Thrombolysis in patients with prior stroke within the last 3 months

BACKGROUND AND PURPOSE Patients with prior stroke within 3 months have been mostly excluded from randomized thrombolysis trials mainly because of the fear of an increased rate of symptomatic intracerebral hemorrhage (sICH). The aim of this study was to compare baseline characteristics and clinical outcome of thrombolyzed patients who had a previous stroke within the last 3 months with those not fulfilling this criterion (comparison group). METHODS In all, 1217 patients were included in our analysis (42.2% women, mean age 68.8 ± 14.4 years). RESULTS Patients with previous stroke within the last 3 months (17/1.4%) had more often a basilar artery occlusion (41.2% vs. 10.8%) and less frequently a modified Rankin scale (mRS) score 0-1 prior to index stroke (88.2% vs. 97.3%) and a higher mean time lapse from symptom onset to thrombolysis (321 min vs. 262 min) than those in the comparison group. Stroke severity was not different between the two groups. Rates of sICH were 11.8% vs. 6%. None of the sICHs and only one asymptomatic intracerebral hemorrhage occurred in the region of the former infarct. At 3 months, favorable outcome (mRS ≤ 2) in patients with previous stroke within 3 months was 29.4% (vs. 48.9%) and mortality 41.2% (vs. 22.7%). CONCLUSIONS In patients with prior stroke within the last 3 months, none of the sICHs and only one asymptomatic intracerebral hemorrhage occurred in the region of the former infarct. The high mortality was influenced by four patients, who died until discharge due to acute major index stroke. It is reasonable to include these patients in randomized clinical trials and registries to assess further their thrombolysis benefit-risk ratio.

Semiautomatic Cochleostomy Target and Insertion Trajectory Planning for Minimally Invasive Cochlear Implantation

A major component of minimally invasive cochlear implantation is atraumatic scala tympani (ST) placement of the electrode array. This work reports on a semiautomatic planning paradigm that uses anatomical landmarks and cochlear surface models for cochleostomy target and insertion trajectory computation. The method was validated in a human whole head cadaver model (n = 10 ears). Cochleostomy targets were generated from an automated script and used for consecutive planning of a direct cochlear access (DCA) drill trajectory from the mastoid surface to the inner ear. An image-guided robotic system was used to perform both, DCA and cochleostomy drilling. Nine of 10 implanted specimens showed complete ST placement. One case of scala vestibuli insertion occurred due to a registration/drilling error of 0.79 mm. The presented approach indicates that a safe cochleostomy target and insertion trajectory can be planned using conventional clinical imaging modalities, which lack sufficient resolution to identify the basilar membrane.

Additional surgical procedure is a risk factor for surgical site infections after laparoscopic cholecystectomy

PURPOSE: Surgical site infections (SSI) are associated with increased costs and length of hospital stay, readmission rates, and mortality. The aim of this study was to identify risk factors for SSI in patients undergoing laparoscopic cholecystectomy. METHODS: Analysis of 35,432 laparoscopic cholecystectomies of a prospective multicenter database was performed. Risk factors for SSI were identified among demographic data, preoperative patients' history, and operative data using multivariate analysis. RESULTS: SSIs after laparoscopic cholecystectomy were seen in 0.8 % (n = 291) of the patients. Multivariate analysis identified the following parameters as risk factors for SSI: additional surgical procedure (odds ratio [OR] 4.0, 95 % confidence interval [CI] 2.2-7.5), age over 55 years (OR 2.4 [1.8-3.2]), conversion to open procedure (OR 2.6 [1.9-3.6]), postoperative hematoma (OR 1.9 [1.2-3.1]), duration of operation >60 min (OR 2.5 [1.7-3.6], cystic stump insufficiency (OR 12.5 [4.2-37.2]), gallbladder perforation (OR 6.2 [2.4-16.1]), gallbladder empyema (OR 1.7 [1.1-2.7]), and surgical revision (OR 15.7 [10.4-23.7]. SSIs were associated with a significantly prolonged hospital stay (p < 0.001), higher postoperative mortality (p < 0.001), and increased rate of surgical revision (p < 0.001). CONCLUSIONS: Additional surgical procedure was identified as a strong risk factor for SSI after laparoscopic cholecystectomy. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for SSI after laparoscopic cholecystectomy.

