Blastic Plasmacytoid Dendritic Cell Neoplasm: A Rare Entity in Clinical Practice.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an exceedingly rare and aggressive hematologic malignancy. In the current World Health Organization classification, it is classified among histiocytic/dendritic cell neoplasms. This report describes the case of an 85-year-old female with a complex medical history, including rheumatoid arthritis, who presented with a one-month history of low-grade fever, anorexia, and unexplained weight loss. The diagnosis of BPDCN was confirmed following an immunophenotyping analysis of a bone marrow aspirate. With this report, the authors intend to shed some light on BPDCN's clinical presentation, diagnostic journey, therapeutic approaches, and patient outcomes, and denote the significance of early detection and interdisciplinary collaboration in enhancing patient care.

A Rare First Presentation of Hodgkin's Lymphoma: Symptomatic Pericardial Effusion.

Symptomatic pericardial effusion occurring as the initial manifestation of Hodgkin's lymphoma is exceedingly uncommon, and there are limited documented instances in the available literature. Pericardial effusion can present various differential diagnoses, and among these, malignancy is an important yet less frequently encountered cause. A heightened level of suspicion is crucial for establishing an accurate diagnosis, particularly when the patient's clinical course deviates from the anticipated trajectory. Through this case, we aim to emphasize the significance of considering lymphoproliferative diseases as a pertinent possibility in the differential diagnosis of pericardial effusion. Additionally, we underscore the importance of promptly reaching a diagnosis, as it can help prevent severe complications and enhance the patient's prognosis.

Propiedades psicométricas de la Escala de Autoeficacia para el rendimiento académico en estudiantes universitarios / Psychometric properties of the Self-Efficacy Scale for Academic Performance in university students

Resumen La Teoría Social Cognitiva reconoce a la autoeficacia en el marco de las creencias personales que permiten a las personas ejercer cierto control sobre su comportamiento, y es de particular relevancia en relación con la vida universitaria y el rendimiento académico. El presente trabajo tuvo como objetivo estudiar las propiedades psicométricas de la versión abreviada de la Escala de Autoeficacia para el Rendimiento Académico en universitarios adaptada por Krumm y Lemos (2012). El estudio que se presenta fue de índole instrumental, con un diseño transversal, no experimental y se utilizó un muestreo no probabilístico incidental. Participaron 1044 estudiantes universitarios residentes todos en Formosa capital al momento del estudio. La edad media de los participantes fue de 26 años (DE = 7.125), de los cuales un 24.9 % de hombres (n = 260) y un 75.1 % de mujeres (n = 784). Según la técnica de ecuaciones estructurales, se efectuó el Análisis Factorial Confirmatorio (AFC) sobre la versión original de la escala (Modelo 1), y se realizaron dos reespecificaciones que generaron dos modelos: el Modelo 2 definido como una escala unidimensional con 24 ítems y el Modelo 3 o versión breve, definido a partir de una escala unidimensional con nueve ítems. La solución final obtuvo índices de ajuste óptimos (RMSEA = .019; TL I = .999; CFI = .998 y GFI = .997) y confirma que la propuesta de una versión breve de la Escala de Autoeficacia para el Rendimiento Académico presenta adecuadas propiedades psicométricas y posibilita la evaluación de la autoeficacia académica en estudiantes universitarios de manera práctica, por lo que resulta particularmente útil en contextos de investigación.

