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Primary health care has been recognized as a critical strategy for improving population health in developing countries. This paper investigates the effect of primary care physicians on the infant mortality rate in Brazil using a dynamic panel data approach. This method accounts for the endogeneity problem and the persistence of infant mortality over time. The empirical analysis uses an eight-year panel of municipalities between 2005 and 2012. The results indicate that primary care physician supply contributed to the decline of infant mortality in Brazil. An increase of one primary care physician per 10,000 population was associated with 7.08 fewer infant deaths per 10,000 live births. This suggests that, in addition to other determinants, primary care physicians can play an important role in accounting for the reduction of infant mortality rates. [ABSTRACT FROM AUTHOR]

Due to the lack of studies with a regional focus on the richness and distribution of the fauna of chiropterans in northeastern Brazil, this paper presents a collection of these data gathered in an extensive literature review. The data analyzed include technical reports of environment consulting agencies, abstracts presented in scientific meetings, monographs, dissertations, theses, papers, scientific notes, short communications, book chapters and books on bats of South America, Brazil and the biomes Amazon, Caatinga, Cerrado and Atlantic Forest. The numbers of municipalities surveyed per biome and the localities, municipalities and species richness for each state and biome in northeastern Brazil were determined. This information indicated the regions lacking more consistent Chiroptera sampling efforts, namely large areas in the Amazon, Caatinga and Cerrado. However, bat surveys in Atlantic Forest environments in most northeastern Brazilian states were considered representative. Although bat populations in some states have been poorly surveyed, the results of this review afford to conclude that a large part of the diversity of bat species known in Brazil has been reported for the northeastern region of the country. This review enlarges the knowledge on bat species richness and distribution in northeastern Brazil, and indicates areas suffering from wide survey gaps. [ABSTRACT FROM AUTHOR]

Objective: This study analysed clinical and sociodemographic aspects and follow-up for notified cases of tuberculosis (TB) and explored inequalities in incidence rates and outcome by colour or race and the geographic macro-regions of Brazil. Methods: This paper reports the results of a population-based descriptive epidemiological study of all notified cases of TB in Brazil during the period from 01/01/2008 to 31/12/2011. We analysed sociodemographic and clinical variables according to colour or race (white, black, Asian, mixed, and indigenous) and geographic macro-regions of the country (North, Northeast, Central-West, South, and Southeast). Results: During the study period, the average incidence of TB in Brazil was 36.7 cases per 100,000 inhabitants, with the highest rates occurring in the North and Southeast regions. The analysis of TB notifications by colour or race revealed that the indigenous population presented the highest incidence rates in all macro-regions except the South, where higher rates were reported in black patients. ‘Cured’ was the most frequently reported treatment outcome for all skin colour categories. The highest cure rate occurred among the indigenous population (76.8%), while the lowest cure rate occurred among the black population (70.7%). Rates of treatment default were highest among blacks (10.5%) and lowest among the indigenous population (6.9%). However, the fatality rate was similar across race categories, varying between 2.8% and 3.8% for whites and the indigenous population, respectively. The lowest cure rates were observed when follow-up was inadequate (58.3%), and the highest was observed when the follow-up was classified as excellent (96.8%). Conclusions: This study revealed that—apart from the heterogeneous distribution of TB among the Brazilian macro-regions—ethnic-racial inequalities exist in terms of clinical-epidemiological characteristics and incidence rates as well as follow-up for cases undergoing treatment. The highest rates of TB occurred among the indigenous people. [ABSTRACT FROM AUTHOR]

AmeroseiusBerlese is the most numerous genus of family Ameroseiidae Evans (in Hughes 1961). Species of this genus have been reported from many regions around the world. A few species of this genus are known from Brazil.Ameroseius mineiroNarita, Bernardi and Moraes, sp. nov. is described based on the morphology of adult females and males collected from guano in caves of Minas Gerais State, Brazil. This is the secondAmeroseiusspecies described from Brazil. The holotypes ofAmeroseius plumosus(Oudemans) andAmeroseius plumigera(Oudemans) were examined, given their close similarity with the species described in this paper, and they are here redescribed. A key is provided to separate these and other most similar species.http://www.zoobank.org/urn:lsid:zoobank.org:pub:17A7D831-EC49-4D65-B06B-5E13EF52C696 [ABSTRACT FROM AUTHOR]

In this paper I examined the usefulness of tree population size distributions in evaluating the conservation status of populations of an endangered tree species. I set expectations derived from two complimentary views of the ecology of rainforest trees and examined whether they were met by size distributions of populations of the South American dominant conifer Araucaria angustifolia and its relationship with forest structural characteristics. Specifically, I evaluated the expectations that (i) A. angustifolia trees have larger diameter than average angiosperm trees and form a higher monospecific canopy layer above the shorter angiosperm canopies; (ii) A. angustifolia populations are characterized by size distributions with many large individuals and a long tail of relatively rare, small individuals (have symmetry coefficient <0); (iii) the symmetry of the size distribution of A. angustifolia populations is negatively related to the abundance of large (d.b.h. ≥ 10.0 cm) individuals in the population; and (iv) the abundance of A. angustifolia trees is negatively related to the abundance of angiosperm trees, as the successional accumulation of angiosperm stems would not be accompanied by the recruitment of new A. angustifolia. These expectations were evaluated using data on 25 populations of A. angustifolia sampled in the Rio Grande do Sul State in southern Brazil. The first, third and fourth expectations were met, while the second one was only partially met. This was because populations showed a bimodal distribution regarding symmetry in size distribution, with most populations showing normal or negative symmetry, and those logged, adult-depleted populations showing positive skewness. [ABSTRACT FROM AUTHOR]

To quantify the relationship between the description dates of anuran species in the Brazilian Cerrado and some macroecological traits, and to verify the spatial patterns of average description dates and their correlation with human occupation and biodiversity knowledge. Brazilian Cerrado (South America). The average date of description of 131 species of anurans found in 181 cells overlaying the Brazilian Cerrado was recorded. Description date was regressed across species on body size and geographical range size. Phylogenetic effects that could bias the significance tests of the multiple regression model of description dates on macroecological traits were taken into account using a phylogenetic subtraction method in which families and genera were classificatory factors in a nested two-way analysis of variance ( anova) model. We also conducted a spatial analysis of the average description date that was estimated for each cell. This cell-based metric was regressed on human population size, the year of foundation of the municipalities and the number of inventories undertaken in each cell. The influence of spatial autocorrelation patterns was taken into account by using the geographically effective number of degrees of freedom. The number of new species being discovered in the Brazilian Cerrado has been increasing, especially over the last 50 years. Cross-species analyses indicated that description dates were negatively correlated with body size and geographical range size, taking phylogenetic effects into account. Even after controlling for the spatial structures in all variables, average description date was positively correlated with human population in geographical space, but because of multicolinearity structure in the data, it was not possible to quantify the independent influence of human population and number of inventories on description date. As found in previous papers, large-bodied and widely distributed species are likely to be described first. Species yet to be discovered are probably small-bodied and with narrow distributions, more restricted to the Cerrado biome. Also, the explicit spatial approach showed that the average description date is spatially correlated with total human population and biodiversity knowledge in the Cerrado region. Our findings suggest that incorporating human population density into the reserve design algorithms, which has usually been done to avoid or minimize conservation conflicts, may also produce good results because this will preserve many places where most of the non-described species will probably be found in the future. [ABSTRACT FROM AUTHOR]

