Nine-year exposure to residential greenness and the risk of metabolic syndrome among Luxembourgish adults: A longitudinal analysis of the ORISCAV-Lux cohort study.

Growing evidence shows a beneficial effect of exposure to greenspace on cardiometabolic health, although limited by the cross-sectional design of most studies. This study examined the long-term associations of residential greenness exposure with metabolic syndrome (MetS) and MetS components within the ORISCAV-LUX study (Wave 1: 2007-2009, Wave 2: 2016-2017, n = 395 adults). Objective exposure to residential greenness was measured in both waves by the Soil-Adjusted Vegetation Index (SAVI) and by Tree Cover Density (TCD). Linear mixed models were fitted to estimate the effect of baseline levels and change in residential greenness on MetS (continuous score: siMS score) and its components (waist circumference, triglycerides, HDL-cholesterol, fasting plasma glucose and systolic blood pressure), respectively. This study provides evidence that an increase in SAVI, but not TCD, may play a role in preventing MetS, as well as improving HDL-cholesterol and fasting plasma glucose levels. Greater baseline SAVI was also associated with lower fasting plasma glucose levels in women and participants living in municipalities with intermediate housing price, and greater baseline TCD was associated with larger waist circumference. Overall, findings suggest a mixed impact of increased greenness on cardiometabolic outcomes. Further longitudinal research is needed to better understand the potential effects of different types of greenness exposure on cardiometabolic outcomes.

How Spatial Epidemiology Helps Understand Infectious Human Disease Transmission.

Both directly and indirectly transmitted infectious diseases in humans are spatial-related. Spatial dimensions include: distances between susceptible humans and the environments shared by people, contaminated materials, and infectious animal species. Therefore, spatial concepts in managing and understanding emerging infectious diseases are crucial. Recently, due to the improvements in computing performance and statistical approaches, there are new possibilities regarding the visualization and analysis of disease spatial data. This review provides commonly used spatial or spatial-temporal approaches in managing infectious diseases. It covers four sections, namely: visualization, overall clustering, hot spot detection, and risk factor identification. The first three sections provide methods and epidemiological applications for both point data (i.e., individual data) and aggregate data (i.e., summaries of individual points). The last section focuses on the spatial regression methods adjusted for neighbour effects or spatial heterogeneity and their implementation. Understanding spatial-temporal variations in the spread of infectious diseases have three positive impacts on the management of diseases. These are: surveillance system improvements, the generation of hypotheses and approvals, and the establishment of prevention and control strategies. Notably, ethics and data quality have to be considered before applying spatial-temporal methods. Developing differential global positioning system methods and optimizing Bayesian estimations are future directions.

Social cohesion, psycho-physical well-being and self-efficacy of school-aged children in Lombardy: Results from HBSC study.

Within the literature on health inequalities and social determinants of health, there is a growing interest in studying how the context of residence is able to influence health conditions and health-related outcomes, over and above individual characteristics. Life context affects people's well-being in a material way, through the availability of services and resources, but also through social, cultural and relational resources, to the extent to which people within the same context share norms, values and behaviours affecting their health conditions. In this study, we analysed the association between social cohesion in the context of residence and two health-related outcomes, psycho-physical well-being and self-efficacy, in school-aged children in Lombardy, using data from the Health Behaviour in School-aged Children (HBSC) study for 2014. The results show a positive association between the variables, indicating that social cohesion matters for young people's health and well-being and suggesting new areas of intervention in policies aiming at promoting health and reducing inequalities.

Neighbourhood effects on obesity: scoping review of time-varying outcomes and exposures in longitudinal designs.

