This article describes a proposed framework called Telehealth Service Maturity Model (TMSMM.br) for evaluating the current stage of telehealth centers in the Brazilian context. The steps included literature review, compilation and interpretation, data collection instrument, survey with center coordinators, model development, and evaluation process. The review resulted in 857 quality aspects for telehealth services, grouped into 12 themes with 34 topics. TMSMM.br consists of defining 3 foundational dimensions (themes, services, stages) and provides a standardized set of 200 requirements ordered across 5 thematic domains (structure, organization, user, operation and community) for 8 services (consultation, consultation, diagnosis, treatment and referral, education and training, social control and communication, healthcare network, and research, development, and innovation). TMSMM.br enables telehealth centers to identify and compare essential characteristics and their maturity stages.

Este artículo describe una propuesta de marco de referencia llamado Modelo de Madurez de Servicios de Telemedicina (TMSMM.br) para evaluar la etapa actual de los centros de telemedicina en el contexto brasileño. Las etapas incluyeron revisión de literatura, compilación e interpretación, instrumento de recolección, encuesta a coordinadores de centros, desarrollo del modelo y proceso de evaluación. La revisión resultó en 857 aspectos de calidad para servicios de telemedicina, agrupados en 12 temas con 34 tópicos. TMSMM.br consiste en la definición de 3 dimensiones estructurales (temas, servicios, etapas) y proporciona un conjunto estandarizado de 200 requisitos ordenados en 5 dominios temáticos (estructura, organización, usuario, operación y comunidad) para 8 servicios (consulta, asesoría, diagnóstico, tratamiento y remisión, educación y capacitación, control social y comunicación, red de atención de salud e investigación, desarrollo e innovación). TMSMM.br ayuda a los centros de telemedicina a identificar y comparar características esenciales y sus etapas de madurez

Este artigo descreve uma proposta de framework denominado Modelo de Maturidade de Serviços de Telessaúde (TMSMM.br) para avaliação do estágio corrente dos núcleos de telessaúde no contexto brasileiro. As etapas incluíram revisão da literatura, compilação e interpretação, instrumento de coleta, inquérito com coordenadores de núcleos, elaboração do modelo e do processo de avaliação. A revisão resultou 857 aspectos de qualidade para serviços de telessaúde, agrupados em 12 temas com 34 tópicos. TMSMM.br consiste na definição de 3 dimensões estruturantes (temas, serviços, estágios) e provê um conjunto padronizado de 200 requisitos ordenados em 5 domínios temáticos (estrutura, organização, usuário, operação e comunidade) para 8 serviços (consulta, consultoria, diagnóstico, tratamento e encaminhamento, formação e capacitação, controle social e comunicação, rede de atenção à saúde, e pesquisa, desenvolvimento e inovação). TMSMM.br colabora para que núcleos de telessaúde possam identificar e comparar características essenciais e seus estágios de maturidade.

ABSTRACT Introduction: Voiding diary (VD) is an important tool in the evaluation of children with voiding symptoms. Voiding frequency, maximal voided volume (MVV), average voided volume (AVV) and nocturnal volume (NV) can be extracted and are valuable in diagnosing and monitoring these disorders. Recently, ICCS has reduced the period of data recording on VD from 3 to 2 days. We hypothesized that one day voiding diary would be enough for guiding treatment. Materials and Methods: Children with overactive bladder (OAB) and primary monosymptomatic enuresis (PMNE) were oriented to fulfill a 3-day VD. Data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD), and all 3 days (3dVD) and compared according to the MVV, AVV, frequency, NV and expected bladder capacity (EBC). The Friedman, Student's t test and the Fisher's exact was used. ANOVA was used for multiple comparisons. We also used Pearson correlation test. Results: Ninety-eight children were included, 59 had PMNE and 30 OAB. Frequency, AVV and VN were similar regardless how many days the voiding episodes were recorded. Only MVV was higher by a mean of only 32 mL on 3dVD compared to 1dVD. A 1dVD has a sensitivity of 93,9% and a positive likelihood ratio of 2.2. As for the correlation of MVV and EBC it was observed that in 83% of children, MVV was lower than EBC. MVV corresponds to 67% and 69% of EBC in children with PMNE and OAB, respectively. Conclusion: We believe that 1dVD is sufficient to assess these children. It has a high sensitivity and good correlation to 3dVD in evaluating these children. Bladder capacity in this population, evaluated by maximum voided volume, was close to 68% of that obtained by the EBC.

