Intoxicación por antidepresivos tricíclicos / Tricyclic antidepressant poisoning

Introducción: el paciente intoxicado sigue siendo un desafío para el personal de salud. La intoxicación por antidepresivos tricíclicos (ATC) es un diagnóstico frecuente y una patología que puede llegar a ser muy grave. A pesar de que ha cambiado el objetivo terapéutico de estos fármacos a lo largo de los años, la alta disponibilidad de estos hace que su uso para intento de autolisis siga presentándose. Su presentación clínica es variada y dado el riesgo de mortalidad asociada, es importante que esta patología sea rápidamente reconocida por los médicos que los reciben para iniciar un manejo oportuno y eficaz. Objetivo: presentar el enfrentamiento inicial y manejo terapéutico de la intoxicación por ATC desde la perspectiva de la medicina de urgencia. Método: se realizó una revisión bibliográfica de la literatura científica sobre el manejo de un paciente intoxicado por ATC. Se presenta la evidencia actual de las intervenciones terapéuticas más utilizadas. respecto al manejo inicial y enfrentamiento de la intoxicación por antidepresivos tricíclicos, en el contexto de la atención en un servicio de urgencia. Conclusión: la intoxicación por ATC puede presentarse con síntomas leves y signos precoces, así como con síntomas graves e incluso fatales, dados principalmente por complicaciones cardiovasculres y neurológicas. Su manejo se basa en el reconocimiento precoz, medidas de soporte y terapias específicas según la clínica que presente.

Managing poisoned patients continues to be a challenge for health personnel. Tricyclic antidepressant are a frequent diagnosis, and a pathology their can be very serious. Although the therapeutic indications for these drugs have changed over the years, their high availability means that their use for suicidal attempts continues to be present. Its clinical presentation is varied and given the mortality risk, it is crucial that this entity must be rapidly recognized by the physicians who care for them to initiate timely and effective treatment. Objective: Present the initial management and therapeutic strategies for tricyclic antidepressant intoxication, from emergency medicine perspective. Method: Bibliographic review of the scientific literature on this subject. Current evidence of the most widely used therapeutic interventions is described regarding the initial management and disposition of tricyclic antidepressant intoxication in the emergency department.

Registro prospectivo de pacientes que presentan paro cardiorrespiratorio extrahospitalario en Santiago, Chile / A registry of out-of-hospital cardiac arrest in Chile

BACKGROUND: The rate of survival to hospital discharge is less than 10% for out-of-hospital cardiac arrest (OHCA). AIM: To develop and implement a Chilean prospective, standardized cardiac arrest registry following the Utstein criteria. MATERIAL AND METHODS: We conducted a prospective registry for patients presenting at an urban, academic, high complexity emergency department (ED) after having an OHCA. The facility serves approximately 10% of the national population. Data were registered and analyzed following the Utstein criteria for reporting OHCA. RESULTS: For three years, 289 patients aged 59 ± 19 years (63% men) were included. Fifty seven percent of patients were taken to a health care facility for the first medical assessment by relatives or witnesses and 34% was assisted and transferred by prehospital personnel. In the subgroup of non-traumatic OHCA, 28% (n = 54) received bystander cardiopulmonary resuscitation (CPR). The registered cardiac rhythms were asystole (61%), pulseless electrical activity (PEA) (25%) and ventricular tachycardia (VT) or ventricular fibrillation (VF) (11%). The overall survival rate to discharge from the hospital was 10%, while survival with mRankin score 0-1 was 5%. The median hospitalization length of stay was 18 days among those who survived, compared with five days for the group of patients that died during the hospital stay. CONCLUSIONS: OHCA is an important cause of death in Chile. The development of a national registry that follows the International Liaison Committee on Resuscitation guidelines is the first step to assess the profile of OHCA in the region. It will provide crucial information to identify prognostic factors and variables that can help develop standards of care and set up the basis to optimize cardiac arrest management within our country and region.

