Urban green spaces in the proximity of residences can reduce the effect of socioeconomic inequalities in sports practice among teenage girls.

Background: We studied if proximity of urban green spaces to residences reduces the socioeconomic inequalities in sports practice, evaluating 17-year-old girls (n = 722) from EPITeen cohort, Porto, Portugal. Methods: The shortest routes from residences to urban green spaces were calculated using the street network from Geographic Information System. Distances were classified as: ≤400, >400 to ≤800, and >800 m. Parental education was used as a proxy of socioeconomic status (SES). We used chi-square test to compare proportions of teenagers practicing sports per SES, stratified by classes of distances to urban green spaces and logistic regression to estimate the association between sports practice and SES through odds ratio (OR) and 95% confidence intervals. Results: Strong inequalities were found. Girls from low SES have ≥75% less odds of sports practice (reference: high SES), regardless of the distance to urban green spaces. As distances are lowering the socioeconomic inequalities in the sports practice between girls from high and medium SES diminishes, being the OR 0.42 (0.22-0.80) at ≥800 m, 0.51 (0.24-1.09) at ≥400 to ≤800 m, and 0.63 (0.29-1.37) at ≤400 m. Conclusion: At closer distances inequalities in the proportion of sports practice between high and medium SES vanishes, but remain to low SES.

Scaling of mortality in 742 metropolitan areas of the Americas.

We explored how mortality scales with city population size using vital registration and population data from 742 cities in 10 Latin American countries and the United States. We found that more populated cities had lower mortality (sublinear scaling), driven by a sublinear pattern in U.S. cities, while Latin American cities had similar mortality across city sizes. Sexually transmitted infections and homicides showed higher rates in larger cities (superlinear scaling). Tuberculosis mortality behaved sublinearly in U.S. and Mexican cities and superlinearly in other Latin American cities. Other communicable, maternal, neonatal, and nutritional deaths, and deaths due to noncommunicable diseases were generally sublinear in the United States and linear or superlinear in Latin America. Our findings reveal distinct patterns across the Americas, suggesting no universal relation between city size and mortality, pointing to the importance of understanding the processes that explain heterogeneity in scaling behavior or mortality to further advance urban health policies.

Life expectancy and mortality in 363 cities of Latin America.

The concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.

Regional drinking water composition effects on hip fracture risk: a spatial analysis of nationwide hospital admissions in Portugal, from 2000 to 2010 / Efeitos da composição regional da água potável no risco de fratura do fêmur: uma análise espacial das admissões hospitalares em Portugal, de 2000 a 2010

Abstract Geographical variation on hip fractures (HF) may be related to the geographical variation of drinking water composition (DWC); minerals in drinking water may contribute to its fragility. We aim to investigate the effects of DWC on HF risk in Portugal (2000-2010). From National Hospital Discharge Register we selected admissions of patients aged ≥50 years, diagnosed with HF caused by low/moderate energy traumas. Water components and characteristics were selected at the municipality level. A spatial generalized additive model with a negative binomial distribution as a link function was used to estimate the association of HF with variations in DWC. There were 96,905HF (77.3% in women). The spatial pattern of HF risk was attenuated after being adjusted for water parameters. Results show an indirect association between calcium, magnesium, and iron and HF risk but no clear relation between aluminum, cadmium, fluoride, manganese, or color and HF risk. Regarding pH, the 6.7pH and 7pH interval seems to pose a lower risk. Different dose-response relationships were identified. The increase of calcium, magnesium, and iron values in DWC seems to reduce regional HF risk. Long-term exposure to water parameters, even within the regulatory limits, might increase the regional HF risk.

