Resumen En Argentina, pocos estudios de costos evalúan los impactos del riego en la productividad, calidad y rentabilidad vitícola. Menos aún relacionando volumen, precio y costos del viticultor. Este artículo analiza la relación costo-volumen-utilidad en la producción de uva Torrontés Riojano bajo riego deficitario controlado (RDC) al 50% desde enero hasta la cosecha. En el Valle de Antinaco - Los Colorados, La Rioja, Argentina evaluamos variaciones del volumen de producción y calidad de las uvas. Luego, determinamos el punto de equilibrio, margen de seguridad, apalancamiento operativo y realizamos un estudio de sensibilidad sobre precios de venta. Los resultados muestran que el RDC por hectárea redujo los kilos de uva cosechados y los costos totales. Pero, los costos unitarios crecieron, afectando negativamente los niveles de equilibrio, seguridad y el apalancamiento operativo. La calidad enológica de la uva mejoró, pero el mercado mantuvo los precios fijos. Se concluye que el RDC contribuye al ahorro de agua, mejora la calidad de la uva, pero no la rentabilidad por hectárea. Así se abre la discusión sobre la rentabilidad como incentivo para expandir la superficie cultivada, economizando agua, sin perjudicar la calidad de las uvas en el sector vitícola provincial. JEL: M41.

Abstract In Argentina, few cost studies evaluate the impacts of irrigation on wine-growing productivity, quality and profitability. Even less relating volume, price and costs of the winegrower. This article analyzes the Cost-Volume-Profit ratio in the production of Torrontés Riojano grapes under controlled deficit irrigation (IDC) at 50% from veraison to harvest. In the Antinaco Valley - Los Colorados, La Rioja, Argentina we evaluate variations in the volume of production and quality of the grapes. Then, we determine the break-even point, margin of safety, operating leverage and perform a sensitivity study on sale prices. The results show that the IDC per hectare reduced the kilos of grapes harvested and the total costs. But, unit costs grew, negatively affecting break-even levels, security and operating leverage. The oenological quality of the grape improved, but the market maintained fixed prices. It is concluded that the IDC contributes to water savings, improves grape quality, but not profitability per hectare. This opens the discussion on profitability as an incentive to expand the cultivated area, saving water, without harming the quality of the grapes in the provincial wine sector. JEL: M41.

Résumé En Argentine, peu d’études sur les coûts évaluent les impacts de l’irrigation sur la productivité, la qualité et la rentabilité du vin. Encore moins en ce qui concerne le volume, le prix et les coûts du vigneron. Cet article analyse le rapport Coût-Volume-Utilité dans la production de raisins Torrontés Riojano sous irrigation déficitaire contrôlée (IDC) à 50% de la véraison à la récolte. Dans la vallée d’Antinaco - Los Colorados, La Rioja, Argentine, nous avons évalué les variations du volume de production et de la qualité des raisins. Ensuite, nous déterminons le pont mort, la marge de sécurité, le levier d’exploitation et réalisons une étude de sensibilité sur les prix de vente. Les résultats montrent que le IDC par hectare a réduit les kilos de raisins récoltés et les coûts totaux. Toutefois, les coûts unitaires ont augmenté, ce qui a eu un impact négatif sur le niveaux d’équilibre, la sécurité et le levier d’exploitation. La qualité œnologique des raisins s’est améliorée, mais le marché a maintenu les prix fixes. On en conclut que le IDC contribue aux économies d’eau, améliore la qualité des raisins, mais pas la rentabilité à l’hectare. Cela ouvre la discussion sur la rentabilité en tant qu’incitation à étendre la surface cultivée, en économisant l’eau, sans nuire à la qualité des raisins dans le secteur viticole provincial. JEL: M41.

