Occupational practice in patients with hereditary transthyretin amyloidosis, a qualitative study.

BACKGROUND: Hereditary transthyretin amyloidosis (ATTRv) is a rare genetic disease that negatively affects patients' quality of life through the involvement of various organs and tissues. Despite a large amount of research on medical and psychosocial interventions, the impact of occupational therapy (OT) on patients with ATTRv is not well understood. OBJECTIVE: The aim of this study was to develop an OT programme to improve the daily functioning and quality of life of patients with ATTRv. METHODS: Fourteen patients with ATTRv were interviewed. Together they developed short- and medium-term occupational goals. Patients received the OT intervention for six months. Outcomes were measured using scores for activities of daily living and psychological well-being. RESULTS: The study found that OT can have a positive impact as a complementary intervention to medical and other psychosocial treatments. Of the 14 patients, 12 maintained the same scores in activities of daily living. Two deteriorated and eight improved their psychological scores. CONCLUSION: This study highlights the need for further research in this area and the importance of OT in the management of patients with ATTRv. Early intervention is of paramount importance and further research is needed to evaluate the long-term effects of OT interventions in patients with ATTRv.

Characteristics of patients with panic disorder attended in primary care during the COVID-19 pandemic: A cross-sectional multicenter study.

OBJECTIVE: To assess the prevalence of panic disorder during the second and third waves of the COVID-19 pandemic. DESIGN: Cross-sectional multicenter study. SETTING: Primary care. PARTICIPANTS: Participating primary care physicians selected patients visiting their primary care centers for any reason over a 16-month period. MAIN OUTCOME MEASURE: Diagnosis of panic disorder was established using The Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument. RESULTS: Of a total of 678 patients who met the inclusion criteria, 36 presented with panic disorder, with a prevalence of 5.3% (95% confidence interval 3.6-7.0). A total of 63.9% of cases occurred in women. The mean age was 46.7±17.1 years. Socioeconomic difficulties, such as very low monthly income rate, unemployment, and financial constraints to make housing payments and to make ends meet were more frequent in patients with panic disorders as compared to patients without panic disorder. A high level of stress (Holmes-Rahe scale>300), concomitant chronic fatigue syndrome and irritable bowel disease, and having financial difficulties in the past 6 months were associated with factors of panic disorder. DISCUSSION: This study characterizes patients with panic disorder diagnosed with a validated instrument during the COVID-19 pandemic and identified risk factors for this disease. CONCLUSIONS: In non-selected consecutive primary care attendees in real-world conditions during the COVID-19 pandemic, the prevalence of panic disorder was 5.3%, being more frequent in women. There is a need to enhance primary care resources for mental health care during the duration of the pandemic and beyond.

Establishing Occupational Therapy Needs: A Semi-Structured Interview with Hereditary Transthyretin Amyloidosis Patients.

The purpose of this study was to explore the occupational performance and needs of patients with hereditary transthyretin amyloidosis (ATTRv). A semi-structured interview was conducted by an occupational therapist with 44 patients with Val50Met-ATTRv recruited through patient associations. The interview addressed three related dimensions. The first one, the physical dimension, was evaluated using the Spanish versions of the Barthel Index, the Lawton and Brody scale, and the Norfolk questionnaire; the second one, the psychological dimension, was assessed with the Warwick-Edinburgh Mental Well-Being Scale and the SF-36 questionnaire; and the third dimension, the occupational performance, was assessed through unstructured questions on daily occupations, work, roles, and hobbies given the lack of standardized scales. Twenty participants (45.4%) responded that the disease had affected their basic activities of daily living, twenty- four (54.5%) perceived an impact on their instrumental activities of daily living, and all the participants reported that the disease symptoms had affected their ability to perform advanced activities as well as their employment status. Only three patients (6.8%) reported a lack of psychological impairment following disease diagnosis. These findings suggest that a semi-structured interview conducted by an occupational therapist can provide essential information that should be considered for the implementation of occupational therapy programs targeting patients living with a diagnosis of ATTRv.

Accessibility to Occupational Therapy Services for Hereditary Transthyretin Amyloidosis.

This study was designed to investigate the global utilization of occupational therapy (OT) services by patients with hereditary transthyretin amyloidosis (ATTRv) in Spain. The main objective was to find out whether these patients have access to OT services and the types of interventions being offered to them, together with their satisfaction and real benefits as users. We developed an online questionnaire which was distributed to patients with ATTRv in Spain through patient associations. Seventy-four patients with a diagnosis of ATTRv residing in Spain participated in the study. Thirteen had already used OT services at least once, felt that OT interventions improved their quality of life, would recommend OT services to others, and would return to see an occupational therapist. However, 61 had never used this type of service before. Of these, 35 knew what OT is and 13 declared that they considered that OT interventions in ATTRv could be positive for them. The results suggest that the use of OT services by ATTRv patients is low, mainly because of the lack of information about the occupational profile of individuals with this disease. The low response rate obtained for the survey limits generalization, and thus further research to confirm these preliminary findings is needed.

