[Dispositional optimism in patients on chronic haemodialysis and its possible influence on their clinical course]. / Optimismo disposicional en pacientes en hemodiálisis y su influencia en el curso de la enfermedad.

INTRODUCTION: Dispositional optimism is a personality trait significantly associated with the use of positive adaptive coping strategies as well as with perceived psychological and physical well-being, and it appears to be an important predictor of illness. OBJECTIVES: To analyse if dispositional optimism is significantly associated with the number of hospital admissions of our chronic haemodialysis patients, as well as its relationship with perceived state of health. METHODS: We studied 239 patients on chronic haemodialysis. Patients were categorised into two groups according to the variables: hospital admissions/no. of admissions in the last year and dispositional optimism (DO). We used the following variables and questionnaires: 1) Dispositional O/P using the Spanish-validated cross-cultural adaptation of the revised version of the Life Orientation Test (LOT-R) (Scheier, 1994): higher scores mean a higher degree of dispositional optimism. 2) Health-related quality of life (HRQoL) using the different aspects of the COOP/WONCA (CW) charts and its total score. In this case higher scores mean lower HRQoL. 3) Modified Charlson Comorbidity Index (mCCI). 4) Age, gender, and time on dialysis. RESULTS: Mean age was 64.8 ± 14.3 years; median time on dialysis 2.9 years (range: 0-32); and median LOT-R 21 (range 6-30). Patients considered DO had a lower risk of hospital admissions than pessimists (DP) (OR: 0.55; IC 95%: 0.32-0.94; P<.05). PD Patients that were admitted in the last year showed a significantly lower score on LOT-R (they were more pessimistic) than those that had no hospital admissions (19.4 ± 5.7 vs 22.3 ± 4.6; P=.001). We found no significant differences between admitted and not admitted patients in age, gender, time on haemodialysis and comorbidity. Admitted patients showed worse HRQoL (higher scores in total CW) than those that were not (Total CW: 22.37 vs 19.42; P<.001). PD patients had significantly higher scores than OD patients in all COOP-WONCA aspects except in aspect 1 (physical fitness) and 5 (change in health). CONCLUSIONS: Pessimistic personality trait is significantly associated with hospital admissions in chronic haemodialysis patients, regardless of age, gender and comorbidity. Optimistic patients perceived a better state of health.

[Phosphorus binders: preferences of patients on haemodialysis and its impact on treatment compliance and phosphorus control]. / Captores del fósforo: preferencias de los pacientes en hemodiálisis y su repercusión sobre el cumplimiento del tratamiento y el control del fósforo.

INTRODUCTION: Non-adherence to phosphate binding (PB) medication may play a role in the difficulty in achieving the targets for phosphorus. We have a wide armamentarium of PB but preferences of patients are poorly understood. OBJECTIVE: to study the patients' preferences and beliefs regarding PB and their influence on adherence and serum phosphate. METHODS: A cross-sectional cohort study was performed. A total of 121 hemodialysis patients answered a specific questionnaire in which they were questioned about adherence, the type of PB they preferred and the reasons for their choice. All patients questioned tasted two or three PB. The consequence of non-adherence to PB was estimated indirectly by determination of serum phosphorus. RESULTS: Specific noncompliance with PB medication was recognized by 21.4% of patients. Patients non-adherent specifically to PB were more likely to have P levels >5.5 mg/dl (χ(2): 4.7; 95% CI 1.07-6.5; p = 0.03). Paradoxically, patients non-adherent showed greater knowledge of the use (χ(2): 17.3; 95% CI -2.2-10.1; p <0.0001) and importance of the drug (χ(2): 10.4; 95% CI -1.5-6.6; p = 0.001). The percentage of patients prescribed binders they did not like was 54.5%. Patients who were taking PB they did not like had a greater risk of having P levels >5.5 mg/dl) (χ(2): 13.3; 95% CI -1.1-1.5; p = 0.0001). Calcium acetate was the preferred PB in 47.1% of patients, lanthanum carbonate in 40%, sevelamer in 20.6% and aluminum hydroxide in 19.4%. The reasons claimed by patients for their negative ratings of PB were the type of dosage form, the taste, the number of tablets and gastric intolerance. Gastric intolerance and bad taste were more frequent in aluminum hydroxide patients (19.4% and 22.2%, respectively). Sevelamer received complaints about its dosage form because the tablets were too large and a large number of tablets were required (27.2%). 17.7% of patient who were taking lanthanum carbonate did not like the chewable tablets. CONCLUSION: patients who were taking binders that they did not like had worse serum P levels and were prescribed higher doses of binders. Knowing patients' preferences about the drugs prescribed may be a key factor in achieving adequate adherence to treatment.

