Impact of COVID-19 on Families of Pediatric Solid Organ Transplant Recipients.

OBJECTIVE: The COVID-19 pandemic and lockdown measures have had a clear psychological impact on families, and specifically those with children with chronic illnesses have reported greater overloads and exhaustion. The objective of this study was to evaluate the exposure, impact and experience of the pandemic on families of pediatric solid organ transplant (SOT) recipients compared to families of healthy children and adolescents. METHODS: We recruited 96 families, 48 with a pediatric SOT recipient and 48 healthy controls, matched by child age and gender. A primary caregiver from each family responded to an online sociodemographic questionnaire and the COVID-19 Exposure and Family Impact Survey (CEFIS), which explores the exposure, impact and experience of the pandemic and lockdown on families. RESULTS: Exposure to the pandemic was greater in families of healthy children and adolescents. The impact was mostly negative in both groups: caregivers reported increased anxiety (76%) and mood disturbances (71.9%) and hindered quality of sleep (64.6%) and health habits (58.3%). On the positive side, family relationships improved. Qualitatively, the SOT group positively perceived isolation and established hygienic measures as protective and destigmatizing, although they reported fear of virus transmission to their child. CONCLUSIONS: The psychological impact of the pandemic has been similar in both groups, although families of transplant recipients have protected themselves more, probably because they are used to prevention measures and they see contagion as a graver risk. Additionally, SOT recipients' families presented some idiosyncratic elements, especially a decrease in their perception of stigma associated with the medical condition.

Assessing the user experience and usability of the PRECIOUS system: a randomized controlled trial in obese patients.

Objective To assess users' usability, satisfaction, acceptance and effectiveness of the PRECIOUS system to promote behavior change toward healthier lifestyles. Design: Thirty-one adult patients with BMI>30 (M = 44.23, SD = 5.91) were recruited and randomized into three conditions for a longitudinal study (3 months length): 1) Control group (TAU + biofeedback + follow-ups); 2) PRECIOUS only (app + biofeedback + follow-ups); 3) PRECIOUS + MI (app + biofeedback + motivational interviewing follow-ups). Main Outcome Measures: Usability, satisfaction, acceptance and effectiveness of PRECIOUS, and stages of change (S-Weight questionnaire). Results: The system was described as easy to use, flexible, fairly satisfying and good as a preventive health system. Participants rated biofeedback and the Physical Activity module as the most satisfying features. However, participants were unsatisfied with the Diet module. All additional features received acceptable scores in terms of satisfaction. Despite this, the PRECIOUS only group reported that they would probably recommend the system to others because it meets its purposes quite well. Conclusion: PRECIOUS was found a usable and acceptable solution, although improving several features in the Diet module in successive versions of the app would promote sustained use and satisfaction among users, possibly increasing its effectiveness in promoting healthier lifestyles. Abbreviations: ADA American Diabetes Association; BG2: BodyGuard2; BMI: Body Mass Index; CBT: Cognitive-behavioral therapy; EMA: Ecological Momentary Assessment; eHealth: Electronic health; mHealth: Mobile health; MI: Motivational interviewing; NCD: Non-communicable diseases; PA: Physical activity; PRECIOUS: PREventive Care Infrastructure based On Ubiquitous Sensing.

Perfil de personalidad en pacientes con trasplante renal: el modelo alternativo de los cinco factores / Personality profile of kidney transplant patients: the alternative five factor model

