Navegando por Assunto "Oncologia"

Agora exibindo 1 - 11 de 11

Acesso aberto (Open Access)
Aspectos hematológicos e clínicos de crianças leucêmicas no período de indução da quimioterapia
(Universidade Federal do Pará, 2012-09-22) MÉLO, Flávia Maria Lessa; QUARESMA, Juarez Antônio Simões; http://lattes.cnpq.br/3350166863853054
The leukemia happens in approximately 30% of cases of pediatric malignant diseases involving the hematopoietic system, affects preferentially the white blood cells, characterized by replacement of normal blood cells to young abnormal cells in the bone marrow. Te leukemia is the most common cause of cancer deaths in childhood, and the main types are: acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) or chronic (CML). Chemotherapy is a specific treatment and the most used for healing or prolong life of these patients, often requiring hospitalization, since these patients show significant changes in blood counts, making them immunocompromised. This increases the risk of potentially serious infections and other complications that often prolong hospital stay and increase the rates of morbidity and mortality. In order to broaden the knowledge about the hematology and clinical characteristics of pediatric leukemia patients during chemotherapy induction in an oncology hospital reference in the northern region of Brazil from 2005 to 2010 aged 0-12 years. Therefore was made a retrospective study with secondary data collection from records filed on the division of medical records and statistics of the hospital involved in the study. In the statistical analysis of the results we obtained mean, standard deviation and median of continuous variables and frequency of categorical variables, and statistical significance assessed by means of obtaining confidence intervals at 95% and by an ANOVA test and Wilcoxon considered α = 5%. These analyzes were performed in Epi-Info software 3.5.1. Of the 556 medical records, 141 were complete, and observed higher prevalence in masculine gender, age group between 1-4 years, coming from the state of Pará, with clinical classification for ALL, with Brazilian protocol GBTLI selected in most cases, making use of empirical antibiotic therapy, especially ceftazidime, amikacin and ceftriaxone, and records of use of blood bag during hospitalization, and the outcome of the type of hospital discharge. The study also revealed alteration of the data found in all variables in the blood count to the white and red, both the first and the fifteenth day of hospitalization these periods chosen for data collection hematological, and found use in blood bags virtually all hospitalized patients (92.20%) with predominance of platelet concentrate (CP5), leukocyte-poor red blood cells (CHPL) and red blood cells. Given the above, it is recommended the development of strategic actions and local policies that address not only the tertiary specialist in pediatric oncology, but all levels of health care for the child, to reduce the impact of this disease in the pediatric population the northern region.
Acesso aberto (Open Access)
Avaliação da integridade genômica mitocondrial em gliomas de alto e baixo grau na população paraense
(Universidade Federal do Pará, 2016-12-14) COSTA JÚNIOR, Carlos Antonio da; BORGES, Bárbara do Nascimento; http://lattes.cnpq.br/0676220027193876
Cancer is characterized by fast abnormal cells proliferation which grow beyond their normal limits and may invade adjacent or distant tissue. Cancer CNS represents 2% of all cancers in the world, being slightly higher in men than in women. Mitochondria are responsible for producing most of the cellular ATP by oxidative phosphorylation (OXPHOS), may also act through glycolysis for same purpose, not requiring only oxygen. This option is a particular cancer cell property, also known as the Warburg effect. One hypothesis to explain this metabolic change may be related to mitochondrial DNA (mtDNA) defects caused by OXPHOS where these mutations can lead cancer cells to glycolysis. Eight mtDNA regions (D-LOOP, ND1, ND3, CO I, CO II CO III, ATPase 6 and ATPase 8) were analyzed in patients’ neoplastic tissues with glial cell cancer in Pará population, relating the data with the pathological and clinical characteristics of the patients. Among the changes found, the complex I seem to be decisive for the progression of high-grade tumors, as well as changes indel seem compromising important structures for OXPHOS. Deletions 4977 bp, when combined with other changes in ND1 / ND3 or heteroplasmias suggest poor prognosis, however, seem to have a reduced risk when changes in ND1 and ND3 are simultaneous.
