Psychosocial predictors of the quality of life of chronic renal failure patients undergoing haemodialysis
Predictores psicosociales de la calidad de vida en pacientes con insuficiencia renal crónica en tratamiento de hemodiálisis
Read
12494
Timeswas read the article
3291
Total PDF
9203
Total HTML
Share statistics
array:21 [ "pii" => "X2013251412001939" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Jun.11447" "estado" => "S300" "fechaPublicacion" => "2012-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:622-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6452 "formatos" => array:3 [ "EPUB" => 281 "HTML" => 5208 "PDF" => 963 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699512001931" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2012.Jun.11447" "estado" => "S300" "fechaPublicacion" => "2012-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2012;32:622-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 18112 "formatos" => array:3 [ "EPUB" => 303 "HTML" => 16913 "PDF" => 896 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Predictores psicosociales de la calidad de vida en pacientes con insuficiencia renal crónica en tratamiento de hemodiálisis" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "622" "paginaFinal" => "630" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Psychosocial predictors of the quality of life of chronic renal failure patients undergoing haemodialysis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11447_108_31295_es_11447_t1..jpg" "Alto" => 1015 "Ancho" => 600 "Tamanyo" => 269734 ] ] "descripcion" => array:1 [ "es" => "Características sociodemográficas y clínicas de la muestra utilizada" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.M. Perales Montilla, Carmen M. Perales-Montilla, A. García León, Ana García-León, G.A. Reyes del Paso, Gustabo A. Reyes-del Paso" "autores" => array:6 [ 0 => array:2 [ "Iniciales" => "C.M." "apellidos" => "Perales Montilla" ] 1 => array:2 [ "nombre" => "Carmen M." "apellidos" => "Perales-Montilla" ] 2 => array:2 [ "Iniciales" => "A." "apellidos" => "García León" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "García-León" ] 4 => array:2 [ "Iniciales" => "G.A." "apellidos" => "Reyes del Paso" ] 5 => array:2 [ "nombre" => "Gustabo A." "apellidos" => "Reyes-del Paso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251412001939" "doi" => "10.3265/Nefrologia.pre2012.Jun.11447" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001939?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001931?idApp=UINPBA000064" "url" => "/02116995/0000003200000005/v0_201502091343/X0211699512001931/v0_201502091344/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251412001920" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Jun.11314" "estado" => "S300" "fechaPublicacion" => "2012-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:631-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6596 "formatos" => array:3 [ "EPUB" => 310 "HTML" => 5593 "PDF" => 693 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "mTOR inhibitor monotherapy. A good treatment choice in renal transplantation?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "631" "paginaFinal" => "638" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Monoterapia m-TOR. ¿Una buena elección en trasplante renal?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11314_16025_35417_en_t111314_copy1.jpg" "Alto" => 670 "Ancho" => 2169 "Tamanyo" => 437657 ] ] "descripcion" => array:1 [ "en" => "Reasons for converting from anticalcineurinic inhibitors to mTor inhibitors" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "antonio Franco Esteve, Antonio Franco-Esteve, diana tordera, Diana Tordera, maria luz de la sen, M. Luz De la sen, luis Jiménez, Luis Jiménez, patricio Mas, Patricio Mas, carlos muñoz, Carlos Muñoz, jesus olivares, Jesús Olivares" "autores" => array:14 [ 0 => array:2 [ "nombre" => "antonio" "apellidos" => "Franco Esteve" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Franco-Esteve" ] 2 => array:2 [ "nombre" => "diana" "apellidos" => "tordera" ] 3 => array:2 [ "nombre" => "Diana" "apellidos" => "Tordera" ] 4 => array:2 [ "nombre" => "maria luz" "apellidos" => "de la sen" ] 5 => array:2 [ "nombre" => "M. Luz" "apellidos" => "De la sen" ] 6 => array:2 [ "nombre" => "luis" "apellidos" => "Jiménez" ] 7 => array:2 [ "nombre" => "Luis" "apellidos" => "Jiménez" ] 8 => array:2 [ "nombre" => "patricio" "apellidos" => "Mas" ] 9 => array:2 [ "nombre" => "Patricio" "apellidos" => "Mas" ] 10 => array:2 [ "nombre" => "carlos" "apellidos" => "muñoz" ] 11 => array:2 [ "nombre" => "Carlos" "apellidos" => "Muñoz" ] 12 => array:2 [ "nombre" => "jesus" "apellidos" => "olivares" ] 13 => array:2 [ "nombre" => "Jesús" "apellidos" => "Olivares" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699512001923" "doi" => "10.3265/Nefrologia.pre2012.Jun.11314" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001923?