Adaptation, validity, and reliability of the Resilience Scale SV-RES in hospital health professionals in Mexico / Adaptación, validez y confiabilidad de la Escala de Resiliencia SV-RES en profesionales de la salud hospitalaria de México

Abstract Introduction Resilience is the capacity in which the qualities and resources of the individual help in the successful coping of adverse situations. Studying the construct of resilience requires seeing it as a process and not only a characteristic of the individual. Saavedra's resilient response is a model that fits this idea and explains resilience satisfactorily. Having a measuring instrument for health personnel working in hospitals would allow discovering its benefits as a protective factor in the workplace. Objective Adapt and validate the Resilience Scale SV-RES in hospital health professionals in Mexico. Method Based on recent research literature, including response models and modified and adapted items from the Resilience Scale SV-RES, a total of 909 health professionals responded. Distribution, factor analysis, and internal consistency tests were performed. Results The process led to a scale of 28 items grouped into six factors with an overall internal consistency of (α = .908) and 50.5% of explained variance. Discussion and conclusion The Resilience Scale SV-RES has adequate psychometric properties that make it appropriate to measure the resilience capacity of hospital health professionals in Mexico.

Resumen Introducción La resiliencia es la capacidad en que las cualidades y recursos del individuo le ayudan al afrontamiento exitoso de situaciones adversas. Se ha advertido que estudiar el concepto de resiliencia requiere verse como un proceso y no sólo como elementos característicos del individuo, un modelo que explica de manera adecuada este proceso es el modelo de respuesta resiliente de Saavedra. Contar con un instrumento que permita su medición en personal de salud hospitalario permitiría descubrir su beneficio como factor protector en el lugar de trabajo y diseñar intervenciones preventivas o remediales. Objetivo Adaptar y validar la Escala de Resiliencia SV-RES en profesionales de salud hospitalaria en México. Método Se tomó como base la literatura de investigación científica contemporánea, modelos de respuesta resiliente y los reactivos de la Escala de Resiliencia SV-RES, adaptados y modificados, a los que respondieron 909 profesionales de la salud. Se realizaron pruebas de distribución, análisis factorial y consistencia interna. Resultados Se obtuvo una escala conformada por 28 reactivos agrupados en seis factores con consistencia interna global de (α = .908) y una varianza explicada de 50.5%. Discusión y conclusión La Escala de Resiliencia SV-RES cuenta con propiedades psicométricas adecuadas que la hacen apropiada para medir la capacidad de resiliencia en profesionales de la salud hospitalaria de México.

Facilitadores de la Violencia de Pareja Percibidos por Víctimas y Victimarios: Estudio Exploratorio en el Contexto de la Teoría del Aprendizaje Social / Facilitators of Intimate Partner Violence as Perceived by Victims and Perpetrators: An Exploratory Study in the Context of Social Learning Theory

Resumen Pocos estudios han documentado la percepción de víctimas y victimarios con respecto a los factores facilitadores e instigadores de la violencia de pareja. El objetivo del presente estudio fue evaluar la percepción de víctimas y victimarios de violencia de pareja con respecto a factores facilitadores e instigadores de la violencia. Participaron 27 víctimas de violencia de pareja con edades entre 18 y 71 años (media = 34.25) y 27 victimarios jurídicamente confirmados, con edades entre 19 y 62 años (media = 40), quienes respondieron un cuestionario integrado por una lista sobre factores facilitadores e instigadores de la violencia de pareja y de datos sociodemográficos. Ambos grupos coincidieron en señalar al estrés y consumo de sustancias como propiciadoras de violencia, así como a la madre de su pareja como instigadoras. El diseño de intervenciones para tratar o prevenir violencia de pareja requieren identificar los factores que la facilitan, incluyendo a las familias circundantes ya que podrían no sólo tolerar o justificar la violencia, sino incluso inducirla. Finalmente, se discuten algunas diferencias notorias entre perpetradores y víctimas respecto de otras variables propiciadoras de violencia en el contexto de la teoría del aprendizaje social.

Abstract Few studies have documented the opinion of victims and perpetrators regarding the facilitating and instigating factors of intimate partner violence. The objective of this study was to evaluate the perception of victims and perpetrators of intimate partner violence regarding facilitating and instigating factors of violence. Participants were 27 victims of intimate partner violence aged between 18 and 71 years (mean = 34.25) and 27 legally confirmed offenders, aged between 19 and 62 years (mean = 40), who answered a questionnaire consisting of a list of facilitating factors and instigators of intimate partner violence and sociodemographic data. Both groups agreed in pointing to stress and substance use as propitiators of violence, as well as the mother of their partner as instigators. The design of interventions to treat or prevent intimate partner violence requires identifying the factors that facilitate it, including the surrounding families, since they may not only tolerate or justify the violence, but even induce it. Finally, some notorious differences between perpetrators and victims are discussed with respect to other variables that promote violence in the context of social learning theory.

Construcción y validación de una prueba de conocimientos de métodos anticonceptivos para adolescentes

Introducción: Se requiere de instrumentos válidos y confiables para medir el nivel de información de métodos anticonceptivos en adolescentes para promover su correcto uso. Objetivo: Construir y validar una prueba de conocimientos de métodos anticonceptivos para adolescentes de entre 15 y 19 años. Método: Se desarrolló una prueba de 36 ítems que incluye los diferentes métodos anticonceptivos y que recolecta información sobre las características, uso, eficacia, ventajas y desventajas de dichos métodos. Una vez validada por jueces expertos, se seleccionó aleatoriamente una preparatoria de Ecatepec y se aplicó la prueba a estudiantes de los tres grados escolares. Resultados: La prueba fue resuelta por un total de 229 estudiantes de entre 15 y 19 años (M = 16.22; DE = .978). La mayoría fueron mujeres (66%), solteros (88.5%) y que vivían con mamá y papá (62.9%). De los 36 ítems iniciales, 31 mostraron tener adecuado poder discriminativo entre los que se desempeñaron bien en la prueba y los que no. El índice de dificultad de la prueba fue de .45 y se estimó un valor de .739 de índice de confiabilidad. El 60% de los participantes obtuvo un porcentaje menor de 50% de respuestas correctas en toda la prueba y solo cerca del 4% obtuvo un porcentaje mayor al 70%. Las categorías de características y uso fueron en las que mejor se desempeñaron los participantes al responder correctamente al 48% de estas preguntas y la peor fue eficacia ventajas y desventajas con un 33%. Conclusión: Las propiedades psicométricas de la prueba evidenciaron que es un instrumento válido y confiable para su aplicación en adolescentes mexicanos. Los resultados señalan que la mayoría de los adolescentes no posee la información necesaria sobre los métodos anticonceptivos y que de lo que menos conocen es sobre su eficacia y efectos secundarios.

