Brazilian Municipalities Research Articles

The role of primary healthcare amid the COVID-19 pandemic: Evidence from the Family Health Strategy in Brazil

This paper investigates the role of primary healthcare in mitigating the consequences of the COVID-19 pandemic, focusing on the Brazilian Family Health Strategy (ESF) as a case study. ESF is Brazil’s major primary care initiative, with prior evidence indicating its effectiveness in improving various health outcomes. The COVID-19 pandemic submitted the Brazilian healthcare system to a rigorous and unprecedented stress test, whose repercussions are still under study. Using comprehensive administrative microdata from 2016 to 2022 encompassing dimensions related to mortality, healthcare service, supply of family health teams, and vaccination coverage, our empirical strategy accounts for heterogeneous effects based on program intensity and pandemic evolution of the 5570 Brazilian municipalities. Our findings reveal that municipalities with high-intensity of ESF coverage (i.e. stronger primary care) experienced 347.93 (95% CI: 289.04, 406.81) fewer COVID-19 and cardiorespiratory deaths per million inhabitants throughout the pandemic period, compared to those in low-intensity ESF areas, despite sharing similar profiles of deaths from respiratory and cardiovascular causes. Among the channels contributing to this relative performance, high-intensity ESF municipalities were found to engage in more home-based primary care visits and health promotion activities while maintaining a similar supply of community health workers. Additionally, they achieved higher vaccination coverage, and these effects were more pronounced in areas with greater ESF presence, emphasising the importance of primary care coverage. In conclusion, our findings underscore the relevance of strong primary care in mitigating the consequences of the pandemic and addressing post-pandemic health challenges.

Overview of the pesticide contamination provided by the last Brazilian water quality surveillance information system for human consumption (SISÁGUA 2022) report

The Water Quality Surveillance Information System for Human Consumption (SISÁGUA) is designed to manage the risks of water contamination for human consumption. This short communication focuses on data from the 2022 Report regarding pesticide analysis. The data centers on 27 active pesticide ingredients found in drinking water samples exceeding the maximum residual limits (MRLs) established by Brazilian legislation. Results indicate that 1609 municipalities (60 %) found at least one pesticide in their water. Two hundred ten municipalities detected all 27 pesticides tested, with 11 of these pesticides reported to have some carcinogenic potential. Nearly one and a half million people were exposed to levels above the Brazilian MRL, with the sum of maximum detected residues exceeding 80,000 ppb. Additionally, the report highlights that 53 % of Brazilian municipalities did not submit water monitoring data for human consumption. Thus, improving and expanding the scope of water analysis within the SISÁGUA framework is essential.

Dynamic Analysis of Vehicle Robberies and Thefts: An Approach with Sliding Windows

Objective: This article aims to jointly analyse the time series of the rates of stolen vehicles and stolen vehicles daily in Salvador, Bahia, Brazil, using DFA and DCCA methods, both with the sliding windows approach. Theoretical Framework: Salvador, the capital of the state of Bahia and the geographic space of the research, has the second largest fleet of motor vehicles in the northeast region of Brazil and the eighth when compared to other municipalities in Brazil. Method: The DFA and ρDCCA with Sliding Windows were used. The DFA is a statistical method that estimates autocorrelation in non-stationary time series on different time scales. Results and Discussion: Through exploratory data analysis, some properties were identified, such as positive asymmetry, stationarity, and nonstationarity depending on the year and crime assessed, as well as inverse fluctuation over the years between the average rates of stolen and stolen vehicles. The sliding windows approach identified greater relative variability around the average vehicle theft rate from 2004 to 2015 for w= 365 and from 2004 to 2016 for w = 1000 and a higher frequency of persistent autocorrelation (αDFA >0.50) (w=365 and w=1000). While the level of cross-correlation varied qualitatively between positive (ρDCCA (n) >0) and negative (ρDCCA (n) <0) depending on the year, time scale, window and crime assessed. Conclusion: Considering the complexity of the modelled series, the methodology used, and our findings, we hope to contribute to research related to the topic and initiatives to monitor, mitigate and plan to combat these crimes.

