SARS-CoV-2 Reinfection Cases in a Household-Based Prospective Cohort in Rio de Janeiro.

This was a household-based prospective cohort study conducted in Rio de Janeiro, in which people with laboratory-confirmed coronavirus disease 2019 (COVID-19) and their household contacts were followed from April 2020 through June 2022. Ninety-eight reinfections were identified, with 71 (72.5%) confirmed by genomic analyses and lineage definition in both infections. During the pre-Omicron period, 1 dose of any COVID-19 vaccine was associated with a reduced risk of reinfection, but during the Omicron period not even booster vaccines had this effect. Most reinfections were asymptomatic or milder in comparison with primary infections, a justification for continuing active surveillance to detect infections in vaccinated individuals. Our findings demonstrated that vaccination may not prevent infection or reinfection with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Therefore we highlight the need to continuously update the antigenic target of SARS CoV-2 vaccines and administer booster doses to the population regularly, a strategy well established in the development of vaccines for influenza immunization programs.

Toxicity of Heavy Metals that Affect Germination, Development and Cell Cycle of Allium cepa L.

This study aimed to investigate the impact of heavy metals copper, cadmium, lead, aluminum and nickel, on the growth, physiology, metabolism, and cell cycle of Allium cepa L. Five treatments with increasing concentrations (0, 50, 100, 250, and 500 µM) were applied to the seeds. The results showed that the highest concentrations of copper and cadmium had phytotoxic and biochemical effects on the onion. Additionally, copper concentrations caused an increase in mitodepressive effect and chromosomal abnormalities. Aluminum also induced several chromosomal abnormalities. The study found that Cd > Cu > Pb > Ni > Al and Cu > Al > Ni > Pb > Cd had the highest phytotoxic and cytotoxic potentials, respectively. Furthermore, the UPGMA method revealed three divergent groups. These results suggest that heavy metals, especially copper, have a significant pollution potential when present in high concentrations.

An open challenge to advance probabilistic forecasting for dengue epidemics.

A wide range of research has promised new tools for forecasting infectious disease dynamics, but little of that research is currently being applied in practice, because tools do not address key public health needs, do not produce probabilistic forecasts, have not been evaluated on external data, or do not provide sufficient forecast skill to be useful. We developed an open collaborative forecasting challenge to assess probabilistic forecasts for seasonal epidemics of dengue, a major global public health problem. Sixteen teams used a variety of methods and data to generate forecasts for 3 epidemiological targets (peak incidence, the week of the peak, and total incidence) over 8 dengue seasons in Iquitos, Peru and San Juan, Puerto Rico. Forecast skill was highly variable across teams and targets. While numerous forecasts showed high skill for midseason situational awareness, early season skill was low, and skill was generally lowest for high incidence seasons, those for which forecasts would be most valuable. A comparison of modeling approaches revealed that average forecast skill was lower for models including biologically meaningful data and mechanisms and that both multimodel and multiteam ensemble forecasts consistently outperformed individual model forecasts. Leveraging these insights, data, and the forecasting framework will be critical to improve forecast skill and the application of forecasts in real time for epidemic preparedness and response. Moreover, key components of this project-integration with public health needs, a common forecasting framework, shared and standardized data, and open participation-can help advance infectious disease forecasting beyond dengue.

Space-time dynamics of a triple epidemic: dengue, chikungunya and Zika clusters in the city of Rio de Janeiro.

Dengue, an arboviral disease transmitted by Aedes mosquitoes, has been endemic in Brazil for decades. However, vector-control strategies have not led to a significant reduction in the disease burden and have not been sufficient to prevent chikungunya and Zika entry and establishment in the country. In Rio de Janeiro city, the first Zika and chikungunya epidemics were detected between 2015 and 2016, coinciding with a dengue epidemic. Understanding the behaviour of these diseases in a triple epidemic scenario is a necessary step for devising better interventions for prevention and outbreak response. We applied scan statistics analysis to detect spatio-temporal clustering for each disease separately and for all three simultaneously. In general, clusters were not detected in the same locations and time periods, possibly owing to competition between viruses for host resources, depletion of susceptible population, different introduction times and change in behaviour of the human population (e.g. intensified vector-control activities in response to increasing cases of a particular arbovirus). Simultaneous clusters of the three diseases usually included neighbourhoods with high population density and low socioeconomic status, particularly in the North region of the city. The use of space-time cluster detection can guide intensive interventions to high-risk locations in a timely manner, to improve clinical diagnosis and management, and pinpoint vector-control measures.

