Cesarean section and increased body mass index in school children: two cohort studies from distinct socioeconomic background areas in Brazil

Abstract Background Recent studies have raised controversy regarding the association between cesarean section and later obesity in the offspring. The purpose of this study was to assess the association of cesarean section with increased body mass index (BMI) and obesity in school children from two Brazilian cities with distinct socioeconomic backgrounds. Methods Two birth cohorts respectively born in 1994 in Ribeirao Preto, a wealthy city in Southeast, and in 1997/98 in Sao Luis, a less wealthy city in Northeast of Brasil, were evaluated. After birth, 2,846 pairs of mothers-newborns were evaluated in Ribeirao Preto and 2,542 in Sao Luis. In 2004/05, 790 children aged 10/11 years were randomly reassessed in Ribeirao Preto and 673 at 7/9 years in Sao Luis. Information on type of delivery, maternal and child characteristics, socioeconomic position and anthropometric measurements were collected after birth and at school age. Obesity was defined as BMI ≥ 95th percentile at school age. Results Obesity rate was 13.0% in Ribeirao Preto and 2.1% in Sao Luis. Cesarean section was associated with obesity and remained significant after adjustment only in Ribeirao Preto [OR = 1.74 (95% CI: 1.04; 2.92)]. The association between cesarean section and BMI remained significant after adjustment for maternal schooling, maternal smoking during pregnancy, duration of breastfeeding, gender, birth weight and gestational age, type of school and, only in Sao Luis, pre-pregnancy maternal weight. In Ribeirao Preto children born by cesarean section had BMI 0.31 kg/m2 (95%CI: 0.11; 0.51) higher than those born by vaginal delivery. In Sao Luis BMI of children born by cesarean section was 0.28 kg/m2 higher (95%CI: 0.08; 0.49) than those born by vaginal delivery. Conclusion A positive association between cesarean section and increased BMI z-score was demonstrated in areas with different socioeconomic status in a middle-income country.

A hearing report from Brazil

The past several decades, the need for hearing health services is still great, especially in the northeast, the Amazonian, and the southern regions Brazil, officially Federative Republic of Brazil, is the largest Portuguese-speaking country, and the fifth largest country in the world by population and by land. The vast land not only brings rich natural resources but also large varieties of exotic vegetation and wildlife. One hundred and ninety-three million inhabitants live in five geographical regions with diverse cultural practices influenced by immigrants from Italy, Spain, Japan, Germany, and other countries. Brazilian people generally are warm-hearted, very welcoming, and resilient. They are optimistic and creative despite having encountered many economic downturns and political challenges throughout history. A bachelor's degree is the entry level for the profession. As only 19 percent of the population aged 18–24 years have access to higher education, the competition for admissions is fierce, especially in government institutions. High school students need to pass tests of general knowledge in a national examination and a university-specific examination. Government educational institutions offer good education without charging tuition. The majority of scientific papers are also produced by scholars working in government institutions. Private institutions are generally ranked lower in academic rigor (Behlau and Gasparini, 2006), except for a few top-ranking institutions. The fields of speech-language pathology and audiology are marked by rapid changes in recent years. Currently, there are 104 undergraduate programs recognized by the Ministry of Education and distributed in all but three federal states of Brazil.

Detection of Hepatitis B virus subgenotype A1 in a Quilombo community from Maranhão, Brazil

Abstract Background The Brazilian population is mainly descendant from European colonizers, Africans and Native Americans. Some Afro-descendants lived in small isolated communities since the slavery period. The epidemiological status of HBV infection in Quilombos communities from northeast of Brazil remains unknown. The aim of this study was to characterize the HBV genotypes circulating inside a Quilombo isolated community from Maranhão State, Brazil. Methods Seventy-two samples from Frechal Quilombo community at Maranhão were collected. All serum samples were screened by enzyme-linked immunosorbent assays for the presence of hepatitis B surface antigen (HBsAg). HBsAg positive samples were submitted to DNA extraction and a fragment of 1306 bp partially comprising HBsAg and polymerase coding regions (S/POL) was amplified by nested PCR and its nucleotide sequence was determined. Viral isolates were genotyped by phylogenetic analysis using reference sequences from each genotype obtained from GenBank (n = 320). Sequences were aligned using Muscle software and edited in the SE-AL software. Bayesian phylogenetic analyses were conducted using Markov Chain Monte Carlo (MCMC) method to obtain the MCC tree using BEAST v.1.5.3. Results Of the 72 individuals, 9 (12.5%) were HBsAg-positive and 4 of them were successfully sequenced for the 1306 bp fragment. All these samples were genotype A1 and grouped together with other sequences reported from Brazil. Conclusions The present study represents the first report on the HBV genotypes characterization of this community in the Maranhão state in Brazil where a high HBsAg frequency was found. In this study, we reported a high frequency of HBV infection and the exclusive presence of subgenotype A1 in an Afro-descendent community in the Maranhão State, Brazil.

Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. Methods This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years). Results Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001). Conclusions A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.

Groundwater resources in Brazil: a review of possible impacts caused by climate change

Groundwater has a strategic role in times of climate change mainly because aquifers can provide water for long periods, even during very long and severe drought. The reduction and/or changes on the precipitation pattern can diminish the recharge mainly in unconfined aquifer, causing available groundwater restriction. The expected impact of long-term climate changes on the Brazilian aquifers for 2050 will lead to a severe reduction in 70% of recharge in the Northeast region aquifers (comparing to 2010 values), varying from 30% to 70% in the North region. Data referring to the South and Southeast regions are more favorable, with an increase in the relative recharge values from 30% to 100%. Another expected impact is the increase in demand and the decrease in the surface water availability that will make the population turn to aquifers as its main source of water for public or private uses in many regions of the country. Thus, an integrated use of surface and groundwater must therefore be considered in the water use planning. The solution of water scarcity is based on three factors: society growth awareness, better knowledge on the characteristics of hydraulic and chemical aquifers and effective management actions.

Taxonomical study on a sample of pulmonates from Santa Maria da Vitória, Bahia, Brazil, with description of a new genus and four new species (Mollusca: Orthalicidae and Megalobulimidae)

A sample of Pulmonata collected in Santa Maria da Vitória, interior of Bahia, Brazil, in Caatinga semi-arid environment, is studied taxonomically. From the five species, four are revealed as new, including a new genus. The new taxa are the Bulimulidae (1) Kora corallina gen. et sp. n. characterized by the elongated shell with aperture somewhat dislocated from the shell axis, and an oblique tooth in middle level of inner lip; (2) Spixia coltrorum, mainly characterized by an uneven spire, delicate sculpture and peristome with 4 equidistant teeth; (3) Anostoma tessa, mainly characterized by a broad spire and well-developed anal canal; and the Megalobulimidae (4) Megalobulimus amandus, mainly characterized by pointed protoconch sculptured by dense quantity of axial cords. Rhinus suturalis is the only previously known species, but its geographic distribution is expanded southwards to Bahia state. A discussion with respect to necessity for improving the study on the malacofauna from the interior region of the Brazilian Northeast and the importance for preservation of the Caatinga biome is also provided.

A retrospective serologic survey of hantavirus infections in the county of Cássia dos Coqueiros, State of São Paulo, Brazil

INTRODUCTION: In recent years, hantavirus infections producing severe diseases have obtained an increased attention from public health authorities from the countries of Eurasia to the Americas. Brazil has reported 1,300 cases of hantavirus cardiopulmonary syndrome (HCPS) from 1993 to 2010, with about 80 of them occurring in the northeast of the State of São Paulo, with 48% fatality rate. Araraquara virus was the causative agent of HCPS in the region. Considering that hantaviruses causing human disease in the Americas were unknown until 1993, we have looked for hantavirus infections in the population of Cássia dos Coqueiros county, northeast of the State of São Paulo, Brazil, before this time. This county has about 2,800 inhabitants and an economy based on agriculture, including cultivation of Brachiaria decumbens grass. The grass seeds are an important rodent attraction, facilitating transmission of hantavirus to man. Four HCPS cases were reported so far in the county. METHODS: In this study, 1,876 sera collected from 1987 to 1990 were tested for IgG to hantavirus by IgG-ELISA, using the N recombinant protein of Araraquara virus as antigen. RESULTS: Positive results were observed in 89 (4.7%) samples, which were all collected in 1987. The positivity among urban inhabitants was 5.3%, compared with 4.3% among those living in rural areas. CONCLUSIONS: Our results showed that hantavirus infections occurred in Cássia dos Coqueiros, completely unrecognized, even before hantaviruses were described in the Americas.

Migrant labor and wear-out in manual sugarcane harvesting in São Paulo, Brazil

The scope of this paper is to describe the work of manual sugarcane harvesters, assessing the nutritional behavior and body composition between the beginning and the end of the harvest. A descriptive longitudinal study was made of harvesters in Piracicaba, São Paulo, Brazil, who answered a socio-demographic questionnaire and authorized measurement of Body Mass Index, Body Fat Percentage and Arm Muscle Circumference at three stages. Creatine kinase on the skeletal isoform, C-reactive protein and plasma urea were measured at the end of the harvest. Thirty male migrant harvesters with ages ranging from 18 to 44 from the Northeast (Ceará) were assessed over a nine-month period. The workers suffered significant body fat and weight loss in the first half of the harvest. Eighteen workers had abnormal levels of creatine kinase and four - out of 24 who had donated blood - had altered urea levels. Sugarcane harvesting work causes weight and body fat loss and gains in the lean body mass index, which suffers wear-out when working on consecutive harvests. It can also cause changes in biochemical markers of chronic systemic inflammation. Further studies will make it possible to comprehend the relationships between stress, wear-out, labor longevity and health in sugarcane harvesting.

