INTRODUCTION: Asthma is the most prevalent chronic disease in children, disproportionately affecting children from racial or ethnic minority groups and low-income families. Boston Medical Center’s Pediatric Primary Care Center serves these patient populations predominantly from the surrounding neighborhoods. It has been found that there are gaps in asthma care including diagnosing asthma in infants and young children, under-prescribing of preventive medication in all age groups, and variable management of children with poorly controlled asthma. In alignment with the accountable care organization model, health care professionals at BMC are using evidence-based care and population-based approaches to reduce asthma morbidity and thus improve the quality of life for patients with asthma and their families. METHODS: A quality improvement initiative was conducted at BMC’s Pediatric Primary Care Center. The aim was to develop routine surveillance of asthma control for the clinic population in order to identify and intervene on patients who have poorly controlled asthma. The Asthma Control Test (ACT) and the Test for Respiratory and Asthma Control in Kids (TRACK) were adapted into practice as validated patient-parent-reported tools to use to assess asthma control at all primary care office visits. Process measure included the percentage of visits with a documented asthma control testing in the electronic medical record. Outcome measures included (1) percentage of patients with poorly controlled asthma presenting to the clinic, as indicated by low ACT/TRACK scores, and (2) percentage of visits with a documented provider action in response to low ACT/TRACK scores. Iterative Plan, Do, Study, Act (PDSA) cycles optimized results; process and outcome measures were analyzed on run charts for trends. RESULTS AND CONCLUSIONS: Patient-centered strategies for visits and population-based systems to analyze outcomes are effective at delivering quality care for BMC’s pediatric asthma patient population. Following the implementation of routine asthma control screening in primary care, the percentage of visits with documented ACT/TRACK scores went from a baseline of 8% to 86%. Week to week variation was mostly attributed to higher patient visit volume beginning in the Fall season when epidemiologically there is a substantially increased frequency of asthma exacerbations in children. A median of 23% of patients report poorly controlled asthma during their visit. The percent of visits with documented provider action increased from 87% to 95% during this quality improvement initiative, indicating that patients were receiving targeted care needs including medication management and asthma education in response to low ACT/TRACK scores. However, consistent and timely delivery of preventive care services continues to be a challenge, particularly for a clinic serving high-risk, underserved, and culturally diverse patient populations. / 2020-06-17T00:00:00Z

Bakgrund: År 2018 diagnostiserades 7630 barn och ungdomar med diabetes mellitus i Sverige. Diabetes mellitus typ 2 var tidigare en sällsynt diagnos hos barn och ungdomar men har ökat i takt med övervikt, fetma och fysisk inaktivitet. Barnkonventionen ger barn och ungdomar rättigheten att stödjas av familjen samt hälso- och sjukvården för att hantera sjukdomen på bästa sätt. Syfte: Var att belysa hur barn och ungdomar med diabetes mellitus typ 2 kan stödjas i sin sjukdom. Metod: Litteraturöversikt som genomfördes med systematisk sökning, granskning och analys av kvalitativa och kvantitativa artiklar. Sökningarna utfördes i databaserna Academic Search Elite, CINAHL, MEDLINE, PsycINFO och Scopus. Litteraturöversikten bestod av nio vetenskapliga artiklar. Resultat: Barn och ungdomar med diabetes mellitus typ 2 var i stort behov av ett fungerande nätverk. Positivt och uppmuntrande stöd var en hörnsten i självhantering av sjukdomen. Emotionellt och praktiskt stöd från familjen och vännerna hade stor betydelse för individens diabeteshantering. Även barnsjuksköterskan hade en viktig roll i att stödjande barnet eller ungdomen genom att informera, undervisa och skapa ett bra samarbete och en god relation runt individen. Slutsats: När barn och ungdomar med diabetes mellitus typ 2 fick stöd från omgivningen underlättades diabeteshanteringen. / Background: In 2018, 7630 children and adolescents with diabetes mellitus were diagnosed in Sweden. Type 2 diabetes mellitus was previously a rare diagnosis in children and adolescents but has increased in line with overweight, obesity and physical inactivity.  