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Obesity has a multifactorial origin. Among the behavioural risk factors, excessive consumption of unhealthy foods, skipping breakfast and reduced physical activity stand out. The main objective of this article was to identify trends in dietary habits and their association with overweight/obesity over a 12‐year period in schoolchildren aged 7 to 10 years in Florianópolis, southern Brazil. A cross‐sectional panel analysis study, using anthropometric, sociodemographic, physical activity and food consumption data of schoolchildren aged 7 to 10 years, collected in three waves of the Study of Prevalence of Obesity in Children and Adolescents (EPOCA), carried out during the years 2007, 2012/2013 and 2018/2019, was performed. To analyse the trend in dietary variables over the years, the 95% CIs were compared with the non‐overlap of intervals indicating statistical significance. Multiple logistic regression analysis was performed to test the association of weight status with dietary markers. The prevalence of overweight/obesity was 34.4%, 37.2% and 34.2% in 2007, 2012/2013 and 2018/2019, respectively, and there were no statistically significant differences among waves. There was a progressive and significant reduction in the consumption of soft drinks and sweets and in eating breakfast by schoolchildren, from 2007 to 2019. Breakfast consumption was inversely associated with the chance of overweight/obesity (OR 0.74, 95% CI 0.59–0.93), and female students were less likely to have overweight/obesity when compared to boys (OR 0.70, 95% CI 0.61–0.81). The reduction in the consumption of soft drinks and sweets over the years might be caused by efforts in public policies that intended to reduce the consumption of unhealthy foods among schoolchildren. The progressive and significant reduction in having breakfast should be better elucidated in future studies, to minimise the potential impact of this practice on schoolchildren's bodyweight. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the elapsed time for symptomatic women with endometrial carcinoma to achieve diagnosis and treatment and its impact on staging and survival. A cohort study was carried out with 430 women divided into in two groups: "Type I" (n = 289, endometrioid carcinoma grade 1 or 2); "Type II" (n = 141, nonendometrioid, endometrioid carcinoma grade 3, or carcinosarcoma). Clinical information, diagnostic methods, histology, staging, and time elapsed between symptoms-diagnosis-treatment were considered. Descriptive, survival, and regression analyses were performed. The symptom-to-diagnosis interval was 284 and 249 days in Types I and II (p = 0.014), with only 30% getting a diagnosis within 90 days. The diagnosis-to-treatment interval was shorter for Type II (100 vs. 123 days for Type I; p = 0.001). Only 12.5% of Type I and 22.7% of Type II started treatment within 60 days after diagnosis. There was no association between symptom-to-diagnosis interval and staging (p = 0.377). The symptom-to-treatment interval did not change the overall survival for Type I and had a paradoxical effect for Type II, with greater overall survival associated with a longer elapsed time (p = 0.003). Symptomatic Brazilian women with endometrial carcinomas showed very long wait times for diagnosis and treatment, and less than 23% started treatment within the regulatory period of 60 days. This critical situation does not exhibit any clear effect on cancer staging or overall survival, possibly counterbalanced by the faster care of patients with a poor prognosis, such as those with Type II endometrial carcinomas. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the association of overweight/obesity based in BMI and purgative behaviours with body image (BI). Methods: Cross-sectional study, with probabilistic sample of 976 adolescents, aged 11–14 years, from the city of Florianópolis, Brazil. Multivariate analyses were performed. Overweight (including obesity) and four variables related to purgative methods for body weight control or eating behaviour were evaluated as outcomes, while BI satisfaction was the primary independent variable in each model. Models were controlled for age, sex, type of school (public or private), intake of fruit and vegetables, number of daily meals, and physical activity scores levels. A total of 31·4 % of adolescents wanted to enlarge their silhouette and 45·6 % wanted to reduce it. Among overweight/obese adolescents, 9·6 % were satisfied with their bodies, while 89·8 % wanted to reduce it, while among the not overweight/obese adolescents, 45·4 % wanted to enlarge their silhouette (P < 0·001). Multivariate analysis showed that the odds for overweight/obesity is higher among adolescents who wanted to reduce their silhouette (OR = 11·20; 95 % CI = 5·55, 22·58). Adolescents who want to reduce their silhouette are more likely to use diuretics (OR = 3·08; CI = 1·78, 5·32) and to use laxatives (OR = 2·10; CI = 1·20, 3·68). A significant association was also found between dissatisfaction with BI and overeating (among those who want to enlarge their silhouette: OR = 1·78; CI = 1·12, 2·85 and among those who want to reduce their silhouette: OR = 1·81; CI = 1·03, 3·19). Conclusion: BI dissatisfaction was associated with overweight/obesity, as well with overeating, and the use of purgative methods. [ABSTRACT FROM AUTHOR]

