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Hosking J, Braubach M, Buss D, Khayesi M, Filho VP, de Sá TH. Towards a global framework for transport, health and health equity. Environ Int 2022; 169:107472. [PMID: 36116365 DOI: 10.1016/j.envint.2022.107472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/11/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
This study derives a generalised global framework for transport, health and health equity, based on a synthesis of 94 urban transport and health frameworks. The framework emphasises factors related to health equity, which are generally ignored in existing conceptual frameworks on the relationship between transport and health. While some factors such as travel behaviour were included in most reviewed frameworks, climate change and other macro-level factors were included in less than a quarter of frameworks, and health equity was included in less than 10%. We developed a framework that includes key framework components identified by a scoping review, as well as addressing important gaps. This framework can be utilized to inform work on transport, health and health equity by different agencies such as the World Health Organization. It can be used to guide health sector engagement with transport issues to lead to healthier and more equitable transport decision-making globally.
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Affiliation(s)
- Jamie Hosking
- Waipapa Taumata Rau/The University of Auckland, Private Bag 92019, Tāmaki Makaurau, Auckland 1142, New Zealand
| | - Matthias Braubach
- WHO European Centre for Environment and Health, UN Campus, Platz der Vereinten Nationen 1, 53113 Bonn, Germany
| | - Daniel Buss
- Pan American Health Organization/World Health Organization, 525 23rd Street NW, Washington, DC 20037, United States
| | | | - Victor Pavarino Filho
- NPC Segurança Viária e Mobilidade Sustentável, UT Determinantes da Saúde, Doençs Crônicas não Transmissíves e Saúde Mental, OPAS/OMS |Setor de Embaixadas Norte, Lote 19, CEP 70.800-400 Brasília, DF, Brazil
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2
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Giles-Corti B, Moudon AV, Lowe M, Cerin E, Boeing G, Frumkin H, Salvo D, Foster S, Kleeman A, Bekessy S, de Sá TH, Nieuwenhuijsen M, Higgs C, Hinckson E, Adlakha D, Arundel J, Liu S, Oyeyemi AL, Nitvimol K, Sallis JF. What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy. Lancet Glob Health 2022; 10:e919-e926. [PMID: 35561726 DOI: 10.1016/s2214-109x(22)00066-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/16/2021] [Accepted: 02/04/2022] [Indexed: 01/13/2023]
Abstract
This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities.
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Affiliation(s)
- Billie Giles-Corti
- Healthy Liveable Cities Lab, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia; Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Anne Vernez Moudon
- Department of Urban Design and Planning, Urban Form Lab, University of Washington, Seattle, WA, USA
| | - Melanie Lowe
- Melbourne Centre for Cities, University of Melbourne, Melbourne, VIC, Australia
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Geoff Boeing
- Department of Urban Planning and Spatial Analysis, Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Howard Frumkin
- Center for Health and the Global Environment, University of Washington School of Public Health, Seattle, WA, USA
| | - Deborah Salvo
- Prevention Research Center, Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Sarah Foster
- Healthy Liveable Cities Lab, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia; School of Agriculture and Environment, The University of Western Australia, Perth, WA, Australia
| | - Alexandra Kleeman
- Healthy Liveable Cities Lab, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia
| | - Sarah Bekessy
- ICON Science, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia
| | - Thiago Hérick de Sá
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Mark Nieuwenhuijsen
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Barcelona Institute for Global Health, Barcelona, Spain; Air Pollution and Urban Environment Programme, Pompeu Fabra University, Barcelona, Spain; Epidemiology and Public Health Network, CIBERSP, Madrid, Spain
| | - Carl Higgs
- Healthy Liveable Cities Lab, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia
| | - Erica Hinckson
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Deepti Adlakha
- Department of Landscape Architecture and Environmental Planning, Natural Learning Initiative, College of Design, North Carolina State University, Raleigh, NC, USA
| | - Jonathan Arundel
- Healthy Liveable Cities Lab, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia
| | - Shiqin Liu
- School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA
| | - Adewale L Oyeyemi
- Department of Physiotherapy, University of Maiduguri, Maiduguri, Nigeria
| | - Kornsupha Nitvimol
- Office of the Permanent Secretary for the Bangkok Metropolitan Administration, Bangkok, Thailand
| | - James F Sallis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
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Marcus G, Siri J, Gatzweiler F, Dora C, Aerts J, Nandudu S, Claeson A, Carbajal P, Roebbel N, Petrella L, de Sá TH. Supporting a Healthy Planet, Healthy People and Health Equity through Urban and Territorial Planning. Plan Pract Res 2022; 37:111-130. [PMID: 35153364 PMCID: PMC8827622 DOI: 10.1080/02697459.2021.2000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The form of human settlements impacts on planetary health, population health and health equity. Yet goals for urban and territorial planning are only tangentially linked to public health outcomes. The WHO and UN-Habitat support actions to bring health to the fore in planning and design of human settlements, recently publishing 'Integrating Health in Urban and Territorial Planning: a sourcebook' focusing on 'why' action is needed, 'how' to initiate it; and curating several existing resources on 'what' to do. Recommendations for research, policy and practice include calls for rapid development of closer relationships between public health and spatial planning.