The effect of farm size and farmland use on agricultural diversification: a spatial analysis of Brazilian municipalities

Brazilian agriculture is characterized by the prevalence of small farms and regions with a high degree of rurality and dominance of the agricultural sector in the economy. These two characteristics affect the diversity of agricultural production in the country. Specifically, the article aims to analyze the effects of size farm and farmland use on agricultural diversification and the effects of demand and technology adopted by farmers. The database encompasses 4298 Brazilian municipalities from 1996 to 2017 (the last three agricultural censuses). Empirically, we consider spillover effects by estimating spatial models at the municipal level using panel data, highlighting the importance of location and neighborhood. The study’s findings indicate a tendency toward local concentration of agricultural production in the country, despite the balance between municipalities with diversified and concentrated production. The results showed a significant effect of small farms and the municipalities’ rurality degree on the agricultural output diversification. The study provides insights into the discussion on measures to strengthen support for small properties and regions that diversify crops to ensure economic efficiency and food security.

Spatial clusters and social inequities in COVID-19 vaccine coverage among children in Brazil.

This study examined the spatial distribution and social inequalities in COVID-19 vaccine coverage among children aged 5-11 in Brazil. First and second dose vaccine coverage was calculated for all Brazilian municipalities and analyzed by geographic region and deciles based on human development index (HDI-M) and expected years of schooling at 18 years of age. Multilevel models were used to determine the variance partition coefficient, and bivariate local Moran's I statistic was used to assess spatial association. Results showed significant differences in vaccine coverage rates among Brazilian municipalities, with lower coverage in the North and Midwest regions. Municipalities with lower HDI and expected years of schooling had consistently lower vaccine coverage rates. Bivariate clustering analysis identified extensive concentrations of municipalities in the Northern and Northeastern regions with low vaccine coverage and low human development, while some clusters of municipalities in the Southeast and South regions with low coverage were located in areas with high HDI-M. These findings highlight the persistent municipal-level inequalities in vaccine coverage among children in Brazil and the need for targeted interventions to improve vaccine access and coverage in underserved areas.

IMPLICATIONS OF RESTORATIVE JUSTICE IN CONFLICT REDUCTION: A CASE STUDY IN OLINDA, PERNAMBUCO

With this qualitative research we aimed to analyze reverberations of restorative justice practices in Brazilian basic education schools. We discuss retributive and restorative justice concepts through a case study carried out in a school in Olinda, a Brazilian northeast municipality. We present data on the restorative practices project implementation in the school. It appears that episodes of conflict and violence prevailed among girls. As a result of the Project implementation, it appears that there is resistance from teachers and part of the students, but a new culture of peace also emerges through affirmative and preventive actions against violence, with emphasis on “female empowerment”. We conclude that such practices are contextualized in particular schools, under democratic leadership, such as the Brazilian case studied.

Understanding the Personal Barriers of Elderly Patients for Carrying out Teleconsultations During COVID-19 Pandemic: An Observational Study.

Introduction: The expansion of telehealth during the COVID-19 pandemic may widen digital divides. It is essential to better understand the use of telehealth by the elderly population for the development of equitable telehealth tools. Objectives: This study aimed to describe the socioeconomic, clinical, and functional characteristics of elderly patients who were supported by a COVID-19 telehealth program. It also investigated the characteristics associated with the need for support for teleconsultations, hospitalization, and mortality. Methods: >Elderly patients supported by the TeleCOVID-MG program, between June 2020 and December 2021, in two Brazilian municipalities (Divinópolis and Teófilo Otoni) were included. Data were collected from electronic records and through phone call interviews. Descriptive and multivariable analyses were performed. Results: Among the 237 patients,121 were women (51.1%), mean age was 70.8 years (±8.5), 121 (51.1%) had less than 4 years of formal education, 123 patients (51.9%) had two or more comorbidities, and 68 (29%) reported functional decline in activities of daily life. Age greater than 80 years (odds ratio [OR]:4.68, 95% confidence interval [CI] 1.93-11.37, p = 0.001), lower educational level (OR:3.85, 95% CI 1.8-8.21, p < 0.001), hearing (OR:5.46, 95% CI: 1.24-11.27, p = 0.019), and visual (OR:15.10, 95% CI: 3.21-71.04, p = 0.001) impairments were characteristics associated with the need for support for teleconsultations. The need for support was associated with hospitalization and mortality (OR:5.08, 95% CI: 2.35-10.98, p < 0.001). Conclusion: Older age, lower educational level, and sensory impairments may compromise the effectiveness and the safety of the telehealth assistance to the elderly population. Functional evaluation and frailty screening should be considered part of the telehealth assessment of elderly patients.

