With increasing age, many older adults reduce and then stop driving. Increased depression may be among the consequences associated with driving reduction or cessation.

Living in low socioeconomic neighbourhoods, and in environments where healthy food is not readily available, is found to be associated with increased obesity risk. Unlike other studies which examined populations in other parts of the US, a positive association between living close to supermarkets and reduced obesity risk was not found in this study. A better understanding of the mechanisms by which neighbourhood physical characteristics influence obesity risk is needed.

Understanding factors that affect driving patterns in older adults, including medical and nonmedical reasons, will assist in developing both enhancements to extend safe driving years and responses to the consequences of driving reduction.

Introduction Accurate assessment of the impact of donor quality on liver transplant (LT) costs has been limited by the lack of a large, multicenter study of detailed clinical and economic data. Methods A novel, retrospective database linking information from the University HealthSystem Consortium and the OPTN registry was analyzed using multivariate regression to determine the relationship between donor quality (assessed through the Donor Risk Index (DRI)), recipient illness severity, and total inpatient costs (transplant and all readmissions) for 1 year following LT. Results Cost data were available for 9,059 LT recipients. Increasing MELD score, higher DRI, simultaneous liver kidney transplant, female gender and prior liver transplant were associated with increasing cost of LT (P<0.05). MELD and DRI interact to synergistically increase the cost of LT (P<0.05). Donors in the highest DRI quartile added close to $12,000 to the cost of transplantation and nearly $22,000 to post-transplant costs in comparison to the lowest risk donors. Among the individual components of the DRI, donation after cardiac death (increased $20,769 vs. brain dead donors) had the greatest impact on transplant costs. Overall one year costs were increased in older donors, minority donors, nationally shared organs, and those with cold ischemic times 7–13 hours (p<0.05 for all) Conclusion Donor quality, as measured by the DRI, is an independent predictor of LT costs in the perioperative and post-operative periods. Centers in highly competitive regions who transplant higher MELD patients with high DRI livers may be particularly affected by the synergistic impact of these factors.

Background and Purpose: A growing body of evidence documents multiple ways in which land use and transportation investments influence health. To date, most evidence linking the built environment to health either focuses on behavioral change or environmental exposures. Few studies simultaneously assess how behavior and exposure-based impacts of the built environment interact. This is concerning as increased walkability and transit access can possibly lead to increased exposure to air pollution and injury risk. Method: This paper synthesizes recent research on behavior and exposure-based mechanisms that connect land use and transportation investments with various health outcomes. Exploring the nexus between these pathways provides a framework to identify priority areas for research to inform policies and investments. Results: The most studied pathway articulates how land use and transportation can support healthy behaviors, such as increased physical activity, healthy diet, and social interactions. The second pathway articulates exposure to harmful substances and stressors and potential differential impacts by travel modes. Increased rates of active travel lead to lower generation of vehicle emissions and kilometers traveled; but may actually result in increased exposure which may have adverse effects on sensitive populations such as elderly and youth. Unhealthy exposures have historically concentrated in areas where the most disadvantaged reside-along major transportation corridors where land is cheapest and more affordable housing is located. Highlights • Synthesizes recent evidence on the link between built environment and health • Highlights the need to capture both behavior and exposure-based impacts • Few studies explicitly link built environment factors with clinical end points • Need longitudinal evidence that assesses unique and collective impacts of environmental and biological effects on disease and cost.