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Affiliation(s)
| | | | - Franz Gatzweiler
- Urban Health and Wellbeing Programme, International Science Council (ISC), China
| | - Carlos Dora
- International Society of Urban Health (ISUH), USA
| | - Jens Aerts
- International Society of City and Regional Planners (Isocarp, The Hague, The Netherlands
| | - Sarah Nandudu
- Slum Dwellers International, Cape Town, South Africa
| | - Alice Claeson
- Department of Emergency Medicine , Vrinnevi Hospital, Norrköping, Sweden
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Jackson C, Johnson R, de Nazelle A, Goel R, de Sá TH, Tainio M, Woodcock J. A guide to value of information methods for prioritising research in health impact modelling. Epidemiol Methods 2021; 10:20210012. [PMID: 35127249 PMCID: PMC7612319 DOI: 10.1515/em-2021-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health impact simulation models are used to predict how a proposed policy or scenario will affect population health outcomes. These models represent the typically-complex systems that describe how the scenarios affect exposures to risk factors for disease or injury (e.g. air pollution or physical inactivity), and how these risk factors are related to measures of population health (e.g. expected survival). These models are informed by multiple sources of data, and are subject to multiple sources of uncertainty. We want to describe which sources of uncertainty contribute most to uncertainty about the estimate or decision arising from the model. Furthermore, we want to decide where further research should be focused to obtain further data to reduce this uncertainty, and what form that research might take. This article presents a tutorial in the use of Value of Information methods for uncertainty analysis and research prioritisation in health impact simulation models. These methods are based on Bayesian decision-theoretic principles, and quantify the expected benefits from further information of different kinds. The expected value of partial perfect information about a parameter measures sensitivity of a decision or estimate to uncertainty about that parameter. The expected value of sample information represents the expected benefit from a specific proposed study to get better information about the parameter. The methods are applicable both to situationswhere the model is used to make a decision between alternative policies, and situations where the model is simply used to estimate a quantity (such as expected gains in survival under a scenario). This paper explains how to calculate and interpret the expected value of information in the context of a simple model describing the health impacts of air pollution from motorised transport. We provide a general-purpose R package and full code to reproduce the example analyses.
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Affiliation(s)
| | - Robert Johnson
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK; and Imperial College London, London, UK
| | | | - Rahul Goel
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thiago Hérick de Sá
- World Health Organization, Geneva, Switzerland; and Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo
| | - Marko Tainio
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; and Finnish Environment Institute, Helsinki, Finland
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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de Rezende LFM, Rey-López JP, de Sá TH, Chartres N, Fabbri A, Powell L, Stamatakis E, Bero L. Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality. PLoS Biol 2018; 16:e2005761. [PMID: 29912869 PMCID: PMC6023226 DOI: 10.1371/journal.pbio.2005761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/28/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022] Open
Abstract
Reporting bias in the literature occurs when there is selective revealing or suppression of results, influenced by the direction of findings. We assessed the risk of reporting bias in the epidemiological literature on health-related behavior (tobacco, alcohol, diet, physical activity, and sedentary behavior) and cardiovascular disease mortality and all-cause mortality and provided a comparative assessment of reporting bias between health-related behavior and statin (in primary prevention) meta-analyses. We searched Medline, Embase, Cochrane Methodology Register Database, and Web of Science for systematic reviews synthesizing the associations of health-related behavior and statins with cardiovascular disease mortality and all-cause mortality published between 2010 and 2016. Risk of bias in systematic reviews was assessed using the ROBIS tool. Reporting bias in the literature was evaluated via small-study effect and excess significance tests. We included 49 systematic reviews in our study. The majority of these reviews exhibited a high overall risk of bias, with a higher extent in health-related behavior reviews, relative to statins. We reperformed 111 meta-analyses conducted across these reviews, of which 65% had statistically significant results (P < 0.05). Around 22% of health-related behavior meta-analyses showed small-study effect, as compared to none of statin meta-analyses. Physical activity and the smoking research areas had more than 40% of meta-analyses with small-study effect. We found evidence of excess significance in 26% of health-related behavior meta-analyses, as compared to none of statin meta-analyses. Half of the meta-analyses from physical activity, 26% from diet, 18% from sedentary behavior, 14% for smoking, and 12% from alcohol showed evidence of excess significance bias. These biases may be distorting the body of evidence available by providing inaccurate estimates of preventive effects on cardiovascular and all-cause mortality.
