Este artigo avalia a influência da descentralização dos trabalhos constituintes na formação da Constituição de 1988. Observamos que o plenário foi menos crucial para a agenda constituinte do que diversos autores apregoam. A inclusão de políticas públicas na Constituição ocorreu, sobretudo, na fase das comissões, sob a égide das lideranças progressistas, tendo sido aprofundado na negociação em plenário. O texto mostra, portanto, como preference outliers na etapa das comissões constituintes determinaram boa parte da Constituição aprovada no fim de 1988.

This article evaluates the influence of the decentralization of the constituent work in the formation of the 1988 Constitution. We note that the plenary was less crucial for the agenda of the constituent than several authors proclaim. The inclusion of public policies in the Constitution occurred mainly during the phase of commissions, under the aegis of progressive leaders, having been deepened in the trading floor. The article shows, therefore, how preference outliers in the step of constituent committee determined much of the Constitution adopted in the end of 1988.

Cet article évalue l'influence de la décentralisation des travaux de l'Assemblée Constituante dans la formation de la Constitution de 1988. Nous observons que la séance plénière a été moins cruciale pour l'agenda de l'Assemblée Constituante que ce que défendent les divers auteurs. L'inclusion de politiques publiques dans la Constitution a eu lieu, surtout, dans la phase des commissions, sous l'égide des leaders progressistes, et a été approfondie au cours des négociations dans la scéance plénière. Le texte démontre, donc, de quelle façon les preference outliers ont déterminé, à l'étape des commissions constituantes, une bonne partie de la Constitution approuvée à la fin de l'année 1988.

This paper aims to demonstrate how the responses of public health officials to judicial decisions have shaped drug distribution policies in the state of São Paulo. Data was collected and structured interviews were conducted at the state of São Paulo Department for Health in order to show how different strategies of response to judicial decisions affected the policy of medication distribution by the public sector. We also analysed recent Supreme Federal Court jurisprudence to show how the Court reformed its earlier views on the subject as a result of the demands made by public health officials. It is our understanding that the current literature has failed to produce a more comprehensive view of this phenomenon because of its focus solely on judicial decisions, without taking a step further to analyse how public health officials reacted to them, which would have addressed the compliance problem inherent to positive rights enforcement. Finally, we see this process not as merely positive or negative, but as one that goes beyond the different normative biases present in the literature on the subject, and focus on the mechanisms behind the impact of the judicialization of the right to healthcare on policies of medication distribution. sector them enforcement Finally negative

INTRODUÇÃO: Síndrome de Landau-Kleffner é uma síndrome epiléptica rara caracterizada pela associação de afasia de recepção, crises epilépticas, distúrbios do comportamento e alterações eletrencefalográficas com descargas nos lobos temporais unilaterais ou bilaterais. Crises convulsivas não são essenciais para o diagnóstico. RELATO DO CASO: J.V.S.S., masculino, três anos de idade, com atraso na aquisição da fala, agitação psicomotora e distúrbio do sono. Ele usava gestos e apontava para os objetos tentando se comunicar. Seu comportamento era muito agitado, impaciente, períodos de agressividade e muita dificuldade em estabelecer contato social com outras crianças da mesma idade. RNM foi normal e o EEG mostrou descargas de ondas agudas nas regiões temporais média e posterior esquerda. Após três meses de tratamento com carbamazepina a criança retornou para reavaliação, apresentando importante melhora da fala, falando palavras simples, melhora do comportamento e do padrão de sono e da interação social. DISCUSSÃO: Alterações na linguagem de recepção e de expressão são relativamente comuns em crianças com diferentes síndromes epilépticas, particularmente na síndrome de Landau-Kleffner. Descargas epileptiformes podem ocorrer em pessoas sem epilepsia sendo denominadas descargas subclínicas. Qual o impacto das descargas subclínicas para estas pessoas é incerto até o momento. Relatamos o caso de um menino com descargas epileptiformes no EEG, sem história de crises convulsivas e excelente evolução clínica após tratamento com droga antiepiléptica.

INTRODUCTION: Landau-Kleffner Syndrome is a rare epileptic syndrome characterized by the association of receptive aphasia, epileptic seizures, behavioral disorders and electroencephalographic changes with discharges at the temporal lobe unilaterally or bilaterally. Seizures are not essential for diagnosis. CASE REPORT: J. V. S. S., 3 y/o male, with delay in acquirement of speech, psychomotor agitation and sleep disorder (sleeplessness). Attempt to communicate was established by gestures and pointing at things. His behavior characterized by agitation, restlessness, aggressiveness and difficulty to establish social contact with other children by the same age. MRI was normal and the EEG showed sharp-wave discharges in the left medial and posterior temporal regions. After three months of treatment with carbamazepine the child returned to an evaluation, presenting substantial improvement at speech, speaking simple words and with meaningful improvement on both behavioral and sleep patterns, as well as, social interaction. DISCUSSION: Expression and reception speech disorders are relatively common in children with different epileptic syndromes, particularly in Landau-Kleffner syndrome. Epileptiform discharges can occur in people without epilepsy and use to be called subclinical discharges. What would be the impact of subclinical discharges on this population remains uncertain at the present time. We reviewed these interactions in the light of a representative case, showing favorable outcome following introduction of an antiepileptic drug.