Ataque de nervios: The impact of sociodemographic, health history, and psychological dimensions on Puerto Rican adults.

Introduction: Ataque de nervios (ADN) is a cultural syndrome prevalent in Puerto Ricans characterized as an episode of intense emotional upset due to overwhelming stress. Methods: The Ataque de Nervios Questionnaire, developed at the Center for the Study and Treatment for Fear and Anxiety (CETMA), served as the diagnostic tool for this retrospective secondary data analysis. We evaluated three models regarding ADN's function as a marker of (1) sociodemographic vulnerability, (2) health history risk, and (3) psychological vulnerability. This last model was subdivided to assess the scores of screening tests regarding anxiety (Anxiety Sensitivity Inventory, Beck Anxiety Inventory, and State-Trait Anxiety Inventory), affect (Beck Depression Inventory, Emotional Dysregulation Scale, Positive and Negative Affective Schedule), personality (NEO Five-Factor Inventory), and trauma (considering the responses to the Childhood Trauma Questionnaire and the Life Event Checklist). Results: Our study sample had a total of 121 Puerto Rican adult patients from CETMA out of which 75% had ADN. We differentiated subjects according to their ADN status with t-tests and Mann-Whitney U tests and evaluated our models using logistic regressions. People with ADN showed more anxiety, depressive symptoms, emotional dysregulation, and negative affect than those without ADN. They also revealed lower positive affect and agreeableness. Highly extraverted but minimally agreeable personalities related to ADN. Living with a partner and being employed were risk factors for ADN. Having higher educational levels showed the strongest effect size: it greatly reduced the odds of an ataque. Discussion: These characteristics suggest a distinct profile of ADN seen in employed, educated, adult Puerto Ricans living on the Island experiencing anxiety. Our study provides clinical tools to comprehend our patients' ADN experience, enriching our practice as culturally competent health providers.

Estimating COVID-19 cases in Puerto Rico using an automated surveillance system.

Due to concerns regarding limited testing and accuracy of estimation of COVID-19 cases, we created an automated surveillance system called "Puerto Rico Epidemiological Evaluation and Prevention of COVID-19 and Influenza" (PREPCOVI) to evaluate COVID-19 incidence and time trends across Puerto Rico. Automated text message invitations were sent to random phone numbers with Puerto Rican area codes. In addition to reported COVID-19 test results, we used a published model to classify cases from specific symptoms (loss of smell and taste, severe persistent cough, severe fatigue, and skipped meals). Between 18 November 2020, and 24 June 2021, we sent 1,427,241 messages, 26.8% were reached, and 6,975 participants answered questions about the last 30 days. Participants were aged 21-93 years and represented 97.4% of the municipalities. PREPCOVI total COVID-19 cases were higher among women and people aged between 21 and 40 years and in the Arecibo and Bayamón regions. COVID-19 was confirmed, and probable cases decreased over the study period. Confirmed COVID-19 cases ranged from 1.6 to 0.2% monthly, although testing rates only ranged from 30 to 42%. Test positivity decreased from 13.2% in November to 6.4% in March, increased in April (11.1%), and decreased in June (1.5%). PREPCOVI total cases (6.5%) were higher than cases reported by the Puerto Rico Department of Health (5.3%) for similar time periods, but time trends were similar. Automated surveillance systems and symptom-based models are useful in estimating COVID-19 cases and time trends, especially when testing is limited.

Coaching tailored by stages: A valuable educational strategy to achieve independence in research.

This study presents an individualized coaching approach tailored to the stages of proximity of promising scientists interested in becoming independently funded researchers in the context of a minority-serving institution. This strategy defined the participant's stage of proximity by their number of first-author publications in peer-reviewed journals and their track record in submitting research grants. We argue that coaching tailored by stages is an asset to maintain the enthusiasm, persistence, and positive attitude of promising scientists as they try to reach independent investigator status. Furthermore, this valuable educational approach supports the development of management and leadership skills in defined scientific domains.

Public Health Academic Alliance for COVID-19 Response: The Role of a National Medical Task Force in Puerto Rico.

Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios.

Ethnic differences in physiological responses to fear conditioned stimuli.

