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Objective: To compare, from an empirical point of view, the use of focus group and photovoice as we conducted two studies on food environment in neighbourhoods with different socio-economic profiles. Method: The European project Heart Healthy Hoods studied the association between the physical and social environment of Madrid (Spain) and the cardiovascular health of its residents. Two ancillary studies were developed to further expand the study of urban health inequalities using focus group and photovoice. Both studies, similar in their objectives and study populations, are the basis for comparing both techniques. The comparison considered the following methodological aspects: study design, logistic aspects, commitment and involvement, ethical issues, and data analysis. Results: We identified differences, similarities, potentialities, and limitations of each technique with their corresponding results. We found that depending on the research objectives, one technique was more beneficial than the other. If the objective is producing new knowledge, using focus group would be the most appropriate technique, whereas if the objective includes generating social change, photovoice would be more suitable. We found that photovoice is a powerful technique in public health, especially studying social processes related to population health, requiring extra effort from researchers and a special care with the related ethical considerations. Conclusions: Increasing participants’ awareness, involving decision makers to channel proposals, the atypical role of researchers and ethical implications of photography are aspects to be considered when choosing photovoice instead of focus group. Resumen: Objetivo: Comparar empíricamente el uso del grupo focal y el fotovoz en investigación sobre el entorno alimentario en barrios con diferente perfil socioeconómico. Método: El proyecto europeo Heart Healthy Hoods estudió la asociación entre el entorno físico y social de Madrid y la salud cardiovascular de sus residentes. Dentro de él se desarrollaron dos estudios para analizar las desigualdades en salud utilizando las técnicas del grupo focal y el fotovoz. Ambos estudios, similares en sus objetivos y población diana, fueron la base para comparar las dos técnicas. Consideramos los siguientes aspectos metodológicos: diseño, aspectos logísticos, compromiso e implicación del equipo investigador y de las personas participantes, cuestiones éticas y análisis de los datos. Resultados: Identificamos diferencias, similitudes, potencialidades y limitaciones de cada técnica utilizada con sus correspondientes resultados. Dependiendo de los objetivos, una técnica sería más beneficiosa que la otra. Si el objetivo es producir nuevo conocimiento, el grupo focal sería la técnica más adecuada, mientras que, si el objetivo incluye generar cambio social, el fotovoz sería más apropiado. Consideramos el fotovoz una técnica muy provechosa para la investigación en salud pública, especialmente para estudiar procesos sociales en relación con la salud de la población, aunque requiere un esfuerzo adicional por parte del equipo investigador y de los participantes, y un cuidado especial con las consideraciones éticas. Conclusiones: Aumentar la conciencia de las personas participantes, involucrar a decisores políticos para canalizar las propuestas resultantes, el papel atípico del equipo investigador y las implicaciones éticas de la fotografía son aspectos a considerar si elegimos el fotovoz frente al grupo focal.

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Una de las principales fuentes de contaminación ambiental en zonas urbanas son las obras de construcción y rehabilitación, en especial, en las fases de demolición. Durante estas actuaciones se observa un importante incremento de material particulado, en especial PM10, así como un aumento de los gases procedentes de la combustión de motores diésel del transporte de materiales y equipamiento. Para evitar esta contaminación es importante la adopción de medidas de minimización de emisión de contaminantes, para lo que se propone la adopción por parte del promotor de la obra, de un Plan de Autocontrol de la Calidad del Aire que considere la valoración de zonas de mayor afectación y sensibilidad poblacional para estimar los vientos que les son más desfavorables, así como la monitorización de condiciones ambientales y los máximos niveles de emisión/inmisión de contaminantes. Se presenta el Plan de Autocontrol de la Calidad del Aire implantado en las obras de demolición del Estadio Vicente Calderón, antigua sede del club de fútbol Atlético de Madrid, como modelo de estrategia para evitar los efectos de estas intervenciones sobre la calidad del aire ambiente y en consecuencia, la disminución de su incidencia sobre la salud de la población expuesta, así como en términos de transparencia de actuaciones de las administraciones públicas.

La urbanización conlleva niveles elevados de contaminación, eventos climáticos extremos, ruido, escasez de espacios verdes, y otros, que influyen en la salud. El objetivo de este trabajo es comparar la salud cardiovascular, respiratoria y mental, en población española, según el tamaño del municipio de residencia. También se pretende conocer la percepción de la población acerca de la influencia de las ciudades en esas enfermedades. Para ello, se ha analizado una muestra de 587 personas (> 18 años), considerando el tamaño del municipio de residencia (< 49 999 habitantes, 50 000 - 499 999 habitantes y > 500 000 habitantes), el estado de salud y nivel de estrés percibidos, el diagnóstico de enfermedades cardiovasculares, respiratorias y mentales y la percepción de la influencia vivir en ciudades sobre la salud. Hemos encontrado que vivir en municipios de tamaño medio incrementa el riesgo de hipertensión (OR=6,35, p

