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To investigate whether quantitative retinal markers, derived from multimodal retinal imaging, are associated with increased risk of mortality among individuals with proliferative diabetic retinopathy (PDR), the most severe form of diabetic retinopathy.
Longitudinal retrospective cohort analysis.
This study was nested within the AlzEye cohort, which links longitudinal multimodal retinal imaging data routinely collected from a large tertiary ophthalmic institution in London, UK, with nationally held hospital admissions data across England.
A total of 675 individuals (1129 eyes) with PDR were included from the AlzEye cohort. Participants were aged ≥40 years (mean age 57.3 years, SD 10.3), and 410 (60.7%) were male.
The primary outcome was all-cause mortality. Quantitative retinal markers were derived from fundus photographs and optical coherence tomography using AutoMorph and Topcon Advanced Boundary Segmentation, respectively. We used unadjusted and adjusted Cox-proportional hazards models to estimate hazard ratios (HR) for the association between retinal features and time to death.
After adjusting for sociodemographic factors, each 1-SD decrease in arterial fractal dimension (HR: 1.54, 95% CI: 1.18 to 2.04), arterial vessel density (HR: 1.59, 95% CI: 1.15 to 2.17), arterial average width (HR: 1.35, 95% CI: 1.02 to 1.79), central retinal arteriolar equivalent (HR: 1.39, 95% CI: 1.05 to 1.82) and ganglion cell-inner plexiform layer (GC-IPL) thickness (HR: 1.61, 95% CI: 1.03 to 2.50) was associated with increased mortality risk. When also adjusting for hypertension, arterial fractal dimension (HR: 1.45, 95% CI: 1.08 to 1.92), arterial vessel density (HR: 1.47, 95% CI: 1.05 to 2.08) and GC-IPL thickness (HR: 1.56, 95% CI: 1.03 to 2.38) remained significantly associated with mortality.
Several quantitative retinal markers, relating to both microvascular morphology and retinal neural thickness, are associated with increased mortality among individuals with PDR. The role of retinal imaging in identifying those individuals with PDR most at risk of imminent life-threatening sequelae warrants further investigation.
Housing First (HF) is an evidence-based approach to ending homelessness, particularly for individuals with mental illness. Yet, limited research explores which aspects of HF programmes facilitate change over time, within the context of a programme theory of change (ToC). A particular research gap includes how mechanisms of change within HF programmes differ between men and women. This study examines gender-specific pathways of change in the HF model based on secondary qualitative data from Toronto’s original At Home/Chez Soi (AH/CS) trial, focusing on outcomes of housing stability, socio-economic status, health and overall well-being.
This was a secondary qualitative analysis of the AH/CS trial data. This analysis was guided using a gender-sensitive ToC framework.
This multisector study was conducted in a large Canadian urban centre in Toronto, Canada.
A total of 32 participants (23 men and nine women) who identified themselves as male or female, 18 months after their enrolment in the treatment arm of the Toronto site of the AH/CS randomised controlled trial.
Semistructured interviews were conducted as part of the trial’s qualitative study. Thematic analysis was guided by the ToC framework and conducted using NVivo software. We assessed differences between men and women across the following outcome domains: housing stability, financial status, physical and mental health, substance use recovery and inpatient care.
The findings largely confirmed the ToC with participants, particularly women, experiencing greater improvements across all mechanisms of change, especially in housing stability, financial status and health outcomes. Men faced ongoing challenges, including difficulty maintaining stable income, limited engagement with education/training and continued struggles with mental health and substance use. Despite these improvements, both men and women participants reported ongoing challenges in achieving consistent income and accessing education or training opportunities.
This study provides insight into how mechanisms of change within HF programmes differ between men and women. It underscores the need for ongoing programme adaptation and gender-responsive evaluation to meet the diverse needs of individuals, particularly those with mental health illness and histories of chronic homelessness.
Osteoporosis is a skeletal condition with decreased bone mass and structural deterioration, increasing fracture vulnerability. Several studies have found a correlation between prostate cancer in men and an increased risk of osteoporosis. This study aims to determine the prevalence of osteoporosis in patients with prostate cancer.
