Dayana Souza Fram

Qualidade de vida de cuidadores de idosos com doença de Alzheimer

Objectives: To evaluate quality of life among caregivers of elders with Alzheimer’s disease and to examine the relationship between patients’ quality of life score measured with the Katz Quality of Life Index and the relationship between the caregivers’ quality of life measured with the SF-36 and depression score measured with the Beck Depression Inventory (BDI). Methods: This study was conducted in a geriatric clinic (Nucleo de Envelhecimento Cerebral) of the Sao Paulo Hospital of the Federal University of Sao Paulo. The sample consisted of 118 patients with Alzheimer’s disease and their caregivers. Sociodemographic and cormobidity data and the Katz score of quality of life and the mini-mental status examination (MMSE) score of the patients with Alzheimer’s disease were obtained through chart review. Data from caregivers comprised sociodemographic and comorbidity data and the SF-36 score of quality of life and the BDI score of depression. Results: SF-36 scores that were indicative of depression among caregivers were vitality (score = 56.8) and the scores on physical and emotional components were = 58.1, respectively. There was a significantly negative correlation between the caregivers’ BDI score and the patients’ Katz score, and between the caregivers’ SF-36 and BDI scores. There was also a significantly positive correlation between the scores of the caregivers’ SF-36 and the patients’ Katz scores and between the patient’s Katz and MMSE scores. Conclusion: The quality of life of caregivers of patients with Alzheimer’s disease was compromised, which could influence the quality of care they provided to the patients. The quality of life of the caregivers got worse when the functional capacity of the elders with Alzheimer’s disease was compromised.

Quality of life among caregivers of elders with Alzheimer's disease

Objectives: To evaluate quality of life among caregivers of elders with Alzheimer’s disease and to examine the relationship between patients’ quality of life score measured with the Katz Quality of Life Index and the relationship between the caregivers’ quality of life measured with the SF-36 and depression score measured with the Beck Depression Inventory (BDI). Methods: This study was conducted in a geriatric clinic (Nucleo de Envelhecimento Cerebral) of the Sao Paulo Hospital of the Federal University of Sao Paulo. The sample consisted of 118 patients with Alzheimer’s disease and their caregivers. Sociodemographic and cormobidity data and the Katz score of quality of life and the mini-mental status examination (MMSE) score of the patients with Alzheimer’s disease were obtained through chart review. Data from caregivers comprised sociodemographic and comorbidity data and the SF-36 score of quality of life and the BDI score of depression. Results: SF-36 scores that were indicative of depression among caregivers were vitality (score = 56.8) and the scores on physical and emotional components were = 58.1, respectively. There was a significantly negative correlation between the caregivers’ BDI score and the patients’ Katz score, and between the caregivers’ SF-36 and BDI scores. There was also a significantly positive correlation between the scores of the caregivers’ SF-36 and the patients’ Katz scores and between the patient’s Katz and MMSE scores. Conclusion: The quality of life of caregivers of patients with Alzheimer’s disease was compromised, which could influence the quality of care they provided to the patients. The quality of life of the caregivers got worse when the functional capacity of the elders with Alzheimer’s disease was compromised.

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case–control study

BackgroundInfection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.MethodsRisk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case–control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.ResultsThere were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17–24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9–23.09).ConclusionsInfection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant

The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.

Screening for group B Streptococcus in pregnant women: a systematic review and meta-analysis

La infeccion por Streptococcus del grupo B (GBS) es considerada un importante problema de salud publica. Los estreptococos estan asociados a: sepsis neonatal, meningitis, neumonia, muerte neonatal, aborto septico, corioamnionitis, endometritis y otras infecciones perinatales. El objetico del estudio fue determinar la mejor estrategia de rastreo de GBS en gestantes. Se trata de una revision Sistematica con Metanalisis. Fue realizada en el Departamento de Enfermeria de la Universidad Federal de Sao Paulo, Centro Cochrane de Brasil. Se utilizaron las siguientes fuentes: EMBASE, LILACS, Medline, lista de referencias bibliograficas, comunicacion personal y Cochrane Library. Como criterio para la seleccion de los estudios, se escogieron los que analizaron algun tipo de rastreo para GBS en gestantes. Independientemente del comparador, todos los analisis fueron favorables al programa de screening universal para la reduccion de la incidencia de sepsis neonatal. Las evidencias obtenidas en el estudio sugieren que la estrategia de screening universal para las gestantes asociado al uso de antibioticos profilacticos es segura y efectiva.Infection with Group B Streptococcus (GBS) is considered an important public health problem. It is associated with: Neonatal sepsis, meningitis, pneumonia, neonatal death, septic abortion, chorioamnionitis, endometritis and other perinatal infections. The aim of this study was to determine the best screening strategy for GBS in pregnant women. For this a systematic review and meta-analysis were carried out in the Nursing Department of the Federal University of São Paulo, Cochrane Center, Brazil. Sources used were, EMBASE, LILACS, Medline, list of references, personal communication and the Cochrane library. The criterion for the selection of the studies was; studies which analyze some type of screening for GBS in pregnant women. Independent of the comparator, all analyses were in favor of a universal screening program for reducing the incidence of neonatal sepsis. The evidence obtained in this study suggests that the strategy of universal screening of pregnant women associated with the use of prophylactic antibiotics is safe and effective.

