Translation and cultural adaptation of the Positive Aspects of Caregiving Scale for caregivers of people living with dementia in Brazilian context: a methodological study.

BACKGROUND: The Positive Aspects of Caregiving (PAC) scale is used to assess psychosocial benefits provided to caregivers by the task of caring. The PAC scale consists of nine items, assessed using a five-point Likert scale, with higher values indicating greater positive perceptions and gains from the caregiving experience. OBJECTIVE: To translate and culturally adapt the PAC scale for informal Brazilian caregivers of people with dementia. DESIGN AND SETTING: A methodological study was conducted at the Federal University of São Carlos. METHODS: The following stages were carried out: Translation; Synthesis of the translations; Back-translation; Evaluation by an experts' committee; and Pre-test. RESULTS: Two independent professionals translated the PAC scale. The consensus version was obtained by merging both translations, which were back-translated into English by a third translator. The expert committee comprised three specialists in the area and project researchers. All scale items presented a Content Validity Index of 1 (CVI = 1.0), and thus remained in the pre-final version of the instrument. The instrument was pre-tested with seven caregivers of people with dementia, the majority of whom were women (57.1%), with a degree of kinship corresponding to sons/daughters (57.1%) and an average age of 55.2 (± 4.1) years. The caregivers considered it clear and understandable and made no suggestions for changes. CONCLUSION: The PAC scale was translated and culturally adapted for use by informal caregivers of people with dementia in Brazil. However, a psychometric analysis of the instrument is necessary to provide normative data for this population group.

Translation and cultural adaptation of the Positive Aspects of Caregiving Scale for caregivers of people living with dementia in Brazilian context: a methodological study

ABSTRACT BACKGROUND: The Positive Aspects of Caregiving (PAC) scale is used to assess psychosocial benefits provided to caregivers by the task of caring. The PAC scale consists of nine items, assessed using a five-point Likert scale, with higher values indicating greater positive perceptions and gains from the caregiving experience. OBJECTIVE: To translate and culturally adapt the PAC scale for informal Brazilian caregivers of people with dementia. DESIGN AND SETTING: A methodological study was conducted at the Federal University of São Carlos. METHODS: The following stages were carried out: Translation; Synthesis of the translations; Back-translation; Evaluation by an experts' committee; and Pre-test. RESULTS: Two independent professionals translated the PAC scale. The consensus version was obtained by merging both translations, which were back-translated into English by a third translator. The expert committee comprised three specialists in the area and project researchers. All scale items presented a Content Validity Index of 1 (CVI = 1.0), and thus remained in the pre-final version of the instrument. The instrument was pre-tested with seven caregivers of people with dementia, the majority of whom were women (57.1%), with a degree of kinship corresponding to sons/daughters (57.1%) and an average age of 55.2 (± 4.1) years. The caregivers considered it clear and understandable and made no suggestions for changes. CONCLUSION: The PAC scale was translated and culturally adapted for use by informal caregivers of people with dementia in Brazil. However, a psychometric analysis of the instrument is necessary to provide normative data for this population group.

Efficacy of iSupport-Brasil for unpaid caregivers of people living with dementia: protocol for a randomized and controlled clinical trial.

Unpaid caregivers of people living with dementia tend to suffer mental health problems as a result of the negative effects associated with the care tasks. Thus, psychosocial interventions for this population group are necessary. iSupport is an online support program for caregivers that was created by the World Health Organization. Objective: To describe the design of a randomized clinical trial to measure the efficacy of the iSupport-Brasil version on caregivers' mental health and well-being. Methods: The participants will be randomized into Intervention Group (IG) (n=195) and Control Group (CG) (n=195). For three months, the IG will access the iSupport-Brasil platform, the CG will enter the electronic page of the Brazilian Alzheimer's Association, and both groups will be emailed the preliminary version of the "Guia de cuidados para a pessoa idosa" e-book (a guide to providing care to the elderly) from the Ministry of Health. The data will be collected at three moments: baseline, and three and six months after the beginning of the intervention. Results: It is expected that it will be possible to provide diverse validity evidence about iSupport-Brasil as an online and free intervention alternative, as a preventive means and as a way to promote mental health among caregivers of people living with dementia. Conclusion: Through the evaluation protocol of this randomized clinical trial on the effects of the iSupport-Brasil program, it may become a reference for countries that plan to adapt and improve the iSupport program using digital health solutions.

Cuidadores informais de pessoas que vivem com demência tendem a sofrer problemas de saúde mental como resultado dos efeitos negativos associados às tarefas de cuidado. Assim, intervenções psicossociais para essa população são necessárias. O iSupport é um programa de apoio online para cuidadores criado pela Organização Mundial da Saúde. Objetivo: Descrever o desenho de um ensaio clínico randomizado para medir a eficácia da versão iSupport-Brasil na saúde mental e no bem-estar de cuidadores. Métodos: Os participantes serão randomizados em Grupo Intervenção (GI) (n=195) e Grupo Controle (GC) (n=195). Durante três meses, o GI acessará a plataforma iSupport-Brasil, o CG entrará na página eletrônica da Associação Brasileira de Alzheimer e ambos os grupos receberão por e-mail a versão preliminar do e-book Guia de cuidados para a pessoa idosa, do Ministério da Saúde. Os dados serão coletados em três momentos: linha de base, três e seis meses após o início da intervenção. Resultados: Espera-se que seja possível fornecer diversas evidências sobre os efeitos do iSupport-Brasil como alternativa de intervenção online e gratuita, de forma a promover a saúde mental entre os cuidadores de pessoas que vivem com demência. Conclusão: O protocolo de avaliação deste ensaio clínico randomizado sobre os efeitos do programa iSupport-Brasil pode se tornar uma referência para os países que planejam adaptar e melhorar esta intervenção, usando soluções digitais de saúde.

