Care to the dependent older person: motivations of caregivers in Brazil and Portugal / O cuidado ao idoso dependente: motivações de cuidadores do Brasil e Portugal / Cuidando a los dependientes mayores: motivaciones de cuidadores en Brasil y Portugal

In an attempt to fulfill care needs to the elderly, the family usually assumes this function. In order to understand the social representations of informal caregivers of Brazilian and Portuguese elderly people about the motivations for care, a qualitative, exploratory-descriptive research was carried out, based on the Social Representations Theory, in which 21 informal Brazilian caregivers and 11 informal Portuguese caregivers of elderly dependents were interviewed. Thematic Content Analysis and QSR NVivo® software were used in the treatment of the data, and the results showed care as the main motivation: family relationships, in which marriage, parenting, and the affections resulting from these relationships led to the function; the negative representation of Portuguese caregivers on the home, as a place of abandonment and action contrary to the cultural norm; and the representation of the elderly as frail and dependent, who, like children, constantly need care and attention.

Na tentativa de suprir as necessidades de cuidado destinado ao idoso, a família comumente é a instituição que assume tal função. Com o objetivo de compreender as representações sociais dos cuidadores informais de idosos brasileiros e portugueses acerca das motivações para o cuidado, realizou-se uma pesquisa qualitativa, exploratória e descritiva, fundamentada na Teoria das Representações Sociais, em que foram entrevistados 21 cuidadores informais brasileiros e 11 cuidadores informais portugueses de idosos dependentes. Utilizaram-se a análise de conteúdo temática e o software QSR NVivo® no tratamento dos dados, e os resultados evidenciaram como principais motivações o cuidado: as relações familiares, em que o matrimônio, a parentalidade e os afetos decorrentes dessas relações conduziram a função; a representação negativa dos cuidadores portugueses sobre o lar como local de abandono e ação contrária à norma cultural; e a representação da pessoa idosa como frágil e dependente, que, assim como as crianças, precisa constantemente de cuidados e atenção.

En un intento por atender las necesidades de cuidado de las personas mayores, la familia suele ser la institución que asume esta función. Para comprender las representaciones sociales de los cuidadores informales de ancianos brasileños y portugueses sobre las motivaciones del cuidado, se realizó una investigación cualitativa, exploratoria-descriptiva, basada en la Teoría de las Representaciones Sociales, en la que 21 cuidadores informales brasileños y 11 informales portugueses Se entrevistó a los cuidadores de ancianos dependientes. En el tratamiento de los datos se utilizó el software de Análisis de Contenido Temático y QSR NVivo® y los resultados se mostraron como las principales motivaciones: las relaciones familiares, en las que el matrimonio, la paternidad y los afectos resultantes de estas relaciones condujeron a la función; la representación negativa de los cuidadores portugueses en el hogar, como lugar de abandono y acción contraria a la norma cultural; y la representación de los ancianos como frágiles y dependientes, quienes, como los niños, necesitan cuidados y atenciones constantes.

Synergistic effect of apoptosis and necroptosis inhibitors in cisplatin-induced nephrotoxicity.

Necroptosis is a nonapoptotic cell death pathway. We aim to study the effect of necrostatin-1 (a specific necroptosis inhibitor) in cisplatin-induced injury. We analyzed the effect of the combined use of inhibitors of apoptosis (z-vad) and necroptosis (necrostatin-1) in acute kidney injury by cisplatin in human proximal tubule cells. Our results showed moderate effectiveness in cytoprotection after treatment with z-vad. But the concomitant use of inhibitors (z-vad and necrostatin-1) presented synergistic and additive protection. The present study analyzed the caspase-3 activity and we observed a significant decrease in the group treated with z-vad and cisplatin. However we did not observe changes in the group treated with both inhibitors (z-vad and necrostatin-1) and cisplatin. Thus, demonstrating that necroptosis is a caspase-independent mechanism. We also analyzed the effect of necrostatin-1 in vivo model. C57BL/6 mice were treated with cisplatin and/or inhibitors. The concomitant use of inhibitors (z-vad and necrostatin-1) recovered renal function and decreased levels of urinary Ngal. Additionally, we analyzed the expression of RIP-1, a specific marker for necroptosis. In animals treated with cisplatin and z-VAD levels of RIP-1 were higher. This result reinforces that necroptosis occurs only in conditions where apoptosis was blocked. However, the use of both inhibitors (z-vad and necrostatin-1) provided additional protection. In conclusion, our study has a significant potential to show in vitro and in vivo protection obtained by necrostatin-1. Therefore, our results suggest that necroptosis may be an important mechanism of cell death after kidney injury.