Urbanization impact on scorpion stings: An epidemiological study

Accidents caused by venomous animals, especially scorpions, are a major public health problem due to the increase in incidence in recent decades, since scorpion species have become well adapted to urbanized environments. Nonetheless, the impact of urbanization in scorpionism is not clear. The objective of this study is to correlate the variation in the incidence of scorpion accidents with the rate of urbanized area. This was a retrospective, epidemiological study of accidents by scorpions in 376 of the most populous Brazilian cities in 2019 and compared to ten years earlier, using Spearman's correlation coefficient. Data were obtained by accessing DATASUS/TABNET and IBGE Cidades platforms. A weak negative correlation between scorpion stings and urbanization was found in 2009 (rs = −0.145). The correlation between the variation in the incidence of scorpionism and the percentage of urbanized area was not significant. Although the highest incidence of scorpionism occurs in-more urbanized environments, there is a wide distribution of scorpion accidents, especially in tropical and subtropical regions due to climatic conditions, the level of urbanization of Brazilian municipalities was not the major factor in the increase of scorpion accidents.

Development of a teacher training program for autism spectrum disorders

Objective: Continuing education focused on the inclusion of children with autism spectrum disorder (ASD) can contribute to better implementation of educational practices, and the use of online technologies is an alternative to increasing the number of specialized professionals. Methods: This study develops a distance teacher training program (DTTP) based on the previous research’s identification of the essential requirements for training education professionals caring for children with ASD within a collaborative digital learning environment are used to facilitate learning techniques, strategies, and resources with the goal of fostering innovation; and tests and discusses the program’s feasibility. Results: A total of 187 education professionals from a municipality in Brazil participated in this study and answered a structured questionnaire to collect information on practices, attitudes, and knowledge. Data were analyzed quantitatively to characterize the sample, and the answers were analyzed qualitatively using Nvivo coding assistance software and manual coding; key concepts were isolated, themes developed, and quotes were identified within the interview transcripts to illustrate data analysis. Data saturation was achieved through interviews to identify themes for the syllabus of the course. Conclusion: From the results and based on active learning methodologies to address real-world problems and promote practical and collaborative solutions to daily challenges with theoretical support, the DTTP was designed, and its application was conducted and evaluated.

Human mobility patterns in Brazil to inform sampling sites for early pathogen detection and routes of spread: a network modelling and validation study

Detecting and foreseeing pathogen dispersion is crucial in preventing widespread disease transmission. Human mobility is a fundamental issue in human transmission of infectious agents. Through a mobility data-driven approach, we aimed to identify municipalities in Brazil that could comprise an advanced sentinel network, allowing for early detection of circulating pathogens and their associated transmission routes. In this modelling and validation study, we compiled a comprehensive dataset on intercity mobility spanning air, road, and waterway transport from the Brazilian Institute of Geography and Statistics (2016 data), National Transport Confederation (2022), and National Civil Aviation Agency (2017-23). We constructed a graph-based representation of Brazil's mobility network. The Ford-Fulkerson algorithm was used to rank the 5570 Brazilian cities according to their suitability as sentinel locations, allowing us to predict the most suitable locations for early detection and to track the most likely trajectory of a newly emerged pathogen. We also obtained SARS-CoV-2 genetic data from Brazilian municipalities during the early stage (Feb 25-April 30, 2020) of the virus's introduction and the gamma (P.1) variant emergence in Manaus (Jan 6-March 1, 2021), for the purposes of model validation. We found that flights alone transported 79·9 million (95% CI 58·3-101·4 million) passengers annually within Brazil during 2017-22, with seasonal peaks occurring in late spring and summer, and road and river networks had a maximum capacity of 78·3 million passengers weekly in 2016. By analysing the 7 746 479 most probable paths originating from source nodes, we found that 3857 cities fully cover the mobility pattern of all 5570 cities in Brazil, 557 (10·0%) of which cover 6 313 380 (81·5%) of the mobility patterns in our study. By strategically incorporating mobility patterns into Brazil's existing influenza-like illness surveillance network (ie, by switching the location of 111 of 199 sentinel sites to different municipalities), our model predicted that mobility coverage would have a 33·6% improvement from 4 059 155 (52·4%) mobility patterns to 5 422 535 (70·0%) without expanding the number of sentinel sites. Our findings are validated with genomic data collected during the SARS-CoV-2 pandemic period. Our model accurately mapped 22 (51%) of 43 clade 1-affected cities and 28 (60%) of 47 clade 2-affected cities spread from São Paulo city, and 20 (49%) of 41 clade 1-affected cities and 28 (58%) of 48 clade 2-affected cities spread from Rio de Janeiro city, Feb 25-April 30, 2020. Additionally, 224 (73%) of the 307 suggested early-detection locations for pathogens emerging in Manaus corresponded with the first cities affected by the transmission of the gamma variant, Jan 6-16, 2021. By providing essential clues for effective pathogen surveillance, our results have the potential to inform public health policy and improve future pandemic response efforts. Our results unlock the potential of designing country-wide clinical sample collection networks with mobility data-informed approaches, an innovative practice that can improve current surveillance systems. Rockefeller Foundation.

