Analyzing Spatial Patterns of Health Vulnerability to Drought in the Brazilian Semiarid Region.

Health determinants might play an important role in shaping the impacts related to long-term disasters such as droughts. Understanding their distribution in populated dry regions may help to map vulnerabilities and set coping strategies for current and future threats to human health. The aim of the study was to identify the most vulnerable municipalities of the Brazilian semiarid region when it comes to the relationship between drought, health, and their determinants using a multidimensional index. From a place-based framework, epidemiological, socio-economic, rural, and health infrastructure data were obtained for 1135 municipalities in the Brazilian semiarid region. An exploratory factor analysis was used to reduce 32 variables to four independent factors and compute a Health Vulnerability Index. The health vulnerability was modulated by social determinants, rural characteristics, and access to water in this semiarid region. There was a clear distinction between municipalities with the highest human welfare and economic development and those municipalities with the worst living conditions and health status. Spatial patterns showed a cluster of the most vulnerable municipalities in the western, eastern, and northeastern portions of the semiarid region. The spatial visualization of the associated vulnerabilities supports decision making on health promotion policies that should focus on reducing social inequality. In addition, policymakers are presented with a simple tool to identify populations or areas with the worst socioeconomic and health conditions, which can facilitate the targeting of actions and resources on a more equitable basis. Further, the results contribute to the understanding of social determinants that may be related to medium- and long-term health outcomes in the region.

Contributions of municipal vulnerability map of the population of the state of Maranhão (Brazil) to the sustainable development goals.

Human vulnerability represents an open field of study that allows us, through the use of indicators, to measure a territory's weakness and potential for dealing with negative climate impacts. This kind of assessment is important within the scope of Sustainable Development Goals (SDGs), especially as a tool that is able to direct the strategies and planning in countries in the context of regional climate change (SDG 13.2). The aim of this work is to demonstrate the application of a method that uses a software created for the Brazilian context (SISVUCLIMA) to evaluate human vulnerability to climate change in the state of Maranhão, Brazil. Via an assessment of socioeconomics, demographics, climate, epidemiological, and environmental aspects compiled to develop a municipal vulnerability index, it was clear that the central and western mesoregions of Maranhão are more fragile regarding exposure, sensitivity, and adaptative capacities. These locations may be the most affected by rising temperatures and reduced rainfall that is projected for the next 20 years in the region. It is believed that the results obtained in this study may contribute indirectly to the adoption of effective actions directed at SDG 13 and other SDGs in the country. By considering the socio-ecological and health determinants that define the vulnerability profile of the municipalities of Maranhão, it will be possible to suggest specific actions to reduce the fragility of the local population to climate impacts. Through a spatial and multi-dimensional view of the problem, the proposed indicators can act as an effective instrument for overall environmental management from a sustainable perspective.

Evaluation matrix for health promotion programs in socially vulnerable territories. / Matriz de avaliação de programas de promoção da saúde em territórios de vulnerabilidade social.

Health promotion has a set of strategies for advancing health and reducing inequalities. However, evaluating the effectiveness of health promotion programs has been a challenge. This paper shows the development and application of the Evaluation Matrix, constructed with qualitative-quantitative and multidimensional indicators supported by public policies targeting socially vulnerable territories. This is a cross-sectional study with the implementation of a health promotion program in order to develop an Evaluation Matrix to be applied in two distinct socio-environmentally vulnerable areas. The Evaluation Matrix proved to be easily applicable and enabled the detection of strengths and weaknesses of health promotion programs applied in different territories. The participation of managers, teams, population and multiple sectors of society was decisive for the success of the program. Furthermore, community health workers stood out as essential stakeholders due to their linkages with the population. Contributions include a tool and methodology for evaluating health promotion programs to be applied in different territories and modified according to the territory.

A promoção da saúde possui um conjunto de estratégias para trazer saúde e reduzir desigualdades. No entanto, tem sido um desafio avaliar a efetividade de programas de promoção de saúde. Este artigo apresenta o desenvolvimento e a aplicação de Matriz de Avaliação, construída por meio de indicadores quali-quantitativos e multidimensionais, que estão apoiados nas políticas públicas voltadas para territórios com vulnerabilidade social. Estudo transversal, com realização de programa de promoção da saúde e a finalidade de desenvolver uma Matriz de Avaliação, com possibilidade de aplicação em duas áreas de distinta vulnerabilidade socioambiental. A Matriz de Avaliação demonstrou ser de fácil aplicação e permitiu detectar os pontos fortes e fracos dos programas de promoção da saúde aplicados em diferentes territórios. Verificou-se que a adesão dos gestores, das equipes, da população e dos diversos setores da sociedade foram decisivos para o sucesso do programa. Adicionalmente, os agentes de saúde se destacaram como atores essenciais devido ao seu vínculo com a população. As contribuições incluem instrumento e metodologia para avaliar os programas de promoção da saúde, que podem ser aplicados em realidades distintas e modificados de acordo com o território.

