Características sociodemográficas en cuidadores principales de pacientes operados de cáncer de cerebro / Socio-demographic characteristics in primary caregivers of patients with brain cancer surgery

RESUMEN Introducción: la atención al enfermo es llevada a cabo por una secuencia específica de la familia, por lo que esta es considerada un cuidador principal. Objetivo: describir las características sociodemográficas en cuidadores principales de pacientes operados de cáncer de cerebro. Materiales y métodos : se realizó un estudio descriptivo, retrospectivo, en un universo de 128 cuidadores principales de pacientes operados de cáncer de cerebro en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, entre 2016 y 2018. Criterio de inclusión: cuidadores que residían en la provincia y aceptación del consentimiento informado. Se excluyeron familiares de pacientes que fallecieron durante la investigación. Se aplicaron cuestionarios y entrevistas para caracterizar los resultados. Los mismos se analizaron en frecuencias absolutas, relativas, porcentual, en paquete estadístico de SPSS versión 20.0 en Windows. Resultados : predominó el sexo femenino (79,68 %). El 100 % de los cuidadores principales residían en casa del enfermo. Prevaleció el nivel de escolaridad de técnico medio (35,93 %); 88,28 % de los cuidadores mantenían vínculo laboral, y 41,40 % eran hermanas de los enfermos. Dentro de las necesidades de aprendizaje del cuidador, el déficit de conocimientos sobre la enfermedad constituyó el 73,43 %. Conclusiones: imperó el género femenino en los cuidadores con vínculo laboral, y con mayor incidencia las hermanas. Se evidenció la complejidad del cuidado en el hogar de los pacientes con secuelas, minusvalía progresiva producidas por la enfermedad, y que generalmente la mujer asume con más facilidad (AU).

ABSTRACT Introduction: the care of the patient is carried out by a specific sequence of the family, catalogued as a main caregiver. Objective: to describe the socio-demographic characteristics in main caregivers of patients who underwent a brain cancer surgery. Materials and methods: a retrospective, descriptive study was carried out in a universe of 128 main caregivers of patients who underwent brain cancer surgery in the University Hospital Faustino Perez Hernandez, of Matanzas, from 2016 until 2018. Inclusion criteria: caregivers living in the province of Matanzas and giving the informed consent. The relatives of patients who died during the research were excluded. Interviews were made and questionnaires applied to characterize the results. They were analyzed in absolute, relative, and percentage frequencies in statistical packet Windows SPSS, 20.0. Results: female sex predominated (79.68%). 100% of main caregivers lived in the house of the patient. The technician scholarship predominated (35.93%); 88.28% of the caregivers kept their employment bonds, and 41.40% were patients' sisters. The deficit of knowledge on the disease was 73.43% of the caregiver learning necessities. Conclusions: female genre prevailed in caregivers with employment bonds, with higher incidence of sisters. It was evidenced the complexity of home care of the patients with sequels, progressive disabilities caused by the disease, generally assumed more easily by women (AU).

The Patterns of Caregiving Activities for Family Caregivers of Older Adults in Hong Kong: An Exploratory Latent Class Analysis.

OBJECTIVES: This study identified the classes (i.e., patterns) of caregivers' activities, based on their engagements in caregiving activities, and explored the characteristics and the caregiver burden of these classes. METHODS: This study was a secondary analysis of a cross-sectional survey on the profiles of family caregivers of older adults in Hong Kong. A latent class analysis approach was adopted to classify family caregivers (N = 932) according to their routine involvements in 17 daily caregiving activities: 6 activities of daily living (ADLs) and 8 instrumental activities of daily living activities (IADLs) in addition to emotional support, decision making, and financial support. Multinomial logistic regression and multiple linear regression illuminated the characteristics of the classes and compared their levels of caregiver burden. RESULTS: The family caregivers fell into 5 classes: All-Round Care (High Demand, 19.5%), All-Round Care (Moderate Demand, 8.2%), Predominant IADLs Care (High Demand, 23.8%), Predominant IADLs Care (Moderate Demand, 32.5%), and Minimal ADLs and IADLs Care (Low Demand, 16.0%). These classes exhibited different characteristics in terms of care recipients' cognitive statuses and caregiver backgrounds. The levels of caregiver burden differed across classes; the All-Round Care (High Demand) class experienced the highest levels of caregiver burden. DISCUSSION: This study contributes to existing scholarship by turning away from a predefined category of care tasks to explore the patterns of caregiving activities. By identifying caregiving activity patterns and understanding their associated characteristics and caregiver burden, prioritizing and targeting caregiver support interventions better is possible.

Reliability and Validity of the Function-Focused Care Checklist for Caregivers.