ABSTRACT Objective To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. Methods This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman’s booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. Results The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). Conclusion Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men’s Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

Abstract Background This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. Methods This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. Results 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. Conclusions HAI increased during COVID-19. The microorganisms’ susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

ABSTRACT Purpose to describe which abilities of central auditory processing are more frequently related for the group of specialists to the performance of the speaker comparison test (CL), traditionally performed by forensic experts. Methods a prospective, descriptive study with quantitative and qualitative analysis and data were obtained through a consensus of experts. Five speech therapists participated in the meeting, two specialists in audiology (EA), two specialists in voice (VS), and an expert speech therapist (FP). The meeting was held virtually and synchronously, lasting 1 hour and 30 minutes. The tasks performed during the Speaker Comparison (LC) exam were considered from a protocol available in the literature. The AEs received explanations about each of the tasks and were asked to discuss which auditory processing skills (ACP) would be involved in the performance of each of them. Results seven PAC skills were considered in the experts' meeting as essential for the tasks performed in the CL exam. Temporal ordering was the most cited skill, being present in six tasks, and the speech material transcription task is the one that requires more skills from the PAC. Conclusion Seven PAC skills were considered in the experts' meeting as essential for the tasks performed in the CL exam. Temporal ordering was the most cited skill, being present in six tasks, and the speech material transcription task is the one that requires more skills from the PAC.

RESUMO Objetivo descrever quais são as habilidades auditivas do processamento auditivo central mais frequentes, relatadas por um grupo de especialistas para a realização do exame de Comparação de Locutor, tradicionalmente realizado por peritos forenses. Métodos estudo prospectivo, descritivo, com análise quantitativa e qualitativa. Os dados foram obtidos por meio de um consenso de especialistas. Participaram da reunião cinco fonoaudiólogos, sendo dois especialistas em audiologia, dois especialistas em voz e uma fonoaudióloga perita. A reunião foi realizada de forma virtual e síncrona, com duração de uma hora e 30 minutos. As tarefas realizadas durante o exame de Comparação de Locutor foram consideradas a partir de um protocolo disponível na literatura. As especialistas em fonoaudiologia receberam explicações a respeito de cada uma das tarefas e foram solicitadas a discutir sobre quais as habilidades do processamento auditivo central estariam envolvidas na execução de cada uma delas. Resultados sete habilidades foram consideradas na reunião dos especialistas como imprescindíveis para as tarefas realizadas no exame de Comparação de Locutor. A ordenação temporal foi a habilidade mais citada, podendo estar presente em seis tarefas, e a tarefa de transcrição do material de fala foi mencionada como sendo a que necessita de mais habilidades do processamento auditivo central. Conclusão Sete habilidades foram consideradas na reunião dos especialistas como imprescindíveis para as tarefas realizadas no exame de Comparação de Locutor. A ordenação temporal foi a habilidade mais citada, podendo estar presente em seis tarefas e a tarefa de transcrição do material de fala foi mencionada como sendo a que necessita de mais habilidades do processamento auditivo central