Resumen Introducción: la investigación sobre rasgos de personalidad en pacientes con trasplante renal es limitada. El objetivo de este estudio fue describir el perfil de personalidad de pacientes con trasplante renal, utilizando el modelo alternativo de cinco factores (AFFM), y compararlo con población estándar española. Material y métodos: la personalidad fue evaluada mediante el Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Una muestra de 207 pacientes con trasplante renal se emparejó por edad y género con 207controles de la población estándar. El análisis de regresión logística permitió estudiar la aportación de cada dimensión del ZKPQ al perfil distintivo de los pacientes trasplantados. Resultados: aparecieron diferencias significativas en las dimensiones de Neuroticismo-Ansiedad (p=.001), Agresión-Hostilidad (p=.009) y Actividad (p=.001), con puntuaciones bajas en pacientes trasplantados en comparación con la población estándar. La sociabilidad (p=.024) fue significativamente mayor en pacientes trasplantados. En el análisis de regresión, las bajas puntuaciones en Neuroticismo-Ansiedad (p=.005) y Actividad (p=.001) fueron predictores significativos para caracterizar los rasgos de personalidad de pacientes trasplantados. Conclusiones: desde el AFFM, los pacientes con trasplante renal muestran un perfil diferente de personalidad comparado con la población estándar, con bajas puntuaciones en las dimensiones de Neuroticismo-Ansiedad y Actividad.

Abstract Background: There is limited research on personality traits that characterized kidney transplant patients. The aim of this study was to describe personality profile of kidney transplant patients using the Alternative Five Factor Model (AFFM), and compared it with the Spanish standard population. Method: Personality was assessed using the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). A sample of 207 kidney transplant patients was matched by age and gender with 207 standard range controls. A logistic regression analyses was utilized to study the contribution of each ZKPQ dimension to describe the distinctive transplant patient's profile. Results: Significant differences were showed in Neuroticism-Anxiety (p=.001), Aggression-Hostility (p=.009), and Activity (p=.001) dimensions, with lower scores on transplant patients compared with standard population. But Sociability (p=.024) was significantly higher on kidney transplant patients. In logistic regression analysis low scores on Neuroticism-Anxiety (p=.005) and Activity (p=.001) were the significant predictors to characterize personality traits of kidney transplant patients. Conclusions: Kidney transplant patients had a differential profile under the AFFM compared to standard range sample, with lower scores on Neuroticism-Anxiety and Activity dimensions.

Evaluación de la empatía en donante vivo de riñón / Evaluation of emphathy in living kidney donors

No disponible

Calidad de vida relacionada con la salud en el trasplante renal: seguimiento longitudinal a 2 años / Health related quality of life in renal transplantation: 2 years of longitudinal follow-up

Antecedentes y objetivo: La calidad de vida relacionada con la salud (CVRS) se considera una medida de resultado del trasplante renal. En este estudio se evaluaron los cambios en la CVRS y los síntomas específicos de la enfermedad renal, además de los efectos de variables sociodemográficas y clínicas en la CVRS percibida por el paciente. Pacientes y método: Se realizó un estudio longitudinal, con 5 momentos de evaluación durante 2 años después del trasplante. Para evaluar la CVRS se administró el Kidney Disease Quality of Life Questionnaire Short Form, y el Hospital Anxiety and Depression Scale para evaluar el malestar emocional. Resultados: A los 6 meses postrasplante, los pacientes tienen una CVRS similar a la población general. La dimensión de efectos de la enfermedad renal obtuvo un tamaño de efecto grande (η2=0,29), y un tamaño medio la dimensión de sobrecarga de la enfermedad renal (η2=0,12), la dimensión de actividad laboral (η2=0,12) y la dimensión de función sexual (η2=0,13). El malestar emocional, la hemoglobina y la creatinina influyeron significativamente en la CVRS percibida por el paciente. Conclusiones: Durante los 2 años posteriores al trasplante renal se observó una mejora de la CVRS en cuanto a aspectos generales y síntomas específicos de la enfermedad (AU)

Background and objective: Health related quality of life (HRQoL) is recognized as an outcome measure in kidney transplantation. In this study was assessed changes on HRQoL and kidney-specific symptoms, also was evaluated the effect of socio-demographic and clinical parameters on patient's perceived HRQoL. Patients and method: A longitudinal study was done, at 5 time-points over 2 years after transplantation. To evaluate HRQoL the Kidney Disease Quality of Life Questionnaire Short Form was administrated, and Hospital Anxiety and Depression Scale was used to assess psychological distress. Results: At 6-months after transplantation, patients had similar HRQoL scores compared to the general population. The improvement on effects of kidney disease domain could be considered as large (η2=0.29), and medium on burden of kidney disease domain (η2=0.12), work status domain (η2=0.12), and sexual function domain (η2=0.13). Psychological distress, depressive symptoms, haemoglobin, and serum creatinine had significant influence on patient's perceived HRQoL over 2 years after transplantation. Conclusions: An improvement of HRQoL was observed on general and specific-targeted symptoms over 2 years after renal transplantation (AU)

