Valuing the health benefits of nature-based recreational physical activity in England

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, 22million 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.

The use of Enhanced Vegetation Index for assessing access to different types of green space in epidemiological studies

BACKGROUND

Exposure to green space can protect against poor health through a variety of mechanisms. However, there is heterogeneity in methodological approaches to exposure assessments which makes creating effective policy recommendations challenging.

OBJECTIVE

Critically evaluate the use of a satellite-derived exposure metric, the Enhanced Vegetation Index (EVI), for assessing access to different types of green space in epidemiological studies.

METHODS

We used Landsat 5-8 (30 m resolution) to calculate average EVI for a 300 m radius surrounding 1.4 million households in Wales, UK for 2018. We calculated two additional measures using topographic vector data to represent access to green spaces within 300 m of household locations. The two topographic vector-based measures were total green space area stratified by type and average private garden size. We used linear regression models to test whether EVI could discriminate between publicly accessible and private green space and Pearson correlation to test associations between EVI and green space types.

RESULTS

Mean EVI for a 300 m radius surrounding households in Wales was 0.28 (IQR = 0.12). Total green space area and average private garden size were significantly positively associated with corresponding EVI measures (β = < 0.0001, 95% CI: 0.0000, 0.0000; β = 0.0001, 95% CI: 0.0001, 0.0001 respectively). In urban areas, as average garden size increases by 1 m2, EVI increases by 0.0002. Therefore, in urban areas, to see a 0.1 unit increase in EVI index score, garden size would need to increase by 500 m2. The very small β values represent no 'measurable real-world' associations. When stratified by type, we observed no strong associations between greenspace and EVI.

IMPACT

It is a widely implemented assumption in epidiological studies that an increase in EVI is equivalent to an increase in greenness and/or green space. We used linear regression models to test associations between EVI and potential sources of green reflectance at a neighbourhood level using satellite imagery from 2018. We compared EVI measures with a 'gold standard' vector-based dataset that defines publicly accessible and private green spaces. We found that EVI should be interpreted with care as a greater EVI score does not necessarily mean greater access to publicly available green spaces in the hyperlocal environment.

Nature-based biopsychosocial resilience: An integrative theoretical framework for research on nature and health

Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose 'nature-based biopsychosocial resilience theory' (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person's set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.

Green-blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey data

Background

Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited.

Objectives

To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use.

Design

A retrospective, dynamic longitudinal panel study.

Setting

Wales, UK.

Participants

An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008-2019). A 5312-strong 'National Survey for Wales (NSW) subgroup' was surveyed on well-being and visits to green and blue spaces.

Main outcome measures

Common mental health disorders, general practice records; subjective well-being, Warwick-Edinburgh Mental Well-being Scale.

Data sources

Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank.

Methods

Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders.

Results and conclusions

Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick-Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) -10.15, 95% CI -17.13 to -3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick-Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta -0.06, 95% CI -0.11 to -0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick-Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation -0.18, 95% CI -0.33 to -0.04) although well-being remained generally lower.

Limitations

Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets.

Future work

Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast.

Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales

BACKGROUND

Living in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities.

METHODS

A cohort of the people in Wales, UK (≥16 years; n=2 341 591) was constructed from electronic health record data sources from Jan 1, 2008 to Oct 31, 2019, comprising 19 141 896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index [EVI]), access to GBS (counts, distance to nearest), and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression [treated or untreated in the preceding 1-year period], or treatment of historical diagnoses from before the current cohort [up to 8 years previously, to 2000], where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out of Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation.

FINDINGS

After adjustment, exposure to greater ambient greenness over time (+0·1 increased EVI on a 0-1 scale) was associated with lower odds of subsequent CMD (adjusted odds ratio 0·80, 95% CI 0·80-0·81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding 1-year period), or treatments. Ten percentile points more access to GBS was associated with lower odds of a later CMD (0·93, 0·93-0·93). Every additional 360 m to the nearest GBS was associated with higher odds of CMD (1·05, 1·04-1·05). We found that positive effects of GBS on mental health appeared to be greater in more deprived quintiles.

INTERPRETATION

Ambient exposure is associated with the greatest reduced risk of CMD, particularly for those who live in deprived communities. These findings support authorities responsible for GBS, who are attempting to engage planners and policy makers, to ensure GBS meets residents' needs.

FUNDING

National Institute for Health and Care Research Public Health Research programme.

What is known about what works in community-involved decision-making relating to urban green and blue spaces? A realist review protocol

BACKGROUND

There is now a relatively well-established evidence base suggesting that greener living environments and time spent in urban green and blue spaces (UGBS) can be beneficial for human health and wellbeing. However, benefits are not universal and there remain widespread social inequalities in access to such resources and experiences, particularly along axes of class, race, ethnicity, age and disability, and in relation to efforts to increase the availability and accessibility of such spaces. These injustices often relate to distributive, procedural and recognition-based processes. There is growing interest in how to ensure that efforts to increase access to or use of UGBS (whether through infrastructural or social programmes) result in equitable outcomes whilst minimising potential for exacerbating existing inequalities and injustices. Community engagement is considered an important step towards more inclusive UGBS decision-making, from planning and design to management and maintenance processes. It is thought to contribute to better and more widely trusted decisions, enhanced democracy, community satisfaction, civic interest and feelings of green space ownership, and greater longevity of UGBS projects. However, uneven representation and barriers to participation can create imbalances and undermine these benefits.

