[Psychosocial factors associated with late HAART initiation in Mexican patients with HIV]. / Factores psicosociales asociados con el inicio tardío de tratamiento antirretroviral en pacientes mexicanos con VIH.

OBJECTIVE: To explore the association between psychosocial factors and late highly active antiretroviral therapy (HAART) initiation in a sample of Mexican patients with HIV. MATERIALS AND METHODS: We conducted a cross-sectional study at the HIV Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), and applied structured questionnaires to 150 patients who initiated HAART between January 2010 and August 2011. Late HAART initiation (LHI) was considered when patients started HAART with CD4 counts of <200+ cells/mm³. RESULTS: By multivariate analysis, the strongest psychosocial risk factor for LHI observed was self-stigma towards HIV/AIDS. In addition, being tested by medical prescription, not by own initiative, as well as having one or more previous medical contacts, were associated with greater risk for LH. CONCLUSIONS: Our findings suggest the need to develop psychosocial interventions to decrease negative self-image and stigmatizing attitudes and behaviors in risk groups for HIV in Mexico.

Factores psicosociales asociados con el inicio tardío de tratamiento antirretroviral en pacientes mexicanos con VIH / Psychosocial factors associated with late HAART initiation in Mexican patients with HIV

Objetivo. Explorar la asociación entre variables psicosociales y el inicio tardío de tratamiento antirretroviral en una muestra de pacientes mexicanos con diagnóstico de VIH. Material y métodos. Estudio transversal en la clínica de VIH del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, donde se aplicaron cuestionarios estructurados a 150 pacientes que iniciaron terapia antirretroviral altamente activa (TARAA) entre enero de 2010 y agosto de 2011. Se consideró inicio tardío (IT) de TARAA cuando los pacientes iniciaron el tratamiento con CD4 <200 células/mm³. Resultados. Mediante el análisis multivariado, se encontró que el principal factor psicosocial asociado con IT fue la percepción de autoestigma relacionada con el VIH/sida. Además, la realización de la prueba del VIH se asoció con la indicación médica y no con la iniciativa del paciente; a su vez, tener uno o más contactos médicos previos se relacionó con un mayor riesgo de presentar IT. Conclusiones. Los resultados sugieren la necesidad de intervenciones psicosociales dirigidas a disminuir la autoimagen negativa y actitudes y comportamientos estigmatizantes en grupos de riesgo.

Objective. To explore the association between psychosocial factors and late highly active antiretroviral therapy (HAART) initiation in a sample of Mexican patients with HIV. Materials and methods. We conducted a cross-sectional study at the HIV Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), and applied structured questionnaires to 150 patients who initiated HAART between January 2010 and August 2011. Late HAART initiation (LHI) was considered when patients started HAART with CD4 counts of <200+ cells/mm³. Results. By multivariate analysis, the strongest psychosocial risk factor for LHI observed was self-stigma towards HIV/AIDS. In addition, being tested by medical prescription, not by own initiative, as well as having one or more previous medical contacts, were associated with greater risk for LH. Conclusions. Our findings suggest the need to develop psychosocial interventions to decrease negative self-image and stigmatizing attitudes and behaviors in risk groups for HIV in Mexico.

Prácticas de Crianza Asociadas a la Reducción de los Problemas de Conducta Infantil: Una Aportación a la Salud Pública / Child Raising Practices Associated to the Reduction of Problematic Child Behavior: A Public Health Approach

El entrenamiento conductual a padres resulta en cambios conductuales que están asociados con la reducción de la conducta problemática de los niños. El objetivo del trabajo fue identificar los componentes de un programa de entrenamiento conductual a padres para cambiar la conducta parental y la de sus hijos. Participaron 84 padres mexicanos de niños con problemas de conducta con edades de entre dos y 12 años. Los padres participaron en un programa de crianza positiva, que consistió en un juego de roles y que los entrenó a responder de forma positiva ante las diferentes conductas del niño con el fin de disminuir su conducta problemática. La conducta de los niños se evaluó mediante cuestionarios de auto-reporte que respondieron los padres. Los resultados mostraron que después del entrenamiento se observó que los padres modificaron su conducta, lo cual redundó en que reportaran que la conducta de sus hijos también se modificó. Los componentes más efectivos del programa fueron la corrección del comportamiento, el elogio, las instrucciones claras, el establecimiento de reglas, la solución de problemas, la interacción social y la reducción en el uso del castigo.

Parent behavioral training results in behavioral changes that are associated with the reduction of a child's problematic behaviors. The purpose of the present study was to identify the most effective components of a parent behavioral training program on both, the observed parents' behavior and their report on the reduction of their child's problematic behavior. Participants were 84 Mexican parents of two to twelve years old children with behavioral problems. Parents attended a positive child raising program based in role playing that trained them to respond in a positive manner to their children's behaviors with the ultimate goal of reducing problematic behaviors. The children's behaviors were assessed using self-report questionnaires answered by the parents. After the behavioral training, a significant change in the parents' behavior was observed. Parents also reported a significant reduction of their child's problematic behavior. The most effective components of the intervention program were behavior correction, praise, giving clear instructions, rule establishment, problem solving, social interaction, and the reduction in punishment.

