A sobrecarga do familiar cuidador no âmbito domiciliar: uma revisão integrativa da literatura La sobrecarga del familiar cuidador en el entorno domiciliario: una revisión de la literatura Overload of family caregiver at home: an integrative literature review

Trata-se de uma revisão integrativa de literatura que teve como objetivo identificar as evidências acerca dos fatores geradores de sobrecarga e suas consequências para os familiares cuidadores de adultos ou idosos. A revisão abrangeu 27 estudos em base de dados, com as palavras-chave cuidadores, família e sobrecarga, no período de 1999 a 2009. Foram desveladas quatro categorias: a imposição de ser o cuidador, o cuidar solitário, a dependência do ser cuidado e o desgaste biopsicossocial do cuidador. Os resultados demonstram que a imposição do papel de cuidador, a falta de apoio dos outros familiares, o grau de dependência do enfermo relacionada à patologia, e o desgaste físico e psicológico são os principais fatores geradores de sobrecarga dos familiares cuidadores. Verifica-se a necessidade de maior suporte dos profissionais de saúde no sentido de apoiar e estar disponível aos familiares cuidadores nas intercorrências das atividades cuidativas no domicílio.<br>Se trata de una revisión integradora de la literatura dirigida a identificar la evidencia de los factores que causan sobrecarga y sus consecuencias para los familiares cuidadores de adultos o ancianos. La revisión abarcó 27 estudios en base de datos con los descriptores cuidadores, familia y sobrecarga, de 1999 a 2009. Cuatro categorías se desvelaron: la imposición de ser el cuidador, el cuidado solitario, la dependencia del ser cuidado y el desgaste biopsicosocial del cuidador. Los resultados muestran que la imposición del rol de cuidador, la falta de apoyo de otros familiares, el grado de dependencia del enfermo relacionado con la patología y el desgaste físico y psicológico son los principales factores generadores de sobrecarga de familiares cuidadores. Se constata la necesidad de mayor soporte de profesionales de la salud para apoyar y estar a disposición de los familiares cuidadores en las complicaciones de las actividades cuidadoras en hogar.<br>This is an integrative literature review that aims to identify evidences on the factors causing overload and their consequences for family caregivers of adults or the elderly. The review covered 27 studies at databases, using the keywords caregivers, family, and overload, in the period from 1999 to 2009. Four categories came up: the imposition of being a caregiver, taking care alone, the dependence of the person that receives care, and the bio-psychosocial weariness of the caregiver. The results showed that the imposition of the role of caregiver, lack of support from other family members, level of dependency of the patient related to the pathology, and physical and psychological weariness are the main factors causing overload in family caregivers. The need for more support and availability by health professionals to family caregivers in their home activities is evident

Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007

Background: Chagas' disease is an important neglected public health problem in many Latin American countries, but population-based epidemiological data are scarce. Here we present a nationwide analysis on Chagas-associated mortality, and risk factors for death from this disease.\ud \ud Methodology/Principal Findings: We analyzed all death certificates of individuals who died between 1999 and 2007 in Brazil, based on the nationwide Mortality Information System (a total of 243 data sets with about 9 million entries). Chagas' disease was mentioned in 53,930 (0.6%) of death certificates, with 44,537 (82.6%) as an underlying cause and 9,387 (17.4%) as an associated cause of death. Acute Chagas' disease was responsible for 2.8% of deaths. The mean standardized mortality rate was 3.36/100.000 inhabitants/year. Nationwide standardized mortality rates reduced gradually, from 3.78 (1999) to 2.78 (2007) deaths/year per 100,000 inhabitants (-26.4%). Standardized mortality rates were highest in the Central-West region, ranging from 15.23 in 1999 to 9.46 in 2007 (-37.9%), with a significant negative linear trend (p = 0.001; R-2 = 82%). Proportional mortality considering multiple causes of death was 0.60%. The Central-West showed highest proportional mortality among regions (2.17%), with a significant linear negative trend, from 2.28% to 1.90% (-19.5%; p = 0.001; R-2 = 84%). There was a significant increase in the Northeast of 38.5% (p = 0.006; R-2 = 82%). Bivariable analysis on risk factors for death from Chagas' disease showed highest relative risks (RR) in older age groups (RR: 10.03; 95% CI: 9.40-10.70; p<0.001) and those residing in the Central-West region (RR: 15.01; 95% CI: 3.90-16.22; p<0.001). In logistic regression analysis, age >= 30 years (adjusted OR: 10.81; 95% CI: 10.03-10.65; p<0.001) and residence in one of the three high risk states Minas Gerais, Goias or the Federal District (adjusted OR: 5.12; 95% CI: 5.03-5.22, p<0.001) maintained important independent risk factors for death by Chagas' disease.\ud \ud Conclusions/Significance: This is the first nationwide population-based study on Chagas mortality in Brazil, considering multiple causes of death. Despite the decline of mortality associated with Chagas' disease in Brazil, the disease remains a serious public health problem with marked regional differences