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Climate change presents an unprecedented public health challenge as it has a great impact on population health outcomes across the global population. The key to addressing these health challenges is adaptation carried out in cities through collaboration between institutions, including public health ones. Through semi-structured interviews ( n = 16), this study investigated experiences and perceptions of what public health aspects are considered by urban and public health planners and researchers when planning climate change adaptation in the coastal cities of Söderhamn (Sweden), Porto (Portugal) and Navotas (the Philippines). Results of the thematic analysis indicated that participating stakeholders were aware of the main climate risks threatening their cities (rising water levels and flooding, extreme temperatures, and air pollution). In addition, the interviewees talked about collaboration with other sectors, including the public health sector, in implementing climate change adaptation plans. However, the inclusion of the public health sector as a partner in the process was identified in only two cities, Navotas and Porto. Furthermore, the study found that there were few aspects pertaining to public health (water and sanitation, prevention of heat-related and water-borne diseases, and prevention of the consequences associated with heat waves in vulnerable groups such as children and elderly persons) in the latest climate change adaptation plans posted on each city's website. Moreover, participants pointed to different difficulties: insufficient financial resources, limited intersectoral collaboration for climate change adaptation, and lack of involvement of the public health sector in the adaptation processes, especially in one of the cities in which climate change adaptation was solely the responsibility of the urban planners. Studies using larger samples of stakeholders in larger cities are needed to better understand why the public health sector is still almost absent in efforts to adapt to climate change.

The images of cities before, during and after the COVID-19 pandemic represent a contemporary challenge. During this period, thinking about being a person, being there and living in an ableist city/society brings to light the loss of rights and the demands of population segments, particularly in the face of architectural, communicational, attitudinal, sensory and sociocultural barriers. To thematize about experiencing the different types of daily inaccessibility in the cities come into contact with and raise discussions about the ethical-aesthetic level of the existential territories of people with disabilities and mental suffering. To what extent do urban planners maintain concepts that support invisibility constructs, which reflect segregations generated by macropolitics? Would they be imagining the cities without thinking about the people who inhabit them? The present essay collaborates with the debate on the need for actions aimed at overcoming capacitism. Based on critical science theories and the concept of the health subject's right, the "topic landscape" is explored with a view to implementing accessible and inclusive public policies.

Background: Urbanisation in Latin America (LA) is heterogeneous and could have varying implications for infant mortality (IM). Identifying city factors related to IM can help design policies that promote infant health in cities., Methods: We quantified variability in infant mortality rates (IMR) across cities and examined associations between urban characteristics and IMR in a cross-sectional design. We estimated IMR for the period 2014-2016 using vital registration for 286 cities above 100 000 people in eight countries. Using national censuses, we calculated population size, growth and three socioeconomic scores reflecting living conditions, service provision and population educational attainment. We included mass transit availability of bus rapid transit and subway. Using Poisson multilevel regression, we estimated the per cent difference in IMR for a one SD (1SD) difference in city-level predictors., Results: Of the 286 cities, 130 had <250 000 inhabitants and 5 had >5 million. Overall IMR was 11.2 deaths/1000 live births. 57% of the total IMR variability across cities was within countries. Higher population growth, better living conditions, better service provision and mass transit availability were associated with 6.0% (95% CI -8.3 to 3.7%), 14.1% (95% CI -18.6 to -9.2), 11.4% (95% CI -16.1 to -6.4) and 6.6% (95% CI -9.2 to -3.9) lower IMR, respectively. Greater population size was associated with higher IMR. No association was observed for population-level educational attainment in the overall sample., Conclusion: Improving living conditions, service provision and public transportation in cities may have a positive impact on reducing IMR in LA cities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Scholars have determined that low socioeconomic status (SES) is associated with unhealthy dietary behaviours and that local food environments shape food inequality. Less is known about how residents' perceptions of their food environment affect their dietary behaviours. We conducted 37 semistructured interviews and 29 focus groups in three socioeconomically distinct neighbourhoods in Madrid. We identified the following main categories related to social and physical food environments: (a) perceptions of healthy and unhealthy dietary behaviours, (b) children's relationships with food, (c) precariousness and (d) residential food retailer types. Older adults were perceived as healthier consumers, whereas younger people were identified as fast-food consumers. In the low- and middle-SES neighbourhoods, residents saw home-cooked legume-based stews as healthy food. In the high-SES neighbourhood, television cooking programs were highlighted as a positive influence. In the low- and middle-SES neighbourhoods, grandparents played an essential role in the transmission of healthy eating habits to their grandchildren. In the high-SES neighbourhood, children's diets at home were determined by school menus. In the low- and middle-SES neighbourhoods, participants talked about a black market where food could be purchased. Food retailers with low-quality foods were also