Testicular regression and recrudescence in the bat Eptesicus furinalis: Morpho-physiological variations and hormonal signaling pathways.

Males of the bat Eptesicus furinalis show at least one process of testicular regression, in which the testes regress and temporarily interrupt the production of sperm, during its annual reproductive cycle. As the process of spermatogenesis is under hormonal control, mainly of pituitary and androgen hormones, our aim was to analyze the morphological variations and the hormonal control of the testes of E. furinalis during the four phases of its reproductive cycle. Testes of 18 adult males, divided into four sample groups (active, regressing, regressed, and recrudescence phases), were submitted to morphological, morphometric, and immunohistochemical analyzes. The results demonstrate that the processes of testicular regression and recrudescence of E. furinalis are under the control of pituitary, androgen and estrogen hormones. The regulation is exerted mainly through the activation and cross signaling of AR and FSHR in Sertoli cells and of LHR in Leydig cells. The testicular regression appears to be activated by an inhibition/reduction of AR expression in Sertoli cells, which inhibits the proliferation and differentiation of new spermatogonia and causes the deactivation of spermatogenesis. Conversely, the testicular recrudescence occurs by the increasing of the expression of LHR in Leydig cells, and AR and FSHR in Sertoli cells, which reactivates the testicular production of androgens and estrogens, the proliferation of spermatogonia and restarts the spermatogenesis.

Effects of experimental glaucoma in Lama1nmf223 mutant mice.

To identify changes in response to experimental intraocular pressure (IOP) elevation associated with the laminin α1 nmf223 mutation in mice. Laminin mutant (LM) mice (Lama1nmf223) and C57BL/6J (B6) mice in two age groups each (4-5 months and >1 year) underwent intracameral microbead injections to produce unilaterally elevated IOP. We assessed axonal transport block of immunofluorescently labeled amyloid precursor protein (APP) after 3 days and retinal ganglion cell (RGC) axon loss after 6 weeks. Light, electron and fluorescent microscopy was used to study baseline anatomic differences and effects of 3-day IOP elevation in younger LM mice. In younger mice of both LM and B6 strains, elevated IOP led to increased APP block in the retina, prelaminar optic nerve head (preONH), unmyelinated optic nerve (UON), and myelinated optic nerve (MON). APP blockade not significantly different between younger B6 and LM mouse strains. Older LM mice had greater APP accumulation in both control and glaucoma eyes compared to older B6, however, accumulation was not significantly greater in LM glaucoma eyes compared to LM controls. Axon loss at 6 weeks was 12.2% in younger LM and 18.7% in younger B6 mice (difference between strains, p = 0.22, Mann Whitney test). Untreated LM optic nerve area was lower compared to B6 (nerve area, p < 0.0001, t-test). Aberrant axon bundles, as well as defects, thickening and reduplication of pia mater, were seen in the optic nerves of younger LM mice. Axonal transport blockade significantly differed between old B6 and old LM mice in control and glaucoma eyes, and younger LM mice had abnormal axon paths and lower optic nerve area.

The Forgotten Psychopathology of Depressed Long-Term Care Facility Residents: A Call for Evidence-Based Practice.

INTRODUCTION: As Earth's population is rapidly aging, the question of how best to care for its older adults suffering from psychiatric disorders is becoming a constant and growing preoccupation. Depression is one of the most common psychiatric disorders among older adults, and depressed nursing home residents are at a particularly high risk of a decreased quality of life. The complex requirements of supporting and caring for depressed older adults in nursing homes demand the development and implementation of innovative clinical and organizational models that can ensure early identification of the disorder and high-quality multidisciplinary services for dealing with it. This perspective article aims to provide an overview of the literature and the state of the art of and the urgent need for research on the epidemiology and clinical treatment of depression among older adults. METHOD: In collaboration with a medical librarian, we conducted literature and bibliometric reviews of published articles in Medline Ovid SP from inception until September 30, 2020, to identify studies related to depression, depressive symptoms, mood disorders, dementia, cognitive disorders, and health complications in long-term care facilities and nursing homes. RESULTS: We had 38,777 and 40,277 hits for depression and dementia, respectively, in long-term care facilities or nursing homes. The search equation found 536 and 1,447 studies exploring depression and dementia, respectively, and their related health complications in long-term care facilities or nursing homes. CONCLUSION: Depression's relationships with other health complications have been poorly studied in long-term care facilities and nursing homes. More research is needed to understand them better.

