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Emerging infectious diseases are a major cause of amphibian declines worldwide. Two of these diseases are amphibian chytridiomycosis caused by the chytrid fungus Batrachochytrium dendrobatidis (Bd) and a viral disease caused by different ranaviruses (Rv). Whereas Bd is known to be widespread in Brazil, Rv was only recently detected in natural habitats. We therefore investigated the co‐occurrence of Bd and Rv in wild tadpoles in the southern Brazilian Atlantic Forest from 21 ponds. Because infection by Bd might cause immune suppression in the host, we hypothesized that tadpoles infected with Bd would be more prone to infection with Rv than Bd‐free individuals, hence presenting higher Rv loads. Surprisingly, co‐infection was rare (less than 6% of the sampled specimens), and we did not find evidence that Bd would facilitate Rv infection. On the other hand, we detected Rv in 38% of tadpoles (125 out of 324), representing twice the prevalence of Bd in the same populations. We tested the influence of biotic and abiotic factors on infection by each pathogen on tadpoles, and we detected a positive relationship between forest cover and infection by Rv, whereas no relationship was found for Bd infection. Based on the putatively low rate of co‐infection and high prevalence of Rv in wild anuran populations, we advocate for the inclusion of Rv screening and monitoring in addition to Bd in conservation‐oriented amphibian surveys. Only surveying both diseases will provide a complete picture of amphibian disease‐related declines. [ABSTRACT FROM AUTHOR]

Several species of mustelids interact with fishermen communities all over the world, however, few studies address this theme in Brazil. Indeed, this is the study focuses on the conflict between Lontra longicaudis (Olfers, 1818 - Order: Carnivora; Family: Mustelidae; Subfamily: Lutrinae) and the fishermen communities in the APA Bonfim Guaraira, located in the state of Rio Grande do Norte. Five communities that carry out fishing activities with artisanal caves were interviewed in different municipalities. The main interaction pointed out by the fishermen was the interest of L. longicaudis on the creels used for fishing the river shrimp Macrobrachium sp. (Order: Decapoda; Family: Palaemonidae). The used creels, which are periodically being broken by the otter, were made with materials from the native vegetation. Therefore, the objective of this work was to introduce a solution to improve fishermen's equipment (creels) using recycling PVC pipes. The new creel have improved the artisanal fisheries and also generated subsidies for the conservation of L. longicaudis. Despite the constant persecution in the region, it can be seen that the majority of fishermen thinks in an ecological way, understanding that otters, like themselves, also depend on shrimp, fish and the river to survive. These ecological ideas were stimulated fishermen to reduce this conflict. [ABSTRACT FROM AUTHOR]

This study provides a detailed description and characterization of a strain of Aeromonas dhakensis isolated from a diseased juvenile Piaractus mesopotamicus obtained from the fish farm of the National Center for Continental Fish Research and Conservation ( CEPTA/ ICMBio), in the state of São Paul, Brazil. Biochemical tests using the VITEK 2 automated bacterial identification system identified the isolate to genus level; however, further molecular analysis of the 16S rRNA, gyrB and rpoD genes showed that the strain belonged to the species A. dhakensis. As expected, the isolated A. dhakensis strain was resistant to ampicillin and ampicillin/sulbactam, as resistance to ampicillin is a typical characteristic of the genus Aeromonas. Resistance to cefoxitin and meropenem was also observed, but the strain was susceptible to most of the tested antibiotics. The isolated strain of A. dhakensis caused acute haemorrhagic septicaemia in experimentally infected P. mesopotamicus, with a fifty per cent lethal dose of 1.14 × 105 CFU/fish. This is the first report of the occurrence of an A. dhakensis strain causing an infection in a fish species of South America, providing important epidemiologic data relating to this important pathogenic species. [ABSTRACT FROM AUTHOR]

Two experiments were conducted to evaluate performance and carcass traits of Guzerat-based beef bulls. In experiment 1, Guzerat; F1 Guzerat x Holstein ('Guzholstein'); F1 Guzerat x Nellore ('Guzonell'); and 1/2 Simmental + 1/4 Guzerat + 1/4 Nellore (Three-Cross) bulls (n = 12 each group) were kept in a feedlot for 84 days, receiving sorghum silage and concentrate supplement. 'Guzholstein' bulls had greater average daily gain (ADG; 1.7 kg/day) compared with 'Guzonell' (1.4 kg/day), but similar to Three-Cross and Guzerat (1.6 and 1.5 kg/day respectively). 'Guzonell' bulls gained less bodyweight (BW; 85.8 kg); however, the gain : feed ratio did not differ among groups. Dry matter intake (DMI) was less for Guzerat (11.8 kg) compared with other groups (12.4, 12.4, and 12.6 kg for 'Guzholstein', 'Guzonell', and Three-Cross respectively); DMI, as a percentage of BW, was lesser for Three-Cross bulls (2.5%) compared with other groups (2.7%, 2.8%, and 2.6% for Guzerat, 'Guzholstein', and 'Guzonell' respectively). In experiment 2, 18 bulls from experiment 1 were randomly selected from 'Guzonell', 'Guzholstein' and Three-Cross groups (n = 6, each breed group), transferred to a state-inspected slaughterhouse, and humanely slaughtered. Three-Cross bulls had greater carcass weight gain (80 kg), greater striploin yield (2.39%), and lesser leg yield (1.86%). 'Guzholstein' bulls had lesser dressing-out percentage and greater liver yield (51.6 and 1.28% respectively), whereas 'Guzonell' bulls had greater rump yield (1.47%). Forequarter yield, hindquarter weight and yield, eye round, flank steak, rump skirt, topside, rump cap, head, heart, lungs and trachea, spleen, tail, and tongue yield did not differ among groups. Despite the limited number of animals used in these experiments, we can conclude that all breed groups have potential for meat production because carcass traits meet the Brazilian beef industry standards, and 'Guzholstein' bulls could be an option for producers to diversify revenues. Guzerat (Bos indicus breed) animals have been used in crossbreeding programs for either beef, dairy or dual purposes, but studies evaluating their performance and carcass traits are scarce. We evaluated performance, carcass traits and meat cuts of Guzerat-based bulls. Results from this study indicate that all groups evaluated have potential for meat production since they meet the Brazilian beef industry standards, and bulls from a dual-purpose cross can be an option for dairy producers, to diversify revenues. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of TP53 pathogenic variants (PV) carriers in the South and Southeast regions of Brazil, germline genetic testing for hereditary breast cancer (HBC) is not available in the Brazilian public health system, and the prevalence of Li-Fraumeni syndrome (LFS) is not well established in other regions of Brazil. We assessed the occurrence of TP53 p.R337H carriers among women treated for breast cancer (BC) between January 2021 and January 2022 at public hospitals of Brasilia, DF, Brazil. A total of 180 patients who met at least one of the NCCN criteria for HBC underwent germline testing; 44.4% performed out-of-pocket germline multigene panel testing, and 55.6% were tested for the p.R337H variant by allelic discrimination PCR. The median age at BC diagnosis was 43.5 years, 93% had invasive ductal carcinoma, 50% had estrogen receptor-positive/HER2 negative tumors, and 41% and 11% were diagnosed respectively at stage III and IV. Two patients (1.11%) harbored the p.R337H variant, and cascade family testing identified 20 additional carriers. The TP53 p.R337H detection rate was lower than that reported in other studies from south/southeast Brazil. Nonetheless, identifying TP53 PV carriers through genetic testing in the Brazilian public health system could guide cancer treatment and prevention.

