Brazilian Cities Research Articles

Racial and income inequalities in access to healthcare in Brazilian cities

IntroductionPeople's access to public healthcare can importantly contribute to reducing the prevalence of diseases and increasing life expectancy. Despite the advances of Brazil's Unified Health System (SUS), the country faces a permanent challenge in improving the coverage and equity of healthcare to reduce racial, spatial, and income inequalities in access to healthcare. Several studies have explored the spatial dimension of socioeconomic inequalities in access to healthcare in Brazil, but few analyze such inequalities within cities and bring evidence of racial inequalities. MethodsThis paper presents the first large-scale study in Brazil examining the social and racial inequalities of access to healthcare at a high spatial resolution. The analysis covers access to primary and high-complexity public healthcare by public transport, automobile, and walking for the 20 largest cities in Brazil in 2019. ResultsThe results show that individuals with low income, regardless of race, have greater accessibility to primary healthcare in general. In contrast, individuals with high-income, mostly white, have substantially better accessibility to high-complexity healthcare. Yet, we find that racial inequalities in access to healthcare become much smaller when controlling for income. ConclusionsThe results contribute to a better understanding of the geographical dimension of inequalities in access to healthcare in major Brazilian cities, showing how access to healthcare is strongly conditioned by social, economic, and transport-related factors.

Elements of Interference in Professional Performance, Well-Being and Productivity: A Comparative Study with Companies in the Supermarket Sector in a Brazilian City

Objective: To analyze which variables interfere with the professional performance, well-being and productivity of employees in companies in the supermarket sector in the city of Governador Nunes Freire/MA. Theoretical Framework: Uses as foundations the theories of Maslow's Hierarchy of Needs and Herzberg's Two Factors relating to professional performance, motivation, well-being at work and productivity. Method: Descriptive and comparative research methods were used. In data collection, a semi-structured questionnaire was applied to 26 employees of the two supermarkets under study. Results and conclusions: The results found in the research show that an adequate organizational environment in the service area; organizational commitment and the family factor are elements that contribute to good organizational performance, well-being and productivity at work. Implications of the research: It contributes to the development of knowledge in an area that still lacks a consensual definition or without clear conceptions: well-being at work and organizational human relations in this type of entity. Originality/value: The study is unprecedented in the northwest region of the state of Maranhão and leaves room for future research, as well as through a more practical perspective, still being able to help companies involved in identifying and analyzing the variables involved in professional performance, the well-being and productivity of its employees to formulate better organizational policies for people.

Assessment of the ABC2-SPH risk score to predict invasive mechanical ventilation in COVID-19 patients and comparison to other scores.

Predicting the need for invasive mechanical ventilation (IMV) is important for the allocation of human and technological resources, improvement of surveillance, and use of effective therapeutic measures. This study aimed (i) to assess whether the ABC2-SPH score is able to predict the receipt of IMV in COVID-19 patients; (ii) to compare its performance with other existing scores; (iii) to perform score recalibration, and to assess whether recalibration improved prediction. Retrospective observational cohort, which included adult laboratory-confirmed COVID-19 patients admitted in 32 hospitals, from 14 Brazilian cities. This study was conducted in two stages: (i) for the assessment of the ABC2-SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC2-SPH score recalibration and also comparison with other existing scores, patients admitted from January 1, 2021, to March 31, 2022, were enrolled. For both steps, the area under the receiving operator characteristic score (AUROC) was calculated for all scores, while a calibration plot was assessed only for the ABC2-SPH score. Comparisons between ABC2-SPH and the other scores followed the Delong Test recommendations. Logistic recalibration methods were used to improve results and adapt to the studied sample. Overall, 9,350 patients were included in the study, the median age was 58.5 (IQR 47.0-69.0) years old, and 45.4% were women. Of those, 33.5% were admitted to the ICU, 25.2% received IMV, and 17.8% died. The ABC2-SPH score showed a significantly greater discriminatory capacity, than the CURB-65, STSS, and SUM scores, with potentialized results when we consider only patients younger than 80 years old (AUROC 0.714 [95% CI 0.698-0.731]). Thus, after the ABC2-SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127). The ABC2-SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age.

