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Microplastics (MPs) are contaminants widely distributed in marine ecosystems. Only few studies approached MP interactions with marine plants, which are considered potential traps for MPs. Here, we determined MPs' densities and types associated with stranded macroalgae on a eutrophic beach in Guanabara Bay. Our results showed that red algae exhibited higher MP densities (1.48 MPs g -1 ), possibly due to their more branched thalli, than green algae (0.27 MPs g -1 ). The predominant MP types were blue and white fragments <3 mm in size and polymers were classified as polyethylene and polyvinyl chloride in fragments, and polypropylene in fibers. The higher densities of MPs in algae seemed to be influenced by the inner bay waters. The densities of MPs associated with algae from Guanabara Bay surpassed those reported in other studies. High MPs densities increase the chances that organisms associated with algae entangle or ingest MPs, impacting their health and survival., 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 © 2024 Elsevier Ltd. All rights reserved.)

Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate public policies and protocols to prevent stillbirth, improve maternal care and support bereaved families. METHODS AND ANALYSIS: In this case-control study with stillbirths and live births in 14 public hospitals in São Paulo, mothers are interviewed at hospitals after delivery, and hospital records and prenatal care registries are reviewed. Maternal and umbilical cord blood samples and placentas are collected to analyse angiogenesis and infection biomarkers, and the placenta's anatomopathological exam. Air pollutant exposure is estimated through the participant's residence and work addresses. Traditional and non-invasive autopsies by image-guided histopathology are conducted in a subset of stillbirths. Subsample mothers of cases are interviewed at home 2 months after delivery on how they were dealing with grief. Information contained in the official prenatal care registries of cases and controls is being compiled. Hospital managers are interviewed about the care offered to stillbirth mothers. Data analysis will identify the main risk factors for stillbirth, investigate their interrelations, and evaluate health services care and support for bereaved families. We hope this project will contribute to the understanding of stillbirth's risk factors and related health services in Brazil, providing new knowledge about this central public health problem, contributing to the improvement of public policies and prenatal and puerperal care, helping to prevent stillbirths and improve the healthcare and support for bereaved families. ETHICS AND DISSEMINATION: This study protocol was approved by the Ethics Committee of the Municipal Health Secretary (process no 16509319.0.3012.5551) and of the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (process no 16509319.0.0000.0068). Results will be communicated to the study participants, policy-makers and the scientific community., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Brazilian biomes are important sources for environmental microorganisms, including efficient metabolic machineries, like actinomycetes. These bacteria are known for their abilities to produce many bioactive compounds, including enzymes with multiple industrial applications. The present work aimed to evaluate lignocellulolytic abilities of actinomycetes isolated from soil and rhizosphere samples collected at Caatinga, Atlantic and Amazon Forest. Laccase (Lac), lignin peroxidase (LiP), manganese peroxidase (MnP) and cellulase were evaluated for their efficiency. These enzymes have an essential role in lignin decomposition, through oxidation of phenolic and non-phenolic compounds, as well as enzymatic hydrolysis of vegetal biomass. In this sense, a total of 173 actinomycetes were investigated. Eleven (11) of them were selected by their enzymatic performance. The actinomycete AC166 displayed some activity in all analysed scenarios in terms of Lac, MnP and LiP activity, while AC171 was selected as the most promising strain, showing the following activities: 29.7 U.L -1 for Lac; 2.5 U.L -1 for LiP and 23 U.L -1 for MnP. Cellulolytic activities were evaluated at two pH conditions, 4.8 and 7.4, obtaining the following results: 25 U.L -1 and 71 U.L -1 , respectively. Thermostability (4, 30 and 60 o C) and salinity concentrations (0 to 4 M) and pH variation (2.0 to 9.0) stabilities of the obtained LiP and Lac enzymatic extracts were also verified. The actinomycete strain AC171 displayed an adaptable response in distinct pH and salt profiles, indicating that bacterial LiP was some halophilic type. Additionally, the strain AC149 produced an alkali and extreme halophilic lignin peroxidase, which are promising profiles for their future application under lignocellulosic biomass at bioethanol biorefineries., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

After four months of fighting the pandemic, the city of São Paulo, Brazil, entered a phase of relaxed social distancing measures in July 2020. Simultaneously, there was a decline in the social distancing rate and a reduction in the number of cases, fatalities, and hospital bed occupancy. To understand the pandemic dynamics in the city of São Paulo, we developed a multi-agent simulation model. Surprisingly, the counter-intuitive results of the model followed the city's reality. We argue that this phenomenon could be attributed to local bubbles of protection that emerged in the absence of contagion networks. These bubbles reduced the transmission rate of the virus, causing short and temporary reductions in the epidemic curve - but manifested as an unstable equilibrium. Our hypothesis aligns with the virus spread dynamics observed thus far, without the need for ad hoc assumptions regarding the natural thresholds of collective immunity or the heterogeneity of the population's transmission rate, which may lead to erroneous predictions. Our model was designed to be user-friendly and does not require any scientific or programming expertise to generate outcomes on virus transmission in a given location. Furthermore, as an input to start our simulation model, we developed the COVID-19 Protection Index as an alternative to the Human Development Index, which measures a given territory vulnerability to the coronavirus and includes characteristics of the health system and socioeconomic development, as well as the infrastructure of the city of São Paulo.

