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A bibliometric analysis was carried out on the production and publication of research papers related to the study of the management variable in the quality of education in Latin America. The purpose of the analysis proposed in this document is to know the main characteristics of the volume of publications registered in Scopus database during the period 2016-2021 in Latin American countries, achieving the identification of 1183 publications in total. The information provided by said platform was organized by means of tables and figures categorizing the information by year of publication, Country of Origin, Area of Knowledge and Type of Publication. Once these characteristics were described, a qualitative analysis was used to refer to the position of different authors on the proposed topic. Among the main findings of this research, it is found that Brazil, with 589 publications, is the Latin American country with the highest production. The area of knowledge that made the greatest contribution to the construction of bibliographic material referring to the study of management in the quality of education was Medicine with 538 published documents, and the type of publication that was most used during the period mentioned above was the journal article, representing 71% of the total scientific production.

Orthodontics in Brazil underwent significant transformations in the 1950s when several dentists returned to the country after completing advanced education courses in the specialty abroad. The first two orthodontic associations, in Rio de Janeiro and São Paulo, were constituted in 1955 and 1959. The specialty's first event with characteristics of a professional meeting occurred in São Paulo in 1957, and Postgraduate Orthodontic education became available. This paper aims to describe the central insights of the constitution and evolving of the education of Orthodontics in Brazil., (Copyright 2023 © American Academy of the History of Dentistry.)

The techniques used for diagnosis of canine visceral leishmaniasis (CVL) in Brazil ELISA and IFAT have been extensively questioned because of the accuracy of these tests. A recent change in the diagnosis protocol excluded IFAT and included the Dual-Path Platform (DPP). We evaluated the prevalence and incidence rates of Leishmania spp. before and after the change in the protocol. In addition, based on our results, we propose a new alternative that is less expensive for the screening and confirmation of CVL. Plasma samples were obtained from a serobank from dogs evaluated in a cross-sectional study (1,226 dogs) and in a cohort study of susceptible animals (n = 447), followed for 26 months. Serology testing was performed using ELISA, IFAT, and DPP. The incidence and prevalence of CVL were determined by using the protocol of the Visceral Leishmaniasis Control and Surveillance Program until 2012 (ELISA and IFAT using filter paper) and the protocol used after 2012 (DPP and ELISA using plasma). The prevalence was 6.2% and the incidence was 2.8 per 1,000 dog-months for the protocol used until 2012. For the new diagnosis protocol for CVL resulted in an incidence of 5.4 per 1,000 dog-months and a prevalence of 8.1%. Our results showed that the prevalence and incidence of infection were far greater than suggested by the previously used protocol and that the magnitude of infection in endemic areas has been underestimated. As tests are performed sequentially and euthanasia of dogs is carried out when the serological results are positive in both tests, the sequence does not affect the number of animals to be eliminated by the Control Program. Then we suggest to municipalities with a large demand of exams to use ELISA for screening and DPP for confirmation, since this allows easier performance and reduced cost. [ABSTRACT FROM AUTHOR]

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

Portuguese colonial exploration and settlement in Brazil during the sixteenth, seventeenth and eighteenth centuries included a significant, though to date largely underappreciated, dimension of medical inquiry, the impact of which resonated throughout the Atlantic scientific world and beyond. This paper examines the role and influence within Portugal's maritime dominions of medical techniques, remedies and specific drugs originating in colonial Brazil. It focuses attention on the earliest collaborative interaction between indigenous healers and Portuguese missionaries—mainly Jesuits—on the Brazilian colonial frontier, who then passed that knowledge on to European physicians, surgeons and pharmacists working in colonial South American medical facilities. In such institutions, indigenous techniques were most often employed to the edification of Portuguese colonial agents (missionaries, colonial administrative officials, maritime commanders and state-licensed medical practitioners), who would then become the conduits disseminating those techniques to Europe or other colonial locations. [ABSTRACT FROM PUBLISHER]

This paper discusses the relationship between people and shrines in the Afro-Brazilian religion Candomble. One of its main points is that shrines cannot be described solely as a particular instance or token of a general formula or type. The power of the shrine is also partially the result of extraordinary and unexpected events of cure and personal formation and transformation, often defined as 'miracles' that bond together shrines and their caretakers. Through these events, new places, objects and substances are recognized as or incorporated into shrines. In other words, the power of the Candomble shrine is also a result of its historicity. [ABSTRACT FROM AUTHOR]

The paper will present data from research on the Family Health Program in a low-income district of Natal, Brazil. Through an institutional ethnographic perspective at the three Family Health Units in the district, it has been possible to create a joint construction of knowledge where the following are evident: (1) the need to consider the limitations of the biomedical approach; (2) the naturalization of social inequities and the lack of agency of health care users; and (3) the need to reflect on unfair power relations being reproduced through hierarchical interactions. [ABSTRACT FROM AUTHOR]

Dr Richard Gumbleton Daunt was an Irish doctor born in England in 1843, related to the Daunts of Kilcascan Castle in Cork, who settled in the city of Campinas in the state of São Paulo. This paper describes Dr Daunt's forebears and the society in which he lived in Brazil and how they influenced his thinking. A staunch traditionalist, his Irish background and the privileged Brazilian elite of which, through his marriage, he became a part, were reflected in his views on medicine and politics of his adopted country. [ABSTRACT FROM AUTHOR]

Introduction: technological developments in artificial intelligence and health are necessary for Latin American health systems. Objective: to describe the trends in scientific production on artificial intelligence and health in Latin America in Scopus. Method: This is a retrospective bibliometric study of Latin American authors' scientific production on artificial intelligence and health in Scopus between 2012 and 2021. Production, visibility and impact indicators were used. VOSviewer and SciVal were used for data analysis. Results: 2871 articles were published, with a variation between 2012 and 2021 of 94.98%. 2,397 articles were original, and 2,741 were written in English. 58.3% were published in first-quartile journals, the most productive being Sensors (Ndoc=79) and Plos One (Ndoc=66). 64,128 citations were received (mean of 22.3 citations per article). Brazil was the most productive country (Ndoc=1420), and the institution was the University of São Paulo (Ndoc=288). 498 thematic groups were identified, and 1376 themes. 54% of the articles had international collaboration and 3.3% with academic-corporation collaboration. Conclusions: there is a growing scientific production on artificial intelligence and health in Latin America, written mainly in English, medical, engineering and computer science research areas, disseminated in specialized magazines in the first quartiles. Brazil and its institutions were the top producers. The main topics were predictive models and the application of artificial intelligence for classifying, diagnosing and treating diseases. [ABSTRACT FROM AUTHOR]

