Paulo Municipality Research Articles

Seroprevalence trends of anti-SARS-CoV-2 antibodies in the adult population of the São Paulo Municipality, Brazil: Results from seven serosurveys from June 2020 to April 2022. The SoroEpi MSP Study.

Sequential population-based household serosurveys of SARS-CoV-2 covering the COVID-19 pre- and post-vaccination periods are scarce in Brazil. This study investigated seropositivity trends in the municipality of São Paulo. We conducted seven cross-sectional surveys of adult population-representative samples between June 2020 and April 2022. The study design included probabilistic sampling, test for SARS-CoV-2 antibodies using the Roche Elecsys anti-nucleocapsid assay, and statistical adjustments for population demographics and non-response. The weighted seroprevalences with 95% confidence intervals (CI) were estimated by sex, age group, race, schooling, and mean income study strata. Time trends in seropositivity were assessed using the Joinpoint model. We compared infection-induced seroprevalences with COVID-19 reported cases in the pre-vaccination period. The study sample comprised 8,134 adults. The overall SARS-CoV-2 seroprevalence increased from 11.4% (95%CI: 9.2-13.6) in June 2020 to 24.9% (95%CI: 21.0-28.7) in January 2021; from 38.1% (95%CI: 34.3-41.9) in April 2021 to 77.7% (95%CI: 74.4-81.0) in April 2022. The prevalence over time was higher in the subgroup 18-39 years old than in the older groups from Survey 3 onwards. The self-declared Black or mixed (Pardo) group showed a higher prevalence in all surveys compared to the White group. Monthly prevalence rose steeply from January 2021 onwards, particularly among those aged 60 years or older. The infection-to-case ratios ranged from 8.9 in June 2020 to 4.3 in January 2021. The overall seroprevalence rose significantly over time and with age and race subgroup variations. Increases in the 60 years or older age and the White groups were faster than in younger ages and Black or mixed (Pardo) race groups in the post-vaccination period. Our data may add to the understanding of the complex and changing population dynamics of the SARS-CoV-2 infection, including the impact of vaccination strategies and the modelling of future epidemiological scenarios.

Association between circulating micro-ribonucleic acids and metabolic syndrome in older adults from a population-based study

Aging is a major factor in development of chronic non-communicable diseases (NCD). Epigenetic causes are risk factors in NCD development since studies indicate that the expression of micro-ribonucleic acids (miRs) is altered under different clinical conditions. This study aimed to analyze the expression profile of circulating miRs and investigate their association with biomarkers of cardiometabolic risk in older adults living in São Paulo municipality, Brazil. A cross-sectional study was conducted based on the analysis of data from 200 older adults, with a mean age of 69.1 (0.5) years old participating in the ISA-Nutrition. The expression profiles of 21 plasma miRs related to glycemic and lipid metabolism, adiposity, and inflammation were evaluated in relation to cardiometabolic risk. Individuals were distributed into groups according to diagnosis of metabolic syndrome (MetS). The Stata Somersd module was used to calculate confidence intervals for Kendall's tau-a to estimate the correlations among variables. Differences in the plasma expression were observed in two of the 21 miRs evaluated according to the MetS presence in participants. Individuals with MetS showed higher expression of miR-30a and miR-122 than individuals without MetS. Considering that miR-30, and miR-122 were altered due to MetS, these miRs may be potential biomarkers for MetS in older adults.

Analyzing the Influence of Vehicular Traffic on the Concentration of Pollutants in the City of São Paulo: An Approach Based on Pandemic SARS-CoV-2 Data and Deep Learning

This study employs surface and remote sensing data jointly with deep learning techniques to examine the influence of vehicular traffic in the seasonal patterns of CO, NO2, PM2.5, and PM10 concentrations in the São Paulo municipality, as the period of physical distancing (March 2020 to December 2021), due to SARS-CoV-2 pandemic and the resumption of activities, made it possible to observe significant variations in the flow of vehicles in the city of São Paulo. Firstly, an analysis of the planetary boundary layer height and ventilation coefficient was performed to identify the seasons’ patterns of pollution dispersion. Then, the variations (from 2018 to 2021) of the seasonal average values of air temperature, relative humidity, precipitation, and thermal inversion occurrence/position were compared to identify possible variations in the patterns of such variables that would justify (or deny) the occurrence of more favorable conditions for pollutants dispersion. However, no significant variations were found. Finally, the seasonal average concentrations of the previously mentioned pollutants were compared from 2018 to 2021, and the daily concentrations observed during the pandemic period were compared with a model based on an artificial neural network. Regarding the concentration of pollutants, the primarily sourced from vehicular traffic (CO and NO2) exhibited substantial variations, demonstrating an inverse relationship with the rate of social distancing. In addition, the measured concentrations deviated from the predictive model during periods of significant social isolation. Conversely, pollutants that were not primarily linked to vehicular sources (PM2.5 and PM10) exhibited minimal variation from 2018 to 2021; thus, their measured concentration remained consistent with the prediction model.

