Paulo City Research Articles

You say potato, I say vegetable; you say tomato, I say fruit: Cognitive validity of food group-based dietary recall questions

BackgroundThere is a need for valid, standardized approach for list-based questionnaires to measure food group consumption for indicators of diet quality including dietary diversity. ObjectiveA common method for collecting dietary diversity data consists of open-ended food group questions, e.g. Yesterday, did you eat any vegetables, such as cucumber, cabbage, or celery? We sought to examine the cognitive validity of open-ended questions that require respondents to categorize foods, and closed-ended alternatives using sentinel foods. MethodsPretesting and 83 cognitive interviews were conducted in five languages in São Paulo and New York City in 2018. In structured interviews, respondents were asked to describe their thought processes in answering each question. Their feedback and responses to closed-ended and open-ended food group questions were compared. The Gallup World Poll then piloted two versions of the questionnaire in a nationally representative sample of 1,000 in Brazil in 2018. ResultsRespondents in all settings miscategorized foods when asked open-ended food group questions (0-82%, depending on the food group), respondents varied in their ability to think of other foods that belonged to specified food groups (35-50% could think of any items), and open-ended questions presented an additional cognitive burden. There were no significant differences between the results from closed-ended and open-ended questions in the national pilot test. In the context of a multi-topic survey, the finalized questionnaire took 3-5 minutes, had no additional training requirements, and enumerators reported similar ease in administration as other survey modules. ConclusionsFor data collection on food group consumption, open-ended questions requiring respondents to categorize foods present cognitive validity problems. Closed-ended questions using sentinel foods reduce or eliminate ambiguity, presenting lower cognitive burden and greater comprehension. Based on these results, the closed-ended method has been adopted in international survey platforms for measuring dietary diversity and other aspects of diet quality.

Air quality modeling intercomparison and multiscale ensemble chain for Latin America

Abstract. A multiscale modeling ensemble chain has been assembled as a first step towards an air quality analysis and forecasting (AQF) system for Latin America. Two global and three regional models were tested and compared in retrospective mode over a shared domain (120–28° W, 60° S–30° N) for the months of January and July 2015. The objective of this experiment was to understand their performance and characterize their errors. Observations from local air quality monitoring networks in Colombia, Chile, Brazil, Mexico, Ecuador and Peru were used for model evaluation. The models generally agreed with observations in large cities such as Mexico City and São Paulo, whereas representing smaller urban areas, such as Bogotá and Santiago, was more challenging. For instance, in Santiago during wintertime, the simulations showed large discrepancies with observations. No single model demonstrated superior performance over others or among pollutants and sites available. In general, ozone and NO2 exhibited the lowest bias and errors, especially in São Paulo and Mexico City. For SO2, the bias and error were close to 200 %, except for Bogotá. The ensemble, created from the median value of all models, was evaluated as well. In some cases, the ensemble outperformed the individual models and mitigated extreme over- or underestimation. However, more research is needed before concluding that the ensemble is the path for an AQF system in Latin America. This study identified certain limitations in the models and global emission inventories, which should be addressed with the involvement and experience of local researchers.

Optimizing vaccination to reduce waste and boost coverage in Primary Health Care Units

Abstract Background In immunization, vaccine consumption typically exceeds the number of recipients. The number of doses per vial influences wastage and vaccination coverage goals. In Brazil, 48% of the National Immunization Program’s vaccines are multidose, with 4 having limited shelf-life post-opening. Strategies to reduce wastage aim to optimize dose utilization, enhance process quality, and broaden coverage effectiveness. The objective was to outline strategies for reducing wastage and expanding coverage for children under 5 in 14 São Paulo city Primary Health Care Units (PHCUs). Methods The Lean Six Sigma approach guided the stages. A group conducted contextual analysis to identify PHCU barriers. Data on wasted doses and vaccination were gathered. Weekly meetings for data analysis began in May 2023, following DMAIC phases: Define, Measure, Analyze, Improve, Control. An action plan stemmed from these phases for PHCU implementation. Results Data analysis, from January 2022 to June 2023, revealed a significant vaccine wastage trend, reaching 59% from January to December 2022 and increasing to 63% from January to June 2023. This wastage incurs an average annual cost of R$614,416.26, due to lost doses from expiration after vial opening and expiration of shelf life. The vaccines analyzed were BCG, Oral Polio Vaccine (OPV), Measles, Mumps, and Rubella (MMR), and Yellow Fever. At the project start in May 2023, vaccination coverage was 90%, increasing to 93% afterward. This rise resulted from actions taken and improved data monitoring. Post-project, vaccine wastage reduced by 7 percentage points (from 62% to 56%). Conclusions Addressing vaccine wastage and expanding vaccination coverage for children under 5 are critical in healthcare. Utilizing Lean Six Sigma, key issues in PHCUs were identified, leading to an action plan that reduced wastage, increased coverage, and standardized processes. Key messages • Vaccines are valuable resources and wasting them means reducing financial resources in health. • Vaccination coverage is crucial to protect the population’s health, prevent disease outbreaks, and maintain the country’s economic health, reducing costs for treating preventable diseases.

