Burden, Stress, and Depression in Informal Caregivers of Patients Pre and Post Liver Transplant.

BACKGROUND: Caring for a patient with chronic liver disease involves exposure to factors that increase family caregivers' vulnerability to developing mental disorders. This study reassessed the scores of burden, stress, and depression in informal (family) caregivers of patients with liver disease after liver transplant. METHODS: In this observational and descriptive study, the caregivers were reassessed for the same outcomes 4 to 10 years following the initial assessment pre-transplant. The data were obtained from the identification card, the interview script, the Brazilian version of the Caregiver Burden Scale, the Lipp Inventory of Stress Symptoms for Adults, and the Beck Depression Inventory. Descriptive statistics of pre- and post-liver transplant phases were calculated, and the Wilcoxon signed rank test was used to compare the burden scores. RESULTS: The 5 caregivers were women, with a mean age of 51.6 (SD, 8.38) years. All of the caregivers' (100%) burden score increased, 2 caregivers needed to seek some form of help, and 3 caregivers showed an indication of burden risk. Regarding stress symptoms, 3 caregivers (60%) maintained a score indicating no stress, 2 caregivers (40%) presented increased scores, and the predominant symptoms changed from psychological to physical. Regarding depression, 3 caregivers (60%) maintained the minimum level of symptoms for depression, and 2 caregivers (40%) presented increased scores. CONCLUSION: After liver transplant, caregivers' burden scores increased, and levels of stress and depression increased for caregivers who already showed symptoms in the pre-transplant phase.

Validation of the Adapted Social Assessment Instrument for Liver Transplantation Candidates.

BACKGROUND AND AIMS: Assessment is considered a duty, as well as a part of the tasks of social workers; in addition, they have an ethical commitment to improve their working tools. This study aimed at validating the Adapted Social Assessment Instrument used in a transplant center in the state of São Paulo, Brazil, for liver transplantation candidates, requiring its improvement and strengthening. METHODS: The methodology was based on both Marxian dialectics and the method of content validation. The content validation analysis was performed by 5 social workers from 3 Brazilian transplant centers. They evaluated the 5 domains of the instrument: identification, socio-demographic profile, eligibility criteria, evaluation, and social interventions. Descriptive statistics of data were performed, and qualitative analysis was associated to the participant observation. RESULTS: The 5 professionals (100%) assigned the scores 3 and 4, which have demonstrated clarity, relevance, and feasibility, pointing out suggestions for improvement, some of which were considered. CONCLUSIONS: The instrument was evaluated with an approval percentage of above 80%; therefore, the instrument is a valid measure.

Effectiveness Analysis of the Immunization Against Hepatitis B in Liver Transplantation Patients.

OBJECTIVE: This article analyzes the effectiveness of a super-accelerated immunization schedule against hepatitis B in patients who have received a liver transplantation. METHODS: This is a quantitative and retrospective study based on secondary data of medical records from 177 patients who have received a liver transplantation at the Hospital de Base in São José do Rio Preto, São Paulo State, Brazil, between 1998 and 2016. RESULTS: From the total number of participants, 72.89% were male, 39.55% had a cirrhosis diagnosis with associated causes, 23.16% had hepatocellular carcinoma, 53.11% were classified according to Child-Turcotte-Pugh C score, 58.76% had the hepatitis C virus, 97.18% had received an unconventional immunization schedule, and seroconversion was 36.63% among those with an unconventional schedule. The fact that the patient had the hepatitis C virus was statistically significant considering the lack of protection of the vaccine against the hepatitis B virus; their chances were 5 times higher of not seroconverting at the end of the immunization schedule. CONCLUSION: The need for high immediate protection in a short term may justify using unconventional immunization schedules in patients who make it to the transplantation waiting list without any previous immunization.