Enfermedades raras desde la farmacia comunitaria / Rare diseases from the community pharmacy

Introducción: la visibilidad de las Enfermedades Raras a nivel multidisciplinar y su humanización, son uno de los retos planteados en la Agenda 2030 de Naciones Unidas. El farmacéutico comunitario necesita renovarse y promover habilidades, como técnicas de atención farmacéutica individualizada, imprescindibles para el apoyo de estos pacientes. El objetivo de esta investigación es identificar las necesidades socio-sanitarias de las familias perte-necientes a asociaciones de enfermedades raras que acude a la farmacia comunitaria en España.Método: Estudio observacional y transversal me-diante cuestionario digital enviado a usuarios de la Asociación de Enfermedades Raras D ́genes, a través de la Asociación y de los Colegios Oficiales de Farmacéuticos, n=253.Resultados: las enfermedades raras se distribuyen por todo el territorio con una alta dispersión. La mayoría de pacientes o familiares suelen visitar la farmacia comunitaria más de dos veces al mes. Estas familias suelen confiar en su farmacia desde hace más de tres años y no encuentran dificultades para obtener su tratamiento. El perfil de los pacien-tes que acuden a la farmacia es muy heterogéneo, pero la mayoría de familiares afirman conocer y centrarse únicamente en sus necesidades sociosa-nitarias. En relación a sus niveles de satisfacción, el recibimiento, la discreción en el trato, el tiempo de atención y la despedida son los factores mejor valorados.Conclusiones: El profesional farmacéutico debe poseer, habilidades científicas y técnicas, necesita promover valores como empatía, habilidades socia-les o capacidad de escucha, para poder prestar una atención farmacéutica personalizada a familias con enfermedades raras y conseguir humanizar la farmacia comunitaria del siglo XXI.(AU)

Introduction: the visibility of Rare Diseases at a multidisciplinary level and their humanization are one of the challenges set out in the 2030 Agenda of the United Nations. Community pharmacists need to renew themselves and promote skills, such as in-dividualized pharmaceutical care techniques, which are essential for the support of these patients. The aim of this research is to identify the socio-health needs of families belonging to rare disease asso-ciations who go to the community pharmacy in Spain.Method: Observational and transversal study by a digital questionnaire to users of the Association of Rare Diseases D'genes, through the Associa-tion and the Official Associations of Pharmacists, n=253.Results: Rare diseases are distributed throughout the territory with a high dispersion. Most patients or relatives usually visit the community pharmacy more than twice a month. These families usually trust their pharmacy for more than three years and do not encounter difficulties in obtaining their treatment. The profile of the patients who visit the pharmacy is very heterogeneous, but the majority of family members claim to know and focus only on their social and health needs. In relation to their levels of satisfaction, the reception, discretion in treatment, time of attention and farewell are the best valued factors.Conclusions: The professional pharmacist must possess, scientific and technical skills, needs to promote values such as empathy, social skills or listening skills, to be able to provide personalized pharmaceutical care to families with rare diseases and manage to humanize the community pharma-cy of the 21st century.(AU)

Course of a major postpartum depressive episode: A prospective 2 years naturalistic follow-up study.

BACKGROUND: Survival methodology has not already been used in studies about postpartum depression (PPD) course. The aims of the present study were to estimate the duration of a Major Postpartum Depressive Episode (MPDE) during 2 years, as well as to explore factors associated with the course. METHOD: This was a prospective, naturalistic, longitudinal study with a cohort of 165 women with a MPDE (DSM-IV criteria). Potential predictors of prognosis were recorded at baseline. Follow-up was conducted using the Longitudinal Interval Follow-up Evaluation (LIFE). RESULTS: Of the total sample, 110 (66.7%) completed the 2 years follow-up. The mean time to full remission was 49.4 weeks (95% CI: 44.0-59.8). The probability of recovering was 30.2% (95% CI: 22.1%-37.4%) at 6 months of follow-up, 66.3% (95% CI: 57.4%-73.4%) at 12 months of follow-up, and 90.3% (95% CI: 79.8%-95.4%) at 24 months of follow-up. Mothers with financial difficulties, onset of depressive episode previous to birth, and those with prior treated depressive episodes took longer in achieving full remission. LIMITATIONS: Results are only generalizable to mothers with PPD treated in a psychiatric outpatient setting. Psychopharmacological treatment was uncontrolled and personality was not assessed. CONCLUSIONS: Our findings suggest that PPD could become a chronic disorder, particularly in mothers with an onset of the episode previous to birth, with a history of depression or with financial problems. Knowledge of these factors may help to improve the guidelines of depression management and treatment during the perinatal period.

