Abstract Objective To analyze the trend of hospitalizations for alcohol use disorder (AUD) in Brazil, by region, and establish its relationship with mental health care facilities. Methods Data were collected through the Brazilian Unified Health System’s (SIH/SUS) Hospital Information System (Sistema de Informação Hospitalar) and the National Register of Health Establishments of Brazil (Cadastro Nacional de Estabelecimentos de Saúde [CNES]). We used linear regression models to estimate the effect of SUS psychiatric beds and Center for Psychosocial Care (Centro de Atenção Psicossocial [CAPS]) numbers on AUD hospitalizations. Results From 2015 to 2020, 298,735 hospitalizations for AUD were recorded. Most of the patients admitted for AUD were male (88.8%). Individuals aged 60 years and older accounted for 11.7% of our cohort. The highest concentration of hospitalizations occurred in the South region (40.1%). The rate of hospitalizations per hospital bed remained relatively constant. The number of CAPS has a negative effect on SUS psychiatric beds in Brazil (average effect -22.31 [95% confidence interval {95%CI} -26.92, -17.70]). Psychiatric beds have a positive effect on AUD hospitalizations in the country (average effect 1.82 [95%CI 0.91, 2.74]). Conclusion Prioritization guidelines for other forms of care are associated with a decrease in hospitalizations for AUD, so we highlight the importance of adequate training of health care professionals for proper referral of these patients to hospital admission when necessary. (AUD facilities Systems s SIH/SUS SIHSUS SIH (SIH/SUS Sistema Hospitalar Cadastro CNES. CNES . [CNES]) Centro [CAPS] 201 2020 298735 298 735 298,73 recorded 88.8%. 888 88.8% 88 8 (88.8%) 6 117 11 7 11.7 cohort 40.1%. 401 40.1% 40 1 (40.1%) constant average 22.31 2231 22 31 -22.3 95% 95 [95 95%CI 95CI CI {95%CI 26.92, 2692 26 92 -26.92 17.70. 1770 17.70 17 70 -17.70]) 182 82 1.8 091 0 91 0.91 2.74. 274 2.74 2 74 2.74]) necessary [CNES] [CAPS 20 202 29873 29 73 298,7 88.8 (88.8% 11. 40.1 4 (40.1% 22.3 223 3 -22. 9 [9 26.92 269 -26.9 177 17.7 -17.70] 18 1. 09 0.9 27 2.7 2.74] [CNES 2987 298, 88. (88.8 40. (40.1 22. -22 [ 26.9 -26. 17. -17.70 0. 2. (88. (40. -2 26. -26 -17.7 (88 (40 - -17. (8 (4 -17 ( -1

Resumo Contexto Estudos indicam uma relação inversa entre volume hospitalar e mortalidade após endarterectomia carotídea. Entretanto, não há dados a nível brasileiro. Objetivos Avaliar a relação entre volume hospitalar de endarterectomia carotídea e mortalidade no estado de São Paulo. Métodos Foram analisados dados do Sistema de Informação Hospitalar do Estado de São Paulo de todas as endarterectomias carotídeas realizadas entre 2015 e 2019. Os hospitais foram categorizados em grupos de acordo com o volume anual de cirurgias (1-10, 11-25 e ≥26). Modelos de regressão logística múltipla foram usados para determinar se o volume de endarterectomias carotídeas era um preditor independente de mortalidade intra-hospitalar entre os pacientes submetidos a esse procedimento. Resultados A mortalidade intra-hospitalar foi quase 60% menor nos pacientes submetidos a endarterectomia carotídea nos hospitais de maior volume em comparação aos pacientes submetidos a endarterectomia nos hospitais de menor volume (OR não ajustado de sobrevida após alta hospitalar, 2,41; IC 95%, 1,11-5,23; p = 0,027). Embora essa taxa mais baixa represente 1,5 menos mortes por 100 pacientes tratados, os centros de alto volume são mais propensos do que os centros de baixo volume a realizarem procedimentos eletivos; portanto, a análise não reteve significância quando ajustada para o caráter de admissão (OR, 1,69; IC 95%, 0,74-3,87; p = 0,215). Conclusões Em um registro brasileiro contemporâneo, centros com maior volume de endarterectomia carotídea foram associados a menor mortalidade intra-hospitalar em comparação aos centros de menor volume. Mais estudos são necessários para verificar essa relação considerando a presença de sintomas em pacientes. Entretanto 201 2019 110, 110 1 10, 10 (1-10 1125 11 25 11-2 ≥26. 26 ≥26 . ≥26) intrahospitalar intra procedimento 60 OR 2,41 241 2 41 95 95% 1,115,23 111523 1,11 5,23 5 23 1,11-5,23 0,027. 0027 0,027 0 027 0,027) 15 1, tratados eletivos portanto OR, 1,69 169 69 0,743,87 074387 0,74 3,87 74 3 87 0,74-3,87 0,215. 0215 0,215 215 0,215) contemporâneo 20 (1-1 112 11- ≥2 6 2,4 24 4 9 115 1,115,2 11152 111 1,1 523 5,2 1,11-5,2 002 0,02 02 1,6 16 743 0,743,8 07438 074 0,7 387 3,8 7 8 0,74-3,8 021 0,21 21 (1- ≥ 2, 1,115, 1115 52 5, 1,11-5, 00 0,0 0,743, 0743 07 0, 38 3, 0,74-3, 0,2 (1 1,115 1,11-5 0,743 0,74-3 ( 1,11- 0,74-