Graph Theory to Map Nursing Knowledge of Diagnosis and Interventions in Women's Health.

Apply Graph Theory to analyze and map knowledge about nursing diagnoses and interventions, based on records of consultations carried out by nurses, in women's health, in primary health care. Secondary data from a cross-sectional study were used. Records of nursing consultations carried out during the month of October 2016, in 21 health units, in a Brazilian municipality were analyzed. Network analysis was carried out using Graphs from 61 nursing consultations. 175 diagnoses were recorded, an average of three per consultation; and 380 interventions, an average of six per consultation. In the analysis, four diagnostic and four intervention network groupings were identified. The mapping allowed reflection on phenomena of interest to Nursing and fostering critical thinking in decision making. The findings are useful for teaching and training nurses, as well as strengthening the use of standardized language systems.

Comprehensive care for childhood obesity in Brazilian municipalities.

To understand the potential and limits of care for childhood obesity from the perspective of comprehensiveness, in the context of Primary Health Care, in Brazilian municipalities. A qualitative approach was adopted, with an electronic form of a dissertative nature being applied in 11 municipalities in the five Brazilian regions, derived from the four axes of comprehensiveness defined by Ayres (needs, purposes, articulations, and interactions). Among the strengths for comprehensive care, the following were observed: the provision of services at different levels of care; the relevance of intersectoral programs in the development of actions aimed at the multidimensionality of childhood obesity; the implementation of strategies for systematizing care and tools that encourage the expansion of dialogue and humanization; and intersectoral coordination to create appropriate responses to the expanded needs of children and their families. Limitations include: the centralization of actions in nutrition professionals and in the care sphere; the failure to prioritize childhood obesity in health agendas; and the lack of trained professionals to deal with the complexity of obesity. The findings suggest that child obesity care practices, in order to be transformative, need to be understood in the context of comprehensiveness. And this includes (re)thinking public policies, professional practices, and the organization of work processes so that they are, in fact, more inclusive, participatory, dialogical, humanized, supportive, fair, and, therefore, effective.

Spatiotemporal analysis of within-country imported malaria in Brazilian municipalities, 2004-2022.

Human mobility has challenged malaria elimination efforts and remains difficult to routinely track. In Brazil, administrative records from the Ministry of Health allow monitoring of mobility locally and internationally. Although most imported malaria cases are between municipalities in Brazil, detailed knowledge of patterns of mobility is limited. Here, we address this gap by quantifying and describing patterns of malaria-infected individuals across the Amazon. We used network analysis, spatial clustering, and linear models to quantify and characterize the movement of malaria cases in Brazil between 2004 and 2022. We identified sources and sinks of malaria within and between states. We found that between-state movement of cases has become proportionally more important than within-state, that source clusters persisted longer than sink clusters, that movement of cases into sinks was seasonal while movement out of sources was not, and that importation is an impediment for subnational elimination in many municipalities. We elucidate the vast travel networks of malaria infected individuals that characterize the Amazon region. Uncovering patterns of malaria case mobility is vital for effective microstratification within Brazil. Our results have implications for intervention stratification across Brazil in line with the country's goal of malaria elimination by 2035.

