Trends in the epidemiology of inflammatory bowel disease in Colombia by demographics and region using a nationally representative claims database and characterization of inflammatory bowel disease phenotype in a case series of Colombian patients.

ABSTRACT: The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort.We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010-2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017.The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09-1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92-0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02-1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19-4.69 P < .001).Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.

[Urbanisation degree and mortality by education level in the Emilia-Romagna Longitudinal Study (Northern Italy)]. / Grado di urbanizzazione e mortalità per livello di istruzione nello Studio Longitudinale dell'Emilia-Romagna.

OBJECTIVES: to present the Longitudinal Study of Emilia-Romagna (SLER) and evaluate whether the effect of the education level on premature mortality is modified by the degree of urbanisation. DESIGN: closed cohort study. SETTING AND PARTICIPANTS: population aged >=30 years, resident in Emilia-Romagna Region (Northern Italy) and registered in the 2011 Italian Census, followed up until death, emigration, attainment of 75th year of age, or end of 2018. MAIN OUTCOME MEASURES: overall and cause-specific premature mortality (malignant tumours, lung and breast tumours, diseases of the circulatory system, respiratory system and digestive system, road accidents, death of despair, alcohol-related causes). RESULTS: the study population consisted of 2,579,936 individuals (15,508,972 person-years and 71,213 deaths). The population was equally distributed across the three degrees of urbanisation, but the prevalence of highly educated subjects was lower in the sparsely populated areas than in cities (12.9% vs 27.7%). The higher risk of mortality among the low educated was greatest, particularly among males, in the cities (MRR 1.68; 95%CI 1.62-1.75), lowest in the intermediate density areas (MRR 1.47; 95%CI 1.40-1.55), and not negligible among women. The interaction between education level and degree of urbanisation was significant for all-cause mortality, mortality from cardiovascular diseases, malignant tumours, especially lung cancer, road accidents (only among men). Among women, there were signs of an effect modification on mortality from diseases of respiratory and digestive systems. CONCLUSIONS: this first application of the SLER revealed that the mortality gradient by education level is greater in the cities, especially among men. These results deserve to be further explored through the analysis of other health outcomes and the investigation of the main drivers of the greater socioeconomic disadvantage observed in the cities.

The changing profile of schistosomiasis in a changing urban landscape.

Since 2007, most of humanity resides in urban areas, a trend which continues worldwide. Diseases usually associated with rural contexts are now emerging or newly recognised in cities. In the neighbourhood of São Bartolomeu in Salvador, Brazil, the prevalence of Schistosoma mansoni infection in 2011 was >20%. Following enrollment and treatment of a portion of the community, ~25% of the area underwent urban renewal. In 2015, we returned to enrol individuals who had previously participated and a cohort that had not taken part in 2011. Thus, infected individuals in one group experienced specific drug treatment plus improved living conditions and the second group only improved living conditions. Between 2011 and 2015 there were no organised treatment programs, but adequate sanitation increased from 69% to 92% coverage, household flooding decreased, and the presence of indoor toilets increased to 99% of households. Ownership of household appliances also increased significantly. The overall prevalence of schistosome infections was 6.2%. In 2015, the cohort first seen in 2011 had a higher prevalence (8.7%) than those first seen in 2015 (4.8%) and showed a few demographic differences. The 2011 cohort was older, more likely born in Salvador, less likely to have lived outside of Salvador, spent a greater percentage of their lifetime in Salvador, but more likely to have travelled. The population structure of the parasites from both cohorts underwent a marked change with similar increased component and infrapopulation differentiation and >10 fold decrease in effective population size. There was a 4-5 year shift in age-specific prevalence in 2015 for all compared with 2011. While praziquantel may have helped reduce prevalence, our evidence suggests that the structural changes and improvements in living conditions had the biggest impact on schistosomiasis in this community.

