Operational effectiveness of tafenoquine and primaquine for the prevention of Plasmodium vivax recurrence in Brazil: a retrospective observational study.

BACKGROUND: Prevention of Plasmodium vivax malaria recurrence is essential for malaria elimination in Brazil. We evaluated the real-world effectiveness of an updated treatment algorithm for P vivax radical cure in the Brazilian Amazon. METHODS: In this non-interventional observational study, we used retrospective data from the implementation of a P vivax treatment algorithm at 43 health facilities in Manaus and Porto Velho, Brazil. The treatment algorithm consisted of chloroquine (25 mg/kg over 3 days) and point-of-care quantitative glucose-6-phosphate dehydrogenase (G6PD) testing followed by single-dose tafenoquine 300 mg (G6PD normal, aged ≥16 years, not pregnant and not breastfeeding), 7-day primaquine 0·5 mg/kg per day (G6PD intermediate or normal, aged ≥6 months, not pregnant, and not breastfeeding or breastfeeding for >1 month), or primaquine 0·75 mg/kg per week for 8 weeks (G6PD deficient, aged ≥6 months, not pregnant, and not breastfeeding or breastfeeding for >1 month). P vivax recurrences were identified from probabilistic linkage of routine patient records from the Brazilian malaria epidemiological surveillance system. Recurrence-free effectiveness at day 90 and day 180 was estimated using Kaplan-Meier analysis and hazard ratios (HRs) by multivariate analysis. This clinical trial is registered with ClinicalTrials.gov, NCT05096702, and is completed. FINDINGS: Records from Sept 9, 2021, to Aug 31, 2022, included 5554 patients with P vivax malaria. In all treated patients of any age and any G6PD status, recurrence-free effectiveness at day 180 was 75·8% (95% CI 74·0-77·6) with tafenoquine, 73·4% (71·9-75·0) with 7-day primaquine, and 82·1% (77·7-86·8) with weekly primaquine. In patients aged at least 16 years who were G6PD normal, recurrence-free effectiveness until day 90 was 88·6% (95% CI 87·2-89·9) in those who were treated with tafenoquine (n=2134) and 83·5% (79·8-87·4) in those treated with 7-day primaquine (n=370); after adjustment for confounding factors, the HR for recurrence following tafenoquine versus 7-day primaquine was 0·65 (95% CI 0·49-0·86; p=0·0031), with similar outcomes between the two treatments at day 180 (log-rank p=0·82). Over 180 days, median time to recurrence in patients aged at least 16 years who were G6PD normal was 92 days (IQR 76-120) in those treated with tafenoquine and 68 days (52-94) in those treated with 7-day primaquine. INTERPRETATION: In this real-world setting, single-dose tafenoquine was more effective at preventing P vivax recurrence in patients aged at least 16 years who were G6PD normal compared with 7-day primaquine at day 90, while overall efficacy at 180 days was similar. The public health benefits of the P vivax radical cure treatment algorithm incorporating G6PD quantitative testing and tafenoquine support its implementation in Brazil and potentially across South America. FUNDING: Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Novel Aphid-Repellent Fiber Mats Based on Poly(lactic acid)-Containing Ionic Liquids.

To protect crops as well as human and animal health, the development of novel repellents based on biopolymers is critical for a growing world population. Here, novel aphid-repellent electrospun mats containing epoxidized ionic liquids (ILs) covalently bonded to the carboxyl or hydroxyl groups of poly(lactic acid) (PLA) were designed to produce nonwoven mats. First, di-, tri-, and tetra-epoxidized imidazolium ILs were synthesized and incorporated in different weight fractions (3, 5, and 10 wt %) into the PLA solution. Then, the effect of ILs' microstructure, thermal properties, mechanical performance, and hydrophobic behavior were investigated. It was found that the incorporation of ILs resulted in a reduction of the fiber diameters while the mechanical properties of the mats, i.e., the three-dimensional fibrous porous structure, were maintained. Finally, the effect of these three ILs against the pea aphid Acyrthosiphon pisum (Harris) was evaluated for the first time, showing an attractive effect for the diepoxidized IL and a repellent effect for the tri- and tetra-epoxidized ILs. By exploiting the chemical nature of ILs, an environmentally friendly strategy can be developed to limit the need for chemical pesticides and petroleum-based polymers.

