Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies.

BACKGROUND: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. OBJECTIVE: Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). METHODS: This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. RESULTS: A total of 2 co-design workshops were held with 18 users-young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions-young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. CONCLUSIONS: The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C-a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

Prevalencia de trastorno obsesivo compulsivo en adolescentes colombianos y su asociación con la doble condición de trabajo y estudio / Prevalence of obsessive-compulsive disorder among Colombian adolescents and its association with working while going to school

Objetivos: Estimar la prevalencia del trastorno obsesivo compulsivo (TOC) en niños y adolescentes escolarizados y determinar los factores sociodemográficos asociados. Método: Se desarrolló un estudio transversal con una muestra de 501 niños y niñas de 10 a 17 años de colegios de Bucaramanga. Se tomaron los datos sociodemográficos y se les realizó la entrevista clínica estructurada para los trastornos del eje I del DSM-IV, versión clínica. Se examinaron los factores sociodemográficos con un análisis bivariado. Se realizó análisis estratificado y una regresión logística no condicional, tomando el trabajo por dinero como una variable explicatoria de riesgo para el desarrollo de TOC. Resultados: La prevalencia del TOC fue de 7,4% (IC 95%: 5,3-10,0). Los estudiantes con TOC presentan una prevalencia de trabajo por dinero mayor que en los que no tienen (OR: 2,23; IC 95%: 1,0-4,4). Al controlar variables confusoras, las niñas que trabajaban por dinero mostraron un mayor riesgo en la presencia de TOC (OR: 5,4; IC 95%: 1,7-17,4). Conclusión: El estudio sugiere que la prevalencia del TOC en niños escolarizados de Bucaramanga es alta. La doble condición de trabajar y estudiar en las niñas podría ser un factor de riesgo asociado con TOC...

Objectives: To estimate the prevalence of obsessive-compulsive disorder (OCD) in children and adolescents attending school in Bucaramanga, Colombia, and to determine its associated socio-demographic factors. Method: A cross-sectional design was used with a sample size of 501 individuals between the ages of 10 to 17 years enrolled in Bucaramanga’s schools. They were administered a structured clinical interview OCD module. Socio-demographic data was also collected. The inquired sociodemographic factors were analyzed with bivariate analysis. Work for money was taken as a risk explanatory variable for developing OCD; stratified analysis and unconditional logistic regression were carried out. Results: Prevalence of OCD was found to be 7.4% (95% CI: 5.3-10.0) in this population. Students with OCD had a prevalence of working for money higher than those who did not (OR: 2.2; 95% CI: 1.0-4.4). Girls who worked for money showed a higher risk of having OCD than those who did not (OR: 5.4; 95% CI: 1.7-7.4), in a logistic regression model. Conclusion: These results suggest that the prevalence of OCD among Colombian school children is higher than elsewhere. In addition, working while going to school might be a risk factor associated with OCD in girls...

Validez y confiabilidad de la escala del Center for Epidemiologic Studies-Depression en estudiantes adolescentes de Colombia / Validity and reliability of the Center for Epidemiologic Studies-Depression scale on colombians adolescent students

Introducción. El trastorno depresivo mayor es la segunda causa productora de discapacidad en Latinoamérica. No hay escalas validadas en Colombia para adolescentes. Objetivo. Evaluar la validez y la confiabilidad de la escala del Centro de Estudios Epidemiológicos para la Depresión en adolescentes colombianos en edad escolar. Materiales y métodos. Se llevó a cabo un estudio de validación de la escala con una muestra de adolescentes en edad escolar de Bucaramanga. Se evaluaron con la escala para depresión y la entrevista clínica estructurada. La escala fue aplicada nuevamente 3 a 28 días después. Se determinaron la validez de criterio, la consistencia interna y la reproducibilidad prueba reprueba. Resultados. Se evaluaron 390 adolescentes con edad promedio de 14,8 +/- 1,22 años. La prevalencia de trastorno depresivo mayor fue de 11,5%. El índice de consistencia, o alfa de Cronbach, fue de 0,85. El área bajo la curva según las características receptor operador fue de 0,82 y el punto de corte mayor o igual a 23 mostró una sensibilidad de 73,3%. Se encontró: especificidad de 73,6%, valor diagnóstico positivo de 26,6% y valor diagnóstico negativo de 95,5%. El coeficiente de concordancia de Lin fue de 0,75. Conclusión. La validez y la confiabilidad de la versión en español de la escala en adolescentes en edad escolar del Centro de Estudios Epidemiológicos para la Depresión, fueron similares a las informadas anteriormente, aunque cambió el punto de corte.