Climate events compromise ecosystems functioning and services. Marine zooplankton play a key role linking primary producers and higher consumers, in the carbon export to deeper regions, and respond quickly to environmental change. We conducted a systematic review to assess the effects of climate on marine zooplankton diversity. We describe the major findings, uses and limitations raised in the literature from worldwide time series ≥5 years. Thirty-five studies were included and only 6 presented extractable data (i.e., those that could be extracted from images) for the most studied group (i.e., copepods). Responses to climate were conflicting, and studies were mostly restricted to the global north, applied richness, alpha- and beta-diversity equally, and had a large number of unresolved taxonomic identification. Standardized open long-term data would meaningfully help unveiling assemblage reorganization and allow meta-analyses to improve our understanding of the effects of climate change and variability on zooplankton biodiversity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: To summarize the data on SARS-CoV-2 seroprevalence surveys conducted in Brazil before the introduction of vaccines METHODS: The authors conducted a systematic review and meta-analysis on the seroprevalence of SARS-CoV-2 infection in Brazil. The present review followed the PRISMA guidelines. The authors searched Medline, Embase, and LILACS databases for serologic surveys conducted in the Brazilian population, in the period from 01/10/2019 to 07/11/2021, without language restrictions. The authors included studies that presented data concerning SARS-CoV-2 antibodies seroprevalence in Brazil and had a sample size ≥50 individuals. Considering the expected heterogeneity between studies, all analyses were performed using the random effects model, and heterogeneity was assessed using the I 2 statistic RESULTS: Of 586 publications identified in the initial searches, 54 were included in the review and meta-analysis, which contained the results of 135 surveys, with 336,620 participants. The estimated seroprevalence was 11.0%, ranging from 1.0% to 83.0%, with a substantial heterogeneity (I 2  = 99.55%). In subgroup analyses, the authors observed that the prevalence of SARS-CoV-2 antibodies was 13.0% in blood donors, 9.0% in the population-based surveys, 13% in schoolchildren, and 11.0% in healthcare workers., Conclusions: Seroprevalence increases over time. Large differences were observed among the regions of the country. It was higher in the Northern region, decreasing towards the South. The present results may contribute to the analysis of the spread of SARS-CoV-2 infection in the Brazilian population before vaccination, one of the factors that may be influencing the clinical presentation of COVID-19 cases related to the new variants, as well as the effectiveness of the vaccination program., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2023 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The objective of the present study was to describe the clinical and epidemiological aspects of recently acquired hepatitis C virus (HCV) infection and the frequency of its spontaneous clearance in a people living with the human immunodeficiency virus (PLWH) cohort., Methods: We reviewed the medical records from all PLWH at the human immunodeficiency virus (HIV) outpatient reference clinic affiliated with the University of São Paulo, Brazil, and identified, by immunoassays and RNA-PCR individuals who acquired HCV infection between January 2015 and December 2017. The factors associated with subsequent spontaneous clearance of the infection in this group were identified and analyzed., Results: Among 3143 PLWH individuals, 362 (11.5%) were coinfected with HCV. Forty-eight (13.2%) of these subjects first became HCV-positive between January 2015 and December 2017. Spontaneous HCV clearance was documented in 23 individuals (47.9%). The majority of this latter group were male (83.3%), and the median age was 31 years (23-39). The main risk group for HCV acquisition was men who had sex with men (MSM) (89.5%). In a multivariate analysis, only an elevated CD4+ T lymphocyte count at the time of seroconversion was found to be associated with subsequent HCV clearance ( p = 0.025)., Conclusions: In HIV-infected individuals in Sao Paulo, Brazil, most cases of recent HCV transmission were by sexual exposure. In PLWH, particularly in MSM, the individual's CD4+ T lymphocyte count is a determinant of whether an acquired HCV infection will be prolonged or will spontaneously clear.