Resumo A variabilidade espacial existente na fratura do colo do fêmur (FCF) pode estar relacionada com a variabilidade geográfica da composição da água para consumo (CAC), devido à ação dos minerais na fragilidade óssea. O objetivo do artigo foi investigar o efeito da CAC no risco de FCF em Portugal (2000-2010). Do registo nacional de altas hospitalares, foram selecionadas todas as admissões em indivíduos ≥50, com diagnóstico de FCF causado por trauma de baixo/moderado impacto. Os componentes e características da água foram usados ao nível do município. Um modelo espacial aditivo generalizado, com a distribuição binomial negativa como função de ligação, foi usado para estimar a associação de FCF e as variações da CAC. Foram selecionadas 96.905 FCF (77,3% em mulheres). O padrão espacial de risco de FCF foi atenuado após ser ajustado pelos parâmetros da CAC. Os resultados mostraram uma associação indireta com cálcio, magnésio e ferro. No entanto, com alumínio, cádmio, fluoreto, manganês e cor, a associação com o risco não foi clara. O intervalo de pH de 6,7 a 7 parece apresentar um menor risco. Foram identificadas diferentes dose-resposta. O aumento do cálcio, magnésio e ferro na CAC parece reduzir o risco regional de FCF. Uma exposição a longo prazo, mesmo obedecendo aos limites impostos por lei, parece aumentar o risco regional de FCF.

School environment associates with lung function and autonomic nervous system activity in children: a cross-sectional study.

Children are in contact with local environments, which may affect respiratory symptoms and allergic sensitization. We aimed to assess the effect of the environment and the walkability surrounding schools on lung function, airway inflammation and autonomic nervous system activity. Data on 701 children from 20 primary schools were analysed. Lung function, airway inflammation and pH from exhaled breath condensate were measured. Pupillometry was performed to evaluate autonomic activity. Land use composition and walkability index were quantified within a 500 m buffer zone around schools. The proportion of effects explained by the school environment was measured by mixed-effect models. We found that green school areas tended to be associated with higher lung volumes (FVC, FEV1 and FEF25-75%) compared with built areas. FVC was significantly lower in-built than in green areas. After adjustment, the school environment explained 23%, 34% and 99.9% of the school effect on FVC, FEV1, and FEF25-75%, respectively. The walkability of school neighbourhoods was negatively associated with both pupil constriction amplitude and redilatation time, explaining -16% to 18% of parasympathetic and 8% to 29% of sympathetic activity. Our findings suggest that the environment surrounding schools has an effect on the lung function of its students. This effect may be partially mediated by the autonomic nervous system.

The association between the neighbourhood social environment and obesity in Brazil: a cross-sectional analysis of the ELSA-Brasil study.

OBJECTIVE: To investigate the association between the neighbourhood social environment, including social cohesion, perceived neighbourhood safety, perceived neighbourhood violence, and obesity in Brazil. DESIGN: Cross-sectional study. SETTING: 6 state capitals in Brazil (Salvador, Vitoria, Belo Horizonte, Porto Alegre, Sao Paulo and Rio de Janeiro) PARTICIPANTS: Current or former employees of five federal universities and one research centre in each of the six Brazilian state capitals who were participants of the baseline wave (2008-2010) of the Brazilian Longitudinal Study of Adult Health (n=11 456; 56% women; 56% White, 28% Brown, and 16% Black). PRIMARY OUTCOME MEASURE: Obesity, based on measured weight and height, and defined as having a body mass index ≥30 kg/m2. RESULTS: No associations were found between the neighbourhood social environment and obesity among men. In multilevel logistic regression models adjusted for age, education, skin colour, state of residence, and individual-level social cohesion and perceived violence scores, respectively, women living in the least socially cohesive neighbourhoods and in those perceived as most violent had higher odds of obesity compared with their counterparts (OR=1.25, 95% CI=1.02-1.53; OR=1.28, 95% CI=1.04-1.56, respectively). When stratified by neighbourhood socioeconomic status (SES)-defined based on number of people per household, proportion of children 0-4 years, median income and per cent of white residents at the neighbourhood level-results for social cohesion and for violence remained only for women residing in high SES and low SES neighbourhoods, respectively. CONCLUSIONS: In this civil-servant sample in six large cities in Brazil, the neighbourhood social environment was associated with obesity among women, but not men. Neighbourhood-level interventions to increase social cohesion and reduce violence may help in the prevention of obesity among women in Brazil.