PREventive Care Infrastructure based On Ubiquitous Sensing (PRECIOUS): A Study Protocol.

BACKGROUND: mHealth has experienced a huge growth during the last decade. It has been presented as a new and promising pathway to increase self-management of health and chronic conditions in several populations. One of the most prolific areas of mHealth has been healthy lifestyles promotion. However, few mobile apps have succeeded in engaging people and ensuring sustained use. OBJECTIVE: This paper describes the pilot test protocol of the PReventive Care Infrastructure based on Ubiquitous Sensing (PRECIOUS) project, aimed at validating the PRECIOUS system with end users. This system includes, within a motivational framework, the Bodyguard2 sensor (accelerometer with heart rate monitoring) and the PRECIOUS app. METHODS: This is a pilot experimental study targeting morbidly obese prediabetic patients who will be randomized to three conditions: (1) Group 1 - Control group (Treatment as usual with the endocrinologist and the nurse + Bodyguard2), (2) Group 2 - PRECIOUS system (Bodyguard2 + PRECIOUS app), and (3) Group 3 - PRECIOUS system (Bodyguard2 + PRECIOUS app + Motivational Interviewing). The duration of the study will be 3 months with scheduled follow-up appointments within the scope of the project at Weeks 3, 5, 8, and 12. During the study, several measures related to healthy lifestyles, weight management, and health-related quality of life will be collected to explore the effectiveness of PRECIOUS to foster behavior change, as well as user acceptance, usability, and satisfaction with the solution. RESULTS: Because of the encouraging results shown in similar scientific work analyzing health apps acceptance in clinical settings, we expect patients to widely accept and express satisfaction with PRECIOUS. We also expect to find acceptable usability of the preventive health solution. The recruitment of the pilot study has concluded with the inclusion of 31 morbidly obese prediabetic patients. Results are expected to be available in mid-2017. CONCLUSIONS: Adopting and maintaining healthy habits may be challenging in people with chronic conditions who usually need regular support to ensure mid/long-term adherence to recommendations and behavior change. Thus, mHealth could become a powerful and efficient tool since it allows continuous communication with users and immediate feedback. The PRECIOUS system is an innovative preventive health care solution aimed at enhancing inner motivation from users to change their lifestyles and adopt healthier habits. PRECIOUS includes ubiquitous sensors and a scientifically grounded app to address three main components of health: physical activity, diet, and stress levels. TRIAL REGISTRATION: Clinicaltrials.gov NCT02818790; https://clinicaltrials.gov/ct2/show/NCT02818790 (Archived by WebCite at http://www.webcitation.org/6qfzdfMoU).

Health related quality of life in renal transplantation: 2 years of longitudinal follow-up. / Calidad de vida relacionada con la salud en el trasplante renal: seguimiento longitudinal a 2 años.

BACKGROUND AND OBJECTIVE: Health related quality of life (HRQoL) is recognized as an outcome measure in kidney transplantation. In this study was assessed changes on HRQoL and kidney-specific symptoms, also was evaluated the effect of socio-demographic and clinical parameters on patient's perceived HRQoL. PATIENTS AND METHOD: A longitudinal study was done, at 5 time-points over 2 years after transplantation. To evaluate HRQoL the Kidney Disease Quality of Life Questionnaire Short Form was administrated, and Hospital Anxiety and Depression Scale was used to assess psychological distress. RESULTS: At 6-months after transplantation, patients had similar HRQoL scores compared to the general population. The improvement on effects of kidney disease domain could be considered as large (η2=0.29), and medium on burden of kidney disease domain (η2=0.12), work status domain (η2=0.12), and sexual function domain (η2=0.13). Psychological distress, depressive symptoms, haemoglobin, and serum creatinine had significant influence on patient's perceived HRQoL over 2 years after transplantation. CONCLUSIONS: An improvement of HRQoL was observed on general and specific-targeted symptoms over 2 years after renal transplantation.