Biodegradable Electrospun Conduit with Aligned Fibers Based on Poly(lactic-co-glycolic Acid) (PLGA)/Carbon Nanotubes and Choline Bitartrate Ionic Liquid.

Functionally active aligned fibers are a promising approach to enhance neuro adhesion and guide the extension of neurons for peripheral nerve regeneration. Therefore, the present study developed poly(lactic-co-glycolic acid) (PLGA)-aligned electrospun mats and investigated the synergic effect with carbon nanotubes (CNTs) and Choline Bitartrate ionic liquid (Bio-IL) on PLGA fibers. Morphology, thermal, and mechanical performances were determined as well as the hydrolytic degradation and the cytotoxicity. Results revealed that electrospun mats are composed of highly aligned fibers, and CNTs were aligned and homogeneously distributed into the fibers. Bio-IL changed thermal transition behavior, reduced glass transition temperature (Tg), and favored crystal phase formation. The mechanical properties increased in the presence of CNTs and slightly decreased in the presence of the Bio-IL. The results demonstrated a decrease in the degradation rate in the presence of CNTs, whereas the use of Bio-IL led to an increase in the degradation rate. Cytotoxicity results showed that all the electrospun mats display metabolic activity above 70%, which demonstrates that they are biocompatible. Moreover, superior biocompatibility was observed for the electrospun containing Bio-IL combined with higher amounts of CNTs, showing a high potential to be used in nerve tissue engineering.

Pandemic Grief and Suicidal Ideation in Latin American Countries: A Network Analysis.

This study aimed to characterize the network structure of pandemic grief symptoms and suicidal ideation in 2174 people from eight Latin American countries. Pandemic grief and suicidal ideation were measured using the Pandemic Grief Scale and a single item, respectively. Network analysis provides an in-depth characterization of symptom-symptom interactions within mental disorders. The results indicated that, "desire to die," "apathy" and "absence of sense of life" are the most central symptoms in a pandemic grief symptom network; therefore, these symptoms could be focal elements for preventive and treatment efforts. Suicidal ideation, the wish to die, and the absence of meaning in life had the strongest relationship. In general, the network structure did not differ among the participating countries. It identifies specific symptoms within the network that may increase the likelihood of their co-occurrence and is useful at the therapeutic level.

Operational feasibility of Plasmodium vivax radical cure with tafenoquine or primaquine following point-of-care, quantitative glucose-6-phosphate dehydrogenase testing in the Brazilian Amazon: a real-life retrospective analysis.

BACKGROUND: To achieve malaria elimination, Brazil must implement Plasmodium vivax radical cure. We aimed to investigate the operational feasibility of point-of-care, quantitative, glucose-6-phosphate dehydrogenase (G6PD) testing followed by chloroquine plus tafenoquine or primaquine. METHODS: This non-interventional, observational study was done at 43 health facilities in Manaus (Amazonas State) and Porto Velho (Rondônia State), Brazil, implementing a new P vivax treatment algorithm incorporating point-of-care quantitative G6PD testing to identify G6PD status and single-dose tafenoquine (G6PD normal, aged ≥16 years, and not pregnant or breastfeeding) or primaquine (intermediate or normal G6PD, aged ≥6 months, not pregnant, or breastfeeding >1 month). Following training of health-care providers, we collated routine patient records from the malaria epidemiological surveillance system (SIVEP-Malaria) retrospectively for all consenting patients aged at least 6 months with parasitologically confirmed P vivax malaria mono-infection or P vivax plus P falciparum mixed infection, presenting between Sept 9, 2021, and Aug 31, 2022. The primary endpoint was the proportion of patients aged at least 16 years with P vivax mono-infection treated or not treated appropriately with tafenoquine in accordance with their G6PD status. The trial is registered with ClinicalTrials.gov, NCT05096702, and is completed. FINDINGS: Of 6075 patients enrolled, 6026 (99·2%) had P vivax mono-infection, 2685 (44·6%) of whom were administered tafenoquine. G6PD status was identified in 2685 (100%) of 2685 patients treated with tafenoquine. The proportion of patients aged at least 16 years with P vivax mono-infection who were treated or not treated appropriately with tafenoquine in accordance with their G6PD status was 99·7% (95% CI 99·4-99·8; 4664/4680). INTERPRETATION: Quantitative G6PD testing before tafenoquine administration was operationally feasible, with high adherence to the treatment algorithm, supporting deployment throughout the Brazilian health system. FUNDING: Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Cross-cultural invariance of the Spanish version of the COVID-19 Assessment Scorecard to measure the perception of government actions against COVID-19 in Latin America.

