Search

Brazil is the largest and most influential country in South America with a population of about 211 million. The reality is a country with a wide gap between rich and poor. Many of its issues of (in)equity are related to a complex mix of factors, such as its large population, ethnic and cultural diversity, class and income disparity, late slavery abolishment, unstable democracy and political governance. At a national level, the former Brazilian government attempted to address the challenges outlined above by passing new legislation in 2007 that expanded the services and scope of the federal universities, particularly in respect to increasing access to tertiary education and providing increased support and infrastructure for people of middle- and low-income families. In this paper we analyse a PETE programme offered at one university in the Brazilian Northeast in response to changes introduced as a result of the 2007 legislation. Drawing on the perspectives of graduates from this programme, we examine how they see the complexity of social justice and equity issues from their experience in the course. Data were generated through focus group and individual interviews with former students. We supplemented this with document analysis of key policy and curriculum artifacts produced by the programme, and consultation with professors from the course to better understand the former students' experiential dynamics. Each participant expressed a strong affinity for and orientation towards social justice as an integral aspect of school physical education. The curricular restructuring enables students to engage with a broad range of content underpinned by ethical, political, aesthetic, epistemological, pedagogical and theoretical-methodological principles. We consider that this curricular orientation seeks to meet the regional and local needs so that future physical education teachers, in turn, intervene with a more critical socio-cultural perspective in their teaching.

Brazil is the largest and most influential country in South America with a population of about 211 million. The reality is a country with a wide gap between rich and poor. Many of its issues of (in)equity are related to a complex mix of factors, such as its large population, ethnic and cultural diversity, class and income disparity, late slavery abolishment, unstable democracy and political governance. At a national level, the former Brazilian government attempted to address the challenges outlined above by passing new legislation in 2007 that expanded the services and scope of the federal universities, particularly in respect to increasing access to tertiary education and providing increased support and infrastructure for people of middle- and low-income families. In this paper we analyse a PETE programme offered at one university in the Brazilian Northeast in response to changes introduced as a result of the 2007 legislation. Drawing on the perspectives of graduates from this programme, we examine how they see the complexity of social justice and equity issues from their experience in the course. Data were generated through focus group and individual interviews with former students. We supplemented this with document analysis of key policy and curriculum artifacts produced by the programme, and consultation with professors from the course to better understand the former students' experiential dynamics. Each participant expressed a strong affinity for and orientation towards social justice as an integral aspect of school physical education. The curricular restructuring enables students to engage with a broad range of content underpinned by ethical, political, aesthetic, epistemological, pedagogical and theoretical-methodological principles. We consider that this curricular orientation seeks to meet the regional and local needs so that future physical education teachers, in turn, intervene with a more critical socio-cultural perspective in their teaching. [ABSTRACT FROM AUTHOR]

The transformation behavior between iron oxides and oxyhydroxides like magnetite, hematite and goethite is still not entirely understood. Crystallographic similarities allow one to predict topotactic relationships between them. The related crystallographic aspects have been explored by means of electron backscatter diffraction (EBSD). Samples from natural aggregates of magnetite, hematite and goethite were collected from iron‐formation rocks that outcrop in the southeast of Brazil, in a region known for large deposits of iron and other ores. EBSD misorientation data indicate a pronounced relationship between these iron phases. The transformation seems to be related to the oxygen framework. The original close‐packed cubic arrangement of O atoms in magnetite changes to a hexagonal close‐packed framework in hematite, i.e. {111} of magnetite is parallel to {0001} of hematite. The matrix in which the magnetite grains are embedded is made of aggregates of hematite and goethite. In the matrix, the coincidence observed in the magnetite grains is not observed. On the other hand, the well known twin boundary relationships already described for these mineral phases can be observed here as an orientation relationship in three‐dimensional misorientation space. The spatial data of axis–angle pairs suggest that the twin boundaries serve as facilitating surfaces for phase transformation in the Fe–O–OH system. The main conclusion of this study is that the transformation occurred in the solid state with the newly transformed goethite inheriting the crystallographic orientations of the former crystals and that this phenomenon is better recognized by combining observations of misorientation relationships. In the matrix, such a relation is not observed and, for that reason, the minerals in the matrix are thought to have been formed by a different process, which might have involved dissolution and precipitation of the phase newly out of solution. [ABSTRACT FROM AUTHOR]

