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Objective: To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil., Methods: This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden., Results: The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%)., Conclusion: The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Aims: Inequalities in diabetes prevalence among immigrants from Andean countries remain unknown. Andean populations are one of the largest groups of immigrants in Madrid city. We examined the association between country of birth and type 2 diabetes mellitus (T2DM) prevalence in Andean immigrant population relative to Spanish-natives; and whether this association varied by age, sex and length of residence., Methods: We analyzed 1,258,931 electronic medical records from Spanish native and Andean immigrant adults aged 40-75 years of Madrid city. We used logistic regression and test interaction terms to address our aims., Results: Andean immigrants showed 1.13 (95% CI 1.10-1.17) greater adjusted odds for T2DM than Spanish natives. This association was positive in Ecuadorians and Bolivians but protective in Peruvians and Colombians. There was heterogeneity of this association according to age and sex. Relative to Spanish natives, odds of T2DM in Andeans of all ages and women were higher but lower in men., Conclusion: Andean adults showed greater odds of T2DM compared with Spanish native adults in Madrid, with variation observed by age and sex. These findings emphasize the need for studying immigrant populations in a disaggregated manner to implement specific clinical and preventive approaches.

Introduction: CYP2C9 metabolizes approximately 15% of the prescribed drugs. Its gene has alleles whose frequencies differ between ethnic groups and populations. The alleles CYP2C9*2 and CYP2C9*3 account for an enzyme with decreased activity and their frequencies have not been determined in the Peruvian mestizo population. Objective: To characterize the frequencies of the allelic variants *2 (rs1799853) and *3 (rs1057910) of CYP2C9 gen in the Peruvian mestizo population from Lima, Tacna y Junín. Materials and methods: We conducted an observational, prospective cross-sectional study with non-probabilistic, by convenience, and incidental sampling. We included 218 subjects according to the inclusion and exclusion criteria, all of whom had signed the informed consent. We obtained the genomic DNA from oral mucosa swab. For the detection of the CYP2C9*2 and CYP2C9*3 genotypes, we used real-time-polymerase chain reaction with TaqMan® probes. Results: The genotyping revealed that CYP2C9*2 and CYP2C9*3 variants have low frequencies (0.046 and 0.062, respectively). The frequency of intermediate metabolizers was 15.13% (CYP2C9*1/*2: 5.96%; CYP2C9*1/*3: 9.17%) and that of slow metabolizers was 3.22% (CYP2C9*2/*2: 1.38%; CYP2C9*3/*3: 1.38%; CYP2C9*2/*3: 0.46%). Conclusions: It was possible to determine the genotypic and allelic frequencies for the variants *2 and *3 of the CYP2C9 gene in a non-probabilistic sample of the Peruvian mestizo population. The frequencies obtained (0.046 and 0.062, respectively) corresponded to those expected for a South American mestizo population with Amerindian, European, African and Asian ancestry.

Introduction: The HapMap and the 1000 Genomes projects have been important for understanding the genetic component of common diseases and normal phenotypes. However, the Colombian genetic variability included in these projects is not fully representative of our country. Objective: To contribute to the knowledge of the Colombian genetic variability through the genomic study of a sample of individuals from Bogotá. Materials and methods: A total of 2,372,784 genetic markers were genotyped in 32 individuals born in Bogotá whose parents are from the same region, using the Illumina™ platform. The genetic variability levels were determined and compared with the data available from other populations of the 1000 Genomes Project. Results: The genetic variability detected in the individuals from Bogotá was similar to those with shared ancestry. However, despite the low levels of genetic differentiation between Bogotá and Medellín, populations the principal component analysis suggested a different genetic composition in them. Conclusions: Our genomic analysis of a Bogotá sample allowed us to detect similarities and differences with other American populations. The increase of the Bogotá sample and the inclusion of samples from other regions of the country will improve our understanding of the genetic variability in Colombia, essential for studies of human health and the prevention and treatment of common diseases in our country.

Ethnic-racial classification criteria are widely recognized to vary according to historical, cultural and political contexts. In Brazil, the strong influence of individual socio-economic factors on race/colour self-classification is well known. With the expansion of genomic technologies, the use of genomic ancestry has been suggested as a substitute for classification procedures such as self-declaring race, as if they represented the same concept. We investigated the association between genomic ancestry, the racial composition of census tracts and individual socioeconomic factors and self-declared race/colour in a cohort of 15,105 Brazilians. Results show that the probability of self-declaring as black or brown increases according to the proportion of African ancestry and varies widely among cities. In Porto Alegre, where most of the population is white, with every 10% increase in the proportion of African ancestry, the odds of self-declaring as black increased 14 times (95%CI 6.08-32.81). In Salvador, where most of the population is black or brown, that increase was of 3.98 times (95%CI 2.96-5.35). The racial composition of the area of residence was also associated with the probability of self-declaring as black or brown. Every 10% increase in the proportion of black and brown inhabitants in the residential census tract increased the odds of self-declaring as black by 1.33 times (95%CI 1.24-1.42). Ancestry alone does not explain self-declared race/colour. An emphasis on multiple situational contexts (both individual and collective) provides a more comprehensive framework for the study of the predictors of self-declared race/colour, a highly relevant construct in many different scenarios, such as public policy, sociology and medicine., Competing Interests: The authors have declared that no competing interests exist.

Purpose: We employed a city-level ecologic analysis to assess predictors of race-specific (black and white) breast cancer mortality rates., Methods: We used data from the National Center for Health Statistics and the US Census Bureau to calculate 2010-2014 race-specific breast cancer mortality rates (BCMR) for 47 of the largest US cities. Data on potential city-level predictors (e.g., socioeconomic factors, health care resources) of race-specific BCMR were obtained from various publicly available datasets. We constructed race-specific multivariable negative binomial regression models to estimate rate ratios (RR) and 95% confidence intervals (CIs)., Results: Predictors of the white BCMR included white/black differences in education (RR 0.95; CI 0.91-0.99), number of religious congregations (RR 0.87; CI 0.77-0.97), and number of Medicare primary care physicians (RR 1.15; CI 1.04-1.28). Predictors of the black rate included white/black differences in household income (RR 1.03; CI 1.01-1.05), number of mammography facilities (RR 1.07; CI 1.03-1.12), and mammogram use (RR 0.93; CI 0.89-0.97)., Conclusions: Our ecologic analysis found that predictors of breast cancer mortality differ for the black and white rate. The results of this analysis could help inform interventions at the local level.