Este artículo describe el proceso de diseño y las características de un cuestionario y una pauta de observación intradomiciliaria desarrollados para evaluar tanto transversal como longitudinalmente la relación vivienda-barrio-salud en el marco de transformaciones urbanas llevadas a cabo en poblaciones de elevada vulnerabilidad socio-territorial. Los instrumentos se desarrollaron para el estudio longitudinal multimétodos RUCAS (Regeneración Urbana, Calidad de Vida y Salud), un experimento natural cuyo objetivo principal es evaluar el impacto en salud y calidad de vida de un programa de Regeneración de Conjuntos Habitacionales en dos conjuntos de vivienda social en Chile. El diseño de los instrumentos siguió cuatro etapas principales: (1) revisión narrativa de la literatura para definir las dimensiones del estudio, y de instrumentos existentes para identificar ítems apropiados para su medición; (2) validación de contenido con expertos; (3) pre-test; y (4) estudio piloto. El cuestionario resultante, compuesto de 262 ítems, tiene en cuenta las distintas etapas del ciclo vital y cuestiones de género. La pauta de observación intradomiciliaria (77 ítems) es aplicada por el/la encuestadora. Los instrumentos abordan (i) características de la situación residencial actual que sabidamente afectan la salud y serán intervenidas por el programa; (ii) dimensiones de la salud potencialmente afectadas por la situación residencial y/o por la intervención dentro de los plazos del estudio (4 años); (iii) otras condiciones de salud y relacionadas con la salud que sean relevantes, aun cuando no se verán modificadas dentro de los plazos del estudio, y (iv) dimensiones socioeconómicas, ocupacionales y demográficas relevantes. Los instrumentos han mostrado ser una herramienta capaz de abordar la multidimensionalidad de los procesos de transformación urbana en contextos de pobreza urbana en vivienda formal.

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Se buscó caracterizar la satisfacción y percepciones de los residentes de Lima Metropolitana sobre distintos aspectos de la ciudad que pueden afectar su calidad de vida y salud, identificando diferencias por nivel socioeconómico (NSE) y cambios en el tiempo. Se realizó un análisis secundario de la Encuesta «Lima Cómo Vamos» entre 2010 y 2019, reportando los resultados mediante porcentajes, con diferencias entre NSE para cada año y entre años. En 2019 la satisfacción y percepciones eran mayoritariamente desfavorables, y han disminuido hasta en 30 puntos porcentuales con el tiempo. Las personas de NSE más bajos tenían valoraciones más desfavorables y con mayores reducciones en el tiempo. Esta insatisfacción y percepciones desfavorables revelan deficiencias en servicios públicos y condiciones urbanas que podrían afectar negativamente la calidad de vida y salud, haciendo necesarias políticas que reduzcan las brechas socioeconómicas y mejoren la salud de los ciudadanos de Lima Metropolitana.

The recent pandemic outbreak warned of the urgent need for closer interaction between health and spatial planning. The relationship between urban space and health has been widely proven and led to the emergence of new concepts, such as neurourbanism, an interdisciplinary field of research that aims to explain the relationship between mental health and the well-being of city life. The embryonic state of these interdisciplinary research fields requires further contributions to their consolidation and guidelines for practitioners and policymakers. The main aim of this article is to contribute to the discussion through reflections on public spaces and urban health. A critical analysis was conducted to respond to the following specific objectives: 1) to highlight the importance of public space for the promotion of quality of life; 2) to reinforce the awareness that the urban environment affects mental health and well-being; 3) to propose an organisation of health impact factors (determinants of urban health) that works as a tool for objective health assessment and monitoring in cities and; 4) to reinforce work on the importance of neurourbanism as an interdisciplinary science that unites neuroscience and urban planning. Despite the empirical association between health (physical and mental) and the built environment recently demonstrated Covid-19 pandemic, scarce research and evidence-based recommendations have been produced towards healthier cities. [ABSTRACT FROM AUTHOR]

Objective: This study aims to describe the accessibility to and promotion of alcohol and tobacco around secondary schools in Madrid and its distribution in relation with area-level socioeconomic deprivation; analyze the relationship between this exposure and individual consumption characteristics of students between 14 and 18 years old; and explore other facilitators of this consumption. Method: Mixed-methods study conducted in three phases: 1) we collected data on accessibility to and promotion of alcohol and tobacco in the environment using systematic social observation around 55 secondary schools; 2) we administered 2287 questionnaires among the students in these centers to gather information about characteristics and determinants of consumption; and 3) we conducted 20 semi-structured interviews and one discussion group to deepen in the results obtained in surveys and systematic social observation. We will use Geographic Information Systems to integrate and analyze the data from a spatial perspective. Resumen: Objetivo: Este estudio tiene como objetivo describir la accesibilidad y la promoción de alcohol y tabaco alrededor de los centros de enseñanza secundaria en Madrid y su distribución en relación con la privación socioeconómica del área; analizar la relación entre esta exposición y las características individuales de consumo en estudiantes de entre 14 y 18 años; y explorar otros facilitadores del consumo. Método: Estudio de métodos mixtos en tres fases: 1) recogimos datos sobre accesibilidad y promoción de estas sustancias en el entorno mediante observación social sistemática alrededor de 55 centros de secundaria; 2) administramos 2287 cuestionarios a estudiantes de estos centros sobre características y determinantes de consumo; y 3) realizamos 20 entrevistas semiestructuradas y un grupo de discusión en estos centros para profundizar en los resultados obtenidos en las encuestas y la observación social sistemática. Utilizaremos Sistemas de Información Geográfica para integrar y analizar los datos desde una perspectiva espacial.

