Children's perceptions of a 'self-explaining road' intervention to improve neighbourhood safety.

AIM: Safe neighbourhood environments can provide important spaces for child activity and well-being. Self-explaining roads (SERs), which reduce vehicle speeds by changing neighbourhood street design, are an intervention with known safety benefits. However, little is known about children's experiences of SERs. METHODS: We engaged schoolchildren in developing a project to articulate children's perspectives of SERs. Students actively researched the experiences of other children at their school, and then participated in a researcher-led focus group. RESULTS: Children emphasised safer spaces for play as an important benefit of SERs. As well as using new designated play spaces adjoining footpaths, children also felt the roadway became safer, and more fun for cycling. In contrast, children reported that parents held mainly negative views of SERs, considering them annoying and inconvenient. CONCLUSION: From children's perspective, SERs can provide safe spaces for neighbourhood play, despite limited parental support. Potential benefits for children as well as established safety benefits should inform future implementation of SERs.

Systematic literature review of built environment effects on physical activity and active transport - an update and new findings on health equity.

BACKGROUND: Evidence is mounting to suggest a causal relationship between the built environment and people's physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic or ethnic differences in intervention effects, and an inability to isolate the effect of the built environment from other intervention types. The aims of this systematic review were to identify which environmental interventions increase physical activity in residents at the local level, and to build on the evidence base by considering intervention cost, and the differential effects of interventions by ethnicity and socioeconomic status. METHODS: A systematic database search was conducted in June 2015. Articles were eligible if they reported a quantitative empirical study (natural experiment or a prospective, retrospective, experimental, or longitudinal research) investigating the relationship between objectively measured built environment feature(s) and physical activity and/or travel behaviours in children or adults. Quality assessment was conducted and data on intervention cost and whether the effect of the built environment differed by ethnicity or socioeconomic status were extracted. RESULTS: Twenty-eight studies were included in the review. Findings showed a positive effect of walkability components, provision of quality parks and playgrounds, and installation of or improvements in active transport infrastructure on active transport, physical activity, and visits or use of settings. There was some indication that infrastructure improvements may predominantly benefit socioeconomically advantaged groups. Studies were commonly limited by selection bias and insufficient controlling for confounders. Heterogeneity in study design and reporting limited comparability across studies or any clear conclusions to be made regarding intervention cost. CONCLUSIONS: Improving neighbourhood walkability, quality of parks and playgrounds, and providing adequate active transport infrastructure is likely to generate positive impacts on activity in children and adults. The possibility that the benefits of infrastructure improvements may be inequitably distributed requires further investigation. Opportunities to improve the quality of evidence exist, including strategies to improve response rates and representativeness, use of valid and reliable measurement tools, cost-benefit analyses, and adequate controlling for confounders.

Towards a global framework for transport, health and health equity.

This study derives a generalised global framework for transport, health and health equity, based on a synthesis of 94 urban transport and health frameworks. The framework emphasises factors related to health equity, which are generally ignored in existing conceptual frameworks on the relationship between transport and health. While some factors such as travel behaviour were included in most reviewed frameworks, climate change and other macro-level factors were included in less than a quarter of frameworks, and health equity was included in less than 10%. We developed a framework that includes key framework components identified by a scoping review, as well as addressing important gaps. This framework can be utilized to inform work on transport, health and health equity by different agencies such as the World Health Organization. It can be used to guide health sector engagement with transport issues to lead to healthier and more equitable transport decision-making globally.

Reducing ethnic disparities in the quality of trauma care: an important research gap.

