Brazilian Black Women are at Higher Risk for COVID-19 Complications: An Analysis of REBRACO, a National Cohort / Mulheres negras brasileiras correm maior risco de complicações da COVID-19: uma análise do REBRACO, uma coorte nacional

Abstract Objective To evaluate the impact of the race (Black versus non-Black) on maternal and perinatal outcomes of pregnant women with COVID-19 in Brazil. Methods This is a subanalysis of REBRACO, a Brazilian multicenter cohort study designed to evaluate the impact of COVID-19 on pregnant women. From February2020 until February 2021, 15 maternity hospitals in Brazil collected data on women with respiratory symptoms. We selected all women with a positive test for COVID-19; then, we divided them into two groups: Black and non-Black women. Finally, we compared, between groups, sociodemographic, maternal, and perinatal outcomes. We obtained the frequency of events in each group and compared them using X2 test; p-values < 0.05 were considered significant. We also estimated the odds ratio (OR) and confidence intervals (CI). Results 729 symptomatic women were included in the study; of those, 285 were positive for COVID-19, 120 (42.1%) were Black, and 165 (57.9%) were non-Black. Black women had worse education (p = 0.037). The timing of access to the health system was similar between both groups, with 26.3% being included with seven or more days of symptoms. Severe acute respiratory syndrome (OR 2.22 CI 1.17-4.21), intensive care unit admission (OR 2.00 CI 1.07-3.74), and desaturation at admission (OR 3.72 CI 1.41-9.84) were more likely to occur among Black women. Maternal death was higher among Black women (7.8% vs. 2.6%, p = 0.048). Perinatal outcomes were similar between both groups. Conclusion Brazilian Black women were more likely to die due to the consequences of COVID-19.

Resumo Objetivo Avaliar o impacto da raça (negra versus não negra) nos desfechos maternos e perinatais de gestantes com COVID-19 no Brasil. Métodos Esta é uma subanálise da REBRACO, um estudo de coorte multicêntrico brasileiro desenhado para avaliar o impacto da COVID-19 em mulheres grávidas. De fevereiro de 2020 a fevereiro de 2021, 15 maternidades do Brasil coletaram dados de mulheres com sintomas respiratórios. Selecionamos todas as mulheres com teste positivo para COVID-19; em seguida, as dividimos em dois grupos: mulheres negras e não negras. Finalmente, comparamos, entre os grupos, os resultados sociodemográficos, maternos e perinatais. Obtivemos a frequência dos eventos em cada grupo e comparamos usando o teste X2; Valores de p <0,05 foram considerados significativos. Também estimamos o odds ratio (OR) e os intervalos de confiança (IC). Resultados 729 mulheres sintomáticas foram incluídas no estudo; desses, 285 foram positivos para COVID-19, 120 (42,1%) eram negros e 165 (57,9%) não eram negros. As mulheres negras apresentaram pior escolaridade (p = 0,037). O tempo de acesso ao sistema de saúde foi semelhante entre os dois grupos, com 26,3% incluídos com sete ou mais dias de sintomas. Síndrome respiratória aguda grave (OR 2,22 CI 1,17-4,21), admissão em unidade de terapia intensiva (OR 2,00 CI 1,07-3,74) e dessaturação na admissão (OR 3,72 CI 1,41-9,84) foram mais prováveis de ocorrer entre mulheres negras. A mortalidade materna foi maior entre as negras (7,8% vs. 2,6%, p = 0,048). Os resultados perinatais foram semelhantes entre os dois grupos. Conclusão Mulheres negras brasileiras tiveram maior probabilidade de morrer devido às consequências da COVID-19.

Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis

Abstract Background Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. Objectives To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. Methods Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. Results The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p< 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p= 0.49). Conclusion Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System

Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)

Screening, diagnosis and management of hypothyroidism in pregnancy: Number 10 - October 2022

