Neighborhood deprivation and biomarkers of health in Britain: The mediating role of the physical environment

Background: Neighborhood deprivation has been consistently linked to poor individual health outcomes; however, studies exploring the mechanisms involved in this association are scarce. The objective of this study was to investigate whether objective measures of the physical environment mediate the association between neighborhood socioeconomic deprivation and biomarkers of health in Britain. Methods: We linked individual-level biomarker data from Understanding Society: The UK Household Longitudinal Survey (2010-2012) to neighborhood-level data from different governmental sources. Our outcome variables were forced expiratory volume in 1 s (FEV1%; n=16,347), systolic blood pressure (SBP; n=16,846), body mass index (BMI; n=19,417), and levels of C-reactive protein (CRP; n=11,825). Our measure of neighborhood socioeconomic deprivation was the Carstairs index, and the neighborhood-level mediators were levels of air pollutants (sulphur dioxide [SO2], particulate matter [PM10], nitrogen dioxide [NO2], and carbon monoxide [CO]), green space, and proximity to waste and industrial facilities. We fitted a multilevel mediation model following a multilevel structural equation framework in MPlus v7.4, adjusting for age, gender, and income. Results: Residents of poor neighborhoods and those exposed to higher pollution and less green space had worse health outcomes. However, only SO2exposure significantly and partially mediated the association between neighborhood socioeconomic deprivation and SBP, BMI, and CRP. Conclusion: Reducing air pollution exposure and increasing access to green space may improve population health but may not decrease health inequalities in Britain

Ancillary human health benefits of improved air quality resulting from climate change mitigation

<p>Abstract</p> <p>Background</p> <p>Greenhouse gas (GHG) mitigation policies can provide ancillary benefits in terms of short-term improvements in air quality and associated health benefits. Several studies have analyzed the ancillary impacts of GHG policies for a variety of locations, pollutants, and policies. In this paper we review the existing evidence on ancillary health benefits relating to air pollution from various GHG strategies and provide a framework for such analysis.</p> <p>Methods</p> <p>We evaluate techniques used in different stages of such research for estimation of: (1) changes in air pollutant concentrations; (2) avoided adverse health endpoints; and (3) economic valuation of health consequences. The limitations and merits of various methods are examined. Finally, we conclude with recommendations for ancillary benefits analysis and related research gaps in the relevant disciplines.</p> <p>Results</p> <p>We found that to date most assessments have focused their analysis more heavily on one aspect of the framework (e.g., economic analysis). While a wide range of methods was applied to various policies and regions, results from multiple studies provide strong evidence that the short-term public health and economic benefits of ancillary benefits related to GHG mitigation strategies are substantial. Further, results of these analyses are likely to be underestimates because there are a number of important unquantified health and economic endpoints.</p> <p>Conclusion</p> <p>Remaining challenges include integrating the understanding of the relative toxicity of particulate matter by components or sources, developing better estimates of public health and environmental impacts on selected sub-populations, and devising new methods for evaluating heretofore unquantified and non-monetized benefits.</p

An overview of geospatial methods used in unintentional injury epidemiology

BACKGROUND: Injuries are a leading cause of death and disability around the world. Injury incidence is often associated with socio-economic and physical environmental factors. The application of geospatial methods has been recognised as important to gain greater understanding of the complex nature of injury and the associated diverse range of geographically-diverse risk factors. Therefore, the aim of this paper is to provide an overview of geospatial methods applied in unintentional injury epidemiological studies. METHODS: Nine electronic databases were searched for papers published in 2000-2015, inclusive. Included were papers reporting unintentional injuries using geospatial methods for one or more categories of spatial epidemiological methods (mapping; clustering/cluster detection; and ecological analysis). Results describe the included injury cause categories, types of data and details relating to the applied geospatial methods. RESULTS: From over 6,000 articles, 67 studies met all inclusion criteria. The major categories of injury data reported with geospatial methods were road traffic (n = 36), falls (n = 11), burns (n = 9), drowning (n = 4), and others (n = 7). Grouped by categories, mapping was the most frequently used method, with 62 (93%) studies applying this approach independently or in conjunction with other geospatial methods. Clustering/cluster detection methods were less common, applied in 27 (40%) studies. Three studies (4%) applied spatial regression methods (one study using a conditional autoregressive model and two studies using geographically weighted regression) to examine the relationship between injury incidence (drowning, road deaths) with aggregated data in relation to explanatory factors (socio-economic and environmental). CONCLUSION: The number of studies using geospatial methods to investigate unintentional injuries has increased over recent years. While the majority of studies have focused on road traffic injuries, other injury cause categories, particularly falls and burns, have also demonstrated the application of these methods. Geospatial investigations of injury have largely been limited to mapping of data to visualise spatial structures. Use of more sophisticated approaches will help to understand a broader range of spatial risk factors, which remain under-explored when using traditional epidemiological approaches

