Objectives: Physical activity (PA) is essential for preventing and managing chronic diseases and improving mental health. Despite national guidelines recommending regular PA, significant disparities exist across demographic groups and regions in the UK, with Birmingham and the West Midlands reporting some of the lowest activity levels. We aimed to explore the development, implementation, and perceived value of Every Step Matters (ESM) tracks—mile-long walking routes installed in eight Birmingham parks situated in neighbourhoods with high deprivation and ethnic diversity. Study design: Qualitative evaluation. Methods: Data were collected from 35 participants through ten in-depth interviews and four focus groups, including community members, track users, and stakeholders from the Birmingham City Council (BCC) Public Health team and a physical activity charity based in the West Midlands who work with communities from a range of socio-economic backgrounds and ethnicities in urban areas. Rapid qualitative analysis was undertaken. Results: Seven themes were identified: (1) use of the tracks, (2) promoting use, (3) increasing appeal, (4) perceived benefits, (5) barriers, (6) sustainability, and (7) interactions between the Public Health team and the PA charity partner. While the tracks were viewed as inclusive, low-cost, and beneficial for health and community cohesion, barriers such as safety concerns, low motivation, and poor maintenance were identified. Recommendations include improving awareness, addressing safety, promoting group activities, and ensuring long-term sustainability. Conclusions: The ESM tracks show promise as a community-based intervention to promote PA in disadvantaged areas. However, sustained impact requires strategic planning, community ownership, and targeted support. Further research is needed to explore adherence, guided versus non-guided use, and the role of social determinants in PA engagement.

BACKGROUND:There is limited information on the association between walkability and health in Asian countries. OBJECTIVE:Our study aimed to investigate the association between neighborhood walkability and mortality in Taiwanese adults. METHODS:We selected 457,874 participants (≥18 y of age) from Taiwan who joined a standard medical examination program between 1998 and 2016 and followed them until 31 July 2021. Three walkability measures were estimated within a walking distance of 640m of participant's addresses: points of interest (POI), transit stations, and impedance (restrictions to walking due to absence of intersections and physical barriers). Walkability measures were applied as continuous and categorical (tertiles) variables in data analyses. Mortality data were obtained from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. A time-varying Cox regression model was used to investigate the association of neighborhood walkability with deaths from natural causes and specific causes. RESULTS:This study identified 24,744 deaths over a median follow-up of 16.9 y. In comparison with participants living with the first tertile for numbers of POI and transit stations, those living with higher numbers of POI and transit stations were associated with a lower risk of natural-cause mortality, with hazard ratios (HRs) of 0.97 [95% confidence intervals (CIs): 0.94, 1.00] and 0.93 (95% CI: 0.90, 0.96) for second and third tertiles of numbers of POI, and 0.99 (95% CI: 0.96, 1.02) and 0.94 (95% CI: 0.92, 0.98) for second and third tertiles of numbers of transit stations, respectively. Each unit increase in POI and transit stations was associated with a 3% (HR= 0.97; 95% CI: 0.96, 0.99) and 2% (HR= 0.98; 95% CI: 0.97, 0.99) reduced risk of natural-cause mortality, respectively. In addition, in comparison with living in areas with the first tertile of impedance, living with the third tertile of impedance was associated a higher risk of natural-cause mortality, with HRs of 1.01 (95% CI: 1.00, 1.03). One unit increase in impedance was associated with a 1% (HR= 1.01; 95% CI: 1.00, 1.03) increased risk of natural-cause mortality. We also found significantly inverse associations between three walkability measures with deaths from cardiovascular diseases and between POI and death from chronic respiratory diseases. CONCLUSION:Our findings indicate that a higher level of neighborhood walkability was associated with a lower risk of mortality. Our data suggest that it is important to take into account neighborhood walkability in urban planning and health guideline development. https://doi.org/10.1289/EHP15209.

