Dental waste management in municipal health clinics in Belo Horizonte, Brazil]

OBJECTIVE: To investigate whether municipal health clinics in the city of Belo Horizonte, Brazil, comply with the legal requirements for managing dental wastes. METHOD: We collected information from 54 of the city's 105 municipal health clinics that provide dental care. At each clinic we interviewed the clinic manager, one dental assistant, and one general assistant. Based on the requirements outlined in the Belo Horizonte Health Waste Management Manual, we assessed characteristics in the following three areas: (1) technical and operational (waste classification and characterization, minimization, segregation, pretreatment, conditioning, collection and internal and external transportation, and external storage); (2) general and organizational (inspection, amount of clinic space, environmental permits, floor plan showing waste-generating areas, and whether the clinic had a technical specialist responsible for managing the health wastes); and (3) human resources (employee vaccination records and oversight, occupational safety and occupational medicine program, environmental risk prevention program, medical oversight and occupational health program, hospital (clinic) infection control committee, and training in health waste management). RESULTS: The clinics produced an average of 270 liters of solid waste per day. None of the clinics surveyed had a plan for managing health wastes. The only requirements with which all the clinics complied were: segregation of needles and mercury, adequately identified cardboard containers used for disposal of cutting and piercing items, and daily internal collection and transportation of wastes. CONCLUSIONS: When the risks associated with each class of waste have not been established, all the wastes should be considered potentially dangerous. Further, a law by itself does not guarantee that the public's health will be protected. Before public agencies impose legal requirements, it is necessary to know if the agencies themselves are capable of enforcing those requirements. Any proposed waste management legislation should be based on scientific research.     

Epidemiology of overweight and obesity and its determinants in Belo Horizonte (MG), Brazil: a cross-sectional population-based study]

OBJECTIVE: To determine the prevalence of overweight and obesity and to study potential risk factors for these conditions in persons over 18 years of age in the metropolitan area of Belo Horizonte, Brazil. METHODS: Data were obtained from a population-based study conducted in 1996 and 1997 by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) with a random sample of 1 105 individuals. Height and weight were measured by trained personnel. Overweight (body mass index [BMI] > or = 25.0 kg/m2) and obesity (BMI > or = 30.0 kg/m2) were the dependent variables. Bivariate analysis and multivariate logistic regression were used to identify potential risk factors for overweight and obesity. RESULTS: The prevalence of overweight and obesity was 31.1% (95% confidence interval 195% CI]: 27.3 to 35.2) and 5.7% (95% CI: 4.0 to 8.1), respectively, in men, and 25.9% (95% CI: 22.4 to 29.8) and 14.7% (95% CI: 11.9 to 17.9), respectively, in women. Multivariate analysis revealed that age and marital status were independent risk factors for overweight, whereas age, sex, and education were independent risk factors for obesity. Being female and well-educated showed a protective effect against overweight (odds ratio [OR] = 0.52; 95% CI: 0.33 to 0.83), but not against obesity (OR = 3.01; IC 95%: 1.14 to 7.94). Women with low education had a significantly greater risk (OR = 5.95; 95%CI: 2.51 to 14.12) of developing obesity than men having a high educational level. CONCLUSIONS: These results suggest that overweight and obesity may be serious public health problems in the metropolitan area of Belo Horizonte, Brazil. It is important to carry out further studies in order to explore the potential relationship between overweight and obesity on the one hand, and behavioral variables, such as smoking and alcohol consumption, on the other.     

A malacological survey in city parks in Belo Horizonte, Minas Gerais, Brasil

The Greater Metropolitan Area of Belo Horizonte currently contains 18 city parks (also known as "ecological parks") with various bodies of water (lakes, springs, streams, etc). Initial research in 17 of these parks showed the occurrence of intermediate mollusk hosts for Schistosoma mansoni in at least 4. Monthly captures done from August 1994 to February 1996 showed the following results for these planorbids: Julien Rien Park: 1,145 specimens of Biomphalaria glabrata (2 to 13 mm); Betania Park: 149 specimens of B. glabrata (4 to 13 mm); Santa Lúcia Park: 2,431 specimens of B. straminea (3 to 9 mm); and Lagoa do Nado Park: 3 specimens of B. tenagophila (3 to 10 mm). Visits to the parks will continue, and after a diagnosis of each park's situation, control and/or eradication measures suitable for each one will be proposed to the municipal authorities.     

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.     

Prevalence of undernutrition in elderly patients hospitalized in a geriatric unit in Belo Horizonte, MG, Brazil

OBJECTIVES: We evaluated, from anthropometric and biochemical indicators, the prevalence of undernutrition within an elderly population hospitalized in Belo Horizonte, Minas Gerais, Brazil, and identified social demographic, clinical and biochemical factors associated with undernutrition. METHODS: A transverse sectional study involving 197 elderly patients was conducted. Anthropometric data were obtained from subjects directly or indirectly; clinical characteristics, including health problems, functional and cognitive abilities, and use of medication, were gathered from medical records; social demographic information was acquired by interviewing the subject or carer. Logistic regression analysis was employed to identify factors associated with undernutrition. RESULTS: According to the body mass index cutoff points recommended by the World Health Organization, 29.7% of subjects were classified as undernourished and 43.8% as eutrophic. Application of the Nutrition Screening Initiative system gave rise to an inverse situation in which 54.7% of subjects were considered undernourished and only 29.2% were eutrophic. Statistical analysis of the studied variables showed that calf circumference < or =31 cm was significantly associated with undernutrition (P < 0.0001) irrespective of the classification system employed, and may thus be considered a strong marker for undernutrition. In contrast, total serum cholesterol level > or =4.14 mmol/L was identified as a protective factor against undernutrition (P = 0.01). CONCLUSION: The prevalence of undernutrition among the hospitalized elderly in Brazil is very high. The measurement of calf circumference is a non-invasive and economical approach that can facilitate evaluation of the nutritional status of elderly individuals.     

