Paulo City Research Articles

Combined application of gamma radiation, cleaning and chemical sanitizers in decontamination of vehicle air conditioning filters

This work aimed to analyze the fungal contamination of air-conditioning filter waste (n=15) as an indicator of Quality Air Indoor from different car models in São Paulo city in São Paulo State, Brazil, during the period from October 2018 to July 2019. Three different treatments were used for the decontamination of car air conditioning filters, such as mechanical vacuum cleaning (I), vacuum cleaning and use of sanitizing product (II), and sanitizing product associated with radiation treatment at a dose of 17 kGy (III). After the treatments, microbiological analyses were performed and samples were plated in Petri dishes containing Sabouraud agar transferred by Swabs, and incubated for 7 days at 25 °C. The Petri dishes were stored in a standard Biochemical Oxygen Demand incubator, for the growth of fungal cultures. After incubation, the fungal cultures were evaluated, and the fungal counting was expressed in unit-forming colonies (UFC) and frequency in samples (%). The fungi were examined by lactophenol blue solution staining for microscopy. All samples of treatment I and II were contaminated with various fungal genera and high bioburden, namely (treatment I) Alternaria alternata, Aspergillus flavus, A. niger, Cladosporium spp., Fusarium spp., Mucor spp., Nigrospora spp., Not Sporulated Fungi (NSF), Penicillium spp., Rhizopus spp., Rhodotorula spp., Trichoderma spp. and yeasts. Treatment II showed Alternaria alternata, Aspergillus flavus, A. fumigatus, A. niger, A. ochraceus, Cladosporium spp., Mucor spp., NSF, Penicillium spp., Phoma spp., Rhizopus spp., Rhodotorula spp., Trichoderma spp., and yeasts. Treatment III presented NSF and yeasts, with 80% of material decontamination.

Epidemiologic Characteristics, Time Trend, and Seasonality of Orofacial Clefts in São Paulo State, Brazil. 2008-2019.

To characterize the epidemiology, identify trends in prevalence, seasonality, and risk factors for orofacial clefts (OFC), selecting the São Paulo state (SPS) population database. A population-based study to estimate the OFC prevalence trends in recent years, stratified by maternal age and SPS geographical clusters. All live births (LB) with OFC in SPS from 2008-2019. 5342 cases of OFC among 7 301 636 LB. Not applicable. OFC prevalence trends, annual percent change (APC) with a 95% confidence interval, and seasonality. We found an OFC prevalence of 7.3/10 000LB in SPS, Brazil. Among all the cases, the majority were male (57.1%), Caucasian (65.4%), 77.8% born at term, 75.8% weight >2500 g, 97.1% singleton, and 63.9% of births were by cesarean section. From 2008-2019, SPS presented a stationary OFC prevalence trend; in São Paulo city, the highest APC was observed (0.05%); the maternal age group with the highest OFC prevalence rate was ≥35 years (9.2/10 000LB). We identified the existence of seasonal variation based on the conception date in the final months of the year, corresponding to the spring season (P < .001). OFC had a stationary prevalence trend in recent years, with the highest prevalence in the Central North Cluster and ≥35 years maternal age group. Seasonality was observed in the spring season, and congenital malformation of lips was the most common associated pathology. This population-based study is the first to summarize the current epidemiology of OFC in SPS.

Granite Weathering, Denudation Processes, and Associated Landforms in the Itu-Cabreúva Region, São Paulo, Brazil

The Itu-Cabreúva region is located about 90 km northwest of the São Paulo city center. The geological setting is characterized by the expressive occurrence of Neoproterozoic granitic rocks. These intrusive rocks form large plutons that have given rise to flattened hills, valleys with concave-convex slopes, and superficial drainage systems. As part of this larger framework, several smaller landforms with unique appearances occur, which can be categorized into six groups: nubbin, boulder, balanced rock, castle koppie, cave, and minor form. Although these reliefs were formed under similar weathering conditions, the research results show that the physical properties of the lithology and the nature and density of the joints strongly influenced the shape and size of the blocks. These geoforms have exceptional scenic value and are situated in a geographically advantageous location for a range of educational and recreational activities that can be adapted to different levels of knowledge. The implementation of such proposals in the context of understanding the physical environment would result in a number of benefits, including (i) greater community involvement in the environment, (ii) valorization of the local landscape as a historical record of the planet's evolution, and (iii) improvement of urban geological risk prevention programs. Finally, these landforms are fascinating and offer conclusive evidence that can be observed on a wide range of scales, illustrating how the brittle deformation and magmatic fabric of the granite massifs influenced the development of the local landscape.

