Quem Cuida de Quem Cuida? Um estudo exploratório sobre o perfil dos cuidadores informais e o suporte online e offline

O cuidador informal é toda a pessoa, não remunerada economicamente, que assume a função de prestar cuidados a uma outra pessoa dependente ou com alguma incapacidade e que não esteja capaz de realizar determinada tarefa sem a ajuda de outra. O principal objetivo desta dissertação foi compreender que recursos online e offline mobilizam os cuidadores informais para consolidar o seu suporte social. Para obter essa informação foi desenvolvido um estudo exploratório que permitiu traçar o perfil dos cuidadores informais através da análise do tipo de suporte social (online e offline) que têm e do tipo de apoio que procuram, das alterações na sua vida a partir desta condição, do tipo de formação que possuem para cuidar de quem cuidam, da avaliação da sobrecarga física, emocional e social dos cuidadores informais com o auxílio do instrumento QASCI, e da identificação da importância das tecnologias na vida dos cuidadores informais. Após a análise dos dados verificou-se que os cuidadores informais são predominantemente do sexo feminino, casados ou a viverem em união de facto, com uma idade média de 48. Estes cuidadores prestam, em média, cuidados há cerca de 5 anos e durante 11 horas diárias. Recorrem ao suporte informal (família, amigos e vizinhos) através da Internet para lidarem com as emoções sentidas e ainda para procurarem apoio específico/técnico relacionado com a doença do cuidado. As mudanças mais sentidas no ambiente familiar são o sentimento de solidão, o stress e a sobrecarga e a falta de apoio familiar. Na relação com os amigos verificase um afastamento e falta de tempo para estarem juntos. Os resultados permitem ainda verificar que as pontuações médias de sobrecarga física, emocional e social dos cuidadores informais do nosso estudo, em comparação com outras investigações, são significativamente mais baixas, o que nos leva a concluir que estas diferenças se devem às competências mobilizadas pela nossa amostra na utilização da Internet. Os resultados mostram também que os inquiridos que afirmam ter maior suporte familiar são os que consideram que a Internet não combate a solidão, já os cuidadores informais que se sentem sozinhos sustentam que a Internet pode ajudar a combater a solidão. / The informal caregiver is any person, not economically paid, who assumes the task of providing care to another dependent or disabled person and who is not able to perform one task without the help of another. The main objective of this dissertation was to understand what online and offline resources mobilize informal caregivers to consolidate their social support. In order to obtain this information, an exploratory study was developed that allowed the profile of informal caregivers to be traced through the analysis of the type of social support (online and offline) they have and the type of support they seek, changes in their life from this condition, the type of training they have to provide care, evaluation of physical, emotional and social burden on informal caregivers with the assistance of QASCI instrument, and the identification of the importance of technology in the lives of informal caregivers. After analysing the data, it was found that informal caregivers are predominantly female, married or living in union of fact, with a mean age of 48. These caregivers provided on average care for about 5 years and during 11 hours daily. They use informal support (family, friends and neighbours) over the Internet to deal with the emotions felt and still to seek specific / technical support related to the illness of the person whom they care. The most significant changes in the family environment are the feeling of loneliness, stress and burden and lack of family support. In the relationship with the friends there is a separation and lack of time to be together. The results allow us to verify that the average physical, emotional and social burden of the informal caregivers of our study, in comparison with other studies, are significantly lower, which leads us to conclude that these differences are due to the competences mobilized by our sample in the use of the Internet. The results also show that respondents who claim to have greater family support are those who consider that the Internet does not combat loneliness, while informal caretakers who feel alone hold that the Internet can help to combat loneliness

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)