Association between stressful life events during pregnancy and adverse pregnancy outcomes: a review / 预防医学

@#Improving the quality of newborns is a health development strategy, which has attracted global attention. Adverse pregnancy outcomes, including preterm birth, low birth weight and small for gestational age, are major causes of perinatal mortality and disability. Based on review of international and national publications pertaining to associations between stressful life events during pregnancy and adverse pregnancy outcomes from 2007 to 2023, this review summarizes the correlation between stressful life events during pregnancy and adverse pregnancy outcomes, including preterm birth, low birth weight and small for gestational age, and describes the underlying biological mechanisms. Previous studies have demonstrated the associations between maternal stressful life events during pregnancy and adverse pregnancy outcomes, and the underlying mechanisms mainly include neuroendocrine regulation, inflammation and microbiota pathways; however, the exact mechanisms remain unclear until now. Further studies to identify the critical window period for the association between stressful life events and adverse pregnancy outcomes, and unravel the pathogenesis of adverse pregnancy outcomes are warranted, so as to provide insights into reduction of adverse pregnancy outcomes.

Terapia sistémica breve en personas expuestas a un evento altamente estresante reciente: Un ensayo controlado aleatorizado / Brief systemic therapy in people exposed to a recent highly stressful event: A randomised controlled trial

Resumen: Antecedentes: Los eventos altamente estresantes pueden tener efectos nocivos en el bienestar y salud mental en las personas. Objetivo: Evaluar la eficacia de un protocolo de intervención preventiva basado en la Terapia Sistémica Breve orientado a personas que vivenciaron de manera reciente un evento altamente estresante. Método: Participaron 75 personas, 39 conformaron el grupo experimental y 36 el grupo control. Para el análisis de los datos se siguió un diseño cuantitativo con dos grupos (experimental y control) y con dos puntos temporales (pre y post-intervención). Al grupo experimental se añadió un seguimiento a los seis meses. El protocolo estuvo estructurado en cuatro sesiones y apuntaba a incidir sobre los síntomas postraumáticos, el crecimiento postraumático, la respuesta rumiativa y las estrategias de afrontamiento. Resultados: Se observó un aumento del crecimiento postraumático, de la rumiación deliberada, del afrontamiento centrado en el problema y de la reinterpretación positiva en el grupo experimental. En cambio, solo hubo una tendencia no significativa en la reducción de la sintomatología postraumática y en la búsqueda de apoyo social. Conclusiones: Estos resultados contribuyen al desarrollo de la Terapia Sistémica Breve y apoyan su utilidad en la intervención preventiva con personas expuestas a un evento altamente estresante.

Abstract: Background: Highly stressful events can have harmful effects on people's well-being and mental health. Objective: To evaluate the efficacy of a preventive intervention protocol based on Brief Systemic Therapy oriented to people who recently experienced a highly stressful event. Method: Seventy-five people participated, 39 were in the experimental group and 36 in the control group. A quantitative design with two groups (experimental and control) and two time points (pre- and post-intervention) was used for data analysis. A six-month follow-up was added to the experimental group. The protocol was structured in four sessions and aimed to impact on posttraumatic symptoms, posttraumatic growth, ruminative response and coping strategies. Results: An increase in posttraumatic growth, deliberate rumination, problem-focused coping, and positive reinterpretation was observed in the experimental group. In contrast, there was only a nonsignificant trend in reduced posttraumatic symptomatology and in seeking social support. Conclusions: These results contribute to the development of Brief Systemic Therapy and support its usefulness in preventive intervention with people exposed to a highly stressful event.

Evaluación de un protocolo de intervención en Terapia Sistémica Breve para personas expuestas a un evento estresante reciente / Evaluation of a Brief Systemic Therapy intervention protocol for people who have experienced a recent stressful event

Resumen Los eventos altamente estresantes son sucesos que potencialmente generan consecuencias negativas en las personas afectadas, como síntomas postraumáticos y depresivos. El presente estudio evalúa un protocolo de intervención preventiva, orientado a personas que han vivido un evento altamente estresante reciente, basado en la Terapia Sistémica Breve. Cuatro terapeutas aplicaron el protocolo a cuatro usuarias. Se entrevistó a estas ocho personas acerca de su experiencia en la aplicación y recepción del protocolo. Mediante escalas de fiabilidad y validez contrastada se evaluaron los cambios pre-post en sintomatología postraumática, sintomatología depresiva, crecimiento postraumático y satisfacción con la vida; también se midió la relación terapéutica. Los resultados muestran apreciaciones positivas en terapeutas y usuarias, el desarrollo de una relación terapéutica adecuada y avances en tres de los cuatro indicadores cuantitativos de cambio. Se concluye que el protocolo está en condiciones de utilizarse en estudios controlados.

Abstract Highly stressful events are occurrences that potentially create negative consequences for the affected people, such as post-traumatic and depressive symptoms. This study assesses a preventive intervention protocol, aimed to people who have lived a recent highly stressful event, based on the Brief Systemic Therapy. Four therapists applied the protocol to four female users. These eight persons were interviewed about the experience in relation to the application and reception of the protocol. Through contrasted reliability and validity scales, pre and post changes in posttraumatic symptomatology, depressive symptomatology, posttraumatic growth and satisfaction with life were assessed; the therapeutic relation was also measured. The results show positive appraisals in therapists and female users, the development of a proper therapeutic relation and progress in three out of four quantitative change indicators. It is concluded that the protocol is suitable to be used in controlled studies.

