided attention contributed to SES-related differences in academic achievement. These findings suggest specificity in how particular aspects of early environmental experience scaffold different types of attention and memory subserved by distinct neural circuits and shed light on a novel cognitive-developmental mechanism underlying SES-related disparities in academic achievement.

Grazing alters the phenology of alpine steppe by changing the surface physical environment on the northeast Qinghai-Tibet Plateau, China

The response of vegetation phenology to environmental changes is very complex. We used time-lapse digital cameras to monitor the phenology of an alpine steppe in four winter pastures with different grazing intensities during 2015-2017. The results showed that the beginning of the growing season (BGS) and the growing season length (GSL) of the alpine steppe separately presented advances or prolonged trends with the increase in grazing intensity. There was no regularity in the end of the growing season (EGS) under the change in grazing intensity gradient, but the EGS of the no grazing (NG) plot occurred 24 days ahead of the other plots disturbed by grazing. Different winter grazing intensities obviously had different influences on the surface litter, soil temperature (ST), and soil moisture (SM) during spring but not during autumn. The ST under different grazing intensities played a decisive role in controlling the BGS of alpine steppe, followed by surface litter and SM. The EGS showed a significant correlation with the surface litter in autumn but did not show correlations with ST and SM. These results could further help us understand the phenological mechanisms of the soil surface and guide the scientific management of grazing to adapt to climate change.

Is the Physical Environment Associated with Spiritual and Religious Coping in Older Age? Evidence from Brazil

In this cross-sectional Brazilian survey, we examined associations between aspects of physical environment (PE) and spiritual/religious coping (SRC) behaviors. Our studied sample was 77 nursing homes (NH) and 326 community-dwelling residents (CDRs). Aspects of the PE were measured using the environmental domain of the WHOQOL-BREF. SRC was assessed using the BRIEF SRC scale. The PE was significantly associated with positive SRC alone and differed between the two studied samples. "Feeling safe in daily life" and "having access to health services" were positively associated with positive SRC behaviors in NH residents. "Having access to information" and "adequate transport" were significant among CDRs. Positive SRC behaviors are influenced by PE and should be considered in geriatric and gerontology care.

Associations between the physical environment and park-based physical activity: A systematic review

BACKGROUND

With an increase in the evidence for the associations between park-based physical activity (PA) and physical environments (especially park and neighborhood environments), researchers face an important challenge in interpreting and summarizing the evidence to develop environmental change interventions. An updated review is needed to better inform policymaking and environmental interventions. The current study aimed to systematically review the research on the associations of park-based PA with park and neighborhood environmental characteristics.

METHODS

We targeted English peer-reviewed articles from 5 electronic databases using keywords related to park-based PA, park environments, and neighborhood environments. Of the 4071 identified papers, 25 studies published between 2008 and 2016 met all the eligibility criteria and were included in this review.

RESULTS

The characteristics of physical environment that received consistent support included paths/trails, lighting, and incivilities (e.g., broken glasses and litter). Mixed findings were revealed for 6 park environmental factors (unspecified active facilities, playgrounds and skating areas, fitness stations, picnic areas, greenness, and park size) and 2 neighborhood environmental factors (park density and park proximity).

CONCLUSION

It can be concluded that paths/trails, lighting, and incivilities are 3 key physical environmental attributes of park-based PA. Given the inconsistent findings on park and neighborhood environmental factors, more robust designs such as prospective investigation are required.

Attractive running environments for all? A cross-sectional study on physical environmental characteristics and runners' motives and attitudes, in relation to the experience of the running environment

Background

Running has become one of the most popular sports and has proven benefits for public health. Policy makers are increasingly aware that attractively designed public spaces may promote running. However, little is known about what makes a running environment attractive and restorative for runners and to what extent this depends on characteristics of the runner. This study aims to investigate 1) to what extent intrapersonal characteristics (i.e. motives and attitudes) and perceived environmental characteristics (e.g. quality of the running surface, greenness of the route, feelings of safety and hinderance by other road users) are associated with the perceived attractiveness and restorative capacity of the running environment and 2) to what extent the number of years of running experience modify these associations.

Methods

Cross-sectional data were collected through the online Eindhoven Running Survey 2015 (ERS15) among half marathon runners (N = 2477; response rate 26.6%). Linear regression analyses were performed for two outcomes separately (i.e. perceived attractiveness and perceived restorative capacity of the running environment) to investigate their relations with motives and attitudes, perceived environmental characteristics and interactions between perceived environmental characteristics and number of years of running experience.

