Individual and geospatial factors associated with receipt of colorectal cancer screening: a state-wide mixed-level analysis.

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer death in US adults but can be reduced by screening. The roles of individual and contextual factors, and especially physician supply, in attaining universal CRC screening remains uncertain. METHODS: We used data from adults 50-75 years old participating in the 2018 New York (NY) Behavioural Risk Factor Surveillance System linked to county-level covariates, including primary care physician (PCP) density and gastroenterologist (GI) density. Data were analysed in 2023-2024. Our analyses included (1) ecological and geospatial analyses of county-level CRC screening prevalence and (2) individual-level Poisson regression models of receipt of screening, adjusted for socioeconomic and county-level contextual variables. RESULTS: Mean prevalence of up-to-date CRC screening was 71% (95% CI 70% to 73%) across NY's 62 counties. County-level CRC screening demonstrated significant spatial patterning (Global Moran's I=0.14, p=0.04), consistent with the existence of county-level contextual factors. In both county-level and individual-level analyses, lack of health insurance was associated with lower likelihood of up-to-date screening (ß=-1.09 (95% CI -2.00 to -0.19); adjusted prevalence ratio 0.68 (95% CI 0.60 to 0.77)), even accounting for age, race/ethnicity and education. In contrast, county-level densities of both PCPs and GIs were completely unassociated with screening at either the county or individual level. As expected, other determinants at the individual level included education status and age. CONCLUSION: In this state-wide representative analysis, physician density was completely unassociated with CRC screening, although health insurance status remains strongly related. In similar screening environments, broadened insurance coverage for CRC screening is likely to improve screening far more effectively than increased physician supply.

Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review.

OBJECTIVE: To synthesise the available evidence on the effects of interventions designed to improve the delivery of healthcare that reduces the greenhouse gas (GHG) emissions of healthcare. DESIGN: Systematic review and structured synthesis. SEARCH SOURCES: Cochrane Central Register of Controlled Trials, PubMed, Web of Science and Embase from inception to 3 May 2023. SELECTION CRITERIA: Randomised, quasi-randomised and non-randomised controlled trials, interrupted time series and controlled or uncontrolled before-after studies that assessed interventions primarily designed to improve the delivery of healthcare that reduces the GHG emissions of healthcare initiated by clinicians or healthcare services within any setting. MAIN OUTCOME MEASURES: Primary outcome was GHG emissions. Secondary outcomes were financial costs, effectiveness, harms, patient-relevant outcomes, engagement and acceptability. DATA COLLECTION AND ANALYSIS: Paired authors independently selected studies for inclusion, extracted data, and assessed risk of bias using a modified checklist for observational studies and the certainty of the evidence using Grades of Recommendation, Assessment, Development and Evaluation. Data could not be pooled because of clinical and methodological heterogeneity, so we synthesised results in a structured summary of intervention effects with vote counting based on direction of effect. RESULTS: 21 observational studies were included. Interventions targeted delivery of anaesthesia (12 of 21), waste/recycling (5 of 21), unnecessary test requests (3 of 21) and energy (1 of 21). The primary intervention type was clinician education. Most (20 of 21) studies were judged at unclear or high risk of bias for at least one criterion. Most studies reported effect estimates favouring the intervention (GHG emissions 17 of 18, costs 13 of 15, effectiveness 18 of 20, harms 1 of 1 and staff acceptability 1 of 1 studies), but the evidence is very uncertain for all outcomes (downgraded predominantly for observational study design and risk of bias). No studies reported patient-relevant outcomes other than death or engagement with the intervention. CONCLUSIONS: Interventions designed to improve the delivery of healthcare that reduces GHG emissions may reduce GHG emissions and costs, reduce anaesthesia use, waste and unnecessary testing, be acceptable to staff and have little to no effect on energy use or unintended harms, but the evidence is very uncertain. Rigorous studies that measure GHG emissions using gold-standard life cycle assessment are needed as well as studies in more diverse areas of healthcare. It is also important that future interventions to reduce GHG emissions evaluate the effect on beneficial and harmful patient outcomes. PROSPERO REGISTRATION NUMBER: CRD42022309428.

Sunlight: Time for a Rethink?

UVR is a skin carcinogen, yet no studies link sun exposure to increased all-cause mortality. Epidemiological studies from the United Kingdom and Sweden link sun exposure with reduced all-cause, cardiovascular, and cancer mortality. Vitamin D synthesis is dependent on UVB exposure. Individuals with higher serum levels of vitamin D are healthier in many ways, yet multiple trials of oral vitamin D supplementation show little benefit. Growing evidence shows that sunlight has health benefits through vitamin D-independent pathways, such as photomobilization of nitric oxide from cutaneous stores with reduction in cardiovascular morbidity. Sunlight has important systemic health benefit as well as risks.

Planetary health education in the United States: four curricular models, one goal.

Global environmental crises demand scaled-up investment in education about planetary health. We identified college and university programs in the United States that focus on the human-animal-ecosystem nexus by systematically searching the 2023-2024 catalogs of more than 1000 schools. We identified four frequently-used curricular models: (1) One Health programs offered by universities with veterinary and agriculture schools that emphasize zoonotic diseases, antimicrobial resistance, food safety, and wildlife conservation; (2) climate change and health (climate medicine) programs for graduate and professional students at large universities with medical and public health schools; (3) global environmental public health programs focused on pollution and other exposures; and (4) sustainability and health programs emphasizing food security, environmental justice, and other health issues that can be improved with ethical design and engineering. Highlighting the shared goals of these distinct academic models may help make planetary health a more visible area of teaching, research, and practice.

Cognitive Interview Validation of a Novel Household Hazard Vulnerability Assessment Instrument.

BACKGROUND: Weather and climate disasters are responsible for over 13 000 US deaths, worsened morbidity, and $1.7 trillion in additional costs over the last 40 years with profound racial disparities. OBJECTIVES: This project empirically generated items for a novel survey instrument of household hazard vulnerability with initial construct validation while addressing racial bias in the data collection process. METHODS: Cognitive interviews facilitated understanding regarding the performance of drafted survey questions with transdisciplinary expert panelists from diverse US regions on unique hazard/disaster/event items. To prevent representation bias in data collection, those with Black and/or African American racial, biracial, or multiracial identities were over-sampled. Interview video recordings were qualitatively analyzed using thematic and pattern coding. RESULTS: A cognitive process mapped to themes of disaster characteristics, resources, individual life facets, and felt effects was revealed. We identified 379 unique instances of linked terms as synonyms, co-occurring, compounding, or cascading events. Potential for racial bias in data collection was elucidated. Analysis of radiation exposure, trauma, and criminal acts of intent items revealed participants may not interpret survey items with these terms as intended. CONCLUSION: Potential for racial bias exists relative to water dam failure, evacuation, external flood, suspicious packages/substances, and transportation failure. Hazard terms that were not interpreted as intended require further revision in the validation process of individual or household disaster vulnerability assessments. Several commonalities in the cognitive process and mapping of disaster terms may be utilized in disaster and climate change research aimed at the individual and household unit of analysis.