OBJECTIVES: The present study aimed to evaluate the measurement invariance of a general measure of the perception of governmental responses to COVID-|19 (COVID-SCORE-10) in the general population of 13 Latin American countries. METHODS: A total of 5780 individuals from 13 Latin American and Caribbean countries selected by non-probabilistic snowball sampling participated. A confirmatory factor analysis was performed and the alignment method was used to evaluate invariance. Additionally, a graded response model was used for the assessment of item characteristics. RESULTS: The results indicate that there is approximate measurement invariance of the COVID-SCORE-10 among the participating countries. Furthermore, IRT results suggest that the COVID-SCORE-10 measures with good psychometric ability a broad spectrum of the construct assessed, especially around average levels. Comparison of COVID-SCORE-10 scores indicated that participants from Cuba, Uruguay and El Salvador had the most positive perceptions of government actions to address the pandemic. Thus, the underlying construct of perception of government actions was equivalent in all countries. CONCLUSION: The results show the importance of initially establishing the fundamental measurement properties and MI before inferring the cross-cultural universality of the construct to be measured.

Assessment of Obsessive Thoughts About COVID-19 in 7 Latin American Countries: Structure and Measurement Invariance of the Obsession With COVID-19 Scale.

The present study aimed to evaluate the measurement invariance of the Obsession with COVID-19 Scale (OCS) among seven Latin American countries: Bolivia, Brazil, Cuba, El Salvador, Guatemala, Paraguay, and Uruguay. Although the OCS has been used in several countries and languages, there is a need for approaches that better integrate the cross-cultural equivalence of the scale. A total of 3185 people participated in the study. The results indicated the presence of a unidimensional structure and good reliability indices for the OCS in each country. The alignment method indicated that the OCS is an invariant measure of COVID-19 obsession among the populations of seven Latin American countries. The findings based on IRT analysis indicated that all OCS items had adequate discrimination and difficulty parameters. The findings contribute to the understanding of the internal structure of the scale in different countries at the same time, something that has been pending evaluation.

Relationship Between Fear of COVID-19, Conspiracy Beliefs About Vaccines and Intention to Vaccinate Against COVID-19: A Cross-National Indirect Effect Model in 13 Latin American Countries.

The present study explored the predictive capacity of fear of COVID-19 on the intention to be vaccinated against COVID-19 and the influence in this relationship of conspiracy beliefs as a possible mediating psychological variable, in 13 Latin American countries. A total of 5779 people recruited through non-probabilistic convenience sampling participated. To collect information, we used the Fear of COVID-19 Scale, Vaccine conspiracy beliefs Scale-COVID-19 and a single item of intention to vaccinate. A full a priori Structural Equation Model was used; whereas, cross-country invariance was performed from increasingly restricted structural models. The results indicated that, fear of COVID-19 positively predicts intention to vaccinate and the presence of conspiracy beliefs about COVID-19 vaccines. The latter negatively predicted intention to vaccinate against COVID-19. Besides, conspiracy beliefs about COVID-19 vaccines had an indirect effect on the relationship between fear of COVID-19 and intention to vaccinate against COVID-19 in the 13 countries assessed. Finally, the cross-national similarities of the mediational model among the 13 participating countries are strongly supported. The study is the first to test a cross-national mediational model across variables in a large number of Latin American countries. However, further studies with other countries in other regions of the world are needed.

Determination of pathogens and contamination indicatorsin fresh pork sausages in the state of São Paulo / Determinação de patógenos e indicadores de contaminação em linguiças frescais de origem suína no estado de São Paulo

The highest cost of beef and chicken meat justifies higher consumption of fresh sausage products, especially linguiça, due to their easy preparation and affordability for consumers, making necessary an evaluation of sanitary hygienic conditions of these products. The objective was to investigate the presence of pathogens such as Salmonella spp., coagulase-positive Staphylococcus, thermotolerant coliforms, Escherichia coli and Campylobacter spp. in artisanal and inspected fresh pork sausages. It was found that 12% (6/50) of the artisanal sausage samples were contaminated with Salmonellaspp., 58% (29/50) presented coagulase-positive Staphylococcus levels above the acceptable limits for consumption and 76% (38/50) presented thermotolerant coliform levels above the acceptable limits. In sausage samples produced under inspected conditions, 6% (3/50) were contaminated with Salmonella spp., 24% (12/50) presented thermotolerant coliform levels above the acceptable limits, 2% (1/50) presented enteropathogenic E. coli. None samples showed coagulase-positive Staphylococcus counts above the limits, or presence of Campylobacter spp. Sensitizing traders and consumers about the importance of inspection service in food of animal origin is urgent for a sanitary acceptable production, since foodborne diseases continue to be a public health problem.

