Sentidos de (des)regulação do mercado de trabalho no setor da saúde em Portugal / Directions of health labor market (de)regulation in Portugal

Resumo Reconhece-se a escassez de investigação sobre o mercado de trabalho do setor da saúde. Com a ampliação dos fenómenos de precarização objetiva e subjetiva, decorrente da agenda neoliberal de mercadorização do valor do trabalho e das reformas gestionárias da saúde, a "atipicidade" dos vínculos laborais e a "insegurança" de vida dos profissionais de saúde têm introduzido lógicas de segmentação e polarização do mercado de trabalho. Este deixa de ser palco apenas de mercados protegidos, passando a incluir mercados desregulados e "híbridos". Neste artigo pretende-se explorar os sentidos, com implicações desiguais, da (des)regulação do mercado de trabalho no setor da saúde em Portugal. Parte-se de fontes secundárias e de investigação qualitativa suportada em 32 entrevistas semiestruturadas feitas com profissionais de saúde, que atestam o fenômeno da crescente individualização e subcontratação laboral. Propõe-se um modelo conceitual que capte os sentidos de (des)regulação, num continuum de regulação social e mobilidade profissional, traduzindo mercados protegidos (profissionais e internos) e mercados híbridos (terciarizados e secundários) a serem testados por confronto empírico e investigação futura.

Abstract The need for further research on the labor market in the health sector is acknowledged. With the expansion of the phenomena of objective and subjective precariousness, resulting from the neoliberal agenda of commodification of the value of work and the managerial reforms in health, the "atypicality" of labor ties and the "insecurity" of health professionals' lives have introduced segmentation and polarization logics into the labor market. The latter is no longer the stage for protected markets, but includes deregulated and "hybrid" markets. This article aims to explore the directions, with unequal implications, of the (de)regulation of the labor market in the health sector in Portugal. We begin from secondary and qualitative research supported by 32 semi-structured interviews with health professionals, which attest to the phenomenon of increasing individualization and labor subcontracting. A conceptual model is proposed that captures the meanings of (de)regulation, in a continuum of social regulation and professional mobility, translating protected markets (professional and internal) and hybrid markets (outsourced and secondary) to be tested by empirical confrontation and future research.

Teorias evolucionistas da depressão: panorama e perspectivas / Teorías evolutivas de la depresión: visión general y perspectivas / Théories évolutionnistes de la dépression: aperçu et perspectives / Evolutionary theories of depression: overview and perspectives

Resumo A depressão tem alcançado níveis epidêmicos ao redor do mundo. Seria a depressão um distúrbio mental, como é consenso na saúde mental? Teóricos evolucionistas têm-se questionado quanto à função da depressão e proposto modelos específicos para explicá-la. O objetivo deste artigo é apresentar teorias evolucionistas da depressão, discutir as relações de complementariedade e contraposição entre elas e as implicações sociais e práticas para o tratamento da depressão. Essas reflexões e questionamentos no domínio da saúde mental podem influenciar novos estudos a partir de uma perspectiva não patológica da depressão. No âmbito da psicologia essa perspectiva fornece subsídios para repensar a psicoterapia com o deprimido, enfocando a análise causal e a resolução de problemas. Sugere-se a realização de estudos empíricos com a finalidade de testar e sistematizar as teorias evolucionistas da depressão.

Resumen La depresión ha alcanzado niveles epidemiológicos alrededor del mundo. ¿Será la depresión un trastorno mental como se cree en el dominio de la salud mental? Teóricos evolucionistas se cuestionan sobre la depresión y han propuesto modelos específicos para explicarla. El objetivo de este artículo fue presentar teorías evolutivas de la depresión, discutir las relaciones de complementariedad y contraposición entre ellas, así como las implicaciones sociales y prácticas para su tratamiento. Estas reflexiones y cuestionamientos, en el dominio de la salud mental, pueden influir en nuevos estudios a partir de una perspectiva no patológica de la depresión. En el ámbito de la psicología, esta perspectiva provee subsidios para repensar la psicoterapia con el deprimido enfocándose en el análisis causal y la resolución de problemas. Se sugiere la realización de estudios empíricos con la finalidad de probar y sistematizar las teorías evolucionistas de la depresión.

