Solidão na perspectiva do idoso / Loneliness from the perspective of the elderly

Resumo Introdução: A solidão é um sentimento penoso e angustiante, que conduz a um mal-estar em que a pessoa se sente só, ainda que rodeada de pessoas, por pensar que lhe falta suporte, sobretudo de natureza afetiva. É mais frequente na adolescência, porém também o é nos idosos. Objetivo: Conhecer a opinião dos idosos em relação aos sentimentos de solidão. Metodologia: Respeitando a confidencialidade, foram inquiridos 73 idosos de ambos os sexos, que vivem em lares ou no domicílio habitual, mas frequentam centros-dia / de convivência. A amostra foi por conveniência, aleatória, constituída por idosos que se encontravam em condições de responder e o desejaram fazer. Foi utilizado um pequeno questionário, devidamente testado, de perguntas de resposta mista. Resultados: Para 78,1% dos entrevistados, a pessoa significativa era um familiar que não o cônjuge (sobretudo filhas e netas); 79,4% referiram sentir algumas vezes ou raramente / nunca solidão. São os viúvos e os divorciados que em maior percentagem referiam sentir muitas vezes solidão. Para diminuição da solidão, sugeriram diversas formas de convívio e atividades em que predominasse a comunicação. A solidariedade intergeracional foi também citada. Conclusões: Embora a solidão esteja descrita como um problema crescente nos idosos, nas pessoas que inquirimos sua frequência não era elevada, talvez pelo fato de os idosos entrevistados manterem atividades sociais. Seria importante realizar estudo longitudinal dirigido a idosos que permanecem no seu domicílio, com uma amostra representativa da população idosa em determinada região, praticando ou não atividades sociais, para abranger uma opinião mais alargada de idosos acerca da solidão.

Abstract Introduction: Loneliness is a painful and distressing feeling that leads to a malaise where a person feels alone, despite being surrounded by people, feeling that he or she lacks support, especially of an emotional nature. It is most common in adolescence, but is also prevalent in old age. Objective: To identify the opinion of elderly persons in relation to feelings of loneliness. Methodology: The respondents were 73 elderly men and women living at home but attending day care/social centers. A random convenience sample was used, consisting of elderly persons who were able and wished to respond to a short, duly tested questionnaire with mixed response questions. Confidentiality was respected throughout the study. Results: In 78.1% of respondents, a significant person was a family member who was not a spouse (especially daughters and granddaughters); 79.4% reported feeling sometimes or rarely/ never feeling lonely. Widowed or divorced elderly persons were those who most frequently referred to sometimes feeling lonely. To reduce loneliness, they suggested various forms of interaction and activities in which communication predominated. Intergenerational solidarity was also cited. Conclusions: Although loneliness is described as an increasing problem for the elderly, its frequency was not high among those interviewed, perhaps because the respondents engaged in social activities. A longitudinal study aimed at elderly persons who stayed at home, with a representative sample of the elderly population in a given region, who participated or did not participate in social activities, is recommended to provide a broader perspective of the views of the elderly about loneliness.

Relational skills: needs experienced by nursing students.

OBJECTIVE: to identify the needs of nursing students in the field of relational competencies. METHOD: qualitative study with an exploratory-descriptive nature. The random sample included 62 students in the 2nd year of the nursing undergraduate program of a school located in the central region of Portugal. The inclusion criterion was the nonexistence of clinical teaching. Data were collected through a form designed to assess relational needs; content analysis was used to analyze data. RESULTS: the results indicated that the students' concept of nursing care at this stage of their education is focused on the performance of nursing tasks and techniques instead of on scientific knowledge. Overall, they are aware that greater personal development and better self-knowledge are determinant for their personal and social well-being and for them to become good professionals. CONCLUSION: these results will support the improvement of an intervention program to be developed with these students.

Competências do cuidador informal atribuídas pelos enfermeiros comunitários: um estudo Delphi / Competencies of the informal caregiver attributed by community nurses: Delphi study / Competencias del cuidador informal atribuidas por los enfermeros comunitarios: un estudio Delphi

O objetivo do presente estudo foi identificar as competências que um cuidador informal deve possuir para cuidar, em domicílio, de pessoas com dependência. Trata-se de estudo exploratório-descritivo, realizado com enfermeiros de Centros de Saúde no Norte de Portugal, que recorreu ao método Delphi, com dois rounds, usando questionários para o efeito. Foi utilizada a análise de conteúdo no primeiro roundde Delphi, confirmando-se uma complexidade de fatores que condicionam as competências dos cuidadores no cuidar de um doente com dependência no domicílio. Com recurso de análise estatística, no segundo round,os indicadores de competências cognitivas, psicomotoras e relacionais obtiveram níveis de concordância excelentes. Foi reconhecida como fundamental a motivação do cuidador informal, considerada o leitmotivno processo de cuidar. Para além disto, o cuidador necessita de apoio, ensino, treino e encaminhamento para se munir das competências para cuidar de um doente dependente no domicílio, com segurança...

