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.

Necesidad de apoyo psicológico y calidad de vida en el cuidador primario de pacientes pediátricos con cáncer / Need of psychological support and assessment of quality of life of family caregivers of children with cancer

El cáncer infantil es un problema de salud pública en México. Esta enfermedad es motivo de angustia y problemas psicosociales tanto en el paciente como en su cuidador primario. Si las necesidades del cuidador no son identificadas y atendidas se impacta sobre el bienestar y la salud del infante. EI objetivo de la presente investigación fue evaluar las necesidades de apoyo (NA) y calidad de vida del cuidador primario informal (CPI) de pacientes pediátricos con cáncer. Método: El diseño fue no experimental y correlacional. Participaron 100 CPIs de pacientes pediátricos con cáncer hospitalizados, la mayoría fueron mujeres y madres de los pacientes. Resultados: Se encontró que las NA mayormente insatisfechas fueron la necesidad de resolver las preocupaciones por el futuro, seguido por las necesidades emocionales y las necesidades de información. Aquellas percibidas con una menor urgencia por resolver fueron las necesidades relacionadas con el acceso médico de los pacientes. El funcionamiento emocional, físico y social fueron las áreas más afectadas en la calidad de vida (CV). Con respecto al impacto familiar, las relaciones familiares mostraron ser uno de los dominios menos afectados. El análisis de regresión múltiple por método intro demostró que las necesidades emocionales y de información no satisfechas, las preocupaciones, actividades diarias, y relaciones familiares de los CPIs explican el 74% de la varianza en calidad de vida. Conclusión: Se recomienda integrar a su protocolo clínico de rutina la detección de necesidades, evaluación de CV, así como la implementación de intervenciones psicoeducativas y, en su caso, la atención psicológica personalizada (AU)

Children’s cancer is a public health problem in Mexico. This disease is also cause of distress and psychosocial problems for the patient, as well as their primary caregiver. The family is the first circle of support for a patient, therefore, if their needs are unmet, the infant’s health and wellbeing will suffer in turn. The purpose of this investigation project was to evaluate supportive needs (SN) and quality of life (QOL) of family caregivers (FCs) of pediatric cancer patients. Method: This investigation’s design was correlational and non-experimental. The study’s participants were 100 FCs for pediatric cancer patients currently hospitalized at the National Institute of Pediatrics in Mexico City, the majority were women and mothers of the patients. Results: The results showed that facing the worries about the future, emotional needs, as well as information needs were the most unsatisfied SN’s. The one with least urgency to solve was the patients access and medical continuity needs. Proper emotional, physical and social function were the most affected areas of their quality of life. On the other hand, the family relationship of the family impact domain was one of the less affected. Furthermore, intro multiple regression showed that unmet needs relating to information and emotions, in addition to worries, daily activities and family relationships explained 74% of the variance in QOL. Conclusion: It is advised that detection of needs, evaluation of quality of life, psychological support and the implementation of psychoeducational interventions be integrated into routine clinical attention in this population (AU)

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.

Validación psicométrica de la Escala de gravedad de fatiga en médicos residentes mexicanos / Psychometric validation of the Fatigue Severity Scale in Mexican medical residents

Los médicos residentes están continuamente expuestos a la fatiga, que puede ocasionarles problemas laborales, académicos y personales, por consiguiente, es importante contar con instrumentos confiables y válidos para medirla. Una de las escalas más utilizadas es la Escala de gravedad de fatiga, sin embargo, hay versiones con una y distinto número de reactivos en distintas poblaciones. Por lo que el propósito de este trabajo fue traducir, adaptar de manera culturalmente relevante y comparar las versiones con distinto número de reactivos de la escala, para identificar la más adecuada en médicos residentes mexicanos. 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 100 médicos residentes y, el tercero, para el análisis factorial confirmatorio y prueba de invarianza por tipo de programa (especialidad y alta especialidad) con 182 médicos residentes. Se probó la distribución, discriminación, confiabilidad y estructura de la escala, en un análisis exploratorio y confirmatorio, quedando una escala final de 6 reactivos con buen ajuste (X2[9] = 9,39, p = 0,40; CFI = 0,99; RMSEA = 0,02), con una confiabilidad = 0,91 e invarianza factorial estricta por tipo de programa de residencia