Maladaptive family dysfunction and parental death as risk markers of childhood abuse in women

This study aims to examine the prevalence and characteristics of physical, emotional and sexual childhood abuse. It also examines whether other non-abuse types of childhood adversities related to maladaptive family functioning and separations during childhood can be used as markers for the presence of childhood abuse. Participants (N = 237) were women at 2-3 days after delivery that completed the Spanish-validated version of the Early Trauma Inventory Self Report (ETI-SR; Bremner, Bolus, & Mayer, 2007; Plaza et al., 2011), designed to assess the presence of childhood adversities. Results show that 29% of the women had experienced some type of childhood abuse, and 10% more than one type. Logistic regression analyses indicate that childhood parental death is a risk marker for childhood emotional abuse (OR: 3.77; 95% CI: 1.327-10.755; p <.013), childhood parental substance abuse is a risk marker for childhood sexual (OR: 3.72; 95% CI: 1.480-9.303; p < .005) and physical abuse (OR: 2.610; 95% CI: 1.000-6.812; p < .05) and that childhood family mental illness is a risk marker for childhood emotional (OR: 2.95; 95% CI: 1.175-7.441; p < .021) and sexual abuse (OR: 2.55; 95% CI: 1.168-5.580; p < .019). The high prevalence of childhood abuse indicates a need for assessment during the perinatal period. Screening for childhood family mental illness, parental substance abuse, and parental death - all identified risk factors for reporting childhood abuse - can help to identify women that should be assessed specifically regarding abuse (AU)

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Maladaptive family dysfunction and parental death as risk markers of childhood abuse in women.

This study aims to examine the prevalence and characteristics of physical, emotional and sexual childhood abuse. It also examines whether other non-abuse types of childhood adversities related to maladaptive family functioning and separations during childhood can be used as markers for the presence of childhood abuse. Participants (N = 237) were women at 2-3 days after delivery that completed the Spanish-validated version of the Early Trauma Inventory Self Report (ETI-SR; Bremner, Bolus, & Mayer, 2007; Plaza et al., 2011), designed to assess the presence of childhood adversities. Results show that 29% of the women had experienced some type of childhood abuse, and 10% more than one type. Logistic regression analyses indicate that childhood parental death is a risk marker for childhood emotional abuse (OR: 3.77; 95% CI: 1.327-10.755; p <.013), childhood parental substance abuse is a risk marker for childhood sexual (OR: 3.72; 95% CI: 1.480-9.303; p < .005) and physical abuse (OR: 2.610; 95% CI: 1.000-6.812; p < .05) and that childhood family mental illness is a risk marker for childhood emotional (OR: 2.95; 95% CI: 1.175-7.441; p < .021) and sexual abuse (OR: 2.55; 95% CI: 1.168-5.580; p < .019). The high prevalence of childhood abuse indicates a need for assessment during the perinatal period. Screening for childhood family mental illness, parental substance abuse, and parental death - all identified risk factors for reporting childhood abuse - can help to identify women that should be assessed specifically regarding abuse.

Childhood physical abuse as a common risk factor for depression and thyroid dysfunction in the earlier postpartum.

