Importance of Social Support of Parents of Children with Cancer: A Multicomponent Model Using Partial Least Squares-Path Modelling

he purpose of the present study is to build a model combining some variables that have been previously studied separately to improve our understanding on how they relate in parents of children with cancer. A total of 112 parents with an average age of 41 completed the self-assessment questionnaires containing the factors studied: social support received, social support provided, stress, adjustment of parents and life satisfaction. Two models were developed: one for social support received and one for social support provided. Structural equation models based on the variance estimated through partial least squares were used to analyze factors involved in quality of life based on an exploratory model of second order. The estimated model was robust in terms of quality of measurement (reliability and validity). According to results from the structural model, in the model of social support received, the impact of social support received on stress was considerable (β = −0.26; p = 0.02) and it explained 16% of the variance. The impact of social support received by parents on their adjustment (β = −0.56; p < 0.001) was also considerable, explaining 32% of the variance. Finally, adjustment of parents also showed an effect on life satisfaction (β = −0.33; p < 0.001) and it explained 26% of the variance. However, the relation between social support received (β = 0.15; p = 0.11) and life satisfaction, the relation between stress (β = −0.15; p = 0.08) and life satisfaction, and the relation between adjustment of parents (β = 0.20; p = 0.07) and stress were not significant. In the model of social support provided by parents, social support provided (β = 0.35; p < 0.001), and adjustment of parents (β = −0.31; p < 0.01) impacted life satisfaction, explaining 36% of the variance. Social support provided (β = −0.34; p < 0.01) impacted adjustment of parents and it explained 12% of the variance. (...)This work was supported by the Groups PAIDI, Junta de Andalucía, Spain [Grant Number HUM-590]. Partial funding for open access charge: Universidad de Málag

Psychosocial and Sociodemographic Determinants Related to Chronic Diseases in Immigrants Residing in Spain

The aim of the study is to analyze the effect of the psychosocial determinants of satisfaction with social support, resilience and satisfaction with life, and the sociodemographic determinants of age, gender and length of residence on chronic diseases in immigrants living in Spain. The sample was composed of 1131 immigrants from Africa, Eastern Europe, Latin America and Asia. 47.1% were men and 52.9% were women. Most relevant results point to age as the sociodemographic variable with the highest predictive effect in the six chronic diseases analyzed. Gender, in this case female, predicts arthrosis, chronic back pain and migraine, whereas length of residence was only significant in the case of chronic allergies. Regarding psychosocial variables, resilience is a good predictor of hypertension, chronic allergies and arthrosis. However, satisfaction with social support appears to be the best predictor for chronic back pain in the regression equation, satisfaction with life being a significant variable in migraine, arthrosis, allergies and high cholesterol. Results are notably relevant for the design of preventive health programs in immigrants, as well as in ensuring their appropriate access to the health system so that their chronic diseases can be diagnosed. Given the relevance and incidence of the chronic diseases analyzed in immigrants, preventive strategies should be improved to tackle chronic diseases that can have a serious impact on immigrants’ healthThis study was made possible by grants from the Spanish Economy and Competitiveness Ministry (Project I+D: PSI2013-40508-P). This research was supported by Grant Number HUM-590 (PAIDI, Junta de Andalucía). Partial funding for open access charge: Universidad de Málaga

La importancia del apoyo social en el manejo del estrés en padres de niños con cáncer.

