Exploring the group heterogeneity in the impact of social cohesion on the walking frequency of older adults in China.

Background: Walkable neighborhoods are closely related to an increase in walking frequency and the strengthening of social cohesion. These factors, in turn, contribute to lower BMI and other positive health-related outcomes. However, with a rapid increase in aging populations in China and the fact that women are facing more challenges than men as they age, especially mobility challenges because they tend to live longer leading to probabilities to become widowed. Nevertheless, less attention has been paid to understanding the gender difference between these relationships. Methods: Based on a survey of 533 older adults in Dalian, China, this study tried to investigate the intertwined relationship between perceived walkability, social cohesion, walking frequency, and BMI. A Structural Equation Model (SEM) and multiple-group analysis were applied to test the proposed framework. Results: First, results show that gender differences existed among the above interrelationships, and the most substantial gender gap was found in effects of social cohesion on BMI. Second, perceived walkability only has a direct effect (0.149) on walking frequencies for female seniors. Third, although the relationships between perceived walkability and BMI are not directly related in both male and female models, the indirect connection (-0.053) is substituted for female seniors. Besides, the inhibiting effect of walking on BMI, which is -0.511, is also valid for female seniors. Finally, in terms of the role of social cohesion, both the positive impacts of perceived walkability on it (0.225 for males and 0.325 for females) and its promoting effects on walking have been confirmed in male (0.142) and female models (0.103). The negative direct effect of social cohesion on BMI (-0.083) is only confirmed in male seniors. Conclusion: Insights derived from this analysis can help bring forward gender-specific interventions to build a more inclusive walkable and social environment to improve the mobility and physical health of older adults.

Transforming the Anthropomorphic Passive Free-Flow Foot Prosthesis Into a Powered Foot Prosthesis With Intuitive Control and Sensation (Bionic FFF).

INTRODUCTION: Approximately 89% of all service members with amputations do not return to duty. Restoring intuitive neural control with somatosensory sensation is a key to improving the safety and efficacy of prosthetic locomotion. However, natural somatosensory feedback from lower-limb prostheses has not yet been incorporated into any commercial prostheses. MATERIALS AND METHODS: We developed a neuroprosthesis with intuitive bidirectional control and somatosensation and evoking phase-dependent locomotor reflexes, we aspire to significantly improve the prosthetic rehabilitation and long-term functional outcomes of U.S. amputees. We implanted the skin and bone integrated pylon with peripheral neural interface pylon into the cat distal tibia, electromyographic electrodes into the residual gastrocnemius muscle, and nerve cuff electrodes on the distal tibial and sciatic nerves. Results. The bidirectional neural interface that was developed was integrated into the existing passive Free-Flow Foot and Ankle prosthesis, WillowWood, Mount Sterling, OH. The Free-Flow Foot was chosen because it had the highest Index of Anthropomorphicity among lower-limb prostheses and was the first anthropomorphic prosthesis brought to market. Conclusion. The cats walked on a treadmill with no cutaneous feedback from the foot in the control condition and with their residual distal tibial nerve stimulated during the stance phase of walking.

Coming back for more: individual participation patterns in the physical activity initiative parkrun in Australia.

Most physical activity (PA) maintenance research has concerned adherence to small-scale interventions or infrequent observation in cohort studies. We analysed individual attendance trajectories and their drivers in a large-scale 'real-world' community-based weekly PA event (parkrun) cohort in Australia. Data were weekly attendance (walking/running) of 223 224 unique parkrun participants over their first 3 years of participation. An unweighted moving average of participation in the preceding 12 weeks from the 12th week since the first participation to the 156th week was calculated and submitted to a cluster analysis of attendance patterns. Association of individual- (demographic, personal parkrun performance) and site-level (aggregated site-level participant characteristics and area-level measures) covariates with cluster membership was estimated with multinomial logistic regression models. We identified four groups: Few-Timers (76.4%), Decliners (12.4%), Low Maintainers (6.9%) and High Maintainers (4.3%). In the first 12 weeks, attendances averaged 2, 6, 5 and 7.5 times for each cluster, respectively, and by 52 weeks, they were 0.17, 1.9, 3.4 and 7.6 times, respectively. Continuing participation (vs Few-Timers) was strongly associated with faster personal finish times, but slower performance at the site level. Higher running club/group membership at a participant's parkrun predicted higher odds of being a High Maintainer. Our identification of a Low Maintainer group shows a community-based initiative may sustain interest, despite not requiring continuous or near-continuous attendance. Where someone is placed 'in the pack' locally and degree of identification with others in the group may be bidirectionally associated with attendance, underscoring the importance of considering social environment of PA maintenance.