Background. Stroke is a widespread and complex health issue, with many survivors requiring long-term rehabilitation due to upper-limb impairment. This study is aimed at comparing the perceived usability of two feedback-based stroke therapies: conventional mirror therapy (MT) and immersive virtual reality mirror therapy (VR). Methods. The study involved 45 participants, divided into three groups: the stroke survivors (n = 15), stroke-free older adults (n = 15), and young controls (n = 15). Participants performed two tasks using both MT and VR in a semirandom sequence. Usability instruments (SUS and NASA-TLX) were applied at the end of the activities, along with two experience-related questions. Results. The results indicated that both MT and VR had similar levels of perceived usability, with MT being more adaptable and causing less overall discomfort. Conversely, VR increased the perception of task difficulty and prevented participants from diverting their attention from the mirror-based feedback. Conclusion. While VR was found to be less comfortable than MT, both systems exhibited similar perceived usability. The comfort levels of the goggles may play a crucial role in determining the usability of VR for upper limb rehabilitation after stroke. [ABSTRACT FROM AUTHOR]

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

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

Copyright of Saúde e Sociedade is the property of Universidade de Sao Paulo, Faculdade de Saude Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: this paper focus on perceptions and experiences of women who practiced exclusive breast- feeding for a minimum period of six months. We tried to understand their attitudes and what breastfeeding meant to them in an attempt to understand how this option took place and was maintained in the group making the decision of exclusive breastfeeding. Methods: the study was oriented by social survey qualitative methodology, with an assessment and interpretative focus. The sample was comprised of 13 lactating mothers, users of the health services network of Fortaleza, State Ceará, Brazil. The technique of choice was in-depth individual interviews. Results: the complexity of breastfeeding became evident, although many times considered natural and easy to be experienced independently from the social environment where it takes place. The role played by parents and grandparents was determined as being an important element in the breastfeeding process. This study concluded that successful breastfeeding was rooted in the concepts construed by the respondents throughout their lives and in their own experiences resulting in new interpretations of concepts prior to their breastfeeding experience, as well as in the events taking place during the experience. Conclusions: such experiences are not only linked to the subjective level for they report to the dimension of real life where relationships with the healthcare professionals and services are established. [ABSTRACT FROM AUTHOR]

Choosing a surgical specialty can be a hard decision for a medical student. Several studies present data showing that most medical students fear the surgical field and end up switching to another specialty. For cardiovascular surgery, the scenario is very similar. In the last decades, the interest in cardiovascular surgery has been decreasing worldwide and the cardiothoracic surgical societies across the globe have been trying to understand the factors that push away medical students and general surgical residents from the specialty. In this regard, our work aims to focus on describe the access of students to cardiovascular surgery, especially during medical school, as well as to provide a brief report of our current data regarding the specialty. [ABSTRACT FROM AUTHOR]

This study aims to know the Brazilian medical literature scientific production on spirituality as a health care practice, as well as to identify the principal interventions-executed by these professionals-that have been characterized as Integrative and Complementary Health Practices. A scope methodology proposed by the Joanna Briggs Institute was used in the following phases: identification of research questions; identification of relevant studies; selection of studies; data mapping; grouping, synthesis of results. Two researchers alone carried out the searches, and a third researcher responded to the doubts of inclusion and exclusion of the identified articles. PubMed was the database, with the descriptors in Portuguese and English. Among the 71 articles identified, 27 were analyzed. The largest number of studies is concentrated in 2016 (44.44%). Concerning the type of study, the clinical trial prevails (77.77%). It was through meditation (29.63%) and Yoga (25.92%) that the discussion of spirituality-as Integrative and Complementary Practices in Health-materialized. Both had positive implications on the health of the groups participating in the studies. Based on the articles synthesis and on the regulations by the Ministry of Health and World Health Organization, it is plausible to assert that spirituality is ingrained in Integrative and Complementary Health Practices and that the concern in these practices has been enhancing. [ABSTRACT FROM AUTHOR]

This article examines the role of national actors articulated with an explicitly counter-hegemonic transnational knowledge network (TKN) mobilising around social medicine in policy debates on population control and family planning. It focuses primarily on Brazil, using Mexico as a shadow case to highlight salient points of contrast. In doing so, it makes two contributions to larger debates about TKNs. First, it highlights the plural and contested nature of the knowledge production they enact, underscoring contestation around a global reproductive regime that consolidated around family planning. Second, it underscores how the position and relative influence of actors articulated with TKNs is shaped by political and institutional contexts at the national level, producing variable opportunities for the mobilisation of applied knowledge. Reflecting its advocates' embeddedness in larger opposition movements to authoritarian states, social medicine had a greater influence on these debates in Brazil, where synergies with a resurgent feminist movement reinforced a shared insistence on comprehensive women's healthcare and increased the salience of sterilisation abuse on the political agenda. [ABSTRACT FROM AUTHOR]

Background: Access to medicines and the development of a strong national pharmaceutical industry are two longstanding pillars of health policy in Brazil. This is reflected in a clear emphasis by Brazil's Federal Government on improving access to medicine in national health plans and industrial policies aimed at promoting domestic pharmaceutical development. This research proposes that such policies may act as incentives for companies to pursue a strategic Corporate Social Responsibility (CSR) agenda. CSR that supports Governmental priorities could help companies to benefit significantly from the Governmental industrial policy. We sought to determine whether CSR activities of Brazilian pharmaceutical firms are currently aligned with the Federal Government's health prioritization. To do so we examined key Brazilian health related policies since 2004, including the specific priorities of Brazil's 2012-2015 Health Plan, and compared these with CSR initiatives that are reported on the websites of select pharmaceutical firms in Brazil.Results: Brazil's national health plans and industrial policies demonstrated that the Federal Government has followed diverse approaches for improving access to medicines, including strengthening health care infrastructure, increasing transparency, and supporting product development partnerships. Case studies of six pharmaceutical firms, representing both public and private companies of varying size, support the perspective that CSR is a priority for firms. However, while many programs target issues such as health infrastructure, health care training, and drug donation, more programs focus on areas other than health and do not seem to be connected to Governmental prioritization.Conclusion: This research suggests that there are loose connections between Governmental priorities and pharmaceutical firm CSR. However, there remains a significant opportunity for greater alignment, which could improve access to medicines in the country and foster a stronger relationship between the Government and industry. [ABSTRACT FROM AUTHOR]

The article offers medical news briefs. Brazilian Ministry of Health has declared public health emergency due to increase in number of newborns with congenital microcephaly and existence of Zika virus. Netherlands plan to offer scientific literature for free after publication. Eighteen children have committed suicide in Kota city, Rajasthan.

