Análise do trabalho dos cuidadores em saúde nas residências terapêuticas / Análisis del trabajo de los cuidadores en salud en las residencias terapéuticas / Work analysis of health caregivers in therapeutics homes

RESUMO As Residências Terapêuticas (RTs) integram os dispositivos de desinstitucionalização criados pela Reforma Psiquiátrica. Este artigo objetiva apresentar uma reflexão sobre o trabalho de cuidadores de saúde inseridos em Residências Terapêuticas (RTs). Foram entrevistados seis cuidadores das RTs e construiu-se, por meio do método de Análise Fenomenológica Interpretativa (AFI), a classe temática nomeada de "Vivências nas Residências". Conclui-se que o trabalho nas RTs envolve complexas relações com os moradores, com a vizinhança e com toda a rede de cuidado do Sistema Único de Saúde (SUS). Essas relações devem ser elaboradas pelas equipes que integram toda a rede de cuidado para que se esclareça, em conjunto com os cuidadores, o cerne da sua função no contexto das RTs. Nesse sentido, ressalta-se a necessidade de instrumentalização, de capacitação, de escuta e de criação de espaços de supervisão que permitam dar suporte ao trabalho dos cuidadores.

RESUMEN Las residencias terapéuticas (RTs) integran los dispositivos de desinstitucionalización creados por la Reforma Psiquiátrica. El artículo reflexiona sobre el trabajo de los cuidadores de salud en las RTs. Se entrevistaron cuidadores y, mediante el método de Análisis Fenomenológica Interpretativa (AFI), se construyó la clase temática Vivencias en las Residencias. Se concluyó que el trabajo en las RTs envuelve complejas relaciones con sus habitantes, la vecindad y toda la red de cuidado del Sistema Único de Salud (SUS). Estas relaciones deben ser elaboradas por los equipos que integran toda la red de cuidado, para que se esclarezca, en conjunto con los cuidadores, el cierne de su función en el contexto de las RTs. Así, se resalta la necesidad de instrumentalización, de capacitación, escucha y creación de espacios de supervisión que permitan dar soporte al trabajo de los cuidadores.

ABSTRACT The Therapeutics Residences (TRs) are part of the dispositions created by the Psychiatric Reform, aiming at the deinstitutionalization. This article aims to present a reflection on the work of health caregivers of the Health System in the TRs. Interviews conducted with the TRs' caregivers led to the creation of a thematic class which we called Living in Homes, through Interpretative Phenomenological Analysis (IPA). It is concluded that the work in the TRs involves complex relationships with the residents, the neighborhood and all the care network of the Universal Health System (SUS). These relationships must be developed by teams that integrate the entire care network to clarify, together with the caregivers, the core of their function in the context of the TRs. Thus, it emphasizes the need for instrumentation, training, listening and creating spaces that allow supervisory support to the caregivers' work.

Combined aerobic and resistance training: are there additional benefits for older hypertensive adults?

OBJECTIVES:: The objective of this study was to compare the effects of a combination of aerobic and resistance training to those of isolated aerobic training on blood pressure, body composition, and insulin sensitivity in hypertensive older adults. METHOD:: Forty-four patients were randomly assigned to the aerobic group, resistance and aerobic group, and control group. Before and after 10 weeks, the following data were obtained: 24-hour ambulatory blood pressure data, abdominal circumference, waist circumference, body mass index, lean mass, fat mass, and insulin sensitivity. The study was conducted with 3 training sessions per week. RESULTS:: Comparison revealed significant reductions in the body mass index, abdominal and waist circumferences, and ambulatory blood pressure (24-hour, wakefulness and sleep systolic/diastolic blood pressures) in both the aerobic group and the resistance and aerobic (combined) group. The fat mass only changed in the combined group. There was no difference in the insulin sensitivity in any group. CONCLUSIONS:: The combined treatment and aerobic treatment alone were equally effective in reducing the blood pressure, body mass index, and abdominal and waist circumferences, although the addition of the resistance component also helped reduce the fat mass.

Combined aerobic and resistance training: are there additional benefits for older hypertensive adults?

