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Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Visceral leishmaniasis (VL) requires diagnostic assays to complement clinical suspicion. However, there is no standardization of a diagnostic flow using available assays. This study aimed to evaluate the performance of parasitological, molecular, and serological assays for diagnosing VL and propose a diagnostic flow based on performance, practicality, and invasiveness. We conducted a study of 10-year (2010-2020) routine diagnoses of VL at the Brazilian National Reference Laboratory. We propose a diagnostic flow where individuals suspected of VL are initially screened for antibodies using an immunochromatographic test (ICT) with rK39 antigen on the nitrocellulose membrane. This is followed by a blood polymerase chain reaction (PCR) for Leishmania sp. kDNA and direct parasitological exam and/or PCR in bone marrow aspirate. A positive result in any of these assays can define a VL case. If clinical suspicion persists in negative individuals, the diagnostic flow should be repeated. The proposed flow has the potential to standardize and improve the diagnosis of VL. It reduces the need for invasive tests without compromising diagnostic accuracy., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Artemia is a brine shrimp genus adapted to extreme habitats like ranges salinity from 5-25 g/L and in temperatures from 9 to 35 °C. It is widely distributed and used as an environmental quality biomarker. Artemia franciscana and Artemia salina species are commonly used in ecotoxicological studies and genotoxicity assays due to their short life cycle, high fecundity rate, easy culture, and availability. Thus, considering the importance of these tests in ecotoxicological studies, the present study aimed to present Artemia genus as a biological model in genotoxicity research. To this end, we reviewed the literature, analyzing data published until July 2023 in the Web of Science, SCOPUS, Embase, and PubMed databases. After screening, we selected 34 studies in which the genotoxicity of Artemia for various substances. This review presents the variability of the experimental planning of assays and biomarkers in genotoxicity using Artemia genus as a biological model for ecotoxicological studies and show the possibility of monitoring biochemical alterations and genetic damage effects. Also highlight innovative technologies such as transcriptomic and metabolomic analysis, as well as studies over successive generations to identify changes in DNA and consequently in gene expression.

Tenofovir disoproxil fumarate (TDF) is a drug used in HIV treatment, and several studies have detected its presence in surface water. Furthermore, more information on its environmental impact is needed in the scientific literature. Thus, due to the lack of data on the impact of this drug, and its presence in different waters of the world, this work aimed to evaluate the potential toxicological effects of TDF on the mollusk Biomphalaria glabrata in vivo and in vitro. For in vitro analysis, hemocytes were exposed to different drug concentrations for 1 h and evaluated for feasibility, and phagocytic and metabolic activity. The in vivo analysis consisted of the exposure of groups of five mollusks, in triplicate, at the same drug concentrations for 72 h and 21 days, evaluating mortality, and mollusk and hemolymph behavior. Although the exposure of the mollusk to TDF did not reduce its survival, however it was toxic to its hemocytes. Even if toxicity was identified on the mollusk and its hemocytes initially, further studies should be conducted to understand the effects of this residue on the environment and different life stages of the mollusk because, per the Globally Harmonized System of Classification and Labeling of Chemicals, for aquatic ecosystems, the results obtained were classified as toxic (EC50% 2.65 [1.98; 5.29] mg/L) and could cause unfeasibility in hemocytes at concentrations below 10 mg/l., 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 B.V. All rights reserved.)

Background: Ocular toxoplasmosis is the leading cause of infectious posterior uveitis worldwide, accounting for 30-50% of all cases in immunocompetent patients. Conventional treatment is associated with adverse effects and does not prevent recurrence. Intravitreal drug administration can improve disease outcomes and reduce side effects. Herein, we conducted a systematic review and meta-analysis on the efficacy of intravitreal injections for treating ocular toxoplasmosis., Methods: The systematic search was conducted using PubMed, SciELO, and Google Scholar with the descriptors "ocular toxoplasmosis" AND "intravitreal". We analyzed studies that met the inclusion criteria, i.e., experimental cases in patients treated intravitreally for ocular toxoplasmosis. Considering the systematic review, we focused on the number of intravitreal injections, the therapeutic drug class, and the presence of preexisting conditions. To assess the efficacy of intravitreal injections, a meta-analysis was performed using visual acuity, side effects, disease recurrence, and inflammatory responses as variables., Results: Intravitreal injection-induced side effects were rarely observed (0.49% [0.00, 1.51%] ). The use of antiparasitic and anti-inflammatory drugs afforded improved visual acuity (99.81% [98.60, 100.00%]) and marked effectiveness in treating ocular toxoplasmosis., Conclusions: Intravitreal injections may facilitate the successful treatment of ocular toxoplasmosis. However, clinicians should carefully evaluate the presence of preexisting conditions for ocular toxoplasmosis or previous diseases, as these can impact the decision to administer intravitreal injections.