The Portuguese Version of the European Deprivation Index: An Instrument to Study Health Inequalities.

INTRODUCTION: Tackling socioeconomic health inequalities is a big public health challenge and ecological deprivation indexes are essential instruments to monitor and understand them. In Portugal, no standard ecological deprivation index exists, contrasting with other countries. We aimed to describe the construction of the Portuguese version of a transnational deprivation index, European Deprivation Index. MATERIAL AND METHODS: The European Deprivation Index was developed under the Townsend theorization of deprivation. Using data from the European Union - Statistics on Income and Living Conditions Survey, we obtained an indicator of individual deprivation. This indicator became the gold-standard variable, based on what we selected the variables at aggregate level (census) to be included in the European Deprivation Index, a total of eight. The European Deprivation Index was produced for the smallest area unit possible (n = 16 094, mean/area = 643 inhabitants) and resulted from the weighted sum of the previous variables. It was then classified into quintiles. RESULTS: The first quintile (least deprived) comprised 20.9% national population and the fifth quintile (most deprived) 18.0%. The European Deprivation Index showed a clear geographic pattern - most deprived areas concentrated in the South and in the inner North and Centre of the country, and the least deprived areas in the coastal areas of North and Centre and in the Algarve. DISCUSSION: The development of the European Deprivation Index was grounded on a solid theoretical framework, individual and aggregate variables, and on a longitudinal Europe-wide survey allowing its replication over the time and in any European country. CONCLUSION: Hopefully, the European Deprivation Index will start being employed by those interested in better understand health inequalities not only in Portugal but across Europe.

Validation of a Single Question for the Evaluation of Physical Activity in Adolescents.

We aimed to assess the validity of a single question to evaluate leisure-time physical activity (PA) in adolescents. We included 209 participants (57.4% girls) aged 14-18 years from Porto, Portugal, evaluated as part of the SALTA project. A self-reported question with four answer options, designed for the EPITeen study, was used to classify the intensity level of usual leisure-time activities. Actigraph accelerometers were used to objectively measure total PA during 7 consecutive days. Since the accelerometers measured PA as a continuous variable, hierarchical cluster analysis was used to identify clusters of individuals with similar level of objectively measured PA. Correlations between self-reported and objective measures were evaluated through polychoric correlations. In girls, we found higher mean time on sedentary activities among those describing their leisure-time PA as "sitting", and an increase on the time spent on light and moderate activities with increasing intensity of PA on self-reported classification. A similar trend was found in boys, but not reaching statistical significance. The correlation between the two measures of PA was 0.42 for girls and 0.46 for boys. We found an acceptable correlation between our single question and the objectively measured PA, showing that, although the single question is not adequate to quantify the intensity of the physical activity, it allows to rank adolescents according to leisure-time physical activity.

Vicinity of Schools, But Not of Residences, Seems to Regulate Physical and Sports Activities of 13-Year-Old Teenagers in a South European Setting.

BACKGROUND: Proximity to urban green spaces (UGS) and open sports spaces (OSS) benefits health, promotes physical activity (PA) and sports practice (SP). OBJECTIVE: Analyze the association between PA or SP according to distances between UGS or OSS and teenagers' residences or schools. METHODS: We evaluated 1333 (53.9% girls) teenagers (13 years old) living and studying in Porto, Portugal (EPITeen cohort). PA was classified as light or moderate/vigorous. Distances were the shortest routes from residences or schools to UGS/OSS, and classified in ≤250 m; >250 m to ≤500 m; >500 m to ≤750 m; >750 m. Chi-square test and chi-square for trends were used to compare proportions; associations were measured using logistic regression, through odds ratio and 95% confidence intervals, adjusting to BMI and parental education. RESULTS: Regarding vicinity' of schools, the prevalence of moderate/vigorous PA among boys, decreases as distances to OSS increases. For girls, the prevalence of sports decreases as distances to UGS increase. For boys, we found an association between moderate/vigorous PA and proximity to OSS in the vicinity of schools: considering ≤250 m as reference, the odds of moderate/vigorous PA is 0.20 (0.06-0.63) for >250 m to ≤500 m; 0.21 (0.07-0.61) for >500 m to ≤750 m and 0.19 (0.06-0.58) for >750 m. CONCLUSION: Vicinities of schools seem to influence teenagers to be more physically active and increase sports participation.

