The impact of urbanisation on nature dose and the implications for human health

This is the final version. Available from Elsevier via the DOI in this record.The last 100 years have seen a huge change in the global structure of the human population, with the majority of people now living in urban rather than rural environments. An assumed consequence is that people will have fewer experiences of nature, and this could have important consequences given the myriad health benefits that they can gain from such experiences. Alternatively, as experiences of nature become rarer, people might be more likely actively to seek them out, mitigating the negative effects of urbanisation. In this study, we used data for 3000 survey respondents from across the UK, and a nature-dose framework, to determine whether (a) increasing urbanisation is associated with a decrease in the frequency, duration and intensity of nature dose; and (b) differences in nature exposure associated with urbanisation impact on four population health outcomes (depression, self-reported health, social cohesion and physical activity). We found negative exponential relationships between nature dose and the degree of urbanisation. The frequency and duration of dose decreased from rural to suburban environments, followed by little change with further increases in urbanisation. There were weak but positive associations between frequency and duration of dose across all four health domains, while different dimensions of dose showed more positive associations with specific health domains in towns and cities. We show that people in urban areas with a low nature dose tend to have worse health across multiple domains, but have the potential for the greatest gains from spending longer in nature, or living in green areas.D.T.C.C, H.L.H. and K.J.G were supported by the Fragments, Functions, Flows and Urban Ecosystem Services project, NERC grant NE/J015237/1, funded under the NERC Biodiversity and Ecosystem Service Sustainability program

The rarity of direct experiences of nature in an urban population

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.As people live more urbanised lifestyles there is potential to lose daily contact with nature, diminishing access to the wide range of associated health benefits of interacting with nature. Experiences of nature vary widely across populations, but this variation is poorly understood. We surveyed 1,023 residents of an urban population in the UK to measure four distinctly different nature interactions: indirect (viewing nature through a window at work and at home), incidental (spending time outside at work), intentional (time spent in private gardens) and intentional (time spent in public parks). Scaled-up to the whole study population, accumulation curves of the total number of hours per week that people were exposed to each type of nature interaction showed that 75% of nature interactions were experienced by half the population. Moreover, 75% of the interactions of a type where people were actually present in nature were experienced by just 32% of the population. The average hours each individual experienced nature per week varied across interactions: indirect (46.0 ± 27.3 SD), incidental (6.4 ± 12.7 SD), intentional-gardens (2.5 ± 2.9 SD) and intentional-parks (2.3 ± 2.7 SD). Experiencing nature regularly appears to be the exception rather than the norm, with a person’s connection to nature being positively associated with incidental and intentional experiences. This novel study provides baseline information regarding how an urban population experiences different types of nature. Deconstructing nature experience will pave the way for developing recommendations for targeted health outcomes.DTCC, HLH & KJG were funded by NERC grant NE/J015237/1. D.F.S. is supported through ARC Discovery Grant DP120102857 and the Centre of Excellence for Environmental Decisions (CEED, Australia); R.A.F. holds an ARC Future Fellowship

Skewed contributions of individual trees to indirect nature experiences

This is the author accepted manuscript. Final version available from Elsevier via the DOI in this record.Exposure to nature is associated with a broad range of benefits to human health. Whilst there has been exploration of how these experiences vary amongst people, the converse – how different individual organisms contribute to human nature experiences – has largely been overlooked. The most common way that people experience nature occurs indirectly, when they are in a room with a natural view. Here, we estimate variation in how individual trees provide indirect nature experiences in an urban human population. As a proxy for its contribution towards indirect nature experiences, within an extended urban area in southern England, UK (n = 612,920) we calculated the number of buildings with line of sight to each tree. We then modelled each tree’s contribution towards these experiences against potential predictors, namely tree height, land ownership, social deprivation, while controlling for human population density. We demonstrate that a small number of trees contribute disproportionately towards indirect nature experiences, with individual trees in socio-economically deprived high density housing falling within the viewscape of significantly more buildings. Further, trees in private gardens were generally more important for providing indirect nature experiences than those in public green spaces. This novel study demonstrates the skewed contribution of different organisms to human population indirect nature experiences. This approach can be applied more broadly to understand how individual organisms provide indirect, incidental and intentional nature experiences. Understanding the ecology behind human nature experiences is an important step towards linking urban design and policy for maximising the health benefits from nature.Natural Environment Research Council (NERC