Objective: Visceral leishmaniasis (VL) is an endemic parasitic disease in Latin America, and its clinical picture is aggravated in coinfections with the human immunodeficiency virus (HIV). The objective of this study was to investigate clinical factors and laboratory variables associated with VL relapse and death in VL/HIV coinfected patients. Methods: A prospective longitudinal study was conducted from January 2013 to July 2020 among 169 patients coinfected with VL and HIV. The outcomes investigated were the occurrence of VL relapse and death. Chi-square test, Mann–Whitney test and logistic regression models were used for statistical analysis. Results: The occurrence rates were 41.4% for VL relapse and 11.2% for death. Splenomegaly and adenomegaly were associated with the increased risk of VL relapse. Patients with VL relapse had higher levels of urea (p =.005) and creatinine (p <.001). Patients who died had lower red blood cell counts (p =.012), hemoglobin (p =.017) and platelets (p <.001). The adjusted model showed that antiretroviral therapy for more than 6 months was associated with a decrease in VL relapse, and adenomegaly was associated with an increase in VL relapse. In addition, edema, dehydration, poor general health status, and paleness were associated with an increase in hospital death. Conclusion: The findings suggest that adenomegaly, antiretroviral therapy, and renal abnormalities can be associated with VL relapse, while hematological abnormalities, and clinical manifestations like paleness, and edema can be associated with an increased odds of hospital death. Trial registration number: The study was submitted to the Ethics and Research Committee of the Federal University of Maranhão (Protocol: 409.351). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prognosis of endocervical adenocarcinomas after reclassification according to the morphologic type based on the 2020 World Health Organization Classification. Methods: A retrospective longitudinal study with cases admitted at the University of Campinas, Brazil, from 2013 to 2020. The sample included 140 cases morphologically reclassified: 100 cases as adenocarcinoma HPV‐associated (HPVA), 17 as HPV‐independent (HPVI), and 23 non‐HPVA/HPVI. Clinic and pathologic variables were evaluated. Analyses were performed by χ2, Fisher exact, and Mann–Whitney U tests, Kaplan–Meier curves, Log‐rank test, and Cox regression. Results: Compared with the HPVA group, advanced stage (FIGO Stage II+) was more frequent in the HPVI group (P = 0.009), which also showed older patients (P = 0.032), and a higher proportion of deaths (P = 0.006). The median overall survival (OS) differed between groups: 73.3 months in HPVA and 42.4 months in HPVI (P = 0.005). At the multivariate analysis, the risk of death was 6.7 (95% confidence interval 1.9–23.0) times higher in patients diagnosed in advanced stages. Conclusion: HPVI cases were more frequent in older patients, presenting at more advanced stages and with worse OS. The morphology‐based approach of the new WHO classification appears to be prognostically valuable and applicable in lower‐ and middle‐income settings. Synopsis: HPV‐independent adenocarcinoma has a worse prognosis; morphologic analysis allows reclassification. The WHO 2020 classification is feasible to use in lower‐ and middle‐income settings. [ABSTRACT FROM AUTHOR]

Background: Children with congenital Zika syndrome (CZS) have severe damage to the peripheral and central nervous system (CNS), greatly increasing the risk of death. However, there is no information on the sequence of the underlying, intermediate, immediate, and contributing causes of deaths among these children. The aims of this study are describe the sequence of events leading to death of children with CZS up to 36 months of age and their probability of dying from a given cause, 2015 to 2018. Methods and findings: In a population-based study, we linked administrative data on live births, deaths, and cases of children with CZS from the SINASC (Live Birth Information System), the SIM (Mortality Information System), and the RESP (Public Health Event Records), respectively. Confirmed and probable cases of CZS were those that met the criteria established by the Brazilian Ministry of Health. The information on causes of death was collected from death certificates (DCs) using the World Health Organization (WHO) DC template. We estimated proportional mortality (PM%) among children with CZS and among children with non-Zika CNS congenital anomalies (CA) by 36 months of age and proportional mortality ratio by cause (PMRc). A total of 403 children with confirmed and probable CZS who died up to 36 months of age were included in the study; 81.9% were younger than 12 months of age. Multiple congenital malformations not classified elsewhere, and septicemia unspecified, with 18 (PM = 4.5%) and 17 (PM = 4.2%) deaths, respectively, were the most attested underlying causes of death. Unspecified septicemia (29 deaths and PM = 11.2%) and newborn respiratory failure (40 deaths and PM = 12.1%) were, respectively, the predominant intermediate and immediate causes of death. Fetuses and newborns affected by the mother's infectious and parasitic diseases, unspecified cerebral palsy, and unspecified severe protein-caloric malnutrition were the underlying causes with the greatest probability of death in children with CZS (PMRc from 10.0 to 17.0) when compared to the group born with non-Zika CNS anomalies. Among the intermediate and immediate causes of death, pneumonitis due to food or vomiting and unspecified seizures (PMRc = 9.5, each) and unspecified bronchopneumonia (PMRc = 5.0) were notable. As contributing causes, fetus and newborn affected by the mother's infectious and parasitic diseases (PMRc = 7.3), unspecified cerebral palsy, and newborn seizures (PMRc = 4.5, each) were more likely to lead to death in children with CZS than in the comparison group. The main limitations of this study were the use of a secondary database without additional clinical information and potential misclassification of cases and controls. Conclusion: The sequence of causes and circumstances involved in the deaths of the children with CZS highlights the greater vulnerability of these children to infectious and respiratory conditions compared to children with abnormalities of the CNS not related to Zika. Maria da Conceição Costa and colleagues investigate the sequence of events leading to death of children with Congenital Zika syndrome up to 36 months of age. Author summary: Why was this study done?: Children with congenital Zika syndrome (CZS) have a broad spectrum of clinical manifestations due to sequelae of central and peripheral nervous system damage that can impair important vital functions and greatly increase the risk of death in affected children. Little is known about the circumstances involved in the death of children affected by this syndrome. Analysis of the sequences of causes attested on the death certificate (DC) can contribute to this understanding and thus support the implementation of health programs and specific postnatal protocols to meet the needs of these children. Brazil was the country with the highest number of live births with CZS. What did the researchers do and find?: We linked administrative data of all reporting live births, deaths, and notification of probable and confirmed CZS cases in Brazil in the period from January 1, 2015 to December 31, 2018. We analyzed the proportional mortality of the main underlying, intermediate, immediate, and contributing causes of death of 403 children with CZS up to 36 months age and compared with the same causes of death of 734 children with non-Zika–related CNS congenital anomalies (CA) who died by 36 months of age from the proportional mortality ratio. The leading underlying causes of death for children with CZS were multiple congenital malformations not classified elsewhere and unspecified septicemia. What do these findings mean?: The sequence of causes and circumstances involved in the deaths of the CZS children by 36 months age, in Brazil, highlighted the greater vulnerability of these children to infectious and respiratory conditions. It is necessary to develop evidence-based health protocols and raising awareness of conditions associated with high mortality in children affected by congenital Zika virus infection to guide health professionals responsible for caring for these children. [ABSTRACT FROM AUTHOR]

