Diabetes knowledge, self-efficacy and dietary, psychological and physical health barriers: Comparing young and usual-onset type 2 diabetes.

AIMS: Young-onset (21-39 years old) type 2 diabetes (YOD) is associated with high complication rates and glycaemic levels, and poor self-management plays a significant role. Knowledge, skills and barriers influence self-management behaviours considerably. Therefore, this study assessed diabetes knowledge, self-efficacy and barriers (situational dietary barriers, physical health, mental health and diabetes-related distress) between participants with young and usual-onset (40-59 years old) (UOD) diabetes. METHODOLOGY: A cross-sectional survey was conducted. Differences between YOD and UOD were analysed using bivariate analysis and effect sizes were estimated with Cohen's d. Differences were further adjusted by demographic factors (gender, ethnicity, marital status, educational level, income level) and diabetes duration. RESULTS: A total of 409 (97 YOD, 312 UOD) participants were recruited. Participants with YOD had lower self-efficacy levels (adjusted B = -0.19, CI -0.35 to -0.03) and higher dietary barriers (adjusted B = 3.6, CI 2.1-5.1), lower mental health scores (adjusted B = -3.5, CI -5.7 to -1.4) and higher diabetes-related distress levels (adjusted B = 0.2, CI 0.2-0.4). CONCLUSIONS: Our study found that participants with YOD faced more challenges with adapting to life with diabetes when compared with UOD. More effective self-management programmes are needed to support the multifaceted needs of adults with YOD.

Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization.

BACKGROUND: Although disparities in cardiac rehabilitation (CR) participation are well documented, the role of community-level distress is poorly understood. This study evaluated the relationship between community-level distress and CR participation, access to CR facilities, and clinical outcomes. METHODS: A retrospective cohort study was conducted on a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. Outpatient claims were used to identify any CR use within 1 year of discharge. Beneficiary and CR facility zip codes were used to describe access to CR facilities. Adjusted logistic regression models evaluated the association between Distressed Community Index quintiles, CR use, and clinical outcomes, including one-year mortality, all-cause hospitalization, and acute myocardial infarction hospitalization. RESULTS: A total of 414 730 beneficiaries were identified, with 96 929 (23.4%) located in the first and 67 900 (16.4%) in the fifth quintiles, respectively. Any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%, P<0.001), which was significant after multivariable adjustment (odds ratio, 0.41 [95% CI, 0.40-0.42]). A total of 98 458 (23.7%) beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR use was associated with absolute reductions in mortality (-6.8% [95% CI, -7.0% to -6.7%]), all-cause hospitalization (-5.9% [95% CI, -6.3% to -5.6%]), and acute myocardial infarction hospitalization (-1.3% [95% CI, -1.5% to -1.1%]), which were similar across each Distressed Community Index quintiles. CONCLUSIONS: Although community-level distress was associated with lower CR participation, the clinical benefits were universally received. Addressing barriers to CR in distressed communities should be considered a significant priority to improve survival after coronary revascularization and reduce disparities.

Architectural accessibility and perception of falls of elderly people in the peridomicile: mixed method.

OBJECTIVE: To describe contents, structure and origin of social representations about falls by elderly people, the peridomiciliary structural conditions that predispose to falls, and to relate the implications of these empirical evidence on the routine of the elderly in the architectural context. METHOD: Convergent mixed method by triangulation. Qualitative approaches(structural, n=195 and procedural, n=40of the Theory of Social Representations) and quantitative (descriptive sectional, n=183) were used. Elderly people enrolled in primary care were interviewed at home in 2018. Analysis techniques: categorical-thematic, prototypical, statistical, and deductive according to Leininger. RESULTS: Categories of analysis: 1) Peridomicile: fall scenario and 2) Aging and vulnerability: risk of falls in peridomicile. The following environmental characteristics were precursors to falls: uneven floors, holes, unevenness and objects in the pathway. Feelings and behaviors allocated in the possible central core are associated, justifying falls, and determining their causes. CONCLUSION: There was an association between the peridomiciliary architectural environment and the predictive characteristics of the risk of falls.

Supervised smoking facility access, harm reduction practices, and substance use changes during the COVID-19 pandemic: a community-engaged cross-sectional study.

