Resumo O objetivo deste estudo foi avaliar a associação entre as práticas alimentares e a condição de insegurança alimentar familiar (InSAN) entre crianças de alto risco durante a pandemia de COVID-19. Trata-se de um estudo transversal foi realizado com 147 crianças de 1 a 9 anos atendidas em três centros de referência de saúde na cidade do Rio de Janeiro. A qualidade da dieta foi avaliada por meio de Índices de Alimentação Saudável. A Escala Brasileira de Insegurança Alimentar e Nutricional mediu o grau de InSAN entre as famílias. As associações entre a InSAN e as práticas alimentares foram avaliadas por meio de modelos de regressão logística. Neste estudo, quase metade das crianças vivia em situação de insegurança alimentar (47,6%). A InSAN foi associada à deterioração da qualidade da dieta, evidenciada pelo aumento da frequência semanal de consumo de alimentos ultraprocessados (AUP), como bebidas adoçadas com açúcar e carnes processadas, e frequência reduzida de frutas e vegetais. A redução de consumo de carne e de leite e o aumento na ingestão de AUP foi mais relatado entre as famílias em InSAN. Nossos resultados sugerem que a condição de InSAN foi associado à deterioração da qualidade da dieta durante a fase crítica do isolamento social.

Resumen El objetivo de este estudio fue evaluar la asociación entre las prácticas alimentarias y la inseguridad alimentaria familiar (InSAN) entre niños de alto riesgo durante la pandemia de COVID-19. Se trata de un estudio transversal realizado con 147 niños de 1 a 9 años atendidos en tres centros de salud de referencia de la ciudad de Río de Janeiro. La calidad de la dieta se evaluó mediante índices de alimentación saludable. La Escala Brasileña de Inseguridad Alimentaria y Nutricional midió el grado de InSAN entre las familias. Las asociaciones entre InSAN y las prácticas dietéticas se evaluaron mediante modelos de regresión logística. En este estudio, casi la mitad de los niños vivían en situación de inseguridad alimentaria (47,6%). InSAN se asoció con un deterioro en la calidad de la dieta, evidenciado por el aumento de la frecuencia semanal de consumo de alimentos ultraprocesados (AUP), como bebidas azucaradas y carnes procesadas, y frecuencia reducida de frutas y verduras. La reducción en el consumo de carne y leche y el aumento en la ingesta de AUP fueron más reportados entre las familias del InSAN. Nuestros resultados sugieren que el estado de InSAN se asoció con el deterioro de la calidad de la dieta durante la fase crítica del aislamiento social.

Abstract The aim of this study was to evaluate the association between dietary practices and household food insecurity (HFI) status among high-risk children during the COVID-19 pandemic. This cross-sectional study was conducted with 147 children aged 1 to 9 attending at three reference health centers in the city of Rio de Janeiro. Diet quality data was assessed using Healthy Eating Indices. The Brazilian Scale of Food and Nutrition Insecurity measured HFI status. Associations between HFI and dietary practices were assessed using logistic regression models. Almost half of the children lived with food insecurity (47.6%). HFI was associated with deteriorated diet quality, evidenced by the increased weekly frequency of consumption of ultra-processed foods (UPF), such as sugar-sweetened beverages and processed meats, and reduced frequency of fruits and vegetables. Parents perceived a reduction in meat and milk consumption and an increase in the intake of UPF among households of children in HFI throughout the pandemic. Our results suggest that HFI status was associated with deterioration in diet quality during the critical phase of social isolation.