A Local View of Informal Urban Environments: a Mobile Phone-Based Neighborhood Audit of Street-Level Factors in a Brazilian Informal Community.

Street-level environment characteristics influence the health behaviors and safety of urban residents, and may particularly threaten health within informal communities. However, available data on how such characteristics vary within and among informal communities is limited. We sought to adapt street audit strategies designed to characterize the physical environment for use in a large informal community, Rio das Pedras (RdP) located in Rio de Janeiro, Brazil. A smartphone-based systematic observation protocol was used to gather street-level information for a high-density convenience sample of street segments (N = 630, estimated as 86% of all street segments in the community). We adapted items related to physical disorder and physical deterioration. Measures selected to illustrate the approach include the presence of the following: (1) low-hanging or tangled wires, (2) litter, (3) structural evidence of sinking, and (4) an unpleasant odor. Intercept-only spatial generalized additive models (GAM) were used to evaluate and visualize spatial variation within the RdP community. We also examined how our estimates and conclusions about spatial variation might have been affected by lower-density sampling from random subsets street observations. Random subsets were selected to determine the robustness of study results in scenarios with sparser street sampling. Selected characteristics were estimated to be present for between 18% (unpleasant odor) to 59% (low-hanging or tangled wires) of the street segments in RdP; estimates remain similar (± 6%) when relying on a random subset created to simulate lower-density spatial sampling. Spatial patterns of variation based on predicted probabilities across RdP differed by indicator. Structural sinking and low-hanging or tangled wires demonstrated relatively consistent spatial distribution patterns across full and random subset sample sizes. Smartphone-based systematic observations represent an efficient and potentially feasible approach to systematically studying neighborhood environments within informal communities. Future deployment of such tools will benefit from incorporating data collection across multiple time points to explore reliability and quantify neighborhood change. These tools can prove useful means to assess street-level exposures that can be modifiable health determinants across a wide range of informal urban settings. Findings can contribute to improved urban planning and provide useful information for identifying potential locations for neighborhood-scaled interventions that can improve living conditions for residents in Rio das Pedras.

Effects of antiretroviral treatment and nadir CD4 count in progression to cardiovascular events and related comorbidities in a HIV Brazilian cohort: a multi-stage approach.

The use of highly active antiretroviral therapy has resulted in changes of comorbidity profile in people living with HIV (PLHIV), increasing non-AIDS-related events. The occurrence of cardiovascular events is greater in PLHIV, but the mechanism responsible for it is still controversial. This article aimed to investigate factors associated with the progression to cardiovascular events in PLHIV using HAART. A 15-years cohort study with 1135 PLHIV was conducted in Rio de Janeiro-Brazil. Clinical progression was stratified in five states: No comorbidities (s1), arterial hypertension (s2), lipid abnormalities (s3), hypertension and lipid abnormalities (s4) and major cardiovascular events (stroke, coronary artery disease, thrombosis or death) (s5). Semi-Markov models evaluated the effects of cardiovascular traditional factors, treatment and clinical covariates on transitions between these states. Hazard Ratios (HR) and 95% confidence intervals (CI) were provided. In addition to traditional factors (age, sex, educational level and skin color), the development of one comorbidity (lipid abnormalities or hypertension) increased in patients with low nadir CD4 (<50 cells/mm3), (HR = 1.59, CI 1.11-2.28 and 1.36, CI 1.11-1.66, respectively). The risk to experience a second comorbidity (s3→s4) increased 75% with low nadir CD4. Age was the only factor that increased the risk of major cardiovascular events once having lipid abnormalities with or without hypertension (s3,s4→s5). The prolonged use of certain antiretroviral drugs (abacavir, didanosine, ritonavir, lopinavir, amprenavir and fosamprenavir) increased the risk of direct transition (s1→s5) to major cardiovascular events (HR = 5.29, CI 1.16-24.05). This analysis suggests that prolonged use of certain antiretroviral drugs led directly to major cardiovascular events, while low nadir CD4 only affected the occurrence of lipid abnormalities and hypertension. Management strategies, including rational use of complex exams (such as, computed-tomography angiography), statins and antihypertensives, should be developed based on the distinct roles of antiretroviral use and of HIV infection itself on the progression to cardiovascular events.

