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This monograph aimed to investigate the relation between Gross Domestic Product (GDP), inflation and unemployment in Brazil from 1999 to 2015. To achieve the objective, we used a descriptive methodology, ex post facto and quantitative method, using the linear regression model to investigate the relations along with the analysis of the average rate of change of the period. The conclusion reached is that through simple linear regression only the relation between unemployment rate and GDP (Okun Law) was proved, since the model generated for the relation between inflation and GDP and between unemployment and inflation did not yield solid results. Now, in the analysis of the average rate of variation showed that the behaviour of the variables as per the theory of Okun’s Law and Phillips Curve, while for inflation and GDP was found a direct relationship in the period.

Background/Objective: Radiofrequency ablation (RFA) has been increasingly used as an alternative to surgery in patients with primary hyperparathyroidism who are unable or unwilling to have surgery. Case Report: We present a case of a 64-year-old woman who had surgery for primary hyperparathyroidism complicated by osteoporosis. Preoperative imaging with 4-dimensional computed tomography scan suggested multigland disease; however, she had persistent hyperparathyroidism after parathyroid exploration. Reevaluation of her imaging studies with ultrasound (US) and US-guided fine needle aspiration for parathyroid hormone washout led to identification of an intrathyroidal parathyroid adenoma that was successfully treated by RFA followed by ethanol injection. Discussion: The case illustrates the utility of US and US-guided fine needle aspiration for the identification of intrathyroidal parathyroid adenomas, as well as successful treatment of a patient who had failed parathyroid surgery, with a combination of both radiofrequency and percutaneous ethanol ablation, a novel technique. Conclusion: RFA, with or without ethanol ablation, can be considered as an alternative to surgery for patients with persistent hyperparathyroidism after parathyroidectomy.

Resumo O objetivo deste estudo é analisar a evolução da competitividade brasileira e de seus principais competidores no mercado mundial de limões para o período de 2002 a 2022. Para tal, aplicou-se os índices de Vantagem Comparativa Revelada (VCR), Posição Relativa de Mercado (PRM), Taxa de Cobertura (TC) e o modelo de Constant Market Share (CMS). Os resultados de VCR, PRM e TC são positivos, evidenciando competitividade e relevância, sendo um produto ponto forte. Entrementes, em 2022, os resultados ficaram abaixo dos encontrados para o México, a África do Sul, a Espanha, a Turquia e a Argentina, sendo a África do Sul detentora de maior competitividade e o México de maior importância. O CMS indica, no Brasil e na África do Sul, que a fonte de crescimento das exportações ocorreu majoritarimente em virtude do efeito competitividade, sendo que a África do Sul foi a maior beneficiária desse efeito, ao passo que para o México foi o efeito destino das exportações e para a Espanha e a Argentina, crescimento mundial.

O objetivo geral da pesquisa é identificar esses diferenciais de desenvolvimen-to para as mesorregiões do estado do Amazonas. Especificamente, procura-se elaborar índices relacionados a aspectos selecionados do desenvolvimento e apon-tar os municípios que apresentam maiores e menores graus de desenvolvimento por mesorregião. Para uma melhor análise desses diferenciais, cada variável utili-zada para medir o desenvolvimento de uma região é tratada estatisticamente pela técnica de análise multivariada, em que componentes principais são destacados e utilizados para a elaboração de índices socioeconômicos (Índice de Desenvolvi-mento Amplo, Índice de Nível Populacional e Alocação de Despesas). Aplicando essa técnica para as mesorregiões do Amazonas, é possível avaliar suas particula-ridades, demonstrando as diferenças presentes no processo de desenvolvimento de cada uma delas, além de permitir, por meio dos índices elaborados, uma visão tanto das regiões que possuem melhor desempenho socioeconômico como das que estão com dificuldades em áreas essenciais para o desenvolvimento.

O objetivo deste estudo é analisar as relações da Teoria do Salário Eficiência e Produtividade do Trabalho na indústria de transformação brasileira no período 2007-2019. A Indústria de Transformação é responsável por 11,30% do PIB do país no primeiro trimestre de 2021 sendo assim uma das principais atividades econômicas do país com uma das maiores massas de trabalhadores empregados na atividade, chegando a mais de 8 milhões de pessoas em 2022. O estudo está segmentado em 4 partes. A primeira aborda a evolução da Massa Salarial da Indústria de Transformação brasileira, ao longo dos anos de 2007 a 2019. Na segunda parte foram feitas análises sobre a produtividade do trabalho do período, em sequência é elaborada uma discussão da relação dos dados. Por fim, os testes de que verificam as relações dos dados através de uma matriz de correlação de Pearson. Os resultados mostram forte Correlação entre Custos e Despesas, representando a Massa Salarial e a produtividade do trabalho no período, indicando que a Teoria dos Salários Eficiência pode ser observada na Indústria de Transformação brasileira.