RESUMEN Objetivo: Comprobar la existencia de una asociación entre la ideación suicida, el apoyo social y los síntomas ansioso-depresivos entre los estudiantes de Ciencias de la Salud. Método: cuantitativo, estudio transversal. La recogida de datos tuvo lugar de noviembre de 2020 a julio de 2021, en Sergipe - Brasil, utilizando el Cuestionario Sociodemográfico, el Cuestionario de Ideación Suicida, la Escala de Satisfacción con el Apoyo Social y la Escala de Ansiedad, Depresión y Estrés. Se estimaron los coeficientes de regresión lineal simple y múltiple y las odds ratio. Resultados: de los 190 entrevistados, 57 (30%) estaban poco satisfechos con el apoyo social, 66 (34,8%) presentaban síntomas de depresión grave o muy grave, 32 (16,8%) tenían un riesgo potencial de suicidio, que puede aumentar en un 18% en las personas con depresión. Conclusión: El estrés, la ansiedad y la depresión son factores de riesgo de ideación suicida en los estudiantes de sanidad. El apoyo social se convierte en un aliado en el control emocional, en la reducción del sufrimiento psicológico y en la precipitación de los trastornos mentales en los estudiantes.

RESUMO Objetivo: verificar a existência de associação entre a ideação suicida, o suporte social e os sintomas ansiosos-depressivos entre os estudantes de Ciências da Saúde. Método: estudo quantitativo e transversal. A coleta de dados ocorreu de novembro de 2020 a julho de 2021, em Sergipe - Brasil, utilizando-se o Questionário Sociodemográfico, Questionário de Ideação Suicida, Escala de Satisfação com o Suporte Social e Escala de Ansiedade, Depressão e Estresse. Foram estimados coeficientes de regressão linear simples e múltipla e razões de chance. Resultados: dos 190 entrevistados, 57 (30%) apresentaram baixa satisfação com o suporte social, 66 (34,8%) relataram sintomas de depressão grave ou muito grave, 32 (16,8%) possuíam potencial risco de suicídio, podendo ser aumentada em 18% em pessoas com depressão. Conclusão: estresse, ansiedade e depressão, são os fatores de risco para a ideação suicida em estudantes da saúde. O suporte social torna-se um aliado no controle emocional, na diminuição do sofrimento psíquico e a precipitação de transtornos mentais de estudantes.

ABSTRACT Objective: To verify the existence of an association between suicidal ideation, social support, and anxious-depressive symptoms among Health Sciences students. Method: Quantitative, cross-sectional study. Data collection took place from November 2020 to July 2021 in Sergipe - Brazil, using the Sociodemographic Questionnaire, Suicidal Ideation Questionnaire, Satisfaction with Social Support Scale, and Anxiety, Depression, and Stress Scale. Simple and multiple linear regression coefficients and odds ratios were estimated. Results: Of the 190 interviewees, 57 (30%) had low satisfaction with social support, 66 (34.8%) reported symptoms of severe or very severe depression, 32 (16.8%) had a potential risk of suicide, which can be increased by 18% in people with depression. Conclusion: Stress, anxiety, and depression are risk factors for suicidal ideation in health students. Social support becomes an ally in emotional control, in the reduction of psychological suffering, and in the precipitation of mental disorders in students.

ABSTRACT Objective: To verify the existence of an association between suicidal ideation, social support, and anxious-depressive symptoms among Health Sciences students. Method: Quantitative, cross-sectional study. Data collection took place from November 2020 to July 2021 in Sergipe - Brazil, using the Sociodemographic Questionnaire, Suicidal Ideation Questionnaire, Satisfaction with Social Support Scale, and Anxiety, Depression, and Stress Scale. Simple and multiple linear regression coefficients and odds ratios were estimated. Results: Of the 190 interviewees, 57 (30%) had low satisfaction with social support, 66 (34.8%) reported symptoms of severe or very severe depression, 32 (16.8%) had a potential risk of suicide, which can be increased by 18% in people with depression. Conclusion: Stress, anxiety, and depression are risk factors for suicidal ideation in health students. Social support becomes an ally in emotional control, in the reduction of psychological suffering, and in the precipitation of mental disorders in students. Objective anxiousdepressive anxious depressive students Method Quantitative crosssectional cross sectional study 202 Brazil Questionnaire Scale Anxiety Depression estimated Results 19 interviewees 5 30% 30 (30% 6 34.8% 348 34 8 (34.8% 3 16.8% 168 16 (16.8% suicide 18 Conclusion anxiety control suffering 20 1 (30 34.8 (34.8 16.8 (16.8 2 (3 34. (34. 16. (16. ( (34 (16 (1

