Reaching the sustainable development goals through healthy environments: are we on track?

The adoption of the 2030 Agenda for Sustainable Development in 2015 opened new opportunities to work towards healthy environments through 'whole of government' and 'whole of society' approaches. It created a strong policy platform that acknowledges health as a result and an enabler of sustainable policies across all sectors of government. Five years into the process, an initial analysis of emerging trends indicates that, despite some encouraging developments in policy as well as overall progress in economy and technology, there remains a gap between rhetoric, ambition and reality. In particular, the monitoring system for environment and health-related sustainable development goals (SDGs) and targets requires further development; inequalities in environment and health persist and in some areas have increased; equity is not yet a central element of implementation and reporting on the achievement of the SDGs; and, most worrying of all, trends in key environmental indicators that are vital to the survival of the human species, such as those related to climate change and biodiversity, are still on an overall negative path. In summary, governments must significantly and rapidly increase action to secure the habitability and safety of planet Earth. The public health community assumes an unprecedented role in placing and maintaining health and equity at the heart of the political agenda. This demands new governance models conferring on the health sector a clear mandate and legitimacy to operate across sectors. It also requires enhancing capacities among health professionals to embrace this new level of complexity, understand the multiple links between sectoral policies and health, and successfully engage with other government sectors and stakeholders.

Manifestaciones neurológicas del déficit de vitamina B12 en pediatría / Neurological manifestations of vitamin B12 deficiency in pediatrics

Introducción: El déficit de vitamina B12 genera un proceso de desmielinización neuronal, manifestándose con anormalidades cerebrales y degeneración del cordón espinal. En pediatría, las manifestaciones neurológicas son una de las formas de presentación. Usualmente, se observa en niños alimentados con lactancia materna exclusiva cuyas madres tienen escaso consumo de alimentos de origen animal. Objetivo: Describir las manifestaciones neurológicas del déficit vitamínico e identificar factores de riesgo alimentario. Pacientes y método: Se realizó un estudio de serie de casos de 6 pacientes internados en el Hospital Garrahan con deficiencia de vitamina B12 en el periodo comprendido entre julio 1996 y diciembre 2013 cuyo diagnóstico se realizó mediante determinación sérica de vitamina B12. Resultados: La edad media de presentación de los síntomas fue de 3,6 meses. El 83.3% de los pacientes presentaron convulsiones, 60% las manifestaron de forma exclusiva y en el 40% se asociaron a hipotonía y pérdida de pautas madurativas. Un 16.7% presentó hipotonía más pérdida de pautas sin presentar convulsiones. Respecto de la alimentación, la totalidad recibía lactancia materna, el 83.3% de forma exclusiva, el 16.7% asociada a leche maternizada. En cuanto a la dieta de las madres de pacientes alimentados con pecho materno exclusivo, el 40% realizaba dieta vegetariana estricta, en otro 40% no se hallaron datos relacionados con su alimentación, pero se diagnosticó déficit de vitamina B12 por dosaje sérico, y el 20% restante refería recibir dieta general. Conclusión: Ante el aumento de la incidencia de la población vegetariana/vegana, se debería considerar la deficiencia de vitamina B12 ante pacientes con manifestaciones neurológicas de etiología desconocida, dado que es una enfermedad con un tratamiento inocuo y efectivo, y se evidencia mejoría clínica, y de los parámetros de laboratorio en todos los casos (AU)