Childhood abuse is a powerful risk factor for developing postpartum depression in adulthood, and recently it has been associated to thyroid dysfunction in postpartum depressive women. The purpose of this study was to investigated the effects of childhood abuse on thyroid status and depressive symptomatology in two hundred and thirty-six (n=236) postpartum women 24-48h after delivery. The Early-Trauma-Inventory Self-Report was used to assess the presence of childhood abuse and the Edinburgh Postpartum Depression Scale (EPDS) to evaluate depressive symptomatology (EPDS≥11). Free thyroxin (fT4) and thyroid-stimulating hormone (TSH) were measured. Thyroid dysfunction (TD) was defined as altered TSH or TSH and fT4. Socio-demographic, reproductive, and psychopathological variables were also collected. Multivariate analysis shows that childhood physical abuse increases by four times the risk for TD (OR: 3.95, 95% CI: 1.23-12.71) and five times the risk for depressive symptomatology (OR: 5.45, 95% CI: 2.17-13.66) in the earlier postpartum. Our findings suggest that women with history of childhood physical abuse are particularly at-risk for thyroid dysfunction and depressive symptomatology 24-48h after delivery. The assessment of childhood abuse in the perinatal period is important to identify women at-risk for physical and mental health problems in this period.

Perfectionism dimensions in major postpartum depression.

BACKGROUND: Although perfectionism from a multidimensional perspective has generally been associated with depressive illness, there are not many studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism dimensions using the Frost Multidimensional Perfectionism Scale (FMPS) and major postpartum depression. METHODS: One-hundred-twenty-two women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women were evaluated using the FMPS, an instrument for the assessment of six perfectionism dimensions: concern over mistakes, personal standards, parental expectations, parental criticism, doubt about actions and organisation. Other variables were also considered: neuroticism, psychiatric history, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms). RESULTS: The prevalence of high-perfectionism was higher in major postpartum depression group than in control group (34% vs. 11%; p<0.001). Multivariate models confirmed high-perfectionism as an independent factor associated with major postpartum depression. Specifically, the high-concern over mistakes dimension increased over four-fold the odds of major depression in postpartum period. (OR=4.14; 95% CI=1.24-13.81) Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors. CONCLUSIONS: High-perfectionism, and particularly high-concern over mistakes is a personality dimension associated with major postpartum depression. The inclusion of perfectionism assessment, together with others factors, may be considered in order to improve the detection of women at risk of postpartum depression, in whom early intervention may be of benefit.

Examining the factor structure and discriminant validity of the 12-item General Health Questionnaire (GHQ-12) among Spanish postpartum women.

In this study, the authors tested alternative factor models of the 12-item General Health Questionnaire (GHQ-12) in a sample of Spanish postpartum women, using confirmatory factor analysis. The authors report the results of modeling three different methods for scoring the GHQ-12 using estimation methods recommended for categorical and binary data. A discriminant function analysis was also performed to test the utility of a multiple factor model. A two-phase cross-sectional study was designed: (a) 1,453 women visiting at 6 weeks postpartum completed the GHQ-12 and the Edinburgh Postnatal Depression Scale questionnaire and (b) based on the Edinburgh Postnatal Depression Scale outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation. Using the Likert-type scoring approach, Hankins's one-factor model with "method effects" obtained the best fit. In addition, Graetz's three-factor model provided little discrimination between diagnostic groups, the factors being highly correlated. These results support the presence of only one latent factor in the GHQ-12.

Validación y comparación de cuatro instrumentos para la detección de la violencia de pareja en el ámbito sanitario / Validation and comparison of four instruments to detect partner violence in health- care setting

Background and objectives: To validate four instruments to detect domestic violence in health-care settings against external criteria -Index of Spouse Abuse (ISA), Psychological Maltreatment of Women Inventory short form (PMWI-SF), Woman Abuse Screening Tool (WAST), Partner Violence Screen (PVS)- and to assess the concordance and compare the diagnostic accuracy.Subjects and method: This was a case-control study. The study sample was recruited from primary care and domestic violence centers. The ISA, PMWI-SF, WAST and PVS were administered to 223 controls and 182 intimate partner violence cases. Received Operating Characteristic (ROC) curve analysis was carried out. Measures were compared in terms of ROC curves and overall agreement. Results:The areas under the curve (AUC) were: ISA 0.99 (IC 95%, 0.98-0.99), PMWI-SF 0.98 (IC 95% 0.97-0.99), WAST 0.95 (IC 95% 0.93-0.97), PVS 0.91 (IC 95% 0.87-0.94). The overall agreement between the four tools was excellent (Fleiss Kappa=0.82). The ISA and the PMWI-SF performed slightly better than WAST, and these three instruments performed better than PVS for detecting domestic violence. The PVS had lower concordance values with the other instruments.Conclusions: The four instruments demonstrated adequate diagnostic accuracy and overall agreement for detect domestic violence. Some overestimation of sensitivity may occur due to different source of cases (AU)