Relaciones entre los usos del suelo, las infraestructuras y la planificación: incidencia de la red viaria y el planeamiento en la aparición del terciario para el caso de la N-VI

Esta tesis examina el papel de la red viaria y el planeamiento urbanístico en la localización de las actividades terciarias. A partir de los años sesenta se produce una modificación de los patrones de comportamiento espacial de las actividades productivas. En la raíz de estos cambios está los procesos de globalización e internacionalización de la economía y un importante aumento de la utilización vehículos privados. Todo ello da lugar a una preocupación entre los profesionales por la identificación de variables en esa organización espacial, y por la búsqueda de modelos que mejorasen las condiciones de competitividad en el entramado urbano, reclamado también la formulación de conceptos diferentes, capaces de entender los cambios territoriales de la reestructuración permanente en que viven las economías capitalistas avanzadas. En este marco, hay un aumento importante de las actividades terciarias o proceso de terciarización; que es el principio basilar para la suburbanización de este sector. Consiste, en buena medida, en unas necesidades de descentralización y dispersión de las actividades terciarias por todo el territorio, con demandas de nuevos espacios para todo tipo de actividades empresariales. Se va así generando un espacio urbano complejo, con nuevas actividades, distintas de la residencial, y con tipologías edificatorias diferentes: centros comerciales, hipermercados, zocos o edificios de empresas dedicadas a servicios avanzados y altamente cualificados. Adquiere, por tanto, un fuerte protagonismo los espacios periféricos de las grandes ciudades. En la transformación de este territorio interviene el planeamiento urbanístico porque prevé la ocupación del suelo y la forma de uso. Y también la carretera considerada clave en el desarrollo histórico de la ciudad. Consecuentemente, se impulsan una plétora de nuevas líneas de investigación y nuevas formas de aproximación al estudio de las relaciones entre las infraestructuras viarias y los usos del suelo. El interés del proyecto de investigación es, por todo ello, estudiar en que medida la localización del terciario depende del planeamiento urbano y de las variaciones en la red viaria. Es decir, la hipótesis de este trabajo se puede enunciar diciendo que: en la aparición del terciario inciden dos variables, el planeamiento urbanístico y la red viaria; lógicamente siendo consciente de la dificultad intrínseca de separar algún parámetro y sus relaciones de un sistema funcional urbano. Centrando este enfoque sobre el caso particular del corredor de la carretera de La Coruña (N-VI) situado en el oeste de la Comunidad de Madrid. Es un ámbito suburbano que comprende los términos municipales de Las Rozas y Majadahonda, un segmento del municipio de Madrid (abarca los barrios de Aravaca, el Plantío y Valdemarín, y una pequeña superficie de la Casa de Campo, Ciudad Universitaria y El Pardo), y la mitad septentrional del municipio de Pozuelo de Alarcón. La conclusión general a la que se ha llegado es que se trata de un fenómeno complejo, en el que se detecta que: A) La aprobación de un nuevo Plan Urbanístico no supone un cambio inmediato en la evolución cuantitativa de la implantación de actividades terciarias en edificio exclusivo en el área de estudio. B) Se evidencia una relación directa entre la implantación de una nueva infraestructura de transporte o modificación de algún elemento importante y el crecimiento de la localización de actividades terciarias. C) Resulta difícil verificar que cuando confluyen mejoras o nuevas construcciones en la red viaria y una estrategia en el planeamiento dirigida a la ordenación e intervención del espacio terciario, el número de edificios terciarios aumente. ABSTRACT This thesis examines the role of road networks and urban planning in the location of tertiary activities. Since the sixties there is a modification of spatial behavior patterns of production activities. At the root of these changes is the process of globalization and internationalization of the economy and a significant increase in private car use. This leads to a concern among professionals in the identification of variables in the spatial organization, and the search for models that would improve the competitive conditions in the urban framework, also called for the formulation of different concepts, able to understand the changes territorial restructuring that live permanently in the advanced capitalist economies. In this context, there is a significant increase in tertiary activities or process outsourcing, which is the beginning basilar to the suburbanization of the sector. It consists, in large part, on the Needs of decentralization and dispersal of tertiary activities throughout the territory, demands for new spaces for all types of business activities. It is thus generating a complex urban area, with new activities, other than residential and with different building typologies: shopping malls, hypermarkets, souks and buildings of companies engaged in advanced and highly skilled services. Thus takes strong role peripheral areas of big cities. In the transformation of this region is involved in providing for urban planning land use and how to use. And the road is considered key in the historical development of the city. Consequently, they are promoting a plethora of new research and new ways of approaching the study of the relationship between road infrastructure and land use. The interest of the research project is, for all that, consider to what extent depends on the location of tertiary urban planning and changes in the road network. That is, the hypothesis of this work can be stated by saying that: the emergence of two variables affecting tertiary, urban planning and road network, of course being aware of the inherent difficulty of separating any parameters and functional relationships of an urban. Approach focusing on the particular case of the road corridor from La Coruña (N-VI) located in the west of Madrid. It is a suburban area comprising the municipalities of Las Rozas and Majadahonda, a segment of the city of Madrid (covering the districts of Aravaca, the planting and Valdemarín, and a small area of the Casa de Campo, Ciudad Universitaria and El Pardo) , and the northern half of the town of Pozuelo de Alarcón. The general conclusion has been reached is that this is a complex phenomenon, which is detected: A) The approval of a new Urban Plan is not an immediate change in the quantitative evolution of the implementation of tertiary activities in exclusive building in the study area. B) It shows a direct relationship between the introduction of a new transport infrastructure or amendment to an important and growing element of the location of tertiary activities. C) It is difficult to verify that when improvements or new construction come together in the road network and planning a strategy aimed at the management and intervention of third space, the number of commercial buildings increases.