OBJECTIVES: The objective of this study was to compare the effects of a combination of aerobic and resistance training to those of isolated aerobic training on blood pressure, body composition, and insulin sensitivity in hypertensive older adults. METHOD: Forty-four patients were randomly assigned to the aerobic group, resistance and aerobic group, and control group. Before and after 10 weeks, the following data were obtained: 24-hour ambulatory blood pressure data, abdominal circumference, waist circumference, body mass index, lean mass, fat mass, and insulin sensitivity. The study was conducted with 3 training sessions per week. RESULTS: Comparison revealed significant reductions in the body mass index, abdominal and waist circumferences, and ambulatory blood pressure (24-hour, wakefulness and sleep systolic/diastolic blood pressures) in both the aerobic group and the resistance and aerobic (combined) group. The fat mass only changed in the combined group. There was no difference in the insulin sensitivity in any group. CONCLUSIONS: The combined treatment and aerobic treatment alone were equally effective in reducing the blood pressure, body mass index, and abdominal and waist circumferences, although the addition of the resistance component also helped reduce the fat mass.

One repetition maximum test in octogenarian: evaluation of blood pressure.

BACKGROUND: The gold standard for resistance training prescription is the one repetition maximum strength test (1RM). However, there are fears that, by making maximum effort, octogenarian may elevate their blood pressure (BP). METHODS: Forty subjects (25 women) aged 83.3±3.2 years underwent two days of office BP measurements (V1 and V2). On the 1RM test day, measurements were performed before (BASAL) and after (POST) test. 1RM tests were performed in the Seated Chest Press (SCP), Leg Press (LP) and Seated Back Row (SBR), with BP measurements immediately after (1RM) and one minute after (1RM(1')) each exercise. RESULTS: Maximum systolic BP (SBP) in the SCP was 137 mmHg in 1RM, with no difference compared to V1 (P=0.29). In LP, maximum SBP was 143 mmHg in 1RM(1'), but BP came down quickly, with SBP in POST equal to V1 (P=0.95). There were differences over time in SBR (P<0.01), but SBP in 1RM and in 1RM(1') was similar to V1 (P=0.20). There was a small difference in diastolic BP over time. CONCLUSIONS: There was a moderate SBP increase in 1RMand 1RM(1'), with emphasis on the LP. In general, BP after 1RM did not differ from the first assessment day.

Effect of different types of exercise on sleep quality of elderly subjects.

OBJECTIVE/BACKGROUND: There are still many gaps in research concerning the effect of different physical training modalities on sleep quality in the elderly population. Thus, the objective of the present study was to compare the quality of sleep of hypertensive elderly subjects submitted to two types of training (ie, aerobic exercise alone or combined aerobic and resistance training). PATIENTS/METHODS: Participants aged 60-75 years were randomized to three groups: aerobic group (AG), combined aerobic and resistance group (ARG), and control untrained group (CG). Training lasted ten consecutive weeks with 30 uninterrupted sessions. The actigraph (Actiwatch Minimitter Company, INC - Sunriver, OR, USA) was placed on the non-dominant wrist and activities were monitored continuously while being recorded at one minute intervals. The participants kept the device for a period of 96 hours before the first and last training sessions. RESULTS: There was a reduction in sleep fragmentation index of 18.9 for AG and 13 for ARG (p < 0.01) and the sleep efficacy was improved in the exercise groups, with a 5.6% increase for AG (p = 0.02) and a 6.1% increase for ARG (p = 0.01). After training, percentage of minutes motionless was increased by 8.2% for AG and by 6.9% for ARG (p < 0.01), indicating improved sleep quality. A reduction in total activity score during sleep was observed for AG and ARG (p < 0.01). CONCLUSIONS: The two types of exercise performed for ten weeks similarly improved sleep quality, thus reducing the fragmentation index, the percentage of minutes in motion and total activity score, and increasing sleep efficacy.

Effect of aerobic training and aerobic and resistance training on the inflammatory status of hypertensive older adults.