O alto custo das carnes de frango e bovina justifica maior consumo de produtos embutidos frescais, especialmente a linguiça, devido ao preço acessível ao consumidor e fácil preparo, tornando necessário estudos para avaliar as condições higiênico-sanitárias. Os objetivos foram verificar a presença de Salmonella spp., Staphylococcus coagulase positiva, coliformes termotolerantes, Escherichia colipatogênicas e Campylobacter spp. em linguiças suínas tipo frescal artesanais e fiscalizadas. Os resultados obtidos em linguiças artesanais foram de 12% (6/50) contaminadas com Salmonella spp., 58% (29/50) de Staphylococcus coagulase positiva e 76% (38/50) nas quantificações de coliformes termotolerantes, dados que apresentam níveis de contaminação superiores aos da legislação vigente. Nas linguiças produzidas sob fiscalização detectou-se 6% (3/50) de contaminação por Salmonella spp.; 24% (12/50) de quantificação de coliformes termotolerantes acima dos limites aceitáveis, e 2% (1/50) de E. coli enteropatogênica. Nenhuma amostra apresentou contagens de Staphylococcus coagulase positiva fora dos padrões, ou contaminação por Campylobacter spp. Sensibilizar comerciantes e consumidores sobre a importância do serviço de inspeção em alimentos de origem animal é premente para que haja uma produção sanitária aceitável, pois doenças transmitidas por alimentos continuam sendo um problema à saúde pública.

Epoxidized Ionic Liquids as Processing Auxiliaries of Poly(Lactic Acid) Matrix: Influence on the Manufacture, Structural and Physical Properties.

In this study, we set out to modify poly(lactic acid) (PLA) by incorporating epoxidized ionic liquids (ILs) that were specifically designed with imidazolium-NTf2 moieties. First, we synthesized di-, tri- and tetra-epoxidized ILs, which were incorporated into a PLA matrix at 3, 5, and 10 wt% through a melt extrusion process. We investigated the relationship between the structure and properties of the resulting materials in terms of thermal, mechanical, rheological, and surface properties. The results showed the potential of ILs to impact these properties. Notably, the tri- and tetra-epoxidized ILs enhanced the thermal stability of the PLA matrix as well as the crystallinity while reducing the glass transition temperature and melting point, which is promising for reactive extrusion processing. Overall, this research opens new routes for using reactive ILs to improve the processing and properties of PLA polymers.

Towards an optimization of functional localizers in non-human primate neuroimaging with (fMRI) frequency-tagging.

Non-human primate (NHP) neuroimaging can provide essential insights into the neural basis of human cognitive functions. While functional magnetic resonance imaging (fMRI) localizers can play an essential role in reaching this objective (Russ et al., 2021), they often differ substantially across species in terms of paradigms, measured signals, and data analysis, biasing the comparisons. Here we introduce a functional frequency-tagging face localizer for NHP imaging, successfully developed in humans and outperforming standard face localizers (Gao et al., 2018). FMRI recordings were performed in two awake macaques. Within a rapid 6 Hz stream of natural non-face objects images, human or monkey face stimuli were presented in bursts every 9 s. We also included control conditions with phase-scrambled versions of all images. As in humans, face-selective activity was objectively identified and quantified at the peak of the face-stimulation frequency (0.111 Hz) and its second harmonic (0.222 Hz) in the Fourier domain. Focal activations with a high signal-to-noise ratio were observed in regions previously described as face-selective, mainly in the STS (clusters PL, ML, MF; also, AL, AF), both for human and monkey faces. Robust face-selective activations were also found in the prefrontal cortex of one monkey (PVL and PO clusters). Face-selective neural activity was highly reliable and excluded all contributions from low-level visual cues contained in the amplitude spectrum of the stimuli. These observations indicate that fMRI frequency-tagging provides a highly valuable approach to objectively compare human and monkey visual recognition systems within the same framework.

