Relationships between street characteristics and perceived attractiveness for walking reported by elderly people

Walking is important for the health of elderly people. Previous studies have found a relationship between neighbourhood characteristics, physical activity and related health aspects. The multivariate linear regression model presented here describes the relationships between the perceived attractiveness of streets for walking along and (physical) street characteristics. Two hundred and eighty-eight independently living elderly people (between 55 and 80 years old) participated in the study. Street characteristics were assessed along homogeneous street subsections defined as ‘links’. Positively related to perceived attractiveness of links were the following street characteristics: slopes and/or stairs, zebra crossings, trees along the route, front gardens, bus and tram stops, shops, business buildings, catering establishments, passing through parks or the city centre, and traffic volume. Litter on the street, high-rise buildings, and neighbourhood density of dwellings were negatively related to perceived link attractiveness. Overall, the results suggest that three main aspects affect perceived attractiveness of streets for walking, namely tidiness of the street, its scenic value and the presence of activity or other people along the street. The results are discussed within the context of these three aspects.     

Intermittent absent and reversed umbilical artery flows in appropriately grown monochorionic diamniotic twins in relation to proximate cord insertion: A harmful combination?

Objective

To compare the prevalence of intermittent absent or reversed end-diastolic flow (iAREDF) in the umbilical artery in appropriately grown monochorionic diamniotic (MCDA) pregnancies with and without proximate cord insertion (PCI), and to evaluate pregnancy outcome.

Methods

The prevalence of iAREDF in MCDA pregnancies with PCI (n = 11) was compared with a control group without PCI (n = 33). PCI was defined as a distance between the cord insertions below the fifth percentile. Placental sharing, number, and diameter of anastomoses were assessed by placental examination. Pregnancy outcome was evaluated.

Results

iAREDF was present in 7/11 PCI pregnancies, compared with 0/33 in the control group (P ≤ .01). All PCI pregnancies and 94% of controls had arterioarterial (AA)-anastomoses (P = .56), the diameter was larger in the PCI group, respectively 3.3 vs 2.1 mm (P = .03). Three cases with iAREDF had adverse outcome, two resulted in fetal death of which one with brain damage in the co-twin, another underwent early premature emergency section for fetal distress.

Conclusion

iAREDF occurs in a large proportion of MCDA pregnancies with PCI and is related to the diameter of the AA anastomosis. We hypothesize that iAREDF in appropriately grown MCDA twin pregnancies reflects an unstable hemodynamic balance with an increased risk for fetal deterioration. Whether outcome in these pregnancies can be improved by altered management requires further investigation.

     

Mind the gap in SEA: An institutional perspective on why assessment of synergies amongst climate change mitigation, adaptation and other policy areas are missing

This article takes its point of departure in two approaches to integrating climate change into Strategic Environmental Assessment (SEA): Mitigation and adaptation, and in the fact that these, as well as the synergies between them and other policy areas, are needed as part of an integrated assessment and policy response. First, the article makes a review of how positive and negative synergies between a) climate change mitigation and adaptation and b) climate change and other environmental concerns are integrated into Danish SEA practice. Then, the article discusses the implications of not addressing synergies. Finally, the article explores institutional explanations as to why synergies are not addressed in SEA practice. A document analysis of 149 Danish SEA reports shows that only one report comprises the assessment of synergies between mitigation and adaptation, whilst 9,4% of the reports assess the synergies between climate change and other environmental concerns. The consequences of separation are both the risk of trade-offs and missed opportunities for enhancing positive synergies. In order to propose explanations for the lacking integration, the institutional background is analysed and discussed, mainly based on Scott's theory of institutions. The institutional analysis highlights a regulatory element, since the assessment of climate change synergies is underpinned by legislation, but not by guidance. This means that great focus is on normative elements such as the local interpretation of legislation and of climate change mitigation and adaptation. The analysis also focuses on how the fragmentation of the organisation in which climate change and SEA are embedded has bearings on both normative and cultural-cognitive elements. This makes the assessment of synergies challenging. The evidence gathered and presented in the article points to a need for developing the SEA process and methodology in Denmark with the aim to include climate change in the assessments in a more systematic and integrated manner.     

Current practice of first-trimester ultrasound screening for structural fetal anomalies in developed countries

Objectives

First-trimester ultrasound screening is increasingly performed to detect fetal anomalies early in pregnancy, aiming to enhance reproductive autonomy for future parents. This study aims to display the current practice of first-trimester ultrasound screening in developed countries.