RESUMEN Objetivo: Comprobar la existencia de una asociación entre la ideación suicida, el apoyo social y los síntomas ansioso-depresivos entre los estudiantes de Ciencias de la Salud. Método: cuantitativo, estudio transversal. La recogida de datos tuvo lugar de noviembre de 2020 a julio de 2021, en Sergipe - Brasil, utilizando el Cuestionario Sociodemográfico, el Cuestionario de Ideación Suicida, la Escala de Satisfacción con el Apoyo Social y la Escala de Ansiedad, Depresión y Estrés. Se estimaron los coeficientes de regresión lineal simple y múltiple y las odds ratio. Resultados: de los 190 entrevistados, 57 (30%) estaban poco satisfechos con el apoyo social, 66 (34,8%) presentaban síntomas de depresión grave o muy grave, 32 (16,8%) tenían un riesgo potencial de suicidio, que puede aumentar en un 18% en las personas con depresión. Conclusión: El estrés, la ansiedad y la depresión son factores de riesgo de ideación suicida en los estudiantes de sanidad. El apoyo social se convierte en un aliado en el control emocional, en la reducción del sufrimiento psicológico y en la precipitación de los trastornos mentales en los estudiantes. Objetivo ansiosodepresivos ansioso depresivos Salud Método cuantitativo transversal 202 2021 Brasil Sociodemográfico Suicida Ansiedad Estrés ratio Resultados 19 entrevistados 5 30% 30 (30% 6 34,8% 348 34 8 (34,8% 3 16,8% 168 16 (16,8% suicidio 18 Conclusión estrés sanidad emocional 20 1 (30 34,8 (34,8 16,8 (16,8 2 (3 34, (34, 16, (16, ( (34 (16 (1

RESUMO Objetivo: verificar a existência de associação entre a ideação suicida, o suporte social e os sintomas ansiosos-depressivos entre os estudantes de Ciências da Saúde. Método: estudo quantitativo e transversal. A coleta de dados ocorreu de novembro de 2020 a julho de 2021, em Sergipe - Brasil, utilizando-se o Questionário Sociodemográfico, Questionário de Ideação Suicida, Escala de Satisfação com o Suporte Social e Escala de Ansiedade, Depressão e Estresse. Foram estimados coeficientes de regressão linear simples e múltipla e razões de chance. Resultados: dos 190 entrevistados, 57 (30%) apresentaram baixa satisfação com o suporte social, 66 (34,8%) relataram sintomas de depressão grave ou muito grave, 32 (16,8%) possuíam potencial risco de suicídio, podendo ser aumentada em 18% em pessoas com depressão. Conclusão: estresse, ansiedade e depressão, são os fatores de risco para a ideação suicida em estudantes da saúde. O suporte social torna-se um aliado no controle emocional, na diminuição do sofrimento psíquico e a precipitação de transtornos mentais de estudantes. Objetivo ansiososdepressivos ansiosos depressivos Saúde Método transversal 202 2021 Brasil utilizandose utilizando se Sociodemográfico Suicida Ansiedade Estresse chance Resultados 19 entrevistados 5 30% 30 (30% 6 34,8% 348 34 8 (34,8% 3 16,8% 168 16 (16,8% suicídio 18 Conclusão estresse saúde tornase torna emocional 20 1 (30 34,8 (34,8 16,8 (16,8 2 (3 34, (34, 16, (16, ( (34 (16 (1

