Going carless in different urban fabrics: socio-demographics of household car ownership

Diverse physical features of urban areas alongside socio-demographic characteristics affect car ownership, and hence the daily mobility choices. As a case of sustainable mobility, we explore how various urban environments and socio-demographics associate with the spatial and social distribution of household car ownership and carlessness in the Helsinki Metropolitan Area, Finland. Three urban fabrics characterizing the study area are established based on the transportation mode (walking, public transportation, or automobile) the physical urban environment primarily supports. The national level Monitoring System of Spatial Structure and Urban Form database, and the National Travel Survey (2016) are utilized to further include spatial and socio-demographic variables into our analysis across these fabrics. Our results show that households with and without cars differ in terms of residential distance to the city center, neighborhood density, house type, and socio-demographic profiles. Single pensioners and students are most likely to be carless, whereas families represent the opposite. Within the carless households the differences are also evident between different groups. For the more affluent households residing in dense and well-connected areas, and mostly possessing driver’s licenses, carlessness is presumably a choice. Contrarily, many other carless households represent the less affluent often located in the more distant, low-density, and less accessible areas, while also possessing less driver’s licenses, making carlessness more of a constraint, as the local urban fabric does not support such lifestyle. Consequently, carless households should be increasingly recognized as a focus group in sustainable urban planning in terms of identifiable best practices and potential vulnerability.

Association of residential distance to coast with myocardial infarction: a prospective cohort study

Background Little is known about whether the residential distance to coast is associated with incident myocardial infarction (MI), as well as which mechanisms may explain the association. We aim to explore this association using data from a prospective, population-based cohort with unprecedented sample size and broad geographical coverage. Methods 377,340 participants from the prospective, population-based UK Biobank cohort were included. Residential distance to the coast was defined as participant's residence location to coast. Results 4,059 MI occurred during median 8.0 years follow-up. Using group (<1 km) as reference, group (20–50 km) was associated with lower risk of MI (hazard ratio, HR 0.79, 95% CI 0.64–0.98) and a U-shaped relation between distance to coast and MI was shown with the low risk interval between 32 km and 64 km (Pnonlinear = 0.0012). Using participants of intermediate region (32–64 km) as reference, participants of offshore region (<32 km) and inland region (>64 km) were both associated with a higher risk of incident MI (HR 1.12, 95% CI 1.04–1.21 and HR 1.09, 95% CI 1.01–1.18, respectively). HR for offshore region (<32 km) was larger in subgroup with low total physical activity (<24 hours/week) (HR 1.24, 95% CI 1.09–1.42, Pinteraction = 0.043), whereas HR for inland region (>64 km) was larger in subgroup in urban area (HR 1.12, 95% CI 1.03–1.22, Pinteraction = 0.065) and in subgroup of high nitrogen dioxide air pollution (HR 1.29, 95% CI 1.11–1.50, Pinteraction = 0.021). Conclusions Our findings highlight the complex and diverse associations between residential distance to the coast and incident MI. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Veterans Affairs hematology/oncology clinic video telehealth experience.