Over time, a growing increase in human pollutants in the aquatic environment has been observed. The global presence of residues in water bodies reinforces the need to develop improved methods to detect them and evaluate their ecotoxicological effects in aquatic environments. Thus, this study aimed to present the main assays using Biomphalaria glabrata as a biological model for ecotoxicological studies. We performed a systematic literature review with data published up to June 2022 on the Web of Science, SCOPUS, Science Direct, PubMed, and SciELO databases. Thirty studies were selected for this review after screening. Biomphalaria glabrata has been studied as an ecotoxicological model for different substances through toxicity, embryotoxicity, cytotoxicity, genotoxicity, and bioaccumulation assays. Studies evaluating the impact of B. glabrata exposure to several substances have reported effects on their offspring, as well as toxicity and behavioral and reproductive effects. This review presents various assays using B. glabrata as a biological model for ecotoxicological studies. The use of a representative species of ecosystems from tropical regions is a necessary tool for tropical environmental monitoring. It was observed that the freshwater snail B. glabrata was effective for the evaluation of the ecotoxicity of several types of chemical substances, but further studies are needed to standardize the model., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The objective of this research was to use a meta-analysis to understand the prevalence of hepatitis B or C in waste pickers worldwide., Methods: Epidemiological studies on hepatitis B and C in waste pickers were included adopting a systematic review with meta-analysis. Each selected article had its quality scored by all authors, evaluated according to the Loney's criteria, and evaluated for quality and bias verified with a funnel plot., Results: After employing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, there were 12 studies used for this meta-analysis. The rate of hepatitis B seropositivity was 0.15 (95% CI 0.10-0.20), and hepatitis C was 0.08 (95% CI 0.04-0.12). This information suggests that waste pickers are exposed to many risks associated with poor quality of life working conditions as well as low health literacy rates., Conclusion: The results of this meta-analysis confirm the vulnerability of waste pickers to hepatitis B and C infection and reinforce the importance of using personal protective equipment and immunizing workers., (© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Standardized treatment regimens for chronic hepatitis B (CHB) are crucial in suppressing viral replication, disease progression and the development of complications. However, information on routine compliance with such therapeutic recommendations in medical practice is rare. Aim: To evaluate the application of Brazilian therapeutic guidelines for CHB within the scope of the Unified Health System in Minas Gerais state. Four key recommendations from the national guidelines were compared with data from treated patients: (i) eligibility to start treatment; (ii) type of treatment applied; (iii) rescue antiviral therapy; and (iv) monitoring of virological response. Most physicians (69.8%) declared to adopt these guidelines, while 10 of them were unaware. However, according to the criteria established by the guidelines, only 39.5% of treated patients should have been considered "truly" eligible to start treatment and only 67.6% of these underwent the recommended pharmacological treatment. The virological response was laboratory monitored in just over a third of patients. Rescue therapy was adequately supplanted in 41.2% of patients previously treated with lamivudine. There was low compliance with national guidelines by public service physicians in Brazil, highlighting the need to raise awareness of the importance of its adherence to expand the control of CHB. Thus, increasing the adherence of health professionals to this tool is a current challenge for health institutions and managers.