Résumé La dépression a atteint les proportions d'une épidémie mondiale. Les théoriciens évolutionnistes se sont interrogés sur la fonction de la dépression et ont proposé des modèles spécifiques pour l'expliquer. Cet article vise à présenter les différentes théories évolutionnistes de la dépression, discuter leurs relations de complémentarité et d'opposition, et débattre les possibles implications sociales et pratiques pour le traitement de la dépression. Ces réflexions dans le domaine de la santé mentale peuvent influencer de nouvelles études dans une perspective non pathologique de la dépression. Dans le domaine de la psychologie, cette perspective permet de repenser la psychothérapie avec les personnes déprimées, en se concentrant sur l'analyse causale et la résolution des problèmes. Des études empiriques sont proposées dans le but de tester et systématiser les théories évolutionnistes de la dépression.

Abstract Depression has reached epidemic levels worldwide. Would that be a mental disorder, as claimed by consensus on mental health? Evolutionary theorists have questioned the function of depression and proposed specific models to explain it. The aim of this paper is to present the evolutionary theories of depression, to discuss the complementarity and contradictions between these theories, and to present the social and practical implications for the treatment of depression. Those reflections and issues in the field of mental health may influence further studies from a non-pathological perspective of depression. In the field of psychology, this perspective provides insights to reevaluate psychotherapy to treat depression by focusing on causal analysis and problem solving. The study suggests that new empirical studies should be conducted to test and systematize evolutionary theories of depression.

Study on the Effects of the Deregulation of Drug Price Control on Drug Price / 中国药房

OBJECTIVE：To study the effects of the deregulation of drug price control on drug price ，and to provide reference for policy formulation. METHODS ：The quarterly price data of 46 875 chemical and biological products （measured by fixed Laspeyres index ）were collected from 788 sample hospitals from the database of National Medical Economic Information Network during Jan. 2012 to Jun. 2017. Based on the interrupted time series model ，changes in the prices of overall situation of chemicals and biological products ，as well as the sub-group ，ie. low-cost drugs ，original and imitated drugs were analyzed after the government’s policies of canceling the price limit control and strengthening the price monitoring （including Notice on Printing and Distributing the Opinions on the Supply and Guarantee of Commonly Used Low-cost Drugs in 2014，Notice on Printing and Distributing the Opinions on Promoting the Reform of Drug Prices in 2015，etc.），returning to market competition ；the effects of canceling the price limit control on drug price were put forward. RESULTS & CONCLUSIONS ：After government deregulation for maximum retail price limit of commonly used low-priced drugs ，the price of low-priced drugs increased substantially （β3＝1.11×10－2， P＝0.008）. After the total abolition of drug price control ，there was no significant change in the overall chemical and biological products（β3＝－1.85×10－3，P＝0.175）and sub-group （low-cost drugs ：β3＝1.10×10－3，P＝0.066；original drugs ：β3＝－7.20×10－4， P＝0.549；generic drugs ：β3＝6.78×10－4，P＝0.784）drug prices. Within two years after government deregulation policy in 2015， drug prices and the drug market had remained stable. It can be seen that it is feasible for canceling the government ’s pricing and opening the price control in the mature market so as to make the price formulation return to the market ，combined with the government strengthening the price monitoring.

Estudio del descontrol de la tensión arterial de los adultos menores de 60 años / Study of the arterial tension deregulation of adults younger than 60 years

RESUMEN Introducción: la hipertensión arterial ocupa dentro de las enfermedades crónicas no trasmisibles un lugar dominante por sus altos índices de prevalencia e incidencia. Objetivo: determinar el comportamiento de la hipertensión arterial en menores de 60 años sin control médico. Materiales y métodos: estudio descriptivo, transversal, realizado en el Hospital Clínico Quirúrgico Docente "Amalia Simoni" en Camagüey, en el periodo 2016-2018. Resultados: más de la mitad de los casos correspondió al sexo masculino, de piel blanco latino, donde fue frecuente el antecedente de hipertensión arterial, el mayor porciento fue clasificado en estadio II, se encontraron como factores de riesgos el tabaquismo y sobrepeso y la hipertrigliceridemia y microalbuminuria, fueron los complementarios destacados. La adherencia al tratamiento farmacológico se logró en solo la mitad de los casos. Conclusiones: la hipertensión arterial sin control se presenta mayormente en el sexo masculino con proporción en las edades superiores a los 40 años, evidencia de mayor incidencia paralela al incremento de la edad, dominando los hipertensos en estadio II, predominan los antecedentes familiares y comorbilidades como la diabetes mellitus, cardiopatías y obesidad. Se detectan niveles alterados de triglicéridos, colesterol y microalbuminuria en un tercio de los casos. Constatando adherencia al tratamiento en menos de la mitad de los casos (AU).