281 Background: Many of the 40,000 veterans annually diagnosed with cancer have limited access to Hematology/Oncology care. An existing method to improve access in the Veterans Affairs (VA) system is the e-consultation, which allows text-based consultation by specialty services. However, many patients require more in-depth care than is feasible by e-consult. Amidst the COVID-19 pandemic, the James A. Haley VA (JAHVA) Hematology/Oncology department implemented VA video connect (VVC) telehealth visits to allow providers to connect with patients in their homes. Our aim was to assess the implementation of this novel telehealth service and assess provider perceptions via questionnaires. Methods: We reviewed charts of patients seen via VVC by the JAHVA Hematology/Oncology department. We gathered data including patient demographics, zip code, primary visit diagnosis, and date of visit. We adapted a previously validated telehealth usability questionnaire by Parmanto et al. Providers were surveyed about perceptions of VVCs prior to implementation and 1 year later. Responses were assessed via 5-point Likert scale. Results: From May 2020 to April 2021, 1290 VVCs were conducted. Median VVCs per month was 106 (range 26 to 161), with peak in June 2020. 71% of patients were ³65 years, 24% were 45-64 years, and 5% were <45 years. 77% of patients were white, 16% African American, 3% other, and 4% declined to answer or were of unknown race. 87% of patients were male. 12.5% of visits were for new consults. 41% of visits were for primary neoplasm-related diagnoses, 27% for hematologic diagnoses, and 32% for other. The mean residential distance from our clinic was 37.2 miles (range 0-212.7 miles). Sixteen Hematology/Oncology providers (faculty, fellows, advanced practice providers) completed the initial questionnaire, and 12 completed the follow-up questionnaire. See table for selected results. Conclusions: VVCs are a feasible method to provide remote access to care for patients. Utilization peaked in summer 2020, at the height of the COVID-19 pandemic. Providers were overall satisfied with video visits, though preference for in-person visits increased with time. Provider concern regarding personal and patient exposure to COVID-19 may have impacted perceptions regarding VVCs. Utilizing the PDSA cycle, future steps include identifying specific patient diagnoses and identifying reasons for VVC failure and using this data to optimize the experience for pati ent and providers.[Table: see text]

Factors Affecting the Compliance of Curative Intent Treatment in Patients with Head and Neck Cancer

Objective: This study aims to investigate the factors that lead to poor compliance in initiating the treatment in patients with newly diagnosed head and neck cancers. Design: Retrospective cohort study Particpants: Data from a total of 271 patients were retrieved and analyzed. After excluding patients with (1) multiple cancers (2) inconclusive diagnoses, (3) rare primary cancer sites, such as the nasal cavity, paranasal sinuses, or salivary glands and (4) primary site unknown, a total of 194 patients were included in this study. Main outcome measures: The variables included in the analysis were age, gender, primary cancer site, T stage, N stage, M stage, overall stage (I-IV), patient’s residential distance, and the impact of COVID-19. Univariate and multivariate analyses were employed to evaluate the significance of these variables in regard to affecting the time to receiving on-time treatment based on the specialist’s suggestion. Results: Upon multivariate analysis, the primary site, stage, and residential distance were significantly associated with initial compliance (P<0.05). The impact of COVID-19 showing a borderline significance (p=0.137). Conclusion: The primary site, overall stage, patient living distance to the healthcare facility, and the impact of COVID-19 might affect the compliance of initiating a curative-intent treatment in patients with newly diagnosed head and neck cancers.

Proximity to Major Roads and Risks of Childhood Recurrent Wheeze and Asthma in a Severe Bronchiolitis Cohort

Air pollution exposures have been suggested as risk factors for childhood respiratory diseases. We investigated proximity to major roads, an indicator of air pollution exposure, and its associations with childhood recurrent wheeze and asthma. We used data from a multicenter prospective cohort study of 921 infants hospitalized for bronchiolitis and recruited from 14 U.S. states. Primary exposure was residential proximity to the nearest major road at birth through age 3 years. Residential distance from nearest major road was divided into four categories: <100, 100–200, 201–300, and >300 m. Outcomes were parent-reported recurrent wheeze by age 3 years and asthma by age 5 years. Associations between residential proximity to major roads and respiratory outcomes were investigated using multivariable Cox proportional hazards modeling and logistic regression, adjusted for confounders. Out of 920 participants with home address data, pooled estimates identified 241 (26%) participants resided within 300 m of a major road, 296 (32%) developed recurrent wheeze by age 3, and 235 out of 858 participants (27%) developed asthma by 5 years. Participants who resided close to a major road had the highest risk of recurrent wheeze (adjusted hazards ratio for <100 m, 1.59, 95%CI: 1.08–2.33) and asthma (adjusted odds ratio for 201–300 m, 1.62, 95%CI: 1.16–2.25), compared to those residing >300 m from a major road. Proximity to major roads is associated with increased risks of recurrent wheeze and asthma in young children.