Estrategias de afrontamiento, estrés percibido y bienestar psicológico en individuos con cefalea primaria / Coping strategies, perceived stress and psychological well-being in individuals with primary headache

Resumen El propósito de este estudio fue evaluar la asociación entre las estrategias de afrontamiento, el bienestar subjetivo y el estrés en personas con cefalea primaria -es decir, con dolor de cabeza sin origen orgánico-. En total, participaron 150 personas adultas -135 mujeres y 15 hombres- diagnosticadas con cefalea primaria y episodios de cefalea en los últimos seis meses. Los instrumentos de medida utilizados fueron la Escala de satisfacción con la vida de Diener, la escala de estrategias de afrontamiento Brief Cope, la Escala de estrés percibido de Cohen, dos preguntas sobre la intensidad y frecuencia del dolor, y un cuestionario sociodemográfico. En general, se encontró que el bienestar subjetivo se relaciona positivamente con la planificación y negativamente con el uso de sustancias y la frecuencia del dolor; a la vez que el estrés percibido se asocia positivamente con negar la realidad del acontecimiento estresante, culpabilizarse por la situación ocurrida y la frecuencia del dolor, y negativamente con la aceptación de la situación estresante. Además, se observó un mayor estrés percibido en usuarios de atención pública de salud que en aquellos que son atendidos en el sistema privado. Este estudio permite identifi car las estrategias que deben ser potenciadas o modificadas con ayuda del personal de salud para mejorar la calidad de vida de las personas con cefalea primaria.

Abstract The purpose of this study was to assess the association between coping strategies, subjective well-being and stress in people with primary headache, i.e., headache with no organically -based origin. In total, 150 adult persons participated -135 women and 15 men -diagnosed with primary headache and headache episodes in the last six months. The measurement instruments used were the Diener Life Satisfaction Scale, the Brief Cope Coping Strategies Scale, the Cohen Perceived Stress Scale, two questions on pain intensity and frequency, and a sociodemographic questionnaire. In general, it was found that subjective well-being is positively related to planning and negatively to substance use and frequency of pain; while perceived stress is positively associated with denying the reality of the stressful event, blaming oneself for the situation that occurred and the frequency of pain, and negatively with accepting the stressful situation. Also, greater perceived stress was observed in users of public health care than in those who are seen in the private system. This study allows the identification of strategies that should be enhanced or modified with the help of health personnel to improve the quality of life of people with primary headache.

A study on the evaluation of Stressful Impact of the COVID-19, Depression and Anxiety among Healthcare Workers and Non-Health Care people who have recovered from COVID 19

Background: Due to the COVID-19, there is an increase in psychological complaints. Healthcare and non- healthcare persons have had differential complaints like anxiety, depression, stress. Such complaints have also seen in the general public but more so in recovered patients from COVID-19. With this background, we conducted this study find out the stressful impact of COVID-19, prevalence of stress, anxiety and depression between healthcare workers and non-healthcare people. Methodology: A cross-sectional study was done in the tertiary-care COVID hospital in Ahmedabad. 50 healthcare workers (HCWs) and 50 non-healthcare people (NHCPs) who had recovered from COVID-19 were included (age 18-65 years) in the study after they consented for the same. They are assessed with a clinical socio-demographic proforma, clinical variables, Impact Of Event Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9) and Anxiety-Self Rating Scale (ASRS). The results were then statistically analysed. Results: Distress by stressful life events and anxiety were not significant (14% and 32%), (14% and 30%) in HCWs and NHCPs respectively. Depression was more prevalent (44% and 38%) in HCWs and NHCPs respectively. Medical illness was more in NHCPs (50%) compared to HCWs (4%) and associated with depression (52.63%) in NHCPs as compared to HCW (4.5%). Clinical variables, O2 requirement was also more in NHCPs (20%) as compared to HCWs (4%) and also significantly associated with anxiety (40% and 12.5%) and depression (36.84% and 4.5%) in NHCPs and HCWs respectively. Conclusions: The prevalence of depression was much higher amongst HCWs and suggests more attention would be required for improving the mental health among HCWs and NHCPs and overall mental health needs attention in patients that are recovering from COVID-19.

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

BACKGROUND@#Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates.@*METHODS@#Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being.@*RESULTS@#86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = -0.096, 95% CI -0.176, -0.033), multiple ACEs (β = -0.338, 95% CI -0.498, -0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being.@*CONCLUSIONS@#Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.

