La teoría de las transiciones como paradigma de apoyo al automanejo en personas con condiciones crónicas / Transitions theory as a paradigm for supporting self-management in people with chronic conditions / A teoria das transições como paradigma para apoiar a autogestão em pessoas com condições crónicas

Resumen Introducción: La experiencia de vivir con una enfermedad crónica no es una tarea sencilla, se requiere de herramientas que permitan aumentar el grado de conciencia para enfrentar las necesidades y superar desafíos sobre el estado de salud y enfermedad. En los últimos años, se ha instaurado el apoyo al automanejo, con la finalidad de potenciar las habilidades en personas con este tipo de afecciones. Resulta trascendental considerar como desde enfermería se puede contribuir al logro de aquello. El objetivo del presente ensayo es reflexionar acerca de la teoría de las transiciones de Meléis como paradigma de apoyo al automanejo en personas con condiciones crónicas. Desarrollo: La teoría de las transiciones de Meléis establece que las personas están en constante cambio, tal como ocurre en el proceso de transición de salud-enfermedad. Recibir el diagnóstico de una enfermedad crónica, conlleva una serie de procesos complejos para la persona, debido a la multiplicidad de variables que ello implica. La teoría de Meléis entrega lineamientos para orientar a la persona profesional de enfermería sobre elementos claves e interrelacionados, como la concepción previa de la naturaleza de la transición y sus condiciones, lo que servirá para la planificación de modalidades de intervención congruentes con las experiencias de la persona y su evaluación en el transcurso del proceso de salud y enfermedad. Conclusión: El paradigma ofrecido por Meléis puede ser considerado un enfoque clave para emprender el proceso de cuidado de enfermería tendiente a apoyar a las personas con enfermedad crónica en el logro del automanejo.

Abstract Introduction: The experience of living with a chronic disease is not a simple task, since it requires tools that allow increasing the degree of awareness to face the needs and overcome challenges about the state of health and disease. In recent years, support for self-management has been established, with the aim of enhancing the skills of people with this type of condition. It is important to consider how the nursing discipline can contribute to achieve this. The aim of this paper is to reflect on Meléis' theory of transitions as a paradigm to support self-management in people with chronic conditions. Development: Meléis' theory of transitions establishes that people are in constant change, as occurs in the health-illness transition process. Receiving the diagnosis of a chronic disease involves a series of complex processes for the person, due to the multiplicity of variables involved. Meléis' theory provides guidelines to orient the nursing professional on key and interrelated elements, such as the previous conception of the nature of the transition and its conditions, which will serve for the planning of intervention modalities congruent with the person's experiences and their evaluation in the course of the health and disease process. Conclusion: The paradigm offered by Meléis can be considered a key approach to undertake the nursing care process aimed at supporting people with chronic illness in achieving self-management.

Resumo Introdução: A experiênca de viver com uma doença crônica não é uma tarefa simple, pois requer ferramentas que permitam aumentar o nível de consciência para enfrentar as necessidades e superar desafios relativos ao estado de saúde e doença. Nos últimos anos, foi estabelecido o apoio à autogestão, com o objetivo de melhorar as habilidades das pessoas com este tipo de condições. É transcendental considerar como a disciplina de Enfermagem pode contribuir para isso. O objetivo deste ensaio é refletir sobre a teoria das transições de Meleis como paradigma de apoio à autogestão em pessoas com condições crônicas. Desenvolvimento: A teoria das transições de Meléis estabelece que as pessoas estão em constante mudança, como acontece no processo de transição saúde-doença. Receber o diagnóstico de uma doença crónica implica uma série de processos complexos para a pessoa, devido à multiplicidade de variáveis envolvidas. A teoria de Meléis fornece directrizes para orientar o profissional de enfermagem sobre elementos-chave e inter-relacionados, como a conceção prévia da natureza da transição e das suas condições, que servirão para o planeamento de modalidades de intervenção congruentes com as experiências da pessoa e a sua avaliação no decurso do processo saúde-doença. Conclusão: O paradigma oferecido por Meleis pode ser considerado uma abordagem chave para empreender o processo de cuidado de enfermagem que visa apoiar as pessoas com doenças crônicas no alcance do autogerenciamento.

Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS.

Background: With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models. Results: After 7-years follow-up, 41.2% (2,951/7163, 95% CI:40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease: HR = 1.197; 2 chronic diseases: HR = 1.310; 3 and more chronic diseases: HR = 1.397). Diabetes or high blood sugar (HR = 1.185), kidney disease (HR = 1.252), stomach or other digestive diseases (HR = 1.128), and arthritis or rheumatism (HR = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese. Conclusion: The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.

Caregiver strain among non-Hispanic Black and Hispanic male caregivers with self-reported chronic health conditions.

