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1.
Artigo em Inglês | PAHO-IRIS | ID: phr-51901

RESUMO

To the editor: In the United States (US), an estimated 2.4 million persons have chronic infection with hepatitis C virus (HCV). The number of deaths from HCV-related mortality is greater than that of HIV and tuberculosis combined. Treatment with direct-acting antivirals (DAAs), usually 1-3 pills a day for 8 or 12 weeks, can cure over 95% of patients. Successful treatment of HCV has been shown to greatly reduce liver-related as well as all-cause mortality. American Indian and Alaska Native (AI/AN) people have over twice the national rate of HCV-related mortality. The largest health care provider for AI/AN communities is the Indian Health System, a national network of federal (Indian Health Service), tribal, and urban health facilities, comprised mostly of rural primary care clinics. As part of the Indian Health System response to HCV, health facilities have access to tele-mentoring support such as the ECHO (Extension for Community Healthcare Outcomes) model, which has demonstrated excellent outcomes in treating HCV. The program connects rural clinicians (‘spokes’) to a specialist team (‘hub’). These participants meet regularly via low-bandwidth video conference technology. The format of case-based learning, supported by short didactic presentations, aims to scale up clinical capacity across a health network. Patient presentations entail a brief de-identified standardized form with a patient’s clinical history to assess liver disease severity and determine optimal HCV treatment. [...]


Assuntos
Hepatite C , Mortalidade , Doenças Transmissíveis , Nativos do Alasca , Índios Norte-Americanos , Saúde da População Urbana , Serviços Urbanos de Saúde , Hepatite , Telemedicina , Telemedicina para as Zonas Rurais e Remotas , Serviços de Saúde do Indígena , Saúde de Populações Indígenas , Organizações Indígenas
4.
Ann Otol Rhinol Laryngol ; 129(2): 149-156, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31559862

RESUMO

OBJECTIVES: We aimed to determine whether certain maxillofacial fracture patterns and injury mechanisms were more prevalent in an urban environment. In addition, we aimed to determine if maxillofacial trauma incidence correlated with income. METHODS: Data was collected from Einstein Healthcare Network and Temple University Health System. These data were compared to the 2016 National Trauma Data Bank© (NTDB©) using chi-square analysis. Multivariate analysis was used to identify correlations between demographic variables and fracture patterns. Sociodemographic data was further characterized utilizing neighborhood mapping. RESULTS: A total of 252 patients from our urban campuses and 14 447 patients from the NTDB© were identified with facial fractures. Maxillofacial trauma patients in the urban population were more likely to be minorities and less likely to be Caucasian compared to the NTDB© (P < .001). Patients in the urban setting were more likely to sustain mandibular and orbital fractures, and less likely to sustain maxillary fractures and multiple fractures (P < .001). Urban maxillofacial trauma patients were more likely to sustain assault and sporting injuries, and less likely to sustain injuries from motor vehicle accidents and self-harm (P < .001). CONCLUSIONS: Maxillofacial trauma patterns and injury mechanisms were shown to be significantly different in an urban environment as compared to national data.


Assuntos
Traumatismos Maxilofaciais/epidemiologia , Adolescente , Adulto , Idoso , Correlação de Dados , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Saúde da População Urbana , Adulto Jovem
5.
BJOG ; 127(1): 116-122, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31553136

RESUMO

OBJECTIVE: To estimate the risk for adverse perinatal outcomes for women who met the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria but not the two-step criteria for gestational diabetes mellitus (GDM). DESIGN: Population-level cross-sectional study. SETTING: Ontario, Canada. POPULATION: A total of 90 140 women who underwent a 75-g oral glucose tolerance test. METHODS: Women were divided into those who met the diagnostic thresholds for GDM by two-step criteria and were therefore treated, those who met only the IADPSG criteria for GDM and so were not treated, and those who did not have GDM by either criteria. MAIN OUTCOME MEASURES: Hypertensive disorders of pregnancy, preterm delivery, primary caesarean section, large-for-gestational-age, shoulder dystocia and neonatal intensive care unit admission. RESULTS: Women who met the IADPSG criteria had an increased risk for all adverse perinatal outcomes compared with women who did not have GDM. Women with GDM by two-step criteria also had an increased risk of most outcomes. However, their risk for large-for-gestational-age neonates and for shoulder dystocia was actually lower than that of women who met IADPSG criteria. CONCLUSION: Women who met IADPSG criteria but who were not diagnosed with GDM based on the current two-step diagnostic strategy, and were therefore not treated, had an increased risk for adverse perinatal outcomes compared with women who do not have GDM. The current strategy for diagnosing GDM may be leaving women who are at risk for adverse events without the dietary and pharmacological treatments that could improve their pregnancy outcomes. TWEETABLE ABSTRACT: Women who meet IADPSG criteria for GDM have an increased risk for adverse perinatal outcomes compared with women without GDM.