Avaliação do tipo de curativo utilizado em cateter venoso central para hemodiálise

Objectives: To evaluate the efficacy of two types of dressings used on central venous catheter (CVC) in patients undergoing hemodialysis and to determine the rate of local and systemic bacterial infection when using gauze and micropore dressings or transparent film dressings. Methods: This study was a controlled randomized clinical trial with 66 subjects who were equally assigned to two groups (33 subjects per group). Group 1 used gauze and micropore dressings and group 2 used transparent film dressings. Measures consisted of a socio demographic questionnaire, clinical data, and catheter tip and blood culture tests. Subjects remained in the study until removal of the catheter. Results: There were no statistically significant differences regarding the types of dressings. Positioning of CVCs at 90 degrees in relation to the skin had higher rate of infections by S. Aureus. Conclusion: Although the use of transparent film dressings did not reduce infection, qualitative data analysis suggested that this type of dressing was preferred by the patients and by the health care providers from a university hospital.Objectives: To evaluate the efficacy of two types of dressings used on central venous catheter (CVC) in patients undergoing hemodialysis and to determine the rate of local and systemic bacterial infection when using gauze and micropore dressings or transparent film dressings. Methods: This study was a controlled randomized clinical trial with 66 subjects who were equally assigned to two groups (33 subjects per group). Group 1 used gauze and micropore dressings and group 2 used transparent film dressings. Measures consisted of a socio demographic questionnaire, clinical data, and catheter tip and blood culture tests. Subjects remained in the study until removal of the catheter. Results: There were no statistically significant differences regarding the types of dressings. Positioning of CVCs at 90 degrees in relation to the skin had higher rate of infections by S. Aureus. Conclusion: Although the use of transparent film dressings did not reduce infection, qualitative data analysis suggested that this type of dressing was preferred by the patients and by the health care providers from a university hospital.

Prevenção de infecções de corrente sanguínea relacionadas a cateter em pacientes em hemodiálise

Objective: To conduct a systematic review of the literature on the prevention of catheter-related bloodstream infections in patients on hemodialysis. Methods: A literature search was performed in Medline, Embase, Scielo, Lilacs, and Cochrane databases for articles published from 1990 to 2008. Results: Two hundred ninety- three articles were retrieved. However, only 12 studies were included in this review. Conclusions: Findings suggest that health care providers use several infection control measures to prevent bloodstream infections in this patient population.OBJETIVO: Realizar uma revisao sistematica sobre medidas padronizadas para prevencao de infeccoes relacionadas a cateter em pacientes em hemodialise. METODOS: Foi realizada uma revisao sobre a prevencao de infeccoes em hemodialise nas bases de dados Medline, Embase, SciElo, Lilacs e Cochrane Library de estudos publicados entre os anos de 1990 e 2008. RESULTADOS: Foram encontrados 293 artigos e destes 12 foram incluidos no estudo. CONCLUSAO: Foi evidenciada a importância da aplicacao de um conjunto de medidas de controle de infeccoes pelos profissionais da saude para prevenir a infeccao nesta populacao de pacientes.

