Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project).

BACKGROUND: Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19. METHODS: This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p<0.05 was considered significant. RESULTS: Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms. CONCLUSION: GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.

Incidence of opioid-induced esophageal dysfunction.

BACKGROUND: Retrospective studies have suggested that long-term use of opioids can cause esophageal motility dysfunction. A recent clinical entity known as opioid-induced esophageal dysfunction (OIED) has been postulated. There is no data from prospective studies assessing the incidence of opioid-induced effects on the esophagus. AIM: Evaluate the incidence of OIED during chronic opioid therapy. METHODS: From February 2017 to August 2018, all patients seen in the Pain Unit of the hospital, who started opioid treatment for chronic non-neoplastic pain and who did not present esophageal symptoms previously, were included. The presence of esophageal symptoms was assessed using the Eckardt score after 3 months and 1 year since the start of the study. In February 2021, the clinical records of all included patients were reviewed to assess whether esophageal symptoms were present and whether opioid therapy was continued. In patients presenting with esophageal symptoms, an endoscopy was performed and, if normal, a high-resolution esophageal manometry was performed. For a confidence level of 95%, a 4% margin of error and an estimated prevalence of 4%, a sample size of 92 patients was calculated. RESULTS: 100 patients were included and followed while taking opioids, for a median of 31 months with a range between 4 and 48 months. Three women presented with dysphagia during the first 3 months of treatment, being diagnosed with esophagogastric junction outflow obstruction; type II and type III achalasia. The cumulative incidence of OIED was 3%; 95%-CI: 0-6%. CONCLUSIONS: Chronic opioid therapy in patients with chronic non-neoplastic pain is associated with symptomatic esophageal dysfunction.

Impact of gastrointestinal symptoms and psychological disturbances on patients' quality of life after restrictive or malabsorptive bariatric surgery.

AIM: The aim of this study was to evaluate and compare the presence and impact of Gastrointestinal (GI) symptoms, physical and psychological disturbances on patients' QoL after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS). METHODS: A prospective, observational, cross-sectional, comparative study was carried-out. GI symptoms and patients' QoL were evaluated by the SF-36 questionnaire and the GI quality of life index (GIQLI). Correlation between GI symptoms, psychological disturbances and QoL scores was analysed. RESULTS: 95 patients were included (mean age 50.5 years, range 22-70; 76 females). Presence of GI symptoms was a consistent finding in all patients, and postprandial fullness, abdominal distention and flatulence had a negative impact on patients' QoL. Patients after SG showed a worsening of their initial psychological condition and the lowest QoL scores. Patients after RYGB showed the best GI symptoms-related QoL. CONCLUSIONS: Both restrictive and malabsorptive bariatric surgical procedures are associated with GI symptoms negatively affecting patients' QoL. Compared to SG and BPD/DS, patients after RYGB showed the best GI symptoms-related QoL, which can be used as additional information to help in the clinical decision making of the bariatric procedure to be performed.

Internalizing and externalizing behaviors in high school adolescents in a northern border city of Mexico and their type of family.

OBJECTIVE: Identify externalizing and internalizing behaviors in high school adolescents in three schools in a northern border city in Mexico and their type of family. DESIGN: Cross-sectional survey. LOCATION: Three schools in the city of Tijuana, Mexico: two public and one private. PARTICIPANTS: 454 baccalaureate students 14-19 years old. MAIN MEASUREMENTS: We utilized Youth Self Report Scale, adapted and validated in Spanish, that measure internalization behaviors (anxiety, depression, isolation or somatic complaints), and externalization behaviors (verbal aggressiveness, delinquent behavior and attention-seeking). For dichotomous discrimination between deviant and nondeviant scores, we use the borderline clinical range by classifying YSR scale's T scores≥60, and to analyze the relationship between behavior problems or competencies and living or not in a nuclear family we utilized multiple logistic regression. RESULTS: 55% were female, mean age 16.4 years±0.98, and 62.3% came from a nuclear family. Prevalence of internalizing behaviors was 15.6%, and externalizing behaviors 14.8%. Women had statistically higher mean scores in depressive, anxious and verbally aggressive behavior, somatic complaints, and thought problems. The prevalence of internalizing behaviors in adolescents with nuclear family was 11.7% (n=33), and for adolescents with another type of family was 22.2% (n=38), OR 2.17 (CI 95% 1.30-3.61, p=0.003), but no differences was observed for externalizing behaviors and family type. When adjusted for sex, age, and public or private school, internalizing behaviors and specifically depressive behavior remained significant. CONCLUSIONS: We detected a moderate prevalence of internalizing behaviors in Mexican adolescents, predominantly among women, and also observed that not living with a nuclear family increases the odds of presenting internalizing behaviors. It is important that parents, teachers, and healthcare workers remain vigilant to detect these problems in a timely manner and develop interventions to improve the mental health and well-being of adolescents.

Longitudinal impact of caregiver transition and family caregiving on psychiatric symptoms and psychosocial functioning among persons with schizophrenia in rural China.