The purpose of the present study was to identify the competencies that an informal caregiver must have in order to provide home care to dependent people. It consists of an exploratory-descriptive study developed with nurses from healthcare centers in the North of Portugal, using the Delphi method with two rounds and utilizing questionnaires for the effect. Content analysis was used in the first round of Delphi, confirming a complexity of factors that condition the competencies of caregivers in the provision of home care to people with dependency. Through the use of statistical analysis, in the second round the indicators for cognitive, psychomotor and relational competences reached excellent levels of agreement. The motivation of the informal caregiver was recognized as fundamental and considered to be the leitmotivin the caregiving process. Furthermore, the caregiver needs support, teaching, training and orientation to be provided with the necessary competencies to take care of a dependent patient in his/her house safely...

El presente estudio apuntó a identificar las competencias que debe poseer un cuidador informal para cuidar en domicilio a personas con dependencia. Estudio exploratorio, descriptivo, realizado con enfermeros de Centros de Salud del Norte de Portugal, recurriendo al método de Delphi, con dos rounds, utilizando cuestionarios al efecto. Se usó análisis de contenido en el primer roundde Delphi, confirmándose una complejidad de factores que condicionaron las competencias de los cuidadores en la atención de un enfermo dependiente en domicilio. Apelando al análisis estadístico, en el segundo round, los indicadores de competencias cognitivas psicomotoras y relacionales obtuvieron niveles de concordancia excelentes. Fue reconocida como fundamental la motivación del cuidador informal, considerada el leitmotiven el proceso del cuidado. Además de esto, el cuidador necesita de apoyo, enseñanza, entrenamiento y seguimiento, para hacerse de las competencias para cuidar de un enfermo dependiente en domicilio con seguridad...

Relational skills: needs experienced by nursing students / Competências relacionais: necessidades sentidas pelos estudantes de enfermagem / Habilidades relacionales: necesidades sentidas por los estudiantes de enfermería

OBJECTIVE: to identify the needs of nursing students in the field of relational competencies. METHOD: qualitative study with an exploratory-descriptive nature. The random sample included 62 students in the 2nd year of the nursing undergraduate program of a school located in the central region of Portugal. The inclusion criterion was the nonexistence of clinical teaching. Data were collected through a form designed to assess relational needs; content analysis was used to analyze data. RESULTS: the results indicated that the students' concept of nursing care at this stage of their education is focused on the performance of nursing tasks and techniques instead of on scientific knowledge. Overall, they are aware that greater personal development and better self-knowledge are determinant for their personal and social well-being and for them to become good professionals. CONCLUSION: these results will support the improvement of an intervention program to be developed with these students.

OBJETIVO: identificar as necessidades manifestadas pelos estudantes de enfermagem na área das competências relacionais. MÉTODO: estudo, qualitativo com características exploratório-descritivas, a amostra aleatória incluiu 62 estudantes do 2º ano do Curso de Licenciatura em Enfermagem (Escola da Região Centro de Portugal). Considerou-se como critério de selecção a inexistência de realização de Ensino Clínico. Coleta de dados realizada por meio da Ficha de Avaliação de Necessidades Relacionais com análise de conteúdo dos dados. RESULTADOS: indicaram que nesta fase da formação, os estudantes detêm um conceito de cuidar em Enfermagem centrado na execução de tarefas e técnicas de enfermagem em vez de na cientificidade do saber em Enfermagem e, que globalmente estão cientes que um maior desenvolvimento pessoal, um melhor conhecimento de si será determinante para o bem-estar pessoal e social e ser um bom profissional. CONCLUSÃO: as evidências permitirão aprimorar o programa de intervenção a desenvolver com estes estudantes.