Key points Pregnancy places a metabolic overload on the maternal thyroid, especially in the first trimester, mainly because of the demand imposed by the conceptus. The fetal thyroid becomes functionally mature only around pregnancy week 20. Until then, the fetus depends on the transfer of maternal thyroid hormones (THs). Thyroid hormones are essential for the adequate fetal neurofunctional and cognitive development. Hypothyroidism brings higher risks of obstetric and fetal complications, namely, first-trimester miscarriage, preeclampsia and gestational hypertension, placental abruption, prematurity, low birth weight, and higher perinatal morbidity and mortality. Primary hypothyroidism (involvement of the gland with difficulty in producing and/or releasing TH) is the most common form of disease presentation, with the main etiology of Hashimoto's thyroiditis of autoimmune origin. In about 85%-90% of cases of Hashimoto's thyroiditis, antithyroid antibodies are present; the antithyroperoxidase (ATPO) is the most frequent. Positivity for ATPO is determined when circulating values exceed the upper limit of the laboratory reference. It implies greater risks of adverse maternal-fetal outcomes. Such a correlation occurs even in ranges of maternal euthyroidism. The critical point for the diagnosis of hypothyroidism during pregnancy is an elevation of thyroid-stimulating hormone (TSH). The measurement of free thyroxine (FT4) differentiates between subclinical and overt hypothyroidism. In subclinical hypothyroidism, FT4 is within the normal range, whereas in overt hypothyroidism, FT4 values are below the lower limit of the laboratory reference. Treatment of hypothyroidism is performed with levothyroxine (LT4) replacement with the aim of achieving adequate TSH levels for pregnancy. Some women have a previous diagnosis of hypothyroidism, and may or may not be compensated at the beginning of pregnancy. Even in compensated cases, the increase in LT4 dose is necessary as soon as possible. In the postpartum period, adjustment of the LT4 dose depends on the condition of previous disease, on the positivity for ATPO, and also on the value of LT4 in use at the end of pregnancy. Recommendations In places with full technical and financial conditions, TSH testing should be performed for all pregnant women (universal screening) as early as possible, ideally at the beginning of the first trimester or even in preconception planning. In places with less access to laboratory tests, screening is reserved for cases with greater risk factors for decompensation, namely: previous thyroidectomy or radioiodine therapy, type 1 diabetes mellitus or other autoimmune diseases, presence of goiter, previous history of hypo or hyperthyroidism or previous ATPO positivity. The TSH dosage should be repeated throughout pregnancy only in these cases. The diagnosis of hypothyroidism is made from the TSH value > 4.0 mIU/L. Pregnant women with previous hypothyroidism, overt hypothyroidism diagnosed during pregnancy or those with the above-mentioned higher risk factors for decompensation should be referred for risk antenatal care, preferably in conjunction with the endocrinologist. Overt hypothyroidism in pregnancy is identified when TSH > 10 mIU/L, and treatment with LT4 is readily recommended at an initial dose of 2 mcg/kg/day. TSH values > 4.0 mUI/L and ≤ 10.0 mUI/L require FT4 measurement with two diagnostic possibilities: overt hypothyroidism when FT4 levels are below the lower limit of the laboratory reference, or subclinical hypothyroidism when FT4 levels are normal. The treatment for subclinical hypothyroidism is LT4 at an initial dose of 1 mcg/kg/day, and the dose should be doubled upon diagnosis of overt hypothyroidism. In cases of TSH > 2.5 and ≤ 4.0 mIU/L, if there are complete conditions, ATPO should be measured. If positive (above the upper limit of normal), treatment with LT4 at a dose of 50 mcg/day is indicated. If conditions are not complete, the repetition of the TSH dosage should be done only for cases at higher risk. In these cases, treatment with LT4 will be established when TSH > 4.0 mIU/L at a dose of 1 mcg/kg/day; if needed, the dose can be adjusted after FT4 evaluation. Women with previous hypothyroidism should have their LT4 dose adjusted to achieve TSH < 2.5 mIU/L at preconception. As soon as they become pregnant, they need a 30% increase in LT4 as early as possible. In practice, they should double the usual dose on two days a week. Levothyroxine should be given 30-60 minutes before breakfast or three hours or more after the last meal. Concomitant intake with ferrous sulfate, calcium carbonate, aluminum hydroxide and sucralfate should be avoided. The target of LT4 therapy during pregnancy is to achieve a TSH value < 2.5 mIU/L. Once the therapy is started, monthly control must be performed until the mentioned goal is reached. In the postpartum period, women with previous disease should resume the preconception dose. Cases diagnosed during pregnancy in use of LT4 ≤ 50 mcg/day may have the medication suspended. The others should reduce the current dose by 25% to 50% and repeat the TSH measurement in six weeks. Cases of ATPO positivity are at higher risk of developing postpartum thyroiditis and de-escalation of LT4 should be performed as explained.