I'm just joking! Perceptions of sexist humour and sexist beliefs in a Latin American context.

Previous research has stated a relationship between sexist ideologies and humour appreciation. However, most research has been done in North America and Europe. In the present study, we aimed to approach in an exploratory way to the social perceptions of sexist humour in Costa Rica. Data was gathered through an online survey, participants (N = 323; 220 females) completed measures to characterise expressions of sexist humour. The main measures included perceived funniness, frequency and means of exposure, and perceived offensiveness, as well as completing the Ambivalent Sexism Inventory (ASI). Overall, previous exposure to this kind of humour was remarkably high. No significant differences were observed between women's and men's perceptions of the frequency, means and places of exposure, but emotional and behavioural reactions to sexist humour were gender-based. Women reported higher displeasure, more confrontation and felt angrier and more offended than men when exposed to this type of humour. Data support existing evidence of the relationship with sexist ideology. Specifically, hostile sexism was found to be a significant predictor of perceived funniness and offensiveness of the sexist jokes. An interaction effect between hostile sexism and the sex of participants was found, showing that as hostile sexism increased, perceived offensiveness decreased, but more rapidly for men. Results are discussed considering the practical implications and limitations, as well as the need for more research in the Latin American context.

Cross-cultural invariance of the Spanish version of the COVID-19 Assessment Scorecard to measure the perception of government actions against COVID-19 in Latin America

Abstract Objectives The present study aimed to evaluate the measurement invariance of a general measure of the perception of governmental responses to COVID--19 (COVID-SCORE-10) in the general population of 13 Latin American countries. Methods A total of 5780 individuals from 13 Latin American and Caribbean countries selected by non-probabilistic snowball sampling participated. A confirmatory factor analysis was performed and the alignment method was used to evaluate invariance. Additionally, a graded response model was used for the assessment of item characteristics. Results The results indicate that there is approximate measurement invariance of the COVID-SCORE-10 among the participating countries. Furthermore, IRT results suggest that the COVID-SCORE-10 measures with good psychometric ability a broad spectrum of the construct assessed, especially around average levels. Comparison of COVID-SCORE-10 scores indicated that participants from Cuba, Uruguay and El Salvador had the most positive perceptions of government actions to address the pandemic. Thus, the underlying construct of perception of government actions was equivalent in all countries. Conclusion The results show the importance of initially establishing the fundamental measurement properties and MI before inferring the cross-cultural universality of the construct to be measured.

Recursos Públicos na Esfera Privada: Política de Educação Especial em um Município Paulista de Grande Porte / Public Resources in the Private Sphere: Special Education Policy in a Large Municipality of São Paulo

RESUMO: A Educação Especial brasileira tem marcas históricas da privatização, uma delas é focalizada neste artigo, que tem por objetivo analisar o repasse de recursos financeiros públicos da educação para a esfera privada em um município paulista de grande porte, entre 2012 e 2017. Adotando abordagem qualitativa, são analisados os valores liquidados em favor da Educação Especial direcionados à esfera privada a partir de fontes documentais, abrangendo contratos com empresas terceirizadas, termos de colaboração e aditamento, relatórios de remuneração de profissionais da Educação Especial e documentos de repasse de recursos à esfera privada. Os resultados indicam aumento dos recursos destinados a essa modalidade na esfera privada em decorrência, principalmente, da necessidade de contratação de cuidadoras(es), até aquele momento sem provimento de cargo nessa rede de ensino. Também expressam que a inclusão escolar reproduz modos de financiamento que marcam a história da Educação Especial no Brasil. A parceria com instituições privadas sem fins lucrativos e a contratação de empresas terceirizadas vão ao encontro da perspectiva gerencial da administração pública. No caso analisado, por um lado, a política de inclusão escolar terceirizou a manutenção dos serviços a partir da concessão para a esfera privada; por outro lado, houve crescente aumento do financiamento do setor público municipal.

