Medium-sized Brazilian City Research Articles

Effect of COVID-19 on Cardiovascular Disease Mortality in a Medium-Sized City

Introduction: Patients hospitalized for COVID-19 have a high prevalence of cardiovascular risk factors, such as hypertension and diabetes mellitus, in addition to chronic cardiovascular conditions, such as ischemic heart disease and heart failure. Other fatal events have also occurred, and are somehow indirectly associated with the pandemic, such as deaths from neglected or inadequately treated diseases due to an overburdened health system or fear of leaving home at the height of the COVID-19 pandemic. The present study aims to evaluate the impact of COVID-19 on CVD statistics in a medium-sized city.Methods: A retrospective observational study with 546 patients who died due to cardiovascular diseases, between January 1, 2019 and December 31, 2020. Regarding the year of death, continuous variables were compared using the unpaired t-test and categorical variables using Pearson’s chi-square or Fisher’s exact test. Considering a significance level of 0.05 in the two-tailed test.Results: A total of 545 deaths due to cardiovascular diseases were evaluated, 272 in 2019 and 274 cases in 2020. There was no difference in age and sex ratios between the years evaluated. There was a higher frequency of deaths at home in 2020 compared to 2019; a reduction in the frequency of deaths occurring in hospitals.Conclusion: The results indicate an increase in the number of deaths at home due to CVD reported by SIM in 2020 compared to the same period in the previous year, in a medium-sized Brazilian city.

Individual and Contextual Factors Associated with Adolescents' Self-Perceived Need for Treatment.

The present study aimed to investigate associations between the self-perceived dental treatment need and clinical factors, familial characteristics, and school context in adolescents. A cross-sectional study was conducted with a representative sample of 746 students aged 15 to 19 years in a medium-sized city in Brazil. Data collection involved the use of a sociodemographic questionnaire, an oral health questionnaire, and the Family Adaptability and Cohesion Scales (FACES III) instrument. Clinical examinations were performed by two trained and calibrated examiners (Kappa > 0.80) using the Nyvad criteria. A robust logistic regression analysis for complex samples was performed using a multilevel approach (α = 5%). The individual factors associated with the self-perceived treatment need were dental pain (OR = 1.08; 95% CI: 1.01-1.16), the loss of the first molars (OR = 1.09; 95% CI: 1.03-1.15), and disengaged family cohesion (OR = 1.15; 95% CI: 1.01-1.31). In terms of context, attending a public school was associated with the self-perceived treatment need (OR = 1.17; 95% CI: 1.02-1.33). Thus, the individual factors of toothache, tooth loss, and a disengaged family, as well as the school context, exerted an influence on the self-perceived treatment need.

Analyzing the clinical-pathological characteristics of HER-2 Ultra-low breast cancer in a medium-sized Brazilian city: A brief communication

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Analysis of strategies for sustainable transit-oriented development (TOD) used in medium-sized Brazilian cities

Analysis of strategies for sustainable transit-oriented development (TOD) used in medium-sized Brazilian cities

Residentes em Instituições para Idosos: Características e sua Relação com a Instituição

Abstract Population aging and the reduction in the availability of family caregivers have driven the demand for care for older adults in long-term care facilities (LTCF). This study aimed to characterize the sociodemographic, functional, cognitive and emotional aspects of residents of philanthropic LTCF in a medium-sized Brazilian city. This study also sought to correlate variables in residents’ life and their levels of depression and cognitive performance. Cognitive (MMSE and ACE-R) and mood screening instruments (GDS-15) and a guided interview were applied to 78 residents. Generally, residents were White, single/widowed, independent women showing depressive symptoms (52%) and cognitive impairment (74%). Most participants reported satisfaction with the care offered by the LTCF, but this satisfaction was negatively correlated with the depression score. This profile suggests the need for an institutional arrangement that considers the needs of residents and promotes their quality of life.

