Adjustment to disease and quality of life in people with vascular Ehlers-Danlos and Loeys-Dietz syndromes: A mixed-method study.

Background: Vascular Ehlers-Danlos (vEDS) and Loeys-Dietz syndromes (LDS) are hereditary disorders of connective tissue having severe vascular complications (HDCTv) which lead to an increased risk of premature death. Little is known about the impact of the disease in patient's daily life. Method: Sixteen HDCTv patients (vEDS = 9 and LDS = 7), 16 age and sex-matched hypermobile Ehlers-Danlos syndrome patients (hEDS) and 18 healthy subjects (HS), responded to self-questionnaires assessing psychosocial adjustment, quality of life (QoL), anxiety, depression, pain, fatigue and sleep problems. Patients with HDCTv were also interviewed in order to explore qualitatively their experience with the disease. Results: Compared with HS, patients with HDCTv scored significantly higher on anxiety, depression, fatigue, sleep problems, and lower on QoL. Most HDCTv patients (93.8%) have optimal psychosocial adjustment. In addition, HDCTv patients scored higher on QoL and psychosocial adjustment, but lower in pain, fatigue, sleep problems, and depressive symptoms than hEDS patients. Four main themes were identified in qualitative analyses: living with HDCTv, knowledge/ignorance of the disease, health behaviors/self-care and coping strategies. Conclusion: Our results suggest that despite the negative impact of HDCTv on the patients' daily lives, overall, they present an optimal disease adjustment which points to appropriate coping strategies. More research in psychosocial aspects of people with these rare diseases are needed to confirm these results and better understand their needs.

Central Sensitization and Chronic Pain Personality Profile: Is There New Evidence? A Case-Control Study.

BACKGROUND: Personality traits are relevant for pain perception in persistent pain disorders, although they have not been studied in depth in sensitized and nonsensitized patients with knee osteoarthritis (OA). OBJECTIVE: To explain and compare the personality profile of patients with OA, with and without central sensitization (CS), and fibromyalgia (FM). SETTING: Participants were selected at the Rheumatology Department in two major hospitals in Spain. PARTICIPANTS: Case-control study where the sample consists of 15 patients with OA and CS (OA-CS), 31 OA without CS (OA-noCS), 47 FM, and 22 controls. We used a rigorous and systematic process that ensured the sample strictly fulfilled all the inclusion/exclusion criteria, so the sample is very well delimited. PRIMARY OUTCOME MEASURES: Personality was assessed by the Temperament and Character Inventory of Cloninger. RESULTS: The percentile in harm-avoidance dimension for the FM group is higher compared to OA groups and controls. The most frequent temperamental profiles in patients are cautious, methodical, and explosive. Patients with FM are more likely to report larger scores in harm-avoidance, with an increase in logistic regression adjusted odds ratio (ORadj) between 4.2% and 70.2%. CONCLUSIONS: Harm-avoidance seems to be the most important dimension in personality patients with chronic pain, as previously found. We found no differences between OA groups and between sensitized groups, but there are differences between FM and OA-noCS, so harm-avoidance might be the key to describe personality in patients with CS rather than the presence of prolonged pain, as found in the literature before.

Development of the Individual and Environmental Resilience Model among children, adolescents and young adults using the empirical evidence: An integrative systematic review.

To create a new conceptual model of resilience based on evidence, this integrative systematic review aims to identify the evidence-based protective factors related to resilience among children, adolescents and young adults at-risk of several exposures. An Integrative Systematic review was conducted by using systematic principles according to PRISMA statement. Searching strategy was conducted through MEDLINE, CINAHL, Web of Science (ISI) and PsycINFO during July 2021(1991-2021). Keywords were related to resilience, self-esteem, hardiness, ego-resilience, risk factors, vulnerability, protective factors, ecological model and theoretical model. Those statiscally significant protective factors found in individual studies conducted with young populations (from 7 to 24 years old) exposed to violence, trauma or socio-economic instability were included in the qualitative synthesis. Of 15,235 peer-reviewed articles initially identified, 93 articles were screened and met the inclusion criteria; finally, 31 articles were included for the quality synthesis. More than 60 protective factors were found. They were classified in 10 different domains and two dimensions of resilience (Individual skills and Environmental), developing a new model of resilience: The Individual and Environmental Resilience Model (IERM). The Environmental dimension includes the domains: Family, School, Peers, Cultural and Community and The Individual skills dimension: Biological, Behaviour, Communications, Cognitive and Emotional domains. These domains and their specific protective factors have been set up as protective factors that significantly buffer negative outcomes in the face of adverse events. Compared with other models currently available, the new IERM model is potentially a more comprehensive approach that may facilitate the development of effective interventions to promote resilience in children, adolescents and young adults.

