RESUMO Objetivo Estimar cobertura vacinal, atraso e perda de seguimento da vacina tríplice viral, em crianças até 24 meses residentes em cidades brasileiras. Método Inquérito domiciliar baseado em uma coorte retrospectiva de nascidos vivos em 2017-2018, que analisou cobertura e dados sociodemográficos das crianças e famílias, a partir dos registros da caderneta de vacinação e entrevista. Resultados A cobertura válida da primeira dose foi de 90,0% (IC95% 88,9;91,0), e da segunda, e 81,1% (IC95% 79,8;82,4). O atraso para ambas as doses foi de 23,2% (IC95% 21,9;24,5) e a perda de seguimento de 10,8% (IC95% 9,9;11,8). O estrato socioeconômico A apresentou menor cobertura e, à medida que a ordem de nascimento aumentava, menor era a cobertura para as duas doses. Crianças de mães com 13 a 15 anos de escolaridade apresentaram maior cobertura. Conclusão As coberturas não alcançaram a meta preconizada. Estratégias diferenciadas para dirimir dificuldade de acesso, desinformação e hesitação poderão melhorar a cobertura. vacinal viral 2 brasileiras 20172018, 20172018 2017 2018, 2018 2017-2018 famílias entrevista 900 90 0 90,0 IC95% IC95 IC (IC95 88,991,0, 889910 88,9 91,0 , 88 9 91 88,9;91,0) segunda 811 81 1 81,1 79,882,4. 798824 79,8 82,4 . 79 8 82 4 79,8;82,4) 232 23 23,2 21,924,5 219245 21,9 24,5 21 5 21,9;24,5 108 10 10,8 9,911,8. 99118 9,9 11,8 11 9,9;11,8) aumentava preconizada acesso 2017201 201 2017-201 90, IC9 (IC9 991 88,991,0 88991 889 88, 910 91, 88,9;91,0 81, 882 79,882,4 79882 798 79, 824 82, 7 79,8;82,4 23, 924 21,924, 21924 219 21, 245 24, 21,9;24, 10, 911 9,911,8 9911 99 9, 118 11, 9,9;11,8 201720 20 2017-20 (IC 88,991, 8899 88,9;91, 79,882, 7988 79,8;82, 92 21,924 2192 21,9;24 9,911, 9,9;11, 20172 2017-2 88,991 88,9;91 79,882 79,8;82 21,92 21,9;2 9,911 9,9;11 2017- 88,99 88,9;9 79,88 79,8;8 21,9; 9,91 9,9;1 88,9; 79,8; 9,9;

ABSTRACT Objective To estimate measles-mumps-rubella vaccination coverage, delay and loss to follow-up in children up to 24 months old living in Brazilian cities. Methods Surveys and questionnaires with a retrospective cohort of live births in 2017-2018, analyzing vaccination coverage and sociodemographic data of children and families, based on vaccination card records and interviews. Results Valid coverage of first dose was 90.0% (95%CI 88.9;91.0) and 81.1% for the second dose (95%CI 79.8;82.4). Delay for both doses was 23.2% (95%CI 21.9;24.5) and loss to follow-up was 10.8% (95%CI 9.9;11.8). Socioeconomic stratum A had the lowest vaccination coverage and the higher the child’s birth order, the lower the vaccination coverage for the second dose. Children whose mothers had 13 to 15 years of education had higher vaccination coverage. Conclusion Coverage did not meet the recommended target. Differentiated strategies to resolve difficulties in access, misinformation, and vaccination hesitancy will help improve vaccination coverage. measlesmumpsrubella measles mumps rubella followup follow 2 cities 20172018, 20172018 2017 2018, 2018 2017-2018 families interviews 900 90 0 90.0 95%CI 95CI CI 95 88.991.0 889910 88.9 91.0 88 9 91 88.9;91.0 811 81 1 81.1 79.882.4. 798824 79.8 82.4 . 79 8 82 4 79.8;82.4) 232 23 23.2 21.924.5 219245 21.9 24.5 21 5 21.9;24.5 108 10 10.8 9.911.8. 99118 9.9 11.8 11 9.9;11.8) childs child s order target access misinformation 2017201 201 2017-201 90. 991 88.991. 88991 889 88. 910 91. 88.9;91. 81. 882 79.882.4 79882 798 79. 824 82. 7 79.8;82.4 23. 924 21.924. 21924 219 21. 245 24. 21.9;24. 10. 911 9.911.8 9911 99 9. 118 11. 9.9;11.8 201720 20 2017-20 88.991 8899 88.9;91 79.882. 7988 79.8;82. 92 21.924 2192 21.9;24 9.911. 9.9;11. 20172 2017-2 88.99 88.9;9 79.882 79.8;82 21.92 21.9;2 9.911 9.9;11 2017- 88.9; 79.88 79.8;8 21.9; 9.91 9.9;1 79.8; 9.9;