Matriz de avaliação de programas de promoção da saúde em territórios de vulnerabilidade social / Evaluation matrix for health promotion programs in socially vulnerable territories

Resumo A promoção da saúde possui um conjunto de estratégias para trazer saúde e reduzir desigualdades. No entanto, tem sido um desafio avaliar a efetividade de programas de promoção de saúde. Este artigo apresenta o desenvolvimento e a aplicação de Matriz de Avaliação, construída por meio de indicadores quali-quantitativos e multidimensionais, que estão apoiados nas políticas públicas voltadas para territórios com vulnerabilidade social. Estudo transversal, com realização de programa de promoção da saúde e a finalidade de desenvolver uma Matriz de Avaliação, com possibilidade de aplicação em duas áreas de distinta vulnerabilidade socioambiental. A Matriz de Avaliação demonstrou ser de fácil aplicação e permitiu detectar os pontos fortes e fracos dos programas de promoção da saúde aplicados em diferentes territórios. Verificou-se que a adesão dos gestores, das equipes, da população e dos diversos setores da sociedade foram decisivos para o sucesso do programa. Adicionalmente, os agentes de saúde se destacaram como atores essenciais devido ao seu vínculo com a população. As contribuições incluem instrumento e metodologia para avaliar os programas de promoção da saúde, que podem ser aplicados em realidades distintas e modificados de acordo com o território.

Abstract Health promotion has a set of strategies for advancing health and reducing inequalities. However, evaluating the effectiveness of health promotion programs has been a challenge. This paper shows the development and application of the Evaluation Matrix, constructed with qualitative-quantitative and multidimensional indicators supported by public policies targeting socially vulnerable territories. This is a cross-sectional study with the implementation of a health promotion program in order to develop an Evaluation Matrix to be applied in two distinct socio-environmentally vulnerable areas. The Evaluation Matrix proved to be easily applicable and enabled the detection of strengths and weaknesses of health promotion programs applied in different territories. The participation of managers, teams, population and multiple sectors of society was decisive for the success of the program. Furthermore, community health workers stood out as essential stakeholders due to their linkages with the population. Contributions include a tool and methodology for evaluating health promotion programs to be applied in different territories and modified according to the territory.

Socioenvironmental conditions and intestinal parasitic infections in Brazilian urban slums: a cross-sectional study.

METHODS: A cross-sectional study covering an agglomeration of urban slums was conducted between 2015 and 2016 using participants observation, a socioeconomic survey, and the spontaneous sedimentation method with three slides per sample to analyze fresh stool specimens ( n =595) searching for intestinal parasites. RESULTS: Endolimax nana ( n =95, 16.0%) and Entamoeba coli ( n =65, 10.9%) were the most frequently identified agents, followed by Giardia intestinalis ( n =24, 4.0%) and Ascaris lumbricoides ( n =11, 1.8%). Coinfections caused by E. nana and E. histolytica/dispar and by Entamoeba coli/A. lumbricoides were significant. The use of piped water as drinking water, the presence of A. lumbricoides , and contamination with coliform bacteria and Escherichia coli were more common in major area (MA) 1. Children (0-19 years) had a greater chance of living in poverty (OR 3.36; 95% CI: 2.50- 4.52; p <0.001) which was pervasive. The predominance of protozoa parasites suggests that a one-size-fits-all approach focusing on preventive chemotherapy for soil-transmitted helminths is not appropriate for all communities in developing countries. It is important that both residents and health professionals consider the socioenvironmental conditions of urban slums when assessing intestinal parasitic infections for disease control and health promotion initiatives.

Intestinal parasitic infections in a lowincome urban community: prevalence and knowledge, attitudes and practices of inhabitants of Parque Oswaldo Cruz, Rio de Janeiro, Brazil

Intestinal parasitic infections (IPIs) are present in Brazil from upper-to low-income communities, with varying infection estimates; however, they affect those living in urban and rural poverty more severely, without adequate access to consistently safe drinking water, sanitation, waste disposal, medical access and education. Estimates show the need for establishing infection prevalence and socioeconomic features, along with population knowledge, attitudes and practices (KAP) regarding IPIs. The purpose of this study is to assess the prevalence and KAP regarding IPIs of residents of an urban low-income community (Parque Oswaldo Cruz/Amorim) of the Complexo de Manguinhos, Rio de Janeiro, Brazil. The Lutz sedimentation technique was used for parasite detection (n=1,121) and, to obtain data on community KAP regarding IPIs, a KAP survey, adapted from Mello et al. was applied (n=505). An overall prevalence of 20.7% was detected with protozoa composing 92.9% (n=235) of the positive samples. Questionnaires revealed generally correct knowledge but with several inconsistencies, unawareness of the association between the etiological agent and the disease, and uncertainty regarding own knowledge of the subject. The population understood the importance of prevention and was willing to utilize prevention strategies despite being unsure of how to prevent infection. Further studies are required to investigate best practices for improving health equity, community health empowerment and IPIs prevention in Rio de Janeiro, Brazil.

