Abstract Introduction: With the evolution of medical education towards competency-based curriculum, the need has emerged to reconfigure curriculum and assessment methods, with increased focus on the professional practice setting, thus leading to the utilization of tools such as the mini-CEX (mini-Clinical Evaluation Exam). Objective: To evaluate the use of the mini-CEX strategy as an assessment method in medical residency programs. Method: This is a scoping review, and the search performed on PubMed resulted in 578 articles. After applying the Joanna Briggs Institute methodology for inclusion and exclusion, 24 cross-sectional studies were selected. Results: The selected articles were based on studies conducted between 1995 and 2021, in various continents and in both clinical and surgical residency programs, including outpatient, inpatient, and emergency settings. The Mini-CEX was shown to be applicable in the context of medical residency, as it is an observational assessment of the care provided by the resident physician in various practice settings such as outpatient clinics, inpatient wards, and emergency departments. It involves a variable observation time ranging from 10 to 40 minutes and allows for the evaluation of various aspects of medical care, including history taking, physical examination, clinical reasoning, counseling, and provides an opportunity for providing feedback on the residents’ performance. Conclusion: The mini-CEX is a tool that is easy to implement and promotes a high degree of satisfaction among stakeholders. It could be used more routinely in medical residency programs. Introduction competencybased competency methods setting miniCEX mini CEX miniClinical Clinical Exam. Exam . Exam) Objective programs Method review 57 exclusion 2 crosssectional cross sectional Results 199 2021 MiniCEX Mini clinics wards departments 1 4 taking examination reasoning counseling residents performance Conclusion stakeholders 5 19 202 20

Resumo Introdução: Com a evolução do ensino médico para currículos baseados em competências, fez-se necessária uma readequação dos currículos e dos métodos de avaliação, com maior enfoque sobre o cenário de prática profissional e, portanto, na utilização de ferramentas como o Mini-Clinical Evaluation Exercise (Mini-CEX). Objetivo: Este estudo teve como objetivo avaliar o uso da estratégia Mini-CEX como método de avaliação nos programas de residência médica. Método: Trata-se de uma revisão de escopo, cuja estratégia de busca realizada no PubMed resultou em 578 artigos. Após aplicar a metodologia do Instituto Joanna Briggs para inclusão e exclusão, foram selecionados 24 estudos transversais. Resultado: Selecionaram-se artigos referentes a estudos realizados entre 1995 e 2021, em diversos continentes, diferentes programas de residência, e cenários ambulatorial, internação e de emergência. O Mini-CEX mostrou-se aplicável no contexto da residência médica, pois trata-se de uma avaliação observacional direta do atendimento realizado pelo médico residente nos diversos cenários de atuação, como ambulatórios, internações e emergências. Trata-se de uma avaliação com tempo de observação variando de dez a 40 minutos e que permite a abordagem de vários aspectos do atendimento médico, como anamnese, exame físico, raciocínio clínico e aconselhamento, além de possibilitar a realização de um feedback sobre o desempenho dos residentes. Conclusão: O Mini-CEX constitui uma ferramenta de fácil aplicabilidade e promove alto grau de satisfação dos envolvidos, podendo ser utilizada de forma rotineira nos programas de residência médica. Introdução competências fezse fez se portanto MiniClinical Mini Clinical MiniCEX. MiniCEX CEX . (Mini-CEX) Objetivo médica Método Tratase Trata escopo 57 exclusão 2 transversais Resultado Selecionaramse Selecionaram 199 2021 continentes ambulatorial emergência mostrouse mostrou tratase trata atuação ambulatórios emergências 4 anamnese físico aconselhamento residentes Conclusão envolvidos (Mini-CEX 5 19 202 1 20