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The transition in the population pyramid is a reality in several locations around the world and projections of an increase in the older population in Brazil demonstrate the relevance of studies on factors that may interfere in the functionality and quality of life in this age group. Thus, the present study aims to assess depression levels and their relationship with sleep quality in institutionalized and community older adults. Methods: This cross-sectional study included 220 older people of both sexes, divided into two groups, institutionalized older adults, and community older adults. The older adults were monitored by Community Health Agents (CHA), through identification of everyone in their micro area using a method of random name generation, based on geographic location. Due to the small number of institutionalized older adults, all residents in the institutions were recruited, according to the inclusion and exclusion criteria. The Geriatric Depression Scale (GDS-15) and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression and sleep quality. Results: Among the 220 older adults, 175 were community members and 45 were institutionalized. The survey revealed that institutionalized older adults had a higher percentage of severe depression compared to community dwelling older adults (p < 0.039). Conclusion: Older adults in the community present greater symptoms of depression and better sleep than institutionalized older adults. There was a direct association between sleep quality and depression. In our sample, being institutionalized and female positively influenced and feeling alone negatively influenced depressive symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Early identification of inaccuracies in body size estimations can be fundamental to plan and accomplish more effective prevention and treatment actions related to body image perception and disorders. Objective: To assess the prevalence of overestimation and underestimation of body size in thin, normal-weight, and obese schoolchildren and the factors associated. Methods: Cross-sectional and school-based study conducted in Florianópolis, Santa Catarina, Brazil. The study was conducted with a sample of 1,530 schoolchildren from seven to ten years old enrolled at public and private schools in Florianópolis-SC, Brazil. Sociodemographic and anthropometric data, as well as their perceptions on body image, were analyzed. Perceptions of body size were evaluated using the Figure Rating Scales for Brazilian Children. Logistic regression was used to analyze associations. Results: The prevalence of thinness or normal-weight schoolchildren who considered themselves with obesity was 10%. None of the schoolchildren with obesity considered themselves thin or normalweighted. Considering thin and normal-weight schoolchildren, a desired body image equivalent to obesity was associated with an overestimation of their own obesity (odds ratio = 2.64, P < 0.05). Overweight in female schoolchildren was associated with an underestimation of self-thinness (odds ratio = 3.07, P < 0.05). Conclusions: Selfoverestimation and underestimation of body sizes were observed among 7-10 yearold schoolchildren, particularly females. Further studies using different variables and methodological approaches are needed to know in depth the causes of distorted body image. [ABSTRACT FROM AUTHOR]

Selenium (Se), iron (Fe), and free sulfides contents in pore waters were measured to study the liberation of soluble Se in suboxic conditions. The sediment core was collected in a salt marsh in Patos Lagoon estuary (southern Brazil), and it was obtained during a brackish water period, in a low intertidal stand vegetated by Spartina alterniflora. The redox potential (Eh), pH, andacid volatile sulfides (AVS) content were also investigated. Pore water results sustained the idea that S. alterniflora roots promote oxygen penetration to depths of ca. 10 cm below the salt marsh surface, increasing Eh and lowering the pH in this interval. High Se concentrations (e.g., 16.9 µg L−1), that are above US. EPA environmental criteria, were observed in the pore water to depths between 10 and 20 cm and are associated to low AVS contents and high concentrations of free sulfides. In the first 10 cm the lowering of Se contents probably happens due the low pH and biological volatilization of the metalloid. [ABSTRACT FROM AUTHOR]

The city of Rio Grande, located on the right bank of the Patos Estuary, has been severely contaminated by mercury (Hg) due to anthropogenic activities that chiefly began in the eighteenth century. To investigate the natural mercury distribution along the salinity gradient in the estuary, three sediment cores were collected from a region of the estuary that has experienced less anthropogenic impacts, namely its left bank. Our study demonstrates that accumulation of Hg and formation of metal sulfide minerals take place in fine grain sediment horizons within the sampled sediment cores. Mercury immobilization in these sediments occurs via binding to organic matter coatings on fine grain sediment particles, as well as by incorporation into and/or co-precipitation with iron sulfide minerals. The grain size controls over Hg accumulation and sulfide mineral formation were statistically demonstrated using principal component analysis. Different fine particulate sediment deposition patterns occurred at each sampling location, which is attributed to the consequence of hydrological changes in the estuary resulting from navigation infrastructure reforms performed over the past 200 years in the local port (e.g., dredging) and its surroundings. We suggest that the port building and maintenance activities have influenced Hg distributions in the estuarine sediments. [ABSTRACT FROM AUTHOR]

The co-circulation of different arboviruses in the same time and space poses a significant threat to public health given their rapid geographic dispersion and serious health, social, and economic impact. Therefore, it is crucial to have high quality of case registration to estimate the real impact of each arboviruses in the population. In this work, a Vector Autoregressive (VAR) model was developed to investigate the interrelationships between discarded and confirmed cases of dengue, chikungunya, and Zika in Brazil. We used data from the Brazilian National Notifiable Diseases Information System (SINAN) from 2010 to 2017. There were three peaks in the series of dengue notification in this period occurring in 2013, 2015 and in 2016. The series of reported cases of both Zika and chikungunya reached their peak in late 2015 and early 2016. The VAR model shows that the Zika series have a significant impact on the dengue series and vice versa, suggesting that several discarded and confirmed cases of dengue could actually have been cases of Zika. The model also suggests that the series of confirmed and discarded chikungunya cases are almost independent of the cases of Zika, however, affecting the series of dengue. In conclusion, co-circulation of arboviruses with similar symptoms could have lead to misdiagnosed diseases in the surveillance system. We argue that the routinely use of mathematical and statistical models in association with traditional symptom-surveillance could help to decrease such errors and to provide early indication of possible future outbreaks. These findings address the challenges regarding notification biases and shed new light on how to handle reported cases based only in clinical-epidemiological criteria when multiples arboviruses co-circulate in the same population. [ABSTRACT FROM AUTHOR]

