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We examined how residents' driving changed after the implementation of low traffic neighbourhoods (LTNs) in Lambeth, London. We used postcode plus numberplate data from controlled parking zones, matched to annual MOT records. From 2018-2020 ('pre') to 2021-2023 ('post'), mean past-year driving decreased by 0.7km/day among residents living inside the new LTNs and increased by 0.6km/day among residents in control areas elsewhere in Lambeth. This represents a difference-in-differences decrease of 1.3km/day (95% confidence interval 0.3 to 2.4) in LTN versus control areas, or a 6.4% relative decrease. Our findings suggest that residents started driving less once their area became an LTN.

Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None of the audit standards, from the 2016 UK Joint Specialists Societies guideline on diagnosis and management of meningitis, were met in all cases. With respect to 20 of 30 assessed standards, clinical management provided for patients was in line with recommendations in less than 50% of cases. 45% of patients had blood cultures taken within an hour of admission, 0.5% had a lumbar puncture within 1 hour, 26% within 8 hours. 28% had bacterial molecular diagnostic tests on cerebrospinal fluid. Median time to first dose of antibiotics was 3.2 hours (IQR 1.3–9.2). 80% received empirical parenteral cephalosporins. 55% ≥60 years and 31% of immunocompromised patients received anti-Listeria antibiotics. 21% received steroids. Of the 1471 patients, 20% had confirmed bacterial meningitis. Among those with bacterial meningitis, pneumococcal aetiology, admission to intensive care and initial Glasgow Coma Scale Score less than 14 were associated with in-hospital mortality (adjusted OR (aOR) 2.08, 95% CI 0.96 to 4.48; aOR 4.28, 95% CI 1.81 to 10.1; aOR 2.90, 95% CI 1.26 to 6.71, respectively). Dexamethasone therapy was weakly associated with a reduction in mortality in both those with proven bacterial meningitis (aOR 0.57, 95% CI 0.28 to 1.17) and with pneumococcal meningitis (aOR 0.47, 95% CI 0.20 to 1.10).Conclusion This study demonstrates that clinical care for patients with meningitis in the UK is not in line with current evidence-based national guidelines. Diagnostics and therapeutics should be targeted for quality improvement strategies. Work should be done to improve the impact of guidelines, understand why they are not followed and, once published, ensure they translate into changed practice.

Exposure to radon is a leading cause of lung cancer worldwide. However, few test their homes for radon. There is a need to increase access to radon testing and decrease radon exposure. This longitudinal, mixed-methods study using a citizen science approach recruited and trained a convenience sample of 60 non-scientist homeowners from four rural Kentucky counties to test their homes for radon using a low-cost continuous radon detector, report back findings, and participate in a focus group to assess their testing experience. The aim was to evaluate changes in environmental health literacy (EHL) and efficacy over time. Participants completed online surveys at baseline, post-testing, and 4–5 months later to evaluate EHL, response efficacy, health information efficacy, and self-efficacy related to radon testing and mitigation. Mixed modeling for repeated measures evaluated changes over time. Citizen scientists reported a significant increase in EHL, health information efficacy, and radon testing self-efficacy over time. While there was a significant increase in citizen scientists’ confidence in their perceived ability to contact a radon mitigation professional, there was no change over time in citizen scientists’ beliefs that radon mitigation would reduce the threat of radon exposure, nor was there a change in their capacity to hire a radon mitigation professional. Further research is needed to understand the role of citizen science in home radon mitigation.

Background: The role of antibodies in coronavirus disease 2019 (COVID-19) in patients with X-linked agammaglobulinaemia (XLA) has yet to be characterised and clinical courses observed in this cohort of patients have been heterogeneous. Whilst some exhibit spontaneous recovery, others have experienced a more protracted disease length. Previous reports have described successful use of convalescent plasma, however there is a paucity of information around the use of the REGN-COV2 antibody cocktail in these patients. Case report: A patient with XLA was admitted to hospital with COVID-19 and remained persistently symptomatic with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab positivity despite treatment with Remdesivir and dexamethasone. Attempts at modulating the immune response with anakinra were unsuccessful. Consent for compassionate use of REGN-COV2 was obtained with administration taking place on day 87 of his illness. This was followed by a period of convalescence and SARS-CoV-2 nasopharyngeal swab negativity. As a consequence of prolonged immunosuppression, the patient developed pneumocystis pneumonia. Conclusion: This case highlights the role of antibodies in clearing SARS-CoV-2 in a hypogammaglobulinaemic host and demonstrates the consequences of prolonged immunosuppression and delayed treatment. We propose that this may be of particular significance given the capacity of SARS-CoV-2 to develop advantageous mutations in a chronically infected host.