ABSTRACT Background: Many gaps in the copaifera oleoresin yield remain unfulfilled, preventing the sustainable management of this valuable non-timber forest product. This work aimed to characterize a natural Copaifera reticulata population in the Amazon rainforest, test different positions and depths in the trees to flow oleoresin, and analyze changes in the productiveness between two harvests ten months-spaced. The study was conducted in a Brazilian rainforest area at the Jari Ecological Station (ESEC) in 2017 and 2018, including 26 trees. Results: The diametric and height distributions evidenced light-demanding and mostly medium-class-diameter trees. The annual increment (0.45 ± 0.003 cm/year) was average, while the occurrence was rare. The area hosts yielding and unyielding trees, providing an average oleoresin production of 603.60 mL/tree. Oleoresin only flowed by reaching the inner heartwood or the pith. Oleoresin was not fully replenished after ten months, but the first drilling stimulated some unyielding trees to deliver it later. Collecting should focus on medium-diameter trees. Conclusion: The growth and distribution behaviors may challenge Copaifera’s sustainable management, which depends on the individual tree mechanisms to provide and replenish the oleoresin.

RESUMO O artigo aprofunda estudos acerca da produção flexível em montadoras no sul fluminense. A revisão da literatura está focada nos papéis dos múltiplos atores - governos locais, sindicatos e trabalhadores -, e no impacto da flexibilidade nas condições de trabalho no setor automotivo. A abordagem interdisciplinar adotada busca desvelar vozes dos trabalhadores que contestam marcas da produção flexível no sul fluminense quanto ao ideal discursivo do encadeamento produtivo, do desenvolvimento regional ou da gestão da produção nas montadoras. A metodologia qualitativa está fundamentada em abordagem discursiva com distintos níveis de análise. A coleta de dados foi realizada por meio de entrevistas com 38 participantes que representam prefeituras, sindicato regional e trabalhadores das montadoras. Da análise dos resultados depreende-se contradições da qualidade e quantidade do emprego de massa, das políticas públicas defasadas e instrumentalizadas pelas montadoras Jaguar Land Rover, MAN, Nissan e PSA Peugeot Citroen, e o retrocesso das condições de trabalho no nível operacional. Ao privilegiar as vozes dos trabalhadores, foi possível desvelar dos elementos retóricos de maior apelo da produção flexível automotiva as contestações em face dos discursos historicamente acoplados aos agentes econômicos e políticos no sul fluminense.

The article deepens studies on the flexible production in automakers in the south of Rio de Janeiro. The literature review is focused on the roles of multiple players - local governments, unions and workers - and on the impact of flexible production in the work conditions in automotive subsidiaries. The interdisciplinary approach adopted aims to unveil workers' voices that contest marks of the flexible production in the discursive ideal of the productive chain, of the regional development or production management. The qualitative methodology is grounded on a discursive approach with distinct levels of analysis. The data collection was accomplished through interviews with 38 individuals that represent local government, regional union and workers from subsidiaries. The analysis of the results expose contradictions in the quality and quantity of mass employment, outdated public policies used by the automakers Jaguar Land Rover, MAN, Nissan e PSA Peugeot Citroen, and the setback of working conditions at the operational level. By privileging the voices of workers, it was possible to unveil from the most appealing rhetorical elements of flexible automotive production the challenges in the face of discourses historically linked to economic and political agents in the south of Rio de Janeiro.

El artículo profundiza los estudios sobre la producción flexible en las automotrices del sur de Río de Janeiro. La revisión de la literatura se centra en los roles de múltiples actores - gobiernos locales, sindicatos y trabajadores - y el impacto de la flexibilidad en las condiciones de trabajo en el sector automotriz. El abordaje interdisciplinario adoptado busca revelar las voces de los trabajadores que cuestionan los marcos de la producción flexible en el sur de Río de Janeiro sobre el ideal discursivo de encadenamiento productivo, desarrollo regional o gestión de la producción en las automotrices. La metodología cualitativa se basa en un enfoque discursivo con diferentes niveles de análisis. La recolección de datos se realizó a través de entrevistas con 38 participantes representantes de prefecturas, sindicatos regionales y trabajadores de las automotrices. Del análisis de los resultados se desprenden las contradicciones en la calidad y cantidad del empleo masivo, las políticas públicas desfasadas e instrumentalizadas por las automotrices Jaguar Land Rover, MAN, Nissan y PSA Peugeot Citroen, y el retroceso de las condiciones de trabajo a nivel operativo. Al privilegiar las voces de los trabajadores, fue posible revelar a partir de los elementos retóricos de mayor atractivo de la producción automotriz flexible las contestaciones frente a discursos históricamente vinculados a los agentes económicos y políticos del sur de Río de Janeiro.

