Using TIF-Seq2 to investigate association between 5´ and 3´mRNA ends.

The development of high-throughput technologies has revealed pervasive transcription in all genomes that have been investigated so far. This has uncovered a highly interleaved transcriptome organization involving thousands of overlapping coding and non-coding RNA isoforms that challenge our traditional definitions of genes and functional regions of the genome. In this chapter, we discuss the application of an improved Transcript Isoform Sequencing approach (TIF-Seq2) able to concurrently determine the start and end sites of individual RNA molecules. We exemplify its use for the investigation of the human transcriptome and show how it is especially well suited to discriminate between overlapping molecules and accurately define their boundaries.

High-resolution analysis of cell-state transitions in yeast suggests widespread transcriptional tuning by alternative starts.

BACKGROUND: The start and end sites of messenger RNAs (TSSs and TESs) are highly regulated, often in a cell-type-specific manner. Yet the contribution of transcript diversity in regulating gene expression remains largely elusive. We perform an integrative analysis of multiple highly synchronized cell-fate transitions and quantitative genomic techniques in Saccharomyces cerevisiae to identify regulatory functions associated with transcribing alternative isoforms. RESULTS: Cell-fate transitions feature widespread elevated expression of alternative TSS and, to a lesser degree, TES usage. These dynamically regulated alternative TSSs are located mostly upstream of canonical TSSs, but also within gene bodies possibly encoding for protein isoforms. Increased upstream alternative TSS usage is linked to various effects on canonical TSS levels, which range from co-activation to repression. We identified two key features linked to these outcomes: an interplay between alternative and canonical promoter strengths, and distance between alternative and canonical TSSs. These two regulatory properties give a plausible explanation of how locally transcribed alternative TSSs control gene transcription. Additionally, we find that specific chromatin modifiers Set2, Set3, and FACT play an important role in mediating gene repression via alternative TSSs, further supporting that the act of upstream transcription drives the local changes in gene transcription. CONCLUSIONS: The integrative analysis of multiple cell-fate transitions suggests the presence of a regulatory control system of alternative TSSs that is important for dynamic tuning of gene expression. Our work provides a framework for understanding how TSS heterogeneity governs eukaryotic gene expression, particularly during cell-fate changes.

TIF-Seq2 disentangles overlapping isoforms in complex human transcriptomes.

Eukaryotic transcriptomes are complex, involving thousands of overlapping transcripts. The interleaved nature of the transcriptomes limits our ability to identify regulatory regions, and in some cases can lead to misinterpretation of gene expression. To improve the understanding of the overlapping transcriptomes, we have developed an optimized method, TIF-Seq2, able to sequence simultaneously the 5' and 3' ends of individual RNA molecules at single-nucleotide resolution. We investigated the transcriptome of a well characterized human cell line (K562) and identified thousands of unannotated transcript isoforms. By focusing on transcripts which are challenging to be investigated with RNA-Seq, we accurately defined boundaries of lowly expressed unannotated and read-through transcripts putatively encoding fusion genes. We validated our results by targeted long-read sequencing and standard RNA-Seq for chronic myeloid leukaemia patient samples. Taking the advantage of TIF-Seq2, we explored transcription regulation among overlapping units and investigated their crosstalk. We show that most overlapping upstream transcripts use poly(A) sites within the first 2 kb of the downstream transcription units. Our work shows that, by paring the 5' and 3' end of each RNA, TIF-Seq2 can improve the annotation of complex genomes, facilitate accurate assignment of promoters to genes and easily identify transcriptionally fused genes.

Self-care activities, sociodemographic variables, treatment and depressive symptoms among older adults with Diabetes Mellitus.

OBJECTIVE: to analyze the association between self-care activities of older adults with Type 2 Diabetes Mellitus (DM) and sociodemographic variables, type of treatment and depressive symptoms. METHOD: inferential and cross-sectional study, with 121 older adults with Type 2 DM in ambulatory care. We used a questionnaire for characterization of sociodemographic and health, questionnaire self-care activities with DM, Mini Mental State Examination and Geriatric Depression Scale. The association of variables was used (Fisher's exact test) and for comparing the means (Student's t-test and analysis of variance). RESULTS: The mean age was 68.1 years, the majority were women (57.2%), retired (71.9%) and married (65.3%). The highest averages were for the activities: "to dry the spaces between the toes, after washing them" and smaller averages for "exercise". CONCLUSION: In spite of high average for self-care activities, there is a need for enhanced performance and compliance to them.

Advanced mobile prehospital nursing care for elderly people post-trauma: integrative review.

OBJECTIVE: to identify scientific evidences available on the literature on nursing interventions on advanced mobile prehospital care for elderly people post-trauma. METHOD: an integrative review of literature on the databases PubMed, CINAHL, and LILACS, from 2012 to 2017. RESULTS: a sample composed by 26 studies, grouped into six thematic categories: circulation with hemorrhage control (n=11); dysfunction, neurological state (n=7); airway with protection of the cervical spine (n=3); secondary evaluation (n=3); ventilation and breathing (n=1), and environment exposition/control (n=1). CONCLUSION: Despite having identified nursing interventions, there was no description of specific nursing interventions related to advanced mobile prehospital care for elderly people post-trauma.

