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.

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.

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.

Cumplimiento de las medidas de restricción del uso residencial de leña en la ciudad de Valdivia

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.

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.

Estrutura, perfil dos frequentadores e padrão de utilização de Academias a Céu Aberto em Belo Horizonte, Minas Gerais / Characteristics, the profile of users, and pattern of use of outdoors gyms in Belo Horizonte, Minas Gerais

O objetivo deste estudo foi descrever a estrutura, o perfil dos frequentadores e o padrão de utilização de Academias a Céu Aberto (ACA) localizadas em áreas de vulnerabilidade distintas de Belo Horizonte, Minas Gerais. Estudo com delineamento transversal e análises exploratórias, realizado em duas ACA no ano de 2016. Foram utilizadas três abordagens in loco para mensurar as variáveis de interesse: das estruturas das ACA (PA R A), entrevistas face-a-face com os usuários presentes e observação sistemática dos frequentadores (SOPARC). Os dados foram analisados com a estatística descritiva e testes de qui-quadrado e Fisher no software R (p < 0,05). ACA-médio risco apresentou melhores estruturas para exercícios, conforto para usuários e condições de limpeza, estética e segurança comparadas à ACA-baixo risco. Foram entrevistados 49 adultos (51,2% mulheres) e observados 294 frequentadores (59,9% homens). Entre os usuários entrevistados, a maioria tinha mais de 50 anos, apresentavam sobrepeso ou obesidade (65,2%). Ademais, 51,0% dos entrevistados realizavam 150 minutos ou mais de atividade física moderada ou vigorosa, sendo que 24,5% deles atingiram esse tempo utilizando apenas as ACA (p = 0,016). Por meio do SOPARC, foi observado proporcionalmente maior presença de adultos (62,0%), de frequentadores em atividades sedentárias (58,4%), seguido de exercícios nos aparelhos das ACA (34,7%), e em dias de semana (64,0%). Proporção significativa de frequentadores em atividades sedentárias foi observada na ACA-baixo risco (p < 0,001). Este estudo contribui para orientação de políticas públicas de promoção de atividade física nas ACA, reforçando a relevância dos aspectos do ambiente físico e social no planejamento, monitoramento e avaliação dessas intervenções

This study aimed to describe the characteristics, the profile of users, and the pattern of use of Outdoors Gym (ACA - Portuguese abbreviation) in different socioeconomic areas of Belo Horizonte, Minas Gerais. A cross-sectional study was carried out in the two ACA in 2016. Three instruments were used to measure the variables of interest in loco: the characteristics of the ACA ( PARA), face to face interviews, and systematic observation of attendees (SOPARC). Data were analyzed using descriptive statistics and chi-square and Fisher tests in the R software (p < 0.05). ACA-medium risk showed better structures for exercises, comfort for users, and conditions of cleanliness, aesthetics, and safety compared to ACA-low risk. Forty-nine adults (51.2% women) were interviewed, and 294 participants were observed (59.9% men). Among the users in-terviewed, most were over 50 years old, were overweight or obese (65.2%). Furthermore, 51.0% of respond-ents performed 150 minutes or more of moderate or vigorous physical activity, and 24.5% of them reached this time using only the ACA (p = 0.016). Through SOPARC was observed a proportionally greater presence of adults (62.0%), who were in sedentary behaviors (58.4%), followed by ACA exercises (34.7%) and dur-ing weekdays (64.0%). A significant proportion of participants in sedentary activities was observed in the ACA-low risk (p < 0.001). This study may contribute to guiding physical activity promotion and reinforces the relevance of physical and social environments in the planning, monitoring, and evaluation of ACA

Sequía y calidad de vida en zona urbano-rural según grupos vulnerables y profesionales de salud