There is a relationship between high levels of inflammatory markers and low adhesion to the practice of physical activity in the older population. The objective of the present study was to compare the effect of two types of exercise programs, i.e., aerobic training and aerobic plus resistance training on the plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) of elderly hypertensive subjects. Hypertensive older volunteers in use of antihypertensive drugs were randomized to three groups: aerobic group (AG), resistance and aerobic group (RAG) and control group (CG). Training lasted 10 weeks, with sessions held three times a week. Blood samples were collected before training and 24 h after completion of the 30 sessions for the determination of serum IL-6 and TNF-α levels. Body mass index was obtained before and after 10 weeks. After intervention, BMI values were lower in AG and RAG compared to CG (p < 0.001), IL-6 was reduced in AG compared to CG (p = 0.04), and TNF-α levels were lower only in RAG compared to CG (p = 0.01). Concluding, both types of training were effective in reducing BMI values in hypertensive older subjects. Aerobic exercise produced the reduction of plasma IL-6 levels. However, the combination of aerobic and resistance exercise, which would be more indicated for the prevention of loss of functionality with aging, showed lower TNF-α mediator after training than control group and a greater fall of TNF-α levels associated to higher BMI reduction.

Effect of a single session of aerobic walking exercise on arterial pressure in community-living elderly individuals.

Several studies have demonstrated that one exercise session (ES) on a cycloergometer or ergometric treadmill causes a reduction in blood pressure (BP). However, there are few similar studies on walking, which is the exercise modality most available to the elderly. We investigated the immediate and 24-h effects of walking on BP in independent, community-living elderly individuals. Volunteers participated in a single ES and resting control session (CS). Before and after each session, BP was measured by auscultatory and oscillometric methods. After each session, 24-h ambulatory blood pressure monitoring was conducted. An accelerometer was installed 48 h before the sessions and left in place for 5 days. The mean volunteer age was 67.7±3.5 years; 11 were hypertensive patients under treatment, and 12 were normotensive. In the total sample, there were immediate 14mm Hg and 12 mm Hg reductions in systolic BP (SBP) after the ES according to the auscultatory and oscillometric methods, respectively. Diastolic BP (DBP) was reduced by 4 mm Hg after the ES according to both methods. SBP during wakefulness and sleep and DBP during wakefulness were lower after the ES than after the CS (P<0.01), when wakefulness and sleep were determined individually (variable-time pattern) using data from the activity monitors and provided by the volunteers. The variable-time pattern was more effective in detecting reductions in BP than the fixed-time pattern.

Extração, secagem por atomização e microencapsulamento de antocianinas do bagaço da uva "Isabel" (Vitis labrusca) / Extraction, spray drying and microencapsulating of 'Isabel' grape (Vitis labrusca) bagasse anthocyanin

Objetivou-se obter neste trabalho um corante natural (antocianina), na forma de pó a partir do bagaço de uva da cultivar "Isabel" (Vitis labrusca), onde foram realizados estudos de extração e encapsulamento. Empregou-se o método de extração por imersão mediante técnica de planejamento experimental, onde as variáveis avaliadas foram pH da solução de extração (1-2), volume de etanol (100-250 mL), tempo de extração (3-7 h) e temperatura de extração (15-35ºC). A concentração máxima de antocianinas totais obtidas foi de 300 mg/100 g de bagaço de uva (umidade 5 por cento) nos níveis inferiores de pH (1,0) e tempo (3 horas) e superiores de temperatura (35ºC) e volume de etanol (250 mL). Os extratos foram secos por atomização. A melhor condição para o encapsulamento e a secagem foi quando utilizaram-se proporções iguais de maltodextrina e goma arábica.

This work had the aim of obtaining a natural pigment (anthocyanin) at powder form from 'Isabel' grape bagasse (Vitis labrusca), studying the extraction and encapsulating steps one applied the method of extraction by immersion by experimental design technique, when the factors investigated were pH of the extraction solution (1-2), volume of ethanol (100-250 mL), extraction time (3-7 h) and extraction temperature (15-35 °C). The maximum concentration of total anthocyanin was 300 mg/100g of grape bagasse (5 percent moisture) at the lower levels of pH (1.0) and time (3 h), and at upper levels of temperature (35ºC) and amount of ethanol (250 mL). The extracts were dried by a spray process. The best condition for encapsulating and drying was obtained when equal amounts of maltodextrin and Arabic gum were used.