Fundamento y objetivo: Estudio de la validación externa y comparación de la precisión diagnóstica y concordancia de cuatro instrumentos para la identificación de la violencia de pareja (VP) en el ámbito sanitario: Index of Spouse Abuse (ISA), Psychological Maltreatment of Women Inventory short form (PMWI-SF), Woman Abuse Screening Tool (WAST), Partner Violence Screen (PVS).Sujetos y método: Estudio de casos y controles. La muestra se reclutó en centros de asistencia primaria y centros especializados en VP. Completaron los cuestionarios ISA, PMWI-SF, WAST y PVS un total de 223 mujeres sin maltrato (controles) y 182 con maltrato de pareja (casos). Se evaluó la precisión diagnóstica mediante la estimación por intervalo del área bajo la curva ROC, se compararon las áreas bajo la curva (ABC) y se realizó un análisis de la concordancia entre ellos.Resultados: Los valores de ABC fueron: ISA 0,99 (intervalo de confianza del 95% [IC 95%] 0,98-0,99), PMWI-SF 0,98 (IC 95% 0,97-0,99), WAST 0,95 (IC 95% 0,93-0,97), PVS 0,91 (IC 95% 0,87-0,94). La concordancia entre los cuatro cuestionarios fue excelente (Kappa de Fleiss=0,82). Los valores del ABC del ISA y el PMWI-SF fueron significativamente mayores que el del WAST, y los tres obtuvieron un mejor funcionamiento que el PVS. El PVS fue el cuestionario que obtuvo menor concordancia con el resto.Conclusiones: Todos los cuestionarios estudiados obtuvieron un buen funcionamiento global para la detección de la VP y una alta concordancia entre ellos. La sensibilidad puede estar sobreestimada debido a la distinta procedencia de los casos (AU)

[Validation and comparison of four instruments to detect partner violence in health-care setting]. / Validación y comparación de cuatro instrumentos para la detección de la violencia de pareja en el ámbito sanitario.

BACKGROUND AND OBJECTIVES: To validate four instruments to detect domestic violence in health-care settings against external criteria -Index of Spouse Abuse (ISA), Psychological Maltreatment of Women Inventory short form (PMWI-SF), Woman Abuse Screening Tool (WAST), Partner Violence Screen (PVS)- and to assess the concordance and compare the diagnostic accuracy. SUBJECTS AND METHOD: This was a case-control study. The study sample was recruited from primary care and domestic violence centers. The ISA, PMWI-SF, WAST and PVS were administered to 223 controls and 182 intimate partner violence cases. Received Operating Characteristic (ROC) curve analysis was carried out. Measures were compared in terms of ROC curves and overall agreement. RESULTS: The areas under the curve (AUC) were: ISA 0.99 (IC 95%, 0.98-0.99), PMWI-SF 0.98 (IC 95% 0.97-0.99), WAST 0.95 (IC 95% 0.93-0.97), PVS 0.91 (IC 95% 0.87-0.94). The overall agreement between the four tools was excellent (Fleiss Kappa=0.82). The ISA and the PMWI-SF performed slightly better than WAST, and these three instruments performed better than PVS for detecting domestic violence. The PVS had lower concordance values with the other instruments. CONCLUSIONS: The four instruments demonstrated adequate diagnostic accuracy and overall agreement for detect domestic violence. Some overestimation of sensitivity may occur due to different source of cases.

Validation and test-retest reliability of Early Trauma Inventory in Spanish postpartum women.