RESUMEN En Chile, la sequía ha afectado a la población social y económicamente vulnerable, impactando desfavorablemente en los determinantes sociales, salud y calidad de vida. Objetivo: Visibilizar los efectos de la sequía de una zona urbano-rural de Chile en la calidad de vida desde la perspectiva de la población vulnerable y de los profesionales de salud. Material y Método: Investigación cualitativa, con estudio de caso múltiple, realizado en zona urbano-rural de la Región de Valparaíso, decretada zona de catástrofe por sequía, por séptimo año consecutivo. Se aplica entrevista cualitativa semiestructurada a 10 personas mayores de 65 años, 10 madres de menores de cinco años y 6 profesionales de salud, con previo consentimiento informado. Se realiza análisis de contenido con Atlas ti® versión 8; surgen códigos y categorías y subcategorias. Se aplicaron los principios éticos de Ezekiel Emanuel y para garantizar rigor metodológico se consideraron los principios de credibilidad, confiabilidad, confirmabilidad y transferibilidad. Resultados: Las categorías que surgieron fueron: 1) Devastadoras consecuencias de la sequía en la familia: empobrecimiento familiar y migración de jóvenes; 2) Desafío de adaptación en el día a día: asegurar provisión de agua a través de la reutilización; 3) Percepción de invisibilidad: sensación de estar sin apoyo y pérdida de la confianza en organizaciones; 4) Visión de los profesionales: medidas de mitigación insuficientes y desinformación. Conclusiones: Los resultados visibilizaron las consecuencias de la sequía en la calidad de vida de grupos vulnerables y los desafíos que los profesionales de la salud tienen al implementar estrategias de adaptación al cambio climático.

ABSTRACT In Chile, drought has affected the socially and economically vulnerable population, adversely impacting social determinants, health and quality of life. Objective: To address the effects of drought in an urban-rural area on the quality of life from the perspective of the vulnerable population and health professionals. Material and Method: Qualitative research, with a multiple case study, carried out in an urban-rural area of the Valparaíso Region, which has been declared as a drought disaster area for the seventh consecutive year. A qualitative semi-structured interview was applied to 10 people over 65 years of age, 10 mothers of children under five years of age and 6 health professionals, after obtaining prior informed consent. Content analysis was performed using Atlas ti® version 8, resulting in codes, categories and subcategories. The ethical principles of Ezekiel Emanuel were applied and in order to ensure methodological rigor, the principles of credibility, reliability, confirmability and transferability were considered. Results: The categories that emerged were: 1. Devastating consequences of drought on families: family impoverishment, youth migration; 2. Day-to-day adaptation challenge: ensuring water supply through reuse; 3. Perception of invisibility: feeling of being unsupported, loss of trust in organizations; 4. Professionals' view: insufficient mitigation measures and misinformation. Conclusions: The results show the consequences of drought on the quality of life of vulnerable groups and the challenges that health professionals face when implementing adaptation strategies to climate change.

RESUMO No Chile, a seca tem afetado a população social e economicamente vulnerável, impactando negativamente os determinantes sociais, a saúde e a qualidade de vida. Objetivo: Tratar os efeitos da seca na qualidade de vida a partir da perspectiva da população vulnerável e dos profissionais de saúde de uma área urbano-rural. Material e Método: Pesquisa qualitativa, com estudo de casos múltiplos, realizada em uma área urbano-rural da Região de Valparaíso, decretada pelo sétimo ano consecutivo como área de desastre por seca. Uma entrevista qualitativa semiestruturada foi aplicada a 10 pessoas maiores de 65 anos, 10 mães de crianças menores de cinco anos e 6 profissionais de saúde, com consentimento prévio informado. A análise de conteúdo foi realizada utilizando Atlas ti® versão 8, resultando em códigos e categorias e subcategorías. Os princípios éticos de Ezekiel Emanuel foram aplicados e para garantir o rigor metodológico foram considerados os princípios de credibilidade, confiabilidade, confirmabilidade e transferibilidade. Resultados: As categorias que emergiram foram: 1. Conseqüéncias devastadoras da seca na família: empobrecimento familiar, migração juvenil; 2. Desafio da adaptação no dia a dia: garantir o abastecimento de água através da reutilização; 3. Percepção da invisibilidade: sensação de estar sem apoio, perda de confiança nas organizações; 4. Visão dos profissionais: medidas de mitigação insuficientes, desinformação. Conclusões: Os resultados evidenciaram as consequências da seca na qualidade de vida de grupos vulneráveis e os desafios que os profissionais de saúde enfrentam na implementação de estratégias de adaptação às mudanças climáticas.

