Caterina Calderón

The ability of multi-type maltreatment and poly-victimization approaches to reflect psychopathological impairment of victimization in Spanish community adolescents

This paper examined the ability of two different approaches (the multi-type maltreatment approach, and the polyvictimization approach) to reflect the psychopathological aftermath of victimization. It also analyzed gender-related differences in psychopathological symptoms at varying levels of exposure to violence. The study was conducted in 923 Spanish community adolescents (aged from 14 to 18 years; 62.4% girls; 87.4% born in Spain), recruited for screening purposes from eight secondary schools in Barcelona and its metropolitan area (Spain). The study was based on cross-sectional data. The Juvenile Victimization Questionnaire and the Youth Self Report (DSM scales) were used to analyze victimization and psychopathological impairment respectively. The results showed that the two approaches present a similar ability to reflect psychopathological outcomes. The use of mean T scores to analyze psychopathological impairments conceals the high percentages of adolescents who are at risk in several psychopathological scales. Gender-related differences, analyzed under the multi-type approach, showed that girls presented slightly higher levels of symptomatology in reaction to their first experiences of victimization, whereas boys presented strong emotional reactions after the accumulation of a high number of victimized areas. Adolescents victimized in up to three areas showed evidence of resiliency to interpersonal victimization events and displayed non-clinical psychopathological profiles. Obsessive-compulsive symptoms had to be considered in high victimized groups, conjointly with affective, somatic and post-traumatic stress as psychopathological symptoms related to victimization.

Ecological Momentary Assessment with smartphones for measuring mental health problems in adolescents

AIM To analyze the viability of Ecological Momentary Assessment (EMA) for measuring the mental states associated with psychopathological problems in adolescents. METHODS In a sample of 110 adolescents, a sociodemographic data survey and an EMA Smartphone application over a one-week period (five times each day), was developed to explore symptom profiles, everyday problems, coping strategies, and the contexts in which the events take place. RESULTS The positive response was 68.6%. Over 2250 prompts about mental states were recorded. In 53% of situations the smartphone was answered at home, 25.5% of cases they were with their parents or with peers (20.3%). Associations were found with attention, affective and anxiety problems (P < 0.001) in the participants who took longer to respond to the EMA app. Anxious and depressive states were highly interrelated (rho = 0.51, P < 0.001), as well as oppositional defiant problems and conduct problems (rho = 0.56, P < 0.001). Only in 6.2% of the situations the subjects perceived they had problems, mainly associated with inter-relational aspects with family, peers, boyfriends or girlfriends (31.2%). We also found moderate-high reliability on scales of satisfaction level on the context, on positive emotionality, and on the discomfort index associated with mental health problems. CONCLUSION EMA methodology using smartphones is a useful tool for understanding adolescents’ daily dynamics. It achieved moderate-high reliability and accurately identified psychopathological manifestations experienced by community adolescents in their natural context.

Satisfaction with gastrostomy feeding in caregivers of children with home enteral nutrition: application of the SAGA-8 questionnaire and analysis of involved factors

AIMS To assess the degree of satisfaction of caregivers of children with gastrostomy tube (GT) feeding through the structured questionnaire SAGA-8. Secondly, to evaluate if the parental satisfaction degree was related to several independent variables. METHODS A cross-sectional observational study was performed in 92 caregivers of children with GT feeding and chronic diseases. The following data was obtained: caregiver satisfaction with GT feeding (SAGA-8), age at GT placement, anthropometric data, length and mode of nutritional support, family demographic characteristics and caregiver psychological status. RESULTS All primary caregivers were mothers. High satisfaction with GT feeding was expressed by 82.6% of families. The simplicity of the system was emphasized by 87%, and 85.9% were very satisfied with the support received from the hospital staff. 73.9% of mothers acknowledged their childs nutritional status had improved and 89.1% rated the enhancement familys overall situation. Moreover, 75% of mothers reduced feeding-time, and 68.5% reported less respiratory infections. Finally, 71.7% of mothers recognized that they would have implemented this technique earlier. Caregiver satisfaction was positively correlated with age at GT placement and length of treatment, and both variables explained the 19.4% of the satisfaction variance. No correlation with anthropometric data, nutrition support mode, family demographic characteristics or caregiver psychological status was observed. CONCLUSIONS The SAGA-8 questionnaire is a simple, specific, straight-forward tool to evaluate parental/caregiver degree of satisfaction with GT feeding and facilitates effective monitoring of the intervention. Lengths of HEN and precocious age at GT placement are responsible for most of parental satisfaction.