Perceptions and Uses of Public and Private Health Care in a Brazilian Favela.

Since 1988, Brazil has reorganized and expanded its public health care system, defining access to health care as a right of every citizen. In parallel, the private health care sector grew rapidly to become one of the largest in the world. We explore the use of public and private health care by a low-income population living in a favela, Rio das Pedras, in Rio de Janeiro. At the time of data collection, only part of the community was covered by the primary health care program. We conducted semistructured interviews with 14 adults, both with and without access to the public primary care program. Regardless of program coverage, participants noted barriers and negative experiences while accessing public health care. The perceived inability of health professionals to deal compassionately with a low-income population was prominent in their narratives, and in the expressed motivation for pursuing private sector health care alternatives. We explore the tension arising from the more recent rights-based health care provision and historic social control and assistentialist framing of state intervention in Brazilian favelas.

Early Evidence for Zika Virus Circulation among Aedes aegypti Mosquitoes, Rio de Janeiro, Brazil.

During 2014-2016, we conducted mosquito-based Zika virus surveillance in Rio de Janeiro, Brazil. Results suggest that Zika virus was probably introduced into the area during May-November 2013 via multiple in-country sources. Furthermore, our results strengthen the hypothesis that Zika virus in the Americas originated in Brazil during October 2012-May 2013.

Animal timing: a synthetic approach.

Inspired by Spence's seminal work on transposition, we propose a synthetic approach to understanding the temporal control of operant behavior. The approach takes as primitives the temporal generalization gradients obtained in prototypical concurrent and retrospective timing tasks and then combines them to synthetize more complex temporal performances. The approach is instantiated by the learning-to-time (LeT) model. The article is divided into three parts. In the first part, we review the basic findings concerning the generalization gradients observed in fixed-interval schedules, the peak procedure, and the temporal generalization procedure and then describe how LeT explains them. In the second part, we use LeT to derive by gradient combination the typical performances observed in mixed fixed-interval schedules, the free-operant psychophysical procedure, the temporal bisection task, and the double temporal bisection task. We also show how the model plays the role of a useful null hypothesis to examine whether temporal control in the bisection task is relative or absolute. In the third part, we identify a set of issues that must be solved to advance our understanding of temporal control, including the shape of the generalization gradients outside the range of trained stimulus durations, the nature of temporal memories, the influence of context on temporal learning, whether temporal control can be inhibitory, and whether temporal control is also relational. These issues attest to the heuristic value of a Spencean approach to temporal control.

Inequalities in socioeconomic status and race and the odds of undergoing a mammogram in Brazil.

BACKGROUND: Access to mammograms, in common with other diagnostic procedures, is strongly conditioned by socioeconomic disparities. Which aspects of inequality affect the odds of undergoing a mammogram, and whether they are the same in different localities, are relevant issues related to the success of health policies. METHODS: This study analyzed data from the 2008 PNAD - Brazilian National Household Sample Survey (11.607 million women 40 years of age or older), on having had at least one mammogram over life for women 40 years of age or older in each of Brazil's nine Metropolitan Regions (MR), according to socioeconomic position. The effects of income, schooling, health insurance and race in the different regions were investigated using multivariate logistical regression for each region individually, and for all MRs combined. The age-adjusted odds of a woman having had a mammogram according to race and stratified by two income strata (and two schooling strata) were also analyzed. RESULTS: Having a higher income increases four to seven times a woman's odds of having had at least one mammogram in all MRs except Curitiba. For schooling, the gradient, though less steep, is favorable to women with more years of study. Having health insurance increases two to three times the odds in all MRs. Multivariate analysis did not show differences due to race (except for the Fortaleza MR), but the stratified analysis by income and schooling shows effects of race in most MRs, with greater differences for women with higher socioeconomic status. CONCLUSIONS: This study confirms that income and schooling, as well as having health insurance, are still important determinants of inequality in health service use in Brazil. Additionally, race also contributes to the odds of having had a mammogram. The point is not to isolate the effect of each factor, but to evaluate how their interrelations may exacerbate differences, generating patterns of cumulative adversity, a theme that is still little explored in Brazil. This is much more important when we consider that race has only recently started be included in analyses of health outcomes in Brazil.

Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings.

BACKGROUND: The efficacy of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System (SUS). METHODS: All patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto's test. Prognostic factors were selected using Cox's models. RESULTS: There were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas' heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation (5.3%) than those undergoing transvenous implantation (1.6%) (p = 0.02). CONCLUSIONS: The results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.

Distance to parks and non-residential destinations influences physical activity of older people, but crime doesn't: a cross-sectional study in a southern European city.

BACKGROUND: Physical activity (PA) has numerous health benefits, but older adults live mostly sedentary lifestyles. The physical and social neighborhood environment may encourage/dissuade PA. In particular, neighborhood crime may lead to feeling unsafe and affect older adults' willingness to be physically active. Yet, research on this topic is still inconclusive. Older population, probably the age group most influenced by the neighborhood environment, has been understudied, especially in Southern Europe. In this study, we aimed to analyze the association between leisure-time physical activity (LTPA) in older adults and objective crime, alongside other neighborhood characteristics. METHODS: We obtained data from a population-based cohort from Porto (2005-2008) to assess LTPA. Only adults aged 65 years or more were included (n = 532). A Geographic Information System was used to measure neighborhood characteristics. Neighborhood crime was expressed as crime rates by category (incivilities, criminal offenses with and without violence and traffic crime). Neighborhood characteristics such as socioeconomic deprivation, land gradient, street density, transportation network, distance to parks, non-residential destinations and sport spaces were also included. Generalized Additive Models were fitted to estimate the association between neighborhood characteristics and the participation (being active vs. inactive) and frequency (min/day) of LTPA. RESULTS: Forty-six percent of the men and 61 % of the women did not engage in any kind of LTPA. Among the active participants, men spent on average 50.5 (35.2 Standard Deviation, SD) min/day in LTPA, whereas the average among women was 36.9 (35.1 SD) min/day (p < 0.001). Neighborhood crime was unrelated to the participation in, or frequency of, LTPA. On the other hand, two neighborhood characteristics - distance to the nearest park (ß = -0.0262, p = 0.029) and to the nearest non-residential destination (ß = -0.0735, p = 0.019) - were associated with time spent on LTPA, but only among active older women. No neighborhood characteristic was related to participation in LTPA. CONCLUSIONS: From a public health point of view, the provision of parks and non-residential destinations (shops, schools, cultural and worship places) might contribute to elevate PA levels of already active older women. On the other hand, in this setting, crime was not a big issue.

Long-Term Lithium Treatment Increases cPLA2 and iPLA2 Activity in Cultured Cortical and Hippocampal Neurons.