CONTEXT AND OBJECTIVES: Neighbourhood effect research on obesity took off in the early 2000s and was composed of mostly cross-sectional observational studies interested in various characteristics of the built environment and the socioeconomic environment. To limit biases related to self-selection and life course exposures, many researchers apply longitudinal designs in their studies. Until now, no review has specifically and exclusively examined longitudinal studies and the specific designs of these studies. In this review, we intend to answer the following research question: how are the temporal measurements of contextual exposure and obesity outcomes integrated into longitudinal studies that explore how neighbourhood-level built and socioeconomic environments impact adult obesity? DESIGN: A systematic search strategy was designed to address the research question. The search was performed in Embase, Web of Science and PubMed, targeting scientific papers published before 1 January 2018. The eligible studies reported results on adults, included exposure that was limited to neighbourhood characteristics at the submunicipal level, included an outcome limited to obesity proxies, and reported a design with at least two exposure measurements or two outcome measurements. RESULTS: This scoping review identified 66 studies that fit the eligibility criteria. A wide variety of neighbourhood characteristics were also measured, making it difficult to draw general conclusions about associations between neighbourhood exposure and obesity. We applied a typology that classified studies by whether exposure and outcome were measured as varying or fixed. Using this typology, we found that 32 studies reported both neighbourhood exposure and obesity outcomes that were varying in time; 28 reported varying outcomes but fixed exposures; and 6 had fixed outcomes and varying exposures. CONCLUSION: Our typology illustrates the variety of longitudinal designs that were used in the selected studies. In the light of our results, we make recommendations on how to better report longitudinal designs and facilitate comparisons between studies.

Trends in urban/rural inequalities in cardiovascular risk bio-markers among Chinese adolescents in two decades of urbanisation: 1991-2011.

BACKGROUND: China has seen rapid socio-economic changes and epidemiological transitions in the last few decades. Previous studies often fail to examine how wider macro-level forces contribute to changes in health inequality among its population in China. This study aims to examine urban/rural inequalities in cardiovascular (CVD) risks biomarkers among Chinese adolescents in two decades from 1991 to 2011 during the process of China's rapid urbanisation. METHODS: Data were drawn from a nationwide longitudinal dataset of the China Health and Nutrition Survey (CHNS) (Sweeps 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011). Children aged between 12 and 18 years (Boys: n = 3472; Girl: n = 3155) were included. A dynamic urbanisation index was created for each community (village or neighbourhood) based on community-level data that can reveal the heterogeneity within and across places and capture dimensions of social, economic and physical characteristics of urban living over time and space. Linear multilevel modeling analyses (Level 1: Occasions; Level-2: Individuals; Level-3: Households; Level-4: Communities) were performed on outcomes of CVD risk biomarkers including anthropometric measures and blood pressure. RESULTS: After adjustment for age, maternal education and household income per capita, cardiovascular (CVD) risk biomarkers increase among Chinese adolescents during 1991 to 2011. Urbanisation tends to have an independent and positive impact on body mass index (BMI) and waist circumference for boys but not for girls. Positive interaction effect between urbanisation index and survey years for waist circumference was observed for girls (0.005; 95% confidence interval [CI], 0.002, 0.007; p < 0.01): time trends become greater when areas become more urbanized. For blood pressure, when areas become more urbanized the trends for boys become decreased (- 0.005; 95% CI, - 0.009, - 0.002; p < 0.01 for systolic blood pressure and - 0.003; 95% CI, - 0.006, - 0.001; p < 0.05 for diastolic blood pressure). CONCLUSION: Chinese adolescents are experiencing an upward trend of cardiovascular (CVD) risks in last two decades. Its rapid urbanisation appears to further increase urban/rural inequalities in CVD risks, especially for boys from less urbanised areas and girls from more urbanised areas, which may contribute to the development of cardiovascular disease (CVD) in adulthood. It is relevant to inform policy making process to target specific vulnerable groups. Given China's urbanisation is strongly influenced by the state, there is a possibility for policy intervention to reduce inequality during the process of China's planned urbanisation.

Longitudinal designs to study neighbourhood effects on the development of obesity: a scoping review protocol.

INTRODUCTION: The prevalence of obesity has increased significantly in the last three decades and became an important public health concern. Evidence of weight status variability at the neighbourhood level has led researchers to look more precisely at the characteristics of local geographic areas that might influence energy balance related behaviours, giving rise to the field of the 'neighbourhood effect' in public health research. Among an abundant literature about neighbourhood effects and obesity, we propose a protocol for a scoping review that will aim at determining how temporal measurements of residential neighbourhood exposure, individual covariates and weight outcome are integrated in longitudinal designs. METHODS AND ANALYSIS: A list of relevant citations will be obtained through a comprehensive systematic database search in Pubmed, Web of Science and Embase. The search strategy will be designed using a broad definition of neighbourhood to take into account the heterogeneity of this concept in research. Two investigators will screen titles, abstracts and entire publications using predetermined eligibility criteria yielding a list of selected publications. Data from the publications included in the scoping review will be charted according to bibliographic information, study population, exposure, outcomes and results. DISCUSSION AND CONCLUSION: To our knowledge, our protocol will yield the first scoping review regarding longitudinal designs of neighbourhood effect on obesity. Describing how longitudinal designs include temporal measurements of exposure, covariates and outcome is a necessary step in the quest to determine if or which contextual characteristics are likely to be involved in the development of obesity. Such information would bring new knowledge to complement current aetiological investigations and would contribute to enhancing resource allocation strategies for stakeholders in developing relevant interventions to prevent obesity and its negative impacts.