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Affiliation(s)
| | - Juan Pablo Rey-López
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, Australia
| | - Thiago Hérick de Sá
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, São Paulo, Brasil
| | - Nicholas Chartres
- Charles Perkins Centre, Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Alice Fabbri
- Charles Perkins Centre, Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Powell
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, Australia
| | - Emmanuel Stamatakis
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, Epidemiology Unit, The University of Sydney, Sydney, Australia
| | - Lisa Bero
- Charles Perkins Centre, Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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de Sá TH, Reis-Santos B, Rodrigues LC. Zika outbreak, mega-events, and urban reform. Lancet Glob Health 2018; 4:e603. [PMID: 27539802 DOI: 10.1016/s2214-109x(16)30174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Thiago Hérick de Sá
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Bárbara Reis-Santos
- LabEpi Laboratory of Epidemiology, University of Espírito Santo, Vitória 29040-091, Brazil.
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Patterson R, McNamara E, Tainio M, de Sá TH, Smith AD, Sharp SJ, Edwards P, Woodcock J, Brage S, Wijndaele K. Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol 2018; 33:811-829. [PMID: 29589226 PMCID: PMC6133005 DOI: 10.1007/s10654-018-0380-1] [Citation(s) in RCA: 649] [Impact Index Per Article: 108.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/12/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To estimate the strength and shape of the dose-response relationship between sedentary behaviour and all-cause, cardiovascular disease (CVD) and cancer mortality, and incident type 2 diabetes (T2D), adjusted for physical activity (PA). Data Sources: Pubmed, Web of Knowledge, Medline, Embase, Cochrane Library and Google Scholar (through September-2016); reference lists. Study Selection: Prospective studies reporting associations between total daily sedentary time or TV viewing time, and ≥ one outcome of interest. Data Extraction: Two independent reviewers extracted data, study quality was assessed; corresponding authors were approached where needed. Data Synthesis: Thirty-four studies (1,331,468 unique participants; good study quality) covering 8 exposure-outcome combinations were included. For total sedentary behaviour, the PA-adjusted relationship was non-linear for all-cause mortality (RR per 1 h/day: were 1.01 (1.00-1.01) ≤ 8 h/day; 1.04 (1.03-1.05) > 8 h/day of exposure), and for CVD mortality (1.01 (0.99-1.02) ≤ 6 h/day; 1.04 (1.03-1.04) > 6 h/day). The association was linear (1.01 (1.00-1.01)) with T2D and non-significant with cancer mortality. Stronger PA-adjusted associations were found for TV viewing (h/day); non-linear for all-cause mortality (1.03 (1.01-1.04) ≤ 3.5 h/day; 1.06 (1.05-1.08) > 3.5 h/day) and for CVD mortality (1.02 (0.99-1.04) ≤ 4 h/day; 1.08 (1.05-1.12) > 4 h/day). Associations with cancer mortality (1.03 (1.02-1.04)) and T2D were linear (1.09 (1.07-1.12)). CONCLUSIONS Independent of PA, total sitting and TV viewing time are associated with greater risk for several major chronic disease outcomes. For all-cause and CVD mortality, a threshold of 6-8 h/day of total sitting and 3-4 h/day of TV viewing was identified, above which the risk is increased.
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Affiliation(s)
- Richard Patterson
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, W6 8RP, UK.
| | - Eoin McNamara
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Marko Tainio
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Thiago Hérick de Sá
- Centre for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Andrea D Smith
- Research Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Phil Edwards
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - James Woodcock
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Søren Brage
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
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Rezende LFMD, Sá THD, Markozannes G, Rey-López JP, Lee IM, Tsilidis KK, Ioannidis JPA, Eluf-Neto J. Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases. Br J Sports Med 2017; 52:826-833. [PMID: 29146752 DOI: 10.1136/bjsports-2017-098391] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide an overview of the breadth and validity of claimed associations between physical activity and risk of developing or dying from cancer. DESIGN Umbrella review. DATA SOURCES We searched Medline, Embase, Cochrane Database and Web of Science. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews about physical activity and cancer incidence and cancer mortality in different body sites among general population. RESULTS We included 19 reviews covering 22 cancer sites, 26 exposure-outcome pairs meta-analyses and 541 original studies. Physical activity was associated with lower risk of seven cancer sites (colon, breast, endometrial, lung, oesophageal, pancreas and meningioma). Only colon (a protective association with recreational physical activity) and breast cancer (a protective association with overall physical activity) were supported by strong evidence and highly suggestive evidence, respectively. Evidence from endometrial, lung, oesophageal, pancreas and meningioma presented hints of uncertainty and bias in the literature (eg, not reaching P values<10-6) showing large between-study heterogeneity and/or not demonstrating a definite direction for the effect when 95% prediction intervals were considered. Four of the 26 meta-analyses showed small study effects and 4 showed excess significance. CONCLUSION Physical activity is associated with a lower risk of several cancers, but only colon and breast cancer associations were supported by strong or highly suggestive evidence, respectively. Evidence from other cancer sites was less consistent, presenting hints of uncertainty and/or bias.