The idea that emotional expression varies with ethnicity is based largely on questionnaires and behavioral observations rather than physiological measures. We therefore compared the skin conductance responses (SCR) of Hispanic (Puerto Rican) and White non-Hispanic subjects in a fear conditioning and fear extinction task. Subjects were recruited from two sites: San Juan, Puerto Rico (PR), and Boston, Massachusetts (MA), using identical methods. A total of 78 healthy subjects (39 from PR, 39 from MA) were divided by sex and matched for age and educational level. Females from the two sites did not differ in their SCRs during any experimental phase of fear conditioning (habituation, conditioning, or extinction). In contrast, PR males responded significantly to the conditioned stimulus than MA males or PR females. Subtracting ethnic differences observed during the habituation phase (prior to conditioning) eliminated differences from subsequent phases, suggesting that PR males are elevated in their response to novelty rather than fear learning. Our findings suggest that, in addition to sex differences, there are ethnic differences in physiological responses to novel stimuli at least in males, which could be relevant for the assessment and treatment of anxiety disorders.

Risk of serotonin syndrome with complementary and alternative medicines: importance to child and adolescent psychiatry.

OBJECTIVES: Evaluate how child and adolescent psychiatrists rate themselves regarding their knowledge and clinical skills in assessing interactions between non-prescribed complementary and alternative medicines (CAM) and prescribed medications. METHODOLOGY: A brief questionnaire about the practice of asking patients about CAM use was given to child and adolescent psychiatrists. RESULTS: The questionnaire was completed by 20 child and adolescent psychiatrists. Only 35% of the sample stated that they always asked about CAM use although 55% stated that they aware of the importance of prescribed drug interactions with CAM. Of the sample, 90% stated that they could recognize serotonin syndrome, but only 65% answered correctly to the description of the syndrome. Given a list of possible CAM that could interact with prescribed drugs to produce serotonin syndrome, only 10% identified all the drugs correctly. CONCLUSION: CAM training should be included in training programs and in continued education curriculums for practicing child psychiatrists.

The role of caregivers' depressive symptoms and asthma beliefs on asthma outcomes among low-income Puerto Rican children.

OBJECTIVE: To examine the relationship between depressive symptoms and asthma beliefs (self-efficacy and empowerment), child asthma outcomes, and caregiver's quality of life among Puerto Rican caregivers of children with asthma. METHODS: The caregivers of 221 children with persistent bronchial asthma were stratified into those with no/low or high levels of depressive symptoms. Differences between the groups in caregiver self-efficacy, family empowerment, child asthma outcomes, and quality of life were examined. RESULTS: Caregivers with more depressive symptoms reported lower self-efficacy, less empowerment, less symptom-free days and nights for their children, and a lower quality of life compared to caregivers with no or fewer depressive symptoms. CONCLUSIONS: Depressive symptoms among Puerto Rican caregivers were associated with asthma beliefs, children's asthma symptoms, and caregiver quality of life. Our findings reinforce the importance of physician screening skills in recognizing caregiver depression in parents of asthma patients.

Translating findings from basic fear research to clinical psychiatry in Puerto Rico.

Recent advances in the neuroscience of classical fear conditioning from both rodent and human studies are beginning to be translated to the psychiatry clinic. In particular, our understanding of fear extinction as a form of "safety learning" holds promise for the treatment of anxiety disorders in which extinction learning is thought to be compromised. The Department of Psychiatry at the UPR, School of Medicine promotes the development of innovative strategies for treating mental health problems. Given the burden resulting from anxiety disorders in Puerto Rico, and the lack of evidence-based treatment practices, there is a pressing need for a future center specializing in the treatment of anxiety related disorders. This center would also serve research and training functions, with the ultimate goal of translating extinction research into clinical practice. This review presents the current developments in extinction research and its relationship to anxiety disorders and treatment. We also analyze the available literature on the epidemiology of anxiety disorders and the existing evidence-based treatments for these conditions.

Applicability of the Spanish Translation of the Zung Self-Rating Depression Scale in a general Puerto Rican population.

Voluntary screening has shown to be an effective way to identify depressive symptoms and to provide adequate treatment. If a screening tool was to be used in a general Puerto Rican population, it should be validated in Spanish and be consistent with the particular response style of this group. The main objective of this research study is to assess if the Spanish translation of the Zung SDS is adequate to screen for depression in Puerto Ricans, and if the translation considers the sociocultural peculiarities of this group. Although the Zung SDS is presented as a self-report scale and was found to be reliable by Alpha coefficient and manageable by both the questioner and the participant, the Spanish version used in this activity presented interpretation difficulties. It is recommendable that a Spanish translation of this scale should be developed taking into consideration the particularities of the Puerto Rican population. The use of other screening tools that have already been validated as being culturally sensitive to Puerto Ricans could also be considered.