Health-related behaviours after 1 year of renal transplantation.

Health-related behaviours and psychological distress were examined after kidney transplantation. Patients were evaluated at 1 month, 6 months and 1 year after transplantation. Participants completed the Healthy Behaviours Questionnaire and the Hospital Anxiety and Depression Scale. No significant differences in Healthy Behaviours Questionnaire's total score and psychological comorbidity were observed at three time points. However, there was an increase in drug-consumer habits ( p < 0.05) and a reduction in sedentary lifestyle ( p < 0.05) at 6 months and 1 year. Moreover, at 1 year, post-transplant had increased the harmful health habits ( p < 0.05). In regression analysis, anxiety symptoms were significant predictors of Healthy Behaviours Questionnaire change at a year post-transplantation.

An exploratory study comparing psychological profiles and its congruence with clinical performance among patients with functional or motility digestive disorders.

Functional gastrointestinal disorders have been related with different psychological conditions. On the contrary, the role of psychological factors within gastrointestinal motor disorders remains unclear. The objective of this study was to explore the differences and congruence with clinical performance of the psychological profile and subjective functionality among patients diagnosed with functional gastrointestinal disorders and gastrointestinal motor disorders. Using a double-blind design, 56 inpatients from a Gastroenterology Department were included in the study. No major differences were detected between the two groups. However, clinical performance was coherent with subjective physical functioning only among patients diagnosed with gastrointestinal motor disorders. These results may provide useful information for gastroenterologists dealing with patients' complaints not consistent with their clinical profile.

Psychosocial factors and antiepileptic drug use related to delayed diagnosis of refractory psychogenic nonepileptic seizures.

OBJECTIVE: We analyzed clinical and psychosocial factors in patients with refractory psychogenic nonepileptic seizures, seeking characteristics that could hasten diagnosis. BACKGROUND: Psychogenic nonepileptic seizures remain a diagnostic challenge. Prognosis is best if patients are treated within 2 years of symptom onset. Psychosocial factors have been shown to provide important information for differential diagnosis. METHODS: Over a year and 1132 consecutive patients, our hospital's Epilepsy Unit suspected 93 patients of having psychogenic nonepileptic seizures and confirmed refractory psychogenic nonepileptic seizures in 67. We referred these patients to our psychiatric consultation unit for detailed diagnostic interviews, and 53 of the patients followed through. Two months after the psychiatric evaluation we gave them a psychiatric intervention, explaining the diagnosis and treating their comorbidities. We also tracked the patients' use of antiepileptic drugs for 3 months, from just before the psychiatric evaluation until a month after they started the intervention. RESULTS: Women, patients with an inadequate primary support group, and patients who had tried many antiepileptic drugs were most likely to have their diagnosis of psychogenic nonepileptic seizures delayed by >2 years after onset. A stepwise logistic regression showed that the 2 best predictors of late diagnosis were lack of availability of a primary support group and patients trying many antiepileptic drugs. CONCLUSIONS: Clinicians evaluating patients with questionable seizures should raise their suspicion of psychogenic nonepileptic seizures especially in female patients with an insufficient primary support group and a history of taking multiple antiepileptic drugs.

Increased cardiovascular and anxiety outcomes but not endocrine biomarkers of stress during performance of endoscopic sinus surgery: a pilot study among novice surgeons.