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Affiliation(s)
| | - Thiago Hérick de Sá
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, Brazil
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Juan Pablo Rey-López
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - I-Min Lee
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, London, UK
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA
| | - José Eluf-Neto
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Sá THD, Tainio M, Goodman A, Edwards P, Haines A, Gouveia N, Monteiro C, Woodcock J. Health impact modelling of different travel patterns on physical activity, air pollution and road injuries for São Paulo, Brazil. Environ Int 2017; 108:22-31. [PMID: 28780491 PMCID: PMC5632958 DOI: 10.1016/j.envint.2017.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/18/2017] [Accepted: 07/13/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND São Paulo city, Brazil, faces challenges caused by rapid urbanization. We illustrate how future travel patterns could lead to different health consequences in the city. METHODS We evaluated the health impacts of different travel pattern scenarios for the São Paulo adult population by comparing the travel patterns of São Paulo in 2012 with counterfactual scenarios in which the city adopted travel patterns of i) those living in the city's expanded centre; ii) London (2012); iii) a highly motorized São Paulo (SP California); and iv) a visionary São Paulo (SP 2040), with high levels of walking and cycling and low levels of car and motorcycle use. For each scenario we estimated changes in exposure to air pollution, road injury risk, and physical activity. Health outcomes were estimated using disability adjusted life years (DALYs) and premature deaths averted. Sensitivity analyses were performed to identify the main sources of uncertainty. RESULTS We found considerable health gains in the SP 2040 scenario (total 63.6k DALYs avoided), with 4.7% of premature deaths from ischemic heart disease avoided from increases in physical activity alone. Conversely, we found substantial health losses in the scenario favouring private transport (SP California, total increase of 54.9k DALYs), with an increase in road traffic deaths and injuries among pedestrians and motorized vehicles. Parameters related to air pollution had the largest impact on uncertainty. CONCLUSIONS Shifting travel patterns towards more sustainable transport can provide major health benefits in São Paulo. Reducing the uncertainties in the findings should be a priority for empirical and modelling research on the health impacts of such shifts.
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Affiliation(s)
- Thiago Hérick de Sá
- Centre for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, SP, Brazil.
| | - Marko Tainio
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Anna Goodman
- London School of Hygiene and Tropical Medicine, London, UK
| | - Phil Edwards
- London School of Hygiene and Tropical Medicine, London, UK
| | - Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nelson Gouveia
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carlos Monteiro
- Centre for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, SP, Brazil
| | - James Woodcock
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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de Sá TH, de Rezende LFM, Borges MC, Nakamura PM, Anapolsky S, Parra D, Adami F, Monteiro CA. Prevalence of active transportation among adults in Latin America and the Caribbean: a systematic review of population-based studies. Rev Panam Salud Publica 2017; 41:e35. [PMID: 31363356 PMCID: PMC6614750 DOI: 10.26633/rpsp.2017.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 06/02/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the prevalence of "active" (self-propelled, human-powered) transportation in the Latin America and Caribbean (LAC) region over the past decade. METHODS MEDLINE, Excerpta Medica (Embase), SportDiscus, Lilacs, MediCarib, Web of Science, OVID, CINAHL, Scopus, Google Scholar, National Transportation Library, and TRIS/TRID were searched for articles on active transportation published between January 2003 and December 2014 with (at least) a title and abstract in English, Portuguese, or Spanish. Research was included in the study if the two reviewing authors agreed it 1) was conducted in an adult sample (≥ 18 years old), 2) was designed to be representative of any LAC area, and 3) reported at least one measure of active transportation. Reference lists of included papers and retrieved reviews were also checked. A total of 129 key informants (87 scientific experts and 42 government authorities) were contacted to identify additional candidate publications. Two other authors extracted the data independently. RESULTS A total of 10 459 unique records were found; the full texts of 143 were reviewed; and a total of 45 studies were included in the study, yielding estimates for 72 LAC settings, most of which were in Argentina, Brazil, and Colombia. No eligible studies were found for the years 2003-2004, resulting in a 10-year study time frame. Estimates were available for walking, cycling, or the combination of both, with a high degree of heterogeneity (heterogeneity index (I2) ≥ 99%). The median prevalence of active transportation (combining walking and cycling) was 12.0%, ranging from 5.1% (in Palmas, Brazil) to 58.9% (in Rio Claro, Brazil). Men cycled more than women in all regions for which information was available. The opposite was true for walking. CONCLUSIONS Prevalence of active transportation in LAC varied widely, with great heterogeneity and uneven distribution of studies across countries, indicating the need for efforts to build comprehensive surveillance systems with standardized, timely, and detailed estimates of active transportation in order to support policy planning and evaluation.
