RESUMO
Nine in 10 road traffic deaths occur in low- and middle-income countries (LMICs). Despite this disproportionate burden, few studies have examined built environment correlates of road traffic injury in these settings, including in Latin America. We examined road traffic collisions in Bogotá, Colombia, occurring between 2015 and 2019, and assessed the association between neighborhood-level built environment features and pedestrian injury and death. We used descriptive statistics to characterize all police-reported road traffic collisions that occurred in Bogotá between 2015 and 2019. Cluster detection was used to identify spatial clustering of pedestrian collisions. Adjusted multivariate Poisson regression models were fit to examine associations between several neighborhood-built environment features and rate of pedestrian road traffic injury and death. A total of 173,443 police-reported traffic collisions occurred in Bogotá between 2015 and 2019. Pedestrians made up about 25% of road traffic injuries and 50% of road traffic deaths in Bogotá between 2015 and 2019. Pedestrian collisions were spatially clustered in the southwestern region of Bogotá. Neighborhoods with more street trees (RR, 0.90; 95% CI, 0.82-0.98), traffic signals (0.89, 0.81-0.99), and bus stops (0.89, 0.82-0.97) were associated with lower pedestrian road traffic deaths. Neighborhoods with greater density of large roads were associated with higher pedestrian injury. Our findings highlight the potential for pedestrian-friendly infrastructure to promote safer interactions between pedestrians and motorists in Bogotá and in similar urban contexts globally.
Assuntos
Acidentes de Trânsito , Ambiente Construído , Pedestres , Características de Residência , Ferimentos e Lesões , Humanos , Colômbia/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Acidentes de Trânsito/mortalidade , Estudos Transversais , Adulto , Masculino , Feminino , Pedestres/estatística & dados numéricos , Adulto Jovem , Pessoa de Meia-Idade , Ferimentos e Lesões/epidemiologia , Adolescente , Características de Residência/estatística & dados numéricos , Criança , Pré-Escolar , Idoso , Planejamento AmbientalRESUMO
BACKGROUND: Cable cars are part of the transport system in several cities in Latin America, but no evaluations of their effects on physical activity are available. TransMiCable is the first cable car in Bogotá, Colombia, and the wider intervention includes renovated parks and playgrounds. We assessed the effects of TransMiCable and the wider intervention on physical activity. METHODS: The Urban Transformations and Health natural experiment was a prospective quasi-experimental study conducted from Feb 1, 2018, to Dec 18, 2018 (baseline, pre-intervention) and from July 2, 2019, to March 15, 2020 (post-intervention follow-up) in the TransMiCable intervention area (Ciudad Bolívar settlement) and a control area without TransMiCable (San Cristóbal settlement). A multistage strategy was used to sample households in each area, with one adult (aged ≥18 years) per household invited to participate. Eligible participants had lived in the intervention or control areas for at least 2 years and were not planning to move within the next 2 years. Physical activity was assessed among participants in the intervention and control areas before and after the inauguration of TransMiCable in Ciudad Bolívar with the International Physical Activity Questionnaire (long form) and with wearable accelerometers. Complete cases (those with baseline and follow-up data) were included in analyses. Respondents were classed as being physically active if they met 2020 WHO guidelines (≥150 min per week of moderate activity, ≥75 min per week of vigorous activity, or equivalent combinations); and accelerometery data were classified with the Freedson cut-points for adults. Data were also gathered in zonal parks (area ≥10â000 m2) and neighbourhood parks (area <10â000 m2) in the intervention and control areas by direct observation with the System for Observing Play and Recreation in Communities, to assess levels of physical activity before and after the TransMiCable intervention. Multilevel regression models were used to assess changes in physical activity associated with the TransMiCable intervention. FINDINGS: Physical activity questionnaires were completed by 2052 adult participants (1289 [62·8%] women and 763 [37·2%] men; mean age 43·5 years [SD 