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The illegal use of natural resources, manifested in activities like illegal logging, poaching, and illegal wildlife trade, poses a global threat to biodiversity. Addressing them will require an understanding of the magnitude of and factors influencing these activities. However, assessing such behaviors is challenging because of their illegal nature, making participants less willing to admit engaging in them. We compared how indirect (randomized response technique) and direct questioning techniques performed when assessing non-sensitive (fish consumption, used as negative control) and sensitive (illegal consumption of wild animals) behaviors across an urban gradient (small towns, large towns, and the large city of Manaus) in the Brazilian Amazon. We conducted 1,366 surveys of randomly selected households to assess the magnitude of consumption of meat from wild animals (i.e., wild meat) and its socioeconomic drivers, which included years the head of household lived in urban areas, age of the head of household, household size, presence of children, and poverty. The indirect method revealed higher rates of wildlife consumption in larger towns than did the direct method. Results for small towns were similar between the two methods. The indirect method also revealed socioeconomic factors influencing wild meat consumption that were not detected with direct methods. For instance, the indirect method showed that wild meat consumption increased with age of the head of household, and decreased with poverty and years the head of household lived in urban areas. Simultaneously, when responding to direct questioning, households with characteristics associated with higher wild meat consumption, as estimated from indirect questioning, tended to underreport consumption to a larger degree than households with lower wild meat consumption. Results for fish consumption, used as negative control, were similar for both methods. Our findings suggest that people edit their answers to varying degrees when responding to direct questioning, potentially biasing conclusions, and indirect methods can improve researchers' ability to identify patterns of illegal activities when the sensitivity of such activities varies across spatial (e.g., urban gradient) or social (e.g., as a function of age) contexts. This work is broadly applicable to other geographical regions and disciplines that deal with sensitive human behaviors., (© 2021 by the Ecological Society of America.)

The National Primary Care Policy has provided a significant change in terms of health actions in the riverside territory, establishing health teams and equipment. The Riverside and Fluvial Family Health teams for the Legal Amazon and Pantanal areas have been innovative regarding the integral care of the forest populations. This study aims to analyze primary health care in the rural and riverside context in the Amazon territory, based on the production of individual and collective actions by health teams, as well as their performance through services offered in the municipalities. The study is cross-sectional, with a descriptive-analytical design and quantitative approach, and analyzes the coverage of primary health care actions of family health strategy teams in urban, rural and riverside areas of eight municipalities located in the state of Amazonas. The results showed that there was an increase in primary care coverage in almost all analyzed municipalities, indicating that techno-assistance models such as the riverside and fluvial teams resulted in the inclusion of a population that is scattered over large areas of the territory of municipalities. A health policy that promotes equity results in changes and alterations in the ways of life and health status of the Amazonian populations.

SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities. METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician. RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI - 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial. DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.

The switch from hunting wild meat for home consumption to supplying more lucrative city markets in Amazonia can adversely affect some game species. Despite this, information on the amounts of wild meat eaten in Amazonian cities is still limited. We estimated wild meat consumption rates in 5 cities in the State of Amazonas in Brazil through 1046 door-to-door household interviews conducted from 2004 to 2012. With these data, we modeled the relationship between wild meat use and a selection of socioeconomic indices. We then scaled up our model to determine the amounts of wild meat likely to be consumed annually in the 62 urban centers in central Amazonia. A total of 80.3% of all interviewees reported consuming wild meat during an average of 29.3 (CI 11.6) days per year. Most wild meat was reported as bought in local markets (80.1%) or hunted by a family member (14.9%). Twenty-one taxa were cited as consumed, mostly mammals (71.6%), followed by reptiles (23.2%) and then birds (5.2%). The declared frequency of wild meat consumption was positively correlated with the proportion of rural population as well as with the per capita gross domestic product of the municipality (administrative divisions) where the cities were seated. We estimated that as much as 10,691 t of wild meat might be consumed annually in the 62 urban centers within central Amazonia, the equivalent of 6.49 kg per person per year. In monetary terms, this amounts to US$21.72 per person per year or US$35.1 million overall, the latter figure is comparable to fish and timber production in the region. Given this magnitude of wild meat trade in central Amazonia, it is fundamental to integrate this activity into the formal economy and actively develop policies that allow the trade of more resilient taxa and restrict trade in species sensitive to hunting., (© 2019 Society for Conservation Biology.)