Socio-spatial segregation, urban growth morphology and socioeconomic fragmentation in medium-sized Brazilian cities

Resumo A segregação socioespacial é um processo que vem constituindo o espaço urbano, particularmente em contextos periféricos e de desigualdades socioeconômicas onde a restrição do contato aprofunda condições de uma urbanização desigual. Neste trabalho analisamos evidências empíricas quantitativas associadas a reflexões teórico-críticas sobre o processo de urbanização contemporânea adotando os conceitos de fragmentação e segregação para analisar 125 cidades brasileiras de porte médio, entre os anos 1985 e 2020, nas quais em 60% dos casos a expansão se deu em velocidades superiores ao crescimento populacional. Detalhamos estudo em Pelotas/RS e Blumenau/SC, às quais aplicamos índices espaciais locais de segregação (dissimilaridade e isolamento) buscando analisar a associação entre morfologia da expansão e indicadores locais de segregação. Para ambas as cidades observamos que os distintos padrões morfológicos de expansão ocorrem com certa estabilidade nos índices globais de dissimilaridade, cujas áreas de expansão urbana combinam e justapõem situações locais de isolamento socioeconômico para os extremos grupos de alta e baixa renda. Os resultados sugerem que a expansão urbana tem sido estruturada pela segregação socioespacial, cujos processos encontram na morfologia urbana interna mecanismos para garantir a separação e a restrição no contato entre grupos sociais distintos.

Prevalence and antimicrobial resistance profile of pathogens isolated from patients with urine tract infections admitted to a university hospital in a medium-sized Brazilian city.

This study aimed to determine the antibiotic profile of microorganisms isolated from urine samples of patients with community urine tract infections (UTI) admitted to the University Hospital of the Federal University of Sao Carlos to support an appropriate local empirical treatment. A retrospective cross-sectional study was conducted from October 2018 to October 2020. Data from 1,528 positive urine cultures for bacterial pathogens and antibiograms were tabulated. Bacterial species prevalence and their resistance profile were analyzed and compared by sex and age. For Gram-negative fermenting bacteria, resistance rates were compared between patients with previous hospitalization and the total of infections caused by this group. For comparisons, the Chi-square test was performed, using Fisher's exact test when necessary (BioEstat program, adopting p ≤ 0.05). A multivariate analysis was applied to assess the effect of the studied variables in predicting multidrug resistance. Infections were more prevalent in women and older adults. Gram-negative bacteria represented 90.44% of total cultures. In both sexes, E. coli prevalence was significantly higher in adults compared with older adults (p < 0.0001). For several antibiotics, resistance rates were higher in the older adults compared with other ages and in patients with Gram-negative fermenting infections and previous hospitalization compared with the total of infections by this group of bacteria. The closer to the hospitalization, the higher the number of antibiotics with superior resistance rates. Resistance rates for aminoglycosides, carbapenems, ceftazidime, nitrofurantoin, piperacillin+tazobactam, and fosfomycin were less than 20%, considered adequate for empirical treatment. Only hospitalization in the previous 90 days was statistically significant in predicting infections by multidrug-resistant bacteria.

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.

The impact of transformation zone representation on the frequency of abnormal cervical cytological results

ObjectiveTo compare the frequency of abnormal cervical cytological results with and without representation of the transformation zone (TZ) in a medium-sized city in Brazil according to the Bethesda categorization. MethodsWe performed an analytical observational study evaluating cytological results over 15 years from conventional smears collected within the Public Brazilian Health System in Araçatuba, Brazil. Tests were stratified by age and cytological result according to Brazilian guidelines and the Bethesda System. ResultsThere were 261,881 examinations, 159,251 with and 102,630 without TZ representation. The global frequency of abnormal results was higher in smears with TZ representation (crude odds ratio [OR] 4.03; 95% confidence interval [CI] [3.71–4.38]). Considering only women between 25 and 64 years (the target of the national guidelines), there were higher results for high-grade squamous intraepithelial lesions (OR 11.54; 95% CI 6.74–19.78), low-grade squamous intraepithelial lesions (OR 2.82; 95% CI 2.17–3.67) atypical squamous cell in which high-grade intraepithelial lesion cannot be excluded (OR 6.90; 95% CI 4.91–9.66) and atypical squamous cell of undetermined significance (OR 3.53; 95% CI 3.11–4.01) among cases with TZ representation. ConclusionSamples with TZ representation were associated with higher rates of abnormal results. Health professionals should be regularly trained to understand the weakness of cytological examinations when the TZ is not represented, especially in developing countries.

