Adverse drug reactions associated with treatment in patients with chronic rheumatic diseases in childhood: a retrospective real life review of a single center cohort

Abstract Background: Adverse drug reactions (ADRs) are the sixth leading causes of death worldwide; monitoring them is fundamental, especially in patients with disorders like chronic rheumatic diseases (CRDs). The study aimed to describe the ADRs investigating their severity and associated factors and resulting interventions in pediatric patients with CRDs. Methods: A retrospective, descriptive and analytical study was conducted on a cohort of children and adolescents with juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). The study evaluated medical records of the patients to determine the causality and the management of ADRs. In order to investigate the risk factors that would increase the risk of ADRs, a logistic regression model was carried out on a group of patients treated with the main used drug. Results: We observed 949 ADRs in 547 patients studied. Methotrexate (MTX) was the most frequently used medication and also the cause of the most ADRs, which occurred in 63.3% of patients, followed by glucocorticoids (GCs). Comparing synthetic disease-modifying anti-rheumatic drugs (sDMARDs) vs biologic disease-modifying antirheumatic drugs (bDMARDs), the ADRs attributed to the former were by far higher than the latter. In general, the severity of ADRs was moderate and manageable. Drug withdrawal occurred in almost a quarter of the cases. In terms of risk factors, most patients who experienced ADRs due to MTX, were 16 years old or younger and received MTX in doses equal or higher than 0.6 mg/kg/week. Patients with JIA and JDM had a lower risk of ADRs than patients with JSLE. In the multiple regression model, the use of GCs for over 6 months led to an increase of 0.5% in the number of ADRs. Conclusions: Although the ADRs highly likely affect a wide range of children and adolescents with CRDs they were considered moderate and manageable cases mostly. However, triggers of ADRs need further investigations.(AU)

Núcleo de apoio à saúde da família: refletindo sobre as acepções emergentes da prática / Support centers for family health: reflecting about practice emerging meanings

Objetivo: Analisar as práticas profissionais das equipes dos Núcleos de Apoio à Saúde da Família (NASF) dos municípios de Campina Grande e João Pessoa, em consonância com osmodelos de apoio matricial identificados. Metodologia:Realizou-se observação não-participante junto aos profissionais do NASF de Campina Grande e João Pessoa, em um total de480 horas, em que puderam ser observadas capacitações promovidas pela Secretaria Estadual de Saúde e Ministério da Saúde para as equipes NASF, reuniões entre equipe e gestores, além de atividades cotidianas das equipes. Foram realizadas também entrevistas semi-estruturadas com 36profissionais, coordenação geral do NASF e dois gerentes distritais. Resultados: Identificaram-se cinco acepções de apoio: o gerencial-administrativo, que busca solucionar problemas burocráticos das unidades de saúde e exercer funções burocráticas; o político-institucional que opera os direcionamentos políticos defendidos pela gestão na condução das ações de saúde; o técnico-pedagógico, que promove processos de educação permanente junto às equipes, comintuito de conferir maior resolubilidade aos problemas de saúde pertinentes; o técnico-assistencial que oferta atendimentos diretos aos usuários; e o político-comunitário que fortalece a organização política da comunidade. Conclusão: A assunção de uma ou mais concepções de apoio matricial por uma gestão não ocorre apenas por opção técnica, mas é influenciada por uma variedade de fatores políticos e econômicos que influenciam a adoção de um determinado modelo técnico assistencial em saúde.

Objective: To analyze the professional practices of teams of the Support Centers for Family Health (SCFH) in the municipalities of João Pessoa and Campina Grande, PB, Brazilin line with the supporting matrix models identified. Material and Methods: We conducted a non-participant observational study with the SCFH professionals from João Pessoa and Campina Grande, making a total of 480 hours, by which itcould be observed: the SCFH teams’ training promoted by theHealth State Department and Ministry of Health; meetingsbetween staff and managers, as well as daily activities of theteams. Semi-structured interviews were also conducted with36 professionals, SCFH general coordination and two district managers. Results: We identified five meanings of support:the managerial and administrative, seeking to resolvebureaucratic problems of health facilities and play bureaucraticroles; the political-institutional, which operates the politicaldirections advocated by managers in the conduction of healthactions; the technical-pedagogical, which promotes permanenteducation processes to the teams, in order to provide health problem-solving; the technical-supportive, of fering direct support to users; and the political-communitarian, whichstrengthens the political organization of the community. Conclusion: The assumption of one or more concepts of matrix support by managers is not only a technical option, but it isinfluenced by a range of political and economic issues reflecting the adoption of a given technical-supportive health model.

O NASF como dispositivo da gestão: limites e possibilidades / The FHSN as management device: limits and possibilities

Objetivo: O presente artigo tem como objetivo identificar em que medida o Núcleo de Apoio à Saúde da Família (NASF) faz operar determinados processos organizativos da rede local de saúde, funcionando, desta forma, como dispositivo de gestão. Material e Métodos: Este estudo consiste num recorte de uma ampla pesquisa de abordagem qualitativa sobre o NASF, desenvolvendo análise documental, 240 horas de observação participante e 39 entrevistas semi-estruturadas com gestores e profissionais do NASF de Campina Grande-PB. Resultados: A investigação evidenciou dois pontos de análise. O primeiro revela que os documentos ministeriais sobre a temática deixam margem para uma diversidade de interpretação sobre a organização dos NASF e seu papel na conformação de redes de saúde locais; e o segundo, aponta para uma disputa no contexto local sobre como operacionalizar o NASF, permitindo a co-existência de diferentes modelos. Conclusão: É possível esperar a conformação de diferentes NASF, segundo o direcionamento dado pelas gestões locais de saúde, o que tem impactos diretos na defesa por diferentes modelos de saúde em disputa no SUS.

Objective: This article aims to identify to what extent the Family Health Support Nucleus (FHSN) does operate certain organizational processes of local health-care system, functioning thus as a management device. Material and Methods: This study is part of a broader qualitative study on the FHSN. It is a documentary analysis and consisted of 240 hours of participant observation and 39 semi-structured interviews with managers and professionals of the FHSN of Campina Grande, PB. Results: This study showed two issues for analysis. The first point reveals that the ministerial documents on this topic leave room for a diversity of interpretation on the FHSN organization and its role in shaping local health networks. The second issue, points out to a dispute in the local context on how to operationalize the FHSN, allowing co-existence of different models. Conclusion: It is possible to expect different conformations of the FHSN, according to the direction given by the local health administrations, which has direct impacts on the defense by different health-care models in dispute in the Brazilian Unified Health System.