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The first years of life are the most dynamic period for childhood growth. There are limited data available on growth patterns of infants and children living in rural Latin America. The aim of this study was to describe the growth patterns from birth to 5 years in children living in a rural District of tropical coastal Ecuador using data from a birth cohort of 2404 neonates. We hypothesize that there would be growth differences according to ethnicity and sex. Evaluations were conducted at birth or until 2 weeks of age and at 7, 13, 24, 36 and 60 months during clinic and home visits. Individual growth trajectories for weight-for-age, height-for-age and weight/height-for-age Z-scores were estimated using multilevel models. Girls were lighter and shorter than boys at birth. However, Afro-Ecuadorian children (versus mestizo or indigenous) were longer/taller and heavier throughout the first 5 years of life and had greater mean trajectories for HAZ and WAZ independent of sex and socioeconomic factors. Our data indicate that ethnicity is a determinant of growth trajectories during the first 5 years of life independent of socioeconomic factors in a birth cohort conducted in a rural region of Latin America.

The Centre for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador, Bahia-Brazil with the objective of integrating data and knowledge aiming to answer scientific questions related to the health of the Brazilian population. This article details our experiences in the establishment and operations of CIDACS, as well as efforts made to obtain high-quality linked data while adhering to security, ethical use and privacy issues. Every effort has been made to conduct operations while implementing appropriate structures, procedures, processes and controls over the original and integrated databases in order to provide adequate datasets to answer relevant research questions. Looking forward, CIDACS is expected to be an important resource for researchers and policymakers interested in enhancing the evidence base pertaining to different aspects of health, in particular when investigating, from a nation-wide perspective, the role of social determinants of health and the effects of social and environmental policies on different health outcomes.

RATIONALE: Exposures to geohelminths during gestation or early childhood may reduce risk of wheezing illness/asthma and atopy during childhood in tropical regions. OBJECTIVES: To investigate the effect of maternal and early childhood geohelminths on development of wheeze/asthma and atopy during the first 5 years of life. METHODS: Cohort of 2,404 neonates followed to 5 years of age in rural District in coastal Ecuador. Data on wheeze collected by questionnaire and atopy measured by allergen skin prick test reactivity to 9 allergens at 5 years. Stool samples from mothers and children examined for geohelminths by microscopy. MEASUREMENTS AND MAIN RESULTS: 2,090 (86.9%) children were evaluated at 5 years. Geohelminths were observed in 45.5% of mothers and in 34.1% of children by 3 years. Wheeze and asthma were reported for 12.6% and 5.7% of children, respectively, while 14.0% had skin test reactivity at 5 years. Maternal geohelminths were associated with an increased risk of wheeze (adjusted OR 1.41, 95% CI 1.06-1.88) while childhood geohelminths over the first 3 years of life were associated with reduced risk of wheeze (adjusted OR 0.70, 95% CI 0.52-0.96) and asthma (adjusted OR 0.60, 95% CI 0.38-0.94) but not skin prick test reactivity. The effects on wheeze/asthma were greatest with later age of first infection, were observed only in skin test-negative children but were not associated with parasite burden or specific geohelminths. CONCLUSIONS: While maternal exposures to geohelminths may increase childhood wheeze, childhood geohelminths during the first 3 years may provide protection through a non-allergic mechanism.

Allergic diseases are on the increase globally in parallel with a decrease in parasitic infection. The inverse association between parasitic infections and allergy at an ecological level suggests a causal association. Studies in human subjects have generated a large knowledge base on the complexity of the interrelationship between parasitic infection and allergy. There is evidence for causal links, but the data from animal models are the most compelling: despite the strong type 2 immune responses they induce, helminth infections can suppress allergy through regulatory pathways. Conversely, many helminths can cause allergic-type inflammation, including symptoms of "classical" allergic disease. From an evolutionary perspective, subjects with an effective immune response against helminths can be more susceptible to allergy. This narrative review aims to inform readers of the most relevant up-to-date evidence on the relationship between parasites and allergy. Experiments in animal models have demonstrated the potential benefits of helminth infection or administration of helminth-derived molecules on chronic inflammatory diseases, but thus far, clinical trials in human subjects have not demonstrated unequivocal clinical benefits. Nevertheless, there is sufficiently strong evidence to support continued investigation of the potential benefits of helminth-derived therapies for the prevention or treatment of allergic and other inflammatory diseases.