Background: Valid and reliable instruments are required to measure the level of information on contraceptive methods in adolescents to promote their correct use. Objective: To construct and validate a test of knowledge of contraceptive methods for adolescents between 15 and 19 years old. Method: A 36-item test was developed that included the different contraceptive methods and information on the characteristics, use, efficacy, advantages and disadvantages of these methods. Once validated by expert judges, a college in Ecatepec was randomly selected as data collection site. Students of the three school grades answered the test. Results: The test was applied to a total of 229 students between 15 and 19 years old (M = 16.22; SD = .978). The majority were women (66%), single (88.5%) and lived with their parents (62.9%). Of the 36 initial items, 31 showed discriminatory power between those who performed well on the test and those who did not. The difficulty index of the questionnaire was .45 and revealed a reliability index value of .739. Around 60% of the participants obtained a percentage below 50% of correct answers in the entire test. Only about 4% of participants got a percentage of correct responses higher than 70%. The categories of characteristics and use were those in which the participants performed best when answering 48% of these questions correctly. The worst was effectiveness, advantages and disadvantages with 33%. Conclusion: The test's psychometric properties showed that it is a valid and reliable test for its application in Mexican adolescents. The results indicate that most adolescents of the simple do not have complete information about contraceptive methods and that they know the least about their effectiveness and side effects.

A preliminary study of the prevalence of post-traumatic stress disorder, depression and anxiety symptoms in female adolescents maltreatment victims in Mexico / Un estudio preliminar sobre la prevalencia de síntomas de estrés postraumático, depresión y ansiedad en mujeres adolescentes femeninas víctimas de maltrato en México

Abstract: Introduction: Although child maltreatment is related with psychopathologic symptoms, however their clinical prevalence in the general population and more so in specific groups of age and gender, such as female adolescents, has been scarcely documented. Objective: The purpose of the present study was to examine the prevalence mental illness symptoms ‒such as post-traumatic stress disorder, depression, and anxiety‒ in female adolescent maltreatment victims in Mexico. Method: Fifty-five 12-17-year old female adolescent victims of maltreatment (sexual, physical, and emotional abuse) recruited from four different Mexican institutions were evaluated through clinical scales for post-traumatic stress, depression, and anxiety, in addition to clinical interviews. Results: More than half of the participants presented significant scores of psychopathological symptoms in the three scales evaluated. Discussion and conclusion: The high prevalence of psychopathologic symptoms found in this study suggests that female adolescents who had experienced some form of abuse present highed a susceptibility to develop psychopathology. Results are discussed in the context of their relevance as a public health problem and their implications for professional interventions.

Resumen: Introducción: Aunque el maltrato infantil se ha asociado con síntomas psicopatológicos, se ha documentado poco la prevalencia clínica que tiene en la población general y aún más en grupos específicos de edad y género, como en el caso de mujeres adolescentes. Objetivo: El presente estudio tiene como propósito examinar la prevalencia de síntomas de enfermedades mentales como el trastorno de estrés postraumático, la depresión y la ansiedad en adolescentes víctimas de maltrato en México. Método: Se evaluaron 55 mujeres adolescentes víctimas de maltrato (abuso sexual, físico y emocional) de 12 a 17 años, reclutadas en cuatro diferentes instituciones mexicanas. A todas se les aplicaron entrevistas y escalas clínicas de estrés postraumático, depresión y ansiedad. Resultados: Más de la mitad de las participantes presentaron altos puntajes de síntomas psicopatológicos en las tres escalas evaluadas. Discusión y conclusión: La alta prevalencia de síntomas psicopatológicos encontrada en este estudio sugiere que las adolescentes que experimentaron alguna forma de abuso presentaron una alta susceptibilidad a desarrollar psicopatología. Se discuten los resultados en el contexto de su relevancia como un problema de salud pública y sus implicaciones para las intervenciones profesionales correspondientes.

Adaptación y validación de la escala de impacto de fatiga / Adaptation and validation of the fatigue impact scale

Resumen: La fatiga es una sensación de cansancio físico con consecuencias adversas en la calidad de vida de las personas, por consiguiente, es importante contar con instrumentos confiables y válidos para medirla. Una de las escalas más utilizadas es la Escala de Impacto de Fatiga, sin embargo, hay versiones con una y tres dimensiones en diversas culturas. Por lo que el propósito de este trabajo fue traducir, adaptar de manera culturalmente relevante y comparar las estructuras de una y tres dimensiones de la Escala de Impacto de Fatiga, para identificar la más adecuada en población general de la Ciudad de México. Se trabajó con tres grupos diferentes de participantes; el primero para la traducción y adaptación conformado por siete jueces expertos en el idioma, el segundo para la validación psicométrica con 205 participantes de población general y, el tercero, para el análisis factorial confirmatorio con 406 habitantes de la Ciudad de México. Se probó la distribución, discriminación, confiabilidad y estructura de la escala, en un análisis exploratorio y confirmatorio, quedando una escala final de 10 reactivos con tres factores: física, mental y psicosocial que explican el 59% de varianza con buen ajuste (X2[21.7] =20,762, p = 0.522; CFI = 1; RMSEA = 0), con una confiabilidad α=0.93.

