Influence of low-level tannin supplementation on comparative growth performance of Holstein and Angus × Holstein cross calf-fed concentrate-based finishing diets for 328 d.

The objective of the current study was to evaluate the effects of tannin and monensin supplementation in feedlot diets and breed (Holstein vs. Angus × Holstein) on growth performance, energetic efficiency, and carcass characteristics. Eighty purebred Holstein calves (HOL; initial body weight (BW) = 130 ±â€…5 kg) and 80 Angus × Holstein calves (AXH; initial BW = 129 ±â€…6 kg) were blocked by initial BW and randomly assigned to 40 pens. Dietary treatments consisted of a steam-flaked corn-based diet supplemented with (1) no feed additive (CON); (2) 30 mg of monensin/kg of dry matter (DM; MON; Rumensin 90, Elanco, Greenfield, IN); (3) 1.5 g tannin)/kg of DM (TAN; ByPro, 70% condensed tannin, SilvaFeed, Indunor, S.A., Buenos Aires, Argentina); (4) M + T, the combination of MON plus TAN dietary treatments. Data were analyzed as a randomized complete block in a 2 × 4 factorial arrangement of treatments, using pens as experimental units. There were no interactions (P > 0.05) between feed additives and breed. Supplemental MON increased (P ≤ 0.04) initial 112-d BW and gain efficiency. However, there were no dietary treatment effects (P > 0.10) on overall growth performance. Monensin supplementation decreased (P = 0.04) minimum daily ruminal temperature compared with other dietary treatments during July, but TAN did not affect ruminal temperature. Holstein steers had greater (P = 0.04) overall DM intake compared with AXH, with no difference (P = 0.19) in overall ADG, leading to increased (P < 0.01) gain efficiency for AXH compared with HOL. Dietary net energy for maintenance and gain, based on growth performance, were greater (P ≤ 0.01) for AXH vs HOL. Compared with HOL, AXH steers had greater (P ≤ 0.01) carcass weight, dressing percentage, kidney, pelvic, and heart fat, 12th rib fat thickness, longissimus area, and preliminary yield grade. Holstein steers had lower (P ≤ 0.04) minimum average ruminal temperature during June compared with AXH, with no differences (P ≥ 0.14) between breeds during July or August. Results indicate that feed additives did not appreciably affect steer growth performance and carcass characteristics, but crossbred AXH steers had greater growth performance, efficiency of dietary energy utilization, and carcass quality measures compared with HOL. This study observed a reduction (4.7%) in maintenance energy expenditure in AXH compared with HOL, implying in maintenance energy coefficient of 0.086 vs 0.082 for HOL and AXH, respectively.

Effects of tannin and monensin supplementation on growth performance, energetic efficiency, and carcass characteristics were evaluated in Holstein and Angus × Holstein steers. The investigation used a factorial design to access the impacts of both feed additives and breed on the study's parameters. Tannin supplementation did not affect growth performance. There were no dietary treatment effects on overall steer growth performance. Calf Holstein steers were fed with grain diet based. Holstein steers had greater overall DM intake than Angus × Holstein steers, but breed did not affect average daily gain. Thus, gain efficiency was greater for Angus × Holstein vs Holstein steers. There was no effect of dietary treatment on carcass measures. Compared with Holsteins, Angus × Holstein steers had greater carcass weight, dressing percentage, internal and external fat, longissimus area, and marbling score than Holstein steers. The current study suggests that monensin and tannin supplementation did not affect overall steer growth performance and carcass characteristics. Compared with Holsteins, crossbred Angus × Holstein steers had increased growth performance and carcass quality measures.

Influence of metabolizable protein and methionine supplementation on growth-performance of Holstein steer calves during the initial 112-d feedlot growing phase.

The objective was to examine the effects of metabolizable protein (MP) and ruminal-protected methionine supplementation on growth performance of Holstein steer calves during the initial feedlot growing phase (112 d). One hundred eighty Holstein steer calves (122 ±â€…7 kg) were blocked by weight and assigned to 30 pens (6 steers per pen). Five treatments were applied: 1) control, a diet based on steam-flaked corn containing urea and dry distillers grains plus solubles as supplemental N sources with no amino acid addition; 2) control diet plus blood meal supplementation; 3) diet from treatment 2, with 0.064% Smartamine M (70% methionine; Adisseo, Alpharetta, GA) supplementation; 4) diet from treatment 2 with 0.096% Smartamine M supplementation; 5) diet from treatment 2 with 0.128% Smartamine M supplementation. All diets were formulated to exceed the estimated MP requirements. The estimated metabolizable lysine, as well as methionine, was deficient in the control diet. Blood meal was added to the control diet to meet estimated lysine requirements (diet 2), the other diets had increasing concentrations of supplemental methionine. Supplemental MP enhanced (10%, P < 0.02) interim and overall 112-d average daily gain (ADG). Additional effects of supplemental methionine on ADG were not appreciable (P > 0.10). Supplemental MP did not affect (P > 0.10) dry matter intake (DMI) during the first 56-d period; however, it tended to increase (P = 0.08) DMI during the subsequent 56-d period. Overall, supplemental MP or methionine had no appreciable effect (P > 0.10) on DMI. Supplemental MP improved (P < 0.01) gain efficiency and estimated dietary net energy (NE) values during the initial 56-d period (11 and 7%, respectively) and overall (7 and 4%, respectively). Supplemental MP did not affect (P > 0.10) gain efficiency during the second 56-d period, although it tended to enhance (P = 0.08) estimated dietary NE. Supplemental methionine did not appreciably affect (P > 0.10) gain efficiency or estimated dietary NE. Therefore, adding MP to cover the estimated limiting amino acid supply in diets may enhance the gain efficiency and dietary energetics of growing Holstein calves. However, amino acid addition supplementation beyond the requirements may not produce extra productive performance of steer calves.

Insights into the microRNA landscape of Rhodnius prolixus, a vector of Chagas disease.