17·7]) before the inauguration of TransMiCable. After the inauguration, the follow-up (final) questionnaire sample comprised 825 adults in the intervention group and 854 in the control group, including 357 adults in the intervention group and 334 in the control group with valid accelerometery data. 334 (40·5%) of 825 participants in the intervention group reported levels of physical activity that met the 2020 WHO guidelines during walking for transport before the intervention, and 426 (51·6%) afterwards (change 11·1 percentage points [95% CI 6·4 to 15·9]). A similar change was observed in the control group (change 8·0 percentage points [3·4 to 12·5]; adjusted odds ratio [OR] for the time-by-group interaction, intervention vs control group: 1·1 [95% CI 0·8 to 1·5], p=0·38). Time spent doing moderate-to-vigorous physical activity, measured with accelerometers, did not change in the intervention group after the inauguration of TransMiCable (change -0·8 min per day [-4·6 to 3·0]) and did not change compared with the control group (adjusted ß for the time-by-group interaction: 1·4 min per day [95% CI -2·0 to 4·9], p=0·41). Moderate-to-vigorous physical activity was 52·1 min per day (SD 24·7) before and 59·4 min per day (35·2) after the inauguration of TransMiCable in new regular users who reported using TransMiCable during mandatory trips for work or education (n=32; change 7·3 min per day [-22·5 to 7·9]). After the intervention, an increase in the proportion of male individuals engaging in moderate or vigorous physical activity was observed in a renovated zonal park (adjusted OR for the time-by-group interaction, intervention vs control park: 2·7 [1·1 to 6·8], p=0·033). Female users of a renovated neighbourhood park were less likely to become engaged in moderate or vigorous physical activity than female users of the control area neighbourhood park (adjusted OR for the time-by-group interaction: 0·4 [0·1 to 0·6], p=0·019). INTERPRETATION: It is encouraging that walking for transport remained high in the TransMiCable intervention area when the use of private motorised transport had increased elsewhere in Bogotá. In low-income urban areas, where transport-related walking is a necessity, transport interventions should be focused on efforts to maintain participation in active travel while improving conditions under which it occurs. FUNDING: Wellcome Trust (as part of the Urban Health in Latin America project); Bogotá Urban Planning Department; Ministry of Science, Technology, and Innovation of Colombia; Universidad de Los Andes; Fundación Santa Fe de Bogotá; and Universidad del Norte. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.
Assuntos
Automóveis , Exercício Físico , Adulto , Humanos , Masculino , Feminino , Adolescente , Colômbia , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Interventions to promote physical activity among women breast cancer survivors (BCS) in low- to middle-income countries are limited. We assessed the acceptability and preliminary effectiveness of a theory-driven, group-based dance intervention for BCS delivered in Bogotá, Colombia. METHODS: We conducted a quasi-experimental study employing a mixed-methods approach to assess the 8-week, 3 times/week group dance intervention. The effect of the intervention on participants' physical activity levels (measured by accelerometry), motivation to engage in physical activity, and quality of life were evaluated using generalized estimating equation analysis. The qualitative method included semi-structured interviews thematically analyzed to evaluate program acceptability. RESULTS: Sixty-four BCS were allocated to the intervention (n = 31) or the control groups (n = 33). In the intervention arm, 84% attended ≥ 60% of sessions. We found increases on average minutes of moderate-to-vigorous physical activity per day (intervention: +8.99 vs control: -3.7 min), and in ratings of motivation (intervention change score = 0.45, vs. control change score= -0.05). BCS reported improvements in perceived behavioral capabilities to be active, captured through the interviews. CONCLUSIONS: The high attendance, behavioral changes, and successful delivery indicate the potential effectiveness, feasibility, and scalability of the intervention for BCS in Colombia. TRIAL REGISTRATION: ClinicalTrial.gov NCT05252780, registered on Dec 7th, 2021-retrospectively registered unique protocol ID: P20CA217199-9492018.