Assuntos
Diabetes Gestacional/epidemiologia , Resultado da Gravidez/epidemiologia , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Macrossomia Fetal/epidemiologia , Teste de Tolerância a Glucose/estatística & dados numéricos , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Terapia Intensiva Neonatal/estatística & dados numéricos , Ontário/epidemiologia , Gravidez , Fatores de Risco , Saúde da População Rural , Saúde da População Urbana
6.
Ther Adv Cardiovasc Dis ; 13: 1753944719891691, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31797738

RESUMO

BACKGROUND: Myocardial infarctions (MIs) are the leading cause of death in the United States (US). Differences in MI mortality rates exist between rural and urban areas in the US. Early recognition of MI symptoms can lead to receiving prompt lifesaving treatment. In this study, we identified the influence of living in a rural area, rurality, on disparities in MI symptom awareness across the US. METHODS: We examined 2007 and 2009 Behavioral Risk Factor Surveillances System survey data using logistic regressions to model the impact of rurality on MI symptom awareness while controlling for sociodemographic and MI clinical factors. From the results of these models, we created a type of marginal probability, known as average adjusted predictions (AAPs) and the difference in AAPs, called average marginal effects (AMEs), to determine patterns of awareness for each MI symptom between rural, suburban, and urban areas. RESULTS: We found that there were similar odds and probabilities of being aware of all five MI symptoms between rural, suburban, and urban areas, although rural residents consistently had a slightly higher odds and probability of being aware of all five MI symptoms compared with suburban and urban residents. Rural, suburban, and urban residents had the highest probability of being aware of chest pain/discomfort (95.5-96.1%) and the lowest probability of being aware of jaw/back/neck pain (68.6-72.0%). After adjustment, more than 25% of rural, suburban, and urban residents were found to be unaware that jaw/back/neck pain and feeling weak/light-headed/faint were symptoms of MI. AMEs were greatest for all areas for jaw/back/neck pain (-3.5% to -3.2%) and smallest for chest pain/discomfort (-0.6% to -0.2%). CONCLUSIONS: The study's results highlight the need to increase awareness of the MI symptoms of jaw/back/neck pain and feeling weak/light-headed/faint to shorten hospital delay and time to treatment, especially for rural areas where cardiovascular disease mortality is high.


Assuntos
Conscientização , Conhecimentos, Atitudes e Prática em Saúde , Infarto do Miocárdio/epidemiologia , Saúde da População Rural , Adolescente , Adulto , Idoso , Angina Pectoris/epidemiologia , Dor nas Costas/epidemiologia , Tontura/epidemiologia , Dor Facial/epidemiologia , Feminino , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Cervicalgia/epidemiologia , Prognóstico , Fatores de Risco , Saúde Suburbana , Estados Unidos/epidemiologia , Saúde da População Urbana , Adulto Jovem
7.
Isr Med Assoc J ; 12(21): 785-789, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814340