OBJECTIVES: Caregiver strain often stems from unmet needs and is a risk factor for poor physical and psychological health. This study aims to identify factors associated with caregiver strain among middle-aged and older non-Hispanic Black and Hispanic male caregivers living with one or more chronic conditions. DESIGN: Data were analyzed from 418 male caregivers collected through Qualtrics Online Panels using an internet-delivered survey instrument (55.7% non-Hispanic Black, 44.3% Hispanic). Three ordinal regression models were fitted to assess factors associated with Caregiver Strain Scale tertiles: one for all men, one for non-Hispanic Black men only; and one for Hispanic men only. RESULTS: Similarities and differences were observed between the two groups in terms of factors associated with higher caregiver strain (i.e. lower disease self-management efficacy scores, providing ≥20 h of care per week). Uniquely for Non-Hispanic Black male caregivers, higher caregiver strain was associated with living with more children under the age of 18 (ß = 0.35, P = 0.011) and feeling more socially disconnected (ß = 0.41, P = 0.008). Uniquely for Hispanic male caregivers, higher caregiver strain levels were associated with experiencing lower pain levels (ß = -0.14, P = 0.040) and higher fatigue levels (ß = 0.23, P < 0.001). CONCLUSION: Findings from this study suggest that non-Hispanic Black and Hispanic men with chronic conditions have differing caregiving experiences. While bolstering social connectedness and caregiver support services may offset caregiver strain, tailored mental health and disease management programming are needed to meet the specific needs of non-Hispanic Black and Hispanic male caregivers.

Racial and Ethnic Disparities in Chronic Stress among Male Caregivers.

Whereas research on caregiving is well documented, less is known about gender inequalities in caregiver stress, coping mechanisms, and health outcomes, all of which may vary by race, ethnicity, and socioeconomic status. This scoping review investigated racial and ethnic disparities using the Stress Process Model among male caregivers. Several databases were searched including Academic Search Premier, Medline Complete, APA PsycInfo, CINHAL, Google, ProQuest, and Web of Science. Included were peer-reviewed articles in English, published from 1990 to 2022. A total of nine articles fulfilled inclusion criteria. Most of the articles indicated that compared to White male caregivers, African American male caregivers provided more hours of care, assisted with more activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and experienced more financial stress. In terms of coping style, one study found African American male caregivers, compared to White male caregivers, held negative religious beliefs. Another study showed that they were at a higher risk for stroke than their White counterparts. The search revealed a dearth of studies on racial disparities in stress, coping, and health outcomes among male caregivers. Further research is needed on the experiences and perspectives of male minority caregivers.

Mental health burdens among North American Asian adults living with chronic conditions: a systematic review.

Asians are likely to experience a high burden of chronic conditions, including, but not limited to, diabetes, cardiovascular disease, and cancer, due to differences in biologic, genetic, and environmental factors across Asian ethnic groups. A diagnosis of any chronic condition can contribute to increased mental health burdens, including depression, psychological distress, and posttraumatic stress disorder (PTSD). However, few studies have examined these comorbid conditions across distinct Asian ethnic groups-an important limitation given the differences in social, cultural, and behavioral drivers of mental health burdens within and across Asian ethnicities. To understand the disparities in mental health burdens among Asians living with a chronic health condition, we conducted a systematic literature review of relevant, peer-reviewed publication databases to identify studies reporting on mental health burdens (e.g., depression, anxiety, distress, PTSD) in distinct Asian ethnic groups in North America. Thirteen studies met the inclusion criteria for this review and collectively demonstrated a high burden of depression, psychological distress, and PTSD among Asians living with chronic conditions. Moreover, there were distinct disparities in mental health burdens across chronic conditions and across Asian ethnic groups. Despite the detrimental impact of poor mental health on chronic disease-specific outcomes, such as death and poor quality of life, few data exist that characterize mental health outcomes among Asian ethnicities living in North America with chronic conditions. Future work should prioritize estimating the national prevalence of mental health outcomes among adults with chronic conditions, by Asian ethnicities, to inform culturally tailored interventions to address this public health burden.

Socioemotional and behavioural difficulties in children with chronic physical conditions: analysis of the Longitudinal Study of Australian Children.

OBJECTIVES: To examine the prevalence of socioemotional and behavioural difficulties (SEBDs) in children with chronic physical conditions (CPCs) and to analyse how this prevalence varied with the type and number of CPCs and the age of the child. DESIGN: Cross-sectional study of a secondary data analysis of the Longitudinal Study of Australian Children. SETTING: An Australian nationally representative sample of general population of children. PARTICIPANTS: 15 610 children-waves aged 6-14 years. INTERVENTION/EXPOSURE: Children reported to have at least 1 of the 21 CPCs by their parents. MAIN OUTCOME MEASURES: Clinically relevant SEBDs were defined using standardised cut-offs of the parent-administered Strengths and Difficulties Questionnaire. RESULTS: Children with a CPC have significantly increased odds of total, internalising and externalising SEBDs than those without (total SEBDs, adjusted odds rartio or OR 3.13, 95% CI 2.52 to 3.89), controlling for sex, age, socioeconomic status and parental mental health status. The highest prevalence of total SEBDs was found in children with chronic fatigue (43.8%), epilepsy (33.8%) and day wetting (31.6%). An increasing number of comorbid CPCs was associated with a rising prevalence of SEBDs. On average, 24.2% of children with at least four CPCs had SEBDs. These children had 8.83-fold increased odds (95% CI 6.9 to 11.31) of total SEBDs compared with children without a CPC. Age was positively related to the odds of SEBDs. CONCLUSION: Children with a CPC have a significantly increased risk of having SEBDs than those without. These findings highlight the need for routine assessment and integrated intervention for SEBDs among children with CPCs.