O presente trabalho é resultado de uma pesquisa de natureza qualitativa, por meio de uma revisão de literatura, realizamos um levantamento bibliográfico de autores que tecem a temática da Economia Regional especialmente nas teorias da Localização e da organização espacial da economia. Foram estudadas as teorias de Von Thunen, Albert Weber, Gunnar Myrdal, François Perroux, Walter Isard, Walter Christaller, Albert Hirschman. Em seguida utilizamos os métodos de análise regional para a verificação das medidas de localização e de especialização que são: Quociente Locacional (QLij), Coeficiente de Localização (CLj), Coeficiente de Redistribuição (CRj), Coeficiente de Especialização (CEi) e o Coeficiente de Reestruturação (CTj). Com relação aos resultados obtidos é importante salientar que conforme vários autores observam que a variável base (mão-de-obra) utilizada para calcular todos indicadores aqui analisados, mesmo sendo a mais utilizada nos trabalhos científicos de mesma natureza, pelos diversos motivos já expostos na metodologia pode ocultar modificações na estrutura produtiva.

Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.

Diffuse alveolar haemorrhage related to an anti-neutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis is an extremely rare form of presentation of breast cancer. Here we report the case of a 77-year-old woman with a histological diagnosis of a papillary ductal carcinoma of the breast presenting with a diffuse alveolar haemorrhage secondary to a perinuclear ANCA-associated vasculitis. To our knowledge, this is the first case ever reported of a diffuse alveolar haemorrhage related to an ANCA-associated small vessel vasculitis as a form of presentation of breast cancer. The therapeutic approach of this paraneoplastic vasculitis included the use of corticosteroids and plasmapheresis, a very useful technique to remove endothelial aggressors (circulating antibodies) as a strategy to earn time for a proper therapeutic decision specifically directed for disease modification, but that can also be associated with several severe adverse effects, which are illustrated in our case.

Pit and fissure sealant is a clinical technique adopted to prevent caries lesion development. Ionomeric and/or resin-based materials are commonly used for this purpose. This article presents a case series of sealed teeth with 22-year follow-up evaluated by clinical, photographic, and microscopic analysis. In 1992, sixteen patients (9-14 years of age) had at least three teeth sealed with one of the following materials: resin-modified glass ionomer cement (RMGIC, Vitrebond or Fuji II LC) or polyacid-modified resin composite (PMRC, VariGlass VLC), totaling 86 sealed permanent teeth. After 22 years, 10 patients were recalled, representing 41 teeth. The retention of sealants was assessed by three methods: clinical analysis by visual inspection; photography; and scanning electron microscope (SEM) images and classified as retained (pits and fissures filled by sealant material); partially retained (pits and fissures partially filled by sealant material); or totally lost (no material was found in pits and fissures). The SEM images provided a higher number of retained sealants when compared with the clinical and photographic evaluations. Also, no totally lost scores were found with SEM analysis, regardless of the sealing material. No caries lesions were found. A fully or partially retained sealant in pits and fissures was capable of preventing caries lesions after 22 years within the patient pool analyzed. [ABSTRACT FROM AUTHOR]

The use of the metaphor of verticality may affect consumers’ motivations to perform product price assessments, and the motivational regulatory focus of the individual may have features that contribute to restoring motivation. This study aims to analyze the influence of the verticality metaphor, and of the regulatory focus on price assessments in order to get a good deal. We performed an experimental study with a design 2 (vertical metaphor: physically tall vs. physically short) x 2 (regulatory focus: promotion vs. prevention) between subjects. The results show that the treatment group, with the individuals who consider themselves physically tall and focused on prevention, had the best performance when assessing price in the context of getting a good deal. The originality of this research lies in the identification of the behavioral characteristics of individuals that are able to mitigate changes in people’s motivation when exposed to mental simulations of verticality, in order to get a good deal. In practical terms, the findings make it evident that the decrease in individuals’ motivation for decision making surrounding prices, under the effects of verticality, can be reestablished when they take on surveillance behavior as well as behavior aimed at avoiding mistakes.

Information available in websites encompasses symbols and hints that help consumers to construct images of the enterprises by interpreting the attributes and benefits of the services and products being offered. A direct communication between company and consumer is thus established. To understand how this communication system works, this article makes use of semiotics as an approach to dealing with the data, and to make hypotheses on how effective the messages are. The propositions made relate to the strategies the enterprises may follow to overcome the intangibility problem – a common feature of services – and establish a brand identity for them. The qualitative research that supports this article focused on the website of the Accord Hotels Network in Brazil, an organization that works with several types of hotels. It was found that the problem of how to create in the consumer a mental image distinctive of a service with so many tangible and intangible features is a complex one which can only be solved with the recourse to diversified and well defined strategies.