Reflections on COVID-19 pandemic and waste management in developing countries: A case study in São Paulo city, Brazil.

COVID-19 pandemic has changed several aspects in human behaviour, whereas population mobility patterns have been strongly affected by social distancing. In parallel, changes in solid waste generation patterns have been reported worldwide. This work assessed the influence of the COVID-19 pandemic on waste generation and collection in São Paulo city, Brazil, the largest city of Latin America. Data on nine types of wastes collected between 2013 and 2021 were obtained, and the quantities of wastes collected before and during the pandemic were compared. These data were also discussed in light of data on COVID-19 cases and rates of social distancing and mobility. An increase in the amount of recyclables collected during the first wave of COVID-19 (March to September 2020) was observed. Decreases in the quantities of construction, demolition and bulky wastes (first wave of COVID-19) and farmers market wastes (second wave - October 2020 to February 2021) were also evidenced. The quantities of medical wastes collected during the pandemic significantly increased. The amount of residential wastes was lower than the mean for the pre-pandemic period during the first months of COVID-19. Thus, changes in lifestyle and consumption patterns of the population of São Paulo city seem to have affected solid waste generation during the pandemic, which reinforces the need of implementing solid waste management policies based on a diagnostic that characterise and consider these changes.

Analysis of the Influence of Digital Marketing and Service Quality on Organizational Culture at St. Catholic Hospital Vincentius a Paulo Surabaya City

Purpose: Health is a right of every citizen, so the hospital's strategy for improving services should see opportunities from various aspects, especially in today's digital era. The purpose of this study is to ascertain how digital advertising and quality of service affect consumer choice to choose health services through organizational culture at St. Vincentius A Paulo City of Surabaya.&#x0D; Design/methodology/approach: This study's methodology brings together a descriptive technique with a quantitative approach. Customers who submitted their information into the database compose the population in the present research. The sample in this research is 200 respondents. Data collection techniques used questionnaires distributed to consumers who served as participants in tests. Analyzing data technique with path analysis method.&#x0D; Findings: The findings revealed that the quality of service (X2) and digital advertising (X1) had a favorable and considerable impact on organizational culture (Y) at St. Vincentius A Paulo / RKZ Surabaya City where X1 = 0.000 and X2 = 0.000 is less than 0.05. Practical implications, as input to the hospital for material evaluation of organizational culture development policies in the St. Vincentius A Paulo City of Surabaya. Theoretical repercussions, serving as a resource for future research on fundamental research of institutional cultures as input to the hospital for material evaluation of organizational culture development policies in the St. Vincentius A Paulo City of Surabaya. Theoretical repercussions, serving as a resource for future research on fundamental research of institutional cultures as input to the hospital for material evaluation of organizational culture development policies in the St. Vincentius A Paulo City of Surabaya. Theoretical repercussions, serving as a resource for future research on fundamental research of institutional cultures.&#x0D; Paper type: Research Paper

Regional Disparities in Prevalence and Causes of Visual Impairment and Blindness, Cataract Surgical Coverage and Ocular Findings in Adults 50 Years and Older in Brazil: A Comparative Analysis between Two Population-Based Cross-Sectional Surveys Performed Within a 10-Year Interval