RESUMO A castanheira-da-amazônia (Bertholletia excelsa) é nativa da floresta amazônica e sua produção de frutos varia naturalmente com as condições climáticas. Nosso objetivo foi avaliar a variação temporal na produção de frutos da castanheira associada a variáveis climáticas, incluindo o forte El Nino de 2015/2016. O estudo foi realizado em parcelas permanentes de 9 ha de 2007 a 2018, uma localizada em floresta (12 anos de monitoramento) e a outra em transição floresta/savana (oito anos). Em total, monitoramos 205 castanheiras com diâmetro à altura do peito ≥ 50 cm. A produção anual de frutos foi relacionada a séries temporais (2005-2018) de dados climáticos (o Índice Oceânico Niño; e a precipitação e temperatura do ar de duas estações meteorológicas locais). A produção média por castanheira em 2017 foi oito vezes menor que em 2015 e duas vezes menor que a média geral nos dois sítios, e foi significativamente associada ao El Niño de 2015/2016, que causou aumento na temperatura máxima mensal e redução na precipitação regional, prolongando a estação seca de três para seis meses. Os anos com maior e menor produção média por castanheira foram os mesmos nos dois ambientes. A produção anual de frutos foi significativa e negativamente correlacionada com as anomalias térmicas ocorridas no terceiro semestre antes da colheita. Anos de maior produção foram relacionados com predominância de neutralidade ou do fenômeno La Niña em escala global, e aumento da precipitação em nível local. A relação entre produção de frutos e clima foi independente do ambiente local.

ABSTRACT The Brazil-nut tree (Bertholletia excelsa) is native to the Amazon rainforest, and its fruit production varies naturally with climatic conditions. Our aim was to evaluate the temporal variation in Brazil-nut production associated with climatic variables, including the strong El Niño of 2015/2016. The study was carried out in two 9-ha permanent plots in the northeastern Brazilian Amazon from 2007 to 2018: one in forest (12-year monitoring) and the other in savannah/forest transition (eight years). Overall, we monitored fruit production of 205 trees with diameter at breast height ≥ 50 cm. Annual fruit production was related to temporal series (2005-2018) of climatic data (the Oceanic Niño Index; and precipitation and air temperature from two local meteorological stations). Average fruit production per tree in 2017 was eight times lower than in 2015 and two times lower than the general average for both sites, and was significantly associated to the El Niño of 2015/2016, that increased average maximum monthly temperature and reduced the precipitation in the region, extending the dry season from three to six months. Years with higher and lower fruit production per tree coincided in both sites. Annual fruit production was significantly and negatively correlated with thermal anomalies that occurred in the third semester prior to harvest monitoring. Years with higher production were related with predominance of neutrality or the La Niña phenomenon at the global scale, and higher rainfall at the local scale. The relationship of fruit production with climate was independent of the local habitat.

Resumo Dinâmicas contrárias à vida da maioria, mobilizadas pelo capitalismo neoliberal neoimperial rumo ao populismo neofascista, ficaram virtualmente invisibilizadas para o campo da gestão/administração. Analisamos esse quadro de radicalização da colonialidade global em uma era de império e descolonização protagonizado pelo neoliberalismo contrarrevolucionário, enfrentando dinâmicas de desocidentalização e descolonização, a partir de um diálogo Sul-Norte entre Teoria/Opção Pensamento Decolonial e Realismo Crítico. Por meio da proposição de um framework transmoderno crítico/decolonial, desvelamos dinâmicas de invisibilização/visibilização contrárias à vida da maioria alimentadas por dinâmicas de negação e apropriação-contenção de materialidades e epistemes sulistas, lideradas e invisibilizadas pelo discurso dominante de mercado livre que vem sendo reproduzido e contestado pela universidade liberal e suas escolas de negócios/gestão. Ao final, propomos a recuperação da relevância ampliada da “administração/gestão” engajada com a maioria, por meio de dinâmicas de reapropriação para a de-subalternização do invisibilizado engajado com a práxis transmoderna de libertação-emancipação e “des-celebração” do mercado livre.

