Cuidados Paliativos en personas sin hogar

En Europa, el problema de la falta de vivienda lejos de desaparecer se ha acentuado. Europa enfrenta la ambivalencia de atesorar dentro de sus fronteras los mejores ejemplos de estados del bienestar y a la vez contemplar cómo las desigualdades sociales se acentúan y la escasez de techo y trabajo se perpetúan. Por otra parte, el interés por los cuidados paliativos y por facilitar una muerte digna a las personas ha ido ganando terreno en las últimas décadas. Siendo los cuidados paliativos reconocidos como la respuesta más ponderada, completa y satisfactoria que cabe dar a las necesidades de asistencia que comporta la etapa terminal en la vida de un enfermo. El desarrollo de los cuidados paliativos no ha sido homogéneo en todos los países europeos ni en las distintas comunidades autónomas. El informe The Economist (2015) destacó recientemente un programa pionero de España consistente en la creación de 42 equipos de atención psicosocial y espiritual de paciente con enfermedades avanzadas. Uno de estos equipos ha iniciado de forma pionera un programa para atender a los pacientes sin hogar que se encuentran en situación paliativa o con enfermedades crónicas y/o avanzadas. Este artículo repasa la situación del sinhogarismo en Europa y España, con especial énfasis en la prevalencia y en las causas de mortalidad, así como las especificidades de los cuidados paliativos en las personas sin hogar. Finalmente, se presenta nuestra experiencia tras 2 años trabajando como psicólogos clínicos con pacientes sin hogar

Efficacy of an integrative approach for bipolar disorder: preliminary results from a randomized controlled trial

Background. Bipolar Disorder (BD) represents one of the most therapeutically complex psychiatric disorders. The development of a feasible comprehensive psychological approach to complement pharmacotherapy to improve its clinical management is required. The main objective of the present randomized controlled trial (RCT) was to test the efficacy of a novel adjunctive treatment entitled integrative approach in patients with BD, including: psychoeducation, mindfulness training, and functional remediation. Methods. This is a parallel two-armed, rater-blind RCT of an integrative approach plus treatment as usual (TAU), versus TAU alone. Participants were recruited at the Hospital Clinic of Barcelona and randomized to one of the two conditions. They were assessed at baseline and after finishing the intervention. The main outcome variable included changes in psychosocial functioning assessed through the Functioning Assessment Short Test (FAST). Results. After finishing the treatment, the repeated-measures analyses revealed a significant group x time interaction in favor of the patients who received the integrative approach (n=28) compared to the TAU group (n=37) (Pillai’s trace= .10; F(1,57)=6.9 p=.01), improving the functional outcome. Significant effects were also found in two out of the six domains of the FAST, including the cognitive domain (Pillai’s trace=.25; F(1,57)=19.1; p<.001) and leisure time (Pillai’s trace=.11; F(1,57)=7.15; p=.01). Regarding the secondary outcomes, a significant group x time interaction in Hamilton Depression Rating Scale changes was detected (Pillai’s trace= .08; F(1,62)=5.6; p=.02). Conclusion. This preliminary study suggest that the Integrative Approach represents a promising cost-effective therapy to improve psychosocial functioning and residual depressive symptoms in patients suffering from BD. </p

Effects of a Mediterranean Diet Intervention on Maternal Stress, Well-Being, and Sleep Quality throughout Gestation-The IMPACT-BCN Trial

Stress and anxiety are frequent occurrences among pregnant women. We aimed to evaluate the effects of a Mediterranean diet intervention during pregnancy on maternal stress, well-being, and sleep quality throughout gestation. In a randomized clinical trial, 1221 high-risk pregnant women were randomly allocated into three groups at 19-23 weeks' gestation: a Mediterranean diet intervention, a Mindfulness-Based Stress Reduction program, or usual care. All women who provided self-reported life-style questionnaires to measure their anxiety (State Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS)), well-being (WHO Five Well Being Index (WHO-5)), and sleep quality (Pittsburgh sleep quality index (PSQI)) at enrollment and at the end of the intervention (34-36 weeks) were included. In a random subgroup of 106 women, the levels of cortisol and related metabolites were also measured. At the end of the intervention (34-36 weeks), participants in the Mediterranean diet group had significantly lower perceived stress and anxiety scores (PSS mean (SE) 15.9 (0.4) vs. 17.0 (0.4), p = 0.035; STAI-anxiety mean (SE) 13.6 (0.4) vs. 15.8 (0.5), p = 0.004) and better sleep quality (PSQI mean 7.0 ± 0.2 SE vs. 7.9 ± 0.2 SE, p = 0.001) compared to usual care. As compared to usual care, women in the Mediterranean diet group also had a more significant increase in their 24 h urinary cortisone/cortisol ratio during gestation (mean 1.7 ± SE 0.1 vs. 1.3 ± SE 0.1, p < 0.001). A Mediterranean diet intervention during pregnancy is associated with a significant reduction in maternal anxiety and stress, and improvements in sleep quality throughout gestation. Keywords: Mediterranean diet; pregnancy; anxiety; well-being; sleep qualit