The arsenic (As) contents of sediment cores from the Patos Lagoon in southern Brazil were measured to better understand the biogeochemical cycling of As in the estuary. Sediment cores (ca. 60 cm) were obtained from three locations within the estuary to capture possible changes in As content across the salinity gradient (i.e., where saline, brackish, and freshwater dominated). Two sediment cores were collected at each location, one beneath open water and the other from the fringing salt marsh. Along with As, we quantified the particle size; redox potential (Eh); manganese (Mn), iron (Fe), total organic carbon (TOC), and free (dissolved) sulfide concentrations; and acid volatile sulfide (AVS) and chromium reducible sulfide (CRS) contents. Bioturbation supports oxygen penetration to depths between 20 and 30 cm below the salt marsh surface, where an As- and Fe-rich zone was identified (3-fold higher As than mean As contents of the sediments). A similar subsurface peak of As, Fe, and Mn occurs in the open-water cores, albeit at greater depths between 40 and 50 cm below the surface. The subsurface peak has As concentrations that are 2-fold higher than the average for each core. Vertical profiles of Eh, free sulfides, and CRS for the shallow open-water cores showed similar distribution at depths of 50 cm, suggesting that pyrite formation is an important sink for As in the open-water cores. The data demonstrate clear differences in the geochemical conditions for salt marshes and shallow open waters that can have important implications for As distribution in estuarine sediments. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of inaccurate estimation of own body size among Brazilian schoolchildren of both sexes aged 7-10 years, and to test whether overweight/obesity; excess body fat and central obesity are associated with inaccuracy. Methods: Accuracy of body size estimation was assessed using the Figure Rating Scale for Brazilian Children. Multinomial logistic regression was used to analyze associations. Results: The overall prevalence of inaccurate body size estimation was 76%, with 34% of the children underestimating their body size and 42% overestimating their body size. Obesity measured by body mass index was associated with underestimation of body size in both sexes, while central obesity was only associated with overestimation of body size among girls. Conclusions: The results of this study suggest there is a high prevalence of inaccurate body size estimation and that inaccurate estimation is associated with obesity. Accurate estimation of own body size is important among obese schoolchildren because it may be the first step towards adopting healthy lifestyle behaviors. [ABSTRACT FROM AUTHOR]

The island rule suggests that, when mainland animals are isolated on islands, large animals tend to become smaller, while small animals tend to become larger. A small frog in eastern Brazil, Phyllodytes luteolus (Wied-Neuwied, 1824), is widely distributed in association with bromeliads. At the end of the last glaciation, parts of the mainland became islands due to rising sea levels, thereby isolating frog populations on these islands. If the island rule holds, we predicted that frogs on islands would tend to be larger than frogs on the mainland. We compared sizes (weight and length) of 30 randomly selected male frogs from the mainland with 30 from an island in the state of Espírito Santo, Brazil. We also sampled population density on the island and mainland because concurrent with changing sizes, depending on the causal relationship, density may also change. As predicted, island frogs tended to be larger (both in snout-vent length and weight) and were much more abundant. While not specifically addressed in this study, the absence of predators and interspecific competitors may explain both of these trends. [ABSTRACT FROM AUTHOR]

Williams-Beuren syndrome (WBS) is a genetic disease caused by a microdeletion in the 7q11.23 region. It is characterized by congenital heart disease, mainly supravalvular aortic stenosis, mental retardation, mild short stature, facial dysmorphisms, and variable abnormalities in different systems. Objectives. To report the clinical findings of 55 Brazilian patients confirmed by multiplex ligation-dependent probe amplification (MLPA). Methods. Patients were followed up for 4 years at the Genetics Unit of the Instituto da Criança of the Hospital das Clínicas, FMUSP, Brazil. A kit specific for WBS was used to detect the 7q11.23 microdeletion. Results. Two patients with negative FISH results had positive MLPA results for WBS. The characteristics of the patients with the deletion were as follows: typical WBS facies (98.2%), neuropsychomotor delay (98.2%), hypersocial behavior (94.5%), hyperacusis (94.5%), and congenital heart disease (81.8%). Conclusions. MLPA was effective in detecting the microdeletion in the 7q11.23 region to confirm the diagnosis of WBS. MLPA was also able to confirm the diagnosis of WBS in two patients with typical clinical characteristics but negative FISH results. Thus, MLPA is a promising method in the diagnostic investigation of WBS. WBS is a multisystemic disorder and therefore requires multidisciplinary care and specific follow-up to prevent complications. [ABSTRACT FROM AUTHOR]