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001920?idApp=UINPBA000064" "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001920/v0_201502091606/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251412001947" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Jun.11460" "estado" => "S300" "fechaPublicacion" => "2012-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:613-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6100 "formatos" => array:3 [ "EPUB" => 295 "HTML" => 5081 "PDF" => 724 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Level of dependence in patients on haemodialysis in Catalonia and evolution of mortality rates" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "613" "paginaFinal" => "621" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Grado de dependencia de las personas sometidas a hemodiálisis en Cataluña y evolución de su mortalidad" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11460_16025_35236_en_t111460.jpg" "Alto" => 1755 "Ancho" => 2186 "Tamanyo" => 985470 ] ] "descripcion" => array:1 [ "en" => "Activities evaluated in the Spanish Law of Dependence scale" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "LOLA ANDREU PERIZ, Lola Andreu-Periz, MONTSERRAT PUIG LLOBET, Montserrat Puig-Llobet, ALEIX CASES AMENÓS, Aleix Cases-Amenós" "autores" => array:6 [ 0 => array:2 [ "nombre" => "LOLA" "apellidos" => "ANDREU PERIZ" ] 1 => array:2 [ "nombre" => "Lola" "apellidos" => "Andreu-Periz" ] 2 => array:2 [ "nombre" => "MONTSERRAT" "apellidos" => "PUIG LLOBET" ] 3 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Puig-Llobet" ] 4 => array:2 [ "nombre" => "ALEIX" "apellidos" => "CASES AMENÓS" ] 5 => array:2 [ "nombre" => "Aleix" "apellidos" => "Cases-Amenós" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X021169951200194X" "doi" => "10.3265/Nefrologia.pre2012.Jun.11460" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X021169951200194X?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001947?idApp=UINPBA000064" "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001947/v0_201502091606/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Psychosocial predictors of the quality of life of chronic renal failure patients undergoing haemodialysis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "622" "paginaFinal" => "630" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "C.M. Perales Montilla, Carmen M. Perales-Montilla, A. García León, Ana García-León, G.A. Reyes del Paso, Gustabo A. Reyes-del Paso" "autores" => array:6 [ 0 => array:3 [ "Iniciales" => "C.M." "apellidos" => "Perales Montilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Carmen M." "apellidos" => "Perales-Montilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "A." "apellidos" => "García León" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Ana" "apellidos" => "García-León" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 4 => array:4 [ "Iniciales" => "G.A." "apellidos" => "Reyes del Paso" "email" => array:1 [ 0 => "greyes@ujaen.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:4 [ "nombre" => "Gustabo A." "apellidos" => "Reyes-del Paso" "email" => array:1 [ 0 => "greyes@ujaen.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Psicología, Univesidad de Jaén Spain, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Departamento de Psicología, Universidad de Jaén, Jaén, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Predictores psicosociales de la calidad de vida en pacientes con insuficiencia renal crónica en tratamiento de hemodiálisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11447_16025_35258_en_t111447.jpg" "Alto" => 1759 "Ancho" => 1083 "Tamanyo" => 523796 ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and clinical characteristics of the study sample" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">In recent decades, several medical advancements have been made in optimising haemodialysis techniques. However, chronic kidney disease and dialytic treatments continue to produce physical, psychological, and social changes in patients.<span class="elsevierStyleSup">1</span> In order to evaluate the interference that renal disease and its treatments produce in the adaptive functioning of these patients, health-related quality of life (HRQOL) was developed as a method of measurement. HRQOL is an evaluation of individual health and functioning in terms of daily activities, including physical, psychological, and social function, and the patient’s general perception of health, mobility, and emotional well-being.<span class="elsevierStyleSup">2</span> HRQOL is becoming a fundamental component of providing integrated care for patients with chronic disease.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">In its use in chronic kidney disease, HRQOL indicators have proven to have a tight relationship with morbidity and mortality rates.<span class="elsevierStyleSup">3,4</span> In addition, dialysis produces several changes in patient lifestyle, which if left unattended, can decrease HRQOL.<span class="elsevierStyleSup">5,6</span> Several studies have evaluated HRQOL in renal patients on renal replacement therapy with dialysis.<span class="elsevierStyleSup">2,7-11</span> The results from these studies have shown that deterioration in HRQOL is associated with clinical,<span class="elsevierStyleSup">12-14</span> sociodemographic,<span class="elsevierStyleSup">13,15,16</span> and dialysis characteristics variables,<span class="elsevierStyleSup">16</span> as well as cognitive deterioration<span class="elsevierStyleSup">17</span> and emotional alterations.<span class="elsevierStyleSup">18,8</span></p><p class="elsevierStylePara">In order to provide integrated care to renal patients, it is essential that psychosocial variables that could affect HRQOL be identified, modulating the interference that the disease produces in the patient’s capacity for adaptive functioning. In our study, we focused on the following components: social support, self-efficacy, dispositional optimism, depression, anxiety, and coping strategies.</p><p class="elsevierStylePara">Social support consists of obtaining resources (whether material, cognitive, or emotional) through interaction with other people or sources of support. These resources reduce the perception of bodily threat and facilitate a more effective approach to coping with stressful situations.