OBJECTIVE: To identify interventions for reducing ethnic disparities in the quality of trauma care. BACKGROUND: Variation in the quality of health care is recognized as an important contributor to ethnic disparities in many domains of health. Although recent articles document ethnic variations in the quality of trauma care in several countries, strategies that address these disparities have received little attention. METHODS: Systematic review of intervention studies designed to reduce ethnic disparities in trauma care. RESULTS: Our systematic literature review revealed no evaluations of interventions designed to reduce ethnic disparities in trauma care. A scan of the equivalent literature in other health care settings revealed 3 types of strategies that could serve as promising interventions that warrant further investigation in the trauma care setting: (1) improving cultural competency of service providers, (2) addressing the effects of health literacy on the quality of trauma care, and (3) quality improvement strategies that recognize equity as a key dimension of quality. The trauma coordinator role may help address some aspects relating to these themes although reducing disparities is likely to require broader system-wide policies. CONCLUSIONS: The implementation and robust evaluation of strategies designed to reduce ethnic disparities in trauma care are long overdue.

A life course approach to injury prevention: a "lens and telescope" conceptual model.

BACKGROUND: Although life course epidemiology is increasingly employed to conceptualize the determinants of health, the implications of this approach for strategies to reduce the burden of injuries have received little recognition to date. METHODS: The authors reviewed core injury concepts and the principles of the life course approach. Based on this understanding, a conceptual model was developed, to provide a holistic view of the mechanisms that underlie the accumulation of injury risk and their consequences over the life course. RESULTS: A "lens and telescope" model is proposed that particularly draws on (a) the extended temporal dimension inherent in the life course approach, with links between exposures and outcomes that span many years, or even generations, and (b) an ecological perspective, according to which the contexts in which individuals live are critical, as are changes in those contexts over time. CONCLUSIONS: By explicitly examining longer-term, intergenerational and ecological perspectives, life course concepts can inform and strengthen traditional approaches to injury prevention and control that have a strong focus on proximal factors. The model proposed also serves as a tool to identify intervention strategies that have co-benefits for other areas of health.

Climate change: the implications for child health in Australasia.

Children are particularly vulnerable to the health effects of climate change, the biggest global health threat of the 21st century. However, the worst effects on child health can be avoided, and well-designed climate policies can have important benefits for child health and equity. We call on child health professionals to seize opportunities to prevent climate change, improve child health and reduce inequalities, and suggest useful actions that can be taken.

Organisational travel plans for improving health.

BACKGROUND: Dependence on car use has a number of broad health implications, including contributing to physical inactivity, road traffic injury, air pollution and social severance, as well as entrenching lifestyles that require environmentally unsustainable energy use. Travel plans are interventions that aim to reduce single-occupant car use and increase the use of alternatives such as walking, cycling and public transport, with a variety of behavioural and structural components. This review focuses on organisational travel plans for schools, tertiary institutes and workplaces. These plans are closely aligned in their aims and intervention design, having emerged from a shared theoretical base. OBJECTIVES: To assess the effects of organisational travel plans on health, either directly measured, or through changes in travel mode. SEARCH STRATEGY: We searched the following electronic databases; Transport (1988 to June 2008), MEDLINE (1950 to June 2008), EMBASE (1947 to June 2008), CINAHL (1982 to June 2008), ERIC (1966 to June 2008), PSYCINFO (1806 to June 2008), Sociological Abstracts (1952 to June 2008), BUILD (1989 to 2002), Social Sciences Citation Index (1900 to June 2008), Science Citation Index (1900 to June 2008), Arts & Humanities Index (1975 to June 2008), Cochrane Database of Systematic Reviews (to August 2008), CENTRAL (to August 2008), Cochrane Injuries Group Register (to December 2009), C2-RIPE (to July 2008), C2-SPECTR (to July 2008), ProQuest Dissertations & Theses (1861 to June 2008). We also searched the reference lists of relevant articles, conference proceedings and Internet sources. We did not restrict the search by date, language or publication status. SELECTION CRITERIA: We included randomised controlled trials and controlled before-after studies of travel behaviour change programmes conducted in an organisational setting, where the measured outcome was change in travel mode or health. Both positive and negative health effects were included. DATA COLLECTION AND ANALYSIS: Two authors independently assessed eligibility, assessed trial quality and extracted data. MAIN RESULTS: Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre-selected group who were already contemplating or preparing for active travel, found improved health-related quality of life on some sub scales, and increased walking. Two controlled before-after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No included studies were conducted in low- or middle-income countries, and no studies measured the social distribution of effects or adverse effects, such as injury. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly-designed research studies, such as well-designed cluster randomised trials.