Introduction: Racial density has not yet been explored in studies of racial inequalities in Brazil. Thisstudy identified categories of racial density in Brazilian cities and described the living and health context in these categories in 2000 and 2010, when demographic censuses were conducted., Method: Ecological study which used skin color or race information from the last two censuses to calculate racial density (the ratio of people aggregated to the same racial group) of the Brazilian cities each year. Four categories of racial density (Brown; Mixed-race, predominantly black; White/Caucasian; and Mixed-race, predominantly white). Socioeconomic, demographic and health indicators were described to each category., Results: The categories of racial density captured important inequalities throughout the census and also indicated the continuance of worse living and health conditions in the cities composed by Browns and mixed-race people, predominantly Black; better conditions were indicated in cities where White/Caucasians are predominant. The cities, composed mainly of Browns and mixed-race people, predominantly Black, presented younger age structure, worse human development indexes, greater social vulnerability, income concentration, infant and premature mortality (<65 years) and lower life expectancy in both censuses, as compared to other cities., Discussion: Similarly to other countries, the racial density reflected inequalities in the Brazilian living and health context as well as a time lag among the cities., Conclusion: The categories of racial density may contribute to social epidemiology and race relations studies in Brazil.

Understanding determinants of urban health is of growing importance. Factors at multiple scales intertwine to influence health in cities but, with the growing autonomy of some cities from their countries, city population health may be becoming more a matter for city-level rather than national-level policy and action. We assess the importance of city, country, and macroregional (Western and East-Central Europe) scales to mortality change over time for 274 cities (population 80 million) from 27 European countries. We then investigate whether mortality changes over time are related to changes in city-level affluence. Using Urban Audit data, all-age all-cause standardised mortality ratios (SMRs) for males and females were calculated at three time points (wave one 1999-2002, wave two 2003-2006, and wave three 2007-2009) for each city. Multilevel regression was used to model the SMRs as a function of survey wave and city region gross domestic product (GDP) per 1000 capita. SMRs declined over time and the substantial East-West gap narrowed slightly. Variation at macroregion and country scales characterised SMRs for women in Western and East-Central European cities, and SMRs for men in East-Central European cities. Between-city variation was evident for male SMRs in Western Europe. Changes in city-region GDP per capita were not associated with changes in mortality over the study period. Our results show how geographical scales differentially impact urban mortality. We conclude that changes in urban health should be seen in both city and wider national and macroregional contexts., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: Dengue is a priority public health problem. During epidemics in Cuba and Haiti, ethnic African descendant population had lower risk of dengue, and the ethnic factor was proposed as a protective one., Objective: To determine the relation between the Dengue's cumulative incidence and the Afro-Colombian proportion in communities of Cali, during the epidemic of 2013., Methods: This study was conducted in Cali, Colombia. The design was ecological, using information from the National Census 2005 projected to 2013, from the National Administrative Department of Statistics (DANE), and the National Epidemiological Surveillance System. It was obtained the Pearson´s correlation coefficient between cumulative incidence and the proportion of Afro-Colombian population by communities. Additionally, the cumulative incidences of dengue were evaluated in two zones with different proportion of Afro-Colombian population. The association was also evaluated for aggregation bias, confounding by social variables, and interaction by area of ​​residence., Results: Dengue´s cumulative incidence was significantly lower for Afro-Colombians regardless of the proportion of Afro-Colombian population in the area of residence. The relative risk of dengue between non-Afro-Colombians and Afro-Colombians was 9.4 (95% CI=8.4-10.6) in zones with high proportion of Afro-Colombian population, while the relative risk of dengue was 4.0 (95% CI :3.6 - 4.4) in the zone with lower proportion of Afro-Colombian population. There was no evidence of aggregation bias or confounding in the association by social variables., Conclusions: The Afro-Colombian population had a significantly lower risk of getting dengue and its complications, compared with the non-Afro-Colombian population. The non-Afro-Colombian populations living in areas with a high proportion of Afro-Colombians increase their risk of dengue more than double, suggesting an asymptomatic viremic environment., Introducción: el dengue es un problema prioritario en salud pública. Durante epidemias en Cuba y Haití, la población étnica afro-descendiente tuvo menor riesgo de dengue. Por ello, se propuso el factor étnico como protector., Objetivo: Determinar la relación entre la incidencia acumulada de dengue y la proporción de población Afrocolombiana de Cali, durante la epidemia de 2013., Métodos: Este estudio se realizó en Cali, Colombia. El diseño fue ecológico, con información del Censo Nacional 2005 y su proyección a 2013 del DANE y del Sistema de entre las incidencias acumuladas de dengue y la proporción de afrocolombianos, según comunidades. Adicionalmente, fueron evaluadas las incidencias acumuladas de dos zonas con diferente proporción de habitantes afrocolombianos. También se evaluó la presencia del sesgo de agregación, de confusión por variables sociales y de interacción según la zona de residencia., Resultados: Para afrocolombianos, la incidencia acumulada de dengue fue significativamente menor, independientemente de la proporción de población afrocolombiana en la zona de residencia. El riesgo relativo de dengue entre no-afrocolombianos y afrocolombianos fue 9.4 (IC 95%= 8.4-10.6) en la zona con más alta proporción de población afrocolombiana, mientras que el riesgo relativo fue 4.0 (IC 95%= 3.6-4.4) en la zona de más baja proporción de población afrocolombiana. No se evidenció sesgo de agregación ni confusión de la asociación por variables sociales., Conclusiones: La población afrocolombiana presentó un riesgo significativamente menor de enfermar por dengue y sus complicaciones en comparación con no-afrocolombianos. La población no-afrocolombiana que reside en zonas con alta proporción de población afrocolombiana aumenta el riesgo de dengue a más del doble, lo cual sugiere un entorno virémico asintomático., Competing Interests: The authors declare no conflict of interest

