Grupos de Ajuda Mútua para Cuidadores Informais de pessoas com demência: no sentido de um helping ethos comunitário / Support Groups for Informal Caregivers of people with dementia: towards a communitarian helping ethos

Resumo No âmbito das intervenções comunitárias que são promovidas conjuntamente por entidades da área da saúde e do social, as intervenções grupais desenvolvidas para cuidadores informais de pessoas com demência têm se instituído como um importante tópico de investigação e objeto de reflexão profissional. O presente estudo tem como objetivo expor o funcionamento de um conjunto de Grupos de Ajuda Mútua (GAM) enquanto respostas de continuidade no apoio a cuidadores informais de pessoas com demência que participam em Programas Psicoeducativos. Partindo de um Projeto de Intervenção Comunitária realizado na zona Norte de Portugal (Projeto Cuidar de Quem Cuida), o estudo descreve cinco GAMs ocorridos em municípios diferentes e implementados/dinamizados por agentes de desenvolvimento local. São apresentados os seus objetivos e principais características de funcionamento enquanto resposta de continuidade. Os resultados revelam a sua importância para os cuidadores, nomeadamente para a dinamização/ manutenção de redes de apoio social informal no âmbito das escassas respostas especificamente destinadas para esta população, bem como para o papel fundamental dos seus agentes dinamizadores (técnicos de saúde e/ou da ação social). Conclui-se pela relevância dos GAMs enquanto iniciativa comunitária de entreajuda e de suporte ativo e continuado para cuidadores informais de idosos com demência.

Abstract Within community interventions that involve entities from both the health and the social sectors, group interventions for informal caregivers of individuals with dementia have received increased attention and are both a contemporary research topic and a subject of professional reflection. This study reports a set of distinct Support Groups for Informal Caregivers that were implemented after the caregivers' participation in a psychoeducational program. Based upon a community intervention project implemented in North Portugal (Caring for the Caregiver Project), the study describes five support groups established in five different municipalities and assumed by local agents from the health and/or social sectors. It focuses on each group's main objectives and functioning characteristics as a continuity response that was organized at a broad community level. Main findings stress the importance of these support groups on maintaining the caregivers' informal social network and mutual support system within a context of reduced services explicitly targeted for this population, and to the need of having a professional who assumes the role of organizing the sessions. Authors conclude on the relevance of support groups as a continuous and lively community intervention targeted at helping family carers of people with dementia.

Vibrating Platform Training Improves Respiratory Muscle Strength, Quality of Life, and Inspiratory Capacity in the Elderly Adults: A Randomized Controlled Trial.

BACKGROUND: Aging affects respiratory strength that could cause reduction in functional capacity and quality of life, playing a fundamental role in healthy aging and survival. To prevent these declines, the whole body vibration (WBV) has been proposed to increase strength and functional capacity. The aim of the study was to evaluate the effects of WBV on respiratory muscle strength, thoracoabdominal ventilation, and quality of life in the elderly adults. METHODS: This study was a controlled, randomized double-blind clinical trial. The study included 28 elderly adults randomized into three groups: Resistance (n = 9), WBV (n = 9), or WBV + resistance exercises (n = 10), performing training, sham, or double training for 3 months, twice per week. The variables of the study were as follows: maximal inspiratory and expiratory pressures (MIP and MEP), distribution of thoracoabdominal volumes variation in optoelectronic plethysmography (pulmonary rib cage-VRCp, abdominal rib cage-VRCa, and abdomen-VAB), and quality of life. RESULTS: After training, WBV and WBV + resistance groups increased MIP and MEP (p < .001). During inspiratory capacity maneuver, WBV groups had incremental increases in chest wall total volume (p < .001), showing a rise in pulmonary rib cage (p = .03) and abdominal rib cage (p = .04). Furthermore, WBV groups improved SF-36 scores in functional capacity, physical aspects, energy, pain, and general heath domains. CONCLUSIONS: The WBV is a training that could improve respiratory muscle strength and quality of life and promote different ventilatory strategies in chest wall and thoracoabdominal compartments in healthy elderly adults.

The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial.