Proposition and application of an environmental salubrity index in rural agglomerations / Proposição e aplicação de um índice de salubridade ambiental em aglomerados rurais

ABSTRACT OBJECTIVE Propose an Índice de salubridade ambiental (ISARural - environmental salubrity index) that expresses the conditions experienced in rural agglomerations, including indicators and subindicators for its subsequent application in rural communities in the state of Goiás. METHODS We developed the research in three phases: 1) previous analysis for the proposition of an ISARural, with the participation of seven specialists; 2) proposition of the ISARural by means of the Delphi method, starting with 168 specialists from 26 federative units of Brazil and Distrito Federal; and 3) application of the ISARural in 43 rural communities in the state of Goiás. RESULTS The proposed ISARural resulted in the composition of eight indicators, four of which related to basic sanitation, and the others to health, socioeconomic conditions, public services offered, and housing conditions. The weight assigned to each indicator ranged from 22.82% for the water supply indicator to 6.35% for the service indicator, it is possible to apply the ISARural fully or to evaluate each indicator individually. The application of ISARural in communities of Goiás classified 86% of them with low salubrity, highlighting the worst conditions for quilombola communities. The sanitary sewage had the lowest score among the ISARural indicators, requiring greater attention from public authorities. CONCLUSIONS This study contributed to the proposition of an index in line with the concept of environmental salubrity, useful in the scope of public policies as a conditioner for the prioritization of actions needed to improve the salubrity conditions identified. The proposed ISARural can be fully applied or used in the individual evaluation of each indicator of its composition. The results of its application made it possible to identify the communities with the worst environmental salubrity conditions and the indicators that require greater priority attention in the communities studied.

RESUMO OBJETIVO Propor um índice de salubridade ambiental que expresse as condições vividas em aglomerados rurais (ISARural), englobando indicadores e subindicadores para sua posterior aplicação em comunidades rurais do estado de Goiás. MÉTODOS A pesquisa foi desenvolvida em três fases: 1) análise prévia para proposição de um ISARural, contando com a participação de sete especialistas; 2) proposição do ISARuralpor meio do método Delphi, iniciando com 168 especialistas das 26 unidades federativas do Brasil e do Distrito Federal; e 3) aplicação do ISARuralem 43 comunidades rurais do estado de Goiás. RESULTADOS O ISARuralproposto resultou na composição de oito indicadores, sendo quatro relacionados ao saneamento básico, e os demais à saúde, às condições socioeconômicas, aos serviços públicos ofertados e às condições de moradia. O peso atribuído para cada indicador variou de 22,82%, para indicador de abastecimento de água, a 6,35%, para o indicador de serviços, podendo o ISARuralser aplicado na sua totalidade ou para avaliação de cada indicador individualmente. A aplicação do ISARuralem comunidades de Goiás evidenciou que 86% se classificam com baixa salubridade, destacando as piores condições para as comunidades quilombolas. Dentre os indicadores do ISARural, o de esgotamento sanitário foi caracterizado com a menor pontuação, o que demanda uma maior atenção do poder público. CONCLUSÕES Esse estudo cumpriu o papel de contribuir com a proposição de um índice em consonância com o conceito de salubridade ambiental, podendo ser empregado no âmbito das políticas públicas como um condicionante para a priorização das ações necessárias à melhoria das condições de salubridade identificadas. O ISARuralproposto pode ser aplicado na sua totalidade ou ainda na avaliação individual de cada indicador de sua composição. Os resultados da sua aplicação possibilitaram identificar as comunidades com piores condições de salubridade ambiental e os indicadores que requerem maior atenção prioritária nas comunidades estudadas.