ABSTRACT Purpose To investigate disparities in the prevalence and causes of visual impairment and blindness, cataract surgical coverage, and ocular findings in older adults from two Brazilian geo-socio-demographic areas, São Paulo and Parintins cities. Methods Data from two population-based studies including participants 50 years and older from the cities of São Paulo (São Paulo Eye Study – SPES, 2004) and Parintins (Brazilian Amazon Region Eye Survey – BARES, 2014) were aggregated. Results A total of 5318 participants (3677 from SPES;1641 from BARES) were included. The prevalence of severe visual impairment (SVI) and blindness were, respectively, 0.74% (0.46–1.02) and 0.77% (0.48–1.05) in SPES and 1.72% (1.09–2.35) and 3.44% (2.55–4.33) in BARES. SVI and blindness were associated with BARES study [OR = 2.27 (1.30–3.95); p = .004 - SVI] [OR:4.07 (2.51–6.60); p < .001- blindness]; and older age [OR = 10.93 (4.20–28.45); p < .001 - SPES; OR = 17.96 (8.75–36.83); p < .001 - BARES] while higher education level was a protective factor [OR = 0.21 (0.05–0.95) - SPES; p = .042; OR = 0.21 (0.05–0.91); p = .037 - BARES]. Cataract was the main cause of bilateral severe visual impairment (25.93% in SPES and 64.29% in BARES) and bilateral blindness (21.43% in SPES and 35.71% in BARES). Cataract surgical coverage was significantly lower in BARES (36.32%) compared to SPES (57.75%). Conclusion The prevalence of SVI and blindness was three times higher in older adults from the Brazilian Amazon compared to those living in São Paulo city, despite a 10-year interval between the two studies. These disparities should be mitigated by initiatives to promote access to eye care services targeting underprivileged and remote Brazilian areas.

Mobility restrictions during the COVID-19 pandemic and reduced outpatient HIV and syphilis testing in Brazil.

In the initial phases of the COVID-19 pandemic, strategies adopted to reduce the dissemination of SARS-CoV-2 relied on non-pharmacological interventions, including physical distancing. Mobility restrictions affected the availability and quality of care for many health conditions, including sexually transmitted infections. To investigate the impact of the COVID-19 pandemic mobility restriction on syphilis and HIV testing in outpatient settings. In this study, we collected the weekly number of syphilis and HIV tests performed in a referent laboratory in São Paulo, Brazil, as well as the percentage of positive tests between January 2019 and December 2021. We also retrieved data on retail and recreation mobility in São Paulo city using Google COVID-19 Community Mobility Reports. We explored the association between populational mobility and the number of weekly tests and the association between the number of weekly tests and the percentage of positive results during the pandemic period. The analyses were conducted separately for syphilis and HIV tests. We found that mobility restrictions during the COVID-19 pandemic have been associated with a significant decrease in both syphilis and HIV tests performed in outpatient settings. We also observed that the number of tests performed was inversely associated with the percentage of positive results for syphilis; this association was also apparent for HIV tests in the first wave of the pandemic in the graphic analysis. Taken together, our findings suggest an indirect impact of COVID-19 pandemic-related mobility restrictions on the uptake of diagnostic tests for HIV and syphilis and the potential adoption of targeted-testing strategies. Understanding the extent and complexity of COVID-19 aftermaths on specific conditions and communities is essential to build strategies to mitigate the long-term consequences of COVID-19.

Access to water, sanitation and hygiene for homeless population: experiences from São Paulo city during the Covid-19 pandemic

Access to water, sanitation and hygiene for homeless population: experiences from São Paulo city during the Covid-19 pandemic

Classification of 2007 Winter Mist and Fog in São Paulo City, Brazil

Mist and fog observed at the Meteorological Station of the Institute of Astronomy, Geophysics and Atmospheric Sciences of the University of São Paulo (EM/IAG) in the southeastern part of São Paulo city in the winter of 2007 were classified according to its formation processes: advection or radiation. Meteorological data from EM/IAG, Congonhas Airport and reanalysis from the European Center for Medium-Range Weather Forecast, as well as radiosondes from Campo de Marte Airport were used. In the 1981-2015 climatology, it was observed that these phenomena are more frequent in the winter, with an average of 11 events per month. For the winter of 2007, 21 advection and 28 radiation events were detected, with radiation fog occurring more frequently in June (13) and advection fog, in August (12). The South Atlantic Subtropical High favored the formation of radiation events in 24 cases; 15 of which had the contribution of humidity advected by the sea breeze. Post-frontal anticyclone was associated with the remaining 25 cases, of which 15 were classified as advection. Four cases were chosen for a more detailed analysis. On July 2, 2007, radiation mist occurred, with the injection of moisture by the sea breeze; the next day, there was also radiation mist, however, with no sea breeze. On the 20th of July, fog was caused by advection of humidity with north/northeast winds coming from the Serra da Cantareira and on the 27th, advection mist developed due to the intensification of winds associated with the movement of a post-frontal anticyclone.