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Affiliation(s)
- Thiago Hérick de Sá
- Department of Nutrition, School of Public HealthUniversidade de São PauloSão PauloBrazilDepartment of Nutrition, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Leandro Fórnias Machado de Rezende
- Department of Preventive Medicine, School of MedicineUniversidade de São PauloSão PauloBrazilDepartment of Preventive Medicine, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Maria Carolina Borges
- Postgraduate program in EpidemiologyUniversidade Federal de PelotasPelotas, RSBrazilPostgraduate program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| | - Priscila Missaki Nakamura
- Postgraduate program in Motor ScienceUniversidade Estadual Paulista Júlio de Mesquita Filho Rio ClarSPBrazilPostgraduate program in Motor Science, Universidade Estadual Paulista Júlio de Mesquita Filho Rio Claro, SP, Brazil.
| | - Sebastian Anapolsky
- Independent ConsultantIndependent ConsultantBuenos Aires, BAArgentinaIndependent Consultant, Buenos Aires, BA, Argentina.
| | - Diana Parra
- Program in Physical Therapy, School of MedicineProgram in Physical Therapy, School of MedicineSt. LouisUnited States of AmericaProgram in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, United States of America.
| | - Fernando Adami
- Laboratório de Epidemiologia e Análise de DadosFaculdade de Medicina do ABCSanto André, SPBrazilLaboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, SP, Brazil.
| | - Carlos Augusto Monteiro
- Department of Nutrition, School of Public HealthUniversidade de São PauloSão PauloBrazilDepartment of Nutrition, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil.
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11
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Silva KS, Garcia LMT, Rabacow FM, de Rezende LFM, de Sá TH. Physical activity as part of daily living: Moving beyond quantitative recommendations. Prev Med 2017; 96:160-162. [PMID: 27840115 DOI: 10.1016/j.ypmed.2016.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/08/2016] [Accepted: 11/06/2016] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to discuss a paradigm shift towards a broader understanding of physical activity (PA) as part of daily living and, therefore, a different approach for PA guidelines, research, and promotion. To this aim, we centered the discussion in two topics: 1) PA: from a restricted view to a broader phenomenon; and 2) Recommendations for PA: moving beyond minutes and dose-response. A holistic understanding of PA and its relationship with health is not possible unless it is considered values, meanings, and symbols that impregnate the human behavior linked to the modes of living of a given people. If we do believe that PA is a behavior essential to human life, we must align our actions to our speech. However, current guidelines, as well as in most policies and programs of PA is largely portrayed as a way to attain longer life expectancy and less diseases, which runs against our consolidated understanding of PA as part of our everyday life. New guidelines could focus on how, when, why, where, and with whom we include PA in our daily lives, based on a day-long approach, instead of how much we should do in order to prevent non-communicable diseases.
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Affiliation(s)
- Kelly Samara Silva
- Federal University of Santa Catarina Sports Center, Campus Universitário Reitor João David Ferreira Lima, Florianópolis, SC 88040-900, Brazil.
| | | | - Fabiana Maluf Rabacow
- Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, São Paulo, SP 01246-903, Brazil
| | | | - Thiago Hérick de Sá
- University of São Paulo, School of Public Health, Av. Dr. Arnaldo, 715, São Paulo, SP 01246-904, Brazil
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12
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Sá THD, Pereira RHM, Duran AC, Monteiro CA. Socioeconomic and regional differences in active transportation in Brazil. Rev Saude Publica 2017; 50:S0034-89102016000100222. [PMID: 27355465 PMCID: PMC4917336 DOI: 10.1590/s1518-8787.2016050006126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 02/15/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To present national estimates regarding walking or cycling for commuting in Brazil and in 10 metropolitan regions. METHODS By using data from the Health section of 2008’s Pesquisa Nacional por Amostra de Domicílio (Brazil’s National Household Sample Survey), we estimated how often employed people walk or cycle to work, disaggregating our results by sex, age range, education level, household monthly income per capita, urban or rural address, metropolitan regions, and macro-regions in Brazil. Furthermore, we estimated the distribution of this same frequency according to quintiles of household monthly income per capita in each metropolitan region of the country. RESULTS A third of the employed men and women walk or cycle from home to work in Brazil. For both sexes, this share decreases as income and education levels rise, and it is higher among younger individuals, especially among those living in rural areas and in the Northeast region of the country. Depending on the metropolitan region, the practice of active transportation is two to five times more frequent among low-income individuals than among high-income individuals. CONCLUSIONS Walking or cycling to work in Brazil is most frequent among low-income individuals and the ones living in less economically developed areas. Active transportation evaluation in Brazil provides important information for public health and urban mobility policy-making
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Affiliation(s)
- Thiago Hérick de Sá
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Rafael Henrique Moraes Pereira
- Instituto de Pesquisa Econômica Aplicada. Brasília, DF, Brasil.,Transport Studies Unit. University of Oxford. Oxford, OX, UK
| | | | - Carlos Augusto Monteiro
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
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Abstract
Christopher Millett and colleagues argue that artificially sweetened beverages should not be promoted as part of a healthy diet.