RESUMO

BACKGROUND: Asthma is a common respiratory disease, which is linked to air pollution. However, little is known about the effect of specific air pollution sources on asthma occurrence. OBJECTIVES: To assess individual asthma risk in three urban areas in Israel characterized by different primary sources of air pollution: predominantly traffic-related air pollution (Tel Aviv) or predominantly industrial air pollution (Haifa bay area and Hadera). METHODS: The medical records of 13,875, 16- 19-year-old males, who lived in the affected urban areas prior to their army recruitment and who underwent standard pre-military health examinations during 2012-2014, were examined. Nonparametric tests were applied to compare asthma prevalence, and binary logistic regressions were used to assess the asthma risk attributed to the residential locations of the subjects, controlling for confounders, such as socio-demographic status, body mass index, cognitive abilities, and education. RESULTS: The asthma rate among young males residing in Tel Aviv was 8.76%, compared to 6.96% in the Haifa bay area and 6.09% in Hadera. However, no statistically significant differences in asthma risk among the three urban areas was found in controlled logistic regressions (P > 0.20). This finding indicates that exposure to both industrial- and traffic-related air pollution is associated with asthma prevalence. CONCLUSIONS: Both industrial- and traffic-related air pollution have a negative effect on asthma risk in young males. Studies evaluating the association between asthma risk and specific air pollutants (e.g., sulfur dioxide, particulate matter, and nitrogen dioxide) are needed to ascertain the effects of individual air pollutants on asthma occurrence.


Assuntos
Poluição do Ar , Asma , Exposição Ambiental , Material Particulado , Emissões de Veículos , Adolescente , Poluição do Ar/prevenção & controle , Poluição do Ar/estatística & dados numéricos , Asma/diagnóstico , Asma/epidemiologia , Asma/prevenção & controle , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Israel/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Dióxido de Nitrogênio/efeitos adversos , Dióxido de Nitrogênio/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Prevalência , Medição de Risco , Fatores de Risco , Saúde da População Urbana/normas , Saúde da População Urbana/estatística & dados numéricos , Emissões de Veículos/análise , Emissões de Veículos/prevenção & controle , Adulto Jovem
8.
BMC Public Health ; 19(1): 1669, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829165

RESUMO

BACKGROUND: Race and place intersect to produce location-based variation in disease distributions. We analyzed the geographic distribution of tuberculosis (TB) incidence in Michigan, USA to better understand the complex interplay between race and place, comparing patterns in Detroit, Wayne County and the state of Michigan as a whole. METHODS: Using cross-sectional TB surveillance data from the Michigan Department of Health and Human Services, multivariable statistical models were developed to analyze the residence patterns of TB incidence from 2007 through 2012. Two-way interactions among the residence location and race of cases were assessed. RESULTS: Overall, Detroit residents experienced 58% greater TB incidence than residents of Wayne County or the state of Michigan. Racial inequalities were less pronounced in Detroit compared to both Wayne County and the state of Michigan. Blacks in Detroit had 2.01 times greater TB incidence than Whites, while this inequality was 3.62 times more in Wayne County and 8.72 greater in the state of Michigan. CONCLUSION: Our results highlight how race and place interact to influence patterns of TB disease, and the ways in which this interaction is context dependent. TB elimination in the U.S. will require strategies that address the local social environment, as much as the physical environment.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Tuberculose/etnologia , Saúde da População Urbana/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Meio Social , Fatores Socioeconômicos , Adulto Jovem
9.
Artigo em Japonês | MEDLINE | ID: mdl-31875633

RESUMO

OBJECTIVES: In this multicity study, we aimed to elucidate the city-specific factors affecting the association of high ambient temperature with ambulance dispatches due to acute illnesses. METHODS: We used the data of ambulance dispatches in 27 cities in Japan with more than 500,000 population excluding Tokyo, from May to September from 2012 to 2015. We included patients 20 years and older (≥20 years) and stratified them into three age groups (20-59, 60-79, and ≥80 years). We explored the city-specific pattern of the daily relative temperature (in temperature percentiles) and the risk of ambulance dispatches for each age group using a distributed lag nonlinear model and estimated the city-specific relative risks of ambulance dispatches at the 95/99 percentile temperature compared with the 77.6 percentile temperature defined as the reference temperature (Tref). Then, the estimates were combined by performing meta-analyses for each age group. We also applied meta-regression models to explore whether the city-specific characteristics modified the association of temperature with ambulance dispatches. RESULTS: The relative risks of the 95th percentile with respect to Tref were 1.14 (95% confidence interval (CI): 1.12, 1.16), 1.16 (95% CI: 1.13, 1.20), 1.13 (95% CI: 1.10, 1.16), and 1.13 (95% CI: 1.00, 1.16), for all-age (≥20) and age-stratified groups (20-59, 60-79, and ≥80 years), respectively. We observed a higher relative risk for the ≥20 years age group in the cities with higher proportions of single-elderly, single-mother, and single-father households. We also found that the relative risk for the 20-59 years age group was higher in the cities with a higher proportion of blue-collar workers. CONCLUSIONS: The present study provides insights into city-specific characteristics modifying heat-related health effects.