Reflexiones sobre el cuidado ambiental desde la perspectiva de estudiantes universitarios de Enfermería / Reflections on Environmental Care from the Perspective of University Nursing Students

Introducción: Cada día el medio ambiente se ve deteriorado por la contaminación ambiental y el cambio climático, por tanto, es necesario que desde su formación universitaria los futuros enfermeros tomen conciencia ambiental, ayuden a prevenir enfermedades emergentes y se comprometan con el cuidado de su entorno, que le permita un hábitat saludable para todos. Objetivo: Comprender las reflexiones sobre el cuidado ambiental desde la perspectiva de estudiantes universitarios de Enfermería. Métodos: Se realizó una investigación cualitativa descriptiva exploratoria en agosto del 2022. La población fue de 20 estudiantes de Enfermería de la Universidad Nacional "Toribio Rodríguez de Mendoza" de Amazonas en Perú, que cursaron la asignatura de Enfermería en Salud Ambiental, y la muestra fue de 12 estudiantes, obtenida por la técnica de saturación y redundancia. Para recolectar los datos se usó la entrevista semiestructurada a través de la plataforma Zoom, procesadas con el análisis de contenido temático. Resultados: Se obtuvieron cuatro categorías: a) Interés para cuidar el medio ambiente, b) Estrategias para cuidar el medio ambiente a nivel personal y familiar, c) Percepción sobre el cuidado/descuido del medio ambiente en su comunidad, y d) Impacto de la formación profesional para cuidar el medio ambiente. Conclusiones: Los estudiantes de Enfermería son conscientes de la importancia del cuidado del medio ambiente y por ello practican, junto a su familia, acciones que ayudan a mitigar el cambio climático. Se confirma el impacto positivo que tiene la asignatura de Enfermería en salud ambiental, por ello otras escuelas y facultades de Enfermería lo deberían considerar en sus planes curriculares(AU)

Introduction: Every day, the environment becomes much deteriorated by environmental pollution and climate change; therefore, it is necessary that, from their university education, future nurses become environmentally aware, help to prevent emerging diseases and commit themselves to taking care of their environment, allowing a healthy habitat for all. Objective: To understand the reflections on environmental care from the perspective of university Nursing students. Methods: An exploratory descriptive and qualitative research was conducted in August 2022. The population was 20 Nursing students from Universidad Nacional Toribio Rodríguez de Mendoza, of Amazonas in Peru, who studied the subject of Nursing in Environmental Health. The sample, of 12 students, was obtained using the saturation and redundancy technique. To collect the data, a semistructured interview was used through the Zoom platform, processed using thematic content analysis. Results: Four categories were obtained: a) Interest in caring for the environment, b) Strategies to care for the environment at a personal and family level, c) Perception on care/neglect of the environment in their community, and d) Impact of professional training to care for the environment. Conclusions: Nursing students are aware of the importance of caring for the environment; therefore, they carry out, together with their family, actions that help to mitigate climate change. The positive impact of the course Nursing in Environmental Health course is confirmed, and other schools or academic institutions of nursing should consider it for their curricular plans(AU)

Avaliação da adesão às dietas sustentáveis, desertos alimentares e associações de saúde, aspectos socioeconômicos e espaciais em adultos e idosos do estudo Brazuca-Natal / Assessment of adherence to sustainable diets, food deserts and health associations, socioeconomic and spatial aspects in adults and elderly people from the Brazuca-Natal study

