Dulce Aparecida Barbosa

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.

Perfil de mulheres usuárias de álcool em ambulatório especializado em dependência química

Embora cresca o numero de mulheres com abuso ou dependencia alcoolica, elas ainda permanecem como alvo nao prioritario na tomada de decisao dos gestores de politicas publicas. OBJETIVOS: Caracterizar o perfil sociodemografico de mulheres com abuso ou dependencia do alcool, identificar o consumo alcoolico, as intervencoes terapeuticas realizadas e alguns fatores que poderiam estar relacionados ao abandono precoce do tratamento nesta populacao. METODOS: Foram incluidas 192 mulheres que procuraram pela primeira vez tratamento na Unidade de Pesquisa em Alcool e Drogas (UNIAD) da Universidade Federal de Sao Paulo (UNIFESP), no periodo de 2000 a 2006. As informacoes foram coletadas nos prontuarios das pacientes, as quais foram separadas em dois grupos, usando-se como criterio o abandono de tratamento. RESULTADOS: Nao houve diferenca significativa nas caracteristicas sociodemograficas da populacao estudada. Em ambos os grupos houve predominio de solteiras, com primeiro grau incompleto e situacao de desemprego. O consumo diario de destilados foi significantemente maior no grupo abandono gradual (p < 0,002). O grau de dependencia grave foi significantemente maior (p < 0,001) nos dois grupos em relacao aos graus leve e moderado. A quantidade de alcool ingerida por semana, o uso de medicacao coadjuvante e a necessidade de atendimento psiquiatrico previo foi significantemente maior no grupo abandono gradual (p < 0,001 e p < 0,002), respectivamente. CONCLUSAO: Mulheres usuarias de alcool que desistiram do tratamento no primeiro mes quando comparadas as nao desistentes fizeram mais uso de fermentados ou a associacao deste com destilados, consumiram menos unidades de alcool por semana, usaram menos medicacoes coadjuvantes e procuraram menos tratamentos previos.

Incidência e fatores de risco para complicações infecciosas no primeiro ano após o transplante renal

INTRODUCAO: Complicacoes infecciosas determinam significativas morbidade e mortalidade apos o transplante renal. A imunossupressao utilizada representa o principal fator de risco e apresenta relacao direta com a incidencia e a severidade dos eventos infecciosos. METODOS: Estudo de coorte, retrospectivo, que analisou a incidencia e fatores de risco para ocorrencia de infeccoes em 1.676 receptores de transplante renal durante o primeiro ano de acompanhamento. RESULTADOS: Eventos infecciosos foram observados em 821 (49%) pacientes. O numero medio de episodios infecciosos entre pacientes com pelo menos um episodio foi de 2,3 (1 - 12). As complicacoes infecciosas mais prevalentes foram infeccao do trato urinario (31,3%), infeccoes por citomegalovirus (12%), infeccao da incisao cirurgica (10,3%), infeccao por herpes virus (9,1%), Infeccao pulmonar (5,2%) e infeccao da corrente sanguinea (4,3%). O tempo de isquemia fria e a utilizacao de rins de doadores falecidos foram fatores de risco importantes para a ocorrencia de episodios infecciosos. CONCLUSOES: infeccoes apresentam prevalencia elevada no primeiro ano de acompanhamento apos o transplante. A principal complicacao infecciosa foi a infeccao do trato urinario.

Lipodystrophy in HIV/AIDS patients with different levels of physical activity while on antiretroviral therapy