Resilience, quality of life and symptoms of depression among elderlies receiving outpatient care.

OBJECTIVE: to analyze the relation between resilience and demographic variables, quality of life and symptoms of depression in elderlies attended at a Geriatric Outpatient Clinic. METHOD: analytical cross-sectional study, conducted with 148 elderlies, with a questionnaire of sociodemographic and health characterization, the Resilience Scale, the World Health Organization Quality of Life Bref, the World Health Organization Quality of Life Old, and the Center for Epidemiologic Survey - Depression Scale. Descriptive statistics, Student's t-test and Pearson correlation were used for data analysis. RESULTS: there was a positive correlation between resilience and schooling (r = 0.208; p = 0.010), income (r = 0.194; p = 0.017), the World Health Organization Quality of Life Bref (r = 0.242; p = 0.003), and the World Health Organization Quality of Life Old (r = 0.522; p <0.001), and negative correlation regarding symptoms of depression (r = -0.270; p = 0.001). CONCLUSION: Resilience presented relation to schooling, income, quality of life and symptoms of depression in the elderly. These results are expected to help the multidisciplinary team plan actions aimed at developing resilience towards the promotion of health and good quality of life in old age.

Single-Cell RNA Sequencing of Oligodendrocyte Lineage Cells from the Mouse Central Nervous System.

Single-cell RNA sequencing has emerged as a powerful technique for the identification of distinct cell states/populations in complex tissues. We have recently used this technology to investigate heterogeneity of cells of the oligodendrocyte lineage in the mouse central nervous system. In this chapter, we describe methods to perform single-cell RNA sequencing on this glial cell lineage, and discuss experimental and computational approaches to explore the potential and to tackle hurdles associated with this technology.

Self-care activities, sociodemographic variables, treatment and depressive symptoms among older adults with Diabetes Mellitus / Actividades de autocuidado, variables sociodemográficas, tratamiento y síntomas depresivos entre adultos mayores con Diabetes Mellitus / Atividades de autocuidado, variáveis sociodemográficas, tratamento e sintomas depressivos entre idosos com Diabetes Mellitus

ABSTRACT Objective: to analyze the association between self-care activities of older adults with Type 2 Diabetes Mellitus (DM) and sociodemographic variables, type of treatment and depressive symptoms. Method: inferential and cross-sectional study, with 121 older adults with Type 2 DM in ambulatory care. We used a questionnaire for characterization of sociodemographic and health, questionnaire self-care activities with DM, Mini Mental State Examination and Geriatric Depression Scale. The association of variables was used (Fisher's exact test) and for comparing the means (Student's t-test and analysis of variance). Results: The mean age was 68.1 years, the majority were women (57.2%), retired (71.9%) and married (65.3%). The highest averages were for the activities: "to dry the spaces between the toes, after washing them" and smaller averages for "exercise". Conclusion: In spite of high average for self-care activities, there is a need for enhanced performance and compliance to them.

RESUMEN Objetivo: Analizar la relación entre las actividades de autocuidado de adultos mayores con Diabetes Mellitus Tipo 2 (DM) y las variables sociodemográficas, clase de tratamiento y síntomas depresivos. Método: se trata de un estudio inferencial y transversal realizado entre 121 adultos mayores con DM tipo 2 en atención ambulatoria, desarrollado mediante el Cuestionario para la caracterización sociodemográfica y de salud, el de Actividades de Autocuidado con la DM, el Mini Examen del Estado Mental y la Escala de Depresión Geriátrica. Para asociar las variables se utilizó la Prueba Exacta de Fisher y para comparar los promedios, la Prueba t de Student y el Análisis de varianza. Resultados: la edad promedio era de 68,1 años, la mayoría del sexo femenino (57,2%), jubilados (71,9%) y casados (65,3%). Los promedios más altos apuntaron hacia las actividades: "secar los espacios entre los dedos después de lavarlos" y los más bajos hacia la "práctica de actividades físicas". Conclusión: A pesar de los promedios elevados en las actividades de autocuidado, se nota la necesidad de mejorar el rendimiento y el cumplimiento de las mismas.

RESUMO Objetivo: Analisar relação entre atividades de autocuidado de idosos com Diabetes Mellitus Tipo 2 (DM) e variáveis sociodemográficas, tipo de tratamento e sintomas depressivos. Método: Estudo inferencial e transversal, com 121 idosos com DM Tipo 2 em atendimento ambulatorial. Utilizaram-se Questionário para caracterização sociodemográfica e de saúde, Questionário Atividades de autocuidado com o DM, Miniexame do Estado Mental e Escala de Depressão Geriátrica. Para associação das variáveis, foi utilizado teste exato de Fisher. Para comparação das médias, foram realizados teste t-Student e análise de variância. Resultados: A média de idade foi 68,1 anos, sendo a maioria mulheres (57,2%), aposentados (71,9%) e casados (65,3%). As maiores médias foram para as atividades "secar os espaços entre os dedos dos pés, depois de lavá-los" e as menores para "prática de atividades físicas". Conclusão: Apesar das médias elevadas para as atividades de autocuidado, observou-se a necessidade de seu melhor desempenho e adesão.