Formas não proprietárias de morar ameaçadas: despejos e remoções em São Paulo durante a pandemia de COVID-19

From the perverse conjunction between an increasing social and economic crisis during the COVID-19 pandemic (2020-2022) — with rising unemployment, deteriorating incomes and increase of debt — and an unprecedent real estate boom, which caused a rise in land and rent prices, emerged new squats and an intensified number of displacements and evictions in São Paulo city, Brazil. However, the occurrence of displacement and evictions is quite invisible in the field of urban policies. This article presents the methods used by the Evictions Observatory to identify these processes, using cartography as a research method and analysis. By mobilizing data derived from different sources, we relate evictions to changes in real estate-renting dynamics that leads to the displacement of non-proprietary forms of living. We also investigated their relation with governmental plans, policies and projects which take on the role of incentivizing the market to produce new real estate products or offering rent as a service, in a context of increasing participation of real estate as financial assets and growing presence of asset managers and digital platforms in these markets.

Sleep is altered during menstruation but not inflammatory parameters: Results from polysomnography of EPISONO database.

Menstruation is an inflammatory process that involves changes in women's physiology leading to mental and physical complaints. Sleep is essential for optimal hormonal release, immune response, and wellbeing, becoming an important factor to be evaluated. We compared sleep, inflammatory mediators, fatigue, anxiety and depression symptoms, and quality of life in menstruating and non-menstruating women. We used the polysomnographic data of 232 women from EPISONO 2007, an epidemiological study from São Paulo city, Brazil. Women were distributed into menstruating (N = 61) and non-menstruating groups (N = 171). We applied questionnaires related to sleep quality, sleepiness, insomnia, fatigue, anxiety and depression symptoms, and quality of life. The serum levels of interleukin 6, tumour necrosis factor-alpha, and C-reactive protein were analysed. For statistical analysis the significance level adopted was p < 0.05. Sleep efficiency was statistically lower in menstruating women (81% ± 13) compared with the non-menstruating group (84.2% ± 13.3, p < 0.023). No statistical differences between the two groups were found in respect to the other parameters analysed. Both groups scored for fatigue symptoms, but no statistical significance was observed between the groups. Our findings indicate that menstruation was associated with lower objective sleep efficiency, suggesting that menstruation may be a physiological factor impairing sleep. Further studies evaluating menstrual variables, and each phase of the menstrual cycle, should be undertaken to detect the main factors associated with sleep complaints, fatigue, and objective parameters of sleep.

Environmental surveillance of Cryptosporidium and Giardia in surface supply water and treated sewage intended for reuse from an urban area in Brazil

