Health Related Quality of Life in Coronary Patients.

The increase observed in the survival of patients with ischemic cardiopathy, together with the effect of the disease on the social, professional, and family life of those suffering from it, have led researchers to consider that the traditional ways of measuring morbidity and mortality are not adequate for assessing the potential benefits of health care interventions. For this reason, there is common agreement on the need to use an indicator of subjective assessment of health, and of health related quality of life (HRQL), as a complementary criterion for monitoring the results of medical interventions in these patients. The term "quality of life" (QoL) or health related quality of life (HRQL) came into use during the 1970s as a multidimensional concept reflecting the overall subjective condition of the physical and mental welfare of the individual, which is a consequence not only of the disease but also of the family and social conditions forming the patient’s environment. The assessment of these patients’ HRQL has been tackled by several authors using both disease-specific and generic instruments such as the Nottingham Health Profile, the Sickness Impact Profile, the SF-36 or the SF-12 health questionnaire. Both types of instrument have advantages and disadvantages, and they may provide additional information since they quantify the patient’s overall health. Using different multidimensional measures, poorer HRQL has been observed in patients with Acute Myocardial Infarction (AMI) and angina pectoris than in other populations, and these differences have been related to low social class, female sex, the presence of mental disorders and the severity of the clinical condition. Measuring changes in the HRQL of coronary patients is also important as a way of assessing interventions and predicting needs for social care, because it has been shown that the focus of attention in the immediate period following a cardiac attack is generally the physical functioning, but following discharge from hospital and in the longer term, general health, vitality, social and emotional functions could be at least as important. In this chapter, we aim to provide an overview of the concept of HRQL and the usefulness of this measure from the perspective of a coronary patient. Likewise, we intend to review the main instruments used to assess HRQL and we analyse the factors that have been seen to affect the quality of life of these patients

Can suicidal behaviour be prevented in patients with chronic pain?

Parece evidente es que la conducta suicida, o al menos la ideación suicida, es más frecuente en los enfermos que padecen dolor crónico que en la población general.2 página

Medicine 5th course student’s attitudes towards mental health

Introducción. El estigma social que persiste hacia la enfermedad mental puede estar presente en los estudiantes de medicina e impactar en la forma de considerar ésta y la psiquiatría como especialidad. Objetivo. Investigar la actitud hacia la enfermedad mental y la psiquiatría en una muestra de estudiantes. Sujetos y métodos. Se realizó una encuesta estructurada, voluntaria y anónima a los 27 estudiantes de quinto curso del grado de medicina de la Universidad San Pablo-CEU de Madrid. La encuesta incluía un cuestionario sobre el nivel de familiaridad hacia la enfermedad mental, el cuestionario de actitud hacia la enfermedad mental (AMI) y el cuestionario adaptado de Balon sobre la actitud hacia la psiquiatría. Resultados. Un total de 22 alumnos respondió la encuesta (72,7% mujeres). Estos alumnos presentaron una alta familiaridad con la enfermedad mental (puntuación media: 7,27; máximo: 11). El 81,8% refirieron una actitud positiva hacia la enfermedad mental (escala AMI). Las puntuaciones de la escala de Balon también mostraron un nivel alto de acuerdo en los méritos globales de la psiquiatría y en la eficacia de ésta. Tampoco las respuestas respecto al rol y función del psiquiatra y a la carrera profesional revelaron una postura negativa. No hubo relación entre la familiaridad y la actitud hacia la enfermedad mental o hacia la psiquiatría. Conclusiones. En esta muestra no se evidencia la existencia de estigma hacia la enfermedad mental o hacia la psiquiatría. Posteriores estudios en muestras más amplias y evaluaciones de la enseñanza de la psiquiatría son necesarios para profundizar en este tema

El Deterioro Cognitivo: un Factor a Tener en Cuenta en la Evaluación e Intervención de Pacientes con Dolor Crónico.