highlighted. In all neighbourhoods, residents missed traditional food stores, and in the low- and middle-SES neighbourhoods, immigrant-run food stores were not well accepted. Our study presents the concepts shaping how neighbourhood SES differences affect dietary behaviours according to residents of a large Mediterranean city., Competing Interests: Declaration of competing interest The authors of this article do not report any conflicts of interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Nicarbazin is an anti-coccidial product sometimes used as a contraceptive to reduce the size of feral pigeon populations. However, its effectiveness in reducing pigeon population size in cities has caused some controversy. Here, we evaluate its effectiveness in the city of Barcelona., Results: In 2017, the Barcelona City Council set 23 feeding stations with nicarbazin and ten with placebo (untreated corn). Censuses were undertaken before and after one year of treatment, within a 200-m radius around each feeder. We also censused 28 circles of 200 m radius distributed randomly 200 m from the feeders and 28 circles > 500 m from the feeders, which acted as controls. Population size across the whole city was also evaluated pre- and post treatment. We found that feral pigeon density did not change after one year of treatment, either in the circles around feeding stations with nicarbazin or in the areas around control stations at 200 and > 500 m from the feeders. Population size in placebo circles rose after a year by 10%. A pigeon census for the whole of Barcelona showed a 10% increase., Conclusion: Overall, our results indicate that the nicarbazin treatment had no effect on feral pigeon population size, and we advise against its use as a pigeon control method, at least in large cities., (© 2020 Society of Chemical Industry.)

Introduction: Cities are the world's engines of economic growth, innovation, and social change, but they are also hot spots for human exposure to air pollution, mainly originating from road traffic. As the urban population continues to grow, a greater quantity of people risk exposure to traffic-related air pollution (TRAP), and therefore also risk adverse health effects. In many cities, there is scope for further improvement in air quality through targeted urban policy interventions. The objective of this protocol is to detail the methods that will be used for a systematic evidence map (SEM) which will identify and characterize the evidence on policy interventions that can be implemented at the urban-level to reduce traffic emissions and/or TRAP from on-road mobile sources, thus reducing human exposures and adverse health impacts., Methods: Articles will be searched for and selected based on a predetermined search strategy and eligibility criteria. A variety of databases will be searched for relevant articles published in English between January 1, 2000 and June 1, 2020 to encompass the interdisciplinary nature of this SEM, and articles will be stored and screened using Rayyan QCRI. Predetermined study characteristics will be extracted and coded from included studies in a Microsoft Excel sheet, which will serve as an open access, interactive database, and two authors will review the coded data for consistency. The database will be queryable, and various interactive charts, graphs, and maps will be created using Tableau Public for data visualization. The results of the evidence mapping will be detailed via narrative summary., Conclusion: This protocol serves to increase transparency of the SEM methods and provides an example for researchers pursuing future SEMs., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Speeding is responsible for countless traffic collisions and road traffic injuries (RTIs) around the world. It threatens the lives of passengers in motor vehicles as well as the safety of other individuals sharing the public roads. Little evidence has been provided by low- and middle-income countries on speed transgression patterns., Objective: To document the prevalence of speeding in motor vehicles with four or more wheels and to analyse the associated factors in four Mexican cities., Methods: We conducted a cross-sectional study in the cities of Guadalajara-Zapopan, León, Cuernavaca and Villahermosa. Data on speed, drivers, vehicles, road infrastructure and the environment were collected from a randomly selected sample of urban road segments. We identified the factors associated with speeding through a logistic multiple regression model., Results: With an overall prevalence of 47% (95% CI 45.83 to 48.18), speeding occurred most frequently in Villahermosa (61.07%, 95% CI 59.10 to 63.01) as compared to León (51%, 95% CI 48.07 to 53.92), Cuernavaca (47.6%, 95% CI 45.35 to 49.85) and Guadalajara-Zapopan (20.76%, 95% CI 18.75 to 22.88). Speeding increased in the afternoons, on roads with numerous lanes, on Thursdays and Sundays and in foggy weather, but decreased in cities with speed control strategies and on roads with low visibility. No differences were observed between sexes or among age groups., Conclusions: Evidence from our study highlights the urgent need to implement speed control measures such as changes in road infrastructure and design, and to promote comprehensive speeding legislation aimed at reducing exposure to this important risk factor., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Urbanization changes the landscape structure and ecological processes of natural habitats. While urban areas expose animal communities to novel challenges, they may also provide more stable environments in which environmental fluctuations are buffered. Species´ ecology and physiology may determine their capacity to cope with the city life. However, the physiological mechanisms underlying organismal responses to urbanization, and whether different physiological systems are equally affected by urban environments remain poorly understood. This severely limits our capacity to predict the impact of anthropogenic habitats on wild populations. In this study, we measured indicators of physiological stress at the endocrine, immune and cellular level (feather corticosterone levels, heterophil to lymphocyte ratio, and heat-shock proteins) in urban and non-urban European blackbirds (Turdus merula) across 10 European populations. Among the three variables, we