Necessidades dos familiares de doentes terminais em cuidados paliativos: Revisão crítica da literatura

Terminal illness and death are critical events that interfere in the family system. The knowledge about illness and death’s impact on the family is, still, scarce. Therefore, a critical review of literature was conducted with the general goal of determining the impact of terminal illness on the family and which are the family’s support needs. The findings suggest that terminal illness is one of the most difficult experiences for the family system and an inadequate or non-existent approach to the family’s problems can put that system in risk. Therefore, palliative care aims at the integration of the family in the care plan. However, the empirical production about this topic is insufficient, which compromises the development of new efficient family approaches that are sensitive to family needs. By this way, it is important to have more research that aims to determine the family needs of terminally ill patients and develop new family intervention strategies.A doença terminal e a morte são acontecimentos críticos que interferem no sistema familiar. Considerando a escassez de literatura sobre o assunto, procedeu-se a uma revisão crítica da literatura, com o objetivo geral de determinar o impacto que a doença terminal tem na família e quais as suas necessidades de suporte. Concluiu-se que a doença terminal constitui uma das experiências mais difíceis para o sistema familiar e que uma abordagem formal inadequada dos problemas emergentes o pode colocar em risco. Por isto, os cuidados paliativos visam a integração da família no plano de cuidados. Todavia, verificou-se que a produção empírica neste âmbito é insuficiente, comprometendo o desenvolvimento de modalidades de intervenção eficazes e sensíveis às necessidades que emergem na família. Urge desenvolver mais estudos que visem determinar as necessidades das famílias do doente terminal e desenvolver estratégias de intervenção dirigidas a essas mesmas famílias

Cuidados paliativos oncológicos em contexto de internamento e domiciliário: Necessidades, morbilidade psicológica e luto antecipatório nos familiares do doente terminal e impacto na qualidade de vida familiar

Terminal cancer has a profound impact on family and its’ elements. Therefore, palliative care foresees a family support. However, there are not many studies that aim to determine the family needs within palliative care. The present study aims to determine family needs, psychological morbidity and anticipatory grief of terminal patients’ relatives, distinguishing two care contexts (hospice and home care), and examine the influence of unmet needs, anticipatory grief, psychological morbidity and care setting on the perceived family quality of life. For such, an exploratory study was conducted with a sample of 40 terminal cancer patients’ relatives in palliative care. It was found that psychosocial needs are lesser satisfied in home-based palliative care. Regardless the context of care, patients’ relatives report clinically significant levels of psychological morbidity and anticipatory grief with impact on family perceived quality of life. Unmet needs, psychological morbidity and anticipatory grief seem to influence on the perceived family quality of life. This study demonstrates the importance of attending patients’ relatives in palliative care, in a holistic and multidisciplinary approach.A doença oncológica na fase terminal tem um importante impacto na família e seus elementos. Por este motivo, os cuidados paliativos pressupõem o suporte à família. No entanto, são escassos os estudos que visam determinar as necessidades das famílias em cuidados paliativos. O presente estudo teve como objetivos determinar quais as necessidades dos familiares dos doentes terminais, a presença de morbilidade psicológica e experiência de luto antecipatório, distinguindo dois contextos de prestação de cuidados (internamento e domicílio), e examinar a influência de uma satisfação inadequada das necessidades, luto antecipatório e contexto de prestação de cuidados na perceção de qualidade de vida familiar. Para tal, procedeu-se a um estudo exploratório junto de uma amostra de 40 familiares de doentes oncológicos terminais em cuidados paliativos. Verificou-se que as necessidades de suporte psicossocial são menos satisfeitas em contexto de cuidados domiciliários. Independentemente do contexto de prestação de cuidados, os familiares apresentam níveis clinicamente significativos de morbilidade psicológica e luto antecipatório com impacto na perceção da qualidade de vida familiar. A satisfação inadequada das necessidades, a presença de morbilidade psicológica e a experiência de luto antecipatório influenciam a perceção de qualidade de vida familiar. Este estudo vem demonstrar a importância de atender às necessidades dos familiares em cuidados paliativos, numa perspetiva holística e multidisciplinar

