Impacts of energy efficiency retrofitting measures on indoor PM concentrations across different income groups in England: a modelling study

As part of an effort to reduce carbon emissions in the UK, policies encouraging the energy-efficient retrofit of domestic properties are being implemented. Typical retrofits, including installation of insulation and double glazing can cause tightening of the building envelope which may affect indoor air quality (IAQ) impacting occupant health. Using the example of PM (an airborne pollutant with known health impacts), this study considers the influence of energy-efficient retrofits on indoor PM concentrations in domestic properties both above and below the low-income threshold (LIT) for a range of tenancies across England. Simulations using EnergyPlus and its integrated Generic Contaminant model are employed to predict indoor PM exposures from both indoor and outdoor sources in building archetypes representative of (i) the existing housing stock and (ii) a retrofitted English housing stock. The exposures of occupants for buildings occupied by groups above and below the LIT are then estimated under current conditions and following retrofits. One-way ANOVA tests were applied to clarify results and investigate differences between the various income and tenure groups. Results indicate that all tenures below the LIT experience greater indoor PM concentrations than those above, suggesting possible social inequalities driven by housing, leading to consequences for health

Health effects of home energy efficiency interventions in England: a modelling study

Objective: To assess potential public health impacts of changes to indoor air quality and temperature due to energy efficiency retrofits in English dwellings to meet 2030 carbon reduction targets. Design: Health impact modelling study. Setting: England. Participants: English household population. Intervention: Three retrofit scenarios were modelled: (1) fabric and ventilation retrofits installed assuming building regulations are met. (2) As with scenario (1) but with additional ventilation for homes at risk of poor ventilation. (3) As with scenario (1) but with no additional ventilation to illustrate the potential risk of weak regulations and non-compliance. Main Outcome: Primary outcomes were changes in quality adjusted life years (QALYs) over 50 years from cardiorespiratory diseases, lung cancer, asthma and common mental disorders due to changes in indoor air pollutants, including: second-hand tobacco smoke, PM2.5 from indoor and outdoor sources, radon, mould, and indoor winter temperatures. Results: The modelling study estimates showed that scenario (1) resulted in positive effects on net mortality and morbidity of 2,241 (95% credible intervals (CI) 2,085 to 2,397) QALYs per 10,000 persons over 50 years due to improved temperatures and reduced exposure to indoor pollutants, despite an increase in exposure to outdoor–generated PM2.5. Scenario (2) resulted in a negative impact of -728 (95% CI -864 to -592) QALYs per 10,000 persons over 50 years due to an overall increase in indoor pollutant exposures. Scenario (3) resulted in -539 (95% CI -678 to -399) QALYs per 10,000 persons over 50 years due to an increase in indoor exposures despite targeting. Conclusions: If properly implemented alongside ventilation, energy efficiency retrofits in housing can improve health by reducing exposure to cold and air pollutants. Maximising the health benefits requires careful understanding of the balance of changes in pollutant exposures, highlighting the importance of ventilation to mitigate the risk of poor indoor air quality

A Qualitative Evaluation of an NHS Weight Management Programme for Obese Patients in Liverpool

Purpose – The increasing prevalence of obesity in the UK has been of concern for some time. This is particularly true in Liverpool and in response the Liverpool Weight Management Programme (LWMP) was devised. It offers a service involving dietitians and other expert agencies working towards facilitating dietary and lifestyle changes in obese NHS patients in Liverpool via a 12-week education programme. This qualitative study aims to investigate patients' experiences of the LWMP. Design/methodology/approach – Informed volunteers participated in focus groups exploring their experiences following the programme. Focus groups were audio recorded and transcribed verbatim, then analysed following a thematic approach utilising constant comparison analysis to allow a qualitative view of the LWMP to be formed. Findings – Participants described an increase in immediate self-confidence during the LWMP, as opposed to coercion and pressure experienced elsewhere. The results also show the implementation of dietary changes by participants and favourable opinions towards both the group settings and patient-centred care. Participants also positively described the LWMP regarding the programmes social approach and aspects of programme content; however, there were issues with over-dependence on healthcare professionals. Healthcare professionals also need to recognise that long-term empowerment may still be lacking and that follow-up support and the effectiveness of some areas of programme content need to be considered to ensure patients benefit from sustainable weight management. Originality/value – This paper addresses an identified need for qualitative research in the area of health service weight management programmes and highlights the importance of long-term support in empowering patients by exploring their lived experience of the LWMP

Type and density of independent takeaway outlets: a geographical mapping study in a low socioeconomic ward, Manchester.