Introdução: Alcançar a segurança alimentar e nutricional e a melhoria da nutrição são metas estabelecidas pelos Objetivos de Desenvolvimento Sustentável (ODS) da ONU e para tanto é fundamental a compreensão das interações entre saúde coletiva, meio ambiente e os determinantes sociais no planejamento de ações eficazes no enfrentamento da Insegurança Alimentar e Nutricional (IAN) e na promoção de territórios saudáveis e sustentáveis. Na perspectiva de identificação da situação da alimentação nos territórios, destacam-se os ambientes alimentares que são influenciados por uma variedade de fatores (disponibilidade, acessibilidade, conveniência, promoção, qualidade dos alimentos e bebidas), incluindo a sustentabilidade dos ecossistemas nos quais estão inseridos. Nesse contexto, este estudo pode fornecer informações valiosas ao identificar e descrever áreas críticas de desigualdades espaciais acerca da adesão às dietas sustentáveis, as quais podem corroborar para o desenvolvimento de políticas públicas focalizadas nas áreas mais vulneráveis do município de Natal. Objetivo: Avaliar a adesão às dietas sustentáveis, desertos alimentares e associações de saúde, aspectos socioeconômicos e espaciais em adultos e idosos do estudo BRAZUCA-Natal. Métodos: Trata-se de um estudo que aborda métodos mistos: 1) Revisão de escopo que buscou compreender as características dos índices de adesão às dietas sustentáveis que foram desenvolvidos com base no relatório da Comissão EAT-Lancet e verificar as principais lacunas de conhecimento destas ferramentas. Essa revisão foi realizada a partir de uma busca sistemática na literatura nas bases de dados PubMed, Embase, Scopus, Web of Science, e Science Direct de 01 de junho a 01 de agosto janeiro de 2022. 2) Estudo transversal que se decompõe, a partir das variáveis independentes, em três artigos científicos que avaliaram 399 adultos e idosos, por meio de entrevistas domiciliares contendo questões sociodemográficas, de estilo de vida, dados clínicos, antropométricos e dietéticos orientado pelo software Globodiet® por meio do Recordatório alimentar de 24h (R24h). A adesão às dietas sustentáveis foi mensurada pelo Planet Health Diet Index (PHDI). No primeiro artigo, avaliamos a adesão às recomendações do EAT-Lancet para dietas saudáveis e sustentáveis em adultos e idosos do estudo Brazuca-Natal. O segundo artigo, buscou avaliar a associação entre a adesão à dieta EAT-Lancet com fatores de risco cardiometabólicos (glicose, triglicerídeos, colesterol total, HDL-c, LDL-c, mensuração da pressão arterial sistólica e diastólica, utilizamos a regressão linear múltipla para avaliar a relação entre o PHDI e variáveis independentes. O terceiro, buscou associar a adesão à dieta sustentável com variáveis individuais e de contexto com foco nos desertos alimentares, IAN e infraestrutura urbana. Essa pesquisa se baseou nos setores censitários da cidade de Natal-RN, a partir da identificação dos estabelecimentos de aquisição de alimentos, agrupados nas categorias de in natura ou minimamente processados, ultraprocessados ou mistos. Os desertos alimentares foram calculados pela densidade de estabelecimentos saudáveis ponderados pela renda dividido por 10 mil habitantes e classificados menor ou igual ao percentil 25. Utilizamos dados socioeconômicos do Censo 2010. Regressão múltipla com seleção Backward foi utilizada para observar a relação entre a adesão às dietas sustentáveis com as variáveis independentes. Resultados: Na revisão de escopo foram recuperados um total de 1.458 artigos, 14 dos quais foram incluídos na revisão. Identificamos sete índices que mensuram dietas sustentáveis, como se segue: EAT-Lancet diet score (ELD-I), New EAT-Lancet diet score (EAT), Planetary Health Diet Index (PHDI), Sustainable Diet Index (SDI), Sustainable-HEalthy-Diet (SHED), novel Nutrient-Based EAT index (NB-EAT) e World Index for Sustainability and Health (WISH). No artigo 2 (transversal), verificamos que o escore total médio de adesão ao PHDI foi de 29,4 pontos (IC 95% 28,04-30,81), em um escore que pode variar de 0 a 150 pontos. As maiores pontuações foram para frutas, leguminosas e vegetais e as menores para gordura animal e carne vermelha. Esse estudo mostrou que a adesão à dieta sustentável está diretamente relacionada a ser do sexo masculino e não consumir álcool e inversamente relacionada a ter 1 a 9 anos de estudos (comparado a quem tem ensino superior) e estar em insegurança alimentar. No artigo 3 (transversal), o PHDI apresentou associação significativa (p <0,05) com a presença de diabetes e dislipidemia, com a pressão arterial sistólica, colesterol total e LDL-c alterados, assim como com um índice que avalia saúde cardiovascular aos seus componentes (de forma positiva com frutas, vegetais e leguminosas e de forma negativa com os alimentos ultraprocessados). No artigo 4 (ecológico transversal) encontramos uma maior adesão à dieta sustentável na região Sul de Natal-RN, em indivíduos com maior renda per capita, em segurança alimentar, moradores de áreas com melhor infraestrutura e que não são desertos alimentares. Identificamos que a ocorrência de desertos alimentares coincide com as áreas em que há uma menor adesão à dieta sustentável, que são as regiões Norte e Oeste da cidade. A adesão à dieta sustentável reduz quando associada à infraestrutura urbana desfavorável e a IAN. Conclusões: Concluímos na revisão de escopo que há a utilização de diferentes métricas que avaliam a adesão às dietas sustentáveis, dificultando a comparação entre os índices e a tendência a negligenciar aspectos sociais. No artigo 2, que a adesão às dietas sustentáveis está distante das recomendações do EAT-Lancet e que essa adesão foi menor em mulheres, com baixa escolaridade, nas classes sociais menos favorecidas, com menor renda per capita e que se encontravam em IAN. No artigo 3, que associação com o padrão alimentar sustentável também sugeriu um menor risco cardiometabólico. E no artigo 4, verificamos no mapeamento de desertos alimentares que a distribuição dos estabelecimentos que comercializam alimentos sustentáveis sofre iniquidades territoriais na cidade de Natal-RN. Apesar de não estarem associados à adesão às dietas sustentáveis nesse estudo, os desertos alimentares ressaltam questões relacionadas às escolhas de alimentos sustentáveis que podem ir além da disponibilidade e acessibilidade. Contudo, são necessários novos estudos que explorem questões relacionadas aos hábitos e poder de compra dessas famílias (AU).

