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Disentangling the impact of the weather on transmission of infectious diseases is crucial for health protection, preparedness and prevention. Because weather factors are co-incidental and partly correlated, we have used geography to separate out the impact of individual weather parameters on other seasonal variables using campylobacteriosis as a case study. Campylobacter infections are found worldwide and are the most common bacterial food-borne disease in developed countries, where they exhibit consistent but country specific seasonality. We developed a novel conditional incidence method, based on classical stratification, exploiting the long term, high-resolution, linkage of approximately one-million campylobacteriosis cases over 20 years in England and Wales with local meteorological datasets from diagnostic laboratory locations. The predicted incidence of campylobacteriosis increased by 1 case per million people for every 5° (Celsius) increase in temperature within the range of 8°–15°. Limited association was observed outside that range. There were strong associations with day-length. Cases tended to increase with relative humidity in the region of 75–80%, while the associations with rainfall and wind-speed were weaker. The approach is able to examine multiple factors and model how complex trends arise, e.g. the consistent steep increase in campylobacteriosis in England and Wales in May-June and its spatial variability. This transparent and straightforward approach leads to accurate predictions without relying on regression models and/or postulating specific parameterisations. A key output of the analysis is a thoroughly phenomenological description of the incidence of the disease conditional on specific local weather factors. The study can be crucially important to infer the elusive mechanism of transmission of campylobacteriosis; for instance, by simulating the conditional incidence for a postulated mechanism and compare it with the phenomenological patterns as benchmark. The findings challenge the assumption, commonly made in statistical models, that the transformed mean rate of infection for diseases like campylobacteriosis is a mere additive and combination of the environmental variables. Author summary: There is good evidence that weather influences some infectious diseases, driving the seasonal and geographic distribution. This is relevant to gastrointestinal infections, which cause high morbidity and mortality worldwide. Weather can impact people's behaviour, pathogen survival and distribution, animal husbandry, and other environmental variables. We used campylobacteriosis in England and Wales as a case-study to examine a new methodology because it has a distinctive seasonality. The approach compares daily data on affected people by laboratory, the population of the laboratory catchments, and local weather variables. This allows Campylobacter incidence to be compared across the values of these variables (e.g. low to high temperature) to provide an estimate of how individual weather variables, alone or in combination, affect disease incidence. We call this the Comparative Conditional Incidence. The results from this analysis are used to build a mathematical model that represents how weather through the year influences the seasonality of disease. The factors most associated with Campylobacter are day-length, air temperature and relative humidity. This will influence future research to understand why the environment influences disease occurrence, and what the burden and pattern of the disease under different climatic scenarios. The methods may have relevance to other seasonal diseases. [ABSTRACT FROM AUTHOR]

• Meteorological conditions and daylight hours affect recreational physical activity. • Research has not explored how these affect physical activity in different environments. • Park-based physical activity associated with temperature, wind speed, and daylight. • Unique associations for physical activity at woodlands, inland waters, and coasts. • Implications for 'green prescriptions' and future climate change are discussed. Meteorological conditions affect people's outdoor physical activity. However, we know of no previous research into how these conditions affect physical activity in different types of natural environments – key settings for recreational physical activity, but ones which are particularly impacted by meteorological conditions. Using responses from four waves (2009–2013) of a survey of leisure visits to natural environments in England (n = 47,613), visit dates and locations were ascribed estimates of energy expenditure (MET-minutes) and assigned meteorological data. We explored relationships between MET-minutes in natural environments (in particular, parks, woodlands, inland waters, and coasts) and the hourly maxima of air temperature and wind speed, levels of rainfall, and daylight hours using generalised additive models. Overall, we found a positive linear relationship between MET-minutes and air temperature; a negative linear relationship with wind speed; no relation with categories of rainfall; and a positive, but non-linear relationship with daylight hours. These same trends were observed for park-based energy expenditure, but differed for visits to other natural environments: only daylight hours were related to energy expenditure at woodlands; wind speed and daylight hours affected energy expenditure at inland waters; and only air temperature was related to energy expenditure at coasts. Natural environments support recreational physical activity under a range of meteorological conditions. However, distinct conditions do differentially affect the amount of energy expenditure accumulated in a range of natural environments. The findings have implications for reducing commonly-reported meteorological barriers to both recreational physical activity and visiting natural environments for leisure, and begin to indicate how recreational energy expenditure in these environments could be affected by future climate change. [ABSTRACT FROM AUTHOR]

