Echoes through time: amazing inferences from a fossil bat.

Sister to the Chiroptera crown-clade, the 50 million year old Vielasia sigei is suggested to have used laryngeal echolocation based on morphometric analyses. We discuss how Vielasia's discovery influences our understanding of the evolution of echolocation in bats and the insights fossils provide to the lives of extinct species.

Educational disparities in Brazil may interfere with the cognitive performance of Parkinson's disease patients.

The prevalence of cognitive impairment in Parkinson's disease (PD) is about 20% to 60%. The Mini-Mental Status Examination (MMSE) is the most used cognitive screening test. Objective: To evaluate the influence of clinical and demographic characteristics, specifically the education level, on the MMSE score in PD patients of a northeast Brazilian sample. Methods: We performed a cross-sectional study of 198 PD patients at a Movement Disorders outpatient clinic in Fortaleza, CE, Brazil. Participants were assessed by detailed clinical history, modified Hoehn and Yahr staging (HY), geriatric depression scale (GDS) and MMSE. Results: We found that 68% of patients had MMSE scores below the Brazilian thresholds, which were based in Brucki et al. study (2003). There was a statistically significant difference in the bivariate analysis between educational level and cut-off classification for MMSE. More years of formal schooling were associated with more patients scoring below threshold. We found that 75%, 68.8%, and 79.7% of individuals with more than 11, 9 to 11, and 4 to 8 years of formal schooling, respectively, were below the suggested Brazilian Brucki's threshold. GDS and age were negatively correlated with total MMSE and all its domains. There was no correlation between disease duration and MMSE. Subjects with hallucinations had lower scores. Conclusion: Most of the sample had lower performance according to Brazilian thresholds, but there was no control group and no neuropsychological test in this study. Further studies in northeast Brazil are needed to review MMSE cut-off values.

A prevalência de comprometimento cognitivo na doença de Parkinson (DP) é de cerca de 20 a 60%. O Miniexame do Estado Mental (MEEM) é o teste de rastreio cognitivo mais utilizado. Objetivo: Avaliar a influência de características clínicas e demográficas, especificamente a escolaridade, no escore do MEEM em pacientes com DP de uma amostra do nordeste brasileiro. Métodos: Realizamos um estudo transversal com 198 pacientes com DP em um ambulatório de Distúrbios do Movimento em Fortaleza. Os participantes foram avaliados por história clínica detalhada, estadiamento modificado de Hoehn e Yahr (HY), escala de depressão geriátrica (EDG) e MEEM. Resultados: Encontramos 68% dos pacientes com escores do MEEM abaixo dos limiares brasileiros baseados em estudo de Brucki et al. (2003). Houve diferença estatisticamente significativa na análise bivariada entre a escolaridade e a classificação de corte para o MEEM. Mais anos de escolaridade foram associados a mais pacientes com pontuação abaixo do limiar. Constatamos que 75, 68,8 e 79,7% dos indivíduos com mais de 11, nove a 11 e quatro a oito anos de escolaridade, respectivamente, estavam abaixo dos limiares sugeridos pelo estudo brasileiro de Brucki et al. (2003). A EDG e a idade correlacionaram-se negativamente com o MEEM total e todos os seus domínios. Não houve correlação entre a duração da doença e o MEEM. Indivíduos com alucinações tiveram pontuações mais baixas. Conclusão: A maioria da amostra apresentou desempenho inferior aos limiares, mas não houve grupo controle e nem teste neuropsicológico neste estudo. Mais estudos no nordeste do Brasil são necessários para revisar os valores de corte do MEEM.

Vocational Rehabilitation and Length of Stay at Work after Work-Related Musculoskeletal Disorders: A Longitudinal Study in Brazil.