We assessed the impacts of Low Traffic Neighbourhoods (LTNs) implemented in 2020 on road traffic injuries. We used police data from October-December 2018/2019 (pre) compared with the same period in 2020 (post). We found absolute numbers of injuries inside LTNs halved relative to the rest of London (ratio 0.51, p

OBJECTIVES:. We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics. DESIGN:. We analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours. SETTING:. A multisite international inpatient trial. PATIENTS:. A total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia. INTERVENTIONS:. Adaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment. MEASUREMENTS AND MAIN RESULTS:. For mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60–0.68), and improved with addition of age (c-index, 0.66–0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65–0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68–0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59–0.69) and improved with addition of age (c-index, 0.63–0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05). CONCLUSIONS:. In the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.

Between March and September 2020, 72 ‘Low Traffic Neighbourhoods’ (LTNs) were implemented in London. We examined the impact on fire brigade emergency response times in October 2020-February 2021 (‘post’), as compared to the same months in the previous two years (‘pre’). We found no evidence that response times inside the LTNs or on boundary roads were affected (e.g. pre/post change for first engine: -14 seconds inside LTNs; -11 seconds in the rest of London; p=0.4 for difference). Fire crews reported more delays due to 'traffic calming measures' in LTNs, but this was entirely offset by a decrease in delays for other reasons, particularly 'traffic'. This was true both in LTNs that predominately blocked motor traffic using physical barriers (e.g. planters) and in LTNs using camera enforcement. These findings add to evidence that LTNs do not adversely affect emergency response times.

Between March and September 2020, 72 ‘Low Traffic Neighbourhoods’ (LTNs) were rapidly rolled out in London under emergency legislation. We examined the association between LTN implementation and street crime in October 2020 - February 2021 (‘post’), as compared to the same months in the previous two years (‘pre’). Overall crime trends in and around LTNs were more favourable than the background trend in Outer London, and similar to or slightly more favourable than the trend in Inner London. This pattern was also seen for numbers of direct attacks against the person - and this may underestimate the benefit per pedestrian, given evidence that LTN introduction is associated with increased walking.

We use longitudinal survey data to compare the impacts of ‘emergency’ low traffic neighbourhoods (LTNs), set up during Covid-19, to the impacts of longer-standing LTNs. While sample sizes are small, both types of LTNs had similar increases in active travel and similar improvements in perceptions of the local environment for cycling (but no change in perceptions of most other aspects of the local environment). Car use tended to decrease. This similarity suggests the emergency LTNs may bring benefits similar to longer-standing LTNs despite their lower budgets and shorter planning periods. We also found that the active travel impacts of the long-standing LTNs grew larger over time, suggesting the emergency LTNs may likewise see larger effects in the future.

Using police data, 2012-2019, we examine the impact on street crime of introducing low traffic neighbourhoods in Waltham Forest, London. Overall, the introduction of a low traffic neighbourhood was associated with a 10% decrease in total street crime (95% confidence interval 7% to 13%), and this effect increased with a longer duration since implementation (18% decrease after 3 years). An even larger reduction was observed for violence and sexual offences, the most serious subcategory of crime. The only subcategory of crime that increased significantly was bicycle theft, plausibly largely reflecting increased cycling levels. There was no indication of displacement of any crime subcategory into adjacent areas.

We examine the impact on road traffic injuries of introducing low traffic neighbourhoods in Waltham Forest, London. Using Stats19 police data 2012-2019, we find a three-fold decline in number of injuries inside low traffic neighbourhoods after implementation, relative to the rest of Waltham Forest and the rest of Outer London. We further estimate that walking, cycling, and driving all became approximately 3-4 times safer per trip. There was no evidence that injury numbers changed on boundary roads. Our findings suggest that low traffic neighbourhoods reduce injury risks across all modes inside the neighbourhood, without negative impacts at the boundary.