Introduction: This paper presents race-specific lung cancer mortality rates and the corresponding rate ratios for the 50 largest U.S. cities for the 5-year intervals 1990-1994 and 2005-2009., Methods: The 50 largest cities in the U.S. were the units of analysis. Numerator data were abstracted from national death files where the cause was malignant neoplasms of trachea, bronchus, and lung (lung cancer) (ICD-9=162 and ICD-10=C33-C34). Population-based denominators were obtained from the U.S. Census Bureau for 1990, 2000, and 2010. To measure the racial disparity, we calculated non-Hispanic Black:non-Hispanic White rate ratios (RRs) and confidence intervals for each 5-year period. We calculated correlation coefficients for 12 ecological variables and the RRs., Results: At the final time point (2005-2009), 15RRs were less than 1, but only 8 significantly so while 29RRs were greater than 1, 16 of them significantly so. Of the 45 cities included in the analysis, 21 saw an increase in the Black:White RR between the first and second time points. Measures of socioeconomic status (SES) and inequalities therein were found to be associated with the RRs., Conclusion: This analysis revealed large disparities in Black:White lung cancer mortality in the U.S. and many of its largest cities during the period 1990-2009. The data demonstrate considerable variation in the degree of disparity across cities, even among cities within the same state. These data can inform and motivate local health officials to implement targeted prevention and treatment strategies where they are needed most, ultimately contributing to a reduction in the disparity in lung cancer mortality rates., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The socioeconomic and ethnic composition of urban neighbourhoods may affect mortality, but evidence on Central European cities is lacking. The aim of this study was to assess the associations between socioeconomic and ethnic neighbourhood indicators and the mortality of individuals aged 20-64 years old in the two biggest cities of the Slovak Republic., Methods: We obtained data on the characteristics of neighbourhoods and districts (educational level, unemployment, income and share of Roma) and on individual mortality of residents aged 20-64 years old, for the two largest cities in the Slovak Republic (Bratislava and Kosice) in the period 2003-2005. We performed multilevel Poisson regression analyses adjusted for age and gender on the individual (mortality), neighbourhood (education level and share of Roma in population) and district levels (unemployment and income)., Results: The proportions of Roma and of low-educated residents were associated with mortality at the neighbourhood level in both cities. Mutually adjusted, only the association with the proportion of Roma remained in the model (risk ratio 1.02; 95 % confidence interval 1.01-1.04). The area indicators - high education, income and unemployment - were not associated with mortality., Conclusion: The proportion of Roma is associated with early mortality in the two biggest cities in the Slovak Republic.

Introduction: Accurate conceptualizations of neighborhood environments are important in the design of policies and programs aiming to improve access to healthy food. Neighborhood environments are often defined by administrative units or buffers around points of interest. An individual may eat and shop for food within or outside these areas, which may not reflect accessibility of food establishments. This article examines the relevance of different definitions of food environments., Methods: We collected data on trips to food establishments using a 1-week food and travel diary and global positioning system devices. Spatial-temporal clustering methods were applied to identify homes and food establishments visited by study participants., Results: We identified 513 visits to food establishments (sit-down restaurants, fast-food/convenience stores, malls or stores, groceries/supermarkets) by 135 participants in 5 US cities. The average distance between the food establishments and homes was 2.6 miles (standard deviation, 3.7 miles). Only 34% of the visited food establishments were within participants' neighborhood census tract. Buffers of 1 or 2 miles around the home covered 55% to 65% of visited food establishments. There was a significant difference in the mean distances to food establishments types (P = .008). On average, participants traveled the longest distances to restaurants and the shortest distances to groceries/supermarkets., Conclusion: Many definitions of the neighborhood food environment are misaligned with individual travel patterns, which may help explain the mixed findings in studies of neighborhood food environments. Neighborhood environments defined by actual travel activity may provide more insight on how the food environment influences dietary and food shopping choices.

This study investigated the relationship between sufficient amounts of physical activity among Brazilian adolescents and the economic and social indicators of the cities where they live. Data from a large national survey including 109,104 boys and girls ages 13 to 15 yr. (47.8% boys, 52.2% girls) were analyzed. The economic and social indicators were the Human Development Index (HDI), which is a comparative measure to rank cities according to their degree of human development, the Gini index (income inequality), population density, and maternal education. Stepwise regression was used to identify associations between physical activity and economic and social indicators of the cities. The physical activity of Brazilian adolescents was associated with the social and economic conditions of the cities where they live. The amount of physical activity of girls was greater in the cities with fewer income inequalities. For boys, physical activity was greater in the cities with a higher HDI and fewer income inequalities.

Unlabelled: Our objective was to develop state and metropolitan area-based surveillance projects to describe the characteristics of those with ALS and to assist with evaluating the completeness of the National ALS Registry. Because the literature suggested that ethnic/racial minorities have lower incidence of ALS, three state and eight metropolitan areas were selected to over-represent ethnic/racial minorities to have a sufficient number of minority patients. Project activities relied on reports from medical providers and medical records abstraction. The project areas represented approximately 27% of the U.S., Population: The combined racial and ethnic distribution of these areas is 64.4% white, 16.0% African-American, 6.7% Asian, and 28.3% Hispanic. Most neurologists did not diagnose or provide care for ALS patients. The number of unique patients reported was close to expected (5883 vs. 6673). Age and gender distribution of patients was similar to the literature. The crude average annual incidence rate was 1.52 per 100,000 person-years, CI 1.44-1.61, and the 2009 prevalence rate was 3.84 per 100,000 population, CI 3.70-3.97. In conclusion, this study represents the largest number of clinically diagnosed ALS patients reported by neurologists in the U.S. Comparison of these data with those in the National ALS Registry will help evaluate the completeness of administrative databases.