Environmental monitoring of protozoa, with the potential to trigger diseases, is essential for decision-making by managing authorities and for the control of water surveillance. This study aimed to detect and quantify Cryptosporidium oocysts and Giardia cysts in surface water for drinking water supply and treated sewage for reuse in the city of São Paulo. Samples collected bimonthly for one year were concentrated using the USEPA 1623.1 and 1693 methods for surface water and treated effluents, respectively. Immunofluorescence and nucleic acid amplification techniques were used to detect and quantify (oo)cysts. The cloning technique followed by sequencing and phylogenetic analyses were performed to characterize species and genotypes. The immunofluorescence detected Cryptosporidium spp. and Giardia spp. in 69.2% (9/13) and 100% (13/13) of the surface water samples (0.1–41 oocysts/L and 7.2–354 cysts/L, respectively). In the reuse samples, 85.7% (12/14) were positive for both protozoa and the concentrations varied from 0.4 to 100.6 oocysts/L and 1.2 and 93.5 cysts/L. qPCR assays showed that 100% of surface water (0.1–14.6 oocysts/L and 0.3–639.8 cysts/L) and reused samples (0.1–26.6 oocysts/L and 0.3–92.5 cysts/L) were positive for both protozoa. Species C. parvum, C. hominis, and C. muris were identified using the 18S rRNA gene, demonstrating anthroponotic and zoonotic species in the samples. Multilocus SSU rRNAanalyses of the SSU rRNA, tpi, and gdh genes from Giardia intestinalis identified the AII, BII, and BIV assemblages, revealing that contamination in the different matrices comes from human isolates. The study showed the circulation of these protozoa in the São Paulo city area and the impairment of surface water supply in metropolitan regions impacted by the discharge of untreated or inadequately treated sewage regarding the removal of protozoa, emphasizing the need to implement policies for water safety, to prevent the spread of these protozoa in the population.

A-290 Prevalence and Antimicrobial Resistance Pattern of Microorganisms Recovered From Bloodstream Infections From Public Hospitals of São Paulo City, Brazil

Abstract Background Nosocomial Bloodstream Infections (nBSI) are an important cause of morbidity and mortality. Brazilian studies concerning bloodstream infections are important tools that can bring specific issues related to antimicrobial resistance. The objective of this study was to describe the frequency and antimicrobial susceptibility profile of bacterial isolates from BSI in patients admitted to public hospitals in 2022 and 2023. Methods This study was a retrospective analysis from 12 hospitals (January 2022 to December 2023) based on BSI isolates laboratory data detected by the clinical microbiology department of a medical diagnostic laboratory. The identification and susceptibility tests were performed using MALDI-TOF mass spectrometry (Vitek MS) and Vitek®2 systems, according to the manufacture’s recommendations. Coagulase Negative Staphylococci (CoNS) BSI was only considered in the presence of at least two sets of positive blood cultures with the same organism. Results During the period (January 2022 to December 2023) a total of 19,588 microorganisms isolated from BSI were obtained from 12 hospitals. The frequency of organism group was Gram-positive (10,707; 54.7%), Gram-negative (7,874; 40.2%), yeasts (961; 4.9%) and filamentous (46; 0.2%). The order of prevalence (top ten) organisms was CoNS (5,149; 26.3%); Staphylococcus aureus (2,769; 14.1%); Klebsiella spp. (2,355; 12.0%); Escherichia coli (1,301; 6.6%); Acinetobacter spp. (1,293; 6.6%); Streptococcus spp. (1,125; 5.7%); Enterococcus spp. (1,112; 5.7%); Candida spp. (937; 4.8%); Pseudomonas spp. (749; 3.8%) and Proteus spp. (553; 2.8%). Extended spectrum beta-lactamase rates for E. coli and Klebsiella pneumoniae were 31.6% (268/848) and 74.9% (1027/1371), respectively. The resistance to carbapenems was detected mainly in 74.1% (661/892) of Acinetobacter spp. isolates, 60.7% (832/1371) of Klebsiella pneumoniae; 24.5% (114/465) of P. aeruginosa; 9.7% (34/349) of Proteus spp. and 1.4% (12/828) of Escherichia coli. Antimicrobial resistance was observed mainly in 87.2% of CoNS (2831/3247) and 44.5% of S. aureus (743/1669) to methicillin; 22.9% (146/637) of Enterococccus spp. to vancomycin. Conclusions The frequency of Klebsiella spp. isolates from nBSI has progressively increased and effective infection control measures should be taken to prevent them from spreading. The rates of antimicrobials resistance reported for Klebsiella pneumoniae, Acinetobacter spp., CoNS, S. aureus and Enterococcus spp. reinforce the high resistance rates to antimicrobials in São Paulo city.

