Basic sanitation, socioeconomic conditions, and degree of risk for the presence and maintenance of malaria in a low-transmission area in the Brazilian Amazon

ABSTRACTINTRODUCTION:This study aimed to evaluate basic sanitation and socioeconomic indicators, reported cases of malaria, and risk of contracting malaria in the Ananindeua municipality, State of Pará.METHODS:Data on basic sanitation and socioeconomic dimensions were taken from the Brazilian Institute of Geography and Statistics [ Instituto Brasileiro de Geografia e Estatística (IBGE)] 2010 census. Epidemiological malaria information was taken from the Epidemiological Malaria Surveillance Information System [ Sistema de Informação de Vigilância Epidemiológica de Malária (SIVEP/Malaria)], between 2003 and 2013 of the Ministry of Health and from the SIVEP/Malaria forms of the municipality's Endemic Diseases Unit for 2,013 cases.RESULTS:Our data do not confirm the correlation among indicators of basic sanitation, socioeconomic conditions, and water supply with malaria cases. Of the 1,557 cases evaluated, most were caused by Plasmodium vivax , with rare cases of Plasmodium falciparum and mixed infections. There were 756 notifications in 2003. The number of reported cases was sharply reduced between 2006 and 2012, but a 142-case outbreak occurred in 2013. Ananindeua municipality's Annual Parasite Index indicated low risk in 2003 and no risk in other years, and the 2,013 cases were predominantly male individuals aged ≥40 years.CONCLUSIONS:Our data confirm the non-endemicity of malaria in the Ananindeua municipality, as the Annual Parasite Indices described for the years 2004-2013 classify it as a risk-free area. However, the 2013 outbreak indicates the need to strengthen prevention, surveillance, and control activities to reduce the risk of new outbreaks and consequent economic and social impacts on the population.

Presence of anti-Leishmania (Viannia) braziliensis antibodies in blood donors in the West-Central region of the State of Paraná, Brazil

ABSTRACTINTRODUCTION:Serological screening in blood banks does not include all transmittable diseases. American cutaneous leishmaniasis (ACL) has a high detection rate in the municipalities of the State of Paraná.METHODS:This study analyzed the presence of anti- Leishmania braziliensisantibodies in 176 blood donors who live in these endemic areas. The variables were analyzed with the χ2 test and Stata 9.1 software. RESULTS: Twenty (11.4%) samples were positive for the presence of anti- L. braziliensisantibodies. CONCLUSIONS: The high percentage of donors with anti- Leishmania spp. antibodies indicates the need to study the risk of ACL transmission through blood donors.

External quality assessment in the voluntary counseling and testing centers in the Brazilian Amazon using dried tube specimens: results of an effectiveness evaluation

INTRODUCTION : In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodeficiency virus (HIV) tests using the dried tube specimen (DTS) method (EQA-RT/DTS-HIV). Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs) in the Brazilian Legal Amazonian area one year after its introduction. METHODS : Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs) (n=39) and VCTC coordinators (n=32) were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program's logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program. RESULTS: The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure), registration in Quali-TR online system 38.7% (process), and VCTC completed the full process in the program's first round 63.4% (result). Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance. CONCLUSIONS: All three program dimensions exhibited satisfactory results (>75%). Nevertheless, the study findings highlight the need to improve certain program components. Additionally, long-term follow-ups is needed to provide a more thorough picture of the process for external quality assessment.

Distribution of hepatitis B infection in Brazil: the epidemiological situation at the beginning of the 21 st century

Abstract Brazil was formerly considered a country with intermediate hepatitis B endemicity, with large heterogeneity between Brazilian regions and areas of high prevalence, especially in the Amazon basin. Systematic vaccination of children was initiated in 1998. Between 2004 and 2009, a large population-based study reported decreased prevalence in all regions of Brazil. This review analyzed the current hepatitis B epidemiological situation in Brazil through a systematic search of the scientific literature in MEDLINE, LILACS, and CAPES thesis database, as well as disease notifications to the Information System for Notifiable Diseases. The search strategy identified 87 articles and 13 theses, resulting in 100 total publications. The most recent results indicate reduced hepatitis B prevalence nationwide, classifying Brazil as having low endemicity. Most studies showed HBV carrier prevalence less than 1%. However, there are still isolated regions with increased prevalence, particularly the Amazon, as well as specific groups, such as homeless people in large cities and isolated Afro-descendant communities in the center of the country. This review alsao detected successful vaccination coverage reported in a few studies around the country. The prevalence of anti-HBs alone ranged from 50% to 90%. However, isolated and distant localities still have low coverage rates. This review reinforces the downward trend of hepatitis B prevalence in Brazil and the need to intensify vaccination strategies for young people and adults in specific regions with persisting higher HBV infection prevalence.

The interception process in tropical rain forests: a literature review and critique (*).

A review of the literature on measurements of rain water interception processes by forests is made. Information on Africa, Central and South America, and Asia is given. A general analysis is made and the need to further the measurements under field conditions is stressed.