Purpose: Recent studies have shown increased incidence of non-affective psychotic disorders (NAPD) among ethnic minorities compared to the native population, but not, or less so, in areas with a high own-group proportion. The aim is to investigate this ethnic density effect in Utrecht and whether this effect is due to higher rates of NAPD among Dutch persons in areas with high minority proportions. We also explore the geographical scale at which this effect occurs and the influence of social drift prior to NAPD., Methods: NAPD cases in the Psychiatric Case Registry Middle Netherlands (N = 2,064) and living in Utrecht during 2000-2009 were analyzed in a Poisson model in relation to both individual-level and district- vs. neighborhood-level characteristics., Results: With increasing minority density, especially of the neighborhood, the rate ratios of NAPD significantly decreased among both non-Western (from 2.36 to 1.24) and Western immigrants (from 1.63 to 1.01), in comparison with Dutch persons. This was partly explained by higher rates of NAPD among Dutch persons in areas with high minority density. But there was also a trend to lower NAPD rates among non-Western minorities in these areas (P = 0.074).This trend was significant among Surinamese/Antilleans (P = 0.001) and Moroccans aged 18-30 years (P = 0.046). Among the Dutch, a social drift to minority-dense neighborhoods prior to NAPD registration was found., Conclusions: Our findings support the beneficial association with own-group presence at the smaller scale neighborhood level. Findings show also that this association is more pronounced in immigrant vs. native comparisons and is not found within all ethnic groups.

Background: Congenital anomalies are a leading cause of infant death and disability and their incidence varies between ethnic groups in the UK. Rates of infant death are highest in children of Pakistani origin, and congenital anomalies are the most common cause of death in children younger than 12 in this ethnic group. We investigated the incidence of congenital anomalies in a large multiethnic birth cohort to identify the causes of the excess of congenital anomalies in this community., Methods: We obtained questionnaire data from the mothers of children with one or more anomalies from the Born in Bradford study, a prospective birth cohort study of 13,776 babies and their families in which recruitment was undertaken between 2007 and 2011. Details of anomalies were prospectively reported to the study and we cross checked these details against medical records. We linked data for anomalies to maternal questionnaire and clinical data gathered as part of the Born in Bradford study. We calculated univariate and multivariate risk ratios (RRs) with 95% CIs for various maternal risk factors., Findings: Of 11,396 babies for whom questionnaire data were available, 386 (3%) had a congenital anomaly. Rates for congenital anomaly were 305·74 per 10,000 livebirths, compared with a national rate of 165·90 per 10,000. The risk was greater for mothers of Pakistani origin than for those of white British origin (univariate RR 1·96, 95% CI 1·56-2·46). Overall, 2013 (18%) babies were the offspring of first-cousin unions. These babies were mainly of Pakistani origin--1922 (37%) of 5127 babies of Pakistani origin had parents in first-cousin unions. Consanguinity was associated with a doubling of risk for congenital anomaly (multivariate RR 2·19, 95% CI 1·67-2·85); we noted no association with increasing deprivation. 31% of all anomalies in children of Pakistani origin could be attributed to consanguinity. We noted a similar increase in risk for mothers of white British origin older than 34 years (multivariate RR 1·83, 95% CI 1·14-3·00). Maternal education to degree level was protective (0·53, 95% CI 0·38-0·75), irrespective of ethnic origin., Interpretation: Consanguinity is a major risk factor for congenital anomaly. The risk remains even after adjustment for deprivation, and accounts for almost a third of anomalies in babies of Pakistani origin. High levels of educational attainment are associated with reduced risk in all ethnic groups. Our findings will be valuable in health promotion and public health, and to those commissioning antenatal, paediatric, and clinical genetic services. Sensitive advice about the risks should be provided to communities at increased risk, and to couples in consanguineous unions, to assist in reproductive decision making., Funding: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care programme., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Little is known about the relationship between body composition and physical fitness in 14 year-old high school adolescents of South Africa. Baseline data from a longitudinal study on physical activity and health (PAHLS) may provide valuable information for future studies, hence to inform public health policy makers. The objectives of this study are to determine the prevalence of underweight, normal weight and overweight among adolescents aged 14 years in the Tlokwe Local Municipality of the North West Province of South Africa, and to assess the association between physical fitness and body composition separately for boys and girls, adjusted for race and locality., Methods: Body weight, height and triceps, and subscapular skinfolds of 256 adolescents (100 boys and 156 girls) aged 14 years were measured, and percentage body fat and body mass index (BMI) were calculated. BMI was used to determine underweight, normal weight and overweight based on the standard criterion. Physical fitness was assessed by standing broad jump, bent arm hang and sit-ups according to the EUROFIT fitness standard procedures. Multinomial logistic regression analyses stratified for gender and adjusted for race (black or white), and the locality (urban or township) of the schools were used to analyze the data., Results: In the total group 35.9% were underweight and 13.7% overweight. Boys were more underweight (44%) than girls (30.7%). The prevalence of overweight was 8% in boys and 17.3% in girls. BMI was strongly (p = 0.01) related with percentage body fat. Strong and significant positive associations between physical fitness and BMI for the underweight girls with high physical fitness scores (OR, 10.69 [95%CI: 2.81-40.73], and overweight girls with high physical fitness scores (OR, 0.11 [95%CI: 0.03-0.50]) were found. Non-significant weaker positive relationship between physical fitness and BMI for the underweight boys with high physical fitness scores (OR, 1.80 [95%CI: 0.63-5.09]), and the overweight boys with high physical fitness scores (OR, 0.18 [95%CI: 0.02-1.78]) were found., Conclusion: Both underweight and overweight among boys and girls in Tlokwe Local Municipality exist, and their effects on physical fitness performances were also noticed. As such, strategic physical activity, interventions or follow-up studies recognizing this relationship particularly in the overweight adolescents are needed. In addition, authorities in health and education departments dealing with adolescents should make use of this evidence base information in policies development.

