Sobrecarga del agente de cuidado dependiente y su relación con la dependencia funcional del adulto mayor / Overload in the dependent care agent and its relation to the elder adult functional dependency

Métodos: Estudio descriptivo, correlacional, transversal, muestreo por conveniencia, incluyó a 90 adultos mayores y 90 agentes de cuidado dependiente. Se describió el perfil socio demográfico, se aplicó el índice de Barthel para evaluar el nivel de dependencia del adulto mayor y la entrevista de Zarit para evaluar la sobrecarga subjetiva del agente de cuidado dependiente. Objetivo: Identificar la relación entre el nivel de sobrecarga subjetiva del agente de cuidado dependiente y el nivel de dependencia funcional del adulto mayor con enfermedad crónico degenerativa en el Hospital General de Silao, Guanajuato en México. Resultados: La edad promedio de los adultos mayores fue de 70.9 ±10, en el índice de Barthel presentaron dependencia leve (41.1%) en las actividades de la vida diaria. El perfil del agente de cuidado dependiente correspondió a una mujer de edad media (53.8 ±5.2), casada (88.9%), ama de casa (73.3%), hija de quien cuida (48.9%). En la entrevista de Zarit se encontró a agentes de cuidado dependiente sin sobrecarga (85.6%). Para verificar si existía correlación entre las variables sobrecarga subjetiva y dependencia funcional, se obtuvo el coeficiente de correlación rho de Spearman (-0.46), p<0.05. Discusión: Orem infirió que en situaciones donde se requiera de cuidado, la sobrecarga del agente de cuidado dependiente se relaciona con la dependencia funcional del adulto mayor. Conclusión: A menor grado de dependencia del adulto mayor, menor es el nivel de sobrecarga subjetiva del agente de cuidado dependiente.

Objective: To identify the relationship between the subjective overload level of the dependent care agent and the functional dependency level of the elder adult suffering from chronic degenerative illnesses at the Silao General Hospital in Guanajuato, Mexico. Methods: A descriptive, correlational, transversal and basic study design was used. Sampling was by convenience, and included 90 elder adults and 90 dependent care agents. The social and demographic profile was described. The Barthel index was used to assess the level of dependence of the elder adult, while the Zarit interview was used to assess the subjective overload of the dependent care agent. Results: The elder adult average age was 70.9 ±10; and after using the Barthel index, 41.1% showed dependency in their daily life. The profile of the dependent care agent corresponded to that of a middle aged woman (53.8 ±5.2), married (88.9%), housewife (73.3%), and daughter of the elder (48.9%). From the Zarit interview, it was found that 85.6% were dependent care agents without overload. In order to verify if a correlation existed between the variables subjective overload and functional dependency, the Spearman correlation rho was calculated, and turned out to be -0.46, p<.05. Discussion: Orem inferred that in situations where healthcare is required, the dependent care agent overload is related to the functional dependency of the elder adult. Conclusions: The lower the grade of dependence of the elder adult, the lower the subjective overload of the dependent care agent.

[Level of knowledge about asthma among parents of asthmatic children]. / Nivel de conocimientos acerca del asma en padres de niños asmáticos.

OBJECTIVE: To determine the level of knowledge of asthma in asthmatic children's parents. MATERIAL AND METHODS: A questionnaire was applied in asthmatic children's parents that had not taken some course about asthma, to explore the knowledge that they have about the illness. A questionnaire of the National Asthma Education Program of NIH was used. They were only questions of false or true options. RESULTS: 512 questionnaires were applied finding mainly that 53.1% considered to the asthma an emotional illness, 52.5% believed that the way that parents raise their children cause the asthma, 32.8% considered that the acute episodes are not dangerous. The 39.1% ignored that it is possible to measure the lung function, 23.4% considered that the patient with asthma should not carry out exercise and 57.8% "knew" that the asthma in the children disappears spontaneously in the adolescence. CONCLUSIONS: The level of education about asthma in the parents is insufficient, and also is wrong in almost half of them.

[Humoral immunodeficiencies in asthmatic children with recurrence rhinopharyngitis]. / Inmunodeficiencias humcrales en niños asmáticos con rinofaringitis recurrente.