Acesso aberto (Open Access)
Avaliação do potencial biotecnológico de compostos isolados de Swietenia macrophylla no tratamento de câncer
(Universidade Federal do Pará, 2015-11-30) BARRETO, Leilane de Holanda; MONTENEGRO, Raquel Carvalho; http://lattes.cnpq.br/0043828437326839
Swietenia macrophylla (mahogany) is a species of plant widely known for its therapeutic potential. The main constituents isolated extracts of this plant are structures known as limonoids. The limonoids also have several biological activities, among them, antitumor activity. The aim of this study was to evaluate the antitumor potential of the extract and limonoid obtained from leaves of S. macrophylla in cancer cell lines. Cytotoxicity to 5 cancer cell lines and normal revealed that the extract had cytotoxic effect in colorectal cancer cell lines (HCT-116 and HT-29), as the limonoids were cytotoxic for colorectal cancer (HCT-116) and melanoma (SKMEL-19). Given these results, we selected the limonoid L3 and HCT-116 cell line to evaluate the mechanism of action, as well as the HT-29 lineage, which has the TP53 gene mutated for comparison as possible of the compound mechanism of action, once it was less sensitive to L3. Moreover, L3 showed more selective for tumor cells. None of the compounds caused hemolysis of erythrocytes in mice. To evaluate the antiproliferative action of L3, the clonogenic assay was performed, where the two lines there was a significant reduction of colonies, however this reduction was more significant in HCT-116. The L3 compound also has caused death by apoptosis in a dose-dependent manner in the lines, where the number of cells in apoptosis was higher in HCT-116. To evaluate DNA damage, it was held the comet assay, which showed that L3 cause damage to the DNA of the two cancer cell lines, with greater damage index in HCT-116. The assessment of cell cycle distribution of cells after treatment with L3 showed that there was blocking the cycle at the G2 / M phase, mainly in HCT-116 (45% of the cells). From these data, it conducted a study of genes involved in this phase of the cycle, from analysis of their expression by RT-PCR. The ATM gene, which is activated by DNA damage activates the CHK-2 which in turn phosphorylates p53 protein. p53 protein can activate the transcription of p21 gene, which triggers cell cycle stopped, or activate cell death pathways. In this study, we found increased expression of genes ATM, CHK-2, TP53, ARF in a dose dependent in both cacer cell lines, and this expression was higher in HCT-116 cell line. The expression of p21 was increased in HCT-116, while in HT-29 decreased, this is due to the fact that HT-29 possess the mutant TP53 gene, then your protein does not work properly. As the path of apoptosis was evaluated caspase-3 gene and the anti-apoptotic gene BCL-2. There was increase in the expression of caspase-3 mainly in HCT-116 and decrease of BCL-2. These results suggest that L3 may be causing damage to the DNA of cells, triggering a cellular signaling pathway dependent on p53. To evaluate the toxicity of S. macrophylla extract, it was held the acute toxicology testing in mice, where the extract did not cause any changes in the physiological parameters of animals. As the claustogenicidade test (micronucleus) also showed that the extract is not mutagenic in the mouse bone marrow cells.
Acesso aberto (Open Access)
Avaliação do uso de nanopartículas lipídicas que se ligam a receptores celulares como instrumento para a terapêutica do câncer
(Universidade Federal do Pará, 2014-12-19) FEIO, Danielle Cristinne Azevedo; LIMA, Patrícia Danielle Lima de; http://lattes.cnpq.br/3411620003450812
Lipid-based nanoparticle systems have been used as vehicles for chemotherapeutic agents in experimental cancer treatments. More recently, those preparations have also been assayed in animal models of cardiovascular, rheumatic and other chronic inflammatory diseases. In general those systems reportedly attenuate the severe toxicities of chemotherapeutic agents. This study was aimed to investigate the effects of associating paclitaxel to a lipid-based nanoparticle system upon the organism of a non-human primate, Cebus apella, by extensively documenting the toxicity by serum biochemistry, hematological and detailed histopathological methods. The lipid nanoparticles (LDE) were constituted of cholesterol esters and esterified