There are increasing worldwide concerns about the negative impacts of healthcare waste generated in hospitals, especially in low- and middle-income countries. Hazardous type of waste can contribute to adverse effects both in human populations and the environment because of its physical, chemical, and biological characteristics. A comprehensive view on increasing waste in the world has not been conducted to understand the breadth of the issue; thus, this paper sought to provide an analysis of hospitals' healthcare waste generation rate. Comparisons were made with Wilcoxon and Kruskal-Wallis tests for simple and multiple comparisons, to analyze nonparametric data, with post hoc by Nemenyi test. Median values indicated that hospital waste was the highest in North and South America (4.42, 1.64 kg/bed/day, respectively) and was almost nonexistent in Oceania (0.19 kg/bed/day), while the median rates for hazardous waste were the highest in Oceania (0.77 kg/bed/day). Africa was almost the lowest producer of waste in each category (0.19 and 0.39 kg/bed/day for hospital and hazardous waste, respectively). Over time, linear regression indicated that hazardous waste in Asia and Europe has increased, while in Oceania, the total waste also increased. Interestingly, in North America, it was observed a reduction in the generation for both total and hazardous waste. This information highlights the importance of understanding continent-specific characteristics and rates, which can be used to create a more individualized approach to addressing healthcare waste in the world., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Chronic hepatitis B (CHB) affects 257 million people worldwide. However, the proportion of patients eligible for treatment in the public health system has not been established. This study describes the clinical and laboratory profiles of untreated CHB patients and estimates the eligibility rate for antiviral therapy in accordance with the Brazilian Clinical Protocol and Therapeutic Guidelines., Methods: Records of 670 CHB patients were collected from May 2012 to September 2013 in Minas Gerais. Data from each patient were analyzed by hepatitis B virus (HBV) management., Results: 461 CHB patients were treatment-naive. Of these, 23 were HBeAg-positive, 352 were HBeAg-negative, and 14 were clinically diagnosed with cirrhosis. Periodic monitoring was performed in only three patients. However, 9.3% of untreated patients met the eligibility criteria for HBV treatment., Conclusions: Few CHB patients were active carriers and eligible candidates for antiviral therapy. This study revealed inadequate pre-treatment conduct in the Brazilian public health system, emphasizing the need for regular laboratory follow-up for patients initially not eligible for treatment. Such information may indirectly subsidize the planning and improvement of actions and services related to optimal HBV management in the public sphere.

Surfactants are substances that when in aquatic environments can cause negative impacts. Hospital effluents carry numerous chemicals daily, including surfactants, used in sanitization and disinfection procedures. These chemicals are found in the effluents and reach water bodies due to a lack of proper removal in the wastewater treatment plants. The present study investigated data about wastewater monitored from healthcare facilities located in the city of Belo Horizonte, Brazil, focusing on anionic surfactants. The results showed 72 establishments monitoring this parameter, resulting in a median concentration of 1 mg L -1 and 2.49 mg L -1 mean value of anionic surfactants, between 2007 and 2019. It is also observed in the correlation between surfactants and oils in all healthcare establishment sizes, except for the medium-sized. Although anionic surfactants are the most used in cleaning product formulations, cationic surfactants still do not have specific legislation in the studied country that dictates a limit for discharge into sewage; consequently, they are not routinely monitored in effluents. However, these compounds are used in the formulation of routine hospital products., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Waste pickers are considered a vulnerable population at risk for potential health damage. Taking into account the risk of hepatitis B or C infection in this population, the aim of this study was to show the prevalence of these diseases in waste pickers from South America, through a systematic review., Methods: The search covered publications until February 2020, accessed through Google Scholar database. Epidemiological studies on hepatitis B or C focused on waste pickers in South America were included. All selected papers were evaluated for quality., Results: Six studies composed this systematic review, all conducted in Brazil and using cross-sectional study. The prevalence of all makers (HBsAg or anti-HBc) for hepatitis B varied from 4.3 to 33.4% while for hepatitis C varied from 1.6 to 12.4%., Conclusion: The lack of results showed the requirement for more research about hepatitis including this informal workers group. High prevalences of hepatitis B and C in waste pickers highlighted the need of increase preventive health protection as vaccination against hepatitis B; training on working conditions; and the use of individual protection., (© The Author(s) 2020. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To describe the hepatitis B prevalence in Brazilian waste pickers., Methods: We performed a literature search in the SciELO, Biblioteca Virtual em Saúde (BVS), PubMed and Web of Science databases using the descriptors: "hepatitis B" AND ("informal recycling" OR "waste picker" OR "recyclable waste collectors" OR "solid waste segregator") AND ("recyclable waste" OR "solid waste") AND Brazil. Epidemiological studies on HBV in Brazilian waste pickers published prior to February 2020 were included and evaluated for quality and bias using a funnel plot., Results: This meta-analysis consisted of five articles. Prevalence of HBV surface antigen seropositivity was 14% (95%CI: 6%-22%) in Brazilian waste pickers., Conclusion: HBV prevalence in Brazilian waste pickers remains high. There should be more campaigns showing the importance of vaccination and personal protective equipment use.