Meteorological gaps in audits of pedestrian environments: a scoping review.

BACKGROUND: Weather and season are determinants of physical activity. Therefore, it is important to ensure built environments are designed to mitigate negative impacts of weather and season on pedestrians to prevent these losses. This scoping review aims to identify built environment audits of pedestrian environments developed for use during a specific weather condition or season. Secondly, this review aims to investigate gaps in the inclusion of relevant weather mitigating built environment features in pedestrian environment audit tools. METHODS: Following a standard protocol, a systematic search was executed in CINAHL, Medline and Web of Science to identify built environment audit tools of pedestrian spaces. These databases were chosen since they are well-known to comprehensively cover health as well as multi-disciplinary research publications relevant to health. Studies were screened, and data were extracted from selected documents by two independent reviewers (e.g., psychometric properties and audit items included). Audit items were screened for the inclusion of weather mitigating built environment features, and the tool's capacity to measure temperature, precipitation, seasonal and sustainability impacts on pedestrians was calculated. RESULTS: The search returned 2823 documents. After screening and full text review, 27 articles were included. No tool was found that was developed specifically for use during a specific weather condition or season. Additionally, gaps in the inclusion of weather mitigating items were found for all review dimensions (thermal comfort, precipitation, seasonal, and sustainability items). Poorly covered items were: (1) thermal comfort related (arctic entry presence, materials, textures, and colours of buildings, roads, sidewalk and furniture, and green design features); (2) precipitation related (drain presence, ditch presence, hazards, and snow removal features); (3) seasonal features (amenities, pedestrian scale lighting, and winter destinations and aesthetics); and (4) sustainability features (electric vehicle charging stations, renewable energy, car share, and bike share facilities). CONCLUSIONS: Current built environment audit tools do not adequately include weather / season mitigating items. This is a limitation as it is important to investigate if the inclusion of these items in pedestrian spaces can promote physical activity during adverse weather conditions. Because climate change is causing increased extreme weather events, a need exists for the development of a new built environment audit tool that includes relevant weather mitigating features.

Can good neighbourhood perception magnify the positive effect of favourable built environment on recreational walking in China?

BACKGROUND: It remains unknown whether good neighbourhood perception can enhance the benefits of favourable built environment to physical activity. Moreover, the moderation pattern is less understood in developing countries. OBJECTIVES: This work aims to examine the moderation effects of perceived neighbourhood safety and aesthetics on the relationship between built environment and time for recreational walking. METHODS: We performed the examination using a sample of 760 residents in Fuzhou City, China. The Negative Binomial Regression Model was developed to examine the moderation roles of neighbourhood safety and aesthetics on the impact of built environment, adjusting for the effects of location, socioeconomic, personal preferences and social environment factors. Moreover, two sensitivity analyses were performed to test whether the moderators found are robust to the control of residential self-selection, and differential measures of conceptually-comparable aspects of built environment. RESULTS: We found stronger associations of time for recreational walking with road density and proportion of parks and squares POIs for residents with high perception of neighbourhood safety, compared to those with low perception of neighbourhood safety. There was a greater effect of the proportion of parks and squares POIs, when perceived aesthetics was high than when perceived aesthetics was low. The findings of neighbourhood safety and aesthetics as moderator, were robust in the two sensitivity analyses. No significant moderation effect was found for land use diversity. CONCLUSIONS: High perceived neighbourhood safety can magnify the positive effects of road connectivity and accessibility to parks and squares. Neighbourhood aesthetics positively moderates the association of time for recreational walking with accessibility to parks and squares. The findings emphasize the need to consider safety- and aesthetics-specific differences in estimates of built environment effects. Improvements in neighbourhood safety and aesthetics are key to effective interventions in built environment to better promote physical activity.

The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis.

Background: Previous literature lacks summative information on the mental health benefits achieved from different forms of walking. Objective: The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety. Methods: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool. Results: This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69). Conclusions: Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

Uneven geography of health opportunities among subsidized households: Illustrating healthcare accessibility and walkability for public rental housing in Seoul, Korea.