Advanced mobile prehospital nursing care for elderly people post-trauma: integrative review / Atención prehospitalaria móvil avanzada de enfermería a ancianos postrauma: una revisión integrativa / Atendimento pré-hospitalar móvel avançado de enfermagem para idosos pós-trauma: revisão integrativa

ABSTRACT Objective: to identify scientific evidences available on the literature on nursing interventions on advanced mobile prehospital care for elderly people post-trauma. Method: an integrative review of literature on the databases PubMed, CINAHL, and LILACS, from 2012 to 2017. Results: a sample composed by 26 studies, grouped into six thematic categories: circulation with hemorrhage control (n=11); dysfunction, neurological state (n=7); airway with protection of the cervical spine (n=3); secondary evaluation (n=3); ventilation and breathing (n=1), and environment exposition/control (n=1). Conclusion: Despite having identified nursing interventions, there was no description of specific nursing interventions related to advanced mobile prehospital care for elderly people post-trauma.

RESUMEN Objetivo: identificar las evidencias científicas disponibles en la literatura acerca de las intervenciones de enfermería durante la atención prehospitalaria móvil avanzada a ancianos postrauma. Método: revisión integrativa de la literatura en las bases de datos PubMed, CINAHL y LILACS, realizada en el período entre 2012 y 2017. Resultados: la muestra constó de 26 estudios, que fueron agrupados en seis ejes temáticos: Circulación con control de la hemorragia (n=11); Disfunción, estado neurológico (n=7); Vía aérea con protección de la columna cervical (n=3); Evaluación secundaria (n = 3); Ventilación y respiración (n=1); y Exposición/control del ambiente (n=1). Conclusión: en las intervenciones de enfermería identificadas, no se describían intervenciones específicas de enfermería relacionadas a la atención prehospitalaria móvil avanzada a ancianos postrauma.

RESUMO Objetivo: identificar as evidências científicas disponíveis na literatura acerca das intervenções de enfermagem no atendimento pré-hospitalar móvel avançado para idosos pós-trauma. Método: revisão integrativa da literatura nas bases de dados PubMed, CINAHL e LILACS, no período de 2012 a 2017. Resultados: amostra composta por 26 estudos, agrupados em seis categorias temáticas: circulação com controle da hemorragia (n=11); disfunção, estado neurológico (n=7); via aérea com proteção da coluna cervical (n=3); avaliação secundária (n=3); ventilação e respiração (n=1) e exposição/controle do ambiente (n=1). Conclusão: apesar de terem sido identificadas intervenções de enfermagem, não houve descrição de intervenções específicas de enfermagem relacionadas ao atendimento pré-hospitalar móvel avançado de idosos pós-trauma.

Idosos em Tratamento Quimioterápico: Relação entre Nível de Estresse, Sintomas Depressivos e Esperança / Elderly People Undergoing Chemotherapy Treatment: Relationship between Stress, Depressive Symptoms and Hope

RESUMO A prevalência do câncer entre idosos tem aumentado nas últimas décadas. O tratamento oncológico pode acarretar aumento dos níveis de estresse e depressão. Nesse cenário, a esperança tem sido definida como um dos recursos relevantes de enfrentamento. Este estudo teve por objetivo analisar a relação entre estresse, sintomas depressivos e esperança em idosos submetidos a tratamento quimioterápico. Trata-se de um estudo quantitativo, descritivo e transversal com amostra não-probabilística de 123 idosos vinculados a um hospital geral público terciário do interior do Estado de São Paulo. Os resultados mostram que os idosos apresentavam elevados níveis de estresse percebido e de esperança; 71,5% não manifestavam sintomas depressivos. Níveis de estresse e esperança foram correlacionados negativamente, assim como sintomas depressivos e níveis de esperança, sugerindo que a esperança pode ter efeitos benéficos sobre o estresse e depressão.

ABSTRACT The prevalence of cancer among the elderly has increased in recent decades. Cancer treatment process can lead to increased levels of stress and depression. In this scenario, hope is defined as one of the relevant coping resources. This study aimed to analyze the relationship between stress, depressive symptoms and hope in the elderly undergoing chemotherapy. It is a quantitative, descriptive and cross-sectional study with a non-probabilistic sample of 123 elderly people linked to a general tertiary public hospital in the interior of the State of São Paulo. The results show that the elderly had high levels of perceived stress and hope; 71.5% of the participants did not present depressive symptoms. Levels of stress and hope are negatively correlated, as well as depressive symptoms and levels of hope, suggesting that hope has beneficial effects on stress and depression.

