RESUMO
The article addresses the British sanitary movement in the 1830s and 1840s, analyzing the ideology that permeated official efforts to promote public health. The sources used consist primarily of the inquiries carried out by royal commissions into the state of sanitation in towns and cities. The main argument is that the ideological assumptions underpinning these inquiries can be understood as part of a political economy of public health, within which tensions can be observed arising from the contradictions between a liberal perspective and the need for greater intervention on the part of the government.
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Política , Saúde Pública , Saneamento , Saneamento/história , Saneamento/legislação & jurisprudência , História do Século XIX , Reino Unido , Saúde Pública/história , HumanosRESUMO
OBJECTIVE: To analyze the spatial patterns and factors associated with tuberculosis incidence in the municipalities of Paraná, Brazil. MATERIALS AND METHODS: Ecological study examining new tuberculosis cases from 2018 to 2022 in Paraná's 399 municipalities. Incidence coefficients, relative risk, and local indicator of spatial autocorrelation were estimated. Negative binomial models were applied to identify associated factors. RESULTS: High-risk areas were observed in the coastal/port, north, and northeast regions. The following factors positively influenced tuberculosis incidence: municipal development index (incidence rate ratio [IRR]: 1.07; 95 % confidence interval [95 % CI]: 1.01-1.14), hospitalizations due to inadequate environmental sanitation (IRR: 1.07; 95 % CI: 1.01-1.14), and Gini index (IRR: 1.09; 95 % CI: 1.02-1.16). CONCLUSIONS: Paradoxically, in municipalities with elevated development indices yet marked by socioeconomic disparities-including deficiencies in sanitation-substantial tuberculosis clusters persist. This suggests that income inequality might play a role in perpetuating the incidence even in regions that are otherwise considered developed.
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Fatores Socioeconômicos , Tuberculose , Brasil/epidemiologia , Humanos , Incidência , Tuberculose/epidemiologia , Feminino , Masculino , Adulto , Análise Espacial , Pessoa de Meia-Idade , SaneamentoRESUMO
Estas herramientas ayudarán a los directores o asociados de los programas de control de las enfermedades infecciosas desatendidas a colaborar con la comunidad de WASH, guiándoles en la creación de alianzas, en la movilización de recursos y en el diseño, la aplicación y la evaluación de las intervenciones.
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Medicina Tropical , Doenças Negligenciadas , Saneamento , Programas Nacionais de Saúde , Conservação dos Recursos NaturaisRESUMO
Sludge from water treatment plants (WTPs) is usually processed by physicochemical clarification followed by thickening, which results in the production of an effluent from dewatering/drying sludge processes that can potentially impact the environment. This paper assessed the viability of employing sludge dewatering water from a water treatment sludge plant (WTSP) in São Paulo State, Brazil, for reuse purposes. Water quality variables were monitored in the effluent and receiving stream. The data were analyzed by paired samples Student t-test (parametric significance test), paired samples Wilcoxon signed rank test (non-parametric significance test), and principal component analysis (multivariate analysis). Despite the distribution of data, typically not Gaussian, both Student and Wilcoxon methods agreed in 9 out of 10 studied parameters regarding the influence of WTSP discharge on waterbody; only for total manganese the Wilcoxon approach provided better fit than Student. Principal component analysis helped to evince correlations among all variables. Results provided useful information for understanding the vocation of WTSP effluent for reuse. For direct non-potable reuse, recirculating the final effluent back to the WTP for two months saved 92,000 m3 of water, the volume of drinking water demanded by the city (n = 292,000 inhabitants) in approximately 30 h.