Method

An online survey among 47 prenatal screening experts in developed countries.

Results

First-trimester structural anomaly screening is available in 30 of the 33 countries and is mostly offered to all women with generally high uptakes. National protocols are available in 23/30 (76.7%) countries, but the extent of anatomy assessment varies. Monitoring of scan quality occurs in 43.3% of the countries. 23/43 (53.5%) of the respondents considered the quality of first-trimester ultrasound screening unequal in different regions of their country.

Conclusions

First-trimester screening for structural fetal anomalies is widely offered in developed countries, but large differences are reported in availability and use of screening protocols, the extent of anatomy assessment, training and experience of sonographers and quality monitoring systems. Consequently, this results in an unequal offer to parents in developed countries, sometimes even within the same country. Furthermore, as offer and execution differ widely, this has to be taken into account when results of screening policies are scientifically published or compared.     

All-in-one whole exome sequencing strategy with simultaneous copy number variant,single nucleotide variant and absence-of-heterozygosity analysis in fetuses with structural ultrasound anomalies: A 1-year experience

Objective

We performed a 1-year evaluation of a novel strategy of simultaneously analyzing single nucleotide variants (SNVs), copy number variants (CNVs) and copy-number-neutral Absence-of-Heterozygosity from Whole Exome Sequencing (WES) data for prenatal diagnosis of fetuses with ultrasound (US) anomalies and a non-causative QF-PCR result.

Methods

After invasive diagnostics, whole exome parent-offspring trio-sequencing with exome-wide CNV analysis was performed in pregnancies with fetal US anomalies and a non-causative QF-PCR result (WES-CNV). On request, additional SNV-analysis, restricted to (the) requested gene panel(s) only (with the option of whole exome SNV-analysis afterward) was performed simultaneously (WES-CNV/SNV) or as rapid SNV-re-analysis, following a normal CNV analysis.

Results

In total, 415 prenatal samples were included. Following a non-causative QF-PCR result, WES-CNV analysis was initially requested for 74.3% of the chorionic villus (CV) samples and 45% of the amniotic fluid (AF) samples. In case WES-CNV analysis did not reveal a causative aberration, SNV-re-analysis was requested in 41.7% of the CV samples and 17.5% of the AF samples. All initial analyses could be finished within 2 weeks after sampling. For SNV-re-analysis during pregnancy, turn-around-times (TATs) varied between one and 8 days.

Conclusion

We show a highly efficient all-in-one WES-based strategy, with short TATs, and the option of rapid SNV-re-analysis after a normal CNV result.     

Influence of environmental street characteristics on walking route choice of elderly people

Walking is an important source of outdoor physical activity among elderly people. In order to devise measures aimed at encouraging walking among the elderly it is important to understand how the local environment influences the walking behaviour of elderly people. Here, a model describing the influence of environmental street characteristics on the walking route choice of elderly people is presented. Techniques adapted from the field of transportation research were employed within the model. Data concerning the walking route choice to specific destinations reported by 364 independently living elderly residents (55–80 years) from three Dutch urban districts were collected. Route choice was modelled within a ‘Geographic Information System’ (GIS) database by using ‘resistance factors’ to describe the resistance to walking of street sections (i.e. links) within the street network. These factors were optimized by minimizing the difference between the estimated and the reported number of trips along each link. This is, to the authors' knowledge the first time that this technique has been applied within this context. The influence of link characteristics on link resistance was investigated by multivariate linear regression. The first results of the route choice model and the influence of street characteristics on route choice are reported and discussed.     

Risk as a challenge in practice: investigating climate change in water management

Climate change is one of the risks that society faces today. Among other things, it has the potential to interfere with the water environment, and thus it can be a relevant factor in current work with river basin management plans (RBMPs) in Denmark. At the same time, climate change in theory has characteristics that can pose challenges, if included in such a planning process. In this article, it is investigated what the attitudes towards climate change are among actors in the planning process, and what the main drivers, barriers and challenges related to including climate change in the RBMPs are, compared to the theoretical challenges. The investigation consists of a document study of hearing responses, interviews, and a survey among Danish municipalities. The overall results are that there are many attitudes towards the inclusion of climate change as a factor in RBMPs and that this diversity theoretically can be a challenge in the planning process. The main theoretical and practical barriers and challenges in connection with inclusion of climate change in RBMPs relate to lacking knowledge and uncertainty.