Cuidados Paliativos en personas sin hogar

En Europa, el problema de la falta de vivienda lejos de desaparecer se ha acentuado. Europa enfrenta la ambivalencia de atesorar dentro de sus fronteras los mejores ejemplos de estados del bienestar y a la vez contemplar cómo las desigualdades sociales se acentúan y la escasez de techo y trabajo se perpetúan. Por otra parte, el interés por los cuidados paliativos y por facilitar una muerte digna a las personas ha ido ganando terreno en las últimas décadas. Siendo los cuidados paliativos reconocidos como la respuesta más ponderada, completa y satisfactoria que cabe dar a las necesidades de asistencia que comporta la etapa terminal en la vida de un enfermo. El desarrollo de los cuidados paliativos no ha sido homogéneo en todos los países europeos ni en las distintas comunidades autónomas. El informe The Economist (2015) destacó recientemente un programa pionero de España consistente en la creación de 42 equipos de atención psicosocial y espiritual de paciente con enfermedades avanzadas. Uno de estos equipos ha iniciado de forma pionera un programa para atender a los pacientes sin hogar que se encuentran en situación paliativa o con enfermedades crónicas y/o avanzadas. Este artículo repasa la situación del sinhogarismo en Europa y España, con especial énfasis en la prevalencia y en las causas de mortalidad, así como las especificidades de los cuidados paliativos en las personas sin hogar. Finalmente, se presenta nuestra experiencia tras 2 años trabajando como psicólogos clínicos con pacientes sin hogar

Cuidados Paliativos en personas sin hogar

En Europa, el problema de la falta de vivienda lejos de desaparecer se ha acentuado. Europa enfrenta la ambivalencia de atesorar dentro de sus fronteras los mejores ejemplos de estados del bienestar y a la vez contemplar cómo las desigualdades sociales se acentúan y la escasez de techo y trabajo se perpetúan. Por otra parte, el interés por los cuidados paliativos y por facilitar una muerte digna a las personas ha ido ganando terreno en las últimas décadas. Siendo los cuidados paliativos reconocidos como la respuesta más ponderada, completa y satisfactoria que cabe dar a las necesidades de asistencia que comporta la etapa terminal en la vida de un enfermo. El desarrollo de los cuidados paliativos no ha sido homogéneo en todos los países europeos ni en las distintas comunidades autónomas. El informe The Economist (2015) destacó recientemente un programa pionero de España consistente en la creación de 42 equipos de atención psicosocial y espiritual de paciente con enfermedades avanzadas. Uno de estos equipos ha iniciado de forma pionera un programa para atender a los pacientes sin hogar que se encuentran en situación paliativa o con enfermedades crónicas y/o avanzadas. Este artículo repasa la situación del sinhogarismo en Europa y España, con especial énfasis en la prevalencia y en las causas de mortalidad, así como las especificidades de los cuidados paliativos en las personas sin hogar. Finalmente, se presenta nuestra experiencia tras 2 años trabajando como psicólogos clínicos con pacientes sin hogar

Maternal Stress, Anxiety, Well-Being, and Sleep Quality in Pregnant Women throughout Gestation