The growing interest in microRNAs (miRNAs) over recent years has led to their characterization in numerous organisms. However, there is currently a lack of data available on miRNAs from triatomine bugs (Reduviidae: Triatominae), which are the vectors of the protozoan parasite Trypanosoma cruzi, the causative agent of Chagas disease. A comprehensive understanding of the molecular biology of vectors provides new insights into insect-host interactions and insect control approaches, which are key methods to prevent disease incidence in endemic areas. In this work, we describe the miRNome profiles from gut, hemolymph, and salivary gland tissues of the Rhodnius prolixus triatomine. Small RNA sequencing data revealed abundant expression of miRNAs, along with tRNA- and rRNA-derived fragments. Fifty-two mature miRNAs, previously reported in Ecdysozoa, were identified, including 39 ubiquitously expressed in the three tissues. Additionally, 112, 73, and 78 novel miRNAs were predicted in the gut, hemolymph, and salivary glands, respectively. In silico prediction showed that the top eight most highly expressed miRNAs from salivary glands potentially target human blood-expressed genes, suggesting that R. prolixus may modulate the host's gene expression at the bite site. This study provides the first characterization of miRNAs in a Triatominae species, shedding light on the role of these crucial regulatory molecules.

Different combinations of monensin and narasin on growth performance, carcass traits, and ruminal fermentation characteristics of finishing beef cattle.

The objective of this study was to evaluate the effects of different combinations of monensin and narasin on finishing cattle. In Exp. 1, 40 rumen-cannulated Nellore steers [initial body weight (BW) = 231 ± 3.64 kg] were blocked by initial BW and assigned to one of the five treatments as follows: Control (CON): no feed additive in the basal diet during the entire feeding period; Sodium monensin (MM) at 25 mg/kg dry matter (DM) during the entire feeding period [adaptation (days 1-21) and finishing (days 22-42) periods]; Narasin (NN) at 13 mg/kg DM during the entire feeding period (adaptation and finishing periods); Sodium monensin at 25 mg/kg DM during the adaptation period and narasin at 13 mg/kg DM during the finishing period (MN); and narasin at 13 mg/kg DM during the adaptation period and sodium monensin at 25 mg/kg DM during the finishing period (NM). Steers fed MM had lower dry matter intake (DMI) during the adaptation period compared to NM (P = 0.02) but not compared to CON, MM, MN, or NN (P ≥ 0.12). No differences in DMI were observed among the treatments during the finishing (P = 0.45) or the total feeding period (P = 0.15). Treatments did not affect the nutrient intake (P ≥ 0.51) or the total apparent digestibility of nutrients (P ≥ 0.22). In Exp. 2, 120 Nellore bulls (initial BW = 425 ± 5.4 kg) were used to evaluate the effects of the same treatments of Exp. 1 on growth performance and carcass characteristics of finishing feedlot cattle. Steers fed NM had greater DMI during the adaptation period compared to CON, MM, and MN (P ≤ 0.03), but no differences were observed between NM and NN (P = 0.66) or between CON, MM, and NN (P ≥ 0.11). No other differences between treatments were observed (P ≥ 12). Feeding narasin at 13 mg/kg DM during the adaptation period increases the DMI compared to monensin at 25 mg/kg DM, but the feed additives evaluated herein did not affect the total tract apparent digestibility of nutrients, growth performance, or carcass characteristics of finishing cattle.

Double perinatal stress reduces the sexual response of adult female Wistar rats.

BACKGROUND: Early-life stress affects physiological development and produces changes in various aspects of emotional behavior. AIM: We sought to examine the effects of double perinatal stress (DPS)-a combination of prenatal systemic hypoxic-ischemic (HI) insults and repeated early maternal separation-on the estrus cycle and sexual behavior of adult rats. METHODS: HI was induced by clamping the uterine arteries of pregnant rats for 45 minutes on the 18th day of gestation (HI group). Sham control animals received laparotomy and anesthesia only. Pups were born at term. Maternal separation was performed from postnatal day 1 (P1) (P0 = day of birth) to P15. At P90, the sexual response of females in estrus was evaluated. Statistical analysis was performed using 2-way analysis of variance followed by Tukey's test. OUTCOMES: We considered the estrous cycle and sexual behavior of female rats submitted to DPS, as well as the influence of female behavior on the sexual response of male rats. RESULTS: Rats submitted to DPS showed a reduction in the lordosis quotient and in the lordosis rate, suggesting a reduction in female sexual receptivity. DPS female rats showed a reduction in the number of hops and darts and in the genital exploration time rate, suggesting a reduction in sexual proceptivity. In addition, males that interacted with DPS females showed a reduction in the number of ejaculations and in copulatory efficiency. CLINICAL IMPLICATIONS: Developing a deeper understanding of perinatal factors that affect adult female sexual response will allow for more effective interventions to prevent and treat such changes. On the other hand, the analysis of the sexual response allows assessing the quality of life and the general state of health. STRENGTHS AND LIMITATIONS: The development of animal models to investigate the environmental factors that interfere in the female sexual response may allow researchers to propose and test new therapeutic strategies. On the other hand, care must be exercised when interpreting animal data and extrapolating these results to estimate the possible effects of perinatal stressors on the human sexual response. CONCLUSION: Our results revealed that females subjected to DPS showed long-term effects on sexual behavior. In conclusion, managing stressors in prenatal life and early postnatal life can prevent problems in adult sexual life and improve overall health.

Economy- and Social-Based Strategies for Anticoagulation of Patients with Atrial Fibrillation. / Estratégias Econômicas e Sociais para Anticoagulação de Pacientes com Fibrilação Atrial.

BACKGROUND: Atrial fibrillation is a public health problem associated with a fivefold increased risk of stroke or death. Analyzing costs is important when introducing new therapies and must be reconsidered in special situations, such as the novel coronavirus pandemic of 2020. OBJECTIVE: This study aimed to evaluate the costs related to anticoagulant therapy in a one-year period, and the quality of life of atrial fibrillation patients treated in a public university hospital. METHODS: Patient costs were those related to the anticoagulation and calculated by the average monthly costs of warfarin or direct oral anticoagulants (DOACs). Patient non-medical costs (eg., food and transportation) were calculated from data obtained by questionnaires. The Brazilian SF-6D was used to measure the quality of life. P-values < 0.05 were considered statistically significant. RESULTS: The study population consisted of 90 patients, 45 in each arm (warfarin vs direct oral anticoagulants). Costs were 20% higher in the DOAC group ($55,532.62 vs $46,385.88), and mainly related to drug price ($23,497.16 vs $1,903.27). Hospital costs were higher in the warfarin group ($31,088.41 vs $24,604.74) and related to outpatient visits. Additionally, non-medical costs were almost twice higher in the warfarin group ($13,394.20 vs $7,430.72). Equivalence of price between the two drugs could be achieved by a 39% reduction in the price of DOACs. There were no significant group differences regarding quality of life. CONCLUSIONS: Total costs were higher in the group of patients taking DOACs than those taking warfarin. However, a nearly 40% reduction in the price of DOACs could make it feasible to incorporate these drugs into the Brazilian public health system.