cholesterol, lecithin and triolin, with addition of paclitaxel. Eighteen Cebus apella were studied; three animals were treated with LDE only, without paclitaxel, as ministered intravenously every three weeks, during six treatment cycles; six animals were treated with paclitaxel associated to LDE at the same administration scheme, three with the lower (175mg/m2) and three with higher (250mg/m2) paclitaxel doses; six animals were treated with commercial paclitaxel, three with the lower and three with the higher doses levels. Three weeks after the treatment cycle the animals were euthanized by lethal anesthetic dose, and tissues fragments were collected for histopathological analysis. In three non-treated animals, the plasma kinetics of LDE’s labeled with radioactive cholesterol was determined after intravenous injection and blood sampling over 24 hours. The ethics committee in research with experimental animals UFPA (BIO008-11) approved the project. In the LDE-paclitaxel group, no clinical toxicity appeared, and the weight food consumption curve were similar to controls. Treatment was interrupted after the second cycle in four animals of commercial paclitaxel group for very high clinical toxicity but the remaining two complete the 6-cycle-treatment. Those two animals presented weight loss, nausea and vomiting, diarrhea, escame decamation, 70% fur loss and loss of physical activity. The 175mg/m2 paclitaxel dose is used in cancer chemoterapie with considerable toxicity, while the 250 mg/m2 dose shows intorable toxicity to the patients. The use of LDE as carrier in both those levels was almost complete neutralized the toxicity of the drug in this species more closed related to human subjects. This was observed not only by clinical, biochemical and hematological profiles but also by the histopathological analysis of stomach, small and large intestine, esophagus, pancreas, trachea and gallbladder. The current results support the assumption that lipid-based nanoparticles systems used was drug carriers can offer valuable tools decrease the toxicity and increase the safety of the chemotherapeutic agents, while extending the use to chronic diseases other than cancer.
Acesso aberto (Open Access)
Estudo epidemiológico da infecção genital pelo Papilomavírus humano (HPV) em mulheres do município de Bragança, Pará
(Universidade Federal do Pará, 2016-04-27) COELHO, Thaís da Conceição Costa; FUZII, Hellen Thais; http://lattes.cnpq.br/0026958665547973
The cervical cancer is a problem of global public health. Despite the easy tracking and have high cure rates when detected early, it is still responsible for the death of approximately 230,000 women, of which 80% occurred in developing countries. Therefore, the objective of this research was to conduct a study of the prevalence of genital infection with human papillomavirus (HPV) and associated risk factors in women living in the city of Bragança, in the state of Pará. It was a cross-sectional observational clinical study and analytical, held in Bragança Regional Hospital Antonio Maria Zaccaria and in health units that municipality, through data collection was conducted with a clinical epidemiological form and collection of biological samples of cervical cells, and then the detection of HPV molecular biology technique known as "nested PCR (polymerase chain reaction). The prevalence of HPV was 37.5% in women from Bragança city, having identified subtypes: 11, 16, 18, 31, 35, 52 and 58, the most prevalent were 16 and 35 and three cases coinfection of subtypes. Infected women were predominantly married, were between 18 and 25, had high levels of education, non-smokers, but were alcoholic, had first sexual intercourse after 15 years, more than 5 partners in life, one or more sexual partners in the last year, and at least one new partner, did not make regular use of contraceptives, they had up to two pregnancies, childbirth, at least one abortion and were taking the first examination of PCCU. A high prevalence of HPV in these women was found but no risk factors was associated with statistically. However, one can trace a profile of the infected women to support health actions and minimize the transmission of this virus through educational activities, mainly focused on the proper use of condoms, in addition to increasing nastiness for cervical cancer in especially the awareness of the preventive test.