Planners and policymakers significantly consider providing suitable living environments for marginalized households, beyond creating affordable homes. Previous studies have explored various socioeconomic attributes of neighborhoods with public rental housing (PRH), particularly regarding education, job, and transportation opportunities; however, we have a limited understanding of health opportunities among such subsidized households. This study, therefore, explores the accessibility and spatial equity of emergency medical services (EMS) and primary health care (PHC) for PRH residents in Seoul, Korea. The findings show that neighborhoods with PRHs are associated with lower odds ratios for EMS and PHC accessibility. In particular, the relationships between the locations of PRHs and medical services accessibility in neighborhoods varied across the types of PRHs. While neighborhoods with large-scale PRHs are associated with lower PHC access, those with small-scale PRHs are associated with lower EMS access. In addition, our findings show that PRHs tend to be located in neighborhoods with lower walkability. These results may help in empirically determining the spatial accessibility of PHC and EMS, as well as neighborhood walkability, which may affect the health status of individuals in subsidized households.

Estimating the effectiveness of marked sidewalks: An application of the spatial causality approach.

Various safety enhancements and policies have been proposed to enhance pedestrian safety and minimize vehicle-pedestrian accidents. A relatively recent approach involves marked sidewalks delineated by painted pathways, particularly in Asia's crowded urban centers, offering a cost-effective and space-efficient alternative to traditional paved sidewalks. While this measure has garnered interest, few studies have rigorously evaluated its effectiveness. Current before-after studies often use correlation-based approaches like regression, lacking effective consideration of causal relationships and confounding variables. Moreover, spatial heterogeneity in crash data is frequently overlooked during causal inference analyses, potentially leading to inaccurate estimations. This study introduces a geographically weighted difference-in-difference (GWDID) method to address these gaps and estimate the safety impact of marked sidewalks. This approach considers spatial heterogeneity within the dataset in the spatial causal inference framework, providing a more nuanced understanding of the intervention's effects. The simplicity of the modeling process makes it applicable to various study designs relying solely on pre- and post-exposure outcome measurements. Conventional DIDs and Spatial Lag-DID models were used for comparison. The dataset we utilized included a total of 13,641 pedestrian crashes across Taipei City, Taiwan. Then the crash point data was transformed into continuous probability values to determine the crash risk on each road segment using network kernel density estimation (NKDE). The treatment group comprised 1,407 road segments with marked sidewalks, while the control group comprised 3,097 segments with similar road widths. The pre-development program period was in 2017, and the post-development period was in 2020. Results showed that the GWDID model outperformed the spatial lag DID and traditional DID models. As a local causality model, it illustrated spatial heterogeneity in installing marked sidewalks. The program significantly reduced pedestrian crash risk in 43% of the total road segments in the treatment group. The coefficient distribution map revealed a range from -22.327 to 2.600, with over 95% of the area yielding negative values, indicating reduced crash risk after installing marked sidewalks. Notably, the impact of crash risk reduction increased from rural to urban areas, emphasizing the importance of considering spatial heterogeneity in transportation safety policy assessments.

[Promoting active mobility in old age through urban design]. / Förderung aktiver Mobilität im Alter durch Stadtgestaltung.

In an ageing society, maintaining independent mobility into old age is an important objective. Mental and physical wellbeing depends not only on individual health status, but also to a large extent on the spatial conditions. Local politics and municipal administrations can influence this, especially in urban planning. This discussion article brings together perspectives from public health and urban planning on urban development and mobility against the background of health equity.The results of the AFOOT (Securing urban mobility of an ageing population) cross-sectional study on socio-spatial conditions in small- and medium-sized towns in northwestern Germany and walking and cycling by older people show the importance of residential environmental factors such as proximity to everyday destinations, walking and cycling infrastructure, and street connectivity. Preferences for the design of an age-friendly living environment and the quality of public spaces exist in terms of urban design quality, quality of stay, and safety in public spaces.In order to improve spatial conditions, the situation needs to be recorded using defined indicators and monitoring, and the perspectives of older people need to be integrated. Strategies and measures to promote active mobility in old age are aimed at the multifunctional design of public spaces, the prioritization of active mobility on everyday trips, and ensuring the accessibility of everyday destinations through urban development. Cross-sectoral cooperation between urban planning, transport planning, and public health is essential to promote the active mobility and health of older people.

Epidemiology of Pediatric Dog Walking-Related Injuries Among Children Presenting to US Emergency Departments, 2001 to 2020.