[Autism Spectrum Disorder in Infancy and Early Childhood: The Model of the Centro de Estudos do Bebé e da Criança for Diagnosis and Therapeutic Intervention]. / A Perturbação do Espetro do Autismo na Primeira Infância: O Modelo do Centro de Estudos do Bebé e da Criança de Avaliação Diagnóstica e Intervenção Terapêutica.

INTRODUCTION: The Centro de Estudos do Bebé e da Criança in Hospital Dona Estefânia has organized a multidisciplinary model for children under three with suspected autism spectrum disorder, thus implementing the recent guidelines established by the Directorate General for Health. The aim of this study is to describe this model and case series. MATERIAL AND METHODS: A retrospective descriptive study of observed children with suspected ASD. They were observed according to the model of the Centro de Estudos do Bebé e da Criança and DC:0-5TM classification, between January 2018 and September 2019. RESULTS: The study included 178 children. The average age at the initial assessment was 27 months. From the total sample, 116 children concluded the diagnostic sessions (axis I): Autism Spectrum Disorder/Early Atypical (36%), Developmental Language Disorder (18%), Other (19%). Factors of axes II, III, IV and V of DC:0-5TM were determinant for clinical diagnosis in 26%. DISCUSSION: Of 116 children, 36% were diagnosed with Autism Spectrum Disorder. This highlights the diagnostic challenge posed by neurodevelopmental disorders in early infancy. The sample shows that the characteristics of the relationship with the caregiver (axis II), presence of physical conditions (axis III), psycho-social stressors (axis IV) and developmental trajectory (axis V) have a significant clinical impact. In the future, the initial assessment should take place well before the age of 27 months because of the impact on prognosis. CONCLUSION: This model is a pioneering approach in Portugal. It promotes a common approach of Child and Adolescent Psychiatry and Neuropediatrics/Developmental Pediatrics in early infancy. Moreover, it increases the diagnostic acuity of Autism Spectrum Disorders and early therapeutic intervention.

Introdução: O Centro de Estudos do Bebé e da Criança do Hospital Dona Estefânia desenvolveu um modelo multidisciplinar de atuação na suspeita de perturbação do espetro do autismo na primeira infância, aplicando a recente norma da Direção Geral da Saúde. Pretende-se descrever a sua apresentação e casuística.Material e Métodos: Estudo retrospetivo descritivo da série de crianças(< 3 anos), observadas por suspeita de perturbação do espetro do autismo, entre janeiro de 2018 e setembro de 2019, segundo este modelo e a classificação DC:0-5TM.Resultados: Foram observadas 178 crianças. A idade média da primeira consulta foi de 27 meses. Do total de crianças observadas, 116 concluíram as sessões diagnósticas (diagnóstico eixo I): perturbação do espetro do autismo/ perturbação do espetro do autismo atípica precoce (36%), perturbação do desenvolvimento da linguagem (18%), outros(19%). Em 26% dos casos, o quadro foi atribuído a fatores classificados em outros eixos.Discussão: O diagnóstico de perturbação do espetro do autismo foi colocado em 36%, demonstrando o desafio diagnóstico das perturbações do neurodesenvolvimento na primeira infância. A casuística demonstra ainda que as características da relação com o cuidador (eixo II), a presença de condições físicas (eixo III), fatores de stress psicossociais (eixo IV) e a trajetória de desenvolvimento (eixo V) têm um impacto clínico significativo. É desejável a antecipação da idade de sinalização pelo impacto no prognóstico.Conclusão: Este modelo é pioneiro em Portugal ao propor uma atuação conjunta de duas especialidades na primeira infância: pedopsiquiatria e neuropediatria/pediatria desenvolvimento. Este modelo de atuação melhora a acuidade diagnóstica e permite a intervenção terapêutica precoce.

