Repositório RCAAP

Abstract Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU), are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.

Resumo O objetivo foi analisar a tendência dos acidentes de transporte terrestre com motociclistas em Belo Horizonte, Minas Gerais, Brasil, de 2007 a 2011, e identificar aglomerados e interseções das vias públicas de maior risco. Foram utilizadas as bases de dados da Polícia Militar e do Serviço de Atendimento Móvel de Urgência (SAMU). Para identificar as interseções críticas foram calculadas as taxas de severidade dos acidentes. Utilizou-se duas técnicas de estatística espacial para analisar os aglomerados de acidentes: análise de kernel e estatística Scan (modelo de Poisson contínuo). Os aglomerados de risco de acidentes foram detectados na Região Central e nos corredores de tráfego. O risco de acidentes, inclusive fatais, foi maior em segmentos que nas interseções. As interseções críticas são rotas de acesso para as regiões da Grande Belo Horizonte. As taxas de mortalidade e de acidentes apresentaram duas tendências distintas. Além disso, a maioria dos óbitos ocorreu à noite. Justifica-se a importância da melhoria das rotas para os motociclistas e do transporte público.

Resumen Se analizó la utilización de servicios de salud reproductiva (atención prenatal, parto y posparto), según la etnia de las mujeres, a partir de la Encuesta Nacional de Demografía y Salud 2010 de Colombia. La etnia fue medida por auto- reconocimiento (indígenas, afrodescendientes y ninguna) y se estimaron modelos logísticos para cada servicio. Encontramos que, respecto a quienes no pertenecen a ninguna etnia, la utilización de servicios de salud reproductiva es menor en las mujeres indígenas y afrodescendientes. En los modelos de regresión se encontró que mujeres indígenas tienen menores posibilidades de un número adecuado de controles prenatales (OR = 0,61), así como también afrodescendientes. Igual situación para la atención institucional del parto: indígenas (OR = 0,33), afrodescendientes (OR = 0,60); y en control posparto: indígenas (OR = 0,80), afrodescendientes (OR = 0,80). En conclusión, existen inequidades en la utilización de servicios de salud reproductiva en las mujeres de grupos étnicos de Colombia que deben ser atendidas con estrategias gubernamentales que garanticen el derecho a la salud.

Resumo Poucos estudos brasileiros abordam a utilização de serviços de saúde mental para população infanto-juvenil. Neste trabalho, objetivou-se caracterizar a distribuição nacional dos Centros de Atenção Psicossocial Infantojuvenis (CAPSi) e descrever o perfil nosológico dos atendimentos infantojuvenis entre 2008 e 2012. Realizou-se estudo ecológico, utilizando registros do sistema de Autorizações de Pagamento de Serviços de Alta Complexidade (APAC) e do Cadastro Nacional de Estabelecimentos de Saúde (CNES). Aspectos sociodemográficos e perfil nosológico foram analisados. Em 2014, 208 CAPSi estavam registrados no CNES, distribuíam-se em 23 das 27 unidades da federação brasileira. Nos atendimentos, predominaram transtornos de comportamento (29,7%), transtornos de desenvolvimento (23,6%) e retardo mental (12,5%). Os CAPSi são insuficientes e desigualmente distribuídos. O perfil nosológico sugere necessidade de articulação entre serviços especializados de saúde mental e atenção básica, além de inclusão do trabalho intersetorial.

Abstract This paper reviews the potential utility of using the concepts and tools of systems to understand and act on health in cities. The basic elements of systems approaches and the links between cities as systems and population health as emerging from the functioning of a system are reviewed. The paper also discusses implications of systems thinking for urban health including the development of dynamic conceptual models, the use of new tools, the integration of data in new ways and the identification of data gaps, and the formulation of different kinds of questions and identification of new policies. The paper concludes with a review of caveats and challenges.

Abstract The term “co-benefits” refers to positive outcomes accruing from a policy beyond the intended outcome, often or usually in other sectors. In the urban context, policies implemented in particular sectors (such as transport, energy or waste) often generate multiple co-benefits in other areas. Such benefits may be related to the reduction of local or global environmental impacts and also extend into the area of public health. A key to identifying and realising co-benefits is the adoption of systems approaches to understand inter-sectoral linkages and, in particular, the translation of this understanding to improved sector-specific and city governance. This paper reviews a range of policies which can yield health and climate co-benefits across different urban sectors and illustrates, through a series of cases, how taking a systems approach can lead to innovations in urban governance which aid the development of healthy and sustainable cities.

Abstract The aim of this study is to discuss the contradictions of the Olympic Games legacy for health and environment in the city of Rio de Janeiro, Brazil. Public policies for sports mega-events have been criticized for contributing to and deepening the city’s historical socio-spatial inequalities. Based on document research and data analysis, the article focused on establishing a proposal for a sustainable city, as provided in Law 10,257/2001, the so-called City’s Statute. The article concludes with remarks on Olympic urban planning, its market orientation, and failures to overcome public health and environmental sanitation problems that will persist as a legacy after 2016.