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Nematode diseases have a worldwide importance for several economic agricultural crops, such as soybean. Frequently, new or secondary pathogens arise as emergent diseases due to the intensified use of agricultural lands, causing extensive yield losses. Helicotylenchus dihystera (Hd) and Scutellonema brachyurus (Sb) appear as potential pathogens for soybean in Brazil, since their spread and population densities have been increased on soybean growing areas. Aiming to evaluate the quantitative distribution of Hd and Sb in soybean fields in South Brazil, a survey was conducted during the growing seasons of 2014–2015 and 2015–2016 in which 1,088 soil samples and 1,043 root samples were analyzed. Besides, two greenhouse experiments were conducted to evaluate the pathogenicity of both nematodes to soybean plants, in comparison with P. brachyurus (Pb), a known pathogen of the crop. The survey demonstrated that Pb, Hd and Sb are widely distributed in the States of Paraná, Santa Catarina and Mato Grosso do Sul. Besides, we proved that Hd and Sb multiply and cause root lesions in soybean cv. Potência, since they were found inside roots, and can be considered as potential pathogens for soybean plants. [ABSTRACT FROM AUTHOR]

Background: Cryptococcosis is a neglected and predominantly opportunistic mycosis that, in Brazil, poses an important public health problem, due to its late diagnosis and high lethality. Methods: The present study analysed cryptococcosis mortality in Brazil from January 2000 to December 2012, based on secondary data (Mortality Information System/SIM-DATASUS and IBGE). Results: Out of 5,755 recorded deaths in which cryptococcosis was mentioned as one of the morbid states that contributed to death, two distinct groups emerged: 1,121 (19.5%) registered cryptococcosis as the basic cause of death, and 4,634 (80.5%) registered cryptococcosis associated with risk factors, mainly AIDS (75%), followed by other host risks (5.5%). The mortality rate by cryptococcosis as the basic cause was 6.19/million inhabitants, whereas the mortality rate by cryptococcosis as an associated cause was 25.19/million inhabitants. Meningitis was the predominant clinical form (80%), males were the more affected (69%), and 39.5 years old was the mean age. The highest mortality rate due to cryptococcosis as basic cause occurred in the state of Mato Grosso (10.96/million inhabitants). Mortality rates due to cryptococcosis as associated cause were highest in the states of Santa Catarina (70.41/million inhabitants) and Rio Grande do Sul (64.40/million inhabitants), both in the South Region. Southeast, Northeast and South showed significant time trends in mortality rates. Conclusions: This study is relevant because it shows the magnitude of cryptococcosis mortality linked to AIDS and removes the invisibility of a particular non-AIDS-related disease, accounting for almost 20% of all cryptococcosis deaths. It can also contribute to control and surveillance programs, beyond highlighting the urgent prioritization of early diagnosis and proper treatment to reduce the unacceptable mortality rate of this neglected mycosis in Brazil. [ABSTRACT FROM AUTHOR]

Coffee is a crop of significant importance for Brazilian agrobusiness. There is evidence that both the geographic distribution of coffee production, and the varieties of coffee produced, have changed throughout Brazil over the course of time. Furthermore, it appears that these developments are associated with structural changes resulting from reductions in government intervention and its effects on prices in the coffee market, which has established a new dynamic of coffee production in the country. In this context, this study’s objective is to analyze the dynamics of coffee production in Brazil, to identify the Brazilian micro-regions specializing in coffee activities, and to track how the spatial distribution of these micro-regions has varied over time. In so doing, the study aims to identify defining economic characteristics of primary coffee-producing regions. Drawing primarily on data from the Brazilian Institute of Geography and Statistics, the study proceeds by applying Pearson correlation, Granger causality test, location quotient, principal components, and clustering analyses to explore how, during the 1984–2015 period, significant changes occurred in the distribution of regions specializing in coffee production. States such as Paraná and São Paulo, historically important coffee producers, declined in importance, leaving only a few micro-regions in these states specialized in coffee production. During the 2014/15 biennium, 80% of the coffee-specialized micro-regions were concentrated in the states of Minas Gerais, Bahia, Rondônia, and Espírito Santo. Minas Gerais and Bahia primarily produced arabica coffee, while Rondônia specialized in conilon (robusta) coffee. Overall, coffee produced in Brazil improved in quality and value-added over this period. [ABSTRACT FROM AUTHOR]

High-energy freshwater environments such as rapids and waterfalls in the Upper-Paraná Atlantic Forest are home to highly endemic minute freshwater snails of the genus Acrorbis. Only one species, Acrorbis petricola, is currently included within this genus, whose geographical distribution is restricted to three known populations, one in Brazil and the other two in Argentina. Because of habitat specificity and limited geographical distribution, the species is considered vulnerable in Argentina and endangered in Brazil. In this work, we identify five new populations of A. petricola in southern Upper-Paraná Atlantic Forest, exclusively found on waterfalls from the Misiones Province, Argentina. Based on these populations and on specimens of one of the two historical populations from the Misiones Province, we explored the morphological features of shells and reproductive system of specimens from each location and provide the first molecular data on the species. We used DNA sequences from cytochrome c oxidase subunit I (COI) and 16S-rRNA genes to investigate the molecular diversity, genetic distances and genealogical relationships among populations. We verified the existence of intra- and interpopulation morphological variability, with the greatest variation being found in spire, spiral sculpture, penis sheath, flagella, prostatic diverticula and bursa copulatrix. We found interpopulation genetic diversity, with no intrapopulation variation, and identified six geographically structured genetic lineages with maximum genetic distances of up to 2.3%. Different combinations of morphological characters with the same genetic background within each locality were observed. The finding of new populations genetically differentiated not only broadens the known distribution of the species, but also illustrates that waterfall environments in the Atlantic Forest harbour a hidden diversity of Acrorbis that still remains to be discovered. This scenario suggests a complex evolutionary history that needs to be unveiled and taken into account for future development of conservation strategies in this endemic genus. [ABSTRACT FROM AUTHOR]

The family Sciaenidae comprises about 300 species. The black drum Pogonias cromis was the only valid species of the genus. Herein, Pogonias courbina Lacepède 1803 is redescribed based on morphological and molecular evidence and a neotype is designated. Pogonias courbina is distinguished by the following characters: the occurrence of characteristic thickening of the dorsal spines VII to XI in all specimens larger than 250 mm SL; all pterygiophores in the dorsal-fin laminar, thin; anal-fin pterygiophores slender excluded those of spines; lateral projections of gas bladder with few finger-like projections; genetic distance between both species 1%; exclusive occurrence of characters in six informative sites of COI (58 G; 214 G; 328 A; 331 A; 553C; 580 G). The method Automatic Barcode gap Discovery detected gaps in nucleotid distance congruent with the NJ, MP, and ML tree analysis. Also, advertisement calls are three times shorter in duration in P. courbina than in P. cromis. In addition, two monophyletic groups for P. cromis and P. courbina appear in trees obtained with different methodologies, emphasizing the absence of shared haplotypes. A gap of about 8000 km occurs in the distribution of both species along coastal areas of the Atlantic Ocean. [ABSTRACT FROM AUTHOR]