Abstract To evaluate the impact of genetic polymorphisms in interleukins (IL1A rs17561, rs1304037; IL10 rs1800871; IL1RN rs9005), nitric oxide (NOS2 rs2779249, rs2897518) and suppressor of cytokine signaling (SOCS1 rs243327, rs33977706) on oral health-related quality of life (OHRQoL) of patients under-going root canal treatment (RCT). Methods: The sample consisted of 108 participants, presenting single-rooted teeth with asymptomatic periapical periodontitis. The impact of the OHRQoL was recorded using the Oral Health Impact Profile (OHIP-14) before, seven, and 30 days after RCT. Saliva samples were collected as a source of genomic DNA. Genetic polymorphisms were genotyped by Real-Time PCR using the Taqman method. Univariate and Multivariate analyses were used (p<0.05). Results: A significant difference was observed for the polymorphism rs2297518 in the NOS2 gene in functional limitation in the codominant (p=0.037) and recessive (p=0.001) models; in the physical pain (p<0.001 in both models); in psychological discomfort (p<0.001 in both models); in physical disability (p<0.001 in both models) and in psychological disability (p<0.001 in both models). Polymorphisms in the SOCS1 gene, in the recessive model, rs33977706 (p=0.045) and rs243327 (p=0.019), influenced the OHRQoL in the psychological discomfort domain. Conclusions: Polymorphisms in NOS2 and SOCS1 genes influenced the OHRQoL of patients undergoing RCT. IL1A ILA IL rs17561 rs rs1304037 IL1 rs1800871 ILRN RN rs9005, rs9005 , rs9005) NOS (NOS rs2779249 rs2897518 SOCS (SOCS healthrelated health related (OHRQoL under going RCT . (RCT) Methods 10 participants singlerooted single rooted periodontitis OHIP14 OHIP 14 (OHIP-14 before seven 3 DNA RealTime Real Time method p<0.05. p005 p p<0.05 0 05 (p<0.05) Results rs229751 p=0.037 p0037 037 (p=0.037 p=0.001 p0001 001 (p=0.001 models p<0.001 (p<0.00 models. model rs3397770 p=0.045 p0045 045 (p=0.045 rs24332 p=0.019, p0019 p=0.019 019 (p=0.019) domain Conclusions rs1756 rs130403 rs180087 rs900 rs277924 rs289751 (RCT 1 OHIP1 (OHIP-1 p00 p<0.0 (p<0.05 rs22975 p=0.03 p003 03 (p=0.03 p=0.00 p000 00 (p=0.00 p<0.00 (p<0.0 rs339777 p=0.04 p004 04 (p=0.04 rs2433 p001 p=0.01 01 (p=0.019 rs175 rs13040 rs18008 rs90 rs27792 rs28975 (OHIP- p0 p<0. rs2297 p=0.0 (p=0.0 (p<0. rs33977 rs243 (p=0.01 rs17 rs1304 rs1800 rs9 rs2779 rs2897 (OHIP p<0 rs229 p=0. (p=0. (p<0 rs3397 rs24 rs1 rs130 rs180 rs277 rs289 p< rs22 p=0 (p=0 (p< rs339 rs2 rs13 rs18 rs27 rs28 p= (p= (p rs33 rs3

Resumo Avaliar o impacto de polimorfismos genéticos em interleucinas (IL1A rs17561, rs1304037; IL10 rs1800871; IL1RN rs9005), óxido nítrico (NOS2 rs2779249, rs2897518) e supressor da sinalização de citocinas (SOCS1 rs243327, rs33977706) na qualidade de vida relacionada à saúde bucal (QVRSB) de pacientes submetidos a tratamento endodôntico (TE). Métodos: A amostra foi composta por 108 participantes, que apresentavam dentes unirradiculares com lesão periapical assintomática. O impacto da QVRSB foi registrado usando o Oral Health Impact Profile (OHIP-14) antes, sete e 30 dias após o TE. Amostras de saliva foram coletadas como fonte de DNA genômico. Os polimorfismos genéticos foram genotipados por PCR em tempo real usando o método Taqman. Análises univariadas e multivariadas foram utilizadas (p<0,05). Resultados: Observou-se diferença significativa para o polimorfismo rs2297518 no gene NOS2 na limitação funcional nos modelos codominante (p=0,037) e recessivo (p=0,001); na dor física (p<0,001 em ambos os modelos); no desconforto psicológico (p<0,001 em ambos os modelos); na deficiência física (p<0,001 em ambos os modelos) e na deficiência psicológica (p<0,001 em ambos os modelos). Polimorfismos no gene SOCS1, no modelo recessivo, rs33977706 (p=0,045) e rs243327 (p=0,019), influenciaram a QVRSB no domínio desconforto psicológico. Conclusões: Polimorfismos nos genes NOS2 e SOCS1 influenciaram a QVRSB de pacientes submetidos a TE. IL1A ILA IL rs17561 rs rs1304037 IL1 rs1800871 ILRN RN rs9005, rs9005 , rs9005) NOS (NOS rs2779249 rs2897518 SOCS (SOCS (QVRSB TE . (TE) Métodos 10 participantes assintomática OHIP14 OHIP 14 (OHIP-14 antes 3 genômico Taqman p<0,05. p005 p p<0,05 0 05 (p<0,05) Resultados Observouse Observou se rs229751 p=0,037 p0037 037 (p=0,037 p=0,001 p0001 001 (p=0,001) p<0,001 (p<0,00 modelos. rs3397770 p=0,045 p0045 045 (p=0,045 rs24332 p=0,019, p0019 p=0,019 019 (p=0,019) Conclusões rs1756 rs130403 rs180087 rs900 rs277924 rs289751 (TE 1 OHIP1 (OHIP-1 p00 p<0,0 (p<0,05 rs22975 p=0,03 p003 03 (p=0,03 p=0,00 p000 00 (p=0,001 p<0,00 (p<0,0 rs339777 p=0,04 p004 04 (p=0,04 rs2433 p001 p=0,01 01 (p=0,019 rs175 rs13040 rs18008 rs90 rs27792 rs28975 (OHIP- p0 p<0, rs2297 p=0,0 (p=0,0 (p=0,00 (p<0, rs33977 rs243 (p=0,01 rs17 rs1304 rs1800 rs9 rs2779 rs2897 (OHIP p<0 rs229 p=0, (p=0, (p<0 rs3397 rs24 rs1 rs130 rs180 rs277 rs289 p< rs22 p=0 (p=0 (p< rs339 rs2 rs13 rs18 rs27 rs28 p= (p= (p rs33 rs3

