ABSTRACT Leaf litter decomposition and the release of nutrients from macauba palm leaves play a major role in nutrient return to the soil in a conservation environment. This study evaluated macauba palm leaf decomposition, macronutrient contents and biochemical composition under contrasting water conditions in the Brazilian Cerrado. Macauba leaves were collected from plants in two different environments (low and high water table conditions), placed in litter bags and evaluated according to their decomposition, macronutrients, lignin, cellulose and hemicellulose for 420 days. In addition, green and dry leaves were collected for macronutrient analyses. Litter decomposition ranged between 49 % and 59 % up to 180 days. The half-life of litter ranged from 141 to 198 days. The leaf litter decomposition of macauba was practically stable during the dry season, whereas at the beginning of the rainy season, decomposition resumed. Nitrogen, P and S were higher in the green leaves, whereas the Ca levels were higher in the dry leaves. In addition, the K levels were twofold higher in the green leaves than in the dry leaves. Lignin release from macauba residues was slower than cellulose and hemicellulose. The decomposition rates of hemicellulose were higher initially due to its high solubility, although it gradually decreased with the decomposition process. Lignin decomposition was also higher at the beginning of the process but stabilized during the drought period. The study indicates that the decomposition process and nutrient cycling of macauba are influenced by its biochemical composition.

Aim To assess oral microbial status in patients with acute lymphoblastic leukemia (ALL) undergoing high-dose chemotherapy and to unravel possible associations between nosocomial pathogens and the establishment of chemotherapy-induced oral mucositis (CIOM). Methods Oral mucosa, saliva, and peripheral blood samples were collected from 46 ALL subjects one day prior to chemotherapy (D0) and 2 weeks after treatment initiation (D14). Clinical intraoral inspection was performed by a single practitioner, with mucositis classification performed according to the WHO oral toxicity scale. Blood components were quantified by automatic flow cytometry, while oral Staphylococcus aureus and Pseudomonas aeruginosa were detected by Polymerase Chain Reaction with species-specific primers. Associations among bacteria and clinical findings were determined by Fisher’s Exact test, longitudinal bacterial changes by paired Macnemar, and correlations among blood parameters and mucositis status or bacteria via Mann-Whitney. Results S. aureus displayed higher detection rates at D14 (p < 0.05) and was positively associated with mucositis, adoption of a non-solid diet (all p < 0.001), nausea and fever (all p < 0.05). Conversely, P. aeruginosa did not correlate to CIOM clinical parameters. At the systemic standpoint, lower hemoglobin levels associated with CIOM and fever events (all p < 0.01). Conclusion The study evidences S. aureus as a potential pathogen in ALL-CIOM, reaffirming microbial control as an important preventive measure during high-dose immunosuppressive therapy. The weight of non-white-blood-cell parameters should be validated as novel CIOM biomarkers in prospective research.

Abstract Objective The aim of this study is to test, in vitro, the anti-cariogenic effect of experimental hybrid coatings, with nano clays of halloysite or bentonite, loaded with sodium fluoride or with a combination of sodium fluoride and stannous chloride, respectively. Methodology The varnish Fluor Protector (1,000 ppm of F-) was used as positive control and no treatment was the negative control. Enamel specimens (5 mm × 5 mm) were obtained from bovine teeth. The specimens (n=10) had their surfaces divided into two halves (5 mm × 2.5 mm each), in which one half received one of the treatments (Hybrid; Hybrid + NaF; Hybrid + NaF + SnCl2; Hybrid + NaF Loaded; Hybrid + NaF + SnCl2 Loaded). The specimens were submitted to a cariogenic challenge using a biofilm model (S. mutans UA159, for 5 days). Enamel surfaces both under and adjacent to the treated area were analyzed for mineral loss and lesion depth, by transverse microradiography. The pH of the medium was measured twice a day, and the fluoride release was analyzed. Additional specimens were submitted to confocal analysis. Results Data were statistically analyzed by two-way ANOVA followed by Tukey test (α=0.05). None of hybrid groups were able to reduce the lesion depth; the Hybrid + NaF group, however, was able to reduce mineral loss differing from the negative control (p=0.008). The groups showed no significant difference in the pH measurement and fluoride release. Confocal analysis confirmed that for all groups the biofilm growth was similar. Conclusion None of the hybrid groups reduced lesion depth, but the Hybrid + NaF group was able to promote protection against mineral loss.