Resident physicians are continually exposed to fatigue, which can lead to work, academic and personal problems, so it is important to have reliable and valid instruments to measure it. One of the most used is Fatigue Severity Scale, but, there are versions with different number of items in different populations. Therefore, the purpose of this work was to translate, adapt culturally relevant and compare versions with different numbers of items, to identify the most appropriate in Mexican resident physicians. With three different groups of participants; first one for translation by seven expert judges in the language, second for psychometric validation with 100 resident physicians, and third for confirmatory factor analysis and invariance test by type of program (specialty and high specialty) with 182 resident physicians. Distribution, discrimination, reliability and factor structure of the scale were tested in an exploratory and confirmatory analysis, leaving a final scale of 6 items with good fit (X2[9] = 9,39, p = 0,40; CFI = 0,99; RMSEA = 0,02), with a reliability = 0,91 and strict factorial invariance by type of residence program

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.

Course and predictors of supportive care needs among Mexican breast cancer patients: A longitudinal study.

OBJECTIVE: This study examined the course and predictors of supportive care needs among Mexican breast cancer patients for different cancer treatment trajectories. METHODS: Data from 172 (66.4% response rate) patients were considered in this observational longitudinal study. Participants were measured after diagnosis, neoadjuvant treatment, surgery, adjuvant treatment, and the first post-treatment follow-up visit. Psychological, Health System and Information, Physical and Daily Living, Patient Care and Support, Sexual, and Additional care needs were measured with the Supportive Care Needs Survey (SCNS-SF34). Linear mixed models with maximum-likelihood estimation were computed. RESULTS: The course of supportive care needs was similar across the different cancer treatment trajectories. Supportive care needs declined significantly from diagnosis to the first post-treatment follow-up visit. Health System and Information care needs were the highest needs over time. Depressive symptoms and time since diagnosis were the most consistent predictors of changes in course of supportive care needs of these patients. CONCLUSIONS: Health system and information care needs of Mexican breast cancer patients need to be addressed with priority because these needs are the least met. Furthermore, patients with high depressive symptoms at the start of the disease trajectory have greater needs for supportive care throughout the disease trajectory.

[Breaking bad news in the emergency room: Suggestions and future challenges]. / Comunicación de malas noticias en urgencias médicas: recomendaciones y retos futuros.

The aim of this paper is to describe educational programs that reportedly teach how to break bad news in the emergency department. We also suggest some recommendations on how to communicate bad news based on the research of evidence available in the field. The examined evidence points toward six major components with which physicians should familiarize when communicating bad news: 1) doctor-patient empathic communication, 2) establishing a proper space to give the news, 3) identifying characteristics of the person who receives the news, 4) essential aspects for communicating the news; 5) emotional support, and 6) medical and administrative aspects of the encounter. Finally, we point out several limitations in the studies in the field and future challenges identified in the communication of bad news in emergency room facilities.

El objetivo del presente trabajo es reseñar una descripción de los programas educativos que incluyen el entrenamiento de la comunicación de malas noticias a médicos pertenecientes al departamento de urgencias. Además se hacen recomendaciones sobre cómo dar malas noticias con base en la evidencia de investigación hasta ahora disponible en las áreas de urgencias. De acuerdo con la información obtenida, es factible identificar seis grandes áreas con las que el médico requiere familiarizase cuando comunica malas noti cias: 1) comunicación empática médico-paciente, 2) preparación del ambiente para dar la noticia, 3) identificación de las características de quien recibe la noticia, 4) aspectos indispensables al comunicar la noticia, 5) manejo de reacciones emocionales y 6) aspectos médicos, administrativos y del cierre del encuentro. Finalmente, se describen las limitaciones que parecen caracterizar a los estudios en el área y se señalan los retos futuros en la comunicación de malas noticias en urgencias médicas.