Resumo Na Argentina, poucos estudos de custo avaliam os impactos da irrigação na produtividade, qualidade e rentabilidade do vinho. Menos ainda quando se trata do volume, preço e custos do viticultor. Este artigo analisa a relação Custo-Volume-Utilidade na produção de uvas Torrontés Riojano irrigadas por déficit controlado (RDC) a 50% do período de colheita até a colheita. No Vale Antinaco - Los Colorados, La Rioja, Argentina, avaliamos variações no volume de produção e qualidade das uvas. Em seguida, determinamos o ponto de equilíbrio, margem de segurança, alavancagem operacional e realizamos um estudo de sensibilidade sobre os preços de venda. Os resultados mostram que a RDC por hectare reduziu os quilos de uvas colhidas e os custos totais. Mas, os custos unitários cresceram, afetando negativamente os níveis de equilíbrio, a segurança e a alavancagem operacional. A qualidade enológica das uvas melhorou, mas o mercado manteve os preços fixos. Conclui-se que a RDC contribui para a economia de água, melhora a qualidade da uva, mas não a rentabilidade por hectare. Isso abre a discussão sobre a rentabilidade como incentivo à expansão da área cultivada, economizando água, sem prejudicar a qualidade das uvas no setor vitivinícola provincial. JEL: M41.

ABSTRACT Wild birds have great prominence in the transmission of diseases to humans, mainly due to their ease of access to human populations, raising concerns about the potential impact of that proximity on public health. The present study reports ARV and PBV occurrence in wild birds from an environmental protection area in the Amazon biome, in Pará state, Brazil. We obtained 155 fecal specimens from 47 species of wild birds for RNA extraction, ARV and PBV detection utilizing molecular methods, nucleotide sequencing, and phylogenetic analysis. ARV prevalence was 0.6% (1/155), being positive in an individual of Myrmotherula longipennis, and PBV prevalence was 1.29% (2/155), affecting two individuals of Guira guira. The PBV strains were assigned to genogroup I based on phylogenetic analysis, and they shared a strong phylogenetic link with strains isolated from different geographic locations. The ARV strain was more closely related to strains that had previously circulated in the same region. The presence of ARV and PBV in this habitat suggests that infection cycles of these agents occur naturally in the wild ecosystem, potentially triggering transmission events between bird species and humans. This is the first study on ARV detection in wild birds in Brazil and the first report on the occurrence of PBV in wild Guira guira. Additional studies are required to determine the epidemiology, origin, evolution, and emergence of new potentially pathogenic viruses in the Amazon. humans populations health biome state 15 4 extraction methods sequencing analysis 06 0 6 0.6 1/155, 1155 1/155 , 1 (1/155) longipennis 129 29 1.29 2/155, 2155 2/155 2 (2/155) guira locations region ecosystem epidemiology origin evolution 0. 115 1/15 (1/155 12 1.2 215 2/15 (2/155 11 1/1 (1/15 1. 21 2/1 (2/15 1/ (1/1 2/ (2/1 (1/ (2/ (1 (2 (

