Jaqueline Brosso Zonta

Objective To identify factors associated with stress among family caregivers of children and adolescents with Down syndrome. Method This was a cross-sectional, analytical, observational study with a quantitative approach. Data were collected in participants’ homes using a sociodemographic and clinical characterization instrument, the Perceived Stress Scale, and salivary cortisol collection upon awakening. Bivariate and multivariate statistical analyses were performed to identify associations. Results A total of 30 family members participated, including 24 mothers, five fathers, and one sister. Of these, 18 (60%) reported experiencing at least one stressful event in the previous 30 days. The mean perceived stress score was 31.9 points. Mean salivary cortisol upon awakening was 0.44 µg/dL, which is within the normal range for the morning period. A statistically significant association was found between salivary cortisol levels upon awakening and occupation. Conclusion A tendency toward low salivary cortisol levels upon awakening was observed among family caregivers. Family members with paid employment had higher salivary cortisol levels than caregivers without employment.

Background: The body of literature on physiological measures of stress in caregivers of children with special health care needs (CSHCN) is emerging; however, a nondisease-based review of this literature has not yet been conducted. This study aimed to synthesize and analyze scientific evidence available in the literature on biomarkers associated with stress in caregivers of CSHCN. Methods: We conducted a systematic review of studies published in 7 electronic bibliographic databases: Embase, MEDLINE/PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, and PsycINFO, with no publication data restrictions. The internal validity and risk of bias of the RCT were assessed using the RoB 2 tool, and for NRCTs, the ROBINS-I was employed. The Newcastle–Ottawa Scale was used to evaluate the internal validity of case–control studies and the JBI tool was used to evaluate cross-sectional studies. Results: The search identified 755 papers, and 7 articles were selected and included in the analysis. The included studies were conducted across diverse geographic regions: 3 in North America (the United States and Canada), 2 in Europe (the United Kingdom and Croatia), 1 in Brazil, and 1 in South Korea, demonstrating a degree of international representation. Most of the studies (n = 3; 42,8%) were experimental (RCT or NRCT). Regarding critical appraisal, the majority (n = 5; 71.42%) were considered to be of high quality and presented a low risk of bias through specific tools by study design, although 2 were classified as having a high risk of bias. Cortisol was analyzed in all studies, whereas alpha-amylase was measured in only one study, predominantly using saliva samples. Studies have indicated a tendency for lower cortisol levels upon awakening among caregivers of CSHCN children compared to caregivers of healthy children. Conclusions: This review suggests that there are important differences between caregivers of CSHCN and healthy children regarding biomarker measures. Biomarkers enable objective measurement of stress and may complement self-report measures that are more commonly used in studies of family caregiving. This review underscores the importance of systematically assessing caregivers’ needs in clinical practice and supports the development of public policies and future research initiatives that incorporate biomarker analysis.

Objectives: This study analyzed the stress experienced by family caregivers of children with special healthcare needs and identified associated factors. Methods: A case–control study was conducted with the “cases” being caregivers of children with chronic conditions and the “controls” being caregivers of healthy children. Recruitment was carried out via social media and complemented by snowball sampling. A sociodemographic questionnaire and the Perceived Stress Scale were applied, with four saliva samples collected in one day (at 8:00 am, 30 min later, and 4 and 12 h later). The Area Under the Curve for total daily cortisol production was calculated using the log-trapezoidal method. The Wilcoxon test and repeated-measures ANOVA were used for statistical analysis. Results: In total, 100 caregivers participated, with 50 in the “case” group and 50 in the “control” group. Significant differences in stress scores and salivary cortisol levels were observed between the groups, with the other variables constant. In both groups, cortisol levels followed a typical circadian pattern. Family income was associated with perceived stress. Caregiver age significantly explained perceived stress (p = 0.0098) and total cortisol production. Caregiver occupation also influenced cortisol results. Conclusions: Caregivers of children with chronic conditions showed higher perceived stress and lower cortisol production compared to those of healthy children. Family income, occupation, and caregiver age were associated with stress.

RESUMO Objetivo: Analisar o conhecimento de professores da Educação Básica com relação à asma e conhecer suas vivências diante da exacerbação dos sintomas na escola. Método: Estudo misto do tipo explanatório sequencial. Na etapa quantitativa, foi aplicado remotamente o Newcastle Asthma Knowledge Questionnaire e o instrumento de caracterização. Dados analisados por estatística descritiva e inferencial. A produção dos dados qualitativos ocorreu a partir de depoimentos escritos analisados pelo método de análise de conteúdo dedutivo. Resultados: Duzentos e sete professores, maioria do sexo feminino (92%) e atuante em escolas públicas (82%). Quanto ao conhecimento, 132 (63,8%) apresentaram desempenho insatisfatório. As questões com menores índices de acerto eram sobre medicamentos utilizados regularmente e na crise. Os professores com maiores pontuações tinham menor tempo de atuação (p = 0,017) e possuíam diagnóstico de asma (p = 0,006). Na etapa qualitativa, participaram 35 professores e os depoimentos corroboraram os achados quantitativos, sobretudo com relação à lacuna de conhecimento e sentimento de maior segurança entre os professores asmáticos. Conclusão: Os professores apresentaram conhecimento insuficiente e relataram medo e despreparo frente à situação.