A-255 Microbiological Profile and Frequency Distribution of Uropathogens in Brazilian Public Hospitals. Data From a Clinical Laboratory (2018-2023)

Abstract Background Urinary tract infections (UTIs) are among the most common infectious diseases in humans and represent a critical health problem, especially due to a significant rise in global antibiotic use in recent years. The purpose of this study was to describe the main uropathogens and determine the antimicrobial resistance profiles among inpatients at public hospitals in the largest city in Brazil, comparing three different epidemiological periods: pre-Covid-19 (2018-2019), Covid-19 (2020-2021) and post-Covid-19 (2022-2023). Methods A 6-year retrospective review of laboratory data from 12 public hospitals of São Paulo city from January 2018 to December 2023. The urine samples were cultivated onto ChromID® CPS agar plates and then incubated at 35°C for 18-24 h. The bacteria identification was performed by MALDI-TOF mass spectrometry (Vitek-MS), and the minimal inhibitory concentrations of antibiotics were determined using the Vitek®2 system. Only positive results with one bacterial species and a colony count ≥ 105 CFU/mL was considered for descriptive analysis. Results In the 6-year period, a total of 58,738 microorganisms from hospitalized patients were included. The frequency of isolates detected during the period were: 33.9% (19,338/58,738) in pre-Covid-19, 30.1% (17,688/58,738) in Covid-19 and 36.9% (21,712/58,738) in post-Covid-19 period. The top ten microorganisms’ prevalence detected in pre-Covid-19, Covid-19 and post-Covid-19 periods were as follow: 23,951 Escherichia coli (47.5%; 37.1%; 37.7%), 9,247 Klebsiella pneumoniae (12.5%; 14.3%; 19.8%), 7,640 Candida spp. (8.8%; 19.2%; 11.7%), 5,476 Enterococcus spp. (8%; 10%; 9.9%), 3,101 Proteus mirabilis (5.56%; 4.9%; 5.4%), 2,166 Pseudomonas aeruginosa (3.3%; 3.5%; 4.1%), 1,252 Coagulase-Negative Staphylococcus (CoNS) (2.5%; 1.6%; 2.2%), 1,166 Enterobacter spp. (2.3%; 2.1%; 1.6%), 1,088 Streptococcus spp. (3.6%; 1.2%; 0.8%) and 758 Acinetobacter spp. (0.8%; 1.5%; 1.5%). Extended spectrum beta-lactamase rates for E. coli were 16.8% and 20.2% and for K. pneumoniae were 65.7% and 65.2% in Covid-19 and Post-Covid-19 periods, respectively. The resistance to carbapenems was observed mainly in Acinetobacter spp. (85.7%, 93.8% and 80.7%), K. pneumoniae (38.3%, 42.6% and 47.3%), Pseudomonas aeruginosa (22.3%, 23.1% and 25%), and Proteus spp. (0.2%, 1.9% and 5%). Between the Gram-positive cocci, the resistance to vancomycin was observed mainly in E. faecium (43.5%, 37.5%, 30.2%) and the resistance to methicillin was detected in S. aureus (30.1%, 35.8%, 34.1%) and CoNS (31.9%, 47.8%, 53.5%). Conclusions In this study, we observed an increase in the incidence of Candida spp. coinciding with the start of the pandemic period. Overall, the frequency of uropathogens isolated from hospital centers increased and exhibited high resistance to various classes of antimicrobial agents. ESBL-producing K. pneumoniae and Carbapenem-resistant Enterobacteriacea, and nonfermenters such as Acinetobacter spp. and P. aeruginosa constitute serious problems in Brazilian hospitals.

A-253 Antimicrobial Susceptibility Pattern in Escherichia coli Isolated From Community-Acquired Urinary Tract Infections in the era Post-Covid-19

