Health Behaviors and Sleep Quality in Portuguese Adolescents: The Moderating Role of Age and Gender / [Los comportamientos relativos a la salud y la calidad del sueño en los adolescentes portugueses: el efecto moderador de la edad y del sexo]

Background: Adolescence is marked by changes such as sleep and health behaviors. This study analyzed the relationships and differences on excessive daytime sleepiness, anxiety and depression symptoms, sleep habits, family sleep behaviors, sleep quality and health behaviors in adolescents including the moderating effect of adolescents’ age and gender. Method: The sample included 272 adolescents, 58% being female. Results: Girls and older adolescents reported worse sleep quality. Older adolescents reported healthier behaviors. Female gender, having a family member with sleep quality problems, coffee intake, anxiety and depression symptoms, daytime sleepiness, and family sleep behaviors contributed to worse sleep quality. Father’s alcohol consumption, anxiety and depression symptoms and family sleep behaviors contributed to adolescents’ sleep habits. Being a girl and an older adolescent were moderators in the relationship between the presence of excessive daytime sleepiness and worse sleep quality. Conclusions: Findings highlight the importance of health promotion programs regarding sleep quality.(AU)

Antecedentes: La adolescencia está marcada por los cambios en el sueño y comportamientos referidos a la salud. Este estudio analizó las relaciones y diferencias en la somnolencia diurna excesiva, los síntomas de ansiedad y depresión, los hábitos de sueño, los comportamientos de sueño familiares, la calidad del sueño, los comportamientos de salud en adolescentes, incluido el efecto moderador de la edad y el sexo de los adolescentes. Método: La muestra de este estudio estaba compuesta por 272 adolescentes, siendo el 58% de sexo femenino. Resultados: Las niñas y los adolescentes mayores indicaron una peor calidad del sueño. Los adolescentes mayores manifestaron comportamientos más saludables. Ser de sexo femenino, tener un familiar con problemas de sueño, consumir café, tener síntomas de ansiedad y depresión, así como somnolencia diurna y conductas de sueño familiares se asocian con una peor calidad del sueño. El consumo de alcohol del padre, los síntomas de ansiedad y depresión y las conductas de sueño familiares se asocian con los hábitos de sueño de los adolescentes. Ser niña y adolescente de mayor edad modera la relación entre la presencia de somnolencia diurna excesiva y peor calidad del sueño. Conclusiones: Los resultados resaltan la importancia de los programas de promoción de la salud en relación con la calidad del sueño.(AU)

The Mediator Role of Illness Representations in Patients with Obstructive Sleep Apnea: A Preliminary Study / [El papel mediador de las representaciones de la enfermedad en pacientes de apnea obstructiva del sueño: un estudio preliminar]

Background: This preliminary study examined the mediating role of illness representations on health-related quality of life (HRQoL) between adherent and poorly adherent obstructive sleep apnea patients (OSA) to the automatic positive airway pressure (APAP) therapy. Method: A total of 185 patients were assessed on determinants of APAP treatment, illness representations, family coping, and self-efficacy, at T1 (prior to APAP treatment) and T2 (1 to 2 months with APAP treatment). Results: Regarding the determinants of APAP, adherent patients showed higher self-efficacy, outcome expectations, and decisional balance index, compared to poorly adherent patients. Adherent patients also showed higher family coping and HRQoL, but less threatening cognitive representations compared to poorly adherent patients. Illness cognitive and emotional representations mediated the relationship between self-efficacy/family coping and HRQoL, in adherent patients. Only illness cognitive representations mediated the relationship between self-efficacy and HRQoL in poorly adherent patients. Conclusions: The results highlight the importance of illness representations during OSA treatment in the promotion of adherence to APAP.(AU)