The Convention on the Rights of the Child gives children and adolescents the right to be supported by the family and the health and medical services to manage the disease in the best way. Purpose: Was to illustrate how children and adolescents with type 2 diabetes mellitus can be supported in their disease. Method: Conducted with systematic search, review and analysis of qualitative and quantitative articles. The searches were performed in five databases. The literature review consisted of nine scientific articles. Results: Children and adolescents with type 2 diabetes mellitus were in great need of a supporting network. Encouraging support was a cornerstone of self-management of the disease. Emotional and practical support from the family and friends was of great importance for the individual's diabetesmanagement. Even the pediatric nurse had an important role in supporting the child or adolescent by informing, teaching and creating a good relationship around the individual. Conclusion: When children and adolescents with type 2 diabetes mellitus received support from the environment, diabetes management was facilitated

Bakgrund: Två vanligt förekommande smärtsamma procedurer på barn i sjukvården är insättning av perifer venkateter (PVK) och behandling med lavemang (KLYX). För att lindra procedursmärta hos barn är det viktigt med en välgenomtänkt planering som gör barn och föräldrar trygga och lugna inför proceduren. Syfte: Studiens syfte var att undersöka hur föräldrar upplevde förberedelser på sjukhus inför insättning av perifer venkateter eller givande av lavemang på deras barn. Metod: Studien var en kvantitativ enkätstudie, där frågorna besvarades av 71 föräldrar med barn upp till 12 års ålder som genomgått PVK-insättning eller lavemangbehandling. Joyce Travelbees omvårdnadsteori användes som teoretiskreferensram för att beskriva vikten av information och god kommunikation i vården. Resultat: Resultatet visade att 91% av föräldrarna fick information om barnets behandling och 78% av föräldrarna var nöjda med informationen de fick inför proceduren på barnet. En större andel av barnen som fick PVK (88%) fick smärtlindring jämfört med barnen som fick KLYX (5%) (p = 0,001). Sjutton föräldrar (24%) i studien upplevde att deras barn inte hade möjlighet att stoppa proceduren om den blev för jobbig. Av föräldrarna blev 36,6% tillfrågade om sina önskemål inför barnets procedur. Slutsats: Denna enkätstudie visade att en stor andel av föräldrarna inte blev tillfrågade om sina önskemål inför proceduren som barnet skulle genomgå. Den belyser också att en grupp föräldrar upplevde att barnet vid de smärtsamma procedurerna inte kunde säga stopp om behandlingen blev för jobbig. Studien belyser vikten av att fråga föräldrar om önskemål för delaktighet i barnets vård samt att barnet måste ges möjlighet till att kunna sätta stopp om behandlingen blir för jobbig. / Background: Two commonly occurring painful procedures for children in healthcare are the insertion of peripheral vein catheters (PVK) and treatment with enema (KLYX). In order to ease the pain for the children during the procedure, it is important to have a well planning that makes children and parents safe and calm before starting the procedure. Purpose: The aim of the study was to investigate how parents experienced preparations in hospitals prior to inserting peripheral vein catheters or giving enema to their children. Method: The study was a quantitative survey, which the questionnaire was answered by 71 parents with children up to 12 years of age who had experienced PVK insertion or enema treatment. Joyce Travelbees nursing theory was chosen as theoretical referencefram to describe the importance of information and good communication in healthcare. Result: The result showed that 91% of the parents got information about the child's treatment and 78% of the parents were satisfied with the information they received before the procedure for the child. A larger proportion of the children who got PVK (88%) received pain relief compared to the children who got KLYX (5%) (p = 0,001). Seventeen parents (24%) in the study found that their children hadn’t possibility to stop the procedure if it became too difficult. 36,6% of the parents were asked about their wishes before the initiating the procedure. Conclusion: This survey showed that a large proportion of the parents were not asked about their wishes before the starting the procedure which the child would undergo. It also highlights that a group of parents felt that the child hadn’t possibility to stop the procedures if the treatment becomes too painful. The study highlights the importance of asking parents about the wishes for participation in the child's care and that the child must be given the opportunity to be able to stop the treatment if it becomes too painful.

