Let's Play? A Board Health Game Development and Validation for Children with Atopic Dermatitis.

Objective: Several health games have been developed for pediatric patients in recent years but few for children with atopic dermatitis (AD). As this chronic disease requires changes in daily habits, this study aimed to develop and validate the content of a board health game for children with AD. Material and Methods: This is a content development and validation study of DermatrilhaTM, a board health game about AD. The instrument aims to promote interactions between children with AD and health care providers and offers the exchange of experiences, feelings, and knowledge about the disease in a playful way. The five stages of development of the board game were (a) planning, (b) development, (c) preparation of content validation questionnaires, (d) evaluation by a committee of experts, and (e) pretest with the target audience. Results: The expert committee group consisted of 20 professionals: 5 physicians specialized in pediatric dermatology, 5 psychologists specialized in health psychology, 5 designers with experience in illustration, and 5 early childhood educators. The target audience consisted of 25 children aged 7-12 years with AD. The evaluation of the expert committee found 0.95 in the general content validity index and 0.92 in the target audience, thus exceeding 0.80 in all items. Conclusion: The board health game Dermatrilha has proven to be a psychoeducational tool for the therapeutic education of children with AD, enabling the exchange of experiences, feelings, and knowledge about the disease among peers and health care providers.

Predictors of Transition Outcomes in Cystic Fibrosis: Analysis of National Patient Registry and CF RISE (Responsibility. Independence. Self-care. Education) Data.

OBJECTIVE: To identify predictors of change in lung function and body weight during health care transition in cystic fibrosis (CF). METHODS: We conducted a retrospective cohort study using data from the CF Foundation Patient Registry and the web-based transition program CF RISE (Responsibility. Independence. Self-care. Education) for patients aged 16-25 years who transitioned to adult care from 2013 through 2019. We modeled change in forced expiratory volume in 1 second % predicted and weight using linear regression fit with generalized estimating equations. Predictors included gap in care (time between last pediatric and first adult outpatient visit), transition program engagement, and sociodemographic and medical factors. RESULTS: Among 12 420 adolescents and young adults (AYAs), 3876 transitioned to adult care with a median gap in care of 7.6 months. Patients from CF centers with greater rates of CF RISE engagement had improved lung function and weight at their first adult outpatient visit. Coverage on a parent's insurance plan and absence of CF complications predicted increased lung function. History of a nonlung transplant and sinus disease predicted increased weight. Comorbid diabetes mellitus and gaps in care >3 months predicted decreased lung function with longer gaps in care associated with greater decrease. A gap in care of 6-9 months predicted decreased weight. Control variables including baseline forced expiratory volume in 1 second and weight, and exacerbation status were also statistically significant. CONCLUSIONS: Findings suggest 2 promising targets to improve transition of AYAs with CF: increasing AYA engagement in CF RISE and reducing gaps in care during the transition period.

Experience of hope in older people with chronic illness: A meta-synthesis.

BACKGROUND: The increase in life expectancy has contributed to an increase in the number of older people, but this population has to learn to live with at least one chronic illness. Thus, hope has become an important resource for the older adult to face the repercussions of chronic illness. OBJECTIVE: To synthesise qualitative evidence on the experience of hope in older people with chronic illness. METHODS: This meta-synthesis included qualitative studies which present the experiences of hope in older people diagnosed with at least one chronic illness. The searches were made from six databases, guided by the SPIDER tool. The identified articles were then independently screened by two reviewers. The results were analysed according to the thematic synthesis approach. RESULTS: Eighteen articles were included, and four analytical themes were constructed. The results allow us to understand that older people live with long-term conditions and hope for an ordinary life. To react to new changes and to maintain hope, they create goals that motivate them in daily life. The treatment is initially seen as a salvation, but the information acquired with the evolution of the illness modifies this perception. In addition, the uncertainty about the success of the treatment creates conflict in their hope. In the support and care of older people in the new context of illness, meaningful relationships strengthen hope most of the time. There is still the hope of being reconciled with death, but there are times when suffering overcomes the hope of living. CONCLUSIONS: This meta-synthesis highlights that the experience of hope in older people is dynamic and influenced by the context of changes related to illness, treatment, significant relationships and proximity to death. IMPLICATIONS FOR PRACTICE: A better understanding of the role and characteristics of hope in older people with chronic illness may help to develop more effective interventions to promote and maintain hope.

