Pre-frailty, frailty and associated factors in older caregivers of older adults.

INTRODUCTION: Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers. OBJECTIVES: To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults. METHODS: A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression. RESULTS: The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty. CONCLUSION: Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population.

Using ordered mesoporous silica SBA-15 to limit cutaneous penetration and transdermal permeation of organic UV filters.

Avobenzone (AVO), oxybenzone (OXY), and octyl methoxycinnamate (OMC), are widely used UV filters. The aim of this study was to investigate the effect of incorporation in mesoporous silica (SBA-15) on their cutaneous deposition and permeation. Stick formulations containing "free" and "incorporated" UV filters (SF1 and SF2, respectively) were prepared and characterized with respect to their physicochemical, thermal, and functional properties. Cutaneous delivery experiments using porcine skin with quantification by UHPLC-MS/MS, demonstrated that skin deposition of AVO and OXY after application of SF2 for 6 and 12 h was significantly lower than that from SF1 at each time-point (Student t-test, p < 0.05): e.g. OXY permeation across the skin was 30-, 12- and 1.5-fold lower after 6, 12 and 24 h, respectively, following application of SF2. Cutaneous biodistribution profiles of AVO and OXY to 800 µm evidenced a significant decrease in the amounts in the viable epidermis and dermis. In contrast, deposition of the more lipophilic OMC was not significantly different (p ˃ 0.05). In vitro photoprotective efficacy results demonstrated that adsorption/entrapment of UV filters enhanced the sun protection factor by 94%. In conclusion, SBA-15, an innovative mesoporous material, increased photoprotection by UV filters while reducing their cutaneous penetration and transdermal permeation.

Effects of valerian on subjective sedation, field sobriety testing and driving simulator performance.

INTRODUCTION: The availability of herbal medicines over-the-counter (OTC) has increased the use of natural products for self-treatment. Valerian has been used to effectively treat generalized anxiety disorder and insomnia. Studies suggest that valerenic acid may increase gamma-aminobutyric acid (GABA) modulation in the brain. Benzodiazepines have a similar mechanism of action and have been linked to an increased risk of hospitalizations due to traffic accidents. Despite the risk of somnolence, the safety of driving while under the influence of valerian remains unknown. PURPOSE: The purpose of the study was to determine the effects of a one-time valerian 1600mg dose on subjective sedation effects, standardized field sobriety testing (SFST) and driving simulator performance parameters. METHODS: The study design was a randomized, placebo-controlled, double-blind, cross-over trial. For each session, participants received either a dose of valerian or placebo. The outcome measures included a simple visual reaction test (SVRT), subjective sleepiness scales, SFST performance scores, and driving simulator performance parameters. RESULTS: There were no significant differences in the SVRT or sleepiness scales between placebo and valerian exposures, but the study may have been underpowered. SFST total and individual test failure rates were not significantly different between the two exposures. The driving simulator performance parameters were equivalent between the two exposure conditions. CONCLUSIONS: A one-time valerian 1600mg dose, often used to treat insomnia, does not appear to impair driving simulator performance after acute ingestion.

The Effects of Dextromethorphan on Driving Performance and the Standardized Field Sobriety Test.

Dextromethorphan (DXM) is abused most commonly among adolescents as a recreational drug to generate a dissociative experience. The objective of the study was to assess driving with and without DXM ingestion. The effects of one-time maximum daily doses of DXM 120 mg versus a guaifenesin 400 mg dose were compared among 40 healthy subjects using a crossover design. Subjects' ability to drive was assessed by their performance in a driving simulator (STISIM® Drive driving simulator software) and by conducting a standardized field sobriety test (SFST) administered 1-h postdrug administration. The one-time dose of DXM 120 mg did not demonstrate driving impairment on the STISIM® Drive driving simulator or increase SFST failures compared to guaifenesin 400 mg. Doses greater than the currently recommended maximum daily dose of 120 mg are necessary to perturb driving behavior.

Pre-frailty, frailty and associated factors in older caregivers of older adults

ABSTRACT INTRODUCTION Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers. OBJECTIVES To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults. METHODS A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression. RESULTS The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty. CONCLUSION Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population.

Pharmacy students' performance and perceptions in a flipped teaching pilot on cardiac arrhythmias.