Vagal dysautonomia in patients with Chagas disease and mortality: 14-year results of a population cohort of the elderly

IntroductionGreat part of Chagas disease (ChD) mortality occurs due to ventricular arrhythmias, and autonomic function (AF) may predict unfavorable outcomes. We aimed to evaluate the predictive value of AF indexes in ChD patients. MethodsThe Bambuí Study of Aging is a prospective cohort of residents ≥60 years at study onset (1997), in the southeastern Brazilian city of Bambuí (15,000 inhabitants). Consented participants underwent annual follow-up visits, and death certificates were tracked. AF was assessed by the maximum expiration on minimum inspiration (E:I) ratio during ECG acquisition and by heart rate variability indices: SDRR (standard deviation of adjacent RR intervals) and RMSSD (square root of the mean of the sum of squares of the differences between adjacent RR intervals)), calculated using a computer algorithm. Cox proportional hazards regression was performed to access the prognostic value of AF indexes, expressed as terciles, for all-cause mortality, after adjustment for demographic, clinical and ECG variables. ResultsFrom 1742 qualifying residents, 1000 had valid AF tests, being 321 with ChD. Among these, median age was 68 (64–74) years, and 32.5% were men. In Cox survival analyses, only SDRR was associated with all-cause mortality in non-adjusted models: SDRR (hazard ratio (HR): 1.26 (95% CI 1.08–1.47), p < 0.001), E:I ratio (HR: 1.13 (95% CI 0,98–1.31), p = 0.10) and RMSSD (HR: 0.99 (0.86–1.16), p = 0.95). After adjustment for sex and age, none of the indexes remained as independent predictors. ConclusionAmong elderly patients with ChD, AF indexes available in this cohort were not independent predictors of 14-year mortality.

When Ethics and the Law Collide: A Multicenter Demonstration Cohort Study of Pre-Exposure Prophylaxis Provision to Adolescent Men Who Have Sex With Men and Transgender Women in Brazil

PurposeTo explore legal and ethical challenges related to adolescents’ participation in human immunodeficiency virus (HIV) research that may affect their best interests. MethodsWe analyzed the ethical principles and legal aspects of the participation of 15–17-year-old men who have sex with men and transgender women in the pre-exposure prophylaxis (PrEP) 1519 study, a PrEP demonstration cohort study in three Brazilian cities. The analyses of ethics review committees’ (ERCs) evaluations and court decisions followed ethical and human rights principles. An HIV vulnerability score was created, and descriptive statistics and multivariate logistic regression were performed using data from 347 participants. ResultsThe ERCs evaluated the benefits and risks of research participation, all finding that the benefits outweighed the risks. ERCs deferred responsibility for decisions about waiving parental consent to the judiciary. State courts reached different decisions about waiving parental consent, reflecting variation in recognition of adolescents’ evolving capacities and the adolescent as a subject of sexual rights and the primary agent capable of deciding on their health and best interests. The most vulnerable adolescent participants were found in sites where the blanket waiver was in place. DiscussionJudicializing the ethical review process is detrimental to fulfilling the ethical principle of justice and vulnerable adolescents’ access to health research. ERCs must be sufficiently independent and autonomous and have the capacity to respect, protect, and help fulfill the rights of participants while ensuring the generation of adequate evidence to inform public health practice.

Violence, Discrimination, and High Levels of Symptoms of Depression Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil

PurposeThis study aimed at describing the prevalence of symptoms of depression among 15–19 year old adolescent men who have sex with men (aMSM) and transgender women (aTGW), who were recruited in an HIV pre-exposure prophylaxis cohort study in three Brazilian capital cities. The study also examined potential associations, including violence and discrimination, with severe symptoms of depression among aMSM. MethodsThis is a cross-sectional study of baseline data among 730 aMSM and 56 aTGW recruited between February 2019 and February 2021. Sociodemographic and behavioral data were collected. The 20-item Center for Epidemiologic Studies Depression scale was used to screen for symptoms of depression. Scores of ≥22 points indicate the presence of severe symptoms associated with major depression. Logistic regression was used to assess independent associations among aMSM, adjusting for sociodemographic variables. ResultsOur findings indicate a high prevalence of symptoms of depression (overall prevalence = 58.5% and 69.6%; 21.2% and 25.0% for mild/moderate, and 37.3% and 44.6% for severe) among these aMSM and aTGW, respectively. Psychological violence (aOR = 1.74; 95% CI = 1.12–2.70), sexual violence (aOR = 1.79; 95% CI = 1.07–2.98), and discrimination due to sexual orientation (aOR = 1.71; 95% CI = 1.23–2.38) were independently associated with severe symptoms of depression in aMSM. DiscussionThe high prevalence of severe symptoms of depression and its association with psychological and sexual violence and discrimination creates cycles of vulnerability and carries important public health implications. Thus, our findings indicate public policies should consider assessing depression, psychological and sexual violence, as well as discrimination, especially in populations that will be targeted by interventions, such as the use of pre-exposure prophylaxis.

