Municipal Human Development Index Research Articles

Eficiência na aplicação de recursos de royalties de petróleo: identificação dos municípios brasileiros de referência

Em um contexto que apresenta a oportunidade de discussão acadêmica sobre a qualidade do recebimento das receitas de royalties de petróleo e sobre a eficiência na aplicação desses recursos, esta investigação teve como objetivo identificar os municípios brasileiros receptores de royalties de petróleo que podem ser considerados referência na aplicação dos recursos orçamentários. A relevância do estudo reside nas discussões acadêmicas e políticas sobre o tema geradas a partir da descoberta de grandes reservas de petróleo no território brasileiro e as consequentes alterações na legislação sobre o modelo de partilha desses recursos. Utilizou-se o instrumento Data Envelopment Analysis, modelo CCR, para verificação da eficiência na alocação dos recursos públicos de 115 municípios localizados em toda a extensão territorial brasileira, considerando como variáveis-insumo as receitas tributárias e as receitas de transferências correntes, e como variável-produto o Índice de Desenvolvimento Humano Municipal, o que foi precedido por uma análise de clusters. Os resultados indicaram que mais de 70% dos municípios estudados possuem escore de eficiência abaixo de 0,4, sugerindo acentuada diferença entre os resultados alcançados pelos municípios benchmark e os demais municípios não localizados na fronteira de eficiência, o que coaduna com estudos anteriores que apontam indícios de que os recursos destinados para a minimização dos efeitos das externalidades negativas provenientes das atividades de extração de petróleo possam não estar gerando os resultados desejados quanto à melhoria no desenvolvimento humano de seus receptores.

Contextual and individual determinants of tooth loss in adults: a multilevel study

BackgroundTooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35–44 years of age), in accordance with individual and contextual social characteristics.MethodsThis was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated.ResultsBrazilian adults lost a mean of 7.57 (95% CI 7.1–8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males.ConclusionsThe number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

A circular approach to the e-waste valorization through urban mining in Rio de Janeiro, Brazil

Electronic waste (e-waste or WEEE) is one of the most critical categories regarding the decision-making for waste management. Brazil is the second major e-waste producer in Americas, after USA, with 1.5 million tones generated annually. However, the absence of adequate system for e-waste reverse logistics are a reality in most of the Brazilian cities. Concerning this hypothesis, we proposed a scenario analysis to support decision-making in e-waste management. This study analyzed the e-waste amount generation, the location of the recycling companies of this segment and the collection routes in the metropolitan region of Rio de Janeiro (MRRJ). Besides, we proposed a set of criteria and indicators to identify the best option for e-waste management. The analysis indicates that Rio de Janeiro is the biggest e-waste producer of the MRRJ, with an amount of approximately 127 ton/day, corresponding to 251 collection points, which represents a high discrepancy in relation to the other municipalities of MRRJ. The findings point out that indicators, such as the Gross Domestic Product (GDP) and Municipal Human Development Index (MHDI), could be used as an alternative for a more accurate analysis for a sustainable urban grid design. This study identified 24 e-waste recycling industries that services the current demand of the MRRJ, most of them concentrated in the central and south portions of the MRRJ, which coincide with the municipalities with the biggest e-waste generation rates. Some hotspots, however, are isolated from the recycling industries, as observed at the MRRJ extremes. In order to provide a better choice for e-waste reverse logistics routes, we proposed 12 indicators, in environmental, economic and social dimensions. Thirty-five hotspots were identified and divided in five main routes according to the recycling industries nearby and the local roads. Urban mining of e-waste seems to be an interesting alternative for secondary raw material recovery, especially in an emerging economy country like Brazil, that consumes huge amounts of electronic devices and demands solutions compatible with environmental law requirements. Hence, this study contributes for a more sustainable development pattern regarding e-waste management in the country, since it reinforces the importance of circularity.

The Quality of Pap Smears from the Brazilian Cervical Cancer Screening Program According to the Human Development Index.

