Identifying barriers to emergency department-initiated buprenorphine: A spatial analysis of treatment facility access in Michigan.

STUDY OBJECTIVES: Emergency department (ED)-initiated buprenorphine/naloxone has been shown to improve treatment retention and reduce illicit opioid use; however, its potential may be limited by a lack of accessible community-based facilities. This study compared one state's geographic distribution of EDs to outpatient treatment facilities that provide buprenorphine treatment and identified ED and geographic factors associated with treatment access. METHODS: Treatment facility data were obtained from the SAMHSA 2018 National Directory of Drug and Alcohol Abuse Treatment Facilities, and ED data were obtained from the Michigan College of Emergency Physician's 2018 ED directory. Geospatial analysis compared EDs to buprenorphine treatment facilities using 5-, 10-, and 20-mile network buffers. RESULTS: Among 131 non-exclusively pediatric EDs in Michigan, 57 (43.5%) had a buprenorphine treatment facility within 5 miles, and 66 (50.4%) had a facility within 10 miles. EDs within 10 miles of a Medicaid-accepting, outpatient buprenorphine treatment facility had higher average numbers of beds (41 vs. 15; p < 0.0001) and annual patient volumes (58,616 vs. 17,484; p < 0.0001) compared to those without. Among Michigan counties with EDs, those with at least one buprenorphine facility had larger average populations (286,957 vs. 44,757; p = 0.005) and higher annual rates of opioid overdose deaths (mean 18.3 vs. 13.0 per 100,000; p = 0.02) but were similar in terms of opioid-related hospitalizations and socioeconomic distress. CONCLUSION: Only half of Michigan EDs are within 10 miles of a buprenorphine treatment facility. Given these limitations, expanding access to ED-initiated buprenorphine in states similar to Michigan may require developing alternative models of care.

Retrospective Cohort Noninferiority Analysis of Barrier Cream in Preventing Pressure Injuries.

OBJECTIVE: To assess the effectiveness of a dimethicone- and zinc-based barrier cream compared with hyperoxygenated fatty acids in preventing pressure injuries (PIs) in patients at high or very high risk. METHODS: Researchers conducted a retrospective noninferiority study in an inpatient acute care hospital in Spain that included hospitalized patients in nonsurgical departments with impaired mobility. RESULTS: The study authors reviewed 522 patients in a control group (hyperoxygenated fatty acids) and an experimental group (barrier cream) over a period of 7 days. The incidence of PI was 31% in the control group and 31.1% in the experimental group. The hazard ratio for developing PI was 0.84 (confidence interval, 0.61-1.17; P = .32) in the experimental group compared with the control group, meeting the criteria for noninferiority. The Kaplan-Meier estimator indicated no statistically significant difference between groups (log-rank = 0.654). CONCLUSIONS: Dimethicone- and zinc-based barrier cream was not inferior to hyperoxygenated fatty acids in preventing PIs in hospitalized patients at high or very high risk of developing them during their hospital stay.

Evaluation of a Novel Ostomy Barrier Ring with Assisted Flow for Individuals with an Ileostomy.

OBJECTIVE: To determine the performance and user experience of a novel ostomy barrier ring over a 4-week period. METHODS: This single-arm investigation conducted across three clinical sites included 25 adult participants with an ileostomy for 3 months or longer. The participants used their standard ostomy pouching appliance along with a novel barrier ring for a period of 4 weeks. Skin condition was assessed using the Ostomy Skin Tool. Change in skin condition over the study period was recorded for each participant. The participants' experience in using the novel barrier ring was measured using a five-point Likert-type scale. RESULTS: Twenty of the 25 participants (80%) completed the trial. Of those participants, the median Ostomy Skin Tool score at both the beginning (range, 0-8) and end was 0 (range, 0-6). In terms of skin condition, 7 participants experienced an improvement in skin condition, 11 experienced no change, and 2 got worse. A median score of 5 out of 5 was recorded for all questions relating to user experience. CONCLUSIONS: Although not statistically significant, there was a clear trend toward improvements in peristomal skin condition using the novel barrier ring, even for participants who were already using a barrier ring. User feedback was positive with respect to comfort, device handling, and the perception of the device's ability to protect the skin. Further, most participants who already used a barrier ring indicated that the novel barrier ring would result in a longer wear time.