resumen está disponible en el texto completo

RESUMO O efeito da política fiscal sobre os ciclos econômicos tem sido fonte de maior controvérsia apesar da crescente literatura empírica e experiência internacional. Este artigo propõe um escopo analítico que permita analisar os canais de transmissão de política fiscal, atualizando as descobertas mais recentes após pandemia. Dessa forma, pretende-se contribuir para um entendimento mais detalhado de alguns dos principais mecanismos pelos quais a política fiscal afeta a economia. internacional pandemia forma pretendese pretende se economia

ABSTRACT The effect of fiscal policy over business cycles has been a source of major controversy despite the growing empirical literature and international experience. This paper proposes an analytical framework that allows us to analyze the transmission channels of fiscal policy, updating the most recent findings after the pandemic. In this way, it aims to contribute to a more detailed understanding of some of the main mechanisms by which fiscal policy affects the economy. experience pandemic way economy

Resumo As Florestas Tropicais Sazonalmente Secas apresentam sazonalidade pronunciada de precipitação, intensa radiação solar e altas temperaturas, que muitas vezes se traduzem em altos níveis de deciduidade durante a estação seca. Nestes ambientes, espécies caducifólias coexistem com algumas espécies perenes que conseguem manter as folhas do dossel durante toda a estação seca. Para entender as estratégias por trás desse comportamento, analisamos características anatômicas foliares de 13 indivíduos de Sarcomphalus joazeiro durante as estações chuvosa e seca em uma floresta estacional decídua. Nossa hipótese é que as folhas da estação chuvosa seriam diferentes anatômica e funcionalmente das folhas da estação seca. Especificamente, esperávamos que as folhas da estação chuvosa apresentassem uma estratégia de utilização de recursos mais aquisitiva em comparação com as folhas da estação seca, que esperávamos que fossem mais conservativas. Avaliamos os efeitos da estação e das variáveis climáticas em 25 características anatômicas foliares usando modelos lineares mistos generalizados (LMM). As características foliares variaram entre as estações chuvosa e seca e interagiram com variáveis climáticas, que juntos sugerem que S. joazeiro produz coortes de folhas específicas para a estação. Esta adaptação permite que a espécieajuste-se às condições contrastantes de intensidade de luz, temperatura e demanda evaporativa em cada estação. precipitação temperaturas ambientes comportamento 1 decídua Especificamente conservativas 2 LMM. LMM . (LMM) S espécieajustese espécieajuste luz (LMM