Disnea en el servicio de urgencia / Dyspnea in the emergency deparmen

La disnea es definida como la sensación subjetiva de ahogo o falta de aire y es un motivo muy frecuente de consulta. Su presentación clínica puede variar, desde manifestaciones leves hasta insuficiencia respiratoria catastrófica, con elevada mortalidad y requerir de terapias invasivas complejas. En los servicios de urgencia se inicia el estudio etiológico del paciente agudo, al mismo tiempo que se realizan intervenciones terapéuticas destinadas a la estabilización y manejo tiempo-dependiente del paciente que consulta por disnea. En vista de las múltiples causas de disnea, es necesario que el especialista en medicina de urgencia conozca los distintos diagnósticos diferenciales y sepa orientar su manejo y estudio. Este manuscrito pretende dar un marco teórico acerca de la presentación del paciente con disnea en el servicio de urgencia, describir sus principales características y orientar el estudio y tratamientos tiempo-dependientes desde su primera evaluación por el equipo médico. Se expone un caso clínico y revisan los componentes esenciales de la fisiopatología que explica la disnea, así como la descripción de herramientas para su evaluación, tratamiento y disposición en el servicio de urgencia. Finalizaremos con la resolución del caso.

Dyspnea, defined as the subjective feeling of shortness of breath, it's a common complaint in emergency departments all over the world. The clinical presentation may include mild symptoms to severe respiratory distress with the requirement of mechanical ventilation. This implies high mortality rates and complex decision-making involving diagnostics, treatment, and invasive management in all groups of ages.It is paramount for the emergency medicine physician to acknowledge its vastly differential diagnostics and be familiarized with time-dependent actions to properly stabilization and treatment. This article aims to review the presentation of dyspneic patients in the Emergency Department, describes the main physiologic characteristics, guide diagnosis, and treatment since the very first-minute patient steps into the hospital. It will present clinical scenarios and handle valuable tools for evaluation and treatment strategies in dyspneic patients while they stay in the Emergency Department.

Osteopenia and osteoporosis among treatment-experienced people living with HIV

Abstract Introduction Life expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system. Objectives Estimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors. Methods A cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age≥18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration. Results Among 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37-35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94-7.37). Conclusions This study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.

Standardization of endometriosis surgery - the coloproctologist's vision / Padronização da cirurgia da endometriose - visão do coloproctologista

ABSTRACT Objective: To demonstrate the standardization of deep endometriosis surgery with intestinal involvement. Methods: Prospective study evaluating 74 women undergoing standardized surgery for deep intestinal endometriosis. Divided into two groups, according to the findings of three-dimensional anorectal ultrasound, Group I with lesions affecting perirectal fat and Group II with lesions affecting at least the muscular layer of the rectum. Results: There was no statistically significant difference between the groups in relation to the size of the focus and the distance of the lesion to the puborectalis muscle (p > 0.05). The type of surgery performed was laparoscopy without lesions in one patient (1.35%), disk resection in 13 patients (17.56%), shaving in 45 patients (60.81%), and rectosigmoidectomy in 15 patients (20.27%). The complications were bleeding from the drain with conservative treatment in three patients (4.05%), fistula in two patients submitted to the shaving method (2.70%), and three patients (4.05%) with lower anterior recession syndrome (LARS), with improvement from conservative treatment. Lesions in other organs were also observed during videolaparoscopy. Conclusion: Surgical standardization is important to guide the general/colorectal surgeon in the effective approach of intestinal endometriosis.

RESUMO Objetivo: Demonstrar a padronização da cirurgia de endometriose profunda com acometimento intestinal. Métodos: Estudo prospectivo que avaliou 74 mulheres submetidas à cirurgia padronizada para endometriose profunda intestinal. Divididas em dois grupos, segundo os achados da ultrassonografia anorretal tridimensional, o Grupo I com lesões acometendo a gordura perirretal e o Grupo II com lesões acometendo, pelo menos, a camada muscular própria do reto. Resultados: Não houve diferença estatisticamente significativa entre os grupos em relação ao tamanho do foco e à distância da lesão ao músculo puborretal (p > 0,05). O tipo de cirurgia realizada foi laparoscopia sem achados da lesão em um paciente (1,35%), ressecção em disco em 13 pacientes (17,56%), Shaving em 45 pacientes (60,81%) e retossigmoidectomia em 15 pacientes (20,27%). As complicações encontradas foram sangramento pelo dreno com tratamento conservador em 3 pacientes (4,05%), fístula em 2 pacientes submetidas ao método de shaving (2,70%), 3 pacientes (4,05%) com Síndrome da Ressecção Anterior do Reto (LARS), com melhora ao tratamento conservador. Lesões em outros órgãos também foram observadas durante a videolaparoscopia. Conclusão: A padronização cirúrgica é importante para orientar o cirurgião geral/colorretal na abordagem eficaz na endometriose intestinal.