Abstract The Social Cognitive Theory recognizes Self-efficacy within the framework of personal beliefs that allow people to exercise some control over their behavior, being of particular relevance in relation to university life and Academic Performance. University life poses not only cognitive challenges but also emotional and social challenges that involve the development and mobilization of personal resources to adapt to the demands of higher education. Self-efficacy linked to Academic Performance in this context can be a factor that favors learning in the case of perceived adequately capable, or it can be a factor that contributes to shelling or abandonment in the case of not being adequately experienced. Given its importance, the conceptualization of the concept of Self-efficacy has made possible the design of various scales that allow evaluating this construct, some oriented to the evaluation of General Self-efficacy and others to Self-efficacy in relation to specific aspects. However, given the complexity of the concept and the factors that influence its configuration, it is considered necessary to research and develop specific instruments related to the transit through university life with all the demands that it entails and that allow a deeper understanding of this particular training stage. The present work aimed to study the psychometric properties of the abbreviated version of the Self-efficacy Scale for Academic Performance in university students adapted by Krumm and Lemos (2012). The study presented was instrumental in nature, with a cross-sectional, non-experimental design, an incidental non-probabilistic sampling was used. 1044 university students, all residing in Formosa Capital at the time of the study, participated. The mean age of the participants was 26 years (SD = 7.125), being 24.9% men (n = 260) and 75.1 % women (n = 784). The original Scale consisted of 24 items and three subscales: (1) coping with negative physical and emotional states; (2) social relationships; and (3) coping with positive emotions. The following reliability indices were reported for each subscale: Cronbach's Alpha of .59, .69 and .55 respectively. Considering the technique of structural equations, the confirmatory factor analysis (CFA) was carried out on the original version of the Scale (Model 1), carrying out two re-specifications, which generated two models, Model 2 defined as a one-dimensional Scale with 24 items and Model 3 or short version, defined from a one-dimensional scale with 9 items. The results obtained show that the three dimensions proposed in the original scale did not emerge as such, since the items that made it up presented differences in grouping by factor. The final solution or short version obtained optimal fit indices (RMSEA = .019; TL I = .999; CFI = .998 and GFI = .997). Regarding reliability, the Omega coefficient showed a high internal consistency of the scale both for the original test and for the abbreviated version, indicating that, despite having reduced the number of items on the scale, it retains adequate reliability. From the results obtained, it is confirmed that the proposal of a short version of the Self-efficacy Scale for Academic Performance presents adequate psychometric properties and enables the evaluation of academic self-efficacy in university students in a practical way, which is why it is particularly useful in research contexts.

Stress Cardiomyopathy as a Complication of SARS-CoV-2 Infection.

The worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020 led to the coronavirus disease 2019 (COVID-19) pandemic. Acute lung diseases, such as COVID-19 pneumonia, can trigger stress cardiomyopathy, raising concerns about potential cardiovascular complications related to these diseases. The current case involved a 72-year-old man with SARS-CoV-2 infection who was experiencing dyspnea, desaturation, and oppressive retrosternal chest pain. On his admission to the hospital, an electrocardiogram demonstrated sinus tachycardia, negative T waves in leads V4-V6, and slight ST-segment elevation in the same precordial leads. The patient also had an increased troponin I value and worsening of his baseline respiratory failure, which required starting noninvasive ventilation. The echocardiogram showed moderately depressed left ventricular systolic function and apical ballooning. The echocardiographic changes resolved during hospitalization without directed therapeutic intervention. We diagnosed Takotsubo syndrome associated with SARS-CoV-2 infection; however, the pathophysiological disruption remains to be clarified.

Análise de custo de um centro de reprodução humana assistida no Sistema Único de Saúde / Cost analysis of an assisted human reproduction center in the Unified Health System (SUS)

Resumo O objetivo do estudo foi estimar o custo da implantação de um centro de reprodução humana em um hospital público de referência nacional localizado no Rio de Janeiro. A população elegível foi a de homens e mulheres que possuem diagnóstico das causas mais frequentes de infertilidade. Os itens de custos incluídos foram consultas, exames, equipamentos, recursos humanos e insumos. Os custos foram identificados e quantificados a partir de consulta a clínicas de reprodução assistida, especialistas e literatura. Foram valorados através de bases públicas. A análise dos dados foi realizada através de um modelo de decisão analítico. A perspectiva do estudo foi do SUS provedor. O custo por procedimento na alta complexidade foi de R$ 18.829 para a fertilização in vitro com injeção intracitoplasmática de espermatozoide e de R$ 5.649 para a inseminação artificial. O investimento inicial necessário para funcionamento do centro de alta complexidade para a realização de 480 ciclos foi de R$ 15.903.361 no primeiro ano, o qual incluiu a estruturação do ambiente físico. A estimativa do investimento necessário para a incorporação e manutenção dos serviços no SUS é indispensável para a gestão financeira.