Staining of E-selectin ligands on paraffin-embedded sections of tumor tissue.

BACKGROUND: The E-selectin ligands expressed by cancer cells mediate adhesion of circulating cancer cells to endothelial cells, as well as within tissue microenvironments important for tumor progression and metastasis. The identification of E-selectin ligands within cancer tissue could yield new biomarkers for patient stratification and aid in identifying novel therapeutic targets. The determinants of selectin ligands consist of sialylated tetrasaccharides, the sialyl Lewis X and A (sLeX and sLeA), displayed on protein or lipid scaffolds. Standardized procedures for immunohistochemistry make use of the antibodies against sLeX and/or sLeA. However, antibody binding does not define E-selectin binding activity. METHODS: In this study, we developed an immunohistochemical staining technique, using E-selectin-human Ig Fc chimera (E-Ig) to characterize the expression and localization of E-selectin binding sites on paraffin-embedded sections of different cancer tissue. RESULTS: E-Ig successfully stained cancer cells with high specificity. The E-Ig staining show high reactivity scores in colon and lung adenocarcinoma and moderate reactivity in triple negative breast cancer. Compared with reactivity of antibody against sLeX/A, the E-Ig staining presented higher specificity to cancer tissue with better defined borders and less background. CONCLUSIONS: The E-Ig staining technique allows the qualitative and semi-quantitative analysis of E-selectin binding activity on cancer cells. The development of accurate techniques for detection of selectin ligands may contribute to better diagnostic and better understanding of the molecular basis of tumor progression and metastasis.

Prevalence and determinants in cytology testing for cervical cancer screening in Spain (2006-14).

Background: Cervical cancer has decreased in developed countries thanks to cytology screening programmes. The aims of this study were To analyse the frequency and evolution of performing cytology tests and to determine the variables that influence their use. Methods: Cross-sectional study of non-institutionalized women who participated in the national health survey (2006, 2011/12) and the European Health Survey in Spain (2009, 2014). Study variables: cytology-testing, time since last cytology-test, reason for performing the test, age, nationality, marital status, social status, education level and place of residence. Results: The study evaluated 53 628 women in Spain over 15 years old, with a mean age of 52.68 (SD ± 19.12). About 94.1% were Spanish, 49.2% were married and 77.2% lived with a partner. In 2014, 72% had a cytology test, a number that increased significantly. Women aged 25-65 were 5.13 times more likely to undergo a cytology test than those aged 15-24 years old (odds ratio (OR): 5.13; P < 0.001); women with university educations were 9.23 times more likely to undergo a cytology test than those without university educations (P > 0.001); those of social classes I and II (high) were 1.2 more likely to undergo a cytology test than those of low social class (P = 0.026); and Spanish women were 1.74 times more likely to undergo a cytology test than foreigners living in Spain (P < 0.001). Conclusion: Frequency of cytology testing has increased in the last few years. Screening for cervical cancer is associated with higher social status, education level, age, and not being foreign.

Inhibition of fucosylation in human invasive ductal carcinoma reduces E-selectin ligand expression, cell proliferation, and ERK1/2 and p38 MAPK activation.