Exploración del discurso de los enfermos crónicos sobre la legalización de la muerte asistida / Exploring the Discourse of Chronically-Ill Patients about the Legalization of Medically-Assisted Death / Exploração do discurso dos doentes crônicos sobre a legalização da morte medicamente assistida

Introducción: las enfermedades crónicas van en aumento e implican múltiples consecuencias que, en un determinado momento, con el paso de los años, pueden llegar a un estado terminal de la enfermedad. El objetivo de este estudio fue analizar el discurso de enfermos crónicos sobre la muerte digna, la eutanasia y el suicidio médicamente asistido para visibilizar la necesidad de la regulación de la muerte digna. Materiales y métodos: se llevó a cabo una investigación cualitativa que se inserta dentro del paradigma del construccionismo social, mediante entrevistas a enfermos crónicos de la Ciudad de México, utilizando una guía semiestructurada. Se empleó el análisis del discurso para encontrar convergencias y diferencias en los discursos. Resultados: se entrevistaron siete personas vía telefónica de enero a marzo del 2022. Las principales enfermedades fueron: lupus, cáncer, artritis, diabetes y ovarios poliquísticos. Los discursos convergen hacia una muerte digna sin dolor, sufrimiento, tranquila y en casa. Coinciden sus discursos en legalizar la eutanasia y el suicidio médicamente asistido; sin embargo, hay divergencias en cuanto a solicitarlas. Conclusiones: la experiencia de la enfermedad crónica es un factor importante para aceptar en un futuro la muerte médicamente asistida, sin ser una carga para otros y evitar el dolor y sufrimiento al final de la vida. La religión influye en las decisiones, pero se puede observar una mayor apertura para aceptar la legalización de la muerte médicamente asistida.

Introduction: Chronic diseases are increasing in frequency and entail multiple consequences that can eventually lead to death. The study aim was to analyze the discourse of chronically-ill patients on death with dignity, euthanasia, and medically-assisted suicide to highlight the need for regulation of death with dignity. Materials and Methods: A qualitative study was conducted within the paradigm of social constructionism. A semi-structured guide was used to conduct interviews with chronically-ill patients in Mexico City. Discourse analysis was performed to identify convergences and differences in the discourses. Results: Seven interviews were conducted by telephone from January to March 2022. The main diseases of the interviewees were lupus, cancer, arthritis, diabetes, and polycystic ovaries. The discourses converged toward a preference for dignified death without pain or suffering that was calm, and occurred at home. The discourses included the topics of legalizing euthanasia and medically-assisted suicide, but the patients differed on whether or not these should be requested. Conclusions: The experience of chronic illness was an important factor in accepting medically-assisted death for the patients, who did not wish to be a burden on others and wanted to avoid pain and suffering at the end of their lives. Religion influenced the patients' decisions, but there was openness to accepting legalization of medically-assisted death.

Introdução: a incidência das doenças crônicas vem aumentando, e têm múltiplas consequências que num determinado momento, ao longo dos anos, podem chegar a um estado terminal da doença. O objetivo deste estudo foi analisar o discurso de pessoas com doenças crônicas sobre morte digna, eutanásia e suicídio medicamente assistido para tornar visível a necessidade de regulamentar a morte digna. Materiais e métodos: foi realizada uma pesquisa qualitativa que se insere no paradigma do construcionismo social. Entrevistas com pacientes crônicos na Cidade do México foram realizadas usando um guia semiestruturado. A análise do discurso foi utilizada para encontrar convergências e divergências nos discursos. Resultados: foram realizadas sete entrevistas por telefone no período de janeiro a março de 2022. As principais doenças foram lúpus, câncer, artrite, diabetes e ovários policísticos. Os discursos convergem para uma morte digna sem dor, sofrimento, tranquila e em casa. Seus discursos coincidem na legalização da eutanásia e do suicídio medicamente assistido; entretanto, há divergências quanto à sua solicitação. Conclusões: a experiência da doença crônica é um fator importante para aceitar a morte medicamente assistida no futuro, sem ser um fardo para os outros e evitando a dor e o sofrimento no final da vida. A religião influencia nas decisões, mas observase uma maior abertura para aceitar a legalização da morte medicamente assistida.