Geospatial analysis of births with congenital disorders, Paraná, 2008-2015: ecological study / Análisis geoespacial de los nacimientos con anomalías congénitas, Paraná, 2008-2015: un estudio ecológico / Análise geoespacial dos nascimentos com anomalias congênitas, Paraná, 2008-2015: estudo ecológico

ABSTRACT Objective: analyze the pattern of spatial distribution of the prevalence rate of births with congenital disorders and its relationship with social, economic, health care and environmental indicators in Paraná, Brazil, from 2008 to 2015. Method: ecological study with variables extracted from secondary banks, related to the births of children of mothers residing in Paraná, in two quadrennial (2008-2011 and 2012-2015). The analysis of the rates was performed with univariate spatial (Moran) and multivariate approach (Ordinary Least Squares and Geographically Weighted Regression). Results: the occurrence of congenital disorders presented a significant association (p<0.05) with: registration in primary care of pregnant women over 20 years of age; urbanization degree; consumption of pesticides; and balance of female formal employment. Conclusion/Final considerations: social, health care and environmental variables showed a non-stationary spatial pattern in the analyzed period and influenced positively and negatively the rates.

RESUMEN Objetivo: Evaluar el patrón de distribución espacial de la tasa de prevalencia de los nacimientos con anomalías congénitas y su relación con los indicadores sociales, económicos, medioambientales, de atención a la salud en el estado de Paraná, Brasil, de 2008 a 2015. Método: Estudio ecológico con variables de bancos secundarios, relativas a los nacimientos de hijos de madres residentes en el estado de Paraná, en dos cuatrienios (2008-2011 y 2012-2015). Se hizo el análisis de las tasas desde el análisis espacial univariada (Moran) y multivariante (Ordinary Least Squares y Geographically Weighted Regression). Resultados: La presencia de anomalías congénitas presentó una asociación significativa (p <0,05) con: el registro en la atención primaria de gestantes mayores de 20 años de edad; el grado de urbanización; el consumo de agrotóxicos; y el saldo de empleo formal femenino. Conclusión: Las variables sociales, medioambientales y de atención a la salud demostraron haber un patrón espacial no estacionario en el período analizado, además influenciaron positiva y negativamente las tasas.

RESUMO Objetivo: Analisar o padrão de distribuição espacial da taxa de prevalência dos nascimentos com anomalias congênitas e sua relação com indicadores sociais, econômicos, de atenção à saúde e ambientais no estado do Paraná, Brasil, de 2008 a 2015. Método: Estudo ecológico com variáveis extraídas de bancos secundários, relativas aos nascimentos de filhos de mães residentes no estado do Paraná, em dois quadriênios (2008-2011 e 2012-2015). A análise das taxas foi realizada com abordagem espacial univariada (Moran) e multivariada (Ordinary Least Squares e Geographically Weighted Regression). Resultados: A ocorrência de anomalias congênitas apresentou associação significativa (p<0,05) com: cadastramento na atenção primária de gestantes maiores de 20 anos; grau de urbanização; consumo de agrotóxicos; e saldo de emprego formal feminino. Conclusão: As variáveis sociais, de atenção à saúde e ambientais demonstraram padrão espacial não estacionário no período analisado e influenciaram positiva e negativamente as taxas.

Effects of urbanization on metabolic syndrome via dietary intake and physical activity in Chinese adults: Multilevel mediation analysis with latent centering.

RATIONALE: China has undergone rapid urbanization in the past decades. Metabolic syndrome refers to a cluster of cardiometabolic risk factors such as abdominal obesity, raised blood pressure, and elevated glucose. Existing studies have not explicitly examined the urbanization effect on metabolic syndrome. OBJECTIVE: The present study aims to examine the temporal effects of urbanization on metabolic syndrome in the Chinese context and evaluate dietary intake and physical activity as potential mediating factors. METHOD: The study sample comprised 6,217 Chinese adults aged between 30 and 65 recruited in 218 communities from 2000 to 2009 waves of the China Health and Nutrition Survey. Growth in urbanization of the communities was derived using latent growth modeling on continuous urbanization index from 2000 to 2009. The participants reported their physical activity and dietary intake. Body mass index and biomarkers were measured at 2009 for diagnosis of metabolic syndrome. Multilevel mediation analysis with novel latent centering approach was conducted across gender to evaluate direct and indirect effects of urbanization on metabolic syndrome via changes in dietary intake and physical activity. RESULTS: The sample displayed linear increasing trends in urbanization, intakes of red meat, dairy products and fast food and declining cereal intake and physical activity with significant inter-individual variations. Controlling for individual-level and community-level covariates, urbanization showed a positive but non-significant direct effect on metabolic syndrome across gender. There were significant and positive indirect effects from urbanization to metabolic syndrome via changes in physical activity in males and via changes in fast food intake in females. CONCLUSIONS: The present results highlight the health impact of urbanization as a dynamic process at the community level on metabolic syndrome via different indirect pathways of lifestyle factors across gender. Methodological and practical implications are discussed in relation to these modifiable lifestyle factors in the urbanizing Chinese society.