Required and Voluntary Occupational Use of Hazard Controls for COVID-19 Prevention in Non-Health Care Workplaces - United States, June 2020.

Certain hazard controls, including physical barriers, cloth face masks, and other personal protective equipment (PPE), are recommended to reduce coronavirus 2019 (COVID-19) transmission in the workplace (1). Evaluation of occupational hazard control use for COVID-19 prevention can identify inadequately protected workers and opportunities to improve use. CDC's National Institute for Occupational Safety and Health used data from the June 2020 SummerStyles survey to characterize required and voluntary use of COVID-19-related occupational hazard controls among U.S. non-health care workers. A survey-weighted regression model was used to estimate the association between employer provision of hazard controls and voluntary use, and stratum-specific adjusted risk differences (aRDs) among workers reporting household incomes <250% and ≥250% of national poverty thresholds were estimated to assess effect modification by income. Approximately one half (45.6%; 95% confidence interval [CI] = 41.0%-50.3%) of non-health care workers reported use of hazard controls in the workplace, 55.5% (95% CI = 48.8%-62.2%) of whom reported employer requirements to use them. After adjustment for occupational group and proximity to others at work, voluntary use was approximately double, or 22.3 absolute percentage points higher, among workers who were provided hazard controls than among those who were not. This effect was more apparent among lower-income (aRD = 31.0%) than among higher-income workers (aRD = 16.3%). Employers can help protect workers from COVID-19 by requiring and encouraging use of occupational hazard controls and providing hazard controls to employees (1).

Assessing environmental barriers by means of the swedish craig hospital inventory of environmental factors among people post-stroke.

BACKGROUND: When occupational therapists address environmental barriers to occupational engagement, some barriers might not be possible to reduce for single individuals, because decisions have to be taken at community or societal level, for example changes in public transport. Investigating environmental barriers by means of the Swedish Craig Hospital Inventory of Environmental Factors (CHIEF-S) may increase our understanding of the environmental impact on occupation engagement and the methodological challenges to assess environmental barriers. AIMS: To investigate and describe the magnitude of encountered environmental barriers in a group of people post-stroke and to assess psychometric properties of the CHIEF-S. MATERIAL AND METHODS: In total, 34 participants, who had sustained a stroke in Sweden were recruited. RESULTS: The participants reported in average 2,7 barriers and the total frequency-magnitude score of barriers (CHIEF-S score) was 0.45. The Cronbach's α for the total CHIEF-S was 0.80 and the analysis of test-retest reliability revealed ICC = 0.86. The entire instrument demonstrated better psychometric properties than the single sub-scales. CONCLUSION: In this study, the frequency-magnitude of environmental barriers encountered by people post-stroke are reported at a group level and adds information to the cumulative knowledge generation on perceived environmental barriers in the society. However, to inform which interventions are needed at a more detailed level, other data collection methods have to be added.

Evaluating the Effectiveness of a Novel Skin Barrier Protectant in a Patient with Acute Radiodermatitis of the Vulva: A Case Report.

OBJECTIVE: To evaluate the use of a novel skin barrier protectant in a patient treated with radiotherapy for vulvar cancer. METHODS: This case report was conducted in a radiotherapy department with two women undergoing radiotherapy for vulvar carcinoma. A novel skin barrier protectant was evaluated in one patient; the other underwent the institutional standard skin care protocol. Skin reactions and pain were evaluated using the Radiotherapy Oncology Group Criteria. MAIN RESULTS: The patient who was treated with the skin protectant showed accelerated healing toward the end of radiotherapy, and this was accompanied with a decrease in pain (maximum pain score 6/10). In comparison, the patient treated with the standard skin care protocol had an extended healing process, experienced a higher pain level (maximum pain score 9/10), and required more nursing care. CONCLUSIONS: This case report is the first to suggest that this novel skin barrier protectant could effectively manage acute radiodermatitis in patients with cancer. This case report hopes to lay the foundation for future randomized controlled trials with a larger and broader patient population.

Environmental Barriers Experienced by People With Spinal Cord Injury Across 22 Countries: Results From a Cross-Sectional Survey.