Resumen La ciudad capitalista es dibujada con bolígrafos privados, cuyos trazos de apropiación describen un caos de los medios de producción. En el capitalismo edificado, el caos no solo permite la asignación de espacios materiales a cada actividad productiva bajo principios de “producción, distribución y acumulación”, sino que la morfología urbana de extracción de plusvalía o renta se resignifica en “extracción/contaminación y fragmentación/destrucción”, considerando solo externamente la salud ambiental y humana. Por tanto, para discutir críticamente el funcionamiento de la ciudad se propone la categoría teórica caos de los medios de producción, asumiendo que la morbilidad urbana es una condición predeterminada de la ciudad capitalista que le confiere el status de fundamental para su reproducción.

The role of urban parks has gained interest in urban health research. However, there are currently no clear definitions of these urban assets as exposure variable across the literature, which do have implications for the analysis. In this study, we exhibit an approach to design a comprehensive spatial database of urban parks in cities, using the example of Madrid. This approach consisted of the combination of different spatial databases containing information about parks and green spaces in the city of Madrid, and then a spatial processing to keep only those that met the selected criteria for urban park definition: accessible for pedestrians (to have at least one path around or through the area) and with the minimum size suitable (bigger than 0.50 ha) for physical activity. This approach can be helpful to design spatial databases that enable conducting epidemiological studies on the relationship between urban parks and population health. Resumen: El papel de los parques ha cobrado interés en la investigación sobre salud urbana. Sin embargo, actualmente no existen definiciones claras de estos activos urbanos como variable de exposición, lo que tiene implicaciones para el análisis. En este estudio se muestra un enfoque para diseñar una base de datos espacial integral de parques en ciudades, utilizando el ejemplo de Madrid. Se combinaron diferentes bases de datos espaciales con información sobre parques y espacios verdes de la ciudad de Madrid, que luego se procesaron espacialmente para mantener aquellos que cumplían los criterios de definición de parque: accesible (disponer de al menos un camino alrededor o a través del área) y un tamaño mínimo adecuado para realizar actividad física (mayor de 0,5 ha). Este enfoque puede ser útil para diseñar bases de datos espaciales que permitan realizar estudios epidemiológicos sobre la relación entre parques urbanos y salud poblacional.

Resumen Este artículo presenta el marco teórico sobre algunos de los problemas de las ciudades del siglo XXI como son el cambio climático, la urbanización y el envejecimiento de la población, con el fin de establecer los antecedentes que guían la investigación del confort térmico y acústico de las personas mayores en espacios públicos de la ciudad. Para ello, se analizan las políticas internacionales, los conceptos de urbanismo y todas sus vertientes contemporáneas que han surgido como producto de la adaptación de las ciudades a los fenómenos demográficos y climáticos, así como su influencia en la salud de la población. Adicionalmente se conceptualiza el fenómeno del envejecimiento de la población, la realidad mundial, regional y local de España en cuanto a este proceso demográfico y las políticas públicas que se han planteado como medida de adaptación en las ciudades. Finalmente, se explican los conceptos sobre confort térmico y acústico, identificando el estado de la cuestión y las principales variables que influyen, mediante un resumen de la revisión bibliográfica sistemática, sobre la percepción de confort térmico y acústico de adultos mayores y sus diferencias con otros grupos de edad. Abstract This article presents the theoretical framework of some of the problems of 21st century cities, such as climate change, urbanisation and population ageing, in order to establish the background that guides research into the thermal and acoustic comfort of older people in public spaces in the city. To this end, international policies, urban planning concepts and all their contemporary aspects that have arisen as a result of the adaptation of cities to demographic and climatic phenomena, as well as their influence on the health of the population, are analysed. In addition, it conceptualises the phenomenon of population ageing, the global, regional and local reality of Spain in terms of this demographic process and the public policies that have been put forward as a measure of adaptation in cities. Finally, the concepts of thermal and acoustic comfort are explained, identifying the state of the art and the main variables that influence, through a summary of the systematic literature review, the perception of thermal and acoustic comfort of older adults and their differences with other age groups.

El artículo analiza la influencia de la estructura territorial en la salud de las ciudades de Oaxaca. Plantea como hipótesis que esta influencia se manifiesta a través de la funcionalidad urbana. Utilizacomo metodología el enfoque bayesiano para el cálculo de los indicadores básicos, y el análisis de redes para la comprobación de la hipótesis. Concluye que la estructura territorial no puede considerarse un factor que genere inequidad sanitaria en el estado de salud de sus pobladores, aunque comienza a destacar en las ciudades grandes y medianas de Oaxaca que aún no consolidan su infraestructura, equipamiento y servicios.