FUNDAMENTO: A fibrilação atrial é um problema de saúde pública associado com um risco cinco vezes maior de acidente vascular cerebral e mortalidade. A análise de custos é importante para a introdução de novas terapias, e deve ser reconsiderada em situações especiais, tais como a pandemia do coronavírus em 2020. OBJETIVO: Avaliar os custos (em um período de um ano) relacionados à terapia anticoagulante e a qualidade de vida de pacientes com fibrilação atrial tratados em um hospital público universitário. MÉTODOS: Os custos do paciente foram aqueles relacionados à anticoagulação e calculados pela média de custos mensais da varfarina ou de anticoagulantes orais diretos (DOACs). As despesas não médicas, como alimentação e transporte, foram calculadas a partir de dados obtidos de questionários. O questionário brasileiro SF-6D foi usado para medir a qualidade de vida. Valores p<0,05 foram considerados estatisticamente significativos. RESULTADOS: A população do estudo consistiu em 90 pacientes, 45 em cada braço (varfarina vs. DOACs). Os custos foram 20% mais altos no grupo dos DOACs (US$55 532,62 vs. US$46 385,88), e principalmente relacionados ao preço dos medicamentos (US$23 497,16 vs. US$1903,27). Os custos hospitalares foram mais altos no grupo da varfarina (US$31 088,41 vs $24 604,74), e relacionados às visitas ao ambulatório. Ainda, as despesas não médicas foram duas vezes maiores no grupo varfarina ($13 394,20 vs $7 430,72). A equivalência de preço entre os dois medicamentos seria alcançada por uma redução de 39% no preço dos DOACs. Não foram observadas diferenças quanto à qualidade de vida. CONCLUSÕES: Os custos totais foram mais altos no grupo de pacientes tratados com DOACs que no grupo da varfarina. No entanto, uma redução de cerca de 40% no preço dos DOACs tornaria viável a incorporação desses medicamentos no sistema de saúde público brasileiro.

Estratégias Econômicas e Sociais para Anticoagulação de Pacientes com Fibrilação Atrial / Economy- and Social-Based Strategies for Anticoagulation of Patients with Atrial Fibrillation

Resumo Fundamento: A fibrilação atrial é um problema de saúde pública associado com um risco cinco vezes maior de acidente vascular cerebral e mortalidade. A análise de custos é importante para a introdução de novas terapias, e deve ser reconsiderada em situações especiais, tais como a pandemia do coronavírus em 2020. Objetivo: Avaliar os custos (em um período de um ano) relacionados à terapia anticoagulante e a qualidade de vida de pacientes com fibrilação atrial tratados em um hospital público universitário. Métodos: Os custos do paciente foram aqueles relacionados à anticoagulação e calculados pela média de custos mensais da varfarina ou de anticoagulantes orais diretos (DOACs). As despesas não médicas, como alimentação e transporte, foram calculadas a partir de dados obtidos de questionários. O questionário brasileiro SF-6D foi usado para medir a qualidade de vida. Valores p<0,05 foram considerados estatisticamente significativos. Resultados: A população do estudo consistiu em 90 pacientes, 45 em cada braço (varfarina vs. DOACs). Os custos foram 20% mais altos no grupo dos DOACs (US$55 532,62 vs. US$46 385,88), e principalmente relacionados ao preço dos medicamentos (US$23 497,16 vs. US$1903,27). Os custos hospitalares foram mais altos no grupo da varfarina (US$31 088,41 vs $24 604,74), e relacionados às visitas ao ambulatório. Ainda, as despesas não médicas foram duas vezes maiores no grupo varfarina ($13 394,20 vs $7 430,72). A equivalência de preço entre os dois medicamentos seria alcançada por uma redução de 39% no preço dos DOACs. Não foram observadas diferenças quanto à qualidade de vida. Conclusões: Os custos totais foram mais altos no grupo de pacientes tratados com DOACs que no grupo da varfarina. No entanto, uma redução de cerca de 40% no preço dos DOACs tornaria viável a incorporação desses medicamentos no sistema de saúde público brasileiro.

Abstract Background: Atrial fibrillation is a public health problem associated with a fivefold increased risk of stroke or death. Analyzing costs is important when introducing new therapies and must be reconsidered in special situations, such as the novel coronavirus pandemic of 2020. Objective: This study aimed to evaluate the costs related to anticoagulant therapy in a one-year period, and the quality of life of atrial fibrillation patients treated in a public university hospital. Methods: Patient costs were those related to the anticoagulation and calculated by the average monthly costs of warfarin or direct oral anticoagulants (DOACs). Patient non-medical costs (eg., food and transportation) were calculated from data obtained by questionnaires. The Brazilian SF-6D was used to measure the quality of life. P-values < 0.05 were considered statistically significant. Results: The study population consisted of 90 patients, 45 in each arm (warfarin vs direct oral anticoagulants). Costs were 20% higher in the DOAC group ($55,532.62 vs $46,385.88), and mainly related to drug price ($23,497.16 vs $1,903.27). Hospital costs were higher in the warfarin group ($31,088.41 vs $24,604.74) and related to outpatient visits. Additionally, non-medical costs were almost twice higher in the warfarin group ($13,394.20 vs $7,430.72). Equivalence of price between the two drugs could be achieved by a 39% reduction in the price of DOACs. There were no significant group differences regarding quality of life. Conclusions: Total costs were higher in the group of patients taking DOACs than those taking warfarin. However, a nearly 40% reduction in the price of DOACs could make it feasible to incorporate these drugs into the Brazilian public health system.

Brazilian-Portuguese Validation Assessment of the Gastrointestinal Quality of Life Index for Patients After Laparoendoscopic Cholecystectomy.