Urban Metabolism and Waste Flows in Small Municipalities: Methodological Advances in Material Flow Analysis

Objective: The objective of this study is to investigate Urban Metabolism (UM) and Material Flow Analysis (MFA) approaches to characterize waste flows in small Brazilian municipalities. Additionally, it aims to develop a method that contributes to the environmental management of municipal waste. Theoretical Framework: This study utilizes the models and concepts from UM and MFA approaches. Method: The EUROSTAT guide, proposed by the Statistical Office of the European Union for national-scale MFA, was adopted as the methodological reference and adapted to the Brazilian municipal context. The method's development involved progressive refinement cycles, including secondary data collection, improvement, and evaluation. The method was tested in a case study in the municipality of Feliz, RS. Results and Discussion: The results indicate that the developed method provides a comprehensive understanding of the municipality's waste flows, including their magnitude, origins, and destinations. The UM and MFA approaches offer an integrated perspective of waste flows with other material flows in the municipality, facilitating the visualization of circular economy possibilities. Research Implications: The research offers insights into the application of the results for environmental waste management in small Brazilian municipalities, providing more informative diagnostics than those required by the National Solid Waste Policy. Originality: This study contributes to the literature by proposing specific methodologies for analyzing waste flows in the municipal context. Additionally, it introduces innovations compared to previous applications of MFA in Brazil.

Spatial and trend analysis of gestational syphilis cases in Brazil from 2011 to 2020: an ecological study

ObjectivesTo analyze the rate of gestational syphilis (GS) based on temporal trends over 11 years, as well as the spatial distribution of GS in Brazil, based on the identification of spatial clusters.MethodologyAn ecological, using Brazil and its regions as an analysis unit, based on gestational syphilis data reported in the Notifiable Diseases Information System (SINAN), from 2011 to 2020. Thematic maps were built for spatial data analysis, and the Prais-Winsten autoregressive model was used to verify the trend. Spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of distribution of GS across Brazilian municipalities, using a 5% significance level.ResultsGestational syphilis experienced a considerable increase in cases during the studied period, with a peak of 37,436 cases in 2018. The spatial distribution of the disease is heterogeneous in the country. A growing trend was observed in all states of Brazil, except for Espírito Santo, where it remained stationary, with a monthly variation of 10.32%.ConclusionThe spatial and temporal trend analysis point to syphilis as an important public health problem. The numbers are alarming and show the urgent need for measures to prevent and control syphilis during pregnancy.

Analyzing the Logistics of the Brazilian Book and Teaching Material Program: a sociotechnical strategy to inform optimization

The National Book and Teaching Material Program, formulated and executed by the Brazilian Ministry of Education and the National Education Development Fund, aims to ensure that students and teachers in Brazilian public schools have the constitutional right to access teaching materials. The program's logistics are complex, requiring the timely and cost-effective delivery of thousands of tons of teaching materials to public schools across thousands of Brazilian municipalities. A sociotechnical analysis is essential to comprehend the logistics challenges of such a program, as it enables considering social, normative, and technical aspects in a comprehensive and integrated manner. This article presents a qualitative analysis of the program logistics by applying different sociotechnical artifacts. The findings reveal a complex problem involving diverse processes and stakeholders who must adhere to several norms, adopt different computer systems, and rely on a direct and intense communication culture. Identifying key attention points and acknowledging the unique Brazilian context, the article argues that a sociotechnical perspective is crucial for understanding the problem's complexity and informing the design of solutions to optimize the program’s logistics.