Resilience, quality of life and symptoms of depression among elderlies receiving outpatient care / Resiliência, qualidade de vida e sintomas depressivos entre idosos em tratamento ambulatorial / Resiliencia, calidad de vida y síntomas depresivos entre ancianos en tratamiento ambulatorio

Objective: to analyze the relation between resilience and demographic variables, quality of life and symptoms of depression in elderlies attended at a Geriatric Outpatient Clinic. Method: analytical cross-sectional study, conducted with 148 elderlies, with a questionnaire of sociodemographic and health characterization, the Resilience Scale, the World Health Organization Quality of Life Bref, the World Health Organization Quality of Life Old, and the Center for Epidemiologic Survey - Depression Scale. Descriptive statistics, Student's t-test and Pearson correlation were used for data analysis. Results: there was a positive correlation between resilience and schooling (r = 0.208; p = 0.010), income (r = 0.194; p = 0.017), the World Health Organization Quality of Life Bref (r = 0.242; p = 0.003), and the World Health Organization Quality of Life Old (r = 0.522; p <0.001), and negative correlation regarding symptoms of depression (r = -0.270; p = 0.001). Conclusion: Resilience presented relation to schooling, income, quality of life and symptoms of depression in the elderly. These results are expected to help the multidisciplinary team plan actions aimed at developing resilience towards the promotion of health and good quality of life in old age.

Objetivo: analisar a relação entre a resiliência e as variáveis sociodemográficas, a qualidade de vida e os sintomas depressivos dos idosos atendidos em um Ambulatório de Geriatria. Método: estudo transversal e analítico, realizado com 148 idosos, utilizando-se um questionário de caracterização sociodemográfica e de saúde, a Escala de Resiliência, o World Health Organization Quality of Life Bref, o World Health Organization Quality of Life Old e a Center for Epidemiologic Survey - Depression. Para a análise dos dados, utilizaram-se a estatística descritiva, o teste t-Student e a correlação de Pearson. Resultados: houve correlação positiva entre a resiliência e a escolaridade (r=0,208; p=0,010), a renda (r=0,194; p=0,017), o World Health Organization Quality of Life Bref (r=0,242; p=0,003) e o World Health Organization Quality of Life Old (r=0,522; p<0,001) e negativa com sintomas depressivos (r=-0,270; p=0,001). Conclusão: a resiliência apresentou relação com a escolaridade, a renda, a qualidade de vida e os sintomas depressivos dos idosos. Espera-se que esses resultados possam auxiliar a equipe multidisciplinar no planejamento de ações que visem à promoção da resiliência, com finalidade de promoção da saúde e boa qualidade de vida na velhice.

Objetivo: analizar la relación entre la resiliencia y variables sociodemográficas, calidad de vida y síntomas depresivos de los ancianos atendidos en un ambulatorio geriátrico. Método: estudio transversal y analítico en que participaron 148 ancianos y que utilizó un cuestionario de caracterización sociodemográfica y de salud, la Escala de Resiliencia, el World Health Organization Quality of Life Bref, el World Health Organization Quality of Life Old y la Center for Epidemiologic Survey - Depression. Para el análisis de datos, se utilizaron estadística descriptiva, la prueba t-Student y la correlación de Pearson. Resultados: hubo una correlación positiva entre resiliencia y escolaridad (r=0,208; p=0,010), ingresos (r=0,194; p=0,017), el World Health Organization Quality of Life Bref (r=0,242; p=0,003) y el World Health Organization Quality of Life Old (r=0,522; p<0,001), y una correlación negativa con síntomas depresivos (r=-0,270; p=0,001). Conclusión: la resiliencia se relacionó con el nivel de escolaridad, ingresos, calidad de vida y síntomas depresivos de los ancianos. Se espera que estos resultados puedan ayudar al equipo multidisciplinario a planificar acciones destinadas a impulsar la resiliencia, con el propósito de promover la salud y la buena calidad de vida en la vejez.

Disease-specific oligodendrocyte lineage cells arise in multiple sclerosis.

Multiple sclerosis (MS) is characterized by an immune system attack targeting myelin, which is produced by oligodendrocytes (OLs). We performed single-cell transcriptomic analysis of OL lineage cells from the spinal cord of mice induced with experimental autoimmune encephalomyelitis (EAE), which mimics several aspects of MS. We found unique OLs and OL precursor cells (OPCs) in EAE and uncovered several genes specifically alternatively spliced in these cells. Surprisingly, EAE-specific OL lineage populations expressed genes involved in antigen processing and presentation via major histocompatibility complex class I and II (MHC-I and -II), and in immunoprotection, suggesting alternative functions of these cells in a disease context. Importantly, we found that disease-specific oligodendroglia are also present in human MS brains and that a substantial number of genes known to be susceptibility genes for MS, so far mainly associated with immune cells, are expressed in the OL lineage cells. Finally, we demonstrate that OPCs can phagocytose and that MHC-II-expressing OPCs can activate memory and effector CD4-positive T cells. Our results suggest that OLs and OPCs are not passive targets but instead active immunomodulators in MS. The disease-specific OL lineage cells, for which we identify several biomarkers, may represent novel direct targets for immunomodulatory therapeutic approaches in MS.

Transcriptional Convergence of Oligodendrocyte Lineage Progenitors during Development.