El dolor crónico constituye un grave problema de salud pública, dada su elevada prevalencia y las consecuencias personales y sociales que produce. La presencia de dolor crónico se ha asociado con un deterioro cognitivo leve, sobre todo en los pacientes afectados por fibromialgia o dolor neuropático, habiéndose relacionado esto con la concurrencia en estos pacientes, de otros procesos, como la ansiedad, la depresión, los trastornos del sueño y el consumo de ciertos fármacos, todos ellos habituales en los pacientes con dolor crónico. En esta revisión, hacemos un repaso del complejo proceso de la cognición así como de los distintos elementos que lo integran. Asimismo, revisamos los mecanismos mediante los que el dolor crónico puede afectar el proceso de la cognición y el modo en el que este puede verse afectado por la concurrencia de otras patologías, o por los fármacos habitualmente utilizados para su tratamiento. Finalmente se plantea la necesidad de evaluar el deterioro cognitivo en los pacientes con dolor crónico, con el objetivo de evitar la progresión de la enfermedad cognitiva hacia un cuadro de deterioro más grave, así como de contribuir a mejorar la respuesta terapéutica al dolor y el aumento de la calidad de vida de los pacientes.Chronic pain constitutes a serious public health problem due to its high prevalence and the social and personal consequences. The presence of chronic pain has been associated with mild cognitive impairment, especially in patients with fibromyalgia and neuropathic pain, and it has been also related with other disease like anxiety, depression, sleep disorders and the use of certain drugs, usually taken on these patients. This document revises the complex issue of the cognitive process and the several elements that comprise it. Likewise, we review the different mechanisms by which pain affect cognitive process and the way it could be affected by other disease, or by drugs commonly used on treatment. It is necessary to assess mild cognitive impairment on chronic pain patients, in order to prevent the develop and the evolution of cognitive disease to a more severe impairment, as well as help to improve therapeutic response to pain and increase health related quality of life of patients

mHealth Intervention for Improving Pain, Quality of Life, and Functional Disability in Patients With Chronic Pain: Systematic Review

Background: Chronic pain (CP) is 1 of the leading causes of disability worldwide and represents a significant burden on individual, social, and economic aspects. Potential tools, such as mobile health (mHealth) systems, are emerging for the self-management of patients with CP. Objective: A systematic review was conducted to analyze the effects of mHealth interventions on CP management, based on pain intensity, quality of life (QoL), and functional disability assessment, compared to conventional treatment or nonintervention. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to conduct a systematic review of randomized controlled trials (RCTs) published in PubMed, Web of Science, Scopus, and Physiotherapy Evidence Database (PEDro) databases from February to March 2022. No filters were used. The eligibility criteria were RCTs of adults (≥18 years old) with CP, intervened with mHealth systems based on mobile apps for monitoring pain and health-related outcomes, for pain and behavioral self-management, and for performing therapeutic approaches, compared to conventional treatments (physical, occupational, and psychological therapies; usual medical care; and education) or nonintervention, reporting pain intensity, QoL, and functional disability. The methodological quality and risk of bias (RoB) were assessed using the Checklist for Measuring Quality, the Oxford Centre for Evidence-Based Medicine Levels of Evidence, and the Cochrane RoB 2.0 tool. Results: In total, 22 RCTs, involving 2641 patients with different CP conditions listed in the International Classification of Diseases 11th Revision (ICD-11), including chronic low back pain (CLBP), chronic musculoskeletal pain (CMSP), chronic neck pain (CNP), unspecified CP, chronic pelvic pain (CPP), fibromyalgia (FM), interstitial cystitis/bladder pain syndrome (IC/BPS), irritable bowel syndrome (IBS), and osteoarthritis (OA). A total of 23 mHealth systems were used to conduct a variety of CP self-management strategies, among which monitoring pain and symptoms and home-based exercise programs were the most used. Beneficial effects of the use of mHealth systems in reducing pain intensity (CNP, FM, IC/BPS, and OA), QoL (CLBP, CNP, IBS, and OA), and functional disability (CLBP, CMSP, CNP, and OA) were found. Most of the included studies (18/22, 82%) reported medium methodological quality and were considered as highly recommendable; in addition, 7/22 (32%) studies had a low RoB, 10/22 (45%) had some concerns, and 5/22 (23%) had a high RoB. Conclusions: The use of mHealth systems indicated positive effects for pain intensity in CNP, FM, IC/BPS, and OA; for QoL in CLBP, CNP, IBS, and OA; and for functional disability in CLBP, CMSP, CNP, and OA. Thus, mHealth seems to be an alternative to improving pain-related outcomes and QoL and could be part of multimodal strategies for CP self-management. High-quality studies are needed to merge the evidence and recommendations of the use of mHealth systems for CP management.25 página