Exploring the risk of hypospadias in children born from mothers living close to a vineyard

Hypospadias (H) is a common birth defect affecting the male urinary tract. It has been suggested that exposure to endocrine disrupting chemicals might increase the risk of H by altering urethral development. However, whether H risk is increased in places heavily exposed to agricultural pesticides, such as vineyards, remains debated and difficult to ascertain. The objective of the work is to test the possible association of H with residential proximity to vineyards. Residential address at birth of 8,766 H cases born 1980–2011 was taken from 17 specialized surgery centers. The geographical distribution of vineyards was obtained from the European Land Parcel Identification System (LPIS) and the distance of address to the nearest vineyard was computed. A first estimate of the variation of H relative risk with distance to vineyards was obtained using as controls 13,105 cryptorchidism (C) cases operated during the same period in the same centers. A separate estimate was obtained from a case-control study using “virtual controls” (VC) defined as points of the map sampled to match the demographic distribution of births within the recruitment territories of the study centers. Non-exposed patients were defined as those with a residence between 5,000 and 10,000 m from the closest vineyard. The residential distance to vineyard was smaller for H than for C cases (p<10−4). We found 42/8766 H cases (0.48%) and 50/13,105 C cases (0.38%) born to mothers living within 20 m of a vineyard. The odds ratios for H were 2.48 (CI: 1.0 to 5.1) and 2.4 (CI: 1.3 to 4.4), vs C or vs VC, respectively, when pregnant mothers lived 10–20 m from a vineyard. In conclusion, our study supports that children born to mothers living close to a vineyard have a two-fold increased risk of H. For environmental research, the use of VC provides an alternative to classical case control technique.

Residential exposure to air pollution and access to neighborhood greenspace in relation to hair cortisol concentrations during the second and third trimester of pregnancy

Background Exposure to air pollution during pregnancy has been associated with adverse pregnancy outcomes in studies worldwide, other studies have described beneficial effects of residential greenspace on pregnancy outcomes. The biological mechanisms that underlie these associations are incompletely understood. A biological stress response, which implies release of cortisol, may underlie associations of air pollution exposure and access to neighborhood greenspaces with health. Methods We explored residential exposure to air pollution and residential access to neighborhood greenspaces in relation to hair cortisol concentrations of participants in a prospective pregnancy cohort study in Flanders, Belgium. Hair samples were collected at the end of the second pregnancy trimester (n = 133) and shortly after delivery (n = 81). Cortisol concentrations were measured in 3-cm scalp-near hair sections, to reflect second and third pregnancy trimester cortisol secretion. We estimated long-term (3 months before sampling) residential exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and black carbon (BC), assessed residential distance to major roads and residential access to neighborhood greenspaces (NHGS). Associations between residential exposures and hair cortisol concentrations were studied using linear regression models while adjusting for season of sampling. Results Three-month mean residential NO2 and BC concentrations were positively associated with third pregnancy trimester hair cortisol concentrations (p = 0.008 and p = 0.017). Access to a large NHGS (10 ha or more within 800 m from residence) was negatively associated with third trimester hair cortisol concentrations (p = 0.019). Access to a large NHGS significantly moderated the association between residential proximity to major roads and second trimester hair cortisol concentrations (p = 0.021). Residential distance to major roads was negatively associated with second trimester hair cortisol concentrations of participants without access to a large NHGS (p = 0.003). The association was not significant for participants with access to a large NHGS. The moderation tended towards significance in the third pregnancy trimester (p < 0.10). Conclusions Our findings suggest a positive association between long-term residential exposure to air pollution and biological stress during pregnancy, residential access to neighborhood greenspaces may moderate the association. Further research is needed to confirm our results. Trial registration The IPANEMA study is registered under number NCT02592005 at clinicaltrials.gov.

