Funcionamiento familiar, sobrecarga y calidad de vida del cuidador del adulto mayor con dependencia funcional / Family dynamics, overload, and quality of life among caregiver of functionally dependent older adults / Funcionamento familiar, sobrecarga e qualidade de vida no cuidador do idoso com dependência funcional

Resumen Introducción: Ser cuidador de personas con dependencia funcional conlleva el riesgo de presentar deterioro de la calidad de vida, esto puede deberse a que la prolongación del cuidado altera la dinámica familiar y genera sobrecarga en el cuidador. Objetivo: 1) Identificar la relación entre funcionamiento familiar y calidad de vida del cuidador del adulto mayor y 2) Determinar la sobrecarga y calidad de vida del cuidador del adulto mayor. Metodología: Estudio descriptivo y correlacional, muestreo por bola de nieve, la muestra conformada por 86 cuidadores de un centro comunitario. Para las mediciones se utilizó el índice de Barthel, el Test de APGAR Familiar, la prueba de Zarit y la Escala de Calidad de Vida WHOQOL-BREF. Se aplicó la Prueba de Kolmogorov Smirnov y Prueba de Correlación de Spearman. Resultados: El 11.6% de los adultos mayores presentó dependencia total, la percepción de disfuncionalidad familiar grave representó el 3.5%. Los cuidadores con sobrecarga intensa fueron el 32.6%, el 8.1% percibió la calidad de vida deficiente. A mayor funcionamiento familiar mayor calidad de vida del cuidador (p<.05) y a mayor sobrecarga, menor calidad de vida del cuidador (p<.05) en todas las dimensiones. Conclusiones: Se observó que la sobrecarga y funcionalidad familiar están relacionadas con la calidad de vida del cuidador, por lo que se convierten en un escenario disciplinar que plantea la posibilidad de diseñar estrategias de intervención, centradas en la sobrecarga y el funcionamiento de la familia para el mejoramiento de la calidad de vida del cuidador.

Abstract Introduction: The prolonged provision of healthcare to functionally dependent persons can result in the deterioration on the caregiver's quality in terms of family dynamics and overload. Objectives: 1) To identify the relationship between the family dynamics and the quality of life of the caregiver of older adults; and 2) to estimate the quality of life and the overload of the caregiver of older adults. Methodology: This is a descriptive and correlational study with a snowball-derived sample of 86 caregivers in a communitarian center. The corresponding measures were estimated using the Barthel Index, the Family APGAR Test, the Zarit Test, and the WHOQOL-BREF Quality of Life Scale. The Kolmogorov-Smirnov and Spearman Correlation tests were calculated. Results: 11.6% of the older adults being cared showed total dependency. 3.5% of the caregiver's sample perceived having a severe family dysfunction. 32.6% of the sample were found having heavy overloads. 8.1% of the sample perceived having poor quality of life. In all dimensions, the better the family dynamics were, the better the quality of life of the caregivers was (p<.05), and the heavier the overload was, the worse the quality of life of the provider was (p<.05). Conclusions: It was noted that both, overload and family dynamics, are related to the quality of life of the caregivers of older adults; therefore, the design of intervention strategies should be focused on the overload and family dynamics of these professionals in order to improve their quality of life.

Resumo Introdução: Ser cuidador de pessoas com dependência funcional implica o risco de apresentar deterioro da qualidade de vida, isto pode dever-se a que o prolongamento do cuidado altera a dinâmica familiar e gera sobrecarga no cuidador. Objetivo: 1) Identificar a relação entre funcionamento familiar e qualidade de vida do cuidador do idoso e 2) Determinar a sobrecarga e qualidade de vida no cuidador do idoso. Metodologia: Estudo descritivo e correlacional, amostragem por bola de neve, a amostragem conformada por 86 cuidadores de um centro comunitário. Para as medições utilizou-se o índice de Barthel, o Teste de APGAR Familiar, a prova de Zarit e a Escala de Qualidade de Vida WHOQOL-BREF. Aplicou-se a prova de Kolmogorov Smirnov e Prova de Correlação de Spearman. Resultados: O 11.6% dos idosos apresentou dependência total, a percepção de disfuncionalidade familiar grave representou o 3.5%. Os cuidadores com sobrecarga intensa foram o 32.6%, o 8.1% percebeu a qualidade de vida deficiente. Quanto maior funcionamento familiar, maior qualidade de vida do cuidador (p<.05) e quanto maior sobrecarga, menor qualidade de vida do cuidador (p<.05) em todas as dimensões. Conclusões: Observou-se que a sobrecarga e funcionalidade familiar estão relacionadas com a qualidade de vida do cuidador, pelo que se tornam em um cenário disciplinar que envolve a possibilidade de desenhar estratégias de intervenção, centradas na sobrecarga e o funcionamento da família para o melhoramento da qualidade de vida do cuidador.