Resumo O desgaste por cavitação representa um dos principais problemas encontrados em turbinas hidráulicas, sendo as áreas danificadas recuperadas com a deposição de revestimentos resistentes a cavitação pelo processo MIG/MAG. Este trabalho buscou caracterizar amostras obtidas após deposição de um revestimento inoxidável austenítico a base de cobalto sobre substrato de ASTM A-743 CA6NM, realizada por meio do processo MIG mecanizado, avaliando as microestruturas obtidas com auxílio das técnicas de microscopia ótica, MEV/EDS, EBSD, DRX e Microdureza. Pode-se identificar a presença de microestrutura austenítica na superfície depositada, com tamanho de grão médio de 11,27 μm e traços de ferrita delta próximos a linha de fusão, com substrato majoritariamente martensítico. Acima da ZF a morfologia da microestrutura se deu em forma colunar na direção da extração de calor. O aporte térmico não afetou a superfície do revestimento, mantendo suas características químicas e de dureza, sem que houvesse uma diluição elevada do metal base no revestimento, se apresentando como uma excelente alternativa para utilização na recuperação de componentes cavitados, devido a sua baixa EFE e microestrutura que favorecem a absorção da energia proveniente do processo de cavitação.

Abstract Cavitation wear represents one of the main problems encountered in turbines, being one of the areas of protection of hydraulic solutions recovered with a cavitation resistant protection by the GMAW process. This work aimed to characterize samples obtained after deposition of a cobalt-based austenitic stainless coating on ASTM A-743 CA6NM substrate, performed through the mechanized MIG process, evaluating the microstructures obtained with the aid of optical microscopy, MEV/EDS, EBSD, DRX and Microhardness techniques. It can be identified the presence of austenitic microstructure on the surface, with an average grain size of 11.27 μm and traces of ferrite from the next surface line with mostly martensitic substrate. Above the ZF, the morphology of the microstructure was in a dendritic form with a direction towards heat. The size provided did not adjust the thermal components, maintaining their characteristics and durability, without having superior protection of the thermal coating, without adequate protection of the supervised components, its use can maintain an excellent alternative for its use and durability. microstructure that favors the absorption of energy from the cavitation process.

ABSTRACT Introduction: Surgical training models prepare the resident for a more ethical surgical practice as well as providing a less steep learning curve. In urology, there are well-known models of pyeloplasty simulation, urethro-vesical anastomosis and nephrectomy, which have helped in the training of urology residents (1–3). Learning laparoscopic prostatectomy is a difficult surgery and requires advanced surgical skill from the surgeon (4), requires operate without a direct view of the surgical field in a two-dimensional space and with longer instruments (5). Laparoscopic prostatectomy step by step makes the surgeon's learning curve less difficult, lead to less intraoperative complications, such as blood loss, while also enabling shorter operative time and less positive surgical margins (6). The objective of surgical models is to simulate surgical procedures in a reliable way thus preparing the surgeon for his daily practice, surgical simulations in animal models have been described to compensate for inadequate clinical exposure (7). The canine model of prostate cancer has many similarities with humans. Despite trying to develop a model that is as credible as possible, there are ethical issues in several countries, such as Brazil, that do not allow the use of live dogs for scientific experimentation and there is a difficulty in not standardizing the animals used (8, 9). The swine surgical training model is widely known, accepted and used as a valuable tool in the teaching of new surgeons (10). The porcine video laparoscopic prostatectomy model allows the urologist in training to exercise the skills required in a real surgical situation, practicing them in a single session (10). We will present an experimental model in pigs for training urology residents in laparoscopic radical prostatectomy with current techniques (11–13). The limitations found are that the prostate has no limits as well defined as in humans, the urethra is long and coiled, the fat surrounding the pelvic organs is scarce and there is no postoperative follow-up for evaluating functionality after the procedure, as well as the effectiveness of the surgery with surgical margins. However, it is similar in surgical model presented, it is reproducible and can provide a realistic simulation environment to the beginner surgeon. Material and Methods: In this paper, according to the institutional protocol approved by the institutional ethics and research committee FMUSP n° 964/2017 and protocol was in accordance with current international regulations for the use of animals in Research: Reporting In Vivo Experiments (ARRIVE) guide. Ten male pigs weighing 20 to 22kg were used. The animals were anesthetized with a combination of Telazol (5mg/kg), Xylazine (1.5mg/kg), Cetamine (22mg/kg) and Atropine (0.04mg/kg) for orotracheal intubation followed by Isoflurane (2%). Animals were euthanized at the end of the procedure with a lethal dose of KCl (2mEq/kg). The trocar insertion points were marked using the epigastric vessels and umbilical region as reference points. Initially, urethral catheterization was performed using a hydrophilic Nitinol guidewire, followed by a perineal incision to dissect the tortuous urethra of the porcine model. A malleable urethral catheter 8Fr was inserted into their bladder. The animal was placed in the Trendelenburg position inserted and 12mm trocars were inserted in its umbilical region, utilizing 10mm in the surgeon's dominant hand, 5mm in his non-dominant hand of the surgeon, and 5mm in the first assistant's trocar. The surgeon replicates the steps performed in a laparoscopic radical prostatectomy in humans, including the bladder catheterization, dissection of the anterior bladder plane, the vesicular and prostatic dissection, the suture of the dorsal venous plexus, a prostatectomy, an urethral vesical anast omosis, as well as the waterproof test, even including the performing of surgical steps using current concepts of anterior urethral suspension as the reconstruction of the posterior plane of the rhabdosphincter. Results: All steps of surgery could be reproduced in all ten porcine cases. No significant bleeding was observed and the surgical time was gradually reduced fifty percent from case one to last cases. Conclusions: The porcine model allowed the surgeon to replicate all the steps usually performed in a laparoscopic radical prostatectomy. The junior surgeons are better prepared to such difficult surgery. However, further studies will be necessary to prove the impact of the animal model presented in urological clinical practice.

