Spatial Clusters of Diabetes and Physical Inactivity: Do Neighborhood Characteristics in High and Low Clusters Differ?

Built and natural environment correlates of physical activity of adults living in rural areas: a systematic review

BACKGROUND

According to social-ecological models, the built and natural environment has the potential to facilitate or hinder physical activity (PA). While this potential is well researched in urban areas, a current systematic review of how the built and natural environment is related to PA in rural areas is lacking.

METHODS

We searched five databases and included studies for adults (18-65 years) living in rural areas. We included quantitative studies investigating the association between any self-reported or objectively measured characteristic of the built or natural environment and any type of self-reported or objectively measured PA, and qualitative studies that reported on features of the built or natural environment perceived as barriers to or facilitators of PA by the participants. Screening for eligibility and quality assessment (using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields) were done in duplicate. We used a narrative approach to synthesize the results.

RESULTS

Of 2432 non-duplicate records, 51 quantitative and 19 qualitative studies were included. Convincing positive relationships were found between the availability and accessibility of places for exercise and recreation and leisure-time PA as well as between the overall environment and leisure-time PA. Possible positive associations were found between the overall environment and total and transport-related PA, between greenness/natural environment and total PA, between cycling infrastructure and aesthetics and MVPA, and between pedestrian infrastructure and total walking. A possible negative relationship was found between safety and security and total walking. Qualitative studies complemented several environmental facilitators (facilities for exercise and recreation, sidewalks or streets with low traffic, attractive natural environment) and barriers (lack of facilities and destinations, lack of sidewalks, speeding traffic and high traffic volumes, lack of street lighting).

CONCLUSIONS

Research investigating the relationship between the built and natural environment and PA behaviors of adults living in rural areas is still limited and there is a need for more high-quality and longitudinal studies. However, our most positive findings indicate that investing in places for exercise and recreation, a safe infrastructure for active transport, and nature-based activities are possible strategies that should be considered to address low levels of PA in rural adults.

TRIAL REGISTRATION

PROSPERO: CRD42021283508.

Spatial clusters of diabetes: individual and neighborhood characteristics in the ELSA-Brasil cohort study

This study identified spatial clusters of type 2 diabetes mellitus among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two cities and verified individual and neighborhood socioeconomic environmental characteristics associated with the spatial clusters. A cross-sectional study was conducted with 4,335 participants. Type 2 diabetes mellitus was defined as fasting blood glucose ≥ 126mg/dL (7.0mmol/L), oral glucose tolerance test ≥ 200mg/dL (11.1mmol/L), or glycated hemoglobin ≥ 6.5% (48mmol/L); by antidiabetic drug use; or by the self-reported medical diagnosis of type 2 diabetes mellitus. Neighborhood socioeconomic characteristics were obtained from the 2011 Brazilian census. A spatial data analysis was conducted with the SaTScan method to detect spatial clusters. Logistic regression models were fitted to estimate the magnitude of associations. In total, 336 and 343 participants had type 2 diabetes mellitus in Belo Horizonte, Minas Gerais State (13.5%) and Salvador, Bahia State (18.5%), respectively. Two cluster areas showing a high chance of type 2 diabetes mellitus were identified in Belo Horizonte and Salvador. In both cities, participants living in the high type 2 diabetes mellitus cluster area were more likely to be mixed-race or black and have a low schooling level and manual work; these were also considered low-income areas. On the other hand, participants in the low type 2 diabetes mellitus cluster area of Salvador were less likely to be black and have low schooling level (university degree) and live in a low-income area. More vulnerable individual and neighborhood socioeconomic characteristics were associated with living in clusters of higher type 2 diabetes mellitus occurrence , whereas better contextual profiles were associated with clusters of lower prevalence.

Associations of the built environment with type 2 diabetes in Asia: a systematic review

OBJECTIVES

Our study aimed to systematically review the literature and synthesise findings on potential associations of built environment characteristics with type 2 diabetes (T2D) in Asia.

DESIGN

Systematic review of the literature.

DATA SOURCES

Online databases Medline, Embase and Global Health were used to identify peer-reviewed journal articles published from inception to 23 January 2023.