Abstract This study aimed to estimate the cost of implementing a center for assisted human reproduction in a public reference hospital in Rio de Janeiro. The cost analysis was carried out from the perspective of the SUS provider of assistance. The eligible population was men and women diagnosed with the most frequent causes of infertility. The cost items included in primary care and medium complexity were consultations and examinations and in high complexity were equipment, human resources and supplies. Costs were identified and quantified through consultation with assisted reproduction clinics, specialists and literature. They have been valued through public databases. Data analysis was performed using an analytical decision model that included costs of assisted reproduction and effectiveness procedures. The cost per procedure in high complexity was R$ 18,829 for in vitro fertilization with intracytoplasmic sperm injection and R$ 5,649 for artificial insemination. The initial investment required to operate the high complexity center for 480 cycles was R$ 15,903,361 in the first year, which included structuring the physical environment. Estimating the investment required for the incorporation and maintenance of services in SUS is essential for the management of available financial resources.

Efetividade do uso de drenos em procedimentos cirúrgicos no trauma hepático / Effectiveness of the use of drains in surgical procedures for liver trauma

O cenário de violência urbana e a alta tecnologia automobilística culminaram no aumento de incidência de lesões penetrantes e contusas. Como o fígado ocupa a maior parte do quadrante superior do abdome, qualquer trauma na parte inferior do tórax ou no abdome superior o coloca em risco de lesão que pode acarretar vazamento biliar, sangue ou seroma. Portanto, a drenagem é indicada para evitar complicações causadas pelo acúmulo desses líquidos. Este estudo visou avaliar a efetividade da drenagem em procedimentos cirúrgicos de trauma hepático. Estudo observacional, com análise retrospectiva de prontuários onde foi avaliado um total de 60 prontuários. Em conclusão, os pacientes com lesões mais graves tiveram maior número de drenagem; o tempo de permanência em UTI foi semelhante àqueles que não utilizaram drenos; reoperações utilizaram o dreno com maior frequência; o uso ou não de drenagem não evidenciou diferenças quanto a necessidade de hemoderivados ou em relação ao número de óbitos

The urban violence scenario and the high automobile technology culminated in an increase in the incidence of penetrating and blunt injuries. Since the liver occupies most of the upper quadrant of the abdomen, any trauma to the lower chest or upper abdomen is risky for injury that can lead to bile leakage, blood, or seroma; therefore, drainage is indicated to avoid complications caused by the accumulation of these liquids. This study aimed to evaluate the effectiveness of drainage in surgical procedures for liver trauma. It is observational, with retrospective analysis of medical records. A total of 60 records were evaluated. In conclusion, patients with more severe injuries had a greater number of drainages; the length of stay in the ICU was similar to those who did not use drains; reoperations used the drain more frequently; the use or not of drainage did not show differences in terms of the need for blood products or in relation to the number of deaths

Sobre cuidados em saúde em um hospital geral / Sobre cuidados de salud en un hospital general / About health care in a general hospital

Este artigo analisa práticas de cuidado em saúde vivenciadas em um hospital geral do Sistema Único de Saúde (SUS), com a intenção de problematizar e refletir sobre o cuidado e as práticas em saúde que se fazem presentes entre pessoas, no cotidiano do serviço, nas relações e nos fluxos que são estabelecidos. Utilizamos a Etnografia para descrever uma cena que reflete as relações entre os saberes, os cuidados e descuidados que se fazem em um hospital. Propomos pensar o cuidado como múltiplo e observamos o hospital por meio de sua constituição como uma "máquina de curar". Refletimos o encontro entre profissional e usuário, entre o cuidador e quem recebe o cuidado, para propor que em todo e qualquer encontro de saúde certo cuidado é realizado. (AU)

Este artículo analiza prácticas de cuidado de salud vividas en un hospital general del Sistema Único de Salud, con la intención de problematizar y reflexionar sobre el cuidado y las prácticas de salud presentes entre las personas, en el cotidiano del servicio, en las relaciones y en los flujos establecidos. Utilizamos la etnografía para describir una escena que refleja las relaciones entre los saberes, los cuidados y descuidados realizados en un hospital. Proponemos pensar el cuidado como múltiple y observamos el hospital a partir de su constitución como "máquina de curar". Reflejamos el encuentro entre profesional y usuario, entre el cuidador y quien recibe el cuidado, para proponer que en todos los encuentros de salud hay cierto cuidado que se realiza. (AU)