Vocational rehabilitation is an intervention to enhance the return to work and improve quality of life. The aim of this study was to evaluate sociodemographic and occupational factors associated with the length of stay at work among workers with work-related musculoskeletal disorders (WRMDs) who had undergone rehabilitation through the Brazilian public social security system. This was a longitudinal study among 680 workers with histories of disability due to WRMDs who returned to the formal job market after vocational rehabilitation between 2014 and 2018. Survival analysis was performed to identify the factors influencing permanence in work. Job dismissal occurred for 29.26% of the workers. The average duration of employment after returning to the formal job position was 56 months. The following factors were associated with shorter length of employment: living in the southeastern region (HR: 2.78; 95% CI 1.12-6.91) or southern region (HR: 2.68; 95% CI 1.04-6.90) of Brazil; working in transportation, storage or postal services (HR: 2.57; 95% CI 1.07-6.17); or working in financial activities, insurance or related services (HR: 2.70; 95% CI 1.05-6.89). These findings may contribute to the discussion about prevention of disability and interventions to ensure health care for workers with WRMD disabilities who undergo rehabilitation.

Educational disparities in Brazil may interfere with the cognitive performance of Parkinson's disease patients / As disparidades educacionais brasileiras podem interferir na performance cognitiva de pacientes com doença de Parkinson

ABSTRACT. The prevalence of cognitive impairment in Parkinson's disease (PD) is about 20% to 60%. The Mini-Mental Status Examination (MMSE) is the most used cognitive screening test. Objective: To evaluate the influence of clinical and demographic characteristics, specifically the education level, on the MMSE score in PD patients of a northeast Brazilian sample. Methods: We performed a cross-sectional study of 198 PD patients at a Movement Disorders outpatient clinic in Fortaleza, CE, Brazil. Participants were assessed by detailed clinical history, modified Hoehn and Yahr staging (HY), geriatric depression scale (GDS) and MMSE. Results: We found that 68% of patients had MMSE scores below the Brazilian thresholds, which were based in Brucki et al. study (2003). There was a statistically significant difference in the bivariate analysis between educational level and cut-off classification for MMSE. More years of formal schooling were associated with more patients scoring below threshold. We found that 75%, 68.8%, and 79.7% of individuals with more than 11, 9 to 11, and 4 to 8 years of formal schooling, respectively, were below the suggested Brazilian Brucki's threshold. GDS and age were negatively correlated with total MMSE and all its domains. There was no correlation between disease duration and MMSE. Subjects with hallucinations had lower scores. Conclusion: Most of the sample had lower performance according to Brazilian thresholds, but there was no control group and no neuropsychological test in this study. Further studies in northeast Brazil are needed to review MMSE cut-off values.

RESUMO. A prevalência de comprometimento cognitivo na doença de Parkinson (DP) é de cerca de 20 a 60%. O Miniexame do Estado Mental (MEEM) é o teste de rastreio cognitivo mais utilizado. Objetivo: Avaliar a influência de características clínicas e demográficas, especificamente a escolaridade, no escore do MEEM em pacientes com DP de uma amostra do nordeste brasileiro. Métodos: Realizamos um estudo transversal com 198 pacientes com DP em um ambulatório de Distúrbios do Movimento em Fortaleza. Os participantes foram avaliados por história clínica detalhada, estadiamento modificado de Hoehn e Yahr (HY), escala de depressão geriátrica (EDG) e MEEM. Resultados: Encontramos 68% dos pacientes com escores do MEEM abaixo dos limiares brasileiros baseados em estudo de Brucki et al. (2003). Houve diferença estatisticamente significativa na análise bivariada entre a escolaridade e a classificação de corte para o MEEM. Mais anos de escolaridade foram associados a mais pacientes com pontuação abaixo do limiar. Constatamos que 75, 68,8 e 79,7% dos indivíduos com mais de 11, nove a 11 e quatro a oito anos de escolaridade, respectivamente, estavam abaixo dos limiares sugeridos pelo estudo brasileiro de Brucki et al. (2003). A EDG e a idade correlacionaram-se negativamente com o MEEM total e todos os seus domínios. Não houve correlação entre a duração da doença e o MEEM. Indivíduos com alucinações tiveram pontuações mais baixas. Conclusão: A maioria da amostra apresentou desempenho inferior aos limiares, mas não houve grupo controle e nem teste neuropsicológico neste estudo. Mais estudos no nordeste do Brasil são necessários para revisar os valores de corte do MEEM.

