Blue space exposure, health and well-being: Does freshwater type matter?

There is growing evidence that spending time in or around water bodies or ‘blue spaces’ can result in improved human health. To date, investigations of the health-promoting potential of blue space exposure have mostly focused on coastal environments. Despite their vital role in many urban landscapes, freshwater blue spaces have received less research attention and very little is known about the potential of different freshwater blue space types to impact health and well-being. This study used logistic and negative binomial regression modelling to quantify the association between proximity and exposure to different freshwater blue space types and general health and mental well-being in Scotland. A nationwide online panel survey (n = 1392) was used to determine how far respondents lived from lakes, rivers and canals and to establish how often they visited these blue spaces. Living within a ten minute walking distance of lakes, rivers or canals was not associated with greater general health or mental well-being. However, frequently visiting rivers and canals but not lakes, in the last month, was associated with greater mental well-being. Frequent green space visitation, but not blue space visitation, was associated with higher odds of reporting good general health. Taken together, our findings suggest that freshwater blue space exposure can provide mental well-being benefits. However, the provision of these benefits may vary among different freshwater blue space types. Understanding the health and well-being impact of different freshwater environments, therefore, offers opportunities for evidence-based policymaking to maximise the health-promoting potential of urban blue spaces

Effects of dietary nitrate supplementation on oral health and associated markers of systemic health:a systematic review

Poor oral health can impact an individual’s ability to eat and has been associated with an increased risk of non-communicable diseases. While the benefits of nitrate consumption on oral health were first proposed more than 20 years ago, no systematic review has been published examining effects of dietary nitrate on oral health. This systematic review investigated the effects of dietary nitrate on markers of oral health in vivo in randomized controlled trials (RCTs). Five databases (PubMed, The Cochrane Library, CINAHL, MEDLINE, and SPORTDiscus) were searched from inception until March 2023. Nine articles reporting data on 284 participants were included. Dietary nitrate was provided via beetroot juice in most studies. The duration of the interventions ranged from one day to six weeks. Dietary nitrate supplementation increased the relative abundance of several individual bacterial genera including Neisseria and Rothia. Dietary nitrate supplementation increased salivary pH and decreased salivary acidification following consumption of a sugar-sweetened beverage. Furthermore, dietary nitrate supplementation resulted in a decrease in the gingival inflammation index. The results of this systematic review suggest that dietary nitrate could represent a potential nutritional strategy to positively modify oral health by impacting the oral microbiome, altering salivary pH, and minimizing gingival inflammation

Freshwater Wild Swimming, Health and Well-Being: Understanding the Importance of Place and Risk

Spending time in or around bodies of water or ‘blue spaces’ can benefit human health and well-being. A growing body of evidence suggests immersion in blue space, e.g., participating in ‘wild’ swimming, can be particularly beneficial for both physical and mental health. To date, wild swimming and health research has primarily focused on the experience of individuals who swim in the sea. Empirical studies of the health-promoting potential of swimming in freshwater environments, such as lochs and lakes, are lacking, despite the popularity of this practice in many countries and the vastly different physical and hydrological properties of freshwater and coastal environments. The aim of this study was to explore the relationship between loch (lake) swimming and health and well-being for adults living in Scotland and determine the importance of perceptions of place and risk in this relationship. Semi-structured interviews were conducted with twelve wild swimmers who regularly swim in lochs in Scotland. Interview data were analysed thematically using Nvivo. The findings suggest loch swimming has a variety of health and well-being benefits that can be categorised over three domains of health: physical, mental and social. Of these domains, mental health benefits e.g., mindfulness promotion, resilience building and increasing one’s ability to listen to their body, were particularly prominent. Our findings also highlight important physical and hydrological characteristics of loch environments, e.g., calm water conditions (relative to the sea), which contribute to positive wild swimming experiences. Finally, the perceived risks of loch swimming and mitigation strategies for these risks are established. Collectively, our findings further support the notion that wild swimming is a unique health-promoting practice. Our findings also highlight differences (in terms of experience and perceived risk) between swimming in freshwater and coastal environments, which can inform public health and water management policy

Valuing inland blue space: A contingent valuation study of two large freshwater lakes

