Inequitable provision of optimal services for patients with chronic heart failure : a national geo-mapping study

Objective : To compare the location and accessibility of current Australian chronic heart failure (CHF) management programs and general practice services with the probable distribution of the population with CHF. Design and setting : Data on the prevalence and distribution of the CHF population throughout Australia, and the locations of CHF management programs and general practice services from 1 January 2004 to 31 December 2005 were analysed using geographic information systems (GIS) technology. Outcome measures : Distance of populations with CHF to CHF management programs and general practice services. Results : The highest prevalence of CHF (20.3–79.8 per 1000 population) occurred in areas with high concentrations of people over 65 years of age and in areas with higher proportions of Indigenous people. Five thousand CHF patients (8%) discharged from hospital in 2004–2005 were managed in one of the 62 identified CHF management programs. There were no CHF management programs in the Northern Territory or Tasmania. Only four CHF management programs were located outside major cities, with a total case load of 80 patients (0.7%). The mean distance from any Australian population centre to the nearest CHF management program was 332 km (median, 163 km; range, 0.15–3246 km). In rural areas, where the burden of CHF management falls upon general practitioners, the mean distance to general practice services was 37 km (median, 20 km; range, 0–656 km). Conclusion : There is an inequity in the provision of CHF management programs to rural Australians.

Validity of an upper-body-mounted accelerometer to measure peak vertical and resultant force during running and change-of-direction tasks

This study assessed the validity of a tri-axial accelerometer worn on the upper body to estimate peak forces during running and change-of-direction tasks. Seventeen participants completed four different running and change-of-direction tasks (0°, 45°, 90°, and 180°; five trials per condition). Peak crania-caudal and resultant acceleration was converted to force and compared against peak force plate ground reaction force (GRF) in two formats (raw and smoothed). The resultant smoothed (10 Hz) and crania-caudal raw (except 180°) accelerometer values were not significantly different to resultant and vertical GRF for all running and change-of-direction tasks, respectively. Resultant accelerometer measures showed no to strong significant correlations (r = 0.00–0.76) and moderate to large measurement errors (coefficient of variation [CV] = 11.7–23.9%). Crania-caudal accelerometer measures showed small to moderate correlations (r = − 0.26 to 0.39) and moderate to large measurement errors (CV = 15.0–20.6%). Accelerometers, within integrated micro-technology tracking devices and worn on the upper body, can provide a relative measure of peak impact force experienced during running and two change-of-direction tasks (45° and 90°) provided that resultant smoothed values are used.

Where do Children Travel to and What Local Opportunities Are Available? The Relationship Between Neighborhood Destinations and Children’s Independent Mobility

Associations between access to local destinations and children’s independent mobility (IM) were examined. In 2007, 10- to 12-year-olds (n = 1,480) and their parents (n = 1,314) completed a survey. Children marked on a map the destinations they walked or cycled to (n = 1,132), and the availability of local destinations was assessed using Geographic Information Systems. More independently mobile children traveled to local destinations than other children. The odds of IM more than halved in both boys and girls whose parents reported living on a busy road (boys, OR = 0.48; girls, OR = 0.36) and in boys who lived near shopping centers (OR = 0.18) or community services (OR = 0.25). Conversely, the odds of IM more than doubled in girls living in neighborhoods with well-connected low-traffic streets (OR = 2.32) and increased in boys with access to local recreational (OR = 1.67) and retail (OR = 1.42) destinations. Creating safe and accessible places and routes may facilitate children’s IM, partly by shaping parent’s and children’s feelings of safety while enhancing their confidence in the child’s ability to use active modes without an adult.

Does urbanization have the potential to create an ecological trap for powerful owls (Ninox strenua)?

Landscape transformation associated with urbanization is one of the most damaging and pervasive impacts humans have on natural ecosystems. The response of species to increasing urbanization has become a major focus of research globally. Powerful owls ( Ninox strenua) are a top-order predator the have been shown to reside in urban environments, but increasing urbanization has also been demonstrated to significantly reduce available habitat. In this paper we use species distribution models established for key food and nesting resources of powerful owls across an urban-forest gradient to constrain habitat predictions from a previously developed powerful owl species distribution model. This multi-criteria decision analysis (MCDA) approach allowed us to investigate the impacts of urbanization on potential powerful owl habitat when challenged with food and nesting requirements. As powerful owls only use tree cavities for nesting we propose that the cue for settlement in an area is associated with the presence of habitat and food and as such breeding requirements may be disconnected from settlement requirements.Our results demonstrate that incorporation of a general prey resource (at least one group of arboreal marsupials) as a cue for settlement does not reduce the amount of available habitat for powerful owls substantially. Further constraining the model with a tree cavity resource, however, leads to a substantial reduction in powerful owl habitat in the urban and urban fringe environments. If a diverse prey resource (two or more groups of arboreal marsupials) is used as the cue for settlement, this sees a substantial reduction in available habitat in urban environments. Incorporation of tree cavities into this model does not reduce the available habitat for powerful owls substantially.We propose that powerful owls do not need a diverse prey base for survival, and that breeding resources are unlikely to be a cue for settlement. As such, we argue in this paper that increasing urbanization has the potential to create an ecological trap for powerful owls as there is a significant difference between habitat capable of supporting powerful owls, and habitat in which owls can breed.Management of powerful owls in urban environments will be difficult, but this research highlights the potential for the use of nest boxes to enhance the breeding activities in increasingly urbanized environments. Replacement of this critical resource may be able to reverse any potential ecological trap that is occurring. © 2014 Elsevier Ltd.

Does the presence and mix of destinations influence walking and physical activity?

Background: Local destinations have previously been shown to be associated with higher levels of both physical activity and walking, but little is known about how specific destinations are related to activity. This study examined associations between types and mix of destinations and both walking frequency and physical activity. Method: The sample consisted of 2349 residents of 50 urban areas in metropolitan Melbourne, Australia. Using geographic information systems, seven types of destinations were examined within three network buffers (400 meters (m), 800 m and 1200 m) of respondents' homes. Multilevel logistic regression was used to estimate effects of each destination type separately, as well as destination mix (variety) on: 1) likelihood of walking for at least 10 min ≥ 4/week; 2) likelihood of being sufficiently physically active. All models were adjusted for potential confounders. Results: All destination types were positively associated with walking frequency, and physical activity sufficiency at 1200 m. For the 800 m buffer: all destinations except transport stops and sports facilities were significantly associated with physical activity, while all except sports facilities were associated with walking frequency; at 400 m, café/takeaway food stores and transport stops were associated with walking frequency and physical activity sufficiency, and sports facilities were also associated with walking frequency. Strongest associations for both outcomes were observed for community resources and small food stores at both 800 m and 1200 m. For all buffer distances: greater mix was associated with greater walking frequency. Inclusion of walking in physical activity models led to attenuation of associations. Conclusions: The results of this analysis indicate that there is an association between destinations and both walking frequency and physical activity sufficiency, and that this relationship varies by destination type. It is also clear that greater mix of destinations positively predicts walking frequency and physical activity sufficiency.