Does Abdominal Obesity Increase All-Cause, Cardiovascular Disease, and Cancer Mortality Risks in Older Adults? A 10-Year Follow-Up Analysis.

There is insufficient evidence on the impact of abdominal obesity (AO) on mortality in older adults. Therefore, the objective to analyze the 10-year impact of AO, assessed using different diagnostic criteria, on all-cause, cardiovascular disease (CVD), and cancer mortality in older adults. In this prospective cohort study of older adults (≥60 years), sociodemographic, lifestyle, clinical history, laboratory test, and anthropometric data were analyzed. The considered were used for AO diagnostic: waist circumference (WC) of ≥88 cm for women and ≥102 cm for men; WC of ≥77.8 cm for women and ≥98.8 cm for men; and increased waist-to-hip ratio (WHR), being the highest tertile of distribution by sex. Multivariate Cox regression and Kaplan-Meier analyses were performed. A total of 418 individuals, with an average age of 70.69 ± 7.13 years, participated in the study. In the analysis adjusted for sex and age, WHR was associated with a high risk of all-cause mortality (p = 0.044). Both cutoff points used for the WC were associated with an increased CVD mortality risk. None of the AO parameters were associated with cancer mortality. An increased WHR was associated to a higher all-cause mortality risk factor, while an increased WC was a risk factor for a higher CVD mortality in older adults.

Prevalence of Vitamin D and Calcium Deficiency and Insufficiency in Women of Childbearing Age and Associated Risk Factors: A Systematic Review and Meta-Analysis.

Vitamin D deficiency and insufficiency as well as low serum calcium levels can trigger negative health outcomes in women of childbearing age. Therefore, we aimed to estimate the prevalence of serum vitamin D and calcium deficiencies and insufficiencies and associated risk factors in Brazilian women of childbearing age and to assess whether there are differences in prevalence according to regions of the country and the presence or absence of pregnancy. The systematic literature review was performed using the following databases: PubMed, LILACS, Embase, Scopus, and Web of Science. Cross-sectional, cohort, and intervention studies were included. Among pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 27% and of vitamin D insufficiency from 33.9% to 70.4%. Among non-pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 41.7% and of vitamin D insufficiency from 38.5% to 69.3%. We found a high prevalence of vitamin D deficiency and insufficiency in women of childbearing age, with insufficiency affecting more than half of these women. The highest prevalence of vitamin D deficiency and insufficiency was observed in the South region. It was not possible to assess the prevalence and factors associated with calcium deficiency.

Procedures for health data linkage: applications in health surveillance. / Procedimentos para vinculação de dados da saúde: aplicações na vigilância em saúde.

OBJECTIVE: To present a standardized methodology for linking different public health databases. METHODS: This was a methodological review article specifically describing data processing procedures for deterministic linkage between structured databases. It instructs on how to: treat data, select linkage keys, and link databases using two databases simulated in R software. RESULTS: The commands used for the deterministic linkage of the inner_join type were presented. The linkage process resulted in a database with 40,108 pairs using only the "Name" key. Adding the second key, "Name of mother", the resulted dropped to 112 pairs. By adding the third key, "Date of birth", only two pairs were identified. CONCLUSION: Database linkage and its analysis are valid and valuable tools for health services in supporting health surveillance actions.

Complications associated with the use of temporary pacemaker in patients waiting for definitive device implantation.

