Abstract Purpose To synthesize and characterize poly(hydroxybutyrate) (PHB) and norbixin membranes to evaluate them for genotoxicity in rats and wound healing in mice by histological staining. Methods For the evaluation of genotoxicity, male rats ( Rattus novegicus ) were divided into three groups (n= 5): 5% PHB/Norbixin membrane introduced into the peritoneum by laparotomy; B – negative control; C – positive control (intraperitoneal dose of cyclophosphamide 50 mg/kg). For the evaluation of biocompatibilty, a cutaneous wound was induced on the back of males mice ( Mus musculus ) divided into two experimental treatment groups: control and membrane that underwent euthanasia after 7 and 14 days treatment. Statistical analysis ware made by One Way Anova post hoc Tukey Test (p<0.05). Results Regarding the incidence of polychromatic erythrocytes, there was no difference between negative control and 5% PHB/Norbixin membrane; however, when compared to the positive control represented by cyclophosphamide, there was a significant difference (p <0.001). As for DNA damage, the changes induced in the first 4h were repaired in 24h. In addition, the membrane was effective in abbreviating the inflammatory process and served as a scaffold due to the stimulus to reepithelialization mainly on the 7 days of treatment. Conclusion The non-genotoxic PHB/Norbixin 5% membrane presented promising results that suggest its effectiveness as a guide for tissue regeneration given its biocompatibility.

RESUMEN Objetivo El objetivo de este estudio es medir el aumento de la pobreza debido a los gastos directos en salud y analizar la equidad del financiamiento del sistema de salud ecuatoriano, con base en datos de encuestas nacionales representativas del país. Método Fue realizado con datos de la "Encuesta de condiciones de vida 2013-2014" (ECV) y utilizó líneas de pobreza, con enfoques relativo y absoluto para medir el aumento de la pobreza y, mediante Análisis de Incidencia en el financiamiento, fueron medidas las desigualdades en la distribución del financiamiento. Resultados La pobreza aumentó 2,2% debido al gasto de las familias en salud, especialmente en gastos de medicamentos y consultas médicas, que representaron 36,7% y 14,6% del gasto total en pagos directos. Además, las fuentes más importantes de financiamiento resultaron ser regresivas, hecho que afecta principalmente a la clase media. Cuando fueron consolidadas, las fuentes de financiamiento analizadas resultaron ser proporcionales. Este, aunque no es el peor escenario, no es el esperado para un sistema de salud que debe garantizar protección financiera a sus usuarios. Discusión Aunque existen metas de financiamiento de difícil alcance, al menos las leyes del país establecen la búsqueda de ese fin. Sin embargo, pérdidas de recursos financieros dificultan el logro de los objetivos trazados.

ABSTRACT Objective The objective of this study is to measure the increase in poverty due to direct health expenditures and to analyze the equity of financing of the Ecuadorian health system, based on data from representative national surveys of the country. Method It was carried out with data from the 2013-2014 Living Conditions Survey and used poverty lines, with relative and absolute approaches to measure the increase in poverty and, through Analysis of Incidence in Financing, inequalities in the financing distribution. Results Poverty increased 2.2% due to families spending on health, especially on expenses for medications and medical consultations, which represented 36.7% and 14.6% of total expenditure on direct payments. Furthermore, the most important sources of financing turned out to be regressive, mainly affecting the middle class. When they were consolidated, the sources of financing analyzed turned out to be proportional that, although it is not the worst-case scenario, it is not the expected one for a health system that must guarantee financial protection to its users. Discussion Although there are financing goals that are difficult to achieve, at least the country's laws establish the pursuit of this goal. However, losses of financial resources make it difficult to achieve the objectives set.