INTRODUCTION Lipodystrophy is related to the use of highly active antiretroviral therapy (HAART) and can cause aesthetic stigma and increase the risk of developing cardiovascular diseases. Physical activity may be a valid alternative for the treatment and prevention of lipodystrophy. However, few studies address this issue. The objective of this study was to assess lipodystrophy related to highly active antiretroviral therapy in HIV/AIDS patients with different physical activity habits. METHODS The sample was composed of 42 HIV/AIDS patients taking HAART medication who were visiting the Counseling and Testing Center (CTC) in Presidente Prudente. The level of physical activity was obtained using the International Physical Activity Questionnaire (IPAQ); lipodystrophy was diagnosed using a self-report questionnaire that was administered to the patient and then followed up by medical confirmation. The percentage of trunk fat was estimated by dual X-Ray absorptiometry (DEXA). Information about sex, age, length of HAART treatment, CD4+ T lymphocyte count (CD4) and viral load was also collected. RESULTS A higher prevalence of lipodystrophy was observed in the sedentary group when compared to the physically active group, which indicates that physical activity may be a protective factor in relation to the occurrence of lipodystrophy. The group that had a higher CD4 had a higher proportion of lipodystrophy and a higher proportion of younger and physically active individuals. The patients with lipodystrophy had a higher percentage of trunk fat and were more sedentary than active individuals. CONCLUSIONS A physically active lifestyle has a protective effect against the occurrence of lipodystrophy related to HAART.

Prevalence of vancomycin-resistant Enterococcus fecal colonization among kidney transplant patients

BackgroundEnd stage renal disease patients are at risk of Vancomycin-Resistant Enterococcus (VRE) infections. The first reports of VRE isolation were from hemodialysis patients. However, to date, VRE fecal colonization rates as well as associated risk factors in kidney transplant patients have not yet been established in prospective studies.MethodsWe collected one or two stool samples from 280 kidney transplant patients and analysed the prevalence of VRE and its associated risk factors. Patients were evaluated according to the post-transplant period: group 1, less than 30 days after transplantation (102 patients), group 2, one to 6 months after transplantation (73 patients) and group 3, more than 6 months after transplantation (105 patients).ResultsThe overall prevalence rate of fecal VRE colonization was 13.6% (38/280), respectively 13.7% for Group 1, 15.1% for group 2 and 12.4% for group 3. E. faecium and E. faecalis comprised 50% of all VRE isolates. No immunologic variables were clearly correlated with VRE colonization and no infections related to VRE colonization were reported.ConclusionFecal VRE colonization rates in kidney transplant patients were as high as those reported for other high-risk groups, such as critical care and hemodialysis patients. This high rate of VRE colonization observed in kidney transplant recipients may have clinical relevance in infectious complications.

Diagnósticos de enfermagem em portadores da Síndrome da Imunodeficiência Adquirida

Os objetivos deste estudo foram identificar os diagnosticos de enfermagem mais frequentes segundo a taxonomia II da NANDA em pacientes adultos portadores de HIV/aids e verificar com que frequencia as caracteristicas definidoras, os fatores relacionados e de risco deram suporte para a elaboracao destes. O levantamento dos dados foi realizado pelos pesquisadores nos 60 pacientes internados com HIV/aids e depois feita a verificacao se os requisitos propostos pela NANDA para realizacao dos DE eram adequados. Foram selecionados 13 dos 38 diagnosticos com frequencia igual ou superior a 80%. Os resultados indicaram concordância e adequacoes para identificacao. Porem, novos estudos serao necessarios tanto para confirmacao dos achados, assim como trazer novos conhecimentos ao assunto e estimular a pesquisa nesta populacao de pacientes.

