O objetivo desta revisão foi sintetizar as evidências disponíveis na literatura referentes aos programas de promoção de atividade física (AF) no Sistema Único de Saúde brasileiro. Foi realizada uma busca sistemática da literatura nas bases de dados PubMed, Science Direct, Biblioteca Virtual de Saúde (BVS), base de dados de dissertações e teses e uma busca manual na Revista Brasileira de Atividade Física e Saúde (RBAFS) no período entre janeiro de 2005 à abril de 2015. Foram incluídos estudos: originais, realizados no Brasil, com desfecho a promoção da AF realizada no Sistema Único de Saúde em idiomas: Inglês, Espanhol e/ou Português. A análise final foi composta por 17 artigos. Desses, 29,41% (n=5) foram realizados em todo o território nacional e 5,88% (n=1) em duas ou mais regiões do país. Observou-se ainda uma disparidade regional, com 29,41% (n=5) dos estudos na região sudeste, 17,64% (n=3) na região sul, 11,76% (n=2) na região nordeste, apenas 5,88% (n=1) na região centro-oeste e nenhum estudo foi realizado na região norte do país. Enquanto ao modo de intervenção verificou-se que 47,05% (n=8) ocorreram no Sistema Único de Saúde e 47,05% (n=8) foram programas com equipe multiprofissional.  Os estudos, em sua maioria forneceram dados descritivos ou sobre resultados na AF ou qualidade de vida, sendo escassas as informações sobre processo e impacto dos programas. Os programas com equipe multiprofissional foram estratégias importantes de promoção de AF. Sugere-se realizar estudos com delineamentos longitudinais ou mesmo experimentais, acerca do custo e benefício dos programas implementados.

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BackgroundLittle is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States.MethodsBetween February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions).ResultsPractitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries.ConclusionsThis study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.

Rev Panam Salud Publica 41, 20171 Este é um artigo de acesso aberto distribuído sob os termos da Licença Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO, que permite o uso, distribuição e reprodução em qualquer meio, desde que o trabalho original seja devidamente citado. Não são permitidas modificações ou uso comercial dos artigos. Em qualquer reprodução do artigo, não deve haver nenhuma sugestão de que a OPAS ou o artigo avaliem qualquer organização ou produtos específicos. Não é permitido o uso do logotipo da OPAS. Este aviso deve ser preservado juntamente com o URL original do artigo. Atualmente, cerca de 80% das mortes ocorridas no mundo são decorrentes das doenças crônicas não transmissíveis (DCNTs), que atingem principalmente países de renda baixa e média (1). A partir das metas globais estabelecidas pela Organização Mundial da Saúde (OMS), políticas públicas voltadas à prevenção e ao controle de DCNTs têm sido desenvolvidas (e em alguns casos implementadas) em diversos países, inclusive no Brasil. Um dos aspectos destacados nessas políticas é a importância do uso de evidências para a tomada de decisão (2).A saúde pública baseada em evidên-cias pode ser definida como o processo de integrar intervenções baseadas na ciência com as preferências da comunidade para melhorar a saúde das populações (3, p. 5). O emprego da tomada de decisão baseada em evidências é relatado em países de renda elevada e está associado, nesses países, ao porte populacional das cidades, à escolaridade dos gestores e à presença de equipes de trabalho qualificadas (4, 5). Todavia, a tomada de decisão baseada em evidências só se concretiza se houver uma escolha políti-ca nesse sentido (3).Entretanto, conforme o relato de gestores de saúde, existem diversas barreiras para a implementação da tomada de decisão baseada em evidências no cotidiano dos serviços de saúde (3,(6)(7)(8). Entre as barreiras citadas estão dificuldade de acesso às evidências científicas, falta de tempo e de habilidade para desenvolver um programa baseado em evidências e falta de financiamento, estrutura e RESUMOObjetivo.

Implementation of evidence-based practices can improve efficiency and effectiveness of public health efforts. Few studies have explored the political contextual factors that impact implementation of evidence-based non-communicable disease prevention (EBNCDP). This study aimed to do so in Australia, Brazil, China and the United States. Investigators conducted 10-13 qualitative, semi-structured interviews of public health practitioners working in functionally similar public health organizations in each country (total N = 50). Study participants were identified through purposive sampling and interviews were structured around an interview guide covering six domains related to EBNCDP. Interviewees from all four countries identified funding as the primary politically-influenced barrier to implementing EBNCDP. Similarly widespread barriers included government funding priorities that shift based on who is in power and the difficulty of convincing policy-makers and funders that non-communicable disease prevention is a wise investment of political capital. Policymakers who are not evidence-driven was another common barrier even in the United States and Australia, where EBNCDP is more established. Findings suggest that political contextual factors influence EBNCDP and vary to an extent by country, though certain factors seem to be universal. This can aid public health practitioners, political leaders, and policymakers in advocating for conditions and policies that encourage evidence-based practice.