This article examines how amplified fetal heartbeats may be used to make claims about fetuses' social presence. These claims are supported by the Mexican Public Health system's selection of the maternal-child relationship as a key site of clinical intervention, intertwining medical and moral discourses. Drawing on the robust literature on cross-cultural propositions of "fetal personhood," this analysis uses ethnographic material from public health institutions in Oaxaca, Mexico, to explore how doctors use diagnostic technology to materialize fetuses for their patients. I argue that Spanish's epistemological distinction between saber (to have knowledge about) and conocer (to be acquainted with) is key to how diagnostic technologies may be deployed to make social claims. I use one doctor's attempts to use technology to shift her patient from saber to conocer as illustrative of underlying cultural logics about fetal embodiment and its proof. Focused on the under-theorized socio-medical deployment of audio fetal heartbeat technology, this article suggests that sound-in addition to sight-is a potent tool for constructing fetal personhood. [ABSTRACT FROM AUTHOR]

This article explores the relationship between genetic research, nationalism and the construction of collective social identities in Latin America. It makes a comparative analysis of two research projects – the ‘Genoma Mexicano’ and the ‘Homo Brasilis’ – both of which sought to establish national and genetic profiles. Both have reproduced and strengthened the idea of their respective nations of focus, incorporating biological elements into debates on social identities. Also, both have placed the unifying figure of the mestizo/mestiço at the heart of national identity constructions, and in so doing have displaced alternative identity categories, such as those based on race. However, having been developed in different national contexts, these projects have had distinct scientific and social trajectories: in Mexico, the genomic mestizo is mobilized mainly in relation to health, while in Brazil the key arena is that of race. We show the importance of the nation as a frame for mobilizing genetic data in public policy debates, and demonstrate how race comes in and out of focus in different Latin American national contexts of genomic research, while never completely disappearing. [ABSTRACT FROM AUTHOR]

Due to the risk of severe vaccine-associated adverse events, yellow fever vaccination in Brazil is only recommended in areas considered at risk for disease. From September 2008 through June 2009, two outbreaks of yellow fever in previously unvaccinated populations resulted in 21 confirmed cases with 9 deaths (case-fatality, 43%) in the southern state of Rio Grande do Sul and 28 cases with 11 deaths (39%) in Sao Paulo state. Epizootic deaths of non-human primates were reported before and during the outbreak. Over 5.5 million doses of yellow fever vaccine were administered in the two most affected states. Vaccine-associated adverse events were associated with six deaths due to acute viscerotropic disease (0.8 deaths per million doses administered) and 45 cases of acute neurotropic disease (5.6 per million doses administered). Yellow fever vaccine recommendations were revised to include areas in Brazil previously not considered at risk for yellow fever. [ABSTRACT FROM AUTHOR]

In Brazil, epizootics among New World monkey species may indicate circulation of yellow fever (YF) virus and provide early warning of risk to humans. Between 1999 and 2001, the southern Brazilian state of Rio Grande do Sul initiated surveillance for epizootics of YF in non-human primates to inform vaccination of human populations. Following a YF outbreak, we analyzed epizootic surveillance data and assessed YF vaccine coverage, timeliness of implementation of vaccination in unvaccinated human populations. From October 2008 through June 2009, circulation of YF virus was confirmed in 67 municipalities in Rio Grande do Sul State; vaccination was recommended in 23 (34%) prior to the outbreak and in 16 (24%) within two weeks of first epizootic report. In 28 (42%) municipalities, vaccination began more than two weeks after first epizootic report. Eleven (52%) of 21 laboratory-confirmed human YF cases occurred in two municipalities with delayed vaccination. By 2010, municipalities with confirmed YF epizootics reported higher vaccine coverage than other municipalities that began vaccination. In unvaccinated human populations timely response to epizootic events is critical to prevent human yellow fever cases. [ABSTRACT FROM AUTHOR]

Current control methodologies have not prevented the spread of visceral leishmaniasis (VL) across Brazil. Here, we describe the development of a new tool for controlling the sand fly vector of the disease: a long-lasting lure, which releases a synthetic male sex pheromone, attractive to both sexes of Lutzomyia longipalpis. This device could be used to improve the effectiveness of residual insecticide spraying as a means of sand fly control, attracting L. longipalpis to insecticide-treated animal houses, where they could be killed in potentially large numbers over a number of weeks. Different lure designs releasing the synthetic pheromone (±)-9-methylgermacrene-B (CAS 183158-38-5) were field-tested in Araçatuba, São Paulo (SP). Experiments compared numbers of sand flies caught overnight in experimental chicken sheds with pheromone lures, to numbers caught in control sheds without pheromone. Prototype lures, designed to last one night, were first used to confirm the attractiveness of the pheromone in SP, and shown to attract significantly more flies to test sheds than controls. Longer-lasting lures were tested when new, and at fortnightly intervals. Lures loaded with 1 mg of pheromone did not attract sand flies for more than two weeks. However, lures loaded with 10 mg of pheromone, with a releasing surface of 15 cm2 or 7.5 cm2, attracted female L. longipalpis for up to ten weeks, and males for up to twelve weeks. Approximately five times more sand flies were caught with 7.5 cm2 10 mg lures when first used than occurred naturally in non-experimental chicken resting sites. These results demonstrate that these lures are suitably long-lasting and attractive for use in sand fly control programmes in SP. To our knowledge, this is the first sex pheromone-based technology targeting an insect vector of a neglected human disease. Further studies should explore the general applicability of this approach for combating other insect-borne diseases. [ABSTRACT FROM AUTHOR]