BACKGROUND: Usually, immunoglobulin M (IgM) serologic analysis is not sufficiently specific to confirm Zika virus (ZIKV) infection. However, since IgM does not cross the placenta, it may be a good marker of infection in neonates. METHODS: We tested blood from 42 mothers and neonates with microcephaly and collected cerebrospinal fluid (CSF) specimens from 30 neonates. Molecular assays were performed for detection of ZIKV, dengue virus, and chikungunya virus; IgM enzyme-linked immunosorbent assays and plaque-reduction neutralization tests (PRNTs) were performed to detect ZIKV and dengue virus. No control neonates without microcephaly were evaluated. RESULTS: Among neonates, all 42 tested positive for ZIKV IgM: 38 of 42 serum specimens (90.5%) were positive, whereas 30 of 30 CSF specimens (100%) were positive. ZIKV IgM-specific ELISA ratios, calculated as the mean optical density (OD) of the test sample when reacted on viral antigen divided by the mean OD of the negative control when reacted with viral antigen, were higher in CSF specimens (median, 14.9 [range, 9.3-16.4]) than in serum (median, 8.9 [range, 2.1-20.6]; P = .0003). All ZIKV IgM-positive results among the neonates were confirmed by the detection of neutralizing antibodies. Mother/neonate pairs with primary ZIKV infection had neutralizing antibodies to ZIKV only, and mother/neonate pairs with ZIKV virus infection secondary to infection with another flavivirus had high titers of neutralizing antibodies to ZIKV. Among secondary infections, median titers in serum were 2072 (range, 232-12 980) for mothers and 2730 (range, 398-12 980) for neonates (P < .0001), and the median titer in CSF was 93 (range, 40-578) among neonates (P < .0001). CONCLUSIONS: Among neonates, detection of ZIKV IgM in serum is confirmatory of congenital ZIKV infection, and detection of ZIKV IgM in CSF is confirmatory of neurologic infection. Therefore, we recommend testing for ZIKV IgM in neonates suspected of having congenital ZIKV infection and performance of PRNTs in equivocal cases.

The aim of this study was to assess the immunoexpression of human papillomavirus genotypes 16 and 18 (E6 and E7) oncoproteins in cervical high-grade squamous intraepithelial lesions (HSIL) of human immunodeficiency virus (HIV)-positive women. These results were also compared to the persistence and/or recurrence of lesions after loop electrosurgical excision procedure. Cervical samples from 158 patients were divided into three groups according to the presence or absence of HSIL in women who were or were not HIV-positive. By using the tissue microarray technique, immunohistochemistry was performed to analyze the expression of HPV 16/18 E6 and E7 oncoproteins. Cervical samples from 95 HIV-positive women and 63 HIV-negative women were studied. A statistically significant difference was found in the immunoexpression of E6 and E7 oncoproteins in samples from HIV-positive women with HSIL and that of women with non-neoplastic tissue (P < 0.001). There was also a statistically significant correlation between the immunoexpression of E6 (P = 0.012) and E7 (P < 0.001) oncoproteins in lesion persistence among HIV-positive women. Within the limitations of this study, the immunoexpression of HPV 16/18 E6 and E7 oncoproteins may have prognostic value regarding lesion persistence in HIV-positive women.