<span class="elsevierStyleSup">19</span> In renal patients, social support influences survival, adherence to treatment, and the intensity of symptoms of depression.<span class="elsevierStyleSup">18,20-22</span></p><p class="elsevierStylePara">Self-efficacy refers to the patient’s own concept of his/her capacity for carrying out actions that will lead to the desired results.<span class="elsevierStyleSup">23</span> In renal patients, self-efficacy is associated with self-care of the disease, adherence to treatment,<span class="elsevierStyleSup">10,24-26</span> and decreased physical and psychological symptoms.<span class="elsevierStyleSup">27</span></p><p class="elsevierStylePara">Dispositional optimism refers to the generalised belief or expectation that life brings positive occurrences.<span class="elsevierStyleSup">28</span> Optimism affects health through coping mechanisms, being associated with more active and effective coping<span class="elsevierStyleSup">29,30</span> as well as by decreasing physical symptoms.<span class="elsevierStyleSup">30</span> In renal patients, optimism is associated with increased social support and decreased levels of depression.<span class="elsevierStyleSup">31</span></p><p class="elsevierStylePara">In light of the particular life situations experienced by renal patients (loss of renal function, well-being, place in family and work, time, financial resources, and sexual function), and the continuing uncertainty surrounding their circumstances, anxiety and depression are relatively common. Depression in renal patients has been associated with immunological and nutritional dysfunction,<span class="elsevierStyleSup">32,33</span> a more negative perception of disease,<span class="elsevierStyleSup">9,18</span> and decreased HRQOL.<span class="elsevierStyleSup">8</span> Anxiety has also been associated with decreased HRQOL, primarily in the first few months of haemodialysis and in elderly patients.<span class="elsevierStyleSup">12</span></p><p class="elsevierStylePara">Coping strategies refer to mechanisms commonly used by the individual to deal with stress and everyday issues. These concrete strategies are used in different contexts and can change based on the situation experienced by the patient in each given moment.<span class="elsevierStyleSup">34</span> In renal patients, the coping mechanism used influences adaptation to disease and adherence to treatment.<span class="elsevierStyleSup">7,35,36</span></p><p class="elsevierStylePara">The objective of our study was to evaluate HRQOL in renal patients on dialysis, 55 year old or younger, from the province of Jaén, and to analyse the association between HRQOL and psychosocial variables (anxiety, depression, self-efficacy, dispositional optimism, social support, and coping strategies). The results of this study may suggest what factor(s) are the most relevant for focusing psychological interventions in order to increase HRQOL in these patients.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleBold"> </span></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Our study sample was composed of 39 chronic kidney disease patients on dialysis. The dialysis technique received was on-line in all cases, with three sessions per week (and an extra session for overweight patients) lasting four hours each (blood flow [Qb]: 250-350ml/m; dialysate flow rate [Qd]: 500ml/m; polysulfone dialyser; infusion volume: 30% dry body weight, and target Kt/V: 1.5). All sociodemographic and clinical variables are summarised in Table 1. The inclusion criteria were: age equal to or less than 55 years, on dialysis for at least 6 months, no recent severe clinical situations (hospitalisations, recent obstruction of a vascular access), psychiatric disorders, or cognitive deterioration. These criteria were used in part to ensure a better comprehension of the evaluation instruments.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Evaluation instruments</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">In addition to a semi-structured interview to compile information regarding sociodemographic, clinical, and lifestyle variables, we used the following questionnaires</p><p class="elsevierStylePara">- <span class="elsevierStyleBold">Short-form health and quality of life survey SF-36</span><span class="elsevierStyleSup">37</span><span class="elsevierStyleItalic">.</span> This instrument evaluates the impact of the disease on adaptive functioning. The scale consists of 36 items referring to 8 basic levels of function: physical function (self-care, walking, climbing stairs, bending over, lifting weight, etc.), physical role (work and daily activities), bodily pain (intensity of pain, in which a lower score indicates more severe pain), general health (personal evaluation of health), vitality (feelings of energy and vitality), social function (normal social life), emotional role (emotional issues), and mental health (depression, anxiety, control of behaviour, and general disposition). The internal consistency of the different sub-scales ranges between 0.7 and 0.94.</p><p class="elsevierStylePara">- <span class="elsevierStyleBold">Hospital anxiety and depression scale (HAD)</span><span class="elsevierStyleSup">38</span><span class="elsevierStyleItalic">.</span> This scale evaluates anxiety and depression without referencing somatic symptoms, which limits the possibility that symptoms derived from the underlying disease might interfere with scores. This scale consists of 14 items related to anxiety (7) and depression (7). This scale has a high internal consistency, with an α coefficient of 0.82 for the anxiety component and 0.84 for the depression component.