The effect of acoustic screens on orchestra musicians

La Directiva 2003/10/CE del Parlamento Europeo y del Consejo, del 6 de febrero de 2003, específica con arreglo al apartado 1 del artículo 16 de la Directiva 89/391/CEE las disposiciones mínimas de seguridad y de salud relativas a la exposición de los trabajadores a los riesgos derivados de los agentes físicos (ruido). En la industria musical, y en concreto en los músicos de orquesta, una exposición de más de ocho horas al día a un nivel de presión sonora de 80dB(A) o más es algo muy común. Esta situación puede causar a los trabajadores daños auditivos como la hiperacusia, hipoacusia, tinitus o ruptura de la membrana basilar entre otros. Esto significa que deben tomarse medidas para implementar las regulaciones de la forma más razonable posible para que la interpretación del músico, la dinámica y el concepto musical que se quiere transmitir al público se vea lo menos afectada posible. Para reducir la carga auditiva de los músicos de orquesta frente a fuertes impactos sonoros provenientes de los instrumentos vecinos, se está investigando sobre el uso de unos paneles acústicos que colocados en puntos estratégicos de la orquesta pueden llegar a reducir el impacto sonoro sobre el oído hasta 20dB. Los instrumentos de viento metal y de percusión son los responsables de la mayor emisión de presión sonora. Para proteger el oído de los músicos frente a estos impactos, se colocan los paneles en forma de barrera entre dichos instrumentos y los músicos colocados frente a ellos. De esta forma se protege el oído de los músicos más afectados. Para ver el efecto práctico que producen estos paneles en un conjunto orquestal, se realizan varias grabaciones en los ensayos y conciertos de varias orquestas. Los micrófonos se sitúan a la altura del oído y a una distancia de no más de 10cm de la oreja de varios de los músicos más afectados y de los músicos responsables de la fuerte emisión sonora. De este modo se puede hacer una comparación de los niveles de presión sonora que percibe cada músico y evaluar las diferencias de nivel existentes entre ambos. Así mismo se utilizan configuraciones variables de los paneles para comparar las diferencias de presión sonora que existen entre las distintas posibilidades de colocarlos y decidir así sobre la mejor ubicación y configuración de los mismos. A continuación, una vez obtenidos las muestras de audio y los diferentes archivos de datos medidos con un analizador de audio en distintas posiciones de la orquesta, todo ello se calibra y analiza utilizando un programa desarrollado en Matlab, para evaluar el efecto de los paneles sobre la percepción auditiva de los músicos, haciendo especial hincapié en el análisis de las diferencias de nivel de presión sonora (SPL). Mediante el cálculo de la envolvente de las diferencias de nivel, se evalúa de un modo estadístico el efecto de atenuación de los paneles acústicos en los músicos de orquesta. El método está basado en la probabilidad estadística de varias muestras musicales ya que al tratarse de música tocada en directo, la dinámica y la sincronización entre los músicos varía según el momento en que se toque. Estos factores junto con el hecho de que la partitura de cada músico es diferente dificulta la comparación entre dos señales grabadas en diferentes puntos de la orquesta. Se necesita por lo tanto de varias muestras musicales para evaluar el efecto de atenuación de los paneles en las distintas configuraciones mencionadas anteriormente. El estudio completo del efecto de los paneles como entorno que influye en los músicos de orquesta cuando están sobre el escenario, tiene como objetivo la mejora de sus condiciones de trabajo. Abstract For several years, the European Union has been adopting many laws and regulations to protect and give more security to people who are exposed to some risk in their job. Being exposed to a loud sound pressure level during many hours in the job runs the risk of hearing damage. Particularly in the field of music, the ear is the most important working tool. Not taking care of the ear can cause some damage such as hearing loss, tinnitus, hyperacusis, diplacusis, etc. This could have an impact on the efficiency and satisfaction of the musicians when they are playing, which could also cause stress problems. Orchestra musicians, as many other workers in this sector, are usually exposed to a sound level of 80dB(A) or more during more than eight hours per day. It means that they must satisfy the law and their legal obligations to avoid health problems proceeding from their job. Putting into practice the new regulations is a challenge for orchestras. They must make sure that the repertoire, with its dynamic, balance and feeling, is not affected by the reduction of sound levels imposed by the law. This study tries to investigate the benefits and disadvantages of using shields as a hearing protector during rehearsals and orchestral concerts.

