Brazilian Journal of Clinical Medicine and Review最新文献

{"title":"Beyond behavioral changes in semantic dementia: principal hurdles on the road to the clinic","authors":"Maria Vitória Rocha Santos Bezerra Maia, Victor Hugo Melo Freitas, Lara Oliveira da Nóbrega, Lucas Olímpio Coimbra, Aline Moreira Lócio, Fairane Sousa Duarte, Rita Almeida Ribeiro, Victor Monteiro Mororó, Sara Diógenes Peixoto de Medeiros, Amanda Rebouças Bezerra de Menezes, Rafaella Iughetti da Costa, Luciano Barroso de Albuquerque-Filho, Lara Maria Fujita Vieira Lima, Camilla Costa Sallem, Camilla Teixeira Pinheiro Gusmão, Yuri Borges Morais, Luiz da Silva Aldir, Tiago Antoniol, Isaac Dantas Sales Pimentel, Natalia Marinho Porto Lima, J. Santos","doi":"10.52600/2965-0968.bjcmr.2023.1.3.49-57","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.3.49-57","url":null,"abstract":"The neurology, psychiatry and psychology areas have played a fundamental role in the characterization of cognitive disturbances associated to dementia disorders, which has contributed to the improvement of diagnostic and therapeutic procedures. Semantic dementia is a subgenre of frontotemporal dementia, consists in a syndrome of primary progressive aphasia characterized by the loss of semantic knowledge, with the preservation of other cognitive functions, such as visual memory, visuospatial capacity, and executive abilities. Thus, the relevance of this study consists in thoroughly analyzing the main alterations in which concerns the behavior of semantic dementia, aiming to know more about this rare subtype of frontotemporal dementia, so that in the future its clinical manifestations, diagnosis and treatment are better elucidated. A narrative literature review was executed in the Medline database (PubMed), from 2010 to 2022, about behavioral alterations in semantic dementia. The present literature review article demonstrates the current comprehension about cognitive, behavioral, and functional alterations as a semantic dementia consequence, besides providing relevant information to prioritize the therapeutic offered to patients that have such a condition. Furthermore, more studies addressing this subject are paramount since the existing studies are still not sufficient to completely elucidate the behavioral changes in semantic dementia.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127902744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke mimics in a Brazilian stroke center: a retrospective cohort in a Brazilian stroke unit","authors":"Michelle Zonkowski Ribas, A. C. Fernandes, Lucas Lopes Penido de Mendonça, Paulo Cesar de Santiago-Filho, Ruan Braga Santiago, G. F. Gomes, N. L. Santos, Rafaella Iughetti da Costa, Stéfani Lara Galvão, Luciano Barroso de Albuquerque-Filho, Fairane Sousa Duarte, Camilla Costa Sallem, Arthur de Oliveira Veras, Felipe Micelli Noleto, L. Ramanzini, G. Paticcié, Diogo Pasquali Nones, Tiago Antoniol, Luiz Aldir da Silva, J. Santos","doi":"10.52600/2965-0968.bjcmr.2023.1.3.41-48","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.3.41-48","url":null,"abstract":"This study assessed stroke patients in a Brazilian unit to describe the prevalence, clinical presentation, etiology, and treatment outcomes of cases initially diagnosed as stroke mimics (SM). SM refers to conditions that mimic stroke but are not caused by cerebrovascular events. Misdiagnosis can lead to unnecessary and potentially harmful treatments. The study examined patients admitted between October 2012 and September 2013. Among patients with symptoms onset within four hours, 7.1% (10 patients) were classified as SM. Six of these patients received intravenous thrombolysis, a treatment for acute ischemic stroke. The main clinical presentations among SM cases were motor symptoms (90%), dysarthria, and sensory symptoms (60%). The etiology of SM cases varied, with functional disorders being the most common (60%). The findings reveal a significant percentage of patients admitted to the stroke unit were ultimately diagnosed as SM, highlighting the need for improved diagnostic strategies to differentiate between stroke and SM. The study underscores the importance of developing well-defined guidelines to assess SM risk and utilize imaging methods for distinguishing between stroke and SM. Further research is necessary to address these issues and enhance stroke diagnosis accuracy.