Escala de Respuestas Emocionales por Estrés al Traslado en Transporte Público / Scale of Emotional Responses due to Commuting Stress in Public Transport

Resumen El traslado cotidiano entre la casa y el trabajo demanda un importante uso de recursos personales y puede llegar a ser estresante. El objetivo fue construir y evaluar una escala de respuestas emocionales por el estrés en el traslado en transporte público para la Zona Metropolitana del Valle de México de manera exploratoria. Método: Se realizó un estudio cualitativo a través de entrevistas semi estructuradas con el propósito de identificar emociones asociadas a la experiencia de estrés por el traslado para desarrollar los reactivos de acuerdo con el contexto. Posteriormente, dos estudios cuantitativos permitieron evaluar las propiedades psicométricas. Participaron 196 y 298 personas respectivamente. La aplicación de la escala se realizó en línea en septiembre de 2020 y abril de 2021. Resultados: la escala incluyó 26 respuestas emocionales asociadas al estrés. En el Análisis Factorial Exploratorio se redujo a nueve emociones negativas (X2=1183, gl=36, p=.001, KMO=.94, 60% de varianza explicada, Alfa ordinal=.93), corroboradas en el Análisis Factorial Confirmatorio (X2=41.87, gl=26, X2/gl=1.61, p=.025; RMR=.036, SRMR=.036, RMSEA=.045; GFI=.997, CFI=.999, TLI=.998). Conclusión: la propuesta exploratoria de la escala para evaluar las respuestas emocionales por el estrés en el traslado presenta valores adecuados para aplicarse en la Zona Metropolitana del Valle de México.

Abstract The stress in urban settings is related to a greater request for personal resources to face situations of daily life, such as the commuting, since in big cities, people spend a lot of time on it, and sometimes is uncomfortable and annoying, which can cause stress. Commuting stress has been assessed, through commuting daily hassles, commuting stressful features and physiological responses, but it is possible assess it through emotional responses. The aim of this study was to develop and assess an exploratory scale of emotional responses for the study of commuting stress by public transport in an urban area of México that is densely populated. Method, a cross sectional design was used, in which a qualitative exploratory study was carried out through 23 individual semi-structured interviews and two focus group, where it was identified the main emotions experienced during the commuting stress to develop the items in the language of the population. Subsequently, those emotions were compared with emotions proposed in previous studies to complement the scale. Thus, 26 emotions were included to assess the commuting stress through emotional responses. Finally, two quantitative studies were carried out to assess the psychometric properties of the scale, in which 196 and 298 people participated, respectively. The scale was applied online in September 2020 and in April 2021. Results, from the 26 emotional stress responses were reduced to nine negative emotions in an Exploratory Factor Analysis (X2=1183, df=36, p=.001, KMO= .94, 60% variance, Alfa ordinal=.93). This solution was corroborated with a Confirmatory Factor Analysis (X2=41.87, d.f.=26, X2/d.f.=1.61, p=.025; RMR= .036, SRMR=.036, RMSEA=.045; GFI=.997, CFI=.999, TLI=.998). Conserve only nine negative emotions is due to statistical analysis but also because some emotions referred to conditions of physical exhaustion or body energy level. On the other hand, positive emotions were related with pleasant commuting situations, not with the commuting stress experience. Conclusion, the exploratory scale to assess the commuting stress through emotional responses presents acceptable values to be applied in this urban area of Mexico.