Advanced Maternal Age: Adverse Outcomes of Pregnancy, A Meta-Analysis

Introduction: The risks of pregnancy in women of advanced maternal age are not consensual amongst studies. The aim of this metaanalysis  was to determine whether women of advanced maternal age (≥ 35 years old) had worse obstetrical and perinatal outcomes than non- advanced maternal age women (20 - 34 years old) in singleton, naturally-conceived pregnancies. Material and Methods: We searched PubMed/ MEDLINE, IndexRMP and the Cochrane Database of Systematic Reviews. Ten studies were included according to the following criteria: population of > 1000 nulliparous and/or multiparous women with singleton gestations who did not undergo any type of infertility treatment. Using Review Manager v. 5.3, two meta-analysis were performed: one comparing the outcomes of 20 - 34-year-old vs 35 - 40-year-old women, and another comparing the outcomes of 35 - 40-year-old women vs > 40-year-old women. Results: Women aged 35 - 40 years old were more likely to have > 12 years of education than 20 - 34 years old and > 40 years old women. Advanced maternal age women (35 - 40 and > 40 years old) were more likely to be overweight and having gestational diabetes and gestational hypertension. They were also more likely to undergo induced labour and elective caesarean deliveries. Furthermore, they had worse perinatal outcomes such as preterm delivery, low birthweight babies, higher rates of Neonatal Intensive Care Unit admission and worse Apgar scores. Advanced maternal age women had higher rates of perinatal mortality and stillbirth. Discussion: Most authors present similar results to our study. Although the majority of adverse outcomes can be explained through the physio-pathological changes regarding the female reproductive apparatus that come with aging and its inherent comorbidities, according to the existing literature advanced maternal age can be an independent risk factor per se. In older pregnant women without comorbidities such as gestational hypertension or diabetes there are still worse obstetric and perinatal outcomes, which indicate that advanced maternal age is an independent strong risk factor alone. Conclusion: Advanced maternal age women are at a higher risk of adverse obstetrical and perinatal outcomes. In both comparisons, worse outcomes were more prevalent in the older group, suggesting that poorer outcomes are more prevalent with increasing age

Influencia del índice de masa corporal en el equilibrio y la configuración plantar en obesos adultos

INTRODUCTION:Obesity is a multifactor chronic degenerative disease that can lead to changes in the musculoskeletal system, such as changing the center of gravity and mechanical loads on the lower limbs.OBJECTIVES:To correlate the body mass index (BMI) with the body balance and verify the association between BMI and foot conformation.METHODS:Thirty obese men and women were evaluated, with BMI greater or equal 30 kg/m². Initially, the volunteers underwent assessments of anthropometric measurements to calculate BMI value. Then the individuals were tested for static body balance by Balance Error Scoring System (BESS) and plantigraphy for identification of footprints. Through the Viladot method, the volunteers were classified into groups: flat foot (GPP/FFG), cavus foot (GPC/CFG) and neutral foot (NFG). The correlation between the variables BESS and BMI was calculated using the Pearson's linear coefficient analysis and association between BMI, and the plantar conformation was performed by analysis of variance (ANOVA). For all analyzes, the level of significance was p<0.05.RESULTS:The values of the correlation between BMI and BESS were r=-0.1, p=0.59. The values of the association between BMI; GPN/NFG-GPP/FFG; GPN/NFG-GPC/CFG; GPP/FFG-GPC/CFG were respectively: p=0.76, p=0.001, p= 0.07.CONCLUSION:The body mass index of obese adults does not influence the body balance, but influences the plantar conformation.INTRODUCCIÓN:La obesidad es una enfermedad crónica degenerativa multifactorial que puede llevar a alteraciones del sistema musculoesquelético, como cambio del centro de gravedad y sobrecarga mecánica cuanto a los miembros inferiores.OBJETIVOS:Correlacionar el índice de masa corporal (IMC) con el equilibrio corporal y verificar el vínculo entre el IMC y la configuración plantar.MÉTODOS:Se evaluaron 30 obesos, de ambos sexos, con IMC mayor o igual a 30 Kg/m². Inicialmente, los voluntarios fueron sometidos a las evaluaciones de medidas antropométricas a fin de calcular el valor del IMC. A continuación, fueron sometidos a la prueba de equilibrio corporal estático Balance Error Scoring System (BESS) y a plantigrafía para la identificación de la impresión plantar. Por medio del método de Viladot, los voluntarios fueron clasificados en grupos: pie plano (GPP), pie cavo (GPC) y pie neutro (GPN). La correlación entre las variables IMC y BESS fue calculada mediante el coeficiente de correlación linear de Pearson y el vínculo entre el IMC y la configuración plantar fue identificado por medio del análisis de variancia (ANOVA). Para todos los análisis, el nivel de significancia que se consideró fue p < 0,05.RESULTADOS:Los valores de correlación entre el IMC y el BESS fueron r = - 0,1 y p = 0,59. Los valores del vínculo del IMC entre GPN-GPP, GPN-GPC, GPP-GPC fueron, respectivamente: p = 0,76; p = 0,001; p = 0,07.CONCLUSIÓN:El índice de masa corporal de adultos obesos no influencia en el equilibrio corporal, no obstante, influye en la configuración plantar.INTRODUÇÃO:A obesidade é uma doença crônica degenerativa multifatorial que pode levar a alterações do sistema musculoesquelético, como mudança do centro de gravidade e sobrecarga mecânica sobre os membros inferiores.OBJETIVOS:Correlacionar o índice de massa corporal (IMC) com o equilíbrio corporal e verificar associação entre o IMC e a configuração plantar.MÉTODOS:Foram avaliados 30 obesos, de ambos os gêneros, com IMC maior ou igual a 30 Kg/m². Inicialmente, os voluntários foram submetidos às avaliações de medidas antropométricas a fim de calcular o valor do IMC. Em seguida, foram submetidos ao teste de equilíbrio corporal estático Balance Error Scoring System (BESS) e a plantigrafia para a identificação da impressão plantar. Por meio do método de Viladot, os voluntários foram classificados em grupos: pé plano (GPP), pé cavo (GPC) e pé neutro (GPN). A correlação entre as variáveis IMC e BESS foi calculada por meio do coeficiente de correlação linear de Pearson e associação entre o IMC e a configuração plantar foi realizada por meio da análise de variância (Anova). Para todas as análises, nível de significância considerado foi p < 0,05.RESULTADOS:Os valores da correlação entre o IMC e o BESS foram r = - 0,1 e p = 0,59. Os valores da associação do IMC entre GPN - GPP; GPN - GPC; GPP - GPC foram respectivamente: p = 0,76; p = 0,001; p = 0,07.CONCLUSÃO:O índice de massa corporal de adultos obesos não influencia o equilíbrio corporal, porém influencia na configuração plantar.Universidade Federal de São Paulo (UNIFESP) Departamento de BiocienciasUNIFESP, Depto. de BiocienciasSciEL