Identification of mechanisms of hepatitis C virus (HCV) acquisition among HIV-infected people is critical for prevention guidance. The aim of this study was to investigate risk factors for HCV infection and variations in HCV genotype distribution in a cohort of HIV-HCV coinfected patients in Brazil. This was a cross-sectional observational epidemiological study of a cohort of HIV-HCV coinfected individuals seen at a referral center for HIV-infected patients in the city of São Paulo between January and December 2017. The time of HCV acquisition, as determined by chart review, was categorized as before 2000, between 2000 and 2009, and from 2010 onward. HCV genotypes were determined by gene amplification and analysis. Among 3,143 HIV-infected individuals analyzed, 362 (11.5%) were HCV-HIV coinfected. Overall, the reported modes of HCV acquisition were sexual exposure in 172 (47.5%), injection drug use (IDU) in 86 (23.8%), use of inhaled drugs in 67 (18.5%) and blood transfusion in 10 (2.8%) individuals. All individuals who acquired HCV after IDU became infected before 2010. HCV acquisition by sexual contact was reported by 26.4%, 65.9%, and 63.8% of patients before 2000, between 2000 and 2009, and from 2010, respectively. There was an increase ( p  < .001) in the proportion of cases due to sexual transmission from the period before 2000 (26.4%) to between 2000 and 2009 (65.9%). There was no corresponding increase from 2000 and 2009 to after 2010 ( p  = .751). HCV genotype 1 was most prevalent at all time periods. The genotype 3 frequency decreased over time (test for trend p  < .001), whereas genotype 4, extremely uncommon before 2010, became the second most prevalent genotype from 2010 onward. In HIV-infected individuals in Sao Paulo, Brazil, sexual transmission has replaced IDU as the most frequent mode of HCV acquisition.

Background: Brazil is facing increasing cycles of numbers of infected people and deaths resulting from coronavirus disease 2019 (COVID-19). This situation involves a series of factors, including the behavior of the population, that can be decisive for controlling the disease., Objective: To determine the knowledge, attitudes and practices of the Brazilian population regarding COVID-19., Design and Setting: Cross-sectional survey-type study, conducted using a population sample from different Brazilian states., Methods: A quantitative, descriptive and analytical approach was used. Sampling was done according to convenience and via snowballing. The data collection instrument was a knowledge, attitudes and practices system., Results: 1,655 people from all over Brazil participated in the survey; 80% were living in the southern region and 70.15% were female. More than 90% had knowledge and good attitudes relating to the means of transmission, preventive care and symptoms associated with COVID-19, although their knowledge and attitudes were not fully reflected in daily practices, for which there was lower adherence (80%). Greater knowledge was correlated with older participants, larger number of children, female sex and marital status; better attitude, with female sex and complete higher education; and better practices, with greater age, larger number of children and female sex., Conclusion: A large part of the population has general knowledge about COVID-19, but not all knowledge was applied in practice. Older people, females and university graduates stood out as the best informed and most committed to controlling the disease.

Objective: This study aimed to describe and analyze the temporal and spatial distribution of deaths due to hepatocellular carcinoma (HCC) associated with hepatitis B (HBV) and C viruses (HCV) in the state of São Paulo., Methods: This is an ecological study of HCC deaths associated with HBV and HCV in the state of São Paulo, from 2009 to 2017, with data from the Mortality Information System (SIM). The temporal trend was analyzed by linear regression with Prais-Winsten estimation. Deaths were described according to sociodemographic characteristics by means of absolute and relative frequencies and were spatially distributed according to the regional health department., Results: It is found that 26.3% of deaths due to HCC were associated with HBV or HCV. A higher proportion of deaths due to HCC associated with HCV was observed (22.2%) when compared to HBV (3.9%). The mortality rate due to HCC associated with HBV showed a downward trend, and the mortality rate due to HCC associated with HCV showed a steady trend. Deaths of males, white individuals, those who aged from 50 to 59 years, and those who had 8-11 years of schooling predominated. Spatial analysis revealed a heterogeneous distribution of deaths in the state of São Paulo., Conclusions: The downward trend in mortality rates due to HCC associated with HBV shows an important advance in the disease control. However, the mortality rate due to HCC associated with HCV has remained stable throughout the study period. The spatial distribution of deaths may contribute to raise hypotheses for deeper knowledge of these diseases in the regions.

Hepatitis A virus (HAV) infection has been considered one of the leading causes of acute hepatitis. The aim of the present study was to estimate the prevalence of HAV among children and adolescents in a population-based study in the capitals of the States of the North, Southeast and South of Brazil and identify predictive factors for the infection. A multi-stage sampling was used to select subjects aged between 5-9 and 10-19 years. Individual and household levels aside from the level of variables in the areas were collected. The outcome was the total IgG antibodies to HAV levels detected using a commercial Enzyme Immuno Assay (EIA). The associations between HAV and the independent variables were assessed using the odds ratio. A multilevel analysis was performed by GLLAMM using the Stata software. The prevalence of HAV infection in the 5-9 and 10-19 age groups was 28.7% and 67.5%, respectively for the North, 20.6% and 37.7%, for the Southeast and 18.9% and 34.5% for the South Region. The prevalence of HAV increased according to age in all sites. Variables related to education at the individual level (North and South), family and area level (South and Southeast) and family income level (Southeast and South) were independently associated with HAV infection. This emphasizes the need for individualized strategies to prevent the infection.

Objective: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016., Methods: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis., Results: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out., Conclusions: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.