Introduction. Major depressive disorder is the second major cause of adolescent psychological incapacitation in Latin-America. However, scales for detecting these disorders have not been validated for screening adolescents in Colombia. Objective. The validity and reliability of a Spanish translation of the Center for Epidemiologic Studies (CES-D)-Depression scale was assessed in adolescent students. Materials and methods. A validation study for a diagnostic scale was performed with a sample of 390 adolescent students from Bucaramanga, Santander Province, in northwestern Colombia. The students were evaluated by two methods: (a) the CPS-depression scale and (b) a semi-structured clinical interview. Three to 28 days after the interview, the scale was re-applied. Criterion validity, internal consistency and test-retest reliability was analyzed. Results. The mean age was 14.8 +/- 1.2 years old. The prevalence of major depressive disorder was 11.5%. Cronbach alpha was 0.85. The area under the curve produced by the receiver operating characteristic curve was 0.82, and the cut point of 23 showed a sensitivity of 73.3%; specificity, 73.6%; positive predictive value, 26.6%, and negative predictive value, 95.5%. Linchs coefficient of concordance was 0.75. Conclusions. The validity and reliability of the Spanish translation of the CES-D scale were similar to those reported in the international literature although with a higher cut point.

[Validity and reliability of the Center for Epidemiologic Studies-Depression scale in Colombian adolescent students]. / Validez y confiabilidad de la escala del Center for Epidemiologic Studies-Depression en estudiantes adolescentes de Colombia.

INTRODUCTION: Major depressive disorder is the second major cause of adolescent psychological incapacitation in Latin-America. However, scales for detecting these disorders have not been validated for screening adolescents in Colombia. OBJECTIVE: The validity and reliability of a Spanish translation of the Center for Epidemiologic Studies (CES-D)-Depression scale was assessed in adolescent students. MATERIALS AND METHODS: A validation study for a diagnostic scale was performed with a sample of 390 adolescent students from Bucaramanga, Santander Province, in northwestern Colombia. The students were evaluated by two methods: (a) the CPS-depression scale and (b) a semi-structured clinical interview. Three to 28 days after the interview, the scale was re-applied. Criterion validity, internal consistency and test-retest reliability was analyzed. RESULTS: The mean age was 14.8 +/- 1.2 years old. The prevalence of major depressive disorder was 11.5%. Cronbach's alpha was 0.85. The area under the curve produced by the receiver operating characteristic curve was 0.82, and the cut point of > or =23 showed a sensitivity of 73.3%; specificity, 73.6%; positive predictive value, 26.6%, and negative predictive value, 95.5%. Lin's coefficient of concordance was 0.75. CONCLUSIONS: The validity and reliability of the Spanish translation of the CES-D scale were similar to those reported in the international literature although with a higher cut point. CONCLUSIONS: The validity and reliability of the Spanish translation of the CES-D scale were similar to those reported in the international literature although with a higher cut point.

Short-Interval Test-Retest Interrater Reliability of the Spanish Version of the Structured Clinical Interview for DSM-IV for Depressive Disorder * * / Confiabilidad interevaluador prueba- reprueba en un intervalo corto de la versión en español de la Entrevista Clínica Estructurada para Trastorno Depresivo

Introduction: Psychometric data concerning structured clinical interviews are affected by age and population characteristics. The present study was designed to investigate the test-retest interrater reliability of a Spanish version of the Structured Clinical Interview for Major Depressive Disorder (MDD) in adolescent students from Colombia. Methods: All participants were interviewed by a psychiatrist with the section for current MDD from the Spanish SCID-I clinical version; after three to ten days another psychiatrist performed the same interview. Both adolescent and second interviewer were blind to the first interview results. The statistical significance of kappa was tested by calculation of z-score. Statistical tests were done in STATA 8.0. Results: 164 adolescents were interviewed; mean age was 15.3 years (SD 0.96); 125 (76.2%) were female. The test-retest levels of agreement between first rater and second rater for current MDD was Kappa coefficient 0.612 (CI 95% 0.457-0.765). Conclusions: The results of this study suggest that SCID-I is reliable not only in adults, as was previously demonstrated, but also in adolescents. New studies are necessary to test the reliability of the different modules of the SCID in adolescents.