This study examines the 21-year longitudinal impacts and predictive effects of family caregiver transition and the presence of family caregiving on the clinical status of persons with schizophrenia (PwSs) in a rural area of China. Using panel data derived from the Chengdu Mental Health Project (CMHP), 250 dyads of PwSs and their family caregivers were investigated in 1994 and 2015. The Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) were utilized. The generalized linear model (GLM) approach was used. The results of this study showed that more severe symptoms in PwSs were found to be significantly predicted by older age and nonmarried status at baseline. Compared with "spousal caregiving in two waves," the PANSS score was significantly higher in the "transition into sibling caregiving" group. A higher degree of psychosocial functioning was found to be significantly predicted by marital status, shorter duration of illness, and better mental status. Compared with "spousal caregiving in two waves," the GAF score was significantly lower in the "transition into parental caregiving" group. The presence of family caregiving was not a significant predictor of the severity of symptoms or psychosocial functioning in the PwSs. In conclusion, this study shows the 21-year predictive effects of family caregiver transition on the mental status of PwSs but not the presence of family caregiving. Psychosocial interventions and specific guidance should be provided to family caregivers to enhance their quality of caregiving and improve the prognosis of PwSs during long periods of home care.

En este estudio se analizan los efectos longitudinales a 21 años y los efectos pronósticos de la transición de los cuidadores familiares y la presencia de cuidado familiar en el estado clínico de las personas con esquizofrenia en un área rural de China. Utilizando datos de panel extraídos del Proyecto de salud mental de Chengdu (Chengdu Mental Health Project, CMHP), se investigaron 250 díadas de personas con esquizofrenia y sus cuidadores familiares en 1994 y 2015. Se utilizó la Escala de síndrome positivo y negativo (Positive and Negative Syndrome Scale, PANSS) y la Evaluación global del funcionamiento (Global Assessment of Functioning, GAF). También se utilizó el método de modelo lineal generalizado. Los resultados de este estudio demostraron que los síntomas más intensos en las personas con esquizofrenia fueron pronosticados principalmente por la edad avanzada y el estado de soltería en el momento basal. En comparación con el grupo de "cuidado de los cónyuges en dos intervalos", el puntaje de la PANSS fue considerablemente más alto en el grupo de "transición al cuidado de los hermanos". Se descubrió que principalmente el estado civil, la duración más corta de la enfermedad y un mejor estado mental pronosticaron un grado más alto de funcionamiento psicosocial. En comparación con el grupo de "cuidado de los cónyuges en dos intervalos", el puntaje de la GAF fue considerablemente más bajo en el grupo de "transición al cuidado de los padres". La presencia de cuidado familiar no fue un factor pronóstico importante de la intensidad de los síntomas ni del funcionamiento psicosocial en las personas con esquizofrenia. En resumen, en este estudio se muestran los efectos pronósticos a 21 años de la transición de los cuidadores familiares en el estado mental de las personas con esquizofrenia, pero no la presencia de cuidado familiar. Deben ofrecerse intervenciones psicosociales y orientación específica a los cuidadores familiares para mejorar su calidad de cuidado y mejorar el pronóstico de las personas con esquizofrenia durante los periodos prolongados de cuidado en el hogar.

Preventing early harsh parenting and toddler behavior problems: The role of neighborhood collective efficacy among low-income Latine families.

Harsh parenting behaviors are alarmingly prevalent during infancy and toddlerhood. From an ecological perspective, predicting and preventing harsh parenting requires probing not only micro- and exosystem-level processes but also the interactions among them. In the current longitudinal study, we examined associations among maternal depressive symptoms, harsh parenting, and neighborhood collective efficacy in 142 low-income Latina mothers and their infants (Mchild age = 14.11 months, SD = 3.60). We hypothesized that there would be a mediated pathway from maternal depressive symptoms to harsh parenting to toddler behavior problems, and that neighborhood collective efficacy would moderate this pathway. As predicted, maternal depressive symptoms predicted toddler behavior problems, and harsh parenting significantly mediated this association. Moreover, neighborhood collective efficacy was a significant moderator such that this indirect pathway was maintained in the context of low neighborhood collective efficacy only. When collective efficacy was high, this pathway was not significant. Results are discussed in terms of the buffering potential of neighborhood collective efficacy. Tentative implications for leveraging neighborhood supports to prevent early harsh parenting are suggested.

Las duras conductas de crianza son alarmantemente prevalentes durante la infancia y la primera etapa de la niñez. Desde una perspectiva ecológica, predecir y prevenir la dura crianza requiere investigar no sólo los procesos de micro niveles y niveles de exosistemas, sino también las interacciones entre ellos. En el presente estudio longitudinal, examinamos las asociaciones entre los síntomas depresivos maternos, la dura crianza y la colectiva efectividad del vecindario en 142 mujeres latinas de bajos recursos económicos y sus infantes (M edad del niño = 14.11 meses, SD = 3.60). Nuestra hipótesis fue que habría un camino mediador entre los síntomas depresivos maternos y la dura crianza y los problemas de conducta del pequeño infante, y que la efectividad colectiva del vecindario moderaría este camino. Tal como se predijo, los síntomas depresivos maternos predijeron los problemas de conducta de los pequeños infantes, y la dura crianza significativamente medió esta asociación. Es más, la efectividad colectiva del vecindario fue un moderador significativo, de tal manera que este indirecto camino se mantuvo sólo dentro del contexto de la baja efectividad colectiva del vecindario. Cuando la efectividad colectiva fue alta, este camino no fue significativo. Los resultados se discuten en términos de la potencialidad amortiguadora de la efectividad colectiva del vecindario. Se sugieren tentativas implicaciones para la nivelación de los apoyos del vecindario para prevenir una temprana dura crianza.