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Esgotos , Eliminação de Resíduos Líquidos , Purificação da Água , Brasil , Eliminação de Resíduos Líquidos/métodos , Purificação da Água/métodos , Saneamento , Monitoramento Ambiental/métodos , Qualidade da Água , Análise de Componente Principal , Poluentes Químicos da Água/análiseRESUMO
A Segunda edição do manual “Colaboração entre o setor de WASH e o setor da saúde: guia prático para programas de doenças tropicais negligenciadas” elaborado pela Organização Mundial de Saúde (OMS) em parceria com o grupo de trabalho em Água, Saneamento e Higiene da Neglected Tropical Disease NGO Network (NNN), é uma revisão da primeira edição lançada em 2019. Essa revisão tem como base a implementação das ferramentas e recursos do manual em diversos países desde o ano de seu lançamento. O objetivo do manual é auxiliar gerentes de programas contra as DTNs, e parceiros, na construção de parcerias multissetoriais bem-sucedidas entre os setores de água, saneamento e higiene (WASH, por sua sigla em inglês) e doenças tropicais negligenciadas (DTN), na mobilização de recursos, e na elaboração, implementação e avaliação das intervenções. Com base em ferramentas e práticas que podem ser utilizadas em programas, coordenados e integrados, de controle e eliminação de DTNs, o manual poderá auxiliar na construção de parcerias multissetoriais; no desenvolvimento de programas inteligentes com foco na prestação de contas e em metas compartilhadas; na construção de uma abordagem adaptável e flexível; na garantia da sustentabilidade das ações apoiando a capacidade local, em todos os níveis; e no apoio e complementaridade de intervenções clínicas e de saúde pública para o controle, eliminação e erradicação das DTNs. O kit de ferramentas foi desenvolvido com base em programas e experiências práticas e pode ser adaptado as diferentes necessidades e contextos.
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Água , Saneamento , Higiene , Doenças Negligenciadas , Doenças TransmissíveisRESUMO
la presente publicación describe las pautas sobre el manejo de las herramientas que ayudarán a los directores o asociados de los programas de control de las enfermedades infecciosas desatendidas a colaborar con la comunidad de WASH, guiándoles en la creación de alianzas, en la movilización de recursos y en el diseño, la aplicación y la evaluación de las intervenciones. Sobre la base de herramientas y prácticas que pueden utilizarse en programas coordinados e integrados para el control y la eliminación de las enfermedades infecciosas desatendidas, el manual puede ayudar a crear asociaciones multisectoriales; a desarrollar programas inteligentes centrados en la rendición de cuentas y los objetivos compartidos; a construir un enfoque adaptable y flexible; a garantizar la sostenibilidad de las acciones mediante el apoyo a la capacidad local a todos los niveles; y a respaldar y complementar las intervenciones clínicas y de salud pública para el control, la eliminación y la erradicación de las enfermedades infecciosas desatendidas. El conjunto de herramientas se desarrolló sobre la base de programas y experiencias prácticas y puede adaptarse a diferentes necesidades y contextos.
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Humanos , Medicina Tropical , Água , Saneamento , Doenças Transmissíveis , Conservação dos Recursos Naturais , Doenças Negligenciadas , Erradicação de DoençasRESUMO
Low-income tropical regions, such as Haiti, grapple with environmental issues stemming from inadequate sanitation infrastructure for fecal sludge management. This study scrutinizes on-site sanitation systems in these regions, evaluating their environmental impacts and pinpointing improvement opportunities. The focus is specifically on systems integrating excreta valorization through composting and/or anaerobic digestion. Each system encompasses toilet access, evacuation, and sludge treatment. A comparative life cycle assessment was undertaken, with the functional unit managing one ton of excreta in Haiti over a year. Six scenarios representing autonomous sanitation systems were devised by combining three toilet types (container-based toilets (CBTs), ventilated improved pit (VIP) latrines, and flush toilets (WC)) with two sludge treatment processes (composting and biomethanization). Biodigester-based systems exhibited 1.05 times higher sanitary impacts and 1.03 times higher ecosystem impacts than those with composters. Among toilet types, CBTs had the lowest impacts, followed by VIP latrines, with WCs having the highest impacts. On average, WC scenarios were 3.85 times more impactful than VIP latrines and 4.04 times more impactful than those with CBTs regarding human health impact. Critical variables identified include the use of toilet paper, wood shavings, greenhouse gas emissions, and construction materials.
