OBJECTIVE: To report the decrease in breast imaging after covid-19 pandemic, obtaining the number of mammograms performed in 2019 and 2020. Additionally, to investigate if there was an increase in the proportion of women undergoing mammography for diagnostic purposes, with palpable lesions. METHOD: This is a cross-sectional study, based on the number of mammograms performed by the Brazilian public health services, provided by DATASUS, an open access database. Mammograms from private institutions were not included. This study compares the number of mammograms performed in 2019 and 2020, in women aged 50–69 years, stratified by month, in each federal state, and the presence of palpable lumps (physician-reported). RESULTS: In total, 1,948,471 mammograms were performed in 2019 and 1,126,688 in 2020, for the population studied. These values represent a 42% decline. Monthly, a significant decreased is observed after April 2020. The results varied slightly according to federal state; yet the entire country was affected. Rondônia was the most affected state, with 67% decline. The proportion of women presenting palpable lumps increased from 7.06% on average in 2019 to 7.94% in 2020 (OR = 1.135, 95%CI 1.125–1.145, p = 0,001). DISCUSSION: The number of mammograms performed in 2020 declined considerably. Out of the women who presented for mammogram, the proportion of palpable lumps was significantly higher in 2020. Considering the detection rate of digital mammography, the loss of 800,000 exams means 4,000 undiagnosed breast cancer cases, by the end of 2020.

We have previously reported the impact of covid-19 pandemic on breast cancer screening, in Brazil: among women aged 50–69 years, mammography attendance decreased by 42% in public healthcare (SUS), comparing 2019 and 2020. In this short communication, we wish to present: a) an update of the number of mammograms performed, in 2021; b) an exploratory analysis of the characteristics of the screened population between 2019 and 2021. A total of 1.675.307 mammograms were performed in 2021, nearly 15% lower than pre-pandemic levels. Almost a third, 29.5% of them, had intervals greater than three years. In accordance with our previous study, the number of patients with palpable lumps on physical exam increased. The consequences of postponing breast cancer screening during the pandemic are still uncertain. Unfortunately, as of December 2021, screening attendance has not resumed. On the contrary, our results show an increase in the fraction of women with mammography delayed beyond three years.

This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited.

Objective To promote informed choice for women and to compare home and hospital births in relation to the Apgar score. Methods Mother's profile and Apgar score of naturally born infants (without forceps assistance) in Brazil between 2011 and 2015, in both settings—hospital or home—were collected from live birth records provided by the Informatics Department of the Unified Health System (DATASUS, in the Portuguese acronym). For the analysis, were included only data from low-risk deliveries, including gestational time between 37 and 41 weeks, singleton pregnancy, at least four visits of prenatal care, infants weighing between 2,500 g, and 4,000 g, mother age between 20-40 years old, and absence of congenital anomalies. Results Home birth infants presented significantly higher risk of 0-5 Apgar scores, both in 1 minute (6.4% versus 3%, odds ratio [OR] = 2.2, confidence interval [CI] IC 2–2.4) and in 5 minutes (4.8% versus 0.4%, OR = 11.5, CI 10.5–12.7). Another finding is related to recovery estimates when from an initially bad 1-minute Apgar (< 6) to a subsequently better 5-minute Apgar (> 6). In this scenario, home infants had poorer recovery, Apgar score was persistently < 6 throughout the fifth minute in most cases (71% versus 10.7%, OR 20.4, CI 17–24.6). Conclusion The results show worse Apgar scores for babies born at home, compared with those born at the hospital setting. This is a pioneer and preliminary study that brings attention concerning differences in Apgar score related to home versus hospital place of birth in Brazil.

Comparação dos padrões da frequência cardíaca fetal no segundo e terceiro trimestres da gestação . Em cada período, a duração média dos intervalos de tempo entre sucessivos batimentos cardíacos fetais foi avaliada e mensurada em milisegundos (ms). A FCF média foi calculada em cada período, e também as diferenças entre períodos adjacentes. Os parâmetros incluíram: FCF basal, acelerações transitórias, duração dos episódios de alta variação, duração dos episódios de baixa variação e variação de curto prazo. Os resultados foram analisados pelos testes t de Student, teste do qui-quadrado e teste exato de Fischer. Foi adotado nível de significância de 0,05. RESULTADOS: dezoito gestações de 2ºT foram comparadas com 25 gestações de 3ºT. Houve diferença significativa nos parâmetros da FCF avaliada pela cardiotocografia computadorizada quando comparados os fetos de 2ºT e os de 3ºT em relação aos seguintes resultados: média da FCF basal (143,8 bpm versus 134,0 bpm, p=0,009), média do número de acelerações transitórias >10 bpm (3,7 versus 8,4, p<0,001) e >15 bpm (0,9 bpm versus 5,4 bpm, p<0,001), duração média dos episódios de alta variação (8,4 min x 15,4 min, p=0,008) e média da variação de curto prazo (8,0 ms versus10,9 ms, p=0,01). Em todos os exames o perfil biofísico fetal apresentou resultado normal. CONCLUSÕES: o presente estudo constata diferenças significativas nos padrões avaliados entre gestações de segundo e terceiro trimestres, e indica a influência da maturação do sistema nervoso autonômico na regulação da FCF.Abstract PURPOSE: to compare the patterns of fetal heart rate (FHR) in the second and third trimesters of pregnancy. METHODS: a prospective and comparative study performed between January 2008 and July 2009. The inclusion criteria were: singleton pregnancy, live fetus, pregnant women without clinical or obstetrical complications, no fetal malformation, gestational age between 24 and 27 weeks (2 nd trimester -2T) or between 36 and 40 weeks (3 rd trimester -3T). Computerized cardiotocography (System 8002 -Sonicaid) was performed for 30 minutes and the fetal biophysical profile was obtained. System 8002 analyzes the FHR tracings for periods of 3.75 seconds (1/16 minutes). During each period, the mean duration of the time intervals between successive fetal heart beats is determined in milliseconds (ms); the mean FHR and also the differences between adjacent periods are calculated for each period. The parameters included: basal FHR, FHR accelerations, duration of high variation episodes, duration of low variation episodes and short-term variation. The dataset was analyzed by the Student t test, chi-square test and Fisher's exact test. Statistical significance was set at p<0.05. RESULTS: eighteen pregnancies on the second trimester were compared to 25 pregnancies on the third trimester. There was a significant difference in the FHR parameters evaluated by computerized cardiotocography between the 2T and 3T groups, regarding the following results: mean basal FHR (mean, 143.8 bpm versus 134.0 bpm, p=0.009), mean