Turning the Tide from Cars to Active Transport: Policy Recommendations for New Zealand

Background: Despite national-level efforts to encourage active transport in New Zealand since 2005, rates of active transport have continued to decline in most parts of the country, with negative impacts on health and the environment. / Purpose: We describe the development of key policy recommendations for active transport in New Zealand as an outcome of multi-sectoral discussions held at The Active Living and Environment Symposium (TALES; www.otago.ac.nz/active-living-2019; Dunedin, New Zealand; February 2019). The goal was to establish a set of priority recommendations to inform active transport decision-making in central and local government, public health units and regional sports trusts in New Zealand. / Project Description: The development of recommendations was planned and led by a working group consisting of ten TALES symposium delegates working in academia, industry and non-governmental organisations with prior work experience in central/local government and the private sector. Symposium delegates provided input prior to the symposium (delegates submitted 1-3 policy recommendations); during the symposium (delegates challenged/discussed/modified the first draft of recommendations at a dedicated final day session); and after the symposium (delegates provided feedback on the second draft of recommendations and associated actions). Using an online survey, the working group members also independently evaluated importance and feasibility of each recommended action before inclusion in the document. The final 13 recommendations (and 39 associated actions) were grouped across four broad categories: A) Evaluation, governance and funding; B) Education and encouragement/promotion; C) Engineering (infrastructure, built environment); and D) Enforcement and regulations. The report aligns with the New Zealand government’s increased focus on wellbeing, walking, cycling, public transport and Vision Zero approach, and recommends national targets for walking, cycling and public transport by 2050. The report was officially launched in April 2019. Initial discussions of recommendations with relevant stakeholders were conducted in four major urban centres in April-May 2019. / Conclusions: This cross-sector effort resulted in a report that has the potential to stimulate the development of a new active transport strategy for New Zealand; prompt setting of targets and monitoring progress/outcomes; and inform New Zealand’s response to the World Health Organization’s Global Action Plan on Physical Activity 2018-2030. Key policy recommendations for active transport in New Zealand include: making a national-level commitment to change; establishing a nationally coordinated and funded programme of education and promotion of active transport; creating a commitment to design cities for people and not for cars; and developing a regulatory system that encourages the use of active transport

Development of key policy recommendations for active transport in New Zealand: A multi-sector and multidisciplinary endeavour

Background: Despite national-level initiatives to encourage active transport (AT) in New Zealand since 2005, rates of AT have continued to decline in most parts of the country, with negative impacts on health and the environment. This article describes the development of key policy recommendations for increasing AT in New Zealand. The goal was to establish a cohesive set of priority recommendations to inform AT decision-making in central and local government, district health boards, public health units and regional sports trusts in New Zealand. Project description: The development of policy recommendations was a planned outcome of multi-sectoral discussions held at The Active Living and Environment Symposium (TALES; Dunedin, New Zealand; February 2019). A ten-member working group consisting of TALES symposium delegates working in academia, industry and non-governmental organisations led the development of the recommendations. Symposium delegates contributed their expertise to draft recommendations and reports prior to, during and after the symposium. Importance and feasibility of each recommended action were independently evaluated by working group members. The final set of 13 policy recommendations (and 39 associated actions) included: making a national-level commitment to change; establishing a nationally coordinated and funded programme of education and promotion of AT; making a commitment to design cities for people, not cars; and developing a regulatory system that encourages AT. The report aligns with the current New Zealand government's increased focus on wellbeing, walking, cycling, public transport and the Vision Zero approach. A final report was officially launched in April 2019 with presentations to stakeholders April-May 2019. Conclusions: This cross-sector effort resulted in a report with a set of recommendations designed to stimulate the development of a new AT strategy for New Zealand; prompt setting of targets and monitoring progress/outcomes; and inform New Zealand's response to the World Health Organization's Global Action Plan on Physical Activity 2018–2030

Examining the transport to school patterns of New Zealand adolescents by home-to-school distance and settlement types

Background: Scholarship on active transport to school has largely focused on children, (large) urban areas, the umbrella term of “active transport” which considered walking and cycling together and without taking into account walking and/or cycling distance. This research examined adolescents’ patterns of transport to school in diverse settlement types and in relation to home-to-school distance in the Otago region of Aotearoa New Zealand. Methods: Patterns of transport to school by home-to-school distance, and across school locations, are described for a sample of 2,403 adolescents (age: 15.1 ± 1.4 years; 55% females) attending 23 out of 27 schools in large urban areas (n = 1,309; 11 schools), medium urban areas (n = 265; three schools), small urban areas (n = 652; four schools) and rural settings (n = 177; five schools). Empirical data were collected through an online survey, in which adolescents reported sociodemographic characteristics, travel to school, and perceptions of walking and cycling. Home-to-school distance was measured on the shortest route determined using Geographic Information Systems (GIS)-based network analysis. Results: Transport to school patterns differed significantly by home-to-school distance and across settlement types. Profiles of different transport user groups showed significant variability in sociodemographic characteristics, family factors, average distance to school, self-reported physical activity, and perceived health. Conclusions: Initiatives to promote active transport and reduce reliance on car transport to school, whether to improve health and the environment or to reduce greenhouse gas emissions, need to pay closer attention to the settlement types, distance to school, and characteristics of different transport user modes

Assessment of quality of care given to diabetic patients at Jimma University Specialized Hospital diabetes follow-up clinic, Jimma, Ethiopia