Des comportements de parentage durs sont extrêmement prévalents durant la petite enfance (bébés et jeunes enfants). D'une perspective écologique, prédire et prévenir le parentage dur exige un examen non seulement des processus au niveau du microsystème et de l'exosystème mais aussi des interactions entre ces systèmes. Dans cette étude longitudinale nous avons examiné les liens entre les symptômes dépressifs maternels, le parentage dure et l'efficacité collective du voisinage chez 142 mères hispaniques ayant de faibles revenus et leurs bébés (M âge de l'enfant = 14,11 mois, SD = 3,60). Nous avons pris comme hypothèse qu'il y aurait une voie de médiation des symptômes dépressifs maternels au parentage dur et aux problèmes de comportement du petit enfant, et que l'efficacité collective du voisinage modérerait cette voie. Comme on l'avait prédit les symptômes dépressifs maternels ont prédit les problèmes de comportement du petit enfant, et le parentage dur a médiatisé ce lien. De plus, l'efficacité collective du voisinage s'est avéré être un modérateur important, à un tel point que cette voie indirecte était maintenue dans le contexte d'une efficacité collective de voisinage même faible. Quand l'efficacité collective était élevée cette voie n'était pas importante. Les résultats sont discutés en termes de potentiel de mise en tampon de l'efficacité collective du voisinage. De possibles implications pour tirer partie des soutiens des voisinages afin de prévenir un parentage dur précoce sont suggérées.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health.

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

Los síntomas de estrés materno postraumático (PTSS) se asocian con consecuencias adversas para niños de mayor edad, pero pocos estudios han examinado las conexiones entre PTSS materno perinatal y los resultados en el infante. El estar expuesta al trauma y la sicopatología de este, incluyendo PTSS, a menudo se intensifican más en el caso de mujeres durante el embarazo y hasta un año después del parto. Por tanto, el período perinatal pudiera ser un omento crítico para comprender el riesgo que el PTSS materno y otros factores de salud mental presentan para la salud socioemocional y física de los infantes. Este estudio exploró la relación entre el PTSS materno y los problemas de salud socioemocional y física del infante en un grupo muestra de díadas madre-infante racial y étnicamente diversas (N = 295), evaluadas prenatalmente y a los 12 meses después del parto. Este estudio también examinó si hay: (1) efectos moderadores de los síntomas depresivos maternos y el estrés de crianza sobre estas asociaciones y (2) efectos indirectos de PTSS sobre los resultados en el infante a través de la observada sensibilidad materna. Los resultados indican que los síntomas depresivos y el estrés de crianza, en vez de PTSS, estaban asociados con mayores problemas de salud socioemocional del infante. Sin embargo, el PTSS se asoció con mayores problemas de salud física en el infante cuando las madres también reportaron niveles clínicamente significativos de síntomas depresivos. No se corroboró el que la sensibilidad materna fuera un mecanismo intermediario de conexión entre PTSS y otros factores de salud mental materna y resultados en el infante.

Les symptômes des stress posttraumatique (SPT) maternel sont liés à des conséquences adverses pour les enfants plus âgés mais peu d'études ont examiné les liens entre le SPT périnatal maternel et les résultats sur les nourrissons. L'exposition au trauma et la psychopathologie, y compris le SPT, est souvent accrues pour les femmes durant la grossesse jusqu'à un an après la naissance. Par conséquent la période périnatale peut être un moment critique pour la compréhension du risque que posent le SPT maternel et d'autres facteurs de santé mentale à la santé socio-émotionnelle et physique des nourrissons. Cette étude a exploré la relation entre le SPT maternel et les problèmes socio-émotionnels et physiques des nourrissons chez un échantillon de dyades mère-nourrisson racialement et ethniquement diverses (N = 295) évaluées au stade prénatal et à 12 mois après la naissance. Cette étude a aussi examiné s'il existait : (1) des effets modérateurs de symptômes dépressifs maternels et du stress de parentage sur ces associations et (2) des effets indirects de SPT sur les résultats du nourrisson à travers une sensibilité maternelle observée. Les résultats ont indiqué que les symptômes dépressifs postpartum et le stress de parentage, plus que le SPT, étaient liés à des problèmes plus élevés de santé socio-émotionnels du nourrisson. Cependant le SPT prénatal était lié à de plus grands problèmes de santé physique du nourrisson quand les mères faisaient aussi état de niveaux cliniquement élevés de symptômes dépressifs postpartum. La sensibilité maternelle n'était pas liée au SPT maternel, aux symptômes dépressifs ou au stress de parentage, et n'était pas non plus liée à la santé socio-émotionnelle et physique du nourrisson. Donc la sensibilité maternelle n'a pas testée comme mécanisme intermédiaire liant la santé mentale maternelle aux résultats du nourrisson. Les implications pour la promotion de la santé mentale maternelle dans la période périnatale afin de soutenir la santé socio-émotionnelle et physique des nourrissons sont discutées.

