Portugal is one of the European Union countries with the highest rates of people aged 65 or more. The old-age dependency index is the third highest in Europe. Longevity is a remarkable human achievement but without a comprehensive approach to fostering healthy ageing over the life-course, the burden on health and care systems and social services will increase. This issue is compounded as life expectancy rises, but many of these additional years are not lived in good health. Promoting healthy ageing is an essential political and moral strategy for the well-being both of individuals and societies. Concerning this, Portugal endorsed the Lisbon Outcome Statement drawn up based on the 2023 Regional Summit on Policy Innovation for Healthy Ageing and made its commitment for the creation of age-friendly environments. The National Programme for Age-Friendly Cities and Communities in Portugal is one of the first concrete steps to fulfill that endorsement.
Objective To estimate the dose–response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. Design Systematic review and cohort-level dose-response meta-analysis. Data sources PubMed, Scopus, Web of Science and reference lists of published studies. Eligibility criteria Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney). Results 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted. Conclusions Inverse non-linear dose–response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. PROSPERO registration number CRD42018095481.
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
Few studies have investigated the association between leisure-time physical activity and long-term medication use in Brazilian populations, especially those of low socioeconomic status. The objective of this study was to analyze the association between the need for long-term medication and leisure-time physical activity in adults from the Ermelino Matarazzo district, a low-income region in São Paulo, Brazil. A population-based cross-sectional study was conducted in 2007 and involved 890 subjects aged 18 years or older. Data regarding the need for long-term medication and types of medications used were collected using a questionnaire. Leisure-time physical activity was measured using the long version of the International Physical Activity Questionnaire. Descriptive analysis, chi-square test, and simple and multiple binary and multinomial logistic regression analysis were used. Among the subjects studied, 29.2% reported the need for long-term medication and 10% required at least two different types of medications. After adjustment for gender, age, education level and Body Mass Index, subjects who did not perform at least 150 min/week of leisure-time physical activity presented 2.78 (95% confidence interval - 95%CI: 1.45; 5.30) and 4.69 (95%CI: 1.90; 11.53) times the odds of requiring long-term medication and two or more types of medications rather than none, respectively, than those who did. Broader discussion of the interaction between medication, leisure-time physical activity and social and economic aspects is needed to reduce inequalities and to improve the health of individuals of low socioeconomic status.
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.
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.
Resumo O progresso do Sistema Único de Saúde brasileiro nas últimas décadas, principalmente com a implementação da Estratégia de Saúde da Família, resultou em melhorias no atendimento à população e no fortalecimento de ações para promover a atividade física, incluindo a incorporação do profissional de Educação Física nos cuidados básicos de saúde. No entanto, existem desafios a serem superados, tais como o desenvolvimento da educação dos trabalhadores da área da saúde de acordo com os princípios orientadores do Sistema Único de Saúde. Desta forma, o objetivo desse estudo foi avaliar os limites e as potencialidades da educação para a promoção da atividade física na Estratégia Saúde da Família por meio de uma pesquisa participativa baseada na comunidade, através da construção de um programa educativo com as equipes de saúde. As análises da conversação e da fala foram aplicadas aos dados de três grupos focais (dois no início e um após o programa) e a triangulação foi usada para combinar esses dados com os dados de notas de campo e notas reflexivas escritas pelo pesquisador e também por um observador independente. Cinco limites e potencialidades foram identificados para a educação da promoção da atividade física: organização do trabalho e educação no trabalho; relação do profissional com a atividade física; ponto de vista profissional sobre o processo saúde-doença, no que se refere ao aconselhamento sobre atividade física; falta de cuidados para o profissional de saúde e o aprendizado incidental; e a avaliação dos elementos-chave da estratégia pedagógica. Os resultados apontam para a necessidade de melhorar a organização do trabalho e a saúde oferecida aos próprios profissionais, de fortalecer ações de educação para valorizar a educação permanente e interprofissional e de trabalhar a conscientização dos profissionais sobre a prática e promoção da atividade física.