Abstract Introduction: The PHEEM (postgraduate hospital educational environment measure) is a validated and reliable instrument to assess the educational environment in medical residency programs. Objective: To map the application of the PHEEM questionnaire in medical residency, evaluate the results found, positive and negative aspects and points for improvement. Method: We performed a scoping review according to the Joanna Briggs institution’s methodology. Studies that followed the PCC structure were included, as follows: P (participants) = resident physicians of any specialty; C (concept) = The PHEEM is an instrument used to assess the educational environment in medical residency, through a 40-item questionnaire divided into 3 subscales that include perception of autonomy, teaching and social support. C (context)= studies on PHEEM in medical residency of any specialty. PubMed, EMBASE and the Virtual Health Library databases were the data sources. Results: We identified 1588 references, and after reading the title and abstract, 50 references were selected for full reading, and 36 studies were included. The studies were carried out in 22 countries, and most revealed a more positive than negative educational environment, albeit with room for improvement. In the subscales, the perception of autonomy was more positive than negative, and the perception of teaching revealed that most programs are moving in the right direction. However, when evaluating social support, the results were divided between an unpleasant environment and an environment with more pros than cons. The main highlighted positive points were low racial and sexual discrimination, possibility of working in a team, adequate level of responsibilities, accessible teachers with good teaching skills, learning opportunities and participation in educational events. The main negative points were lack of adequate food and accommodation during the shifts, excessive workload, lack of feedback from preceptors and lack of protected time for study and the culture of blaming the resident. Conclusion: The application of PHEEM revealed that in most medical residency programs the educational environment was more positive than negative, albeit with room for improvement. Efforts are needed to improve the educational environment, especially social support, in medical residency programs. Introduction postgraduate measure Objective found improvement Method institutions institution s methodology included follows participants (participants specialty concept (concept 40item item 40 support context= context (context) PubMed sources Results 158 abstract 5 2 countries direction However cons discrimination team responsibilities skills events shifts workload Conclusion 4 (context 15 1

Resumo Introdução: O Postgraduate Hospital Educational Environment Measure (PHEEM) é um instrumento validado e confiável para avaliar o ambiente educacional nos programas de residência médica. Objetivo: Este estudo teve como objetivos mapear a aplicação do questionário PHEEM na residência médica e avaliar os resultados, os aspectos positivos e negativos e os pontos passíveis de melhoria. Método: Trata-se de uma revisão de escopo de acordo com a metodologia do Instituto Joanna Briggs de revisões de escopo. Foram incluídos estudos seguindo a estrutura PCC: P (participantes) = médicos residentes de qualquer especialidade; C (conceito) = o PHEEM é um instrumento utilizado para avaliar o ambiente educacional na residência médica, por meio de um questionário de 40 itens divididos em três subescalas que incluem percepção de autonomia, ensino e suporte social; C (cenário) = pesquisas sobre o PHEEM na residência médica de qualquer especialidade. As bases eletrônicas pesquisadas foram: PubMed, Embase e Biblioteca Virtual em Saúde (BVS). Resultado: As estratégias de busca rodadas resultaram em 1.588 estudos, 50 foram lidos na íntegra, e incluíram-se 36. Os estudos foram realizados em 22 países, e a maioria revelou um ambiente educacional mais positivo que negativo, entretanto com espaço para melhorias. Nas subescalas, a percepção de autonomia se mostrou mais positiva que negativa, e a percepção de ensino revelou que a maioria dos programas está caminhando na direção certa. Entretanto, na avaliação do suporte social, os resultados foram divididos entre um ambiente não agradável e um ambiente com mais prós do que contras. Os principais pontos positivos destacados foram baixa discriminação racial e sexual, possibilidade de trabalhar em equipe, nível adequado de responsabilidades, professores acessíveis e com boas habilidades de ensino, oportunidades de aprendizado e participação em eventos educacionais. Os principais pontos negativos foram falta de alimentação e acomodação adequadas durante o plantão, carga horária excessiva, falta de feedback por parte dos preceptores, falta de tempo protegido para estudo e cultura de culpar o residente. Conclusão: A aplicação do PHEEM revelou que, na maioria dos programas de residência médica, o ambiente educacional se mostrou mais positivo que negativo, entretanto com espaço para melhorias. São necessários esforços para a melhoria do ambiente educacional, especialmente do suporte social, nos programas de residência médica. Introdução (PHEEM Objetivo Método Tratase Trata PCC participantes (participantes especialidade conceito (conceito 4 social cenário (cenário PubMed BVS. BVS . (BVS) Resultado 1588 1 588 1.58 5 íntegra incluíramse incluíram 36 2 países negativo melhorias negativa certa Entretanto contras sexual equipe responsabilidades educacionais plantão excessiva preceptores residente Conclusão (BVS 158 58 1.5 3 15 1.