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Affiliation(s)
- Maria Carolina Borges
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Maria Laura Louzada
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Thiago Hérick de Sá
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Diana C. Parra
- Washington University in St. Louis School of Medicine, Program in Physical Therapy, St. Louis, Missouri, United States of America
| | - Josefa Maria Fellegger Garzillo
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- PhD Program on Global Health and Sustainability, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Carlos Augusto Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Christopher Millett
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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14
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Stevenson M, Thompson J, de Sá TH, Ewing R, Mohan D, McClure R, Roberts I, Tiwari G, Giles-Corti B, Sun X, Wallace M, Woodcock J. Land use, transport, and population health: estimating the health benefits of compact cities. Lancet 2016; 388:2925-2935. [PMID: 27671671 PMCID: PMC5349496 DOI: 10.1016/s0140-6736(16)30067-8] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Using a health impact assessment framework, we estimated the population health effects arising from alternative land-use and transport policy initiatives in six cities. Land-use changes were modelled to reflect a compact city in which land-use density and diversity were increased and distances to public transport were reduced to produce low motorised mobility, namely a modal shift from private motor vehicles to walking, cycling, and public transport. The modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420-826 disability-adjusted life-years (DALYs) per 100 000 population. However, for moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population). The findings suggest that government policies need to actively pursue land-use elements-particularly a focus towards compact cities-that support a modal shift away from private motor vehicles towards walking, cycling, and low-emission public transport. At the same time, these policies need to ensure the provision of safe walking and cycling infrastructure. The findings highlight the opportunities for policy makers to positively influence the overall health of city populations.
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Affiliation(s)
- Mark Stevenson
- University of Melbourne, Melbourne, VIC, Australia; Monash University, Clayton, VIC, Australia.
| | - Jason Thompson
- University of Melbourne, Melbourne, VIC, Australia; Monash University, Clayton, VIC, Australia
| | | | - Reid Ewing
- University of Utah, Salt Lake City, UT, USA
| | | | - Rod McClure
- Harvard School of Public Health, Boston, MA, USA; Monash University, Clayton, VIC, Australia
| | - Ian Roberts
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Xiaoduan Sun
- Beijing University of Technology, Beijing, China
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Cubero DIG, Fumis RRL, de Sá TH, Dettino A, Costa FO, Van Eyll BMRHA, Beato C, Peria FM, Mota A, Altino J, Azevedo SJ, da Rocha Filho DR, Moura M, Lessa ÁER, Del Giglio A. "Burnout in Medical Oncology Fellows: a Prospective Multicenter Cohort Study in Brazilian Institutions". J Cancer Educ 2016; 31:582-587. [PMID: 25952940 DOI: 10.1007/s13187-015-0850-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Burnout syndrome is a common occurrence among oncologists. Doctors enrolled in residency programs in clinical oncology are exposed to similar risk factors; however, few data are available in this population. This study assessed the occurrence of burnout and associated factors among first-year residents at Brazilian institutions. The present prospective, multicenter, cohort study was conducted with doctors enrolled in residency programs in clinical oncology at Brazilian institutions affiliated with the public health system. The participants answered a sociodemographic questionnaire, the Maslach Burnout Inventory (MBI), Lipp's Stress Inventory, and the Beck Depression Inventory (BDI), upon admission to the program and 6 and 12 months later. Of 37 eligible residency programs in 2009, 11 (30.6 %) agreed to participate in the study. Fifty-four residents, representing 100 % of new admissions to the participating institutions, were included. Most of the participants met the criteria for severe burnout upon admission to the residency programs (emotional exhaustion in 49.0 % and depersonalization in 64.7 %). The scores on MBI domains emotional exhaustion and depersonalization increased significantly (p < 0.01) during the first year of residency, and the prevalence of burnout increased to 88 % at the end of that first year. The present study found a high prevalence of burnout among doctors enrolled in residency programs in clinical oncology at Brazilian institutions. A large fraction of the participants met the criteria for burnout syndrome upon admission to the program, which suggests that the problem began during the course of the previous residency program in internal medicine.
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Affiliation(s)
- Daniel I G Cubero
- Department of Oncology and Hematology, ABC Foundation School of Medicine, 821 Av Principe de Gales, Anexo 3, Santo André, SP, 09060-650, Brazil.