RESUMO As aves silvestres têm grande destaque na transmissão de doenças ao homem, principalmente pela facilidade de acesso à população humana, levantando preocupações sobre o potencial impacto dessa proximidade no contexto da saúde pública. O presente estudo relata a ocorrência de ARV e PBV em aves silvestres de uma área de proteção ambiental no bioma Amazônico. Obtivemos 155 espécimes fecais de 47 espécies de aves silvestres, que foram submetidos a extração de RNA, detecção de ARV e PBV por técnicas moleculares, sequenciamento nucleotídico e análise filogenética. A prevalência de infecção por ARV foi 0,6% (1/155), sendo positivo em um indivíduo de Myrmotherula longipennis, e a prevalência de PBV foi 1,29% (2/155), afetando dois insdivíduos de Guira guira. A análise filogenética agrupou as cepas de PBV no genogrupo I, mostrando intensa relação filogenética com cepas isoladas de outras regiões geográficas. A cepa de ARV esteve mais relacionada filogeneticamente a cepas previamente circulantes na mesma região. Este é o primeiro estudo sobre detecção de ARV em aves silvestres no Brasil e o primeiro relato sobre a ocorrência de PBV em Guira guira. A circulação de ARV e PBV nesse ambiente demonstra que os ciclos desses agentes estão ocorrendo de forma natural no ecossistema silvestre, o que pode desencadear possíveis eventos de transmissão entre as espécies aviárias e humanos. Estudos adicionais são necessários para determinar a epidemiologia, origem, evolução e surgimento de novos vírus potencialmente patogênicos na Amazônia. homem humana pública Amazônico 15 4 RNA moleculares 06 0 6 0,6 1/155, 1155 1/155 , 1 (1/155) longipennis 129 29 1,29 2/155, 2155 2/155 2 (2/155) guira I geográficas região silvestre humanos epidemiologia origem Amazônia 0, 115 1/15 (1/155 12 1,2 215 2/15 (2/155 11 1/1 (1/15 1, 21 2/1 (2/15 1/ (1/1 2/ (2/1 (1/ (2/ (1 (2 (

Abstract The aim of this study was to evaluate the expression of the EZH2 protein and describe the clinical and microscopic characteristics of adenoid cystic carcinoma (ACC) and pleomorphic adenoma (PA). The study included 16 ACC cases and 12 PA. All ACC and PA cases were positive for EZH2 and the ACC samples showed significantly higher EZH2 expression. The clinical and microscopic covariates were described in relation to EZH2 staining in ACC samples. The highest mean values of EZH2 were observed in cases with local metastasis, recurrence, perineural invasion, and predominantly cribriform growth pattern without solid areas. EZH2 is a potential marker of malignancy. EZH (ACC . (PA) 1 metastasis recurrence invasion areas malignancy (PA

ABSTRACT The use of Stizolobium aterrimum (velvet bean) as green manure has been encouraged in agriculture as a source of nitrogen-rich phytomass for incorporation into the soil to enhance subsequent crop yield. The nitrogen-fixing capacity of this legume can be optimized through symbiosis with selected strains of rhizobia. The aim of this study was to evaluate the effectiveness of new strains of Bradyrhizobium in promoting the growth of velvet bean plants, both in potted soil and in the field. The study involved three experiments (two in pots and one in the field) with four replications of each in an Oxisol. An additional experiment was carried out to estimate the native rhizobial community in the experimental soil. The efficiency of the strains was estimated by compared plant growth with them to plant growth in two non-inoculated controls (one without mineral N and the other with mineral N) and plant growth with the strain BR2811, which is approved as an inoculant for velvet bean plants. Evaluations of velvet bean were performed at 60 and 100 days after emergence in non-sterile soil pots, and at 170 days after sowing (at flowering) in the field. Native rhizobia are efficient in symbiosis with velvet bean, as they were similar to BR2811 and to the control with mineral N, but they had lower biological nitrogen fixation efficiency than the new strains tested–UFLA05-18 and UFLA05-20. The new strains increased velvet bean yield and accumulation of N in velvet bean phytomass and, therefore, have potential for being used as inoculants for this species. nitrogenrich rich nitrogenfixing fixing plants field Oxisol noninoculated non inoculated BR 6 10 nonsterile sterile 17 flowering BR281 tested–UFLA0518 testedUFLA0518 testedUFLA tested–UFLA05 18 tested UFLA05 UFLA tested–UFLA05-1 UFLA0520. UFLA0520 20. 20 UFLA05-20 therefore species 1 BR28 UFLA0518 tested–UFLA051 testedUFLA051 testedUFLA05 tested–UFLA0 UFLA0 tested–UFLA05- UFLA052 2 UFLA05-2 BR2 UFLA051 testedUFLA0 tested–UFLA UFLA05-