The aims were to study the validity and test-retest reliability of the Early Trauma Inventory-Self Report (ETI-SR) and its short-form (ETI-SF), which retrospectively assess different childhood trauma, in a sample of Spanish postpartum women. A total of 227 healthy postpartum women completed the ETI-SR and ETI-SF. The longitudinal, expert, all data procedure was used as the external criterion for the assessment of childhood trauma. The ETI-SR and ETI-SF were also administered to a sample of 102 postpartum depressive women (DSM-IV) and the results were compared with those of the healthy postpartum sample. The area under the curve values of the ETI-SR and ETI-SF were 0.77 (95% confidence interval [CI], 0.71-0.84) and 0.78 (95% CI, 0.72-0.85), the internal consistencies of the 2 scales were 0.79 and 0.72, and the intraclass correlation coefficients were 0.92 (95% CI, 0.80-0.97) and 0.91 (95% CI, 0.78-0.96), all respectively. The ETI-SR and ETI-SF had higher test-retest reliability on all subscales. The ETI-SR and ETI-SF are shown to be valid and reliable instruments for assessing childhood trauma in postpartum women.

The Vulnerable Personality Style Questionnaire: psychometric properties in Spanish postpartum women.

The Vulnerable Personality Style Questionnaire (VPSQ) is a nine-item self-report scale developed to asses personality traits which increase the risk of postpartum depression. The aim of the present study was to examine the psychometric properties of the Spanish version of the VPSQ in a sample of postpartum women. A cohort of 309 postpartum women was followed up for 32 weeks after delivery. All women were assessed with the Spanish version of the VPSQ, the Eysenck Personality Questionnaire-R Short Scale, the Frost Multidimensional Perfectionism Scale and the harm avoidance dimension of the Temperament and Character Inventory at 2-3 days postpartum. Depressive symptoms were evaluated at 8 and 32 weeks after delivery by the Edinburgh Postnatal Depression Scale, and a diagnostic interview was used to confirm the presence of major depression disorder. Factor analysis results revealed the unidimensionality of the Spanish version of the VPSQ. Cronbach's alpha coefficient for the VPSQ total score was 0.63. The test-retest reliability indicated a good temporal stability (ICC = 0.88; 95% confidence interval (CI) = 0.82-0.91). A moderate association between the VPSQ and other personality measures provided evidence for its construct validity. Logistic regression analyses showed that women with higher scores on the VPSQ had a higher risk of developing depressive symptoms (OR = 1.20; 95% CI = 1.11-1.29) and major depression (OR = 1.16; 95% CI = 1.07-1.26) throughout the 32 weeks after delivery. Overall, our results suggest adequate psychometric properties of the Spanish version of the VPSQ and its usefulness in identifying women with a personality style that increases the risk of developing postpartum depression.

Childhood sexual abuse and hypothalamus-pituitary-thyroid axis in postpartum major depression.

OBJECTIVE: The aim of this study was to investigate the association between early life events in women with postpartum major depression and concomitant hypothalamus-pituitary-thyroid axis disturbances (HPTD), thyroid dysfunction or presence of thyroid antibodies. METHODS: Serum total tri-iodothyronine (TT3), free thyroxin (FT4), Thyroid-stimulating hormone (TSH), Thyroperoxidasa (TPOAb) and Thyroglobulin (TGAb) autoantibodies was measured in 103 major postpartum depressive women. HPTD was defined as TSH and/or T4 abnormal, presence of thyroid autoantibodies and alterations of TT3. All women were assessed with a psychiatry structured interview for DSM-IV. Early Trauma Inventory Self Report, sociodemographic, reproductive, psychosocial and psychopathological variables were also assessed. RESULTS: Sixty three percent of women had suffered childhood trauma, which was childhood sexual abuse in 27.2%. Childhood sexual abuse in postpartum major depression women increased the risk for thyroid dysfunction (OR=5.018, 95%CI=1.128-22.327), presence of thyroid autoantibodies (OR=2.528; 95%CI=1.00-6.39) and HPTD (OR=2.955; 95%CI=1.191-7.32). Moreover, age over 34 (OR=12.394; 95%CI=1.424-107.910) and previous postpartum depression (OR=8.470; 95%CI=1.20-59.43) increased the risk for thyroid dysfunction in postpartum depression. LIMITATIONS: The study design does not allow us to know the direction of the association and there is a lack of previous assessment of current posttraumatic stress disorder. CONCLUSIONS: According to the present findings, childhood sexual abuse may represent an important risk factor for the presence of thyroid autoantibodies and HPTD in women with postpartum depression.

Family caregiver role and premenstrual syndrome as associated factors for postnatal depression.

