Brazilian Metropolitan Regions Research Articles

The organization of health services and visceral leishmaniasis: an integrated intervention to improve diagnosis and treatment

The objective of this study, carried out in municipalities located in a metropolitan region of Brazil, was to promote the early diagnosis and prompt treatment of visceral leishmaniasis. In the intervention model a health professional underwent training that covered all procedures involved in assisting patients with suspected visceral leishmaniasis. The professionals then returned to their municipalities where they implemented a workplan with the following aims: (a) at least one physician able to diagnose and treat patients; (b) training of professionals for the laboratorial diagnosis of visceral leishmaniasis; (c) delivery of information on visceral leishmaniasis to the health workers. The implementation process was evaluated by follow-up meetings. Attendance of health professionals at the meetings, implementation of the workplan, and the visceral leishmaniasis case fatality rate before (1998-1999) and after (2001-2002) implementation of the model were used in the analysis. Among the 36 municipalities in the region, 22 were enrolled. Eight (36.3%) guaranteed at least 50% attendance in the meetings, and 14 (63.6%) had less than 50% attendance with no activities implemented. The fatality rate decreased in the municipalities that implemented the activities.

Diretrizes para a gestão metropolitana no Brasil

Brazilian Metropolitan Regions lack the institutionalized arrangements for the formulation, implementation and control of public policies involving multiple municipalities, particularly policies with strategic elements that cannot be resolved within municipal boundaries, such as urban development, transport and environment. Th is paper researches the possibilities for creating a metropolitan municipality, understood as a specifi c urban reality that is distinct from the traditional municipality and the spatial fragmentation of megamunicipalities which, given their political and economic importance, have exercised a disaggregating role in the metropolitan space. Th ese possibilities are understood as interventions that, in spite of their political and technical complexities and their diffi cult implementation, can contribute to resolving two of the principal obstacles to Brazilian metropolitan management: a rigid and monolithic perception of municipal autonomy - a perception that is still widely promoted in the country - and asymmetry in power relations generated by the existence of megamunicipalities in almost all the Metropolitan Regions.

Preferência revelada e arbitragem espacial: determinando um ranking de qualidade de vida para as regiões metropolitanas do Brasil

O artigo propõe extensões da metodologia de Kahn (1995) para determinação de um ranking de qualidade de vida para um conjunto de localidades, aplicando-as ao conjunto de regiões metropolitanas do Brasil a partir de microdados da Pesquisa Nacional por Amostra de Domicílio (PNAD) do ano de 2004, depois de corrigir os salários regionais através do Índice de Custo de Vida proposto por Azzoni et alii (2000). As propostas eliminam grande parte das fragilidades envolvidas na construção de índices de qualidade de vida a partir de estimações de preços hedônicos e consideram os diferenciais regionais de preços dos bens e serviços comercializáveis entre as localidades. No sentido de apontar a consistência dos resultados obtidos com algumas hipóteses levantadas, o ranking obtido para 2004 é cotejado com aquele de 1993.

Informal work, unemployment and health in Brazilian metropolitan areas, 1998 and 2003

This study investigates whether employment with no social security, as well as short and long term unemployment are associated with worse health among Brazilians. The representative study sample was taken from two National Health Surveys and included men aged between 15 and 64 who lived in one of the eight metropolitan regions of Brazil in 1998 (n = 31,870) and 2003 (n = 32,887). Both surveys showed that full and part time workers with no social security, as well as those in short and long term (> 12 months) unemployment had worse health indicators, regardless of age or schooling, when compared with full-time workers (> 40 hours/week) who had some form of social security through their employment. Hepatic cirrhosis was the disease most strongly associated with labor market status. Its prevalence was higher among individuals in long term unemployment and those with no social security. Labor market status was also negatively associated with the use of health care services, especially medical visits. The present study shows that the absence of social security at work, unemployment and length of unemployment, characterize heterogeneous groups of individuals in relation to health. Results reinforce the need to incorporate labor market status in research into health inequalities.

Bases para o desenvolvimento sustentável e competitivo da indústria de agregados nas regiões metropolitanas do país: parte 1

O presente artigo encontra-se compreendido em duas partes. A primeira assinala a importância do planejamento estratégico e do ordenamento territorial na estimulação da competitividade e da sustentabilidade de empreendimentos produtores de agregados para a construção civil. A segunda parte, a ser publicada na próxima edição dessa revista, analisará o caso do parque produtor de brita da RMRJ, investigará os mecanismos alternativos de reconversão tecnológica, territorial e ambiental dos pólos produtores e apresentará propostas de políticas públicas para a promoção do desenvolvimento competitivo e sustentável da produção de agregados nas RMs do país.