Evidence of validity, reliability and psychometric parameters of the items of the Cognitive Emotion Regulation Questionnaire-Short (CERQ-Short) / Evidência de validade, fidedignidade e parâmetros psicométricos dos itens do Questionário Cognitivo de Regulação Emocional-Short (CERQ-Short) / Evidencia de validez, fidedignidad y parámetros psicométricos de los ítems del Cuestionario Cognitivo de Regulación Emocional-Short (CERQ-Short)

The aim of the present study was to evaluate the construct validity, internal consistency and psychometric indicators of the reduced version of the Cognitive Emotion Regulation Questionnaire (CERQ-short). The CERQ-short was adapted and translated to Portuguese prior to its administration to 254 adults, mainly from the state of Paraíba, Brazil. The Difficulties in Emotion Regulation Scale (DERS), the Compulsive Buying Scale (CBS) and a sociodemographic questionnaire were also applied. The original CERQ-short nine-factor structure was preserved. The convergent and discriminant validity, the reliability and the psychometric adequacy concerning item difficulty and item discrimination were also confirmed. The results support the use of this scale for rapid screening and research. (AU)

O presente estudo teve como objetivo buscar evidências de validade de construto, de consistência interna e indicadores psicométricos dos itens da versão adaptada para o português do Questionário Cognitivo de Regulação Emocional versão reduzida (CERQ-short). Após tradução e adaptação, foi aplicado o CERQ-Short, as escalas de dificuldade em regulação emocional (DERS) e de Compras Compulsivas (CBS), além de um questionário demográfico em uma amostra de 254 adultos, maioria de paraibanos. Verificou-se que a estrutura original de nove fatores do CERQ-Short foi mantida, também foram confirmadas as validades convergente e discriminante, a fidedignidade e a adequação psicométrica dos itens no que se refere à dificuldade e à discriminação dos itens. A escala apresentou evidência para a utilização em rastreio rápido e pesquisas. (AU)

El presente artículo tuvo como objetivo la búsqueda de evidencias de la validez del construto e indicadores psicométricos de los ítems, de una versión adaptada para el portugués, del Cuestionario Cognitivo de Regulación Emocional, versión reducida (CERQ-short). Inicialmente, fue realizada la traducción y adaptación semántica; posteriormente, fue aplicado el cuestionario CERQ-Short a las escalas de dificultad en regulación emocional (DERS) y de las Compras Compulsivas (CBS), además de un cuestionario demográfico en una muestra de 254 adultos, la mayoría de los paraibanos. Se verificó que la estructura original de nueve factores del CERQ-Short fue mantenida, así como las evidencias de validez del construto, fiabilidad y adecuación psicométrica de los ítems. La escala presentó evidencias para la utilización en rastreo rápido y pesquisas. (AU)

Influencia del historial de victimización en mujeres nicaragüenses en la transmisión intergeneracional de la violencia / Influence of the victimization history in Nicaraguan women in the intergenerational transmission of violence

Resumen La exposición a la violencia y las experiencias de abuso infantil son factores de riesgo para su reproducción en la siguiente generación. Muchos estudios han analizado la transmisión intergeneracional de la violencia, aunque en menor medida se ha investigado este fenómeno en Nicaragua. El objetivo del presente trabajo es analizar la relación entre el historial de maltrato en madres nicaragüenses en situación de pobreza y la violencia en la siguiente generación. En el estudio de corte transversal participaron 124 mujeres que han sufrido diversas formas de polivictimización a lo largo de su vida. Los resultados indican que la presencia de violencia en los y las menores se relaciona con el historial de victimización de la madre, circunstancia que predice la violencia ejercida y padecida en la siguiente generación. Visibilizar el maltrato en la infancia constituye un objetivo prioritario, ya que crecer en contextos en los que se normaliza la violencia deriva en su reproducción.

Abstract Exposure to violence in childhood and experiences of child abuse are risk factors for a consequent repetition of them in the next generation. Many studies have analyzed the intergenerational transmission of violence, although this phenomenon has been investigated to a lesser extent in Nicaragua. The objective of this paper is to analyze the relationship between the history of abuse in Nicaraguan mothers in poverty and the violence in the next generation. The cross-sectional study involved 124 women who have undergone various forms of poly-victimization throughout their lives. The results indicate that the presence of violence in children is related to the mother's victimization history, circumstance that predicts the violence suffered in the next generation. Highlighting and identifying child abuse constitutes a priority objective, since growing up in contexts where violence is normalized leads to its reproduction.

Validación psicométrica de la versión breve del Inventario de Características Institucionales Estresoras / Psychometric validation of the short version of the Inventory of Stressor-related Institutional Characteristics

Resumen Objetivo: Realizar la validación psicométrica del Inventario de Características Institucionales Estresoras. Método: Estudio instrumental desarrollado a través de la aplicación del Inventario de Características Institucionales Estresoras a 300 alumnos de la Universidad Pedagógica de Durango, en Durango, México; de estos alumnos el 32% son del sexo masculino y el 68% del sexo femenino, la edad mínima es de 19 años y la máxima de 67 años, siendo el promedio 29 años de edad, y el 75% cursaba en ese momento la licenciatura y el 25% restante la maestría o doctorado. Resultados: Se construyó una versión breve del inventario, la cual obtuvo un nivel de confiabilidad de .71 en alfa de Cronbach; en el análisis de consistencia interna todos los ítems correlacionaron positivamente (con un nivel de significación de p< .001) con el puntaje global obtenido por cada encuestado; el análisis factorial exploratorio reporta dos componentes que explican 40% de la varianza total y el análisis factorial confirmatorio muestra un buen ajuste a dos factores (χ2 = 16,70; RMSEA = 0,000; χ2 / df = 0,49). Conclusión: Las características institucionales generadoras del estrés, en las instituciones escolares, es una de las áreas del campo de estudio del estrés menos investigada; una de las razones centrales es la falta de instrumentos que permitan medir cómo diversas variables situacionales influyen en la valoración que el sujeto hace de las demandas para considerarlas estresores. En ese sentido, esta versión breve del ICIE se vuelve una opción válida para este tipo de estudios.