</p><p class="elsevierStylePara">- <span class="elsevierStyleBold">Bárez scale of concerns and self-efficacy.</span><span class="elsevierStyleSup">39</span> This scale was developed in order to analyse the beliefs patients hold regarding their own concerns and abilities to manage certain life situations related to their disease, family, work, social activity, and finances. The scale is composed of 25 items and produces two types of scores: one related to the level of concern generated by the different situations presented, and another concerning the degree to which the patient feels capable of coping with these situations (self-efficacy). The internal consistency of this scale ranges between 0.71 and 0.86.<span class="elsevierStyleSup">39</span></p><p class="elsevierStylePara">- <span class="elsevierStyleBold">Social support scale (AS-25).</span><span class="elsevierStyleSup">40</span><span class="elsevierStyleItalic"> </span>Consists of 25 items scored on a scale of 1 to 4. The objective of this scale is to quantify the availability of social support for the patient. The internal consistency of this instrument (Cronbach’s α coefficient) is 0.87.</p><p class="elsevierStylePara">- <span class="elsevierStyleBold">Revised lifestyle orientation scale</span><span class="elsevierStyleSup">41</span><span class="elsevierStyleItalic">.</span> This is the most commonly used instrument for dispositional optimism in a patient’s disposition. The scale is composed of 10 items with a Likert-type response format. The test-retest reliability is 0.74, and internal consistency (α coefficient) is 0.87.</p><p class="elsevierStylePara">- <span class="elsevierStyleBold">Mental adjustment to disease or coping strategies</span><span class="elsevierStyleSup">42</span><span class="elsevierStyleItalic">.</span> This scale evaluates the level of a patient’s adjustment to the suffering produced by disease. It has commonly been used in cancer patients, and so we adapted the scale for use in our study by eliminating three of the items. The scale is comprised of 4 sub-scales concerning fighting spirit, anxiety, helplessness/hopelessness, and fatalism. The internal consistency of this scale ranges between 0.55 and 0.80.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Procedure and statistical analysis</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Upon approval of the study protocol by the hospital administrations, patients were recruited from the four dialysis departments located in the province of Jaén (Unidad de Hemodiálisis del Hospital Médico Quirúrgico, Centro de Hemodiálisis Santa Catalina, NefroLinares, and Centro de Diálisis Playa de la Victoria). All patients that complied with inclusion criteria and were treated within the study area were invited to participate (45 patients). Of these, 39 accepted participation in the study. Once the patients were selected, we explained the research objectives and obtained signed informed consent. For the evaluation of the results, we first compiled information regarding sociodemographic, clinical, and lifestyle variables through a direct interview with each patient. We then provided each patient with a folder with each questionnaire in a counterbalanced order.</p><p class="elsevierStylePara">For the interpretation of the HRQOL values, the direct scores of the SF-36 were transformed into standardised scores using the available standards for the general Spanish population<span class="elsevierStyleSup">43</span> and then normalised (mean [M] =50, standard deviation [SD] =10). We analysed the relationship between predictive variables and the dependent variable (HRQOL) using an exploratory correlational analysis with bivariate Pearson’s correlation coefficients, and then performed a multiple regression analysis with a step-wise procedure. With a collinearity diagnosis, we eliminated all predictive variables with a total tolerance value less than 0.4: anxiety, which was correlated with depression (r=0.64), and fatalism, which was correlated with helplessness/hopelessness (r=0.62). The resulting predictive variables (depression, concern, self-efficacy, optimism, social support, helplessness/hopelessness, fighting spirit, and anxiety)<span class="elsevierStyleSup">*</span> all had tolerance values greater than 0.5. The regression analyses produced a corrected r<span class="elsevierStyleSup">2</span> value as predictive value index of the model and standardised β values as the slope of the regression line. The level of statistical significance was set at <span class="elsevierStyleItalic">P</span><.05.</p><p class="elsevierStylePara">* This number of predictive variables could be considered to be too large for the sample size. However, we must keep in mind that the regression model used (step-wise) does not include all predictive variables together in the model at once, but rather incorporates each one in turn if it contributes significantly to an increase in the amount of variance explained. In this sense, the maximum number of predictive variables that entered into the analyses was 4.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">a) Quality of life levels</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The scores for the different dimensions of the HRQOL (SF-36) are summarised in Table 2. As we can see, the values reported by the patients in our study are below those from the reference study in which the instrument was initially tested, with particularly low values for general health, social function, emotional role, physical function, and physical role.