Measuring a Lagrangian drifter's slip with an onboard ADCP.

A perfect Lagrangian drifter should move with the same velocity as the water volume that it is following. Deviations from this ideal will result in a relative velocity between the drifter's drogue and its surrounding water, commonly named "slip". Estimating a drifter's slip is difficult, especially for custom and heavily instrumented drifters. We propose to use a Self-Contained Acoustic Doppler Current Profiler (SCADCP) attached to the drifter to: •Measure the drifter's slip directly at the drogue depth.•Obtain complementary data of current at other depths.

The difficulty of the postural control task affects multi-muscle control during quiet standing.

The aim of this study was to compare the electromyographic (EMG) coherence between the lower limb and the core muscles when carrying out two postural tasks at different difficulty levels. EMG was recorded in 20 healthy male subjects while performing two independent quiet standing tasks. The first one involved a bipedal stance with the eyes open, while the second consisted of a dominant unipedal stance also with the eyes open. The obtained EMG signals were analysed by computing estimations of EMG-EMG coherence between muscle pairs, both singly (single-pair estimations) and combined (pooled estimations). Pooled and single coherence of anterior, posterior, core, antagonist and mixed pairs of muscles were significant in the 0-5 Hz frequency band. The results indicate that core and antagonist muscle groups, such as the anterior and posterior muscles, share low-frequency neural inputs (0-5 Hz) which could be responsible of the M-modes assembly. The core muscles could therefore provide the necessary synergy to maintain spine stability during the balancing exercise. Finally, differences in EMG-EMG coherence suggest that the muscle synergies formed during unipedal stance tasks are different from those established during bipedal stance.

Ultra-fast laser microprocessing of medical polymers for cell engineering applications.

Picosecond laser micromachining technology (PLM) has been employed as a tool for the fabrication of 3D structured substrates. These substrates have been used as supports in the in vitro study of the effect of substrate topography on cell behavior. Different micropatterns were PLM-generated on polystyrene (PS) and poly-L-lactide (PLLA) and employed to study cellular proliferation and morphology of breast cancer cells. The laser-induced microstructures included parallel lines of comparable width to that of a single cell (which in this case is roughly 20µm), and the fabrication of square-like compartments of a much larger area than a single cell (250,000µm(2)). The results obtained from this in vitro study showed that though the laser treatment altered substrate roughness, it did not noticeably affect the adhesion and proliferation of the breast cancer cells. However, pattern direction directly affected cell proliferation, leading to a guided growth of cell clusters along the pattern direction. When cultured in square-like compartments, cells remained confined inside these for eleven incubation days. According to these results, laser micromachining with ultra-short laser pulses is a suitable method to directly modify the cell microenvironment in order to induce a predefined cellular behavior and to study the effect of the physical microenvironment on cell proliferation.

Force normalization in paraplegics.

The principal aim of our study was the determination of the effectiveness of a standardized ratio, allometric scaling model and a gamma function model in normalizing the isometric torque data of spinal cord patients and healthy subjects. For this purpose we studied a sample of 21 healthy males and 23 spinal cord injury males. The experiment consisted of the measurement of the force of the upper limb movement executed by all the subjects. We also determined anthropometric variables with dual-energy x-ray absorptiometry. The experimental data were analyzed with 3 force normalization methods. Our results indicate that the most important confounding variable was the fat free mass of the dominant upper limb (r>0.36, p<0.05). With the standardization by body mass and allometric scaling model, the normalized torque was influenced by body size variables. However, the normalized torque by the gamma function model was independent of body size measures. Paraplegics were weaker (p<0.05) in extension movements when the data were normalized by the gamma function model. In summary, this study shows that the gamma function model with fat free mass of the dominant upper limb was more effective than the standardized ratio in removing the influence of body size variables.

Effect of fatigue on the intra-cycle acceleration in front crawl swimming: a time-frequency analysis.

The present study analyzes the changes in acceleration produced by swimmers before and after fatiguing effort. The subjects (n = 15) performed a 25-m crawl series at maximum speed without fatigue, and a second series with fatigue. The data were registered with a synchronized system that consisted of a position transducer (1 kHz) and a video photogrametry (50 Hz). The acceleration (ms(-2)) was obtained by the derivative analysis of the variation of the position with time. The amplitude in the time domain was calculated with the root mean square (RMS); while the peak power (PP), the peak power frequency (PPF) and the spectrum area (SA) were calculated in the frequency domain with Fourier analysis. On the one hand, the results of the temporal domain show that the RMS change percentage between series was 67.5% (p < 0.001). On the other hand, PP, PPF, and SA show significant changes (p < 0.001). PP and SA were reduced by 63.1% and 59.5%, respectively. Our results show that the acceleration analysis of the swimmer with Fourier analysis permits a more precise understanding of which propulsive forces contribute to the swimmer performance before and after fatigue appears.