Introduction: Achieving food security and improving nutrition are goals set by the UN's Sustainable Development Goals (SDGs). To this end, it is essential to understand the interactions between public health, the environment and social determinants in order to plan effective actions to tackle Food and Nutrition Insecurity (FNI) and promote healthy and sustainable territories. From the perspective of identifying the food situation in the territories, food environments stand out, which are influenced by a variety of factors (availability, accessibility, convenience, promotion, quality of food and drink), including the sustainability of the ecosystems in which they are inserted. In this context, this study can provide valuable information by identifying and describing critical areas of spatial inequalities regarding adherence to sustainable diets, favoring the development of public policies focused on the most vulnerable areas. Objective: To evaluate adherence to sustainable diets, food deserts and health associations, socioeconomic and spatial aspects in adults and elderly people from the BRAZUCA-Natal study. Methods: This is a multi-method study. 1) A scoping review that sought to understand the characteristics of the sustainable diet adherence indices that were developed on the basis of the EATLancet Commission report and to verify the main knowledge gaps in these tools. This review was carried out through a systematic literature search in the PubMed, Embase, Scopus, Web of Science, and Science Direct databases from June 1 to August 1, 2022. 2) A cross-sectional study that was broken down, based on the independent variables, into two scientific articles that assessed 399 adults and elderly people, through home interviews containing sociodemographic, lifestyle, clinical, anthropometric and dietary questions, guided by the Globodiet® software using the 24-hour dietary recall (R24h). Adherence to sustainable diets was measured using the Planet Health Diet Index (PHDI). In the first article, we assessed adherence to the EAT-Lancet recommendations for healthy and sustainable diets in adults and the elderly in the Brazuca-Natal study. The second article sought to assess the association between adherence to the EAT-Lancet diet and cardiometabolic risk factors (glucose, triglycerides, total cholesterol, HDL-c, LDL-c, measurement of systolic and diastolic blood pressure, we used multiple linear regression to assess the relationship between the PHDI and independent variables. 3) A transversal ecological study that sought to associate adherence to a sustainable diet with individual and contextual variables, focusing on food deserts, FNI and urban infrastructure. This research was based on the census sectors of the city of Natal-RN, based on the identification of food purchasing establishments, grouped into the categories of in-natura or minimally processed, ultra-processed or mixed. Food deserts were calculated by the density of healthy establishments weighted by income divided by 10,000 inhabitants and classified as less than or equal to the 25th percentile. We used socioeconomic data from the 2010 Census. Multiple regression with Backward selection was used to observe the relationship between total of 1,458 articles, 14 of which were included in the review. We identified seven indices that measure sustainable diets, as follows: EAT-Lancet diet score (ELD-I), New EAT-Lancet diet score (EAT), Planetary Health Diet Index (PHDI), Sustainable Diet Index (SDI), Sustainable-HEalthy-Diet (SHED), novel Nutrient-Based EAT index (NB-EAT) and World Index for Sustainability and Health (WISH). In article 2 (cross-sectional), we found that the average total score for adherence to the PHDI was 29.4 points (95% CI 28.04-30.81), out of a score that can vary from 0 to 150 points. The highest scores were for fruit, pulses and vegetables and the lowest for animal fat and red meat. This study showed that adherence to a sustainable diet is directly related to being male and not consuming alcohol, and inversely related to having 1 to 9 years of schooling and being food insecure. In article 3 (cross-sectional), the PHDI showed a significant association (p <0.05) with the presence of diabetes and dyslipidemia, with systolic blood pressure, total cholesterol and LDL-c, as well as with an index that assesses cardiovascular health and its components (positively with fruits, vegetables and legumes and negatively with ultra-processed foods). In article 4 (transversal ecological) we found greater adherence to the sustainable diet in the southern region of Natal-RN, in individuals with higher per capita income, food security, living in areas with better infrastructure and which are not food deserts. We found that the occurrence of food deserts coincides with the areas where there is less adherence to the sustainable diet, which are the North and West regions of the city. Adherence to a sustainable diet decreases when associated with unfavorable urban infrastructure and FNI. Conclusions: The scoping review observed the use of different metrics that assess adherence to sustainable diets, making it difficult to compare the indices and the tendency to neglect social aspects. In article 2, we concluded that adherence to sustainable diets is far from the EAT-Lancet recommendations and that this adherence was lower in women, with low education, in less favored social classes, with lower per capita income and who were in the IAN. In article 3, the association with a sustainable dietary pattern also suggested a lower cardiometabolic risk. And in article 4, we verified in the mapping of food deserts that the distribution of establishments that sell healthy and sustainable food suffers territorial inequities in the city of Natal-RN, concentrated in the South and East regions. Despite not being associated with adherence to sustainable diets in this study, food deserts highlight issues related to sustainable food choices that may go beyond availability and accessibility. However, new studies are needed that explore issues related to the habits and purchasing power of these families (AU).

Distribution of cases of congenital heart disease in a hospital in Oeste Paulista / Distribuição dos casos de cardiopatias congênitas em um hospital do Oeste Paulista

The aim of this research was to conduct a comprehensive spatial-temporal analysis of the population affected by congenital heart anomalies assisted at the Pediatric Cardiology Outpatient Department at the distinguished Western Paulista reference hospital. We conducted a retrospective study involving the analysis of electronic database records and patient medical charts for individuals diagnosed with congenital heart disease during the period from July 2013 to July 2018. A total of 298 medical records were selected for the analysis of variables encompassing the ICD-10 codes, gender, spatial distribution, and temporal trends. It was possible to observe that septal defects were the most prevalent congenital heart abnormalities, and there was no gender-based difference. An increase in diagnoses was noted from 2014, coinciding with the implementation of the "heart test," and 51% of the cases were from Presidente Prudente, with a higher concentration of cases in the industrial park area. There is an association between cardiac congenital malformations and an adverse environmental context. The findings can inform public health policies aimed at reducing the exposure of the most vulnerable population in pursuit of improving health indicators (AU).

O objetivo deste trabalho foi analisar a distribuição espaço-temporal dos pacientes com cardiopatias congênitas aten-didos no Ambulatório de Cardiologia Pediátrica do Hospital de referência do Oeste Paulista. Realizamos um estudo retrospectivo com análise de dados de base eletrônica e prontuários dos pacientes diagnosticados com cardiopatia congênita entre os períodos de julho de 2013 a julho de 2018. Foram selecionados 298 prontuários para análise das variáveis de CID-10, gênero, distribuição espacial e série temporal. Foi possível observar que os defeitos septais foram as cardiopatias mais prevalentes, não houve diferença entre os gêneros. Notou-se aumento do diagnóstico a partir de 2014, com implementação do teste do coraçãozinho e 51% dos casos eram da cidade de Presidente Prudente, com maior concentração de casos na região do parque industrial. Há uma relação na incidência das malformações cardíacas com o meio ambiente desfavorável. Os resultados encontrados podem guiar políticas de saúde pública, visando reduzir a exposição da população mais vulnerável, na busca da melhora nos índices de saúde (AU).

Microplásticos, una amenaza invisible para la salud humana y ambiente / Micro Plastics, An Invisible Threat to Human Health and the Environment

Introducción: Los microplásticos son pequeñas partículas de plástico, de menos de 5 milímetros de tamaño, que están presentes en nuestro entorno, incluyendo el agua, los alimentos y el aire que respiramos. Aunque su presencia es preocupante desde una perspectiva ambiental, también plantea riesgos para la salud humana, dado que la exposición a estos puede ocurrir a través de múltiples vías, por ejemplo, la ingestión de alimentos y agua contaminados, así como la inhalación de partículas presentes en el aire. Objetivo: Describir los riesgos y daños asociados con el microplástico a nivel de la salud de las personas y del medio ambiente desde una perspectiva de metabolismo, sociedad y naturaleza. Posición: Se evidencian múltiples actores y diversos factores que favorecen a la problemática, pero desde el metabolismo social naturaleza, se puede identificar que el consumidor juega un papel fundamental. No obstante, se requiere de la participación de múltiples actores para lograr frenar o reducir las consecuencias propias de esta situación. Conclusiones: Se logra entender que es una problemática, que se fortalece con el paso del tiempo y aún permanece invisible en algunos campos, pero que requiere una intervención inmediata y profunda, se destaca que abordar este problema requiere un enfoque integral y colaborativo que involucre a diversos actores, incluyendo a los gobiernos, la industria, la sociedad civil y los consumidores(AU)

