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The built environment is a key social determinant of health. Exposure to parks and greenspace can improve physical and mental health and provide other benefits that enhance well-being. Programs and initiatives that capitalize on nature-based opportunities offer health care providers with a cost-effective alternative for upstream health promotion.

ABSTRACTOverweight and obesity are steadily rising in South Asia, the world’s most populous region. India, a low- and middle-income country in South Asia is experiencing an obesity epidemic. Built environment features may profoundly influence physical activity and counter the risk from overweight and obesity. This cross-sectional study investigated built environment correlates of overweight and obesity among adults (N = 370, 47.2% female, mean age = 37.9 years) in Chennai, India. Participants from low-socioeconomic status households were more likely to be overweight/obese (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.1–2.9) than participants from high-socioeconomic status households. Driving to work predicted a three-fold increase in overweight or obesity compared to active commuting (OR = 2.9, 95%CI = 1.3–6.4). Household car ownership was linked with an increased likelihood of overweight or obesity (OR = 1.5, 95%CI = 0.7–3.2). Low walkability neighbourhoods significantly predicted an increase in odds of overweight or obesity (OR = 1.8, 95%CI = 1.1–2.8). By 2030, Indian cities are projected to add 250 million people accompanied by a 9.9% annual motor vehicle growth rate. As car ownership increases across Southern Asia, there is an urgent need to develop interventions to promote physical activity.

Purpose: To explore combinations of worksite supports (WSS) for physical activity (PA) that may assist employees in meeting PA recommendations and to investigate how availability of WSS differs across industries and occupations.Design: Cross-sectional.Setting: Several Missouri metropolitan areas.Participants: Adults employed >20 h/wk outside the home.Measures: Survey utilized existing self-reported measures (eg, presence of WSS for PA) and the International Physical Activity Questionnaire.Analysis: Logistic regression was conducted for 2 outcome variables: leisure and transportation PA. Independent variables included 16 WSS. Of particular interest were interaction effects between WSS variables. Analyses were stratified by 5 occupation and 7 industry types.Results: Overall, 2013 people completed the survey (46% response rate). Often, availability of 1 WSS did not increase the likelihood of meeting PA recommendations, but several pairs of WSS did. For example, in business occupations, the odds of meeting PA recommendations through transportation PA increased when employees had access to showers and incentives to bike/walk (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.16-2.22); showers and maps (OR = 1.25; 1.02-1.55); maps and incentives to bike/walk (OR = 1.48; 1.04-2.12).Conclusion: Various combinations of WSS may increase the likelihood that employees will meet PA recommendations. Many are of low or no cost, including flexible time for exercise and maps of worksite-adjacent walk/bike routes. Findings may be instructive for employers seeking to improve employee health through worksite PA.

BackgroundTo investigate associations between active transport, employment status and objectively measured moderate-to-vigorous physical activity (MVPA) in a representative sample of US adults.MethodsCross-sectional analyses of data from the National Health and Nutrition Examination Survey. A total of 5180 adults (50.2 years old, 49.0% men) were classified by levels of active transportation and employment status. Outcome measure was weekly time spent in MVPA as recorded by the Actigraph accelerometer. Associations between active transport, employment status and objectively measured MVPA were examined using multivariable linear regression models adjusted for age, body mass index, race and ethnicity, education level, marital status, smoking status, working hour duration (among the employed only) and self-reported leisure time physical activity.ResultsPatterns of active transport were similar between the employed (n=2897) and unemployed (n=2283), such that 76.0% employed and 77.5% unemployed engaged in no active transport. For employed adults, those engaging in high levels of active transport (≥90 min/week) had higher amount of MVPA than those who did not engage in active transport. This translated to 40.8 (95% CI 15.7 to 65.9) additional minutes MVPA per week in men and 57.9 (95% CI 32.1 to 83.7) additional minutes MVPA per week in women. Among the unemployed adults, higher levels of active transport were associated with more MVPA among men (44.8 min/week MVPA, 95% CI 9.2 to 80.5) only.ConclusionsFindings from the present study support interventions to promote active transport to increase population level physical activity. Additional strategies are likely required to promote physical activity among unemployed women.

The effects of neighborhood morphology and walkability over active travel patterns of ageing older adults are still largely unknown. We used a difference-in-differences design to compare the changes in active transport indicators on older adults ageing for ten years in different areas of the Barcelona Metropolitan Region (Spain). Participants were drawn from two large cross-sectional travel surveys in 2004 and 2014 creating a 10 year span in which they aged from 65–75y.o. to 75–85y.o. High walkability was associated with more minutes spent walking, and higher odds of meeting Physical Activity (PA) recommendations. Ageing in low walkable areas, in contrast, was associated with lower amounts of PA derived from transportation.

The article discusses the analysis conducted by the Physical Activity Research Center (PARC) investigators regarding physical activity (PA) in the parks, schools, recreation, built environments and rural areas using equity lens. Topics mention including the American Planning Association (APA) who acknowledged the importance of PA prevalence and urban planning fields, relationship pf PA and green and recreational space availability and equity challenges in rural areas.

