Cycling in São Paulo, Brazil (1997-2012): Correlates, time trends and health consequences

The purpose of the study was to describe cyclists and cycling trips, and to explore correlates, time trends and health consequences of cycling in São Paulo, Brazil from 1997 to 2012. Cross-sectional analysis using repeated São Paulo Household Travel Surveys (HTS). At all time periods cycling was a minority travel mode in São Paulo (1174 people with cycling trips out of 214,719 people). Poisson regressions for individual correlates were estimated using the entire 2012 HTS sample. Men were six times more likely to cycle than women. We found rates of bicycle use rising over time among the richest quartile but total cycling rates dropped from 1997 to 2012 due to decreasing rates among the poor. Harms from air pollution would negate benefits from physical activity through cycling only at 1997 air pollution levels and at very high cycling levels (≥ 9 h of cycling per day). Exposure-based road injury risk decreased between 2007 and 2012, from 0.76 to 0.56 cyclist deaths per 1000 person-hours travelled. Policies to reduce spatial segregation, measures to tackle air pollution, improvements in dedicated cycling infrastructure, and integrating the bicycle with the public transport system in neighborhoods of all income levels could make cycling safer and prevent more individuals from abandoning the cycling mode in São Paulo.THS acknowledges funding from the Brazilian Science without Borders Scheme (Process number: 200358/2014-6) and the Sao Paulo Research Foundation (Process number: 2012/08565-4). ACD received a postdoctoral research fellowship from the Brazilian National Council for Scientific and Technological Development (249038/2013-7). MT and JW: The work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust (MR/K023187/1), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged

Mortality, greenhouse gas emissions and consumer cost impacts of combined diet and physical activity scenarios: a health impact assessment study

$\textbf{Objective:}$ To quantify changes in mortality, greenhouse gas (GHG) emissions and consumer costs for physical activity and diet scenarios. $\textbf{Design:}$ For the physical activity scenarios, all car trips from <1 to <8 miles long were progressively replaced with cycling. For the diet scenarios, the study population was assumed to increase fruit and vegetable (F&V) consumption by 1–5 portions of F&V per day, or to eat at least 5 portions per day. Health effects were modelled with the comparative risk assessment method. Consumer costs were based on fuel cost savings and average costs of F&V, and GHG emissions to fuel usage and F&V production. $\textbf{Setting:}$ Working age population for England. $\textbf{Participants:}$ Data from the Health Survey for England, National Travel Survey and National Diet and Nutrition Survey. $\textbf{Primary outcomes measured:}$ Changes in premature deaths, consumer costs and GHG emissions stratified by age, gender and socioeconomic status (SES). $\textbf{Results:}$ Premature deaths were reduced by between 75 and 7648 cases per year for the physical activity scenarios, and 3255 and 6187 cases per year for the diet scenarios. Mortality reductions were greater among people of medium and high SES in the physical activity scenarios, whereas people with lower SES benefited more in the diet scenarios. Similarly, transport fuel costs fell more for people of high SES, whereas diet costs increased most for the lowest SES group. Net GHG emissions decreased by between 0.2 and 10.6 million tons of carbon dioxide equivalent (MtCO$_2$e) per year for the physical activity scenarios and increased by between 1.3 and 6.3 MtCO$_2$e/year for the diet scenarios. $\textbf{Conclusions:}$ Increasing F&V consumption offers the potential for large health benefits and reduces health inequalities. Replacing short car trips with cycling offers the potential for net benefits for health, GHG emissions and consumer costs.MT, PM, NJ and JW were supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. JW is also supported by an MRC Population Health Scientist fellowship (grant number: MR/K021796/1). CB is supported by the UK Research Councils (grant number: EPSRC EP/L024756/1) as part of the Decision Making Theme of the UK Energy Research Centre Phase 3

Miten perusopetus tukee esimurrosikäisen lapsen kokonaisvaltaista kasvua ja kehitystä?

