This Thesis examines the benefits and usefulness of a National Drug Policy (NDP) for the developing of the Health Care System in Kuwait. The NDP is one of the most important structures of the Health System which can lead to improved health services by establishing guidelines, proposals and directives to organize, structure and regulate health legislation; it is of help to ensure the availability of quality, safety and efficacy in using medicines and it can reduce the irrational use of medicines. The NDP is a frame work between the government, schools and universities, media, health professionals, pharmaceutical industries and companies and public. It is cooperation between the public and private sectors to achieve the goal of access to good quality medicines for all. However there are many key factors which need to be examined before the National Drug Policy is introduced and these are considered the baseline for establishing a good policy, and includes; selection of essential drugs, affordability of drugs, drug financing, supply management, drug regulation, rational use of drugs, drugs registration, purchasing of drugs, health research and human resource development. During this research study from 2012 – 2015 several visits to the public and private health areas, were undertaken. At this time there were discussions with 121 health professionals and data was collected and this indicated that in Kuwait there are no such policies. This is despite the availability of financial means, specialized human resources and the existence of the ministerial decisions and regulations governing the health sector in both public and private, whether hospitals, health centers, pharmacies and health departments. In addition it is suggested that the process of a good NDP should be built around 3 main components which includes: 1.Development, 2. Implementation and 3. Monitoring and Evaluation. Therefore the establishing of a NDP without implementation and monitoring is not enough and does not achieve the desired results. The aim of this Thesis is to establish a NDP in the State of Kuwait. This policy is necessary for the State of Kuwait to ensure development an improvement of the Health Care System and ensure better health for population.

As doenças inflamatórias intestinais (DII) - doença de Crohn e retocolite ulcerativa, são condições crônicas que, na maioria dos casos, exigem controle com terapia medicamentosa. A atenção farmacêutica (AF), definida como a provisão responsável do tratamento farmacológico, com o propósito de alcançar resultados concretos que melhorem a qualidade de vida do paciente, constitui nova forma de cuidado ao paciente, que necessita ser mais extensivamente avaliada. Este estudo teve o objetivo de avaliar a contribuição da atenção farmacêutica ao tratamento clínico de pacientes com DII em acompanhamento ambulatorial em hospital terciário. Ao longo de um ano, foi avaliado um grupo que recebeu a atenção farmacêutica (GAF; N=18) e um grupo controle (GC; N=17) não submetido aos procedimentos da AF. Os resultados da contribuição da AF foram avaliados pela comparação de diferentes variáveis entre os grupos, que foram obtidas na primeira entrevista - T(0), aos seis - T(6) e 12 - T(12) meses do estudo. Quanto aos aspectos clínicos, houve redução significativa dos índices de atividade clínica de T(6) para T(12) no GAF (mediana; variação: 2,20; 0,99 3,77 versus 1,90; 0,99 3,77; p=0,02), o que não ocorreu no GC (1,69; 0,99 3,77 versus 1,69; 0,99 3,48). No GAF, houve aumento significativo do percentual de pacientes mais aderentes ao tratamento medicamentoso (27,8% versus 72,2%; p<0,05), quando da avaliação por meio do teste de Morisky, mas não foram observadas diferenças (72,2% versus 88,9%) na adesão avaliada pelo cotejo entre medicamentos utilizados e prescrições registradas. Em ambas as formas de avaliação da adesão, tanto pelo teste de Morisky (41,2% versus 41,2%), quanto pelo confronto das medicações utilizadas e prescrições registradas (88,2% versus 82,4%), não