Changes in Green Space Use During a COVID-19 Lockdown Are Associated With Both Individual and Green Space Characteristics

Mobility restrictions imposed during the COVID-19 pandemic present a useful study system for understanding the temporal and spatial patterns of green space use. Here, we examine green space characteristics and sociodemographic factors associated with change in frequency of green space use before and during a COVID-19 lockdown in Brisbane, Australia drawing on a survey of 372 individuals. Applying regression analysis, we found that individuals who visited a different green space during lockdown than before tended to decrease their frequency of visits. In contrast, individuals who continued visiting their usual green space during lockdown were more inclined to increase their number of visits. Changes in frequency of green space use were also associated with particular characteristics of their usually visited green space. The presence of blue spaces and accessibility (carparks/public transport) were associated with increased frequency of use while foliage height diversity was associated with reduced frequency of use. We found that females were more likely to change their green space visitation frequency during COVID-19 compared to men and they also reported greater importance of green spaces for social and family interactions and spiritual reasons during COVID-19 compared to before. Males showed greater increases than females in the importance of green space for nature interactions and mental health benefits during the COVID-19 lockdown compared to before. Our results provide key insights for future resilient urban planning and policy that can fulfil a wide range of physical and psychological needs during a time of crisis and beyond. Copyright © 2022 Berdejo-Espinola, Zahnow, Suárez-Castro, Rhodes and Fuller.

The placement wellbeing project: A remote intervention to support student health and wellbeing whilst on practice placement

Keywords: Wellbeing;Placement Purpose: Physiotherapy students commencing their practice placement journeys in the Covid-19 pandemic experienced unique challenges. Prior to the pandemic there was already an exponential rise in student mental health needs and higher education institutions (HEIs) have been urged to be proactive in preparing to support students’ mental health. The Placement Wellbeing Project (PWP) was a newly constructed, remote intervention delivered using Microsoft Teams (MS Teams) and was piloted to support students’ health and wellbeing whilst on placement. Methods: This action research project used a single group, repeated measures design to explore the effect of the intervention on self-efficacy and coping skills in a cohort of 14 physiotherapy students. Ethical approval was gained from the Queen Margaret University Divisional Ethics Committee. Participants worked through a digital Placement Wellbeing Toolkit, which contained resources and activities to promote positive coping strategies for a range of challenges faced on placement. Participants then took part in a pre-placement peer group discussion facilitated by a wellbeing advisor using MS Teams and a placement de-briefing session after placement. Outcomes were measured using the Placement Coping Scale (PCS) and the General Self-Efficacy Scale (GSE). Scores were taken at baseline, pre-placement and post-placement. Qualitative feedback about the whole project was gained through a project evaluation. Results: Significant improvements were observed in the total PCS score (Friedman's test χ2(2) = 19.75, p = 0.000) and all individual items of the PCS from baseline to post-placement. Post hoc analysis (Bonferroni correction applied) detected significant improvements between baseline and pre-placement total PCS scores (p = 0.005). Improvements were observed across all items of the PCS between baseline and pre-placement score, however only item “I have strategies to help me cope with the challenges of placement” saw statistically significant improvements (p =.010). Total GSE scores improved significantly from baseline to final measure (Wilcoxon sum-rank test Z = 2.105, p =.035). Conclusion(s): The results of this study indicate that physiotherapy students may benefit from interventions aimed to develop positive coping strategies to prepare them for the challenges of placement. This intervention has been successfully delivered remotely which may allow for flexibility of future delivery. These results are in a single institution and further research is required to evaluate the project with a larger number of students at different institutions. Seeking to understand which parts of the intervention were most helpful and why, may also support the delivery of this project at scale. Impact: To develop a resilient future workforce we need to ensure that students are prepared for the challenges faced on placement and in the practice setting and can manage their own wellbeing in response to those challenges. This project has developed and evaluated a successful intervention which may be used in other HEIs in the UK. Furthermore, improving the coping skills of students on placement may support practice educators supervising students at this challenging time. Funding acknowledgements: No funding to declare.