Suburb-level changes for active transport to meet the SDGs: Causal theory and a New Zealand case study.

The 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs) represent a historic global linking of health, equity and environmental sustainability. Accumulated evidence suggests that improving urban neighbourhoods to make them safer and more attractive for walking and cycling can accelerate progress towards the SDGs. The pathways to change are complex, non-linear and involve multiple pathways and multiple SDG outcomes, yet the SDG goals are often considered in isolation. Further, there have been few studies of environmental interventions for healthier transport that foreground equity. The aim of this paper is to describe and demonstrate practically how integrated interventions for placemaking and active transport can contribute to a wide range of SDG targets. First, we take an evidence-based approach to describing how such interventions are connected to targets within the SDGs. Second, we propose a complex causal theory of the pathways to change and the inter-relationships between SDGs. Third, we show, with concrete examples, how a case study project in Auckland, New Zealand illustrates these pathways, contributing to achieving the SDG targets, including barriers and challenges. We find that by addressing Goal 11 in particular ways that focus on equity (Goal 10), eight of the other goals can also be advanced. Our causal theory describes one balancing and 12 reinforcing patterns of behaviour that link interventions improvements to neighbourhoods with ten of the SDGs in a complex system. Our case study demonstrates that it is possible to successfully put this causal theory into practice through interventions, but these require strong partnerships between researchers, public health practitioners, policy-makers and communities, long-term evaluation and addressing both physical and social environments.

Hip radiography for the investigation of nontraumatic, short duration hip pain presenting to a children's emergency department.

OBJECTIVE: To assess the diagnostic accuracy of routine hip x-ray in 2- to 11-year-old children presenting to the emergency department with recent onset, nontraumatic hip pain and to assess the predictive value of other clinical presenting variables. METHODS: Retrospective chart review of children with hip pain of less than 2 weeks duration, presenting to a metropolitan children's emergency department in New Zealand. Data were extracted on radiography results, diagnosis on final discharge from hospital, and other clinical details. Diagnostic categories were divided into urgent pathology (those requiring immediate treatment) and nonurgent pathology (those requiring follow up and those requiring no treatment or follow up). Contingency analysis and logistic regression were performed on variables to assess ability to predict urgent pathology. RESULTS: Hip x-rays were performed in 99% of 310 eligible patients. Of these, 3% had some degree of significant abnormality reported on hip x-ray. Final diagnoses were transient synovitis in 86% of patients, osteomyelitis or other significant musculoskeletal sepsis in 8%, slipped upper femoral epiphysis in 1%, and other musculoskeletal disorder in 4%, with no cases of septic arthritis. In children 9 years or older, the likelihood ratio with a positive x-ray was 17, compared with 6 in children younger than 9 years. Fever, weight-bearing status, and age were the most important predictors of urgent pathology. CONCLUSIONS: In children younger than 9 years presenting with recent onset, nontraumatic hip pain, hip x-ray is of limited value. In children 9 years or older, hip x-ray may be useful to exclude slipped upper femoral epiphysis. Fever, weight bearing status, and age may better predict urgent pathology.

Searching for health equity: validation of a search filter for ethnic and socioeconomic inequalities in transport.