A geographically weighted regression approach to investigate air pollution effect on lung cancer: A case study in Portugal.

The risk of developing lung cancer might to a certain extent be attributed to tobacco. Nevertheless, the role of air pollution, both form urban and industrial sources, needs to be addressed. Numerous studies have concluded that long-term exposure to air pollution is an important environmental risk factor for lung cancer mortality. Still, there are only a few studies on air pollution and lung cancer in Portugal and none addressing its spatial dimension. The goal was to determine the influence of air pollution and urbanization rate on lung cancer mortality. A geographically weighted regression (GWR) model was performed to evaluate the relation between particle matter10 (PM10) emissions and lung cancer mortality relative risk (RR) for males and females in Portugal between 2007 and 2011. RR was computed with the BYM model. For a more in-depth analysis, the urbanization rate and the percentage of industrial area in each municipality were added. GWR efforts led to identifying three variables that were statistically significant in explaining lung cancer relative risk mortality, PM10 emissions, urbanization rate and the percentage of industrial area with an adjusted R2 of 0,63 for men and 0,59 for women. A small set of 8 municipalities with high correlation values was also identified (local R2 above 0,70). Stronger relationships were found in the north-western part of mainland Portugal. The local R2 tends to be higher when the emissions of PM10 are joined by urbanization and industrial areas. However, when assessing the industrial areas alone, it was noted that its impact was lower overall. As one of the first communications on this subject in Portugal, we have identified municipalities where possible impacts of air pollution on lung cancer mortality RR are higher thereby highlighting the role of geography and spatial analysis in explaining the associations between a disease and its determinants.

Differences in Fecal Gut Microbiota, Short-Chain Fatty Acids and Bile Acids Link Colorectal Cancer Risk to Dietary Changes Associated with Urbanization Among Zimbabweans.

The incidence of colorectal cancer (CRC) is gradually rising in sub-Saharan Africa. This may be due to dietary changes associated with urbanization, which may induce tumor-promoting gut microbiota composition and function. We compared fecal microbiota composition and activity in 10 rural and 10 urban Zimbabweans for evidence of a differential CRC risk. Dietary intake was assessed by a food frequency questionnaire. Fecal microbiota composition, metabolomic profile, functional microbial genes were analyzed, and bile acids and short chain fatty acids quantified. Animal protein intake was higher among urban volunteers, but carbohydrate and fiber intake were similar. Bacteria related to Blautia obeum, Streptococcus bovis, and Subdoligranulum variabile were higher in urban residents, whereas bacteria related to Oscillospira guillermondii and Sporobacter termitidis were higher in rural volunteers. Fecal levels of primary bile acids, cholic acid, and chenodeoxycholic acid (P < 0.05), and secondary bile acids, deoxycholic acid (P < 0.05) and ursodeoxycholic acid (P < 0.001) were higher in urban residents. Fecal levels of acetate and propionate, but not butyrate, were higher in urban residents. The gut microbiota composition and activity among rural and urban Zimbabweans retain significant homogeneity (possibly due to retention of dietary fiber), but urban residents have subtle changes, which may indicate a higher CRC risk.

Independent markers of nonalcoholic fatty liver disease in a gentrifying population-based Chinese cohort.