Relationship between initial symptoms and prognosis of patients with Covid-19.

OBJECTIVE: Aims to describe the initial symptoms most related to the prognosis of Covid-19. DESIGN: This is a retrospective cross sectional, quantitative, data analyzed study. SITE: This study was made in the family medicine centers (n=82) of Çorlu district of Tekirdag province, in Turkey. PARTICIPANTS: The study included patients (n=1.506) who had a positive PCR test for Covid-19 from March to September 2020. And we asked them their initial symptoms which bring them to the family medicine centers before the test. MAIN MEASUREMENTS: The participants' age, gender, presence of chronic disease, and initial symptoms which they come to a healthcare facility were evaluated. These variables were analyzed in terms of length of hospital stay, intensive care unit admission and mortality rates. RESULTS: The most common initial symptom in Covid-19 patients was cough. The presence of a chronic disease, the shortness of breath, malaise, the loss of smell and taste, and vomiting were found to be associated with an increased mortality rate. Advanced age, the presence of cough, malaise, the loss of smell and taste, and vomiting as the initial symptoms were found to have increased the likelihood of being admitted to the intensive care unit. CONCLUSIONS: The authors advise placing more attention on the initial symptoms of cough, malaise, the loss of smell and taste and vomiting in Covid-19 patients. Because these symptoms are related with severe prognosis indicators.

Symptom control.

In addition to symptoms secondary to splenomegaly, microvascular abnormalities, and thrombohemorrhagic complications, patients with MPN may experience a significant symptom burden attributed to an increase in circulating inflammatory cytokines. These symptoms can be severe and limit quality of life. Therefore, in addition to the prevention of complications, one of the objectives of the treatment of MPN is the control of symptoms.

Además de la sintomatología secundaria a la esplenomegalia, a las alteraciones microvasculares y a las complicaciones trombohemorrágicas, los pacientes con neoplasias mieloproliferativas (NMP) pueden experimentar una importante carga sintomática atribuida a un aumento de citocinas inflamatorias circulantes. Estos síntomas pueden ser severos y limitar la calidad de vida. Por ello, además de la prevención de las complicaciones, uno de los objetivos del tratamiento de las NMP es el control de los síntomas.

Symptom attribution in patients with medically unexplained symptoms. A scale development and validation study.

INTRODUCTION: In the care of patients with medically unexplained physical symptoms (MUPS) it is important what they think about their symptoms. OBJECTIVE: To validate the psychometric properties of a symptom attribution scale in patients with MUPS and to verify its reliability. METHODS: A non-probabilistic sample of 400 male and female adult patients were interviewed in the outpatient services of a family medicine hospital, 200 with MUPS and 200 with a defined organic pathology. Each group was diagnosed with defined criteria, and a scale with content and construct validity was applied by means of principal component analysis with varimax rotation. RESULTS: The scale was made up of 12 items with two factors, one of symptom psychosocial attribution and other with organic attribution. The psychosocial-origin factor showed a variance of 49.7%. The goodness-of-fit test demonstrated that the correlation matrix was adequate, and Bartlett's sphericity test indicated statistical significance (p < 0.0001); Cronbach's alpha was 0.841. CONCLUSION: The scale showed acceptable construct validity and good reliability and stability. The implications of these results for future measurement research are discussed.

INTRODUCCIÓN: En la atención de pacientes con síntomas físicos médicamente no explicables (SFMNE) es importante lo que el paciente piensa de sus síntomas. OBJETIVO: Validar propiedades psicométricas de una escala de atribución del síntoma en pacientes con SFMNE y verificar su confiabilidad. MÉTODOS: Se entrevistó a una muestra no probabilística de 400 pacientes adultos, hombres y mujeres, en la consulta de un hospital con medicina familiar, 200 con SFMNE y 200 con patología orgánica concreta. Se diagnosticó a cada grupo con criterios definidos y se aplicó una escala con validez de contenido y de constructo por medio de análisis de componentes principales con rotación varimax. RESULTADOS: La escala quedó integrada por 12 reactivos con dos factores, uno de atribución psicosocial y otro de atribución orgánica del síntoma. El factor de origen psicosocial tuvo una varianza de 49.7 %. La prueba de bondad de ajuste mostró que la matriz de correlaciones fue adecuada y la prueba de esfericidad de Bartlett indicó significación estadística (p < 0.0001); el alfa de Cronbach fue de 0.841. CONCLUSIÓN: La escala mostró una validez de constructo aceptable y buena confiabilidad y estabilidad. Se discuten las implicaciones de estos resultados para la investigación de mediciones futuras.

Patient-Reported Outcome Measures in Real-World Atopic Dermatitis Studies in Spain: A Systematic Review. / Medidas de los resultados percibidos por el paciente en estudios de vida real en dermatitis atópica en España: revisión sistemática de la literatura.