Bone Marrow-Derived Mesenchymal Stem Cells and Their Conditioned Medium Attenuate Fibrosis in an Irreversible Model of Unilateral Ureteral Obstruction.

The therapeutic potential of mesenchymal stem cells (MSCs) and their conditioned medium (MSC-CM) has been extensively studied. MSCs can repair tissue, reduce local inflammation, and modulate the immune response. Persistent renal tubular interstitial inflammation results in fibrosis and leads to chronic kidney disease (CKD). Unilateral ureteral obstruction (UUO) is a very well-accepted renal fibrosis model. In this study, we evaluated factors influenced by the administration of MSCs or MSC-CM in the UUO model. MSCs extracted from rat bone marrow were cultivated in vitro and characterized by flow cytometry and cellular differentiation. Eight groups of female rats were used in experiments (n = 7, each), including Sham, UUO, UUO + MSC (obstruction + MSC), and UUO + CM (obstruction + MSC-CM) for 7 days of obstruction and Sham, UUO, UUO + MSC, and UUO + CM for 14 days of obstruction. The MSCs or MSC-CM was administered via the abdominal vena cava after total ligation of the left ureter. After 7 or 14 days, rats were euthanized, and serum and obstructed kidney samples were collected. MSCs or MSC-CM decreased the expression of molecules, such as Col1a1, α-SMA, and TNF-α. We also observed reductions in the levels of caspase 3, α-SMA, and PCNA in treated animals by immunohistochemistry. Our results suggest that the intravenous administration of MSCs or MSC-CM improves fibrosis progression and factors involved in apoptosis, inflammation, cell proliferation, and epithelial-mesenchymal transition in Wistar rats subjected to UUO, indicating a potential tool for preventing CKD.

Quality of life and associated factors for caregivers of functionally impaired elderly people.

BACKGROUND: Lifestyle changes, factors inherent to the caregiver's family and social environment, and physical and mental aspects determine a caregiver's quality of life (QOL). OBJECTIVE: To evaluate the QOL and associated factors for caregivers of functionally impaired elderly people. METHOD: This was a cross-sectional study that analyzed data from a home-based care survey. The study sites were the homes of elderly people enrolled in Family Health Centers (Unidades de Saúde da Família) in Jequié, Bahia, Brazil. The sample consisted of 40 caregivers of functionally impaired elderly people. The instrument consisted of demographic data, health status, the Perceived Family Support Inventory, the Social Support Satisfaction Scale, and the World Health Organization Quality of Life Assessment (WHOQOL-BREF). The data were analyzed using a descriptive analysis and the chi-squared test at a 5% significance level, performed in SPSS version 15.0. RESULTS: An association was found between the WHOQOL-BREF physical domain and the presence of sequelae (p=0.006), affective-cognitive inconsistency (p=0.009), and being the primary caregiver (p=0.002). The psychological domain showed an association with the presence of sequelae (p=0.006), the environment domain with the presence of diseases (p<0.001) and being the primary caregiver (p=0.033), and the social relations domain with the presence of diseases (p<0.001). CONCLUSION: The presence of sequelae or diseases, affective-cognitive inconsistency, and being the primary caregiver were related to decreases in their QOL.