The indoor home environment plays a crucial role in determining the outcome of respiratory diseases, including asthma. Researchers, clinicians, and patients would benefit from self-reported questionnaires to assess indoor home environmental exposures that may impact on respiratory health. To review self-reported instruments for assessing indoor home environmental exposures in asthma patients and to characterise their content, development, and psychometric properties. A scoping review was conducted with content assessment. A literature search was conducted in Embase and PubMed using the key words housing quality, questionnaire and asthma and their index terms, covering articles published in English between January 2000 to July 2023. Articles in which questionnaires or single item questions were used to assess indoor home environmental exposures in asthma patients in middle- and high-income countries were included. We excluded articles in which the questionnaire required an interviewer or onsite observations and those conducted in low-income countries. We screened 1584 articles to identify 44 studies containing self-reported questionnaires measuring indoor home environmental exposures. 36 studies (82

BACKGROUND:There are limited data on the risks of obstetric complications among survivors of adolescent and young adult cancer with most previous studies only reporting risks for all types of cancers combined. The aim of this study was to quantify deficits in birth rates and risks of obstetric complications for female survivors of 17 specific types of adolescent and young adult cancer. METHODS:The Teenage and Young Adult Cancer Survivor Study (TYACSS)-a retrospective, population-based cohort of 200 945 5-year survivors of cancer diagnosed at age 15-39 years from England and Wales-was linked to the English Hospital Episode Statistics (HES) database from April 1, 1997, to March 31, 2022. The cohort included 17 different types of adolescent and young adult cancers. We ascertained 27 specific obstetric complications through HES among 96 947 women in the TYACSS cohort. Observed and expected numbers for births and obstetric complications were compared between the study cohort and the general population of England to identify survivors of adolescent and young adult cancer at a heighted risk of birth deficits and obstetric complications relative to the general population. FINDINGS:Between April 1, 1997, and March 31, 2022, 21 437 births were observed among 13 886 female survivors of adolescent and young adult cancer from England, which was lower than expected (observed-to-expected ratio: 0·68, 95% CI 0·67-0·69). Other survivors of genitourinary, cervical, and breast cancer had under 50% of expected births. Focusing on more common (observed ≥100) obstetric complications that were at least moderately in excess (observed-to-expected ratio ≥1·25), survivors of cervical cancer were at risk of malpresentation of fetus, obstructed labour, amniotic fluid and membranes disorders, premature rupture of membranes, preterm birth, placental disorders including placenta praevia, and antepartum haemorrhage. Survivors of leukaemia were at risk of preterm delivery, obstructed labour, postpartum haemorrhage, and retained placenta. Survivors of all other specific cancers had no more than two obstetric complications that exceeded an observed-to-expected ratio of 1·25 or greater. INTERPRETATION:Survivors of cervical cancer and leukaemia are at risk of several serious obstetric complications; therefore, any pregnancy should be considered high-risk and would benefit from obstetrician-led antenatal care. Despite observing deficits in birth rates across all 17 different types of adolescent and young adult cancer, we provide reassurance for almost all survivors of adolescent and young adult cancer concerning their risk of almost all obstetric complications. Our results provide evidence for the development of clinical guidelines relating to counselling and surveillance of obstetrical risk for female survivors of adolescent and young adult cancer. FUNDING:Children with Cancer UK, The Brain Tumour Charity, and Academy of Medical Sciences.

Objective: To determine the change in English emergency postnatal maternal readmissions 2007-2017 (pre-COVID-19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS). Design: National cohort study. Setting: All English National Health Service hospitals. Population: A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017. Methods: Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database. Main Outcome Measures: Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS. Results: A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28-1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31-1.39); age < 20 years (aOR 1.09, 95% CI 1.05-1.12); 40+ years (aOR 1.07, 95% CI 1.03-1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91-0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82-1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53-1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06-2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83-2.21). Conclusions: The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those <20 and >= 40 years old; primiparous women; and those with specified obstetric risk factors.

