Objective. Recent evidence suggests that fibromyalgia is a disorder characterized by dysfunctional brain activity. Because transcranial direct current stimulation (tDCS) can modulate brain activity noninvasively and can decrease pain in patients with refractory central pain, we hypothesized that tDCS treatment would result in pain relief in patients with fibromyalgia.Methods. Thirty-two patients were randomized to receive sham stimulation or real tDCS with the anode centered over the primary motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC) (2 mA for 20 minutes on 5 consecutive days). A blinded evaluator rated the patient's pain, using the visual analog scale for pain, the clinician's global impression, the patient's global assessment, and the number of tender points. Other symptoms of fibromyalgia were evaluated using the Fibromyalgia Impact Questionnaire and the Short Form 36 Health Survey. Safety was assessed with a battery of neuropsychological tests. To assess potential confounders, we measured mood and anxiety changes throughout the trial.Results. Anodal tDCS of the primary motor cortex induced significantly greater pain improvement compared with sham stimulation and stimulation of the DLPFC (P < 0.0001). Although this effect decreased after treatment ended, it was still significant after 3 weeks of followup (P ‫؍‬ 0.004). A small positive impact on quality of life was observed among patients who received anodal M1 stimulation. This treatment was associated with a few mild adverse events, but the frequency of these events in the active-treatment groups was similar to that in the sham group. Cognitive changes were similar in all 3 treatment groups. Conclusion. Our findings provide initial evidence of a beneficial effect of tDCS in fibromyalgia, thus encouraging further trials.Recent evidence has shown that fibromyalgia is associated with specific changes in brain activity. In a recent single-photon-emission computed tomography study, patients with fibromyalgia (as compared with healthy controls) showed a decrease in regional cerebral blood flow in the thalamus, caudate nucleus, and pontine tegmentum (1). In addition, it has long been demonstrated that antidepressants, such as tricyclic agents, improve pain in fibromyalgia (2), and recent studies suggest that centrally acting drugs such as dopaminergic drugs are effective in alleviating the symptoms of fibromyalgia, as compared with placebo (3).In this context of brain dysfunction, techniques for neuromodulation could be a beneficial approach for this group of patients. In fact, results of several studies have shown that motor cortex stimulation with epidural electrodes or with repetitive transcranial magnetic stimDr. Fregni

The modified sphygmomanometer proved to be a reproducible technique for measuring muscle strength of the finger flexor muscles.

A Saúde Suplementar no Brasil conquistou oficialmente seu espaço por meio da Constituição Federal de 1988 e teve seu marco regulatório estabelecido pela Lei n. 9.656 de 1998. Apresentando-se como alternativa de obtenção de serviços assistenciais para a população, a Saúde Suplementar vem ganhando destaque não só pela quantidade de serviços realizados, mas também pela percepção da boa qualidade dos atendimentos prestados aos seus usuários. Com a responsabilidade de atender mais de 50 milhões de brasileiros, a Saúde Suplementar se fundamentou como importante pilar de sustentabilidade do setor. Por meio de buscas desenvolvidas em bases de dados eletrônicas da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO), bem como dados oficiais do Instituto Brasileiro de Geografia e Estatística (IBGE) e da Agência Nacional de Saúde Suplementar (ANS) ficou claro que o setor público, representado pelo Sistema Único de Saúde (SUS), não teria condições de suprir a demanda de atendimentos assistenciais caso não existisse o setor privado. Dessa forma, a Saúde Suplementar tornou-se indispensável para o Estado que, visivelmente, não teria como suportar a incorporação dos gastos desse setor no orçamento da União. Em contrapartida a esse fato e na contramão da lógica do processo, percebe-se que a regulamentação do setor tem apontado para um cenário de grande dificuldade de manutenção das empresas que participam da Saúde Suplementar, cuja importância é expressa pelos seus números e sua dificuldade de atuação imposta pelos rigorosos marcos regulatórios. Cabe analisar as consequências de tal contradição. Palavras AbstractPrivate Health Care in Brazil has officially conquered your space by the Federal Constitution of 1988 and had its regulatory framework established by Law 9656 of 1998. Presenting itself as an alternative for obtaining health care services for the population, the Private Health Care has been gaining attention not only by the amount of services offered, but also by the perceived quality of care provided to its users. With the responsibility to serve more than 50 million Brazilians, Private Health Care is relied as an important pillar of sustainability of the health sector. Through searches conducted in electronic databases of Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), also in official data from the Instituto Brasileiro de Geografia e Estatística (IBGE) and Agência Nacional de Saúde Suplementar (ANS), it was clear that the public sector, represented by Sistema Único de Saúde (SUS), would be unable to meet the demand of medical care if the private sector does not exist. Thus, the Private Health Care has become essential to the state, which clearly would not support the inclusion of this sector's investments and costs in the budget of the Union. In contrast to this fact and against the logic of the process, we see that regulation of the sector have pointed to a time of great difficulty i...