Abstract Seasonally Dry Tropical Forests experience pronounced precipitation seasonality, intense solar radiation, and high temperatures, which often translate into high levels of deciduousness during the dry season. In these environments, deciduous species coexist with some evergreen species that are able to maintain their canopy leaves throughout the dry season. To understand the strategies behind this behavior, we analyzed leaf anatomical traits of 13 individuals of Sarcomphalus joazeiro during both the wet and dry seasons in a seasonal deciduous forest. We hypothesized that wet-season leaves would differ anatomically and functionally from dry-season leaves. Specifically, we expected wet-season leaves to show a more acquisitive resource-use strategy compared to dry-season leaves, which we expected to be more conservative. We assessed the effects of season and climatic variables on 25 leaf anatomical traits using generalized linear mixed models (LMM). Leaf traits varied between the wet and dry seasons and interacted with climatic variables, which together suggest that S. joazeiro produces season-specific leaf cohorts. This adaptation allows the species to adjust to the contrasting conditions of light intensity, temperature, and evaporative demand in each season. seasonality radiation temperatures environments behavior 1 forest wetseason dryseason Specifically resourceuse resource use conservative 2 LMM. LMM . (LMM) S seasonspecific specific cohorts intensity temperature (LMM

ABSTRACT Aggregate Production Planning (APP) aims at balancing the forecast demand for product families with the available production resources, thus allowing changes to be made in the system and the best action strategy to be found. APP decisions are strategic decisions for the organization, which take an intermediate time horizon which spans 12 months, in general. As different issues may influence business success, this kind of decision problem will take multiple objectives into account, when a strategic view is considered. Conflicts between objectives frequently increase the complexity of APP problems. In order to deal with this kind of problem, this paper proposes a multi-criteria decision model considering the five objectives related to manufacturing strategy, namely: quality, speed, dependability, flexibility, and cost. By applying a multi-objective optimizing model which considers the organization’s strategical objectives, and by using the NSGA-II algorithm, a subset of representative solutions of the Pareto Frontier is obtained, thereby enabling the application of the FITradeoff method. A multi-criteria method, such as the FITradeoff, assists Decision Makers (DMs) in choosing a production plan more suitable to their objectives. The results show that the FITradeoff method contributes to the evaluation of solutions by aiding the DM to consider a significant set of alternatives while at the same time reducing the cognitive effort that he/she needs to make. (APP resources found organization 1 months general success account considered problems multicriteria multi criteria namely quality speed dependability flexibility cost multiobjective objective organizations s NSGAII NSGA II algorithm obtained DMs (DMs heshe he she make

Abstract: The minimally invasive endodontic access is not directly associated with tooth discoloration in the presence of bioceramic or epoxy resin-based root canal sealers. This study aimed to evaluate the influence of minimally invasive access and endodontic sealer composition on the color stability of endodontically-treated teeth, the restorative material adaptation, and the presence of remaining filling material in the pulp chamber. Endodontic access surgery was performed in maxillary central incisors, either through conservative or minimally invasive approaches, and the root was filled with AH Plus or Bio-C Sealer. The crown color was measured with a spectrophotometer at baseline and after root obturation, restoration, and specimen storage for one year in an oven. The occurrence of voids in the restoration and the remaining filling material was analyzed using micro-CT scans. The Yellowness Index (YI) and color changes (∆E00) were calculated after each color measurement. Data of micro-CT were submitted to 2-way ANOVA, and YI and ∆E00 were analyzed with repeated-measures ANOVA. Pair-wise comparisons were performed with Tukey's test (α = 0.05). The experimental conditions had no effect on the presence of the remaining material. The minimally invasive access associated with Bio-C Sealer resulted in more voids between the restoration and the remaining filling material. Only the evaluation time affected YI and ∆E00 values. Specimens became more yellow after filling and storage in the oven (the highest ∆E00 values). The present study showed that sealer and minimally invasive cavities are not associated with crown color stability following endodontic treatment. Abstract resinbased resin based sealers endodonticallytreated endodontically treated teeth adaptation chamber incisors approaches BioC Bio C obturation microCT micro CT scans (YI E00 E (∆E00 measurement 2way way 2 ANOVA ∆E0 repeatedmeasures repeated measures Pairwise Pair wise Tukeys Tukey s α 0.05. 005 0.05 . 0 05 0.05) values values) treatment E0 (∆E0 ∆E 00 0.0 (∆E 0.