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">b) Exploratory correlational analysis</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Table 3 presents the correlations between predictive variables and the various components of HRQOL. The results indicate that there were significant, negative associations with depression, anxiety, concern, and the coping strategies of helplessness/hopelessness and fatalism. On the other hand, we observed significant, positive associations with self-efficacy, optimism, social support, and the fighting spirit coping strategy.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">c) Multiple regression analysis for predicting health-related quality of life</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The results from the multiple regression analysis for predicting HRQOL using the psychosocial variables studied are presented in Table 4. These were the principal results we obtained:</p><p class="elsevierStylePara">- Depression predicts a lower HRQOL in all of the components of the SF-36.</p><p class="elsevierStylePara">- The level of concern predicts a lower HRQOL in the majority of the components of the HRQOL scale (physical function, physical role, general health, and mental health).</p><p class="elsevierStylePara">- The helplessness/hopelessness coping strategy and anxiety predict lower levels of HRQOL in the components of physical function, physical role, and social function.</p><p class="elsevierStylePara">- Optimism is a predictor for better general health.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Our primary objective was to evaluate HRQOL in dialysis patients in the province of Jaén. Based on our results, there appears to be a substantial impairment to HRQOL in our sample. All components of HRQOL were below the reference values established by the SF-36 questionnaire, the most heavily affected components being general health, social function, and physical function. This reflects the psychological impact that this disease has in daily activity. The worst HRQOL score was for the general health section, which implies that patients on dialysis have a negative self-assessment of current health and the possibility of future improvements. The results from our study are comparable to those from other studies that have used the SF-36 scale in patients with chronic renal failure,<span class="elsevierStyleSup">44</span> and generally corroborate the previously available evidence on the subject.<span class="elsevierStyleSup">1,17,36</span></p><p class="elsevierStylePara">Our second objective was to identify the psychosocial variables that could be significant predictors of HRQOL. The results clearly demonstrate that depression was the primary predictor for HRQOL in our sample, with negative correlations with all components of the SF-36 scale and accounting for approximately 50% of variance for physical function, physical role, vitality, social function, and mental health. According to our results, depression produced a highly significant impediment in daily activities, producing lower productivity than desired, increased interference of bodily pain in normal tasks, a more negative appraisal of current health and future prospects, a heightened perception of fatigue and weariness, decreased social life, and greater emotional problems that interfere with daily activities and decrease the mental health of the patient. These results are similar to those presented by other authors, who showed that depression negatively affects the quality of life of renal patients,<span class="elsevierStyleSup">8,45,46</span> their nutritional state at the start of dialysis,<span class="elsevierStyleSup">47</span> and the level of physical and mental deterioration in general, along with morbidity and mortality rates.<span class="elsevierStyleSup">48,49</span></p><p class="elsevierStylePara">Our results also indicated that the degree of concern professed by the patient is negatively correlated with the majority of the components of the HRQOL. This finding corroborates the results from previous studies that showed that, when renal patients are worried about situations regarding their disease, HRQOL diminishes.<span class="elsevierStyleSup">10,24,26</span> On the other hand, the correlational analysis demonstrated that the level of self-efficacy is positively associated with increased physical function, general health, social function, and emotional role. These results also reflect those from previous studies,<span class="elsevierStyleSup">27</span> where the level of self-efficacy was found to be associated with increased adherence to treatment and behaviours that promote health, and decreased physical and psychological symptoms experienced by renal patients. All of these results support the theory proposed by Bandura,<span class="elsevierStyleSup">23</span> which states that a strong sense of self-efficacy increases personal well-being and that, in contrast, individuals that doubt their own capacities shun difficult tasks, considering them to be a threat against their person. In this sense, renal patients are constantly faced with the perception of a lack of control over the situations they are experiencing in life.</p><p class="elsevierStylePara">Focusing our attention on optimism, this factor predicts perceptions of increased general health, including both the current state of health and perspectives for future health. In addition, as the correlational analysis showed, optimism is associated with increased vitality scores. These results concur with those from Maruta<span class="elsevierStyleSup">50</span> and suggest that optimism effectively aids in coping with the disease in a more adaptive manner.