The pedestrian place in urban mobility plans in Minas Gerais (Brazil)

This research presents a survey of the Municipalities of the State of Minas Gerais (Brazil)with population above 250 thousand inhabitants that have Urban Mobility Plansanctioned according to a Federal Law. This survey is be carried out using exploratoryresearch through the recording data on the website of the Ministry of Cities, between thedays 18.09.2023 to 20.09.2023. It was found that only 53.45% of municipalities are in compliance with the legislation. When analyzing municipalities with up to 250 thousand inhabitants, it was found that only 13.11% meet the legal requirements. From this survey, it was possible to outline an overviewof Brazilian municipalities that are legally required to have Urban Mobility Plans. It wasfound that Belo Horizonte, Contagem, and Governador Valadares have plans approvedby law, allowing for an examination of their relationship with pedestrians. The outcomeis presented in forms of graphs, that compare the different Brazilian scenarios regardingthe Urban Mobility Plans focusing mainly the pedestrian way of displacement.

Short-term ozone exposure and cancer mortality in Brazil: A nationwide case-crossover study.

Exposure to ambient ozone (O3) is linked to increased mortality risks from various diseases, but epidemiological investigations delving into its potential implications for cancer mortality are limited. We aimed to examine the association between short-term O3 exposure and site-specific cancer mortality and investigate vulnerable subgroups in Brazil. In total 3,459,826 cancer death records from 5570 Brazilian municipalities between 2000 and 2019, were included. Municipal average daily O3 concentration was calculated from a global estimation at 0.25°×0.25° spatial resolution. Thetime-stratified case-crossover design was applied to assess the O3-cancer mortality association. Subgroup analyses by age, sex, season, time-period, region, urban hierarchy, climate classification, quantiles of GDP per capita and illiteracy rates were performed. A linear and non-threshold exposure-response relationship was observed for short-term exposure to O3 with cancer mortality, with a 1.00% (95% CI: 0.79%-1.20%) increase in all-cancer mortality risks for each 10-μg/m3 increment of three-day average O3. Kidney cancer was most strongly with O3 exposure, followed by cancers of the prostate, stomach, breast, lymphoma, brain and lung. The associated cancer risks were relatively higher in the warm season and in southern Brazil, with a decreasing trend over time. When restricting O3 concentration to the national minimum value during 2000-2019, a total of 147,074 (116,690-177,451) cancer deaths could be avoided in Brazil, which included 17,836 (7014-28,653) lung cancer deaths. Notably, these associations persisted despite observed adaptation within the Brazilian population, highlighting the need for a focus on incorporating specific measures to mitigate O3 exposure into cancer care recommendations.

BIBLIOGRAPHIC REVIEW THAT REPORTS ON THE SUSTAINABLE URBAN MOBILITY INDEX, BETWEEN THE YEARS 2018 AND 2022

The referring work presents a narrative bibliographic review, on the subject “Sustainable Urban Mobility Index”, based on research carried out at Capes, Scielo, Google Scholar and Digital Bank of Theses and Dissertations within the time frame from 2018 to 2022, where we will point out the main authors used as references and their contributions. During the research, we noticed that there is little academic production in the area to contribute, with the majority being prepared based on the analysis methodology proposed by Costa. Next, we will talk about the importance of urban mobility indices and their relationship with Brazilian municipalities. Later we will describe the main contributions of the sustainable urban mobility indices in the cities of Sinop, Lençóis Paulista, Aracaju, São Mateus and Campinas, in parallel we will demonstrate the sustainable urban mobility indices in the cities of São Mateus, Lençóis Paulista and Sinop.

Production factors, regional economic development and agriculture in brazil: A spatial econometrics approach

Agriculture has a great effect on the development process of a region and production land, labor, and technology are determinant factors in its dynamism. This work carries out a spatial analysis for each production factor of Brazilian municipalities in 2006 and 2017 and intends to verify if there are patterns of association and agglomerations. This work is applied research of quantitative and exploratory nature. The Exploratory Analysis of Spatial Data (ESDA) was used to perform spatial analysis for each production factor in Brazilian municipalities in 2006 and 2017 and to check the patterns of association and agglomerations. The main agricultural activities and practice are related to exports as proposed by North. The formation of clusters verified both in the use of the factors of land, labor and technology, and in the value of agricultural production has a polarized role in the Brazilian space, as described by Perroux. This polarization and the formation of clusters expanded at certain points over time, indicating the formation of new links with neighboring municipalities (a la Hirschman). The spatial association pattern was significant in all analyzed variables, with emphasis on the non-physical technology factor, presenting the highest spatial autocorrelation coefficient in both periods analyzed.