Pdgfra+ oligodendrocyte precursor cells (OPCs) arise in distinct specification waves during embryogenesis in the central nervous system (CNS). It is unclear whether there is a correlation between these waves and different oligodendrocyte (OL) states at adult stages. Here, we present bulk and single-cell transcriptomics resources providing insights on how transitions between these states occur. We found that post-natal OPCs from brain and spinal cord present similar transcriptional signatures. Moreover, post-natal OPC progeny of E13.5 Pdgfra+ cells present electrophysiological and transcriptional profiles similar to OPCs derived from subsequent specification waves, indicating that Pdgfra+ pre-OPCs rewire their transcriptional network during development. Single-cell RNA-seq and lineage tracing indicates that a subset of E13.5 Pdgfra+ cells originates cells of the pericyte lineage. Thus, our results indicate that embryonic Pdgfra+ cells in the CNS give rise to distinct post-natal cell lineages, including OPCs with convergent transcriptional profiles in different CNS regions.

The frailty syndrome in institutionalized elderly persons / Síndrome da fragilidade em idosos institucionalizados

Abstract Objective: to analyze the relationship between the level of frailty and sociodemographic and health characteristics among elderly residents of a long-term care facility (LTCF) in Ribeirão Preto, São Paulo, Brazil. Method: this descriptive and cross-sectional study included 56 elderly persons living in a LTCF. Data were collected from April to June 2016. A questionnaire addressing sociodemographic and health profiles was used together with the Mini-Mental State Examination, the Tilburg Frailty Indicator, the Barthel Index, and the Geriatric Depression Scale (GDS-15). Descriptive statistics were applied. The normality of the continuous variables was tested using the Shapiro-Wilk test. Spearman's correlation was used for the continuous variables with frailty as the dependent variable. Result: Most elderly individuals were female (57.1%); the average age was 77.77; and 35.7% were widowed. In terms of health, 55.4% presented cognitive deficit; 62.5% had depression symptoms; 75.0% were considered frail; 42.9% had suffered falls in the last 12 months; and the individuals scored an average of 68.30 in the Barthel Index. A positive correlation between the frailty score and the GDS-15 (r=0.538; p=0.00) was observed, while a negative correlation was found between frailty and the Barthel Index (r=-0.302; p=0.02). Conclusion: increased frailty among institutionalized elderly persons is correlated with the presence of depressive symptoms and inferior performance of basic activities of daily living. The results of the present study can support the planning of care provided to elderly individuals living in LTCFs and encourage broader assessments of these individuals. AU

Resumo Objetivo: analisar a relação entre o nível de fragilidade e as características sociodemográficas e de saúde de idosos residentes em uma Instituição de Longa Permanência para Idosos (ILPI) do município de Ribeirão Preto, SP, Brasil. Método: estudo descritivo e transversal, com 56 idosos residentes em ILPI. A coleta de dados foi realizada de abril a junho de 2016. Utilizaram-se um questionário para o perfil sociodemográfico e de saúde, o Mini Exame do Estado Mental, o Tilburg Frailty Indicator, o Índice de Barthel e a Geriatric Depression Scale (GDS-15). Foram realizadas análises descritivas. Para as variáveis numéricas foi testada a normalidade por meio do teste de Shapiro-Wilk. Utilizou-se a correlação de Spearman para as variáveis numéricas tendo a fragilidade como variável dependente. Resultado: a maioria era do sexo feminino (57,1%); média de idade 77,77 anos; 35,7% viúvos. Quanto à avaliação de saúde, 55,4% tinham deficit cognitivo, 62,5% apresentavam sintomas de depressão e 75,0% foram classificados como frágeis; 42,9% tiveram quedas nos últimos 12 meses; a média de pontos no Índice de Barthel foi 68,30. Observou-se correlação positiva entre a pontuação da fragilidade e da GDS-15 (r=0,538; p=0,00) e negativa entre a fragilidade e o índice de Barthel (r=-0,302; p=0,02). Conclusão: o aumento da fragilidade está correlacionado com a presença de sintomas depressivos e a diminuição do desempenho para as atividades básicas da vida diária do idoso institucionalizado. Espera-se que os resultados deste estudo possam subsidiar o planejamento do cuidado ao idoso residente de ILPI, além de fomentar avaliações mais amplas desses idosos. AU

Sintomas neuropsiquiátricos de idosos com demência: repercussões para o cuidador familiar / Síntomas neuropsiquiátricos de ancianos con demencia: repercusiones para el cuidador familiar / Neuropsychiatric symptoms of elderly individuals with dementia: repercussions for family caregivers