foram observadas alterações no GC. Houve aumento significativo dos índices de conhecimento do paciente sobre o tratamento no GAF entre T(0) e T(12) (mediana; variação: 80%; 40% 100% versus 100%; 100% 100%; p0,0001), o que não ocorreu no GC (80%; 0 100% versus 80%; 60% 100%). No que se refere à qualidade de vida, avaliada pelo instrumento SF36, houve diferenças estatisticamente significativas nos dois grupos apenas no domínio de saúde mental. No GAF, houve elevação dos escores deste domínio entre T(0) e T(12) (54,0 versus 66,0; p=0,04), o que, também ocorreu no GC (60,0 versus 68,0; p=0,01). Porém, no GAF, esta mudança ocorreu mais precocemente, de T(0) para T(6) (54,0 versus 66,0; p<0,01). A AF possibilitou a identificação, em média, de 3,8 problemas relacionados ao medicamento por paciente, que em sua maioria foram resolvidos, com intervenções predominantemente focadas em orientações aos pacientes. Os pacientes do GAF, ao término do estudo, apresentaram alto grau de satisfação com a AF. Os resultados obtidos permitem concluir que a introdução de um programa de atenção farmacêutica a pacientes ambulatoriais com DII seguidos em hospital terciário trouxe contribuição positiva, proporcionando benefícios mensuráveis aos pacientes. / Inflammatory bowel diseases (IBD) Crohns disease and ulcerative colitis are chronic conditions which are usually controlled with drug therapy. Pharmaceutical care (PC), defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve patients quality of life, is a new patient care modality, which needs to be more extensively evaluated. This study aimed at assessing the contribution of pharmaceutical care to the clinical treatment of outpatients with IBD assisted at a reference hospital. During one year, a group receiving pharmaceutical care (PCG; N=18) and a control group (CG; N=17), which did not undergo PC procedures, were evaluated. Results of PC contribution were assessed by comparing the two groups regarding different variables obtained in the first interview at - T(0), at six - T(6) and 12 - T(12) months of study. Regarding the clinical aspects, there was a significant decrease of clinical activity indexes from T(6) to T(12) in the PCG (median; range: 2.20; 0.99 3.77 versus 1.90; 0.99 3.77; p=0.22), but not in the CG (1.69; 0.99 3.77 versus 1.69; 0.99 3.48). In the PCG, there was a significant increase in the percentage of patients who were more compliant to drug treatment (27.8 % versus 72.2 %; p<0.05) as assessed using the Morisky scale; however, no differences in compliance rates were observed (72.2 % versus 88.9 %) by comparing drugs taken with registered prescriptions. In the CG, no differences were observed in none of the compliance assessment methods, neither by the Morisky scale (41.2% versus 41.2%), nor by comparing drugs taken with registered prescriptions (88.2% versus 81.2%). There was a significant increase in the values of an index for patients knowledge about the treatment in the PCG between T(0) and T(12) (median; range: 80%; 40 100 versus 100%; 100 100; p0,0001), but not in the CG (80%; 0 100 versus 80%; 60 100). With respect to quality of life, assessed by the SF36 scale, there were statistically significant differences in both groups only in the mental health domain. There was an increase in scores for this domain between T(0) and T(12) in both PCG (54.0 versus 66.0; p=0,04), and CG (60.0 versus 68.0; p=0,01). However, PCG had this increasing scores earlier, between T(0) and T(12) (54.0 versus 74.0; p<0,01). PC enabled the identification of a number of drug-related problems per patient (mean = 3.8), which were mostly solved by interventions predominantly focused on patient orientation. At the end of the study, patients in the PC group showed a high degree of satisfaction with the intervention. The achieved results allow concluding that the implementation of a pharmaceutical care program to outpatients with IBD followed at a tertiary hospital gave a positive contribution, providing measurable benefits to patients.