Chronic Disease Self-Management of Post-Acute Sequelae of COVID-19 Among Older Adults: A Mixed-Methods Analysis.

Introduction: Approximately 20-30% of individuals who contract acute coronavirus disease (COVID-19) infection develop longer term complications of their initial infection, referred to as Post-Acute Sequelae of SARS-CoV-2 infection (PASC). PASC is characterized by chronic, varying symptomatology. Methods: Using a mixed methods study design, we aimed to gain insight into individuals' experience with PASC, including cognitive issues, fatigue, and sleep disturbances. We explored whether our previously developed application (app), aimed at improving self-management skills among individuals with chronic diseases, is relevant for individuals with PASC and gained information to adapt the app for individuals with PASC. The study included 19 individuals, aged 40 years and older, recruited from our research participant database, Nova Southeastern University clinics, and community locations. We included this age range because older adults are more likely to have comorbid conditions, allowing us to better understand the impact of COVID-19 infection in these individuals. Participants completed seven standardized self-report questionnaires online, and an individual semi-structured interview via videoconferencing. Quantitative data were assessed using descriptive statistics and calculating individuals' scores in relation to norms. Qualitative data were analyzed using a thematic analysis approach. Triangulation of the data was accomplished by calculating correlations between participants' responses on self-report scales and themes found in semi-structured interviews. Results: Themes included disruption of everyday life, diverse physical symptoms, and cognitive problems including brain fog, fatigue, coping, and emotional upset. Quantitative analysis demonstrated that participants experienced high levels of fatigue, negative mood, cognitive problems, and overall reduction in health-related quality of life (HRQOL). Correlation analyses revealed that individual interview responses were related to participants' self-report of symptoms on standard questionnaires. Discussion: Findings indicate that self-report questionnaires may reflect the experience of individuals with PASC and its impact. Additionally, further efforts to expand our prior mobile app are warranted among individuals with PASC.

Patterns of adolescent perceived social support and inflammation in adulthood within major racial groups: Findings from a longitudinal, nationally representative sample.

Inflammation, the body's protective response to injury and infection, plays a critical role in physical and mental health outcomes. Elevated chronic inflammation is implicated as a predictor of disease and all-cause mortality and is linked with several psychological disorders. Given that social support is associated with lower rates of mortality and psychopathology, the links between inflammation and social support are well-studied. However, there are many significant gaps related to both the specificity and generalizability of extant findings. There is a paucity of research on the association between social support and inflammation within different racial groups. Additionally, more research is warranted to understand whether social support from different sources uniquely contributes to inflammation, above and beyond other sources of support. Thus, the current study examined whether perceived emotional social support during adolescence predicted inflammation during adulthood within several racial groups. Participants (n = 3,390) were drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health), identified as either Asian, Black, Latinx, White, or Multiracial, and had complete data on study variables. Consistent with our hypotheses and previous research, greater perceived support during adolescence was associated with lower inflammation during adulthood, but only for White participants. Contrastingly, greater perceived support during adolescence was associated with higher inflammation during adulthood for individuals who identified as Asian, Latinx, Black, or Multiracial. Furthermore, patterns of social support and inflammation within each racial group varied by relationship type. These results highlight the importance of studying relationship processes and health outcomes within racial groups to understand their unique, lived experiences.

Involvement of miR-135a-5p Downregulation in Acute and Chronic Stress Response in the Prefrontal Cortex of Rats.

Stress is a key risk factor in the onset of neuropsychiatric disorders. The study of the mechanisms underlying stress response is important to understand the etiopathogenetic mechanisms and identify new putative therapeutic targets. In this context, microRNAs (miRNAs) have emerged as key regulators of the complex patterns of gene/protein expression changes in the brain, where they have a crucial role in the regulation of neuroplasticity, neurogenesis, and neuronal differentiation. Among them, miR-135a-5p has been associated with stress response, synaptic plasticity, and the antidepressant effect in different brain areas. Here, we used acute unavoidable foot-shock stress (FS) and chronic mild stress (CMS) on male rats to study whether miR-135a-5p was involved in stress-induced changes in the prefrontal cortex (PFC). Both acute and chronic stress decreased miR-135a-5p levels in the PFC, although after CMS the reduction was induced only in animals vulnerable to CMS, according to a sucrose preference test. MiR-135a-5p downregulation in the primary neurons reduced dendritic spine density, while its overexpression exerted the opposite effect. Two bioinformatically predicted target genes, Kif5c and Cplx1/2, were increased in FS rats 24 h after stress. Altogether, we found that miR-135a-5p might play a role in stress response in PFC involving synaptic mechanisms.

Relationship between resilience and self-care in people with chronic conditions: A systematic review and meta-analysis.

