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1.
Clin Exp Rheumatol ; 31(5): 739-48, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23899791

RESUMO

OBJECTIVES: This study aims to assess the impact of a structured education and home exercise programme in daily practice patients with ankylosing spondylitis. METHODS: A total of 756 patients with ankylosing spondylitis (72% males, mean age 45 years) participated in a 6-month prospective multicentre controlled study, 381 of whom were randomised to an education intervention (a 2-hour informative session about the disease and the implementation of a non-supervised physical activity programme at home) and 375 to standard care (controls). Main outcome measures included Bath Ankylosing Spondylitis Disease Activity and Functional Index (BASDAI, BASFI). Secondary outcome measures were 0-10 cm visual analog scale (VAS) for total pain, nocturnal pain and global disease activity and quality of life (ASQoL), knowledge of disease (self-evaluation ordinal scale) and daily exercise (diary card). RESULTS: At 6 months, the adjusted mean difference between control and educational groups for BASDAI was 0.32, 95% confidence interval (CI) 0.10-0.54, p=0.005, and for BASFI 0.31, 95%CI 0.12-0.51, p=0.002. Significant differences were found also in VAS for total pain, patient´s global assessment and in ASQoL. Patients in the education group increased their knowledge about the disease and its treatments significantly (p<0.001) and practised more regular exercise than controls (p<0.001). CONCLUSIONS: A structured education and home exercise programme for patients with ankylosing spondylitis in daily practice was feasible and helped to increase knowledge and exercise. Although statistically significant, the magnitudes of the clinical benefits in terms of disease activity and physical function were poor.


Assuntos
Terapia por Exercício , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Assistência Domiciliar , Educação de Pacientes como Assunto , Espondilite Anquilosante/terapia , Atividades Cotidianas , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Recuperação de Função Fisiológica , Espanha , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
2.
Mediators Inflamm ; 2013: 560632, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24489444

RESUMO

PURPOSE: To assess the efficacy and safety of adalimumab in patients with juvenile idiopathic arthritis (JIA) and associated refractory uveitis. DESIGN: Multicenter, prospective case series. METHODS: Thirty-nine patients (mean [SD] age of 11.5 [7.9] years) with JIA-associated uveitis who were either not responsive to standard immunosuppressive therapy or intolerant to it were enrolled. Patients aged 13-17 years were treated with 40 mg of adalimumab every other week for 6 months and those aged 4-12 years received 24 mg/m(2) body surface. RESULTS: Inflammation of the anterior chamber (2.02 [1.16] versus 0.42 [0.62]) and of the posterior segment (2.38 [2.97] versus 0.35 [0.71] decreased significantly between baseline and the final visit (P < 0.001). The mean (SD) macular thickness at baseline was 304.54 (125.03) µ and at the end of follow-up was 230.87 (31.12) µ (P < 0.014). Baseline immunosuppression load was 8.10 (3.99) as compared with 5.08 (3.76) at the final visit (P < 0.001). The mean dose of corticosteroids also decreased from 0.25 (0.43) to 0 (0.02) mg (P < 0.001). No significant side effects requiring discontinuation of therapy were observed. CONCLUSION: Adalimumab seems to be an effective and safe treatment for JIA-associated refractory uveitis and may reduce steroid requirement.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Uveíte/tratamento farmacológico , Adalimumab , Adolescente , Artrite Juvenil/complicações , Criança , Pré-Escolar , Feminino , Humanos , Imunossupressores/uso terapêutico , Inflamação , Masculino , Segurança do Paciente , Estudos Prospectivos , Esteroides/química , Esteroides/uso terapêutico , Resultado do Tratamento , Uveíte/complicações
3.
Investig. segur. soc. salud ; 7: 117-140, 2005. graf
Artigo em Espanhol | LILACS, COLNAL | ID: lil-439961