Background: Little information on the factors influencing intraoperative cardiac arrest and its outcomes in trauma patients is available. This survey evaluated the associated factors and outcomes of intraoperative cardiac arrest in trauma patients in a Brazilian teaching hospital between 1996 and 2009. Methods: Cardiac arrest during anesthesia in trauma patients was identified from an anesthesia database. The data collected included patient demographics, ASA physical status classification, anesthesia provider information, type of surgery, surgical areas and outcome. All intraoperative cardiac arrests and deaths in trauma patients were reviewed and grouped by associated factors and also analyzed as totally anesthesia-related, partially anesthesia-related, totally surgery-related or totally trauma patient condition-related. Findings: Fifty–one cardiac arrests and 42 deaths occurred during anesthesia in trauma patients. They were associated with male patients (P<0.001) and young adults (18–35 years) (P = 0.04) with ASA physical status IV or V (P<0.001) undergoing gastroenterological or multiclinical surgeries (P<0.001). Motor vehicle crashes and violence were the main causes of trauma (P<0.001). Uncontrolled hemorrhage or head injury were the most significant associated factors of intraoperative cardiac arrest and mortality (P<0.001). All cardiac arrests and deaths reported were totally related to trauma patient condition. Conclusions: Intraoperative cardiac arrest and mortality incidence was highest in male trauma patients at a younger age with poor clinical condition, mainly related to uncontrolled hemorrhage and head injury, resulted from motor vehicle accidents and violence. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU) among Brazilian children/adolescents are extremely scarce and are needed to guide public policy. Objectives: To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders from four Brazilian regions; and to identify structural/psychosocial/demographic barriers associated with child/adolescent MHSU. Methods: Multicenter cross-sectional-study involving four towns from four out of five Brazilian regions. In each town, a representative sample of elementary public school students was randomly selected (sample: 1,721). Child/adolescent MHSU was defined as being seen by a psychologist/psychiatrist/neurologist in the previous 12 months. Standardized instruments measured: (1) children/adolescent characteristics [(1.1) Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL)-psychiatric disorders; (1.2) Ten Questions Screen-neurodevelopment problems; (1.3) two subtests of WISC-III-estimated IQ; (1.4) Academic Performance Test-school performance)], (2) factors related to mothers/main caregivers (Self-Reporting Questionnaire-anxiety/depression), (3) family (Brazilian Research-Companies-Association's Questionnaire-SES). Results: Only 19.8% of children/adolescents with psychiatric disorder have used mental health services in the previous 12 months. Multiple logistic regression modeling identified five factors associated with lower rates of MHSU (female gender, adequate school performance, mother/main caregiver living with a partner, lower SES, residing in deprived Brazilian regions) regardless of the presence of any psychiatric disorders/neurodevelopmental problems. Conclusions: Only a small proportion of children/adolescents with psychiatric disorders had been seen by a mental health specialist in the previous 12 months. Structural/psychosocial/demographic factors were associated with uneven access to service for certain groups of children/adolescents. These results call attention to the urgent need to implement programs to help reduce this large unmet mental health need; inequalities must be considered by policy makers when planning strategies to address barriers for care. [ABSTRACT FROM AUTHOR]

Background: More than 200,000 new cases of leprosy were reported by 105 countries in 2011. The disease is a public health problem in Brazil, particularly within high-burden pockets in the Amazon region where leprosy is hyperendemic among children. Methodology: We applied geographic information systems and spatial analysis to determine the spatio-temporal pattern of leprosy cases in a hyperendemic municipality of the Brazilian Amazon region (Castanhal). Moreover, we performed active surveillance to collect clinical, epidemiological and serological data of the household contacts of people affected by leprosy and school children in the general population. The occurrence of subclinical infection and overt disease among the evaluated individuals was correlated with the spatio-temporal pattern of leprosy. Principal Findings: The pattern of leprosy cases showed significant spatio-temporal heterogeneity (p<0.01). Considering 499 mapped cases, we found spatial clusters of high and low detection rates and spatial autocorrelation of individual cases at fine spatio-temporal scales. The relative risk of contracting leprosy in one specific cluster with a high detection rate is almost four times the risk in the areas of low detection rate (RR = 3.86; 95% CI = 2.26–6.59; p<0.0001). Eight new cases were detected among 302 evaluated household contacts: two living in areas of clusters of high detection rate and six in hyperendemic census tracts. Of 188 examined students, 134 (71.3%) lived in hyperendemic areas, 120 (63.8%) were dwelling less than 100 meters of at least one reported leprosy case, 125 (66.5%) showed immunological evidence (positive anti-PGL-I IgM titer) of subclinical infection, and 9 (4.8%) were diagnosed with leprosy (8 within 200 meters of a case living in the same area). Conclusions/Significance: Spatial analysis provided a better understanding of the high rate of early childhood leprosy transmission in this region. These findings can be applied to guide leprosy control programs to target intervention to high risk areas. [ABSTRACT FROM AUTHOR]

Background: Although child undernutrition and stunting has been decreasing worldwide while obesity rates increase, these extreme conditions might coexist in families from low- and middle-income countries. We examined the association between maternal and child anthropometric indicators using a population representative sample. Methods: 4,258 non-pregnant women and their children <60 months who participated in the 2006 Brazilian Demographic Health Survey. We compared the distributions of two nutritional indexes of children, height-for-age (HAZ) and body mass index-for age (BAZ) z-scores, by categories of maternal height, body mass index (BMI), and waist circumference (WC). Adjusted mean differences and 95% confidence intervals (95% CI) were estimated from linear regression, taking into account the complex survey design. We also examined the associations of maternal anthropometry with the prevalence of child stunting (HAZ<−2) and overweight/obesity (BAZ>2). Results: HAZ was positively associated with maternal height and WC in a linear fashion. After adjustment, for sociodemographic characteristics, children whose mothers' height was<145 cm had 1.2 lower HAZ than children whose mothers were ≥160 cm tall (p-trend<0.0001). After further adjustment for maternal height and maternal BMI, children of mothers with a waist circumference ≥88 cm had 0.3 higher HAZ than those of mothers with WC<80 cm (p-trend<0.01). Adjusted prevalence ratios and 95% CI for stunting by the categories of maternal height (<145, 145–149, 150–154, 155–159 and ≥160 cm) were, respectively, 2.95 (1.51;5.77), 2.29 (1.33;3.93), 1.09 (0.63;1.87), and 0.89 (0.45;1.77), (p-trend = 0.001). BAZ was positively associated with maternal BMI and WC. Conclusion: We observed a strong, positive association of maternal and child nutritional status. Mothers of low stature had children with lower stature, mothers with central obesity had taller children, and mothers with overall or abdominal obesity had children with higher BAZ. [ABSTRACT FROM AUTHOR]

