Múltiplos aspectos relacionados à formulação de políticas, à construção do conhecimento e à implementação das práticas no setor saúde interagem mutuamente e têm como produto a maneira como se prestam os serviços de saúde em determinado contexto histórico ou ainda resultam na disponibilidade ou na escassez de um determinado conjunto de ações e serviços de saúde. Compreender essas relações é fundamental para se avaliar a trajetória da política de saúde no país. Tomando-se como referência o princípio constitucional da integralidade da atenção à saúde e os desafios de sua implementação, analisam-se as formulações teóricas relacionadas ao conceito de Vigilância da Saúde e as mudanças implementadas pelo Ministério da Saúde no campo da Atenção Básica e da Saúde da Família. Busca-se ainda analisar em que medida essas proposições contribuem atualmente para o desenvolvimento do Sistema Único de Saúde.

Our findings suggest that Wii-based exercise can be an effective tool to improve physical fitness, functional mobility and motor proficiency of adults with DS, including crucial measures such as aerobic capacity and lower limb strength. Exergames using Wii Fit or other equipment can be appealing alternatives for adults with DS to engage in regular physical activity, preventing sedentary behaviour and decreasing the risk to develop cardiovascular diseases.

The aim of this study was to investigate the effects of transcranial direct current stimulation (tDCS) on countermovement jump performance (CMJ) in men with advanced strength training experience. Ten healthy male subjects, with advanced strength training and squatting exercise experience, were included. Participants took part in an initial visit to the laboratory to complete anthropometric measurements and CMJ kinematic test-retest reliability. Participants then completed three experimental conditions, 48-72 hours apart, in a randomized, double-blinded crossover design: anodal, cathodal and sham tDCS (2 mA for 20 minutes targeting the motor cortex bilaterally). Participants completed three CMJ tests before and after each experimental condition, with one-minute recovery interval between each test. The best CMJ in each moment was selected for analysis. Two-way (condition by moment) repeated measures ANOVA's were performed for CMJ height, flight time and muscular peak power. Effect sizes and interindividual variability of tDCS responses were also analyzed. There was a significant condition by moment interaction for all outcome measures, with a large pre-post increase in CMJ height, flight time and muscular peak power in the anodal condition. All the participants displayed CMJ performance improvements after the anodal condition. There were no significant differences in both cathodal and sham conditions. Anodal tDCS may be a valuable tool to enhance muscle power related tasks performance, which is extremely relevant for sports that require vertical jumping ability. Anodal tDCS may also be used to support strength training, enhancing its effects on performance-oriented outcome measures.

Avaliação da atenção básica pela perspectiva dos usuários: adaptação do instrumento EUROPEP para grandes centros urbanos brasileirosEvaluation of primary care from the perspective of users: adaptation of the EUROPEP instrument for major Brazilian urban centers

Facebook is notably the most widely known and used social network worldwide. It has been described as a valuable tool for leisure and communication between people all over the world. However, healthy and conscience Facebook use is contrasted by excessive use and lack of control, creating an addiction with severely impacts the everyday life of many users, mainly youths. If Facebook use seems to be related to the need to belong, affiliate with others and for self-presentation, the beginning of excessive Facebook use and addiction could be associated to reward and gratification mechanisms as well as some personality traits. Studies from several countries indicate different Facebook addiction prevalence rates, mainly due to the use of a wide-range of evaluation instruments and to the lack of a clear and valid definition of this construct. Further investigations are needed to establish if excessive Facebook use can be considered as a specific online addiction disorder or an Internet addiction subtype.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique increasingly explored for Parkinson's disease (PD). Although evidence is still inconsistent, there are preliminary findings suggesting its efficacy to improve motor function in individuals with PD, as the role of secondary motor areas remains unclear. The goal of this study was to investigate the effects of left dorsolateral prefrontal cortex (DLPFC) tDCS on balance and functional mobility of individuals with PD. Seventeen individuals with PD, on-medication, aged between 40 and 90 years were recruited to enroll in a double-blind, randomized, cross-over trial. Each participant completed two conditions at least 48h apart, namely anodal-tDCS and sham-tDCS (placebo). The a-tDCS condition targeted the left DLPC (F3) and was applied during 20min using a 2mA current intensity. In the sham-tDCS condition, electrode position remained the same but the stimulator was turned off after 30s. Functional mobility and balance were assessed using the Berg Balance Scale, Dynamic Gait Index and Timed Up and Go. There were significant differences between conditions on all outcome measures, as the a-tDCS condition was associated with better performance in comparison to the sham condition (p<0.05). Our findings suggest that a-tDCS on the left DLPFC improves balance and functional mobility in comparison to sham-tDCS. Compensatory mechanisms that support motor function in individuals with PD may have been enhanced by a-tDCS on the DLPFC, leading to improved functional mobility and balance. Future trials should explore left DLPFC stimulation with larger samples and compare t-DCS protocols targeting several brain regions.

The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first-pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity.

Recent governmental initiatives allowed for quality assessment proposals to Primary Healthcare in Brazil. This is a new field but a priority in the current strengthening of Family Health strategy following a decade of expansion and consolidation. This article focuses on assessment and quality improvement strategies in the context of Primary Healthcare.