Introducción: Los datos psicométricos acerca de la entrevista clínica estructurada son modificados por la edad y las características de la población. El objetivo del presente estudio es establecer la confiabilidad interevaluador prueba-reprueba en un intervalo corto de la versión en español de la Entrevista Clínica Estructurada (SCID, por su sigla en inglés) para trastorno depresivo mayor (TDM) en estudiantes adolescentes. Métodos: Un psiquiatra entrevistó a todos los participantes con el módulo para TDM de la versión clínica en español de la SCID-I; tres a diez días después otro psiquiatra realizó la misma entrevista. El adolescente y el entrevistador fueron enmascarados respecto a los resultados de la primera entrevista. La significancia estadística de kappa fue analizada mediante el cálculo del resultado de z. Los análisis estadísticos fueron hechos en STATA 8.0. Resultados: Se entrevistaron a 164 adolescentes, cuyo promedio de edad era 15,3 años (DS: 0,96); 125 (76,2%) eran mujeres. El nivel de concordancia prueba-reprueba del primero y el segundo entrevistador para TDM actual mostró un coeficiente de kappa de 0,612 (IC 95%: 0,457-0,765). Conclusiones: Estos resultados sugieren que la SCID-I es confiable en adolescentes y en adultos, como se ha demostrado previamente. Son necesarios nuevos estudios para probar la confiabilidad de los diferentes módulos de la SCID en adolescentes.

[Prevalence of Obsessive Compulsive Disorder and its comorbidity with Major Depressive Disorder in adolescent students]. / Prevalencia del Trastorno Obsesivo Compulsivo y su comorbilidad con el Trastorno Depresivo Mayor en adolescentes escolarizados.

INTRODUCTION: at least two-thirds of the adolescents with Obsessive Compulsive Disorder have another psychiatric disorder. The objective of this study was to estimate the prevalence of Obsessive Compulsive Disorder and Major Depressive Disorder in adolescent students and its comorbidity. METHODS: 390 adolescents were performed a structured clinical interview, clinical version: Obsessive Compulsive Disorder and Major Depressive Disorder modules. The inquired sociodemographic factors were analyzed with bivariate and multivariate statistical analysis and with non conditional logistic regression. RESULTS: Obsessive Compulsive Disorder was 7.63, its comorbility with major depressive disorder was 48.27 and there was an association between both disorders (OR 6.6 IC 3.45 - 12.61); Major Depressive Disorder prevalence was 11.7; when we controlled confusing variables in women we found that work (OR 3,14), age (OR 1,45) and major depressive disorder (OR 3,88), showed higher risk of having Obsessive Compulsive Disorder; in contrast with the men just Major Depressive Disorder showed higher risk of having obsessive compulsive disorder (OR 10,88). CONCLUSIONS: the Obsessive Compulsive Disorder and Major Depressive Disorder prevalence and its association in adolescent students are high; age and work could be a risk factor of having Obsessive Compulsive Disorder.

Prevalencia del Trastorno Obsesivo Compulsivo y su comorbilidad con el Trastorno Depresivo Mayor en adolescentes escolarizados / Prevalence of Obsessive Compulsive Disorder and its comorbidity with Major Depressive Disorder in adolescent students

Introducción: dos tercios de los adolescentes con Trastorno Obsesivo Compulsivo tienen otro diagnóstico psiquiátrico. El objetivo del estudio fue estimar la prevalencia del Trastorno Obsesivo Compulsivo y del Trastorno Depresivo Mayor en adolescentes escolarizados y su comorbilidad. Métodos: 390 adolescentes realizaron la entrevista clínica estructurada para los trastornos del Eje 1, módulos para Trastorno Obsesivo Compulsivo y Trastorno Depresivo Mayor. Examinamos los factores socio demográficos con análisis bivariado, estratificado y con regresión logística no condicional. Resultados: la prevalencia del Trastorno Obsesivo Compulsivo fue 7,63, la comorbilidad con depresión fue 48,27 y se encontró asociación entre los dos dos trastornos (RP 6,6 IC 3,45 - 12,61); la prevalencia de depresión fue 11,7; controlando variables confusoras en mujeres se observó que trabajar (RP 3,14), la edad (RP 1,45) Y tener trastorno depresivo mayor (RP 3,88), aumentan el riesgo de padecer de trastorno obsesivo compulsivo; en cambio en hombres solo el trastorno depresivo mayor mostró un mayor riesgo (RP 10,88). Conclusiones: la prevalencia del trastorno obsesivo compulsivo y trastorno depresivo mayor así como su comorbilidad en adolescentes escolarizados es alta; la edad de las adolescentes y el hecho de trabajar podrían ser un factor de riesgo en la presencia de Trastorno Obsesivo Compulsivo.