[Sexual function and quality of life in hemodialysis male patients]. / Función sexual y calidad de vida en pacientes varones de hemodiálisis.

BACKGROUND: The sexual dysfunction is a highly prevalent problem among uremic men that limits their quality of life. The aim of this study was to determine the sexual function in chronic renal failure in males patients on hemodialysis and to find the nature of the problem. Also, we explored the impact of sexual dysfunction on health-related quality of life. METHODS: 103 male patients older than 18 years and receiving HD treatment were studied. The sexual function was evaluated with the International Index of Erectile Function, and the health-related quality of life was quantified with the COOP-WONCA Charts, both in their Spanish versions. RESULTS: 47% of the patients didn't have any kind of sexual activity. These ones presented a more advanced age (p < 0.001), a longer stay on dialysis (p < 0.001), a greater comorbidity index (p < 0.05) and smaller levels of seric albumin (p < 0.05). The sexually active patients presented a better physical fitness (p < 0.001) and overall health (p < 0.05), and a smaller difficulty to carry out the daily activities (p < 0.05) and pain (p < 0.05). A 40% of the patients with some kind of sexual function had a good erectile function, the 34.5% suffered a slight erectile dysfunction, the 16.4% a moderate one and the 9.1% a severe one. Multiple linear regression analysis demonstrated that the main determinant of the sexual activity was the age, followed by the physical fitness and the time on HD (32.7% of the variance explained). We found statistically significative correlation between the total score of IIEF and felings (r = -0.34; p < 0.05), daily activities (r = -0.27; p < 0.05), social activities (r = -0.30; p < 0.05), social support (r = -0.45; p < 0.01) and quality of life (r = -0.29; p < 0.05). The patients without sexual activity didn't perceive their deficiency as a problem and considered this situation inherent to the ageing process. CONCLUSIONS: The sexual dysfunction is a highly prevalent problem in the uremic male, but it doesn't have to be necessarily associated to a serious deterioration of the HRQOL. In this way, the presence or not of sexual activity doesn't present significant effect on the things that one has or wants to do. With everything, the patient without sexual activity frequently has advanced age, refers worse state of health and presents more problems of physical functioning and at the moment of taking to daily activities.

[Burnout's syndrome in critical care nursing professionals]. / Síndrome de Burnout en profesionales de enfermería de cuidados críticos.

The concept of the "Burnout Syndrome" has come as a result of the chronic work-stress developed in workers involved in human services during their professional activity. The working conditions and the specific characteristics of the job developed at the Intensive Care Units by the nursing staff, involve a high risk for this group to acquire this syndrome. The main objective of this study is to assess the prevalence of the Burnout Syndrome in the nursing staff of the ICUs in different hospitals of the Alicante province, Spain, by means of the Malsach Burnout Inventory questionnaire. This questionnaire is self-administered and was handed to all the nursing staff at the ICUs in the University Hospitals of Alicante and Elche and in the Hospital Marina Baixa of Villajoyosa. form the total of 107 questionnaires, 83 proved to be valid. The average total of MBI was of 55.05, indicating low values of emotional tiredness, low depersonalisation, and an adequate level of personal accomplishment.

[Gastrointestinal signs and symptoms during pregnancy and postpartum in a sample of Spanish women]. / Signos y síntomas gastrointestinales durante el embarazo y puerperio en una muestra de mujeres españolas.

OBJECTIVE: To describe the evolution of the signs and more frequent gastrointestinal symptoms during the pregnancy and in the two weeks later the birth. SUBJECTS: 583 pregnant women, elects in an accidental way, interviewees between the 8 and 12 weeks of gestation (n = 133), among 18 and 22 (n = 155), among 37 and 42 (n = 203) and two weeks after the childbirth (n = 92) and coming from centers of health and hospitals of the Comunidad Valenciana and Murcia. The questionnaire, answered in a voluntary way by interview, it contained a listing on the signs and more frequent gastrointestinal symptoms during the pregnancy, and she answered on the presence or not of the same ones in the two weeks previous to the moment of the interview. RESULTS: The percentage of nauseas and vomits, although higher in the first trimester, stays around the 25-30% in the third gestation trimester. The heartburn is presented in 58.6% of the pregnant women in the third trimester. The sialorrea is presented in 7.7% of all the pregnant women and she stays during the whole gestation. The constipation stays constant during the gestation above at the 25-30%. The prevalence of haemorrhoids to the beginning of the gestation is over to 8% to be located in the postpartum in 53.3%. CONCLUSIONS: The description of the evolution of the signs and symptoms of the pregnancy described in the obstetrics manuals don't come up with our data.