Life satisfaction, ethnicity and neighbourhoods: Is there an effect of neighbourhood ethnic composition on life satisfaction?

Immigrants and ethnic minorities tend to have lower life satisfaction than majority populations. However, current understanding of the drivers of these gaps is limited. Using a rich, nationally representative data set with a large sample of ethnic minorities and matched neighbourhood characteristics, we test whether first and second generation minorities experience lower life satisfaction once accounting for compositional differences and whether, specifically, neighbourhood deprivation impacts their wellbeing. We further investigate whether a larger proportion of own ethnic group in the neighbourhood improves satisfaction. We find life satisfaction is lower among ethnic minorities, and especially for the second generation, even controlling for individual and area characteristics. Neighbourhood concentration of own ethnic group is, however, associated with higher life satisfaction for Black Africans and UK born Indians and Pakistanis. The effect for Black Africans may stem from selection into areas, but findings for Indians and Pakistanis are robust to sensitivity tests.

Neighbourhood effects on body constitution-A case study of Hong Kong.

Traditional Chinese Medicine (TCM) has long perceived environment as an integral part of the development of body constitution, which is a personal state of health closely related to disease presence. Despite of the ever-growing studies on the clinical effectiveness of TCM and the scientific linking between body constitution and diseases, the geographical influence on body constitution has yet remained an unexplored territory. This study sought to investigate whether the neighbourhood environment is relevant to the composition of body type of a population through statistical multilevel and Geographic Information Systems modelling. The analysis comprised 3277 participants who had completed their body type assessment between 2009 and 2012 inclusive. The multilevel analysis also took simultaneous accounts of both individual-level (gender, age, BMI, type of housing) and area-level (percent greenery, percent road surface, total road intersection, sky view factor, temperature, relative humidity, rainfall and social deprivation index) characteristics to explain geographical variation by body types. Significant random or place effects (p < 0.001) were identified in the multilevel models. The spatial variation of body constitution involved the dynamic interplay between individual and environmental factors. The findings amassed the first scientific indications to back the common belief that place does play a role in the development of body constitution and is worthy of further investigation. By considering spatial and personal attributes simultaneously, the study can yield valuable insights into the patterning of area variation in body constitution and disease presence.

Is the implementation of quality improvement methods in hospitals subject to the neighbourhood effect?

OBJECTIVE: Quality improvement (QI) methods have been fashionable in hospitals for decades. Previous studies have discussed the relationships between the implementation of QI methods and various external and internal factors, but there has been no examination to date of whether the neighbourhood effect influences such implementation. The aim of this study was to use a multilevel model to investigate whether and how the neighbourhood effect influences the implementation of QI methods in the hospital setting in Taiwan. DESIGN: This is a retrospective questionnaire-based survey. SETTING: All medical centres, regional hospitals and district teaching hospitals in Taiwan. PARTICIPANTS: Directors or persons in charge of implementing QI methods in hospitals. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The breadth and depth of QI method implementation. RESULTS: Seventy-two of the 139 hospitals contacted returned the questionnaire, yielding a 52% response rate. The breadth and depth of QI method implementation increased over the 10-year study period, particularly between 2004 and 2006. The breadth and depth of the QI methods implemented in the participating hospitals were significantly associated with the average breadth and depth of those implemented by their competitors in the same medical area during the previous period. In addition, time was positively associated with the breadth and depth of QI method implementation. CONCLUSIONS: In summary, the findings of this study show that hospitals' QI implementation status is influenced by that of their neighbours. Hence, the neighbourhood effect is an important factor in understanding hospital behaviour.