Quality of life, burden, social support, marital adjustment and psychological morbidity in caregivers of elders with functional dependence

Mudanças recentes ao nível dos serviços de saúde resultaram em internamentos mais curtos nos hospitais e na procura de substitutos para cuidar dos doentes, levando a que as famílias assumissem frequentemente esses cuidados. Os familiares que se tornam cuidadores têm que lidar com várias mudanças nas suas vidas, especialmente quando o familiar de quem cuidam se encontra dependente. Este estudo focou-se nas implicações do cuidar ao nível da sobrecarga, atividadades de vida diária, qualidade de vida, satisfação com o suporte social, ajustamento da díada, depressão e ansiedade. Participaram neste estudo 109 cuidadores informais de idosos funcionalmente dependentes. Os instrumentos usados foram: Índice de Barthel; Escala de Sobrecarga do Cuidador; WHOQOL-BREF; Escala da Satisfação com o Suporte Social; Escala de Ajustamento Conjugal Revista; Inventário de Beck para a Depressão e o Inventário de Avaliação da Ansiedade Estado e Traço. Os resultados revelaram que a qualidade de vida estava negativamente relacionada com a sobrecarga e morbidade e positivamente com a satisfação com os amigos. A sobrecarga e qualidade de vida correlacionaram-se com o suporte social total. O ajustamento conjugal moderou a relação entre depressão e qualidade de vida (dimensões física e psicológica), mas não entre sobrecarga e qualidade de vida. Os cuidadores cônjuges apresentam menor qualidade de vida e os cuidadores filhos, mais morbidade psicológica. Verificou-se também que cuidadores que possuem apoio ao nível da prestação de cuidados apresentam maior satisfação conjugal. Os resultados enfatizam a importância de intervir junto desta população no sentido de aumentar a qualidade de vida dos cuidadores.Changes in medical practice resulted in shorter hospitalization and in the search for substitute caregivers leading families to assume care. Family members who become caregivers need to deal with changes in their lives on several levels, particularly when caregiving falls upon a dependent family member. This study focused on the implications of caregiving on burden, life activities, quality of life, satisfaction with social support, dyadic adjustment, depression and anxiety. 109 informal caregivers of functionally dependent elders participated in the study. The instruments used were: Barthel Index, Zarit Burden Interview, WHOQOL-BREF, Satisfaction with Social Support Scale, Revised Dyadic Adjustment Scale, Beck Depression Inventory and State Trait Anxiety Inventory. The results revealed that quality of life was inversely related with burden and psychological morbidity and positively with satisfaction with friends. Burden and quality of life were correlated with social support. In turn, marital adjustment was found to be a moderator in the relationship between depression and quality of life (physical and psychological dimensions) but not between burden and quality of life. Caregivers that were partners of those they cared for showed lower quality of life and adult children caregivers revealed more psychological morbidity. Caregivers who received support in caregiving tasks showed more marital satisfaction. Results emphasize the importance of intervention with this population particularly regarding psychological morbidity and burden, in order to increase caregivers’ quality of life.Los recientes cambios a nivel de los servicios de salud dieron lugar a hospitalizaciones más cortas y a la búsqueda de sustitutos para el cuidado de los pacientes, haciendo con que las familias asumieran frecuentemente esos cuidados. Miembros de la familia que se convierten en cuidadores tienen que lidiar con varios cambios en sus vidas, especialmente, cuando el familiar depende de su atención. Este estudio se centró en las implicaciones de la tensión a nivel de sobrecarga, actividades de la vida diaria, la calidad de vida, satisfacción con el apoyo social, depresión y ansiedad. En este estudio participaron 109 cuidadores informales de ancianos con dependencia funcional. Los instrumentos utilizados fueron el Índice de Barthel, la Escala de sobrecarga del cuidador, WHOQOL-BREF, Escala de Satisfacción con el Apoyo Social, la Escala de Ajuste Marital Revisado, Inventario de Depresión de Beck y la evaluación del Estado y Rasgo de ansiedad. Los resultados revelaron que la calidad de vida estaba relacionada negativamente con la sobrecarga y morbilidad, y positivamente con la satisfacción con los amigos. La sobrecarga y la calidad de vida se correlacionaron con el apoyo social total. El ajuste marital moderó la relación entre la depresión y la calidad de vida (las dimensiones físicas y psicológicas), pero no entre la sobrecarga y la calidad de vida. Los cónyuges cuidadores tienen menor calidad de vida y los cuidadores hijos más morbilidad psicológica. También se constató que los cuidadores que tienen soporte a nivel de la prestación de cuidados tienen una mayor satisfacción conyugal. Los resultados enfatizan la importancia de intervenir en esta población para aumentar la calidad de vida de los cuidadores