Atopic dermatitis (AD) is a chronic inflammatory skin disease with symptoms such as pruritus that can be a major burden for patients. Patient-reported outcomes (PRO) complement clinician-reported outcomes in AD. This systematic review aims to identify and describe patient-reported outcome measures (PROM) used in observational studies of AD over the last decade in Spain. Eighteen PROM were identified to measure 13 different PRO that assess multiple aspects of the disease, including symptoms and disease severity, impact on daily activities and on work productivity/functioning, psychosocial impact, patient empowerment, and health-related quality of life (HRQoL). HRQoL, symptoms (particularly pruritus), and anxiety/depression were the most frequently assessed PRO, and the Dermatology Quality of Life Index, the Visual Analogue Pruritus Scale, and the Hospital Anxiety and Depression Scale were the most frequently used PROM, respectively. The growing number of observational studies on AD including PROM in Spain suggests that PRO are becoming increasingly important in the management of AD.

Risk and Resiliency Factors Related to Dementia Caregiver Mental Health.

Prevalence rates for dementia are expected to rise exponentially as the elderly population rises. With this comes a corresponding increase in the number of family members who will become dementia caregivers. Caregivers of people with dementia often experience a deterioration in mental health. Identifying factors that relate to caregiver mental health is necessary to develop appropriate interventions. The current study explored how family functioning (measured with a latent variable that includes family cohesion, family balance, and family communication), caregiver expressed emotion (EE), and patient symptom severity related to caregiver mental health (measured with a latent variable that includes depression, anxiety, and stress). Participants included 107 dementia caregivers. The following specific hypotheses were tested: lower levels of both (1) EE and (2) patient symptom severity, and (3) higher levels of family functioning would be related to better caregiver mental health. Results produced a well-fitting model: X2 (18) = 14.858, p = .672; CFI = 1.00; RMSEA = .00; SRMR = .037. Moreover, results indicated that better family functioning (Ɣ = -3.54, SE = 1.34, p = .008), lower levels of caregiver EE (ß = .36, SE = 0.07, p < .01), and higher patient symptom severity (ß = -3.03, SE = 0.88, p = .001) were related to better caregiver mental health. Results from this study suggest that efforts to bolster family functioning (i.e., enhance communication, promote cohesion, encourage flexibility) could help improve caregiver mental health.

Se espera que los índices de prevalencia de la demencia aumenten exponencialmente a medida que se incremente la población de personas mayores. Esto trae aparejado un aumento correspondiente del número de familiares que se convertirán en cuidadores de personas con demencia. Los cuidadores de personas con demencia frecuentemente sufren un deterioro de la salud mental. Por eso, es necesario identificar los factores relacionados con la salud mental de los cuidadores para desarrollar intervenciones adecuadas. El presente estudio analizó cómo el funcionamiento familiar (medido con una variable latente que incluye cohesión familiar, equilibrio familiar y comunicación familiar), la emoción expresada por los cuidadores y la gravedad de los síntomas de los pacientes se relacionaron con la salud mental de los cuidadores (medida con una variable latente que incluye depresión, ansiedad y estrés). Los participantes fueron 107 cuidadores de personas con demencia. Se evaluaron las siguientes hipótesis específicas: los niveles bajos de 1) emoción expresada y 2) gravedad de los síntomas de los pacientes, y 3) los niveles más altos de funcionamiento familiar estarían relacionados con una mejor salud mental de los cuidadores. Los resultados generaron un modelo con buen ajuste: X2 (18) = 14.858, p = .672; CFI = 1.00; RMSEA = .00; SRMR = .037. Además, los resultados indicaron que un mejor funcionamiento familiar (Ɣ = -3.54, SE = .1.34, p = .008), niveles más bajos de emoción expresada por los cuidadores (ß = .36, SE = .07, p<.01) y una mayor gravedad de los síntomas de los pacientes (ß = -3.03, SE = .88, p = .001) estuvieron relacionados con una mejor salud mental de los cuidadores. Los resultados de este estudio sugieren que los esfuerzos para reafirmar el funcionamiento familiar (p. ej.: mejorar la comunicación, promover la cohesión, estimular la flexibilidad) podrían contribuir a mejorar la salud mental de los cuidadores.

Couple Satisfaction, Depressive Symptoms, and the Therapeutic Alliance: A Systemic Perspective.

There is a well-established bidirectional, negative association between couple satisfaction and depressive symptoms. Yet, a family systems perspective emphasizes the role of the therapist in interrupting this recursive cycle between couple satisfaction and depressive symptoms. The current study utilized longitudinal data to explore the bidirectional associations between depressive symptoms and couple satisfaction, moderated by the therapeutic alliance over the course of therapy. The study included 108 couples participating in couple therapy at a university training clinic. Couples rated their depressive symptoms and couple satisfaction separately before the intake session and at the end of the fourth session, and they also reported their individual therapeutic alliance with the therapist at the end of the second and third sessions. Actor-partner interdependence moderation model analysis revealed several moderation effects. In general, with low therapeutic alliance, couples with higher initial symptoms (such as depressive symptoms and low couple satisfaction) reported more severe symptoms at the fourth session, compared to those who had fewer initial symptoms. The moderating effect of alliance on a couple's symptoms was found both among individuals, and between partners. Systemic clinical implications and suggestions for future research are discussed.