A multimedia program for caregivers of pediatric patients with chronic kidney disease in Guatemala.

OBJECTIVES: A multimedia medication training program for parents and legal guardians of children with chronic kidney disease (CKD) aimed to improve comprehension CKD and general information about medications used in pediatric patients attending The Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City). METHODS: A quasi-experimental study was carried out to measure the impact of the educational intervention on medication knowledge, at FUNDANIER from September to October 2019. Means and standard deviations was used to described test results. A Wilcoxon test was performed, to compare scores of pre and post-tests. Odds Ratio (OR) was used to determine if there was an improvement in the knowledge score before and after the intervention. Results There was significant improvement in knowledge scores knowledge before and after the intervention(27/35 versus 33/35, P < 0.005). Mestizo participants had higher odds of improvement before and after the intervention (OR 7, CI: 0.6-78). Parent-guardians with prior education, and who spoke Spanish had higher odds of improved knowledge scores (OR 3.2, CI:0.3-35; OR 1.1 CI: 0.1-14 respectively). CONCLUSION: Caregivers who participated in the educational workshop improved and retained information related to CKD comprehension and medications used. This study provides a model for educational modules that can be used, tested, and applied in other chronic disease settings in low to middle income countries. PRACTICE IMPLICATIONS: A culturally relevant multimedia CKD educational platform was effective in improving medication knowledge among parent/guardians of children with CKD in a low literacy setting.

A descriptive analysis of hospitalized adolescents facing chronic illnesses with different durations of disease.

OBJECTIVES: To assess characteristics of hospitalized adolescents facing chronic diseases, correlating the perceptions of their illness, quality of life and the prevalence of risk behaviors, considering gender and the diseases' durations. METHODS: The sample consisted of 61 adolescents, aged between 10 and 19 years, with chronic diseases, hospitalized at the University Hospital of the State University of Londrina. They answered a questionnaire and the scales World Health Organization Quality of Life (WHOQOL-BREF) and Illness Perception Questionnaire (IPQ). They were divided in groups, according to the durations of the disease: group 1 (up to 4 years) and group 2 (5 years or more). RESULTS: Group 2 demonstrated higher leisure activity (p = 0.02) and more painful symptoms (p = 0.02). In WHOQOL-BREF, group 2 had a higher quality of life in the domain on environment (p = 0.02) and a higher total score (p = 0.04). Lower scores on the IPQ were associated with higher scores on the WHOQOL-BREF. Positive correlation was found between WHOQOL-BREF total score and years of disease, in which male presented higher scores. CONCLUSIONS: These findings may alert to the need for more knowledge about the diseases and the importance of encouraging ways to improve quality of life and care to reduce risky behaviors.

Psicologia na atenção básica: cuidado aos idosos com doenças crônicas não transmissíveis / Psychology in primary care: healthcare for the elderly diagnosed with noncommunicable diseases / Psicología en atención primaria: atención a la salud de los adultos mayores con enfermedades crónicas no transmisibles

OBJETIVO: Este trabalho tem por objetivo compreender como os Determinantes Sociais da Saúde estão presentes nas práticas de cuidado à população idosa com hipertensão arterial sistêmica e diabetes mellitus ofertadas pelas psicólogas da Atenção Básica. MÉTODO: Foi realizada uma pesquisa descritiva e de abordagem qualitativa, a partir de entrevistas semiestruturadas, com 7 psicólogas atuantes em Unidade Básica de Saúde (UBS) e/ou Unidade de Saúde da Família (USF) de Salvador (BA), que atendem o público idoso, tendo ocorrido em plataforma digital. A análise de dados ocorreu através do método hermenêutico-dialético e teve a Psicologia Social Crítica como base teórica. RESULTADOS: Verificou-se que a atuação das psicólogas na Atenção Básica à população idosa com Hipertensão Arterial Sistêmica e Diabetes Mellitus, em sua maioria, é orientada por práticas de promoção da saúde, prevenção à doença e políticas públicas em saúde. Identificou-se, de modo geral, a compreensão dos Determinantes Sociais da Saúde como produtores de iniquidades em saúde nos relatos das psicólogas, tendo sido mapeado somente 2 psicólogas que demonstraram não compreender a categoria 'raça' como um Determinante Social indissociável dos demais. CONCLUSÃO: Observou-se que o campo de atuação da psicologia no contexto da Atenção Básica, guiada pela Psicologia Social Crítica e pela Saúde Coletiva, promovem contribuições teóricas para todos os campos da psicologia.