In this pilot study, we aimed to evaluate the feasibility of whole genome sequencing (WGS) as a first-tier diagnostic test for infants hospitalized in neonatal intensive care units in the Brazilian healthcare system. The cohort presented here results from a joint collaboration between private and public hospitals in Brazil considering the initiative of a clinical laboratory to provide timely diagnosis for critically ill infants. We performed trio (proband and parents) WGS in 21 infants suspected of a genetic disease with an urgent need for diagnosis to guide medical care. Overall, the primary indication for genetic testing was dysmorphic syndromes (n = 14, 67%) followed by inborn errors of metabolism (n = 6, 29%) and skeletal dysplasias (n = 1, 5%). The diagnostic yield in our cohort was 57% (12/21) based on cases that received a definitive or likely definitive diagnostic result from WGS analysis. A total of 16 pathogenic/likely pathogenic variants and 10 variants of unknown significance were detected, and in most cases inherited from an unaffected parent. In addition, the reported variants were of different types, but mainly missense (58%) and associated with autosomal diseases (19/26); only three were associated with X-linked diseases, detected in hemizygosity in the proband an inherited from an unaffected mother. Notably, we identified 10 novel variants, absent from public genomic databases, in our cohort. Considering the entire diagnostic process, the average turnaround time from enrollment to medical report in our study was 53 days. Our findings demonstrate the remarkable utility of WGS as a diagnostic tool, elevating the potential of transformative impact since it outperforms conventional genetic tests. Here, we address the main challenges associated with implementing WGS in the medical care system in Brazil, as well as discuss the potential benefits and limitations of WGS as a diagnostic tool in the neonatal care setting., (© 2024 Wiley Periodicals LLC.)

Importance: The health outcomes of increased poverty and inequalities in low- and middle-income countries (LMICs) have been substantially amplified as a consequence of converging multiple crises. Brazil has some of the world's largest conditional cash transfer (Programa Bolsa Família [PBF]), social pension (Beneficio de Prestacão Continuada [BPC]), and primary health care (Estratégia de Saúde da Família [ESF]) programs that could act as mitigating interventions during the current polycrisis era of increasing poverty, slow or contracting economic growth, and conflicts., Objective: To evaluate the combined association of the Brazilian conditional cash transfer, social pension, and primary health care programs with the reduction of morbidity and mortality over the last 2 decades and forecast their potential mitigation of the current global polycrisis and beyond., Design, Setting, and Participants: This cohort study used a longitudinal ecological design with multivariable negative binomial regression models (adjusted for relevant socioeconomic, demographic, and health care variables) integrating the retrospective analysis from 2000 to 2019, with dynamic microsimulation models to forecast potential child mortality scenarios up to 2030. Participants included a cohort of 2548 Brazilian municipalities from 2004 to 2019, projected from 2020 to 2030. Data analysis was performed from September 2022 to February 2023., Exposure: PBF coverage of the target population (those who were poorest) was categorized into 4 levels: low (0%-29.9%), intermediate (30.0%-69.9%), high (70.0%-99.9%), and consolidated (≥100%). ESF coverage was categorized as null (0), low (0.1%-29.9%), intermediate (30.0%-69.9%), and consolidated (70.0%-100%). BPC coverage was categorized by terciles., Main Outcomes and Measures: Age-standardized, all-cause mortality and hospitalization rates calculated for the entire population and by age group (<5 years, 5-29 years, 30-69 years, and ≥70 years)., Results: Among the 2548 Brazilian municipalities studied from 2004 to 2019, the mean (SD) age-standardized mortality rate decreased by 16.64% (from 6.73 [1.14] to 5.61 [0.94] deaths per 1000 population). Consolidated coverages of social welfare programs studied were all associated with reductions in overall mortality rates (PBF: rate ratio [RR], 0.95 [95% CI, 0.94-0.96]; ESF: RR, 0.93 [95% CI, 0.93-0.94]; BPC: RR, 0.91 [95% CI, 0.91-0.92]), having all together prevented an estimated 1 462 626 (95% CI, 1 332 128-1 596 924) deaths over the period 2004 to 2019. The results were higher on mortality for the group younger than age 5 years (PBF: RR, 0.87 [95% CI, 0.85-0.90]; ESF: RR, 0.89 [95% CI, 0.87-0.93]; BPC: RR, 0.84 [95% CI, 0.82-0.86]), on mortality for the group aged 70 years and older, and on hospitalizations. Considering a shorter scenario of economic crisis, a mitigation strategy that will increase the coverage of PBF, BPC, and ESF to proportionally cover the newly poor and at-risk individuals was projected to avert 1 305 359 (95% CI, 1 163 659-1 449 256) deaths and 6 593 224 (95% CI, 5 534 591-7 651 327) hospitalizations up to 2030, compared with fiscal austerity scenarios that would reduce the coverage of these interventions., Conclusions and Relevance: This cohort study's results suggest that combined expansion of conditional cash transfers, social pensions, and primary health care should be considered a viable strategy to mitigate the adverse health outcomes of the current global polycrisis in LMICs, whereas the implementation of fiscal austerity measures could result in large numbers of preventable deaths.

This study aimed to develop a green method to obtain an anthocyanin-rich edible extract of Clitoria ternatea flowers grown in southern Brazil. The extract was characterized by UHPLC-MS n and analyzed for toxicological potential in an in vivo model, total phenolic content, and biological activities. By using a 2 3 multivariate design to study the effects of temperature, acidified solvent, and time on the total anthocyanin content (487.25 mg/g), total phenolic content (2242.47 mgGAE/g), it was possible to determine the optimal point (45 °C, 16 min, and 22.5 mL extraction solution). Thirteen anthocyanins and nine non-anthocyanins were quantified. In vivo toxicity assay using Galleria mellonella showed a safe concentration when administered up to 2.2 g of extract per body kg. The extract showed antioxidant activity and antibacterial action against food pathogens, the method proved to have a low environmental impact, in addition to producing an extract with potential for application in food., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: The article analyzed homeless people's (HP) access to health and social protection policies and tailored inter-sector care, including emergency measures, during the COVID-19 pandemic in Belo Horizonte (BH), capital of Minas Gerais state, Brazil. It intended to provide data on HP and evaluate existing public policies focused on vulnerable populations during this health emergency., Methods: The study adopted a mixed-methods design with triangulation of quantitative and qualitative data., Results: Social cartography showed that in the early months of the pandemic, the health administration had difficulty reordering the health system, which experienced constant updates in the protocols but was nevertheless consolidated over the months. The evidence collected in the study showed that important emergency interventions in the municipality of BH involved activities that facilitated access by HP to the supply of services., Discussion: The existence of national guidelines for inter-sector care for HP cannot be ruled out as a positive influence, although the municipalities are responsible for their implementation. Significantly, a health emergency was necessary to intensify the relationship between health and social protection services. Roving services were among those with the greatest positive evidence, with the least need for infrastructure to be replicated at the local level. In addition, the temporary supply of various inter-sector services, simultaneously with the provision of day shelters by organized civil society, was considered a key factor for expanding and intensifying networks of care for HP during the emergency phase. A plan exists to continue and expand this model in the future. The study concluded that understanding the inter-sector variables that impact HP contributes to better targeting of investments in interventions that work at the root causes of these issues or that increase the effectiveness of health and social protection systems., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Martins, Souza, Silva, Dantas, Marinho, Fernandes, Oliveira, Magalhães Júnior and Paes-Sousa.)

Despite the considerable morbidity and mortality of yellow fever virus (YFV) infections in Brazil, our understanding of disease outbreaks is hampered by limited viral genomic data. Here, through a combination of phylogenetic and epidemiological models, we reconstructed the recent transmission history of YFV within different epidemic seasons in Brazil. A suitability index based on the highly domesticated Aedes aegypti was able to capture the seasonality of reported human infections. Spatial modeling revealed spatial hotspots with both past reporting and low vaccination coverage, which coincided with many of the largest urban centers in the Southeast. Phylodynamic analysis unraveled the circulation of three distinct lineages and provided proof of the directionality of a known spatial corridor that connects the endemic North with the extra-Amazonian basin. This study illustrates that genomics linked with eco-epidemiology can provide new insights into the landscape of YFV transmission, augmenting traditional approaches to infectious disease surveillance and control.