[Economic evaluation of cases of dengue fever attributed to the disaster of 2011 in Nova Friburgo (State of Rio de Janeiro/Brazil)]. / Avaliação econômica dos casos de Dengue atribuídos ao desastre de 2011 em Nova Friburgo (RJ), Brasil.

The prospects outlined in climate scenarios produced for Brazil indicate a probable increase in the number of extreme hydrometeorological events in the coming years. Therefore, a study of the health scourges that may intensify due to these events is important. The scope of this article is to estimate the cost represented by the cases of dengue fever attributed to the 2011 disaster in Nova Friburgo (RJ). There were 1,356 suspected cases of dengue fever, 937 of which were confirmed. The total cost of the disease may have been between R$66,000 and R$499,000 taking the minimum salary as a benchmark, with approximately 70% of this amount being among the confirmed cases. The disaster caused extensive changes in the city's environment which, together with the urban sanitation and clearing up process that occurred in the post-event period, led to an increase in the number of potential mosquito breeding sites, facilitating their proliferation and increasing the number of cases of dengue fever. This was a disease that in the decade prior to the disaster recorded few cases of the disease in the municipality. This illustrates the potential of events like the one that occurred in 2011 in Nova Friburgo may have on the increase in the number of cases, and consequently on the cost of the disease.

Avaliação econômica dos casos de Dengue atribuídos ao desastre de 2011 em Nova Friburgo (RJ), Brasil / Economic evaluation of cases of dengue fever attributed to the disaster of 2011 in Nova Friburgo (State of Rio de Janeiro/Brazil)

A perspectiva apontada pelos cenários climáticos desenvolvidos para o Brasil é de provável aumento no número de eventos hidrometeorológicos extremos nos próximos anos. Por isso, se faz importante o estudo dos agravos em saúde que poderão se intensificar em decorrência desses eventos. Portanto, por meio deste artigo, propõe-se estimar o custo representado pelos casos de dengue atribuídos ao desastre de 2011, em Nova Friburgo (RJ). Verificou-se que ocorreram 1.356 casos suspeitos de dengue, dos quais 937 foram confirmados. O custo total da doença pode ter variado, no mínimo, entre R$ 66 mil e R$ 499 mil, no cenário de menor valor de salário, sendo que cerca de 70% desse custo ocorreu entre os casos confirmados. O desastre provocou grandes mudanças no ambiente do município que, junto com os problemas de saneamento e limpeza urbana, que ocorreram em períodos posteriores ao evento, acabou por aumentar a disponibilidade de locais que pudessem servir de criadouro do mosquito, facilitando sua proliferação e aumentando a incidência da dengue, doença que na década anterior ao desastre teve baixa incidência no município. Isso ilustra o potencial que eventos como ao ocorrido em 2011, em Nova Friburgo, podem ter no incremento desses casos e, consequentemente, nos custos da doença.

The prospects outlined in climate scenarios produced for Brazil indicate a probable increase in the number of extreme hydrometeorological events in the coming years. Therefore, a study of the health scourges that may intensify due to these events is important. The scope of this article is to estimate the cost represented by the cases of dengue fever attributed to the 2011 disaster in Nova Friburgo (RJ). There were 1,356 suspected cases of dengue fever, 937 of which were confirmed. The total cost of the disease may have been between R$66,000 and R$499,000 taking the minimum salary as a benchmark, with approximately 70% of this amount being among the confirmed cases. The disaster caused extensive changes in the city's environment which, together with the urban sanitation and clearing up process that occurred in the post-event period, led to an increase in the number of potential mosquito breeding sites, facilitating their proliferation and increasing the number of cases of dengue fever. This was a disease that in the decade prior to the disaster recorded few cases of the disease in the municipality. This illustrates the potential of events like the one that occurred in 2011 in Nova Friburgo may have on the increase in the number of cases, and consequently on the cost of the disease.