ABSTRACT Introduction: Medical Residency (MR) is considered, both academically and professionally, the gold standard method in teaching university graduates. The Integrated Residency Program in Family and Community Medicine (PIRMFC) in Fortaleza-CE brings together the programs of Universidade Federal do Ceará, the School of Public Health of Ceará and the City Hall of Fortaleza and is the first of its kind on a large scale, with about 70 residents in the first edition, implemented in a capital city, concomitantly with the process of implementation of the Family Health Strategy (ESF) service network by the City Hall. Objective: To evaluate an Integrated Residency Program in Family and Community Medicine, from the perspective of resident doctors. Method: This is an exploratory study, with a qualitative approach, using the Kirkpatrick model in its first level, reaction and satisfaction of residents. Data collection was carried out with the participation of 18 residents (R2) in five Focus Groups, in the second half of 2020. Questionnaires with closed questions were also applied to characterize the sample, followed by multiple-choice questions graded on a Likert scale. The qualitative data were analyzed by the Thematic Analysis technique and quantitative data through simple frequency and percentage. Results: The following main categories were identified: Teaching-learning strategies, Evaluation of the teaching-learning process, Production of autonomy, Transfer of training into practice, Weaknesses and Potentialities of the residency. Residents understand the responsibility they have in daily medical care, even if they are apprentices. They felt insecure as training subjects, feeling more comfortable when they are placed in the passive role. On the other hand, the program students recognize the active teaching-learning methodology as adequate for teaching adults but need strategies to be used to solve common problems in their professional practice. Conclusion: The Program was not able to establish the basis for the engagement of residents in some simulated active teaching-learning strategies, such as Tutorial Groups. It is necessary to value the experiences and competences heterogeneously acquired by the residents to constitute moments of equalization of learning, seeking the student’s protagonism instead of the imposition of knowledge. Introduction MR (MR considered professionally graduates PIRMFC (PIRMFC FortalezaCE CE scale 7 edition city ESF (ESF Objective doctors Method study approach level 1 R2 R (R2 Groups 2020 sample multiplechoice multiple choice percentage Results identified Teachinglearning Teaching learning teachinglearning autonomy practice residency care apprentices subjects role hand Conclusion student s knowledge (R 202 20 2

RESUMO Introdução: A residência médica (RM) é considerada acadêmica e profissionalmente o método padrão ouro no ensino de médicos egressos da universidade. O Programa Integrado de Residência em Medicina de Família e Comunidade (PIRMFC) de Fortaleza, no Ceará, reúne os programas da Universidade Federal do Ceará, da Escola de Saúde Pública do Ceará e da prefeitura, e é o primeiro do gênero em larga escala, contando com cerca de 70 residentes na primeira edição, implantado em uma capital, paralelamente ao processo de implantação da rede de serviços da Estratégia Saúde da Família (ESF) pela prefeitura. Objetivo: Este estudo teve como objetivo avaliar um PIRMFC a partir da ótica dos residentes. Método: Trata-se de uma pesquisa exploratória, com abordagem qualitativa, utilizando o modelo de Kirkpatrick no seu primeiro nível: reação e satisfação dos residentes. A coleta de dados foi realizada com a participação de 18 residentes (R2) em cinco grupos focais, no segundo semestre de 2020. Aplicaram-se também questionários com perguntas fechadas para caracterização da amostra, seguidas de questões de múltipla escolha graduadas em escala Likert. Os dados qualitativos foram examinados pela técnica de análise temática, e os quantitativos, por meio de frequências simples e percentuais. Resultado: Identificaram-se as seguintes categorias principais: estratégias de ensino-aprendizagem, avaliação do processo ensino-aprendizagem, produção de autonomia, transferência da formação para a prática, fragilidades e potencialidades da residência. Os residentes compreendem a responsabilidade que têm no atendimento médico diário, ainda que como aprendizes. Eles demonstram insegurança como sujeitos da formação, sentindo-se mais confortáveis quando são colocados no papel passivo. Contudo, os discentes do programa reconhecem a metodologia ativa de ensino-aprendizagem como adequada para o ensino de adultos, mas precisam que as estratégias estejam voltadas para a resolução de problemas comuns à prática profissional deles. Conclusão: O programa não conseguiu firmar bases para o engajamento dos residentes em algumas estratégias ativas simuladas de ensino-aprendizagem, como grupos tutoriais. É preciso valorizar as experiências e competências adquiridas heterogeneamente pelos residentes para compor momentos de equalização do aprendizado, buscando o protagonismo do aluno em vez da imposição de conhecimentos. Introdução RM (RM universidade (PIRMFC Fortaleza prefeitura 7 edição capital ESF (ESF Objetivo Método Tratase Trata se exploratória qualitativa nível 1 R2 R (R2 focais 2020 Aplicaramse Aplicaram amostra Likert temática quantitativos percentuais Resultado Identificaramse Identificaram principais ensinoaprendizagem, ensinoaprendizagem aprendizagem, aprendizagem autonomia diário aprendizes sentindose sentindo passivo Contudo adultos deles Conclusão tutoriais aprendizado conhecimentos (R 202 20 2