Hummingbird communities tend to respond to variation in resources, having a positive relationship between abundance and diversity of food resources and the abundance and/or diversity of hummingbirds. Here we examined the influence of floral resource availability, as well as seasonality and type of habitat on the composition of hummingbird species. The study was carried out in two habitats of eastern Brazilian mountaintops. A gradient representative of the structure of hummingbird community, based on species composition, was obtained by the ordination of samples using the method of non-metric multidimensional scaling. The composition of hummingbird species was influenced by the type of habitat and floral resource availability, but not by seasonality. Hummingbird communities differ between habitats mainly due to the relative abundance of hummingbird species. The variation in composition of hummingbird species with the variation in floral resource availability may be related to differences in feeding habits of hummingbirds. Hummingbird species with the longest bills visited higher proportions of ornithophilous species, while hummingbirds with shorter bills visited higher proportions of non-ornithophilous species. The results demonstrate that at local-scale the composition of hummingbird species is affected by the type of habitat and floral resources availability, but not by seasonality. Comunidades de beija-flores tendem a responder a variação em recursos, havendo uma relação positiva entre a abundância e diversidade de recurso alimentar com a abundância e/ou diversidade de beija-flores. Neste estudo nós analisamos a influencia da disponibilidade de recurso floral, bem como da sazonalidade e do tipo de habitat na composição de espécies de beija-flores. O estudo foi realizado em dois habitas de montanha do leste do Brasil. Um gradiente representativo da estrutura da comunidade de beija-flores, baseado na composição de espécies, foi obtido através da ordenação das amostras usando o método de escalonamento multidimensional não-métrico. A composição de espécies de beija-flores foi influenciada pelo tipo de habitat e disponibilidade de recurso floral, mas não pela sazonalidade. As comunidades de beija-flores variaram entre os habitas, principalmente devido a abundância relativa das espécies de beija-flores. A variação na composição de espécies de beija-flores com a variação na disponibilidade de recurso floral parece estar relacionada a diferenças nos hábitos alimentares dos beija-flores. Espécies de beija-flores com bicos de comprimentos maiores visitaram maiores proporções de espécies ornitófilas, enquanto beija-flores com bicos de comprimento menores visitaram maiores proporções de espécies não-ornitófilas. Os resultados demonstram que em escala local a composição de espécies de beija-flores é afetada pelo tipo de habitat e a disponibilidade de recurso floral, mas não pela sazonalidade.

BACKGROUND: The association between atopy and asthma is attenuated in non-affluent populations, an effect that may be explained by childhood infections such as geohelminths. OBJECTIVE: To investigate the association between atopy and wheeze in schoolchildren living in urban and rural areas of Ecuador and examine the effects of geohelminths on this association. METHODS: We performed nested case-control studies among comparable populations of schoolchildren living in rural communities and urban neighbourhoods in the Province of Esmeraldas, Ecuador. We detected geohelminths in stool samples, measured recent wheeze and environmental exposures by parental questionnaire, and atopy by specific IgE (sIgE) and skin prick test (SPT) reactivity to aeroallergens. RESULTS: Atopy, particularly sIgE to house dust mite (HDM), was more strongly associated with recent wheeze in urban than rural schoolchildren: (urban, adj. OR 5.19, 95% CI 3.37-8.00, P < 0.0001; rural, adj. OR 1.81, 95%CI 1.09-2.99, P = 0.02; interaction, P < 0.001). The population fractions of wheeze attributable to atopy were approximately two-fold greater in urban schoolchildren: SPT to any allergen (urban 23.5% vs. rural 10.1%), SPT to HDM (urban 18.5% vs. rural 9.6%), and anti-HDM IgE (urban 26.5% vs. rural 10.5%), while anti-Ascaris IgE was related to wheeze in a high proportion of rural (49.7%) and urban (35.4%) children. The association between atopy and recent wheeze was attenuated by markers of geohelminth infections. CONCLUSIONS: Our data suggest that urban residence modifies the association between HDM atopy and recent wheeze, and this effect is explained partly by geohelminth infections.

OBJECTIVES: To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children. DESIGN: Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts. SETTING: Community congregate settings and households. INCLUSION CRITERIA: Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays. DATA EXTRACTION: Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis. RESULTS: The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77). CONCLUSIONS: BCG protects against M tuberculosis infection as well as progression from infection to disease.Trial registration PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).