In many land-scarce Asian cities, planning agencies have sought to reduce space for the dead to release land for the living, encouraging conversion from burial to cremation over several decades. This has caused secular principles privileging efficient land use to conflict with symbolic values invested in burial spaces. Over time, not only has cremation become more accepted, even columbaria have become overcrowded, and new forms of burials (sea and woodland burials) have emerged. As burial methods change, so too do commemorative rituals, including new on-line and mobile phone rituals. This paper traces the ways in which physical spaces for the dead in several east Asian cities have diminished and changed over time, the growth of virtual space for them, the accompanying discourses that influence these dynamics and the new rituals that emerge concomitantly with the contraction of land space.

In recent decades, problems with the provision of drinking water and sanitation services around the world have increasingly been addressed by attempts at privatisation, recasting clean water as an essentially economic, rather than public, good. This approach gained particular acceptance in Latin America, but with limited success. In order to address the full range of social, economic and environmental values necessary to sustain water resources over time, public and governmental involvement in establishing integrated water management, pursuing ‘soft path’ approaches, assuring stakeholder input and setting policy will be essential to the process.

Jim Dyos, founding-father of British urban history, argued that cities have commonly acknowledged “individual characteristics” that distinguish them. Such distinctive characteristics, though usually based on material realities, are promoted through literary and visual representations. This article argues that those who seek to convey a city’s distinctiveness will do so not only through describing its particular topography, architecture, history or functions but also by describing its “local colour”: the supposedly unique customs, manner of speech, dress, or other special features of its inhabitants. In colonial cities this process involved white racial stereotyping of “others”. In Cape Town, depictions of “Coloured” inhabitants as unique “city types” became part of the city’s “destination branding”. The article analyses change and continuity in such representations. To this end it draws on the insights of Gareth Stedman Jones into changing depictions of London’s “Cockneys” and the insights of Stephen Ward into historical “place-selling”.

Many American and European cities have to deal with demographic and economic trajectories leading to urban shrinkage. According to official data, 13% of urban regions in the US and 54% of those in the EU have lost population in recent years. However, the extent and spatial distribution of declining populations differ significantly between Europe and the US. In Germany, the situation is driven by falling birth rates and the effects of German reunification. In the US, shrinkage is basically related to long-term industrial transformation. But the challenges of shrinking cities seldom appeared on the agendas of politicians and urban planners until recently. This article provides a critical overview of the development paths and local strategies of four shrinking cities: Schwedt and Dresden in eastern Germany; Youngstown and Pittsburgh in the US. A typology of urban growth and shrinkage, from economic and demographic perspectives, enables four types of city to be differentiated and the differences between the US and eastern Germany to be discussed. The article suggests that a new transatlantic debate on policy and planning strategies for restructuring shrinking cities is needed to overcome the dominant growth orientation that in most cases intensifies the negative consequences of shrinkage.

This article presents an analysis of social sustainability in comparative theoretical context and as a challenge to the post-political interpretation of sustainability in policy practice at the urban and regional scales. Metro Vancouver provides a case study for improving our understanding of the meaning of social sustainability as a framework for social policy in that it is among the handful of cities around the world currently working to define and enact social sustainability in governance terms. Results of this participant research provide evidence that some cities are politically engaging alternative development pathways using the concept of social sustainability. For sustainable development to retain its promise as an alternative policy framework for cities, social sustainability must be at the forefront.

In this paper, the Curitiba-centred narrative on the success of its urban planning experience will be qualified in light of the complexities of its metropolitan development trajectory. It will be claimed that the institutional vacuum that surrounds Brazilian metropolitan areas in general, and Greater Curitiba in particular, has been intensified by the emergence of a competitive and decentralised state spatial regime, which has consolidated a fragmented and neo-localist system of governance. Preliminary empirical evidence will be provided on the challenges that are being faced within the new regime in articulating socio-spatial, economic and environmental strategies in the direction of a more sustainable metropolitan future.

Urban shrinkage is not a new phenomenon. It has been documented in a large literature analyzing the social and economic issues that have led to population flight, resulting, in the worse cases, in the eventual abandonment of blocks of housing and neighbourhoods. Analysis of urban shrinkage should take into account the new realization that this phenomenon is now global and multidimensional — but also little understood in all its manifestations. Thus, as the world's population increasingly becomes urban, orthodox views of urban decline need redefinition. The symposium includes articles from 10 urban analysts working on 30 cities around the globe. These analysts belong to the Shrinking Cities International Research Network (SCIRN), whose collaborative work aims to understand different types of city shrinkage and the role that different approaches, policies and strategies have played in the regeneration of these cities. In this way the symposium will inform both a rich diversity of analytical perspectives and country-based studies of the challenges faced by shrinking cities. It will also disseminate SCIRN's research results from the last 3 years.

Despite the fortification of buildings, streets, and public squares, Rio de Janeiro's beaches remain widely regarded as democratic spaces of social diversity and accessibility. Our study revisits the question of Rio's “democratic” beachfronts, based on local interviews, field observations, official reports, and newspaper accounts. We focus on historical and contemporary perceptions of planning, privatization, and public-order programs on the city's southern seaside. Institutional discourses have justified increasing regulation to combat threats of disorder and insecurity. While residents value the relative openness of beachfronts, they also acknowledge issues of safety, social segmentation, and subtle forms of bias. The public generally applauds recent “Shock of Order” policing and commercial revitalization, although critics lament the loss of traditional freedoms for informal beach vendors and casual sports. These paradoxes highlight enduring tensions between social order and hierarchy on one hand, and democratic rights and equality on the other.