This study was partially funded by the "LaCaixa" Foundation under grant agreements LCF/PR/GN14/10270005 and LCF/PR/GN18/10310003, the CEREBRA Foundation for the Brain Injured Child (Carmarthen, Wales, UK) and the Departament de Recerca i Universitats de la Generalitat de Catalunya 2021-SGR-01422. LB and FC have received funding from the Instituto de Salud Carlos III (ISCIII) through the projects CM21/00058 and INT21/00027 which are co-funded by the European Union. Funders played no role in the study's design, data collection, data analysis, data interpretation, or the writing of the manuscript.Background: Maternal stress, anxiety, well-being, and sleep quality during pregnancy have been described as influencing factors during pregnancy. Aim: We aimed to describe maternal stress, anxiety, well-being, and sleep quality in pregnant women throughout gestation and their related factors. Methods: A prospective study including pregnant women attending BCNatal, in Barcelona, Spain (n = 630). Maternal stress and anxiety were assessed by the Perceived Stress Scale (PSS) and State-Trait Anxiety Inventory (STAI)-validated questionnaires. Maternal well-being was assessed using the World Health Organization Well-Being Index Questionnaire (WHO-5), and sleep quality was assessed using the Pittsburgh Sleep Quality Index Questionnaire (PSQI). All questionnaires were obtained twice during the second and third trimester of pregnancy. A multivariate analysis was conducted to assess factors related to higher maternal stress and anxiety and worse well-being and sleep quality. Results: High levels of maternal stress were reported in 23.1% of participants at the end of pregnancy, with maternal age <40 years (OR 2.02; 95% CI 1.08-3.81, p = 0.03), non-white ethnicity (OR 2.09; 95% CI 1.19-4.02, p = 0.01), and non-university studies (OR 1.86; 95% CI 1.08-3.19, p = 0.02) being the parameters mostly associated with it. A total of 20.7% of women had high levels of anxiety in the third trimester and the presence of psychiatric disorders (OR 3.62; 95% CI 1.34-9.78, p = 0.01) and non-university studies (OR 1.70; 95% CI 1.11-2.59, p = 0.01) provided a significant contribution to high anxiety at multivariate analysis. Poor maternal well-being was observed in 26.5% of women and a significant contribution was provided by the presence of psychiatric disorders (OR 2.96; 95% CI 1.07-8.25, p = 0.04) and non-university studies (OR 1.74; 95% CI 1.10-2.74, p = 0.02). Finally, less sleep quality was observed at the end of pregnancy (p < 0.001), with 81.1% of women reporting poor sleep quality. Conclusion: Maternal stress and anxiety, compromised maternal well-being, and sleep quality disturbances are prevalent throughout pregnancy. Anxiety and compromised sleep quality may increase over gestation. The screening of these conditions at different stages of pregnancy and awareness of the associated risk factors can help to identify women at potential risk

Effects of a Mediterranean Diet Intervention on Maternal Stress, Well-Being, and Sleep Quality throughout Gestation-The IMPACT-BCN Trial

Stress and anxiety are frequent occurrences among pregnant women. We aimed to evaluate the effects of a Mediterranean diet intervention during pregnancy on maternal stress, well-being, and sleep quality throughout gestation. In a randomized clinical trial, 1221 high-risk pregnant women were randomly allocated into three groups at 19-23 weeks' gestation: a Mediterranean diet intervention, a Mindfulness-Based Stress Reduction program, or usual care. All women who provided self-reported life-style questionnaires to measure their anxiety (State Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS)), well-being (WHO Five Well Being Index (WHO-5)), and sleep quality (Pittsburgh sleep quality index (PSQI)) at enrollment and at the end of the intervention (34-36 weeks) were included. In a random subgroup of 106 women, the levels of cortisol and related metabolites were also measured. At the end of the intervention (34-36 weeks), participants in the Mediterranean diet group had significantly lower perceived stress and anxiety scores (PSS mean (SE) 15.9 (0.4) vs. 17.0 (0.4), p = 0.035; STAI-anxiety mean (SE) 13.6 (0.4) vs. 15.8 (0.5), p = 0.004) and better sleep quality (PSQI mean 7.0 ± 0.2 SE vs. 7.9 ± 0.2 SE, p = 0.001) compared to usual care. As compared to usual care, women in the Mediterranean diet group also had a more significant increase in their 24 h urinary cortisone/cortisol ratio during gestation (mean 1.7 ± SE 0.1 vs. 1.3 ± SE 0.1, p < 0.001). A Mediterranean diet intervention during pregnancy is associated with a significant reduction in maternal anxiety and stress, and improvements in sleep quality throughout gestation

Tratamiento psicológico grupal para pacientes con sintomatología de Covid persistente: protocolo para un ensayo controlado aleatorizado.