Objectives: To evaluate the prevalence of multidrug-resistant tuberculosis (MDR-TB) in individuals living in Latin America and the Caribbean (LAC)., Methods: We searched the MEDLINE, Embase and Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) databases until 08 August 2019 for all studies on the subject, without time or language restrictions. Original studies reporting the prevalence of infection with Mycobacterium tuberculosis resistant to isoniazid and rifampicin simultaneously (MDR) in LAC, the prevalence of resistance in cases with no previous treatment (new cases) and the prevalence of resistance in previously treated cases were selected. Considering the expected heterogeneity between studies, all analyses were performed using the random effects model, and heterogeneity was assessed using the I 2 statistic., Results: We included 91 studies from 16 countries. The estimated overall prevalence was 13.0% (95% CI 12.0-14.0%), and the heterogeneity between studies was substantial (I 2  = 96.1%). In the subgroup analyses, it was observed that the prevalence of MDR-TB among new cases was 7.0% (95% CI 6.0-7.0%) and in previously treated cases was 26.0% (95% CI 24.0-28.0%)., Conclusions: This review highlights multidrug resistance to antituberculosis drugs in LAC, indicating that prevention strategies have not been effective. Government institutions should invest heavily in strategies for early diagnosis and the rapid availability of effective treatments and prioritise adequate protection for health professionals. In addition, screening programmes should be adopted to prevent secondary cases., (© 2020 John Wiley & Sons Ltd.)

The present cohort study was set up with the aim of determining the incidence of dengue among children and adolescents, from 2 to 16 years of age, living in Araraquara, South-Eastern Brazil, a city classified as a mid-level endemicity location for dengue. Enrollment took place from September 2014 to March 2015. Baseline socio-demographic data were collected, and a blood sample from the participant was drawn, for dengue serology. Families were contacted weekly for fever surveillance. If the child developed fever, a nurse visited the household to collect a blood sample. PCR, NS1 and IgM were used for dengue diagnosis. Parents or legal guardians of participating children provided a written informed consent. 3,514 children and adolescents were enrolled in the cohort. Dengue baseline seroprevalence was 12.2% (95%CI: 11.1 - 13.3). The incidence density of symptomatic dengue was 8.94 per 100 person/years in the first year of follow-up, 0.58 in the second, and 0.19 in the fourth. No cases were confirmed in the third year. Incidence was associated with age, sex, baseline seroprevalence and with living in a house as opposed to an apartment. This study provides relevant information on the epidemiology of dengue in mid-level transmission settings that may be useful to policymakers in the evaluation of control strategies., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: EJA Luna has received consultancy fees and travel grants form Sanofi-Pasteur. The other authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: to describe the occurrence of hepatitis B among pregnant women, immunoprophylaxis and vertical and perinatal transmission in children exposed to the virus in the São Paulo state primary care network, Brazil., Methods: this was a cross-sectional study using prenatal records of pregnant women attending health services between January and June 2012 and a cohort of newborns; the frequencies of the results were described and the estimated occurrence of hepatitis B was calculated., Results: 6,233 pregnant women were included, of whom 53.1% were between 20-29 years old, 58.7% had 8-11 years of schooling, 53.3% were white, and 73.9% lived with a partner; occurrence of hepatitis B was 0.13% (95%CI 0.04; 0.21); of the eight children of mothers with chronic hepatitis B, six had a complete vaccination schedule, and there was no vertical or perinatal transmission., Conclusion: there was low occurrence of hepatitis B in pregnant women and absence of vertical or perinatal transmission.

Polymorphisms in the microsomal triglyceride transfer protein (MTTP) gene were genotyped in individuals who were chronically infected with hepatitis C virus (HCV). In the 236 patients, the frequencies of risk alleles of the -164T/C (rs1800804), -400A/T (rs1800803) and H297Q (rs2306985) polymorphisms were 0.30, 0.41 and 0.50, respectively. A significant association between the risk alleles of the -164T/C and -400A/T polymorphisms combined with HCV genotype 3 infection and the occurrence of steatosis was detected (p = 0.004 and p = 0.032), suggesting that a combination of host and viral factors can potentially be used to predict hepatic steatosis.