BACKGROUND: Experimental evidence supports the neuroprotective properties of lithium, with implications for the treatment and prevention of dementia and other neurodegenerative disorders. Lithium modulates critical intracellular pathways related to neurotrophic support, inflammatory response, autophagy and apoptosis. There is additional evidence indicating that lithium may also affect membrane homeostasis. OBJECTIVE: To investigate the effect of lithium on cytosolic phospholipase A2 (PLA2) activity, a key player on membrane phospholipid turnover which has been found to be reduced in blood and brain tissue of patients with Alzheimer's disease (AD). METHODS: Primary cultures of cortical and hippocampal neurons were treated for 7 days with different concentrations of lithium chloride (0.02 mM, 0.2 mM and 2 mM). A radio-enzymatic assay was used to determine the total activity of PLA2 and two PLA2 subtypes: cytosolic calcium-dependent (cPLA2); and calcium-independent (iPLA2). RESULTS: cPLA2 activity increased by 82% (0.02 mM; p = 0.05) and 26% (0.2 mM; p = 0.04) in cortical neurons and by 61% (0.2 mM; p = 0.03) and 57% (2 mM; p = 0.04) in hippocampal neurons. iPLA2 activity was increased by 7% (0.2 mM; p = 0.04) and 13% (2 mM; p = 0.05) in cortical neurons and by 141% (0.02 mM; p = 0.0198) in hippocampal neurons. CONCLUSION: long-term lithium treatment increases membrane phospholipid metabolism in neurons through the activation of total, c- and iPLA2. This effect is more prominent at sub-therapeutic concentrations of lithium, and the activation of distinct cytosolic PLA2 subtypes is tissue specific, i.e., iPLA2 in hippocampal neurons, and cPLA2 in cortical neurons. Because PLA2 activities are reported to be reduced in Alzheimer's disease (AD) and bipolar disorder (BD), the present findings provide a possible mechanism by which long-term lithium treatment may be useful in the prevention of the disease.

[CSP in 40 years of scientific publications]. / CSP em 40 anos de publicação científica.

In 2024, Cadernos de Saúde Pública (CSP) celebrates 40 years of uninterrupted publications. This article analyzes the trajectory of the journal and projects its future considering contemporary challenges in scientific publishing in the field of Public Health. This study was based on the analysis of main editorial policy milestones and the identification of the most popular topics. Three periods were recognized. In the "beginning" (1985 to 1990), the journal had restricted circulation, with a quarterly frequency. The word "epidemiology", used in a descriptive context, is highlighted. Then, in the period of "consolidation" (1991 to October 2012), CSP was indexed in the Index Medicus-MEDLINE database and had its online collection published by the Scientific Electronic Library Online (SciELO), expanding the reach of articles. In this period, the words that characterize the field of policy, planning, and management were clearly seen, and terms related to the epidemiological method emerged. The period of "diversity" (November 2012 to November 2023) introduced the requirement of an external editor to the Oswaldo Cruz Foundation's staff among the three co-editors-in-chief, aiming to ensure editorial independence. New activities and a similar frequency among the five most common terms highlight such "diversity". Several issues are observed in scientific publishing in 2024: non-commercial Open Science, artificial intelligence, appreciation of science, scientific dissemination, among others. Addressing new challenges in an ethical and transparent manner will allow future advances, maintaining CSP's credibility among authors and readers and its commitment to improvements in the living and health conditions of populations.

Cadernos de Saúde Pública (CSP) completa, em 2024, 40 anos de publicação ininterrupta. Este artigo analisa a trajetória da revista e projeta o futuro diante dos desafios contemporâneos da publicação científica do campo da Saúde Coletiva. O estudo foi desenvolvido com base na análise dos principais marcos da política editorial e na identificação dos temas mais publicados. Três períodos foram delimitados. No "início" (1985 a 1990), a revista tinha circulação restrita, com periodicidade trimestral. A palavra "epidemiologia", usada em contexto descritivo, se sobressai. Segue-se o período de "consolidação" (1991 a outubro de 2012), quando CSP é indexado na base bibliográfica Index Medicus-MEDLINE e tem seu acervo online publicado pela Scientific Electronic Library Online (SciELO), ampliando o alcance dos artigos junto à academia. Nesse momento, torna-se visível o conjunto de palavras que caracterizam o campo da política, do planejamento e da gestão, e surgem os termos relacionados ao método epidemiológico. O período "diversidade" (novembro de 2012 a novembro de 2023) apresenta a obrigatoriedade de um editor externo aos quadros da Fundação Oswaldo Cruz entre os três coeditores-chefes, visando garantir a independência editorial. Novas atividades e a frequência similar entre os cinco termos mais encontrados capturam a "diversidade". Inúmeras questões permeiam a publicação científica em 2024: Ciência Aberta não comercial, inteligência artificial, valorização da ciência, divulgação científica, entre outros. Enfrentar os novos desafios, de forma ética e transparente, permitirá avanços futuros, mantendo a credibilidade de CSP junto a autores e leitores e seu compromisso com a melhoria das condições de vida e de saúde das populações.