Background: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) have been recently developed and introduced into clinical practice., Methods: We retrospectively analyzed data from patients with confirmed HR+/HER2 metastatic breast cancer treated with hormonal therapy in combination with ribociclib (R), palbociclib (P), or abemaciclib (A)., Outcomes: median progression-free survival (mPFS), time to treatment discontinuation (mTTD), and objective response rate (ORR)., Results: Between January 2016 - June 2021, 142 patients were treated with an CDK4/6i (79 P, 42 R, 21 A). The median age was 59 years and 67.6% had recurrent disease. Roughly 35.2%, 36.6%, 28.2% of the patients had 1, 2 or 3+ metastatic sites, respectively, and 55.6% of the patients received CDK4/6i as a first-line treatment. The mPFS was 28m(R) vs. 14m(P) vs. 6m(A) (P = 0.002), with a higher proportion of patients receiving R in the first-line setting. However, no difference was seen when the analysis was restricted to the first-line scenario (P = 0.193). Sixty-four patients required one dose reduction, and 19 patients required two. ORR was 76.2% (R) vs 62% (P) vs 42.9% (A). More patients achieved a complete response with R and P, with no difference in the incidence of partial response and stable disease. Adverse events occurred in 94.4% of the population, with the most common grade 3-4 AE being neutropenia (59.1%)., Conclusions: Our results confirm the efficacy and tolerability of CDK4/6i in routine clinical practice. This is the first real-world data describing and comparing the efficacy and toxicity of CDK4/6i in the Brazilian population., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Authors MMQ, RS, LJCO, and AK have no conflicts to declare. Author KPS reported consultant fees from Eurofarma and as a speaker from Novartis, AstraZeneca, Janssen, Lilly. Author MFR received honoraria from Bristol-Myers-Squibb. Author LLG reported receiving speaker bureau fees from the companies Novartis, AstraZeneca. Author RDML participates in clinical studies sponsored by the company Daiichi-Sankyo, Lilly, Roche, MSD, Bayer, GSK, Pfizer; as a speaker for AstraZeneca, Daiichi-Sankyo, Novartis, Pfizer, MSD, Lilly, Zodiac, United Medical, Grunenthal, Roche; participated in scientific events for the companies Lilly, Novartis, Roche, Fleury, Daiichi-Sankyo, Pfizer. Author MRSC reported receiving advisory board and presentations fees from Roche, AstraZeneca, Pfizer, MSD, Lilly, Gilead, BMS, Agendia, Janssen, Sanofi. Author RBS reported receiving speaker bureau fees from Agilant, AstraZeneca, Daichi-Sankyo, Eli Lilly, Pfizer, Novartis, Merck, Libbs and Roche; he has also served as a consultant/ advisor for AstraZeneca, Daichi-Sankyo, Eli Lilly, Libbs, Roche, Merck and has received support for attending medical conferences from AstraZeneca, Eli Lilly, Daichi-Sankyo, and Merck. Author MS reported consultant fees from MSD, Pfizer, AstraZeneca, Daiichi-Sankyo and Novartis. Author TSC participates in clinical studies sponsored by the company Lilly, Pfizer, Novartis, BMS; and reported receiving speaker bureau fees from AstraZeneca, Novartis, Pfizer, Novartis, Libs. Author MSM declares advisory engagements, presentations and educational expenses for Pfizer, Lilly and Novartis. DAS participates in clinical studies sponsored by the company Lilly, as a speaker at events for AstraZeneca, MSD, Novartis, Roche, Pfizer, Advisory, GSK, Roche; board advisory for Gilead. AKS participates as a sub investigator in clinical studies sponsored by the company Pfizer, Lilly, MSD, AstraZeneca, Novartis, Roche; as a speaker for Pfizer, Novartis, Lilly, AstraZeneca, Daiichi-Sankyo, MSD, Roche, Janssen, Amgen, Grunenthal., (Copyright © 2023. Published by Elsevier Ltd.)

In Brazil, the coronavirus disease 2019 (COVID-19) epidemic spread rapidly in a heterogeneous way, mainly due to the different socioeconomic and behavioral characteristics of different regional populations and different evaluation periods. We performed a cross-sectional study including 1,337 individuals (first wave = 736/second wave = 601) after the first two waves of COVID-19 in the city of Belém, the capital of the state of Pará. The detection of IgG anti-SARS-CoV-2 antibodies was performed using an enzyme-linked immunosorbent assay test followed by statistical analysis using the RStudio program. Our results showed an increase in the seroprevalence (first wave= 39.1%/second wave= 50.1%) of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies in the population of Belém from the first to the second pandemic wave. Advanced age, primary or secondary education level, lack of social isolation, and a low frequency of protective mask use were considered risk factors for SARS-CoV-2 infection during the first wave compared to the second wave. This study is one of the firsts to provide important information about the dynamics of virus circulation and the groups vulnerable to exposure in the two major periods. Our data emphasize the socioeconomic characteristics of the affected population and that nonpharmacological prevention measures are crucial for combating the pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 da Silva Torres, Lopes, de Lima, Cordeiro Lima, dos Santos Brito, Gonçalves, dos Santos Oliveira, de Oliveira Freitas, dos Santos, Santos de Sousa, Carvalho Gomes, Sarmento Botelho, Alves Correa, Machado, Martins Feitosa, Lima, Cayres Vallinoto and Vallinoto.)

Chromosomal microarray analysis (CMA) has been recommended and practiced routinely since 2010 both in the USA and Europe as the first-tier cytogenetic test for patients with unexplained neurodevelopmental delay/intellectual disability, autism spectrum disorders, and/or multiple congenital anomalies. However, in Brazil, the use of CMA is still limited, due to its high cost and complexity in integrating the results from both the private and public health systems. Although Brazil has one of the world's largest single-payer public healthcare systems, nearly all patients referred for CMA come from the private sector, resulting in only a small number of CMA studies in Brazilian cohorts. To date, this study is by far the largest Brazilian cohort (n = 5788) studied by CMA and is derived from a joint collaboration formed by the University of São Paulo and three private genetic diagnostic centers to investigate the genetic bases of neurodevelopmental disorders and congenital abnormalities. We identified 2,279 clinically relevant CNVs in 1886 patients, not including the 26 cases of UPD found. Among detected CNVs, the corresponding frequency of each category was 55.6% Pathogenic, 4.4% Likely Pathogenic and 40% VUS. The diagnostic yield, by taking into account Pathogenic, Likely Pathogenic and UPDs, was 19.7%. Since the rational for the classification is mostly based on Mendelian or highly penetrant variants, it was not surprising that a second event was detected in 26% of those cases of predisposition syndromes. Although it is common practice to investigate the inheritance of VUS in most laboratories around the world to determine the inheritance of the variant, our results indicate an extremely low cost-benefit of this approach, and strongly suggest that in cases of a limited budget, investigation of the parents of VUS carriers using CMA should not be prioritized., (© 2022. The Author(s).)

This article has two integrated objectives: (i) to identify the representation of health in the 2030 Agenda from health-related indicators implemented by international and national institutions; and (ii) to compare the potential of platforms for monitoring Brazilian health commitments in the SDGs. It is argued that there are still important controversies brought about by the greater complexity of the 2030 Agenda, particularly in the operationalization of health-related indicators, whose determinants permeate many other objectives and goals. Finally, even though the picture of the country currently available on national and international platforms is already broad, improvements are required for more effective monitoring and evaluation of Brazilian commitments in the SDGs, with greater disaggregation and stratification of indicators in the population.

We provide hematologic and biochemical information for 13 jaguars (Panthera onca) from the Amazon. Most showed increased lymphocytes, monocytes, eosinophils, aspartate aminotransferase, and alanine aminotransferase; all individuals showed lower mean red blood cell (RBC) counts compared to findings from other biomes. Males had a significantly higher RBC count and alkaline phosphatase than did females., (© Wildlife Disease Association 2022.)

The present study aimed to identify larval trematodes shed by snails found in water bodies used by urban communities in a former schistosomiasis endemic area in the state of Piauí, in the Brazilian semiarid region. A malacological survey was performed followed by analysis of the cercariae shed by the snails after light exposure. Biomphalaria straminea specimens (n=1,224) were obtained from all seven collection sites. Cercariae shed by snails were i) single tailed, in which one type of cercariae was identified ( Echinostoma cercariae), and ii) with bifurcated tail (brevifurcate apharyngeate distome, brevifurcate pharyngeate distome, and longifurcate pharyngeate distome [strigeocercaria]). Brevifurcate apharyngeate distome were further examined and the presence of spikes in swimming membranes enabled the identification of Spirorchiidae cercariae in all individuals, demonstrating the absence of cercariae compatible with Schistosoma mansoni . Nevertheless, the accurate diagnosis of S. mansoni circulation in former endemic areas is still necessary.