This article analyzes health care practices experienced in a general hospital of the Brazilian National Health System, with the intention of problematizing and reflecting on the care and health practices that are present among people, in the daily service, in the relationships and flows that are established. We use ethnography to describe a scene that reflects the relationship between knowledge, care and un-care practices that are performed in a hospital. We propose to think of care as multiple and we observe the hospital from its constitution as a "healing machine". We reflect the encounter between professional and user, between the caregiver and the one who receives the care, to propose that in any and all health meetings, certain care is performed. (AU)

Farmacogenética da varfarina como ferramenta de apoio na decisão terapêutica para prevenção de eventos tromboembólicos em idoso frágil com fibrilação atrial / Warfarin pharmacogenetics as a therapeutic decision support tool for the prevention of thromboembolic events in frail elderly patients with atrial fibrillation

INTRODUÇÃO: Fibrilação atrial (FA) é a taquiarritmia sustentada mais frequente em idosos. Acidente vascular cerebral (AVC) é uma das principais complicações relacionadas à FA, com risco crescente com a idade. Assim, a anticoagulação oral (ACO) é medida importante para reduzir o risco de AVC. Varfarina continua sendo muito utilizada, apesar do advento de anticoagulantes orais diretos. Há grande diferença individual na dose necessária de varfarina. A farmacogenética possui impacto no ajuste da dosagem e tem sido alternativa para sua quantificação. Quando há contraindicação para ACO ou presença de eventos embólicos na vigência de ACO efetiva, pode-se indicar oclusão do apêndice atrial esquerdo, capaz de reduzir eventos em mais de 90%. OBJETIVO: Descrever a importância do perfil farmacogenético da varfarina como suporte na decisão da terapia mais adequada para prevenção de eventos tromboembólicos em idoso frágil com FA. RELATO DE CASO: Paciente N.A.P.D, 78 anos, admitida com dispneia aos moderados esforços. Antecedente de FA, HAS e insuficiência cardíaca. CHA2 DS2 -VASc= 3 e HASBLED= 2. Iniciado ACO com varfarina. Evolui com necessidade progressiva de aumento da dose de varfarina (37,5mg/sem), labilidade de INR (TTR=43,77%) e dificuldade social para comparecer às consultas de controle, devido fratura de fêmur após queda e fragilidade. O perfil farmacogênico revelou padrão homozigoto para o gene CYP4F2, implicando em necessidade de aumento da dose de varfarina para alcance da meta. Entretanto, pela fragilidade, dificuldade de manter ACO e risco de aumento na dose, optou-se por oclusão do apêndice atrial esquerdo. DISCUSSÃO: A farmacogenética da resposta a varfarina é ferramenta importante para acompanhamento da ACO. A variação genética mostra impacto clinicamente importante na dose estável de varfarina. A associação entre CYP2C9, VKORC1 e dose de varfarina foi investigada em vários estudos e sua influência confirmada. O CYP4F2 controla a biodisponibilidade da vitamina K, cofator necessário para a coagulação. Variações no gene CYP4F2 afetam a biodisponibilidade da vitamina K e a dosagem de antagonistas da vitamina K, como varfarina, causando resistência e necessidade de maior dose de ACO. Assim a farmacogenética tem sido uma alternativa para a quantificação da dose da varfarina. CONCLUSÃO: Este relato enfatiza a importância do perfil farmacogenético da varfarina na decisão terapêutica para prevenção de eventos tromboembólicos em idosos, corroborando para a escolha da terapêutica mais adequada para esta população.

Uncertainty in times of medical emergency: Knowledge gaps and structural ignorance during the Brazilian Zika crisis.