Introduction: Micro plastics are small plastic particles, smaller than 5 millimeters, that are present in our environment, including water, food and the air we breathe. Although their presence is concerning from an environmental perspective, it also poses risks to human health, given that exposure to them can occur through multiple pathways; for example, ingestion of contaminated food and water, as well as inhalation of airborne particles. Objective: To describe the risks and damages associated with microplastic at the level of people's health and the environment from a metabolism, society and nature perspective. Position: Multiple actors and various factors are evident favoring this issue, but from the nature social metabolism the consumer is identified to play a fundamental role. However, the participation of multiple actors is required to stop or reduce the consequences of this situation. Conclusions: It is possible to understand that it is a problem that strengthens with time and still remains invisible in some fields, but requires immediate and profound intervention. It is highlighted that addressing this problem requires a comprehensive and collaborative approach involving diverse actors, including governments, industry, civil society, and consumers(AU)

Análisis de interacciones de los actores de la red de conocimiento en salud ambiental del Observatorio Nacional de Salud de Colombia

Introducción: Las interrelaciones positivas y negativas entre el hombre y el medioambiente impactan en la salud general de la población, por esto, la gestión del conocimiento y la transformación social, orientadas a la prevención de la exposición a factores de riesgo ambiental y a la creación de ambientes propicios, deben realizarse a través de acciones multidisciplinares intersectoriales, como el trabajo colaborativo de redes del conocimiento. Objetivo: Describir las interacciones entre los actores de la Red de Conocimiento de Salud Ambiental del Observatorio Nacional de Salud de Colombia (ONS), con el fin de promover, mejorar y fortalecer la colaboración, intercambio de información y planificación conjunta de acciones. Metodología: Estudio descriptivo transversal de análisis de redes sociales mediante herramientas de minería de texto del lenguaje de programación R. Se analizaron las categorías de agua y saneamiento, clima, calidad del aire, radiaciones electromagnéticas e intoxicaciones químicas de un corpus documental de 99 textos de los actores de la red general de conocimiento en salud pública del ONS. Se calcularon medidas de centralidad y prestigio y se graficaron redes dirigidas multicapa con Power BI. Resultados: Los actores con mayor centralidad en la red fueron: Ministerio de Salud y Protección Social, Superintendencia de Salud, Profamilia, universidades de Antioquia y La Salle, ONS, Observatorio de Salud Ambiental de Bogotá, Organización Panamericana de la Salud y Organización Mundial de la Salud. Las cinco categorías analizadas presentaron bajas centralidades de grado, y las categorías de agua y clima mostraron mayor participación de los actores (más nodos e interacciones). Conclusiones: El análisis de redes sociales permitió identificar temas relevantes de salud ambiental entre los actores de la red del ONS, además de actores clave para desarrollar espacios de interacción y gestión del conocimiento. Acorde con las limitaciones del análisis, se sugiere la inclusión de aproximaciones bibliométricas para la actualización de las interacciones de la red.

Introduction: Positive and negative interactions between the human beings and the environment have an impact on the general health of the population. Therefore, it is necessary to use knowledge management and social transformation, in order to limit exposure to environmental risk factors by creating a favorable environment for healthcare. This should be carried out through multidisciplinary and intersectorial actions, such as the collaborative work of knowledge networks. Objective: To describe the interactions between the actors within the Environmental Health Knowledge Network Colombia's National Observatory of Health (ONS acronym in Spanish), in order to promote, improve and strengthen collaboration, information exchange and planning of collaborative actions. Methodology: Cross-sectional descriptive study to analyze social interactions through text mining tools by R, programmer language. Categories analyzed: Water and sanitation, climate, air quality, electromagnetic radiation and chemical poisoning. Data source: a documentary corpus of 99 texts done by actors of Environmental Health Knowledge Network of Colombia's ONS. We calculated centrality and prestige measures. We used Power BI in order to plot multi-layered directed networks. Results: Actors with greatest centrality in the network: Ministry of Health and Social Protection, Health Superintendency, Profamilia, Antioquia and La Salle universities, National Health Observatory, Bogota's Observatory of Environmental Health, the Pan American Health Organization and the World Health Organization. The five categories analyzed provides a low centrality degree, and water and climate categories presented greater participation by actors (more nodes and links). Conclusions: Social interactions analysis provides the identification of relevant environmental health issues in Colombia and key actors in order to develop interaction spaces for knowledge management. The analysis had limitations that suggest the inclusion of bibliometric approaches for updating the interactions within the network.

Descarte de medicamentos e os impactos ambientais: uma revisão integrativa da literatura / Disposal of drugs and the ensuing environmental impacts: an integrative review of the literature

Resumo O objetivo deste artigo é investigar as evidências nacionais e internacionais disponíveis sobre o descarte de medicamentos e os impactos em matrizes ambientais. Trata-se de uma revisão integrativa da literatura realizada nas bases de dados PubMed, SciELO e Biblioteca Virtual em Saúde (BVS) e que incluiu artigos em inglês, espanhol e português publicados entre 2010 e 2020. Foram selecionados 26 artigos, que evidenciaram o descarte incorreto de medicamentos por profissionais e consumidores devido, principalmente, à falta de conhecimentos sobre os impactos ambientais que esses podem ocasionar. Estudos apontaram a contaminação de água, esgoto e sedimentos por fármacos descartados de forma incorreta. Além disso, observou-se que seres vivos aquáticos podem ser impactados pela presença de medicamentos em matrizes ambientais. O descarte de medicamentos incorreto ainda é uma realidade nas evidências avaliadas, que promove a contaminação de matrizes ambientais e muitas vezes não é removido por estações de tratamento de águas residuárias e interfere no equilíbrio da vida ambiental.

Abstract The scope of this article is to investigate the national and international evidence available on the forms of drug disposal and the presence of drugs in environmental matrices. It involved an integrative review of the literature conducted in the PubMed, SciELO and Virtual Health Library (VHL) databases, which included articles in English, Spanish and Portuguese published between 2010 and 2020. Twenty-six articles were selected, which revealed the incorrect disposal of medicines by professionals and consumers due mainly to the lack of knowledge about the environmental impacts that they may cause. Studies have highlighted the contamination of water, sewage and sediments by incorrectly discarded drugs. Furthermore, it was observed that aquatic living creatures can be impacted by the presence of drugs in environmental matrices. The incorrect disposal of drugs continues to be a reality in the evidence assessed, which leads to the contamination of environmental matrices and is often not removed by wastewater treatment plants and interferes with the equilibrium of environmental life.