BACKGROUND: Living with chronic condition(s) is difficult, due in part to the complexities of effective disease self-care. Self-care has been considered a challenging process according to the literature which describes multiple barriers patients with chronic conditions experience. Resilience has the potential to buffer the adversities of daily self-care and maintain physical and emotional well-being. No systematic review and meta-analysis have been conducted to synthesise and quantify the relationship between resilience and self-care across chronic conditions. AIMS: (1) To examine how the definitions and measurements of self-care and resilience align with the middle-range theory of self-care of chronic illness (i.e. self-care maintenance, self-care monitoring, and self-care management) and 3 Rs of resilience process from the society-to-cells framework (i.e. resistance, recovery and rebound) across different chronic conditions; and (2) to examine whether and the degree to which resilience is correlated with self-care across different chronic conditions. DESIGN: Systematic review and meta-analysis, following PRISMA guidelines. METHODS: PubMed, CINAHL, SocINDEX and PsychINFO were searched for quantitative studies published from January 2000 through July 2020. Descriptive data were summarised using numerical counting to provide an overview of the study characteristics. Definitions and measurements of self-care and resilience were synthesised narratively based on self-care and resilience theories. Numerical data with Pearson's product-moment correlation among observational studies were examined using meta-analysis. RESULTS: This review included 20 articles, involving 9,269 individuals across 11 chronic conditions. Despite self-care and resilience being defined and operationalised in a variety of ways, most definitions shared some underlying core constructs. Meta-analysis showed a positive relationship between resilience and self-care across chronic conditions. Findings from interventional studies indicated a bidirectional relationship between resilience and self-care. CONCLUSIONS: Overall, resilience was positively associated with self-care in people with chronic conditions. Longitudinal and experimental studies are needed to better understand the causal relationship between resilience and self-care. RELEVANT TO CLINICAL PRACTICE: Resilience has the potential to buffer the adversities of daily self-care and maintain physical and emotional well-being. The positive relationship between resilience and self-care found in this review provides preliminary evidence for clinicians to not only focus on reducing barriers and risk factors of self-care but also to improve or increase patients' resilience through various evidence-based interventions.

Behavior Problems, Self-Esteem, and Prosocial Behavior in Siblings of Children With Chronic Physical Health Conditions: An Updated Meta-Analysis.

OBJECTIVE: Chronic physical health conditions (CPHC) of children affect the whole family. The aim of the present meta-analysis was to compare levels of internalizing, externalizing, and total problems as well as self-esteem/positive self-concept and prosocial behavior of the healthy siblings with children from families not affected by CPHC and test norms, respectively. METHODS: A systematic search for literature was conducted using the electronic data bases CINAHL, PsycInfo, PubMed, PSYNDEX, and Web of Science. In total, results from 216 studies were included in random-effects meta-analyses that had been published or made available online before February 15, 2022. RESULTS: Healthy siblings of children with CPHC had elevated levels of internalizing (g = .18 standard deviation units), externalizing (g = .13), and total behavior problems (g = .22), and effect sizes were found to be small to very small. While levels of self-esteem did, on average, not vary between healthy children with and without a sibling with CPHC or test norms (g = .08), higher levels of prosocial behavior were found in the healthy siblings of children with CPHC (g = .18). In addition, some moderating effects of kind of CPHC and its intrusiveness as well as mortality risk, country, sociodemographic equivalence of the compared groups, and year of publication were identified. CONCLUSIONS: It is concluded that CPHC of a child can have negative as well as positive effects on psychosocial outcomes of healthy siblings. Psychosocial interventions are recommended for healthy siblings at elevated risk for psychological problems.

Impact of xerostomia and the use of dental prosthesis on the quality of life of elderly: a cross-sectional study

Aim: To evaluate the impact of xerostomia, edentulism, use of dental prosthesis, and presence of chronic diseases on quality of life in relation to oral health in institutionalized elderly individuals. Methods: This is a cross-sectional study. A questionnaire was administered containing the following instruments: Oral Health Impact Profile (OHIP-14), which measures the quality of life related to oral health; the Summated Xerostomia Inventory questionnaire (SXI-PL) for evaluation of xerostomia, sociodemographic data, clinical description, and patient-reported factors was assessed (edentulism, use of dental prostheses, and chronic diseases). Results: Most elderly individuals did not have any teeth in their mouths and used dental prosthesis. The impact on quality of life, considering the mean of the OHIP-14 scores, was positive in 58.3% of the elderly. Those who used a dental prosthesis were three times more likely to have their oral health negatively impacted (OR=3.09; 95%CI =1.17 8.11), compared to those who did not use, and individuals with xerostomia were more likely to have their oral health negatively impacted (OR=1.57; 95%CI=1.25-1.98) compared to those without xerostomia. There was no difference in the quality of life of individuals with and without chronic diseases. Conclusions: The feeling of dry mouth and use of dental prostheses negatively impacted the quality of life in relation to oral health of the elderly