METHODS

An iterative, multi-stage realist-inspired review will be conducted to ask what works, in what context and in what ways relating to the meaningful involvement of communities in UGBS decision-making, focusing on the skills, capacities and capabilities of different stakeholders and the role of contexts and processes. 'Effectiveness' (or what works) will be understood as a multifaceted outcome, encompassing both the processes and results of community engagement efforts. Following a scoping stage to identify initial programme theory, inclusion/exclusion criteria and derive search terms, relevant databases and grey literature will be searched to identify interdisciplinary literature in two phases. The first phase will be used to further develop programme theories, which will be articulated as 'if then' statements. The second phase searches will be used to identify sources to further explore and evidence the programme and formal theory. We will assess all includable evidence for conceptual richness, prioritising more conceptually rich sources if needed.

DISCUSSION

The realist synthesis will explore the key context, mechanism and outcome configurations that appear to explain if and how different approaches to community-involved UGBS decision-making are or are not effective. We will consider factors such as different conceptualisations of community, and if and how they have been involved in UGBS decision-making; the types of tools and approaches used; and the socio-cultural and political or governance structures within which decision-making takes place.

Jamestown Canyon virus (Bunyavirales: Peribunyaviridae) vector ecology in a focus of human transmission in New Hampshire, USA

Jamestown Canyon virus disease (JCVD) is a potentially neuroinvasive condition caused by the arbovirus Jamestown Canyon virus (JCV). Human cases of JCVD have increased in New Hampshire (NH) over the past decade, but vector surveillance is limited by funding and person power. We conducted mosquito surveillance with a focus on human JCVD cases south central NH during 2021. Routine surveillance with CDC miniature traps baited with CO2 (lights removed) was supplemented by a paired trapping design to test the collection efficiency of octenol, and New Jersey light traps. We performed virus testing, blood meal analysis, and compared morphological identification with DNA barcoding. Over 50,000 mosquitoes were collected representing 28 species. Twelve JCV-positive pools were derived from 6 species of more than 1,600 pools tested. Of those, Aedes excrucians/stimulans (MLE 4.95, Diptera: Culicidae, Walker, 1856, 1848), and Aedes sticticus (MLE 2.02, Meigen, 1838) had the highest JCV infection rates, and Aedes canadensis (MLE 0.13, Theobold, 1901) and Coquillettidia perturbans (0.10, Diptera: Culicidae, Walker, 1856) had the lowest infection rates. One hundred and fifty-one blood meals were matched to a vertebrate host. All putative vectors fed on the amplifying host of JCV, white-tailed deer (36-100% of bloodmeals). Putative vectors that fed on human hosts included Aedes excrucians (8%), Anopheles punctipennis (25%, Diptera: Culicidae, Say, 1823), and Coquillettidia perturbans (51%). CDC traps baited with CO2 were effective for collecting putative vectors. DNA barcoding enhanced morphological identifications of damaged specimens. We present the first ecological overview of JCV vectors in NH.

Visiting nature is associated with lower socioeconomic inequalities in well-being in Wales

Natural environments can promote well-being through multiple mechanisms. Many studies have investigated relationships between residential green/blue space (GBS) and well-being, fewer explore relationships with actual use of GBS. We used a nationally representative survey, the National Survey for Wales, anonymously linked with spatial GBS data to investigate associations of well-being with both residential GBS and time in nature (N = 7631). Both residential GBS and time spent in nature were associated with subjective well-being. Higher green-ness was associated with lower well-being, counter to hypotheses (predicting the Warwick and Edinburgh Mental Well-Being Scale (WEMWBS): Enhanced vegetation index β =  - 1.84, 95% confidence interval (CI) - 3.63, - 0.05) but time spent in nature was associated with higher well-being (four hours a week in nature vs. none β = 3.57, 95% CI 3.02, 4.13). There was no clear association between nearest GBS proximity and well-being. In support of the equigenesis theory, time spent in nature was associated with smaller socioeconomic inequalities in well-being. The difference in WEMWBS (possible range 14-70) between those who did and did not live in material deprivation was 7.7 points for those spending no time in nature, and less at 4.5 points for those spending time in nature up to 1 h per week. Facilitating access and making it easier for people to spend time in nature may be one way to reduce socioeconomic inequalities in well-being.

GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health - a new initiative

Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes , with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application.

A Tailored Approach: A model for literature searching in complex systematic reviews

Our previous work identified that nine leading guidance documents for seven different types of systematic review advocated the same process of literature searching. We defined and illustrated this process and we named it ‘the Conventional Approach’. The Conventional Approach appears to meet the needs of researchers undertaking literature searches for systematic reviews of clinical interventions. In this article, we report a new and alternate process model of literature searching called ‘A Tailored Approach’. A Tailored Approach is indicated as a search process for complex reviews which do not focus on the evaluation of clinical interventions. The aims of this article are to (1) explain the rationale for, and the theories behind, the design of A Tailored Approach; (2) report the current conceptual illustration of A Tailored Approach and to describe a user’s interaction with the process model; and (3) situate the elements novel to A Tailored Approach (when compared with the Conventional Approach) in the relevant literature. A Tailored Approach suggests investing time at the start of a review, to develop the information needs from the research objectives, and to tailor the search approach to studies or data. Tailored Approaches should be led by the information specialist (librarian) but developed by the research team. The aim is not necessarily to focus on comprehensive retrieval. Further research is indicated to evaluate the use of supplementary search methods, methods of team-working to define search approaches, and to evaluate the use of conceptual models of information retrieval for testing and evaluation.