Objectives Examine longitudinal associations between modes of travel to school and adiposity.Setting The UK.Participants 8432 children surveyed at ages 7, 11 and 14 years from the UK Millennium Cohort Study.Primary and secondary outcomes Objective percentage body fat and body mass index (BMI). Transport mode was categorised as private motorised transport, public transport and active transport (walking or cycling). Socioeconomic position (SEP) was measured by household income group and occupational social class. We adjusted analyses for changes in the country of UK, frequency of eating breakfast, self-reported growth spurts, hours of screen time and days per week of moderate-to-vigorous physical activity. Longitudinal (panel) regression models adjusting for individual fixed effects examined associations in changes in mode of travel to school and adiposity, controlling for both time-varying and time-invariant potential confounders. Interaction tests and stratified analyses investigated differences by markers of SEP.Results At age 14 years, 26.1% of children (2198) reported using private motorised transport, 35.3% (2979) used public transport and 38.6% (3255) used active transport to get to school. 36.6% (3083) of children changed mode two times between the three waves and 50.7% (4279) changed once. Compared with continuing to use private transport, switching to active transport was associated with a lower BMI (−0.21 kg/m2, 95% CI −0.31 to −0.10) and body fat (−0.55%, 95% CI −0.80% to −0.31%). Switching to public transport was associated with lower percentage body fat (−0.43%, 95% CI −0.75% to −0.12%), but associations with BMI did not reach statistical significance (−0.13 kg/m2, 95% CI −0.26 to 0.01). Interaction tests showed a trend for these effects to be stronger in more deprived groups, but these interactions did not reach statistical significance.Conclusion This longitudinal study during a key life course period found switching to physically active forms of travel can have beneficial adiposity impacts; these associations may be more apparent for more disadvantaged children. Increasing active travel has potential to ameliorate inequalities.

We use vehicle registration data to examine whether active travel interventions in Outer London between 2015-2019 affected motor vehicle ownership, compared to other neighbourhoods. We find statistically significant reductions in car/van ownership in areas introducing ‘low traffic neighbourhoods’ (-6%, or 23 cars/vans per 1000 adults, after two years). We also find statistically significant but smaller reductions in areas introducing other infrastructure such as cycle tracks (-2%, or 7 cars/vans per 1000 adults, after 2 years). These effects increased after adjusting for the changing age profile of the intervention areas. Our findings indicate that active travel interventions can reduce motor-vehicle ownership, particularly interventions involving low traffic neighbourhoods.

There is sometimes concern that low traffic neighbourhoods slow emergency vehicles. We test this using London Fire Brigade data (2012-2020) in Waltham Forest, where from 2015 low traffic neighbourhoods have been implemented. We find no evidence that response times were affected inside low traffic neighbourhoods, and some evidence that they improved slightly on boundary roads. However, while the proportion of delays was unchanged, the reasons given for delays initially showed some shift from ‘no specific delay cause identified’ to ‘traffic calming measures’. Our findings indicate that low traffic neighbourhoods do not adversely affect emergency response times, although while LTNs are novel this perception may exist among some crews.

This paper reports on analysis of impacts of active travel interventions in Outer London between 2016-19. We find larger effects (decreased car ownership and use, increased active travel) in intervention areas where Low Traffic Neighbourhoods (LTNs) were introduced. Decreased car ownership and use is only found in such areas. Sample size for LTN areas is small and hence uncertainty about effect magnitude is large, but effect direction is consistent. This suggests that to reduce car use as well as increase active travel, LTNs are an important part of the intervention toolbox.

Introduction Antimicrobial resistance is rising, largely due to the indiscriminate use of antimicrobials. The human gut is the largest reservoir of antibiotic resistant bacteria (ARB). Individuals colonised with ARB have the potential to spread these organisms both in the community and hospital settings. Infections with ARB such as extended spectrum beta-lactamase producing enterobacteriales (ESBL-E) and carbapenemase producing enterobacteriales (CPE) are more difficult to treat and are associated with an increased morbidity and mortality. Presently, there is no effective decolonisation strategy for these ARB. Faecal microbiota transplant (FMT) has emerged as a potential strategy for decolonisation of ARB from the human gut, however there is significant uncertainty about the feasibility, effectiveness and safety of using this approach.Methods and analysis Prospective, randomised, patient-blinded, placebo-controlled feasibility trial of FMT to eradicate gastrointestinal carriage of ARB. Eighty patients with a recent history of invasive infection secondary to ESBL-E or CPE and persistent gastrointestinal carriage will be randomised 1:1 to receive encapsulated FMT or placebo. The primary outcome measure is consent rate (as a proportion of patients who fulfil inclusion/exclusion criteria); this will be used to determine if a substantive trial is feasible. Participants will be followed up at 1 week, 1 month, 3 months and 6 months and monitored for adverse events as well as gastrointestinal carriage rates of ARB after intervention.Ethics and dissemination Research ethics approval was obtained by London—City and East Research Ethics Committee (ref 20/LO/0117). Trial results will be published in a peer-reviewed journal and presented at international conferences.Trial registration number ISRCTN registration number 34 467 677 and EudraCT number 2019-001618-41.