OBJECTIVES: To investigate the experience of environmental barriers by people with spinal cord injury (SCI) across 22 countries. Specific aims were to describe and compare the prevalence of environmental barriers experienced across countries, and to analyze determinants of environmental barriers at individual and country level. DESIGN: Cross-sectional community survey. PARTICIPANTS: Individuals (N=12,591) living with SCI in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Nottwil Environmental Factors Inventory-Short Form. RESULTS: Most barriers were experienced in relation to accessibility, climate, transportation, finances, and state services. More severe barriers were experienced in settings with lower gross domestic product (GDP), which especially refers to medical supplies (gamma=-0.38; P<.001) and finances (gamma=-0.37; P<.001) in this study. However, in a multivariable negative binomial regression using within-between estimation of the number of barriers experienced on the selected predictors, the effect of GDP was reversed when it was adjusted for covariates. On the individual level, the number of experienced barriers decreased with better mental health and greater self-care ability. People with low income, with paraplegia, complete lesions, and more health problems reported more barriers. On the country level, fewer barriers were reported in countries with higher average age, better mental health, and greater self-care ability, as well as in those with a higher percentage of traumatic SCI, paraplegia, and complete lesions. More barriers were reported in countries with a higher percentage of married individuals, lower average household income, higher average time since injury, higher mean vitality scores, and greater income inequality. CONCLUSIONS: Study participants reported a significant number of environmental barriers, many of which are modifiable. Complementary interventions are recommended. Within and between country effects of covariates sometimes pointed in different directions, suggesting that countries with a different composition of SCI population also differed in environmental contexts.

Architectural and communications barriers to access to primary health care in Brazil: an analysis based on the first national census of primary health care centers, 2012. / Barreiras arquitetônicas e de comunicação no acesso à atenção básica em saúde no Brasil: uma análise a partir do primeiro Censo Nacional das Unidades Básicas de saúde, 2012.

OBJECTIVE: to analyze the results of the National Census of Primary Health Care Centers with regard to architectural and communication barriers in Primary Health Care throughout Brazil. METHODS: this was a cross-sectional study based on data from the first National Census of Primary Health Care Centers conducted between May and October 2012. RESULTS: the Northern region had the lowest rates of adequacy; although the Southeast region had the best rates when compared to the country's other regions, they were nevertheless unsatisfactory, since for many items adequacy was still below 50%; the items relating to accessibility by people with disabilities (5.7 to 34.2%) and/or the illiterate (0.1 to 27.4%) had very low scores. CONCLUSION: the majority of services evaluated had architectural and communication barriers, hindering access to health services by disabled, illiterate or elderly people; the importance of allocating resources to reduce iniquities and improve access is stressed.

Barreiras arquitetônicas e de comunicação no acesso à atenção básica em saúde no Brasil: uma análise a partir do primeiro Censo Nacional das Unidades Básicas de saúde, 2012 / Barreras arquitectónicas y de comunicación en el acceso a la Atención Básica de Salud en Brasil: Un análisis a partir del primer Censo Nacional de las Unidades Básicas de Salud, 2012 / Architectural and communications barriers to access to primary health care in Brazil: an analysis based on the first national census of primary health care centers, 2012

Resumo Objetivo: analisar os resultados do Censo Nacional das Unidades Básicas de Saúde no que se refere às barreiras arquitetônicas e de comunicação na Atenção Básica em Saúde em todo o território brasileiro. Métodos: estudo transversal com base nos dados do primeiro Censo Nacional das Unidades Básicas de Saúde, coletados de maio a outubro de 2012. Resultados: a região Norte apresentou menores índices de adequação, enquanto a Sudeste apresentou os melhores índices, comparados às demais regiões, porém insatisfatórios, pois muitos itens permaneceram abaixo de 50%; itens sobre acessibilidade por pessoas com deficiência (5,7 a 34,2%) e não alfabetizadas (0,1 a 27,4%) apresentaram pontuação muito baixa. Conclusão: a maioria das unidades avaliadas possuem barreiras arquitetônicas e de comunicação, prejudicando a acessibilidade aos serviços de saúde prestados às pessoas com deficiência, não alfabetizadas ou idosas; destaca-se a importância da alocação de recursos para redução de iniquidades e melhoria do acesso.