Green-Blue Spaces and Mental Health: A Longitudinal Data Linkage Study

IntroductionA growing evidence base indicates health benefits are associated with access to green-blue spaces (GBS), such as beaches and parks. However, few studies have examined associations with changes in access to GBS over time. Objectives and ApproachWe have linked cross-sector data collected within Wales, United Kingdom, quarterly from 2008 to 2019, to examine the impact of GBS access on individual-level well-being and common mental health disorders (CMD). We created a longitudinal dataset of GBS access metrics, derived from satellite and administrative data sources, for 1.4 million homes in Wales. These household-level metrics were linked to individuals using the Welsh Demographic Service Dataset within the Secure Anonymised Information Linkage (SAIL) Databank. Linkage to Welsh Longitudinal General Practice data within SAIL enabled us to identify individual-level CMD over time. We also linked individual-level self-reported GBS use and well-being data from the National Survey for Wales (NSW) to routine data for cross-sectional survey participants. ResultsWe created a longitudinal cohort panel capturing all 2.84 million adults aged 16+ living in Wales between 2008 and 2019 and with a general practitioner (GP) registration. Individual-level health data and household-level environmental metrics were linked for each quarter an individual is in the study. Household addresses were linked to 97% of the cohort, creating 110+ million rows of anonymously linked cross-sector data. The cohort provides an average follow-up period of 8 years, during which 565,168 (20%) adults received at least one CMD diagnosis or symptom. Conclusion / ImplicationsThis example of multi-sectoral data linkage across multiple environmental and administrative data sources has created a rich data source, which we will use toquantify the impact of changes in GBS access on individual–level CMD and well-being. This evidence will inform policy in the areas of health, planning and the environment.

Is Wellbeing Associated with Time Spent in Nature?

IntroductionGreen and blue spaces (GBS), such as parks, woodlands, rivers, and beaches, are thought to be important for mental health and wellbeing. Our longitudinal cohort contains objective household-level environment data linked at the invidual level to routinely recorded mental health data, augmented with cross sectional self-reported health behaviours, including leisure visits to the outdoors. Objectives and ApproachOur overall approach will evaluate if residential proximity to GBS is associated with mental health and wellbeing, and if any associations aremodified by visits to outdoors spaces following individual-level data linkage. Here, we examined cross-sectional survey data on time spent visiting nature outdoors. Wellbeing outcomes were assessed using self-reported scores. Data were analysed using generalised additive models in the SAIL Databank. ResultsUsing a sample of National Survey for Wales respondents (2016/17, n=3,481), over 40% of adults in Wales reported spending less than 30 minutes outdoors each week. Weekly time outdoors was positively associated with wellbeing (p=0.007) and life satisfaction (p=0.03) having adjusted for potential confounders including, age, rurality, loneliness, employment status. Confidence intervals varied along the fitted GAM model. Models using a second wave of survey data (n≈7,000), anonymously record-linked to residential environment and health data will explore these associations further. ConclusionA previous study based in England (White et al. 2019) found an upper wellbeing benefit threshold of 2 hours per week for time spent in nature. This was not apparent in our preliminary models, but may be revealed in further analyses. We will next incorporate longitudinal mental health and environmental data for 2 million adults living in Wales, UK. Linking to ambient and accessible residential GBS, while taking into account changes due to migration and actual visits, will allow us to provide valuable guidance to local government, who are often responsible for provisioning and maintaining outdoor facilities.

What approaches to social prescribing work, for whom, and in what circumstances? A realist review

The use of non-medical referral, community referral or social prescribing interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of 'if-then' statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web-based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.

Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes

Engagement with nature is an important part of many people's lives, and the health and wellbeing benefits of nature-based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature-based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature-based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

Longitudinal access and exposure to green-blue spaces and individual-level mental health and well-being: protocol for a longitudinal, population-wide record-linked natural experiment

INTRODUCTION

Studies suggest that access and exposure to green-blue spaces (GBS) have beneficial impacts on mental health. However, the evidence base is limited with respect to longitudinal studies. The main aim of this longitudinal, population-wide, record-linked natural experiment, is to model the daily lived experience by linking GBS accessibility indices, residential GBS exposure and health data; to enable quantification of the impact of GBS on well-being and common mental health disorders, for a national population.

METHODS AND ANALYSIS

This research will estimate the impact of neighbourhood GBS access, GBS exposure and visits to GBS on the risk of common mental health conditions and the opportunity for promoting subjective well-being (SWB); both key priorities for public health. We will use a Geographic Information System (GIS) to create quarterly household GBS accessibility indices and GBS exposure using digital map and satellite data for 1.4 million homes in Wales, UK (2008-2018). We will link the GBS accessibility indices and GBS exposures to individual-level mental health outcomes for 1.7 million people with general practitioner (GP) data and data from the National Survey for Wales (n=~12 000) on well-being in the Secure Anonymised Information Linkage (SAIL) Databank. We will examine if these associations are modified by multiple sociophysical variables, migration and socioeconomic disadvantage. Subgroup analyses will examine associations by different types of GBS. This longitudinal study will be augmented by cross-sectional research using survey data on self-reported visits to GBS and SWB.