Breast cancer tissue overexpresses fucosylated glycans, such as sialyl-Lewis X/A (sLeX/A ), and α-1,3/4-fucosyltransferases (FUTs) in relation to increased disease progression and metastasis. These glycans in tumor circulating cells mediate binding to vascular E-selectin, initiating tumor extravasation. However, their role in breast carcinogenesis is still unknown. Here, we aimed to define the contribution of the fucosylated structures, including sLeX/A , to cell adhesion, cell signaling, and cell proliferation in invasive ductal carcinomas (IDC), the most frequent type of breast cancer. We first analyzed expression of E-selectin ligands in IDC tissue and established primary cell cultures from the tissue. We observed strong reactivity with E-selectin and anti-sLeX/A antibodies in both IDC tissue and cell lines, and expression of α-1,3/4 FUTs FUT4, FUT5, FUT6, FUT10, and FUT11. To further assess the role of fucosylation in IDC biology, we immortalized a primary IDC cell line with human telomerase reverse transcriptase to create the 'CF1_T cell line'. Treatment with 2-fluorofucose (2-FF), a fucosylation inhibitor, completely abrogated its sLeX/A expression and dramatically reduced adherence of CF1_T cells to E-selectin under hemodynamic flow conditions. In addition, 2-FF-treated CF1_T cells showed a reduced migratory ability, as well as decreased cell proliferation rate. Notably, 2-FF treatment lowered the growth factor expression of CF1_T cells, prominently for FGF2, vascular endothelial growth factor, and transforming growth factor beta, and negatively affected activation of signal-regulating protein kinases 1 and 2 and p38 mitogen-activated protein kinase signaling pathways. These data indicate that fucosylation licenses several malignant features of IDC, such as cell adhesion, migration, proliferation, and growth factor expression, contributing to tumor progression.

Total tumor load assessed by one-step nucleic acid amplification assay as an intraoperative predictor for non-sentinel lymph node metastasis in breast cancer.

BACKGROUND: This study aimed to determine the relationship between CK19 mRNA copy number in sentinel lymph nodes (SLN) assessed by one-step nucleic acid amplification (OSNA) technique, and non-sentinel lymph nodes (NSLN) metastization in invasive breast cancer. A model using total tumor load (TTL) obtained by OSNA technique was also constructed to evaluate its predictability. METHODS: We conducted an observational retrospective study including 598 patients with clinically T1-T3 and node negative invasive breast cancer. Of the 88 patients with positive SLN, 58 patients fulfill the inclusion criteria. RESULTS: In the analyzed group 25.86% had at least one positive NSLN in axillary lymph node dissection. Univariate analysis showed that tumor size, TTL and number of SLN macrometastases were predictive factors for NSLN metastases. In multivariate analysis just the TTL was predictive for positive NSLN (OR 2.67; 95% CI 1.06-6.70; P = 0.036). The ROC curve for the model using TTL alone was obtained and an AUC of 0.805 (95% CI 0.69-0.92) was achieved. For TTL >1.9 × 105 copies/µL we got 73.3% sensitivity, 74.4% specificity and 88.9% negative predictive value to predict NSLN metastases. CONCLUSION: When using OSNA technique to evaluate SLN, NSLN metastases can be predicted intraoperatively. This prediction tool could help in decision for axillary lymph node dissection.

Trabajo en equipo y negociación con la familia en Pediatría / Teamwork and negotiation with family in pediatrics

OBJETIVO: Analizar el proceso de negociación e interacción en la práctica enfermera con las madres de los niños hospitalizados en Pediatría desde la perspectiva del trabajo en equipo. MÉTODO: Estudio cualitativo, basado en la teoría fundamentada y tomando como referencia el interaccionismo simbólico. Participaron en el estudio 12 enfermeras de la unidad pediátrica y 18 madres cuyos hijos se encontraban hospitalizados en dicha unidad. El número de participantes fue definido con respecto al criterio de la saturación de los datos. Para la recogida de datos se utilizó la observación participante y la entrevista semiestructurada, y posteriormente se analizaron mediante el programa NVivo8. RESULTADOS: Del análisis efectuado emergió la categoría central, «debilidades en el proceso de negociación», en las interacciones que las enfermeras establecen con las madres. Las enfermeras revelaron dificultades en la comunicación; no contemplaron la necesaria clarificación de los roles junto a las madres para su participación en el proceso de cuidados y fue evidente un desequilibrio de poder en las relaciones que establecían con ellas. CONCLUSIONES: En el contexto estudiado, se observaron importantes carencias en el desarrollo del trabajo colaborativo con las madres de los niños hospitalizados. Las debilidades en el proceso de negociación, en particular, las dificultades en la comunicación, la falta de clarificación de los roles y tareas que cada uno debe asumir así como el desequilibrio de poder percibido en las relaciones obstaculizan el compromiso de las madres en el proceso de atención del niño, lo cual es esencial para conseguir una mayor implicación, unos mejores resultados en términos de salud y un menor impacto de la hospitalización en el niño