Efforts to reverse the decline of endangered golden lion tamarin monkeys have been relatively successful because the Brazilian organization dedicated to the species’ conservation (Associação Mico-Leão-Dourado, AMLD) relies on science-based computer modeling to determine the number of tamarins necessary to achieve demographic and genetic goals, and a process of strategic planning to achieve those goals. Accurate estimates of the numbers of tamarins in forest fragments are essential to evaluate progress in achieving goals and adapt strategies as necessary. In this report we present the results of a new method to survey the number of tamarins in the wild, a modification of the point transect with lures procedure. Using this method, we estimate that in 2014 there were approximately 3,700 golden lion tamarins in 41,400 hectares of Atlantic Forest. Of these, 59% are from remnant wild populations, 34% are descendants of captive-born reintroduced animals and 7% are descendants of wild translocated groups. The number of tamarins and amount of forest estimated in this survey exceeded values necessary to meet AMLD’s definition of a viable population, determined to be 2,000 tamarins in 25,000 hectares of connected and protected forest. However, the seven forest blocks and their tamarin populations are not yet adequately connected and protected. AMLD’s strategic plan to achieve a viable population of golden lion tamarins includes 12 strategies that mitigate these and other threats or contribute directly to the conservation goal. The point transect with lures survey method provides a way to evaluate progress in achieving that goal and adapt strategies as appropriate. [ABSTRACT FROM AUTHOR]

The market demand for octopus grows each year, but landings are decreasing, and prices are rising. The present study investigated (1) diversity of Octopodidae in the Western Indian Ocean (WIO) and (2) connectivity and genetic structure of Octopus cyanea and O. vulgaris populations in order to obtain baseline data for management plans. A fragment of the cytochrome C oxidase subunit 1 (COI) gene was sequenced in 275 octopus individuals from Madagascar, Kenya and Tanzania. In addition, 41 sequences of O. vulgaris from South Africa, Brazil, Amsterdam Island, Tristan da Cunha, Senegal and Galicia were retrieved from databases and included in this study. Five different species were identified using DNA barcoding, with first records for O. oliveri and Callistoctopus luteus in the WIO. For O. cyanea (n = 229, 563 bp), 22 haplotypes were found, forming one haplogroup. AMOVA revealed shallow but significant genetic population structure among all sites (ϕST = 0.025, p = 0.02), with significant differentiation among: (1) Kanamai, (2) southern Kenya, Tanzania, North and West Madagascar, (3) Southwest Madagascar and (4) East Madagascar (ϕCT = 0.035, p = 0.017). For O. vulgaris (n = 71, 482 bp), 15 haplotypes were identified, forming three haplogroups. A significant genetic population structure was found among all sites (ϕST = 0.82, p ≤ 0.01). Based on pairwise ϕST-values and hierarchical AMOVAs, populations of O. vulgaris could be grouped as follows: (1) Brazil, (2) Madagascar and (3) all other sites. A significant increase in genetic distance with increasing geographic distance was found (Z = 232443, 81 r = 0.36, p = 0.039). These results indicate that for O. cyanea four regions should be considered as separate management units in the WIO. The very divergent haplogroups in O. vulgaris from Brazil and Madagascar might be evolving towards speciation and therefore should be considered as separate species in FAO statistics. [ABSTRACT FROM AUTHOR]

Background: Linking routinely-collected data provides an opportunity to measure the effects of exposures that occur before birth on maternal, fetal and infant outcomes. High quality linkage is a prerequisite for producing reliable results, and there are specific challenges in mother-baby linkage. Using population-based administrative databases from Brazil, this study aimed to estimate the accuracy of linkage between maternal deaths and birth outcomes and dengue notifications, and to identify potential sources of bias when assessing the risk of maternal death due to dengue in pregnancy. Methods: We identified women with dengue during pregnancy in a previously linked dataset of dengue notifications in women who had experienced a live birth or stillbirth during 2007–2012. We then linked this dataset with maternal death records probabilistically using maternal name, age and municipality. We estimated the accuracy of the linkage, and examined the characteristics of false-matches and missed-matches to identify any sources of bias. Results: Of the 10,259 maternal deaths recorded in 2007–2012, 6717 were linked: 5444 to a live birth record, 1306 to a stillbirth record, and 33 to both a live and stillbirth record. After identifying 2620 missed-matches and 124 false-matches, our estimated sensitivity was 72%, specificity was 88%, and positive predictive value was 98%. Linkage errors were associated with maternal education and self-identified race; women with more than 7 years of education or who self-declared as Caucasian were more likely to link. Dengue status was not associated with linkage error. Conclusion: Despite not having unique identifiers to link mothers and birth outcomes, we demonstrated a high standard of linkage, with sensitivity and specificity values comparable to previous literature. Although there were no differences in the characteristics of dengue cases missed or included in our linked dataset, linkage error occurred disproportionally by some social-demographic characteristics, which should be taken into account in future analyses. [ABSTRACT FROM AUTHOR]

Family Health Strategy, the primary health care program in Brazil, has been scaled up throughout the country, but its expansion has been heterogeneous across municipalities. We investigate if there are unique municipal characteristics that can explain the timing of uptake and the pattern of expansion of the Family Health Strategy from years 1998 to 2012. We categorized municipalities in six groups based on the relative speed of the Family Health Strategy uptake and the pattern of Family Health Strategy coverage expansion. We assembled data for 11 indicators for years 2000 and 2010, for 5,507 municipalities, and assessed differences in indicators across the six groups, which we mapped to examine spatial heterogeneities. Important factors differentiating early and late adopters of the Family Health Strategy were supply of doctors and population density. Sustained coverage expansion was related mainly to population size, marginal benefits of the program and doctors’ supply. The uptake was widespread nationwide with no distinct patterns among regions, but highly heterogeneous at the state and municipal level. The Brazilian experience of expanding primary health care offers three lessons in relation to factors influencing diffusion of primary health care. First, the funding mechanism is critical for program implementation, and must be accompanied by ways to support the supply of primary care physicians in low density areas. Second, in more developed and bigger areas the main challenge is lack of incentives to pursue universal coverage, especially due to the availability of private insurance. Third, population size is a crucial element to guarantee coverage sustainability over time. [ABSTRACT FROM AUTHOR]

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

We project forward total Zika virus disease (ZVD) under varying hazards of infection and consider how the age distribution of disease burden varies between these scenarios. Pathogens with age structured disease outcomes, such as rubella and Zika virus, require that management decisions consider their impact not only on total disease incidence but also on distribution of disease burden within a population. Some situations exhibit a “paradox of control” in which reductions of overall transmission decrease the total incidence but increase the incidence of severe disease. This happens because of corresponding increases in the average age of infection. Beginning with the current population structure and demographic rates of Brazil, we project forward total ZVD burden as measured by cases occurring in pregnant women and document the scenarios under which a paradox of control for ZVD management emerges. We conclude that while a paradox of control can occur for ZVD, the higher total costs from increasing the average age of infection will only be realized after several decades and vanish under conservative discounting of future costs. This indicates that managers faced with an emerging pathogen are justified to prioritize current disease incidence over potential increases in severe disease outcomes in the endemic state. [ABSTRACT FROM AUTHOR]

The main objective of the study was to analyze the effect of age, period and birth cohort on esophageal cancer mortality in Brazil and its geographic regions, per sex. An ecological study is presented herein, which evaluated the deaths by esophageal cancer and the distribution, per geographic region. Poisson Regression was utilized to calculate the effects of age, period and birth cohort, and projections were made with the statistical software R, using the age-period-cohort model. Projection of data covered the period 2015–2029. Regarding the geographic regions of Brazil, a decrease was verified, throughout time, for the mortality rates of the South and Southeast regions, for men and women. For the North, Northeast and Midwest regions, an increase was evidenced in mortality rates, mainly for men, after the 2000's. Regarding the projections, a progressive increase of mortality rates was verified for the Northeast and North regions. Divergences evidenced for observed and projected esophageal cancer mortality rates revealed inequalities among the geographic regions of Brazil. [ABSTRACT FROM AUTHOR]