BACKGROUND: Dog walking is associated with a significant injury burden among adults, but the risk of injury associated with dog walking among children is poorly understood. This study describes the epidemiology of children treated at US emergency departments for injuries related to leash-dependent dog walking. METHODS: The National Electronic Injury Surveillance System (NEISS) database was retrospectively analyzed to identify children (5 to 18 years of age) presenting to US emergency departments between 2001 and 2020 with dog walking-related injuries. Primary outcomes included annual estimates of injury incidence, injury characteristics, and risk factors for fracture or traumatic brain injury (TBI). Weighted estimates, odds ratios (ORs), and 95% confidence intervals (CIs) were generated using NEISS sample weights. RESULTS: An estimated 35,611 children presented to US emergency departments with injuries related to dog walking. The mean age of patients was 11 years, and most patients were girls (63%). Over half (55%) of injuries were orthopaedic, and patients commonly injured their upper extremity (57%) and were hurt while falling when pulled or tripped by the leash (55%). The most frequent injuries were wrist strain/sprain (5.6%), finger strain/sprain (5.4%), and ankle strain/sprain (5.3%). On multivariable analysis, injured children aged 5 to 11 years were more likely to have sustained a TBI (OR: 3.2, 95% CI: 1.1-9.7) or fracture (OR: 1.6; 95% CI: 1.1-2.3). Boys were more likely than girls to have experienced a fracture (OR: 2.0, 95% CI: 1.3-2.5). CONCLUSIONS: Dog walking-related injuries in children are primarily orthopaedic and involve the upper extremity. Younger children and boys are at greater risk for serious dog walking-related injuries. LEVEL OF EVIDENCE: Level III.

Measuring Active Transportation on National Health Surveys in Canada From 1994 to 2020.

BACKGROUND: Active transportation (AT), described as self-powered modes of travel (eg, walking and cycling), is an important source of health-promoting physical activity. While AT behaviors have been measured on national health surveys in Canada for over 2 decades, historic prevalence has not been previously reported. We aimed to document the measures of AT on Canada's various national health surveys, examine AT over time, and interpret them within the context of evolving methods of assessment. METHODS: We compiled and summarized the questions used to measure AT among Canadians on 4 national health surveys: National Population Health Survey (1994-1998), Canadian Community Health Survey (2000-2020), Canadian Health Measures Survey (2007-2019), and the Health Behaviour in School-aged Children Study (2010-2018). Among youth and adults (12+ y), we summarized over time: (1) the prevalence of AT participation and (2) time spent in AT (in hours per week) among those who report any AT participation. Where possible, we reported separate estimates of walking and cycling and produced an aggregate estimate of total AT. We stratified results by age group and sex. RESULTS: Changes in AT survey questions over time and between surveys limit the interpretation and comparability of temporal trends. Nevertheless, a consistently higher proportion of females report walking, while a higher proportion of males report cycling. Irrespective of mode, males report spending more total time in AT. Participation in AT tends to decrease with age, with youth reporting the highest rates of AT and young adults often spending the most time in AT. CONCLUSIONS: Monitoring trends in AT can help assess patterns of behavior and identify whether promotion strategies are needed or whether population interventions are effective. Our evaluation of AT over time is limited by questions surveyed; however, consistent differences in AT by age and sex are evident over time. Moving forward, ensuring consistency of AT measurement over time is essential to monitoring this important behavior.

Dose-response relationship between weekly physical activity level and the frequency of colds in Chinese middle-aged and elderly individuals.