Abstract Dynamics contrary to the life of the majority mobilized by neo-imperial neo-liberal capitalism evolving toward neo-fascist populism has become virtually invisible to the field of Management/Administration, which is driven by dynamics of appropriation-contention focused on alternatives and transmodern epistemes of the emerging South-East. We analyze this picture of radicalization of global coloniality within the context of counterrevolutionary neoliberalism facing dynamics of dewesternization and decoloniality from a South-North dialogue between Decolonial Theory/Option and Critical Realism. By proposing a critical/decolonial transmodern framework, we unveil dynamics of invisibilization/visibilization against the life of the majority, invisibilized by market sub-theorization and dominant discourse and by the liberal university and its business/management schools. In the end, we propose to recover the expanded relevance of “administration/management” engaged with the majority, through reappropriation dynamics based on de-subalternization of non-market and ‘de-celebration’ of free market.

Resumen Introducción: Pentaclethra macroloba es un árbol hiperdominante en el estuario del Amazonas, de gran importancia socioeconómica para la región, pues el aceite de sus semillas es un poderoso medicamento natural. Objetivo: Nuestro objetivo fue caracterizar la estructura morfológica, las adaptaciones morfológicas en respuesta a las inundaciones diarias del estuario del Amazonas y el área biogeográfica de P. macroloba. Métodos: Una descripción detallada de la morfología externa, desde la germinación hasta el árbol adulto, se obtuvo de individuos ubicados en el bosque periódicamente inundado, al noreste de la Amazonia. El área de ocupación y la extensión geográfica de P. macroloba se determinaron a partir del punto de coordenadas geográficas de muestras botánicas depositadas en las colecciones digitales de Mobot y SpeciesLink. Resultados: Los individuos adultos tienen estructuras adaptadas en respuesta a las inundaciones diarias, tales como: raíces adventicias para aumentar la eficiencia respiratoria y lenticelas en el tronco, que sirven como punto de conexión para el transporte de oxígeno entre la raíz y la parte aérea. Los frutos secos favorecen la activación del mecanismo de dehiscencia explosiva, permitiendo que la semilla sea expulsada a larga distancia. La forma deltoidea de la semilla permite la fluctuación en el agua y una dispersión más eficiente. La plántula es hipogel fanerocotiledones y con un par de cotiledones de reserva que proporcionan a la plántula una fuente extra de energía para escapar de la inundación. La tasa de germinación fue del 78 % y la velocidad fue de 0.2 semillas día-1. El método Circular buffer reveló la presencia de 123 subpoblaciones de P. macroloba distribuidas en un radio de 5 699 943 km² a lo largo de la región neotropical. Conclusiones: Gran parte de las estructuras morfológicas de P. macroloba son respuestas adaptativas y evolutivas al ambiente periódicamente inundado del estuario del Amazonas, lo que demuestra que estos ambientes actúan como filtro ambiental seleccionado las especies mejor adaptadas al medio. Su amplia área geográfica denota la plasticidad de adaptarse a diferentes ambientes, lo que puede justificar su monodominancia en algunas regiones.

