The association between natural outdoor environments and common somatic symptoms.

There is growing evidence that urban natural outdoor environments (NOE) may positively impact health by reducing stress and stress-related symptoms. However, there is limited research investigating this link across a range of NOE indicators. This cross-sectional study investigated the association between neighbourhood NOE (availability, use, and satisfaction with NOE) and common somatic symptoms and the role of potential mediators. Data were analysed from 3481 adults from Barcelona (Spain), Doetinchem (Netherlands), Kaunas (Lithuania) and Stoke-on-Trent (United Kingdom). NOE data were obtained through self-reported data and environmental measurements. Common somatic symptom data were self-reported. Mixed effects regression models were used for analysis, with models adjusted for potential sociodemographic confounders. Higher satisfaction with neighbourhood NOE was associated with lower prevalence of common somatic symptoms (exp(ß) 0.97; 95% CI 0.96, 0.98); an association partially mediated by mental health, social cohesion and air quality concern. A longer time spent in NOE was associated with lower prevalence of common somatic symptoms in low socioeconomic status neighbourhoods (exp(ß) 0.98; 95% CI 0.96, 1.00). A higher number of neighbourhood green spaces (300m buffer) was associated with higher prevalence of common somatic symptoms (exp(ß) 1.03; 95% CI 1.00, 1.05). No statistically significant associations were found for other NOE indicators. Study findings suggest that higher satisfaction with NOE may be associated with lower prevalence of common somatic symptoms, with mental health, social cohesion and concern about air quality playing partial mediating roles. Little evidence was found of an association between objective NOE measurements and common somatic symptoms, underlining the importance of perceptions of NOE for conferring health benefits.

Improving cardiovascular disease risk communication in the UK national health service health check programme.

OBJECTIVE: To develop and test training to improve practitioners' confidence and perceived understanding when communicating cardiovascular disease (CVD) risk using novel tools and metrics. METHODS: A CVD risk communication training workshop was developed through interviews with patients and practitioners delivering Health Checks, a literature review, NICE guidance and the UK Health Check competency framework. It was pilot-tested with practitioners delivering Health Checks in the UK. Perceived practitioner understanding and confidence were measured before and up to 10 weeks after the workshop, and changes were compared with those in a control group (who received no intervention). Perceived impact was also explored through semi-structured interviews. RESULTS: Sixty-two practitioners (34 intervention, 28 control) took part. Perceived practitioner understanding (p = .030) and perceived patient understanding (p = .007) improved significantly for those delivering Health Checks in the training group compared with controls. Practitioner confidence also improved significantly more in practitioners who attended the training (p = .001). Findings were supported by interviews with a sub-sample of practitioners (n = 13). CONCLUSION: The training workshop improved practitioners' confidence and perceived understanding of CVD risk in Health Checks. PRACTICE IMPLICATIONS: The training is an important step to improving practitioner understanding of CVD risk in Health Checks and should be implemented on a wider scale.

A qualitative study of disengagement in disadvantaged areas of the UK: 'You come through your door and you lock that door'.

Health inequalities are a major concern in the UK. Power imbalances are associated with health inequalities and should be challenged through health promotion and empowering strategies, enabling individuals who feel powerless to take control over their own life and act on the determinants of health (Green and Tones, 2010). This study aimed to explore resident expectations of a community engagement programme that intended to empower communities to take action on pre-identified priorities. The programme targeted communities in deprived areas of a mid-sized city in the UK. A qualitative design was implemented. In-depth semi-structured interviews were undertaken with 28 adult residents at the start of the programme. Transcripts were analysed using an inductive approach to thematic analysis. Resident expectations were explored from a constructivist epistemological perspective. The qualitative inductive approach allowed a second research question to develop which led this paper to focus on exploring how disempowerment was experienced by individuals before taking part in a community engagement programme. Analysis of interviews revealed a 'process of deterioration' that provided insight into how communities might become (more) disadvantaged through disempowerment. Five master themes were identified: external abandonment at the institutional-level (master theme 1); a resulting loss of sense of community (master theme 2); this negatively affected psychological wellbeing of residents (master theme 3); who adopted coping strategies (e.g., disengagement) to aid living in such challenging areas; (master theme 4); disengagement further perpetuated the deterioration of the area (master theme 5). Distrust was identified as a major barrier to participation in community engagement programmes. Overall, our data suggested that community engagement approaches must prioritise restoration of trust and be accompanied by supportive policies to mitigate feelings of abandonment in communities.

Understanding implementation and uptake in the National Health Service Health Check Programme.

OBJECTIVES: We present findings from a national online survey of uptake and implementation of the National Health Service Health Check (NHSHC) programme. The research aimed to understand national variation in implementation of NHSHCs and to explore the relationship between uptake and different components of implementation. STUDY DESIGN: The study design was a descriptive online survey. METHODS: Data were collected via an online survey between November 2015 and August 2016. The survey was distributed nationally to practice managers in the Midlands and East of England, South of England, North of England and London via local NHSHC leads with the help of the national programme manager. RESULTS: Responses were received from 153 participants, half of who were practice managers (49.7%). Common components of implementation included using postal invitations accompanied by the national leaflet, delivering NHSHCs routinely with other appointments, offering NHSHC outside of working hours and taking blood samples during the consultation. Meaningful exploration of the relationship between uptake and components of implementation was not possible given the inaccuracy of self-reported uptake data, which was confirmed by comparison with public health data in a subsample (n = 18). The comparison also found that a number of practices were reporting more completed health checks than the total number of patients invited, which again indicates problems that may have implications for uptake figures locally and nationally. CONCLUSIONS: Overall, our findings showed considerable variation in the implementation of NHSHCs on a national scale and issues with quality of programme uptake data, which has implications for national reporting for NHSHC.