Oral Pre-Exposure Prophylaxis for HIV Discontinuation in a Large Cohort of Adolescent Men Who Have Sex With Men and Transgender Women in Brazil

PurposeThis study aimed to describe pre-exposure prophylaxis (PrEP) for HIV discontinuation in adolescent men who have sex with men (aMSM) and adolescent transgender women (aTGW) and to identify factors associated with discontinuation. MethodsThe PrEP1519 study included a cohort of aMSM and aTGW aged 15–19 years old, and it was conducted in three large Brazilian capital cities. For this analysis, we included adolescents who initiated PrEP. PrEP discontinuation was defined as no possession of PrEP pills for >90 days. Kaplan-Meier curves were used to analyze the probabilities of discontinuation, and survival distributions stratified by covariates were compared using log-rank or Wilcoxon tests. Cox regression models were used to estimate the adjusted hazard ratio (aHR) with a 95% confidence interval (95% CI). ResultsWe included 908 adolescents, 829 (91.30%) aMSM and 79 (8.70%) aTGW, most of whom were 18–19 years (80.29%). The incidence rate of discontinuation was 75.6 per 100 person-years. The probability of discontinuation was 52.61% in the first year. The multivariate analysis demonstrated that the aTGW (aHR = 1.63; 95% CI: 1.02–1.64) and adolescents with a medium (aHR = 1.29; 95% CI: 1.02–1.64) or low (aHR = 1.65; 95% CI: 1.29–2.12) perceived risk of HIV infection had an increased risk of discontinuation, whereas the adolescents with a partner living with HIV had a lower risk of discontinuation (aHR = 0.57; 95% CI: 0.35–0.91). DiscussionAdolescents with a high risk for discontinuation may need additional support that emphasizes the value of PrEP as a tool for HIV prevention because PrEP discontinuation was associated with a disconnect between HIV risk perception and HIV prevention.

Same-Day Initiation of Oral Pre-Exposure Prophylaxis is High Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil

PurposeThis study analyzed the sociodemographic and behavioral characteristics of adolescent men who have sex with men (aMSM) and transgender women (aTGW) initiating oral pre-exposure prophylaxis (PrEP) in human immunodeficiency virus (HIV) prevention clinics. MethodsPrEP1519 is a prospective, multicenter, open-label PrEP demonstration cohort study of aMSM and aTGW aged 15–19 years living in three large Brazilian capital cities. For this analysis, we included adolescents who enrolled in PrEP1519 from February 2019 to August 2021. Adolescents who visited PrEP clinics were classified into four groups based on PrEP eligibility and on their decision to use PrEP: (1) ineligible for same-day PrEP initiation; (2) eligible for same-day PrEP initiation, initiated PrEP at first visit; (3) eligible for PrEP initiation, initiated PrEP after the first visit; and (4) eligible for same-day PrEP initiation but declined. The groups that were eligible for same-day PrEP initiation were compared using the Chi-square and Fisher’s exact tests. ResultsOf the 1,254 adolescents enrolled in the PrEP1519 study, 61 (4.9%) were considered ineligible for same-day PrEP initiation. Of the 1,193 eligible for same-day PrEP initiation, 1,113 (93.3%) initiated PrEP [1,054 initiated PrEP in the first visit (88.3%) and 59 in subsequent visits (4.9%)] and 80 (6.7%) did not. Despite 90% of the PrEP decliners reporting a low risk of HIV infection, most reported condomless anal sex in the past six months (70%). DiscussionSame-day PrEP initiation among aMSM and aTGW was high, highlighting that this strategy was important to promote PrEP initiation among adolescents with increased vulnerability to HIV in Brazil.

