[Psychoneuroimmunological predictors for burden in older caregivers of patients with Alzheimer's disease]. / Los predictores psiconeuroinmunológicos de la sobrecarga de cuidado en ancianos cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: The responsibility of giving care to patients with Alzheimer's disease (AD) may result in health changes in the older caregiver. It is important to explore the factors which influence the presence of care burden and to create strategies to face this condition. In this context, the aims of present study were to investigate the relationships between psychoneuroimmunological parameters and determine the predictors to burden in older caregivers of patients with AD. MATERIAL AND METHODS: A total of 30 AD older caregivers participating in the «Cognitive and Functional Kinesiotherapy Program in Elderly with Alzheimer's disease«(PRO-CDA)¼, de Rio Claro, SP-Brazil, were submitted to an assessment protocol to evaluate the psychoneuroimmunological parameters. A descriptive statistical analysis, Pearson correlation and multiple linear regressions were performed. RESULTS: The mean age of caregivers was 71.3 (±9.3), and predominantly are first-grade relatives. The caregiver burden was associated with depressive symptoms (r=0.60, P<.001), caregiver distress (r=0.68, P<.001), and neuropsychiatric disorders of AD patients (r=0.53, P<.001). The multiple regression analysis confirmed depressive symptoms and neuropsychiatric disturbances as predictors of caregiver burden. CONCLUSION: Caregiver burden is associated with, and influenced by parameters related to the caregiver psychological suffering and to characteristics inherent to AD. Thus, it is important to find strategies and implement non-pharmacological programs to provide support to older caregivers, and to assist in the treatment of patients with AD, in order to improve the integral health of this population.

Distribution of physical therapists working on public and private establishments in different levels of complexity of health care in Brazil.

BACKGROUND: The Brazilian Health System is organized on a regional and hierarchical form with three levels of complexity of health care. The Primary Care represents the first element of a continuing health care process, complemented by specialized actions. However, the centrality of the specialized care is still a problem in Brazil, especially in the private sector. Studies on the distribution of professionals in the health system allowing the formulation of appropriate policies are needed. OBJECTIVES: To investigate the distribution of physical therapists in the levels of complexity of health care and between public and private establishments, according to data from the National Register of Health Service Providers (NRHSP). METHOD: A descriptive cross-sectional study was performed considering NRHSP-national bank data collected in March 2010 and demographic census 2010 data. Data were analyzed through descriptive statistics techniques. RESULTS: We identified 53,181 registries of physical therapists, 60% linked to the private sector. Only 13% of all entries were linked to primary care. The predominance in specialized care occurred in the public sector (65%) and private sector (100%). The specialized establishments of private sector linked to the southeast region (16,043) were the main sites of physical therapists. Only the public sector in the south had a majority in the Primary Care. When considering the sizes of the cities, there is focus on specialist care in bigger cities. CONCLUSIONS: This study identified the concentration of physical therapists in the specialized care, mostly in metropolis and big cities and in the private sector, with restricted to participation in the primary care.

Los predictores psiconeuroinmunológicos de la sobrecarga de cuidado en ancianos cuidadores de pacientes con enfermedad de Alzheimer / Psychoneuroimmunological predictors for burden in older caregivers of patients with Alzheimer's disease

Introducción. La responsabilidad de cuidar de un paciente con enfermedad de Alzheimer (EA) puede generar alteraciones en la salud del anciano cuidador. Es importante investigar los factores que influyen en la presencia de sobrecarga para crear estrategias de enfrentamiento. En este contexto, los objetivos del presente estudio fueron investigar las relaciones entre parámetros psiconeuroinmunológicos y determinar los predictores de la sobrecarga de cuidado en ancianos cuidadores de pacientes con EA. Material y métodos. Un total de 30 cuidadores de pacientes con EA, participantes del Programa de Cinesioterapia Funcional e Cognitiva em Idosos com Doença de Alzheimer (PRO-CDA), de Rio Claro (SP, Brasil) fueron evaluados para estimar los parámetros psiconeuroinmunológicos. Se utilizó el análisis estadístico descriptivo, correlación de Pearson y regresión lineal múltiple. Resultados. Los cuidadores presentaron un promedio de edad de 71,3 (± 9,3) años, y la gran mayoría eran parientes de primer grado. La sobrecarga de cuidado se relacionó con los síntomas depresivos (r = 0,60; p < 0,001), desgaste del cuidador (r = 0,68; p < 0,001) y perturbaciones neuropsiquiátricas del paciente con EA (r = 0,53; p < 0,001). El análisis de regresión apuntó los síntomas depresivos y perturbaciones neuropsiquiátricas como predictores de la sobrecarga de cuidado. Conclusión. La sobrecarga de cuidado es asociada e influida por parámetros relacionados con el sufrimiento psíquico del cuidador y características inherentes a la EA. Así, es importante buscar estrategias e implementar programas de carácter no farmacológico para ofrecer soporte a los ancianos cuidadores, para que puedan auxiliar en el tratamiento del paciente con EA, buscando mejorar la salud holística de esta población (AU)