Assuntos
Ambulâncias/estatística & dados numéricos , Saúde da População Urbana , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Mudança Climática , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Risco , Adulto Jovem
10.
Global Health ; 15(1): 87, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31856877

RESUMO

BACKGROUND: Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and well-being are explicitly addressed in SDG 3, health is also present as a pre condition of SDG 11, that aims at inclusive, safe, resilient and sustainable cities. Health in All Policies (HiAP) is an approach to public policy across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP is key for local decision-making processes in the context of urban policies to promote public health interventions aimed at achieving SDG targets. HiAPs relies heavily on the use of scientific evidence and evaluation tools, such as health impact assessments (HIAs). HIAs may include city-level quantitative burden of disease, health economic assessments, and citizen and other stakeholders' involvement to inform the integration of health recommendations in urban policies. The Barcelona Institute for Global Health (ISGlobal)'s Urban Planning, Environment and Health Initiative provides an example of a successful model of translating scientific evidence into policy and practice with regards to sustainable and healthy urban development. The experiences collected through ISGlobal's participation implementing HIAs in several cities worldwide as a way to promote HiAP are the basis for this analysis. AIM: The aim of this article is threefold: to understand the links between social determinants of health, environmental exposures, behaviour, health outcomes and urban policies within the SDGs, following a HiAP rationale; to review and analyze the key elements of a HiAP approach as an accelerator of the SDGs in the context of urban and transport planning; and to describe lessons learnt from practical implementation of HIAs in cities across Europe, Africa and Latin-America. METHODS: We create a comprehensive, urban health related SDGs conceptual framework, by linking already described urban health dimensions to existing SDGs, targets and indicators. We discuss, taking into account the necessary conditions and steps to conduct HiAP, the main barriers and opportunities within the SDGs framework. We conclude by reviewing HIAs in a number of cities worldwide (based on the experiences collected by co-authors of this publication), including city-level quantitative burden of disease and health economic assessments, as practical tools to inform the integration of health recommendations in urban policies. RESULTS: A conceptual framework linking SDGs and urban and transportplanning, environmental exposures, behaviour and health outcomes, following a HiAP rationale, is designed. We found at least 38 SDG targets relevant to urban health, corresponding to 15 SDGs, while 4 important aspects contained in our proposed framework were not present in the SDGs (physical activity, noise, quality of life or social capital). Thus, a more comprehensive HiAP vision within the SDGs could be beneficial. Our analysis confirmed that the SDGs framework provides an opportunity to formulate and implement policies with a HiAP approach. Three important aspects are highlighted: 1) the importance of the intersectoral work and health equity as a cross-cutting issue in sustainable development endeavors; 2) policy coherence, health governance, and stakeholders' participation as key issues; and 3) the need for high quality data. HIAs are a practical tool to implement HiAP. Opportunities and barriers related to the political, legal and health governance context, the capacity to inform policies in other sectors, the involvement of different stakeholders, and the availability of quality data are discussed based on our experience. Quantitative assessments can provide powerful data such as: estimates of annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity, exposure to air pollution, noise, heat, and access to green spaces; the associated economic impacts in health care costs per year; and the number of preventable premature deaths when improvements in urban and transport planning are implemented. This information has been used to support the design of policies that promote cycling, walking, public, zero and low-emitting modes of transport, and the provision of urban greening or healthy public open spaces in Barcelona (e.g. Urban Mobility, Green Infrastructure and Biodiversity Plans, or the Superblocks's model), the Bus Rapid Transit and Open Streets initiatives in several Latin American cities or targeted SDGs assessments in Morocco. CONCLUSIONS: By applying tools such as HIA, HiAP can be implemented to inform and improve transport and urban planning to achieve the 2030 SDG Agenda. Such a framework could be potentially used in cities worldwide, including those of less developed regions or countries. Data availability, taking into account equity issues, strenghtening the communication between experts, decision makers and citizens, and the involvement of all major stakeholders are crucial elements for the HiAP approach to translate knowledge into SDG implementation.