BACKGROUND: The potential public health benefits of supervised smoking facilities (SSFs) are considerable, and yet implementation of SSFs in North America has been slow. We conducted this study to respond to significant knowledge gaps surrounding SSF utilization and to characterize substance use, harm reduction practices, and service utilization following the onset of the COVID-19 pandemic. METHODS: A questionnaire was self-administered at a single site by 175 clients using an outdoor SSF in Vancouver, Canada, between October-December 2020. Questionnaire responses were summarized using descriptive statistics. Multinomial logistic regression techniques were used to examine factors associated with increased SSF utilization. RESULTS: Almost all respondents reported daily substance use (93% daily use of opioids; 74% stimulants). Most used opioids (85%) and/or methamphetamine (66%) on the day of their visit to the SSF. Respondents reported drug use practice changes at the onset of COVID-19 to reduce harm, including using supervised consumption sites, not sharing equipment, accessing medically prescribed alternatives, cleaning supplies and surfaces, and stocking up on harm reduction supplies. Importantly, 45% of SSF clients reported using the SSF more often since the start of COVID-19 with 65.2% reporting daily use of the site. Increased substance use was associated with increased use of the SSF, after controlling for covariates. CONCLUSIONS: Clients of the SSF reported increasing not only their substance use, but also their SSF utilization and harm reduction practices following the onset of COVID-19. Increased scope and scale of SSF services to meet these needs are necessary.

Analysis of Building Accessibility Using Inertial and Optical Sensors.

The inclusive use of urban spaces necessitates detailed knowledge of the accessibility of public buildings or places where educational, health or administrative services are provided. Despite the improvements already made in many cities regarding architectural work, further changes to public buildings and other spaces, such as old buildings or areas of historical importance, are still required. To study this problem, we developed a model based on photogrammetric techniques and the use of inertial and optical sensors. The model allowed us to perform a detailed analysis of urban routes in the surroundings of an administrative building, by means of mathematical analysis of pedestrian routes. It was applied to the specific case of people with reduced mobility and included analysis of the building accessibility as well as detection of suitable transit routes, deterioration of the road surfaces and the presence of architectural obstacles on the route.

Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study.

PURPOSE: To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke. BACKGROUND: Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse. METHODS: In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis. RESULTS: Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings. CONCLUSIONS: Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.

The Role and Implication of UD to Foster Inclusion in Built Environments.

The level of inclusion of all its members in the complex of community activities is a fundamental indicator of the progress of a society that wants to be defined as civil and there is a rising awareness about the evidence that diversity and inclusion are linked to positive outcomes. The Universal Design approach is increasingly recognized as the one that helps to shape environments - in terms of physical and virtual environments, as well as buildings, goods and services - so that it can be accessed, understood, and used to the greatest extent possible by all people, regardless of their diversity. Thus, making a more inclusive society for all. This short essay summarizes some reflections resulting from studies, research and field practices reported by literature, and also experienced by the author in her training as a researcher and university professor. Attention is focused in particular on some critical issues and implications inherent in the practical application of UD principles, as well as on the importance of its multidisciplinary dimension, which also entails a different attitude towards the training of professionals.

Designing for inclusion in public playgrounds: a scoping review of definitions, and utilization of universal design.

PURPOSE: Public playgrounds afford children and families important opportunities for outdoor play, social participation, and inclusion. Unfortunately, many children and families experience barriers to accessing, using, and being included in public playgrounds. Consequently, Universal Design (UD) is promoted for providing conceptual guidance for designing for inclusion in public playgrounds. However, a lack of research evidence means researchers have engaged in the ongoing interpretation of the UD concept and related non-discriminatory planning and design concepts. Therefore, the aim of this study was to examine how UD, and related concepts, are used in peer-reviewed articles concerning public playgrounds. MATERIALS AND METHODS: A scoping review was conducted in November 2019, which identified 15 peer-reviewed articles that met the inclusion criteria. RESULTS: Analysis revealed that the terms UD, inclusive design, accessibility, and usability are all being used to describe non-discriminatory planning and design concepts arbitrarily and without regard for higher or lower order concepts. Two broad interpretations were evident: (a) UD is synonymous with accessibility for some, and (b) UD is a higher-order concept that goes beyond accessibility for others. Nevertheless, findings highlight the utility of UD in underpinning the design of public playgrounds in many developed countries; however, the concept requires further clarity and specificity as it pertains to playground design and more pertinently inclusion in outdoor play. CONCLUSIONS: We argue for further conceptual refinement to consolidate the importance and future application of UD for Play (UDP) in the design of public playgrounds that promote outdoor play, social participation, and inclusion.IMPLICATIONS FOR REHABILITATIONMost peer-reviewed journal articles reviewed fail to define what is meant by the term Universal Design.Of those that do provide a definition, the outcome of inclusion in play, or the application of Universal Design to enable play in public playgrounds was unclear.Research to date has mostly focused on related concepts, including accessibility and usability, with less emphasis on Universal Design.Recommend a tailored perspective of Universal Design for Play (UDP).