Generalidades y manejo inicial del shock / Generalities and initial shock management

El shock es un síndrome multifactorial que requiere un enfrentamiento sistematizado para su identificación, clasificación y tratamiento adecuado. A pesar de los avances en medicina, distintos estudios y series clínicas indican que la mortalidad puede llegar hasta un 50p or ciento. La única variable que ha mostrado ser consistente en disminuir la mortalidad, independiente de la causa del shock, es su reconocimiento y manejo precoz. Este manuscrito pretende dar un marco teórico acerca de la presentación del paciente en shock en el servicio de urgencia, describir sus principales características y orientar el estudio y tratamientos tiempo-dependientes desde su primera evaluación por el equipo médico. Inicia con la exposición de casos clínicos relevantes al tema. Luego revisa la fisiopatología del fenómeno del shock y sus subtipos. Finalmente ofrece herramientas para su evaluación y tratamiento en el servicio de Urgencia.(AU)

Shock is a complex syndrome that requires a systematic and structured approach for its identification, classification and management. Despite advances in medical science, studies show that mortality could be as high as 50 percent and, up until now, early recognition and adequate management of shock is the only consistent variable proven to be effective in lowering mortality rates. This article aims to review the presentation of shocked patients in the Emergency Department, describe its main physiologic characteristics and guide its diagnosis and treatment timely since the very first minute the patient steps into the hospital. It will present clinical scenarios, review shock's unique physiopathology and present its subtypes. Finally, this article will handle valuable tools for evaluation and treatment strategies in shocked patients while they stay in the Emergency Department.(AU)

Alteración de signos vitales dentro de las 72 h previas a la activación de código azul en pacientes adultos hospitalizados de un hospital universitario / Deterioration of vital signs as predictors of major medical emergencies in hospitalized patients

Background: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. Aim: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. Patients and Methods: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. Results: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. Conclusions: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.

Prevalencia de pacientes con alto riesgo de caídas en un servicio médico-quirúrgico de un hospital universitario / Risk of falls among patients admitted to a medical-surgical ward: analysis of 376 medical records

Background: Detecting patients at risk of falls during hospital stay is of utmost importance to implement preventive measures. Aim: To determine the frequency of patients with a high risk of falls admitted to a medical-surgical ward. To assess the preventive measures implemented. Materials and Methods: Review of medical records of 376 patients aged 20 to 97 years (28% older than 70 years) admitted to a clinical hospital in a period of four months. Results: Eleven percent of patients had a history of falls, 50% had a sensory deficit, 68% had unstable gait, 8% had a neurological risk condition, 8% had drowsiness or disorientation, 4% had psychomotor agitation or delirium, 86 % used high risk medications, 73% used 2 or more high risk drugs and 72% were using devices that decrease mobility. One hundred forty-one patients (38%) had a high risk of falling. The mean age of the latter was 77 years, 89% had a sensory deficit, 96% had unstable gait, 4% had psychomotor agitation or delirium and 98% used high risk drugs. Less than 1% had a medical prescription of a caregiver, physical restraints or antipsychotics, however, 21% of patients had a caregiver. Conclusions: The percentage of patients with a high risk of falling is important. The main risk factors were sensory deficit, unstable gait and the use of high risk medications. The low frequency of preventive measures prescriptions is striking.

Paro cardiorrespiratorio extrahospitalario. Realidad de un hospital terciario chileno / Out of hospital cardiac arrest events at an urban Hospital in Chile

Background: The incidence of out of hospital cardiac arrest (OHCA) is approximately 20 to 140 per 100.000 inhabitants. International registries, based on Utstein criteria have allowed standardized reporting of OHCA profiles and outcomes in different countries. We proposed to create a local OHCA registry. Aim: To assess the quality of the information about OHCA currently recorded in medical records according to Utstein guidelines. Material and Methods: A retrospective analysis of medical records of patients arriving in the emergency room of a public hospital with OHCA during a 3-year period. Data regarding the patient characteristics, event and outcomes were analyzed. Results: During the revision period, 317 patients arrived with an OHCA. None of the medical records had complete data on items that are considered a minimum requirement by Utstein guidelines. Mean age of patients was 63 years old, 60% were men, the most common arrest rhythm was asystole (43%) and 8% of patients were discharged alive. Conclusions: Data recorded in medical records is insufficient to inform the profile of OHCA. A prospective registry is currently being implemented based on the information provided by this study. This registry should optimize reporting and data analysis.

