Actitudes hacia el endeudamiento y estrés financiero en adultos emergentes: rol mediador de las compras planificada e impulsiva / Attitudes toward debt and financial stress in emerging adults: mediating role of planning and impulsive buying

Resumen Introducción: la preocupación por las finanzas es una de las principales causas de estrés financiero, especialmente en grupos poblacionales con ingresos y trabajos inestables. El objetivo de este artículo fue determinar si las actitudes austera y hedonista hacia el endeudamiento se relacionan directamente con el estrés financiero e indirectamente a través de las actitudes de compra planificada e impulsiva en adultos emergentes. Método: el diseño fue transversal, con un alcance correlacional-explicativo. Se aplicaron escalas de autorreporte en formato en línea a una muestra conformada por 624 adultos emergentes (63.1 % mujeres). El promedio de edad fue 20.44 (DE = 3.35). Resultados: el análisis de ecuaciones estructurales reveló que las actitudes austeras se vinculan directamente con el estrés financiero, y también indirectamente a través de la compra planificada. En cuanto a las actitudes hedonistas, se encontró una asociación directa con la compra impulsiva, pero no con el estrés financiero. Conclusiones: el estrés financiero aumenta cuando los adultos emergentes tienen actitudes de compra más austeras y planificadas. Por lo tanto, tales actitudes pueden presionarlos a hacer un uso más eficiente del dinero. Sería interesante en futuros estudios tener muestras de otros rangos etarios que permitan comparar la evidencia encontrada para contribuir al desarrollo de estrategias de educación financiera basadas en la evidencia científica.

Abstract Introduction: Worry about finances is one of the main causes of financial stress, especially in population groups with unstable income and jobs. This article aimed to determine whether austere and hedonistic debt attitudes are directly related to financial stress and indirectly through planned and impulsive buying attitudes in emerging adults. Method: The design was cross-sectional, with a correlational-explanatory scope. Self-report scales were answered online by a sample of 624 emerging adults (63.1 % women) with an average age of 20.44 (SD = 3.35). Results: Structural equation modeling analysis revealed that austere attitudes are directly linked to financial stress, and indirectly through planned purchases. Regarding hedonistic attitudes, a direct association with impulsive buying was found, but no relationship with financial stress was observed. Conclusion: Financial stress increases when emerging adults have more austere and planned purchasing attitudes, therefore, they may feel pressure to make more efficient use of money. It would be interesting in future studies to have samples from other age ranges that allow comparing the evidence found to contribute to the development of Financial Education strategies based on scientific evidence.

Patients' and Caregivers' Experiences Navigating the Burden of Atopic Dermatitis in Argentina.

Background and Objectives: Little is known about patients' and caregivers' experiences with atopic dermatitis (AD) in Argentina, so a survey was administered to learn more. Materials and Methods: A 53-item anonymous survey was administered in Spanish to adult AD patients (n = 334) and caregivers (n = 339) of pediatric AD patients in Argentina (total n = 673). Demographics, healthcare provider information, financial burden, disease severity, disease burden, level of disease-specific education, and experience with shared physician/patient decision making were collected. Linear and logistic regression models were used for statistical comparisons. Results: Survey respondents were overwhelmingly female (90.8%), as was the overall patient population (72.8%). Patients were seen mostly by healthcare specialists (66.8% dermatologists, 13.5% pediatricians, 7.7% allergists, and 7.2% general practitioners). Only 2.8% of respondents reported no symptoms, while 33.3%, 52.4%, and 11.5% reported mild, moderate, and severe AD disease, respectively. Anxiety/depression and pain/discomfort were the most impactful on respondents' quality of life. Caregivers of children with moderate to severe AD and adult patients with severe AD reported a significant financial burden, including using savings or not purchasing food or other essentials to afford medical care. Few people reported receiving disease-specific education or having their own treatment priorities taken into consideration. For adult patients, receiving disease education and being asked about treatment priorities were associated with higher treatment satisfaction and AD control. Discussion: Mental health, pain/discomfort, and financial worries are the most important burdens for adult AD patients and caregivers of children with AD in Argentina. We recommend prioritizing disease-specific education and shared decision making to improve AD care in Argentina.