Hay una asociación bidireccional y negativa firmemente establecida entre la satisfacción en la pareja y los síntomas depresivos. Sin embargo, la perspectiva de sistemas familiares enfatiza el papel que desempeña el terapeuta en la interrupción de este ciclo recurrente entre la satisfacción en la pareja y los síntomas depresivos. El presente estudio utilizó datos longitudinales para analizar las asociaciones bidireccionales entre los síntomas depresivos y la satisfacción en la pareja, moderadas por la alianza terapéutica durante el transcurso de la terapia. El estudio incluyó 108 parejas que participaron en terapia de pareja en una clínica universitaria de formación. Las parejas calificaron sus síntomas depresivos y la satisfacción en la pareja por separado antes de la sesión de ingreso y al final de la cuarta sesión, y también informaron su alianza terapéutica individual con el terapeuta al final de la segunda y la tercera sesión. El análisis del modelo de moderación de la interdependencia entre el actor y la pareja reveló varios efectos de la moderación. En general, con una alianza terapéutica baja, las parejas con síntomas iniciales más altos (como síntomas depresivos y baja satisfacción en la pareja) informaron síntomas más intensos en la cuarta sesión en comparación con aquellos que tenían menos síntomas iniciales. El efecto moderador de la alianza en los síntomas de la pareja se halló tanto entre las personas como entre las parejas. Se debaten las consecuencias clínicas sistémicas y las sugerencias para futuras investigaciones.

Longitudinal changes in attachment patterns of preterm infants born in a non-Western country.

Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and sociodemographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.

El inesperado nacimiento prematuro de un infante pudiera afectar la formación de la afectividad de las díadas madre-niño. Este estudio longitudinal se propuso explorar los patrones de afectividad madre-infante de infantes nacidos muy prematuramente (VPT) e infantes prematuros (PT) comparados con sus compañeros nacidos dentro del término regular en un país no occidental. Se evaluaron los resultados de desarrollo neurológico de los infantes, la ansiedad y síntomas depresivos maternos, así como las características socio-demográficas, con el fin de explorar sus efectos sobre la afectividad. Dieciocho VPT 11 PT, 11 infantes nacidos dentro del término regular y sus madres participaron. Las observaciones de patrones de afectividad y evaluaciones de desarrollo neurológico se llevaron a cabo a los 18 y 24 meses de la edad corregida. Este estudio identificó un cambio en los patrones de afectividad de los infantes VPT a lo largo del tiempo, de tal manera que los infantes VPT tendieron a tener menos patrones de afectividad insegura con sus madres al final del período de infancia. Mientras que los puntajes de desarrollo motor y de lenguaje se asociaron con patrones de afectividad a los 18 meses, los modelos que predijeron los patrones de afectividad ya no eran significativos a los 24 meses. Por tanto, el cambio en los resultados de desarrollo de los infantes VPT y los patrones de afectividad a lo largo del tiempo sugieren que el nacimiento prematuro en sí no es necesariamente un factor de riesgo para desarrollar patrones de afectividad insegura, pero los retardos en el desarrollo pudieran ser responsables de patrones de afectividad insegura. Se sugiere que los esfuerzos para promover los resultados de desarrollo de infantes prematuros pudieran mejorar la afectividad madre-niño.

Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and socio-demographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.

A prospective study on the course of sleep disturbances in first-time fathers during the transition to parenthood.

INTRODUCTION: This study examined sleep disturbances in first-time fathers from the third trimester of their partner's pregnancy to 2 months postpartum to determine prevalence, incidence, and persistence of sleep disturbances and identify associated determinants. METHODS: Men expecting their first child were recruited from local prenatal classes and university-affiliated obstetric clinics. During their partner's third trimester of pregnancy and 2 months postpartum, 459 men completed standardized online self-report questionnaires measuring sociodemographics, lifestyle, and psychosocial variables and sleep quality. RESULTS: Disturbed sleep (Pittsburgh Sleep Quality Index [PSQI] global score >5) increased from 29.6% during the third trimester to 44.7% at 2 months postpartum. The incidence of poor sleep at 2 months postpartum was 33.7%. Among men with disturbed sleep at the antenatal assessment, 70.6% continued to have sleep disturbances at 2 months postpartum. An increase in depressive symptoms and higher parenting stress was independently associated with onset and persistence of disturbed sleep at 2 months postpartum. CONCLUSIONS: Sleep is compromised in expectant and new fathers. Strategies aimed at improving sleep, depressed mood, and managing the challenges of parenting may be important components to include in prenatal interventions aimed at enhancing the transition to parenthood and infant development.

Development of a predictive prognostic rule for early assessment of COVID-19 patients in primary care settings.