OBJECTIVE: To implement the flipped teaching method in a 3-class pilot on cardiac arrhythmias and to assess the impact of the intervention on academic performance and student perceptions. DESIGN: An intervention group of 101 first-year pharmacy students, who took the class with the flipped teaching method, were supplied with prerecorded lectures prior to their 3 classes (1 class in each of the following subjects: basic sciences, pharmacology, and therapeutics) on cardiac arrhythmias. Class time was focused on active-learning and case-based exercises. Students then took a final examination that included questions on cardiac arrhythmias. The examination scores of the intervention group were compared to scores of the Spring 2011 control group of 105 first-year students who took the class with traditional teaching methods. An online survey was conducted to assess student feedback from the intervention group. ASSESSMENT: The mean examination scores of the intervention group were significantly higher than the mean examination scores of the control group for the cardiac arrhythmia classes in pharmacology (with 89.6 ± 2.0% vs 56.8 ± 2.2%, respectively) and therapeutics (89.2 ± 1.4% vs 73.7 ± 2.1%, respectively). The survey indicated higher student satisfaction for flipped classes with highly rated learning objectives, recordings, and in-class activities. CONCLUSION: Use of the flipped teaching method in a 3-class pilot on cardiac arrhythmias improved examination scores for 2 of the 3 classes (pharmacology and therapeutics). Student satisfaction was influenced by the quality of the learning objectives, prerecorded lectures, and inclass active-learning activities.

Implementation of an accelerated physical examination course in a doctor of pharmacy program.

OBJECTIVE: To describe the implementation of a 1-day accelerated physical examination course for a doctor of pharmacy program and to evaluate pharmacy students' knowledge, attitudes, and confidence in performing physical examination. DESIGN: Using a flipped teaching approach, course coordinators collaborated with a physician faculty member to design and develop the objectives of the course. Knowledge, attitude, and confidence survey questions were administered before and after the practical laboratory. ASSESSMENT: Following the practical laboratory, knowledge improved by 8.3% (p<0.0001). Students' perceived ability and confidence to perform a physical examination significantly improved (p<0.0001). A majority of students responded that reviewing the training video (81.3%) and reading material (67.4%) prior to the practical laboratory was helpful in learning the physical examination. CONCLUSION: An accelerated physical examination course using a flipped teaching approach was successful in improving students' knowledge of, attitudes about, and confidence in using physical examination skills in pharmacy practice.

Autopercepção do pré-natal odontológico pelas gestantes de uma unidade básica de saúde / Autoperception of dentistry prenatal by the pregnant women of a Basic Health Unit

Introdução:O tratamento odontológico durante o pré-natal desencadeia medo nas mães, visto que ainda circunda o mito de que seria prejudicial à saúde do bebê e da gestante, proporcionando o distanciamento da gestante à atenção odontológica.Objetivo:Identificar autopercepção das gestantes sobre pré-natal odontológico.Métodologia:Pesquisa de natureza qualitativa, do tipo exploratória. Foi aplicado um instrumento com questões abertas, contendo dados socioeconômicos e informações sobre a percepção do pré-natal odontológico pelas gestantes usuárias dos serviços de uma Unidade Básica de Saúde do interior do Rio Grande do Norte. Para análise dos dados foi realizada a triangulação dos resultados obtidos pelas técnicas de coleta: entrevista, análise documental e teoria científica.Resultados:83,3% das gestantes ouviram falar em pré-natal odontológico, 75% delas afirmaram que foram orientadas por algum profissional de saúde sobre a importância de se fazer o pré-natal odontológico, onde os enfermeiros foram os mais citados. Todas as gestantes afirmaram ser importante ir a uma consulta odontológica durante a gestação, 91,7% das usuárias foram a uma consulta odontológica durante a gravidez e 91,7% acreditam que alguma alteração na boca durante a gestação pode interferir na saúde geral do bebê.Conclusão:As gestantes consideram importante o pré-natal odontológico, pois veem como uma oportunidade de acesso aos serviços de saúde, compareceram a consulta odontológica e apresentaram um grau de adesão ao aconselhamento fornecido pelos profissionais de saúde (AU).

Introduction: Dental treatment during prenatal care triggers fear in mothers, since it still surrounds the myth that it would be harmful to the health of the baby and the pregnant woman, thus distancing the pregnant woman to dental care.ObjectiveTo identify self-perception of pregnant women about dental prenatal care.Methodology: Research of a qualitative nature, exploratory type. An instrument with open questions, containing socioeconomic data and information about the perception of prenatal dentistry by pregnant women users of the services of a Basic Health Unit in the interior of Rio Grande do Norte, was applied. For the analysis of the data, the triangulation of the results obtained by the collection techniques was performed: interview, documentary analysis and scientific theory.Results: 83.3% of the pregnant women heard about prenatal dentistry, 75% of them said that they were advised by a health professional about the importance of doing prenatal dentistry, where nurses were the most cited. All the pregnant women stated that it was important to go to a dental appointment during pregnancy, 91.7% of the users went to a dental appointment during pregnancy and 91.7% believed that any changes in the mouth during pregnancy could interferewith their overall baby.Conclusion: Pregnant women consider dental prenatal to be important, since they see as an opportunity to access health services, attended the dental consultation and presented a degree of adherence to the advice provided by health professionals (AU).