Exercise and heart failure. Relation of the severity of the disease to the anaerobic threshold and the respiratory compensation point

OBJECTIVE - To identify, the anaerobic threshold and respiratory compensation point in patients with heart failure. METHODS - The study comprised 42 Men,divided according to the functional class (FC) as follows: group I (GI) - 15 patients in FC I; group II (GII) - 15 patients in FC II; and group III (GIII) - 12 patients in FC III. Patients underwent a treadmill cardiopulmonary exercise test, where the expired gases were analyzed. RESULTS - The values for the heart rate (in bpm) at the anaerobic threshold were the following: GI, 122±27; GII, 117±17; GIII, 114±22. At the respiratory compensation point, the heart rates (in bpm) were as follows: GI, 145±33; GII, 133±14; GIII 123±22. The values for the heart rates at the respiratory compensation point in GI and GIII showed statistical difference. The values of oxygen consumption (VO2) at the anaerobic threshold were the following (in ml/kg/min): GI, 13.6±3.25; GII, 10.77±1.89; GIII, 8.7±1.44 and, at the respiratory compensation point, they were as follows: GI, 19.1±2.2; GII, 14.22±2.63; GIII, 10.27±1.85. CONCLUSION - Patients with stable functional class I, II, and III heart failure reached the anaerobic threshold and the respiratory compensation point at different levels of oxygen consumption and heart rate. The role played by these thresholds in physical activity for this group of patients needs to be better clarified.

Hypertension and clustering of cardiovascular risk factors in a community in Southeast Brazil: the Bambuí Health and Ageing Study

OBJECTIVE - A population-based prospective study was analysed to: a) determine the prevalence of hypertension; b) investigate the clustering of other cardiovascular risk factors and c) verify whether older differed from younger adults in the pattern of clustering. METHODS - The data comprised a representative sample of the population of Bambuí, Brazil. Multiple logistic regression was used to investigate the independent association between hypertension and selected factors. RESULTS - A total of 820 younger adults (82.5%) and 1494 older adults (85.9%) participated in this study. The overall prevalence of hypertension was 24.8% (SE=1.4 %), being higher in women (26.9±1.5%) than in men (22.0± 1.7%) (p=0.033). Hypertension was positively and significantly associated with physical inactivity, overweight, hypercholesterolemia hyperglycemia and hypertriglyceridemia. The coexistence of hypertension with 4 or more of these risk factors occurred 6 times more than expected by chance, after adjusting for age and sex (OR=6.3; 95%CI: 3.4-11.9). The pattern of risk factor clustering in hypertensive individuals differed with age. CONCLUSION - Our results reinforce the need to increase detection and treatment of hypertension and to approach patients' global risk profiles.

Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit

OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeirão Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.

Assessment of the Cardiovascular Risk and Physical Activity of Individuals Exercising at a Public Park in the City of São Paulo

OBJECTIVE: Physical exercise helps to prevent cardiovascular disorders. Campaigns promoting exercise have taken many people to the parks of our city. The most appropriate exercise for preventing cardiovascular disorders is the aerobic modality; inappropriate exercise acutely increases cardiovascular risk, especially in individuals at higher risk. Therefore, assessing the cardiovascular risk of these individuals and their physical activities is of practical value. METHODS: In the Parque Fernando Costa, we carried out the project "Exercício e Coração" (Exercise and Heart) involving 226 individuals. Assessment of the cardiovascular risk and of the physical activity practiced by the individuals exercising at that park was performed with a questionnaire and measurement of the following parameters: blood pressure, weight, height, and waist/hip ratio. The individuals were lectured on the benefits provided by exercise and how to correctly exercise. Each participant received a customized exercise prescription. RESULTS: In regard to risk, 43% of the individuals had health problems and 7% of the healthy individuals had symptoms that could be attributed to heart disorders. High blood pressure was observed in a large amount of the population. In regard to the adequacy of the physical activity, the individuals exercised properly. The project was well accepted, because the participants not only appreciated the initiative, but also reported altering their exercise habits after taking part in the project. CONCLUSION: Data obtained in the current study point to the need to be more careful in assessing the health of individuals who exercise at parks, suggesting that city parks should have a sector designated for assessing and guiding physical activity.

The relation of the concentration of macronutrients in the substrate and in the foliage to cell wall thickness and cellulose concentration in the xylem of slash pine (Pinus elliotti)