Abstract The coastal lagoons of the Tramandaí River basin are dynamic ecosystems characterized by high biodiversity. They provide important ecosystem services, such as water supply for human consumption, industry, agriculture, animal husbandry, leisure activities, tourism and fishing. Constant increases in the human population and the use and occupation of the land around the lagoons has brought growing demands for their resources, resulting in increased pressure that compromises these ecosystems. Understanding how biological populations respond to these anthropogenic pressures is essential. This study examined whether the degree of urbanization around 23 lagoons in the Tramandaí River basin influences the size and biomass of the characid fish species Diapoma alburnum. Specimens were collected between 2009 and 2012 using standardized drag nets. All specimens were measured for standard length to determine average length (size) per lagoon, while all fish collected per lagoon were weighed together to determine average biomass per lagoon by dividing by the number of specimens. Urbanization around the lagoons was measured using satellite images representing artificial nocturnal light as a proxy for urbanization. Nocturnal light intensity was measured within 1 km, 3 km, and 5 km buffers around each lagoon. The resulting urbanization index ranged 6 – 44% for the 5 km buffer, from 3 – 55% for the 3 km buffer and 1 – 65% for the 1 km buffer. Regression analyses showed a significant positive relationship with increasing urbanization around lagoons for D. alburnum average biomass in the 3 km and 5 km buffers and for D. alburnum average length in the 3 km buffer. Although urbanization around the lagoons is not fully established, the results indicate its impact on the size and biomass of D. alburnum. biodiversity services consumption industry agriculture husbandry activities fishing resources essential 2 200 201 nets (size 44 55 65 D established 20 4