OBJECTIVE: Analyze the negotiation and interaction process within nurses' practice with mothers of hospitalized children in pediatric unit from the teamwork perspective. Method: A qualitative approach was used in this study, based on the Grounded Theory from the symbolic interaction perspective. The study included 12 nurses of the pediatric unit and 18 mothers who stayed in the hospital with their hospitalized children. The number of participants was defined according to data saturation. Participant observation and semi-structured interviews were chosen as data collection techniques and it was analyzed using the program NVivo8. RESULTS: From the analysis performed, the central category identified was «weaknesses in the negotiation process», within the interactions between nurses and mothers. Nurses revealed difficulties in the communication process, they did not include roles definition with mothers in order to establish their participation in the care process and a power imbalance was also evidenced. CONCLUSIONS: Within the studied settings, an important lack of collaborative work with hospitalized children's mothers was observed. The weaknesses in the negotiation process and specifically the difficulties found in communication; the lack of roles and tasks clarification and the perceived power imbalance regarding relationships, prevent mothers involvement in their children care process, considered a basic component to achieve a greater mother implication, better results in terms of health and a lower impact of hospitalization in the children

Prognostic value of microRNA-203a expression in breast cancer.

Tumor heterogeneity and the poor outcome of breast cancer (BC) patients have led researchers to define new markers of this disease. In recent years, microRNA expression patterns have proven to be valuable disease indicators. The level of miR-203a, in particular, was shown to be altered in different types of cancer. The objective of the present study was to assess the relationship between miR-203a expression and clinicopathological features of BC in a Portuguese cohort. The expression levels of miR­203a were analyzed in 109 formalin­fixed paraffin-embedded paired normal and tumor tissue samples. Significant overexpression of miR­203a in the tumor tissues was found (1.7-fold higher) compared to the expression in the normal adjacent tissues (p=0.003). In addition, several clinicopathological characteristics presented an association with higher miR-203a expression levels. Tumors with diameter ≤18.5 mm (1.5-fold; p=0.019), tumors positive for estrogen receptor (fold-change, 1.71; p=0.042), progesterone receptor (fold-change, 1.50; p=0.046) and negative for HER2 (fold-change, 1.50; p=0.016) and high Ki-67 index (fold-change, 2.60; p=0.024) presented a significant difference in miR-203a expression compared with adjacent normal tissues. Tumors without invasion of lymph nodes also presented higher expression of miR-203a (fold-change, 2.40; p=0.004). With regard to histological classification, ductal carcinomas in situ (fold-change, 2.20; p=0.028) and invasive carcinoma NOS (fold-change, 1.71; p=0.009) displayed significantly higher expression of miR-203a. Moreover, we found a significant downregulation of miR-203a with increased stage in invasive lobular carcinomas, suggesting that miR-203a could represent a potential marker to discriminate stages in invasive lobular carcinomas.

[Teamwork and negotiation with family in pediatrics]. / Trabajo en equipo y negociación con la familia en Pediatría.

OBJECTIVE: Analyze the negotiation and interaction process within nurses' practice with mothers of hospitalized children in pediatric unit from the teamwork perspective. METHOD: A qualitative approach was used in this study, based on the Grounded Theory from the symbolic interaction perspective. The study included 12 nurses of the pediatric unit and 18 mothers who stayed in the hospital with their hospitalized children. The number of participants was defined according to data saturation. Participant observation and semi-structured interviews were chosen as data collection techniques and it was analyzed using the program NVivo8. RESULTS: From the analysis performed, the central category identified was «weaknesses in the negotiation process¼, within the interactions between nurses and mothers. Nurses revealed difficulties in the communication process, they did not include roles definition with mothers in order to establish their participation in the care process and a power imbalance was also evidenced. CONCLUSION: Within the studied settings, an important lack of collaborative work with hospitalized children's mothers was observed. The weaknesses in the negotiation process and specifically the difficulties found in communication; the lack of roles and tasks clarification and the perceived power imbalance regarding relationships, prevent mothers involvement in their children care process, considered a basic component to achieve a greater mother implication, better results in terms of health and a lower impact of hospitalization in the children.