Abstract Introduction: Pentaclethra macroloba is a hyperdominant tree in the Amazon estuary of great socioeconomic importance for the region because the oil from its seeds is a powerful herbal medicine. Objective: We aimed to characterize the morphological structure, the morphological adaptations in response to the daily flooding of the Amazon estuary and the biogeographic area of P. macroloba. Methods: Detailed description of the external morphology, from germination to the adult tree, was obtained from individuals located in floodplain forest, Northeast Amazonia. The occupation area and the geographical extension of P. macroloba were determined from point of geographical coordinates of botanical samples deposited in the digital collections of Mobot and SpeciesLink. Results: Adult individuals have adapted structures in response to daily flooding, such as: adventitious roots to increase respiratory efficiency and lenticels in the trunk, serving as a connection point for oxygen transport between the root and the aerial part. Dried fruit favours the activation of the explosive dehiscence mechanism, allowing the seed to be expelled long distance. Deltoid shape of the seed allows water fluctuation and more efficient dispersal. Seedling is phanerocotylar hypogeal and with one pair of reserve cotyledons that provide the seedling an extra source of energy to escape the flood. Germination rate was 78 % and the speed was 0.2 seeds.day-1. Circular buffer method revealed the presence of 123 subpopulations of P. macroloba distributed in a radius of 5 699 943 km² across the Neotropical region. Conclusions: Much of the morphological structures of P. macroloba are adaptive and evolutionary responses to the periodically flooded environment of the Amazon estuary, showing that these environments select the trees, best adapted, to inhabit the flood. P. macroloba has a wide geographical area denotes the plasticity of adapting to different environments, which may justify its monodominance in some regions.

Resumo Esta pesquisa objetiva refletir sobre a presença do endividamento no cotidiano urbano. Com enfoque no endividamento imobiliário, revela um caminho que envolve pesquisas iniciadas com relação à metrópole de São Paulo e que tiveram continuidade com a Região Metropolitana do Rio de Janeiro. Um de seus principais propósitos é enfrentar a carência de dados e o silenciamento do debate acerca da presença do endividamento imobiliário e da consequente expulsão silenciada. Como desafio, busca corporificar seus estudos, com centralidade no entrecruzamento dos dados de gênero e classe social e com recorte analítico nos editais de leilões de imóveis da Caixa Econômica Federal, refletindo e revelando uma Geografia do Endividamento. Além disso, dá os passos iniciais para um diálogo crítico sobre o peso da dívida e da casa para a mulher em um contexto de precarização, assimetria de remuneração e significação hierárquica entre trabalho produtivo e reprodutivo.

Abstract This research intends to reflect on the presence of indebtedness in urban daily life. With a focus on housing indebtedness, it reveals a path of research followed, from research for the metropolis of São Paulo to Rio de Janeiro. It has as one of its main purposes to face the lack of data and the silencing of debate about the presence of real estate indebtedness and the consequent silenced expulsion. As a challenge, it aims to embody its studies, with a central focus on the intersection of gender and social class data. It has an analytical cut in the Real Estate Auction Notice of Caixa Econômica Federal, reflecting and revealing a Geography of Debt. Besides that, it takes the initial steps to critically discuss the weight of debt and the home for women in a context of precariousness, asymmetry of remuneration and hierarchical significance between productive and reproductive work.

OBJECTIVE: This study aimed to evaluate the occurrence of coronavirus disease 2019 (COVID-19) in hemodialysis facilities and the occurrence of and risk factors for clustering of COVID-19 cases. METHODS: We conducted a cross-sectional online survey between March and July 2020, in all dialysis facilities in São Paulo state, using Google Forms. The online questionnaire contained questions addressing specific components of infection prevention and control practices and the number of cases during the COVID-19 pandemic. RESULTS: A total of 1,093 (5%) COVID-19 cases were reported among 20,984 patients; approximately 56% of the facilities had ≥1 cluster. Most facilities implemented various measures (such as allocation of dedicated COVID-19 areas/shifts, symptom screening, environmental disinfection, and maintenance of adequate ventilation) to prevent the transmission of severe acute respiratory syndrome coronavirus 2. Clustering of COVID-19 cases was suspected in only 7% of dialysis facilities. The only variable associated with this event was the performance of aerosol-generating procedures (odds ratio: 4.74; 95% confidence interval: 1.75-12.86). CONCLUSION: Attention should be paid to avoiding the performance of aerosol-generating procedures in dialysis facilities and monitoring the clustering of cases.

