Estratégias de coping do cuidador informal do idoso dependente

Enquadramento: O envelhecimento demográfico conduz a um acréscimo de situações patológicas e de dependência física, onde emerge como foco de atenção o cuidado informal à pessoa idosa dependente, tendo sido atribuída essa responsabilidade à família. Esta situação constitui um acontecimento stressante, perante o qual, a resposta da família estará dependente da capacidade de mobilizar estratégias de coping. A enfermagem comunitária assume um papel primordial na prevenção do declínio da saúde física e mental destes cuidadores e na adaptação ao seu novo papel. Objetivo: Identificar as estratégias de coping de cuidadores informais de idosos dependentes. Métodos: Estudo não experimental, quantitativo, transversal, descritivo e correlacional, realizado numa amostra não probabilística, de conveniência, constituída por 33 cuidadores informais de idosos dependentes referenciados numa Equipa de Cuidados Continuados Integrados da Região Centro de Portugal. A colheita de dados foi efetuada através do preenchimento de um questionário para obtenção de dados sociodemográficos do idoso dependente e do cuidador informal, bem como do contexto dos cuidados, recorrendo-se também à aplicação do Índice de Barthel, versão portuguesa de Araújo, Ribeiro, Oliveira e Pinto (2007), da Escala de Graffar adaptada para a população portuguesa por Amaro (2001) e do Inventário de Avaliação Pessoal Orientado para a Crise em Família (F-COPES), versão portuguesa de Vaz Serra, Firmino, Ramalheira e Canavarro (1990). Resultados: Os idosos cuidados são maioritariamente (60,6%) do sexo masculino, com média de idades de 80,45 anos, portadores de doenças crónicas (100%) e totalmente dependentes (81,8%). Os cuidadores informais, na sua maioria (75,8%) são do sexo feminino, com média de idades de 66,1 anos, casados (81,8%), residentes no meio urbano (51,5%) e pertencentes à classe média baixa (60,6%). A maioria são cônjuges (60,6%) e coabitam com o idoso (90,9%). Os cuidadores informais de idosos dependentes recorrem a estratégias de coping, sendo os melhores resultados obtidos para o fator “Reenquadramento” e “Mobilização de Apoio Formal”. Cuidadores informais de idosos mais velhos e mais dependentes, recorrem mais à estratégia “Procura de apoio espiritual”; cuidadores mais novos, que ocupam uma posição social mais elevada e que cuidam de idosos mais dependentes, utilizam um maior número de estratégias de coping. Conclusões: Os resultados obtidos apontam para a necessidade de implementar intervenções de enfermagem focadas na família, que ajudem a mobilizar estratégias de coping, que permitam otimizar o papel de cuidador e eliminar ou minimizar o impacto negativo, decorrente desse papel, conduzindo desta forma à obtenção de ganhos em saúde nesta amostra específica

Benign and Suspicious Ovarian Masses—MR Imaging Criteria for Characterization: Pictorial Review

Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are currently used to evaluate ovarian tumors. US is the first-line imaging investigation for suspected adnexal masses. Color Doppler US helps the diagnosis identifying vascularized components within the mass. CT is commonly performed in preoperative evaluation of a suspected ovarian malignancy, but it exposes patients to radiation. When US findings are nondiagnostic or equivocal, MRI can be a valuable problem solving tool, useful to give also surgical planning information. MRI is well known to provide accurate information about hemorrhage, fat, and collagen. It is able to identify different types of tissue contained in pelvic masses, distinguishing benign from malignant ovarian tumors. The knowledge of clinical syndromes and MRI features of these conditions is crucial in establishing an accurate diagnosis and determining appropriate treatment. The purpose of this paper is to illustrate MRI findings in neoplastic and non-neoplastic ovarian masses, which were assessed into three groups: cystic, solid, and solid/cystic lesions. MRI criteria for the correct diagnosis and characteristics for differentiating benign from malignant conditions are shown in this paper

Resposta diferencial de cultivares de sorgo forrageiro para tolerância ao alumínio.