ETHICS AND DISSEMINATION

All data will be anonymised and linked within the privacy protecting SAIL Databank. We will be using anonymised data and therefore we are exempt from National Research Ethics Committee (NREC). An Information Governance Review Panel (IGRP) application (Project ID: 0562) to link these data has been approved.The research programme will be undertaken in close collaboration with public/patient involvement groups. A multistrategy programme of dissemination is planned with the academic community, policy-makers, practitioners and the public.

Association between blue and green space availability with mental health and wellbeing

IntroductionGreen-blue spaces (GBS), such as parks, woodlands, and beaches, may be beneficial for population mental health and wellbeing. However, there are few longitudinal studies on the association between GBS and mental health and wellbeing, and few that incorporate network analysis as opposed to simple Euclidian proximity. Objectives and ApproachWe are examining the association between the availability of GBS with wellbeing and common mental health disorders. We will use geographic information systems (GIS) to create quarterly household level GBS availability data using digital map and satellite data (2008-2018) for over 1 million homes in Wales, United Kingdom. We will link GBS availability to individual level mental health (1.7 million people with General Practitioner (GP) data) and data from the National Survey for Wales (n = 24,000) on wellbeing (Warwick Edinburgh Mental Wellbeing Scale (WEMWBS)) using the Secure Anonymised Information Linkage (SAIL) databank. ResultsWe created an historic dataset of GBS availability using road network and path data to create quarterly household level GBS exposures (2008-2018). We tested Residential Anonymised Linking Fields (RALFs) and accurately linked 97\% of individuals and their health data to their home and GBS exposure. The 1.65 million exposure-health data pairs, updated quarterly, will enable a longitudinal panel study to be built. Using GP recorded data on treatments, diagnoses, symptoms and prescriptions for mental health problems we identified 35,000 people had a common mental health disorder in 2016, and 24,000 people answered the National Survey for Wales questions about their wellbeing and use of GBS. We will explore how house moves, and visits to GBS change the association between GBS availability and outcomes. Conclusion/ImplicationsThis study fills the gap in the evidence base around environmental planning policy to shape living environments to benefit health. It will inform the planning and management of GBS in urban and rural environments and contribute to international work on impacts of the built environment on mental health and wellbeing.

When does the influence of maturation on anthropometric and physical fitness characteristics increase and subside?

The relationships between maturation and anthropometric and physical performance characteristics are dynamic and often asynchronous; confounding the capability to accurately evaluate performance during adolescence. This study aimed to (i) examine the influence of chronological age (CA) and somatic maturation (YPHV) upon anthropometric and physical performance parameters, and (ii) identify the transition/change time points in these relationships using segmental regression. N = 969 soccer players (8-18 years of age) completed anthropometric and physical test assessments, including a countermovement jump (CMJ), agility T test, 10 and 20 m sprints, and multistage fitness test (MSFT). When modeled against CA and YPHV, results identified time point phases with increased rates of stature (CA-7.5, YPHV-8.6 cm/y at 10.7-15.2 years or -3.2 to +0.8 YPHV) and body mass gain (CA-7.1, YPHV-7.5 kg/y at 11.9-16.1 years or -1.6 to +4.0 YPHV), followed by gain reductions. Increased rates of sprint performance development (31%-43% gains) occurred at 11.8-15.8 CA or -1.8 to +1.2 YPHV, with gains subsiding thereafter. CMJ, T test, and MSFT gains appeared relatively linear with no change in developmental rate apparent. Developmental tempos did again, however, subside at circa (CMJ and T test) to post-PHV (MSFT). Based on our sample and analysis, periods of increased developmental rates (stature, mass, sprint) were apparent alongside progressive gains for other physical measures, before all subsided at particular age and maturation time points. Findings highlight dynamic asynchronous development of players, physical attributes, and the need to account for the influence of maturation on athletic performance until post-PHV.

What approaches to social prescribing work, for whom, and in what circumstances? A protocol for a realist review

BACKGROUND

The use of non-drug, non-health-service interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve their health and well-being. Interventions typically involve accessing activities run by the third sector or community agencies and may also be described as non-medical referral, community referral or social prescribing. To be effective, patients need to be "transferred" from the primary care setting into the community and to maintain their participation in activities. However, it is not currently known how and why these approaches enable which people under what circumstances to reach community services that may benefit their health and well-being.

METHODS

Database searches and extensive searching of grey sources will be carried out in an attempt to find evidence associated with referral and retention in social prescribing. After initial scoping searches, two main phases of searching will be conducted: (a) will focus on the identification of programme theories to illustrate how approaches to social prescribing work for different people and in different contexts and (b) will consist of targeted searches to locate evidence to refine these candidate theories into configurations of the contexts in which populations and the main mechanisms outcomes are achieved. Inclusion criteria will initially be broad in order to develop a clear picture of the ways in which social prescriptions might operate but may iteratively become more focused in response to initially identified evidence, for example, in terms of the population group. An expert advisory group consisting of professionals working in a range of organisations involved in social prescribing will be convened to check the approaches in the review and provide real-life experience of social prescribing. Findings from the review will be disseminated to commissioners, published in a peer-reviewed journal and used to help refine an intervention model for an outdoor nature-based group intervention.

DISCUSSION

This realist review will explore why mechanisms of social prescribing work, for what groups of people and their impact on enrolment, attendance and adherence to programmes. The use of realist approaches to detail the social prescribing process is novel and will offer insights into effective transfer of patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016039491.