AbstractPokemon GO and its ability to get people moving highlights new beginnings for gamification of health and social life of urban spaces with implications for people–space interaction.

Data on built environment (BE) and physical activity (PA) in low- and middle- income countries is sparse. This study compared BE features, PA levels, and weight status among adults living in neighborhoods stratified by walkability and socio-economic status (SES) in the city of Chennai, India.

Purpose. Ciclovía, or Open Streets initiatives, are events where streets are opened for physical activity and closed to motorized traffic. Although the initiatives are gaining popularity in the United States, little is known about planning and implementing them. The goals of this paper are to explore the development and implementation of Open Streets initiatives and make recommendations for increasing the capacity of organizers to enhance initiative success.Approach. Phenomenology with qualitative analysis of structured interviews was used.Setting. Study setting was urban and suburban communities in the United States.Participants. Study participants were organizers of Open Streets initiatives in U.S. cities.Method. Using a list of 47 events held in 2011, 27 lead organizers were interviewed by telephone about planning, implementation, and lessons learned. The interviews were digitally recorded and transcribed. A phenomenologic approach was used, an initial coding tool was developed after reviewing a sample of transcripts, and constant comparative coding methodology was applied. Themes and subthemes were generated from codes.Results. The most common reasons for initiation were to highlight or improve health and transportation. Most initiatives aimed to reach the general population, but some targeted families, children, or specific neighborhoods. Getting people to understand the concept of Open Streets was an important challenge. Other challenges included lack of funding and personnel, and complex logistics.Conclusion. These initiatives democratize public space for citizens while promoting physical activity, social connectedness, and other broad agendas. There are opportunities for the research community to contribute to the expanse and sustainability of Open Streets, particularly in evaluation and dissemination.

Promoting the use of public transit and active transport (walking and cycling) instead of car driving is an appealing strategy to increase overall physical activity.

We created virtual three-dimensional reconstruction models from computed tomography scans obtained from patients with acetabular fractures. Virtual cylindrical implants were placed intraosseously in the anterior column, the posterior column and across the dome of the acetabulum. The maximum diameter which was entirely contained within the bone was determined for each position of the screw. In the same model, the cross-sectional diameters of the columns were measured and compared to the maximum diameter of the corresponding virtual implant.We found that the mean maximum diameter of virtual implant accommodated by the anterior columns was 6.4 mm and that the smallest diameter of the columns was larger than the maximum diameter of the equivalent virtual implant.This study suggests that the size of the screw used for percutaneous fixation of acetabular fractures should not be based solely on the measurement of cross-sectional diameter and that virtual three-dimensional reconstructions might be useful in pre-operative planning.

Recent groundbreaking work revealed CA19–9 is not only a tumor marker for PDAC. It also induces severe pancreatitis and promotes pancreatic fibrosis. The aim of this study was evaluation if due fibrosis CA19–9 may stratify for reduced postoperative pancreatic fistula (POPF) risk.

Abstract: Objective. To determine whether the load-bearing capacity of human proximal femora with metastatic defects can be predicted from the bone mineral content. Design. The bone mineral content (BMC) of the total proximal femur was measured by dual-energy X-ray absorptiometry (DXA). The femurs were loaded so as to simulate stair ascent or external rotation. Patients. Simulated lytic defects were created using specialized cutting tools in the intertrochanteric region of 32 human cadaveric femora. Bone density measurements were made before and after creating defects. Results. A linear relation could be used to predict failure load from BMC or bone mineral density. The slope of the linear relation was greater for loads representing external rotation than for loads representing stair ascent. The linear relations suggest that the BMC measurements account for both the density of the host bone and the amount of bone removed by the defect. Conclusions. The data suggest that between 70% and 80% of the variation in failure load of human femora with lytic metastatic defects can be predicted from the BMC and that relations between BMC and failure load are sensitive to the type of loading. Combined with information on the loads associated with the activities of daily living, these data may be used to help identify patients in whom prophylactic stabilization might prevent a pathologic fracture.

A series of 8-substituted derivatives of 3,7-dimethyl-1-propargylxanthine (DMPX) was synthesized and investigated as A2A adenosine receptor antagonists. Different synthetic strategies for the preparation of DMPX derivatives and analogues were explored. A recently developed synthetic procedure starting from 3-propargyl-5,6-diaminouracil proved to be the method of choice for the preparation of this type of xanthine derivatives. The novel compounds were investigated in radioligand binding studies at the high-affinity adenosine receptor subtypes A1 and A2A and compared with standard A2A adenosine receptor antagonists. Structure−activity relationships were analyzed in detail. 8-Styryl-substituted DMPX derivatives were identified that exhibit high affinity and selectivity for A2A adenosine receptors, including 8-(m-chlorostyryl)-DMPX (CS-DMPX, Ki A2A = 13 nM, 100-fold selective), 8-(m-bromostyryl)-DMPX (BS-DMPX, Ki A2A = 8 nM, 146-fold selective), and 8-(3,4-dimethoxystyryl)-DMPX (Ki A2A = 15 nM, 167-fold selective). These and other novel compounds are superior to the standard A2A adenosine receptor antagonists KF17837 (4) and CSC (5) with respect to A2A affinity and/or selectivity.