Brazil is a country with strong socioeconomic disparities, which may explain the different rates of cervical cancer incidence and mortality and influence the quality of cervical cancer screening tests. The aim of this study was to perform a trend analysis of some quality indicators of Pap smears according to the Municipal Human Development Index (MHDI). Information about cytopathological exams (approximately 65,000,000) performed from 2006 to 2014 in women ages 25 to 64 years was obtained from the Cervical Cancer Information System (SISCOLO). The average annual percentage change (AAPC) for each indicator was calculated using the Joinpoint Regression Program, according to MHDI levels. Very low frequencies of unsatisfactory cases (<5%) were observed at different MHDI levels. Although the positivity index in the low- and medium-MHDI groups has increased, the values remained below international recommendations (3%-10%). The HSIL (high-grade squamous intraepithelial lesion) percentage remained stationary at all levels of the MHDI. In the low- and medium-MHDI groups, most quality indicators were below the recommendations by Brazilian National Cancer Institute INCA, with no improvement trend; in the high-MHDI group, the majority of the indicators also presented no improvement, although they show slightly better quality indicators. The MHDI should be considered in the definition of the policies of the screening program for cervical cancer in Brazil, and the current program may require adjustments to achieve improved efficiency.

Initial analysis of the spatial correlation between the incidence of COVID-19 and human development in the municipalities of the state of Ceará in Brazil.

To analyze the spatial distribution of the incidence of COVID-19 and its correlation with the municipal human development index (MHDI) of the municipalities of Ceará. This is an ecological study with data recovered from the 15th epidemiological week and the 19th one of the year 2020 using the MHDI and the COVID-19 incidence coefficient for each municipality as variables. The univariate spatial correlation and the bivariate one were analyzed using the TerraView and GeoDa softwares. The incidence of COVID-19 has spatial dependence with moderate positive correlation and the formation of high-high clusters located in the metropolitan region of Fortaleza and municipalities in the north region. The lowest incidence was a low-low cluster in the south and west regions. There was a positive bivariate correlation between MHDI and the incidence of COVID-19 with the formation of a cluster in the metropolitan region of Fortaleza. The uneven mapping of COVID-19 and its relationship with MHDI in Ceará can contribute to actions to regional combat the pandemic.

O que os indicadores socioeconômicos IDHM e IPC nos revelam em distintas realidades urbanas: São Paulo (SP) e Fortaleza (CE)

This paper aims to analyze the possibilities and limitations of using synthetic indicators using two globally applied systems as a reference, the Municipal Human Development Index (MHDI) and the City Prosperity Index-CPI. Therefore, aims to analyze two different urban realities: São Paulo (SP) and Fortaleza (CE), based on two indexes: The Municipal Human Development Index (MHDI) of the United Nations Program (PNUD) and the City Prosperity Index (CPI) started in 2012 by the United Nations Program for Human Settlements (ONU-Habitat). The MHDI is based on indicators in three dimensions: longevity, education, and family income, while the CPI measures the characteristics of the municipalities in terms of productivity, infrastructure, inclusion and social equity, quality of life, environmental sustainability, and governance and legislation. Comparative analysis of the results of indicators that reveal the limitations and potentials considered for the construction of improved systems indicators. It is noticed, from the analyzed properties, factors that go beyond the character of the indicator must be considered. Efficiency in the collection, acceptance of the target audience, and qualitative analysis must be considered in use for the adequate measurement of the actions developed in the municipal public management and for the understanding of the appropriate and social changes in the cities.

Contextual and individual factors associated with arterial hypertension among Brazilian older adults (National Health Survey - 2013)

To investigate the association of contextual and individual variables with systemic arterial hypertension (SAH) among elderly Brazilians. Cross-sectional study with data from the National Health Survey (2013) and the Atlas of Human Development in Brazil. SAH was defined by direct measurement of blood pressure and/or the use of medications for this condition. The contextual independent variables were the Municipal Human Development Index (MHDI) and the Gini Index, by Federation Unit. The individual independent variables included sociodemographic factors, health behaviors, health conditions, and the use of health service. Multilevel logistic models were used to study the associated factors. Among the 10,211 participants aged 60 years and older, the prevalence of hypertension was 66.7% (95%CI 65.1 - 68.3). After adjusting for all variables, the chance of hypertension was higher in the Federation Units with the highest MHDI, in women, aged 70 years or older, in non-whites, with one or more chronic diseases, overweight and obesity, high waist circumference, and among those who had four or more medical appointments in the previous year. On the other hand, a negative association was observed between hypertension and education. The individual profile associated with hypertension was similar to what had already been reported in the scientific literature, but it is noteworthy that the elderly residing in the higher MHDI Federation Units were more likely to have this condition, suggesting a higher survival of hypertensive patients in these regions.

Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals

To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.