Abstract Objective This study aimed to evaluate the psychometric properties of the Brazilian version of the Maternal-Fetal Attachment Scale applied to pregnant women in Primary Health Care. Method This is a methodological study conducted with 937 pregnant women assisted in the Family Health Strategy in Montes Claros, Minas Gerais, Brazil. Psychometric sensitivity, construct and criterion validity, and reliability were evaluated. Results The instrument achieved adequate psychometric sensitivity (skewness < 3 and kurtosis < 7). Quality fit indicators of the model were obtained: x2/gl = 4.72, CFI = 0.89, GFI = 0.90, TLI = 0.87, RMSEA = 0.063 (90% CI = 0.059-0.067, p = 0.000). Hypothesis testing indicated associations with marital status (p = 0.036), income (p= 0.030), trimester (p < 0.001), planned pregnancy (p = 0.003), social support (p < 0.001), and family APGAR score (p < 0.001). Significant correlations (p < 0.001) with stress (r = -0.12) and depressive symptoms (r = -0.17) demonstrated divergent criterion validity. Cronbach’s α of 0.874 was recorded. Conclusion The scale showed adequate psychometric evidence for application to pregnant women in the Primary Health Care setting. MaternalFetal Maternal Fetal 93 Claros Gerais Brazil validity evaluated skewness 7. 7 . 7) obtained x2gl xgl x2 gl x 472 4 72 4.72 089 0 89 0.89 090 90 0.90 087 87 0.87 0063 063 0.06 90% (90 0.0590.067, 00590067 0.059 0.067, 059 067 0.059-0.067 0.000. 0000 0.000 000 0.000) 0.036, 0036 0.036 , 036 0.036) p= 0.030, 0030 0.030 030 0.030) 0.001, 0001 0.001 001 0.003, 0003 0.003 003 0.003) 0.001. r 0.12 012 12 -0.12 0.17 017 17 -0.17 Cronbachs Cronbach s 0874 874 recorded setting 9 47 4.7 08 8 0.8 09 0.9 006 06 0.0 (9 0590 0.0590.067 0059006 0059 0.05 0067 0.067 05 0.059-0.06 0.00 00 0.03 03 0.1 01 1 -0.1 4. 0. ( 0.0590.06 005900 005 0.059-0.0 -0. 0.0590.0 00590 0.059-0. -0 0.0590. 0.059-0 - 0.0590 0.059-

Resumo Objetivo Este estudo teve por objetivo avaliar as propriedades psicométricas da versão brasileira da Escala de Apego Materno-Fetal, aplicada às gestantes da Atenção Primária à Saúde. Método Estudo metodológico, realizado com 937 gestantes assistidas na Estratégia Saúde da Família, em Montes Claros, Minas Gerais - Brasil. Avaliaram-se sensibilidade psicométrica, validade de construto, validade de critério e confiabilidade. Resultados O instrumento alcançou adequada sensibilidade psicométrica (assimetria < 3 e curtose < 7). Obtiveram-se os indicadores de qualidade do ajuste do modelo: x2/gl = 4,72, CFI = 0,89, GFI = 0,90, TLI = 0,87, RMSEA = 0,063 (90% = 0,059-0,067, p = 0,000). O teste de hipóteses indicou associações com estado conjugal (p = 0,036), renda (p = 0,030), trimestre (p < 0,001), gestação planejada (p = 0,003), apoio social (p < 0,001) e APGAR familiar (p < 0,001). Correlações significantes (p < 0,001) com estresse (r = -0,12) e sintomas depressivos (r = -0,17) evidenciaram a validade de critério divergente. Registrou-se α de Cronbach de 0,874. Conclusão A escala apresentou evidências psicométricas adequadas para aplicação a gestantes no cenário da Atenção Primária à Saúde. MaternoFetal, MaternoFetal Materno Fetal, Fetal Materno-Fetal metodológico 93 Família Claros Brasil Avaliaramse Avaliaram se construto confiabilidade assimetria 7. 7 . 7) Obtiveramse Obtiveram modelo x2gl xgl x2 gl x 472 4 72 4,72 089 0 89 0,89 090 90 0,90 087 87 0,87 0063 063 0,06 90% (90 0,0590,067, 00590067 0,059 0,067, 059 067 0,059-0,067 0,000. 0000 0,000 000 0,000) 0,036, 0036 0,036 , 036 0,036) 0,030, 0030 0,030 030 0,030) 0,001, 0001 0,001 001 0,003, 0003 0,003 003 0,003) 0,001. r 0,12 012 12 -0,12 0,17 017 17 -0,17 divergente Registrouse Registrou 0874 874 0,874 9 47 4,7 08 8 0,8 09 0,9 006 06 0,0 (9 0590 0,0590,067 0059006 0059 0,05 0067 0,067 05 0,059-0,06 0,00 00 0,03 03 0,1 01 1 -0,1 4, 0, ( 0,0590,06 005900 005 0,059-0,0 -0, 0,0590,0 00590 0,059-0, -0 0,0590, 0,059-0 0,0590 0,059-