Resumen El presente trabajo aborda el reto del envejecimiento activo desde la perspectiva del diseño urbano: ¿son los espacios públicos de las ciudades españolas “amigables” para las personas mayores? Se ha realizado una caracterización de las necesidades específicas del adulto mayor y los elementos de diseño del espacio público que deberían tenerse en cuenta en proyectos de renovación urbana. Esta caracterización, junto con una revisión de guías y documentos técnicos, ha dado como resultado la selección de 25 elementos para la evaluación de un caso de estudio en el casco urbano de la ciudad consolidada de las 3 ciudades españolas más pobladas. Los resultados muestran un mínimo de habitabilidad y accesibilidad de los espacios públicos, pero un déficit en los parámetros de calidad para favorecer entornos “amigables” con las personas mayores, como zonas estanciales con bancos ergonómicos, elementos de apoyo cada cierta distancia o señalética accesible para orientarse en las calles. Abstract This study addresses active ageing from the urban perspective: are public spaces in Spanish cities age-friendly? A characterization of the older adult has been done identifying the elements of the public space that should be considered in projects of urban renovation. From this characterization, as well as a review of guides and technical documents, 25 elements have been proposed in order to evaluate one study case in the urban city centre of the 3 largest cities in Spain. Results show a minimum quality of habitability and accessibility in the built environment. However, there is a lack of quality parameters in order to promote healthy and age-friendly urban environments, such as ergonomic benches in places to stay, minimum distance between supports or signals to support way-finding in streets.

Tuberculosis remains an urgent issue on the urban health agenda, especially in low- and middle-income countries. There is a need to develop and implement innovative and effective solutions in the tuberculosis diagnostic process. In this article, We describe the importance of artificial intelligence as a strategy to address tuberculosis control, particularly by providing timely diagnosis. Besides technological factors, the role of socio-technical, cultural and organizational factors is emphasized. The eRx tool involving deep learning algorithms and specifically the use of convolutional neural networks is presented as a case study. eRx is a promising artificial intelligence-based tool for the diagnosis of tuberculosis; which comprises a variety of innovative techniques involving remote X-ray analysis for suspected tuberculosis cases. Innovations based on artificial intelligence tools can optimize the diagnostic process for tuberculosis and other communicable diseases.

We aimed to characterize the satisfaction and perceptions of the residents of Lima about different aspects of urban life that can affect their quality of life and health, identifying differences by socioeconomic status (SES) and changes over time. A secondary data analysis of the "Lima Cómo Vamos" survey was conducted between 2010 and 2019. Results are reported through percentages, with differences between SES for each year and between years. In 2019, satisfaction and perceptions were mostly unfavorable, and have decreased by up to 30% over time. People with lower SES had more unfavorable evaluations and with greater reductions over time. This dissatisfaction and unfavorable perceptions reveal deficiencies in public services and urban conditions that could negatively affect the quality of life and health, making it necessary to design and implement policies that reduce socioeconomic gaps and improve the health of Lima citizens. [ABSTRACT FROM AUTHOR]

Investigamos el estado de la contaminación del aire en la ciudad de Quito, las trayectorias para mejorar su calidad, y la relación entre contaminantes y condición socioeconómica medida a partir del valor del suelo urbano. Nos concentramos en tres contaminantes: material particulado fino, material particulado grueso y partículas sedimentables. Utilizamos fuentes secundarias y bases de datos del Municipio de Quito. Han existido políticas y acciones para mejorar la calidad del aire, enfocadas en varios sectores. Pese a ello, los tres contaminantes estudiados sobrepasan lo recomendado en normas nacionales e internacionales de calidad del aire. Existe, además, una relación inversa entre contaminación y valor del suelo: las poblaciones que viven en lugares con menor valor del suelo reciben mayor contaminación. Las regulaciones para mejorar la calidad del aire, si bien han tenido algunos logros, en la mayoría de casos han sido incumplidas.

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Estudios Demográficos y Urbanos is the property of El Colegio de Mexico AC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Tuberculosis remains an urgent issue on the urban health agenda, especially in low- and middle-income countries. There is a need to develop and implement innovative and effective solutions in the tuberculosis diagnostic process. In this article, We describe the importance of artificial intelligence as a strategy to address tuberculosis control, particularly by providing timely diagnosis. Besides technological factors, the role of socio-technical, cultural and organizational factors is emphasized. The eRx tool involving deep learning algorithms and specifically the use of convolutional neural networks is presented as a case study. eRx is a promising artificial intelligence-based tool for the diagnosis of tuberculosis; which comprises a variety of innovative techniques involving remote X-ray analysis for suspected tuberculosis cases. Innovations based on artificial intelligence tools can optimize the diagnostic process for tuberculosis and other communicable diseases. [ABSTRACT FROM AUTHOR]