SUMMARY Introduction: arterial hypertension occupies a predominant place among the non-transmitted chronic diseases due to its high indexes of prevalence and incidence. Objective: to determine the behavior of arterial hypertension in people younger than 60 years without medical control. Materials and methods: cross-sectional descriptive study, carried out in the Hospital "Amalia Simoni" in Camagüey, in the period 2016 - 2018. Results: more than half of the cases were male, white Latin patients, frequently with antecedents of high arterial hypertension; the highest percent were classified in stage II. Smoking and overweigh were found as risk factors; hypertriglyceridemia and microalbuminuria were the highlighted complementary. Adherence to pharmacological treatments was achieved only in half of the cases. Conclusions: out of control arterial hypertension shows mostly in male sex with proportion in ages more than 40 years, an evidence of higher incidence in parallel to age growth; most of hypertensive patients are in stage II, predominating familiar antecedents and comorbidities like diabetes mellitus, heart diseases and obesity. One third of the cases presented altered levels of triglycerides, cholesterol and microalbuminuria. Treatment adherence was found in less than half of the cases (AU).

Odontología y Ética: sobreoferta y sobreterapia / Dentistry and Ethics: Oversupply and Overtherapy

RESUMEN: Esta revisión está concebida con el propósito de analizar la situación actual de la odontología en Colombia. La revisión se centra en la inoperancia y desregulación del estado sin un modelo planificador sobre la estructura del sistema de salud actual, como causa principal de la sobreoferta profesional, así como del sobretratamiento. Está dividida en dos grandes secciones (orígenes y consecuencias), en los que se busca hacer conexas situaciones concomitantes. En orígenes se trata sobre el tema ético, la realidad desregulatoria e inoperante de los mandos y gremios profesionales, el nivel de evidencia humildemente traducido a la práctica diaria y la necesaria autodeterminación profesional que guie hacia una mejor caracterización entre el paciente saludable y el paciente enfermo, que restrinja el sobretratamiento que está cada vez más cerca a la iatrogenia. En la sección consecuencias, algunos ejemplos de excesos facultativos que se ven reflejados en terapias sin justificación y redundantes que vulneran al paciente. El cambio por un mejor rumbo a futuro debe originarse en la autodeterminación de aquellos objetores de conciencia comprometidos con responsabilidad compartida: El estado Colombiano y sus entes reguladores, los programas académicos que impactan en la conciencia de sus orientados, como el profesional con una meditación íntima y autocrítica que venza los escenariosterapéuticos en contravía del paciente saludable.

ABSTRACT: This review was conceived with the purpose of analysing the current situation of dentistry in Colombia, The review focuses on the inoperability and deregulation of the state without a regulatory model for an actual health system structure as a principal cause of the professional oversupply and over-treatment. It is divided into two major sections (origins and consequences), which seek to make concomitant situations related. In origins, the ethical issue, the deregulatory and inoperative reality of the professional commands and guilds, the level of evidence humbly translated into daily practice and the necessary professional self-determination that guides a better characterization between the healthy patient and the sick patient trying to restricts the over-treatment that is increasingly close to iatrogeny. In consequences section, some facultative excesses examples that are reflected in redundant therapies without justification that victimizes patients. The change for a better course for the future must originate in the selfdetermination of those conscientious objectors committed with shared responsibility: The Colombian state and its regulatory bodies, academic programs that impact on the conscience of its orientated, and the professional with an intimate meditation and self-criticism that overcomes the therapeutic scenarios in wrong way of the healthy patient.

Política nacional de promoção da saúde: os dilemas da autonomização1 / National health promotion policy the dilemmas of autonomy

Este artigo analisa o discurso da Política Nacional de Promoção da Saúde, especialmente a concepção de autonomia presente nesse documento, interrogando seus efeitos nas sociabilidades quanto à ênfase na responsabilidade individual no cuidado com a saúde. Procedendo à revisão do documento oficial da política, definimos três eixos sobre os quais desenvolvemos a análise: responsabilização individual; ênfase na escolha individual e nos hábitos de vida; processos de subjetivação. Tal objeto se justifica na medida em que é fundamental refletir sobre como são formulados os modelos de atenção à saúde, a que relações de poder eles estão a serviço e quais são os processos de produção discursiva que permitem a enunciação de um determinado modelo de política pública de saúde. Com esta pesquisa pretendemos contribuir para o debate no interior do campo da Saúde Coletiva com relação às formulações conceituais da Promoção da Saúde, a fim de propor reflexões comprometidas com a transformação na maneira de pensar e intervir na saúde da população brasileira.