The Mikania laevigata (Asteraceae) is a Brazilian medicinal plant used to treat respiratory tract diseases. It is produced on a large scale for phytotherapic formulation. No studies on the endophytes of Mikania laevigata have been described in the literature. The endophytic fungi isolated from the leaves of M. laevigata cultivated in a floral garden located in the south region of the Bahia state, Brazil, were investigated. After surface disinfection, the performing the isolation procedure, a total of forty endophytic fungi were obtained and grouped into different morphospecies. The fungi were characterized by molecular sequencing the ITS rDNA regions, and they were identified by comparing the results published Gen Bank sequences. The phylogenetic analyses revealed four major clades of fungi from the sequenced ITS-rDNA regions: Nodulisporium sp. (3 isolates), Hypoxylon sp. (3 isolates), Daldinia sp. (1 isolate) and Xylaria luteostromata (aunique isolate).The Xylariaceae Genus was the dominant group of fungi associated with Mikania laevigata. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Kineanthropometry & Human Performance is the property of Brazilian Journal of Kineanthropometry & Human Performance and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The Brazilian Health System is organized on a regional and hierarchical form with three levels of complexity of health care. The Primary Care represents the first element of a continuing health care process, complemented by specialized actions. However, the centrality of the specialized care is still a problem in Brazil, especially in the private sector. Studies on the distribution of professionals in the health system allowing the formulation of appropriate policies are needed. Objectives: To investigate the distribution of physical therapists in the levels of complexity of health care and between public and private establishments, according to data from the National Register of Health Service Providers (NRHSP). Method: A descriptive cross-sectional study was performed considering NRHSP-national bank data collected in March 2010 and demographic census 2010 data. Data were analyzed through descriptive statistics techniques. Results: We identified 53,181 registries of physical therapists, 60% linked to the private sector. Only 13% of all entries were linked to primary care. The predominance in specialized care occurred in the public sector (65%) and private sector (100%). The specialized establishments of private sector linked to the southeast region (16,043) were the main sites of physical therapists. Only the public sector in the south had a majority in the Primary Care. When considering the sizes of the cities, there is focus on specialist care in bigger cities. Conclusions: This study identified the concentration of physical therapists in the specialized care, mostly in metropolis and big cities and in the private sector, with restricted to participation in the primary care. [ABSTRACT FROM AUTHOR]

Background: Chronic venous disease (CVD) is to change the system causing a venous valvular incompetence associated with obstruction of flow or not. It affects 10 to 20% of world population, with higher prevalence in females. It presents as the most common symptoms and pain and swelling in advanced form, venous ulcer, and brings functional limitations, social isolation, affecting quality of life. Objective: Profiling of patients with CVD, the survey data indicate that clinical and socio-demographic characteristics that may contribute to possible change of habit in the life, who for reasons of work, lack of knowledge and/or instructions had affected their routine by the disease, with consequent decline in their quality of life. Methods: A descriptive, observational, cross-sectional study that evaluated patients with CVD treated at health centers in Maceió (AL) Brazil, applying a form for collecting data, such as CEAP, Brazil Criterion of Economic Classification Questionnaire and SF-36. Results: The sample consisted of 66 patients with CVD, 83% were female and 17% male. The patients had predominantly aged between 50 and 60 years who were sedentary, assuming prolonged standing, low educational level and economic status, severe clinical disease (symptomatic C6), and quality of life variable. Conclusion: The results showed a predominance of females, 50 to 60 years old, with triggering factors and/or aggravating factors for development of CVD as lack of physical activity, low education and low economic income, affecting quality of life. [ABSTRACT FROM AUTHOR]

The objective of the study was to estimate abnormal eating attitudes influenced by associated factors among female students of the Universidade Federal de Santa Catarina, Florianópolis, southern Brazil. Abnormal eating attitudes were investigated using the eating attitudes test (EAT-26), according to the presence (EAT+) and absence (EAT-) of symptoms in a sample of 220 students. The body-image was assessed by the bodyshape questionnaire (BSQ-34). Body mass index, body-fat percentage, waist-circumference, food intake (24-hour food recall), and socioeconomic characteristics (monthly household income, monthly per-capita income, and parental schooling) were also investigated. Statistical associations were tested by multivariate Poisson regression analysis. The prevalence of EAT+ and dissatisfaction with the body-image were 8.3% [confidence interval (CI) 95% 4.6-12.0] and 20.0% (CI 95% 14.7-25.3) respectively. Dissatisfaction with the body-image maintained its independent association with abnormal eating attitudes, indicating symptoms of anorexia nervosa. The results of this work highlight the importance of the planning of nutrition-education programmes in universities, aiming at assisting in the choices of food that comprise a healthful diet in a period of life of so many changes and decisions. [ABSTRACT FROM AUTHOR]

The organic fertilization provides nutrients for the plants, improves the soil physical structure, increases the water retention, reduces the erosion losses and favors the biological control. Ocimum selloi is a native medicinal plant of south and southeast of Brazil where is used popularly as antidiarrhetic, antispasmodic and anti-inflammatory. This research aimed to verify the effect of different doses of two organic fertilizers souces in O. selloi growth, essential oil yield and chemical composition. The experiments were carried out in Lavras, MG, with pots in polyethylene greenhouse with two manuring treatments: Test A - Cattle manure: 1) Soil without manuring (control); 2) Soil + 3kg m-2 cattle manure; 3) Soil + 6kg m-2 cattle manure; 4) Soil + 9kg m-2 cattle manure; 5) Soil + 12kg m-2 cattle manure; Test B - Chicken manure: 1) Soil without manuring (control); 2) Soil + 1.5kg m-2 chicken manure; 3) Soil + 3 kg m-2 chicken manure; 4) Soil + 4.5kg m-2 chicken manure and 5) Soil + 6kg m-2 chicken manure. The influence of cattle and chicken manuring doses was verified on plant height, stem diameter, dry biomass weight, TLA, SLA, LWR, chlorophylls content, leaf thickness, essential oil yield and composition. [ABSTRACT FROM AUTHOR]