Impact of financial toxicity on adults with cancer during the COVID-19 pandemic: an integrative review / Repercusiones de la toxicidad financiera en adultos con cáncer durante la pandemia de COVID-19: revisión integrativa / Repercussões da toxicidade financeira em adultos com câncer durante a pandemia da COVID-19: revisão integrativa

ABSTRACT Objectives: to identify the repercussions of financial toxicity on the lives of adult cancer patients during the COVID-19 pandemic. Methods: an integrative review was conducted using the PubMed, Web of Science, Scopus, and Embase databases, as well as the Virtual Health Library portal, in March 2023. Results: out of 62 studies found, 13 were included for analysis. The primary repercussions of financial toxicity included difficulties in covering basic expenses such as food, housing, medication, transportation, and internet access; increased anxiety and concerns related to health and financial situations; reduction or absence of income; challenges in obtaining treatment or accessing healthcare services; rising expenses; and telemedicine as a less burdensome alternative. Conclusions: the pandemic has exacerbated financial toxicity; therefore, healthcare teams must recognize it as an adverse event of oncological treatment and understand its potential to affect various aspects of patients' lives.

RESUMEN Objetivos: identificar las repercusiones de la toxicidad financiera en la vida de pacientes adultos con cáncer durante la pandemia de COVID-19. Métodos: revisión integrativa realizada en las plataformas de datos PubMed, Web of Science, Scopus, Embase y en el portal de la Biblioteca Virtual en Salud en marzo de 2023. Resultados: de 62 estudios encontrados, 13 fueron incluídos para análisis. Las principales repercusiones de la toxicidad financiera fueron: dificultades para cubrir gastos básicos como alimentación, vivienda, medicamentos, transporte e internet; aumento de la ansiedad y preocupaciones relacionadas con la salud y la situación financiera; reducción o ausencia de ingresos; dificultad para obtener tratamiento o acceso a los servicios de salud; aumento de los gastos y telemedicina como alternativa menos costosa. Conclusiones: la pandemia ha intensificado la toxicidad financiera; por lo tanto, los equipos de salud necesitan reconocerla como un evento adverso del tratamiento oncológico y comprender que puede afectar diferentes ámbitos de la vida de los pacientes.

RESUMO Objetivos: identificar as repercussões da toxicidade financeira na vida de pacientes adultos com câncer durante a pandemia da COVID-19. Métodos: revisão integrativa realizada nas plataformas de dados PubMed, Web of Science, Scopus, Embase e no portal da Biblioteca Virtual em Saúde no mês de março de 2023. Resultados: de 62 estudos encontrados, 13 foram incluídos para análise. As principais repercussões da toxicidade financeira foram: dificuldades em custear despesas básicas como alimentação, moradia, medicamentos, transporte e internet; aumento da ansiedade e preocupações relacionadas à saúde e à situação financeira; redução ou ausência de renda; dificuldade para obter tratamento ou acesso aos serviços de saúde; aumento das despesas e telemedicina como alternativa menos onerosa. Conclusões: a pandemia acentuou a toxicidade financeira; portanto, as equipes de saúde precisam reconhecê-la como um evento adverso do tratamento oncológico e compreender que ela pode afetar diferentes âmbitos da vida dos pacientes.

Adaptation and validation of the financial stress scale in social conflict contexts: a study conducted with small and medium-sized Peruvian entrepreneurs.

Introduction: Social conflicts have repercussions on the mental health of the economically active population. Objective: To adapt and validate the Financial Stress Scale in the context of social conflicts (ESECPS). Method: An instrumental study involving 2,242 owners of small and medium enterprises (50.9% women), aged between 18 and 74 years old, selected through a non-probabilistic purposive sampling. The participants were recruited across three regions of Peru during periods of protests and strikes against the incumbent Peruvian government. The instrument for adaptation was the financial stress scale EFEmp-Cov19, created in the context of the COVID-19 pandemic's impact. Results: All items proved to be clear, relevant, and representative (V > 0.70). Exploratory Factor Analysis (EFA) revealed the existence of one underlying factor across the 11 items (KMO = 0.962, Bartlett = 5434.3; df = 55; p < 0.001). However, for Confirmatory Factor Analysis (CFA), items 4 and 11 were removed, resulting in support for a unidimensional model with 9 items (χ2 = 262.73, df = 23, p < 0.001; RMR = 0.022; TLI = 0.972; CFI = 0.980; and RMSEA = 0.072). Regarding reliability, a very high value was found (ω = 0.92). Conclusion: The ESECPS demonstrates adequate psychometric properties, making it a suitable measure to assess financial stress among Peruvian entrepreneurs facing economic instability and financial threats in the context of social conflicts.

