Health care accessibility and mobility in breast cancer: a Latin American perspective.

BACKGROUND: Latin America (LATAM) encompasses a vast region with diverse populations. Despite publicly funded health care systems providing universal coverage, significant socioeconomic and ethno-racial disparities persist in health care access across the region. Breast cancer (BC) incidence and mortality rates in Brazil are comparable to those in other LATAM countries, supporting the relevance of Brazilian data, with Brazil's health care policies and expenditures often serving as models for neighboring countries. We evaluated the impact of mobility on oncological outcomes in LATAM by analyzing studies of patients with BC reporting commuting routes or travel distances to receive treatment or diagnosis. METHODS: We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, LILACS, and Google Scholar databases. Studies eligible for inclusion were randomized controlled trials and observational studies of patients with BC published in English, Portuguese, or Spanish and conducted in LATAM. The primary outcome was the impact of mobility or travel distance on oncological outcomes. Secondary outcomes included factors related to mobility barriers and access to health services. For studies meeting eligibility, relevant data were extracted using standardized forms. Risk of bias was assessed using the Newcastle-Ottawa Scale. Quantitative and qualitative evidence synthesis focused on estimating travel distances based on available data. Heterogeneity across distance traveled or travel time was addressed by converting reported travel time to kilometers traveled and estimating distances for unspecified locations. RESULTS: Of 1142 records identified, 14 were included (12 from Brazil, 1 from Mexico, and 1 from Argentina). Meta-analysis revealed an average travel distance of 77.8 km (95% CI, 49.1-106.48) to access BC-related diagnostic or therapeutic resources. Nonetheless, this average fails to precisely encapsulate the distinct characteristics of each region, where notable variations persist in travel distance, ranging from 88 km in the South to 448 km in the North. CONCLUSION: The influence of mobility and travel distance on access to BC care is multifaceted and should consider the complex interplay of geographic barriers, sociodemographic factors, health system issues, and policy-related challenges. Further research is needed to comprehensively understand the variables impacting access to health services, particularly in LATAM countries, where the challenges women face during treatment remain understudied. TRIAL REGISTRATION: CRD42023446936.

Cambios afectivos en niñas/os y adolescentes: antes y durante el confinamiento preventivo por covid-19

Objetivo: Analizar cambios afectivos en niños/as y adolescentes entre 8 y 16 años, antes y durante el confinamiento por Pandemia de COVID-19. Material y Método: Estudio observacional-transversal con medición repetida evocada. Bajo muestreo no-probabilístico, se encuestó en formato online a 87 niños/as y adolescentes escolarizados voluntarios, mediante el cuestionario de afectividad positiva/negativa para niños, adicionando preguntas sociodemográficas. Se realizó análisis descriptivo/asociativo para conocer el comportamiento de la afectividad infanto-juvenil pre y posconfinamiento. Resultados: Se observó disminución significativa de la afectividad positiva durante el confinamiento (Z =-3,073; p= ,002), además de aumento significativo en la probabilidad de que el estado afectivo previo, positivo (OR= 32,1: IC 95% 8,1 - 127,2) o negativo (OR= 10,8: IC 95% 3,9 - 29,4), incremente el deterioro de la afectividad presente. Por último, no se registraron cambios significativos en la afectividad negativa antes y durante el confinamiento. Conclusiones: Durante el periodo de confinamiento se aprecia deterioro en la percepción de bienestar emocional asociado a una disminución del afecto positivo, siendo la afectividad previa un factor de riesgo de deterioro del bienestar percibido por los niños/as y adolescentes. Se requiere potenciar la capacidad de afrontamiento de los/as infantes para que el afecto positivo se constituya en un factor protector ante nuevas catástrofes.

Objective: To analyze affective changes in children and adolescents between 8 and 16 years of age, before and during COVID-19 lockdown. Materials and Methods: Observational, cross-sectional study with repeated evoked measurement. Under non-probabilistic sampling, 87 voluntary school children and adolescents were surveyed online using the positive/negative affect questionnaire for children, with the addition of sociodemographic questions. Descriptive/associative analysis was performed to determine the behavior of child and adolescent affectivity before and after lockdown. Results: A significant decrease in positive affect during lockdown was observed (Z =-3.073; p=.002), as well as a significant increase in the probability that the previous affective state, positive (OR: 32.1: 95% CI 8.1 - 127.2) or negative (OR: 10.8: 95% CI 3.9 - 29.4), would increase the deterioration of present affectivity. Finally, there were no significant changes in negative affectivity before and during lockdown. Conclusions: During lockdown, a deterioration in the perception of emotional well-being associated with a decrease in positive affect was observed, with previous affectivity being a risk factor for the deterioration of well-being perceived by children and adolescents. It is necessary to strengthen the coping capacity of children so that positive affect becomes a protective factor in the face of new catastrophes.