Introduction: Vitamin B12 deficiency may cause a process of neuronal demyelination associated with brain abnormalities and degeneration of the spinal cord. In pediatrics, neurological manifestations are one of the forms of presentation. It is usually observed in exclusively breast fed children whose mothers do not consume food of animal origin. Aim: To describe neurological manifestations of vitamin B12 deficiency and identify nutritional risk factors. Patients and method: A series of 7 patients admitted to Hospital Garrahan with vitamin B12 deficiency diagnosed by vitamin B12 serum level testing were evaluated between July and December of 1996-2013. Results: Mean age at symptom presentation was 3,6 months. Overall, 83.3% of the patients presented with seizures, in 60% as the only symptom and in 40% associated with hypotonia and developmental delay. Hypotonia and developmental delay without seizures were observed in 16.7%. A single patient presented with pancytopenia only. All infants were breastfed, 83.3% exclusively, 16.7% in combination with formula, and the remaining 14.3% in combination with food. Regarding the diet of the mothers of the exclusively breastfed children, 40% followed a strict vegetarian diet, for another 40% no data on their diet were available but they were diagnosed with vitamin B12 based on serum values, and the remaining 20% followed a general diet. Conclusion: As the incidence of vegetarianism/veganism is increasing in the population, vitamin B12 deficiency should be considered in patients with neurological symptoms of unclear etiology, as treatment of the condition is innocuous and effective and leads to clinical and laboratory parameter improvement in all cases (AU)

Sport promotion policies in the European Union: results of a contents analysis.

Although sport promotion may play an important role in achieving the recommended levels of physical activity for health, until now, there has been no comprehensive assessment of how sport policies in Europe address health. This article aimed at filling this gap by reviewing and analyzing recent national policy developments in the area of sport promotion, with a focus on synergies and discrepancies with the promotion of health-enhancing physical activity. By applying various search methods, 130 documents focusing on sport and physical activity were identified in the World Health Organization (WHO) European Region. An analysis grid covering key indicators was developed for a systematic content analysis of 25 documents, selected according to established criteria. Analysis showed that general recommendations for good policy making were followed, such as establishing general goals, specifying time frame and responsible body for implementation and addressing different target groups. Furthermore, all sport strategies addressed health on an overall level and recognized the importance of Sport for All. However, in several strategies, there was a lack of measurable targets, specified budgets, and evaluation plans. The analysis showed that there is a great opportunity for health and sport sectors to work more closely together in the future, and identified areas where this could take place.

Measuring the food and built environments in urban centres: reliability and validity of the EURO-PREVOB Community Questionnaire.

OBJECTIVES: The authors designed an instrument to measure objectively aspects of the built and food environments in urban areas, the EURO-PREVOB Community Questionnaire, within the EU-funded project 'Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe' (EURO-PREVOB). This paper describes its development, reliability, validity, feasibility and relevance to public health and obesity research. STUDY DESIGN: The Community Questionnaire is designed to measure key aspects of the food and built environments in urban areas of varying levels of affluence or deprivation, within different countries. The questionnaire assesses (1) the food environment and (2) the built environment. METHODS: Pilot tests of the EURO-PREVOB Community Questionnaire were conducted in five to 10 purposively sampled urban areas of different socio-economic status in each of Ankara, Brno, Marseille, Riga, and Sarajevo. Inter-rater reliability was compared between two pairs of fieldworkers in each city centre using three methods: inter-observer agreement (IOA), kappa statistics, and intraclass correlation coefficients (ICCs). RESULTS: Data were collected successfully in all five cities. Overall reliability of the EURO-PREVOB Community Questionnaire was excellent (inter-observer agreement (IOA) > 0.87; intraclass correlation coefficients (ICC)s > 0.91 and kappa statistics > 0.7. However, assessment of certain aspects of the quality of the built environment yielded slightly lower IOA coefficients than the quantitative aspects. CONCLUSIONS: The EURO-PREVOB Community Questionnaire was found to be a reliable and practical observational tool for measuring differences in community-level data on environmental factors that can impact on dietary intake and physical activity. The next step is to evaluate its predictive power by collecting behavioural and anthropometric data relevant to obesity and its determinants.

Who owns the roads? How motorised traffic discourages walking and bicycling.