Background: Recent research in two cholera-endemic communities of Zanzibar has shown that a majority (∼94%) of the adult population was willing to receive free oral cholera vaccines (OCVs). Since OCV uptake in the 2009 campaign reached only ∼50% in these communities, an evaluation of social and cultural factors and of barriers was conducted to understand this difference for future cholera control planning., Methodology/principal Findings: A random sample of 367 adult peri-urban and rural community residents (46.6% immunized vs. 53.4% unimmunized) was studied with a semi-structured interview that inquired about social and cultural features of cholera depicted in a vignette and barriers to OCV uptake. Symptoms (rectal pain, loose skin only in rural community) and perceived causes (uncovered food, contact with contaminated water) specific for severe diarrhea were associated with uptake. Purchasing drugs from pharmacies to stop diarrhea and vomiting was negatively associated with uptake. Increasing household size, age and previous enteric illness episode were positively related to uptake, the latter only at the rural site. The most prominent barrier to uptake was competing obligations or priorities (reported by 74.5%, identified as most important barrier by 49.5%). Next most prominent barriers were lacking information about the campaign (29.6%, 12.2%), sickness (14.3%, 13.3%) and fear of possible vaccine side effects (15.3%, 5.6%). The majority of unvaccinated respondents requested repetition of the vaccination with free OCVs., Conclusions/significance: Factors associated with uptake indicated a positive impact of the vaccination campaign and of sensitization activities on vaccine acceptance behavior. Unlike communities opposed to cholera control or settings where public confidence in vaccines is lacking, identified barriers to uptake indicated a good campaign implementation and trust in the health system. Despite prospects and demand for repeating the vaccination, local decision-makers should reconsider how careful logistical arrangements may improve community coverage and thus effectiveness of vaccination campaigns.

Seventy years ago, General Motors’ Highways and Horizons exhibit at the World’s Fair, designed by Norman Bel Geddes and Eero Saarinen, promoted demand for cars and federal highways without any concern for environmental sustainability, the theme of our 2010 conference. The main exhibit included a sequence of four parts (entrance ramps, map lobby, Futurama ride, and “intersection of 1960”) where the viewer’s perception of spatial scale was manipulated. Setha M. Low’s theory of “embodied space” helps decode why movement through these diverse spaces influenced millions of Americans’ views of transportation and urban form, a promotional success yet to be equaled by advocates of environmental sustainability.

Shrinking mining cities — once prosperous settlements servicing a mining site or a system of mining sites — are characterized by long-term population and/or economic decline. Many of these towns experience periods of growth and shrinkage, mirroring the ebbs and flows of international mineral markets which determine the fortunes of the dominant mining corporation upon which each of these towns heavily depends. This dependence on one main industry produces a parallel development in the fluctuations of both workforce and population. Thus, the strategies of the main company in these towns can, to a great extent, determine future developments and have a great impact on urban management plans. Climate conditions, knowledge, education and health services, as well as transportation links, are important factors that have impacted on lifestyles in mining cities, but it is the parallel development with the private sector operators (often a single corporation) that constitutes the distinctive feature of these cities and that ultimately defines their shrinkage. This article discusses shrinking mining cities in capitalist economies, the factors underpinning their development, and some of the planning and community challenges faced by these cities in Australia, Canada, Japan and Mexico.

Suburban shrinkage, understood as a degenerative urban process stemming from the demise of the Fordist mode of urbanism, is generally manifested in a decline in population, industry and employment. It is also intimately linked to the global restructuring of industrial organization associated with the rise of the post-Fordist mode of urbanism and, more recently, the thrust of Asian industrialization. Framed in the discourse of industrial urbanism, this article examines the first ring of industrial suburbs that developed around large cities in their most rapid Fordist urbanization phase. These industrial suburbs, although they were formed at different times, are today experiencing specific mutations and undergoing profound restructuring on account of their particular spatial position between the central area and the expanding peripheries of the post-Fordist metropolis. This article describes and compares suburban decline in two European cities (Glasgow and Paris) and two Latin American Cities (São Paulo, Brazil and Guadalajara, Mexico), as different instances of places asymmetrically and fragmentarily integrated into the geography of globalization.

Serial forced displacement has been defined as the repetitive, coercive upheaval of groups. In this essay, we examine the history of serial forced displacement in American cities due to federal, state, and local government policies. We propose that serial forced displacement sets up a dynamic process that includes an increase in interpersonal and structural violence, an inability to react in a timely fashion to patterns of threat or opportunity, and a cycle of fragmentation as a result of the first two. We present the history of the policies as they affected one urban neighborhood, Pittsburgh's Hill District. We conclude by examining ways in which this problematic process might be addressed.

For domiciled individuals, homeless people provide a disturbing reminder that all is not right with the world. Reactions to seeing homeless people frequently encompass repulsion, discomfort, sympathy and sometimes futility. This paper considers domiciled constructions of homeless people drawn from interviews with 16 participants recruited in the central business district of a New Zealand city. It documents how, when trying to make sense of this complex social problem, domiciled people draw on shared characterizations of homeless people. The concept of "social distance" is used to interrogate the shifting and sometimes incongruous reactions evident in participant accounts. "Social distancing" is conceptualised as a dynamic communal practice existing in interactions between human beings and reflected in the ways that domiciled people talk about their experiences with homeless individuals.

This essay on Shenzhen, China, presents three vignettes addressing the question of home in a city of migrants. The first section explores the ubiquitous narratives of success forming the city's foundational myth. The second follows this myth into the world of a Shenzhen filmmaker and his characters, as they navigate the tension between the idea of home and the urge to start anew, resulting in the suspended possibility of the title. The last section looks at young architects who hope to preserve the city's heterotopic sites of migrants and original villagers through architectural innovations. The cases show how an economy of desire supplements the political economy of this export-driven city. The city appears as an urban desiring machine that produces itself as an object of desire for the migrants of all classes who flock to its factories, "urban villages", white-collar jobs, luxury villas and underground economy. The essay is an encounter with the mythology of success and failure, the intertwining of home as an end and home as the beginning, and with the manipulation of space that allows residents to control their own subjectivity.