Percepción de las motivaciones en el ingreso a una carrera del área de la salud / Perception of the motivational factors for pursuing a career in healthcare

Interpretar la percepción de las motivaciones que presentan estudiantes a ingresar en una carrera del área de la salud en la Facultad de Medicina de la Universidad Católica de la Santísima Concepción, Chile durante el año 2015. Material y Métodos: A través de un diseño cualitativo y utilizando un enfoque fenomenológico, se aplica entrevista semiestructurada a 55 estudiantes que ingresan a la carrera de Medicina, Enfermería, Nutrición y Dietética, Kinesiología o Tecnología Médica de la Facultad de Medicina de la Universidad Católica de la Santísima Concepción, Chile, durante el año 2015. Los resultados, sometidos a triangulación de informantes, son analizados utilizando la técnica de análisis de discurso. Resultados: La vocación de servicio público, el campo laboral una vez egresados o la vivencia de experiencias personales y/o familiares frente a una condición de salud se perciben como parte importante en las motivaciones de ingreso a una carrera del área de salud. La familia, el establecimiento educacional de procedencia o los amigos no se identifican como influyentes en la selección de la carrera de formación profesional a seguir. Esta situación es identificada independiente de la disciplina seleccionada. Conclusiones: El altruismo y la vocación de servicio público son percibidos como el principal factor condicionante al momento de ingresar a una carrera del área de salud...

To interpret the perception of the motivational factors presented by students who decide to pursue a career in healthcare in the Faculty of Medicine at the Catholic University of the Most Holy Conception, Chile during 2015. Material and Methods: Through a qualitative design and using a phenomenological approach, a semi-structured interview was applied to 55 new students. They were all pursuing a degree in the fields of Medicine, Nursing, Nutrition and Dietetics, Physical Therapy or Medical Technology of the School of Medicine at Universidad Católica de la Santísima Concepción, Chile, in 2015. The results were subject to triangulation of informants, and were analyzed using the technique of discourse analysis. Results: Vocation for public service, the career field once graduated or the experience of personal /familiar experiences when facing a health condition are perceived as an important part of the motivational factors for pursuing a degree in healthcare. Family, school where they graduated from or friends are not identified as an influence when deciding what professional field to pursue. This situation is not necessarily linked to a specific area of expertise. Conclusions: Altruism and vocation for public service are perceived as the main conditioning factor when deciding to pursue a degree in healthcare...

Adolescent adjustment in at-risk families: The role of psychosocial stress and parental socialization / Ajuste adolescente en familias en situación de riesgo: El rol del estrés psicosocial y de la socialización parental

Introduction The study of factors associated with internalizing and externalizing problems in adolescents living in at-risk families is a subject of recent interest in mental health in Spain. The presence of mental health problems in children and adolescents is too frequent in these families due to their high exposure to a variety of risk factors and the lack of protection factors. However, few studies have examined the contribution of specific factors to each type of mental health problem in adolescents from at-risk Spanish families. This study strives to contribute to knowledge in this field, by analyzing the role of two important dimensions frequently linked to adolescents' adjustment: psychosocial stress and parental socialization. Likewise, this study seeks to identify whether both dimensions predict differently for two types of mental health problems in adolescents from at-risk families. Methodology The sample was composed by 134 Spanish adolescents (56 girls and 78 boys) with an average age of 13.52 (SD = 1.57). These adolescents grew up in families who were receiving psychosocial intervention from Social Services in Spain for family preservation reasons. This research is considered to be a cross-sectional descriptive study and the instruments administered allowed the collection of data about mental health problems, psychosocial stress, parental socialization and intervention data by Social Services. Results The hierarchical multiple regression models showed that both domains (psychosocial stress and parental socialization) were significantly related to mental health problems, but a different pattern of findings emerged for each type of problem. When co-morbidity between both problems was controlled, psychosocial stress was mainly related to internalizing problems, whereas parental socialization predicted the externalizing ones. Discussion and conclusions This study underscores the importance of distinguishing between two types of mental health problems analyzed (internalizing and externalizing) and emphasizes that both, the enhancement in parental socialization as well as the training of adolescents in positive social skills to cope better with stressful life events, should be part of at-risk family programs.