Abstract Objective: Perform the psychometric validation of the Inventory of Stressor Institutional Characteristics. Method: Instrumental study developed through the application of the Inventory of Stressor Institutional Characteristics to 300 students of the Pedagogical University of Durango, Durango, Mexico; of these students 32% are male and 68% female, the minimum age is 19 years and the maximum of 67, with the average being 29 years of age, and 75% were studying at the time the degree and the remaining 25% the masters or doctorate. Results: A short version of the inventory was built, which obtained a reliability level of .71 in Cronbach's alpha; in the analysis of internal consistency, all the items correlated positively (with a level of significance of p <.001) with the overall score obtained by each respondent; exploratory factor analysis reports two components that explain 40% of the total variance and the confirmatory factor analysis shows a good adjustment to two factors (χ2 = 16.70, RMSEA = 0.000, χ2 / df = 0.49). Conclusion: Institutional characteristics that generate stress, in school institutions, is one of the least researched areas ; one of the main reasons is the lack of instruments that allow us to measure how various situational variables influence the assessment that the subject makes of the demands to consider them stressors. In this sense, this short version of the ICIE becomes a valid option for this type of studies.

Psychiatric Morbidity and Stressful Life Events in Elderly -A Hospital Based Cross-Sectional Study.

BACKGROUND There has been increasing prevalence of mental health problems in the elderly, with stressful life events being a precipitating factor and hence impairing the quality of life.METHODS263 patients of age 60 years and above attending psychiatry outpatient department and admitted in medical wards were included in the study. Patients with MMSE score ≥24 were included in the study. MINI PLUS was used to assess the psychiatric morbidity. Life events were assessed by PSLES. Statistical analysis was done using SPSS. Descriptive statistics and chi-square test were used for analysis.RESULTSOut of 263 patients, 207 (78.7%) were in the age group 60-69 yrs. The common psychiatric morbidity was found to be depression (43%), substance use disorders (16.7%) and anxiety spectrum disorders (15.5%). The most common precipitating stressful life events were family conflict (9.5%), son or daughter leaving home (8.7%), death of spouse (6.5%) and financial loss (6.5%). The common psychiatric morbidity precipitated by stressful life events were depression (44.4%) and substance use (18.2%) followed by anxiety and stress related disorders (22.2%).CONCLUSIONSThe above study emphasizes that psychiatric morbidity is common in the geriatric population, of which depression is the most common mental health problem. Stressful life events can lead to mental health problems. These factors impair the quality of life of the elderly. Hence it necessitates psychiatrists and physicians to recognize mental health problems at the earliest and provide the necessary support to improve the quality of life.

Relationship between stressful life events and emotional intelligence in Mexican adolescents: Male vs. female comparative study / Relación entre sucesos estresantes de la vida e inteligencia emocional percibida en adolescentes mexicanos: Estudio comparativo entre hombres y mujeres

Abstract Introduction Adolescents can present high levels of stress when faced with various biopsychosocial changes, affecting their daily activities and influencing the initiation and development of risk behaviours and/or a mental disorder. Therefore, it is important to identify protective factors against stress, such as emotional intelligence, for adolescents. Objective Determine the effect of stressful life events (SLE) and perceived emotional intelligence (PEI) on the stress level in adolescent high school students and identify differences by sex. Method Cross-sectional study, 1 417 adolescents (57% women and 43% men), with an average age of 15.90 (SD = .91), who were evaluated in levels of PEI, SLE, and stress perceived. Results The results show high rates of stressful events experienced. Attention to emotions increases the perception of stress in both sexes, while clarity and emotional repair have a stress-reducing effect on women. Discussion and conclusions The results suggest that the PEI is determinant in the emotional self-control and the adaptive capacity of the adolescent to face stressful situations.

Resumen Introducción Los adolescentes pueden presentar altos niveles de estrés cuando se enfrentan a diversos cambios biopsicosociales, que afectan sus actividades diarias e influyen en el inicio y el desarrollo de conductas de riesgo y/o trastornos mentales. Por lo tanto, es importante identificar en los adolescentes los factores de protección contra el estrés, como el caso de la inteligencia emocional. Objetivo Determinar el efecto de los sucesos vitales estresantes (SVE) y de la inteligencia emocional percibida (IEP) sobre el nivel de estrés en los adolescentes estudiantes de bachillerato e identificar las diferencias por sexo. Método Estudio transversal, con una muestra de 1 417 adolescentes (57% mujeres y 43% hombres), con una edad media de 15.90 (SD = .91), a los que se evaluó en niveles de IEP, los SVE y el estrés percibido de dichos SVE experimentados. Resultados Los resultados muestran altos índices de eventos estresantes experimentados. La atención a las emociones incrementa la percepción de estrés en ambos sexos, mientras que la claridad y la reparación emocional tienen un efecto amortiguador del estrés en mujeres. Discusión y conclusión Estos resultados sugieren que la IEP resulta determinante en el autocontrol emocional y la capacidad adaptativa del adolescente para afrontar situaciones estresantes.

