SATISFACTION IN CARING FOR OLDER ADULTS WITH ALZHEIMER’S: PERCEPTIONS OF THE FAMILY CAREGIVERS

O objetivo deste estudo foi apreender as condições de satisfação de cuidadores familiares de idososcom Doença de Alzheimer no município de Umuarama-PR. Trata-se de um estudo de natureza qualitativa,descritivo e exploratório, realizado com oito cuidadores familiares. Os dados foram coletados no período dejulho a setembro de 2013, por meio de entrevistas semiestruturadas realizadas no domicilio e após, submetidas àanálise, da qual emergiram quatro categorias: a vivência com o cuidado permite desenvolvimento de habilidades,o provimento de bem-estar ao idoso permite satisfação para o cuidador familiar, a religiosidade favorece asatisfação em cuidar e demonstrar amor e gratidão por meio do cuidado favorece a satisfação do cuidadorfamiliar. Os resultados apontaram que também existe satisfação no ato de cuidar, desmitificando o imagináriode que essa atividade é permeada apenas por insatisfação e sobrecarga.This study aimed to ascertain the conditionsof satisfaction of family caregivers for older adults withAlzheimer’s Disease in the municipality of Umuaramain the Brazilian state of Paraná (PR). It is a qualitative,descriptive and exploratory study, undertaken with eightfamily caregivers. The data were collected in the period July– September 2013, through semistructured interviews heldin the caregivers’ homes and later subjected to analysis,from which four categories emerged: The experience withthe care allows the development of skills; The provisionof well-being to the older adult affords satisfaction tothe family caregiver; Religiosity promotes satisfaction incaring; and Demonstrating love and gratitude throughthe care promotes the satisfaction of the family caregiver.The results indicated that satisfaction also exists in the actof caring, demystifying the imaginary that this activity ispermeated only by dissatisfaction and overload.El objetivo de este estudio fue aprender lascondiciones de satisfacción de cuidadores familiaresde ancianos con Enfermedad de Alzheimer en elmunicipio de Umuarama, PR. Es un estudio de naturalezacualitativa, descriptivo y exploratorio, realizado con ochocuidadores familiares. Los datos fueron obtenidos en elperiodo de julio a septiembre de 2013, por medio deentrevistas semiestructuradas realizadas en domicilio y,después, sometidas al análisis, del cual resultaron cuatrocategorías: la vivencia con el cuidado posibilita desarrollode habilidades, el proveimiento de bienestar al anciano,trae satisfacción para el cuidador familiar, la religiosidadfavorece la satisfacción en cuidar y demostrar amor ygratitud por medio del cuidado posibilita la satisfacción delcuidador familiar. Los resultados apuntaron que tambiénhay satisfacción en el hecho de cuidar, desmitificando elimaginario de que esa actividad es permeada solamentepor insatisfacción y sobrecarga

Acute exacerbation of chronic obstructive pulmonary disease in primary care setting in Spain: the EPOCAP study

Background: The present study was designed to describe the clinical profile of acute exacerbations of chronic obstructive pulmonary disease (COPD) and the treatment prescribed by primary care physicians (PCPs) in Spain. Method: An observational, multicenter and cross-sectional study was performed in patients diagnosed with acute exacerbation of COPD and treated by PCPs. Patients diagnosed with asthma, cystic fibrosis, significant bronchiectasis or pneumonia were not included in the study. Results: A total of 329 general physicians recruited 1088 evaluable patients across the country. Mean age was 66.5±10.2 years; male : female ratio was 3 : 1. Spirometry was performed in 28.3% of the patients. The number of acute exacerbations in the last year was 3.3±2.5; 88.7% had increased expectoration, 87.5% increased dyspnea, 64.4% increased sputum purulence, and 43.5% fever. A total of 6.1% ( n = 59) of patients were hospitalized due to exacerbation. The most frequently prescribed medications were antibiotics (84.5%, n = 919), mucolytic agents (72.5%, n = 789), inhaled corticosteroids (ICs) (71.3%, n = 776), and short-acting beta-adrenergic drugs (67.8%, n = 738). Oral corticosteroids were prescribed to 436 patients (40.1%). Conclusions: The clinical profile of acute exacerbations of COPD treated in a primary care setting in Spain was characterized by shortness of breath and increased sputum production. Patients were managed by PCP mainly in outpatient clinics with antibiotics, mucolytic agents, inhaled corticosteroids, oral corticosteroids and short-acting beta-adrenergic agents. The percentage of patients with confirmed diagnosis of COPD by pulmonary function tests was very low

Physicians' Knowledge of Inhaler Devices and Inhalation Techniques Remains Poor in Spain