OBJETIVO: identificar las necesidades manifestadas por los estudiantes de enfermería en el área de las habilidades relacionales. MÉTODO: estudio, cualitativo con características exploratorio-descriptivas, la muestra aleatoria incluyó 62 estudiantes del 2º año del Curso de Licenciatura en Enfermería (Escuela de la Región Centro de Portugal). Se consideró como criterio de selección la inexistencia de realización de Enseño Clínico. Recogida de datos realizada por medio de la Ficha de Evaluación de Necesidades Relacionales con análisis de contenido de los datos. RESULTADOS: indicaron que en esta fase de la formación, los estudiantes detienen un concepto de cuidar en Enfermería centrado en la ejecución de tareas y técnicas de enfermería en vez de en la cientificidad del saber en Enfermería y, que globalmente saben que un mayor desarrollo personal, un mejor conocimiento de sí será determinante para el bienestar personal y social y serán buenos profesionales. CONCLUSIÓN: las evidencias permitirán apurar el programa de intervención a desarrollar con estos estudiantes.

Happiness among the elderly in communities: a study in senior clubs of Chonburi Province, Thailand.

AIM: To study the levels of happiness perception in the elderly in different regions, and determine the reasons affecting it. METHODS: The Thai Happiness Indicators: THI-15; 2001 were used in this study of 306 participants (> or =60 years) in different regions: rural, suburban, and urban. The elderly were chosen by chance from those belonging to Thai senior clubs in opportunistic random. RESULTS: The elderly perceived their happiness as good, fair, and poor, respectively, 12.4%, 37.9%, and 49.7%. There was a difference in happiness perception among the regions: poor happiness perception (64.5%, 61.2%, and 22.8% in rural, suburban, and urban areas, respectively) (P < 0.001). We also verified that there was a difference in poor happiness perception between males (57.9%) and females (42.2%) (P < 0.01). There were differences in the happiness perception among people with different levels of education (chi(2) (4, N = 306) = 14.15, P = 0.007). There was also a difference between happiness perceptions as related to occupation: the results showed elderly who were not working had a better score of happiness perception than the elderly who had to work. CONCLUSIONS: Although we cannot generalize from the results the happiness of all Thai elderly, the present study found that formal education, geographical areas, and gender can influence happiness. Health-care providers should be concerned about and provide the proper intervention and/or activities in order to alleviate the mental health problems among the elderly in communities, especially the elderly who are identified with poor happiness.

[Training of primary health care nurses on sexuality: a study of associated factors]. / Formação sobre sexualidade dos enfermeiros dos cuidados de saúde primários: estudo de factores a ela associados.

The present work presents a mixed study that evaluates the factors related to the basic formation in sexuality for Portuguese nurses of primary health care. 1735 nurses working in the 18 Health Sub-Regions of the Continent and the 2 Health Regional Secretaries of the Autonomous Regions of Madeira and Azores, corresponding to 226 Health Centers, were studied between March 2004 and July 2005. The profile of the Portuguese primary health care nurse with basic training on sexuality is between 22/30 years of age, 1/7 years of professional exercise, single, resident in Madeira or Azores, with bachelor degree and from a private nursing school. The nurses with special training in sexuality are essentially nurses with more than 38 years of age, with more than 13 years of professional exercise, seaside or Azores resident, specialists in one nursing branch, a masters degree and from public nursing schools. It was found that the 31-37 age group shows a deficit either in basic or specific training about sexuality.

Burnout in European family doctors: the EGPRN study.

INTRODUCTION: The aim of this study was to determine the prevalence of burnout, and of associated factors, amongst family doctors (FDs) in European countries. Methodology. A cross-sectional survey of FDs was conducted using a custom-designed and validated questionnaire which incorporated the Maslach Burnout Inventory Human Services Survey (MBI-HSS) as well as questions about demographic factors, working experience, health, lifestyle and job satisfaction. MBI-HSS scores were analysed in the three dimensions of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). RESULTS: Almost 3500 questionnaires were distributed in 12 European countries, and 1393 were returned to give a response rate of 41%. In terms of burnout, 43% of respondents scored high for EE burnout, 35% for DP and 32% for PA, with 12% scoring high burnout in all three dimensions. Just over one-third of doctors did not score high for burnout in any dimension. High burnout was found to be strongly associated with several of the variables under study, especially those relative to respondents' country of residence and European region, job satisfaction, intention to change job, sick leave utilization, the (ab)use of alcohol, tobacco and psychotropic medication, younger age and male sex. CONCLUSIONS: Burnout seems to be a common problem in FDs across Europe and is associated with personal and workload indicators, and especially job satisfaction, intention to change job and the (ab)use of alcohol, tobacco and medication. The study questionnaire appears to be a valid tool to measure burnout in FDs. Recommendations for employment conditions of FDs and future research are made, and suggestions for improving the instrument are listed.

Informal stroke rehabilitation: what are the main reasons of Thai caregivers?