La prescripción por principio activo en la Comunidad autónoma de Valencia / Prescription according to active ingredient in the community of Valencia, Spain

Con el objetivo de racionalizar el gasto farmacéutico e impulsada por los resultados alcanzados tras el acuerdo firmado con los Colegios Oficiales de Farmacéuticos de la Comunidad Autónoma de Valencia en 1996, la Cosellería de Sanidad desarrolla, a principios del presente año 2007, un nuevo sistema de precios máximos de financiación para aquellos medicamentos cuya prescripción se realice por principio activo. El resultado ha sido la firma de un acuerdo entre la Agencia Valenciana de Salud y los Colegios Oficiales de Farmacéuticos de las tres provincias. Tras una breve reflexión acerca de los antecedentes en la propia Comunidad y en otras donde se han firmado acuerdos similares, se pretende mostrar un análisis descriptivo de su desarrollo y principios, así como valorar su impacto a nivel tanto económico como sobre la práctica habitual de la profesión sanitaria desde los puntos de vista de los profesionales de la salud (facultativos y farmacéuticos), de los pacientes y de la propia administración pública (AU)

For the purpose of rationalizing pharmacy costs, and motivated by the results achieved after the agreement signed with the Official Pharmaceutical Associations of the Community of Valencia in1996, early this year, the Department of Health of the community developed a new system for establishing reference prices, or the maximum prices for public funding, for those drugs that are prescribed according to their active ingredient. The result was the signing of an agreement between the Valencia Health Agency and the Official Pharmaceutical Associations of the three provinces (Valencia, Alicante and Castellón). Following a brief reflection on the background in this community and in others in which similar agreements have been reached, the authors provide a descriptive analysis of its development and principles, and assess its impact both in economic terms and with respect to routine healthcare practice from the perspective of healthcare professionals 8physicians and pharmacists), of patients and of the public administration (AU)

Bacterial protein patterning by micro-contact printing of PLL-g-PEG.

Biomimetic micro-patterned surfaces of three S-layer (fusion) proteins, wild type (SbpA), enhanced green fluorescence protein (SbpA-EGFP) and streptavidin (SbpA-STV), were built by microcontact printing of poly-L-lysine grafted polyethylene glycol (PLL-g-PEG). The functionality of the adsorbed proteins was studied with atomic force microscopy and fluorescence microscopy. Atomic force microscopy (AFM) measurements showed that wild-type SbpA recrystallized on PLL-g-PEG free areas, while fluorescent properties of SbpA-EGFP and the interaction of SbpA-streptavidin heterotetramers with biotin were not affected due to the adsorption on the micro patterned substrates.

An open-label study of chronic polyethylene glycol laxative use in chronic constipation.

BACKGROUND: Polyethylene glycol 3350 (MiraLAX, Braintree Laboratories Inc., Braintree, MA, USA) is approved for the short-term treatment of occasional constipation. AIM: To extend the safety data of polyethylene glycol used for chronic treatment of chronic constipation. METHODS: Study subjects who met defined criteria for chronic constipation were enrolled in this open-labelled, single-treatment multi-centre study to receive polyethylene glycol laxative as a single daily dose of 17 g for 12 months. Subjects returned to their study centres after 2, 4, 6, 9 and 12 months of treatment where blood and urine samples were collected and adverse events were reviewed. At each visit, subjects were queried for ROME constipation criteria and they rated their overall improvement using a global efficacy scale. RESULTS: 311 patients including 117, age 65 and older, were enrolled and received treatment at one of 50 centres. One hundred and eighty-four completed all 12 months of treatment. With respect to the 'Global Efficacy Assessment', depending on the month of observation, 80-88% of enrolled patients, and 84-94% of the elderly, were treated successfully. Similar results were obtained from secondary efficacy measures that assessed individual ROME constipation criteria at each visit. The response to treatment was durable over time. Over the 1-year course of study representing 218 patient-years at the labelled dose, medication-associated adverse effects were gastrointestinal complaints of diarrhoea, loose stool, flatulence and nausea. These effects were generally mild or moderate in severity. There were no clinically significant changes in haematology or blood chemistry, particularly electrolytes, for the study population as a whole or the elderly group. CONCLUSIONS: Polyethylene glycol laxative is safe and effective for treating constipation in adult and elderly patients for periods up to 12 months, with no evidence of tachyphylaxis.

