Alcoholic Etiology, Severity of Liver Disease, and Post-Transplant Adherence Are Correlated with Worse Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Liver Transplant Candidates.

Introduction: Psychosocial pre-transplant evaluation in patients undergoing liver transplantation (LT) could help identify those patients at higher risk of pharmacological non-adherence, organ rejection, and mortality. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated tool for assessing LT candidates' psychosocial well-being. Data on the ability of the SIPAT evaluation to predict post-transplant outcomes are sparse. Material and Methods: clinical and psychosocial data from a sample of 134 candidates for LT were analyzed. Moreover, the association between pre-transplant psychosocial evaluation and post-transplant clinical outcomes, including organ rejection, mortality, and immunosuppressant drug adherence, was calculated. Results: At the pre-transplant evaluation, patients who showed high SIPAT scores (77, 57%) also had more liver disease assessed by model for end-stage liver disease (MELD; F = 5.04; p < 0.05), alcoholic etiology (F = 35.80; p < 0.001), encephalopathy (F = 5.02; p < 0.05), and portal hypertension (F = 7.45; p < 0.01). Of the 51 transplant patients, those who had a high pre-transplant SIPAT score showed lower post-transplant immunosuppressive adherence, linked to more frequent immunological events. Conclusions: Patients with an alcoholic etiology of liver disease and more severe liver dysfunction are likelier to not adhere to medical prescriptions following transplantation. Current data suggests that this specific group of patients could benefit from early psychological pre-habilitation before undergoing liver transplantation.

Experience of donation and quality of life in living kidney and liver donors.

Italian guidelines on living donation demand that we ascertain the donor's free and informed consent. Assessments to do so have to be conducted by an independent 'third party' who has nothing to do with the medical team treating the recipient. From February 2002 to December 2006, the Veneto Regional Authority's Third Party Commission evaluated 201 living liver and kidney donors. A sample of these were contacted after their surgery to assess their living donation experience and quality of life (QoL); 81 were eligible for the assessment and 69 (85.2%) responded. All donors involved in the study completed an anonymous document that included the SF-36 and a questionnaire on their donation experience. The majority (96%) of the sample expressed a positive global opinion of the experience. We concluded that the donation had positive effects on their QoL and that family support had a fundamental influence on their general well-being, and their psychic balance in particular. Some crucial issues emerged, however, i.e. 11% of donors judged the information received before the operation inadequate, 17% reported a subjective perception of bodily changes after the operation and 14% were concerned about their current health: these findings emphasize the importance of informing potential donors thoroughly before they submit to surgery.

La intermediación parental en la elaboración de la separación del niño en el jardín maternal / The parent mediation in the child’s capacity to elaborate the separation in the nursery

Los autores presentan los resultados de una investigación que estudia el impacto de la función parental de “Intermediación” sobre las capacidades del niño de elaborar la separación diaria de sus padres en el jardín maternal. La hipótesis principal considera la Intermediación parental como una función que se manifiesta a nivel interactivo y que mide la capacidad del progenitor de adaptarse de manera rápida y flexible a un ambiente modificado por una consigna, presentándoselo a su hijo. Esta función influye sobre las capacidades del niño de reorganizarse en una situación de frustración, como es la separación de sus padres. Se han establecido los parámetros de tres tipos de Intermediación (sintónica, no sintónica y ambivalente). La hipótesis principal de esta investigación ha sido confirmada por los resultados obtenidos : los padres que saben mediatizar de manera sintónica favorecen la competencia emotiva y social de sus hijos después de la separación, ofrecen una descripción rica y coherente del niño y son capaces de representarse los sentimientos depresivos que el niño tiene que dominar.

La llegada del niño a la familia: nuevos equilibrios / The arrival of the boy to the family: new balances

De acuerdo con las posiciones teóricas (Bowlby, 1980; Ster, 1985, Fava Vizziello, 1996) que subrayan la importancia de las representaciones parentales sobre el desarrollo del niño y sus interacciones futuras, los autores presentan una investigación sobre las representaciones parentales de padres adoptivos, comparando los resultados obtenidos con una muestra de 20 parejas adoptivas y 20 parejas biológicas. Los autores han suministrado la entrevista “Mate-R” (Fava Vizziello, Antonioli & Volpe, 1994) antes de la adopción y al término del año de entrega pre-adoptivo para las parejas adoptivas, durante el embarazo y al año de vida del niño por las parejas biológicas. Los autores discuten los datos obtenidos de la comparación estadística entre las “escalas perceptivas” de la entrevista entre las dos muestras, padres biológicos y adoptivos, con hipótesis clínicas sobre las diferencias y las semejanzas encontradas en las mismas.