Background: Road traffic injuries (RTI) are a major public health epidemic killing thousands of people daily. Low and middle-income countries, such as Brazil, have the highest annual rates of road traffic fatalities. In order to improve road safety, this study mapped road traffic fatalities on a Brazilian highway to determine the main environmental factors affecting road traffic fatalities. Methods and Findings: Four techniques were utilized to identify and analyze RTI hotspots. We used spatial analysis by points by applying kernel density estimator, and wavelet analysis to identify the main hot regions. Additionally, built environment analysis, and principal component analysis were conducted to verify patterns contributing to crash occurrence in the hotspots. Between 2007 and 2009, 379 crashes were notified, with 466 fatalities on BR277. Higher incidence of crashes occurred on sections of highway with double lanes (ratio 2∶1). The hotspot analysis demonstrated that both the eastern and western regions had higher incidences of crashes when compared to the central region. Through the built environment analysis, we have identified five different patterns, demonstrating that specific environmental characteristics are associated with different types of fatal crashes. Patterns 2 and 4 are constituted mainly by predominantly urban characteristics and have frequent fatal pedestrian crashes. Patterns 1, 3 and 5 display mainly rural characteristics and have higher prevalence of vehicular collisions. In the built environment analysis, the variables length of road in urban area, limited lighting, double lanes roadways, and less auxiliary lanes were associated with a higher incidence of fatal crashes. Conclusions: By combining different techniques of analyses, we have identified numerous hotspots and environmental characteristics, which governmental or regulatory agencies could make use to plan strategies to reduce RTI and support life-saving policies. [ABSTRACT FROM AUTHOR]

The Childhood Trauma Questionnaire (CTQ) is internationally accepted as a key tool for the assessment of childhood abuse and neglect experiences. However, there are relative few psychometric studies available and some authors have proposed two different factor solutions. We examined the dimensional structure and internal consistency of the Brazilian version of the CTQ. A total of 1,925 participants from eight different clinical and non-clinical samples including adolescents, adults and elders were considered in this study. First, we performed Confirmatory Factor Analysis to investigate the goodness of fit of the two proposed competitive factor structure models for the CTQ. We also investigated the internal consistency of all factors. Second, multi-group analyses were used to investigate measurement invariance and population heterogeneity across age groups and sex. Our findings revealed that the alternative factor structure as opposed to the original factor structure was the most appropriate model within adolescents and adults Brazilian samples. We provide further evidence for the validity and reliability of the CTQ within the Brazilian samples and report that the alternative model showed an improvement in fit indexes and may be a better alternative over the original model. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to assess the prevalence of hypertension and cardiovascular risk factors among the native indigenous of Jaguapiru village in Dourados, Mato Grosso do Sul, Brazil. Method: A cross-sectional, population-based study was conducted with adult indigenous aged 18 years or more. The subjects' blood pressure was measured twice, and the mean of the two measurements was calculated. Body weight, height, capillary blood glucose and waist circumference were measured. Pregnant women, individuals using glucocorticoids, and non-indigenous villagers and their offspring were excluded. Multivariate regression analyses were conducted on the socio-demographic and clinical independent variables. Interactions between independent variables were also tested. Results: We included 1,608 native indigenous eligible to the research. The prevalence of hypertension was 29.5% (95% CI: 27–31.5), with no significant difference between the genders. For both men and women, diastolic hypertension was more common than systolic hypertension. The prevalence of hypertension was higher among obese, diabetic, and older participants, as well as those who consumed alcohol, had a lower educational level, or had a family history of hypertension. There was no association between hypertension and tobacco smoking or family income. Conclusion: Hypertension among the indigenous from Jaguapiru village was similar to the prevalence in the Brazilians, but may have a more negative effect in such disadvantaged population. The associated factors we found can help drawing prevention policies. [ABSTRACT FROM AUTHOR]

Malaria is a significant public health threat in the Brazilian Amazon. Previous research has shown that deforestation creates breeding sites for the main malaria vector in Brazil, Anopheles darlingi, but the influence of selective logging, forest fires, and road construction on malaria risk has not been assessed. To understand these impacts, we constructed a negative binomial model of malaria counts at the municipality level controlling for human population and social and environmental risk factors. Both paved and unpaved roadways and fire zones in a municipality increased malaria risk. Within the timber production states where 90% of deforestation has occurred, compared with areas without selective logging, municipalities where 0–7% of the remaining forests were selectively logged had the highest malaria risk (1.72, 95% CI 1.18–2.51), and areas with higher rates of selective logging had the lowest risk (0.39, 95% CI 0.23–0.67). We show that roads, forest fires, and selective logging are previously unrecognized risk factors for malaria in the Brazilian Amazon and highlight the need for regulation and monitoring of sub-canopy forest disturbance. [ABSTRACT FROM AUTHOR]

The present study investigated the prevalence of HIV-1 multiple infections in a population composed by 47 patients under HAART failure and enrolled at the National DST/AIDS, Program, Ministry of Health, Brazil.Detection of multiple infections was done using a previously published RFLP assay for the HIV-1 protease gene, which is able of distinguishing between infections caused by a single or multiple HIV-1 subtypes. Samples with multiple infections were cloned, and sequence data submitted to phylogenetic analysis. We were able to identify 17 HIV-1 multiple infections out of 47 samples. Multiple infections were mostly composed by a mixture of recombinant viruses (94%), with only one case in which protease gene pure subtypes B and F were recovered. This is the first study that reports the prevalence of multiple infections and intersubtype recombinants in a population undergoing HAART in Brazil. Based on the data there was a steep increase of multiple infections after the introduction of the combined antiretroviral therapy in Brazil. Cases of multiple infections may be associated with HIV-1 genetic diversity through recombination allowing for the generation of viruses showing a combination of resistance mutations. [ABSTRACT FROM AUTHOR]