Geocoding processes in cohort studies: methods applied in the EpiFloripa Aging / Processos de geocodificação em estudos de coorte: métodos aplicados no EpiFloripa Idoso

ABSTRACT OBJECTIVE To describe the process and epidemiological implications of georeferencing in EpiFloripa Aging samples (2009-2019). METHOD The EpiFloripa Aging Cohort Study sought to investigate and monitor the living and health conditions of the older adult population (≥ 60) of Florianópolis in three study waves (2009/2010, 2013/2014, 2017/2019). With an automatic geocoding tool, the residential addresses were spatialized, allowing to investigate the effect of the georeferencing sample losses regarding 19 variables, evaluated in the three waves. The influence of different neighborhood definitions (census tracts, Euclidean buffers, and buffers across the street network) was examined in the results of seven variables: area, income, residential density, mixed land use, connectivity, health unit count, and public open space count. Pearson's correlation coefficients were calculated to evaluate the differences between neighborhood definitions according to three variables: contextual income, residential density, and land use diversity. RESULT The losses imposed by geocoding (6%, n = 240) caused no statistically significant difference between the total sample and the geocoded sample. The analysis of the study variables suggests that the geocoding process may have included a higher proportion of participants with better income, education, and living conditions. The correlation coefficients showed little correspondence between measures calculated by the three neighborhood definitions (r = 0.37-0.54). The statistical difference between the variables calculated by buffers and census tracts highlights limitations in their use in the description of geospatial attributes. CONCLUSION Despite the challenges related to geocoding, such as inconsistencies in addresses, adequate correction and verification mechanisms provided a high rate of assignment of geographic coordinates, the findings suggest that adopting buffers, favored by geocoding, represents a potential for spatial epidemiological analyses by improving the representation of environmental attributes and the understanding of health outcomes.

RESUMO OBJETIVO Descrever o processo e as implicações epidemiológicas do georreferenciamento nas amostras do EpiFloripa Idoso (2009-2019). MÉTODO O estudo de coorte EpiFloripa Idoso buscou investigar e acompanhar as condições de vida e saúde da população idosa (≥ 60) de Florianópolis em três ondas de estudo (2009/2010, 2013/2014, 2017/2019). Com uma ferramenta de geocodificação automática, os endereços residenciais foram espacializados, permitindo a investigação do efeito das perdas amostrais do georreferenciamento em relação a 19 variáveis, avaliadas nas três ondas. A influência de diferentes definições de vizinhança (setores censitários, buffers euclidianos e buffers pela rede de ruas) foi examinada nos resultados de sete variáveis: área, renda, densidade residencial, uso misto do solo, conectividade, contagem de unidades de saúde, e contagem de espaços livres públicos. Coeficientes de correlação de Pearson foram calculados para avaliar as diferenças entre as definições de vizinhança de acordo com três variáveis: renda contextual, densidade residencial e diversidade de uso do solo. RESULTADO As perdas impostas pela geocodificação (6%, n = 240) não ocasionaram diferença estatística significativa entre a amostra total e a georreferenciada. A análise das variáveis do estudo sugere que o processo de geocodificação pode ter incluído uma maior proporção de participantes com melhor nível de renda, escolaridade e condições de vida. Os coeficientes de correlação evidenciaram pouca correspondência entre medidas calculadas pelas três definições de vizinhança (r = 0,37-0,54). A diferença estatística entre as variáveis calculadas por buffers e setores censitários ressalta limitações no uso destes na descrição dos atributos geoespaciais. CONCLUSÃO Apesar dos desafios relacionados à geocodificação, como inconsistências nos endereços, adequados mecanismos de correção e verificação propiciaram elevada taxa de atribuição de coordenadas geográficas. Os achados sugerem que a adoção de buffers, favorecida pela geocodificação, representa uma potencialidade para análises epidemiológicas espaciais ao aprimorar a representação dos atributos do ambiente e a compreensão dos desfechos de saúde.

COVID-19: una oportunidad para revitalizar la autonomía alimentaria en comunidades indígenas / COVID-19: an opportunity to revitalize food autonomy in indigenous communities / Covid-19: uma oportunidade para revitalizar a autonomia alimentar nas comunidades indígenas

Resumen La autonomía alimentaria permite a las comunidades determinar sus prácticas alimentarias, comenzando con la producción agrícola en sus territorios garantizando la economía propia y la armonía con la madre tierra, en este contexto, la pandemia por COVID-19 generó cambios en las practicas sociales en las comunidades indígenas, incluidas sus prácticas alimentarias. Objetivo: Describir prácticas de autonomía alimentaria revitalizadas a partir del confinamiento por COVID-19 en una comunidad indígena Nasa del sur de Colombia. Método: Estudio cualitativo orientado en investigación participativa basada en comunidad (CBPR) realizado en una comunidad indígena Nasa del sur de Colombia. La recolección e interpretación de información se efectuó con técnicas de la investigación cualitativa: codificación abierta y axial y hasta llegar a la descripción de categorías emergentes. Resultados: Se fortalecieron prácticas ancestrales del sistema alimentario para mejorar el acceso a los alimentos sanos producidos en sus territorios, dentro de las que se destacan: tul (huerta familiar), trueque, mano-cambio, mercado Nasa y recetas tradicionales. Conclusiones: El confinamiento representó una oportunidad para retomar y revitalizar las prácticas alimentarias ancestrales de la comunidad que respondieron a necesidades concretas de salud y de alimentación, fortaleciendo el tejido social y la identidad indígena, acciones que pueden trascender a políticas públicas, planes de vida y aspiraciones de buen vivir.

Abstract Food autonomy allows communities to determine their food practices, starting with agricultural production in their territories, guaranteeing their own economy and harmony with Mother Earth. In this context, the COVID-19 pandemic generated changes in social practices in the communities. indigenous communities, including their food practices. Objective: Describe food autonomy practices revitalized following the COVID-19 confinement in a Nasa indigenous community in southern Colombia. Method: Qualitative study oriented on community-based participatory research (CBPR) carried out in a Nasa indigenous community in southern Colombia. The collection and interpretation of information was carried out with qualitative research techniques: open and axial coding and until reaching the description of emerging categories. Results: Ancestral practices of the food system were strengthened to improve access to healthy foods produced in their territories, among which the following stand out: tul (family garden), barter, hand-exchange, Nasa market and traditional recipes. Conclusions: Confinement represented an opportunity to resume and revitalize the community's ancestral food practices that responded to specific health and food needs, strengthening the social fabric and indigenous identity, actions that can transcend public policies, life plans and aspirations for a good life.

