Identifying High and Low Walkable Neighbourhoods Using Multi-disciplinary Walkability Criteria

Neighbourhood features contributing to the walkability (pedestrian friendliness) of a neighbourhood are diverse and depend on both its physical and social attributes. Earlier work in the Cleaner, Greener, Leaner (CGL) Study identified differences in opinion between professional stakeholder groups (planners, designers, engineers, public representatives, and public health and advocacy professionals) on what constitutes a walkable environment [1]. This diversity has implications for neighbourhood design and planning policy. The findings of a multi-disciplinary focus group study were used to generate a list of walkability criteria to select areas for a population study. In this study twenty areas were shortlisted and grouped under four categories: high walkable deprived, high walkable not deprived, low walkable deprived and low walkable not deprived. This paper presents the process undertaken to identify the study sites. International walkability research has favoured macro-scale objective geographic information systems (GIS) information to identify study areas [2]. While these macro scale attributes are important for walkability, alone they were considered insufficient for site selection by the CGL team as street characteristics were not considered and the attributes had a bias towards transportation walking. Also, indications from the focus group participants were that walkability is perceptual and therefore some resulting criteria were subjective, for example ‘a pleasant atmosphere contextual to area characteristics’ and therefore difficult to measure objectively. The CGL site selection process presented a number of challenges including limitations with available GIS information, unrepresentative neighbourhood boundaries on GIS datasets, and only one deprived neighbourhood identified as high walkable by the focus group participants. An investigation of the role of high and low walkable environments on resident’s behaviours and health can be used to inform future planning, transport, public health and neighbourhood design policies

A picture of medically assisted reproduction activities during the COVID-19 pandemic in Europe

STUDY QUESTION: How did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)? SUMMARY ANSWER: MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks. WHAT IS KNOWN ALREADY: With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020. STUDY DESIGN, SIZE, DURATION: A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email. PARTICIPANTS/MATERIALS, SETTING, METHODS: The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country. MAIN RESULTS AND THE ROLE OF CHANCE: By aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic. LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: Data collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country. WIDER IMPLICATIONS OF THE FINDINGS: The current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations.peer-reviewe

Are neurocognitive factors associated with repetition of self-harm? A systematic review

Background: Prediction of self-harm is limited clinically. Early identification of individuals likely to repeat self-harm could improve outcomes and reduce suicide risk. Various neurocognitive deficits have been found in people who self-harm, but the ability of these to predict repetition has yet to be established Aims: Identify neurocognitive factors that may predict repetition of self-harm. Methods: Systematic narrative review of English language publications assessing neurocognitive functioning and self-harm repetition, searching multiple databases from inception to March 2015. Quality of studies was appraised. A narrative synthesis was performed. Results: 7026 unique records were identified, and 169 full-texts assessed. 15 unique studies provided data. No imaging studies could be included. Most studies assessed cognitive control or problem solving, but neither factor was consistently associated with repetition. However, specific tasks may show promise. Two studies in adolescents suggest that value-based decision-making impairments could be predictive of repetition. There were too few results for memory to draw specific conclusions. Conclusions: Selected studies suggest promise for particular neurocognitive factors and specific cognitive tasks in terms of repetition of self-harm

Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016.

OBJECTIVE: To compare dementia incidence and prevalence after age 50 years by HIV status. DESIGN: Observational cohort, 2000-2016. METHODS: People with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWoH), all aged 50 years and older, were identified from Kaiser Permanente healthcare systems in Northern California, Southern California, and Mid-Atlantic States (Maryland, Virginia, Washington DC). Dementia diagnoses were obtained from electronic health records. Incidence and prevalence of dementia, overall and by time period (i.e. 2000-2002, 2003-2004, …, 2015-2016), were calculated using Poisson regression. Trends were examined using Joinpoint regression. Rate ratios were used to compare dementia by HIV status with adjustment for sociodemographics, substance use, and clinical factors. RESULTS: The study included 13 296 PWH and 155 354 PWoH (at baseline: for both, mean age = 54 years, 89% men; for PWH, 80% with HIV RNA <200 copies/ml). From 2000 to 2016, overall incidence of dementia was higher among PWH [adjusted incidence rate ratio (aIRR) = 1.80, 95% confidence interval (CI) = 1.60-2.04]. Dementia incidence decreased among both PWH and PWoH (-8.0 and -3.1% per period, respectively) but remained higher among PWH in the most recent time period, 2015-2016 (aIRR = 1.58, 95% CI = 1.18-2.12). The overall prevalence of dementia from 2000 to 2016 was higher among PWH [adjusted prevalence ratio (aPR) = 1.86, 95% CI = 1.70-2.04] and was also higher among PWH in 2015-2016 (aPR = 1.75, 95% CI = 1.56-1.97). CONCLUSION: Reductions in dementia incidence are encouraging and may reflect ART improvement, but PWH are still more likely to have dementia than PWoH. Monitoring the burden of dementia among PWH is important as this population ages

Human β defensin-1 and -2 expression in human pilosebaceous units: upregulation in acne vulgaris lesions

A rich residential microflora is harboured by the distal outer root sheath of the hair follicle and the hair canal – normally without causing skin diseases. Although the basic mechanisms involved in the development of inflammation during acne vulgaris remain unclear, microbial agents might play an important role in this process. In this study we have analyzed by in situ hybridization and immunohistochemistry the expression patterns of two antimicrobial peptides, human β defensin-1 and human β defensin-2, in healthy human hair follicles as well as in perilesional and intralesional skin of acne vulgaris lesions such as comedones, papules, and pustules. Strong defensin-1 and defensin-2 immunoreactivity was found in all suprabasal layers of the epidermis, the distal outer root sheath of the hair follicle, and the pilosebaceous duct. Marked defensin-1 and defensin-2 immunoreactivity was also found in the sebaceous gland and in the basal layer of the central outer root sheath including the bulge region. The majority of acne biopsies displayed a marked upregulation of defensin-2 immunoreactivity in the lesional and perilesional epithelium – in particular in pustules – and a less marked upregulation of defensin-1 immunoreactivity. The upregulation of β -defensin expression in acne vulgaris lesions compared to controls suggests that β -defensins may be involved in the pathogenesis of acne vulgaris