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126547131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of medial prefrontal cortex in cognition, aging and Parkinson disease","authors":"Lia de Oliveira Jereissati, Luiz Aldir da Silva, Tiago Antoniol, Vitor Olímpio Coimbra, Alexandre Almeida da Silva, Amanda Rebouças Bezerra de Menezes, G. F. Gomes, Stéfani Lara Galvão, R. Oliveira, N. L. Santos, P. Cardoso, Luciano Barroso de Albuquerque Filho, Camilla Costa Sallem, Rafaella Iughetti da Costa, Lara Maria Fujita Vieira Lima, Micael Porto Portela Lima, Júlio César Carvalho Santos","doi":"10.52600/2965-0968.bjcmr.2023.1.3.28-40","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.3.28-40","url":null,"abstract":"The prefrontal cortex (PFC) is a vital center for executive control, influencing cognition, emotion, memory, and sociability. Specifically, the medial prefrontal cortex (mPFC), a part of the PFC, monitors actions toward goals, aids decision-making, and regulates cognitive control. It assesses outcomes relative to expected rewards, selects appropriate behavior based on continuous performance analysis, and facilitates strategic adaptation in response to adverse results. Unfortunately, these cognitive functions decline with age due to changes in neuroplasticity, especially in neurodegenerative disorders like Parkinson's Disease (PD) and Alzheimer's Disease (AD). Neurodegenerative diseases disrupt normal brain activity, leading to tissue atrophy and cognitive impairment caused by degeneration and neuronal death. PD is the second most common neurodegenerative disease globally, characterized by a decline in neurotransmitters and dopaminergic neuron death in the substantia nigra, along with the presence of Lewy bodies. Recognizing these factors as risk factors for PD development is crucial. This article examines how aging affects cognitive activities regulated by the mPFC, a pivotal region for critical cognitive functions. By applying predetermined criteria, the review selects the most relevant articles to provide a comprehensive understanding of cognitive deficits mediated by the mPFC in both healthy and pathological aging.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133537901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of coronary artery stenosis on computed tomography angiography of the coronary arteries in stable patients with zero coronary calcium score in Angola","authors":"H. Morais, Preciosa Lourenço, Carlos Martins, Lorette Cardona, M. Gonçalves","doi":"10.52600/2965-0968.bjcmr.2023.1.3.19-27","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.3.19-27","url":null,"abstract":"Coronary artery calcium is a component of atherosclerosis and a marker for the presence of coronary artery disease (CAD). It can be quantified based on non-contrast computed tomography (CT) using coronary calcium score (CCS) according to the Agatston method. This study aimed to assess the prevalence of CAD in a population with a zero CCS, using 64-slice CT in Angola. A total of 204 patients were included in the study. Of the total sample, 60.3% of the patients were male. The mean age was 56.46±9.19 years. The mean CCS of the cohort was 44.4±117(range, 0–889). Among 204 patients, CCS was zero in 136 (66.7%) patients, and 68 (33.3%) patients had a CCS ≥1. Compared to CCS ≥1, patients with CCS=0 were younger (age 54.7±9.3 years vs. 59.9±7.9 years, p <0.001) and the proportion of women was significantly higher (47.1% vs. 25.0%, p 0.002). Patients with CCS zero had also less history of diabetes mellitus, dyslipidemia, and smoking in the past. Of the 136 patients with CCS=0, one (0.7%) had obstructive CAD, and 16 (11.8%) had non-obstructive CAD. Our results suggest that the absence of calcium was associated with a very low probability of significant stenosis of the coronary arteries.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130205273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indicadores de qualidade e desempenho aplicados à assistência de enfermagem","authors":"Marselle Pimenta Estefanio, Karla Temístocles de Brito Dantas Lemos, Allan Carlos Mazzoni Lemos, Luciano Godinho Almuinha Ramos, Maria da Glória Lima da Silva","doi":"10.52600/2965-0968.bjcmr.2023.1.3.3-18","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.3.3-18","url":null,"abstract":"A mensuração da qualidade dos cuidados de enfermagem é fundamental para o planejamento, organização e avaliação das atividades. Para isso, é necessário elaborar instrumentos que possibilitem avaliar de forma sistemática os níveis de qualidade dos cuidados prestados. Os indicadores de qualidade e desempenho são uma maneira efetiva de avaliar a eficiência da gestão e a qualidade do cuidado. O objetivo deste estudo foi evidenciar a necessidade de auditar os serviços de enfermagem e definir os conceitos de auditoria, acreditação hospitalar e indicadores, além de apresentar os principais indicadores de qualidade e desempenho que podem ser aplicados aos serviços de enfermagem. Os indicadores propostos incluem indicadores de processo, que estão relacionados à execução de tarefas diárias pela equipe de enfermagem, indicadores de estrutura, que abrangem os recursos físicos, humanos, materiais e financeiros necessários para a assistência; e indicadores de resultado, que correspondem ao produto da assistência prestada. O acompanhamento e análise desses indicadores são fundamentais para a melhoria dos processos de enfermagem nas instituições hospitalares, uma vez que se constituem em pontos críticos dos processos relacionados à assistência.