We performed a systematic review of the prevalence of metabolically healthy obesity (MHO). Medline, Web of Science and EMBASE were searched for original articles from inception to November 2013. Only prospective and cross-sectional studies were included. After screening 478 titles, we selected 55 publications, of which 27 were population-based studies and were used in the narrative synthesis. From the 27 studies, we identified 30 definitions of metabolic health, mainly based on four criteria: blood pressure, high-density lipoprotein cholesterol, triglycerides and plasma glucose. Body mass index ≥30 kg m(-2) was the main indicator used to define obesity (74% of the studies). Overall, MHO prevalence ranged between 6% and 75%. In the studies that stratified the analysis by sex, prevalence was higher in women (seven out of nine studies) and in younger ages (all four studies). One-third of the studies (n = 9) reported the response rate. Of these, four reported a response rate of ≥70% and they showed MHO prevalence estimates between 10% and 51%. The heterogeneity of MHO prevalence estimates described in this paper strengthens calls for the urgent need for a commonly established metabolic health definition.

Our study is in accordance with other studies that have shown low overall HCV vertical transmission risk and a trend toward higher risk with maternal risk factors such as HIV-coinfection or HCV viremia. A delay in infant HCV antibody response may be associated with HIV coinfection although larger studies are needed to confirm these findings.

These findings support the importance of severity of maternal HIV-1 disease in the risk of vertical transmission of HIV-1, indicate measures to reduce transmission by avoiding amniocentesis and breastfeeding and suggest that race and Rhesus blood type may be markers for genetic susceptibility to infection.

Although vertical transmission of HIV-1 can occur through breast-feeding, little is known about the effect of colostrum, duration of breast-feeding, mixing feeding, and nipple pathology. We used retrospective cohort data to examine the association between breast-feeding-related factors and transmission of HIV-1 from mother to child in São Paulo State, Brazil. Information on maternal and postnatal factors was collected by medical record review and interview. Infection status was determined for 434 children by anti-HIV-1 tests performed beyond 18 months of age or diagnosis of AIDS at any age. Among 168 breast-fed children, the risk of transmission of HIV-1 was 21%, compared with 13% (p = .01) among 264 children artificially fed. Breast-feeding was independently and significantly associated with mother-to-child transmission of HIV-1 after controlling for stage of maternal HIV-1 disease (odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.3-3.8). A trend was shown toward an increased risk of transmission with longer duration of breast-feeding, a history of bleeding nipples, and introduction of other liquid food before weaning, but these associations were not statistically significant. History of colostrum intake or cracked nipples without bleeding were not associated with transmission. Most of the women who breast-fed were unaware of their HIV-1 infection status at the time of delivery. Avoidance of mixed feeding and withholding of breast-feeding in the presence of bleeding nipples should be considered in further research as strategies to reduce postnatal transmission of HIV-1 in settings in which safe and sustainable alternatives for breast-feeding are not yet available.

ResumoOs profissionais da Estratégia Saúde da Família (ESF) atuam em comunidades onde a complexidade de problemáticas médico-sociais pode levá-los a sofrer psicologicamente, com prejuízos ao atendimento aos usuários e à consolidação da ESF como modelo de reorganização da atenção básica no Brasil. Esse estudo investigou as dificuldades e as formas de enfrentamento referidas por profissionais de equipes da ESF frente às demandas médico-sociais apresentadas pelos usuários em seu cotidiano de trabalho. Grupos focais e entrevistas semiestruturadas foram realizados com 68 profissionais de três Unidades de Saúde da Família da cidade de São Paulo. Tráfico e uso de drogas ilícitas, alcoolismo, depressão e violência doméstica são as demandas mais significativas para o grupo estudado. Frente a elas, os profissionais referem formação profissional e capacitação técnica insuficientes, sobrecarga e condições desfavoráveis de trabalho, com sentimentos de impotência e frustração. No enfrentamento das dificuldades, destacam-se as estratégias coletivas, especialmente as reuniões de equipe e apoio matricial, nas quais há troca de experiências, conhecimentos e apoio compartilhado. Os resultados indicam que as dificuldades referidas podem deixar os profissionais da ESF em situação de vulnerabilidade, tal como os usuários por eles atendidos. O investimento no desenvolvimento de competências, o fortalecimento de estratégias de enfrentamento coletivas, assim como maior articulação com as redes de serviços e as lideranças locais, mostram-se necessários para que os profissionais de saúde atuem com menor estresse frente às complexas demandas médico-sociais presentes