Reproduction and population traits of the Atlantic forest tree frog Bokermannohyla hylax: an exploratory study in an urban forest fragment in São Paulo municipality, Brazil

Bokermannohyla hylax is an endemic tree frog from the Atlantic Forest and despite being a common species, very little is known about its population traits and reproduction. We undertook acoustic and visual encounter surveys, and individual marking studies of a subpopulation in an urban forest fragment, the Parque Estadual das Fontes do Ipiranga, located in the São Paulo municipality. We detected a small population that breeds in only one forest stream, and deposits eggs inside burrows along the stream’s clayey border. Our findings also suggest that this subpopulation might be vulnerable due to the specific characteristics of its reproduction, which may be affected by the degree of disturbance of this fragment.

Fostering emotional self-regulation in female teachers at the public teaching network: A mindfulness-based intervention improving psychological measures and inflammatory biomarkers

ObjectiveTo examine the effect of a mindfulness-based program specifically designed for teachers in reducing perceived stress and improving the quality of experienced emotion in female active working teachers. A second outcome evaluated is the associated change in cellular inflammatory activity, measured by peripheral blood levels of cytokines. MethodEighty-eight female active teachers from public schools from São Paulo Municipality were recruited, and randomly allocated to an eight-week Mindfulness-Based Health Program for Educators (MBHP-Educa) or to Neuroscience for Education Program (Neuro-Educa: active control group). The venue of both programs were several public school facilities, where many of the teachers actually worked. Both groups received activities during eight weeks in a 2 ​h/week regimen, totalizing 16 ​h. Sixty-five participants completed the program and pre- and post-interventions measures were taken from the following scales: Interpersonal Multidimensional Reactivity Scale (IRI), Positive-and-Negative Affects Scale (PANAS), Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RISC), and a primary outcome in Ryff's Psychological Well-Being Scale (PBWS). At pre-and post-intervention, blood samples were collected for the measurement of several important inflammatory biomarkers, Tumor Necrosis Factor – α (TNF-α), Interleukin 1β (IL-1β), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Interleukin 10 (IL-10) and Interleukin 12p70 (IL-12P70) through flow cytometry assay. Intervention effects were analyzed via Generalized mixed models (GLMM). ResultsAccording to the GLMM, MBHP-Educa significantly reduced the scores of perceived stress (p ​< ​0.0001), and negative affect (p ​< ​0.0001) compared to active control group (Neuro-Educa). Conversely, an increase was observed on Psychological Well Being Scale in dimensions of Self-acceptance (p ​< ​0.0001), and Autonomy (p ​= ​0.001), as well as improvements in Resilience (p ​< ​0.0001), and Positive Affect (p ​< ​0.0001). MBHP-Educa also promoted a reduction in the levels of IL-6 (p ​= ​0.003), IL-8 (p ​= ​0.036), and increase in the levels of IL-10 (p ​< ​0.0001) and IL-12p70 (p ​< ​0.044). TNF-α, IL-1β, and IL-10p70 showed results below theoretical limit of detection accepted for CBA kit. ConclusionsOur data suggest that mindfulness-based interventions introduced as a strategy for reducing stress, promoting well-being and improve immune function can be a useful asset in promoting psychological health among teachers in Basic Education.

Urban River Interventions in São Paulo Municipality (Brazil): The Challenge of Ensuring Justice in Sociotechnical Transitions

The paper aims to discuss the sociotechnical transitions regarding urban rivers policy in São Paulo Municipality by focusing on programs and projects conducted since 2000. Accordingly, we use a theoretical reflection on sociotechnical transitions and just transitions in interventions related to water and cities. Our work is based on a documental analysis of programs and projects for urban rivers in the municipality conducted via theoretical discussion. The primary focus is on the current sociotechnical regime, the channeling of streams and construction of road systems on its banks, and disputes and pressures brought by the technological landscape and niches, which lead to the construction of linear parks and leisure areas along with the bodies of water. It also shows how the issue of justice has been losing ground in this transition, which although is “in the making,” already presents many factors of injustice. This is due to the low presence of the theme of precarious settlements, in innovative speeches and practices, and the different treatment given by the programs and projects for rivers in the consolidated middle- and upper-class regions and for those located on the peripheries.