A nationwide study of chronic pain prevalence in the general Spanish population, identifying clinical subgroups through cluster analysis.

Objective. This study aims to assess the prevalence of chronic pain, its characteristics, and its impact on the general Spanish population. Also, to establish chronic pain patient subgroups according to the characteristics of pain and to identify variables specifically associated with each subgroup. Design. Telephone-based, cross-sectional nationwide study. Subjects. A sample of 1,957 individuals representative of the Spanish population. Methods. Data were collected through telephone interviews. A subject was considered to have chronic pain if they had suffered pain (at least 4 days a week) during the last 3 months. The subjects were divided into two subgroups through a cluster analysis, and a regression model was established to determine the variables most specifically associated with these subgroups. Results. The prevalence of chronic pain was 16.6% (95% confidence interval: 14.9–18.3) and among these subjects, more than 50% referred to limitations in their daily activities, 30% felt sad and/or anxious, and 47.2% indicated that their pain was affecting their family life. Two subgroups of subjects with pain were identified: 1) characterized by generalized pain in more than one location and of a long evolution (150 months); and 2) characterized by pain localized to only one site with a shorter duration (100 months). Individuals who felt anxious because of their pain and those who considered that their pain was affecting their family were more likely to belong to group 1. Conclusions. Pain affects an important proportion of the Spanish adult population and that it has a strong personal impact. Two pain groups were clearly distinguished by their clinical characteristics

Living with opioids: A qualitative study with patients with chronic low back pain

Background Opioids are one of the most prescribed treatments for chronic pain (CP). However, their long-term use (>3 months) has been surrounded by controversy, due to loss of beneficial effects. Objective To explore the experiences of people with chronic non-malignant low back pain in Spain undergoing long-term treatment with opioids. Design Qualitative study. Setting and participants We conducted 15 semi-structured interviews at the Pain Clinic with persons taking opioid treatment. Methods The interviews were analysed by qualitative content analysis as described by Graneheim and Lundman, and developed categories and themes discussed in light of a biomedicalization framework. Main results We developed one overarching theme-Living with opioids: dependence and autonomy while seeking relief-and three categories:The long pathway to opioids due to the invisibility of pain; Opioids: from blind date to a long-term relationship; andWhat opioids cannot fix. Discussion The long and difficult road to find effective treatments was a fundamental part of coping with pain, involving long-term relationships with the health system. This study reflects the benefits, and drawbacks of opioids, along with struggles to maintain autonomy and make decisions while undergoing long-term treatment with opioids. The paper also highlights the consequences of pain in the economy, family and social life of patients. Conclusions Patients' experiences should be considered to a greater extent by health-care professionals when giving information about opioids and setting treatment goals. Greater consideration of the social determinants of health that affect CP experiences might lead to more effective solutions to CP

Sleep Characteristics in Diabetic Patients Depending on the Occurrence of Neuropathic Pain and Related Factors

