The contribution of objective and perceived crime to neighbourhood socio-inequity in loneliness.

Loneliness tends to be more prevalent in socioeconomically disadvantaged neighbourhoods, yet few studies explore the environmental differences contributing to area-based inequity in loneliness. This study examined how perceived and objective crime contributed to differences in loneliness between advantaged and disadvantaged neighbourhoods. The study used cross-sectional data from 3749 individuals aged between 48 and 77 years, residing in 200 neighbourhoods in Brisbane, Australia. We found that participants in disadvantaged neighbourhoods reported higher levels of loneliness and perceived crime, and the most disadvantaged neighbourhoods also had highest prevalence of objective crime. However, while perceived and objective crime were positively correlated with loneliness, only perceived crime accounted for socio-economic inequity in loneliness. Consequently, perceived crime plays an important role in addressing loneliness in disadvantaged communities and requires equitable resourcing for multiple strategies that aim to decrease crime and increase perceived safety.

Associations between changes in crime and changes in walking for transport with effect measure modification by gender: A fixed-effects analysis of the multilevel longitudinal HABITAT study (2007-2016).

Walking for transport is a potential solution to increasing physical activity in mid to older aged adults however neighbourhood crime may be a barrier. Using data from the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) study 2007-2016, this study examined associations between changes in crime (perceived crime and objectively measured crime) and changes in transport walking, and whether this association differed by gender. Fixed effects regression modelled associations between changes in crime and changes in transport walking, with interaction terms examining effect modification by gender. Positive associations were found between crimes against person and walking for transport. There was no evidence of effect modification by gender. Understanding the relationship between crime and walking for transport can inform policies aimed at promoting transport walking.

Construct and criterion validity of muscle ultrasonography for assessment of skeletal muscle in patients recovering from COVID-19.

Background: The purpose was to investigate the content, construct, and criterion validity of muscle ultrasound in a mixed cohort of participants recovering from mild and critical COVID-19. Methods: A secondary analysis of a prospective cross-sectional study was conducted on data obtained from a battery of muscle and physical function assessments including a muscle biopsy and muscle ultrasonography (US). Rectus femoris (RF) muscle thickness (mT), quadricep complex (QC) mT, RF muscle cross-sectional area (CSA) using 2D freeform trace and estimated from Feret's diameter, and RF echo intensity (EI) were assessed with US. Muscle fiber CSA, fiber type, protein content in muscle fibers, extracellular matrix content (ECM; wheat-germ agglutin), and percent area of collagen in ECM (picrosirius red) were examined from vastus lateralis muscle biopsies. Spearman rho correlations (r) were performed to assess validity of ultrasound parameters. Results: Thirty-three individuals participated including 11 patients surviving critical COVID-19, 15 individuals recovering from mild-COVID, and 7 controls. There were several significant correlations between RF mT, QC mT, RF CSA, and RF EI with age, comorbid burden, body-mass index, and measures of muscle strength, muscle power, and physical function (range r = 0.35-0.83). RF Feret's CSA correlated to CSA of type II muscle fibers (r = 0.41, p = 0.022) and the average size of all muscle fibers (r = 0.39, p = 0.031). RF EI was correlated with collagen in muscle ECM (r = 0.53, p = 0.003) and protein content in muscle tissue (r = -0.52, p = 0.012). Conclusion: Muscle size and quality measured using US has moderate content and construct validity, and to lesser extent, fair to moderate criterion validity in a mixed cohort of individuals recovering from COVID. Muscle ultrasound quality (EI) appears to be sensitive at detecting muscle dysfunction as it is associated with strength, power, physical function, and collagen distribution in a mixed group of individuals recovering from COVID-19.

What are the lessons from COVID-19 for creating healthy, sustainable, resilient future cities?

The COVID-19 pandemic has disrupted lives and the economy, reminding the global community of the devastating health and economic impacts of uncontrolled infectious disease. It has affected how and where people live, work, shop, and play, and exposed our cities' vulnerabilities, leading to calls for a health lens to be applied in designing, approving, and evaluating city plans. Socioeconomic, spatial and health inequities have been amplified, particularly for those living in inadequate or poorly designed housing, neighbourhoods, and cities. Hence, city mayors have committed to 'build back better' with all daily living amenities within a 15-min walking or cycling trip. Designed well, these cities have the potential to be healthier, more sustainable, equitable, and resilient. Yet their delivery requires a rethink of city planning. Drawing on lessons from the COVID-19 pandemic, we argue that to reduce the risk of future pandemics, we must mitigate climate change, limit urban expansion, and use nature-based solutions to protect natural habitats and biodiversity. We then explore how healthy, sustainable, and resilient 15-minute cities could be planned to reduce emissions and ensure our cities are more resilient in the event of future crises. Given that higher density housing underpins the success of 15-minute cities, we also examine how to create more resilient housing stock, through well-implemented health-supportive apartment design standards. Finally, we argue that to achieve all this, cross-sector leadership and investment will be vital.

