Relationship between behavioural coping strategies and acceptance in patients with fibromyalgia syndrome: Elucidating targets of interventions

BACKGROUND: Previous research has found that acceptance of pain is more successful than cognitive coping variables for predicting adjustment to pain. This research has a limitation because measures of cognitive coping rely on observations and reports of thoughts or attempts to change thoughts rather than on overt behaviours. The purpose of the present study, therefore, is to compare the influence of acceptance measures and the influence of different behavioural coping strategies on the adjustment to chronic pain. METHODS: A sample of 167 individuals diagnosed with fibromyalgia syndrome completed the Chronic Pain Coping Inventory (CPCI) and the Chronic Pain Acceptance Questionnaire (CPAQ). RESULTS: Correlational analyses indicated that the acceptance variables were more related to distress and functioning than were behavioural coping variables. The average magnitudes of the coefficients for activity engagement and pain willingness (both subscales of pain acceptance) across the measures of distress and functioning were r = 0.42 and 0.25, respectively, meanwhile the average magnitude of the correlation between coping and functioning was r = 0.17. Regression analyses examined the independent, relative contributions of coping and acceptance to adjustment indicators and demonstrated that acceptance accounted for more variance than did coping variables. The variance contributed by acceptance scores ranged from 4.0 to 40%. The variance contributed by the coping variables ranged from 0 to 9%. CONCLUSIONS: This study extends the findings of previous work in enhancing the adoption of acceptance-based interventions for maintaining accurate functioning in fibromyalgia patients

Help4Mood: avatar-based support for treating people with major depression in the community

BACKGROUND: The Help4Mood consortium, comprising partners from Scotland, Spain, Romania, and Italy, aims to develop a system for supporting the treatment of people with major depressive disorder in the community. The Help4Mood system consists of three parts: (1) A Personal Monitoring System that collects activity and sleep data; (2) a Virtual Agent (avatar) that interacts with the patient in short, structured sessions that involve mood checks, psychomotor tests, and brief therapy-related exercises; (3) a Decision Support System that controls the interaction between user and Virtual Agent, extracts relevant information from the monitoring data, and produces reports for clinicians. In this paper, we report the results of focus groups that were conducted to gather user requirements for Help4Mood. These involved two core stakeholder groups, patients with depression and clinicians. AIMS AND OBJECTIVES: We invited comments on all aspects of system design, focusing on the nature and intensity of monitoring; the interaction between the Virtual Agent and patients; and the support patients and clinicians would wish to receive from Help4Mood. METHODS: Ten focus groups were conducted in Scotland, Spain, and Romania, one each with patients and 2–3 each with psychiatrists, clinical psychologists, and psychiatric nurses. Following a presentation of a sample Help4Mood session, the discussion was structured using a set of prompts. Group sessions were transcribed; data were analysed using framework analysis. RESULTS: Regarding the overall Help4Mood system, participants raised three main issues, integration with treatment; configurability to support local best practice; and affordability for health services. Monitoring was discussed in terms of complexity, privacy in shared spaces, and crisis. Clinicians proposed physiological, mood, and neuropsychomotor variables that might be monitored, which would yield a complex picture of the patient’s state. Obtrusiveness (of monitors) and intrusiveness (to routines and environment) were raised as important barriers. Patients felt that Help4Mood should provide them with tailored resources in a crisis; clinicians were clear that Help4Mood should not be used to detect acute suicide risks. Three main design characteristics emerged for the Virtual Agent—ease of use, interaction style, and humanoid appearance. The agent should always react appropriately, look and behave like a good therapist, and show positive or neutral emotion. Core functions of the decision support system were characterized by the themes adaptation, informing treatment, and supporting clinician-patient interaction. The decision support system should adapt the patient’s session with the Virtual Agent in accordance with the patient’s mood and stamina. Monitoring data should be presented as a one-page summary highlighting key trends to be discussed with the patient during a consultation. CONCLUSIONS: Consulting with patients and clinicians showed that Help4Mood should focus on tracking recovery in the community in a way that informs and supports ongoing treatment. The design of the Virtual Agent will be crucial for encouraging adherence to the Help4Mood protocol. To ensure uptake of the system, Help4Mood needs to be flexible enough to fit into different service delivery contexts

Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care:A systematic review of the evidence

BACKGROUND: Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. METHODS: Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. RESULTS: Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. CONCLUSIONS: Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-015-0417-x) contains supplementary material, which is available to authorized users

