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Background: Primary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. Methods and findings: A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study. Conclusions: AIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030. Priscila Pinto and colleagues assess the impact of a community-based primary health program—the Brazilian Family Health Strategy—on HIV/AIDS incidence and HIV-related mortality in Brazil. Author summary: Why was this study done?: The Family Health Strategy (FHS), the main model for Primary Health Care (PHC) in Brazil, has been associated with improved healthcare access and quality as well as better health outcomes. Although PHC is identified as a key element to achieve the goal of ending AIDS by 2030, the impact of FHS on HIV/AIDS outcomes has not been studied. What did the researchers do and find?: Using a large cohort of 3.4 million low-income Brazilians, we evaluate the impact of FHS on AIDS incidence and mortality. We found lower AIDS incidence and mortality among individuals exposed to FHS throughout the study period. What do these findings mean?: FHS is a robust community-based PHC model associated with improved population health outcomes including for people living with HIV/AIDS. While promising, these findings must be interpreted cautiously considering that some confounders, such as sexual behavior, were unavailable. [ABSTRACT FROM AUTHOR]

Neurocysticercosis, a parasitic infection of the central nervous system (CNS), is a significant public health issue globally, including in Brazil. This article presents a case report of a 44-year-old male patient residing in the rural area of Roraima, the northernmost region of Brazil within the Amazon Forest. The patient, with chronic HIV infection, acquired the Taenia solium helminth, resulting in neurocysticercosis development. Remarkably, the diagnosis of neurocysticercosis was not initially apparent but emerged through meticulous analysis following a motorcycle accident. The absence of seizures, a common clinical manifestation, complicated the diagnostic process, making it an uncommon case of NCC, which may be related to co-infection. As the patient's condition progressed, multiple complications arose, requiring additional medical attention and interventions. This case underscores the immense challenges faced by healthcare teams in managing neurocysticercosis effectively. It emphasizes the critical need for a comprehensive, multidisciplinary approach to provide optimal care for such complex cases. The study's findings underscore the importance of raising awareness and implementing improved strategies for tackling neurocysticercosis, particularly in regions where it remains a prevalent concern. [ABSTRACT FROM AUTHOR]

Living with extremely low-income is an important risk factor for HIV/AIDS and can be mitigated by conditional cash transfers. Using a cohort of 22.7 million low-income individuals during 9 years, we evaluated the effects of the world's largest conditional cash transfer, the Programa Bolsa Família, on HIV/AIDS-related outcomes. Exposure to Programa Bolsa Família was associated with reduced AIDS incidence by 41% (RR:0.59; 95%CI:0.57-0.61), mortality by 39% (RR:0.61; 95%CI:0.57-0.64), and case fatality rates by 25% (RR:0.75; 95%CI:0.66-0.85) in the cohort, and Programa Bolsa Família effects were considerably stronger among individuals of extremely low-income [reduction of 55% for incidence (RR:0.45, 95% CI:0.42-0.47), 54% mortality (RR:0.46, 95% CI:0.42-0.49), and 37% case-fatality (RR:0.63, 95% CI:0.51 −0.76)], decreasing gradually until having no effect in individuals with higher incomes. Similar effects were observed on HIV notification. Programa Bolsa Família impact was also stronger among women and adolescents. Several sensitivity and triangulation analyses demonstrated the robustness of the results. Conditional cash transfers can significantly reduce AIDS morbidity and mortality in extremely vulnerable populations and should be considered an essential intervention to achieve AIDS-related sustainable development goals by 2030. Brazil has operated a conditional cash transfer program to support families living in precarious conditions since 2004. Here, the authors use linked administrative and health data to investigate the impacts of the program on HIV/AIDS-related outcomes, demonstrating strong positive associations. [ABSTRACT FROM AUTHOR]

Background: Neglected tropical diseases affect the most vulnerable populations and cause chronic and debilitating disorders. Socioeconomic vulnerability is a well-known and important determinant of neglected tropical diseases. For example, poverty and sanitation could influence parasite transmission. Nevertheless, the quantitative impact of socioeconomic conditions on disease transmission risk remains poorly explored. Methods: This study investigated the role of socioeconomic variables in the predictive capacity of risk models of neglected tropical zoonoses using a decade of epidemiological data (2007–2018) from Brazil. Vector-borne diseases investigated in this study included dengue, malaria, Chagas disease, leishmaniasis, and Brazilian spotted fever, while directly-transmitted zoonotic diseases included schistosomiasis, leptospirosis, and hantaviruses. Environmental and socioeconomic predictors were combined with infectious disease data to build environmental and socioenvironmental sets of ecological niche models and their performances were compared. Results: Socioeconomic variables were found to be as important as environmental variables in influencing the estimated likelihood of disease transmission across large spatial scales. The combination of socioeconomic and environmental variables improved overall model accuracy (or predictive power) by 10% on average (P < 0.01), reaching a maximum of 18% in the case of dengue fever. Gross domestic product was the most important socioeconomic variable (37% relative variable importance, all individual models exhibited P < 0.00), showing a decreasing relationship with disease indicating poverty as a major factor for disease transmission. Loss of natural vegetation cover between 2008 and 2018 was the most important environmental variable (42% relative variable importance, P < 0.05) among environmental models, exhibiting a decreasing relationship with disease probability, showing that these diseases are especially prevalent in areas where natural ecosystem destruction is on its initial stages and lower when ecosystem destruction is on more advanced stages. Conclusions: Destruction of natural ecosystems coupled with low income explain macro-scale neglected tropical and zoonotic disease probability in Brazil. Addition of socioeconomic variables improves transmission risk forecasts on tandem with environmental variables. Our results highlight that to efficiently address neglected tropical diseases, public health strategies must target both reduction of poverty and cessation of destruction of natural forests and savannas. [ABSTRACT FROM AUTHOR]

Leukocyte immunoglobulin (Ig)‐like receptors (LILR) LILRB1 and LILRB2 may play a pivotal role in maintaining self‐tolerance and modulating the immune response through interaction with classical and nonclassical HLA molecules. Although both diversity and natural selection patterns over HLA genes have been extensively evaluated, little information is available concerning the genetic diversity and selection signatures on the LILRB1/2 regions. Therefore, we identified the LILRB1/2 genetic diversity using next‐generation sequencing in a population sample from São Paulo State, Brazil. We identified 58 LILRB1 Single Nucleotide Variants (SNVs), which gave rise to 13 haplotypes, and 41 LILRB2 SNVs arranged into 11 haplotypes. Although we may not exclude as a possible effect of population structure, we found evidence of either positive or purifying selection on LILRB1/2 coding regions. Some residues in both proteins showed to be under the effect of positive selection, suggesting that amino acid replacements in these proteins resulted in beneficial functional changes. Finally, we have revealed that allelic variation (six and five amino acid exchanges in LILRB1 and LILRB2, respectively) affects the structure and/or stability of both molecules. Nonetheless, LILRB2 has shown higher average stability, with no D1/D2 residue affecting protein structure. Overall, our findings demonstrate that LILRB1 and LILRB2 are as polymorphic as HLA class Ib genes and provide strong evidence supporting the directional selection regime hypothesis. [ABSTRACT FROM AUTHOR]