Tiivistelmä. Tässä kandidaatintutkielmassa tarkastellaan sitä, miten suomalainen perusopetusjärjestelmä tukee lapsen kokonaisvaltaista kasvua ja kehitystä esimurrosiässä. Esimurrosikää kehitysvaiheena on syytä tarkastella, sillä se tuo mukanaan suuria muutoksia lapsen persoonallisessa, älyllisessä, sosiaalisessa ja fyysisessä kehityksessä. Tutkielma on tutkimusotteeltaan laadullinen eli kvalitatiivinen. Tutkimusmetodeina on käytetty kuvailevaa kirjallisuuskatsausta sekä haastattelua. Kuvailevan kirjallisuuskatsauksen keinoin on muodostettu tutkielman aiheen kannalta keskeinen teoreettinen viitekehys. Haastattelemalla kasvatusalan ammattilaisia on puolestaan saatu selville tutkielman aiheeseen liittyviä keskeisiä käytännön näkökulmia. Tutkielman tuloksena saatiin selville, että perusopetuksella on lapsen esimurrosiässä tapahtuvan kasvun ja kehityksen kannalta merkittävä rooli. Perusopetuksen opetussuunnitelmassa esimurrosikä ei käsitteenä ilmene. Opetussuunnitelman tulkinnanvaraisuuden vuoksi esimurrosikään liittyvä kasvun ja kehityksen tuki toteutuu ensisijaisesti käytännön kasvatus- ja opetustyössä. Tutkielman luotettavuuden kannalta merkittävinä tekijöinä voidaan pitää vertaisarvioitua tutkimuskirjallisuutta sekä haastateltavien pedagogiseen ammattitaitoon pohjautuvaa haastatteluaineistoa. Tutkielma tarjoaa aiheesta kiinnostuneille katsauksen siitä, mitä esimurrosikä kehitysvaiheena pitää sisällään, ja miten se saattaa näkyä koulun arjessa

An economic way of reducing health, environmental, and other pressures of urban traffic: a decision analysis on trip aggregation

BACKGROUND: Traffic congestion is rapidly becoming the most important obstacle to urban development. In addition, traffic creates major health, environmental, and economical problems. Nonetheless, automobiles are crucial for the functions of the modern society. Most proposals for sustainable traffic solutions face major political opposition, economical consequences, or technical problems. METHODS: We performed a decision analysis in a poorly studied area, trip aggregation, and studied decisions from the perspective of two different stakeholders, the passenger and society. We modelled the impact and potential of composite traffic, a hypothetical large-scale demand-responsive public transport system for the Helsinki metropolitan area, where a centralised system would collect the information on all trip demands online, would merge the trips with the same origin and destination into public vehicles with eight or four seats, and then would transmit the trip instructions to the passengers' mobile phones. RESULTS: We show here that in an urban area with one million inhabitants, trip aggregation could reduce the health, environmental, and other detrimental impacts of car traffic typically by 50–70%, and if implemented could attract about half of the car passengers, and within a broad operational range would require no public subsidies. CONCLUSION: Composite traffic provides new degrees of freedom in urban decision-making in identifying novel solutions to the problems of urban traffic

The modelled impact of increases in physical activity: the effect of both increased survival and reduced incidence of disease

Physical activity can affect ‘need’ for healthcare both by reducing the incidence rate of some diseases and by increasing longevity (increasing the time lived at older ages when disease incidence is higher). However, it is common to consider only the first effect, which may overestimate any reduction in need for healthcare. We developed a hybrid micro-simulation lifetable model, which made allowance for both changes in longevity and risk of disease incidence, to estimate the effects of increases in physical activity (all adults meeting guidelines) on measures of healthcare need for diseases for which physical activity is protective. These were compared with estimates made using comparative risk assessment (CRA) methods, which assumed that longevity was fixed. Using the lifetable model, life expectancy increased by 95 days (95% uncertainty intervals: 68–126 days). Estimates of the healthcare need tended to decrease, but the magnitude of the decreases were noticeably smaller than those estimated using CRA methods (e.g. dementia: change in person- years, -0.6%, 95% uncertainty interval -3.7% to +1.6%; change in incident cases, -0.4%, -3.6% to +1.9%; change in person-years (CRA methods), -4.0%, -7.4% to -1.6%). The pattern of results persisted under different scenarios and sensitivity analyses. For most diseases for which physical activity is protective, increases in physical activity are associated with decreases in indices of healthcare need. However, disease onset may be delayed or time lived with disease may increase, such that the decreases in need may be relatively small and less than is sometimes expected.Oliver Mytton is supported by a Welcome Trust clinical doctoral fellowship (RG73907). Marko Tainio is funded by the Centre for Diet and Activity Research (CEDAR), which receives funding from UK Clinical Research Collaboration. David Ogilvie and Jenna Panter are supported by the Medical Research Council [Unit Programme number MC_UU_12015/6]. Jenna Panter was supported by an NIHR post-doctoral fellowship [PDF-2012-05-157]. Linda Cobiac is supported by an NHMRC Sidney Sax Early Career Research Fellowship (Grant ID: 1036771). James Woodcock is funded by an MRC Population Health Scientist Fellowship

Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance : systematic review and meta-analysis

OBJECTIVE To estimate the regression, persistence, and progression of untreated cervical intraepithelial neoplasia grade 2 (CIN2) lesions managed conservatively as well as compliance with follow-up protocols. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1 January 1973 to 20 August 2016. ELIGIBILITY CRITERIA Studies reporting on outcomes of histologically confirmed CIN2 in non-pregnant women, managed conservatively for three or more months. DATA SYNTHESIS Two reviewers extracted data and assessed risk of bias. Random effects model was used to calculate pooled proportions for each outcome, and heterogeneity was assessed using I-2 statistics. MAIN OUTCOME MEASURES Rates of regression, persistence, or progression of CIN2 and default rates at different follow-up time points (3, 6, 12, 24, 36, and 60 months). RESULTS 36 studies that included 3160 women were identified (seven randomised trials, 16 prospective cohorts, and 13 retrospective cohorts; 50% of the studies were at low risk of bias). At 24 months, the pooled rates were 50% (11 studies, 819/1470 women, 95% confidence interval 43% to 57%; I-2= 77%) for regression, 32% (eight studies, 334/1257 women, 23% to 42%; I-2= 82%) for persistence, and 18% (nine studies, 282/1445 women, 11% to 27%; I-2= 90%) for progression. In a subgroup analysis including 1069 women aged less than 30 years, the rates were 60% (four studies, 638/1069 women, 57% to 63%; I-2= 0%), 23% (two studies, 226/938 women, 20% to 26%; I-2= 97%), and 11% (three studies, 163/1033 women, 5% to 19%; I-2= 67%), respectively. The rate of non-compliance (at six to 24 months of follow-up) in prospective studies was around 10%. CONCLUSIONS Most CIN2 lesions, particularly in young women (<30 years), regress spontaneously. Active surveillance, rather than immediate intervention, is therefore justified, especially among young women who are likely to adhere to monitoring.Peer reviewe

Health impact assessment of particulate pollution in Tallinn using fine spatial resolution and modeling techniques

<p>Abstract</p> <p>Background</p> <p>Health impact assessments (HIA) use information on exposure, baseline mortality/morbidity and exposure-response functions from epidemiological studies in order to quantify the health impacts of existing situations and/or alternative scenarios. The aim of this study was to improve HIA methods for air pollution studies in situations where exposures can be estimated using GIS with high spatial resolution and dispersion modeling approaches.</p> <p>Methods</p> <p>Tallinn was divided into 84 sections according to neighborhoods, with a total population of approx. 390 000 persons. Actual baseline rates for total mortality and hospitalization with cardiovascular and respiratory diagnosis were identified. The exposure to fine particles (PM_2.5) from local emissions was defined as the modeled annual levels. The model validation and morbidity assessment were based on 2006 PM₁₀or PM_2.5levels at 3 monitoring stations. The exposure-response coefficients used were for total mortality 6.2% (95% CI 1.6–11%) per 10 μg/m³increase of annual mean PM_2.5concentration and for the assessment of respiratory and cardiovascular hospitalizations 1.14% (95% CI 0.62–1.67%) and 0.73% (95% CI 0.47–0.93%) per 10 μg/m³increase of PM₁₀. The direct costs related to morbidity were calculated according to hospital treatment expenses in 2005 and the cost of premature deaths using the concept of Value of Life Year (VOLY).</p> <p>Results</p> <p>The annual population-weighted-modeled exposure to locally emitted PM_2.5in Tallinn was 11.6 μg/m³. Our analysis showed that it corresponds to 296 (95% CI 76528) premature deaths resulting in 3859 (95% CI 10236636) Years of Life Lost (YLL) per year. The average decrease in life-expectancy at birth per resident of Tallinn was estimated to be 0.64 (95% CI 0.17–1.10) years. While in the polluted city centre this may reach 1.17 years, in the least polluted neighborhoods it remains between 0.1 and 0.3 years. When dividing the YLL by the number of premature deaths, the decrease in life expectancy among the actual cases is around 13 years. As for the morbidity, the short-term effects of air pollution were estimated to result in an additional 71 (95% CI 43–104) respiratory and 204 (95% CI 131–260) cardiovascular hospitalizations per year. The biggest external costs are related to the long-term effects on mortality: this is on average €150 (95% CI 40–260) million annually. In comparison, the costs of short-term air-pollution driven hospitalizations are small €0.3 (95% CI 0.2–0.4) million.</p> <p>Conclusion</p> <p>Sectioning the city for analysis and using GIS systems can help to improve the accuracy of air pollution health impact estimations, especially in study areas with poor air pollution monitoring data but available dispersion models.</p