Nos planteamos como objetivo analizar si el apoyo social actúa amortiguando el estrés padecido por los padres de niños con cáncer. En el estudio participaron padres de niños con cáncer. Los datos se recogieron utilizando un cuestionario sobre el estrés y un cuestionario sobre el apoyo social. Los padres manifestaron sentir un estrés medio-alto, y en concreto les produce más estrés la frecuencia o el número elevado de situaciones a las que tienen que hacer frente que el propio esfuerzo de estas situaciones. También manifiestan un nivel de apoyo medio. Las correlaciones han sido significativas y negativas entre el apoyo social en sus fuentes y tipos con las dos dimensiones del estrés. Los análisis de regresión mostraron que el apoyo familiar disminuye la frecuencia del estrés, el apoyo de los amigos y la comunidad disminuyen el esfuerzo relacionado con el estrés. Con respecto a los tipos de apoyo es el instrumental el que disminuye la frecuencia del estrés y el apoyo informacional el que reduce el estrés relacionado con el esfuerzo. El análisis multidimensional del apoyo social y del estrés ha permitido estudiar en mayor profundidad las relaciones entre estas dos variables. Estos resultados son muy novedosos de cara a su aplicación práctica.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

A multi-level perspective on perceived unmet needs for home support in home-dwelling older adults in the Swiss context: a secondary data analysis of a population study

Unmet needs for home support occur when any support services perceived by older people as needed are not being received. Not meeting these needs can negatively impact older adults' quality of life, and increase health care utilization, hospitalizations, institutionalizations, or death. To date there is no consensus in how to define and assess these unmet needs. In parallel, previous research of factors associated with unmet needs for home support has mostly focused on factors at the micro level. Thus, this paper aims to identify the prevalence of unmet needs for home support among a home-dwelling older population and the factors at the macro, meso and micro levels contributing to them.; Using an ecological approach we identified multi-level factors associated with the presence of unmet needs for home support among the home-dwelling older population (aged 75+) in Switzerland. This is a secondary cross-sectional analysis of the INSPIRE Population Survey of home-dwelling older adults (n = 8,508) living in Basel-Landschaft in Switzerland, conducted as part of the TRANS-SENIOR Project. Prevalence of perceived unmet needs for home support was self-reported, using a dichotomized question. Multiple logistic regression analyses were performed to investigate the associations of factors at each level with unmet needs for home support.; 4.3% of participants reported unmet needs for home support, with a median age of 81 years. 45.1% had private health insurance and 6.3% needed additional government support. Being a recipient of other type of government support (OR = 1.65; 95% CI = 1.17-2.29) (macro-); the use of transportation services (OR = 1.74; 95% CI = 1.15-2.57) (meso-); and feeling depressed (OR = 1.40; 95% CI = 1.06-1.85) or abandoned (OR = 2.60; 95% CI = 1.96-3.43) (micro-) increased odds of having perceived unmet needs for home support. Having a private health insurance (macro-) (OR = 0.63; 95% CI = 0.49-0.80), speaking Swiss-German (OR = 0.44; 95% CI = 0.24-0.88) or German (OR = 0.47; 95% CI = 0.24-0.98), having a high level of education [primary (OR = 0.48; 95% CI = 0.24-1.02); secondary (OR = 0.49; 95% CI = 0.25-1.03); tertiary (OR = 0.38; 95% CI = 0.19-0.82); other (OR = 0.31 (0.12-0.75)], having a high score of self-perceived health status [score ≥ 76 (OR = 0.42; 95% CI = 0.20-0.96)] and having informal care (OR = 0.57; 95% CI = 0.45-0.73), among others (micro-) were associated with decreased odds of having perceived unmet needs for home support.; Our study findings highlight the role of socio-economical inequality in the perception of unmet needs for home support in home-dwelling older adults. In order to address unmet needs in home-dwelling older adults, healthcare leaders and policy makers should focus on strategies to reduce socio-economic inequalities at the different levels in this population

Pacientes con cáncer en confinamiento por Covid19. Análisis de la satisfacción con el apoyo social recibido, estrés percibido, felicidad subjetiva y resiliencia