A state-wide implementation of a whole of hospital sepsis pathway with a mortality based cost-effectiveness analysis from a healthcare sector perspective.

With global estimates of 15 million cases of sepsis annually, together with a 24% in-hospital mortality rate, this condition comes at a high cost to both the patient and to the health services delivering care. This translational research determined the cost-effectiveness of state-wide implementation of a whole of hospital Sepsis Pathway in reducing mortality and/or hospital admission costs from a healthcare sector perspective, and report the cost of implementation over 12-months. A non-randomised stepped wedge cluster implementation study design was used to implement an existing Sepsis Pathway ("Think sepsis. Act fast") across 10 of Victoria's public health services, comprising 23 hospitals, which provide hospital care to 63% of the State's population, or 15% of the Australian population. The pathway utilised a nurse led model with early warning and severity criteria, and actions to be initiated within 60 minutes of sepsis recognition. Pathway elements included oxygen administration; blood cultures (x2); venous blood lactate; fluid resuscitation; intravenous antibiotics, and increased monitoring. At baseline there were 876 participants (392 female (44.7%), mean 68.4 years); and during the intervention, there were 1,476 participants (684 female (46.3%), mean 66.8 years). Mortality significantly reduced from 11.4% (100/876) at baseline to 5.8% (85/1,476) during implementation (p>0.001). Respectively, at baseline and intervention the average length of stay was 9.1 (SD 10.3) and 6.2 (SD 7.9) days, and cost was $AUD22,107 (SD $26,937) and $14,203 (SD $17,611) per patient, with a significant 2.9 day reduction in length of stay (-2.9; 95%CI -3.7 to -2.2, p<0.01) and $7,904 reduction in cost (-$7,904; 95%CI -$9,707 to -$6,100, p<0.01). The Sepsis Pathway was a dominant cost-effective intervention due to reduced cost and reduced mortality. Cost of implementation was $1,845,230. In conclusion, a well-resourced state-wide Sepsis Pathway implementation initiative can save lives and dramatically reduce the health service cost per admission.

Neighbourhood socio-economic disadvantage and loneliness: the contribution of green space quantity and quality.

Disadvantaged areas experience higher levels of loneliness than advantaged areas, though studies rarely identify environmental determinants of neighbourhood inequity in loneliness. We studied the contribution of the quantity and quality of green space to neighbourhood inequity in loneliness in three buffer sizes (400 m, 800 m, 1600 m), using cross-sectional data from 3778 individuals aged 48-77 years old living in 200 neighbourhoods in Brisbane, Australia. Levels of loneliness were significantly higher in disadvantaged neighbourhoods, and these neighbourhoods had less green space and less access to quality green space. However, there was no evidence that neighbourhood disparities in green space contributed to the association between neighbourhood disadvantage and loneliness. Possible methodological and substantive reasons for this result are discussed.

What is the cost, impact, and willingness to pay for an Amputee Peer Support Program?

BACKGROUND: The provision of peer support from those who have already made positive adjustments to amputation is recommended for people incurring a major limb amputation; however, few receive this service. OBJECTIVE: From a program perspective, determine the cost, impact, and willingness to pay for an Amputee Peer Support Program. STUDY DESIGN: Cost analysis. METHODS: Cost of the Amputee Peer Support Program included a cost analysis of program data over a 5-year time horizon (2013-2018) reported in Australian Dollars 2018/2019. Impact and willingness to pay for an Amputee Peer Support Program was determined through surveys of the 3 participant groups: referring health professionals, program volunteers, and program participants. RESULTS: Over 5 years, there were 793 program participants, serviced by 256 program volunteers, for a cost of $631,497. The cost per program participant was $796. Thirty-eight health professionals, 86 program volunteers, and 12 program participants reported on impact and willingness to pay. The Program was reported to have a positive impact on all participant groups. The themes of access to resources and information and the provision of social and emotional well-being were identified across all 3 groups as being important. All 3 groups reported a higher willingness to pay for the health service (range $113-$450), National Disability Insurance Scheme ($156-$432), and private health insurance ($153-$347), and a lower willingness to pay for the program participant ($23-$49). CONCLUSION: Amputee peer support had a positive impact on those receiving and providing the service. Amputee peer support is likely to be a powerful yet inexpensive addition to routine care.

What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy.

This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities.

Racial Disparities in the Provision of Pediatric Psychosocial End-of-Life Services: A Systematic Review.