This article analyses the National Health Promotion Policy discourse and the conception of autonomy in this document, raising questions about its social effects, especially in what concerns the individual responsibility towards health care. The official document was examined and three main ideas were defined for its analysis: individual responsibility; focus on personal choices and everyday habits; subjectification processes. We consider that the discourse of promotional health determines a standardization of life styles that are considered to be healthy, highlighting the responsibility of each individual of preserving their personal health. Such object is justified because it is essential to reflect on how the health care models are formulated, that power relations they are at the service and what are the discursive production processes that allow the enunciation of a given model of public health policy. We intend to contribute with this research to the debate within the public health field, regarding the conceptual formulations under the Health Promotion, to propose reflections aimed to transform the way they think and intervene in Brazilian population's health.

Distancia a la frontera e impacto asimétrico en los sectores económicos por las políticas de desregulación

Introducción. En este artículo se analiza el impacto de las políticas de desregulación propuestas por el Banco Mundial (BM) con el fin de que las economías puedan mejorar su capacidad de hacer negocios en los sectores de comercio de bienes y de comercio de servicios. Objetivo. El propósito es identificar el impacto asimétrico en los principales sectores y las consecuencias económicas en la reducción de la pobreza debido a la forma como están diseñadas las políticas de desregulación. Materiales y métodos. Mediante el uso de herramientas estadísticas se han efectuado análisis de correlación en las mediciones históricas que el BM ha recopilado durante el período 2010-2012. Resultados. Se encontró que las políticas de desregulación producen un efecto distinto en el comercio de mercancías y en el comercio de bienes intangibles. Conclusión. El análisis de los resultados deja en evidencia que dichas políticas inducen a los países a tener un mejor desempeño en el comercio de mercancías y no en el comercio de servicios. Lo anterior resulta catastrófico para el propósito de reducir la pobreza, debido a que el comercio de intangibles es el que genera una mayor riqueza, mientras que el comercio de mercancías da como resultado ganancias marginales y rezago económico.

Introduction. In this article the impact of the deregulation policies proposed by the World Bank in order to increase the economies´ capacity to make businesses in the trade of goods and services are analyzed. Objective. To identify the asymmetric impact on the main sectors and the economic consequences on the reduction of poverty due to the way the deregulation policies are designed. Materials and methods. By the use of statistic tools, correlation analyses have been performed on the historical measurements compiled by the World Bank in the period between the years 2010-2012. Results. The deregulation policies have a different effect on the trade of goods, in comparison to the trade of services. Conclusion. The analysis of the results shows that such policies help countries to have a better performance in the trade of goods, but not in that of services. This is catastrophic for the goal of reducing poverty, due to the fact that the trade of services generates more wealth, while the trade of goods produces marginal gains and economic backwardness.

Introdução. Neste artigo se analisa o impacto das políticas de desregulação propostas pelo Banco Mundial (BM) com o fim de que as economias possam melhorar sua capacidade de fazer negócios nos setores de comércio de bens e de comércio de serviços. Objetivo. O propósito é identificar o impacto assimétrico nos principais setores e as consequências económicas na redução da pobreza devido à forma como estão desenhadas as políticas de desregulação. Materiais e métodos. Mediante o uso de ferramentas estatísticas se efeituaram análise de correlação nas medições históricas que o BM há recopilado durante o período 2010-2012. Resultados. Se encontrou que as políticas de desregulação produzem um efeito diferente no comércio de mercancias e no comércio de bens intangíveis. Conclusão. A análise dos resultados deixa em evidência que ditas políticas induzem aos países a ter um melhor desempenho no comércio de mercancias e não no comercio de serviços. O anterior resulta catastrófico para o propósito de reduzir a pobreza, devido a que o comércio de intangíveis é o que gera uma maior riqueza, enquanto que o comercio de mercancias dá como resultado lucros marginais e deficiência económica.