Morbidities, Self-reported Health, Purpose, and Satisfaction with Life in Older Adults / Morbidades, Autoavaliação de Saúde, Propósito e Satisfação com a Vida em Idosos / Morbilidades, Autoevaluación de Salud, Propósito y Satisfacción con la Vida en Adultos Mayores

Abstract This study aims to estimate the prevalence of overall satisfaction with life regarding sense of purpose in life, morbidities, and self-reported health, and to identify their direct and indirect associations among the domains in community-dwelling older adults. The research has a cross-sectional design, and we evaluated 419 older adults. Morbidities were assessed using a dichotomous question; self-reported health and satisfaction with life were assessed using a 5-point Likert scale; and sense of purpose was assessed using the Ryff and Keyes 10-item scale. An analysis of structural equations was conducted using Path Analysis. The relationship between morbidities and overall satisfaction with life was mediated by self-reported health; purpose in life mediated the relationship between self-reported health and overall satisfaction with life. Beyond managing chronic illnesses, subjective assessments of health and well-being are key to successful aging.

Resumo Este estudo teve como objetivo estimar a prevalência de satisfação global com a vida e referenciada a domínios, propósito de vida, morbidades e autoavaliação de saúde e identificar associações diretas e indiretas de morbidades, autoavaliação geral de saúde e propósito de vida com satisfação global com a vida em idosos comunitários. Trata-se de um delineamento transversal que avaliou 419 idosos. Morbidades foram avaliadas por questão dicotômica, autoavaliação de saúde e satisfação com a vida por escala tipo Likert de 5 pontos, e propósito pela escala de 10 itens de Ryff e Keyes. Utilizou-se análise de equações estruturais via análise de caminhos. A relação entre morbidades e satisfação global com a vida foi mediada pela autoavaliação de saúde; propósito de vida mediou a relação entre autoavaliação de saúde e satisfação global com a vida. Além do tratamento de doenças crônicas, avaliações subjetivas da saúde e bem-estar são essenciais para o envelhecimento bem-sucedido.

Resumen Este estudio tuvo como objetivo estimar la prevalencia de satisfacción global con la vida y referenciada a los dominios propósito de vida, morbilidades y salud autoevaluada, e identificar asociaciones directas e indirectas de morbilidades, autoevaluación general de salud y propósito con la satisfacción general con la vida en adultos mayores comunitarios. Es un diseño transversal que evaluó a 419 adultos mayores. Las morbilidades se evaluaron mediante una pregunta dicotómica, la autoevaluación de salud y la satisfacción con la vida por la escala Likert de 5 puntos, y el propósito mediante la escala de 10 ítems de Ryff y Keyes. Se utilizó análisis de ecuaciones estructurales vía análisis de trayectoria. La relación entre morbilidades y satisfacción general con la vida estuvo mediada por autoevaluación de la salud; el propósito de vida medió la relación entre autoevaluación de salud y satisfacción general con la vida. Más allá del manejo de enfermedades crónicas, las evaluaciones subjetivas de salud y bienestar son clave para un envejecimiento exitoso.

The prevalence and correlates of depression among patients with chronic diseases in the United Arab Emirates.

BACKGROUND: Chronic diseases constitute a major public health problem in the United Arab Emirates (UAE) and are the leading cause of mortality and morbidity. Chronic diseases have been found to be associated with an increased prevalence of depression and depressive symptoms. Depression can have detrimental effect on the prognosis of the disease and quality of life in patients. AIMS AND OBJECTIVES: This study aimed to estimate the prevalence and correlates of depression in a sample of patients suffering from chronic disease in Al-Ain city, UAE. MATERIALS AND METHODS: A cross-sectional survey based study was conducted with 417 participants recruited from seven primary health care centers of Al-Ain city. Men and women aged 18 years and above suffering from chronic disease filled the Patient Health Questionnaire (PHQ-9). Univariate and multivariable logistic regressions were performed on the collected data to investigate correlates of different factors with depression. Data was analyzed using SPSS (version 26). The study was approved by Ambulatory Healthcare Services (AHS) Human Ethics Research Committee. RESULTS: The majority 62.41% (n = 254) of the sample were females, 57.97% (n = 240) aged above 55 years and with a median (Q25, Q75) duration of chronic disease of 8 (4, 15) years. The prevalence of depression was 21.1% (95% CI: 17.5%-25.3%). With severe depression was in 1.7% and mild-moderate in 34.7% of the participants. Depression severity was statistically significantly associated with increasing age (p = 0.006), low level of education (p<0.001), presence of asthma (p = 0.007) and heart disease (p = 0.013). Unadjusted logistic regression reported that presence of depression was significantly associated with female gender (cOR = 1.8, [95% CI; 1.1-3.1], p = 0.025), and presence of chronic kidney disease (cOR = 4.9, [95% CI; 1.3-20.2], p = 0.020) and heart disease (cOR = 2.9, [95% CI; 1.6-5.4], p = 0.001) longer duration of disease in years (cOR = 1.04, [95% CI; 1.01-1.07], p = 0.003). However, in the adjusted logistic regression analysis, participants with heart disease (aOR = 2.8, [95% CI; 1.4-5.5], p = 0.004), and with longer duration of disease (aOR = 1.04, [1.01-1.07], p = 0.014) remained significantly associated statistically with higher chance of having depression. CONCLUSION: The prevalence of depression was quite high and the study highlights for health care professionals and policy makers, the importance of mental health support as part of a comprehensive management plan for patients with chronic diseases. A multidisciplinary comprehensive program will improve the long-term outcomes of these patients. Patients with chronic diseases may need more support and counseling at primary health care levels.