Abstract The slope stability analyses are important to predict environmental, financial, and human life impacts. The Limit Equilibrium Method (LEM) is commonly used to estimate a slope’s Safety Factor (SF). However, the Finite Element Method (FEM) is increasingly applied to slope stability analyses, using different approaches, among which the technique of Shear Strength Reduction (SSR) is commonly used in perfectly plastic elastic models. The objective of this study is to present a discussion about these two methodologies, using critical state models with or without hardening will be used to model the stress-strain behavior of the soil mass. The results obtained in the case study presented, using LEM and FEM considering critical state models with and without hardening are consistent and allowed verifying the stability condition of the slope. Also, the reduction factors are smaller when compared to the results using perfectly plastic elastic models. environmental financial impacts (LEM slopes s SF. SF . (SF) However (FEM approaches SSR (SSR methodologies stressstrain stress strain mass presented Also (SF

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. (RA therefore minimized Brazil ACREULAR ACR EULAR 2010 (2010 assessed opportunity 6 1 MannKendall Mann Kendall test chisquared chi squared Cramers Cramer s conducted 111 894 89 4 89.4 female 568 56 56.8 white SD (SD 571 57 57. 11.5 115 5 (11.5 tau 0677 0 677 0.677 0.001 0001 001 0695 695 0.695 199 2015 period , 3- 6- 12month month 0120 120 0.120 0200 200 0.20 0261 261 0.261 respectively. respectively . respectively) improvements 2011–2015 20112015 2011 (2011–2015 median IQR (IQR) 4–12 412 (4–12 5–17 517 17 (5–17 respectively, respectively] 172 2 17.2 shortest 3month window ≥ ( ≤ months. 201 (201 89. 56. 11. (11. 067 67 0.67 0.00 000 00 069 69 0.69 19 012 0.12 020 20 0.2 026 26 0.26 2011–201 2011201 (2011–201 (IQR 4–1 41 (4–1 5–1 51 (5–1 17. (20 (11 06 0.6 0.0 01 0.1 02 0. 2011–20 201120 (2011–20 4– (4– 5– (5– (2 (1 2011–2 20112 (2011–2 (4 (5 2011– (2011– (2011

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. (RA reallife real life settings care longterm term conditions ACREULAR ACR EULAR 2010 (2010 1987 (1987 conducted “early “late afterwards inquired DAS28CRP DASCRP DAS28 CRP DAS (DAS28-CRP HAQDI HAQ DI (HAQ-DI Students Student s t MannWhitney Mann Whitney U chisquared chi squared tests analysis scorematched score vs lateassessed assessed approval consent 105 89.4% 894 89 4 (89.4 female 565 56 5 56.5 white white) SD (SD age 569 9 56. 11.5 115 11 (11.5 years duration 1731 173 1 173. 114.5 1145 114 (114.5 IQR (IQR coincided 6–36 636 36 (6–36 64.6% 646 64 (64.6% practitioner Notwithstanding 807 80 7 80.7 28.7% 287 28 (28.7% ≤ ( symptoms. . symptoms) rho 0.816 0816 0 816 0.001. 0001 0.001 001 0.001) OR 2.77 277 2 77 95 CI 193 93 1.93 3.97. 397 3.97 3 97 3.97) remissionlow remission low 0.74 074 74 055 55 0.55 0.99, 099 0.99 , 99 0.99) earlyassessed difference [95 CI] 025 25 −0.2 −0.46, 046 46 [−0.46 −0.04 004 04 0196 196 0.19 −0.306, 0306 306 [−0.306 −0.087 0087 087 respectively. respectively respectively) propensityscore whole (whole sample 201 (201 198 (198 DAS2 10 89.4 8 (89. 11. (11. 17 114. (114. 6–3 63 (6–3 64.6 (64.6 80. 28.7 (28.7 0.81 081 81 000 0.00 00 2.7 27 19 1.9 39 3.9 0.7 07 05 0.5 09 0.9 [9 02 −0. −0.46 [−0.4 −0.0 019 0.1 −0.306 030 30 [−0.30 −0.08 008 08 20 (20 (19 89. (89 (11 (114 6– (6– 64. (64. 28. (28. 0.8 0.0 2. 1. 3. 0. [ −0 −0.4 [−0. 01 −0.30 03 [−0.3 (2 (1 (8 (6 (64 (28 [−0 −0.3 [−