OBJECTIVE: The study aims to identify the major role of psychologists in the promotion of health and disease prevention of elderly people diagnosed with Systemic Arterial Hypertension and Diabetes Mellitus quality of life. METHOD: A descriptive research with a qualitative approach was carried out, based on semi-structured interviews, with 7 psychologists working in a Basic Health Unit (Unidade Básica de Saúde - UBS) and/or Family Health Unit (Unidade de Saúde da Família - USF) in Salvador (BA), which serve the elderly, having taken place on a digital platform. Data analysis was carried out using the hermeneutic-dialectic method and Critical Social Psychology as a theoretical basis. RESULTS: It was found that the role of psychologists in Primary Care for elderly with Systemic Arterial Hypertension and Diabetes Mellitus is mostly guided by health promotion practices, disease prevention and public health policies. In general, the understanding of the Social Determinants of Health as producers of health inequities was identified in the psychologists' reports, with only 2 psychologists demonstrating that they did not understand the category 'ethnicity' as a Social Determinant inseparable from the others. CONCLUSION: It was identified that the field of action of psychology in the context of Primary Care guided by Critical Social Psychology and Public Health promotes theoretical contributions to all fields of psychology.

OBJETIVO: Este trabajo tiene como objetivo comprender cómo los Determinantes Sociales de la Salud están presentes en las prácticas de atención a la población anciana con hipertensión arterial sistémica y diabetes mellitus ofrecidas por psicólogos de Atención Primaria. MÉTODO: Se realizó una investigación descriptiva con enfoque cualitativo, basada en entrevistas semiestructuradas, con 7 psicólogos que actúan en una Unidad Básica de Salud (Unidade Básica de Saúde - UBS) y/o Unidad de Salud de la Familia (Unidade de Saúde da Família - USF) en Salvador (BA), que atienden al público mayor, teniendo lugar en una plataforma digital. El análisis de los datos se realizó a través del método hermenéutico-dialéctico y tuvo como base teórica la Psicología Social Crítica. RESULTADOS: Se constató que el trabajo de los psicólogos en la Atención Básica para ancianos con Hipertensión Arterial Sistémica y Diabetes Mellitus, en su mayoría, está orientado por prácticas de promoción de la salud, prevención de enfermedades y políticas públicas de salud. En general, la comprensión de los Determinantes Sociales de la Salud como productores de inequidades en salud fue identificada en los informes de los psicólogos, siendo mapeados solo 2 psicólogas que demostraron no entender la categoría raza como un Determinante Social inseparable de los demás. CONCLUSIÓN: Se observó que el campo de la psicología en el contexto de la Atención Primaria orientado por la Psicología Social Crítica y la Salud Colectiva promueve aportes teóricos para todos los campos de la psicología.

Health-Related Quality of Life in Adolescents With Chronic Illness in Jamaica: Adolescent and Parent Reports.

PURPOSE: The aim of this study is to assess the level of agreement between adolescents' self-assessment and parent-proxy reports on health-related quality of life (HRQOL) in Jamaican adolescents with chronic illness. METHODS: A cross-sectional study was conducted, recruiting adolescents living with a chronic illness (ALCIs)-asthma, human immunodeficiency virus, insulin-dependent diabetes mellitus, or sickle cell disease and age/sex-matched healthy adolescents. Data were collected on HRQOL from adolescents and parents using the Pediatric Quality of Life Scale. Parent-adolescent agreement was determined at group level (Wilcoxon signed-rank test) and individual level (intraclass correlation coefficient). RESULTS: Two hundred twenty-six (226) parent/adolescent pairs participated: 130 ALCIs and 96 healthy peers; mean age 14.9 ± 2.8 years; 58% females. Adolescents with and without chronic illness reported similar HRQOL; parent-proxies reported better HRQOL for healthy adolescents compared to ALCIs. Intraclass correlation demonstrated higher levels of parent-adolescent correlation for ALCIs than healthy adolescents (ALCIs: 0.11-0.34; healthy adolescents: 0.01-0.10). At group level, analyses demonstrated better parent-proxy rating of QOL in all of the scores with the exception of the general health score. Parent-proxies overestimated QOL for asthma and insulin-dependent diabetes mellitus but not for sickle cell disease and human immunodeficiency virus. Linear regression modeling revealed that female sex and living with chronic illness were significant predictors of agreement. DISCUSSION: Parent-proxies overestimated adolescents' QOL compared to adolescents' report regardless of whether the adolescent was living with a chronic illness or not. As such, health care providers should elicit feedback from the adolescent wherever possible and proxy reports should be used as complementary information rather than primary source.