The association between green space and depressive symptoms in pregnant women: moderating roles of socioeconomic status and physical activity.

BACKGROUND: The current study explored the association between green space and depression in a deprived, multiethnic sample of pregnant women, and examined moderating and mediating variables. METHOD: 7547 women recruited to the 'Born in Bradford' cohort completed a questionnaire during pregnancy. A binary measure of depressive symptoms was calculated using a validated survey. Two green space measures were used: quintiles of residential greenness calculated using the normalised difference vegetation index for three neighbourhood sizes (100, 300 and 500 m buffer zones around participant addresses); access to major green spaces estimated as straight line distance between participant address and nearest green space (>0.5 hectares). Logistic regression analyses examined relationships between green space and depressive symptoms, controlling for ethnicity, demographics, socioeconomic status (SES) and health behaviours. Multiplicative interactions explored variations by ethnic group, SES or activity levels. Mediation analysis assessed indirect effects via physical activity. RESULTS: Pregnant women in the greener quintiles were 18-23% less likely to report depressive symptoms than those in the least green quintile (for within 100 m of green space buffer zone). The green space-depressive symptoms association was significant for women with lower education or who were active. Physical activity partially mediated the association of green space, but explained only a small portion of the direct effect. CONCLUSIONS: Higher residential greenness was associated with a reduced likelihood of depressive symptoms. Associations may be stronger for more disadvantaged groups and for those who are already physically active. Improving green space is a promising intervention to reduce risk of depression in disadvantaged groups.

Physical activity and screen time in adolescents transitioning out of compulsory education: a prospective longitudinal study.

BACKGROUND: Within the UK context, it is unclear whether physical activity and screen time changes between completing compulsory education and the period afterwards, and the factors associated with any change. METHODS: A prospective population-based longitudinal design among adolescents (n = 2204 at baseline) was adopted. A self-report questionnaire was administered at baseline (final year of compulsory education) and follow-up (i.e. post compulsory education) to measure physical activity over the previous 7 days and screen time (weekday and weekend) in relation to recommended guidelines. Magnitude of change in physical activity and screen time and key influencing variables associated with changes were analysed. RESULTS: For physical activity, there was a significant change in participants meeting guidelines at baseline but not meeting guidelines at follow-up with 81.0% not meeting guidelines at baseline and follow-up. For screen time, there was no significant change between baseline and follow-up, with 70.6% not meeting guidelines at baseline and follow-up. Gender was associated with the change in physical activity with a decline less likely in females. CONCLUSIONS: Findings reinforce the importance of reducing physical inactivity and sedentary behaviour during this transition. Factors associated with changes in physical inactivity and sedentary behaviour need further investigation.

A meta-analysis of brief high-impact exercises for enhancing bone health in premenopausal women.

UNLABELLED: A snapshot of current evidence from 6 randomised controlled trials for the effects of short bouts of high-impact exercises in 256 women via meta-analysis reveals that ample osteogenic response could be realised at the femoral neck and trochanter of premenopausal women with rest-inserted bouts of few mechanical bone loading cycles. INTRODUCTION: Exercise is an important means of improving bone health and preventing osteoporosis. Brief bouts of simple exercises may be useful for aiding lifestyle compliance to physical activity. This study aimed to review the evidence on the effect of brief, high-impact exercise on bone health among premenopausal women. METHODS: A structured and comprehensive search of databases was undertaken along with hand searching of key journals and reference lists to locate relevant studies published and unpublished up to January 2011. Six randomised controlled trials met predetermined inclusion criteria. Brief high-impact exercises (<30 min) were examined for their effect on bone mineral density (BMD) among premenopausal women. Trial quality was assessed using the Effective Public Health Practice Project quality assessment tool. Study outcomes for analysis, absolute change (grams per square centimetre) or relative change (in percent) in BMD at femoral neck, trochanter and lumbar spine were compared by calculating standardised mean difference (SMD) using fixed- and random effects models. RESULTS: Quality of included trials varied from medium to high on a scale of 1 to 3. Brief bouts of exercise led to significant increases in femoral neck BMD (SMD = 0.64, 95% confidence interval (CI) = 0.38, 0.90, overall effect Z value = 4.84, p = 0.001); a modest increase in trochanteric BMD (SMD = 0.36, 95% CI = 0.10, 0.61, Z value = 2.08, p = 0.04) and no increase in spinal BMD (SMD = 0.04, 95% CI= -0.23, 0.31, Z value = 0.26, p = 0.79). CONCLUSION: Based on the meta-analysis, brief high-impact exercise improves BMD at the hip but not at the lumbar spine. Effectiveness of this form of exercise as a lifestyle physical activity for prevention of osteoporosis should be explored in larger populations.