Calidad de vida y toxicidad financiera de los receptores de trasplantes de células madre hematopoyéticas en COVID-19 / Quality of life and financial toxicity of hematopoietic stem cell transplant recipients in COVID-19 / Qualidade de vida e toxicidade financeira dos transplantados de células-tronco hematopoéticas na COVID-19

Objetivo: evaluar y correlacionar la calidad de vida y la toxicidad financiera de pacientes adultos sometidos a trasplante de células madre hematopoyéticas durante el período de la pandemia de COVID-19. Método: estudio observacional, analítico, realizado con 35 pacientes en un hospital de referencia para trasplante en Latinoamérica. Para la recolección de datos, se utilizaron los cuestionarios Functional Assessment Cancer Therapy Bone Marrow Transplantation y el COmprehensive Score for financial Toxicity. Para el análisis de los datos se utilizaron las pruebas de correlación de Spearman y Mann-Whitney. Resultados: la calidad de vida general durante la COVID-19 mostró un puntaje bajo (67,09/108) con mayor deterioro en el bienestar funcional (14,47/28), bienestar social (16,76/28) y preocupaciones adicionales (23,41/40). Los promedios del grupo alogénico fueron inferiores a los del grupo autólogo en todos los dominios, presentando diferencia significativa en relación a preocupaciones adicionales (p=0,01) y en el índice de evaluación del tratamiento (p=0,04). Se consideró que la toxicidad financiera tenía un impacto leve (22.11/44). Se observó una relación, aunque no significativa, entre la calidad de vida y la toxicidad financiera (p=0,051). Conclusión: la calidad de vida de la muestra fue baja; existe una correlación entre la calidad de vida y la toxicidad financiera, aunque no significativa. Cuanto mayor es la toxicidad financiera, menor es la calidad de vida.

Objective: to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic. Method: observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis. Results: general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051). Conclusion: the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.

Objetivo: avaliar e correlacionar a qualidade de vida e a toxicidade financeira dos pacientes adultos submetidos ao transplante de células-tronco hematopoéticas no período da pandemia de COVID-19. Método: estudo observacional, analítico, realizado com 35 pacientes em um hospital de referência para o transplante na América Latina. Para coleta de dados, utilizaram-se os questionários Functional Assessment Cancer Therapy Bone Marrow Transplantation e COmprehensive Score for financial Toxicity. Na análise dos dados empregaram-se os testes de correlação de Spearman e Mann-Whitney. Resultados: a qualidade de vida geral, durante a COVID-19, apresentou baixo escore (67,09/108), com maior comprometimento nas funções bem-estar funcional (14,47/28), social (16,76/28) e preocupações adicionais (23,41/40). As médias do grupo alogênico foram inferiores às do autólogo em todos os domínios, apresentando diferença significativa em relação às preocupações adicionais (p=0,01) e ao índice de avaliação do tratamento (p=0,04). A toxicidade financeira foi considerada de impacto leve (22,11/44). Observou-se relação, ainda que não significativa, entre a qualidade de vida e a toxicidade financeira (p=0,051). Conclusão: a qualidade de vida da amostra foi baixa, logo há uma correlação entre qualidade de vida e a toxicidade financeira, embora não significativa. Quanto maior a toxicidade financeira, menor a qualidade de vida.

Global financial crisis and musculoskeletal pain: systematic review / Crise financeira mundial e dores musculoesqueléticas: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: In recent history, major catastrophes are followed by economic crisis, which are commonly succeeded by high levels of psychological stress related to financial hardships. The relationship between this financial stress (FS) and musculoskeletal pain (MP) is not elucidated. The aim of this systematic review was to critically evaluate the evidence of the relationship between these financial difficulties and MP. METHODS: A comprehensive search was conducted on the following databases: Medline, LILACS, Scielo and PsycINFO. Studies included were observational, among adults, measuring FS and its association with MP worsening or development, recruiting participants or data from any setting, and providing outcome data for at least one pain outcome measure. RESULTS: 445 potentially relevant citations was identified, which included 438 unique citations, 419 of which did not meet inclusion criteria. Final search included nine studies. The most frequent pain types reported were low back pain and neck pain. Descriptions of financial stress varied. Overall, exposure to financial stress was determined according to some difficulty in relation to afford necessities. All studies, except one, found significant associations between some type of MP and FS. CONCLUSION: This systematic review brought the available data on the relationship between FS and MP. It is possible to state that there is reasonable evidence of FS as a strong predictor for the onset of MP. It is necessary to be aware of this issue when dealing with pain patients during the current humanitarian crisis.