| | | | - Thiago Hérick de Sá
- School of Public Health, University of São Paulo, 715 Av. Dr. Arnaldo, 01255-000, São Paulo, Brazil
| | - Aldo Dettino
- AC Camargo Hospital, 211 Rua Professor Antônio Prudente, 01509-010, São Paulo, Brazil
| | - Felipe Osório Costa
- UNICAMP, State University of Campinas, 126 R. Tessália Vieira de Camargo, FCM 9, 13083-887, Campinas, Brazil
| | | | - Carlos Beato
- Amaral Carvalho Foundation, 122 Rua das Palmeiras, n.122, 17210-120, Jaú, Brazil
| | - Fernanda Maris Peria
- Ribeirão Preto School of Medicine, 3900 Av. Bandeirantes, 14048-900, Ribeirão Preto, Brazil
| | - Augusto Mota
- Saint Raphael Hospital, 619 Alameda das Samambaias, casa 50, 41650-230, Salvador, Brazil
| | - José Altino
- São José do Rio Preto School of Medicine, 1118 Rua Presciliano Pinto, 15025-100, São José do Rio Preto, Brazil
| | - Sérgio Jobim Azevedo
- Clinical Hospital of Porto Alegre, 2350 Rua Ramiro Barcelos, Prédio 21- 2° andar, 90035-903, Porto Alegre, Brazil
| | | | - Melba Moura
- Santa Izabel Hospital, 500 Praça Conselheiro Almeida Couto, 40050-410, Salvador, Brazil
| | | | - Auro Del Giglio
- Department of Oncology and Hematology, ABC Foundation School of Medicine, 821 Av Principe de Gales, Anexo 3, Santo André, SP, 09060-650, Brazil
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16
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Adami F, Figueiredo FWDS, Paiva LDS, de Sá TH, Santos EFDS, Martins BL, Valenti VE, de Abreu LC. Mortality and Incidence of Hospital Admissions for Stroke among Brazilians Aged 15 to 49 Years between 2008 and 2012. PLoS One 2016; 11:e0152739. [PMID: 27332892 PMCID: PMC4917086 DOI: 10.1371/journal.pone.0152739] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012. Methods Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60–I64). Crude and standardized mortality (WHO reference) and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0. Results There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15–49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54) in 2008 to 6.32 (95% CI 6.31; 6.32) in 2012 (β = -0.27, p = 0.013, r2 = 0.90). During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67) in 2008 and 25.11 (95% CI 25.10; 25.11) in 2012 (β = 0.09, p = 0.692, r2 = 0.05). There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group. Conclusion We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults.
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Affiliation(s)
- Fernando Adami
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- * E-mail:
| | - Francisco Winter dos Santos Figueiredo
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Laércio da Silva Paiva
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Thiago Hérick de Sá
- Departamento de Nutrição da Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, São Paulo, Brasil
| | - Edige Felipe de Sousa Santos
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Epidemiologia, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, São Paulo, Brasil
- Unidade Saúde, Faculdade Leão Sampaio, Juazeiro do Norte, Ceará, Brasil
| | - Bruno Luis Martins
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Vitor Engrácia Valenti
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências da Universidade Estadual Paulista Júlio de Mesquita Filho, Marília, São Paulo, Brasil
| | - Luiz Carlos de Abreu
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
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Tainio M, de Nazelle AJ, Götschi T, Kahlmeier S, Rojas-Rueda D, Nieuwenhuijsen MJ, de Sá TH, Kelly P, Woodcock J. Can air pollution negate the health benefits of cycling and walking? Prev Med 2016; 87:233-236. [PMID: 27156248 PMCID: PMC4893018 DOI: 10.1016/j.ypmed.2016.02.002] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 12/18/2022]
Abstract
Active travel (cycling, walking) is beneficial for the health due to increased physical activity (PA). However, active travel may increase the intake of air pollution, leading to negative health consequences. We examined the risk-benefit balance between active travel related PA and exposure to air pollution across a range of air pollution and PA scenarios. The health effects of active travel and air pollution were estimated through changes in all-cause mortality for different levels of active travel and air pollution. Air pollution exposure was estimated through changes in background concentrations of fine particulate matter (PM2.5), ranging from 5 to 200μg/m3. For active travel exposure, we estimated cycling and walking from 0 up to 16h per day, respectively. These refer to long-term average levels of active travel and PM2.5 exposure. For the global average urban background PM2.5 concentration (22μg/m3) benefits of PA by far outweigh risks from air pollution even under the most extreme levels of active travel. In areas with PM2.5 concentrations of 100μg/m3, harms would exceed benefits after 1h 30min of cycling per day or more than 10h of walking per day. If the counterfactual was driving, rather than staying at home, the benefits of PA would exceed harms from air pollution up to 3h 30min of cycling per day. The results were sensitive to dose-response function (DRF) assumptions for PM2.5 and PA. PA benefits of active travel outweighed the harm caused by air pollution in all but the most extreme air pollution concentrations.
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Affiliation(s)
- Marko Tainio
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK.