Abstract There is little scientific evidence that urban upgrading helps improve health or reduce inequities. This article presents the design for the BH-Viva Project, a “quasi-experimental”, multiphase, mixed-methods study with quantitative and qualitative components, proposing an analytical model for monitoring the effects that interventions in the urban environment can have on residents’ health in slums in Belo Horizonte, Minas Gerais State, Brazil. A preliminary analysis revealed intra-urban differences in age-specific mortality when comparing areas with and without interventions; the mortality rate from 2002 to 2012 was stable in the “formal city”, increased in slums without interventions, and decreased in slums with interventions. BH-Viva represents an effort at advancing methodological issues, providing learning and theoretical backing for urban health research and research methods, allowing their application and extension to other urban contexts.

Abstract There is growing interest among urban health researchers in addressing complex problems using conceptual and computation models from the field of complex systems. Agent-based modeling (ABM) is one computational modeling tool that has received a lot of interest. However, many researchers remain unfamiliar with developing and carrying out an ABM, hindering the understanding and application of it. This paper first presents a brief introductory guide to carrying out a simple agent-based model. Then, the method is illustrated by discussing a previously developed agent-based model, which explored inequalities in diet in the context of urban residential segregation.

Abstract Neighborhood problems constitute sources of chronic stress that may increase the risk of poor self-rated health. The associations of census tract level income and perceived neighborhood problems with self-rated health were examined in Florianópolis, Santa Catarina State, Brazil (1,720 adults). Odds ratios (OR) and their 95% confidence intervals (95%CI) of poor self-rated health were estimated through multilevel models. Residents in census tracts in the lower and intermediate tertiles of income reported poorer health than those in the highest tertile. OR of reporting poorer health was 2.44 (95%CI: 2.35- 2.54) in the higher tertile of social disorder (adjusting for mental health). The chances of reporting the poorer health with neighborhood problems ranged from 1.07 (95%CI: 1.03-1.11) to 2.02 (95%CI: 1.95-2.10) for the higher tertile of social disorder (physical health) and physical problem (health-related variables). Perceived neighborhood problems were independently associated with poor health. The perception of a neighborhood among its residents should be considered by health policymakers.

Abstract This study analyzes the profile of deaths from road traffic accidents in Belo Horizonte, Minas Gerais State, Brazil, by linking two public databases, the Information System of the Urban Transportation and Transit Company (BH10) and the Mortality Information System (SIM). The linked database (n = 306) identified a 24% under-recording rate for deaths and differed in the age distribution from the BH10 database and in roadway user category when compared to the mortality database. The mortality rate for road traffic accidents within the city limits was 10.2 per 100,000 thousand, and was higher among men, young adults, and the elderly. Poisson multivariate regression showed a higher mean death rate for motorcycle occupants (rate ratio – RR: 1.81); pedestrians (RR: 1.32); males (RR: 1.24); single/divorced (RR: 1.27); young adults 18-29 years of age (RR: 1.75); elderly (RR: 1.59); and deaths at the crash site (RR: 1.39) when compared to the reference categories. The study unveils the city’s traffic violence, expressed by the large proportion of deaths at the crash site and within the first 24 hours, and confirms the relevance of database linkage for characterizing vulnerable groups and traffic accident mortality in the urban setting.

Abstract An urban health index (UHI) was used to quantify health inequalities within Rio de Janeiro, Brazil, for the years 2002-2010. Eight main health indicators were generated at the ward level using mortality data. The indicators were combined to form the index. The distribution of the rank ordered UHI-values provides information on inequality among wards, using the ratio of the extremes and the gradient of the middle values. Over the decade the ratio of extremes in 2010 declined relative to 2002 (1.57 vs. 1.32) as did the slope of the middle values (0.23 vs. 0.16). A spatial division between the affluent south and the deprived north and east is still visible. The UHI correlated on an ecological ward-level with socioeconomic and urban environment indicators like square meter price of apartments (0.54, p < 0.01), low education of mother (-0.61, p < 0.01), low income (-0.62, p < 0.01) and proportion of black ethnicity (-0.55, p < 0.01). The results suggest that population health and equity have improved in Rio de Janeiro in the last decade though some familiar patterns of spatial inequality remain.

Abstract This study assesses the prevalence of poor self-rated health and investigates its association with individual and environmental characteristics in adults with and without reported morbidity. A household survey assessed 4,048 adults in two districts of Belo Horizonte, Minas Gerais State, Brazil. We used Poisson regression with robust variance stratified by the presence of reported morbidity. Prevalence of poor self-rated health was 29.9% (42.6% in those with morbidity and 13.1% in the group without morbidity). All assessed domains were associated with self-rated health in subjects with reported morbidity. In the group without reported morbidity, the following were associated with self-rated health: social environment, socio-demographic factors, lifestyle, and psychological health. Perceived problems in the environment were associated with poor self-rated health in both groups, even after hierarchical adjustment. The results suggest the importance of investigating self-rated health stratified by reported morbidity and reinforce the need to include variables that characterize the physical and social environment.