Prevalence and factors associated with supportive care needs among newly diagnosed Mexican breast cancer patients.

PURPOSE: Mexican breast cancer patients are generally diagnosed in advanced stages of the disease and often experience delays in cancer treatment delivery. Currently, little is known about these patients' psychological care needs. This study assessed levels and correlates of supportive care needs of Mexican breast cancer patients around the time of cancer diagnosis. METHODS: One hundred seventy-three newly diagnosed Mexican breast cancer patients participated in the study. Supportive care needs, anxiety, depression, and patients' sociodemographic and clinical characteristics were assessed. Multiple regression analyses were used to examine factors associated with care needs. RESULTS: Up to 44% of patients showed unmet care needs. Health system/information needs were the most prevalent (68%), while physical/daily living needs the least (19%). Level of depressive symptoms was most consistently related to care needs. Patients with higher levels of depressive symptoms had higher psychological (ß = 0.38), physical/daily living (ß = 0.43), patient care/support (ß = 0.17), and additional unmet care needs (ß = 0.30), than patients with lower levels of depressive symptoms. CONCLUSIONS: This study suggests that mainly health system/information needs arise at the time of cancer diagnosis among Mexican breast cancer patients. Patients suffering high levels of depressive symptoms reported the highest levels of unmet needs. Future studies should be conducted to elucidate the care needs throughout the disease trajectory, as such information can inform health care professionals and policy makers and lead to improvements in the organization and provision of health care services for Mexican breast cancer patients.

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.

Efectos de la solución de problemas sobre los comportamientos de autocuidado de cuidadores de pacientes oncológicos en fase paliativa: un estudio piloto / No disponible

Cuidar de un familiar con cáncer avanzado trae consigo una serie de problemas familiares, laborales, económicos, y sociales que impactan negativamente sobre la calidad de vida y la salud física y psicológica de los cuidadores primarios. El objetivo de la presente investigación fue evaluar la eficacia de una intervención basada en la terapia de solución de problemas sobre la adquisición de habilidades de autocuidado, la calidad de vida, y la sintomatología ansiosa y depresiva en cuidadores primarios de pacientes que reciben cuidados paliativos. Se utilizó un diseño de N=1 de medidas repetidas, con evaluación pre y post- test con los inventarios de ansiedad y depresión de Beck, el inventario de calidad de vida WHOQol Bref y un cuestionario de conductas de autocuidado diseñado ex profeso para esta investigación. Se identificaron mejorías clínicamente significativas en las medidas de sintomatología ansiosa y depresiva, un incremento en la calidad de vida y la identificación de la Terapia de Solución de Problemas como una herramienta útil para afrontar las problemáticas derivadas de las actividades de cuidado. La principal limitante para el desarrollo de la intervención fue que el tiempo propuesto no correspondió con el promedio de sobrevida de los pacientes atendidos en el servicio (AU)

Caring for a relative with terminal cancer brings a series of problems in the family, work, financial and social arenas. These problems, in turn, cause a negative impact on the Quality of Life (QOL) of the patients’ primary caregivers, including their physical and psychological health. The purpose of the present study was to examine the effects of an intervention based on Problem Solving Therapy on QOL, anxious and depressive symptoms and on the acquisition of self-care skills by terminal cancer patients’ primary caregivers. A repeated measures N=1 design was used on pre and post intervention measurements on Beck’s anxiety and depression inventories, the WHOQOL-Bref and a questionnaire on self-care expressly designed for the study. Results revealed clinically significant improvements on anxious and depressive symptoms and improvement on the participants’ QOL. Problem Solving Therapy resulted a viable and effective approach to cope with the problems posed by caring for a terminal patient and improving self-care skills. A possible drawback of the procedures includes a lengthy intervention howhich was not always commensurate with the survival time of the terminal patients (AU)

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.

Parenting strategies and socio-cultural influences in childhood anxiety: Mexican, Latin American descent, and European American families.