Learning Deliberative Capacities in Brazilian Schools

What are the impacts of teaching deliberation on students’ attitudes in practical discussions? This study presents research findings from a field experiment involving more than 500 students from five public schools in the Brazilian cities of Belo Horizonte and Belém. We found a small effect of deliberative training on students’ justifications of their views and telling personal stories. However, much larger effects emerged when data were analysed separately by schools’ socioeconomic contexts, suggesting that middleclass students benefited more from training than disadvantaged students. Respect did not vary between groups and school contexts. Overall participation in discussion increased, and the effect was significantly greater in treatment groups, with positive inclusion of female students. The results support the view that learning deliberation is not a unidimensional process, but a complex combination of different components, and some capacities are more easily achieved than others.

Merging transport network companies and taxis in Curitiba’s BRT system

AbstractThe Brazilian city of Curitiba became known around the world for pioneering bus rapid transit (BRT) in the 1970s. Five decades later, public transport ridership is declining on the city’s bus-based system. One-person car trips and car ownership are soaring, and services provided by transport network companies rapidly proliferate and then disappear as congestion worsens and expands across the road network. This was the macro-scale scenario for mobility and modal trends in Curitiba until COVID-19 brought things to a screeching halt in 2020. The widespread use of information and communication technologies has allowed taxi and car ride-hailing transport network schemes to emerge while blurring the lines between public and private and individual and collective transport, locally as well as globally. In 2016, transport network company systems, apps, private cars, services, drivers and passengers disrupted Curitiba’s longstanding and well-regulated taxi system and market for licenses. In 2023, hailing a cab or a shared ride feels and costs the same for passengers (now customers). This study investigates whether these actors and technologies compete with or complement each other in this city, locating and quantifying the benefits for passengers of merging taxi and car ridesharing with the BRT system as first- and last-mile transport to and from BRT corridors. We developed mobile information and communication technologies and acquired, processed, and analyzed millions of data points for passenger location on BRT, ordinary bus, and taxi trips at the city scale. The shareability index for Curitiba’s taxi or car rides was calculated, demonstrating that 60% of all taxi trips have the potential to serve as first- and last-mile transport solution to and from the BRT terminals, stations, and corridors and that nearly 40% of taxi trips both originate and end near (&lt; 500 m) this BRT system infrastructure. By envisioning how transport network companies could merge into the built environment thanks to urban transport digitization, we have developed a model for integrating public transport with the analytic framework of transport network companies that could be deployed in other cities with similar challenges related to public transport, sociotechnical arrangements, system complexity, policymaking, and planning.

Do Brazilian regulatory measures promote sustainable and healthy eating in the school food environment?

BackgroundRegulatory measures regarding food in the school environment aim to promote a healthier food environment in public and private schools. In Brazil, implementing regulations in the school food environment does not occur the same way across states and cities, and no national regulation covers public and private schools. The present study aims to analyze regulatory measures for school food environments in Brazilian states and cities and develop a score to evaluate them.MethodsA systematic search of the regulatory measures in force and implemented until 2021 was conducted. The score was developed based on the Model Law Project prepared by the Brazilian Institute for Consumer Protection. It considered food and nutrition education actions, restrictions on the sale and distribution of food, a ban or restriction on food advertising and marketing, and points of excellence. These points included regulations that addressed the importance of supervision and social control, laws regulated by decree, the mention of a ban on ultra-processed foods, and whether the regulatory measures covered public and private schools.ResultsSixty-five cities and states regulatory measures in force were found to be evaluated jointly by a federal entity (n = 43). Among the federal entities evaluated, only 13.95% fulfilled the function of promoting sustainable and healthy eating (8–12 points).ConclusionsBrazilian children and adolescents are exposed to a school food environment with regulations that partially fulfill the function of promoting an adequate, healthy, and sustainable diet. In this sense, it is necessary to improve regulatory measures or to encourage states and cities to develop effective legal provisions that are in line with the food guide for the Brazilian population and with the perspective of a healthy school food environment for the effective promotion of adequate, healthy and sustainable and healthy food in schools.