Introduction: at least two-thirds of the adolescents with Obsessive Compulsive Disorder have another psychiatric disorder. The objective of this study was to estimate the prevalence of Obsessive Compulsive Disorder and Major Depressive Disorder in adolescent students and its comorbidity. Methods: 390 adolescents were performed a structured clinical interview, clinical version: Obsessive Compulsive Disorder and Major Depressive Disorder modules. The inquired sociodemographic factors were analyzed with bivariate and multivariate statistical analysis and with non conditional logistic regression. Results: Obsessive Compulsive Disorder was 7.63, its comorbility with major depressive disorder was 48.27 and there was an association between both disorders (OR 6.6 IC 3.45 -12.61); Major Depressive Disorder prevalence was 1l.7; when we controlled confusing variables in women we found that work (OR 3,14), age (OR 1,45) and major depressive disorder (OR 3,88), showed higher risk of having Obsessive Compulsive Disorder; in contrast with the men just Major Depressive Disorder showed higher risk of having obsessive compulsive disorder (OR 10,88). Conclusions: the Obsessive Compulsive Disorder and Major Depressive Disorder prevalence and its association in adolescent students are high; age and work could be a risk factor of having Obsessive Compulsive Disorder.

Adicción a Internet: revisión crítica de la literatura / Internet Addiction: A Critical Review of the Literature

Introducción: La adicción a Internet (AI) es una dependencia psicológica caracterizada por un incremento en las actividades que se realizan por este medio, con malestar cuando la persona no está en línea, tolerancia y negación de su problemática. Objetivos: Realizar una revisión crítica, profunda y actualizada de la literatura sobre la AI. Desarrollo y conclusión: Su importancia para la salud pública radica en el creciente aumento de su prevalencia en el mundo, especialmente en adolescentes, con graves consecuencias en la salud mental, como problemas familiares, relaciones sociales, rendimiento académico, abuso de sustancias, alcohol y cigarrillo y trastornos mentales: depresión, trastorno bipolar, défi cit de atención e hiperactividad y suicidio. Aunque la sociedad colombiana y los medios de comunicación han llamado la atención sobre su presencia y consecuencias, no hay estudios sobre la prevalencia de la AI en Colombia y sus factores de riesgo o asociados. Esto se debe, en parte, a la ausencia de instrumentos válidos y confi ables para tamizar o diagnosticar este trastorno.

Introduction: Internet Addiction (IA) is a psychological dependence. Symptoms of IA often include increased preoccupation with online activities, symptoms of withdrawal when not online, tolerance and denial of IA. Objective: The objective of this paper is to make a critical, in depth and update review of the scientifi c literature about IA. Results- conclusion: IAs importance in public health lies in the ongoing increase of its prevalence around the world especially in adolescents, with serious consequences on their mental health such as family problems, impaired social relations and academic achievement, alcohol, cigarette and other substance abuse and the presence of mental disorders such as depression, bipolar disorder, ADHD (Attention Defi cit Hyperactivity Disorder) and suicidal behavior. Even though Colombian society and the media have shed a light upon its presence and consequences, there are not any studies about the prevalence of Internet Addiction in Colombia and its associated risk factors, explained in part by the absence of a psychometrically developed assessment instrument.

[Validation of the short version of the Leyton obsessional inventory for children and adolescents in Bucaramanga, Colombia]. / Validación del Inventario de Obsesiones de Leyton, versión corta, en niños y adolescentes de Bucaramanga (Colombia).

OBJECTIVE: To determine the internal consistency, factorial structure, reproducibility and validity of criterion of the Leyton Obsessional Inventory in children and adolescents. DESIGN: Study of validation with probabilistic sampling. SETTING: Secondary schools in Bucaramanga, Colombia. PARTICIPANTS: A total of 581 students selected at random, of whom 38 did not answer, 8 were excluded because they were over 17, and 33 did not attend the clinical interview. MAIN MEASUREMENTS: The Inventory and the Structured Clinical Interview for axis I of the DSM-IV (SCID-I), clinical version, were used. Cronbach's alpha, factorial analysis, sensibility, specificity, probability, and Lin' s coefficient were calculated. RESULTS: The prevalence of obsessive-compulsive disorder was 11.8% (95% CI, 8.9-14.6). Cronbach's alpha was 0.803 and just one factor with 3.60 eigenvalue explained 74.8% of variance. The area under the ROC curve was 0.799 (95% CI, 0.752-0.847) and the best cut-off point was 12, with sensitivity at 69.5% (95% CI, 56.0-80.5) and specificity at 77.7% (95% CI, 72.9-88.9). Its reproducibility was acceptable (Lin's coefficient at 0.752; 95% CI, 0.714-0.790). CONCLUSION: The Leyton Obsessional Inventory is a fair screening tool for detecting obsessive-compulsive disorder in Colombian children and adolescents.