Coronavirus-19 disease (COVID-19) acquired pandemic status in March 2020. The new virus has caused serious implications in the healthcare services management, including several sectors, among them the generation of waste. Healthcare wastes (HCW) generation increased along pandemic representing a health problem due to potentially infected ones. From this perspective, the study sought to analyse the challenges and changes imposed by COVID-19 in the HCW management in a large public hospital from Brazil. For this purpose, data about the Contingency Plan prepared by the hospital and HCW generation from 2017 to 2020 were used, analysed by statistical methods. When dealing with the Contingency Plan, the Brazilian hospital adopted measures similar to other hospitals around the world as described by the literature, such as: adoption of new protocols, specific team assigned to manage actions and training of professionals and suspension of elective surgeries. Regarding the generation of HCW, there was a significant increase in the mass of biological waste with a high risk of infection. The waste of this group increased from March 2020, coinciding with the start of care for the patients infected by COVID-19. The contribution of this type of waste to total generation jumped from approximately 0.2% in previous years to almost 5% in 2020. In addition, a reduction in the average of total waste generated in kilogrammes per bed per day from 2017 to 2019 was indicated compared to the 2020. COVID-19 pandemic led to major challenges for hospitals that had to care for patients infected with the SARS-CoV-2 virus, including new protocols, changing the work shifts and training the teams in the new procedures. The biological waste with a high risk of infectiousness also increased 30 times.

Concern over the management of chemical wastes from laboratories has been gaining importance since the 1990s. For a good management of chemical wastes generated from laboratories, it is recommended that managers encourage an environment of cooperation and exchange, thus reusing chemical reagents. The institution under study implemented the Chemical Waste Exchange, whose objective is to capture reagents past their expiry dates that would be discarded and make them available internally to other areas or even to other institutions. A total of 1075 reagents were reused internally and 4382 items were donated for external institutions. As for financial data, between 2011 and 2018, the internal economy was US$16,700.70 and for external institutions it was US$62,633.11. When comparing the waste reuse according to the destination, an internal address showed a significant difference when compared with the external use. Some categories of reagents have greater added value and provide even greater benefits when reused. The strategy of capturing and making available expired reagents through the Chemical Waste Exchange is positive; it helps the management of the waste generated; the economic benefit will depend on the market value of the material; the adopted strategy avoids the need to remove raw material from nature for the production of new reagents and reduces the costs related to treatment and environmentally appropriate final destination.

Minas Gerais is one of the 27 federative units of Brazil; it is the fourth state with the largest territorial area and the second in number of inhabitants. Since 1997, the monitoring of the surface water quality of the State of Minas Gerais has been carried out. In this study, generalized regression models were constructed to determine the correlation between the Water Quality Index (WQI) and the sanitary and socioeconomic variables: Municipal Population, Human Development Index (HDI), Gini Index, Percentage of Vulnerables to Poverty (Poverty), Monthly Per Capita Income, Percentage of Inadequate or Poor Sanitation. In addition to the sanitary and socioeconomic variables listed, it also used year of water quality monitoring, altitude of the monitoring point, and distance from the monitoring point to the urban center of the municipality. The results from the generalized models showed that the variables year, altitude, Gini Index, monthly per capita income, and poor sanitation variables were positively associated with WQI. In other words, high values of each variable increased WQI, while population variables HDI and poverty were negatively related to WQI, that is, a high population value, HDI, or poverty implies a low WQI value. Socioeconomic variables such as HDI, Gini Index, poorness, or poor sanitation percentage present the coefficients with the largest modulus. Thus, among the socioeconomic variables studied, these are the ones that most contribute to the variability of WQI. The year and altitude variables have positive regression coefficients, indicating that when these variables increase, WQI also increases. The positive correlation with the year shows that the surface water quality of Minas Gerais improved during the monitoring years.