Resumen Objetivo: analizar la accesibilidad de los usuarios al Censo Nacional de las Unidades Básicas de Salud en lo referente a barreras arquitectónicas y de comunicaciones en todo Brasil. Métodos: estudio descriptivo analítico con base en los datos del primer Censo Nacional de las Unidades Básicas de Salud; la encuesta se realizó entre mayo y octubre de 2012. Resultados: la región Norte presentó menores índices de adecuación, mientras que el Sudeste presentó mejores índices comparados a las demás regiones, pero insatisfactorios, pues muchos ítems permanecieron por debajo del 50%; los ítems sobre accesibilidad por personas con discapacidad (5,7 a 34,2%) y no alfabetizadas (0,1 a 27,4%) presentaron una puntuación muy baja. Conclusión: los datos demuestran que la mayoría de los servicios evaluados poseen barreras arquitectónicas y de comunicación, perjudicando la accesibilidad a los servicios de salud prestados a las personas con discapacidad, no alfabetizadas o ancianas, y exalta la importancia de asignación de recursos para la reducción de iniquidades y mejoría del acceso.

Abstract Objective: to analyze the results of the National Census of Primary Health Care Centers with regard to architectural and communication barriers in Primary Health Care throughout Brazil. Methods: this was a cross-sectional study based on data from the first National Census of Primary Health Care Centers conducted between May and October 2012. Results: the Northern region had the lowest rates of adequacy; although the Southeast region had the best rates when compared to the country's other regions, they were nevertheless unsatisfactory, since for many items adequacy was still below 50%; the items relating to accessibility by people with disabilities (5.7 to 34.2%) and/or the illiterate (0.1 to 27.4%) had very low scores. Conclusion: the majority of services evaluated had architectural and communication barriers, hindering access to health services by disabled, illiterate or elderly people; the importance of allocating resources to reduce iniquities and improve access is stressed.

Evaluating health facility access using Bayesian spatial models and location analysis methods.

BACKGROUND: Floating catchment methods have recently been applied to identify priority regions for Automated External Defibrillator (AED) deployment, to aid in improving Out of Hospital Cardiac Arrest (OHCA) survival. This approach models access as a supply-to-demand ratio for each area, targeting areas with high demand and low supply for AED placement. These methods incorporate spatial covariates on OHCA occurrence, but do not provide precise AED locations, which are critical to the initial intent of such location analysis research. Exact AED locations can be determined using optimisation methods, but they do not incorporate known spatial risk factors for OHCA, such as income and demographics. Combining these two approaches would evaluate AED placement impact, describe drivers of OHCA occurrence, and identify areas that may not be appropriately covered by AED placement strategies. There are two aims in this paper. First, to develop geospatial models of OHCA that account for and display uncertainty. Second, to evaluate the AED placement methods using geospatial models of accessibility. We first identify communities with the greatest gap between demand and supply for allocating AEDs. We then use this information to evaluate models for precise AED location deployment. METHODS: Case study data set consisted of 2802 OHCA events and 719 AEDs. Spatial OHCA occurrence was described using a geospatial model, with possible spatial correlation accommodated by introducing a conditional autoregressive (CAR) prior on the municipality-level spatial random effect. This model was fit with Integrated Nested Laplacian Approximation (INLA), using covariates for population density, proportion male, proportion over 65 years, financial strength, and the proportion of land used for transport, commercial, buildings, recreation, and urban areas. Optimisation methods for AED locations were applied to find the top 100 AED placement locations. AED access was calculated for current access and 100 AED placements. Priority rankings were then given for each area based on their access score and predicted number of OHCA events. RESULTS: Of the 2802 OHCA events, 64.28% occurred in rural areas, and 35.72% in urban areas. Additionally, over 70% of individuals were aged over 65. Supply of AEDs was less than demand in most areas. Priority regions for AED placement were identified, and access scores were evaluated for AED placement methodology by ranking the access scores and the predicted OHCA count. AED placement methodology placed AEDs in areas with the highest priority, but placed more AEDs in areas with more predicted OHCA events in each grid cell. CONCLUSION: The methods in this paper incorporate OHCA spatial risk factors and OHCA coverage to identify spatial regions most in need of resources. These methods can be used to help understand how AED allocation methods affect OHCA accessibility, which is of significant practical value for communities when deciding AED placements.

Public entrance accessibility: Psychometric approach to the development of a new assessment instrument.

