Marián Pérez-Marín

Diabetes mellitus tipo 1: factores psicosociales y adaptación del paciente pediátrico y su familia. Revisión

Type 1 diabetes mellitus is the most common chronic endocrine disease in children, with a very low incidence in the first months of life and reaching its peak during puberty (10-15 years old is the age group with the highest incidence at the time of onset). Based on the review of the scientific literature, our objective is to study the main psychosocial factors associated with the adjustment of these pediatric patients and their families. Research underscore the following risk factors: situational (stressful life events), personal (additional physical diseases, low self-esteem, emotional disturbances), and interpersonal (family breakdown and conflicts), and also protection factors (coping strategies, social support, fluent communication). There is a pressing need to deal with the disturbances that affect these diabetic patients and their families, by implementing effective health care psychological interventions that take into account psychosocial factors associated with the course of type 1 diabetes mellitus.

Patients with limited communication in end-of-life situations: Initial psychometric properties of a discomfort observation scale

This work presents an observational scale which takes into account different observable indicators of discomfort of patients in end-of-life situations with difficulties in communicating due to cognitive impairment, fatigue or sedation and provides details of its validation. In all, 71 adults participated. Model fit was adequate (χ2(27) = 43.28, p = .024, comparative fit index = .975, root mean square error of approximation = .092 and confidence interval 90% (.033–.140)). Alpha coefficient was .70 and composite reliability index was .90. Our study provides data regarding the properties of a discomfort assessment scale. Such a scale is needed and could be very useful for the evaluation of such patients and thus to attend to their needs.

Frail elderly with and without cognitive impairment at the end of life: Their emotional state and the wellbeing of their family caregivers

PURPOSE OF THE STUDY (1) To identify the main predictors of the emotional state of the frail elderly at the end-of-life and that of their primary family caregivers, taking into consideration the presence/absence of significant cognitive impairment in the patient and (2) to analyse the relationship between the emotional state of the patient and that of their primary family caregiver. METHODS Our study is cross-sectional. 85 frail elderly patients at the end-of-life and their primary family caregivers participated. Information on the following aspects was collected: (1) From the patients: Socio-demographics, Functional independence, and Cognitive and Emotional state; (2) From the caregivers: Socio-demographics, Emotional state and Overburden (according to Zarit Scale). Descriptive, correlational and linear regression analyses were computed using SPSS. RESULTS The models that best predict the observed variance in the emotional state of patients (with or without significant cognitive impairment) include the same variables: functional independence of the patient and caregivers overburden. Similarly, the models that best predict the observed variance in the emotional state of family caregivers include: cognitive state of the patient and caregivers overburden. IMPLICATIONS The overburden of the family caregiver stands out as a key factor in the reduction of the emotional distress of frail elder patients -whether or not they present significant cognitive impairment- and that of their family caregivers. Our results suggest that reducing overburden of the family caregiver may also reduce the emotional distress of the patient and that of their family caregiver.

A brief version of the Pediatric Inventory for Parents (PIP) in Spanish population: Stress of main family carers of chronic paediatric patients

A chronic illness in childhood has a negative impact on the paediatric patient and on family functioning. Psychological stress in parents influences the level of adjustment to the illness of their children. The Pediatric Inventory for Parents (PIP) was designed to measure stress in parents whose child has a chronic illness or requires prolonged medical monitoring. The main objective of this study is to provide a brief version of the Spanish translation of the PIP, across a sample consisting of 465 main familial caregivers (85.2% female, n = 396) between 27 and 67 years old (X¯ = 44.13; SD = 5.35) of paediatric patients between 9 and 18 years old (X¯ = 12.10, SD = 2.20; 56.8% men, n = 264) diagnosed with diabetes mellitus type I (20.9% of the sample; n = 97), short stature (32.5% of the sample; n = 151), or a chronic respiratory disease (asthma, cystic fibrosis, bronchiolitis obliterans and bronchiectasis) (46.6% of the sample; n = 217). After performing several EFAs (Exploratory Factor Analyses) and CFAs (Confirmatory Factorial Analyses), it was decided that 30 items need to be removed. Reliability and validity results suggest that the new 12-item version possesses appropriate psychometric properties. Cronbach’s alpha value ranging between α = .42 and α = .81 and fit values obtained indicate a good fit: χ2/df (88.393/48) = 1.84 (α < .01); S-B χ2(df) = 88.393 (48); CFI = .95; IFI = .95; RMSEA = .05 (.033 - .074) for the frequency scales and χ2/df (72.002/48) = 1.5 (α < .01); S-Bχ2(df) = 72.002 (48); CFI = .97; IFI = .97; RMSEA = .04 (.011 - .063) for the difficulty scales. The PIP also showed predictive ability in regards to anxiety and depression, a positive relationship between the instruments own scales and a negative relationship with the caregivers age. Finally, depending on the paediatric patients diagnosis, differences in stress levels were found.

Trastorno mental y tipo de sustancia consumida: estudio piloto sobre la utilización de la Entrevista de Cribado de Patología Dual (ECDD)

Introduction: Dual pathology defines an illness case when a substance abuse disorder and a mental disorder simultaneously affect an individual patient. Both disorders influence each other, mutually, that its recommended what recommends to treat them together. Objective: to analyse the psychopatologic character and its association with different types of substances, evaluated through the Dual Pathology Screening interview (ECDD). Method: the participants were 63 patients between 18 and 45 years, with an average age of 37.7 years (SD = 9.6), assisted in the Unit of Addictive Behaviours of a Valencia town. The sociodemographic variables, clinical and toxycologic, were evaluated through the questionnaire from the Information System for the Evaluation of Quality Assistance in Drug Addiction (DRY). The Dual Pathology diagnostics were evaluated through the Dual Pathology Screening interview (ECDD). Results: substances with greater assistance demand were cocaine and alcohol. Our study indicates that 84.13% of the participants present some type of axis I disorder (one or more). Cocaine consumption presented the greater number of associated psychopathologies. Discussion: according to ECDD, the presence of possible cases of dual diagnosis in the sample was very high. Our study demonstrates a direct relationship between the substance type consumption and the psychopathological diagnosis. ECDD would appear to be a useful assessment tool in clinical practice for the detection of psychopathologies among patients with addictions.

Adjustment to Type 1 Diabetes Mellitus and its Relation with Anxiety and Depression in Pediatric Patients

Around 26 and 43% of pediatric patients diagnosed with type 1 diabetes mellitus presents psychological problems, being anxiety and depression the more frequent ones. An important factor regarding the wellbeing of these patients is the presence of good adjustment indicators in the process of adapting to this chronic disease.The present study aims to analyze the relationship between the difficulties of adapting to type 1 diabetes mellitus and the presence of clinical symptoms of anxiety and depression in pediatric patients. Our research is an exploratory cross-sectional study in which participated 23 children and adolescents in the age range of 6 to 16 years. All of them were attended in the Pediatric Endocrinology Unit of the General Hospital of Valencia. Our results point out the presence of psychological problems in these patients and a deficient adaptation to the disease. The regression analyses allow observing that the global score in adaptive response to disease predicts the scores in depression (19%), anxiety (16%), useless (17%), irritability (42%) and psycho-physiological symptoms (20%). The present work highlights that an inadequate response to disease in these patients influences their psychological well-being in a negative and significant way.