Graffiti enquanto arte contratada: proteção da moralidade artística

After decades of marginalization, graffiti has started to appear in public contracts related to the composition of the landscape in important metropolitan areas. Despite the prestige achieved worldwide, there are still disagreements between graffiti artists and public managing officials, especially in the context of urban maintenance policies in which these paintings are targeted for deletion without prior dialogue with its authors — This action may be considered a violation of the author’s moral right to ensure the integrity of the work. Motivated by the controversial removal of the mural on Avenida 23 de Maio (São Paulo city, 2017), this paper aims to verify within the Copyright Law, the hypothetical existence of a gap in the law that undermines the exercise of this right, using the hypothetic deductive method. Some pertinent cases are commented, to refine the contours of this prerogative and of the protection offered by Law 9.610/98, also aiming to assess whether it covers the preservation of graffiti in urban support. The conclusion is that the law does not present obstacles to the right to ensure the integrity of the graffiti artwork, and that artists do face vulnerabilities, but it is unrelated to a gap in copyright law.

Relationship between polyvictimization and overweight among adolescents from São Paulo city, Brazil

This study is to identify victimization patterns and analyze the association between the experience of polyvictimization and overweight or obesity among adolescent girls and boys. The sample consisted of 2680 Brazilian ninth-graders enrolled in public and private schools, taken from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Victimization was explored in two ways: (i) as per Finkelhor and (ii) by latent class analysis (LCA). The interest outcomes were overweight and obesity. Multinomial logistic regression models were used to study the relationship between victimization and overweight or obesity, controlling for confounders. LCA grouped boys and girls adolescents into three classes. These classes received the same labels, but the patterns differed between sexes. Class 1 was characterized by fewer types of victimization suffered and lower endorsement values in the analyzed items and was named bullying and indirect victimization (♀: 42.7%, n = 546; ♂: 21.6%, n = 293). Class 2 included more victimization types than Class 1 and less than Class 3. This class was labeled family violence and peer victimization (♀: 29.1%, n = 356; ♂: 47.9%, n = 652). Class 3 was named high polyvictimization (♀: 28.2%, n = 345; ♂: 30.5%, n = 418). According to Finkelhor, polyvictimization was not associated with overweight or obesity in both sexes. Only the class of high polyvictimization was associated with being overweight (ORadj: 1.60, 95%CI: 1.01–2.54) in girls. In this study, polyvictimization was associated with being overweight only among adolescent girls. Longitudinal studies in different contexts and populations are needed to understand this relationship.

The Relationship Between Art Fairs and the Internationalization of the Brazilian Contemporary Art Market

The objective of this article is to observe possible relationships between the occurrence of international art fairs and the exports of Brazilian artworks from the years 2010 to 2021, with special consideration to SP-Arte, the Brazilian international art fair held every year in São Paulo City, Brazil, since 2005. In order to achieve our objective, we, first, briefly review the historical process of Brazilian art internationalization and the role of art fairs in it. Then, we examine data from the 2018 report from the Brazilian Association of Contemporary Art, that is, the Brazilian association for art galleries in the primary art market. Next, we analyze data on Brazilian artwork exports, extracted from the website of the Brazilian Ministry of Industry, Foreign Trade and Services (MDIC). The third source of investigation is a set of websites from art fairs and art galleries, where we captured data on the participation of Brazilian art galleries in selected international art fairs, from 2010 to 2022. Finally, we compare the historical data of the three data sources to identify possible relationships between the presence of Brazilian art galleries in international art fairs and the value of Brazilian art exports, as export peaks and certain art fairs could occur at the same time.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines.

Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n=211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n=89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

The governance of E-waste recycling networks: Insights from São Paulo City

Electronic waste is an environmental problem because its production volume exceeds its recycling capacity. Academic and managerial production affirm two reasons: (a) dominant market logic and; (b) unresolved asymmetries among actors, causing conflicts to work together. Following the qualitative methodology, we investigate the e-waste situation in São Paulo City. The results allow us to propose that governance constructed by local actors could be a thoughtful way to promote e-waste recycling. Examples from around the world sustain this proposition. The theoretical principle is that the social process of constructing the mechanisms for collective action can solve challenges because the rules, roles, and actions are discussed and assumed by the actors working together. We present a matrix of indicators to be used in future studies in order to refine the proposition of constructed governance.

Microbiological monitoring of coagulase-negative Staphylococcus in public drinking water fountains: Pathogenicity factors, antimicrobial resistance and potential health risks.

The presence of opportunistic bacteria such as coagulase-negative Staphylococcus (CoNS) in drinking water poses public health concerns because of its potential to cause human infection and due to its antimicrobial resistance (AMR) diversity. This study evaluated the occurrence, virulence markers and AMR of CoNS in 468 drinking water samples from 15 public fountains located in four urban parks of São Paulo city (Brazil). Out of 104 samples positive for the presence of Staphylococcus genus, we detected CoNS in 75 of them (16%), which did not meet the Brazilian sanitary standards for residual chlorine. All isolates were of concern to public health for being responsible for infection in humans from low to high severity, nine of them are considered the most of concern due to 63.6% being multiresistant to antimicrobials. The results demonstrated that CoNS in drinking water must not be neglected. It is concluded that the presence of resistant staphylococci in drinking water is a potential health risk, which urges feasible and quick control measures to protect human health, especially in crowded public places.

Automating the assessment of sound power levels of running vehicles using information extracted from a static video

Noise has become a ubiquitous pollutant in big cities, especially Road Traffic Noise compared with other means of transportation. Several countries/regions have developed road noise prediction models based on local measurements, adjusting their requirements and goals for evaluating this pollutant. Differently than most developed countries, industrializing countries have different characteristics of noise generation due to implied differences, such as degree of maintenance (both vehicle and road conditions) and the driving behavior, for instance. The data acquisition needed for evaluating the vehicle fleet's sound power emission is expensive and time-consuming. This research proposes using a video camera close to the microphone to automate the data gathering and analysis. Using a Python script, this system extracts the sound pressure, estimates the running speed, assesses the distance from the receiver point, and classifies the vehicle under investigation. In addition, to discard inaccurate data, the expected trajectory and sound pressure are evaluated. The proposed system's performance was compared against manual measurements. The resulting sound levels differ less than 0.2 dB for most cases. Thus, acquired 3.4 times the amount of data in the same time interval. After this verification, measurements in different conditions and vehicle fleet were tested in Hokkaido, Oita, and São Paulo cities.

In-field performance of continuous flight auger (CFA) energy piles with different configurations

In order to face the national energy crisis in Brazil, the use of geothermal energy piles (GEP) integrated with heat pumps is an attractive and cost-effective solution for the building cooling demand. On the other hand, there are very few field studies on the thermal performance of GEP systems in Brazilian soils and climate conditions, and for this reason, the implementation of this technology is still a challenge. Motivated by this need, continuous flight auger (CFA) energy piles were constructed to support a building in São Paulo city, and an experimental study, described in this paper, was carried out to provide useful data for the design of these GEPs. This work examined two key aspects of the design of GEP systems: (1) the influence of the heat exchange pipe configuration, and (2) the thermal response of GEPs and their effect on nearby piles installed in multi-layered ground. For this study, thermal response tests (TRTs) were conducted on four GEPs constructed with different pipe configurations, installed in a saturated sandy deposit intercalated by soft organic clay layers. The results obtained showed that: (i) the influence of pipe configuration on the GEP heat transfer is more significant during the first hours of pile heating process, and decreases with time due to the thermal interference between the pipe loops; (ii) the GEP temperature profile is impacted by the presence of soil layers of highly different thermal conductivities and groundwater flow velocities; and (iii) the temperature variation of nearby piles was also affected by the thermal characteristics of the soil layers, and therefore it should be considered for the structural design of GEPs.