Introducción: El objetivo del presente estudio consiste en analizar en pacientes con cáncer confinados por la situación de pandemia producida por Covid19, la relación entre satisfacción con apoyo social, resiliencia, estrés percibido y felicidad subjetiva. En el estudio se han analizado diferentes variables sociodemográficas, la satisfacción con las diferentes dimensiones del apoyo social (apoyo emocional, instrumental e informacional) y la satisfacción con el apoyo recibido por diferentes fuentes que proporcionan apoyo (amigos, familia, pareja y comunidad). Método: En el estudio participaron 42 pacientes con cáncer que pertenecen a diferentes ciudades españolas. Resultados: La satisfacción con el apoyo proporcionado por la pareja se relaciona positivamente con la felicidad subjetiva de los pacientes, al igual que la satisfacción con el apoyo instrumental e informacional. La satisfacción con el apoyo proporcionado por la familia y por los amigos se relaciona positivamente con al resiliencia de los pacientes con cáncer, al igual que la satisfacción con el apoyo emocional e informacional recibido. Asimismo existe una relación positiva entre felicidad subjetiva y resiliencia. El estrés percibido se relaciona negativamente con la felicidad subjetiva y con la resiliencia de los pacientes con cáncer. Conclusiones: El análisis multidimensional realizado del apoyo social enfatiza que, en pacientes con cáncer, el apoyo social puede aumentar la resiliencia de los pacientes con cáncer, posibilitando un mejor afrontamiento de la situación de confinamiento que puede producir una pandemia como la ocasionada por Covid19. Del mismo modo resalta la importancia del apoyo social para reducir el impacto que puede tener una situación de confinamiento sobre la felicidad subjetiva de los pacientes con cáncer.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry

Eosinophilic esophagitis; Swallowed topical corticosteroids; Cross-sectional studyEsofagitis eosinofílica; Corticosteroides tópicos ingeridos; Estudio transversalEsofagitis eosinofílica; Corticoides tòpics ingerits; Estudi transversalBackground: Swallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses. Objective: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice. Methods: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations. Results: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness. Conclusion: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.Instituto de Salud Carlos III, Grant/Award Number: JR19/0000

Accurate and timely diagnosis of Eosinophilic Esophagitis improves over time in Europe. An analysis of the EoE CONNECT Registry.

Diagnostic delay; Endoscopy; Eosinophilic esophagitisRetraso en el diagnóstico; Endoscopia; Esofagitis eosinofílicaRetard diagnòstic; Endoscòpia; Esofagitis eosinofílicaBackground: Poor adherence to clinical practice guidelines for eosinophilic esophagitis (EoE) has been described and the diagnostic delay of the disease continues to be unacceptable in many settings. Objective: To analyze the impact of improved knowledge provided by the successive international clinical practice guidelines on reducing diagnostic delay and improving the diagnostic process for European patients with EoE. Methods: Cross-sectional analysis of the EoE CONNECT registry based on clinical practice. Time periods defined by the publication dates of four major sets of guidelines over 10 years were considered. Patients were grouped per time period according to date of symptom onset. Results: Data from 1,132 patients was analyzed and median (IQR) diagnostic delay in the whole series was 2.1 (0.7-6.2) years. This gradually decreased over time with subsequent release of new guidelines (p < 0.001), from 12.7 years up to 2007 to 0.7 years after 2017. The proportion of patients with stricturing of mixed phenotypes at the point of EoE diagnosis also decreased over time (41.3% vs. 16%; p < 0.001), as did EREFS scores. The fibrotic sub-score decreased from a median (IQR) of 2 (1-2) to 0 (0-1) when patients whose symptoms started up to 2007 and after 2017 were compared (p < 0.001). In parallel, symptoms measured with the Dysphagia Symptoms Score reduced significantly when patients with symptoms starting before 2007 and after 2012 were compared. A reduction in the number of endoscopies patients underwent before the one that achieved an EoE diagnosis, and the use of allergy testing as part of the diagnostic workout of EoE, also reduced significantly over time (p = 0.010 and p < 0.001, respectively). Conclusion: The diagnostic work-up of EoE patients improved substantially over time at the European sites contributing to EoE CONNECT, with a dramatic reduction in diagnostic delay

Calidad de vida de los padres de niños enfermos de cáncer: un modelo multicomponente