Introdução: A manutenção da boa adesão aos medicamentos antirretrovirais é considerada fundamental para a terapia de pacientes com HIV/Aids, pois falhas no seguimento da prescrição podem levar ao comprometimento de toda a terapia, desenvolvimento de resistência viral e consequente redução nas opções de tratamento. Nas crianças, a adesão plena torna-se mais relevante se forem considerados os diferentes graus de maturidade do sistema imunológico no momento da infecção pelo HIV, tornando, assim, fundamental a avaliação da adesão nesta população. Objetivos: Analisar a taxa de adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids. Métodos: Este estudo transversal, aninhado à coorte de crianças e adolescentes com HIV/Aids atendidas no ambulatório do Instituto da Criança, analisou 101 pacientes. Os dados dos pacientes foram obtidos por meio de questionários sobre as características sociodemográficas e clínicas, sobre a aderência, além de escalas de expectativa de auto-eficácia. A taxa de adesão foi calculada classificando como aderentes aqueles pacientes que tomaram 95 por cento ou mais das doses referidas.  A análise descritiva (média, desvio-padrão, mediana e proporções) foi realizada para caracterizar a população do estudo e o teste de Wilcoxon foi utilizado para comparação das médias da escala de auto-eficácia dos pais/cuidadores e pacientes acima de 11 anos. Resultados: A taxa de adesão ao tratamento antirretroviral foi de 93,1 por cento (IC = [88,7;94,4]). Houve 7 pacientes que apresentaram má adesão. Os medicamentos antirretrovirais mais utilizados foram lopinavir (51,5 por cento ), lamivudina (43,6 por cento ) e Biovir® (associação de lamivudina e zidovudina) (28,7 por cento ). Conclusão: Alta taxa de adesão ao tratamento antirretroviral por crianças e adolescentes pode ser atingida, independentemente de seu perfil sociodemográfico e/ou 95 por cento de seus cuidadores, por meio do cuidado que a equipe multiproffisional dedica aos pacientes / Introduction: Maintaining good adherence to antiretroviral drugs is considered critical to drug therapy of patients with HIV/Aids, because prescription noncompliance can compromise the entire therapy, lead to the development of viral resistance and consequent reduction in treatment options. In children, full adherence becomes more relevant if different degrees of maturity of the immune system at the time of HIV infection are considered, thereby making the assessment of adherence required in this population. Objectives: To analyze adherence rate to antiretroviral treatment in children and adolescents with HIVAids. Methods: This cross-sectional study nested in a cohort of children and adolescents with HIVAids followed up at the Instituto da Criança, assessed 101 patients. Patient data were obtained by means of questionnaires on sociodemographic and clinical characteristics, adherence and self-efficacy expectancy scales. The adherence rate was calculated by classifying as adherents those patients who had taken 95 per cent or more of these doses. The descriptive analysis (mean, standard deviation, median and proportions) was performed to characterize the study population and the Wilcoxon test was used for the correlation between the scale of self-efficacy of parents/caregivers and patients over 11 years old. Results: The adherence rate to antiretroviral treatment was 93.1 per cent (CI = [88.7;94.4]). There were 7 patients who have poor adherence. Antiretroviral drugs frequently used were lopinavir (51.5 per cent ), lamivudine (43.6 per cent ) and Biovir 95 per cent TM (lamivudine plus zidovudine) (28.7 per cent ). Conclusions: High rate of adherence to antiretroviral treatment for children and adolescents can be met, regardless of their demographic profile and/or of their caregivers, through the care that the multiprofessional team dedicated to patients

Introdução: A carga de trabalho dos profissionais de enfermagem, referida como a principal variável dos métodos de dimensionamento, não tem sido objeto de investigação na área de pediatria, evidenciando-se, consequentemente, a ausência de parâmetros específicos para atendimento dos pacientes assistidos em unidades pediátricas. Objetivo: Mensurar a carga de trabalho da equipe de enfermagem em Unidade de Pediatria. Método: Estudo descritivo, observacional, transversal de natureza quantitativa, realizado na Clínica Pediátrica (Cl.Ped.) do Hospital Universitário da Universidade de São Paulo (HU-USP). Participaram da pesquisa todos os profissionais de enfermagem que trabalharam na Cl.Ped. no período de 