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      Impact of High-Density Urban Built Environment on Chronic Obstructive Pulmonary Disease: A Case Study of Jing’an District, Shanghai

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          Abstract

          Respiratory health is a focus of interdisciplinary studies involving urban planning and public health. Studies have noted that urban built environments have impacts on respiratory health by influencing air quality and human behavior such as physical activity. The aim of this paper was to explore the impact of urban built environments on respiratory health, taking chronic obstructive pulmonary disease (COPD) as one of the typical respiratory diseases for study. A cross-sectional study was conducted including all cases (N = 1511) of death from COPD in the high-density Jing’an district of Shanghai from 2001 to 2010. Proxy variables were selected to measure modifiable features of urban built environments within this typical high-density district in Shanghai. A geographically weighted regression (GWR) model was used to explore the effects of the built environment on the mortality of COPD and the geographical variation in the effects. This study found that land use mix, building width-height ratio, frontal area density, and arterial road density were significantly correlated to the mortality of COPD in high-density urban area. By identifying built environment elements adjustable by urban planning and public policy, this study proposes corresponding environmental intervention for respiratory health.

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          Most cited references 63

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          Health effects of particulate air pollution: time for reassessment?

           C Pope,  D Bates,  M E Raizenne (1995)
          Numerous studies have observed health effects of particulate air pollution. Compared to early studies that focused on severe air pollution episodes, recent studies are more relevant to understanding health effects of pollution at levels common to contemporary cities in the developed world. We review recent epidemiologic studies that evaluated health effects of particulate air pollution and conclude that respirable particulate air pollution is likely an important contributing factor to respiratory disease. Observed health effects include increased respiratory symptoms, decreased lung function, increased hospitalizations and other health care visits for respiratory and cardiovascular disease, increased respiratory morbidity as measured by absenteeism from work or school or other restrictions in activity, and increased cardiopulmonary disease mortality. These health effects are observed at levels common to many U.S. cities including levels below current U.S. National Ambient Air Quality Standards for particulate air pollution. Images Figure 1.
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            Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease.

            Physical inactivity is common in patients with chronic obstructive pulmonary disease (COPD) compared with age-matched healthy individuals or patients with other chronic diseases. Physical inactivity independently predicts poor outcomes across several aspects of this disease, but it is (at least in principle) treatable in patients with COPD. Pulmonary rehabilitation has arguably the greatest positive effect of any current therapy on exercise capacity in COPD; as such, gains in this area should facilitate increases in physical activity. Furthermore, because pulmonary rehabilitation also emphasizes behavior change through collaborative self-management, it may aid in the translation of increased exercise capacity to greater participation in activities involving physical activity. Both increased exercise capacity and adaptive behavior change are necessary to achieve significant and lasting increases in physical activity in patients with COPD. Unfortunately, it is readily assumed that this translation occurs naturally. This concise clinical review will focus on the effects of a comprehensive pulmonary rehabilitation program on physical activity in patients with COPD. Changing physical activity behavior in patients with COPD needs an interdisciplinary approach, bringing together respiratory medicine, rehabilitation sciences, social sciences, and behavioral sciences.
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              The Minimal Important Difference in Physical Activity in Patients with COPD

              Background Changes in physical activity (PA) are difficult to interpret because no framework of minimal important difference (MID) exists. We aimed to determine the minimal important difference (MID) in physical activity (PA) in patients with Chronic Obstructive Pulmonary Disease and to clinically validate this MID by evaluating its impact on time to first COPD-related hospitalization. Methods PA was objectively measured for one week in 74 patients before and after three months of rehabilitation (rehabilitation sample). In addition the intraclass correlation coefficient was measured in 30 patients (test-retest sample), by measuring PA for two consecutive weeks. Daily number of steps was chosen as outcome measurement. Different distribution and anchor based methods were chosen to calculate the MID. Time to first hospitalization due to an exacerbation was compared between patients exceeding the MID and those who did not. Results Calculation of the MID resulted in 599 (Standard Error of Measurement), 1029 (empirical rule effect size), 1072 (Cohen's effect size) and 1131 (0.5SD) steps.day-1. An anchor based estimation could not be obtained because of the lack of a sufficiently related anchor. The time to the first hospital admission was significantly different between patients exceeding the MID and patients who did not, using the Standard Error of Measurement as cutoff. Conclusions The MID after pulmonary rehabilitation lies between 600 and 1100 steps.day-1. The clinical importance of this change is supported by a reduced risk for hospital admission in those patients with more than 600 steps improvement.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                30 December 2019
                January 2020
                : 17
                : 1
                Affiliations
                [1 ]College of Architecture and Urban Planning, Tongji University, 1239 Siping Road, Shanghai 200092, China; wanglan@ 123456tongji.edu.cn (L.W.); 1630043@ 123456tongji.edu.cn (W.S.)
                [2 ]Institute of Engineering and Industry, Tongji University, 1239 Siping Road, Shanghai 200092, China; chenrui_tongji@ 123456163.com
                [3 ]Jing’an District Center for Disease Control and Prevention, Shanghai 200072, China
                Author notes
                [* ]Correspondence: yangjiewater@ 123456163.com (X.Y.); xhli@ 123456tongji.edu.cn (X.L.); Tel.: +86-159-6080-6936 (X.L.)
                Article
                ijerph-17-00252
                10.3390/ijerph17010252
                6982330
                31905874
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                Categories
                Article

                Public health

                geographically weighted regression, built environment, copd, respiratory health

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