OBJECTIVE: To investigate possible early prognostic factors among middle-aged and older adult and explore prognostic rules stratifying risk of patients. DESIGN: Community-based retrospective cohort. SETTING: Primary Health Care Tarragona region. PARTICIPANTS: 282 community-dwelling symptomatic patients ≥50 years with laboratory-confirmed COVID-19 (hospitalised and/or outpatient) during March-June 2020 in Tarragona (Southern Catalonia, Spain). MAIN OUTCOME MEASUREMENTS: Relationship between demographics, pre-existing comorbidities and early symptomatology (first 5-days) and risk of suffering critical outcome (ICU-admission/death) across clinical course was evaluated by logistic regression analyses, and simple predictive models were developed. RESULTS: Of the 282 cases (mean age: 65.9 years; 140 men), 154 (54.6%) were hospitalised (30 ICU-admitted) and 45 (16%) deceased. Median time follow-up in clinical course was 31 days (range: 30-150) for survivors and 14 days (range: 1-81) for deceased patients. In crude analyses, increasing age, male sex, some comorbidities (renal, respiratory or cardiac disease, diabetes and hypertension) and symptoms (confusion, dyspnoea) were associated with an increased risk to suffer critical outcome, whereas other symptoms (rinorrhea, myalgias, headache, anosmia/disgeusia) were related with reduced risk. After multivariable-adjustment only age/years (OR: 1.04; 95% CI: 1.01-1.07; p=0.004), confusion (OR: 5.33; 95% CI: 1.54-18.48; p=0.008), dyspnoea (OR: 5.41; 95% CI: 2.74-10.69; p<0.001) and myalgias (OR: 0.30; 95% CI: 0.10-0.93; p=0.038) remained significantly associated with increased or reduced risk. A proposed CD65-M prognostic rule (acronym of above mentioned 4 variables) showed a good correlation with the risk of suffering critical outcome (area under ROC curve: 0.828; 95% CI: 0.774-0.882). CONCLUSION: Clinical course of COVID-19 is early unpredictable, but simple clinical tools as the proposed CD65-M rule (pending external validation) may be helpful assessing these patients in primary care settings.

[Health professionals' perception about the socio-educational group intervention with women who present somatic symptoms without organic cause]. / Percepción de profesionales de la salud sobre la intervención grupal socioeducativa con mujeres que presentan síntomas somáticos sin causa orgánica.

OBJECTIVE: To know the perception and opinion of primary care health professionals on the impact of non-medicalizing group educational intervention (GRUSE) with women who present somatic symptoms without organic cause. DESIGN: Qualitative phenomenological study. SETTING: Primary care health centers in Andalusia, during 2017 and 2018. PARTICIPANTS AND/OR CONTEXTS: Twenty-four health professionals, selected according to their level of involvement in the GRUSE strategy (socio-educational groups). METHOD: A qualitative methodology is applied, through the phenomenological method. The technique used to collect the information is the discussion group, and a content analysis is carried out on it. The software Atlas.ti 8.0 is used as a support resource for the analysis. RESULTS: Health professionals highlight group work as a means of achieving change, and point to the importance of intervention as a non-medicalizing strategy. They perceive that the participants obtain some benefits: the improvement of their personal well-being, the increase of their self-esteem and self-determination, and the generation of social networks, benefits that also affect their immediate surroundings. CONCLUSIONS: In the opinion of the professionals, the strategy has positive effects on women and does not mean an increase in resources for the health system. In addition, they express the importance of provide women with tools to cope with daily life problems derivates mostly from gender mandates of a patriarchal society.

Assessing ADHD symptoms in clinical public practice: Is a reliable final diagnosis possible?

INTRODUCTION: Attention deficit and hyperactivity disorder (ADHD) rates vary between 1% and 20% depending on the type of diagnosis guide used, the test used in the assessment, psychosocial factors, and professional in charge of the assessment. GOAL: to describe and compare current clinical ADHD assessment processes in public health system in two cohorts and analyze variables related to final diagnosis. DESIGN: Descriptive, multicenter, longitudinal (retrospective-prospective). LOCATION: primary care (PC) centers in Oviedo, Asturias (Spain). PARTICIPANTS: a Spanish clinical ADHD symptomatic sample (n=134) from two cohorts (2004 and 2009). VARIABLES: clinical professional in charge of ADHD assessment (PC, mental health professional [MH], neuropediatrician [NP]), type of test used in the assessment, confirmation/disconfirmation of ADHD diagnosis, and final diagnosis. RESULTS: the use of symptoms checklists and the assessments in charge of primary care (PC) and neuropediatrician (NP) professionals show an upward trend from 2004 to 2009. ADHD final diagnosis shows low inter-professional (NP-MH) reliability (kappa=0.39). Final diagnoses for the same symptoms are different depending on the professional (NP or MH). DISCUSSIONS: the professional in charge of the assessment appears to be a relevant variable for the final diagnosis. ADHD diagnosis criteria seem not to be clear. This data suggests that ADHD diagnosis must be used with caution to ensure good quality clinical standards when assessing and treating ADHD symptoms. Assessments supported by symptoms checklists and performed by NP or PC could be contributing factors to an ADHD over-diagnosis tendency.