Post-vaccination incidence and side effects of COVID-19 in a cohort of Brazilian healthcare professionals: an internet-based survey

Abstract Objective So far, at least 18 different severe acute respiratory syndrome coronavirus-2 vaccines have been approved. Until October 2022, 12.8 billion doses had been administered all over the world. Vaccination of high-risk groups and healthcare professionals was initially prioritized. This cross-sectional survey aimed to investigate the occurrence of vaccine side effects, as well as the incidence of COVID-19 among vaccinated healthcare professionals. Methods A survey was structured and shared with healthcare professionals using a digital platform to collect data between May and June 2021. Results This study included 6,115 participants. The most prevalent age group was 30-39 years (31.3%), 67.3% were female and 73.2% accounted for physicians, and nearly half worked in frontline care for COVID-19. Approximately, two-thirds of them were vaccinated with CoronaVac, and about 60% reported at least one side effect following the vaccination. Nevertheless, minor reactions were more frequent, such as pain at site of injection, fatigue, and headache. Our data could be used to inform people on the likelihood of side effects of COVID-19 vaccines, particularly CoronaVac, since this is the largest study about vaccine reactions using this vaccine, to our best knowledge. Conclusion The incidence of side effects in Brazilian healthcare professionals was 60%, and the most common side effects included local swelling/pain, fatigue/tiredness, fever, headache, and limb pain.

Perinatal Outcomes and Factors Associated with Ethnic Group in cases of Preterm Birth: the Multicenter Study on Preterm Birth in Brazil / Resultados perinatais e fatores associados à etnia em casos de parto pré-termo: Estudo multicêntrico de investigação de prematuridade no Brasil

Abstract Objective To investigate the characteristics of women who had preterm birth (PTB) and related outcomes according to ethnicity. Methods A secondary analysis of a multicenter cross-sectional study conducted in Brazil. Women who had PTB were classified by self-report as white and non-white. Clinical, pregnancy, and maternal data were collected through postpartum interviews and reviews of medical charts. The sociodemographic, obstetric and clinical characteristics of the women, as well as the mode of delivery and the neonatal outcomes among different ethnic groups were compared through a bivariate analysis. Results Of the 4,150 women who had PTB, 2,317 (55.8%) were non-white, who were more likely: to be younger than 19 years of age (prevalence ratio [PR]: 1.05; 95% confidence interval [95%CI]: 1.01-1.09); to be without a partner; to live on low income; to have lower levels of schooling; to have ≥ 2 children; to perform strenuous work; to be fromthe Northeastern region of Brazil rather than the from Southern region; to have a history of ≥ 3 deliveries; to have an interpregnancy interval<12 months; to have pregnancy complications such as abortion, PTB, preterm premature rupture of membranes (pPROM), and low birth weight; to initiate antenatal care (ANC) visits in the second or third trimesters; to have have an inadequate number of ANC visits; to be under continuous overexertion; to smoke in the first and second or third trimesters; and to have anemia and gestational hypertension. The maternal and neonatal outcomes did not differ between the groups, except for the higher rate of low birth weight (73.7% versus 69.0%) in infants born to non-white women, and the higher rate of seizures (4.05% versus 6.29%) in infants born to white women. Conclusion Unfavorable conditions weremore common in non-whites than inwhites. Proper policies are required to decrease inequalities, especially in the context of prematurity, when women and their neonates have specific needs.