Participation in environmental enhancement and conservation activities for health and well-being in adults: a review of quantitative and qualitative evidence

BACKGROUND

There is growing research and policy interest in the potential for using the natural environment to enhance human health and well-being. This resource may be underused as a health promotion tool to address the increasing burden of common health problems such as increased chronic diseases and mental health concerns. Outdoor environmental enhancement and conservation activities (EECA) (for instance unpaid litter picking, tree planting or path maintenance) offer opportunities for physical activity alongside greater connectedness with local environments, enhanced social connections within communities and improved self-esteem through activities that improve the locality which may, in turn, further improve well-being.

OBJECTIVES

To assess the health and well-being impacts on adults following participation in environmental enhancement and conservation activities.

SEARCH METHODS

We contacted or searched the websites of more than 250 EECA organisations to identify grey literature. Resource limitations meant the majority of the websites were from UK, USA, Canada and Australia. We searched the following databases (initially in October 2012, updated October 2014, except CAB Direct, OpenGrey, SPORTDiscus, and TRIP Database), using a search strategy developed with our project advisory groups (predominantly leaders of EECA-type activities and methodological experts): ASSIA; BIOSIS; British Education Index; British Nursing Index; CAB Abstracts; Campbell Collaboration; Cochrane Public Health Specialized Register; DOPHER; EMBASE; ERIC; Global Health; GreenFILE; HMIC; MEDLINE-in-Process; MEDLINE; OpenGrey; PsychINFO; Social Policy and Practice; SPORTDiscus; TRoPHI; Social Services Abstracts; Sociological Abstracts; The Cochrane Library; TRIP database; and Web of Science. Citation and related article chasing was used. Searches were limited to studies in English published after 1990.

SELECTION CRITERIA

Two review authors independently screened studies. Included studies examined the impact of EECA on adult health and well-being. Eligible interventions needed to include each of the following: intended to improve the outdoor natural or built environment at either a local or wider level; took place in urban or rural locations in any country; involved active participation; and were NOT experienced through paid employment.We included quantitative and qualitative research. Includable quantitative study designs were: randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, cluster quasi-RCTs, controlled before-and-after studies, interrupted-time-series, cohort studies (prospective or retrospective), case-control studies and uncontrolled before-and-after studies (uBA). We included qualitative research if it used recognised qualitative methods of data collection and analysis.

DATA COLLECTION AND ANALYSIS

One reviewer extracted data, and another reviewer checked the data. Two review authors independently appraised study quality using the Effective Public Health Practice Project tool (for quantitative studies) or Wallace criteria (for qualitative studies). Heterogeneity of outcome measures and poor reporting of intervention specifics prevented meta-analysis so we synthesised the results narratively. We synthesised qualitative research findings using thematic analysis.

MAIN RESULTS

Database searches identified 21,420 records, with 21,304 excluded at title/abstract. Grey literature searches identified 211 records. We screened 327 full-text articles from which we included 21 studies (reported in 28 publications): two case-studies (which were not included in the synthesis due to inadequate robustness), one case-control, one retrospective cohort, five uBA, three mixed-method (uBA, qualitative), and nine qualitative studies. The 19 studies included in the synthesis detailed the impacts to a total of 3,603 participants: 647 from quantitative intervention studies and 2630 from a retrospective cohort study; and 326 from qualitative studies (one not reporting sample size).Included studies shared the key elements of EECA defined above, but the range of activities varied considerably. Quantitative evaluation methods were heterogeneous. The designs or reporting of quantitative studies, or both, were rated as 'weak' quality with high risk of bias due to one or more of the following: inadequate study design, intervention detail, participant selection, outcome reporting and blinding.Participants' characteristics were poorly reported; eight studies did not report gender or age and none reported socio-economic status. Three quantitative studies reported that participants were referred through health or social services, or due to mental ill health (five quantitative studies), however participants' engagement routes were often not clear.Whilst the majority of quantitative studies (n = 8) reported no effect on one or more outcomes, positive effects were reported in six quantitative studies relating to short-term physiological, mental/emotional health, and quality-of-life outcomes. Negative effects were reported in two quantitative studies; one study reported higher levels of anxiety amongst participants, another reported increased mental health stress.The design or reporting, or both, of the qualitative studies was rated as good in three studies or poor in nine; mainly due to missing detail about participants, methods and interventions. Included qualitative evidence provided rich data about the experience of participation. Thematic analysis identified eight themes supported by at least one good quality study, regarding participants' positive experiences and related to personal/social identity, physical activity, developing knowledge, spirituality, benefits of place, personal achievement, psychological benefits and social contact. There was one report of negative experiences.

AUTHORS' CONCLUSIONS

There is little quantitative evidence of positive or negative health and well-being benefits from participating in EECA. However, the qualitative research showed high levels of perceived benefit among participants. Quantitative evidence resulted from study designs with high risk of bias, qualitative evidence lacked reporting detail. The majority of included studies were programme evaluations, conducted internally or funded by the provider.The conceptual framework illustrates the range of interlinked mechanisms through which people believe they potentially achieve health and well-being benefits, such as opportunities for social contact. It also considers potential moderators and mediators of effect.One main finding of the review is the inherent difficulty associated with generating robust evidence of effectiveness for complex interventions. We developed the conceptual framework to illustrate how people believed they benefited. Investigating such mechanisms in a subsequent theory-led review might be one way of examining evidence of effect for these activities.The conceptual framework needs further refinement through linked reviews and more reliable evidence. Future research should use more robust study designs and report key intervention and participant detail.