Background: Cholelithiasis is currently one of the most common diagnosis in Brazil. The aim of this study was to validate the Gastrointestinal Quality of Life Index (GIQLI) as a quality-of-life (QoL) assessment among the Brazilian population with syntomatic gallstone. Materials and Methods: The questionnaire was translated and culturally adapted after the linguistic validation process determined by the international methodology. Sixty-three patients who underwent laparoscopic cholecystectomy responded to the GIQLI-Brazil and Short-Form Health Survey (SF-36) instruments. For the evaluation of reproducibility, 30 patients responded to GIQLI-Brazil two more times after 2 and 4 weeks. After the University of São Paulo Ethics Commitee Board approval (UNIFESP/CEP: 1270/2019), the study was carryed out between May 2019 and February 2020 at the Gastroenterology outpatient clinic of Hospital São Paulo-Federal University of São Paulo (UNIFESP). Cronbach's alpha, the calculation of the intraclass correlation coefficient (ICC), and Spearman's correlation were used to assess the validity and reproducibility of the instrument translated into Portuguese, and to measure correlation between the domains of the GIQLI-Brazil and SF-36 (P < .05). Results: Seven questions were modified during the process of translation and cultural adaptation. The Brazilian version of the instrument presented a Cronbach's alpha of 0.89, and excellent reproducibility through the ICC, with the following variation between domains: meteorism (ICC = 0.918; P < .001) and gastrointestinal function (lower tract) (ICC = 0.956; P < .001). The dimensions of the GIQLI-Brazil and SF-36 demonstrated a significant correlation (P < .001), except between the domains: functional aspects of the SF-36 and gastrointestinal function (lower tract) of the GIQLI-Brazil (r = 0.211). Conclusion: The GIQLI was translated and validated for Portuguese-Brazil and can be used to assess the QoL of adult patients with gastrointestinal diseases and/or disorders.

Effects of narasin supplementation frequency on intake, ruminal fermentation parameters, and nutrient digestibility of Bos indicus Nellore steers fed with forage-based diets.

The study aimed to evaluate if the frequency of narasin supplementation impacts dry matter intake, ruminal fermentation parameters, and apparent digestibility of nutrient in Nellore (Bos indicus) steers fed forage-based diets. A total of 32 rumen-cannulated Nellore steers (initial body weight [BW] = 317 ± 27 kg; age =18 ± 1 mo) were assigned to individual pens in a randomized complete block design according to their initial shrunk BW. Within block, steers were randomly assigned to 1 of 4 treatments: 1) forage-based diet without the addition of narasin (CON; n = 8), 2) CON diet plus 13 ppm of narasin every 24 h (N24; n = 8), 3) CON diet plus 26 ppm of narasin every 48 hours (N48; n = 8), or 4) CON diet plus 39 ppm of narasin every 72 hours (N72; n = 8). The experimental period lasted 30 d, with 18 d for diet adaptation and 12 d for sample collection. The experimental diets contained 95% of Tifton-85 (Cynodon dactylon spp.) haylage and 5% ground corn used as a delivery vehicle for narasin. Ruminal fluid was obtained from d 25 to 30 at 6 h after feeding to determine ruminal fermentation parameters. Narasin supplementation frequency did not affect (P ≥ 0.22) nutrient intake and total tract apparent digestibility. Steers fed N24 and N48 had reduced (P = 0.02) ruminal acetate concentration compared with CON and N72. Daily supply of narasin increased (P = 0.01) the molar proportion of propionate compared with CON and N72, and it did not differ between N24 vs. N48, N48 vs. N72, and N72 vs. CON. Also, N48 steers had greater (P = 0.01) rumen propionate concentration compared with CON. The N24 treatment decreased the Ac:Prop (P = 0.01) and AcBut:Prop (P = 0.02) ratio compared with CON and N72, while N48 had reduced (P = 0.01) Ac:Prop and AcBut:Prop ratio when compared with CON steers. Steers fed N24 and N48 had greater (P = 0.04) ruminal short-chain fatty acids compared with CON, but it did not differ (P > 0.11) between N24, N48, and N72. Supplementing narasin to steers fed forage-based diets decreased (P < 0.01) ruminal ammonia concentration compared with CON steers regardless of supplementation frequency, being the least result observed for N24 steers. Collectively, narasin supplementation frequency affected fermentation parameters without altering the nutrient intake and total tract apparent digestibility. Hence, decreasing frequency of narasin supplementation to Nellore steers fed a forage-based diet did not reduce the capacity to modulate rumen fermentation parameters.

An emergency system for monitoring pulse oximetry, peak expiratory flow, and body temperature of patients with COVID-19 at home: Development and preliminary application.

BACKGROUND: COVID-19 is characterized by a rapid change in the patient's condition, with major changes occurring over a few days. We aimed to develop and evaluate an emergency system for monitoring patients with COVID-19, which may be useful in hospitals where more severe patients stay in their homes. METHODOLOGY/PRINCIPAL FINDINGS: The system consists of the home-based patient unit, which is set up around the patient and the hospital unit, which enables the medical staff to telemonitor the patient's condition and help to send medical recommendations. The home unit allows the data transmission from the patient to the hospital, which is performed using a cell phone application. The hospital unit includes a virtual instrument developed in LabVIEW® environment that can provide a real-time monitoring of the oxygen saturation (SpO2), beats per minute (BPM), body temperature (BT), and peak expiratory flow (PEF). Abnormal events may be fast and automatically identified. After the design details are described, the system is validated by a 30-day home monitoring study in 12 controls and 12 patients with COVID-19 presenting asymptomatic to mild disease. Patients presented reduced SpO2 (p<0.0001) and increased BPM values (p<0.0001). Three patients (25%) presented PEF values between 50 and 80% of the predicted. Three of the 12 monitored patients presented events of desaturation (SpO2<92%). The experimental results were in close agreement with the involved pathophysiology, providing clear evidence that the proposed system can be a useful tool for the remote monitoring of patients with COVID-19. CONCLUSIONS: An emergency system for home monitoring of patients with COVID-19 was developed in the current study. The proposed system allowed us to quickly respond to early abnormalities in these patients. This system may contribute to conserving hospital resources for those most in need while simultaneously enabling early recognition of patients under acute deterioration, requiring urgent assessment.