Using data from the Brazilian Higher Education Census and other public institutions, this study aims to obtain and compare efficiency scores from stochastic frontier analysis (SFA) and data envelopment analysis (DEA) models for 56 Brazilian federal universities for the period of 2010 to 2016. The output distance function includes financial and human resources as inputs, and teaching, research, patents and third mission activities as outputs. The research is innovative considering: (i) the estimation of SFA for Brazilian universities as whole institutions, (ii) its comparison with DEA; and (iii) the inclusion of patents and third mission variables. The findings suggest there is inefficiency in Brazilian higher education production, with a very small increase through time and with some influence from universities and environmental characteristics. Thus, consolidated traditional institutions with university hospitals tend to be more efficient than the younger ones. The values and the rank of the efficiencies are sensitive to the model/method employed, presenting highly significant although modest correlations. In general, the inclusion of third mission activities improves the efficiencies for both approaches, mainly for DEA. Hence, as advised in other international comparative analyses, caution is required when deriving management and policy recommendations from the analytical results. [ABSTRACT FROM AUTHOR]

Introduction: The morphological patterns in indirect immunofluorescence assay on HEp-2 cells (HEp-2 IFA) reflect the autoantibodies in the sample. The International Consensus on ANA Patterns (ICAP) classifies 30 relevant patterns (AC-0 to AC-29). AC-4 (fine speckled nuclear pattern) is associated to anti-SS-A/Ro, anti-SS-B/La, and several autoantibodies. Anti-SS-A/Ro samples may contain antibodies to Ro60 and Ro52. A variation of AC-4 (herein designated AC-4a), characterized by myriad discrete nuclear speckles, was reported to be associated with anti-SS-A/Ro. The plain fine speckled pattern (herein designated AC-4b) seldom was associated with anti-SS-A/Ro. This study reports the experience of four expert laboratories on AC-4a and AC-4b. Methods: Anti-Ro60 monoclonal antibody A7 was used to investigate the HEp-2 IFA pattern. Records containing concomitant HEp-2 IFA and SS-A/Ro tests from Durand Laboratory, Argentina (n = 383) and Fleury Laboratory, Brazil (n = 144,471) were analyzed for associations between HEp-2 IFA patterns and disease-associated autoantibodies (DAA): double-stranded DNA, Scl-70, nucleosome, SS-B/La, Sm, and U1-RNP. A total of 381 samples from Dresden Technical University (TU-Dresden), Germany, were assayed for HEp-2 IFA and DAA. Results: Monoclonal A7 recognized Ro60 in Western blot and immunoprecipitation, and yielded the AC-4a pattern on HEp-2 IFA. Analyses from Durand Laboratory and Fleury Laboratory yielded compatible results: AC-4a was less frequent (8.9% and 2.7%, respectively) than AC-4b (26.1% and 24.2%) in HEp-2 IFA-positive samples. Reactivity to SS-A/Ro occurred in 67.6% and 96.3% of AC-4a-pattern samples against 23% and 6.8% of AC-4b pattern samples. Reciprocally, AC-4a occurred in 24% and 47.1% of anti-SS-A/Ro-positive samples, and in 3.8% and 0.1% of anti-SS-A/Ro-negative samples. Data from TU-Dresden show that the AC-4a pattern occurred in 69% of 169 anti-SS-A/Ro-monospecific samples (62% of all anti-SS-A/Ro-positive samples) and in 4% of anti-SS-A/Ro-negative samples, whereas anti-SS-A/Ro occurred in 98.3% of AC-4a samples and in 47.9% of AC-4b samples. In all laboratories, coexistence of anti-SS-B/La, but not other DAA, in anti-SS-A/Ro-positive samples did not disturb the AC-4a pattern. AC-4a was predominantly associated with anti-Ro60 antibodies. Conclusions: This study confirms the association of AC-4a pattern and anti-SS-A/Ro in opposition to the AC-4b pattern. The results of four international expert laboratories support the worldwide applicability of these AC-4 pattern variants and their incorporation into ICAP classification under codes AC-4a and AC-4b, respectively. The AC-4 pattern should be maintained as an umbrella pattern for cases in which one cannot discriminate AC-4a and AC-4b patterns. The acknowledgment of the AC-4a pattern should add value to HEp-2 IFA interpretation. [ABSTRACT FROM AUTHOR]

Neophysopella tropicalis, one of the causal agents of Asian grapevine leaf rust (AGLR), can cause severe epidemics in Brazil that lead to yield losses in commercial vineyards. An early detection of the pathogen by air sampling of urediniospores on spore traps or in symptomless leaves would be valuable to multiple studies, such as epidemics modelling, risk forecasting, monitoring of pathogen introductions in rust‐free areas, and predicting the beginning of epidemics. This study developed a quantitative PCR (qPCR) protocol to quantify N. tropicalis urediniospores attached to adhesive tapes and in grapevine leaves before symptom appearance. A specific primer pair was designed based on the internal transcribed spacer (ITS) sequence region of the AGLR pathogen. Standard amplification curves using genomic DNA from urediniospores of N. tropicalis and from urediniospores attached to adhesive tapes were established. Grapevine leaves inoculated with N. tropicalis were collected at 2, 5, and 7 days postinoculation (dpi). One primer pair (580F/720R) amplified a 140 bp product in all AGLR isolates but did not amplify products of other rust genera, such as Phakopsora, Puccinia, Hemileia, Tranzschelia, Cerotelium, and Coleosporium. As little as 0.1 pg DNA and 10 urediniospores of N. tropicalis attached to adhesive tapes could be detected. qPCR enabled the detection of the pathogen as early as 2 dpi, before symptom appearance. This method can be used to monitor N. tropicalis inoculum in grapevine‐growing areas and to quantify symptomless infections of the AGLR pathogen. [ABSTRACT FROM AUTHOR]