Resumo Objetivo Investigar as características das mulheres com parto pré-termo e os respectivos resultados de acordo com a etnia. Métodos Uma análise secundária de umestudo de corte transversalmulticêntrico no Brasil. Mulheres com parto pré-termo foram classificadas por autodefinição como brancas ou não brancas. Dados maternos, clínicos, e da gestação foram coletados por entrevista pós-parto e revisão de prontuários. As características sociodemográficas, obstétricas e clínicas das mulheres, o tipo de parto, e os resultados neonatais dos grupos étnicos foram comparados por análise bivariada. Resultados Das 4.150 mulheres que tiveram parto pré-termo, 2.317 (55,8%) eram não brancas, que com mais frequência: eram menores de 19 anos de idade (razão de prevalência [RP]: 1,05; intervalo de confiança de 95% [IC95%]: 1,01-1,09); não tinham parceiro; eramde baixa renda; tinham baixa escolaridade; tinham ≥ 2 filhos; realizavam trabalho extenuante; provinhammais do Nordeste do que do Sul; tinham histórico de ≥ 3 partos; tinham intervalo interpartal<12 meses; e tiveram complicações gestacionais como aborto, parto pré-termo, rotura prematura de membranas pré-termo (RPM-PT) e baixo peso ao nascimento; iniciaram as consultas de pré-natal no segundo ou terceiro trimestres; comparecerama um número inadequado de consultas; viviam sob contínua exaustão; fumaram no primeiro e segundo ou terceiro trimestres; e tiveram anemia e hipertensão gestacional. Os resultados maternos e neonatais não diferiram entre os grupos, exceto pelamaior taxa de baixo peso ao nascimento (73,7% versus 69,0%) entre as crianças das mulheres não brancas, e e a maior taxa de convulsões (4,05% versus 6,29%) entre as das brancas. Conclusão Condições desfavoráveis foram mais comuns entre não brancas do que entre brancas. Políticas apropriadas são necessárias para diminuir as diferenças, especialmente no contexto da prematuridade, quando mulheres e seus neonatos têm necessidades específicas.

Secondary protein in the muscle of exercised rats that received creatine supplementation / Proteína secundaria en el músculo de ratones ejercitados que recibieron suplemento de creatina / Proteína secundária no músculo de ratos exercitados que receberam suplemento de creatina

ABSTRACT Introduction: Currently there is a lack of clarity around the use of Fourier transform infrared (FT-IR) spectroscopy to analyze the effect of creatine (Cr) supplementation on the secondary structures of skeletal muscle tissue protein subjected to exercise. Objective: The objective of this study was to evaluate the spectral characteristics of the tibialis anterior muscle in rats subjected to exercise in a pool and to Cr supplementation. Methods: Experiment 1. First, an experiment was conducted to ensure that FT-IR would be able to detect change in the secondary structures of skeletal muscle tissue protein in the group of sedentary rats (SED) and in the group of rats that received creatine supplementation (CRE). Experiment 2. Next, the effect of physical exercise on the spectral characteristics of muscle tissue, especially when compared to the groups without exercise practice, was examined. Results: It was possible to verify that the peaks centered on 1658 cm-1 (amide I) and 1546 cm-1 (amide II) are characteristic spectra and indicated as markers of protein content. Conclusion: Thus, FT-IR spectroscopy proved to be able to monitor changes in secondary structures of skeletal muscle protein in both animals that received supplements and in those subjected to exercise and both cases reconciled. Furthermore, the FT-IR technique proved to be a viable method for the nondestructive evaluation of skeletal muscle protein structures. Level of evidence II, Investigation of treatment results.

RESUMEN Introducción: Actualmente, no hay claridad en lo que se refiere al uso de la técnica de espectroscopia de Infrarrojo con transformada de Fourier (FT-IR) para análisis del efecto de la suplementación de creatina (Cr) sobre las estructuras secundarias de la proteína del tejido muscular esquelético sometido a ejercicio. Objetivo: El objetivo de este estudio fue evaluar las características espectrales del músculo tibial anterior de ratones sometidos a ejercicio en piscina y a la suplementación con Cr. Métodos: Experimento 1. En primer lugar, fue realizada una experiencia para asegurar que la FT-IR sería capaz de detectar la variación en las estructuras secundarias de la proteína del tejido muscular esquelético en el grupo de ratones sedentarios (SED) y el grupo de ratones que sólo recibieron suplemento de creatina (CRE). Experimento 2. A continuación, fue examinado el efecto del ejercicio físico sobre las características espectrales del tejido muscular, especialmente cuando comparado con los grupos sin práctica de ejercicio. Resultados: Fue posible verificar que los picos centrados en 1658 cm−1 (amida I) y 1546 cm−1 (amida II) son espectros característicos e indicados como marcadores del tenor proteico. Conclusión: Siendo así, la técnica de espectroscopia de FT-IR mostró ser capaz de monitorizar las variaciones en las estructuras secundarias de la proteína del tejido muscular esquelético, tanto en animales que recibieron suplementos, como en los que fueron sometidos a ejercicio y ambos casos conciliados. Además, la técnica FT-IR probó ser un método viable para la evaluación no destructiva de las estructuras proteicas en el músculo esquelético. Nivel de evidencia II, Investigación de los resultados del tratamiento.