BACKGROUND: Prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing in developing countries, but its causes are not known. We aimed to ascertain the prevalence and determinants of NAFLD in a new largely unmedicated population-based cohort from the rapidly gentrifying region of Pinggu, China. METHODS: We randomized cluster sampled 4002 Pinggu residents aged 26 to 76 years. Data from 1238 men and 1928 women without significant alcohol drinking or hepatitis virus B or C infection were analysed. NAFLD was defined using a liver-spleen ratio (L/S ratio) ≤1.1 on unenhanced abdominal computed tomography (CT) scanning. RESULTS: Of men and women, 26.5% and 20.1%, respectively, had NAFLD. NAFLD prevalence was highest in younger men and older women. In multivariate logistic regression models, higher body mass index, waist circumference, serum triglyceride, alanine transaminase, and haemoglobin A1c independently increased the odds of NAFLD in both men and women separately. Higher annual household income and systolic blood pressure for men and higher serum uric acid and red meat intake and lower physical activity levels for women also independently associated with higher odds of NAFLD. Individuals with L/S ratio ≤1.1 had linearly increasing rates of obesity, diabetes, and metabolic syndrome that paralleled fatty liver increase. CONCLUSIONS: NAFLD is common in a gentrifying Chinese population particularly in younger men of high socioeconomic status and older women with sedentary behaviour who eat red meat. Demographic factors add independent risk of NAFLD above traditional metabolic risk factors. A CT L/S ratio of ≤1.1 identifies individuals at high risk of metabolic disease.

Structural decomposition analysis of embodied carbon in trade in the middle reaches of the Yangtze River.

The middle reaches of the Yangtze River are the first demonstration zone for low-carbon urbanization in the midwest regions of China, and the division of carbon emission reduction responsibility is an important aspect of construction of ecological civilization. In this paper, the embodied carbon emissions in trade are estimated by using an input-output model in the middle reaches of the Yangtze River, and then a structural decomposition analysis (SDA) model is further applied to conduct decomposition analysis on factors of embodied carbon changes. Our primary findings show the following: (1) Production-based CO2 emissions from Hubei and Hunan are higher than consumption-based CO2 emissions. There are situations in Jiangxi and Anhui where production-based CO2 emissions are both higher and lower than consumption-based CO2 emissions. However, inter-regional trade implied carbon is dominated by net inflows. Moreover, the inter-regional embodied carbon emissions in trade mainly flow out to relatively developed regions, such as Jiangsu and Shanghai. The inflow of embodied carbon in trade comes mainly from relatively backward economic development areas, such as Shaanxi and Inner Mongolia. (2) From the perspective of industry, industries in Jiangxi and Anhui are dominated by net inflow, whereas industries in Hunan and Hubei are dominated by net outflow. Meanwhile, industry in the middle reaches of the Yangtze River displays a high carbon-locked phenomenon. Specifically, the high carbon-locked outflow industries are mainly concentrated in the transportation and warehousing industry, agriculture, and the chemical industry, and the outflow provinces flow out mainly to Jiangsu, Guangdong, and other economically developed regions; high carbon-locked inflows are concentrated in metal smelting and rolling processing, food manufacturing and tobacco processing, and construction, and the provinces are mainly Hebei, Henan, and Inner Mongolia, where economic development is lacking. (3) Furthermore, the results of SDA decomposition indicate that scale effect is generally the most important factor leading to embodied carbon outflow. Meanwhile, the energy carbon emission effect, the energy intensity effect, and the structural effect are important factors-the inter-industry association effect mainly promotes the embodied carbon outflow. Consequently, based on the distinction between production and consumer responsibility, and from the perspective of scale effect and structural effect, the related policy suggests that consumers should be held responsible.

Urban-rural disparity in colorectal cancer incidence and increasing trend in relation to socioeconomic development and urbanization in China.

Objective To study urban-rural disparity in colorectal cancer incidence and the increasing trend in relation to rapid socioeconomic development and urbanization in China. Methods We compared the age-standardized incidence rates (ASRs) of colorectal cancer between rural and urban areas in China in 2012 and analyzed the trend in Shexian County for 2000-2015 using population-based tumor registration data collected in Shijiazhuang city (2012) and Shexian County (2000-2015). Results The ASRs of colorectal cancer in Shijiazhuang (urban) were considerably higher than in Shexian (rural) in both men (22.8 vs. 11.9/100,000) and women (15.0 vs. 9.3/100,000). The difference was similar to that between countries with high and medium human development indices according to GLOBOCAN 2012. In trend analysis, the biennial ASR in Shexian increased from 6.6 in 2000-2001 to 15.9/100,000 in 2014-2015 in men (averaged biennial percent change (ABPC) = +6.0%), and from 4.0 to 11.7/100,000 in women (ABPC=+5.5%). Conclusions The incidence of colorectal cancer in China is rising in parallel with socioeconomic development and urbanization. Integrated efforts should be made to reduce the incidences of overweight and obesity in society to help prevent this increase.