Water bodies, or blue spaces, offer a range of health and well-being benefits. Many of these benefits occur in waterside spaces and do not require direct water contact. For example, non-water based physical activity (e.g. walking and running) or reduced stress as a result of viewing water from a distance. However, research dedicated to understanding the economic impact of changes to freshwater ecosystems predominantly focuses on water-based recreation and water quality. As a result, the economic impacts of changes to waterside space are often overlooked. This study used the contingent valuation method to determine public preference for the protection of lakeside quality, in terms of lake views, path quality and lakeside access, at two large freshwater lakes in Scotland (Loch Lomond and Loch Leven). The aim of the study was to estimate willingness to pay among a sample of adults in Scotland (n = 1056) for the protection of lakeside quality. Results indicate that the majority of respondents are willing to pay for the preservation of lakeside quality at each lake. Based upon the most conservative estimates obtained, mean willingness to pay for the protection of lakeside quality was £12.06 per household per year at Loch Lomond and £8.44 at Loch Leven. These findings provide valuable economic data and suggest that changes to waterside space at destination water bodies have nationally important economic impacts. Greater consideration of the economic impact of changes to lakeside space is recommended in order to develop cost-effective and socially optimal water resource management policies at large freshwater lakes

Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort.

OBJECTIVES: To describe the characteristics of children and adults with incident type 1 diabetes in contemporary, multiethnic UK, focusing on differences between the islet autoantibody negative and positive. DESIGN: Observational cohort study. SETTING: 146 mainly secondary care centres across England and Wales. PARTICIPANTS: 3312 people aged ≥5 years were recruited within 6 months of a clinical diagnosis of type 1 diabetes via the National Institute for Health Research Clinical Research Network. 3021 were of white European ethnicity and 291 (9%) were non-white. There was a small male predominance (57%). Young people <17 years comprised 59%. MAIN OUTCOME MEASURES: Autoantibody status and characteristics at presentation. RESULTS: The majority presented with classical osmotic symptoms, weight loss and fatigue. Ketoacidosis was common (42%), especially in adults, and irrespective of ethnicity. 35% were overweight or obese. Of the 1778 participants who donated a blood sample, 85% were positive for one or more autoantibodies against glutamate decarboxylase, islet antigen-2 and zinc transporter 8. Presenting symptoms were similar in the autoantibody-positive and autoantibody-negative participants, as was the frequency of ketoacidosis (43%vs40%, P=0.3). Autoantibody positivity was less common with increasing age (P=0.0001), in males compared with females (82%vs90%, P<0.0001) and in people of non-white compared with white ethnicity (73%vs86%, P<0.0001). Body mass index was higher in autoantibody-negative adults than autoantibody-positive adults (median, IQR 25.5, 23.1-29.2vs23.9, 21.4-26.7 kg/m2; P=0.0001). Autoantibody-negative participants were more likely to have a parent with diabetes (28%vs16%, P<0.0001) and less likely to have another autoimmune disease (4%vs8%, P=0.01). CONCLUSIONS: Most people assigned a diagnosis of type 1 diabetes presented with classical clinical features and islet autoantibodies. Although indistinguishable at an individual level, autoantibody-negative participants as a group demonstrated features more typically associated with other diabetes subtypes. TRIAL REGISTRATION NUMBER: ISRCTN66496918; Pre-results

Use of Antiviral Drugs to Reduce Household Transmission of Pandemic (H1N1) 2009, United Kingdom1

TOC Summary: Early treatment of primary case-patients and prophylaxis of household contacts provides effective protection

A synthesis is emerging between biodiversity–ecosystem function and ecological resilience research: reply to Mori

Letter

Biodiversity and resilience of ecosystem functions

Accelerating rates of environmental change and the continued loss of global biodiversity threaten functions and services delivered by ecosystems. Much ecosystem monitoring and management is focused on the provision of ecosystem functions and services under current environmental conditions, yet this could lead to inappropriate management guidance and undervaluation of the importance of biodiversity. The maintenance of ecosystem functions and services under substantial predicted future environmental change (i.e., their ‘resilience’) is crucial. Here we identify a range of mechanisms underpinning the resilience of ecosystem functions across three ecological scales. Although potentially less important in the short term, biodiversity, encompassing variation from within species to across landscapes, may be crucial for the longer-term resilience of ecosystem functions and the services that they underpin

Existing and potential infection risk zones of yellow fever worldwide: a modelling analysis.