RESUMO Introdução: Atualmente, não há clareza no que diz respeito ao uso da técnica de espectroscopia de infravermelho com transformada de Fourier (FT-IR) para análise do efeito da suplementação de creatina (Cr) sobre as estruturas secundárias da proteína do tecido muscular esquelético submetido a exercício. Objetivo: O objetivo deste estudo foi avaliar as características espectrais do músculo tibial anterior de ratos submetidos a exercício em piscina e à suplementação com Cr. Métodos: Experimento 1. Em primeiro lugar, foi realizada uma experiência para assegurar que a FT-IR seria capaz de detectar a variação nas estruturas secundárias da proteína do tecido muscular esquelético no grupo de ratos sedentários (SED) e no grupo de ratos que só receberam suplemento de creatina (CRE). Experimento 2. Em seguida, foi examinado o efeito do exercício físico sobre as características espectrais do tecido muscular, especialmente quando comparado com os grupos sem prática de exercício. Resultados: Foi possível verificar que os picos centrados em 1658 cm−1(amida I) e 1546 cm−1(amida II) são espectros característicos e indicados como marcadores do teor proteico. Conclusão: Assim sendo, a técnica de espectroscopia de FT-IR mostrou ser capaz de monitorar as variações nas estruturas secundárias da proteína do tecido muscular esquelético tanto em animais que receberam suplementos, quanto nos que foram submetidos a exercício e ambos os casos conciliados. Além disso, a técnica FT-IR provou ser um método viável para a avaliação não destrutiva de estruturas proteicas no músculo esquelético. Nível de evidência II, Investigação dos resultados do tratamento.

Validation study of a software for proprioceptive evaluation / Estudo de validação de um programa de computador para avaliação proprioceptiva

Objective: To validate the PhisioPlay software for proprioceptive evaluation of the shoulder joint based on the data obtained by isokinetic dynamometry equipment. Methods: Thirty-one individuals constituted a single group for proprioceptive evaluation of both shoulder joints by means of joint position sense (JPS). The testing protocol of PhisioPlay consisted of the abduction movement of the shoulder to the target angles of 45° and 90° and the maintenance of these positions for 30 seconds. In the isokinetic dynamometer, the test was performed using its proprioceptive evaluation protocol for the same movement, target angles, and maintenance time established for the previous test. Results: For the 90° variables, statistical analysis pointed to agreement for the dominant limb in relation to the mean angulation and the absolute difference and for the non-dominant limb in relation to the absolute difference. The results of mean comparisons of the absolute differences via the Wilcoxon Test corroborate the literature regarding the behavior of the JPS considering joint amplitude, lateral dominance, and greater or lesser torque affecting the joint. Reliability and sensitivity measures also strengthen the conclusions. Conclusion: The results point to the construct validity of the PhisioPlay software for evaluating the JPS of the shoulder joint at 45° and 90° and suggest that the JPS is more influenced by the angle of the joint during the motor task than by the lateral dominance.

Objetivo: Validar do software PhisioPlay para avaliação proprioceptiva da articulação do ombro realizando movimento de abdução a 45º e 90º utilizando os dados obtidos por um equipamento de dinamometria isocinética. Métodos: Trinta e um indivíduos compuseram um único grupo de avaliação da propriocepção pelo senso de posição articular (SPA) do ombro. O protocolo de teste no PhisioPlay consistiu no movimento de abdução do ombro para o ângulo alvo de 45° e 90° e sua manutenção por 30 segundos. No dinamômetro isocinético o teste foi realizado utilizando seu protocolo de avaliação proprioceptiva para o mesmo movimento, ângulos alvo e tempo de manutenção no ângulo alvo estabelecidos para o teste anterior. Resultados: Para as variáveis de 90° foi observada concordância moderada para o membro dominante em relação à angulação média e à diferença absoluta, e para o membro não dominante em relação à diferença absoluta. O teste de Wilcoxon ao comparar os valores dos erros absolutos em relação ao ângulo alvo obtidos pelo PhisioPlay corroboram com a literatura sobre o comportamento do SPA observando amplitude articular, lateralidade e maior ou menor torque incidindo sobre a articulação. Medidas de confiabilidade e sensibilidade também reforçaram este comportamento. Conclusão: Os resultados apontam para validade de construto do software PhisioPlay para a avaliação do SPA da articulação do ombro a 45° e 90° e sugerem que o SPA é mais influenciado pela angulação da articulação durante a tarefa motora do que pela dominância lateral.