Acesso aberto (Open Access)
Farmacogenômica das fluoropirimidinas no tratamento oncológico personalizado
(Universidade Federal do Pará, 2016-12-29) FERNANDES, Marianne Rodrigues; BURBANO, Rommel Mario Rodriguéz; http://lattes.cnpq.br/4362051219348099
Recently, cancer has become an obvious public health problem worldwide. The Fluoropyrimidine-based regimen has been the most widely used chemotherapy regimen worldwide in several types of solid tumors, including gastric and colorectal cancer. Of the total number of patients treated with 5-Fluorouracil (5-FU), 10-40% have severe toxicities, which usually result in prolonged and costly hospitalizations. The principle of personalized medicine is to study responses to medications based on individual genomic information. The high degree of miscegenation is a challenge for the worldwide implementation of personalized medicine in clinical practice. Many studies in the specialized literature have reported the influence of pharmacogenomic markers in mixed populations such as the Brazilian population. The aim of this study was to investigate the pharmacogenomic variability of different biomarkers in pharmacogenes involved in the metabolism pathway of Fluoropyrimidines in patients with gastric cancer or colorectal cancer, which are sub-strutured according to response and toxicity to treatment. To perform the research we used 216 patients with colorectal or gastric cancer who received 5-FU chemotherapy treatment. We investigated 33 genetic polymorphisms in 17 pharmacogens (ABCB1, ABCC2, ABCC4, ABCG2, CYP2A6, DPYD, FPSG, ITGB5, MTHFR, SLC22A7, SLC29A1, TP53, TYMS, UMPS, GGH, RRM1, TYMP) involved in the metabolism pathway of fluoropyrimidines. Our results showed that 77.3% of the patients presented some type of toxicity related to 5-FU treatment, of which 22% presented severe toxicities classified in grade 3 and 4. Death occurred in 23 patients, where three cases were related to toxicity and four cases with tumor progression and chemotherapeutic toxicity. Population substructuration was not influential in the association results for pharmacogenetic polymorphisms with the use of 5-FU. The FPGS gene (rs4451422) was shown to be significant in association with overall toxicity (p = 0.0052; OR 0.32) and toxicity events (p = 0.0004; OR 0.22). The ABCC4 gene (rs148551) had a significant association with the clinical response (p = 0.0056; OR 0.28). The SLC29A1 gene (rs760370) was shown to be significant for grade 3 and 4 toxicities (p = 0.0033; OR 4.73). In conclusion, due to the high degree of miscegenation in the Brazilian population, and particularly in the North of Brazil, the generated 5-FU pharmacogenomics data are particularly unique when compared to the homogenous populations investigated to date. The ABCC4, FPGS and SLC29A1 genes have been shown to be important biomarkers predictive of personalized medicine therapy using 5-FU.
Acesso aberto (Open Access)
Identificação de polimorfismos de nucleotídeo único com efeitos deletérios em transcriptomas de câncer gástrico
(Universidade Federal do Pará, 2015-09-29) SILVA, Viviane Santos da; DARNET, Sylvain Henri; http://lattes.cnpq.br/4586614214029929
Gastric cancer is one of the leading causes of cancer mortality in the world. Its development is associated with factors related to lifestyle and genetic alterations that can modify genes and important biosynthetic and metabolic pathways that help maintaining cellular and tissue integrity. One of the main cancer research objectives is identify genes and mutations that may be used as genetic markers and potential therapeutic targets. Studies with genes related to the pathway of steroid hormones proteins have already identified polymorphisms that may be related to the risk of cancer. Because it is an important route for physiological and pathological processes identification of genetic polymorphisms in this and cholesterol biosynthesis pathway may contribute to the understanding of gastric carcinogenesis. Therefore, we performed a comprehensive bioinformatics analysis of transcriptome datasets from gastric tissues with and without cancer, in order to identify SNPs in genes associated to enzymes of biosynthetic pathways of steroid hormones, cholesterol and progesterone receptor that may be related to gastric cancer. The analysis was performed using the Galaxy Platform, the Bowtie alignment tool and the Provean software for functional analysis of variations. Deleterious mutations have been identified in CYP51A1, DHCR24 and SQLE genes in the steroid hormone biosynthesis pathway, and in CYP3A5, HSD17B12, UGT1A1, UGT1A5, UGT1A6 and AKR1C3 genes in the cholesterol biosynthetic pathway. The CYP3A5 gene had the highest number of deleterious SNPs. These results indicate a possible participation of genes analyzed in the molecular mechanisms involved in the development of gastric cancer.