Exploring the use of strategic frameworks in dental practice

This paper explores the use of strategic frameworks in NHS and private dental practice. It reviews the policy context of dentistry and suggests the challenges in this context will require dental practices to prioritise understanding and engagement with a strategic approach. A strategic approach will be required in order to enhance and improve performance. Two specific strategic frameworks will be explored in terms of their relevance to NHS and private dental practic

Long-term impact of four different strategies for delivering an on-line curriculum about herbs and other dietary supplements

BACKGROUND: Previous research has shown that internet education can lead to short-term improvements in clinicians' knowledge, confidence and communication practices. We wished to better understand the duration of these improvements and whether different curriculum delivery strategies differed in affecting these improvements. METHODS: As previously described, we conducted a randomized control trial comparing four different strategies for delivering an e-curriculum about herbs and other dietary supplements (HDS) to clinicians. The four strategies were delivering the curriculum by: a) email over 10 weeks; b) email within one week; c) web-site over 10 weeks; d) web-site within one week. Participants were surveyed at baseline, immediately after the course and 6–10 months after completing the course (long-term). Long-term outcomes focused on clinicians' knowledge, confidence and communication practices. RESULTS: Of the 780 clinicians who completed the course, 385 (49%) completed the long-term survey. Completers and non-completers of the long-term survey had similar demographics and professional characteristics at baseline. There were statistically significant improvements from baseline to long-term follow-up in knowledge, confidence and communication practices; these improvements did not differ by curriculum delivery strategy. Knowledge scores improved from 67.7 ± 10.3 at baseline to 78.8 ± 12.3 at long-term follow-up (P < 0.001). Confidence scores improved from 53.7 ± 17.8 at baseline to 66.9 ± 12.0 at long term follow-up (P < 0.001); communication scores improved from 2.6 ± 1.9 at baseline to 3.6 ± 2.1 (P < 0.001) at long-term follow-up. CONCLUSION: This e- curriculum led to significant and sustained improvements in clinicians' expertise about HDS regardless of the delivery strategy. Future studies should compare the impact of required vs. elective courses and self-reported vs. objective measures of behavior change

Doses of neighborhood nature: the benefits for mental health of living with nature

This is the author accepted manuscript. The final version is available from OUP via the DOI in this record.Experiences of nature provide many mental health benefits, particularly for people living in urban areas. The natural characteristics of city residents’ neighborhoods are likely to be critical determinants of the daily nature dose that they receive, however which characteristics are important remains unclear. One possibility is that the greatest benefits are provided by characteristics that are most visible during the day and so most likely to be experienced by people. We demonstrate that of five neighborhood nature characteristics tested, vegetation cover and afternoon bird abundances were positively associated with a lower prevalence of depression, anxiety and stress. Further, dose-response modelling shows a threshold response where the population prevalence of mental health issues is significantly lower beyond minimum limits of neighborhood vegetation cover (depression >20% cover, anxiety >30% cover, stress >20% cover). Our findings demonstrate quantifiable associations of mental health with the characteristics of nearby nature that people actually experience

Randomized controlled trial comparing four strategies for delivering e-curriculum to health care professionals [ISRCTN88148532]