Validación del Inventario de Obsesiones de Leyton, versión corta, en niños y adolescentes de Bucaramanga (Colombia) / Validation of the short version of the leyton obsessional inventory for children and adolescents in Bucaramanga, Colombia

Objetivo. Determinar la consistencia interna, la estructura factorial, la reproducibilidad y la validez de criterio del Inventario de Obsesiones de Leyton en niños y adolescentes Diseño. Estudio de validación. Emplazamiento. Colegios de secundaria de Bucaramanga, Colombia. Participantes. Se incluyó a 581 estudiantes seleccionados al azar, de los cuales 38 no contestaron el inventario, 8 fueron excluidos por tener más de 17 años y 33 no acudieron a la entrevista clínica. Mediciones principales. Aplicación independiente del Inventario de Obsesiones de Leyton y de la Entrevista Clínica Estructurada para los Trastornos del Eje I del DSM-IV (SCID-I), versión clínica. Se calculó el índice alfa de Cronbach y se realizó un análisis de los factores, la sensibilidad, la especificidad, la verosimilitud y el coeficiente de Lin. Resultados. La prevalencia de trastorno obsesivo compulsivo fue del 11,8% (intervalo de confianza [IC] del 95%, 8,9-14,6). El alfa de Cronbach fue 0,803 y se halló un único factor con 3,60 de valor propio que explica el 74,8% de la varianza. El área bajo la curva ROC fue 0,799 (IC del 95%, 0,752-0,847) y el mejor punto de corte en esta población fue 12, a partir del cual la sensibilidad fue del 69,5% (IC del 95%, 56,0-80,5) y la especificidad del 77,7% (IC del 95%, 72,9-88,9). La reproducibilidad fue aceptable (coeficiente de Lin de 0,752; IC del 95%, 0,714-0,790). Conclusión. El Inventario de Obsesiones de Leyton es un instrumento aceptable para cribar la presencia de trastorno obsesivos compulsivos en niños y adolescentes de Colombia

Objective. To determine the internal consistency, factorial structure, reproducibility and validity of criterion of the Leyton Obsessional Inventory in children and adolescents. Design. Study of validation with probabilistic sampling. Setting. Secondary schools in Bucaramanga, Colombia. Participants. A total of 581 students selected at random, of whom 38 did not answer, 8 were excluded because they were over 17, and 33 did not attend the clinical interview. Main measurements. The Inventory and the Structured Clinical Interview for axis I of the DSM-IV (SCID-I), clinical version, were used. Cronbach's alpha, factorial analysis, sensibility, specificity, probability, and Lin' s coefficient were calculated. Results. The prevalence of obsessive-compulsive disorder was 11.8% (95% CI, 8.9-14.6). Cronbach's alpha was 0.803 and just one factor with 3.60 eigenvalue explained 74.8% of variance. The area under the ROC curve was 0.799 (95% CI, 0.752-0.847) and the best cut-off point was 12, with sensitivity at 69.5% (95% CI, 56.0-80.5) and specificity at 77.7% (95% CI, 72.9-88.9). Its reproducibility was acceptable (Lin's coefficient at 0.752; 95% CI, 0.714-0.790). Conclusion. The Leyton Obsessional Inventory is a fair screening tool for detecting obsessive-compulsive disorder in Colombian children and adolescents

Bases genéticas y moleculares de la preeclampsia / Genetic and molecular bases of preeclampsia

La preeclampsia es una enfermedad compleja, exclusiva de la gestación humana y responsable de una alta morbimortalidad perinatal. Ha sido denominada la enfermedad de las múltiples teorías, en la cual tanto factores medioambientales como genéticos se han asociado al desarrollo de la misma. Para la identificación de los genes candidatos asociados con la PE, se han empleado dos tipos de metodología, los estudios de asociación y los estudios de ligamiento. En el presente artículo se explica el fundamento de ambos estudios y se revisan los principales genes candidatos dentro de la fisiopatología de la enfermedad, entre los que se encuentran los que codifican para las enzimas metileneterahidrofolato reductasa, la lipoprotein lipasa y la óxido nítrico sintasa endotelial; el factor V de Leiden, el angiotensinógeno, el HLA-G y el factor de necrosis tumoral alfa