Objective: To investigate whether solid waste management and municipal socioeconomic indicators are associated with incidence rates of dengue, Zika, and Chikungunya in municipalities located in the state of Minas Gerais, Brazil., Methods: This exploratory, quantitative, cross-sectional study included all the 853 municipalities of Minas Gerais. Only secondary data were used, collected and grouped according to planning regions. Independent variables included regular urban solid waste collection, separated waste collection, and urban solid waste mass, in addition to a quality indicator of final waste disposal, municipal human development and Gini indices, monthly per capita income, and percentage of population vulnerable to poverty. The factors potentially associated with outcomes - municipal incidence of dengue, Chikungunya, and Zika - were initially selected by univariate analysis, followed by linear regression analysis for the incidence of dengue, Chikungunya, or Zika using the predictors selected through univariate analysis., Results: Solid waste management was not associated with incidence of Zika or Chikungunya. In turn, the incidence of dengue was associated with solid waste management and had a significant inverse association with percent population vulnerable to poverty. A direct association was also observed with Gini index, suggesting that the higher the incidence of dengue from 2007 to 2016, the higher the municipal Gini coefficient and thus social inequality. Selective waste collection was inversely and significantly correlated with dengue cases, suggesting that the lower the coverage by regular separated waste collection, the higher the number of dengue cases., Conclusions: Solid waste management may influence the occurrence of dengue cases, and therefore should be considered in the planning of public health actions., Competing Interests: Conflitos de interesse. Nada declarado pelos autores.

An evaluation of the environmental risk assessment (ERA) proposed by European Medicines Agency (EMA) and its applicability in Brazil was performed on ten of Belo Horizonte's most pharmaceuticals by the Brazilian National Health Service (SUS). The predicted environmental concentrations (PECs) was proposed, with some refinements to a better representation of the city of study. All PECs obtained were compared only to measured environmental concentrations around the world, due to the lack available data in the city of study and in Brazil. During the performance of EMA's guideline, the risk quotient (RQ) of impact was established through the ratio of PECs and predicted no-effect concentrations (PNECs). The PECs obtained in more refined phases show the initial evaluation of EMA's guideline, possible subdimensions, and the potential risks. The RQ for all studied pharmaceuticals ranges from clonazepam (1.26) to losartan (5457.45). These results indicate potential risks to the aquatic life present in the streams that receive the wastewater treatment plant's effluent. This risk can be spread since the streams carry these contaminants to other water bodies that undergo to multiple cities of Brazil, and even after dilutions, it can still be potentially toxic to the biotic life. ERA shows that it can be a useful tool for a better understanding and modeling of pharmaceuticals fate in the environment, specifically in water bodies. In addition, the usage of this model shows to be a useful tool that determines which contaminant should follow a more thorough study since the detection and analysis of pharmaceuticals in environmental samples are costly and technically challenging.

Some healthcare waste presents hazardousness characteristics and requires specific procedures to ensure the safety management. Waste segregation is an important action to control the risks of each type of waste. Healthcare waste indicators also may improve the waste management system. The aim of this article was to evaluate the healthcare waste management in a Brazilian university hospital, as well as the waste indicators, quantifying and qualifying the waste generation. Weighing of wastes occurred by sampling occurred sampling of seven consecutive days or daily, between 2011 and 2017. General wastes represent more than 55.6% of the total generated, followed by infectious, sharps and chemicals wastes, respectively, 39.1%, 2.9% and 2.4%. The generation rate in 2017 was 4.09 kg bed -1  day -1 , including all types of wastes. Non-dangerous wastes represented around 93.3%, including infectious wastes with low potential risks, while dangerous was represented by high infectious risk (1.4%), chemicals (2.4%) and sharps (2.9%). Healthcare waste indicators may favour the risk identification and improve the waste management system, in particular when involving hazardous wastes. Failures in healthcare waste segregation could represent, in addition to the health risks, unnecessary expenses.