Increased Hospitalizations for Neuropathies as Indicators of Zika Virus Infection, according to Health Information System Data, Brazil.

Evidence is increasing that Zika virus can cause extensive damage to the central nervous system, affecting both fetuses and adults. We sought to identify traces of possible clinical manifestations of nervous system diseases among the registers of hospital admissions recorded in the Brazilian Unified Health System. Time series of several diagnoses from the International Classification of Diseases, 10th Revision, were analyzed by using control diagrams, during January 2008-February 2016. Beginning in mid-2014, we observed an unprecedented and significant rise in the hospitalization rate for congenital malformations of the nervous system, Guillain-Barré syndrome, encephalitis, myelitis, and encephalomyelitis. These conditions are compatible with viral infection and inflammation-associated manifestations and may have been due to the entrance of Zika virus into Brazil. These findings show the necessity of adequately diagnosing and treating suspected cases of Zika virus infection and also that health surveillance systems can be improved by using routine data.

Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000-2010) in Portugal: age and sex temporal trends in a population based study.

BACKGROUND: Socioeconomic factors may influence changes in hip fracture (HF) incidence over time. We analysed HF temporal trends during the Bone and Joint Decade in Portugal (BJD-Portugal), 2000-2010, by regional socioeconomic status (SES), sex and age. METHODS: We selected registers of patients aged 50+ years with HF (International Classification of Diseases, V.9-Clinical Modification, ICD9-CM) caused by traumas of low/moderate energy, from the National Hospital Discharge Database. Annual time series of age-specific incidence rates were calculated by sex and regional SES (deprived, medium, affluent). Generalised additive models were fitted to identify shape/turning points in temporal trends. RESULTS: We selected 96 905 HF (77.3% in women). Women were older than men at admission (81.2±8.5 vs 78.2±10.1 years-old, p<0.001). For women 65-79 years, a continuously decreasing trend (1.7%/year) only in affluent and increasing trends (3.3-3.4%/year) after 2006/2007 in medium and deprived was observed. For men, trends were stable or increased in almost all age/SES groups (only two decreasing periods). For the oldest women, all SES present similar trends: turning points around 2003 (initiating decreasing periods: 1.8-2.9%/year) and around 2007 (initiating increasing periods: 3.7-3.3%/year). CONCLUSIONS: There were SES-sex-age inequalities in temporal trends during BJD-Portugal: marked SES inequalities among women aged 65-79 years (a persistent, decreasing trend only in the affluent) vanished among the oldest women; the same was not observed in men, for them, there were almost no declining periods; women aged ≥80 years, presented increasing trends around 2007, as in most deprived/age/sex groups. Despite some successful periods of decreasing trends, incidence rates did not improve overall in almost all age groups and both sexes.

Development of a cross-cultural deprivation index in five European countries.

BACKGROUND: Despite a concerted policy effort in Europe, social inequalities in health are a persistent problem. Developing a standardised measure of socioeconomic level across Europe will improve the understanding of the underlying mechanisms and causes of inequalities. This will facilitate developing, implementing and assessing new and more effective policies, and will improve the comparability and reproducibility of health inequality studies among countries. This paper presents the extension of the European Deprivation Index (EDI), a standardised measure first developed in France, to four other European countries-Italy, Portugal, Spain and England, using available 2001 and 1999 national census data. METHODS AND RESULTS: The method previously tested and validated to construct the French EDI was used: first, an individual indicator for relative deprivation was constructed, defined by the minimal number of unmet fundamental needs associated with both objective (income) poverty and subjective poverty. Second, variables available at both individual (European survey) and aggregate (census) levels were identified. Third, an ecological deprivation index was constructed by selecting the set of weighted variables from the second step that best correlated with the individual deprivation indicator. CONCLUSIONS: For each country, the EDI is a weighted combination of aggregated variables from the national census that are most highly correlated with a country-specific individual deprivation indicator. This tool will improve both the historical and international comparability of studies, our understanding of the mechanisms underlying social inequalities in health and implementation of intervention to tackle social inequalities in health.