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Compostagem , Banheiros , Compostagem/métodos , Haiti , Fezes/química , Esgotos , Clima Tropical , Saneamento , Humanos , Países em DesenvolvimentoRESUMO
INTRODUCTION: People who inject drugs (PWID) are at high risk of developing injection-related infections, including abscesses. Access to water, sanitation, and hygiene (WASH) are key human rights and services; yet these services have been underexplored as predictors of abscesses among PWID. METHODS: Longitudinal analysis was employed among a cohort of PWID to determine if WASH insecurity (lack of access) was associated with abscess incidence in the Tijuana, Mexico and San Diego, United States metropolitan area during 24-months of follow-up survey data from 2020 to 2023. We calculated abscess prevalence at baseline and tracked the incidence of new abscesses among individuals without an abscess during the previous visit. Time dependent Cox regression modeling was employed with variance clustered by participant to characterize the relationship between WASH insecurity and abscess incidence. RESULTS: At baseline, hand hygiene insecurity, bathing insecurity in the previous six months and open defecation in the last week, were reported by 60 %, 54 % and 38 % of participants, respectively; 21 % reported an abscess in the last six months. The incidence of abscesses was 24.4 (95 %CI: 21.1-27.6) per 100 person-years. After adjusting for covariates, the hazard of developing an abscess remained significantly elevated among individuals using non-improved (with risk of contamination) water sources (e.g., surface water) for preparing drugs (adjusted HR [adjHR]: 1.49 [95 %CI: 1.01-2.21], experiencing bathing insecurity (adjHR: 1.59 [95 %CI: 1.12-2.24]) and open defecation (adjHR: 1.65 [95 %CI: 1.16-2.35]). CONCLUSIONS: PWID in the Tijuana-San Diego metropolitan area reported facing high rates of insecurity accessing WASH services. Abscess incidence was higher (four to nine times) than observed rate among PWID cohorts in other settings. Access to continuously available toilet facilities, bathing infrastructure, and safe water sources for preparing drugs for injection could prevent abscesses among PWID. Accessible WASH infrastructure should be ensured among PWID communities and promoted as a key component of harm reduction infrastructure.
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Higiene , Saneamento , Abuso de Substâncias por Via Intravenosa , Humanos , Estudos Longitudinais , Incidência , Masculino , Feminino , Adulto , Abuso de Substâncias por Via Intravenosa/epidemiologia , México/epidemiologia , Pessoa de Meia-Idade , Estudos de Coortes , California/epidemiologia , Abastecimento de Água , Estados Unidos/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVE: This study aimed to assess the consistency of data regarding the provision of fluoridation in Brazilian municipalities with water supply systems. METHODS: Official data from the National Basic Sanitation Survey and the National Information System on Sanitation for 2017 were compared. RESULTS: Out of 5,570 municipalities in Brazil, 4,546 (81.6%) had water supply systems. The agreement between data sources was 84%, with a Kappa of 0.668, indicating substantial agreement. However, the estimates of fluoridation provision exhibited an average discrepancy of 8.1 percentage points, ranging from 1.2 points in the Central-West region to 21.4 points in the Northeast region. CONCLUSION: To address these inconsistencies, it is essential to enhance information sources, ensuring more reliable data for health, sanitation authorities, and society at large.
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Fluoretação , Brasil , Fluoretação/estatística & dados numéricos , Fluoretação/normas , Humanos , Abastecimento de Água/normas , Saneamento/normas , CidadesRESUMO
Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (-11%), functional handwashing access points accessible for individuals with disabilities (-17%) and small children (-29%), and functional alcohol-based hand rub dispensers (-13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures.
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COVID-19 , Higiene , Saneamento , Instituições Acadêmicas , COVID-19/epidemiologia , COVID-19/prevenção & controle , Instituições Acadêmicas/estatística & dados numéricos , Humanos , Belize/epidemiologia , Abastecimento de Água , SARS-CoV-2 , Pandemias , Higiene das Mãos/estatística & dados numéricosRESUMO
BACKGROUND: Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS: In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS: Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION: WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.