Objective: Green Tobacco Sickness (GTS) is an occupational illness caused by dermal absorption of nicotine from tobacco leaves. It affects thousands of farm workers worldwide. Brazil is the second tobacco producer in the world; despite this, there are few studies on GTS among Brazilian harvesters. This study aimed to determine the prevalence of GTS among a population of tobacco workers from a producing area in northeastern Brazil and investigate whether the occurrence of the disease was influenced by factors such age, gender and smoking status. In addition, it was investigated if there was association between the onset of GTS and genetic polymorphisms in genes that encode some detoxification enzymes. A semi-structured questionnaire was used to collect demographic, behavioral and occupational data from the referred workers. Polymorphisms were tested through the Polymerase Chain Reaction technique. Results: The total prevalence of GTS found was 56.9%, with a significant difference between genders (71.7% for women and 35.3% for men, p < 0.0001). No association was identified between the investigated polymorphisms and GTS. This study confirms the occurrence of GTS among tobacco harvesters in Brazil with high prevalence. The investigation suggests the need to take preventive measures to protect tobacco workers against this disease. [ABSTRACT FROM AUTHOR]

The Limoeiro Ni-Cu-(platinum-group elements (PGE)) deposit is a recent discovery associated with an igneous tubular conduit system in northeastern Brazil. Representative ores from the deposit have been used for platinum-group minerals (PGM) identification and for PGE in base metal sulfides (BMS) quantification. Ninety-eighty percent of the PGM in the massive sulfide ores is homogeneous Pt-Ni-Bi-bearing merenskyite (PdTe) enclosed primarily by pyrrhotite, suggesting that it is formed by exsolution from monosulfide solid solution (MSS). Merenskyite gradually but systematically becomes poorer in Pt and Ni with increasing fractionation, which is interpreted to reflect a transition to a more evolved sulfide liquid that segregated in the eastern parts of the intrusion. In massive sulfide ores, merenskyite forms unusually large (up to 5000 μm) euhedral grains, commonly in contact with spherical silicate inclusions. BMS hosts 12-16 % of the Pd, with the remainder hosted by PGM, which is interpreted to indicate that merenskyite recrystallized from a PGE-bearing bismuthotelluride metamorphic melt formed during high-grade metamorphism. Sperrylite (PtAs) is the second most abundant PGM (18 % of PGM in disseminated ore) and in contrast to merenskyite occurs mainly as very small (median of 25 μm) inclusions in high-temperature silicates and oxides, interpreted to have crystallized at high temperatures directly from sulfide blebs that formed and were transported within the Limoeiro magma conduit. [ABSTRACT FROM AUTHOR]

The Limoeiro deposit, located in a high-grade mobile belt of the Brasiliano orogenic cycle (650-500 Ma), represents one of the few magmatic Ni-Cu(-PGE) sulfide discoveries in recent years. The deposit is hosted by an ultramafic chonolith consisting in a partly deformed and metamorphosed tube-like body affected by brittle faults within high-grade gneiss and schist. The absolute age of the ultramafic intrusion that hosts the Limoeiro deposit is not yet known, but regional geologic constraints suggest that both intrusion and host rocks belong to a terrane older than the orogenic cycle. Peak metamorphic parageneses of the ultramafic intrusion and country rocks indicate granulite fades of metamorphism, interpreted as the result of the Neoproterozoic Brasiliano orogenic cycle. The Limoeiro deposit is the first significant discovery of Ni-Cu sulfide in the Borborema province, opening a new window for exploration in this large orogenic belt. Despite the high-grade metamorphism and the tectonic deformation, the primary magmatic structure of the intrusion hosting the Limoeiro deposit is remarkably well preserved. This intrusion forms a tube-like conduit (chonolith) with cross sections a few hundreds of meters in diameter and with a considerable length of more than 4 km. The conduit consists of two distinct sequences of ultramafic rocks, denominated Upper and Lower sequences, each one consisting of a core of harzburgite enveloped by orthopyroxenite, with an irregular and discontinuous outer shell of amphibolite. These ultramafic sequences, characterized by similar composition and structure, have distinctively different S contents resulting from the presence of disseminated Ni-Cu sulfide mineralization only in the Upper sequence. The magmatic system of the Limoeiro deposit is interpreted to result from the input of two major pulses of magma with similar composition, but sulfide saturation and segregation is restricted to the second magma pulse (Upper sequence). Nickel-Cu(-PGE) sulfide mineralization is broadly concordant with the Upper sequence and different orebodies resulted from tectonic slicing of the originally continuous tube-like structure. The bulk of the mineralization in all orebodies consists of thick (up to 150 m) and elongated (up to 1 km) masses of rock containing disseminated sulfides broadly concordant with the chonolithic structure. Thin layers of massive ore occur in the lower portions of some of the orebodies, and represent about 3 vol % of the Limoeiro deposit. The intrusion hosting the Limoeiro deposit is probably the best preserved chonolith that has been overprinted by granulite fades metamorphism within an orogenic terrane. This study indicates that reconstruction of small magma conduits, an important tool for exploration for Ni-Cu sulfide deposits, may be successfully achieved within high-grade orogenic terranes. [ABSTRACT FROM AUTHOR]

