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Parents' posttraumatic stress after burns in their school-aged child: A prospective study.

Objective: This prospective study examined the course and potential predictors of parents’ posttraumatic stress symptoms (PTSS) after burn injury in their child (Age 8 to 18 years). Method: One hundred eleven mothers and 91 fathers, representing 118 children, participated in the study. Within the first month after the burn event and subsequently at 3, 12, and 18 months postburn, both parents completed the Impact of Event Scale (IES). Parental emotions related to the burn event and appraisal of threat to the child’s life were assessed, which were investigated in a multilevel regression model. Results: Within the first month postburn, 48% of the mothers and 26% of the fathers reported clinically significant PTSS (IES ≥26), which decreased to, respectively, 19% and 4% 18 months postburn. Symptoms of intrusion were mainly individually experienced, whereas parents within a couple were more similar in terms of their avoidance symptoms. The perceived life threat and feelings of guilt and anger linked to the burn event were significantly related to parental PTSS, especially in mothers. Conclusions: The results indicate that a burn event to a child has a severe (acute) psychological impact on parents and that clinical levels of PTSS may persist in a subgroup of parents. The findings underline the need to incorporate parent support in burn care, especially for mothers with a strong emotional response during the first months after the burn event.

Catastrophizing, pain and traumatic stress symptoms following burns : A prospective study

Pain and posttraumatic stress disorder (PTSD) symptoms are significant problems in the aftermath of a burn injury and they often co‐occur. Catastrophizing has been linked to both phenomena. The aim of this study was to investigate the underlying role of catastrophizing in PTSD symptoms and pain following burns.

Predictors of response to psychological treatment in somatoform disorder and somatic symptom disorder: A meta-analysis

Aims: Somatoform disorder and somatic symptom disorder are associated with substantial psychosocial and functional impairment. Meta-analysis can clarify whether this group of disorders tends to be difficult to treat and whether effects of therapy depend on specific variables. The main aim of the present meta-analysis was to examine whether type of intervention and type of outcome variable predicted response to treatment. Methods: Included were studies evaluating a psychological intervention given to patients diagnosed with somatoform disorder or somatic symptom disorder. Of 2,655 initially identified records, 22 studies were eligible for quantitative analysis, involving 3,160 patients. Outcome domains were somatic symptoms, psycho-behavioral features (e.g., psychopathology) and illness consequences (e.g., mental and physical well-being and functioning). Results: An overall medium-to-large pre-post effect size across 27 intervention conditions (d = 0.77) and a medium pre-post effect size across 10 control conditions (d = 0.49) was obtained. Psychological interventions were significantly superior to control conditions for illness consequences but not for somatic symptoms or psycho-behavioral features. Pre-post effect sizes for cognitive-behavioral therapy (CBT) did not significantly differ from those of other psychological interventions. Longer symptom duration, younger age and lower methodological quality predicted larger effect sizes. Conclusion: Overall, the present findings suggest that psychological interventions are effective in improving illness consequences but may not yield larger amounts of change when compared to control conditions in terms of symptoms or psychopathology. Effects of CBT did not prove superior to effects of other psychological interventions. Relatively modest effects of treatment and the difficulty of identifying modifiable predictors of treatment effects, such as type of treatment, provide support for previous suggestions in the literature that somatoform disorder is difficult to treat.

Objective and subjective measures of physical functioning in women with fibromyalgia: What type of measure is associated most clearly with subjective well-being? The al-Ándalus project

Background: In fibromyalgia there is a discordance between performance-based (i.e., objective) and patient-reported (i.e., subjective) physical functioning (1,2). However, it is unknown whether the association of physical functioning with health outcomes is different between objective and subjective measures. Objectives: To analyse the associations of the objective and subjective dimensions of physical activity, sedentary behaviour, and physical fitness with subjective well-being in women with fibromyalgia. Methods: This population-based cross-sectional study included 375 women with fibromyalgia from southern Spain. Physical activity, sedentary behaviour, and physical fitness were measured by questionnaires, accelerometers, and performance testing. Participants self-reported their levels of positive affect, negative affect, and satisfaction with life. Conservative multivariate analyses were used to analyse the association between these physical functioning measures and the assessment of affect and life satisfaction. Results: We found independent associations of the objective measures but not the subjective assessments of physical activity with positive affect and satisfaction with life (both, p<0.01 and adjusted R2>0.06) and of sedentary time with positive affect (p<0.02 and adjusted R2>0.03). Moreover, we observed consistent and independent associations of both the objective and subjective dimensions of physical fitness with all the components of subjective well-being (all, p<0.01 and adjusted R2 ranged from 0.02 to 0.05). Conclusions: Both objective and subjective measures of physical activity and sedentary behaviour independently impact affect and subjective well-being. Strategies to enhance both dimensions of physical fitness may be a promising approach for improving the subjective well-being in fibromyalgia. References 1. Estévez-López F, et al. Disabil Rehabil2018;40(3):329–337. 2. Estévez-López F, et al. Rheumatology (Oxford)2017;56(11):2015–2024. Acknowledgements: This study was funded by the Spanish Ministries of Economy and Competitiveness [I+D+I DEP2013–40908-R, I+D+I DEP2010–15639, BES-2014–067612] and Education [FPU15/00002]. Disclosure of Interest: None declared

Cognitive-behavioural and social factors do not predict recurrent secondary health care use in patients with fibromyalgia: a longitudinal study

Background Health care use in fibromyalgia (FM) is relatively high. Besides disease-related variables, cognitive-behavioural factors have been concurrently associated with health care use. It is unknown whether cognitive-behavioural and social factors also predict future health care use. Objectives To identify cognitive-behavioural and social factors predicting recurrent secondary health care use in FM. Methods Data were drawn from a prospective cohort of recently diagnosed patients with fibromyalgia (n=199), spanning 18 months. Patients were recruited after receiving their diagnosis and protocolled treatment advice by a rheumatologist. Using self-report questionnaires, health care use, cognitive-behavioural (i.e. illness cognitions, pain coping, coping flexibility), social (i.e. invalidation by family, spousal responses to pain and well behaviour), sociodemographic and disease-related variables including comorbidities, severity of FM, and depressive and anxiety symptoms were collected. Primary outcome was recurrent secondary health care use at 18 months follow-up defined as the use or non-use for each of the following four categories of secondary health care: consultation with medical specialists, diagnostic procedures, admission to health care institutions, and multimodal treatment program. A patient was considered a recurrent secondary health care user, if secondary health care from at least one of the four categories was used in the past six months. Univariate and multivariate logistic regression models examined whether and which variables were predictors for recurrent secondary health care use. Internal validation was performed to correct for over-fit of the final multivariate model. Results Recurrent secondary health care use was lower than initial secondary health care use. Univariate analysis showed that having at least one comorbidity, depressive feelings, severe consequences of fibromyalgia, low personal control and a high severity of fibromyalgia predicted recurrent secondary health care use. In the multivariate model, having at least one comorbidity was the only remaining predictor for recurrent secondary health care use. Conclusions Our results suggest that the existence of comorbidities as communicated by the patient is the strongest warning signal for recurrent secondary health care use in FM. There seems no value in using cognitive-behavioural and social factors for early identification of patients with FM at risk for recurrent secondary health care use. Disclosure of Interest None declared