Acesso aberto (Open Access)
Papel do gene PIWIL1 como possível agente no processo de transição epitélio-mesenquimal no câncer gástrico
(Universidade Federal do Pará, 2019) PAIVA, Juliana Albuquerque Pinto; KHAYAT, André Salim; http://lattes.cnpq.br/6305099258051586
The PIWI-LIKE PROTEIN 1 (PIWIL1) gene has emerged as an attractive target for gastric cancer, as studies have shown that PIWIL1 protein is expressed at increased levels in cancer tissues, stem cells and germ cells, but it has been shown to be absent in normal somatic tissues. This means that it could be a potential target for therapy, since most non-cancer cells would not be affected by cytotoxic effects. Although relevant information on the possible role of PIWIL1 in the carcinogenesis of gastric cancer is provided by the current literature, the molecular mechanisms involved in this carcinogenic process remain unclear. Therefore, in order to investigate the molecular mechanisms by which PIWIL1 confers advantages to cancer cells, CRISPR/Cas9 technology was employed in order to perform the permanent knockout of PIWIL1 gene in the AGP01 gastric cancer cell line. After knockout, experiments were carried out to evaluate the effect of this molecular alteration on the migration and invasion capacity of the cell line, as well as on the expression of genes involved in these two cellular mechanisms. The results demonstrated that PIWIL1 gene knockout caused a significant decrease in the migration capacity of AGP01 after 24 hours, as well as a significant decrease in the cell invasion capacity. In addition, gene expression results revealed 26 genes (five overexpressed and 21 hypoexpressed - when comparing the cell lines before and after knockout) that encode proteins involved in invasion and migration cellular processes. According to the current literature, nine of these 26 genes (DOCK2, ZNF503, PDE4D, ABL1, ABL2, LPAR1, SMAD2, WASF3 and DACH1) are possibly related to the mechanisms used by PIWIL1 to promote carcinogenic effects related to migration and invasion, since their functions are consistent with the observed modification (being overexpressed or hypoexpressed after knockout). Taken together, these data reinforce the idea that PIWIL1 should play a crucial role in the gastric cancer signaling pathway, regulating several genes involved in the migration and invasion processes, so its use as a therapeutic target can generate promising results in the treatment of this type of cancer.
Acesso aberto (Open Access)
Programa de estágio extracurricular teórico-prático interdisciplinar de iniciação em oncologia
(Universidade Federal do Pará, 2022-08-18) SILVA, José Henrique Santos; RAMOS, Raquel de Souza; http://lattes.cnpq.br/3576658450395680; ELIASQUEVICI, Marianne Kogut; http://lattes.cnpq.br/6655468164115415
From the identification of existing gaps in early learning stages of Health professionals to act upon the field of Oncology, this research sought to respond the focus question “How to assist in the training of undergraduates in the area of Health and sensitize them to work in the promotion, prevention, treatment, rehabilitation and palliation in oncology from an interdisciplinary perspective?”. To do so, the general objective was to “Structure an extracurricular internship program in Oncology for undergraduate students of courses in the area of Health in a theoretical-practical and interdisciplinary format of initiation in Oncology, based on the assumptions of active teaching-learning methodologies and interdisciplinary action”. This program was developed at the Instituição Oncológica do Brasil, a cancer research and treatment center located in Belém, Pará. Based on action research, the methodological path was divided into four phases: (i) carrying out a bibliographical survey; (ii) construction of the action plan; (iii) implementation of a pilot program; and (iv) follow-up of the investigation-action cycle. As an educational product resulting from the research, the “Guia didático: Programa de Estágio Extracurricular Teórico-Prático Interdisciplinar de Iniciação em Oncologia” was prepared, describing the structure of the Program (curricular organization, selection process, use of active teaching-learning strategies, evaluation process and others). The results obtained from the study also made it possible to verify the improvement in the training of undergraduates in the area of Health in terms of knowledge of Oncology subjects, which are scarcely addressed in the curricula of undergraduate courses. Because the Program is divided into axes (Teaching, Research and Extension), it provides a broader experience for the undergraduate student and the possibility of greater insertion in the Oncology specialty, expanding the vision of care and assistance in general. The division of the theoretical content into modules and the use of clinical cases makes teaching more focused on practical issues, related to the problems faced in the daily life of interdisciplinary assistance, providing the development of skills and competences for a differentiated support. Therefore, from the analysis of this experience, we believe that this developed product can favor and serve as an inspiration for the implementation of extracurricular internship programs in several other realities, whether or not in the area of Oncology – provided that the necessary adaptations are made and that the pedagogical proposals are similar.
