Synthesising evidence for equity impacts of population-based physical activity interventions: a pilot study.

BACKGROUND: This study applied an equity lens to existing research to investigate what is known about the impact of population-level physical activity interventions on social inequalities. METHODS: We performed a pilot systematic review to assess the availability of information on the social distribution of intervention effects, the targeting or allocation of interventions, and the baseline characteristics of participants. This comprised (i) a rapid review of systematic reviews and (ii) a review and synthesis of a sample of primary studies included in the eligible systematic reviews. RESULTS: We found 19 systematic reviews of environmental and policy interventions. Relatively few of these (26%, n=5) were prospectively designed to examine effects on inequalities, and none were able to fully synthesise evidence of distributional effects. Over 40% of primary studies reported subgroup intervention effects; 18% reported socio-demographic interaction effects. Studies most often compared effectiveness by gender, followed by age, ethnicity, and socio-economic status. For gender, effects appeared to be evenly distributed overall, although heterogeneity in gradients between studies suggested that some interventions affect males and females differently. CONCLUSIONS: Our findings suggest that it is feasible to generate better evidence about how public health interventions may affect health inequalities using existing data and innovative methods of research synthesis.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Evaluating the Impact of Florida's "Stand Your Ground" Self-defense Law on Homicide and Suicide by Firearm: An Interrupted Time Series Study.

Importance: In 2005, Florida amended its self-defense laws to provide legal immunity to individuals using lethal force in self-defense. The enactment of "stand your ground" laws in the United States has been controversial and their effect on rates of homicide and homicide by firearm is uncertain. Objective: To estimate the impact of Florida's stand your ground law on rates of homicide and homicide by firearm. Design, Setting, and Participants: Using an interrupted time series design, we analyzed monthly rates of homicide and homicide by firearm in Florida between 1999 and 2014. Data were collected from the Wide-ranging Online Data for Epidemiologic Research (WONDER) web portal at the Centers for Disease Control and Prevention. We used seasonally adjusted segmented Poisson regression models to assess whether the onset of the law was associated with changes in the underlying trends for homicide and homicide by firearm in Florida. We also assessed the association using comparison states without stand your ground laws (New York, New Jersey, Ohio, and Virginia) and control outcomes (all suicides and suicides by firearm in Florida). October 1, 2005, the effective date of the law, was used to define homicides before and after the change. Main Outcomes and Measures: Monthly rates of homicide, firearm-related homicide, suicide, and suicide by firearm in Florida and the 4 comparison states. Results: Prior to the stand your ground law, the mean monthly homicide rate in Florida was 0.49 deaths per 100 000 (mean monthly count, 81.93), and the rate of homicide by firearm was 0.29 deaths per 100 000 (mean monthly count, 49.06). Both rates had an underlying trend of 0.1% decrease per month. After accounting for underlying trends, these results estimate that after the law took effect there was an abrupt and sustained increase in the monthly homicide rate of 24.4% (relative risk [RR], 1.24; 95%CI, 1.16-1.33) and in the rate of homicide by firearm of 31.6% (RR, 1.32; 95% CI, 1.21-1.44). No evidence of change was found in the analyses of comparison states for either homicide (RR, 1.06; 95% CI, 0.98-1.13) or homicide by firearm (RR, 1.08; 95% CI, 0.99-1.17). Furthermore, no changes were observed in control outcomes such as suicide (RR, 0.99; 95% CI, 0.94-1.05) and suicide by firearm (RR, 0.98; 95% CI, 0.91-1.06) in Florida between 2005 and 2014. Conclusions and Relevance: The implementation of Florida's stand your ground self-defense law was associated with a significant increase in homicides and homicides by firearm but no change in rates of suicide or suicide by firearm

Evaluating the impact of flexible alcohol trading hours on violence: an interrupted time series analysis.

