RESUMO
OBJECTIVE: Studies have been conducted to determine the causal factors and clinical consequences of non-adherence to treatment in systemic lupus erythematosus (SLE). However, no interventions have been performed to increase drug adherence. Our objective was to assess the effectiveness of pharmaceutical care (PC) for drug treatment adherence in lupus nephritis (LN). METHODS: This was a randomized clinical trial (pragmatic trial) in patients with LN in Rio de Janeiro, Brazil, allocated in two groups: an intervention group (Dader Method for PC) and a control group (institution's usual care). Drug treatment adherence was measured by the combination of five questions normally used in clinical practice. RESULTS: A total of 131 patients were randomized, and 122 completed the study, with a mean follow-up of 12.7 months and use of six drugs per day and 10-12 doses per day. Low adherence was observed at baseline (intervention group: 30%; control group: 29%). PC showed 27% effectiveness (95% confidence interval (CI) -6% to 50%) in the intention to treat analysis and 31% (95% CI 0-52%) in per protocol analysis, considering all drugs. As for adherence to specific drugs for SLE, effectiveness of PC was 64% (95% CI 34-80%) with intention-to-treat analysis and 62% (95% CI 32-79%) in per protocol analysis. CONCLUSIONS: PC was effective for increasing drug treatment adherence in SLE. The detailed account provided by the Dader Method of the difficulties with patients' drug therapy proved invaluable to approach non-adherence.
Assuntos
Nefrite Lúpica/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Assistência Farmacêutica/organização & administração , Adulto , Brasil , Feminino , Seguimentos , Humanos , Análise de Intenção de Tratamento , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
In this study we investigated: (a) the effects of intracerebroventricular (i.c.v.) injections of moxonidine (an alpha2-adrenergic and imidazoline receptor agonist) on the ingestion of water and NaCl induced by 24 h of water deprivation; (b) the effects of i.c.v. injection of moxonidine on central angiotensin II (ANG II)- and carbachol-induced water intake; (c) the effects of the pre-treatment with i.c.v. idazoxan (an alpha2-adrenergic and imidazoline receptor antagonist) and RX 821002 (a selective alpha2-adrenergic antagonist) on the antidipsogenic action of central moxonidine. Male Holtzman rats had stainless steel cannulas implanted in the lateral cerebral ventricle. Intracerebroventricular injection of moxonidine (5 and 20 nmol/1 microl) reduced the ingestion of 1.5% NaCl solution (4.1 +/- 1.1 and 2.9 +/- 2.5 ml/2 h, respectively vs. control = 7.4 +/- 2.1 ml/2 h) and water intake (2.0 +/- 0.6 and 0.3 +/- 0.2 ml/h, respectively vs. control = 13.0 +/- 1.4 ml/h) induced by water deprivation. Intracerebroventricular moxonidine (5 nmol/1 microl) also reduced i.c.v. ANG II-induced water intake (2.8 +/- 0.9 vs. control = 7.9 +/- 1.7 ml/1 h) and i.c.v. moxonidine (10 and 20 nmol/1 microl) reduced i.c.v. carbachol-induced water intake (4.3 +/- 1.7 and 2.1 +/- 0.9, respectively vs. control = 9.2 +/- 1.0 ml/1 h). The pre-treatment with i.c.v. idazoxan (40 to 320 nmol/1 microl) abolished the inhibitory effect of i.c.v. moxonidine on carbachol-induced water intake. Intracerebroventricular idazoxan (320 nmol/1 microl) partially reduced the inhibitory effect of moxonidine on water deprivation-induced water intake and produced only a tendency to reduce the antidipsogenic effect of moxonidine on ANG II-induced water intake. RX 821002 (80 and 160 nmol/1 microl) completely abolished the antidipsogenic action of moxonidine on ANG II-induced water intake. The results show that central injections of moxonidine strongly inhibit water and NaCl ingestion. They also suggest the involvement of central alpha2-adrenergic receptors in the antidipsogenic action of moxonidine.