QUESTIONS: In people with chronic obstructive pulmonary disease, does the Manual Diaphragm Release Technique improve diaphragmatic mobility after a single treatment, or cumulatively? Does the technique also improve exercise capacity, maximal respiratory pressures, and kinematics of the chest wall and abdomen? DESIGN: Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors. PARTICIPANTS: Twenty adults aged over 60 years with clinically stable chronic obstructive pulmonary disease. INTERVENTION: The experimental group received six treatments with the Manual Diaphragm Release Technique on non-consecutive days within a 2-week period. The control group received sham treatments following the same regimen. OUTCOME MEASURES: The primary outcome was diaphragmatic mobility, which was analysed using ultrasonography. The secondary outcomes were: the 6-minute walk test; maximal respiratory pressures; and abdominal and chest wall kinematics measured by optoelectronic plethysmography. Outcomes were measured before and after the first and sixth treatments. RESULTS: The Manual Diaphragm Release Technique significantly improved diaphragmatic mobility over the course of treatments, with a between-group difference in cumulative improvement of 18mm (95% CI 8 to 28). The technique also significantly improved the 6-minute walk distance over the treatment course, with a between-group difference in improvement of 22 m (95% CI 11 to 32). Maximal expiratory pressure and sniff nasal inspiratory pressure both showed significant acute benefits from the technique during the first and sixth treatments, but no cumulative benefit. Inspiratory capacity estimated by optoelectronic plethysmography showed significant cumulative benefit of 330ml (95% CI 100 to 560). The effects on other outcomes were non-significant or small. CONCLUSION: The Manual Diaphragm Release Technique improves diaphragmatic mobility, exercise capacity and inspiratory capacity in people with chronic obstructive pulmonary disease. This technique could be considered in the management of people with chronic obstructive pulmonary disease. TRIAL REGISTRATION: NCT02212184.

A construção do laço educador-bebê a partir da Metodologia IRDI / Construction of the educator-baby bond from the IRDI Methodology / La construction du lien enseignant-enfant à partir le méthode IRDI / La construcción del enlace educador-bebé a partir de la Metodología IRDI

O presente artigo apresenta uma reflexão a partir de uma cena bservada em uma creche na cidade de São Paulo. Discute-se o modo pelo qual um profissional, atravessado pela psicanálise, trabalhando nesta creche cria condições para o surgimento de um enlace do professor com o bebê da creche tendo como referência a Metodologia IRDI. Esta metodologia é um procedimento de acompanhamento do desenvolvimento psíquico feito por psicanalistas em instituições de Educação Infantil por meio de indicadores clínicos com valor de previsão precoce de problemas de desenvolvimento. Conclue-se que é necessária a existência de uma transferência entre o professor da creche e o profissional, o que dá suporte para a construção deste enlace...

This article presents a reflection from a scene observed inside a nursery in the city of São Paulo. The way which a professional, working in the nursery, crossed by psychoanalysis, creates conditions for the emergence of a bond between teacher and baby in daycare is here discussed, using as reference the IRDI Methodology. This method is a procedure for the monitoring of psychic development by psychoanalysts in early childhood institutions through clinical indicators with predictive values of early developmental problems. We conclude that the existence of a dialogue between the teacher and the nursery rofessional is necessary in order to support the development of the bond...

Cet article présente une réflexion sur une scène qui a eu lieu dans une pépinière dans la ville de São Paulo. Il examine la façon dont un professionnel, traversé par la psychanalyse, qui travaille dans cette pépinière, crée les conditions pour l’émergence d’un lien entre l’enseignant et l’enfant, en prenant comme référence la méthode IRDI. Cette méthode est une procédure de accompagnement du développement mental par des psychanalystes dans l’éducation préscolaire. Les psychanalystes utilisent des indicateurs cliniques qui ont une valeur prédictive des problèmes de développement précoce. Nous concluons que l’existence d’un transfert entre l’enseignant et le professionnel de la pépiniè...

