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Age-friendly Cities and Communities has emerged as a significant policy, participative and governance response to ageing and its spatial effects. This paper argues that it has important benefits in mobilising older people, placing age on the urban agenda and building recognition across politicians, policy makers and programme managers. Based on the experience of Belfast (UK), the analysis suggests however, that it needs to be understood within wider urban restructuring processes, the importance of the property economy and how planning practices favour particular groups and modes of development. Drawing on demographic data, policy documents and in-depth interviews, it evaluates the relationship between age and urban regeneration, research-based advocacy and central-local relations in health and place-based care. The paper concludes by highlighting the importance of knowledge in competitive policy arenas and the need to focus on the most excluded and isolated old and where and how they live.

OBJECTIVE: To describe the steps involved in evidence-based decision making for the implementation of programs aimed at the promotion of physical activity. METHODS: It is a descriptive, cross-sectional study with quali-quantitative approach, held with municipal health secretaries chosen deliberately by regional health representatives of the state of Paraná. A total of 27 secretaries participated in a telephone interview consisting of 17 open questions. Content analysis was conducted according to the categories of an evidencebased decision-making model consisting of seven steps. RESULTS: None of the participants employed every step of the evidence-based decision-making model. The steps that were most often mentioned included: evaluation of the program (33.3%), use of evidence from the literature (22.2%) and identification of the problem (22.2%). The steps that were reported the least included: quantification of the problem (14.8%), development and prioritization of actions (14.8%), development of the plan of action (14.8%) and evaluation of the community (3.7%). CONCLUSIONS: The use of evidence-based decision making in the context of the promotion of physical activity was shown to be incipient among the health secretaries of the state of Paraná. We suggest widening dissemination and training on the use of evidence-based decision making among municipal administrators to increase the effectiveness of actions for promotion of physical activity.

Implementation of evidence-based practices can improve efficiency and effectiveness of public health efforts. Few studies have explored the political contextual factors that impact implementation of evidence-based non-communicable disease prevention (EBNCDP). This study aimed to do so in Australia, Brazil, China and the United States. Investigators conducted 10-13 qualitative, semi-structured interviews of public health practitioners working in functionally similar public health organizations in each country (total N = 50). Study participants were identified through purposive sampling and interviews were structured around an interview guide covering six domains related to EBNCDP. Interviewees from all four countries identified funding as the primary politically-influenced barrier to implementing EBNCDP. Similarly widespread barriers included government funding priorities that shift based on who is in power and the difficulty of convincing policy-makers and funders that non-communicable disease prevention is a wise investment of political capital. Policymakers who are not evidence-driven was another common barrier even in the United States and Australia, where EBNCDP is more established. Findings suggest that political contextual factors influence EBNCDP and vary to an extent by country, though certain factors seem to be universal. This can aid public health practitioners, political leaders, and policymakers in advocating for conditions and policies that encourage evidence-based practice. Refereed/Peer-reviewed