The hummingbird-visited plant community located on the open-habitat mountaintop of the Espinhaço Range was studied for two years (from August 2007 to July 2009) in Serra do Cipó National Park, Southeastern Brazil (19° 15′ S and 43° 31′ W). The floral characteristics and flowering period of the hummingbird-visited plants was monthly recorded along trails located in three vegetation types: (1) typical campos rupestres (TCR), (2) open fields (OPF), and (3) capões de mata(CAM). Hummingbird visitation was observed in 51 plant species, 22 ornithophilous and 29 non-ornithophilous species. The TCR showed the greatest number of species visited (N = 38), followed by the OPF (N = 18) and CAM (N = 17). Six species of hummingbirds were recorded visiting flowers: Augastes scutatus, Campylopterus largipennis, Colibri serrirostris, Chlorostilbon lucidus, Eupetomena macroura and Phaethornis pretrei. This study demonstrates that the species richness and the number of ornithophilous species visited by the hummingbirds at the study site are more similar to hummingbird-plant communities of the Atlantic Forest than to those of the Cerrado communities and other Brazilian highland open-habitat communities. The plant families most visited by hummingbirds were Bromeliaceae and Asteraceae. Although the Asteraceae family is rarely used as a food resource for hummingbirds in other high and lowland communities, in the study site this family is used mainly by the endemic hummingbird Augastes scutatus. We found a large overlap of flowering throughout the year among the species visited by the hummingbirds. Thus, the nectar availability supports these resident hummingbirds. The present study also showed that the studied hummingbird-plant community is composed of many species endemic to the campos rupestres of the Espinhaço Range, some of which are considered to be in danger of extinction, thus constituting a unique and threatened community. Thus, understanding hummingbird-plant pollination dynamics becomes fundamental to the conservation of the campos rupestres. A comunidade de flores visitadas por beija-flores em habitats abertos de montanhas da Serra do Espinhaço, sudeste do Brasil foi estudada por dois anos (de agosto de 2007 a julho de 2009) no Parque Nacional da Serra do Cipó (19° 15′ S e 43° 31′ W). As características florais e o período de floração das plantas visitadas foram registradas mensalmente ao longo de trilhas localizadas em três tipos vegetacionais: (1) campos rupestres típicos (TCR), (2) campos abertos (OPF), e (3) capões de mata (CAM). Foram observadas visitas de beija-flores a 51 espécies de plantas: 22 ornitófilas e 29 não-ornitófilas. O TCR apresentou o maior número de espécies visitadas (N = 38), seguido pelo OPF (N = 18) e CAM (N = 17). Seis espécies de beija-flores foram observadas visitando as flores: Augastes scutatus, Campylopterus largipennis, Colibri serrirostris, Chlorostilbon lucidus, Eupetomena macrourae Phaethornis pretrei. A riqueza de espécies e o número de espécies ornitófilas visitadas pelos beija-flores, neste estudo, foi mais similar à comunidades de plantas visitadas por beija-flores na Floresta Atlântica, que as comunidades do Cerrado, bem como de outras comunidades de ambientes abertos do Brasil. As famílias com maior número de plantas visitadas pelos beija-flores foram Bromeliaceae e Asteraceae. Apesar da família Asteraceae, raramente ser utilizada como fonte alimentar pelos beija-flores em outras comunidades, nas áreas amostradas neste estudo esta família foi utilizada, principalmente, pelo beija-flor endêmico A. scutatus. Nós registramos grande sobreposição de floração ao longo do ano entre as espécies visitadas pelos beija-flores. Portanto, a disponibilidade de néctar mantem os beija-flores residentes. Este estudo, demonstrou também, que a comunidade de plantas visitadas pelos beija-flores nesta área é composta por muitas espécies endêmicas dos campos rupestres da Serra do Espinhaço, algumas das quais consideradas em perigo de extinção, constituindo assim uma comunidade única e ameaçada. Portanto, o entendimento da dinâmica de polinização desta comunidade é fundamental para a conservação dos campos rupestres.