Resumo As lagoas costeiras da bacia do Rio Tramandaí são ecossistemas dinâmicos que apresentam uma alta biodiversidade e fornecem importantes serviços ecossistêmicos como água para consumo humano, para indústrias, agricultura, criação animal, áreas para lazer, turismo e pesca. Com o constante aumento populacional e o uso e ocupação do solo ao entorno das lagoas, crescem as demandas por seus recursos, pressionando e comprometendo cada vez mais esses ecossistemas. Desta forma, faz-se necessário compreender como as populações biológicas respondem a essas pressões antropogênicas. Esse estudo tem por objetivo avaliar se diferenças no grau de urbanização ao entorno das lagoas afetam a biomassa e comprimento de uma espécie de Characidae (Diapoma alburnum) presente em 23 lagoas da bacia do rio Tramandaí. Exemplares foram coletados entre os anos de 2009 e 2012, utilizando redes de arrasto. Para a coleta e análise de dados foi medido o comprimento padrão dos indivíduos, e para biomassa foi feita a pesagem de todos os peixes, dividido pelo número de indivíduos coletados por lagoa. Para mensurar a urbanização ao entorno das lagoas, utilizou-se imagem de satélite representando luz noturna como proxy de urbanização e extraiu-se a intensidade de luz noturna em buffers de 1 km, 3 km e 5 km ao redor de cada lagoa. O índice de urbanização variou entre 6% e 44% para o buffer de 5 km, de 3% a 55% para o buffer de 3 km e 1% a 65% para o buffer de 1 km ao redor dessas lagoas. Os resultados de análises de regressões mostraram que D. alburnum apresentou relação significativa positiva para biomassa nos buffers de 3 km e 5 km, e uma relação significativa positiva no comprimento médio para o buffer de 3 km, conforme aumenta a urbanização ao entorno das lagoas costeiras. Evidenciamos neste estudo, que apesar da urbanização ao entorno das lagoas ainda não está totalmente consolidada, é possível ver impactos em tamanho e biomassa em populações de D. alburnum, e por ser mais tolerante a fatores de pressão antrópica, a espécie pode ser usada como bioindicador. humano indústrias agricultura animal lazer pesca recursos forma fazse faz antropogênicas Diapoma 2 200 2012 arrasto peixes lagoa utilizouse utilizou extraiuse extraiu 6 44 55 65 D consolidada antrópica bioindicador 20 201 4

Abstract Background Early rheumatoid arthritis (RA) offers an opportunity for better treatment outcomes. In real-life settings, grasping this opportunity might depend on access to specialized care. We evaluated the effects of early versus late assessment by the rheumatologist on the diagnosis, treatment initiation and long-term outcomes of RA under real-life conditions. Methods Adults meeting the ACR/EULAR (2010) or ARA (1987) criteria for RA were included. Structured interviews were conducted. The specialized assessment was deemed “early” when the rheumatologist was the first or second physician consulted after symptoms onset, and “late” when performed afterwards. Delays in RA diagnosis and treatment were inquired. Disease activity (DAS28-CRP) and physical function (HAQ-DI) were evaluated. Student's t, Mann-Whitney U, chi-squared and correlation tests, and multiple linear regression were performed. For sensitivity analysis, a propensity score-matched subsample of early- vs. late-assessed participants was derived based on logistic regression. The study received ethical approval; all participants signed informed consent. Results We included 1057 participants (89.4% female, 56.5% white); mean (SD) age: 56.9 (11.5) years; disease duration: 173.1 (114.5) months. Median (IQR) delays from symptoms onset to both RA diagnosis and initial treatment coincided: 12 (6–36) months, with no significant delay between diagnosis and treatment. Most participants (64.6%) first sought a general practitioner. Notwithstanding, 80.7% had the diagnosis established only by the rheumatologist. Only a minority (28.7%) attained early RA treatment (≤ 6 months of symptoms). Diagnostic and treatment delays were strongly correlated (rho 0.816; p < 0.001). The chances of missing early treatment more than doubled when the assessment by the rheumatologist was belated (OR 2.77; 95% CI: 1.93, 3.97). After long disease duration, late-assessed participants still presented lower chances of remission/low disease activity (OR 0.74; 95% CI: 0.55, 0.99), while the early-assessed ones showed better DAS28-CRP and HAQ-DI scores (difference in means [95% CI]: −0.25 [−0.46, −0.04] and − 0.196 [−0.306, −0.087] respectively). The results in the propensity-score matched subsample confirmed those observed in the original (whole) sample. Conclusions Early diagnosis and treatment initiation in patients with RA was critically dependent on early access to the rheumatologist; late specialized assessment was associated with worse long-term clinical outcomes.