Introducción: el Análisis de la Situación de Salud es un instrumento científico metodológico que tiene como propósito identificar características sociopsicológicas, económicas, históricas, geográficas, culturales y ambientales que inciden en el proceso salud-enfermedad de un área de salud. Objetivo: describir el análisis de la situación de salud del consultorio médico 30 perteneciente al Policlínico Universitario “Pedro Borrás Astorga” durante el año 2016. Método: se realizó un estudio observacional, descriptivo y transversal en el consultorio médico 30 perteneciente al Grupo Básico de Trabajo 2 del Policlínico Universitario “Pedro Borrás Astorga” de la ciudad Pinar del Río durante el año 2016. El universo quedó constituido por 429 familias con un total de 1 071 habitantes.Los resultados se expresaron en tablas y gráficos para su mejor comprensión. Resultados: predominó el sexo femenino con 51,3% así como el grupo etario de 60 y más años con 24,5%. En cuanto a la dispensarizaciónel grupo dispensarial III fue superior con un 47,4%. Prevalecieron los factores de riesgo sedentarismo y hábito de fumar en hombres con 42,1% y 35,7% respectivamente, así como las enfermedades crónicas Hipertensión Arterial (20,7%) y Asma Bronquial (10,1%). Se destacaron las consultas totales (4 285) y el empleo de la Medicina Natural y Tradicional (2 134). Conclusiones: dicho estudio enriquece y amplía el trabajo asistencial, docente, investigativo y gerencial en el consultorio médico, contribuyendo con ello al fortalecimiento de los programas e indicadores de salud, así como al análisis del proceso salud-enfermedad en individuos, familia y comunidad.

Objective: To describe the seroprevalence of and risk factors for brucellosis and leptospirosis in urban citizens with backyard breeding in the district of José Leonardo Ortiz, Chiclayo. Methods: Cross-sectional study including 90 citizens during the month of October and December of 2016. IgM and IgG specific antibodies for brucellosis and leptospirosis were determined using the indirect ELISA method. Factors associated with these diseases were gathered using a structural survey. Results: The seroprevalence of brucellosis and leptospirosis was 2.2% and 28.9%, respectively. The most common environmental features of the population were that 73.3% use latrines 83.3% had contact with stagnant water and 62.2% had contact with rodents. No association between the variables looked for and these two diseases was found. Conclusions: We found a high seroprevalence of leptospirosis but a low prevalence of brucellosis in this setting. We suggest performing longitudinal studies that may identify risk factors to prevent these diseases. [ABSTRACT FROM AUTHOR]

O objetivo foi verificar a validade de dados secundários na investigação do ambiente alimentar e analisar as características do ambiente da comunidade e do consumidor em territórios de serviço de promoção da saúde. Estudo ecológico desenvolvido em 18 unidades do Programa Academia da Saúde de Belo Horizonte, Minas Gerais, Brasil, selecionadas por amostragem de conglomerado simples. A validação dos estabelecimentos que comercializam frutas e hortaliças, obtidos valendo-se de bases de dados públicas, foi realizada por contato telefônico, uso da ferramenta Google Street View e auditoria. As variáveis do ambiente alimentar da comunidade investigadas foram: tipo de estabelecimento e localização; e do ambiente do consumidor: disponibilidade, variedade, preço e propaganda de frutas e hortaliças, e disponibilidade e variedade de alimentos ultraprocessados; e aspectos higiênico-sanitários. Para mensurar o acesso a alimentos saudáveis, utilizou-se o índice de acesso a estes alimentos. A auditoria revelou concordância fraca (45,7%) das bases secundárias de dados. Dos 298 estabelecimentos auditados, a maioria era sacolões e feiras-livres (61,3%), que apresentavam maior disponibilidade de alimentos saudáveis, mas também comercializavam de forma expressiva alimentos ultraprocessados (60,7%). Quanto às condições sanitárias, 1/3 dos estabelecimentos foi reprovado. Foi baixa a validade das bases secundárias, reforçando a necessidade de realizar auditoria nos estabelecimentos. Ademais, os estabelecimentos investigados apresentaram presença marcante de alimentos ultraprocessados e inadequadas condições higiênico-sanitárias.

Objective: To compare, from an empirical point of view, the use of focus group and photovoice as we conducted two studies on food environment in neighbourhoods with different socio-economic profiles., Method: The European project Heart Healthy Hoods studied the association between the physical and social environment of Madrid (Spain) and the cardiovascular health of its residents. Two ancillary studies were developed to further expand the study of urban health inequalities using focus group and photovoice. Both studies, similar in their objectives and study populations, are the basis for comparing both techniques. The comparison considered the following methodological aspects: study design, logistic aspects, commitment and involvement, ethical issues, and data analysis., Results: We identified differences, similarities, potentialities, and limitations of each technique with their corresponding results. We found that depending on the research objectives, one technique was more beneficial than the other. If the objective is producing new knowledge, using focus group would be the most appropriate technique, whereas if the objective includes generating social change, photovoice would be more suitable. We found that photovoice is a powerful technique in public health, especially studying social processes related to population health, requiring extra effort from researchers and a special care with the related ethical considerations., Conclusions: Increasing participants' awareness, involving decision makers to channel proposals, the atypical role of researchers and ethical implications of photography are aspects to be considered when choosing photovoice instead of focus group., (Copyright © 2024 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Abstract There is little scientific evidence that urban upgrading helps improve health or reduce inequities. This article presents the design for the BH-Viva Project, a “quasi-experimental”, multiphase, mixed-methods study with quantitative and qualitative components, proposing an analytical model for monitoring the effects that interventions in the urban environment can have on residents’ health in slums in Belo Horizonte, Minas Gerais State, Brazil. A preliminary analysis revealed intra-urban differences in age-specific mortality when comparing areas with and without interventions; the mortality rate from 2002 to 2012 was stable in the “formal city”, increased in slums without interventions, and decreased in slums with interventions. BH-Viva represents an effort at advancing methodological issues, providing learning and theoretical backing for urban health research and research methods, allowing their application and extension to other urban contexts.