BACKGROUND: The accessibility of public facilities for all is an issue increasingly gaining focus in policy debates, especially regarding the ageing population. OBJECTIVE: This paper describes a psychometric approach to the development of a new instrument for assessing the accessibility of public entrances. METHODS: Items to include were selected by means of literature review and classified according to a typology of person-environment fit that uses the International Classification of Functioning, Disability and Health (ICF) as theoretical framework. Content validity was assessed by a scientific panel approach and construct validity by using simulation techniques and correlation analysis with a related construct. Reliability was evaluated by inter-rater agreement analysis, where 15 strategically selected public entrances were assessed by five rater pairs. RESULTS: Content validity was assessed as high (3.6 on a scale from 1 to 4) and correlation indicating convergent validity between instrument scores and a related construct was moderate (rs = 0.60, p < 0.001). Inter-rater reliability was acceptable to good (kappa 0.42, overall agreement 81%). After an iterative process including review of validity and reliability results, the resulting assessment instrument consisted of 56 items in 7 sections. CONCLUSIONS: This study demonstrated good content validity and acceptable to good inter-rater reliability. Though initial results were promising, user involvement and further testing of construct validity is needed. The goal of the new instrument is a feasible tool for planning, evaluation and accomplishment of policies intended to make public entrances accessible for all. The extent to which the instrument succeeds remains to be tested by practical use.

The provision of urban green space and its accessibility: Spatial data effects in Brussels.

Urban green space (UGS) has many environmental and social benefits. UGS provision and access are increasingly considered in urban policies and must rely on data and indicators that can capture variations in the distribution of UGS within cities. There is no consensus about how UGS, and their provision and access, must be defined from different land use data types. Here we identify four spatial dimensions of UGS and critically examine how different data sources affect these dimensions and our understanding of their variation within a city region (Brussels). We compare UGS indicators measured from an imagery source (NDVI from Landsat), an official cadastre-based map, and the voluntary geographical information provided by OpenStreetMap (OSM). We compare aggregate values of provision and access to UGS as well as their spatial distribution along a centrality gradient and at neighbourhood scale. We find that there are strong differences in the value of indicators when using the different datasets, especially due to their ability to capture private and public green space. However we find that the interpretation of intra-urban spatial variations is not affected by changes in data source. Centrality in particular is a strong determinant of the relative values of UGS availability, fragmentation and accessibility, irrespective of datasets.

Health-Related Quality of Life among People Applying for Housing Adaptations: Associated Factors.

Housing adaptations (HA) clients are a heterogeneous group of people with disabilities experiencing restricted performance and participation in everyday life. While health-related quality of life is a common and relevant outcome in health care research, associated factors among HA clients are largely unknown. Thus, the aim of this study was to investigate which factors are associated with health-related quality of life among HA clients in Sweden. The study has a cross-sectional design, using baseline data collected among 224 participants in three municipalities in Sweden. The main outcome was health-related quality of life measured by the EQ-5D. Factors investigated as potentially associated were age, sex, living conditions, cognitive impairment, usability of the home, activities of daily living (ADL) dependence, participation, and fear of falling. The associations were explored using multiple linear regression analysis. Younger age and higher dependence in ADL were associated with lower scores on the EQ-5D. The social aspect of usability in the home had a positive association with the EQ VAS. Results suggest that certain groups of HA clients might be at risk for low health-related quality of life. Knowledge of their characteristics can potentially improve development and implementation of tailored interventions aiming at increasing their health-related quality of life.

How available to European children and young people with cerebral palsy are features of their environment that they need?