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The distribution and accumulation of rare earth elements (REE) in the labile fraction of sediment cores collected from salt marshes in the Patos Lagoon estuary from southern Brazil were investigated. Sediment cores (ca. 40 cm) were obtained from three locations within the estuary to capture possible changes in REE content across the salinity gradient (i.e., where saline, brackish, and freshwater dominate). Salt marsh sediments from all three coring locations were enriched in the light REE (LREE) over the heavy REE (HREE) when normalized to the North American shale composite (NASC). Shale normalized values for the LREE of marsh sediments from sites M2 and M3 in the mid- and upper estuary commonly approximates unity indicating these sediments chiefly exhibit a terrigenous signature. In contrast, all 14 naturally occurring REE are depleted in the sediments from the M1 coring location in the lower estuary compared to shale. Sediments from the mid-estuary (M2 core location) where typical salinity values are ca. 10 practical salinity units, exhibit the greatest shale normalized LREE enrichments. The higher LREE contents of the M2 sediments likely reflect preferential removal of LREE from the water column owing to salt-induced coagulation of river-borne colloids that occurs during estuarine mixing processes. Sediments samples collected from the salt marsh in the lower estuary nearer the Atlantic Ocean (i.e., M1), have substantially lower REE contents than salt marsh sediments from sites M2 and M3 in the mid- and upper estuary, respectively. The more sand-rich lower estuary sediments are exposed to higher salinity water from the South Atlantic compared to the generally finer grained sediments from the mid- and upper estuary, which are dominated by brackish and freshwater conditions, respectively. Negative Ce-anomalies (i.e., Ce/Ce* < 1) in marsh sediments from depths generally greater than 27 cm support the occurrence of early diagenetic reactions consistent with suboxic to anoxic conditions whereby reductive dissolution of ferromanganese oxide/oxyhydroxide carrier phases, and/or Ce(IV) phases, release Ce(III) to the marsh pore waters. The negative Ce anomalies suggests that a suboxic or anoxic environment predominates to a depth of 9 cm, and then again below 27 cm depth in sediments from the M2 salt marsh core, and below a depth of 13 cm in the upper estuary marsh sediments (i.e., M3). In contrast, positive Ce anomalies (Ce/Ce* > 1) for much of the sediment from the M1 core, the mid depths of core M2 (i.e., 9 cm to 27 cm), and shallower than 13 cm in sediments from core M3 support oxic conditions where Ce is enriched in sediments from these depths by preferential scavenging from pore waters onto Fe/Mn oxides/oxyhydroxides. These trends in Ce/Ce* with depth in each sediment core are also consistent with known bioturbation that occurs within these marsh sediments. The relatively high REE contents of the sediments from location M3 are also related to the fact that these sediments are dominantly composed of clay-silt deposits that are enriched in organic matter. Finally, we find no conclusive evidence that the studied salt marsh sediments have been impacted by addition of REE from the local fertilizer manufacturing industry. • ƩLREE/ƩHREE ratios were generally lower in saltmarshes sediments closer to the sea. • REE enrichment in freshwater dominate part of the estuary is due to high fine-grained and organic contents. • Positive Ce-anomalies are supported by oxic conditions in salt marsh sediment. [ABSTRACT FROM AUTHOR]

The content of rare earth elements (REE) and their distribution in sediment cores collected from the Patos Lagoon estuary from southern Brazil were investigated. Sediment cores (ca. 44 cm) were obtained from two locations within the estuary, including a relatively unimpacted site (PI) that has not been strongly affected by human activities and a well-known polluted area within Coroa do Boi Bay (CB), located in the industrialized central part of the estuary, to capture possible features that may help to identify contamination by the local fertilizer manufacturing industry. Sediments from both coring locations are enriched in the light REEs (LREE) over the heavy REEs (HREE) when normalized to the North American Shale Composite (NASC). The PI core was collected in the mid-estuary, an area where salinity values were lower than 10 practical salinity units and where river water and seawater mixing occurs. The features observed in PI sediments likely reflect preferential removal of LREEs from the water column owing to salt-induced coagulation of river-borne colloids. Sediments samples collected from the impacted CB location have substantially higher REE contents than PI sediments. Furthermore the relatively constant REE content and measures of REE fractionation (i.e., ΣLREE/ΣHREE ratios, NASC normalized patterns, NASC normalized La/Yb ratios) with depth in sediments from the CB site suggests that the impact of fertilizer manufacturing on these sediments is a long-term phenomenon. Using sedimentation rates determined for Coroa do Boi Bay, we show that anthropogenic contamination of the CB core sediments by total urban, industrial, and port emissions of REEs can be traced to the early 1900's and was largely continuous throughout the 20th century. • High REE contents in sediment cores provide evidence for long-term industrial impact in estuary. • La/Eu versus Gd/Yb ratios help identify the impact of the local fertilizer industry. • Pr anomaly strengthens the evidence of fertilizer manufacturing influence. [ABSTRACT FROM AUTHOR]

Zika virus (ZIKV) became a worldwide public health emergency after its introduction in the Americas. Brazil was implicated as central in the ZIKV dispersion, however, a better understanding of the pathways the virus took to arrive in Brazil and the dispersion within the country is needed. An updated genome dataset was assembled with publicly available data. Bayesian phylogeography methods were applied to reconstruct the spatiotemporal history of ZIKV in the Americas and with more detail inside Brazil. Our analyses reconstructed the Brazilian state of Pernambuco as the likely point of introduction of ZIKV in Brazil, possibly during the 2013 Confederations Cup. Pernambuco played an important role in spreading the virus to other Brazilian states. Our results also underscore the long cryptic circulation of ZIKV in all analyzed locations in Brazil. Conclusions: This study brings new insights about the early moments of ZIKV in the Americas, especially regarding the Brazil-Haiti cluster at the base of the American clade and describing for the first time migration patterns within Brazil. [ABSTRACT FROM AUTHOR]