Cognitive performance, burden and stress in aged caregivers of older adults with and without cognitive impairment.

There is an increasing number of aged people who provide care for other older people. Commonly existing burden and stress can change the forms of cognitive performance depending on the context of the aged caregivers. Objective: To compare the cognitive performance, burden and stress of aged caregivers of older adults with and without signs of cognitive impairment. Methods: A cross-sectional and quantitative study conducted with 205 aged caregivers of older adults with signs of cognitive impairment and 113 aged caregivers of older adults without signs of cognitive impairment treated in Primary Health Care. They were evaluated for sociodemographic characteristics, cognition, burden, and stress. Descriptive (Kolmogorov-Smirnov test) and comparative (Student's t-test and Pearson's χ² test) analyses were performed. Results: Aged caregivers of older adults with signs of cognitive impairment were older, had lower schooling levels, and a higher percentage of daily care hours compared to the aged caregivers of older adults without signs of cognitive impairment. Regarding cognitive performance, the means were lower for all domains. In addition, this same group had higher scores, with a statistically significant difference for perceived stress and burden. Conclusion: Aged caregivers of older adults with signs of cognitive impairment showed lower cognitive performance, as well as higher burden and stress levels. These findings guide the planning of interventions with aged caregivers in the Primary Health Care.

Nota-se um crescente número de idosos que prestam cuidados a outros idosos. A sobrecarga e o estresse comumente existentes podem afetar de formas diferentes o desempenho cognitivo, a depender do contexto desses idosos cuidadores. Objetivo: Comparar o desempenho cognitivo, a sobrecarga e o estresse de idosos cuidadores de idosos com e sem indícios de alterações cognitivas. Métodos: Estudo transversal e quantitativo realizado com 205 idosos cuidadores de idosos com indícios de alterações cognitivas e 113 idosos cuidadores de idosos sem indícios de alterações cognitivas atendidos na Atenção Primária à Saúde. Eles foram avaliados quanto às características sociodemográficas, cognição, sobrecarga e estresse. Análises descritivas (teste de Kolmogorov-Smirnov) e comparativas foram realizadas (teste t de Student e χ² de Pearson). Resultados: Os idosos cuidadores de idosos com indícios de alterações cognitivas eram mais velhos, com menor escolaridade e maior percentual de horas diárias de cuidado em comparação aos idosos cuidadores de idosos sem indícios de alterações cognitivas. Já quanto ao desempenho cognitivo, as médias foram inferiores para todos os domínios. Além disso, esse mesmo grupo apresentou maior pontuação, com diferença estatisticamente significante, para o estresse percebido e para a sobrecarga. Conclusão: Os cuidadores de idosos com indícios apresentaram menor desempenho cognitivo e maiores níveis de sobrecarga e estresse. Tais achados norteiam o planejamento de intervenções voltadas aos idosos cuidadores na Atenção Primaria à Saúde.

iSupport-Brasil: Cross-cultural adaptation of the content included in the iSupport program for caregivers of people who have dementia.

OBJECTIVE: Examine the process of culturally adapting the content of the World Health Organization iSupport program for family caregivers of people living with dementia in Brazil. METHOD: This is a multicenter and methodological study to cross-culturally adapt the iSupport program. Initially, the content of the iSupport program was translated into Brazilian Portuguese by professional translator trained in Psychology, with mastery of the original language of the content (English). Focus groups were then held with caregivers/former caregivers of people who have dementia (n = 24) and health professionals specialized in aging (n = 24). The participants had access to part of the iSupport material for analysis purposes. Semi-structured interviews were conducted between June and September 2019. All the interviews were recorded and transcribed in full for subsequent analysis. All the ethical aspects were respected. RESULTS: The translator implemented some cross-cultural adaptations, such as substituting 69 proper names used in the original version by names of different Brazilian regions. In relation to the analysis of the material and comments from the focus groups, in general, all the participants had positive opinions about the material included in iSupport. Some changes were suggested in relation to the terminology and examples given in the modules to better fit the Brazilian culture and health systems, and links to relevant pages of the local Alzheimer's association were included. All the linguistic and cultural adaptations proposed were systematically documented and duly justified in structured forms provided by the World Health Organization, which approved all of them after verification of fidelity. CONCLUSION: The product of this research is the first version of the iSupport-Brasil program and the inclusion of its content in a digital platform. For the most part, the content offered in iSupport proved to be an important online tool to provide support and diverse information to the caregivers of people who have dementia.