Aspectos controversos no tratamento da hipertensão no idoso: fragilidade, distúrbios cognitivos e octogenários / Controversial aspects of the hypertension treatment in the elderly: frailty, cognitive disorders and octogenarians

Existem aspectos ainda controversos no tratamento da hipertensão arterial de idosos, entre eles a abordagem do idoso frágil e do indivíduo com risco de demência ou dementado, além dos octogenários. O diagnóstico e o tratamento da hipertensão, bem como o adequado controle de outros fatores de risco cardiovascular, fazem parte da prevenção da síndrome da fragilidade. Por outro lado, verifica-se a elevação da mortalidade nos idosos com pressão arterial mais baixa, quando há fragilidade intensa ou doenças debilitantes. Há ainda vários aspectos a serem estudados em relação à associação entre o tratamento e a redução do declínio cognitivo ou a incidência de demência, bem como na redução da velocidade de progressão do declínio, mas os resultados dos estudos até o momento parecem indicar benefícios. Na população octogenária e nonagenária, o tratamento da hipertensão ainda apresenta aspectos não totalmente definidos, havendo uma tendência ao aumento da mortalidade geral ao lado da menor morbidade cardiovascular, sendo necessário aguardar a finalização de mais estudos. Por enquanto, é fundamental avaliar essas situações individualmente e, ao se optar pelo uso de medicamentos, realizar tratamento cuidadoso, com especial atenção à t presença de hipotensão postural.

Avaliação cardiorespiratória em mulheres com lupus eritematoso sistêmico / Cardiorespiratory evaluation in women with systemic lupus erythematosus

Objetivo: Avaliar a capacidade aeróbia estimada, através do teste de caminhada de 6 minutos (TC6), juntamente com a análise da função pulmonar em mulheres com Lupus Eritematoso Sistêmico (LES). Métodos: Participaram do estudo 17 pacientes do sexo feminino, com idade entre 16 a 50 anos, tempo de doença superior a 12 meses. Todas as pacientes preencheram os critérios de classificação do American College of Rheumatology para LES e se encontravam na fase inativa da doença, constatada pelo índice de atividade da doença (SLEDAI). A avaliação pulmonar foi feita com base em parâmetros de função pulmonar e a capacidade submáxima ao exercício pela aplicação do TC6. Resultados: Na função pulmonar pode-se observar que a Pressão Expiratória Máxima e a Capacidade Vital Forçada apresentaram valores inferiores, com alteração significativa de 23,57% e 33,3% respectivamente, quando comparados a valores preditos. A Pressão Inspiratória Máxima e o Pico de Fluxo Expiratório, não apresentaram alteração estatística. No TC6 os valores obtidos foram inferiores aos preditos, média de 46,26%. Conclusão: Análises da população estudada demonstram que mulheres com LES apresentam um condicionamento físico limitado, contribuindo para níveis baixos de atividade aeróbia, o que pode ser constatado por valores inferiores no TC6 e nos testes de função pulmonar.

Objective: To evaluate the estimate aerobic capacity, throught a 6 minute walk test (6MW), along with analysis of pulmonary function in women with systemic lupus erythematosus (SLE). Methods: 17 female patients participated in the study, age 16-50 years, body mass index (BMI) < 30 kg/m2, time of disease ƒ®ƒn12 months. Every patient satisfied the diagnostic criteria of the American College of Rheumatology for SLE, and were in the inactive phase of the disease, checked by the index of activity of the disease (SLEDAI). The pulmonary evaluation was made based on analysis of pulmonary function tests and the submaxim capacity of exercise for application of the 6MW. Results: In analysis of pulmonary function tests it could be observed that the maximal expiratory pressure (PeMax) and the Forced Vital Capacity (FVC), presented inferiors values than predicted ones, with significant alteration of 23,57% and 33,3% respectively, when compared with predicted values. The maximal inspiratory pressure (PiMax) and the expiratory Peak Flow did not present significant alteration. In the 6MW, the values obtained were smaller predicted ones, average 46,26% (p < 0,05). Conclusion: Analyses of the studied population demonstrate that women with SLE, present a limited physical conditioning, contributing for low levels of aerobic activity, what can be shown by smaller values of 6MW and pulmonary function tests.