ABSTRACT Dopamine agonists are the first line of treatment for patients with symptomatic hyperprolactinemia due to prolactinomas and in those with idiopathic hyperprolactinemia. Treatment with these agents is effective in 80%-90% of the cases. Infertility treatment of patients with hyperprolactinemia is also carried out with dopamine agonists, aiming for the normalization of prolactin levels. The risk of symptomatic growth of prolactinomas during pregnancy is dependent on the tumor's size, duration of previous treatments, and prolactin levels. Notably, the corresponding risk is relatively low in cases of microprolactinomas (<5%). Remission of hyperprolactinemia occurs in about 30% of the patients after drug treatment and may also occur after pregnancy and menopause. The use of some drugs, such as antidepressants and antipsychotics, is a frequent cause of hyperprolactinemia, and managing this occurrence involves unique considerations. This position statement by the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and Brazilian Society of Endocrinology and Metabolism (SBEM) addresses the recommendations for measurement of serum prolactin levels and the investigations of symptomatic and asymptomatic hyperprolactinemia and drug-induced hyperprolactinemia in women. 80%90% 8090 80% 90% 80 90 80%-90 tumors tumor s size treatments Notably <5%. 5 <5% . (<5%) 30 menopause drugs antipsychotics considerations Febrasgo (Febrasgo SBEM (SBEM druginduced induced women 80%90 809 8 9 80%-9 <5 (<5% 3 80%9 80%- < (<5 (< (

ABSTRACT Hyperprolactinemia is a frequent cause of menstrual irregularity, galactorrhea, hypogonadism, and infertility. The most common etiologies of hyperprolactinemia can be classified as physiological, pharmacological, and pathological. Among pathological conditions, it is essential to distinguish prolactinomas from other tumors and pituitary lesions presenting with hyperprolactinemia due to pituitary stalk disconnection. Proper investigation considering clinical data, laboratory tests, and, if necessary, imaging evaluation, is important to identify the correct cause of hyperprolactinemia and manage the patient properly. This position statement by the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and Brazilian Society of Endocrinology and Metabolism (SBEM) addresses the recommendations for measurement of serum prolactin levels and the investigations of symptomatic and asymptomatic hyperprolactinemia and medication-induced hyperprolactinemia in women. irregularity galactorrhea hypogonadism infertility physiological pharmacological conditions disconnection data tests necessary evaluation properly Febrasgo (Febrasgo SBEM (SBEM medicationinduced medication induced women

ABSTRACT Objective: To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion: New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy. Objective COVID19 COVID 19 COVID-1 Brazil Methods Experts methodologists guideline andor ADOLOPMENT eCOVID19 eCOVID e e-COVID-1 platform Results Twentyone Twenty one generated authorization imdevimab infection hydroxychloroquine plasma colchicine made Conclusion recommended recommendation evidencebased economy COVID1 1 COVID- eCOVID1 e-COVID- e-COVID

RESUMO Objetivo: Atualizar as recomendações para embasar as decisões para o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: A elaboração desta diretriz foi feita por especialistas, incluindo representantes do Ministério da Saúde e metodologistas. O método utilizado para o desenvolvimento rápido de diretrizes baseou-se na adoção e/ou adaptação de diretrizes internacionais existentes (GRADE ADOLOPMENT) e contou com o apoio da plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Chegaram-se a 21 recomendações, incluindo recomendações fortes quanto ao uso de corticosteroides em pacientes em uso de oxigênio suplementar e recomendações condicionais para o uso de tocilizumabe e baricitinibe, em pacientes com oxigênio suplementar ou ventilação não invasiva, e de anticoagulantes, para prevenção de tromboembolismo. Devido à suspensão da autorização de uso, não foi possível fazer recomendações para o tratamento com casirivimabe + imdevimabe. Foram feitas recomendações fortes contra o uso de azitromicina em pacientes sem suspeita de infecção bacteriana, hidroxicloroquina, plasma convalescente, colchicina e lopinavir + ritonavir, além de recomendações condicionais contra o uso de ivermectina e rendesivir. Conclusão: Foram criadas novas recomendações para o tratamento de pacientes hospitalizados com COVID-19, como as recomendações de tocilizumabe e baricitinibe. Ainda são recomendados corticosteroides e profilaxia contra tromboembolismo, esta em caráter condicional. Vários medicamentos foram considerados ineficazes e não devem ser usados, no intuito de proporcionar o melhor tratamento segundo os princípios da medicina baseada em evidências e promover a economia de recursos. Objetivo COVID19 COVID 19 COVID-1 Brasil Métodos especialistas metodologistas baseouse baseou se eou GRADE ADOLOPMENT eCOVID19 eCOVID e-COVID-1 RecMap Resultados Chegaramse Chegaram 2 baricitinibe invasiva anticoagulantes tromboembolismo imdevimabe bacteriana hidroxicloroquina convalescente ritonavir rendesivir Conclusão COVID19, 19, condicional usados recursos COVID1 1 COVID- eCOVID1 e-COVID- e-COVID

Abstract Objectives To evaluate the effectiveness of maxillomandibular advancement surgery in the treatment of Obstructive Sleep Apnea by comparing the pre- and postoperative Apnea and Hypopnea Index, in addition to classifying the degree of evidence and risk of intervention bias. Methods A systematic review of the literature was carried out in the PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE platforms, including cohort studies with polysomnographic follow-up, without other associated pharyngeal or nasal surgical procedures. The risk of study bias was assessed using the Modified Delphi technique. Pre- and postoperative Apnea and Hypopnea Index data were plotted for meta-analysis, and the quality of evidence was assessed using the GRADE system. Results Of 1882 references, 32 articles were selected for full-text reading, of which four studies were included, totaling 83 adults with obstructive sleep apnea who underwent maxillomandibular advancement. The meta-analysis was in favor of the intervention (DM = −33.36, 95% CI −41.43 to −25.29, p< 0.00001), with a mean percentage reduction in the Apnea and Hypopnea Index of 79.5% after surgery, even though the level of evidence was classified as very low quality by the GRADE system. Conclusion The meta-analysis was in favor of the intervention, characterizing maxillomandibular advancement surgery as an effective treatment for obstructive sleep apnea in adults. pre PUBMED LILACS EMBASE SCOPUS platforms followup, followup follow up, up follow-up procedures technique Pre metaanalysis, metaanalysis meta analysis, analysis system 188 references 3 fulltext full text reading included 8 DM 3336 33 36 −33.36 95 4143 41 43 −41.4 2529 25 29 −25.29 p 0.00001, 000001 0.00001 , 0 00001 0.00001) 795 79 5 79.5 18 333 −33.3 9 414 4 −41. 252 2 −25.2 00000 0.0000 0000 7 79. 1 −33. −41 −25. 0.000 000 −33 −4 −25 0.00 00 −3 − −2 0.0 0.

