A study of multidrug-resistant tuberculosis in risk groups in the city of Santos, Sao Paulo, Brazil

Monitoring the extent of and trends in multidrug-resistant tuberculosis (MDR-TB) is a priority of the Brazilian National Tuberculosis Control Programme. The current study aimed to estimate the incidence of MDR-TB, describe the profile of TB drug resistance in risk groups and examine whether screening for MDR-TB adhered to the recommended guidelines. A descriptive study that examined diagnosed cases of pulmonary TB was conducted in the city of Santos, Brazil, between 2000-2004. Of the 2,176 pulmonary TB cases studied, 671 (30.8%) met the criteria for drug sensitivity testing and, of these cases, 31.7% (213/671) were tested. Among the tested cases, 9.4% were resistant to one anti-TB drug and 15% were MDR. MDR was observed in 11.6% of 86 new TB cases and 17.3% of 127 previously treated cases. The average annual incidence of MDR-TB was 1.9 per 100,000 inhabitants-years. The extent of known MDR-TB in the city of Santos is high, though likely to be underestimated. Our study therefore indicates an inadequate adherence to the guidelines for MDR-TB screening and suggests the necessity of alternative strategies of MDR-TB surveillance.

A 30-year quantitative comparison of the bird community of a semideciduous forest remnant in the state of Sao Paulo

A 30-year quantitative comparison of the bird community of a semideciduous forest remnant in the state of Sao Paulo. Few studies have evaluated long-term changes in avian abundance in forest remnants. To compare both species richness and abundance of the bird community in a forest fragment located in the municipality of Galia, state of Sao Paulo, southeastern Brazil, we surveyed forest birds using transect counts. We compared our results with a survey conducted 30 years earlier at the same locality and further classified bird species according to their food habits to eventually predict fluctuations of specific abundance. Although species with population declines predominated in the community, all trophic categories had species which increased their abundances. Most species prone to move around remnants decreased in abundance. We suggest that, regarding specific abundances, trophic categories may be equally affected as a result of fragmentation processes and that the forest regeneration of this remnant may have led to the loss of edge species. Species that suffered from abundance loss during this time period may become locally extinct in the near future.

Ecological distribution of the shrimp Litopenaeus schmitti (Burkenroad, 1936) (Decapoda, Penaeoidea) in Ubatuba Bay, Sao Paulo, Brazil

The penaeidean Litopenaeus schmitti, popularly known as white shrimp, is a species of great economic importance, being a target of fishing fleets in the southeast region of Brazil. It is distributed through the western Atlantic, from Cuba to Brazil, until Rio Grande do Sul. Adults are found from shallow depths up to 30 m and have been found to depths of 47 m in the state of Rio de Janeiro, while juveniles are located in bays and estuaries. The studied species is seasonally distributed in the region of Ubatuba. The objectives of this study are to analyze the abundance and ecological distribution of L. schmitti and to assess if and when juveniles use the Indaia estuary during their life cycle. Furthermore, the hypothesis was tested that the main period of recruitment in the bay coincides with the period of closure of fisheries defined by the Instruction of IBAMA. To that end, samples were taken monthly from July 2005 through June 2007, both in Ubatuba Bay and in the estuary formed by the Rio Indaia. At each sampling station, salinity, temperature (bottom), depth, organic matter content (%), and grain size of sediments were measured. We found that the largest catches in the estuary were in late spring and early summer. In Ubatuba Bay, peak catches occurred during winter and early spring, whereas in the second year, already in May, there was a high peak capture. The variation in the number of individuals was correlated with some environmental factors both in the estuary and in the inlet (p < 0.05). In the estuary, abundance was positively correlated with temperature (p = 0.008) and organic matter (p = 0.025) and negatively with depth (p = 0.009). Regarding the Ubatuba Bay, only temperature (p = 0.034) and depth (p = 0.013) were significantly associated with the distribution of the shrimp, both being negative relations. The shrimp L. schmitti uses both the estuarine as well the shore environment, particularly the Ubatuba estuary and its adjacent bay, to complete its life cycle. The proposed period of fisheries closure (between March to May in the state of Sao Paulo) for this and other shrimps coincides with individuals capable of reproduction entering the inlet and thus are being protected.