INTRODUCTION:Excess body weight causes 4 million deaths annually across the world. The number of people affected by humanitarian crises stands at a record high level with 1 in 95 people being forcibly displaced. These epidemics overlap. Addressing obesity is a post-acute phase activity in non-communicable disease management in humanitarian settings. Information is needed to inform guidelines and timing of interventions. The objective of this review was to explore the prevalence of overweight and obesity in populations directly affected by humanitarian crises; the cascade of care in these populations and perceptions of patients with overweight and obesity.METHODS:Literature searches were carried out in five databases. Grey literature was identified. The population of interest was non-pregnant, civilian adults who had experience of humanitarian crises (armed conflict, complex emergencies and natural disasters). All study types published from January 1st, 2011, were included. Screening, data extraction and quality appraisal were carried out in duplicate. A narrative synthesis is presented.RESULTS:Fifty-six reports from forty-five studies were included. Prevalence estimates varied widely across the studies and by subgroups. Estimates of overweight and obesity combined ranged from 6.4% to 82.8%. Studies were heterogenous. Global distribution was skewed. Increasing adiposity was seen over time, in older adults and in women. Only six studies were at low risk of bias. Body mass index was the predominant measure used. There were no studies reporting cascade of care. No qualitative studies were identified.CONCLUSION:Overweight and obesity varied in crisis affected populations but were rarely absent. Improved reporting of existing data could provide more accurate estimates. Worsening obesity may be prevented by acting earlier in long-term crises and targeting risk groups. The use of waist circumference would provide useful additional information. Gaps remain in understanding the existing cascade of care. Cultural norms around diet and ideal body size vary.

BACKGROUND AND AIM: Good walkability has been proposed as a broad strategy for promoting physical activity. However, little is known about the association between walkability and health, especially in the context of Asian regions with high population densities. Our study aims to investigate the association between neighborhood walkability and mortality in Taiwanese adults. METHOD: We selected 362,740 participants (≥18 years old) from Taiwan who joined a standard medical examination program between 2001 and 2016, and followed them until 31 July 2021. Three walkability measures were estimated within a walking distance of 640m of participant's addresses: point of interest (POI), transit stations, and impedance. Mortality data was obtained from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. A time-varying Cox regression model was used to investigate the association of neighborhood walkability with death from natural-cause and specific causes. RESULTS: This study identified 14,351 deaths over 5,327,780.58 person-years of follow-up. Compared with living in areas with the first tertile of POI and transit station, living in areas with higher numbers of POI and transit stations were associated with a lower risk of natural-cause mortality, with hazard ratios(HRs) (95% confidence intervals(CIs)) of 0.95 (0.91, 0.99) and 0.89 (0.86, 0.93) for second and third tertiles of POI, and 0.95 (0.91, 0.99) and 0.92 (0.89, 0.96) for second and third tertiles of transit station, respectively. In addition, compared with living in areas with the first tertile of impedance, living with the third tertile of impedance was associated a higher risk of natural-cause mortality, with HRs(95%CI) of 1.07 (1.02, 1.11). We also found protective effects of POI and transit station on death from cardiovascular diseases and cancer. CONCLUSIONS: Better neighborhood walkability was associated with a lower risk of mortality. Our findings reinforced the importance of neighborhood walkability in urban planning and health guideline development.

BackgroundCombined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart - formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic.MethodTwelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1(st) February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database.Results372 studies were performed on 265 patients. There was a small but significant relationship between LUS score >8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction (p < 0.05). Change in management occurred in 65% of patients following a combined scan.ConclusionsIn COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication.