The hypertension-based chronic disease model in a primary care setting

BackgroundDriver-based chronic disease models address the public health challenge of cardiometabolic risk. However, there is no data available about the novel Hypertension-Based Chronic Disease (HBCD) model. This study investigates the prevalence, characteristics, and prognostic significance of HBCD Stages in a primary care cohort. MethodsThis study included participants aged ≥45 years, randomly selected from the primary care program of a Brazilian medium-sized city. Participants underwent electrocardiogram, tissue Doppler echocardiogram and were followed for a median of 6 years. Participants were classified into HBCD Stages as follows: Stage 1: hypertension risk factors; Stage 2: pre-hypertension; Stage 3: hypertension; and Stage 4: hypertension complications. ResultsOverall, 633 participants were included in the cross-sectional analysis and 560 that had follow-up data were included in the prognostic analysis. From 633 participants, 1.3% had no identifiable risk factors for HBCD, 10.0% were Stage 1, 14.7% Stage 2, 51.5% Stage 3, and 22.5% Stage 4. Increasing HBCD stages had worse glomerular filtration rates, echocardiographic markers, and higher body mass index, waist circumference, blood glucose levels, and prevalence of type 2 diabetes. Rates of all-cause mortality or cardiovascular hospitalization increased across HBCD Stages: Stage 1: 3.6%; Stage 2: 4.8%, Stage 3: 7.6%; and Stage 4: 39.5%. Kaplan-Meier curves showed composite outcome worsened across HBCD Stages 1–4 (p < 0.001). ConclusionsHBCD is a conceptually and prognostically valid model. Remarkably, HBCD stages were associated with progressively worsening markers of heart disease, declining kidney function and higher rates of all-cause mortality or cardiovascular hospitalization.

Complexity of the COVID-19 pandemic in Maringá

While extensive literature exists on the COVID-19 pandemic at regional and national levels, understanding its dynamics and consequences at the city level remains limited. This study investigates the pandemic in Maringá, a medium-sized city in Brazil’s South Region, using data obtained by actively monitoring the disease from March 2020 to June 2022. Despite prompt and robust interventions, COVID-19 cases increased exponentially during the early spread of COVID-19, with a reproduction number lower than that observed during the initial outbreak in Wuhan. Our research demonstrates the remarkable impact of non-pharmaceutical interventions on both mobility and pandemic indicators, particularly during the onset and the most severe phases of the emergency. However, our results suggest that the city’s measures were primarily reactive rather than proactive. Maringá faced six waves of cases, with the third and fourth waves being the deadliest, responsible for over two-thirds of all deaths and overwhelming the local healthcare system. Excess mortality during this period exceeded deaths attributed to COVID-19, indicating that the burdened healthcare system may have contributed to increased mortality from other causes. By the end of the fourth wave, nearly three-quarters of the city’s population had received two vaccine doses, significantly decreasing deaths despite the surge caused by the Omicron variant. Finally, we compare these findings with the national context and other similarly sized cities, highlighting substantial heterogeneities in the spread and impact of the disease.

Describing physical activity in public open spaces in Brazil: Active City, Healthy City Program

This study aimed to describe the physical activity (PA) in public open spaces (POS) in a medium-sized city in Brazil. The System for Observing Play and Recreation in Communities (SOPARC) was applied to evaluate a representative sample of users in 10 POS which received actions from the Active City, Healthy City Program. The places were evaluated four days a week (Tuesday, Wednesday, Saturday, and Sunday) at four times (8 am, 10 am, 2 pm, and 4 pm). The proportion of users by gender, age group, skin color, and PA level was compared between the POS using the chi-square test for heterogeneity in the STATA software (p&lt;0.05). As main results, 32,768 scans were performed in 64 target areas and identified 8,634 individuals. The highest proportion of people were males (58%), adults (38%), with white skin color (97%), and in light or moderate PA (76%). Except for skin color, there was a significant difference in the proportion of all other variables between the POS (p &lt; 0.05). In conclusion, the POS was more commonly used by men, adults, and people of white skin color for light and moderate PA. Based on the results, program managers could reallocate resources to increase utilization and PA at each place.