Environmental and health impacts of household solid waste handling and disposal practices in third world cities: the case of the Accra Metropolitan Area, Ghana

Inadequate provision of solid waste management facilities in Third World cities results in indiscriminate disposal and unsanitary environments, which threatens the health of urban residents. The study reported here examined household-level waste management and disposal practices in the Accra Metropolitan Area, Ghana. The residents of Accra currently generate large amounts of solid waste, beyond the management capabilities of the existing waste management system. Because the solid waste infrastructure is inadequate, over 80 percent of the population do not have home collection services. Only 13.5 percent of respondents are served with door-to-door collection of solid waste, while the rest dispose of their waste at communal collection points, in open spaces, and in waterways. The majority of households store their waste in open containers and plastic bags in the home. Waste storage in the home is associated with the presence of houseflies in the kitchen (r = .17, p < .0001). The presence of houseflies in the kitchen during cooking is correlated with the incidence of childhood diarrhea (r = .36, p < .0001). Inadequate solid waste facilities result in indiscriminate burning and burying of solid waste. There is an association between waste burning and the incidence of respiratory health symptoms among adults (r = .25, p < .0001) and children (r = .22, p < .05). Poor handling and disposal of waste are major causes of environmental pollution, which creates breeding grounds for pathogenic organisms, and the spread of infectious diseases. Improving access to solid waste collection facilities and services will help achieve sound environmental health in Accra.     

The urban environment from the health perspective: the case of Belo Horizonte, Minas Gerais, Brazil

This study aims to determine spatial patterns of mortality and morbidity for five health problems in an urban environment: homicides, adolescent pregnancy, asthma hospitalization, and two vector-borne diseases, dengue and visceral leishmaniasis. All events were obtained through the city health database and geoprocessed using residential addresses and 80 planning units consisting of census tracts. We used thematic maps, proportionate mortality/morbidity ratios by planning unit, and the overlapped rank of the 20th worse planning unit rates for each event. A spatial pattern of high rates of homicides, proportion of young mothers, and hospitalization due to asthma overlapped in socially and economically disadvantaged areas. For the two vector-borne diseases, high rates with great dispersion were found in underprivileged areas, in contrast with very low rates among higher income areas. The results indicated the coexistence of heavier disease burden for residents of urban areas where poverty and lack of effective public health policies may be modulating social health problems. For the two vector-borne diseases, an environmental intervention in one mosquito-borne disease might be playing a role in the other's incidence.     

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.     

Adherence to standard precautions by the public pre-hospital health team in Belo Horizonte, Minas Gerais State, Brazil

This was a cross-sectional study of workers in the pre-hospital care team in Belo Horizonte, Minas Gerais State, Brazil, aimed at evaluating adherence to precautions. The study instrument included questions on knowledge, attitudes, and facilitating factors for adherence to standard precautions. Adherence was verified by percentage of adequacy: > 75% correct answers. Drivers showed the lowest degree of knowledge and physicians the highest. In self-reported answers, none of the workers demonstrated adequate use of face masks, goggles, or personal protective equipment (PPE), and drivers reported inadequate attitudes on all the items. In the univariate analysis, job position, gender, and specific rescue unit were associated with adoption of precautions. Meanwhile, in the multivariate analysis, only job position was related (drivers and nurse technicians/aides). The most frequently cited facilitating factors for improvement of adherence were: training focusing on infections, occupational risks, and use of PPE; periodic team meetings; and creation of a central unit for cleaning, disinfecting, and sterilizing equipment and materials. Workers in the pre-hospital care service demonstrated attitudes that were compatible with knowledge, but professional class affected knowledge on standard precautions and self-reported adequate attitudes.     

Maternal and child health indicators in Belo Horizonte, Minas Gerais State, Brazil, 2001: an analysis of intra-urban differences

Spatial analysis of health indicators is as an important methodology for detection of intra-urban differences. This study aimed to examine the spatial distribution of all live births in Belo Horizonte, analyzing the presence of spatial clusters of health indicators for newborns and their mothers, using data from the Information System on Live Births. For each area covered by a Primary Health Care Unit, we calculated the indicators using empirical Bayesian methods. For spatial analysis, the indicators obtained from the global Moran (I) index and Local Indicators of Spatial Association (LISA) were used. Analysis using LISA showed the presence of relevant spatial clusters for adolescent mothers and those with low schooling, stillbirths in previous pregnancies, cesarean sections, and low attendance at prenatal care, especially in areas with low socio-demographic characteristics. The methodology adopted was configured as a key instrument for detecting risk areas where clustering occurs. The method can easily be incorporated into health surveillance systems as a mechanism for controlling events related to births in a given area.