Background: Home-visiting programs are a common and effective public health approach to promoting parent and child well-being, including in low- and middle-income countries. The World Health Organization and UNICEF have identified responsive caregiving as one key component of the nurturing care children need to survive and thrive. Nonetheless, the importance of responsive caregiving and how to coach it is often overlooked in trainings for staff in home-visiting programs., Methods: To determine whether it is possible to enhance home-visitors' understanding of responsive caregiving and how to coach it, we conducted a cluster randomized controlled trial with 181 staff working in Brazil's national home-visiting program. We used a computerized random number generator to randomly assign half of participants to take an online professional development course about responsive caregiving immediately and the other half to a waitlist. Individuals assessing outcome data were blind to group assignment., Results: Compared to those in the control group (N = 90, both randomized and analyzed), participants assigned to take the course (N = 91, both randomized and analyzed) were more knowledgeable about responsivity (Cohen's d  = 0.64, 95% Confidence Interval (CI) = 0.34, 0.94) and its importance for children's socioemotional (odds ratio (OR) = 1.88, 95% CI = 1.00, 3.50) and cognitive (OR = 2.57, 95% CI = 1.15, 5.71) development, better able to identify responsive parental behaviors in videotaped interactions ( d  = 1.86, 95% CI = 1.51, 2.21), and suggested more effective strategies for coaching parents on responsivity ( d  = 0.51, 95% CI = 0.21, 0.80) and tracking goal implementation (OR  =  3.20, 95% CI = 1.28, 7.99). There were no significant changes in participants' tendency to encourage goal setting and reflection, or their perspective-taking skills. Participants were very satisfied with the course content and mode of delivery and there was no drop-out from the program., Conclusions: A short, online professional development program created moderate to large improvements in home-visitors' knowledge and intended coaching practices. This suggests that such programs are feasible, even in low-income and rural areas, and provide a low-cost, scalable option for possibly maximizing the impact of home-visiting programs - particularly with regard to parental responsivity, and in turn, child outcomes., Competing Interests: Competing interests: The authors completed the ICMJE Declaration of Interest Form (available upon request from the corresponding author), and declare no competing interests., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

In recent decades food banks have become a worldwide response to the contradicting the coexistence of food losses and waste, on the one hand, and hunger and food insecurity on the other. In Brazil, food banks had a rapid expansion, becoming the object of public policy on Food and Nutrition Security and of non-profit private institutions. Our study presents an unprecedented overview of all the food banks currently active in the Brazilian territory, discussing their performances and perspectives. We conducted descriptive research, aiming to characterize the number, spatial distribution, performance, and modalities of operation of the Brazilian food banks. We mapped 217 active food banks and they all participated in the study. The results revealed the important capillarity of the food banks, which exist in all 27 Brazilian federative units, but also demonstrate the potential and need for expansion. Most of the Brazilian food banks has commercial establishments as their largest donor partners and have fruits and vegetables as their most donated items. They mostly complement the feeding of families at social risk and children served by social institutions. Food and nutrition education actions are offered by all the studied units to donor partners and beneficiary institutions and families.

We analyzed the social isolation relaxation strategies adopted by the twelve biggest Brazilian cities in 2020, in relation to the number of cases, number of deaths and the effective reproduction number (Rt), which are internationally considered the fundamental epidemiological criteria for allowing wider population mobility in public spaces. The Brazilian central government has not set unique guidelines neither for closure nor for opening, and states and cities have taken the lead in strategy definition. Until July 31 2020, in Belém do Pará, Fortaleza, Manaus, Recife and Rio de Janeiro, where the epidemic peak had already been surpassed, and in Salvador and São Paulo, in which the peak seemed to be already reached, the Rt curve followed a decreasing path after the openings. Porto Alegre, a city in which the epidemic curve was flattened, had an increase in Rt after the start of relaxation. In Belo Horizonte, Brasília, Curitiba and Goiânia, where the curve was also flattened, the Rt remained stable after the opening. The decision on how to operationalize the relaxation of social isolation and the speed with which it happened was heterogeneous among the cities studied. Also, broad population testing strategies were not done in any of the cities.

Background: This study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old., Methods: The study design is ecological, with longitudinal analysis in a balanced panel. The period covered is 2006 to 2016, including 3467 municipalities from all regions of the country, which resulted in 38,137 observations. The generalized linear models were adjusted considering the Negative Binomial (NB) distribution for the number of deaths due to malnutrition and diarrhea, with fixed effects. NB models with and without zero-inflation were assessed. Subsequent interaction models were applied to assess the combined effects of the two public policies., Results: In relation to the decline of mortality rates due to diarrhea in the municipalities, positive effect modification were observed in the presence of: high coverage of the target population by the PBF and access to water, 0.54 (0.28-1.04) / 0.55 (0.29-1.04); high coverage by the total population by the PBF and access to water, 0.97 (0.95-1.00) and high coverage by the total population by the PBF and access to sanitation, 0.98 (0.97-1.00). Decline on diarrhea mortality was also observed in the joint presence of high coverage of solid waste collection and access to water, categories 1 (> 60% ≤85%): 0.98 (0.96-1.00), 0.98 (0.97-1, 00) and 2 (> 85% ≤ 100%): 0.97 (0.95-0.98), 0.97 (0.95-0.99). Negative effect modification were observed for mortality due to malnutrition in the presence of simultaneous high coverage of the total population by the PBF and access to sanitation categories 1 (≥ 20 < 50%): 1.0061 (0.9991-1.0132) and 2 (≥ 50 < 100%): 1.0073 (1.0002-1.0145) and high coverage of the total population by the PBF and solid waste collection, 1.0004 (1.0002-1.0005), resulting in malnutrition mortality rates increase., Conclusion: Implementation of environmental health services and the coverage expansion by the PBF may enhance the prevention of early deaths in children under 5 years old due to diarrhea, a poverty related disease.

Introduction: Governmental measures aiming at social protection, with components of disease control, have potential positive impacts in the nutritional and health outcomes of the beneficiaries. The concomitant presence of these measures with environmental sanitation interventions may increase their positive effect. The context of simultaneous improvement of social protection and environmental sanitation is found in Brazil since 2007 and an assessment of the combined effects of both programs has not been performed so far., Objective: To evaluate whether interaction effects between improvement of access to water, sanitation and solid waste collection with the Bolsa Família Program [PBF] were related to better responses in the reduction of morbidity due to diarrhea and malnutrition in children less than five years of age, acknowledging the positive results of these improved conditions and the PBF separately in coping with these diseases., Methods: Descriptive and inferential analyses were performed through Generalized Linear Models of the Negative Binomial type of fixed effects, with and without addition of zeros. Interaction models were inserted in order to evaluate the outcomes when the two public policies of interest in the current study were present simultaneously in the municipalities., Results: Interaction with negative effect when a concomitantly high municipal coverage of the Bolsa Família Program and adequate access to sanitation and solid waste collection were present. In contrast, regardless of municipal coverage by the PBF, the simultaneous presence of water and sanitation (0.028% / 0.019%); water and solid waste collection (0.033% / 0.014%); sanitation and solid waste collection (0.018% / 0.021%), all resulted in a positive effect, with a decrease in the average morbidity rates for both diseases., Conclusion: Investments aimed at universalizing water, sanitation and solid waste collection services should be priorities, aiming at reducing the incidence of morbidity due to malnutrition and diarrhea and preventing deaths from these poverty-related diseases., Competing Interests: The authors have declared that no competing interests exist.