Visceral leishmaniasis (VL) has recently emerged in various urban and peri-urban areas of Brazil and other countries. Understanding the urbanization of VL requires identification of risk factors associated with human and canine infection. To determine the predictors of risk for canine VL, a survey was conducted of 1,443 dogs, from which a cohort was selected (n = 455) and evaluated for approximately 26 months. Serology was conducted with two enzyme-linked immunosorbent assays (ELISA): one conducted in the Laboratory of Zoonosis of the Belo Horizonte Health Department (LZOON) and the other in the Laboratory of Immunopathology of the Federal University of Ouro Preto (LIMP). A molecular diagnostic method (PCR–restriction fragment length polymorphism) and a structured questionnaire were also used. To identify the factors associated with seroconversion, two time-dependent Cox regression models were performed with different sensitivities (model 1, seroconversion by ELISA/LZOON; model 2, seroconversion by ELISA/LIMP). The overall incidences of seroconversion were 6.5/1000 dogs-months and 11.2/1000 dogs-months for ELISA/LZOON and ELISA/LIMP, respectively. Increased risk of seroconversion was associated with short fur (model 1: hazard ratio [HR] 1.9), the presence of dry leaves (model 1: HR 2.8) or manure (model 1: HR 3.5) in the backyard, dogs sleeping predominantly in the backyard (model 2: HR 2.1), the presence of symptoms (model 2: HR 2.0), and positive molecular results during follow-up (model 2: HR 1.5). Decreased risk was associated with insecticide spraying in the house (model 2: HR 0.5). These results indicate that more-vulnerable domiciles, certain dog behaviors, lack of vector control measures, and positive molecular results were associated with the occurrence of canine VL. Furthermore, it is important to emphasize that PCR-positive dogs should be monitored, owing to the possibility of seroconversion. Identifying risk factors for seroconversion in dogs is crucial for developing adequate strategies for VL prevention and control. [ABSTRACT FROM AUTHOR]

The wetlands of the Brazilian Pantanal host large concentrations of diverse wildlife species and hematophagous arthropods, conditions that favor the circulation of zoonotic arboviruses. A recent study from the Nhecolândia sub-region of Pantanal reported serological evidence of various flaviviruses, including West Nile virus and Ilheus virus (ILHV). According to the age of seropositive horses, at least three flaviviruses, including ILHV, circulated in the Brazilian Pantanal between 2005 and 2009. To extend this study, we collected 3,234 adult mosquitoes of 16 species during 2009 and 2010 in the same sub-region. Mosquito pool homogenates were assayed for infectious virus on C6/36 and Vero cell monolayers and also tested for flaviviral RNA by a group-specific real-time RT-PCR. One pool containing 50 non-engorged female specimens of Aedes scapularis tested positive for ILHV by culture and for ILHV RNA by real-time RT-PCR, indicating a minimum infection rate of 2.5 per 1000. Full-length genomic sequence exhibited 95% identity to the only full genome sequence available for ILHV. The present data confirm the circulation of ILHV in the Brazilian Pantanal. [ABSTRACT FROM AUTHOR]

Background: Schistosomiasis mansoni is an endemic parasitic disease and a public health problem in Northeast Brazil. In some patients, hepatic abnormalities lead to periportal fibrosis and result in the most severe clinical form, hepatosplenic schistosomiasis. This study aimed to evaluate whether abnormal blood coagulation and liver function tests in patients with hepatosplenic schistosomiasis (n = 55) correlate with the severity of their periportal fibrosis. Methodology/Principal Findings: Blood samples were used for liver function tests, hemogram and prothrombin time (International Normalized Ratio, INR). The blood coagulation factors (II, VII, VIII, IX and X), protein C and antithrombin IIa (ATIIa), plasminogen activator inhibitor 1 (PAI-1) and D-dimer were measured by photometry or enzyme linked immunosorbent assay. Hyperfibrinolysis was defined on the basis of PAI-1 levels and a D-dimer concentration greater than a standard cut-off of 483 ng/mL. Standard liver function tests were all abnormal in the patient group compared to healthy controls (n = 29), including raised serum transaminases (p<0.001) and lower levels of albumin (p = 0.0156). Platelet counts were 50% lower in patients, while for coagulation factors there was a 40% increase in the INR (p<0.001) and reduced levels of Factor VII and protein C in patients compared to the controls (both p<0.001). Additionally, patients with more advanced fibrosis (n = 38) had lower levels of protein C compared to those with only central fibrosis (p = 0.0124). The concentration of plasma PAI-1 in patients was one-third that of the control group (p<0.001), and D-dimer levels 2.2 times higher (p<0.001) with 13 of the 55 patients having levels above the cut-off. Conclusion/Significance: This study confirms that hemostatic abnormalities are associated with reduced liver function and increased liver fibrosis. Of note was the finding that a quarter of patients with hepatosplenic schistosomiasis and advanced periportal fibrosis have hyperfibrinolysis, as judged by excessive levels of D-dimer, which may predispose them to gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

A total of 179 individuals with acute Chagas disease mainly transmitted by oral source, from Pará and Amapá State, Amazonian, Brazil were included during the period from 1988 to 2005. Blood samples were used to survey peripheral blood for T. cruzi hemoparasites by quantitative buffy coat (QBC), indirect xenodiagnosis, blood culture and serology to detection of total IgM and anti-T. cruzi IgG antibodies by indirect immunofluorescence assay (IFA) and indirect hemagglutination assay (HA). All assays were performed pre-treatment (0 days) and repeated 35 (±7) and 68 (±6) days after the initiation of treatment with benznidazol and every 6 months while remained seropositive. The endpoint of collection was performed in 2005. Total medium period of follow-up per person was 5.6 years. Also, a blood sample was collected from 72 randomly chosen treated patients to perform polimerase chain reaction (PCR) method. Proportions of subjects with negative or positive serology according to the number of years after treatment were compared. In the endpoint of follow-up we found 47 patients (26.7%) serologically negative, therefore considered cured and 5 (2.7%) exhibited mild cardiac Chagas disease. Other 132 patients had persistent positive serologic tests. The PCR carried out in 72 individuals was positive in 9.8%. Added, there was evidence of therapeutic failure immediately following treatment, as demonstrated by xenodiagnosis and blood culture methods in 2.3% and 3.5% of cases, respectively. There was a strong evidence of antibody clearing in the fourth year after treatment and continuous decrease of antibody titers. Authors suggest that control programs should apply operational researches with new drug interventions four years after the acute phase for those treated patients with persistently positive serology. [ABSTRACT FROM AUTHOR]