Decoupling emissions of greenhouse gas, urbanization, energy and income: analysis from the economy of China.

The adoption and ratification of relevant policies, particularly the household enrolment system metamorphosis in China, led to rising urbanization growth. As the leading developing economy, China has experienced a drastic and rapid increase in the rate of urbanization, energy use, economic growth and greenhouse gas (GHG) pollution for the past 30 years. The knowledge of the dynamic interrelationships among these trends has a plethora of implications ranging from demographic, energy, and environmental and sustainable development policies. This study analyzes the role of urbanization in decoupling GHG emissions, energy, and income in China while considering the critical contribution of energy use. As a contribution to the extant body of literature, the present research introduces a new phenomenon called "the environmental urbanization Kuznets curve" (EUKC), which shows that at the early stage of urbanization, the environment degrades however, after a threshold point the technique effects surface and environmental degradation reduces with rise in urbanization. Applying the autoregressive distributed lag model and the vector error correction model, the paper finds the presence of inverted U-shaped curve between urbanization and GHG emission of CO2, while the same hypothesis cannot be found between income and GHG emission of CO2. Energy use in all the models contributes to GHG emission of CO2. In decoupling greenhouse gas emissions, urbanization, energy, and income, articulated and well-implemented energy and urbanization policies should be considered.

Mental health and urbanization: a Russian perspective.

PURPOSE OF REVIEW: Despite being a pressing problem, the influence of urbanization on mental health is still underestimated in Russia. Although few studies on the topic in recent years were available, viewpoints of the expert community in Russia will be presented. Intensive urbanization impacts on the living conditions of the majority of the country's population being associated with mass migration of the population, a change in the structure of employment, the restructuring of family relations, and the need to adapt to unaccustomed living conditions. RECENT FINDING: Modern urbanization can adversely affect mental health due to stressful factors related to overpopulation, environmental contamination, poverty, violence, and lack of social support. SUMMARY: The main factors that directly affect mental health in Russia are consequences of urbanization such as:The society and the Government are taking a number of measures to prevent the consequences of urbanization (restrictions in the consumption of alcohol and tobacco, mass green plantations, a ban on noise in the evening, closure of landfills, etc.).

Dissolution and redistribution of trace elements and nutrients during dredging of iron monosulfide enriched sediments.

The increased use of estuarine waters for commercial and recreational activities is one consequence of urbanisation. Western Australia's Peel-Harvey Estuary highlights the impacts of urbanisation, with a rapidly developing boating industry and periodic dredging activity. The aim of this research is to evaluate the potential mobility of nutrients and trace elements during dredging, and the influence of flocculation on iron and sulfur partitioning in iron monosulfide enriched sediments. Our findings indicate a short-term increase in nitrate, phosphate and ammonium, during dredging through the resuspension of sediments. However, no increase in metal mobilisation during dredging was observed except copper (Cu) and zinc (Zn). Flocculant addition increased the release of nutrients, zinc (Zn) and arsenic (As) from sediments, had no effect on acid volatile sulfides and pyritic sulfur, but corresponded with an initial sharp rise in elemental sulfur concentrations. The run-off water from geofabric bags should be treated to decrease the concentrations of Zn and As to their background levels before releases into the estuary. Long-term impact of dredging on organic matter mineralisation and its subsequent effect on nutrients and trace elements dynamics needs further investigation.

The spatio-temporal distribution and risk factors of thyroid cancer during rapid urbanization-A case study in China.