The primary objective of this study will be to estimate the prevalence of osteoporosis in prostate cancer survivor patients. An extensive search will be conducted on PubMed, Scopus, Embase, Web of Science, CINAHL and ProQuest databases to ensure comprehensive coverage. The search will encompass the timeframe from 1 January 1994 to 24 September 2024. Furthermore, we will not impose any limitations on the language or geographical location of the published studies. In order to assess the potential bias in the included studies, the Joanna Briggs Institute critical appraisal checklist for prevalence studies will be employed. The analysis of data will be performed using STATA V.17. The prevalence of osteoporosis or osteopenia will be calculated for each study by dividing the number of participants with these conditions by the total number of patients diagnosed with prostate cancer. A subgroup analysis will examine prevalence regarding geographical location, age groups, ethnicity, definitions and measurements of osteoporosis or osteopenia, risk of bias in the included studies, type and duration of androgen deprivation therapy, and site of osteoporosis diagnosis. We will employ multiple methods to detect publication bias, including funnel plot analysis, Begg’s and Egger’s tests, and the Trim and Fill method. If we have enough data, we will conduct a sensitivity analysis using the leave-one-out-remove method.
No ethical approval or patient consent is required as this study synthesises only published aggregate data. Results will be disseminated via a peer-reviewed publication.
CRD42024600884.
by Ana Paula Cândido Oliveira, Daniela Alencar Vieira, Cristiane Wanderley Cardoso, Tereza Magalhães, Rosangela Oliveira Anjos, Eduardo José Farias Borges Reis, Kionna Oliveira Bernardes Santos, Guilherme Sousa Ribeiro
Work ability is a subjective concept that reflects the balance between an individual’s perception of the physical, mental, and social demands of work and their competence and resources to meet those demands. The COVID-19 crisis significantly impacted health, work, and socioeconomic conditions worldwide. However, few studies have examined work ability in disadvantaged urban communities during this period. To analyze factors associated with work ability within the context of social vulnerability during the COVID-19 pandemic, we conducted a cross-sectional study in a low-income neighborhood in Salvador, Brazil, between February and June 2022. Sociodemographic, health, and labor data were collected, and work ability was assessed using the Work Ability Index (WAI), a widely used tool for evaluating work ability. Multivariable analyses based on a hierarchical model were run to investigate factors associated with low WAI scores. The study included 292 workers aged ≥16 years (59.6% women; median age 41 years). Most workers (84.6%) were classified as having adequate work ability based on their WAI scores. Multivariable analyses found that inadequate work ability was more frequent among women (prevalence ratio [PR]: 1.89, 95% confidence interval [CI]: 1.02-3.48), individuals who self-rated their health as moderate/good (PR: 5.91; 95% CI: 1.45-24.05) or poor/very poor (PR: 21.62; 95% CI: 5.14-90.91) compared to those with excellent/very good health, and those reporting diabetes (PR: 2.1; 95% CI: 1.13-3.9). Working >40 hours per week (PR: 0.47; 95% CI: 0.28-0.96) was negatively associated with inadequate work ability, suggesting that individuals with adequate work ability may be selected for longer working hours. A history of COVID-19 was not associated with inadequate work ability. These findings suggest that targeted interventions to improve work ability in low-income communities should prioritize women and workers with chronic health conditions, such as diabetes.The purpose of this article is to evaluate the potential role of a protective colostomy after reconstructive plastic surgery in individuals with spinal cord injury and neurological bowel, where pressure injuries are a serious complication. This began as a case-control observational study. From 2019, the therapeutic protocol was modified, and colostomy was proposed to all individual. 45 people with spinal cord injuries and grade 3 or 4 of pressure injuries were recruited. The experimental group underwent colostomy, while the control group received direct lesion reconstruction. Fisher's exact test and Student's t-test were utilized for group comparison. Primary outcomes included the number of healed ulcers and post-operative infections. The number of lesions healed within 30 days and the rate of flap infections showed significant differences between the two groups. A crucial statistical difference was found (p < 0.05). The complication rate was 44.44% in the control group and 17.65% in the experimental group (p-value < 0.05). Quality of life also showed encouraging results. Protective colostomy may prevent local complications after surgery, reducing long-term hospitalization and healthcare costs. It also may improve individuals’ quality of life.
