Association between household solid waste disposal and health, Belo Horizonte (MG), Brasil]

There are few published studies about the effects of inadequate solid waste collection on the health of the population exposed to this situation. The objective of the present work was to describe this association in a sample of children under 5 years of age living in seven low-income neighborhoods and favelas in the city of Belo Horizonte, state of Minas Gerais, Brazil. We defined as "exposed" those children whose families were not served by waste collection; "not-exposed" were children who lived in areas with waste collection. The study employed data collected in 1994 and organized as a database by the municipal department of health. We employed a cross-sectional design, in which a "case" was defined as a child whose outpatient clinic record indicated a diagnosis of diarrheal, parasitic, or dermatological disease. Other diagnoses for the same age group composed the control group. Our epidemiological study revealed an association between the absence of domestic solid waste collection and public health. Our results suggest that the children exposed to the absence of solid waste collection have a 40% higher odds (OR = 1.40) of presenting diarrheal, parasitic, and dermatological diseases than not-exposed children. In addition, the calculation of attributable risk revealed that the presence of waste collection could prevent (based on the 1995 situation) 512 cases in the neighborhoods studied and (based on the 1994 conditions) 2316 cases among children in the entire city of Belo Horizonte.     

Gravimetric characterization of potentially infectious material in urban solid waste in southern Belo Horizonte, Minas Gerais State, Brazil

This study investigated potentially infectious waste (feces, urine, blood, body fluids) in the composition of total municipal solid waste. From August to September 2002, solid waste samples from southern Belo Horizonte, capital of the State of Minas Gerais, were collected and sent to the solid waste treatment and disposal site at BR-040 for segregation and quantification. Sharps (objects that can cause cuts or puncture wounds) made up 0.02+/-0.02% of the collected waste, while non-sharps accounted for 5.47+/-1.11%. In the sharps category, the majority were razor blades (0.01+/-0.01%), while among non-sharps the most frequent components were toilet paper (3.00+/-0.90%), diapers (2.21+/-1.08%), and sanitary napkins (0.22+/-0.12%). Household infectious waste was twice the total amount of waste (infectious + common) from healthcare units. The study was discussed in light of the health hazards and safety aspects for formal and informal waste collectors.     

Equity in the health sector: evaluation of public policy in Belo Horizonte,Minas Gerais State,Brazil, 1993-1997

This article evaluates government measures to reduce inequity in the health sector in Belo Horizonte from 1993 to 1997. Our hypothesis is that a municipal administration committed to equity can reduce disparities in health with the support of the Unified National Health System (SUS). The methodology used an urban quality of life index in Belo Horizonte to detect social inequalities in living conditions, as well as differences between the component indices in the infant mortality rate. Other municipal measures were assessed according to the investment resulting from the implementation of a participatory local budget and open planning process. The urban quality of life index appeared to be an appropriate measure for orienting municipal administration. The infant mortality rate proved to be a good indicator for measuring inequality in health. There was a reduction in IMR and mortality reducing gaps in the districts studied. We observed greater investment of physical and financial resources in the districts with the lowest urban quality of life index, and it can thus be stated that the municipal administration reduced the prevailing inequalities.     

Musculoskeletal disorders among healthcare workers in Belo Horizonte, Minas Gerais State, Brazil

This cross-sectional study investigated the prevalence of musculoskeletal disorders and associated factors in a sample of 1,808 workers (from a total of 13,602) in the municipal health system in Belo Horizonte, Minas Gerais State, Brazil. Prevalence was calculated according to self-reported pain in the upper or lower limbs and/or back, and size of associations was estimated by univariate (p < 0.20) and multivariate Poisson regression (p < 0.05). Musculoskeletal disorders showed a prevalence of 49.9% and were statistically associated with female gender, living with a partner, physical activity less than twice a week, self-reported common mental disorder, certain job positions (dentists, dental technicians, and community health workers), high physical demand, and inadequate working conditions. The results confirm the complexity of musculoskeletal disorders and suggest areas for development of health promotion programs in health services.     