RESUMEN Objetivo El objetivo de este estudio es medir el aumento de la pobreza debido a los gastos directos en salud y analizar la equidad del financiamiento del sistema de salud ecuatoriano, con base en datos de encuestas nacionales representativas del país. Método Fue realizado con datos de la "Encuesta de condiciones de vida 2013-2014" (ECV) y utilizó líneas de pobreza, con enfoques relativo y absoluto para medir el aumento de la pobreza y, mediante Análisis de Incidencia en el financiamiento, fueron medidas las desigualdades en la distribución del financiamiento. Resultados La pobreza aumentó 2,2% debido al gasto de las familias en salud, especialmente en gastos de medicamentos y consultas médicas, que representaron 36,7% y 14,6% del gasto total en pagos directos. Además, las fuentes más importantes de financiamiento resultaron ser regresivas, hecho que afecta principalmente a la clase media. Cuando fueron consolidadas, las fuentes de financiamiento analizadas resultaron ser proporcionales. Este, aunque no es el peor escenario, no es el esperado para un sistema de salud que debe garantizar protección financiera a sus usuarios. Discusión Aunque existen metas de financiamiento de difícil alcance, al menos las leyes del país establecen la búsqueda de ese fin. Sin embargo, pérdidas de recursos financieros dificultan el logro de los objetivos trazados.

ABSTRACT Objective The objective of this study is to measure the increase in poverty due to direct health expenditures and to analyze the equity of financing of the Ecuadorian health system, based on data from representative national surveys of the country. Method It was carried out with data from the 2013-2014 Living Conditions Survey and used poverty lines, with relative and absolute approaches to measure the increase in poverty and, through Analysis of Incidence in Financing, inequalities in the financing distribution. Results Poverty increased 2.2% due to families spending on health, especially on expenses for medications and medical consultations, which represented 36.7% and 14.6% of total expenditure on direct payments. Furthermore, the most important sources of financing turned out to be regressive, mainly affecting the middle class. When they were consolidated, the sources of financing analyzed turned out to be proportional that, although it is not the worst-case scenario, it is not the expected one for a health system that must guarantee financial protection to its users. Discussion Although there are financing goals that are difficult to achieve, at least the country's laws establish the pursuit of this goal. However, losses of financial resources make it difficult to achieve the objectives set.

Resumo Este artigo compara as redes sociais existentes antes e depois da execução de projetos baseados no método de resolução criativa de problemas, adaptado para funcionar com grupos grandes. A apresentação do caso, desenvolvido junto a um agrupamento escolar, inclui a preparação e execução do fórum, a implementação de projetos de inovação e a medida das redes de comunicação existentes nas equipes, antes e depois da realização dos projetos. Os resultados comprovam a eficácia da metodologia para o estabelecimento de projetos de inovação. A análise das redes sociais permite compreender melhor o que se passa durante a execução dos projetos pelas equipes, seja em termos de liderança, seja quanto à evolução da rede de relações de trabalho. Do estudo deste caso, ressaltam características desejáveis para a melhoria do referido método de intervenção e para a construção de modelos de análise da execução dos projetos, a partir da evolução das redes sociais.

Abstract This article compares existing social networks before and after the execution of projects generated by the use of creative problem-solving method, adapted to work with large groups. The presentation of the case, with a school grouping, includes the preparation and execution of the forum, the implementation of the innovation projects and the measurement of existing small-world networks within teams, before and after the projects were carried out. The results support the effectiveness of the methodology in the establishment of innovation projects. The analysis of networks allows a better understanding of what happens during the execution of the projects by the teams, in terms of leadership and evolution of work connections. From this case, we highlight desirable characteristics for the improvement of the present method of intervention, and for the construction of models of analysis of project execution, from the evolution of small-world networks.