Introduction. The responsibility of giving care to patients with Alzheimer's disease (AD) may result in health changes in the older caregiver. It is important to explore the factors which influence the presence of care burden and to create strategies to face this condition. In this context, the aims of present study were to investigate the relationships between psychoneuroimmunological parameters and determine the predictors to burden in older caregivers of patients with AD. Material and methods. A total of 30 AD older caregivers participating in the «Cognitive and Functional Kinesiotherapy Program in Elderly with Alzheimer's disease«(PRO-CDA)», de Rio Claro, SP-Brazil, were submitted to an assessment protocol to evaluate the psychoneuroimmunological parameters. A descriptive statistical analysis, Pearson correlation and multiple linear regressions were performed. Results. The mean age of caregivers was 71.3 (± 9.3), and predominantly are first-grade relatives. The caregiver burden was associated with depressive symptoms (r = 0.60, P<.001), caregiver distress (r = 0.68, P<.001), and neuropsychiatric disorders of AD patients (r = 0.53, P<.001). The multiple regression analysis confirmed depressive symptoms and neuropsychiatric disturbances as predictors of caregiver burden. Conclusion. Caregiver burden is associated with, and influenced by parameters related to the caregiver psychological suffering and to characteristics inherent to AD. Thus, it is important to find strategies and implement non-pharmacological programs to provide support to older caregivers, and to assist in the treatment of patients with AD, in order to improve the integral health of this population (AU)

Distribution of physical therapists working on public and private establishments in different levels of complexity of health care in Brazil / Distribuição de fisioterapeutas entre estabelecimentos públicos e privados nos diferentes níveis de complexidade de atenção à saúde

BACKGROUND: The Brazilian Health System is organized on a regional and hierarchical form with three levels of complexity of health care. The Primary Care represents the first element of a continuing health care process, complemented by specialized actions. However, the centrality of the specialized care is still a problem in Brazil, especially in the private sector. Studies on the distribution of professionals in the health system allowing the formulation of appropriate policies are needed. OBJECTIVES: To investigate the distribution of physical therapists in the levels of complexity of health care and between public and private establishments, according to data from the National Register of Health Service Providers (NRHSP). METHOD: A descriptive cross-sectional study was performed considering NRHSP-national bank data collected in March 2010 and demographic census 2010 data. Data were analyzed through descriptive statistics techniques. RESULTS: We identified 53,181 registries of physical therapists, 60% linked to the private sector. Only 13% of all entries were linked to primary care. The predominance in specialized care occurred in the public sector (65%) and private sector (100%). The specialized establishments of private sector linked to the southeast region (16,043) were the main sites of physical therapists. Only the public sector in the south had a majority in the Primary Care. When considering the sizes of the cities, there is focus on specialist care in bigger cities. CONCLUSIONS: This study identified the concentration of physical therapists in the specialized care, mostly in metropolis and big cities and in the private sector, with restricted to participation in the primary care.

CONTEXTUALIZAÇÃO: O Sistema Único de Saúde (SUS) é organizado de forma regionalizada e hierarquizada, apresentando três níveis de complexidade de atenção à saúde. A atenção primária à saúde (APS) representa o primeiro elemento de um continuado processo de assistência à saúde, sendo complementada pelas ações especializadas. No entanto, a centralidade na atenção especializada ainda é uma realidade no país, principalmente no setor privado. Estudos sobre a distribuição das profissões no sistema de saúde permitem a formulação de políticas adequadas que fortaleçam a APS. OBJETIVOS: Investigar a distribuição dos fisioterapeutas nos níveis de complexidade de atenção à saúde e entre os estabelecimentos públicos e privados de acordo com dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES). MÉTODO: Foi realizado um estudo transversal descritivo. Os dados foram coletados no banco nacional do CNES, em março de 2010, sendo analisados por técnicas estatísticas descritivas. RESULTADOS: Foram identificados 53.181 cadastros de fisioterapeutas, com 60% vinculados ao setor privado. Apenas 13% de todos os cadastros estiveram vinculados à APS. A predominância na atenção especializada ocorreu no setor público (65%) e privado (aproximadamente 100%), sendo o maior número de profissionais vinculados a estabelecimentos privados especializados da região Sudeste (16.043). Apenas o setor público da região Sul apresentou maioria na APS. Quando considerados os portes dos municípios, verifica-se concentração na atenção especializada em municípios de maior porte. CONCLUSÃO: Este estudo identificou concentração de fisioterapeutas na atenção especializada, majoritariamente em municípios de maior porte populacional e no setor privado, sendo ainda restrita a participação na APS.