The workplace is an important setting for promoting health and well-being. We sought to understand how successful workplace health and well-being programs were developed and implemented to inform the development of a program for a National Health Service (NHS) hospital. Case studies of successful healthy workplace programs with 34 semi-structured employee interviews informed 12 interviews with NHS staff. Interviews were thematically analyzed using Nvivo. Themes were fed back to participants for further clarification and validation. Healthy workplace programs were characterized by senior management endorsement; collective sense of ownership; presence of visible “quick wins”; and a sense that participation was easy and fun, not mandated. Programs evolved organically, allowing trust to be built and activities to be developed with employees. Interviews with NHS staff suggested a lack of belief in the possibility of change in their workplace due to time and workload pressures, and a sense of an “us and them” relationship with management, as well as environmental barriers. A consistent pattern of how the conditions for a healthy workplace can be created, which map onto the results from the NHS ward staff, suggest that without creating an enabling environment for health-promoting behaviors, workplace programs will have poor uptake and retention. [ABSTRACT FROM AUTHOR]

Background: Campylobacteriosis is a major public health concern. The weather factors that influence spatial and seasonal distributions are not fully understood.Methods: To investigate the impacts of temperature and rainfall on Campylobacter infections in England and Wales, cases of Campylobacter were linked to local temperature and rainfall at laboratory postcodes in the 30 days before the specimen date. Methods for investigation included a comparative conditional incidence, wavelet, clustering, and time series analyses.Results: The increase of Campylobacter infections in the late spring was significantly linked to temperature two weeks before, with an increase in conditional incidence of 0.175 cases per 100,000 per week for weeks 17 to 24; the relationship to temperature was not linear. Generalized structural time series model revealed that changes in temperature accounted for 33.3% of the expected cases of Campylobacteriosis, with an indication of the direction and relevant temperature range. Wavelet analysis showed a strong annual cycle with additional harmonics at four and six months. Cluster analysis showed three clusters of seasonality with geographic similarities representing metropolitan, rural, and other areas.Conclusions: The association of Campylobacteriosis with temperature is likely to be indirect. High-resolution spatial temporal linkage of weather parameters and cases is important in improving weather associations with infectious diseases. The primary driver of Campylobacter incidence remains to be determined; other avenues, such as insect contamination of chicken flocks through poor biosecurity should be explored. [ABSTRACT FROM AUTHOR]

• In 2019, 22 million adults in England visited natural environments at least weekly. • Physical activity on these visits prevented 12,763 cases of non-communicable disease. • Annual societal costs of the disease avoided were estimated at £108.7 million. • Strategies increasing visitor activity or volume may prevent more cases of disease. Physical activity (PA) reduces the risk of several non-communicable diseases (NCDs). Natural environments support recreational PA. Using data including a representative cross-sectional survey of the English population, we estimated the annual value of nature-based PA conducted in England in 2019 in terms of avoided healthcare and societal costs of disease. Population-representative data from the Monitor of Engagement with the Natural Environment (MENE) survey (n = 47,580; representing 44,386,756) were used to estimate the weekly volume of nature-based recreational PA by adults in England in 2019. We used epidemiological dose–response data to calculate incident cases of six NCDs (ischaemic heart disease (IHD), ischaemic stroke (IS), type 2 diabetes (T2D), colon cancer (CC), breast cancer (BC) and major depressive disorder (MDD)) prevented through nature-based PA, and estimated associated savings using published costs of healthcare, informal care and productivity losses. We investigated additional savings resulting from hypothetical increases in: (a) visitor PA and (b) visitor numbers. In 2019, 22 million adults > 16 years of age in England visited natural environments at least weekly. At reported volumes of nature-based PA, we estimated that 550 cases of IHD, 168 cases of IS, 1,410 cases of T2D, 41 cases of CC, 37 cases of BC and 10,552 cases of MDD were prevented, creating annual savings of £108.7million (95 % uncertainty interval: £70.3million; £150.3million). Nature-based recreational PA in England results in reduced burden of disease and considerable annual savings through prevention of priority NCDs. Strategies that increase nature-based PA could lead to further reductions in the societal burden of NCDs. [ABSTRACT FROM AUTHOR]