Prenatal hypoxia predisposes vascular functional and structural changes associated with oxidative stress damage and depressive behavior in adult offspring male rats.

Intrauterine hypoxia-ischemia (HI) provides a strong stimulus for a developmental origin of both the central nervous system and cardiovascular diseases. This study aimed to investigate vascular functional and structural changes, oxidative stress damage, and behavioral alterations in adult male offspring submitted to HI during pregnancy. The pregnant Wistar rats had a uterine artery clamped for 45 min on the 18th gestational day, submitting the offspring to hypoxic-ischemic conditions. The Sham group passed to the same surgical procedure as the HI rats, without occlusion of the maternal uterine artery, and the controls consisted of non-manipulated healthy animals. After weaning, the male pups were divided into three groups: control, sham, and HI, according to the maternal procedure. At postnatal day 90 (P90), the adult male offspring performed the open field and forced swim tests. In P119, the rats had their blood pressure checked and were euthanized. Prenatal HI induced a depressive behavior in adult male offspring associated with a reduced vasodilator response to acetylcholine in perfused mesenteric arterial bed, and reduced superoxide dismutase and glutathione peroxidase activities in the aorta compared to control and sham groups. Prenatal HI also increased the vasoconstrictor response to norepinephrine, the media thickness, collagen deposition, and the oxidative damage in the aorta from adult male offspring compared to control and sham groups. Our results suggest an association among prenatal HI and adult vascular structural and functional changes, oxidative stress damage, and depressive behavior.

Willingness of Infertile Couples to Pay for In Vitro Fertilization Treatment in the Integrated Human Reproduction Section of the Escola Paulista de Medicina, São Paulo Federal University.

OBJECTIVE: To describe the willingness to pay (WTP) of infertile couples for in vitro fertilization (IVF) treatment. METHOD: This was a prospective study with an anonymous questionnaire for infertile couples in an academic setting. Clinical characteristics were analyzed by a Student's t test or Mann-Whitney test, categorical variables were compared by a chi-square or Fisher exact test, and correlations were assessed using a Spearman's test. An alpha of 5% was adopted. RESULTS: Mean female and male ages were 31.5 and 35.9 years, respectively; 80.2% were married; 19.8% were in consensual union; 48.1% of women had college degrees; and 49.4% of men had a high school education. Most women (77.8%) and men (75.3%) were white, with a household income of class C. Average duration of union was 8.5 years, and average infertility was 4.7 years. Using a willingness-to-pay (WTP) evaluation and the technique of "direct questioning," the average value was determined to be R$18 720.18 (by payment scale R$22 831.17). WTP positively correlated with household income and each woman's education level. Previous parenthood or use of public health system negatively correlated with WTP. CONCLUSION: We conclude that the higher the couple's monthly income and the woman's educational level, the higher the WTP for an IVF treatment; previous parenthood determined a lower WTP for an IVF treatment, and previous use of the Brazilian Unified Health System, determined a lower WTP for an IVF treatment.

Milk yield and composition from ewes fed diets containing narasin and their lambs' performance.

The changes promoted by feed additives in ruminal fermentation, especially increasing the availability of propionate, can improve the energy balance of an animal, which is of great importance in the lactation period. This trial aimed to evaluate the inclusion of narasin in the diet of lactating ewes on milk yield, composition, dry matter intake (DMI), and plasma metabolites of the ewes and growth rate of lambs. Thirty-two lactating ewes (59.0 ± 2.42 kg) were assigned to a randomized complete block design. The experimental diets contained 500 g/kg of dry matter (DM) of coast cross (Cynodon dactylon (L.) Pers) hay and 500 g/kg DM of concentrate, and the treatments were: N0-no narasin inclusion; N13-inclusion of 13 mg of narasin/kg DM. Once a week, from week 2 to 10 of lactation, ewes were separated from their lambs, injected with oxytocin, and milked mechanically to empty the udder. After 3 h, the milk production was recorded, using the same procedure, and sampled to evaluate the composition. The blood samples were taken weekly, 4 h after feeding. The average daily gain (ADG) and starter DMI of the lambs were evaluated weekly from week 2 to 12 of age. The inclusion of narasin did not affect (P = 0.93) DMI of ewes; however, it increased milk production (P < 0.01) and feed efficiency (P = 0.02; FE). Ewes fed N13 had a greater milk fat (P < 0.01), protein (P < 0.01), lactose (P = 0.04), and total solids production (P < 0.01). Narasin inclusion in ewe's diet increased plasma glucose concentration (P = 0.05) at weeks 8, 9 and 10; however, there was no effect on plasma urea concentration (P = 0.96). The lambs of N0 ewes had a greater starter DMI (P < 0.01) at weeks 7, 8, 9, and 10; however, the ADG and body weight at weaning and after weaning were similar between treatments (P > 0.05). The results showed that the inclusion of 13 mg of narasin/kg DM improved the milk production and FE of the ewes without altering the composition of the milk. The lower initial consumption of concentrate by N13 lambs before weaning was caused by the higher production of milk. The results obtained in the present study demonstrate the possible productive gain with the inclusion of narasin in diets for lactating ewes.

Implications of carbohydrate sources and rate of body weight gain on puberty in ewe lambs in tropical climate conditions.

The objectives were to evaluate the effects of two non-fibrous carbohydrate sources and the rate of body weight gain on puberty status in ewe lambs. Sixty ewe lambs (½ Dorper × ½ Santa Ines) with an initial body weight of 25.1 ± 4.1 kg and 102.8 ± 1.5 days old were distributed in a randomized complete block design with 10 blocks and 3 treatments. The trial lasted 119 days, in which performance was evaluated on days 28, 56, 84, and 119, and puberty status was every week evaluated by progesterone concentration. The treatments were characterized by the inclusion of different carbohydrate sources in the diets in order for ewe lambs to reach different rates of body weight gain: CORN, total diet containing 46% of corn (% DM); PCP, total diet containing 46% of pelleted citrus pulp (% DM); and HAY, total diet containing 80% of coastcross hay (% DM). The CORN- and PCP-based diets were formulated for an average daily gain (ADG) of 0.200 kg/day and a HAY-based diet for an ADG of 0.100 kg/day. There was an interaction between treatments and experimental periods for dry matter intake (DMI) (P < 0.01), in which lambs in the CORN treatment presented DMI similar to PCP in the first and second periods, but lambs from the PCP treatment presented lower DMI than the CORN treatment in subsequent periods. In all periods, the body weight, average daily gain, and feed efficiency of CORN lambs were similar to PCP lambs, but higher than HAY lambs. The age at puberty was not affected by treatments; however, lambs fed with non-fibrous carbohydrate sources reached puberty heavier (P < 0.0001) than lambs from the HAY treatment. Despite the high increase in body weight for lambs fed with non-fibrous carbohydrate sources, it did not affect the age of puberty.