RELACIÓN DE LA LEPRA CON LA COBERTURA DE LA ESTRATEGIA DE SALUD FAMILIAR Y CONDICIONES SOCIOECONÓMICAS

Objective: To analyze the epidemiology of leprosy and its relationship with the coverage of the Family Health Strategy and the socioeconomic conditions in Paraiba, Brazil, from 2001 to 2016. Material and Method: Ecological study with a quantitative approach. We extracted secondary data from the Notifiable Diseases Information System (SINAN, as per its Portuguese acronym). We checked the relationship of leprosy epidemiological indicators with the coverage of the Family Health Strategy and the Municipal Human Development Index by Zero-inflated Poisson regression model. Results: We analyzed a total of 12,134 new leprosy cases. The increased coverage of the Family Health Strategy contributed significantly to the increment in the detection rate in the general population. The improvement of the Municipal Human Development Index contributed to the increased number of cases of the disease in the general population and decrease in people under the age of 15. Conclusion: There was an improvement in the epidemiological indicators of the disease through the implementation of health services and advances in social indicators; however, there are still situations of poverty and inequality that contribute to the continuity of leprosy. We should emphasize the importance of investments in health actions and inclusive policies, with a view to minimizing the existing inequities and controlling this endemic.

Mercado de trabalho para o cirurgião-dentista no Pará: panorama atual e perspectivas

O objetivo desta pesquisa foi analisar a distribuição de cirurgiões-dentistas (CD) no estado do Pará, visando melhorar a compreensão dos rumos da profissão no estado para direcionar a atuação dos futuros profissionais. Para isso, utilizou-se de um estudo documental analítico, com base nos dados do Conselho Federal de Odontologia, Conselho Regional de Odontologia do Pará e do Instituto Brasileiro de Geografia e Estatística, para avaliar a relação habitante/CD por município, e essa razão à renda per capita, ao índice de desenvolvimento humano municipal (IDH-M) e às especialidades odontológicas. Os dados foram analisados de forma descritiva tomando-se como parâmetro, a proporção habitante por CD. Os resultados mostraram que o Pará apresentou uma proporção de 1.687 habitantes por CD. Em apenas 13,2% dos municípios do estado havia baixa proporção de habitantes por CD, de acordo com recomendação estabelecida pelo Conselho Federal de Odontologia. Já 23,6% dos municípios não apresentavam CD. A tendência dos profissionais é de se fixarem nos municípios de maior renda e de maior IDH-M. No campo das especialidades observou-se que 72% dos profissionais especialistas se concentravam na capital e municípios próximos à capital do estado, sendo Ortodontia e Endodontia as especialidades mais prevalentes. Assim, constatou-se que existe má distribuição dos profissionais no estado, sendo necessário promover uma política de interiorização dos CD, o que irá favorecer maior cobertura e melhor prestação de serviços de saúde bucal à população.

Fatores associados à transparência pública municipal

Um dos objetivos dos Conselhos Regionais de Desenvolvimento (COREDEs), assim como dos mecanismos de transparência pública, diz respeito à aplicação correta dos recursos públicos. Este estudo buscou identificar os fatores relacionados ao nível de transparência dos 77 municípios da região funcional de planejamento RF7. Os fatores avaliados foram socioeconômicos (desemprego, investimento, dívida, Índice de Desenvolvimento Humano Municipal (IDHM) e Índice Firjan), políticos (participação eleitoral, competitividade política, reeleição, gênero do prefeito) e um fator demográfico (população). Todos os dados, de origem secundária, foram coletados em bases disponíveis na internet. Para a análise fez-se uso de técnicas de estatística descritiva e multivariada. Os resultados demonstraram que, há uma relação positiva do índice de transparência com o tamanho da população e com o investimento anual do município; já com a participação eleitoral e o desemprego verificou-se a existência de uma relação negativa. Além disso, não foi verificada relação da transparência com a dívida municipal, com o Índice de Desenvolvimento Humano Municipal (IDHM), com o Índice Firjan de Desenvolvimento Municipal (IFDM) e com o fator competitividade política.&#x0D; Palavras-chaves: Acesso à informação. Fatores socioeconômicos. Fatores políticos.