CONTEXTO: O Diabetes Mellitus (DM) é fator de risco para a doença arterial obstrutiva periférica (DAOP). A prevalência de DAOP no DM tipo 2 (T2) e o prejuízo adicional causado por esta na qualidade de vida (QoL) e na atividade física (AF) não são bem descritos na população brasileira. OBJETIVOS: Avaliar a prevalência e a associação da DAOP recém-diagnosticada com a QoL, a AF e a composição corporal em pacientes T2DM provenientes de um hospital universitário. MÉTODOS: Setenta e três pacientes T2DM, sem complicações maiores relacionadas ao T2DM, foram incluídos. A DAOP foi avaliada pelo índice tornozelo-braquial (ITB); a QoL, pelo questionário traduzido e validado SF-36, e a AF, pelo questionário modificado de Baecke. A composição corporal foi avaliada pela impedância bioelétrica segmentar multifrequencial. RESULTADOS: A prevalência de DAOP foi 13,7%, predominantemente de severidade leve (ITB entre 0,8-0,9). O ITB correlacionou-se com a idade (ρ= -0,26; P= 0,03), a duração do DM (ρ=-0,28; P=0,02) e a pressão arterial sistólica e diastólica (ρ= -0,33; P= 0,007 e ρ= -0,28; P= 0,02; respectivamente). O sumário de saúde física (PCS) do questionário SF-36 estava abaixo da variação normal; contudo, nenhum impacto negativo da DAOP foi identificado no PCS (ABI normal = 42,9±11,2 vs. ABI-DAOP = 38,12±11,07) ou no nível de AF. A análise da composição corporal demonstrou gordura corporal excessiva, especialmente em mulheres; contudo, sem diferenças entre grupos. CONCLUSÃO: A prevalência de DAOP sem diagnóstico prévio nesta amostra de pacientes T2DM foi de 13,7%, predominantemente assintomática e leve, e ainda não associada com piores índices de QoL, nível de AF e composição corporal.

BACKGROUND: Diabetes mellitus (DM) is a risk factor for peripheral arterial disease (PAD). Neither the prevalence of PAD in type 2 (T2) DM nor its detrimental effects on quality of life (QoL) or physical activity (PA) have been well described in the Brazilian population. OBJECTIVES: To evaluate the prevalence of newly diagnosed PAD and its associations with QoL, PA and body composition in a sample of T2DM patients from a University Hospital. METHODS: Seventy-three (73) T2DM patients without previous diagnoses of major complications related to T2DM were enrolled. PAD was assessed using the ankle-brachial index (ABI); QoL was measured using a translated and validated SF-36 questionnaire; PA was measured using a modified Baecke questionnaire; and body composition was measured by segmental multi-frequency bioelectrical impedance. RESULTS: PAD prevalence was 13.7%, predominantly of mild severity (ABI between 0.8-0.9). The ABI results correlated with age (ρ=-0.26, P=0.03), DM duration (ρ=-0.28, P=0.02) and systolic and diastolic blood pressure (ρ=-0.33, P=0.007 and ρ=-0.28, P=0.02; respectively). Scores for the SF-36 physical component summary (PCS) were below the normal range, but no negative impact from PAD was identified by the PCS scores (normal-ABI 42.9±11.2 vs. PAD-ABI 38.12±11.07) or the Baecke PA results. Body composition analysis detected excessive body fat, especially in women, but there was no difference between groups. CONCLUSIONS: The prevalence of previously undiagnosed PAD in this population of T2DM patients was 13.7%, predominantly mild and asymptomatic forms, and was not yet associated with worsened QoL, PA levels or body composition variables.

Psoriasiform Keratosis is a rare clinic entity. The etiopathogenesis remains unknown and the disease is characterized by a solitary, scaly or keratotic papule, or plaque mainly located on the extremities. Histopathological features closely resemble those of psoriasis. We report the case of a 70-year-old woman presenting a solitary and asymptomatic keratotic plaque, located on the back of the left leg, unresponsive to topical corticosteroids. We performed an excisional biopsy and histopathology was consistent with psoriasiform keratosis.

O Projeto Educativo, como instrumento fundamental para a autonomia das escolas, em Portugal, deve aglutinar as principais expectativas da comunidade escolar, implicando rigor na metodologia de investigação, utilizada para sua elaboração, e na implementação da mudança requerida. O presente artigo relata a forma como foi possível obter esses aspectos, numa escola secundária, ao longo de mais de um ano, por meio do uso do método de Resolução Criativa de Problemas, que envolveu toda a comunidade escolar. Conforme o planeamento definido, a elaboração do Projeto Educativo seguiu os passos de um trabalho de investigação e resultou num documento estratégico e operacional, sujeito, posteriormente, a várias tentativas de implementação que, no entanto, tiveram apenas sucesso relativo. A discussão das condições necessárias para que o documento final possa servir de base à implementação das políticas e ações definidas, o que simplificaria todo o esquema de funcionamento escolar, sob um prisma de gestão efetiva das organizações, é aqui iniciada e sugerida para futuras investigações.