Abstract Introduction Although Rheumatoid Arthritis (RA) extra-articular manifestations (ExtRA) occurrence has been decreasing over time, they are still a major mortality risk factor for patients. Objective To determine the prevalence of ExtRA in a large cohort, and its association with demographic and clinical variables. Method Cross-sectional and observational study, based on a multi-centric database from a prospective cohort, in which 11 public rheumatology centres enrolled RA patients (1987 ARA or 2010 ACR-EULAR). Data collection began in 08-2015, using a single online electronic medical record. Continuous variables were compared using Mann–Whit-ney U-test, and Fisher's exact test or chi-square test, as appropriate, were used for categorical variables. The level of significance was set at 5% (p < 0.05). Results 1115 patients were included: 89% women, age [mean ± SD] 58.2 ± 11.5 years, disease duration 14.5 ± 12.2 years, positive Rheumatoid Factor (RF, n = 1108) in 77%, positive anti-cyclic citrullinated peptide (ACPA, n = 477) in 78%. Regarding ExtRA, 334 occurrences were registered in 261 patients, resulting in an overall prevalence of 23.4% in the cohort. The comparison among ExtRA and Non-ExtRA groups shows significant higher age (p < 0.001), disease duration (p < 0.001), RF high titers (p = 0.018), Clinical Disease Activity index (CDAI) (p < 0.001), Disease Activity Index 28 (DAS 28) (p < 0.001), and Health Assessment Questionnaire (HAQ) (p < 0.001) in ExtRA group. Treatment with Azathioprine (p = 0.002), Etanercept (p = 0.049) Glucocorticoids (GC) (‘p = 0.002), and non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001) were more frequent in ExtRA group. Conclusions ExtRA manifestations still show an expressive occurrence that should not be underestimated. Our findings reinforce that long-term seropositive disease, associated with significant disability and persistent inflammatory activity are the key factors related to ExtRA development.

Abstract Background Management delays imply worse outcomes in rheumatoid arthritis (RA) and, therefore, should be minimized. We evaluated changes in diagnostic and treatment delays regarding RA in the last decades in Brazil. Methods Adults fulfilling the ACR/EULAR (2010) criteria for RA were assessed. Delays in diagnosis and treatment, and the frequencies of early management initiation within thresholds (windows of opportunity) of 3, 6, and 12 months from symptoms onset were evaluated. The Mann–Kendall trend test, chi-squared tests with Cramer’s V effect sizes and analysis of variance were conducted. Results We included 1116 patients: 89.4% female, 56.8% white, mean (SD) age 57.1 (11.5) years. A downward trend was found in diagnostic (tau = - 0.677, p < 0.001) and treatment (tau = - 0.695, p < 0.001) delays from 1990 to 2015. The frequency of early management increased throughout the period, with ascending effect sizes across the 3-, 6-, and 12-month windows (V = 0.120, 0.200 and 0.261, respectively). Despite all improvements, even in recent years (2011–2015) the diagnostic and treatment delays still remained unacceptably high [median (IQR): 8 (4–12) and 11 (5–17) months, respectively], with only 17.2% of the patients treated within the shortest, 3-month window. Conclusion The delays in diagnosis and treatment of RA decreased during the last decades in Brazil. Improvements (effect sizes) were greater at eliminating extreme delays (≥ 12 months) than in attaining really short management windows (≤ 3 months). Very early treatment was still an unrealistic goal for most patients with RA.

Abstract This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

Resumo O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Resumo O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Abstract This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