RESUMO JUSTIFICATIVA E OBJETIVOS: Na história recente, grandes catástrofes são seguidas de crises econômicas, que comumente são acompanhadas por altos níveis de estresse psicológico relacionado a dificuldades financeiras. A relação entre esse estresse financeiro (EF) e a dor musculoesquelética (DME) não está elucidada. O objetivo desta revisão sistemática foi avaliar criticamente as evidências da relação entre tais dificuldades financeiras e a DME. MÉTODOS: Uma busca abrangente foi realizada nas seguintes bases de dados: Medline, LILACS, Scielo e PsycINFO. Os estudos incluídos foram observacionais, entre adultos, aferindo o EF e sua associação com a piora ou desenvolvimento de uma DME, recrutando participantes ou dados de qualquer ambiente, e fornecendo dados de resultado para ao menos uma medida de resultado de dor. RESULTADOS: Foram identificadas 445 citações potencialmente relevantes, que incluíram 438 citações únicas, 419 das quais não atenderam aos critérios de inclusão. A pesquisa final incluiu 9 estudos. Os tipos de dor mais frequentes relatados foram lombalgia e cervicalgia. Descrições de estresse financeiro variaram. No geral, a exposição ao estresse financeiro foi determinada de acordo com alguma dificuldade em relação às necessidades de pagamento. Todos os estudos, exceto um, encontraram associações significativas entre algum tipo de DME e EF. CONCLUSÃO: Este estudo trouxe os dados disponíveis sobre a relação entre EF e DME. É possível afirmar que há razoável evidência do EF como um forte preditor para o aparecimento de DME. É preciso estar ciente dessa questão ao lidar com pacientes com dor durante a atual crise humanitária.

Follow-up of patients diagnosed with and treated for tuberculosis in Brazil: financial burden on the household / Acompanhamento de pacientes com diagnóstico e tratamento de tuberculose no Brasil: ônus financeiro para a família

ABSTRACT Objective: To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. Methods: This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). Results: A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). Conclusions: Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.

RESUMO Objetivo: Avaliar as implicações da proporção da renda familiar anual gasta nos períodos pré e pós-diagnóstico em pacientes com tuberculose acompanhados durante pelo menos um ano após o término do tratamento da tuberculose no Brasil. Métodos: Estudo transversal com pacientes com tuberculose acompanhados durante pelo menos um ano após o término do tratamento da tuberculose em cinco capitais brasileiras (uma em cada região do país). Resultados: Foram incluídos na análise 62 pacientes. O custo médio global da tuberculose foi de R$ 283,84 no período pré-diagnóstico e de R$ 4.161,86 no período pós-diagnóstico. Após os custos da doença tuberculosa, 71% dos pacientes ficaram desempregados, com um aumento global do desemprego; além disso, o número de pacientes não pobres diminuiu 5%, o número de pacientes pobres aumentou 6% e o número de pacientes extremamente pobres aumentou 5%. A maior proporção de renda familiar anual para cobrir os custos totais da tuberculose foi observada nos pacientes extremamente pobres (40,37% vs. 11,43% nos menos pobres). Conclusões: As políticas para mitigar os custos catastróficos devem incluir intervenções planejadas pelo sistema de saúde e medidas de proteção social para pacientes de baixa renda com tuberculose, a fim de eliminar a epidemia global de tuberculose até 2035, uma meta da OMS alinhada com os Objetivos de Desenvolvimento Sustentável propostos pela Organização das Nações Unidas.

Frequency and economic burden of psychogenic non-epileptic seizures in patients applying for disability benefits due to epilepsy / Frequência e impacto econômico das crises psicogênicas não epilépticas em pacientes requerentes de aposentadoria por invalidez devido a epilepsia

Abstract Background Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures and are often misdiagnosed as epilepsy. Objective To investigate the frequency of PNES and to calculate the economic burden of the patients who admitted to video-electroencephalographicmonitoring (VEM) to obtain a diagnosis of epilepsy in order to apply for disability retirement. Methods The present retrospective study included 134 patients who required disability reports between 2013 and 2019 and had their definite diagnoses after VEM. Following VEM, the patients were divided into three groups: epilepsy, PNES, and epilepsy + PNES. Results In total, 22.4% (n = 30) of the patients were diagnosed with PNES, 21.6% (n = 29) with PNES and epilepsy, and 56% (n = 75), with epilepsy. The frequency of PNES among all patients was of 44% (n = 59). In patients with PNES alone, the annual cost of using anti-seizure medication was of 160.67 ± 94.04 dollars; for psychostimulant drugs, it was of 148.3 ± 72.48 dollars a year; and the mean direct cost for diagnostic procedures was of 582.9 ± 330.0 (range: 103.52-1601.3) dollars. Conclusions Although it is challenging to determine the qualitative and quantitative total cost in these patient groups, early diagnosis and sociopsychological support will reduce the additional financial burden on the health system and increase the quality of life of the patients.