The Educational Project in Portugal, as a fundamental instrument for school autonomy, must concentrate the main expectations of the school community, involving rigor in the research methodology used for its elaboration and in the implementation of the changes required. This article reports how these aspects were achieved in a high school, using the Creative Problem Solving method and involving the whole school community, over more than one year. According to the established planning, the preparation of the Educational Project followed the steps of a research project, resulting in a strategic and operational document, which was subsequently subjected to various implementation attempts. However, the success was only relative. The discussion of the conditions necessary for the final document to be the basis for the implementation of policies and actions, by simplifying the whole scheme of school functioning, from the perspective of the effective management of organizations, is initiated here and suggested for future investigations.

O Hemangioma em penacho é uma proliferação vascular adquirida de características histológicas peculiares. Sua característica clínica mais comum são máculas eritematosas. Ocorre predominantemente em crianças e adultos jovens, principalmente no tórax e pescoço. Relata-se o caso de paciente do sexo masculino, 12 anos, com aumento do pavilhão auricular direito associado a máculas eritematosas e aumento da temperatura local, encaminhado com diagnóstico de Hanseníase Virchowiana, entretanto, tal diagnóstico foi questionado. Histopatologia compatível com Hemangioma em penacho.

Tufted angioma is an acquired vascular proliferation with specific histological characteristics. The most common clinical features are erythematous macules. It occurs predominantly in children and young adults, especially in the chest and neck. We report the case of a male patient, 12 years old, with an increased right ear auricle associated with erythematous macules and increased local temperature, referred with a diagnosis of lepromatous leprosy; however, this diagnosis was questioned. Histopathology was consistent with tufted angioma.

OBJETIVO: Avaliar os resultados preliminares da prótese METIS-Newdeal® como tratamento de hallux rigidus grau III/IV. MÉTODOS: Estudo prospectivo de oito próteses MTF colocadas em seis pacientes entre nov/2007 e jul/2009. A idade média foi de 55 anos e o tempo de seguimento após a cirurgia de 50 semanas. Na avaliação dos resultados foi utilizado o escore AOFAS-MTF e controle imageológico por radiografia. RESULTADOS: Verificou-se um aumento pontual significativo do escore AOFAS-MTF que passou de 42p pré-operatório para 82p após a cirurgia (↑1,95x), tendo sido ao nível da função o maior ganho. Radiologicamente não se identificaram intercorrências. Dos cinco pacientes operados, apenas um se mostrou descontente com a cirurgia, após o surgimento de infecção precoce no local cirúrgico, sendo que corresponde à única complicação pós-op encontrada. CONCLUSÃO: A artroplastia total metatarsofalângica METIS-Newdeal® apresenta resultados promissores no curto prazo. No entanto, é necessário avaliar um maior número de casos com um tempo de seguimento mais longo para que se possa obter conclusões mais consistentes.

OBJECTIVE: To evaluate the preliminary results from the METIS-Newdeal® metatarsophalangeal prosthesis for treating hallux rigidus grade III/IV. METHODS: This was a prospective study on eight metatarsophalangeal prostheses that were placed in six patients between November 2007 and July 2009. The patients' mean age was 55 years and the mean follow-up after the surgery was 50 weeks. The results were evaluated using the AOFAS-MTF score and x-ray images as controls. RESULTS: The AOFAS-MTF score increased significantly from 42p before the surgery to 82p after the surgery (↑1.95x), mainly due to improvement in the functional level. No intercurrences were identified radiologically. Among the five patients who underwent operations, only one expressed dissatisfaction with the surgery: this was expressed after early infection appeared at the surgical site, and it was the only postoperative complication found. CONCLUSION: Total metatarsophalangeal arthroplasty using METIS-Newdeal® presented promising short-term results. However, evaluations on a larger number of cases with a longer follow-up are needed in order to draw more consistent conclusions.