<span class="elsevierStyleSup">28,30</span> Optimism is associated with increased subjective well-being,<span class="elsevierStyleSup">51</span> which translates into positive effects on patient behaviour and HRQOL.</p><p class="elsevierStylePara">As regards coping strategies, when strategies such as helplessness/hopelessness are used, we can predict decreased physical and social function. In addition, as the correlational analysis showed, helplessness/hopelessness and fatalism were negatively associated with the majority of the components in the SF-36 scale. On the other hand, we also observed that fighting spirit was associated with increased physical function, general health, vitality, and mental health, and decreased pain. In conclusion, and in agreement with previously published studies,<span class="elsevierStyleSup">7,30,36</span> we can affirm that active coping strategies (when the patient deliberately works to solve his/her problems through action) predict an increase in HRQOL, whereas passive coping strategies (when the patient does nothing to improve or resolve his/her problems, reacting with inhibition) predict a decrease in HRQOL.</p><p class="elsevierStylePara">As regards social support, the correlational analysis demonstrated that this component was associated with increased physical function, such that patients with greater social support find fewer limitations in the physical activity of their everyday lives. Remember that physical function was one of the dimensions of HRQOL that was most heavily deteriorated in our sample. This suggests the possible usefulness of promoting physical groups activities or activities geared towards generating social support.</p><p class="elsevierStylePara">As regards anxiety, the correlational analysis demonstrated that this factor was negatively associated with all dimensions of HRQOL. Several studies have pointed out the importance of mental health in chronic kidney disease. For example, patients on dialysis with a better perception of their mental health adapt better to disease and treatment progression.<span class="elsevierStyleSup">52</span> This suggests the relevance of implanting strategies for detecting depression/anxiety disorders in these patients, which would facilitate an improved HRQOL and clinical results.</p><p class="elsevierStylePara">The primary limitation of our study was the small sample size. However, our research protocol was proposed to all patients that complied with the inclusion criteria (45), and the majority of these accepted participation in the study (39). The main cause of the relatively small number of patients lies in our inclusion criteria based on age (equal to or younger than 55 years), which drastically reduced the potential pool of participants. The objective of this criterion was to ensure optimal comprehension of the psychological tests, and in this manner to achieve maximum validity of the results obtained. The impact of age on HRQOL is well documented, and so our results cannot be directly extrapolated to other age ranges. Another limitation could lie in the fact that we had no control group. Even so, our primary objective was to evaluate the possibility of predicting HRQOL using a series of psychosocial variables, and not to compare these variables between patients with renal disease and healthy subjects. Finally, we must keep in mind that our study was carried out within a multidimensional, biopsychosocial perspective, where health and disease are considered as the mutual interaction of several variables at many levels (bio-psycho-social), and can be explained through various levels of analysis. Picking up on these subtle relationships and mutual influences is a very difficult task. As such, the direction of causality may be interactive or inverse to that presented in this study.</p><p class="elsevierStylePara">To conclude, the results of our study suggest that intervention in several psychosocial aspects may be useful for improving HRQOL in renal patients. Firstly, given the fact that depression appeared as the primary predictor of HRQOL, our results demonstrate the need for evaluating (and treating, if necessary) the emotional state of renal patients (including states of anxiety or excessive worrying). This would have the impact of improving HRQOL and aiding the patient in adapting to the disease, thus facilitating a better prognosis and response to treatment. Depression was also negatively correlated with optimism and self-efficacy, variables that have been shown to correlate positively in our study with several aspects of HRQOL. In this context, we currently have several tools with demostrated effectiveness for simultaneously treating depression and improving optimism and self-efficay through cognitive behavioural therapy,<span class="elsevierStyleSup">53-55</span> which is known to lead to long-term improvements, decreased anxiety, and decreased apprehension. As regards social support, we might suggest implementing programmes for physical activity that are stimulated by social support networks (for example, involving a family member or creating patient groups for carrying out activities). Finally, our results also indicate an important role played by the coping mechanisms used in determining HRQOL. Any intervention in this context must be directed towards reducing the use of passive coping strategies (such as fatalism and helplessness/hopelessness) and increasing the use of active strategies. In this context, self-efficacy is associated with active coping strategies, and so interventions in this aspect can produce improved coping profiles.