The study aimed to identify information sources for decision-making and barriers to access in the use of scientific journals by Municipal Health Secretaries in the State of Paraná, Brazil. Study participants included Secretaries of Health from 181 municipalities in the year 2014. Interviews focused on the frequency of consultation of resources for obtaining evidence, including from scientific journals. 40.9% of the participants were 18 to 39 years of age (mean age was 43±10.2 years; median 42 years). More than two-thirds (69.1%) had held the office of health secretary for less than five years. The majority were males (56.4%), and only one in three had a graduate degree in public health. The main sources of information were "non-scientific periodicals" (76.2%), "print/online journals" (71.4%), and "Ministry of Health guidelines" (71.3%). The main barriers to use of scientific journals were "lack of time for reading" (72.9%), "periodical's high cost" (69.1%), and "difficulty in identifying the best periodicals" (63.5%). The main information sources were non-scientific periodicals and Ministry of Health guidelines. The use of scientific journals is hindered by lack of time and limited familiarity with scientific language. Access to scientific information should be facilitated by the use of more accessible sources and training for municipal administrators in the use of open-access periodicals. Such measures can foster knowledge of current evidence among municipal health secretaries.O objetivo foi identificar fontes de acesso a informações para a tomada de decisão e barreiras para o uso de periódicos científicos entre Secretários Municipais de saúde do Estado do Paraná, Brasil. Participaram do trabalho Secretários Municipais de Saúde de 181 municípios do Estado do Paraná, no ano de 2014. Foram realizadas entrevistas sobre a frequência e o uso de recursos, para obter informação sobre as evidências científicas relacionadas ao uso de periódicos científicos. Em geral, 40,9% dos participantes tinham entre 18 e 39 anos (média 43 ± 10,2; mediana 42 anos), ocupavam o cargo por um período menor de cinco anos (69,1%), eram do sexo masculino (56,4%) e apenas um a cada três possuía pós-graduação em saúde pública. As principais fontes de informação utilizadas foram “revistas não científicas” (76,2%), “jornais impressos/online” (71,4%)” e “diretrizes do Ministério da Saúde” (71,3%). As principais barreiras reportadas para o uso de periódicos científicos foram a “falta de tempo para leitura” (72,9%), o “custo elevado de periódico” (69,1%) e a “dificuldade de identificar os melhores periódicos” (63,5%). As principais fontes de acesso à informação utilizadas são veículos não científicos e as diretrizes do Ministério da Saúde. O emprego de periódicos científicos é dificultado pela falta de tempo e baixa familiaridade com a linguagem científica. O acesso a informações científicas deve ser facilitado com o emprego de fontes mais acessíveis, assim como o treinamento dos gestores para o uso de periódicos de livre acesso. Tais ações podem auxiliar no conhecimento de evidências atualizadas entre os secretários municipais de saúde.El objetivo fue identificar fuentes de acceso a la información para la toma de decisiones y las barreras existentes, para el uso de periódicos científicos entre Secretarios Municipales de Salud del estado de Paraná, Brasil. Participaron en el trabajo Secretarios Municipales de Salud de 181 municipios del estado de Paraná, durante el año 2014. Se realizaron entrevistas sobre la frecuencia y el uso de recursos, con el fin de obtener información sobre las evidencias científicas relacionadas con el uso de periódicos científicos. En general, un 40,9% de los participantes tenían entre 18 y 39 años (media 43 ± 10,2; mediana de 42 años), ocupaban el cargo por un período menor de cinco años (69,1%), eran de sexo masculino (56,4%), y solamente uno de cada tres contaba con posgrado en salud pública. Las principales fuentes de información utilizadas fueron “revistas no científicas” (76,2%), “periódicos impresos/online” (71,4%) y “directrices del Ministerio de Salud” (71,3%). Las principales barreras informadas para el uso de periódicos científicos fueron la “falta de tiempo para lectura” (72,9%), el “coste elevado del periódico” (69,1%) y la “dificultad de identificar los mejores periódicos” (63,5%). Las principales fuentes de acceso a la información utilizadas son vehículos no científicos y las directrices del Ministerio de Salud. El empleo de periódicos científicos está dificultado por falta de tiempo y baja familiaridad con el lenguaje científico. El acceso a información científica debe ser facilitado con el empleo de fuentes más accesibles, así como el entrenamiento de gestores para el uso de periódicos de libre acceso. Tales acciones pueden ayudar en el conocimiento de evidencias actualizadas entre los secretarios municipales de salud.

Background Little is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States. Methods Between February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions). Results Practitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries. Conclusions This study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.

The aim of this study was to analyze the association between perceived barriers for active commuting to school in the form of displacement of adolescents from Curitiba, Brazil. Interviews were conducted in six schools (three public and three private) with 741 adolescents aged 11-18 yrs. Perceived barriers for active commuting were assessed through a questionnaire with seventeen questions. Active commuting was defined as walking or bicycling to or form school at least one day per week. The associations were tested by Poisson regressions with 5% significance level. The prevalence of active commuting was of 42.9% (50.0% in boys and 37.2% in girls, p

To identify the barriers to evidence-based decision-making regarding chronic noncommunicable diseases perceived by health administrators from the state of Paraná, Brazil.Telephone interviews were performed with 20 health region directors using a semi-structured script. The interviews were performed in 2015 and had a mean duration of 23 minutes. After transcription of the interview, the contents were analyzed for identification of subject categories.Two categories were identified: organizational and personal barriers. The most frequent organizational barriers were "poor planning or management" and "regional and cultural characteristics of the population." The most frequent personal barriers were "lack of incentive and difficulty to work with scientific evidence" and "lack of training and professional qualification."Support to health professionals should be enhanced through technical training courses linked to political and scientific efforts that address the health needs of the community.Determinar los obstáculos para la toma de decisiones basada en la evidencia referentes a la prevención de enfermedades crónicas no transmisibles, según la percepción de los administradores de servicios de salud en el estado de Paraná.Se realizaron entrevistas telefónicas a 20 directores de unidades regionales de salud, por medio de una guía semiestructurada. Las entrevistas se efectuaron en el 2015 y duraron un promedio de 23 minutos. Después de la transcripción, se analizó su contenido para determinar los tipos de obstáculos existentes.Se detectaron dos tipos de obstáculos, a saber, organizacionales y personales. Los obstáculos organizacionales más frecuentes fueron la falta de planificación y de gestión y las características regionales y culturales de la población. Los obstáculos personales más frecuentes fueron la falta de incentivos, las dificultades para trabajar con pruebas científicas y la falta de capacitación y de idoneidad profesional.Se sugiere reforzar el apoyo a los profesionales de salud por medio de cursos de capacitación técnica que abarquen esfuerzos políticos y científicos y atiendan las prioridades de salud de la comunidad.