RESUMO

Introducción El anterior Sistema Nacional de Salud atendía las necesidades de una parte de la población colombiana mediante el subsidio a la oferta (1). Actualmente, se garantiza a la población el derecho a la salud (2) a través de los regímenes contributivo y subsidiado, transfiriendo los recursos del subsidio a la oferta en subsidios a la demanda; lo anterior, en sujeción a los principios de eficiencia, universalidad y solidaridad. Es por ello que a través del presente estudio se pretende determinar en forma cuantitativa y cualitativa los tipos de quejas en la prestación de los servicios a los afiliados al régimen subsidiado en salud, incluidos en el Plan Obligatorio de Salud Subsidiado, el manejo de los eventos no cubiertos por las ARS y que se presentan con regularidad en la población afiliada; los hechos anteriormente relacionados, han conllevado a evaluar el actual programa de aseguramiento del régimen subsidiado y plantear mecanismos de ajustes que repercutan en beneficio de la población pobre y vulnerable (3). Los resultados de la misma sirven de referencia para los actores que conforman el sistema, en aras de una mejor atención a los usuarios que requieren de los servicios contemplados por ley. Objetivo general Determinar los tipos de quejas presentadas por los usuarios del régimen subsidiado en Bogotá, relacionadas con el Plan Obligatorio de Salud Subsidiado y los eventos no contemplados en Plan Obligatorio de Salud Subsidiado, durante el segundo semestre de 2001 y primer semestre de 2002, interpuestas en la Secretaría Distrital de Salud, la Superintendencia Nacional de Salud y el Ministerio de la Protección Social, con el fin de tener una aproximación de cómo se está prestando el servicio y plantear estrategias de solución. Método Estudio de tipo descriptivo realizado en los afiliados al régimen subsidiado en Bogotá que radicaron quejas en el segundo semestre del año 2001 y el primer semestre del año 2002 en la Secretaría Distrital de Salud de Bogotá, el Ministerio de Protección Social y la Superintendencia Nacional de Salud a 14 ARS y 22 Empresas Sociales del Estado, en eventos POSS y no POSS en el periodo anteriormente descrito. Para la recolección de los datos, se aplicó un formato que permitió la medición de variables, las cuales fueron de tipo nominal, intervalo y razón; además, se utilizó el programa estadístico epiinfo 2000 para el análisis. Resultados De 166 quejas interpuestas en los entes de control, el 89,90% fueron en la Secretaría Distrital de Salud. De lo anterior, el 28% de las quejas fueron en los servicios de endocrinología, obstetricia, odontología, ortopedia, hospitalización, rehabilitación, cardiología y urgencias, seguido de entrega de medicamentos por farmacia el 24% y el 18% en el servicio de consulta externa. De las quejas, el 39% fueron por personas que padecían patologías de tipo neurológico, hematológico y dermatológico, seguido de cáncer en un 15% y traumatología en un 7%. Del total de quejas, el 62% de las atenciones solicitadas por los usuarios del Régimen Subsidiado se encuentran contenidas en el POS-S (4), en los grupos etáreos entre 15-44 años y 45-60 años. El mayor número de quejas provienen de las localidades Tunjuelito, Bosa y Ciudad Bolívar. Se observa aumento de las quejas en el primer semestre de 2002 en comparación con el segundo semestre de 2001. Del tipo de queja interpuesta por lo usuarios del Régimen Subsidiado, se observó que el 42% era por la negación del servicio, seguida por la demora en la prestación del servicio en un 25%, la falta de claridad en la interpretación de la norma y desconocimiento por parte de los usuarios en un 12,65% y, por último, la limitación del contenido del POSS en un 7,23%. En cuanto a las atenciones contenidas en el POSS, el 63% de las quejas eran por servicios y patologías que están contempladas en el Acuerdo 72/97 y el 37% de las quejas restantes eran por atenciones no contenidas en el POSS. Conclusiones Con base en el análisis de resultados y las observaciones plasmadas en el instrumento de recolección de datos de la investigación, se concluyeron los siguientes aspectos: 1. Los usuarios no saben tramitar la queja. 2. Delimitación imprecisa de funciones en los organismos de vigilancia y control. 3. Incumplimiento del POSS por las Administradoras del Régimen Subsidiado. 4. Falta de claridad y desconocimiento de la norma en las Empresas Sociales del Estado. 5. Discontinuidad en la ¡ntegralidad del Plan Obligatorio de Salud Subsidiado.


