Asthma and the diver

Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with nearly 9 million sport divers in the United States alone. Approximately 7% of the population has been diagnosed with asthma, which is similar to the percentage of divers admitting they have asthma. Numerous concerns exist regarding subjects with asthma who choose to participate in recreational diving. Among these concerns are pulmonary barotrauma, pneumomediastinum, pneumothorax, arterial gas embolism, ear barotrauma, sinus barotrauma, and dental barotrauma. Despite these concerns, a paucity of information exists linking asthma to increased risk of diving complications. However, it has long been the norm to discourage individuals with asthma from participating in recreational scuba diving. This article examines the currently available literature to allow for a more informed decision regarding the possible risks associated with diving and asthma. It examines the underlying physiological principles associated with diving, including Henry’s law and Boyle’s law, to provide a more intimate understanding on physiological changes occurring in the respiratory system under compressive stress. Finally, this article offers a framework for guiding the patient with asthma who is interested in scuba diving. Under the right circumstances, the patient with asthma can safely participate in recreational diving without apparent increased risk of an asthma-related event.     

Associations of park features with park use and park-based physical activity in an urban environment in Asia: A cross-sectional study

Park use is associated with health, yet our understanding of park features related to their use is limited. Singapore's parks were audited for 30 micro-features, then geospatial analysis characterized micro-features scores for parks nearest to participants' homes. Adults (3,435) reported their park use and park-based physical activity. Using linear regression models, we found living near a park with higher micro-features scores was associated with more time in parks and park-based physical activity. Specific micro-features were associated with more park time (wildlife areas, water features, forested areas, unpaved trails (2–2.6 h/month, p < 0.05)) and with physical activity in parks (water features, forested areas, large playground, open green spaces (1.8–2.2 h/month, p < 0.05)). These findings could inform parks planning to support population-health.     

Natural Environments,Obesity, and Physical Activity in Nonmetropolitan Areas of the United States

Purpose: To assess the associations of the natural environment with obesity and physical activity in nonmetropolitan areas of the United States among representative samples by using 2 indices of outdoor activity potential (OAP) at the county level. Methods: We used the data from 457,820 and 473,296 noninstitutionalized adults aged over 18 years for obesity and physical activity, respectively, from the 2000‐2006 Behavioral Risk Factor Surveillance System. The OAP indices were (1) a recreational opportunity index based on 24 variables related to outdoor physical activity, such as the number of facilities available for walking, biking, hiking, and swimming derived from the 1997 National Outdoor Recreation Supply Information System; and (2) a natural amenities index which was based on physical and social environmental characteristics, such as climate, topographic relief, land cover, and tourism. We fitted logistic regression models using generalized estimating equations to control for county level intracorrelation and tested each index separately to assess its relationship with obesity and physical activity. Findings: Recreational opportunities were higher in areas with greater natural amenities. After controlling for individual‐level socioeconomic and demographic characteristics, the prevalence of obesity decreased and propensity for physical activity increased with increasing levels of both recreational opportunities and natural amenities. Conclusions: Multiple indices of OAP based on characteristics of the built, natural and social environments were associated with decreased obesity and increased physical activity in nonmetropolitan areas. Public health interventions should consider the opportunities and limitations offered by the natural environment for promoting physical activity and reducing obesity in rural areas.     

Aging and Diversity: An Active Learning Experience,by Chandra M. Mehorta and Lisa S. Wagner

This study evaluated a 10-week chair yoga intervention on cognition, balance, activities of daily living (ADLs), anxiety, and depression for persons with Alzheimer's disease (AD). Residents were assigned to three groups: (a) mild AD (n?=?6), (b) moderate AD (n?=?6), or (c) severe AD (n?=?7). There was no significant change in balance, anxiety, or cognition. ADLs showed a significant effect (p?=?.02), which suggests that yoga may have more benefit early in the progression of AD. Depression increased significantly (p < .01). Yoga over an extended period of time with a larger sample size may demonstrate benefits to persons with AD and serve as means to improve overall quality of life.     