In a passionate Editorial, The Lancet Global Health defends a human rights approach to Zika virus,1The Lancet Global HealthThe right(s) approach to Zika.Lancet Glob Health. 2016; 4: e427Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar and includes mosquito control as part of the "sound recommendations, duly relayed by health authorities". We would like to argue the case for a rights-based approach to mosquito control, which would be aimed not at small-scale tinkering in the environment but at large-scale urban transformation, as proposed in the early drafts of the New Urban Agenda. Such an approach encompasses, among others, the right to the city, the right to health, and the right to freedom of movement. Faria and colleagues2Faria NR Azevedo Rdo S Kraemer MU et al.Zika virus in the Americas: early epidemiological and genetic findings.Science. 2016; 352: 345-349Crossref PubMed Scopus (715) Google Scholar suggest that large-scale patterns in human mobility, including the role of mega-events,3Elachola H Gozzer E Zhuo J Memish ZA A crucial time for public health preparedness: Zika virus and the 2016 Olympics, Umrah, and Hajj.Lancet. 2016; 387: 630-632Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar should be assessed to understand the epidemiology of the virus. Since 2010, Brazil has hosted a series of mega-events, with delegations from all over the world. These have included the 2011 Military Games, the 2013 Salesian Youth Movement world meeting (with the Pope's visit), the 2013 Fédération Internationale de Football Association (FIFA) Confederations' Cup, the 2014 FIFA World Cup, and all the preparatory games for the 2016 Olympics. Beyond changes in human mobility, there are other effects of hosting mega-events that should be discussed. Families living in well located informal settlements have been displaced from their homes to make way for mega-event structures and urban gentrification projects.4Paula MD Bartelt DD Copa para quem e para quê? Um olhar sobre os legados dos mundiais de futebol no Brasil, África do Sul e Alemanha. Fundação Heinrich Böll, Rio de Janeiro, Brasil2014Google Scholar By 2013, approximately 40 000 people had been removed from their homes in Rio de Janeiro as a direct consequence of mega-event stadium construction,5Comitê Popular Rio Copa e OlimpíadasMegaeventos e violações dos direitos humanos no Rio de Janeiro. Fundação Heinrich Böll, Rio de Janeiro Brasil2013Google Scholar and a greater number of these have been forced to move from informal settlements in areas with reasonable infrastructure to the outskirts of the cities on account of increased real estate valuation. They will join many already living in poor areas—where sanitary conditions and waste management are worse—increasing the proportion of the population forced to store water and the amount of garbage thrown in water streams, blocking water flow, both of which favour the proliferation of A aegypti, the vector of Zika, dengue, and chikungunya viruses. Despite being highly beneficial for its partners and organisers—the highest profit in history for FIFA occurred in the 2014 World Cup in Brazil—mega-events in Brazil have not conformed to the guidelines of the New Urban Agenda, resulting in clear health and societal harms, and have contributed to the increased circulation of Zika virus in the Americas. Governments and societies must take the New Urban Agenda into consideration if they wish to seriously engage in controlling A aegypti whenever deciding to host mega-events; and, if such events take place, preparations should respect this new agenda. We declare no competing interests. THdS was supported by the Brazilian Science without Borders Scheme (process number: 200358/2014-6) and the São Paulo Research Foundation (process number: 2012/08565-4). BR-S was supported by International Clinical, Operational and Health Services Research Training Award (ICOHRTA grant: 5 U2R TW006883-02) from the National Institutes of Health (Bethesda, Maryland, United States).
Health impact simulation models are used to predict how a proposed intervention or scenario will affect public health outcomes, based on available data and knowledge of the process. The outputs of these models are uncertain due to uncertainty in the structure and inputs to the model. In order to assess the extent of uncertainty in the outcome we must quantify all potentially relevant uncertainties. Then to reduce uncertainty we should obtain and analyse new data, but it may be unclear which parts of the model would benefit from such extra research.
This paper presents methods for uncertainty quantification and research prioritisation in health impact models based on Value of Information (VoI) analysis. Specifically, we
1. discuss statistical methods for quantifying uncertainty in this type of model, given the typical kinds of data that are available, which are often weaker than the ideal data that are desired;
2. show how the expected value of partial perfect information (EVPPI) can be calculated to compare how uncertainty in each model parameter influences uncertainty in the output;
3. show how research time can be prioritised efficiently, in the light of which components contribute most to outcome uncertainty.
The same methods can be used whether the purpose of the model is to estimate quantities of interest to a policy maker, or to explicitly decide between policies. We demonstrate how these methods might be used in a model of the impact of air pollution on health outcomes.
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