Electromyograpic activity of the abdominal and paravertebral muscles during coffee harvesting / Atividade eletromiográfica dos músculos abdominal e paravertebral durante a colheita de café / Actividad electromiográfica de los músculos abdominal y paravertebral durante la cosecha de café

ABSTRACT Introduction The rural worker involved in the coffee harvest is an important person for the economy of the many countries. However, scientific studies on the health of this worker are rare. Objective To analyze the lumbar paravertebral musculature and abdominal rectus of rural workers during coffee harvesting with the manual machines with different footrest bases (inclined, declined and horizontal), by means of electromyography. Methods Eight male rural workers from the region of Muzambinho participated in the study. All procedures and electromyographic routines were applied according to the SENIAN protocol. The workers made the usual coffee harvesting movements, using the manual machine for one minute. The data are expressed as means and standard deviations. The RMS (root mean square) signal and the median frequency (FM) were also analyzed. Results It was observed that the type of footrest base did not influence the electromyographic activity RMS or the FM, but we found that the paravertebral muscles have greater electromyographic activation when compared to the abdominal muscles, regardless of the type of footrest base. Conclusion For the task performed, the paravertebral muscles present greater electromyographic activation compared to the abdominal rectus. Level of Evidence III; Diagnostic studies - Investigating a diagnostic test.

RESUMO Introdução O trabalhador rural envolvido na colheita de café é um personagem importante para a economia de muitos países. Contudo, são raros os estudos que envolvam a saúde desse trabalhador. Objetivo Analisar através da eletromiografia a musculatura paravertebral lombar e reto abdominal dos trabalhadores rurais durante a colheita de café com a derriçadeira manual, em diferentes bases de apoio para os pés (inclinado, declinado e horizontal). Métodos Participaram do estudo oito trabalhadores rurais da região de Muzambinho, do sexo masculino. Todos os procedimentos e rotinas eletromiográficas foram aplicados de acordo com o protocolo de SENIAN. Os trabalhadores realizaram os movimentos usuais da colheita do café utilizando a derriçadeira manual durante um minuto. Os dados foram expressos em média e desvio padrão com o sinal RMS (root mean square), além disso, foi analisada a frequência mediana (FM). Resultados Observou-se que os planos não influenciaram na atividade eletromiográfica RMS e nem na FM, no entanto, foi constatado que os músculos paravertebrais possuem maiores níveis de ativação eletromiográfica quando comparados aos músculos abdominais, independentemente dos planos. Conclusão Conclui-se que para a tarefa realizada os músculos paravertebrais apresentam maior ativação eletromiográfica em comparação aos retos abdominais. Nível de evidência III; Estudos diagnósticos-Investigação de exame para diagnósticos.

RESUMEN Introducción El trabajador rural involucrado en la cosecha de café es un personaje importante para la economía de muchos países. Sin embargo, son raros los estudios que abarquen la salud de este trabajador. Objetivo Analizar a través de electromiografía la musculatura paravertebral lumbar y recto abdominal de los trabajadores rurales durante la cosecha de café con la cosechadora manual, en diferentes bases de apoyo para los pies (inclinado, declinado y horizontal). Métodos Participaron en el estudio ocho trabajadores rurales de la región de Muzambinho, del sexo masculino. Todos los procedimientos y rutinas electromiográficas fueron aplicadas de acuerdo con el protocolo de SENIAN. Los trabajadores realizaron los movimientos usuales de la cosecha de café utilizando una cosechadora manual durante un minuto. Los datos fueron expresados en promedio y desviación estándar con la señal RMS (root mean square) y también fue analizada la frecuencia mediana (FM). Resultados Se observó que los planos no influenciaron en la actividad electromiográfica RMS y tampoco en la FM, sin embargo, fue constatado que los músculos paravertebrales poseen mayores niveles de activación electromiográfica cuando comparados a los músculos abdominales, independientemente de los planos. Conclusión Se concluye que para la tarea realizada los músculos paravertebrales presentan mayor activación electromiográfica en comparación a los rectos abdominales. Nivel de evidencia III; Estudios diagnósticos-Investigación de examen para diagnósticos.