OBJECTIVES: The socioeconomic disparity in childhood and early adult obesity prevalence has been well characterised. Takeaway outlets may cluster in lower socioeconomic areas and their proximity to schools is of concern. This study aimed to map takeaway food outlets, characterise takeaway types and their proximity to educational institutions within a low socioeconomic ward in Manchester. DESIGN: The Rusholme ward and a 2 km Euclidean buffer were included as the study area. Local authority Environmental Health data were used to map the takeaway outlets, using QGIS V.2.18.0 (OPENGIS.ch LLC, Einsiedeln, Switzerland). The types of takeaway outlets and major roads were included. Number of outlets within a 400 m Euclidean walking buffer of educational institutions were mapped. SETTING: Rusholme, Manchester, UK. RESULTS: Within the study area, 202 takeaway food outlets were identified and mapped as cluster points. Of these, 62.3% are located on major (A and B) roads, while the remaining outlets were located on minor roads. The majority (57.4%) of takeaway outlets sold similar items (fried chicken, burgers, pizzas, kebabs), with the remainder offering more diverse menus. Of the 53 schools, colleges and universities within the study area, 28 (52.8%) had 1-5 takeaway food outlets within 400 m, 9 (17.0%) had 6-10 outlets; 4 (7.5%) more than 11 outlets with 12 (22.6%) having zero outlets within 400 m. CONCLUSION: Within this low socioeconomic area, there was a high concentration of takeaway food outlets, predominantly along major roads and in easy walking distance of educational establishments with the majority offering similar foods. In addition, a high proportion of these outlets were in easy walking distance of educational establishments. Public health policy needs to consider the implications of current takeaway food outlets and not just the proliferation of these outlets with current planning laws

Exploring high protein diets in the context of cardiac rehabilitation

The review aims to explore the potential benefit and risk of high-protein diets (HPD) regarding the comorbidity of sarcopoenia and CVD in the setting of cardiac rehabilitation (CR). CR is standard care for individuals who have experienced a cardiac event, but the current practice of predominantly aerobic exercise, a lower-fat diet and weight loss poorly addresses the issue of sarcopoenia. HPD, especially when combined with resistance exercise (RE), may be valuable adjuncts to current CR practice and benefit both muscle and cardiovascular health. Meta-analyses and randomised controlled trials of HPD and CVD risk show beneficial but variable effects regarding weight loss, the lipid profile, insulin resistance and lean body mass in those living with or high risk of CVD. Meta-analyses of prospective cohort studies on hard CVD endpoints favour lower- and plant-protein diets over higher animal protein, but the evidence is inconsistent. HPD augment the strength and muscle gaining benefits of RE in older populations, but there are no published data in those living with CVD providing promising opportunities for CR research. HPD raise concern regarding renal and bone health, the microbiome, branched chain amino acids and environmental sustainability and findings suggest that plant-based HPD may confer ecological and overall health advantages compared to animal-based HPD. However, incorporating RE with HPD might alleviate certain health risks. In conclusion, a largely plant-based HPD is deemed favourable for CR when combined with RE, but further research regarding efficacy and safety in CR populations is needed

Prevalence of plasma small dense LDL is increased in obesity in a Thai population