Results

Perceived environmental characteristics, including green and lively routes and a comfortable running surface were more important for runners’ evaluation of the attractiveness and restorative capacity of the running environment than runners’ motives and attitudes. In contrast to experienced runners, perceived hinder from unleashed dogs and pedestrians positively impacted the attractiveness and restorative capacity for less experienced runners.

Conclusions

Perceived environmental characteristics were important determinants of the attractiveness and restorative capacity of the running environment for both novice and experienced runners. However, green and lively elements in the running environment and hinderances by cars were more important for less experienced runners. In order to keep novice runners involved in running it is recommended to design comfortable running tracks and routes and provide good access to attractive, green and lively spaces.

Impact of built environment on physical activity and obesity among children and adolescents in China: A narrative systematic review

BACKGROUND

Neighborhood built environment may profoundly influence children's physical activity (PA) and body weight. This study systematically reviewed scientific evidence regarding the impact of built environment on PA and obesity among children and adolescents in China.

METHODS

A keyword and reference search was conducted in Active Living Research, Cochrane Library, PubMed, and Web of Science. Studies that met all of the following criteria were included in the review: (1) study designs-experimental studies, observational studies, and qualitative studies; (2) study subjects-Chinese children and/or adolescents aged ≤17 years; (3) exposures-neighborhood built environment; (4) outcomes-PA and/or body weight status; (5) article type-peer-reviewed publications; (6) time window of search-from the inception of an electronicbibliographic database to May 31, 2018; (7) country-China; and (8) language-articles written in English.

RESULTS

A total of 20 studies, including 16 cross-sectional studies, 3 longitudinal studies, and 1 descriptive study, met the predetermined selection criteria and were included in the review. A total of 13 studies adopted subjective built environment measures reported by parents and/or children,2 adopted objective measures (e.g., geographical information system, field observations), and 5 adopted both objective and subjective measures. PA behaviors included PA, physical inactivity, sedentary behavior, active/passive commuting from/to school, and park visits. Among the 16 studies that provided some quantitative estimates of the influence of built environment on PA and body weight status, all reported a statistically significant relationship in the expected direction. Availability and accessibility in proximity to greenspaces, parks, recreational facilities, and sidewalks were found to be associated with increased PA levels, reduced sedentary behaviors, and/or active commuting among Chinese childrenand adolescents. In contrast, the absence of bike lanes and living in higher density residential areas were associated with increased likelihood of childhood overweight and obesity.

CONCLUSION

Neighborhood built environment plays an important role in Chinese children's PA engagement and weight outcomes. Building new exercise facilities and enhancing the accessibility of existing facilities hold the potential to enhance PA engagement among Chinese children and adolescents. In addition, urban designs that incorporate sidewalks, bike lanes, walking paths, less motorized traffic, and lower residential density are likely to promote PA and prevent childhood obesity in China.

The Moderating Role of Social Neighbourhood Factors in the Association between Features of the Physical Neighbourhood Environment and Weight Status

BACKGROUND

This paper investigated the independent and joint associations between aspects of the physical neighbourhood environment and social neighbourhood factors with BMI and overweight status in European adults.

METHODS

Data from 5,199 participants in the SPOTLIGHT survey were analysed. Participants reported on their height, weight and perceptions of the neighbourhood. Objectively measured aspects of the physical neighbourhood environment included: presence of recreational facilities, features of the active transportation environment, neighbourhood aesthetics and presence of different types of food outlets. Social factors included the self-reported variables social network, social cohesion, social trust and perceived crime and the census variable neighbourhood socioeconomic status. Outcome measures were BMI and overweight status. Main associations between physical and social factors and BMI/overweight status were analysed using multilevel regression analyses adjusted for confounders. Moderation analysis was conducted by adding the interaction terms between physical and social neighbourhood factors one by one to the multivariable models. Significant interaction terms were then stratified.

RESULTS

Significant associations with BMI/overweight status were found for features of the active transportation environment and all social factors, except perceived crime. Several significant interaction terms were detected, but no significant associations between the physical neighbourhood environment and BMI/overweight status were found after stratification.

CONCLUSION

We did not find consistent interactions between physical and social neighbourhood factors to explain BMI and overweight status.