Evaluation of the urban form in the mobility of medium-sized cities in Brazil

Evaluation of the urban form in the mobility of medium-sized cities in Brazil

Community food environment and childhood obesity in a medium-sized Brazilian city: An approach to school and neighborhood environments.

We aimed to analyze the relationship of community food environments with childhood obesity in a medium-sized Brazilian city. This is a cross-sectional study with 366 schoolchildren aged 8 and 9 years. Children's body mass index (BMI), waist circumference and concentrations of total cholesterol (TC), high cholesterol density lipoprotein (HDL-c), low cholesterol density lipoprotein (LDL-c) and triglycerides (TG) were measured. The parent's nutritional status was assessed by calculating the BMI. All food stores within a 200- and 400-m radius buffers of schools and households were evaluated. The food stores were classified as healthy, unhealthy, and mixed according to the predominance of foods commercialized. Binary logistic regression models were proposed for each category. Over seventy percent (70.2%) of the food stores were categorized as "unhealthy". The prevalence of obesity was 15.6%. In the 200-m buffer around schools, there was an inverse and direct association between obesity and the presence of healthy food stores and unhealthy food stores, respectively. Around the households, there was an inverse association between the presence of healthy food stores and obesity in both buffers. The community food environment may be protective or potentiating childhood obesity, depending on the access and types of food sold.

A machine learning approach for mapping surface urban heat island using environmental and socioeconomic variables: a case study in a medium-sized Brazilian city

A machine learning approach for mapping surface urban heat island using environmental and socioeconomic variables: a case study in a medium-sized Brazilian city

Comorbidities do not mitigate the effect of habitual physical activity on the reduction of healthcare costs among adults with cardiovascular diseases: A mediation analysis

BackgroundHabitual Physical activity (HPA) is a non-pharmacological strategy to prevent and control chronic diseases, and it plays an important role in minimizing healthcare costs. ObjectivesThis study aimed to investigate the relationship between HPA and healthcare costs from the perspective of the Brazilian National Healthcare System, and to establish the mediating role of comorbidities in this relationship among patients with cardiovascular diseases (CVD). Design and settingThis longitudinal study was conducted in a medium-sized Brazilian city and included 278 participants assisted by the Brazilian National Healthcare System. MethodsInformation on healthcare costs were obtained from medical records and included primary, secondary, and tertiary levels. Comorbidities (diabetes, dyslipidemia, and arterial hypertension) were self-reported, and obesity was confirmed with the percentage of body fat. HPA was measured using a questionnaire (Baecke questionnaire). Face-to-face interviews provided information on sex, age, and education level. Statistical analysis included linear regression and Structural Equation Modeling, significance was set at 5 % and the Stata software (version 16.0) was used to perform the analysis. ResultsThe sample included 278 adults with a mean age of 54.49 (8.32) years. For each score of HPA, there was a reduction in healthcare costs of US$ 83.99/24 months (95 % CI: − 159.15; − 8.84), and the sum of comorbidities did not mediate this relationship. ConclusionIt is concluded that healthcare costs seem to be affected by HPA among patients with CVD, while this phenomenon seems not to be mediated by the sum of comorbidities.