Abstract A autonomia alimentar permite que as comunidades determinem suas práticas alimentares, começando pela produção agrícola em seus territórios, garantindo sua própria economia e harmonia com a Mãe Terra. Nesse contexto, a pandemia da Covid-19 gerou mudanças nas práticas sociais nas comunidades indígenas, incluindo suas práticas alimentares. Objetivo: Descrever as práticas de autonomia alimentar revitalizadas após o confinamento da COVID-19 em uma comunidade indígena Nasa no sul da Colômbia. Método: Estudo qualitativo orientado à pesquisa participativa de base comunitária (CBPR) realizada em uma comunidade indígena Nasa no sul da Colômbia. A coleta e interpretação das informações foram realizadas com técnicas de pesquisa qualitativa: codificação aberta e axial e até chegar à descrição das categorias emergentes. Resultados: As práticas ancestrais do sistema alimentar foram fortalecidas para melhorar o acesso aos alimentos saudáveis produzidos em seus territórios, entre os quais se destacam: tul (horta familiar), escambo, troca de mãos, mercado Nasa e receitas tradicionais. Conclusões: O confinamento representou uma oportunidade para retomar e revitalizar as práticas alimentares ancestrais da comunidade que respondiam às necessidades específicas de saúde e alimentação, fortalecendo o tecido social e a identidade indígena, ações que podem transcender as políticas públicas, os planos de vida e as aspirações por uma vida boa.

An ontology-based study on water quality: probabilistic risk assessment of exposure to fluoride and nitrate in Shiraz drinking water, Iran using fuzzy multi-criteria group decision-making models.

World Health Organization reports that 2.2 million people die yearly from insufficient sanitary drinking water. This ontology-based study focused on investigating the chemical quality of drinking water through a new water quality index designed by fuzzy multi-criteria group decision-making methods, merged with GIS, and, secondly, surveying non-carcinogenic risk assessment of fluoride and nitrate using Monte Carlo simulation and sensitivity analysis in Shiraz's water sources. F-, NO3-, NO2-, EC, TDS, alkalinity, TH, SO42-, Cl-, and Na were applied in the WQI. The NO3- mean concentrations were 23.15 and 27.66 mg/L in the cold and warm seasons, while the mean concentrations of fluoride were 0.50 and 0.46 mg/L during the cold and warm period. The 95th centiles of fluoride's HQs among infants, children, teenagers, and adults were 0.56, 0.7, 0.49, and 0.4, respectively, in the cold season, which was 0.65 and 0.81, respectively, 0.57 and 0.46 for mentioned groups in the warm season. In comparison, the 95th centiles of nitrate's HQs among infants, children, teenagers, and adults were 1.27, 1.59, 1.13, and 0.9, respectively. The HQs were more than 1 for infants, children, and teenagers, so nitrate can have various adverse effects, whereas fluoride does not adversely affect all aging groups in both seasons. Also, nitrate concentration can increase the non-carcinogenic risk, which the IR and ED lead to the HQ increasing. In contrast, BW has a negative effect on risk increasing. Overall, source management of these parameters can significantly reduce the concentration of nitrate and their adverse human health effect.

Beneficios de los espacios verdes y actividad física en el bienestar y salud de las personas / Benefits of green spaces and physical activity for the well-being and health of people

BACKGROUND: Physical environment can influence well-being, quality of life and health and population health in several ways. Exposure to green spaces improves the physical and mental health of individuals. Chile has privileged conditions for outdoor activities that could benefit millions of people. However, a small percentage of the Chilean population is exposed to green spaces in the recommended amounts to promote health. AIM: To describe the benefits of green spaces on physical and mental health and their relationship with the practice of physical activity. MATERIAL AND METHODS: Review of the scientific literature in English in the Web of Science (WoS) electronic database published between 2006-2019. RESULTS: In addition to the direct benefits of green spaces, there are synergistic effects of performing physical activities in these environments such as feelings of good health, satisfaction with life and pleasure, increased physiological relaxation, positive emotions, mental well-being, restoration of attention, decreased perceived stress and a reduction negative affections. CONCLUSIONS: This review supports strategies for improving access to green spaces in urban areas coupled with physical activity promotion in these settings. Health and urban planning stakeholders should consider these aspects in future programs.

Cumplimiento de las medidas de restricción del uso residencial de leña en la ciudad de Valdivia / Compliance with the measures of restrict the residential use of firewood in Valdivia, Chile

BACKGROUND: Atmospheric pollution is a problem that causes great concern and health risks for the population and the earth, as it affects developed countries and third world countries. Locally, there are no studies that prove the fulfillment level of the restriction about the usage of residential firewood, considering that since 2014 there is a procedure called "The Environmental Decontamination Plan" in Valdivia (PDAV). Aim: To determine the fulfillment level of the restriction about residential firewood and its related factors. MATERIAL AND METHODS: The population study were 594 homes that were assigned randomly and proportionally according to 2 territorial areas (A and B) established in the PDAV. The sample's characteristics were described, comparison techniques were applied by subgroups (sociodemographic, home's structures and humidity's perception and percentage of the firewood) to identify factors related mainly with the fulfillment of measurements about firewood usage. RESULTS: 52% of households do not comply with the residential firewood use restriction measure, having sociodemographic factors related with this failure, such as schooling, health insurance and home structure. Besides, it is noted that the knowledge level of PDAV is associated with the accomplish level of restriction measures. When people know more about PDAV, there is a higher proportion of accomplishment. Conclusion: In more than half of the households, the restriction on the use of woodstove is not complied. The lack of knowledge of the population about the PDAV directly influences its compliance, which requires strategies to promote adherence to this program.