A study on the lateralization of the effect of musical imagery on spontaneous otoacoustic emissions

It has been suggested that different pathways through the brain are followed depending on the type of information that is being processed. Although it is now known that there is a continuous exchange of information through both hemispheres, language is considered to be processed by the left hemisphere, where Broca?s and Wernicke?s areas are located. On the other hand, music is thought to be processed mainly by the right hemisphere. According to Sininger Y.S. & Cone- Wesson, B. (2004), there is a similar but contralateral specialization of the human ears; due to the fact that auditory pathways cross-over at the brainstem. A previous study showed an effect of musical imagery on spontaneous otoacoustic emissions (SOAEs) (Perez-Acosta and Ramos-Amezquita, 2006), providing evidence of an efferent influence from the auditory cortex on the basilar membrane. Based on these results, the present work is a comparative study between left and right ears of a population of eight musicians that presented SOAEs. A familiar musical tune was chosen, and the subjects were trained in the task of evoking it after having heard it. Samples of ear-canal signals were obtained and processed in order to extract frequency and amplitude data on the SOAEs. This procedure was carried out before, during and after the musical image creation task. Results were then analyzed to compare the difference between SOAE responses of left and right ears. A clear asymmetrical SOAEs response to musical imagery tasks between left and right ears was obtained. Significant changes of SOAE amplitude related to musical imagery tasks were only observed on the right ear of the subjects. These results may suggest a predominant left hemisphere activity related to a melodic image creation task.

Comparing in vitro, in situ, and in vivo experimental data in a three-dimensional model of mammalian cochlear mechanics

Normal mammalian hearing is refined by amplification of the motion of the cochlear partition. This partition, comprising the organ of Corti sandwiched between the basilar and tectorial membranes, contains the outer hair cells that are thought to drive this amplification process. Force generation by outer hair cells has been studied extensively in vitro and in situ, but, to understand cochlear amplification fully, it is necessary to characterize the role played by each of the components of the cochlear partition in vivo. Observations of cochlear partition motion in vivo are severely restricted by its inaccessibility and sensitivity to surgical trauma, so, for the present study, a computer model has been used to simulate the operation of the cochlea under different experimental conditions. In this model, which uniquely retains much of the three-dimensional complexity of the real cochlea, the motions of the basilar and tectorial membranes are fundamentally different during in situ- and in vivo-like conditions. Furthermore, enhanced outer hair cell force generation in vitro leads paradoxically to a decrease in the gain of the cochlear amplifier during sound stimulation to the model in vivo. These results suggest that it is not possible to extrapolate directly from experimental observations made in vitro and in situ to the normal operation of the intact organ in vivo.