Impact of the COVID-19 Pandemic on Cervical Cancer Screening in São Paulo State, Brazil

Introduction: The early identification of precursor lesions followed by appropriate treatment prevents development of cervical cancer and its consequences. Objective: The present study evaluated the influence of the COVID-19 pandemic on cervical cancer screening by comparing the quantity of tests to detect cervical cellular changes performed in São Paulo state in 2019, prior to the detection of SARS-CoV-2 in Brazil, to the first (2020) and second (2021) years following its appearance. Materials and Methods: Data from Fundação Oncocentro de São Paulo (FOSP), the agency that analyses approximately 220,000 Papanicolaou (Pap) tests annually, were reviewed. Results: A median of 1,835 Pap tests were performed in 55 municipalities in 2019. This was reduced to 815 tests in 2020, a 56% decrease (p = 0.0026). In 2021, the median number was 1,745, a 53% increase over 2020 levels (p = 0.0233). The 26 municipalities with >1,000 tests in 2020 had a median reduction from 4,433 in 2019 to 2,580 in 2020 (p = 0. 0046). The 29 municipalities with <1,000 tests had a median reduction from 951 in 2019 to 554 in 2020 (p < 0.0001). There was a 44% reduction in the number of follow-up cytological evaluations from 2019 to 2020, followed by a 30% increase in the following year. However, the percentage of women with a normal finding or with any abnormality remained unchanged. The findings from a histological evaluation of women in São Paulo city indicated that the percent of cases positive for CIN-1 (p < 0.0410) and CIN-3 (p < 0.0012) increased in 2020 and 2021 as compared to 2019 levels. Conclusion: A reduction in testing for cervical cancer in the first year of the COVID-19 pandemic, accompanied by an elevated incidence of precancerous lesions in each of the first 2 years following its initiation, may portend a subsequent increased occurrence of cervical cancer in Brazil.

Collaborative Watershed Modeling as Stakeholder Engagement Tool for Science-Based Water Policy Assessment in São Paulo, Brazil

This study describes a collaborative modeling process deployed at the Cantareira Water Supply System (CWSS) in São Paulo City Metropolitan Area, Brazil. The CWSS faces challenges for meeting the increasing water demand, while land-use and climate change and their combined effect on its water cycle and balance have created a complex water resources management problem. Through a stakeholder engagement process—involving scientists and policymakers, the water utility company, and state administration—environmental simulation models were developed to elicit and represent multiple environmental, economic, and policy perspectives, developing a mutual language to communicate and establish common goals of water resources management. Study outputs include estimation of biophysical and economic benefits associated with prioritized native vegetation restoration activities in the source watersheds. These outputs are deployed in support of landscape planning and the decision process integrating multiple stakeholder perspectives in São Paulo state administration, the water utility company, and municipalities.

Efficiency of public spending on primary health care: analysis of São Paulo’s cities

Objective: To analyze the efficiency of São Paulo’s cities with spending on the Primary Health Care sub-function in the year of 2018 and its association with geographic location, population size, wealth generated in the city (GDP – Gross Domestic Product) and budget expenditures with this public policy.&#x0D; Methodology: Exploratory descriptive and explanatory study with São Paulo’s cities in six similar cluster whit combine population and GDP. It uses the settled expense as input, the Number of FHS (Family Health Strategy) Teams, FHS’s Coverage Percentage, Number of Basic Health Units (BHU) and Percentage of Live Births of mothers who performed more than 7 doctor's appointments in the prenatal period as an output. The efficiency level of each city is shown on georeferenced maps. Pearson's correlation is used to estimate the levels of associations between quantitative variables.&#x0D; Results: 102 cities have a maximum level of efficiency, distributed between the six groups. Cities with a lower number of inhabitants and GDP tend to be more inefficient. Efficiency has a low correlation with population size, GDP or health public spending. The cities with the lowest levels of efficiency are neighbors of São Paulo (Metropolitan Region) or small cities scattered throughout the state’s territory.&#x0D; Theoretical Contributions: The research identifies that the management (formulation, implementation and evaluation) of the primary health care policy must consider different programs that focus on its location in the cities’ territory, population and wealth. There are references to the benchmarks for good practices in managing Primary Health Care policies.