The gentrification that has transformed high-poverty neighbourhoods in US cities since the mid 1990s has been characterised by high levels of state reinvestment. Prominent among public-sector interventions has been the demolition of public housing and in some cases multimillion dollar redevelopment efforts. In this paper, the racial dimension of state-supported gentrification in large US cities is examined by looking at the direct and indirect displacement induced by public housing transformation. The data show a clear tendency towards the demolition of public housing projects with disproportionately high African American occupancy. The pattern of indirect displacement is more varied; public housing transformation has produced a number of paths of neighbourhood change. The most common, however, involve significant reductions in poverty, sometimes associated with Black to White racial turnover and sometimes not. The findings underscore the central importance of race in understanding the dynamics of gentrification in US cities.

In the history of city planning, the dichotomy between the aesthetic aspirations of the City Beautiful and City Practical movements is overstated. The aesthetic impulse did not disappear but persisted as an important thread through the development of comprehensive planning approaches into the 1920s. The nexus between beauty and utility was negotiated and expressed across four main discourses: broad social improvement, aesthetic functionality, economic rationality, and holistic design. Ultimately, beauty became wedded to utility within the very nature of the comprehensive city plan itself. The work of the leading city planner John Nolen is central to an understanding of these historic continuities and informed the early evolution of city planning theory and practice. Nolen’s challenge to the City Beautiful paradigm, while still retaining an artistic sensibility, reaestheticizes scholars’ appreciation of the City Practical.

Since the early Chicago School, urban researchers have used residential proximity to assess contacts within and between racial and ethnic groups. This approach is increasingly limited. Diverse groups use email, social networking sites, instant messaging and mobile phones to communicate across urban zones and distant cities. These practices enable mutual support among far-flung family members and co-ethnics as they engage with an array of institutions throughout their day. Through interviews and observations that include women and men of diverse occupations, races and national origins, the author explores how and why cross-place enclosures of sociality and resources develop. Rather than framing the residential area as the locus of racial/ethnic concentration, the author focuses on cross-place concentrations in the technologically mediated workspace. This study enhances theorization of the structural negotiations, interpersonal pressures and group preferences that produce separate lifeworlds in globalizing cities.

Berlin has always been a literary space of extremely diverse political and cultural projections. This essay investigates why after the unification of East and West Berlin the city has been imagined as a play zone of sexual self-fulfilment by authors such as Inka Parei, Tanja Dückers, Kathrin Röggla, Judith Hermann and Julia Franck. Have such erotic adventures replaced political vision in our post-utopian decade? What is the purpose of the laboured allegorisation of the fall of the wall in Durs Grünbein's essays or in the novels of Katja Lange-Müller and Thomas Hettche? The sexification of historical and political processes recalls similar stereotypes in the East German literature of the 1980s: the metropolis as a whore in works by Heiner Müller or Wolf Biermann, but also by younger authors of the independent literary scene in Berlin like Uwe Kolbe or Frank-Wolf Matthies.

GIS methods are used to construct measures of food access for neighbourhoods in the Portland, Oregon, US metropolitan area and the sensitivity of such measures to methodological variation is examined. The level of aggregation of data inputs is varied and the effect of using both Euclidean and street network distances is tested. It is found that, regardless of the level of geographical disaggregation, distance-based measures generate approximately the same conclusions about the distribution of food access in the area. It is also found that, while the relationship between street network and Euclidean distances varies with population density, measures computed with either construct generate the same relative patterns of food access. These findings suggest that results from food access studies employing disparate methodologies can often be compared.

Vehicle-related hyperthermia is an unfortunate tragedy that leads to the accidental deaths of children each year. This research utilizes the most extensive dataset of child vehicle-related hyperthermia deaths in the United States, including 414 deaths between 1998 and 2008. Deaths follow a seasonal pattern, with a peak in July and no deaths in December or January. Also, deaths occurred over a wide range of temperature and radiation levels and across virtually all regions, although most of them took place across the southern United States. In particular, the Phoenix, Houston, Dallas, and Las Vegas metropolitan areas had the greatest number of deaths. We utilize our vehicle hyperthermia index (vhi) to compare expected deaths versus actual deaths in a metropolitan area, based on the number of children in the area who are under the age of five and on the frequency of hot days in the area. The vhi indicates that the Memphis, West Palm Beach-Boca Raton, and Las Vegas metropolitan areas are the most dangerous places for vehicle-related hyperthermia. We conclude by discussing several recommendations with public health policy implications.

Many local governments are adopting inclusionary zoning (IZ) as a means of producing affordable housing without direct public subsidies. In this paper, panel data on IZ in the San Francisco metropolitan area and suburban Boston are used to analyse how much affordable housing the programmes produce and how IZ affects the prices and production of market-rate housing. The amount of affordable housing produced under IZ has been modest and depends primarily on how long IZ has been in place. Results from suburban Boston suggest that IZ has contributed to increased housing prices and lower rates of production during periods of regional house price appreciation. In the San Francisco area, IZ also appears to increase housing prices in times of regional price appreciation, but to decrease prices during cooler regional markets. There is no evidence of a statistically significant effect of IZ on new housing development in the Bay Area.

This article attempts to capture some of the complexity in the way that memory, meaning and agenda interact in the history of the cemetery of Roodepoort West. Roodepoort West was the 'old location' where Africans and others lived until 1955, after which a gradual process of removals took place until 1967, when it was finally destroyed. However, not everything was lost of the old location. The cemetery remained, after unrest caused by the proposed removal of the local cemetery during the late 1950s persuaded the authorities to leave it alone. More recently, the cemetery has played a part in land restitution, becoming both a site of tension and remembrance. This article explores the many meanings attached to the old cemetery, and funerals more broadly, over a period of time beginning from the 1950s to 2005. By looking at the history of funerals, and the cemetery, new insights and an alternative understanding of what it meant to live in an urban area in Apartheid South Africa can be gained.