Cadernos de Saúde Pública (CSP) celebra 40 años de publicación continua en 2024. Este artículo analiza la trayectoria de la revista y hace proyecciones al futuro ante los retos contemporáneos de la publicación científica en el campo de la Salud Pública. El estudio se desarrolló a partir del análisis de los principales hitos de la política editorial y la identificación de los temas más publicados. Para ello, se dividieron en tres períodos. Al "comienzo" (1985 a 1990), la revista tenía una circulación restringida, con una periodicidad trimestral. En ese contexto, se destaca la palabra "epidemiología". Después pasó al período de "consolidación" (1991 a octubre de 2012), en el que CSP se indexa en la base de datos Index Medicus-MEDLINE y tiene su colección en línea publicada por la Scientific Electronic Library Online (SciELO), lo que amplió el alcance de los artículos en la academia. En aquel momento se volvió perceptible el conjunto de palabras que caracterizan el campo de la política, la planificación y la gestión, además de aparecer términos relacionados con el método epidemiológico. En el período de "diversidad" (noviembre de 2012 a noviembre de 2023), hubo una necesidad de incluir a un editor externo al equipo de la Fundación Oswaldo Cruz entre los tres coeditores en jefe para garantizar la independencia editorial. Las nuevas actividades y la frecuencia similar entre los cinco términos principales capturan la "diversidad". La publicación científica para el 2024 aborda numerosos temas: Ciencia Abierta no comercial, inteligencia artificial, apreciación de la ciencia, difusión científica, entre otros. Afrontar los nuevos retos, de forma ética y transparente, permitirá futuros avances manteniendo la credibilidad de CSP junto a autores y lectores, y su compromiso con la mejora de las condiciones de vida y salud de la población.

Biosolid as an alternative source of nutrients in chrysanthemum cultivation.

The objective was to evaluate the biosolids as an alternative source of nutrients in the production of chrysanthemums by adding increasing doses to the cultivation substrate. The experimental design was in blocks with 6 treatments and 5 replications. The treatments consisted of the mixture (commercial substrate + biosolid) at the concentrations: 20%, 40%, 60% and 80% of biosolid + two controls (100% of biosolid and 100% of substrate). The experiment was conducted in a greenhouse for 90 days. Physiological parameters, number of flower buds, dry biomass and nutrient accumulation were evaluated. Physiological parameters were evaluated using the Infrared Gas Analyzer. The number of flower buds was evaluated by counting. Biomass was determined after drying the structures and then calculated the accumulation of nutrients. A total of 90 plants were evaluated. Concentrations of up to 40% of biosolid promoted a greater number of flower buds, dry biomass and nutrient accumulation. Concentrations above 60% lower number of buds, biomass increment and nutrient accumulation. It is concluded that the biosolid has potential as an alternative source of nutrients in the cultivation of chrysanthemums, indicating concentrations of up to 40% and the nutrient content of each batch generated must be verified.

The development of an early warning system for climate-sensitive disease risk with a focus on dengue epidemics in Southeast Brazil.

Previous studies demonstrate statistically significant associations between disease and climate variations, highlighting the potential for developing climate-based epidemic early warning systems. However, limitations include failure to allow for non-climatic confounding factors, limited geographical/temporal resolution, or lack of evaluation of predictive validity. Here, we consider such issues for dengue in Southeast Brazil using a spatio-temporal generalised linear mixed model with parameters estimated in a Bayesian framework, allowing posterior predictive distributions to be derived in time and space. This paper builds upon a preliminary study by Lowe et al. but uses extended, more recent data and a refined model formulation, which, amongst other adjustments, incorporates past dengue risk to improve model predictions. For the first time, a thorough evaluation and validation of model performance is conducted using out-of-sample predictions and demonstrates considerable improvement over a model that mirrors current surveillance practice. Using the model, we can issue probabilistic dengue early warnings for pre-defined 'alert' thresholds. With the use of the criterion 'greater than a 50% chance of exceeding 300 cases per 100,000 inhabitants', there would have been successful epidemic alerts issued for 81% of the 54 regions that experienced epidemic dengue incidence rates in February-April 2008, with a corresponding false alarm rate of 25%. We propose a novel visualisation technique to map ternary probabilistic forecasts of dengue risk. This technique allows decision makers to identify areas where the model predicts with certainty a particular dengue risk category, to effectively target limited resources to those districts most at risk for a given season.