Abstract The Belo Horizonte Observatory for Urban Health (OSUBH), housed in an academic setting, was founded in 2002 as part of a broader agenda to strengthen local and national health systems. Its mission is to build the capacity of the workforce in research on population health and to conduct studies on urban issues that can guide the planning of activities aimed at improving the health of populations, especially in heavily urbanized areas, associated with intra-urban inequalities. It focuses on the acquisition of advanced knowledge on urban health (metric) through scientific research, to contribute to public policies that may interfere with health, both at individual and community levels. During its lifetime, many partnerships and studies have been developed, but many challenges still exist in order for it to consolidate its position as a legitimate space and as a tool to generate systematic information for governments and populations.

Abstract Health observatories may differ according to their mission, institutional setting, topical emphasis or geographic coverage. This paper discusses the development of a new urban-focused health observatory, and its operational research and training infrastructure under the academic umbrella of the Department of Epidemiology and the Institute of Urban Health at the Johns Hopkins Bloomberg School of Public Health (BSPH) in Baltimore, USA. Recognizing the higher education mission of the BSPH, the development of a new professional training in public health was an important first step for the development of this observatory. This new academia-based observatory is an innovative public health research and training platform offering faculty, investigators, professional epidemiology students and research partners a physical and methodological infrastructure for their operational research and training activities with both a local urban focus and a global reach. The concept of a public health observatory and its role in addressing social health inequalities in local urban settings is discussed.

Abstract This study provides a spatial analysis of distribution and access to commercial fruit and vegetable establishments within the territory of a representative sample of public fitness facilities known as the Health Academy Program (HAP) in Belo Horizonte, Minas Gerais State, Brazil. The study evaluated commercial food establishments within a buffer area based on a radius of 1,600 meters around each of 18 randomly selected fitness facilities. Quality of access to fruits and vegetables was assessed by the Healthy Food Store Index (HFSI), consisting of the variables availability, variety, and advertising of fruits, vegetables and ultra-processed foods. The analysis was based on calculation of the Kernel intensity estimator, nearest neighbor method, and Ripley K-function. Of the 336 food establishments, 61.3% were green grocers and open-air markets, with a median HFSI of 11 (5 to 16). In only 17% of the territories, the majority of the “hot area” establishments displayed better access to healthy foods, and only three areas showed a clustering pattern. The study showed limited access to commercial establishments supplying healthy fruits and vegetables within the territory of the public fitness program.

Abstract This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the program’s potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.

Abstract Obesity prevalence is rapidly increasing in developing countries. Existing research investigating social patterning of obesity and its risk factors in Latin American urban contexts has inconsistent findings. This study analyzed a multistage household survey in adults in Belo Horizonte, Minas Gerais State, Brazil. Marginal models were used to examine the association of education and household and neighborhood income with body mass index (BMI), obesity, physical inactivity, and low fruit and vegetable intake after adjusting for age and ethnicity and stratifying by sex. BMI and obesity were inversely associated with education in women. BMI was positively associated with household and neighborhood income in men. Additionally, physical inactivity and low fruit and vegetable intake were inversely associated with education and household income in both men and women, and physical inactivity was inversely associated with neighborhood income in men. Understanding the drivers of these patterns will allow for development of appropriate policy and interventions to reduce cardiovascular disease risk in large cities in Latin America.

Abstract Public Health Observatories (PHOs) were created in England in 2000 as an important adjunct to the public health system in the country. The observatories were networked together, which allowed pooling of expertise and rapid dissemination of methods and results. The network grew to include the whole of the UK and Ireland and was a very successful force for change until PHOs were subsumed into the new Government Agency Public Health Organization, Public Health England. This paper describes the lessons learnt from their existence in the public health system in England for fourteen years.

Abstract This study’s aims are: (i) identifying spatial patterns for the risk of hospitalization due to mental illness and for the potential risk resulting from contextual factors with influence on mental health; and (ii) analyzing the spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors in the metropolitan areas of Lisbon and Porto, Portugal. A cross-sectional ecological study was conducted by applying statistical methods for assessing spatial dependency and heterogeneity. Results reveal a spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors with a statistical relevance of moderate intensity. 20% of the population under study lives in areas with a simultaneously high potential risk resulting from contextual factors and risk of hospitalization due to mental illness. Porto Metropolitan Area show the highest percentage of population living in parishes with a significantly high risk of hospitalization due to mental health, which puts forward the need for interventions on territory-adjusted contextual factors influencing mental health.