BACKGROUND: Incidences of thyroid cancer (TC) have been increasing worldwide in recent decades. In this research, we aimed to analyze the spatiotemporal pattern of TC and explore relevant environmental risk factors in Hangzhou (HZ), which is rapidly urbanizing and home to the highest TC incidence in China. METHODS: Spatial scan statistic was employed to analyze the spatiotemporal pattern of TC in HZ from 2008 to 2012. The geographically weighted regression model (GWR) was implemented to explore environmental risk factors. Its performance was compared to the traditional ordinary least squares model (OLS). RESULTS: A total of 7147 TC cases (5385 female and 1762 male) were diagnosed in HZ from 2008 to 2012. High TC clusters were detected in the northeast, urban areas and expanded outwards while low clusters were located in the southwest rural areas. The GWR model generally performed better than the OLS in analyzing the associations between TC incidence and environmental factors. The industrial density, chemical oxygen demand of wastewater (COD) and the percentage of building area had a strong positive influence on the TC in the northeastern suburb areas of HZ, while the elevation, slope and the percentage of forest area had a significant negative correlation with TC in the middle, rural areas of HZ. Meanwhile, the accessibility to health care might have an impact on the TC incidence. CONCLUSION: High clusters were mostly located in the northeastern urban areas and showed an expansion process from the center urban area to the suburb area, especially for female TC. Intensive industrial activities and the emission of organic pollutants, which positively correlated with the high TC clusters in the northeast suburb areas of HZ, should get proper attention.

Urbanization is Associated with Increased Trends in Cardiovascular Mortality Among Indigenous Populations: the PAI Study / Urbanização Associa-se com Tendência a Maior Mortalidade Cardiovascular em Populações Indígenas: o Estudo PAI

Abstract Background: The cardiovascular risk burden among diverse indigenous populations is not totally known and may be influenced by lifestyle changes related to the urbanization process. Objectives: To investigate the cardiovascular (CV) mortality profile of indigenous populations during a rapid urbanization process largely influenced by governmental infrastructure interventions in Northeast Brazil. Methods: We assessed the mortality of indigenous populations (≥ 30 y/o) from 2007 to 2011 in Northeast Brazil (Bahia and Pernambuco states). Cardiovascular mortality was considered if the cause of death was in the ICD-10 CV disease group or if registered as sudden death. The indigenous populations were then divided into two groups according to the degree of urbanization based on anthropological criteria:9,10 Group 1 - less urbanized tribes (Funi-ô, Pankararu, Kiriri, and Pankararé); and Group 2 - more urbanized tribes (Tuxá, Truká, and Tumbalalá). Mortality rates of highly urbanized cities (Petrolina and Juazeiro) in the proximity of indigenous areas were also evaluated. The analysis explored trends in the percentage of CV mortality for each studied population. Statistical significance was established for p value < 0.05. Results: There were 1,333 indigenous deaths in tribes of Bahia and Pernambuco (2007-2011): 281 in Group 1 (1.8% of the 2012 group population) and 73 in Group 2 (3.7% of the 2012 group population), CV mortality of 24% and 37%, respectively (p = 0.02). In 2007-2009, there were 133 deaths in Group 1 and 44 in Group 2, CV mortality of 23% and 34%, respectively. In 2009-2010, there were 148 deaths in Group 1 and 29 in Group 2, CV mortality of 25% and 41%, respectively. Conclusions: Urbanization appears to influence increases in CV mortality of indigenous peoples living in traditional tribes. Lifestyle and environmental changes due to urbanization added to suboptimal health care may increase CV risk in this population.

Resumo Fundamento: O risco cardiovascular das diversas comunidades indígenas não está bem estabelecido e pode ser influenciado pelo processo de urbanização a que se submetem esses povos. Objetivos: Investigar o perfil da mortalidade cardiovascular (CV) das populações indígenas durante o rápido processo de urbanização altamente influenciado por intervenções governamentais de infraestrutura no Nordeste do Brasil. Métodos: Avaliamos a mortalidade de populações indígenas (≥ 30 anos) do Vale do São Francisco (Bahia e Pernambuco) no período de 2007-2011. Considerou-se mortalidade CV se a causa de morte constasse no grupo de doenças CV do CID-10 ou se tivesse sido registrada como morte súbita. As populações indígenas foram divididas em dois grupos conforme o grau de urbanização baseado em critérios antropológicos: Grupo 1 - menos urbanizadas (Funi-ô, Pankararu, Kiriri e Pankararé); e Grupo 2 - mais urbanizadas (Tuxá, Truká e Tumbalalá). Taxas de mortalidade de cidades altamente urbanizadas (Petrolina e Juazeiro) nas proximidades das áreas indígenas foram também avaliadas. A análise explorou tendências na porcentagem de mortalidade CV para cada população estudada. Adotou-se o valor de p < 0,05 como significância estatística. Resultados: Houve 1.333 mortes indígenas nas tribos da Bahia e de Pernambuco (2007-2011): 281 no Grupo 1 (1,8% da população de 2012) e 73 no Grupo 2 (3,7% da população de 2012), mortalidade CV de 24% e 37%, respectivamente (p = 0,02). Entre 2007 e 2009, houve 133 mortes no Grupo 1 e 44 no Grupo 2, mortalidade CV de 23% e 34%, respectivamente. Entre 2009 e 2010, houve 148 mortes no Grupo 1 e 29 no Grupo 2, mortalidade CV de 25% e 41%, respectivamente. Conclusões: A urbanização parece influenciar os aumentos de mortalidade CV dos povos indígenas vivendo de modo tradicional. Mudanças no estilo de vida e ambientais devidas à urbanização somadas à subótima atenção à saúde podem estar implicadas no aumento do risco CV nos povos indígenas.