Background: Measuring the Global Burden of Disease (GBD) has been the key to verifying the evolution of health indicators worldwide. We analyse subnational GBD data for Brazil in order to monitor the performance of the Brazilian states in the last 28 years on their progress towards meeting the health-related SDGs., Methods: As part of the GBD study, we assessed the 41 health-related indicators from the SDGs in Brazil at the subnational level for all the 26 Brazilian states and the Federal District from 1990 to 2017. The GBD group has rescaled all worldwide indicators from 0 to 100, assuming that for each one of them, the worst value among all countries and overtime is 0, and the best is 100. They also estimate the overall health-related SDG index as a function of all previously estimated health indicators and the SDI index (Socio-Demographic Index) as a function of per capita income, average schooling in the population aged 15 years or over, and total fertility rate under the age of 25 (TFU25)., Results: From 1990 to 2017, most subnational health-related SDGs, the SDG and SDI indexes improved considerable in most Brazilian states. The observed differences in SDG indicators within Brazilian states, including HIV incidence and health worker density, increased over time. In 2017, health-related indicators that achieved good results globally included the prevalence of child wasting, NTD, household air pollution, conflict mortality, skilled birth attendance, use of modern contraceptive methods, vaccine coverage, and health worker density, but poor results were observed for child overweight and homicide rates. The high rates of overweight, alcohol consumption, and smoking prevalence found in the historically richest regions (i.e., the South and Southeast), contrast with the high rates of tuberculosis, maternal, neonatal, and under-5 mortality and WASH-related mortality found in the poorer regions (i.e., the North and Northeast)., Conclusions: The majority of Brazil's health-related SDG indicators have substantially improved over the past 28 years. However, inequalities in health among the Brazilian states and regions remain noticeable negatively affecting the Brazilian population, which can contribute to Brazil not achieving the SDG 2030 targets.

Fasciolosis is a food-borne disease that causes great distress to a range of hosts, including humans. The objectives of this study were to (1) evaluate the liver damage and carcass weight of cattle naturally infected with Fasciola hepatica from the state of Rio Grande do Sul (RS), Brazil, and to (2) determine the distribution of adult flukes in 12,236 cattle liver from RS. The data from these experiments were used to calculate the overall economic loss due to F. hepatica infection. Eighteen adult Polled Hereford cows were divided into a triclabendazole (TbG) and a F. hepatica-positive group (FhG). For Experiment 1, a generalized linear mixed model revealed a statistical difference in carcass weight (49.8 kg) between TbG and FhG. The Monte Carlo analysis also revealed that the animals' weight differences were due to the disease. For Experiment 2, the prevalence of infected livers was above 16% (1904/12,236), mostly (20.1%) from the south-west region of RS. The Susceptible-infected-recovered (SIR) epidemic model revealed the evolution of the infection using a high infectivity and low recovery rate. Other distinctive scenarios that occur in RS were also established with different rates of infectivity. The economic assessment showed a potential loss of US$45 million to the beef cattle industry of RS, with an overall State cost of US$90.3 million. These novel findings reveal the importance of fasciolosis infection, which can cause a significant health condition and poor animal welfare.

Aim: To validate a model to estimate the nursing workload required by trauma victims on intensive care unit (ICU) discharge., Background: Identifying a reliable model of nursing workload measurement that can assist professionals., Methods: A prospective cohort study conducted in 2010 (first phase) and 2015 (second phase) with 342 trauma victims admitted into the ICU of four hospitals located in São Paulo, Brazil. The original model was created during the first phase and included the Simplified Acute Physiology Score and New Injury Severity Score variables. Coefficients of determination (R 2 ) were calculated to identify the reliability., Results: The original model presented high reliability (R 2  = 44%) in the hospital of origin, and unsatisfactory performance (R 2  < 4%) in the other institutions. An improvement in R 2 was observed after adjusting the coefficients for each hospital., Conclusion: For the Nursing Activities Score prediction of survivors for ICU discharge, trauma centres must validate the original model with coefficient adjustments for their population, or preferably derive their own models., Implications for Nursing Management: Although models are useful in predicting discharge of these ICU patients, for treatment continuity after critical care and for organising services, the study showed that they should be evaluated prior to use for nursing management., (© 2019 John Wiley & Sons Ltd.)

Fiscal austerity policies have been used as responses to economic crises and fiscal deficits in both developed and developing countries. While they vary in regard to their content, intensity and implementation, such models recommend reducing public expenses and social investments, retracting the public service and substituting the private sector in lieu of the State to provide certain services tied to social policies. The present article discusses the main effects of the recent economic crisis on public health based on an updated review with consideration for three dimensions: health risks, epidemiological profiles of different populations, and health policies. In Brazil, the combination of economic crisis and fiscal austerity policies is capable of producing a direr situation than those experienced in developed countries. The country is characterized by historically high levels of social inequality, an under-financed health sector, highly prevalent chronic degenerative diseases and persisting preventable infectious diseases. It is imperative to develop alternatives to mitigate the effects of the economic crisis taking into consideration not only the sustainability of public finance but also public well-being.

Background: Economic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014-16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession., Methods: In this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick-Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied., Findings: Between 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09-0·91) in all-cause mortality, mainly due to cancer and cardiovascular disease. Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698-33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15-0·80]), men (0·67 [0·22-1·13]), and individuals aged 30-59 years (0·43 [0·16-0·69] per 1 percentage-point increase in the unemployment rate. No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15-29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed., Interpretation: The Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally., Funding: None., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The vegetation physionomy and cover can show patterns of diversity and composition of the edaphic community, depending on the quantity and quality of litter in a specific habitat. The objective of this study was to evaluate the effect of the vegetation gradient formed by Graminoid Field (GRF), Cerrado Sensu Stricto (CSS), Cerradão (CRD) and Semideciduous Seasonal Forest (SSF) on density, diversity and composition of the edaphic fauna community in two seasons of the year, in the Sete Cidades National Park (Piauí state). For fauna sampling, a total of eight pitfall traps, distanced 10 m, were placed in each area in the central part of each system, where they remained for seven days. In the wet period, there was a tendency to increase the number of individuals as a function of the complexity of the vegetation formation, with the inverse occurring in the dry period. It was verified an environmental variation of the climatic factors temperature and humidity according to the vegetal formation, contributing to a heterogeneous distribution of the fauna. The GRF formation presented a significantly lower value of average richness only in the dry period. Regarding the variables of diversity and uniformity, they did not show drastic variations in relation to the vegetation gradient studied. The dominant groups in the vegetation gradient were Formicidae, Coleoptera, Aranae, Acari and Collembola, with reduction of the number of Coleoptera in the dry season. Principal component analysis (PCA) revealed greater differences in the composition of the communities between the vegetation formations for the rainy season. At this time, the formations SSF and CRD were associated to a greater diversity of invertebrates than CSS and GRF, demonstrating the influence of the vegetation complexity on the soil fauna community.

It is suggested that bovine enteroviruses (BEV) are involved in the aetiology of enteric infections, respiratory disease, reproductive disorders and infertility. In this study, bovine faecal samples collected in different Brazilian states were subjected to RNA extraction, reverse transcription-polymerase chain reaction analysis and partial sequencing of the 5'-terminal portion of BEV. One hundred and three samples were tested with an overall positivity of 14.5%. Phylogenetic analysis clustered these BEV Brazilian samples into the Enterovirus F clade. Our results bring an important update of the virus presence in Brazil and contribute to a better understanding of the distribution and characterisation of BEV in cattle.