BACKGROUND: Yellow fever cases are under-reported and the exact distribution of the disease is unknown. An effective vaccine is available but more information is needed about which populations within risk zones should be targeted to implement interventions. Substantial outbreaks of yellow fever in Angola, Democratic Republic of the Congo, and Brazil, coupled with the global expansion of the range of its main urban vector, Aedes aegypti, suggest that yellow fever has the propensity to spread further internationally. The aim of this study was to estimate the disease's contemporary distribution and potential for spread into new areas to help inform optimal control and prevention strategies. METHODS: We assembled 1155 geographical records of yellow fever virus infection in people from 1970 to 2016. We used a Poisson point process boosted regression tree model that explicitly incorporated environmental and biological explanatory covariates, vaccination coverage, and spatial variability in disease reporting rates to predict the relative risk of apparent yellow fever virus infection at a 5 × 5 km resolution across all risk zones (47 countries across the Americas and Africa). We also used the fitted model to predict the receptivity of areas outside at-risk zones to the introduction or reintroduction of yellow fever transmission. By use of previously published estimates of annual national case numbers, we used the model to map subnational variation in incidence of yellow fever across at-risk countries and to estimate the number of cases averted by vaccination worldwide. FINDINGS: Substantial international and subnational spatial variation exists in relative risk and incidence of yellow fever as well as varied success of vaccination in reducing incidence in several high-risk regions, including Brazil, Cameroon, and Togo. Areas with the highest predicted average annual case numbers include large parts of Nigeria, the Democratic Republic of the Congo, and South Sudan, where vaccination coverage in 2016 was estimated to be substantially less than the recommended threshold to prevent outbreaks. Overall, we estimated that vaccination coverage levels achieved by 2016 avert between 94 336 and 118 500 cases of yellow fever annually within risk zones, on the basis of conservative and optimistic vaccination scenarios. The areas outside at-risk regions with predicted high receptivity to yellow fever transmission (eg, parts of Malaysia, Indonesia, and Thailand) were less extensive than the distribution of the main urban vector, A aegypti, with low receptivity to yellow fever transmission in southern China, where A aegypti is known to occur. INTERPRETATION: Our results provide the evidence base for targeting vaccination campaigns within risk zones, as well as emphasising their high effectiveness. Our study highlights areas where public health authorities should be most vigilant for potential spread or importation events. FUNDING: Bill & Melinda Gates Foundation

Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis.

BACKGROUND: Substantial outbreaks of yellow fever in Angola and Brazil in the past 2 years, combined with global shortages in vaccine stockpiles, highlight a pressing need to assess present control strategies. The aims of this study were to estimate global yellow fever vaccination coverage from 1970 through to 2016 at high spatial resolution and to calculate the number of individuals still requiring vaccination to reach population coverage thresholds for outbreak prevention. METHODS: For this adjusted retrospective analysis, we compiled data from a range of sources (eg, WHO reports and health-service-provider registeries) reporting on yellow fever vaccination activities between May 1, 1939, and Oct 29, 2016. To account for uncertainty in how vaccine campaigns were targeted, we calculated three population coverage values to encompass alternative scenarios. We combined these data with demographic information and tracked vaccination coverage through time to estimate the proportion of the population who had ever received a yellow fever vaccine for each second level administrative division across countries at risk of yellow fever virus transmission from 1970 to 2016. FINDINGS: Overall, substantial increases in vaccine coverage have occurred since 1970, but notable gaps still exist in contemporary coverage within yellow fever risk zones. We estimate that between 393·7 million and 472·9 million people still require vaccination in areas at risk of yellow fever virus transmission to achieve the 80% population coverage threshold recommended by WHO; this represents between 43% and 52% of the population within yellow fever risk zones, compared with between 66% and 76% of the population who would have required vaccination in 1970. INTERPRETATION: Our results highlight important gaps in yellow fever vaccination coverage, can contribute to improved quantification of outbreak risk, and help to guide planning of future vaccination efforts and emergency stockpiling. FUNDING: The Rhodes Trust, Bill & Melinda Gates Foundation, the Wellcome Trust, the National Library of Medicine of the National Institutes of Health, the European Union's Horizon 2020 research and innovation programme