Sand culture experiments, using a sub-irrigation technique, were installed in order to find out the effects of the macronutrients N, P, K, Ca, Mg and S on growth, aspect, mineral composition, length of fibers, thickness of cell wall and cellulose concentration in slash pine. The aim was to obtain, under controlled conditions, basic information which could eventually lead to practical means designed to increase the rate of growth and to make of slash pine a richer source of cellulose. Nitrogen, Phosphorus, Potassium Experiment A 3 x 3 x 3 factorial design with two replicates was used. Nitrogen was supplied initially at the levels of 25, 50 and 100 ppm; phosphorus was given at the rates of 5, 10 and 20 ppm; potassium was supplied at the rates of 25, 50 and 100 ppm; six months after the experiment was started the first level for each element was dropped to zero. Others macro and all micronutrients were supplied at uniform rates. Fifteen hours of illumination per day were provided. The experimental technique for growing the slash pine seedlings proved quite satisfactory. Symptoms of deficiency of nitrogen, phosphorus and potassium were observed, described and recorded in photographs and water colors. These informations will help to identify abnormalities which may appear under field conditions. Chemical analysis of the several plant parts, on the other hand, give a valuable means to assess the nutritional status of slash pine, thus confirming when needed, the visual diagnosis. The correctness of manurial pratices, on the other hand, can be judged with the help of the analytical data tabulated. Under the experimental conditions nitrogen caused the highest increases on growth, as measured by increments in height and dry weights, whereas the effects of phosphorus and potassium were less marked. Cellulose concentration was not significantly affected by the treatments used. Higher levels of N seemed to decrease both length of fiber elements and the thickness of cell wall. The effects of P and K were not well defined. Calcium, Magnesium, Sulfur Experiment A 3 x 3 x 3 factorial design with two replicates was used. Calcium was supplied initially at the levels of 12.5, 25 and 50 ppm; magnesium and sulfur were given at the rates of 6, 12.5 and 25 ppm. Other macro and micronutrients were supplied at uniform rates, common to all treatments. Three months after starting the experiment the first level for each element was dropped to zero. Symptoms of deficiency of calcium, magnesium and sulfur were observed, described and recorded as in the case of the previous experiment. Chemical analysis were made, both for mineral content and cellulose concentration. Length of fibers and thickness of cell wall were measured. Both calcium and magnesium increase height, sulfur failing to give significant response. Dry weight was beneficially affected by calcium and sulfur. The levels of calcium, magnesium and sulfur in the needles associated with deficiency and maximum growth are comparable with those found in the literature. Cellulose concentration increased when the level of sulfur in the substrate was raised. The thickness of cell wall was negatively affected by the treatments; no effect was observed with regards to length of fibers.

Effect of bird density on the decision to join a group in the Sicalis flaveola pelzeni (Passeriformes, Emberizidae)

A change in bird density within a captive flock of Sicalis flaveola pelzeni (Sclater, 1872) affected the decision to join a group. Ruling out inter-individual differences and maintaining constant the size of a food patch, birds were found to fly more often to the food source and spend a longer time in its environs when kept in greater groups.

Effects of both ecdysone and the acclimation to low temperature, on growth and metabolic rate of juvenile freshwater crayfish Cherax quadricarinatus (Decapoda, Parastacidae)

Growth, metabolic rate, and energy reserves of Cherax quadricarinatus (von Martens, 1868) juveniles were evaluated in crayfish acclimated for 16 weeks to either 25ºC (temperature near optimum) or 20ºC (marginal for the species). Additionally, the modulating effect of ecdsyone on acclimation was studied. After 12 weeks of exposure, weight gain of both experimental groups acclimated to 25ºC (control: C25, and ecdysone treated: E25) was significantly higher than that of those groups acclimated to 20ºC (C20 and E20). A total compensation in metabolic rate was seen after acclimation from 25ºC to 20ºC; for both the control group and the group treated with ecdysone. A Q10value significantly higher was only observed in the group acclimated to 20ºC and treated with ecdysone. A reduction of glycogen reserves in both hepatopancreas and muscle, as well as a lower protein content in muscle, was seen in both groups acclimated to 20ºC. Correspondingly, glycemia was always higher in these groups. Increased lipid levels were seen in the hepatopancreas of animals acclimated to 20ºC, while a higher lipid level was also observed in muscle at 20ºC, but only in ecdysone-treated crayfish.

Methods for field detection of resistance to temephos in simuliids. Larval esterase level and topical application of the insecticide to adults

Two practical field methods for indirect detection of simuliid populations resistant to temephos are proposed. The first is based on high esterase activity in resistant larvae and involves adaptations of a filter paper test in which faintly stained spots indicate susceptible populations and strongly stained ones reveal populations resistant to temephos. The second is based on the resistance to the larvicide when adults are topically exposed, and involves the use of diagnostic doses obtained by the comparison between the LD50 for susceptible and resistant populations. The relevance of such methods is discussed in order to help resistance detection in Simulium pertinax Kollar control programmes.

Schistosomiasis research funding: the TDR contribution

In spite of the recent decline in financial support on the part of some major donors, the overall international support for schistosomiasis research in current US dollars has been holding steady. However, when adjusted for inflation, a clear decline during the last decade appears and only in a few countries has this decline been balanced by increased national or bilateral funding. The prevailing level of support for schistosomiasis research is barely sufficient to maintain estabilished laboratories and researchers, and highlights the need to attract young investigators. The important goal of brunging a new generation of scientists into the field of schistosomiaisis can only be achieved by a considerable long-term increase in funding, both at the national and the international levels. A break-through in current research emphasizing improved techniques for control is needed to encourage donors and governments to improve the situation.