PURPOSE: The purpose of this study was to test the reliability and validity of the Function-Focused Care Checklist for Caregivers using Rasch analysis. DESIGN: This was a descriptive study using data from the study "Testing the Dissemination and Implementation of Function-Focused Care for Assisted Living Using the Evidence Integration Triangle." The study was approved by a university institutional review board. METHODS: A Rasch analysis was completed, which included 691 staff-resident observations from 85 assisted living facilities. FINDINGS: There was evidence of internal consistency (alpha coefficient of .93), construct validity except for a high OUTFIT statistic for wheelchair mobility, and hypothesis testing based on an increase in performance of function-focused care by caregivers over 12 months. CONCLUSIONS: The findings provided psychometric support for the measure and guidance for revisions. CLINICAL RELEVANCE: This measure can be used clinically to teach caregivers to provide function-focused care to residents in assisted living.

Factors associated with caregiving appraisal of informal caregivers: A systematic review.

AIMS AND OBJECTIVES: To identify factors associated with the caregiving appraisal of informal caregivers. BACKGROUND: Caregiving appraisal, the cognitive evaluation of the caregiving situation, is an essential factor in determining positive or negative caregiving outcomes. Identifying factors associated with appraisal is fundamental for designing effective health promotion strategies. DESIGN: A systematic review. METHODS: PubMed, EMBASE, CINAHL, PsycINFO, Social Sciences Citation Index, Scopus, CNKI and Wanfang Database were searched for papers published from 1984 to December 2018. Keywords related to informal caregivers' caregiving appraisal were used. Cross-sectional and cohort studies were included. The Quality Assessment and Validity Tool for Correlational Studies, and the CASP Cohort Study Checklist were used for quality assessment. Descriptive and narrative synthesis were used to analyse data. Social ecological model was used for classifying the associated factors into different levels. The PRISMA checklist was followed. RESULTS: Forty studies were included. The quality of the studies was moderate to high. Data were organised into three levels (individual, interpersonal and community level) and categorised into modifiable factors (e.g. patient behavioural problems, caregiver self-efficacy and social support) and nonmodifiable factors (e.g. caregiving duration, gender and education). The majority of studies have investigated the factors at the individual level. CONCLUSION: There are inconsistencies in the understanding of caregiving appraisal, and consensus is needed for conceptual clarity. Caregiving appraisal is associated with three levels of factors. These modifiable factors provide evidence for designing evidence-based interventions, and the nonmodifiable factors help identify confounding factors in assessment and appraisal. RELEVANCE TO CLINICAL PRACTICE: Nurses are the best-placed healthcare professionals to support informal caregivers. The three levels of associated factors and the interactive approaches provide direction for informing clinical nursing practice. They also provide evidence for healthcare researchers and policymakers to develop interventions and theoretical perspectives and to better allocate healthcare resources.

Profiles of family caregivers of patients at the end of life at home: a Q-methodological study into family caregiver' support needs.

BACKGROUND: Family caregivers of patients at the end of life often experience care-related burden. To prevent caregiver burden and to enhance the capacity to provide care it is important to have insight in their support needs. The purpose of this study was to identify profiles of family caregivers who provide care to patients at the end of life at home. METHODS: A Q-methodological study was conducted in which family caregivers ranked 40 statements on support needs and experiences with caregiving. Thereafter they explained their ranking in an interview. By-person factor analysis was used to analyse the rankings and qualitative data was used to support the choice of profiles. A set of 41 family caregivers with a variety on background characteristics who currently or recently provided care for someone at the end of life at home were included. RESULTS: Four distinct profiles were identified; profile (1) those who want appreciation and an assigned contact person; profile (2) was bipolar. The positive pole (2+) comprised those who have supportive relationships and the negative pole (2-) those who wish for supportive relationships; profile (3) those who want information and practical support, and profile (4) those who need time off. The profiles reflect different support needs and experiences with caregiving. CONCLUSIONS: Family caregivers of patients at the end of life have varying support needs and one size does not fit all. The profiles are relevant for healthcare professionals and volunteers in palliative care as they provide an overview of the main support needs among family caregivers of patients near the end of life. This knowledge could help healthcare professionals giving support.

Factors associated with the development of diabetes mellitus in older caregivers.

OBJECTIVE: evaluate the factors associated with the risk of diabetes mellitus in older caregivers. METHOD: this is a cross-sectional study conducted with 326 older caregivers enrolled in Family Health Units. Data were collected using a sociodemographic characterization questionnaire, clinical and care information, and the Finnish Diabetes Risk Score to assess the risk of developing diabetes. RESULTS: 35.5% of the caregivers presented a high risk of developing diabetes. The factors associated with the risk of developing diabetes were: use of medication (OR = 3.88), satisfactory or poor health assessment (OR = 1.72), and the fact of being female (OR = 0.48). CONCLUSION: more than one third of older caregivers present high risk of developing diabetes. Therefore, being female, living with other people, using medication, and having a poor health assessment are factors associated with increased risk of developing diabetes.

The Correlation between Caregivers' Characteristics and Emotional Development of Pre-School Children in Depok, Indonesia.