Evaluación de conocimientos sobre habilidades de manejo conductual infantil en profesionales de la salud / Children Behavior Management Skills: Assessment of Knowledge in Health Professionals

El objetivo del estudio fue evaluar conocimientos sobre habilidades para manejar problemas de conducta infantil. Los conocimientos se evaluaron a través de situaciones hipotéticas de crianza, entrevistando a 294 profesionales de diversos estados del país, empleando un diseño pre-experimental pre-post. Se empleó un instrumento con 13 situaciones hipotéticas de problemas de conducta infantil en casa, donde se calificaba las respuestas de los participantes sobre las habilidades a emplear por los adultos. Los resultados mostraron que a partir de una capacitación breve hubo un aumento significativo en los conocimientos sobre las habilidades de manejo conductual para las 13 situaciones. Se concluye que el cuestionario de situaciones hipotéticas de crianza fue útil para evaluar el conocimiento sobre habilidades de crianza. Además, los profesionales lograron reportar estrategias para el aumento de conductas pro-sociales, la corrección de conducta inadecuada, el establecimiento de reglas en el hogar y la solución de problemas en familia. Investigación adicional mostrará el proceso de adquisición de las habilidades a través de técnicas de observación directa de estas situaciones hipotéticas de crianza.

The purpose of this study was to assess knowledge acquisition of children behavior management skills by professionals. Knowledge of skills use was assessed by a hypothetical breeding situations questionnaire interviewing nationwide to 294 health professionals using a pre experimental pre test post test design. Professionals responded to 13 hypothetical child rearing home situations indicating in each what management skill were to be used by adults. Results show that after a brief training, professional's knowledge of child behavior management skills use increase significantly over the 13 child rearing situations. It is concluded that the hypothetical breeding situations questionnaire was helpful to assess knowledge acquisition. Also professionals were able to report strategies for the strengthening of prosocial behavior, the correction of inappropriate behavior, the establishing of home rules, and family problem solving. Further research will show the process of skill acquisition through direct observation techniques of the hypothetical breeding situations used here.

[Anxiety and depression in patients with chronic pain: neuropathic and nociceptive]. / Ansiedad y depresión por dolor crónico neuropático y nociceptivo.

OBJECTIVE: To describe and compare anxiety and depression symptoms between two group patients with neuropathic and nociceptive pain those arrive for first time to a clinic of pain. METHODS: Non-experimental, exploratory and descriptive design. Seventy-eight patients that arrive the first time to a clinic of pain were evaluated; those patients were divided in two groups: neuropathic pain with 44 patients and nociceptive pain with 34 patients. To evaluate anxiety and depression we use the Anxiety and Depression Scale (HAD), this scale is adapted and validated in Mexico. RESULTS: From the 78 patients in the study, the 76.9% were female and 23.1% were male. The age average was (56.9 +/- 16.8 year-old for neuropathic pain and 63.1 +/- 17.2 year-old for nociceptive pain). The reliability of the scale HAD was evaluated by the Chronbach's alpha analysis with an r = 0.826. There was no significance difference in anxiety and depression between types of pain, but after analyzing all of the patients we found that anxiety was more frequent than depression p < 0.0001. CONCLUSIONS: Independently of the algological diagnosis, patients presented almost the same affective symptoms.

[Burden, anxiety and depression in patient's caregivers with chronic pain and in palliative care]. / Sobrecarga, ansiedad y depresión en cuidadores primarios de pacientes con dolor crónico y terminales.

BACKGROUND: In Mexico there are few studies about the psychological characteristics of the person that voluntary and in a complete sense assumes the role of responsible of a patient. The purpose of this study was to assess and compare the levels of burden, anxiety and depression of 56 caregivers of patients with chronic pain with the ones of 35 caregivers of terminally ill patients. METHODS: The study was conduced at the Chronic Pain and Palliative Medicine Department of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". We used the Spanish version of the Burden Interview and the Informal Primary Caregiver Health Survey. RESULTS: Both groups went over the cut off point of the Burden Scale even though no significative differences between groups were found nor in burden or in anxiety. The caregivers of terminal patients had more depression symptoms and a greater perception of the impact of the care activity in their mood. Positive correlations between burden and depression, depression and anxiety and burden and anxiety were found. CONCLUSIONS: All caregivers reported multiple depression symptoms--greater if they cared terminally ill patients--so, it may suggest that the patient's illness directly influences the depression symptoms of their caregivers. This study can help to develop intervention programs directed to help this population that is the principal support of the patient's treatment.