ABSTRACT
Objetiva-se apresentar os relatos de mães de crianças com dermatose crônica e discuti-los de acordo com a perspectiva da Análise do Comportamento. Trinta e duas mães de crianças de 6 a 12 anos de idade com dermatose crônica responderam a um roteiro de entrevista. As mães descreveram as crianças como ansiosas, isoladas socialmente, com queixas somáticas, irritabilidade e com dificuldades de adesão ao tratamento. Houve relato de sentimentos de culpa, desamparo e preocupações relacionadas à doença, e cansaço, por não conseguirem fazer com que a criança seguisse o tratamento. A análise comportamental dos relatos, conduzida por meio da descrição de contingências e da formulação de hipóteses funcionais, permitiu identificar situações ou condições aversivas (reação ao diagnóstico, identificação de fatores responsáveis pelo aparecimento e/ou piora dos sintomas, adesão ao tratamento e preconceito) nas quais estes sentimentos foram relatados e suas consequências para as mães e as crianças...
The study aimed analyzes according to Behavior Analysis view the maternal report about their children' behavior with chronic skin disease. Thirty two mothers of children between 6 and 12 years old with chronic skin diseases were interviewed. Mothers described their children as anxious, socially isolated, showing somatic complains, irritability, easily staying bore and hurt, and difficulty to follow medical treatment. Mothers reported guilt, hopelessness and concerns about their children condition, and tiredness by not being able to manage children' compliance behavior to the treatment. Behavioral analysis of the reports, conducted by describing contingencies and by formulating functional hypotheses, identified situations or aversive conditions (reaction to the diagnosis, identification of factors responsible for the onset and/or worsening symptoms, treatment adherence and prejudice) in which these feelings were reported and its consequences for mothers and their children...
Subject(s)
Humans , Child , Mothers , Skin DiseasesABSTRACT
Background: Methotrexate has been widely used as an effective systemic therapy for psoriasis. Retrospective data showed efficacy rate of 70-80% but recent RCTs using PASI 75 as primary endpoint showed wide variations in efficacy. Different dosing regimens for methotrexate may explain this variation. Objectives: To compare the efficacy and tolerability of two different dosing regimes of oral methotrexate in patients with moderate to severe plaque psoriasis. Methods: A prospective comparative study was conducted from October 2009 to June 2010. Patients with moderate-to-severe plaque psoriasis were randomized to receive either a ‘step-up dose’ regime (starting dose 7.5mg) or a ‘step-down dose’ regime (starting dose 20mg) of oral methotrexate for 16 weeks. The primary efficacy endpoint was PASI 75. Tolerability and safety were assessed. Results: Forty patients received oral methotrexate with equal numbers in each arm. After 16-week, 55% (11) of patients in ‘step-up dose’ group and 65% (13) of patients in ‘step-down dose’ group achieved PASI 75 (p > 0.05). Significantly higher number of patients in ‘step-down dose’ group achieved PASI 75 at week 4 and week 8 (p < 0.05) compared to ‘step-up dose’ group. One patients from ‘step-down dose’ group discontinued study prematurely due to adverse effect but no significant difference in rate of adverse events was noted. Conclusion: There was no significant difference in efficacy between both regimes at the end of 16 weeks but significant efficacy was observed in patients on ‘step-down dose’ regime as early as week 4. The side effect profile and tolerability were similar.