Resumo Objetivo Descrever o perfil epidemiológico e clínico dos pacientes com doença de Dupuytren tratados por fasciectomia seletiva e os fatores associados com a gravidade da doença. Metodologia Estudo observacional descritivo retrospectivo envolvendo 247 pacientes com doença de Dupuytren, no período de 2013 a 2019. Foi realizada regressão logística multivariada para análise dos dados. Resultados A maioria dos pacientes era do sexo masculino (83,8%), autodeclarados brancos (65,2%), etilistas (59,6%), e 49% eram tabagistas. A média de idade foi de 66 ± 9 anos, sendo que 77,2% apresentaram os sintomas da doença após os 51 anos. Aproximadamente 51,9, 29,6, e 17,3%, respectivamente, apresentaram hipertensão arterial, diabetes mellitus e dislipidemia. O acometimento bilateral das mãos foi observado em 73,3% dos pacientes. A taxa de complicações intra- e pós-fasciectomia seletiva foi de 0,6 e 24,3%, respectivamente, sendo que 5,2% dos pacientes necessitaram de reintervenção após 1 ano de acompanhamento. Após análise multivariada, o sexo masculino foi associado com acometimento bilateral das mãos (odds ratio [OR] = 2,10; intervalo de confiança [IC] 95%: 1,03–4,31) e com maior número de raios acometidos (OR = 3,41; IC 95%: 1,66–7,03). A dislipidemia foi associada com a reintervenção (OR = 5,7; CI 95%: 1,03–31,4) e a bilateralidade com maior número de complicações (35,7% versus 19,7%). Conclusão Foi observada uma baixa taxa de reintervenção e complicações operatórias nos pacientes com doença de Dupuytren tratados por fasciectomia seletiva. O sexo masculino foi associado com o quadro grave da doença (bilateralidade e mais de dois raios acometidos), e a dislipidemia com a reintervenção.

Abstract Objective To describe the epidemiological and clinical profile of patients with Dupuytren disease treated by selective fasciectomy and the factors associated with the severity of the disease. Methods Retrospective descriptive observational study involving 247 patients with Dupuytren disease, from 2013 to 2019. Multivariate logistic regression was performed for data analysis. Results Most patients were male (83.8%), self-declared white (65.2%), alcoholics (59.6%) and 49% were smokers, with a mean age of 66 ± 9 years old, with 77.2% presenting symptoms of the disease after the age of 51 years old. Approximately 51.9, 29.6 and 17.3%, respectively, had arterial hypertension, diabetes mellitus and dyslipidemia comorbidities. Bilateral involvement of the hands was observed in 73.3% of the patients. The rate of intra- and post-selective fasciectomy complications was of 0.6 and 24.3%, respectively, with 5.2% of the patients needing reintervention after 1 year of follow-up. After multivariate analysis, males were associated with bilateral involvement of the hands (odds ratio [OR] = 2.10; 95% confidence interval [CI]: 1.03–4.31) and with a greater number of affected rays (OR = 3.41; 95% CI: 1.66–7.03). Dyslipidemia was associated with reintervention (OR = 5.7; 95% CI = 1.03–31.4) and bilaterality with a higher number of complications (35.7 versus 19.7%). Conclusion A low rate of reintervention and operative complications was observed in patients with Dupuytren disease treated by selective fasciectomy. Male gender was associated with severe disease (bilaterality and more than two affected rays), and dyslipidemia with reintervention.