OBJECTIVE: To determine the serum immunoglobulin concentrations in children with asthma and recurrent rinofaringitis. MATERIAL AND METHODS: We made a descriptive survey in children with persistent moderate asthma and with recurrent infections. Serum IgA, IgG, IgM and IgE concentrations was determined in the laboratory of Immunology and the results were considered according to the age and to the technique used in the laboratory. RESULTS: They were 45 patients (26 males and 19 females) with age average of 5.5 +/- 2.8 years +/- SD. In 12 patients (26%) had deficiency of IgA, in 2 (4%) it was absolute and in 10 (22%) it was partially. They were 4 (9%) with deficiency of IgG and IgM had not deficiency, but in 5 (11%) had elevated concentrations. We find 28 patients (62%) with high serum IgE. CONCLUSIONS: The prevalence of the serum immunodeficiency would be bigger if they were looked for deliberately in groups with risk, like it is demonstrated in this study, where, of the 45 patients they met 18 with some serum immunoglobulin deficiency (40%).

[Effect of immunotherapy with allergens in asthmatic children with integral treatment]. / Efecto de la inmunoterapia con alergenos en niños asmáticos con tratamiento integral.

OBJECTIVE: To analyze the effect of the immunotherapy with allergens (ITA) in asthmatic pediatric patients with integral treatment. MATERIAL AND METHODS: We included children with allergic rhinitis and asthma to treatment in the Clinic of Asthma and Allergy. We made a monthly evaluation of symptoms and annual of laboratory tests. RESULTS: The results are described in averages, G1 followed by G2. They were 16 (12 M/4 F) and 17 (11 M/F) patients with ages of 6.1 +/- 2.8 and 6.2 +/- 2 years. They presented 1.2 +/- 0.5 and 1.3 +/- 0.5 crisis per month and also 4.9 +/- 3.4 and 4.8 +/- 3 hospitalizations per year. In all the treatment began with CGIDS in spray and in 8 and 7 BDP was also used. The use of b-agonists at home was bigger in G1: 3 +/- 2.1 vs 0.6 +/- 0.7 (p = 0.0004). Acute treatment in more occasions was granted in G1: 21 vs 2 (p < 0.0001). It was bigger the number of applications of CGIDS in G1: 30.1 +/- 5.3 vs 15.4 +/- 2.7 (p < 0.0001) and of immunotherapy with allergens 8.1 +/- 9.6 vs 5.1 +/- 6.4 (p = 0.1). CONCLUSIONS: The asthmatic pediatric patients on integral treatment present a bigger and quicker improvement of their rhinitic and asthmatic symptoms when they are also treated with specific IT, even from the beginning of the treatment, they also improve their general immunity and they present reduction of allergic markers. They also use less medications, they present less acute exacerbation's and less hospitalizations.

[Evaluation of the quality of life of asthmatic children]. / Evaluación de la calidad de atención al paciente pediátrico asmático.

OBJECTIVE: In order to know the impact of patient's treatment in a Asthma and Allergy Clinic we evaluated the quality of life of asthmatic children. MATERIAL AND METHOD: We included schoolchildren with moderate asthma. In the initial evaluation we considered the number of acute crisis and hospitalizations, medications use, knowledge about environmental control measures (ECM), MDI's correct use, bronchodilators indications, satisfaction and treatment effect and patient's quality of life were scored with an analogous visual score. All patients received pharmacologic treatment and asked to achieve both ECM and assist to information and training sessions. They were evaluated during one year. Were analyzed with Student's t test. RESULTS: Were 40 patients with an age-average of 5.9 years-old +/- 2.9 SD, at the beginning we observed in average: duration of the disease 3.3 years +/- 2.5, number of crisis/year 17.1 +/- 9.5, emergency room visits/year 9 +/- 5.6. Only 9 children (22%) used MDI's correctly and 5 (12.5%) had knowledge about beta agonists indications. At the end of the year they had an annual average of 1.15 crisis +/- 1 SD. Only 7 patients (17.5%) went to emergency room one time. In the questionnaire the scoring average at the onset and at the end was: patient and patient's family care 62 +/- 12.3 SD and 91.5 +/- 9.1 SD (p < 0.01); treatment effectiveness 39.6 +/- 16.7 SD and 93.3 +/- 8.6 SD (p < 0.001); information and acquired skills 34.9 +/- 15.2 SD and 92.9 +/- 10.6 SD (p < 0.001); family cost 82.4 +/- 13.5 SD and 16.1 +/- 14.4 SD (p < 0.001) and daily patient's activities. 32.8 +/- 15.1 SD and 90.1 +/- 8.4 SD (p < 0.001) CONCLUSIONS: The chronic asthma treatment in children with monitored education by allergist improves significantly patient's quality of life and reduce treatment costs.