Objective: To identify the incidence of and risk factors for tuberculosis in people living with HIV (PLHIV). Design: Observational, prospective cohort study. Methods: A total of 2069 HIV-infected patients was observed between July 2007 and December 2010. The Kaplan-Meier method was used to estimate the probability of survival free of tuberculosis, and Cox regression analysis to identify risk factors associated with the development of tuberculosis. Results: Survival free of tuberculosis (TB) was 91%. The incidence rate of tuberculosis was 2.8 per 100 persons/years. Incidence of tuberculosis was higher when subjects had CD4 cell count <200 cells/mm3; were not on antiretroviral therapy; in those who had, a body mass index <18.5 kg/m2, anemia (or were not tested for it), were illiterate or referred previous tuberculosis treatment at entry into the cohort. Those not treated for latent TB infection had a much higher risk (HR = 7.9) of tuberculosis than those with a negative tuberculin skin test (TST). Having a TST≥5 mm but not being treated for latent TB infection increased the risk of incident tuberculosis even in those with a history of previous tuberculosis. Conclusions: Preventive actions to reduce the risk of TB in people living with HIV should include an appropriate HAART and treatment for latent TB infection in those with TST≥5 mm. The actions towards enabling rigorous implementation of treatment of latent TB infection and targeting of PLHIV drug users both at the individual and in public health level can reduce substantially the incidence of TB in PLHIV. [ABSTRACT FROM AUTHOR]

Global dengue virus spread in tropical and sub-tropical regions has become a major international public health concern. It is evident that DENV genetic diversity plays a significant role in the immunopathology of the disease and that the identification of polymorphisms associated with adaptive responses is important for vaccine development. The investigation of naturally occurring genomic variants may play an important role in the comprehension of different adaptive strategies used by these mutants to evade the human immune system. In order to elucidate this role we sequenced the complete polyprotein-coding region of thirty-three DENV-3 isolates to characterize variants circulating under high endemicity in the city of São José de Rio Preto, Brazil, during the onset of the 2006-07 epidemic. By inferring the evolutionary history on a local-scale and estimating rates of synonymous (dS) and nonsynonimous (dN) substitutions, we have documented at least two different introductions of DENV-3 into the city and detected 10 polymorphic codon sites under significant positive selection (dN/dS > 1) and 8 under significant purifying selection (dN/dS < 1). We found several polymorphic amino acid coding sites in the envelope (15), NS1 (17), NS2A (11), and NS5 (24) genes, which suggests that these genes may be experiencing relatively recent adaptive changes. Furthermore, some polymorphisms correlated with changes in the immunogenicity of several epitopes. Our study highlights the existence of significant and informative DENV variability at the spatio-temporal scale of an urban outbreak. [ABSTRACT FROM AUTHOR]

Background: Leishmaniasis is endemic in 98 countries with an estimated 350 million people at risk and approximately 2 million cases annually. Brazil is one of the most severely affected countries. Methodology: We applied Bayesian geostatistical negative binomial models to analyze reported incidence data of cutaneous and visceral leishmaniasis in Brazil covering a 10-year period (2001–2010). Particular emphasis was placed on spatial and temporal patterns. The models were fitted using integrated nested Laplace approximations to perform fast approximate Bayesian inference. Bayesian variable selection was employed to determine the most important climatic, environmental, and socioeconomic predictors of cutaneous and visceral leishmaniasis. Principal Findings: For both types of leishmaniasis, precipitation and socioeconomic proxies were identified as important risk factors. The predicted number of cases in 2010 were 30,189 (standard deviation [SD]: 7,676) for cutaneous leishmaniasis and 4,889 (SD: 288) for visceral leishmaniasis. Our risk maps predicted the highest numbers of infected people in the states of Minas Gerais and Pará for visceral and cutaneous leishmaniasis, respectively. Conclusions/Significance: Our spatially explicit, high-resolution incidence maps identified priority areas where leishmaniasis control efforts should be targeted with the ultimate goal to reduce disease incidence. [ABSTRACT FROM AUTHOR]

Introduction: The implementation of a public HPV vaccination program in several developing countries, especially in Latin America, is a great challenge for health care specialists. Aim: To evaluate the uptake and the three-dose completion rates of a school-based HPV vaccination program in Barretos (Brazil). Methods: The study included girls who were enrolled in public and private schools and who regularly attended the sixth and seventh grades of elementary school (mean age: 11.9 years). A meeting with the parents or guardians occurred approximately one week before the vaccination in order to explain the project and clarify the doubts. The quadrivalent vaccine was administered using the same schedule as in the product package (0–2–6 months). The school visits for regular vaccination occurred on previously scheduled dates. The vaccine was also made available at Barretos Cancer Hospital for the girls who could not be vaccinated on the day when the team visited the school. Results: Among the potential candidates for vaccination (n = 1,574), the parents or guardians of 1,513 girls (96.1%) responded to the invitation to participate in the study. A total of 1,389 parents or guardians agreed to participate in the program (acceptance rate = 91.8%). The main reason for refusing to participate in the vaccination program was fear of adverse events. The vaccine uptake rates for the first, second, and third doses were 87.5%, 86.3% and 85.0%, respectively. The three-dose completion rate was 97.2%. Conclusions: This demonstrative study achieved high rates of vaccination uptake and completion of three vaccine doses in children 10–16 years old from Brazil. The feasibility and success of an HPV vaccination program for adolescents in a developing country may depend on the integration between the public health and schooling systems. [ABSTRACT FROM AUTHOR]

Background: Several studies have evaluated the relationship between diabetes mellitus (DM) and tuberculosis (TB), but the nature of this relationship is not fully understood. TB incidence may be influenced by immunosuppression from DM, but this association may be confounded by other clinical and socioeconomic factors. We aimed to assess socio-demographic and clinical differences in TB patients with and without DM. Methods: Using the Brazilian national surveillance system (SINAN), we compared 1,797 subjects with TB and DM with 29,275 subjects diagnosed with TB only in 2009. We performed multivariate analysis to identify factors associated with the presence of DM among TB patients. Results: Subjects with TB – DM were older; have initial positive sputum smear test (OR = 1.42, 95% CI 1.26–1.60), and were more likely to die from TB (OR = 1.44, 95% CI 1.03–2.01). They were less likely to have been institutionalized [in prison, shelter, orphanage, psychiatric hospital (OR = 0.74, 95% CI 0.60–0.93)]; developed extra pulmonary TB (OR = 0.62, 95% CI 0.51–0.75) and to return to TB treatment after abandonment (OR = 0.66, 95% CI 0.51–0.86). Conclusions: Prevalence of NCD continues to rise in developing countries, especially with the rise of elderly population, the prevention and treatment of infectious diseases will be urgent. DM and TB represent a critical intersection between communicable and non-communicable diseases in these countries and the effect of DM on TB incidence and outcomes provide numerous opportunities for collaboration and management of these complex diseases in the national public health programs. [ABSTRACT FROM AUTHOR]