Background: São Paulo city, Brazil, faces challenges caused by rapid urbanization. We illustrate how future travel patterns could lead to different health consequences in the city. Methods: We evaluated the health impacts of different travel pattern scenarios for the São Paulo adult population by comparing the travel patterns of São Paulo in 2012 with counterfactual scenarios in which the city adopted travel patterns of i) those living in the city's expanded centre; ii) London (2012); iii) a highly motorized São Paulo (SP California); and iv) a visionary São Paulo (SP 2040), with high levels of walking and cycling and low levels of car and motorcycle use. For each scenario we estimated changes in exposure to air pollution, road injury risk, and physical activity. Health outcomes were estimated using disability adjusted life years (DALYs) and premature deaths averted. Sensitivity analyses were performed to identify the main sources of uncertainty. Results: We found considerable health gains in the SP 2040 scenario (total 63.6k DALYs avoided), with 4.7% of premature deaths from ischemic heart disease avoided from increases in physical activity alone. Conversely, we found substantial health losses in the scenario favouring private transport (SP California, total increase of 54.9k DALYs), with an increase in road traffic deaths and injuries among pedestrians and motorized vehicles. Parameters related to air pollution had the largest impact on uncertainty. Conclusions: Shifting travel patterns towards more sustainable transport can provide major health benefits in São Paulo. Reducing the uncertainties in the findings should be a priority for empirical and modelling research on the health impacts of such shifts.

Several studies have found that parental absences in childhood are associated with individuals’ reproductive strategies later in life. However, these associations vary across populations and the reasons for this heterogeneity remain debated. In this paper, we examine the diversity of parental associations in three ways. First, we test whether different kinds of parental availability in childhood and adolescence are associated with women’s and men’s ages at first birth using the intergenerational and longitudinal Uppsala Birth Cohort Study (UBCoS) dataset from Sweden. This cultural context provides a strong test of the hypothesis that parents influence life history strategies given that robust social safety nets may buffer parental absences. Second, we examine whether investments in education help explain why early parental presence is associated with delayed ages at first birth in many post-industrial societies, given that parents often support educational achievement. Third, we compare parental associations with reproductive timing across two adjacent generations in Sweden. This historical contrast allows us to control for many sources of heterogeneity while examining whether changing educational access and norms across the 20th-century change the magnitude and pathways of parental influence. We find that parental absences tend to be associated with earlier first births, and more reliably so for women. Many of these associations are partially mediated by university attendance. However, we also find important differences across cohorts. For example, the associations with paternal death become similar for sons and daughters in the more recent cohort. One possible explanation for this finding is that fathers start influencing sons and daughters more similarly. Our results illustrate that historical changes within a population can quickly shift how family affects life history.

Abstract Background Globally most children do not engage in enough physical activity. Day length and weather conditions have been identified as determinants of physical activity, although how they may be overcome as barriers is not clear. We aim to examine if and how relationships between children’s physical activity and weather and day length vary between countries and identify settings in which children were better able to maintain activity levels given the weather conditions they experienced. Methods In this repeated measures study, we used data from 23,451 participants in the International Children’s Accelerometry Database (ICAD). Daily accelerometer-measured physical activity (counts per minute; cpm) was matched to local weather conditions and the relationships assessed using multilevel regression models. Multilevel models accounted for clustering of days within occasions within children within study-cities, and allowed us to explore if and how the relationships between weather variables and physical activity differ by setting. Results Increased precipitation and wind speed were associated with decreased cpm while better visibility and more hours of daylight were associated with increased cpm. Models indicated that increases in these variables resulted in average changes in mean cpm of 7.6/h of day length, −13.2/cm precipitation, 10.3/10 km visibility and −10.3/10kph wind speed (all p