Associated factors of environmental health in primary and secondary schools in Beijing from 2017 to 2020 / 中国学校卫生

Objective@#To understand the current situation of teaching and living environment in primary and secondary schools in Beijing and to provide basis for further intervention.@*Methods@#According to the national plan, an annual average of 92 schools in 16 districts of Beijing were investigated from 2017 to 2020, including school drinking water, canteen, toilet, dormitory management and equipment allocation. Classroom environment of some schools were tested,including the per capita area of classrooms, the agreement rate of desks and chairs distribution, blackboard reflectance, the average illumination and uniformity of desks, the average illumination and uniformity of blackboards, and noise.@*Results@#From 2017 to 2020,most of schools provided water purifiers and direct drinking water, accounting for 85.1% of all investigated schools. The proportion of students canteens in urban schools was increasing,accounting for 90.5% of all schools in 2020. And there was little change in suburban schools,reaching 85.1% in 2020. The proportion of school toilets equipped with soap increased significantly, 92.0% of school toilets were equipped with soap in 2020. The proportion of student dormitories with a per capita area of less than 3 m 2 decreased by year, and all reached the standard in 2020. The qualified rates of various classroom testing indicators, including per capita area in classroom, desk illumination uniformity, and noises, were higher than 80%, while the qualified rates of the blackboard illumination uniformity, desk allotment were lower than 80%.@*Conclusion@#The teaching and living environment in Beijing has improved in recent years, but there are still some problems need to be solved.

Analysis of health monitoring results in the teaching environment of primary and secondary schools in Sichuan Province from 2017 to 2021 / 中国学校卫生

Objective@#To analyze the current situation of teaching environmental sanitation in primary and secondary schools in Sichuan Province from 2017 to 2021, and to provide basis for the development of teaching environmental sanitation intervention measures in Sichuan Province.@*Methods@#A total of 7 510 primary and secondary schools were supervised and sampled from 2017 to 2021 according to the unified questionnaire. Descriptive statistical analysis method was used to analyze the monitoring results.@*Results@#The overall pass rate from 2017 to 2021 is only 51.70% (3 883), a total of 2 282 were sampled in 2017 and 1 414 were qualified, with the pass rate was the highest (61.96%),a total of 1 768 were sampled in 2019 and 750 were qualified, with the lowest pass rate (42.42%). The pass rate of different testing items in each year from 2017 to 2021 and the pass rate of the same test item in different years from 2017 to 2021 were statistically significant ( P <0.05). A total of 2 095 samples were inspected in rural areas in five years, and 1 177 were qualified, with the highest pass rate (56.18%). In urban areas, a total of 2 124 samples were inspected in five years, and 1 040 were qualified, with the lowest pass rate (48.96%). In the five year period of primary school, a total of 4 867 schools were sampled, and 2 626 were qualified, with the highest pass rate (53.93%). There were statistically significant differences in the qualification rate of desks and chairs, classroom lighting, blackboard illumination, per capita area of classrooms, and per capita area of student dormitories in different regions ( χ 2=9.87, 17.51, 37.69, 75.43, 11.22, P ＜0.05), and there were statistically significant differences in the pass rates of classroom lighting, per capita area of classrooms, per capita area of student dormitories, and ventilation of classrooms and student dormitories between different school sections ( χ 2=9.16, 39.37, 79.56 , 31.37, P <0.05).@*Conclusion@#The teaching environment of primary and secondary schools in Sichuan Province needs to be improved continuously, the qualified rate of classroom lighting and desks and chairs is low, and the investment in weak links should be increased.