Abstract: Fatigue is a sensation of physical weariness with adverse consequences on the quality of life of people, therefore, it is important to have reliable and valid instruments to measure it. One of the most widely used is the Fatigue Impact Scale, however, there are one-and three-dimensional versions in several cultures. Therefore, the aim of this work was to translate, culturally relevant and compare the one and three-dimensional structures of the Fatigue Impact Scale to identify the most appropriate in the general population of Mexico City, with three different groups of participants. The first one for translation and adaptation made up with seven expert judges in the language; the second for psychometric validation with 205 participants from the general population, and the third, for confirmatory factor analysis with 406 inhabitants of Mexico City. The distribution, discrimination, reliability and structure of the scale were tested in an exploratory and confirmatory analysis, with a final scale of 10 items with three factors: physical, mental and psychosocial explaining the 59% variance with goodness of fit (X2[21.7] = 20.762, p = 0.522; CFI = 1; RMSEA = 0), with reliability α = 0.93.

Niñas y adolescentes en riesgo de calle: Bienestar subjetivo y salud mental / Girls at risk of homelessness: Subjective well-being and mental health

La salud mental de mujeres menores en riesgo de calle se ve seriamente afectada por las condiciones vulnerables en las que se desenvuelven; empero, mundialmente, hay pocos estudios al respecto. Este estudio se realizó para explorar la salud mental de 26 niñas y adolescentes en riesgo de calle mediante diferencias por nivel de bienestar subjetivo y el efecto de la ansiedad, depresión, asertividad y regulación emocional sobre éste. Los resultados principales muestran discrepancias significativas por grado de bienestar subjetivo en conductas asertivas y regulación emocional; consecuentemente, se encontraron deficiencias en salud mental. La utilidad clínica reside en elaborar intervenciones partiendo de las necesidades detectadas, contribuyendo, así, a mejorar la salud mental y, con ello, la calidad de vida de tal colectivo social.

Mental health of girls at risk of homelessness is seriously affected by the vulnerable conditions in which they are involved. However, there are few studies that have addressed the issue worldwide. This study was conducted to explore the mental health of a sample of 26 girls at risk of homelessness, through differences by subjective well-being level and the effect of anxiety, depression, assertiveness and emotional regulation. The findings show significant discrepancies by subjective well-being grade in assertiveness and emotional regulation. Therefore, participants present mental health deficiency. The clinical benefit consists in taking action from the identified needs, in order to improve mental health conditions and consequently, the quality of life of the mentioned social group.

Variables psicológicas y adhesión en personas con VIH: evaluación en función del tiempo de infección / Psychological variables and adherence among HIV persons: evaluation based on length of infection

Se realizó un estudio transversal con el objetivo de evaluar la influencia de un conjunto de variables psicológicas sobre los comportamientos de adhesión al tratamiento en función del tiempo de infección en meses. Participaron 93 personas con VIH, quienes contestaron dos instrumentos: 1) Variables psicológicas y comportamientos de adhesión, y 2) Situaciones vinculadas con estrés. Se emplearon los siguientes procedimientos estadísticos: la ji al cuadrado de Pearson, la U de Mann-Whitney y un análisis de regresión múltiple. Los análisis de regresión revelaron una influencia diferenciada de las variables psicológicas en función del tiempo de infección: en el grupo de personas con < 42 meses, los predictores de los comportamientos de adhesión fueron una buena motivación, un óptimo desempeño competencial presente y bajos niveles de estrés vinculados con tolerancia a la frustración. En el grupo con 43 o más meses los predictores fueron una buena motivación y bajos niveles de estrés vinculados con toma de decisiones. El tiempo de infección en meses constituye una variable crítica respecto de la forma en que operan las variables psicológicas sobre la práctica de los comportamientos de adhesión en personas con VIH expuestas a tratamiento con medicamentos antirretrovirales.

This cross-sectional study was carried out to assess the influence of psychological variables on antiretroviral treatment adherence behaviors, based on length of infection in months. Participants included ninety-three HIV-positive persons, who answered two self-administered questionnaires: 1) Psychological variables and adherence behaviors, and 2) Stress-related situations. Three consecutive statistical testing procedures were applied for data analysis: Pearson's chi-square, Mann-Whitney U, and multiple regressions. Regression analyses found psychological variables influencing adherence behaviors in different ways based on length of infection: in the group of persons with < 42 months, psychological predictors were a good motivation, an optimal competential performance and low stress-related with tolerance to frustration, whereas in the group of persons with 43 or more months predictors were a good motivation and low stress-related with decision-making. Results strongly support the tenet that length of infection is a critical variable related to psychological variables influencing adherence behaviors among HIV-positive persons under antiretroviral treatment.

Ansiedad y depresión en mujeres con cáncer de mama en radioterapia: Prevalencia y factores asociados / Anxiety and Depression in Women with Breast Cancer Undergoing Radiation Therapy: Prevalence and Associated Factors

Someterse a radioterapia y padecer los efectos secundarios son situaciones que generan ansiedad y depresión en las mujeres con cáncer de mama. El objetivo fue evaluar la prevalencia de ansiedad y depresión que presentan las mujeres con cáncer de mama en radioterapia y analizar los efectos y las diferencias de variables clínicas y sociodemográficas sobre su malestar psicológico. Participaron 203 mujeres mexicanas con cáncer de mama en estadios 0-III. Para evaluar ansiedad y depresión se utilizó la versión adaptada de la escala The Hospital Anxiety and Depression Scale (HADS) y los datos sociodemográficos se recolectaron mediante una entrevista estructurada. La prevalencia de ansiedad y depresión fue 27 y 28% respectivamente. Escolaridad F (6,203) = 2.39, p =.009 y ocupación F (3,203) = 1.32, p =.009 tuvieron un efecto significativo sobre depresión; mientras que "vive con" resultó significativa F (6,203) = 2.69, p = .016 únicamente con ansiedad. Significativamente las pacientes deprimidas (M = 3.73) presentaron más efectos secundarios que las no deprimidas (M = 2.84). Resequedad en la boca, irritación en la piel y dolor en la zona radiada fueron los síntomas más reportados. La prevalencia de ansiedad y depresión encontrada, indica la importancia de proporcionar apoyo psicológico a las pacientes.