Assuntos
Política Pública , Desenvolvimento Sustentável , Saúde da População Urbana , Saúde Global , Equidade em Saúde , Avaliação do Impacto na Saúde , Humanos
11.
BMC Infect Dis ; 19(1): 1066, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856747

RESUMO

BACKGROUND: Symptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infections, there have been few rigorous interventions studies to assess this, and no studies in low income urban settings where risks are plausibly very high. The aim of this study is to evaluate the impact of a novel infant food hygiene intervention on infant enteric infections and diarrhoea in peri-urban settlements of Kisumu, Kenya. METHODS: This is a cluster randomized control trial with 50 clusters, representing the catchment areas of Community Health Volunteers (CHVs), randomly assigned to intervention or control, and a total of 750 infants recruited on a rolling basis at 22 weeks of age and then followed for 15 weeks. The intervention targeted four key caregiver behaviours related to food hygiene: 1) hand washing with soap before infant food preparation and feeding; 2) bringing all infant food to the boil before feeding, including when reheating or reserving; 3) storing all infant food in sealed containers; and, 4) using only specific utensils for infant feeding which are kept separate and clean. RESULTS: The primary outcome of interest is the prevalence of one or more of 23 pre-specified enteric infections, determined using quantitative real-time polymerase chain reaction for enteric pathogen gene targets. In addition, infant food samples were collected at 33 weeks, and faecal indicator bacteria (Enterococcus) isolated and enumerated to assess the impact of the intervention on infant food contamination. CONCLUSION: To our knowledge this is the first randomized controlled trial to assess the effect of an infant food hygiene intervention on enteric infections in a high burden, low income urban setting. Our trial responds to growing evidence that food may be a key pathway for early childhood enteric infection and disease and that basic food hygiene behaviours may be able to mitigate these risks. The Safe Start trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the local health extension system can improve the health of young children. TRIAL REGISTRATION: The trial was registered at clinicaltrial.gov on March 16th 2018 before enrolment of any participants (https://clinicaltrials.gov/ct2/show/NCT03468114).


Assuntos
Diarreia/epidemiologia , Diarreia/microbiologia , Enterite/epidemiologia , Enterite/microbiologia , Desinfecção das Mãos/métodos , Pobreza , Cuidadores , Culinária , Diarreia/prevenção & controle , Enterite/prevenção & controle , Enterococcus/isolamento & purificação , Fezes/microbiologia , Feminino , Contaminação de Alimentos/prevenção & controle , Armazenamento de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/prevenção & controle , Humanos , Lactente , Controle de Infecções , Quênia/epidemiologia , Masculino , Saúde Pública , Sabões , Saúde da População Urbana
12.
Sleep Health ; 5(6): 532-538, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31708438

RESUMO

BACKGROUND: Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health. OBJECTIVES: The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample. METHODS: Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9 years, with (n = 216) and without asthma (n = 130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire. RESULTS: Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLW = -22.10, SE = 5.02; mean difference AA vs NLW = -18.69, SE = 5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes. CONCLUSION: Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.