A toxidez de alumínio é um dos principais fatores limitantes à produção de grãos e forragem em solos ácidos, os quais compreendem grandes áreas em regiões tropicais e subtropicais. A cultura do sorgo apresenta grande variabilidade para esta característica, havendo no mercado híbridos de sorgo granífero tolerantes ao alumínio. O presente estudo objetivou avaliar a resposta diferencial de um conjunto de cultivares de sorgo forrageiro, buscando entender o efeito do alumínio no crescimento radicular e selecionar cultivares tolerantes para cultivo em áreas afetadas por este estresse abiótico. Foram avaliados quatro híbridos comerciais, vinte híbridos experimentais, quatro variedades, e duas testemunhas, totalizando 32 tratamentos. Os tratamentos foram submetidos a duas concentrações de alumínio (Al) em solução nutritiva, 0 e 27 uM de atividade de Al3+. Foi utilizado o delineamento em blocos ao acaso em fatorial simples, com três repetições. Foram avaliadas as características Crescimento Líquido de Raiz e Crescimento Relativo de Raiz Seminal. Houve diferenças significativas dos efeitos de genótipos, ambientes e da interação genótipos x ambientes, mostrando uma resposta diferencial das cultivares. O estresse de alumínio reduziu o crescimento radicular em aproximadamente 54%, indicando a necessidade da seleção de cultivares mais tolerantes, para atingir o potencial de rendimento de massa verde da cultura. Todas as cultivares apresentaram médias de crescimento menores no ambiente com alta saturação de alumínio em relação ao ambiente sem alumínio, exceto pela testemunha tolerante BRS 373 e o híbrido experimental CMSXS 222x1141570. Os híbridos comerciais BRS 610 e BRS 655, os híbridos experimentais BR007x1141570 e CMSXS157x1141570, e as variedades experimentais 1141562, 1141572 e 1140562 mostraram-se tolerantes ao alumínio, com redução mínima no crescimento de raiz.bitstream/item/160910/1/bol-150.pd

Depression in internal medicine inpatients at the time of hospital discharge and referral to primary care

Background and objectives: This is the first multi-center study intended to document the prevalence, characteristics, and associations of depression in Medicine patients at the time of hospital discharge and their referral to Primary Care (PC). Methods: Adult patients randomly selected among consecutive admissions to Medicine wards in 8 hospitals in Spain, covering health districts, were examined in a two-phase ''case-finding'' procedure. Standardized, Spanish versions of instruments were used, including the Standardized Polyvalent Psychiatric Interview (SPPI) and Cumulative Illness Rating Scale (CIRS). Cases of depression were diagnosed according to ICD-10 general hospital research criteria. Results: Three hundred and twelve patients with treatable depression and 777 non-depressed controls were identified. In a conservative estimate, the global prevalence of major depression was 7.1%, dysthymia 4.2% and adjustment depression 7.1%, and 51.9% of cases were of moderate/ severe intensity. Depression was more frequent in women, the differences being significant in all categories of depression. The prevalence of depression was lower in individuals aged 85 or more years, the differences being significant in cases of both dysthymia and adjustment depression. A clear pattern of decreasing prevalence with age was observed in women. The depressed had as an average five medical systems affected, and higher CIRS scores compared with the controls, the differences being significant in cases of both major depression and dysthymia. Conclusions: This is the first report showing a considerable prevalence of treatable cases of depression in Medicine patients at the time of hospital discharge and referral to PC. Depression is associated with the severity of the medical condition, and differences observed by age and sex have clinical implications. Paper read at the 3rd Annual Meeting of the European Association of Psychosomatic Medicine, Nuremberg 2015. © 2022 Asociación Universitaria de Zaragoza para el Progreso de la Psiquiatría y la Salud Menta

Adenosine A2A receptor modulation of hippocampal CA3-CA1 synapse plasticity during associative learning in behaving mice

© 2009 Nature Publishing Group All rights reservedPrevious in vitro studies have characterized the electrophysiological and molecular signaling pathways of adenosine tonic modulation on long-lasting synaptic plasticity events, particularly for hippocampal long-term potentiation(LTP). However, it remains to be elucidated whether the long-term changes produced by endogenous adenosine in the efficiency of synapses are related to those required for learning and memory formation. Our goal was to understand how endogenous activation of adenosine excitatory A2A receptors modulates the associative learning evolution in conscious behaving mice. We have studied here the effects of the application of a highly selective A2A receptor antagonist, SCH58261, upon a well-known associative learning paradigm - classical eyeblink conditioning. We used a trace paradigm, with a tone as the conditioned stimulus (CS) and an electric shock presented to the supraorbital nerve as the unconditioned stimulus(US). A single electrical pulse was presented to the Schaffer collateral–commissural pathway to evoke field EPSPs (fEPSPs) in the pyramidal CA1 area during the CS–US interval. In vehicle-injected animals, there was a progressive increase in the percentage of conditioning responses (CRs) and in the slope of fEPSPs through conditioning sessions, an effect that was completely prevented (and lost) in SCH58261 (0.5 mg/kg, i.p.)-injected animals. Moreover, experimentally evoked LTP was impaired in SCH58261- injected mice. In conclusion, the endogenous activation of adenosine A2A receptors plays a pivotal effect on the associative learning process and its relevant hippocampal circuits, including activity-dependent changes at the CA3-CA1 synapse.This study was supported by grants from the Spanish Ministry of Education and Research (BFU2005-01024 and BFU2005-02512), Spanish Junta de Andalucía (BIO-122 and CVI-02487), and the Fundación Conocimiento y Cultura of the Pablo de Olavide University (Seville, Spain).B. Fontinha was in receipt of a studentship from a project grant (POCI/SAU-NEU/56332/2004) supported by Fundação para a Ciência e Tecnologia (FCT, Portugal), and of an STSM from Cost B30 concerted action of the EU