OBJECTIVE: To determine the rate of complications associated with the use of temporary pacemakers in patients in the waiting list for the definitive pacemaker implantation in a public hospital located in São Paulo, SP, Brazil. METHODS: Retrospective observational study based on data extracted from medical records of patients admitted to Hospital Municipal Dr. Moyses Deutsch, Hospital Israelita Albert Einstein from January 2014 to December 2018. Patients aged 18 years or older, diagnosed with high degree atrioventricular block upon admission and with indications for definitive pacemaker implantation were included. All-cause mortality, clinical and surgical complications and length of hospital stay while waiting for the procedure were defined as primary outcomes. RESULTS: The sample comprised 66 patient allocated to one of two groups: with and without the need of temporary pacemaker while in hospital (n=45 and n=21, respectively). The rate of complications was higher in patients who used a temporary pacemaker (p<0.001). These included primarily pneumonia (p=0.048) and length of hospital stay (p=0.029). CONCLUSION: Patients who required a temporary pacemaker stayed longer in hospital. Longer hospital stay is associated with higher rates of general complications and all-cause mortality.

Complete Pericardial Agenesis in a Pregnant Patient: A Clinical Dilemma

Abstract Pericardial agenesis is a rare congenital anomaly found predominantly in men, and its complete form is extremely rare and difficult to diagnose. This report describes the case of a pregnant patient with complete pericardial agenesis in which mode of delivery and sterilization raised debate among specialists.

Prevalence of vitamin D and calcium deficiencies and their health impacts on women of childbearing age: a protocol for systematic review and meta-analysis.

INTRODUCTION: No systematic reviews has synthesised data on the available evidence to determine the prevalence of calcium and vitamin D deficiencies as a public health problem globally. Therefore, this study presents a protocol for conducting a review and meta-analysis to estimate the prevalence of calcium and vitamin D serum deficiencies in women of childbearing age and stratify these data by age group, urban and rural area, world region and pregnant/non-pregnant women whenever possible. METHODS AND ANALYSIS: The systematic review protocol involves conducting a literature search in the following databases: PubMed, LILACS, Embase, Scopus and Web of Science. The selected articles will be checked thoroughly, including the references to include grey literature. Cross-sectional studies and baseline data from cohort studies or clinical and community trials conducted with women of childbearing age with representative probabilistic sampling will be included. Two independent researchers will be responsible for article selection and data extraction, and discrepancies, if any, will be dealt with by a third reviewer. Methodological quality and risk of bias will be analysed using the Grading of Recommendations, Assessment, Development and Evaluations and Joanna Briggs Institute's checklist, respectively. The heterogeneity of the estimates between studies will also be evaluated. Dissemination of the key findings from the systematic review will help identify priorities for action, establish dietary guidelines, develop health-related public policies and reduce and combat micronutrient deficiencies among women of childbearing age and their children. ETHICS AND DISSEMINATION: Formal ethical approval is not required, and findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020207850.

Building an isoscape based on tooth enamel for human provenance estimation in Brazil.

In this study, we present a correlation between δ18OC values of carbonate in tooth enamel samples from the modern Brazilian population and the available δ18ODW data for the meteoric water from the Global Network of Isotopes in Precipitation (GNIP). Tooth enamel from 119 Brazilian individuals from five different regions of the country were analyzed. The δ18OC isoscape obtained is in good agreement with the isoscape based on regional meteoric and drinking water. The regression matrix obtained for the δ18O values of the carbonate tooth enamel and meteoric water was used to build an isoscape using the regression-kriging approach. Our data show that Brazil can be divided in two main regions with respect to the δ18O values of the carbonate tooth enamel: (1) the most easterly part of the northeast region, which is characterized by a warm and dry climate and (2) the remainder of the country, stretching from the Amazon rain forest to the more southernly regions. The data herein reported can be used for forensic purposes related to human identification.

Procedimentos para vinculação de dados da saúde: aplicações na vigilância em saúde / Procedimientos para la vinculación de datos sanitarios: aplicaciones en la vigilancia en la salud / Procedures for health data linkage: applications in health surveillance

Objetivo: Apresentar metodologia padronizada para vinculação de diferentes bancos de dados em saúde pública. Métodos: Artigo de revisão metodológica, com descrição específica de processos de tratamento de dados para vinculação (linkage) determinística entre bancos de dados estruturados. Instruiu-se como tratar os dados, selecionar chaves de vinculação e vincular os bancos, utilizando-se dois bancos de dados simulados no software R. Resultados: Foram apresentados os comandos utilizados para a vinculação determinística, do tipo inner_join. O processo de vinculação resultou em um banco de dados com 40.108 pares ao se utilizar apenas a chave "Nome". Com a adição da segunda chave, "Nome da mãe", o resultado caiu para 112 pares. Ao adicionar a terceira chave, "Data de nascimento", apenas dois pares foram identificados. Conclusão: A vinculação de bancos de dados e suas análises são ferramentas válidas e úteis para os serviços de saúde, no apoio a ações de vigilância em saúde.