This study investigated the enrichment influence due to fish farming in net cages on the phytoplankton composition, density and diversity in two arms of a subtropical reservoir (Salto Caxias, Paraná). There were no statistically significant differences in the phytoplankton composition and diversity, as well as for concentrations of nutrients among the handled treatment. The density values were higher during the summer. Richness and Shannon diversity values were low during the study period. The equitability values were high during the winter and low in the summer. Variations of phytoplankton community and nutrients were mainly influenced by seasonality. The absence of significant differences between the treatments was probably due to the small number of net cages and fish used, as well as to the hydrodynamics of the studied environments, which are influenced by upstream rivers inflows. Este estudo investigou os efeitos do enriquecimento devido ao cultivo de peixes em tanques-rede sobre a composição, densidade e diversidade fitoplanctônica em dois braços de um reservatório subtropical (Salto Caxias, Paraná). Não foram registradas diferenças significativas para a composição e diversidade fitoplanctônica e para as concentrações de nutrientes entre os tratamentos utilizados. A densidade foi maior durante o verão. Os valores de riqueza de espécies e diversidade de Shannon foram baixos durante todo o período de estudo. A equitabilidade foi elevada no inverno e baixa no verão. As variações da comunidade fitoplanctônica e dos nutrientes parecem ter sido influenciadas principalmente pela sazonalidade. A ausência de diferenças significativas entre os tratamentos, provavelmente se devem ao pequeno número de tanques e peixes utilizados, e à hidrodinâmica dos ambientes estudados, os quais são influenciados pelos influxos dos rios à montante.

The work aimed to show variations in the composition and structure of the phytoplankton community at high water and low water in Iguaçu Falls, Iguaçu River and to examine the influence of these waterfalls and environmental variables on the community. Phytoplankton samples were taken monthly during a year from two sampling stations in the Iguaçu River. A total of 408 taxa were identified, with Bacillariophyceae being the most strongly represented group. A large differentiation in the composition of the phytoplankton was observed between the sampling stations. The total richness and density of the phytoplankton groups was very low in both sample locations, as well as the Shannon diversity index, but the evenness value was generally high. No significant seasonal and spatial difference in the studied features of the phytoplankton community was seen. But, significant seasonal differences were observed when the density and richness of the algae classes were assessed separately. The heterogeneity of the Iguaçu River's characteristics between the sampling sites caused no significant spatial differentiation in the features of the phytoplankton community. However, the seasonal variation of the climatic conditions has significantly influenced the composition and structure of the community in the Iguaçu River.

BACKGROUND: Recent evidence suggests that the duration of protection by bacillus Calmette-Guérin (BCG) may exceed previous estimates with potential implications for estimating clinical and cost-efficacy. OBJECTIVES: To estimate the protection and duration of protection provided by BCG vaccination against tuberculosis, explore how this protection changes with time since vaccination, and examine the reasons behind the variation in protection and the rate of waning of protection. DATA SOURCES: Electronic databases including MEDLINE, Excerpta Medica Database (EMBASE), Cochrane Databases, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Web of Knowledge, Biosciences Information Service (BIOSIS), Latin American and Caribbean Health Sciences Literature (LILACs), MEDCARIB Database, Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception to May 2009. Index to Theses, System for Information on Grey Literature in Europe (SIGLE), Centre for Agricultural Bioscience International (CABI) Abstracts, Scopus, Article First, Academic Complete, Africa-Wide Information, Google Scholar, Global Health, British National Bibliography for Report Literature, and clinical trial registration websites were searched from inception to October 2009. REVIEW METHODS: Electronic databases searches, screening of identified studies, data extraction and analysis were undertaken. Meta-analysis was used to present numerical and graphical summaries of clinical efficacy and efficacy by time since vaccination. Evidence of heterogeneity was assessed using the tau-squared statistic. Meta-regression allowed the investigation of observed heterogeneity. Factors investigated included BCG strain, latitude, stringency of pre-BCG vaccination tuberculin testing, age at vaccination, site of disease, study design and vulnerability to biases. Rate of waning of protection was estimated using the ratio of the measure of efficacy after 10 years compared with the efficacy in the first 10 years of a study. RESULTS: Study selection. A total of 21,030 references were identified, providing data on 132 studies after abstract and full-text review. Efficacy. Protection against pulmonary tuberculosis in adults is variable, ranging from substantial protection in the UK MRC trial {rate ratio 0.22 [95% confidence interval (CI) 0.16 to 0.31]}, to absence of clinically important benefit, as in the large Chingleput trial [rate ratio 1.05 (95% CI 0.88 to 1.25)] and greater in latitudes further away from the equator. BCG vaccination efficacy was usually high, and varied little by form of disease (with higher protection against meningeal and miliary tuberculosis) or study design when BCG vaccination was given only to infants or to children after strict screening for tuberculin sensitivity. High levels of protection against death were observed from both trials and observational studies. The observed protective effect of BCG vaccination did not differ by the strain of BCG vaccine used in trials. DURATION: Reviewed studies showed that BCG vaccination protects against pulmonary and extrapulmonary tuberculosis for up to 10 years. Most studies either did not follow up participants for long enough or had very few cases after 15 years. This should not be taken to indicate an absence of effect: five studies (one trial and four observational studies) provided evidence of measurable protection at least 15 years after vaccination. Efficacy declined with time. The rate of decline was variable, with faster decline in latitudes further from the equator and in situations where BCG vaccination was given to tuberculin-sensitive participants after stringent tuberculin testing. LIMITATIONS: The main limitation of this review relates to quality of included trials, most of which were conducted before current standards for reporting were formulated. In addition, data were lacking in some areas and the review had to rely on evidence from observational studies. CONCLUSIONS: BCG vaccination protection against tuberculosis varies between populations, to an extent that cannot be attributed to chance alone. Failure to exclude those already sensitised to mycobacteria and study latitude closer to the equator were associated with lower efficacy. These factors explained most of the observed variation. There is good evidence that BCG vaccination protection declines with time and that protection can last for up to 10 years. Data on protection beyond 15 years are limited; however, a small number of trials and observational studies suggest that BCG vaccination may protect for longer. Further studies are required to investigate the duration of protection by BCG vaccination. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