Background: Studies in many countries in the 1990s revealed deficiencies in physicians' knowledge about inhalation therapy. In an attempt to remedy this situation, Spanish scientific societies implemented a variety of educational strategies. The objective of the present study was to assess changes in attitudes and knowledge about inhalers and inhalation techniques in a sizable sample of physicians. Methods: An 11-question multiple choice test was developed and administered throughout Spain to practicing physicians from specialties that frequently prescribe inhaler devices. The survey collected demographic characteristics (four items), preferences (two items), and issues related to knowledge (three items) and education (two items) about devices and inhalation techniques. Completion of the questionnaire was voluntary, individual, and anonymous. Results: A total of 1514 respondents completed the questionnaire. Dry powder inhalers (DPI) were preferred by 61.2% physicians, but only 46.1% identified “inhale deeply and forcefully” as the most significant step in the inhalation maneuver using these devices. Only 27.7% stated that they always checked the patient's inhalation technique when prescribing a new inhaler. A composite variable, general inhaled therapy knowledge, which pooled the correct answers related to knowledge, revealed that only 14.2% physicians had an adequate knowledge of inhaled therapy. Multivariate analysis showed that this knowledge was lowest among internal medicine and primary care physicians. Conclusions: Prescribers' knowledge of inhalers and inhalation techniques remains poor in Spain. The causes should be identified in further research to allow effective educational strategies to be developed. Specific educational policies should be addressed to general practitioners.Depto. de MedicinaFac. de MedicinaTRUEpu

Reasons that led hypertensive elderly to seek assistance in primary care

This study aimed to verify the complaints causing elderly hypertensive patients to seek a health center in a municipality of the state of Paraná, Brazil. Analytical and exploratory retrospective study conducted between November 2013 and January 2014, with 106 medical records of hypertensive elderly who attended nursing consultations in the past five years. Female elderly (73.5%), aged up to 70 years (61.3%), with a partner (57.5%) and with up to 4 years of education (73.5%) composed most of the sample. The main complaints causing elderly hypertensive patients to seek health care focused on endocrine and nutritional diseases (36%). There was significant association between gender and seeking the health service, with hypertension as major complaint, but no association was observed between complaints related to hypertension and number of interventions prescribed by nurses. The data revealed enable the planning of specific interventions to the needs of hypertensive elderly, allowing adjustments in care

Motivos que levaram idosos com hipertensão arterial a procurar atendimento na atenção primária

El objetivo fue verificar quejas que motivaron ancianos hipertensos a buscar un centro de salud en municipio del estado de Paraná-Brasil. Estudio analítico y exploratorio, de naturaliza retrospectiva, llevado a cabo entre noviembre 2013 y enero de 2014, con 106 registros médicos de ancianos que efectuaron consulta de enfermería en los últimos cinco años. Ancianos del sexo femenino (73,5%), hasta 70 años (61,3%), con compañero (57,5%) y hasta 4 años de estudio (73,5%) representaron la mayoría de la muestra. Las principales quejas de los ancianos que buscan atención centraron en enfermedades endócrinas y nutricionales (36%). Hubo asociación significativa entre sexo y búsqueda por el servicio de salud, teniéndose la hipertensión como principal queja, pero no hubo asociación entre quejas relacionadas con la hipertensión y el número de intervenciones prescritas por la enfermería. Los datos permitieron planificación de intervenciones específicas para necesidades de ancianos hipertensos, posibilitando, así, adecuaciones en la atención

Exhaled nitric oxide fraction as an add-on to ACQ-7 for not well controlled asthma detection.

BACKGROUND:The measurement of fractional nitric oxide concentration in exhaled breath (FeNO), a noninvasive indicator of airway inflammation, remains controversial as a tool to assess asthma control. Guidelines currently limit asthma control assessment to symptom and spirometry based appraisals such as the Asthma Control Questionnaire-7 (ACQ-7). We aimed at determining whether adding FeNO to ACQ-7 improves current asthma clinical control assessment, through enhanced detection of not well controlled asthma. METHODS:Asthmatic subjects, classified as not well controlled as per ACQ-7 on regular clinical practice, were included in a prospective, multicenter fashion, and had their maintenance treatment adjusted on visit 1. On follow-up (visit 2) four weeks later, the subjects were reevaluated as controlled or not well controlled using ACQ-7 versus a combination of FeNO and ACQ-7. RESULTS:Out of 381 subjects enrolled, 225 (59.1%) had not well controlled asthma on visit 2 as determined by ACQ-7, and 264 (69.3%) as per combined FeNO and ACQ-7. The combination of FeNO to ACQ-7 increased by 14.8% the detection of not well controlled asthma following maintenance therapy adjustment. CONCLUSIONS:The addition of FeNO to ACQ-7 increased the detectability of not well controlled asthma upon adjustment of maintenance therapy. Adding a measure of airway inflammation to usual symptom and spirometry based scores increases the efficacy of current asthma clinical control assessment

Correlation between the ACQ-7 score and FeNO change on visit 2 versus visit 1.

<p>The axes represent the ACQ-7 and FeNO differences on visit 2 minus visit 1, respectively. The magnitude of the decrease in the FeNO values showed a significant, positive correlation with the magnitude of the decrease in the ACQ-7 scores. </p