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PURPOSE: Depression and anxiety have been associated with lower urinary tract symptoms (LUTS) in several studies. In our population, the prevalence of LUTS is high, consequently, it is essential and an objective of this study, to determine the association between anxiety, depression, and LUTS in a large Hispanic population. METHODS: A sub-analysis of a cross-sectional population-based study to estimate LUTS prevalence in the Colombian population was performed (COBaLT study) (Plata et al. in Neurourol Urodyn 38:200-207, 2018). The Hospital Anxiety and Depression Scale (HADS) was used to evaluate mental health. Logistic regression was carried out to estimate the association of depression and anxiety with different LUTS. Variables that proved statistically significant (p < 0.05) were included in a multivariate model. RESULTS: A total of 1060 individuals were assessed. The prevalence of anxiety in women and men was 17.1% and 6.7%, respectively. Depression in women and men was 20.1% and 9.4%, respectively. An association was found between anxiety and overactive bladder (OAB) without urinary incontinence (OR = 3.7) and moderate or severe LUTS in men (OR = 3.8). In women, anxiety was associated with nocturia (OR = 4.2) and stress urinary incontinence (OR = 2.4). For depression, an association was found between sexual dysfunction (OR = 4.3) and moderate or severe LUTS (OR = 4.0) in men; while in women it was associated with stress urinary incontinence (OR = 2.3), the sensation of incomplete emptying (OR = 1.7) and decreased frequency of sexual activity (OR = 1.8). CONCLUSIONS: The associations found are consistent with other reports. It is essential to inquire about possible symptoms related to the mental sphere in the urology consultation to make appropriate referrals and subsequent management.
Assuntos
Sintomas do Trato Urinário Inferior , Bexiga Urinária Hiperativa , Incontinência Urinária por Estresse , Masculino , Humanos , Feminino , Depressão/epidemiologia , Estudos Transversais , Sintomas do Trato Urinário Inferior/diagnóstico , Bexiga Urinária Hiperativa/epidemiologia , Bexiga Urinária Hiperativa/diagnóstico , Ansiedade/epidemiologia , PrevalênciaRESUMO
This paper introduces a novel benchmark to study the impact and relationship of built environment elements on pedestrian collision prediction, intending to enhance environmental awareness in autonomous driving systems to prevent pedestrian injuries actively. We introduce a built environment detection task in large-scale panoramic images and a detection-based pedestrian collision frequency prediction task. We propose a baseline method that incorporates a collision prediction module into a state-of-the-art detection model to tackle both tasks simultaneously. Our experiments demonstrate a significant correlation between object detection of built environment elements and pedestrian collision frequency prediction. Our results are a stepping stone towards understanding the interdependencies between built environment conditions and pedestrian safety.
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Background and Objectives: Particulate Matter (PM), particles of variable but small diameter can penetrate the respiratory system via inhalation, causing respiratory and/or cardiovascular diseases. This study aims to evaluate the association of environmental particulate matter (PM2.5) and black carbon (BC) with respiratory health in users of different transport modes in four roads in Bogotá. Materials and Methods: this was a mixed-method study (including a cross sectional study and a qualitative description of the air quality perception), in 300 healthy participants, based on an exploratory sequential design. The respiratory effect was measured comparing the changes between pre- and post-spirometry. The PM2.5 and black carbon (BC) concentrations were measured using portable devices. Inhaled doses were also calculated for each participant according to the mode and route. Perception was approached through semi-structured interviews. The analysis included multivariate models and concurrent triangulation. Results: The concentration of matter and black carbon were greater in bus users (median 50.67 µg m-3; interquartile range (-IR): 306.7). We found greater inhaled dosages of air pollutants among bike users (16.41 µg m-3). We did not find changes in the spirometry parameter associated with air pollutants or transport modes. The participants reported a major sensory influence at the visual and olfactory level as perception of bad air quality. Conclusions: We observed greater inhaled doses among active transport users. Nevertheless, no pathological changes were identified in the spirometry parameters. People's perceptions are a preponderant element in the assessment of air quality.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Carbono , Colômbia , Estudos Transversais , Exposição Ambiental/efeitos adversos , Humanos , Material Particulado/efeitos adversosRESUMO