30 de setembro a seis de outubro de 2013. A pesquisa foi desenvolvida em quatro etapas: identificação das atividades de enfermagem realizadas na assistência ao paciente pediátrico (prontuário e observação em campo); mapeamento das atividades em intervenções, segundo a Nursing Intervention Classification (NIC); validação do mapeamento das atividades em intervenções da NIC (Oficinas de Trabalho); mensuração da carga de trabalho da equipe de enfermagem (Técnica de Amostragem do Trabalho, em intervalos de 10 minutos). Resultados: Foram coletados 8.387 amostras de intervenções e atividades realizadas pelos profissionais de enfermagem. Verificou-se que as intervenções que mais demandaram tempo de trabalho da equipe foram: DOCUMENTAÇÃO (16,2%) e administração de MEDICAMENTOS (13,3%). Os profissionais despenderam 33,7% do seu tempo em intervenções de cuidado direto, 35,9% em intervenções de cuidado indireto, 27,6% em atividades de tempo pessoal e 2,8% em atividades associadas. A produtividade média da equipe de enfermagem foi de 72,4%, considerado um índice de produtividade satisfatório, de acordo com os critérios de avaliação apontados na literatura. As intervenções que exigiram maior tempo para sua execução foram: Desenvolvimento de FUNCIONÁRIOS, Punção VENOSA, PRECEPTOR: estudante e Cuidados na ADMISSÃO. O tempo médio de assistência utilizado para atender os pacientes pediátricos, nas 24 horas, correspondeu à 4,61 horas na categoria de Cuidados Mínimos, 6,26 horas na de Cuidados Intermediários e 6,49 horas na categoria Alta Dependência de Enfermagem. A carga média de trabalho da equipe de enfermagem da Cl.Ped. correspondeu à 5,8 horas, cujo valor apresenta correspondência com as horas de assistência de cuidados intermediários, preconizados pelo COFEN. Conclusão: A presente investigação identificou a carga de trabalho dos profissionais de enfermagem em unidade de pediatria, apresentando valiosa contribuição para o planejamento e avaliação de recursos humanos nesta área, bem como para o estabelecimento de condições que favoreçam a segurança do paciente e a qualidade dos cuidados oferecidos. / Introduction: The nursing staff workload, mentioned as the main variable to dimensioning methods, has not been the subject of research in Pediatrics, thus evidencing the absence of specific parameters for patient care in assisted units pediatric. Objective: To measure the nursing staff workload at a Pediatric Unit. Method: This is a descriptive, observational, transversal and quantitative study conducted in the Pediatric Clinic (Ped.Cl.) in a University Hospital, at the Universidade de São Paulo (HU-USP). All the nurses who worked in Ped.Cl. participated in the survey, from September 30th to October 6th 2013. This study was carried out in four moments: identification of nursing care activities performed in the care unit for pediatric patients (medical records and field observation); mapping intervention activities according to the Nursing Intervention Classification (NIC); validation of the mapping activities in NIC interventions (Workshops); determine nursing staff workload (Technical Sampling Work, 10 minute intervals). Results: 8.387 samples of interventions and activities performed by nursing professionals were collected. It was found that interventions which demanded more working time were: DOCUMENTATION (16,2%) and MEDICATION managing (13,3%). Professionals spent 33,7% of their time in direct care interventions, 35,9% in indirect care interventions, 27,6% in personal time activities and 2.8% in associated activities. The average productivity of the nursing staff was 72,4%, which is considered an index of satisfactory productivity, according to the evaluation criteria identified in the literature. Interventions requiring more time for its implementation were: Development of EMPLOYEES, VENOUS puncture, PRECEPTOR: Students and care in the ADMISSION process. The mean care time used to assist the pediatric patients, in 24 hours, corresponded to 4,61 hours in category of Minimum Care, 6,26 hours in the Intermediate Care and 6,49 hours in High Dependency Nursing category. The mean workload of the nursing staff in the Ped.Cl. corresponded to 5,8 hours, this value matches with the hours of intermediate care recommended by COFEN. Conclusion: The present study identified the workload of nursing staff in the pediatric unit, bringing a valuable contribution to the planning and evaluation of human resources in this area as well as to establish conditions favoring the patient safety and the quality of care offered.