Efficacy of iSupport-Brasil for unpaid caregivers of people living with dementia: protocol for a randomized and controlled clinical trial / Eficácia do iSupport-Brasil para cuidadores informais de pessoas que vivem com demência: protocolo de um ensaio clínico randomizado e controlado

ABSTRACT. Unpaid caregivers of people living with dementia tend to suffer mental health problems as a result of the negative effects associated with the care tasks. Thus, psychosocial interventions for this population group are necessary. iSupport is an online support program for caregivers that was created by the World Health Organization. Objective: To describe the design of a randomized clinical trial to measure the efficacy of the iSupport-Brasil version on caregivers' mental health and well-being. Methods: The participants will be randomized into Intervention Group (IG) (n=195) and Control Group (CG) (n=195). For three months, the IG will access the iSupport-Brasil platform, the CG will enter the electronic page of the Brazilian Alzheimer's Association, and both groups will be emailed the preliminary version of the "Guia de cuidados para a pessoa idosa" e-book (a guide to providing care to the elderly) from the Ministry of Health. The data will be collected at three moments: baseline, and three and six months after the beginning of the intervention. Results: It is expected that it will be possible to provide diverse validity evidence about iSupport-Brasil as an online and free intervention alternative, as a preventive means and as a way to promote mental health among caregivers of people living with dementia. Conclusion: Through the evaluation protocol of this randomized clinical trial on the effects of the iSupport-Brasil program, it may become a reference for countries that plan to adapt and improve the iSupport program using digital health solutions.

RESUMO. Cuidadores informais de pessoas que vivem com demência tendem a sofrer problemas de saúde mental como resultado dos efeitos negativos associados às tarefas de cuidado. Assim, intervenções psicossociais para essa população são necessárias. O iSupport é um programa de apoio online para cuidadores criado pela Organização Mundial da Saúde. Objetivo: Descrever o desenho de um ensaio clínico randomizado para medir a eficácia da versão iSupport-Brasil na saúde mental e no bem-estar de cuidadores. Métodos: Os participantes serão randomizados em Grupo Intervenção (GI) (n=195) e Grupo Controle (GC) (n=195). Durante três meses, o GI acessará a plataforma iSupport-Brasil, o CG entrará na página eletrônica da Associação Brasileira de Alzheimer e ambos os grupos receberão por e-mail a versão preliminar do e-book Guia de cuidados para a pessoa idosa, do Ministério da Saúde. Os dados serão coletados em três momentos: linha de base, três e seis meses após o início da intervenção. Resultados: Espera-se que seja possível fornecer diversas evidências sobre os efeitos do iSupport-Brasil como alternativa de intervenção online e gratuita, de forma a promover a saúde mental entre os cuidadores de pessoas que vivem com demência. Conclusão: O protocolo de avaliação deste ensaio clínico randomizado sobre os efeitos do programa iSupport-Brasil pode se tornar uma referência para os países que planejam adaptar e melhorar esta intervenção, usando soluções digitais de saúde.

Cognitive performance, burden and stress in aged caregivers of older adults with and without cognitive impairment / Desempenho cognitivo, sobrecarga e estresse de idosos cuidadores de idosos com e sem alterações cognitivas

ABSTRACT. There is an increasing number of aged people who provide care for other older people. Commonly existing burden and stress can change the forms of cognitive performance depending on the context of the aged caregivers. Objective: To compare the cognitive performance, burden and stress of aged caregivers of older adults with and without signs of cognitive impairment. Methods: A cross-sectional and quantitative study conducted with 205 aged caregivers of older adults with signs of cognitive impairment and 113 aged caregivers of older adults without signs of cognitive impairment treated in Primary Health Care. They were evaluated for sociodemographic characteristics, cognition, burden, and stress. Descriptive (Kolmogorov-Smirnov test) and comparative (Student's t-test and Pearson's χ² test) analyses were performed. Results: Aged caregivers of older adults with signs of cognitive impairment were older, had lower schooling levels, and a higher percentage of daily care hours compared to the aged caregivers of older adults without signs of cognitive impairment. Regarding cognitive performance, the means were lower for all domains. In addition, this same group had higher scores, with a statistically significant difference for perceived stress and burden. Conclusion: Aged caregivers of older adults with signs of cognitive impairment showed lower cognitive performance, as well as higher burden and stress levels. These findings guide the planning of interventions with aged caregivers in the Primary Health Care.

RESUMO. Nota-se um crescente número de idosos que prestam cuidados a outros idosos. A sobrecarga e o estresse comumente existentes podem afetar de formas diferentes o desempenho cognitivo, a depender do contexto desses idosos cuidadores. Objetivo: Comparar o desempenho cognitivo, a sobrecarga e o estresse de idosos cuidadores de idosos com e sem indícios de alterações cognitivas. Métodos: Estudo transversal e quantitativo realizado com 205 idosos cuidadores de idosos com indícios de alterações cognitivas e 113 idosos cuidadores de idosos sem indícios de alterações cognitivas atendidos na Atenção Primária à Saúde. Eles foram avaliados quanto às características sociodemográficas, cognição, sobrecarga e estresse. Análises descritivas (teste de Kolmogorov-Smirnov) e comparativas foram realizadas (teste t de Student e χ² de Pearson). Resultados: Os idosos cuidadores de idosos com indícios de alterações cognitivas eram mais velhos, com menor escolaridade e maior percentual de horas diárias de cuidado em comparação aos idosos cuidadores de idosos sem indícios de alterações cognitivas. Já quanto ao desempenho cognitivo, as médias foram inferiores para todos os domínios. Além disso, esse mesmo grupo apresentou maior pontuação, com diferença estatisticamente significante, para o estresse percebido e para a sobrecarga. Conclusão: Os cuidadores de idosos com indícios apresentaram menor desempenho cognitivo e maiores níveis de sobrecarga e estresse. Tais achados norteiam o planejamento de intervenções voltadas aos idosos cuidadores na Atenção Primaria à Saúde.

ISupport-Brasil: Preliminary results of the usability and acceptability assessment by caregivers of people who have dementia.