Background To investigate the spatial distribution of congenital syphilis (CS) and its association to social vulnerability indexes in northeast Brazil. Methods This was an ecological study referring to all cases of CS and CS deaths recorded in the northeast region of Brazil from 2008 to 2015. Data were obtained from three Brazilian information systems. We examined statistical correlations between CS indicators by state and municipality and their socioeconomic and social vulnerability characteristics. We used Bayesian empirical local models to identify fluctuations of the indicators. Spatial statistical tests were used to identify spatial clusters and the municipalities at high risk of CS. Results The incidence of CS ranged from 2.1 cases/1000 live births (LB) in 2008 to 6.9/1000 LB in 2015, with an annual increase of 19.9% (p < 0.001). The mortality coefficient of CS ranged from 2.9/1000 LB in 2008 to 6.5/1000 LB in 2015, resulting in an annual increase of 15.1% (p < 0.001). Nine spatial clusters were identified. Cases of congenital syphilis occurred in well-defined spatiotemporal clusters and in areas with high levels of social vulnerability. Conclusions CS incidence is associated with social vulnerability. CS control programmes should target spatial clusters and populations with high levels of social vulnerability. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between religious beliefs and the constructs of the Theory of Planned Behavior in entrepreneurial intention. Originality/value: The article stands out by promoting the understanding of entrepreneurship from the Theory of Planned Behavior proposed by Ajzen (1991), aligning it with religious beliefs. Design/methodology/approach: It is an exploratory and descriptive study, of a quantitative nature. The survey method was used to collect the data, in which a sample of 448 students from the Business Administration courses at two public universities in the northeast of Brazil was obtained. Structural Equation Modeling was used to treat and analyze the data. Findings: The results demonstrated that personal attitude, perceived control, and religious beliefs influence the entrepreneurial intention of university students, which did not occur with subjective norms. However, subjective norms influenced the personal attitude and perceived control of university students. The university students presented a predisposition to entrepreneurship and recognized that they have the necessary skills to create a business. However, the choice to become an entrepreneur may not be motivated directly by the expectation of its social referents. Moreover, university students did not perceive the influence of religious beliefs in the manifestation of their behavior, because vocation and prosocial motivation are far from the environmental context in which university students are inserted or because they are not practicing a religion that fosters such beliefs. [ABSTRACT FROM AUTHOR]

Leptospirosis is a bacterial disease that represents a major problem in animal and public health due to its high prevalence and widespread distribution. This zoonotic disease is most prevalent in tropical environments where conditions favour pathogen survival. The ecological preferences of Leptospira serovars are poorly understood, limiting our knowledge of where and when outbreaks can occur, which may result in misinformed prevention and control plans. While the disease can occur consistently in time and space in tropical regions, research on the ecology of leptospirosis remains limited in subtropical regions. This research gap regarding Leptospira ecology brings public and veterinary health problems, impacting local economies. To fill this gap of knowledge, we suggest to assess geographic and ecological features among Leptospira serovars in a subtropical area of Brazil where leptospirosis is endemic to (a) highlight environmental conditions that facilitate or limit Leptospira spread and survival and (b) reconstruct its geographic distribution. An ecological niche modelling framework was used to characterize and compare Leptospira serovars in both geographic and environmental space. Our results show that despite the geographic overlap exhibited by the different serovars assessed, we found ecological divergence among their occupied ecological niches. Ecological divergences were expressed as ranges of potential distributions and environmental conditions found suitably by serovar, Sejroe being the most asymmetric (<0.15). Most important predictors for the potential distribution of most serovars were soil pH (31.7%) and landscape temperature (24.2%). Identification of environmental preferences will allow epidemiologists to better infer the presence of a serovar based on the environmental characteristics of regions rather than inferences based solely on historical epidemiological records. Including geographic and ecological ranges of serovars also may help to forecast transmission potential of Leptospira in public health and the food animal practice. [ABSTRACT FROM AUTHOR]

This paper primarily aims to test a Pleistocene refuge-type scenario, as previously proposed for the gonyleptidGeraeocormobius sylvarum, a semi-deciduous forests dweller in subtropical Argentina, Brazil and Paraguay. Palaeodistributional models of this species were built using MaxEnt for two Last Glacial Maximum (LGM = 21,000 years ago) simulations – Community Climate System Model (CCSM) and Model for Interdisciplinary Research on Climate (MIROC) – and for 6000 years ago (−6k = HCO, the Holocene climatic optimum). Both LGM models retrieved a fragmented pattern. For CCSM, range was split into multiple, scattered fragments. MIROC resulted in very few patches, with a decided range reduction because of a strong humidity drop. Models for −6k recovered a moderate range expansion. No past connection between the core area and the yungas was predicted. Analysis of variables importance showed that two precipitation predictors (bc18, precipitation warmest quarter; bc14, precipitation driest month) and two temperature predictors (bc7, temperature annual range; bc9, mean temperature driest quarter) scored as the most influencing overall. The Limiting Factor analysis recognized them as limiting too, in different parts of the species range. LGM palaeomodels ofG. sylvarumare compatible with the refuge hypothesis invoked in previous molecular analyses, to explain the high genetic diversity found in the core area. Additionally, the results reinforced the hypothesis of the recent anthropogenic origin of the yungas disjunct populations. [ABSTRACT FROM AUTHOR]

Objective. Complete deficiency of Complement C4 component is a strong genetic risk factor for SLE. C4 is encoded by two different genes, C4A and C4B, which show considerable gene copy number (GCN) variation. This study investigates the association of total C4, C4A and C4B GCN with JSLE. Methods. Ninety JSLE patients, 170 adult-onset SLE (aSLE) patients and 200 healthy individuals were evaluated for C4A and C4B GCN by quantitative real-time PCR. Results. JSLE patients had lower GCN for C4A (mean = 1.7; 95% CI: 1.5, 1.9) and C4B (mean = 1.5; 95% CI: 1.3, 1.6) compared with healthy individuals (mean C4A = 2.3; 95% CI: 2.2, 2.5, P< 0.001; C4B = 2.0; 95% CI: 1.8, 2.1; P<0.001) or with aSLE patients (mean C4A = 1.9; 95% CI: 1.8, 2.1, P = 0.006; mean C4B = 1.8; 95% CI: 1.7, 1.9, P< 0.001). Low total C4 GCN (<4 copies) was more frequent in JSLE than in healthy individuals (59% vs 28%; P< 0.001). The same was observed for low C4A (≤1 copy) (52% vs 18%; P < 0.001) and for low C4B (60% vs 31 %; P < 0.001). JSLE had a stronger association with low total C4 (OR = 3.68, 95% CI: 2.19, 6.20), C4A (OR = 4.98, 95% CI: 2.88, 8.62) and C4B (OR = 3.26; 95% CI: 1.95, 5.47) than aSLE (C4 OR = 2.03; 95% CI: 1.32, 3.13; C4A OR = 2.36; 95% CI: 1.46, 3.81; C4B OR = 1.13; 95% CI: 0.73, 1.74). In addition, pericarditis in JSLE patients was associated with low C4 (OR=4.13; 95% CI: 1.02, 16.68; P = 0.047) and low C4A (OR = 5.54; 95% CI: 1.37, 22.32; P = 0.016). Conclusion. Low total C4, C4A and C4B GCN were associated with a stronger risk for developing JSLE than aSLE. Additionally, low total C4 and C4A GCN are risk factors for pericarditis in JSLE. [ABSTRACT FROM AUTHOR]