Chimpanzee included in the genus Homo? How Biology teachers from three Latin American countries conceive it

This work intended to understand the biology teachers’ conceptions about the humans’ position regarding other animal species. It was carried out in three countries with contrasting secularism conditions: Argentina, Brazil and Uruguay. Teachers were asked to answer, in a Likert-type scale, to the question B7 of the European project BIOHEAD-CITIZEN: “The Chimpanzee should be included in the genus Homo, notably because 98.5% of its DNA is identical to that of Homo sapiens”.. Results were analyzed within the KVP model framework and the Barbour’s four categories of relationship between science knowledge and religion. The majority of teachers surveyed in the three countries rejected the idea of including the chimpanzee in the genus Homo, suggesting the conception of human beings having a special position in relation to other animal species, despite evidence of current molecular biology. The religiosity in all countries were similar, therefore no specific influence could be tested regarding the inclusion of chimpanzee in genus Homo. This study also indicates that it is important to study further the training of biology teachers in the three countries to verify how they are being trained and evaluate their knowledge regarding molecular biology, phylogeny and evolution.CIEC - Centro de Investigação em Estudos da Criança, IE, UMinho (UI 317 da FCT)Projeto Estratégico da FCT: UID/CED/00317/201

Quality of life: Non-amputee patients with diabetic foot ulcer versus amputee patients

A úlcera do Pé Diabético acarreta várias consequências para o indivíduo, família e sistema de saúde. O objetivo deste estudo é caracterizar a QdVRS de uma amostra de doentes com Pé Diabético e perceber se existem diferenças ao nível da QdVRS física (QVF) e QdVRS Mental (QVM) quando comparados com doentes com Pé Diabético já amputados. Estudo transversal que incluiu 175 doentes com úlcera de Pé Diabético. Destes, 102 doentes já tinham sido amputados e os restantes 73 iriam ser submetidos a uma amputação, pela primeira vez. Os doentes foram avaliados durante a hospitalização usando um questionário sociodemográfico e clínico bem como o SF-36. Os doentes apresentaram níveis baixos de QVF e moderados de QVM. Verificaram-se diferenças na QdVRS nos doentes com úlcera de Pé Diabético não amputados versus os doentes com úlcera de Pé Diabético já amputados, ao nível do género, idade, estatuto profissional e tipo de pé. Não se verificaram diferenças ao nível da QVF e QVM entre os doentes amputados e não amputados, mas os doentes com úlcera de Pé Diabético não amputados apresentaram melhor saúde geral quando comparados com os doentes já amputados. O nível da amputação revelou-se importante ao nível da saúde mental. Este trabalho enfatiza a necessidade de intervenções multidisciplinares para promover a QdVRS, nos doentes com ulceras de Pé Diabético não amputados e nos já amputados. Assim, o acompanhamento psicológico revela-se fundamental, nesta população.A Diabetic Foot Ulcer (DFU) has several implications for individual, family and the health system. The aim of this study was to characterize the Health Related Quality of Life (HRQoL), in a sample of patients with DFU and to find differences in physical (PHRQoL) and mental quality of life (MHRQoL) when compared with patients already amputated. Cross sectional study including 175 patients with Diabetic Foot Ulcer. Of these, 102 were already amputated and 73 were going to be amputated for the first time. Patients were assessed during hospitalization using a socio demographic and clinical questionnaire as well as the SF-36. Patients showed low levels of PHRQoL and moderate levels of MHRQoL. There were differences in HRQoL in non-amputee patients with DFU versus patients with DFU already amputated, according to gender, professional status, age and type of foot. There were no differences in non-amputee and amputees patients on PHRQoL and MHRQoL but nonamputee patients with DFU showed better general health compared with patients already amputated. The level of amputation proved to be important for mental health. This study emphasizes the need for multidisciplinary interventions to promote HRQoL in non-amputee patients with DFU and those already amputated. Thus, psychological support seems essential, in this populatio

Effectiveness of two stress reduction interventions in patients with chronic diabetic foot ulcers (PSY-DFU): protocol for a longitudinal RCT with a nested qualitative study involving family caregivers