BACKGROUND: Efforts to improve health equity should be informed by the best available evidence. However, equity-related research is inconsistently indexed, and uses a variety of terms to describe key concepts, making it difficult to reliably identify all relevant studies. We report the development and validation of a search strategy for studies investigating whether the effects of interventions differ by ethnicity or socio-economic status, using the field of transport and health as an example. METHODS: Adapting previously described methods, we followed four steps: generation of a test set of eligible studies, search strategy development, search strategy validation, and documentation. RESULTS: Drawing from 12 systematic reviews, supplemented by additional studies identified by experts and colleagues, we identified a test set of 11 studies that met our eligibility criteria. We assigned five studies to a development set, which we used to develop and refine our search strategy. We assigned the remaining six studies to a validation set, against which we tested our final search strategy. The final search strategy identified all studies in both validation and development sets. CONCLUSIONS: The validated search strategy derived in this study facilitates the conduct of systematic reviews and other literature searches investigating whether the effects of interventions differ by ethnicity or socio-economic status and may be further developed in future for other equity-focused searches and reviews.

Ethnic, socioeconomic and geographical inequalities in road traffic injury rates in the Auckland region.

OBJECTIVE: To describe ethnic, socioeconomic and geographical differences in road traffic injury (RTI) within Auckland, New Zealand's largest city. METHODS: We analysed rates of RTI deaths and non-fatal hospital admissions using the New Zealand Mortality Collection and the National Minimum Data Set 2000-08. Poisson regression examined the association of age, gender, prioritised ethnicity and small area deprivation (New Zealand Index of Deprivation) with RTI rates, and RTI rates were mapped for 21 local board areas within the Auckland region. RESULTS: While RTI rates increased with levels of deprivation in all age groups, the gradient was steepest among children (9% increase/decile) and adults aged 25-64 years (11% increase/decile). In all age groups, RTI risk was highest among Maori. Pacific children had an elevated risk of RTI compared with the NZ European/Other group, but Pacific youth (15-24 years) and adults (25-64 years) had a lower risk. While RTI rates were generally higher for those living in rural local board areas, all but one local board in the southern Auckland urban area had among the highest rates. CONCLUSIONS: There are substantial ethnic, socioeconomic and geographic inequalities in RTI risk in the Auckland region, with high rates among Maori (all ages), Pacific children, people living in socioeconomically deprived neighbourhoods, the urban south and rural regions. IMPLICATIONS: To meet the vision of regional plans, road safety efforts must prioritise vulnerable communities at greatest risk of RTI, and implement and monitor the effectiveness of strategies that specifically include a focus on reducing inequalities in RTI rates.

How well does climate change and human health research match the demands of policymakers? A scoping review.

BACKGROUND: In 2008, the World Health Organization (WHO) Member States passed a World Health Assembly resolution that identified the following five priority areas for research and pilot projects on climate change and human health: health vulnerability, health protection, health impacts of mitigation and adaptation policies, decision-support and other tools, and costs of health protection from climate change. OBJECTIVES: To assess the extent to which recently published research corresponds to these priorities, we undertook a scoping review of original research on climate change and human health. Scoping reviews address topics that are too broad for a systematic review and commonly aim to identify research gaps in existing literature. We also assessed recent publication trends for climate change and health research. METHODS: We searched for original quantitative research published from 2008 onward. We included disease burden studies that were specific to climate change and health and included intervention studies that focused on climate change and measured health outcomes. We used MEDLINE, Embase, and Web of Science databases and extracted data on research priority areas, geographic regions, health fields, and equity (systematic differences between advantaged and disadvantaged social groups). DISCUSSION: We identified 40 eligible studies. Compared with other health topics, the number of climate change publications has grown rapidly, with a larger proportion of reviews or editorials. Recent original research addressed four of the five priority areas identified by the WHO Member States, but we found no eligible studies of health adaptation interventions, and most of the studies focused on high-income countries. CONCLUSIONS: Climate change and health is a rapidly growing area of research, but quantitative studies remain rare. Among recently published studies, we found gaps in adaptation research and a deficit of studies in most developing regions. Funders and researchers should monitor and respond to research gaps to help ensure that the needs of policymakers are met.

Why New Zealand must rapidly halve its greenhouse gas emissions.