Condiciones psicométricas de la Escala de Acontecimientos Vitales Estresantes usada en población colombiana / Psychometric Conditions of the Stressful Life Events Scale Used on Colombian Population

Resumen Objetivo. Determinar las condiciones psicométricas desde el modelo TRI y evaluar la permanencia a través del tiempo de su calidad métrica determinada desde la Teoría Clásica de los Test de la Escala de Acontecimientos Vitales Estresantes. Muestra. Fue de 1225 colombianos entre 17 y 64 años (M = 33.14; DT = 12.47) de edad y ambos sexos, estratificada por sexos y procedencia. Metodología. Se analizaron las condiciones psicométricas de la escala desde la Teoría de Respuesta al Ítem (TRI), se mejoró el formato de presentación, se definieron límites de interpretación de los puntajes, y se analizó la diferencia en el impacto psicológico provocado por cada evento de acuerdo al sexo. Resultados. Los resultados muestran que la escala cuenta con un nivel adecuado de validez y confiabilidad, que el cambio de formato facilita su diligenciamiento y que es necesario ratificar si existen diferencias de sexo que deben ser estudiadas.

Abstract Objective. This paper seeks to find the psychometric qualities of validity and reliability of the Scale of Stressful Life Events for Colombian people. Sample. 1225 participants aged between 17 and 64, (M = 33.14 years old; SD = 12.47) stratified by gender and origin. Method. We analyzed the psychometric conditions of the scale from the Item Response Theory (IRT) improved the format of presentation, defined limits of interpretation of the scores, and analyzed the difference in psychological impact caused by each event according to sex. Results. The results show that the scale has an adequate level of validity and reliability, that the change of format facilitates its correct fulfillment, and that the need to study differences between the sexes must be assessed further.

Effects of peppermint, chewing gum on memory, cognition, alertness, reaction time, arithmetic skills and athletic performance during laboratory induced stress in undergraduate medical students

Background: Many medical students are dealing with day to day stress in their lives and they need to be both physically and mentally active to counter and overcome their daily problems. In such scenario, a non-pharmacological adjunct could prove useful to counter all of it so that they can work more efficiently. Many universities do recommend the use of peppermints and chewing gums. This study is conducted to see if any of these items actually have an influence on cognitive and physical abilities.Methods: A non-randomized controlled trial was performed on the undergraduate medical students of N.K.P. Salve Institute of Medical Sciences and Research Centre belonging to the age group of 18-21 years. They were given normal flavoured gum, mint flavoured gum and peppermint. A series of cognitive and physiological tests in both stressful and stress free environments were performed.Results: Consumption of peppermint in a stressful environment showed increase in attention span of the subjects and it increased the intelligence Wechsler Adult Intelligence Scale-R (WAIS-R) in both stress free and stressful environments. As compared to normal gum, peppermint and peppermint gum proved to be more effective. There was no significant change observed in alertness, reaction time, arithmetic ability, short term memory and fatigue index in any of the subjects.Conclusions: Peppermint has caused increase in the attention span and intelligence of medical students in a stressful work scenario. Peppermint gum was found to be more beneficial than normal gum.

Validación de una prueba para medir eventos vitales estresantes en adultos gay, lesbianas y bisexuales colombianos / Validation test in order to measure stressful life events in Colombian gays, lesbians and bisexual adults

Resumen Objetivo: Evaluar las características psicométricas de una prueba para valorar eventos vitales estresantes (PEVE), así como comparar el constructo según sexo, edad y orientaciones sexuales no heterosexuales residentes en tres ciudades de Colombia, Barranquilla, Bogotá y Tunja. Método: Se implementó un muestreo no probabilístico tipo bola de nieve mediante el cual 208 participantes con edades entre 18 y 67 años (ME= 26,16; DE=8,56) diligenciaron la PEVE, que medía diversos eventos estresantes (EE). Resultados: La consistencia interna obtenida a través de alfa de Cronbach fue 0,79 y el Omega de McDonald fue de 0,89. El 34,62% no experimentó EE durante el pasado año, el 56,25% experimentó bajos niveles y solo un 9,13% tuvo EE en alto grado. Análisis Paralelo y Test MAP sugieren un único factor que explicó el 54% de la varianza. Los EE en mujeres se asocian con mayor proporción de discusiones con la familia debido a su homosexualidad (p<0,05), mientras que EE en hombres se asocian con problemas con la policía y ser agredidos físicamente (p<0,05). Con relación a orientación sexual, EE se asocian con mayor proporción de homosexuales que reportan problemas con familiares en comparación de la proporción de bisexuales (p<.05). Con respecto a la edad, adultos jóvenes tienden a experimentar mayores niveles promedio de EE que adultos (p<.05). Conclusión: En población LGB colombiana, PEVE muestra adecuada validez de constructo y consistencia interna. La mayoría de participantes perciben un nivel bajo de EE y estos niveles cambian teniendo en cuenta variables como el sexo, orientación sexual y edad. Se requieren más investigaciones en contextos latinoamericanos.