A Aposentadoria no Contexto das Transformações das Condições de Trabalho / Retirement in the Context of the Changes of Working Conditions

Este artigo tem como objetivos: (i) apresentar as relações de trabalho que surgiram do processo de flexibilização dos mercados de trabalho na década de 90 e a distinção entre os processos de flexibilização, desregulamentação e precarização das relações de trabalho, compreendidas pela grande maioria dos autores como parte das reformas neoliberais das últimas décadas do século passado. Essa distinção é necessária porque, no Brasil, as relações de trabalho são rigidamente regulamentadas desde a promulgação da Consolidação das Leis do Trabalho em 1943 e sempre foram muito precárias; (ii) apresentar as reformas da Previdência Social empreendidas pelos governos Fernando Henrique Cardoso e Luiz Inácio Lula da Silva e o novo projeto de reforma e suas consequências sobre o cálculo do valor da aposentadoria, no contexto das transformações das condições de trabalho que flexibilizaram as relações de trabalho.

his article aims: (i) to present work relations that emerged from the process of flexibility labour markets in the 90 and the distinction between the processes of flexibility, deregulation and news precarious labor relations, understood by most authors as part of the neoliberal reforms of the last decades of the twentieth century. This distinction is necessary because, in Brazil, labor relations are rigidly regulated since the promulgation of the Consolidation of Labor Laws in 1943 and have always been precarious; (ii) to present social security reforms undertaken by governments Fernando Henrique Cardoso and Luiz Inácio Lula da Silva and the new reform bill and its impact on the calculation of the value of retirement in the context of the changes of working conditions that made new labor relations.

Proteomic and gene expression patterns of keratoconus.

Keratoconus is a progressive corneal thinning disease associated with significant tissue remodeling activities and activation of a variety of signaling networks. However, it is not understood how differential gene and protein expression direct function in keratoconus corneas to drive the underlying pathology, ectasia. Research in the field has focused on discovering differentially expressed genes and proteins and quantifying their levels and activities in keratoconus patient samples. In this study, both microarray analysis of total ribonucleic acid (RNA) and whole proteome analyses are carried out using corneal epithelium and tears from keratoconus patients and compared to healthy controls. A number of structural proteins, signaling molecules, cytokines, proteases, and enzymes have been found to be deregulated in keratoconus corneas. Together, the data provide clues to the complex process of corneal degradation which suggest novel ways to clinically diagnose and manage the disease. This review will focus on discussing these recent advances in the knowledge of keratoconus biology from a gene expression and function point-of-view.

Reestruturação produtiva e seu impacto nas relações de trabalho nos serviços públicos de saúde no Brasil / Productive restructuring and its impact on labor relations in the public health services in Brazil

A reestruturação dos sistemas produtivos e a globalização econômica vêm interferindo diretamente sobre os direitos sociais básicos dos trabalhadores. Em países semiperiféricos como o Brasil, onde a sociedade salarial e a consolidação dos direitos sociais não se implantaram de fato, este processo de mudança, nas formas e relações de trabalho, assume características particulares, acentuando-se a desigualdade na relação capital-trabalho e dificultando o acesso ao emprego. Através de uma revisão crítica da produção científica sobre as mudanças no mundo do trabalho e seu impacto na organização e produção dos serviços de saúde no Brasil este artigo procurou mostrar a fragilidade da regulação do mercado de trabalho no Brasil, principalmente na área da saúde. Aponta a necessidade de ampliar a reflexão sobre novas formas de institucionalização das relações de trabalho, no sentido de garantir a equidade e o direito ao e no trabalho.

The restructuring of productive systems and economic globalization are directly impacting the basic social rights of workers. In the semi-peripheral countries such as Brazil, where the wage-based society and the consolidation of social rights are not completely implemented, this process of change in the world of labor contributes to aggravate the inequality in the capital-labor relationship and hampers access to employment. By means of a critical review of the scientific literature regarding changes in the world of labor and its impact on the organization and production of health services in Brazil, this article pinpoints the weakness of regulation of the labor market in Brazil, especially in the health sector. It also stresses the need to increase the debate on new forms of institutionalization of the labor relationship in order to ensure equity in the workplace and protect the rights to work and in the workplace.

Interpretación del mecanismo fisiopatogénico de la psoriasis / Interpretation about physiopathogenic mechanism of psoriasis

La psoriasis es una enfermedad de base inmuno-genética, que se acompaña de enigmas en el compromiso genético, la compleja red bioquímica de interleuquinas participantes, la interacción de las moléculas de adhesión, el rol definitivo de las células involucradas: célula de Langerhans, linfocitos, queratinocitos, mastocitos y neutrófilos, en el sistema de señalización intercelular, el condicionamiento biológico del paciente vulnerable y en el rol dominante del stress, como factor desencadenante a través de la liberación de neuropéptidos. Todos estos enigmas se irán develando en el devenir del avance de los constantes estudios, que se realizan sobre esta dinámica enfermedad.