An alternative system to improve accessibility for wheelchair users: The stepped ramp.

Ramps are one of the main solutions for people with motor disabilities to overcome small disparities in height, both across cities and inside buildings. To permit the autonomous use of ramps, they must satisfy specific requisites. In particular, the slopes must not be excessively steep but adhere to the values identified in regulations and validated by scientific research. In historic cities, however, the placement of ramps is often complicated by a lack of space required for their length. In Venice, in particular, its urban morphology often makes it impossible to conform to the required slopes. For this reason, a specific ramp, known as "stepped ramp", has been designed by technicians of the City of Venice with a steeper slope than allowed by regulations. It offers many possibilities but even some key problems. This paper presents a scientific analysis of ten different ramps to evaluate the structures that directly influence the feeling of comfort or discomfort of a wheelchair user with assistance, as well as the coefficients of friction of the different flooring surfaces. This study aims to understand objectively if this solution is efficient to improve accessibility in some specific circumstances, where it is not possible to follow the regulations using flat ramps.

Evaluation of anti-rollback systems in manual wheelchairs: muscular activity and upper limb kinematics during propulsion.

Self-propelling a wheelchair up a hill requires intense muscular effort and introduces the risk of the wheelchair rolling down. The purpose of this paper was to assess the user's muscular activity during ramp climbing. Tests were carried out on a group of 10 subjects who had to propel a wheelchair up a standardized wheelchair ramp. Basic parameters of upper limb kinematics were measured to determine the total push-rim rotation angle. This was 105.91° for a wheelchair with a stiff anti-rollback system, 99.39° for a wheelchair without an anti-rollback system and 98.18° for a wheelchair with a flexible anti-rollback system. The upper limb muscle effort was measured at 55 ± 19% for the wheelchair without an anti-rollback system, 59 ± 19% for the wheelchair with a stiff anti-rollback system and 70 ± 46% for the wheelchair with a flexible anti-rollback system. The conducted research showed an increase in muscle effort while using anti-rollback systems. In the case of push-rim rotation angle, no significant differences in the value of the rotation angle were found.

'Frontrunners" Understanding of Universal Design in Architecture.

In Denmark, the building sector is in a state of transition towards Universal Design (UD). Thus, UD has not yet completely found its way into the practice of architects and their clients. Legislation about accessibility has dominated. This paper studies understandings of UD through a discourse analysis based on a survey among professionals with experience and interest in UD and professionals who were expected to keep their fingers on the pulse of the profession's development. The findings illustrate the existence of five discourses: 1) Social sustainability, 2) Re-instatement of humans as a focal point, 3) It is not just about ramps, 4) Equality, and 5) Giving a voice. Across the discourses there exists a genuine attempt to legitimise and mainstream UD into the architectural practice, focusing on multisensory and architectural quality in the design of spaces for human diversity in all scales.

Universal Design in Exhibit.

Universal Design has become more prevalent in the general use of architectural design buT has rarely been applied to exhibits. This paper features two manuals developed for exhibit accessibility that incorporate several principles of Universal Design.

Perspectives on Accessibility and Its Users Amongst Practicing Danish Landscape Architects.

This paper presents findings from 15 interviews of randomly selected Danish landscape architectural offices focusing on how these work with and understand accessibility. The paper finds that Danish landscape architects mostly understand accessibility and its users in relation to existing building regulations. Moreover, in finding that the informants possessed a limited professional vocabulary for understanding accessibility, the paper discusses the type of knowledge requested and by, and necessary for, Danish landscape architects to gain a more reflective understanding of accessibility and its users. Towards such ends, universal design can help the profession. However, with only a few informants mentioning ideas related to universal design, this indicates that more education is needed for universal design to provide a different perspective on accessibility and its users amongst Danish landscape architects.

A "Best Practice" for Inclusive Art Cities: The Case Study of the I-Access Project.