DOI: http://dx.doi.org/10.5007/1980-0037.2017v19n2p174 The aim of this study was to analyze the contribution of physical activity (PA) and sedentary time (ST) to Body Mass Index (BMI) in adults. The study was conducted in 2009, in Curitiba, Parana, Brazil with adults aged 18-65 years (1,411). A multidimensional questionnaire was used in which BMI, weekly minutes of PA and ST were obtained from self-reports. PA and ST were combined to determine the following independent variables: a) “active and not sedentary”; b) “active and sedentary”; c) “not active and not sedentary” and d) “not active and sedentary”. Multinomial logistic regressions were used to test the associations between PA, ST and BMI. The adjusted regression model showed that PA, regardless of ST, lowered the likelihood of participants being classified as obese by 34% and 55%, respectively. In addition, PA at recommended levels (≥150 minutes/week), while not being sedentary, lowered by 85% the likelihood of being classified in the underweight category. Finally, ≥10 minutes/week of PA, while reporting higher ST levels, reduced the likelihood of being classified as overweight by 37%. PA is associated with BMI regardless of TS. In addition, PA at recommended levels is inversely related to obesity and overweight.

O objetivo desta revisao foi atualizar a evolucao da producao cientifica em epidemiologia da atividade fisica no Brasil. Tambem buscamos verificar a distribuicao geografica das pesquisas e a evolucao do conhecimento conforme os principais dominios que caracterizam a pesquisa em atividade fisica e saude. Foi realizada uma busca sistematica da literatura nas bases de dados PubMed, LILACS e SciELO, alem de buscas manuais por autores e referencias cruzadas. Artigos originais publicados entre 2005 e 2013 foram incluidos contendo um ou mais dominios da atividade fisica, conhecimento sobre atividade fisica e/ou comportamento sedentario, com amostra igual ou maior a 500 participantes. Apos a sintese descritiva, os estudos foram estratificados conforme localizacao geografica, delineamento e dominios de pesquisa na area da atividade fisica e saude. A analise final foi feita com 276 estudos. Os dados obtidos demonstraram crescente publicacao cientifica brasileira na area de epidemiologia da atividade fisica (de 7 para 49 artigos/ano), sendo 82,2% delineados para analisar os determinantes, niveis e tendencias temporais e as consequencias a saude da pratica regular da atividade fisica e/ou do prolongamento do comportamento sedentario. No plano regional, houve concentracao das pesquisas nas regioes Sul (43,5%) e Sudeste (22,1%) do pais e crescimento das publicacoes provindas da regiao Nordeste (18,5%), e dos trabalhos com representatividade nacional, ou que envolvem cidades de regioes distintas (12,3%). Foi evidenciada grande evolucao no numero de publicacoes brasileiras em epidemiologia da atividade fisica, apesar de importantes limitacoes regionais, tipo de delineamento utilizado e dos dominios de pesquisa desenvolvidos.

O objetivo desta revisão foi sintetizar as evidências disponíveis na literatura referentes aos programas de promoção de atividade física (AF) no Sistema Único de Saúde brasileiro. Foi realizada uma busca sistemática da literatura nas bases de dados PubMed, Science Direct, Biblioteca Virtual de Saúde (BVS), base de dados de dissertações e teses e uma busca manual na Revista Brasileira de Atividade Física e Saúde (RBAFS) no período entre janeiro de 2005 à abril de 2015. Foram incluídos estudos: originais, realizados no Brasil, com desfecho a promoção da AF realizada no Sistema Único de Saúde em idiomas: Inglês, Espanhol e/ou Português. A análise final foi composta por 17 artigos. Desses, 29,41% (n=5) foram realizados em todo o território nacional e 5,88% (n=1) em duas ou mais regiões do país. Observou-se ainda uma disparidade regional, com 29,41% (n=5) dos estudos na região sudeste, 17,64% (n=3) na região sul, 11,76% (n=2) na região nordeste, apenas 5,88% (n=1) na região centro-oeste e nenhum estudo foi realizado na região norte do país. Enquanto ao modo de intervenção verificou-se que 47,05% (n=8) ocorreram no Sistema Único de Saúde e 47,05% (n=8) foram programas com equipe multiprofissional. Os estudos, em sua maioria forneceram dados descritivos ou sobre resultados na AF ou qualidade de vida, sendo escassas as informações sobre processo e impacto dos programas. Os programas com equipe multiprofissional foram estratégias importantes de promoção de AF. Sugere-se realizar estudos com delineamentos longitudinais ou mesmo experimentais, acerca do custo e benefício dos programas implementados.