Compression, gain, and nonlinear distortion in an active cochlear model with subpartitions

The propagation of inhomogeneous, weakly nonlinear waves is considered in a cochlear model having two degrees of freedom that represent the transverse motions of the tectorial and basilar membranes within the organ of Corti. It is assumed that nonlinearity arises from the saturation of outer hair cell active force generation. I use multiple scale asymptotics and treat nonlinearity as a correction to a linear hydroelastic wave. The resulting theory is used to explain experimentally observed features of the response of the cochlear partition to a pure tone, including: the amplification of the response in a healthy cochlea vs a dead one; the less than linear growth rate of the response to increasing sound pressure level; and the amount of distortion to be expected at high and low frequencies at basal and apical locations, respectively. I also show that the outer hair cell nonlinearity generates retrograde waves.

Molecular mechanisms of sound amplification in the mammalian cochlea

Mammalian hearing depends on the enhanced mechanical properties of the basilar membrane within the cochlear duct. The enhancement arises through the action of outer hair cells that act like force generators within the organ of Corti. Simple considerations show that underlying mechanism of somatic motility depends on local area changes within the lateral membrane of the cell. The molecular basis for this phenomenon is a dense array of particles that are inserted into the basolateral membrane and that are capable of sensing membrane potential field. We show here that outer hair cells selectively take up fructose, at rates high enough to suggest that a sugar transporter may be part of the motor complex. The relation of these findings to a recent candidate for the molecular motor is also discussed.

Resonant tectorial membrane motion in the inner ear: its crucial role in frequency tuning.

The tectorial membrane has long been postulated as playing a role in the exquisite sensitivity of the cochlea. In particular, it has been proposed that the tectorial membrane provides a second resonant system, in addition to that of the basilar membrane, which contributes to the amplification of the motion of the cochlear partition. Until now, technical difficulties had prevented vibration measurements of the tectorial membrane and, therefore, precluded direct evidence of a mechanical resonance. In the study reported here, the vibration of the tectorial membrane was measured in two orthogonal directions by using a novel method of combining laser interferometry with a photodiode technique. It is shown experimentally that the motion of the tectorial membrane is resonant at a frequency of 0.5 octave (oct) below the resonant frequency of the basilar membrane and polarized parallel to the reticular lamina. It is concluded that the resonant motion of the tectorial membrane is due to a parallel resonance between the mass of the tectorial membrane and the compliance of the stereocilia of the outer hair cells. Moreover, in combination with the contractile force of outer hair cells, it is proposed that inertial motion of the tectorial membrane provides the necessary conditions to allow positive feedback of mechanical energy into the cochlear partition, thereby amplifying and tuning the cochlear response.

Active control of waves in a cochlear model with subpartitions.

Multiscale asymptotic methods developed previously to study macromechanical wave propagation in cochlear models are generalized here to include active control of a cochlear partition having three subpartitions, the basilar membrane, the reticular lamina, and the tectorial membrane. Activation of outer hair cells by stereocilia displacement and/or by lateral wall stretching result in a frequency-dependent force acting between the reticular lamina and basilar membrane. Wavelength-dependent fluid loads are estimated by using the unsteady Stokes' equations, except in the narrow gap between the tectorial membrane and reticular lamina, where lubrication theory is appropriate. The local wavenumber and subpartition amplitude ratios are determined from the zeroth order equations of motion. A solvability relation for the first order equations of motion determines the subpartition amplitudes. The main findings are as follows: The reticular lamina and tectorial membrane move in unison with essentially no squeezing of the gap; an active force level consistent with measurements on isolated outer hair cells can provide a 35-dB amplification and sharpening of subpartition waveforms by delaying dissipation and allowing a greater structural resonance to occur before the wave is cut off; however, previously postulated activity mechanisms for single partition models cannot achieve sharp enough tuning in subpartitioned models.

Discovery of adrenomedullin in rat ischemic cortex and evidence for its role in exacerbating focal brain ischemic damage.