The essay aims to illustrate the results of the I-Access Interreg Italia-Malta 2016-20 project, carried out by a partnership led by the Department of Architecture of the University of Palermo with the scientific coordination of Renata Prescia. The project involved the Vucciria district in Palermo and the Bijcceria district in Valletta. Within the framework of the products created (database, web platform, mobile apps, protocol, etc.), we would like to explain in this paper the measures taken to facilitate physical and cultural accessibility from the integrated point of view of restoration and exhibition design, that is, in particular measures to overcome architectural barriers, measures for cultural dissemination and measures of a museographic-communicative nature, including re-evocations of lost or dislocated monuments and artistic works. The proposal is designed as a method for historic urban areas that have similar problems to the district under study. The Vucciria, for example, despite its high density of monuments, has a low quality of life because many of its monuments, especially churches, are closed and therefore unusable and because there is little motivation for local people to engage with these monuments, partly because it is an evolving community. The proposal, therefore, provides for concrete actions to restore the memory of the inhabitants and to re-establish an identity bond with the context, with concrete implications for attracting widespread tourism to provide opportunities for renewal for the district. Project proposals included the installation of three urban totems, ten tactile maps associated with as many churches, and the design of two new access ramps to two churches. By being realized as smart additions in a contemporary and stimulating way compared to the interventions characterized by a solipsistic retour au passè and previously carried out in accordance with the philosophy of the current urban plan, they also become an educational opportunity for a dialoguing community.

Policies and Processes for Accessibility from a UD Perspective: The Integrated Approach Supported by the Friuli Venezia Giulia Region (IT).

With Regional Law no. 10 of 19 March 2018 (General principles and implementing provisions on accessibility), the Autonomous Region of Friuli Venezia Giulia has set itself the objective of improving urban accessibility throughout the regional territory, in order to guarantee equal conditions for everyone to enjoy open spaces and the built environment. The improvement of accessibility is conceived as a long-term objective, to be implemented in stages, according to an incremental development project model. Still today, when work is carried out to eliminate architectural barriers, designers adopt an approach that looks at the "barrier/disability" binomial, identifying "dedicated" solutions and tackling the problem of accessibility in relation to specific targets of users whose ability to access and use spaces and environments is assessed in relation to the capability of a person generically defined as "normally able". In contrast, in a barrier-free approach, designers are called upon to adopt a broader perspective, to look at the variety of people who make up a real community (extended user base), and to consider different physical conditions, ages, abilities and capacities (motor, sensory and cognitive), from the early stages of the project. In order to promote change and to impart this change of approach, the Autonomous Region of Friuli Venezia Giulia has envisaged integrated actions, aimed, as a whole, at accompanying the process that guides the project culture towards a progressive adherence to the methodological criteria of Universal Design, introducing, at the same time, support measures aimed at financing the Municipalities of the Region both for the preparation of barrier elimination plans (PEBAs) and the implementation of the interventions identified in those plans. Among the envisaged actions, the most important is a general accessibility mapping, which includes the adoption of a terminology system (accessibility ontology) integrated in a specific computer application, through which the municipalities will be able to detect architectural barriers, in a homogeneous way, over the entire regional territory.

Plans for the Removal of Architectural Barriers (PEBAs) from a UD Perspective. An Interdisciplinary Process in the Italian Region Friuli Venezia Giulia.

It is more than thirty years since the Italian Law introduced the Plans for the Removal of Architectural Barriers (PEBAs). However, their implementation by municipalities is still limited, and accessibility is often understood as the result of the elimination of single physical obstacles, rather than the development of interconnected systems of urban spaces and collective equipment that are usable and inclusive according to Universal Design (UD) criteria. Since 2018, the Italian Friuli Venezia Giulia Autonomous Region has started a collaboration with the Universities of Trieste and Udine, in order to bring UD at the core of the implementation of the Regional Law no. 10/2018. This Law introduced significant innovations: the disposal of regional funds to support local administrations when drafting PEBAs; the delivery of a software application to facilitate the drawing of these plans; the establishment of a reference center in charge of training, information and consultancy activities on accessibility at a regional level (CRIBA); the delivery of a regional observatory for mapping and continuous monitoring of accessibility conditions and the implementation of PEBAs. The paper presents: i) an overview of the interdisciplinary work carried out by the Universities with the Region and CRIBA; ii) a focus on Universities' research activities and the current state of the collaboration process; iii) reflections on further research and its operational outcomes.