Given the implications of microplastics contamination in aquatic ecosystems and information scarcity about microplastic abundances in estuarine sediments, this study aimed to quantify and describe the microplastics in the sublittoral sediments from Guanabara Bay. Sediment samples were collected at four sites and three months, microplastics were separated and classified according to type, color, size, and polymer composition. High abundances of microplastic (160 to 1000 items kg -1 or 4367 to 25,794 items m -2 ) occurred independent of area or period, indicating microplastics are widely spread in Guanabara Bay. The dominant microplastic in the sediment was the translucent polyester microfiber of <1 mm size; which is a secondary microplastic, possibly coming from washing machines wastes. The extremely high availability of microplastics in Guanabara Bay, compared to the majority of studies around the world, suggests high risk of contamination to benthic organisms and demersal fish, as they may be ingesting microplastics., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: We aimed to estimate and compare the ability of clinical tools for dengue diagnosis in a pediatric population., Methods: We prospectively evaluated episodes of acute febrile syndrome identified during the follow-up of a population-based cohort of children and adolescents residing in a dengue endemic city. We estimated the area under the receiver operating characteristic curve (AU-ROC) for dengue diagnosis of three clinical tools: the summation of manifestations of the WHO case definition, a predefined clinical scale and a logistic regression model obtained in this study., Results: We compared 219 dengue cases (confirmed by laboratory) and 286 patients with other febrile illnesses. In a multiple model, variables independently associated with dengue included the duration of fever, sleepiness and exanthema. Rhinorrhea, cough and minimal leukocyte count were inversely associated with dengue. This model reached an accuracy of 84.2% (for a cut-off of >0.5, sensitivity: 79.5%, specificity: 87.9%, positive predictive value: 83.7%, negative predictive value: 84.6%). The AU-ROC of this model (89.8%) was significantly higher than that obtained with either the predefined scale (82.1%) or the WHO definition manifestations (77%)., Conclusion: We validated a predefined scale and identified a multiple model suitable for the clinical diagnosis of dengue in the pediatric population., (© The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Hepatitis E virus (HEV) is a member of the Hepeviridae family; it has four main genotypes and one serotype. While genotypes 1 and 2 cause epidemic hepatitis and are transmitted via water and the fecal-oral route, genotypes 3 and 4 are zoonotic. In the various seroprevalence studies of hepatitis E in Brazil, the numbers reported vary widely and are difficult to interpret. The aim of this study was to analyze existing seroprevalence studies of hepatitis E in adults in Brazil., Main Text: We searched the PubMed, Latin American and Caribbean Health Sciences and Embase databases for studies published from inception to May 12, 2018 concerning infection by HEV in Brazil without time period or language restrictions. We included studies that presented data concerning hepatitis E seroprevalence in adults in Brazil, had a sample size ≥50 patients and whose method used for the detection of anti-HEV was standardized and commercialized. We also evaluated the quality of the articles using a list of criteria that totalized 9 items. Of the 20 studies ultimately analyzed, 10 (50%) were from the southeast region of Brazil, 3 (15%) were from the central-west region, 3 (15%) were from the northern region, 2 (10%) were from the northeast region and 2 (10%) were from the southern region. Regarding the quality evaluation of the studies, the mean score was 5.6 (range: 4-8). The estimated overall seroprevalence of HEV infection in the adult population was 6.0% (95% CI: 5.0-7.0); in subgroup analyses, we observed that the prevalence of anti-HEV antibodies in blood donors was 7.0% (95% CI: 5.0-8.0), whereas in the general population, it was 3.0% (95% CI: 2.0-4.0)., Conclusions: The results of this systematic review indicate that there should be national investment in the prevention of hepatitis E virus infection in Brazil, including the implementation of improvements in basic sanitation and guidance regarding the appropriate handling of animal waste and the optimal cooking of vegetables, meat and their derivatives.

Microplastic ingestion by mesozooplankton may be an important pathway for the microplastics to enter the food web. To determine microplastic abundance in Guanabara Bay, samples were collected by neustonic haul with a 64-μm-net and oblique hauls using 64- and 200-μm nets. Microplastic size and abundance as well as copepod, fish-larvae, and chaetognath sizes, densities, and preferential prey sizes were determined. Microplastic abundance was higher in samples collected with fine nets (average 4.8 microplastics m -3 , maximum 11 microplastics m -3 ) than in those collected with coarse net. Microplastic abundance in Guanabara Bay was higher than that in other marine ecosystems. Microplastics >100 μm were too large to be ingested by copepods. However, for fish larvae and chaetognaths, the abundance of microplastics, at the corresponding prey size range, were, respectively, ~9000- and 14,400-folds lower than the preferential copepod prey, in the same size range. Thus, in Guanabara Bay, microplastics were available, but too diluted to be frequently ingested by fish larvae and chaetognaths., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Planktonic models represent a powerful tool for creating hypotheses and making predictions about the functioning of marine ecosystems. Their complexity varies according to the number of state variables and the choice of functional forms. We evaluated plankton models during the last 15 years (n =145) with the aims of understanding why they differ in complexity, evaluating model robustness, and describing studies of plankton modelling around the globe. We classified models into four groups: Nutrient-Phytoplankton-Zooplankton (NPZ), Nutrient-Phytoplankton-Zooplankton-Detritus (NPZD), Size-Structured (SS) and Plankton-Functional-Type (PFT). Our results revealed that the number of state variables varied according to the question being addressed: NPZ models were more frequently applied in physical-biological studies, while PFT models were more applied for investigating biogeochemical cycles. Most models were based on simple functional forms which neglect important feedback related to control of plankton dynamics. Modelling studies sometimes failed to describe sensitivity analysis, calibration and validation. The importance of testing different functional forms was commonly overlooked, and the lack of empirical data affected the verification of model robustness. Lastly, we highlight the need to develop modelling studies in the Southern Hemisphere, including Brazil, in order to provide predictions that assist the management of marine ecosystems.