RESUMO Objetivo: identificar a presença, frequência e gravidade dos sintomas neuropsiquiátricos em idosos com demência, identificar o desgaste do cuidador familiar e analisar os fatores relacionados ao desgaste do cuidador. Método: estudo transversal, descritivo, exploratório e correlacional, realizado com 54 cuidadores familiares de idosos com demência, atendidos em um ambulatório de geriatria de alta dependência de um Hospital Geral Terciário. Utilizaram-se questionário de caracterização dos cuidadores, o Inventário Neuropsiquiátrico e o Inventário Neuropsiquiátrico Desgaste. Resultados: a maioria (85,2%) dos cuidadores familiares era de mulheres, média de idade de 51,2 anos e residia com o idoso (74,1%). A média de sintomas neuropsiquiátricos foi 4,5; o mais presente foi apatia/indiferença (74,1%), seguido de disforia/depressão (46,3%); o mais frequente foi o comportamento motor aberrante (75,1%), seguido de agitação/agressividade (52,9%). Quanto à gravidade dos sintomas, a moderada foi a mais prevalente. Observou-se correlação forte positiva entre o escore total dos questionários aplicados (r=0,82, p=<0,001) e entre o escore total do Inventário Neuropsiquiátrico-Desgaste e o número de sintomas neuropsiquiátricos, apresentados pelos idosos com demência (r=0,83, p=<0,001); correlação fraca positiva entre o escore total do Inventário Neuropsiquiátrico-Desgaste e o número de dias na semana dedicado ao cuidado (r=0,28, p=0,042) e entre problemas de saúde do cuidador e o escore total do Inventário neuropsiquiátrico Desgaste (r=0,29, p=0,034), com significância estatística. Conclusão: os resultados encontrados mostram a necessidade de investimentos na assistência ao binômio idoso/cuidador com vistas ao melhor manejo dos sintomas neuropsiquiátricos e à redução do desgaste do cuidador.

RESUMEN Objetivo identificar la presencia, frecuencia y gravedad de los síntomas neuropsiquiátricos en ancianos con demencia, identificar el desgaste del cuidador familiar y analizar los factores relacionados con el desgaste del cuidador. Método estudio transversal, descriptivo, exploratorio y correlacional realizado con 54 cuidadores familiares de ancianos con demencia atendidos en un ambulatorio de geriatría de alta dependencia de un Hospital General Terciario. Se utilizó el cuestionario de caracterización de los cuidadores, el Inventario Neuropsiquiátrico y el Inventario Neuropsiquiátrico de Desgaste. Resultados la mayoría (85,2%) de los cuidadores familiares eran mujeres de media edad, 51,2 años, y residía con el anciano (74,1%). La media de síntomas neuropsiquiátricos fue de 4,5. El más presente fue apatía/indiferencia (74,1%), seguido de disforia/depresión (46,3%) y el más frecuente fue el comportamiento motor aberrante (75,1%), seguido de agitación/agresividad (52,9%). En relación a la gravedad de los síntomas, el que más prevaleció fue el moderado. Se observó una correlación fuerte y positiva entre el resultado total de los cuestionarios aplicados (r=0,82, p=<0,001), el resultado total del Inventario Neuropsiquiátrico de Desgaste y el número de síntomas neuropsiquiátricos presentados por los ancianos con demencia (r=0,83, p=<0,001). Hubo una correlación débil y positiva entre el resultado total del Inventario Neuropsiquiátrico de Desgaste y el número de días de la semana dedicados al cuidado (r=0,28, p=0,042), y entre problemas de salud del cuidador y el resultado total del Inventario Neuropsiquiátrico de Desgaste (r=0,29, p=0,034) con la significancia estadística. Conclusión los resultados encontrados señalan la necesidad de mayores inversiones en la asistencia para el binomio anciano/cuidador con vistas a un mejor manejo de los síntomas neuropsiquiátricos y para la reducción del desgaste del cuidador.

ABSTRACT Objective: to identify the presence, frequency and severity of neuropsychiatric symptoms among elderly individuals with dementia, identify family caregiver distress, and analyze factors related to caregiver distress. Method: cross-sectional, descriptive, exploratory and correlational study conducted with 54 family caregivers of elderly individuals with dementia, receiving care in a geriatric outpatient clinic for highly dependent individuals in a tertiary general hospital. The instruments used included a questionnaire to characterize the caregivers, the Neuropsychiatric Inventory and Neuropsychiatric Inventory Caregiver Distress Scale. Results: most (85.2%) family caregivers were women aged 51.2 years old, on average, who lived with the elderly individuals (74.1%). There was an average of 4.5 neuropsychiatric symptoms; the most prevalent was apathy/indifference (74.1%), followed by disphoria/depression (46.3%). The most frequent was aberrant motor activity (75.1%), followed by agitation/agression (52.9%). Severity of symptoms was most frequently moderate. A strong positive correlation was found between the questionnaires' total scores (r=0.82, p=<0.001) and the total score of the Neuropsychiatric Inventory Caregiver Distress Scale and the number of neuropsychiatric symptoms presented by the elderly individuals with dementia (r=0.83, p=<0.001); weak correlation between the total score of the Inventory Caregiver Distress Scale and number of days dedicated to providing care in a week (r=0.28, p=0.042) and between the caregivers' health problems and the Inventory Caregiver Distress Scale total score (r=0.29, p=0.034); all of these have statistical significance. Conclusion: the results show a need to invest in the assistance provided to the elderly individual/caregiver pair in order to improve neuropsychiatric symptoms and decrease caregiver distress.

Spiritual well-being and quality of life of older adults in hemodialysis.