There is growing concern about the sustainability of burrowing-shrimp fisheries in many coastal areas because of their widespread use as bait and their importance as ecosystem engineers. The response of the target populations to the effect of long-term fishing pressure is still poorly understood. The present study reassessed the growth parameters, size structure and reproductive aspects of an exploited population of Callichirus major in northeastern Brazil, comparing it to a population on a beach where fishing pressure is negligible. The results are also discussed in the light of a previous study at the same site in 1999–2000. Sampling was carried out from September 2015 to May 2017 on two urban sandy beaches. Monthly length (dorsal oval) frequency data were analyzed using the FISAT II software package. Growth parameters were estimated with the ELEFAN I routine, using the von Bertalanffy seasonal growth model. The relationship between fecundity and individual size was estimated by linear regression. The exploited population had individual maximum sizes smaller than both those on the unexploited beach and in the population studied 16 years ago on the same beach. The percentages of ovigerous females were smaller than in 1999, and also differed widely between the two populations, with the exploited-beach population having one-fourth as many ovigerous females. This population showed smaller sizes at sexual maturation and low fecundity, and the females were 20% smaller. This study showed that the observed interpopulational differences in the size structure and reproductive parameters of Callichirus major can be attributed to overfishing, and indicated that the exploited population will tend toward collapse if regulatory measures to limit or prohibit fishing are not implemented. Image 1 • We reassessed an exploited population of Callichirus major , comparing it with one under negligible fishing pressure. • Interpopulation differences in size distribution and body size can be attributed to overfishing. • The loss of reproductive potential indicates that the exploited population of C. major is tending toward collapse. [ABSTRACT FROM AUTHOR]

Background: The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child's health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child–maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015–2017. Methods: Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. Results: The microcephaly/CZS case fatality rate was 10% (95% CI 9.2–10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63–2.83), and very low birth weight (OR = 3.77; 95% CI 2.20–6.46); late preterm births (OR = 1.65; 95% CI 1.21–2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46–8.02) and 5th minutes (OR = 4.13; 95% CI 2.78–6.13), among others. Conclusions: A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes. [ABSTRACT FROM AUTHOR]

Background: Currently, norovirus (NoV) is associated with one-fifth of all acute gastroenteritis (AGE) cases worldwide. The NoV GII.17_2014 variant has been associated with gastroenteritis outbreaks in several Asian countries, replacing the previously dominant Sydney 2012 variant. There is limited data about circulation of this new strain in Brazil. This study aimed to describe the phylogenetic and evolutionary characteristics of the GII.17_2014 strains in the Northern region of Brazil.Methods: NoV was detected by enzyme immunoassay (EIA) in 645 stool samples of AGE cases that were reported in Pará and Amazonas states during 2015-2016. All positive samples were tested for NoV GI and GII by reverse transcription polymerase chain reaction (RT-PCR) and the amplicons were subjected to genome sequencing. The GII.17-positive samples were retested by PCR using different sets of designed primers, which target a highly conserved capsid gene region. Next, the amplicons were sequenced and phylogenetically analyzed using Bayesian inferences.Results: Of the 645 samples tested, 208 (32.2%) tested were positive for NoV by EIA, among which 95 (45.7%) were genotyped. Among the genotyped samples, 12 (12.6%) were characterized as GII.17_2014 with the first case detected in November 2015 (1/30, 3.3%) and the others in 2016 (11/65, 16.9%). All strains found in our study were clustered in clade D (epidemic strain). The uncorrelated log-normal model estimations calculated the rate of evolution for GII-17 strains as 1.95 × 10- 3 (1.28 × 10- 3-2.63 × 10- 3). In total, 36 nucleotide changes were observed after analyzing the VP1 sequence, among which 28 occurred in the P2 region.Conclusions: These data demonstrate the evolutionary dynamics in NoV GII.17_2014 strains, which indicated high mutation rates with nucleotide substitutions and indels that are related to the elevated levels of antigenic diversity. This partly explains the increase in viral prevalence. [ABSTRACT FROM AUTHOR]

We describe an interesting case of unusual origin of precordial pain. A 75-year-old man was admitted to the Emergency Room of José Frota Institute, Fortaleza city, Brazil, because of precordial pain and malaise, three days after eating a bread. Physical examination was unremarkable. The electrocardiogram showed diffuse upward STsegment. A chest radiography showed a foreign body (a pin) in the topography of the esophagus. Esophagoscopy was performed and the pin was removed, with improvement of the patient. [ABSTRACT FROM AUTHOR]

• Hepatocellular carcinoma was detected in 51% of patients who had a liver transplant in 10 years at a university transplant center. • Patients meeting Milan Criteria in explant had a higher survival than those outside the criteria, and those within Brazilian expanded criteria had a higher survival than those outside the criteria. • Patients exceeding both Milan and Brazilian Criteria had the lowest survival rate. • Finding of tumor exceeding Milan criteria in the explant was an independent risk factor for death in patients with hepatocellular carcinoma. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, accounting for up to 90% of all primary liver neoplasms. HCC treatment options depend on tumor burden, the degree of liver dysfunction, and performance status. Orthotopic liver transplant offers the best chance for cure. The selection criteria adopted for transplant are based on the Milan Criteria (MC), which depend on tumor size and number (1 lesion ≤5 cm or up to 3 lesions of ≤3 cm, without vascular invasion or extrahepatic spread). In Brazil, an expanded version of the original MC, named the Brazilian Criteria (BC), takes into consideration only tumors larger or equal to 2 cm. This retrospective cohort aims to describe the prevalence of primary liver tumors and analyze the macro and microscopic characteristics of HCC on explant pathology in a university hospital over 10 years. Of 485 transplants, 243 (50.1%) had HCC. Most patients were men (77.4%) with a mean age of 58.4 years, and the most common primary etiology of liver disease was hepatitis C infection (64.2%). The total number of tumors was 628, generally multicentric (55.6%); segment VIII was the most affected, and alpha-fetoprotein was altered in 70.7% of the cases. Most patients had tumors meeting MC at pretransplant and on explant evaluation, along with higher overall survival when compared to those exceeding MC and BC, and especially with those outside both criteria. In addition, tumors outside MC represent an independent risk factor associated with death. [ABSTRACT FROM AUTHOR]