Absenteísmo-doença entre trabalhadores terceirizados do serviço de higiene e limpeza de um hospital universitário do Município de São Paulo, 2015-17 / Sickness absenteeism among outsourced hygiene and cleaning workers at a university hospital in São Paulo, Brazil, 2015­2017

Introdução: Absenteísmo-doença é a ausência do trabalhador justificada por atestados médicos ou licença de saúde ao trabalho. Objetivo: Conhecer a frequência do absenteísmo-doença de curta duração (1 a 15 dias de afastamento), entre trabalhadores terceirizados do serviço de higiene e limpeza de um hospital universitário localizado na cidade de São Paulo. Métodos: Estudo de coleta retrospectiva de todos os atestados de saúde ­ médicos e odontológicos ­ recebidos pela empresa de limpeza contratada no período de dois anos (2015­2017). Os dados foram analisados por estatística descritiva de acordo com a natureza da variável (frequência absoluta e relativa para variáveis categóricas; medidas de tendência central e variabilidade para variáveis numéricas) e seguida do teste χ2 de Pearson. Resultados: Com 370 trabalhadores, a população do estudo foi caracterizada basicamente por mulheres (338; 91,4%) entre 30 e 50 anos de idade e de baixa escolaridade. A média de absenteísmo por mês foi de 5,2%, e a frequência do absenteísmo-doença, de 68,1%. As doenças mais prevalentes que causaram ao trabalhador o afastamento do trabalho foram as doenças osteomusculares (271; 20,7%) e as doenças do aparelho digestivo (141; 10,8%). O número de dias perdidos de trabalho foi de 8.788 no período do estudo. Conclusão: O perfil epidemiológico divide-se entre as doenças ocupacionais (doenças osteomusculares) e aquelas não relacionadas direta ou indiretamente às funções laborais. O percentual de dias perdidos por absenteísmo-doença foi considerado baixo, em proporção ao absenteísmo por todas as causas.

Background: Absenteeism refers to frequent absences from work without producing a medical certificate or having been granted sick leave. Objective: To establish the rate of short-term sickness absenteeism (1 to 15 days) among outsourced hygiene and cleaning workers at a university hospital. Methods: Retrospective analysis of all medical and dental certificates collected by the contractor along two years (2015 through 2017). Descriptive statistics analysis was performed according to the nature of variables (absolute and relative frequencies and measures of central tendency and variability for categorical and numerical variables respectively) followed by Pearson's χ2 test. Results: The study population consisted of 370 workers, most of whom were female (n=333, 91.4%), aged 30 to 50 and with low educational level. The monthly absenteeism rate was 5.2%, on average, and the sickness absenteeism rate 37.9%. The most prevalent reasons for sick leave were musculoskeletal disorders (n=271, 20.7%) and diseases of the digestive system (n=141, 10.8%). The total number of missed work days along the analyzed period was 8,788. Conclusion: The epidemiological profile of sick leave spells included both occupational diseases (musculoskeletal disorders) and conditions without direct or indirect relationship to work. The proportion of sickness absence was low relative to the overall absenteeism rate.

Real-World Evidence in Healthcare Decision Making: Global Trends and Case Studies From Latin America.

BACKGROUND: Real-world evidence (RWE) is increasingly used to inform health technology assessments for resource allocation, which are valuable tools for emerging economies such as in America. Nevertheless, the characteristics and uses in South America are unknown. OBJECTIVES: To identify sources, characteristics, and uses of RWE in Argentina, Brazil, Colombia, and Chile, and evaluate the context-specific challenges. The implications for future regulation and responsible management of RWE in the region are also considered. METHODS: A systematic literature review, database mapping, and targeted gray literature search were conducted to identify the sources and characteristics of RWE. Findings were validated by key opinion leaders attending workshops in 4 South American countries. RESULTS: A database mapping exercise revealed 407 unique databases. Geographic scope, database type, population, and outcomes captured were reported. Characteristics of national health information systems show efforts to collect interoperable data from service providers, insurers, and government agencies, but that initiatives are hampered by fragmentation, lack of stewardship, and resources. In South America, RWE is mainly used for pharmacovigilance and as pure academic research, but less so for health technology assessment decision making or pricing negotiations and not at all to inform early access schemes. CONCLUSIONS: The quality of real-world data in the case study countries vary and RWE is not consistently used in healthcare decision making. Authors recommend that future studies monitor the impact of digitalization and the potential effects of access to RWE on the quality of patient care.

A Comparison of UK and Brazilian SF-6D Preference Weights When Applied to a Brazilian Urban Population.

BACKGROUND: The 6-dimensional health state short form (SF-6D) is a health preference measure used in economic evaluations of many treatments. OBJECTIVES: To compare the results provided by the SF-6D index, when applied to a representative sample of the Brazilian population, using Brazilian and UK preference weights. METHODS: Five thousand individuals were assessed in the 5 regions of Brazil. Preference measures in healthcare were assessed using the SF-6D Brazil, version 2002. To calculate the single utility score, 2 preference weights were used: one established for the Brazilian population (SF-6D Brazil) and the other for the UK population (SF-6D UK). Agreement between the SF-6D Brazil and the SF-6D UK was assessed using the intraclass correlation coefficient, the Wilcoxon signed rank test, confidence intervals (CIs), and the Bland-Altman method. RESULTS: The mean values of the SF-6D Brazil and the SF-6D UK were 0.83 ± 0.15 and 0.84 ± 0.15, respectively. The intraclass correlation coefficient was 0.952 (CI 0.942-0.960; P<.010). The Wilcoxon signed rank test and CI showed a statistically significant difference between the 2 measures; this difference was, however, very small and considered clinically irrelevant (CI 0.011-0.013; P<.010). Using the Bland-Altman method resulted in a mean difference of 0.012 and the limits of agreement were between -0.077 and 0.101. CONCLUSIONS: The present study identified very small quantitative differences between UK- and Brazilian-derived SF-6D scores. Tests of agreement, however, showed that the impact of using different sets of preference weights in the construction of quality-adjusted life-year might be considered irrelevant.