OBJECTIVE:: To analyze the relationship between spiritual well-being, sociodemographic, economic, religious, and health variables and the quality of life of older adults undergoing hemodialysis. METHOD:: This was a cross-sectional and correlational study conducted with 169 older adults undergoing hemodialysis. The researchers conducted interviews to collect sociodemographic, economic, religious, and health data and applied the Spiritual Well-Being Scale (SWBS) and the WHO quality of life assessment (WHOQOL-BREF and WHOQOL-OLD). RESULTS:: Most of the older adults attained a moderate level of total spiritual well-being (SWB). In terms of QOL, the psychological domain (66.8; sd=13.9) and social relationships domain (66.8; sd=15.1) presented the highest mean scores. The WHOQOL-BREF domains were positively correlated with the SWB scale, with statistical significance among all domains and subscales except the environmental domain. CONCLUSION:: The QOL of older adults was associated with the construct of SWB, either positively or negatively. OBJETIVO:: Analisar a relação entre o bem-estar espiritual, variáveis sociodemográficas, econômicas, religiosas e de saúde com a qualidade de vida de idosos em tratamento hemodialítico. MÉTODO:: Estudo transversal e correlacional feito com 169 idosos que realizavam hemodiálise. Foram realizadas entrevistas para caracterização sociodemográfica, econômica, religiosa e de saúde, além de aplicação da Escala de Bem-Estar Espiritual (EBE) e de Qualidade de vida (QV) (WHOQOL- bref e WHOQOL - Old). RESULTADOS:: A maioria dos idosos possuía moderado bem-estar espiritual total (EBE). Com relação à QV, os domínios psicológico (66,8; dp=13,9) e relações sociais (66,8; dp=15,1) apresentaram os maiores escores médios. A correlação dos domínios do WHOQOL- bref com os escores da escala de EBE foi positiva, com significância estatística em todos os domínios e nas subescalas, exceto no domínio meio ambiente. CONCLUSÃO;: A QV dos idosos está relacionada, seja de forma positiva ou negativa, com o constructo EBE.

Nursing diagnosis in older adults with chronic kidney disease on hemodialysis.

Objective: To identify the main nursing diagnoses (NSs) in older adult patients under hemodialysis treatment. Method: Exploratory research using case studies in data collection performed by interview and physical examination of older adults, in the first semester of 2016. Were included twenty-eight older adults undergoing chronic hemodialysis treatment who met the selection criteria. The analysis followed two steps (RISNER, 1990): Phase I - Data analysis and synthesis; and Phase II - Establishment of nursing diagnoses using the taxonomy of NANDA-I (2015). Results: The total of NSs was 110, averaging 3.9 per patient. It was listed seven different NSs, and both the Risk of infection and the Volume of excessive liquids appeared on all patients (28; 100%), and risk of electrolyte imbalance, in 26 (96.8%) older adults, being considered as main NSs. Conclusion: Such results can help systematize the care of older people who are undergoing hemodialysis treatment.

Objetivo: Identificar os principais diagnósticos de enfermagem (DEs) em pacientes idosos em tratamento hemodialítico. Método: Pesquisa exploratória utilizando estudos de casos na coleta de dados realizada por entrevista e exame físico dos idosos, no primeiro semestre de 2016. Foram incluídos 28 idosos em tratamento crônico por hemodiálise que atenderam aos critérios de seleção. A análise seguiu duas etapas (RISNER, 1990): Fase I - Análise e síntese dos dados; e Fase II - Estabelecimento dos diagnósticos de enfermagem utilizando a taxonomia da NANDA-I (2015). Resultados: O total de DEs foi de 110, com média de 3,9 por paciente. Foram elencados sete DEs diferentes, sendo que tanto o Risco de infecção quanto o Volume de líquidos excessivo apareceram em todos os pacientes (28; 100%), e Risco de desequilíbrio eletrolítico, em 26 (96,8%) idosos, sendo considerados como principais DEs. Conclusão: Tais resultados podem colaborar na sistematização da assistência do idoso em tratamento hemodialítico.

Nursing diagnosis in older adults with chronic kidney disease on hemodialysis / Diagnósticos de enfermería en ancianos con enfermedad renal crónica en hemodiálisis / Diagnósticos de enfermagem em idosos com doença renal crônica em hemodiálise

ABSTRACT Objective: To identify the main nursing diagnoses (NSs) in older adult patients under hemodialysis treatment. Method: Exploratory research using case studies in data collection performed by interview and physical examination of older adults, in the first semester of 2016. Were included twenty-eight older adults undergoing chronic hemodialysis treatment who met the selection criteria. The analysis followed two steps (RISNER, 1990): Phase I - Data analysis and synthesis; and Phase II - Establishment of nursing diagnoses using the taxonomy of NANDA-I (2015). Results: The total of NSs was 110, averaging 3.9 per patient. It was listed seven different NSs, and both the Risk of infection and the Volume of excessive liquids appeared on all patients (28; 100%), and risk of electrolyte imbalance, in 26 (96.8%) older adults, being considered as main NSs. Conclusion: Such results can help systematize the care of older people who are undergoing hemodialysis treatment.