En este artículo se presenta una reflexión a partir de una escena observada en una guardería de la ciudad de São Paulo. Se describe la forma como un profesional, atravesado por el psicoanálisis, trabajando en esta guardería, crea las condiciones para el surgimiento de un enlace del educador con el bebé en este establecimiento, teniendo como referencia la metodología IRDI. Esta es un procedimiento para el seguimiento del desarrollo psíquico por los psicoanalistas en las instituciones de Educación Inicial a través de indicadores clínicos capaces de diagnosticar temprano a los problemas de desarrollo. Se llega a la conclusión de que es necesaria la existencia de una transmisión entre el profesor y el profesional de la guardería, base para la construcción de este enlace...

A construção do laço educador-bebê a partir da Metodologia IRDI / Construction of the educator-baby bond from the IRDI Methodology / La construction du lien enseignant-enfant à partir le méthode IRDI / La construcción del enlace educador-bebé a partir de la Metodología IRDI

O presente artigo apresenta uma reflexão a partir de uma cena bservada em uma creche na cidade de São Paulo. Discute-se o modo pelo qual um profissional, atravessado pela psicanálise, trabalhando nesta creche cria condições para o surgimento de um enlace do professor com o bebê da creche tendo como referência a Metodologia IRDI. Esta metodologia é um procedimento de acompanhamento do desenvolvimento psíquico feito por psicanalistas em instituições de Educação Infantil por meio de indicadores clínicos com valor de previsão precoce de problemas de desenvolvimento. Conclue-se que é necessária a existência de uma transferência entre o professor da creche e o profissional, o que dá suporte para a construção deste enlace.(AU)

This article presents a reflection from a scene observed inside a nursery in the city of São Paulo. The way which a professional, working in the nursery, crossed by psychoanalysis, creates conditions for the emergence of a bond between teacher and baby in daycare is here discussed, using as reference the IRDI Methodology. This method is a procedure for the monitoring of psychic development by psychoanalysts in early childhood institutions through clinical indicators with predictive values of early developmental problems. We conclude that the existence of a dialogue between the teacher and the nursery rofessional is necessary in order to support the development of the bond.(AU)

Cet article présente une réflexion sur une scène qui a eu lieu dans une pépinière dans la ville de São Paulo. Il examine la façon dont un professionnel, traversé par la psychanalyse, qui travaille dans cette pépinière, crée les conditions pour l’émergence d’un lien entre l’enseignant et l’enfant, en prenant comme référence la méthode IRDI. Cette méthode est une procédure de accompagnement du développement mental par des psychanalystes dans l’éducation préscolaire. Les psychanalystes utilisent des indicateurs cliniques qui ont une valeur prédictive des problèmes de développement précoce. Nous concluons que l’existence d’un transfert entre l’enseignant et le professionnel de la pépiniè...(AU)

En este artículo se presenta una reflexión a partir de una escena observada en una guardería de la ciudad de São Paulo. Se describe la forma como un profesional, atravesado por el psicoanálisis, trabajando en esta guardería, crea las condiciones para el surgimiento de un enlace del educador con el bebé en este establecimiento, teniendo como referencia la metodología IRDI. Esta es un procedimiento para el seguimiento del desarrollo psíquico por los psicoanalistas en las instituciones de Educación Inicial a través de indicadores clínicos capaces de diagnosticar temprano a los problemas de desarrollo. Se llega a la conclusión de que es necesaria la existencia de una transmisión entre el profesor y el profesional de la guardería, base para la construcción de este enlace.(AU)

[Montessori method applied to dementia - literature review]. / Método de Montessori aplicado à demência - revisão da literatura.

The Montessori method was initially applied to children, but now it has also been applied to people with dementia. The purpose of this study is to systematically review the research on the effectiveness of this method using Medical Literature Analysis and Retrieval System Online (Medline) with the keywords dementia and Montessori method. We selected lo studies, in which there were significant improvements in participation and constructive engagement, and reduction of negative affects and passive engagement. Nevertheless, systematic reviews about this non-pharmacological intervention in dementia rate this method as weak in terms of effectiveness. This apparent discrepancy can be explained because the Montessori method may have, in fact, a small influence on dimensions such as behavioral problems, or because there is no research about this method with high levels of control, such as the presence of several control groups or a double-blind study.