In the last few years, the presence of young athletes between 20 and 23 years old has been growing on the most important marathon podiums. This study has the objective of analyzing whether chronological age is a determining factor for the achievement in these competitions. Instruments which have been used: literature review, content analysis, statistical analysis of the main results obtained by Brazilian an foreign athletes, and interviews with coaches who were responsible for preparing some of the best Brazilian marathoners. Although the results confirm the age of 30 as the average for getting great results in marathons, the participation of athletes whose ages are between 20 and 23, is due mainly to social economic needs, and it might lead to physical problems, which, often, lead to the shortening of their careers. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the frequencies of Epstein-Barr virus, types 1 and 2 infection, and 30 bp del-latent membrane protein 1 viral polymorphism in gastric adenocarcinomas, as well as to investigate the association between Epstein-Barr virus infection and tumor location, type, and the patient's sex., Methods: Samples were collected from 38 patients treated at a university hospital in Rio de Janeiro, Brazil. Epstein-Barr virus detection and genotyping were performed by polymerase chain reaction, followed by polyacrylamide gel electrophoresis and staining by the silver nitrate method., Results: Overall, 68.4% of patients had Epstein-Barr virus-positive tumors. Of these, 65.4% presented infection by Epstein-Barr virus type 1, 23.1% by Epstein-Barr virus type 2, and 11.5% had coinfection with types 1 and 2. The 30 bp del-latent membrane protein 1 polymorphism was found in 42.3% of Epstein-Barr virus-positive tumors, 23.1% had the wild-type virus, and 23.1% had the wild-type and the polymorphism concomitantly. In 11.5% of Epstein-Barr virus-positive tumors, it was impossible to determine whether there was polymorphism or not. Tumor location in the antrum (22 of 38) and diffuse type (27 of 38) were predominant. There was no significant difference in Epstein-Barr virus infection or the 30 bp del-latent membrane protein 1 polymorphism between men and women., Conclusion: Epstein-Barr virus infection was found in 68.4% of tumors investigated in this study. To the best of our knowledge, this is the first article showing the coinfection of Epstein-Barr virus types 1 and 2 in gastric carcinoma in Brazil.

Objectives: Cancer cachexia (CC) is a multifactorial syndrome that is associated with worse outcomes. Several criteria for its diagnosis have been suggested, but notable disparities exist. This study compared different diagnostic criteria for CC in patients with incurable cancer who are in palliative care., Methods: A prospective cohort study was conducted at the National Cancer Institute in Brazil. Patients were classified by three CC diagnostic criteria, and comparisons between clinical, nutritional, and functional variables were verified according to the CC stage identified. Kaplan-Meier survival curves and Cox regression were used for the survival analysis. Concordance statistics were used to test the prognostic predictive accuracy of the criteria., Results: The prevalence of cachexia in the 1384 patients included in the study varied from 13.8% to 53.9% according to the classification criteria used. All criteria distinguished noncachectic patients from other categories according to the majority of the domains studied. However, the results were inconsistent in distinguishing patients with intermediate cachexia (mainly precachexia) from noncachectic and cachectic patients. Patients with cachexia or refractory cachexia faced a higher risk of 90-d mortality. The criteria described by Vigano et al. were found to be better at distinguishing the stages of CC regarding overall survival (hazard ratio increases according to CC severity: 1.87 to 2.87; concordance statistic: 0.74)., Conclusions: Our results demonstrate the disparities in existing CC diagnostic criteria and their inability to discriminate intermediate stages. Vigano et al.'s criteria is/was the most effective in predicting the prognosis. The development of new diagnostic criteria to improve CC classification requires future exploration., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Admissions due to primary health care sensitive conditions from 1999 to 2009 among children < 5 years old were analyzed for municipalities in Pernambuco State, Brazil. Using data from the Brazilian Unified National Health System's Hospital Information System, a negative binomial regression was applied to estimate rate ratio (RR) and 95%CI for the effect on primary health care sensitive condition rates (admissions/10,000 inhabitants) of the Family Health Program (FHP) coverage (%), some demographic variables and living conditions. Hospitalizations due to primary health care sensitive conditions represented 44.1% of 861,628 admissions and the rate declined from 557.6 to 318.9 (-42.8%), a reduction three times greater than the rate due to all other causes. Increased FHP coverage was protective against primary health care sensitive conditions (RR = 0.94; 95%CI: 0.89-0.99). A decline in hospitalizations due to primary health care sensitive conditions indicated improvements in health status and may be associated with the consolidation of primary health care. Studies on access and quality of primary health care in relation to child morbidity and hospitalizations are needed.