Abstract Objective: This paper aims to evaluate psychometric properties of the test stressful life events (SLE) and also to compare the construct according to sex, age and non-heterosexual sexual orientations in individuals who live in three different cities in Colombia, Barranquilla, Bogotá y Tunja. Method: A non-probabilistic or snowball sampling was implemented. 208 participants between 18 and 67 years old (ME = 26.16, SD = 8.56) who completed the SLE test, being measured various stressful events (SE). 34.62% did not face SE during last year, 56.25% have experienced low levels of SE and only 9.13% faced a high degree of SE. Parallel Analysis and MAP Test suggested a single factor that showed 54% of the variance. In women, SE are associated with discussions with their family because of their homosexuality (p <.05), but in men SE are associated with problems with the police and being physically assaulted (p <.05). In relation with sexual orientation, SE are associated with homosexuals who report problems with relatives, comparing with bisexuals (p <.05). According to age, results show that young adults tend to experience higher levels of SE than adults (p <.05). Conclusion: In Colombian LGB population, PEVE shows adequate construct validity and internal consistency. Most participants faced low level of SE and these levels change taking into account variables such as sex, sexual orientation and age. More researches are required in Latin American contexts.

Dificuldades percebidas na transição para a universidade / Dificultades percibidas en la transición para la universidad / xxx

Este estudo investigou as principais dificuldades enfrentadas por estudantes universitários durante o ingresso no ensino superior e se a percepção das mesmas poderia variar em função do gênero, do semestre no curso, do fato do estudante estar frequentando o curso inicialmente desejado e tipo de instituição. Participaram dessa pesquisa 423 estudantes. Através de duas questões abertas, investigou-se as principais dificuldades acadêmicas e não acadêmicas vivenciadas pelos estudantes. As respostas foram submetidas a análise de conteúdo temática. A principal dificuldade acadêmica observada foi relacionada a diferenças entre o ensino médio e o superior. Já entre as dificuldades não acadêmicas, "gestão do tempo" foi a mais frequentemente citada. Alunos da Universidade tenderam a apresentar um pouco mais de dificuldades do que os do Instituto Federal. Implicações metodológicas e práticas dos resultados são discutidas.

This study investigated the main difficulties faced by undergraduate students when entering higher education, and whether their perception could vary according to gender, semester, if the student is attending the course initially desired and type of institution. 423 students participated in this study. Through two open questions, the main academic and non-academic difficulties experienced by the students were investigated. The answers were submitted to thematic content analysis. The main academic difficulty observed was related to differences between high school and higher education. Among the non-academic difficulties, "time management" was the most frequently cited. Students from the University tended to present a little more difficulties than those of the Federal Institute. Methodological and practical implications of the results were discussed.

Este estudio investigó las principales dificultades enfrentadas por estudiantes universitarios al ingresar a la educación superior y si la percepción de las mismas podría variar con relación al género, semestre, hecho del estudiante estar frecuentando la carrera inicialmente deseada y tipo de institución. Participaron en la investigación 423 estudiantes. A través de dos cuestiones abiertas, se estudiaron las principales dificultades académicas y no académicas vivenciadas por los estudiantes. Las respuestas fueron sometidas a análisis de contenido temático. La principal dificultad académica observada está relacionada con las diferencias entre la enseñanza media y superior. Entre las dificultades no académicas, "la gestión del tiempo" fue citada con mayor frecuencia. Los estudiantes de la Universidad tienden a presentar un poco más de dificultades que los de la Institución Federal. Se discuten las implicaciones metodológicas y prácticas de los resultados.

Extrinsic Factors Influencing Relapse in Alcohol Dependence

Introduction: Relapse is a common problem faced whenalcohol dependence is treated. The present study was doneto find the influence of extrinsic factors such as stressful lifeevents, peer pressure and perceived social support on relapsein alcohol dependence, which will be useful to developeffective interventions to prevent it.Material and methods: This cross sectional study conductedin tertiary care teaching hospital in Kottayam, included 60subjects who were grouped into 30 Late Relapsers (whorelapsed drinking after 3 months of abstinence) and 30Early Relapsers-(who relapsed drinking within 3 months ofabstinence). Mini-Mental Status Examination, DiagnosticCriteria for Research for ICD-10 (DCR-10) and the StressfulLife Inventory were used for each patient to collect theirdetails.Results: The mean age of onset of alcohol use of EarlyRelapsers was lower than that of the Late Relapsers. Alsothe number of stressful life events related to work, marriage,family and finance were more in the Early Relapsers comparedto the other and the difference was statistically significant forthe above mentioned factors.Conclusions: Early age of onset of alcohol use and occurrenceof stressful life events in 6 months preceding the relapse areassociated with relapse in alcohol dependence. Communitybased studies with larger sample size are needed to substantiatethe results of this study