Objetivo: Presentar metodología estandarizada para vincular diferentes bases de datos de salud pública. Métodos: Artículo de revisión metodológica y descripción de los procesos de tratamiento de datos para la vinculación determinista entre bases de datos. Se dieron instrucciones sobre como manejar los datos, seleccionar claves de vinculación y vincular las bases de datos empleando dos bases de datos simuladas en el software R. Resultados: Se presentaron los comandos utilizados para la vinculación determinista, del tipo inner-join. El proceso resultó en una base de datos con 40.108 pares utilizando únicamente la clave "Nombre". Con la adición de la segunda clave, "Nombre de la madre", el resultado se redujo a 112 pares. Al agregar la tercera clave, "Fecha de nacimiento", solo se identificaron dos pares. Conclusión: La vinculación de bases de datos y sus análisis son herramientas válidas y útiles para que los servicios de salud las utilicen para apoyar las acciones de vigilancia en la salud.

Objective: To present a standardized methodology for linking different public health databases. Methods: This was a methodological review article specifically describing data processing procedures for deterministic linkage between structured databases. It instructs on how to: treat data, select linkage keys, and link databases using two databases simulated in R software. Results: The commands used for the deterministic linkage of the inner_join type were presented. The linkage process resulted in a database with 40,108 pairs using only the "Name" key. Adding the second key, "Name of mother", the resulted dropped to 112 pairs. By adding the third key, "Date of birth", only two pairs were identified. Conclusion: Database linkage and its analysis are valid and valuable tools for health services in supporting health surveillance actions.

Complications associated with the use of temporary pacemaker in patients waiting for definitive device implantation

ABSTRACT Objective To determine the rate of complications associated with the use of temporary pacemakers in patients in the waiting list for the definitive pacemaker implantation in a public hospital located in São Paulo, SP, Brazil. Methods Retrospective observational study based on data extracted from medical records of patients admitted to Hospital Municipal Dr. Moyses Deutsch, Hospital Israelita Albert Einstein from January 2014 to December 2018. Patients aged 18 years or older, diagnosed with high degree atrioventricular block upon admission and with indications for definitive pacemaker implantation were included. All-cause mortality, clinical and surgical complications and length of hospital stay while waiting for the procedure were defined as primary outcomes. Results The sample comprised 66 patient allocated to one of two groups: with and without the need of temporary pacemaker while in hospital (n=45 and n=21, respectively). The rate of complications was higher in patients who used a temporary pacemaker (p<0.001). These included primarily pneumonia (p=0.048) and length of hospital stay (p=0.029). Conclusion Patients who required a temporary pacemaker stayed longer in hospital. Longer hospital stay is associated with higher rates of general complications and all-cause mortality.

Does arthroscopy cause more complications than arthrocentesis in patients with internal temporomandibular joint disorders? Systematic review and meta-analysis.

The objective of this study was to compare, through a systematic review with a meta-analysis, the relative risks of arthroscopy and arthrocentesis in the temporomandibular joint. MEDLINE/PUBMED, EMBASE, Cochrane Library (CENTRAL), Web of Science, SCOPUS were the researched databases, as well as grey literature and manual searches. The search results showed 656 studies, but only five met the eligibility criteria. The evaluation included 194 joints (104 patients): 101 were arthroscopy and 93 arthrocentesis. Complications were observed in four patients undergoing arthroscopy (two with temporary facial paralysis and two with prolonged cervical oedema) and in three patients undergoing arthrocentesis (two with severe bradycardia and one with prolonged cervical oedema). The meta-analysis demonstrated a relative risk of 0.99 for complications after arthroscopy compared with arthrocentesis, but the results showed no statistical differences. In conclusion, this systematic review suggests that there is no increased risk of complications with arthroscopy than arthrocentesis. When complications were present, they were temporary.