Kidney failure, status passage, and the transitional nature of living with the disease: A qualitative study in Argentina.

The span of kidney failure (KF) has been extended by advances in treatment. To elucidate the lived experiences of people with KF, we draw on Glaser and Strauss's theory of status passage. Semi-structured interviews were conducted with 50 patients with KF and 14 health professionals, from two healthcare facilities in Buenos Aires, Argentina. The theory informed on the temporal dimensions of people's passages and dimensions related to what actors know of this passage. We described the status passage as a sequence of transitions (starting dialysis, receiving a transplant, returning to dialysis) that have devastating effects on patient's roles, and are accompanied with fear and experience of wasting time. Temporal aspects were crucial and planning was useless; indeed, timing of statuses was uncertain. With a transplant, certain roles and capacities could be regained. Some patients were not aware of the chronic nature of the disease and the ultimate reversibility of the transplant. Control over the passage was minimal because of the unpredictable prognosis of the disease but patients employed strategies to regain it. Control was even more limited for people who migrated to receive a treatment; whose lives were completely altered. Status passage theory signaled the overwhelming impact of the passage on all aspects of people's lives, the uncertainty of the transitions, lack of control and awareness of essential aspects, and unexpected aspects of desirability, adding to our understanding of how people experience this disease and its treatments.

Coping strategies for chronically ill children and adolescents facing the COVID-19 pandemic / Estrategias de afrontamiento para niños y adolescentes con enfermedades crónicas ante la pandemia COVID-19 / Estratégias de enfrentamento de crianças e adolescentes cronicamente adoecidos frente à pandemia de COVID-19

ABSTRACT Objective: to understand the experiences and coping strategies of children and adolescents with chronic illnesses during the COVID-19 pandemic. Methods: a descriptive study, with a qualitative approach, carried out with six children and adolescents at the reception of an outpatient clinic of a pediatric hospital in the state of Ceará. Data collection took place from April to September 2021, using story-drawing, analyzed in light of Coutinho's criteria. Results: two thematic categories emerged: Situations experienced by children and adolescents in times of COVID-19; Coping strategies for children and adolescents in their chronic illness process during the COVID-19 pandemic. Final considerations: understanding the experiences and coping strategies of children and adolescents with chronic illness demonstrated the expression of creative imagination, incorporated by subjective components, which brings to light an approximation with the reality perceived and interpreted in a context of the COVID-19 pandemic.

RESUMEN Objetivo: comprender las experiencias y estrategias de afrontamiento de niños y adolescentes con enfermedades crónicas durante la pandemia de COVID-19. Métodos: estudio descriptivo, de enfoque cualitativo, realizado con seis niños y adolescentes en la recepción de un ambulatorio de un hospital pediátrico del estado de Ceará. La recolección de datos se realizó de abril a septiembre de 2021, mediante dibujo-cuento, analizados a la luz del criterio de Coutinho. Resultados: surgieron dos categorías temáticas: Situaciones que viven niños y adolescentes en tiempos de COVID-19; Estrategias de afrontamiento de niños y adolescentes en su proceso de enfermedad crónica durante la pandemia de COVID-19. Consideraciones finales: comprender las experiencias y estrategias de afrontamiento de niños y adolescentes con enfermedades crónicas demostró la expresión de la imaginación creativa, incorporado por componentes subjetivos, que pone de manifiesto una aproximación con la realidad percibida e interpretada en un contexto de pandemia de COVID-19.