Resumo Antecedentes As crises psicogênicas não epilépticas (CPNE) se assemelham a crises epilépticas, e muitas vezes são diagnosticadas erroneamente como epilepsia. Objetivo Investigar a frequência de CPNE e calcular o impacto econômico dos pacientes internados para serem submetidos a monitoramento videoencefalográfico (MVE) para obter um diagnóstico de epilepsia e requerer aposentadoria por invalidez. Métodos Este estudo retrospectivo incluiu 134 pacientes que solicitaram laudo médico de incapacidade entre 2013 e 2019, e obtiveram seus diagnósticos definitivos após serem submetidos a MEV. Os pacientes foram divididos em três grupos: epilepsia, CPNE, e epilepsia + CPNE. Resultados Após o MEV, 22,4% (n = 30) dos pacientes foram diagnosticados com CPNE, 21,6% (n = 29), com CPNE + epilepsia, e 56%, com epilepsia. A frequência de CPNE entre todos os pacientes foi de 44% (n = 59). Em pacientes somente com CPNE, o custo anual do uso de anticonvulsivantes foi de US$ 160,67 ± 94,04; para os psicoestimulantes, o custo anual foi de US$ 148,3 ± 72,48; e a média do custo direto de procedimentos diagnósticos foi de US$ 582,9 ± 330,0 (variação: 103,52-1601,3). Conclusões Embora seja um desafio determinar o custo total qualitativo e quantitativo nesses grupos de pacientes, o diagnóstico precoce e o apoio sociopsicológico reduzirão o impacto financeiro adicional ao sistema de saúde e aumentarão a qualidade de vida dos pacientes.

Serious financial difficulties, psychological stress, and subclinical cardiovascular disease in Mexican women.

PURPOSE: To investigate the association between serious financial difficulties (SFD), stress, and cardiovascular health in women. METHODS: We categorized 1759 employed and insured disease-free women from the Mexican Teachers' Cohort according to their response to a question on SFD included in the Life Stressor Checklist-Revised administered in 2012 and 2016. We also measured perceived stress (n = 1598) and hair cortisol levels (n = 539) in study participants. Carotid intima-media thickness was measured, and carotid atherosclerosis determined in all participants. RESULTS: Multivariable regression models indicated that women exposed to SFD had 1.6% (95% CI: 0.05, 3.2) higher mean intima-media thickness and 1.37 (95% CI: 1.02, 1.85) higher odds of carotid atherosclerosis relative to women without SFD. The magnitude of the observed associations was higher in women reporting longer duration of the event and higher emotional burden. Mediation analyses suggested a potential role of perceived stress and body mass index in these associations. Cortisol levels did not differ between groups. CONCLUSIONS: SFD was associated with subclinical cardiovascular disease among employed and insured women. Limiting stress and adiposity may be potential targets for interventions.

Trajectories of family and employment stress associated with cerebrovascular accidents / Trayectorias de estrés familiar y laboral y su asociación con accidentes cerebrovasculares

ABSTRACT OBJECTIVES: Reconstruct types of simultaneous stress trajectories in the family and employment domain at different stages of life and estimate their association with cerebrovascular accident (CVA) in old age. METHODS: We used a retrospective, face-to-face, representative survey of people aged 65 to 75 years in the city of Santiago, Chile, (n = 802). We performed a multichannel sequence analysis to reconstruct family and employment stress trajectory types at various life stages and then used logistic regression models to estimate the association of these trajectory types with CVA in old age, controlled for traditional cardiovascular risk factors. RESULTS: Four representative types of family and employment stress trajectories were identified: (1) Absence of family and employment stress, (2) Absence of family stress, persistent employment stress, (3) Absence of family stress, out of the labor market, and (4) Persistent family stress, absence of employment stress. The 61.7% of the sample followed trajectories marked by the permanent presence of family and/or employment stress. Likewise, 18.3% had a trajectory characterized by prolonged absence from the labor market. Individuals with persistent family or employment stress trajectories, as well as those with extended periods of inactivity, are more at risk of developing CVA. CONCLUSIONS: Stress is a risk factor for cardiovascular disease experienced by many people at different stages and domains of life on a prolonged basis. Consequently, prevention systems for this type of chronic diseases should emphasize the highly harmful effects of daily and cumulatively stressful life experiences. This could mitigate the multiple health and financial consequences associated with CVA.