found consistent differences in feather corticosterone, which was higher in non-urban habitats. This effect seems to be dependent on sex, being greater in males. In contrast, we found no significant differences between urban and non-urban habitats in the two other physiological indicators. The discrepancy between these different measurements of physiological stress highlights the importance of including multiple physiological variables to understand the impact of urbanization on species' physiology. Overall, our findings suggest that adult European blackbirds living in urban and non-urban habitats do not differ in terms of physiological stress at an organismal level. Furthermore, we found large differences among populations on the strength and direction of the urbanization effect, which illustrates the relevance of spatial replication when investigating urban-induced physiological responses., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This paper analyzed the Burnout Syndrome (BS) among the managers of the Family Health Strategy (ESF) in the city of Rio de Janeiro and its associations with factors that influence the presence/absence of BS among these professionals. This is a descriptive study that used data from a questionnaire consisting of two parts: 1) manager profile and factors that could influence the presence of Burnout; 2) Maslach Burnout Inventory. The return rate was 63.5% (143) of the 225 questionnaires sent. The ESF managers are generally nurses (68.6%), young (63.6% under 39 years) female (76.9%), who have acted as managers for less than 5 years (85.2%). A BS presence was identified in 11.2% of the managers. The factors of an organizational nature were those that obtained the highest number of variables with an association. These data point to the need to make changes in the organizational practices of services and changes in work processes. Further studies on these issues can contribute to this.

Background: Transportation systems have an essential role in satisfying individuals' needs for mobility and accessibility. Yet, they have been linked to several adverse health impacts, with a large, but modifiable, burden of disease. Among the several transportation-related health risk factors, this study focused on transportation-related noise as an emerging exposure whose burden of disease remains partially recognized. We compared premature deaths potentially attributable to transportation-related noise with deaths from motor vehicle crashes, a well-researched and widely recognized transportation risk factor., Method: We employed a standard burden of disease assessment framework to quantify premature cardiovascular diseases mortality attributable to transportation-related (road and aviation) noise at the census tract level (n = 592) in Houston, Texas. The results were compared to motor vehicle crash fatalities, which are routinely observed and collected in the study area. We also investigated the distribution of premature deaths across the city and explored the relationship between household median income and premature deaths attributable to transportation-related noise., Results: We estimated 302 (95% CI: 185-427) premature deaths (adults 30-75 years old) attributable to transportation-related noise in Houston, compared to 330 fatalities from motor vehicle crashes (adults younger than 75 years old). Transportation-related noise and motor vehicle crashes were responsible for 1.7% and 1.9% of all-cause premature deaths in Houston, respectively. Households with lower median income had a higher risk of adverse exposure and premature deaths potentially attributable to transportation-related noise. A larger number of premature deaths was associated with living in the central business district and the vicinity of highways and airports., Conclusion: This study highlighted the significant contribution of transportation-related noise and motor vehicle crashes to premature deaths in the city of Houston. The analogy between the estimated premature deaths attributable to transportation-related noise and motor vehicle crashes showed that the health impacts of transportation-related noise were as significant as motor vehicle crashes. The estimated premature death rate attributable to transportation-related noise was also comparable to the death rate caused by suicide, influenza, or pneumonia in the US. There is an urgent need for imposing policies to reduce transportation noise emissions and human exposures and to equip health impact assessment tools with a noise burden of disease analysis function., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Street-level environment characteristics influence the health behaviors and safety of urban residents, and may particularly threaten health within informal communities. However, available data on how such characteristics vary within and among informal communities is limited. We sought to adapt street audit strategies designed to characterize the physical environment for use in a large informal community, Rio das Pedras (RdP) located in Rio de Janeiro, Brazil. A smartphone-based systematic observation protocol was used to gather street-level information for a high-density convenience sample of street segments (N = 630, estimated as 86% of all street segments in the community). We adapted items related to physical disorder and physical deterioration. Measures selected to illustrate the approach include the presence of the following: (1) low-hanging or tangled wires, (2) litter, (3) structural evidence of sinking, and (4) an unpleasant odor. Intercept-only spatial generalized additive models (GAM) were used to evaluate and visualize spatial variation within the RdP community. We also examined how our estimates and conclusions about spatial variation might have been affected by lower-density sampling from random subsets street observations. Random subsets were selected to determine the robustness of study results in scenarios with sparser street sampling. Selected characteristics were estimated to be present for between 18% (unpleasant odor) to 59% (low-hanging or tangled wires) of the street segments in RdP; estimates remain similar (± 6%) when relying on a random subset created to simulate lower-density spatial sampling. Spatial patterns of variation based on predicted probabilities across RdP differed by indicator. Structural sinking and low-hanging or tangled wires demonstrated relatively consistent spatial distribution patterns across full and random subset sample sizes. Smartphone-based systematic observations represent an efficient and potentially feasible approach to systematically studying neighborhood environments within informal communities. Future deployment of such tools will benefit from incorporating data collection across multiple time points to explore reliability and quantify neighborhood change. These tools can prove useful means to assess street-level exposures that can be modifiable health determinants across a wide range of informal urban settings. Findings can contribute to improved urban planning and provide useful information for identifying potential locations for neighborhood-scaled interventions that can improve living conditions for residents in Rio das Pedras.