Background: Engaging in appropriate physical activity can significantly lower the risk of various diseases among middle-aged and older adults. Investigating optimal levels of physical activity (PA) is crucial for enhancing the health of this demographic. This study aims to explore the dose-response relationship between weekly PA levels and the frequency of colds among Chinese middle-aged and elderly individuals, identifying the necessary PA level to effectively diminish the risk of colds. Methods: We conducted a cross-sectional study using a web-based survey targeting individuals aged 40 and older (n = 1, 683) in China. The survey collected information on PA and the frequency of colds. Data was analyzed using Kruskal-Wallis test and the χ2 test. We explored the dose-response relationship between weekly PA and cold frequency over the past year through an ordered multivariate logistic regression model and a restricted cubic spline model. Results: (1) Brisk walking emerged as the preferred physical exercise for those over 40. The findings suggest that engaging in moderate (odds ratio (OR) = 0.64, P < 0.001, 95% confidence interval (CI) [0.50-0.81]) and high (OR = 0.64, P < 0.001, 95% CI [0.51-0.79]) levels of PA weekly significantly reduces the risk of catching a cold. Individuals with one (OR = 1.47, P < 0.001, 95% CI [1.20-1.80]) or multiple chronic diseases (OR = 1.56, P < 0.001, 95% CI [1.21-2.00]) were at increased risk. Those residing in central (OR = 1.64, P < 0.001, 95% CI [1.33-02.01]) and western China (OR = 1.49, P = 0.008, 95% CI [1.11-02.00]) faced a higher risk compared to their counterparts in eastern China. (2) According to the restricted cubic spline model, adults who experienced one cold in the past year had a weekly PA level of 537.29 metabolic equivalent-minutes per week (MET-min/wk) with an OR value of 1. For those reporting two or more colds, the PA level was 537.76 MET-min/wk with an OR of 1. Conclusions: (1) Brisk walking is the most favored exercise among the Chinese middle-aged and elderly, with the prevalence of colds being affected by the number of chronic diseases and the geographic location. (2) Regular, moderate exercise is linked to a lower risk of colds. To effectively reduce cold frequency, it is recommended that middle-aged and elderly Chinese individuals engage in a minimum of 538 MET-min/wk of exercise.

Factors Associated with Discharge Destination in Patients with Bone Metastases.

Background and Objectives: The discharge destination of patients with advanced cancer correlates with their quality of life. Patients with bone metastases often undergo lifestyle changes owing to pain and activity limitations. However, there are few reports on factors related to the discharge destination of patients with bone metastases. This study aimed to elucidate the factors associated with the discharge destination of patients with bone metastases. Methods: This study included 278 patients diagnosed with bone metastases who were admitted to the University of Tsukuba Hospital between April 2015 and March 2020. This study examined discharge destination, occurrence of skeletal-related events (SREs), primary lesions, locations of bone metastases, functional ambulation categories (FAC), age, and length of hospital stay. A binomial logistic regression analysis was conducted to compare the home and non-home discharge groups. Results: Of the 278 patients, 142 were discharged to home, 89 were discharged to somewhere other than home (non-home), and 47 died. The discharge destination was associated with spinal cord compression (SCC) (odds ratio [OR] 3.37, 95% confidence interval [CI] 1.35-8.43), hypercalcemia (OR 6.84, 95% CI 1.09-42.76), and FAC at admission (OR 0.45, 95% CI 0.35-0.58). The admission FAC cut-off value for discharge to home was determined to be 1.5 (area under the curve [AUC] 0.79, sensitivity 77.5%, specificity 68.5%). Conclusions: Factors associated with discharge destination were identified. The walking ability required for discharge to home was FAC 1.5, meaning that the patient needed one person to assist in preventing falls when walking on level ground. A cut-off value for FAC on admission for predicting outcomes was identified, suggesting the importance of gait ability assessment on admission.

Climate protection, health and other motives for active transport - results of a cross-sectional survey in Germany.

BACKGROUND: Active transport- for example walking and bicycling to travel from place to place- may improve physical fitness and health and mitigate climate change if it replaces motorised transport. The aim of this study is to analyse the active transport behaviour of adults living in Germany, to investigate differences among population groups and to determine whether climate protection is a frequent motive for this behaviour. METHODS: This study uses self-reported data of 4,971 adults who participated in a national health survey (German Health Update 2021), which was conducted as a telephone survey from July to December 2021. Associations between active transport behaviour and corresponding motives with sociodemographic and health-related variables were analysed using logistic regression models. RESULTS: Of the adult population, 83% use active transport at least once a week. The frequency and duration of walking per week are significantly higher than those for bicycling (walking 214 min/week; bicycling 57 min/week). Those with a lower education level are less likely to practise active transport than those with a higher education level. Furthermore, women are less likely to use a bicycle for transport than men. Among those practising active transport, the most frequently mentioned motive is "is good for health" (84%) followed by "to be physically active" (74%) and "is good for the climate/environment" (68%). Women and frequent bicyclists (at least 4 days/week) mention climate protection as a motive more often than men and those bicycling occasionally. CONCLUSIONS: The improvement of active transport, especially among people with lower education and women (for bicycling), may benefit from better insights into motives and barriers. Climate protection is an important motivator for practising active transport within the adult population living in Germany and should therefore have greater emphasis in behavioural change programmes.