Angiostrongylus cantonensis is the etiologic agent of eosinophilic meningoencephalitis in humans. Cases have been recorded in many parts of the world, including Brazil. The aim of this study was to compare the differences in the biology and morphology of two different Brazilian haplotypes of A. cantonensis: ac8 and ac9. A significantly larger number of L1 larvae eliminated in the faeces of rodents at the beginning of the patent period was observed for ac9 haplotype and compared to the total of L1 larvae eliminated, there was a significant difference between the two haplotypes. The ac9 haplotype showed a significant difference in the proportion of female and male specimens (0.6:1), but the same was not observed for ac8 (1.2:1). The morphometric analysis showed that male and female specimens isolated from ac8 haplotype were significantly larger with respect to body length, oesophagus length, spicule length (male) and distance from the anus to the rear end (female) compared to specimens from ac9. The morphological analysis by light microscopy showed little variation in the level of bifurcations at the lateral rays in the right lobe of the copulatory bursa between the two haplotypes. The biological, morphological and morphometric variations observed between the two haplotypes agree with the observed variation at the molecular level using the cytochrome oxidase subunit I marker and reinforce the possible influence of geographical isolation on the development of these haplotypes.

In seeking to provide universal health care through its primary care-oriented Family Health Program, Brazil has attempted to reduce hospitalization rates for preventable illnesses such as childhood gastroenteritis. We measured rates of Primary Care-sensitive Hospitalizations and evaluated the impact of the Family Health Program on pediatric gastroenteritis trends in high-poverty Northeast Brazil. We analyzed aggregated municipal-level data in time-series between years 1999-2007 from the Brazilian health system payer database and performed qualitative, in-depth key informant interviews with public health experts in municipalities in Bahia. Data were sampled for Bahia's Salvador microregion, a population of approximately 14 million. Gastroenteritis hospitalization rates among children aged less than 5 years were evaluated. Declining hospitalization rates were associated with increasing coverage by the PSF (P = 0.02). After multivariate adjustment for garbage collection, sanitation, and water supply, evidence of this association was no longer significant (P = 0.28). Qualitative analysis confirmed these findings with a framework of health determinants, proximal causes, and health system effects. The PSF, with other public health efforts, was associated with decreasing gastroenteritis hospitalizations in children. Incentives for providers and more patient-centered health delivery may contribute to strengthening the PSF's role in improving primary health care outcomes in Brazil., (Copyright © 2013 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.)

Information management in large multicenter studies requires a specialized approach. The Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil - Brazilian Longitudinal Study for Adult Health) has created a Datacenter to enter and manage its data system. The aim of this paper is to describe the steps involved, including the information entry, transmission and management methods. A web system was developed in order to allow, in a safe and confidential way, online data entry, checking and editing, as well as the incorporation of data collected on paper. Additionally, a Picture Archiving and Communication System was implemented and customized for echocardiography and retinography. It stores the images received from the Investigation Centers and makes them available at the Reading Centers. Finally, data extraction and cleaning processes were developed to create databases in formats that enable analyses in multiple statistical packages.