Assuntos
Afro-Americanos/estatística & dados numéricos , Asma/etnologia , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Sono , Saúde da População Urbana/etnologia , Cuidadores , Criança , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , New England , Higiene do Sono , Inquéritos e Questionários , Fatores de Tempo
14.
BMC Public Health ; 19(1): 1561, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31771549

RESUMO

BACKGROUND: Childhood obesity is a growing public health concern in many low-income urban settings; but its determinants are not clear. The purpose of this study is to assess the prevalence of childhood obesity and associated factors among in-school children aged 5-16 years in a Metropolitan district of Ghana. METHODS: A cross-sectional quantitative survey was conducted among a sample of 285 in-school children aged 5-16 years. Pre-tested questionnaires and anthropometric data collection methods were used to collect data. Descriptive, bivariate, binary and multivariate logistic regression statistical techniques were used to analyse data. RESULTS: Some 46.9% (42.2% for males and 51.7% for females) of the children were overweight. Of this, 21.2% were obese (BMI falls above 95th percentile). Childhood obesity was higher in private school (26.8%) than public school (21.4%), and among girls (27.2%) than boys (19%). Factors that increased obesity risks included being aged 11-16 as against 5-10 years (aOR = 6.07; 95%CI = 1.17-31.45; p = 0.025), having a father whose highest education is 'secondary' (aOR =2.97; 95% CI = 1.09-8.08; p = 0.032), or 'tertiary' (aOR = 3.46; 95% CI = 1.27-9.42; p = 0.015), and consumption of fizzy drinks most days of the week (aOR = 2.84; 95% CI = 1.24-6.52; p = 0.014). Factors that lowered obesity risks included engaging in sport at least 3times per week (aOR = 0.56; 95% CI = 0.33-0.96; p = 0.034), and sleeping for more than 8 h per day (aOR = 0.38; 95% CI = 0.19-0.79; p = 0.009). CONCLUSION: Higher parental (father) educational attainment and frequent consumption of fizzy drinks per week may increase obesity risks among in-school children aged 5-16 years in the Metropolitan district of Ghana. However, regular exercise (playing sport at least 3 times per week) and having 8 or more hours of sleep per day could lower obesity risks in the same population. Age and sex-appropriate community and school-based interventions are needed to promote healthy diet selection and consumption, physical activity and healthy life styles among in-school children.


Assuntos
Obesidade Pediátrica/epidemiologia , Saúde da População Urbana/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Masculino , Fatores de Risco , Inquéritos e Questionários
15.
Environ Health Prev Med ; 24(1): 65, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775610

RESUMO

BACKGROUND: Little is known regarding the effect of exposure to biomass fuel smoke inhalation on respiratory symptoms in the Bangladeshi population which is a major health hazard in most of the developing countries. This study aims to explore the association between respiratory symptoms and biomass fuel smoke exposure among children under 5 years of age. METHODS: Data were extracted from the Bangladesh Urban Health Survey conducted in 2013. A total of 10,575 mothers with at least one surviving children were selected. Respiratory symptoms among children under 5 years of age were considered as the primary outcome. Sequential multiple logistic regression models were used to observe the association between respiratory symptoms and biomass fuel smoke exposure adjusting the effect of residential factors and mother and child characteristics. RESULTS: Around 40% of the mothers exclusively used biomass fuel irrespective of the kitchen location and 54% of them were habituated in indoor cooking. The prevalence of respiratory symptoms of under-five children among in-house and outdoor biomass fuel users was 23.0% and 21.9%, respectively. Results of fitted multiple logistic regression models showed that the odds of having respiratory symptoms among children under 5 years of age were increased due to in-house biomass fuel use [OR = 1.18; 95% CI, 1.04-1.36] compared with the non-biomass user. An increased risk of respiratory symptoms was also significantly associated with mother's birth complication [OR = 1.51; 95% CI, 1.36-1.67], non-government organization (NGO) membership of mothers [OR = 1.32; 95% CI, 1.16-1.51], age of the child (6-23m) [OR = 1.29; 95% CI, 1.10-1.52], and nutritional status (stunting) [OR = 1.18; 95% CI, 1.06-1.31]. CONCLUSION: This study found the use of in-house biomass fuel as a significant risk factor associated with respiratory symptoms of children under 5 years of age. More longitudinal studies should be designed to establish a causal relationship between HAP (household air pollution) and respiratory symptoms among children with more direct measures of HAP and clinical procedure.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição por Inalação/efeitos adversos , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/etiologia , Fumaça/efeitos adversos , Poluição do Ar em Ambientes Fechados/efeitos adversos , Bangladesh/epidemiologia , Biomassa , Pré-Escolar , Culinária/métodos , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Mães , Prevalência , Fatores de Risco , Saúde da População Urbana
16.
Environ Sci Pollut Res Int ; 26(36): 36226-36235, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31713138