Vulnerable road user injury trends following the COVID-19 pandemic in Toronto, Canada: An interrupted time series analysis.

BACKGROUND: The COVID-19 pandemic altered traffic patterns worldwide, potentially impacting pedestrian and bicyclists safety in urban areas. In Toronto, Canada, work from home policies, bicycle network expansion, and quiet streets were implemented to support walking and cycling. We examined pedestrian and bicyclist injury trends from 2012 to 2022, utilizing police-reported killed or severely injured (KSI), emergency department (ED) visits and hospitalization data. METHODS: We used an interrupted time series design, with injury counts aggregated quarterly. We fit a negative binomial regression using a Bayesian modeling approach to data prior to the pandemic that included a secular time trend, quarterly seasonal indicator variables, and autoregressive terms. The differences between observed and expected injury counts based on pre-pandemic trends with 95% credible intervals (CIs) were computed. RESULTS: There were 38% fewer pedestrian KSI (95%CI: 19%, 52%), 35% fewer ED visits (95%CI: 28%, 42%), and 19% fewer hospitalizations (95%CI: 2%, 32%) since the beginning of the COVID-19 pandemic. A reduction of 35% (95%CI: 7%, 54%) in KSI bicyclist injuries was observed, but However, ED visits and hospitalizations from bicycle-motor vehicle collisions were compatible with pre-pandemic trends. In contrast, for bicycle injuries not involving motor vehicles, large increases were observed for both ED visits, 73% (95% CI: 49%, 103%) and for hospitalization 108% (95% CI: 38%, 208%). CONCLUSION: New road safety interventions during the pandemic may have improved road safety for vulnerable road users with respect to collisions with motor vehicles; however, further investigation into the risk factors for bicycle injuries not involving motor vehicles is required.

"I Go Outdoors for Activities Every Day": Go-Along With Seniors With Slow Walking Speeds to Explore Environmental Factors Influencing Mobility.

Objectives: This study aims to: 1) Explore the mobility experiences of seniors with slow walking speeds (SSWS) in urban neighborhoods; and 2) Investigate their environmental barriers and supports. Methods: Go-along interviews were conducted with 36 SSWS residing in urban neighborhoods of Chongqing City, China. The mobility patterns and built environment factors influencing their mobility were revealed through cartographic analysis and thematic analysis. Results: SSWS primarily focused their activities within a 400-meter radius of their homes. Built environment themes included topography, neighborhood services, sidewalks, seating, traffic safety, weather, greenery, and lighting. Significant mobility barriers included long stairs, steep slopes, fast-moving objects on sidewalks, road crossings, and fast traffic. Available handrails, nearby food-service places, ample seating, and greenery were identified as supportive factors for their mobility. Conclusion: This study stands out as the first to specifically examine the mobility of SSWS within the built environment. We suggest that SSWS should be taken into account when establishing a benchmark for general design frameworks. These improvements not only contribute to the mobility of slow walkers but also have positive impacts on the broader population.

Infant Care: Predictors of Outdoor Walking, Infant Carrying and Infant Outdoor Sleeping.