Background: Since changes in the national guidance in 2011, prophylactic antibiotics for women undergoing caesarean section are recommended prior to skin incision, rather than after the baby's umbilical cord has been clamped. Evidence from randomised controlled trials conducted outside the UK has shown that this reduces maternal infectious morbidity; however, the prophylactic antibiotics also cross the placenta, meaning that babies are exposed to them around the time of birth. Antibiotics are known to affect the gut microbiota of the babies, but the long-term effects of exposure to high-dose broad-spectrum antibiotics around the time of birth on allergy and immune-related diseases are unknown. Objectives: We aimed to examine whether or not in-utero exposure to antibiotics immediately prior to birth compared with no pre-incisional antibiotic exposure increases the risk of (1) asthma and (2) eczema in children born by caesarean section. Design: This was a controlled interrupted time series study. Setting: The study took place in primary and secondary care. Participants: Children born in the UK during 2006-18 delivered by caesarean section were compared with a control cohort delivered vaginally. Interventions: In-utero exposure to antibiotics immediately prior to birth. Main outcome measures: Asthma and eczema in children in the first 5 years of life. Additional secondary outcomes, including other allergy-related conditions, autoimmune diseases, infections, other immune system-related diseases and neurodevelopmental conditions, were also assessed. Data sources: The Health Improvement Network (THIN) and the Clinical Practice Research Datalink (CPRD) primary care databases and the Hospital Episode Statistics (HES) database. Previously published linkage strategies were adapted to link anonymised data on mothers and babies in these databases. Duplicate practices contributing to both THIN and the CPRD databases were removed to create a THIN-CPRD data set. Results: In the THIN-CPRD and HES data sets, records of 515,945 and 3,945,351 mother-baby pairs were analysed, respectively. The risk of asthma was not significantly higher in children born by caesarean section exposed to pre-incision antibiotics than in children whose mothers received post cord clamping antibiotics, with an incidence rate ratio of 0.91 (95% confidence interval 0.78 to 1.05) for diagnosis of asthma in primary care and an incidence rate ratio of 1.05 (95% confidence interval 0.99 to 1.11) for asthma resulting in a hospital admission. We also did not find an increased risk of eczema, with an incidence rate ratio of 0.98 (95% confidence interval 0.94 to1.03) and an incidence rate ratio of 0.96 (95% confidence interval 0.71 to 1.29) for diagnosis in primary care and hospital admissions, respectively. Limitations: It was not possible to ascertain the exposure to pre-incision antibiotics at an individual level. The maximum follow-up of children was 5 years. Conclusions: There was no evidence that the policy change from post-cord clamping to pre-incision prophylactic antibiotics for caesarean sections during 2006-18 had an impact on the incidence of asthma and eczema in early childhood in the UK. Future work: There is a need for further research to investigate if pre-incision antibiotics have any impact on developing asthma and other allergy and immune-related conditions in older children. Study registration: This study is registered as researchregistry3736. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 30. See the NIHR Journals Library website for further project information.

BACKGROUND:Coronavirus disease 2019 has had a dramatic impact on the delivery of acute care globally. Accurate risk stratification is fundamental to the efficient organisation of care. Point-of-care lung ultrasound offers practical advantages over conventional imaging with potential to improve the operational performance of acute care pathways during periods of high demand. The Society for Acute Medicine and the Intensive Care Society undertook a collaborative evaluation of point-of-care imaging in the UK to describe the scope of current practice and explore performance during real-world application.METHODS:A retrospective service evaluation was undertaken of the use of point-of-care lung ultrasound during the initial wave of coronavirus infection in the UK. We report an evaluation of all imaging studies performed outside the intensive care unit. An ordinal scale was used to measure the severity of loss of lung aeration. The relationship between lung ultrasound, polymerase chain reaction for SARS-CoV-2 and 30-day outcomes were described using logistic regression models.RESULTS:Data were collected from 7 hospitals between February and September 2020. In total, 297 ultrasound examinations from 295 patients were recorded. Nasopharyngeal swab samples were positive in 145 patients (49.2% 95%CI 43.5-54.8). A multivariate model combining three ultrasound variables showed reasonable discrimination in relation to the polymerase chain reaction reference (AUC 0.77 95%CI 0.71-0.82). The composite outcome of death or intensive care admission at 30 days occurred in 83 (28.1%, 95%CI 23.3-33.5). Lung ultrasound was able to discriminate the composite outcome with a reasonable level of accuracy (AUC 0.76 95%CI 0.69-0.83) in univariate analysis. The relationship remained statistically significant in a multivariate model controlled for age, sex and the time interval from admission to scan Conclusion: Point-of-care lung ultrasound is able to discriminate patients at increased risk of deterioration allowing more informed clinical decision making.