Systematics of interstitial encrusting bryozoans from southeastern Brazil

This paper describes 22 species of marine bryozoans found in the sand-grain-encrusting interstitial epifauna of the northeast coast of São Paulo state, Brazil: one new cyclostome, Disporella calcitrapa sp. nov., and 21 cheilostomes. Sixteen of the cheilostomes are new species, and three represent new genera. They are Ammatophora arenacea sp. nov., Discoporella gemmulifera sp. nov., Puellina caraguata sp. nov., Puellina tuba sp. nov., Rosulapelta rosetta gen. et sp. nov., Collarina spicata sp. nov., Hippothoa calcicola sp. nov., Trypostega ilhabelae sp. nov., Reptadeonella granulosa sp. nov., Drepanophora irregularis sp. nov., Allotherenia sabulosa gen. et sp. nov., Bryopesanser tilbrooki sp. nov., Psammocleidochasma tridentatum gen. et sp. nov., Celleporina abstrusa sp. nov., Hippoporella castellana sp. nov., and Hippoporella sabulonis sp. nov. Other species found in this habitat, Alderina smitti, Cymulopora uniserialis, Vibracellina laxibasis, Akatopora leucocypha, and Smittipora sawayai, have previously been described. The family Cymuloporidae fam. nov. is erected for Cymulopora and Crepis. The occurrence in this habitat of living colonies of bryozoans more characteristic of larger subtidal shell substrata indicates the potential importance of an interstitial refuge in maintaining and dispersing encrusting bryozoan populations along continental shelves where larger substrata are absent or rare.

Catch rates of artisanal fisheries targeting Dasyatis guttata (Bloch & Schneider, 1801) in Todos os Santos Bay, northeastern Brazil

Dasyatis guttata has been target of artisanal fisheries in the coast of Bahia (Northeast Brazil) mainly by “arraieira” (gillnet) and “grozeira” (bottom long-line), but until now there is no stock assessment study. One of the important data for this knowledge is reliable indices of abundance. The aims of the present work are to: (1) estimate the best predictor for relative abundance (catch-per-unit-of-effort, CPUE), examining whether catch (production – kg) was related to: soak time of the gear, size of the gillnet or number of hooks, applying generalized linear model (GLM); (2) estimate the annual CPUE (kg/hooks and kg/m) averaged by gear; and (3) assess the temporal CPUE variance. Based on monthly sampling between January 2012 and January 2013, 222 landings by grozeira and 76 by arraiaiera were recorded in the two landing sites in Todos os Santos Bay, Bahia. A total of 14,550 kg (average = 44 kg/month) of D. guttata was captured. Models for both gears were highly significant (P < 0.0001). The analysis indicated that the most appropriate variable for CPUE analysis was the size of the gillnet (P < 0.001) and the number of hooks (P < 0.0001). Soak time of the gear was not significant for both gears (P = 0.4). High residual deviance expresses the complexity of the relations between ecosystem factors and other fisheries factors affecting relative abundance, which were not considered in this study. The average CPUE by grozeira was 6.39 kg/100 hooks ± 8.89 and by arraieira, 1.47 kg/100 m ± 1.66 over the year. Kruskal-Wallis test showed effect of the month on the mean grozeira CPUE (P = <0.001), but no effect (P = 0.096) on the mean arraieira CPUE. Grozeira CPUE values were highest in December and March, and lowest between May to August

Visceral leishmaniasis in Brazil: trends and challenges

The urbanization of visceral leishmaniasis in Brazil has been related to environmental changes, migration, interaction and spread of sylvatic reservoirs and infected dogs to areas with no transmission, and adaptation of the vector Lutzomyia longipalpis to the peridomiciliary environment. From 1980 to 2005, Brazil recorded 59,129 cases of visceral leishmaniasis, 82.5% of which in the Northeast region. Visceral leishmaniasis gradually spread to other regions of the country: in 1998 these other regions reported 15% of all cases, but by 2005 this proportion had increased to 44%. From 1998 to 2005, indigenous cases were reported in 1,904 different municipalities of the country (34.2%). Reservoir and vector control pose major challenges for disease control, since there is a need for better knowledge of vector behavior in urban areas, and control activities involve high operational costs. In recent years the Brazilian Ministry of Health has supported research on the laboratory diagnosis of infection and disease in humans and dogs, treatment of patients, evaluation of the effectiveness of control strategies, and development of new technologies that could contribute to the surveillance and control of visceral leishmaniasis in the country.

Biogeographic regionalization of snakes in the Atlantic Forest hotspot: interpolating the faunal dissimilarity

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