Background: Prenatal exposure to Zika virus has potential teratogenic effects, with a wide spectrum of clinical presentation referred to as congenital Zika syndrome. Data on survival among children with congenital Zika syndrome are limited.Methods: In this population-based cohort study, we used linked, routinely collected data in Brazil, from January 2015 through December 2018, to estimate mortality among live-born children with congenital Zika syndrome as compared with those without the syndrome. Kaplan-Meier curves and survival models were assessed with adjustment for confounding and with stratification according to gestational age, birth weight, and status of being small for gestational age.Results: A total of 11,481,215 live-born children were followed to 36 months of age. The mortality rate was 52.6 deaths (95% confidence interval [CI], 47.6 to 58.0) per 1000 person-years among live-born children with congenital Zika syndrome, as compared with 5.6 deaths (95% CI, 5.6 to 5.7) per 1000 person-years among those without the syndrome. The mortality rate ratio among live-born children with congenital Zika syndrome, as compared with those without the syndrome, was 11.3 (95% CI, 10.2 to 12.4). Among infants born before 32 weeks of gestation or with a birth weight of less than 1500 g, the risks of death were similar regardless of congenital Zika syndrome status. Among infants born at term, those with congenital Zika syndrome were 14.3 times (95% CI, 12.4 to 16.4) as likely to die as those without the syndrome (mortality rate, 38.4 vs. 2.7 deaths per 1000 person-years). Among infants with a birth weight of 2500 g or greater, those with congenital Zika syndrome were 12.9 times (95% CI, 10.9 to 15.3) as likely to die as those without the syndrome (mortality rate, 32.6 vs. 2.5 deaths per 1000 person-years). The burden of congenital anomalies, diseases of the nervous system, and infectious diseases as recorded causes of deaths was higher among live-born children with congenital Zika syndrome than among those without the syndrome.Conclusions: The risk of death was higher among live-born children with congenital Zika syndrome than among those without the syndrome and persisted throughout the first 3 years of life. (Funded by the Ministry of Health of Brazil and others.). [ABSTRACT FROM AUTHOR]

• The Brazilian sequence ZIKV lineage proportion changed across five years. • The automated surveillance system helps identify ZIKV molecular epidemiology. • A new lineage emerged in Brazil and could be a potential risk of a new epidemic. There is currently no system to track the emergence of Zika virus (ZIKV) subtypes. We developed a surveillance system able to retrieve sequence submissions and further classify distinct ZIKV genotypes in the world. This approach was able to detect a new occurrence of ZIKV from an African lineage in Brazil in 2019. [ABSTRACT FROM AUTHOR]

Lychnophora pinaster, known as arnica, is a medicinal plant of the Cerrado ecosystem in Brazil. It is widely used in the form of alcoholic extract for its anti-inflammatory and anesthetic and healing effects on sprains, bruises, and inflammation. Owing to the great difficulty of propagation, it is listed by the Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis in the category of plants vulnerable to extinction. Micropropagation offers a solution to this problem by allowing the preservation and expansion of germplasm. The objective of this research was to establish a protocol for in vitro propagation of arnica. The best medium for germination of arnica embryos and plantlet growth was a quarter strength semisolid Murashige and Skoog medium (MS/4) containing 0.75% (w/v) sucrose. For shoot induction, the best results were obtained on MS/4 with 2.76 µM of benzylaminopurine. Maximum shoot elongation before rooting occurred in the presence of 8.67 µM of gibberellic acid for 19 d. Microshoots were successfully rooted in the presence of 10.7 µM of naphthalene acetic acid for 15 d. After rooted plantlets were acclimatized in a greenhouse for 20 d, the survival rate was 100% when planted in a soil from the area of occurrence of the species, whereas 0% survived when planted in Plantmax. [ABSTRACT FROM AUTHOR]

• The largest species of carnivorous fish contain Hg above the permissible limit for consumption. • According to the Se:Hg molar ratio, no fish species studied pose a danger when eaten. • The most popular fish species to consumers had the highest Se:Hg molar ratios. • The Se:Hg molar ratios in shellfish are significantly higher than in fin fish. • High HBV indexes may result from exceeding the permissible Se limit in the product. In this study we estimate the content of mercury (Hg) and selenium (Se) in 32 fish and 6 shellfish species that represent the most intensively caught, consumed, and exported seafood species from the Brazilian subtropics. The mean Hg contents in three species of large carnivorous fish (i.e., shortfin mako; 502 μg kg−1; dusky grouper, 789 μg kg−1; school shark, 806 μgkg−1) were above the allowable limit (500 μg kg−1) for human consumption. However, the content of Se in the fin fish, as well as the shellfish, were substantially below (147 μgkg−1 ≤ Se ≤ 688 μgkg−1) what is considered safe for human consumption (i.e., 2000 μgkg−1). The only exception was in the deep-sea red crab sample, which exhibited an elevated Se content of ca. 5400 μg kg−1. Nevertheless, all studied species had mean Se:Hg molar ratios greater than 1:1, suggesting that human consumption of the studied sea food species are relatively safe with respect to their Hg content. The highest Se:Hg molar ratios were found in the shellfish species investigated, as well as the most sought after commercial fish. The calculated Se health benefit value index (Se-HBV, HBV Se), which is a qualitative measure of the ability of Se to mute the toxic effects of Hg, exhibited high positive values in most of the studied fish species, suggesting human consumption of these species was safe. An exception was sardine, an important species for producing canned fish, which exhibited the lowest HBV. [ABSTRACT FROM AUTHOR]