Time to death in a prospective cohort of 252 patients treated for fracture of the proximal femur in a major hospital in Portugal.

The objectives were to analyze one-year survival and mortality predictors in patients with fracture of the proximal femur (low/moderate trauma). A prospective cohort was formed by inviting all patients hospitalized in the Orthopedic Ward of the second largest hospital in Portugal (May 2008-April 2009). Survival was assessed at 3, 6, 9, and 12 months after fracture and related to demographic factors, lifestyle, and clinical history, as well as to data from medical records (fracture type, surgery date, surgical treatment, and preoperative risk). Of the 340 patients hospitalized, 252 were included (78.9% women). Mortality at 3, 6, 9, and 12 months was 21.2%, 25%, 28.8%, and 34.6% for men and 7.8%, 13.5%, 19.2%, and 21.4% for women, respectively. Predictors of death were male gender (HR = 2.54; 95%CI: 1.40-4.58), ASA score III/IV vs. I/II (HR = 1.95; 95%CI: 1.10-3.47), age (HR = 1.06; 95%CI: 1.03-1.10), and delay in days to surgery (HR = 1.07; 95%CI: 1.03-1.12). Factors related to death were mainly related to patients' characteristics at admission.

Time to death in a prospective cohort of 252 patients treated for fracture of the proximal femur in a major hospital in Portugal / Tempo até a morte após fratura do fêmur proximal: uma coorte prospectiva de 252 doentes tratados no segundo maior hospital em Portugal / Tiempo transcurrido hasta la muerte después de una fractura de cadera: una cohorte prospectiva de 252 pacientes del segundo mayor hospital de Portugal

The objectives were to analyze one-year survival and mortality predictors in patients with fracture of the proximal femur (low/moderate trauma). A prospective cohort was formed by inviting all patients hospitalized in the Orthopedic Ward of the second largest hospital in Portugal (May 2008-April 2009). Survival was assessed at 3, 6, 9, and 12 months after fracture and related to demographic factors, lifestyle, and clinical history, as well as to data from medical records (fracture type, surgery date, surgical treatment, and preoperative risk). Of the 340 patients hospitalized, 252 were included (78.9% women). Mortality at 3, 6, 9, and 12 months was 21.2%, 25%, 28.8%, and 34.6% for men and 7.8%, 13.5%, 19.2%, and 21.4% for women, respectively. Predictors of death were male gender (HR = 2.54; 95%CI: 1.40-4.58), ASA score III/IV vs. I/II (HR = 1.95; 95%CI: 1.10-3.47), age (HR = 1.06; 95%CI: 1.03-1.10), and delay in days to surgery (HR = 1.07; 95%CI: 1.03-1.12). Factors related to death were mainly related to patients’ characteristics at admission.

Os objetivos foram analisar a sobrevivência após um ano e os fatores associados para doentes com fratura do fêmur proximal (baixo impacto). Foi constituída uma coorte com todos os doentes hospitalizados no serviço de ortopedia do segundo maior hospital de Portugal (maio de 2008 a abril de 2009). A sobrevivência foi avaliada aos 3, 6, 9 e 12 meses após a fratura e relacionada com fatores demográficos, estilo de vida, história clínica e fatores médicos (tipo de fratura, data da cirurgia, tratamento e risco pré-operatório). Dos 340 doentes hospitalizados, 252 (78,9% mulheres) foram incluídos. Mortalidade aos 3, 6, 9 e 12 meses de seguimento foi 21,2%, 25%, 28,8%, 34,6% para homens e 7,8%, 13,5%, 19,2%, 21,4% para mulheres. Os fatores associados com a mortalidade foram: sexo masculino (HR = 2,54; IC95%: 1,40-4,58), escore da American Society of Anesthesiologists mais elevado, III/IV vs. I/II (HR = 1,95; IC95%: 1,10-3,47), idade (HR = 1,06; IC95%: 1,03-1,10) e dias de atraso na cirurgia (HR = 1,07; IC95%: 1,03-1,12). Fatores associados com a mortalidade estão na maioria relacionados com as características do doente na admissão.