A tale of two communities: Comparing user perceptions of condominial and conventional sewer systems in Salvador, Brazil

Problems of access and quality of sanitary sewage disproportionately impact the health of populations in urban peripheries of low-and middle-income countries. The condominial sewer system is a practical, low-cost, effective, and simplified engineering approach compared to conventional sewer systems. In support of meeting the sanitation needs in highly populated urban settings, there is a need to understand the residents’ perceptions regarding the advantages and disadvantages of this sanitation model compared to conventional sewer systems. We conducted a cross-sectional study from September to December 2021 in two urban communities of Salvador, Bahia, Brazil, where condominial and conventional sewer systems had been implemented in the last five years. Of the 203 residents we interviewed, 50.7% lived in a site served by a condominial sewer system. Residents in the condominial sewer site reported not connecting to public sewage network (23.7% vs. 11.2%; p = 0.022) more often than in the conventional site. They reported more collective action to solve urban sanitation problems (69.9% vs. 54.0%; p = 0.020), such as manhole cleaning and unclogging efforts to fix plumbing. Despite these challenges, these residents expressed that the current service quality is better than it was in the previous two years. Our results suggest that even within urban periphery communities of a large Brazilian city, disparities exist in access to and quality of sanitation services that may be linked to sewage system implementation. Implementing simplified sewer systems is important to meet the growing sanitation demands of urban areas. However, these systems should also play a role in reducing sanitation disparities and the adoption of participatory approaches to meet the needs of populations in the most disadvantaged conditions. Despite challenging conditions, there is the potential for community engagement and active participation in sanitation-related matters, which could enhance the implementation and long-term sustainability of these systems.

Applying the index of sustainable urban mobility (I_SUM) in a planned small city: The case of Itá, Brazil

Few cities in the world start in a planned way. Even less those that remain in the initially projected size. Uncontrolled urban and population growth negatively affect urban mobility, such as inefficient public transport and lack of accessibility. Furthermore, constant investment and continued political action are needed to guarantee the sustainability of urban mobility. However, whether planned and small cities also have such mobility problems is unknown. Itá is a small Brazilian city planned and constructed less than 50 years ago due to hydroelectric dam construction. The Index of Sustainable Urban Mobility (I_SUM), developed by Costa, was used to analyze the quality of mobility in Itá. From 87 indicators, 59 could be measured, resulting in a grade of 0.546 (from zero to one). The lower scores in environmental and political aspects reflect the municipal administration's limited actions, despite the well-developed areas due to investments by the group that manages a prominent local business. Also, non-motorized transportation presents an excellent opportunity for the city due to its size. Finally, investments in transport infrastructure and non-motorized modes are necessary to sustain urban mobility.

The Park and the city: analysis of the Ecological Park “Valdemar Salmeirão”, in the city of Birigui/SP

Most Brazilian cities have developed disorderly and in little harmony with the natural landscape, especially in the valley bottoms. It is understood that harmonious integration with the environment is the way to the permanence of cities and the well-being of their inhabitants, besides being a way to solve the problems that affect the urban environment. Thus, strategies have been formed in favor of quality urban expansion. The creation of linear parks in valley bottoms (aiming at the integration between people, vegetation, and waterways) is a good intervention that culminates in quality spaces and quality of life in society. However, if these spaces are not used and are not properly maintained, they will not achieve their purpose and tend to be abandoned. This article aims to highlight the relationship between river and city, analyzing the issue of interventions in valley bottoms, having as a case study the Ecological Park "Valdemar Salmeirão" in Birigui-SP, verifying its state and its current appropriation, based on bibliographic, cartographic and photographic surveys that support and illustrate the area in question.

Implementing a digital platform for patient navigation: Experience of a Brazilian oncology network.