Associations between lifestyle, physical and social environments and frailty among Chinese older people: a multilevel analysis

BACKGROUND

Frailty represents a public health priority and an increasingly prevalent condition in the ageing population. It is seen as reflecting an interaction among individual factors and a range of environmental elements. This study aims to examine the association between frailty and individual factors, physical and social environments among Chinese older people.

METHODS

The data were from the Shanghai Healthy City Survey in 2017, which sampled 2559 older people aged ≥60 years from 67 neighbourhoods. The FRAIL scale was used to assess frailty, and social and physical environments were assessed using validated and psychometrically tested instruments. Individual factors included age, gender, education, employment, marital status, smoking, drinking, physical exercise, organization participation, self-rated health and psychological well-being. A multilevel analysis was conducted to examine whether physical and social environments were associated with frailty.

RESULTS

The prevalence of pre-frailty and frailty were 39.5 and 16.9%, respectively. The prevalence of frailty increased with age from 14.6% (60-64 years) to 26.5% (≥75 years). After adjusting for age and/or gender, older age, women, and those with low education, alcohol dependence, physical inactivity, poor self-rated health, or psychological disorders had a higher prevalence of frailty. The multilevel analysis indicated that after controlling for individual covariates, compared to the 1st quartile of aesthetic quality, the odds ratio (OR) of frailty for the 4th quartile was 0.65 (0.47-0.89); compared to the 1st quartile of walking environment, the OR of frailty for the 4th quartile was 0.43 (0.19-0.95); compared to the 1st quartile of social cohesion, the OR of frailty for the 4th quartile was 0.73 (0.54-0.99); compared to the 1st quartile of social participation, the ORs of frailty for the 2nd, 3rd and 4th quartiles were 0.76 (0.59-0.97), 0.59 (0.45-0.77) and 0.59 (0.45-0.77), respectively.

CONCLUSIONS

Frailty is a highly prevalent health condition among the aged population in China. Healthcare should focus on frail elderly who are older age, women, those with low education, and those with mental health problems. It may decrease frailty among Chinese older people to encourage social participation and healthy behaviours and to build aesthetic, walkable and cohesive neighbourhoods.

"Engaging in my rural community": perceptions of people aged 85 years and over

PURPOSE

 Globally, numbers of people aged 85 years and over are increasing. Many older people, including those 85 years and over, are ageing in rural areas. For successful ageing in place, physical and social environments must be appropriate. The aim of this study is to understand the influence the physical and social environments have on enabling those aged 85 years and over to remain engaged in a rural community. Method: Utilizing an environmental gerontological approach, semi-structured interviews were undertaken with 15 people who lived independently in a rural community. Following transcription data were analyzed and themes identified. Results: Two themes were identified; "Negotiating the physical environment: 'Getting there and back'" and "Maintaining social networks: 'Places to go, people to see'". The findings provide insight into the importance of driving, parking close to amenities and negotiating the local environment to this group of older people and their ability to engage with their community. All participants agreed social engagement with friends, family or neighbors was important to them. Conclusion: These findings highlight the interconnection between physical and social environments. An enabling physical environment is essential to support social participation of people aged 85 years and over.

Developmentally appropriate care for adolescents and young adults with cancer: how well is Australia doing?

PURPOSE

Developmentally appropriate care underpins quality cancer treatment. This study aimed to describe how well Australian cancer services deliver patient-focussed, developmentally appropriate care to adolescents and young adults (AYAs) with cancer.

METHODS

In a national, cross sectional study, 196 AYAs with cancer aged between 15 and 25 years at diagnosis reported their general experiences of the cancer care team (Cancer Needs Questionnaire), access to age-appropriate treatment environments (Cancer Needs Questionnaire) and frequency of psychosocial assessment (Adolescent Friendly Hospital Survey).

RESULTS

Very positive responses were reported around engagement and communication with staff who were reported as approachable, friendly and trustworthy; 11 of the 14 items were positively rated by over 90% of respondents. In contrast, over 70% of AYAs expressed unmet need around their physical and social environments, whether in relation to the opportunity to be nursed in wards designed for AYAs, spend time with other young people with cancer, or talk to young people their own age; less than a third reported their needs had been met on the majority of these items. The frequency that specific psychosocial assessment domains were discussed was highly variable; responses suggested that AYAs were less commonly questioned about overtly sensitive topics. AYAs who experienced private consultations with health care providers (41%) were significantly more likely to experience thorough psychosocial assessment.