Background: Pain emerges as a challenge in the treatment of leprosy patients. In this study, we describe the prevalence and type of pain in patients with leprosy, and its effect on patients' quality of life in an endemic area of Northeast Brazil. Findings: A cross-sectional survey of 260 patients attending leprosy reference centres in Sergipe, Northeast Brazil was conducted. Individuals were assessed for the presence and type of pain, skin sensory loss, peripheral nerve enlargement, touch and pinprick sensations, mechanical allodynia and nerve palpation. Participants completed the Douleur Neuropathique 4 questionnaire, and we also used the Brief Pain Inventory scale and the World Health Organization Quality of Life-BREF instrument to arrive at our results. One hundred and ninety-five (75 %) patients reported pain, mostly of the neuropathic type. Pain was moderate in 84 (43.1 %) and severe in 94 (48.2 %) participants. The presence of pain was associated with disability (p = 0.001), leprosy reactions (p = 0.004) and lower quality of life. Most patients with neuropathic pain were treated with steroids, despite their low efficacy for this type of pain. Conclusion: Pain is highly prevalent among leprosy patients and is associated with low quality of life. Leprosy management should include a systematic assessment of the type of pain a patient experiences in order to provide adequate treatment. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the association between quality of life (QoL) and functional activity limitations (FAL) of leprosy patients as determined by the Screening of Activity Limitation and Safety Awareness scale (SALSA). Aim: To identify the association between FALs and the QoL of patients during and post leprosy treatment. Materials and Methods: Cross-sectional survey of 104 patients with leprosy followed in specialist reference centres in Sergipe, Brazil, between June and October 2014. QoL was evaluated using the World Health Organization-QoL-BREF (WHOQoL-BREF) questionnaire. The SALSA scale was used to measure FALs. Results: Low SALSA scores were present in 76% of patients. QoL scores were lower for the physical and environmental domains, with median (interquartile range (IQR)) scores of 53.6 (32.1–67.9) and 53.1 (46.9–64.8), respectively. There was a statistical association between increasing SALSA scores and lower QoL as measured by the WHOQoL-BREF. Conclusion: Functional limitations are associated with lower QoL in leprosy patients, especially in the physical and environmental WHOQoL-BREF domains. [ABSTRACT FROM AUTHOR]

Background and Aims: Rotavirus causes severe diarrhoea and Brazil introduced the Rotarix G1P vaccine in 2006. We aimed to describe changes in rotavirus incidence and diarrhoea epidemiology before and after vaccine introduction. Methods: Design: (i) hospital-based survey of children with diarrhoea (2006–2012); (ii) diarrhea-mortality and hospitalization surveillance (1999–2012). Setting: (i) Aracaju and (ii) state and national level. Results: 1841 children were enrolled and 231 (12.5%) had rotavirus. Rotavirus was less frequent from January-June than from July-December (9.4% versus 20.9%, p<0.01), but the seasonal variation was less defined after 2009. Very few rotavirus cases (8–3.9%) were detected in 2011, with an increase in 2012 (13–18.5%). In 2006, unvaccinated children were more likely to have rotavirus, but thereafter unvaccinated and vaccinated children had equally low incidence. Older children and those with rotavirus were more likely to have severe diarrhea episodes. The most frequent genotype from 2006 to 2010 was G2P; except in 2009, when most cases were G1P. Very few G2P were detected from 2011 and 50% cases in 2012 were G8P. Diarrhoea-hospitalizations decreased nationally from 89,934 (2003) to 53,705 (2012; 40.3% reduction) and in the state from 1729 to 748 (56.7% reduction). Diarrhoea-deaths decreased nationally from 4368 in 1999 to 697 in 2012 (84% reduction, p<0.001) and in the state from 132 to 18 (86% reduction). These changes were much larger after vaccine introduction. Conclusions: The vaccine was associated with substantial reductions in rotavirus incidence and diarrhoea-hospitalizations and deaths. The G2P genotype predominance disappeared over time and may be replaced by other heterotypic genotypes. [ABSTRACT FROM AUTHOR]

In a context of unregulated practice, strategic environmental assessment (SEA) contribution to environmentally sound decision-making may be difficult to gauge. Recent Brazilian experience, where there is no legal requirement for SEA, was studied by reviewing cases selected by considering distinctive drivers for undertaking an assessment, varied locations and different consultancies hired to prepare the report. A quality review checklist was used to evaluate the contents of SEA reports according to: (i) adherence to good practice; (ii) technical quality and adequacy to decision-making processes; (iii) achievement of sound and enduring environmental benefits. Interviews aimed at gauging their actual influence. SEAs reached a relatively high level of technical quality and procedural effectiveness, but very low substantive effectiveness. Influence on decision-making varied from null to limited consideration of information in developing programs. The main challenge for SEA in unregulated contexts is to demonstrate its value to decision-makers and citizens' organisations. [ABSTRACT FROM AUTHOR]

In the context of compounding health, environmental, and climatic crises, Brazil may witness two of its most important environmental policy instruments, environmental licensing and impact assessment, be severely weakened. On May 13, 2021, the Chamber of Deputies passed a new General Law of Environmental Licensing, ignoring the concerns of civil society, scientists, and other relevant parties. If approved by the Senate and ratified by President Bolsonaro, this law will further undermine Brazil's increasingly fragile environmental protection and public participation in decision-making. Here, we review the bill's main provisions, highlighting potential far-reaching implications for environmental protection and governance, public participation in decision-making, and human rights in Brazil and beyond. Scientists can play an important role in debunking misinformation and advising Senators and the public opinion on the bill's dangerous effects. • A General Law of Environmental Licensing is a roll-back in Brazil's environmental legislation. • Bill 2159/2021 was approved by Chamber of Deputies without civil society dialogue. • The Bill's provisions affect each stage of licensing and impact assessment process. • The proposed bill weakens the territorial rights of Indigenous and Afro-descendant communities. • National and international adverse consequences of this bill are far-reaching. [ABSTRACT FROM AUTHOR]