Home enteral nutrition in children: a 10 year experience with 304 pediatric patients

BACKGROUND & AIMS Home enteral nutrition is used increasingly in pediatric populations. Our objective was to describe the profile of pediatric patients requiring this treatment. MATERIAL AND METHODS All patients under 18 years old requiring treatment with home enteral nutrition between January 1995 and December 2004 were analyzed retrospectively. RESULTS 304 patients were studied (157 boys). The mean age at the start of treatment was 4.02 ± 4.09 years, median of 2.5 years; 28% of all patients were under 1 year. The main indications were oncological disease in 91 patients (29.9%) and digestive diseases in 84 (27.6%). There were significant differences depending on the clinical diagnosis for the start age, type of access, infusion regime and formula prescribed. Nutrients were delivered by nasogastric tube in 218 patients (71.7%). Overnight enteral nutrition was the preferred infusion regime in 155 patients (51%). Adult or pediatric polymeric formulas were mostly prescribed in 190 patients (62.5%). The mean treatment duration was 306 ± 544 days. CONCLUSION In our series, enteral support usually begins at an early age. Its characteristics varied depending on patient pathology. Knowledge of the pediatric patient profile is important to design the most effective strategy for home enteral nutrition.

Visual performance in preterm infants with brain injuries compared with low-risk preterm infants

BACKGROUND Neonatal brain injuries are the main cause of visual deficit produced by damage to posterior visual pathways. While there are several studies of visual function in low-risk preterm infants or older children with brain injuries, research in children of early age is lacking. AIM To assess several aspects of visual function in preterm infants with brain injuries and to compare them with another group of low-risk preterm infants of the same age. STUDY DESIGN AND SUBJECTS Forty-eight preterm infants with brain injuries and 56 low-risk preterm infants. OUTCOME MEASURES The ML Leonhardt Battery of Optotypes was used to assess visual functions. This test was previously validated at a post-menstrual age of 40 weeks in newborns and at 30-plus weeks in preterm infants. RESULTS The group of preterm infants with brain lesions showed a delayed pattern of visual functions in alertness, fixation, visual attention and tracking behavior compared to infants in the healthy preterm group. The differences between both groups, in the visual behaviors analyzed were around 30%. These visual functions could be identified from the first weeks of life. CONCLUSION Our results confirm the importance of using a straightforward screening test with preterm infants in order to assess altered visual function, especially in infants with brain injuries. The findings also highlight the need to provide visual stimulation very early on in life.

Role of Coping Responses in the Relationship Between Perceived Stress and Psychological Well-Being in a Sample of Spanish Educational Teacher Students

Stress in teacher education students is a key issue, due to its physical and social impact and its relevance to students’ future as professionals. This study uses the Perceived Stress Scale, the Coping Responses Inventory—Adult Form, and the Psychological Well-Being Scale to analyze how coping strategies mediate the relationship between stress and well-being in a sample of Spanish teacher education students (n = 334). The results show that the students had a good general level of psychological well-being, although with little personal growth and autonomy. Their level of stress meant that they could offer active, engaged responses, although the coping strategies that were used tended to be avoidance type, which could lead to certain adaptive difficulties. Our results also indicate that coping has a partial mediating role. Finally, organizational actions are proposed for universities that could help to enhance students’ personal resources for dealing with stress.