A opinião dos enfermeiros diretores sobre a intervenção do enfermeiro chefe / The Opinion Directors of Nurses have in Relation to the Head Nurse's Intervention / La opinión de las enfermeras directoras sobre la intervención de la enfermera jefe

A gestão moderna, para além das componentes administrativas ­ planeamento, organização, direção e controle ­ exige uma combinação de conhecimentos, aptidões, atitudes e comportamentos, como a liderança, a gestão do desempenho, o pensamento e planeamento estratégicos, a negociação, a comunicação, a gestão de recursos humanos e a melhoria da qualidade, com reflexos na intervenção dos enfermeiros chefes. Neste artigo, apresenta-se parte de um estudo, que está a ser desenvolvido no âmbito do doutoramento em Enfermagem. Objetivo: Conhecer a opinião dos enfermeiros diretores de cinco hospitais do Norte de Portugal, sobre as áreas de intervenção do enfermeiro chefe. Metodo: Trata-se de um estudo de natureza qualitativa com recurso à entrevista semiestruturada efetuada a enfermeiros diretores. Os dados foram tratados através da análise de conteúdo segundo Bardin. Resultados: Através dos relatos dos participantes, ressalta a convergência acentuada de opiniões, destacando-se, o referencial da função construído em torno de: gestão de cuidados, de recursos humanos e materiais, e de projetos; planeamento estratégico; formação de enfermeiros; investigação e divulgação científica. Conclusões: Verificou-se que o enfermeiro chefe é encarado como elemento estruturante na gestão de uma unidade de cuidados e impulsionador do desenvolvimento da qualidade dos cuidados, dos profissionais e dos serviços, tornando-se necessário uma maior aposta na formação destes profissionais.

Modern management, beyond its administrative components­planning, organizing, directing and control­requires a combination of knowledge, skills, attitudes and behaviors, such as leadership, performance management, strategic thinking and planning, negotiation, communication, human resource management and continual improvement, reflected on the intervention of head nurses. This article presents a part of a study developed in the PhD in Nursing. Objective: To know the opinion of the directors of nurses from five hospitals in northern Portugal, in the areas of intervention of the head nurses. Method: This is a qualitative study in which a semi - structured interview to directors of nurses was used. Data processing was performed using content analysis according to Bardin. Results: it is highlighted the convergence of views of respondents around care management, human resource management, materials and projects; strategic planning; nursing education; research and science. Conclusions: The head nurse is seen as a structural element in managing a care unit and driving force of development of care quality, professionals and services, making it essential to have a greater commitment in training these professionals.

La gestión moderna, más allá de sus componentes administrativos ­planificación, organización, dirección y control­ requiere una combinación de conocimientos, habilidades, actitudes y comportamientos, como el liderazgo, la gestión del rendimiento, el pensamiento y planificación estratégica, la negociación, la comunicación, la gestión de recursos humanos y la mejora de la calidad, con reflejos en la intervención de las enfermeras jefe. Este artículo presenta una parte de un estudio desarrollado en el Doctorado en Enfermería. Objetivo: Conocer la opinión de las enfermeras directoras de cinco hospitales en el norte de Portugal, en las áreas de intervención de la enfermera jefe. Método: Este es un estudio cualitativo en que se utilizó la entrevista semiestructurada realizada a las enfermeras directores. El procesamiento de datos se realizó mediante el análisis de contenido según Bardin. Resultados: Se destaca la convergencia de puntos de vista de los encuestados, en torno a gestión de la atención, gestión de recursos humanos, materiales y proyectos; planificación estratégica; educación en enfermería; investigación y divulgación científica. Conclusiones: La enfermera jefe es vista como elemento estructural en la gestión de una unidad de atención y fuerza motriz de desarrollo de la calidad de la atención, de los profesionales y de los servicios, por lo que es necesaria una mayor apuesta en la formación de estos profesionales.