Cuidados paliativos (CPs) no Sistema Único de Saúde (SUS) devem ser realizados de modo integral e multidisciplinar na interface com usuário, família, cuidadores e equipe na aproximação à finitude humana. Objetivou-se descrever os sentidos sobre o cuidar nos cenários da morte e do morrer, produzidos por psicólogos que trabalham com CPs no SUS. Trata-se de pesquisa qualitativa construcionista social inspirada na descrição da produção de sentidos do cotidiano. Foram entrevistados quatro psicólogos que atuavam em atenção domiciliar, ambulatório de CPs e atenção hospitalar. Dois eixos temáticos foram construídos: “Os processos de trabalho e seus avessos” e “Nas proximidades da morte e do morrer”. Destaca-se a importância do trabalho em equipe nos processos autoformativos; os desafios do trabalho com a morte e o morrer diante de limitações do cotidiano; e construções críticas e reflexivas do trabalho que promovem saúde mental.

Palliative care (PC) in Brazilian National Health System (SUS) should be provided in a comprehensive and multidisciplinary manner at the interface between service users, families, carers and the health team, addressing human finitude. The aim of this study was to describe meanings about caring in settings of death and dying produced by psychologists working with PC in the SUS. We conducted a qualitative study drawing on social constructionism and inspired by the description of meanings from everyday life. We interviewed four psychologists working in home care, outpatient PC and hospital care. Two core themes were developed: work processes and their reverse; and close to death and dying. The findings show the importance of team working in self-educational processes, the challenges of working with death and dying in the face of everyday limitations, and critical and reflective constructions of work that promote mental health.

Cuidados paliativos (CPs) en el Sistema Brasileño de Salud (SUS) deben realizarse de modo integral y multidisciplinario en el interfaz con usuario, familia, cuidadores y equipo en la aproximación de la finitud humana. El objetivo fue describir los sentidos sobre el cuidar en los escenarios de la muerte y del morir, producidos por psicólogos que trabajan con CPs en el SUS. Se trata de una investigación cualitativa construccionista social inspirada en la descripción de la producción de sentidos del cotidiano. Fueron entrevistados cuatro psicólogos que actuaban en atención a domicilio, ambulatorio de CP y atención hospitalaria. Se construyeron dos ejes temáticos: Los procesos de trabajo y sus contrarios; En las proximidades de la muerte y del morir. Se destaca la importancia del trabajo en equipo en los procesos auto-formativos, los desafíos del trabajo con la muerte y el morir ante las limitaciones del cotidiano y construcciones críticas y reflexivas del trabajo que promueven en salud mental.

Cuidados paliativos (CPs) no Sistema Único de Saúde (SUS) devem ser realizados de modo integral e multidisciplinar na interface com usuário, família, cuidadores e equipe na aproximação à finitude humana. Objetivou-se descrever os sentidos sobre o cuidar nos cenários da morte e do morrer, produzidos por psicólogos que trabalham com CPs no SUS. Trata-se de pesquisa qualitativa construcionista social inspirada na descrição da produção de sentidos do cotidiano. Foram entrevistados quatro psicólogos que atuavam em atenção domiciliar, ambulatório de CPs e atenção hospitalar. Dois eixos temáticos foram construídos: “Os processos de trabalho e seus avessos” e “Nas proximidades da morte e do morrer”. Destaca-se a importância do trabalho em equipe nos processos autoformativos; os desafios do trabalho com a morte e o morrer diante de limitações do cotidiano; e construções críticas e reflexivas do trabalho que promovem saúde mental.