BackgroundA modal shift to cycling has the potential to reduce greenhouse gas emissions and provide health co-benefits. Methods, models, and tools are needed to estimate the potential for cycling uptake and communicate to policy makers the range of impacts this would have.Methods and findingsThe Impacts of Cycling Tool (ICT) is an open source model with a web interface for visualising travel patterns and comparing the impacts of different scenarios of cycling uptake. It is currently applied to England. The ICT allows users to visualise individual and trip-level data from the English National Travel Survey (NTS), 2004-2014 sample, 132,000 adults. It models scenarios in which there is an increase in the proportion of the population who cycle regularly, using a distance-based propensity approach to model which trips would be cycled. From this, the model estimates likely impact on travel patterns, health, and greenhouse gas emissions. Estimates of nonoccupational physical activity are generated by fusing the NTS with the English Active People Survey (APS, 2013-2014, 559,515 adults) to create a synthetic population. Under 'equity' scenarios, we investigate what would happen if cycling levels increased equally among all age and gender categories, as opposed to in proportion to the profile of current cyclists. Under electric assist bike (pedelecs or 'e-bike') scenarios, the probability of cycling longer trips increases, based on the e-bike data from the Netherlands, 2013-2014 Dutch Travel Survey (50,868 adults).Outcomes are presented across domains including transport (trip duration and trips by mode), health (physical activity levels, years of life lost), and car transport-related CO2 emissions. Results can be visualised for the whole population and various subpopulations (region, age, gender, and ethnicity). The tool is available at www.pct.bike/ict. If the proportion of the English population who cycle regularly increased from 4.8% to 25%, then there would be notable reductions in car miles and passenger related CO2 emissions (2.2%) and health benefits (2.1% reduction in years of life lost due to premature mortality). If the new cyclists had access to e-bikes, then mortality reductions would be similar, while the reduction in car miles and CO2 emissions would be larger (2.7%). If take-up of cycling occurred equally by gender and age (under 80 years), then health benefits would be marginally greater (2.2%) but reduction in CO2 slightly smaller (1.8%). The study is limited by the quality and comparability of the input data (including reliance on self-report behaviours). As with all modelling studies, many assumptions are required and potentially important pathways excluded (e.g. injury, air pollution, and noise pollution).ConclusionThis study demonstrates a generalisable approach for using travel survey data to model scenarios of cycling uptake that can be applied to a wide range of settings. The use of individual-level data allows investigation of a wide range of outcomes, and variation across subgroups. Future work should investigate the sensitivity of results to assumptions and omissions, and if this varies across setting.