Abstract Background Previous studies indicate an inverse relationship between hospital volume and mortality after carotid endarterectomy. However, data at the level of Brazil are lacking. Objectives To assess the relationship between hospital carotid endarterectomy procedure volumes and mortality in the state of São Paulo. Methods Data from the São Paulo State Hospital Information System on all carotid endarterectomies performed between 2015 and 2019 were analyzed. Hospitals were categorized into clusters by annual volume of surgeries (1-10, 11-25, and ≥26). Multiple logistic regression models were used to determine whether the volume of carotid endarterectomy procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure. Results Crude in-hospital mortality was nearly 60 percent lower in patients who underwent carotid endarterectomy at the highest volume hospitals than among those who underwent endarterectomy at the lowest volume hospitals (unadjusted OR of survival to hospital discharge, 2.41; 95% CI, 1.11-5.23; p = 0.027). Although this lower rate represents 1.5 fewer deaths per 100 patients treated, high-volume centers are more likely than low-volume centers to perform elective procedures, thus the analysis did not retain statistical significance when adjusted for admission character (OR, 1.69; 95% CI, 0.74-3.87; p = 0.215). Conclusions In a contemporary Brazilian registry, higher volume carotid endarterectomy centers were associated with lower in-hospital mortality than lower volume centers. Further studies are needed to verify this relationship considering the presence of symptoms in patients. However lacking 201 analyzed 110, 110 1 10, 10 (1-10 1125, 1125 11 25, 25 11-25 ≥26. 26 ≥26 . ≥26) inhospital 6 unadjusted discharge 2.41 241 2 41 95 CI 1.115.23 111523 1.11 5.23 5 23 1.11-5.23 0.027. 0027 0.027 0 027 0.027) 15 1. treated highvolume high lowvolume low OR, (OR 1.69 169 69 0.743.87 074387 0.74 3.87 74 3 87 0.74-3.87 0.215. 0215 0.215 215 0.215) registry 20 (1-1 112 11-2 ≥2 2.4 24 4 9 115 1.115.2 11152 111 1.1 523 5.2 1.11-5.2 002 0.02 02 1.6 16 743 0.743.8 07438 074 0.7 387 3.8 7 8 0.74-3.8 021 0.21 21 (1- 11- ≥ 2. 1.115. 1115 52 5. 1.11-5. 00 0.0 0.743. 0743 07 0. 38 3. 0.74-3. 0.2 (1 1.115 1.11-5 0.743 0.74-3 ( 1.11- 0.74-

A cinética do consumo de oxigênio (VO2) e a resposta do lactato sanguíneo durante o exercício de carga constante em diferentes intensidades permitem caracterizar os domínios moderado, pesado e severo do exercício. Em exercício de intensidade constante, o perfil da resposta do VO2, analisada por ajustes exponenciais, apresenta as fases cardiodinâmica, fundamental e lenta. A ocorrência do componente lento (CL) tem sido associada a fatores como recrutamento de fibras do tipo II e acúmulo de metabólitos, como lactato, íons H+, fosfato inorgânico e ADP. O CL expressa uma redução da eficiência muscular e tem sido associado à menor tolerância de exercícios aeróbios de intensidade alta. O presente estudo teve por objetivo detalhar a fundamentação teórica sobre sua ocorrência, a influência na tolerância ao exercício, bem como prover os diferentes procedimentos adotados em sua quantificação.

Oxygen uptake (VO2) kinetics and blood lactate response during constant workload exercise at different intensities allow characterizing the moderate, heavy and severe exercise domains. In constant-intensity exercise, the VO2response profile, analyzed by exponential fits, shows the cardiodynamic, fundamental and slow phases. The occurrence of the slow component (SC) has been associated with factors such as the recruitment of type II fibers and the accumulation of metabolites such as lactate, ions H+, inorganic phosphate and adenosine diphosphate. The SC expresses a reduction of muscular efficiency and has been associated with lower tolerance to high-intensity aerobic exercise. The present study aimed to detail the theoretical framework of its occurrence and its influence on exercise tolerance, as well as providing the different procedures used in its quantification.