This study examined the relationship between anxiety in Latin American children and Latino cultural schemas, parenting strategies, being an ethnic minority, and assimilation. Latin American (n=72; LA) and white European-American (n=46; EA) children living in the U.S., Mexican children living in Mexico (n=99; M), and at least one parent per family (n=283) were administered measures assessing anxiety, parenting strategies, collectivism, family cohesion, simpatia, parent-child communication, and assimilation. M and LA children expressed more anxiety symptoms than EA children. More mother control and less father acceptance were associated with childhood anxiety across all three groups. However, father control was associated with more anxiety for the EA group but not the MA group, and mother acceptance was associated with more anxiety for the EA and MA groups but with less anxiety for the M group. Family cohesion was negatively associated with children's anxiety independent of ethnic group. Finally, differing from parents in assimilation did not influence LA children's anxiety.

Efectos del tiempo de infección sobre predictores de adherencia en personas con VIH / Effects of length of infection on predictors of adherence in persons with HIV

A crosssectional study was made with the main objective to prove the effects of length of infection (in months) on predictors of adherence behaviors to antiretroviral therapy in a sample of 44 persons with HIV. A multiple linear regression analysis showed that motives and stress-related to high tolerance to ambiguity predicted adherence behaviors (F[3,43]= 8,310; p= 0.000). Using length of infection (average 55 months) as a criteria variable, in the group of ≤55 months predictors were motives and low depressive symptomatology (F[2,21]= 10,435; p= 0.001), meanwhile in the group of >55 months predictors were motives and stress-related to high tolerance to frustration (F[2,21]= 11,057; p= 0.001). The results of this study support the hypothesis of a causal relationship between the lenght of infection and predictors of adherence behaviors in people with HIV, aspect that must be considere in the proccesses of desing and implementing interdisciplinary intervention programs directed to promote the consistent and efficient practice of such behaviors (AU)

Se realizó un estudio transversal con el objeto de probar los efectos del tiempo de infección (en meses) sobre predictores de comportamientos de adherencia a la terapéuticaantirretroviral en una muestra de 44 personas con VIH. Un análisis de regresión lineal múltiple aportó como predictores de los comportamientos de adherencia a las variables motivos y estrés vinculado con alta tolerancia a la ambigüedad (F[3,43]= 8,310; p= 0.000). Al considerar el tiempo de infección en meses (media 55 meses) como variable criterio en el grupo de ≤55 meses emergieron como predictores las variables motivos y baja sintomatología depresiva (F[2,21]= 10,435; p= 0.001), mientras que en el grupo de >55 meses lo fueron las variables motivos y estrés vinculado con alta tolerancia a la frustración (F[2,21]= 11,057; p= 0.001). Los resultados de este estudio sugieren que el tiempo de infección es una variable crítica que afecta de manera diferencial el papel de los predictores de comportamientos de adherencia en personas con VIH, aspecto que debe ser tenido en cuenta al diseñar y desarrollar programas de intervención dirigidos a promoverla práctica consistente y eficiente de tales comportamientos (AU)

An international perspective on behavioral science education in medical schools.

The behavioral sciences are taught in medical curricula around the world. In the current paper psychologists teaching in medical schools in Australia, Mexico, Saudi Arabia, Thailand, the United Kingdom and the United States share their experience and reflections. Whilst direct comparisons between countries are not made, the themes that are evident within and between accounts are instructive. As behavioral scientists around the globe are struggling to maintain a presence in medical education many of the reasons behind this are shared, regardless of the country. Challenges discussed include those related to the impact of unrealized potential contributions of psychologists as health care professionals, teaching of behavioral sciences by other professions, domination of the biomedical model without a corresponding recognition of psychology as science, and modern medical pedagogies such as problem-based learning, which favor biomedicine. Systemic and political barriers over which we as a discipline may have little control are also highlighted.

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

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% of the 64 participants reported having faithfully followed the prescribed treatment, while 34.4% had failed, in some way, to follow the treatment (chi(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% 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.