Percepciones sobre maternidad, riesgo obstétrico y planificación familiar en mujeres con enfermedad crónica que fueron madres / Percepções da maternidade, risco obstétrico e planejamento familiar em mulheres com doenças crônicas que eram mães / Perceptions of motherhood, obstetric risk and family planning in women with chronic illness who were mothers

Objective: To analyze the perceptions that a group of women have about maternity, obstetric risk and family planning who, knowing that they were diagnosed with chronic diseases, assumed the experience of pregnancy and childbirth. Methodology: Qualitative study. The informants were summoned through convenience sampling and “snowballing”. Individual semi-structured interviews were applied to nine women who recognized themselves as having a chronic noncommunicable disease. The data analysis was carried out with the Grounded Theory proposal withemergent design. Results: Motherhood is considered an unavoidable event in the life project ofwomen, even those who have been informed of the risk. There is little awareness of the impact thedisease can have on your reproductive life. Family planning is seen as a strategy for procreation,classifying it as a general option for all people, without being able to elucidate its relevance for theirindividual situation. There is also a late identification of risk pregnancies and a delayed prenatalcontrol. Conclusions: The communication of reproductive risk is ineffective because it is constructedoutside the social imaginary of women, family planning is seen as an imposition and not as a human right of women. (AU)

Objetivo: Analizar las percepciones que sobre maternidad, riesgo obstétrico y planificación familiar tiene un grupo de mujeres que sabiéndose diagnosticadas con enfermedades crónicas,asumieron la experiencia del embarazo y parto. Metodología: Estudio cualitativo. Se convocó a lasinformantes mediante muestreo por conveniencia y “bola de nieve”. Se aplicaron entrevistas semiestructuradas individuales a nueve mujeres que se reconocían diagnosticadas con una enfermedadcrónica no transmisible. El análisis de datos se realizó con la propuesta de Teoría Fundamentadacon diseño emergente. Resultados: La maternidad es considerada como un evento ineludible en elproyecto de vida de las mujeres, aun de aquellas que han sido informadas del riesgo. Existe pocaconsciencia del impacto que la enfermedad puede tener sobre su vida reproductiva. La planificaciónfamiliar es vista como una estrategia para la procreación, catalogándola como una opción generalpara todas las personas, sin alcanzar a dilucidar la relevancia que tiene para su situación individual.Existe además una identificación tardía de embarazos de riesgo y un control prenatal retrasado.Conclusiones: La comunicación del riesgo reproductivo es inefectiva porque se construye ajena alos imaginarios sociales de las mujeres, la planificación familiar es vista como una imposición y nocomo un derecho humano de las mujeres. (AU)

Objetivo: Analisar as percepções que um grupo de mulheres tem sobre a maternidade, orisco obstétrico e o planejamento familiar que, sabendo ser diagnosticadas com doenças crônicas,assumiram a experiência da gravidez e do parto. Metodologia: Estudo qualitativo. Os informantesforam convocados por amostragem de conveniência e “bola de neve”. Entrevistas individuaissemiestruturadas foram aplicadas a nove mulheres que se reconheciam portadoras de doençacrônica não transmissível. A análise dos dados foi realizada com a proposta da Teoria Fundamentadanos Dados com desenho emergente. Resultados: a maternidade é considerada um evento inevitávelno projeto de vida das mulheres, mesmo aquelas que foram informadas do risco. Há poucaconsciência do impacto que a doença pode ter em sua vida reprodutiva. O planejamento familiar évisto como uma estratégia de procriação, classificando-o como uma opção geral para todas aspessoas, sem poder elucidar sua relevância para sua situação individual. Há também identificaçãotardia de gestações de risco e controle pré-natal tardio. Conclusões: A comunicação do riscoreprodutivo é ineficaz porque é construída fora do imaginário social da mulher, o planejamentofamiliar é visto como uma imposição e não como um direito humano das mulheres. (AU)

Impacto de la carga de trabajo del paciente crónico en la adherencia terapéutica / Impacto da carga de trabalho crónica do paciente na aderência ao tratamento / Impact of chronic patient treatment burden on adherence to treatment