Abstract Background Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed in the community as well as in hospitals. Community-acquired urinary tract infections caused by Escherichia coli represent the largest proportion of infectious diseases affecting women and a significant amount of oral antibiotics are prescribed daily to treat UTI in community outpatient clinics. Having knowledge of regional susceptibility data regarding E. coli is very important for selecting an appropriate empirical antibiotic. This study aimed to report the frequency and antimicrobial susceptibility of E. coli isolated from community-acquired urinary tract infections post-Covid-19 pandemic. Methods This study was a retrospective analysis from January to December 2023 based on the analysis of 24,019 uropathogens isolated from 182 outpatient health centers located in several regions of São Paulo city, Brazil. The urine samples were cultivated onto ChromID™CPS® agar plates by semi-quantitative technique using 1µL disposable loop, incubated at 35-37°C and the colony counting were read after 24h and 48h of incubation. The bacteria identification was performed by MALDI-TOF mass spectrometry (Vitek-MS), and the minimal inhibitory concentrations of antibiotics were determined using the Vitek®2 system, according to the manufacture’s recommendations. Only positive results with one bacterial species and a colony count ≥105 CFU/mL was considered for descriptive analysis. Results Of the 24,019 urine samples tested, 71.44% (17,159/24,019) were identified as Escherichia coli. The major frequency of E. coli infection occurred among women (90.48%) and the main age range was over 60 years (38.57%), while 21-30 comprised 16.5% of cases. The antimicrobial resistance profile for E. coli isolates showed 39.9% (6852/17158) of resistance to ciprofloxacin (MIC, &amp;gt;0.5 mg/L), 34.7% (5,921/17,075) to trimethoprim/sulfamethoxazole (MIC, &amp;gt;0.5 mg/L), 37.5% (6,371/17,002) to Amoxicillin/clavulanate (MIC, &amp;gt;8 mg/L), 8.75% (1,501/17,592) to ceftriaxone (MIC, &amp;gt;1 mg/L), 4.88% (837/17,138) to cefepime (MIC, &amp;gt;4 mg/L), 3.64% (616/16,901) to piperacillin/tazobactam (MIC, &amp;gt;8 mg/L), 11.07% (1,900/17,156) of gentamicin (MIC, &amp;gt;2 mg/L), 0.43% (74/17,158) of amikacin (MIC, &amp;gt;8 mg/L) and 2.23% (377/16,909) of fosfomycin (MIC, &amp;gt;16 mg/L). High-level of susceptibility was detected to carbapenems with 99.94% (10/17159) to ertapenem (MIC, ≤0.5 mg/L) and 99.8% (4/17,159) to meropenem (MIC, ≤2 mg/L). The rate of Extended-spectrum beta-lactamase production was 8.1% (1391/17159). Conclusions This data could be used locally with other related samples, to properly interpret significant resistance patterns and choose the most appropriate antimicrobial for empirical treatment of patients with community-acquired urinary tract infections.

Lifestyle and Cardiometabolic Risk Factors Associated with Impoverishment Due to Out-of-Pocket Health Expenditure in São Paulo City, Brazil.

The rise in obesity and related chronic noncommunicable diseases (NCDs) during recent decades in Brazil has been associated with increases in the financial burden and risk of impoverishment due to out-of-pocket (OOP) health expenditure. Thus, this study investigated trends and predictors associated with impoverishment due to health expenditure, in the population of São Paulo city, Brazil, between 2003 and 2015. Household data from the São Paulo Health Survey (n = 5475) were used to estimate impoverishment linked to OOP health expenses, using the three thresholds of International Poverty Lines (IPLs) defined by the World Bank at 1.90, 3.20, and 5.50 dollars per capita per day purchasing power parity (PPP) in 2011. The results indicated a high incidence of impoverishment due to OOP disbursements for health care throughout the period, predominantly concentrated among low-income individuals. Lifestyle choices referring to leisure-time physical activity (OR = 0.766 at $3.20 IPL, and OR = 0.789 at $5.50 IPL) were linked to reduction in the risk for impoverishment due to OOP health expenditures whilst there were increases in the probability of impoverishment due to cardiometabolic risk factors referring to obesity (OR = 1.588 at $3.20 IPL, and OR = 1.633 at $5.50 IPL), and diagnosis of cardiovascular diseases (OR = 2.268 at $1.90 IPL, OR = 1.967 at $3.20 IPL, and OR = 1.936 at $5.50 IPL). Diagnosis of type 2 diabetes mellitus was associated with an increase in the probability of impoverishment at only the $1.90 IPL (OR = 2.506), whilst coefficients for high blood pressure presented lack of significance in the models. Health policies should focus on interventions for prevention of obesity to ensure the financial protection of the population in São Paulo city, Brazil, especially targeting modifiable lifestyle choices like promotion of physical activity and reduction of tobacco use.