This study aimed to identify the correlation between emotional developments in pre-school children and the caregivers' characteristics. This study employed cross sectional design with cluster sampling technique and involved 206 respondents. The inclusion criteria were mothers of a child aged 3-6 years old and willing to participate in the study. The result showed 42.7% children exhibited deviation in emotional development. There was a significant relationship of mother's education and emotional development in children (p = 0.024; α = 0.05). Children of unemployed mothers had higher percentage of emotional deviation compared to working mother, although it was not significantly different (p = 0.387; α = 0.05). There was no significant correlation between caregivers and emotional development in children (p = 0.102; α = 0.05), child's age and emotional development (p = 0.183; α = 0.05), and child's gender and emotional development (p = 0.206; α = 0.05). Based on these findings, the stimulation of emotional development should be integrated into the curriculum for pre-school children in order to optimize their development.

Necesidades de cuidado paliativo en hemodiálisis percibidas por pacientes, cuidadores principales informales y profesionales de enfermería / Needs of paliative care in hemodialysis perceived by patients, principal caregivers and nursing professionals

Introducción: La hemodiálisis (HD) puede mejorar la supervivencia en los pacientes con Enfermedad Renal Crónica (ERC), pero trae consigo complicaciones y efectos físicos negativos, cambios emocionales y de autoimagen que disminuyen la calidad de vida y determinan la necesidad de cuidados paliativos desde el inicio del tratamiento. Objetivo: Comprender las necesidades paliativas percibidas por el profesional de enfermería, pacientes sometidos a hemodiálisis y sus cuidadores principales informales atendidos en una Unidad Renal de la cuidad de Bogotá-Colombia. Material y Método: Estudio descriptivo, fenomenológico. Se recolectaron los datos a través de la entrevista a profundidad individual semiestructurada. Se entrevistaron 16 personas (6 pacientes, 5 cuidadores principales y 5 enfermeras). El tamaño de la muestra se determinó por saturación de datos. El análisis se llevó a cabo mediante el método propuesto por Colaizzi. Resultados: Emergieron 10 categorías: percepciones sobre la enfermedad, red de apoyo e interacción familiar, limitaciones laborales, económicas y sociales, red de apoyo asistencial, necesidades de afrontamiento de la persona y cuidador, intervenciones del equipo de salud, factores motivacionales para cuidar, cambios en los estilos de vida, generación de redes apoyo y proyecto de vida. Conclusión: La imposibilidad de continuar con el trabajo, los estudios y el proyecto de vida es la necesidad de mayor impacto negativo en cuanto a la calidad de vida de los pacientes y cuidadores familiares. Sentimientos de tristeza, soledad y baja autoestima están presentes en la mayoría de los pacientes y cuidadores que requieren de la intervención oportuna del equipo interdisciplinario

Introduction: Hemodialysis (HD) can improve survival in patients with Chronic Kidney Disease (CKD), but it causes complications and negative physical effects, emotional changes and self-image that diminish the quality of life and determine the need for palliative care from the beginning of treatment. Objective: To understand the palliative needs perceived by the nursing professional, patients on hemodialysis and by their main informal caregivers treated in a Renal Unit of the city of Bogotá - Colombia. Material and Method: Descriptive, phenomenological study. The data was collected through semi-structured in-depth interviews. Sixteen people were interviewed (6 patients, 5 main caregivers and 5 nurses). The sample size was determined by data saturation. The analysis was carried out using the method proposed by Colaizzi. Results: 10 categories emerged: Perceptions about the disease; Support network and family interaction; Labor, economic and social limitations; Support network; Needs of coping with the person and caregiver; Interventions of the health team; Motivational factors to care; Changes in lifestyles; Generation of support networks and Life project. Conclusion: The impossibility of continuing with working life, studies and life project is the need of greater negative impact in terms of the quality of life of patients and family caregivers. Feelings of sadness, loneliness and low self-esteem are present in most patients and caregivers who require timely intervention by the interdisciplinary team

Factors associated with the development of diabetes mellitus in older caregivers / Factores asociados al desarrollo de diabetes mellitus en ancianos cuidadores / Fatores associados ao desenvolvimento de diabetes mellitus em idosos cuidadores

ABSTRACT Objective: evaluate the factors associated with the risk of diabetes mellitus in older caregivers. Method: this is a cross-sectional study conducted with 326 older caregivers enrolled in Family Health Units. Data were collected using a sociodemographic characterization questionnaire, clinical and care information, and the Finnish Diabetes Risk Score to assess the risk of developing diabetes. Results: 35.5% of the caregivers presented a high risk of developing diabetes. The factors associated with the risk of developing diabetes were: use of medication (OR = 3.88), satisfactory or poor health assessment (OR = 1.72), and the fact of being female (OR = 0.48). Conclusion: more than one third of older caregivers present high risk of developing diabetes. Therefore, being female, living with other people, using medication, and having a poor health assessment are factors associated with increased risk of developing diabetes.