Surface electrical stimulation of the quadriceps femoris in patients affected by haemophilia A.

Eighteen sessions of surface electrical stimulation was applied to the quadriceps femoris of the left leg of ten male subjects affected by severe haemophilia A, while ten healthy subjects constituted the control group. The isometric strength, the electromyographic activity and the diameter of the rectus femoris were measured in both legs before and after a six-week treatment period. After the treatment, the people affected by haemophilia showed a gain in strength by 13.8% in the stimulated leg and by 17.1% in the non-stimulated one. No changes were detected in the electromyographic activity. On the contrary, the diameter of the rectus femoris of the stimulated leg increased in 24.34%, while no significant change was found in the nonelectrically stimulated leg. These results show for the first time that the application of electrical stimulation in haemophilic patients contributes to the gain and development of strength and trophism. The results also show that the surface electrical stimulation does not represent a threat to the patients' health, and that can be used for therapeutic purposes.

Local versus global interactions in nonequilibrium transitions: A model of social dynamics.

A nonequilibrium system of locally interacting elements in a lattice with an absorbing order-disorder phase transition is studied under the effect of additional interacting fields. These fields are shown to produce interesting effects in the collective behavior of this system. Both for autonomous and external fields, disorder grows in the system when the probability of the elements to interact with the field is increased. There exists a threshold value of this probability beyond which the system is always disordered. The domain of parameters of the ordered regime is larger for nonuniform local fields than for spatially uniform fields. However, the zero field limit is discontinous. In the limit of vanishingly small probability of interaction with the field, autonomous or external fields are able to order a system that would fall in a disordered phase under local interactions of the elements alone. We consider different types of fields which are interpreted as forms of mass media acting on a social system in the context of Axelrod's model for cultural dissemination.

Influence of the oceanographic conditions during spring 2003 on the transport of the Prestige tanker fuel oil to the Galician coast.

Hydrographic data collected during the cruise HIDROPRESTIGE were combined with meteorological and dynamic data provided by remote sensors and drifting/moored buoys, to describe the surface circulation of the Northern Iberian basin in March-April 2003. Sea surface winds transported the floating Prestige oil slicks from the sinking area to the continental slope off the Rías Baixas in 1/2 month: the surface current intensity was 2% of the wind intensity and it was rotated clockwise 5 degrees from the wind direction. Mesoscale cyclonic and anticyclonic structures west of 10 degrees W increased the residence time of oil patches in the Northern Iberian basin, as compared with the expected southwards flow of the Iberian current (IC). On the other hand, the Iberian poleward current (IPC) formed a marked surface front with coastal waters, preventing the entry of fuel oil into the rías. PAHs in the surface layer during the cruise were <0.5 microgL(-1), except in the Galicia bank (approximately 1 microg L(-1); where the Prestige tanker was still leaking) and the vicinity of Cape Fisterra (approximately 1.5 microg L(-1); where the convergence front between the IPC and coastal waters vanished).

Establecimiento de un único modelo de atención farmacéutica en los centros sociosanitarios de la Comunidad Valenciana / No disponible

La elevada incidencia de problemas relacionados con la medicación en la población geriátrica ofrece unaoportunidad al farmacéutico para disminuir la morbilidad y el coste de los tratamientos farmacológicos. Larespuesta a esta demanda, en el ámbito sociosanitario de la Comunidad Valenciana, se plasmó en el Programade Atención Farmacéutica en centros sociosanitarios dependientes de la Dirección General de ServiciosSociales de la Conselleria de Bienestar Social.Este programa de atención farmacéutica sociosanitario, pionero en España, que se inició en el año 1990 enla Residencia Mixta de Carlet (Valencia), se realizó en coordinación con la Conselleria de Sanidad. Actualmente, el Programa de Atención Farmacéutica sociosanitario está implantado en Centros sociosanitarios Públicos y en Centros de Discapacitados Psíquicos, siendo cinco los Servicios de Farmacia ubicados en toda la Comunidad Valenciana, realizándose la dispensación de medicamentos en dosis unitarias.Desde el Servicio de Provisión y Asistencia Farmacéutica de la Dirección General de Farmacia y ProductosSanitarios de la Conselleria de Sanidad, se propone establecer un único modelo de Atención Farmacéuticaen Centros sociosanitarios, dando cobertura no sólo a los Centros de titularidad Pública sino también a losCentros de titularidad Privada. Dicho proyecto de futuro está basado en un análisis DAFO, donde se reflejanlas Debilidades, Amenazas, Fortalezas y Oportunidades del sistema