560 Background: Cancer treatment involves the use of long-term therapies, mostly oral, and new drug developments are improving patients’ survival, bringing hope, but also more complexity to care delivered. Trials using digital platforms for patient remote monitoring demonstrated increased survival and patient satisfaction, but demands a great effort in implementation and multidisciplinary team engagement. Oncoclínicas Group is a large multidisciplinary private oncology network present in 35 Brazilian cities with 133 units that have specialists in the areas of oncology, radiotherapy, hematology and bone marrow transplantation, multidisciplinary teams, complementary care and the most advanced in integrated assistance and individualized treatment. Here we describe our experience in developing and implementing the platform OC por Você. Methods: In July 2022, Oncoclinicas Group partnered with Meu Médico startup to develop an EHR-integrated platform that was adherent to Oncoclínicas safety needs. The agile development process incorporated user-centered design principles that required engagement from patients, clinicians, and health care systems. Defined features: a chat center specifically designed for the patient and multidisciplinary team with decision tree for patients specifics needs; embedded telemedicine; digital prescription; sending images or documents; view of the patient chart, health professionals agenda, pathology test results; access to treatment protocols for each cancer type. In January 2023 a first wave was planned, implementing in three sites. From April through June 2023, seven waves of implementation were planned. The Oncoclínicas Digital Team trained all health professionals before launch, and educational videos and digital cards were developed for both health professionals and patients. Results: From January through April 2023, 149 users downloaded the mobile platform. There were 11 doctors, 44 non-medical health professionals and 94 patients. A total of 199 chats were initiated, with 3409 messages exchanged and 20 teleconsultations. From April through June 2023, the platform was implemented in a total of 21 units, 10 cites, where 990 users downloaded the mobile platform. There were 173 doctors, 318 non-medical health professionals and 499 patients. A total of 870 chats were initiated, with messages exchanged and 224 teleconsultations. Until December 2025 other waves of implementation will happen to complete the full implementation process. Conclusions: Implementing a digital mobile platform for cancer patient care is feasible in a private oncology practice network in Brazil. Several pitfalls were identified, especially the need for constant engagement with the care provider team. Systems of this nature should be encouraged in order to keep the communication channel open to patients and families, improving the care to be rendered.

Ankle fractures malreduction rate and its causes in two Brazilian tertiary training hospitals

IntroductionAnkle fractures are one of the most frequent injuries managed by any trauma surgeon. Literature has shown that adequate reduction is of utmost importance to achieve satisfactory functional outcomes. However, malreduction rates remain high worldwide. The objective of the present study is to evaluate the quality of ankle fracture reduction in two major trauma centers in a large Brazilian city and to analyze the factors associated with malreduction MethodsEpidemiologic data of 382 patients (189 men; 193 women) aged between 7 and 87 years who underwent osteosynthesis of the ankle in two trauma centers in a large Brazilian city. Electronic clinical records, preoperative and immediate postoperative radiographs in anteroposterior (AP), lateral and mortise views were evaluated. Pettrone's criteria were used to evaluate the quality of ankle fractures reduction. All radiographs were independently evaluated by two foot and ankle senior surgeons ResultsOverall, malreduction rate was 22.2%. Forty-seven (55.2%) fractures classified as malreduced had medial malleolar displacement The results showed three factors that significantly affected the quality of reduction (p<0.05), patients over 60 years, open fractures and fracture-dislocations. Patients aged over 60 years were twice more likely to have poor reduction of ankle fractures than younger ones. The risk of poor fracture reduction among those individuals with open fractures is 2.15 times greater than among patients with closed injuries. Fracture-dislocation imposed a 2.7 higher risk for malreduction DiscussionWe found a malreduction rate below most series previously published. Further results agree with the literature. Elderly people aged over 60 years, fracture dislocations and open fractures are associated with worse results, influencing the quality of the reduction, clinical outcomes, and the development of post-traumatic arthrosis ConclusionAnkle fractures malreduction are associated with higher age, open fractures, and fracture-dislocations.

Land use and environmental impacts: Flood model in a medium-sized Brazilian city as a tool for urban sustainability

Thinking, articulating, and promoting research focused on themes and issues inherent to urban spaces has posed challenges to various areas of science, particularly encouraging multidisciplinary research. Among the various studies on urban phenomena, those that reflect structural problems, whether of natural origin or resulting from human actions in space, stand out. Examples include recurrent flooding in various cities. In this regard, with the aim of correlating urban problems with the perspectives inherent to Urban Sustainability, this research aims to propose a flood model as a tool for thinking and planning space utilization. The method used consisted of creating a Flood Model, adopting an applied research approach and employing a multidisciplinary theoretical-methodological framework. This research was conducted using a medium-sized city, Montes Claros, in the state of Minas Gerais, Brazil. Geotechnologies and Geographic Information System (GIS) were utilized in constructing the Flood Model. As conclusions, the results point towards new perspectives on the conception of Urban Policies and Planning, seeking to establish guidelines to achieve the sustainability of urban spaces and to prevent flooding disasters and risks based on the structured model in this study. Additionally, it underscored the need for oversight of installation works in subdivisions and public area paving to require the construction of an appropriate drainage system tailored to the local reality, as well as the regulation of subdivisions and occupations in floodplains of watercourses, primarily through technical, management, and policy approaches.