Serum and Dietary Vitamin D in Individuals with Class II and III Obesity: Prevalence and Association with Metabolic Syndrome.

The association between vitamin D deficiency and metabolic syndrome (MS) in severe obesity is unclear and controversial. We analyzed serum and dietary vitamin D and their association with MS in 150 adults with class II and III obesity (BMI ≥ 35 kg/m2) from the DieTBra Trial (NCT02463435). MS parameters were high fasting blood glucose, low HDL cholesterol, high triglycerides, elevated waist circumference, and hypertension. Vitamin D deficiency was considered as a level < 20 ng/mL. We performed multivariate Poisson regression adjusted for sociodemographic and lifestyle variables. The prevalence of serum vitamin D deficiency was 13.3% (mean 29.9 ± 9.4 ng/mL) and dietary vitamin D median was 51.3 IU/day. There were no significant associations between vitamin D, serum, and diet and sociodemographic variables, lifestyle, and class of obesity. Serum vitamin D deficiency was associated with age ≥ 50 years (p = 0.034). After a fully adjusted multivariate Poisson regression, MS and its parameters were not associated with serum or dietary vitamin D, except for lower HDL, which was associated with serum vitamin D deficiency (PR = 0.71, 95% CI 0.52-0.97; p = 0.029). Severe obese individuals had a low prevalence of vitamin D deficiency, which was not associated with MS.

What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol.

INTRODUCTION: The development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. This study will also review the average length of hospital stay and the occurrence of hospital readmission. METHODS AND ANALYSIS: A systematic review of the literature will be carried out using the PubMed, Embase and Scopus databases. The inclusion criteria will incorporate cross-sectional, cohort and case-control studies that analysed the association between multimorbidity (defined as the presence of ≥2 and/or ≥3 chronic conditions and complex multimorbidity) and hospitalisation (yes/no, days of hospitalisation and number of readmissions) in older adults (aged ≥60 years or >65 years). Effect measures will be quantified, including ORs, prevalence ratios, HRs and relative risk, along with their associated 95% CI. The overall aim of this study is to widen knowledge and to raise reflections about the association between multimorbidity and hospitalisation in older adults. Ultimately, its findings may contribute to improvements in public health policies resulting in cost reductions across healthcare systems. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete. PROSPERO REGISTRATION NUMBER: CRD42021229328.

Covid-19: Por que a proteção de trabalhadores e trabalhadoras da saúde é prioritária no combate à pandemia? / COVID-19: why the protection of health workers is a priority in the fight against the pandemic? / COVID-19: ¿por qué la protección de los trabajadores de la salud es prioridad en la lucha contra la pandemia?

Resumo A pandemia causada pelo novo coronavírus (SARS-CoV-2) configura quadro de emergência de saúde pública mundial. Algumas categorias ocupacionais têm risco elevado de exposição à infecção, como os(as) trabalhadores(as) da saúde. Neste artigo, objetiva-se sumarizar e sistematizar aspectos relativos às condições de trabalho e de saúde dos(as) trabalhadores(as) da saúde nessa pandemia, enfatizando a situação no Brasil, experiências exitosas na proteção do trabalho em saúde em outros países e recomendações para o contexto brasileiro. Iniciativas imediatas de proteção e combate à pandemia em outros países incluíram como pontos estratégicos: adequação das condições de trabalho; testagem sistemática e ações específicas de assistência aos(às) trabalhadores(as). Para o enfrentamento da Covid-19 no Brasil, destacam-se como recomendações: revisão de fluxos de atendimento e definição de características e condições para cada etapa de atendimento; estabelecimento da Covid-19 como doença relacionada ao trabalho para os grupos expostos; registro efetivo da 'ocupação' nos sistemas de informação; estabelecimento de condições especiais para execução do trabalho na situação de epidemia; atenção às jornadas laborais e ações para redução de estressores ocupacionais. A atuação desses(as) trabalhadores(as) é elemento central no enfrentamento da pandemia, portanto, o plano de combate ao Covid-19 deve incluir proteção e preservação de sua saúde física e mental.