CONCLUSION

Australian cancer services are generally communicating well with AYAs. There is room for improvement around more developmentally specific aspects of healthcare quality, such as psychosocial assessment, and around treatment environments that promote greater social interaction between AYAs.

Social and physical environmental correlates of independent mobility in children: a systematic review taking sex/gender differences into account

BACKGROUND

Children's independent mobility (CIM) is an important contributor to physical activity and health in children. However, in the last 20 years CIM has significantly decreased. To develop effective intervention programs to promote CIM, the impact of the environment on CIM must be identified. This review seeks to provide an overview of sex/gender-specific socio-ecological correlates of CIM.

METHODS

A systematic literature search of five databases (PubMed, PsycInfo, Scopus, Medline, Web of Science) was conducted with a priori defined eligibility criteria and identified 1838 potential articles published between January 1990 and November 2017. Two independent reviewers screened the literature and identified and rated methodological quality of the studies. Related factors of CIM were summarized separately for CIM license (parental permission to travel independently) and CIM destination (destinations to which a child travels independently), and separately for boys and girls using a semi-quantitative method.

RESULTS

Twenty-seven peer-reviewed journal articles were identified which examined the relationship between the social and physical environment and CIM. Only seven studies reported results divided by sex/gender. Most associations between the environment and CIM were found in the expected direction (positive or negative) or not associated at all. The social environment seemed to be more influential for ensuring CIM than the physical environment. Neighborhood safety, fear of crime and stranger, parental support, and perception of traffic were important social environmental factors influencing CIM, while car ownership, distance, and neighborhood design were relevant physical environmental attributes. Few studies examined sex/gender-related environmental correlates of independent mobility, and those findings were inconsistent.

CONCLUSION

The findings of this systematic review serve as suggestions for intervention programs to increase CIM and to identify future directions in research. To establish a robust comprehension of the impact of the social and physical environment on CIM, further sex/gender-sensitive studies using comparable measurements for CIM and environmental correlates are needed.

Subgroups of adolescents differing in physical and social environmental preferences towards cycling for transport: A latent class analysis

In order to be able to tailor environmental interventions to adolescents at risk for low levels of physical activity, the aim of the present study is to identify subgroups of adolescents with different physical and social environmental preferences towards cycling for transport and to determine differences in individual characteristics between these subgroups. In this experimental study, 882 adolescents (12-16 years) completed 15 choice tasks with manipulated photographs. Participants chose between two possible routes to cycle to a friend's house which differed in seven physical micro-environmental factors, cycling distance and co-participation in cycling (i.e. cycling alone or with a friend). Latent class analysis was performed. Data were collected from March till October 2016 across Flanders (Belgium). Three subgroups could be identified. Subgroup 1 attached most importance to separation of the cycle path and safety-related aspects. Subgroup 2 attached most importance to being able to cycle together with a friend and had the highest percentage of regular cyclists. In subgroup 3, the importance of cycling distance clearly stood out. This subgroup included the lowest percentage of regular cyclists. Results showed that in order to stimulate the least regular cyclists, and thus also the subgroup most at risk for low levels of active transport, cycling distances should be as short as possible. In general, results showed that providing well-separated cycle paths which enable adolescents to cycle side by side and introducing shortcuts for cyclists may encourage different subgroups of adolescents to cycle for transport without discouraging other subgroups.

Neighborhood deprivation and biomarkers of health in Britain: the mediating role of the physical environment

BACKGROUND

Neighborhood deprivation has been consistently linked to poor individual health outcomes; however, studies exploring the mechanisms involved in this association are scarce. The objective of this study was to investigate whether objective measures of the physical environment mediate the association between neighborhood socioeconomic deprivation and biomarkers of health in Britain.

METHODS

We linked individual-level biomarker data from Understanding Society: The UK Household Longitudinal Survey (2010-2012) to neighborhood-level data from different governmental sources. Our outcome variables were forced expiratory volume in 1 s (FEV1%; n=16,347), systolic blood pressure (SBP; n=16,846), body mass index (BMI; n=19,417), and levels of C-reactive protein (CRP; n=11,825). Our measure of neighborhood socioeconomic deprivation was the Carstairs index, and the neighborhood-level mediators were levels of air pollutants (sulphur dioxide [SO2], particulate matter [PM10], nitrogen dioxide [NO2], and carbon monoxide [CO]), green space, and proximity to waste and industrial facilities. We fitted a multilevel mediation model following a multilevel structural equation framework in MPlus v7.4, adjusting for age, gender, and income.