Uncertainty was a defining feature of the Brazilian Zika crisis of 2015-2016. The cluster of cases of neonatal microcephaly detected in the country's northeast in the second half of 2015, and the possibility that a new virus transmitted by Aedes mosquitoes was responsible for this new syndrome, created a deep sense of shock and confusion in Brazil and around the world. When in February 2016 the WHO declared a Public Health Emergency of International Concern (PHEIC), it noted that it did so on the basis of what was not known about the virus and its pathogenic potential. To better understand the role that non-knowledge played in the unfolding of the Brazilian Zika crisis we differentiate between three different kinds of uncertainty: global health uncertainty, public health uncertainty, and clinical uncertainty. While these three forms of uncertainty were difficult to disentangle in the early weeks of the crisis, very soon each one began to trace a distinct trajectory. Global health uncertainty centered on the question of the causative link between Zika virus infection and congenital malformations, and was declared resolved by the time the PHEIC was lifted in November 2016. Public health and clinical uncertainty, in contrast, persisted over a longer period of time and did, in some important ways, become entrenched. This taxonomy of uncertainties allows us to explore the systematic nonproduction of knowledge in times of medical emergency, and suggests structural limitations in the framework of "emergency research" that global health institutions have developed to deal with unexpected threats.

Características clínico-epidemiológico de pacientes nonagenários ambulatoriais / Clinical-epidemiological characteristics of outpatients nonagenarians

INTRODUÇÃO: o envelhecimento populacional é um fenômeno observado em todo mundo e também na população brasileira e esta associado ao aumento da incidência de doenças cardiovasculares, impactando na qualidade de vida, morbidade e mortalidade, apesar do aumento do número de pacientes muito idosos, existe ainda escassez de dados sobre os mesmos. A realização de perfil clínico epidemiológico de nonagenários fornece informações relevantes quanto ao sexo, prevalência de doenças e fármacos em uso. Estes dados podem auxiliar na avaliação de condutas e tratamento farmacológico nesta faixa etária. MÉTODO: estudo retrospectivo, descritivo e observacional, desenvolvido a partir da revisão de prontuários de pacientes com idade igual ou superior a 70 anos. Destes, foram analisados os pacientes com idade igual ou superior a 90 anos que compareceram a consulta ambulatorial em hospital terciário de Cardiologia, de janeiro a dezembro de 2018. As variáveis quantitativas foram apresentadas em forma de média, desvio padrão e gráficos com valores expressos em percentuais e/ou porcentagem de prevalência. RESULTADOS: dos 5100 prontuários de pacientes com idade igual ou superior a 70 anos, cerca de 312 (6,11%) eram nonagenários, com idade média de 93,4 anos (±2,44), sendo 60% do sexo feminino. As principais doenças encontradas foram hipertensão arterial sistêmica (93%), diabetes mellito (25%), dislipidemia (25%), doença arterial coronariana (18%), fibrilação atrial (18%) e insuficiência cardíaca (14%). Os medicamentos mais prescritos foram: estatina (84%), diuréticos (52%), aspirina (41%), bloqueadores de receptor de angiotensina (39%), betabloqueador (39%), inibidor de enzima de conversão (31%). CONCLUSÃO: os pacientes nonagenários estudados neste trabalho são predominantemente mulheres, quase que a totalidade hipertensos e um quarto deles, dislipidêmicos e diabéticos. Destacou-se a maior concomitância destas três doenças associadas em nonagenários. (AU)

Cervical pedicle morphometry in a Latin American population: A Brazilian study.

The goal of this study was to conduct a detailed computed tomography (CT) assessment in the Brazilian population of the screw starting point, trajectory, and dimensions of pedicle in the cervical spine.Two hundred consecutive patients were retrospectively evaluated using cervical spine CT, with imaging reconstruction of each cervical vertebrae in the axial plane with 2 mm, and in sagittal reconstructions with 3 mm. Parameters in axial plane included the pedicle width (PW), pedicle axis length (PAL), pedicle transverse angle (PTA), and the distance from the entry point to the point between the lamina and spinous process (DEP). Measurements in the sagittal plane involved the pedicle height (PH) and the pedicle sagittal angle (PSA).The mean PW and PH were smaller in females than in males in all cervical vertebrae, but there were no significant differences of PTA among genders. PSA ranged from 15.2° to 23.7°. Mean values of PAL and DEP had a tendency to decrease from the proximal to distal cervical vertebrae. PW was <4 mm in 7.5% of men (C3) and 25% of women (C3), and <4.5 mm in 20% (C3 male) and 66% (C3 female). The intra- and inter-observer reliability were very good for the tomographic measurement of PW, and good for PH. For PAL, the intraobserver reliability was good, but the interobserver reliability varied from moderate to good. Considering PTA and PSA, the intraobserver reliability was good, but the interobserver reliability moderate for PTA and poor or fair for PSA. DEP measurements showed poor intraobserver reliability, and poor or moderate interobserver reliability.Our results presented similar trend of previous studies, but the frequency of patients with PW <4.5 mm in our population is higher, suggesting an increased risk during the attempting of transpedicular screw technique.