OBJECTIVE: To compare psychophysiological responses among novice surgeons during performance of endoscopic sinus surgery (ESS). DESIGN: Randomized study. SETTING: Academic institution. PARTICIPANTS: Fifteen novice surgeons. MAIN OUTCOME MEASURES: The psychophysiological effects of performing ESS were assessed among 15 novice surgeons at 30 minutes before (T - 30), at the beginning of (T0), at 15 minutes (T15), and 45 minutes (T45) during, and at 30 minutes after (T + 30) surgery. Participants were randomized to perform ESS with a computer-assisted surgery system, to perform ESS without a computer-assisted surgery system, or to be evaluated on a nonsurgical day (control day). Measured were the State-Trait Anxiety Inventory score, Visual Analog Anxiety Scale score, heart rate, blood pressure, and plasma cortisol and prolactin levels. RESULTS: Anxiety as measured by the State-Trait Anxiety Inventory score was not modified by the experimental conditions. The mean (SEM) Visual Analog Anxiety Scale score increased (P < .05) during ESS at T0 (2.45 [0.32]), T15 (3.46 [0.50]), and T45 (3.17 [0.46]) compared with the control day (1.19 [0.19], 1.32 [0.26], and 1.20 [0.19], respectively). The mean (SEM) systolic blood pressure (in millimeters of mercury) increased (P < .05) during ESS at T0 (127 [2]), T15 (126 [3]), and T45 (125 [2]) compared with the control day (120 [3], 119 [4], and 116 [3], respectively). The mean (SEM) heart rate (in beats per minute) increased during ESS but was significant only at T15 (73 [4]) compared with the control day (64 [3]). The mean (SEM) plasma cortisol level (in micrograms per deciliter) increased 29% above baseline during performance of ESS and reached a maximum peak at T45 (12.6 [1.2]) compared with the control day (9.7 [1.1]), while prolactin levels did not change. The Visual Analog Anxiety Scale score, heart rate, blood pressure, and endocrine biomarkers of stress were not significantly modified during performance of ESS with a computer-assisted surgery system. CONCLUSION: This study demonstrates for the first time that cardiovascular and anxiety changes during performance of ESS are not associated with increased levels of prototypical endocrine stress hormones.

Lack of association between antipsychotic-induced extrapyramidal symptoms and polymorphisms in dopamine metabolism and transport genes.

The purpose of this study was to investigate the relationship between functional polymorphisms in genes coding for dopamine metabolism and transport enzymes and the incidence of acute antipsychotic (AP)-induced extrapyramidal symptoms (EPS). We did not find evidence of the involvement of these polymorphisms in the predisposition towards or protection from EPS.

Somatosensory amplification in schizophrenia is associated with preserved neuropsychological function.

BACKGROUND: Some alexithymic features are similar to negative symptoms of schizophrenia, while somatosensory amplification has been defined as an abnormal perceptual style that could be related to hallucinations and positive schizophrenic symptoms. This study analyzed whether both psychological constructs are related to the type of clinical symptoms and to the neuropsychological performance of patients with schizophrenia. METHODS: Thirty-seven patients with schizophrenia were assessed psychologically (20-item Toronto Alexithymia Scale and Somatosensory Amplification Scale), clinically, and neuropsychologically and were compared with a control group of healthy subjects (n= 37). RESULTS: No differences were found in alexithymia or somatosensory amplification between patients and controls and there was no relationship between the two psychological variables and the type of psychotic symptoms in the patient group. However, among patients with schizophrenia, somatosensory amplification was related to significantly better neuropsychological performance than that found in alexithymic subjects and in patients in general. CONCLUSIONS: Alexithymia was unrelated to negative symptoms and to the neuropsychological performance of patients with schizophrenia, and as a psychological construct seems to be separate from the disease. However, in patients with an amplifier style, neuropsychological performance was highly similar to that found in healthy controls, raising the possibility of studying somatosensory amplification as a psychological variable that is potentially related to the clinical and neuropsychological outcomes of patients with schizophrenia.

A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission.