Método de Montessori aplicado à demência: revisão da literatura / Montessori Method applied to dementia: literature review / Método Montessori aplicado a la demencia: revisión de la literatura

O método de Montessori foi aplicado inicialmente às crianças, mas atualmente aplica-se a pessoas com demência. O objetivo deste trabalho é fazer uma revisão sistemática da investigação sobre a eficácia desse método, utilizando a Medical Literature Analysis and Retrieval System Online (Medline) com as palavras-chave demência e método de Montessori. Foram selecionados 10 estudos, onde se verificam melhorias significativas na participação e no envolvimento construtivo e diminuição dos afectos negativos e do envolvimento passivo. Não obstante, as revisões da literatura acerca desta intervenção não farmacológica em demência classificam esse método como fraco, em termos de eficácia. Essa aparente discrepância pode explicar-se porque o método de Montessori pode ter, de fato, uma influência pouco significativa em dimensões como a dos problemas comportamentais ou porque não existe investigação acerca desse método com elevados níveis de controle como são a presença de vários grupos de controle ou o duplo-cego.

The Montessori method was initially applied to children, but now it has also been applied to people with dementia. The purpose of this study is to systematically review the research on the effectiveness of this method, using Medical Literature Analysis and Retrieval System Online (Medline) with the keywords dementia and Montessori method. We selected 10 studies, in which there were significant improvements in participation and constructive engagement, and reduction of negative affects and passive engagement. Nevertheless, systematic reviews about this non-pharmacological intervention in dementia rate this method as weak in terms of effectiveness. This apparent discrepancy can be explained because the Montessori method may have, in fact, a small influence on dimensions such as behavioral problems, or because there is no research about this method with high levels of control, such as the presence of several control groups or a double-blind study.

El método Montessori se aplicó inicialmente a los niños, pero ahora se aplica a las personas con demencia. El propósito de este estudio es revisar de forma sistemática la investigación sobre la eficacia de este método, utilizando Medical Literature Analysis and Retrieval System Online (Medline) con las palabras clave demencia y método Montessori. Se seleccionaron 10 estudios, que tienen mejoras significativas en la participación y en el compromiso constructivo, y la reducción de efectos negativos y de la participación pasiva. Sin embargo, la revisión de la literatura sobre esta intervención no farmacológica en la demencia clasifica este método como débil en términos de eficacia. Esta aparente discrepancia puede explicarse porque el método Montessori puede tener una influencia poco significativa en los problemas de conducta, o porque no hay investigación sobre este método con altos niveles de control como son la presencia de varios grupos de control o el estudio doble ciego.

Perfil da terapia analgésica utilizada na dor pós-operatória de hemorroidectomia / Perfil de la terapia analgésica utilizada en el dolor postoperatorio de hemorroidectomía / Study on the profile of the analgesic therapy used in postoperative pain of hemorrhoidectomy

O objetivo deste estudo foi analisar o perfil terapêutico dos medicamentos prescritos para pacientes hemorroidectomizados no período pós-operatório quanto à classificação terapêutica, ao tipo de regime analgésico e ao potencial para interação. O estudo, de caráter descritivo, foi realizado a partir de 246 prescrições médicas de pacientes adultos, hospitalizados no período de 2002 a 2004 em hospital privado da cidade de São Paulo. Para classificação terapêutica e analise do potencial interativo dos medicamentos utilizaram-se, respectivamente, o sistema Alfa e a literatura. Os dados foram analisados por meio de estatística descritiva. A casuística foi composta por 54,6% de pacientes do sexo feminino, cuja média de idade era 44,4 anos (dp±9,8). Os analgésicos (46,2%) e os agentes com ação no sistema digestório (46,1%) foram os mais utilizados, destacando-se a dipirona (83,7%) e a lactulose (70,3%). Para o controle da dor destacou-se o regime multimodal (88,6%) e a associação entre antiinflamatórios não-esteroidais (49,6%), Cerca de um terço dos medicamentos (38,5%) apresentou potencial interativo, sendo os inibidores enzimáticos (60%) os mais freqüentes. O conhecimento do perfil farmacológico dos medicamentos é essencial para evitar respostas iatrogênicas nos pacientes, principalmente quando expostos a polifarmácia.