A population-based hepatitis survey was carried out to estimate the prevalence of hepatitis B virus (HBV) infection and its predictive factors for the state capitals from the north, south, and southeast regions of Brazil. A multistage cluster sampling was used to select, successively, census tracts, blocks, households, and residents in the age group 10-69 years in each state capital. The prevalence of hepatitis B surface antigen (HBsAg) was lower than 1% in the north, southeast, and south regions. Socioeconomic condition was associated with HBV infection in north and south regions. Variables related to the blood route transmission were associated with HBV infection only in the south whereas those related to sexual behavior were associated with HBV infection in the north and south regions. Drug use was associated in all regions, but the type of drug differed. The findings presented herein highlight the diversity of the potential transmission routes for hepatitis B transmission in Brazil. In one hand, it reinforces the importance of national control strategies of large impact already in course (immunization of infants, adolescents, and adults up to 49 years of age and blood supply screening). On the other hand, it shows that there is still room for further control measures targeted to different groups within each region., (© The American Society of Tropical Medicine and Hygiene.)

Background: Despite a National Policy on Pain and Palliative Care (working since 2002) and the Family Health Strategy (primary care), Brazil does not have a strategy to integrate palliative care in primary care. The Atlas of Palliative Care in Latino America (ALCP-2013) did not find any team working with this mode: a primary care teach working., Aim: Propose a model of palliative care in the Public Health Service of Brazil offered through the Primary Care to community., Method: The Pilot Project is in the city of Rio Grande, south of Brazil, covering the area 29 with 3000 persons. This area has a team with a family physician, a nurse, a technical nurse and 6 Community Agents of Health (persons of area who work directly with population). The team has 3 aims 1) care: identification of possible patients (using the tracking and opinions of community health workers and the area diagnostics) > evaluation using PIG and SPCIT > care according to needs of these patients 2) awareness and needs assessment of the local/area community with ongoing monthly meetings and community engagement 3) awareness of management institutions in the city., Results: The project started in November of 2014 and the first identification found 51 patients. Evaluation and assessment will begins and this number will be reduced. The first local meeting will happen in January/2015., Conclusion: This project seeks to provide a proposal for palliative care offered through primary care in a public health service which does not exist in Brazil., (© 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Species of the dinoflagellate genus Alexandrium produce phycotoxins responsible for paralytic shellfish poisoning. Blooms of Alexandrium minutum reach very high concentrations of vegetative cells in the water column; and when these blooms occur, large numbers of toxic cysts can be produced and deposited on sediments becoming available to benthic species. The present study investigated the potential effect of exposure to toxic cysts of A. minutum on the periwinkle Littorinalittorea. Snails were exposed for nine days to pellicle cysts of toxic and non-toxic dinoflagellates, A. minutum and Heterocapsa triquetra, respectively, followed by six days of depuration while they were fed only H. triquetra. Toxin accumulation, condition index, immune and histopathological responses were analyzed. Histological alterations were also monitored in snails exposed to a harmful A. minutum bloom, which naturally occurred in the Bay of Brest. Snails exposed to toxic cysts showed abnormal behavior that seems to be toxin-induced and possibly related to muscle paralysis. Periwinkles accumulated toxins by preying on toxic cysts and accumulation appeared dependent on the time of exposure, increasing during intoxication period but tending to stabilize during depuration period. Toxic exposure also seemed to negatively affect hemocyte viability and functions, as ROS production and phagocytosis. Histological analyses revealed that toxic exposure induced damages on digestive organs of snails, both in laboratory and natural systems. This study demonstrates that an exposure to the toxic dinoflagellate A. minutum leads to sublethal effects on L. littorea, which may alter individual fitness and increase the susceptibility of snails to pathogens and diseases., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The aim of this study was to determine the influence of temperature increase combined to conditions of light incidence on functional response of Heleobia australis. Experiments were conducted using nine to ten food concentrations for each treatment: 20°C without light; 30°C without light and, 30°C under low light intensity. For each experiment, the functional response type III (sigmoidal) was fitted and equation parameters were determined. Results suggest that, if the sediment temperature increases, H. australis will not have its ingestion rates affected negatively, whilst its feeding behavior seems to be negatively affected by light. Ingestion rates estimated for organic content in the Guanabara Bay were: 0.34 µgC ind-1h-1 at 20°C without light, 1.44 µgC ind-1h-1 at 30°C without light and 0.64 µgC ind-1h-1 at 30°C under light incidence. Higher ingestion rates were estimated at the high temperature, even under light incidence, and temperature seems to have outweighed the light effect. In contrast, if higher carbon content is considered, despite high temperature, the experiment conducted with light incidence showed lower ingestion rates than those from the experiment at 20°C without light. This study provides the first quantification of H. australis ingestion rates and the effects that changes in temperature and light have on its feeding behavior.

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.