Background: Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of long-term fiscal austerity measures that will substantially reduce expenditure on social welfare programmes as a percentage of the country's GDP over the next 20 years. The Bolsa Família Programme (BFP)-one of the largest conditional cash transfer programmes in the world-and the nationwide primary healthcare strategy (Estratégia Saúde da Família [ESF]) are affected by fiscal austerity, despite being among the policy interventions with the strongest estimated impact on child mortality in the country. We investigated how reduced coverage of the BFP and ESF-compared to an alternative scenario where the level of social protection under these programmes is maintained-may affect the under-five mortality rate (U5MR) and socioeconomic inequalities in child health in the country until 2030, the end date of the Sustainable Development Goals., Methods and Findings: We developed and validated a microsimulation model, creating a synthetic cohort of all 5,507 Brazilian municipalities for the period 2017-2030. This model was based on the longitudinal dataset and effect estimates from a previously published study that evaluated the effects of poverty, the BFP, and the ESF on child health. We forecast the economic crisis and the effect of reductions in BFP and ESF coverage due to current fiscal austerity on the U5MR, and compared this scenario with a scenario where these programmes maintain the levels of social protection by increasing or decreasing with the size of Brazil's vulnerable populations (policy response scenarios). We used fixed effects multivariate regression models including BFP and ESF coverage and accounting for secular trends, demographic and socioeconomic changes, and programme duration effects. With the maintenance of the levels of social protection provided by the BFP and ESF, in the most likely economic crisis scenario the U5MR is expected to be 8.57% (95% CI: 6.88%-10.24%) lower in 2030 than under fiscal austerity-a cumulative 19,732 (95% CI: 10,207-29,285) averted under-five deaths between 2017 and 2030. U5MRs from diarrhoea, malnutrition, and lower respiratory tract infections are projected to be 39.3% (95% CI: 36.9%-41.8%), 35.8% (95% CI: 31.5%-39.9%), and 8.5% (95% CI: 4.1%-12.0%) lower, respectively, in 2030 under the maintenance of BFP and ESF coverage, with 123,549 fewer under-five hospitalisations from all causes over the study period. Reduced coverage of the BFP and ESF will also disproportionately affect U5MR in the most vulnerable areas, with the U5MR in the poorest quintile of municipalities expected to be 11.0% (95% CI: 8.0%-13.8%) lower in 2030 under the maintenance of BFP and ESF levels of social protection than under fiscal austerity, compared to no difference in the richest quintile. Declines in health inequalities over the last decade will also stop under a fiscal austerity scenario: the U5MR concentration index is expected to remain stable over the period 2017-2030, compared to a 13.3% (95% CI: 5.6%-21.8%) reduction under the maintenance of BFP and ESF levels of protection. Limitations of our analysis are the ecological nature of the study, uncertainty around future macroeconomic scenarios, and potential changes in other factors affecting child health. A wide range of sensitivity analyses were conducted to minimise these limitations., Conclusions: The implementation of fiscal austerity measures in Brazil can be responsible for substantively higher childhood morbidity and mortality than expected under maintenance of social protection-threatening attainment of Sustainable Development Goals for child health and reducing inequality., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: SB receives a stipend as a specialty consulting editor for PLOS Medicine and serves on the journal's editorial board. The authors have declared that no other competing interests exist.

Bellucia dichotoma Cogn. (Melastomataceae) is one of various plant species used in folk medicine in the west of the state of Pará, Brazil, to treat snake bites. Many studies have been carried out to evaluate the effectiveness of anti-snake bite plants, but few of these use the same preparation methods and doses as those traditionally used by the local populations. This study therefore compared inhibition of the main local effects of B. atrox venom (BaV) by aqueous extract of B. dichotoma (AEBd) administered according to traditional methods and pre-incubated with BaV). The concentrations of phenolic compounds (tannins and flavonoids) in AEBd were determined by colorimetric assays. The effectiveness of AEBd in inhibiting the hemorrhagic and edematogenic activities of BaV was evaluated in mice in four different experimental in vivo protocols: (1) pre-incubation (venom:extract, w/w); (2) pre-treatment (p.o.); (3) post-treatment (p.o.); and (4) AEBd (p.o.) in combination with Bothrops antivenom (BA) (i.v.). To assess in vitro inhibition of BaV phospholipase A₂ activity, the pre-incubation method or incorporation of AEBd or BA in agarose gels were used. The effect of AEBd on BaV was determined by SDS-PAGE, zymography and Western blot. Colorimetric assays revealed higher concentrations of (condensed and hydrolyzable) tannins than flavonoids in AEBd. Hemorrhagic activity was completely inhibited using the pre-incubation protocol. However, with pre-treatment there was no significant inhibition for the concentrations tested, and with the post-treatment only the 725 mg/kg dose of AEBd was able to inhibit 40.5% (p = 0.001) of the hemorrhagic activity of BaV. Phospholipase A₂ activity was only inhibited when AEBd was pre-incubated with BaV. BaV-induced edema was completely inhibited with pre-incubation (p < 0.05) and significantly reduced (p < 0.05) with pre- and post-treatment (p.o.) for the concentrations tested. The reduction in local edema was even greater when AEBd was administered in combination with BA. The SDS-PAGE profiles showed that several of the BaV protein (SDS-PAGE) and enzyme (zymography) bands were not detected when the venom was pre-incubated, and Western blot revealed that this was not caused by the AEBd enzymes observed in the zymogram. The "pseudo inhibition" observed after pre-incubation in this study may be due to the presence of tannins in the extract, which could act as chelating agents, removing metalloproteins and Ca²⁺ ions and thus inhibiting hemorrhagin and PLA₂ activity. However, when administered according to traditional methods, B. dichotoma extract was effective in blocking BaV-induced edematogenic activity and had an additional effect on inhibition of this activity by BA., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To determine the validity of alpha-1-acid glycoprotein as a novel biomarker for mortality in patients with severe sepsis., Methods: We prospectively included patients with severe sepsis or septic shock at the emergency department at a single tertiary referral teaching hospital. All of the patients were enrolled within the first 24 hours of emergency department admission, and clinical data and blood samples were obtained. As the primary outcome, we investigated the association of serum levels of alpha-1-acid glycoprotein and 96-hour mortality with logistic regression analysis and generalized estimating equations adjusted for age, sex, shock status and Acute Physiology and Chronic Health Evaluation II score., Results: Patients with septic shock had lower alpha-1-acid glycoprotein levels at the time of emergency department admission compared to patients without shock (respectively, 149.1 ±42.7 vs. 189.8 ±68.6; p = 0.005). Similarly, non-survivors in the first 96 hours were also characterized by lower levels of alpha-1-acid glycoprotein at the time of emergency department admission compared to survivors (respectively, 132.18 ±50.2 vs. 179.8 ±61.4; p = 0.01). In an adjusted analysis, alpha-1-acid glycoprotein levels ≤120 mg/dL were significantly associated with 96-hour mortality (odds ratio = 14.37; 95% confidence interval = 1.58 to 130.21)., Conclusion: Septic shock patients exhibited lower circulating alpha-1-acid glycoprotein levels than patients without shock. Alpha-1-acid glycoprotein levels were independently associated with 96-hour mortality in individuals with severe sepsis.

Leishmania (Viannia) braziliensis causes three main types of American tegumentary leishmaniasis (ATL), localized cutaneous leishmaniasis (CL), mucosal leishmaniasis (ML), and disseminated leishmaniasis (DL). All forms are observed among individuals of Corte de Pedra, Brazil. We previously used random amplified markers to identify a multiclonal population among L. (V.) braziliensis isolates from ATL patients, defining parasite clades associated with different clinical syndromes. Herein we compared sequences of random amplified markers to identify genotypes of L. (V.) braziliensis recovered from lesions of CL, ML, and DL patients. Six polymorphic genomic loci were sequenced from 35 parasite isolates. Single-nucleotide polymorphisms (SNPs) and insertions-deletions (indels) at each locus allowed us to segregate the L. (V.) braziliensis population according to haplotypes. Several SNPs, indels, and haplotypes were significantly associated with an increased risk of DL. Molecular genotyping may provide markers to identify L. (V.) braziliensis strains likely to cause this emerging, hard-to-treat form of ATL.

Aim: To assess the prevalence of traumatic dental injury (TDI), as well as associated factors, behaviour of affected schoolchildren and normative treatment needs., Methods: The present cross-sectional study involved 590 children aged 7-14 years at state schools in Campina Grande, Brazil. The O'Brien classification [1994] was used for the diagnosis of TDI and the body mass index (BMI) was used as an indicator of overweight/obesity. Clinical tests were carried out by two duly calibrated examiners (intra-observer and inter-observer agreement: 0.87 and 0.90, respectively). The Chi-square test was used (5% level of significance) to determine whether TDI was associated with age, gender, ethnicity, overweight/obesity, lip seal and overjet. Backward stepwise multivariate regression analysis was performed. Normative treatment needs were determined based on the criteria of the International Association of Dental Traumatology (IADT). When the absence of treatment was detected, each child/adolescent was asked about the reason for non-treatment., Results: The prevalence of TDI was 12.7%. The most common type of trauma was enamel fracture (67.0%), followed by enamel-dentine fracture (25.3%). TDI was 4.9-fold greater (95% CI: 1.6-14.4) among children aged 13 and 14 years, 1.9- fold greater (95% CI: 1.1-3.2) among males and 2.6-fold greater (95% CI: 1.2-5.4) among those with inadequate lip seal. The majority of schoolchildren did not undergo treatment (82.6%) due to a belief that it was unnecessary (53.2%). The normative clinical evaluation revealed that adhesive restoration was the most common form of treatment (84.0%)., Conclusion: The prevalence of TDI was low. Age, gender and inadequate lip seal were associated with dental trauma. A significant number of schoolchildren did not receive treatment for dental trauma.