The high incidence of drug-related problems among the geriatric population provides an opportunity for thepharmacist to reduce the morbidity and costs associated with drug treatments. The response to this demand,in the social health care setting of the Community of Valencia, Spain, was reflected in the PharmaceuticalCare Program in the social health care centers under the General Social Services Administration of the SocialWelfare Department.This program of social health pharmaceutical care, a pioneering effort in Spain, initiated in 1990 at theResidencia Mixta in Carlet, Valencia, was carried out in cooperation with the Health Care Department. To date, the social health pharmaceutical care program has been introduced into public social health care centers and centers for the mentally handicapped. There are now five pharmacy services throughout the Community of Valencia that dispense medications in unit doses.The Pharmaceutical Care and Provision Service of the General Pharmacy and Health Care Products Administrationof the Health Care Department proposes to establish a single model for pharmaceutical care in social health care centers, providing coverage not only to public centers but to private centers as well. Thisprojection for the future is based on a SWOT analysis reflecting the strengths, weaknesses, opportunities and threats of the system (AU)

La nueva reglamentación sobre ensayos clínicos multicéntricos y su repercusión en el funcionamiento de los actuales Comités Éticos de Investigación Clínica / New regulation for multicenter clinical trials and its repercussions on the function of current clinical trial ethics committees

No disponible

Analysis of sweet diterpene glycosides from Stevia rebaudiana: improved HPLC method.

An improved analytical method was developed which may be applied to quality control of stevioside and rebaudioside A contents in dried leaves of Stevia rebaudiana before processing; in a selective sampling program searching for plants of higher yield in diterpene glycosides content; or when a large number of samples are sent to the laboratory for analysis. The procedure developed involves two steps: solvent extraction followed by an isocratic HPLC analysis. The sample, 1 g of dried leaves of S. rebaudiana, is ground and solvent-extracted with EtOH 70% (w/w) in Erlenmeyer flasks by shaking for 30 min in a 70 degrees C water bath. After the extract was cooled, it was filtered and analyzed by HPLC using an NH(2) column (250 x 4.6 mm) and a mixture of acetonitrile/water (80:20, v/v) as mobile phase, pH 5 adjusted with acetic acid. The detection was in the UV range at 210 nm (0.04 AUFS). Quantitation was performed by means of an external standard calibration curve for each analyte which had been obtained from standard solutions of pure stevioside and rebaudioside A. Working under these conditions there were no observed interference effects. The method saves time in sample preparation, and reduces sample handling and chromatographic analysis time, while having little loss of precision [coefficient of variation (CV%) between 1.8% and 3.0%] and recovery [between 98.5% and 100.5%]. The method was applied to 30 samples of S. rebaudiana from Misiones (Northeastern Argentina), and the stevioside content found ranged between 3.78 and 9.75% (weight) whereas Rebaudioside A content ranged between 1.62 and 7.27% (weight).

Chronic hepatitis C: implications for the primary care clinician.

The seeds of an epidemic were sown 2 decades ago, and PAs need to be alert for those at risk for developing chronic hepatitis C before cirrhosis, liver failure, or liver cancer develops. Identifying the patient at risk is as uncomplicated as asking the right questions in the right setting.

X-ray diffraction and foam film investigations of PC head group interaction in water/ethanol mixtures.

The influence of ethanol on single phospholipid monolayers at the water/air interface and in foam films has been investigated. Grazing incidence X-ray diffraction investigations (GIXD) of Langmuir monolayers from 1,2-distearoyl-phosphatidylcholine (DSPC) spread on water subphases with different amounts of ethanol were performed. The thickness and free specific energy of formation of foam films stabilized by 1,2-dimyristoyl-phosphatidylcholine (DMPC) at different concentrations of ethanol in the film forming dispersions were measured. The GIXD investigations show that the tilt angle of the alkyl chains in the PC lipid monolayer decreases with increasing concentration of ethanol caused by a decrease of the diameter of the head groups. With increasing ethanol content of the solution also the thickness of the aqueous core of PC lipid foam films decreases. We assume that ethanol causes a decreasing probability for the formation of hydrogen bonds of water molecules to the PC head groups. The distinct difference between the effects of ethanol on lipid bilayers as described in the literature and on monolayers and foam films found in this study is discussed. Whereas PC monolayers at the water/air interface become unstable above 25 vol.% ethanol, the PC foam films are stable up to 50 vol.% ethanol. This is related to the decrease of the surface excess energy per lipid molecule by the interaction between the two film surfaces.