The informal caregiver's socioeconomic prism and its implications on state of mind.

INTRODUCTION: The act of caring for a dependent elderly victim of cerebrovascular accident exerts different impacts on caregivers. Knowledge of their socioeconomic level by health professionals supports the planning and implementation of actions appropriate to the reality of the elderly and their caregivers. OBJECTIVE: To determine whether socioeconomic status predicts informal caregivers' state of mind (depression). DESIGN: Cross-sectional, descriptive study in the Dão Lafões sub-region. PARTICIPANTS: Non-probabilistic sample of 636 informal caregivers, aged 17-85 years (mean = 50.19±14.30). MEASURING INSTRUMENTS: The Beck Depression Inventory and the Graffar Socioeconomic Level Scale. RESULTS: We found class III (middle class family/reasonable socioeconomic status) was the most common (40.4%), class IV (upper lower class family/low socioeconomic level) with 37.7%. A majority of the sample (62.9%) does not have depressive symptoms, with their presence observed in 37.1% of informal caregivers, in which 24.3% are men and 39.6% women. The results sustain that socioeconomic level (P=.004) in the total sample predicts state of mind, inferring that caregivers with poorer socioeconomic status have a worse state of mind. CONCLUSIONS: The evidence found from the research show that informal caregivers with depressive symptoms have a poorer socioeconomic status, so that it is compulsory to consider these variables when planning interventions whose primary focus of attention is aimed at caregivers and elderly cerebrovascular accident victims experiencing situations of transition.

The informal caregiver’s socioeconomic prism and its implications on state of mind

INTRODUCTION: The act of caring for a dependent elderly victim of cerebrovascular accident exerts different impacts on caregivers. Knowledge of their socioeconomic level by health professionals supports the planning and implementation of actions appropriate to the reality of the elderly and their caregivers. OBJECTIVE: To determine whether socioeconomic status predicts informal caregivers' state of mind (depression). DESIGN: Cross-sectional, descriptive study in the Dão Lafões sub-region. Participants: Non-probabilistic sample of 636 informal caregivers, aged 17-85 years (mean = 50.19 ± 14.30). Measuring instruments: The Beck Depression Inventory and the Graffar Socioeconomic Level Scale. RESULTS: We found class III (middle class family/reasonable socioeconomic status) was the most common (40.4%), class IV (upper lower class family/low socioeconomic level) with 37.7%. A majority of the sample (62.9%) does not have depressive symptoms, with their presence observed in 37.1% of informal caregivers, in which 24.3% are men and 39.6% women. The results sustain that socioeconomic level (P = .004) in the total sample predicts state of mind, inferring that caregivers with poorer socioeconomic status have a worse state of mind. CONCLUSIONS: The evidence found from the research show that informal caregivers with depressive symptoms have a poorer socioeconomic status, so that it is compulsory to consider these variables when planning interventions whose primary focus of attention is aimed at caregivers and elderly cerebrovascular accident victims experiencing situations of transition

No disponible

Independencia en las actividades de la vida. Estudio de validación de una escala para la población portuguesa / Independence in the performance of Daily life activities (ADLs): validating a research scale applied to the Portuguese population

La funcionalidad cobra un lugar relevante en la independencia de los mayores, situación que se pretende se mantenga el mayor tiempo posible de la vida. La funcionalidad es un construto multidimensional medido a través de las actividades personales e instrumentales de la vida. El objetivo primordial del estudio es validar una escala de actividades de la vida, para la población portuguesa, de mediana edad y envejecida (n = 1.322). De los resultados del estudio verificamos la existencia de tres factores con características psicométricas adecuadas: movilidad, actividades instrumentales de la vida diaria y actividades personales de la vida diaria, con una variación explicada del 64,75%, teniendo un interés específico para la población que vive en la comunidad (AU)