RESUMO Objetivo: compreender as vivências e estratégias de enfrentamento das crianças e adolescentes com doenças crônicas durante a pandemia de COVID-19. Métodos: estudo descritivo, de abordagem qualitativa, realizado com seis crianças e adolescentes em acompanhamento ambulatorial de um hospital pediátrico do estado do Ceará. A coleta de dados foi realizada de abril a setembro de 2021, utilizando-se desenho-estória, analisada à luz dos critérios de Coutinho. Resultados: emergiram duas categorias temáticas: Situações vivenciadas por crianças e adolescentes em tempos de COVID-19; Estratégias de enfrentamento de crianças e adolescentes em seu processo de adoecimento crônico durante a pandemia de COVID-19. Considerações finais: a compreensão das vivências e estratégias de enfrentamento das crianças e adolescentes com adoecimento crônico demonstrou a expressão da imaginação criadora, incorporada por componentes subjetivos, que traz à tona aproximação com a realidade percebida e interpretada em um contexto de pandemia pela COVID-19.

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.

Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas / Care models at the second level: Experience of the Medical Specialties Unit

Resumen Objetivo: Reportar la implementación y los beneficios del Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas, su utilidad en el manejo y seguimiento de los pacientes con enfermedades crónicas. Material y métodos: Se lograron implementar 9 consultorios de atención médica de la siguiente forma, 2 de Endocrinología, 3 consultorios de Clínica de Enfermedades Crónicas, uno de educación en diabetes e hipertensión, así como 3 de apoyo nutricional. Se midió valores absolutos del número de consultas durante los años 2017, 2018, 2019 y parte del 2020. Así mismo se buscó identificar las patologías más prevalentes con la idea en tener un mejor control y seguimiento de los pacientes, con una mejor organización de personal de atención médico y de enfermería. Resultados y discusión: Se lograron incrementar los números de consulta, con un control y seguimiento más estricto de los pacientes, además de los beneficios en cuanto a la formación y capacitación de médicos residentes, generales tanto militares como profesionales de la salud civiles para enfrentar estos padecimientos prevalentes en nuestro país.

Abstract Objective: To report the implementation as well as the benefits of the Comprehensive Care Model at the second level: Experience of the Medical Specialties Unit, and assess its usefulness in the management and monitoring of patients with chronic diseases. Material and methods: 9 medical care clinics were implemented as follows, 2 for Endocrinology, 3 Clinics for Chronic Diseases, one for education in diabetes and hypertension, as well as 3 for nutritional support. Absolute values of the number of consultations were measured during the years 2017, 2018, 2019 and part of 2020. Likewise, it was sought to identify the most prevalent pathologies with the idea of having a better control and monitoring of patients, with a better organization of medical and nursing care personnel. Results and discussion: It was possible to increase the consultation numbers, with a stricter control and monitoring of patients, in addition to the benefits in terms of training and training of resident doctors, both military generals and civilian health professionals to face these prevalent conditions in our country.

Parenting and the Development of Impulse Control in Youth with Type 1 Diabetes: The Mediating Role of Negative Affect.

Parents are important for the development and maintenance of regulatory control. The current longitudinal study examined associations between parental coercion and autonomy support and impulse control in 117 youth (ages 8-16; Mage= 12.87, SD=2.53; 44% male) with Type 1 diabetes and explored whether youth negative affect mediated these associations. Parental coercion (but not autonomy support) was concurrently associated with lower impulse control and higher negative affect within individuals. Increases in youth negative affect partially mediated the within-person association between parental coercion and impulse control. These findings suggest that parent-directed interventions to reduce parental coercion may be most beneficial for impulse control if combined with youth-directed interventions to help them regulate negative affect. Replication of the current findings in a larger sample of youth with and without a chronic illness is needed to address the theoretical and empirical importance of negative affect as a potential mechanism through which parental coercion impacts youth impulsivity.