RESUMO

The residential areas are located around one of the oldest and largest non-nuclear industrial cities in Saudi Arabia, Arabian Gulf. Therefore, it is important to study the radioactivity levels in the urban soil in order to estimate the potential risk of radiation in environment and for public. The activity concentrations of 226Ra, 232Th, 40K, and 137Cs in urban soil around non-nuclear industries were measured using gamma ray spectrometric technique. The mean values of activity concentrations were found to be 7.64 ± 0.4, 3.76 ± 0.2, 174 ± 3.7, and 0.391 ± 0.03 (Bq/kg) for 226Ra, 232Th, 40K, and 137Cs, respectively. Radium equivalent activity (Raeq), gamma absorbed dose rate in air (D), and annual effective dose equivalent (E) for outdoor were calculated. The mean values of these radiological parameters were found to be less than the allowed limits in soil. The obtained results were compared with other studies from Arabian Gulf and other regions of the world. Consequently, the direct gamma radiation exposure from the urban soil in the study area was found to be safe for public. Additionally, the present study is the first in this area which could be used as a baseline for radioactivity levels in soil nearby industrial areas of the Arabian Gulf region.


Assuntos
Exposição à Radiação/análise , Monitoramento de Radiação , Radioisótopos/análise , Poluentes Radioativos do Solo/análise , Raios gama , Humanos , Radioatividade , Medição de Risco , Arábia Saudita , Saúde da População Urbana
17.
Rev Esp Salud Publica ; 932019 Nov 15.
Artigo em Espanhol | MEDLINE | ID: mdl-31719517

RESUMO

OBJECTIVE: The increase in traffic accidents depends on multiple factors; it generates an economic and public health problem that must be analyzed jointly by agents involved in road safety. The aim of the work was to quantify the effect of various factors in the cost savings due to traffic accidents on interurban roads in Spain. METHODS: It was analyzed, through a lineal regression with panel data model and in the period 2000-2017, how different factors affected cost savings due to the risk of mortality or injury avoided on Spanish interurban roads. RESULTS: A 1% increase in traffic volume led to a reduction in costs per MVKT (million vehiclekilometres travelled) of €162.46 referring to the risk of mortality, €115.32 for serious injuries and €10.10 for mild injuries. This increase in unemployment caused a cost reduction of €31.43, €10.76 and €0.98, respectively. The same increase in the investment in replacement implied a reduction of these costs of €11 for any risk. A 1% increase in the ageing index led to an increase in costs of €276.83 in terms of mortality risk and €257.49 in terms of injury. Foreign tourism generated a cost of more than €40 for any risk. A 1% increase in GDP per capita led to an increase in costs of €155.50, €138.09 and €8.21 for defined risks. The points driving license led to an increase in costs of €785.50 per MVKR when referring to mortality risks. CONCLUSIONS: Determining factors for cost savings: motorization rate, unemployment rate and investment in replacement interurban roads. Determining factors that increased costs: expiry of the effect of the penalty - points driving licence, ageing index of the population, increase in GDP or proportion of foreign travelers.


Assuntos
Acidentes de Trânsito/economia , Redução de Custos/estatística & dados numéricos , Saúde da População Urbana/economia , Ferimentos e Lesões/economia , Prevenção de Acidentes/economia , Prevenção de Acidentes/métodos , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo/estatística & dados numéricos , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Fatores de Risco , Espanha/epidemiologia , Saúde da População Urbana/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-31635362

RESUMO

Urban green spaces (UGS) have been linked with a series of benefits for the environment, and for the physical health and well-being of urban residents. This is of great importance in the context of the aging of modern societies. However, UGS have different forms and characteristics that can determine their utilization. Common elements in UGS such as the type of vegetation and the type of surface are surprisingly understudied in regard to their relationship with the type of activity undertaken in UGS. This paper aims to explore the relationship between landscape diversity and the type of surface with the time spent and the physical activity intensity performed by seniors. To do so, this study uses GPS tracking data in combination with accelerometer data gathered from 63 seniors residing in Barcelona, Spain. Results showed that senior participants spent little time inside the analyzed UGS and sedentary behaviors (SBs) were more common than physical activities (PAs). The presence of pavement surfaces positively influenced the total time spent in UGS while gravel surfaces were negatively associated with time spent in active behaviors. The provision of well-defined and maintained paved areas and paths are some key infrastructures to be considered when designing UGS for overall urban residents and, especially, when aiming to potentiate the access for senior visitors.