Outcomes of three different models for sex education and citizenship programs concerning knowledge, attitudes, and behavior of Brazilian adolescents

Three different school-based sex education and citizenship programs in public schools in Rio de Janeiro, Belo Horizonte, and Salvador, Brazil, were evaluated in a cross-sectional study comparing knowledge, attitudes, and practices in sexuality, citizenship, and gender issues among adolescents participating in the programs' activities as compared to adolescents enrolled in schools without such programs (controls). Results showed that Salvador's program achieved good results, with significant changes in knowledge on sexuality and reproductive physiology, attitudes regarding citizenship, and current use of modern contraceptives; Rio de Janeiro's program succeeded in improving students' knowledge of reproductive physiology and attitudes towards sexuality; Belo Horizonte's participants showed greater knowledge of reproductive physiology and STI/HIV prevention but had less positive attitudes towards gender issues, while reporting greater sexual activity. The main difference between Salvador's program and the others was the focus on creative and cultural activities; Belo Horizonte's main difference was its lack of interaction with health services and professionals. However, after the evaluation Belo Horizonte reframed its educational strategies and launched a scaling-up process in a joint effort with the health and school systems.     

Assessment of waste amalgam management in dental clinics in Ramallah and al-Bireh cities in Palestine

The behavior of dental health personnel was examined with regard to the handling and proper disposal of wastes generated at common dental clinics, and some of the amounts of waste they produce were estimated. In January 2002, a random sample of 37 dental clinics was chosen in the cities of Ramallah and al-Bireh. The visited clinics were distributed between 31 private practices and six public/NGO dental clinics. The dentists were asked about the methods they follow in disposing and discarding of amalgam wastes. An average dentist is estimated to place two small, seven medium and nine large amalgam restorations releasing 22.6 grams of mercury each week. The majority of amalgam wastes ended up in trash or drain.     

Employment and sociodemographic characteristics: a study of increasing precarity in the health districts of Belo Horizonte, Brazil

Background  

The fundamental importance of human resources for the development of health care systems is recognized the world over. Health districts, which constitute the middle level of the municipal health care system in the city of Belo Horizonte, Brazil, deal with demands from all parts of the system. This research seeks to provide the essential features required in order to understand the phenomenon of increase in precarity of employment in these health districts.     

Self-reported dental fear among dental students and their patients

The aim of the present study was to compare self-reported dental fear among dental students and patients at a School of Dentistry in Belo Horizonte, Brazil. Eighty students ranging in age from 20 to 29 years and 80 patients ranging in age from 18 to 65 years participated in the study. A self-administered pre-tested questionnaire consisting of 13 items was used for data acquisition. The city of Belo Horizonte Social Vulnerability Index (SVI) was employed for socioeconomic classification. The chi-square test and binary and multinomial logistic regression were employed in the statistical analysis, with the significance level set at 0.05. The majority of dental students (76.5%) sought the dentist for the first time for a routine exam, while patients (77.3%) mostly sought a dentist for the treatment of dental pain. Dental fear was more prevalent among the patients (72.5%) than the students (27.5%). A total of 47.1% of the students and 52.9% of the patients reported having had negative dental experiences in childhood. The logistic model revealed an association between dental fear and a pain-related experience (OR: 1.8; 95%CI: 1.3-2.6). Patients were more prone to dental fear (OR: 2.2; 95%CI: 1.0-5.0). Although at different percentages, both students and patients experienced dental fear. Current patient with previous experience of dental pain had more dental fear.     

The nurse's participation in implementing the Family Health Program (PSF0 in Belo Horizonte

This study analyzes the nurse's participation in implementing the Family Health Program (PSF) in Belo Horizonte and aims at understanding their inclusion and expectations as an agent in the organization of health services and in overcoming problems found in the implementation of the program in a large city. A qualitative approach is used based on dialectic historic materialism. Eleven nurses participating in the PSF were the subjects of the research. Data was collected by means of a semi-structured interview and submitted to a discourse analysis treatment. The results demonstrate that the nurse has been involved with family health and playing a significant role ever since the implementation of the Community Health Agents Program (PACS) and that their inclusion in the PSF is favored both by their generalist background and their experience in planning, executing and evaluating health actions. Factors related to the nurse's work conditions, such as inadequacy of the environment, differentiated salary and treatment in relation to the doctor in team activities and the overload of tasks and responsibilities stand out as difficulty factors in implementing the PSF in Belo Horizonte.     