Made available in DSpace on 2016-04-29T13:31:39Z (GMT). No. of bitstreams: 1 Cynara Teixeira Ribeiro.pdf: 506090 bytes, checksum: 6ff8a6ad1dc7e8fe80293fd77d650b3c (MD5) Previous issue date: 2008-03-28 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Universal and millenary is the human practice of consuming drugs. To understand the reasons of the fascination effect incited for these drugs in the human beings, a lot of learnings go in for studying their utilization. Among them, the psychoanalysis differentiates from the others for accosting the use of drugs as a possible answer of the fellow to unwell-being extant in the civilization. According to this perspective, the highest visibility of this use in the contemporariness is related to the advent of science and the profusion of the liberal ideology, which inaugurate a new way of that Lacan named of address: the address of capitalist characterizes for representing the imperative of an enjoyment self-centered, in opposition the establishment of the social links. In a sense, taking this form of address as guidance for acting at the present time, aims at going into how this way associates to the alarming use of drugs at contemporariness. However, furthermore, we also ask: how this address occurs on each single fellow and that influence has on the form as each one is related with the drugs? In this sense, which delimitate the difference between the morbid condition that has amply been named of drug addictions and the practice of simple use of drugs? To think suchlike questions, they will be analyzed two interviews with fellows that used drugs, interrogating if such uses may to shape according to what assign of drug addicts . With the results of this research, it aim at offering improvement in the treatment both of drug addicts and other users of drugs, as well as, making breakthrough in the psychoanalysis while field of knowing / Universal e milenar é a prática humana de consumir drogas. Tentando desvendar as razões do efeito de fascinação provocado por essas substâncias nos seres humanos, muitos saberes se dedicam a estudar a sua utilização. Dentre esses, a psicanálise se diferencia por abordar o uso de drogas como uma resposta possível do sujeito ao mal-estar existente na civilização. De acordo com tal perspectiva, a maior visibilidade desse uso na contemporaneidade está relacionada ao advento da ciência e à profusão da ideologia liberal, as quais inauguraram uma nova modalidade daquilo que Lacan denominou de discurso: o discurso do capitalista, que se caracteriza por representar o imperativo de um gozo auto-centrado, em contraposição ao estabelecimento dos laços sociais. Nesse sentido, tomando essa modalidade de discurso como orientadora do agir na atualidade, se pretende investigar como esta se relaciona ao alarmante uso de drogas na contemporaneidade. Porém, para mais além disso, nos perguntamos também: como esse discurso incide sobre cada sujeito singular e que influência tem sobre a forma como cada um se relaciona com as drogas? E, nesse sentido, o quê delimita a diferença entre a condição mórbida que tem sido largamente denominada de toxicomanias e a prática que se configura como o simples uso de drogas? Para pensar tais questões, serão analisadas duas entrevistas com sujeitos que fizeram uso de drogas, questionando se tais usos podem chegar a configurá-los como o que se designa de toxicômanos . Pretende-se que os achados proporcionados por essa pesquisa venham a propiciar uma melhoria no tratamento tanto dos chamados toxicômanos quanto dos demais usuários de drogas, bem como possam fazer avançar a psicanálise enquanto campo de saber

As doenças inflamatórias intestinais (DII) - doença de Crohn e retocolite ulcerativa, são condições crônicas que, na maioria dos casos, exigem controle com terapia medicamentosa. A atenção farmacêutica (AF), definida como a provisão responsável do tratamento farmacológico, com o propósito de alcançar resultados concretos que melhorem a qualidade de vida do paciente, constitui nova forma de cuidado ao paciente, que necessita ser mais extensivamente avaliada. Este estudo teve o objetivo de avaliar a contribuição da atenção farmacêutica ao tratamento clínico de pacientes com DII em acompanhamento ambulatorial em hospital terciário. Ao longo de um ano, foi avaliado um grupo que recebeu a atenção farmacêutica (GAF; N=18) e um grupo controle (GC; N=17) não submetido aos procedimentos da AF. Os resultados da contribuição da AF foram avaliados pela comparação de diferentes variáveis entre os grupos, que foram obtidas na primeira entrevista - T(0), aos seis - T(6) e 12 - T(12) meses do estudo. Quanto aos aspectos clínicos, houve redução significativa dos índices de