• 1 SD increase in nature visits led to +17% of 1 SD in general environmental behaviour. • 1 SD increase in nature appreciation was associated with +45% of 1 SD in behaviour. • Neighbourhood nature had direct and indirect effects via visits and appreciation. • Evidence emerged of nature visits compensating for low neighbourhood nature. • Effects of neighbourhood nature differed across specific environmental behaviours. Progress on changing human behaviour to meet the challenges of regional and global sustainability has been slow. Building on theory as well as small-scale survey and experimental evidence that exposure to nature may be associated with greater pro-environmentalism, the aim of the current study was to quantify relationships between exposure to nature (operationalised as neighbourhood greenspace, coastal proximity, and recreational nature visits) as well as appreciation of the natural world, and self-reported pro-environmental behaviour for the adult population of England. Using data from a nationally representative sample (N = 24,204), and controlling for potential confounders, a structural equation model was used to estimate relationships. Indirect effects of neighbourhood exposures via nature visits and nature appreciation were accounted for. We found positive relationships between both recreational nature visits and nature appreciation and pro-environmental behaviour across both the whole sample and key socio-demographic groups. The more individuals visited nature for recreation and the more they appreciated the natural world, the more pro-environmental behaviour they reported. Although rural and coastal dwellers tended to also be more pro-environmental on average, patterns were complex, potentially reflecting situational constraints and opportunities. Importantly, positive associations between pro-environmental behaviours and high neighbourhood greenspace and coastal proximity were present for both high and low socio-economic status households. Improving access to, and contact with, nature, e.g., through better urban planning, may be one approach for meeting sustainability targets. [ABSTRACT FROM AUTHOR]

After adjusting for covariates, self-reported general health in England is higher among populations living closer to the coast, and the association is strongest amongst more deprived groups. We explored whether similar findings were present for mental health using cross-sectional data for urban adults in the Health Survey for England (2008-2012, N ≥25,963). For urban adults, living ≤1 km from the coast, in comparison to >50 km, was associated with better mental health as measured by the GHQ12. Stratification by household income revealed this was only amongst the lowest-earning households, and extended to ≤5 km. Our findings support the contention that, for urban adults, coastal settings may help to reduce health inequalities in England. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a major public health concern. Natural, or semi-natural, environments may encourage physical activity, but the influences of socio-economic factors have been under-researched., Methods: We explored the associations between meeting physical activity (PA) guidelines and both neighbourhood green (area coverage) and blue (freshwater coverage and coastal proximity) environments for urban adults using data from the Health Survey for England [HSE] (2008/2012). We considered different domains of self-reported PA: walking (n = 18,391), sports and other exercise (n = 18,438), non-recreational (domestic/gardening/occupational; n = 18,446) and all three domains combined (n = 18,447); as well as accelerometer-derived PA data using a subsample (n = 1,774). Relationships were stratified by equivalised household income as an indicator of socio-economic status., Results: After adjusting for covariates, living <5 km from the coast was associated with significantly higher odds of meeting UK 2010 guidelines through self-reported total, walking and non-recreational PA (e.g. total PA, <5 km vs. >20 km, adjusted odds ratio (OR adj ) = 1.26; 95% confidence interval (CI) = 1.15-1.39) but unrelated to sports and exercise. Greater neighbourhood greenspace, however, was only associated with significantly higher odds of meeting guidelines through non-recreational PA alone (e.g. 80-100% vs. <20% OR adj  = 1.32; 95% CI = 1.12-1.56). Although associations were most consistent in the lowest income quintile, income-related results were mixed. Relationships were not replicated in the smaller accelerometry subsample., Conclusion: Our self-report findings for the differing domains of PA as a function of neighbourhood green and blue space broadly replicated previous research, yet the reasons for the observed differences between PA domains and environments remain unclear. We did not observe any associations between environmental variables and accelerometer-measured PA; further research with larger samples is needed., (Copyright © 2020 Elsevier Inc. All rights reserved.)