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Purpose -The purpose of this paper is to explore how a people-centred, design-led approach to the different needs and aspirations of adults with autism could help inform the design of space, objects and activities for individuals in their own homes to enhance everyday life experiences. There are dozens of studies that have reported the health benefits associated with good design and the Kingwood Trust set out to research what that might mean for the adults with autism it supports. Design/methodology/approach -The paper describes three projects: Housing Design, Garden Design and Exploring Sensory Preferences whose design interventions were realised through a process of design ethnography, to include and work with the people that Kingwood support who have limited verbal speech and learning disabilities. Participatory observation, co-design workshops, interviews, visual probes and mapping tools were created to gather insights about how a person perceives and engages with the physical environment, with a particular focus on their sensory sensitivities and special interests. Findings -The outcome of the project is a holistic, design-led approach to identifying the sensory preferences and special interests of adults with autism to inform the design of residential accommodation. A second project will be published at a later date, which will test and evaluate the effectiveness of the design interventions described in this paper as part of a PhD by practice supported by Kingwood Trust. Originality/value -Autistic adults with limited verbal speech and additional learning disabilities, are often excluded from design research. This paper bridges this gap by selecting and adapting design methods that invite the people that Kingwood support to be active participants within the design process. The revised DSM-5 is an important milestone that puts the sensory environment back onto the roadmap within autism research, however the relationship between people with autism and the physical environment is a relatively under-researched area. This paper bridges this gap in research and illustrates how an autistic person's interaction and reaction to their home environment, can create understanding, tangible insights and clues to inform the design and adaptation of environments to reduce triggers of anxiety, making them more comfortable, enjoyable and meaningful for that person.

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Table 1 Benefits and limitations of a new virtual electronic inpatient dermatology referral service versus a paper and face-to-face (FTF) system Benefits Limitations Faster access to dermatology opinions for inpatients Access to photographs rate-limiting step All essential clinical details fully included in e-referral Accuracy of diagnosis reliant on quality of photographs Automatic paper trail (no referrals physically misplaced) Need to convert to FTF for some patients if diagnosis unclear and/or biopsy required Audit (centrally recorded list of virtual activity) Reliance on a non-dermatologist to communicate with patient Access from all hospital sites Equity of serviceopinions available for distant hospital sites Enhanced access to senior review Enhanced access to peer review Resident teaching using virtual ward rounds Typed dermatology opinion recorded on patient record

BACKGROUND: 40% of hepatitis B carriers have no knowledge of their diagnosis. A prior study in British Columbia suggested high rates of hepatitis B among immigrants. The authors undertook a large-scale screening study to validate these rates. METHODS: Attendees at Asian health fairs without knowledge of their hepatitis B status participated. They completed a questionnaire, and blood was drawn for HBV serologies. Active HBV was defined as HBV surface antigen positive. RESULTS: Of 2,726 patients, 1,704 (62.5%) were female and 1,022 (37.5%) male. Mean age was 62.7 ± 22.1 years, and mean time of residing in Canada was 27.5 ± 15.3 years. Most patients originated from China (1,042 patients, 38.2%) and Hong Kong (871, 31.2%). 56 patients tested positive (seroprevalence rate 2.05%, 95% CI 1.52%–2.59%). Most seropositive patients were from China (28 patients, 50.0%). Mean time of residence in Canada for seropositive patients (23.8 ± 2.1 years) was less than seronegative patients (27.6 ± 0.3 years) ( p = 0.06). There was a trend towards association of seropositivity with time of residence in Canada (OR 0.98, 95% CI 0.96–1.00, p = 0.09). 8 (14.3%) seropositive patients did not have family doctors, compared with 128 (4.8%) seronegative patients. Lack of a family doctor was strongly associated with seropositivity (OR 3.31, 95% CI 1.32–7.25, χ2 = 10.42, p = 0.001). INTERPRETATION: The authors have shown that high risk immigrant populations may have seroprevalence rates as high as 2,700 per 100,000. Lack of a family physician was associated with seropositivity. These results should be used to design improved outreach programs.