The goal of this study was to identify sociodemographic, psychopathological, and obstetric risk factors associated with postnatal depression (PND) and their relative weight. A cross-sectional two-stage design was used. All consecutive women receiving a routine check-up 6 weeks postpartum at Obstetric Services during a 1-year period were included. In the first stage, women completed the Edinburgh Post-natal Depression Scale (EPDS). In the second stage, mothers with EPDS scores > or =9 and a randomized sample of 16% with EPDS <9 were explored through a structured clinical interview to diagnose DSM-IV PND (major and minor depression). Variables were entered into stepwise regression models. A total of 1,201 women were recruited and did the EPDS; 261 women with EPDS scores > or =9 and 151 with EPDS scores <9 were selected. Three hundred and thirty-four women agreed to be interviewed and 100 were diagnosed with PND. Family caregiver role (defined as women who have to take care of handicapped or ill relatives) was associated with a 4.4-fold increase in risk for major PND (OR: 4.39, 95%CI: 1.10-17.38). Premenstrual syndrome was identified as an independent risk factor for major and minor PND (OR: 1.81, 95%CI: 1.03-3.18). Moreover, previous depression, poor partner relationship, and lower social support were also confirmed as risk factors for PND. Both family caregiver role and premenstrual syndrome should be considered for inclusion in the rating scales of pregnant women at risk for PND.

Non-psychotic psychiatric disorders after childbirth: prevalence and comorbidity in a community sample.

BACKGROUND: Postnatal psychiatric morbidity is a frequent and serious complication of childbirth. The aim of the present study was to determine the prevalence and co-occurrence of DSM-IV psychiatric disorders in a community sample of postpartum Spanish mothers. METHODS: A two-phase cross-sectional study was conducted in which all consecutive women attending the routine 6-week postnatal control visit at the Department of Obstetric and Gynecology of a university-affiliated hospital over a one year period were included. In the first phase, 1453 women were screened with the Edinburgh Postnatal Depression Scale (EPDS). In the second phase, 428 participants stratified according to employment status and EPDS outcomes were randomly selected within each stratum for clinical psychiatric evaluation using the Structured Clinical Interview for DSM-IV. Weighted prevalence estimates were obtained for DSM-IV disorders with or without comorbidity. RESULTS: The overall 6-week prevalence rate for postpartum psychiatric disorders was 18.1% (95% CI 15.0-21.8) and 2.0% (95% CI 1.2-2.9) of postpartum women met criteria for more than one disorder. Mood disorders was the most prevalent group (9.8%; 95% CI 7.9-12.1) followed by adjustment disorders (4.3%; 95% CI 3.0-6.3), and anxiety disorders (4%; 95% CI 3.0-6.3). Comorbidity was associated to major depressive disorder. LIMITATIONS: Underestimation of some disorders due to the cross-sectional design and the use of a screening instrument with good psychometric characteristics restricted to depression, anxiety, and adjustment disorders. CONCLUSIONS: In the context of a 6-week postnatal visit, a high prevalence and heterogeneity of postnatal psychiatric morbidity in a community sample of Spanish women was found.

Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools.

OBJECTIVE: To assess the validity of the 12-Item General Health Questionnaire (GHQ-12) and the Edinburgh Postnatal Depression Scale (EPDS) in screening for the most common postnatal psychiatric morbidities (mood, anxiety and adjustment disorders). METHOD: A two-phase cross-sectional study was designed. First, a sample of 1453 women visiting at 6 weeks postpartum completed the GHQ-12 and the EPDS questionnaires. Second, based upon EPDS outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation [Structured Clinical Interview for DSM-IV (SCID)]. Receiver operating characteristic (ROC) analysis was used. RESULTS: The concurrent validity was satisfactory (0.80). At optimum cut-off scores, both GHQ-12 and EPDS yielded very good sensitivity (80; 85.5) and specificity (80.4; 85.3), respectively. ROC curves showed that the performance of the EPDS (AUC=0.933) is slightly superior to that of GHQ-12 (AUC=0.904). CONCLUSION: Both GHQ-12 and EPDS are valid instruments to detect postnatal depression as well as postnatal anxiety and adjustment disorders.