O Transtorno Obsessivo Compulsivo (TOC) afeta de 2% a 4% da população pediátrica. Entre os fatores associados com a pior resposta ao tratamento do TOC pediátrico encontram-se a presença de sintomas de ansiedade nos pais, presença de histórico psiquiátrico nos familiares de primeiro grau, maior grau de acomodação familiar (AF) e ambiente familiar com características disfuncionais. No entanto, poucos estudos até o momento investigaram a variação da ansiedade parental, da acomodação familiar e do ambiente familiar em relação à resposta ao tratamento do TOC pediátrico. Nesse estudo foram avaliados, prospectivamente, 43 pais (31 mães e 12 pais) de 33 jovens com TOC (7 a 17 anos), antes e após o tratamento de seus filhos por 14 semanas com Terapia Cognitiva Comportamental (TCC) em grupo ou com fluoxetina. Os instrumentos utilizados para avaliar os pais foram: o Inventário de Ansiedade Traço e Estado (IDATE), a Escala de Acomodação Familiar (FAS), a Escala de Ambiente Familiar (FES-R) e um questionário para avaliar a presença de sintomas ansiosos, sintomas obsessivo-compulsivos (SOC), sintomas depressivos e uso nocivo de substâncias nos familiares de primeiro grau dos jovens com TOC. Os sintomas dos filhos foram avaliados pela Escala Yale-Brown de Sintomas Obsessivo-Compulsivos (Y-BOCS). De modo geral, os pais não apresentaram redução significativa da ansiedade traço ou estado, e não foi observada associação entre a variação da ansiedade parental e a melhora clínica dos filhos. No entanto, para os pais cujos familiares de primeiro grau não tinham sintomas psiquiátricos, houve associação significativa entre a redução da ansiedade traço e estado com a melhora clínica dos filhos. A acomodação familiar diminuiu após o tratamento dos filhos, e essa redução associou-se à melhora clínica dos jovens. No ambiente familiar, as subdimensões coesão e lazer aumentaram após o tratamento dos filhos, sendo que a variação da gravidade do TOC associou-se com a variação da coesão familiar. Esses resultados indicam que, mesmo sem uma abordagem focada na família, o tratamento do TOC pediátrico pode exercer impacto positivo sobre a acomodação familiar e o ambiente familiar. Estudos futuros poderão esclarecer as influências recíprocas entre esses fatores familiares e o tratamento do TOC pediátrico / Obsessive-Compulsive Disorder (OCD) occurs in 2% to 4% of the pediatric population. A worse prognosis has been associated with the presence of anxiety symptoms among parents, the presence of psychiatric symptoms among first-degree relatives, higher levels of family accommodation (FA) and a greater dysfunction in the family environment. So far, few studies have investigated the associations between the variation of parental anxiety, family accommodation and family environment with the response to pediatric OCD treatment. Forty-three subjects, 31 mothers and 12 fathers, of 33 children and adolescents with OCD (between 6 to17 years old), were evaluated before and after treatment of their children with group Cognitive-Behavioral Therapy (CBT) or fluoxetine for 14 weeks. The instruments used to assess the parents were: the State-Trait Anxiety Inventory (STAI), the Family Accommodation Scale (FAS), the Family Environment Scale - Real form (FES-R), and a questionnaire to assess the presence of anxiety symptoms, obsessive-compulsive symptoms, depressive symptoms and substance abuse in the first degree relatives of the youths. The children\'s symptoms were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). After their children\'s treatment, parents showed no significant reduction in their trait or state anxiety, and parental anxiety was not related to children\'s response to treatment. However, a decrease in anxiety levels after treatment was observed among those whose first degree-relatives did not report psychiatric symptoms. Family accommodation decreased after the children\'s treatment, and this decrease accompanied the children\'s clinical improvement. In the family environment, the sub-dimensions cohesion and leisure increased after the children\'s treatment, and cohesion accompanied the children\'s clinical improvement. These results suggest that, even without a family-focused approach, the child-focused treatment of pediatric OCD may have a positive impact on family accommodation and family environment. Future studies should further clarify the reciprocal influences of family factors and the treatment of pediatric OCD

Both researchers and primary care providers vary in their methods for assessing weight status in infants. The purpose of the present investigation was to compare standing-height-derived to recumbent-length-derived weight-for-length standardized (WLZ) scores, using the WHO growth curves, in a convenience sample of infants who visited the lab at 18 and 21 months of age. Fifty-eight primarily White, middle class infants (25 girls) from a semi-rural region of southern Appalachia visited the lab at 18 months, with 45 infants returning 3 months later. We found that recumbent-length-derived WLZ scores were significantly higher at 18 months than corresponding standing-height-derived WLZ scores. We also found that recumbent-length-derived WLZ scores, but not those derived from standing height measures, decreased significantly from 18 to 21 months. Although these differential results are attributable to the WHO database data entry syntax, which automatically corrects standing height measurements by adding 0.7cm, they suggest that researchers proceed cautiously when using standing-height derived measures when calculating infant BMI z-scores. Our results suggest that for practical purposes, standing height measurements may be preferred, so long as they are entered into the WHO database as recumbent length measurements. We also encourage basic science infancy researchers to include BMI assessments as part of their routine assessment protocols, to serve as potential outcome measures for other basic science variables of theoretical interest.