Microrganismos isolados de pacientes em hemodiálise por cateter venoso central e evolução clínica relacionada

OBJETIVO: Identificar os microrganismos isolados da pele pericateter, ponta do cateter e corrente sanguinea de pacientes em hemodialise por cateter venoso central, verificar o perfil de sensibilidade destes microrganismos aos antimicrobianos e avaliar a evolucao clinica e a mortalidade relacionada a estes microrganismos. METODOS: Estudo transversal. As cepas isoladas de pacientes em hemodialise por cateter venoso central que em estudo previo apresentaram infeccao na pele pericateter, ponta do cateter e corrente sanguinea foram analisadas quanto ao perfil microbiologico e letalidade relacionada. RESULTADOS: Foram isolados 128 microrganismos em corrente sanguinea nos 94 pacientes estudados. Ocorreram 35 casos de septicemia e 27 de endocardite. A letalidade nos casos de endocardite por Staphylococcus aureus resistente a meticilina foi 100%. CONCLUSAO: Infeccao em corrente sanguinea e endocardite por Staphylococcus aureus resistente a meticilina sao preditivas de alta mortalidade e letalidade.

Prevention of Catheter-Related Bloodstream Infections in Patients on Hemodialysis

Objective: To conduct a systematic review of the literature on the prevention of catheter-related bloodstream infections in patients on hemodialysis. Methods: A literature search was performed in Medline, Embase, Scielo, Lilacs, and Cochrane databases for articles published from 1990 to 2008. Results: Two hundred ninety- three articles were retrieved. However, only 12 studies were included in this review. Conclusions: Findings suggest that health care providers use several infection control measures to prevent bloodstream infections in this patient population.OBJETIVO: Realizar uma revisao sistematica sobre medidas padronizadas para prevencao de infeccoes relacionadas a cateter em pacientes em hemodialise. METODOS: Foi realizada uma revisao sobre a prevencao de infeccoes em hemodialise nas bases de dados Medline, Embase, SciElo, Lilacs e Cochrane Library de estudos publicados entre os anos de 1990 e 2008. RESULTADOS: Foram encontrados 293 artigos e destes 12 foram incluidos no estudo. CONCLUSAO: Foi evidenciada a importância da aplicacao de um conjunto de medidas de controle de infeccoes pelos profissionais da saude para prevenir a infeccao nesta populacao de pacientes.

Knowledge and attitudes about sexuality in the elderly with HIV/AIDS

ReSumo Objetivos: Avaliar o conhecimento e atitudes sobre sexualidade em idosos com HIV/AIDS atendidos em ambulatorio especializado; e Identificar o perfil epidemiologico desses pacientes. Metodos: Estudo de corte transversal, descritivo e analitico com amostra de 148 pessoas com 50 anos ou mais. Utilizou-se a Aging Sexual Knowledge and Attitudes Scale para avaliar o conhecimento e atitudes sobre a sexualidade dos idosos. Resultados: Participaram do estudo 148 idosos, sexo masculino (63,5%), solteiro (30,5%), aposentados e pensionistas (53%), classe economica baixa (60%), somente 21% possuiam ate ensino medio completo, renda familiar mensal 3,3 salarios, tempo de diagnostico 156 meses e forma de contagio predominante via sexual (66,2%). Escore da ASKAS de conhecimento foi 32,2 e de atitudes 15,5. Houve associacao significante entre ASKAS conhecimento e genero feminino, ser viuvo e mais de uma comorbidade e ASKAS atitudes com ensino medio completo e atividade fisica. Conclusao: Pacientes com HIV/AIDS demonstraram conhecimento e atitudes favoraveis sobre a sexualidade no idoso, e mulheres donas de casa apresentaram conhecimento significante. Descritores: Envelhecimento; Sexualidade; Sindrome de imunodeficiencia adquirida; Conhecimentos, atitudes e pratica em saudeOBJECTIVES: Assess the knowledge and attitudes about sexuality in the elderly with HIV/AIDS served in a specialized ambulatory clinic; and identify the epidemiological profile of these patients. METHODS: Cross-sectional, descriptive and analytical study with a sample of 148 people aged 50 years and over. The Aging Sexual Knowledge and Attitudes Scale was used to assess the knowledge and the attitudes about sexuality of the elderly. RESULTS: The study included 148 elderly, male gender (63.5%), single (30.5%), retired and pensioners (53%), low socioeconomic class (60%), only 21% have completed the Secondary Education, monthly family income 3.3 minimum wages, time since diagnosis 156 months and predominant form of infection via sexual (66.2%). ASKAS knowledge score was 32.2 and attitudes score was 15.5. There was significant association between the knowledge ASKAS with the female gender, being a widow and more than one comorbidity; and between the attitudes ASKAS with complete Secondary Education and physical activity. CONCLUSION: Patients with HIV/AIDS showed favorable knowledge and attitudes about sexuality in the elderly, and women that were housewives showed significant knowledge.