Introduction: The aims of this study were to estimate all-cause and cause-specific mortality and years of life lost, investigated by disability-adjusted life-years (DALYs), due to colorectal cancer attributable to physical inactivity in Brazil and in the states; to analyze the temporal trend of these estimates over 25 years (1990–2015) compared with global estimates and according to the socioeconomic status of states of Brazil. Methods: Databases from the Global Burden of Disease Study (GBD) for Brazil, Brazilian states and global information were used. It was estimated the total number and the age-standardized rates of deaths and DALYs for colorectal cancer attributable to physical inactivity in the years 1990 and 2015. We used the Socioeconomic Development Index (SDI). Results: Physical inactivity was responsible for a substantial number of deaths (1990: 1,302; 2015: 119,351) and DALYs (1990: 31,121; 2015: 87,116) due to colorectal cancer in Brazil. From 1990 to 2015, the mortality and DALYs due to colorectal cancer attributable to physical inactivity increased in Brazil (0.6% and 0.6%, respectively) and decreased around the world (-0.8% and -1.1%, respectively). The Brazilian states with better socioeconomic indicators had higher rates of mortality and morbidity by colorectal cancer due to physical inactivity (p<0.01). Physical inactivity was responsible for deaths and DALYs due to colorectal cancer in Brazil. Conclusions: Over 25 years, the Brazilian population showed more worrisome results than around the world. Actions to combat physical inactivity and greater cancer screening and treatment are urgent in the Brazilian states. [ABSTRACT FROM AUTHOR]

The impacts of global climate change have been a worldwide concern for several research areas, including those dealing with resources essential to human well being, such as agriculture, which directly impact economic activities and food security. Here we evaluate the relative effect of climate (as indicated by the Ecological Niche Model—ENM) and agricultural technology on actual soybean productivity in Brazilian municipalities and estimate the future geographic distribution of soybeans using a novel statistical approach allowing the evaluation of partial coefficients in a non-stationary (Geographically Weighted Regression; GWR) model. We found that technology was more important than climate in explaining soybean productivity in Brazil. However, some municipalities are more dependent on environmental suitability (mainly in Southern Brazil). The future environmental suitability for soybean cultivation tends to decrease by up 50% in the central region of Brazil. Meanwhile, southern-most Brazil will have more favourable conditions, with an increase of ca. 25% in environmental suitability. Considering that opening new areas for cultivation can degrade environmental quality, we suggest that, in the face of climate change impacts on soybean cultivation, the Brazilian government and producers must invest in breeding programmes and more general ecosystem-based strategies for adaptation to climate change, including the development of varieties tolerant to climate stress, and strategies to increase productivity and reduce costs (social and environmental). [ABSTRACT FROM AUTHOR]

Background: Differential trends in mortality suggest that stillbirths may dominate neonatal mortality in the medium to long run. Brazil has made major efforts to improve data collection on health indicators at granular geographic levels, and provides an ideal environment to test this hypothesis. Our goals were to examine levels and trends in stillbirths and neonatal deaths and the extent to which the mortality burden caused by stillbirths dominates neonatal mortality at the municipality- and state-level. Methods: We used data from the Brazilian Ministry of Health’s repository on births, fetal, and neonatal deaths (2010–2014) to calculate stillbirth and neonatal mortality rates for São Paulo state’s 645 municipalities. Results: At the state level, 7.9 per 1000 pregnancies ended in stillbirth (fetal death >22 weeks gestation or fetal weight >500g), but this varied from 0.0 to 28.4 per 1000 across municipalities. 7.9 per 1000 live births also died within the first 28 days. 42% of municipalities had a higher stillbirth rate than neonatal mortality rate, and in 61% of areas with low neonatal mortality (<8.0 per 1000), stillbirth rates exceeded neonatal mortality rates. Conclusions: This analysis suggests large variability and inequality in mortality outcomes at the sub-national level. The results also imply that stillbirth mortality may exceed neonatal mortality in Brazil and similar settings in the next few decades, which suggests a need for a shift in policy. This work further underscores the importance of continued research into causes and prevention of stillbirth. [ABSTRACT FROM AUTHOR]

Invasive species are one among many threats to biodiversity. Brazil has been spared, generically, of several destructive invasive species. Reports of invasive snakes’ populations are nonexistent, but the illegal pet trade might change this scenario. Despite the Brazilian laws forbid to import most animals, illegal trade is frequently observed and propagules are found in the wild. The high species richness within Brazilian biomes and accelerated fragmentation of natural reserves are a critical factors facilitating successful invasion. An efficient way to ease damages caused by invasive species is identifying potential invaders and consequent prevention of introductions. For the identification of potential invaders many factors need to be considered, including estimates of climate matching between areas (native vs. invaded). Ecological niche modelling has been widely used to predict potential areas for invasion and is an important tool for conservation biology. This study evaluates the potential geographical distribution and establishment risk of Lampropeltis getula (Linnaeus, 1766), Lampropeltis triangulum (Lacépède, 1789), Pantherophis guttatus (Linnaeus, 1766), Python bivittatus Kuhl, 1820 and Python regius (Shaw, 1802) through the Maximum Entropy modelling approach to estimate the potential distribution of the species within Brazil and qualitative evaluation of specific biological attributes. Our results suggest that the North and Midwest regions harbor major suitable areas. Furthermore, P. bivittatus and P. guttatus were suggested to have the highest invasive potential among the analyzed species. Potentially suitable areas for these species were predicted within areas which are highly relevant for Brazilian biodiversity, including several conservation units. Therefore, these areas require special attention and preventive measures should be adopted. [ABSTRACT FROM AUTHOR]

Background: Aedes aegypti, commonly known as “the yellow fever mosquito”, is of great medical concern today primarily as the major vector of dengue, chikungunya and Zika viruses, although yellow fever remains a serious health concern in some regions. The history of Ae. aegypti in Brazil is of particular interest because the country was subjected to a well-documented eradication program during 1940s-1950s. After cessation of the campaign, the mosquito quickly re-established in the early 1970s with several dengue outbreaks reported during the last 30 years. Brazil can be considered the country suffering the most from the yellow fever mosquito, given the high number of dengue, chikungunya and Zika cases reported in the country, after having once been declared “free of Ae. aegypti”. Methodology/Principal findings: We used 12 microsatellite markers to infer the genetic structure of Brazilian Ae. aegypti populations, genetic variability, genetic affinities with neighboring geographic areas, and the timing of their arrival and spread. This enabled us to reconstruct their recent history and evaluate whether the reappearance in Brazil was the result of re-invasion from neighboring non-eradicated areas or re-emergence from local refugia surviving the eradication program. Our results indicate a genetic break separating the northern and southern Brazilian Ae. aegypti populations, with further genetic differentiation within each cluster, especially in southern Brazil. Conclusions/Significance: Based on our results, re-invasions from non-eradicated regions are the most likely scenario for the reappearance of Ae. aegypti in Brazil. While populations in the northern cluster are likely to have descended from Venezuela populations as early as the 1970s, southern populations seem to have derived more recently from northern Brazilian areas. Possible entry points are also revealed within both southern and northern clusters that could inform strategies to control and monitor this important arbovirus vector. [ABSTRACT FROM AUTHOR]