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Higiene , Saneamento , Humanos , Estudos Transversais , Saneamento/normas , Saneamento/estatística & dados numéricos , Feminino , Masculino , Adulto , Higiene/normas , California , Abuso de Substâncias por Via Intravenosa/epidemiologia , Pessoa de Meia-Idade , México , Abastecimento de Água/normas , Água Potável/normas , Adulto JovemRESUMO
La encefalitis equina del oeste (WEEV, por su sigla en inglés, Western Equine Encephalitis) es una enfermedad reemergente en Argentina a partir del año 2023. La co-municación inicial fue en 1933, las últimas epizootias ocurrieron en 1983 y el último caso humano se registró en 1996. Se revisan las características del agente causal, la ecología con especial referencia a los vectores iden-tificados en el país, su competencia en la transmisión y el ciclo así como los factores de riesgo para adquirir la enfermedad. La situación epidemiológica en equinos y humanos desde noviembre 2023 hasta marzo 2024 es analizada. Se describen las formas clínicas de presen-tación de la enfermedad humana, las posibilidades evo-lutivas, los datos disponibles en los casos confirmados y el tratamiento. La metodología y algoritmo empleados para el diagnóstico etiológico en el Centro Nacional de Referencia son detallados. Las estrategias para la pre-vención y el control se basan en la vacunación de los equinos, el saneamiento ambiental y el control del foco ante la presentación de la enfermedad animal (vigilancia epidemiológica activa)
Western equine encephalitis (WEE) is a re-emerging dis-ease in Argentina starting in 2023. Since the initial notifi-cation in 1933, the last epizootics occurred in 1983, and the last human case was recorded in 1996.The charac-teristics of the causative agent, the ecology with special reference to vectors identified in the country, their compe-tence in transmission, and the cycle as well as the risks factors for acquiring the disease, are reviewed.The epidemiological situation in horses and humans from November 2023 to March 2024 is analyzed. The clinical presentation of the human disease, its evolutionary po-tential, available data in confirmed cases, and the treat-ment are described.The methodology and algorithm used for the etiological diagnosis at the National Reference Center are detailed. Strategies for prevention and control are based on vaccination of horses, environmental sani-tation and outbreak control in the presence of the animal disease (active epidemiological surveillance)
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Humanos , Animais , Masculino , Feminino , Saneamento/legislação & jurisprudência , Fatores de Risco , Encefalomielite Equina do Oeste/epidemiologia , Vírus da Encefalite Equina do Oeste/imunologia , Monitoramento Epidemiológico/veterináriaRESUMO
Post-COVID-19, schools urgently need to enhance infection control and prevention (IPC) measures, including water, sanitation, and hygiene (WASH), to prepare for future outbreaks and pandemics. Particularly in Brazil, that is of particular concern, as students are still recovering from the 20th longest school closure in the world. Hence, the current study had two goals: (i) to describe WASH solutions outlined in policies released at the federal, state, and capital city levels in Brazil during the COVID-19 pandemic for the safe reopening of schools and (ii) to discuss their potential to enhance school's capacity to remain operational during a new pandemic or outbreak. With a qualitative exploratory approach, we performed content analysis to discuss the direction (what, where, how and for whom?) of 66 public policies by integrating four frameworks. Solutions were discussed in the light of the principles of human rights and the human rights to water and sanitation, international guidelines for WASH and IPC in schools and the Sphere minimum standards for humanitarian aid. One hundred and fifty-nine solutions, spanning five thematic areas and five population groups, including software and hardware interventions, were compiled for potential use in Brazil and beyond. While suggested solutions have the potential to provide a cleaner and safer learning environment, it is essential to exercise caution when implementing these measures and adapt them to the specific circumstances of each school.
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COVID-19 , Saneamento , Humanos , Água , Pandemias/prevenção & controle , Brasil , Abastecimento de Água , Higiene , COVID-19/prevenção & controle , Instituições Acadêmicas , PolíticasRESUMO
BACKGROUNDS: This study assesses the impact of Water, Sanitation, and Hygiene (WASH) interventions on cholera understanding and hygiene practices in La Gonâve Island, Haiti. It examines the changes after implementing interventions in seven villages across the Downtown, Mountain, and Seaside regions. METHODS: A retrospective investigation surveyed 210 school students from each region using a validated questionnaire. It assessed knowledge, attitudes, practices (KAP), and environmental aspects related to cholera and hygiene. Data analysis involved descriptive statistics and chi-square tests. RESULTS: The study highlights significant disparities in education levels, toilet ownership, and healthcare access. Challenges in finding public toilets (86.67%) and accessing water sources (67.78%) are consistent across regions, with Seaside facing financial constraints (85.00%) and water cost concerns (91.67%). Attitudes toward hygiene vary, with the Mountain region having the highest 'Never' responses for handwashing (38.89%), and Downtown leading in water treatment practices (11.67%). There is a strong willingness to share health knowledge, particularly in Downtown (100.00%). Seaside (83.33%) and Downtown (73.33%) revealed a higher cholera awareness, while nearly half of Mountain students lacked knowledge (54.44%). CONCLUSIONS: This study highlights significant disparities in WASH practices among La Gonâve's adolescents in Downtown, Mountain, and Seaside regions. Urgent interventions are crucial for improving sanitation, ensuring clean water access, and implementing targeted hygiene education, especially in the resource-constrained Mountain and Seaside areas. The findings underscore the vital roles of adolescents and schools in disseminating knowledge, with further research needed to explore intervention differences.