Background Plasma low density lipoprotein (LDL) particles vary in size, density, electrical charge and chemical composition. An increased presence of small dense LDL (sdLDL), along with raised triglyceride concentrations and decreased high density lipoprotein (HDL) cholesterol concentrations is commonly known as the atherogenic triad and has been observed in some cases of obesity, principally in Europe and America. This study examines the prevalence of sdLDL in the plasma of an obese (BMI ≥ 25 kg/m2) Thai population. Methods Plasma from fasted obese (n = 48) and non-obese (n = 16) Thai participants was subjected to density gradient ultracentrifugation in iodixanol to separate lipoproteins. Gradients were unloaded top-to-bottom into 20 fractions which were assayed for cholesterol, triglyceride, apo B and apo A-1 to identify lipoprotein types and subtypes. Results LDL cholesterol was subfractionated into LDL I + II (fractions 3–6, ρ = 1.021-1.033 g/ml) which was considered to represent large buoyant LDL (lbLDL), LDL III (fractions 7–9, ρ = 1.036-1.039 g/ml) which was considered to represent sdLDL, and, LDL IV (fractions 10–12, ρ = 1.044-1.051 g/ml) which was considered to represent very sdLDL. Concentrations of LDL III and IV were increased by 15-20% in obese participants whilst that of LDL I + II was concomitantly decreased by 10%. This was accompanied by a 50% increase in plasma triglyceride concentrations and 15% decrease in HDL cholesterol concentrations. Only 3/16 (19%) non-obese participants had a pattern B LDL cholesterol profile (peak density of >1.033 g/ml), whilst 28/48 (58%) obese participants were pattern B. When expressed as a fraction of the LDL concentration, total sdLDL (i.e. LDL III + IV) showed highly significant correlations to plasma triglyceride concentrations and the triglyceride/HDL cholesterol ratio. Conclusions The prevalence of sdLDL is increased in obesity in a Thai population such that they demonstrate a similar atherogenic triad to that previously observed in European and American populations

Positive Affect as a Buffer Against Psychopathology in Diabetes Patients: A Randomised Controlled Trial

The aim of this study was to assess a brief ‘positive’ psychological intervention’s effectiveness in facilitating positive affect amongst people with diabetes

A narrative review on female physique athletes: the physiological and psychological implications of weight management practices

Physique competitions are events in which aesthetic appearance and posing ability are valued above physical performance. Female physique athletes are required to possess high lean body mass and extremely low fat mass in competition. As such, extended periods of reduced energy intake and intensive training regimens are used with acute weight loss practices at the end of the precompetition phase. This represents an increased risk for chronic low energy availability and associated symptoms of relative energy deficiency in sport, compromising both psychological and physiological health. Available literature suggests that a large proportion of female physique athletes report menstrual irregularities (e.g., amenorrhea and oligomenorrhea), which are unlikely to normalize immediately postcompetition. Furthermore, the tendency to reduce intakes of numerous essential micronutrients is prominent among those using restrictive eating patterns. Following competition, reduced resting metabolic rate, and hyperphagia, is also a concern for these female athletes, which can result in frequent weight cycling, distorted body image, and disordered eating/eating disorders. Overall, female physique athletes are an understudied population, and the need for more robust studies to detect low energy availability and associated health effects is warranted. This narrative review aims to define the natural female physique athlete, explore some of the physiological and psychological implications of weight management practices experienced by female physique athletes, and propose future research directions

An Assessment of the Hydration Status of Recreational Endurance Athletes during Mountain Marathon Events.

Changes in hydration status have been shown to have deleterious effects on physiological functioning, physical performance, mental decision making, and subjective sensation of effort. This exploratory study assessed the hydration status of athletes taking part in mountain marathon events and the implications on performance, cognition and well-being markers. Twenty-nine male recreational athletes from the Original Mountain Marathon (OMM) and nineteen from the Longmynd Hike (LH) provided urine samples before, at mid-point (in the OMM) and after the events. Body mass; reaction time tests; and subjective ratings of well-being and effort were also collected/performed at these time points. Post-urine specific gravity (Usg) values [(OMM: 1.023 (range: 1.008 – 1.038) g/ml; LH: 1.024 (range: 1.014 – 1.035) g/ml] were significantly higher than pre-values [(OMM: 1.013 (range: 1.002 – 1.026) g/ml; LH: 1.013 (range: 1.002 – 1.026) g/ml] in both events (p 0.05). There was no association between hydration status and overall performance in the LH, whilst change in Usg from pre- to mid-event was positively associated with performance in the OMM (r = .561, p = 0.004). Whilst no associations were observed between hydration status and reaction time, rate of perceived exertion and subjective ratings of nausea showed positive associations with Usg. These findings suggest that although changes in hydration status of this level may not significantly affect performance, they can impact on participant sensations of effort and well-being