RESUMO OBJETIVO Investigar os fatores associados ao diagnóstico precoce do autismo e de outros tipos de transtorno global do desenvolvimento (TGD) de crianças atendidas no Centro de Atenção Psicossocial Infantojuvenil do Sistema Único de Saúde, no período de 2013 a 2019, no Brasil. MÉTODOS Estudo transversal exploratório, com base nos dados do Registro das Ações Ambulatoriais de Saúde (RAAS) do primeiro atendimento de crianças de 1 a 12 anos. Foram estimados o risco relativo bruto (RRb) e ajustado (RRa), e respectivo intervalo de confiança de 95% (IC95%), utilizando o modelo de regressão de Poisson com estimativa de variância robusta. RESULTADOS Das 22.483 crianças incluídas no estudo, a maioria era do sexo masculino (81,9%), residia no mesmo município em que foi diagnosticada (96,8%) e na região Sudeste (57,7%). O diagnóstico precoce foi maior para autismo infantil (RRb= 1,48; IC95% 1,27–1,71), TGD sem designação de subtipo (RRb= 1,55; IC95% 1,34–1,80), outros TGD (RRb= 1,48; IC95% 1,21–1,81) e TGD não especificado (RRb= 1,44; IC95% 1,22–1,69) do que para autismo atípico. As crianças que residiam no mesmo município onde foi realizado o diagnóstico tiveram maior índice de diagnóstico precoce (RRb= 1,31; IC95% 1,10–1,55) do que as demais; bem como aquelas encaminhadas pela atenção básica (RRb= 1,51; IC95% 1,37–1,68) e por demanda espontânea (RRb= 1,45; IC95% 1,31–1,61) do que as oriundas de outros tipos de encaminhamento. O diagnóstico precoce foi maior a partir de 2014 e menor na região Norte quando comparada às demais. Na análise múltipla, a magnitude do RRafoi similar ao do RRb. CONCLUSÕES A identificação precoce de autismo e outros TGD tem melhorado no país, mas ainda representa cerca de 30% dos diagnósticos realizados. As variáveis incluídas no modelo foram significativas, mas ainda explicam pouco do diagnóstico precoce de crianças com autismo e outros TGD.

ABSTRACT OBJECTIVE To investigate the factors associated with the early diagnosis of autism and other types of pervasive developmental disorder (PDD) in children treated at the Psychosocial Care Center for Children and Adolescents of the Unified Health System, from 2013 to 2019,in Brazil. METHODS An exploratory cross-sectional study, based on data from the Record of Outpatient Health Actions (RAAS) of the first appointment of children aged 1 to 12 years. The gross (RRg) and adjusted (RRa) relative risks and respective 95% confidence intervals (95%CI) were estimated using the Poisson regression model with robust variance estimation. RESULTS Of the 22,483 children included in the study, the majority were male (81.9%), lived in the same municipality where they were diagnosed (96.8%) and in the Southeast region (57.7%). Early diagnosis was higher for childhood autism (RRg = 1.48; 95%CI 1.27–1.71) , PDD without subtype designation (RRg = 1.55; 95%CI 1.34–1.80), other PDD (RRg = 1.48; 95%CI 1.21–1.81) and PDD not otherwise specified (RRg = 1.44; 95%CI 1.22–1.69) than for atypical autism. Children residing in the same municipality where the diagnosis was made had a higher rate of early diagnosis (RRg = 1.31; 95%CI 1.10–1.55) than the others; as well as those referred by primary care (RRg = 1.51; 95%CI 1.37–1.68) and by spontaneous demand (RRg = 1.45; 95%CI 1.31–1.61) than those from other types of referral. Early diagnosis was higher from 2014 and lower in the North region than in the other regions. In the multiple analysis, the magnitude of RRa was similar to that of RRg. CONCLUSIONS Early identification of autism and other PDD has improved in Brazil, but it still represents about 30% of the diagnoses made. The variables included in the model were significant, but still explain little of the early diagnosis of children with autism and other PDD.