by Salma Ahi, Amirreza Reiskarimian, Mohammad Aref Bagherzadeh, Zhila Rahmanian, Parisa Pilban, Saeed Sobhanian
Vitamin D has been increasingly recognized for its potential role in modulating various health conditions, including diabetes and its complications. Despite growing evidence suggesting that adequate vitamin D levels may reduce the risk of developing type 2 diabetes and its associated microvascular complications, the precise nature of this relationship remains unclear. This study aims to elucidate the connection among vitamin D status, glycemic control, and microvascular complications in patients with type 2 diabetes, thereby highlighting the importance of vitamin D in diabetes management.This analytical cross-sectional study included 199 type 2 diabetic mellitus (T2DM) patients from the Jahrom city endocrinology clinic. Serum 25(OH)D levels were measured, and their microvascular complications (microalbuminuria, retinopathy, neuropathy, macroalbuminuria) and glycemic control (HbA1C) were measured and confirmed according to ADA guidelines and endocrinologist supervision. All analysis were done with SPSS software. The study enrolled 199 type 2 diabetic patients with a mean age of 56.79 ± 10.8 years, of which 63.3% were female and 57.3% had hypertension. The mean BMI was 28.91 kg/m², and 29.1% of participants had vitamin D deficiency. The prevalence of microvascular complications was 25.6% for retinopathy, 14.1% for neuropathy, and 40% for nephropathy. Vitamin D deficiency was notably higher among patients with retinopathy (37.25%), neuropathy (50%), and macroalbuminuria (56.25%). Patients with neuropathy and retinopathy had significantly lesser serum 25(OH)D concentrations compared to patients without these complications. There was a slight inverse correlation between vitamin D levels and both the urine albumin creatinine ratio (r = -0.175, p = 0.018) and HbA1C (r = -0.19, p = 0.007). Although the link between vitamin D levels and retinopathy was not statistically significant (η = 0.903, p = 0.68), the alteration in vitamin D levels was suggestively linked with neuropathy (η = 0.975, pApproximately 25% of the Brazilian population suffers from mental disorders, a prevalence exacerbated by systemic and cultural factors such as socioeconomic inequalities, underfunded mental health services, regional disparities, and persistent stigma. These conditions significantly impact hospital care. Nurses, due to their direct contact with these patients, face challenges ranging from managing physical conditions to handling verbal aggression and psychiatric crises. This study aimed to assess the scientific evidence regarding nursing care for hospitalized patients with psychiatric disorders.
A systematic review with a mixed-methods approach was conducted, registered in PROSPERO (#CRD42022359288) and guided by PRISMA standards. Databases, such as MEDLINE, LILACS, PubMed, Web of Science, Scopus, and BDEnf, were searched using keywords like “Mental disorder,” “Psychiatric health,” “Nursing care,” and “Hospital.” Methodological quality was assessed using JBI and SQUIRE tools. The integration of quantitative and qualitative components occurred through meta-aggregation of qualitative data and frequency-based coding of quantitative themes, allowing thematic convergence across study designs.
Six studies were included. Meta-aggregation revealed frequent terms, such as “Nurse,” “Emergency,” “Screening,” “Patient,” and “Care.” Similarity analysis linked “Nurse” with “perception” and “experience” and “Emergency” with “Screening” and “Mental health,” highlighting the importance of experience and training. Five categories emerged: (1) professional experience (19.05%, showing skill gaps despite experience); (2) caring process (19.05%, stressing efficient screening); (3) barriers and challenges (19.05%, revealing difficulty with comorbidities); (4) training process (19.05%, identifying training deficiencies); and (5) therapeutic interventions (23.81%, discussing restraint use). These percentages refer to the proportional frequency of themes identified across the total number of studies analyzed. For thematic classification, only statistically significant chi-square values (p < 0.05) were considered in the grouping of content.