Intra-urban differentials of fetal mortality in clusters of social vulnerability in S\xe3o Paulo Municipality, Brazil

This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007–2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.

How to Estimate Food Prices and Diet Costs in Population-Based Studies?

Health and nutrition surveys usually comprise detailed information on health characteristics and food consumption of certain population groups; however, the lack of data collection on the food prices may pose challenges for the estimation of the diet costs for the comprehensive analysis of food demand. The Household Budget Survey (HBS) represents an opportunity to obtain the data on the food prices for the nutrition surveys in the diverse countries worldwide. Although the HBS and the health and nutrition surveys may correspond to different periods, the application of the appropriate Consumer Price Index (CPI) allows to address the changes in the relative prices to perform the linkage between the data of food consumption with information on the food prices. Therefore, the aim of this study was to present the methods for the extraction and linkage of the food prices data from the Brazilian HBS (2002–2003 and 2008–2009) by using the pairing features related to the household characteristics to match the Health Survey of São Paulo [Inquérito de Saúde de São Paulo (ISA-Capital)] conducted in 2003, 2008, and 2015. Data referring to the household characteristics and food prices acquired by the household members living in São Paulo municipality were selected from the HBS datasets for integration with the ISA-Capital dataset. Specific deflators referring to the food items surveyed in São Paulo were obtained from the datasets of the Brazilian Broad Consumer Price Index (BCPI). Therefore, the pairing criteria referring to time, location, and household characteristics were adopted to allow linking foods consumed by the individuals in the ISA-Capital with the prices from the foods acquired by household members interviewed in the HBS. Matching data on the key pairing criteria (location/year/household income per capita/number of residents/family profile) resulted in the linkage of 94.4% (2003), 92.6% (2008), and 81.2% of the cases (2015). Following the data linkage, it was possible to estimate diet costs per gram and per calorie including application of cooking and conversion factors. Data were presented in the International Monetary Unit under the purchasing power parity (PPP) to allow the comparison at the international level. The mean diet costs identified in the population of São Paulo municipality were $8.45 (dp = 0.38) per capita per day in 2003, $8.72 (dp = 0.24) per capita per day in 2008, and $9.62 (dp = 0.23) per capita per day in 2015. Thus, it was possible to estimate the diet costs based on the prices of food items through pairing linkage of information from the household surveys, such as the Brazilian HBS, with the health and nutrition surveys lacking information on the expenditures or prices such as the ISA-Capital. Similar procedures may be used in the diverse countries with availability of the datasets of the household expenditures and health and nutrition surveys, allowing the researchers worldwide to associate the diet quality with food demand.

Individual and contextual socioeconomic status as effect modifier in the air pollution-birth outcome association

BackgroundSeveral studies have examined whether air pollution is associated with adverse births outcomes, but it is not clear if socioeconomic status (SES) modifies this relationship. ObjectivesWe investigated if maternal education and area-level socioeconomic status modified the relationship between ozone, nitrogen dioxide and particulate matter with aerodynamic diameter <10 μm (PM10) on preterm births (PTB; gestational age <37 weeks) and term low birth weight (TLBW; weight < 2500 g on term deliveries). MethodsAnalyses were based on almost 1 million singleton live births in São Paulo municipality between 2011 and 2016. The final sample included 979,306 births for PTB analysis and 888,133 for TLBW analysis. Exposure to PM10, NO2 and O3 were based on date of birth and estimated for the entire gestation and for each trimester. Multilevel logistic regression models were conducted to examine the effect of air pollutants on both adverse birth outcomes and whether it was modified by individual and area-level SES. ResultsIn fully adjusted models, over the entire pregnancy, a 10 μg/m3 increase in O3 and PM10 was associated with increased chance of PTB (odds ratio; OR = 1.14 CI 1.13, 1.16 and 1.08 CI = 1.02, 1.15 respectively) and PM10 with TLBW (OR = 1.08 CI 1.03, 1.14). Associations were modified by maternal educational and area-level SES for both outcomes. Mothers of lower education had an additional chance of PTB and TLBW due to PM10 exposure (OR = 1.04 CI 1.04, 1.05 and 1.10 CI 1.08, 1.14 respectively), while mothers living in low SES areas have an additional chance for TLBW (OR = 1.05 CI 1.03, 1.06). Similar modification effects were found for O3 exposure. Trimester specific associations were weaker but followed a similar pattern. ConclusionSocioeconomic status modifies the effect of air pollution on adverse birth outcomes. Results indicate that mothers with lower SES may be more susceptible to air pollution effects.