Titanium dioxide induced inflammation in the small intestine.

AIM: To investigate the effects of titanium dioxide (TiO2) nanoparticles (NPTiO2) and microparticles (MPTiO2) on the inflammatory response in the small intestine of mice. METHODS: Bl 57/6 male mice received distilled water suspensions containing TiO2 (100 mg/kg body weight) as NPTiO2 (66 nm), or MPTiO2 (260 nm) by gavage for 10 d, once a day; the control group received only distilled water. At the end of the treatment the duodenum, jejunum and ileum were extracted for assessment of cytokines, inflammatory cells and titanium content. The cytokines interleukin (IL)-1b, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, IL-17, IL-23, tumor necrosis factor-α (TNF-α), intracellular interferon-γ (IFN-γ) and transforming growth factor-ß (TGF-ß) were evaluated by enzyme-linked immunosorbent assay in segments of jejunum and ileum (mucosa and underlying muscular tissue). CD4+ and CD8+ T cells, natural killer cells, and dendritic cells were evaluated in duodenum, jejunum and ileum samples fixed in 10% formalin by immunohistochemistry. The titanium content was determined by inductively coupled plasma atomic emission spectrometry. RESULTS: We found increased levels of T CD4+ cells (cells/mm²) in duodenum: NP 1240 ± 139.4, MP 1070 ± 154.7 vs 458 ± 50.39 (P < 0.01); jejunum: NP 908.4 ± 130.3, MP 813.8 ± 103.8 vs 526.6 ± 61.43 (P < 0.05); and ileum: NP 818.60 ± 123.0, MP 640.1 ± 32.75 vs 466.9 ± 22.4 (P < 0.05). In comparison to the control group, the groups receiving TiO2 showed a statistically significant increase in the levels of the inflammatory cytokines IL-12, IL-4, IL-23, TNF-α, IFN-γ and TGF-ß. The cytokine production was more pronounced in the ileum (mean ± SE): IL-12: NP 33.98 ± 11.76, MP 74.11 ± 25.65 vs 19.06 ± 3.92 (P < 0.05); IL-4: NP 17.36 ± 9.96, MP 22.94 ± 7.47 vs 2.19 ± 0.65 (P < 0.05); IL-23: NP 157.20 ± 75.80, MP 134.50 ± 38.31 vs 22.34 ± 5.81 (P < 0.05); TNFα: NP 3.71 ± 1.33, MP 5.44 ± 1.67 vs 0.99 ± 019 (P < 0.05); IFNγ: NP 15.85 ± 9.99, MP 34.08 ± 11.44 vs 2.81 ± 0.69 (P < 0.05); and TGF-ß: NP 780.70 ± 318.50, MP 1409.00 ± 502.20 vs 205.50 ± 63.93 (P < 0.05). CONCLUSION: Our findings indicate that TiO2 particles induce a Th1-mediated inflammatory response in the small bowel in mice.

[Health policies in Brazil in the 2000s: the national priority agenda]. / Políticas de saúde no Brasil nos anos 2000: a agenda federal de prioridades.

This article analyzes Brazilian national health priorities from 2003 to 2008 under the Lula Administration. The study included a literature review, document analysis, and interviews with Federal health administrators. Four priorities were identified on the national health agenda: the Family Health Program, Smiling Brazil, Mobile Emergency Services, and the Popular Pharmacy Program. The first is a policy with high institutional density launched by the previous Administration, constituting an example of path dependence. The other three are innovations in areas where there had been weaknesses in Federal government action. The four policy priorities are strategies focused on solving key problems in the Brazilian health system. However, they display important differences in their historical development, political and institutional base, inclusion on the Federal agenda, and implications for the principles of the Unified National Health System. Although incremental changes have been introduced, national health policy has been characterized predominantly by continuity.