<p>Abstract</p> <p>Background</p> <p>Sub-Saharan Africa is currently enduring the heaviest global burden of diabetes and diabetes care in such resource poor countries is far below standards. This study aims to describe the gaps in the care of Ethiopian diabetic patients at Jimma University Specialized Hospital.</p> <p>Methods</p> <p>329 diabetic patients were selected as participants in the study, aged 15 years or greater, who have been active in follow-up for their diabetes for more than 1 year at the hospital. They were interviewed for their demographic characters and relevant clinical profiles. Their charts were simultaneously reviewed for characters related to diabetes and related morbidities. Descriptive statistics was used for most variables and Chi-square test, where necessary, was used to test the association among various variables. P-value of < 0.05 was used as statistical significance.</p> <p>Results</p> <p>Blood glucose determination was done for 98.5% of patients at each of the last three visits, but none ever had glycosylated haemoglobin results. The mean fasting blood sugar (FBS) level was 171.7 ± 63.6 mg/dl and 73.1% of patients had mean FBS levels above 130 mg/dl. Over 44% of patients have already been diagnosed to be hypertensive and 64.1% had mean systolic BP of > 130 and/or diastolic > 80 mmHg over the last three visits. Diabetes eye and neurologic evaluations were ever done for 42.9% and 9.4% of patients respectively. About 66% had urine test for albumin, but only 28.2% had renal function testing over the last 5 years. The rates for lipid test, electrocardiography, echocardiography, or ultrasound of the kidneys during the same time were < 5% for each. Diabetic neuropathy (25.0%) and retinopathy (23.1%) were the most common chronic complications documented among those evaluated for complications.</p> <p>Conclusions</p> <p>The overall aspects of diabetes care at the hospital were far below any recommended standards. Hence, urgent action to improve care for patients with diabetes is mandatory. Future studies examining patterns and prevalence of chronic complications using appropriate parameters is strongly recommended to see the true burden of diabetes.</p

Effects of lifestyle education program for type 2 diabetes patients in clinics: study design of a cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>The number of patients with type 2 diabetes is drastically increasing worldwide. It is a serious health problem in Japan as well. Lifestyle interventions can reduce progression from impaired glucose tolerance to type 2 diabetes, and glycemic control has been shown to improve postprandial plasma glucose levels. Moreover, several studies have suggested that continuous interventions (combined diet and exercise) can improve the plasma glucose level and reduce dosage of hypoglycemic agents.</p> <p>Although many interventional studies of lifestyle education for persons with diabetes in hospitals have been reported, only a few have been clinic-based studies employing an evidence-based lifestyle education program. This article describes the design of a cluster randomized controlled trial of the effectiveness of lifestyle education for patients with type 2 diabetes in clinics by registered dietitians.</p> <p>Methods/Design</p> <p>In Japan, general practitioners generally have their own medical clinics to provide medical care for outpatients in the community, including those with type 2 diabetes. With the collaboration of such general practitioners, the study patients were enrolled in the present study. Twenty general practitioners were randomly allocated to each provide patients for entry into either an intervention group (10) or a control group (10). In total, 200 participants will be included in the study. The intervention group will receive intensive education on lifestyle improvement related to type 2 diabetes by registered dietitians in clinics. Lifestyle education will be conducted several times during the study period. The control group will receive information on dietary intake and standard advice on glycemic control by registered dietitians. The primary endpoint is the change from the baseline value of HbA1c at 6 months. Data on health behavior and related issues will be gathered continuously over a 6-month period.</p> <p>Discussion</p> <p>This is the first study to evaluate lifestyle education in clinics by a cluster randomization trial in Japan. The proposed study will provide practical information about the usefulness of the intensive lifestyle improvement education program in primary care settings. The study was started in September 2007 and entry of subjects was completed in December 2010. Data on the effect evaluation will be available in 2011.</p> <p>Trial Registration</p> <p>UMIN000004049</p

Treatment of Diabetes with Lifestyle Changes: Diet

The present chapter critically reviews scientific evidence on the impact of the diet and its components on the metabolic control, cardiovascular risk factors, and morbidity/mortality in diabetic patients. Three main topics are included in this chapter: (1) the effects of dietary treatment on body weight control in diabetic patients; (2) the optimal dietary composition in order to achieve blood glucose control and reduce other cardiovascular risk factors associated with type 2 diabetes; (3) the effects of lifestyle modifications and dietary changes on the risk to develop type 2 diabetes. The overall body of evidence seems to confirm the efficacy of current recommendations for diabetes management. However, although dietary strategies based on structured interventions are often successful, particularly in relation to body weight control, they are not easily applicable in clinical practice and, therefore, more feasible strategies should be identified. In addition, further intervention studies focused on the effects of lifestyle on hard endpoints in diabetic subjects are needed to definitively prove the role of diet in the prevention of both cardiovascular and microvascular complications in these patients over and above their impact on weight reduction

Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in pediatric patients : a new classification from the European society for blood and marrow transplantation

The advances in hematopoietic cell transplantation (HCT) over the last decade have led to a transplant-related mortality below 15%. Hepatic sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication of HCT that belongs to a group of diseases increasingly identified as transplant-related, systemic endothelial diseases. In most cases, SOS/VOD resolves within weeks; however, severe SOS/VOD results in multi-organ dysfunction/failure with a mortality rate > 80%. A timely diagnosis of SOS/VOD is of critical importance, given the availability of therapeutic options with favorable tolerability. Current diagnostic criteria are used for adults and children. However, over the last decade it has become clear that SOS/VOD is significantly different between the age groups in terms of incidence, genetic predisposition, clinical presentation, prevention, treatment and outcome. Improved understanding of SOS/VOD and the availability of effective treatment questions the use of the Baltimore and Seattle criteria for diagnosing SOS/VOD in children. The aim of this position paper is to propose new diagnostic and severity criteria for SOS/VOD in children on behalf of the European Society for Blood and Marrow Transplantation.Peer reviewe