Background: Prenatal and early childhood lead exposures have been associated with reduced weight in infants and young children, while studies that have examined such associations in children during peripubescence are rare., Objectives: We investigated the associations of prenatal and early-life exposure to lead with indices of adiposity in peripubertal children living in Mexico City., Methods: Maternal bone lead (as a proxy for cumulative fetal exposure) was assessed at 1 month postpartum. Blood samples were obtained from children annually from 1 to 4 years. Multivariable linear regression models were used to examine the association between each lead biomarker and BMI z-score, waist circumference, sum of skinfolds and body fat percentage in 248 children aged 8-16 years., Results: After adjusting for covariates, maternal patella lead was associated with lower child BMI z-score (β = -0.02, 95% CI: 0.03, -0.01, p = 0.004), waist circumference (β = -0.12 cm, 95% CI: 0.22, -0.03, p = 0.01), sum of skinfolds (β = -0.29 mm, 95% CI: 0.50, -0.08, p = 0.007) and body fat percentage (β = -0.09%, 95% CI: 0.17, -0.01, p = 0.03). No significant associations were detected from the postnatal exposure period., Conclusions: We observed a significant and inverse association of prenatal lead exposure with body composition in Mexican children, suggesting the potential role of early lead exposure in the fetal programming of child growth. Further research on the biological mechanisms underlying these associations is needed., (Copyright © 2019. Published by Elsevier GmbH.)

Urban areas in Europe are facing a range of environmental public health challenges, such as air pollution, traffic noise and road injuries. The identification and quantification of the public health risks associated with exposure to environmental conditions is important for prioritising policies and interventions that aim to diminish the risks and improve the health of the population. With this purpose in mind, the EURO-HEALTHY project used a consistent approach to assess the impact of key environmental risk factors and urban environmental determinants on public health in European metropolitan areas. A number of environmental public health indicators, which are closely tied to the physical and built environment, were identified through stakeholder consultation; data were collected from six European metropolitan areas (Athens, Barcelona, Lisbon, London, Stockholm and Turin) covering the period 2000-2014, and a health impact assessment framework enabled the quantification of health effects (attributable deaths) associated with these indicators. The key environmental public health indicators were related to air pollution and certain urban environmental conditions (urban green spaces, road safety). The air pollution was generally the highest environmental public health risk; the associated number of deaths in Athens, Barcelona and London ranged between 800 and 2300 attributable deaths per year. The number of victims of road traffic accidents and the associated deaths were lowest in the most recent year compared with previous years. We also examined the positive impacts on health associated with urban green spaces by calculating reduced mortality impacts for populations residing in areas with greater green space coverage; results in Athens showed reductions of all-cause mortality of 26 per 100,000 inhabitants for populations with benefits of local greenspace. Based on our analysis, we discuss recommendations of potential interventions that could be implemented to reduce the environmental public health risks in the European metropolitan areas covered by this study., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose of Review: By 2050, 70% of the global population will live in urban areas, exposing a greater number of people to specific city-related health risks that will only be exacerbated by climate change. Two prominent health risks are poor air quality and physical inactivity. We aim to review the literature and state the best practices for clean air and active transportation in urban areas., Recent Findings: Cities have been targeting reductions in air pollution and physical inactivity to improve population health. Oslo, Paris, and Madrid plan on banning cars from their city centers to mitigate climate change, reduce vehicle emissions, and increase walking and cycling. Urban streets are being redesigned to accommodate and integrate various modes of transportation to ensure individuals can become actively mobile and healthy. Investments in pedestrian, cycling, and public transport infrastructure and services can both improve air quality and support active transportation. Emerging technologies like electric and autonomous vehicles are being developed and may reduce air pollution but have limited impact on physical activity. Green spaces too can mitigate air pollution and encourage physical activity. Clean air and active transportation overlap considerably as they are both functions of mobility. The best practices of clean air and active transportation have produced impressive results, which are improved when enacted simultaneously in integrated policy packages. Further research is needed in middle- and low-income countries, using measurements from real-world interventions, tracing air pollution back to the sources responsible, and holistically addressing the entire spectrum of exposures and health outcomes related to transportation.