Abstract: Nowadays, the usage of systems based on solar energy have been largely stimulated. The correct designing and efficiency of these systems are highly dependent of the seasonal climatic characteristics of the regions where they will be installed. In this work, we propose a hybrid structure to simulate the thermodynamic behavior of pools, which uses neural computational models to incorporate the climatic information of the regions being analyzed. The neural models have as input variables data of geographic position such as: elevation, latitude and longitude, what permits to delineate the climatic profile of the region being considered. The human activity is another factor that directly influences the thermodynamic behavior of pools and, therefore, is also considered. In this work, changes of volume are estimated in order to track losses due to the human activity. [Copyright &y& Elsevier]

Brazil has the largest commercial beef cattle herd in the world, with cattle ranching being particularly prominent in the 200-million ha, Brazilian neotropical moist savanna biome, known as Cerrado, one of the world's hotspots for biodiversity conservation. As decreasing productivity is a major concern affecting the Cerrado pasturelands, evaluation of pasture conditions through the determination of biophysical parameters is instrumental for more effective management practices and herd occupation strategies. Within this context, the primary goal of this study was the regional assessment of pasture biophysical properties, through the scaling of wet- and dry-season ground truth data (total biomass, green biomass, and % green cover) via the combined use of high (Landsat-TM) and moderate (MODIS) spatial resolution vegetation index images. Based on the high correlation found between NDVI (normalized difference vegetation index) and % green cover (r = 0.95), monthly MODIS-based % green cover images were derived for the 2009-2010 hydrological cycle, which were able to capture major regional patterns and differences in pasture biophysical responses, including the increasing greenness values towards the southern portions of the biome, due to both local conditions (e.g., more fertile soils) and management practices. These results corroborate the development of biophysically-based landscape degradation indices, in support of improved land use governance and natural area conservation in the Cerrado. [ABSTRACT FROM AUTHOR]

It can be expected that, over a long time span, both the contents and the scope of environmental impact statements (EISs) will evolve to incorporate new issues and new analytical approaches. A diachronic review was conducted of a sample of EISs produced by one consultancy in Brazil, specializing in mining and quarrying. Nine EISs prepared in the period 1987–2010 were selected, covering different minerals and locations. Content analysis showed that the scope of the EISs has widened and the content has deepened over time, particularly in terms of level of detail and issues dealt with in baseline studies, while impact analysis has evolved to incorporate some quantitative predictions and mitigation measures have become structured along a consistent framework, as compared with a simple list of loose commitments that appeared in the first EISs. Interviews conducted with both regulators and consultants suggest that the main driver of change has been new legislation, followed by better regulation and administrative control exerted by the environmental agencies and improved consultants' capacity, while proponents' policies had little influence on the observed evolution. If EISs are to evolve further in order to incorporate new analytical approaches and become less descriptive, the initiative should come mainly from regulators. [ABSTRACT FROM PUBLISHER]

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Background: Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in children worldwide. This study aimed to determine the viral and atypical bacterial causes of different severities and clinical manifestations of ARI in preschool children from low-income families in North-East Brazil. Methods: Clinical/demographic data and nasopharyngeal aspirates (NPA) were prospectively collected from children <5 years presenting with ARI over one year to a paediatric A&E department. Disease severity was grouped according to presence of lower respiratory tract signs, need for hospital admission and need for oxygen. Clinical manifestation of ARI was based on discharge diagnosis from hospital with four conditions predominating: bronchiolitis, pneumonia, episodic viral wheeze/asthma and upper respiratory tract infection. Multiplex PCR was used to detect 17 common respiratory viral and atypical bacterial pathogens in NPA. Findings: 407 children with a median age of eight months were recruited. Pathogens were detected in 85?5% samples with co-infection being particularly common (39?5%). Respiratory Syncytial Virus (RSV; 37%), Adenoviruses (AdV; 25%), Rhinoviruses (hRV; 19%), Bocavirus (hBoV; 19%), human Meta-pneumovirus (hMPV; 10%) and Mycoplasma pneumoniae (Mpp; 10%) were most prevalent. Detection and co-infection rates were similar in all severities and clinical manifestations of ARI apart from RSV, which was associated with more severe disease and specifically more severe cases of bronchiolitis, and Mpp, which was associated with more severe cases of pneumonia. Mpp was detected in 17% of children admitted to hospital with pneumonia. Interpretation: This study underlines the importance of viral and atypical bacterial pathogens in ARI in pre-school children and highlights the complex epidemiology of these pathogens in this age group. Generally, viruses and atypical bacteria were detected in all severities and clinical manifestations of ARI but RSV and Mpp were associated with more severe cases of bronchiolitis and pneumonia respectively. [ABSTRACT FROM AUTHOR]

Despite the importance that international migration has attained in the media and academia worldwide, there are only a few scattered studies on international migration in the Amazon. How is the process of international migration presented in the Amazon and what is its importance in the destiny of the region? This article is an initial approach to that question. The text summarizes results of recent research conducted by the Research Group on Environment, Population and Development in the Amazon (MAPAZ) of the Center for Advanced Amazonian Studies (NAEA) of the Federal University of Pará. First, it discusses the difficulty of defining the Amazon, then some considerations are made about international migration in the Greater Amazon Region, aggregating the accumulated migrants of the national portions, according to the census of population of each country, and, finally, this issue is considered with regard to Brazilian Amazon highlighting countries of birth and the spatial distribution of migrants in the Amazon. In the Amazon the patterns and trends discussed here will become more dynamic and complex as development policies in pursuit of regional integration and economic development advance. [ABSTRACT FROM AUTHOR]

Objective [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell 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.)

