BackgroundThe study explores associations between perceived neighbourhood characteristics, physical activity and diet quality, which in Latin America and Brazil have been scarcely studied and with inconsistent results.MethodsWe conducted a cross-sectional analysis of 14,749 individuals who participated in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil) baseline. The study included current and retired civil servants, aged between 35 and 74 years, from universities and research institutes in six Brazilian states. The International Physical Activity Questionnaire (IPAQ) long form was used to characterize physical activity during leisure time and commuting; additional questions assessed how often fruit and vegetables were consumed, as a proxy for diet quality. Neighbourhood characteristics were evaluated by the “Walking Environment” and “Availability of Healthy Foods” scales originally used in the Multi-Ethnic Study of Atherosclerosis (MESA). Associations were examined using multinomial logistic regression.ResultsPerceiving a more walkable neighbourhood was positively associated with engaging in leisure time physical activity and doing so for longer weekly. Compared with those who saw their neighbourhood as less walkable, those who perceived it as more walkable had 1.69 (95 % CI 1.57–1.83) and 1.39 (1.28–1.52) greater odds of engaging in leisure time physical activity for more than 150 min/week or up to 150 min/week (vs. none), respectively. Perceiving a more walkable neighbourhood was also positively associated with transport-related physical activity. The same pattern was observed for diet: compared with participants who perceived healthy foods as less available in their neighbourhood, those who saw them as more available had odds 1.48 greater (1.31–1.66) of eating fruits, and 1.47 greater (1.30–1.66) of eating vegetables, more than once per day.ConclusionsPerceived walkability and neighbourhood availability of healthy food were independently associated with the practice of physical activity and diet quality, respectively, underlining the importance of neighbourhood-level public policies to changing and maintaining health-related habits.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3447-5) contains supplementary material, which is available to authorized users.

Abstract

Summary An age-period cohort model was fitted to analyse time effects on hip fracture incidence rates by sex (Portugal, 2000(Portugal, -2008. Rates increased exponentially with age (age effect). Incidence rates decreased after 2004 for women and were random for men (period effect). New but comprehensive fluctuations in risk were coincident with major political/economic changes (cohort effect).Introduction Healthcare improvements have allowed preven-tion but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000Portugal, -2008 Methods From the National Hospital Discharge Register, we selected admissions (aged ≥49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages,we usedanage-period-cohort model (1-year in-tervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. Results There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increas-ing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable-increasing), 1940 (decreasing-increasing) and 1950 (in-creasing-decreasing only among women). Conclusions Hip fracture risk was higher for those born dur-ing major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.

Since 1988, Brazil has reorganized and expanded its public health care system, defining access to health care as a right of every citizen. In parallel, the private health care sector grew rapidly to become one of the largest in the world. We explore the use of public and private health care by a low-income population living in a favela, Rio das Pedras, in Rio de Janeiro. At the time of data collection, only part of the community was covered by the primary health care program. We conducted semistructured interviews with 14 adults, both with and without access to the public primary care program. Regardless of program coverage, participants noted barriers and negative experiences while accessing public health care. The perceived inability of health professionals to deal compassionately with a low-income population was prominent in their narratives, and in the expressed motivation for pursuing private sector health care alternatives. We explore the tension arising from the more recent rights-based health care provision and historic social control and assistentialist framing of state intervention in Brazilian favelas.

The current "refugee crisis" has been called the most serious humanitarian crisis in recent decades, with more than 22 million refugees worldwide, the largest contingents coming from Syria (5.5 million), Afghanistan (2.5 million), and Sudan (1.4 million) 1. Much recent media attention has focused on the arrival of refugees on Europe's borders-especially Greece and Italy. However, the approximately 2 million people that have reached Europe are proportionally few compared to those in Lebanon (1.1 million), Pakistan (1.4 million), and Turkey (2.9 million) 1. The vast majority of persons currently in situations of forced cross-border or internal displacement are in countries of the Global South, 67% of whom in Africa, Asia, and the Middle East 1. Although forced displacement of populations is probably as old as war itself, most of the legal mechanisms on the issue are recent, having emerged soon after World War II. The United Nations Convention on the Status of Refugees, from 1951, is still the world's main reference, defining refugee as someone who has to cross international borders due to well-founded fear of suffering persecution based on race, religion, nationality, political opinion, or membership in a given social group 2. The convention was created in a historical context in which millions of European had sought asylum around the world. However, the direction changed in the 1980s, with a sharp increase in migratory flows from the countries of the Global South to the Global North 3,4,5. The so-called "no-entry" system has been consolidated since then. Many of the system's initial practices have been challenged in courts (and condemned) in recent decades, and several so-called developed countries have begun dodging such legal hurdles by "outsourcing" their border control policies. The latest generation of policies is anchored in the territories around Europe and focuses on containing refugees-and migrants-in their home countries or countries of transit, through increasingly intense collaboration with such nations as Turkey and Libya 6. The countries rely on various strategies for this purpose: prison construction, technical assistance, and technology transfer, among others. Such policies shape the paths needed to obtain asylum. It is essential to keep these paths in mind when we speak of the refugee population's health, since many of the health risks and outcomes are related to the spaces, times, and institutions comprising the "no-entry" systems: countries of origin and of transit, the border, the camp, the "asylum office", sometimes the detention or deportation center.