Depressive Symptom Clusters in Relation to Body Weight Status: Results From Two Large European Multicenter Studies.

Background: There is strong evidence for a bidirectional association between depression and obesity. Several biological, psychological, and behavior-related factors may influence this complex association. Clinical impression and preliminary evidence suggest that patients with a diagnosis of major depressive disorder may endorse very different depressive symptom patterns depending on their body weight status. Until now, little is known about potential differences in depressive symptoms in relation to body weight status. Objective: The aim of this analysis is the investigation of potential differences in depressive symptom clusters (mood symptoms, somatic/vegetative symptoms, and cognitive symptoms) in relation to body weight status. Methods: Cross-sectional baseline data were derived from two large European multicenter studies: the MooDFOOD Trial and the NESDA cohort study, including persons with overweight and obesity and normal weight reporting subthreshold depressive symptoms (assessment via Inventory of Depressive Symptomatology Self-Report, IDS-SR30). Different measures for body weight status [waist-to-hip ratio (WHR) and body mass index (BMI)] were examined. Propensity score matching was performed and multiple linear regression analyses were conducted. Results: A total of n = 504 individuals (73.0% women) were analyzed. Results show that more somatic/vegetative depressive symptoms, such as pain, change in appetite and weight, gastrointestinal symptoms, and arousal-related symptoms, were significantly associated with both a higher BMI and higher WHR, respectively. In addition, being male and older age were significantly associated with higher WHR. Mood and cognitive depressive symptoms did not yield significant associations for both body weight status measures. Conclusions: Somatic/vegetative symptoms and not mood and cognitive symptoms of depression are associated with body weight status. Thus, the results support previous findings of heterogeneous depressive symptoms in relation to body weight status. In addition to BMI, other body weight status measures for obesity should be taken into account in future studies. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02529423.

Gender differences on functioning in depressive patients.

BACKGROUND: Depression is one of the most common disorders in primary care and the fourth most disabling medical condition worldwide. Although gender differences in the prevalence of depression are well established, the little available data on gender-related differences in disabilities among depression patients gives controversial results. This study aims to analyse whether there are gender differences in the disabilities experienced by patients with depression. METHODS: A cross-sectional, multicentre, nationwide epidemiological study was conducted, with 1226 patients. A Case Report Form was used to collect sociodemographic data and the 12-item version of the World Health Organization Disability Assessment Schedule II (WHO-DAS-II) was used to assess functioning. Depression severity was assessed using the Quick Inventory of Depressive Symptomatology (QIDS). RESULTS: Non-statistically significant differences in functioning were found between males and females. An item-by-item analysis of the WHO-DAS-II shows significant differences between both sexes in specific areas. Women obtained higher scores than men for standing for long periods and walking a long distance. Males scored higher than women in dealing with people you did not know well and maintaining a friendship. LIMITATIONS: Given the descriptive and cross-sectional nature of the study, the results are limited, highlighting the need for further research. Also, other variables that might influence disability, such as medical illnesses, were not considered. CONCLUSIONS: The effect of depression on disability is similar for both sexes but not uniform in terms of the impact on different aspects of the quality of life. These findings could be an important factor in the assessment of functioning and management of depression.

Perceived stress latent factors and the burnout subtypes: a structural model in dental students.

BACKGROUND: Students of health-professions suffer high levels of stress and burnout. The aim of the present study was to evaluate the relationship between perceived stress latent factors ('tenseness' and 'frustration') and the features ('overload', 'lack of development' and 'neglect') of the three burnout subtypes ('frenetic', 'under-challenged' and 'worn-out', respectively), in a sample of Spanish dental students. METHODS: The study employed a cross-sectional design. A sample of Spanish dental students (n = 314) completed the 'Perceived Stress Questionnaire' and the 'Burnout Clinical Subtype Questionnaire Student Survey'. The associations among variables were observed by means of structural equation modelling using the unweighted least squares method from polychoric correlations. RESULTS: Strong associations among perceived stress factors and the burnout characteristics were observed, although a distinct pattern of relations was observed for each burnout subtype. The 'overload' was moderately and positively associated with both 'tenseness' (0.45), and 'frustration' (0.38) dimensions of perceived stress; the 'lack of development' was positively associated with the 'frustration' dimension (0.72), but negatively associated with 'tenseness' (-0.69); the 'neglect' showed a weaker positive associated with 'frustration' (0.41), and a small negative association with 'tenseness' (-0.20). The model was a very good fit to the data (GFI  =  0.96; RSMR  =  0.07; AGFI = 0.96; NFI = 0.95; RFI = 0.95). CONCLUSIONS: The stress factors of 'frustration' and 'tenseness' seems to be related in a distinct way to the burnout subtypes in Spanish dental students. This finding suggests that intervention programs specifically tailored to these subtypes may be a promising future direction.