Biodiversity and infrastructure interact to drive tourism to and within Costa Rica

Nature-based tourism has potential to sustain biodiversity and economic development, yet the degree to which biodiversity drives tourism patterns, especially relative to infrastructure, is poorly understood. Here, we examine relationships between different types of biodiversity and different types of tourism in Costa Rica to address three questions. First, what is the contribution of species richness in explaining patterns of tourism in protected areas and country-wide in Costa Rica? Second, how similar are the patterns for birdwatching tourism compared to those of overall tourism? Third, where in the country is biodiversity contributing more than other factors to birdwatching tourism and to overall tourism? We integrated environmental data and species occurrence records to build species distribution models for 66 species of amphibians, reptiles, and mammals, and for 699 bird species. We used built infrastructure variables (hotel density and distance to roads), protected area size, distance to protected areas, and distance to water as covariates to evaluate the relative importance of biodiversity in predicting birdwatching tourism (via eBird checklists) and overall tourism (via Flickr photographs) within Costa Rica. We found that while the role of infrastructure is larger than any other variable, it alone is not sufficient to explain birdwatching and tourism patterns. Including biodiversity adds predictive power and alters spatial patterns of predicted tourism. Our results suggest that investments in infrastructure must be paired with successful biodiversity conservation for tourism to generate the economic revenue that countries like Costa Rica derive from it, now and into the future.

The tourism sector is well-poised to generate win–win approaches to biodiversity conservation and sustainable development given its nonextractive nature and its dependence on scenic beauty (1). However, for sustainable tourism to succeed as a strategy for biodiversity conservation, the role that biodiversity plays in driving tourism patterns needs to be better understood. On one hand, wildlife and nature motivate a significant portion of global tourism (2), and protected areas with higher species richness tend to attract more tourists and yield higher economic benefits (3). On the other hand, tourism hotspots also tend to occur in places where more human-built infrastructure (e.g., hotels, roads, and airports) enables access (4, 5). Studies have reached mixed conclusions on the relative importance of biodiversity and accessibility for tourism, and little is known about how they work in concert (6–11). Given the potential negative impacts of infrastructure on biodiversity conservation, their relative contributions to tourism deserves explicit study, particularly in developing countries where both biodiversity conservation and sustainable development are urgently needed (7, 12).Drivers of tourism patterns across landscapes have been explored through questionnaire surveys and structured interviews that ask tourists about their affinity for landscape features (13–15) and through spatial models that predict recreation using photographs (e.g., geographically weighted regression, MaxEnt) (16, 17). Recently, geo-tagged photographs and species lists shared on social media platforms have become popular tools for tourism-focused research (18–22). These studies, however, typically focus narrowly on the role of single taxa (22, 23) and landscape attributes without accounting for species diversity (14, 20), or they focus only on the role of infrastructure as a driver of tourism (5). Recent advances in satellite Earth observations make it possible to capture more of the ecosystem heterogeneity that can drive variability in species distributions, compared to more conventional modeling based on land cover (24–26). An integrated approach is needed, linking species richness of multiple taxa along with infrastructure variables, both modeled and mapped through high resolution Earth observations. Such an approach could be scaled up to larger regions and applied globally, helping to identify where biodiversity is playing a significant role in driving tourism, such that governments and the tourism sector can prioritize investments in biodiversity conservation.Here, we ask three questions in the iconic case of Costa Rica. First, what is the contribution of species richness (of vertebrate taxa) in explaining patterns of tourism in protected areas and also country-wide? Second, how similar are the patterns for birdwatching tourism compared to those of overall tourism? Third, where in the country is biodiversity contributing more than other factors to birdwatching tourism and to overall tourism? We predict that vertebrate species richness is more important for driving tourism in protected areas than in the rest of the country, because nature-seeking tourists often go to protected areas to find wildlife (3). We also expect that birdwatching tourism is predicted by richness of threatened and endemic bird species rather than total species richness, given birdwatchers’ preferences for rare birds (27). We predict a saturating relationship between species richness and tourism, because beyond a large number of species additional species are unlikely to contribute more to tourism (28). Finally, we predict that national-level tourism is better explained by infrastructure (such as roads and hotels) and distance to water than by biodiversity, because tourists going to Costa Rica often seek activities such as surfing and relaxing in beach resorts (29, 30). We predict nonlinear effects of proximity to roads and water, because a place is deemed inaccessible if it is further away from roads, and a beach tourist destination is also either close to water or not a destination at all. Access diminishes rapidly over a few miles (31).To answer our research questions, we analyze patterns of tourism at two different spatial scales. First, we analyze tourism patterns in protected areas only. Many protected areas provide reliable data on visitation rates and biodiversity tends to be higher inside than outside protected areas (29). However, given that they are often visited by tourists who are already interested in biodiversity, protected areas are not representative of all tourism patterns (30). Second, we evaluate the relative importance of biodiversity to all tourism across Costa Rica (excluding offshore islands). Investigating tourism across the whole nation may give a better understanding of how biodiversity contributes to tourism writ large and not only for tourists with a predisposition for finding wildlife. At both the protected area and national scales, we use a modified MaxEnt model that integrates species distribution models for 66 terrestrial vertebrate species (including amphibians, reptiles, and mammals) and 699 bird species, based on remotely sensed climate and habitat variables, with spatial patterns of infrastructure (hotel density and distance to roads) and distance to water. We measure tourism in two ways for both scales: using eBird checklists as a proxy for birdwatching (32), and using Flickr photographs as a proxy for all international and domestic tourism (19).Costa Rica is an ideal country to explore these questions because tourism represents 7% of the national gross domestic product and employs 3% of the working population directly and a further 9% indirectly (33). Approximately 70% of all international visitors to Costa Rica state that the wildlife, dramatic scenery, and opportunities for adventure sports are the main motivation for visiting the country (33, 34). However, the importance of biodiversity as a factor that influences tourism to, or domestically within, the country has not been evaluated (apart from very local studies) (35, 36). The Central Bank of Costa Rica is currently piloting a nature-based tourism account under the United Nations System of Environmental Economic Accounts (UN SEEA). The state of the art with this methodology is to attribute value to different ecosystems, which may vary widely in their biodiversity. Understanding the relationships between biodiversity and tourism in Costa Rica is a key step toward maintaining the vibrant ecotourism industry and can serve as an example for other biodiverse nations that often look to Costa Rica as a leader in sustainable development (37).     