Report of the Council on Scientific Affairs. Biohazardous waste management: what the physician needs to know. American Medical Association

Sources of biohazardous waste include not only large hospitals and laboratories, but also physicians' offices, dental offices, clinics, research facilities, surgery centers, veterinary offices, funeral homes, and a growing number of settings where home health care is delivered. State and local municipality definitions and regulations on biohazardous waste vary widely. Most regulations exempt home health care settings, but include physicians' offices. Although the infectious public health risk posed by medical waste is exceedingly low, this fact is not well understood by the general public. Physicians should develop biohazardous waste management programs that fulfill their county, state, and municipal regulations and that consider the difference between health risks to employees and risks to the general public. Physicians can considerably reduce the amount and costs of biohazardous waste disposal by proper identification and segregation of waste in a manner that meets their state's criteria. Using products that can be recycled may reduce the amount and costs of disposal of biohazardous waste. Processing costs also may be reduced by cooperative arrangements among medical groups or health care facilities to negotiate group disposal rates with vendors.     

广东省44家口腔诊所牙科X射线诊断放射防护现状及常见问题探讨

目的 掌握广东省44家口腔诊所牙科X射线诊断项目放射防护的相关措施,探讨常见问题。方法 根据放射防护三原则及国家有关法律法规和标准规范,结合放射卫生现场调查、放射防护检测等结果,分析放射卫生防护及管理现况。结果 44家诊所56间机房的平面布局（基本）合理;56台设备的防护性能和质量控制检测均符合标准要求;56间机房的周围剂量当量率为本底～1.47μSv/h,能满足国家标准要求;电离辐射警告标志、工作状态指示灯及门灯联锁、自动闭门、通风及个人防护用品等符合率为85.70%～98.20%;口腔影像医师和专（兼）职管理人员的配置、职业健康监护、放射防护相关管理制度及放射卫生档案等符合率为79.5%～100.0%。结论 牙科X射线诊断机房的放射防护及管理现状较好,需出台或健全相关国家法规、标准等,以规范锥形束CT的质量控制检测、口腔诊所场址要求及放射工作人员的配置等。     

Use of medications by elderly Brazilian retirees: 1--methodology and response rates of a multicenter survey

This paper reports methodological aspects and response rates of a survey with the main objective of describing the drug utilization profile of retirees of the Institute of National Social Security of Brazil, 60 years of age or older, in three simple random samples: Brazil (countrywide), Belo Horizonte municipality, and Rio de Janeiro municipality. This cross-sectional study employed two approaches: mail (self-report questionnaires) and home interviews (questionnaires completed by interviewers). This strategy allowed evaluation of response agreement between the mail and home interview approaches. In the national sample of 3,000 individuals, 1,025 only responded to the self-report questionnaire. Despite this the low response rate, there was reasonable resemblance between respondents and non-respondents, suggesting that this sample is representative of the target population. In Belo Horizonte and Rio de Janeiro the initial samples of 800 individuals were replicated for both approaches, mail and home interview. The response rates to the mail surveys were 46.8% and 34.4% in Belo Horizonte and Rio de Janeiro, respectively. The response rates to the home interviews were 80.3% and 70.7% in Belo Horizonte and Rio de Janeiro, respectively, after unavoidable attrition.     

试论职业健康监护文书的种类与规范

[目的]为配合《职业健康监护技术规范》的推广和实施,针对目前我国大陆各地职业健康监护文书有关内容与格式不统一的情况,阐述了制定统一规范文书的必要性和意义。[方法]根据长期工作实践,并与上海市有关机构就职业健康检查文书的相关问题进行研讨。[结果]提出制定我国统一格式的职业健康监护文书的种类及基本要求。[结论]制定统一格式的规范文书有助于逐渐解决我国职业健康监护工作的数据库建设、异地信息检索、检查结果告知和质量控制及评价等问题。     

Dental Services for Migrant and Seasonal Farmworkers in US Community/Migrant Health Centers

CONTEXT: Migrant and seasonal farmworkers are recognized as a medically underserved population, yet little information on need, access, and services is available-particularly with regard to oral health care. PURPOSE: This study describes the facilities, services, staffing, and patient characteristics of US dental clinics serving migrant and seasonal farmworkers, and identifies trends and issues that may impede or improve dental care access and service. METHODS: National databases were used to identify community and migrant health centers providing oral health care to migrant and seasonal farmworkers. Mailed surveys collected information on clinic history, operational details, services provided, patient demographics, employment and resource needs, and perceived barriers to care. FINDINGS: Among the 81 respondents (response rate 41%), hours of operation varied from 1 evening a week to more than 40 hours a week; 52% had no evening hours. Almost all the clinics offered preventive, diagnostic, and basic restorative dental services, and roughly two thirds also offered complex restorative services. Patients most frequently sought emergency dental care (44%) followed by basic restorative services (32%) and preventive services (26%). The dentist position was the most difficult to fill, and new funding sources were cited as the most important resource need. Respondents perceived cost of services, lack of transportation, and limited clinic hours as primary barriers to care. CONCLUSIONS: While some barriers to care have been almost universally addressed (eg, language), there is evidence that some impediments remain and may present significant obstacles to a broad improvement in oral health care for migrant and seasonal farmworkers.     

Waste disposal and infection transmission in health care institutions

In the present study waste disposal patterns of 10 purposelyselected health care institutions from two states of India havebeen examined. Data were collected by pre-structured interviewsof hospital administrators and on-the-spot observations, andwere evaluated with reference to the possibility of transmissionof various diseases, including HIV infection. It was observedthat none of these institutions had a documented waste managementand disposal policy. All categories of waste were disposed bybeing thrown on the open ground or in open municipal cans withoutany pre-treatment, rendering them accessible to rag-pickers.Both the internal and external transportation of hospital wasteswere faulty and hazardous. A physical examination of 40 rag-pickersand 70 hospital workers who were directly involved in the disposalof hospital wastes, revealed that almost 40% (n= 47) of themsuffered from skin infections and/or had cuts or abrasions ontheir palms, hands, or feet. None of them ever ued hand gloveswhile working and only a limited few (n = 23) were found tobe wearing shoes while coming in contact with hospital wastes.This study stresses the importance of periodic in-service orientationprogrammes for all categories of health care personnel and suggestssome acceptable and affordable alternative measures for disposalof hospital wastes.     

Mortality caused by pneumonia in children under 5 years of age in a locality of the State of Minas Gerais (Brazil), 1979-1985

Death rates due to pneumonia in children under five years old in Belo Horizonte, Minas Gerais State, Brazil, during the period from 1979 to 1985, were studied on the basis of official reports and death certificates. The data show that mortality was 35 times higher in Belo Horizonte than in developed countries in 1979. The annual reduction in the death rate in Belo Horizonte over the same period was two-thirds of that observed in the developed countries. The death rate was higher among children from lower-income families and those living in poor areas of the city, at least during 1985, but the difference was not statistically significant (Z = 1.2, p less than 0.05).     

Out-of-pocket drug expenditures by retirees and pensioners 60 years and older in Belo Horizonte, Minas Gerais, Brazil

The aim of this study was to analyze the structure of private drug expenditures by individuals 60 years and older in Belo Horizonte, Minas Gerais, Brazil. The study population consisted of a representative sample of retirees under the National Social Security Institute (INSS) in the city of Belo Horizonte, interviewed through a household survey. Monthly out-of-pocket drug expenditures were calculated, and a drug cost structure analysis was performed according to drug characteristics. 667 elders answered the survey. Mean drug expenditures per month were US$ 38.91. The therapeutic groups representing the majority of drug expenditures were: cardiovascular system (26%), nervous system (24%), and digestive/metabolic system (15%). Considering drug registration categories, brand-name drugs accounted for the majority of expenditures (54%). The results of this study can support policies to improve both access to medicines and overall health conditions for the Brazilian elderly population.     

Health conditions and smoking among older adults in two communities in Brazil (The Bambuí and Belo Horizonte Health Surveys)

The aim of this study was to determine smoking prevalence and associated factors among older adults (> 60 years). The study was conducted in Greater Metropolitan Belo Horizonte and Bambuí town, both located in Minas Gerais, Brazil. In the former, 1,774 subjects were selected, and in the latter, 1742. In Belo Horizonte, prevalence of current and past smoking was 19.6% and 39.2% among men and 8.1% and 14.1% among women, respectively. In Bambuí, the corresponding figures were 31.4% and 40.2% among men and 10.3% and 11.2% among women, respectively. In Belo Horizonte, poor health and poor physical functioning were associated significantly with past smoking, but these associations were not observed in Bambuí. Among current smokers, these associations were not consistent. Our results agree with the data observed in developed countries, showing great heterogeneity of factors associated with smoking. Strategies to reduce smoking by the elderly should take into consideration the absence of association between signs/symptoms and smoking.