PREVALENCE AND DETERMINANTS OF EXCLUSIVE BREASTFEEDING IN THE CITY OF SERRANA, SAO PAULO, BRAZIL

The objective of this cross-sectional and quantitative study was to identify the prevalence and determinants of exclusive breastfeeding among infants less than six months of age in the city of Serrana, Sao Paulo, Brazil in 2009. A validated semi-structured questionnaire was administered to the guardians of the children less than six months of age who attended the second phase of a Brazilian vaccination campaign against polio. Univariate and multivariate analysis presented in odds ratios and confidence intervals was accomplished. Of the total of 275 infant participants, only 29.8% were exclusively breastfed. Univariate analysis revealed that mothers who work outside the home without maternity leave, mothers who did not work outside the home, adolescent mothers, and the use of pacifiers have a greater chance of interrupting exclusive breastfeeding. In the multivariate analysis, mothers who work outside the home without maternity leave are three times more likely to wean their children early. Results provide suggestions for the redirection and planning of interventions targeting breastfeeding.

Anemia and dementia among the elderly: the Sao Paulo Ageing & Health Study

Background: Anemia and dementia are common diseases among the elderly, but conflicting data are available regarding an association between these two conditions. We analyzed data from the Sao Paulo Ageing & Health Study to address the relationship between anemia and dementia. Methods: This cross-sectional observational study included participants aged 65 years and older from a deprived area of the borough of Butantan, Sao Paulo, Brazil. Data about demographics, education, income, and cognitive and daily life function were collected, as well as blood samples. Anemia and dementia were defined according to WHO and DSM-IV criteria, respectively. Results: Of the 2267 subjects meeting the inclusion criteria, 2072 agreed to participate in the study; of whom 1948 had a valid total blood count and were included in the analysis. Anemia was diagnosed in 203 (10.2%) participants and dementia in 99 (5.1%). The frequency of anemia was higher in patients with dementia according to univariate analysis (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17-3.41, p = 0.01), but this association was not present after adjusting for age (OR = 1.33, 95% CI = 0.76-2.33, p = 0.32). Further multivariate adjustment did not change the results. Conclusion: Although anemia and dementia are frequent disorders in older people, we found their relationship to be mediated exclusively by aging in this low-income population from Sao Paulo.

Prevalence of Arterial Hypertension Among Seventh-Day Adventists of the Sao Paulo State Capital and Inner Area

Background: Inadequate life habits are known to favor hypertension, and Adventists recommend healthy life habits. Objective: To assess the prevalence of hypertension among Seventh-Day Adventists from the inner Sao Paulo state and Sao Paulo state capital. Methods: This study assessed 264 Adventists (mean age, 41.17 +/- 15.27 years; women, 59.8%) with a high religiosity level assessed by use of the Duke University Religion Index. Blood pressure was measured with a validated automatic device. The significance level adopted was p < 0.05. Results: The total prevalence of hypertension was 22.7% (27.4% in the inner state and 15% in the capital). The Adventists from the capital differed from those of inner state as follows (p < 0.05), respectively: higher education (62% vs 36.6%); employed by a third party (44%) vs self-employed (40.9%); family income (8.39 +/- 6.20 vs 4.59 +/- 4.75 minimum wages); individual income (4.54 +/- 5.34 vs 6.35 +/- 48; couple responsible for family income (35% vs 39.6%); vegetarianism (11% vs 3%); blood pressure (115.38 +/- 16.52/68.74 +/- 8.94 vs 123.66 +/- 19.62/74.88 +/- 11.85 mmHg); white ethnicity (65% vs 81.1%); married (53% vs 68.9%); lower tangible support in the social aspect (15.7 +/- 5.41 vs 16.9 +/- 4.32); and recalling the last time one's blood pressure was measured (65% vs 48.8%). On multivariate analysis, hypertension associated with the following: 1) vegetarianism (OR 0.051; 95% CI: 0.004-0.681); 2) educational level (OR 5.317; 95% CI: 1.674-16.893); 3) recalling the last time one's blood pressure was measured (OR 2.725; 95% CI: 1.275-5.821); 4) being retired (OR 8.846; 95% CI: 1.406-55.668); and 5) being responsible for family income (OR 0.422; 95% CI: 0.189-0.942). Conclusion: The prevalence of hypertension among Adventists was lower as compared with that reported in Brazilian studies, and it was lower in the Sao Paulo state capital as compared with that in the inner Sao Paulo state, possibly because of the better socioeconomic conditions and life habits of the former. (Arq Bras Cardiol 2012; 98(4): 329-337)