The Rise of Noncommunicable Diseases in Kenya: An Examination of the Time Trends and Contribution of the Changes in Diet and Physical Inactivity.

This study examined correlations of historical changes in diet and physical inactivity with the rise of noncommunicable diseases (NCDs) in Kenya. Historical data on diet, wage jobs by industry, urbanization, gross domestic product (GDP), and morbidity due to NCDs were extracted from Kenya Statistical Abstracts, Food and Agriculture Organization (FAOSTAT), and the World Bank online database. These data were plotted and correlations between these factors and the incidence of different NCDs over time were evaluated. There was a rapid rise in the incidence of circulatory disease starting in 2001, and of hypertension and diabetes starting in 2008. The rise of these NCDs, especially hypertension and diabetes, was accompanied over the same period by a rise in per capita GDP and physical inactivity (as measured by increased urbanization and declining proportion of agricultural and forestry wage jobs); a rise in per capita supply of rice, wheat and its products, and cooking oils; and a decline in the per capita supply of maize and sugar. In conclusion, the positive correlations between indicators of dietary consumption and physical inactivity and rates of hypertension, circulatory disease, and diabetes suggest that the rapid rise of NCDs in Kenya may be, in part, due to changes in these modifiable factors.

Depth-distribution, possible sources, and toxic risk assessment of organochlorine pesticides (OCPs) in different river sediment cores affected by urbanization and reclamation in a Chinese delta.

Sediment cores were collected in urban (0-50 cm), rural (0-40 cm) and reclamation-affected river (0-40 cm) environments in the Pearl River Delta. Concentrations of 16 organochlorine pesticides (OCPs) were determined in all collected samples to identify the depth-distribution, possible sources and ecotoxicological risks of OCPs in river sediments affected by urbanization and reclamation in a Chinese delta. The results showed that the top 10 cm of rural river sediments had slightly lower concentrations of the 16 OCPs compared to urban and reclamation-affected rivers, whereas the 30-40 cm sediment layers in the rural river showed higher levels of the 16 OCPs. However, higher OCPs levels were observed in the 20-30 cm sediment layers in the urban river than in the rural and reclamation-affected rivers. The principal OCPs in most deeper sediment layers were hexachlorobezene (HCB), the combination of aldrin, endrin and dieldrin (ΣDRINs) and the combination of α-HCH, ß-HCH and γ-HCH (ΣHCHs). The predominant OCPs in surface sediments were HCB, ΣDRINs and the combination of p,p'-DDD, o,p'-DDT, p,p'-DDT and p,p'-DDE (ΣDDTs). Generally, OCP concentrations decreased with depth along sediment profiles at most sampling sites in the three types of rivers. The source analyses indicated that some sampling sites were still suffering from the recent use of hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs) and aldrin. According to the soil quality thresholds of China, the levels of HCHs and DDTs at most sampling sites were below class Ⅰ criteria. Based on the sediment quality guideline quotient (SQGQ), the combined ecotoxicological risk of OCPs (γ-HCH, dieldrin, p,p'-DDD, p,p'-DDE and p,p'-DDT) in surface sediments (0-10 cm) was higher than deeper sediments, and the rural river sediments exhibited a higher combined ecotoxicological risk than the sediments in urban and reclamation-affected rivers.