Analysis of teaching environment of primary and middle schools in Zhengzhou City from 2014 to 2018 / 中国学校卫生

Objective@#To understand the changing trend of the teaching environment of the elementary and secondary schools in Zhengzhou, and to provide data for further improving the teaching environment of the elementary and secondary schools.@*Methods@#A survey of teaching facilities and teaching aids in 534 secondary and primary schools in Zhengzhou was conducted from 2014 to 2018 by using a stratified random sampling method.@*Results@#Teaching facilities: the qualified rate of the railings in the outer corridor of the teaching building was 88.8% (474), the qualified rate of classroom lighting was 79.6% (425), the qualified rate of the light desk distance was 82.8% (442), and the qualified rate of black plate lights 86.1% (460), the qualified rate of each year was statistically significant ( χ 2=9.97, 23.74, 80.10, 53.33, P <0.05); the qualified rate of classroom area per capita was 52.8% (282), the qualified rate of the outer corridor width of the teaching building was 64.0% (342), the qualified rate of each year showed no statistical difference( χ 2=7.38, 8.71, P >0.05). Teaching ancillary facilities: the proportion of centralized water supply was 65.0% (347), toilet with hand washing facilities was 81.6% (436), these two indicators showed an increasing trend, hand washing facilities in campus was 70.6% (377), showed a decreasing trend, the rate of each year differed significantly( χ 2=88.62, 42.71 , 123.53, P <0.05).@*Conclusion@#The overall situation of teaching environment in Zhengzhou primary and secondary schools is relatively good, the qualified rate of most indicators of teaching facilities increased from 2014 to 2018. However, there are still some indicators to be strengthened.

La amenaza del cambio climático a la salud de la población y la necesidad urgente de actuar

Climate change is associated with negative health outcomes, such as cardiovascular and respiratory diseases. This article analyses the threat of climate change on population health and the urgent need to implement measures to avoid this damage. Heat vulnerability, heatwave exposures, and wildfire exposure to forest fires have increased in Chile. In 2018, the annual mean concentration of fine particulate matter (PM2.5) exceeded the safe level proposed by the World Health Organization, increasing the risk of negative health outcomes. Thus, multidisciplinary and intersectoral mitigation and adaptation policies are needed. Among other elements, mental health impacts of climate change, health education provided by health workers to reduce negative health impacts of climate change, greater engagement of academia to generate evidence useful for policy-making processes and a better articulation between central and local governments should be considered. Finally, achieving a healthy population should be the aim of all these policies and efforts.

Connecting the right to health and anti-extractivism globally / Conectando o direito à saúde e o antiextrativismo globalmente / Conectando el derecho a la salud y el anti-extractivismo a nivel mundial

ABSTRACT Natural resources are essential to health and are global commons. Recognizing the devastating damage posed by extraction to health and the environment, as well as the erosion of the sovereignty of our governments that have increasingly conceded people's health in the interest of profit and development, is important in framing our resistance. Our communities experience growing displacement, the loss of social services, of land, water and livelihood, heightened militarization, violence and repression, and increased incidence of communicable diseases and health problems resulting from exposure to toxics. All of these are linked to an extractivist project driven by global financial capital promoting an unsustainable and inequitable development model that threatens people's health and the health of the planet. Is it compatible with the right to health to finance national health systems with revenues of activities that intrinsically destroy life? The essay portrays the inconsistency of development policies that fund health/right to health with extractivism and depicts examples of resistance to extractive industries tied to the People's Health Movement (Canada,Turkey, India and Ecuador) in different types of governments. The need to strengthen the link between the right to health struggles and anti-extractive resistance is highlighted.