Background: Cable cars provide urban mobility benefits for vulnerable populations. However, no evaluation has assessed cable cars' impact from a health perspective. TransMiCable in Bogotá, Colombia, provides a unique opportunity to (1) assess the effects of its implementation on the environmental and social determinants of health (microenvironment pollution, transport accessibility, physical environment, employment, social capital, and leisure time), physical activity, and health outcomes (health-related quality of life, respiratory diseases, and homicides); and (2) use citizen science methods to identify, prioritize, and communicate the most salient negative and positive features impacting health and quality of life in TransMiCable's area, as well as facilitate a consensus and advocacy-building change process among community members, policymakers, and academic researchers. Methods: TrUST (In Spanish: Transformaciones Urbanas y Salud: el caso de TransMiCable en Bogotá) is a quasi-experimental study using a mixed-methods approach. The intervention group includes adults from Ciudad Bolívar, the area of influence of TransMiCable. The control group includes adults from San Cristóbal, an area of future expansion for TransMiCable. A conceptual framework was developed through group-model building. Outcomes related to environmental and social determinants of health as well as health outcomes are assessed using questionnaires (health outcomes, physical activity, and perceptions), secondary data (crime and respiratory outcomes) use of portable devices (air pollution exposure and accelerometry), mobility tracking apps (for transport trajectories), and direct observation (parks). The Stanford Healthy Neighborhood Discovery Tool is being used to capture residents' perceptions of their physical and social environments as part of the citizen science component of the investigation. Discussion: TrUST is innovative in its use of a mixed-methods, and interdisciplinary research approach, and in its systematic engagement of citizens and policymakers throughout the design and evaluation process. This study will help to understand better how to maximize health benefits and minimize unintended negative consequences of TransMiCable.
Assuntos
Automóveis , Confiança , Colômbia , Atividades de Lazer , Qualidade de VidaRESUMO
Introducción: la enfermedad coronaria es una de las principales causas de morbimortalidad a nivel mundial; se sabe que la diabetes mellitus tipo 2 (DM2) es un factor de riesgo importante para esta patología y que puede producir una forma asintomática o con manifestaciones atípicas. Objetivos: exponer los principales datos epidemiológicos, pronósticos y determinantes de la enfermedad coronaria asintomática en DM2 y discutir las formas de tamización y su utilidad en diabéticos asintomáticos. Materiales y métodos: se realizó una búsqueda en PubMed, LILACS y SciELO usando las palabras clave "Diabetes Mellitus, type 2", "Coronary disease", "Coronary Artery Disease", "Coronary Vessels", "Atherosclerosis", "Arteriosclerosis", "Asymptomatic Diseases", "Asymptomatic", "Silent" y "Myocardcial infarction", ajustando la búsqueda según las necesidades de cada base de datos. Se incluyeron artículos que cumplieran los criterios de inclusión y no los de exclusión, a consideración de los autores, así como algunas referencias adicionales. Resultados: se revisó el título y resumen de 504 artículos encontrados en las bases de datos, tras lo cual se escogieron 81 para su lectura total. De ellos, 56 fueron incluidos, así como 48 publicaciones adicionales conocidas por los autores o referenciados en las artículos leídos, lo que dio un total de 104 artículos incluidos en la revisión final. Conclusiones: los pacientes con DM2 presentan altas prevalencias de enfermedad coronaria asintomática que aumentan en presencia de otros factores de riesgo cardiovascular o de mayor duración o progresión de la DM2. Si bien existen varios métodos anatómicos o funcionales para su detección, la tamización de esta población no ha mostrado beneficio alguno, por lo que no puede recomendarse de rutina en asintomáticos
Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality worldwide. It is well known that type 2 diabetes mellitus (DM2) is an important risk factor for CAD, and that it can produce an asymptomatic form of the disease or one with atypical manifestations. The association between DM2 and coronary atherogenesis is such that CAD has been reported in up to 91% of asymptomatic diabetic patients, a higher prevalence than that of non-diabetic controls. In this narrative review we summarize the main epidemiologic, prognostic and determinant factors of asymptomatic CAD in DM2. We also discuss the screening methods available and the usefulness of routine screening for asymptomatic diabetics.