A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence

BACKGROUND

School gardening programmes are increasingly popular, with suggested benefits including healthier eating and increased physical activity. Our objectives were to understand the health and well-being impacts of school gardens and the factors that help or hinder their success.

METHODS

We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42014007181). We searched multiple databases and used a range of supplementary approaches. Studies about school gardens were included if they reported on physical or mental health or well-being. Quantitative studies had to include a comparison group. Studies were quality appraised using appropriate tools. Findings were narratively synthesised and the qualitative evidence used to produce a conceptual framework to illustrate how benefits might be accrued.

RESULTS

Evidence from 40 articles (21 quantitative studies; 16 qualitative studies; 3 mixed methods studies) was included. Generally the quantitative research was poor. Evidence for changes in fruit and vegetable intake was limited and based on self-report. The qualitative research was better quality and ascribed a range of health and well-being impacts to school gardens, with some idealistic expectations for their impact in the long term. Groups of pupils who do not excel in classroom activities were thought to particularly benefit. Lack of funding and over reliance on volunteers were thought to threaten success, while involvement with local communities and integration of gardening activities into the school curriculum were thought to support success.

CONCLUSION

More robust quantitative research is needed to convincingly support the qualitative evidence suggesting wide ranging benefits from school gardens.

Height, body mass index, and socioeconomic status: mendelian randomisation study in UK Biobank

OBJECTIVE

To determine whether height and body mass index (BMI) have a causal role in five measures of socioeconomic status.

DESIGN

Mendelian randomisation study to test for causal effects of differences in stature and BMI on five measures of socioeconomic status. Mendelian randomisation exploits the fact that genotypes are randomly assigned at conception and thus not confounded by non-genetic factors.

SETTING

UK Biobank.

PARTICIPANTS

119,669 men and women of British ancestry, aged between 37 and 73 years.

MAIN OUTCOME MEASURES

Age completed full time education, degree level education, job class, annual household income, and Townsend deprivation index.

RESULTS

In the UK Biobank study, shorter stature and higher BMI were observationally associated with several measures of lower socioeconomic status. The associations between shorter stature and lower socioeconomic status tended to be stronger in men, and the associations between higher BMI and lower socioeconomic status tended to be stronger in women. For example, a 1 standard deviation (SD) higher BMI was associated with a £210 (€276; $300; 95% confidence interval £84 to £420; P=6 × 10(-3)) lower annual household income in men and a £1890 (£1680 to £2100; P=6 × 10(-15)) lower annual household income in women. Genetic analysis provided evidence that these associations were partly causal. A genetically determined 1 SD (6.3 cm) taller stature caused a 0.06 (0.02 to 0.09) year older age of completing full time education (P=0.01), a 1.12 (1.07 to 1.18) times higher odds of working in a skilled profession (P=6 × 10(-7)), and a £1130 (£680 to £1580) higher annual household income (P=4 × 10(-8)). Associations were stronger in men. A genetically determined 1 SD higher BMI (4.6 kg/m(2)) caused a £2940 (£1680 to £4200; P=1 × 10(-5)) lower annual household income and a 0.10 (0.04 to 0.16) SD (P=0.001) higher level of deprivation in women only.

CONCLUSIONS

These data support evidence that height and BMI play an important partial role in determining several aspects of a person's socioeconomic status, especially women's BMI for income and deprivation and men's height for education, income, and job class. These findings have important social and health implications, supporting evidence that overweight people, especially women, are at a disadvantage and that taller people, especially men, are at an advantage.

Understanding how environmental enhancement and conservation activities may benefit health and wellbeing: a systematic review

BACKGROUND

Action taken to enhance or conserve outdoor environments may benefit health and wellbeing through the process of participation but also through improving the environment. There is interest, amongst both health and environmental organisations, in using such activities as health promotion interventions. The objective of this systematic review was to investigate the health and wellbeing impacts of participation in environmental enhancement and conservation activities and to understand how these activities may be beneficial, to whom and in what circumstances or contexts.

METHODS

A theory-led mixed-method systematic review was used to assess evidence of effect and to identify pathways to change (protocol: http://onlinelibrary.wiley.com/doi/ 10.1002/14651858.CD010351/full ). Due to the multi-disciplinary, dispersed and disparate body of evidence an extensive multi-stage search strategy was devised and undertaken. Twenty-seven databases and multiple sources of grey literature were searched and over 200 relevant organisations were contacted. The heterogenous evidence was synthesised using a narrative approach and a conceptual model was developed to illustrate the mechanisms of effect. Due to the limited nature of the evidence additional higher order evidence was sought to assess the plausibility of the proposed mechanisms of effect through which health and wellbeing may accrue.

RESULTS

The majority of the quantitative evidence (13 studies; all poor quality and lower-order study designs) was inconclusive, though a small number of positive and negative associations were observed. The qualitative evidence (13 studies; 10 poor quality, 3 good) indicated that the activities were perceived to have value to health and wellbeing through a number of key mechanisms; including exposure to natural environments, achievement, enjoyment and social contact. Additional high level evidence indicated that these pathways were plausible.

CONCLUSIONS

Despite interest in the use of environmental enhancement activities as a health intervention there is currently little direct evidence of effect, this is primarily due to a lack of robust study designs. Further rigorous research is needed to understand the potential of the activities to benefit health and environment.