A dificuldade de realização de estudos clínicos com a população pediátrica favorece a prescrição off-label de medicamentos. Paralelamente, existe uma grande diversidade de fontes de informações sobre medicamentos disponíveis para consulta e diferentes formas de expressar doses para a pediatria, podendo resultar em padrões variados no uso de medicamentos. Este estudo avaliou a concordância de fontes de informação, em nível nacional e internacional, que orientam a prescrição pediátrica de antimicrobianos para faringotonsilite, otite média aguda (OMA) e rinossinusite, em relação ao fármaco de escolha, à posologia e aos tipos de referências utilizadas para sua elaboração. Foram selecionados documentos de entidades brasileiras e estrangeiras e as bulas dos medicamentos neles mencionados, totalizando 23 documentos diferentes para as três doenças avaliadas. A classe das penicilinas foi prevalente como terapia de primeira escolha nas três doenças estudadas, contudo houve grande variação nas doses indicadas e no modo como elas são expressas. A idade mínima para uso foi informada em 51,2% das fontes, sendo menos recorrente nas fontes nacionais. A duração do tratamento esteve presente em 66,7% dos fármacos indicados nas fontes. De forma geral, as fontes analisadas para as três doenças avaliadas citam principalmente referências classificadas como artigos de revisão e estudos experimentais, seguidos dos formulários e listas oficiais e consensos, diretrizes e manuais para embasar seus dados. Os resultados encontrados neste estudo reforçam a necessidade de estimular a realização de ensaios clínicos e/ ou estudos de farmacometria para a definição de doses de antimicrobianos para a pediatria, assim como, a harmonização das informações disponibilizadas para orientar a prescrição. / The difficulty of conducting clinical studies with the pediatric population favors off-label prescribing. At the same time, there is easy access to a great diversity of sources of information about drugs and different ways of expressing pediatric doses. These factors have impact on drug prescription and may result in varying standards in the use of medications. The present study assessed, at national and international levels, the agreement of information sources that guide pediatric prescription of antimicrobials for pharyngotonsillitis, acute otitis media (AOM) and rhinosinusitis, in relation to the drug of choice, dosage and types of references used in its preparation. Documents from Brazilian and international entities and the package inserts of the medications mentioned in these documents were selected. To three diseases, was analyzed 23 differents documents. The penicillin class was prevalent as first-line therapy in the three diseases investigated. However, there was great variation in the doses indicated and in the way they are expressed. The minimum age for use was reported in only 51,2% of the sources, being less recurrent in the national sources. Duration of treatment was present in 66,7% of the drugs indicated in the sources. In general, the sources analyzed for the three disorders investigated most often cite references classified as review articles and experimental studies, followed by formularies and official lists and consensus, guidelines and manuals to support their data. The results obtained reinforce the need to encourage clinical trials and/or pharmacometrics studies for establishing dosing recommendations of antimicrobials for pediatric patients, as well as to harmonize the information provided to guide prescriptions.