Quality of life and associated factors for caregivers of functionally impaired elderly people / Quality of life and associated factors of caregivers for the elderly with impaired functional capacity

BACKGROUND: Lifestyle changes, factors inherent to the caregiver's family and social environment, and physical and mental aspects determine a caregiver's quality of life (QOL). OBJECTIVE: To evaluate the QOL and associated factors for caregivers of functionally impaired elderly people. METHOD: This was a cross-sectional study that analyzed data from a home-based care survey. The study sites were the homes of elderly people enrolled in Family Health Centers (Unidades de Saúde da Família) in Jequié, Bahia, Brazil. The sample consisted of 40 caregivers of functionally impaired elderly people. The instrument consisted of demographic data, health status, the Perceived Family Support Inventory, the Social Support Satisfaction Scale, and the World Health Organization Quality of Life Assessment (WHOQOL-BREF). The data were analyzed using a descriptive analysis and the chi-squared test at a 5% significance level, performed in SPSS version 15.0. RESULTS: An association was found between the WHOQOL-BREF physical domain and the presence of sequelae (p=0.006), affective-cognitive inconsistency (p=0.009), and being the primary caregiver (p=0.002). The psychological domain showed an association with the presence of sequelae (p=0.006), the environment domain with the presence of diseases (p<0.001) and being the primary caregiver (p=0.033), and the social relations domain with the presence of diseases (p<0.001). CONCLUSION: The presence of sequelae or diseases, affective-cognitive inconsistency, and being the primary caregiver were related to decreases in their QOL. .

CONTEXTUALIZAÇÃO: O rearranjo no modo de viver, acompanhado de fatores inerentes ao ambiente familiar e social do cuidador, além de aspectos físicos e mentais, irão se associar e serão fundamentais para a boa qualidade de vida (QV) da pessoa que cuida. OBJETIVO: Avaliar a QV e os fatores associados em cuidadores de idosos com comprometimento da capacidade funcional. MÉTODO: Trata-se de um estudo seccional que analisou dados de uma pesquisa de intervenção de base domiciliar. O local de estudo foram as residências dos idosos cadastrados em Unidades de Saúde da Família, no município de Jequié, BA, Brasil. A amostra foi constituída por 40 cuidadores de idosos com comprometimento da capacidade funcional. O instrumento foi constituído de informações sociodemográficas, condições de saúde, Inventário de Percepção do Suporte Familiar, Escala de Satisfação do Suporte Social e o WHOQOL-BREF. Os dados foram analisados no Programa Estatístico SPSS, versão 15.0, sendo realizada análise descritiva e aplicação do qui-quadrado de Pearson, com um nível de significância de 5%. RESULTADOS: Verificou-se associação entre o Domínio Físico do WHOQOL-BREF e as variáveis do estudo: presença de sequelas (p-valor=0,006), afetividade-consistência (p-valor=0,009) e ser cuidador principal (p-valor=0,002). O Domínio Psicológico apresentou associação com a presença de sequelas (p-valor=0,006) e o Domínio Meio Ambiente, com presença de doenças (p-valor<0,001) e ser o cuidador principal (p-valor=0,033) e o Domínio Relações Sociais com presença de doença (p-valor<0,001). CONCLUSÃO: Observou-se ...

Heme oxygenase 1 improves glucoses metabolism and kidney histological alterations in diabetic rats.