BACKGROUND: Although spending time outdoors is beneficial for development, little is known about outdoor time during infancy. The aim of this study was to assess frequencies and durations of (1a) outdoor walking and carrying in mother-infant dyads and (1b) infant outdoor sleeping in a stationary cot or pram. We furthermore aimed to identify associations of (2a) outdoor walking and carrying and (2b) infant outdoor sleeping, with infant, maternal and environmental sample characteristics. METHODS: An online survey was distributed among mothers of 0- to 12-month-old infants. Initially, 1453 mothers were recruited, of which 1275 were included in the analyses. With respect to (1a) the outcomes of interest were: mother-infant dyads' total weekly duration of walking in minutes, frequency of walking on weekdays, as well as weekends, and the frequency of using an infant carrier during walks, as well as the daily duration of carrying in hours (indoors and outdoors together). With respect to (1b) the outcome variables were: placing the infant outdoors to sleep (yes/no), the total weekly duration of outdoor sleeping and the weekly frequency of outdoor sleeping. For aim 2, associations of the outcome variables with infant (i.e., age), maternal (i.e., working status) and environmental (i.e., house type) sample characteristics were assessed. RESULTS: Mother-infant dyads engaged in walks for a total weekly duration of 201 min, for approximately one to three walks over weekdays (Monday through Friday), as well as one to three walks on the weekend. The infant carrier was used by 22% of mothers at least half of the time during outdoor walks, and 18% reported a daily duration of infant carrying of one hour or more. Among other associations, infant and maternal enjoyment of outdoor walking correlated positively with the duration as well as the frequency of walking during weekdays and during the weekend. Furthermore, employed mothers walked for a shorter duration and less frequently on weekdays as compared to mothers on maternity leave or mothers without a paid job. The availability of nearby recreational areas correlated positively with the weekly duration and frequency of walks. The infant carrier was used more frequently during outdoor walks if more than one child lived in the household. Infant carrying during outdoor walks was also related to infant behavior at night. Roughly a third of the mothers (29%) regularly had their infant sleep outdoors for a weekly duration of four hours and a weekly frequency of approximately one to two times. Younger infants, infants of mothers with higher education and infants living in detached houses were more likely to be placed outdoors to sleep. DISCUSSION: We identified associations of infant, maternal and environmental characteristics with outdoor time spent during infancy. These results lay the foundation for future research on the effects of the outdoors on child development as well as on facilitators and barriers for caregivers.

Disaggregation of Green Space Access, Walkability, and Behavioral Risk Factor Data for Precise Estimation of Local Population Characteristics.

BACKGROUND: Social and Environmental Determinants of Health (SEDH) provide us with a conceptual framework to gain insights into possible associations among different human behaviors and the corresponding health outcomes that take place often in and around complex built environments. Developing better built environments requires an understanding of those aspects of a community that are most likely to have a measurable impact on the target SEDH. Yet data on local characteristics at suitable spatial scales are often unavailable. We aim to address this issue by application of different data disaggregation methods. METHODS: We applied different approaches to data disaggregation to obtain small area estimates of key behavioral risk factors, as well as geospatial measures of green space access and walkability for each zip code of Allegheny County in southwestern Pennsylvania. RESULTS: Tables and maps of local characteristics revealed their overall spatial distribution along with disparities therein across the county. While the top ranked zip codes by behavioral estimates generally have higher than the county's median individual income, this does not lead them to have higher than its median green space access or walkability. CONCLUSION: We demonstrated the utility of data disaggregation for addressing complex questions involving community-specific behavioral attributes and built environments with precision and rigor, which is especially useful for a diverse population. Thus, different types of data, when comparable at a common local scale, can provide key integrative insights for researchers and policymakers.

[How to improve active mobility in São Paulo, Brazil? Survey with leaders of nongovernmental organizations and public and private sector managers]. / Como melhorar a mobilidade ativa em São Paulo, Brasil? Inquérito com lideranças de organizações não governamentais e com gestores públicos e privados.

This study aimed to describe a quantitative survey conducted with leaders to investigate effective and feasible actions that can be evaluated in computational models to inform policies to promote active mobility based in the city of São Paulo, Brazil. In 2022, an online survey was conducted during the Health Survey in São Paulo (Physical Activity and Environment study), which is monitored by representatives of nongovernmental organizations and public and private sector managers. A questionnaire was elaborated with three questions with 13 alternative answers about actions to promote walking and/or cycling. Leaders should select up to three alternatives based on their potential regarding: (1) effectiveness; (2) feasibility or ease of implementation; and (3) desire to verify tests in computational models to inform policies. The survey was answered by 18 leaders from 16 institutions, comprising 13 (72%) women and 12 (67%) representatives of the third sector, whose average age was 48 years and all had complete higher education. Reducing the speed of motor vehicles was the most cited option in all three questions. Other actions mentioned refer to controlling the traffic of vehicles in central areas, improving pedestrian safety, reducing the distances between homes and places of employment, conducting educational campaigns, and expanding and enhancing structures such as bicycle lanes and sidewalks. The results are relevant to support evidence-based decision-making in public management and to provide subsidies for the development of computational models with a view to promoting active mobility.