RESUMEN Objetivo: Identificar los principales diagnósticos de enfermería (DE) en ancianos que reciben tratamiento de hemodiálisis. Método: Estudio exploratorio que se utilizó de estudios de caso mediante entrevistas y examen físico en ancianos para la recolección de datos, llevado a cabo en el primer semestre de 2016. Del estudio, participaron 28 ancianos que recibían tratamiento de hemodiálisis y que estaban bajo los criterios de selección. El análisis de datos siguió dos etapas (RISNER, 1990): En la Fase I se hizo el análisis y la síntesis de los datos; y en la Fase II se establecieron los diagnósticos de enfermería empleando la taxonomía NANDA-I (2015). Resultados: Los DE fueron 110, con un promedio de 3,9 por paciente. Se eligieron siete DE distintos, siendo que tanto el Riesgo de infección como el Volumen de líquidos excesivo estaban presentes en todos los pacientes (28; 100%), y el Riesgo de desequilibrio electrolítico en 26 ancianos (96,8%), siendo considerados como principales DE. Conclusión: Los resultados pueden ayudar que se sistematice la asistencia al anciano que recibe tratamiento de hemodiálisis.

RESUMO Objetivo: Identificar os principais diagnósticos de enfermagem (DEs) em pacientes idosos em tratamento hemodialítico. Método: Pesquisa exploratória utilizando estudos de casos na coleta de dados realizada por entrevista e exame físico dos idosos, no primeiro semestre de 2016. Foram incluídos 28 idosos em tratamento crônico por hemodiálise que atenderam aos critérios de seleção. A análise seguiu duas etapas (RISNER, 1990): Fase I - Análise e síntese dos dados; e Fase II - Estabelecimento dos diagnósticos de enfermagem utilizando a taxonomia da NANDA-I (2015). Resultados: O total de DEs foi de 110, com média de 3,9 por paciente. Foram elencados sete DEs diferentes, sendo que tanto o Risco de infecção quanto o Volume de líquidos excessivo apareceram em todos os pacientes (28; 100%), e Risco de desequilíbrio eletrolítico, em 26 (96,8%) idosos, sendo considerados como principais DEs. Conclusão: Tais resultados podem colaborar na sistematização da assistência do idoso em tratamento hemodialítico.

Spiritual well-being and quality of life of older adults in hemodialysis / Bienestar espiritual y calidad de vida de ancianos en tratamiento de hemodiálisis / Bem estar espiritual e qualidade de vida de idosos em tratamento hemodialítico

ABSTRACT Objective: To analyze the relationship between spiritual well-being, sociodemographic, economic, religious, and health variables and the quality of life of older adults undergoing hemodialysis. Method: This was a cross-sectional and correlational study conducted with 169 older adults undergoing hemodialysis. The researchers conducted interviews to collect sociodemographic, economic, religious, and health data and applied the Spiritual Well-Being Scale (SWBS) and the WHO quality of life assessment (WHOQOL-BREF and WHOQOL-OLD). Results: Most of the older adults attained a moderate level of total spiritual well-being (SWB). In terms of QOL, the psychological domain (66.8; sd=13.9) and social relationships domain (66.8; sd=15.1) presented the highest mean scores. The WHOQOL-BREF domains were positively correlated with the SWB scale, with statistical significance among all domains and subscales except the environmental domain. Conclusion: The QOL of older adults was associated with the construct of SWB, either positively or negatively.

RESUMEN Objetivo: Analizar relación entre bienestar espiritual, variables sociodemográficas, económicas, religiosas y de salud con la calidad de vida de ancianos en tratamiento de hemodiálisis. Método: Estudio trasversal, correlacional, realizado con 169 ancianos en tratamiento de hemodiálisis. Fueron efectuadas entrevistas para caracterización sociodemográfica, económica, religiosa y de salud, además de aplicación de la Escala de Bienestar Espiritual (EBE) y de Calidad de Vida (QV) (WHOQOL-bref y WHOQOL-Old). Resultados: La mayoría de los ancianos tenía bienestar espiritual total (EBE) moderado. Respecto a la QV, los dominios psicológico (66,8; SD=13,9) y relaciones sociales (66,8; SD=15,1) presentaron los mayores puntajes medios. La correlación de los dominios del WHOQOL-bref con los puntajes de la escala de EBE fue positiva, con significatividad estadística en todos los dominios y las subescalas, excepto en el dominio medioambiente. Conclusión: La QV de los ancianos está relacionada, tanto positiva como negativamente, con el constructo EBE.

RESUMO Objetivo: Analisar a relação entre o bem-estar espiritual, variáveis sociodemográficas, econômicas, religiosas e de saúde com a qualidade de vida de idosos em tratamento hemodialítico. Método: Estudo transversal e correlacional feito com 169 idosos que realizavam hemodiálise. Foram realizadas entrevistas para caracterização sociodemográfica, econômica, religiosa e de saúde, além de aplicação da Escala de Bem-Estar Espiritual (EBE) e de Qualidade de vida (QV) (WHOQOL- bref e WHOQOL - Old). Resultados: A maioria dos idosos possuía moderado bem-estar espiritual total (EBE). Com relação à QV, os domínios psicológico (66,8; dp=13,9) e relações sociais (66,8; dp=15,1) apresentaram os maiores escores médios. A correlação dos domínios do WHOQOL- bref com os escores da escala de EBE foi positiva, com significância estatística em todos os domínios e nas subescalas, exceto no domínio meio ambiente. Conclusão; A QV dos idosos está relacionada, seja de forma positiva ou negativa, com o constructo EBE.