Acesso aberto (Open Access)
A representação social dos enfermeiros sobre o câncer e suas implicações para o cuidado de enfermagem prestado aos pacientes oncológicos
(Universidade Federal do Pará, 2017-06-22) JESUS, José Maria Barreto de; SILVA, Sílvio Éder Dias da; http://lattes.cnpq.br/0084512862619143; https://orcid.org/0000-0003-3848-0348
Presented to the Graduate Program in Nursing of the Health Sciences Institute of the Federal University of Pará, Master's Degree in Nursing of the UFPa as part of the requisites required to obtain the Master's Degree in Nursing. This research aims to study the social representation of nurses on cancer and its implications for the nursing care provided to cancer patients. Interest in this subject appeared when I began to perceive the change in the profile of patients hospitalized at the hospital where they worked, from acute patients (leptospirosis, rabies, bacterial and viral meningitis, among others) to chronic diseases, specifically cancer. Cancer is a disease that first affects the cognitive level of the individual, who after the process of assimilation, comes to understand and fear. For this reason it accepts the treatment, which also implies suffering (mutilating surgeries, radiotherapy and chemotherapy). But when the manifestations of the disease materialize in the patient's body, his previous biotype is altered which translates into signs and symptoms, such as: severe weight loss, loss of muscle strength and others. The disease, now visualized by others, leaves the psychological sphere passing, also, to the sociological one - it becomes a psychosocial disease. Regarding the professional's view, cultural dimensions imply the understanding that cancer is a terminal illness, that is, when the individual is affected by the pathology, however great the dedication of the health team to death is inevitable . I emphasize that this reality is grounded not because cancer is a terminal disease, but because of the existence of a strong bureaucracy present in health services. It is worth mentioning that in the state of Pará, this problem is more pronounced due to the large size of the territory, which makes it difficult for patients to access health services. Cancer is a disease that is widely exploited by many types of research, including those of a psychosocial nature. But I would like to point out that the discussion about the social representations of nurses about cancer is of fundamental importance for a rethinking of nursing about the care given to a patient with a chronic and almost always terminal illness. Based on this understanding, I formulated the following objectives: characterize the social representation of nurses on cancer and analyze the implications of this social representation for the nursing care provided to cancer patients. The study is descriptive-exploratory, with a qualitative approach and theoretical contribution of the concepts of Theory of Social Representations. The work is based on primary sources: statements of nineteen nurses and a nurse, produced from a semi-structured interview and the technique of free association of ideas. I first opted for the application of the technique of free association of ideas, as a way to deepen the themes that emerged in the free association of ideas, I used the semi-guided interview as a second technique. The information was worked through the thematic analysis, which allows to know a reality, through the communications of individuals who have ties with it. I sought to follow the guidance of this author who unfolds this type of analysis in three stages: the first is the pre-analysis, which consisted in the selection and organization of the material, with the realization of floating reading and the constitution of the corpus; The second the exploitation of the material and the third, the data treatment and interpretation. As a result of the consolidation of two thematic units, so-called: cancer a chronic, degenerative, suffering and deadly disease and cancer patient: the experience of a new nursing care. The results evidenced the suffering experienced by the nurses in providing care to the cancer patient due to the frustration of the unreached cure. The implementation of a new care allowed the deponents to insert in their care practice an integral and humane care to this clientele.
Acesso aberto (Open Access)
Sobre a forma de ocupar-se de cuidar de pessoas sob cuidados paliativos
(Universidade Federal de São Carlos, 2019-01) PINTO, Aline da Cruz Cavalcante de; SILVA, Vanessa do Socorro Mendes da; SOUZA, Airle Miranda de; CORRÊA, Victor Augusto Cavaleiro
Introduction: Palliative care is a set of approaches to improve the quality of living for people who are out of the possibility of cure of a particular illness. Generally, they demand from family members the task of being caretakers, implying in their day-to-day occupations. The occupations are the various daily actions carried out by individuals, in groups and in the communities to which they belong, to fill the time and bring meanings and purposes to life. The occupational form understands what people do, how they do it, and in what circumstances they do. It is understood that caregivers of people who are in palliative care have a peculiar way of occupying themselves and with characteristic conditions. Objective: To understand the form of occupations of the main caregivers of people in oncological palliative care. Method: This is a qualitative research, carried out at a reference hospital in palliative care in the Northern Region of Brazil, at the Oncology Palliative Care Clinic (CCPO). An open interview was conducted with 20 family caregivers. Results: Outstanding changes in routine organization and dedication to caring for the loved one in palliative care. It also revealed that being a caregiver led to the difficult task of including, maintaining, and excluding day-to-day occupations. Conclusion: The study highlights the implications in the occupational repertoire in the condition of being a caregiver in palliative care and how the occupation is developed and drawing attention to the need for health professionals to direct their attention also to caregivers.