Validation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to validate a Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ). Pain acceptance is the process of giving up the struggle with pain and learning to live a worthwhile life despite it. The Chronic Pain Acceptance Questionnaire (CPAQ) is the questionnaire most often used to measure pain acceptance in chronic pain populations.</p> <p>Methods</p> <p>A total of 205 Spanish patients diagnosed with fibromyalgia syndrome who attended our pain clinic were asked to complete a battery of psychometric instruments: the Pain Visual Analogue Scale (PVAS) for pain intensity, the Hospital Anxiety and Depression Scale (HADS), the Medical Outcome Study Short Form 36 (SF-36), the Pain Catastrophising Scale (PCS) and the Fibromyalgia Impact Questionnaire (FIQ).</p> <p>Results</p> <p>Analysis of results showed that the Spanish CPAQ had good test-retest reliability (intraclass correlation coefficient 0.83) and internal consistency reliability (Cronbach's α: 0.83). The Spanish CPAQ score significantly correlated with pain intensity, anxiety, depression, pain catastrophising, health status and physical and psychosocial disability. The Scree plot and a Principal Components Factor analysis confirmed the same two-factor construct as the original English CPAQ.</p> <p>Conclusion</p> <p>The Spanish CPAQ is a reliable clinical assessment tool with valid construct validity for the acceptance measurement among a sample of Spanish fibromyalgia patients. This study will make it easier to assess pain acceptance in Spanish populations with fibromyalgia.</p

Community pharmacist intervention in depressed primary care patients (PRODEFAR study): randomized controlled trial protocol.

Background: Treatment of depression, the most prevalent and costly mental disorder, needs to be improved. Non-concordance with clinical guidelines and non-adherence can limit the efficacy of pharmacological treatment of depression. Through pharmaceutical care, pharmacists can improve patients' compliance and wellbeing. The aim of this study is to evaluate the effectiveness and costeffectiveness of a community pharmacist intervention developed to improve adherence and outcomes of primary care patients with depression. Methods/design: A randomized controlled trial, with 6-month follow-up, comparing patients receiving a pharmaceutical care support programme in primary care with patients receiving usual care. The total sample comprises 194 patients (aged between 18 and 75) diagnosed with depressive disorder in a primary care health centre in the province of Barcelona (Spain). Subjects will be asked for written informed consent in order to participate in the study. Diagnosis will be confirmed using the SCID-I. The intervention consists of an educational programme focused on improving knowledge about medication, making patients aware of the importance of compliance, reducing stigma, reassuring patients about side-effects and stressing the importance of carrying out general practitioners' advice. Measurements will take place at baseline, and after 3 and 6 months. Main outcome measure is compliance with antidepressants. Secondary outcomes include; clinical severity of depression (PHQ-9), anxiety (STAI-S), health-related quality of life (EuroQol-5D), satisfaction with the treatment received, side-effects, chronic physical conditions and sociodemographics. The use of healthcare and social care services will be assessed with an adapted version of the Client Service Receipt Inventory (CSRI). Discussion: This trial will provide valuable information for health professionals and policy makers on the effectiveness and cost-effectiveness of a pharmaceutical intervention programme in the context of primary care. Trial registration: NCT0079419

In-patient costs of agitation and containment in a mental health catchment area

Background: There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. Methods: A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. Results: During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. Conclusions: Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.Peer ReviewedPostprint (published version

Fine-scale collision risk mapping and validation with long-term mortality data reveal current and future wind energy development impact on sensitive species

The ongoing demand for renewable energy has boosted the development of wind farms worldwide. Given the impact these facilities have on flying species, a spatially explicit assessment of collision risk in vulnerable species is needed to guide management actions and prioritise areas for installing these infrastructures. We used GPStracking data of 127 adult and 50 juvenile griffon vultures in peninsular Spain gathered between 2014 and 2022 to evaluate factors influencing vulnerability and exposure and predict collision risk. We validate the observed collision risk with recorded long-term mortality data (1999–2022) at regional and wind farm scales and evaluate the estimated impact of current and future turbine facilities. Our results showed that overall food availability increases vulnerability and exposure, whilst distance to nesting areas and the presence of conspecifics decreased both vulnerability and exposure in adults and juveniles, respectively. Our maps revealed that 19% and 10% of the Spanish peninsular area had a high collision risk for adults and juveniles, respectively. Importantly, the number of turbine casualties was positively related to collision risk at the regional and wind farm scale and ~ 18 of the breeding population lies within high collision risk areas.Moreover, the areas with the highest risk of collision also have the highest number of turbines and largely overlap with areas suitable for developing new wind farms. Our study highlights the need to reduce collision risk mapping uncertainties by validating model outputs with actual mortality data. Moreover, it emphasises the urgent need for spatial planning of wind energy development, searching for safer alternatives for biodiversity. This approach undoubtedly serves as a tool to define “not go to” areas for installing new turbines for one of the most sensitive species