COVID-19 outbreak and air quality: Analyzing the influence of physical distancing and the resumption of activities in São Paulo municipality

• Higher variations occurred in pollutants more dependent on the vehicle emissions. • In autumn, the values observed of PM10 and PM2.5 are similar to predict ones. • The reduction in pollutant concentration did not avoid high pollutions episodes. • Activities resumption collaborates with an increase in pollutant concentration.

Multicriteria methodological-rational model to evaluated urban areas: A case study of the São Paulo City/Brazil

Differently from what literature indicates, the relationship between socio-spatial metrics is not necessarily systematic in urban areas. In other words, the most compact areas are not always the most diverse areas; neither are the areas with higher population density the areas with the higher job densities, in the case of São Paulo municipality. The dependence among these urban variables is not clear and direct, and possibly it is influenced, in a more comprehensive approach, by other urban factors. Today, there is a research question about how to systematically analyse various criteria in urban planning decisions. Therefore, the application of a multicriterial model, which considers the heterogeneity of the city, based on indicators that present the characteristics of economic and social development of a region, can help to identify areas that should be the object of, for example, more investments and greater incentives from State power. The objective of this article is to propose and apply a new methodological-rational model for the distribution of comparative weights in multicriteria analyses, in the context of urban planning, using the municipality of São Paulo as a case study. Specifically, to the method application in the São Paulo case study, a significant influence of the job density was verified in the hierarchy of urban areas, while the diversity emerged as the most dominant criterion that influence the characteristics of urban areas in the city. The results also show that a multicriterial analysis using indicators might contribute to the establishment of specific hierarchies for different urban areas, useful for city managers and researchers, able to be applied in different cities. Besides, the method may be suitable in other multicriterial problem contexts, as it represents a Decision Support System for trade-off and uncertainty analysis.

DETECTION OF LEISHMANIA INFANTUM IN DOGS (CANIS FAMILIARIS) FROM SÃO PAULO MUNICIPALITY, BRAZIL

OBJECTIVE: Visceral leishmaniasis is caused by Leishmania infantum. In the state of São Paulo, this zoonosis is expanding to urban areas and the incidence of human disease is related to canine infection. Herein, we performed a serological and molecular diagnosis on 152 dogs (Canis familiaris) from the Grajau and Ilha do Bororé neighborhoods, in the extreme south of the São Paulo municipality, Brazil. METHODS: We observe the prevalence of L. infantum in these animals that are identified as the main reservoirs of the etiologic agent of visceral leishmaniasis. RESULTS: Serological tests showed a low positivity rate, while the molecular tests showed positive animals at 3.94% and 0.65% for the Leishmania infantum L-like cathepsin and ITS of ribosomal gene, respectively. CONCLUSION: Molecular diagnosis of 3.94% positivity suggesting the introduction of L. infantum in this locality of São Paulo, which still preserves 80% of the Atlantic Forest. Our data point to the need for effective control of infected dogs to prevent the spread of visceral leishmaniasis in humans.

Spatial association between the incidence rate of COVID-19 and poverty in the São Paulo municipality, Brazil.

In this article, we investigated the spatial dependence of the incidence rate by COVID-19 in the São Paulo municipality, Brazil, including the association between the spatially smoothed incidence rate (INC_EBS) and the social determinants of poverty, the average Salary (SAL), the percentage of households located in slums (SLUMS) and the percentage of the population above 60 years of age (POP>60Y). We used data on the number notified cases accumulated per district by May 18, 2020. The spatial dependence of the spatially smoothed incidence rate was investigated through the analysis of univariate local spatial autocorrelation using Moran's I. To evaluate the spatial association between the INC_EBS and the determinants SAL, POP>60Y and SLUMS, we used the local bivariate Moran's I. The results showed that the spatially smoothed incidence rate for COVID-19 presented significant spatial autocorrelation (I = 0.333; P<0.05), indicating that the cases were concentrated in clusters of neighbouring districts. The INC_EBS showed a negative spatial association with SAL (I = -0.253, P<0.05) and POP>60Y (I = -0.398, P<0.05). We also found that the INC_EBS showed a positive spatial association with households located in the slums (I = 0.237, P<0.05). Our study concluded that the households where the population most vulnerable to COVID-19 resides were spatially distributed in the districts with lower salaries, higher percentages of slums and lower percentages of the population above 60 years of age.