Diabetic foot ulcer (DFU) is the leading cause of lower-limb amputations, with a significant impact on patients, families, and society. Since DFU medical treatments represent a major socioeconomic burden, cost-effective interventions are needed. This trial aims to assess the effectiveness of a muscle relaxation intervention compared to a hypnosis intervention versus active and passive control groups on DFU healing, physiological indicators of healing prognosis, and quality of life (QoL) in clinically distressed patients with a chronic DFU. A multicenter, randomized controlled trial with three assessment moments (baseline, two months post-intervention, and four months follow-up) will be conducted. Approximately 170 patients will be randomized and allocated to either treatment or control groups. Primary outcomes will be DFU healing, physiological indicators of healing prognosis, and QoL. Secondary outcomes will include perceived stress, psychological morbidity, and DFU representations. The efficacy of sessions on DFU healing will be qualitatively assessed in 12 patients allocated to the treatment and active control groups, as well as their family caregivers. This study will provide evidence regarding the effectiveness of two psychological interventions for the DFU healing process and the QoL of patients, with direct clinical relevance regarding DFU treatment and recurrenceThis study was conducted at the Psychology Research Centre (CIPsi/UM) School of Psychology, the University of Minho, supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget UIDB/01662/2020, UIDB/04539/2020, UIDP/04539/2020 and LA/P/0058/2020, and an FCT grant (PTDC/PSI-GER/28163/2017) assigned to the first and last authors

A predictive model of anxiety and depression symptoms after a lower limb amputation

Patients with Diabetic Foot Ulcer (DFU) show high levels of depression and anxiety symptoms. The loss of a limb is undoubtedly a devastating experience and several studies have shown that anxiety and depression symptoms are a common reaction after a lower limb amputation (LLA). However, no study has focused on the immediate emotional reactions to LLA as a personal factor based on the ICF Model. Objective: This study focused on the characterization of anxiety and depression levels, before and after surgery, differences in levels of depression and anxiety before and after surgery and the predictors of anxiety and depression one month after surgery, in a sample of patients with DFU. Methods: This was a longitudinal study with 179 patients with Diabetes Mellitus Type 2 and DFU indicated for amputation, screened for the presence of anxiety and depression symptoms during the hospitalization that preceded amputation and one month after surgery, during a follow-up consultation. Results: The results showed a significant effect of anxiety and depression symptoms at pre-surgery in the prediction of anxiety and depression symptoms one month after LLA. Patients showed higher levels of anxiety than depression symptoms at pre-surgery, although anxiety significantly decreased on month after surgery. Both anxiety and depression symptoms contributed to depression after LLA, although anxiety at pre-surgery was the only predictor of anxiety at post-surgery. Conclusions: Tailored multidisciplinary interventions need to be developed providing support before and after an amputation surgery, in order to reduce anxiety and depression symptoms and promote psychological adjustment to limb loss.POCI-01-0145-FEDER-007653. Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technolog

Dyadic adjustment in HPV-infected women one year after diagnosis

Objective: This study examined the contribution of age, type of human papillomavirus (HPV), attachment, sexual satisfaction, and spirituality in dyadic adjustment in women with HPV from diagnosis to one year later. Method: This is a longitudinal study with three assessment moments: (T1) at the diagnosis appointment, (T2) six months after, and (T3) 12 months after the diagnosis. Participants answered a sociodemographic questionnaire as well as several other measures: HPV Knowledge Questionnaire (HPVQ), Papanicolaou Exam Knowledge Questionnaire (PEK-Q), Hospital Anxiety and Depression Scale (HADS), Courtauld Emotional Control Scale (CECS), Index of Sexual Satisfaction (ISS), Experiences in Close Relationship Scale-Short Form (ECR-S), Spiritual and Religious Attitudes in Dealing With Illness (SpREUK), and the Revised Dyadic Adjustment Scale (RDAS). Results: Age showed a positive impact on sexual dissatisfaction at T2. Sexual dissatisfaction at T1 predicted sexual dissatisfaction at T2 and dyadic adjustment at T3. Spirituality and insecure attachment at T1 negatively predicted insecure attachment at T2, and the latter predicted dyadic adjustment at T3. Conclusions: The results corroborate the need to assess the dyad when women are diagnosed with HPV. Only then it will be possible to design differentiated intervention programs that take into consideration women's age, attachment style, and sexual satisfaction. Interventions should also include women's partners to promote dyadic adjustment in this population

Predictors of quality of life in patients with diabetic foot ulcer: The role of anxiety, depression, and functionality

The goal of this study was to analyze the relationships between anxiety, depression symptoms, and functionality as predictors of quality of life, in patients with diabetic foot ulcer taking in consideration clinical variables. A sample of 202 participants indicated for a lower limb amputation surgery, were assessed before the surgery, on physical and mental quality of life, functionality, a anxiety and depression symptoms. Anxiety and depression symptoms, as well as functionality level were predictors of mental quality of life. Pain, having a first amputation, depression symptoms, and functionality were predictors of physical quality of life. In order to promote quality of life, psychological variables should be targeted, in clinical practice.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology

GDNF modulates HO-1 expression in substantia nigra postnatal cell cultures

Heme oxygenase-1 (HO-1) has been strongly highlighted because of its induction in many cell types by toxic stimuli, including oxidative stress. The intense HO-1 immunostaining in the substantia nigra of Parkinson disease (PD) patients suggests its involvement in the pathogenesis of this neurodegenerative disease. In this work we investigated HO-1 expression in rat substantia nigra postnatal cell cultures under conditions mimicking dopamine toxicity and its modulation by glial cell line-derived neurotrophic factor (GDNF), a potent neuroprotective factor for dopaminergic neurons. In neuron-glia cultures, we found that H2O2, a product of dopamine metabolism, or l-3,4-dihydroxyphenylalanine (l-DOPA), the dopamine precursor used in the therapy of PD, induced a fast up-regulation of HO-1 mRNA and protein levels, followed by a secondary down-regulation. H2O2 and l-DOPA also increased HO-1 expression in astrocyte cultures, but with a delayed time course in H2O2-treated cultures. HO-1 expression was decreased in neuron-glia cultures under conditions under which GDNF up-regulation was observed. Because exogenously applied GDNF prevented HO-1 up-regulation in cultures treated with H2O2 or l-DOPA, and antibody neutralization of GDNF prevented the secondary HO-1 down-regulation observed in neuron-glia cultures, we propose that GDNF negatively modulates HO-1 expression induced by oxidative stress. To our knowledge, this is the first report showing the modulation of HO-1 expression by GDNF.http://www.sciencedirect.com/science/article/B6T38-4GY83GS-1/1/db5c1961511769a30a115fcbfcd902c

Cost and efficiency analysis of commercial softeners in the sewability behavior of cotton fabrics

This paper reports a comparative case study on the use of different softening products for bed linen fabrics, specifically regarding the sewability of the fabrics. The market offers a wide variety of commercial formulations of softeners for this purpose, but the composition and price varies considerably. This work was aimed to assess the relationship between the cost and effectiveness of different softener formulations in home textiles finishing. Objectively, the effect of different softeners and their concentrations on sewability of the fabrics was studied. Non-ionic polyethylene dispersions and a cationic silicone softener micro-emulsion in different concentrations and combinations were considered in this investigation. It was found that a combination of silicone and polyethylene based softeners presents the most interesting cost/performance behavior.This work has been funded by FEDER through Programa Operacional Factores de Competitividade - COMPETE and by national funds by FCT - Fundacao para a Ciencia e a Tecnologia in the context of project PEst-C/CTM/UI0264/2011

Psychosocial adjustment to a lower limb amputation ten months after surgery

Objective: This longitudinal multisite study examined the influence of demographic characteristics psychological reactions, functionality coping strategies, and social support on psychosocial adjustment to lower limb amputation 10 months after suigery. Method: Of an initial referral of 206 Portuguese patients, a sample of 86 patients who underwent a lower limb amputation due to Diabetes Mellitus Type II were evaluated during the hospitalization that preceded surgery (t0) and at inpatient follow-up consultations, 1 (tl) 6 (t2), and 10 months (t3) after surgery. Results: Higher levels of anxiety symptoms and functionality at presurgery were associated with lower social adjustment to amputation and with higher adjustment to the limitations (t3) respectively. Traumatic stress symptoms (tl) were negatively associated with general and social adjustment, and with the adjustment to the limitations (t3). Perceived social support (t2) mediated the relationship between traumatic stress symptoms (tl) and adjustment to the limitations (t3). Male gender was associated with a higher anxiety and depression symptoms (t0) and with a higher level of functionality (tl). Male gender was associated with functionality at presurgery and postsurgery, and with anxiety and depression symptoms of presurgery. Implications: Results support the need to improve psychological screening and early treatment of anxiety symptoms before the surgery, as well a.s depression and traumatic stress symptoms after a lower limb amputation, and the promotion of social support over time, in order to promote psychosocial adjustment to amputation. This set of psychosocial variables should be included when planning postamputation rehabilitation and psychosocial intervention programs for this target population.- This study was conducted at the Psychology Research Center (PSI/01662), University of Minho, and supported by the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653) and by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology. The authors gratefully acknowledge the contributions of the Multidisciplinary Diabetic Foot Clinics of the following hospitals: CHP, CHSJ, CHVNG/E, CHTS, ULSAM, and the Vascular Surgery Departments in Braga and CHSJ Hospitals. The authors also wish to thank all patients who agreed to participate in this study