Introdução: A manutenção da boa adesão aos medicamentos antirretrovirais é considerada fundamental para a terapia de pacientes com HIV/Aids, pois falhas no seguimento da prescrição podem levar ao comprometimento de toda a terapia, desenvolvimento de resistência viral e consequente redução nas opções de tratamento. Nas crianças, a adesão plena torna-se mais relevante se forem considerados os diferentes graus de maturidade do sistema imunológico no momento da infecção pelo HIV, tornando, assim, fundamental a avaliação da adesão nesta população. Objetivos: Analisar a taxa de adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids. Métodos: Este estudo transversal, aninhado à coorte de crianças e adolescentes com HIV/Aids atendidas no ambulatório do Instituto da Criança, analisou 101 pacientes. Os dados dos pacientes foram obtidos por meio de questionários sobre as características sociodemográficas e clínicas, sobre a aderência, além de escalas de expectativa de auto-eficácia. A taxa de adesão foi calculada classificando como aderentes aqueles pacientes que tomaram 95 por cento ou mais das doses referidas.  A análise descritiva (média, desvio-padrão, mediana e proporções) foi realizada para caracterizar a população do estudo e o teste de Wilcoxon foi utilizado para comparação das médias da escala de auto-eficácia dos pais/cuidadores e pacientes acima de 11 anos. Resultados: A taxa de adesão ao tratamento antirretroviral foi de 93,1 por cento (IC = [88,7;94,4]). Houve 7 pacientes que apresentaram má adesão. Os medicamentos antirretrovirais mais utilizados foram lopinavir (51,5 por cento ), lamivudina (43,6 por cento ) e Biovir® (associação de lamivudina e zidovudina) (28,7 por cento ). Conclusão: Alta taxa de adesão ao tratamento antirretroviral por crianças e adolescentes pode ser atingida, independentemente de seu perfil sociodemográfico e/ou 95 por cento de seus cuidadores, por meio do cuidado que a equipe multiproffisional dedica aos pacientes / Introduction: Maintaining good adherence to antiretroviral drugs is considered critical to drug therapy of patients with HIV/Aids, because prescription noncompliance can compromise the entire therapy, lead to the development of viral resistance and consequent reduction in treatment options. In children, full adherence becomes more relevant if different degrees of maturity of the immune system at the time of HIV infection are considered, thereby making the assessment of adherence required in this population. Objectives: To analyze adherence rate to antiretroviral treatment in children and adolescents with HIVAids. Methods: This cross-sectional study nested in a cohort of children and adolescents with HIVAids followed up at the Instituto da Criança, assessed 101 patients. Patient data were obtained by means of questionnaires on sociodemographic and clinical characteristics, adherence and self-efficacy expectancy scales. The adherence rate was calculated by classifying as adherents those patients who had taken 95 per cent or more of these doses. The descriptive analysis (mean, standard deviation, median and proportions) was performed to characterize the study population and the Wilcoxon test was used for the correlation between the scale of self-efficacy of parents/caregivers and patients over 11 years old. Results: The adherence rate to antiretroviral treatment was 93.1 per cent (CI = [88.7;94.4]). There were 7 patients who have poor adherence. Antiretroviral drugs frequently used were lopinavir (51.5 per cent ), lamivudine (43.6 per cent ) and Biovir 95 per cent TM (lamivudine plus zidovudine) (28.7 per cent ). Conclusions: High rate of adherence to antiretroviral treatment for children and adolescents can be met, regardless of their demographic profile and/or of their caregivers, through the care that the multiprofessional team dedicated to patients

O câncer corresponde a um grupo de doenças que têm em comum o poder de proliferar células anormais de natureza embrionária primitiva em qualquer parte do organismo. A despeito dos avanços científicos e tecnológicos que permitem um aumento nas possibilidades de cura, o câncer desencadeia repercussões psicológicas em pacientes e familiares. Neste cenário de adoecimento torna-se essencial que esses indivíduos possam ser assistidos por profissionais de saúde que os orientem e os acolham em suas necessidades específicas. Porém, a atuação permeada pelo contato com profissionais de diferentes áreas, por jornadas prolongadas de trabalho e pelo convívio frequente com imprevisibilidade, vulnerabilidade, sofrimento e perda de pacientes, pode gerar sofrimento aos profissionais, dificultando uma assistência de qualidade aos pacientes. Esse estudo teve como objetivo compreender como profissionais de saúde, de diferentes especialidades, atuantes em um serviço especializado em tratamento oncológico pediátrico, vinculado a um hospital-escola do interior do estado de São Paulo, significam suas vivências neste contexto de trabalho. Foram entrevistados oito profissionais e, mediante autorização prévia dos mesmos, as entrevistas foram gravadas e transcritas na íntegra. A