Influencia de los hábitos en la depresión del estudiante de medicina peruano: estudio en siete departamentos / Influence of Habits on Depression in the Peruvian Medical Student: Study in Seven Administrative Regions

RESUMEN Objetivo: Determinar la influencia de los hábitos en la depresión del estudiante de medicina de 7 departamentos de Perú. Métodos: Estudio transversal analítico de un análisis secundario de datos. El diagnóstico de depresión se obtuvo según el resultado del test de Zung, considerado positivo ante cualquier grado de esta condición. Además, se comparó esto con otras variables socioeducativas importantes según publicaciones previas. Resultados: De los 1.922 encuestados, el 54,5% (n = 1.047) eran mujeres; la mediana de edad era de 20 [intervalo intercuartílico, 18-22] arios. El 13,5% (n = 259) tenía algún grado de depresión según la escala de Zung. En el análisis multivariable, incrementaron la frecuencia de depresión la mayor cantidad de horas de estudio por día (razón de prevalencias ajustada [RPa] = 1,03; intervalo de confianza del 95% [IC95%], 1,01-1,04; p < 0,001) y que el estudiante trabaje (RPa = 1,98; IC95%, 1,21-3,23; p = 0,006); en cambio, disminuyeron la frecuencia de depresión tener horarios similares para comer (RPa = 0,59; IC95%, 0,38-0,93; p = 0,022) y un lugar fijo donde conseguir sus alimentos (RPa = 0,66; IC95%, 0,46-0,96; p = 0,030), ajustado por el año de ingreso a la universidad. Conclusiones: Se encontró que algunos factores estresantes predisponen a la depresión (trabajar y estudiar más horas por día); en cambio, tener un orden en su rutina diaria disminuye esta condición (tener un lugar y horarios fijos para comer.

ABSTRACT Objective: To determine the influence of habits on depression in medical students from 7 Peruvian Regions. Methods: Analytical cross-sectional study of a secondary data analysis. The diagnosis of depression was obtained according to the Zung test result, with any level of this condition being considered positive. This was also compared with other social and educational variables that were important according to previous literature. Results: Of the 1922 respondents, 54.5% (1047) were female. The median age was 20 [interquartile range, 18-22] years, and 13.5% (259) had some degree of depression according to the Zung scale. In the multivariate analysis, the frequency of depression increased with the hours of study per day (RPA= 1.03; 95%CI; 1.01-1.04; P<.001) and the student work (RPA = 1.98; 95%CI; 1.21-3.23; P=.006). On the other hand, decreased the frequency of depression decreased on having similar meal schedules (RPA = 0.59; 95%CI; 0.38-0.93; P=.022), and having a fixed place in which to get food (RPA = 0.66; 95%CI; 0.46-0.96; P=.030), adjusted for the year of college entrance. Conclusions: Some stressors predisposed to depression were found (the work and studying more hours a day). On the other hand, to have order in their daily routine decreased this condition (having a set place and times for meals).

Stressful Events and Executive Functioning in Adolescents with and without History of Grade Repetition / Eventos estresores y funcionamiento ejecutivo en adolescentes con y sin historia de repetición escolar

Abstract A number of studies have investigated the association between psychiatric disorders and alterations in cognitive development, academic performance, and learning ability. However, few studies have explored the relationship between stressful events and grade repetition. Therefore, the main goal of the present study was to compare the frequency of exposure to stressful events, academic performance, executive functioning, and performance on working memory tasks between adolescents with and without a history of grade repetition. This was a cross-sectional study. The sample was composed of 83 adolescents divided into two groups: (1) individuals with a history of grade repetition (n = 39) and (2) participants who had never repeated a grade (n = 44). Participants were administered tests to assess executive functions, intelligence, exposure to stressful events, and academic performance. Results showed that individuals with a history of grade repetition reported to experiencing a higher number of stressful events in adolescence, had worse academic performance, and obtained lower scores on executive functioning and working memory tasks than non-repeaters.

Resumen Varios estudios han investigado la asociación entre trastornos psiquiátricos y alteraciones en el desarrollo cognitivo, el rendimiento académico y la capacidad de aprendizaje. Sin embargo, pocos estudios han explorado la relación entre los eventos estresantes y la repetición escolar. Por lo tanto, el objetivo principal de este estudio fue comparar la frecuencia de exposición a eventos estresantes, el rendimiento académico, el funcionamiento ejecutivo y el desempeño en tareas de memoria de trabajo en los adolescentes con y sin antecedentes de repetición escolar. Se trata de un estudio transversal. La muestra estuvo constituida por 83 adolescentes, divididos en dos grupos: (1) los individuos con antecedentes de repetición escolar (n = 39) y (2) los participantes que nunca repitieron un año escolar (n = 44). Los participantes fueron sometidos a pruebas para evaluar las funciones ejecutivas, la inteligencia, la exposición a eventos estresantes y el rendimiento académico. Los resultados mostraron que los individuos con historia de repetición escolar relataron la ocurrencia de un mayor número de eventos estresantes durante la adolescencia, tuvieron un peor rendimiento académico y obtuvieron puntuaciones más bajas en las tareas de funcionamiento ejecutivo y memoria de trabajo que los que no repitieron.