Strength training for physical performance and injury prevention in sports. Individualised and supervised training for female athletes.

The overall purpose of this thesis was to obtain knowledge about individualised, supervised strength and conditioning programmes for physical performance and injury prevention in female athletes. Data are presented both on the influence of individualisation and supervision during resistance training for physical performance and injury prevention and on the athletes’ experience of resistance training and the role of the physical coach. Data are also presented on physical performance testing and injury prevalence and preventive action in female volleyball. Study I: The purpose of this study was to examine the prevalence of injury and the extent of preventive action in elite Swedish volleyball players. Injuries to players in the elite male and female Swedish division, during the 2002-2003 season, were registered using a questionnaire. Of the 158 volleyball players, a total of 82 players (52%) reported 121 injuries, during a total exposure time of 24,632 h. The majority of the injuries were located in the ankle, knee and back. Most injuries were classified as being of minor severity. Although most players took part in some kind of preventive action, one in every two players incurred an injury during the season, which indicates that the risk of suffering an injury in elite volleyball is relatively high. Study II: The purpose of Study II was to evaluate the test-retest reliability of sit-ups and push-ups and to investigate performance differences in muscular endurance (maximum number of repetitions) and power (timed; maximum number of repetitions in 30 s) in young women and men. Thirty-eight women and 25 men (age18-35) participated in the study. Thirteen female participants performed two test sessions of each test using a test-retest design. A high level of reliability was noted for both the sit-up and the push-up tests. There were no significant differences between the men and the women in the sit-up test, whereas the men performed significantly more push-ups than the women. Study III: The purpose of Study III was to evaluate the effects of a 26-week individualised and supervised strength and injury-prevention programme on performance enhancement. Young female volleyball players completed resistance training with either a supervised, individualised training programme (experimental group; n=10) or an unsupervised, non-individualised training programme (control group; n=17). Exposure and injury data were collected during the 2006-2007 season (baseline) and the 26-week programme with physical performance testing was carried out during the 2007-2008 season. After the intervention, the experimental group had improved significantly more (p<0.05) than the control group in the squat, barbell bench press, push-ups and sit-ups. Individualisation and supervision of resistance training seem to improve greater training adherence and strength gains compared with non-individualised and unsupervised training. Study IV: The purpose of Study IV was to explore and describe volleyball players’ experience of an individualised, supervised strength-training programme aiming at physical performance and injury prevention. The purpose was also to use the players’ observations to obtain an understanding of the role of a physical coach. The study comprised nine participants (mean age 19 years) who had been involved as the experimental group in Study III. Data were collected using semi-structured interviews and were analysed using qualitative conventional content analysis. Three overarching themes describing the content of the text emerged: 1) being in an enjoyable, relaxed situation, 2) interaction between coach and athlete and 3) mental and physical achievements. Conclusions: Individualisation and supervision appear to be of importance for compliance, strength gains and athletic performance, during strength training. From the female team athletes’ perspective, the willingness to perform strength training is dependent on team spirit, individual goal-setting and bonding with the coach. Strength training, on the one hand, could be used to improve self-esteem among young females. On the other hand, when designing strength-training intervention studies, it is important to be aware of the fear and feeling of uncertainty that may exist among the participants when it comes to strength training