Non-suicidal self-injuries in a sample of Mexican university students / Autolesiones no suicidas en una muestra de estudiantes universitarios mexicanos

Abstract Introduction Non-suicidal self-injuries (NSSI) are a worldwide health problem that affects principally young people, and can impact negatively the mental and physical health of those that self-injure. Objective To examine the frequency of NSSI in 564 undergraduate students (132 male, 432 female) from Mexico City and the association of NSSI with depressive symptoms, anxiety, impulsivity, self-efficacy, and emotion regulation. Method A convenience sample of 564 undergraduate students (aged 17-26 years) from eight universities in the Mexico City metropolitan area completed a survey in their classrooms. Results Of the total sample, 30.9% had experimented at some point in their lifetime with NSSI on one to four occasions, while 26.9% had recurrent NSSI (i.e., five or more occasions). Nearly eleven percent self-injured in the prior 12 months. The NSSI most often reported among those who self-injured was cutting oneself (48.0%). Recurrent self-injurers reported higher levels of depression and impulsivity, and less self-efficacy than those who had experimented with such behaviors or without any lifetime NSSI. While 54.4% perceived the need for professional help, only 18.1% sought professional services. Discussion and conclusion NSSI is a hidden problem in the college population in Mexico City which needs to be addressed by university administrators and mental health professionals. Depressive symptomatology, impulsivity, and self-efficacy are factors that should be considered when developing preventive intervention strategies.

Resumen Introducción Las autolesiones no suicidas (ANS) son un problema mundial de salud que afecta principalmente a jóvenes, y puede impactar de manera negativa la salud mental y física de la persona que se autolesiona. Objetivo Examinar la frecuencia de ANS en 564 estudiantes de licenciatura (132 hombres, 432 mujeres) de la Ciudad de México y la asociación de las ANS con síntomas depresivos, ansiedad, impulsividad, autoeficacia y regulación emocional. Método Una muestra de conveniencia de 564 estudiantes universitarios (edades 17-26 años) de ocho universidades del área metropolitana de la Ciudad de México completó una encuesta en sus salones de clases. Resultados Del total de la muestra, 30.9% se habían infligido ANS de manera experimental de una a cuatro ocasiones, mientras que 26.9% presentaron ANS recurrentes (cinco o más ocasiones) en algún momento en su vida. Casi once por ciento reportaron ANS en los 12 meses previos. Las ANS reportadas con mayor frecuencia entre aquellos que se autolesionaron fueron cortarse a sí mismos (48.0%). Las personas con autolesiones recurrentes reportaron mayores niveles de depresión e impulsividad, y menos autoeficacia que aquellas que habían experimentado con estos comportamientos o sin ninguna historia de ANS en su vida. Aunque 54.4% percibían la necesidad de atención, solo 18.1% buscaron servicios profesionales. Discusión y conclusión Las ANS son una problemática oculta en la población universitaria de la Ciudad de México, la cual necesita ser atendida por las autoridades universitarias y los profesionales de la salud. La sintomatología depresiva, impulsividad y autoeficacia son factores que se deben considerar para desarrollar estrategias preventivas.

Adaptación y propiedades psicométricas del Inventory of Statements About Self-injury en estudiantes mexicanos / Adaptation and psychometric properties of the Inventory of Statements About Self-injury in Mexican students

Resumen La presente investigación evalúa las propiedades psicométricas de la adaptación al español del Inventory of Statements About Self-injury de Klonsky y Glenn (2009). Esta escala evalúa las diferentes motivaciones o funciones que las personas refieren para realizar autolesiones no suicidas. Se aplicó la escala en una muestra (N = 435) de alumnos universitarios de ambos sexos con una historia de autolesiones no suicidas. El análisis factorial confirmatorio detectó 7 factores interpretables (autorregulación, venganza, búsqueda de sensaciones/fortaleza, evitando el suicidio, manifestando angustia, autodeterminación y embotamiento), 5 más que el instrumento original. La confiabilidad de la escala fue aceptable, con un alfa de Cronbach de 0.89 para la escala total y de 0.72 a 0.82 para cada factor. Se presenta la validez convergente a través de correlaciones positivas entre la escala y mediciones de depresión, ansiedad e impulsividad. El instrumento adaptado al español presenta propiedades psicométricas aceptables para la medición de autolesiones no suicidas en población universitaria mexicana.