Políticas de saúde no Brasil nos anos 2000: a agenda federal de prioridades / Health policies in Brazil in the 2000s: the national priority agenda

This article analyzes Brazilian national health priorities from 2003 to 2008 under the Lula Administration. The study included a literature review, document analysis, and interviews with Federal health administrators. Four priorities were identified on the national health agenda: the Family Health Program, Smiling Brazil, Mobile Emergency Services, and the Popular Pharmacy Program. The first is a policy with high institutional density launched by the previous Administration, constituting an example of path dependence. The other three are innovations in areas where there had been weaknesses in Federal government action. The four policy priorities are strategies focused on solving key problems in the Brazilian health system. However, they display important differences in their historical development, political and institutional base, inclusion on the Federal agenda, and implications for the principles of the Unified National Health System. Although incremental changes have been introduced, national health policy has been characterized predominantly by continuity.

O artigo analisa as prioridades da política nacional da saúde no período de 2003 a 2008, correspondente ao Governo Lula. A pesquisa envolveu revisão bibliográfica, análise documental, análise de dados e entrevistas com dirigentes federais. Foram identificadas quatro prioridades na agenda federal da saúde: a Estratégia Saúde da Família, o Brasil Sorridente, os Serviços de Atendimento Móvel de Urgência e o programa Farmácia Popular. A primeira configura uma política de alta densidade institucional, iniciada no governo anterior, constituindo um exemplo de "dependência da trajetória". As demais foram adotadas como marcos de governo e trouxeram inovações em áreas em que havia fragilidades da atuação federal. As quatro políticas prioritárias analisadas se voltam para problemas relevantes do sistema de saúde brasileiro, porém apresentam diferenças quanto à sua trajetória, base de apoio e implicações para os princípios do Sistema Único de Saúde. Apesar de mudanças incrementais, observou-se a predominância de elementos de continuidade na política nacional de saúde no período.

Comparação do equilíbrio estático e dinâmico entre atletas com deficiência visual, praticantes de goalball e atletismo / Comparison of the static and dynamic balance between athletes with visual impairment that practice goalball and athletics

O objetivo deste estudo foi comparar o equilíbrio dinâmico e estático de pessoas com deficiência visual praticantes de goalball e atletismo. Participaram desta pesquisa 20 pessoas com deficiência visual total e congênita, sendo 10 praticantes de goalball (idade 24 ± 6 anos; estatura 165 ± 10 cm e peso 68 ± 16 Kg) e 10 praticante de atletismo (idade 31 ± 7 anos; estatura 170 ± 10 cm e peso 64 ± 10 Kg) e todos realizaram dois testes de equilíbrio dinâmico (anterior e posterior) e um teste de equilíbrio estático. Os resultados das análises estatísticas (T-TESTE para AMOSTRAS independentes) demonstraram diferenças significativas nos dois testes de equilíbrio dinâmico do grupo de goalball em relação ao grupo de atletismo (p<0,05), mas não foi encontrada diferença significativa no teste de equilíbrio estático (p=0.67) entre os grupos. Verificou-se que a especificidade da modalidade goalball tem relação direta com o equilíbrio dinâmico para pessoas com deficiência visual congênita e que a força muscular principalmente membros inferiores tanto no atletismo como no goalball estão relacionadas ao equilíbrio estático.

The aim of this study was to compare the dynamic and static balance visually impaired goalball practitioners and athletics. participated this research 20 people in total and congenital blindness, 10 practitioners goalball (age 24 ± 6 years, height 165 ± 10 cm, weight 68 ± 16 Kg) and 10 practicing athletics (age 31 ± 7 years, height 170 ± 10 cm and weight 64 ± 10 kg) and all performed two tests of dynamic balance (previous and later) and a test of static equilibrium. The results of the analyzes statistics (T-test for independent samples) showed significant differences in both dynamic balance test group goalball regarding athletics group (p <0.05), but was not found significant differences in static equilibrium (p = 0.67) between test groups. It was found that the specificity of sport goalball is directly related with the dynamic balance for people with congenital blindness and mainly the lower limbs muscle strength both in athletics and in goalball are related to static equilibrium.