Sickness absenteeism among outsourced hygiene and cleaning workers at a university hospital in São Paulo, Brazil, 2015-2017.

BACKGROUND: Absenteeism refers to frequent absences from work without producing a medical certificate or having been granted sick leave. OBJECTIVE: To establish the rate of short-term sickness absenteeism (1 to 15 days) among outsourced hygiene and cleaning workers at a university hospital. METHODS: Retrospective analysis of all medical and dental certificates collected by the contractor along two years (2015 through 2017). Descriptive statistics analysis was performed according to the nature of variables (absolute and relative frequencies and measures of central tendency and variability for categorical and numerical variables respectively) followed by Pearson's χ2 test. RESULTS: The study population consisted of 370 workers, most of whom were female (n=333, 91.4%), aged 30 to 50 and with low educational level. The monthly absenteeism rate was 5.2%, on average, and the sickness absenteeism rate 37.9%. The most prevalent reasons for sick leave were musculoskeletal disorders (n=271, 20.7%) and diseases of the digestive system (n=141, 10.8%). The total number of missed work days along the analyzed period was 8,788. CONCLUSION: The epidemiological profile of sick leave spells included both occupational diseases (musculoskeletal disorders) and conditions without direct or indirect relationship to work. The proportion of sickness absence was low relative to the overall absenteeism rate.

INTRODUÇÃO: Absenteísmo-doença é a ausência do trabalhador justificada por atestados médicos ou licença de saúde ao trabalho. OBJETIVO: Conhecer a frequência do absenteísmo-doença de curta duração (1 a 15 dias de afastamento), entre trabalhadores terceirizados do serviço de higiene e limpeza de um hospital universitário localizado na cidade de São Paulo. MÉTODOS: Estudo de coleta retrospectiva de todos os atestados de saúde - médicos e odontológicos - recebidos pela empresa de limpeza contratada no período de dois anos (2015-2017). Os dados foram analisados por estatística descritiva de acordo com a natureza da variável (frequência absoluta e relativa para variáveis categóricas; medidas de tendência central e variabilidade para variáveis numéricas) e seguida do teste χ2 de Pearson. RESULTADOS: Com 370 trabalhadores, a população do estudo foi caracterizada basicamente por mulheres (338; 91,4%) entre 30 e 50 anos de idade e de baixa escolaridade. A média de absenteísmo por mês foi de 5,2%, e a frequência do absenteísmo-doença, de 68,1%. As doenças mais prevalentes que causaram ao trabalhador o afastamento do trabalho foram as doenças osteomusculares (271; 20,7%) e as doenças do aparelho digestivo (141; 10,8%). O número de dias perdidos de trabalho foi de 8.788 no período do estudo. CONCLUSÃO: O perfil epidemiológico divide-se entre as doenças ocupacionais (doenças osteomusculares) e aquelas não relacionadas direta ou indiretamente às funções laborais. O percentual de dias perdidos por absenteísmo-doença foi considerado baixo, em proporção ao absenteísmo por todas as causas.

Stakeholder value judgments in decision-making on the incorporation, financing, and allocation of new health technologies in limited-resource settings: a potential Brazilian approach

[ABSTRACT]. Objective. To analyze the value judgments behind cost–benefit tradeoffs made by health stakeholders in deciding whether or not to incorporate new health technologies and how they should be financed and allocated in limited-resource settings in Brazil. Method. From June 2009 to January 2010, a sample of stakeholders in the public and private health sector was identified and invited to complete an online survey consisting of two questionnaires: one collecting socio-demographic/professional information and one capturing resource allocation preferences in four hypothetical scenarios for the incorporation of new health technologies. Results. A total of 193 respondents completed the survey; more than half were male (53.9%) and the most common age group was 31–40 years (36.8%). Scenario 1 (incorporation of a new drug treatment for chronic disease, by reducing/eliminating resources for existing programs) was rejected by 49.2% of the survey sample, who preferred to maintain the status quo for existing programs. Scenario 2 (incorporation of the same new treatment, but financed by a new tax) was rejected by 58.0%. Scenario 3 (incorporation of a new treatment for a highly lethal disease, by age group—20–75 years versus 75+ years—by reducing/eliminating resources for existing programs), was rejected by 42.0%, while 20.7% supported allocations for both groups, 34.2% supported allocations exclusively for the 20–75-year age group, and 3.1% supported allocations exclusively for the 75+ year age group. For Scenario 4, which consisted of five different resource allocations for prevention and treatment programs for another highly lethal disease, the most preferred option (chosen by 50.8% of respondents) was 75%:25% (prevention versus treatment). Conclusions. When incorporating a new health technology requires reducing/eliminating other health programs, financing it through a tax, or having to choose certain age groups (e.g., younger, working people versus older people), respondents are likely to reject it. When offered the choice of limiting the scope of the program (e.g., prevention versus treatment), respondents are likely to favor prevention. This was the first study in Brazil to capture value judgments that affect stakeholder decision-making on various resource allocations for different scenarios for health technology introduction in limited-resource settings. Future research should investigate the perspective of society as a whole to determine the best approach for decision-making based on common values and consensus within a particular health care system.