Enduring the symptoms of breast cancer and the effects of radiation therapy frequently lead to depressive and anxious symptoms in patients. The purpose of the present study was to examine the prevalence of anxious and depressive symptomatology in these patients and to explore the effects of clinical and socio-demographic variables on psychological distress. A total of 203 women with breast cancer, in stages 0 - III from a large public medical center in Mexico City participated. Anxious and depressive symptomatology was assessed through the Hospital Anxiety and Depression Scale (HADS) and Socio-demographic data were obtained through a structured interview. Prevalence of anxious and depressive symptomatologies were 27% and 28% respectively. One-way ANOVA on socio-demographic variables with symptomatology revealed that schooling F (6.203) = 2.39, p = .009 and occupation F (3.203) = 1.32, p = .009 were significant for depressive symptomatology. Living with specific persons was significant F (6.203) = 2.69, p = .016 for anxious symptomatology. The clinical variables "radiotherapy week" and specific features of the diagnostic, as well as marital status and age groups showed small differences related to either anxious or depressive symptomatology. More radiation side effects were reported by women with (M = 3.73) than those without (M = 2.84) depressive symptoms. The most frequent side effects were dry mouth, skin irritation and pain in the radiated area. The high levels of distress and the extreme physical discomfort produced by radiotherapy make the present findings useful for developing interventions aimed at helping breast cancer patients under radiation therapy.

Un modelo psicológico en los comportamientos de adhesión terapéutica en personas con VIH / A psychological model for therapeutic adherence behaviors in persons with HIV

Introduction HIV infection is a disease that demands a consistent and efficient practice of adherence behaviors related to antiretroviral treatment. However, research findings in the last few years have shown that psychological and social variables (e.g., depression, stress, low motivation, as well as little or no social support) interfere with the practice of those behaviors. This facilitates the clinical progression of the disease, and reduces the quality of life and survival time in people living with HIV. The intersection area between psychology and health involves widely diverse theoretical models, including self-regulation, health beliefs, and the one linking information-motivation-behavior. Such models have sought to account for the way in which the addressed variables affect adherence behavior. While analyzing psychological factors, these models usually emphasize either cognitive concepts or adopt a more traditional stance such as relating adherence behavior to personality, motivation, behavioral skills and stress management. Although this diversity seems inclusive, it fails to integrate explanations on therapeutic adherence under a more comprehensive theoretical umbrella. Thus, the present study was conducted within the scope of an interactive-functional model which attempts to articulate the interaction of sets of biological and psychological variables along four phases. The first involves psychological processes and results variables; the second comprises the diagnostic of HIV infection and later development of other opportunistic diseases; the third contains two types of behavior: therapeutic adherence and disease-related behaviors; the fourth involves conventional biological indicators and health outcomes. This model contrasts with others not only in the sense of proposing an inter-behavioral approach derived from Kantor's work, including articulated behavioral and personality theories, but it also proposes an interactive and functional emphasis on analyzing those variables assumed to determine therapeutic adherence behaviors. Such variables subsume personality phenomena, behavioral competencies and motives to behave. Thus, the approach includes those consistent ways in which HIV-positive persons interact with stress-related situations which contain unpredictable, ambiguous or uncertain stimulus signals and behavior consequences. The behavioral competencies category synthesizes what the patient knows on HIV, including those self-care actions that need to be taken efficiently. For instance, what is HIV-AIDS, what are the clinical stages of the infection, what medications help, how should they be used and, above all, why is so important to take medications in a consistent and efficient manner on the basis of the indications of the healthcare personnel. On the other hand, motives or motivation refer, in the traditional conception, to variables related to willing to act. It is said that a person is motivated to engage in therapeutic adherence behaviors when he/she is willing to behave accordingly, after having understood the relation between such behavior and some specific consequences. Such consequences may vary widely, ranging from interpersonal in nature, such as verbal praise or support from others, and intrinsic, such as self-perceived physical and psychological well-being. Materials and method A cross-sectional study was carried out in order to identify predictors of adherence behaviors related to antiretroviral treatment in a group of 68 persons living with HIV. Participants answered two self-administered questionnaires: i) psychological factors and adherence behaviors, and ii) stress-related situations in three modalities: decision-making, tolerance to ambiguity, and tolerance to frustration. Data analysis included univariate statistics, the Pearson's x² test, the T-test for independent samples, as well as a linear multiple regression analysis. Results Of the total of participants, 58 (85.3%) reported that they self-administered their antiretroviral medication everyday of the last week, and 10 (14.7%) did it with some inconsistence. Differences were significant (x² [1] =33.882; p<0.001); the T-test showed a significant difference among adherents and non-adherents in the motivation variable (t [66] = -27.954; p<0.001). Finally, the linear multiple regression analysis contributed as predictor of the adherence behaviors at variables like motivation (β =O.8O2; p<0.001), as well as low stress-related situations in the modalities of decision-making ( β = -0.268; p<0.01) and tolerance to frustration ( β = -0.280; p<0.01), with the adjusted determination coefficient [adjusted R²] = 0.629, thus explaining 62.9% of the total variance. Discussion The results of this study show that persons with HIV who are 100% adherent to antiretroviral medication are those who are clearly more motivated and are experiencing less stress-related to decision-making, as well as higher levels of tolerance to frustration. These findings suggest that interventions aimed at improving the treatment of HIV-positive patients should expressly include components related to these factors. It seems especially relevant to consider two additional aspects: first, once psychological factors are identified and explained through research, they need to be translated into viable intervention strategies subject to systematic methodological evaluation. Second, interventions must be consistent with the theoretical assumptions underlying the model used so that those techniques designed or selected to establish adequate medication use and other adherence and well-being-inducing behaviors will actually result effective. Given the context of the institutional treatment of this condition, it seems especially relevant to insure that such programs actually have an interdisciplinary character in order to facilitate and maintain therapeutic adherence. Such inter-professional collaboration is especially important in a public healthcare context in which resources, ranging all the way from facilities, equipment and caregiver salaries to the schooling of the patients, pose special challenges in places like Latin American countries, where real optimization can occur mainly through the quality of integrated professional performance. After all, the key healthcare ingredient in public health problems affecting ever-growing portions of the population, such as the HIV infection, remains the human being, i.e., actual persons with biological, psychological, and social functional components.