RESUMO Os recursos naturais são essenciais para a saúde e são bens comuns globais. Reconhecer os danos devastadores causados pelo extrativismo à saúde e ao meio ambiente, bem como a erosão da soberania de nossos governos, que cada vez mais têm subordinado a saúde das pessoas ao interesse do lucro e do desenvolvimento, é importante para enquadrar nossa resistência. Nossas comunidades sofrem deslocamentos crescentes, a perda de serviços sociais, de terra, água e meios de subsistência, militarização aumentada, violência e repressão e aumento da incidência de doenças transmissíveis e problemas de saúde resultantes da exposição a substâncias tóxicas. Tudo isso está vinculado a um projeto extrativista impulsionado pelo capital financeiro global que promove um modelo de desenvolvimento insustentável e desigual que ameaça a saúde das pessoas e a saúde do planeta. É compatível com o direito à saúde financiar sistemas nacionais de saúde com receitas de atividades que destroem intrinsecamente a vida? Este ensaio retrata a inconsistência das políticas de desenvolvimento que financiam a saúde/direito à saúde com o extrativismo e descreve exemplos de resistência às indústrias extrativas ligadas ao Movimento pela Saúde dos Povos (Canadá, Turquia, Índia e Equador) em diferentes tipos de governo. Destaca-se a necessidade de fortalecer o vínculo entre o direito à saúde e a resistência antiextrativa.

RESUMEN Los recursos naturales son bienes comunes a escala global esenciales para la salud. Reconocer la devastación que produce el extractivismo en la salud y el ambiente, así como la erosión de la soberanía de nuestros gobiernos que han cedido en favor del desarrollo y el lucro es importante para estructurar nuestras resistencias. Nuestras comunidades sufren un creciente desplazamiento, la pérdida de servicios sociales, tierras, agua, medios de subsistencia, militarización, violencia y represión. A la par vemos una mayor incidencia de enfermedades transmisibles y problemas de salud derivados de la exposición a sustancias tóxicas, todo ello vinculado a un proyecto extractivista impulsado por el capital financiero global que promueve un modelo de desarrollo insostenible e injusto, amenazando la salud de las personas y del planeta. ¿Es compatible con el derecho a la salud financiar los sistemas nacionales de salud con ingresos de actividades que destruyen la vida intrínsecamente? El ensayo reflexiona sobre la inconsistencia del modelo de desarrollo que financia el derecho a la salud con extractivismo y coloca historias de resistencia a las industrias extractivas ligadas al Movimiento para la Salud de los Pueblos (Canadá, Turquía, India, Ecuador) y en diferentes tipos de gobiernos. Destaca la necesidad de fortalecer el vínculo entre las luchas por el derecho a la salud y la resistencia contra el extractivismo.

Connecting the right to health and anti-extractivism globally / Conectando o direito à saúde e o antiextrativismo globalmente / Conectando el derecho a la salud y el anti-extractivismo a nivel mundial

ABSTRACT Natural resources are essential to health and are global commons. Recognizing the devastating damage posed by extraction to health and the environment, as well as the erosion of the sovereignty of our governments that have increasingly conceded people's health in the interest of profit and development, is important in framing our resistance. Our communities experience growing displacement, the loss of social services, of land, water and livelihood, heightened militarization, violence and repression, and increased incidence of communicable diseases and health problems resulting from exposure to toxics. All of these are linked to an extractivist project driven by global financial capital promoting an unsustainable and inequitable development model that threatens people's health and the health of the planet. Is it compatible with the right to health to finance national health systems with revenues of activities that intrinsically destroy life? The essay portrays the inconsistency of development policies that fund health/right to health with extractivism and depicts examples of resistance to extractive industries tied to the People's Health Movement (Canada,Turkey, India and Ecuador) in different types of governments. The need to strengthen the link between the right to health struggles and anti-extractive resistance is highlighted.