| | | | - Thomas Götschi
- Physical Activity and Health Unit, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sonja Kahlmeier
- Physical Activity and Health Unit, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - David Rojas-Rueda
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mark J Nieuwenhuijsen
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Thiago Hérick de Sá
- Centre for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, UK
| | - James Woodcock
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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Sá THD, Rezende LFMD, Rabacow FM, Monteiro CA. Aumento no uso de transporte motorizado privado no deslocamento das crianças para a escola na Região Metropolitana de São Paulo, Brasil, 1997-2012. CAD SAUDE PUBLICA 2016; 32:S0102-311X2016000500801. [DOI: 10.1590/0102-311x00140215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 04/06/2016] [Indexed: 11/21/2022] Open
Abstract
Resumo: A Região Metropolitana de São Paulo, Brasil, apresentou, entre 1997 e 2007, tendência de aumento do uso transporte motorizado privado nos deslocamentos de crianças para a escola, com potenciais prejuízos à saúde. O objetivo deste estudo foi ampliar a análise de tal tendência para 2012 e discutir possíveis estratégias para aumentar a proporção de crianças que andam, pedalam e usam o transporte público. A análise dos dados da Pesquisa de Mobilidade de 2012 indica não apenas a continuidade, mas a aceleração no aumento do uso transporte motorizado privado em deslocamentos de crianças entre 6 e 11 anos para a escola. O efeito de iniciativas em andamento sobre essa tendência só será devidamente compreendido com o devido monitoramento dos deslocamentos cotidianos e a avaliação do impacto dessas ações sobre a saúde da população. Um pacote de políticas e programas voltados especificamente para a promoção e proteção da mobilidade a pé, de bicicleta ou por transporte público de crianças é imprescindível para garantir o deslocamento seguro, independente e ativo de crianças para a escola na Região Metropolitana de São Paulo.
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Rey-López JP, de Rezende LF, de Sá TH, Stamatakis E. Is the metabolically healthy obesity phenotype an irrelevant artifact for public health? Am J Epidemiol 2015; 182:737-41. [PMID: 26363513 DOI: 10.1093/aje/kwv177] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/08/2015] [Indexed: 01/29/2023] Open
Abstract
Some obese persons do not develop (at least in the short term) the metabolic complications of obesity that are thought to be causally linked to cardiovascular events or premature mortality. This phenomenon has been termed "metabolically healthy obesity" (MHO), and it has received much attention recently, to the extent that some authors argue that "new metrics" must be developed to estimate the risk associated with obesity beyond body mass index. In this commentary, we argue that the MHO phenotype is not benign and as such has very limited relevance as a public health target. More efforts must be allocated to reducing the distal and actual causal agents that lead to weight gain, instead of the current disproportionate scientific interest in the biological processes that explain the heterogeneity of obesity.
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Rey-López JP, de Rezende LF, de Sá TH, Stamatakis E. Rey-López et al. respond to "the metabolically healthy obesity phenotype". Am J Epidemiol 2015; 182:745-6. [PMID: 26363512 DOI: 10.1093/aje/kwv179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/24/2015] [Indexed: 01/04/2023] Open
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21
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Gomez LF, Sarmiento R, Ordoñez MF, Pardo CF, de Sá TH, Mallarino CH, Miranda JJ, Mosquera J, Parra DC, Reis R, Quistberg DA. Urban environment interventions linked to the promotion of physical activity: a mixed methods study applied to the urban context of Latin America. Soc Sci Med 2015; 131:18-30. [PMID: 25748111 PMCID: PMC4594859 DOI: 10.1016/j.socscimed.2015.02.042] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This study summarizes the evidence from quantitative systematic reviews that assessed the association between urban environment attributes and physical activity. It also documents sociopolitical barriers and facilitators involved in urban interventions linked with active living in the ten most populated urban settings of Latin America. The synthesis of evidence indicates that several attributes of urban environments are associated with physical activity, including land-use mix and cycling infrastructure. The documentary analysis indicated that despite the benefits and opportunities provided by the programs and existing infrastructure in the examined cities, an overall concern is the rising inequality in the coverage and distribution of the initiatives in the region. If these programs and initiatives are to achieve a real population level effect that helps to reduce health disparities, they need to examine their social and spatial distribution within the cities so they can reach underserved populations and develop to their full potential.
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Affiliation(s)
- Luis F Gomez
- Departamento de Medicina Preventiva y Social, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia.
| | - Rodrigo Sarmiento
- Departamento de Medicina Preventiva y Social, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia
| | - Maria Fernanda Ordoñez
- Departamento de Medicina Preventiva y Social, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia
| | | | - Thiago Hérick de Sá
- Núcleo de Pesquisas Epidemioloógicas em Nutrição e Saúde, Faculdade de Saúde Pública, Universidade de São Paulo, Brazil
| | - Christina H Mallarino
- Departamento de Medicina Preventiva y Social, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Janeth Mosquera
- Grupo de Epidemiología y Salud Poblacional (GESP), Escuela de Salud Pública Universidad del Valle, Colombia
| | - Diana C Parra
- Centro de Investigaciones Epidemiologicas en Nutricion y Salud, Departamento de Nutricion, Escuela e Salud Publica, Universidad de Sao Paulo, Sao Paulo, SP, Brazil; Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Rodrigo Reis
- School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Brazil
| | - D Alex Quistberg
- Harborview Injury Prevention & Research Center, University of Washington, USA
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22
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Affiliation(s)
- Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Thiago Hérick de Sá
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Carlos A Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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Affiliation(s)
- Thiago Hérick de Sá
- University of São Paulo, School of Public Health, Nutrition, São Paulo, SP 01246-904, Brazil.
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