RESUMEN Objetivo: evaluar los factores asociados al riesgo de diabetes mellitus en ancianos cuidadores. Método: se trata de un estudio transversal, en el cual participaron 326 ancianos cuidadores registrados en Unidades de Salud de la Familia. Se utilizó en la recolección de datos un cuestionario de caracterización sociodemográfica, de informaciones clínicas y del cuidado, y en la evaluación del riesgo de desarrollo de la diabetes el Finnish Diabetes Risk Score. Resultados: el 35,5% de los cuidadores presentaron un alto riesgo de desarrollo de diabetes. Los factores asociados al riesgo de desarrollo fueron: el uso de medicamentos (OR = 3,88), la evaluación de la salud como regular o negativa (OR = 1,72) y ser del sexo femenino (OR = 0,48). Conclusión: más de un tercio de los los ancianos cuidadores presentaron un alto riesgo de desarrollo de diabetes. Por lo tanto, el hecho de ser del sexo femenino, residir con más personas, hacer uso de medicamentos y tener una evaluación negativa de la salud son los factores asociados al aumento de ese riesgo.

RESUMO Objetivo: avaliar os fatores associados ao risco de diabetes mellitus em idosos cuidadores. Método: trata-se de um estudo transversal, realizado com 326 idosos cuidadores cadastrados em Unidades de Saúde da Família. Para a coleta de dados utilizou-se um questionário de caracterização sociodemográfica, informações clínicas e do cuidado, e o Finnish Diabetes Risk Score para a avaliação do risco de desenvolvimento de diabetes. Resultados: dos cuidadores, 35,5% apresentaram alto risco de desenvolvimento de diabetes. Os fatores associados ao risco de desenvolvimento foram o uso de medicamentos (OR = 3,88), a avaliação da saúde regular ou negativa (OR = 1,72) e ser do sexo feminino (OR = 0,48). Conclusão: mais de um terço dos idosos cuidadores apresentam alto risco de desenvolvimento de diabetes. Portanto, ser do sexo feminino, residir com mais pessoas, fazer uso de medicamentos e ter uma avaliação negativa da saúde são fatores associados ao aumento desse risco.

Asociación entre el tipo de sintomatología neuropsiquiátrica percibida según el tipo de cuidador principal en pacientes con demencia evolucionada / No disponible

Objetivo: Los síntomas neuropsiquiátricos de los pacientes con demencia deterioran la calidad de vida tanto del cuidador como del paciente e incrementan los problemas mentales (depresión y ansiedad principalmente) en los cuidadores, con disminución de la esperanza de vida para ambos. El presente estudio intenta encontrar una asociación entre el tipo de sintomatología neuropsiquiátrica percibida según el tipo de cuidador principal en pacientes con demencia evolucionada, y la dificultad de estos cuidadores para asumir los cuidados en el domicilio, para beneficiar tanto a pacientes como a los cuidadores de estos. Método: Se incluyeron cuidadores de pacientes que ingresaron por cualquier causa en una Unidad de media estancia de Psicogeriatría y que padeciesen una demencia de cualquier etiología, en una fase moderada a severa y se valoraban la carga sintomática de los pacientes dementes mediante la escala de Cornell de depresión en demencia y el NPI-Q en su versión en castellano, y las características de los cuidadores. Resultados: Se analizaron los datos de 34 pacientes y sus familiares. No se encontró diferencias ni estadísticamente significativas ni objetivas entre el grupo de los pacientes que tenían un cuidador particular ni en los que tenían un cuidador familiar. La mayor parte de los pacientes presentaban sintomatología depresiva mayor asociada a la demencia según la escala cornell y el NPI-Q. Ambos grupos tenían unos valores elevados de NPI-Q, escala de cornell y un deterioro funcional muy importante.El síntoma más frecuente fue la apatía. El síntoma menos frecuente fue la euforia. Conclusión: No se encontró asociación estadísticamente significativa entre el tipo de cuidador y la gravedad de los SCPD percibidos

Objective: The neuropsychiatric symptoms of patients with dementia deteriorate the quality of life of both the patient and their caregivers. And increase the mental problems (depression and anxiety mainly) in the caregivers, with the decrease in life expectancy for both. The present study attempts to find an association between the type of neuropsychiatric symptomatology perceived according to the type of primary caregiver in patients with evolved dementia, and the difficulty of these caregivers for home care, to benefit both patients and caregivers. Method: Family members of patients admitted for any cause to a Psychogeriatric medium stay ward and suffering from dementia due to any aetiology were included. The patients were in a phase ranging from moderate to severe and the symptomatic burden of the patients was assessed through the Cornell depression scale in dementia and the NPI-Q in its Spanish version, and the characteristics of the caregivers. Results: The data of 34 patients and their caregivers were analysed. No statistically significant or objective differences were found between the group of patients who had a particular caregiver and those who had a family relative as their caregiver. Most of the patients presented major depressive symptomatology associated with dementia according to the Cornell scale and the NPIQ. Both groups had high values of NPI-Q, Cornell scale and very functional deteriorated. The most frequent symptom was apathy. The less frequent symptom was euphoria. Conclusion: No statistically significant association was found between the type of caregiver and the severity of the BPSD perceived

Elderly and caregiver demand: proposal for a care need classification.