Objective: To examine the association between Brazil's Bolsa Familia programme (BFP), which is the world's largest conditional cash transfer programme, and the anthropometric indicators of nutritional status in children., Methods: Using the opportunity provided by vaccination campaigns, the Brazilian government promotes Health and Nutrition Days to estimate the prevalence of anthropometric deficits in children. Data collected in 2005-2006 for 22 375 impoverished children under 5 years of age were employed to estimate nutritional outcomes among recipients of Bolsa Família. All variables under study, namely child birth weight, lack of birth certificate, educational level and gender of family head, access to piped water and electricity, height for age, weight for age and weight for height, were converted into binary variables for regression analysis., Findings: Children from families exposed to the BFP were 26% more likely to have normal height for age than those from non-exposed families; this difference also applied to weight for age. No statistically significant deficit in weight for height was found. Stratification by age group revealed 19% and 41% higher odds of having normal height for age at 12-35 and 36-59 months of age, respectively, in children receiving Bolsa Familia, and no difference at 0-11 months of age., Conclusion: The BFP can lead to better nutritional outcomes in children 12 to 59 months of age. Longitudinal studies are needed to confirm these findings.

Ventriculoperitoneal shunt (VPS) is the most common treatment for hydrocephalus, however it is not free of complications. Abdominal cerebrospinal fluid pseudocyst (ACP) is an uncommon, but potentially life-threatening, complication of VPS. It is characterized by a fluid filled collection of cerebrospinal fluid (CSF) in the peritoneal cavity containing the distal end of the VPS catheter and is surrounded by a wall composed of fibrous tissues without an epithelial lining. We report the case a Brazilian Amazon woman that presented ACP fifteen years after the placement of a VPS. Physicians should be aware of this possible complication once early diagnosis would improve outcome and reduce patient's suffering and distress.

The chemical composition of essential oils from three species of plants belonging to the Eucalyptus genus was determined and, their insecticidal effects on egg, larva and adult phases of Lutzomyia longipalpis were assessed. The insects were collected in the municipality of Sobral in the State of Ceará, Brazil. Five treatments with different concentrations were performed along with two negative controls, distilled water and Tween 80 (3%), and a positive control, cypermethrin (0.196mg/ml). The tests were carried out in plastic pots internally coated with sterile plaster and filled with a substrate made of rabbit feces and crushed cassava leaves. The eggs, larvae and adults were sprayed with the oils. The hatched larvae were counted for 10 consecutive days and observed until pupation. Insect mortality was observed after 24, 48 and 72h. E. staigeriana oil was the most effective on all three phases of the insect, followed by E. citriodora and E. globulus oils, respectively. The major constituents of the oils were Z-citral and alpha-citral (E. staigeriana), citronellal (E. citriodora) and 1,8-cineole (E. globulus). The Eucalyptus essential oils constitute alternative natural products for the control of L. longipalpis since the median effective concentration (EC(50)) values revealed relevant action as compared with other natural products, some of their chemical constituents are already known for their insecticidal activity and these oils are produced in commercial scale in Brazil., (Copyright 2009 Elsevier B.V. All rights reserved.)

Problem: To achieve the Millennium Development Goals it is necessary to set up low-cost, real-time monitoring systems which can provide feedback to managers and policy-makers in a timely fashion. The gold-standard approach for monitoring nutritional situations is to conduct household surveys. However, they are costly, time consuming and do not furnish information about smaller disaggregated units., Approach: Brazil pioneered National Immunization Days (NIDs) in the 1980s, and later integrated them with vitamin A supplementation. This report discusses implementation of five large-scale Health and Nutrition Days (HNDs) using NIDs as a platform to monitor nutritional status and estimate coverage of health and social welfare services, including conditional cash transfer benefits., Local Setting: Brazil is composed of 26 states, one federal district and 5564 municipalities, with around 18 million children under five years of age. It was decided that HNDs would be carried out among high-risk populations: children from the semi-arid north-eastern region; agrarian reform settlements; isolated rural black communities or quilombolas and municipalities of Amazonas state., Relevant Changes: It was possible to draw inferences for almost 3 million children from different subgroups of underprivileged populations who had never before been studied in such detail, including state-level data., Lessons Learned: Implementation of large scale HNDs in conjunction with NIDs proved to be feasible in Brazil and resulted in data which are very relevant for policy-makers, obtained over a short period of time and at reasonably low cost. It is sensible to conclude that the experience reported here could be reproduced wherever NID coverage is very high.

Background/aims: Non-alcoholic steatohepatitis (NASH) has been associated with exposure to chemicals among workers from an industrial complex in Brazil. We investigated the NASH profile of these individuals associated or not with metabolic conditions., Methods: Eighty-four patients with NASH were classified into three groups: G1, 31 patients exposed to chemicals (benzene, xylene, vinyl chloride and others); G2, 30 exposed patients who also presented with obesity, hyperlipidemia and diabetes; and G3, 23 non-exposed patients who presented with metabolic conditions., Results: G1 and G2 were similar in terms of gender (97% and 100% males) and age (37+/-5.4 and 39+/-6.5 years). In G3, 74% were males and the age was 48+/-3.4 years (P<0.05). In G2, obesity was present in 26.6%, hyperlipidemia in 66.6% and diabetes in 6.6%. In G3, obesity was observed in 43.4%, hyperlipidemia in 30.4% and diabetes in 26%. Macro- and microsteatosis were observed in 100% of cases. Perisinusoidal fibrosis was observed in 71% patients in G1, 80% in G2 and 52% in G3 (P<0.05). Histological evidence of cholestasis was present in 53% of cases in G1, 50% in G2 and 13% in G3 (P<0.05)., Conclusions: Exposure to chemicals appears to be an independent risk factor for NASH that presents a peculiar profile. It is more frequently seen in men younger than non-exposed ones. Steatosis, fibrosis and cholestasis were frequent histological findings. Co-existing metabolic factors did not seem to influence clinical or histopathological presentation., (Copyright Blackwell Munksgaard 2004)

Biomphalaria tenagophila is very important for schistosomiasis transmission in Brazil. However its mechanisms of interaction with Schistosoma mansoni are still scantly studied. Since this snail displays strains highly susceptible or completely resistant to the parasite infection, the knowledge of that would be a useful tool to understand the mechanism of snail resistance. Particularly, the Taim strain consistently shows absolute resistance against the trematode, and this resistance is a dominant character. A multidisciplinary research group was created aiming at studying B. tenagophila/S. mansoni interaction. The possibility for applying the knowledge acquired to obtain a biological model for the control of S. mansoni transmission in endemic areas is discussed.