BackgroundThe National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation.Methods and findingsWe developed a microsimulation model to estimate the health benefits (incident ischaemic heart disease, stroke, dementia, and lung cancer) of the NHS Health Check programme in England. We simulated a population of adults in England aged 40-45 years and followed until age 100 years, using data from the Health Survey of England (2009-2012) and the English Longitudinal Study of Aging (1998-2012), to simulate changes in risk factors for simulated individuals over time. We used recent programme data to describe uptake of NHS Health Checks and of 4 associated interventions (statin medication, antihypertensive medication, smoking cessation, and weight management). Estimates of treatment efficacy and adherence were based on trial data. We estimated the benefits of the current NHS Health Check programme compared to a healthcare system without systematic health checks. This counterfactual scenario models the detection and treatment of risk factors that occur within 'routine' primary care. We also explored the impact of making feasible changes to implementation of the programme concerning eligibility, uptake of NHS Health Checks, and uptake of treatments offered through the programme. We estimate that the NHS Health Check programme prevents 390 (95% credible interval 290 to 500) premature deaths before 80 years of age and results in an additional 1,370 (95% credible interval 1,100 to 1,690) people being free of disease (ischaemic heart disease, stroke, dementia, and lung cancer) at age 80 years per million people aged 40-45 years at baseline. Over the life of the cohort (i.e., followed from 40-45 years to 100 years), the changes result in an additional 10,000 (95% credible interval 8,200 to 13,000) quality-adjusted life years (QALYs) and an additional 9,000 (6,900 to 11,300) years of life. This equates to approximately 300 fewer premature deaths and 1,000 more people living free of these diseases each year in England. We estimate that the current programme is increasing QALYs by 3.8 days (95% credible interval 3.0-4.7) per head of population and increasing survival by 3.3 days (2.5-4.1) per head of population over the 60 years of follow-up. The current programme has a greater absolute impact on health for those living in the most deprived areas compared to those living in the least deprived areas (4.4 [2.7-6.5] days of additional quality-adjusted life per head of population versus 2.8 [1.7-4.0] days; 5.1 [3.4-7.1] additional days lived per head of population versus 3.3 [2.1-4.5] days). Making feasible changes to the delivery of the existing programme could result in a sizable increase in the benefit. For example, a strategy that combines extending eligibility to those with preexisting hypertension, extending the upper age of eligibility to 79 years, increasing uptake of health checks by 30%, and increasing treatment rates 2.5-fold amongst eligible patients (i.e., 'maximum potential' scenario) results in at least a 3-fold increase in benefits compared to the current programme (1,360 premature deaths versus 390; 5,100 people free of 1 of the 4 diseases versus 1,370; 37,000 additional QALYs versus 10,000; 33,000 additional years of life versus 9,000). Ensuring those who are assessed and eligible for statins receive statins is a particularly important strategy to increase benefits. Estimates of overall benefit are based on current incidence and management, and future declines in disease incidence or improvements in treatment could alter the actual benefits observed in the long run. We have focused on the cardiovascular element of the NHS Health Check programme. Some important noncardiovascular health outcomes (e.g., chronic obstructive pulmonary disease [COPD] prevention from smoking cessation and cancer prevention from weight loss) and other parts of the programme (e.g., brief interventions to reduce harmful alcohol consumption) have not been modelled.ConclusionsOur model indicates that the current NHS Health Check programme is contributing to improvements in health and reducing health inequalities. Feasible changes in the organisation of the programme could result in more than a 3-fold increase in health benefits.

BackgroundStreet imagery is a promising and growing big data source providing current and historical images in more than 100 countries. Studies have reported using this data to audit road infrastructure and other built environment features. Here we explore a novel application, using Google Street View (GSV) to predict travel patterns at the city level.MethodsWe sampled 34 cities in Great Britain. In each city, we accessed 2000 GSV images from 1000 random locations. We selected archived images from time periods overlapping with the 2011 Census and the 2011-2013 Active People Survey (APS). We manually annotated the images into seven categories of road users. We developed regression models with the counts of images of road users as predictors. The outcomes included Census-reported commute shares of four modes (combined walking plus public transport, cycling, motorcycle, and car), as well as APS-reported past-month participation in walking and cycling.ResultsWe found high correlations between GSV counts of cyclists ('GSV-cyclists') and cycle commute mode share (r = 0.92)/past-month cycling (r = 0.90). Likewise, GSV-pedestrians was moderately correlated with past-month walking for transport (r = 0.46), GSV-motorcycles was moderately correlated with commute share of motorcycles (r = 0.44), and GSV-buses was highly correlated with commute share of walking plus public transport (r = 0.81). GSV-car was not correlated with car commute mode share (r = -0.12). However, in multivariable regression models, all outcomes were predicted well, except past-month walking. The prediction performance was measured using cross-validation analyses. GSV-buses and GSV-cyclists are the strongest predictors for most outcomes.ConclusionsGSV images are a promising new big data source to predict urban mobility patterns. Predictive power was the greatest for those modes that varied the most (cycle and bus). With its ability to identify mode of travel and capture street activity often excluded in routinely carried out surveys, GSV has the potential to be complementary to new and traditional data. With half the world's population covered by street imagery, and with up to 10 years historical data available in GSV, further testing across multiple settings is warranted both for cross-sectional and longitudinal assessments.