Objective: To assess usability and acceptability of iSupport-Brasil (iSupport-BR) to virtually support family caregivers of people who have dementia. Materials and methods: In the first stage, nine caregivers/former caregivers assessed the interface of the platform that hosts iSupport-BR. In the second stage, 10 caregivers assessed acceptability of the platform and answered the System Usability Scale (SUS), which varies from 0 to 100 points. A descriptive analysis of the quantitative data was performed, as well as a thematic analysis on the open questions. All the ethical aspects were respected. Results: The results of the first stage indicated a user-friendly interface of the system and relevant content of the program, with 55.6 and 77.8% of the participants assigning the maximum grade to these questions, respectively. Of the five possible points, the system's mean score was 3.7. In Stage 2, 80% of the caregivers rated the program as very useful and 100% would recommend it to other caregivers. Perception of the program's usability by the SUS scale was excellent (M = 86.5 ± 11.5). Conclusion: This research allowed elaborating the final version of iSupport-BR, considering usability and acceptability of the platform and the program for computers/notebooks, being a pioneer in evaluating it for use in smartphones. Future research studies will have to assess the effects of iSupport-BR on the caregivers' mental health.

Usability and acceptability of internet-based interventions for family carers of people living with dementia: systematic review.

Objectives: Internet-based interventions can help carers of people living with dementia to cope with care-related challenges and can help improve their wellbeing. This systematic review aimed at investigating the criteria of usability and acceptability of self-guided internet-based interventions for family carers of people living with dementia. Method: Searches were conducted on PubMed, Virtual Health Library Regional Portal (Americas), MEDLINE, PsycINFO, Scopus, and Cochrane. Studies published up to December 2019, in English, Portuguese, or Spanish, were eligible. We followed the definition/criteria from ISO ISO-9241-11 for usability (efficiency, effectiveness, and satisfaction) and acceptability (barriers for using and utility). Methodological quality was evaluated using specific tools according to each study design. Results: Ten studies were included, all of which had high methodological quality. Carers of people living with dementia indicated that internet-based interventions were mostly effective, efficient, and satisfactory. They considered these to be informative, relevant, and functional, highlighting the utility and intention of using the resource in the future. The high heterogeneity in the terms and methods used to evaluate usability and acceptability hindered cross-study comparisons, however internet-based interventions were considered useful and acceptable by most carers. Conclusion: Future research should consider expanding the criteria of usability and acceptability to better reflect the needs of this population.

Efeitos da música nas expressões corporais e faciais e nos sintomas psicológicos e comportamentais de idosos / Effects of music on body and facial expressions and psychological and behavioral symptoms of older adults

Resumo Objetivo Comparar os efeitos da música popular brasileira (representativa da história de vida do idoso) e da música clássica nas expressões corporais e faciais e sintomas psicológicos e comportamentais de idosos com demência institucionalizados. Método Realizou-se um estudo quantitativo, quase experimental e comparativo, com dois grupos: "Grupo Intervenção com Música Popular" (GIMP; n=19) e "Grupo Controle com Música Clássica" (GCMC; n=14), em duas Instituições de Longa Permanência para Idosos (ILPI). Após aprovação do Comitê de Ética em Pesquisa (Processo nº 1.981.699/2017), foram realizadas quatro (4) sessões individuais, com apresentação de cinco (5) músicas. Foram comparadas as medidas dos Sintomas Psicológicos e Comportamentais da Demência (SPCD) entre os grupos; os parâmetros fisiológicos (frequência e pressão arterial) antes e após intervenção; as expressões faciais por meio do "Facial Action Coding System" (FACS); e movimentos corpóreos. Resultados Maior percentual obtido pelo GIMP para: expressões pelo FACS de alegria (p=0,039) e surpresa (p=0,041); e maior número de movimentos de Tronco e Cabeça (TC) (t=2,94; p=0,006) quando comparados ao GCMC. Quanto aos SPCD, o GIMP apresentou diminuição significativa na gravidade dos sintomas de delírio (t=2,379; p=,029). Conclusão Os achados demonstram que as músicas representativas da trajetória de vida a esta população podem despertar: satisfação com a vida, recordações e alegria em viver quando comparadas às músicas clássicas.

Abstract Objective To compare the physiological, behavioral and expressive effects of nonpharmacological interventions through songs of Brazilian popular character (representative of the life history of the older adults) and classical music in the elderly population with institutionalized dementia. Method A quantitative, almost-experimental and comparative study was carried out in two groups: "Intervention Group with Popular Music" (IGPM; n = 19) and "Control Group with Classical Music" (CGCM n = 14) in two Long Institutions Stay for the Elderly people (ILPI). After approval by the Research Ethics Committee (Process nº 1,981,699 / 2017), four (4) individual sessions were held, with five (5) songs. The measures of Psychological and Comparative Symptoms of Dementia (PCSD) were compared between groups; the physiological parameters (frequency and blood pressure) before and after the intervention; facial expressions through the Facial Action Coding System (FACS); and bodily movements. Results Greater percentage obtained by IGPM for: expressions by FACS of joy (p = 0.039) and surprise (p = 0.041); and greater number of head and trunk movements (t) (t = 2.94, p = 0.006) when compared to CGCM. Regarding SPCD, GIMP presented a significant decrease in the severity of delirium symptoms (t = 2.379, p = .029). Conclusion The findings demonstrate that the representative of the song of the life trajectory of this population can awaken: satisfaction with life, memories, and joy to live when compared to classical music.