BACKGROUND: Studies on individual psychotherapy indicate that some interventions may reduce the number of recurrences in bipolar patients. However, there has been a lack of structured, well-designed, blinded, controlled studies demonstrating the efficacy of group psychoeducation to prevent recurrences in patients with bipolar I and II disorder. METHODS: One hundred twenty bipolar I and II outpatients in remission (Young Mania Rating Scale score <6, Hamilton Depression Rating Scale-17 score <8) for at least 6 months prior to inclusion in the study, who were receiving standard pharmacologic treatment, were included in a controlled trial. Subjects were matched for age and sex and randomized to receive, in addition to standard psychiatric care, 21 sessions of group psychoeducation or 21 sessions of nonstructured group meetings. Subjects were assessed monthly during the 21-week treatment period and throughout the 2-year follow-up. RESULTS: Group psychoeducation significantly reduced the number of relapsed patients and the number of recurrences per patient, and increased the time to depressive, manic, hypomanic, and mixed recurrences. The number and length of hospitalizations per patient were also lower in patients who received psychoeducation. CONCLUSION: Group psychoeducation is an efficacious intervention to prevent recurrence in pharmacologically treated patients with bipolar I and II disorder.

Quetiapine in the treatment of rapid cycling bipolar disorder.

INTRODUCTION: This prospective open-label study assessed the impact of add-on quetiapine in the treatment of rapid cycling bipolar patients. METHODS: Fourteen rapid cycling bipolar patients were treated with quetiapine, which was added to their ongoing medication regimen for 112 +/- 33 days. At the beginning of the study, five were manic, three were in a mixed state, three were depressed, two hypomanic and one was euthymic. Patients were assessed prospectively with a modified version of the Clinical Global Impression Scale for Bipolars (CGI-BP), the Young Scale for mania (YMRS) and the Hamilton Scale for Depression (HDRS). RESULTS: A significant reduction of the following scale scores was observed: a 1.8 point reduction for the general CGI-BP (p = 0.013), a -1.3 point for the mania subscale (p = 0.016), a -1.01 point for the YMRS (p = 0.025). Improvement in depressive symptoms was not significant, neither in the CGI-BP (-1 point, p = 0.074) nor in the HDRS (-5.2 points, p = NS). The most common side-effect was sedation (n = 6, 43%). Doses of quetiapine were significantly reduced by the end of the study (443 +/- 235 mg/day versus 268 +/- 190 mg/day, p = 0.008) and they also differed according to the initial episode to be treated (720 +/- 84 mg/day for mania, and 183 +/- 29 mg/day for depression, p = 0.023). CONCLUSIONS: Quetiapine could possibly be an effective treatment for rapid cycling bipolar patients. Adequate doses for acute episodes could significantly differ according to the episode polarity and the length of treatment.

Risperidone in the treatment of mania: efficacy and safety results from a large, multicentre, open study in Spain.

BACKGROUND: A number of open studies and preliminary results of unpublished double-blind trials have suggested that the novel antipsychotic risperidone may be effective and well tolerated in the treatment of acute mania in bipolar disorder. METHODS: A total of 174 patients entered this large, open, multicentre trial. Inclusion criteria were: current manic, hypomanic or mixed episode (DSM-IV), and a Young Mania Rating Scale (YMRS) score of >7. Assessments included the YMRS, Positive and Negative Syndrome Scale (PANSS), Hamilton Rating Scale for Depression (HAM-D), Clinical Global Impression (CGI), and Udvalg for Kliniske Undersøgelser (UKU) subscale for neurological side effects. RESULTS: There were significant reductions (P<0.0001) on the YMRS, PANSS and HAM-D scores and a significant improvement (P<0.0001) in CGI ratings at the endpoint. There were no statistically significant increments in the severity of extrapyramidal symptoms according to the UKU. Risperidone was generally well tolerated. The mean dose of risperidone at the endpoint was 4.9+/-2.9 mg/day. CONCLUSIONS AND CLINICAL IMPLICATIONS: This open study provides further evidence that risperidone is safe and effective in combination with mood stabilisers in the manic phase of bipolar disorder. LIMITATIONS: The open design and the use of concomitant medications make unclear to what extent the positive results were entirely related to risperidone.