Abstract Cardiomyopathy is characterized by structural and functional abnormalities in the heart muscle that are not influenced by coronary disease, hypertension, valve disease, or congenital heart defects. Genetic testing, which helps diagnose the molecular bases of cardiomyopathy, can affect prognostication and clinical decisions. Recent guidelines advocate classifying cardiomyopathies based on phenotypic categories, which encompass a range of clinical presentations, underlying causes, and outcomes. Beyond deepening our grasp of the disease, genetic testing can distinguish between diseases with similar presentations, known as genocopies, which can profoundly influence treatment decisions. Genetic testing is also essential for reproductive counseling and risk evaluation among family members. Combined with advanced imaging techniques such as magnetic resonance imaging, genetic investigation offers a comprehensive understanding of the disease. Thus, as the nature of cardiomyopathies continues to be unraveled, cardiologists must stay updated on advances in genetic testing and their practical applications. disease hypertension defects cardiomyopathy decisions categories presentations causes outcomes genocopies members Thus unraveled applications

O Brasil possui seis biomas que compreendem a vasta biodiversidade encontrada no país. São eles a Amazônia, a Caatinga, o Cerrado, a Mata Atlântica, o Pampa e o Pantanal. Cada bioma possui características únicas em termos de fauna, flora, clima e características físicas, que proporcionam ambientes exclusivos onde se abrigam espécies endêmicas, sejam elas plantas ou animais. Nas espécies vegetais, por sua vez, existe um mundo oculto: o dos fungos endofíticos - seres microscópicos que residem no interior dos tecidos vegetais sem causar doenças, convivendo de forma harmoniosa com seus hospedeiros. Esses microrganismos desempenham diversas funções ecológicas em suas plantas hospedeiras e contribuem substancialmente para a biodiversidade nos biomas brasileiros. Portanto, conhecer como as comunidades fúngicas se estruturam e interagem nos diferentes ecossistemas é essencial para a compreensão do papel desses microrganismos nos biomas.

Abstract Objective Advances in medicine have increased the life expectancy of pediatric patients with chronic illnesses, and challenges with the guided transition of adolescents and young adults from pediatric clinics to adult clinics have grown. The aim of this study was to better understand readiness and factors related to this transition process in Brazil. Method In this cross-sectional study of 308 patients aged from 16 to 21 years under follow-up in pediatric specialties, the degree of readiness for transition was assessed using the Transition Readiness Assessment Questionnaire (TRAQ) and its domains. Associations with demographic data, clinical data, socio-economic level, medication adherence, family functionality, and parental satisfaction with health care were evaluated. Results The median TRAQ score was 3.7 (3.2 - 4.2). Better readiness was associated with female patients, socio-economic class A-B, current active employment, higher level of education, not failing any school year, attending medical appointments alone, functional family, and a good knowledge of disease and medications. A low correlation was observed between TRAQ and age. TRAQ presented good internal consistency (alpha-Cronbach 0.86). In the multiple linear regression, TRAQ score showed a significant association with female gender, advanced age, socio-economic class A-B, better knowledge of disease and medications, and independence to attend appointments alone. Conclusion TRAQ instrument can guide healthcare professionals to identify specific areas of approach, in order to support adolescents with chronic disease to set goals for their own personal development and improve their readiness to enter into the adult healthcare system. In this study, some factors were related to better TRAQ scores. illnesses grown Brazil crosssectional cross sectional 30 1 2 followup follow up specialties (TRAQ domains data socioeconomic socio economic adherence functionality evaluated 37 3 7 3. 3.2 32 (3. 4.2. 42 4.2 . 4 4.2) AB, AB B, B A-B employment education year alone medications age alphaCronbach alpha Cronbach 0.86. 086 0.86 0 86 0.86) regression gender approach system scores (3 4. 08 0.8 8 ( 0.