Seeking everyday wellbeing: The coast as a therapeutic landscape

Recent research suggests coastal environments may promote human health and wellbeing. This article explores the diverse coastal experiences sought out by residents of two towns in south west England to promote and preserve their personal wellbeing in the context of their everyday lives. It draws on the findings of an in-depth interpretive study conducted from May to November 2013 that examined the relative contribution of varied green and blue space experiences to individual wellbeing through the life course. Personalised activity maps produced using accelerometer and Global Positioning System (GPS) data were used to guide in-depth geo-narrative interviews with a purposive sample of 33 participants. This was combined with a subset of nine case study go-along interviews in places deemed therapeutic by the participants themselves, offering deeper insight into the lived experiences and relationships playing out within such places. Situated in a novel adaptation of the therapeutic landscapes framework, this article explores how symbolic, achievement-oriented, immersive and social experiences contributed to participants' sense of wellbeing in their local coastal areas. Participants expressed particularly strong and often enduring connections to the local coastline, with different coastal stretches perceived to cater for varied therapeutic needs and interests, at multiple scales and intensities. The findings suggest the need for greater acknowledgement of people's emotional, deeply embodied and often shared connections to the coast within coastal management policy and practice, both nationally and internationally. Importantly, such efforts should recognise the fluid, dynamic nature of this land-sea boundary, and the valued therapeutic experiences linked to this fluidity.

Beyond greenspace: an ecological study of population general health and indicators of natural environment type and quality

Background

Many studies suggest that exposure to natural environments (‘greenspace’) enhances human health and wellbeing. Benefits potentially arise via several mechanisms including stress reduction, opportunity and motivation for physical activity, and reduced air pollution exposure. However, the evidence is mixed and sometimes inconclusive. One explanation may be that “greenspace” is typically treated as a homogenous environment type. However, recent research has revealed that different types and qualities of natural environments may influence health and wellbeing to different extents.

Methods

This ecological study explores this issue further using data on land cover type, bird species richness, water quality and protected or designated status to create small-area environmental indicators across Great Britain. Associations between these indicators and age/sex standardised prevalence of both good and bad health from the 2011 Census were assessed using linear regression models. Models were adjusted for indicators of socio-economic deprivation and rurality, and also investigated effect modification by these contextual characteristics.

Results

Positive associations were observed between good health prevalence and the density of the greenspace types, “broadleaf woodland”, “arable and horticulture”, “improved grassland”, “saltwater” and “coastal”, after adjusting for potential confounders. Inverse associations with bad health prevalence were observed for the same greenspace types, with the exception of “saltwater”. Land cover diversity and density of protected/designated areas were also associated with good and bad health in the predicted manner. Bird species richness (an indicator of local biodiversity) was only associated with good health prevalence. Surface water quality, an indicator of general local environmental condition, was associated with good and bad health prevalence contrary to the manner expected, with poorer water quality associated with better population health. Effect modification by income deprivation and urban/rural status was observed for several of the indicators.

Conclusions

The findings indicate that the type, quality and context of ‘greenspace’ should be considered in the assessment of relationships between greenspace and human health and wellbeing. Opportunities exist to further integrate approaches from ecosystem services and public health perspectives to maximise opportunities to inform policies for health and environmental improvement and protection.

Individualisation of time-motion analysis: a method comparison and case report series

This study compared the intensity distribution of time-motion analysis data, when speed zones were categorized by different methods. 12 U18 players undertook a routine battery of laboratory- and field-based assessments to determine their running speed corresponding to the respiratory compensation threshold (RCT), maximal aerobic speed (MAS), maximal oxygen consumption (vV˙O2max) and maximal sprint speed (MSS). Players match-demands were tracked using 5 Hz GPS units in 22 fixtures (50 eligible match observations). The percentage of total distance covered running at high-speed (%HSR), very-high speed (%VHSR) and sprinting were determined using the following speed thresholds: (1) arbitrary; (2) individualised (IND) using RCT, vV˙O2max and MSS; (3) individualised via MAS per se; (4) individualised via MSS per se; and (5) individualised using MAS and MSS as measures of locomotor capacities (LOCO). Using MSS in isolation resulted in 61% and 39% of player's % HSR and % VHSR, respectively, being incorrectly interpreted, when compared to the IND technique. Estimating the RCT from fractional values of MAS resulted in erroneous interpretations of % HSR in 50% of cases. The present results suggest that practitioners and researchers should avoid using singular fitness characteristics to individualise the intensity distribution of time-motion analysis data. A combination of players' anaerobic threshold, MAS, and MSS characteristics are recommended to individualise player-tracking data.

A systematic review of the health and well-being benefits of biodiverse environments

Recent ecosystem service models have placed biodiversity as a central factor in the processes that link the natural environment to health. While it is recognized that disturbed ecosystems might negatively affect human well-being, it is not clear whether biodiversity is related to or can promote "good" human health and well-being. The aim of this study was to systematically identify, summarize, and synthesize research that had examined whether biodiverse environments are health promoting. The objectives were twofold: (1) to map the interdisciplinary field of enquiry and (2) to assess whether current evidence enables us to characterize the relationship. Due to the heterogeneity of available evidence a narrative synthesis approach was used, which is textual rather than statistical. Extensive searches identified 17 papers that met the inclusion criteria: 15 quantitative and 2 qualitative. The evidence was varied in disciplinary origin, with authors approaching the question using different study designs and methods, and conceptualizations of biodiversity, health, and well-being. There is some evidence to suggest that biodiverse natural environments promote better health through exposure to pleasant environments or the encouragement of health-promoting behaviors. There was also evidence of inverse relationships, particularly at a larger scale (global analyses). However, overall the evidence is inconclusive and fails to identify a specific role for biodiversity in the promotion of better health. High-quality interdisciplinary research is needed to produce a more reliable evidence base. Of particular importance is identifying the specific ecosystem services, goods, and processes through which biodiversity may generate good health and well-being.