OBJECTIVE: To propose a care need classification for elderly people by identifying their functional demands. METHOD: Cross-sectional study carried out in São Paulo, in 2006, with 1,413 elderly (≥ 60 years old), participants in the Health, Well-being and Aging study (SABE - Saúde, Bem Estar e Envelhecimento). For the care need classification, we used the Guttman Scaling method e the frequency of assistance required by the elderly. RESULTS: The hierarchy of activities of daily living had good internal consistency (α = 0.92) and satisfactory coefficients of reproducibility (98%), scalability (84%) and minimum marginal reproducibility (87%). Care need was categorized into: no need (requires no caregiver), minimum need (requires caregiver sporadically), moderate need (requires caregiver intermittently) and maximum need (requires full-time caregiver). CONCLUSION: This classification will allow identifying elderly that need assistance in everyday activities and will orientante health professionals in the development of a line of care.

Training needs for dementia care in China from the perspectives of mental health providers: who, what, and how.

ABSTRACTBackground:Acknowledging increasing demand of dementia care for patients in China, this paper aims to understand the training needs of dementia care from the perspectives of mental health providers by examining who should be the trainees, what should be the contents of training, and how to deliver the training in China. METHODS: Using purposive sampling, data were gathered via four focus group discussions with 40 mental health providers in Beijing, China, in 2011. Data were transcribed by independent investigators and then translated into English. Researchers used content analysis to separately identify themes and codes. Discrepancies were discussed until final agreement achieved. RESULTS: To improve the quality of dementia care, all participants agreed there is a significant need to train both formal or professional (physicians, nurses, hospital administrators, community workers) and informal caregivers (family, friends, or non-kin hired caregivers). For formal or professional caregivers, suggested training content included clinical knowledge of dementia (i.e. pathogenesis, approaches for preventing dementia deterioration) and clinical practice skills (i.e. diagnostic, treatment, caregiving, counseling, communicating skills). For informal caregivers, basic dementia knowledge and home-based caregiving skills such as safety, restorative, stress management, and communication were identified as key training contents. Multilevel support from the government and community centers were considered crucial factors to delivering the training and educating the public to enhance awareness of dementia. CONCLUSIONS: Culturally, sensitive education and specific trainings for formal and informal dementia caregivers are urgently needed in China. Policy and program implications are discussed.

Elderly and caregiver demand: proposal for a care need classification / Anciano y demanda de cuidador: propuesta de clasificación de la necesidad de cuidado / Idoso e demanda de cuidador: proposta de classificação da necessidade de cuidado

ABSTRACT Objective: To propose a care need classification for elderly people by identifying their functional demands. Method: Cross-sectional study carried out in São Paulo, in 2006, with 1,413 elderly (≥ 60 years old), participants in the Health, Well-being and Aging study (SABE - Saúde, Bem Estar e Envelhecimento). For the care need classification, we used the Guttman Scaling method e the frequency of assistance required by the elderly. Results: The hierarchy of activities of daily living had good internal consistency (α = 0.92) and satisfactory coefficients of reproducibility (98%), scalability (84%) and minimum marginal reproducibility (87%). Care need was categorized into: no need (requires no caregiver), minimum need (requires caregiver sporadically), moderate need (requires caregiver intermittently) and maximum need (requires full-time caregiver). Conclusion: This classification will allow identifying elderly that need assistance in everyday activities and will orientante health professionals in the development of a line of care.

RESUMEN Objetivo: Proponer una clasificación de la necesidad de cuidado de las personas ancianas mediante la identificación de sus demandas funcionales. Método: Estudio transversal realizado en el municipio de São Paulo, en el año del 2006, con 1413 ancianos (≥ 60 años) participantes en el Estudio SABE (Salud, Bienestar y Envejecimiento). Para clasificación de la necesidad de cuidado se utilizaron el método de Escalamiento de Guttman y la frecuencia de ayuda requerida por el anciano. Resultados: La jerarquización de las actividades de la vida diaria presentó buena consistencia interna (α=0,92) y satisfactorios coeficientes de reproductibilidad (98 %), de escalabilidad (84 %) y de reproductibilidad mínima marginal (87 %). Se categorizó la necesidad de cuidado en: sin necesidad (no necesita cuidador), necesidad mínima (demanda cuidador de manera ocasional), necesidad moderada (requiere cuidador intermitente) y necesidad máxima (demanda cuidador en tiempo integral). Conclusión: Esta clasificación permitirá identificar a los ancianos que demandan ayuda en las actividades cotidianas y orientará a los profesionales de salud en la elaboración de una línea de cuidados.

RESUMO Objetivo: Propor uma classificação da necessidade de cuidado de pessoas idosas por meio da identificação de suas demandas funcionais. Método: Estudo transversal realizado no município de São Paulo, no ano de 2006, com 1413 idosos (≥ 60 anos) participantes do Estudo SABE (Saúde, Bem-Estar e Envelhecimento). Para classificação da necessidade de cuidado foram utilizados o método de Escalonamento de Guttman e a frequência de ajuda requerida pelo idoso. Resultados: A hierarquização das atividades de vida diária apresentou boa consistência interna (α=0,92) e satisfatórios coeficientes de reprodutibilidade (98%), de escalabilidade (84%) e de reprodutibilidade mínima marginal (87%). Categorizou-se a necessidade de cuidado em: sem necessidade (não necessita de cuidador), necessidade mínima (demanda cuidador esporadicamente), necessidade moderada (requer cuidador intermitente) e necessidade máxima (demanda cuidador em tempo integral). Conclusão: Esta classificação possibilitará a identificação de idosos demandantes de auxílio nas atividades cotidianas e direcionará os profissionais de saúde na elaboração de uma linha de cuidados.