Acesso ao atendimento odontológico dos pacientes especiais: a percepção de cirurgiões-dentistas da atenção básica / Access to dental care of special patients: the perception of primary care dentists

Introdução: Os Pacientes com Necessidades Especiais requerem um atendimento odontológico diferenciado do convencional devido a algumas limitações inerentes a sua condição e às vezes por falta de manejo do profissional. Quando a busca é pelos serviços de saúde bucal, a dificuldade é ainda maior de acesso para esse grupo de pacientes. Esse é um problema que encontramos muitas vezes nas Unidades Básicas de Saúde da Família, que compõem a Atenção Básica no Sistema Único de Saúde. Objetivo: Verificar a percepção dos Cirurgiões-Dentistas da Atenção Básica, quanto ao acesso e resolubilidade dos serviços de saúde bucal, oferecidos a esses pacientes no município de Currais Novos-RN. Metodologia: Estudo do tipo transversal de natureza quantitativa, com coleta de dados realizada entre outubro e dezembro de 2017, entre Cirurgiões-Dentistas da Atenção Básica do referido município a partir de um questionário semiestruturado. As variáveis do questionário compreenderam dados sócio demográficos, dados da atenção oferecida a esse tipo de paciente, além de aspectos gerais sobre a formação e percepção da atenção ofertada pelos Cirurgiões-Dentistas a essa clientela. Resultados: Dos 15 cirurgiões-dentistas entrevistados todos afirmaram atender o paciente com necessidade especial, 13 realiza exame clínico e o tratamento possível, 8 tiveram algum contato com esses pacientes desde a graduação e 12 aprovaram o acesso, o acolhimento e a assistência odontológica oferecida a esses pacientes pelo serviço público de saúde municipal. Conclusão: De acordo com os profissionais entrevistados, esses pacientes têm acesso aos serviços odontológicos em Currais Novos-RN, seja apenas para um exame clínico ou orientação, bem como para outros procedimentos. Se por algum motivo não conseguem atender na atenção básica, eles encaminham ao Centro de Especialidades Odontológicas, que conta com especialistas, os quais consolidam a resolubilidade dos casos (AU).

Introduction: Patients with Special Needs require a dental care different from the conventional one due to some limitations inherent in their condition and sometimes due to lack of professional management. When the search is for the oral health services, the difficulty is even greater of access for this group of patients. This is a problem that we often encounter in the primary care of family health, which make up primary care in the Unified Health System. Objective: To verify the perception of Primary Care dentists regarding the access and resolubility of oral health services offered to these patients in the municipality of Currais NovosRN. Metodology: A cross-sectional study of a quantitative nature, with data collection performed between October and December 2017, among of Primary Care dentists of the mentioned municipality from a semistructured questionnaire. The variables of the questionnaire comprised socio-demographic data, data on the care offered to this type of patient, as well as general aspects about the training and perception of the attention offered by the dentists to this clientele. Results: Of the 15 interviewed dentists, all of them reported attending patients with special needs, 13 performed a clinical examination and possible treatment, 8 had some contact with these patients since graduation and 12 approved the access, reception and dental care offered to these patients by the municipal public health service. Conclusion: According to the professionals interviewed, these patients have access to dental services in Currais Novos-RN, either for a clinical examination or guidance, as well as for other rocedures. If for some reason they can not attend basic care, they refer to the Center of Dental Specialties, which has specialists, which consolidate the resolubility of cases (AU).

Interprofessional education: cooperation among osteopathic medicine, pharmacy, and physician assistant students to recognize medical errors.