Abstract Background Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions. Objective To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change. Methods A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes. Results Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%). Conclusion An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program’s long-term effects on clinical outcomes. solutions lowincome low income selfreported self 20 activity adherence motivation Mucuri MG diseases months 13 11 86.0% 860 86 0 (86.0% 86.3%, 863 86.3% , 3 (86.3%) 90.6%, 906 90.6% 90 (90.6%) 65.0% 650 65 (65.0%) 846 84 84.6 healthier 85.5%, 855 85.5% 85 (85.5%) 65.8%, 658 65.8% (65.8%) 56.4%. 564 56.4% . 56 4 (56.4%) 60.7% 607 60 7 (60.7% acquaintances 89.7% 897 89 (89.7% 95.7%. 957 95.7% 95 (95.7%) lowresource resource settings programs s longterm long term outcomes 2 1 86.0 (86.0 86.3 (86.3% 90.6 9 (90.6% 65.0 (65.0% 84. 85.5 (85.5% 65.8 (65.8% 56.4 (56.4% 60.7 (60.7 89.7 (89.7 95.7 (95.7% 86. (86. (86.3 90. (90.6 65. (65.0 85. (85.5 (65.8 56. (56.4 60. (60. 89. (89. 95. (95.7 (86 (90. (65. (85. (56. (60 (89 (95. (8 (90 (65 (85 (56 (6 (95 ( (9 (5

ABSTRACT Background: Leprosy is a neglected chronic infection caused by Mycobacterium leprae, that is curable. The magnitude of the disease and severity of the debilitation it causes renders leprosy a public health problem. This study aimed to analyze the endemic profile of leprosy in the Murrupula district and evaluate the socioeconomic, clinical, and serological profiles of leprosy contacts. Methods: A cross-sectional study of patients with leprosy diagnosed between 2013 and 2017 and their household and community contacts was conducted in Murrupula District, Nampula Province, Mozambique. Interviews, simplified dermatoneurological examinations, Mycobacterium leprae flow (ML Flow) tests, and Mitsuda tests were performed. Results: Most of the leprosy cases were multibacillary. The patients had some degree of physical disability. ML Flow positivity was more common in household contacts of the patients diagnosed with leprosy and in community individuals who spontaneously presented for testing. In total, 17 patients were diagnosed with leprosy. Conclusions: This study revealed an active chain of transmission, hidden prevalence, and operational deficiencies in leprosy surveillance and care. The results suggest that the implementation of a public health policy for leprosy prevention and control in Nampula Province is necessary. In future, the possibility of expanding the policy to the entire country should be considered. Background curable problem socioeconomic clinical Methods crosssectional cross sectional 201 District Mozambique Interviews examinations performed Results multibacillary disability testing total 1 Conclusions transmission prevalence care necessary future considered 20 2

Abstract Background The diet’s inorganic nitrate (NO3–) may provide a physiological substrate for reducing nitrate (NO2–) to NO independent of the endothelium. Studies suggest that inorganic NO3– has beneficial effects on cardiovascular health. Objective This study evaluated the acute effects of 500 mL nitrate-rich beetroot juice (BRJ; containing 11.5mmol NO3–) on blood pressure and endothelial function in treated hypertensive patients. Methods A randomized, placebo-controlled, crossover study was conducted in treated hypertensive patients (n=37; women=62%) who underwent clinical and nutritional evaluation and assessment of central hemodynamic parameters and microvascular reactivity. The significance level was p<0.05. Results The mean age was 59±7 years, and mean systolic and diastolic blood pressures were 142±10/83±9mmHg. There was a significant increase in the subendocardial viability ratio (SEVR; 149±25 vs. 165±30%, p<0.001) and reduction in ejection duration (ED; 37±4 vs. 34±4%, p<0.001) in the beetroot phase but no significant SEVR difference in the control phase. The % increase in perfusion (155 vs. 159 %, p=0.042) was significantly increased in the beetroot phase, which was not observed in the control phase. In the beetroot phase, the change in SEVR showed a significant correlation with the change in the area under the curve of post-occlusive reactive hyperemia (AUC-PORH) (r=0.45, p=0.012). The change in ED showed a significant correlation with the post-intervention perfusion peak (r=-0.37, p=0.031) and AUC-PORH (r=-0.36, p=0.046). Conclusions The acute ingestion of BRJ by hypertensive patients resulted in an improvement of endothelial function, which was associated with higher subendocardial viability and performance in myocardial contraction. diets diet s NO3 (NO3– NO2– NO2 (NO2– endothelium health 50 nitraterich rich (BRJ 115mmol mmol 11 5mmol randomized placebocontrolled, placebocontrolled placebo controlled, controlled placebo-controlled n=37 n37 n 37 (n=37 women=62% women62 women 62 reactivity p005 p 0 05 p<0.05 597 59 7 59± years 14210839mmHg mmHg 142 10 83 9mmHg 142±10/83±9mmHg (SEVR 14925 149 25 149±2 vs 16530 165 30 165±30% p<0.001 p0001 001 (ED 374 4 37± 344 34 34±4% 155 (15 15 p=0.042 p0042 042 postocclusive post occlusive AUCPORH AUC PORH (AUC-PORH r=0.45, r045 r 45 (r=0.45 p=0.012. p0012 p=0.012 . 012 p=0.012) postintervention intervention r=0.37, r037 r= 0.37, (r=-0.37 p=0.031 p0031 031 r=0.36, r036 0.36, 36 (r=-0.36 p=0.046. p0046 p=0.046 046 p=0.046) contraction (NO3 (NO2 5 1 n=3 n3 3 (n=3 women=62 women6 6 p00 p<0.0 14 8 1492 2 149± 1653 16 165±30 p<0.00 p000 00 34±4 (1 p=0.04 p004 04 r=0.45 r04 (r=0.4 p001 p=0.01 01 r=0.37 r03 037 0.37 (r=-0.3 p=0.03 p003 03 r=0.36 036 0.36 (NO n= (n= women=6 p0 p<0. 165±3 34± ( p=0.0 r=0.4 r0 (r=0. r=0.3 0.3 (r=-0. (n women= p<0 165± p=0. r=0. (r=0 0. (r=-0 p< p=0 r=0 (r= (r=- p= (r