Introducción El estudio de factores asociados con problemas internalizantes y externalizantes en adolescentes que viven en familias en riesgo es objeto de interés reciente en salud mental en España. La presencia de problemas de salud mental en menores y adolescentes es demasiado frecuente en estas familias debido a la alta y variada exposición a factores de riesgo, así como a la falta de elementos de protección que les rodean. Sin embargo, pocos estudios han examinado la contribución que factores específicos hacen a cada tipo de problemas de salud mental en adolescentes de familias españolas en riesgo. Este estudio intenta contribuir al conocimiento en este campo, analizando el papel de dos dimensiones frecuentemente relacionadas con el ajuste adolescente: estrés psicosocial y socialización parental. Asimismo, este estudio trata de identificar si ambas dimensiones predicen de forma diferente los dos tipos (internalizantes y externalizantes) de problemas de salud mental en adolescentes de familias en situación de riesgo. Metodología La muestra se compone de 134 adolescentes españoles (56 chicas y 78 chicos) con una media de edad de 13.52 (DT=1.57). Estos adolescentes crecieron en familias que estaban recibiendo una intervención psicosocial por parte de los Servicios Sociales españoles por razones de preservación familiar. El diseño de esta investigación es de carácter transversal y descriptivo. Los instrumentos administrados permitieron recabar datos sobre problemas de salud mental, estrés psicosocial, socialización parental y la intervención recibida por los Servicios Sociales. Resultados Los modelos de regresión múltiple jerárquica mostraron que ambos dominios (estrés psicosocial y socialización parental) estuvieron significativamente relacionados con los problemas de salud mental, pero emergió un patrón de resultados diferentes para cada tipo de problemas. Cuando la comorbilidad entre ambos problemas fue controlada, el estrés psicosocial estuvo significativamente relacionado con los problemas internalizantes, mientras que la socialización parental se asoció con los problemas externalizantes. Discusión y conclusiones Este estudio subraya la importancia de distinguir entre los dos problemas de salud mental analizados y hace hincapié en que, tanto la mejora en la socialización de los progenitores como el entrenamiento de los adolescentes en habilidades sociales positivas que permitan afrontar adecuadamente acontecimientos estresantes, deben ser contenidos fundamentales en los programas de intervención destinados a familias en situación de riesgo psicosocial.

La escala para la Evaluación de la Calidad del Vecindario (ECAVE): proceso de elaboración y análisis preliminares de sus propiedades psicométricas / Scale to assess quality of neighbourhood ECAVE: design and preliminary analyses of its psychometric properties

En este artículo se describe el proceso de elaboración del ECAVE, un cuestionario cuyo objetivo es evaluar la calidad del vecindario para las familias y sus integrantes, a partir de la información aportada por equipos de profesionales de los Servicios Sociales (psicólogos, trabajadores sociales y educadores sociales) que trabajen en la zona a evaluar. Asimismo, en el artículo se presentan los análisis preliminares sobre las propiedades psicométricas de este instrumento de evaluación. Los resultados obtenidos ofrecen evidencias de la fiabilidad y validez de la prueba, así como de su potencialidad para examinar, de manera sistemática, algunas de las principales características de los vecindarios que pueden incidir en el funcionamiento de las familias que en ellos residen y en el desarrollo psicológico de sus miembros. En el anexo final del artículo se ofrece el ECAVE, así como una entrevista semiestructurada para ser utilizada con los equipos de profesionales de los Servicios Sociales y que permite recoger la información necesaria para completar el cuestionario.

In this article the design of a scale to assess quality of neighbourhood (with information given by teams of psychologists, social workers and social educators from Social Services) for families and individuals is presented. Preliminary analyses about psychometric properties are discussed. Results obtained indicate some evidences for the reliability and the validity of the scale, and its potential for examining, in a systematic way, some relevant dimensions of neighbourhoods for family functioning and individual psychological adjustment. Both the questionnaire and a semi-structured interview (for collecting the data with the teams of practitioners from Social Services) are included at the end of the article.