atividade clínica de T(6) para T(12) no GAF (mediana; variação: 2,20; 0,99 3,77 versus 1,90; 0,99 3,77; p=0,02), o que não ocorreu no GC (1,69; 0,99 3,77 versus 1,69; 0,99 3,48). No GAF, houve aumento significativo do percentual de pacientes mais aderentes ao tratamento medicamentoso (27,8% versus 72,2%; p<0,05), quando da avaliação por meio do teste de Morisky, mas não foram observadas diferenças (72,2% versus 88,9%) na adesão avaliada pelo cotejo entre medicamentos utilizados e prescrições registradas. Em ambas as formas de avaliação da adesão, tanto pelo teste de Morisky (41,2% versus 41,2%), quanto pelo confronto das medicações utilizadas e prescrições registradas (88,2% versus 82,4%), não foram observadas alterações no GC. Houve aumento significativo dos índices de conhecimento do paciente sobre o tratamento no GAF entre T(0) e T(12) (mediana; variação: 80%; 40% 100% versus 100%; 100% 100%; p0,0001), o que não ocorreu no GC (80%; 0 100% versus 80%; 60% 100%). No que se refere à qualidade de vida, avaliada pelo instrumento SF36, houve diferenças estatisticamente significativas nos dois grupos apenas no domínio de saúde mental. No GAF, houve elevação dos escores deste domínio entre T(0) e T(12) (54,0 versus 66,0; p=0,04), o que, também ocorreu no GC (60,0 versus 68,0; p=0,01). Porém, no GAF, esta mudança ocorreu mais precocemente, de T(0) para T(6) (54,0 versus 66,0; p<0,01). A AF possibilitou a identificação, em média, de 3,8 problemas relacionados ao medicamento por paciente, que em sua maioria foram resolvidos, com intervenções predominantemente focadas em orientações aos pacientes. Os pacientes do GAF, ao término do estudo, apresentaram alto grau de satisfação com a AF. Os resultados obtidos permitem concluir que a introdução de um programa de atenção farmacêutica a pacientes ambulatoriais com DII seguidos em hospital terciário trouxe contribuição positiva, proporcionando benefícios mensuráveis aos pacientes. / Inflammatory bowel diseases (IBD) Crohns disease and ulcerative colitis are chronic conditions which are usually controlled with drug therapy. Pharmaceutical care (PC), defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve patients quality of life, is a new patient care modality, which needs to be more extensively evaluated. This study aimed at assessing the contribution of pharmaceutical care to the clinical treatment of outpatients with IBD assisted at a reference hospital. During one year, a group receiving pharmaceutical care (PCG; N=18) and a control group (CG; N=17), which did not undergo PC procedures, were evaluated. Results of PC contribution were assessed by comparing the two groups regarding different variables obtained in the first interview at - T(0), at six - T(6) and 12 - T(12) months of study. Regarding the clinical aspects, there was a significant decrease of clinical activity indexes from T(6) to T(12) in the PCG (median; range: 2.20; 0.99 3.77 versus 1.90; 0.99 3.77; p=0.22), but not in the CG (1.69; 0.99 3.77 versus 1.69; 0.99 3.48). In the PCG, there was a significant increase in the percentage of patients who were more compliant to drug treatment (27.8 % versus 72.2 %; p<0.05) as assessed using the Morisky scale; however, no differences in compliance rates were observed (72.2 % versus 88.9 %) by comparing drugs taken with registered prescriptions. In the CG, no differences were observed in none of the compliance assessment methods, neither by the Morisky scale (41.2% versus 41.2%), nor by comparing drugs taken with registered prescriptions (88.2% versus 81.2%). There was a significant increase in the values of an index for patients knowledge about the treatment in the PCG between T(0) and T(12) (median; range: 80%; 40 100 versus 100%; 100 100; p0,0001), but not in the CG (80%; 0 100 versus 80%; 60 100). With respect to quality of life, assessed by the SF36 scale, there were statistically significant differences in both groups only in the mental health domain. There was an increase in scores for this domain between T(0) and T(12) in both PCG (54.0 versus 66.0; p=0,04), and CG (60.0 versus 68.0; p=0,01). However, PCG had this increasing scores earlier, between T(0) and T(12) (54.0 versus 74.0; p<0,01). PC enabled the identification of a number of drug-related problems per patient (mean = 3.8), which were mostly solved by interventions predominantly focused on patient orientation. At the end of the study, patients in the PC group showed a high degree of satisfaction with the intervention. The achieved results allow concluding that the implementation of a pharmaceutical care program to outpatients with IBD followed at a tertiary hospital gave a positive contribution, providing measurable benefits to patients.