ABSTRACT: Brazilian Special Education has historical marks of privatization, one of which is focused on this article, which aims to analyze the transfer of public financial resources from education to the private sphere in a large municipality in São Paulo, between 2012 and 2017. Adopting a qualitative approach, the amounts settled in favor of Special Education directed to the private sphere are analyzed based on documentary sources, covering contracts with outsourced companies, terms of collaboration and additions, reports on remuneration of Special Education professionals and documents for the transfer of funds to the private sphere. The results indicate an increase in resources allocated to this modality in the private sphere, mainly due to the need to hire caregivers, until that moment without filling a position in this teaching network. They also express that school inclusion reproduces funding modes that mark the history of Special Education in Brazil. The partnership with non-profit private institutions and the contracting of outsourced companies are in line with the managerial perspective of public administration. On the one hand, in the analyzed case, the school inclusion policy outsourced the maintenance of services from the concession to the private sphere, on the other hand, there was a growing increase in funding from the municipal public sector.

Association between Fathers' and Mothers' Parenting Styles and the Risk of Overweight/Obesity among Adolescents in San José Province, Costa Rica.

Parenting styles are a risk factor for adolescents overweight/obesity worldwide, but this association is not well understood in the context of Latin America. This study examines the association between the parenting styles of mothers and fathers and the risk of overweight/obesity among Costa Rican adolescents. Data are cross-sectional from a sample of adolescents (13-18 years old) enrolled in ten urban and eight rural schools (n = 18) in the province of San José, Costa Rica, in 2017. Hierarchical logistic regression analyses were performed to assess the likelihood of adolescents being overweight according to the mothers' and fathers' parenting styles. A significant association was found between the risk of adolescent overweight/obesity and the paternal authoritarian style only in rural areas (B = 0.622, SE = 0.317, Wald = 3.864, ExpB = 1.863, p = 0.04), and between said risk and the paternal permissive style only in male adolescents (B = 0.901, SE = 0.435, Wald = 4.286, ExpB = 2.461, p = 0.038). For maternal parenting styles, no associations reached significant levels once logistic regression models were adjusted for the fathers' parenting styles. These findings underscore the importance of further studying the role of fathers' paternal parenting styles on Latin American adolescent weight outcomes. Expanding our understanding of the parenting styles of fathers has important implications for the design and implementation of culturally- and gender-appropriate family interventions.

Acculturative Stress, Perceived Social Support, and Mental Health: The Mediating Effect of Negative Emotions Associated with Discrimination.

The role of perceived social support in the acculturation process of immigrants remains unclear. In this study, we jointly evaluated the associations between acculturative stress and negative emotions associated with discrimination as antecedents of anxiety, depression, and stress symptoms in 283 immigrants living in Chile. Three competing models were tested via structural equation modelling to assess (1) the association among these variables and mental health symptoms and (2) to clarify the role of perceived social support. The third model was theoretically more adequate, showed a better fit, and explained 42.7% of the variance of mental health symptoms. In this model, perceived social support was associated with acculturative stress by reducing mental health symptomatology. Moreover, a direct relationship and an indirect relationship were found between acculturative stress (through negative emotions associated with discrimination) and mental health symptomatology. These results contribute to the understanding of the acculturation process experienced by immigrants in Chile and provide empirical evidence to be used to improve migration policies.

Characterization of primary direct-acting antiviral (DAA) drugs resistance mutations in NS5A/NS5B regions of hepatitis C virus with genotype 1a and 1b from patients with chronic hepatitis.

The Hepatitis C virus (HCV) infection is a public health problem. The high level of HCV replication and its lack of post-transcriptional correction mechanisms results in the emergence of viral variants and the difficulty in determining polymorphisms and variants that contain the substitutions associated with resistance towards new antivirals. The main focus of this study was to map the NS5A and NS5B polymorphisms and resistance mutations to new antiviral drugs in HCV strains genotype 1 from patients with chronic hepatitis C infection. Serum samples were collected from patients who underwent routine viral load tests at the Instituto Adolfo Lutz, Sao Paulo city, Brazil. A total of 698 and 853 samples were used for the characterization of NS5A and NS5B regions, respectively, which comprise the HCV genotypes 1a and 1b. The prevalence of resistance mutations found in the NS5A region was 6.4%, with Y93H, L31M, Q30R, and Y93N as the main resistance-associated substitutions (RAS). No NS5B-associated RAS was observed for any of the analyzed drugs. These findings support that the RAS test should be offered to individuals with poor response to double combination regimens prior to treatment initiation, thereby assisting strain vigilance and selection of effective treatment or retreatment options using DAA regimens.