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This study aimed to evaluate aspects relating to interest, perception and knowledge levels regarding ethics in physiotherapy among lecturers of this course at a university in the Brazilian Amazon region. Eighteen lecturers participated and responded to 21 questions divided in sections related to "interest", "perception" and "knowledge levels". The data was considered in terms of absolute and relative frequency. In the "interest" section, 77.77% (n = 14) indicated internet as a primary source of updates regarding the issue of ethics in physiotherapy. In the "perception" section, 94.44% (n = 17) considered the ethical behavior of students in their evaluations. Regarding "knowledge levels", 83.33% (n = 15) erred to say that treatment prescription can only be established after an appointment. Therefore, it is necessary to enhance knowledge and stimulate ethical considerations of lecturers regarding their ethical behavior for their own growth and the training of students. Keywords: Ethics. Physical therapy specialty. Faculty. Resumo Percepção, interesse e conhecimento de docentes de fisioterapia sobre a ética na profissãoEste estudo objetivou avaliar aspectos relacionados ao interesse, percepção e níveis de conhecimento sobre ética em fisioterapia entre docentes da área de uma universidade pública na Amazônia brasileira. Participaram 18 professores, que responderam às 21 questões distribuídas nos eixos "interesse", "percepção" e "níveis de conhecimento". Os dados foram trabalhados em frequência absoluta e relativa. No eixo interesse, 77,77% (n = 14) indicaram a Internet como principal fonte de atualização sobre ética em fisioterapia. Em termos de percepção, 94,44% (n = 17) consideraram a postura ética dos alunos em suas avaliações. Quanto aos níveis de conhecimento, 83,33% (n = 15) erraram ao dizer que a prescrição terapêutica só pode ser instituída depois da consulta. Portanto, é necessário aprofundar o conhecimento e estimular a reflexão ética dos docentes sobre sua postura ética, tendo em vista o próprio crescimento e a formação dos discentes.Palavras-chave: Ética. Fisioterapia. Docentes. ResumenPercepción, interés y conocimiento de docentes de fisioterapia sobre la ética en la profesión Este estudio tuvo como objetivo evaluar aspectos relacionados con el interés, la percepción y los niveles de conocimiento sobre la ética en la fisioterapia entre los profesores de esta carrera en una universidad pública de la Amazonia brasilera. Participaron 18 profesores que respondieron al cuestionario de 21 preguntas distribuidas en los ejes de "interés", "percepción" y "niveles de conocimiento". Los datos fueron trabajados en frecuencia absoluta y relativa. En la escala de Interés, el 77,77% (n = 14) indicó a Internet como la fuente principal de actualización sobre la ética en fisioterapia. En términos de percepción, el 94,44% (n = 17) consideró la postura ética de los estudiantes en sus evaluaciones. En cuanto a los niveles de conocimiento, el 83,33% (n = 15) se equivocó al decir que la prescripción del tratamiento só...