Objective: To analyze the inequalities found using health indicators in the states and regions of Brazil, according to 1999 socioeconomic and demographic indicators., Methods: An exploratory ecological cross-sectional study was carried out. The units of analysis were Brazilian states (n = 27) and regions (n = 5). Descriptive measures of inequality were calculated. Pearson's correlation and also linear regression analysis were used to identify associations between health indicators and selected socio-economic and demographic indicators. The health indicators analyzed were: life expectancy at birth, infant mortality rate, mortality rate for children < 5 years due to acute diarrheal diseases and to acute respiratory infections, and deaths due to homicides and traffic accidents., Results: Important gains were seen in life expectancy at birth over the 1991-1999 period, especially for males. There was a trend towards larger gains in states that had had lower life expectancy at birth in 1991, which produced greater homogeneity across Brazil in this indicator in recent years. The infant mortality rate decreased by 28% between 1991 and 1999. However, this indicator still varies widely among the regions--from 52.5 per 1,000 live births in the northeast to 17.1 per 1,000 in the south--and among states--from 64.0 per 1,000 in Alagoas to 15.1 per 1,000 in Rio Grande do Sul. With respect to children < 5 years, the mortality rate due to acute diarrheal diseases was equal to or higher than the national median (4.1 per 10,000) in all the north-eastern states, and the mortality rate due to acute respiratory infections was equal to or higher than the national median (10.8 per 10,000) in all the southern, southeastern, and central-western states. The mortality rates (standardized by sex and age) due to traffic accidents and to homicides in 1999 were 17.7 and 26.0 per 100,000 inhabitants, respectively. Extreme values were found in some states for mortality due to homicide (57.8 per 100,000 in Pernambuco) and traffic accidents (54.5 per 100,000 in Roraima). The mortality rate due to homicide was strongly associated with urbanization (P = 0.001). Higher mortality rates due to traffic accidents were associated with lower poverty levels (beta = -0.93; P < 0.001), lower literacy rates (beta = -1.16; P = 0.005), and larger population growth over the past decade (beta = 3.10; P = 0.016)., Conclusions: The pattern of health inequality in Brazil indicates a polarization among regions and states as well as a juxtaposition of diseases associated with under-development and diseases linked to development, suggesting the need for a health system that is committed to addressing these issues.

Demographic and epidemiological transition models have seldom been debated within the Brazilian scientific community. This study aims to critically review the studies based on such transition models, analyzing their contributions and limitations for health research in Brazilian cities. Data from the city of Belo Horizonte were used to illustrate the theoretical issues raised in this paper. A total of 10,558 death certificates from 1994 were classified according to underlying cause of death and place of residence (75 geographical areas). Areas were classified according to the proportion of heads of households with low formal education. Population age structures and age- and sex-adjusted mortality rates in the areas were compared. Mortality rates indicate that Belo Horizonte is experiencing a multiple and unequal epidemiological transition process. In the poorer areas, infectious diseases have been replaced by homicides as cause of death in adulthood. The findings suggest that large Brazilian cities have mortality patterns that vary according to social and economic differentials.

A prospective and longitudinal study about head injury victims was carried out in order to identify their return to productivity after 6 months and 1 year post-trauma and to analyze the relationship between their return to work and their educational level as well as to determine the relationship between their return to work and their type of job before the onset of the injury. Of the 72 patients who were students or employees pre-injury, or housewives at the time of injury, the majority (73.6%) had returned to productivity 6 months after onset of injury. Of the victims who had returned to productivity, 25.0% had changed their original occupations or reported significant problems when returning to productivity. Baseline return was achieved in 48.6% of the victims at 6 months. Return to productivity was higher at 1 year after injury than at 6 months. When the relationship between return to work and educational level and job type was analyzed, return to work was not related to educational level or job type.

Objective: The purpose of this study was to discover the differences among victims who had traumatic brain injury due to traffic accidents., Methods: Medical record of the head injury patients were analyzed according to their classification as traffic accident victims (pedestrian, motorcyclist or passenger and other motor vehicle deriver or passenger), age, gender, admission type (admitted from scene of the injury or from another hospital), duration of hospitalization, type of head injury, types of lesions present in other body segments and mortality. Patient's injury severity was measured by Injury Severity Score and head injury severity was analyzed using the ranking on the Glasgow Coma Scale, recorded by neurosurgeons during their first neuro assessment. All head injured patients admitted to a trauma center in S. Paulo city over a four-month period from March through June 1993, were included in the study. The sample was of 156 victims, with subsets of 80 pedestrians, 26 occupants of motorcycles and 50 occupants of other motor vehicles., Results and Conclusion: The results of this study showed that the mortality rate was higher in the pedestrian subset (25.0%) than among other victims and higher for motorcycle occupants (19.2%) than for motor vehicle victims (8.0%). Statistical differences between the subsets were established when the head injury severity variable was analyzed using the Glasgow Coma Scale. On the other hand, the differences between the three subsets was not statistically significant when the measurement used was the Injury Severity Score. Analyses of other variables showed important differences among subset distributions.

We analysed samples of Aedes aegypti from São José do Rio Preto and Franca (Brazil) by C-banding and Ag-banding staining techniques. C-banding pattern of Ae. aegypti from São José do Rio Preto examined in metaphase cells differed from Franca. The chromosomes 2, 3 and X showed centromeric C-bands in both populations, but a slightly stained centromeric band in the Y chromosome was observed only in São José do Rio Preto. In addition, the X chromosome in both populations and the Y chromosome of all individuals from São José do Rio Preto showed an intercalary band on one of the arms that was absent in Franca. An intercalary, new band, lying on the secondary constriction of chromosome 3 was also present in mosquitoes of both populations. The comparison of the present data with data in the literature for Ae. aegypti from other regions of the world showed that they differ as to the banding pattern of sex chromosomes and the now described intercalary band in chromosome 3. The observations suggested that the heterochromatic regions of all chromosomes are associated to constitute a single C-banded body in interphase cells. Ag-banding technique stained the centromeric regions of all chromosomes (including the Y) and the intercalary C-band region of the X chromosome in both populations. As Ae. aegypti populations are widespread in a great part of the world, the banding pattern variations indicate environmental interactions and may reveal both the chromosome evolutionary patterns in this species and the variations that may interfere with its vector activity.

This study is part of a project about ICU's characteristics in São Paulo city. This article describes the continuing education programs for nursing staff. 43 ICUs were analysed and the questionnaire answered by the ICU nurse coordinator was used to collect data. Results showed that 34 (79.1%) of the ICUs have initial program for training each nursing staff category and 18 (41.9%) had regular continuing education program focusing primarily on nursing procedures and routines and the update in pathologies. Continuing education programs are developed primarily by ICU's nurses. 50.2% of the nurses answered that they attended specialisation/extension courses too, in Medical Surgical Nursing or in other areas or in both areas. Due to this result and the development of the ICU's nurses as specialists, some suggestions are presented to improve the continuing education program in these Units.

Two cases of cutaneous Pythiosis insidiosi were diagnosed in cattle from the Pantanal region, Brazil. The lesions were observed in the limbs of two 8-month-old beef calves. Close examination showed local swelling and focal ulceration of the skin. Microscopically, there was multifocal granulomatous dermatitis with intralesional Pythium insidivosum hyphae. The diagnosis was based on the morphological aspects, immunohistochemical findings and culture of the etiologic agent.

Baturite is an important endemic zone of American cutaneous leishmaniasis in the state of Ceara, where an entomologic survey has been carried out to obtain information about transmission of the disease. From October 1989 through August 1991, natural infections with flagellates were detected in 34 of 3,000 Lutzomyia whitmani, five of 1,667 Lu. migonei, three of 5,278 Lu. wellcomei, one of 646 Lu. shannoni, and one of 21 Lu. evandroi. Thirty-five infections were peripylarian (i.e., behind the pylorus in the sand fly gut with a tendency to invade the midgut anterior to the pylorus). Fifteen infections (14 from Lu. whitmani and one from Lu. migonei) have been characterized as Leishmania (Viannia) braziliensis by isoenzyme electrophoresis, incriminating this species as a vector of the parasite in this area. Other possible vectors include Lu. wellcomei, Lu. migonei, and Lu. shannoni. Transmission appears to occur in peridomestic sites, especially around animal enclosures. Most cases of cutaneous leishmaniasis were recorded between September and December in Baturite during the period of study.

From October until July 1991, CDC miniature light traps were set up and man and animal-landing and biting catches were made in 100 different catching zones, in different habitats, throughout the ACL focus of the Serra de Baturité. Female Lutzomyia whitmani and Lu. wellcomei appeared to be highly anthropophilic and were the most prevalent species in man-landing catches in peridomestic sites. Most Lu. migonei were attracted to animals, especially mules. Seasonal fluctuations and habitat preference were noted for the principal populations present.