Características y experiencias de los cuidadores familiares en el contexto de la salud mental / Characteristics and experiences of family caregivers in the mental health setting

RESUMEN Objetivo. Describir las características y experiencias de los cuidadores familiares de personas con trastorno mental, atendidos en una institución de alta complejidad. Materiales y métodos. Estudio de método mixto, explicativo, con una secuencia inicial cuantitativa y luego cualitativa. La fase cuantitativa se realizó mediante instrumentos validados: ficha de caracterización de la díada persona con enfermedad crónica-cuidador familiar; el inventario de habilidad de cuidado (CAI) de Nkongho, y la escala de sobrecarga de Zarit. La fase cualitativa se realizó con un enfoque fenomenológico hermenéutico, la información se recolectó mediante entrevistas en profundidad para comprender las necesidades de los cuidadores. Resultados. Los cuidadores fueron, en su mayoría, mujeres, principalmente madres e hijas, con educación básica primaria, ocupación hogar y dedicados al trabajo independiente, nivel socioeconómico bajo, nivel de habilidad de cuidado bajo y un importante número de cuidadores perciben algún grado de sobrecarga. Los temas identificados en el análisis de las entrevistas fueron: sintiendo miedo ante la enfermedad; la experiencia del cansancio del cuidador; perder el trabajo: otro costo de la enfermedad; el temor de delegar el cuidado; el amor: un soporte para el cuidador; necesitando apoyo para cuidar. Conclusiones. El cuidador experimenta una situación compleja asociada con la gran demanda de cuidados, y condiciones en que progresa la alteración de la salud mental.

ABSTRACT Objective. To describe the characteristics and experiences of family caregivers of persons with mental disorders in a highly complex institution. Materials and methods. Mixed method, explanatory study, with an initial quantitative and then qualitative sequence. The quantitative phase was carried out using validated instruments: characterization sheet of the person with chronic illness-family caregiver dyad; the Nkongho Caregiving Ability Inventory (CAI), and the Zarit burden scale. The qualitative phase was conducted with a hermeneutic phenomenological approach; the information was collected through in-depth interviews to understand the needs of the caregivers. Results. The caregivers were mostly women, mainly mothers and daughters, home-occupied and self-employed, with basic primary education, low socioeconomic level and low caregiving skill level; a significant number of caregivers perceived some degree of overload. The themes identified in the analysis of the interviews were: feeling fear before the disease; the experience of caregiver fatigue; losing one's job: another cost of the disease; fear of delegating care; love: a support for the caregiver; needing support to care. Conclusions. The caregiver experiences a complex situation associated with the high demand for care, and conditions under which mental health impairment progresses.

Incidence of multimorbidity and associated factors during the COVID-19 pandemic in Brazil: a cohort study

ABSTRACT BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, access to healthcare services may have become difficult, which may have led to an increase in chronic diseases and multimorbidity. OBJECTIVES: To assess the incidence of multimorbidity and its associated factors among adults living in the state of Rio Grande do Sul, Brazil. DESIGN AND SETTING: Cohort study conducted in Rio Grande do Sul, Brazil. METHODS: We included data from the two waves of the Prospective Study About Mental and Physical Health (PAMPA). Data were collected via online questionnaires between June and July 2020 (wave 1) and between December 2020 and January 2021 (wave 2). Multimorbidity was defined as the presence of two or more diagnosed medical conditions. RESULTS: In total, 516 individuals were included, among whom 27.1% (95% confidence interval, CI: 23.5-31.1) developed multimorbidity from wave 1 to 2. In adjusted regression models, female sex (hazard ratio, HR: 1.97; 95% CI: 1.19-3.24), middle-aged adults (31-59 years) (HR: 1.78; 95% CI: 1.18-2.70) and older adults (60 or over) (HR: 2.41; 95% CI: 1.25-4.61) showed higher risk of multimorbidity. Back pain (19.4%), high cholesterol (13.3%) and depression (12.2%) were the medical conditions with the highest proportions reported by the participants during wave 2. CONCLUSION: The incidence of multimorbidity during a six-month period during the COVID-19 pandemic was 27.1% in the state of Rio Grande do Sul, Brazil.

Emotional State of Mexican University Students in the COVID-19 Pandemic.