Past Child Abuse and Neglect in Adults From Northern Mexico: Development of a Scale and Prevalence.

Child abuse has been present in Mexico but there have been few studies that analyze its effects in adults. There are no Mexican validated scales that measure the relationship between abuse experienced in childhood and its effects into adulthood. The purpose of this study is to develop a past child abuse and neglect scale to measure these phenomena in adults and also to analyze the relationship the effects have with other psychological variables (e.g., anxiety, depression, self-esteem, partner-violence, personality, and fatalism). There were 763 participants from Juarez City, located on the northern border of Mexico. All participants were above the age of 18 years. The scale was developed, and its psychometric properties were analyzed. A first analysis consisted of analyzing the factor structure of the scale items with an Exploratory Factor Analysis (EFA), and then a Confirmatory Factor Analysis (CFA) was used to corroborate the factor structure. The resulting factors were guilt, relationship with parents, strong physical abuse, sexual abuse, mild physical and verbal abuse, and basic care. The internal reliabilities for all factors in both analyses were between Cronbach's alpha values of .77 and .92. Correlations of these factors with psychological variables were analyzed, and several statistically significant correlations were found. The scale has a good factor structure that correctly reflects the indicators of child abuse and neglect with good internal reliability values. The analysis showed that the prevalence rates of child abuse and neglect in Juarez were higher than those reported by the World Health Organization (WHO) in other locations worldwide. Actions by governments, universities, and civil associations should take place to reduce these rates, especially because of their long-term physical, emotional, and psychological consequences.

Relationship Between Different Types of Violence and Mental Health in High School Students From Northern Mexico.

Different types of violence have been present in Mexico but there have been few studies that have analyzed their relationship with mental health in adolescents, especially in cities with high rates of social violence. It is important to compare different violence types and their relationship with mental health since not all relationships are the same. It appears that social violence has a stronger relationship with mental health, and for this reason it receives more attention, but other types of violence have a stronger relationship and do not receive as much attention. Chihuahua has been one of the most violent states in Mexico, and Juarez has been the most violent city in the world in 2009 and 2010. The purpose of the study is to compare the relationship of different types of violence (social, cyberbullying, partner violence, and child abuse and neglect) with mental health indicators (depression, anxiety, stress, self-esteem, and paranoid thoughts). There were 526 high school students, from the cities of Juarez (n = 282) and Chihuahua (n = 244). The mean age was 16.5 (SD = 1.4) years and 50.6% reported being males. The relationships among the variables were analyzed using Pearson's correlations and multiple linear regressions. Both cities that have experienced social violence like carjacking, kidnapping, and sexual assault, but they have very small or no relationships with mental health indicators. Other types of violence have stronger correlations. Our findings suggest that interventions should not focus only in preventing and dealing with social violence, but that other types of violence must also be addressed in adolescents.

Adaptation and Psychometric Properties of the Spanish Version of Child and Youth Resilience Measure (CYRM-32).

Resilience is defined as a dynamic process that entails a positive adaptation to contexts of adversity. According to the ecological model, resilient behavior emerges as a result of the interaction between individual, relational, community and cultural variables. The Child and Youth Resilience Measure (CYRM-28), developed in Canada and based on the ecological model, has been validated in several countries. The objective of this article is to present the cultural adaptation (studies I and II) and validation (study III) in Spanish at risk youth. A three-study mixed-method design was selected. Study I includes translations and a confirmatory and exploratory factor analysis of a sample of 270 Spanish young persons (56.9% boys) aged between 12 and 18 years (M = 14.65; SD = 1.27) from an urban public elementary school. Study II uses semi-structured interviews with adolescents identified as resilient and presents a content analysis and a reformulation of items with experts. Study III includes the confirmatory factor analysis, internal consistency, test-retest, convergent and discriminant validity, and multivariate analysis of variance to explore group differences of the resulting scale CYRM-32. The sample consisted of 432 at-risk young persons (54.9% boys) aged between 12 and 19 years old (M = 14.99; SD = 2.23). The results confirm the adequate psychometric properties of the CYRM-32 scale. From the original scale, 4 items were eliminated, 5 were reformulated presenting very low saturations. Meanwhile, 6 items were added to the cultural adaptation phase, resulting in a 32-item scale. The confirmatory analysis confirms the 3 factors expected in the CYRM-32 scale with good reliability indexes (Cronbach's α total scale 0.88, family interaction 0.79, interaction with others 0.72 and individual skills 0.78). The scale has convergent and discriminant validity in relation to the Brief Resilient Coping Scale, Coping Scale for Adolescents and Self-Concept. Significant differences were found in the scores of the CYRM-32 scale for the ethnic variable [F(71. 358) = 1.714, p < 0.001], while no differences appear according to age and gender. This finding confirms the importance of culture in the resiliency processes. The CYRM-32 scale has good psychometric properties and is a new alternative for measuring resilience in Spanish at-risk youth.