Membrane progesterone receptors in human regulatory T cells: a reality in pregnancy

Objective - To provide evidence of the existence of membrane progesterone receptor alpha (mPRa) on regulatory T cells (Treg) in peripheral blood during pregnancy, postulating a possible explanation for the effect of progesterone on preterm birth. Design Cross-sectional study. Setting - Tertiary Obstetric Department in a University Hospital. Population - Healthy pregnant women. Methods - Treg cells from peripheral blood samples were studied by flow cytometry using multiple monoclonal antibody expression. Main outcome measures - Evaluate the number and percentage of CD4+CD25highCD127low, the number and percentage of Treg cells among the total CD4+ T cells, and the percentage and mean fluorescence intensity (MFI) of mPRa in that population, using several gating strategies. Results - 43 peripheral blood samples were collected from healthy women during pregnancy, whose median gestational age was 28.7 7.1 (16–40) weeks. The percentage of CD4+ in the total lymphocytes was 43% (32–51) and the percentage of CD4+CD25highCD127low was 4.8% (1.6–5.9), with only 45% (16–72) of those cells expressing the intracellular marker FoxP3 (Treg cell pool). We confirmed the existence of mPRa in that specific population because 8.0% (2.02–33) of the Treg cells were marked with the specific monoclonal antibody, with an mPRa+ MFI of 719 (590–1471). Conclusions - This research shows that Treg cells express mPRa during pregnancy, which might play an important role in immune modulation by progesterone

Living with, managing and minimising treatment burden in long term conditions: a systematic review of qualitative research.

BACKGROUND: 'Treatment burden', defined as both the workload and impact of treatment regimens on function and well-being, has been associated with poor adherence and unfavourable outcomes. Previous research focused on treatment workload but our understanding of treatment impact is limited. This research aimed to systematically review qualitative research to identify: 1) what are the treatment generated disruptions experienced by patients across all chronic conditions and treatments? 2) what strategies do patients employ to minimise these treatment generated disruptions? METHODS AND FINDINGS: The search strategy centred on: treatment burden and qualitative methods. Medline, CINAHL, Embase, and PsychINFO were searched electronically from inception to Dec 2013. No language limitations were set. Teams of two reviewers independently conducted paper screening, data extraction, and data analysis. Data were analysed using framework synthesis informed by Cumulative Complexity Model. Eleven papers reporting data from 294 patients, across a range of conditions, age groups and nationalities were included. Treatment burdens were experienced as a series of disruptions: biographical disruptions involved loss of freedom and independence, restriction of meaningful activities, negative emotions and stigma; relational disruptions included strained family and social relationships and feeling isolated; and, biological disruptions involved physical side-effects. Patients employed "adaptive treatment work" and "rationalised non-adherence" to minimise treatment disruptions. Rationalised non-adherence was sanctioned by health professionals at end of life; at other times it was a "secret-act" which generated feelings of guilt and impacted on family and clinical relationships. CONCLUSIONS: Treatments generate negative emotions and physical side effects, strain relationships and affect identity. Patients minimise these disruptions through additional adaptive work and/or by non-adherence. This affects physical outcomes and care relationships. There is a need for clinicians to engage with patients in honest conversations about treatment disruptions and the 'adhere-ability' of recommended regimens. Patient-centred practice requires management plans which optimise outcomes and minimise disruptions