Urban ecological infrastructure: The importance of vegetation cover in the control of floods and landslides in Salvador / Bahia, Brazil

The city of Salvador has undergone a hasty population growth over the last five decades, from a mere 250,000 inhabitants in 1950 to ca. 2.9 million in 2017. This surge in population has resulted in a series of environmental issues directly connected with the reduction of the vegetation cover. Landslides and floods are among the most striking of such issues because they have put at risk, successively over the years, the lives and assets of hundreds of people, very in particular of those in less privileged circumstances. In view of this vulnerability framework and recognising the role that green areas play in the urban fabric, this work sought to determine the correlation between remnant vegetation cover and recorded occurrences of mass movements and floods. Particular consideration was given to the socioeconomic profile of the population segments most affected by these occurrences, assessed in terms of Municipal Human Development Index (M-HDI). We conclude that municipal government negligence in the control of the occupation and use of the land has been responsible for the emergence of hundreds of areas at risk, those where most mass movement and flood occurrences have taken place, which largely correspond with the neighbourhoods with the lowest rates of human development. In contrast, both the number of occurrences and their impact are smaller or non-existent in the northern part of the municipal territory, where the largest forest remnants are located, as well as in the most affluent neighbourhoods, where the ecological infrastructure has been replaced with costly public works.

Incidence of cervical cytological abnormalities following a negative smear result in an opportunistic screening scenario: A cohort study

ObjectivesTo analyse the incidence of atypical cells and their risk factors in an opportunistic screening context. Study designThis cohort study with passive follow-up is based on analysis of 86,609 women living in Maranhão State - Brazil, who had a negative cervical cytological test recorded in the Cervical Cancer Information System (SISCOLO) in 2007 and who had at least 1 follow-up test up to 31 December 2012. The cumulative incidence (CI) and incidence rate (IR) of low grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesions and cancer (HSIL+) were calculated. A Cox regression model was used to identify independent factors associated with the risk of presenting atypical cells. ResultsAt 60 months follow-up the CI of LSIL reached 10.7 per 1000 and that of HSIL + was 3.9 per 1000. LSIL and HSIL + IRs were 334.7 and 120.3 per 100,000 person-years (PYs), respectively. LSIL and HSIL + occurred in 65.0% and 57.3% of women <3 years after the study entry, respectively. The risk of presenting HSIL + increased when a previous cervical cytological test had not been performed, with advancing age and when the Municipal Human Development Index (MHDI) decreased. ConclusionThis study highlights a significant tendency towards increased IR and risk of presenting HSIL + as MHDI decreased.

Tuberculosis and malaria walk side by side in the Brazilian Amazon: an ecological approach.

To assess the spatial distribution of TB and malaria incidence, as well as their spatial association with each other, regardless of environmental and socio-economic factors commonly reported as determinants of both disease rates among the municipalities of Amazonas State, Brazil between 2012 and 2015. Through an ecological approach considering municipalities of Amazonas, Brazil, as unit of analysis, a negative binomial regression model was used to assess association between malaria and TB rates, in which the dependent variable was the average municipal tuberculosis incidence rate. Positive associations of overall malaria (β=0.100 [CI=0.032, 0.168], P=0.004), P.vivax malaria (β=0.115 [CI=0.036, 0.195], P=0.005), and P.falciparum malaria (β=0.389 [CI=-0.0124, 0.791], P=0.057) with TB rates were found, regardless of the sociodemographic factors included in the study. In the Brazilian Amazon, TB and malaria are spatially associated. Therefore, it is very likely that co-infections also occur in this region, regardless of the HIV status.

(Un)Equitable distribution of health resources and the judicialization of healthcare: 10 years of experience in Brazil

BackgroundEquity has been acknowledged as a required principle for the fulfilment of the universal right to health once it seeks to tackle avoidable and unfair inequalities among individuals. In Brazil, a country marked by iniquities, this principle was adopted in the Brazilian National Health System (SUS) organization. But the phenomenon known as judicialization of healthcare, anchored in the argument of universality of the right, has been consolidated as a health policy parallel to the SUS. The analysis of these lawsuits distribution according to their beneficiaries’ socio-economic profile can contribute to the verification of the judicialization’s potential for reducing inequalities, thus becoming an auxiliary activity in the fulfilment of the universal and egalitarian right to health. This study aimed to assess what socioeconomic factors are associated to municipalities that had larger numbers of beneficiaries from lawsuits in health in the state of Minas Gerais, Brazil, from 1999 to 2009.MethodsIt is a descriptive quantitative study of the residence municipalities of beneficiaries registered in database regarding all deferred lawsuits against the state of Minas Gerais from 1999 to 2009. The verification of cities’ socio-economic profile was performed based on information of the Brazilian Institute of Geography and Statistics’ 2010 Demographic Census and on indexes derived from it. The variables studied for each municipality were: number of beneficiaries; resident population; Social Vulnerability Index (IVS); and Municipal Human Development Index (IDHm). Descriptive and statistical analysis were used to verify factors associated with a larger number of beneficiaries in a municipality.ResultsOut of 853 municipalities in Minas Gerais, 399 were registered as residence of at least one of the 6.906 beneficiaries of studied lawsuits. The residence non-information index was 11,5%. The minimum number of identified beneficiaries living in a municipality was 1 (one) while the maximum was 1920. The binary logistic regression revealed that high and very high IDHm (OR = 3045; IC = 1773-5228), IVS below 0.323 (OR = 2044; IC = 1099- 3800) and population size above 14.661 inhabitants (OR = 6162; IC = 3733-10,171) are statistically associated to a greater number of beneficiaries of lawsuits in health within a municipality.ConclusionsThe judicialization of health care in Minas Gerais, from 1999 to 2009, didn’t reach the most vulnerable municipalities. On the contrary, it favored a concentration of health resources in municipalities with better socioeconomic profiles. The register of all beneficiaries’ municipalities of residence as well as individual socioeconomic data can contribute to a more conclusive analysis. Nevertheless, in general, the results of this study suggest that the judicial health policy conducted from 1999 to 2009 was not an auxiliary tool for the fulfilment of an equitable right to health in Minas Gerais.