Vulnerability to Psychopathology and Dimensions of Personality in Patients With Fibromyalgia.

OBJECTIVE: Fibromyalgia (FM) patients may present psychopathology and some characteristic personality traits that may affect their adaptation to the disease. The aim of this paper was to study the relationship between personality dimensions according to the psychobiological model of Cloninger and the presence of psychopathology. MATERIALS AND METHODS: The study sample consisted of 42 patients with FM and 38 pain-free controls. The assessment instruments administered were the Temperament and Character Inventory-Revised and the Millon Clinical Multiaxial Inventory. RESULTS: A higher proportion of clinical psychopathologic syndromes (CPS) was observed in the FM group than in the control group, the most prevalent being anxiety disorder and dysthymia. Patients with FM (with CPS or without CPS) presented higher Harm Avoidance than the control group, and the presence of a CPS also increased Harm Avoidance scores. FM patients with CPS had low Self-directedness (SD) compared with both the control group and with their FM peers without CPS. Purposefulness and Anticipatory worry-Pessimism explained 38% of the variance of dysthymia, and anticipatory worry-Pessimism explained 18% of the variance of anxiety disorders. CONCLUSIONS: Patients with FM have a high probability of anxious-depressive-type psychopathologic alterations. Their vulnerability to these conditions may be determined by personality traits. The SD character dimension may have implications for therapy, as low SD is associated with the presence of psychopathology and with a low capacity to cope with the disease.

Cloninger's psychobiological model of personality and psychological distress in fibromyalgia.

AIM: Personality can play an important role in the clinical symptoms of fibromyalgia (FM). The aim of this study is to identify personality profiles in FM patients and the possible presence of personality disorder (PD) from the Temperament and Character Inventory-Revised (TCI-R), and to assess whether personality dimensions are related to psychological distress in FM. METHOD: The sample consisted of 42 patients with FM and 38 healthy controls. The TCI-R, Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, Short-Form-36 Health Survey, Fibromyalgia Impact Questionnaire and McGill Pain Questionnaire were administered. RESULTS: The personality profile of the FM group based on the TCI-R is defined by high Harm Avoidance (HA), low Novelty Seeking (NS), and low Self-Directedness (SD). Only one-third of patients with FM present a possible psychometric PD, principally from Cluster C. In the FM group, HA and SD are associated positively and negatively, respectively, with indicators of emotional distress. Patients with higher HA present higher perceived pain intensity rated via a verbal-numerical scale while Determination (SD2) reduced the perceived level of pain induced by the stimulus. NS is negatively related to the number of work absences caused by FM. CONCLUSIONS: The study suggests that HA and SD play an important role in psychological distress in FM. The fact that SD is prone to modification and has a regulatory effect on emotional impulses is a key aspect to consider from the psychotherapeutic point of view.

Actitud hacia la violencia de género de los profesionales de Atención Primaria: estudio comparativo entre Cataluña y Costa Rica / Attitude of primary care professionals to gender violence. A comparative study between Catalonia and Costa Rica