compreensão dos relatos foi realizada segundo o referencial fenomenológico, que se justifica pela necessidade de chegar à experiência tal como é vivida e de aproximar dos sentidos atribuídos pelos participantes. As entrevistas foram analisadas qualitativamente conforme o método de análise da estrutura do fenômeno situado, proposto por Martins e Bicudo (1989), Giorgi (1985) e Valle (1997) e, posteriormente, foi realizada uma reflexão sobre os resultados à luz da Psicologia Fenomenológica proposta por Forghieri (2009). Os resultados mostraram que os participantes vivenciam sua atuação de forma ambivalente, marcada por satisfações e dificuldades. A satisfação aparece associada ao vínculo construído e às lições aprendidas com pacientes e familiares, ao reconhecimento recebido pelo trabalho prestado e à oportunidade de servir ao próximo. As dificuldades estão relacionadas ao contato com o sofrimento e com a morte de pacientes, ao convívio com profissionais de diferentes especialidades e à dificuldade de comunicação entre eles, essas últimas representando obstáculos a uma atuação integrada. Apesar das dificuldades, eles revelam disponibilidade e desejo de cuidar de seus pacientes, o que faz com que continuem escolhendo esse trabalho. Com intuito de lidar melhor com esse cenário, mobilizam diferentes recursos de enfrentamento, porém, ainda assim, em vários momentos, sentem-se desamparados tanto pelos colegas como pela instituição hospitalar e pela formação acadêmica. Frente aos desafios da prática, esse estudo ressalta a importância de repensar a formação em saúde, bem como a necessidade de oferta de assistência psicológica aos profissionais, como uma estratégia de cuidado ao cuidador. Destinar atenção à saúde mental dos profissionais de saúde é essencial para que eles tenham condições para adotar condutas mais humanizadas, proporcionando uma melhor qualidade da assistência aos pacientes. / Cancer corresponds to a group of diseases that have in commom the power to proliferate abnormal cells of a primitive embrio origin in any part of the organism. Despite the scientific advances which allow a raise in the chances of cure, cancer triggers psychological repercussions in patients and their families. In this scenario of illness it is tantamount that these individuals may be assisted by health professionals who guide them and cater for their specific needs. However, the acting permeated by the contact with professionals from various areas, by long working hours and by the constant idea of unpredictability, vulnerability, suffering and loss of patients might generate anguish to these professionals, making it difficult to have high quality assistance towards these patients. This study aimed at understanding how health professionals, of different areas of expertise, actively working in a job which is specific to the pediatrics oncologic treatment, linked to a university hospital in the inner area of the state of São Paulo, see the experiences they have within the scope of their work. Eight professionals were interviewed and, having the subjects previously authorized, the interviews were recorded and transcribed word by word. The comprehension of the reports was performed according to the phenomenological reference, which is justified by the need to reach the experience exactly the same way it is lived and to get closer to the senses assigned by the participants. The interviews were qualitatively analysed in accordance with the method of situated phenomenon structure analysis, proposed by Martins and Bicudo (1989), Giorgi (1985) and Valle (1997) and, later, a reflexion upon the results was carried out in light of the Phenomenological Psychology proposed by Forghieri (2009). The results showed that the participants live their acting in an ambivalent way, marked by pleasures and difficulties. The pleasures are associated with the bonding built and with the lessons learned with patients and their families, with the recognition awarded by the done service and the opportunity of helping a peer. The difficulties are related to the contact with suffering and to the death of the patients, to the living with professionals of different specialities and to the difficult communication among them, the latest representing obstacles to an integrated acting. In spite of the difficulties, they reveal availability and good will to handle the patients, which makes them keep choosing this line of work. Aiming at dealing better with this scenario, they mobilize different resources of confrontation, yet, still in numerous moments, they feel unassisted both by their co-workers and the hospital institution, as well as by the academic course. Facing the practice challenges, this paper highlights the importance of rethinking the graduation in the area of health, and also the need of offering psychological aid to the professionals as a strategy of care towards the caretaker. Paying attention to the mental health of the health professionals is essential so that they are in good shape to adopt more humanistic approaches, offering assistance of a higher quality towards these patients.