Impact of borosilicate bioactive glass scaffold processing and reactivity on in-vitro dissolution properties

In this study, bulk borosilicate glasses and 3D scaffolds (processed by the burn-off technique and by robocasting) were synthesized to investigate the impact of the manufacturing method, glass composition and preincubation time on in vitro dissolution and cell response. The studied compositions are based on commercial bioactive glass S53P4 (BonAlive) where 12.5% SiO2 has been replaced by B2O (labelled B12.5), and part of the CaO is replaced with MgO and SrO (labelled B12.5-Mg-Sr). First, the impact of the processing and glass composition, on the dissolution rate, was assessed. As expected, scaffolds were found to exhibit faster dissolution, due to the increased surface area, when compared to the bulk glass. Furthermore, the 3D printed scaffolds were found to dissolve faster than the burn-off scaffolds. Moreover, scaffolds made from B12.5-Mg-Sr glass composition exhibited slower ion release and precipitation of calcium phosphate (CaP) layer, when compared to B12.5, due to the stabilizing effect of Mg and Sr. Finally, dynamic condition produces lower ion releases that static condition and could be more optimal for in vitro cell growth. Secondly, in culture with murine MC3T3-E1 cells, it was shown that 3 days preincubation would be optimal to decrease the burst of ions that is known to lead to cell death. However, it was found that MC3T3-E1 survived and proliferated only in presence of B12.5-Mg-Sr scaffolds. Finally, it was shown that despite scaffolds having different porosities, they had no significant difference on human adipose-derived stem cells (hADSCs) survival. This manuscript brings new information on 1) the impact of material design (porosity) and composition on dissolution kinetic sand reactivity, 2) the impact of static vs dynamic testing on in-vitro dissolution and 3) the impact of materials’ pre-incubation on cell behavior.publishedVersionPeer reviewe

Parameter and model uncertainty in a life-table model for fine particles (PM2.5): a statistical modeling study

<p>Abstract</p> <p>Background</p> <p>The estimation of health impacts involves often uncertain input variables and assumptions which have to be incorporated into the model structure. These uncertainties may have significant effects on the results obtained with model, and, thus, on decision making. Fine particles (PM_2.5) are believed to cause major health impacts, and, consequently, uncertainties in their health impact assessment have clear relevance to policy-making. We studied the effects of various uncertain input variables by building a life-table model for fine particles.</p> <p>Methods</p> <p>Life-expectancy of the Helsinki metropolitan area population and the change in life-expectancy due to fine particle exposures were predicted using a life-table model. A number of parameter and model uncertainties were estimated. Sensitivity analysis for input variables was performed by calculating rank-order correlations between input and output variables. The studied model uncertainties were (i) plausibility of mortality outcomes and (ii) lag, and parameter uncertainties (iii) exposure-response coefficients for different mortality outcomes, and (iv) exposure estimates for different age groups. The monetary value of the years-of-life-lost and the relative importance of the uncertainties related to monetary valuation were predicted to compare the relative importance of the monetary valuation on the health effect uncertainties.</p> <p>Results</p> <p>The magnitude of the health effects costs depended mostly on discount rate, exposure-response coefficient, and plausibility of the cardiopulmonary mortality. Other mortality outcomes (lung cancer, other non-accidental and infant mortality) and lag had only minor impact on the output. The results highlight the importance of the uncertainties associated with cardiopulmonary mortality in the fine particle impact assessment when compared with other uncertainties.</p> <p>Conclusion</p> <p>When estimating life-expectancy, the estimates used for cardiopulmonary exposure-response coefficient, discount rate, and plausibility require careful assessment, while complicated lag estimates can be omitted without this having any major effect on the results.</p