RESUMO Os recursos naturais são essenciais para a saúde e são bens comuns globais. Reconhecer os danos devastadores causados pelo extrativismo à saúde e ao meio ambiente, bem como a erosão da soberania de nossos governos, que cada vez mais têm subordinado a saúde das pessoas ao interesse do lucro e do desenvolvimento, é importante para enquadrar nossa resistência. Nossas comunidades sofrem deslocamentos crescentes, a perda de serviços sociais, de terra, água e meios de subsistência, militarização aumentada, violência e repressão e aumento da incidência de doenças transmissíveis e problemas de saúde resultantes da exposição a substâncias tóxicas. Tudo isso está vinculado a um projeto extrativista impulsionado pelo capital financeiro global que promove um modelo de desenvolvimento insustentável e desigual que ameaça a saúde das pessoas e a saúde do planeta. É compatível com o direito à saúde financiar sistemas nacionais de saúde com receitas de atividades que destroem intrinsecamente a vida? Este ensaio retrata a inconsistência das políticas de desenvolvimento que financiam a saúde/direito à saúde com o extrativismo e descreve exemplos de resistência às indústrias extrativas ligadas ao Movimento pela Saúde dos Povos (Canadá, Turquia, Índia e Equador) em diferentes tipos de governo. Destaca-se a necessidade de fortalecer o vínculo entre o direito à saúde e a resistência antiextrativa.

RESUMEN Los recursos naturales son bienes comunes a escala global esenciales para la salud. Reconocer la devastación que produce el extractivismo en la salud y el ambiente, así como la erosión de la soberanía de nuestros gobiernos que han cedido en favor del desarrollo y el lucro es importante para estructurar nuestras resistencias. Nuestras comunidades sufren un creciente desplazamiento, la pérdida de servicios sociales, tierras, agua, medios de subsistencia, militarización, violencia y represión. A la par vemos una mayor incidencia de enfermedades transmisibles y problemas de salud derivados de la exposición a sustancias tóxicas, todo ello vinculado a un proyecto extractivista impulsado por el capital financiero global que promueve un modelo de desarrollo insostenible e injusto, amenazando la salud de las personas y del planeta. ¿Es compatible con el derecho a la salud financiar los sistemas nacionales de salud con ingresos de actividades que destruyen la vida intrínsecamente? El ensayo reflexiona sobre la inconsistencia del modelo de desarrollo que financia el derecho a la salud con extractivismo y coloca historias de resistencia a las industrias extractivas ligadas al Movimiento para la Salud de los Pueblos (Canadá, Turquía, India, Ecuador) y en diferentes tipos de gobiernos. Destaca la necesidad de fortalecer el vínculo entre las luchas por el derecho a la salud y la resistencia contra el extractivismo.

Concepto de Developmental Origins of Health and Disease: El ambiente en los primeros mil días de vida y su asociación con las enfermedades no transmisibles / Developmental Origins of Health and Disease Concept: The environment in the first 1000 days of life and its association with noncommunicable diseases

En las últimas décadas, las enfermedades crónicas no transmisibles (ENT) se han convertido en la principal causa de mortalidad global y han aumentado en América Latina. La contribución de recursos de la ciencia del desarrollo, la epigenética, las neurociencias, las ciencias ambientales, la epidemiología y la investigación ha generado evidencia del origen de las ENT desde la programación fetal. Los resultados de salud y enfermedad devienen de una trayectoria dinámica en la que se agregan factores protectores para una vida saludable o factores de riesgo para enfermedades del individuo y las comunidades.El concepto de Developmental Origins of Health and Disease redimensiona el papel del equipo de salud materno-infantil y debe guiar las políticas públicas para priorizar los primeros mil días de vida para un desarrollo saludable y la prevención de ENT. Se presenta una actualización sobre las principales condiciones ambientales adversas que pueden alterar la programación del desarrollo y predisponer a ENT en el curso de la vida.

In recent decades, chronic non-communicable diseases (NCDs) have become the leading cause of global mortality and increased in Latin America. The contribution of the resources from development science, epigenetics, neurosciences, environmental sciences, epidemiology and research has generated evidence of the origin of NCDs since fetal programming. The healt and disease outcomes result from a dynamic trajectory where protective factors are added for a healthy life or risk factors for diseases of the individual and the communities. Developmental Origins of Health and Disease concept resizes the role of the maternal and child health team and should guide public policies by prioritizing the first 1000 days of life for healthy development and NCDs prevention. We present an update on principal adverse environmental conditions that may alter development programming and predispose NCDs in life course