This paper documents the experience of teaching environmental impact assessment (EIA) to undergraduate students at Escola Politécnica, an engineering school in Brazil, where EIA was first introduced as a graduate course in 1990, evolving to be taught as an undergraduate course. Learning objectives, course contents and teaching approaches are described. The courses have always sought to prevent a "legal trap" in teaching EIA, i.e. shaping the contents and the approach upon the applicable legal requirements, as it is assumed that, ultimately, EIA is not practiced because of laws, but because society calls for environmentally and socially responsible decision-making. Given the limited literature on EIA education, the paper also hopes to stimulate further reflection and debate on the role of teaching in enhancing environmental assessment practice and in improving its effectiveness and disseminating best practices. [ABSTRACT FROM AUTHOR]

Background. In a Latin American trial, a monovalent G1P[8] rotavirus vaccine showed high efficacy against severe rotavirus diarrhea. Protection was lower against serotypically unrelated G2P[4] strains, which circulated infrequently. This case-control study was undertaken to assess the effectiveness of this monovalent G1P[8] rotavirus vaccine against G2P[4] strains in Brazil. Methods. Case patients were children with severe G2P[4] rotavirus diarrhea who presented at a hospital in Recife, Brazil, from March 2006 through September 2008. Vaccination rates among case patients were compared with rates among 2 groups of control participants—children with rotavirus-negative diarrhea and children admitted for acute respiratory tract infection (ARI)—to calculate vaccine effectiveness, after controlling for the birth month and year. Results. We enrolled 70 G2P[4] rotavirus-positive case patients with severe diarrhea, 484 rotavirus-negative control participants with diarrhea, and 416 control participants with ARI, aged ⩾6 months. Among children aged 6-11 months, the effectiveness of the vaccine against G2P[4] diarrhea was 77% (95% confidence interval [CI], 42%-91%) and 77% (95% CI, 43%-90%) among the rotavirus-negative control participants with diarrhea and control participants with ARI, respectively. Vaccine effectiveness in children aged ⩾ 12 months decreased to -24% (95% CI, -190% to 47%) and 15% (95% CI, -101 to 64) among the rotavirus-negative control groups with diarrhea and ARI, respectively. Conclusions. This monovalent G1P[8] rotavirus vaccine was effective against severe G2P[4] rotavirus diarrhea among children aged 6-11 months. Effectiveness declined among children aged ⩾12 months, which suggests waning immunity. [ABSTRACT FROM AUTHOR]

This paper provides the description of a new species in the genus Zabius Thorell (Scorpiones, Buthidae), Z gaucho n. sp., from four localities in the State of Rio Grande do Sul, Brazil. It differs from Zabius fuscus (Thorell 1877) and Z. birabeni Mello-Leitão 1938 in details of the telson shape, the longitudinal carinae on mesosomal tergites II-VI, and the number of pectinal teeth. The genus was hitherto known only from Argentina, Z. fuscus being a frequent inhabitant of the central Sierras: Z. birabeni, in turn, is probably a rare and non-orophilous scorpion, collected in scattered localities on the monte/chaco ecotone and in northern Patagonia. The presence of a species of Zabius in southern Brazil lends additional support to the generalized distributional track known as "peripampasic track," which zoogeographically links the central Sierras Pampeanas with ancient mountains in the southern province of Buenos Aires, southeastern Uruguay and southern Brazil. [ABSTRACT FROM AUTHOR]

In 2006, Brazil will initiate universal immunization of its 4‐million infants with a live attenuated serotype G1P[8] human rotavirus vaccine. In anticipation of the national immunization program, this study was undertaken to characterize rotavirus strains circulating among children in Recife, one of the largest cities in the northeast region of Brazil. Group A rotaviruses were detected in 102 (35%) of 290 faecal specimens collected from children under 5 years of age who presented with acute diarrhoea during a 1‐year period between May 2004 and April 2005. In addition to the globally common G1P[8] serotype that accounted for 49% of strains, emerging rotavirus serotypes G8P[6] and G9P[8] represented 2% and 29% of strains, respectively. Following cell culture adaptation, RNA‐RNA hybridization demonstrated that two Brazilian G8P[6] rotavirus strains shared a high level of genomic RNA homology with Malawian G8P[6] strains, and a Brazilian G9P[8] strain was related most closely to a G9P[8] strain from India. The results suggest that certain rotavirus strains have a much wider global circulation than generally appreciated. Continued global spread of such strains might challenge the efficacy of current rotavirus vaccines. J. Med. Virol. 79:335–340, 2007. © 2007 Wiley‐Liss, Inc. [ABSTRACT FROM AUTHOR]

Acute respiratory infections (ARI) are one of the most important causes of death in children. Human metapneumovirus (HMPV), a virus first described in 2001, has now been detected in almost all continents. HMPV causes bronchiolitis and pneumonia with a clinical spectrum similar to respiratory syncytial virus (RSV). We describe the incidence of HMPV and RSV during two consecutive seasons with a high incidence of ARI in Aracaju, Brazil. HMPV was responsible for 24% of cases of bronchiolitis in the 1st season (April-May 2002) but was not found in the 2nd year (April-May 2003). RSV was recovered from 61 (55%) children with ARI in 2002 and from 72 (68%) in 2003. Children with RSV bronchiolitis in 2002 had more hypoxia but less wheezing than in 2003. The incidence of HMPV and RSV genotypes causing bronchiolitis varied between the years. Long-term prospective studies are required to better describe the epidemiology of these viruses in children. [ABSTRACT FROM AUTHOR]

Serra do Mar, in Southeastern Brazil, is an extremely diverse and rich environment characterized by intense rainfall and steep slopes covered by tropical rainforest. A number of roads, highways, railways, pipelines, and transmission lines cross this zone. A new highway that has been approved by the Sa˜o Paulo State environment authorities is currently under construction.During the approval phase, the issue of ensuring proper implementation of mitigation measures arose as a significant concern. As a consequence, an innovative institutional arrangement has been set up for following-up, by which a multi-institutional multidisciplinary team performs weekly inspection tours, whereas the project owner hired its own consultant to oversee the construction, putting the contractor under strict scrutiny. Among the most significant issues addressed, the following are particularly relevant: (1) erosion and sediment yield; (2) river siltation; (3) slope stability; (4) excavated soil and rock disposal; (5) management of water pumped from tunneling; and (6) minimizing habitat loss.Results show that strict environmental supervision can effectively ensure that environmental impacts can be maintained within the limits of predicted impacts or legal requirements. Furthermore, this case showed that careful review of environmental impact studies and the establishment of detailed terms and conditions to be fulfilled by the proponent during the construction phase are necessary conditions for a successful follow-up. [Copyright &y& Elsevier]

Although oral rehydration therapy greatly reduces mortality from diarrhoeal diseases, it has little effect on stool frequency. However, there is mounting evidence that zinc is an effective adjunct to the treatment of diarrhoea, although few studies have examined its efficacy in Latin America. This study assessed the efficacy of zinc supplementation in children with acute diarrhoea in Brazil. The study was a double-blind, placebocontrolled, randomised, clinical trial in children < 5 years of age attending emergency services in Sergipe, Brazil. Subjects received zinc or vitamin C as placebo. There was a marked reduction in the duration of the diarrhoea (1.1 vs 2.6 days) and of watery stools in the zinc-supplemented group. The efficacy of zinc was independent of the presence of viral enteropathogens in the stools. It is concluded that, similar to studies in India and Bangladesh, zinc could be an important adjunct for treating acute diarrhoea in Brazilian children. [ABSTRACT FROM AUTHOR]