Los objetivos del estudio fueron analizar la supervivencia tras un año y los factores asociados para enfermos con fractura de la cadera (bajo impacto). Fue constituida una cohorte con todos los enfermos hospitalizados en el servicio de ortopedia del segundo mayor hospital de Portugal (mayo/2008 – abril/2009). La supervivencia fue evaluada a los 3, 6, 9 y 12 meses tras la fractura y relacionada con factores demográficos, estilo de vida, historia clínica y factores médicos (tipo de fractura, fecha de la cirugía, tratamiento y riesgo preoperatorio). De los 340 enfermos hospitalizados, 252 (78,9% mujeres) fueron incluidos. La mortalidad a los 3, 6, 8 y 12 meses de seguimiento fue de un 21,2%, 20%, 28,8%, 34,6% en hombres y un 7,8%, 13,5%, 19,2%, 21,4% en mujeres. Los factores asociados con la mortalidad fueron: sexo masculino (HR = 2,54; IC95%: 1,40-4,58), ASA puntuación más elevada, III/IV vs. I/II (HR = 1,95; IC95%: 1,10-3,47), edad (HR = 1,06; IC95%: 1,03-1,10) y días de retraso en la cirugía (HR = 1,07; IC95%: 1,03-1,12). Los factores están en su mayoría relacionados con las características del enfermo en la admisión.

Distance to parks and non-residential destinations influences physical activity of older people, but crime doesn't: a cross-sectional study in a southern European city.

BACKGROUND: Physical activity (PA) has numerous health benefits, but older adults live mostly sedentary lifestyles. The physical and social neighborhood environment may encourage/dissuade PA. In particular, neighborhood crime may lead to feeling unsafe and affect older adults' willingness to be physically active. Yet, research on this topic is still inconclusive. Older population, probably the age group most influenced by the neighborhood environment, has been understudied, especially in Southern Europe. In this study, we aimed to analyze the association between leisure-time physical activity (LTPA) in older adults and objective crime, alongside other neighborhood characteristics. METHODS: We obtained data from a population-based cohort from Porto (2005-2008) to assess LTPA. Only adults aged 65 years or more were included (n = 532). A Geographic Information System was used to measure neighborhood characteristics. Neighborhood crime was expressed as crime rates by category (incivilities, criminal offenses with and without violence and traffic crime). Neighborhood characteristics such as socioeconomic deprivation, land gradient, street density, transportation network, distance to parks, non-residential destinations and sport spaces were also included. Generalized Additive Models were fitted to estimate the association between neighborhood characteristics and the participation (being active vs. inactive) and frequency (min/day) of LTPA. RESULTS: Forty-six percent of the men and 61 % of the women did not engage in any kind of LTPA. Among the active participants, men spent on average 50.5 (35.2 Standard Deviation, SD) min/day in LTPA, whereas the average among women was 36.9 (35.1 SD) min/day (p < 0.001). Neighborhood crime was unrelated to the participation in, or frequency of, LTPA. On the other hand, two neighborhood characteristics - distance to the nearest park (ß = -0.0262, p = 0.029) and to the nearest non-residential destination (ß = -0.0735, p = 0.019) - were associated with time spent on LTPA, but only among active older women. No neighborhood characteristic was related to participation in LTPA. CONCLUSIONS: From a public health point of view, the provision of parks and non-residential destinations (shops, schools, cultural and worship places) might contribute to elevate PA levels of already active older women. On the other hand, in this setting, crime was not a big issue.