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors have no potential conflicts of interest to declare.</p><p class="elsevierStylePara"><a href="grande/11447_16025_35258_en_t111447.jpg" class="elsevierStyleCrossRefs"><img src="11447_16025_35258_en_t111447.jpg" alt="Sociodemographic and clinical characteristics of the study sample"></img></a></p><p class="elsevierStylePara">Table 1. Sociodemographic and clinical characteristics of the study sample</p><p class="elsevierStylePara"><a href="grande/11447_16025_35259_en_t211447.jpg" class="elsevierStyleCrossRefs"><img src="11447_16025_35259_en_t211447.jpg" alt="Mean and standard deviation for the different sub-scales of the SF-36"></img></a></p><p class="elsevierStylePara">Table 2. Mean and standard deviation for the different sub-scales of the SF-36</p><p class="elsevierStylePara"><a href="grande/11447_16025_35260_en_t311447.jpg" class="elsevierStyleCrossRefs"><img src="11447_16025_35260_en_t311447.jpg" alt="Associations between the different components of health-related quality of life and predictive variables"></img></a></p><p class="elsevierStylePara">Table 3. Associations between the different components of health-related quality of life and predictive variables</p><p class="elsevierStylePara"><a href="grande/11447_16025_35261_en_t411447.jpg" class="elsevierStyleCrossRefs"><img src="11447_16025_35261_en_t411447.jpg" alt="Results of the step-wise regression analysis for predicting the different components of quality of life"></img></a></p><p class="elsevierStylePara">Table 4. Results of the step-wise regression analysis for predicting the different components of quality of life</p>" "pdfFichero" => "P1-E543-S3677-A11447-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:7 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437589" "palabras" => array:1 [ 0 => "Optimismo" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437591" "palabras" => array:1 [ 0 => "Autoeficacia" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437593" "palabras" => array:1 [ 0 => "Calidad de vida relacionada con la salud" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437595" "palabras" => array:1 [ 0 => "Insuficiencia renal crónica" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437597" "palabras" => array:1 [ 0 => "Apoyo social" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437599" "palabras" => array:1 [ 0 => "Afrontamiento del estrés" ] ] 6 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437601" "palabras" => array:1 [ 0 => "Depresión" ] ] ] "en" => array:7 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437590" "palabras" => array:1 [ 0 => "Optimism" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437592" "palabras" => array:1 [ 0 => "Self-efficacy" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437594" "palabras" => array:1 [ 0 => "Health-related quality of life" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437596" "palabras" => array:1 [ 0 => "Chronic renal failure" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437598" "palabras" => array:1 [ 0 => "Social support" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437600" "palabras" => array:1 [ 0 => "Stress coping" ] ] 6 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437602" "palabras" => array:1 [ 0 => "Depression" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Objetivo:</span> Valorar la calidad de vida relacionada con la salud (CVRS) de los pacientes con insuficiencia renal crónica sometidos a tratamiento sustitutivo de diálisis, así como evaluar la capacidad predictiva de algunas variables psicosociales (apoyo social, autoeficacia, optimismo disposicional, depresión, ansiedad y estrategias de afrontamiento) sobre los niveles de CVRS. <span class="elsevierStyleBold">Método:</span> Se evaluó la CVRS de 39 pacientes en hemodiálisis mediante el instrumento SF-36. La capacidad predictiva de las variables evaluadas se analizó mediante correlaciones bivariadas y análisis de regresión múltiple. <span class="elsevierStyleBold">Resultados:</span><span class="elsevierStyleItalic"><span class="elsevierStyleItalic"> </span></span>Los pacientes mostraron niveles de CVRS inferiores a los valores normativos del instrumento. La depresión es el principal predictor de la CVRS, asociándose negativamente a todas sus dimensiones. El grado de preocupación, así como las estrategias de afrontamiento pasivo del estrés como la indefensión-desesperanza y el fatalismo, también se asocian a menores niveles de CVRS. Por el contrario, la autoeficacia, el optimismo, el apoyo social y el espíritu de lucha se asociaron a mayores niveles de CVRS. <span class="elsevierStyleBold">Conclusiones:</span> Estos resultados tienen unas claras implicaciones clínicas respecto a los aspectos a los que debe orientarse la intervención psicológica destinada a la mejora de la CVRS en los enfermos renales.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives:</span> To assess health-related quality of life (HRQOL) of chronic renal failure patients undergoing dialysis replacement therapy, and to evaluate the predictive power of psychosocial variables (social support, self-efficacy, optimistic outlook, depression, anxiety and coping strategies) on the different levels of HRQOL. <span class="elsevierStyleBold">Methods:</span> We evaluated the HRQOL of 39 haemodialysis patients using the SF-36 instrument. The predictive ability of the evaluated variables was analysed using bivariate correlations and multiple regression analysis. <span class="elsevierStyleBold">Results:</span> Patients showed lower levels of HRQOL than the reference values for the instrument. Depression is the main predictor of HRQOL, associated negatively with all of its components. The degree of concern and the use of passive coping strategies for stress such as helplessness-hopelessness and fatalism are also associated with lower levels of HRQOL. By contrast, self-efficacy, optimism, social support, and fighting spirit were associated with higher levels of HRQOL. <span class="elsevierStyleBold">Conclusions:</span> These results have clear clinical implications regarding the ways in which psychological interventions should be aimed at improving HRQOL in renal patients.