BACKGROUND: On November 24(th) 2005, the Government of England and Wales removed regulatory restrictions on the times at which licensed premises could sell alcohol. This study tests availability theory by treating the implementation of Licensing Act (2003) as a natural experiment in alcohol policy. METHODS: An interrupted time series design was employed to estimate the Act's immediate and delayed impact on violence in the City of Manchester (Population 464,200). We collected police recorded rates of violence, robbery, and total crime between the 1st of February 2004 and the 31st of December 2007. Events were aggregated by week, yielding a total of 204 observations (95 pre-, and 109 post-intervention). Secondary analysis examined changes in daily patterns of violence. Pre- and post-intervention events were separated into four three-hour segments 18∶00-20∶59, 21∶00-23.59, 00∶00-02∶59, 03∶00-05∶59. RESULTS: Analysis found no evidence that the Licensing Act (2003) affected the overall volume of violence. However, analyses of night-time violence found a gradual and permanent shift of weekend violence into later parts of the night. The results estimated an initial increase of 27.5% between 03∶00 to 06∶00 (ω = 0.2433, 95% CI = 0.06, 0.42), which increased to 36% by the end of the study period (δ = -0.897, 95% CI = -1.02, -0.77). CONCLUSIONS: This study found no evidence that a national policy increasing the physical availability of alcohol affected the overall volume of violence. There was, however, evidence suggesting that the policy may be associated with changes to patterns of violence in the early morning (3 a.m. to 6 a.m.)

Trajectories of Exposure to Neighborhood Deprivation and the Odds of Experiencing Intimate Partner Violence Among Women: Are There Sensitive Periods for Exposure?

Neighborhood disadvantage is commonly hypothesized to be positively associated with intimate partner violence (IPV) against women. However, longitudinal investigation of this association has been limited, with no studies on whether the timing of exposure matters. We used data from 2,115 women in the UK-based Avon Longitudinal Study of Parents and Children. Exposure to neighborhood-level deprivation was measured at 10-time points from baseline (gestation) until age 18. Family-level socioeconomic characteristics were measured at baseline. At age 21, participants self-reported whether they had experienced any IPV since age 18. We used a three-step bias-adjusted longitudinal latent class analysis to investigate how different patterns of neighborhood deprivation exposure were associated with the odds of experiencing IPV. A total of 32% of women experienced any IPV between ages 18 and 21. Women who consistently lived in deprived neighborhoods (chronic high deprivation) or spent their early childhoods in more deprived neighborhoods and later moved to less deprived neighborhoods (decreasing deprivation) had higher odds of experiencing IPV compared to those who consistently lived in non-deprived neighborhoods. The odds of experiencing IPV did not consistently differ between women who lived in non-deprived neighborhoods during early childhood and later moved to deprived neighborhoods (increasing deprivation) and those stably in non-deprived neighborhoods. Living in more deprived neighborhoods during early childhood, regardless of later exposure, was associated with higher odds of experiencing later IPV. This is congruent with prior research demonstrating the persistent effects of early neighborhood disadvantage on health and well-being. Replication, and underlying mechanisms, should be assessed across contexts

Questioning the application of risk of bias tools in appraising evidence from natural experimental studies: critical reflections on Benton et al., IJBNPA 2016.

We recently read the article by Benton et al. which reviewed risk of bias in natural experimental studies investigating the impact of the built environment on physical activity (Benton et al., 2016; Int J Behav Nutr Phys Act 13:107). As a technical exercise in assessing risk of bias to understand study quality, we found the results of this study both interesting and potentially useful. However, it prompted a number of concerns with the use of risk of bias tools for assessing the quality of evidence from studies exploiting natural experiments. As we discuss in this commentary, the rigid application of such tools could have adverse effects on the uptake and use of natural experiments in population health research and practice

From both sides now: Crossover effects influence navigation in patients with unilateral neglect