Introducción La infección por VIH es un padecimiento que demanda la práctica consistente y eficiente de los comportamientos de adhesión al tratamiento antirretroviral en sí y a otras actividades de apoyo al mismo. Sin embargo, en años recientes se ha identificado una diversidad de variables psicológicas y sociales (i.e., depresión, estrés, bajos niveles de motivación y carencia de apoyo social, principalmente) que dificultan la práctica de esos comportamientos, favoreciendo así el progreso clínico de la enfermedad y una reducción en la calidad y tiempo de sobrevida en las personas con VIH. En el subcampo de conocimiento conocido como psicología y salud existen diversos modelos teóricos con los que se ha buscado dar cuenta de cómo es que esas variables influyen sobre los comportamientos de adhesión; destacan, principalmente, el autorregulatorio, el de creencias en salud y el de información-motivación-habilidades conductuales. En general, se trata de modelos que, o bien privilegian el análisis de lo psicológico a partir de conceptos de naturaleza cognoscitiva, o bien carecen de análisis de fenómenos como los de estrés y personalidad, así como de los comportamientos asociados a la enfermedad. El presente estudio se realizó con base en un modelo psicológico para la investigación de los comportamientos de adhesión terapéutica; se trata de un modelo interactivo y funcional en el sentido de consignar la interacción de un conjunto de variables psicológicas y biológicas a lo largo de cuatro fases comportamentales en el proceso del desarrollo de padecimientos crónicos. En la primera se incluyen variables psicológicas de procesos y resultados; en la segunda el diagnóstico de la infección por VIH y el posterior desarrollo de otras enfermedades oportunistas; la tercera, psicológica, contempla la práctica de dos tipos de comportamientos, los de adhesión terapéutica y los asociados a la enfermedad; finalmente, en la cuarta se contemplan los indicadores biológicos convencionales y los resultados de salud. Materiales y método Se condujo un estudio transversal que tuvo como objetivo identificar predictores de los comportamientos de adhesión al tratamiento antirretroviral en 68 personas con VIH. Los participantes respondieron a dos instrumentos: i) factores psicológicos y comportamientos de adhesión, y ii) situaciones vinculadas con estrés. Para el análisis de los datos se utilizaron estadísticas univariadas, la x² de Pearson, la prueba T para muestras independientes y un análisis de regresión lineal múltiple. Resultados Del total de participantes, 58 (85.3%) respondieron que se habían administrado sus medicamentos todos los días de la última semana y los restantes 10 (14.7%) lo habían hecho con inconsistencia, diferencia que resultó significativa (x² [1] =33.882; p<0.001). La prueba T para muestras independientes arrojó una sola diferencia significativa entre las personas con VIH adherentes y no-adherentes en la variable motivos ( t [66] = -27.954; p<0.001); finalmente, el análisis de regresión lineal múltiple aportó como predictores de los comportamientos de adhesión a las variables motivos (β = 0.802; p<0.001) y bajos niveles de estrés vinculados con toma de decisiones ( β = -0.268; p<0.01) y con tolerancia a la frustración (β = -0.280; p<0.01), con un coeficiente de determinación [R² ajustado] = 0.629, es decir, que las tres variables explican 62.9% de la varianza total. Discusión Los resultados muestran que las personas con VIH 100% adherentes son aquellas que se encuentran claramente motivadas y que en general experimentan bajos niveles de estrés relacionados con la toma de decisiones y tolerancia a la frustración. Estos hallazgos sugieren que en el diseño e instrumentación de programas de intervención orientados a mejorar la adhesión de estos pacientes es indispensable incorporar módulos o componentes basados directamente en dichos factores, poniendo especial énfasis en programas interdisciplinarios.

Asociación entre los niveles de estrés y depresión y la adhesión al tratamiento en personas seropositivas al VIH en Hermosillo, México / Association between stress and depression levels and treatment adherence among HIV-positive individuals in Hermosillo, México

OBJETIVOS: Evaluar la asociación entre las variables relacionadas con el estrés, los motivos y la depresión en personas seropositivas al VIH y la adhesión al tratamiento, y analizar su consistencia según un modelo psicológico teórico. MÉTODOS: Estudio transversal con la participación de 25 mujeres y 39 hombres seropositivos al VIH atendidos en el Centro Ambulatorio para la Prevención y Atención a VIH/Sida e Infecciones de Transmisión Sexual, en Hermosillo, Sonora, México. Se exploraron las variables psicológicas y el grado de adhesión al tratamiento, las situaciones vinculadas con el estrés y el grado de depresión. Se elaboraron índices de las variables de interés asociadas con el estrés, los motivos y la depresión. La asociación entre las variables se determinó mediante regresión múltiple. RESULTADOS: En el mes previo al estudio, 65,6 por ciento de los 64 participantes informó haber seguido fielmente el tratamiento indicado, mientras 34,4 por ciento incumplieron el tratamiento en alguna medida (χ2 = 6,250; P = 0,012). Según el análisis de regresión se encontró que solamente la combinación de niveles intermedios de estrés vinculado con la tolerancia a la ambigüedad y niveles bajos de depresión presentó una asociación significativa (F [3,58] = 3,298; P = 0,027) con la adhesión al tratamiento; la combinación de ambas variables explicó 38,2 por ciento de la varianza total encontrada. CONCLUSIONES: La combinación de los niveles de estrés vinculado con la tolerancia a la ambigüedad y de depresión podría emplearse como factor de predicción del fiel cumplimiento de las indicaciones médicas prescritas. Se deben tener en cuenta estos resultados al diseñar intervenciones y programas dirigidos a promover la adhesión al tratamiento en personas seropositivas al VIH.