Resumo Fundamento O nitrato inorgânico (NO3–) da dieta pode fornecer substrato fisiológico para reduzir o nitrito (NO2–) a óxido nítrico (NO) independente do endotélio. Estudos sugerem que o NO3– inorgânico tem efeitos benéficos na saúde cardiovascular. Objetivos Este estudo avaliou os efeitos agudos de 500 mL de suco de beterraba rico em nitrato (SB; contendo 11,5mmol NO3–) na pressão arterial e na função endotelial em pacientes hipertensos tratados. Métodos Estudo cruzado, randomizado, controlado por placebo foi realizado em pacientes hipertensos tratados (n=37; mulheres=62%) que foram submetidos à avaliação clínica e nutricional, avaliação dos parâmetros hemodinâmicos centrais e reatividade microvascular. O nível de significância foi p<0,05. Resultados A média de idade foi 59±7 anos e das pressões sistólica e diastólica foi de 142±10/83±9 mmHg. Houve aumento significativo na taxa de viabilidade subendocárdica (RVSE; 149±25 vs. 165±30%, p<0,001) e redução na duração da ejeção (DE; 37±4 vs. 34±4%, p<0,001) na fase beterraba, mas nenhuma diferença significativa de RVSE na fase controle. O % de aumento na perfusão (155 vs. 159%, p=0,042) cresceu significativamente na fase beterraba, o que não foi observado na fase controle. Na fase beterraba, a alteração da RVSE apresentou correlação significativa com a alteração da área sob a curva de hiperemia reativa pós-oclusiva (ASC-HRPO) (r=0,45, p=0,012). A mudança na DE mostrou uma correlação significativa com pico de perfusão pós-intervenção (r=-0,37, p=0,031) e ASC-HRPO (r=-0,36, p=0,046). Conclusão A ingestão aguda de SB por pacientes hipertensos resultou em melhora da função endotelial, que foi associada à maior viabilidade subendocárdica e desempenho na contração miocárdica. NO3 NO (NO3– NO2– NO2 (NO2– (NO endotélio cardiovascular 50 (SB 115mmol mmol 11 5mmol cruzado randomizado n=37 n37 n 37 (n=37 mulheres=62% mulheres62 mulheres 62 nutricional microvascular p005 p 0 05 p<0,05 597 59 7 59± 14210839 142 10 83 9 142±10/83± mmHg (RVSE 14925 149 25 149±2 vs 16530 165 30 165±30% p<0,001 p0001 001 (DE 374 4 37± 344 34 34±4% controle 155 (15 159 159% p=0,042 p0042 042 pósoclusiva pós oclusiva ASCHRPO ASC HRPO (ASC-HRPO r=0,45, r045 r 45 (r=0,45 p=0,012. p0012 p=0,012 . 012 p=0,012) pósintervenção intervenção r=0,37, r037 r= 0,37, (r=-0,37 p=0,031 p0031 031 r=0,36, r036 0,36, 36 (r=-0,36 p=0,046. p0046 p=0,046 046 p=0,046) miocárdica (NO3 (NO2 5 1 n=3 n3 3 (n=3 mulheres=62 mulheres6 6 p00 p<0,0 1421083 14 8 142±10/83 1492 2 149± 1653 16 165±30 p<0,00 p000 00 34±4 15 (1 p=0,04 p004 04 r=0,45 r04 (r=0,4 p001 p=0,01 01 r=0,37 r03 037 0,37 (r=-0,3 p=0,03 p003 03 r=0,36 036 0,36 n= (n= mulheres=6 p0 p<0, 142108 142±10/8 165±3 34± ( p=0,0 r=0,4 r0 (r=0, r=0,3 0,3 (r=-0, (n mulheres= p<0 14210 142±10/ 165± p=0, r=0, (r=0 0, (r=-0 p< 1421 142±10 p=0 r=0 (r= (r=- 142±1 p= (r 142±