Palliative care (PC) in Brazilian National Health System (SUS) should be provided in a comprehensive and multidisciplinary manner at the interface between service users, families, carers and the health team, addressing human finitude. The aim of this study was to describe meanings about caring in settings of death and dying produced by psychologists working with PC in the SUS. We conducted a qualitative study drawing on social constructionism and inspired by the description of meanings from everyday life. We interviewed four psychologists working in home care, outpatient PC and hospital care. Two core themes were developed: work processes and their reverse; and close to death and dying. The findings show the importance of team working in self-educational processes, the challenges of working with death and dying in the face of everyday limitations, and critical and reflective constructions of work that promote mental health.

Cuidados paliativos (CPs) en el Sistema Brasileño de Salud (SUS) deben realizarse de modo integral y multidisciplinario en el interfaz con usuario, familia, cuidadores y equipo en la aproximación de la finitud humana. El objetivo fue describir los sentidos sobre el cuidar en los escenarios de la muerte y del morir, producidos por psicólogos que trabajan con CPs en el SUS. Se trata de una investigación cualitativa construccionista social inspirada en la descripción de la producción de sentidos del cotidiano. Fueron entrevistados cuatro psicólogos que actuaban en atención a domicilio, ambulatorio de CP y atención hospitalaria. Se construyeron dos ejes temáticos: Los procesos de trabajo y sus contrarios; En las proximidades de la muerte y del morir. Se destaca la importancia del trabajo en equipo en los procesos auto-formativos, los desafíos del trabajo con la muerte y el morir ante las limitaciones del cotidiano y construcciones críticas y reflexivas del trabajo que promueven en salud mental.

Resumo O efeito macroeconômico da política fiscal é objeto de amplo debate na literatura econômica e, apesar disso, não há incorporação desses efeitos nos indicadores sintéticos de acompanhamento macroeconômico. Este artigo analisa a introdução de estimativas desagregadas de multiplicadores fiscais no cálculo do impulso fiscal estrutural. Os resultados indicam maior acurácia no acompanhamento da política fiscal e também explica que a evidência de baixos multiplicadores agregados é compatível com elevados multiplicadores de investimento público e das transferências de renda. Essa situação prevalece quando ocorrem variações expressivas em despesas com baixo multiplicador ao longo do ciclo. Nesse caso, estimativas de multiplicadores fiscais pequenos podem constituir evidência de que a política fiscal foi mal implementada ao invés de demonstrar uma eventual ineficácia.

Abstract This paper incorporates disaggregated estimates of fiscal multipliers in the structural fiscal impulse’s calculation. The results indicate an improvement to fiscal policy monitoring and helps to explain why is possible to have low aggregate fiscal multipliers while public investment and income transfers have big multipliers. This is the case when there are significant variations in expenditures with low multipliers. In this sense, a low fiscal multiplier is evidence of a weak fiscal policy design instead of fiscal policy ineffectiveness.