Background: Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil., Methods: The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case-control approach., Results: The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%-1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country., Conclusions: The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

The aim of this study was to describe the total density, densities of developmental stages and the reproduction period of Parasagitta friderici. Weekly samples were collected at one station in the channel of Guanabara Bay, Rio de Janeiro, during one year. Three vertical hauls were made for each sample, and P. friderici was separated, the developmental stages were identified, and body length (BL), ovary length (OL) and seminal vesicle width (SVW) were measured. Throughout the year P. friderici was the most abundant chaetognath species occurring in all four developmental stages, the densities of which varied from week to week. Higher densities of adults occurred in the spring, followed by peaks of juveniles in the summer. Although P. friderici seems to reproduce continuously in Guanabara Bay, a reproductive peak was apparent during the spring. The intensification of reproduction during the spring, with juveniles occurring in the summer, seems to be related to the period of higher food supply during the rainy season and intrusions of the South Atlantic Central Water.

A population-based survey to provide information on the prevalence of hepatitis viral infection and the pattern of risk factors was carried out in the urban population of all Brazilian state capitals and the Federal District, between 2005 and 2009. This paper describes the design and methodology of the study which involved a population aged 5 to 19 for hepatitis A and 10 to 69 for hepatitis B and C. Interviews and blood samples were obtained through household visits. The sample was selected using stratified multi-stage cluster sampling and was drawn with equal probability from each domain of study (region and age-group). Nationwide, 19,280 households and ~31,000 residents were selected. The study is large enough to detect prevalence of viral infection around 0.1% and risk factor assessments within each region. The methodology seems to be a viable way of differentiating between distinct epidemiological patterns of hepatitis A, B and C. These data will be of value for the evaluation of vaccination policies and for the design of control program strategies.

Since the introduction of the microbial loop concept, awareness of the role played by protozooplankton in marine food webs has grown. By consuming bacteria, and then being consumed by metazooplankton, protozoa form a trophic link that channels dissolved organic material into the "classic" marine food chain. Beyond enhancing energy transfer to higher trophic levels, protozoa play a key role in improving the food quality of metazooplankton. Here, we consider a third role played by protozoa, but one that has received comparatively little attention: that as prey items for ichthyoplankton. For >100 years it has been known that fish larvae consume protozoa. Despite this, fisheries scientists and biological oceanographers still largely ignore protozoa when assessing the foodweb dynamics that regulate the growth and survival of larval fish. We review evidence supporting the importance of the protozooplankton-ichthyoplankton link, including examples from the amateur aquarium trade, the commercial aquaculture industry, and contemporary studies of larval fish. We then consider why this potentially important link continues to receive very little attention. We conclude by offering suggestions for quantifying the importance of the protozooplankton-ichthyoplankton trophic link, using both existing methods and new technologies.

This multicentric population-based study in Brazil is the first national effort to estimate the prevalence of hepatitis B (HBV) and risk factors in the capital cities of the Northeast, Central-West, and Federal Districts (2004-2005). Random multistage cluster sampling was used to select persons 13-69 years of age. Markers for HBV were tested by enzyme-linked immunosorbent assay. The HBV genotypes were determined by sequencing hepatitis B surface antigen (HBsAg). Multivariate analyses and simple catalytic model were performed. Overall, 7,881 persons were included; < 70% were not vaccinated. Positivity for HBsAg was less than 1% among non-vaccinated persons and genotypes A, D, and F co-circulated. The incidence of infection increased with age with similar force of infection in all regions. Males and persons having initiated sexual activity were associated with HBV infection in the two settings; healthcare jobs and prior hospitalization were risk factors in the Federal District. Our survey classified these regions as areas with HBV endemicity and highlighted the risk factors differences among the settings.

Background: The objectives were to estimate the prevalence of hepatitis A among children and adolescents from the Northeast and Midwest regions and the Federal District of Brazil and to identify individual-, household- and area-levels factors associated with hepatitis A infection., Methods: This population-based survey was conducted in 2004-2005 and covered individuals aged between 5 and 19 years. A stratified multistage cluster sampling technique with probability proportional to size was used to select 1937 individuals aged between 5 and 19 years living in the Federal capital and in the State capitals of 12 states in the study regions. The sample was stratified according to age (5-9 and 10- to 19-years-old) and capital within each region. Individual- and household-level data were collected by interview at the home of the individual. Variables related to the area were retrieved from census tract data. The outcome was total antibodies to hepatitis A virus detected using commercial EIA. The age distribution of the susceptible population was estimated using a simple catalytic model. The associations between HAV infection and independent variables were assessed using the odds ratio and corrected for the random design effect and sampling weight. Multilevel analysis was performed by GLLAMM using Stata 9.2., Results: The prevalence of hepatitis A infection in the 5-9 and 10-19 age-group was 41.5 and 57.4%, respectively for the Northeast, 32.3 and 56.0%, respectively for the Midwest and 33.8 and 65.1% for the Federal District. A trend for the prevalence of HAV infection to increase according to age was detected in all sites. By the age of 5, 31.5% of the children had already been infected with HAV in the Northeast region compared with 20.0% in the other sites. By the age of 19 years, seropositivity was approximately 70% in all areas. The curves of susceptible populations differed from one area to another. Multilevel modeling showed that variables relating to different levels of education were associated with HAV infection in all sites., Conclusion: The study sites were classified as areas with intermediate endemicity area for hepatitis A infection. Differences in age trends of infection were detected among settings. This multilevel model allowed for quantification of contextual predictors of hepatitis A infection in urban areas.