The aim of this study was to analyze the association between perceived barriers for active commuting to school in the form of displacement of adolescents from Curitiba, Brazil. Interviews were conducted in six schools (three public and three private) with 741 adolescents aged 11-18 yrs. Perceived barriers for active commuting were assessed through a questionnaire with seventeen questions. Active commuting was defined as walking or bicycling to or form school at least one day per week. The associations were tested by Poisson regressions with 5% significance level. The prevalence of active commuting was of 42.9% (50.0% in boys and 37.2% in girls, p<0,001). For boys the barriers: "It is too far" (RP: 0.71; 95%CI: 0.60-0.86), "Route as boring" (RP: 1.30; 95%CI: 1.04-1.62) and "Too much traffic" (PR: 1.27; 95%CI: 1:04 to 1:56) were associated with active commuting. For girls, the barriers: "It is easier to go by car or bus" (RP: 0.70; 95%CI: 0.56-0.88) and involve "It requires too much planning" (RP: 0.60; 95%CI: 0.42-0.86) were associated with active commuting. Environmental and psychological barriers were associates with active commuting among adolescents to school. Efforts to promote active commuting, should consider gender specific actions. Providing safe routes and organize group activities for girls, and indicate faster routes for boys could help increasing this behavior among adolescents. KeywordsArchitectural Accessibility; Adolescents; Motor Activity; Cross-Sectional Studies; Brazil. 42,9% (50,0% meninos e 37,2% meninas p<0,001). Para os meninos, as barreiras associadas com o deslocamento ativo foram: "Morar longe da escola" (RP: 0,71; IC95%: 0,86), identificar o "Percurso como chato" (RP: 1,30; IC95%: 1,62) e "Muito tráfego" (RP: 1,27; IC95%: 1,56). Para as meninas, perceber que é "Mais fácil ir de carro/ ônibus" (RP: 0,70; IC95%: 0,88) e envolver "Muito planejamento" (RP: 0,60; IC95%: 0,86) Resumo O objetivo desse estudo foi analisar a associação entre as barreiras percebidas para o deslocamento ativo com a forma de deslocamento para a escola em adolescentes de Curitiba, Brasil. Foram entrevistados 741 adolescentes com idade entre 11-18 anos em seis escolas (três públicas e três privadas). A percepção de barreiras para o deslocamento ativo para escola foi avaliado por uma escala com 17 itens. O deslocamento ativo para escola foi considerado quando o adolescente relatou ir ou voltar da escola caminhando ou andando de bicicleta em ao menos um dia na semana. A associação foi testada com a regressão de Poisson e o nível de significância mantido em 5%. A prevalência de deslocamento ativo foi de Palavras-chaveEstruturas de acesso; Adolescente; Atividade motora; Estudos transversais; Brasil.Perceived barriers for active commuting to school among adolescents from Curitiba, BrazilBarreiras percebidas para o deslocamento ativo para a escola entre os adolescentes de Curitiba, Brasil

Age-friendly cities and communities have emerged as a significant policy, participative and governance response to ageing and its spatial effects. This paper argues that it has important benefits in mobilizing older people, placing age on the urban agenda and building recognition across politicians, policy makers and programme managers. Based on the experience of Belfast (UK), the analysis suggests, however, that it needs to be understood within wider urban restructuring processes, the importance of the property economy and how planning practices favour particular groups and modes of development. Drawing on demographic data, policy documents and in-depth interviews, it evaluates the relationship between age and urban regeneration, research-based advocacy and central-local relations in health and placebased care. The paper concludes by highlighting the importance of knowledge in competitive policy arenas and the need to focus on the most excluded and isolated old and where and how they live.

Background: Evidence-based chronic disease prevention (EBCDP) effectively reduces incidence rates of many chronic diseases, but contextual factors influence the implementation of EBCDP worldwide. This study aims to examine the following contextual factors across four countries: knowledge, access, and use of chronic disease prevention processes.Methods: In this cross-sectional study, public health practitioners (N = 400) from Australia (n = 121), Brazil (n = 76), China (n = 102), and the United States (n = 101) completed a 26-question survey on EBCDP. One-way ANOVA and Pearson's Chi-Square tests were used to assess differences in contextual factors of interest by country.Results: Practitioners in China reported less knowledge of EBCDP processes (p < 0.001) and less use of repositories of evidence-based interventions, than those from other countries (p < 0.001). Academic journals were the most frequently used method for accessing information about evidence-based interventions across countries. When selecting interventions, Brazilian and Chinese practitioners were more likely to consider implementation ease while the Australian and United States practitioners were more likely to consider effectiveness (p < 0.001).Conclusions: These findings can help inform and improve within and across country strategies for implementing EBCDP interventions.