Sociodemographic and health characteristics of formal and informal caregivers of elderly people with Alzheimer's Disease / Características sociodemográficas y de salud de cuidadores formales e informales de ancianos con enfermedad de Alzheimer / Características sociodemográficas e de saúde de cuidadores formais e informais de idosos com Doença de Alzheimer

Abstract Objective: to evaluate and compare the sociodemographic characteristics, depressive symptoms, anxiety and perceived stress of formal and informal caregivers of elderly people with Alzheimer's disease. Method: Quantitative, cross-sectional and comparative study with 44 caregivers that were divided into two groups of 26 informal caregivers (IC) and 18 formal caregivers (FC). The Instrument for Characterization of the Caregiver, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Perceived Stress Scale (PSS) were applied. Results: Of those IC, the majority were women (96.2%), mean age of 52.9 years, majority represented by sons (daughters) (65.4%). They presented, on average, depressive symptoms (10.1%), anxiety symptoms (11.5%) and scored 32.1 in the PSS. The FC group, the majority were women (94.4%), mean age of 45.2 years were not related to the elderly people (66.7%). They presented, on average, depressive symptoms (7.1%), anxiety symptoms (6.4%) and scored 31.7 in the PSS. Conclusion: Similarities were shown in the sociodemographic aspects, but the groups differ in the health profile, revealing an alert for the planning of interventions looking for health promotion and disease prevention. Implications for practice: The study contributes to the improvement of the caregivers´ quality of life.

Resumen Objetivo: evaluar y comparar las características sociodemográficas, síntomas depresivos, ansiosos y estrés percibido de cuidadores formales e informales de ancianos portadores de la enfermedad de Alzheimer. Método: Estudio cuantitativo, transversal y comparativo, realizado con 44 cuidadores divididos en dos grupos de 26 cuidadores informales (CI) y 18 cuidadores formales (CF). Se aplicó el Instrumento para Caracterización del Cuidador, Inventario de Depresión de Beck (BDI), Inventario de Ansiedad de Beck (BAI) y Escala de estrés Percibido (PSS). Resultados: De los CI, mayoría mujeres (96,2%), edad media de 52,9 años, mayoría representada por hijos(as) (65,4%). En promedio, los síntomas depresivos (10,1%), síntomas de ansiedad (11,5%) y puntualizó de 32,1 en el PSS. De los CF, mayoría mujeres (94,4%), edad media de 45,2 años, no poseen grado de parentesco con los ancianos (66,7%). En promedio, los síntomas depresivos (7,1%), síntomas de ansiedad (6,4%) y puntuaron un escore de 31,7 en el PSS. Conclusión: Se revelan similitudes en los aspectos sociodemográficos, pero los grupos difieren en el perfil de salud, revelando una alerta para la planificación de intervenciones para promoción de salud y prevención de enfermedades. Implicaciones para la práctica: El estudio contribuye a la mejora de la calidad de vida de los cuidadores.

Resumo Objetivo: avaliar e comparar as características sociodemográficas, sintomas depressivos, de ansiedade e estresse percebido em cuidadores formais e informais de idosos com Doença de Alzheimer. Método: Estudo quantitativo, transversal e comparativo, realizado com 44 cuidadores, divididos em dois grupos: 26 cuidadores informais (CI) e 18 cuidadores formais (CF). Aplicou-se o Instrumento para Caracterização do Cuidador, Inventário de Depressão de Beck (BDI), Inventário de Ansiedade de Beck (BAI) e Escala de Estresse Percebido (PSS). Resultados: Dos CI, a maioria eram mulheres (96,2%), representada por filhos(as) (65,4%), com idade média de 52,9 anos. Apresentaram, em média, sintomas depressivos (10,1%), sintomas de ansiedade (11,5%) e pontuaram 32,1, no PSS. Dos CF, a maioria eram mulheres (94,4%), idade média de 45,2 anos, sem grau de parentesco com os idosos (66,7%). Apresentaram, em média, sintomas depressivos (7,1%), sintomas de ansiedade (6,4%), e pontuaram 31,7, no PSS. Conclusão: Revelaram-se similaridades nos aspectos sociodemográficos, porém os grupos diferem-se no perfil de saúde, revelando um alerta no planejamento de intervenções visando à promoção de saúde e prevenção de doenças. Implicações para a prática: O estudo contribui para melhorar a qualidade de vida dos cuidadores.

Intervenção cognitiva domiciliar para cuidadores de idosos com Alzheimer / Home cognitive intervention for elderly with Alzheimer's caregivers

Objetivo: avaliar o efeito de intervenção cognitiva domiciliar sobre a cognição, a sobrecarga e o estresse em cuidadores de idosos com Doença de Alzheimer. Método: trata-se de estudo quantitativo, tipo quaseexperimental, com 17 cuidadores informais de idosos com Doença de Alzheimer. Utilizaram-se o Addenbrooke's Cognitive Examination-Revised (ACE-R), a Escala de Estresse Percebido (PSS) e a Escala de Sobrecarga de Zarit para a avaliação antes e depois da intervenção. Analisaram-se os resultados pelo SPSS, aplicando-se o test t de student para avaliar o efeito da intervenção. Resultados: identificaram-se mulheres (88,2%), com idade média de 52,5 anos e escolaridade média de 8,8 anos. Constatou-se melhora significativa na cognição geral pelo MEEM (p=0,008) e ACE-R (p= 0,003) e nos domínios atenção (p= 0,004), memória (p= 0,017) e fluência verbal (p= 0,023). Conclusão: avaliou-se pela intervenção cognitiva domiciliar melhora na cognição geral em cuidadores de idosos com Doença de Alzheimer, podendo ser uma importante ferramenta de promoção a saúde.(AU)

Catheter for Cleaning Surgical Optics During Surgical Procedures: A Possible Solution for Residue Buildup and Fogging in Video Surgery.

