Stress and coping strategies of families of pediatric solid organ transplant recipients in times of pandemic.

Objective: Pediatric solid organ transplantation (SOT) is a chronic condition that impacts the whole family system. The objective of this study is to evaluate psychopathology, family stress, and coping strategies in families of SOT recipients compared to families of healthy children and adolescents. Moreover, it analyzes if the stress related to the COVID-19 pandemic has had an additional impact on these families. Methods: The sample was recruited between May and July 2021, during the fourth and fifth wave of the pandemic in Spain. It consisted of 102 families, 51 with a pediatric recipient who had undergone a SOT (liver, kidney, heart, or lung) and 51 healthy controls, matched by child age and gender. A primary caregiver from each family answered an online sociodemographic questionnaire and different tests to evaluate family stress, depression, anxiety, coping strategies, and effects of the pandemic on the family. Results: Caregivers were mostly mothers (89.2%). Families of SOT recipients showed greater anxiety (U = 863.5, p = 0.003) and more total stress, stress related to childcare (t = -2.043; p = 0.045), and parent-child interaction stress (U = 355.5, p = 0.015). SOT families used more avoidance strategies, specifically denial (U = 889.5; p = 0.010) and abandonment of coping efforts (U = 1,013; p = 0.047), more religious strategies (U = 792.5; p = 0.031), and fewer social support coping strategies (t = 2.098; p = 0.038). No differences were found between groups in terms of exposure, impact, and distress more than 1 year after the start of the pandemic. Conclusion: SOT families showed clinical levels of anxiety, more parent-child interaction stress, more difficulties in taking care of their child, more avoidance and religious strategies, and less use of social support strategies, even 4 years after transplantation. The pandemic did not have an additional differential effect on SOT families. Caregivers of SOT patients can benefit from psychological interventions focused on parents' mental health, parent-child connectedness, skill building, and social support aid groups, with attention to multiculturalism and promoting a better balance between caregivers. There is a need for family interventions that are maintained over time. Strategies that offer this support to families through digital resources can facilitate adjustment to chronic illness, especially in pandemic times.

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.

End of Life Intervention Program During COVID-19 in Vall d'Hebron University Hospital.

Introduction: The coronavirus disease 19 (COVID-19) and its consequences have placed our societies and healthcare systems under pressure. Also, a major impact on the individual and societal experience of death, dying, and bereavement has been observed. Factors such as social distancing, unexpected death or not being able to say goodbye, which might predict Prolonged Grief Disorder (PGD), are taking place. Moreover, hospitals have become a habitual place for End of Life (EOL) situations but not in the usual conditions because, for example, mitigation measures prevent families from being together with hospitalized relatives. Therefore, we implemented an EOL program with a multidisciplinary team involving health social workers (HSW) and clinical psychologists (CP) in coordination with the medical teams and nursing staff. Objectives: We aim to describe an EOL intervention program implemented during COVID-19 in the Vall d'Hebron University Hospital (HUVH). We present its structure, circuit, and functions. Descriptive analyses of the sample and the interventions that required psychological and social attention are reported. Material and methods: The total sample consists of 359 relatives of 219 EOL patients. Inclusion criteria were families cared for during the COVID-19 pandemic with family patients admitted to the HUVH in an EOL situation regardless of whether or not the patient was diagnosed with COVID-19. Results: Our program is based on family EOL care perceptions and the COVID-19 context features that hinder EOL situations. The program attended 219 families, of which 55.3% were COVID-19 patients and 44.7% had other pathologies. The EOL intervention program was activated in most of the EOL situations, specifically, in 85% of cases, and 78% of relatives were able to come and say goodbye to their loved ones. An emotional impact on the EOL team was reported. It is necessary to dignify the EOL situation in the COVID-19 pandemic, and appropriate psychosocial attention is needed to try to minimize future complications in grief processes and mitigate PGD.

Psychiatric Comorbidity and Addiction Severity Differences in Patients With ADHD Seeking Treatment for Cannabis or Cocaine Use Disorders.