Abstract This research evaluates the psychometric properties of the Spanish language adaptation of the Inventory of Statements About Self-injury (Klonsky and Glenn, 2009). This scale assesses the motivations or functions that people with non-suicidal self-injuries report for engaging in self-injurious behaviors. The inventory was administered to a sample of 435 male and female university students with a lifetime history of non-suicidal self-injuries. A confirmatory factor analysis detected 7 interpretable factors (self-regulation, revenge, sensation seeking/toughness, avoiding suicide, marking distress, self-determination and numbness), 5 more than the original instrument. The scale had adequate internal consistency with a Cronbach's alpha of 0.89 and Cronbach's alphas of 0.72 to 0.82 for each factor. Positive correlations between the scale and measures of depression, anxiety and impulsivity suggest the convergent validity of the scale. Overall, the scale presents acceptable psychometric properties for the measurement of non-suicidal self-injuries in a Mexican university population.

Perforación tardía del ventrículo derecho con electrodo de fijación activa en el septum y estimulación diafragmática como primera manifestación clínica / Late right ventricular perforation with active fixation electrode in the septum with diaphragmatic stimulation as first clinical manifestation

La perforación miocárdica es una complicación infrecuente, relacionada con el implante de marcapasos y cardiodesfibriladores, que puede ocurrir al insertar los electrodos; sin embargo, en relación con la utilización de electrodos de fijación activa, ésta puede suceder después de varios días o semanas del implante. Se describe un caso clínico de un paciente a quien se le implantó un marcapasos bicameral con electrodos de fijación activa evidenciándose una semana más tarde perforación miocárdica por el electrodo ventricular, con estimulación diafragmática como manifestación clínica. Inicialmente no había evidencia radiológica de la perforación y requirió abordaje endovascular para extracción.

Myocardial perforation is a rare complication of pacemakers and defibrillators implantation that can occur when inserting the electrodes. However, regarding the use of active fixation electrodes, perforation can occur several days or weeks after the implant . We describe the case of a patient who was implanted a dual chamber pacemaker with active fixation electrodes. A week later we evidenced myocardial perforation by the ventricular electrode with diaphragmatic stimulation as clinical manifestation. Initially there was no radiological evidence of perforation and it required endovascular approach for extraction.