OBJECTIVES: To evaluate the association between variables related to stress, reasons, and depression, and adherence to treatment in HIV-positive individuals, and to analyze the robustness according to a theoretical psychology model. METHODS: This was a cross-sectional study of 25 female and 39 male HIV-positive participants receiving services at the Outpatient Center for Prevention and Treatment of HIV/AIDS and Sexually-transmitted Diseases (Centro Ambulatorio para la Prevención y Atención del VIH/Sida e Infecciones de Transmisión Sexual) in Hermosillo, Sonora, Mexico. The psychological variables, the degree of treatment adherence, stress-related circumstances, and the severity of depression were examined. Rates were calculated for the key variables associated with stress, reasons, and depression. The associations among variables were determined by multiple regression. RESULTS: During the month preceding the study, 65.6 percent of the 64 participants reported having faithfully followed the prescribed treatment, while 34.4 percent had failed, in some way, to follow the treatment (¯2 = 6.250; P = 0.012). Regression analysis found that there was only one combination, an intermediate level of stress linked to tolerance of uncertainty and low levels of depression, that was significantly associated (F [3.58] = 3.298; P = 0.027) with adherence to treatment; the combination of these two variables explained 38.2 percent of the total variance found. CONCLUSIONS: The combination of stress levels with tolerance of uncertainty and depression could be used as a predictor for true compliance with prescribed treatment plans. These results should be taken into account when designing intervention and treatment-adherence campaigns in HIV-positive individuals.

Desarrollo de un Modelo Cognitivo-Conductual Motivacional de Atención Escalonada para Estudiantes Universitarios con Problemas de Alcohol / Development of a stepped-care cognitive behavioral motivational model for colege students with alcohol problems

Outcome deta research from international surveys on college students report that alcohol problems in colleges are an emergent health concern. This paper describes the development and evaluation of a stepped-care cognitive-behavioral motivational model for college students with alcohol problems, that includes three specific treatment programs, "BASICS", "GSC", and "SRP", which are part of the state-of-the-art cognitive-behavioral motivational treatments to address a broad spectrum of drinking problems available in centers for alcohol problems at the National Autonomous University of México. A modified version of the stepped-care approach and strategies of treatment-client matching were used to select patients for the treatment programs. This article describes the model and its programs and the initial outcome data from a study designed to evaluate its efficacy on a group of college students that address a broad spectrum of alcohol problems and its future perspectives.

Resultados de encuestas internacionales en estudiantes universitarios documentan que los problemas de alcohol constituyen un problema emergente de salud pública. Se describe el desarrollo y evaluación de un modelo cognitivo-conductual motivacional de atención escalonada para estudiantes universitarios con problemas de alcohol, que incluye tres programas de tratamiento, "BASICS", "GSC" y "SRP", que forman parte del estado del arte de los tratamientos cognitivo-conductuales y motivacionales para el abordaje de un amplio espectro de problemas de alcohol, disponibles en centros y programas de la UNAM. Se empleó una versión modificada del enfoque de atención escalonada y una combinación de estrategias de igualación "cliente-tratamiento", para la asignación de participantes a tratamientos específicos. Se describe el modelo y los resultados obtenidos en un estudio diseñado para evaluar su eficacia con un grupo de estudiantes universitarios que cubren un amplio espectro de problemas de alcohol.

Escala de ansiedad ante el envejecimiento de Lasher y Faulkender: propiedades psicométricas en adultos mayores mexicanos