Objective: The objective of this study was to compare psychiatric comorbidity and consumption-related variables in ADHD patients seeking treatment for cocaine, cannabis, or both. Method: Assessment was conducted using European Addiction Severity Index (EuropASI), Conners' Adult ADHD Diagnostic Interview (CAADID), Structured Clinical Interview for DSM Disorders (SCID), Adult Self-Report Scale (ASRS), Wender Utah Rating Scale (WURS), Barratt Impulsiveness Scale-11 (BIS-11), and FIDI, with statistical analyses of analysis of variance (ANOVA), Student's t test, chi-square test, and multinomial regression model. Results: In total, 1,538 patients with substance use disorder (SUD) were evaluated for ADHD; 239 (15.5%) had ADHD, with cannabis 41, cannabis/cocaine 36, and cocaine 74. Men represented 80%, with mean age of 32.9 ± 10 years. Significant variables were-in bivariate analysis-more years of cannabis use in cannabis group and younger age for cocaine use disorder in cannabis/cocaine group, and-in multivariate analysis-lifetime anxiety disorder and younger age at onset of any SUD in cannabis group and working affected scale in cannabis and polysubstance use in cannabis/cocaine group. Conclusion: Groups with cannabis use had higher severity. ADHD features were similar in all groups. The assessment of ADHD and comorbid disorders is important.

Intervención motivacional de la obesidad en Atención Primaria mediante un programa de actividad física / Motivational intervention for obesity in Primary Care using a physical activity program

INTRODUCCIÓN Y OBJETIVOS: la obesidad y el sobrepeso constituyen uno de los principales problemas de salud pública en el mundo. De ahí la importancia de desarrollar y aplicar estrategias que logren disminuir el peso en esta población. Por ello nos propusimos como objetivo evaluar la efectividad de la intervención en la obesidad con tres enfoques diferentes, uno de ellos con una plataforma que promueve la actividad física. MATERIAL Y MÉTODOS: ensayo clínico multicéntrico, aleatorizado, controlado y de grupos paralelos que comparó 3 brazos de pacientes con sobrepeso u obesidad con un seguimiento de 12 meses. Los pacientes se asignaron al azar a tres grupos de intervención en un centro de Atención Primaria: G1: grupo de control que recibió las recomendaciones habituales para perder peso siguiendo el Consenso SEEDO 2000; G2: intervención motivacional de la obesidad (IMOAP) con enfermera entrenada y pequeños grupos de trabajo periódico; G3: intervención motivacional de la obesidad (IMOAP) añadiendo el uso de una plataforma digital que permite registrar la actividad física, la monitoriza y favorece la práctica de esta (IWOPI). Se recolectaron las variables: peso, talla, IMC, circunferencia de la cintura, parámetros lipídicos, presión arterial y hemoglobina glucosilada. Después de realizar las intervenciones se estudiaron los indicadores de relevancia clínica: riesgo relativo (RR), reducción del riesgo absoluto (ARR), reducción del riesgo relativo (RRR) y número necesario de pacientes a tratar (NNT), tanto por intención de tratar como por eficacia biológica. RESULTADOS: Inicialmente se incluyeron 185 pacientes en el estudio. En total, 17 pacientes abandonaron el estudio: un paciente en el G3 debido a un cambio de domicilio, uno en el G2 por razones de trabajo y 15 en el G1 aduciendo ausencia de resultados. De este modo, 168 pacientes completaron el estudio: 47 en G1, 61 en G2 y 60 en G3. De la población estudiada, el 57,1 % eran mujeres y el 42,9 % eran varones. El peso de los pacientes de los tres grupos descendió en cada una de las visitas, observándose al final del estudio una reducción de peso media de 4,37 kg, siendo esta de 5,34 kg en el G2, de 6,29 kg en el G3 y de 1,25 kg en el grupo de control (G1). También se observó una reducción de los niveles de colesterol en los tres grupos. El IMC mostró una reducción promedio general de -1,56, siendo esta de -1,70 en el G2, de -2,26 en el G3 y de 0,47 en el G1. En relación con el perfil lipídico, los niveles de colesterol total se redujeron en todos los grupos, siendo la mayor disminución la observada en el G3. Los niveles de triglicéridos se redujeron significativamente solo en dos grupos, G2 y G3 (-19,66 y -19,43, respectivamente). La hemoglobina glucosilada mostró una ligera disminución que no alcanzó la significación estadística. Los parámetros clínicamente relevantes fueron: a) G1 (control) frente a G2 (IMOAP): riesgo relativo (RR), 0,10 a 0,46; reducción del riesgo relativo (RRR), 0,54 a 0,90; reducción del riesgo absoluto (ARR), 0,30 a 0,61; número necesario a tratar (NNT), 3 a 2; b) G1 frente a G3 (IMOAP-PA): RR, 0,07 a 0,30; RRR, 0,70 a 0,93; ARR, 0,61 a 0,86; NNT: 2 a 1; c) G2 frente a G3: RR, 0,54 a 0,84; RRR, 0,16 a 0,46; ARR, 0,14 a 0,43; NNT, 7 a 2. CONCLUSIONES: la plataforma de salud digital que estimula la actividad física, agregada a una intervención motivacional en pacientes con sobrepeso u obesidad, aporta un beneficio adicional significativo en términos de resultados de pérdida de peso, de reducción del IMC y de mejora del perfil de lípidos en estas personas con un coste más efectivo

