A cross sectional study investigating the association between exposure to food outlets and childhood obesity in Leeds, UK.

Background: Current UK policy in relation to the influence of the ‘food environment’ on childhood obesity appears to be driven largely on assumptions or speculations because empirical evidence is lacking and findings from studies are inconsistent. The aim of this study was to investigate the number of food outlets and the proximity of food outlets in the same sample of children, without solely focusing on fast food. Methods: Cross sectional study over 3 years (n = 13,291 data aggregated). Body mass index (BMI) was calculated for each participant, overweight and obesity were defined as having a BMI >85th (sBMI 1.04) and 95th (sBMI 1.64) percentiles respectively (UK90 growth charts). Home and school neighbourhoods were defined as circular buffers with a 2 km Euclidean radius, centred on these locations. Commuting routes were calculated using the shortest straight line distance, with a 2 km buffer to capture varying routes. Data on food outlet locations was sourced from Leeds City Council covering the study area and mapped against postcode. Food outlets were categorised into three groups, supermarkets, takeaway and retail. Proximity to the nearest food outlet in the home and school environmental domain was also investigated. Age, gender, ethnicity and deprivation (IDACI) were included as covariates in all models. Results: There is no evidence of an association between the number of food outlets and childhood obesity in any of these environments; Home Q4 vs. Q1 OR = 1.11 (95% CI = 0.95-1.30); School Q4 vs. Q1 OR = 1.00 (95% CI 0.87 – 1.16); commute Q4 vs. Q1 OR = 0.1.00 (95% CI 0.83 – 1.20). Similarly there is no evidence of an association between the proximity to the nearest food outlet and childhood obesity in the home (OR = 0.77 [95% CI = 0.61 – 0.98]) or the school (OR = 1.01 [95% CI 0.84 – 1.23]) environment. Conclusions: This study provides little support for the notion that exposure to food outlets in the home, school and commuting neighbourhoods increase the risk of obesity in children. It seems that the evidence is not well placed to support Governmental interventions/recommendations currently being proposed and that policy makers should approach policies designed to limit food outlets with caution

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need

Speech Analysis

Contains reports on two research projects

Is BMI alone a sufficient outcome to evaluate interventions for child obesity?

BACKGROUND: BMI is often used to evaluate the effectiveness of childhood obesity interventions, but such interventions may have additional benefits independent of effects on adiposity. We investigated whether benefits to health outcomes following the Mind, Exercise, Nutrition…Do It! (MEND) childhood obesity intervention were independent of or associated with changes in zBMI. METHODS: A total of 79 obese children were measured at baseline; 71 and 42 participants were followed-up at 6 and 12 months respectively, and split into four groups depending on magnitude of change in zBMI. Differences between groups for waist circumference, cardiovascular fitness, physical and sedentary activities, and self-esteem were investigated. RESULTS: Apart from waist circumference and its z-score, there were no differences or trends across zBMI subgroups for any outcome. Independent of the degree of zBMI change, benefits in several parameters were observed in children participating in this obesity intervention. CONCLUSION: We concluded that isolating a single parameter like zBMI change and neglecting other important outcomes is restrictive and may undermine the evaluation of childhood obesity intervention effectiveness

Climate Change in New York State Updating the 2011 ClimAID Climate Risk Information Supplement to NYSERDA Report 11-18 (Responding to Climate Change in New York State)

In its 2013-2014 Fifth Assessment Report (AR5), the Intergovernmental Panel on Climate Change (IPCC) states that there is a greater than 95 percent chance that rising global average temperatures, observed since the mid-20th century, are primarily due to human activities. As had been predicted in the 1800s, the principal driver of climate change over the past century has been increasing levels of atmospheric greenhouse gases associated with fossil-fuel combustion, changing land-use practices, and other human activities. Atmospheric concentrations of the greenhouse gas carbon dioxide are now approximately 40 percent higher than in preindustrial times. Concentrations of other important greenhouse gases, including methane and nitrous oxide, have increased rapidly as well

Participatory Climate Research in a Dynamic Urban Context: Activities of the Consortium for Climate Risk in the Urban Northeast (CCRUN)

The Consortium for Climate Risk in the Urban Northeast (CCRUN), one of ten NOAA-RISAs, supports resilience efforts in the urban corridor stretching from Philadelphia to Boston. Challenges and opportunities include the diverse set of needs in broad urban contexts, as well as the integration of interdisciplinary perspectives. CCRUN is addressing these challenges through strategies including: 1) the development of an integrated project framework, 2) stakeholder surveys, 3) leveraging extreme weather events as focusing opportunities, and 4) a seminar series that enables scientists and stakeholders to partner. While recognizing that the most extreme weather events will always lead to surprises (even with sound planning), CCRUN endeavors to remain flexible by facilitating place-based research in an interdisciplinary context

Making sense of being at 'high risk' of coronary heart disease within primary prevention

types: Journal ArticleCurrent National Health Service policy advocates screening to identify individuals at 'high risk' of cardio-vascular disease (CHD) in primary care. This article utilizes the work of Radley to explore how 'high risk' of CHD patients make sense of their new risk status. Results are presented here from a nested qualitative study within a quantitative randomized trial of a CHD risk intervention in primary care. 'Discovery' interviews were conducted with 'high risk' participants (n = 38, mean age = 55) two weeks after intervention and thematically analysed. In response to perceived threat, many participants sought to both 'minimize' and 'normalize' their risk status. They also reported intentions to act, particularly concerning dietary change and exercise, although less so for smoking amongst the lower socio-economic status participants. Such perceptions and intentions were contextualized within the life-course of later middle-age, so that both being at risk, and being treated for risk, were normalized as part of growing older. Social position, such as gender and SES, was also implicated. CHD risk interventions should be context-sensitive to the life-course and social position of those who find themselves at 'high risk' of CHD in later middle-age

Climate Hazard Assessment for Stakeholder Adaptation Planning in New York City

This paper describes a time-sensitive approach to climate change projections, developed as part of New York City's climate change adaptation process, that has provided decision support to stakeholders from 40 agencies, regional planning associations, and private companies. The approach optimizes production of projections given constraints faced by decision makers as they incorporate climate change into long-term planning and policy. New York City stakeholders, who are well-versed in risk management, helped pre-select the climate variables most likely to impact urban infrastructure, and requested a projection range rather than a single 'most likely' outcome. The climate projections approach is transferable to other regions and consistent with broader efforts to provide climate services, including impact, vulnerability, and adaptation information. The approach uses 16 Global Climate Models (GCMs) and three emissions scenarios to calculate monthly change factors based on 30-year average future time slices relative to a 30- year model baseline. Projecting these model mean changes onto observed station data for New York City yields dramatic changes in the frequency of extreme events such as coastal flooding and dangerous heat events. Based on these methods, the current 1-in-10 year coastal flood is projected to occur more than once every 3 years by the end of the century, and heat events are projected to approximately triple in frequency. These frequency changes are of sufficient magnitude to merit consideration in long-term adaptation planning, even though the precise changes in extreme event frequency are highly uncertai