Background: When compared with White patients, racial and ethnic minorities experience greater barriers to quality end-of-life care. Each year, approximately 52,000 children die in the United States, yet little is known about the disparities in pediatric palliative care, especially when looking at psychosocial palliative care services such as those provided by child life specialists, social workers, and pediatric psychologists. Objectives: In an effort to consolidate and synthesize the literature on this topic for psychosocial professionals working with children and families confronting a life-threatening diagnosis, a review was conducted. Design: This work was a systematic review of several academic databases that were searched from January 2000 to December 2020 for studies exploring disparities in pediatric end-of-life services and written in English. Setting/Subjects: This review was conducted in the United States. The search yielded 109 articles, of which 16 were included for review. Measurements: Three psychosocial researchers independently reviewed, critically appraised, and synthesized the results. Results: Emerging themes from the literature (n = 16) include service enrollment, decision making, and communication. Results highlight a lack of research discussing psychosocial variables and the provision of psychosocial services. Despite this gap, authors were able to extract recommendations relevant to psychosocial providers from the medical-heavy literature. Conclusions: Recommendations call for more research specific to possible disparities in psychosocial care as this is vital to support families of all backgrounds who are confronting the difficulties of pediatric loss.

High Life Study protocol: a cross-sectional investigation of the influence of apartment building design policy on resident health and well-being.

INTRODUCTION: The rapid increase in apartment construction in Australia has raised concerns about the impacts of poorly designed and located buildings on resident health and well-being. While apartment design policies exist, their content varies across jurisdictions and evidence on their impact on health and well-being is lacking. This cross-sectional observational study (2017-2021) aims to generate empirical evidence to guide policy decisions on apartment development and help to create healthy, equitable higher-density communities. Objectives include to benchmark the implementation of health-promoting apartment design requirements and to identify associations between requirements and resident health and well-being outcomes. METHODS AND ANALYSIS: Eligible buildings in three Australian cities with different apartment design guidelines will be stratified by area disadvantage and randomly selected (~n=99). Building architects, developers and local governments will be approached to provide endorsed development plans from which apartment and building design features will be extracted. Additional data collection includes a resident survey (~n=1000) to assess environmental stressors and health and well-being impacts and outcomes, and geographic information systems measures of the neighbourhood. The study has 85% power to detect a difference of 0.5 SD in the primary outcome of mental well-being (Warwick-Edinburgh Mental Well-being Scale) at a 5% level of significance. Analyses will compare policy compliance and health-promoting design features between cities and area disadvantage groups. Regression models will test whether higher policy compliance (overall and by design theme) is associated with better health and well-being, and the relative contribution of the neighbourhood context. ETHICS AND DISSEMINATION: Human Research Ethics Committees of RMIT University (CHEAN B 21146-10/17) and the University of Western Australia (RA/4/1/8735) approved the study protocol. In addition to academic publications, the collaboration will develop specific health-promoting indicators to embed into the monitoring of apartment design policy implementation and impact, and co-design research dissemination materials to facilitate uptake by decision makers.

A Case Study of a Natural Experiment Bridging the 'Research into Policy' and 'Evidence-Based Policy' Gap for Active-Living Science.

The translation of research into tangible health benefits via changes to urban planning policy and practice is a key intended outcome of academic active-living research endeavours. Conversely, policy-makers and planners identify the need for policy-specific evidence to ensure policy decisions and practices are informed and validated by rigorously established evidence. In practice, however, these two aspirations rarely meet and a research-translation gap remains. The RESIDE project is a unique longitudinal natural experiment designed to evaluate the health impacts of the 'Liveable Neighbourhoods' planning policy, which was introduced by the Western Australian Government to create more walkable suburbs. This commentary provides an overview and discussion of the policy-specific study methodologies undertaken to quantitatively assess the implementation of the policy and assess its active living and health impacts. It outlines the key research-translation successes and impact of the findings on the Liveable Neighbourhoods policy and discusses lessons learnt from the RESIDE project to inform future natural experiments of policy evaluation.

Nature and scope of certified nurse-midwifery practice: A workforce study.

AIMS AND OBJECTIVES: To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. BACKGROUND: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. DESIGN: Mixed methods research utilising prospective descriptive survey and interview. METHODS: An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed. RESULTS: The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years. CONCLUSIONS: An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice. RELEVANCE TO CLINICAL PRACTICE: Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.

Relationship between the neighbourhood built environment and early child development.

The relationship between features of the neighbourhood built environment and early child development was investigated using area-level data from the Australian Early Development Census. Overall 9.0% of children were developmentally vulnerable on the Physical Health and Well-being domain, 8.1% on the Social Competence domain and 8.1% on the Emotional Maturity domain. After adjustment for socio-demographic factors, Local Communities with the highest quintile of home yard space had significantly lower odds of developmental vulnerability on the Emotional Maturity domain. Residing in a Local Community with fewer main roads was associated with a decrease in the proportion of children developmentally vulnerable on the Social Competence domain. Overall, sociodemographic factors were more important than aspects of the neighbourhood physical environment for explaining variation between Local Communities in the developmental vulnerability of children.