Purpose: To assess the in vivo release profile and the retinal toxicity of a poly (lactic-co-glycolic acid) (PLGA) sustained-release sirolimus (SRL) intravitreal implant in normal rabbit eyes., Methods: PLGA intravitreal implants containing or not SRL were prepared, and the viability of ARPE-19 and hES-RPE human retinal cell lines was examined after 24 and 72 h of exposure to implants. New Zealand rabbits were randomly divided into two groups that received intravitreal implants containing or not SRL. At each time point (1-8 weeks), four animals from the SRL group were euthanized, the vitreous was collected, and drug concentration was calculated. Clinical evaluation of the eyes was performed weekly for 8 weeks after administration. Electroretinography (ERG) was recorded in other eight animals, four for each group, at baseline and at 24 h, 1, 4, 6, and 8 weeks after the injection. ERG was carried out using scotopic and photopic protocols. The safety of the implants was assessed using statistical analysis of the ERG parameters (a and b waves, a and b implicit time, B/A ratio, oscillatory potential, and Naka-Rushton analysis) comparing the functional integrity of the retina between the PLGA and SRL-PLGA groups. After the last electrophysiological assessment, the rabbits were euthanized and retinal histopathology was realized., Results: After 24 and 72 h of incubation with PLGA or SRL-PLGA implants, ARPE-19 and hES-RPE cells showed viability over 70%. The maximum concentration of SRL (199.8 ng/mL) released from the device occurred within 4 weeks. No toxic effects of the implants or increase in the intraocular pressure was observed through clinical evaluation of the eye. ERG responses showed no significant difference between the eyes that received PLGA or SRL-PLGA implants at baseline and throughout the 8 weeks of follow-up. No remarkable difference in retinal histopathology was detected in rabbit eyes treated with PLGA or SRL-PLGA implants., Conclusions: Intravitreal PLGA or SRL-PLGA implants caused no significant reduction in cell viability and showed no evident toxic effect on the function or structure of the retina of the animals. SRL was released from PLGA implant after application in the vitreous of rabbits during 8 weeks.

Frequent contact with hazardous materials makes waste collection a potentially unhealthy activity. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Brazil. Six focus groups were performed between June 2014 and August 2015. The aims of this study were to apprehend different aspects of the participants' health, workers' experiences of work-related accidents and perception of risks. Cuts and puncture injuries were reported most frequently in the line of work and were often considered as irrelevant. Immunization against hepatitis B was not common among all workers, which increases the risk of infection for those individuals. Finally, it is considered urgent to consolidate an inclusive space in which workers can have discussions on their health.

Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.

Healthcare waste (HCW) management represents a big challenge for managers around the world. Segregation is a fundamental action to allow the risk management inherent to each type of wastes. HCW indicators may favour the understanding of the waste management system status. The aim of this paper is to evaluate the HCW indicators applied in a Brazilian public institution, seeking to improve the management system and suggesting methods of applying this tool as an alternative of continuous improvement to the management process. Wastes were weighed every trimester for seven consecutive days, between of 2012 to 2017. The data represent daily, monthly and quarterly averages of the waste generated. Group B (chemical) and Group E (sharps) indicators had statistical non-significant data, suggesting very distant results from the stipulated goal. The generation rate was 355.3-500.7 kg.day -1 including all types of waste. Considering the approximate values of the non-infected wastes, which may be discarded in a landfill, the percentage represents about 75% of all HCW generated. The other 25% need to be treated at cost of $US0.76kg -1 . An effectively dangerous portion of the infectious waste would be approximately 6%. Failures in segregation could represent, in addition to the health risks, unnecessary expenses of the generating establishments. HCW indicators have good potential to provide adequate risk management in health service environments.

This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.