The aim of this study was to identify the reasons for the provision of informal rehabilitation services at home to stroke relatives by Thai caregivers. Twenty primary informal caregivers were individually interviewed at their homes by using semistructured questions elaborated by the researchers. All interviews were recorded on audiotape. Content analysis was used to determine the reasons for performing informal rehabilitation. Four major reasons, (i) biological, (ii) psychological, (iii) social, and (iv) spiritual, emerged from our content analysis to maintain for the stroke victims the highest possible quality of life. Improvement and prevention of further deterioration were the two main concepts in the biological and psychological reasons expressed by these Thai caregivers, whereas maintaining human relations and usual social activities were the two main considerations in the social reason. The main concepts in the spiritual reason were respecting the religious beliefs, superstitions, and culture of the caregivers or patients, improving patients' empowerment, and improving caregivers' satisfaction. These four reasons encompassed the biological, psychological, social, and spiritual aspects of a holistic approach to the definition of health. The health professional in Thailand should encourage stroke caregivers to continue providing informal rehabilitation services for their stroke relatives, as it might sustain the well being of stroke survivors during their stay at home.

Adaptation to Portuguese of the Depression, Anxiety and Stress Scales (DASS)

Objective: to adapt to Portuguese, of Portugal, the Depression, Anxiety and Stress Scales, a 21-item short scale (DASS 21), designed to measure depression, anxiety and stress. Method: After translation and back-translation with the help of experts, the DASS 21 was administered to patients in external psychiatry consults (N=101), and its internal consistency, construct validity and concurrent validity were measured. Results: The DASS 21 properties certify its quality to measure emotional states. The instrument reveals good internal consistency. Factorial analysis shows that the two-factor structure is more adequate. The first factor groups most of the items that theoretically assess anxiety and stress, and the second groups most of the items that assess depression, explaining, on the whole, 58.54 percent of total variance. The strong positive correlation between the DASS 21 and the Hospital Anxiety and Depression scale (HAD) confirms the hypothesis regarding the criterion validity, however, revealing fragilities as to the divergence between theoretically different constructs.

Objetivo: adaptar a la lengua portuguesa, de Portugal, la Depression, Anxiety and Stress Scale, versión corta de 21 ítems, (DASS-21), que permite evaluar depresión, ansiedad y estrés. Método: Después de haber sido traducida y retrovertida, con la ayuda de peritos, la DASS-21 fue administrada a enfermos en consulta externa de psiquiatría (N=101), y fue evaluada la consistencia interna, la validez de constructo y la validez concurrente. Resultados: Las propiedades de la DASS-21 atestiguan su calidad para evaluar estados emocionales. El instrumento reveló buena consistencia interna. El análisis factorial muestra que la estructura de dos factores es la más ajustada. El primer factor agrupa la mayoría de los ítems que teóricamente evalúan ansiedad y estrés, y el segundo agrupa la mayoría de los ítems que evalúan depresión, explicando en su conjunto el 58,54 por ciento de la variación total. La fuerte correlación positiva entre la DASS-21 y la escala Hospital Anxiety and Depression confirma la hipótesis relativa a la validez de criterio, siendo sin embargo reveladas fragilidades relativamente a la divergencia entre constructos teóricamente diferentes.

Objetivo: adaptar para a língua Portuguesa, de Portugal, a Depression, Anxiety and Stress Scale, versão curta de 21 itens (DASS-21), que permite avaliar depressão, ansiedade e estresse. Método: Após ter sido traduzida e retrovertida, com a ajuda de peritos, a DASS-21 foi administrada a doentes em consulta externa de psiquiatria (N=101), e foi avaliada a consistência interna, a validade de construto e a validade concorrente. Resultados: As propriedades da DASS-21 atestam a sua qualidade para avaliar estados emocionais. O instrumento revelou boa consistência interna. A análise fatorial mostra que a estrutura de dois fatores é mais ajustada. O primeiro fator agrupa a maioria dos itens que teoricamente avaliam ansiedade e estresse e o segundo agrupa a maioria dos itens que avaliam depressão, explicando no seu conjunto 58,54 por cento da variância total. A forte correlação positiva entre a DASS-21 e a HAD confirma a hipótese relativa à validade de critério, sendo no entanto reveladas fragilidades relativamente à divergência entre construtos teoricamente diferentes.

Informal stroke rehabilitation: what do Thai caregivers perform?