ABSTRACT Coronavirus disease 19 (COVID-19) is caused by SARS-Cov-2 and the manifestations of this infection range from an absence of symptoms all the way up to severe disease leading to death. To estimate the prevalence of past infection in a population, the most readily available method is the detection of antibodies against the virus. This study has investigated the prevalence of anti-SARS-CoV-2 antibodies in outpatients of the Hospital das Clinicas, in Sao Paulo city (Brazil), which is a large university hospital belonging to the public health system that cares for patients with complex diseases who need tertiary or quaternary medical care. Our serological inquiry was carried out for 6 weeks, with once-a-week blood sampling and included 439 patients from several outpatient services. Overall, 61 patients tested positive for anti-SARS-CoV-2 IgG (13.9%); 56.1 % of the patients live in Sao Paulo city, with the remaining living in other towns of the metropolitan area; 32.8% of the patients testing positive for IgG antibodies to SARS-CoV-2 were asymptomatic, 55.7% developed mild or moderate disease and 11.5% had to be hospitalized. The prevalence of SARS-CoV-2 positive serology was lower among patients who had received the seasonal influenza vaccine compared to the ones who did not. These findings may indicate that those individuals care more about health issues, and/or that they have a better access to health care and/or a better quality of health care service. The large proportion of patients who were unaware of having had contact with SARS-CoV-2 deserves attention, reflecting the scarcity of tests performed in the population.

Abstract The wheat cultivar UTF 25 is recommended for wheat-growing regions 1 and 2 of Paraná and Santa Catarina states. It has a good disease resistance, early cycle, and high grain yield potential, with an average yield of 3.511 kg ha-1. It is classified as bread wheat with white flour.

Abstract Aims: The purpose of the present study was to evaluate the effects of the resistance training (RT) on the lipid profile and metabolism, oxidative stress, and activity of metalloproteinase-2 (MMP-2) in the left ventricle (LV) of diet-induced obesity rats. Methods: Forty males Wistar rats 90 days-old were grouped into four groups (n=10): i) Sedentary group (SED); ii) Obese sedentary group, feed with high-fat diet (Ob-SED); iii) Resistance Trained group (RT), and iv) Obese Resistance trained group (Ob-RT). The LV was assayed to Obesity index, LV lipid content, citrate synthase activity, lipid peroxidation (TBARS), enzymatic and non-enzymatic antioxidant systems, lipid profile, cardio-metabolic parameters, and activity of MMP-2. Results: High-fat diet was associated with manifestations of the obesity, body mass gain, and increased obesity index, accompanied by an alteration in the lipid profile. On the other hand, RT was able to prevent body weight gain, to reduce the obesity index and to improve the lipid profile, to elevate the activation of the citrate synthase, and to decrease MMP-2 activity in the LV of obese rats. Conclusion: RT positively modulated blood lipid profile and antioxidant enzymes preventing the increased activity of MMP-2 in the left ventricle from rats fed with high-fat diet.

Abstract Aims: To evaluate whether body mass (BM) and body composition may influence mountain bike cycling performance. Methods: Forty male amateur mountain bikers attended the laboratory on two non-consecutive days. At the first visit, anthropometric measures (height, BM, body fat [BF], fat-free mass [FFM] and body mass index [BMI]) and familiarization to incremental cycling test were performed. On the second visit, cyclists performed again the incremental cycling test to measure peak power output (PPO), peak power output relative to BM (PPO-BM), and time to exhaustion (TE), which were posteriorly correlated with BM and anthropometric measures. Results: A low and moderate significant correlation were observed between TE and BM (p<0.01; r=0.40) and FFM (p<0.01; r=0.56). Moderate significant correlation was found between PPO and BM (p<0.01; r=0.45), BMI (p=0.03; r=0.35) and strong with FFM (p<0.01; r=0.59). Also, PPO-BM significantly correlated with BM (p=0.04; r=-0.31), BMI (p=0.02; r=-0.35) and BF (p<0.01; r=-0.55). No other significant correlations were observed. Conclusion: Considering PPO-BM as mainly performance variable, BM and BF can be a determining factor in mountain biking performance but FFM did not.