Nursing care for psychiatric patients in hospitals faces challenges like insufficient training and difficulty managing psychiatric comorbidities. Recommendations include incorporating structured mental health content into nursing curricula and hospital-based continuing education programs. These strategies may guide future healthcare policies in Brazil by improving patient safety, reducing hospital readmissions, and promoting more humane, evidence-based therapeutic interventions.
The findings emphasize the urgent need for targeted education and training to improve nursing care for psychiatric patients in hospital settings.
The combination of a reduction in the Danish hospital bed count, the shortage of hospital staff and demographic changes challenges the Danish hospital capacity. This was further highlighted during the COVID-19 pandemic when hospitals worldwide were overwhelmed by infected patients requiring acute hospital care. To address these challenges, a hospital-at-home (HaH) programme offers an alternative to conventional in-hospital admission. Furthermore, HaH has the potential to improve patient outcomes, reduce costs and increase patient satisfaction. However, few studies have evaluated HaH in a Scandinavian setting, and this article describes the protocol for a randomised controlled trial (RCT) comparing an HaH model with continued conventional in-hospital admission. The main aim of the trial is to evaluate physical activity level and mental wellbeing in patients admitted at home compared with conventionally admitted patients.
110 clinically stable patients from two internal medical wards at Nordsjaellands Hospital in Denmark will be included and randomised in a ratio of 1:1 to either continued conventional in-hospital admission (control group) or virtual HaH model (intervention group). The control group will receive standard hospital treatment, and the intervention group will be transferred home for continued treatment (eg, intravenous antibiotics or oxygen treatment). The primary outcome measures are physical activity assessed using daily step count (during the first 24 hours after inclusion, as an intermediary indicator of the risk of adverse events) and treatment satisfaction (assessed using a patient satisfaction survey). Secondary outcome measures are adverse events of special interest, escalation of care, readmission rate postdischarge (30 days and 90 days), mortality (associated and 7 days, 30 days and 90 days postdischarge), process data (eg, the number of teleconsultations) and a health economic evaluation.
The study was approved by the Danish Research Ethics Committees (no. 2303051) and the Danish Medicines Agency (CIV-23-03-042542) and will be monitored by the Copenhagen University Hospital Good Clinical Practice unit. Results will be published in peer-reviewed journals and presented at relevant national and international conferences. We also plan to communicate the results to relevant stakeholders in the Danish healthcare system.
For transgender and gender-diverse (TGD) people, it is known that there is a lack of healthcare professionals with experience in trans healthcare. This may result in either inadequate provision of healthcare or in an increased seeking of adequate trans healthcare. Little is known about healthcare services utilisation and resulting costs in treatment-seeking TGD people with gender incongruence or gender dysphoria (GIC/GD). Therefore, the aim of this study was to determine the excess costs associated with GIC/GD in Germany.
In a secondary analysis, baseline data of a randomised controlled trial with a sample of TGD people with GIC/GD were combined with data of a telephone survey conducted in a representative sample of the general German population. The data sets were matched using entropy balancing. Self-reported healthcare services utilisation was valued by standardised unit costs for the German healthcare system, and absenteeism from work and unemployment were valued with the gross hourly wage of persons in manufacturing and services sectors.
TGD people with GIC/GD living at least 50 km outside Hamburg in the federal state Bremen, Mecklenburg-Western Pomerania, Lower Saxony or Schleswig Holstein and the German general adult population.
Treatment-seeking TGD people with GIC/GD (n=167) and people of the general German population (n=2811).
6-month excess healthcare costs and indirect costs from a societal perspective were calculated for the year 2020 using two-part models with logit specification for the first part and a generalised linear model with gamma family and log link function for the second part.