RESULTS

Residents of poor neighborhoods and those exposed to higher pollution and less green space had worse health outcomes. However, only SO2 exposure significantly and partially mediated the association between neighborhood socioeconomic deprivation and SBP, BMI, and CRP.

CONCLUSION

Reducing air pollution exposure and increasing access to green space may improve population health but may not decrease health inequalities in Britain.

Differences in physical environmental characteristics between adolescents' actual and shortest cycling routes: a study using a Google Street View-based audit

BACKGROUND

The objective evaluation of the physical environmental characteristics (e.g. speed limit, cycling infrastructure) along adolescents' actual cycling routes remains understudied, although it may provide important insights into why adolescents prefer one cycling route over another. The present study aims to gain insight into the physical environmental characteristics determining the route choice of adolescent cyclists by comparing differences in physical environmental characteristics between their actual cycling routes and the shortest possible cycling routes.

METHODS

Adolescents (n = 204; 46.5% boys; 14.4 ± 1.2 years) recruited at secondary schools in and around Ghent (city in Flanders, northern part of Belgium) were instructed to wear a Global Positioning System device in order to identify cycling trips. For all identified cycling trips, the shortest possible route that could have been taken was calculated. Actual cycling routes that were not the shortest possible cycling routes were divided into street segments. Segments were audited with a Google Street View-based tool to assess physical environmental characteristics along actual and shortest cycling routes.

RESULTS

Out of 160 actual cycling trips, 73.1% did not differ from the shortest possible cycling route. For actual cycling routes that were not the shortest cycling route, a speed limit of 30 km/h, roads having few buildings with windows on the street side and roads without cycle lane were more frequently present compared to the shortest possible cycling routes. A mixed land use, roads with commercial destinations, arterial roads, cycle lanes separated from traffic by white lines, small cycle lanes and cycle lanes covered by lighting were less frequently present along actual cycling routes compared to the shortest possible cycling routes.

CONCLUSIONS

Results showed that distance mainly determines the route along which adolescents cycle. In addition, adolescents cycled more along residential streets (even if no cycle lane was present) and less along busy, arterial roads. Local authorities should provide shortcuts free from motorised traffic to meet adolescents' preference to cycle along the shortest route and to avoid cycling along arterial roads.

The roles of health culture and physical environment in workplace health promotion: a two-year prospective intervention study in China

BACKGROUND

To understand the potential influencing factors on the effectiveness of workplace health promotion interventions and examine whether workplace health culture and physical environment can mediate the relationship between workplace health promotion and intervention effectiveness.

METHODS

A total of 719 participants from 10 Chinese government agencies were recruited for a prospective self-controlled trial. Questionnaires, qualitative interviews, and direct observation were used for the baseline evaluation, process evaluation, and effectiveness evaluation. Based on the results of the need assessment and risk assessment at each workplace, a two-year comprehensive health intervention was conducted by each workplace. Health outcomes including self-rated health (SRH) and mental health were measured at baseline and 24 months. Health culture was measured at 24 months. Physical environment and intervention implementation were measured at 12 months and 24 months.

RESULTS

Compared with the baseline, the means of SRH and mental health increased significantly by 0.302 and 2.698, respectively. The SRH scores were different before and after intervention; furthermore, the differences varied by workplace. Health culture mediated the relationship between intervention implementation and intervention effectiveness, including SRH and mental health improvement, but physical environment did not. Physical environment quality was significantly negatively correlated with SRH improvement and mental health improvement. Under the relatively high-quality interventions with scores higher than 4.047 or 4.151 (out of 5), better health culture may led to greater SRH and mental health improvements.

CONCLUSIONS

Health culture may mediate the relationship between intervention implementation and intervention effectiveness, whereas physical environment does not seem to mediate this relationship. Under relatively high-quality interventions, a better health culture may lead to more positive improvements in SRH and mental health. Future studies will need to examine the physical environment as a moderating effect rather than mediating effect.

TRIAL REGISTRATION

This study was retrospectively registered in Chinese Clinical Trial Registry.

TRIAL REGISTRATION NUMBER

ChiCTR-OOC-16010059 . Date of registration: Dec 1, 2016.

Spatial modelling of malaria cases associated with environmental factors in South Sumatra, Indonesia

Background

Malaria, a parasitic infection, is a life-threatening disease in South Sumatra Province, Indonesia. This study aimed to investigate the spatial association between malaria occurrence and environmental risk factors.