[Study on health related quality of life based on information from COOP/WONCA sheets]. / Evaluación de la calidad de vida relacionada con la salud mediante las láminas COOP/WONCA.

BACKGROUND: The main objective of this study is to describe the quality of life related to health (QLRH) in primary health patients, in escorts of primary health care patients, in pregnant women, in relatives caring for Alzheimer patients, and in drug addicts. PATIENTS AND METHODS: The sample consists of 1,408 persons: primary health care patients (n = 475), escorts of primary health care patients (n = 200), in pregnant women (n = 510), in relatives caring for Alzheimer patients (n = 169), and in drug addicts (n = 68). The QLRH has been measured according to the Spanish version of the COOP/WONCA charts. The questionnaire was filled directly by the people surveyed. RESULTS: The group of pregnant women is the group less physically fit but at the same time the group with best health status, higher social support and best quality of life. At the other end, the group of addicts is the worst considered group regarding the variables of feelings, social activities and quality of life. The factor analysis shows a unifactor structure and its internal consistency is 0.79 (Cronbach's alpha). The multiple regression of COOP/WONCA charts over the variables of age, sex and study groups explains the 14% of the variance (r2 = 0.14). CONCLUSIONS: The COOP/WONCA charts allow for the establishment of distinctions in some of the groups studied (pregnant women and drug addicts), but do not establish enough differences with respect to other groups, which may be due to a certain homogeneity among them. The use of a global score for the COOP/WONCA charts would be theoretically and methodology feasible.

[Cross cultural adaptation of a health related quality of life measurement: the Spanish version of the COOP/WONCA cartoons]. / Adaptación transcultural de una medida de la calidad de vida relacionada con la salud: la versión española de las viñetas COOP/WONCA.

OBJECTIVES: Cross-cultural adaptation to Castilian Spanish of the original COOP/WONCA charts questionnaire and its validation for use in Spain. DESIGN: Descriptive crossover study. SETTING: Primary Care. PATIENTS: Pilot test with a consecutive sample of 63 patients from a medical list. The final version was administered to a random sample of 475 patients from five medical lists of two urban Health Centres. MEASUREMENTS AND MAIN RESULTS: The adaptation was based on the method of translations and independent back-translations by bilingual persons, from the original version of the instrument and performance of the pilot test. The conceptual equivalence between the final version and the original questionnaire was satisfactory in 8 of the 9 items. Mean scores of the semantic and syntactic equivalences were high and equally satisfactory. Cronbach's alpha was above 0.7 for 6, 7 and 9 items. Spearman's correlation coefficients between two administrations of the questionnaire, separated by 15 days, scored between 0.52 and 0.72. The factorial analysis of 6, 7 and 9 items revealed a unifactorial structure. All the load values ranged between 0.5 and 0.8 except item 5. CONCLUSIONS: The adaptation of the COOP/WONCA charts questionnaire finished with an instrument apparently equivalent to the original and with acceptable reliability and validity. However, other basic characteristics such as sensitivity to changes need to be explored, and aspects of construct validity examined more closely.

[Construction and validation of an index of psychosocial adjustment in intensive care without interviewing the patient. Group of Researchers of the ASCI (social support in intensive care) Project]. / Construcción y validación de un índice de ajuste psicosocial en cuidados intensivos sin entrevista del paciente. Grupo de Investigadores del Proyecto ASCI.

BACKGROUND: Psycho-social support factors play an important role in the health status of the community. Their effect on the clinical course of critically ill patients is poorly known. One of the main obstacles for their study is the difficulty of the measurement of psychosocial factors in the critical care environment. The objective of this study is to build-up and validate an instrument to assess the psycho-social adjustment in critical care patients. METHODS: We have studied 214 adult patients admitted to the intensive care unit (ICU) in a public hospital with 420 beds. None of them was in coma or showed signs of encephalopathy or acute psychosis. Each patient was independently evaluated by two nurses that rated 15 variables related to the patient's psychosocial environment, without direct interview of the patient. The inter-observer concordance was assessed using the weighted kappa index. The internal consistency of the selected items was assessed by the Cronbach's index. RESULTS: The inter-observer concordance in the assessment of the different items was always higher than 0.4. The classical analysis of the internal consistency selected 7 items (environmental confidence, perceived family-support, refusal of the critical situation, irritation, affliction, empathy and liking) which showed an alpha coefficient of 0.77. The psychosocial adjustment scale built upon these 7 items showed a good inter-observer concordance (kappa = 0.71). CONCLUSIONS: Critical care nurses can reliably assess some psychosocial variables in critical care patients. These assessments allows the building of a scale of psychosocial adjustment in the ICU applicable to a wide variety of critical patients and that does not requires direct interview of the patient.