Thirty-nine volunteer students from 3 health science colleges at Touro University California participated in an exercise designed to promote interprofessional collaboration. In the event, thirteen 3-person multidisciplinary teams of students identified potential medical errors in a series of case-based scenarios. In an immediate postevent survey, 33 of 39 respondents (85%) indicated that the exercise marked the first time that they had worked on clinical problems with students from other health professions. All respondents agreed that interprofessional education was useful and necessary. A 6-month follow-up survey had 24 respondents, 9 of whom (38%) indicated that the experience helped them in interprofessional communications in their clinical rotations. Twenty-two respondents (92%) recalled that all team members were involved in the selection of answers. Respondents reported that team answer selections were made by consensus (12 [50%]), by accepting the opinion of an "expert" on the team (9 [38%]), or by majority vote (3 [13%]). Since this exercise, there has been a surge of interprofessional activities at Touro University California, including steps toward the implementation of campus-wide interprofessional education.

Manifestações orais decorrentes da quimioterapia em crianças de um centro de tratamento oncológico / Oral manifestations of chemotherapy in children from a cancer treatment center

Objetivo: Identificar as manifestações orais em pacientes pediátricos em tratamento quimioterápico de um Centro de Tratamento Oncológico de Teresina-PI e correlacioná-las com a qualidade da sua saúde oral. Métodos: A amostra desta pesquisa consistiu de 24 crianças entre seis e 12 anos de idade. Durante os meses de junho a julho de 2010, foi aplicado um questionário com perguntas objetivas e subjetivas, direcionado ao paciente e seu responsável, para a coleta dos seguintes dados: idade, gênero, tipo de câncer, sinais e sintomas das manifestações bucais apresentadas após a quimioterapia e hábitos de higiene bucal. Realizou-se, também, um exame clínico intrabucal nos pacientes, pelo pesquisador, para visualização das alterações na mucosa oral e classificar a sua saúde bucal em favorável ou desfavorável. Foram utilizados os testes estatísticos de correlação de Kendall´s, Spearman´s e para relacionar a saúde oral dos pacientes da amostra com as manifestações orais encontradas. Resultados: Os resultados encontrados mostraram que a idade média dos pacientes pesquisados foi de 8,5 anos; o gênero masculino (75,0%) foi predominante na amostra; a neoplasia maligna mais incidente foi a leucemia (50,0%); 83,3% dos pacientes apresentaram pelo menos uma manifestação oral, sendo a mucosite de maior prevalência (62,5%), seguida da xerostomia (54,1%), disfagia (50,0%), disgeusia (45,8%), candidíase (41,6%), sangramento gengival (25,0%), herpes labial (25,0%) e odontoalgia (12,5%). Encontraram-se 28,6% dos pacientes com saúde bucal favorável e 71,4% deles com saúde bucal desfavorável, os quais todos estes apresentaram complicações orais da quimioterapia. Conclusão: As manifestações orais dos pacientes submetidos à quimioterapia do Centro de Tratamento de Teresina no período estudado foram diversas: mucosite, xerostomia, disfagia, disgeusia, sangramento gengival, candidíase, herpes labial e odontoalgia. Os efeitos colaterais na cavidade oral do pacientes foram associados à presença de uma saúde bucal desfavorável.

Objective: identify the oral manifestations in pediatric patients caused by chemotherapy at a Cancer Treatment Center in Teresina, PI, Brazil and correlate them with the quality of oral health. Methods: The sample of this research consisted of 24 children between 6 and 12 years. From June to July, 2010, a questionnaire directed to the patients and their parents/caregivers, with subjective and objective questions, was applied for collecting the following data: age, gender, type of cancer, signs and symptoms of oral manifestations presented after chemotherapy, and oral hygiene habits. Intraoral clinical examination of patients was performed by the researcher, to detect the changes in the oral mucosa caused by chemotherapy and classify their oral health as favorable or unfavorable. Kendall's, Spearman's and Pearson's statistical tests were used to correlate the oral health of the patients with the found oral manifestations. Results: The results showed that the mean age of the patients was 8.5 years; the male gender (75.0%) was prevalent in the sample; the most frequent malignancy was leukemia (50.0%); 83. 3% of patients had at least one oral manifestation, mucositis being the most prevalent (62,5%), followed by xerostomia (54.1%), dysphagia (50.0%), dysgeusia (45.85), candidiasis (41.6%), gingival bleeding (25.0%), herpes labialis (25.0%) and toothache (12.5%). Favorable and unfavorable oral health was found for 28.6% and 71.4% of the patients, respectively, and all of them presented oral complications due to chemotherapy. Conclusion: The oral manifestations of the patients at Teresina' cancer treatment center within the studied period were diverse: mucositis, xerostomia, dysphagia, dysgeusia, gingival bleeding, candidiasis, herpes labialis and toothache. Side effects in the oral cavity of these patients were associated with the presence of an unfavorable oral health.