BACKGROUND: Internet education is increasingly provided to health professionals, but little is known about the most effective strategies for delivering the content. The purpose of this study is to compare four strategies for delivering an Internet-based (e-) curriculum on clinicians' knowledge (K), confidence (CONF), and communication (COMM) about herbs and other dietary supplements (HDS). METHODS: This national randomized 2 × 2 factorial trial included physicians, pharmacists, nurses, nutritionists and trainees in these fields. Participants were randomly assigned to one of four curriculum delivery strategies for 40 brief modules about HDS: a) delivering four (4) modules weekly over ten (10) weeks by email (drip-push); b) modules accessible on web site with 4 reminders weekly for 10 weeks (drip-pull); c) 40 modules delivered within 4 days by email (bolus-push); and d) 40 modules available on the Internet with one email informing participants of availability (bolus-pull). RESULTS: Of the 1,267 enrollees, 25% were male; the average age was 40 years. The completion rate was 62%, without significant differences between delivery groups. There were statistically significant improvements in K, CONF and COMM scores after the course (P<0.001 for all), although the difference in COMM was small. There were no significant differences in any of the three outcomes by delivery strategy, but outcomes were better for those who paid for continuing education credit. CONCLUSION: All delivery strategies tested similarly improved K, CONF, COMM scores about HDS. Educators can use the strategy that is most convenient without diminishing effectiveness. Additional curricula may be necessary to make substantial changes in clinicians' communication practices

High genetic diversity at the extreme range edge: nucleotide variation at nuclear loci in Scots pine (Pinus sylvestris L.) in Scotland

Nucleotide polymorphism at 12 nuclear loci was studied in Scots pine populations across an environmental gradient in Scotland, to evaluate the impacts of demographic history and selection on genetic diversity. At eight loci, diversity patterns were compared between Scottish and continental European populations. At these loci, a similar level of diversity (θsil=~0.01) was found in Scottish vs mainland European populations, contrary to expectations for recent colonization, however, less rapid decay of linkage disequilibrium was observed in the former (ρ=0.0086±0.0009, ρ=0.0245±0.0022, respectively). Scottish populations also showed a deficit of rare nucleotide variants (multi-locus Tajima's D=0.316 vs D=−0.379) and differed significantly from mainland populations in allelic frequency and/or haplotype structure at several loci. Within Scotland, western populations showed slightly reduced nucleotide diversity (πtot=0.0068) compared with those from the south and east (0.0079 and 0.0083, respectively) and about three times higher recombination to diversity ratio (ρ/θ=0.71 vs 0.15 and 0.18, respectively). By comparison with results from coalescent simulations, the observed allelic frequency spectrum in the western populations was compatible with a relatively recent bottleneck (0.00175 × 4Ne generations) that reduced the population to about 2% of the present size. However, heterogeneity in the allelic frequency distribution among geographical regions in Scotland suggests that subsequent admixture of populations with different demographic histories may also have played a role

The relationship between parent and child dysfunctional beliefs about sleep and child sleep

Cognitive theories emphasise the role of dysfunctional beliefs about sleep in the development and maintenance of sleep-related problems (SRPs). The present research examines how parents' dysfunctional beliefs about children's sleep and child dysfunctional beliefs about sleep are related to each other and to children's subjective and objective sleep. Participants were 45 children aged 11 -12 years and their parents. Self-report measures of dysfunctional beliefs about sleep and child sleep were completed by children, mothers and fathers. Objective measures of child sleep were taken using actigraphy. The results showed that child dysfunctional beliefs about sleep were correlated with father (r=.43, p<.05) and mother (r=.43, p<.05) reported child SRPs, and with Sleep Onset Latency (r=.34, p<.05). Maternal dysfunctional beliefs about child sleep were related to child SRPs as reported by mothers (r=.44, p<.05), and to child dysfunctional beliefs about sleep (r=.37, p<.05). Some initial evidence was found for a mediation pathway in which child dyfunctional beliefs mediate the relationship between parent dysfunctional beliefs and child sleep. The results support the cognitive model of SRPs and contribute to the literature by providing the first evidence of familial aggregation of dysfunctional beliefs about sleep

Serotonin tranporter methylation and response to cognitive behaviour therapy in children with anxiety disorders

Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35-45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT