Sérgio Viana Peixoto

Introduction: Self-rated health is a robust measure of overall health status, encompassing an individual’s physical, mental, and social health. This multidimensional characteristic highlights the potential of this variable in studies conducted in regions affected by major disasters. This study assessed the prevalence of poor self-rated health and its association with sociodemographic factors, health behaviors, multimorbidity, and place of residence among adult residents of Brumadinho, Minas Gerais State, Brazil, following the collapse of a mining tailings dam. Materials and methods: It is a cross-sectional study based on baseline data from the Brumadinho Health Project, which was conducted in 2021 and included 2,771 individuals aged 18 years or older. The outcome variable was poor self-rated health, while the exploratory variables included sociodemographic characteristics, health behaviors, multimorbidity, and place of residence (area directly affected by the disaster; region with mining activity; unexposed). The association between exploratory variables and the outcome was evaluated using logistic regression. Results: The prevalence of poor self-rated health was 6.4% in the municipality’s population, being higher in the region directly affected by the tailings mud (12.7%). The likelihood of perceiving health as poor or very poor was higher among women, current smokers, and those with multimorbidity and lower among those who reported consuming alcoholic beverages one or more times per month. Engaging in physical activities at recommended levels reduced the likelihood of poor self-rated health, but only among the unexposed — residents in areas unaffected by mud and without mining activity ( p interaction = 0.002). Discussion: These results demonstrate that the residential context modifies the effect of physical activity on self-rated health, such that residents in areas affected by tailings mud or with mining activity do not benefit from engaging in physical activity at recommended levels, at least regarding health perception. Greater efforts to improve environmental conditions may be necessary in regions impacted by major disasters or environmental degradation due to mining processes.

RESUMO Objetivo: Avaliar a associação entre o contexto socioeconômico e indicadores de uso dos serviços de saúde entre mulheres com 50 anos ou mais, segundo a fonte de atenção (usuárias exclusivas do Sistema Único de Saúde [SUS] versus de plano de saúde). Métodos: Estudo transversal com dados da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (2015-2016), com amostra representativa da população com 50 anos ou mais. Foram analisados os seguintes indicadores de uso dos serviços de saúde: realização de mamografia, Papanicolau, dosagem de colesterol e glicemia e aferição da pressão arterial. A condição socioeconômica contextual foi medida pelo Índice Brasileiro de Privação (IBP). Utilizou-se modelo logístico multinível, bruto e ajustado, depois de constatar variabilidade significativa entre setores censitários. Resultados: A amostra incluiu 5.314 mulheres, sendo 54,2% com 60 anos ou mais. Observou-se um gradiente socioeconômico na realização de exames de glicemia e colesterol, com menor probabilidade de realização entre mulheres de áreas de maior privação. Esse padrão persistiu independentemente da fonte de atenção, sendo identificado tanto entre usuárias exclusivas do SUS quanto entre beneficiárias de plano privado (glicemia: odds ratio - OR 0,82, intervalo de confiança de 95% - IC95% 0,69-0,96 e OR 0,91, IC95% 0,87-0,96; colesterol: OR 0,71, IC95% 0,59-0,87 e OR 0,89, IC95% 0,85-0,95, respectivamente). Conclusão: Os resultados revelam iniquidades nas dosagens de glicemia e colesterol por mulheres com 50 anos ou mais, especialmente entre aquelas que dependem do SUS e vivem em áreas de pior contexto socioeconômico. Reforça-se a necessidade de políticas públicas focadas nas mulheres para reduzir as iniquidades presentes na utilização dos serviços de saúde.

Objective: To evaluate the association between contextual socioeconomic conditions and indicators of health service use among women aged 50 years or older, according to source of care (Brazilian Unified Health System-SUS vs. private health insurance). Methods: A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (2015-2016), a nationally representative survey of the population aged 50 years and older. The following indicators of health service use were analyzed: mammogram, Pap smear, measurements of cholesterol, blood glucose, and blood pressure. Contextual socioeconomic condition was assessed using the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP). Crude and adjusted multilevel logistic models were fitted after significant between-census-tract variability was confirmed. Results: The sample included 5,314 women, 54.2% of whom were aged 60 years or older. A socioeconomic gradient was observed in blood glucose and cholesterol testing, with lower odds of undergoing these tests among women living in areas of greater deprivation. This pattern was observed among both SUS users and private health insurance beneficiaries (blood glucose: OR 0.82, 95%CI 0.69-0.96 and OR 0.91, 95%CI 0.87-0.96; cholesterol: OR 0.71, 95%CI 0.59-0.87 and OR 0.89, 95%CI 0.85-0.95, respectively). Conclusion: The findings highlight socioeconomic inequities in cholesterol and blood glucose testing among women aged 50 years or older, particularly among SUS users living in areas with higher levels of deprivation. These results reinforce the need for public policies aimed at reducing socioeconomic inequities in healthcare utilization among women.

Resumen El objetivo de este estudio se centra en el análisis de las necesidades del servicio de salud tras el desastre del rompimiento de la presa de Brumadinho-MG desde la perspectiva de los gestores y los profesionales. Se trata de un estudio con un enfoque metodológico cualitativo, basado en 26 entrevistas orientadas por un guion semiestructurado. Los datos se procesaron mediante la técnica de análisis de contenido y la interpretación estuvo mediada por el marco teórico-metodológico de la antropología hermenéutica. El estudio demostró que tanto el trámite de adquisición de las indemnizaciones como su materialización tuvieron un gran impacto en el servicio de salud, tanto por la aparición de nuevas demandas en salud como por la sobrecarga de trabajo para los profesionales que tuvieron que mediar en situaciones ajenas a sus competencias, en los porosos límites de los acuerdos y negociaciones entre la población y la empresa responsable por el desastre. El análisis muestra la necesidad de desarrollar y equiparar estrategias que contemplen la garantía de los derechos sin comprometer la salud y la calidad de vida de todos los afectados: los que cuidan y los que son cuidados. Se espera que los resultados presentados puedan apoyar acciones de vigilancia, a la asistencia en salud y a la gestión de futuros riesgos en contextos similares.

Resumo O objetivo do trabalho consiste em analisar as necessidades do serviço de saúde após o desastre do rompimento da barragem em Brumadinho-MG na perspectiva dos gestores e profissionais. Trata-se de uma pesquisa com abordagem metodológica qualitativa, a partir da realização de 26 entrevistas guiadas por roteiro semiestruturado. Os dados foram tratados a partir da técnica de análise de conteúdo e a interpretação mediada pelo referencial teórico-metodológico da antropologia hermenêutica. O estudo evidenciou que tanto o percurso para a aquisição das indenizações como a sua materialização afetou sobremaneira o serviço de saúde, tanto no que se refere ao surgimento de novas demandas em saúde, como a sobrecarga de trabalho dos profissionais que precisaram mediar situações para além das suas atribuições, envolvendo limites porosos dos acordos e negociações entre população e a empresa responsável pelo desastre. Depreende-se da análise a necessidade de desenvolver e equacionar estratégias que considere a garantia de direitos sem comprometimento à saúde e à qualidade de vida de todos os afetados: quem cuida e quem é cuidado. Espera-se que os resultados apresentados possam subsidiar ações de vigilância, cuidados em saúde e a gestão de riscos futuros em contextos semelhantes.

The present study aims to analyze the needs of health services after the tailings dam collapse disaster in Brumadinho-MG Brazil from the perspective of managers and professionals. This is a qualitative methodological study, based on 26 interviews guided by a semi-structured script. The data were processed using the content analysis technique, and the interpretation was mediated by the theoretical-methodological framework of hermeneutic anthropology. The study showed that both the process of obtaining compensation and its materialization had a major impact on local health services, both in terms of the emergence of new health demands and the work overload of professionals who had to handle situations beyond their designated jobs, involving porous limits of agreements and negotiations between the population and the company responsible for the disaster. The analysis shows the need to develop and equate strategies that consider the guarantee of rights without compromising the health and quality of life of those affected: those who care and those who are cared for. It is expected that this study’s results may support surveillance actions, health care, and future risk management in similar contexts.

A imunossenescência refere-se às alterações do sistema imunológico com o envelhecimento, incluindo o aumento dos biomarcadores inflamatórios, fenômeno conhecido como inflammaging, que está relacionado ao surgimento de doenças associadas ao envelhecimento. O objetivo deste estudo foi descrever a distribuição de biomarcadores imunológicos nas cinco regiões brasileiras e estimar as probabilidades preditas de suas concentrações nos tercis da distribuição, segundo as regiões geográficas. Amostras sorológicas de 2.111 participantes (≥ 50 anos) coletadas na linha de base (2015/2016) do ELSI-Brasil foram analisadas. As regiões geográficas (Norte, Nordeste, Centro-oeste, Sudeste e Sul) foram a exposição de interesse do estudo, e os potenciais fatores de confusão incluíram idade, sexo, nível educacional, área de residência, consumo de álcool e tabaco, atividade física e autodeclaração de diagnósticos médicos de hipertensão, diabetes, asma, artrite e câncer. As probabilidades preditas das concentrações dos biomarcadores em cada tercil foram estimadas a partir de modelos de regressão logística multinomial, ajustados pelos confundidores. Notou-se uma maior probabilidade de as regiões Norte e Nordeste apresentarem níveis séricos mais altos, enquanto a Região Centro-oeste níveis mais baixos, sugerindo diferenças na imunobiografia que podem ser resultado de exposições ambientais, socioeconômicas e infecciosas distintas ao longo da vida. No entanto, as razões para essas diferenças ainda não foram elucidadas e precisam ser investigadas em estudos posteriores.

To describe the health profile and patterns of exposure to mining waste over the period of three years in a cohort of children living in areas affected by the collapse of a mining tailings dam in Brumadinho, Minas Gerais State, Brazil, in 2019. This prospective cohort study included all children aged 0 to six years residing in four selected locations: three in the disaster zone (Parque da Cachoeira, Córrego do Feijão, and Tejuco - exposed areas) and one located 10 km away (Aranha - non-exposed area). Assessments included anthropometric growth, neuromotor and cognitive development, and respiratory conditions. Urine samples were collected and analyzed for lead, arsenic, cadmium, mercury, and manganese using inductively coupled plasma mass spectrometry (ICP-MS). The average percentage of children assessed in the period was 80% of the projected population. There was an increase in the percentage of children with urinary arsenic levels above the reference value over the three-year period (2021 = 42%; 2022 = 44%; 2023 = 57%), as well as in detection rates of lead (88.9%) and mercury (63.9%) in 2021, both reached 100% in 2023. The median urinary arsenic concentration increased from 2021 (9.35 μg/g; IQR = 5.45-13.9) to 2023 (10.8 μg/g; IQR = 7.0-15.3) in the total sample of children (p = 0.064), with a statistically significant increase among those living in exposed areas (p = 0.015; Parque da Cachoeira). Over the three-year period, there was a decrease in the percentage of neurodevelopmental alterations and overweight/obesity, and an increase in reports of respiratory alterations in the total population, although these changes were not related to metal exposure. The findings indicate ongoing exposure of the metals analyzed in the study population; however, no associated health effects have been identified thus far. It is essential that the Brazilian Unified Health System be structured according to specificities of the productive processes in each territory.

This study proposed a methodology for obtaining a valid database of food retail establishments and characterized the community food environment, understood as the distribution and type of food outlets, in a Brazilian medium-sized municipality after the collapse of a mining tailings dam. An ecological study was conducted with establishments selling food for home consumption (butcher shops, fish markets; fruit and vegetable specialty markets; large- and small-chain supermarkets; bakeries and local markets) and immediate consumption (bars, snack bars, and restaurants). For home-consumption establishments, data were requested from governments and completed with website/app searches, virtual audits (Google Street View), and on-site audits. For immediate-consumption establishments, only on-site audit was used due to the low quality of the secondary databases. Agreement between databases was assessed with the Kappa statistic. Density (d) was calculated by the area (in km²) of the sampling stratum. Public databases presented low validity (23.0%; Kappa −0.388; p = 1.000), even after virtual auditing (31.4%; Kappa 0.37; p < 0.001). 96 establishments for home consumption and 261 for immediate consumption were identified, with predominance of local markets (35.4%), bars (35.2%), and snack bars (29.1%). The region with the highest density of establishments was the “Other Areas” stratum (d = 4.7 for home-consumption establishments and d = 13.2 for immediate-consumption establishments). Audit proved most effective, especially for small establishments. The lack of governmental databases and the identified food environment should inform municipal policies to promote food and nutrition security and reduce inequalities after the disaster.

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