Dinámicas metropolitanas en la era de la globalización: la promoción inmobiliaria para empresas en la ciudad de São Paulo, Brasil

We propose to discuss a distinguishing element of the metropolis in the present period: the real estate promotion for companies and their implications for the planning and the urban life, trying to consider the metropolis like a space that shelters a multiplicity of interests and conflicts. Our approach is centered in the city of Sao Paulo, host municipality of the greater metropolitan region of Brazil, doing to emphasize the characteristics that also share with other metropolis of peripheral countries and their specificities.

Diferenças de rendimento do trabalho de homens e mulheres com educação superior nas metrópoles

Este artigo faz uma análise das diferenças de rendimento entre homens e mulheres ocupados, com nível superior de escolaridade, no conjunto das regiões metropolitanas do país, partindo-se de duas constatações: a) as diferenças de rendimento entre homens e mulheres, apesar de terem diminuído na última década, continuam grandes e fazem parte de um contexto de enorme diferenciação de remunerações, em que sobressaem as diferenças de escolaridade, destacando-se os altos rendimentos do nível superior, cujas diferenças em relação aos outros níveis de escolaridade ampliaram-se ainda mais nesta década e b) as maiores diferenças de rendimento entre homens e mulheres ocorrem exatamente no nível superior de escolaridade, justamente naqueles em que as mulheres têm maior participação. O artigo analisa as mudanças ocorridas na década de 90, no nível e dispersão dos rendimentos dos ocupados, mostrando as diferenças segundo sexo, escolaridade e posição na ocupação. Também é feito um estudo específico, para o ano de 2004, das diferenças de rendimento entre homens mulheres com curso superior, conforme posição na ocupação e setor de atividade. É considerado, ainda,o tipo de ocupação (dirigentes em geral, profissionais das ciências e artes, técnicos de nível médio, trabalhadores de serviços administrativos, outras ocupações) como "proxy" da hierarquia dos cargos. A fonte de dados utilizada é a Pesquisa Nacional por Amostra de Domicílios - PNAD.

Juventude e poder local: um balanço de iniciativas públicas voltadas para jovens em municípios de regiões metropolitanas

Reúne os resultados preliminares do projeto de pesquisa "Juventude, escolarização e poder local", que examina iniciativas públicas desenvolvidas pelo Executivo municipal em 74 municípios de regiões metropolitanas do Brasil (Sudeste, Sul, Centro-Oeste e Nordeste) no período entre 2001 e 2004. As principais ações são investigadas tendo como eixos analíticos o conjunto de percepções sobre juventude que ancoram as iniciativas e as formas que são propostas pelo poder público para a interação com os segmentos juvenis.

Situação do indivíduo no mercado de trabalho e iniqüidade em saúde no Brasil

To investigate inequalities in personal health conditions and in the utilization of healthcare services according in relation to the individual's status in the labor market. This study was based on 39,925 males aged 15 to 64 years living in 10 Brazilian metropolitan regions, who took part in the 1998 National Household Survey. They were classified as formal labor, informal labor, unemployed or outside of the labor market. Each category was compared with formal labor regarding sociodemographic characteristics, health status indicators and healthcare utilization. This analysis was by means of Pearson's Chi-square test. Multinomial logistic regression was used to investigate independent associations between labor market status, health status indicators and healthcare utilization. The classification of the participants' status was that 52.2% were formal labor, 27.7% informal labor, 10% unemployed and 10.2% were outside of the labor market. There were significant differences between these categories with respect to age, schooling, household income, household status and region of residence. Independent of the sociodemographic characteristics, unemployment, informal labor status and, especially, exclusion from the labor market remained associated with poor health status. The individual's status in the labor market is expressed through a gradient of inequality in health conditions. These findings reinforce the need to also consider the individual's status in the labor market in studies on healthcare inequalities.

The "common soil" theory: coronary disease, diabetes and inflammation

The "common soil" theory: coronary disease, diabetes and inflammation

Brazilian metropolitan regions: regime change and governance vacuum

AbstractThe article analyses the political and the institutional features of Brazilian metropolitan regions in relation to (a) the influence of regime change, from authoritarianism to democracy; (b) the changes in the federal system brought about by the 1988 Constitution designed to legitimise the new democratic order; and (c) the dynamics of intergovernmental relations. It argues that the institutionalisation of metropolitan regions and the creation of agencies for their management during the military regime became associated with the regime's major negative features—authoritarianism and centralisation—hence influencing future choices and leaving metropolitan governance in a political, institutional, financial and administrative vacuum. Copyright © 2005 John Wiley & Sons, Ltd.