Burnout syndrome among dental students: a short version of the "Burnout Clinical Subtype Questionnaire" adapted for students (BCSQ-12-SS).

BACKGROUND: Burnout has been traditionally defined in relation to the dimensions of "exhaustion", "cynicism", and "inefficiency". More recently, the Burnout Clinical Subtype Questionnaire (BCSQ-12) further established three different subtypes of burnout: the "frenetic" subtype (related to "overload"), the "under-challenged" subtype (related to "lack of development"), and the "worn-out" subtype (related to "neglect"). However, to date, these definitions have not been applied to students. The aims of this research were (1) to adapt a Spanish version of the BCSQ-12 for use with students, (2) to test its factorial validity, internal consistency, convergent and discriminant validity, and (3) to assess potential socio-demographic and occupational risk factors associated with the development of the subtypes. METHOD: We used a cross-sectional design on a sample of dental students (n = 314) from Santiago and Huesca universities (Spain). Participants completed the Burnout Clinical Subtype Questionnaire Student Survey (BCSQ-12-SS), the Maslach Burnout Inventory Student Survey (MBI-SS), and a series of socio-demographic and occupational questions formulated for the specific purpose of this study. Data were subjected to exploratory factor analysis (EFA) using the principal component method with varimax orthogonal rotation. To assess the relations with the criterion, we calculated the Pearson correlation coefficient (r), multiple correlation coefficient (R(y.123)), and the coefficient of determination (R(2)(y.123)). To assess the association between the subtypes and the socio-demographic variables, we examined the adjusted odds ratio (OR) obtained from multivariate logistic regression models. RESULTS: Factorial analyses supported the theoretical proposition of the BCSQ-12-SS, with α-values exceeding 0.80 for all dimensions. The "overload-exhaustion" relation was r = 0.59 (p < 0.001), "lack of development"-"cynicism", r = 0.49 (p < 0.001), "neglect"-"inefficiency", r = 0.47 (p < 0.001). The "overload"-"lack of development" relation was r = 0.21 (p < 0.001), "overload"-"neglect", r = 0.20 (p < 0.001), and "lack of development"-"neglect", r = 0.38 (p < 0.001). The BCSQ-12-SS explained 38.44% of the variability in "exhaustion", (R(y.123) = 0.62), 30.25% in "cynicism" (R(y.123) = 0.55), and 26.01% in "inefficiency" (R(y.123) = 0.51). "Hours spent on studying" was found to be associated with "overload" (p = 0.001), "campus" with "lack of development" (p = 0.013), and ""failed subjects" with "neglect" (p = 0.011). CONCLUSIONS: The results support the definition of burnout as established by the BCSQ-12-SS. As such, the BCSQ-12-SS can be used for the recognition of clinical profiles and for the suggestion of potential intervention strategies specific to the characteristics of each particular case.

Towards a brief definition of burnout syndrome by subtypes: development of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-12).

BACKGROUND: Burnout has traditionally been described by means of the dimensions of exhaustion, cynicism and lack of eficacy from the "Maslach Burnout Inventory-General Survey" (MBI-GS). The "Burnout Clinical Subtype Questionnaire" (BCSQ-12), comprising the dimensions of overload, lack of development and neglect, is proposed as a brief means of identifying the different ways this disorder is manifested. The aim of the study is to test the construct and criterial validity of the BCSQ-12. METHOD: A cross-sectional design was used on a multi-occupational sample of randomly selected university employees (n = 826). An exploratory factor analysis (EFA) was performed on half of the sample using the maximum likelihood (ML) method with varimax orthogonal rotation, while confirmatory factor analysis (CFA) was performed on the other half by means of the ML method. ROC curve analysis was preformed in order to assess the discriminatory capacity of BCSQ-12 when compared to MBI-GS. Cut-off points were proposed for the BCSQ-12 that optimized sensitivity and specificity. Multivariate binary logistic regression models were used to estimate effect size as an odds ratio (OR) adjusted for sociodemographic and occupational variables. Contrasts for sex and occupation were made using Mann-Whitney U and Kruskall-Wallis tests on the dimensions of both models. RESULTS: EFA offered a solution containing 3 factors with eigenvalues > 1, explaining 73.22% of variance. CFA presented the following indices: χ² = 112.04 (p < 0.001), χ²/gl = 2.44, GFI = 0.958, AGFI = 0.929, RMSEA = 0.059, SRMR = 0.057, NFI = 0.958, NNFI = 0.963, IFI = 0.975, CFI = 0.974. The area under the ROC curve for 'overload' with respect to the 'exhaustion' was = 0.75 (95% CI = 0.71-0.79); it was = 0.80 (95% CI = 0.76-0.86) for 'lack of development' with respect to 'cynicism' and = 0.74 (95% CI = 0.70-0.78) for 'neglect' with respect to 'inefficacy'. The presence of 'overload' increased the likelihood of suffering from 'exhaustion' (OR = 5.25; 95% IC = 3.62-7.60); 'lack of development' increased the likelihood from 'cynicism' (OR = 6.77; 95% CI = 4.79-9.57); 'neglect' increased the likelihood from 'inefficacy' (OR = 5.21; 95% CI = 3.57-7.60). No differences were found with regard to sex, but there were differences depending on occupation. CONCLUSIONS: Our results support the validity of the definition of burnout proposed in the BSCQ-12 through the brief differentiation of clinical subtypes.