New Zealand must commit to substantial decreases in its greenhouse gas emissions, to avoid the worst impacts of climate change on human health, both here and internationally. We have the fourth highest per capita greenhouse gas emissions in the developed world. Based on the need to limit warming to 2 degrees C by 2100, our cumulative emissions, and our capability to mitigate, New Zealand should at least halve its greenhouse gas emissions by 2020 (i.e. a target of at least 40% less than 1990 levels). This target has a strong scientific basis, and if anything may be too lenient; reducing the risk of catastrophic climate change may require deeper cuts. Short-term economic costs of mitigation have been widely overstated in public debate. They must also be balanced by the far greater costs caused by inertia and the substantial health and social benefits that can be achieved by a low emissions society. Large emissions reductions are achievable if we mobilise New Zealand society and let technology follow the signal of a responsible target.

Screening and intervention for alcohol problems among patients admitted following unintentional injury: a missed opportunity?

AIM: To describe current screening and intervention practice for alcohol problems in a New Zealand trauma centre. METHODS: Retrospective analysis of a trauma registry database at a metropolitan hospital in New Zealand, and hospital chart review for documentation of alcohol screening and intervention on a random sample of 120 adults, stratified by ethnicity and blood alcohol status, admitted following unintentional injury for the period January 2003 to December 2004. RESULTS: Among 1970 patients admitted following unintentional injury during the study period, 23% had a blood alcohol test at admission. Approximately half of these tests were positive. While 68% of charts reviewed included a general comment on alcohol use, only 7.3% recorded information that suggested a possible drinking problem. No formal alcohol screening interviews were documented, and in only 1.5% of admissions was an alcohol intervention in the hospital setting recorded. CONCLUSION: Formal screening and interventions for alcohol problems among this group of inpatients were infrequent, indicating missed opportunities to reduce alcohol-related harm and, potentially, trauma recurrence. Effective approaches for alcohol screening and intervention in the New Zealand trauma inpatient setting require review.

Immunogenicity, reactogenicity, and safety of a P1.7b,4 strain-specific serogroup B meningococcal vaccine given to preteens.

New Zealand (NZ) has experienced a Neisseria meningitidis serogroup B epidemic since 1991. MeNZB, a strain-specific outer membrane vesicle vaccine made using an NZ epidemic strain isolate, NZ98/254 (B:4:P1.7b,4), from two manufacturing sites, the Norwegian Institute of Public Health (NIPH) and Chiron Vaccines (CV; now Novartis), was evaluated for safety, immunogenicity, and reactogenicity in this observer-blind trial with 8- to 12-year-old children. In year 1, cohort A (n = 302) was randomized 4:1 for receipt of NIPH-MeNZB or MenBvac (Norwegian parent vaccine strain 44/76; B:15:P1.7,16). In year 2, cohort B (n = 313) was randomized 4:1 for receipt of CV-MeNZB or NIPH-MeNZB. Participants all received three vaccinations 6 weeks apart. Local and systemic reactions were monitored for 7 days. Seroresponse was defined as a fourfold or greater rise in the serum bactericidal antibody titer from the baseline titer as measured by a serum bactericidal assay. Those with baseline titers of <1:4 required titers of >/=1:8 to serorespond. Intention-to-treat (ITT) and per protocol (PP) analyses are presented. In cohort A, 74% (ITT) and 73% (PP) of NIPH-MeNZB recipients demonstrated seroresponses against NZ98/254 after three doses, versus 32% (ITT and PP) of MenBvac recipients. In cohort B, seroresponses against NZ98/254 after three doses occurred in 79% (ITT and PP) of CV-MeNZB versus 75% (ITT) and 76% (PP) of NIPH-MeNZB recipients. Vaccines were tolerable, with no vaccine-related serious adverse events. In conclusion, the NZ strain meningococcal B vaccine (MeNZB) from either manufacturing site was immunogenic against New Zealand epidemic vaccine strain meningococci with no safety concerns when given in three doses to these 8- to 12-year-old children.