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Summary: Lifshitz has documented that conceptualization of old age is influenced by stereotypes. Milligan, Powell, Harley and Furchtgott, made evident that elderly people with poor health have a tendency to see themselves as the stereotype of an "old person", whereas those with better health tend to see themselves as younger people. Lasher and Faulkender have stressed the importance of anxiety in the process of getting old as an important factor adjusting to themselves. Lack of adjustment may manifest in four main dimensions: physical, psychological and social, and transpersonal or spiritual. These four dimensions are synthesized in three specific fears: 1. Fear of the process of aging, 2. fear of the state of being old, and 3. fear or anxiety facing old people. Based on this theoretical frame, the authors developed the Anxiety about Aging Scale, and Watkins, Coates and Ferroni pointed out the need to adapt it in order to apply it on elderly people. The objective of this paper is to evaluate the psychometric properties of the original Lasher and Faulkender scale, as well as presenting an adapted version for Mexican elderly people. Method. Two independent samples of elder adults were used (n=234 and n=151) selected by availability within a government health clinic; on average, they were 63 years old. The original Lasher and Faulkender scale was translated into Spanish following a double blind procedure, using Likert type answer options with four alternatives. Two questionnaires were used, which included the original scale (EAE-O), in one, and the adapted scale (EAE-A) in the other, as well as the sub-scale of attitude facing one's own aging of the Philadelphia Geriatric Center Morale Scale, APE (2), and the Suicidal Ideational Scale (EIS), designed by Roberts (3). Additionally, interviewees were asked: «If you should have to set an age, forgetting a little about what doctors and people say, at what age would you consider that you really start to be "Old"? ¼ and at what age do you think one would get "very old"? The scales were applied to subjects who agreed voluntarily to participate in an anonymous and informed way. Resulting data were analyzed with the system SPSS, v. 11.0. Factorial structure. A factorial analysis with varimax rotation and eigen values greater than 1 produced the following results: EAE-O: The structure obtained was compounded by three factors that explained 53.1% of the variance with Cronbach's alpha of .74 (Fear facing one's own aging, Positive attitude towards old people and Optimism facing one's own aging). EAE-A: The analysis shed a factorial structure compounded by four factors that explained 60.8% of the variance with a general internal alpha consistency of .76 (Positive attitude towards old people, Fear of physical changes, Age and satisfaction with the self and life, and Age and dissatisfaction with the self and life). Concurrent validity. EAE-O. The correlation among the total punctuations of the EAE-O and APE was moderate and significant (r=.481, p<.000). The factors Fear facing one's own aging and Optimism facing one's own aging of the EAE-O, calculated here, obtained a moderate association with the total punctuation of the APE (r=.423, p<.000; r=.333, p<.000, respectively), and the factor of Positive attitude facing old people reported a very low association and no significant (r=.075, p=.252). As expected, the two factors of the APE that seem to evaluate positive and negative attitudes facing aging obtained moderate associations and significant with the two scales of the EAE-O that seem to evaluate the same attitudes (Optimism facing one's own aging, r=.415, p<.000; and Fear facing one's own aging, r=.424, p<.000, respectively). Consequently, a very low association was obtained when relating it with the opposite factor (v.gr. negative vs. positive). EAE-A. Associations between the factors Age and dissatisfaction and Age and satisfaction (similar to the factors of Fear facing one's own aging and Optimism facing one's own aging) and the total score of the APE were moderately high (r =.499, p<.000, and r =.383, p<.000, respectively), as long as the other two factors of the EAE-A presented associations moderately low. As it was to be expected, again were associated in an important way the EAE-A scales with a positive nuance (aging and satisfaction, Positive attitude before old people) with the scale of the APE's Positive attitude, and vice versa. The factors of aging and dissatisfaction and Fear to physical changes were significantly associated with the negative attitude of the APE. The relationship between perceived aging (when is one old?, and when is one too old?) and anxiety before aging; with a marginal meaning, it was found that those people with low levels of anxiety tend to refer an age but remote ( X - =68.2 years, DE= 9.8), than those with high levels of anxiety ( X - =64.47, DE=11.7; t=1.74, gl=57.9, p=.08), to the question of the age that one is "old". Concerning the question when is one too old?, the same tendency it was observed, but this time in a meaningful way (Low Anxiety: X - =80.9 years; DE=9.1; High Anxiety: X - =76.4 years; DE=9.1; t=2.51, gl=128, p=.01). Regarding suicidal ideation, it was found that subjects who score low levels of anxiety before aging according to EAE-A also had lower levels of anxiety of suicidal ideation ( X - = 1.25, DE=1.47), than those with high levels of anxiety ( X - =2.35, DE=2.51; t=2.84, gl=64.45, p=.006). Results contributed by the psicometric analysis of both versions of the EAE have allowed to confirm their utility in Mexican samples. Together, the EAE-O seems to investigate the anxiety before aging as a stage of life; as a state of being, and perhaps could be specially useful on people who are not necessarily elders (old people caretakers, adults between 50 and 60 years old in a frank transition towards the socially conceived old Adulthood, etc.). However, it could be worthwhile to focus on the singular situation of a subject regarding his own aging process (physical or psychosocial), when this is precisely the objective to be investigated; the EAE-A could be useful to this effect. Elderly adults seem to conceptualize "being old" as an event that occurs approximately at 70, and "very old" around 80; this chronological approach seems to obey, at least in part, to the level of anxiety before the aging process; the higher the anxiety, the earlier the beginning of old age. Results allowed to highlight the anxiety facing aging like a variable importantly linked to the psychological imbalance in the old adult, as it was possible to evidence in broadly significant terms with the EAE-A as with the APE, starting from their relationship with the suicidal ideational, and more, when this relationship is found in fellows without current marital commitment and of low educational level. This should be considered in programs of attention to this age sector where these factors of risk are evaluated with a view toward preventing the incidence of suicides. Different studies have highlighted the importance of developing a positive attitude before one's own aging and that of the other ones, in order to achieve a successful aging. This suggests the need to identify methods to promote positive attitudes in young adults toward the elders and the aging process.

Modelo psicológico para la investigación de los comportamientos de adhesión en personas con VIH / Psychological model for investigation of therapeutic compliance behaviors in people with HIV

Se presenta un modelo psicológico para la investigación de los comportamientos de adhesión al tratamiento en personas con VIH, cuyos elementos se agrupan en cuatro fases, dos psicológicas y dos biológicas. La primera incluye variables disposicionales -situaciones interactivas vinculadas con estrés, competencias funcionales y motivos- y comportamientos instrumentales de riesgo y prevención; la segunda contempla, en una primera instancia, la enfermedad por VIH y otras resultantes en diferentes patologías; la tercera, el papel que juegan dos tipos de comportamientos, los de adhesión al tratamiento y los asociados a la enfermedad; la cuarta y última, comprende los efectos potenciales que ambos comportamientos tienen sobre la modulación y vulnerabilidad biológicas, y su posterior impacto sobre el desarrollo de otras patologías relacionadas con el VIH, consideradas en la segunda fase.

The present paper proposes a psychological model for research on treatment adherence behavior in persons with HIV. The elements of the model are grouped in four stages, two psychological and two biological. The first includes dispositional variables such as interactive situations related to stress, functional competencies and motives, as well instrumental risk and preventive behaviors. The second includes the disease generated by HIV and others resulting in diverse pathologies. In the third phase, once pathology sets its course, the model involves the role of two types ofbehaviors, treatment adherence and those typically associated to the disease itself. The fourth includes the potentialeffects of the psychological components as modulators of both biological vulnerability and the development offurther HIV-related pathology.

Empowering women abused by their problem drinker spouses: effects of a cognitive-behavioral intervention

Abstract: According to the National Survey of Addictions, in México nearly one in ten males (9.6%) inhabiting urban areas complies with the alcohol dependence criterion established in the DSM-IV Problem drinking men frequently drive their spouses to develop severe personality disorders and tolerate extremely degrading situations. Diverse interventions have been used to treat these problems. These include group counseling, and improving self-esteem. Family therapy has also been used to assess the extent to which these women actually influence their problem-drinking partner. Family education may promote self-sufficiency and assertiveness. Other results suggest that group training reduces the abused spouse's psychiatric symptoms. Rational-Emotive Behavioral Therapy (REBT) operates on cognitive biases related to personal interaction and assertiveness. This includes effectively expressing desires, beliefs, needs, and opinions. Thus, the purpose of the present study was to examine the effects of an intervention designed to promote self-esteem, coping strategies and assertiveness in abused spouses of problem drinkers. Method A non-probabilistic random sampling procedure was used to select 35 women from two community centers. One produced 18 participants, and the other 17. All were spouses of problem drinkers, between 25 and 50 years of age and their schooling fluctuated from complete elementary school to college education and their socioeconomic level fluctuated from low to middle. A scheme similar to a multiple baseline design across two groups as well as an accidental control group, was used to evaluate the pertinent comparisons. Instruments used to collect data included the Assertion Inventory validated for Mexico by Guerra, the Coopersmith's Self-esteem Inventory, validated by Lara-Cantú, Verduzco, Acevedo and Cortés, The Coping Inventory and the Mini International Neuropsychiatric Interview (MINI). The Wilcoxon statistical test was run on the data in order to establish the probability associated to the differences between pretest and post-test, follow-up 1, follow-up 2 and follow-up 3. Results revealed significant improving differences on assertiveness, coping responses and self-esteem.