Este estudo teve como objetivo descrever um inquérito quantitativo realizado com lideranças para investigar ações efetivas, viáveis e que podem ser testadas em modelos computacionais para informar políticas de promoção da mobilidade ativa, tendo como base a cidade de São Paulo, Brasil. Em 2022, foi realizado um inquérito online no contexto da pesquisa de Atividade Física e Ambiente do Inquérito de Saúde de São Paulo, acompanhada por representantes de organizações não governamentais, gestores públicos e de entidades privadas. Foi elaborado questionário com três perguntas com 13 alternativas de respostas sobre ações para promoção da caminhada ou uso de bicicleta. As lideranças deveriam selecionar até três alternativas a partir de seu potencial em termos de (1) efetividade; (2) viabilidade ou facilidade de implementação; e (3) desejo de realizar testes em modelos computacionais para informar políticas. O inquérito foi respondido por 18 lideranças de 16 instituições, sendo 13 (72%) mulheres e 12 (67%) representantes do terceiro setor, cuja média de idade era 48 anos, todos com nível superior de escolaridade. A redução da velocidade dos veículos motorizados foi a opção mais citada nas três questões. Outras ações citadas referem-se ao controle de circulação de veículos em regiões centrais, à segurança de pedestres, à diminuição das distâncias entre residências e locais de emprego, às campanhas educativas e à ampliação e melhoria de estruturas como ciclovias e calçadas. Os resultados são relevantes para apoiar a tomada de decisões baseadas em evidências na gestão pública e oferecer subsídios para a elaboração de modelos computacionais com vistas à promoção da mobilidade ativa.

Este estudio tuvo como objetivo presentar una encuesta cuantitativa realizada con líderes para investigar las acciones efectivas, viables y que puedan probarse en modelos informáticos para orientar las políticas que promuevan la movilidad activa en la ciudad de São Paulo, Brasil. En 2022 se realizó una encuesta en línea en el contexto de la Encuesta de Salud de São Paulo (Actividad Física y Medio Ambiente), que es monitoreada por representantes de organizaciones no gubernamentales, gestores públicos y entidades privadas. Se elaboró un cuestionario de tres preguntas con 13 respuestas alternativas sobre acciones para promover la caminata o el uso de la bicicleta. Los líderes podían seleccionar hasta tres alternativas en función de su potencial en términos de (1) efectividad; (2) viabilidad o facilidad de implementación; y (3) deseo de verificar las pruebas en modelos informáticos para orientar las políticas. La encuesta fue respondida por 18 líderes de 16 instituciones; de los cuales 13 (72%) eran mujeres y 12 (67%) representaban el tercer sector; la edad promedio de ellos fue de 48 años y todos contaban con educación superior. Reducir la velocidad de los vehículos de motor fue la opción más citada en las tres preguntas. Otras acciones mencionadas se refieren al control de la circulación de vehículos en las regiones centrales, la seguridad de los peatones, la reducción de las distancias entre los hogares y los lugares de trabajo, las campañas educativas y la expansión y mejora de estructuras como carriles bici y aceras. Los resultados son relevantes para apoyar la toma de decisiones basada en la evidencia en la gestión pública y ofrecer subsidios para la elaboración de modelos computacionales destinados a promover la movilidad activa.

The impact of road environments on rural periodic market travel satisfaction: a heterogeneity analysis of travel modes.

Introduction: Travel satisfaction as experienced by rural residents is closely related to personal physical and mental health, as well as rural economic conditions. An improved rural road environment can be expected to enhance villagers' satisfaction with regards to visits to markets, but to date this has not been established empirically. Methods: In this study, a questionnaire was designed to obtain local residents' evaluations of road environment characteristics for periodic market travel. And we use an Oprobit regression model and Importance-Performance Map Analysis (IPMA) to explore the heterogeneity of the 14 key elements of the "home-to-market" road environment impact on villagers' satisfaction under different modes of travel. Results: The results of the study reveal that villagers expressed dissatisfaction with the current lack of sidewalks and non-motorized paths, and except for road traffic disturbances and road deterioration, which did not significantly affect mode of travel, other factors proved significant. Significantly, bus services are associated with a significant positive effect on walking, non-motorized and bus travel satisfaction, while distance travel also affects walking, non-motorized and motorized travel satisfaction. It is worth noting that greening and service facilities negatively affect motorized travel satisfaction. In summary, road width, sidewalks, bus service, and road deterioration, are among the elements most in need of urgent improvement for all modes of travel. Discussion: The characteristics of the road environment that influence satisfaction with travel to the periodic market vary by travel mode, and this study is hoped to provide data support and optimization recommendations for the improvement of the rural road environment in China and other countries.