This study aims to compare the sleep characteristics (structure and quality) in patients with type-2 diabetes mellitus with and without diabetic neuropathic pain (DNP), and to investigate the relationship of sensory phenotypes, anxiety, and depression with sleep quality in DNP patients. A cross-sectional study was performed in patients with type-2 diabetes mellitus and neuropathy. Patients were classified into two groups-with or without neuropathic pain-according to the "Douleur Neuropathique-4 (DN4)" scale. Sleep characteristics and quality (Medical Outcomes Study-MOS-sleep), pain phenotype (Neuropathic Pain Symptom Inventory-NPSI), mood status (Hospital Anxiety and Depression scale-HADS), pain intensity (Visual Analogue Scale-VAS), and quality of life (SF-12v2) were measured. The sample included 130 patients (65 with DNP). The mean scores in all the dimensions of the MOS-sleep scale were higher (more disturbances) in the DNP patients. Higher scores in anxiety or depression, greater intensity of pain or a higher score in the paroxysmal pain phenotype were associated with lower sleep quality in DNP patients. A shorter duration of the diabetes and lower levels of glycated hemoglobin were also associated with lower sleep quality. The results show the relationship between DNP and sleep quality, and the importance of assessing sensory phenotypes and mental comorbidities in these patients. Taking these factors into consideration, to adopt a multimodal approach is necessary to achieve better clinical results

Opioids in the Treatment of Pain. Beliefs, Knowledge, and Attitudes of the General Spanish Population. Identification of Subgroups Through Cluster Analysis

Context. A lack of information has been found related to patients’ perception toward pain management. Objectives. To analyze the point of view of the general Spanish population regarding the use of opioids in pain treatment. To identify groups of individuals based on this information. Methods. Nationwide cross-sectional study on a representative sample of 1299 Spanish adults. Data were collected on beliefs, knowledge, fears, opinions, and attitudes toward the use of opioids. A cluster analysis to identify groups of people based on these parameters and a multinomial logistic regression model to analyze the variables related to the clusters were performed. Results. Three groups of subjects were identified based on their perspective toward opioids: a first group with a positive point of view (N ¼ 448) composed of people older than 65 years who would accept a treatment if prescribed and who were less fearful of these drugs; a second group with a moderate point of view (N ¼ 337) formed by younger subjects with university education, better informed about opioids, afraid of these drugs (odds ratio [OR] 2.67), and more frequently associated them with drowsiness (OR 2.58), nausea (OR 3.04), and tolerance (OR 2.16); and a third group with a negative point of view (N ¼ 468), with lower educational level who would more often reject treatment with opioids, more afraid of them (OR 3.95), considering that they may not be able to stop the treatment (OR 3.04) and may produce tolerance (OR 3.03). Conclusion. The different perspectives of patients regarding the use of opioids to treat pain should be taken into consideration by the physician when designing strategies to inform patients about the treatment of pain with opioids. This should promote their correct use, specially preventing their misuse

Simple Generalized Estimating Equations (GEE) and Weighted Generalized Estimating Equations (WGEE) in longitudinal studies with dropouts: guidelines and implementation in R.

Missing data are a common problem in clinical and epidemiological research, especially in longitudinal studies. Despite many methodological advances in recent decades, many papers on clinical trials and epidemiological studies do not report using principled statistical methods to accommodate missing data or use ineffective or in appropriate techniques. Two refined techniques are presented here: generalized estimating equations (GEEs) and weighted generalized estimating equations (WGEEs). These techniques are an extension of generalized linear models to longitudinal or clustered data, where observations are no longer independent. They can appro priately handle missing data when the missingness is completely at random (GEE and WGEE) or at random (WGEE) and do not require the outcome to be normally distributed. Our aim is to describe and illustrate with a real example, in a simple and accessible way to researchers, these techniques for handling missing data in the context of longitudinal studies subject to dropout and show how to implement them in R. We apply them to assess the evolution of health-related quality of life in coronary patients in a data set subject to dropout