ELIGIBILITY CRITERIA

Eligible studies included cohort, cross-sectional and case-control studies that explored associations of built environment characteristics with T2D among adults 18 years and older in Asia.

DATA EXTRACTION AND SYNTHESIS

Covidence online was used to remove duplicates and perform title, abstract and full-text screening. Data extraction was carried out by two independent reviewers using the OVID database and data were imported into MS Excel. Out of 5208 identified studies, 28 studies were included in this systematic review. Due to heterogeneity in study design, built environment and outcome definitions, a semiqualitative analysis was conducted, which synthesised results using weighted z-scores.

RESULTS

Five broad categories of built environment characteristics were associated with T2D in Asia. These included urban green space, walkability, food environment, availability and accessibility of services such as recreational and healthcare facilities and air pollution. We found very strong evidence of a positive association of particulate matter (PM_2.5, PM₁₀), nitrogen dioxide and sulfur dioxide (p<0.001) with T2D risk.

CONCLUSION

Several built environment attributes were significantly related to T2D in Asia. When compared with Western countries, very few studies have been conducted in Asia. Further research is, therefore, warranted to establish the importance of the built environment on T2D. Such evidence is essential for public health and planning policies to (re)design neighbourhoods and help improve public health across Asian countries.

PROSPERO REGISTRATION NUMBER

CRD42020214852.

Digital health: trends, opportunities and challenges in medical devices, pharma and bio-technology

Digital health interventions refer to the use of digital technology and connected devices to improve health outcomes and healthcare delivery. This includes telemedicine, electronic health records, wearable devices, mobile health applications, and other forms of digital health technology. To this end, several research and developmental activities in various fields are gaining momentum. For instance, in the medical devices sector, several smart biomedical materials and medical devices that are digitally enabled are rapidly being developed and introduced into clinical settings. In the pharma and allied sectors, digital health-focused technologies are widely being used through various stages of drug development, viz. computer-aided drug design, computational modeling for predictive toxicology, and big data analytics for clinical trial management. In the biotechnology and bioengineering fields, investigations are rapidly growing focus on digital health, such as omics biology, synthetic biology, systems biology, big data and personalized medicine. Though digital health-focused innovations are expanding the horizons of health in diverse ways, here the development in the fields of medical devices, pharmaceutical technologies and biotech sectors, with emphasis on trends, opportunities and challenges are reviewed. A perspective on the use of digital health in the Indian context is also included.

Geographic clusters of objectively measured physical activity and the characteristics of their built environment in a Swiss urban area

Introduction

Evidence suggests that the built environment can influence the intensity of physical activity. However, despite the importance of the geographic context, most of the studies do not consider the spatial framework of this association. We aimed to assess individual spatial dependence of objectively measured moderate and vigorous physical activity (MVPA) and describe the characteristics of the built environment among spatial clusters of MVPA.

Methods

Cross-sectional data from the second follow-up (2014–2017) of CoLaus|PsyCoLaus, a longitudinal population-based study of the Lausanne area (Switzerland), was used to objectively measure MVPA using accelerometers. Local Moran’s I was used to assess the spatial dependence of MVPA and detect geographic clusters of low and high MVPA. Additionally, the characteristics of the built environment observed in the clusters based on raw MVPA and MVPA adjusted for socioeconomic and demographic factors were compared.

Results

Data from 1,889 participants (median age 63, 55% women) were used. The geographic distribution of MVPA and the characteristics of the built environment among clusters were similar for raw and adjusted MVPA. In the adjusted model, we found a low concentration of individuals within spatial clusters of high MVPA (median: 38.5mins; 3% of the studied population) and low MVPA (median: 10.9 mins; 2% of the studied population). Yet, clear differences were found in both models between clusters regarding the built environment; high MVPA clusters were located in areas where specific compositions of the built environment favor physical activity.

Conclusions

Our results suggest the built environment may influence local spatial patterns of MVPA independently of socioeconomic and demographic factors. Interventions in the built environment should be considered to promote physically active behaviors in urban areas.