In the context of analgesic therapy, the characteristic of the medicine represents an important variable that helps to predict the potential of interaction of each agent. The purpose this study was to analyze the therapeutic profile of medicines used in the postoperative period (PO) by patients submitted to hemorrhoidectomy. These profiles were divided into the following categories: therapeutic classification, adverse drug reactions and drug interaction potential. This descriptive study comprises 246 medical prescriptions of adult patients hospitalized between 2002 and 2004 in a private hospital of Sao Paulo. There was predominance of female patients (54.6%), whose average age was 44.4 years. The Alpha system was used for the therapeutic classification of medicines. Data was analyzed through descriptive statistics. The class of analgesics (46.2%) and medicine with action in the digestion system (46,1%) had been used. Dypirone (83.7%) and lactulose (70.3%) were among the most prescribed medicines. About one third (38.5%) of the medicines presented interactive potential, with prominence for enzymatic inhibitors (60%) classified as precipitants, which had been used as adjuvant in the therapy. The nervous and gastrointestinal systems potentially were most affected by the adverse drug reactions, representing 69.2%. The understanding of the pharmacologic profile of medicines, as well as the pharmacokinetic, adverse drug reactions, mechanism of action are essential to prevent iatrogenic response in patients, mainly when they are exposed to polypharmacy.

El objetivo de este estudio fue analizar el perfil terapéutico de las medicinas prescriptas para pacientes hemorridectomizados en el período postoperatorio con relación a la clasificación terapéutica, al tipo de régimen analgésico y al potencial para la interacción. El estudio, de carácter descriptivo, fue realizado a partir de 246 prescripciones médicas de pacientes adultos, hospitalizados en el periodo de 2002 a 2004, en hospital privado de la ciudad de São Paulo. Para la clasificación terapéutica y análisis del potencial interactivo de los medicamentos se utilizaron, respectivamente, del sistema Alfa y de la literatura. Los datos fueran analizados a través de estadística descriptiva. La casuística fue compuesta por 54.6% de pacientes del sexo femenino, cuya media de edad era de 44.4 años (dp±9,8). Los analgésicos (46,2%) y los agentes con acción en el sistema digestivo (46,1%) fueron los más utilizados, destacándose la dipirona (83,7%) y la lactulose (70,3%). Para el control del dolor se destacó el régimen multimodal (88,6%) y la asociación entre antiinflamatorios no esteroideos (49,6%), Cerca de un tercio de los medicamentos (38,5%) presentó potencial interactivo, siendo los inhibidores enzimáticos (60%) los más frecuentes. El conocimiento del perfil farmacológico de los medicamentos es esencial para evitar respuestas iatrogénicas en los pacientes, principalmente cuando expuestos a polifarmacia.

Post hatching development: a novel system for extended in vitro culture of bovine embryos.

Although acceptable rates of blastocyst formation are achieved with in vitro production of bovine embryos, several problems still compromise the subsequent development of the fetus and newborn, especially in embryos originating from somatic cell nuclear transfer. Routinely, the potential development of a bovine conceptus is predicted either on blastocyst quality or on various parameters related to the embryonic-fetal development in a foster mother. These methods are either imprecise or costly, highlighting the need for more reliable and practical methods to evaluate early embryonic development and differentiation. Thus, our aim was to improve the in vitro culture of embryos post hatching and to define a stable and repeatable system to monitor the development of bovine embryos. For that, in vitro-derived embryos were cultured in agarose gel tunnels in a modified culture medium (SOFaaci within 10% fetal bovine serum and 27.7 mM glucose). Daily monitoring of embryo length revealed that 56%-67% of the embryos in culture showed rapid growth and elongated until Day 13. Electron microscopy of elongated embryos at Day 14 confirmed successful localization of differentiated cells forming the trophoblast and hypoblast, with the definition of the Rauber layer. In conclusion, a stable culture system of post hatching embryos was first defined and can be used as a model for rapid growth, elongation, and initial differentiation of bovine post hatching embryos produced entirely in vitro.