Abstract The term “co-benefits” refers to positive outcomes accruing from a policy beyond the intended outcome, often or usually in other sectors. In the urban context, policies implemented in particular sectors (such as transport, energy or waste) often generate multiple co-benefits in other areas. Such benefits may be related to the reduction of local or global environmental impacts and also extend into the area of public health. A key to identifying and realising co-benefits is the adoption of systems approaches to understand inter-sectoral linkages and, in particular, the translation of this understanding to improved sector-specific and city governance. This paper reviews a range of policies which can yield health and climate co-benefits across different urban sectors and illustrates, through a series of cases, how taking a systems approach can lead to innovations in urban governance which aid the development of healthy and sustainable cities.

Abstract The present study aimed to evaluate factors associated with overweight among adults living in urban areas, with the income of the census tract as a context variable. The survey assessed individuals from two health districts of Belo Horizonte, Minas Gerais State, Brazil. Excess weight was determined by body mass index > 25kg/m2. Multilevel logistic regression was used. The sample comprised 2,935 individuals aged 20 to 60 years. The prevalence of overweight was 52.3% (95%CI: 49.9-54.8), similar between men and women. Higher schooling proved to be protective against overweight in women and a risk for men. Living in census tracts with higher income was associated with excess weight only in males. Report of the consumption of diet soft drinks was positively associated with overweight in both sexes. The occurrence of this event seems to be influenced by different factors or to interrelate differently in men and women.

Abstract An urban health index (UHI) was used to quantify health inequalities within Rio de Janeiro, Brazil, for the years 2002-2010. Eight main health indicators were generated at the ward level using mortality data. The indicators were combined to form the index. The distribution of the rank ordered UHI-values provides information on inequality among wards, using the ratio of the extremes and the gradient of the middle values. Over the decade the ratio of extremes in 2010 declined relative to 2002 (1.57 vs. 1.32) as did the slope of the middle values (0.23 vs. 0.16). A spatial division between the affluent south and the deprived north and east is still visible. The UHI correlated on an ecological ward-level with socioeconomic and urban environment indicators like square meter price of apartments (0.54, p < 0.01), low education of mother (-0.61, p < 0.01), low income (-0.62, p < 0.01) and proportion of black ethnicity (-0.55, p < 0.01). The results suggest that population health and equity have improved in Rio de Janeiro in the last decade though some familiar patterns of spatial inequality remain.

Abstract This study aimed to estimate the prevalence of leisure-time physical activity and investigate its association with contextual characteristics of the social and physical environment in different socioeconomic statuses, using a household survey in Belo Horizonte, Minas Gerais State, Brazil (2008-2009). Leisure-time physical activity was measured by the International Physical Activity Questionnaire; and the social and physical environment by scales arising from perception of neighborhood attributes. Multilevel logistic regression analysis was performed separately for each socioeconomic status stratum. The overall prevalence of leisure-time physical activity was 30.2%, being 20.2% amongst participants of low socioeconomic status, 25.4% in the medium and 40.6% in the high socioeconomic status group. A greater perception of social cohesion was associated with increased leisure-time physical activity only amongst participants of the lowest socioeconomic status even after adjusting for individual characteristics. The results demonstrate the importance of social cohesion for the promotion of leisure-time physical activity in economically disadvantaged groups, supporting the need to stimulate interventions for enhancing social relationships in this population.

Abstract Human contact with solid waste poses biological, chemical, and physical health risks for workers involved in waste collection, transportation, and storage. The potential risk to human health resulting from contact with health services waste or household waste still sparks considerable controversy. The aim of this study was to identify the context of scientific discussions on risk/infection from the hepatitis B and C viruses in workers that collect solid waste from health services or households. The search covered publications up to 2013 in Brazilian and international databases, and 11 articles were selected through a literature review. Of these, six conclude that there is an increased risk of infection in workers that collect household waste when compared to those unexposed to waste, three point to greater risk for workers that collect health services waste as compared to those that collect ordinary waste, and the other two found no difference between exposed and unexposed individuals.

Abstract This study analyzes the profile of deaths from road traffic accidents in Belo Horizonte, Minas Gerais State, Brazil, by linking two public databases, the Information System of the Urban Transportation and Transit Company (BH10) and the Mortality Information System (SIM). The linked database (n = 306) identified a 24% under-recording rate for deaths and differed in the age distribution from the BH10 database and in roadway user category when compared to the mortality database. The mortality rate for road traffic accidents within the city limits was 10.2 per 100,000 thousand, and was higher among men, young adults, and the elderly. Poisson multivariate regression showed a higher mean death rate for motorcycle occupants (rate ratio – RR: 1.81); pedestrians (RR: 1.32); males (RR: 1.24); single/divorced (RR: 1.27); young adults 18-29 years of age (RR: 1.75); elderly (RR: 1.59); and deaths at the crash site (RR: 1.39) when compared to the reference categories. The study unveils the city’s traffic violence, expressed by the large proportion of deaths at the crash site and within the first 24 hours, and confirms the relevance of database linkage for characterizing vulnerable groups and traffic accident mortality in the urban setting.