Resumen Este artículo describe la incidencia acumulada y características de los niños hasta 12 años con trastorno del desarrollo global (TGD) tratados en CAPSi. Se realizó un estudio descriptivo transversal, utilizando Registro de Acciones Ambulatorias de Salud. Se evaluó la incidencia acumulada de TGD en período 2013-2019 y tendencia temporal de características de niños y cuidado, utilizando método Prais-Winsten. Se identificaron 23.657 registros con primera asistencia, pero 10,8% sin seguimiento. La tasa acumulada fue 13,2/10.000, con amplia variación entre municipios y grandes regiones, aunque varias sin registro de casos. No hubo descenso en porcentaje de primeras visitas, con incremento medio anual del -17,8%. La mayoría de niños fueron atendidos en municipio de residencia (96,8%) y diagnosticados de autismo (30,6%), aunque el 54,0% no tenía TGD especificado en primera visita. Solo 30,2% fueron diagnosticados hasta los tres años de edad. Asegurar la atención en cuidados especiales y diagnóstico precoz temprano como desafíos. 1 (TGD CAPSi transversal Salud 20132019 2013 2019 2013-201 cuidado PraisWinsten. PraisWinsten Prais Winsten. Winsten Prais-Winsten 23657 23 657 23.65 asistencia 108 10 8 10,8 seguimiento 13210000 13 2 000 13,2/10.000 regiones casos visitas 17,8%. 178 17 -17,8% 96,8% 968 96 (96,8% 30,6%, 306 30,6% , 30 6 (30,6%) 540 54 0 54,0 visita 302 30,2 edad desafíos 2013201 201 2013-20 2365 65 23.6 10, 1321000 00 13,2/10.00 17,8% -17,8 96,8 9 (96,8 30,6 3 (30,6% 5 54, 30, 201320 20 2013-2 236 23. 132100 13,2/10.0 17,8 -17, 96, (96, (30,6 20132 2013- 13210 13,2/10. 17, -17 (96 (30, 1321 13,2/10 -1 (9 (30 132 13,2/1 - ( (3 13,2/ 13,2 13,

Abstract This article describes the accumulated incidence and characteristics of children until 12 years old with global developmental disorder (TGD) treated at CAPSi. A descriptive cross-sectional study was carried out using Register of Outpatient Health Actions. Cumulative incidence of TGD in the period 2013-2019 and the temporal trend of characteristics of children and care were evaluated using the Prais-Winsten method. It were identificated 23,657 records with first care, but 10.8% without follow-up. The cumulative incidence was 13.2/10,000, with wide variation between municipalities and large regions although several without record of cases. There was decrease in the percentage of first appointment, with an average annual increase of -17.8%. Most children were attended to in the municipality of residence (96.8%) and initially diagnosed as autism (30.6%), although 54.0% hadn’t TGD specified in the first appointment. Only 30.2% were diagnosed until three years old. Ensuring care in specialized care and early diagnosis remain challenges. 1 (TGD CAPSi crosssectional cross sectional Actions 20132019 2013 2019 2013-201 PraisWinsten Prais Winsten method 23657 23 657 23,65 108 10 8 10.8 followup. followup follow up. up follow-up 13210000 13 2 000 13.2/10,000 cases appointment 17.8%. 178 17 -17.8% 96.8% 968 96 (96.8% 30.6%, 306 30.6% , 30 6 (30.6%) 540 54 0 54.0 hadnt hadn t 302 30.2 challenges 2013201 201 2013-20 2365 65 23,6 10. 1321000 00 13.2/10,00 17.8% -17.8 96.8 9 (96.8 30.6 3 (30.6% 5 54. 30. 201320 20 2013-2 236 23, 132100 13.2/10,0 17.8 -17. 96. (96. (30.6 20132 2013- 13210 13.2/10, 17. -17 (96 (30. 1321 13.2/10 -1 (9 (30 132 13.2/1 - ( (3 13.2/ 13.2 13.

Resumo Este artigo descreve a incidência acumulada e as características das crianças de até 12 anos com transtorno global do desenvolvimento (TGD) atendidas no CAPSi. Realizou-se estudo transversal descritivo, utilizando o Registro de Ações Ambulatoriais de Saúde. Avaliou-se a incidência acumulada de TGD no período 2013-2019 e tendência temporal das características das crianças e do atendimento pelo método de Prais-Winsten. Identificaram-se 23.657 registros de primeiro atendimento, mas 10,8% sem seguimento. A incidência acumulada foi de 13,2/10.000, com ampla variação entre municípios e grandes regiões, embora vários sem registro de casos. Observou-se queda no percentual de primeiro atendimento, com incremento médio anual de 17,8%. A maioria das crianças foi atendida no município de residência (96,8%) e recebeu diagnóstico inicial de autismo infantil (30,6%), embora 54,0% sem TGD especificado no primeiro atendimento. Apenas 30,2% foram diagnosticadas até três anos de idade. A garantia do cuidado na atenção especializada e o diagnóstico precoce permanecem como desafios. 1 (TGD CAPSi Realizouse Realizou se descritivo Saúde Avaliouse Avaliou 20132019 2013 2019 2013-201 PraisWinsten. PraisWinsten Prais Winsten. Winsten Prais-Winsten Identificaramse Identificaram 23657 23 657 23.65 108 10 8 10,8 seguimento 13210000 13 2 000 13,2/10.000 regiões casos Observouse Observou 178 17 17,8% 96,8% 968 96 (96,8% 30,6%, 306 30,6% , 30 6 (30,6%) 540 54 0 54,0 302 30,2 idade desafios 2013201 201 2013-20 2365 65 23.6 10, 1321000 00 13,2/10.00 17,8 96,8 9 (96,8 30,6 3 (30,6% 5 54, 30, 201320 20 2013-2 236 23. 132100 13,2/10.0 17, 96, (96, (30,6 20132 2013- 13210 13,2/10. (96 (30, 1321 13,2/10 (9 (30 132 13,2/1 ( (3 13,2/ 13,2 13,