To investigate whether and how social class and social mobility in grandparents and parents predict alcohol-related disorders (ARDs) in males and females aged 12+ years, and whether intergenerational social prediction of ARDs varies across time periods.The study sample included four successive generations (G) of Swedish families from the Uppsala Birth Cohort Multigenerational Study: G0 born 1851-1912; G1 born 1915-1929; G2 born 1940-1964 and G3 born 1965-1989. Two study populations were created, each consisting of grandparents, parents and offspring: population I 'G0-G1-G2' (offspring n = 18 430) and population II 'G1-G2-G3' (offspring n = 26 469). Registers and archives provided data on ancestors' socio-demographic factors and ARD history, together with offspring ARD development between 1964-2008. Cox regression models examined the hazard of offspring ARD development according to grandparental social class and grandparental-to-parental social trajectories, controlling for offspring birth year, grandmother's and mother's marital status and parental ARDs.Disadvantaged grandparental social class predicted increased ARD risk in offspring in population I, although the effect attenuated and became non-significant in males after adjusting for parental characteristics (adjusted hazard ratio (HR) = 1.80 (95%CI; 1.07, 3.03) in females, HR = 1.32 (95%CI; 0.93, 1.89) in males). In population II, no increase in ARD risk by grandparental social was evident. In both populations, males were at the highest ARD risk if both parents and grandparents belonged to disadvantaged social class (population I: HR = 1.82 (95%CI; 1.22-2.72); population II: HR = 1.68 (95%CI; 1.02-2.76)).Intergenerational social patterning of ARDs appears to be time-contextual and gender-specific. The role of grandparental social class in developing ARDs in grandchildren seems to decline over time, while persistent grandparental-to-parental social disadvantage remains associated with higher ARD risk in males. When targeting higher risk groups, continuity of familial social disadvantage, particularly among males, should be considered.

Getting people cycling is an increasingly common objective in transport planning institutions worldwide. A growing evidence base indicates that high quality infrastructure can boost local cycling rates. Yet for infrastructure and other cycling measures to be effective, it is important to intervene in the right places, such as along ‘desire lines’ of high latent demand. This creates the need for tools and methods to help answer the question ‘where to build?’. Following a brief review of the policy and research context related to this question, this paper describes the design, features and potential applications of such a tool. The Propensity to Cycle Tool (PCT) is an online, interactive planning support system that was initially developed to explore and map cycling potential across England (see www.pct.bike). Based on origin-destination data it models cycling levels at area, desire line, route and route network levels, for current levels of cycling, and for scenario-based ‘cycling futures.’ Four scenarios are presented, including ‘Go Dutch’ and ‘Ebikes,’ which explore what would happen if English people had the same propensity to cycle as Dutch people and the potential impact of electric cycles on cycling uptake. The cost effectiveness of investment depends not only on the number of additional trips cycled, but on wider impacts such as health and carbon benefits. The PCT reports these at area, desire line, and route level for each scenario. The PCT is open source, facilitating the creation of scenarios and deployment in new contexts. We conclude that the PCT illustrates the potential of online tools to inform transport decisions and raises the wider issue of how models should be used in transport planning.

Research on forecasting is effectively limited to forecasts that are expressed with clarity; which is to say that the forecasted event must be sufficiently well-defined so that it can be clearly resolved whether or not the event occurred and forecasts certainties are expressed as quantitative probabilities. When forecasts are expressed with clarity, then quantitative measures (scoring rules, calibration, discrimination, etc.) can be used to measure forecast accuracy, which in turn can be used to measure the comparative accuracy of different forecasting methods. Unfortunately most real world forecasts are not expressed clearly. This lack of clarity extends to both the description of the forecast event and to the use of vague language to express forecast certainty. It is thus difficult to assess the accuracy of most real world forecasts, and consequently the accuracy the methods used to generate real world forecasts. This paper addresses this deficiency by presenting an approach to measuring the accuracy of imprecise real world forecasts using the same quantitative metrics routinely used to measure the accuracy of well-defined forecasts. To demonstrate applicability, the inferred probability method is applied to measure the accuracy of forecasts in fourteen documents examining complex political domains.

Background: In September 2005 London introduced a policy granting young people aged 60 years. An increase in assaults largely preceded the scheme. Qualitative data suggested that the scheme increased opportunities for independent travel, social inclusion, and a sense of belonging and that it ‘normalised’ bus travel. The monetised benefits of the scheme substantially outweighed the costs, providing what the Department for Transport (DfT) considers ‘high’ value for money. Conclusion: The free bus travel scheme for young people appears to have encouraged their greater use of bus transport for short trips without significant impact on their overall active travel. There was qualitative evidence for benefits on social determinants of health, such as normalisation of bus travel, greater social inclusion and opportunities for independent travel. In the context of a good bus service, universal free bus travel for young people appears to be a cost-effective contributor to social inclusion and, potentially, to increasing sustainable transport in the long term. Further research is needed on the effects of both active and other travel modes on the determinants of health; the factors that influence maintenance of travel mode change; travel as ‘social practice’; the impact of driving license changes on injury rates for young adults and the value of a statistical life for young people. Funding: The National Institute for Health Research Public Health Research programme.