Background: This study describes trends in hospital admission rates for primary healthcare-sensitive conditions (PHCSC) in Brazil., Objectives: To evaluate the impact of increased primary healthcare availability through the implementation of the Family Health Program (FHP) on PHCSC admissions rates at the national, regional, and state-levels between 1999 and 2007., Research Design: An ecologic panel data study was used and a fixed effects multivariate negative binomial model was used to estimate the association of PHCSC admission rate and FHP controlling for other relevant covariates., Results: It was shown that, at the national level, PHCSC hospital admissions declined by 24%-over 2.5 times more rapidly than the decline in hospitalizations for all other (non-PHCSC) conditions. Greater reductions in the PHCSC admission rates when compared with the non-PHCSC admission rates were also observed when the data were divided by regions and states. Regression models showed that at the state level the greater the FHP coverage, the less was the PHCSC hospital admissions even when controlling for confounding variables., Conclusions: The results of this study have important implications for the healthcare model in countries that base their national health systems on primary healthcare. This is the first study to evaluate the association between FHP coverage and PHCSC admissions rates in all the Brazilian states over a long and relevant period for the consolidation of FHP in the country.

The human cases of eosinophilic meningitis recently reported from Brazil have focused the attention of the public health agencies on the role the introduced snail Achatina fulica plays as hosts of the metastrongylid nematodes. Determining the potential of this snail to host and develop infective larval stages of metastrongylids in the wild and identify the species harbored by them is crucial for designing effective control measures. Here we assess if A. fulica may act as intermediate host of A. cantonensis at the peridomiciliary areas of a patient's house from state of Pernambuco (PE), who was diagnosed with eosinophilic meningitis and a history of ingesting raw molluscs. Larvae obtained from naturally infected A. fulica were orally administered to Rattus norvegicus. The worms were collected from the pulmonary artery and brain, and were morphologically characterized and compared to the Japan isolate of A. cantonensis. Adult worms and infective L(3) larvae (PE isolate) recovered from A. fulica specimens were also analyzed by polymerase chain reaction and restriction fragment length polymorphism of ITS2 region from rDNA and compared to A. cantonensis (ES isolate), A. vasorum (MG isolate) and A. costaricensis (RS isolate). The large size of the spicules (greater than those observed in other species of Angiostrongylus) and the pattern of the bursal rays agree with the original species description by Chen (1935). Furthermore, the morphology of the PE isolate was similar to that of Japan isolate. The PCR-RFLP profiles obtained were distinctive among species and no variation in patterns was detected among adult individuals from A. cantonensis isolates from PE and ES. The importance of A. fulica as an intermediate host of eosinophilic menigoencepahlitis in Brazil is emphasized., (2010 Elsevier B.V. All rights reserved.)

Purpose: To present the success rate in treating congenital nasolacrimal duct obstruction with hydrostatic pressure (Crigler method)., Methods: Clinical data from 186 children aged up to 32 months treated from 1990 until 2005 were reviewed retrospectively. The procedure was repeated up to 3 times at a one week interval. Using EPI INFO version 6.04 software for analysis, data were tabulated and statistical significance was evaluated by applying chi-square and Kruskal-Wallis tests., Results: Leading age group was 1 to 5 months old (56.4%) for males and females. Affection was bilateral in 36.3%, 34.1% on right side and 29.6% on the left side. All cases had epiphora and 56.5% presented mucopurulent discharge. Cure was achieved with one massage for 43.6%, 23.3% with two, 17.4% with three and, with 4 and 5+ sessions in respectively 5.8% and 9.0%. Those 14 cases who did not respond to massage were treated with probing., Conclusion: The Crigler method was effective in managing congenital nasolacrimal duct obstruction cases.

Objective: To analyze the number of cases, deaths, incidence and fatality rate due to visceral leishmaniasis, and to estimate its underreporting, as well as the coverage of the national information systems., Methods: Confirmed cases of visceral leishmaniasis were analyzed, based on the following systems: the Sistema de Informação de Agravos de Notificação (SINAN - Information System on Disease Notification), the Sistema de Informações sobre Mortalidade (SIM - Mortality Information System) and the Sistema de Informações Hospitalares (SIH - Hospital Information System), between 2002 and 2003. The variables utilized in relationship for pair identification were: patient's name, mother's name, date of birth, gender, city of residence, and mailing address. The capture-recapture method was applied to calculate the estimates, by means of the Chapman formula., Results: The estimated underreporting of visceral leishmaniasis in the SINAN, in relation to the SIH and the SIM, was 42.2% and 45.0% respectively. The estimated underreporting of deaths was 53% and 46.5%, when compared to SINAN-deaths and SIH-deaths respectively. The estimated incidence was 2.9 per 100,000 inhabitants, from the comparison between the SINAN and the SIH, 70.5% higher than the one found when SINAN's data were the only ones utilized. Furthermore, when comparing data from SIM and SINAN-deaths, an estimated fatality rate of 8% was observed, representing an increase in 16% from the one initially registered in the SINAN-deaths., Conclusions: The results show high estimated underreporting of cases and deaths due to visceral leishmaniasis in Brazil. The relationship between information systems and the capture-recapture method application enabled to know and improve the epidemiological estimates, making its utilization in health services feasible.