Evidence of the importance of urban agglomeration and the offsetting effects of congestion are provided in a number of studies of productivity and wages. Little attention has been paid to this evidence in the economic growth literature, where the recent focus is on technological change. We extend the idea of agglomeration and congestion effects to the area of innovation by empirically looking for a nonlinear link between population density and patent activity. A panel data set consisting of observations on 302 USA metropolitan statistical areas (MSAs) over a 10-year period from 1990 to 1999 is utilized. Following the patent and R&D literature, models that account for the discreet nature of the dependent variable are employed. Strong evidence is found that agglomeration and congestion are important in explaining the vast differences in patent rates across US cities. The most important reason cities continue to exist, given the dramatic drop in transportation costs for physical goods over the last century, is probably related to the forces of agglomeration as they apply to knowledge spillovers. Therefore, the empirical investigation proposed here is an important part of understanding the viability of urban areas in the future.

Every summer from 1927 to 1968, Toronto conservationist Charles Sauriol and his family moved from their city home to a rustic cottage just a few kilometres away, within the urban wilderness of Toronto’s Don River Valley. In his years as a cottager, Sauriol saw the valley change from a picturesque setting of rural farms and woodlands to an increasingly threatened corridor of urban green space. His intimate familiarity with the valley led to a lifelong quest to protect it. This paper explores the history of conservation in the Don River Valley through Sauriol’s experiences. Changes in the approaches to protecting urban nature, I argue, are reflected in Sauriol’s personal experience – the strategies he employed, the language he used, and the losses he suffered as a result of urban planning policies. Over the course of Sauriol’s career as a conservationist, from the 1940s to the 1990s, the river increasingly became a symbol of urban health – specifically, the health of the relationship between urban residents and the natural environment upon which they depend. Drawing from a rich range of sources, including diary entries, published memoirs, and unpublished manuscripts and correspondence, this paper reflects upon the ways that biography can inform histories of place and better our understanding of individual responses to changing landscapes.

This article examines the making of a modern colonial city through the rhetoric of ‘improvement’ and ‘progress’ in relation to water. The reference is to the history of water in the city of Delhi and what may be called ‘the first science of environment’ in a colonial urban context, with a focus not so much on the ‘extent’ of water supply and drainage, and its (in)adequacy in the colonial city, as on concerns around the ‘(im)purity’ of water, narratives of pollution, technologies of purity and the transformations they effected in a colonial context. In doing so it hopes to build upon a rich tradition of writings on urban water, its modernisation as also its location within a colonial regime, being suggestive of a framework in which we may consider water both as infrastructure and as environment, as much a network of pipes and drains as matters of pollution and well-being, as much a story of the search for and protection of the source as of the fate of the sink into which it ultimately flows.

In the eyes of many, the steel city of Gary, Indiana, entered a period of decline in the middle of the twentieth century. The once great city was seemingly racked by job loss, crime, racial division, or moral decay. Which of these caused the decline of the city depended upon the perspective of the story's teller. Each narrative of decline contained a different moment where the city went wrong and it began to decay. For some it was the moral decay of the 1950s, for others it was the rise of black power and politics in the 1960s, for still others it was the white backlash against civil rights in the 1970s. Some saw a microcosm of America, some saw a dangerous cauldron of race and ethnicity. The source of decline and the origins of the urban crisis were largely in the eye of the beholder. The stories people chose to tell about Gary mattered because for much of the twentieth century, Gary was at the center of American narratives about industrialism. These were outsider narratives of decline read onto the Indiana steel city because Gary represented larger debates. People read onto Gary their changing expectations and anxieties about industry and industrial spaces. This article traces the changing attitudes outsiders held toward Gary from the middle of the twentieth century through the period of deindustrialization at the end of the century and examines American narratives about deindustrialization and urban decline.

This paper critically examines developments in Irish urban governance through an ethnographic account of one community's historical memory and contemporary structure. During an era of rapid economic growth, the Irish state has courted previously excluded communities, offering them greater "inclusion" as "partners" in responding to urban decay and crime. The micro-governance structures this creates, however, become sites of contest between competing community factions and class-cultural imperatives. Tensions emerge between aspirational community leaders championing the aesthetics (if not the values) of "respectability" and residual residents who are presented as "rough". The paper demonstrates that nuances of class-cultural identity dictate the character of partnership governance at the community level with particular implications for local regeneration and crime control agendas.

This article examines a crucial site for modernity’s encounter with religion during the long nineteenth century, albeit one largely ignored both by religious and urban historians: the modern big city. Drawing on evidence from Strasbourg, which joined the ranks of Germany’s big cities soon after the Franco-Prussian War, it points out first, that urbanization had a significant urban dimension. It altered the absolute and relative size of the city’s faith communities, affected the confessional composition of urban neighborhoods, and prompted faith communities to mark additional parts of the urban landscape as sacred. Second, while urban growth—both demographic and physical—frequently challenged traditional understandings of religious community, it also facilitated the construction of new understandings of piety and community, especially via voluntary organizations and the religious media. Thereby, urbanization emerged as a key force behind sacralization in city and countryside as the nineteenth century ended and the twentieth began.

One of the main tasks in analyzing pedestrian movement is to detect places where pedestrians stop, as those places usually are associated with specific human activities, and they can allow us to understand pedestrian movement behavior. Very few approaches have been proposed to detect the locations of stops in positioning data sets, and they often are based on selecting the location of candidate stops as well as potential spatial and temporal thresholds according to different application requirements. However, these approaches are not suitable for analyzing the slow movement of pedestrians where the inaccuracy of a nondifferential global positioning system commonly used for movement tracking is so significant that it can hinder the selection of adequate thresholds. In this article, we propose an exploratory statistical approach to detect patterns of movement suspension using a local indicator of spatial association (LISA) in a vector space representation. Two different positioning data sets are used to evaluate our approach in terms of exploring movement suspension patterns that can be related to different landscapes: players of an urban outdoor mobile game and visitors of a natural park. The results of both experiments show that patterns of movement suspension were located at places such as checkpoints in the game and different attractions and facilities in the park. Based on these results, we conclude that using LISA is a reliable approach for exploring movement suspension patterns that represent the places where the movement of pedestrians is temporally suspended by physical restrictions (e.g., checkpoints of a mobile game and the route choosing points of a park).