Population biology, growth and reproductive aspects of the amphidromous shrimp Palaemon pandaliformis (Stimpson, 1871) were investigated in a Neotropical river of northeastern Brazil. The specimens were collected every month from September 2009 to August 2010. Total and monthly sex ratios deviated in favour of males. Von Bertalanffy growth parameters indicated that the females grew more rapidly, reached larger sizes, and had a longer life span than males. We also observed continuous reproductive activity and juvenile recruitment throughout the year. Relations between the number of eggs (fecundity) and body size indicated that fecundity in females increase with size. Compared with previous results, some population biology parameters of the freshwater population of P. pandaliformis differ from estuarine populations. The reproductive aspects analyzed here and their comparison with other marine species were consistent with the hypothesis that Palaemonidae species are undergoing an adaptation process and colonizing fresh water environments. [ABSTRACT FROM AUTHOR]

The Human immunodeficiency virus type-1 (HIV-1) epidemic in Brazil is mainly driven by the subtype B pandemic lineage (BPANDEMIC), while Caribbean non-pandemic subtype B clades (BCAR) seem to account for a very low fraction of HIV-infections in this country. The molecular characteristics of the HIV-1 subtype B strains disseminated in the Northern and Northeastern Brazilian regions, however, have not been explored so far. In this study, we estimate the prevalence of the HIV-1 BPANDEMIC and BCAR clades across different Brazilian regions and we reconstruct the spatiotemporal dynamics of dissemination of the major Brazilian BCAR clades. A total of 2,682 HIV-1 subtype B pol sequences collected from 21 different Brazilian states from the five country regions between 1998 and 2013 were analyzed. Maximum Likelihood phylogenetic analyses revealed that the BCAR strains reached 16 out 21 Brazilian states here analyzed. The BCAR clades comprise a low fraction (<10%) of subtype B infections in most Brazilian states analyzed, with exception of Roraima (41%), Amazonas (14%) and Maranhão (14%). Bayesian phylogeographic analyses indicate that BCAR strains originally from the Hispaniola and Trinidad and Tobago were introduced at multiple times into different states from all Brazilian regions and a few of those strains, probably introduced into Roraima, Maranhão and São Paulo between the late 1970s and the early 1980s, established secondary outbreaks in the Brazilian population. These results support that the HIV-1 subtype B epidemics in some Brazilian states from the Northern and Northeastern regions display a unique molecular pattern characterized by the high prevalence of BCAR lineages, which probably reflects a strong epidemiological link with the HIV-1 epidemics in the Caribbean region. [ABSTRACT FROM AUTHOR]

Osteological lesions can be important to positively identify human remains in forensic contexts, as well as contribute to past population studies. However, their analysis requires training and appropriate research conditions, which may be lacking in certain geographic areas as, for example, the northern region of Brazil. Emphasising existing resources, such as anatomical collections, may help to address this issue. This study explores the anatomical collection of Professor Dr. Manuel da Silva Braga of the Federal University of Pará (Brazil), introducing the traumatic lesions identified in seven crania (13.7%; 7/51) of male (four) and female (three) individuals. The sample profile and the cases identified are in accordance with the pattern of violent victims in the region. This study is the first of its kind in the Pará State, contributing with case studies and examples, to the disciplines of biological anthropology, paleopathology, and bioarchaeology and forensic discipline. It also highlights the significance that anatomical collections may have in the development of those disciplines, suggesting a need for reappraisal and reevaluation of existing resources, as these may be of use for training and research. Lastly, this study builds a bridge towards the social and cultural context of the collection, reinforcing the value of an interdisciplinary approach to human remains. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study aimed to examine Brazilian M. oryzae populations using 18 microsatellites. Fifty cultivars were sown in plastic trays for the pathotyping of 847 isolates. The DNA of 494 isolates was extracted and purified using the modified Doyle and Doyle method, the genetic structure was determined by the software Structure, and the actual number was selected from the prediction method based on the K values. Nei's genetic distance among the subpopulations was determined with the aid of the program Genetix, and the amova was performed with the program Arlequin. Out of 847 inoculated monosporic isolates, 528 infected their respective cultivars; of the 528 isolates pathotyped, there was a prevalence of group IA and pathotype IF-1, which was the most frequent pathotype in the rice production areas of Brazil. The Bayesian clustering analysis indicated that 19 was the optimal value of K; this value was the lowest standard deviation and log (ln K) closest to zero, which predicted the 494 isolates of M. oryzae that were selected for molecular studies to be grouped into 19 subpopulations. The AMOVA detected a 37.13% variability within the 19 subpopulations and 62.87% variability among the subpopulations. The polymorphic information content ( PIC) ranged from 0 to 0.756. Thirty three rare alleles were found distributed among 15 out of 19 subpopulations. The Margalef index ranged from 38.69 to 79.21 for all 18 analysed locus. The results indicated that the identification of different blast resistance genes must consider the composition of each subpopulation and that the identification is most effective when performed within a subpopulation and then between subpopulations. [ABSTRACT FROM AUTHOR]

Visceral leishmaniasis (VL) is a zoonosis found worldwide. Its incidence has increased in Brazil in recent years, representing a serious public and animal health problem. The strategies applied in Brazil are questionable and are not sufficient to control the disease. Thus, we have compared the efficacy of some of the currently available strategies focused on dogs to prevent and control zoonotic VL in endemic areas by optimizing a mathematical model. The simulations showed that the elimination of seropositive dogs, the use of insecticide-impregnated dog collars, and the vaccination of dogs significantly contribute to reducing the prevalence of infection in both canines and humans. The use of insecticide-impregnated collars presented the highest level of efficacy mainly because it directly affected the force of infection and vector-dog contact. In addition, when used at a coverage rate of 90%, insecticide-impregnated collar was able to decrease the prevalence of seropositive dogs and humans to zero; moreover, because of the easy application and acceptance by the targeted population, these collars may be considered the most feasible for inclusion in public policies among the three simulated measures. Vaccination and euthanasia were efficacious, but the latter method is strongly criticized on ethical grounds, and both methods present difficulties for inclusion in public policies. When we compared the use of euthanasia and vaccination at coverages of 70 and 90%, respectively, the proportion of infected populations were similar. However, on evaluating the implications of both of these methods, particularly the negative aspects of culling dogs and the proportion of animals protected by vaccination, the latter measure appears to be the better option if the total cost is not significantly higher. The comparison of complications and advantages of different control strategies allows us to analyze the optimal measure and offer strategies to veterinary and public health authorities for making decisions to prevent and control zoonotic VL. Hence, improvements in both public and animal health can be achieved in regions with scenarios similar to that considered in the present study; such scenarios are characteristically found in some areas of Brazil and other countries. [ABSTRACT FROM AUTHOR]

Aims: To investigate the hypothesis that the change from the female predominance of diabetes mellitus to a standard of equality or even male preponderance can already be observed in Brazilian mortality statistics. Methods: Data on deaths for which diabetes mellitus was listed as the underlying cause were obtained from the Brazilian Mortality Information System for the years 1980 to 2012. The mortality data were also analyzed according to the multiple causes of death approach from 2001 to 2012. The population data came from the Brazilian Institute of Geography and Statistics. The mortality rates were standardized to the world population. We used a log-linear joinpoint regression to evaluate trends in age-standardized mortality rates (ASMR). Results: From 1980 to 2012, we found a marked increment in the diabetes ASMR among Brazilian men and a less sharp increase in the rate among women, with the latter period (2003–2012) showing a slight decrease among women, though it was not statistically significant. Conclusions: The results of this study suggest that diabetes mellitus in Brazil has changed from a pattern of higher mortality among women compared to men to equality or even male predominance. [ABSTRACT FROM AUTHOR]