Currently, there is a tendency to perform surgical procedures via laparoscopic or thoracoscopic access. However, even with the impressive technological advancement in surgical materials, such as improvement in quality of monitors, light sources, and optical fibers, surgeons have to face simple problems that can greatly hinder surgery by video. One is the formation of "fog" or residue buildup on the lens, causing decreased visibility. Intracavitary techniques for cleaning surgical optics and preventing fog formation have been described; however, some of these techniques employ the use of expensive and complex devices designed solely for this purpose. Moreover, these techniques allow the cleaning of surgical optics when they becomes dirty, which does not prevent the accumulation of residue in the optics. To solve this problem we have designed a device that allows cleaning the optics with no surgical stops and prevents the fogging and residue accumulation. The objective of this study is to evaluate through experimental testing the effectiveness of a simple device that prevents the accumulation of residue and fogging of optics used in surgical procedures performed through thoracoscopic or laparoscopic access. Ex-vivo experiments were performed simulating the conditions of residue presence in surgical optics during a video surgery. The experiment consists in immersing the optics and catheter set connected to the IV line with crystalloid solution in three types of materials: blood, blood plus fat solution, and 200 mL of distilled water and 1 vial of methylene blue. The optics coupled to the device were immersed in 200 mL of each type of residue, repeating each immersion 10 times for each distinct residue for both thirty and zero degrees optics, totaling 420 experiments. A success rate of 98.1% was observed after the experiments, in these cases the device was able to clean and prevent the residue accumulation in the optics.

Metabolic acidosis components in advanced chronic kidney disease: association with serum albumin and parathyroid hormone.

OBJECTIVE: To investigate the associations between the 2 main components of metabolic acidosis (unmeasured anions [UA] and hyperchloremia) with serum albumin and intact parathormone (iPTH) in patients with advanced chronic kidney disease. DESIGN AND METHODS: Cross-sectional study with advanced chronic kidney disease patients (estimated glomerular filtration rate <30 mL/minute/1.73 m(2)) not receiving phosphate binders, alkali therapy, or vitamin D analogs. Arterial blood sample was collected for biochemical and blood gas analysis. UA and strong ion difference (SID) were calculated according to quantitative acid-base analysis. Reduced SID was used as a measure of hyperchloremia. MAIN OUTCOME MEASURES: Serum albumin and parathormone (iPTH). RESULTS: A total of 383 patients were included with a mean age of 64.7 ± 16.3 year and a mean estimated glomerular filtration rate of 19.9 ± 12.1 mL/minute/1.73 m(2). Among patients with metabolic acidosis, 45.7% had metabolic acidosis exclusively because of UA and 53.7% had a hyperchloremic component (either mixed metabolic acidosis or pure hyperchloremic metabolic acidosis). Considering the main acid-base status determinants, only UA had a significant correlation with serum albumin (r = -0.278, P < .001). There was no correlation between serum albumin and SID (r = 0.083, P = .156). This is in opposition to serum iPTH, where there was no correlation with UA (r = 0.082, P = .114), but an inverse correlation between iPTH and SID was observed (r = -0.228, P < .001). Multiple linear regressions with all acid-base determinants confirmed these findings. CONCLUSIONS: Our data brings further knowledge on the associations between metabolic acidosis with bone disorders and nutritional status, suggesting that the two main metabolic acidosis components (UA and hyperchloremia) have different effects on serum parathormone and serum albumin.

A aplicabilidade dos indicadores de saúde no contexto da atenção primária à saúde / Indicators of health and quality of life in the context of primary health care

A implantação dos indicadores de saúde é de grande re- levância. Os indicadores, quando bem administrados, são ferramentas fundamentais para a gestão de programas e serviços bem como para avaliação do sistema de saúde. Trata-se de um estudo de casos múltiplos, qualitativo, que objetivou conhecer a compreensão dos profissionais de equipes Saúde da Família e das equipes de apoio sobre o uso de indicadores de saúde na Atenção Primária à Saúde (APS), em Belo Horizonte, Minas Gerais, Brasil. No muni- cípio, atualmente, são trabalhados 26 indicadores, que fo- ram apresentados e discutidos nas Oficinas de Qualificação da APS, promovidas, em 2010, pela Prefeitura Municipal de Belo Horizonte e pela Escola de Saúde Pública de Minas Gerais. Para se trabalhar com indicadores, é necessário que os profissionais envolvidos no processo sejam devidamente treinados a ponto de ter uma real compreensão sobre os mesmos. Os resultados demonstram que alguns profissio- nais apresentam um amplo conceito sobre os indicadores. Outros têm noções incipientes. De modo geral, é baixa a aplicabilidade dessa ferramenta. Isso se reflete nas ações, no desenvolvimento de programas e no alcance de metas, evidenciando que há obstáculos a serem enfrentados pelas equipes de Saúde da Família. Percebe-se a necessidade de uma educação permanente para os profissionais de saúde para que as equipes sejam cada vez mais capacitadas a tra- balhar com efetividade os indicadores de saúde, visando à qualidade da assistência à saúde na Atenção Primária

The implementation of health indicators is extremely important. The indicators, when properly administered, are an essential tool for managing programs and services, and for evaluating the health system. This is a qualitative, multiple-case study that aimed to learn from the knowledge of professionals of the Family Health teams and support teams about using health indicators in Primary Health Care (PHC) in Belo Horizonte, Minas Gerais, Brazil. Currently, in the city, 26 indicators are employed, which were presented and discussed in the PHC Qualification Workshops, promoted in 2010 by the Municipal Government of Belo Horizonte and the Public Health School of Minas Gerais. To employ the indicators, it is necessary that the professionals involved in the process be duly trained until they have a real understanding of them. The results show that some professionals have a broad concept of the indicators. Others have rudimentary notions. In general, the applicability of this tool is low. This is reflected in the actions, in developing programs and achieving goals, showing that there are barriers to be faced by the Family Health teams. The need is clear for continuing education for health professionals so that the teams are increasingly well trained to effectively employ health indicators, focusing on the quality of health assistance in Primary Health Care.