Methods

The number of confirmed malaria cases was analysed for the year 2013 from the routine reporting of the Provincial Health Office of South Sumatra. The cases were spread over 436 out of 1613 villages. Six potential ecological predictors of malaria cases were analysed in the different regions using ordinary least square (OLS) and geographically weighted regression (GWR). The global pattern and spatial variability of associations between malaria cases and the selected potential ecological predictors was explored.

Results

The importance of different environmental and geographic parameters for malaria was shown at global and village-level in South Sumatra, Indonesia. The independent variables altitude, distance from forest, and rainfall in global OLS were significantly associated with malaria cases. However, as shown by GWR model and in line with recent reviews, the relationship between malaria and environmental factors in South Sumatra strongly varied spatially in different regions.

Conclusions

A more in-depth understanding of local ecological factors influencing malaria disease as shown in present study may not only be useful for developing sustainable regional malaria control programmes, but can also benefit malaria elimination efforts at village level.

Can the physical environment itself influence neurological patient activity?

PURPOSE

To evaluate if a changed physical environment following redesign of a hospital ward influenced neurological patient physical and social activity.

METHODS

A "before and after" observational design was used that included 17 acute neurological patients pre-move (median age 77 (IQR 69-85) years Ward A and 20 post-move (median age 70 (IQR 57-81) years Ward B. Observations occurred for 1 day from 08.00-17.00 using Behavioral Mapping of patient physical and social activity, and location of that activity. Staff and ward policies remained unchanged throughout. An Environmental Description Checklist of each ward was also completed.

RESULTS

Behavioral Mapping was conducted pre-/post-move with a total of 801 Ward A and 918 Ward B observations. Environmental Description Checklists showed similarities in design features in both neurological wards with similar numbers of de-centralized nursing stations, however there were more single rooms and varied locations to congregate in Ward B (30% more single-patient rooms and separate allied health therapy room). Patients were alone >60% of time in both wards, although there was more in bed social activity in Ward A and more out of bed social activity in Ward B. There were low amounts of physical activity outside of patient rooms in both wards. Significantly more physical activity occurred in Ward B patient rooms (median = 47%, IQR 14-74%) compared to Ward A (median = 2% IQR 0-14%), Wilcoxon Rank Sum test z = -3.28, p = 0.001.

CONCLUSIONS

Overall, patient social and physical activity was low, with little to no use of communal spaces. However we found more physical activity in patient rooms in the Ward B environment. Given the potential for patient activity to drive brain reorganization and repair, the physical environment should be considered an active factor in neurological rehabilitation and recovery. Implications for Rehabilitation Clinicians should include consideration of the impact of physical environment on physical and social activity of neurological patients when designing therapeutic rehabilitation environments. Despite architectural design intentions patient and social activity opportunities can be limited. Optimal neurological patient neuroplasticity and recovery requires sufficient environmental challenge, however current hospital environments for rehabilitation do not provide this.

Supportive environments for physical activity in deprived communities in the United Kingdom: A qualitative study using photo elicitation

The health benefits of regular physical activity are substantial and well-established. However, population activity levels are insufficient to obtain health benefits in the United Kingdom (UK), and strategies to increase activity, particularly in income-deprived communities, are sought. Socioecological models of physical activity posit that activity levels are influenced by social, physical and wider environmental factors. In line with a growing evidence base, there is a need to understand the factors that contribute to an activity-supportive neighbourhood within deprived settings within the UK. This study used photo-elicitation qualitative interviews to explore environmental facilitators and barriers to neighbourhood-based, outdoor physical activity in 23 adults living in two income-deprived neighbourhoods in Glasgow, UK. Data were collected between June and October 2015, and were explored using thematic analysis. Five themes were identified: 'diversity of destinations in the neighbourhood', 'provision of services to support healthy environments', 'ownership of public space and facilities to encourage physical activity', 'collective control of public space to prevent disorder' and 'perceived value of the neighbourhood'. Findings highlighted the close interaction between these themes and more broadly between social and physical facets of neighbourhood environments that were unsupportive of physical activity. Discourse about economic aspects was pervasive and emerged as deeply affecting characteristics of the social and physical environment and upstream influences on physical activity. This study supports evidence that multi-faceted interventions addressing aspects of the social, physical and economic environment may be needed to support outdoor physical activity in deprived communities.