Abstract The pandemic caused by the new coronavirus (SARS-CoV-2) is a worldwide public health emergency. Some occupational categories, such as health workers, are at high risk of exposure to the infection. This article aims to summarize and systematize aspects related to the health and working conditions of health workers in this pandemic, especially in Brazil, successful experiences in the protection of healthcare work in other countries and recommendations for the Brazilian context. Immediate initiatives to protect and combat the pandemic in other countries included as strategic points: adequacy of working conditions; systematic testing and specific assistance actions for healthcare workers. In order to face COVID-19 in Brazil, the following recommendations stand out: review of service flows and definition of characteristics and conditions for each stage of service; establishment of COVID-19 as a work-related disease for exposed groups; effective registration of 'occupation' in information systems; establishment of special conditions for carrying out work in the event of an epidemic; attention to working hours and actions to reduce occupational stressors. The performance of these workers is a central element in facing the pandemic, therefore, the plan to combat COVID-19 must include protection and preservation of their physical and mental health.

Resumen La pandemia causada por el nuevo coronavirus (SARS-CoV-2) constituye una emergencia mundial de la salud pública. Algunas categorías profesionales corren un alto riesgo de exposición a la infección, como lo son los trabajadores de la salud. Este artículo tiene como objetivo resumir y sistematizar aspectos relacionados a las condiciones laborales y de salud de los trabajadores de salud en esta pandemia, enfatizando la situación en Brasil, experiencias que dieron resultado para la protección del trabajo de salud en otros países y recomendaciones para el contexto brasileño. Iniciativas inmediatas de protección y combate de la pandemia en otros países incluyen como puntos estratégicos: adecuación de las condiciones de trabajo; pruebas sistemáticas y acciones puntuales de asistencia para los trabajadores. Para enfrentar el COVID-19 en Brasil, se destacan las siguientes recomendaciones: revisión de los flujos de atendimiento y definición de características y condiciones para cada etapa del atendimiento; establecimiento de COVID-19 como enfermedad relacionada al trabajo para grupos expuestos; registro efectivo de "ocupación" en los sistemas de información; establecimiento de condiciones especiales para realizar trabajos en caso de epidemia; control de las horas de trabajo y acciones para reducir los motivadores de estrés laboral. El desempeño de estos trabajadores es un elemento central para enfrentar la pandemia, por lo tanto, el plan para combatir COVID-19 debe incluir protección y preservación de su salud física y mental.

Timed artificial insemination plus heat I: effect of estrus expression scores on pregnancy of cows subjected to progesterone-estradiol-based protocols.