We described a comprehensive analysis of the molecular epidemiology of multidrug-resistant (MDR) P. aeruginosa. Molecular analysis included typing by Pulsed Field Gel Electrophoresis, identification of genes of interest through PCR-based assays and sequencing of target genes. Case-control study was conducted to better understand the prognostic of patients and the impact of inappropriate therapy in patients with bacteremia, as well as the risk factors of MDR infections. We observed a high rate of MDR isolates (40.7%), and 51.0% of them was independently associated with inappropriate antibiotic therapy. Bacteremia was detected in 66.9% of patients, and prolonged hospital stay was expressive in those resistant to fluoroquinolone. Plasmid-mediated quinolone resistance genes (PMQR), qnrS1 and aac(6’)Ib-cr, were detected in two different nosocomial isolates (5.3%), and the aac(6’)-Ib7 variant was detected at a high frequency (87.5%) in those negative to PMQR. The presence of mutations in gyrA and parC genes was observed in 100% and 85% of selected isolates, respectively. Isolates harboring PMQR genes or mutations in gyrA and parC were not closely related, except in those containing SPM (São Paulo metallo-β-lactamase) clone. In addition, there is no study published in Brazil to date reporting the presence of Pseudomonas aeruginosa isolates harboring both qnrS1 and aac(6’)Ib-cr genes, with alarming frequency of patients with inappropriate therapy. [ABSTRACT FROM AUTHOR]

Population connectivity in the blue crab Callinectes sapidus was evaluated along 740 km of the Western South Atlantic coast. Blue crabs are the most exploited portunid in Brazil. Despite their economic importance, few studies report their ecology or population structure. Here we sampled four estuarine areas in southern Brazil during winter 2013 and summer 2014 in order to evaluate diversity, gene flow and structure of these populations. Nine microsatellite markers were evaluated for 213 adult crabs, with identification of seven polymorphic loci and 183 alleles. Pairwise FST values indicated low population structure ranging from -0.00023 to 0.01755. A Mantel test revealed that the geographic distance does not influence genetic (r = -0.48), and structure/migration rates confirmed this, showing that even the populations located at the opposite extremities of our covered region presented low FST and exchanged migrants. These findings show that there is a significant amount of gene flow between blue crab populations in South Brazil, likely influenced by local current dynamics that allow the transport of a high number of larvae between estuaries. Considering the elevated gene flow, the populations can be considered a single genetic stock. However, further information on population size and dynamics, as well as fishery demands and impacts at different regions, are necessary for harvest management purposes. [ABSTRACT FROM AUTHOR]

The non-recombining nature of the Y chromosome and the well-established phylogeny of Y-specific Single Nucleotide Polymorphisms (Y-SNPs) make them useful for defining haplogroups with high geographical specificity; therefore, they are more apt than the Y-STRs to detect population stratification in admixed populations from diverse continental origins. Different Y-SNP typing strategies have been described to address issues of population history and movements within geographic territories of interest. In this study, we investigated a set of 41 Y-SNPs in 1217 unrelated males from the five Brazilian geopolitical regions, aiming to disclose the genetic structure of male lineages in the country. A population comparison based on pairwise FST genetic distances did not reveal statistically significant differences in haplogroup frequency distributions among populations from the different regions. The genetic differences observed among regions were, however, consistent with the colonization history of the country. The sample from the Northern region presented the highest Native American ancestry (8.4%), whereas the more pronounced African contribution could be observed in the Northeastern population (15.1%). The Central-Western and Southern samples showed the higher European contributions (95.7% and 93.6%, respectively). The Southeastern region presented significant European (86.1%) and African (12.0%) contributions. The subtyping of the most frequent European lineage in Brazil (R1b1a-M269) allowed differences in the genetic European background of the five Brazilian regions to be investigated for the first time. [ABSTRACT FROM AUTHOR]

The muriqui (Brachyteles spp.), endemic to the Atlantic Forest of Brazil, is the largest primate in South America and is endangered, mainly due to habitat loss. Its distribution limits are still uncertain and need to be resolved in order to determine their true conservation status. Species distribution modeling (SDM) has been used to estimate potential species distributions, even when information is incomplete. Here, we developed an environmental suitability model for the two endangered species of muriqui (Brachyteles hypoxanthus and B. arachnoides) using Maxent software. Due to historical absence of muriquis, areas with predicted high habitat suitability yet historically never occupied, were excluded from the predicted historical distribution. Combining that information with the model, it is evident that rivers are potential dispersal barriers for the muriquis. Moreover, although the two species are environmentally separated in a large part of its distribution, there is a potential contact zone where the species apparently do not overlap. This separation might be due to either a physical (i.e., Serra da Mantiqueira mountains) or a biotic barrier (the species exclude one another). Therefore, in addition to environmental characteristics, physical and biotic barriers potentially shaped the limits of the muriqui historical range. Based on these considerations, we proposed the adjustment of their historical distributional limits. Currently only 7.6% of the predicted historical distribution of B. hypoxanthus and 12.9% of B. arachnoides remains forested and able to sustain viable muriqui populations. In addition to measurement of habitat loss we also identified areas for conservation concern where new muriqui populations might be found. [ABSTRACT FROM AUTHOR]

The physical activity practice is highlighted as a strategy to health promotion and to avoid chronic diseases. In addition to individual factors, environmental characteristics in which people live, may offer opportunities or barriers in adopting healthy habits and this is related to the physical activity (PA) practice among individuals. The aim of this study is to investigate the associations between neighborhood environment and leisure-time physical activity in adults. This is a cross-sectional study, developed using the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL 2008/2010) of Belo Horizonte, Brazil. Individuals with the habit of practicing PA for at least 150 minutes of moderate-intensity PA or at least 75 minutes of vigorous-intensity PA throughout the week in leisure time were classified as active in leisure time. To characterize the built and social environment we used georeferenced data of public and private places for physical activity, population density, residential density, homicide rate and total income of the coverage area of the basic health units. The covered area of the basic health units was used as context unit. For data analysis, we used multilevel logistic regression. The study included 5779 adults, 58.77% female. There was variability of physical activity in leisure time between area covered by the basic health units (Median Odds ratio = 1.30). After adjusting for individual characteristics, the increase of density of private places for physical activity (Odds ratios—OR = 1.31; 95% confidence interval—95% CI: 1.15 to 1.48) and the smaller homicide rate (OR = 0.82; IC95%: 0.70 to 0.96) in the neighborhood increased physical activity in leisure time. The evidence of this study shows that neighborhood environment may influence the physical activity practice in leisure time and should be considered in future interventions and health promotion strategies. [ABSTRACT FROM AUTHOR]

Habitat loss and fragmentation intensify the effects of genetic drift and endogamy, reducing genetic variability of populations with serious consequences for wildlife conservation. The Harpy Eagle (Harpia harpyja) is a forest dwelling species that is considered near threatened and suffers from habitat loss in the forests of the Neotropical region. In this study, 72 historical and current samples were assessed using eight autosomal microsatellite markers to investigate the distribution of genetic diversity of the Harpy Eagle of the Amazonian and Atlantic forests in Brazil. The results showed that the genetic diversity of Harpy Eagle decreased in the regions where deforestation is intense in the southern Amazon and Atlantic Forest. [ABSTRACT FROM AUTHOR]