OBJECTIVES: to evaluate the effectiveness of three interventions for obesity, one of them including a platform that promotes physical activity. MATERIAL AND METHODS: a multicenter, randomized, controlled, parallel clinical trial that compared 3 arms with overweight or obese patients with a follow-up of 12 months. Patients were randomized into three groups for an intervention in a primary care center: G1: control group, which received the usual recommendations for losing weight according to the SEEDO 2000 Consensus; G2: motivational intervention for obesity (IMOAP) with a trained nurse and small, regular workgroups; G3: motivational intervention for obesity (IMOAP) plus use of a digital platform that records, monitors, and fosters physical activity (IWOPI). Variables collected included: weight, height, BMI, waist circumference, lipid parameters, blood pressure, and glycosylated hemoglobin. RESULTS: a total of 185 patients were initially included in the study. Seventeen patients left the study, and 168 patients completed the study: 47 in G1, 61 in G2, and 60 in G3. Of the population studied, 57.1 % were women. A general average weight reduction of 4.37 kg was seen at the end of the study - 5.34 kg in G2, 6.29 kg in G3, and 1.25 kg in the control group (G1). Cholesterol levels were also reduced in the three groups, but without reaching statistical significance. Clinically relevant parameters included: G1 (control) versus G2 (IMOAP): relative risk (RR), 0.10 to 0.46; relative risk reduction (RRR), 0.54 to 0.90; absolute risk reduction (ARR), 0.30 to 0.61; number needed to treat (NNT), 3 to 2; G1 versus G3 (IMOAP-PA): RR, 0.07 to 0.30; RRR, 0.70 to 0.93; ARR, 0.61 to 0.86; NNT: 2 to 1; G2 versus G3: RR, 0.54 to 0.84; RRR, 0.16 to 0.46; ARR, 0.14 to 0.43; NNT, 7 to 2. CONCLUSIONS: the digital health platform that fostered physical activity, added to a motivational intervention in overweight or obese patients, provided a significant additional benefit in terms of weight loss, BMI reduction, and lipid profile improvement in patients affected by overweight or obesity with a more effective cost

[Motivational intervention for obesity in Primary Care using a physical activity program]. / Intervención motivacional de la obesidad en Atención Primaria mediante un programa de actividad física.