BACKGROUND: Since the WHO declared the COVID-19 crisis a pandemic in March 2020, the young population is suffering from a range of psychological symptoms. The present study measured symptoms of stress, anxiety and depression in university students of Saltillo, Mexico, using the Depression and Anxiety Stress Scale-21 (DASS-21). METHODS: The DASS-21 scale and an ad hoc questionnaire were used to collect sociodemographic information. RESULTS: The results show that the students who participated in this study suffer from high levels of stress, anxiety and depression. In terms of sociodemographic variables, women, people suffering from a chronic disease and people living with a chronic disease had the highest levels of stress, anxiety and depression, and people who live with a chronically ill person, people who have had the COVID-19 disease and those who have had someone close to them fall sick have had more stress, anxiety and depression than the rest. Another finding of the present study is that university students who believe that others comply with COVID-19 safety measures have significantly lower anxiety and depression than those who believe that others do not comply. CONCLUSIONS: It is concluded that university students are a psychologically vulnerable group in the face of the pandemic.

Sociodemographic determinants of multimorbidity in Brazilian adults and older adults: a cross-sectional study

ABSTRACT BACKGROUND: Multimorbidity due to non-communicable chronic diseases (NCDs) constitutes a significant challenge for healthcare systems. To attenuate its impacts, it is essential to identify the sociodemographic determinants of this condition, which can discriminate against population segments that are more exposed. OBJECTIVE: To identify associations between multimorbidity conditions and sociodemographic indicators among Brazilian adults and older adults. DESIGN AND SETTING: Cross-sectional telephone-based survey in 26 Brazilian state capitals and the federal district. METHODS: The Vigitel 2013 survey was used, with data collected via a questionnaire. The outcome was multimorbidity (2, 3 or 4 NCDs), and the exposures were sociodemographic indicators (age, sex, skin color, marital status and education). The analysis consisted of multinomial logistic regression (odds ratio), stratified by age. RESULTS: Among adults, multimorbidity comprising two, three or four diseases was associated with advancing age (P < 0.001); two and three diseases, with having a partner (P = 0.004 and P < 0.001, respectively); and two, three or four diseases, with lower education (P < 0.001). Among older adults, two, three or four diseases were associated with female sex (P < 0.001); three diseases, with living with a partner (P = 0.018); two diseases, with black skin color (P = 0.016); and two or three diseases, with lower education (P < 0.001). CONCLUSIONS: To control and prevent multimorbidity, strategies for individuals with existing chronic diseases, with partners and with lower education levels are needed. Particularly for adults, advancing age should be considered; and for older adults, being a woman and having black skin color.

Quality of Communication Questionnaire for Patients Hospitalized in Intensive and Palliative Care: Validity Evidence for Use in Brazil.

The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants' mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach's alpha was .75, and .84 in the general communication subscale and .51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach's alpha was .83, and .88 in the general communication subscale, and .71 in the end-of-life communication subscale. The root mean square error of approximation was .07 (90% CI: .04 - .08); Tucker-Lewis index was .97 (95% CI: .95 - .98); comparative fit index was .98 (95% CI: .97 - .99), and χ2/df ratio was 1.33 (χ2[53] = 70.858, p = .05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC.

The impact of stressors and overload on informal caregivers of patients with cirrhosis: The first use of the Burden Scale for Family Caregivers in Brazil.

INTRODUCTION: Cirrhosis affects liver functions and compromises much of the body's organs. The significant increase in chronic diseases, including cirrhosis, has led to changes in medical practice and health systems, leading the informal caregiver to play a major role because of family ties or some level of proximity to the patient, assuming daily care function. However, the burden generated by informal caregivers for uninterrupted care is present at different levels (physical, mental, social, professional, and financial) and even in the prognosis of the patient. OBJECTIVE: The present study aims to evaluate the impact of stressors and overload on informal caregivers of cirrhosis patients. METHOD: Cross-sectional study, conducted with 54 informal caregivers of cirrhosis patients, followed up at the Liver Transplant Service Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas, where they had access to a sociodemographic questionnaire, history of the patient's disease and the scale Burden Scale for Family Caregivers. RESULTS: It was observed that higher levels of education and income of the caregiver correlates with a lower degree of stress. In addition, there is a significant difference found in the caregiver's age variable, which indicates that the youngest are those who have the highest degree of stress. The variable Na mEg/l of the patient also presents a statistically significant difference. CONCLUSION: Our study was a precursor using the BSFC scale of worldwide coverage and that had not yet been applied in any study in Brazil, thus allowing a look at the various aspects that affect the quality of life of caregivers of patients with cirrhosis. Our results and the literature corroborate the importance not only of the patient, but also the informal caregiver's health.