Our aim was to explore the informal rehabilitation activities performed by Thai caregivers for stroke survivors at home. Twenty primary informal caregivers were individually interviewed, using semi-structured questions developed by researchers, to investigate the informal rehabilitation activities provided for the stroke survivors at their homes. All interviews were audiotape recorded and some pictures of rehabilitation activities were taken during data collection. The data collected underwent content analysis. Findings revealed three major categories of rehabilitation activities - biological, psychological and social rehabilitation. Biological rehabilitation was the most frequently undertaken by all Thai caregivers. Several methods were used to rehabilitate the stroke survivors in each category, based on the scientific background and cultural beliefs of the caregivers and survivors. In conclusion, informal caregivers always have in mind all activities, thus providing a holistic approach for informal rehabilitation. This plays a very significant role in minimizing residual disabilities, preventing related complications and sustaining the well-being of stroke survivors. Health professionals should motivate caregivers of stroke survivors to maintain informal rehabilitation activity at home. Additionally, health care providers should be concerned about the coordination between institutional and informal rehabilitation in order to better optimize the quality of care provided at home.

Thai stroke patient caregivers: who they are and what they need.

BACKGROUND AND PURPOSES: Primary informal caregivers play a significant role in providing care to stroke survivors after having been discharged from the hospital. Our aims were to describe the characteristics of Thai stroke caregivers and to explore their needs while providing care to their stroke relatives. METHODS: Using open-ended questions, we individually interviewed 20 caregivers of stroke survivors to identify their characteristics and their own needs. Additional field notes were made during all interviews. RESULTS: Our findings revealed that the majority of Thai informal stroke caregivers in this study were female, mostly daughters, with the exception of 2 Thai primary stroke caregivers found to be nieces. The majority of caregivers provided care to their stroke relatives 24 h per day. The four major categories of informal rehabilitation were: physical, psychological, social, and spiritual rehabilitation activities. Assistance, information and social support were the three main needs of the caregivers. CONCLUSION: Based on these findings, appropriate nursing information and assistance focusing on rehabilitation and stroke caregivers' needs should be provided to Thai stroke caregivers performing informal care to ensure that both patients and caregivers have the best possible quality of life.

Adaptation to Portuguese of the Depression, Anxiety and Stress Scales (DASS).

OBJECTIVE: To adapt to Portuguese, of Portugal, the Depression, Anxiety and Stress Scales, a 21-item short scale (DASS 21), designed to measure depression, anxiety and stress. METHOD: After translation and back-translation with the help of experts, the DASS 21 was administered to patients in external psychiatry consults (N=101), and its internal consistency, construct validity and concurrent validity were measured. RESULTS: The DASS 21 properties certify its quality to measure emotional states. The instrument reveals good internal consistency. Factorial analysis shows that the two-factor structure is more adequate. The first factor groups most of the items that theoretically assess anxiety and stress, and the second groups most of the items that assess depression, explaining, on the whole, 58.54% of total variance. The strong positive correlation between the DASS 21 and the Hospital Anxiety and Depression scale (HAD) confirms the hypothesis regarding the criterion validity, however, revealing fragilities as to the divergence between theoretically different constructs.

Comparison between two common methods for measuring Giardia lamblia susceptibility to antiparasitic drugs in vitro.

In this study a comparison between two different methods for measuring the susceptibility of Giardia lamblia trophozoites to metronidazole and albendazole is performed. Modifications of Meloni's method, based on the loss of adherence of parasites to surfaces, and the Hill method, based on the loss of parasite division capacity, are compared. A logistic model was used to calculate the inhibitory concentrations IC(10), IC(50) and IC(90) that were further compared using the respective standard errors. The results obtained, after contact of parasites with the antiparasitic drugs for 24h, show that the adherence method is more sensitive than the multiplication method for low and moderate inhibitory concentrations of albendazole. Conversely for metronidazole the multiplication method seems to be more sensitive for high inhibitory concentrations of the drug. For screening the IC(50), both methods seem to be effective, however, the inhibition of adherence method have even better performance for the benzimidazole like drugs.

Isolation, excystation and axenization of Giardia lamblia isolates: in vitro susceptibility to metronidazole and albendazole.

From 53 samples of human faeces containing Giardia lamblia cysts, 18 isolates were successfully excysted in vitro, and cultivated axenically in TYI-S-33 modified medium. The in vitro effects of metronidazole and albendazole on these isolates were evaluated by the trophozoite adherence inhibition method. The IC50 was between 2.4 and 11.5 micro M for metronidazole and 0.027 and 0.192 micro M for albendazole. These IC50 values were similar to those found for the ATCC 30888 and 30957 reference isolates. All isolates were susceptible to the antiparasitic drugs tested. These results suggest that resistance of G. lamblia to metronidazole and albendazole does not seem to be a significant problem in our population.