Survey for Leptospira and Brucella in Amazonian manatees, Amazon river dolphins, and a tucuxi in the Brazilian Amazon.

Leptospirosis and brucellosis are zoonotic diseases with global distributions that represent severe hazards to humans and animals. We investigated exposure to Leptospira spp. and Brucella spp. in samples from Amazonian manatees Trichechus inunguis, Amazon river dolphins Inia geoffrensis, and a tucuxi Sotalia fluviatilis. The animals were free-ranging or undergoing in situ rehabilitation in the mid-Solimões River region, Brazilian Amazon. Serum samples from 19 Amazonian manatees were tested by microscopic agglutination test, Rose Bengal test, and 2-mercaptoethanol Brucella agglutination test. Antibodies against Leptospira spp. were detected in 63% of the manatees tested and serovar Patoc was considered the infecting serovar in all positive samples. Titers were generally low, indicating chronic exposure, but higher titers indicative of an active infection were detected in 3 animals. Anti-Brucella spp. antibodies were not detected. Tissue and/or body fluid samples from 12 Amazon river dolphins, a tucuxi, and 2 Amazonian manatees were investigated by multiplex PCR and bacteriology for Leptospira spp. and Brucella spp. All samples were negative. However, Enterococcus faecalis was isolated from uterine fluid, lymph node, and lung of 3 Amazon river dolphins. Bacillus spp. were isolated from milk and synovial fluid from 2 Amazon river dolphins and from a milk sample from 1 Amazonian manatee. Knowledge of the pathogens present in Amazonian manatees, Amazon river dolphins, and tucuxis is of great relevance to species conservation and environmental health. Although no clinical signs were noted, further research is needed to elucidate the clinical relevance of infection by Leptospira sp. serovar Patoc in Amazonian aquatic mammals.

Association between Parental Feeding Styles and Excess Weight, and Its Mediation by Diet, in Costa Rican Adolescents.

BACKGROUND: Whereas parental feeding styles (PFS) influence children's diet, less is known about this relationship in adolescents. METHODS: A cross-sectional study in 686 Costa Rican adolescents (13-18 years) evaluated 4 validated PFS scores: healthy eating verbal encouragement; scolding; directly controlling diet; instrumental/emotional. Diet was evaluated through 3-day food records, deriving a Traditional Costa Rica Adolescents Diet Score (TCRAD). Excess weight (EW) measured by BMI was dichotomized following standards. Regression-based mediation analysis estimated the overall and sex-stratified odds ratios of EW for natural direct (NDE), natural indirect (NIE), and total effects (TE) of the pathway PFS→TCRAD→EW. RESULTS: A one-unit increase in the direct control PFS score was associated with higher EW odds overall [(TE: 1.55; 95% CI: 1.04-2.31; p-value = 0.033), (NDE: 1.52; 95% CI: 1.02-2.27; p-value = 0.039)], and in boys [(TE: 2.13; 95% CI: 1.04-4.38; p-value = 0.039), (NDE: 2.10; 95% CI: 1.03-4.31; p-value = 0.042)]. Non-significant mediation by TCRAD was observed for the healthy eating verbal encouragement PFS overall (p-value = 0.06). Associations for the instrumental/emotional and scolding PFS were not significant. CONCLUSIONS: Direct diet control from parents may contribute to adolescents' excess weight, particularly among boys. Parents encouraging healthy eating might support adolescents' healthy weight through a healthy diet. Longitudinal research should clarify the association between PFS and diet-related outcomes among diverse adolescents.

Integrating Photovoice and Citizen Science: The Our Voice Initiative in Practice.

Community engagement methods like photovoice have allowed researchers to gather and incorporate the experiences and perspectives of community members in their work but have at times faced challenges regarding systematization, accessibility, and scalability. This practice note describes the Our Voice initiative, one example of a community-based participatory research framework that aims to build on photovoice theories and best practices and address these challenges by incorporating the use of a mobile app as well as elements of participatory action-based citizen science to support community-driven data collection, analysis, and advocacy. We explore the application of the Our Voice method and evaluation of multilevel participant and community outcomes across three different Bay Area, California, communities. In doing so, we hope to provide a potential example for practitioners of other community-based participatory research and photovoice-based models to draw from when working with diverse communities to integrate local perspectives and insights in the generation and implementation of sustainable community health improvements.