Does socioeconomic status modify the effect of air pollution on birth outcomes?

BACKGROUND: Several studies have examined whether air pollution is associated to adverse births outcomes but it is not clear if socioeconomic status (SES) modifies this relationship. OBJECTIVES: We investigated if individual and area-level socioeconomic status modified the relationship between ozone, nitrogen dioxide and particulate matter with aerodynamic diameter &lt;10µm (PM10) and preterm deliveries (gestational age &lt;37 weeks) and term low birth weight (TLBW; &lt; 2500g). METHODS: Analyses were based on almost 1 million singleton live births in São Paulo municipality between 2011 and 2016. Exposure to PM10, NO2 and O3 were estimated by average trimestral and entire gestation based on date of birth and using daily averages of air pollution from the network of monitoring stations. Multilevel logistic regression models were conducted to examine the effect of air pollutants on both birth outcomes and whether it was modified by SES. RESULTS: In fully adjusted models, over the entire pregnancy, a 10µg/m³ increase in O3 and PM10 was associated to PTD (odds ratio; OR = 1.14 CI 1.13,1.16 and 1.08 CI = 1.02,1.15 respectively) and PM10 was associated to TLBW (OR = 1.08 CI 1.03, 1.14). Associations were modified by individual and area-level SES for both outcomes (p&lt;0,001). Mothers with low individual SES had an additional risk for PTD and TLBW associated with PM10 exposure (OR = 1.04 CI 1.04,1.05 and 1.10 CI 1.08,1.14 respectively). Lower area-level SES also implied in a stronger risk for TLBW (OR = 1.05 CI 1.03,1.06). Similar effect modifications were observed for O3 exposure. Trimester specific associations were weaker but followed a similar pattern. CONCLUSION: Individual and neighborhood socioeconomic status modifies the effect of air pollution on adverse birth outcomes. Mothers with lower SES may be more susceptible to adverse pregnancy outcomes associated with air pollution exposure.

Yellow fever surveillance challenge: Investigation of a marmoset non-autochthonous case

Yellow fever (YF) surveillance in Brazil is focused mainly on the detection of epizootic events regarding New World non-human primates (NWNHP). We present a challenging case of a Callitrichidae (Callithrix spp) kept as a domiciliated pet that lived in the urban area of São Paulo municipality and was positive to YF virus by RT-qPCR and immunohistochemistry. After investigation, it was the first occurrence of non-autochthonous YF case of NWNHP described, with probable place of infection in the North shore of São Paulo state. This case illustrates the importance of coordinated laboratorial and field actions, and risks posed by transit of wildlife.

Brazilian spotted fever serological investigation among equids at the Guarapiranga Dam area in the city of São Paulo, Brazil

The Guarapiranga Dam region, in the metropolitan area of São Paulo, has been an endemic area for Brazilian spotted fever (BSF), a tick-borne disease caused by the bacterium Rickettsia rickettsii. In this particular area, R. rickettsii is known to be transmitted to humans by Amblyomma aureolatum, a typical dog tick that is not associated with horses. In other BSF-endemic areas, R. rickettsii transmission is associated with Amblyomma sculptum, a tick species that typically infest capybaras and horses. The Guarapiranga Dam bears abundant populations of capybaras and horses; however, since nothing is known about a possible cycle of transmission of R. rickettsii by A. sculptum in this area, this study evaluated such transmission by performing a serosurvey of horses living in the Guarapiranga Dam region. A total of 206 equids living in the margins of the Guarapiranga Dam were serologically tested for antibodies reactive to five Rickettsia species, four of the spotted fever group (R. rickettsii, R. parkeri, R. amblyommatis, R. rhipicephali) and one basal group species, R. bellii. Overall, 171 (83%) equids reacted positively to at least one Rickettsia species. A total of 160 (78%), 123 (60%), 80 (39%), 72 (35%), and 71 (34%), equid sera reacted to R. bellii, R. rickettsii, R. parkeri, R. rhipicephali, and R. amblyommatis, respectively, with endpoint titers ranging from 64 to 1024 for R. bellii, and 64 to 512 for the remaining four Rickettsia species. Endpoint titers to R. bellii (median: 256) was significantly higher (P&lt;0.05) than the endpoint titers to the other four Rickettsia species, for which the median values varied from 64 to 128. A total of 65 (32%) equid sera showed endpoint titers to R. bellii at least 4-fold higher than those to any of the other four antigens, indicating that they have been exposed to R. bellii or a very closely related species. Our results provide serological evidence that the sampled equids were not frequently exposed to R. rickettsii-infected ticks. Since horses are a highly suitable sentinel for R. rickettsii transmission by A. sculptum, we conclude that this tick species has no epidemiological role in the transmission of R. rickettsii in the BSF-endemic area of the Guarapiranga Dam in the metropolitan area of São Paulo Municipality.