ABSTRACT Objectives To validate an experimental non-animal model for training of vasectomy reversal. Materials and Methods The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software. Results Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035). Conclusion The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.

Abstract Polymer matrix nanocomposites (NMP) have attracted a great interest mainly in the automotive, aerospace and medical industries since they have good mechanical properties, dimensional, thermal and chemical stability, as well as interesting electrical conductivity and cost reduction in the manufacturing process. However, welding of this class of materials presents serious challenges such as improving weldability of the joint and understanding the mechanisms responsible for coalescence. The objective of this work was to evaluate the coalescence of an NMP joint (comprising a PA6 matrix and with nanosilica of different percentages of silicon) using ultrasonic welding, as well as to perform an acoustic approach of the energy dissipation during the welding process. It is concluded that the NMP samples tend to show better coalescence as the percentage of nanosilica increases, up to a certain limit. On the other hand, the higher the content of nanoparticle the smaller the energy absorption.

Resumo Recentemente, no Brasil, cultivares de tegumento colorido estão sendo desenvolvidas, como as de tegumentos marrom e preto. A soja com tegumento preto tem sido amplamente utilizada há décadas, devido aos seus benefícios para a saúde e ao uso na medicina popular oriental em razão da presença de fitoquímicos. Estes foram reconhecidos como ingredientes alimentares funcionais promotores da saúde, devido à sua atividade antioxidante, sendo também, conhecidos por terem efeitos anticancerígenos, hipoglicêmicos e anti-inflamatórios, e ainda têm sido usados no tratamento de vários distúrbios circulatórios. Este estudo teve como objetivo determinar a composição centesimal, os níveis de ácidos graxos e a atividade de lipoxigenase de linhagens de soja específicas para a alimentação humana, com diferentes colorações de tegumento. A linhagem MGBR10-16601, de tegumento amarelo, apresentou o teor mais elevado de proteína (37,6 g 100 g-1) e menor teor de gorduras (18,3 g 100 g-1). A linhagem MGBR10-1620, de tegumento amarelo, foi identificada como livre das isoenzimas de lipoxigenase. Os teores de ácidos graxos insaturados variaram de 18,48 a 31,37 mg g-1 para o ácido oleico e de 47,36 a 58,31 mg g-1 para o ácido linoleico. A linhagem de tegumento preto, BRN07-50543, apresentou teores de ácidos oleico (31,37 mg g-1) e linoleico (47,36 mg g-1) inferiores aos padrões definidos pelo Codex Alimentarius para o óleo de soja, e elevado teor de isoflavonas totais (546 mg 100 g-1). A cultivar BRSMG 790A, de tegumento amarelo, apresentou o menor nível de isoflavonas (171,4 mg 100 g-1). Todos os materiais genéticos avaliados estão dentro dos parâmetros de soja comercial para os níveis de proteína bruta, gorduras, fibras alimentares e cinzas.

Abstract Recently, in Brazil, coloured-tegument soybean cultivars have been developed, such as those with brown and black teguments. Soybeans with black teguments have been widely used for decades due to their health benefits and their use in oriental folk medicine as a result of the presence of phytochemicals. They have been recognized as health-promoting functional food ingredients due to their antioxidant activity, and are also known to have anti-cancer, hypoglycaemic and anti-inflammatory effects and have been used in the treatment of various circulatory disorders. This study aimed to determine the proximate composition, fatty acid levels and lipoxygenase activity of soybean lineages with different tegument colours intended for human consumption. The lineage MGBR10-16601 which has a yellow tegument, presented the highest protein and lowest fat contents, with values of 37.6 g 100 g-1 and 18.3 g 100 g-1, respectively. The lineage MGBR10-16201, which also has a yellow tegument, was identified as free of lipoxygenase isoenzymes. The unsaturated fatty acid levels ranged from 18.48 to 31.37 mg g-1 and from 47.36 to 58.31 mg g-1 for oleic and linoleic acids, respectively. The lineage BRN07-50543, which has a black tegument, presented high total isoflavone levels (546 mg 100 g-1), with an oleic acid level above and linoleic acid level below the standards established by the Codex Alimentarius for soybean oil, with values of 31.37 mg g-1 and 47.36 mg g-1, respectively. The cultivar BRSMG 790A, which has a yellow tegument, presented the lowest isoflavone level (171.4 mg 100 g-1). All the genetic materials examined presented crude protein, fat, dietary fibre and ash levels within the commercial parameters established for soybeans.