Post-transplant T cell chimerism predicts graft versus host disease but not disease relapse in patients undergoing an alemtuzumab based reduced intensity conditioned allogeneic transplant

In this multicentre retrospective study we have studied the impact of T cell chimerism on the outcome of 133 patients undergoing an alemtuzumab based reduced intensity conditioning allograft (RIC). The median age of the patients was 50 years (range 42-55 years). 77 patients were transplanted using an HLA identical sibling donor while 56 patients received a fully matched volunteer unrelated donor graft. 64 patients had a lymphoid malignancy and 69 were transplanted for a myeloid malignancy. 38 patients (29%) relapsed with no significant difference in risk of relapse between patients developing full donor and mixed donor chimerism in the T-cell compartment on D+90 and D+180 post transplant. Day 90 full donor T cell chimerism correlated with an increased incidence of acute GVHD according to NIH criteria (p=0.0004) and the subsequent development of chronic GVHD. Consistent with previous observations, our results confirmed a correlation between the establishment of T cell full donor chimerism and acute GVHD in T deplete RIC allografts. However our study failed to identify any correlation between T cell chimerism and relapse risk and challenge the use of pre-emptive donor lymphocyte infusions (DLI) in patients with mixed T cell chimerism transplanted using an alemtuzumab based RIC regimen.

Effects of different half-time strategies on second half soccer-specific speed, power and dynamic strength

This study compared the effects of whole body vibration (WBV) and a field-based re-warm-up during half-time (HT) on subsequent physical performance measures during a simulated soccer game. Ten semi-professional male soccer players performed 90-min fixed-intensity soccer simulations (SAFT(90)), using a multi-directional course. During the HT period players either remained seated (CON), or performed intermittent agility exercise (IAE), or WBV. At regular intervals during SAFT(90), vastus lateralis temperature (T(m)) was recorded, and players also performed maximal counter-movement jumps (CMJ), 10-m sprints, and knee flexion and extension contractions. At the start of the second half, sprint and CMJ performance and eccentric hamstring peak torque were significantly reduced compared with the end of the first half in CON (P≤0.05). There was no significant change in these parameters over the HT period in the WBV and IAE interventions (P>0.05). The decrease in T(m) over the HT period was significantly greater for CON and WBV compared with IAE (P≤0.01). A passive HT interval reduced sprint, jump and dynamic strength performance. Alternatively, IAE and WBV at HT attenuated these performance decrements, with limited performance differences between interventions.

The time-profile of the PBMC HSP70 response to in vitro heat shock appears temperature-dependent

Heat shock proteins (HSPs) are synthesised by cells subsequent to a stress exposure and are known to confer protection to the cell in response to a second challenge. HSP induction and decay are correlated to thermotolerance and may therefore be used as a biomarker of thermal history. The current study tested the temperature-dependent nature of the heat shock response and characterised its time profile of induction. Whole blood from 6 healthy males (Age: 26 +/- (SD) 2 yrs; Body mass 74.2 +/- 3.8 kgs; VO(2max): 49.1 +/- 4.0 ml.kg(-1).min(-1)) were isolated and exposed to in vitro heat shock (HS) at 37, 38, 39, 40, and 41 degrees C for a period of 90 min. After HS the temperature was returned to 37 degrees C and intracellular HSP70 was quantified from the leukocytes at 0, 2, 4, and 6 h after heat treatment. The concentration of HSP70 was not different between temperatures (P > 0.05), but the time-profile of HSP70 synthesis appeared temperature-dependent. At control (37 degrees C) and lower temperatures (38-39 degrees C) the mean HSP70 concentration increased up to 4 h post HS (P < 0.05) and then returned towards baseline values by 6 h post HS. With in vitro hyperthermic conditions (40-41 degrees C), the time-profile was characterised by a sharp rise in HSP70 levels immediately after treatment (P < 0.05 for 40 degrees C at 0 h), followed by a progressive decline over time. The results suggest a temperature-dependent time-profile of HSP70 synthesis. In addition, the temperature at which HSP70 is inducted might be lower than 37 degrees C.

Identification of non-B human immunodeficiency virus type 1 subtypes in rural Georgia

As part of an ongoing molecular epidemiological investigation of human immunodeficiency virus type 1 (HIV-1) in rural Georgia, the 5' half of reverse transcriptase (RT) genotypes from 30 patients was sequenced and phylogenetically analyzed. Two patients, GA132 and GA169, were infected with pol sequences of non-B subtype origin that were found to cluster phylogenetically with subtype A-E of Thai origin. Sliding window bootstrap analysis of GA169 showed clear evidence of A/B recombination within the pol gene segment, whereas in the other patient, GA132, no break point within RT could be identified. Interestingly, pairwise comparisons between these 2 patients' C2-V3 env region revealed a 13.5% divergence. However, similar comparisons within the non-B pol segments yielded a 1.23% nucleotide divergence, which suggests a complex phylogenetic and epidemiological history of the subtype A pol genotype in this region. These data demonstrate an increasing diversity of HIV-1 subtypes and the potential emergence of previously unidentified HIV-1 A-E/B recombinants in the rural United States.