Understanding how customer experience and engagement translate into behavioral intention is central to service and relationship marketing. Yet, these mechanisms remain underexplored in highly regulated health services, particularly in emerging markets. While dominant theories posit direct or satisfaction-mediated effects of experience and engagement on intention, these relationships may weaken under institutional and contractual constraints. Grounded primarily in expectation–disconfirmation theory, this study examines how such constraints reshape loyalty formation in Brazil’s Supplementary Health Subsector (SSS). Using survey data and partial least squares structural equation modeling (PLS-SEM), we test a serial mediation model in which experience enhances engagement, engagement elevates satisfaction, and satisfaction operates as the principal gateway to behavioral intention. Results show that direct effects of experience and engagement on intention attenuate under regulation, while satisfaction plays a dominant mediating role, with significant differences across operator types. The findings refine loyalty mechanisms in regulated services and offer managerial and policy insights for governance in hybrid healthcare systems.
O prefeito da cidade de Nova Promessa implementou um programa de gestão por competências em todas as áreas da prefeitura. No entanto, agora ele enfrenta o desafio de avaliar a eficácia do programa e determinar quais métricas podem ser utilizadas. O dilema do prefeito se concentra no questionamento sobre “como avaliar se um programa de capacitação por competências para gestores da prefeitura foi eficaz?”. Isso envolve limitações e dificuldades pertinentes à gestão pública, como entraves burocráticos, resistência a mudanças por parte dos colaboradores (líderes e liderados) e a necessidade de demonstrar resultados concretos em um ambiente de constantes restrições orçamentárias. Este caso de ensino é destinado a alunos de Administração, com ênfase na gestão pública, na modernização da gestão e na superação de desafios burocráticos. Tradicionalmente, a gestão pública encontra maior resistência a mudanças estruturais, tornando essencial a análise de estratégias para implementação de novas práticas gerenciais. O caso oferece alternativas para uso didático, incluindo sugestões de enquadramento teórico e questões para discussão em classe. Dessa forma, proporciona uma oportunidade para refletir sobre os desafios da modernização do setor público e a adaptação de novas metodologias em ambientes burocráticos.
This study examines the role of mentorship programs in mitigating student attrition in higher education institutions (HEIs) through a systematic scientific mapping of 87 empirical studies published between 1978 and 2024. While previous research has explored the functions of mentorship, no comprehensive analysis has explicitly focused on its contribution to reducing dropout. Using the SPAR-4-SLR protocol and bibliometric mapping, this study investigates intellectual, structural, and thematic interactions in the field. The findings indicate that mentorship consistently provides academic, psychological, and emotional support; however, its effectiveness varies depending on institutional, disciplinary, and cultural contexts. Key gaps remain, particularly the underexploration of mentorship as role modeling. The analysis highlights that effective mentorship programs combine academic support, social integration, and personalized guidance, with growing importance in e-learning and minority student contexts. Practical implications suggest that successful mentorship initiatives require clearly defined roles, sustained mentor–mentee relationships, and inclusive strategies that are sensitive to diverse student needs. This study advances both theoretical understanding and practical guidance for designing context-sensitive mentorship programs that foster retention and student success.
An implantable cardioverter-defibrillator (ICD) intended to prevent malignant arrhythmias can, in rare cases, precipitate them. We report a 44-year-old man with cardiac sarcoidosis who suffered recurrent polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) due to an intradevice timing interaction. Premature ventricular contractions (PVCs) fell within the ICD's post-atrial pacing ventricular blanking period and went undetected ("masked"), resulting in ventricular pacing during the vulnerable period (R-on-T), which triggered VT/VF. Reprogramming the device from DDD to VVI mode prevented further arrhythmias. This case highlights the importance of individualized ICD programming to avoid device-induced arrhythmias.
BACKGROUND:Pulmonary hypertension (PH) is a complex disorder associated with various underlying conditions, including cardiac and respiratory diseases. PH is classified into five groups based on etiology, disease mechanisms, hemodynamic data, and treatment options. Preliminary data suggest that sodium-glucose cotransport-2 inhibitors (SGLT2-I), known for their benefits in chronic kidney disease, heart failure, and type-2 diabetes mellitus, may have therapeutic implications in PH through their metabolic effects, which include reducing aerobic glycolysis, improving mitochondrial function, and enhancing fatty acid oxidation. OBJECTIVE:This study aimed to evaluate the clinical effects of SGLT2-I in PH by analyzing a large multicenter database of medical records from the TriNetX Network. DESIGN:The cohort included adult patients with PH diagnosed between January 1, 2012, and January 1, 2023, classified by PH group and treatment with SGLT2-I. Propensity score matching (PSM) was used to balance baseline characteristics between the SGLT2-I and non-SGLT2-I groups. METHODS:The primary endpoint was a composite of all-cause mortality, RHF, and hospital admissions over 365 days. Secondary endpoints included the individual components of the primary endpoint, intubations, RHF incidence, IV diuretic use, and NT-Pro-BNP levels. PSM was used to adjust for baseline differences between cohorts. RESULTS:A total of 771,490 patients with PH were identified, with 58,303 treated with SGLT2-I. After PSM, each cohort of treated and untreated patients included 58,302 patients. Patients treated with SGLT inhibitors had a significant reduction in the primary composite endpoint (HR 0.71, 95% CI: 0.707-0.729). Secondary outcomes, including all-cause mortality, hospitalization, and the number of intubations, were also significantly lower in patients treated with SGLT-2 inhibitors. Beneficial effects of SGLT2-I were observed across all PH groups. CONCLUSION:This study demonstrates that SGLT2-I may be clinically beneficial in patients with PH by reducing all-cause mortality, RHF, and hospital admissions. Our findings support the role of SGLT2-I as a therapeutic option in PH and provide support for future randomized controlled trials using this treatment.