The nexus between urbanization and PM2.5 related mortality in China.

The launch of China's new national urbanization plan, coupled with increasing concerns about air pollution, calls for better understandings of the nexus between urbanization and the air pollution-related health. Based on refined estimates of PM2.5 related mortality in China, we developed an Urbanization-Excess Deaths Elasticity (U-EDE) indicator to measure the marginal PM2.5 related mortality caused by urbanization. We then applied statistical models to estimate U-EDE and examined the modification effects of income on U-EDE. Urbanization in China between 2004 and 2012 led to increased PM2.5 related mortality. A 1% increase in urbanization was associated with a 0.32%, 0.14%, and 0.50% increase in PM2.5 related mortality of lung cancer, stroke, and ischemic heart disease. U-EDEs were modified by income with an inverted U curve, i.e., lower marginal impacts at the lowest and highest income levels. In addition, we projected the future U-EDE trend of China as a whole and found that China had experienced the peak of U-EDE and entered the second half of the inverted U-shaped curve. In the near future, national average U-EDE in China will decline along with the improvement of income level if no dramatic changes happen. However, the decreased U-EDE only implies that marginal PM2.5-related mortality brought by urbanization would decrease in China. Total health damage of urbanization will keep going up in the predictable future because the U-EDE is always positive.

Condicionantes socioeconómicos y obesidad en adultos: evidencia basada en regresiones por cuantiles y datos de panel / Socioeconomic factors conditioning obesity in adults. Evidence based on quantile regression and panel data

Objetivo Se pretende medir el efecto de variables de naturaleza socioeconómica sobre la prevalencia de obesidad, con base en el nivel de ingreso, la urbanización, la incorporación de la mujer al mercado laboral y la accesibilidad a alimentos no saludables. Método Se realizaron estimaciones econométricas de la proporción de varones y mujeres obesas por país, aplicando modelos basados en datos de panel y regresiones por cuantiles, con datos provenientes de 192 países para el período 2002-2005. Como variables explicativas se consideraron los niveles de ingreso per cápita, urbanización, la razón ingreso/precio del Big Mac e indicadores laborales de la población femenina. Resultado Los factores que inciden en la obesidad en adultos difieren entre varones y mujeres; la accesibilidad a comida rápida afecta en mayor medida a la obesidad masculina mientras que la modalidad de inserción laboral provoca mayores guarismos de obesidad en las mujeres. Los factores socioeconómicos subyacentes en la obesidad también son diferentes según la magnitud de esta problemática en cada país; en países con baja prevalencia, aumentos del nivel de ingreso favorecen el tránsito hacia hábitos obesogénicos, mientras que en países con elevadas tasas de obesidad, el nivel de ingresos atenúa el problema. Discusión Identificar las causas socioeconómicas del notable incremento en la prevalencia de obesidad es fundamental para la implementación de estrategias efectivas para su prevención, no sólo por la disminución de la calidad de vida de quienes la padecen sino por la presión sobre los sistemas sanitarios de los costos de tratamiento de las patologías asociadas.(AU)

Objective To measure the effect of socioeconomic variables on the prevalence of obesity. Factors such as income level, urbanization, incorporation of women into the labor market and access to unhealthy foods are considered in this paper. Method Econometric estimates of the proportion of obese men and women by country were calculated using models based on panel data and quantile regressions, with data from 192 countries for the period 2002-2005.Levels of per capita income, urbanization, income/big mac ratio price and labor indicators for female population were considered as explanatory variables. Results Factors that have influence over obesity in adults differ between men and women; accessibility to fast food is related to male obesity, while the employment mode causes higher rates in women. The underlying socioeconomic factors for obesity are also different depending on the magnitude of this problem in each country; in countries with low prevalence, a greater level of income favor the transition to obesogenic habits, while a higher income level mitigates the problem in those countries with high rates of obesity. Discussion Identifying the socio-economic causes of the significant increase in the prevalence of obesity is essential for the implementation of effective strategies for prevention, since this condition not only affects the quality of life of those who suffer from it but also puts pressure on health systems due to the treatment costs of associated diseases.(AU)