One important concern in the treatment of diabetes is the maintenance of glycemic levels and the prevention of diabetic nephropathy. Inducible heme oxygenase 1 (HO-1) is a rate-limiting enzyme thought to have antioxidant and cytoprotective roles. The goal of the present study was to analyze the effect of HO-1 induction in chronically hyperglycemic rats. The hyperglycemic rats were divided into two groups: one group, called STZ, was given a single injection of streptozotocin; and the other group was given a single streptozotocin injection as well as daily injections of hemin, an HO-1 inducer, over 60 days (STZ + HEME). A group of normoglycemic, untreated rats was used as the control (CTL).Body weight, diuresis, serum glucose levels, microalbuminuria, creatinine clearance rate, urea levels, sodium excretion, and lipid peroxidation were analyzed. Histological alterations and immunohistochemistry for HO-1 and inducible nitric oxide synthase (iNOS) were assessed. After 60 days, the STZ group exhibited an increase in blood glucose, diuresis, urea, microalbuminuria, and sodium excretion. There was no weight gain, and there was a decrease in creatinine clearance in comparison to the CTL group. In the STZ + HEME group there was an improvement in the metabolic parameters and kidney function, a decrease in blood glucose, serum urea, and microalbuminuria, and an increase of creatinine clearance, in comparison to the STZ group.There was glomerulosclerosis, collagen deposition in the STZ rats and increase in iNOS and HO-1 expression. In the STZ + HEME group, the glomerulosclerosis and fibrosis was prevented and there was an increase in the expression of HO-1, but decrease in iNOS expression and lipid peroxidation. In conclusion, our data suggest that chronic induction of HO-1 reduces hyperglycemia, improves glucose metabolism and, at least in part, protects the renal tissue from hyperglycemic injury, possibly through the antioxidant activity of HO-1.

Bone marrow-derived mesenchymal stem cells repaired but did not prevent gentamicin-induced acute kidney injury through paracrine effects in rats.

This study evaluated the effects of bone marrow-derived mesenchymal stem cells (BMSCs) or their conditioned medium (CM) on the repair and prevention of Acute Kidney Injury (AKI) induced by gentamicin (G). Animals received daily injections of G up to 20 days. On the 10(th) day, injections of BMSCs, CM, CM+trypsin, CM+RNase or exosome-like microvesicles extracted from the CM were administered. In the prevention groups, the animals received the BMSCs 24 h before or on the 5(th) day of G treatment. Creatinine (Cr), urea (U), FENa and cytokines were quantified. The kidneys were evaluated using hematoxylin/eosin staining and immunohystochemistry. The levels of Cr, U and FENa increased during all the periods of G treatment. The BMSC transplantation, its CM or exosome injections inhibited the increase in Cr, U, FENa, necrosis, apoptosis and also increased cell proliferation. The pro-inflammatory cytokines decreased while the anti-inflammatory cytokines increased compared to G. When the CM or its exosomes were incubated with RNase (but not trypsin), these effects were blunted. The Y chromosome was not observed in the 24-h prevention group, but it persisted in the kidney for all of the periods analyzed, suggesting that the injury is necessary for the docking and maintenance of BMSCs in the kidney. In conclusion, the BMSCs and CM minimized the G-induced renal damage through paracrine effects, most likely through the RNA carried by the exosome-like microvesicles. The use of the CM from BMSCs can be a potential therapeutic tool for this type of nephrotoxicity, allowing for the avoidance of cell transplantations.

Depressive symptoms and motor performance in the elderly: a population based study / Sintomas depressivos e desempenho motor em idosos: estudo de base populacional

BACKGROUND: There is a growing incidence of depression in the elderly, and this impairment interferes directly in the reduction of motor skills. OBJECTVE: This study aims to examine the association between depressive symptoms and motor performance in community-dwelling elderly. METHOD: This is a cross-sectional study that analyzed data from 316 elders of a home and population-based epidemiological survey. The information used was: socio-demographic characteristics; motor performance tests; physical activity; and Geriatric Depression Scale. The data were analyzed using the Statistical Package for Social Sciences. Mann-Whitney U test, chi-square, Spearman correlation and Poisson regression, with a confidence interval of 95%, were calculated. RESULTS: For all motor tests, motor performance was negatively associated with depressive symptoms, regardless of gender, age, literacy and illiteracy, per capita income and physical activity. Elderly people with depressive symptoms have between 58% and 82% more functional limitation, depending on the motor performance test compared to those who were not depressed. CONCLUSIONS: There is an inverse relationship between depressive symptoms and motor performance in the elderly.