Suicidal ideation during pregnancy: prevalence and associated factors among low-income women in Sao Paulo, Brazil

The aim of this study was to estimate the prevalence and correlates of suicidal ideation among low-income pregnant women living in Brazil. We performed a cross-sectional analysis of 831 women surveyed during 20 to 30 weeks of pregnancy using the Self-Report Questionnaire-20. The prevalence of suicidal ideation was 6.3%. The factors associated with suicidal ideation were common mental disorders, single partner status, past psychiatric history, and smoking tobacco. All cases of suicidal ideation were associated with common mental disorders.

Prevalence of asthma and risk factors associated: population based study in Sao Paulo, Southeastern Brazil, 2008-2009

OBJECTIVE: To assess the prevalence of asthma and risk factors associated in children and adolescents. METHODS: Population-based cross-sectional study with 1,185 female and male children and adolescents carried out in the city of Sao Paulo, Southeastern Brazil, from 2008 to 2009. Data were collected through home interviews. Respondents were selected from two-stage (census tract, household) cluster random sampling stratified by gender and age. Multiple Poisson regression was used in the adjusted analysis between the outcome and socioeconomic, demographic, lifestyle and health condition variables. RESULTS: Of all respondents, 9.1% (95%CI 7.0; 11.7) reported asthma. After adjustment, the following variables were found independently associated with asthma: age (0 to 4 years vs. 15 to 19) (PR 3.18, 95%CI 1.20;8.42); age (5 to 9 years vs. 15 to 19) (PR 6.37, 95%CI 2.64;15.39); age (10 to 14 years vs. 15 to 19) (PR 4.51,95%CI 1.95;10.40); allergy (yes vs. no) (PR 2.22, 95%CI 1.24;4.00); rhinitis (yes vs. no) (PR 2.13, 95%CI 1.22;3.73); health conditions in the 15 days preceding the interview (yes vs. no) (PR 1.96, 95%CI 1.23;3.11); number of rooms in the household (1 to 3 vs. 4 and more) (PR 1.67, 95%CI 1.05;2.66); and skin color (black and mixed vs. white) (PR 2.00, 95%CI 1.14;3.49). CONCLUSIONS: This study showed the importance of factors associated with asthma including rhinitis and allergy; age between 5 to 9 years old; black and mixed skin color; and household with few rooms. Frequent health problems are seen as a common consequence of asthma.

The impact of atmospheric particulate matter on cancer incidence and mortality in the city of Sao Paulo, Brazil

This study aimed to verify the impact of inhalable particulate matter (PM10) on cancer incidence and mortality in the city of Sao Paulo, Brazil. Statistical techniques were used to investigate the relationship between PM10 on cancer incidence and mortality in selected districts. For some types of cancer (skin, lung, thyroid, larynx, and bladder) and some periods, the correlation coefficients ranged from 0.60 to 0.80 for incidence. Lung cancer mortality showed more correlations during the overall period. Spatial analysis showed that districts distant from the city center showed higher than expected relative risk, depending on the type of cancer According to the study, urban PM10 can contribute to increased incidence of some cancers and may also contribute to increased cancer mortality. The results highlight the need to adopt measures to reduce atmospheric PM10 levels and the importance of their continuous monitoring.

LIFE TABLE ANALYSIS OF DIAPHORINA CITRI (HEMIPTERA: PSYLLIDAE) INFESTING SWEET ORANGE (CITRUS SINENSIS) IN SAO PAULO

An ecological life table for eggs and nymphs of Diaphorina citri Kuwayama (Hemiptera: Psyllidae) was constructed with data obtained from orange orchards (Citrus sinensis Osbeck) in 2 regions of the State of Sao Paulo, over 4 generations in the period from XI-2006 to V-2007, comprising spring, summer, and fall seasons. Young growing shoots with D. citri eggs present were identified, and live individuals were counted until adult emergence. No predatory arthropods were observed in association with D. citri eggs and nymphs during the study. The mean parasitism of fourth- and fifth-instar nymphs by Tamarixia radiata Waterston (Hymenoptera: Eulophidae) was 2.3%. The durations of the egg-adult period were similar among the 4 generations, ranging from 18.0 to 24.7 d (at mean temperatures ranging from 21.6 to 26.0 degrees C) and followed the temperature requirement models obtained in the laboratory for D. citri. However, survival from the egg to the adult stage for the same period varied considerably from 1.7 to 21.4%; the highest mortalities were observed in the egg and small nymphal (first- to thirdinstar) stages, which were considered to be key phases for population growth of the pest.