Microplastics in the Olfactory Bulb of the Human Brain

Microplastic (MP) pollution is an emerging environmental and health concern. While MPs have been detected in various human tissues, their presence in the human brain has not been documented, raising important questions about potential neurotoxic effects and the mechanisms by which MPs might reach brain tissues. To determine the presence of MPs in the human olfactory bulb and to analyze their characteristics such as size, morphology, color, and polymeric composition. This case series study used a cross-sectional design involving the analysis of olfactory bulb tissues obtained from deceased individuals during routine coroner autopsies. The sampling procedures were conducted at São Paulo City Death Verification Service, with laboratory analysis carried out at the Brazilian Synchrotron Light Laboratory (LNLS). Participants included 15 adult individuals who had been residents of São Paulo for more than 5 years and underwent coroner autopsies. Exclusion criteria included previous neurosurgical interventions. Data analysis was performed in April 2024. The primary exposure assessed was the presence of MPs in the olfactory bulb, analyzed through direct tissue examination and digested tissue filtration followed by micro-Fourier transform infrared spectroscopy. The main outcomes were the identification and characterization of MPs within the olfactory bulb, including their size, morphology, color, and polymeric composition. The median age of the 15 deceased individuals was 69.5 years, ranging from 33 to 100 years, with 12 males and 3 females. MPs were detected in the olfactory bulbs of 8 out of 15 individuals. A total of 16 synthetic polymer particles and fibers were identified, with 75% being particles and 25% being fibers. The most common polymer detected was polypropylene (43.8%). Sizes of MPs ranged from 5.5 μm to 26.4 μm for particles, and the mean fiber length was 21.4 μm. Polymeric materials were absent in procedural blank and negative control filters, indicating minimal contamination risk. This case series provides evidence of MPs found in the human olfactory bulb, suggesting a potential pathway for the translocation of MPs to the brain. The findings underscore the need for further research on the health implications of MP exposure, particularly concerning neurotoxicity and the potential for MPs to bypass the blood-brain barrier.

The relationships between Urban Tree Canopy Cover and Crime in São Paulo City, Brazil

Prior research has indicated lower crime rates in areas with greater tree canopy cover predominantly in the Global North. There are few studies from the Global South, and more specifically in Latin America. Given the high prevalence of crime in Latin American cities, the need to address social and environmental inequalities using nature-based solutions is urgent. This study examines crime and tree canopy cover through a series of spatial analyses for São Paulo city, Brazil, while controlling for potential confounders. We tested six levels of data aggregation that were combined with three different crime types and two denominators of crime, to account for spurious findings from Modifiable Areal Unit Problems (MAUP). Of the 36 models, a majority of 27 models (75 %) indicate a negative relationship between crime and tree cover canopy, while 4 models (11 %) show a positive correlation, and 5 models (14 %) suggest no statistically significant relationship. Our best models allow us to infer that 10 % greater tree canopy cover is associated with a 1.20 % fewer property, personal and total reported crimes, with statistical significance at the p < 0.001 level. These findings support our hypothesis that there is a negative relationship between tree canopy cover and crime, with a stronger association observed for property crime than personal or total crime. The negative relationship persisted independently of the level of data aggregation, crime types, crime denominator and spatial models specifications (lag and SARMA), avoiding statistical bias of MAUP. The results follow the literature that have observed tree cover associated with lower crime rates, for different types of crime, while adding a new climatic and cultural context to the evidence base.

The role of air pollution in the development of chronic kidney disease in inhabitants of São Paulo city, Brazil

The role of air pollution in the development of chronic kidney disease in inhabitants of São Paulo city, Brazil

Transmitted Antiretroviral Drug Resistance to Integrase Strand Transfer Inhibitors Class in São Paulo Metropolitan Area, Brazil.

A newer integrase strand transfer inhibitor (INSTI) cabotegravir was recently approved for both therapy and prophylaxis and can play an essential role in the fight against AIDS. It shares similar resistance profile to dolutegravir, the cornerstone of Brazilian antiretroviral (ARV) treatment, with about 600 thousand people living with HIV in Brazil currently on regimens that contain this INSTI. Health services in the São Paulo metropolitan area are responsible for a large proportion of ARV dispensation in the country. Estimating transmitted drug resistance mutation (TDRM) in the area before cabotegravir introduction may provide a useful baseline information. Partial HIV-1 pol gene was sequenced (Sanger) from 192 newly diagnosed individuals from São Paulo and nearby cities (2020 to March 2023) at integrase, with 85 also at protease/reverse transcriptase regions. Retrotranscribed plasma RNA, amplified with nested PCR, was edited (Recall or Sequencher) and analyzed at Rega and Stanford db. Surveillance drug resistance mutations (SDRM) to INSTI class was detected in three cases (1.6%; 95% CI: 0.5%-5%), two E138K and one R263K, with 7.8% (95% CI: 5%-13%) with resistance mutations (major or accessory). SDRM for nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and PI classes were identified in 7 (8.2% CI: 95% 4%-16%) cases. Subtype B predominated (69%), followed by subtype C (16%), now the second most prevalent infection in this area. Among 131 patients treated for over 6 months, 92% were virally suppressed below 200 copies/mL, with low TCD4 counts independently associated to failure. SDRM to INSTI class is rare in the area. Intermediate rates of transmitted resistance to other ARV classes are comparable to previous estimates. Viral suppression rates may depend on TCD4 counts, another negative impact of late diagnosis in care that deserves more attention.