Inclusive Path Through Pavia: A Study to Link the Langobardic Heritage.

The Italian historic centers have an architectural and archeological heritage widespread in the urban structure, which is not always easily accessible due to the orography and materials the streets and the squares are paved with. The topic of the urban accessibility is extremely complex and not easy to solve, also because the removal and overcoming of the architectural and sensorial barriers that could alter the original layout and consolidated historical memory must be avoided. The research investigates the accessibility and usability conditions of the urban environment between the Langobardic building and archeological sites in Pavia (Italy) to identify pedestrian routes that can be covered by weak persons in autonomy or with the help of a companion. The analysis and synthesis of the urban environment produce some maps which report the level of accessibility of the streets and allow to identify the best route between the Langobardic masterpieces in the downtown. The adopted evaluation system is the result of an investigation methodology defined and consolidated over the years by the activities of a group of researchers from the University of Pavia and is independent of the heritage of Langobardic origin; the same methodology can also be used to other types of widespread heritage in the historic center of the city (Romanesque, Lombard Gothic, etc.). The same methodology can be exported to other historical centers and can constitute the tool for the promotion of the architectural and archaeological heritage.

Does Pure Contemplation Belong to Architecture? The Denied Ramps at the Church of San Salvatore in the Santa Giulia Museum in Brescia.

This paper addresses the issue of balancing the two values underlying the accessibility and conservation of cultural heritage: its use and its protection. These values are often, wrongly, regarded as opposites, or as incompatible. The reason for this contrast originates in the way of understanding ancient architecture and in the value of the relationship between architecture and people. This issue is considered by presenting a recent case concerning the Museum of Santa Giulia in Brescia, a multi-layered complex that preserves evidence ranging from the prehistoric to the contemporary age, housed in a monastic complex of Longobard origin. The recent failure to build some ramps proposed for increasing accessibility to the church of San Salvatore, an integral part of the museum's itinerary, offers an opportunity to reflect on the need for better integration between different, and only apparently opposed, instances. The topic is dealt with by referring to the most recent disciplinary reflections in the field of conservation carried out in Italy with respect to the issue of accessibility to the cultural heritage, without neglecting juridical-normative aspects and international documents, such as the Faro Convention. This multidisciplinary reading aims to highlight the main significance of accessing cultural heritage, with reference also to the objectives of sustainable development and the human development of the individual and the reference community.

Outside, Around, Inside. New Paths to Discover San Michele Castle (Cagliari, Sardinia).

In the framework of conservation and enhancement of cultural heritage, accessibility plays a crucial role. Architectural heritage peculiarities call for specific approaches: the same care must be adopted to improve accessibility to historic architecture, designing actions case by case. Starting from these considerations, the contribution is aimed to discuss the accessibility of fortified architecture, a not easily accessible heritage, to make it accessible both in a physical meaning as well as in cognitive, cultural and social. Particularly, the authors propose some reflections about alternative ways of usability for inaccessible architectures due to their typological configuration and as a consequence of previous conservation design. The case study is the medieval castle of San Michele in Cagliari (Sardinia), which was transformed several times during its life and restored at the end of the 20th century. The contribution analyses how a multidisciplinary approach is necessary for the formulation of effective accessibility solutions, especially in complex cases such as fortified architecture. This multidisciplinary approach must be accompanied by the widest possible consideration of the causes limiting accessibility, whether they are physical or related to motor, perceptive or cognitive disabilities.

Values-Based Conservation in Practice - Accessibility at Akershus Castle.

Akershus Castle is one of Norway's most important historical monuments and is listed with the highest grade of protection. The earlier medieval castle from around the year 1300 is an arena for the Norwegian state and in use for such as government dinners and receptions. The castle is also an important tourist destination and is used for public events like concerts, etc. Until today, people in wheelchair have had to be carried into the buildings due to stairs and differences in levels inside. In the autumn of 2021 five measures that make large parts of the castle accessible, were completed. Making public buildings accessible has high priority in Norway. Having achieved this at Akershus Castle is of great symbolic value. During the process of defining the projects extent and measures the method values-based conservation was applied. This was done through involving several stakeholders in assessing and quantifying an array of values and criteria. On this basis it was possible to define the project, achieve the permits from the heritage authorities and get acceptance from the organisations representing people with disabilities. The result has been very well received by the public, stakeholders and by the cultural heritage authorities.