Abstract Objective To understand the impact of the coronavirus disease 2019 pandemic on in vitro fertilization (IVF) clinical pregnancy rates and analyze factors that may have influenced their outcome. Methods This was a retrospective observational study conducted at a tertiary-care Brazilian fertility center. All fresh IVF and embryo warming cycles performed from March 11 to December 31, 2018–2021 were analyzed, and their data were used to calculate fertilization, embryo cleavage, cycle cancellation, embryo transfer (ET), and clinical pregnancy rates. Statistical tests were used to evaluate the alterations found. Logistic regression models were used to explore the association of the categorical variables with the observed clinical pregnancy rates. Data from 2018 and 2019 (prepandemic) and 2020 and 2021 (pandemic) were grouped. Results A total of 756 cycles were analyzed (n = 360 prepandemic and n = 396 pandemic). The age group of the patients, fertilization rates, and cleavage rates did not have significant differences (p > 0.05). There was a reduction in the percentage of fresh IVF and an increase in embryo warming cycles (p = 0.005) during the pandemic. There was also an increase in fresh cycle cancellations (p < 0.001) and a reduction in ET rates (p < 0.001). The pandemic had a negative impact on clinical pregnancy rates (p < 0.001) especially due to the increase in fresh cycle cancellations (p < 0.001). Conclusion Embryo warming cycles with subsequent frozen-thawed ET were presented as a viable alternative to continue assisted reproductive treatments against pandemic restrictions on fresh cycles, ensuring clinical pregnancy, albeit at a lower rate than that of the prepandemic period.

Resumo Objetivo Compreender os impactos da pandemia de COVID-19 nas taxas de gravidez clínica em fertilização in vitro (FIV) e analisar fatores que possam ter influenciado seu resultado. Métodos Foi realizado um estudo observacional retrospectivo em um centro brasileiro de reprodução assistida. Todos os ciclos de FIV com embriões frescos e descongelados realizados entre 11 de março e 31 de dezembro, 2018-2021 foram analisados, e seus dados utilizados para cálculo das taxas de fertilização, clivagem embrionária, cancelamento de ciclos, transferência de embriões (TE) e gravidez clínica. Testes estatísticos avaliaram significância das alterações encontradas e modelos de regressão logística exploraram associação das variáveis categóricas estudadas com as taxas de gravidez clínica observadas. Os dados de 2018 e 2019 (pré-pandemia) e 2020 e 2021 (pandemia) foram agrupados. Resultados Foram analisados um total de 756 ciclos (n = 360 na pré-pandemia e n = 396 na pandemia). A faixa etária das pacientes e as taxas de fertilização e de clivagem não tiveram alterações significativas (p > 0,05). Na pandemia, houve redução da porcentagem de ciclos de FIV com embriões frescos e aumento dos com descongelamento (p = 0,005). Também foi notado aumento das taxas de cancelamentos de ciclos com embriões frescos (p < 0,001) e redução do número de TEs (p < 0,001). A pandemia exerceu impacto negativo na taxa de gravidez clínica (p < 0,001), especialmente devido ao aumento de cancelamentos dos ciclos a fresco (p < 0,001). Conclusão Frente às limitações pandêmicas impostas aos ciclos com embriões frescos, os ciclos de descongelamento de embriões se apresentaram como alternativa viável à continuidade dos ciclos de FIV, garantindo gravidez clínica ainda que em taxas inferiores às do período pré-pandêmico.