More than just sweet: current insights into microplastics in honey products and a case study of Melipona quadrifasciata honey.

Honey, traditionally known as a pure and natural substance, has become an unexpected reservoir for microplastic contamination. This study consisted of an experimental investigation to assess the occurrence of microplastics in honey produced by Melipona quadrifasciata, a native bee species in Brazil. Our investigation covers eight areas (one sample per area), including built and vegetated areas located in São Paulo city, Brazil, to understand the distribution of microplastics in these environments. Honey samples (10 mL) were collected using a syringe and sent to the laboratory for further analysis. Microplastics extracted from honey samples were characterized under a stereomicroscope to determine their size, color, and morphology. Also, the polymer type was determined by FTIR analysis. All honey samples (100%) showed microplastics. The predominant particles displayed a fiber shape with a size below 299 μm and a transparent color and were primarily composed of polypropylene. Their concentrations ranged from 0.1 to 2.6 particles per mL of honey, raising concerns about their potential impact on bee populations and human consumers. This study underscores the need for further research on the sources and implications of microplastic contamination in Melipona quadrifasciata honey, shedding light on the broader issue of environmental plastic pollution and its impact on pollinators.

Human mobility patterns in Brazil to inform sampling sites for early pathogen detection and routes of spread: a network modelling and validation study

Detecting and foreseeing pathogen dispersion is crucial in preventing widespread disease transmission. Human mobility is a fundamental issue in human transmission of infectious agents. Through a mobility data-driven approach, we aimed to identify municipalities in Brazil that could comprise an advanced sentinel network, allowing for early detection of circulating pathogens and their associated transmission routes. In this modelling and validation study, we compiled a comprehensive dataset on intercity mobility spanning air, road, and waterway transport from the Brazilian Institute of Geography and Statistics (2016 data), National Transport Confederation (2022), and National Civil Aviation Agency (2017-23). We constructed a graph-based representation of Brazil's mobility network. The Ford-Fulkerson algorithm was used to rank the 5570 Brazilian cities according to their suitability as sentinel locations, allowing us to predict the most suitable locations for early detection and to track the most likely trajectory of a newly emerged pathogen. We also obtained SARS-CoV-2 genetic data from Brazilian municipalities during the early stage (Feb 25-April 30, 2020) of the virus's introduction and the gamma (P.1) variant emergence in Manaus (Jan 6-March 1, 2021), for the purposes of model validation. We found that flights alone transported 79·9 million (95% CI 58·3-101·4 million) passengers annually within Brazil during 2017-22, with seasonal peaks occurring in late spring and summer, and road and river networks had a maximum capacity of 78·3 million passengers weekly in 2016. By analysing the 7 746 479 most probable paths originating from source nodes, we found that 3857 cities fully cover the mobility pattern of all 5570 cities in Brazil, 557 (10·0%) of which cover 6 313 380 (81·5%) of the mobility patterns in our study. By strategically incorporating mobility patterns into Brazil's existing influenza-like illness surveillance network (ie, by switching the location of 111 of 199 sentinel sites to different municipalities), our model predicted that mobility coverage would have a 33·6% improvement from 4 059 155 (52·4%) mobility patterns to 5 422 535 (70·0%) without expanding the number of sentinel sites. Our findings are validated with genomic data collected during the SARS-CoV-2 pandemic period. Our model accurately mapped 22 (51%) of 43 clade 1-affected cities and 28 (60%) of 47 clade 2-affected cities spread from São Paulo city, and 20 (49%) of 41 clade 1-affected cities and 28 (58%) of 48 clade 2-affected cities spread from Rio de Janeiro city, Feb 25-April 30, 2020. Additionally, 224 (73%) of the 307 suggested early-detection locations for pathogens emerging in Manaus corresponded with the first cities affected by the transmission of the gamma variant, Jan 6-16, 2021. By providing essential clues for effective pathogen surveillance, our results have the potential to inform public health policy and improve future pandemic response efforts. Our results unlock the potential of designing country-wide clinical sample collection networks with mobility data-informed approaches, an innovative practice that can improve current surveillance systems. Rockefeller Foundation.