Abstract This study aimed to estimate the prevalence of leisure-time physical activity and investigate its association with contextual characteristics of the social and physical environment in different socioeconomic statuses, using a household survey in Belo Horizonte, Minas Gerais State, Brazil (2008-2009). Leisure-time physical activity was measured by the International Physical Activity Questionnaire; and the social and physical environment by scales arising from perception of neighborhood attributes. Multilevel logistic regression analysis was performed separately for each socioeconomic status stratum. The overall prevalence of leisure-time physical activity was 30.2%, being 20.2% amongst participants of low socioeconomic status, 25.4% in the medium and 40.6% in the high socioeconomic status group. A greater perception of social cohesion was associated with increased leisure-time physical activity only amongst participants of the lowest socioeconomic status even after adjusting for individual characteristics. The results demonstrate the importance of social cohesion for the promotion of leisure-time physical activity in economically disadvantaged groups, supporting the need to stimulate interventions for enhancing social relationships in this population.

Abstract The present study aimed to evaluate factors associated with overweight among adults living in urban areas, with the income of the census tract as a context variable. The survey assessed individuals from two health districts of Belo Horizonte, Minas Gerais State, Brazil. Excess weight was determined by body mass index > 25kg/m2. Multilevel logistic regression was used. The sample comprised 2,935 individuals aged 20 to 60 years. The prevalence of overweight was 52.3% (95%CI: 49.9-54.8), similar between men and women. Higher schooling proved to be protective against overweight in women and a risk for men. Living in census tracts with higher income was associated with excess weight only in males. Report of the consumption of diet soft drinks was positively associated with overweight in both sexes. The occurrence of this event seems to be influenced by different factors or to interrelate differently in men and women.

Abstract This study provides a spatial analysis of distribution and access to commercial fruit and vegetable establishments within the territory of a representative sample of public fitness facilities known as the Health Academy Program (HAP) in Belo Horizonte, Minas Gerais State, Brazil. The study evaluated commercial food establishments within a buffer area based on a radius of 1,600 meters around each of 18 randomly selected fitness facilities. Quality of access to fruits and vegetables was assessed by the Healthy Food Store Index (HFSI), consisting of the variables availability, variety, and advertising of fruits, vegetables and ultra-processed foods. The analysis was based on calculation of the Kernel intensity estimator, nearest neighbor method, and Ripley K-function. Of the 336 food establishments, 61.3% were green grocers and open-air markets, with a median HFSI of 11 (5 to 16). In only 17% of the territories, the majority of the “hot area” establishments displayed better access to healthy foods, and only three areas showed a clustering pattern. The study showed limited access to commercial establishments supplying healthy fruits and vegetables within the territory of the public fitness program.

Abstract Social and sexual contact networks between men who have sex with men (MSM) play an important role in understanding the transmission of HIV and other sexually transmitted infections (STIs). In Salvador (Bahia State, Brazil), one of the cities in the survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis among Men Who Have Sex with Men in 10 Brazilian Cities, data were collected in 2008/2009 from a sample of 383 MSM using Respondent Driven Sampling (RDS). Network analysis was used to study friendship networks and sexual partner networks. The study also focused on the association between the number of links (degree) and the number of sexual partners, in addition to socio-demographic characteristics. The networks’ structure potentially facilitates HIV transmission. However, the same networks can also be used to spread messages on STI/HIV prevention, since the proximity and similarity of MSM in these networks can encourage behavior change and positive attitudes towards prevention.

Abstract Obesity prevalence is rapidly increasing in developing countries. Existing research investigating social patterning of obesity and its risk factors in Latin American urban contexts has inconsistent findings. This study analyzed a multistage household survey in adults in Belo Horizonte, Minas Gerais State, Brazil. Marginal models were used to examine the association of education and household and neighborhood income with body mass index (BMI), obesity, physical inactivity, and low fruit and vegetable intake after adjusting for age and ethnicity and stratifying by sex. BMI and obesity were inversely associated with education in women. BMI was positively associated with household and neighborhood income in men. Additionally, physical inactivity and low fruit and vegetable intake were inversely associated with education and household income in both men and women, and physical inactivity was inversely associated with neighborhood income in men. Understanding the drivers of these patterns will allow for development of appropriate policy and interventions to reduce cardiovascular disease risk in large cities in Latin America.

Abstract This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the program’s potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.

Abstract This observational study aimed to estimate the prevalence of speeding on urban roadways and to analyze associated factors. The sample consisted of 8,565 vehicles circulating in areas with and without fixed speed cameras in operation. We found that 40% of vehicles 200 meters after the fixed cameras and 33.6% of vehicles observed on roadways without speed cameras were moving over the speed limit (p < 0.001). Motorcycles showed the highest recorded speed (126km/h). Most drivers were men (87.6%), 3.3% of all drivers were using their cell phones, and 74.6% of drivers (not counting motorcyclists) were wearing their seatbelts. On roadway stretches without fixed speed cameras, more women drivers were talking on their cell phones and wearing seatbelts when compared to men (p < 0.05 for both comparisons), independently of speed limits. The results suggest that compliance with speed limits requires more than structural interventions.