Residential exposure to air pollution and access to neighborhood greenspace in relation to hair cortisol concentrations during the second and third trimester of pregnancy

Background: Exposure to air pollution during pregnancy has been associated with adverse pregnancy outcomes in studies worldwide, other studies have described beneficial effects of residential greenspace on pregnancy outcomes. The biological mechanisms that underlie these associations are incompletely understood. A biological stress response, which implies release of cortisol, may underlie associations of air pollution exposure and access to neighborhood greenspaces with health. Methods: We explored residential exposure to air pollution and residential access to neighborhood greenspaces in relation to hair cortisol concentrations of participants in a prospective pregnancy cohort study in Flanders, Belgium. Hair samples were collected at the end of the second pregnancy trimester (n = 133) and shortly after delivery (n = 81). Cortisol concentrations were measured in 3-cm scalp-near hair sections, to reflect second and third pregnancy trimester cortisol secretion. We estimated long-term (3 months before sampling) residential exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and black carbon (BC), assessed residential distance to major roads and residential access to neighborhood greenspaces (NHGS). Associations between residential exposures and hair cortisol concentrations were studied using linear regression models while adjusting for season of sampling.Results: Three-month mean residential NO2 and BC concentrations were positively associated with third pregnancy trimester hair cortisol concentrations (p = 0.008 and p = 0.017). Access to a large NHGS (10 hectares or more within 800 meters from residence) was negatively associated with third trimester hair cortisol concentrations (p = 0.019). Access to a large NHGS significantly moderated the association between residential proximity to major roads and second trimester hair cortisol concentrations (p = 0.021). Residential distance to major roads was negatively associated with second trimester hair cortisol concentrations of participants without access to a large NHGS (p = 0.003). The association was not significant for participants with access to a large NHGS. The moderation tended towards significance in the third pregnancy trimester (p < 0.10).Conclusions: Our findings suggest a positive association between long-term residential exposure to air pollution and biological stress during pregnancy, residential access to neighborhood greenspaces may moderate the association. Further research is needed to confirm our results.Trial registration: The IPANEMA study is registered under number NCT02592005 at clinicaltrials.gov.

Residential exposure to air pollution and access to neighborhood greenspace in relation to hair cortisol concentrations during the second and third trimester of pregnancy

Background: Exposure to air pollution during pregnancy has been associated with adverse pregnancy outcomes in studies worldwide, other studies have described beneficial effects of residential greenspace on pregnancy outcomes. The biological mechanisms that underlie these associations are incompletely understood. A biological stress response, which implies release of cortisol, may underlie associations of air pollution exposure and access to neighborhood greenspaces with health. Methods: We explored residential exposure to air pollution and residential access to neighborhood greenspaces in relation to hair cortisol concentrations of participants in a prospective pregnancy cohort study in Flanders, Belgium. Hair samples were collected at the end of the second pregnancy trimester (n = 133) and shortly after delivery (n = 81). Cortisol concentrations were measured in 3-cm scalp-near hair sections, to reflect second and third pregnancy trimester cortisol secretion. We estimated long-term (3 months before sampling) residential exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and black carbon (BC), assessed residential distance to major roads and residential access to neighborhood greenspaces (NHGS). Associations between residential exposures and hair cortisol concentrations were studied using linear regression models while adjusting for season of sampling.Results: Three-month mean residential NO2 and BC concentrations were positively associated with third pregnancy trimester hair cortisol concentrations (p = 0.008 and p = 0.017). Access to a large NHGS (10 hectares or more within 800 meters from residence) was negatively associated with third trimester hair cortisol concentrations (p = 0.019). Access to a large NHGS significantly moderated the association between residential proximity to major roads and second trimester hair cortisol concentrations (p = 0.021). Residential distance to major roads was negatively associated with second trimester hair cortisol concentrations of participants without access to a large NHGS (p = 0.003). The association was not significant for participants with access to a large NHGS. The moderation tended towards significance in the third pregnancy trimester (p < 0.10).Conclusions: Our findings suggest a positive association between long-term residential exposure to air pollution and biological stress during pregnancy, residential access to neighborhood greenspaces may moderate the association. Further research is needed to confirm our results.Trial registration: The IPANEMA study is registered under number NCT02592005 at clinicaltrials.gov.