The total 6-month excess costs associated with GIC/GD from a societal perspective were estimated to be 672 (95% CI: –3315 to 4657; p=0.741) per person. The direct excess healthcare costs were estimated to be 2 (–1115 to 1119; p=0.977) and the indirect excess costs due to absenteeism from work and unemployment were 669 (–3031 to 4370; p=0.723) per person. The total excess costs associated with GIC/GD in trans men, trans women and non-binary people were estimated to be –5572 (–12 232 to 1088), 4238 (–1694 to 10 170) and 3041 (–4268 to 10 351) per person (all with p>0.05), respectively.
The total 6-month costs in TGD people with GIC/GD did not differ statistically significantly from the costs in the general German population. Indirect excess costs due to absenteeism from work accounted for the largest part of the excess costs associated with GIC/GD, yet with wide 95% CIs. Potential causes of absenteeism from work, such as experienced or expected discrimination, need to be identified and addressed so that TGD people can experience a healthy work environment.
To explore the current state of the science on influencing factors of acute care nursing professional identity.
Integrative review.
Data were collected and screened using Covidence systematic review software, adhering to pre-defined inclusion criteria. The Critical Appraisal Skills Programme checklist was used for critical appraisal, and content analysis was applied to analyse the data.
CINAHL, PsycINFO and PubMed were utilised to search literature published between 2018 and 2023.
A total of 18 articles were included. Five themes were identified: (1) internal influences; (2) external influences; (3) externalisation of role; (4) early versus seasoned career experiences and (5) barriers to professional identity formation.
This review found evidence of multiple influencing factors, predominantly external, shaping acute care nurse professional identity. Research on the long-term impacts on practice, management, policy and education remains limited.
Enablers to forming professional identity foster empowerment, confidence, belonging and job satisfaction. Barriers to formation lead to hesitation, performance impediments, stress and exhaustion. Development of nurse professional identity may be instrumental in tackling acute care workforce challenges.
Review findings on professional identity formation can guide initiatives for enhancing healthy work environments and workforce retention. This exploration has international contemporary relevance for the nursing profession with suggestions for future research.
Existing literature underscores the significance of professional identity in nursing, yet the mechanisms underlying its integration and maintenance in the contemporary acute care workforce remain unclear. In the context of overwhelming workloads that adversely affect nurse mental health and retention, coupled with the escalating nursing shortage as we emerge from the pandemic, this examination of professional identity formation holds contemporary relevance for the evolving acute care landscape, offering implications for future research. The insights gleaned from this review may guide organisational leaders in developing new strategies addressing acute care nurse management, policy, education and retention.
Reporting adheres to the EQUATOR network, ENTREQ guidelines.
None.
To map interventions in the sexuality of men with stomas.
Scoping review, following JBI and PRISMA-ScR guidelines to report results.
Databases consulted were PubMed, via National Library of Medicine, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, Embase, Scientific Electronic Library Online, Brazilian Electronic Library of Thesis and Dissertations, CAPES Catalogue of Thesis and Dissertations and Open Access Scientific Repository of Portugal. Texts were read by independent reviewers, with no time or language restrictions.
The final sample included 10 studies. Data were synthesised and grouped for its similarity to approach models, preoperative orientations, self-care promotion, collecting pouch hygiene and safety, sexual health discussion and education, construction of bonds and sexual function evaluation.
Interventions in the sexuality of men with stomas included adherence to models for approaching sexuality, focusing on the permission and coparticipation of the patient, open conversations on the topic, self-care promotion, collecting pouch hygiene and safety, encouragement to the creation of bonds, sexual function evaluation in pre- and postoperative periods and individual and/or collective sexual health education.
This study contributes to the sexuality of men with stomas. It identified recommendations to approach and conduct the topic at hand, addressing the rehabilitation process since the surgery to place the stoma is considered.
This study addressed scientific literature on the sexuality of men with stomas. Most were from Europe and results demonstrated a gap in knowledge. This research will impact the stoma therapy research, affecting teams involved in the care to men with stomas, encouraging reflections on the sexuality of these patients.
This study complies with the PRISMA-ScR.
There was no patient or public contribution.