[Inhibitory effect of astemizol in skin tests with histamine]. / Efecto inhibitorio del astemizol en pruebas cutáneas con histamina.

OBJECTIVE: To determine the effect of the astemizol to inhibit the cutaneous response to the histamine. MATERIAL AND METHODS: We made a clinical assay in healthy adult subjects realising skin tests with histamine for prick (1 mg/ml) and intradermal (0.01 mg/ml) daily during the taking of astemizol 10 mg during 7 days and during 7 days after suspending it, as well as the day 14, 21 and 28. It was determined the inhibition and the reappearance of the cutaneous response. RESULTS: They were 12 subjects with mean age of 36 years old +/- 11.2 SD. The complete inhibition was presented starting from the fourth day and most (79%) until the seventh day. The normal reaction, recovered in more than seven days but less than fourteen in 100%. CONCLUSIONS: According to these results, the astemizol inhibits the skin reaction to the histamine from the first day in 50% of the subjects and its principal action is to the seventh day, while when suspend it the normal response it recovers in more than seven days.

[Prevalence on acute asthma in children]. / Prevalencia de asma aguda en niños.

OBJECTIVE: In this descriptive study we considered age, sex, and admission's month of children under 15 years-old admitted to the emergency room for acute asthma between January 94 to july 95. MATERIAL AND METHOD: There were 594 boys and 421 girls. Male to female mean ratio was 1.4:1. We found a greater and significative admission's number in boys than in girls (x2: p < 0.001). Odds ratio was greater in boys. 1.18 (CI 95%: 1.04-1.35) than in girls, 0.85 (CI 95%: 0.750.96). RESULTS: The acute asthma admissions monthly trend was in third place (median) and second place (mode) when compared with other children's admission diagnoses. Total monthly admissions amount did not show a significative differences when compared the first seven months of 1994 and 1995 (Mann-Whitney's U: p > 0.05). CONCLUSIONS: The acute asthma admissions are currently predominant in boys over girls, and that bronchial asthma is one of the more frequent emergency admission's causes in children.

[Incidence of allergic diseases and atopic markers in a tertiary hospital]. / Incidencia de enfermedades alérgicas y marcadores atópicos en un hospital de tercer nivel.

With the aim to know both the distribution and features of allergic disorders in a third level hospital at Mexico city we performed a descriptive study throughout one year, patients data were obtained from their clinical records at initial evaluation. We attended 1486 patients, 744 females (50.1%) and 742 males (49.9%). Children under 10 years-old were the main ages group (46.8%). Forty-four percent of the patients had at least one atopic relative, one brother or sister in 19.5%. White blood cells results showed peripheral cosinophilia in 57.6% patients and nasal cosinophilia in 58.1%. We found S. aureus, coagulase positive in 55% of 192 positive throat cultures. The more frequent diagnoses were rhinitis and asthma (46.3%), rhinitis (20.7%) and asthma (14.1%). We consider that the more prominent findings were the high index of S. aureus, higher atopic family history in brothers and the association between cosinophilia and allergic disorders.

[Comparison of extracts of cockroaches, house dust and Dermatophagoides with intradermal tests in allergy patients]. / Comparación entre extractos de cucaracha, polvo casero y Dermatophagoides con pruebas intradérmicas en pacientes alérgicos.

In the order to know both the sensitivity and positivity between the allergenic extracts of cockroach (C), house dust (HDJ, and Dermatophagoides pteronyssinus (Dpt) we made a transversal study in 783 allergic patients who underwent intradermal skin tests with the antigens of C, HD and Dpt. Allergic asthma and rhinitis were the more frequent diagnosis. There was no significative difference between the sensitivity to C and HD (p = 0.1),-women were more sensitive to C than to HD (p < 0.05). We found a greater sensitivity to Dpt than C and HD (p < 001). There were more positive patients to C than to HD (p = 0.01) and although we observed more positive patients to Dpt than to C (p = 0.01) this difference was not significative for women (p = 0.05). We can conclude than cockroach, as an allergic source, has similar importance that house dust mite, and it is inadequate its substitution with house dust extracts in skin tests screening.