ABSTRACT. This study aimed to evaluate the effects of different levels of dietary fiber on the performance and egg quality of laying hens at pre-laying and laying peak periods. The experimental period was divided into three periods: pre-laying (16 to 19 weeks of age), the start of laying (20 to 22 weeks of age) and laying peak (23 to 28 weeks of age). The experimental design was completely randomized with treatments constituted by five levels of fiber (2.00, 2.50, 3.00, 3.50, and 4.00%) in the diets, with five replicates (pens) of six birds each, totalling 180 hens. Performance and egg quality results were evaluated by polynomial regression at 5%. Fiber levels were not influenced (p >0.05) the first laying of the hens. However, levels above 2.50% of fiber provided worst (p <0.05) performance results, regardless of the period evaluated. Shortly after the start of laying, higher levels of fiber also caused a linear reduction (p <0.05) on egg weight and percentages of yolk and albumen, and an increase (p <0.05) on eggshells. Higher fiber levels caused a linear reduction (p <0.05) in the quality of the eggs, regardless of the period evaluated. It was concluded that the fiber levels did not influence the start period of the laying. Both pre-laying and start of the laying, levels above 2.5% of fiber caused a gradual worsening in performance. From the start of laying up to laying peak, levels above 2.5% of fiber also caused a gradual worsening in egg quality.

RESUMO O artigo analisa aspectos da mudança da natureza jurídica de instituições privadas de assistência à saúde, de estabelecimentos “com” para “sem” fins lucrativos. Trata-se de uma pesquisa exploratória, apoiada no referencial de análise de políticas, com foco em dados secundários, provenientes do Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES), de 2012 a 2020, e estudo de caso. Os resultados apresentam aumento dessas entidades em todas as regiões do país e evidências de que se comportam como estabelecimentos com fins lucrativos. A mudança de natureza jurídica oculta um processo mais amplo de mercantilização implícita dos serviços de saúde, incentivado por políticas estatais e relacionado às isenções previstas em lei. saúde “com sem “sem lucrativos Tratase Trata exploratória secundários SCNES, SCNES , (SCNES) 201 2020 caso lei (SCNES 20 202 2

ABSTRACT The article analyzes aspects of the change in the legal nature of private healthcare from “for-profit” to “non-profit” entities. It is an exploratory research, supported by the policy analysis framework, focusing on secondary data from the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities – CNES) from 2012 to 2020 and a case study. The results show an increase in these entities in all regions of the country and evidence that they behave like profit-oriented entities. The change in legal nature hides a broader process of implicit commodification of healthcare services, encouraged by state policies and related to exemptions provided by law. forprofit for profit “for-profit nonprofit non “non-profit research framework National CNES 201 202 study profitoriented oriented services law 20 2

Abstract Background and aims From a clinical point of view, post-stroke patients present difficulties in swallowing management. The purpose of this research was to identify risk factors that were independently related to the maintenance of a severe restriction of oral intake in patients affected by acute ischemic stroke. Methods The authors conducted a prospective observational cohort study of patients with dysphagia post-acute ischemic stroke who were admitted to an Emergency Room (ER). Demographic and clinical data were collected at ER admission. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at the patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment (at hospital outcome): G1 with severe restriction of oral intake and indication of feeding tube - patients with FOIS levels 1 to 4; G2 without restriction of food consistencies in oral intake - patients with FOIS levels 5 to 7. Results One hundred and six patients were included in our study. Results of the multivariate logistic regression model for the prediction of maintenance of a severe restriction of oral intake at hospital outcome in patients post-acute ischemic stroke indicated that increasing age (p = 0.006), and dysarthria (p = 0.003) were associated with higher chances of presenting severe restriction of oral intake at hospital outcome. Conclusions Patients with acute ischemic stroke in an Emergency Room may experience non-resolved severe dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.