Tratamiento psicofisiológico y conductual del trastorno de ansiedad

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Abstract: Panic disorder is a complex phenomenon according to its biochemical and psychosocial etiology. Therapeutic interventions of panic disorder are aimed to promote effectiveness through the combined use of medication and behavioral cognitive therapy. Anxiety is a normal human response. Moderate levels of anxiety are well accepted because they act as an aid to improve performance, and high levels of anxiety are experienced as normal if they are consistent with the demands of the situation. Persons with anxiety disorders complain of experiencing anxiety too often but they seek help also to overcome fears they recognize as irrational and intrusive. From a psychological point of view, behavioral cognitive techniques -such as hyperventilation control, exposure, and cognitive therapy- and structured problem solving have been successful in the treatment of the symptoms associated to anxiety. It is worth to emphasize that graded exposure is perhaps the most powerful technique assisting patients to overcome fearful situations. Cognitions are also important because it has been found that panic attacks occur when people process information in the external environment, as well as internal somatic stimuli, as though they were threatening experiences. In other words, they feel they have no control over their sensations. Panic attacks prevalence in Mexico City is 1.1% in men and 2.5% in women. It is more frequent among 25-to 34- year old single men and married women, with an average scholarity between 7 and 9 years. From a biological point of view, it is suggested that the etiology of panic attacks involves the participation of the serotonergic and adrenergic neurotransmitter systems, as well as the GABA/ benzodiacepine. Studies based on the noradrenergic theory had lead to conclude that panicking patients have more sensitive brainstem carbon dioxide receptors than normal control subjects. At the same time, other lines of work indicate that serotonergic transmission may also play an important role in the genesis of panic attacks. It has been found that patients with panic disorder may have a lower tolerance threshold to methoclorophenylpiperazine response than control subjects because of hypertensive serotonergic receptors. The accumulated laboratory evidence seems to support the idea that panic attacks begin with the stimulation of irritable foci in one of three brainstem areas: the medullary chemoreceptors, the noradrenergic pontine locus coeruleus, or the serotonergic midbrain dorsal raphe. On the other hand, biofeedback is a psychophysiological intervention that allows in the first place for the external control of some of the physical symptoms involved in this disorder, which is later transferred to internal control of psychophysiological cognitions and behaviors that enable the patient to prevent symptom's occurrence. Based on the principles of the General Systems Theory, biofeedback utilizes the concepts of self regulation and disregulation to describe the conditions under wich normally integrated self-regulatory systems may become imbalanced with regard to their positive and negative feedback loops. Technically, all that a person needs to do is to attend to the signals feedback and not to "try" to control them; the effects of a positive feedback loop should occur automatically, without conscious awareness, as long as the person processes the stimuli. Biofeedback has been effectively used in the treatment of essential hypertension, migraine headaches, Raynaud's disease, tension headaches, temporomandibular joint syndrome, asthma, primary dysmenorrhea, peptic ulcers, fecal incontinence, and conditioning of electroencephalographic rhythms, among other problems. The present study reports data from 32 panic disorder outpatients from the National Psychiatry Institute, Mexico City. They were randomly assigned to: Control Group (N = 14): daily doses of 75 milligrams of imipramine. The participants of this group were required to assist to the psychology department in order to obtain a baseline (pre-test and post-test) with the biofeedback equipment. In addition, every two weeks they visited a psychiatrist who verified that there were no collateral effects from the medicament. Experimental Group (N = 18): besides daily doses of imipramine, and visits to the psychiatrist, these patients went through eight multimodal biofeedback and behavioral cognitive techniques which were assisted with relaxation training sessions. All biofeedback sessions lasted 30 minutes divided in six five-minute trails. The first and final trials served to stabilize the biological responses, and the four middle trials were used to give biofeedback and reinforcement to the response being trained in addition to the verbal explanation of the changes occurring on the screen of the computer. All patients were assessed with the Anxiety Sensitivity Index, and with Beck's Anxiety and Depression Inventories. Results showed that patients in the experimental group reported significant lower scores in the anxiety sensitivity index than the control group. Post-test differences showed that the electromiographic and electrodermic activity from the experimental group was lower than the one from the control group. Diaphragmatic respiration training and progressive muscular relaxation and imagery proved to be effective in reducing the symptoms associated to panic attacks. The overall final result is that all patients improved clinically. They verbally reported that the intensity, frequency and evitative behaviors derived from panic attacks had almost disappeared. However, the cognitive factor of anxiety sensitivity changed significanty only in the experimental group. These findings support the hypothesis that clinical improvement results from a symptom "reattribution" which gives them cognitive skills to cope with stressing stimuli. Further studies should reassess the effectiveness of the combined treatment (imipramine and behavioral cognitive techniques). It is also recommended to expand the study to generalized anxiety disorder and to adjust the experimental design in order to incorporate a second phase with neurofeedback as independent variable. Equally important is to investigate the mechanisms of the hypnotic ability and its impact on the clinical improvement of anxiety disorders.

Manual de autoayuda para el paciente con vértigo / Manual of help self for the patient with vertigo

Se abordan aspectos emocionales que se presentan de manera secundaria o se potencializan ante la presencia de sensaciones de vértigo, mareo, inestabilidad, zumbido de oído, náusea, dolor de cabeza, sudoración, fátiga y pérdida de audición, entre otros. Asimismo, se proporcionan sugerencias para su identificación y qué hacer ante la presencia de estas "sensaciones". Contenido: Introducción. 1) Antecedentes históricos. 2) Definición. 3) Síntomas. 4) Control respiratorio. 5) Relajación autogénica. 6) Reestructuración cognoscitiva. 7) Solución de problemas. 8) Conclusiones