Background: Nosocomial infections (NIs) are important causes of morbidity and mortality in pediatric hospitals. Multiple factors contribute towards exposing children to the risk of infection when hospitalized, and some of them differ from those in adults., Methods: This was a prospective study in a tertiary-level teaching pediatric hospital in Salvador, Bahia, Brazil, conducted from January to July, 2003, to describe the epidemiologic characteristics of NIs. Centers for Disease Control's standard definitions were used and the data recorded included intrinsic and extrinsic risk factors., Results: We evaluated 808 patients. There were 143 episodes of NI in 124 patients (15.4%). The overall incidence of NI cases was 9.2 per 1,000 patient-days, with higher rates among children aged less than 1 year (P < 0.001) and those with nonsurgical clinical diseases (P < 0.001). Gastrointestinal infections (39.2%) and eye, ear, nose, throat or mouth infections (29.4%) were most common. The factors most closely associated with higher incidence of NI were respiratory disease on admission (incidence density ratio [IDR], 4.0; 95% confidence interval [CI], 2.83-5.72), another disease associated with admission diagnosis (IDR, 3.5; 95% CI, 2.41-5.02), nonsurgical clinical disease (IDR, 5.9; 95% CI, 3.92-8.85) and pediatric intensive care unit residence (IDR, 3.5; 95% CI, 1.91-6.28). The lengths of hospital stay for patients with and without nosocomial infection were, respectively, 14.1 days (SD, 20.5 days) and 5.1 days (SD, 6.6 days) (t = 121.76; P < 0.001)., Conclusions: Nosocomial infections are a frequent complication in pediatrics. They are not necessarily related to invasive procedures but certainly are related to a group of factors that have particular characteristics in the pediatric age group.

Dengue epidemics account annually for several million cases and deaths worldwide. The high endemic level of dengue fever and its hemorrhagic form correlates to extensive domiciliary infestation by Aedes aegypti and multiple viral serotype human infection. This study analyzed serial case reports registered in Brazil since 1981, describing incidence evolutionary patterns and spatial distribution. Epidemic waves followed the introduction of every serotype (DEN 1 to 3), and reduction in susceptible individuals possibly accounted for decreasing case frequency. An incremental expansion of affected areas and increasing occurrence of dengue fever and its hemorrhagic form with high case fatality were noted in recent years. In contrast, efforts based solely on chemical vector control have been insufficient. Moreover, some evidence demonstrates that educational measures do not permanently modify population habits. Thus, as long as a vaccine is not available, further dengue control depends on potential results from basic interdisciplinary research and intervention evaluation studies, integrating environmental changes, community participation and education, epidemiological and virological surveillance, and strategic technological innovations aimed to stop transmission.

Aims: Different patterns of glomerulonephritis (GN) are reported from all over the world and the occurrence of primary GN is changing in the course of time. We report the frequencies of primary GN in a major teaching hospital in Brazil, from 1979-1999., Methods: The case files of renal biopsies of primary GN were reviewed. The included patients were > 14 years of age, with native kidneys, and the specimens were examined with at least light and immunofluorescence microscopy. We excluded biopsy results of patients with any kind of known secondary glomerular involvement. Differences in proportions of diagnoses between the periods over time were evaluated using Chi-square test for trend., Results: We considered 943 patients for the analysis. Focal and segmental glomerulosclerosis (FSGS) was the most common lesion (n = 279), followed by membranous GN (n = 140), membranoproliferative type I GN (n = 109) and IgA nephropathy (n = 109). FSGS (32.1%) was the most frequent diagnosis among nephrotic patients whereas IgAN (29.4%) predominated in non-nephrotic ones. The occurrence of FSGS increased from the earlier to the later periods: 22.3% (1979-1983), 23.7% (1984-1988), 35.7% (1989-1993), 33.9% (1994-1999), p < 0.05. The increase in frequency of FSGS was proportionally higher in non-nephrotic patients and FSGS became as common as IgA nephropathy in this group (31.6% and 28.0%, respectively) from 1994-1999., Conclusions: FSGS was the most common pattern of primary glomerulonephritis and its relative frequency seems to be increasing in biopsied patients over time. The reasons for this behavior are unclear and warrant further investigations.