Creating the Image of a Modern Fortaleza

With close to 2 million inhabitants, Fortaleza, capital of state of Ceara, concentrates majority of population and economic activity of its metropolitan region.' Its unemployment rate stands at over 12 percent, and more than 36 percent of population work in informal sector (Fortaleza, Prefeitura Municipal, 1998: 23). About 30 percent of inhabitants live in shantytowns that are found in 87 of 114 administrative districts into which city is divided (Falcao, 1996: 96). The proportion of heads of families with monthly incomes of R$ 755 (US$400)2 or less is 78 percent, and over a third of these survive on minimum wage of R$ 151 (US$80) a month or less (Fortaleza, Prefeitura Municipal, 1998: 25). With regard to income distribution, Gini index relating to average family monthly income in 1996 was 0.618. According to household budget survey of Instituto Brasileiro de Geografia e Estatistica (Brazilian National Institute of Geography and Statistics-IBGE) (1990; available at http:// www.sidra.ibge.gov.br), this places it as worst among nine metropolitan regions of Brazil. Despite such statistics, since early 1990s Fortaleza's image has been no longer one of misery and drought but one of the Miami of Brazilian Northeast or the Brazilian Caribbean (Cabral, 1994). One sign of this change has been increase in number of tourists it has attracted. In 1997, according to a survey conducted by Associaqao Brasileira de Agencias de Viagem, Fortaleza had become most popular destination for Brazilian tourists (Pessoa, 1998: 62). Another indication is offered by a

Education, cost of living and regional wage inequality in Brazil

The objective of this article is to analyze wage inequality among the 10 largest metropolitan regions in Brazil in the 1990s. We assess the extent to which worker characteristics (education, age, gender, race, position in the family) and job characteristics (occupational position, sector, experience) can explain wage inequality. The analysis is made both with regional-nominal and with regional-real wage data. In the second case regional price indexes are used to control for differences in cost of living among regions. Wage differentials in Brazil were slightly lowered when control variables were introduced, but the leftover inequality remained high. The results indicate that cost of living levels do have a role in explaining wage inequality in Brazil, but even after controlling for this factor, the remaining regional differentials are still important.

Competitiveness and Comparative Dynamics of the Brazilian Metropolitan Regions

This paper which is a sequence of previous works (Lemos e Diniz, 2000 and Diniz, 1993) attempts to analyze in an introductory and comparative way the aggregate competitiveness of the major Brazilian metropolitan areas. It is theoretically based on two fundamental concepts of urban economics: agglomeration gains and agglomeration diseconomies. With such a goal, this paper was divided into four parts. In the first part, a specific methodology for comparative analysis of competitiveness was developed, based on some theoretical premises. In the second part, the adequate levels of regionalization and the splitting of national economic space in polarized regions and their respective metropolitan areas are defined. In the third part, a first comparative analysis-static-of competitiveness is made based on the year of 1996. In the fourth part, an attempt is made of a dynamic competitiveness analysis based on the evolution in the period of 1985/96.

Migration in Intermediary Size Cities and Metropolitan Areas in Brazil: The 1980/96 Period Experience

This study has two objectives. The first one is to show how immigration has played a significant role in the demographic growth observed for the medium size cities in the period 1980/91. The intention is to evaluate the importance of these cities as alternative places to locate the flow of persons that otherwise would choose to live in the Brazilian metropolitan regions. The results obtained in this study confirm this expected performance. The second objective is to compare how immigrants were absorbed in the labor market of these metropolitan regions and intermediate size cities. Data show that metropolitan regions were able to offer better conditions to their immigrants, what can explain the importance of these areas as the preferred destination of these flows, weaking the significant importance shown by the medium cities as the locational choice.

Wage differentials by gender and color: a comparison between Brazilian metropolitan regions

RESUMO O estudo analisa o comportamento das diferenças salariais considerando gênero e raça nas áreas metropolitanas brasileiras. Com base em uma amostra da PNAD (1989), foram examinados empiricamente o padrão das diferenças salariais nas áreas metropolitanas em geral e, posteriormente, foi feita uma comparação regional. Repensando pesquisas anteriores, este artigo revela que, em média, os salários dos homens são mais altos que as mulheres e os recebidos pelos brancos são superiores aos negros. Mesmo após a realização de uma série de controles, tais como: idade, bolsa de estudos, local de vida e raça (gênero). As diferenças de gênero revelaram-se mais homogêneas entre as regiões do que as diferenças raciais.