A doença coronária é uma das principais causas mundiais de morbi-mortalidade e a diabetes mellitus tipo 2 é um fator de risco importante, pode desenvolver-se de forma assintomática ou apresentando manifestações pouco comuns. Até 91% dos pacientes diabéticos apresentam doença coronária, um dado bem maior do que no caso dos pacientes no diabéticos. No presente artigo apresentam-se OS principados dados epidemiológicos, diagnósticos, pronósticos e determinantes da doença coronária em pacientes com diabetes tipo 2. Do mesmo jeito discute-se métodos diagnósticas
Assuntos
Humanos , Doença das Coronárias , Diabetes Mellitus Tipo 2 , Doenças AssintomáticasRESUMO
Con el propósito de determinar la incidencia de la infección nosocomial (INS) en el Servicio de Medicina Interna del HCAMP; de investigar la distribución y tipos de INS a través de los criterios recomendados por el Centro de Control de Enfermedades de Atlanta, Georgia, de los EE.UU; conocer si existe relación entre la INS y la estancia hospitalaria de los pacientes, al igual que conocer la mortalidad por dicha infección durante el período de estudio, se realizó un estudio prospectivo no experimental. La población de estudio correspondió a 213 pacientes, mayores o iguales a 18 años que ingresaron al Servicio de Medicina Interna (Sala de mujeres y sala de hombres) durante un período de 7 meses. A dichos pacientes se les realizó una vigilancia continua desde su ingreso hasta egreso o fallecimiento, por medio de una encuesta. Entre los resultados más relevantes se encontró que la incidencia de infección intrahospitalaria (I.I.H) fue de 7.51 por ciento siendo las más frecuentes: Infecciones urinarias (31.6 por ciento); neumonías (23.3 por ciento); flebitis (10.5 por ciento) en 6 de los 16 pacientes con I.I.H se realizaron procedimientos invasivos como: Venoclisis, cateterismo vesical, soporte ventilatorio, con una duración promedio de 6 a 10.6 días. El promedio de estancia hospitalaria de la población general fue de 22.43 días y de 33.93 en los pacientes con infeccción nosocomial, con una sobreestancia de 11.5 días. El porcentaje de mortalidad por I.I.H fue 18.75 por ciento por cada 100 episodios. La incidencia de INS es alta en comparación con otros hospitales, siendo por ende, importante como problema de salud pública en el servicio estudiado, lo que sustenta la necesidad de fomentar medidas preventivas para el control de dicha infección
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Humanos , Masculino , Feminino , Adolescente , Adulto , Hospitalização/estatística & dados numéricos , Hospitais Estaduais/estatística & dados numéricos , Incidência , Infecção Hospitalar/complicações , Infecção Hospitalar/mortalidade , Infecção Hospitalar/epidemiologiaRESUMO
Se practicó la prueba de Mantoux en 194 escolares de 6 a 12 años de edad de Barquisimeto para evaluar la respuesta al PPD en ralación con la vacunación BCG y el estado nutricional. Se encontraron 23 (11,06 por ciento)escolares sin vacunación y 171 (88,14 por ciento) vacunados y se consideraron sólo 167 con una cicatriz del BCG para evaluar la vacunación del nacimiento. La repuesta negativa al PPD fue alta en vacunados (94,01 por ciento) y no vacunados (86,96 por ciento) y positiva en 2 (1,20 por ciento) vacunados, con un tamaño promedio de induración similar (p>0,05 entre ambos grupos. El 18,05 por ciento de escolares fueron desnutridos y no presentaron diferencia (p>0.05) respecto al porcentaje de reactores y tamaño de induración al PPD con los escolares normales. En conclusión, el BCG del nacimiento no es efectivo, en términos de reactividad tuberculínica, después de los 6 años de edad y el estado nutricional de los escolares no alteró la respuesta al PPD.