This study is a multifactorial analysis of the risk factors for low birthweight in a group of newborns in an urban area of Brazil. A total of 1023 infants born in four maternity units in Salvador, Bahia, between July 1987 and February 1988 were included in the study. The sources of information were clinical histories and interviews with the mothers in the maternity units. The analysis was by means of logistic regression. In the final model the risk factors were the following: maternal age less than 21 years or more than 35; gestational age less than 38 weeks; unfavorable outcome of an earlier pregnancy; interval of 12 months or less since prior birth; tobacco smoking; and hypertension. The population attributable risk values for the risk factors included in the final model are presented. These factors should be used to identify pregnant women at high risk of giving birth to a low-birthweight baby, in order to provide them with more prenatal care.

Hepatitis C virus can be found in all continents. However, differences exist with respect to its prevalence. In Brazil, epidemiological data are scarce, and are based, in their majority, on information obtained from blood donors and not from the general population. Our objective is to show the prevalence of anti-HCV in two distinct populations: one rural and one urban: Salvador, a metropolis, and Castro Alves, a rural village with very little contact with other populations. Eight hundred individuals from Salvador and 800 from Castro Alves were randomly visited. After obtaining consent, we collected blood samples for serology tests and determination of ALT levels. The anti-HCV antibody was tested using ELISA II (ABBOTT Labs), and confirmed by RIBA III (Chiron). We studied the prevalence of anti-HCV in two populations and its distribution with respect to age group and sex and ALT level. chi 2 and Fisher exact were used for the statistical analysis. Of the 800 individuals from Salvador, 44% were women and 56% were men. The age group varied from 10 to 70 years, with an average age of 42. Ten (1.25%) individuals were anti-HCV positive in the urban population and none in the rural population (P < 0.001). No evident correlation was found regarding sex and ALT level, between anti-HCV positive and anti-HCV negative individuals in the urban population. In conclusion, our results suggest a higher prevalence of HCV infection in the urban population probably due to a high level of exposure. The sero-epidemiological studies using blood donors do not reflect the epidemiological reality of HCV in Brazil due to selection bias which could overestimate its seroprevelence.

Hepatitis B virus (HBV) serological markers were investigated in 40 incident cases of hepatocellular carcinoma (HCC) and in two age and sex matched control groups, comprising 40 patients with other cancers and 80 healthy individuals, resident in Bahia, Brazil. Serologic tests were done by radioimmunoassay. The study observed high proportion of seropositivity to HBsAg (42.5%) and of those presenting HBsAg or antiHBc (65.0%) among HCC cases, higher in men than women and in those aged 17 to 30 years old. HBsAg seropositivity among HCC patients was greater than in the control group with other cancers (7.5%) and in healthy controls (2.5%), corresponding to odds ratio estimates of 15.0 (95% CI 3.29, 68.30) and 33.0 (95% CI 9.13, 119.28), both statistically significant. HBeAg was not observed and antiHBe was present in 41.2% of cases, suggesting the absence of viral replication, possibly with viral DNA integration into the hepatocyte genome. The presence of cirrhosis was associated with HBsAg seropositivity among HCC cases. A history of chronic alcoholism is shown to be more frequently related to those cases with cirrhosis. This study highlights the relevant association between HCC and HBV in Northeast Brazil, particularly for young individuals, and the high risk of development of HCC for HBsAg carriers.