Humanização na ambiência de Práticas Integrativas e Complementares: significado de bem-estar na perspectiva dos usuários / Humanisation in the Complementary and Integrative Practice ambience: the meaning of well-being from the users' perspective

Resumo Na busca pelo incremento qualitativo dos espaços de saúde e por uma experiência positiva de seus usuários, este artigo apresenta os significados de bem-estar relacionados à ambiência, atribuídos pelos usuários de ambientes terapêuticos de Práticas Integrativas e Complementares (PIC). A pesquisa qualitativa teve como um de seus objetivos "Identificar o significado de bem-estar e os estímulos que o influenciam, em ambientes de PIC". Foi realizada uma avaliação ambiental em três estudos de caso no ano de 2017, com múltiplos métodos, dos quais as entrevistas - com terapeutas, pacientes e coordenadores das instituições - e as observações sistemáticas foram os que melhor contribuíram para os resultados aqui apresentados. A categorização dos resultados sugere que os significados de bem-estar atribuídos pelos usuários de ambientes terapêuticos de PIC sejam: Acolhimento, Ânimo, Beleza, Concentração, Confiança, Relaxamento e Simplicidade. Neste artigo, apresenta-se a discussão da categorização em relação à revisão de literatura, às amostras de usuários, aos estímulos ambientais e aos métodos. Estima-se que essa categorização possa contribuir para a humanização das ambiências de PIC e para a melhoria de seus projetos arquitetônicos.

Abstract Aiming to have a qualitative increase in health spaces and provide a positive experience for its users, this article presents the meanings of well-being related to the environment, attributed by users of therapeutic environments with complementary and integrative practices (CIPs). One of the objectives of the qualitative research was to "Identify the meaning of well-being and the stimuli that influence it in CIP environments". An environmental assessment was carried out in three case studies in 2017, using multiple methods, of which interviews - with therapists, patients and coordinators from institutions - and systematic observations best contributed to the results presented here. The categorisation of the results suggests that the meanings of well-being attributed by users of therapeutic CIP environments are: Welcomeness, Motivation, Beauty, Concentration, Trust, Relaxation and Simplicity. In this article, the discussion of categorisation in relation to the literature review, user samples, environmental stimuli and methods is presented. It is estimated that this categorisation can contribute to the humanisation of CIP ambiences and to improving their architectural projects.

Estratégia saúde da família rural no Nordeste do Brasil: percepções de profissionais sobre a saúde e ambiente / Rural family health strategy in Northeastern Brazil: professionals' perceptions of health and the environment

Objetivo: compreender as percepções de profissionais da Estratégia Saúde da Família (ESF) que atuam em territórios rurais de municípios do Nordeste brasileiro acerca das inter-relações entre a saúde e ambiente no processo saúde-doença-cuidado da população.Método: pesquisa de abordagem qualitativa, em que se realizaram 29 entrevistas de sete categorias profissionais. Adotou-se a análise temática para o processamento e interpretação do material empírico. Resultados: foram discutidas a necessidade de informação acerca de questões ambientais e seu impacto no processo saúde-doença e a consciência ambiental na dimensão do território. Há compreensão do ambiente como determinante de saúde, porém sob uma perspectiva embrionária, além de uma articulação insuficiente entre determinação social e práticas emancipatórias no contexto de saúde e ambiente. Conclusões: ressalta-se a importância de fortalecer as práticas na ESF a partir dos pressupostos explicitados na Política Nacional de Saúde Integral da População de Campo Florestas e Águas. Reforça-se a necessidade de se desenvolver processos formativos, envolvendo a equipe para contribuir na transformação da realidade em saúde da população de campo e das águas.

Objective: To understand the perceptions of Family Health Strategy (ESF, in Portuguese) professionals working in rural territories in municipalities of the Brazilian Northeast on the interrelationships between health and the environment in the health-disease-care process of the population. Method: qualitative research, in which 29 interviews in seven professional categories were carried out. Thematic analysis was adopted for the processing and interpretation of the empirical material. Results: it was discussed the need for information about environmental issues and their impact on the health-disease process, as well as environmental awareness in the dimension of the territory. From an embryonic perspective, there is an understanding of the environment as a determinant of health, with insufficient articulation between social determinants and emancipatory practices in the context of health and the environment. Conclusion: We emphasize the importance of strengthening ESF practices based on the assumptions outlined in the National Policy for the Integral Health of the Populations of the Field, Forest, and Water. We reinforce the need to develop training processes involving the team to contribute to the transformation of the health reality of the countryside and water populations.

Spatial distribution of sedentary behavior and unhealthy eating habits in Belo Horizonte, Brazil: the role of the neighborhood environment / Distribuição espacial do comportamento sedentário e do hábito alimentar não saudável em Belo Horizonte, Brasil: o papel do ambiente da vizinhança

Abstract The study aimed to analyze the spatial distribution of sedentary behavior and unhealthy eating habits, and to assess its relationship with the neighborhood environment. Cross-sectional study with data of Surveillance System of Risk and Protective Factors for Chronic Diseases, carried out in Belo Horizonte, Minas Gerais. Watching television for four hours or more per day was identified as sedentary behavior. Unhealthy eating habits were defined based on regular consumption of sodas, excess fat meat, and red meat, and irregular consumption of fruits and vegetables. Georeferenced data of places for physical activity, food establishments, population and residential density, homicide rate, mean total income, and social vulnerability index were entered into the Vigitel database. The coverage area by basic health units was used as the geographical unit of neighborhood. SaTScan was used to analyze the spatial distribution. Spatial analysis identified a significant cluster of high prevalence of sedentary behavior and unhealthy eating habits, after adjusting for sociodemographic characteristics. The comparison of environmental characteristics inside and outside clusters showed significant differences in the physical and social environment. Physical and social environment might be related to clusters of high prevalence of sedentary behavior and unhealthy eating habits.

Resumo O objetivo foi analisar a distribuição espacial do comportamento sedentário e do hábito alimentar não saudável e verificar a relação com o ambiente da vizinhança. Estudo transversal com dados do Sistema de Vigilância de fatores de risco e proteção para doenças crônicas, realizado em Belo Horizonte, Minas Gerais. Considerou-se comportamento sedentário o hábito de assistir televisão quatro ou mais horas por dia. O hábito alimentar não saudável foi avaliado pelo consumo regular de carne com excesso de gordura, refrigerante e carne vermelha e irregular de frutas e hortaliças. Informações georreferenciadas dos locais para a prática de atividade física, estabelecimentos com venda de alimentos, densidade populacional e residencial, taxa de homicídio, renda e índice de vulnerabilidade social foram inseridas na base do Vigitel. A área de abrangência da unidade básica de saúde foi usada como unidade geográfica da vizinhança. A análise espacial identificou cluster significativo de alta prevalência de comportamento sedentário e hábito alimentar não saudável, mesmo após ajuste. Os ambientes físico e social podem estar relacionados a cluster de alta prevalência de comportamento sedentário e hábito alimentar não saudável.