Acute stress disorder and defense mechanisms: a study of physical trauma patients admitted to an emergency hospital / Transtorno de estresse agudo e mecanismos de defesa: pesquisa com pacientes que sofreram trauma físico atendidos em um hospital de emergência

Abstract Introduction: Acute stress disorder (ASD) encompasses a set of symptoms that can arise in individuals after exposure to a traumatic event. This study assessed the defense mechanisms used by victims of physical trauma who developed ASD. Method: This was a controlled cross-sectional study of 146 patients who suffered physical trauma and required hospitalization. A structured questionnaire was used to evaluate ASD symptoms based on DSM-5 diagnostic criteria, in addition to the Defense Style Questionnaire (DSQ). Results: Ten participants (6.85%) received a positive diagnosis of ASD, and 136, (93.15%) a negative diagnosis. The majority of the sample consisted of men with median age ranging from 33.50 to 35.50. The most prevalent defense mechanisms among the 10 patients with ASD were cancellation and devaluation, which belong to the neurotic and immature factors, respectively. Positive associations between the presence of symptoms from criterion B of the DSM-5 and defense mechanisms from the DSQ were found. These included the mechanisms of undoing, projection, passive aggression, acting out, autistic fantasy, displacement, and somatization. Conclusion: Patients with ASD employed different defense mechanisms such as undoing and devaluation when compared to patients not diagnosed with ASD. These results mark the importance of early detection of ASD symptoms at a preventative level, thereby creating new possibilities for avoiding exacerbations related to the trauma, which represents an important advance in terms of public health.

Resumo Introdução: O transtorno de estresse agudo (TEA) reúne um conjunto de sintomas que pode surgir nos indivíduos após exposição a um evento traumático. Este estudo verificou a relação entre o estilo defensivo e o desenvolvimento de TEA e seus sintomas em uma amostra de pacientes que sofreram trauma físico. Métodos: Este estudo transversal controlado envolveu 146 pacientes que sofreram trauma físico e necessitaram hospitalização. Um questionário estruturado foi utilizado para avaliar sintomas de TEA, baseado nos critérios diagnósticos do DSM-5, além do Questionário de Estilo Defensivo (Defense Style Questionnaire - DSQ). Resultados: Dez (6,85%) pacientes tiveram diagnóstico positivo para TEA, e 136 (93,15%), diagnóstico negativo. A maioria da amostra foi composta por homens com idade mediana variando de 33,50 a 35,50. Nos 10 pacientes positivos para TEA, destacou-se a maior utilização de mecanismos de defesa de anulação e desvalorização, pertencentes ao fator neurótico e ao fator imaturo, respectivamente. Foram observadas associações positivas entre presença de sintomas de TEA do critério B do DSM-5 e os mecanismos de defesa do DSQ, sobretudo nos mecanismos de anulação, projeção, agressão passiva, acting out, fantasia autística, deslocamento e somatização. Conclusão: Pacientes com TEA utilizaram mais mecanismos de defesa do tipo anulação e desvalorização quando comparados aos pacientes sem diagnóstico de TEA. Ressalta-se a importância da detecção precoce de sintomas de TEA a fim de evitar outros agravos relacionados ao trauma, o que representa uma importante evolução em termos de saúde pública.

Transtornos relacionados a traumas e a estressores / Trauma and stressor-related disorders

Os Transtornos relacionados a traumas e a estressores são quadros psiquiátricos relacionados a exposi- ção a um evento traumático ou estressante, resultando em sofrimento psicológico relevante, prejuízo social, profissional e em outras áreas importantes da vida do indivíduo. A apresentação clínica de tais transtornos é caracterizada por sintomas de ansiedade e de medo, anedonia, disforia, externalizações da raiva, agressividade e sintomas dissociativos. De acordo com a 5ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5), as categorias diagnósticas inclusas nesse espectro são Transtorno de Apego Reativo, Transtorno de Interação Social Desinibida, Transtorno de Estresse PósTraumático, Transtorno de Estresse Agudo e os Transtornos de Adaptação. O objetivo desta revisão é introduzir o debate sobre a conceituação clínica e as diretrizes terapêuticas dos Transtornos Relacionados a Traumas e a Estressores, direcionando a escolha do profissional pelas práticas terapêuticas adequadas relacionadas a tais categorias diagnósticas. Além disso, os autores discutem as consequências do Estresse Precoce (situações traumáticas ocorridas na infância e adolescência) na vida adulta. (AU)

Trauma and Stressor-Related Disorders are psychiatric conditions related to exposure to a traumatic or stressful event, resulting in significant psychological distress social, professional and other relevant areas of the individual's life. The clinical presentation of these disorders is characterized by symptoms of anxiety and fear, anhedonia, dysphoria, externalizations of anger, aggressiveness and dissociative symptoms. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic categories included in this spectrum are Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder and Adjustment Disorders. The objective of this review is to introduce the debate on clinical conceptualization and therapeutic guidelines of Trauma and Stressor-Related Disorders, directing professional's choice for proper therapeutic practices related to such diagnostic categories. Also, the authors discuss the consequences of early life stress (traumatic situations that occur in childhood and adolescence) in adulthood. (AU)