This is the first study comparing societal costs of acute illness with Salmonella Typhimurium (ST) and Salmonella Enteritidis (SE) in the UK. It included the cost and severity of the illness and explored the impact of each Salmonella serovar on the patients, their families, the NHS, and the wider economy. The study ascertained confirmed cases of ST and SE between July and November 2008. The mean costs per case were £1282 (ST) and £993 (SE). The indirect costs associated with the work-time lost by the case, parents, or carers were £409 (ST) and £228 (SE); this difference was statistically significant. The aggregate cost of ST and SE identified using laboratory test results for the UK as a whole was estimated as £6.5 million. Work-time lost and caring activities are cost categories that are not frequently investigated within the infectious intestinal disease literature, although they represent an important societal cost.

Background The low prevalence of allergic disease in the rural tropics has been attributed to the protective effects of chronic helminth infections. There is concern that treatment-based control programmes for these parasites may lead to an increase in the prevalence of allergic diseases. Objective We measured the impact of 15–17 years of anthelmintic treatment with ivermectin on the prevalence of allergen skin test reactivity and allergic symptoms in school-age children. Methods The prevalence of allergen skin test reactivity, exercise-induced bronchospasm and allergic symptoms was compared between school-age children living in communities that had received community-based treatments with ivermectin (for onchocerciasis control) for a period of 15–17 years with those living in geographically adjacent communities that had received no ivermectin. Results The prevalence of allergen skin test reactivity was double in children living in treated communities compared with those in untreated communities (16.7% vs. 8.7%, adjusted OR 2.10, 95% CI 1.50–2.94, P

