Population cardiovascular health and urban environments: the Heart Healthy Hoods exploratory study in Madrid, Spain

Abstract

BackgroundOur aim is to conduct an exploratory study to provide an in-depth characterization of a neighborhood’s social and physical environment in relation to cardiovascular health. A mixed-methods approach was used to better understand the food, alcohol, tobacco and physical activity domains of the urban environment.MethodsWe conducted this study in an area of 16,000 residents in Madrid (Spain). We obtained cardiovascular health and risk factors data from all residents aged 45 and above using Electronic Health Records from the Madrid Primary Health Care System. We used several quantitative audit tools to assess: the type and location of food outlets and healthy food availability; tobacco and alcohol points of sale; walkability of all streets and use of parks and public spaces. We also conducted 11 qualitative interviews with key informants to help understanding the relationships between urban environment and cardiovascular behaviors. We integrated quantitative and qualitative data following a mixed-methods merging approach.ResultsElectronic Health Records of the entire population of the area showed similar prevalence of risk factors compared to the rest of Madrid/Spain (prevalence of diabetes: 12 %, hypertension: 34 %, dyslipidemia: 32 %, smoking: 10 %, obesity: 20 %). The food environment was very dense, with many small stores (n = 44) and a large food market with 112 stalls. Residents highlighted the importance of these small stores for buying healthy foods. Alcohol and tobacco environments were also very dense (n = 91 and 64, respectively), dominated by bars and restaurants (n = 53) that also acted as food services. Neighbors emphasized the importance of drinking as a socialization mechanism. Public open spaces were mostly used by seniors that remarked the importance of accessibility to these spaces and the availability of destinations to walk to.ConclusionThis experience allowed testing and refining measurement tools, drawn from epidemiology, geography, sociology and anthropology, to better understand the urban environment in relation to cardiovascular health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-016-0213-4) contains supplementary material, which is available to authorized users.

Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED)

“…This study was part of the European-funded project “Heart Healthy Hoods”, which assesses the physical and social urban environment in relation to residents’ cardiovascular risk in Madrid [ 24 ]. As part of this larger project, we adapted the original NEMS-S survey for the Mediterranean context using the city of Madrid as an example.…”

“…They walked a predefined route within each census tract to guide the fieldwork. They assessed all food stores present in the census tracts and classified them into the following categories, adapted from Glanz et al to the Mediterranean context [ 21 , 24 ] as supermarkets (including discounters), convenience stores (including gas stations), or traditional/specialized stores (e.g., fruit and vegetable stores, butcheries, bakeries, or fishmongers). Further, raters also collected data on the business name, street address, and hours of operation.…”

“…We compared the NEMS-MED scoring across types of food stores with known differences regarding the foods they carry according to the original NEMS-S and previous research [ 18 , 19 ]. We hypothesized that supermarkets would have greater availability of healthy foods, while convenience stores would have the lowest availability of healthy foods, based on previous research [ 24 ]. Finally, we compared the scorings across area-level socioeconomic status, by tertiles.…”

The mismatch between observational measures and residents’ perspectives on the retail food environment: a mixed-methods approach in the Heart Healthy Hoods study

“…Previous studies have highlighted the need for understanding the perceptions on the food environment (12)(13)(14) . Qualitative methods can extend existing quantitative research by providing an in-depth understanding of residents' perspectives (15,16) . Using a mixedmethods research approach, we focused on a research question that calls for real-life contextual understandings and multilevel perspectives (16) .…”

SemEHR: A General-purpose Semantic Search System to Surface Semantic Data from Clinical Notes for Tailored Care, Trial Recruitment and Clinical Research

“…The opportunity for secondary use of the wealth of information contained within Electronic Health Records (EHRs) has attracted researchers interested in investigating approaches to provide more tailored and timely care, improve efficiency of services and to derive new scientific and medical insights [1][2][3][4]. In addition to structured data contained within relational database tables (such as ICD-10 diagnoses codes), EHR documents are filled with unstructured clinical notes, such as nursing records, radiology reports or discharge summaries.…”