WHO

• The 15-minute city is all about accessibility, time efficiency and expanding options for everyone, not just the most well-off.
• Achieving this goal, and designing healthier spaces, begins with a comprehensive understanding of how urban environments impact our health and well-being — along with a realistic look at the current barriers to healthier urban design.

Designing better spaces

• Neighbourhoods with accessible public and community spaces and social events have been shown to improve mental health, increase happiness, and offer a sense of belonging and community.
• At the same time, readily accessible grocery stores, community gardens and farmers’ markets have been shown to enhance mental, social and physical health.
• This is where urban planning comes in as municipal policy-makers develop and implement policies, which can alter the structure, use and regulations of public spaces in cities.

Day-to-day challenges

• While the importance of physical and mental health was widely acknowledged, a glaring gap exists in the recognition of the social dimension of health.
• Administrative roadblocks, such as a lack of co-ordination between, and within, provincial and municipal governments, can prevent access to crucial data needed for policy making.
• Meanwhile, technical barriers — including the use of jargon and overly-technical language by the academic community — can interfere with the accessibility of academic literature.

• This lack of co-ordination among different branches and divisions within a municipality can result in missed opportunities for collaboration.
• Differences in the use of terminology can exacerbate the problem, causing confusion and impeding cross-sectoral work.
• Conflicts between the objectives of various divisions, such as those between active transportation planners and traffic engineers, underscore the challenges posed by siloed governance.
• 4 – Political ideologies get in the way Beyond bureaucratic challenges, differing political ideologies present a formidable barrier.

Overcoming these barriers

• The journey towards creating healthier and more equitable cities is riddled with challenges.
• From a lack of shared understanding, to inaccessible evidence, fragmented governance and legal limitations of municipalities and differing political ideologies, the barriers are multifaceted.

• Akram Mahani holds funding from SHRF (Saskatchewan Health Research Foundation) and CIHR (Canadian Institutes of Health Research).
• Nazeem Muhajarine receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada.

• Reflection paper on investigations of pharmacokinetics in
  the obese population
  Table of contents
  1.
• References .............................................................................................. 9

  Reflection paper on investigations of pharmacokinetics in the obese population
  EMA/CHMP/535116/2016

  Page 2/12

  1.

• This is considered
  a shortcoming that is potentially compounded by obese patients often being poorly represented in
  clinical studies.
• The specific aims of this reflection paper are to:
  ?

  describe how the effects of obesity can be investigated during clinical medicinal product
  development.

• ?

  provide recommendations on when investigations of the effect of obesity on the PK of a
  medicinal product should be particularly considered.

• Reflection paper on investigations of pharmacokinetics in the obese population
  EMA/CHMP/535116/2016

  Page 3/12

  ?

  discuss how to reflect PK (and/or PK/PD) findings in weight/weight-based dosing
  recommendations.

• Absorption
  Reduced rate of absorption linked to locally reduced blood flow (8) is reported for the subcutaneous
  and transdermal routes in obese subjects.
• Distribution
  The distribution of medicinal products is driven by body composition, regional blood flow and binding to
  tissue and plasma proteins.
• Obese subjects have a larger absolute lean body weight (LBW) as well as fat mass.
• The physicochemical properties of a medicinal product (lipophilicity, polarity, molecular size, and
  degree of ionization) influence its distribution in the body.
• In BMI class III obese
  subjects, the blood flow per gram of fat is significantly lower than that observed in class I obese or
  lean subjects (4).
• Reflection paper on investigations of pharmacokinetics in the obese population
  EMA/CHMP/535116/2016

  Page 4/12

  An increased amount of alpha-1-acid-glycoprotein (AAG), linked to a chronic inflammatory state, is
  reported in obese individuals.

• Fatty infiltrations are present in the liver for 90% of obese subjects, with the extent of the infiltrations
  being proportional to the degree of obesity.
• In some cases, in particular for CYP3A4 metabolized medicinal products,
  bodyweight normalized clearance can be lower in obese patients (23).
• Based on presently available data, it has been suggested that uptake transporters

  Reflection paper on investigations of pharmacokinetics in the obese population
  EMA/CHMP/535116/2016

  Page 5/12

  are downregulated while efflux transporters may be upregulated (31).

• Platelet hyper-reactivity is also observed,
  which can impair the response to anti-platelet medicinal products in obese patients (42, 43).
• Reflection paper on investigations of pharmacokinetics in the obese population
  EMA/CHMP/535116/2016

  Page 6/12

  3.

  the medicinal product properties and scientific literature indicate that obesity may lead to a
  marked effect on elimination and/or distribution or on the PK/PD relationship.

• These
  models may aid in extrapolating the known efficacy and safety in the non-obese population to the
  obese population.
• The Pharmacokinetics of the CYP3A Substrate Midazolam in Morbidly Obese Patients
  Before and One Year After Bariatric Surgery.
• Reflection paper on investigations of pharmacokinetics in the obese population
  EMA/CHMP/535116/2016

  Page 11/12

  41.

• Reflection paper on investigations of pharmacokinetics in the obese population
  EMA/CHMP/535116/2016

  Page 12/12

• With this in mind, the World Health Organisation (WHO) has put “healthy ageing” on its agenda.
• However, there is a difference between energy requirements and nutrient requirements, and nutrient requirements actually remain the same, if not increase, as we get older.
• This means we need to get more nutrients into less energy which can be tricky as older adults often have lower appetites.

How to spot when someone isn’t eating enough?

• However, it affects five in ten older people living in nursing homes, and seven in ten older people in hospital.
• And when older adults lose weight, they lose muscle, meaning that they are more likely to lose their abilities to do daily tasks.
• But clothing that’s too loose or a watchstrap that floats on the wrist are all warning signs of undernourishment.

Getting more nutrients into less food

• If people are eating small amounts of food, it is important to think about how to add more nutrients into it.
• A very effective technique, “fortification” is commonly done with pre-made products such as breakfast cereals, plant-based milk and bread in the UK.
• This versatile ingredient can be mixed into porridge before cooking or used it as a substitute for other powdered ingredients in baking.

Importance of physical activity and strength exercises

Physical activity and nutrition go hand-in-hand – both are equally important. As we age, being physically active becomes even more essential as it helps to prevent disease, maintains independence, decreases risk of falls, improves cognitive function, mental health and sleep.

• Often strength training gets ignored when we think of being active but to keep independence and prevent falls, older adults should do varied physical activity that emphasises balance and strength training at moderate or greater intensity on three or more days a week.
• Ultimately, it’s essential to contact a doctor or dietician with any worries or concerns about malnutrition or unintentional weight loss.

• Miriam Clegg receives funding from the Medical Research Council, Biotechnology and Biological Sciences Research Council, EIT Food, Horizon 2020, Apetito, and Tanita Healthy Weight Community Trust.
• She is affiliated with Association for Nutrition.

• PITTSBURGH, Feb. 12, 2024 /PRNewswire/ -- "I wanted to create a fun and exciting drinking game to enjoy at parties and with friends," said an inventor, from Bronx, N.Y., "so I invented WHO'S LIT- WE LIT.
• My design would offer a more engaging and entertaining activity than simply conversing and drinking."
• The invention provides a new drinking-themed board game for individuals ages 21 and older.
• 22-MBQ-347, InventHelp, 100 Beecham Drive, Suite 110, Pittsburgh, PA 15205-9801, or call (412) 288-1300 ext.