Self-medication among the elderly in Iran: a content analysis study.

BACKGROUND: Self-medication is described as the use of drugs without a physician's prescription to treat self-recognized illness or symptoms, and an important health issue among the elderly. Despite the wide range of different definitions, recognizing all forms of self-medication among older adults, particularly, in developing countries, help healthcare professionals and providers to reduce harmful effects of self-medication. The purpose of this study is to describe the practice of self-medication and its related factors among elderly people in Iran based on the experiences of people who are involved in this phenomenon. METHODS: This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until saturation. The participants were the elderly, their care-givers, physicians, and pharmacists. Data was collected using semi-structured interviews, and analysis was done using an inductive approach. The theory of planned behavior was used as a framework to explain the role of the emerged factors in the occurrence of self-medication behavior. RESULTS: Based on the expressed experiences of the participants, factors related to the practice of self- medication among the elderly in Iran fit in these 5 categories: "patient's attitudes towards disease, treatment, and physicians", "living with disease", "unfriendly environments", "enabling health system", and "influential others". CONCLUSIONS: Based on the results of this study, self-medication of the elderly in Iran has commonalities with many countries in regard to over-the-counter medications and complementary and alternative medicine; however, self-medication is also seen with drugs that require a prescription but can easily be obtained from pharmacies. Contributing factors, apart from the elderly themselves, include their families, caregivers, and social circle, the physical environment where they live, and the health system from which they receive services.

Assessment of Caregiving Constructs: Toward a Personal, Familial, Group, and Cultural Construction of Dementia Care through the Eyes of Personal Construct Psychology.

Conditions that cause cognitive impairment and behavioural and personality changes, such as Alzheimer's disease (AD) and related dementia, have global impact across cultures. However, the experience of dementia care can vary between individuals, families, formal caregivers, and social groups from various cultures. Self-reported measures, caregiving stress models, and conceptual theories have been developed to address the physical, financial, psychological, and social factors associated with the experience of dementia care. Given the cross-cultural variability in the experience of dementia care, it is important for such methodologies to take individual and cultural construct systems into account. We contend that personal and group constructs associated with dementia care should be explored in both the formal and informal caregiving contexts. Therefore, in this paper we introduce the theory of Personal Construct Psychology (PCP) with its explicit philosophy, well-elaborated theory, and derived assessment methods as a potential constructivist research approach to examine the personal, familial, group, and cultural construct systems that determine the experience of dementia caregiving. These concepts and assessment procedures are illustrated in this paper through case study examples and scenarios from the context of dementia care with a focus on family home caregivers. This paper elaborates the assessment and therapeutic approaches of personal construct theory (PCT) to further expand alternatives for support services and program interventions and to amplify policies for dementia care within and across cultures.

[Stability of home based care arrangements for people with dementia : Development of a consensus definition of stability using expert focus groups]. / Stabilität von häuslichen Versorgungsarrangements für Menschen mit Demenz : Entwicklung und Konsentierung einer Definition von Stabilität durch Expertenfokusgruppen.

BACKGROUND: The majority of people with dementia in Germany live at home. These informal care arrangements, which are mostly coordinated by informal carers, are the backbone of home-based dementia care. Creating and maintaining stability is an underlying theme in informal care; however, a definition of the complex phenomenon of 'stability' in this context is still lacking. AIM: The aim was to develop a working definition of stability of home-based care arrangements for people with dementia, which can be applied in current and future research projects at the German Center for Neurodegenerative Diseases in Witten (DZNE Witten) and others. MATERIAL AND METHODS: Ensuing from prior research a preliminary version of the definition was formulated. This definition was discussed in a focus group of scientific experts with expertise in dementia research and care (n = 8). After data analysis using content analysis, the definition was revised during a scientific colloquium (n = 18) and a consensus was finally reached. RESULTS: There were four major themes which were considered by the experts as being relevant for the definition of stability: (1) creating and maintaining stability as a continuous adaptation process, (2) a qualitative component of stability, (3) persons with dementia and informal carers as pivotal players and (4) transitions to residential care. CONCLUSION: The working definition introduced in this article reflects the authors' understanding of the phenomenon of stability of home-based care arrangements for people with dementia. In times of increasing need for evidence-based interventions it is necessary to develop elaborated definitions of complex phenomena in order to be able to systematically evaluate the efficacy of interventions on the basis of a common understanding.

Consistency of dementia caregiver intervention classification: an evidence-based synthesis.