Sociodemographic and occupational risk factors associated with the development of different burnout types: the cross-sectional University of Zaragoza study.

BACKGROUND: Three different burnout types have been described: The "frenetic" type describes involved and ambitious subjects who sacrifice their health and personal lives for their jobs; the "underchallenged" type describes indifferent and bored workers who fail to find personal development in their jobs, and the "worn-out" in type describes neglectful subjects who feel they have little control over results and whose efforts go unacknowledged. The study aimed to describe the possible associations between burnout types and general sociodemographic and occupational characteristics. METHODS: A cross-sectional study was carried out on a multi-occupational sample of randomly selected university employees (n = 409). The presence of burnout types was assessed by means of the "Burnout Clinical Subtype Questionnaire (BCSQ-36)", and the degree of association between variables was assessed using an adjusted odds ratio (OR) obtained from multivariate logistic regression models. RESULTS: Individuals working more than 40 hours per week presented with the greatest risk for "frenetic" burnout compared to those working fewer than 35 hours (adjusted OR = 5.69; 95% CI = 2.52-12.82; p < 0.001). Administration and service personnel presented the greatest risk of "underchallenged" burnout compared to teaching and research staff (adjusted OR = 2.85; 95% CI = 1.16-7.01; p = 0.023). Employees with more than sixteen years of service in the organisation presented the greatest risk of "worn-out" burnout compared to those with less than four years of service (adjusted OR = 4.56; 95% CI = 1.47-14.16; p = 0.009). CONCLUSIONS: This study is the first to our knowledge that suggests the existence of associations between the different burnout subtypes (classified according to the degree of dedication to work) and the different sociodemographic and occupational characteristics that are congruent with the definition of each of the subtypes. These results are consistent with the clinical profile definitions of burnout syndrome. In addition, they assist the recognition of distinct profiles and reinforce the idea of differential characterisation of the syndrome for more effective treatment.

Commitment, enjoyment and motivation in young soccer competitive players.

Building upon Deci's and Ryan (1985) Self-determination theory as well as the sportive behavioral correlates of the model of Commitment (Scanlan et al., 1976), this study tries to establish the relationship between motivation and commitment in youth sport. For this purpose 454 young competitive soccer players answered the Sport Motivation Scale (SMS) and the Sport Commitment Questionnaire (SCQ) during the regular season. The SMS measures the three dimensions of the Motivational continuum (the Amotivation, the Extrinsic Motivation and the Intrinsic Motivation). The SCQ measures the Sportive Commitment and its composing factors such as the Enjoyment, the Alternatives to the sport, and the Social Pressure. Our findings provided a clear pattern of the influence of motivation in sport enjoyment and commitment, outlining the positive contribution of intrinsic and extrinsic motivation to enjoyment and commitment. Amotivation, contributes positively to alternatives to sport and negatively to enjoyment and commitment, It should be noted that extrinsic motivation has a higher contribution to enjoyment whereas intrinsic motivation has a higher contribution to commitment.

[Quality of life and personality in inflammatory bowel disease]. / Calidad de vida y personalidad en la enfermedad inflamatoria intestinal.

The present article reviews recent studies analyzing the association between health-related quality of life (HRQoL) and personality in inflammatory bowel disease (IBD). HRQoL is especially important in chronic diseases, since the strategic goals of treatment are to relieve symptoms, delay progression and improve functional quality. Some studies show that HRQoL in patients with IBD is significantly lower than that in the general population. Few studies have analyzed the association between personality and IBD and the results are contradictory. The most prevalent personality disorders in IBD are avoidant personality disorder and obsessive-compulsive personality disorder. Some results of a longitudinal study corroborating impaired HRQoL in these patients and the presence of one or more personality disorders in 57% of the sample are discussed.