Background: Aedes aegypti is the most important vector of dengue fever in Brazil, where severe epidemics have recently taken place. Ae. aegypti in Brazil was the subject of an intense eradication program in the 1940s and 50s to control yellow fever. Brazil was the largest country declared free of this mosquito by the Pan-American Health Organization in 1958. Soon after relaxation of this program, Ae. aegypti reappeared in this country, and by the early 1980s dengue fever had been reported. The aim of this study is to analyze the present-day genetic patterns of Ae. aegypti populations in Brazil. Methodology/Principal Findings: We studied the genetic variation in samples of 11 widely spread populations of Ae. aegypti in Brazil based on 12 well-established microsatellite loci. Our principal finding is that present-day Brazilian Ae. aegypti populations form two distinct groups, one in the northwest and one in the southeast of the country. These two groups have genetic affinities to northern South American countries and the Caribbean, respectively. This is consistent with what has been reported for other genetic markers such as mitochondrial DNA and allele frequencies at the insecticide resistance gene, kdr. Conclusions/Significance: We conclude that the genetic patterns in present day populations of Ae. aegypti in Brazil are more consistent with a complete eradication of the species in the recent past followed by re-colonization, rather than the alternative possibility of expansion from residual pockets of refugia. At least two colonizations are likely to have taken place, one from northern South American countries (e.g., Venezuela) that founded the northwestern group, and one from the Caribbean that founded the southeastern group. The proposed source areas were never declared free of Ae. aegypti. [ABSTRACT FROM AUTHOR]

Background: The impact of non-communicable diseases on tuberculosis incidence has received significant attention. It has been suggested that the risk of tuberculosis is higher among subjects with diabetes and these subjects also has poor TB treatment outcomes.This study was aimed at assessing the socio-demographic and clinical factors that may influence different outcome of TB in patients with DM (TB-DM) identified in the Brazilian national database from 2001 to 2011. Methods: TB-DM cases reported in the Brazilian information system were identified and compared.Covariates associated with the outcomes of interest (cure, default, deaths, and development of TB MDR) were included in a hierarchical regression model. Results: TB-DM cases increased from 380/100,000/year in 2001 to 6,150/100,000/year in 2011. Some of the main associations found are pointed. The odds of default was higher among those in the age group 20–39 years (OR = 2.07, 95%CI 1.32–3.24); alcoholics (OR = 2.17, 95%CI 1.86–2.54), and HIV/AIDS (OR = 2.16, 95%CI 1.70–2.74);positive monitoring smear (OR = 1.94, 95%CI 1.55–2.43); prior default (OR = 5.41, 95%CI 4.47–6.54), and unknown type of treatment (OR = 3.33, 95%CI 1.54–7.22). The odds of death was greater for subjects ≥60 years old (OR = 2.74, 95%CI 1.74–4.29); institutionalized in shelter (OR = 2.69, 95%CI 1.07–6.77); alcoholics (OR = 2.70, 95%CI 2.27–3.22); HIV/AIDS (OR = 2.87, 95%CI 2.13–3.86); pulmonary+extrapulmonary TB (OR = 2.49, 95%CI 1.79–3.46); with unknown type of treatment (OR = 14.12, 95%CI 7.04–28.32).Development of MDR TB was more related to relapse (OR = 9.60, 95%CI 6.07–15.14);previous default (OR = 17.13, 95%CI 9.58–30.63); and transfer of treatment center (OR = 7.87, 95%CI 4.74–13.07). Conclusions: Older subjects and those with comorbidities and with a previous treatment of TB had poorest outcomes. TB control program in Brazil will need to expand efforts to focus on treatment of TB-DM patients to improve their cure rates in order to achieve the goals of tuberculosis elimination. [ABSTRACT FROM AUTHOR]

Germline TP53 mutations predispose individuals to multiple cancers and are associated with Li-Fraumeni/Li-Fraumeni-Like Syndromes (LFS/LFL). The founder mutation TP53 p.R337H is detected in 0.3% of the general population in southern Brazil. This mutation is associated with an increased risk of childhood adrenal cortical carcinoma (ACC) but is also common in Brazilian LFS/LFL families. Breast Cancer (BC) is one of the most common cancers diagnosed in TP53 mutation carriers. We have assessed the prevalence of p.R337H in two groups: (1) 59 BC affected women with a familial history (FH) suggestive of hereditary cancer syndrome but no LFS/LFL features; (2) 815 BC affected women unselected for cancer FH, diagnosed with BC at or before age 45 or at age 55 or older. Among group 1 and group 2 patients, 2/59 (3.4%, CI95%: 0.4%–11.7%) and 70/815 (8.6%, CI95%: 6.8%–10.7%), respectively, were p.R337H carriers in the germline. The prevalence of p.R337H was higher in women diagnosed with BC at or before age 45 (12.1%, CI95%: 9.1%–15.8%) than at age 55 or older (5.1%, CI95%: 3.2%–7.7%), p<0.001). The Brazilian founder p.R337H haplotype was detected in all carriers analysed. These results suggest that inheritance of p.R337H may significantly contribute to the high incidence of BC in Brazil, in addition to its recently demonstrated impact on the risk of childhood ACC. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify the transmission pattern of hepatitis A (HA) infection based on a primary dataset from the Brazilian National Hepatitis Survey in a pre-vaccination context. The national survey conducted in urban areas disclosed two epidemiological scenarios with low and intermediate HA endemicity. Methods: A catalytic model of HA transmission was built based on a national seroprevalence survey (2005 to 2009). The seroprevalence data from 7,062 individuals aged 5–69 years from all the Brazilian macro-regions were included. We built up three models: fully homogeneous mixing model, with constant contact pattern; the highly assortative model and the highly assortative model with the additional component accounting for contacts with infected food/water. Curves of prevalence, force of infection (FOI) and the number of new infections with 99% confidence intervals (CIs) were compared between the intermediate (North, Northeast, Midwest and Federal District) and low (South and Southeast) endemicity areas. A contour plot was also constructed. Results: The anti- HAV IgG seroprevalence was 68.8% (95% CI, 64.8%–72.5%) and 33.7% (95% CI, 32.4%–35.1%) for the intermediate and low endemicity areas, respectively, according to the field data analysis. The models showed that a higher force of infection was identified in the 10- to 19-year-old age cohort (∼9,000 infected individuals per year per 100,000 susceptible persons) in the intermediate endemicity area, whereas a higher force of infection occurred in the 15- to 29-year-old age cohort (∼6,000 infected individuals per year per 100,000 susceptible persons) for the other macro-regions. Conclusion: Our findings support the shift of Brazil toward intermediate and low endemicity levels with the shift of the risk of infection to older age groups. These estimates of HA force of infection stratified by age and endemicity levels are useful information to characterize the pre-vaccination scenario in Brazil. [ABSTRACT FROM AUTHOR]

Understanding the connections between sea turtle populations is fundamental for their effective conservation. Brazil hosts important hawksbill feeding areas, but few studies have focused on how they connect with nesting populations in the Atlantic. Here, we (1) characterized mitochondrial DNA control region haplotypes of immature hawksbills feeding along the coast of Brazil (five areas ranging from equatorial to temperate latitudes, 157 skin samples), (2) analyzed genetic structure among Atlantic hawksbill feeding populations, and (3) inferred natal origins of hawksbills in Brazilian waters using genetic, oceanographic, and population size information. We report ten haplotypes for the sampled Brazilian sites, most of which were previously observed at other Atlantic feeding grounds and rookeries. Genetic profiles of Brazilian feeding areas were significantly different from those in other regions (Caribbean and Africa), and a significant structure was observed between Brazilian feeding grounds grouped into areas influenced by the South Equatorial/North Brazil Current and those influenced by the Brazil Current. Our genetic analysis estimates that the studied Brazilian feeding aggregations are mostly composed of animals originating from the domestic rookeries Bahia and Pipa, but some contributions from African and Caribbean rookeries were also observed. Oceanographic data corroborated the local origins, but showed higher connection with West Africa and none with the Caribbean. High correlation was observed between origins estimated through genetics/rookery size and oceanographic/rookery size data, demonstrating that ocean currents and population sizes influence haplotype distribution of Brazil's hawksbill populations. The information presented here highlights the importance of national conservation strategies and international cooperation for the recovery of endangered hawksbill turtle populations. [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]