Procedimentos Minimamente Invasivos ? Formas Direta e Videoassistida no Tratamento das Cardiopatias / Minimally Invasive Procedures - Direct and Video-Assisted Forms in the Treatment of Heart Diseases

Fundamento: Procedimentos cardiovasculares minimamente invasivos têm sido progressivamente empregados no tratamento das cardiopatias. Objetivo: Descrever as técnicas e os resultados imediatos dos procedimentos minimamente invasivos ao longo de uma experiência de 5 anos. Métodos: Estudo unicêntrico, descritivo e prospectivo, com abordagem quantitativa, no qual 102 pacientes foram submetidos a procedimentos minimamente invasivos de forma direta e de forma videoassistida. Foram avaliadas variáveis clínicas, operatórias e evolução imediata dos pacientes operados. Resultados: Quatorze pacientes foram submetidos a procedimentos minimamente invasivos diretos e 88 a videoassistidos. Entre os submetidos a procedimentos minimamente invasivos diretos, 13 tinham cardiopatia valvar aórtica. Entre os submetidos a procedimentos minimamente invasivos videoassistidos, 43 tinham cardiopatia valvar mitral, 41 defeito do septo interatrial e quatro tumores. Entre os portadores de cardiopatia valvar mitral, foram realizadas 26 trocas e 17 reconstruções valvares. As médias de tempo de clampeamento aórtico, de extracorpórea e do procedimento foram, respectivamente, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutos entre os submetidos a procedimentos minimamente invasivos diretos. Já entre os submetidos a procedimentos minimamente invasivos videoassistidos, foram 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutos, respectivamente. Considerando os tempos de terapia intensiva e de internamento, foram 41,1 ± 14,7 horas e 4,6 ± 2 dias entre os submetidos a procedimentos minimamente invasivos diretos e 36,8 ± 16,3 horas e 4,3 ± 1,9 dias entre os videoassistidos. Conclusão: Procedimentos minimamente invasivos foram empregados de duas formas - direta e videoassistida - com segurança no tratamento das cardiopatias ...

Background: Minimally invasive cardiovascular procedures have been progressively used in heart surgery. Objective: To describe the techniques and immediate results of minimally invasive procedures in 5 years. Methods: Prospective and descriptive study in which 102 patients were submitted to minimally invasive procedures in direct and video-assisted forms. Clinical and surgical variables were evaluated as well as the in hospital follow-up of the patients. Results: Fourteen patients were operated through the direct form and 88 through the video-assisted form. Between minimally invasive procedures in direct form, 13 had aortic valve disease. Between minimally invasive procedures in video-assisted forms, 43 had mitral valve disease, 41 atrial septal defect and four tumors. In relation to mitral valve disease, we replaced 26 and reconstructed 17 valves. Aortic clamp, extracorporeal and procedure times were, respectively, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutes in minimally invasive procedures in direct form. Between minimally invasive procedures in video-assisted forms, 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutes. Considering intensive care and hospitalization times, these were 41,1 ± 14,7 hours and 4,6 ± 2 days in minimally invasive procedures in direct and 36,8 ± 16,3 hours and 4,3 ± 1,9 days in minimally invasive procedures in video-assisted forms procedures. Conclusion: Minimally invasive procedures were used in two forms - direct and video-assisted - with safety in the surgical treatment of video-assisted, atrial septal defect and tumors of the heart. These procedures seem to result in longer surgical variables. However, hospital recuperation was faster, independent of the access or pathology. .

Minimally invasive procedures - direct and video-assisted forms in the treatment of heart diseases.

BACKGROUND: Minimally invasive cardiovascular procedures have been progressively used in heart surgery. OBJECTIVE: To describe the techniques and immediate results of minimally invasive procedures in 5 years. METHODS: Prospective and descriptive study in which 102 patients were submitted to minimally invasive procedures in direct and video-assisted forms. Clinical and surgical variables were evaluated as well as the in hospital follow-up of the patients. RESULTS: Fourteen patients were operated through the direct form and 88 through the video-assisted form. Between minimally invasive procedures in direct form, 13 had aortic valve disease. Between minimally invasive procedures in video-assisted forms, 43 had mitral valve disease, 41 atrial septal defect and four tumors. In relation to mitral valve disease, we replaced 26 and reconstructed 17 valves. Aortic clamp, extracorporeal and procedure times were, respectively, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutes in minimally invasive procedures in direct form. Between minimally invasive procedures in video-assisted forms, 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutes. Considering intensive care and hospitalization times, these were 41,1 ± 14,7 hours and 4,6 ± 2 days in minimally invasive procedures in direct and 36,8 ± 16,3 hours and 4,3 ± 1,9 days in minimally invasive procedures in video-assisted forms procedures. CONCLUSION: Minimally invasive procedures were used in two forms - direct and video-assisted - with safety in the surgical treatment of video-assisted, atrial septal defect and tumors of the heart. These procedures seem to result in longer surgical variables. However, hospital recuperation was faster, independent of the access or pathology.