Introduction: There is a paucity of data in the scientific literature on the morbidity and mortality of bariatric and metabolic surgery (BMS) in individuals suffering from Type 2 diabetes mellitus (T2D). The current study is a secondary analysis of the GENEVA dataset to understand this. Materials and Methods: Logistic regressions were performed to investigate the influence of diabetes on complication rates and procedure selection. Ethical approval was not required. Results: One thousand four hundred and seventy-five of these patients were suffering from T2D at the time of the surgery (416 diet-treated type 2 diabetes), 806 oral agent-treated type 2 diabetes, and 253 insulin-treated type 2 diabetes [ITD]). Six hundred and fifty (44.1%) of these patients underwent laparoscopic sleeve gastrectomy (LSG); 487 (33%) underwent Roux-en-Y gastric bypass; 230 (15.6%) underwent a one anastomosis gastric bypass (OAGB); and 108 (7.3%) underwent some other procedures. The 30-day mortality of BMS in those without T2D was 0.07% (4/5609) as compared to 0.4% (6/1475) and 0.8% (2/253) in those with T2D and ITD, respectively. 7.9% of those with T2D developed a 30-day complication compared to 6.5% without T2D (P = 0.0475). There was an increased risk of complications in patients with ITD on univariate and multivariate analysis. Patients with T2D were significantly less likely to undergo an LSG and significantly more likely to undergo an OAGB. Conclusions: ITD patients undergoing BMS experienced significantly higher 30-day morbidity and mortality. Although LSG was the most common procedure in patients with T2D, these patients were less likely to undergo LSG than patients without T2D.

OBJECTIVE To investigate the impact on child health up to age 5 years of a policy to use antibiotic prophylaxis for caesarean section before incision compared with after cord clamping. DESIGN Observational controlled interrupted time series study. SETTING UK primary and secondary care. PARTICIPANTS 515 945 children born in 2006-18 with linked maternal records and registered with general practices contributing to two UK primary care databases (The Health Improvement Network and Clinical Practice Research Datalink), and 7 147 884 children with linked maternal records in the Hospital Episode Statistics database covering England, of which 3 945 351 were linked to hospitals that reported the year of policy change to administer prophylactic antibiotics for caesarean section before incision rather than after cord clamping. INTERVENTION Fetal exposure to antibiotics shortly before birth (using pre-incision antibiotic policy as proxy) compared with no exposure. MAIN OUTCOME MEASURES The primary outcomes were incidence rate ratios of asthma and eczema in children born by caesarean section when pre-incision prophylactic antibiotics were recommended compared with those born when antibiotics were administered post-cord clamping, adjusted for temporal changes in the incidence rates in children born vaginally. RESULTS Prophylactic antibiotics administered before incision for caesarean section compared with after cord clamping were not associated with a significantly higher risk of asthma (incidence rate ratio 0.91, 95% confidence interval 0.78 to 1.05) or eczema (0.98, 0.94 to 1.03), including asthma and eczema resulting in hospital admission (1.05, 0.99 to 1.11 and 0.96, 0.71 to 1.29, respectively), up to age 5 years. CONCLUSIONS This study found no evidence of an association between pre-incision prophylactic antibiotic use and risk of asthma and eczema in early childhood in children born by caesarean section.

Aim To examine public perspectives on lateral flow testing (LFT) for COVID-19. Design Online survey with nested semi-structured interviews. Setting Birmingham, UK. Participants 220 Birmingham residents, 21 of whom took part in an interview. Results Fifty-six per cent of respondents had taken an LFT. Reasons for not testing included adherence to other government COVID-19 guidance, having had a vaccination and not thinking LFTs were accurate. In 16% of households with children nobody, including children, was testing. In households where children were testing, their parents or other adults were often not. Those who were testing and eligible for workplace and school testing were more likely to be testing twice weekly. In other settings, respondents were more likely to be testing on a one-off or ad hoc basis. Approximately half of respondents said that they were likely to visit friends and family after a negative test result and 10% that they were unlikely to self-isolate following a positive test result. In interviews, participants who were testing described the peace of mind that testing afforded them prior to activities or interactions with family and friends, including those they considered to be vulnerable. Interviewees who were not testing described concerns about test accuracy and also cited a lack of face-to-face interaction with others precluding the need to test. Participants were often testing flexibly according to circumstances and perceived risk of COVID-19 transmission. Conclusions While some choose not to test, others are doing so in order to provide peace of mind to engage in personal interactions they might otherwise have avoided. This peace of mind may be a necessary pre-requisite for some to more fully re-engage in pre-pandemic activities. Despite clear concerns about test accuracy among those not testing, those who are testing held generally positive attitudes towards the continued use of LFTs.