We identified 21 rotaviruses in 129 patients with diarrhea in a Brazilian city with high rotavirus vaccine coverage. All rotaviruses were genotype P[4]G2 with 1 mixed infection with P[NT]G9. Although virus predominance could have occurred randomly, the vaccine may be less protective against P[4]G2. Prospective surveillance is urgently needed. [ABSTRACT FROM AUTHOR]

We describe the epidemiologic and clinical characteristics of 111 children attending clinics and hospitals in Aracaju, northeast Brazil, with acute respiratory infections attributable to human metapneumovirus (HMPV), respiratory syncytial virus (RSV), or both in May and June 2002. Fifty-three (48%) children were infected with RSV alone, 19 (17%) with HMPV alone, and 8 (7%) had RSV/HMPV co-infections. [ABSTRACT FROM AUTHOR]

Achievement gaps refer to the difference in the performance on assessments of students belonging to different social groups. Achievement gaps between ethnic groups have been observed in countries with heterogeneous populations. In this paper, achievement gaps between ethnic populations in Brazil were analyzed by studying the performance of a large cohort of senior high-school students in a standardized national exam. Ethnic groups were stratified by Brazilian states and socio-economic variables to homogeneize the groups, and the analyses focused on the disciplines of mathematics and writing that involve different cognitive functions. A Welch's t-test analysis was performed and key socio-economic variables that may explain the gaps were studied. The results show that gaps between ethnic groups of students living in low-income households were either statistically insignificant or small (2– 6 % ) if statistically significant. Larger gaps however were observed for students coming from high-income families in some contexts. Although parental education was associated with higher performance, it may either increase, decrease or maintain the gaps between White and Black, and between White and Pardo students. Our results support that socio-economic variables, linked to historical developments, have an impact on student's performance irrespective of ethnic background, resulting on little to no influence on group performance when students are exposed to similar cultural and economic contexts. [ABSTRACT FROM AUTHOR]

The article reviews the summary report "Environmental Licensing for Hydroelectric Projects in Brazil: A Contribution to the Debate," prepared by World Bank. It states that the country has a complex environmental licensing process wherein the excessive power and undue political pressure in reviewing environmental impact studies are big issues. It mentions the role of the prosecutors in the licensing process, the costs of licensing, and the recommendations to deal with process inefficiencies.

Objectives: To examine drug overdose records in Brazil from 2000 to 2020, analyzing trends over time in overdoses and overall sociodemographic characteristics of the deceased. Methods: Using data from the Brazilian Mortality Information System (Sistema de Informações sobre Mortalidade), we identified records from 2000-2020 in which the underlying cause-of-death was one of the following codes: X40-X45 (accidental poisoning), X60-X65 (intentional poisoning), or Y10-Y15 (undetermined intentionality poisoning). The Brazilian dataset included 21,410 deaths. We used joinpoint regression analysis to assess changes in trends over time. Results: People who died of drug overdoses in Brazil between 2000 and 2020 had a mean age of 38.91 years; 38.45% were women, and 44.01% were identified as White. Of the overdose deaths, 44.70% were classified as intentional and 32.12% were classified as unintentional. Among the identified drugs, stimulants were the most common class. However, most records did not report which drug was responsible for death. Conclusion: Sociodemographic trends in overdose deaths in Brazil must guide country-specific policies. Nevertheless, data collection protocols must be improved, particularly regarding the drug used in overdoses. [ABSTRACT FROM AUTHOR]

Hantavirus cardiopulmonary syndrome is an emerging zoonosis in Brazil. Human infections occur via inhalation of aerosolized viral particles from excreta of infected wild rodents. Necromys lasiurus and Oligoryzomys nigripes appear to be the main reservoirs of hantavirus in the Atlantic Forest and Cerrado biomes. We estimated and compared ecological niches of the two rodent species, and analyzed environmental factors influencing their occurrence, to understand the geography of hantavirus transmission. N. lasiurus showed a wide potential distribution in Brazil, in the Cerrado, Caatinga, and Atlantic Forest biomes. Highest climate suitability for O. nigripes was observed along the Brazilian Atlantic coast. Maximum temperature in the warmest months and annual precipitation were the variables that most influence the distributions of N. lasiurus and O. nigripes, respectively. Models based on occurrences of infected rodents estimated a broader area of risk for hantavirus transmission in southeastern and southern Brazil, coinciding with the distribution of human cases of hantavirus cardiopulmonary syndrome. We found no demonstrable environmental differences among occurrence sites for the rodents and for human cases of hantavirus. However, areas of northern and northeastern Brazil are also apparently suitable for the two species, without broad coincidence with human cases. Modeling of niches and distributions of rodent reservoirs indicates potential for transmission of hantavirus across virtually all of Brazil outside the Amazon Basin. [ABSTRACT FROM AUTHOR]

Cumulative impact assessment (CIA) is particularly challenging when several projects from different proponents are presented simultaneously for a region. The impacts of such projects are typically assessed individually, but approaches and methods commonly applied to single-project impact assessment may not be adequate to such problems. The pressure–state–response (PSR) model was adapted to tackle cumulative impacts of ten projects concentrated in an iron ore mining region in Southeastern Brazil. Using information from individual assessments, a set of indicators was built to depict current and future pressures on valued environmental and social components, to describe the current and to derive trends for the future state of the environment, and to review mitigation responses. It was found that the future state will likely be critical for both air and water quality, possibly stable for natural vegetation, due to the likely combined result of rehabilitation and offsets, and for both cultural heritage and public roads, due to likely effect of mitigation. Relying on individual assessments proved to be unsatisfactory, because key information on both the characteristics of the projects and baseline are largely inconsistent across studies and presented in very different formats. An indicator-based PSR approach to CIA is information-intense and is recommended only when databases are reliable and built on the basis of standard protocols. The need to better understand cumulative impacts and to provide corresponding, landscape or watershed scale, mitigation and management responses could be a driver for a more widespread and consistent use of standardized indicators in individual impact assessments. [ABSTRACT FROM AUTHOR]