RESUMO Introdução: Pacientes com câncer, em geral, e particularmente pacientes com glioblastoma estão sob elevado risco de desenvolver síndrome respiratória aguda grave devido à infecção pelo SARS-CoV-2, e alcançar um equilíbrio entre risco de exposição à infecção e benefício clínico do tratamento seria o ideal. O comportamento agressivo desse grupo de tumores justifica a necessidade de equipe multidisciplinar para auxiliar nas decisões clínicas durante a pandemia vigente. O Brasil ocupa hoje o segundo lugar em número de casos e óbitos pela COVID-19, e as atuais disparidades no tratamento de pacientes neuro-oncológicos desafiarão as decisões clínicas e cirúrgicas dessa população, possivelmente afetando a sobrevida global. Objetivo: Guiar decisões clínicas e cirúrgicas relacionadas ao manejo de glioblastoma durante a pandemia pelo COVID-19 no Brasil por meio de pesquisa em literatura. Métodos: Busca sistemática no banco de dados eletrônico da PubMed por estudos ou consensos quanto à abordagem de glioblastoma durante a pandemia por COVID-19 até 18/07/2020. Resultado: Ao abordar o glioblastoma durante a pandemia pela COVID-19, parâmetros importantes que auxiliam no processo de tomada de decisão são idade, desempenho, perfil molecular tumoral e consentimento do paciente. Pacientes jovens devem seguir protocolo padrão após máxima ressecção cirúrgica, principalmente aqueles com metilação do promotor MGMT. Idosos e pacientes debilitados devem ser cuidadosamente avaliados, e monoterapia deve ser provavelmente considerada. Centros de saúde são orientados a utilizar-se da telemedicina e de meios para reduzir infecção local. Conclusão: A abordagem do glioblastoma durante a pandemia por COVID-19 será mundialmente desafiadora, mas particularmente no Brasil, onde ainda existe significativa inequidade no cuidado com a saúde.

ABSTRACT Background: Cancer patients in general and glioblastoma patients, in particular, have an increased risk of developing complications from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and reaching a balance between the risk of exposure to infection and the clinical benefit of their treatment is ideal. The aggressive behavior of this group of tumors justifies the need for a multidisciplinary team to assist in clinical decisions during the current pandemic. Brazil is now ranked #2 in the number of cases and deaths from COVID-19 pandemic, and existing disparities in the treatment of neuro-oncology patients in Brazil will challenge the clinical and surgical decisions of this population, possibly affecting global survival. Objective: To search the literature about the management of glioblastomas during COVID-19 pandemic to guide surgical and clinical decisions in this population of patients in Brazil. Methods: We performed a systematic search on the PubMed electronic database targeting consensus statements concerning glioblastoma approaches during COVID-19 pandemic up to July 18, 2020. Results: When approaching glioblastoma during the COVID-19 pandemic, important parameters that help in the decision-making process are age, performance status, tumor molecular profile, and patient consent. Younger patients should follow the standard protocol after maximal safe resection, mainly those with MGMT methylated tumors. Aged and underperforming patients should be carefully evaluated, and probably a monotherapy scheme is to be considered. Centers are advised to engage in telemedicine and to elaborate means to reduce local infection. Conclusion: Approaching glioblastoma during the COVID-19 pandemic will be challenging worldwide, but particularly in Brazil, where a significant inequality of healthcare exists.

Abstract Background: Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. Drugs used for RA treatment may increase or decrease the risk of a cardiovascular event. This study aims to analyze cardiovascular risk comorbidities in patients with RA and the correlation with the use of anti-rheumatic drugs. Methods: Cross-sectional study conducted based on the real-life rheumatoid arthritis study database - REAL, a prospective observational cohort study. Associations between the use of anti-rheumatic drugs and the presence of comorbidities were represented by their prevalence ratio and evaluated using the Chi-square or Fisher’s Exact tests. Results: We assessed 1116 patients, 89.4% women, mean age of 55.15 years and predominance of seropositive disease. 63.3% had some cardiovascular comorbidity, predominantly hypertension (49.9%). The use of glucocorticoids was observed in 47.4% of patients and there was a significant tendency of lower use of these drugs in the presence of dyslipidemia (PR: 0.790; p = 0.007). We observed that the presence of cardiovascular comorbidities was associated with higher use of bDMARDs (PR:1.147; p = 0.003). Conclusions: The presence of cardiovascular risk comorbidities was confirmed to be higher in RA patients. Different treatment strategies using less glucocorticoids in the presence of dyslipidemia and more common use of bDMARDs in patients with cardiovascular comorbidities suggest that rheumatologists are aware of the potential influence of the DMARDs in the risk of cardiovascular event. Reinforcing these results, we highlight the need for a better baseline assessment to guide the choice of anti-rheumatic drugs in RA patients who have comorbidities.