Objetivo: Analisar as mudanças afetivas em crianças e adolescentes entre os 8 e 16 anos de idade, antes e durante o confinamento. Materiais e Métodos: Estudo observacional transversal com medições evocadas repetidas. Sob amostragem não-probabilística, 87 crianças e adolescentes foram inquiridos online utilizando o questionário de afeto positivo/negativo para crianças, com o acréscimo de perguntas sociodemográficas. Foi realizada uma análise descritiva/associativa para determinar o comportamento da afetividade infantil e adolescente pré e pós- confinamento. Resultados: Houve uma diminuição significativa do afeto positivo durante o confinamento (Z=-3,073; p= ,002), bem como um aumento significativo da probabilidade de que o estado afetivo anterior, positivo (OR= 32,1: 95% CI 8,1 - 127,2) ou negativo (OR= 10,8: 95% CI 3,9 - 29,4), aumentasse a deterioração da afetividade atual. Finalmente, não houve mudanças significativas no afeto negativo antes e durante o confinamento. Conclusões: Durante o período de confinamento, observou-se uma deterioração da percepção do bem-estar emocional associada a uma diminuição do afeto positivo, sendo a afetividade anterior um fator de risco para a deterioração do bem-estar percebido pelas crianças e adolescentes. É necessário fortalecer a capacidade de reação das crianças para que o afeto positivo se torne um fator de proteção face a novas catástrofes.

Relación entre organización de personalidad y prevalencia de síntomas de depresión, ansiedad y estrés entre universitarios de carreras de la salud en la Región de Coquimbo, Chile / Relationship between personality organization and the prevalence of symptoms of depression, anxiety and stress among university students in health careers in the Region of Coquimbo, Chile

Resumen Objetivo: La literatura informa de un conjunto de variables asociadas a la depresión, la ansiedad y el estrés en estudiantes de salud. La única de ellas que tendría un influjo constante es la organización estructural de la personalidad. El presente trabajo ha determinado la relación de las dimensiones de organización de la personalidad con los síntomas depresivos, ansiosos y de estrés reportados por estudiantes universitarios de primer año de carreras de salud. Material y método: Con un diseño no experimental ex-post-facto, se evaluó la organización de personalidad de 235 universitarios de primer año de Medicina, Enfermería y Kinesiología de tres universidades de La Serena y Coquimbo (Chile). Se utilizó el inventario de organización de la personalidad y la escala de depresión, ansiedad y estrés para tamizar a los participantes. La relación de la personalidad con los síntomas depresivos, ansiosos y de estrés se determinó mediante análisis de regresión múltiple. Resultados: Se encontró que las dimensiones primarias y generales de la personalidad explican un 28% de la varianza de la depresión (p < 0,01), un 20% de la de ansiedad y un 22% de la de estrés, y el uso de defensas primitivas y difusión de identidad son las dimensiones que aportan mayormente al modelo explicativo. Conclusiones: Las dimensiones de la organización de la personalidad tendrían relación significativa en la emergencia de depresión, ansiedad y estrés; la dimensión defensas primitivas y difusión de identidad aporta la mayor carga explicativa. Estos resultados pueden ser útiles para reconocer tempranamente los aspectos de personalidad de los postulantes y realizar acciones que la fortalezcan para mejorar la eficacia adaptativa.

Abstract Objective: The literature reports a set of variables associated with depression, anxiety and stress in health career students. The only one of these that could have a constant input is the structure of personality organisation. The present study aims to determine the relationship between the dimensions of personality organization and depression, anxiety, and stress symptoms reported by first-year university health career students. Methods: Under a non-experimental ex-post-facto design, the personality organisation was evaluated in 2351st year university, medical, nursing, and kinesiology from three universities of La Serena and Coquimbo (Chile). Inventory of personality organization and scale of depression, anxiety and stress to sift participants was used. The relationship of personality with depressive, anxiety and stress symptoms was determined by multiple regression analysis. Results: It was found that the primary and overall personality dimensions explained 28% of the variance of depression (P<.01), 20% of anxiety, and stress 22%, with the use of primitive defenses and identity diffusion dimensions that largely contribute to the explanatory model. Conclusions: The dimensions of personality organization could have a significant relationship with the emergence of depression, anxiety and stress, as the explanatory burden dimensionprovidestheprimitivedefensesandidentitydiffusion.Theseresultsmaybeuse-fulforearlyrecognitionofaspectsofpersonalityofapplicants, and to perform actions that strengthen them in order to improve efficiency.