The Associations between Mothers' and Grandmothers' Depressive Symptoms, Parenting Stress, and Relationship with Children: An Actor-Partner Interdependence Mediation Model.

Three-generation households that include parents and grandparents raising children together have become increasingly common in China. This study examined the relations among depressive symptoms, parenting stress, and caregiver-child relationships in the mother-grandmother dyadic context. Participants were mothers and grandmothers from 136 three-generation households. Results from Actor-Partner Interdependence Mediation Modeling indicated that mothers' depressive symptoms were indirectly related to mother-child conflict/closeness through own parenting stress; grandmothers' depressive symptoms were indirectly related to grandmother-child conflict through own parenting stress. Mothers' depressive symptoms were indirectly related to grandmothers' conflict with children through grandmothers' parenting stress, and grandmothers' depressive symptoms were indirectly related to mothers' conflict/closeness with children through mothers' parenting stress. The relation between mothers' parenting stress and mother-child closeness was stronger than the relation between grandmothers' parenting stress and grandmother-child closeness. Findings highlight the implications of using a family system perspective and the dyadic approach in understanding and improving family functioning in Chinese three-generation households.

Los hogares de tres generaciones integrados por padres y abuelos que crían a niños juntos son cada vez más comunes en China. Este estudio examinó las relaciones entre los síntomas depresivos, el estrés por la crianza y las relaciones entre cuidadores y niños en el contexto diádico madre-abuela. Las participantes fueron madres y abuelas de 136 hogares de tres generaciones. Los resultados del modelo de mediación de la interdependencia actor-pareja indicaron que los síntomas depresivos de las madres estuvieron relacionados indirectamente con el conflicto/la cercanía entre madre e hijo mediante el propio estrés por la crianza; los síntomas depresivos de las abuelas estuvieron indirectamente relacionados con el conflicto entre la abuela y el niño mediante el propio estrés por la crianza. Los síntomas depresivos de las madres estuvieron indirectamente relacionados con el conflicto de las abuelas con los niños mediante el estrés por la crianza de las abuelas, y los síntomas depresivos de las abuelas estuvieron indirectamente relacionados con el conflicto/la cercanía de las madres con los niños mediante el estrés por la crianza de las madres. La relación entre el estrés por la crianza de las madres y la cercanía entre madre e hijo fue más fuerte que la relación entre el estrés por la crianza de las abuelas y la cercanía entre abuela y niño. Los resultados destacan las implicancias de usar una perspectiva de sistema familiar y el enfoque diádico a la hora de comprender y mejorar el funcionamiento familiar en los hogares chinos de tres generaciones.

Community, Context, and Coping: How Social Connections Influence Coping and Well-Being for Military Members and Their Spouses.

Military members and their spouses (n = 223 families) were selected from an Active Duty Army installation and assessed with regard to their connections with the military community, their levels of coping with military culture demands, and their reports of individual (depression and life satisfaction) and family well-being. Guided by the contextual model of family stress and the social organization theory of action and change, results from a structural equation model indicated that military community connections, for both military members and their civilian spouses, were related to coping with the military culture and its demands, which in turn was related to both individual and family well-being. Unique actor and partner effects also emerged where both active duty military members' and their civilian spouses' perceptions of military community connections influenced the civilian spouses' satisfaction with military life, but only the active duty military members' community connections influenced their military-specific coping. Additionally, the associations between military-specific coping and individual and family well-being only had actor effects. When examined within the context of important military culture elements, namely rank and extent of military transitions (deployment and relocation), these core findings linking communities to coping and well-being were unchanged. Implications for theory, future research, and practice are shared.

Se seleccionaron militares y sus cónyuges (n = 223 familias) de una instalación de servicio activo del ejército y se evaluaron en términos de sus conexiones con la comunidad militar, sus niveles de afrontamiento de las demandas de la cultura militar, y sus informes de bienestar individual (depresión y satisfacción de vida) y familiar. Los resultados de un modelo de ecuaciones estructurales, guiado por el modelo contextual de estrés familiar y la teoría de acción y cambio de organizaciones sociales, indicaron que las conexiones con la comunidad militar, tanto para militares como para sus cónyuges civiles, se asociaron al afrontamiento con la cultura militar y sus demandas, asociado a su vez al bienestar individual y familiar. Además, efectos únicos de actor y de pareja emergieron cuando las percepciones de sus conexiones con la comunidad militar tanto de militares en servicio activo como de sus cónyuges influyeron en la satisfacción del cónyuge civil con la vida militar pero sólo las conexiones con la comunidad militar de los militares en servicio activo influyeron en su propio afrontamiento específicamente militar. Por otra parte, las asociaciones entre el afrontamiento específicamente militar y el bienestar individual y familiar sólo tuvieron efectos de actor. Al examinarse dentro del contexto de elementos de cultura militar importantes, específicamente de rango y alcance de transiciones militares (despliegue y reubicación), estas relaciones de la comunidad central al afrontamiento al bienestar se mantuvieron sin cambio. Se comparten las implicaciones para la teoría, investigaciones futuras y la práctica.