RESUMO CONTEXTO: A deficiência de cobre tem sido relacionada a alterações no metabolismo lipídico e esteatose hepática. O estresse oxidativo desempenha um papel fundamental na fisiopatologia da doença hepática gordurosa não alcoólica. Uma das enzimas que neutralizam o estresse oxidativo é a Cobre/Zinco superoxido dismutase, que depende da disponibilidade de quantidades adequadas de cobre. OBJETIVO: Correlacionar os níveis de ceruloplasmina e de cobre não ligado à ceruloplasmina (NCBC) com parâmetros clínicos, bioquímicos e histológicos de pacientes com doença hepática gordurosa não alcoólica (DHGNA). MÉTODOS: Dados de 95 pacientes com DHGNA internados consecutivamente e submetidos à biópsia hepática compuseram os grupos com base em níveis de ceruloplasmina inferiores a 25 mg/dL e em NCBC negativo. Os fatores de risco para DHGNA em cada grupo foram comparados. RESULTADOS: O índice de massa corporal foi menor nos pacientes com ceruloplasmina <25 mg/dL (29,1±3,47 vs 32,8±6,24 kg/m2; P=0,005), assim como os níveis de LDL, HDL e colesterol total, quando comparados aos seus pares com ceruloplasmina >25 mg/dL (101±38 vs 116±35 mg/dL, P=0,05; 43±9 vs 51±16 mg/dL, P=0,01; 174±43 vs 197±39 mg/dL, P=0,01, respectivamente). Os níveis médios de ferritina sérica foram maiores no grupo ceruloplasmina <25 mg/dL (343±327 vs 197±190 mg/mL; P=0,02). Os pacientes com NCBC negativo apresentaram maior HOMA-IR (8,2±14,7 vs 4,6±3,7; P=0,03). Idade, sexo, hipertensão e diabetes não mostraram diferença estatística. CONCLUSÃO: Pacientes com DHGNA apresentaram diferentes marcadores clínicos e bioquímicos de acordo com os níveis de NCBC e ceruloplasmina.

ABSTRACT BACKGROUND: Copper deficiency has been linked to alterations in lipid metabolism and hepatic steatosis. Oxidative stress plays a role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). One of the enzymes that neutralize oxidative stress is Cu/Zn superoxide dismutase, which depends on the availability of adequate amounts of copper. OBJECTIVE: Correlate the levels of ceruloplasmin and of non-ceruloplasmin-bound copper (NCBC) with clinical, biochemical and histological parameters of non-alcoholic fatty liver disease (NAFLD) patients. METHODS: Data from 95 consecutively admitted NAFLD patients who underwent liver biopsy composed the groups based on ceruloplasmin levels lower than 25 mg/dL and on negative NCBC. The risk factors for NAFLD in each group were compared. RESULTS: Body mass index was lower in patients with ceruloplasmin <25 mg/dL (29.1±3.47 vs 32.8±6.24 kg/m2; P=0.005) as were the levels of LDL, HDL and total cholesterol, when compared with their counterparts with ceruloplasmin >25 mg/dL (101±38 vs 116±35 mg/dL, P=0.05; 43±9 vs 51±16 mg/dL, P=0.01; 174±43 vs 197±39 mg/dL, P=0.01, respectively). Mean serum ferritin levels were higher in the ceruloplasmin <25 mg/dL group (343±327 vs 197±190 ng/mL; P=0.02). Otherwise, patients with negative NCBC had higher HOMA-IR (8.2±14.7 vs 4.6±3.7; P=0.03). Age, gender, hypertension and diabetes showed no statistical difference. CONCLUSION: Patients with NAFLD had different clinical and biochemical markers according to the levels of NCBC and ceruloplasmin.