Bayesian modeling of hematologic cancer and vehicular air pollution among young people in the city of São Paulo, Brazil

ABSTRACT Traffic-related air pollution is being associated with hematologic cancer in young individuals. This study performed a spatial analysis of the hematologic cancer incidence and mortality among younger people, using a Bayesian approach, to associate with traffic density in the city of São Paulo, Brazil. Two databases were employed: incidence (2002–2011) and mortality (2002–2013). The relationships between the cases of hematologic cancer and the covariates – traffic density, the Municipal Human Development Index (MHDI), and population density – were evaluated using a Besag–York–Mollié ecological model with relative risks (RRs) estimates. Per 1-unit standard-deviation increase in traffic density, in the MHDI, and in population density, the RR for the incidence was 1.06 (95% CI: 0.97–1.14), 1.28 (95% CI: 1.16–1.42), and 1.01 (95% CI: 0.94–1.08), respectively. For mortality, no covariates were considered risk factors. Our findings suggest significant association between living in regions with better socioeconomic conditions, where traffic density is usually higher, and risk of hematologic cancer in younger people.

Individual and contextual factors associated with traumatic dental injuries in a population of Brazilian adolescents.

Traumatic dental injuries (TDIs) stand out as one of the major public health problems worldwide, characterized by a high prevalence in children and adolescents. However, their association with the 15-19years age group has not been fully described. The aim of this study was to evaluate TDIs in a population of Brazilian adolescents. An association study was performed with 5558 adolescents attending the São Paulo State Oral Health Survey (SBSP-15). Individual predisposing variables (gender, age, schooling, ethnic, overjet, and molar relationship); contextual predisposing (city size and Municipal Human Development Index); individual enabling (per capita income and type of service used); contextual enabling (number of dentists, family health team coverage, and family median income); individual need (satisfaction and perception regarding treatment) and contextual needs (average supervised brushing, number of visits, and dental extractions per city), as well as health behaviors were analyzed. Andersen's behavioral model was used for the data analysis. A multilevel logistic regression with fixed effects was performed to calculate the odds ratio (OR), with 95% confidence interval (CI). The prevalence of TDIs in adolescents was 1.42% (95% CI: 0.94-2.13). Individual and contextual factors of need, predisposing factors, facilitators, and health behaviors were associated with TDIs. In the adjusted analysis, gender (OR = 0.32, 95% CI: 0.18-0.53), mean family income (OR=2.52, 95% CI: 1.35-4.69), number of dental visits (OR=0.40, 95% CI: 0.19-0.84), and time of last visit (OR=2.64, 95% CI: 1.46-4.77) remained significant concerning trauma. At least one variable of the individual and contextual predisposing, enabling, and need factors (except for individual enabling variables) were associated with dental trauma in Brazilian adolescents aged 15-19years. This information may help with the planning of preventive actions and dental treatment, especially in mid-sized and large cities.