Co-morbidade e mortalidade de pacientes em início de diálise

OBJECTIVES: to identify to the co-morbity and causes of mortality of the patients in beginning of dialysis and to analyze if the personal variables, the co-morbity, the laboratory results, the number of days of internment and number of dialysis sessions are factors of risk for mortality. METHODS: was included in this study 102 patients who had initiated dialysis treatment in a university hospital. The prospective record was realized to collect personals data, laboratory data, morbity and mortality. RESULTS: the arterial hypertension and the infection was more frequent causes of co-morbity (58,8%). The infection locality more frequent was the blood circulation in 30 (50%). CONCLUSION: the majority of the patients who had arrived at the service was in dialysis urgency; the morbity most prevalent was the arterial hypertension and the infection; the infection locality more frequent was the blood circulation related to the use of the central venous catheter; and that the male sex, the white race, the uremia, and the morbity arterial hypertension and infection, had been the ones that more contributed for the increase of the mortality risk.OBJETIVOS: identificar el co-morbidad y las causas de la mortalidad de los pacientes en el principio de la dialisis y analizar si resultan las variables personales, el co-morbidad, los dados laboratoriais, del numero de dias de la internacion y del numero de las sesiones de la dialisis son factores del riesgo para la mortalidad. METODOS: fueron incluido 102 pacientes en el estudio que habian iniciado el tratamiento de la dialisis en un hospital de la universidad. Fue realizado uno registro de los dados personales, laboratoriais, de la morbidad y de la mortalidad. RESULTADOS: la hipertension arterial y las infecciones eram las mas frecuente causas de la co-morbidad (58,8%). El local de la infeccion mas frecuente era la circulacion del sangre en 30 (50%). CONCLUSAO: la mayoria de los pacientes que habian llegado el servicio estaban en urgencia de la dialisis; el morbidad mas frecuente era el hipertension arterial y la infeccion; el local de la infeccion mas frecuente era la circulacion del sangre relacionada con el uso del cateter venoso central; y que el sexo masculino, la raza blanca, la uremia y las morbidad la hipertension arteriale y la infeccion, habian sido los ese contribuido mas para el aumento del riesgo de la mortalidad.

Perfil epidemiológico dos clientes com HIV/AIDS da unidade ambulatorial de hospital escola de grande porte: município de São Paulo

This study aimed to characterize the epidemiological profile of patients with HIV/AIDS at an outpatient service, to analyze the infection stage on the patients first return, lethality and program evasion. A descriptive and analytical epidemiological study was carried out during nursing appointments with 1837 clients. Most participants were men (1.71 men/1 woman), between 30 and 39 years old (46.8%); residents in São Paulo (86.5%); low education level (76.3%). Most women were living with partners (45.4%), whereas most men were single (53.3%). The main category of exposure was heterosexual behavior (83.5% among men and 71.2% among women). Both male and female participations discovered their HIV/AIDS positive condition in advanced stages (57%). Opportunistic infection levels were significantly higher (p < 0.05) among men. For men and women, the predominant opportunistic infection was tuberculosis (26.2%). CD4 < 350 results on the first return were significantly higher (p = 0.04) among women. Death risk was greater among women (OR = 1.72), whereas the risk of treatment evasion was greater among men (OR = 1.72).El objetivo del estudio fue caracterizar la poblacion con VIH/SIDA; analizar la fase de infeccion, la letalidad y desercion del programa. Metodo: estudio epidemiologico descriptivo analitico realizado durante las consultas de enfermeria con 1837 clientes. La relacion hombre-mujer era de 1,71/1. El grupo de edad predominante fue de 30 a 39 anos (46,8%). La mayoria de los participantes vivia en el Municipio de Sao Paulo (86,5%), con bajo grado de instruccion (76,3%). Las mujeres vivian con una pareja (45,4%) y los hombres eran solteros (53,3%). La categoria de exposicion predominante en la transmision del VIH fue la sexual con comportamiento heterosexual (el 83,5% entre los hombres y el 71,2% entra las mujeres). Ambos descubrieron ser portadores del VIH/SIDA en estadios avanzados (57%). Para ambos la infeccion oportunista predominante fue la tuberculosis (26,2%), CD4 < 350 en el primer reingreso fue significativamente mayor (p= 0,04) entre las mujeres. El riesgo de muerte fue mayor entre las mujeres (OR= 1,72).Os objetivos deste estudo foram: caracterizar o perfil epidemiologico dos clientes com HIV/AIDS de Ambulatorio de hospital/escola no Municipio de Sao Paulo de 1993 a 2001; analisar a fase da infeccao dos clientes que compareceram ao retorno; a letalidade e a evasao do atendimento. O metodo de estudo epidemiologico descritivo analitico, foi utilizado durante as consultas de enfermagem com 1837 clientes. Resultados: relacao homem/mulher 1,71/1; maiores concentracoes: faixa etaria 30 a 39 anos (46,8%), residentes no Municipio (86,5%), baixa escolaridade (76,3%). Entre as mulheres 45,4% viviam com companheiros; 53,3% dos homens eram solteiros. Categoria sexual com comportamento heterossexual foi predominante (83,5% dos homens e 71,2% das mulheres). Ambos (57%) descobriram ser portadores em estagios considerados avancados. A infeccao oportunista predominante foi a tuberculose (26,2%), CD4 < 350 foi significativamente maior (p = 0,04) entre as mulheres. O risco de obito foi maior nas mulheres (OR = 1,72), e para abandono foi maior nos homens (OR = 1,72).