The association between infection with Trypanosoma cruzi and the development of electrocardiographic alterations and mortality was studied longitudinally for 9 years in a population residing in an endemic area in Castro Alves, Bahia, Brazil. Annual censuses were begun in 1973. At 3 year intervals from 1974 to 1983, the population was examined serologically and subjected to electrocardiography using standardized techniques. Of 1,751 individuals registered during the 10 censuses, 1,541 (88%) were examined serologically at least once. Of 747 individuals in constant residence and originally seronegative, 24 were seropositive upon subsequent evaluation, giving a seroconversion rate of 4.92/1,000 person-years (PY). The overall rate of development of an abnormal ECG was 25.7/1,000 PY for seropositive individuals and 12.5/1,000 PY for seronegative individuals, a relative risk of 2. The 10-14-year-old seropositive group had the highest risk of developing ECG abnormalities (24.1/1,000 PY, relative risk = 3.5). The age-adjusted mortality rate of seropositive individuals was slightly higher than for seronegative individuals (8.9 vs. 7.8/1,000 PY). In sero-positive individuals, mortality was strongly associated with the presence of ventricular conduction defects and arrhythmias. Ventricular conduction defects appeared most frequently in younger individuals. Older individuals presented the highest risk of development of frequent and multifocal extrasystoles.

We studied the association between human incidence of Trypanosoma cruzi infection and household infestation density of Panstrongylus megistus in Castro Alves, Bahia, Brazil. During a 9-year period, 19 persons seroconverted; 17 were children, 17 lived in nonplastered houses, and 13 lived in houses infested with triatomines. Although 6 seroconverting persons lived in houses where triatomines could not be found, the risk of seroconversion was significantly greater in infested houses and 16 times greater in densely infested houses (greater than 15 bugs/person-hour of search). The highest rate of seroconversion (6/100 person-years exposure) occurred in houses containing the greatest number of bugs infected with T. cruzi (greater than 6 infected bugs/person-hour). These observations suggest that vector control measures could have a dramatic impact on transmission of T. cruzi by P. megistus.

The prevalence of Trypanosoma cruzi parasitemia as determined by xenodiagnosis on domestic dogs and cats was correlated with household rates of seroreactivity to T. cruzi and household Panstrongylus megistus infestation in a rural area in northeast Brazil where P. megistus was the only domiciliary triatomine vector. T. cruzi infection was present in about 18% of domestic dogs and cats. Two-thirds of seroreactive children below age 10 resided in houses with T. cruzi-infected animals. In houses with a T. cruzi-infected dog or cat, as well as at least one infected P. megistus, the household rate of seroreactivity to T. cruzi was five times greater than in houses with non-infected domestic animals and no infected triatomine vectors. Domestic dogs and cats are important reservoirs of T. cruzi in an endemic area where P. megistus is the only domiciliary triatomine vector.

Oral oxamniquine was tested as a control strategy for endemic schistosomiasis in a rural area of Bahia, Brazil. Adults were treated with a single dose (12.5 to 15 mg per kg) and children (less than 12 years old) with a total of 20 mg per kg in two doses. The 191 (infected) persons treated represented 69% of the infected population in the study area. Follow-up stool examinations (Kato-Katz method) at one, 3, 6, 13, 25 and 33 months showed the cure rate declining from 80% at three months to 46% at 33 months. Over one half of those not cured showed a decrease in egg counts throughout the follow-up which, after 33 months, remained 66% below the pre-treatment levels. Stool examinations conducted on all study area residents during three years before chemotherapy showed the prevalence and intensity of Schistosoma mansoni infection to be high and stable. 33 months after the chemotherapy the prevalence was 41% and for infected individuals the geometric mean egg count was 121 epg, a decline of respectively 35% and 40% from pre-treatment levels for each index. Chemotherapy of infected persons with oxamniquine protected the community as a whole from high worm burdens for almost three years, although at this point the prevalence began to rise towards pretreatment levels.

A cross-sectional study of morbidity associated with Schistosoma mansoni infection in an area in North-East Brazil where the disease is endemic was carried out in 1974. The survey was repeated in 1977, before mass treatment with oxamniquine, providing a cohort of 210 individuals who had both examinations. The high prevalence of hepatomegaly (over 80%) and of splenomegaly (over 15%) contrasted with rates of 10% and 1%, respectively, in a non-endemic area. Over the 3-year period hepatomegaly spontaneously regressed in 13% of patients, and splenomegaly regressed in 56%, a phenomenon most common in older individuals with light infections. Those with heavy infections--ie, 500 or more eggs per g faeces, had an excess risk of splenomegaly of 19.6% and, of its persistence, of 61.5%. Thus, intensity of infection was a critical factor in liver and spleen involvement, and programmes of chemotherapy that reduce infection should mitigate the risk of schistosomal morbidity.