Background: Children with Special Health Care Needs (CSHCN) require greater attention from family caregivers as they present temporary or permanent physical, developmental, behavioral, or emotional issues. This demand for care generates overload and stress among family caregivers. So far, there is no study that gathers the available literature regarding the use of biomarkers to assess stress among caregivers of CSHCN. Hence, we aimed to synthetize and to assess the scientific evidence on biomarkers associated with stress in caregivers of CSHCN. Methods: This systematic review and meta-analysis protocol was elaborated following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The search strategy will be undertaken through 7 electronic bibliographic databases: Embase, MEDLINE/PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, and PsycINFO. In addition, secondary searches in other sources, such as Clinical trials.gov-NIH, The British Library, Pro Quest Dissertations Database, Google Scholar, and medRXiv will be also carried out. The reference section of the included studies will be hand searched for additional relevant studies. There will be no restriction regarding the publication dates or languages for this systematic review. Moreover, in an independently manner, 2 investigators will select studies, perform data extraction, as well as perform a critical appraisal of the risk of bias and overall quality of the selected studies, based on their designs. The heterogeneity among the studies will be assessed using the I ² statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the SPSS version 23.0. Results: This systematic review and meta-analysis will provide better insights regarding the biomarkers associated with stress in caregivers of CSHCN. Hence, consistent data and robust evidence will be provided to help practitioners and decision-makers in this area. Conclusions: To the best of our knowledge this study, will be the first to synthetize and critically evaluate the scientific evidence on biomarkers associated with stress in caregivers of CSHCN.

Objetivo: Identificar a qualidade de vida relacionada à saúde de cuidadores de crianças com transtornos do neurodesenvolvimento e analisar os fatores associados. Método: Estudo com delineamento observacional, transversal de abordagem quantitativa. Aplicado instrumento de caracterização e The Medical Outcomes Study 36-Item Short em 25 cuidadores. Utilizou-se o teste de Mann-Whitney e Correlação de Spearman, com nível de significância de 5%. Dentre os domínios da qualidade de vida relacionada à saúde, vitalidade e dor apresentaram os menores escores. Houve diferença significativa entre crença religiosa e os domínios aspectos sociais (p=0,046) e saúde mental (p=0,008) e, entre estado marital e os domínios aspectos sociais (p=0,029) e aspectos emocionais (p=0,035). Observou-se correlação negativa entre capacidade funcional e idade do cuidador. Conclusão: Cuidadores de crianças com transtornos do neurodesenvolvimento se percebem cansados e pouco dispostos. Crença religiosa, estado marital e idade se constituíram em fatores relacionados.

Objetivo analisar as contribuições da simulação in situ na autoconfiança de professores da educação infantil e fundamental I com relação ao manejo inicial das intercorrências de saúde na escola. Método estudo quase experimental, do tipo pré e pós-teste. Aplicou-se em 76 professores dois instrumentos pré e pós simulação in situ, os quais foram: escala visual analógica de autoconfiança dos professores para manejo das intercorrências de saúde na escola e questionário para avaliar o conhecimento na temática. A atividade educativa foi composta por quatro cenários de simulação in situ. Os dados foram analisados mediante estatística descritiva e analítica, utilizou-se regressão linear univariada e multivariada. Resultados a comparação dos resultados de autoconfiança pré e pós simulação in situ identificou promoção da autoconfiança (p<0,001) em especial para aqueles professores com menor tempo de experiência profissional (p=0.008), sem vivência prévia semelhante (p=0.003) e que participaram ativamente da simulação (p=0.009). Conclusão os professores sentem-se pouco confiantes para manejar intercorrências de saúde. A simulação in situ elevou a percepção da autoconfiança entre os professores.

Objective: To describe the construction and validation of a visual analogue scale of teachers' self-confidence with regard to the initial management of health issues in schools. Method: A methodological study was developed based on theoretical (items' construction and content validation), empirical (semantic analysis and pilot test), and analytical procedures (internal consistency analysis). The project was approved by a research ethics committee. Results: The scale consisted of 12 items regarding the main health issues in schools, presented content validity index of 100% in the second round, was understood by the target audience, and presented high internal consistency among items (Cronbach's alpha of 0.89). Conclusion and implications for practice: An easy-to-use tool that proved to be relevant to meet the dimension of teachers' self-confidence in the initial management of health issues in schools. The scale may contribute to the planning of systematized and effective educational strategies among teachers.