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

O objetivo deste estudo foi avaliar a incidencia e os fatores de risco de infeccao da corrente sanguinea (ICS) em pacientes com cateter venoso central (CVC) duplo lumen, para hemodialise (HD) e identificar os micro-organismos isolados na corrente sanguinea. Como metodo, usou-se o follow up, realizado no periodo de um ano, incluindo todos os 156 pacientes que estavam em tratamento de HD por CVC duplo lumen, na Universidade Federal de Sao Paulo - UNIFESP. Os resultados mostraram que dos 156 pacientes estudados, 94 apresentaram ICS, desses, 39 tiveram culturas positivas no local de insercao do cateter. Dos 128 micro-organismos isolados da corrente sanguinea, 53 eram S.aureus, dos quais 30 eram sensiveis a metilcilina e 23 resistentes. Entre as complicacoes relacionadas a ICS, houve 35 casos de septicemia e 27 casos de endocardite, dos quais 15 progrediram a obito. A incidencia de ICS neste grupo de pacientes mostrou-se bastante elevada bem como sua progressao para quadros infecciosos de grande magnitude e obito.This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo-UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Taking care of children with cancer: evaluation of the caregivers' burden and quality of life

El cancer es una enfermedad de alta incidencia entre ninos, los que necesitan de un cuidador durante el tratamiento. Se tuvo por objetivo evaluar la sobrecarga de cuidado y la calidad de vida (CV) de los cuidadores de ninos/adolescentes portadores de cancer durante el tratamiento quimioterapico, y relacionarlas entre si y a los datos sociodemograficos, y a la presencia y grado de senales de depresion. Se trata de un estudio transversal, con 32 cuidadores. Fueron recolectados datos sociodemograficos, sobrecarga de cuidado (Caregiver Burden Scale) y de CV a traves del SF-36. El 87,5% de los cuidadores eran madres, la edad promedio fue 35 anos, el puntaje general de sobrecarga fue 1,92±0,09 y los puntajes del SF-36 mas comprometidos fueron: aspectos emocionales (59,3), vitalidad (60,0) y dolor (60,9). Se encontro correlacion significativa entre sobrecarga, salud mental y vitalidad. Concluimos que los cuidadores presentaron sobrecarga de cuidado y aspectos de CV comprometidos y posiblemente necesitan de intervenciones que promuevan el bienestar fisico, el social y el emocional, para disminuir la sobrecarga y mejorar la CV, y asi consecuentemente mejorar la asistencia.El cancer es una enfermedad de alta incidencia entre ninos, los que necesitan de un cuidador durante el tratamiento. Se tuvo por objetivo evaluar la sobrecarga de cuidado y la calidad de vida (CV) de los cuidadores de ninos/adolescentes portadores de cancer durante el tratamiento quimioterapico, y relacionarlas entre si y a los datos sociodemograficos, y a la presencia y grado de senales de depresion. Se trata de un estudio transversal, con 32 cuidadores. Fueron recolectados datos sociodemograficos, sobrecarga de cuidado (Caregiver Burden Scale) y de CV a traves del SF-36. El 87,5% de los cuidadores eran madres, la edad promedio fue 35 anos, el puntaje general de sobrecarga fue 1,92±0,09 y los puntajes del SF-36 mas comprometidos fueron: aspectos emocionales (59,3), vitalidad (60,0) y dolor (60,9). Se encontro correlacion significativa entre sobrecarga, salud mental y vitalidad. Concluimos que los cuidadores presentaron sobrecarga de cuidado y aspectos de CV comprometidos y posiblemente necesitan de intervenciones que promuevan el bienestar fisico, el social y el emocional, para disminuir la sobrecarga y mejorar la CV, y asi consecuentemente mejorar la asistencia.