Kidney Disease Improving Global Outcomes or creatinine kinetics criteria in acute kidney injury: a proof of concept study.

BACKGROUND: It has been recently mathematically demonstrated that the percentage increase in serum creatinine (SCr) can delay acute kidney injury (AKI) diagnosis in patients with previous chronic kidney disease (CKD). Based on creatinine (Cr) kinetics, it was suggested a new AKI classification using absolute increase in SCr elevation over specified time periods. However, this classification has not been evaluated in clinical studies. METHODS: A prospective cohort study evaluated myocardial infarction patients during the first 7 days of hospital stay with daily SCr measurements. They were classified using Kidney Disease Improving Global Outcomes (KDIGO) and Cr kinetics systems. Both classifications were compared by net reclassification improvement (NRI) and area under the receiver operator characteristic (AuROC) curve regarding hospital mortality. RESULTS: A total of 584 patients were included, of which 34.1% had previous CKD. Patients had more AKI by KDIGO than by Cr kinetics criteria (25.7 versus 18.0%, P < 0.001) and 81 patients (13.9%) had different AKI severity classification. Patients with AKI by KDIGO criteria and non-AKI by Cr kinetics had higher hospital mortality rates than patients with non-AKI using both classifications [adjusted mortality odds ratios (ORs): 4.753; 95% confidence interval (CI): 1.119-9.023, P = 0.014]. In patients with previous CKD, NRI analysis was 6.2% favoring Cr kinetics criteria. However, there was no difference using the AuROC curve analysis. In patients with no previous CKD, NRI analysis was 33.0%, favoring KDIGO, and this was in accordance with a better AuROC curve (0.828 versus 0.664, P < 0.05). CONCLUSIONS: AKI classification proposed by a Cr kinetics model can be superior when diagnosing patients with previous CKD. However, KDIGO had a better performance in patients with no previous CKD.

Indicadores de saúde e qualidade de vida no contexto da atenção primária à saúde / Indicadores de salud y calidad de vida en el contexto de la atención primaria de salud / Indicators of health and quality of life in the context of primary health care

Trata-se de um estudo qualitativo de casos múltiplos que objetivou conhecer a compreensão dos profissionais de equipesSaúde da Família e das equipes de apoio sobre o usode indicadores de saúde na Atenção Primária à Saúde (APS), em BeloHorizonte, Minas Gerais, Brasil. No município, atualmente, são trabalhados 26 indicadores, que foram apresentados ediscutidos nas Oficinas de Qualificação da APS, promovidas, em 2010, pela Prefeitura Municipal de BeloHorizonte e pelaEscola de Saúde Pública de Minas Gerais. Constatou-se que conhecer a real situação de saúde de uma população torna-seimprescindível para o planejamento e implementaçãode ações voltadas para a melhoria das condições desaúde. A partirda avaliação dos resultados dos indicadores, é possível o estabelecimento de metas, a comparação de padrões internos doserviço e externos à Instituição e o controle do desempenho das ações realizadas. Analisou-se que mensurar o nível desaúde e a qualidade de vida da população representauma dificuldade para os profissionais da área. A maioria dosentrevistados conseguiu expressar uma noção da ferramenta e de sua importância para o serviço, entretanto, nem todosdeclaram a aplicabilidade dos mesmos.

This is a multiple case qualitative study which aimed to identify the understanding of the professional staff of FamilyHealth and support staff about using health indicators in Primary Health Care (PHC) in Belo Horizonte,Minas Gerais,Brazil. Nowadays, there are 26 indicators in the borough which were presented and discussed in PHC Qualificationworkshops, promoted in 2010 by Municipal Town Hallof Belo Horizonte and the Health Public School of Minas Gerais. Itwas found that knowing about the real health situation of the population becomes essential to plan andimplement theactions focused on the improving of health conditions. From the evaluation of the results of indicators it is possible toestablish goals, to compare patterns of internal and external Service to the Institution and to control the performance ofthe actions. It was concluded that to measure the health level and the quality of the population’s life is very difficult forthe health professionals. The majority of the interviewees managed to express the sense of the tool and its importance tothe Service. However, not all of them declare theirapplicability.

Se trata de un estudio cualitativo de casos múltiples que tuvo como objetivo conocer la comprensión del personalprofesional de la salud de la familia y personal deapoyo sobre el uso de indicadores de salud de Atención Primaria deSalud (APS), en Belo Horizonte, Minas Gerais, Brasil. En la ciudad, hoy en día son trabajados 26 indicadores que fueronpresentados y discutidos en talleres de Capacitación de la APS, promovidos en 2010 por la Municipalidad de Belo Horizontey la Escuela de Salud Pública de Minas Gerais. Se encontró que el conocimiento del estado real de salud de una poblaciónes imprescindible para la planificación y ejecuciónde acciones destinadas a mejorar las condiciones de salud. De laevaluación de los resultados de los indicadores, esposible establecer metas, comparar los patrones deservicio interno yexterno a la institución y controlar la ejecución de las medidas adoptadas. Se analizó que medir el nivel de salud y calidadde vida representa una dificultad para los profesionales. La mayoría de los encuestados son capaces deexpresar unsentido de herramienta y su importancia para el Servicio. Sin embargo, no todos ellos declaran su aplicabilidad.