[Relationship between personality organization and the prevalence of symptoms of depression, anxiety and stress among university students in health careers in the Region of Coquimbo, Chile]. / Relación entre organización de personalidad y prevalencia de síntomas de depresión, ansiedad y estrés entre universitarios de carreras de la salud en la Región de Coquimbo, Chile.

OBJECTIVE: The literature reports a set of variables associated with depression, anxiety and stress in health career students. The only one of these that could have a constant input is the structure of personality organisation. The present study aims to determine the relationship between the dimensions of personality organization and depression, anxiety, and stress symptoms reported by first-year university health career students. METHODS: Under a non-experimental ex-post-facto design, the personality organisation was evaluated in 235 1st year university, medical, nursing, and kinesiology from three universities of La Serena and Coquimbo (Chile). Inventory of personality organization and scale of depression, anxiety and stress to sift participants was used. The relationship of personality with depressive, anxiety and stress symptoms was determined by multiple regression analysis. RESULTS: It was found that the primary and overall personality dimensions explained 28% of the variance of depression (P<.01), 20% of anxiety, and stress 22%, with the use of primitive defenses and identity diffusion dimensions that largely contribute to the explanatory model. CONCLUSIONS: The dimensions of personality organization could have a significant relationship with the emergence of depression, anxiety and stress, as the explanatory burden dimension provides the primitive defenses and identity diffusion. These results may be useful for early recognition of aspects of personality of applicants, and to perform actions that strengthen them in order to improve efficiency.

Relación entre inteligencia emocional y depresión-ansiedad y estrés en estudiantes de medicina de primer año / Relationship between emotional intelligence and depression-anxiety and stress in medical students freshmen

Background: Emotional management has been described as part of the desirable clinical skills in medical students, however the high prevalence of depression, anxiety and stress, especially freshmen, would negatively affect their emotional perception deteriorating learning, welfare personal and social. Objective: To determine the degree of relationship between the branches of emotional intelligence and self-rated depressive-anxious and stress symptoms reported by college freshmen medicine. Method: Under a non-experimental design, a sample of 106 freshmen of medicine of the 2013-2014 cohorts were surveyed, to raise the TMMS-24 data and DASS-21 scale was used. Data analysis was done using the Pearson correlation coefficient. Results: The results indicate the existence of inverse correlations between branches clarity and repair anxious depressive symptoms and stress and direct correlations between branch care and depression. Discussion: Lower levels of depression-anxiety and stress involve greater perceived ability to understand and manage emotions, while higher levels of depression involve a tendency to pay more attention to emotions which perpetuate itself rumination of these states. These results provide valuable information as to the need to enhance the skills of emotional intelligence in order to reduce the negative effects of mood and anxiety symptoms in medical students and increase the positive perception of emotional management linked to clinical skills.

Antecedentes: El manejo emocional ha sido descrito como parte de las habilidades clínicas deseables en estudiantes de medicina, sin embargo, la alta prevalencia de depresión, ansiedad y estrés, especialmente de estudiantes de primer año, afectaría negativamente su autopercepción emocional deteriorando el aprendizaje, el bienestar personal y social. Objetivo: Determinar el grado de relación entre las ramas de la inteligencia emocional autopercibida y los síntomas depresivos-ansiosos y estrés reportados por estudiantes universitarios de primer año de medicina. Método: Bajo un diseño no experimental, se encuestó una muestra de 106 estudiantes de primer año de medicina de las cohortes 2013-2014. Para levantar los datos se utilizó el TMMS-24 y la escala DASS-21. El análisis de datos se hizo mediante el coeficiente de correlación de Pearson. Resultados: Los resultados indican la existencia de correlaciones inversas entre las ramas claridad y reparación con los síntomas depresivos ansiosos y estrés y correlaciones directas entre la rama de atención y depresión. Discusión: Los menores niveles de depresión-ansiedad y estrés implicarían una mayor percepción de habilidad para comprender y manejar las emociones, en tanto que mayores niveles de depresión implicarían una tendencia a prestar mayor atención a las emociones lo cual perpetuaría la rumiación propia de estos estados. Estos resultados aportan información valiosa en cuanto a la necesidad de potenciar las habilidades de inteligencia emocional a fin de disminuir los efectos negativos de los síntomas anímicos y ansiosos en los estudiantes de medicina e incrementar la percepción positiva de manejo emocional vinculada a las habilidades clínicas.