Effects of landscape changes on urban climate change: A case study in the city of São Paulo

Given the vulnerability of Brazilian cities to climate change, it is imperative to monitor urban areas’ susceptibility to temperature fluctuations. In this article, we employ thermal remote sensing and digital image processing techniques to illustrate a substantial rise in surface temperatures across the Northwest Region of São Paulo City over the past three decades. This surge in surface temperature is closely linked to alterations in the urban landscape. Our findings emphasize that one significant environmental consequence of São Paulo City’s rapid urbanization is the pronounced increase in surface temperatures. These results also underscore the significance of assessing landscape features, such as vegetation cover, to inform the prudent, sustainable, and resilient management of urban centers, thereby mitigating climate change effects in metropolitan areas.

Genetic Ancestry and Self-Reported "Skin Color/Race" in the Urban Admixed Population of São Paulo City, Brazil.

Epidemiological studies frequently classify groups based on phenotypes like self-reported skin color/race, which inaccurately represent genetic ancestry and may lead to misclassification, particularly among individuals of multiracial backgrounds. This study aimed to characterize both global and local genome-wide genetic ancestries and to assess their relationship with self-reported skin color/race in an admixed population of Sao Paulo city. We analyzed 226,346 single-nucleotide polymorphisms from 841 individuals participating in the population-based ISA-Nutrition study. Our findings confirmed the admixed nature of the population, demonstrating substantial European, significant Sub-Saharan African, and minor Native American ancestries, irrespective of skin color. A correlation was observed between global genetic ancestry and self-reported color-race, which was more evident in the extreme proportions of African and European ancestries. Individuals with higher African ancestry tended to identify as Black, those with higher European ancestry tended to identify as White, and individuals with higher Native American ancestry were more likely to self-identify as Mixed, a group with diverse ancestral compositions. However, at the individual level, this correlation was notably weak, and no deviations were observed for specific regions throughout the individual's genome. Our findings emphasize the significance of accurately defining and thoroughly analyzing race and ancestry, especially within admixed populations.

Social Work and social struggles: an account of an experience in São Paulo City Hall (1979-1982)

O artigo trata do relato do trabalho de assistentes sociais e de demais profissionais vinculados a um órgão da Prefeitura Municipal de São Paulo junto a um movimento de moradia no período de 1979 a 1982. Esta experiência profissional é explicitada em suas relações e articulações com o processo de reativação da organização sindical da categoria em uma conjuntura política de forte ascensão do movimento operário e sindical e de proliferação de diversos movimentos sociais. São tais processossociopolíticos que possibilitam a formulação de uma nova proposta de trabalho profissional no interior de um espaço sócio-ocupacional que tem como diretiva o estabelecimento de uma relação direta com os processos de mobilização e organização popular. Explicitamos aqui a implementação da referida diretiva e o processo de tensionamento, de repressão e de criminalização imposto pelo órgão institucional aos profissionais que estavam envolvidos na sua implementação e na sua defesa.

Semeadura dos Cravos: intelectuais expatriados na resistência ao salazarismo

In this article we deal with the political resistance of intelectual Portugueses who migrated to the city of São Paulo in the 1950s. The vast majority of these intellectuals, were persecuted for their contrary ideas to the Salazarist regime in Portugal. Such intellectuals left their homeland to avoid being persecuted and arrested by the PIDE. In São Paulo city, they began to express themselves through academic productions, conferences, publications of books, articles and magazines; later they created the newspapers Portugal Democrático and Portugal Livre, the latter being the result of dissent from the former. These intellectuals formed a platoon of resistance to the Portuguese dictatorial regime, spreading ideas favorable to freedom of expression in Portugal and the decolonization of Portuguese Africa, which consequently weakened the Portuguese dictatorial system. The ideas of these intellectuals added to the international situation and the transformations through which spans this historical period.