Assuntos
Ambiente Construído , Exercício , Natureza , Saúde da População Urbana , Idoso , Feminino , Humanos , Masculino , Espanha , Inquéritos e Questionários
19.
Metabolism ; 100S: 153940, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31610855

RESUMO

Most of the world's population now lives in cities. While living in cities have both health risks and benefits, mental health has been usually considered to be negatively affected by urbanicity. While mental health disorders have complex etiology and multiple causes, it has been shown in multiple observational studies that mood and anxiety disorders are more prevalent in urban centers and incidence has been increasing. In addition, the incidence of schizophrenia is strongly increased in people born and raised in cities. Studies on the effects of urbanicity on the brain, however, are more challenging to conduct, since individual and environmental factors are hard to distinguish. The main objective of this article is to review studies on how specific neural processes mediate those associations between urbanicity and psychiatric disorders and how environmental factors affect genetic regulation (epigenetics). Neuroimaging studies have shown how urban stressors might affect the brain by conducting experiments using functional magnetic resonance imaging (fMRI). There have been demonstrations that urban upbringing and city living have dissociable impacts on social evaluative stress processing in humans. City living was associated with increased amygdala activity and the urban upbringing has been shown to affect the perigenual anterior cingulate cortex, a key region for regulation of amygdala activity, negative affect and stress. In addition, studies on epigenetics have shown associations between exposure to features of the environment and methylation patterns. The goal of understanding how urban environments act as a risk factor for mental disorders may be pursued on several levels. It can be approached by measuring the effects of economic factors (unemployment, socioeconomic status), social condition (social network support), environmental exposures (toxins, air pollution, noise, light), that must be weighed to identify how it contributes to mental disorders.


Assuntos
Transtornos Mentais/etiologia , Saúde da População Urbana/tendências , Exposição Ambiental/efeitos adversos , Humanos , Imagem por Ressonância Magnética , Neurociências/métodos , Fatores de Risco , Fatores Socioeconômicos
20.
BMC Public Health ; 19(1): 1358, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651269

RESUMO

BACKGROUND: Rapid urbanization, unmatched by an associated supply of housing, has resulted in overcrowding in the cities of many developing countries, including in Johannesburg, South Africa. Household overcrowding has been associated with a range of ill-health outcomes, including acute respiratory infections and diarrhoeal diseases. The aim of this study was to describe the levels of household crowding, and examine associations with respiratory and gastrointestinal symptoms in selected two low-income neighbourhoods in Johannesburg. METHODS: Questionnaire data from a panel study conducted over an 11-year period between 2006 and 2016 were extracted to conduct the analyses. Structured questionnaires, designed to collect information on housing conditions, socio-economic and health status were administered to adult representatives of households occupying the primary dwelling on pre-selected study sites. RESULTS: Over the 11-year study period, levels of overcrowding remained unchanged. Around 57.6% of dwellings in the study neighbourhoods were determined to be overcrowded in relation to international guidelines. Results from the multiple logistic regression analyses indicated that crowded dwellings were associated with elevated levels of acute respiratory and gastrointestinal symptoms, as well as fever/chills. CONCLUSION: Respondent perceptions varied from objective measures of overcrowding. Crowded dwellings were associated with elevated reports of acute respiratory and gastrointestinal symptoms, as well as fever/chills.


Assuntos
Características da Família , Áreas de Pobreza , Saúde da População Urbana/estatística & dados numéricos , Cidades , Feminino , Humanos , Masculino , África do Sul , Inquéritos e Questionários
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