Condições associadas a atividade de planejamento nos centros de especialidades odontológicas

Antecedentes: O planejamento nos serviços de saúde visa especificamente melhorar o estado de saúde de uma determinada população, garantindo o acesso com equidade e justiça, bem como agilizar a resposta do sistema de saúde às necessidades percebidas pela comunidade. Objetivo: Analisar a associação entre o relato da prática do planejamento nos Centros de Especialidades Odontológicas (CEO) com as características do município, do serviço e do gestor do serviço. Método: É um estudo de natureza quantitativa, onde se utilizou o banco de dados da Avaliação Externa do primeiro ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade dos CEO (PMAQ-CEO), relativos ao módulo de entrevista com o Gerente e um Cirurgião-Dentista do CEO, além de verificação de documentos. A análise ocorreu do ponto de vista descritiva e analítica para a qual aplicou-se o teste qui-quadrado de Pearson, considerando o nível de significância de 5 %. Resultados: A maioria dos CEO que relataram ter realizado alguma atividade de planejamento, nos últimos 12 meses, está na Região Centro-Oeste (88,7 %) e Sul (82,1 %), em municípios com menor cobertura de saúde bucal da estratégia Saúde da Família e com alto Índice de Desenvolvimento Humano (IDHM). Porém não houve correlação com o porte populacional dos municípios. Conclusões: Os CEO que possuem gerente, com um tempo de atuação no serviço maior do que 2 anos e que tenha uma formação complementar na área de gestão pública ou de saúde coletiva tendem a realizar atividades de planejamento.

Per capita municipal solid waste generation and its relationship with socioeconomic and demographic factors in a developing country

In Brazil, per capita municipal solid waste (MSW) generation has increased in recent years. This situation, combined with inadequate management of MSW, provides a disturbing scenario in the Brazilian States. For example, in the State of Goias, just 16 of 246 municipalities send their MSW to licensed landfills. To change this, one of the measures that Goias should adopt is the prevention of waste generation, as the waste hierarchy advocates. To do this, it is necessary to identify elements that may be associated with increased production of MSW. Thus, the objective of this study is to perform a statistical analysis to identify socioeconomic and demographic factors that may be associated with per capita MSW generation in the municipalities of Goias State. For such analysis, statistical techniques were used as descriptive analysis and linear regression. Results showed that daily per capita MSW generation in Goias can be better justified by socioeconomic and demographic variables than just by socioeconomic variables. The Municipal Human Development Index for Education has been shown to be a statistically significant variable to exert influence on the production of waste, in order to contribute to the 39% growth of daily per capita generation of MSW, in the State.

Area-level social development and indicators of public dental services in Southern Brazil.

This study aimed to test associations between a municipal social development indicator and indicators of public dental services; examine differences in the achievement of public dental services goals between fluoridated and nonfluoridated municipalities; and, quantify contribution of a municipal social development indicator in estimated mean differences in the public dental services indicators between fluoridated and nonfluoridated municipalities. A secondary analysis of data from 293 municipal dental health services records from Southern Brazil between 2010 and 2015 was conducted. Multivariable log-binomial regression models were fitted to test the associations between municipal Human Development Index (HDI) and multiple public dental services indicators (proportion of public dental health service coverage, the proportion of tooth extraction among all clinical procedures, and monthly participation in supervised tooth brushing). Cut-off points for outcomes were based on state goals for public dental services. Blinder-Oaxaca decomposition analyses were performed to quantify the relative contribution of HDI in the differences in outcomes according to the municipal water fluoridation status. Municipalities within the lowest tertile of HDI had 66% lower prevalence of having insufficient public dental health service coverage (less than state goals)than those in the highest tertile of HDI (PR: 0.44; 95% CI: 0.24, 0.50). Municipalities with lowest HDI had nearly 30% higher prevalence of failing the state goals regarding the proportion of extraction and supervised tooth brushing (PR: 1.30; 95% CI: 1.20, 1.40 and PR: 1.34; 95% CI: 1.23, 1.45, respectively). Mean public dental health service coverage was higher in nonfluoridated municipalities than fluoridated municipalities, and municipal HDI explained 36% of the total estimated mean difference. This study found associations between municipal social development and public dental services indicators in Southern Brazil. However, higher HDI was associated with lower public dental health service coverage, lower proportion of extraction and higher coverage of supervised tooth brushing [Correction added on 2 April 2019, after first online publication: In the preceding sentence, the text "but with a higher proportion of extraction and supervised tooth brushing" was changed to "lower proportion of extraction and higher coverage of supervised tooth brushing"]. Municipal HDI contributed significantly towards the gap in public dental coverage between fluoridated and nonfluoridated municipalities, favoring nonfluoridated municipalities. These findings have important policy implications for reducing oral health inequalities as it highlights the interplay between key oral health policies and their distribution according to municipal social development.