OBJECTIVE: To examine the impact of traffic on levels of walking and bicycling. METHOD: Review of the literature of medical, public health, city planning, public administration and traffic engineering. RESULTS: The real and perceived danger and discomfort imposed by traffic discourage walking and bicycling. Accurately or not, pedestrians and bicyclists judge injury risk and respond accordingly. Although it can be difficult to measure these effects, observed behaviour provides good evidence for these effects, with the strongest association being an inverse correlation between volumes and speeds of traffic and levels of walking and cycling. CONCLUSION: Interventions to reduce traffic speed and volume are likely to promote walking and bicycling and thus result in public health gains.

Reduction of fecal contamination of street-vended beverages in Guatemala by a simple system for water purification and storage, handwashing, and beverage storage.

Street-vended foods and beverages, an integral part of urban economies in the developing world, have been implicated in cholera transmission in Latin America. To improve the microbiologic quality of market-vended beverages in Guatemala, we tested a simple system consisting of dilute bleach (4.95% free available chlorine) for water purification, narrow-mouth plastic vessels with spigots for disinfecting and storing water and for preparing and storing beverages, handwashing soap, and education in using the system. We conducted a randomized controlled intervention trial among 41 vendors who received the intervention and 42 control vendors, comparing total and fecal coliform bacteria and Escherichia coli contamination of market-vended beverages, stored water, and vendors' hands. Samples were obtained at baseline and at each of six weekly follow-up visits. At baseline, fecal coliform bacteria were found in 40 (48%) market-vended beverages and E. coli in 14 (17%). When compared with samples from control vendors, a significant decrease in total coliform (P < 0.001) and fecal coliform (P < 0.001) bacteria in samples of stored water and beverages sold by intervention vendors was observed over the course of the study. The vessel system was well accepted by vendors. This simple inexpensive system consisting of hypochlorite disinfectant, plastic vessels, soap, and education can significantly reduce fecal contamination of market-vended beverages.

Household bleaches based on sodium hypochlorite: review of acute toxicology and poison control center experience.

Bleaches based on solutions of sodium hypochlorite (NaOCl) are widely used in the household to disinfect and clean hard surfaces and to bleach the laundry. A review of both published and unpublished toxicological data is presented. In addition, the results of a survey of human accidents with hypochlorite bleaches by the Poison Control Centers of France, Italy, Belgium, Greece, Turkey, Spain and Portugal for the period 1989-1992 are presented. The data show that acute accidental exposure to household bleach in use or in foreseeable misuse situations results, in the great majority of the cases, in minor, transient adverse effects on health, with no permanent sequelae. Ingestion is the most frequent route of exposure, followed by inhalation of gases evolved by mixing sodium hypochlorite bleach with acid or alkaline products. All evidence presented confirms the normal safety profile of hypochlorite-based bleaches to be similar to that of other 'generally recognized as safe' household products.

[Legal abortivity and life project of women]. / Abortivita volontaria e progetti di vita femminile

PIP: This article concerns the relationship between fertility and legal abortivity in the first 5-year period of the 80's. The legal abortivity pattern of married women, by age and prior fertility is studied in 4 typical regions. This typology is stated considering both levels of fertility of abortivity at 1980-81 (low fertility-low abortivity; low fertility-high abortivity; high fertility-high abortivity; high fertility-low abortivity). In each region the change in the age-conception order specifies abortivity rate is examined by a regression model. Same interesting results can be stressed. Young women seem to be the most involved in the changing fertility pattern during the years considered. They appear at 1984-85 with a number of children more strictly reduced than during 1980-81. Of them, those residing in the too low fertility regions, as well as those residing in the high fertility-high abortivity region seem to be exposed to a lower risk of a legal abortion. The same results cannot be found for young residents in the high fertility-low abortivity region. In other words, those above seem to be in progress as it concerns the prevention possibility of an unplanned conception, otherwise the same cannot be stated for these latter. Many more women had a legal abortion in the early 80's, while less younger women, in a similar status, seem to risk the same 5 years later. At least, spreading knowledge about family planning methods seems to be working as outlined in the spirit of the 194 law operating in public health services. (Author's modified).^ieng