The interannual variation of phytoplankton communities in the three main rivers of the Upper Paraná River floodplain is evaluated in relation to changes in the hydrosedimentological regime. These changes are a result of climatic variability and the formation of Porto Primavera Reservoir, located at the upper Paraná River. Phytoplankton species richness and density were investigated in rivers during a prior period (1993-1994) and eight years after reservoir impoundment (2000-2007). Multiple analyses were conducted to test the differences between these time periods in order to find predictor variables for phytoplankton attributes. A total of 454 phytoplanktonic taxa were found. The regression analysis revealed significant differences between periods. In the years following construction of the Porto Primavera dam, species richness was lower in the Paraná River and density was higher in the three rivers. In general, the algal density decreased from 2005 to 2007. Diatoms and cyanobacteria contributed significantly to the total density during the period from March 1993 to February 1994. The years 2000-2007 presented the lowest diatom contribution to species richness and the highest cyanobacteria contribution. From 2000 on, cryptomonads and cyanobacteria dominated. The interannual variability of phytoplankton was probably influenced by changes in hydrosedimentological regime due to climatic variations (La Niña and El Niño - Southern Oscillation events - ENSO) and the operational procedures associated with an upstream reservoirs. Studies on climatic variability and its effects on hydrosedimentological regimes of the Paraná, Baía and Ivinhema rivers and the biota therein are necessary to obtain subsidies for management, including decisions related to the operation of dams upstream and downstream of the study area, with the purpose of minimizing risks to the Environmental Protection Area. A variação interanual da estrutura fitoplanctônica nos três principais rios da planície de inundação do Alto Rio Paraná foi avaliada em relação às modificações no regime hidrossedimentológico. Essas modificações são resultantes da variabilidade climática e da formação do reservatório de Porto Primavera, localizado no Alto Rio Paraná. Foi avaliada a riqueza de espécies e a densidade, em um período anterior à construção da UHE de Porto Primavera (1993-1994) e nos 8 anos seguintes (2000-2007) a formação do reservatório. Foram realizadas análises de regressão múltipla para testar as diferenças entre os períodos e buscar variáveis preditoras dos atributos fitoplanctônicos analisados. Foram registrados 454 táxons. A análise de regressão evidenciou variações significativas entre os períodos analisados. A riqueza de espécies foi menor no Rio Paraná e a densidade fitoplanctônica foi maior nos três rios nos anos seguintes à formação do reservatório de Porto Primavera. Registrou-se um decréscimo nos valores de densidade nos anos de 2005 a 2007. Diatomáceas e cianobactérias contribuíram significativamente para a densidade durante o período de março de 1993 a fevereiro de 1994. No período de 2000 a 2007 ocorreu menor contribuição de diatomáceas e, maior contribuição de cianobactérias para a riqueza de espécies. A partir de 2000, criptofíceas e cianobactérias dominaram. As alterações nos atributos analisados também estiveram associadas às flutuações no regime hidrossedimentológico dos rios estudados, provavelmente, influenciadas pelas fases La Niña e El Niño (Oscilação Sul - ENOS). Estes resultados salientam a necessidade de estudos enfocando a variabilidade climática e seus efeitos sobre o regime hidrossedimentológico do Rio Paraná e, sobre sua biota, de modo a fornecer subsídios para o manejo adequado, incluindo decisões quanto à operação das barragens situadas a montante e jusante da região de estudo, para minimizar as perdas de biodiversidade nesta Área de Preservação Ambiental.

Campylobacter is the most common bacterial cause of gastroenteritis in England and Wales, with 45000 cases reported annually. Campylobacter incidence is highly seasonal; the consistent peak in late spring suggests a role for meteorological factors in the epidemiology of this organism. We investigated the relationship between ambient temperature and Campylobacter enteritis using time-series analysis to study short-term associations between temperature and number of Campylobacter reports adjusted for longer-term trend and seasonal patterns. We found a linear relationship between mean weekly temperature and reported Campylobacter enteritis, with a 1 degrees C rise corresponding to a 5% increase in the number of reports up to a threshold of 14 degrees C. There was no relationship outside this temperature range. Our findings provide evidence that ambient temperature influences Campylobacter incidence, and suggest that its effect is likely to be indirect, acting through other intermediate pathways.

OBJECTIVE: To validate the BCG scar as a marker of BCG vaccination status. METHODS: A cross-sectional survey was carried out among 53,348 schoolchildren aged 6-14 years who underwent BCG scar examination as part of a large BCG vaccine trial taking place in the city of Manaus, Brazil. Results of BCG scar reading were compared with information on vaccine status of their vaccination cards or provided by parents or guardians. Double-reading was performed in a sub-sample. Data analysis was conducted using Stata 7 and Kappa coefficient. RESULTS: Of 52,348 schoolchildren studied, vaccine status information from parents/guardian letters was available for 29,254 and from vaccination cards for 4,947. There was found a high agreement between the double-readings of the scars (Kappa=0.81). When the agreement between letter and card information was the gold standard, the sensitivity of BCG scar readings was 96.6% (95%CI 96.0-97.1) and the specificity was 71.1% (95%CI 55.7-83.7). The sensitivity was 96.1%, 97.3% and 95.3% for children vaccinated up to one month of age, four months and one year, respectively. CONCLUSIONS: Sensitivity and specificity did not show an association with the child's age at the scar reading. BCG scar was a good marker of BCG vaccination status regardless of age - from the first years of life up to 14 years old.