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Cólera , Saneamento , Humanos , Adolescente , Estudos Retrospectivos , Cólera/epidemiologia , Cólera/prevenção & controle , Haiti/epidemiologia , HigieneRESUMO
Identifying and classifying poor and rich groups in cities depends on several factors. Using data from available nationally representative surveys from 38 sub-Saharan African countries, we aimed to identify, through different poverty classifications, the best classification in urban and large city contexts. Additionally, we characterized the poor and rich groups in terms of living standards and schooling. We relied on absolute and relative measures in the identification process. For absolute ones, we selected people living below the poverty line, socioeconomic deprivation status and the UN-Habitat slum definition. We used different cut-off points for relative measures based on wealth distribution: 30%, 40%, 50%, and 60%. We analyzed all these measures according to the absence of electricity, improved drinking water and sanitation facilities, the proportion of children out-of-school, and any household member aged 10 or more with less than 6 years of education. We used the sample size, the gap between the poorest and richest groups, and the observed agreement between absolute and relative measures to identify the best measure. The best classification was based on 40% of the wealth since it has good discriminatory power between groups and median observed agreement higher than 60% in all selected cities. Using this measure, the median prevalence of absence of improved sanitation facilities was 82% among the poorer, and this indicator presented the highest inequalities. Educational indicators presented the lower prevalence and inequalities. Luanda, Ouagadougou, and N'Djaména were considered the worst performers, while Lagos, Douala, and Nairobi were the best performers. The higher the human development index, the lower the observed inequalities. When analyzing cities using nationally representative surveys, we recommend using the relative measure of 40% of wealth to characterize the poorest group. This classification presented large gaps in the selected outcomes and good agreement with absolute measures.
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Pobreza , População Urbana , Humanos , África Subsaariana , População Urbana/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos , Saneamento/normas , Saneamento/estatística & dados numéricos , Cidades , Masculino , Feminino , Adulto , Características da FamíliaRESUMO
The world's urban population is growing rapidly, and threatening natural ecosystems, especially streams. Urbanization leads to stream alterations, increased peak flow frequencies, and reduced water quality due to pollutants, morphological changes, and biodiversity loss, known as the urban stream syndrome. However, a shift towards recognizing urban streams as valuable natural systems is occurring, emphasizing green infrastructure and nature-based solutions. This study in Uruguay examined water quality in various watersheds with different urbanization levels and socio-environmental characteristics along a precipitation gradient. Using Geographic Information Systems (GIS) and in situ data, we assessed physicochemical parameters, generated territorial variables, and identified key predictors of water quality. We found that urbanization, particularly urban areas, paved areas, and populations without sanitation, significantly influenced water quality parameters. These factors explained over 50% of the variation in water quality indicators. However, the relationship between urbanization and water quality was non-linear, with abrupt declines after specific urban intensity thresholds. Our results illustrate that ensuring sanitation networks and managing green areas effectively are essential for preserving urban stream water quality. This research underscores the importance of interdisciplinary teams and localized data for informed freshwater resource management.
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Rios , Urbanização , Uruguai , Ecossistema , Saneamento , Qualidade da Água , Monitoramento AmbientalRESUMO
Scientific publications in research journals have adeptly investigated into topics of considerable interest, rendering nursing care more intricate in the face of increasingly thorough investigations into numerous phenomena. This ongoing exploration contributes significantly to the body of knowledge disseminated within the scientific community. Nevertheless, the advent of the global era has presented nursing with novel challenges that persist from the dawn of history parallel to a lingering shadow obscuring the true essence of the profession. An example is environmental nursing, often overlooked from the lens of social sustainabilitya neglect that researchers, as minority groups in a relentless struggle, have sidelined. These challenges align with the dynamic demands imposed by society and the mandates of state and/or governmental parliaments.