Phlebotomine sand flies are small insects of great medical importance. This study presents new records of phlebotomine sand flies, which augment the list of species, recorded in the state of Alagoas, Brazil. Sand flies were collected using CDC miniature light traps. Collections were made between November 2008 and April 2016, in 47 municipalities within the state of Alagoas. Twenty-seven thousand two-hundred forty-four sand flies were collected, representing 18 species in seven genera. Lutzomyia longipalpis was the predominant species (85.4% of total), and it was recorded in all biomes. Three species (Evandromyia evandroi (Costa Lima and Antunes 1936), Evandromyia tupynambai (Mangabeira 1942), and Pressatia choti (Floch and Abonnenc 1941)) were collected in coastal and Atlantic forest biomes; five species (Lutzomyia villelai (Mangabeira 1942), Micropygomyia oswaldoi (Mangabeira 1942), Nyssomyia umbratilis (Ward and Frahia 1977), Nyssomyia intermedia (Lutz and Neiva 1912), and Nyssomyia whitmani (Antunes and Coutinho 1939)) were collected in Atlantic forest and Caatinga biomes. The species Evandromyia corumbaensis (Galati, Nunes, Oshiro and Rego 1989) and Psathyromyia naftalekatzi (Falcão, Andrade-Filho, Almeida and Brandão-Filho 2000) were found only in the coastal zones. This work provides an updated list of the phlebotomine sand flies of Alagoas, with some notes on their taxonomy, ecology, distribution, and epidemiological relevance., (© The Author(s) 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Within the MSM population, men who have sex with both men and women (MSMW) are identified as a high-risk group both worldwide and in Europe. In a multi-centred bio-behavioural cross-sectional study, we aimed to assess the relationship(s) between socio-demographic factors, stigma, sexual behavioural patterns, test seeking behaviour and sero-status amongst MSMW. A multi-level analysis was conducted to identify factors associated with being MSMW versus Men who have Sex with Men Only (MSMO). A total of 4901 MSM were enrolled across the 13 study sites. Participants were categorised as MSMW in the 12.64% of the cases. Factors such as educational status, perceived homonegativity, testing facilities knowledge and HIV testing lifetime seem to be relevant factors when characterising the MSMW group. The results highlight the vulnerability of MSMW and the wide spectrum of risky behavioural and psycho-social patterns, particularly in terms of HIV testing, 'outness', and perceived stigma.

It has been suggested that certain residents, such as those with a low socioeconomic status, the elderly, and women, may benefit more from the presence of neighbourhood green space than others. We tested this hypothesis for age, gender, educational level, and employment status in four European cities. Data were collected in Barcelona (Spain; n = 1002), Kaunas (Lithuania; n = 989), Doetinchem (The Netherlands; n = 847), and Stoke-on-Trent (UK; n = 933) as part of the EU-funded PHENOTYPE project. Surveys were used to measure mental and general health, individual characteristics, and perceived neighbourhood green space. Additionally, we used audit data about neighbourhood green space. In Barcelona, there were positive associations between neighbourhood green space and general health among low-educated residents. In the other cities and for the other population groups, there was little evidence that the association between health and neighbourhood green space differed between population groups. Overall, our study does not support the assumption that the elderly, women, and residents who are not employed full-time benefit more from neighbourhood green space than others. Only in the highly urbanised city of Barcelona did the low-educated group benefit from neighbourhood green spaces. Perhaps neighbourhood green spaces are more important for the health of low-educated residents in particularly highly urbanised areas., Competing Interests: The authors have declared that no competing interests exist.