A proposição de uma ação em perspectiva de fé frente à prevenção ao uso indevido de drogas na adolescência e a importância do envolvimento da Igreja Cristã em prol de ações sociais enquanto rede social e espaço de grande influência nas famílias. O estudo se utiliza de pesquisa bibliográfica teórica, a partir da qual se estabeleceu um diálogo com base nos dados do VI Levantamento Nacional Sobre o Consumo de Drogas Psicotrópicas entre Estudantes do Ensino Fundamental e Médio das Redes Pública e Privada de Ensino nas 27 Capitais Brasileiras, de 2010. Posteriormente, analisa os dados da cidade de Campo Grande/MS, do respectivo estudo, o qual ressaltou que é na adolescência que acontece o primeiro uso de drogas. Nessa primeira parte, apresentam-se alguns conceitos acerca da adolescência enquanto uma fase de descobertas e de mudanças físicas e emocionais, indicando quais são os tipos de drogas existentes, bem como as que estão na preferência dessa faixa etária. Na segunda parte, o estudo pontua o papel do Estado e da sociedade civil, o papel da família e o da igreja enquanto parte da rede social e suas respectivas responsabilidades frente à prevenção ao uso indevido de drogas na adolescência. A terceira e última parte traz um diálogo, ainda, sobre o papel da igreja em uma perspectiva de fé e amor enfatizando ações de Jesus e, consequentemente, uma proposta de ação social para realização nas Igrejas Cristãs. No decorrer dessa produção, estabeleceu-se uma troca com legislações, autores de psicologia, serviço social e teologia. / This is a proposition for an action from a faith perspective in relation to the prevention of the improper use of drugs during adolescence and to the importance of the involvement of the Christian church in favor of social actions as a social network and a space of great influence in the families. The study works with theoretical bibliographical research, from which a dialog was established based on the data from the VI National Survey About the Consumption of Psychotropic Drugs among Students of Grade School and Middle Education of the Public and Private Teaching Networks in the 27 Brazilian Capitals of 2010. Following this it analyzes the data of the city of Campo Grande/MS, from the above mentioned study, which highlighted that it is in adolescence where the first use of drugs occurs. In this first part, some concepts about adolescence as a phase of discovery and physical and emotional changes are presented, indicating what are the types of drugs in existence, as well as which ones are preferred during this age bracket. In the second part, the study points to the role of the State and of civil society, the role of the family and of the church as part of the social network and their respective responsibilities with regard to the prevention of improper use of drugs in adolescence. The third and last part brings, yet, a dialog about the role of the church in a faith and love perspective emphasizing the actions of Jesus and, consequently, a proposal for social action to be carried out in the Christian churches. During the production of this paper, an exchange was established with legislations, psychology authors, social services and theology.

There is a perception that drug use is a serious and growing problem to be solved by medicine, social work and drug enforcement agencies. This thesis takes a critical standpoint again such populist views and interprets drug use as one of any number of normal activities that people engage. This qualitative research utilising a bricoleur ethnographic methodology focuses on the drug taking of non-treatment seeking illegal drug users. The data reveals that they manage several social identities and the potential stigma of being discovered as an illicit user of illegal drugs utilising several strategies to remain intentionally unseen. The thesis explores how and in what way socially competent drug users differ from visible treatment seeking drug users. In order to develop this understanding, several gatekeepers were identified and within their social networks the participants were recruited into this research. The participants (n=24) were recruited from a wide range of age groups (21-52) and geographical locations within Scotland. One to one interviews, a focus group, and several pair bonded partners were interviewed together providing rich sources of data. Interviews were transcribed and analysed thematically from a social constructionist perspective. The findings illuminate the ways in which the intentionally unseen identify and manage risks from drugs, drugs policy and the potential shame and stigma were their hidden social worlds revealed. The practical implications of the results of this thesis are explored and recommendations for future research are discussed.