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125794093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons to reatin","authors":"Irene Inakulo Moisés","doi":"10.52600/2965-0968.bjcmr.2023.1.suppl.1.32-33","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.suppl.1.32-33","url":null,"abstract":"PERMITA-ME SUA EXCELÊNCIA SECRETÁRIA DO ESTADO PARA CIÊNCIA, TECNOLOGIA E INOVAÇÃO. PROFª. DOUTORA ALICE CEITA; \u0000LÍDIMOS DEPUTADOS; \u0000DISTINTOS MEMBROS DO GOVERNO; \u0000EXMO. DIRECTOR GERAL DA FUNDECIT PROF. DOUTOR MÁRIO FRESTA; \u0000DIGNÍSSIMOS MEMBROS DA COMISSÃO DE HONRA DESTE MAGNO EVENTO \u0000EXMOS CONVIDADOS; \u0000REPRESENTANTES DE INSTITUIÇÕES CONGÉNERES DA FUNDECIT (BRASIL, PORTUGAL, AFRICA DO SUL E MOÇAMBIQUE); \u0000MAGNÍFICOS REITORES; \u0000DIGNOS GESTORES E/OU REPRESENTANTES DE INSTITUIÇÕES DE ENSINO SUPERIOR - IES PUBLICAS E PRIVADAS; \u0000GESTORES DE INSTITUTOS DE INVESTIGAÇÃO E DESENVOLVIMENTO – II&D; \u0000ESTIMADOS DOCENTES, INVESTIGADORES ANGOLANOS E ESTRANGEIROS; \u0000MINHAS SENHORAS E MEUS SENHORES. \u0000O Workshop Integridade e Ética na investigação cientifica, realizou-se no formato hibrido (presencial e virtual), tendo contado com a presença física de 125 participantes, incluindo representantes de instituições congéneres da FUNDECIT ( Brasil, Portugal, África do Sul e Moçambique), responsáveis  das Instituições do Ensino Superior e Instituições de Investigação Cientifica e Desenvolvimento, membros do Conselho Consultivo do MESCTI, membros do Governo, membros do Comité de Ética do Ministério da Saúde, membros da Comunidade Académica, Investigadores, Inovadores e Docentes Universitários. No formato virtual, houve cerca de 84 participantes. \u0000Queremos retomar, neste momento, os objectivos do Workshop, designadamente: \u0000 \u0000Desenvolver a consciência e compreensão das implicações éticas da ciência em Angola e no mundo. \u0000Buscar experiências regionais e globais que irão possibilitar a criação em Angola de referências, recomendações e normas de ética em ciência, tecnologia e inovação. \u0000Promover na comunidade académica e na sociedade a conformidade das políticas e práticas científicas com as recomendações internacionais. \u0000 \u0000Em função desses objectivos, devemos destacar como lições a reter, coligidas de todas as apresentações e intervenções, começando pelo douto discurso de abertura, muito orientador, da Exma. Secretária de Estado para a Ciência, Tecnologia e Inovação, os seguintes aspectos: \u0000A Investigação científica para além do rigor científico propriamente dito, tem a obrigatoriedade de pautar por padrões de integridade e ética, para que os resultados sejam confiáveis e valorizados pela sociedade. \u0000A FUNDECIT deve consolidar as referências e debates deste Workshop para elaborar ou adoptar as recomendações e normas de integridade e ética mais adequadas ao contexto científico em Angola. Assim, é conveniente aprovar um código de ética do investigador, que norteie os docentes universitários, investigadores e todos os que actuam no SNCTI nomeadamente os propoentes de projectos a financiamento pela FUNDECIT. \u0000É fundamental consentimento esclarecido dos inqueridos ou sujeitos da investigação, em função da tipologia do estudo, e a colheita e gestão de dados pessoais tem de respeitar a respectiva legislação e autoridades instituídas no País. \u0000A inclusividade, promoção da participação ","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129805000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double standard in clinical research","authors":"Nilceu José Oliveira","doi":"10.52600/2965-0968.bjcmr.2023.1.suppl.1.30","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.suppl.1.30","url":null,"abstract":"In the development of clinical research, the social conditions of the societies involved must be taken into account, such as vulnerability and social vulnerability. The contexts of conflicts of interest, whether economic or academic, must also be considered. Another highlight is related to the so-called moral imperialism, a condition in which societies impose their moral standards on others, not considering cultural differences, geographical conditions and social development. Thus, the “double ethical standard” in research imposes a form of imperialism of principles, values, moral relativism and na exclusively economic vision above all. The principles of ethics in biomedical research promulgated by international consensus statements are not sufficient to protect the most vulnerable societies, especially the poorest countries. The ethical principles that govern clinical research need to be translated into procedures and practices that take into account the different cultural aspects and socioeconomic resources of societies. Research participants cannot just bear the risks and not reap the benefits. There are arguments that propose the double standard as a violation of human rights, especially for not taking into account the principles of the Universal Declaration of Bioethics and Human Rights of UNESCO, approved by consensus by the countries in 2005. The existence of a “strong” system ethical evaluation of research projects, with social participation, especially in local ethics committees in the most vulnerable societies, is a minimum condition for the protection of people and societies.