The physiopathogenic mechanism of psoriasis continues representing a challenge for dermatologists, immunologists and molecular biologists; trying to discover the biochemical primary alteration and the set of immunological events on that they put in march for her clinical expression. Up to the present it is of unknown reason. It is defines as an inflammatory chronic disease that compromises dominant the skin, being characterized by papules and erythematic-scaly plates. The genetic factor is indispensable in order that the individual falls ill with psoriasis, but not sufficiently. A fault must exist in his immune system, without which the disease would not express either. An intrinsic aberration exists in the skin of the vulnerable patients. The genetic determinism, the deregulation and activation of the immune system with the subsequent waterfall of inflammatory half-full events for cytokines would be the base to interpret and to understand the development of the psoriasis.

Concepto de equivalencia sustancial aplicado alimentos derivados de cultivos genéticamente mejorados / The concept of substantial equivalence as applied to foodstuffs derived from genetically-modified crops

El objetivo del presente artículo es describir la aplicación del concepto de equivalencia sustancial, el cual es utilizado y aceptado internacionalmente para realizar la evaluación de la inocuidad de un alimento nuevo derivado de cultivos genéticamente mejorados. La metodología utilizada fue revisión de literatura actualizada, considerando, información tanto de revistas nacionales como internacionales y documentos de la Organización Mundial para la Agricultura y la Alimentación, FAO, Organización Mundial de la Salud, OMS, Codex Alimentarius, Organización Económica de Cooperación y Desarrollo, OECD, la Food and Drug Administration, FDA y otras. El artículo presenta la tendencia mundial en la siembra de cultivos genéticamente mejorados, así como la situación actual en Costa Rica con respecto a la siembra de cultivos genéticamente mejorados para incremento de semilla. Además, se detalla el concepto de equivalencia sustancial y se describe el conjunto de características de calidad que se deben evaluar los procedimientos metodológicos a seguir para demostrar que un alimento, derivado de un cultivo genéticamente mejorado, adCGM, es seguro para el consumo humano y animal. Como conclusión el concepto de equivalencia sustancial es el grupo de técnicas y metodologías, vigentes y aceptadas internacionalmente para evaluar la inocuidad de un nuevo alimento desarrollado mediante biotecnología moderna.

The objective of this article is to describe the complete application of the concept of substantial equivalence, which is internationally accepted and widely used for food safety evaluation of new foods. The methodology consists of a literature review of current documents from several agencies such as the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), Organization for Economic Cooperation and Development (OECD), the Food and Drug Administration of the USA (FDA), and others. This article presents the global trends related to the planting of genetically modified crops, and the Costa Rican situation on planting genetically modified crops for increasing seed yield. The article introduces the concept of substantial equivalence, and discusses several tests that should be applied in order to demonstrate that a genetically modified food derived from a GM crop is safe for human and animal consumption. As conclusion, the concept of substantial equivalence is the internationallyand currently accepted criteria the food safety assessment of crops developed by modern biotechnology.

Síndrome de Evans: nuevo enfoque clínico. Revisión bibliográfica / Evans syndrome: new clinic approach. Bibliographical revision

El Síndrome de Evans es un desorden heterogéneo caracterizado por el desarrollo simultáneo o secuencial de trombocitopenia autoinmune y anemia hemolítica autoinmune. Esta enfermedad de curso crónico ha sido correlacionada con inmunodeficiencias primarias, enfermedades colágeno-vasculares, desórdenes linfoproliferativos, y síndromes linfoproliferativos auto inmunes (ALPS). Los nuevos conceptos en su patogénesis aumentan el campo de investigación clínica del paciente, y constituyen el punto de partida para futuras terapias.

Evans syndrome is a heterogeneous disorder characterized by simultaneous development and sequence of autoimmune thrombocytopenia and autoimmune hemolytic anemia. This disease of chronic course has been correlated with primary immunodeficiency, collagen- vascular diseases, linfoproliferative disorders, and autoimmune linfoproliferative syndromes (ALPS). The news concepts in his pathogenesis increase the field of clinic investigation of the patient, and constitute the point to begin future therapies.