Effect of total knee arthroplasty on recreational and sporting activity

BACKGROUND: Common concerns of patients undergoing total knee arthroplasty (TKA) are whether they can continue with certain recreational and sporting activities or even commence new ones after the procedure. The present study was designed to determine preoperative and postoperative activities, the numbers participating and the time to resume these activities. METHODS: Between 1 and 2 years after TKA, patients who had undergone 144 arthroplasties, were surveyed by postal questionnaire to ascertain how the arthroplasty had affected their recreational and sporting ability. Their preoperative and postoperative activity along with the time to resume was recorded. The Oxford knee score and estimate of physical activity was also collected. RESULTS: Out of the 144 TKA performed, 122 participated in sport and recreational activity preoperatively and 108 participated postoperatively. Patients stated that the surgery had a beneficial effect on their performance of sporting and recreational activities although the number of sporting events decreased. By multiplying individuals by the number of activities they participated in, there were 254 occurrences of sport and recreational activities preoperatively giving a mean for the group of 1.76 sports/patient. Postoperatively this had reduced to 204, giving a mean of 1.41. Three activities showed a significant change for individual patients from pre- to postoperation. Those which showed an increase were exercise walking, where 19 patients (13.2%) who did not walk before surgery took up walking afterwards (P < 0.006) and aqua aerobics, where five took up aqua aerobics postoperatively for the first time (P < 0.025). Golf was the only sport which had a significant fall in participation from pre- to postoperation, with 10 out of 19 golfers giving up (P < 0.025). CONCLUSION: The present study has shown that patients are adopting lower impact activities to participate in after TKA. The total number of patients performing a sport decreases postoperatively and the total amount of sport played decreases. These data will help to counsel patients.     

The role of an international nightlife resort in the proliferation of recreational drugs

Aims The study compares types, frequencies and quantities of substances used by young people while holidaying in the international dance resort of Ibiza (Spain) with their patterns of use in the United Kingdom. It measures changes in substance use at both locations between 1999 and 2002 and examines the role of dance resorts in recruiting individuals into using new substances. Design Data were collected from visitors to Ibiza in 1999 (n = 846) and 2002 (n = 868). Information on drug use was surveyed through a short anonymous questionnaire. Setting Individuals were sampled at Ibiza airport just prior to returning to the UK. Findings Most individuals visiting Ibiza used illicit drugs in the United Kingdom (57.4% in 2002), with nearly all users continuing to use in Ibiza. Use of most drugs in Ibiza was characterized by binge behaviour, with many individuals using drugs 5 or more nights per week. Proportions using cocaine, ecstasy and GHB have risen significantly (1999–2002) in both locations, as have numbers of ecstasy tablets taken on a usual night. Substance use was associated positively with number of previous visits to Ibiza and new users were recruited into use while abroad (17.4 and 33.1 per 1000 people were introduced to cocaine and ecstasy use, respectively, in Ibiza). Conclusions The emergence of international nightlife resorts increasingly links drug use abroad with that in individuals’ countries of origin. Our results indicate that resorts such as Ibiza offer tourists the opportunity to increase levels of drug consumption and try different substances in an atmosphere conducive to experimentation. Patterns of recreational drug use in leading international resorts may help predict developments in drug use elsewhere and as such be an important tool in planning appropriate interventions.