Resumo: O presente estudo tem o objetivo de caracterizar a população idosa brasileira durante a pandemia de COVID-19, considerando suas condições de saúde, socioeconômicas, desigualdade de sexo, adesão ao distanciamento social e sentimento de tristeza ou depressão. Estudo transversal realizado com idosos brasileiros que participaram de um inquérito de saúde (N = 9.173), com método de amostragem “bola de neve virtual”. Os dados foram coletados via web, por meio de questionário autopreenchido. Foram estimadas prevalências, intervalos de confiança e, para verificar a independência das estimativas, utilizou-se o teste qui-quadrado de Pearson. Durante a pandemia, houve diminuição da renda em quase metade dos domicílios dos idosos. O distanciamento social total foi adotado por 30,9% (IC95%: 27,8; 34,1) e 12,2% (IC95%: 10,1; 14,7) não aderiram. Idosos que não trabalhavam antes da pandemia aderiram em maior número às medidas de distanciamento social total. Grande parte apresentou comorbidades associadas ao maior risco de desenvolvimento da forma grave de COVID-19. Sentimentos de solidão, ansiedade e tristeza foram frequentes entre os idosos, especialmente entre as mulheres. A pandemia da COVID-19 aprofundou a desigualdade ao afetar os idosos mais vulneráveis. Estratégias para mitigar a solidão e o distanciamento social devem ser feitas levando-se em conta a vulnerabilidade social e a acentuada diferença entre homens e mulheres quanto à composição domiciliar e às condições socioeconômicas e de trabalho. Recomenda-se o desenvolvimento de pesquisas representativas da população idosa brasileira e que investiguem o impacto da pandemia neste grupo.

Resumen: El objetivo de este estudio es caracterizar a la población anciana brasileña durante la pandemia de COVID-19, considerando sus condiciones de salud, socioeconómicas, desigualdad de sexo, adhesión al distanciamiento social y sentimiento de tristeza o depresión. Es un estudio transversal realizado con ancianos brasileños que participaron en una encuesta de salud virtual (N = 9.173), con un método de muestra “bola de nieve virtual”. Los datos fueron recogidos vía web, mediante un cuestionario autocompletado. Se estimaron las prevalencias, intervalos de confianza y, para verificar la independencia de las estimaciones, se utilizó el test chi-cuadrado de Pearson. Durante la pandemia, hubo una disminución de la renta en casi la mitad de los domicilios de los ancianos. El distanciamiento social total fue adoptado por un 30,9% (IC95%: 27,8; 34,1) y 12,2% (IC95%: 10,1; 14,7) no se adhirieron. Los ancianos que no trabajaban antes de la pandemia se adhirieron en mayor número a las medidas de distanciamiento social total. Gran parte presentó comorbilidades asociadas a un mayor riesgo de desarrollo de la forma grave de COVID-19. Sentimientos de soledad, ansiedad y tristeza fueron frecuentes entre los ancianos, especialmente entre las mujeres. La pandemia de COVID-19 profundizó la desigualdad al afectar a los ancianos más vulnerables. Se deben elaborar estrategias para mitigar la soledad y el distanciamiento social, teniéndose en cuenta la vulnerabilidad social y la acentuada diferencia entre hombres y mujeres, respecto a la composición domiciliaria y las condiciones socioeconómicas y de trabajo. Se recomienda el desarrollo de investigaciones representativas de la población anciana brasileña, que investiguen el impacto de la pandemia en esta población.

Abstract: The goal of this study is to characterize the population of older adults in Brazil during the COVID-19 pandemic with regard to health, socioeconomic conditions, gender inequality, adherence to social distancing and feelings of sadness or depression. It is a cross-sectional study carried out with Brazilian older adults who responded to an online health survey (N = 9,173), using a “virtual snowball” sampling method. Data were collected online via a self-administered questionnaire. Prevalence and confidence interval estimates were performed and verified for independence using Pearson’s chi-square test. During the pandemic there was a fall in household income among almost half of older adults. Extreme social distancing was practiced by 30.9% (95%CI: 27.8; 34.1) and 12.2% (95%CI: 10.1; 14.7) did not adhere to it. Older adults who were not working before the pandemic adhered in greater numbers to extreme social distancing measures. Most of them presented comorbidities associated with a higher risk of developing the severe form of COVID-19. Feelings of loneliness, distress and sadness were frequent among older adults, especially women. The COVID-19 pandemic widened the inequality gap by affecting the most vulnerable older people. Strategies to mitigate loneliness and social distancing should consider social vulnerability and the marked difference between men and women in terms of household composition and socioeconomic and working conditions. The development of representative surveys of Brazilian older adults is recommended, investigating the impact of the pandemic on this population.