Liquor landscapes: Does access to alcohol outlets influence alcohol consumption in young adults?

Few longitudinal studies have examined the impact of liquor licences on alcohol consumption, and none in young adults, the life stage when alcohol intake is at its highest. We examined associations between liquor licences (i.e., general licences, on-premise licences, liquor stores, and club licences) and alcohol consumption at 20-years (n=988) and 22-years (n=893), and whether changes in the licences between time-points influenced alcohol consumption (n=665). Only general licences were associated with alcohol consumption at 20-years (p=0.037), but by 22-years, all licences types were positively associated with alcohol consumption (p<0.05). Longitudinal analyses showed that for each increase in liquor stores over time, alcohol consumption increased by 1.22g/day or 8% (p=0.030), and for each additional club licence, consumption increased by 0.90g/day or 6% (p=0.007). Limiting liquor licences could contribute to a reduction in young adults' alcohol intake.

Does alcohol outlet density differ by area-level disadvantage in metropolitan Perth?

INTRODUCTION AND AIMS: Research suggests that there are area-level disparities in alcohol outlets, with greater density in disadvantaged areas. In part, this might be explained by the inequitable distribution of retail, attracted by lower rents to disadvantaged neighbourhoods. This ecological study examines the distribution of liquor licences in Perth, Australia, and whether discrepancies in the distribution of retail land-uses could account for a socio-economic gradient. DESIGN AND METHODS: Area disadvantage was determined for each Statistical Area 1 (SA1) using the Australian Bureau of Statistics Index of Relative Socio-economic Disadvantage, and licence locations were mapped in GIS. Negative binomial loglinear models examined whether licence densities within SA1s differed by area disadvantage, controlling for demographics and spatial correlation. Models included an offset term, so the estimated effects of area-level disadvantage were on licences per km2 , or licences per retail destination. RESULTS: In the area-based analyses, for every unit increase in disadvantage decile (i.e. a reduction in relative disadvantage), general licences reduced by 15% (P = 0.000) and liquor stores reduced by 7% (P = 0.004). These gradients were not apparent when licences were examined as a function of retail; however, for every unit increase in disadvantage decile, the density of on-premise licences per retail destination increased by 14% (P = 0.000). DISCUSSION AND CONCLUSIONS: The direction of the socio-economic gradient for general licences and liquor stores in Perth is concerning, as all licences selling packaged alcohol were more abundant in disadvantaged areas. However, the over-representation of packaged liquor in disadvantaged areas may relate to the increased provision of retail.

Examining associations between area-level spatial measures of housing with selected health and wellbeing behaviours and outcomes in an urban context.

Adequate and affordable housing is a major social determinant of health; yet no work has attempted to conceptually map and spatially test area-level measures of housing with selected health and wellbeing outcomes. Sourcing data from 7,753 adults from Melbourne, Australia, we tested associations between area-level measures of housing density, tenure, and affordability with individual-level measures of neighbourhood safety, community satisfaction, and self-rated health. Compared with the reference groups, the odds of: feeling unsafe was higher for residents living in areas with less affordable housing; community dissatisfaction was ~30% higher in those living in areas with >36% residential properties assigned as rentals, and was significantly higher in the least affordable areas (OR =1.57). Compared with the reference groups, as dwelling density, proportion of rental properties, and housing unaffordability increased, the odds of reporting poorer self-rated health increased; however these associations did not always reach statistical significance. This work highlights the benefits of evidenced-based planning spatial measures to support health and wellbeing.

City planning and population health: a global challenge.

Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

Can neighborhood green space mitigate health inequalities? A study of socio-economic status and mental health.

This study examined whether the association of psychological distress with area-level socio-economic status (SES) was moderated by the area and attractiveness of local green space. As expected, the odds of higher psychological distress was higher in residents in lower SES areas than those in higher SES areas. However, our results were inconclusive with regard to the moderating role of green space in the relationship between psychological distress and SES. Further investigations incorporating safety and maintenance features of green space and street-level greenery are warranted.

The influence of the neighborhood physical environment on early child health and development: A review and call for research.

This review examines evidence of the association between the neighborhood built environment, green spaces and outdoor home area, and early (0-7 years) child health and development. There was evidence that the presence of child relevant neighborhood destinations and services were positively associated with early child development domains of physical health and wellbeing and social competence. Parents׳ perceptions of neighborhood safety were positively associated with children׳s social-emotional development and general health. Population representative studies using objective measures of the built environment and valid measures of early child development are warranted to understand the impact of the built environment on early child health and development.