Abstract Neighborhood problems constitute sources of chronic stress that may increase the risk of poor self-rated health. The associations of census tract level income and perceived neighborhood problems with self-rated health were examined in Florianópolis, Santa Catarina State, Brazil (1,720 adults). Odds ratios (OR) and their 95% confidence intervals (95%CI) of poor self-rated health were estimated through multilevel models. Residents in census tracts in the lower and intermediate tertiles of income reported poorer health than those in the highest tertile. OR of reporting poorer health was 2.44 (95%CI: 2.35- 2.54) in the higher tertile of social disorder (adjusting for mental health). The chances of reporting the poorer health with neighborhood problems ranged from 1.07 (95%CI: 1.03-1.11) to 2.02 (95%CI: 1.95-2.10) for the higher tertile of social disorder (physical health) and physical problem (health-related variables). Perceived neighborhood problems were independently associated with poor health. The perception of a neighborhood among its residents should be considered by health policymakers.

Abstract The aim of this study was to determine and quantify the association between one’s perception of the place of residence and self-rated health. 4,048 adult residents of Belo Horizonte, Minas Gerais State, Brazil, participated in the study in 2008 and 2009. Ordinal logistic regression was used to estimate the magnitude of the association. Health was rated as good or very good, fair, or poor or very poor by 65.7%, 27.8%, and 6.5% of the subjects, respectively. Better self-rated health was associated with the following neighborhood characteristics: positive evaluation of aesthetics and mobility, better quality of public services, less physical and social disorder. The perception of violence had a borderline statistically significant association with worse self-rated health. These associations persisted after controlling for potential confounding demographic, socioeconomic, health, and health behavior variables. The results indicate that public and health policies should incorporate interventions that address the physical and social environment in addition to policies focused on individuals.

Abstract This paper reviews the potential utility of using the concepts and tools of systems to understand and act on health in cities. The basic elements of systems approaches and the links between cities as systems and population health as emerging from the functioning of a system are reviewed. The paper also discusses implications of systems thinking for urban health including the development of dynamic conceptual models, the use of new tools, the integration of data in new ways and the identification of data gaps, and the formulation of different kinds of questions and identification of new policies. The paper concludes with a review of caveats and challenges.

Abstract The Ciclovia program (CP) has emerged as an effective initiative to promote active living in urban spaces in Latin America. This study assessed the association between social conditions, the urban environment and participation in the CP among adults living in the city of Cali, Colombia. A cross-sectional study was conducted in 2011 and 2012 among 719 adults aged 18 to 44. Urban environment measures were obtained using Geographic Information Systems. A multilevel logistic regression was used for the analysis. Slightly more than 7% of participants had participated in the CP in the previous four weekends. Being male and having a high school degree were positively associated with participation in the CP. Participation in the CP was positively associated with living in neighborhoods with Ciclovia lanes. In contrast, a negative association was found among those living in neighborhoods with a presence of traffic fatalities. This study provides new insights about a recreational program that has potential health benefits in a region marked by urban inequalities in terms of opportunities for physical activity.

Abstract This observational study aimed to estimate the prevalence of speeding on urban roadways and to analyze associated factors. The sample consisted of 8,565 vehicles circulating in areas with and without fixed speed cameras in operation. We found that 40% of vehicles 200 meters after the fixed cameras and 33.6% of vehicles observed on roadways without speed cameras were moving over the speed limit (p < 0.001). Motorcycles showed the highest recorded speed (126km/h). Most drivers were men (87.6%), 3.3% of all drivers were using their cell phones, and 74.6% of drivers (not counting motorcyclists) were wearing their seatbelts. On roadway stretches without fixed speed cameras, more women drivers were talking on their cell phones and wearing seatbelts when compared to men (p < 0.05 for both comparisons), independently of speed limits. The results suggest that compliance with speed limits requires more than structural interventions.

Abstract This study assesses the prevalence of poor self-rated health and investigates its association with individual and environmental characteristics in adults with and without reported morbidity. A household survey assessed 4,048 adults in two districts of Belo Horizonte, Minas Gerais State, Brazil. We used Poisson regression with robust variance stratified by the presence of reported morbidity. Prevalence of poor self-rated health was 29.9% (42.6% in those with morbidity and 13.1% in the group without morbidity). All assessed domains were associated with self-rated health in subjects with reported morbidity. In the group without reported morbidity, the following were associated with self-rated health: social environment, socio-demographic factors, lifestyle, and psychological health. Perceived problems in the environment were associated with poor self-rated health in both groups, even after hierarchical adjustment. The results suggest the importance of investigating self-rated health stratified by reported morbidity and reinforce the need to include variables that characterize the physical and social environment.