Assuntos
Anti-Hipertensivos/administração & dosagem , Ingestão de Líquidos/efeitos dos fármacos , Imidazóis/administração & dosagem , Cloreto de Sódio na Dieta/administração & dosagem , Antagonistas Adrenérgicos alfa/administração & dosagem , Antagonistas Adrenérgicos alfa/farmacologia , Angiotensina II/farmacologia , Animais , Anti-Hipertensivos/farmacologia , Carbacol/administração & dosagem , Carbacol/farmacologia , Agonistas Colinérgicos/administração & dosagem , Agonistas Colinérgicos/farmacologia , Idazoxano/administração & dosagem , Idazoxano/análogos & derivados , Idazoxano/farmacologia , Imidazóis/farmacologia , Injeções Intraventriculares , Masculino , Ratos , Ratos Sprague-Dawley , Fatores de Tempo , Vasoconstritores/farmacologiaRESUMO
The escalating role played by managed care organizations in the health-care system is reflected in the increased demand for cost-effectiveness analyses (CEAs) to assess the balance between economic impact and clinical efficacy. For example, the high incidence and costs associated with colorectal cancer in Latin America calls for a comprehensive economic evaluation to ensure appropriate allocation of limited health-care funds. In addition, the current call for a "societal" perspective of such analyses indicates the need for increased consideration of the concerns of both patient and health-care provider. The introduction of oral tegafur and uracil (UFT) provided the opportunity to evaluate the pharmacoeconomic advantage of the new agent compared with the standard fluorouracil (5-FU). Results of this study indicated an economic advantage for oral UFT vs a 5-FU-based regimen in the treatment of colorectal cancer in Brazil and Argentina. It was further noted that the mild toxicity profile of UFT reduced both the number of clinic visits and the need for venipuncture procedures. Noting that oral UFT may have a positive impact on quality of life in addition to its estimated economic benefit, it was concluded that prospective economic research and quality-of-life evaluations are needed to fully assess the pharmacoeconomic impact of oral UFT.
Assuntos
Neoplasias Colorretais/economia , Tegafur/economia , Uracila/economia , Argentina , Brasil , Quimioterapia Adjuvante/economia , Neoplasias Colorretais/tratamento farmacológico , Custos e Análise de Custo , Combinação de Medicamentos , Custos de Medicamentos , Fluoruracila/administração & dosagem , Fluoruracila/economia , Humanos , Método de Monte Carlo , América do Sul , Tegafur/uso terapêutico , Uracila/uso terapêuticoRESUMO
The Program for S. mansoni Control (PCE) has been developed in some areas of the State of Bahia by the Fundação Nacional de Saúde (FNS). In 1989, activities on Information, Education, Communication and Community Mobilization (IEC/MC) were initiated. This study evaluates the epidemiological impact of the IEC/MC, using a quasi-experimental study design strategy, comparing the prevalences of infection for S. mansoni in areas of IEC/MC and estimates of other areas. The data used were routinely collected by the local staff of the FNS. A decrease on the prevalence of S. mansoni infection was found in all study areas, specially in those of IEC/MC activities. Findings indicate that PCE activities are more effective among school-age individuals and male adults, although IEC/MC allows for higher epidemiological impact among women, reflecting the differences among the strategies. These findings point out the need for qualitative evaluation research, as well as cost benefit and cost effectiveness analyses, that are more appropriate for decision making processes.
Assuntos
Comunicação , Educação em Saúde , Avaliação de Programas e Projetos de Saúde , Esquistossomose mansoni/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Criança , Fezes/parasitologia , Feminino , Humanos , Masculino , Contagem de Ovos de Parasitas/estatística & dados numéricos , Prevalência , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/parasitologia , Distribuição por Sexo , População Urbana/estatística & dados numéricosRESUMO
An in vitro study was conducted to examine the influence of the number of remaining cusps and the use of the amalgapin technique on the tensile resistance of complete cast crowns in posterior teeth. Results showed the number of amalgapins and remaining cusps to have no influence on the tensile strength. Failure occurred predominantly at the cemented area (ie, the crown was dislodged from the core).