A Decision Framework for Identifying Methods to Construct Stable Composite Indicators That Capture the Concept of Multidimensional Social Phenomena: The Case of Social Exclusion

This research proposes a decision framework that allows for the identification of the most suitable methods to construct stable composite indicators that capture the concept of multidimensional social phenomena. This decision framework is applied to discover which method among six best represents the social exclusion of eight medium-sized Brazilian cities. The results indicate that space is important in the definition and performance of the method, and ease methods to apply present the best performance. However, one of them fails to capture the concept of the multidimensional phenomenon in two cities. The research makes six important contributions to the literature. First, it offers a decision framework for choosing the best-fit method to construct a composite social indicator. Second, it shows to what extent geographic space matters in defining the best-fit method. Third, it identifies the best-fit method regarding stability and linkage with the conceptually most significant indicator of social exclusion. Fourth, it reveals the methods to be avoided, given their poor performance. Fifth, it indicates the mathematical properties that best represent composite social phenomena. Sixth, it illuminates the debate on social exclusion from a geographical and public policy perspective.

Association between health risk behaviors and food consumption in adolescents

ABSTRACT The study aims to evaluate the association between substance use and social isolation with food consumption in adolescents. A cross-sectional study was conducted with 2,040 adolescents from a medium-sized city in Brazil. The exposures assessed were the use of alcohol, tobacco, and other substances, and social isolation. The outcomes were the regular consumption (≥5 times/week) of beans, fruit/fruit salad, candies, and soft drinks, and an unhealthy eating score. The association between health risk behaviors and food consumption was assessed through logistic and linear regressions. Regular users of alcohol were more likely to have regular consumption of candies and soft drinks, and those who used tobacco regularly were less likely to have regular bean consumption and more likely to have regular candies consumption. The use of at least one substance was negatively associated with regular bean consumption and positively associated with regular consumption of sweets and soft drinks. Socially isolated adolescents were less likely to have regular bean consumption. Substance use was positively associated with the unhealthy eating score. In conclusion, substance use and social isolation were associated with less regular consumption of healthy food markers and greater regular consumption of unhealthy food markers.

Geographic Information Systems (GIS) to Assess Dental Caries, Overweight and Obesity in Schoolchildren in the City of Alfenas, Brazil.

Childhood-related obesity and overweight are increasing concerns for the health and well-being of children. Dental caries (decay) is the most prevalent oral disease during childhood, and several studies have suggested that nutritional status and dental caries are associated in children. Therefore, this study aimed to determine the geographic distribution of childhood overweight/obesity and dental caries in a medium-sized Brazilian city. This cross-sectional study was conducted with 269 children of both genders enrolled in four public schools in the city of Alfenas. The children were clinically examined to assess cavitated dental caries and nutritional status (overweight and obesity). In addition, the GIS was used for the geospatial clustering analyses. A heat map was created by the Kemel method to estimate the concentration of the outcomes. The cavitated dental caries and overweight/obesity were also pointed out by dots on the map. However, of the 269 children, 118 were boys (43.87%) and 151 were girls (56.13%). One hundred fifty-seven children (58.4%) were classified as having "non-cavitated caries," while 112 (41.6%) were classified as having "cavitied caries." In the nutritional status assessment, 204 children (75.84%) were classified as "eutrophic," while 65 children (24.16%) were classified as "overweight/obesity," A geographical correlation of dental caries with overweight/obesity may exist in the northeast and southwest areas. In conclusion, a geographical concordance between the dental caries and the occurrence of overweight/obesity among the schoolchildren from Alfenas may exist in some areas. Future studies are necessary.

Local government shift and national housing program: Spatial repercussions on urban growth

This paper contributes to understanding the territorial politics of urban growth, especially concerning the strategies and means of controlling urban expansion (transformation of natural or rural land into urban, built-up areas). We analysed the urban growth/expansion processes resulting from three consecutive periods of master plan implementation practices in a medium-sized Brazilian city (Araraquara). The goal was to quantitatively assess whether a national market-oriented housing program (MCMV) could be accountable for disparities in spatial outcomes of physical growth associated with different territorial governance arrangements during contrasting local government mandates. Although the MCMV program introduced extensive peri-urban expansion, especially towards headwater preservation areas that nowadays juxtapose social and environmental vulnerabilities in Araraquara, it was not solely responsible for the discernible spatial trends observed after 2009. These results offer insights into how changes in territorial governance arrangements can affect master plan implementation practices.