The role of maternal infection in preterm birth: evidence from the Brazilian Multicentre Study on Preterm Birth (EMIP)

OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case-control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.

Maturation, morphological, motor and technical characteristics of under 16 female track and field athletes / Características maturacionais, morfológicas, motoras e técnicas de atletas femininas sub 16 de atletismo

Abstract There is growing interest in identifying morphological, motor, maturation characteristics, as well as their changes, of children and adolescents in systematized training in various sports. Knowledge of these characteristics is important for coaches and researchers because they provide parameters for assessing youth development during training. For track and field, studies on the category under 16 are scarce. Thus, the objectives of this study are to describe the profile and to design a percentile table of morphological, motor, maturation and event-specific variables of under 16 athletes. 105 young athletes were evaluated on two consecutive days. On the first day, an anamnesis of athletes and coaches was performed. Anthropometric and anaerobic measurements were analyzed in shot put, long jump, 800 m run. On the second day, flexibility, vertical impulse, upper limb strength, speed and maximal aerobic speed were evaluated. The biological maturation was evaluated by the percentage of the predicted height. A table with percentiles was prepared with the data of all athletes. Another table with the results of the whole group plus mean and standard deviation was prepared. A last table was prepared containing data divided by group of sports events. The morphological variables presented differences between the groups as to body mass, BMI and sum of skinfolds. Significant differences were observed only for the motor variable VMA. No significant differences were observed only for long jump. When divided by groups, it was evident that throwers are different from the other athletes in some morphologic variables and in specific sports events.

Resumo É crescente o interesse em identificar características morfológicas, motoras e maturacionais, bem como suas modificações em crianças e adolescentes inseridos em treinamentos sistematizados nas mais variadas modalidades esportivas. O conhecimento dessas características é importante para que treinadores e pesquisadores tenham parâmetros de avaliação do desenvolvimento do jovem durante o treinamento. Para o atletismo, são limitados estudos para a categoria sub 16. Desta forma, os objetivos são, descrever o perfil e elaborar uma tabela de percentil das variáveis morfológicas, motoras, maturacionais e de provas específicas de atletas sub 16. Foram avaliadas 105 jovens atletas em dois dias consecutivos. No primeiro dia, foi realizada a anamnese nos atletas e treinadores, medidas antropométricas, anaeróbicas e as provas do arremesso de peso, salto em distância, corrida de 800m. No segundo dia, foi avaliada a flexibilidade, impulsão vertical, força de membro superior, velocidade e velocidade aeróbia máxima. A maturação biológica foi avaliada pelo percentual da estatura predita. Foram elaboradas uma de percentis com resultado de todas as atletas, outra com média e desvio padrão com os resultados do grupo todo e uma última dividida por grupo de provas. Nas variáveis morfológicas foram encontradas diferenças entres os grupos para a massa corporal, IMC e somatório de dobras, nas motoras apenas na VMA e nas provas específicas não foi observada diferença significativa apenas salto em distância. Quando dividido pelos grupos, se evidenciou que as lançadoras são diferentes das demais atletas em algumas variáveis moforlógicas e nas provas específicas.

The role of pregnant women with rash in the Zika virus sentinel surveillance

Abstract INTRODUCTION: The state of São Paulo has been monitoring cases of microcephaly and pregnant women presenting with acute rash, through CeVeSP. METHODS: This was a descriptive study focusing on pregnant women with rash and the outcome of their pregnancy, based on the notifications through the CeVeSP. RESULTS: During 2016, 2,209 cases of pregnant women with rash were reported and investigated. Of these, 36.6% were confirmed. Of the pregnant women who tested positive for ZIKV, 6.4% did not have a favorable outcome. CONCLUSIONS Our results allowed the characterization of pregnant women exposed to ZIKV and the outcome of pregnancy.