Background: The effects of vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella) on the esophageal mucosa of patients with histological esophagitis are poorly understood. To evaluate long-term effects, we investigated the persistence, aggravation or disappearance of histological esophagitis in patients with morbid obesity and reflux esophagitis (diagnosed by endoscopic biopsy) after Roux-en-Y gastric bypass., Methods: Twenty-one patients with morbid obesity and esophagitis (histological diagnosis) were submitted to gastric bypass (Fobi-Capella technique) and underwent upper endoscopy and esophageal biopsy during the late postoperative period., Results: The mean age of the patients was 42.57 +/- 7.49 years (30 to 56). Nineteen (90.48%) patients were women, and two (9.52%) were men. Before surgery, the patients presented a mean weight of 124.26 +/- 19.09 kg and a mean body mass index (BMI) of 48.46 +/- 6.37 kg/m(2). Thirteen (61.90%) patients had endoscopic esophagitis before surgery. The mean weight and BMI were 81.65 +/- 13.16 kg and 31.91 +/- 4.99 kg/m(2), respectively, during the late postoperative period (29.80 +/- 8.91 months). The mean percentage of excess weight loss was 68.7 +/- 14.6%. Among the 21 patients with a preoperative histological diagnosis of reflux esophagitis, five (23.18%) had the same diagnosis after surgery, and four (19.04%) continued to present findings of endoscopic esophagitis., Conclusion: Vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella technique) is effective in the treatment of reflux esophagitis. No association was observed between the percentage of excess weight loss and improvement of esophagitis.

The reorganization of the Brazilian health system in the last few years has been based on the decentralization of the services and the integration of preventive and curative medicine, then creating new needs in term of the health information needed for health planning. The planning and administration of a regionalized and integrated health system calls for information about the population's morbidity profile, and the description of the pattern of the utilization of the health services, which can be obtained by means of household health surveys. The methodology utilized in a household health survey carried out in the Metropolitan Area of S. Paulo, Brazil, from July 1989 to June 1990, is described. This survey has some distinct methodological characteristics, such as the sampling process that defined the domains by age and sex, allowing an analysis of populational groups less well represented in the general population, as that of less than one year of age and that of aged people, as well as the use of the results of the latest Brazilian Census in 1991 for adjusting the sample.

The diagnostic categories of the patients discharged from the "Hospital das Clínicas" of the University of São Paulo in 1989 were arranged according the International Classification of Diseases (I.C.D.) and analysed. In each Group sex, age and the reason of discharge or death was indicated. The data concerning 39,601 cases were provided by the Medical Data Service of the "Instituto Central" of the "Hospital das Clínicas". Only the principal diagnosis was taken into account. In the "Instituto de Psiquiatria" most the patients (55.4%) were males between 20 and 49 years of age. The main diagnostic categories were affective psychoses (20.3%), schizophrenic disorders (15%), and disorders related to alcoholism (9.5%). The mortality rate was 0.27%. In the "Instituto da Criança" 56% of the patients that left the hospital were male children and 45.8% of them were less than one year old. Regarding to the diagnostic categories the most important one was that of the diseases of the respiratory system with 27.1% of cases, followed by that of infectious and parasitic diseases with 16.0% of cases. Within the respiratory diseases the most important were the pneumonias caused by not specified microorganisms, and within the infectious diseases the most important was the diarrhea of presumably infectious origin. The mortality rate in this Institute was 9.4%. The "Instituto de Ortopedia e Traumatologia" left 3,825 patients 61.7% males, and 46.9% of them were aged between 20 and 49 years. The greatest number of cases (57.1%) belonged to the Chapter "Injury and Poisoning" followed by that of "Diseases of the Muscoleskeletal System" and Connective Tissue Diseases (23.5%). In this Institute the mortality rate was 1.2%. From the "Instituto do Coração" 7,194 patients were discharged; 65% of them were males, varying their age between 50 and 69 years. The diseases of the circulatory system were mostly ischemic heart disease, miocardiopathies and rheumatic heart diseases. Mortality rate in this Institute was 10.8%. The "Instituto Central" was responsible for 65.6% of all the patients discharged from the "Hospital das Clínicas" (26,015 cases). As to the diagnostic categories the predominant chapter was that of "Injury and Poisoning" (12.8% of cases) followed by the "Diseases of the Digestive System" (10.9%) "Neoplasms" (10.8%) and the "Diseases of Circulatory System" (9.2%). The mortality rate in the "Instituto Central" was 7.2%.