OBJETIVO: Relacionar la actitud hacia la violencia de género (VG) de profesionales de Atención Primaria con satisfacción laboral, carga laboral, orientación de práctica profesional, conocimientos, formación y uso de los recursos socio sanitarios en Cataluña y Costa Rica. DISEÑO: Estudio exploratorio transversal y comparativo. Emplazamientos: Atención Primaria en Barcelona y comarcas, y Gran Área Metropolitana en Costa Rica. PARTICIPANTES: 235 profesionales de Medicina, Enfermería, Psicología y Trabajo Social. MEDICIONES PRINCIPALES: Cuestionario con 8 bloques que miden actitudes, satisfacción profesional, orientación de práctica profesional, carga laboral, conocimientos, formación y uso de los recursos sociosanitarios. Se realizan 3 tipos de análisis de datos: descriptivo de cada variable, de correlación de variables y un modelo de regresión lineal múltiple. RESULTADOS: La actitud hacia la violencia de género fue similar en ambos contextos (Cataluña: 3,90, intervalo de confianza [IC del 95%], 3,84-3,96; Costa Rica 4,03, IC del 95%, 3,94-4,13). En el análisis multivariable, los factores que se asociaron a la actitud fueron: 1) formación (B = 0,10; p = 0,02); 2)uso de recursos sociosanitarios (B = 0,20; p = <0,01), y 3) el país Costa Rica (B = 0,16; p = < 0,01). Las interacciones entre las variables independientes y el país no fueron significativas. CONCLUSIONES: El uso de los recursos sociosanitarios y la formación actualizada puede incrementar una actitud favorable para el abordaje de la violencia de género en Atención Primaria. El efecto de las variables es el mismo tanto en Cataluña como en Costa Rica

OBJECTIVE: Describe the relationship between the attitude towards violence against women (VAW) of professionals of the health of primary care with variables such professional satisfaction, workload, orientation of professional practice, knowledge, training and use of network in Catalonia and Costa Rica. DESIGN: Cross-exploratory and comparative study. LOCATION: Primary care in Barcelona and nearby counties and the Greater Metropolitan Area (GAM) of Costa Rica. PARTICIPANTS: 235 primary health professionals of Medicine, Nursing, Psychology and Social Work. MAIN MEASUREMENTS: Questionnaire with eight sections about attitudes, professional satisfaction, and orientation of professional practice, workload, knowledge, training and use of network. Three types of analysis were carried out: a descriptive one by country; a bivariate analysis; and a multivariable linear regression model. RESULTS: Primary Health Professionals attitudes towards VAW health were similar in both contexts (Catalonia: 3.90 IC 95% 3.84-3.96; Costa Rica: 4.03 IC 95% 3.94-4.13). The variables associated with attitudes towards VAW were: Use of network resources (B = 0.20, 95% CI -0.14-0.25, P=<.001), Training (B = 0.10, 95% CI 0.04 to 0.17, P=<0.001), and country, Costa Rica (B = 0.16, 95% CI 0.06 to 0.25,P=<0.001). There was no interaction between the country and the other variables, suggesting that the association between the variables and the attitude is similar in both countries. CONCLUSIONS: The results suggest that increased use of network resources and training are related to a positive attitude towards VWA in primary health professionals, both in Catalonia and Costa Rica

[Attitude of primary care professionals to gender violence. A comparative study between Catalonia and Costa Rica]. / Actitud hacia la violencia de género de los profesionales de Atención Primaria: estudio comparativo entre Cataluña y Costa Rica.

OBJECTIVE: Describe the relationship between the attitude towards violence against women (VAW) of professionals of the health of primary care with variables such professional satisfaction, workload, orientation of professional practice, knowledge, training and use of network in Catalonia and Costa Rica. DESIGN: Cross-exploratory and comparative study. LOCATION: Primary care in Barcelona and nearby counties and the Greater Metropolitan Area (GAM) of Costa Rica. PARTICIPANTS: 235 primary health professionals of Medicine, Nursing, Psychology and Social Work. MAIN MEASUREMENTS: Questionnaire with eight sections about attitudes, professional satisfaction, and orientation of professional practice, workload, knowledge, training and use of network. Three types of analysis were carried out: a descriptive one by country; a bivariate analysis; and a multivariable linear regression model. RESULTS: Primary Health Professionals attitudes towards VAW health were similar in both contexts (Catalonia: 3.90 IC 95% 3.84-3.96; Costa Rica: 4.03 IC 95% 3.94-4.13). The variables associated with attitudes towards VAW were: Use of network resources (B=0.20, 95% CI -0.14-0.25, P=<.001), Training (B=0.10, 95% CI 0.04 to 0.17, P=<0.001), and country, Costa Rica (B=0.16, 95% CI 0.06 to 0.25, P=<0.001). There was no interaction between the country and the other variables, suggesting that the association between the variables and the attitude is similar in both countries. CONCLUSIONS: The results suggest that increased use of network resources and training are related to a positive attitude towards VWA in primary health professionals, both in Catalonia and Costa Rica.