Resumo: Introdução: A realização de residência médica (RM) é uma vertente de qualificação considerada “padrão ouro” para a especialização médica. A compreensão dos motivos que levam ou não à maior fixação do profissional estimulado pela RM e a identificação dos fatores que dificultam a permanência do médico no local ou contribuem para isso são importantes informações para a estruturação dos programas de RM e sistema de saúde. O objetivo deste estudo foi avaliar a prevalência de fixação dos egressos no estado do Tocantins, após a implantação das residências médicas no período de 2013 a 2017. Método: Trata-se de uma pesquisa observacional do tipo quantitativo, com delineamento transversal, de caráter descritivo e analítico, com uso da técnica telematizada e questionário próprio, realizada com 44 egressos dos programas de RM no estado do Tocantins. O projeto foi revisado e aprovado pelo Comitê de Ética da Universidade Federal do Tocantins (UFT) sob o Parecer nº 2.292.540. Resultados: A prevalência de fixação foi de 65,9% dos médicos no estado do Tocantins. A maioria dos residentes era do sexo feminino (59,1%), com idade média de 30,8±3,1 anos e renda entre dez e 20 salários mínimos (55,8%), e trabalhou durante a residência (84,1%). As especialidades com maior índice de fixação foram as cirurgias geral e médica. No caso desse estudo, a maioria dos participantes atua nas redes privada e estadual. O principal motivo para não fixação no Tocantins foi cursar outra residência ou subespecialidade em outro estado (64,7%). Conclusão: A prevalência de fixação das RMs no Tocantins no período analisado pode ser considerada alta (65,9%). O perfil de feminização, o juvenescimento e o motivo da não fixação dos egressos são importantes indicadores para serem analisados em conjunto com o processo de fixação e oferta de vagas nas especialidades disponibilizadas no Tocantins. Os resultados do estudo apontaram uma perspectiva favorável e estratégica dos Programas de Residência Médica (PRM) na fixação de médico no Tocantins, o que não pode ser generalizado para a realidade de um sistema de saúde tão desigual no país. Um maior investimento público na estruturação dos serviços da rede de saúde, em especial na rede municipal, na organização de apoio e no desenvolvimento socioeconômico das cidades é necessário.

Abstract: Introduction: The accomplishment of medical residency (MR) is a type of qualification considered to be the “gold standard” for medical specialization. Understanding whether there is actually greater professional settlement or not stimulated by MR and which factors hinder or contribute to the physician’s permanence in that place, are important information for the structuring of medical residency and health system programs. The aim of this study was to evaluate the prevalence of settlement of medical residents who finished the residency training in the state of Tocantins, after the implementation of medical residency programs in the period from 2013 to 2017. Method: This is an observational quantitative research, with a cross-sectional, descriptive and analytical design, using the telematic technique and its own questionnaire, carried out with 44 medical residents that finished the medical residency program in the state of Tocantins. The project was reviewed and approved by the Ethics Committee of the Federal University of Tocantins (UFT) under Opinion number 2.292.540. Results: The prevalence of settlement was 65.9% of physicians in the state of Tocantins. Most residents were females (59.1%), with a mean age of 30.8 ± 3.1 years, income between 10 and 20 minimum wages (55.8%) and worked during their residency training (84.1%). The specialties that showed the highest settlement rates were general surgery and clinical medicine, and among these, the majority works for the private and state health networks. The main reason for not settling in Tocantins was to attend another residency or subspecialty program in another state (64.7%). Conclusion: The prevalence of medical residents that finished the residency and settled in Tocantins during the analyzed period can be considered high (65.9%). The fact that most of these individuals are young and female and the reason for not settling in the state are important indicators to be analyzed together with the settlement process and the offering of positions in the specialties available in Tocantins. The results of the study indicated a favorable and strategic perspective of the Medical Residency Programs (MRP) in the medical settlement in Tocantins, which cannot be generalized to the reality of such an unequal health system in the country. A larger public investment in the structuring of health network services is necessary, especially in the municipal network, in the organization of support and socioeconomic development of cities.