Introduction: We describe temporal trends in the mortality rates and factors associated with AIDS and non-AIDS related mortality at the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (FIOCRUZ). Methods: Adult patients enrolling from 1986 through 2009 with a minimum follow up of 60 days were included. Vital status was exhaustively checked using patients’ medical charts, through active contact with individuals and family members and by linkage with the Rio de Janeiro Mortality database using a previously validated algorithm. The CoDe protocol was used to establish the cause of death. Extended Cox proportional hazards models were used for multivariate modeling. Results: A total of 3530 individuals met the inclusion criteria, out of which 868 (24.6%) deceased; median follow up per patient was 3.9 years (interquartile range 1.7–9.2 years). The dramatic decrease in the overall mortality rates was driven by AIDS-related causes that decreased from 9.19 deaths/100PYs n 1986–1991 to 1.35/100PYs in 2007–2009. Non-AIDS related mortality rates remained stable overtime, at around 1 death/100PYs. Immunodeficiency significantly increased the hazard of both AIDS-related and non-AIDS-related causes of death, while HAART use was strongly associated with a lower hazard of death from either cause. Conclusions: Our results confirm the remarkable decrease in AIDS-related mortality as the HIV epidemic evolved and alerts to the conditions not traditionally related to HIV/AIDS which are now becoming more frequent, needing careful monitoring. [ABSTRACT FROM AUTHOR]

Background: Latent tuberculosis infection (LTBI) is a reservoir for new TB cases. Isoniazid preventive therapy (IPT) reduces the risk of active TB by as much as 90%, but LTBI screening has limitations. Unlike tuberculin skin testing (TST), interferon-gamma release assays are not affected by BCG vaccination, and have been reported to be cost-effective in low-burden countries. The goal of this study was to perform a cost-effectiveness analysis from the health system perspective, comparing three strategies for LTBI diagnosis in TB contacts: tuberculin skin testing (TST), QuantiFERON®-TB Gold-in-Tube (QFT-GIT) and TST confirmed by QFT-GIT if positive (TST/QFT-GIT) in Brazil, a middle-income, high-burden country with universal BCG coverage. Methodology/Principal Findings: Costs for LTBI diagnosis and treatment of a hypothetical cohort of 1,000 adult immunocompetent close contacts were considered. The effectiveness measure employed was the number of averted TB cases in two years. Health system costs were US$ 105,096 for TST, US$ 121,054 for QFT-GIT and US$ 101,948 for TST/QFT-GIT; these strategies averted 6.56, 6.63 and 4.59 TB cases, respectively. The most cost-effective strategy was TST (US$ 16,021/averted case). The incremental cost-effectiveness ratio was US$ 227,977/averted TB case for QFT-GIT. TST/QFT-GIT was dominated. Conclusions: Unlike previous studies, TST was the most cost-effective strategy for averting new TB cases in the short term. QFT-GIT would be more cost-effective if its costs could be reduced to US$ 26.95, considering a TST specificity of 59% and US$ 18 considering a more realistic TST specificity of 80%. Nevertheless, with TST, 207.4 additional people per 1,000 will be prescribed IPT compared with QFT. [ABSTRACT FROM AUTHOR]

The American/Asian genotype of Dengue virus type 2 (DENV-2) was introduced into the Americas in the 80′s. Although there is no data showing when this genotype was first introduced into Brazil, it was first detected in Brazil in 1990. After which the virus spread throughout the country and major epidemics occurred in 1998, 2007/08 and 2010. In this study we sequenced 12 DENV-2 genomes obtained from serum samples of patients with dengue fever residing in São José do Rio Preto, São Paulo (SJRP/SP), Brazil, in 2008. The whole open reading frame or envelope sequences were used to perform phylogenetic, phylogeographic and evolutionary analyses. Isolates from SJRP/SP were grouped within one lineage (BR3) close to isolates from Rio de Janeiro, Brazil. Isolates from SJRP were probably introduced there at least in 2007, prior to its detection in the 2008 outbreak. DENV-2 circulation in Brazil is characterized by the introduction, displacement and circulation of three well-defined lineages in different times, most probably from the Caribbean. Thirty-seven unique amino acid substitutions were observed among the lineages, including seven amino acid differences in domains I to III of the envelope protein. Moreover, we dated here, for the first time, the introduction of American/Asian genotype into Brazil (lineage BR1) to 1988/89, followed by the introduction of lineages BR2 (1998–2000) and BR3 (2003–05). Our results show a delay between the introduction and detection of DENV-2 lineages in Brazil, reinforcing the importance and need for surveillance programs to detect and trace the evolution of these viruses. Additionally, Brazilian DENV-2 differed in genetic diversity, date of introduction and geographic origin and distribution in Brazil, and these are important factors for the evolution, dynamics and control of dengue. [ABSTRACT FROM AUTHOR]

Background: High technology in the field of interventional cardiology applied in tertiary hospitals has brought enormous benefits in the treatment of ischemic heart disease (IHD). However, IHD mortality rates remain high. We analyzed the relationship between IHD mortality rate and the socioeconomic, demographic, and geographic conditions in 399 cities in Parana state, Brazil, from 2006 to 2010. Methods and Results: Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics and evaluated through Exploratory Spatial Data Analysis. GeoDa™ was used to analyze 29.351 deaths across 399 cities. We found a positive spatial autocorrelation regarding IHD mortality (I = 0.5913, p = 0.001). There was a significant positive association between each of three socioeconomic and demographic indicators and IHD mortality rate: Population Elderly Index (I = 0.3436), Illiteracy Rate (I = 0.1873) and City Development Index (I = 0.0900). In addition, two indicators presented significant negative association with IHD mortality rate: Adjusted Population Size (I = −0.1216) and Gross Domestic Product (I = −0.0864). We also found a positive association between IHD mortality rates and the geographic distances between patients’ city of residence and their corresponding regional referral centers in interventional cardiology (I = 0.3368). Cities located within Regional Health Units with Reference Interventional Cardiology Center presented a significantly lower average specific mortality rate by IHD. The high mortality rate by IHD within the Regional Health Units was not restricted to socioeconomic and demographic variables, but dependent on the distance between each city and their reference interventional cardiology center. Conclusions: We conclude that geographic factors play a significant role in IHD mortality within cities. These findings have important policy implications regarding the geographic distribution of cardiac health care networks in Latin America and in other emerging countries. [ABSTRACT FROM AUTHOR]