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 influence of self-reported “race/color”, geographical origin and genetic ancestry on the distribution of three functional CYP3A5 polymorphisms, their imputed haplotypes and inferred phenotypes was examined in 909 healthy, adult Brazilians, self-identified as White, Brown or Black (“race/color” categories of the Brazilian census). The cohort was genotyped for CYP3A5*3 (rs776746), CYP3A5*6 (rs10264272) and CYP3A5*7 (rs41303343), CYP3A5 haplotypes were imputed and CYP3A5 metabolizer phenotypes were inferred according to the number of defective CYP3A5 alleles. Estimates of the individual proportions of Amerindian, African and European ancestry were available for the entire cohort. Multinomial log-linear regression models were applied to infer the statistical association between the distribution of CYP3A5 alleles, haplotypes and phenotypes (response variables), and self-reported Color, geographical region and ancestry (explanatory variables). We found that Color per se or in combination with geographical region associates significantly with the distribution of CYP3A5 variant alleles and CYP3A5 metabolizer phenotypes, whereas geographical region per se influences the frequency distribution of CYP3A5 variant alleles. The odds of having the default CYP3A5*3 allele and the poor metabolizer phenotype increases continuously with the increase of European ancestry and decrease of African ancestry. The opposite trend is observed in relation to CYP3A5*6, CYP3A5*7, the default CYP3A5*1 allele, and both the extensive and intermediate phenotypes. No significant effect of Amerindian ancestry on the distribution of CYP3A5 alleles or phenotypes was observed. In conclusion, this study strongly supports the notion that the intrinsic heterogeneity of the Brazilian population must be acknowledged in the design and interpretation of pharmacogenomic studies, and dealt with as a continuous variable, rather than proportioned in arbitrary categories that do not capture the diversity of the population. The relevance of this work extrapolates the Brazilian borders, and extends to other admixed peoples of the Americas, with ancestral roots in Europe, Africa and the American continent. [ABSTRACT FROM AUTHOR]

Reproductive aspects ofAmeerega braccata, a Cerrado endemic species of Dendrobatidae, were studied in the surroundings of the type locality of the species, Chapada dos Guimarães, mid-southern Mato Grosso State, Brazil. We found that males call mainly early in the morning and in the late afternoon. During courtship, the female approaches a calling male and tactile and visual communication occurs. Males call continuously while guiding females to the oviposition site, which may be situated as far as 24 m (in a straight line) from the initial encounter site. Spawn are deposited over fallen leaves on the soil surface or in burrows. Female snout–vent length and body mass did not explain the variation in ovary mass, or the variation in the number and size of post-vitellogenic oocytes. The results reported here forA. braccatamight help to understand trends in the evolution of dendrobatids in open Cerrado environments. [ABSTRACT FROM AUTHOR]

Objective To quantify the trend of ischaemic heart disease (IHD) deaths in Brazil during the last decade (2000-2010) for various population characteristics and to forecast the upcoming mortality trends across regions in Brazil until the year 2015. Design Nationwide comparative observational study. Patients and methods The population studied encompassed all adult residents (=20 years) living in five Brazilian regions between 2000 and 2010. Demographic, economic and mortality data were obtained from Brazilian National Mortality Data System and National Applied Economics Research Institute. Subnotified deaths were redistributed proportionally to IHD deaths. Age-standardised mortality rates (ASMRs) per 100 000 inhabitants, by sex and region, were calculated employing a standard Brazilian population and constructing multivariate regression models to quantify and to project temporal trends. Main outcome measures Absolute numbers of death due to IHD and region-specific death rates in Brazil by age and sex. Results During the study period, 627 786 men and 452 690 women died due to IHD in Brazil. ASMR trends across all regions for men and women converged, driven by a declining trend in the South and Southeast and an opposite incline in the North and Northeast ( p<0.05). Future projections demonstrated potential widening of the observed North-South gap in coming years. Conclusions The IHD death trend in Brazil has changed from a decline to a stagnant state. However, a significant discrepancy in mortality trends exists between the northern and southern regions, which is likely to widen further. Reappraisal of the public health policies tailored to populations with diverse socioeconomic structures is urgently required. [ABSTRACT FROM AUTHOR]

Habitat loss and attendant fragmentation threaten the existence of many species. Conserving these species requires a straightforward and objective method that quantifies how these factors affect their survival. Therefore, we compared a variety of metrics that assess habitat fragmentation in bird ranges, using the geographical ranges of 127 forest endemic passerine birds inhabiting the Atlantic Forest of Brazil. A common, non-biological metric — cumulative area of size-ranked fragments within a species range — was misleading, as the least threatened species had the most habitat fragmentation. Instead, we recommend a modified version of metapopulation capacity. The metric links detailed spatial information on fragment sizes and spatial configuration to the birds’ abilities to occupy and disperse across large areas (100,000+ km2). In the Atlantic Forest, metapopulation capacities were largely bimodal, in that most species’ ranges had either low capacity (high risk of extinction) or high capacity (very small risk of extinction). This pattern persisted within taxonomically and ecologically homogenous groups, indicating that it is driven by fragmentation patterns and not differences in species ecology. Worryingly, we found IUCN considers some 28 of 58 species in the low metapopulation capacity cluster to not be threatened. We propose that assessing the effect of fragmentation will separate species more clearly into distinct risk categories than does a simple assessment of remaining habitat. [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]

In populations that have a high degree of admixture, such as in Brazil, the sole use of ethnicity self-declaration information is not a good method for classifying individuals regarding their ethnicity. Here, we evaluate the relationship of self-declared ethnicities with genomic ancestry and mitochondrial haplogroups in 492 individuals from southeastern Brazil. Mitochondrial haplogroups were obtained by analyzing the hypervariable regions of the mitochondrial DNA (mtDNA), and the genomic ancestry was obtained using 48 autosomal insertion-deletion ancestry informative markers (AIM). Of the 492 individuals, 74.6% self-declared as White, 13.8% as Brown and 10.4% as Black. Classification of the mtDNA haplogroups showed that 46.3% had African mtDNA, and the genomic ancestry analysis showed that the main contribution was European (57.4%). When we looked at the distribution of mtDNA and genomic ancestry according to the self-declared ethnicities from 367 individuals who self-declared as White, 37.6% showed African mtDNA, and they had a high contribution of European genomic ancestry (63.3%) but also a significant contribution of African ancestry (22.2%). Of the 68 individuals who self-declared as Brown, 25% showed Amerindian mtDNA and similar contribution of European and African genomic ancestries. Of the 51 subjects who self-declared as black, 80.4% had African mtDNA, and the main contribution of genomic ancestry was African (55.6%), but they also had a significant proportion of European ancestry (32.1%). The Brazilian population had a uniform degree of Amerindian genomic ancestry, and it was only with the use of genetic markers (autosomal or mitochondrial) that we were able to capture Amerindian ancestry information. Additionally, it was possible to observe a high degree of heterogeneity in the ancestry for both types of genetic markers, which shows the high genetic admixture that is present in the Brazilian population. We suggest that in epidemiological studies, the use of these methods could provide complementary information. [ABSTRACT FROM AUTHOR]