Bupropion Increases Selection of High Effort Activity in Rats Tested on a Progressive Ratio/Chow Feeding Choice Procedure: Implications for Treatment of Effort-Related Motivational Symptoms

Background: Depression and related disorders are characterized by deficits in behavioral activation, exertion of effort, and other psychomotor/motivational dysfunctions. Depressed patients show alterations in effort-related decision making and a bias towards selection of low effort activities. It has been suggested that animal tests of effort-related decision making could be useful as models of motivational dysfunctions seen in psychopathology. Methods: Because clinical studies have suggested that inhibition of catecholamine uptake may be a useful strategy for treatment of effort-related motivational symptoms, the present research assessed the ability of bupropion to increase work output in rats responding on a test of effort-related decision-making (ie, a progressive ratio/chow feeding choice task). With this task, rats can choose between working for a preferred food (high-carbohydrate pellets) by lever pressing on a progressive ratio schedule vs obtaining a less preferred laboratory chow that is freely available in the chamber. Results: Bupropion (10.0–40.0 mg/kg intraperitoneal) significantly increased all measures of progressive ratio lever pressing, but decreased chow intake. These effects were greatest in animals with low baseline levels of work output on the progressive ratio schedule. Because accumbens dopamine is implicated in effort-related processes, the effects of bupropion on markers of accumbens dopamine transmission were examined. Bupropion elevated extracellular dopamine levels in accumbens core as measured by microdialysis and increased phosphorylated dopamine and cyclic-AMP related phosphoprotein 32 kDaltons (pDARPP-32) immunoreactivity in a manner consistent with D1 and D2 receptor stimulation. Conclusion: The ability of bupropion to increase exertion of effort in instrumental behavior may have implications for the pathophysiology and treatment of effort-related motivational symptoms in humans

Prefrontal Norepinephrine Determines Attribution of “High” Motivational Salience

Intense motivational salience attribution is considered to have a major role in the development of different psychopathologies. Numerous brain areas are involved in “normal” motivational salience attribution processes; however, it is not clear whether common or different neural mechanisms also underlie intense motivational salience attribution. To elucidate this a brain area and a neural system had to be envisaged that were involved only in motivational salience attribution to highly salient stimuli. Using intracerebral microdialysis, we found that natural stimuli induced an increase in norepinephrine release in the medial prefrontal cortex of mice proportional to their salience, and that selective prefrontal norepinephrine depletion abolished the increase of norepinephrine release in the medial prefrontal cortex induced by exposure to appetitive (palatable food) or aversive (light) stimuli independently of salience. However, selective norepinephrine depletion in the medial prefrontal cortex impaired the place conditioning induced exclusively by highly salient stimuli, thus indicating that prefrontal noradrenergic transmission determines approach or avoidance responses to both reward- and aversion-related natural stimuli only when the salience of the unconditioned natural stimulus is high enough to induce sustained norepinephrine outflow. This affirms that prefrontal noradrenergic transmission determines motivational salience attribution selectively when intense motivational salience is processed, as in conditions that characterize psychopathological outcomes

Speed/Accuracy Trade-Off between the Habitual and the Goal-Directed Processes

Instrumental responses are hypothesized to be of two kinds: habitual and goal-directed, mediated by the sensorimotor and the associative cortico-basal ganglia circuits, respectively. The existence of the two heterogeneous associative learning mechanisms can be hypothesized to arise from the comparative advantages that they have at different stages of learning. In this paper, we assume that the goal-directed system is behaviourally flexible, but slow in choice selection. The habitual system, in contrast, is fast in responding, but inflexible in adapting its behavioural strategy to new conditions. Based on these assumptions and using the computational theory of reinforcement learning, we propose a normative model for arbitration between the two processes that makes an approximately optimal balance between search-time and accuracy in decision making. Behaviourally, the model can explain experimental evidence on behavioural sensitivity to outcome at the early stages of learning, but insensitivity at the later stages. It also explains that when two choices with equal incentive values are available concurrently, the behaviour remains outcome-sensitive, even after extensive training. Moreover, the model can explain choice reaction time variations during the course of learning, as well as the experimental observation that as the number of choices increases, the reaction time also increases. Neurobiologically, by assuming that phasic and tonic activities of midbrain dopamine neurons carry the reward prediction error and the average reward signals used by the model, respectively, the model predicts that whereas phasic dopamine indirectly affects behaviour through reinforcing stimulus-response associations, tonic dopamine can directly affect behaviour through manipulating the competition between the habitual and the goal-directed systems and thus, affect reaction time