Tools for address georeferencing - limitations and opportunities every public health professional should be aware of.

Various address georeferencing (AG) tools are currently available. But little is known about the quality of each tool. Using data from the EPIPorto cohort we compared the most commonly used AG tools in terms of positional error (PE) and subjects' misclassification according to census tract socioeconomic status (SES), a widely used variable in epidemiologic studies. Participants of the EPIPorto cohort (n = 2427) were georeferenced using Geographical Information Systems (GIS) and Google Earth (GE). One hundred were randomly selected and georeferenced using three additional tools: 1) cadastral maps (gold-standard); 2) Global Positioning Systems (GPS) and 3) Google Earth, single and in a batch. Mean PE and the proportion of misclassified individuals were compared. Google Earth showed lower PE than GIS, but 10% of the addresses were imprecisely positioned. Thirty-eight, 27, 16 and 14% of the participants were located in the wrong census tract by GIS, GPS, GE (batch) and GE (single), respectively (p<0.001). Misclassification according to SES was less frequent but still non-negligible -14.4, 8.1, 4.2 and 2% (p<0.001). The quality of georeferencing differed substantially between AG tools. GE seems to be the best tool, but only if prudently used. Epidemiologic studies using spatial data should start including information on the quality and accuracy of their georeferencing tools and spatial datasets.

The influence of drug physical state on the dissolution enhancement of solid dispersions prepared via hot-melt extrusion: a case study using olanzapine.

In this study, we examine the relationship between the physical structure and dissolution behavior of olanzapine (OLZ) prepared via hot-melt extrusion in three polymers [polyvinylpyrrolidone (PVP) K30, polyvinylpyrrolidone-co-vinyl acetate (PVPVA) 6:4, and Soluplus® (SLP)]. In particular, we examine whether full amorphicity is necessary to achieve a favorable dissolution profile. Drug­polymer miscibility was estimated using melting point depression and Hansen solubility parameters. Solid dispersions were characterized using differential scanning calorimetry, X-ray powder diffraction, and scanning electron microscopy. All the polymers were found to be miscible with OLZ in a decreasing order of PVP>PVPVA>SLP. At a lower extrusion temperature (160°C), PVP generated fully amorphous dispersions with OLZ, whereas the formulations with PVPVA and SLP contained 14%-16% crystalline OLZ. Increasing the extrusion temperature to 180°C allowed the preparation of fully amorphous systems with PVPVA and SLP. Despite these differences, the dissolution rates of these preparations were comparable, with PVP showing a lower release rate despite being fully amorphous. These findings suggested that, at least in the particular case of OLZ, the absence of crystalline material may not be critical to the dissolution performance. We suggest alternative key factors determining dissolution, particularly the dissolution behavior of the polymers themselves.

Association between neighborhood deprivation and fruits and vegetables consumption and leisure-time physical activity: a cross-sectional multilevel analysis.