Concentration levels of atmospheric contaminants in Brazilian cities measured by passive sampling

Measurements of air pollutants were made using passive sampling in Brazilian urban centers. The levels of SO2 and NO2 exceeded the WHO recommendations in São Paulo (SP), Londrina and Rio de Janeiro. Formaldehyde concentrations exceeded international recommendations in all urban centers and benzene concentrations exceeded 1.7 μg m−3, level associated with the probability of leukemia, according to the WHO. Sewage discharge in the Pinheiros River - SP and in Lake Pampulha - BH contributed to higher levels of H2S and NH3 in these urban centers. The BH atmosphere was also influenced by emissions from landfills. Organic and inorganic acids contributed similarly to atmospheric acidity. 71% of the calculated ratios between concentrations of formic and acetic acids were < 1, demonstrating the predominant influence of vehicle emissions on the atmospheric levels of these acids. Multivariate analysis showed that VOCs and organic acids are more influenced by temperature and solar radiation. The stronger direct relationship of NOx was with wind direction, showing competition between local emission and photochemical aging of these compounds brought from other locations. On a global scale, studies of this type are necessary and important to increase the accuracy of exposure estimates in different places where people live.

Addressing pressures on health services in Belo Horizonte, Brazil through community-based care for poor older people: a qualitative study

In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to examine these effects for a specific scheme, Programa Maior Cuidado (PMC) in the Brazilian city of Belo Horizonte. Building on quantitative findings reported elsewhere, we use qualitative data to develop and test theories of change. These include data from 50 meetings with policymakers, managers and staff in 30 health centres and social assistance posts. Data collection was embedded in key informant interaction and knowledge coproduction. Data include participant and non-participant observation, focus groups and semi-structured interviews with key informants, as well as older people and carers from seven families. The data reveal three theories of change. Theory 1 is PMC maintains older people's health which reduces their need for inpatient or outpatient care. We find strong evidence to support this, through effects on use of medication, chronic disease management and risk prevention. Theory 2 is PMC promotes timely intervention by anticipating health problems, thus reducing demand for emergency and acute care. We find some evidence for this, but it was limited by limited availability of timely treatment or referral beyond PMC. Theory 3 is PMC facilitates hospital discharge. We find limited evidence for this, reflecting a lack of formal liaison between PMC and hospitals. Schemes like PMC have potential to reduce pressures on health service utilisation by older people, if they are well articulated with wider health services. Medical Research Council, Newton Fund and Brazilian Council of State Funding Agencies.

Assessing the macro-scale patterns of urban tree canopy cover in Brazil using high-resolution remote sensing images

This study creates a 0.5 m resolution urban tree canopy (UTC) cover dataset using high-resolution remote sensing images based on the deep learning method to clarify urban tree-cover characteristics in Brazilian cities. The results revealed that the UTC cover of Brazilian cities is spatially heterogeneous, ranging from 5% to 34%. There was a difference in UTC coverage between the old and new urban areas, with the average largest difference near 5%. More than 76% urban population exposure to UTC coverage of 0∼0.2. Most cities have a relatively high inequality in human exposure to urban tree-covered spaces, especially in northeastern and southeastern Brazil. Results from the geographical detector models show climatic factors play a major role in determining the UTC cover patterns in Brazilian cities, followed by socioeconomic, geographical, soil, and urbanization factors. This study suggests the Brazilian government pay more attention to greening renovation projects in old urban areas and formulate effective urban tree irrigation policies for cities with limited autumn and winter rainfall. The study also suggests follow-up research on UTC cover patterns that consider the effects of race, urban history, city structure, land use, and local government policy factors to further support the goals of sustainable development in Brazilian cities.