CONTEXTUALIZAÇÃO: É crescente a ocorrência de depressão em idosos, e esse acometimento interfere diretamente na redução da capacidade motora. OBJETIVO: Analisar a associação entre sintomas depressivos e desempenho motor em idosos residentes na comunidade. MÉTODO: Trata-se de um estudo transversal que analisou dados de 316 idosos de uma pesquisa epidemiológica de base domiciliar e populacional. As informações usadas foram: características sociodemográficas; testes de desempenho motor; atividade física e Escala de Depressão Geriátrica. Os dados foram analisados no The Statistical Package for Social Sciences, sendo realizados testes U de Mann-Whitney, qui-quadrado, Correlação de Spearman e regressão de Poisson, com intervalo de confiança de 95%. RESULTADOS: Para todos os testes motores, o desempenho motor foi negativamente associado à sintomatologia depressiva, independentemente do sexo, idade, saber ler e escrever, renda familiar per capita e atividade física. Idosos com sintomas depressivos possuem entre 58% e 82% mais limitação funcional, a depender do teste de desempenho motor. CONCLUSÕES: Conclui-se que existe uma relação inversa entre sintomas depressivos e desempenho motor em idosos.

Depressive symptoms and motor performance in the elderly: a population based study.

BACKGROUND: There is a growing incidence of depression in the elderly, and this impairment interferes directly in the reduction of motor skills. OBJECTIVE: This study aims to examine the association between depressive symptoms and motor performance in community-dwelling elderly. METHOD: This is a cross-sectional study that analyzed data from 316 elders of a home and population-based epidemiological survey. The information used was: socio-demographic characteristics; motor performance tests; physical activity; and Geriatric Depression Scale. The data were analyzed using the Statistical Package for Social Sciences. Mann-Whitney U test, chi-square, Spearman correlation and Poisson regression, with a confidence interval of 95%, were calculated. RESULTS: For all motor tests, motor performance was negatively associated with depressive symptoms, regardless of gender, age, literacy and illiteracy, per capita income and physical activity. Elderly people with depressive symptoms have between 58% and 82% more functional limitation, depending on the motor performance test compared to those who were not depressed. CONCLUSIONS: There is an inverse relationship between depressive symptoms and motor performance in the elderly.

Receptor-induced dilatation in the systemic and intrarenal adaptation to pregnancy in rats.

Normal pregnancy is associated with systemic and intrarenal vasodilatation resulting in an increased glomerular filtration rate. This adaptive response occurs in spite of elevated circulating levels of angiotensin II (Ang II). In the present study, we evaluated the potential mechanisms responsible for this adaptation. The reactivity of the mesangial cells (MCs) cultured from 14-day-pregnant rats to Ang II was measured through changes in the intracellular calcium concentration ([Cai]). The expression levels of inducible nitric oxide synthase (iNOS), the Ang II-induced vasodilatation receptor AT2, and the relaxin (LGR7) receptor were evaluated in cultured MCs and in the aorta, renal artery and kidney cortex by real time-PCR. The intrarenal distribution of LGR7 was further analyzed by immunohistochemistry. The MCs displayed a relative insensitivity to Ang II, which was paralleled by an impressive increase in the expression level of iNOS, AT2 and LGR7. These results suggest that the MCs also adapt to the pregnancy, thereby contributing to the maintenance of the glomerular surface area even in the presence of high levels of Ang II. The mRNA expression levels of AT2 and LGR7 also increased in the aorta, renal artery and kidney of the pregnant animals, whereas the expression of the AT1 did not significantly change. This further suggests a role of these vasodilatation-induced receptors in the systemic and intrarenal adaptation during pregnancy. LGR7 was localized in the glomeruli and on the apical membrane of the tubular cells, with stronger labeling in the kidneys of pregnant rats. These results suggest a role of iNOS, AT2, and LGR7 in the systemic vasodilatation and intrarenal adaptation to pregnancy and also suggest a pivotal role for relaxin in the tubular function during gestation.