To investigate which facets of parent and grandparent socio-economic position (SEP) are associated with eating disorders (ED), and how this varies by ED subtype and over time.Total-population cohort study of 1,040,165 females and 1,098,188 males born 1973-1998 in Sweden, and followed for inpatient or outpatient ED diagnoses until 2010. Proportional hazards models estimated associations with parental education, income and social class, and with grandparental education and income.15,747 females and 1051 males in our sample received an ED diagnosis, with rates increasing in both sexes over time. ED incidence in females was independently predicted by greater educational level among the father, mother and maternal grandparents, but parent social class and parental income showed little or no independent effect. The associations with education were equally strong for anorexia nervosa, bulimia nervosa and ED not-otherwise-specified, and had increased over time. Among males, an apparently similar pattern was seen with respect to anorexia nervosa, but non-anorexia ED showed no association with parental education and an inverse association with parental income.Family history of education predicts ED in gender- and disorder-specific ways, and in females the effect is observed across multiple generations. Particularly given that these effects may have grown stronger in more recent cohorts, these findings highlight the need for further research to clarify the underlying mechanisms and identify promising targets for prevention. Speculatively, one such mechanism may involve greater internal and external demands for academic success in highly educated families.

Increasing walking and cycling, and reducing motorised transport, are health and environmental priorities. This paper examines levels and trends in the use of different commute modes in England and Wales, both overall and with respect to small-area deprivation. It also investigates whether commute modal share can serve as a proxy for travel behaviour more generally.23.7 million adult commuters reported their usual main mode of travelling to work in the 2011 census in England and Wales; similar data were available for 1971-2001. Indices of Multiple Deprivation were used to characterise socio-economic patterning. The National Travel Survey (2002-2010) was used to examine correlations between commute modal share and modal share of total travel time. These correlations were calculated across 150 non-overlapping populations defined by region, year band and income.Among commuters in 2011, 67.1% used private motorised transport as their usual main commute mode (-1.8 percentage-point change since 2001); 17.8% used public transport (+1.8% change); 10.9% walked (-0.1% change); and 3.1% cycled (+0.1% change). Walking and, to a marginal extent, cycling were more common among those from deprived areas, but these gradients had flattened over the previous decade to the point of having essentially disappeared for cycling. In the National Travel Survey, commute modal share and total modal share were reasonably highly correlated for private motorised transport (r = 0.94), public transport (r = 0.96), walking (r = 0.88 excluding London) and cycling (r = 0.77).England and Wales remain car-dependent, but the trends are slightly more encouraging. Unlike many health behaviours, it is more common for socio-economically disadvantaged groups to commute using physically active modes. This association is, however, weakening and may soon reverse for cycling. At a population level, commute modal share provides a reasonable proxy for broader travel patterns, enhancing the value of the census in characterising background trends and evaluating interventions.

Growing up with many siblings, at least in the context of modern post-industrial low fertility, low mortality societies, is predictive of relatively poor performance on school tests in childhood, lower levels of educational attainment, and lower income throughout adulthood. Recent studies further indicate these relationships hold across generations, so that the descendants of those who grow up with many siblings are also at an apparent socioeconomic disadvantage. In this paper we add to this literature by considering whether such relationships interact with the sex and relative age of siblings. To do this we utilise a unique Swedish multigenerational birth cohort study that provides sibling configuration data on over 10,000 individuals born in 1915-1929, plus all their direct genetic descendants to the present day. Adjusting for parental and birth characteristics, we find that the 'socioeconomic cost' of growing up in a large family is independent of both the sex of siblings and the sex of the individual. However, growing up with several older as opposed to several younger siblings is predictive of relatively poor performance on school tests and a lower likelihood of progression to tertiary education. This later-born disadvantage also holds across generations, with the children of those with many older siblings achieving lower levels of educational attainment. Despite these differences, we find that while individual and descendant income is negatively related to the number of siblings, it is not influenced by the relative age of siblings. Thus, our findings imply that the educational disadvantage of later-born children, demonstrated here and in numerous other studies, does not necessarily translate into reduced earnings in adulthood. We discuss potential explanations for this pattern of results, and consider some important directions for future research into sibling configuration and wellbeing in modern societies.