The protocol of this scoping review was registered in the Open Science Framework, registered under DOI 10.17605/OSF.IO/X9DSC. It can be accessed through the following link: https://osf.io/x9dsc/?view_only=a9c62ef6c11f44499f7b2bfe1fe379f9.
Chronic wounds, characterized by prolonged healing processes, pose a significant medical challenge with multifaceted aetiologies, including local and systemic factors. Here, it explores the complex pathogenesis of chronic wounds, emphasizing the disruption in the normal phases of wound healing, particularly the inflammatory phase, leading to an imbalance in extracellular matrix (ECM) dynamics and persistent inflammation. Senescent cell populations further contribute to impaired wound healing in chronic lesions. Traditional medical management focuses on addressing underlying causes, but many chronic wounds resist to conventional treatments, necessitating innovative approaches. Recent attention has turned to autologous orthobiologics, such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and mesenchymal stem cells (MSCs), as potential regenerative interventions. These biologically derived materials, including bone marrow aspirate/concentrate (BMA/BMAC) and adipose tissue-derived stem cells (ADSCs), exhibit promising cytokine content and regenerative potential. MSCs, in particular, have emerged as key players in wound healing, influencing inflammation and promoting tissue regeneration. This paper reviews relevant scientific literature regarding basic science and brings real-world evidence regarding the use of orthobiologics in the treatment of chronic wounds, irrespective of aetiology. The discussion highlights the regenerative properties of PRP, PRF, BMA, BMAC and SVF, showcasing their potential to enhance wound healing. Despite advancements, further research is essential to elucidate the specific roles of each orthobiologic and determine optimal applications for different wound types. The conclusion underscores the evolving landscape in chronic wound management, with a call for more comprehensive studies to refine treatment strategies and maximize the benefits of regenerative medicine.
Gynaecological cancer illness and treatment have a significant impact on women's sexual health and concerns regarding sexual health are known to be an unmet need in survivors. The digital support programme Gynea was designed to enhance women's health, including sexual health, after gynaecological cancer treatment. This study aimed to explore how cancer survivors experienced participation in Gynea.
This is a phenomenological hermeneutic study. Individual, in-depth semi-structured interviews were conducted to explore lived experiences. Twenty women were interviewed after completing the Gynea programme. The transcripts were analysed using Lindseth and Norberg's phenomenological hermeneutic method.
Three main themes (with subthemes) emerged from the analysis: (1) A silent existential trauma; (2) Redefining sexual health; (3) Communicating with a partner about sexuality. The women redefined sexual health rather than just being sexual intercourse, being a rediscovery of the body. The women's increased awareness and understanding of their own sexual health empowered their communication about their sexuality with their partners. This was important for regaining sexual health and intimacy in their relationships.
Participation in Gynea helped to strengthen the women's sexual integrity. Knowledge and support empowered them to take care of their sexual needs and communicate these with their partners.
Healthcare services and nurses need to be aware that sexual health is an existential state of being, in which good sexual health does not necessarily equate to sexual function, but rather to sexual empowerment. Digital support with nurse guidance can support women in caring for their sexual health after cancer illness by thematizing sexual health with a holistic approach and should be part of the medical treatment.
Twenty gynaecological cancer survivors contributed by sharing their experiences from the sexual health module in Gynea.
Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring.
Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress).
The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW.
Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts.
This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.
Objetivo: evaluar la calidad de vida de los cuidadores de niños con necesidades especiales de salud. Método: estudio cuantitativo, en una Unidad de Pediatría, con 16 madres de niños con necesidades especiales de salud. La recolección de datos se produjo mediante la aplicación del instrumento WHOQOL-bref. Para el análisis de los datos se utilizó la estadística descriptiva e inferencial. Resultados: la calidad de vida de los familiares cuidadores es influenciada por los aspectos físicos; psicológica; del medio ambiente y de las relaciones sociales. Conclusiones: la percepción general de la calidad de vida de estos cuidadores no puede considerarse satisfactoria, ya que los valores asociados a todos los ámbitos son relativamente bajos.
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