Resumen La sintomatología de Covid persistente aparece en 1-2 de cada 10 personas infectadas por el virus SARS-CoV-2 y pueden presentar severas dificultades de adaptación a su nueva condición de salud.  Por un lado, este artículo presenta nuestra propuesta de tratamiento psicológico grupal basada en la ya conocida terapia de aceptación y compromiso. Se ha descrito brevemente el contenido de la psicoterapia sesión a sesión y se han detallado los aspectos formales para su correcta implementación y posibilidad de replicación.  Por otro lado, se describen las particularidades metodológicas de un ensayo controlado aleatorizado: diseño experimental pre-post con asignación aleatoria a dos modalidades de tratamiento; criterios de inclusión y exclusión de la muestra; proceso de reclutamiento y aleatorización, procedimiento, variables e instrumentos de evaluación y análisis y contraste estadístico de los resultados.  El protocolo que hemos elaborado pretende evaluar, de forma metodológicamente rigurosa, la efectividad de un tratamiento específicamente dirigido a mejorar la calidad de vida y el funcionamiento psicosocial de las personas que sufren síntomas persistentes de Covid-19. Los resultados permitirán saber si dicho tratamiento es realmente eficaz.

Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment

Is a Mediterranean diet or mindfulness-based stress reduction intervention during pregnancy effective in improving child neurodevelopment at age 2 years? In this randomized clinical trial that included 626 children, Bayley-III scores were significantly higher in cognitive and social-emotional domains in the Mediterranean diet group and significantly higher in the social-emotional domain in the stress reduction group compared with the usual care group. Structured interventions during pregnancy based on a Mediterranean diet or mindfulness-based stress reduction significantly improved child neurodevelopment at 2 years. This prespecified analysis of a randomized clinical trial evaluates the effect of a Mediterranean diet or mindfulness-based stress reduction during pregnancy on child neurodevelopment at age 2 years. Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and childhood neurodevelopment. To test the hypothesis that structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (MBSR) during pregnancy improve child neurodevelopment at age 2 years. This was a prespecified analysis of the parallel-group Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) randomized clinical trial, which was conducted at a university hospital in Barcelona, Spain, from February 2017 to March 2020. A total of 1221 singleton pregnancies (19 to 23 weeks' gestation) with high risk of delivering newborns who were small for gestational age were randomly allocated into 3 groups: a Mediterranean diet intervention, an MBSR program, or usual care. A postnatal evaluation with the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III), was performed. Data were analyzed from July to November 2022. Participants in the Mediterranean diet group received monthly individual and group educational sessions and free provision of extra virgin olive oil and walnuts. Those in the stress reduction group underwent an 8-week MBSR program adapted for pregnancy. Individuals in the usual care group received pregnancy care per institutional protocols. Neurodevelopment in children was assessed by Bayley-III at 24 months of corrected postnatal age. A total of 626 children (293 [46.8%] female and 333 [53.2%] male) participated at a mean (SD) age of 24.8 (2.9) months. No differences were observed in the baseline characteristics between intervention groups. Compared with children from the usual care group, children in the Mediterranean diet group had higher scores in the cognitive domain (β, 5.02; 95% CI, 1.52-8.53; P = .005) and social-emotional domain (β, 5.15; 95% CI, 1.18-9.12; P = .01), whereas children from the stress reduction group had higher scores in the social-emotional domain (β, 4.75; 95% CI, 0.54-8.85; P = .02). In this prespecified analysis of a randomized clinical trial, maternal structured lifestyle interventions during pregnancy based on a Mediterranean diet or MBSR significantly improved child neurodevelopmental outcomes at age 2 years

Antidepressants overuse in primary care:Prescription trends between 2010 and 2019 in Catalonia

INTRODUCTION: There has been an increase in the prescription of antidepressants (AD) in primary care (PC). However, it is unclear whether this was explained by a rise in diagnoses with an indication for AD. We investigated the changes in frequency and the variables associated with AD prescription in Catalonia, Spain.METHODS: We retrieved AD prescription, sociodemographic, and health-related data using individual electronic health records from a population-representative sample (N=947.698) attending PC between 2010 and 2019. Prescription of AD was calculated using DHD (Defined Daily Doses per 1000 inhabitants/day). We compared cumulative changes in DHD with cumulative changes in diagnoses with an indication for AD during the study period. We used Poisson regression to examine sociodemographic and health-related variables associated with AD prescription.RESULTS: Both AD prescription and mental health diagnoses with an indication for AD gradually increased. At the end of the study period, DHD of AD prescriptions and mental health diagnoses with an indication for AD reached cumulative increases of 404% and 49% respectively. Female sex (incidence rate ratio (IRR)=2.83), older age (IRR=25.43), and lower socio-economic status (IRR=1.35) were significantly associated with increased risk of being prescribed an AD.CONCLUSIONS: Our results from a large and representative cohort of patients confirm a steady increase of AD prescriptions that is not explained by a parallel increase in mental health diagnoses with an indication for AD. A trend on AD off-label and over-prescriptions in the PC system in Catalonia can be inferred from this dissociation.</p