Organização dos serviços urbanos de saúde frente à mudança do clima e ao risco de desastres na América Latina / Organization of urban health services in the face of climate change and disaster risk in Latin America

Países da América Latina que sofreram com eventos extremos e desastres nas últimas décadas têm buscado alternativas para melhorar a organização e a capacidade de resposta dos serviços de saúde, evitando o impacto que a população sofreria no caso de tais serviços serem afetados. Neste artigo são relatadas experiências de países da América Latina no que se refere à preparação e adaptação às mudanças do clima no setor saúde, que poderiam ser replicadas em outros locais. Espera-se, por meio desta revisão crítica da literatura, que se possa motivar o setor saúde a se reorganizar para que se torne menos vulnerável aos efeitos das mudanças do clima.

Latin American countries that have suffered extreme events and disasters in the last decades have been searching for alternatives to improve the organization and the response capacity of health services, avoiding the impact that the population would suffer in case those services would be affected. This article presents experiences of Latin American countries regarding the preparation and adaptation of the health sector to climate changes. With this critical literature review, we expect to motivate the health sector to reorganize itself in order to become less vulnerable to the effects of climate change.

Desafios e oportunidades para a saúde na gestão socioambiental da indústria de petróleo e energia. / Health?s challenges and opportunities for social and environmental management of oil and energy industry.

Este artigo faz uma reflexão sobre os principais desafios e oportunidades para a abordagem integrada de Saúde Pública e Meio Ambiente, considerando-se o cenário energético atual, a introdução de novas tecnologias e a necessidade de construção de uma referência conceitual e prática que considere a interação entre Saúde, Meio Ambiente, Responsabilidade Social e Desenvolvimento Sustentável. Introduz os conceitos de Saúde Ambiental e avaliação de impacto à saúde (AIS) e sinaliza a utilização desse instrumento metodológico para a incorporação da Saúde no licenciamento ambiental e na gestão socioambiental.

This paper has pondered the main challenges and opportunities for an integrated approach among Public Health and Environment, considering the current energy scenario, the introduction of new technologies and the need for a more comprehensive conceptual and practical reference between Health, Environment, Social Responsibility and Sustainable Development. It introduces the concepts of Environmental Health and health impact assessment (HIA), and indicates the methodology of insertion of Health in the environmental licensing and in the social and environmental management.

[Environmental management in the public sector: a question of social and economic relevancy]. / A gestão ambiental no setor público: uma questão de relevância social e econômica.

Discussing the need to implement an environmental management system in civil service entities, this paper offers a brief description of some management practices used by companies in various sectors that are endeavoring to establish the best possible relationships between business activities, environmental issues and human needs, today and in the future. Some economic arguments are presented, including the benefits obtained by private sector companies adopting eco-efficiency criteria that are in themselves sufficient to justify the implementation of an effective environmental management policy in government institutions. The relevance is also stressed of drawing up the Civil Service Environment Agenda (A3P), striving to introduce a new cultural approach that will mobilize civil servants in order to optimize resources, combating waste and encouraging better work environments. For this Agenda to be effective, civil servants and managers must obviously be fully engaged.

A gestão ambiental no setor público: uma questão de relevância social e econômica / Environmental management in the public sector: a question of social and economic relevancy

Este texto apresenta uma discussão a respeito da necessidade de implantar um sistema de gestão ambiental nos órgãos da administração pública. Efetua-se breve descrição de práticas gerenciais de empresas de setores variados que assumem o compromisso de estabelecer a melhor relação possível entre atividade empresarial, meio ambiente e necessidades humanas presentes e futuras. Expõem-se alguns argumentos de caráter econômico, referentes aos benefícios obtidos por iniciativas privadas que adotaram critérios de ecoeficiência que, em si, seriam suficientes para justificar a implantação de uma política efetiva de gestão ambiental nas instituições públicas. Destaca-se a relevância da criação da Agenda Ambiental na Administração Pública (A3P), que pretende instaurar uma nova cultura institucional, visando à mobilização dos servidores para a otimização dos recursos, para o combate ao desperdício e para a busca de uma melhor qualidade do ambiente de trabalho. Evidencia-se que para o êxito e efetivação da agenda será decisivo o grau de engajamento do próprio servidor e de seus dirigentes.

Discussing the need to implement an environmental management system in civil service entities, this paper offers a brief description of some management practices used by companies in various sectors that are endeavoring to establish the best possible relationships between business activities, environmental issues and human needs, today and in the future. Some economic arguments are presented, including the benefits obtained by private sector companies adopting eco-efficiency criteria that are in themselves sufficient to justify the implementation of an effective environmental management policy in government institutions. The relevance is also stressed of drawing up the Civil Service Environment Agenda (A3P), striving to introduce a new cultural approach that will mobilize civil servants in order to optimize resources, combating waste and encouraging better work environments. For this Agenda to be effective, civil servants and managers must obviously be fully engaged.