BACKGROUND: There are many systematic reviews and meta-analyses (SRs) of interventions for family caregivers of persons with Alzheimer's disease or a related dementia. A challenge when synthesizing the efficacy of dementia caregiver interventions is the potential discrepancy in how they are categorized. The objective of this study was to systematically examine inconsistencies in how dementia caregiver interventions are classified. METHODS: We searched Ovid Medline®, Ovid PsycINFO®, Ovid Embase®, and the Cochrane Library to identify previous SRs published and indexed in bibliographic databases through January 2015. Following a graphical network analysis, open-coding of classification definitions was conducted. A descriptive analysis was then completed to examine classification consistency of individual interventions across SR grouping labels. RESULTS: Twenty-three SRs were identified. A graphical network analysis revealed a significant amount of overlap in individual studies included across SRs, but stark differences in how reviews labeled or categorized them. The qualitative content analysis identified seven themes; one of these, content of the intervention, was used to compare classification consistency. When subjecting the classification of interventions to descriptive empirical analysis, extensive inconsistency was apparent. CONCLUSIONS: The substantial inconsistency in how dementia caregiver interventions are classified across SRs has hindered the science and practice of dementia caregiver interventions. Specifically, accurate reporting of intervention components and SRs would allow for more precise assessments of efficacy as well as a fuller determination of how caregiver interventions can best yield benefits for caregivers and persons with dementia.

Uso de inhaladores: detección de errores e intervención por el farmacéutico comunitario / Use of inhalers: Error detection and intervention by the community pharmacist

Introducción: Los inhaladores son medicamentos que requieren un adiestramiento especial para su correcto uso. Conocer a los usuarios de inhaladores y evaluar cuáles son los errores que cometen puede ser el punto de partida para su abordaje y solución. El farmacéutico comunitario es clave para asegurar el uso correcto de inhaladores. Objetivos: Conocer variables sociodemográficas de los usuarios de inhaladores. Analizar los errores que se comenten en el uso de inhaladores e intervenir sobre ellos. Conocer si perciben controlado su problema de salud y evaluar qué opinan sobre la actitud activa del farmacéutico. Material y método: Estudio observacional multicéntrico en seis farmacias de la provincia de Badajoz con hoja de recogida de datos con cuestionario y hojas de evaluación de los sistemas de inhalación. Resultados: Participan 152 pacientes y 26 cuidadores. Se evalúan 202 inhaladores y se detectan e intervienen 876 errores. El error clínicamente significativo más frecuente en la técnica de inhalación es no contener la respiración 10 segundos o lo máximo posible tras la inhalación (57,2% de los casos). En el 60,9% de los casos no conocen correctamente cómo limpiar el inhalador, en el 43,9% no saben cuándo el inhalador está vacío y en el 36,1% no saben que deben enjuagarse la boca tras su uso. El 61,8% de los usuarios cree que el problema de salud para el que usan los inhaladores no está bien controlado y el 99,4% cree que la actitud activa del farmacéutico ayuda a mejorar el uso de los inhaladores (AU)

Introduction: Inhalers are drugs that require special training for proper use. Define users of inhalers and assess what mistakes are made can be the starting point for tackle them and get a solution. The community pharmacist is key to ensuring the correct use of inhalers. Objectives: To find out social and demographic variables of users inhalers. To analyze the mistake made in the use of inhalers and act on them. To find out if users perceive their health problem controlled and to assess what they think about the active role of the pharmacist. Material and methods: Multicenter observational study whose data collection was performed in sixcommunity pharmacies located in the province of Badajoz using a questionnaire and evaluation sheets of the inhalers. Results: Participants included 152 patients and 26 careers. 202 inhalers are evaluated and 876 errors are detected and intervened. The most frequent inhalation technique clinically significant error is not contain the respiration for 10 seconds or as long as possible after inhalation (57.2% of cases). In 60.9% of cases users do not know how to clean the inhaler correctly, in 43.9% users do not know when the inhaler is empty and the 36.1% do not know they should rinse their mouth after use. The 61.8% of users believe that the health problem for using inhalers is not well controlled and 99.4% believe that the active role of the pharmacist helps improve the use of inhalers (AU)

Humanización de la visita médica en pacientes ingresados en la planta de Neumología / No disponible