The evaluation of a Peer Enhanced eLearning Placement (PEEP) in MSc Physiotherapy (pre-registration) education

Keywords: e-learning, Peer enhanced, Placement Purpose: COVID-19 has brought many challenges with the availability of practice placements a key issue in Physiotherapy education. The Peer Enhanced ePlacement (PEEP) model was therefore used to develop an alternative approach to the initial two-week placement in the first year of the MSc Physiotherapy (pre-registration) programme. The evaluation aimed to understand the student experience of undertaking an online PEEP placement and to help inform the development of future models of placement delivery. Methods: A online practice-based learning experience was developed, based on the PEEP model, which included the use of case histories and presentations delivered by practice-based educators and patient video diaries to follow a journey through a case. Individual learning activities, peer learning tasks, reflective blogs and simulation suite activities were all underpinned by completion of an interactive on-line workbook. The learning outcomes remained unchanged from the previously established initial placement. Two pre-placement tutorials were run to familiarise student with the PEEP model. Evaluation was completed via an online questionnaire and focused on pre-placement preparation, PEEP content, student learning, the placement experience, perceptions of student support and issues faced as a result of the PEEP model. Results: 93.9% of students felt expectations were clear and they were prepared for placement, with 81% reporting they met all the learning outcomes and 21% stating they met most of the learning outcomes. The students identified their top 3 learning activities as the simulation suite (56.4%), the patient journey (37.5%) and the case histories (31.3%). Reflective blogs were the least favourite activity (56.3%). Prior to the placement, there was some anxiety about the PEEP model with 12.1% reporting they were very anxious, 18.2% somewhat anxious and 45.5% a little anxious. This decreased to 18.2% having a little anxiety about the model post placement. Students reported the strengths of the model were the variety of teams the students met, the support of the small peer group in learning, the clear structure of the placement, following a patient journey and support from university staff. Barriers were described as internet stability, lack of hands-on learning, self-motivation when isolated at home, lack of one-to-one opportunities and feedback, as well as not seeing real time patient assessment. Conclusion(s): The PEEP model provided an effective alternative model for an initial placement experience. The information provided to students ahead of the placement was valuable in setting expectations although anxiety was still apparent. The students valued the range of experiences provided which was potentially an enhancement from a more traditional model of delivery. The barriers were similar to other digital learning experiences. The evaluation will allow specific issues raised to be addressed in further iterations of this model. Impact: The PEEP model has previously been used to deliver placements for AHP students who have already experienced traditional models of practice based learning. This evaluation demonstrates the model is effective in providing a first experience of practice-based learning to physiotherapy students. As we move forward, we must utilise a variety of placement models to embrace all practice-based learning opportunities Funding acknowledgements: This placement evaluation was funded by NHS Education Scotland (NES).

Vitamin d and inflammation: potential implications for severity of COVID-19

Background: Recent research has indicated that vitamin D may have immune supporting properties through modulation of both the adaptive and innate immune system through cytokines and regulation of cell signalling pathways. We hypothesize that vitamin D status may influence the severity of responses to Covid-19 and that the prevalence of vitamin D deficiency in Europe will be closely aligned to Covid-19 mortality.

Perspective: Vitamin D deficiency and COVID-19 severity - plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis.

BACKGROUND: SARS-CoV-2 coronavirus infection ranges from asymptomatic through to fatal COVID-19 characterized by a 'cytokine storm' and lung failure. Vitamin D deficiency has been postulated as a determinant of severity. OBJECTIVES: To review the evidence relevant to vitamin D and COVID-19. METHODS: Narrative review. RESULTS: Regression modelling shows that more northerly countries in the Northern Hemisphere are currently (May 2020) showing relatively high COVID-19 mortality, with an estimated 4.4% increase in mortality for each 1 degree latitude north of 28 degrees North (P = 0.031) after adjustment for age of population. This supports a role for ultraviolet B acting via vitamin D synthesis. Factors associated with worse COVID-19 prognosis include old age, ethnicity, male sex, obesity, diabetes and hypertension and these also associate with deficiency of vitamin D or its response. Vitamin D deficiency is also linked to severity of childhood respiratory illness. Experimentally, vitamin D increases the ratio of angiotensin-converting enzyme 2 (ACE2) to ACE, thus increasing angiotensin II hydrolysis and reducing subsequent inflammatory cytokine response to pathogens and lung injury. CONCLUSIONS: Substantial evidence supports a link between vitamin D deficiency and COVID-19 severity but it is all indirect. Community-based placebo-controlled trials of vitamin D supplementation may be difficult. Further evidence could come from study of COVID-19 outcomes in large cohorts with information on prescribing data for vitamin D supplementation or assay of serum unbound 25(OH) vitamin D levels. Meanwhile, vitamin D supplementation should be strongly advised for people likely to be deficient.