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Meio Social , Saneamento , Enfermagem , Desenvolvimento Sustentável , Política de SaúdeRESUMO
ABSTRACT OBJECTIVES: To correlate the incidence of leptospirosis with sociodemographic data in the Brazilian Unified Health System from 2011 to 2022. METHODS: This ecological study used national health and economic secondary data sources. Secondary analyses summarized the scenario of disease-related hospitalizations among federative units. In total, two analyses were conducted: variable description for relationship analysis and a secondary analysis with population health and sanitation indicators and economic indicators from the Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). The statistical analysis following this framework summarized raw data by year-month-federative unit. A time series regression was conducted, comparing the time variable with other national-level variables. Then, several simple linear regressions were performed. RESULTS: Linear regressions show the relationship between the reduction in cases and improved access to treated water and sewage collection, whereas an increase in per capita income seems to be inversely related to leptospirosis incidence. Geospatial distribution shows higher incidence in the Brazilian South and Southeast. Disease lethality varied over time but without significant change during the period. The average treatment cost remained constant over the years, despite its complexity. CONCLUSION: Leptospirosis incidence in Brazil from 2011 to 2021 decreased and was associated with improvements in socioeconomic conditions despite no changes in lethality.
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Indicadores Econômicos , Brasil , Sistemas de Saúde , Custos de Cuidados de Saúde , Estudos Ecológicos , Leptospirose , Sistema Único de Saúde , Saneamento , Interpretação Estatística de Dados , Saúde da PopulaçãoRESUMO
Resumo Avaliação do impacto do Plano Municipal de Saneamento Básico (PMSB) e da Política Municipal de Saneamento Básico (PolMSB) na eficiência das prestadoras de serviço de saneamento básico dos municípios de Santa Catarina. No primeiro estágio, emprega-se o método de Análise Envoltória de Dados (DEA) para obter os escores de eficiência das empresas de saneamento relativos ao período de 2012 a 2020. No segundo estágio, combina-se o modelo Tobit com o método de Diferenças em Diferenças (DiD) para verificar o efeito das variáveis ambientais, incluindo o PMSB e a PolMSB, na eficiência dos contratos firmados. Os resultados deste estudo mostram que a regulação não contribuiu para fomentar a eficiência em relação à maximização da produção do setor - dentro do período observado -, que apresentou declínio ao longo dos anos. Outro achado diz respeito ao fato de que as companhias de saneamento operado pelo poder público municipal, com exceção de autarquias, demonstram possuir mais eficiência que operadoras privadas. Também é relevante a comprovação de ganhos de escala e escopo nos serviços de água e esgoto.
Resumen Evaluación del impacto del Plan Municipal de Saneamiento Básico (PMSB) y de la Política Municipal de Saneamiento Básico (PolMSB) en la eficiencia de los prestadores de servicios de saneamiento básico en los municipios de Santa Catarina. En una primera etapa se utiliza el método de análisis envolvente de datos (DEA) para obtener los puntajes de eficiencia de las empresas sanitarias para el periodo 2012 a 2020. En una segunda etapa se combina el modelo tobit con el método de diferencias en diferencias (DiD) para verificar el efecto de las variables ambientales, incluidas PMSB y PolMSB, sobre la eficiencia de los contratos firmados. Los resultados de este estudio muestran que la regulación no contribuyó a promover la eficiencia en relación con la maximización de la producción del sector -en el período observado-, que mostró una caída con el paso de los años. Otro hallazgo se refiere al hecho de que las empresas de saneamiento operadas por el poder público municipal, con excepción de las entidades autárquicas, demuestran una mayor eficiencia que los operadores privados. También es relevante la comprobación de ventajas de escala y alcance en los servicios de agua y alcantarillado.
Abstract This article assesses the impact of the Municipal Basic Sanitation Plan (PMSB) and the Municipal Basic Sanitation Policy (PolMSB) on the efficiency of basic sanitation service providers in the municipalities of Santa Catarina. In the first stage, the Data Envelopment Analysis (DEA) method is used to obtain sanitation companies' efficiency scores for the period from 2012 to 2020. In the second stage, the Tobit model is combined with the Differences in Differences (DiD) method to verify the effect of environmental variables, including PMSB and PolMSB, on the efficiency of signed contracts. The results show that regulation did not promote efficiency concerning maximizing the sector's production - within the observed period - which showed a decline over the years. Another finding is that sanitation companies operated by municipal public authorities, with the exception of local authorities, demonstrate greater efficiency than private operators. Proof of economies of scale and scope in water and sewage services is also relevant.