Aim: To relate the treatment burden of the independent chronic patient to adherence totreatment. Method: Cross-sectional observational analytical study. The sample consisted of 390 patients from the Basic Health Area of Mogán (Gran Canaria) systematically selected according to thecriteria of chronic patient over 50 years of age with established cardiovascular disease includingdiagnoses of Acute Myocardial Infarction, Atrial Fibrillation and Heart Failure (AMI, AF and HF).Chronic Obstructive Pulmonary Disease (COPD) and neurological disease with the diagnoses ofstroke and Parkinson's disease. The Treatment Burden Questionnaire (TBQ) was used to quantifyworkload, and the Morisky Treatment Adherence Scale (MMAS-8) was used for adherence. Results:40.5% of the sample had moderate burden and moderate (38.2%)-low (35.4%) adherence. Low-moderate treatment adherence was associated with a high TBQ score (mean score 64.8 points). The disease groups with the highest burden were neurological diseases (mean TBQ score 74.73 points),COPD (mean TBQ score 69.08 points), and finally cardiovascular diseases (mean TBQ score 64.47points). There is a statistically significant association between workload and adherence x2= 68.343p<0.000. Conclusions: Chronic patients with higher workload present lower therapeutic adherence. (AU)

Objetivo: Relacionar la carga de trabajo del paciente crónico independiente con la adherencia terapéutica. Método: Estudio analítico observacional de tipo transversal. La muestra constade 390 pacientes de la Zona Básica de Salud de Mogán (Gran Canaria), seleccionados de forma sistemática según cumplieran el criterio de paciente crónico mayor de 50 años con enfermedad cardiovascular establecida incluyéndose diagnósticos de Infarto Agudo de Miocardio, Fibrilación Auricular e Insuficiencia cardíaca (IAM, FA e IC). Enfermedad Pulmonar Obstructiva Crónica (EPOC) yenfermedad neurológica con los diagnósticos de ICTUS y Parkinson. Se utilizó el cuestionario“Treatment Burden Questionnarie” (TBQ) para cuantificar la carga de trabajo, y la Escala de Adherencia al Tratamiento de Morisky (MMAS-8) para la adherencia. Resultados: El 40,5% de la muestrapresenta una carga moderada y adherencia moderada (38,2%)-baja (35,4%). La baja-moderada adherencia se asoció con una puntuación elevada del TBQ (puntuación media de 64,8 puntos). Losgrupos de enfermedades que mayor carga tienen son las neurológicas (puntuación media TBQ 74,73puntos), EPOC (puntuación media TBQ de 69,08 puntos), y, por último, las enfermedades cardiovasculares (puntuación media TBQ de 64,47 puntos). Existe una asociación estadísticamente significativa entre la carga de trabajo y la adherencia terapéutica x2= 68,343 p <0,000. Conclusiones: Lospacientes crónicos con mayor carga de trabajo presentan una menor adherencia terapéutica. (AU)

Objectivo: Relacionar a carga de trabalho do paciente crónico independente com a aderência ao tratamento. Método: Estudo analítico observacional transversal. A amostra consistiu em 390pacientes da Área de Saúde Básica de Mogán (Gran Canaria), sistematicamente seleccionados deacordo com os critérios de paciente crónico com mais de 50 anos de idade com doença cardiovascular estabelecida, incluindo diagnósticos de Infarto Agudo do Miocárdio, Fibrilação Atrial e Insuficiência Cardíaca (IAM, FA e IC). Doença Pulmonar Obstrutiva Crónica (DPOC) e doença neurológicacom o diagnóstico de AVC e doença de Parkinson. O Questionário de Carga de Tratamento (TBQ)foi utilizado para quantificar a carga de trabalho, e a Escala de Adesão ao Tratamento Morisky(MMAS-8) foi utilizada para a aderência. Resultados: 40,5% da amostra teve carga moderada e aderência moderada (38,2%)-baixa (35,4%). A adesão ao tratamento com baixa moderação foi associadaa uma pontuação elevada de TBQ (pontuação média de 64,8 pontos). Os grupos de doenças commaior carga são as doenças neurológicas (nota média TBQ de 74,73 pontos), DPOC (nota média TBQde 69,08 pontos), e finalmente as doenças cardiovasculares (nota média TBQ de 64,47 pontos). Existeuma associação estatisticamente significativa entre carga de trabalho e aderência x2= 68.343 p<0.000.Conclusões: Os doentes crónicos com maior carga de trabalho têm menor aderência terapêutica. (AU)

Translation and psychometric evaluation of chronic illness anticipated stigma scale (CIASS) among patients in Ethiopia.

BACKGROUND: Stigma is common among patients with chronic illnesses. It affects the delivery of healthcare for not addressing the psychological components and may interfere with the patient's attendance to necessary health care services. Therefore, a valid and reliable instrument to measure anticipated stigma related to chronic illness is vital to inform possible interventions. This study aimed to translate the Chronic Illness Anticipated Stigma Scale (CIASS) into the Amharic language and evaluate its psychometric properties in Ethiopia. METHODS: The CIASS was translated into Amharic language using standard procedures. The Amharic version was completed by 173 patients (response rate 96%) with chronic illness from three referral hospitals in the Amhara region. Internal consistency was examined through Cronbach's alpha. Construct validity was evaluated by confirmatory factor analysis and convergent validity by using a Pearson correlation of P-value less than or equal to 0.05. RESULTS: The internal consistency was estimated at Cronbach alpha of 0.92. By using a structural equation model, and modification indices a model fitness testing was run and shows a root mean squared error of approximation 0.049 (90% CI, 0.012-0.075). The structural validity results in 78.8% of confirmatory factor analysis showed from the extraction of the three-dimension (components). Validity tests for convergent by using Pearson correlation positively correlated with common mental distress and negatively correlated with quality of life-BREF, and the construct validity shows a good valid tool to CIASS. CONCLUSION: The Amharic language version of the chronic illness anticipated stigma scale shows a satisfactory level of reliability and validity on different psychometric measures of assessment. The tool may be useful for future researchers and patients with chronic illness in the Amharic-speaking population. Moreover, it will be used to see the psychological burden related to chronic illness and for comparison among international population groups.