BACKGROUND: The UN Convention on the Rights of Persons with Disabilities requires accessibility to the physical and social environments. However, individuals with cerebral palsy (CP) have many difficulties in accessing the environment they need for functional independence and social inclusion. AIMS: To examine the availability of environmental features which children with CP need for optimal participation, and whether availability changed for them between ages 8-12 and 13-17 years. METHODS: The sample is the 594 children with CP, born 31/07/1991-01/04/1997, who took part in the SPARCLE study at age 8-12 (SPARCLE 1) and again at 13-17 years (SPARCLE 2). Participants were randomly sampled from population registers of children with CP in eight European regions; one further region recruited from multiple sources. Data about environment were captured with the European Child Environment Questionnaire (60 items). Differences in availability of environmental features between childhood and adolescence were assessed using McNemar's test; differences between regions were assessed by ranking regions. Differences in availability between regions were assessed by ranking regions. RESULTS: For seven environmental features significantly (p<0.01) fewer individuals needed the feature in SPARCLE 2 than in SPARCLE 1, whilst for two features more individuals needed the feature. Nine features in SPARCLE 1 and six features in SPARCLE 2 were available to less than half the participants who needed them. Eight features showed significantly (p<0.01) higher availability in SPARCLE 2 than in SPARCLE 1 (enlarged rooms, adapted toilet, modified kitchen and hoists at home, adapted toilets and lifts at school, an adequate vehicle, grants for home modifications) while none showed significantly lower availability. The relative rankings of the better and less good regions persisted from the age 8-12year age group to the 13-17year age group. CONCLUSIONS: Needed environmental features are unavailable to many children at ages 8-12 and 13-17 years. This lack of availability is more pronounced in some regions than others, which probably results from their policy, legislative and statutory frameworks.

Physical Limitations, Walkability, Perceived Environmental Facilitators and Physical Activity of Older Adults in Finland.

The aim was to study objectively assessed walkability of the environment and participant perceived environmental facilitators for outdoor mobility as predictors of physical activity in older adults with and without physical limitations. 75-90-year-old adults living independently in Central Finland were interviewed (n = 839) and reassessed for self-reported physical activity one or two years later (n = 787). Lower-extremity physical limitations were defined as Short Physical Performance Battery score ≤9. Number of perceived environmental facilitators was calculated from a 16-item checklist. Walkability index (land use mix, street connectivity, population density) of the home environment was calculated from geographic information and categorized into tertiles. Accelerometer-based step counts were registered for one week (n = 174). Better walkability was associated with higher numbers of perceived environmental facilitators (p < 0.001) and higher physical activity (self-reported p = 0.021, step count p = 0.010). Especially among those with physical limitations, reporting more environmental facilitators was associated with higher odds for reporting at least moderate physical activity (p < 0.001), but not step counts. Perceived environmental facilitators only predicted self-reported physical activity at follow-up. To conclude, high walkability of the living environment provides opportunities for physical activity in old age, but among those with physical limitations especially, awareness of environmental facilitators may be needed to promote physical activity.

Barreras percibidas en el desplazamiento activo al centro educativo: fiabilidad y validez de una escala / Perceived barriers to active commuting to school: reliability and validity of a scale

Objetivo: Examinar la fiabilidad y la validez de una escala para evaluar las barreras percibidas en el desplazamiento activo al centro escolar en jóvenes españoles. Método: La validez de la escala fue evaluada en una muestra de 465 adolescentes (14-18 años de edad) mediante un análisis factorial confirmatorio y a través de la asociación con el transporte activo autorreportado. Una submuestra completó la escala dos veces, con una separación de una semana, a fin de evaluar su fiabilidad. Resultados: Los resultados mostraron que la escala tenía índices de ajuste satisfactorios con dos factores. Un factor incluyó los ítems relativos a ambiente y seguridad (α=0,72), y otro los ítems sobre planificación y aspectos psicosociales (α=0,64). El transporte activo se relacionó significativamente con la puntuación total de la escala de barreras (rho=−0,27; p <0,001), con las barreras ambientales/seguridad (rho=−0,22; p <0,001) y con las barreras de planificación/psicosociales (rho=−0,29; p <0,001). Los test-retest (coeficiente de correlación intraclase) para las barreras mostraron valores entre 0,68 y 0,77. Conclusión: La escala muestra una validez aceptable y una fiabilidad adecuada para evaluar las barreras en el transporte activo al centro educativo en jóvenes españoles (AU)

Objective: To examine the reliability and validity of a scale to measure perceived barriers to active commuting to school among Spanish young people. Method: The validity of the scale was assessed in a sample of 465 adolescents (14-18 years) using a confirmatory factor analysis and studying its association with self-reported active commuting to school. The reliability of the instrument was evaluated in a sub-sample that completed the scale twice separated by a one-week interval. Results: The results showed that the barriers scale had satisfactory fit indices, and two factors were determined. The first included environment- and safety-related items (α=0.72), while the other concerned planning and psychosocial items (α=0.64). Active commuting to school showed significant correlations with the total score of the barriers scale (rho=−0.27; p <0.001), with the environmental/safety barriers (rho=−0.22; p <0.001), as well as with the planning/psychosocial barriers (rho=−0.29; p <0.001). Test-retest ICCs for the barriers ranged from 0.68 to 0.77. Conclusion: The developed scale has acceptable validity and good reliability to assess barriers to active commuting to school among Spanish young people (AU)

Social Isolation and Physical Barriers in the Houses of Stroke Survivors in Rural China.