Efeito de um protocolo de exercícios realizado em ambientes domiciliar e clínico para prevenir o risco de quedas em idosos comunitários / Effect of an exercise protocol performed at home and clinical environments to prevent falls in elderly community residents

As quedas estão dentre as principais causas de morbimortalidade na população idosa. As causas são multifatoriais, incluindo fatores intrínsecos e extrínsecos. A probabilidade para queda aumenta à medida que se acumulamos fatores de risco. O objetivo deste estudo foi analisar o efeito de um protocolo de exercícios para treinamento de equilíbrio e fortalecimento muscular no risco de quedas em idosos,em ambiente domiciliar e clínico. Neste estudo quase experimental com abordagem quantitativa, realizado no domicílio dos idosos e nas Clínicas Integradas de Fisioterapia da Universidade de Itaúna, foram incluídos 20 idosos com idade ≥ 70 anos, residentes na comunidade e divididos em dois grupos: IC (Intervenção na Clínica)e ID (Intervenção Domiciliar). Instrumentos utilizados: Escala de Equilíbrio de Berg, Timed Get Up and GO, Mini Mental, Perfil de Saúde de Nottingham, Escala de Depressão Geriátrica e Questionário Clínico e Demográfico. Os resultados mostraram melhora em ambos os grupos no aspecto equilíbrio. O grupo ID melhorou também no aspecto qualidade de vida (p < 0,05). Comparando os dois grupos, foi observado melhora significativa no aspecto risco de quedas no grupo IC. Concluiu-se que o atendimento em ambiente domiciliar e ambulatorial são eficazes se os pacientes forem orientados e estimulados pelo fisioterapeuta.

Falls are among the leading causes of morbimortality in the elderly population. The causes are multifactorial, including intrinsic and extrinsic risk factors. The risk of falling increases with the number of risk factors. The aim of this study was to analyze the effect of balance training and muscle strengthening exercise protocol to prevent risk of falling in older adults at clinical and home environments. In this quasi experimental study with a quantitative approach performed at elderly homes and at Integrated Physical Therapy Clinics at the University of Itaúna/MG were included 20 elderly ≥70 years old, living in the community and divided into two groups:IC (Intervention in the Clinic) and ID (Household Intervention). Instruments used were Berg Balance Scale, Timed Get Up Go, MiniMental Nottingham Health Profile, Geriatric Depression Scale and Clinical and Demographic Questionnaire. The results showed an improvement in both groups in balance aspect. The ID group also improved in quality of life aspects (p < 0.05). Comparing the two groups, we observed significant improvement in risk of falling inthe IC group. It was concluded that the exercise protocol held atout patient clinic and home environments are effective when physical therapist offers a well oriented and stimulating program.

Estrés y competencia parental: un estudio con madres y padres trabajadores / Stress and parental competence: a study with working parents

El objetivo de este estudio es evaluar dimensiones relativas al contexto familiar y laboral, y examinar su contribución al nivel de estrés asociado a la paternidad. Se analizó el papel desempeñado por la percepción de competencia, tanto del padre como de la madre, una vez controladas algunas características de ambos contextos. Se realizaron análisis con la información obtenida de 74 progenitores que, en el momento de la evaluación, disponían de un puesto laboral y cuidaban al menos a un menor en edad escolar. Los resultados indicaron que la dedicaciónlaboral, el número de hijos y la percepción de dificultad en el cuidado del menor, fueron las variables más robustas para explicar el estrés parental. Asimismo, los análisis mostraron que una evaluación positiva y optimista del papel que la persona desempeña en la educación y el cuidado de sus hijos, tendió a atenuar la aparición de estrés parental.

The aim of this study is to explore the role of some dimensions related with labor and family context, and examine their influence to the stress level associated with parenthood. Special attention was given to the perceived competence as a parent after controlling different characteristics from both contexts. Several analyses were performed with the information obtained from 74 active-working parents responsible for at least one school-aged child. The results indicated that the work time, the number of children at home and the perception of difficulty about child caring were the most important variables for explaining the parental stress. Furthermore,analysis showed that a positive and optimistic perception of the parental role and child care helped to mitigate the appearance of parental stress.