Unilateral neglect is a challenging disorder that pervades a range of behaviours following stroke and hampers recovery. Although a preponderance of clinical studies measure performance on a range of bedside assessments, including line bisection and cancellation tasks, there have been calls for studies to embrace more relevant functional measures. Here, for the first time, we present data from two separate tasks that characterise the performance of seven patients with unilateral neglect when navigating a power wheelchair. The tasks involved negotiating an obstacle course and steering a central path between gaps of different sizes. Results from the obstacle course confirmed the clinical observation and predicted bias of contralesional errors. However, the second task revealed a robust "crossover" effect. Patients deviated to the ipsilesional side for large gaps but deviated increasingly contralesionally when steering through small gaps in behaviour that was analogous to that previously shown on line bisection tasks. Contrary to being seen as an unintuitive finding, further analysis of these errors suggests that patients are giving disproportionate weight to the location of the ipsilesional object when plotting a midline course between two objects. Our results provide a platform for further studies to investigate the modulation and rehabilitation of this important skill

Exact isotropic cosmologies with local fractal number counts

We construct an exact relativistic cosmology in which an inhomogeneous but isotropic local region has fractal number counts and matches to a homogeneous background at a scale of the order of $10^2$ Mpc. We show that Einstein's equations and the matching conditions imply either a nonlinear Hubble law or a very low large-scale density.Comment: revised version, to appear Class. Q. Grav.; minor corrections following eqn 16, additional comments on relation to other work, some new reference

Regular spherical dust spacetimes

Physical (and weak) regularity conditions are used to determine and classify all the possible types of spherically symmetric dust spacetimes in general relativity. This work unifies and completes various earlier results. The junction conditions are described for general non-comoving (and non-null) surfaces, and the limits of kinematical quantities are given on all comoving surfaces where there is Darmois matching. We show that an inhomogeneous generalisation of the Kantowski-Sachs metric may be joined to the Lemaitre-Tolman-Bondi metric. All the possible spacetimes are explicitly divided into four groups according to topology, including a group in which the spatial sections have the topology of a 3-torus. The recollapse conjecture (for these spacetimes) follows naturally in this approach.Comment: Minor improvements, additional references. Accepted by GR

Association Between Enactment of a "Stand Your Ground" Self-defense Law and Unlawful Homicides in Florida.

Results from our study of the influence of Florida’s “Stand Your Ground” self-defense law on homicide and suicide by firearm1 have been questioned for not distinguishing between “unlawful” homicide (ie, murder) and “justifiable” homicide (ie, lawful use of lethal force).2,3 Using an interrupted time series design, we found “an abrupt and sustained increase in the monthly homicide rate of 24.4%” (31.6% for homicide by firearm) following the effective date of the law.1 Readers have suggested that if the increase in homicide rates resulted from an increase in homicides that were justifiable, the law may be working as intended. We investigated this possibility by acquiring additional data and conducting new analyses

Disclosure of Financial Conflicts of Interests in Interventions to Improve Child Psychosocial Health: A Cross-Sectional Study.

Academic journals increasingly request a full disclosure of financial conflict of interest (CoI). The Committee for Publication Ethics provides editors with guidance about the course of action in the case of suspected non-disclosure. No prior study has examined the extent to which journal articles on psychosocial interventions disclose CoI, and how journal editors process requests to examine suspected undisclosed CoI. Four internationally disseminated psychosocial interventions were examined. 136 articles related to an intervention, co-authored by intervention developers and published in health sciences journals were retrieved as requiring a CoI statement. Two editors refused consent to be included in the study. COI disclosures and editor responses were coded for 134 articles. Overall, 92/134 (71%) of all articles were found to have absent, incomplete or partly misleading CoI disclosures. Disclosure rates for the four programs varied significantly between 11% and 73%. Journal editors were contacted about 92 published articles with no CoI disclosure or a disclosure that was considered problematic. In 65/92 (71%) of all cases the editors published an 'erratum' or 'corrigendum'. In 16 of these cases the journal had mishandled a submitted disclosure. The most frequent reason for non-publication of an erratum was that the journal had no disclosure policy at the time of the publication (16 cases). Consumers of research on psychosocial interventions published in peer-reviewed journals cannot currently assume that CoI disclosures are adequate and complete. More efforts are needed to achieve transparency