Characterization of Primary Isolates of HIV Type 1 CRF28_BF, CRF29_BF, and Unique BF Recombinants Circulating in Sao Paulo, Brazil

We report for the first time the genetic and biological characterization of 10 HIV-1 primary isolates representing CRF28_BF and CRF29_BF together with additional unique BF recombinant forms (URFs) obtained by PBMC cocultivation. Recombination is an important factor promoting the increase in the genetic diversity of HIV-1. Notably, more than 20% of HIV-1 sequences worldwide were recombinants. Several recombinant viruses were reported in Brazil, and six circulating recombinant forms (CRFs) have been identified (CRF28_BF, CRF29_BF, CRF31_BC, CRF39_BF, CRF40_BF, and CRF46_BF). CRF28_BF and CRF29_BF were found to infect almost 30% of the patients in Sao Paulo State. The near full-length genomes of these 10 primary isolates were amplified by nested PCR in three overlapping segments, purified, and sequenced. Three samples were related to CRF28_BF, three to CRF29_BF, and four were unique recombinant forms (URFs), as determined by their breakpoint profile determined with the jpHMM program. Additionally, the coreceptor usage of these isolates was investigated in vitro using GHOST assays, which revealed three dual-tropic (X4/R5) viruses, four lymphotropic (X4) viruses, and three macrophage-tropic (R5) viruses with different V3-loop motifs, which challenges the notion that GWGR-carrying viruses are macrophage-tropic only. In sum, we report a much-anticipated well-characterized panel of viruses representing CRF28_BF, CRF29_BF, and URFs from Sao Paulo State, Brazil.

Geoelectrical mapping of contamination in the cemeteries: the case study in Piracicaba, Sao Paulo/Brazil

This paper presents the results of electrical resistivity methods in the area delineation that was potentially contaminated by liquefaction products, which are also called putrefactive liquids in Vila Rezende municipal cemetery, Piracicaba, So Paulo, Brazil. The results indicate a depth of water table between 3.1 and 5.1 m, with two groundwater direction flows, one to the SW and another to the SE. Due to the contamination plumes, which have the same groundwater direction flow, as well the conductive anomalies observed in the geoelectric sections, the contamination suspicions in the area were confirmed. The probable plume to the SE extends beyond the limits of the cemetery. The location of the conductive anomalies and the probable contamination plumes showed that the contamination is linked with the depth of the water table and the burial time. Mapping using the geostatistical method of ordinary kriging applied to the work drew structural characteristics of the regional phenomenon and spatial behavior of the electrical resistivity data, resulting in continued surfaces. Thus, this method has proved to be an important tool for mapping contamination plumes in cemeteries.

TDEM survey in an area of seismicity induced by water wells in Parana sedimentary basin, Northern Sao Paulo State, Brazil

This article presents TDEM results from an area with recent induced shallow seismicity. The purpose was to do a geoelectrical mapping of sedimentary and fractured basaltic aquifers for better understanding of the hydrogeologic setting. The study area is in the Parana basin where flood basalts are overlain by sedimentary units near the city of Bebedouro, northern Sao Paulo State, Brazil. 86 TDEM soundings were acquired in an area of 90 km(2) in the Andes and Botafogo study areas. The soundings were chosen next to wells for calibration, and also along profiles crossing the seismically active areas. 1-D interpretation results showed the general geoelectrical stratigraphy of this part of the Parana basin. The upper geoelectrical layer is the shallow sedimentary aquifer (Adamantina formation) with less than 80 m thickness. The second geoelectrical layer contains the upper basalts of the Serra Geral formation at about 60-80 m depths. A saturated fractured basalt zone between 100 and 300 m depths was identifiable on various TDEM soundings. This depth range corresponds to the range of hypocentral depths for more than 3000 micro-earthquakes in this area. The lower basalt layer was estimated to lie between 400 and 650 m depth. The deepest geoelectrical layer detected by various TDEM soundings corresponds to the Botucatu sandstone (Guarani aquifer). Results suggest that the high-discharge wells are located in the fractured zone in the middle basalt of the Serra Geral formation. There is a good correlation between seismically active areas, high discharge wells (>190 m(3)/h), and fracture zones in the middle basalt. The results reinforce the hypothesis that the shallow seismic activity in the Bebedouro region is being triggered by high rates of groundwater withdrawal. (C) 2012 Elsevier B.V. All rights reserved.