Introduction The former National Health System met the needs of part of the Colombian population by means of supply subsidies (1). Currently, the population is guaranteed the right to health (2) through the contributory and subsidized systems, transferring the resources from the supply subsidy to the demand subsidy, subject to the principles of efficiency, universality and solidarity. It is for this reason that this study aims to determine quantitatively and qualitatively the types of complaints in the provision of services to members of the subsidized health system, included in the Mandatory Subsidized Health Plan, the management of events not covered by the ARS and that occur regularly in the affiliated population; the above facts have led to evaluate the current insurance program of the subsidized system and to propose adjustment mechanisms that have an impact on the benefit of the poor and vulnerable population (3). The results of the same serve as a reference for the actors that make up the system, in order to provide better attention to the users who require the services contemplated by law. General objective To determine the types of complaints filed by users of the subsidized system in Bogotá, related to the Obligatory Subsidized Health Plan and events not contemplated in the Obligatory Subsidized Health Plan, during the second semester of 2001 and first semester of 2002, filed with the District Health Secretariat, the National Health Superintendence and the Ministry of Social Protection, in order to have an approximation of how the service is being provided and to propose solution strategies. Method A descriptive study was carried out on the affiliates of the subsidized regime in Bogotá who filed complaints in the second semester of 2001 and the first semester of 2002 with the District Health Secretariat of Bogotá, the Ministry of Social Protection and the National Superintendence of Health to 14 ARS and 22 State Social Enterprises, in POSS and non POSS events in the period described above. For data collection, a format was applied that allowed the measurement of variables, which were nominal, interval and ratio; in addition, the statistical program epiinfo 2000 was used for the analysis. Results Of 166 complaints filed with the control entities, 89.90% were filed with the District Health Secretariat. Of the above, 28% of the complaints were in endocrinology, obstetrics, dentistry, orthopedics, hospitalization, rehabilitation, cardiology and emergency services, followed by 24% in the delivery of medicines by the pharmacy and 18% in the outpatient service. Of the complaints, 39% were for people suffering from neurological, hematological and dermatological pathologies, followed by cancer (15%) and traumatology (7%). Of the total number of complaints, 62% of the care requested by users of the Subsidized Regime is contained in the POS-S (4), in the age groups between 15-44 years and 45-60 years. The greatest number of complaints come from the Tunjuelito, Bosa and Ciudad Bolivar localities. There was an increase in the number of complaints in the first half of 2002 compared to the second half of 2001. Of the type of complaints filed by users of the Subsidized Regime, 42% were for denial of service, followed by 25% for delays in the provision of service, 12.65% for lack of clarity in the interpretation of the regulations and lack of knowledge on the part of the users, and 7.23% for the limitation of the content of the POSS. As for the services contained in the POSS, 63% of the complaints were for services and pathologies covered by Agreement 72/97 and 37% of the remaining complaints were for services not contained in the POSS. Conclusions Based on the analysis of results and the observations reflected in the research data collection instrument, the following aspects were concluded: 1. The users do not know how to process the complaint. 2. Imprecise delimitation of functions in the surveillance and control agencies. 3. Non-compliance with the POSS by the Administrators of the Subsidized Regime. 4. Lack of clarity and lack of knowledge of the norm in the State Social Enterprises. 5. Discontinuity in the completeness of the Mandatory Subsidized Health Plan.


Assuntos
Humanos , Masculino , Feminino , Atenção à Saúde , Populações Vulneráveis , Serviços de Saúde , Previdência Social , Sistemas Nacionais de Saúde , Necessidades e Demandas de Serviços de Saúde , Alocação de Recursos , Direito à Saúde , Direitos Humanos
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