BACKGROUND: Most studies of the association between neighborhood socioeconomic deprivation and individual lifestyles leading to cardiovascular disease focused on a single cardiovascular risk factor. The concomitant assessment of more than one risk factor may provide clues to specific mechanisms linking neighborhood disadvantage to individual lifestyles. We investigated the association of neighborhood deprivation with fruits and vegetables consumption and leisure-time physical activity in adults living in an urban center in Portugal. METHODS: In 1999-2003, we assembled a random sample of 2081 adult residents in the city of Porto. Data on sociodemographic characteristics were collected by trained interviewers using structured questionnaires. Fruits and vegetables consumption was estimated using a validated 82-item semiquantitative food frequency questionnaire covering the previous year and expressed in portions per day. Physical activity was evaluated using a questionnaire exploring leisure-time activities over the previous year and expressed in metabolic equivalents (MET).minute/day. Self-reported address was used to place individuals in neighborhoods. Neighborhoods' socioeconomic characterization was based on aggregated data at the census block level provided by the 2001 National Census. Latent class analysis models were used to identify three discrete socioeconomic classes of neighborhoods. Random effects models with random intercepts at the neighborhood level were used to explore clustering and contextual effects of neighborhood deprivation on each of the outcomes. RESULTS: We found evidence of neighborhood clustering of fruits and vegetables consumption and leisure-time physical activity that persisted after adjustment for neighborhood deprivation only among women. Women living in the most deprived neighborhoods presented a consumption increase of 0.43 (95% CI: -0.033 to 0.89) portions of fruits and vegetables per day and a decrease in leisure-time physical activity of 47.8 (95% CI: -91.8 to 1.41) MET.minute/day, when compared to those living in the most affluent neighborhoods. Among men, no contextual neighborhood deprivation effects were observed. CONCLUSION: Overall, neighborhood deprivation had a small effect on the consumption of fruits and vegetables and leisure-time physical activity. Neighborhood factors other than socioeconomic deprivation may still impact on the studied outcomes among women. This study provides relevant information for the design of interventions directed to neighborhood characteristics in the prevention of cardiovascular diseases.

Osteoporotic hip fractures: bisphosphonates sales and observed turning point in trend. A population-based retrospective study.

The aim is to examine the temporal trends of hip fracture incidence in Portugal by sex and age groups, and explore the relation with anti-osteoporotic medication. From the National Hospital Discharge Database, we selected from 1st January 2000 to 31st December 2008, 77,083 hospital admissions (77.4% women) caused by osteoporotic hip fractures (low energy, patients over 49years-age), with diagnosis codes 820.x of ICD 9-CM. The 2001 Portuguese population was used as standard to calculate direct age-standardized incidence rates (ASIR) (100,000 inhabitants). Generalized additive and linear models were used to evaluate and quantify temporal trends of age specific rates (AR), by sex. We identified 2003 as a turning point in the trend of ASIR of hip fractures in women. After 2003, the ASIR in women decreased on average by 10.3 cases/100,000 inhabitants, 95% CI (-15.7 to -4.8), per 100,000 anti-osteoporotic medication packages sold. For women aged 65-69 and 75-79 we identified the same turning point. However, for women aged over 80, the year 2004 marked a change in the trend, from an increase to a decrease. Among the population aged 70-74 a linear decrease of incidence rate (95% CI) was observed in both sexes, higher for women: -28.0% (-36.2 to -19.5) change vs -18.8%, (-32.6 to -2.3). The abrupt turning point in the trend of ASIR of hip fractures in women is compatible with an intervention, such as a medication. The trends were different according to gender and age group, but compatible with the pattern of bisphosphonates sales.

[Spatial pattern of legionellosis in Spain, 2003-2007]. / Patrón espacial de la legionelosis en España, 2003-2007.

OBJECTIVES: To analyze the spatial pattern of legionellosis in Spain for men and women during the period 2003-2007 and to identify spatial clustering of risk. METHODS: We identified the spatial pattern of the distribution of legionellosis rates based on calculation of rates by municipality through the direct method. Smoothing of these rates was performed by the Empirical Bayes method for studying the spatial pattern of disease for both sexes. We used Morans index to analyze spatial autocorrelation rates globally. To calculate local rates, the Local Moran's Index [known as local indicators of spatial association (LISA)], was used to analyze the clusters of municipalities with the highest risk. RESULTS: After smoothing the risk, the highest rates (over 50 per 100,000 inhabitants) were grouped in the eastern Mediterranean coastal areas and the north of the mainland, as well as in the Mediterranean islands. Moran's index smoothed rates were 0.15 for men and 0.23 for women. The spatial clusters of statistically significant higher rates calculated by the LISA index were distributed in the north and east for both sexes. CONCLUSIONS: These methods of spatial analysis allow patterns of disease distribution to be identified. All the methods used yielded similar results. These techniques are a complementary tool for epidemiological surveillance of infectious diseases.