La atención médica a los pacientes ingresados en el hospital gira alrededor del «pase de planta». La forma de realizarlo no está estandarizada, siendo habitual hacer salir a los familiares de la habitación mientras atendemos al paciente. No disponemos de estudios que hayan valorado el impacto de realizar el pase de planta dejando a los familiares dentro de la habitación. Es por ello que nos planteamos realizar el presente estudio prospectivo, controlado, sobre humanización de la visita médica en pacientes ingresados en la planta de neumología, fundamentado en la incorporación de los familiares de los pacientes ingresados al pase de visita médica. En el periodo comprendido entre enero 2014 y diciembre 2015 fueron incluidos en el estudio 895 pacientes. Los resultados muestran que el 98% de los pacientes quieren que estén presentes su familiares (cónyuge, hijos,..) y el 100% de los familiares directos quieren estar presentes en el momento del pase de visita médica. El 95% de los pacientes quiere compartir la información médica con sus familiares en un único escenario. El grado de satisfacción de los pacientes y familiares fue muy elevado en la escala analógica-visual. La valoración del cuestionario de satisfacción mostró una elevada puntuación en todos los apartados: «comunicación médico-paciente», «relación médico-paciente» y «accesibilidad y disponibilidad». El grado de satisfacción de los profesionales fue muy elevado con este modelo de pase de visita. Además, se ha estimado un ahorro de tiempo sustancial al no tener que repetir la información a diferentes personas en distinto espacio y tiempo. Se han evitado problemas de comunicación e incertidumbres al proporcionar una información común al paciente acompañado de su familia. Han disminuido drásticamente las situaciones de conflicto entre pacientes y profesionales. Se ha reducido la variabilidad en la interpretación de la información transmitida. Por último y no menos importante, se ha generado un clima de confianza con el equipo médico que facilita la toma de decisiones por ambas partes

Medical care for patients admitted to the hospital revolves around the «daily medical visit». The way of doing this is not standardized, being common to flush out the family of the room while we take care of the patient. No studies that have assessed the impact of the daily medical visit leaving the family inside the room. That is why we plan to make this prospective controlled study on humanization of daily medical visits in patients admitted to the pulmonology plant, based on the incorporation of the relatives of patients. In the period between January 2014 and December 2015 they were included in the study 895 patients. The results have shown that 98% of patients want their family members (spouse, children, ..) are present and 100% of the relatives want to be present at the time of daily medical visit. 95% of patients want to share medical information with your family in a unique setting. The degree of satisfaction of patients and relatives was very high in the visual analog scale. The assessment of satisfaction survey showed a high score in all sections: «doctor-patient communication», «doctor-patient relationship» and «accessibility and availability». The degree of professional satisfaction was very high with this model of daily medical visit. In addition, it is estimated a substantial saving time by not having to repeat information to different people in different space and time. They have been avoided communication problems and uncertainties by providing a common patient information accompanied his family. They have drastically reduced the conflict between patients and professionals. It has been reduced variability in the interpretation of the information transmitted. Last but not least, it has generated a climate of trust with the medical team that facilitates decision-making by both parties

Habilidad de cuidado y sobrecarga en cuidadores familiares de personas con enfermedad crónica / Ability of care and care burden in family caregivers of people with chronic illness

Introducción: la sobrecarga del cuidador ha mostrado ser una variable que se relaciona con factores como el género, funcionalidad del receptor de cuidados, el tiempo dedicado al cuidado, entre otros. Objetivo: determinar si existe relación entre sobrecarga de cuidador y habilidad de cuidado en cuidadores familiares de personas con enfermedad crónica no transmisible y comparar dicha relación en las regiones de Colombia. Métodos: estudio de abordaje cuantitativo, correlacional, la muestra fue de 2040 cuidadores de personas con enfermedad crónica de las regiones Andina, Pacífica, Caribe y Amazonia en Colombia. Los datos fueron recolectados en el Inventario de Habilidad de Cuidado de Nkongho y la escala de sobrecarga del cuidador de Zarit. El estadístico de elección fue el coeficiente Rho de Spearman. Resultados: en Colombia y en las regiones de Amazonia y Pacífico se observa una correlación negativa débil, pero estadísticamente significativa (p<0,01). En la región Caribe, se observa una correlación negativa moderada y estadísticamente significativa (p<0,01). En la región Andina, no existe relación alguna entre la habilidad de cuidado y la sobrecarga del cuidador. Conclusiones: se observó un relación débil pero estadísticamente significativa entre la habilidad de cuidado y la sobrecarga del cuidador en Colombia y sus regiones, excepto en la región Andina. Intervenciones en el fortalecimiento de la habilidad de cuidado podrían demostrar utilidad para disminuir la sobrecarga del cuidador(AU)

Introduction: Caregiver burden has proved to be a variable that is related to gender factors, the functionality of the care recipient, the time spent on care, among others. Additional research to determine if the burden of care is related to the caring ability of the family caregiver is required. Objective: To determine the correlation between burden of care and caring in family caregivers of people with chronic illness and to compare that relationship in the different regions of Colombia. Methods: Quantitative study, with a correlational approach. The sample included 2040 caregivers of people with chronic illness of the Andean, Pacific, Caribbean and Amazon regions in Colombia. Informed consent process was performed. Data were collected with the Caring Ability Inventory of Nkonghoy and with the Zarit Caregiver Burden Interview. The statistical approach was done with the Spearman Rho test. Results : In Colombia and in its Amazonic and Pacific regions, a weak negative statistically significant correlation (p <0.01) was observed. In the Caribbean Region, a moderate and statistically significant negative correlation (p <0.01). In the Andean region, no connection between the ability of care and caregiver burden was found. Conclusion: A weak but statistically significant relationship between the ability of care and caregiver burden was found in Colombia, except in the Andean region were no correlation was founded. Interventions in strengthening the ability of care, could be useful in decreasing caregivers burden with care(AU)