Antecedentes: Este estudio preliminar examina el papel mediador de la representación de la enfermedad en la calidad de vida relacionada con la salud (CVRS) entre pacientes con apnea obstructiva del sueño (AOS) observantes y poco observantes de la terapia de presión positiva automática en las vías respiratorias (APAP). Método: Se evaluó a un total de 185 pacientes sobre los determinantes del tratamiento APAP, las representaciones de la enfermedad, el afrontamiento familiar y la autoeficacia en T1 (antes del tratamiento APAP) y T2 (1 a 2 meses con tratamiento APAP). Resultados: En cuanto a los determinantes de la APAP, los observantes mostraron mayor autoeficacia, expectativas de resultados e índice de equilibrio decisional en comparación con los poco observantes. Los observantes también mostraron un mayor afrontamiento familiar y CVRS pero menos representaciones cognitivas amenazantes en comparación con los observantes deficientes. Las representaciones cognitivas y emocionales de la enfermedad mediaron la relación entre la autoeficacia/afrontamiento familiar y la CVRS en pacientes observantes. Solo las representaciones cognitivas de enfermedad mediaron la relación entre la autoeficacia y la CVRS en pacientes de baja observancia. Conclusiones: Los resultados destacan la importancia de las representaciones de la enfermedad durante el tratamiento de la AOS en la promoción de la adherencia a la APAP.(AU)

Wound healing and healing process in patients with diabetic foot ulcers: A survival analysis study.

AIMS: This study aimed to identify demographic, clinical, and psychological contributors to DFU healing and favorable healing process. METHODS: Patients with a chronic DFU were evaluated at baseline (T0; n = 153), two months later (T1; n = 108), and six months later (T2; n = 71). Patients were evaluated on health literacy, perceived stress, anxiety, depression, and illness perceptions. Cox proportional hazard models were built to analyze the predictors of DFU healing and favorable healing process (wound area reduction), including the assessment of time to achieve those outcomes. RESULTS: More than half of patients had their DFU healed (56.1%) or showed a favorable healing process (83.6%). Median time for healing was 112 days, while for favorable process was 30 days. Illness perceptions were the only predictor of wound healing. Being female , with adequate health literacy, and a first DFU predicted a favorable healing process. CONCLUSIONS: This is the first study showing that beliefs about DFU are significant predictors of DFU healing, and that health literacy is a significant predictor of a favorable healing process. Brief, comprehensive interventions should be implemented, at the treatment initial stage, in order to change misperceptions and to promote DFU literacy and better health outcomes.

Predictors of emotional distress in pregnant women: the mediating role of relationship intimacy.

Background: Assessment and treatment of emotional distress during pregnancy show that worries during pregnancy and interpersonal relationships with partners are the important factors determining psychological health.Aims: The present study aimed to investigate the impact of worries during pregnancy, relationship intimacy, and marital satisfaction on anxiety, depression, and stress symptoms in pregnant women, as well as to analyse the mediating effect of relationship intimacy between marital satisfaction and emotional distress.Method: During their second and third trimester of pregnancy, 200 Portuguese women were recruited during childbirth preparation consultations and completed the Cambridge Worry Scale (CWS), the Personal Assessment of Intimacy in Relationships Scale (PAIR), the Marital Life Areas Satisfaction Evaluation Scale (MLASES), and the Depression, Anxiety, and Stress Scale (DASS-21).Results: Hierarchical multiple regression analyses showed that being unemployed or on sick leave, being younger, having a history of miscarriage, having more worries during pregnancy, and declaring low-relationship intimacy were the main predictors of emotional distress. Relationship intimacy mediated the relation of marital satisfaction to anxiety and depression symptoms.Conclusions: This study highlights the importance of the worries during pregnancy and relationship intimacy in shaping pregnant women's emotional distress, and identifies both as targets of intervention.

Validation of the Quality of Life Multiple Myeloma Module Questionnaire (QLQ-MY20) in Portuguese myeloma patients.

OBJECTIVE: The aim of this study was the validation of the European Organization for Research and Treatment of Cancer's Multiple Myeloma Module (QLQ-MY20) in Portuguese myeloma patients. METHODS: A total of 213 Portuguese patients diagnosed with multiple myeloma participated in this study and were assessed with the European Organization for Research and Treatment of Cancer's (EORTC) Questionnaire C30 (QLQ-C30), the EORTC Multiple Myeloma Module (QLQ-MY20), the Hospital Anxiety and Depression Scale (HADS) and the Satisfaction with Social Support Scale (SSSS). RESULTS: The validated version includes 17 items presenting good global adjustment and good internal consistency. Overall, the Portuguese validation maintains the original model with the exception of three items that were excluded. The instrument also showed good reliability and good convergent and divergent validity. CONCLUSION: The Portuguese version of the EORTC Multiple Myeloma Module questionnaire seems to be a valid instrument for myeloma patients to help monitor interventions in this population focused on the promotion of quality of life.

The impact of informal cancer caregiving: A literature review on psychophysiological studies.