Ethnicity and Cutaneous Melanoma in the City of Sao Paulo, Brazil: A Case-Control Study

Background: Over the last century the incidence of cutaneous melanoma has increased worldwide, a trend that has also been observed in Brazil. The identified risk factors for melanoma include the pattern of sun exposure, family history, and certain phenotypic features. In addition, the incidence of melanoma might be influenced by ethnicity. Like many countries, Brazil has high immigration rates and consequently a heterogenous population. However, Brazil is unique among such countries in that the ethnic heterogeneity of its population is primarily attributable to admixture. This study aimed to evaluate the contribution of European ethnicity to the risk of cutaneous melanoma in Brazil. Methodology/Principal Findings: We carried out a hospital-based case-control study in the metropolitan area of Sao Paulo, Brazil. We evaluated 424 hospitalized patients (202 melanoma patients and 222 control patients) regarding phenotypic features, sun exposure, and number of grandparents born in Europe. Through multivariate logistic regression analysis, we found the following variables to be independently associated with melanoma: grandparents born in Europe-Spain (OR = 3.01, 95% CI: 1.03-8.77), Italy (OR = 3.47, 95% CI: 1.41-8.57), a Germanic/Slavic country (OR = 3.06, 95% CI: 1.05-8.93), or >= 2 European countries (OR = 2.82, 95% CI: 1.06-7.47); eye color-light brown (OR = 1.99, 95% CI: 1.14-3.84) and green/blue (OR = 4.62; 95% CI 2.22-9.58); pigmented lesion removal (OR = 3.78; 95% CI: 2.21-6.49); no lifetime sunscreen use (OR = 3.08; 95% CI: 1.03-9.22); and lifetime severe sunburn (OR = 1.81; 95% CI: 1.03-3.19). Conclusions: Our results indicate that European ancestry is a risk factor for cutaneous melanoma. Such risk appears to be related not only to skin type, eye color, and tanning capacity but also to others specific characteristics of European populations introduced in the New World by European immigrants.

Epidemiological and clinical characteristics of injuries among adolescents attended at an emergency service in the city of Ribeirao Preto, Sao Paulo

CONTEXT AND OBJECTIVE: Injuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries among adolescents attended at an emergency service. DESIGN AND SETTING: Retrospective descriptive study on adolescents attended at the emergency service of the Teaching Health Center, Faculdade de Medicina de Ribeirao Preto (FMRP), between January 1, 2009, and September 30, 2009. METHODS: Age, sex, type of injury, site, day and time of occurrence, part of body involved, care received, whether the adolescent was accompanied at the time of injury and whether any type of counseling regarding injury prevention had been given were analyzed. RESULTS: Among 180 adolescents attended, 106 (58.8%) were boys and 74 (41.1%) were girls. Their ages were: 10 to 12 (66/36.6%), 12 to 14 (60/33.3%) and 14 to 16 years (54/30%). The injuries had occurred in public places (47.7%) and at home (21.1%). The main types were bruises (45.1%) and falls (39.2%), involving upper limbs (46.1%), lower limbs (31%) and head/neck (13.1%). The injuries occurred in the afternoon (44.4%) and morning (30%), on Mondays (17.7%) and Thursdays (16.6%). Radiological examinations were performed on 53.8%. At the time of injury, 76.1% of the adolescents were accompanied. Some type of counseling about injury prevention had been received by 39.4%. CONCLUSIONS: Although the injuries were of low severity, preventive attitudes need to be incorporated in order to reduce the risks and provide greater safety for adolescents.