Manaus is the Capital City of Amazonas State, Brazil, in the heart of the Amazon rainforest. Its metropolitan area has a huge hydrographic basin where the disorganized urbanization has caused adverse effects in the urban rivers and creeks water quality. Thus, this study was conducted to evaluate the contents of Ba, Cr, Mn, Zn, Ni, Cu, the physicochemical parameters and their respective health risks in water samples from rivers and creeks located in urban areas with different degrees of urbanization in two different seasons. The determination of the physicochemical parameters showed the samples collected in areas with riparian vegetation presented mean values of temperature, pH, total dissolved solids and electrical conductivity lower than samples collected in urban environment. The hotspots of trace elements content were associated to the presence of industrial and domestic effluents as the main pollution source. The Water Quality Index results denoted a low water quality in four sampling sites, one during the rainy season and three others during the dry season. The overall non-carcinogenic health in the urban rivers was considered high in regions with huge population and intense anthropogenic activity. The results showed the potential risk of some of the trace elements on human beings, especially on children. The main element contributor to non-carcinogenic risk was Cr, although Mn and Ni also contributed to non-carcinogenic risk in a few areas, mainly for children during the dry season., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier B.V. All rights reserved.)

We use a compartmental model to project scenarios for the spread of COVID-19 in the city of Manaus, with different degrees of social distancing and isolation of infectious individuals. In a scenario without any containment measures, our projections point to more than 50,000 (simultaneously) infectious individuals before the end of April 2020. Only in a scenario with strict and extensive social distancing (lockdown), implemented and observed as of March 23rd, 2020, would this number be less than 50,000 in the first half of June. Furthermore, an increase in the number of tests or in the collective awareness among the population regarding the importance of strict distancing measures would have only had a significant impact if implemented before the end of March.

Introduction: Leukemia is the most common cancer in children and has the highest rates of incidence in industrialized countries, followed by developing countries. This epidemiologic profile can mainly be attributed to the availability of diagnostic resources. In Brazil, leukemia diagnosis is a challenge due to financial viability, lack of hemovigilance services in isolated regions and the vast size of the territory. Its incidence in the state of Amazonas has been increasing since 2010. Therefore, this study aims to describe the epidemiological pattern and spatial distribution of patients with acute lymphoid leukemia and acute myeloid leukemia in Amazonas and identify the predictors of comorbidity and death., Materials and Methods: A retrospective cross-sectional study was carried out based on patients' data which was obtained from the database of a referral center for the period of 2005 to 2015. Variables included age, gender, ethnicity, civil status, schooling, income, location of residence, subtype of leukemia, comorbidities, and date of death. The spatial distribution was performed using QGIS v.2.18. Stata software was used for univariable and multivariable logistic regression to evaluate the association between both comorbidities and death for all characteristic groups of ALL and AML., Results: The group that was studied was composed of 577 ALL and 266 AML patients. For both, most patients were male, with a schooling period of 1-4 years, received<1 minimum wage, and lived mostly in Manaus, followed by the municipality of Tefé. There was no association between the development of comorbidities and analyzed variables in patients with ALL. AML patients that were >60 years old and with family history of the disease had the highest risk of developing comorbidities (OR = 5.06, p = 0.038; OR = 2.44, p = 0.041, respectively). Furthermore, patients with ALL and in the 41-50-year age group had a higher risk of death (OR = 31.12; p = 0.001). No association between death and explanatory variables were found in patients with AML. In addition, significant difference was observed in time to death (chi2 = 4,098.32, p = 0.000), with 50% of patients with AML dying within two years after diagnosis, whereas in ALL, this percentual of death only is reached in approximately 5 years., Conclusion: Our study describes the data of patients with acute leukemia in Amazonas, a remote region in the north of Brazil. In addition, it highlights the importance of hemovigilance in an Amazon region state, while focusing on peripheral areas which don't have prevention, diagnosis and treatment tools for this disease., Competing Interests: The authors have declared that no competing interests exist.