Caregiving can be experienced as a stressful process, which can cause psychological and physical consequences. The combination of prolonged stress and the physical demands of caregiving may impair the physiological functioning of caregivers and increase the risk of health problems creating considerable stress in the life of caregivers regarding emotional, physical, social and financial areas. This literature review explored studies that used measures of the autonomic nervous system in caregivers of oncology patients such as electrodermal and cardiovascular (re)activity. The results revealed that caregivers had elevated stress levels and a serious autonomic imbalance that may, in the long term, trigger negative health consequences such as infectious diseases, cancer progression, cardiovascular disease and even premature death. The results showed the need to carry out preventive strategies in this population, in order to improve the autonomic profile of caregivers of cancer patients.

Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study.

OBJECTIVE: Limited research has focussed on the development of traumatic stress symptoms following an amputation due to a chronic disease such as Diabetes. This study analysed whether coping strategies, anxiety and depression symptoms, sociodemographic and clinical variables were related to traumatic stress symptoms in a sample of patients who had undergone a lower limb amputation. DESIGN: A longitudinal design with three assessments, one month (T1), six (T2) and ten months after an amputation surgery (T3), included 144 patients. MAIN OUTCOME MEASURES: IES-R, WOC and HADS. RESULTS: Traumatic stress symptoms were prevalent at T1 (M = 15.65, SD = 15.40) and probable PTSD was observed in 13.9% patients. Presence of pain, high level of anxiety symptoms and emotion-focused strategies contributed to traumatic stress symptoms, and the period between T1 and T2, was critical. Six to ten months (Λ = 0.871, F (2,84) =6.245, p=. 003), after surgery, symptoms tended to decrease 0.122 units (SE = 0.032, p = 0.002) per assessment. CONCLUSIONS: Findings raise awareness to the need of urgent identification of traumatic stress symptoms in medically ill patients who underwent a lower limb amputation, given the prevalence of traumatic stress symptoms right after surgery and in the following six months.

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain.

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient's illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.

Obstructive sleep apnea representations, self-efficacy and family coping regarding APAP adherence: a longitudinal study.

Adherence is still an important issue considering new advances in Obstructive Sleep Apnea (OSA) treatment, as automatic positive airway pressure (APAP). The aim of the present study was to identify and explore relationships between identified predictors of adherence, over time. After overnight sleep study and OSA diagnosis and during a six-month APAP treatment period, a total of 153 patients underwent a three time psychological protocol evaluation. Generalized estimating equations were applied to analyzed repeated measurements in the same individuals. Results show that 40% of patients were poorly adherent and 60% were adherent after six months of treatment. The results confirmed a predictive value of age, self-efficacy, decisional balance index and health-related quality of life (HRQoL) in APAP adherence. Furthermore, the results revealed an interaction between time and illness cognitive representations, and self-efficacy and family coping, in explaining adherence patterns over time. Therefore, understanding the causality of theoretically derived constructs is crucial to predict the continuity of APAP adherence.

Anxiety, depression, traumatic stress and quality of life in colorectal cancer after different treatments: A study with Portuguese patients and their partners.

PURPOSE: This study examines the impact of different modes of treatment on depression, anxiety, traumatic stress and quality of life in colorectal cancer patients and their partners. METHODS: The sample was comprised of 114 oncology patients and 67 partners. All patients were diagnosed with colorectal cancer. Participants were recruited from an Oncology Hospital in the North of Portugal and had been submitted to three modes of treatment: surgery, surgery plus chemotherapy or surgery followed by radiotherapy. RESULTS: The results showed that patients who received only surgery, as treatment, had lower levels of depression, anxiety and traumatic stress symptoms when compared with patients who received surgery and chemotherapy or surgery plus radiotherapy. Partners of surgical patients presented lower levels of state anxiety and traumatic stress symptoms when compared with the other two groups. Patients with more depression had partners also more depressed. No relationship was found between anxiety and traumatic stress symptoms in patients and partners. Patients who received a diagnosis longer than 12 months had more traumatic stress, intrusion and hypervigilance. Patients with illness recurrence showed more traumatic symptoms. Anxiety and depression were the main predictors of patient's quality of life. Traumatic stress was a predictor of symptom distress - pain/bowel pattern. CONCLUSION: This study highlights the importance of providing psychological interventions for cancer patients and their partners. Chemotherapy patients and those diagnosed over a year, as well as their partners, are more at risk.