INTRODUCTION: Objective: to evaluate the effectiveness of the obesity intervention with three different approaches, one of them with a platform that promotes physical activity. Material and method: randomized, controlled, parallel clinical trial that compared 3 arms, multicenter study in overweight or obese patients with a follow-up of 12 months. The patients were randomized into three groups: Intervention in the primary care center with G1 intervention: Control group, which received the usual recommendations to lose weight following the SEEDO 2000 Consensus. G2: Motivational intervention of obesity (IMOAP) with trained nurse and small periodic work groups. G3: Motivational intervention of obesity (IMOAP) adding the use of a digital platform that allows physical activity to be recorded, monitored and at the same time favors the practice of this (iwopi). Variables were collected: weight, height, BMI, circumference of the waist, lipid parameters, blood pressure, glycosylated hemoglobin. Results: 185 patients were initially included in the study. Seventeen patients left the study. Thus, 168 patients completed the study: 47 in G1, 61 in G2 and 60 in G3. Of the population studied, 57.1% were women. observing a general average weight reduction at the end of the study of 4.37 kg, being 5.34 kg in the group 2.6.29 kg in the group 3 and 1.25 kg in the control group (G1). It was also observed that cholesterol levels in three groups were reduced. at did not reach a statistically significant value. The clinically relevant parameters were: group 1 (control) versus group 2 (IMOAP): relative risk (RR), 0.10 to 0.46; relative risk reduction (RRR), 0.54 to 0.90; absolute risk reduction (ARR), from 0.30 to 0.61; number needed to treat (NNT), 3 to 2. Group 1 versus group 3 (IMOAP-PA): RR, 0.07 to 0.30; RRR, 0.70 to 0.93; ARR, 0.61 to 0.86; NNT: 2 to 1. Group 2 versus group 3: RR, 0.54 to 0.84; RRR, 0.16 to 0.46; ARR, 0.14 to 0.43; NNT, 7 to 2. Conclusions: The digital health platform that stimulates physical activity added to an interventionist motivation in overweight or obese patients is a significant additional benefit in terms of weight loss results, reduction of BMI and lipid profile in patients affected by overweight or obesity and a more effective cost.

INTRODUCCIÓN: Objetivo: evaluar la efectividad de la intervención de la obesidad con tres enfoques diferentes, uno de ellos con una plataforma que promueve la actividad física. Material y métodos: ensayo clínico aleatorizado, controlado, paralelo que comparó 3 brazos, estudio multicéntrico en pacientes con sobrepeso u obesos con un seguimiento de 12 meses. Los pacientes fueron asignados al azar en tres grupos: Intervención en el centro de Atención Primaria con intervención G1: Grupo control, el cual recibía las recomendaciones habituales de perder peso siguiendo el Consenso SEEDO 2000 G2: Intervención motivacional de la obesidad (IMOAP) con enfermera entrenada y pequeños grupos de trabajo periódico. G3: Intervención Motivacional de la obesidad (IMOAP) añadiendo el uso de una plataforma digital que permite registrar la actividad física, Se recolectaron variables: peso, talla, IMC, circunferencia de la cintura, parámetros lipídicos, presión arterial, hemoglobina glicosilada. Resultados: 185 pacientes fueron incluidos inicialmente en el estudio. 17 pacientes abandonaron el estudio. De ese modo, 168 pacientes completaron el estudio: 47 en G1, 61 en G2 y 60 en G3. De la población estudiada, el 57,1% eran mujeres. Se observa una reducción de peso promedio general al final del estudio de 4,37 kg, siendo 5,34 kg en el grupo 2,6,29 kg en el grupo 3 y 1,25 kg en el grupo control (G1). También se observó que los niveles de colesterol en tres grupos se redujeron. El IMC mostró una reducción promedio general de -1,56, siendo -1,70 en G2, -2,26 en G3 y 0,47 en G1. Los parámetros clínicamente relevantes fueron: grupo 1 (control) versus grupo 2 (IMOAP): riesgo relativo (RR), 0,10 a 0,46; reducción del riesgo relativo (RRR), 0.54 a 0.90; reducción del riesgo absoluto (ARR), de 0.30 a 0.61; número necesario para tratar (NNT), 3 a 2. Grupo 1 versus grupo 3 (IMOAP-PA): RR, 0.07 a 0.30; RRR, 0,70 a 0,93; ARR, 0,61 a 0,86; NNT: 2 a 1. Grupo 2 versus grupo 3: RR, 0.54 a 0.84; RRR, 0,16 a 0,46; ARR, 0,14 a 0,43; NNT, 7 a 2. Conclusiones: la plataforma de salud digital que estimula actividad física agregada a una motivación intervencionista en pacientes con sobrepeso u obesidad es un beneficio adicional significativo en términos de resultados de pérdida de peso, reducción del IMC y perfil de lípidos en pacientes afectados por sobrepeso u obesidad y un costo más efectivo.