Expression of estrus near timed artificial insemination (TAI) is associated with greater fertility, and estrus detection could improve TAI fertility or direct TAI management, although accurate estrus detection can be difficult and time-consuming using traditional methods. The aim of this study is to evaluate influence of estrus on pregnancy (artificial insemination pregnancy rates (P/AI)) and to validate an alternative method to classify estrus/heat expression using tail chalking (HEATSC) in postpartum Bos indicus cows subjected to TAI in progesterone-estrogen-based protocols. In experiment 1 (Exp. 1), cows (5491) were subjected to visual observation of estrus after progesterone device removal, before TAI, and P/AI was evaluated according to estrus and body condition score (BCS). Cows received a progesterone device and 2 mg estradiol benzoate (EB). After 8 days, the device was removed and 150 µg of d-cloprostenol and 300 IU equine chorionic gonadotrophin was given. Later, animals in Exp. 1 received 1 mg EB and TAI 44 to 48 h. In the Exp. 2 - 3830 cows using similar protocol, received different ovulation inducers: 1 mg EB (n=1624) or 1 mg estradiol cypionate (EC; n=2206) on day 8 (D8). Cows were then marked with chalk, and HEATSC evaluated at TAI on D10 (HEATSC1 - no chalk removal=no estrus expression; HEATSC2 - partial chalk removal=low estrus expression; HEATSC3 - near complete/complete chalk removal=high estrus expression). In Exp. 1, cows showing estrus presented greater P/AI (48.4% v. 40.2%, P<0.05). In Exp. 2, P/AI (HEATSC1 - 40.0%; HEATSC2 - 49.7%; HEATSC3 - 60.9%; P<0.001), and larger follicle timed artificial insemination (LFTAI) (<0.001) varied according to HEATSC. There was no difference in P/AI (P=0.41) or LFTAI (P=0.33) according to ovulation inducer. Cows with greater BCS showed greater P/AI in both experiments (P<0.05). Estrus presence and greater HEATSC improved P/AI, and EC v. EB used promoted differential estrus manifestation (cows showing HEATSC2 and HEATSC3: 79.5% with EB v. 69.98% with EC use, P<0.001), however, with similar P/AI. The use of HEATSC in B. indicus cows subjected to TAI is useful to identify cows with greater estrus expression and consequently improved pregnancy rates in TAI, allowing the cows with low HEATSC to be targeted for additional treatments aimed at improving P/AI.

Timed artificial insemination plus heat II: gonadorelin injection in cows with low estrus expression scores increased pregnancy in progesterone/estradiol-based protocol.

The use of tail chalk and estrus/heat expression scores (HEATSC) evaluation is instrumental in identifying cows with greater estrus expression and greater artificial insemination pregnancy rates (P/AI) in cows submitted to timed artificial insemination (TAI), and cows with low or no estrus expression present lower P/AI. It was intended in this study to improve the pregnancy rates in TAI for Bos indicus beef cows, and gonadotrophin-releasing hormone (GnRH) injection was hypothesized to increase pregnancy rates in a TAI program for cows submitted to progesterone-estradiol-based protocols with low or no estrus expression, evaluated by HEATSC. Cows (n= 2284) received a progesterone device and 2 mg estradiol benzoate, after 8 days the device was removed and 1 mg estradiol cypionate, 150 µg of d-cloprostenol and 300 IU equine chorionic gonadotropin was administered. All cows were marked with chalk and HEATSC evaluated (scales 1 to 3) at TAI performed on day 10. Animals with HEATSC1 and HEATSC2 (n= 937) received 100 µg de gonadorelin (GNRH group; n= 470), or 1 ml saline (Control group; n= 467), and cows with HEATSC3 (named HEAT group; n= 1347) received no additional treatment. The larger dominant follicle, evaluated on day 8and at TAI (day 10), was greater in HEAT group (P= 0.0145 and P <0.001, respectively). Corpus luteum (CL) area and progesterone concentration was evaluated on day 17, and CL area was larger in HEAT group, intermediary in Control and lower in GnRH group (Control= 2.68 cm2, GnRH= 2.37 cm2, HEAT group= 3.07 cm2, P <0.001). Greater progesterone concentrations were found in HEAT group than in Control and GnRH groups (Control= 4.74 ng/ml, GnRH= 4.29 ng/ml, HEAT group= 6.08 ng/ml, P<0.001). There was a difference in ovulation rate, greater in HEAT group than GnRH and Control groups (Control= 72.5%; GnRH= 81.25%; HEAT group= 90.71%; P= 0.0024). Artificial insemination pregnancy rates was greater in HEAT group (57.09% (769/1347) than in Control and GNRH groups, with positive effect of GnRH injection at the time of TAI in P/AI (Control= 36.18% (169/467), GnRH= 45.95% (216/470); P<0.0001). In conclusion, GnRH application in cows with low HEATSC (1 and 2) is a simple strategy, requiring no changes in TAI management to increase pregnancy rates in postpartum beef cows submitted to progesterone-estradiol-based TAI protocols, without reaching, however, the pregnancy rates of cows that demonstrate high estrus expression at the TAI.