Resumen: Según la Encuesta Nacional de Adicciones, uno de cada diez varones (9.6%) que habitan en zonas urbanas cumplen el criterio de dependencia al alcohol del DSM-IV. Este consumo crea intensos problemas familiares, incluidos trastornos de la personalidad en las esposas, las lleva a tolerar situaciones extremas y abate su desarrollo personal. El presente estudio usó algunas técnicas como las de Loughead, Kelly y Bartlett en consejo psicológico (counseling) en grupo. También se ha señalado que al inicio de este tipo de tratamientos se requiere fortalecer la autoestima, antes de tratar los problemas familiares. La terapia familiar ha evaluado si estas mujeres influyen sobre sus parejas. Otras terapias buscan generar autosuficiencia y asertividad. Asimismo, hay hallazgos que señalan que el entrenamiento en grupo disminuye los síntomas psiquiátricos en parejas de bebedores problema. Así, es necesario generar en la pareja del bebedor cambios cognitivos y conductuales, entre otros. El presente estudio evaluó una intervención cognitivo-conductual sobre asertividad, autoestima y afrontamiento para habilitar a la pareja del bebedor. Algunos abordajes se basan en la reducción de cogniciones irracionales y su efecto en emociones negativas y sus conductas desadaptativas. La asertividad incluye la habilidad de expresar deseos, creencias, necesidades y opiniones Así, el propósito del presente estudio fue examinar los efectos de una intervención cognitivo-conductual en la autoestima, afrontamiento y asertividad en cónyu ges de bebedores problema. Método Se emplearon un diseño similar al de línea base múltiple y una condición control accidental. Se comparó la preevaluación con la postevaluación y seguimientos a tres, seis y 18 meses. Se usaron los siguientes instrumentos: Inventario de Asertividad de Gambrill y Richey, en versión validada por Guerra, el Inventario de Autoestima de Coopersmith, validado por Lara-Cantú, Verduzco, Acevedo y Cortés; el Inventario de Afrontamiento, descrito por Orford, Natera, Davis, Nava, Mora, Rigby, Bradbury, Bowie, Copello y Velleman, y la entrevista Mini International Neuropsychiatric Interview (MINI) 5.00, descrita por Ferrando, Bobes-García, Gilbert-Rahola y Lecrubier. Se captaron 35 parejas de bebedores problema de dos centros, uno comunitario del sur de la Ciudad de México, y otro del Centro de Ayuda al Alcohólico y sus Familiares: 18 en uno y 17 en el otro. Sus edades oscilaron entre los 25 y 50 años, y su escolaridad de primaria terminada a profesional, con un nivel socioeconómico de bajo a medio. Tres sufrían depresión mayor y tres abusaban del alcohol (canalizadas a otros programas); tres dejaron el estudio por razones laborales y ocho se dieron de baja voluntaria, con lo que permanecieron 18 participantes. A los datos se les aplicó la prueba de Wilcoxon en las diferencias entre preevaluación, postevaluación y los seguimientos 1, 2 y 3. Los resultados revelaron mejorías clínica y estadísticamente significativas en asertividad, afrontamiento y autoestima.

Quality os life in patients with diabetic nephropathy / Quality of life in patients with diabetic nephropathy

Chronic renal insufficiency (CRI)due to diabetic nephropaty (DN), represents in Mexicoa matter of concern in public health. This illness has an impact so much psysical as emotional along the process of the chronicity, this process deteriorates the quality of people's life that suffer it. For such reason, the purpose of the present investigation is to determine the impact of the deterioration of the quality of life in a sample of patients with diabetic nephropathy. It was carried out an expo-facto, af traverse type study, in this study we try to identify and typify their possible functional peculiarities. The fellows that participated in the study were 100 patients that attend to the continuos peritoneal dialysis program, in a hospital of the IMSS, of the capital of San Luis' State Potosí, diagnosed by their own doctors with DN. The deteriration of the quality of life was measured with the scale of quality of life related with the health (QOLRH), in its validated version and standardized to spanish. The dependent variable to consider was the evaluation of the index of deterioration of the quality of life estimated though the QOLRH scale. The independent variable understood the evolution time of the chronic-degenerative condition of the DN of the selected patients, as well as some socio-demographic aspects. the results revelead that 100 per cent of the studied sample deals with some grade of deterioration in its quality of life in the valued areas that included the scale. The areas of interaction stand out with the team of health, the sexual dysfunction, the emotional and physical aspects, among others. Having more risk in the deterioration, those patients with more than ten years of evolution of the suffering with DM-2, the educational level, over 50 years age. We conclude that the grade of deterioration of the quality of life in this type of patient with DN is progressive and associated to the degenerative evolution of illness.

La soledad como fenómeno psicológico: un análisis conceptual / Loneliness as a psychologic phenomenon: a conceptual analysis

Con el propósito de conocer algunos de los componentes psicológicos vinculados con la experiencia de la soledad, se hace un análisis exhaustivo de la bibliografía científica vinculada con este fenómeno. Se describen seis esquemas conceptuales que intentan explicar la soledad, identificando sus alcances y limitaciones tanto teóricas como metodológicas. Finalmente, se propone un esquema integrativo como opción para estudiar la soledad dentro del contexto mexicano.