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11447_16025_35258_en_t111447.jpg" "Alto" => 1759 "Ancho" => 1083 "Tamanyo" => 523796 ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and clinical characteristics of the study sample" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11447_16025_35259_en_t211447.jpg" "Alto" => 681 "Ancho" => 2160 "Tamanyo" => 457181 ] ] "descripcion" => array:1 [ "en" => "Mean and standard deviation for the different sub-scales of the SF-36" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11447_16025_35260_en_t311447.jpg" "Alto" => 845 "Ancho" => 2173 "Tamanyo" => 642609 ] ] "descripcion" => array:1 [ "en" => "Associations between the different components of health-related quality of life and predictive variables" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Tab. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11447_16025_35261_en_t411447.jpg" "Alto" => 2290 "Ancho" => 2169 "Tamanyo" => 1033713 ] ] "descripcion" => array:1 [ "en" => "Results of the step-wise regression analysis for predicting the different components of quality of life" ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001939/v0_201502091606/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000005/v0_201502091606/X2013251412001939/v0_201502091606/en/P1-E543-S3677-A11447-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001939?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 15 | 31 |
| 2024 October | 51 | 52 | 103 |
| 2024 September | 75 | 65 | 140 |
| 2024 August | 62 | 47 | 109 |
| 2024 July | 58 | 44 | 102 |
| 2024 June | 77 | 59 | 136 |
| 2024 May | 67 | 40 | 107 |
| 2024 April | 64 | 37 | 101 |
| 2024 March | 59 | 27 | 86 |
| 2024 February | 59 | 46 | 105 |
| 2024 January | 40 | 20 | 60 |
| 2023 December | 45 | 25 | 70 |
| 2023 November | 73 | 38 | 111 |
| 2023 October | 88 | 46 | 134 |
| 2023 September | 87 | 46 | 133 |
| 2023 August | 66 | 31 | 97 |
| 2023 July | 78 | 85 | 163 |
| 2023 June | 61 | 38 | 99 |
| 2023 May | 70 | 44 | 114 |
| 2023 April | 49 | 48 | 97 |
| 2023 March | 60 | 26 | 86 |
| 2023 February | 28 | 21 | 49 |
| 2023 January | 42 | 31 | 73 |
| 2022 December | 61 | 34 | 95 |
| 2022 November | 70 | 37 | 107 |
| 2022 October | 54 | 44 | 98 |
| 2022 September | 61 | 50 | 111 |
| 2022 August | 45 | 56 | 101 |
| 2022 July | 53 | 59 | 112 |
| 2022 June | 61 | 51 | 112 |
| 2022 May | 90 | 47 | 137 |
| 2022 April | 63 | 48 | 111 |
| 2022 March | 76 | 67 | 143 |
| 2022 February | 75 | 43 | 118 |
| 2022 January | 99 | 71 | 170 |
| 2021 December | 56 | 57 | 113 |
| 2021 November | 43 | 37 | 80 |
| 2021 October | 60 | 76 | 136 |
| 2021 September | 66 | 57 | 123 |
| 2021 August | 49 | 56 | 105 |
| 2021 July | 100 | 42 | 142 |
| 2021 June | 81 | 36 | 117 |
| 2021 May | 97 | 52 | 149 |
| 2021 April | 241 | 68 | 309 |
| 2021 March | 148 | 46 | 194 |
| 2021 February | 88 | 24 | 112 |
| 2021 January | 60 | 24 | 84 |
| 2020 December | 60 | 20 | 80 |
| 2020 November | 52 | 20 | 72 |
| 2020 October | 56 | 29 | 85 |
| 2020 September | 59 | 18 | 77 |
| 2020 August | 63 | 21 | 84 |
| 2020 July | 51 | 13 | 64 |
| 2020 June | 76 | 26 | 102 |
| 2020 May | 79 | 21 | 100 |
| 2020 April | 138 | 21 | 159 |
| 2020 March | 66 | 19 | 85 |
| 2020 February | 56 | 22 | 78 |
| 2020 January | 65 | 32 | 97 |
| 2019 December | 71 | 24 | 95 |
| 2019 November | 62 | 31 | 93 |
| 2019 October | 26 | 25 | 51 |
| 2019 September | 42 | 27 | 69 |
| 2019 August | 32 | 17 | 49 |
| 2019 July | 113 | 23 | 136 |
| 2019 June | 135 | 13 | 148 |
| 2019 May | 58 | 30 | 88 |
| 2019 April | 87 | 44 | 131 |
| 2019 March | 103 | 40 | 143 |
| 2019 February | 42 | 20 | 62 |
| 2019 January | 121 | 30 | 151 |
| 2018 December | 95 | 54 | 149 |
| 2018 November | 102 | 69 | 171 |
| 2018 October | 84 | 45 | 129 |
| 2018 September | 81 | 32 | 113 |
| 2018 August | 47 | 19 | 66 |
| 2018 July | 65 | 16 | 81 |
| 2018 June | 54 | 10 | 64 |
| 2018 May | 62 | 13 | 75 |
| 2018 April | 68 | 13 | 81 |
| 2018 March | 74 | 8 | 82 |
| 2018 February | 62 | 16 | 78 |
| 2018 January | 53 | 14 | 67 |
| 2017 December | 67 | 14 | 81 |
| 2017 November | 80 | 23 | 103 |
| 2017 October | 59 | 15 | 74 |
| 2017 September | 64 | 15 | 79 |
| 2017 August | 52 | 19 | 71 |
| 2017 July | 59 | 11 | 70 |
| 2017 June | 65 | 14 | 79 |
| 2017 May | 69 | 10 | 79 |
| 2017 April | 69 | 32 | 101 |
| 2017 March | 55 | 17 | 72 |
| 2017 February | 59 | 16 | 75 |
| 2017 January | 58 | 22 | 80 |
| 2016 December | 63 | 8 | 71 |
| 2016 November | 104 | 15 | 119 |
| 2016 October | 163 | 10 | 173 |
| 2016 September | 262 | 11 | 273 |
| 2016 August | 247 | 13 | 260 |
| 2016 July | 208 | 18 | 226 |
| 2016 June | 151 | 0 | 151 |
| 2016 May | 148 | 0 | 148 |
| 2016 April | 147 | 0 | 147 |
| 2016 March | 112 | 0 | 112 |
| 2016 February | 107 | 0 | 107 |
| 2016 January | 104 | 0 | 104 |
| 2015 December | 118 | 0 | 118 |
| 2015 November | 109 | 0 | 109 |
| 2015 October | 136 | 0 | 136 |
| 2015 September | 104 | 0 | 104 |
| 2015 August | 90 | 0 | 90 |
| 2015 July | 108 | 0 | 108 |
| 2015 June | 53 | 0 | 53 |
| 2015 May | 71 | 0 | 71 |
| 2015 April | 10 | 0 | 10 |
Show all