OBJECTIVE: To describe the home barriers and social isolation of stroke survivors in the rural areas of China and to explore which home barriers are associated with social isolation. DESIGN: Cross-sectional survey. SETTING: Structured interviews and observation in the participants' homes. PARTICIPANTS: Community-dwelling stroke survivors in the rural areas of China (N=818). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical barriers in rural homes were surveyed using a home fall hazards assessment. Social isolation was identified if ≥2 of the following indicators were observed: low frequency of getting out of the home, lacking leisure activities, and living alone in the previous 3 months. RESULTS: The prevalence rates of 18 among 30 home barriers were >20%, and the highest was 93% (lack of handrails in the bathroom). The prevalence of social isolation was 30%. Three home barriers were independently related to social isolation. These were a distant toilet (odds ratio [OR], 2.363; 95% confidence interval [CI], 1.527-3.658; P<.001), unsuitable seating (OR, 1.571; 95% CI, 1.026-2.404; P=.038), and inaccessible light switches (OR, 1.572; 95% CI, 1.064-2.324; P=.023). CONCLUSIONS: Many barriers exist in the houses of stroke survivors in rural China. Some of them are related to social isolation. Eliminating or decreasing home barriers could be a feasible and effective approach to reducing social isolation.

A public health perspective to environmental barriers and accessibility problems for senior citizens living in ordinary housing.

BACKGROUND: Housing environments that hinder performance of daily activities and impede participation in social life have negative health consequences particularly for the older segment of the population. From a public health perspective accessible housing that supports active and healthy ageing is therefore crucial. The objective of the present study was to make an inventory of environmental barriers and investigate accessibility problems in the ordinary housing stock in Sweden as related to the functional capacity of senior citizens. Particular attention was paid to differences between housing types and building periods and to identify environmental barriers generating the most accessibility problems for sub-groups of senior citizens. METHODS: Data on environmental barriers in dwellings from three databases on housing and health in old age was analysed (N = 1021). Four functional profiles representing large groups of senior citizens were used in analyses of the magnitude and severity of potential accessibility problems. Differences in terms of type of housing and building period were examined. RESULTS: High proportions of one-family houses as well as multi-dwellings had substantial numbers of environmental barriers, with significantly lower numbers in later building periods. Accessibility problems occurred already for senior citizens with few functional limitations, but more profound for those dependent on mobility devices. The most problematic housing sections were entrances in one-family houses and kitchens of multi-dwellings. CONCLUSIONS: Despite a high housing standard in the Swedish ordinary housing stock the results show substantial accessibility problems for senior citizens with functional limitations. To make housing accessible large-scale and systematic efforts are required.

Outdoor motivation moderates the effects of accessibility on mobility in old age.

BACKGROUND: Mobility plays a major role in healthy aging and social participation. This study explored whether accessibility problems in the housing environment are negatively associated with mobility in old age and whether this association is moderated by differences in an individual's preference for spending time outside the home (outdoor motivation). MATERIAL AND METHODS: This article reports the results of a research project on mobility in old age. The project included a survey study of 120 community-dwelling older adults between 59 and 92 years of age (mean = 71.7 years, SD = 7.3 years) living in the metropolitan region of Nuremberg, Germany. Objective assessments were conducted in the participants' housing environment to evaluate the magnitude of accessibility problems. RESULTS: Accessibility problems were negatively associated with mobility. Interaction analyses suggested a buffering effect of outdoor motivation on this association, i.e. participants who reported a preference for spending time outside the home had a higher mobility in the face of accessibility problems as compared with those who preferred staying at home. CONCLUSION: Outdoor motivation may have protective effects for older adults when accessibility problems challenge mobility. These findings contribute to improving the understanding of how and under what circumstances older adults stay mobile and active in everyday life. Considering interindividual differences in outdoor motivation may binterventions and public health programs that are aimed at enhancing mobility and social participation in old age.