Although osteoporosis is a major public health concern, the effect of this condition on oral bone has not been determined. Using the ovariectomized rat, we tried to determine if estrogen depletion and aging affect the mandible of the rat. Sixty-one ovariectomized (ovx) and shamoperated (sham) 6-month-old Sprague Dawley rats were divided equally into six groups. The baseline, adult, and old rats were euthanized 14, 114, 200 days post-ovx, respectively. The bone mineral density of the mandible was measured using high resolution dual energy x-ray absorptiometry. The failure load and stiffness of the mandible were measured in three-point bending. The bone area fraction and area moment of inertia of digitized images of mandible sections were measured using image analyzing software. In adult rats, ovx led to a 15% and 28% increase in failure load and stiffness, respectively, but no change in bone area fraction or bone mineral density. In the old rats, ovx led to an 8% decrease in bone area fraction, but no change in failure load, stiffness, or bone mineral density of the mandible. In the ovx rats, aging led to a 20% and 7% decrease in stiffness and bone area fraction of the mandibles in the old rats compared with that in the adult rats. In the adult ovx rats, the increase in structural properties of the mandible may be a consequence of an increase in masticatory function as it has been reported that ovx rats eat approximately 10% more than sham controls. Overall, ovx led to a decrease in bone area fraction in the mandible and a decrease in bone area fraction and stiffness in the mandible of the aging rat. These findings indicate that in this model, estrogen depletion affects the mandible and may contribute to oral bone loss and that this loss may be accentuated with aging.

In contrast to normal microvessels, those that supply tumors are strikingly hyperpermeable to circulating macromolecules such as plasma proteins. This leakiness is largely attributable to a tumor-secreted cytokine, vascular permeability factor (VPF). Tracer studies have shown that macromolecules cross tumor vascular endothelium by way of a recently described cytoplasmic organelle, the vesiculo-vacuolar organelle or VVO (VVOs are grapelike clusters of interconnected, uncoated vesicles and vacuoles). However, equivalent VVOs are also present in the cytoplasm of normal venules that do not leak substantial amounts of plasma protein. To explain these findings, we hypothesized that VPF increased the permeability of tumor blood vessels by increasing VVO function and that the VVOs of normal venules were relatively impermeable in the absence of VPF stimulation. To test this hypothesis, VPF was injected intradermally in normal animals after intravenous injection of a soluble macromolecular tracer, ferritin, whose extravasation could be followed by electron microscopy. VPF caused normal venules to leak ferritin, and, as predicted by our hypothesis, ferritin extravasated by way of VVOs, just as in hyperpermeable tumor microvessels. Ultrathin (14-nm) serial electron microscopic sections and computer-aided three-dimensional reconstructions better defined VVO structure. VVOs occupied 16-18% of endothelial cytoplasm in normal venules. Individual VVOs were clusters of numerous (median, 124) interconnected vesicles and vacuoles that formed complex pathways across venular endothelium with multiple openings to both luminal and abluminal surfaces. Like VPF, histamine and serotonin also stimulated ferritin extravasation across venules by way of VVOs. Together, these data establish VVOs as the major pathway by which soluble plasma proteins exit venules in response to several mediators that increase venular hyperpermeability. These same mediators also increased the extravasation of colloidal carbon, but this large particulate nonphysiological tracer exited venules primarily through endothelial gaps.

Des lésions osseuses avec effraction corticale ont été simulées au niveau des vertèbres thoraciques afin d'étudier les effets du siège du défect, de sa taille et de la rupture pédiculaire sur la solidité vertébrale. Des vertèbres provenant de 15 rachis thoraciques ont été regroupés en 5 types topographiques de défects: antérieur, postérieur, latéral, un seul pédicule ou deux pédicules. Les autres vertèbres ont servi de témoins. Toutes les vertèbres ont été soumises à une charge combinée de compression axiale et de flexion jusqu'à leur rupture. La charge de rupture présumée des vertèbres préparées, en dehors de tout défect, a été estimée d'après les charges de rupture effectives des vertèbres témoins du même rachis. Les charges de rupture des vertèbres présentant un défect cortical (antérieur, postérieur, latéral) se sont montrées significativement moins élevées (p=0,0001) que les charges de rupture estimées sur les vertèbres intactes; cela n'a pas été le cas des vertèbres présentant une rupture pédiculaire simple (p=0.90). Les solidités relatives (définies comme le rapport de la charge de rupture des vertèbres présentant un défect à la charge de rupture estimée sur les vertèbres intactes) ne présentaient pas de différences dans les groupes vertébraux porteurs d'un défect antérieur (moyenne=0,51), postérieur (0,55) et latéral (0,58), mais différaient de celles du groupe présentant un défect pédiculaire simple (1,09). La solidité relative ne dépendait que faiblement de la taille du défect. La comparaison de ces résultats à ceux d'une étude préalable portant sur des vertèbres présentant des défects corporéaux centraux laisse penser que les défects corticaux provoquent une diminution de la solidité vertébrale un peu plus importante que celle engendrée par des défects de taille comparable ne touchant que l'os spongieux.

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