Focal brain ischemia is the most common event leading to stroke in humans. To understand the molecular mechanisms associated with brain ischemia, we applied the technique of mRNA differential display and isolated a gene that encodes a recently discovered peptide, adrenomedullin (AM), which is a member of the calcitonin gene-related peptide (CGRP) family. Using the rat focal stroke model of middle cerebral artery occlusion (MCAO), we determined that AM mRNA expression was significantly increased in the ischemic cortex up to 17.4-fold at 3 h post-MCAO (P < 0.05) and 21.7-fold at 6 h post-MCAO (P < 0.05) and remained elevated for up to 15 days (9.6-fold increase; P < 0.05). Immunohistochemical studies localized AM to ischemic neuronal processes, and radioligand (125I-labeled CGRP) displacement revealed high-affinity (IC50 = 80.3 nmol) binding of AM to CGRP receptors in brain cortex. The cerebrovascular function of AM was studied using synthetic AM microinjected onto rat pial vessels using a cranial window or applied to canine basilar arteries in vitro. AM, applied abluminally, produced dose-dependent relaxation of preconstricted pial vessels (P < 0.05). Intracerebroventricular (but not systemic) AM administration at a high dose (8 nmol), prior to and after MCAO, increased the degree of focal ischemic injury (P < 0.05). The ischemia-induced expression of both AM mRNA and peptide in ischemic cortical neurons, the demonstration of the direct vasodilating effects of the peptide on cerebral vessels, and the ability of AM to exacerbate ischemic brain damage suggests that AM plays a significant role in focal ischemic brain injury.

Sentidos de solidariedade

A solidariedade ressurge, na contemporaneidade, como valor ético e princípio jurídico, envolvendo o desafio da responsabilidade para com o outro. Torna-se fundamental, assim, investigar os diversos sentidos de solidariedade, a qual se mostra relevante para a construção de um espaço comum, marcado pelo respeito à pluralidade e destinado a uma eficaz proteção aos necessitados. Um dos princípios norteadores deste trabalho é a indagação acerca de até onde estamos dispostos a financiar um sistema fundado no princípio da solidariedade. Outro questionamento também se revela essencial: seria preciso buscar, em alguma esfera de transcendência, motivações possíveis para a solidariedade num mundo pós-moderno que parece primar pelo individualismo exacerbado? Na busca por respostas, delineia-se um sentido específico do humano, voltado à responsabilidade para com o outro, sobretudo para com aquele que é estranho, estrangeiro, diferente. A solidariedade, para além da mera noção de tolerância que incorpora a diferença, exige um compromisso coletivo. Alcançar a plenitude polissêmica da solidariedade passa pelo esforço de valorizar a diversidade humana, de modo a viabilizar o agir conjunto, pressuposto basilar da atitude política.

Diagnóstico de vertigem no serviço de urgência

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Desenvolvimento de competências sociais no cuidador informal

O cuidador informal tem nos últimos anos ganho visibilidade em inúmeras investigações. No entanto, não foram encontrados registos em Portugal relativamente às competências do cuidador informal e a forma como a exposição a um programa de informação o pode influenciar. Desta forma, foi desenvolvido o presente estudo no âmbito do desenvolvimento de competências no cuidador informal, recorrendo à metodologia de investigação ação. A estratégia metodológica utilizada na componente da ação (característica basilar na metodologia selecionada) consistiu na realização de um conjunto de sessões em contexto de domicílio com os cuidadores informais. Pretendeu-se com esta estratégia expor os cuidadores a um conjunto de informações e intervenções planeadas de acordo com as suas necessidades. Durante o estudo foram utilizados instrumentos de recolha de dados de natureza quantitativa e qualitativa. Salientamos ainda que em contexto de domicílio, foram também utilizadas outras estratégias e técnicas de desenvolvimento de competências sociais que permitiram complementar a informação a que os cuidadores foram expostos. Os instrumentos referidos anteriormente foram utilizados numa população de seis cuidadores provenientes do distrito de Portalegre. Após a realização do estudo foi possível verificar que as visitas domiciliárias são uma estratégia de ação que influenciam o desenvolvimento de competências sociais no cuidador informal, a informação adequada ao cuidador influencia o conhecimento dos cuidadores informais relativamente ao ato de cuidar, os cuidadores informais que têm redes familiares apresentam uma maior resiliência, o desenvolvimento de competências sociais influencia a sobrecarga no cuidador informal, que o aumento da resiliência influencia os níveis de sobrecarga nos cuidadores informais e que os cuidadores informais que identificam e gerem as emoções apresentam menor sobrecarga.