Functionality has primordial importance in old people's independence; situation we wish to be as long as possible in the course of one's life. Functionality is a multidimensional construct measured through personal and instrumental activities of the life (ADL and IADL). The aim of this study is to validate a scale of daily life activities for the Portuguese population, middle-aged and elderly (n = 1322). Results of this study show us the existence of three factors, with suitable psychometric characteristics, which are: mobility, instrumental activities of daily life and personal activities of daily life, with an explained variation of 64.75%. It has a specific interest for the population living in the community (AU)

Famílias cuidadoras de idosos: estrutura e desenvolvimento / Family caregivers of elderly: structure and development / Familias cuidadoras de ancianos: estructura y desarrollo

This exploratory descriptive study of qualitative nature aimed at: Identification of the type and life cycle stage offamilies with an elderly dependent. We selected a convenience sample, 108 families from a northern region ofPortugal. To collect information, we used the genogram construction with the support of a semi-structuredinterview to the family caregiver. To perform the content analysis we chose the steps proposed by Bardin. Datawere collected in the period between October 2007 and June 2008. The results highlighted that families withdependent elderly are of nuclear type with or without children, with adult children or elderly, or they are in the"empty nest" stage. The obtained data are important on the decision making of the care given not only to theelderly but also to families who are the primary caregivers. We seek to encourage nurses to expand this field ofintervention.

Este estudo, descritivo-exploratório de natureza qualitativa, teve como objetivo identificar a tipologia e a fase dociclo vital das famílias com um idoso dependente. Selecionamos uma amostra intencional de 108 famílias daregião do Norte de Portugal. Para a colheita de informações recorremos à construção de genograma com oapoio de uma entrevista semiestruturada ao cuidador familiar. Para realizar a análise de conteúdo optamos pelasetapas propostas por Bardin. Os dados foram recolhidos no período de outubro 2007 a junho de 2008. Osresultados revelaram que as famílias com idoso dependente são do tipo nuclear, com ou sem filhos, filhosadultos ou idosos, vivenciando a fase do “ninho vazio”. Os dados obtidos têm interesse para a tomada dedecisão dos cuidados a prestar não só à pessoa idosa dependente, mas também às famílias, que são asprincipais cuidadoras. Procuramos estimular os enfermeiros a ampliar o seu campo de intervenção.

Este estudio, descriptivo exploratorio de naturaleza cualitativa, tuvo como objetivo identificar el tipo y la etapa delciclo vital de las familias con un anciano dependiente. Seleccionamos una muestra intencional de 108 familias de la región del norte de Portugal. La recolección de informaciones fue hecha a través de la construccióngenograma con el apoyo de una entrevista semiestructurada al cuidador familiar. Para realizar el análisis decontenido hemos elegido las etapas propuestas por Bardin. Los datos han sido recolectados en el período deoctubre 2007 a junio 2008. Los resultados muestran que las familias con ancianos dependientes son del tiponuclear, con o sin hijos, hijos adultos o ancianos, viviendo la fase del “nido vacío”. Los datos obtenidos tieneninterés para la toma de decisiones de los cuidados dados no solo al anciano como a las familias, que son lasprincipales cuidadoras. Buscamos estimular a los enfermeros para ampliar su campo de intervención.

[Living older in the family context: dependency in self-care]. / Viver com mais idade em contexto familiar: dependência no auto cuidado.

The purpose of this study is to help improve nursing care to dependent people and their families. The study objectives were: to describe the degree of dependency of the elderly in the family context; to identify the sociodemographic characteristics of the dependent elderly in the family context; to describe the main cause of dependency in the aged at home. This is a exploratory, descriptive study with a quantitative approach. In the period comprised between October 2007 and June 2008, 108 families from a northern region of Portugal were selected, with an elderly dependent. It was a convenience sample. For the collection of information, we used a questionnaire with the Barthel Index. Results showed that older people are predominantly women, widows, in average 81 years old, with severe level of dependence, and the leading cause of dependence was circulatory system diseases.