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      Vulnerabilidades de cuidadores familiares de pacientes com doenças raras: uma revisão integrativa Translated title: Vulnerabilities of family caregivers of patients with rare diseases: an integrative review

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          Abstract

          Resumo Atualmente existem em média 300 milhões de pessoas com algum tipo de doença rara no mundo, essas doenças são progressivas, degenerativas e podem ser fatais, afetando em sua maioria crianças, a partir de um itinerário terapêutico muitas vezes longo. Quando se discute sobre doenças raras automaticamente deve-se pensar em quem acompanha e cuida de tais pessoas, bem como, do seu processo de saúde/doença. Os cuidadores familiares e as pessoas com doenças raras vivenciam uma realidade complexa, repleta de vulnerabilidades. O objetivo deste estudo é analisar sob o ponto de vista bioético as vulnerabilidades dos cuidadores familiares de pacientes com doenças raras. O método é uma revisão integrativa das bases de dados Bireme.org e Scielo.org, com textos completos, de língua portuguesa, espanhola e inglesa, publicados desde 2009 até 2019. Criou-se um quadro que observa as vulnerabilidades programática, individual, social e moral e compôs-se com as análises de textos selecionados. Percebe-se que a vulnerabilidade programática esteve presente na maior parte dos textos, e a vulnerabilidade moral não se mostrou tão presente no discurso dos cuidadores familiares. Conclui-se que é de extrema importância cuidar de quem cuida, para além de redes de apoio e ações políticas, é necessário cuidar da saúde mental de quem assume a responsabilidade do cuidado.

          Translated abstract

          Abstract Currently, there are an average of 300 million people with some type of rare disease in the world, these diseases are progressive, degenerative and can be fatal, affecting their many children, from an often long therapeutic itinerary. When he talks about rare diseases, he talks about who accompanies and cares for these people, as well as about their health / disease process. Family caregivers and people with rare diseases experience a complex reality, full of vulnerabilities, such as: programmatic, individual, social and moral vulnerability. The aim of this study is to analyze, from a bioethical point of view, the vulnerabilities of family caregivers of patients with rare diseases. The method is an integrative review of the Bireme.org and Scielo.org databases, with full texts, in Portuguese, Spanish and English, published from 2009 to 2019. It created a table that looks at how vulnerabilities and causes a relationship with how analyzes were performed the texts of the databases already cited. Perhaps a programmatic vulnerability is present in most texts, and a moral vulnerability has not shown so little in the speech of family caregivers. Conclude if it is extremely important to take care of those who care, in addition to support networks and political actions, it is necessary to take care of the mental health of those who assume a responsibility to care, such a responsibility that no one learns to do except in that position.

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          A influência das doenças crônicas na capacidade funcional dos idosos do Município de São Paulo, Brasil

          O objetivo principal deste estudo foi investigar a influência de doenças crônicas (hipertensão arterial, diabetes mellitus, doença cardíaca, doença pulmonar, câncer e artropatia) na capacidade funcional (atividades de vida diária - AVDs - e atividades instrumentais de vida diária - AIVDs) dos idosos, controlando por idade, sexo, arranjo familiar, educação e presença de outras comorbidades. Os dados foram obtidos do Projeto SABE que inclui pessoas de 60 anos e mais, residentes no Município de São Paulo, Brasil, entre janeiro de 2000 e março de 2001. A amostra foi constituída de 1.769 idosos. Para a análise dos dados foi utilizada a regressão logística multinomial múltipla. Em comparação com a categoria de referência independente, as doenças que exercem uma significativa influência na categoria dependente nas AIVDs são a doença cardíaca (OR = 1,82), a artropatia (OR = 1,59), a doença pulmonar (OR = 1,50) e a hipertensão arterial (OR = 1,39). Quanto à resposta na categoria dependente nas AIVDs e AVDs, os resultados mostram que a doença pulmonar (OR = 2,58), a artropatia (OR = 2,27), a hipertensão arterial (OR = 2,13) e a doença cardíaca (OR = 2,10) demonstram um forte efeito. Os resultados são estatisticamente significativos (p < 0,05).
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            Assessment of the impact of phenylketonuria and its treatment on quality of life of patients and parents from seven European countries

            Background The strict and demanding dietary treatment and mild cognitive abnormalities seen in PKU treated from a young age can be expected to affect the health-related quality of life (HRQoL) of patients and their families. Our aim was to describe the HRQoL of patients with PKU from a large international study, using generic HRQoL measures and an innovative PKU-specific HRQoL questionnaire (PKU-QOL). Analyses were exploratory, performed post-hoc on data collected primarily to validate the PKU-QOL. Methods A multicentre, prospective, non-interventional, observational study conducted in France, Germany, Italy, The Netherlands, Spain, Turkey and the UK. Patients diagnosed with PKU aged ≥9 years old and treated with a Phe-restricted diet and/or Phe-free amino acid protein supplements and/or pharmacological therapy were included in the study; parents of at least one patient with PKU aged <18 years were also included. HRQoL was assessed by generic measures (Pediatric Quality-of-Life Inventory; Medical Outcome Survey 36 item Short Form; Child Health Questionnaire 28 item Parent Form) and the newly developed PKU-QOL. Mean generic domain scores were interpreted using published reference values from the general population. PKU-QOL domain scores were described overall and in different subgroups of patients defined according to severity of PKU, overall assessment of patient’s health status by the investigator and treatment with tetrahydrobiopterin (BH4). Results Data from 559 subjects were analysed: 306 patients (92 children, 110 adolescents, 104 adults) and 253 parents. Mean domain scores of generic measures in the study were comparable to the general population. The highest PKU-QOL impact scores (indicating greater impact) were for emotional impact of PKU, anxiety about blood Phe levels, guilt regarding poor adherence to dietary restrictions or Phe-free amino acid supplement intake and anxiety regarding blood Phe levels during pregnancy. Patients with mild/moderate PKU and those receiving BH4 reported lower practical and emotional impacts of the diet and Phe-free amino acid supplement intake. Conclusion Patients with PKU showed good HRQoL in the study, both with the generic and PKU-specific measures. Negative impacts of PKU on a patient’s life, including the emotional impact of PKU and its management, was delineated by the PKU-QOLs across all age groups. Electronic supplementary material The online version of this article (doi:10.1186/s13023-015-0294-x) contains supplementary material, which is available to authorized users.
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              Challenging symptoms in children with rare life-limiting conditions: findings from a prospective diary and interview study with families.

              The aim was to describe the nature, frequency, severity and management challenges of symptoms in children with two rare life-limiting conditions [Mucopolysaccharide (MPS) and Batten disease].
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                Author and article information

                Journal
                psd
                Psicologia, Saúde & Doenças
                Psic., Saúde & Doenças
                Sociedade Portuguesa de Psicologia da Saúde (Lisboa, , Portugal )
                1645-0086
                September 2021
                : 22
                : 2
                : 659-673
                Affiliations
                [1] Curitiba Paraná orgnamePontifícia Universidade Católica do Paraná orgdiv1Escola de Ciências da Vida Brazil aline.brotto@ 123456hotmail.com
                Article
                S1645-00862021000200659 S1645-0086(21)02200200659
                10.15309/21psd220228
                2857cd9e-a41d-4a8c-8ced-7592c2a6ac18

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 23 May 2021
                : 24 April 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 67, Pages: 15
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                SciELO Portugal

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                rare diseases,saúde mental,acesso à saúde,bioética,psicologia,vulnerabilidades,Doenças raras,mental health,access to health,bioethics,psychology,vulnerabilities

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