Mental healthcare for children with chronic conditions: a qualitative study.

OBJECTIVE: To explore parent perspectives on accessing mental healthcare for children with a chronic physical health condition. DESIGN: Qualitative research using semistructured interviews and Framework Analysis. Rankings were used to select attributes for a Discrete Choice Experiment (DCE). SETTING: Four specialty outpatient clinics (diabetes, epilepsy, bronchiectasis unrelated to cystic fibrosis and epidermolysis bullosa) at an Australian tertiary paediatric hospital. PARTICIPANTS: Eighteen parents of children with a chronical physical health condition. RESULTS: Most parents identified the child's general practitioner and/or hospital team as an initial pathway to seek help if they were worried about their child's mental health. Parents see mental healthcare as part of care for the whole child and want the outpatient clinics to proactively discuss child and family mental health, as well as refer to appropriate services as needed. The hospital being a familiar, child-friendly environment was identified as a key reason the hospital might be a desired place to access mental healthcare, as previous research has found. Six attributes of mental health services were identified as important and will be included in an upcoming DCE: travel time, cost, wait time, available hours, knowledge of physical health condition, and recommendation. CONCLUSIONS: This study highlights the opportunity presented in specialist outpatient clinics to address the often unmet mental healthcare needs of children with chronic physical health conditions. Parents identified practical ways for outpatient clinics to better facilitate access to mental healthcare. These will be further explored through a quantitative study of parent preferences.

People's preferences for self-management support.

OBJECTIVE: To identify and assess the preferences of people with long-term health conditions toward generalizable characteristics of self-management support interventions, with the objective to inform the design of more person-centered support services. DATA SOURCES: Primary qualitative and quantitative data collected on a representative sample of individuals with at least one of the fifteen most prevalent long-term conditions in the UK. STUDY DESIGN: Targeted literature review followed by a series of one-to-one qualitative semistructured interviews and a large-scale discrete choice experiment. DATA COLLECTION: Digital recording of one-to-one qualitative interviews, one-to-one cognitive interviews, and a series of online quantitative surveys, including two best-worst scaling and one discrete choice experiment, with individuals with long-term conditions. PRINCIPAL FINDINGS: On average, patients preferred a self-management support intervention that (a) discusses the options available to the patient and make her choose, (b) is individual-based, (c) face to face (d) with doctor or nurse, (e) at the GP practice, (f) sessions shorter than 1 hour, and (g) occurring annually for two-third of the sample and monthly for the rest. We found heterogeneity in preferences via three latent classes, with class sizes of 41% (C1), 30% (C2), and 29% (C3). The individuals' gender [P < 0.05(C1), P < 0.01(C3)], age [P < 0.05(C1), P < 0.05(C2)], type of long-term condition [P < 0.05(C1), P < 0.01(C3)], and presence of comorbidity [P < 0.01(C1), P < 0.01(C3), P < 0.01(C3)] were able to characterize differences between these latent classes and help understand the heterogeneity of preferences toward the above mentioned features of self-management support interventions. These findings were then used to profile individuals into different preference groups, for each of whom the most desirable form of self-management support, one that was more likely to be adopted by the recipient, could be designed. CONCLUSIONS: We identified several factors that could be used to inform a more nuanced self-management support service design and provision that take into account the recipient's characteristics and preferences.

Perceived Gratitude, Role Overload, and Mental Health Among Spousal Caregivers of Older Adults.

OBJECTIVES: We investigated whether spousal caregivers' greater perception of being appreciated by their partner for their help was associated with caregivers' better mental health and whether caregivers' higher role overload was related to their poorer mental health. We further evaluated whether spousal caregivers' greater perceived gratitude buffered the association between their role overload and mental health. METHODS: We examined 306 spousal caregivers of older adults with chronic illness or disability, drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving. We defined mental health as better psychological well-being and less psychological distress (i.e., fewer depressive and anxiety symptoms). Hierarchical regression models were estimated to test hypotheses. RESULTS: Greater perceived gratitude was associated with better psychological well-being, and higher role overload was related to poorer psychological well-being and greater psychological distress. In addition, greater perceived gratitude buffered the associations between role overload and anxiety symptoms as well as psychological well-being. DISCUSSION: Findings suggest that spousal caregivers' role overload may be a strong risk factor for their poorer mental health, especially when caregivers feel less appreciated by their partner. Couple-oriented interventions to improve spousal caregivers' mental health could be aimed at reducing their role overload and enhancing perceived gratitude.