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121237672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scientific misconduct (Fraud, falsification, fabrication and plagiarism)","authors":"Carla Braga","doi":"10.52600/2965-0968.bjcmr.2023.1.suppl.1.31","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.suppl.1.31","url":null,"abstract":"We live in a historic moment in which the boundaries between true and false become porous and the differentiation between fact and fiction is destabilized, for example, in the context of the so-called “fake news”. At a global level, social movements and in some cases even governments, have assumed denialist and even “anti-science” positions, as occurred during the COVID-19 pandemic or in the face of climate change. We also see a reduction in funding for research in several countries. Trust in science, as well as the credibility of the knowledge production process, has been called into question, making the issue of integrity crucial in the process of scientific research and academic writing. Although it may seem redundant and even repetitive, a categorization of what constitutes fraud in science was presented, which included fabrication and falsification of data as well as co-authorship by authority. They also referred to various types of plagiarism, including self-plagiarism. However, it has been argued that the excessive and reductive focus on fraud can make invisible a number of other topics of crucial importance with regard to integrity in scientific research. Among these absences are, for example, the power relations between the global North and the South in terms of knowledge production, as well as the premises for collaborative research based on honesty. At a global level, the intensification of the search for research participants, or rather their bodies, to carry out clinical trials, implies taking a critical look at the practices of these studies when they are implemented in the global South. Likewise, it is important to pay attention to the growing commodification of “life itself”, which concepts such as biocapital or bioavailability try to capture.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"11 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114317411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of the National Research Fund of Mozambique","authors":"Vitória Langa De Jesus","doi":"10.52600/2965-0968.bjcmr.2023.1.suppl.1.28","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.suppl.1.28","url":null,"abstract":"The rapid growth of research units on the African continent has been identified as a preponderant factor in achieving their development. However, this assumption remains a mirage and demands from science managers a deep reflection on the practices of integrity and ethics in research in order to reinforce the quality of its results. Our reflection on the relevance of Integrity and Ethics in research practice, taking the case of Mozambique as an example based on the analysis of legislation and experiences of the National Research Fund (FNI) of Mozambique. The results demonstrated a commitment by the government to boost research based on integrity and ethics, which is evidenced by the fact that in 2007 the country approved the Code of Ethics for Science and Technology through Decree n. 71/2007, of December 24th. However, the rapid growth of research institutions (Universities, institutes and research centers) in the last ten years and the promotion of research by the FNI and other organizations has raised the largest scientific production in the country, with emphasis on the health area that between 2014 -2018 concentrated 60% of all publications in the country. In this way, several government initiatives (MCTES-FNI) and with partners such as UNESCO, are underway to boost national ethics committees in Mozambique.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134376036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Universal Declaration on Bioethics and Human Rights in relation to Biomedical and Multinational Research","authors":"Suzana Vidal","doi":"10.52600/2965-0968.bjcmr.2023.1.suppl.1.29","DOIUrl":"https://doi.org/10.52600/2965-0968.bjcmr.2023.1.suppl.1.29","url":null,"abstract":"The conference provides an introduction to the Universal Declaration on Bioethics and Human Rights approved by UNESCO in 2005. It begins by analyzing the historical and geopolitical context in which it was approved. and what were the global debates that the standard includes. The different stages of the consultation are analyzed that led to its approval from the preparation of the first draft. The ethical-legal roots are presented and the background on which it bases its principles and a description of the novelties is presented that the Declaration offers with respect to other regulations for multinational research. A detail about your articles and their contents to conclude with the way in which you can ensure your due implementation by the states in terms of public policies and regulations.","PeriodicalId":176982,"journal":{"name":"Brazilian Journal of Clinical Medicine and Review","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131335777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}