[RESUMEN]. Objetivo. Analizar los juicios de valor que subyacen las concesiones en términos de costo-beneficio que hacen los interesados directos en materia de salud al decidir si se incorporan nuevas tecnologías sanitarias y cómo deben financiarse y asignarse en los entornos con recursos limitados en Brasil. Método. De junio del 2009 a enero del 2010, se estableció una muestra de interesados directos en el sector público y privado de la salud y se los invitó a responder a una encuesta en línea que constaba de dos cuestionarios: uno que recopilaba información sociodemográfica y profesional, y otro que recogía las preferencias respecto a la asignación de recursos en cuatro situaciones hipotéticas para la incorporación de un nuevo tratamiento farmacológico. Resultados. En total, 193 personas respondieron la encuesta; más de la mitad eran hombres (53,9%) y el grupo etario más común fue de 31 a 40 años (36,8%). La situación 1 (incorporación de un nuevo tratamiento farmacológico mediante reducción o eliminación de los recursos para programas existentes) fue rechazada por 49,2% de la muestra de la encuesta, que prefirió que se mantuviera el statu quo para los programas existentes. La situación 2 (incorporación de un tratamiento nuevo, financiada por un nuevo impuesto) fue rechazada por 58,0%. La situación 3 (incorporación de un tratamiento nuevo por grupo etario, a saber, de 20 a 75 años frente a mayores de 75 años) fue rechazada por 42,0%, mientras que 34,2% apoyó la asignación exclusivamente para el grupo de 20 a 75 años y 3,1% apoyó la asignación exclusivamente para el grupo de mayores de 75 años. En cuanto a la situación 4, consistente en cinco asignaciones diferentes de recursos para un nuevo tratamiento farmacológico, la opción más preferida (elegida por 50,8% de los encuestados) fue de 75% a favor de la prevención y 25% a favor del tratamiento. Conclusiones. Cuando la incorporación de una nueva tecnología sanitaria requiere reducir o eliminar otros programas de salud, financiarla mediante un impuesto o tener que elegir a ciertos grupos etarios (por ejemplo, personas más jóvenes que trabajan frente a personas mayores), es probable que los encuestados la rechacen. Cuando se ofrece la opción de limitar el alcance del programa (por ejemplo, prevención frente a tratamiento), es probable que los encuestados favorezcan la prevención. Este fue el primer estudio en Brasil que ha recogido los juicios de valor que influyen en la toma de decisiones por los interesados directos sobre diversas asignaciones de recursos para diferentes situaciones de introducción de tecnologías sanitarias en los entornos con recursos limitados. Las investigaciones futuras deben indagar la perspectiva de la sociedad en su conjunto para determinar el mejor enfoque para la toma de decisiones basada en los valores comunes y el consenso dentro de un sistema de atención de salud particular.

[RESUMO]. Objetivo. Analisar a apreciação valorativa oculta nos trade-offs de custo-benefício feitas pelos interessados diretos da saúde ao decidirem se serão incorporados novos tratamentos medicamentosos e como eles serão custeados e alocados em cenários com recursos limitados no Brasil. Métodos. De junho de 2009 a janeiro de 2010, uma amostra de interessados diretos do setor público-privado da saúde foi identificada e convidada a responder uma pesquisa online compreendendo dois questionários: o primeiro para coleta de dados sociodemográficos/profissionais e o segundo para conhecer as preferências de alocação de recursos com a incorporação de um novo tratamento medicamentoso em quatro cenários hipotéticos. Resultados. Ao todo, 193 participantes responderam a pesquisa. Mais da metade da amostra era do sexo masculino (53,9%) e pertencia à faixa etária de 31 a 40 anos (36,8%). O cenário 1 (incorporação do novo tratamento medicamentoso com a redução ou a extinção de recursos para programas existentes) foi rejeitado por 49,2% da amostra estudada, que deram preferência a manter a situação corrente dos programas existentes. O cenário 2 (incorporação do novo tratamento custeado por um novo imposto) foi rejeitado por 58,0%. O cenário 3 (incorporação do novo tratamento por faixa etária: 20 a 75 anos ou acima de 75 anos) foi rejeitado por 42,0%, sendo que 34,2% apoiaram a alocação exclusiva para a faixa etária de 20 a 75 anos e 3,1%, para a faixa acima de 75 anos. Quanto ao cenário 4, que compreendia cinco tipos de alocação de recursos para o novo tratamento medicamento, a opção de maior preferência (indicada por 50,8% dos participantes) foi uma razão de 75% a 25% (para prevenção e tratamento, respectivamente). Conclusões. Quando a incorporação de uma nova tecnologia em saúde requeria a redução ou a extinção de outros programas de saúde, o custeio com a arrecadação tributária ou a escolha entre determinadas faixas etárias (por exemplo, população jovem, ativa ou idosa), os participantes tenderam a rejeitá-la. Quando eles tiveram a opção de restringir o alcance do programa (por exemplo, prevenção ou tratamento), verificou-se uma tendência a favor da prevenção. Trata-se do primeiro estudo realizado no Brasil para conhecer a apreciação valorativa que influencia a tomada de decisão dos interessados diretos em alocações variadas de recursos em diferentes situações para a introdução de tecnologia em saúde em cenários com recursos limitados. Outras pesquisas devem ser realizadas para investigar a perspectiva da sociedade como um todo a fim de se determinar a melhor perspectiva para a tomada de decisão fundada nos valores comuns e no consenso em um sistema de atenção de saúde em particular.

Internal Consistency of the SF-6D as a Health Status Index in the Brazilian Urban Population.

OBJECTIVES: To investigate the internal consistency of the SF-6D as a health status index in the Brazilian urban population. STUDY DESIGN: Cross-sectional population based study. METHODS: Five thousand individuals, older than the age of 15, were assessed in the five regions of the country. Two different methods of scoring the SF-6D where compared: "weighting the items" of the questionnaire through the Brazilian official weight coefficients, and "unweighting the items" through a parallel non preference scoring rule solely based on patients' answers to SF-6D health classification system (SF-6DHSI). Principal component factor analysis was used for the development of the SF-6DHSI. Pearson's, Spearman's, and intraclass correlation coefficients were used to assess the psychometric properties. RESULTS: The SF-6DHSI scoring formula summarized the pattern of factor loadings and the item-internal consistency (Cronbach's α = 0.858). The scale showed good item-internal consistency, exceeding the 0.70 standard. The association between weighted and unweighted (SF-6DHSI) scores was extremely high (Spearman's ρ = 0.971). The correlations of the SF-6DHSI with the Physical Component of the 12-Item Short-Form Health Survey (SF-12) and the Health Assessment Questionnaire was moderate to strong. The intraclass correlation coefficient obtained (0.917) also suggested that the concordance between the weighted and unweighted score distributions was prominent. CONCLUSIONS: A nonweighted approach to score the SF-6D provides a reliable global measure of health status. The SF-6D health classification system is useful for assessing quality of life in a large and representative sample of the Brazilian population.