Physical activity-friendly neighbourhood among older adults from a medium size urban setting in Southern Europe.

OBJECTIVE: In this cross-sectional study, we examined the relationship between socio-environmental characteristics of neighborhood of residence and the frequency of leisure-time physical activity (LTPA) among older adults from Porto (Portugal). METHOD: Data from EpiPorto - a prospective adult cohort study from Porto (Portugal) - were used. Only adults aged ≥ 65 at baseline (1999-2003) were included (n=580). We used a Geographic Information System to objectively measure the neighborhood characteristics and Generalized Additive Models to estimate their effect on participation in LTPA (none vs. some reported) and frequency of LTPA (min/day). RESULTS: 62% of the participants reported no LTPA. Active elderly spent on average 38 (women) and 67 (men) minutes per day exercising. Neighborhood characteristics were unrelated to whether older people exercised or not. However, among active individuals, distance to the nearest destination (ß=-0.154, p=0.016), in women, and distance to the nearest park, in men (-0.030, 0.050), were predictors of LTPA frequency. CONCLUSION: There was almost no association between neighborhood characteristics and whether older adults engaged in LTPA or not, but among those that did engage, neighborhood characteristics were associated with increased frequency of LTPA. The promotion of well distributed destinations and parks might improve physical activity levels among the elderly.

[Social determinants and self-reported tuberculosis: National Research by Household Sample, metropolitan areas, Brazil]. / Determinantes sociais e autorrelato de tuberculose nas regiões metropolitanas conforme a Pesquisa Nacional por Amostra de Domicílios, Brasil.

OBJECTIVE: To verify the association between individual demographic and socioeconomic variables and the incidence of self-reported tuberculosis in Brazil. METHODS: This cross-sectional study used data from the health supplement of the 2008 National Research by Household Sample (PNAD) for Brazil's metropolitan areas. An analysis was done of the association between demographic, social, and health service use variables and the odds of having been diagnosed with tuberculosis, according to data from PNAD. Socioeconomic status was assessed based on per capita household income, educational attainment, race, and number of persons per bedroom. Having a place of reference for health care and having health insurance were used as proxy for access to health care, and having been to a doctor in the previous 12 months was used as a variable of health service use. Due to the complex sample design of PNAD, logistic regression was used, taking into account the design effect. RESULTS: The odds of being diagnosed with tuberculosis increased with age and were greater among men. Within the nine metropolitan areas, the effect of income was observed starting at half the minimum wage, with odds decreasing as income increased. Not having seen a doctor in the previous year and having finished high school reduced the odds of reporting tuberculosis by 60%. CONCLUSIONS: Improving the living conditions of vulnerable population segments and facilitating their access to diagnosis should be primary strategies for controlling tuberculosis.

Midsession reversal task with starlings: A quantitative test of the timing hypothesis.

In the Mid-Session Reversal task (MSR), an animal chooses between two options, S1 and S2. Rewards follow S1 but not S2 from trials 1-40, and S2 but not S1 from trials 41-80. With pigeons, the psychometric function relating S1 choice proportion to trial number starts close to 1 and ends close to 0, with indifference (PSE) close to trial 40. Surprisingly, pigeons make anticipatory errors, choosing S2 before trial 41, and perseverative errors, choosing S1 after trial 40. These errors suggest that they use time into the session as the preference reversal cue. We tested this timing hypothesis with 10 Spotless starlings. After learning the MSR task with a T-s Inter-Trial Interval (ITI), they were exposed to either 2 T or T/2 ITIs during testing. Doubling the ITI should shift the psychometric function to the left and halve its PSE, whereas halving the ITI should shift the function to the right and double its PSE. When the starlings received one pellet per reward, the ITI manipulation was effective: The psychometric functions shifted in the direction and by the amount predicted by the timing hypothesis. However, non-temporal cues also influenced choice.