A population-based household survey was performed to estimate the prevalence of IgM and IgG to SARS-CoV-2 in residents of six districts in Sao Paulo City, Brazil. Serum samples collected from 299 randomly-selected adults and 218 cohabitants (N=517) were tested by chemiluminescence immunoassay ten weeks after the first reported case. Weighted overall seroprevalence was 4.7% (95% CI 3.0-6.6%). The low seroprevalence suggests that most of this population could still be infected. Serial serosurveys were initiated aiming to monitor the progress of the ongoing pandemic throughout the entire city. This may help inform public health authority decisions regarding prevention and control strategies.

Several case-control studies have found increased prevalence of hepatitis C virus (HCV) in patients with non-Hodgkin lymphoma (NHL) and other B-cell lymphoproliferative disorders. We examined whether HCV infection preceded the development of these neoplasms in a prospective cohort study of 48 420 individuals in northern California. Stored sera from 95 subjects with NHL (n ‫؍‬ 57), multiple myeloma (n ‫؍‬ 24), or Hodgkin disease (n ‫؍‬ 14) diagnosed a mean of 21 years after phlebotomy were screened for antibodies to HCV as well as viral RNA, based on previous reports of antibody-negative viremia. Sera from 4 cases and one of 95 age-, sex-, and race-matched controls were repeatedly reactive by enzyme immunoassay, but none were confirmed by recombinant immunoblot assay; none of the case

Abstract. Sera from 516 participants enrolled in a population-based cross-sectional study in northwest Tanzania were tested for antibodies to hepatitis C virus (HCV). The mean age of study subjects was 29 years (range ϭ 16-49 years); 43% were men, 6% reported a history of blood transfusion, and 4% were infected with human immunodeficiency virus-1 (HIV-1). Although 53 of 516 sera (10.3%, 95% confidence interval [CI] ϭ 7.8-13.2%) were repeatedly reactive by a third-generation enzyme immunoassay (EIA-3), only 6 of the 53 were positive when tested with a thirdgeneration recombinant immunoblot assay (confirmed HCV seroprevalence ϭ 1.2%, 95% CI ϭ 0.4-2.5%). The positive predictive value of the HCV EIA-3 in this population was 18.8% (95% CI ϭ 7.0-36.4%). False positivity was not correlated with EIA-3 optical density values, age, sex, infection with HIV-1, or a history of blood transfusion, but it was marginally associated with increased serum IgG levels. We conclude that the prevalence of HCV is low in this region and that the HCV EIA-3 has a higher false-positivity rate in this population than has been reported among U.S. blood donors.Hepatitis C virus (HCV) is the major etiologic agent of post-transfusional hepatitis worldwide 1 and may also be an important cause of community acquired non-A, non-B hepatitis in certain parts of Africa. 2,3 Infection with HCV is usually asymptomatic, but may result in chronic hepatitis with progression to cirrhosis and hepatocellular carcinoma. 4,5 Assays for the detection of antibodies against HCV proteins were developed soon after the viral genome was cloned in 1989. 6 An enzyme immunoassay (EIA) represented an important advance in reducing HCV transmission through blood transfusion. Supplemental tests for detecting antibodies to HCV, such as the recombinant immunoblot assay (RIBA), have been developed to confirm reactivity detected by the EIA. 7 Studies of volunteer blood donors and general populations have shown considerable geographic variation in HCV seroprevalence:8 0.5-1.5% in western Europe, northern Europe, North America, and Australia; 1.5-2.5% in Japan and the Mediterranean region; and as high as 14% in Egypt. In sub-Saharan Africa, data on the prevalence of HCV are limited and the extent of HCV infection remains unknown in most countries. In this study, we estimated the seroprevalence of HCV in a population-based cross-sectional study in northwest Tanzania. METHODSDuring 1989 and 1990, a population-based study was conducted to estimate the prevalence of human immunodeficiency virus (HIV) in northwest Tanzania. The protocol for this study was approved by the appropriate review committees of the Tanzanian Ministry of Health and the National Cancer Institute. The study methods have been described elsewhere. 9 Briefly, the target population consisted of people living in rural, peri-urban (mainly subsistence farmers and their families), and urban areas (commercial workers). Subjects 15-49 years of age were randomly selected from household rosters supplied by the local governmen...