Psychometric properties of the Shared Decision-Making Questionnaire (SDM-Q-9) in oncology practice

Background/Objective: This study sought to assess the psychometric properties of the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) in patients with resected, non-metastatic cancer and eligible for adjuvant chemotherapy. Method: A total of 568 patients were recruited from a multi-institutional, prospective, transversal study. Patients answered the SDM-Q-9 after visiting their medical oncologist who, in turn, completed the SDM-Q–Physician version. Reliability, factorial structures [exploratory factor analysis (EFA), confirmatory factor analysis (CFA)], and convergent validity of the SDM-Q-9 scores were explored. Results: SDM-Q-9 showed a clear factorial structure, compatible with a strong and replicable general factor and a secondary group factor, in patients with resected, non-metastatic cancer. Total sum scores derived from the general factor showed good reliability in terms of omega coefficient: .90. The association between patient and physician perception of SDM was weak and failed to reach statistical significance. Males and patients over 60 years of age displayed the greatest satisfaction with SDM. Conclusions: SDM-Q-9 can aid in evaluating SDM from the cancer patients’ perspective. SDM-Q-9 is helpful in studies examining patient perspectives of SDM and as an indicator of the degree of quality and satisfaction with health care and patient-physician relationship.

Ecological momentary assessment of contextual variables, satisfaction, and emotional and behavioral states of adolescents by level of victimization

The harmful effects of victimization on mental health have been demonstrated in several age groups, cultures, and populations, but there is wide variability in the resulting psychopathology. Ecological momentary assessment (EMA) allows the expression of an emotional state to be recorded at any given time and linked to a situation or context. This study aimed to analyze the contextual variables (where, with whom, and what), momentary satisfaction, and perception of momentary emotional and behavioral symptoms in a cohort of adolescents by the level of victimization, using EMA. We explored the everyday symptom profiles and the contexts in which events took place among 100 adolescents over a one-week period. Sociodemographic data were collected and assessment was done using the EMA (as a smartphone application) and the Juvenile Victimization Questionnaire (to assess childhood and adolescent victimization). In this study, regarding contextual variables, the group with the highest level of victimization (top 10%) showed a significant relationship with being away from home and being with friends other than classmates, and not being with parents or relatives. There was also an unexpectedly higher frequency of sporting engagement in this group. A relationship existed between emotional and behavioral problems and higher levels of victimization. In conclusion, the different groups of victimized subjects present a relatively high level of satisfaction in relation to the daily contexts and show low levels of emotional and behavioral symptomatology.

The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients

ObjectiveThe objectives of this study were (a) to determine the psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale and (b) to provide that FACIT scores behave one-dimensional to establish the mediating role of spiritual well-being in psychological distress and mental adjustment in a sample of patients with non-metastatic, resected cancer.MethodA total of 504 consecutive patients completed the FACIT-Sp, Brief Symptom Inventory, and Mini-Mental Adjustment to Cancer scales. The dimensionality and structure of the scale were assessed by semi-confirmatory factor analysis; the reliability of the derived scale scores was evaluated using the omega coefficient, and regression analysis appraised the FACIT-Sp’s mediating role between psychological distress and mental adjustment.ResultsA clear and theoretically interpretable solution in two factors that agreed generally with solutions reported in other languages was obtained for the FACIT item scores and omega reliabilities of the derived Meaning/Peace (0.85) and Faith (0.86) scales were acceptable. The oblique solution in two factors was compatible with an essentially unidimensional solution of general well-being and associated strongly with psychological distress and mental adjustment. Spiritual well-being acted as a partial mediator between psychological distress and mental adjustment strategies, such as fighting spirit, hope, and cognitive avoidance.ConclusionsThe Spanish version of the FACIT-Sp scale is a reliable and valid clinical evaluation tool, and further highlights the potential clinical implications of spirituality for improving quality of life and adjustment to cancer.

Living with Cancer: Through the Eyes of the Patient and the Physician

This article is co-authored by a patient with colon cancer and his treating oncologist, who interact at two different levels: the instrumental and the emotional and affective one. The patient relates in detail his personal experiences struggling with cancer, including his fears, expectations, purposes, and attitudes through the most important events in the evolution of his illness. The professional reflects how patient-based communication and shared decision-making impact on quality of life and coping with cancer.