• We propose a model based on ANN for forecasting of extreme rain event. • We consider atmospheric data for different pressure levels. • Our approach allows different forecasting horizon. • Our approach allows considering different previous periods to the extreme event. Extreme rainfall events can devastate urban and rural infrastructure, affect the economy and even lead to loss of life. In this work, we propose an approach based on Long Short Term Memory networks (LSTM) to forecast precipitation volume extreme rainfall using multivariate time series data. Our methodology combines reanalysis data from 12 isobaric pressure levels, surface data, and data from meteorological stations from Brazil's southeastern region. Our method allows handles the imbalanced data typical of time-series data used for this type of problem. In order to identify the best model, we performed several experiments with different configurations of LSTM networks. The test results showed that the best prediction model has as input previous data up to 24 h for a forecast of 6 h ahead with a mean absolute error (MAE) of 6.9 mm and root mean squared error (RMSE) of 6.94 mm. Our methodology shows the possibility to use reanalysis data from global mathematical models to obtain less computationally expensive regional models. [ABSTRACT FROM AUTHOR]

Ticks of the Amblyomma cajennense species complex are important vectors of spotted fever in Latin America. Environmental conditions determine the geographic distribution of ticks, such that climate change could influence the distribution of tick-borne diseases. This study aimed to analyze the potential geographic distribution of A. cajennense complex ticks in a Brazil region under present-day and future climate models, assuming dispersal limitations and non-evolutionary adaptation of these tick populations to climate warming. Records of A. cajennense sensu stricto ( s.s. ) and Amblyomma sculptum were analyzed. Niche models were calibrated using Maxent considering climate variables for 1950–2000 and projecting models to conditions anticipated for 2050 and 2070 under two models of future climate (CCSM4 and HadGEM2-AO). Broad suitable areas for A. cajennense s.s. and A. sculptum were found in present-day climate models, but suitability was reduced when models were projected to future conditions. Our exploration of future climates showed that broad areas had novel climates not existing currently in the study region, including novel extremely high temperatures. Indeed, predicted suitability in these novel conditions would lead to biologically unrealistic results and therefore incorrect forecasts of future tick-distribution. Previous studies anticipating expansions of vectors populations due to climate change should be considered with caution as they assume that model extrapolation anticipates that species would evolve rapidly for adaptation to novel climatic conditions. [ABSTRACT FROM AUTHOR]

Aims: Maturity-Onset Diabetes of the Young (MODY) comprises a heterogeneous group of monogenic forms of diabetes caused by mutations in at least 14 genes, but mostly by mutations in Glucokinase (GCK) and hepatocyte nuclear factor-1 homeobox A (HNF1A). This study aims to establish a national registry of MODY cases in Brazilian patients, assessing published and unpublished data.Methods: 311 patients with clinical characteristics of MODY were analyzed, with unpublished data on 298 individuals described in 12 previous publications and 13 newly described cases in this report.Results: 72 individuals had GCK mutations, 9 described in Brazilian individuals for the first time. One previously unpublished novel GCK mutation, Gly178Ala, was found in one family. 31 individuals had HNF1A mutations, 2 described for the first time in Brazilian individuals. Comparisons of GCK probands vs HNF1A: age 16±11 vs 35±20years; age at diagnosis 11±8 vs 21±7years; BMI 19±6 vs 25±6kg/m2; sulfonylurea users 5 vs 83%; insulin users 5 vs 17%; presence of arterial hypertension 0 vs. 33%, all p<0.05. No differences were observed in lipids and C-peptide.Conclusions: Most MODY cases in Brazil are due to GCK mutations. In agreement with other studied populations, novel mutations are common. Only 14% of patients with familial diabetes carry a HNF1A mutation. Diagnosis of other rare forms of MODY is still a challenge in Brazilian population, as well as adequate strategies to screen individuals for molecular diagnosis. [ABSTRACT FROM AUTHOR]

Leaf scald is one of the most important diseases of sugarcane in Brazil. Despite its importance, little is known about the genetic and pathogenic variability of its causal agent, Xanthomonas albilineans. The genetic diversity of 44 X. albilineans isolates from diverse geographic regions of Brazil was assessed using 15 newly developed short sequence repeat (SSR) loci designed from the genome sequence of X. albilineans strain GPE PC73. In addition, the aggressiveness of each isolate was evaluated by inoculating on a susceptible sugarcane cultivar and scoring the disease severity. Of the 15 SSR loci, 12 were polymorphic and produced 54 polymorphic alleles. The average number of polymorphic alleles per locus was 4.5, and ranged from 2 to 12 alleles. Phenetic analysis based on Nei's unbiased genetic distance, clustered the isolates into two major groups. Group I included 32 isolates from all four geographic regions studied, whereas group II included 9 isolates from two regions. Three isolates did not cluster within these groups. Analysis of disease severity data also revealed variability in aggressiveness among isolates but no correlation could be established with either SSR haplotypes or phenetic groups. Isolates with identical haplotypes differed in aggressiveness and vice versa. However, single marker-trait analysis revealed two markers associated with this trait. [ABSTRACT FROM AUTHOR]

Abstract: This study assessed the family and heath system''s costs due to diarrhoea in children <2 years old, before/after the introduction of a rotavirus vaccine in Brazil in 2006. Information on diarrhoea health care costs and morbidity were obtained from the primary health care system, the National Public Health database (2004–2008) and care-givers. Diarrhoea ambulatory consultations and hospitalizations had a declining trend during the entire period, with additional steeper reductions after vaccine introduction. The vaccine thus is associated with reduced diarrhoea consultations and hospitalization costs and families’ out-of-pocket expenses. Despite these gains, the overall health system''s costs have increased. [Copyright &y& Elsevier]

Abstract: Background: Rotavirus vaccine was recently introduced in Brazil, which has the potential to greatly reduce childhood deaths from diarrhoea. To provide baseline data to assess the effect of mass rotavirus vaccination on the ecology of circulating rotavirus strains, we systematically analysed published studies in the pre-vaccine era. Aims: To describe the distribution of rotavirus genotypes in Brazil prior to vaccine introduction. Methods: Systematic literature searches in health-related databases from 1986 to 2006. Information extracted and analysed by time and region. Results: 117 studies with 48,401 participants were included. Of these, 3036 were infected with rotavirus. More than 51 genotype combinations were reported, the distribution of which changed over time. P[8]G1 (43%) was the most frequent genotype throughout, followed by P[8]G9 (22%) and P[4]G2 (7%). The detection rate of P[8]G9 increased, while P[4]G2 decreased during the study period. There was a high frequency of G/P combinations between 1995 and 2000 and a low frequency before and after these years. Conclusions: While considerable diversity of rotavirus strains was recognized during the pre-vaccine era, three strains comprised 72% of the total analysed. These data provide a baseline against which any changes in circulating rotavirus strains post-vaccine introduction can be measured. [Copyright &y& Elsevier]