Resumo Os sambaquis do litoral do Espírito Santo foram pouco estudados pelas pesquisas arqueológicas realizadas no estado. Apesar de serem conhecidos desde finais do século XIX, foram recorrentemente considerados uma extensão marginal dos desenvolvimentos culturais que aconteciam no Rio de Janeiro. À escassez de informações sobre as características dos sítios, soma-se a ausência de datações 14C bem referenciadas, as quais impedem o entendimento da profundidade temporal e da evolução da ocupação humana pré-colonial no litoral do estado. Este artigo apresenta as metas e os resultados da retomada das pesquisas arqueológicas nos sambaquis do litoral norte do Espírito Santo, em Linhares. Até o momento, foram escavados dois sambaquis cuja idade recua em quase 2000 anos o registro de presença humana na costa do estado. As novas pesquisas seguem um método padronizado para escavação dos sítios, especialmente desenhado para a primeira caracterização dos sambaquis, o qual envolve a construção de um banco de dados digital e a incorporação de sistemas informatizados para gerenciamento das escavações. As pesquisas revelaram evidências da ocupação humana na região anterior ao máximo transgressivo holocênico (sítio Suruaca 20, datado em c. 6800 cal. AP), momento em que manguezais, restingas e florestas de tabuleiros constituíam o ambiente costeiro.

Abstract The shell mounds (sambaquis) on the coast of Espírito Santo have received little attention in archaeological research. Despite being known to scholars since the end of the nineteenth century, shell mounds were recurrently considered marginal to the cultural developments in the neighboring state of Rio de Janeiro. Scarce information on the contents of the sites and the lack of well-referenced 14C dating prevented a complete understanding of the time-depth and evolution of pre-colonial settlement on this fragment of the Brazilian coast. This paper introduces the aims and preliminary results of renewed archaeological research on the shell mounds of the northern coast of Espírito Santo, in the municipality of Linhares. Two shell mounds have been excavated thus far, pushing the record of human presence on the coast back by almost 2000 years. The new research follows a standardized method of excavation specially designed for initial characterization of shell mound deposits; this method involves creating a digital database and incorporating computerized methods for excavation management. Signs of human presence were seen along the northern coast before the Holocene maximum transgression (Suruaca site, dated c. 6800 cal. BP), when mangroves, restingas, and the Atlantic rainforest comprised the coastal environment.

Resumo O envelhecimento da população e o crescimento no número de pessoas expostas aos cuidados do sistema de saúde suplementar no Brasil aumentam a preocupação dos gestores públicos e privados com o crescimento dos custos da área de saúde. Neste trabalho foram analisados os custos por gênero, por tipo de gasto médico e por faixa etária de uma operadora de autogestão brasileira no período entre 2007 a 2013. Tal operadora é de grande interesse pois além de retratar uma condição única de restrição de crescimento de receita, também replica o perfil demográfico esperado para o Brasil no ano de 2050, quando aproximadamente um terço da sua população estará acima dos 60 anos. As análises corroboram a literatura vigente uma vez que demonstram um aumento na utilização do plano pelos mais idosos, e apontam para uma diferença nas taxas de internação entre os gêneros. O estudo também mostra um expressivo aumento no tempo médio de permanência nos hospitais e mostra crescimento dos gastos médicos muito acima da inflação, com destaque para materiais e medicamentos. No geral, esperamos que o presente estudo auxilie estudiosos e interessados em futuras comparações dos gastos médicos por idade e gênero e que colabore na sustentabilidade das operadoras de saúde no Brasil.

Abstract Brazil’s aging population and the rising number of people reliant upon the country’s supplementary healthcare system have elicited the concern of public and private managers regarding the increase in healthcare costs. In this paper, the costs per gender, per type of medical expenses and per age group of a major Brazilian self-managed healthcare provider between 2007 and 2013 were analyzed. This healthcare provider is of interest because, besides portraying a single condition of revenue growth restricted to the existing contributors, it also replicates the demographic profile expected for Brazil in 2050, when approximately one-third of its population will be over 60 years of age. The analyses confirm the current literature as they show an increase in healthcare plan usage by the elderly and the difference between admission rates by gender. They also reveal an increase in average length of stay in hospital and the increase in medical costs far above inflation, especially for materials and medicines. It is hoped that this study will help scholars and others interested in comparisons of medical expense trends, especially by age and sex, and that it encourages further collaboration on the sustainability of health insurance providers in Brazil.