Introducción: El objetivo de este estudio es examinar las variables que contribuyen a la calidad de vida en padres de niños con cáncer. metodología: Un total de 112 padres con una edad media de 41 años completaron los cuestionarios de autoevaluación de las variables estudiadas referidas al apoyo social proporcionado, estrés, ajuste y satisfacción vital. La metodología de modelos de ecuaciones estructurales basados en la varianza estimado por mínimos cuadrados parciales se utilizó para examinar las variables que contribuyen a la calidad de vida a partir de un modelo exploratorio de segundo orden. Resultados: El modelo estimado fue robusto en cuanto a su calidad de medición (fiabilidad y validez). Según los resultados del modelo estructural, el apoyo social proporcionado por los padres y el ajuste de los padres influyen en la satisfacción vital y explicaron el 36 % de la varianza. El apoyo social proporcionado influye en el ajuste y explicó el 12 % de la varianza. El ajuste influye en la percepción de estrés y explica el 14 % de la varianza. Sin embargo, la relación entre apoyo social proporcionado y estrés, y la relación entre estrés y satisfacción vital, no fueron significativas. Conclusiones: El apoyo social proporcionado y el ajuste de los padres se asocian con la satisfacción vital de éstos. Además, el apoyo social proporcionado contribuye a disminuir los desajustes en diferentes áreas de la vida de los padres y a aumentar la satisfacción vital. Estos desajustes que se pueden producir aumentan el estrés y disminuyen la satisfacción vital. El modelo puede tener repercusión sobre la calidad de vida de los padres e implicaciones prácticas.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Instrumento de evaluación del programa de democracia participativa Ágora infantil

En el presente documento se detalla los instrumentos construidos para la evaluación del programa de democracia participativa Ágora Infantil (AI). Esta política es analiza para conocer sus efectos psicosociales por un equipo interdisciplinar de la Universidad de Málaga y de la Universidad de Huelva tal y como figura en el contrato 8.07/5.38.4408. En el presente documento se detallan los instrumentos utilizados por el equipo de investigación, asegurando así su registro. Por lo tanto, el uso parcial o total de los mismo requeriría la cita de la correspondiente autoría

Protocol for a mixed methods feasibility and implementation study of a community-based integrated care model for home-dwelling older adults: The INSPIRE project

Evaluations of integrated care models for home-dwelling frail older adults have shown inconclusive results on health and service outcomes. However, limited research has focused on the implementation of integrated care models. Applying implementation science methods may facilitate uptake of integrated care models, thus generating positive outcomes e.g., reduced hospital admissions. This paper describes the protocol to assess the feasibility of an integrated care model (featuring a four-step comprehensive geriatric assessment: screening, a multi-dimensional assessment, a coordinated individualized care plan and follow-up) designed for a new community-based center for home-dwelling older adults in Switzerland. The study includes the following objectives: 1) to assess implementation by a) monitoring respondents to the outreach strategies and describing the Center's visitors; b) assessing implementation outcomes related to the care model (i.e., adoption, acceptability, feasibility, fidelity) and implementation processes related to collaboration; and 2) assessing implementation costs.; For objective 1a, we will use a descriptive design to assess respondents to the outreach strategies and describe the Center's visitors. We will use a parallel convergent mixed methods design for objective 1b. Implementation outcomes data will be collected from meetings with the Center's staff, interviews with older adults and their informal caregivers, and reviewing older adults' health records at the Center. Implementation processes related to collaboration will be assessed through a questionnaire to external collaborators (e.g., GPs) towards the end of the study. For objective 2, implementation costs will be calculated using time-driven activity-based costing methods. Data collection is anticipated to occur over approximately six months.; This study of a contextually adapted integrated care model will inform adaptations to the outreach strategies, care model and implementation strategies in one community center, prior to evaluating the care model effectiveness and potentially scaling out the intervention.; Feasibility study registration ID with clinicaltrials.gov: NCT05302310; registration ID with BMC: ISRCTN12324618