Abstract The social isolation measures adopted during the critical phase of the COVID-19 pandemic led children to spend most of their time at home. Isolation may alter the pattern of traumatic dental injury occurrences, inasmuch as studies point out that most traumatic accidents occur at home. Considering this scenario and the influence of emergency management on the prognosis of the injury, the aim of this study was to evaluate the experience of traumatic dental injuries in children before and during the pandemic, and the knowledge of this topic by the children’s guardians. This cross-sectional study was conducted with guardians of children aged 0 to 6 years, residing in Juiz de Fora, MG, Brazil. The guardians answered an online questionnaire addressing personal information, traumatic dental injury experience before and during the pandemic, and knowledge of this topic. Descriptive and statistical analyses were performed using Pearson’s chi-square test at a 5% significance level. The total sample consisted of 343 volunteers. A total of 95 and 92 injuries were reported before and during the pandemic, respectively; the home was the place of greatest occurrence. Most volunteers (88.1%) agreed that traumatic dental injuries are emergency situations, and were aware that the tooth/fragment had to be taken to the dentist after a fracture or avulsion (97.4%). This study revealed that the traumatic dental injury experience was similar before and during the pandemic, and that the volunteers had satisfactory knowledge, especially in recognizing the importance of immediate attention for a more favorable prognosis of these injuries.

Abstract Genetic tests for dilated cardiomyopathy (DCM) have a diagnostic yield of up to 40%, but there is significant genetic heterogeneity and other challenges, such as variable expressivity and incomplete penetrance. Pedigree analysis is essential for distinguishing between sporadic and familial DCM cases by assessing family history. Familial DCM yields higher results in genetic testing, but sporadic DCM does not rule out the possibility of a genetic cause. Some genes have specific phenotypes, with the Lamin gene ( LMNA ) being associated with a phenotype of malignant arrhythmias and advanced heart failure (HF). The presence of a causal genetic variant can also aid in prognostic evaluation, identifying more severe cases with lower rates of reverse remodeling (RR) compared to individuals with a negative genotype. Current guidelines recommend genetic evaluation and counseling for individuals with DCM, along with cascade screening in first-degree relatives in cases where one or more variants are identified, offering an opportunity for early diagnosis and treatment. Relatives with a positive genotype and negative phenotype are candidates for serial evaluation, with frequency varying by age. Genotype also assists in individualized recommendations for implantable cardioverter-defibrillator (ICD) placement and advice regarding physical activity and family planning. Ongoing studies are progressively elucidating the details of genotype/phenotype relationships for a large number of variants, making molecular genetics increasingly integrated into clinical practice.

Resumo Os testes genéticos para cardiomiopatia dilatada (CMD) apresentam uma positividade de até 40%, mas há uma grande heterogeneidade genética e outros desafios decorrentes de expressividade variável e penetrância incompleta. O heredograma é fundamental para diferenciar os casos de CMD esporádica e familiar, por meio da avaliação do histórico familiar. A CMD familiar apresenta um rendimento maior nos testes genéticos, mas a CMD esporádica não exclui a possibilidade de causa genética. Alguns genes têm fenótipos específicos, sendo o gene da Lamina ( LMNA ) o mais fortemente associado a um fenótipo de arritmias malignas e quadros de insuficiência cardíaca (IC) avançada. A presença de uma variante genética causal também pode ajudar na avaliação prognóstica, identificando quadros mais graves e com menores taxas de remodelamento reverso em comparação com indivíduos com genótipo negativo. As diretrizes atuais recomendam a avaliação e aconselhamento genético em indivíduos com CMD, além do rastreamento em cascata nos familiares de primeiro grau nos casos em que há uma ou mais variantes identificadas, sendo uma oportunidade para o diagnóstico e tratamento precoces. Familiares com genótipo positivo e fenótipo negativo são candidatos à avaliação seriada, com periodicidade que varia conforme a idade. O genótipo também auxilia na indicação individualizada de cardiodesfibrilador implantável e em recomendações quanto à atividade física e planejamento familiar. Estudos em curso esclarecem progressivamente os detalhes das relações genótipo/fenótipo de um grande número de variantes e fazem com que a genética molecular esteja cada vez mais presente na prática clínica.