Background The concept of an ‘obesogenic environment’ a term first used in 1997 has become embedded in Public Health and health geography research. Research suggests that deprived populations in Britain not only have worse access to sources of affordable, healthy foodstuffs, but they also appear to be more exposed to take-away outlets offering cheap, energy-dense food. However measuring the relationship between socio-economic factors and food geography is methodologically complex. This observational study has two aims. Firstly, to describe the availability of pre-prepared hot food in a large urban population, with reference to walk-time geography and secondly, to explore the association between access to take-away outlets and neighbourhood deprivation. Methods Using Geographical Information System (GIS) software, we measured access to fast food outlets from a large number of randomly generated points (n = 3803) in residential areas of two Local Authorities in central England. Two regression models were built. One modelled the relationship between deprivation and walking distance to the nearest outlet and the other modelled the relationship between deprivation and the number of outlets within a 640 metre ‘short walk’. Adjustments were made for interactions, road connectivity and population density. Results After adjustment for other variables, we found a statistically significant association (p < 0.001) between deprivation and fast food accessibility. Points in poorer neighbourhoods were closer to an outlet and had a greater density of outlets within a short walking distance. The effect size was modest however. Adjusting for other variables, our model predicted points at the 75th centile of deprivation were about two minutes closer to the nearest outlet by foot, compared to points at the 25th centile of deprivation (467 m, lcl = 455m, ucl = 480 m compared to 603 m, lcl = 588 m, ucl = 618 m). In the density analysis, our model predicts that there will be fewer than one outlet in a 640 metre walk where deprivation is at the 25th centile (0.84, lcl = 0.78, ucl = 0.91) and at least one in the same radius at the 75th centile (1.41, lcl = 1.34, ucl = 1.48). Conclusion Many Local Authorities, including those in this study, have policies to restrict the growth of take-away outlets, especially near to schools. However we concluded that the existing food landscape already has an abundance of outlets and all neighbourhoods both deprived and less deprived have a large choice and ready access. This calls into question how effective planning laws will be in modifying the food environment.
. To examine trends independent of anti-hypertensive treatment, untreated BP was estimated from the recorded BP on treatment. To do this, a model was derived using published data on the effect of anti-hypertensives used singly and in combination at differing pre-treatment BP levels. BP untreated with statins was similarly estimated. Results Among an average 9,147 subjects per year, mean systolic BP (SBP) Conclusion For 15 years, BP declined in English adults. The overall decline in SBP of nearly 5 mmHg over the study period is likely to be of clinical significance in reducing CVD events. For an individual aged 40-49 a 5 mmHg reduction in SBP, as seen here, would be expected to reduce the risk of stroke by 23% and of IHD by 16%. It is therefore of concern that, in recent years, the decline has essentially ceased in the youngest age groups, particularly in younger men. The effect of treatment was modest; less than 25% of the male SBP decline is attributable to it. Other explanations for this fall, occurring whilst obesity has increased, need further exploration, but reduced salt intake is a likely candidate. Background It has been hypothesised that dissolved minerals in water, particularly calcium carbonate and magnesium carbonate, are protective against heart disease. Animal studies suggest biologically plausible mechanisms for this and statistically significant effects have been presented from several large ecological studies. Setting The West Midlands Government Office Region in central England, has a large and diverse population which has great variation in water hardness over a relatively small area. Our units of analysis were West Midlands neighbourhoods (lower level super output areas) falling in areas supplied by two water companies. We obtained exposure estimates from water industry measurements taken in 2007. Methods Using geographical information system software, digitised supply water supply maps were mapped to our neighbourhood geography. Having established the distribution of water hardness through neighbourhoods, we mapped tertiles of hardness and identified neighbourhoods inside them. To these we linked emergency myocardial infarction (MI) admissions for 45-74 year-old residents for a three year period, adjusting for the age distribution of the neighbourhoods, ethnic mix and socio-economic deprivation. We used a negative binomial model to determine the degree of association between water hardness and MI admission counts, adjusting for the other variables. Results We were able to accurately determine the mineral content of water supplied to 2,925 neighbourhoods with a total population of over 4.5 million. Contrary to other studies, we found just a small but non-significant negative correlation between hardness and MI admissions were seen in men, with an incidence rate ratio (IRR) of 0.97, per tertile, (0.92 -1.03, p=0.37) and a small, non-significant positive one seen in women, IRR=1.02, (0.93 -1.12, p=2). IS THERE A PROTECTIVE EFFECT OF HIGH MINERAL CONTENT IN DRINKING WATER ON CORONARY HEART DIS...
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