Abortion among women living with or not living with HIV/AIDS users of public health services in São Paulo municipality: prevalence, contexts and reasons

Abstract Objectives: we investigated the lifetime prevalence of abortion and life contexts and reasons reported for first abortion among women living (WLHA) and not living with HIV/AIDS(WNLHA). Methods: representative samples of 975 users of public health care reference network for HIV/AIDS and of 1,003 users of the primary care public services in São Paulo municipality were selected by cluster-stratified sampling and answered an electronic socio-behavioral questionnaire. Results: the prevalence of abortion was 11.9% (CI95%9.8-13.9) among WLHA and 3.0% (CI95%2.4-5.7) for WNLHA.Most abortions (128) among WLHA occurred before diagnosis and 28 after diagnosis or during pregnancy when diagnosis was given. The majority of women did not use any contraception at the time of the first abortion. The use of misoprostol was the most reported method. Having HIV was very important in deciding to abort for half of the WLHA. Absence of marital life and the lack of desire to have children were the most reported reasons by both groups. Conclusions: the similarity in contexts and reasons to abort among WLHA and WNLHA suggests that they share experiences molded by gender and social inequalities that affect their ability to access sexual and reproductive health resources and services.

Effects of Urbanization on Bothrops jararaca Populations in São Paulo Municipality, Southeastern Brazil

Abstract Quantitative and qualitative alterations in the environment may have serious ecological consequences for populations of native species. Isolated forest fragments, such as those surrounded by highly urbanized areas, may function similarly to oceanic islands with differences in species diversity compared to mainland areas. These differences may include changes in prey availability and predator pressure, with consequent effects on growth and size of species that interact with those prey and predators. Here, we investigate body size, prey availability, and predation pressure in populations of Bothrops jararaca in two forest fragments within an urban environment in southeastern Brazil (a completely isolated, small forest fragment and a large, well-connected forest fragment). While we found no differences in mean body size or stoutness between the two populations, we did find larger specimens in the small isolated fragment. Prey availability and predator pressure also were significantly lower in the sm...

Implantação da Residência Médica e Multiprofissional em Saúde da Família em um município paulista: percepção de residentes da primeira turma (2014-2016)

Implementation of Medical and Multi-professional Residency in Family Health in Health in a São Paulo municipality: first class residents’ perception of (2014-2016)

Tuberculosis among South American immigrants in São Paulo municipality: an analysis in space and time.

To identify spatial and temporal, and spatial variation in temporal trends in clusters of tuberculosis (TB) among South American migrants residing in São Paulo municipality, SP, Brazil, between 2006 and 2013. An ecological descriptive study was conducted using data obtained from official TB reports and the 2010 Brazilian demographic census. Clusters were identified using scan statistics and SaTScan software; those with P < 0.05 were considered statistically significant. Social and economic characteristics of residents within the clusters were investigated. One high-risk spatial cluster (relative risk [RR] 4.46, P < 0.001) for TB was identified. Bolivian immigrants comprised the majority of immigrants residing in this area. One purely temporal high-risk cluster was identified between 2011 and 2013 (RR 1.55, P = 0.001). In one of the spatial variation in temporal trends clusters, the annual increase in TB incidence was 17.54% inside the cluster and 5.17% outside. We found areas of high risk for TB among South American immigrants. These areas and those with increasing trends of TB incidence must be prioritised by TB control programmes.