CONTEXT AND OBJECTIVE: Recent studies have shown noncontrast computed tomography (NCT) to be more effective than ultrasound (US) for imaging acute ureterolithiasis. However, to our knowledge, there are few studies directly comparing these techniques in an emergency teaching hospital setting. The objectives of this study were to compare the diagnostic accuracy of US and NCT performed by senior radiology residents for diagnosing acute ureterolithiasis; and to assess interobserver agreement on tomography interpretations by residents and experienced abdominal radiologists. DESIGN AND SETTING: Prospective study of 52 consecutive patients, who underwent both US and NCT within an interval of eight hours, at Hospital São Paulo. METHODS: US scans were performed by senior residents and read by experienced radiologists. NCT scan images were read by senior residents, and subsequently by three abdominal radiologists. The interobserver variability was assessed using the kappa statistic. RESULTS: Ureteral calculi were found in 40 out of 52 patients (77%). US presented sensitivity of 22% and specificity of 100%. When collecting system dilatation was associated, US demonstrated 73% sensitivity, 82% specificity. The interobserver agreement in NCT analysis was very high with regard to identification of calculi, collecting system dilatation and stranding of perinephric fat. CONCLUSIONS: US has limited value for identifying ureteral calculi in comparison with NCT, even when collecting system dilatation is present. Residents and abdominal radiologists demonstrated excellent agreement rates for ureteral calculi, identification of collecting system dilatation and stranding of perinephric fat on NCT.

The incidence of AIDS and other sexually transmitted diseases (STDs) is increasing among adolescents. In order to better understand high-risk sexual behavior among students, a cross-sectional study based on a self-answered anonymous questionnaire was conducted in 10 public and private high schools in Rio de Janeiro, Brazil. Data were obtained on sociodemographics, knowledge of STD/AIDS, and sexual behavior. Among 945 students aged 13-21, 59% were sexually initiated, and the median age at first sexual intercourse was 15 years (range: 7-19). Although 94% reported being aware of the need for condom use for protection, only 34% informed always using condoms during sex. Low family income was associated with unsatisfactory knowledge (OR = 9.40; 95% CI = 6.05-14.60) and inconsistent condom use (OR = 11.60; 95% CI = 5.54-24.30). However, unsatisfactory knowledge was not associated with inconsistent condom use. School-based educational programs should focus on sexual behavior more than on transmission of knowledge, as well as targeting low-income students.

OBJECTIVES: Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS: This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS: A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION: The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.

Introduction: Despite improving maternal-child indicators in Brazil, congenital malformations are still the second cause of mortality in the first years of life. This work aims to compare statistical data before and after flour fortification with folic acid (FA) in Brazil., Methods: A cross-sectional Brazilian-population-based study compares the spina bifida (SB) rates pre- and post-fortification of the flour with folate. Data collected from the public database of the Live Birth Information System (SINASC/SUS) was performed. The period 1999-2004 (pre-fortification) was compared with 2005-2010 (post-maize and wheat fortification with FA), and another analysis comparing 2005-2010 and 2011-2020 (cassava flour fortification) was performed. The estimator was the prevalence ratio (PRR); the confidence interval selected was 95%. We used a random effects analysis model and inverse variance., Results: The review showed a tendency to decrease the PRR after flour fortification; however, there is no statistical significance between studies. DATASUS data analysis comparing 5 years before and 5 years after mandatory maize and wheat flour fortification demonstrated a rate ratio of 1.05 (95% CI 0.99-1.1; p = 0.075). Furthermore, comparing 10 years after additional cassava flour folate fortification, the rate ratio increased to 1.4 (95% CI 1.34-1.45; p < 0.01)., Conclusion: This study demonstrated an increase in SB after FA fortification. Possible explanations rely on national registry improvement, not fortified staple food, or further unidentified causes. Moreover, suggestions can be made for creating a mandatory registry for malformations, inspecting the concentrations of FA in the flour, and fortifying all food., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This case describes a female patient with agenesis of the maxillary right lateral incisor, with her permanent canine in its position and the deciduous canine retained. Additionally, she presented with a maxillary left peg lateral incisor. To solve her functional and esthetic complaints, a multidisciplinary approach involving perio-restorative procedures was proposed. Periodontal surgeries were performed to align the gingival contour, and the restorative approach utilized ceramic veneers. At the 18-month clinical and radiographic follow-up, the treatment outcome was stable, with maintenance of the clinical results achieved and without any sign of deciduous tooth resorption.

Despite the reduction in the prevalence of dental caries, very little is known about the prevalence of the disease, especially in deciduous teeth, in small Brazilian cities (<20,000 inhabitants). The aim of this study was to evaluate the prevalence of dental caries in children aged 3 and 5 years of age in the city of Cambira - State of Parana. All children that participated in the national vaccination campaign against poliomyelitis in 2002 at the two basic health units of the city were examined. The campaign covered 99.5% of the population aged 1 to 5 years. Two previously trained and calibrated dentists performed the clinical examinations after the children brushed their teeth and recorded their caries experience by means of the dmf index. The results showed that there was no statistically significant difference in the prevalence of the disease between the male and female genders and between the rural and urban zones. At the age of 3, 68.50% of the children were caries-free, compared to 31.10% at the age of 5. In the total population, 11.19% of the children accounted for 50.86% of the teeth affected by dental caries. The dmf index at 3 and 5 years in the study population was 2.10 and 3.51, respectively. These data showed that the city has not yet reached the goals proposed by the WHO for the year 2000, what indicates the need for greater investment in programs aimed to prevention and control of the disease.