RESUMEN OBJETIVOS: Reconstruir tipos de trayectorias de estrés simultáneo en el dominio familiar y laboral en diferentes etapas de la vida y estimar su asociación con accidentes cerebrovasculares (ACV) en la vejez. MÉTODOS: Se utilizó una encuesta retrospectiva, cara a cara, y representativa de personas de 65 a 75 años en la ciudad de Santiago de Chile (n = 802). Se empleó un análisis de secuencias multicanal para reconstruir tipos de trayectorias de estrés familiar y laboral en diversas etapas de la vida y luego se utilizaron modelos de regresión logística para estimar la asociación de estos tipos de trayectoria con ACV en la vejez, controlado por factores tradicionales de riesgo cardiovascular. RESULTADOS: Se identificaron cuatro tipos representativos de trayectorias de estrés familiar y laboral: (1) Ausencia de estrés familiar y laboral, (2) Ausencia de estrés familiar, estrés laboral persistente, (3) Ausencia de estrés familiar, fuera de mercado laboral, y (4) Estrés familiar persistente, ausencia de estrés laboral. El 61,7% de la muestra siguió trayectorias marcadas por la presencia permanente de estrés familiar y/o laboral. Asimismo, el 18,3% tuvo una trayectoria caracterizada por la ausencia prolongada del mercado del trabajo. Las personas con trayectorias de estrés familiar o laboral persistente, así como aquellas con períodos extensos de inactividad, tienen más riesgo de desarrollar ACV. CONCLUSIONES: El estrés es un factor de riesgo de enfermedades cardiovasculares que experimenta de manera prolongada muchas personas en distintas etapas y dominios de la vida. En consecuencia, los sistemas de prevención de este tipo de enfermedades crónicas deben enfatizar los efectos altamente nocivos de enfrentar cotidiana y acumulativamente experiencias de vida estresantes. Esto a su vez podría mitigar las múltiples consecuencias sanitarias y financieras asociadas al ACV.

Pathways to inflammation in adolescence through early adversity, childhood depressive symptoms, and body mass index: A prospective longitudinal study of Chilean infants.

Early adversity, depression, and obesity are associated with increases in low-grade inflammation. However, there are few prospective and longitudinal studies to elucidate how these associations unfold in children. The present study used latent growth curve models to examine pathways between family adversity in infancy, depressive symptoms in childhood, body mass index (BMI) in childhood, and inflammation in adolescence (age = 16-18). The study is an adolescent follow-up of infants from working-class communities around Santiago, Chile, who participated in a preventive trial of iron supplementation at 6 months of age. Anthropometrics, stressful life events, maternal depression, socioeconomic status, and developmental assessments were measured at 12 months, 5 years, 10 years, and adolescence. In adolescence, participants provided blood samples for high-sensitivity C-reactive protein (hsCRP) assessment. Greater exposure to early adversity in the form of interpersonal conflict stress in infancy indirectly associated with increased hsCRP through its association to increased intercept and slope of childhood BMI. Depressive symptoms at any time were not directly or indirectly associated with increased hsCRP. These findings contribute to our understanding of how early family adversity and its associations with obesity and depressive symptoms across childhood are linked to low-grade, chronic inflammation in adolescence. The model identified as best capturing the data supported the pivotal role of childhood BMI in explaining how early-life adversity is associated with inflammation in adolescence.

Work Status, Financial Stress, Family Problems, and Gender Differences in the Prevalence of Depression in Chile.

INTRODUCTION: It is widely known that women have a higher prevalence of depression than men. These differences may be explained by social differences between women and men due to gender roles. In Chile, as elsewhere, women have greater household responsibilities, lower job incomes, and especially low labor market participation. However, the incidence of these gender differences on the higher prevalence of depression in women requires further study in the Chilean context. OBJECTIVE: To identify main social differences between women and men associated with gender differences in the prevalence of depression in middle-aged Chilean men and women. DATA SOURCE: Data comes from the second Chilean National Health Survey (2009-2010), a cross-sectional, nationally representative sample (n = 2771) composed of 1103 men and 1668 women (39.8 and 60.2%, respectively), whose age range goes from 25 to 55 years old. This study was approved by the Ethics Committee of Pontificia Universidad Católica de Chile. METHODS: Prevalence ratios were calculated through Poisson regression models to estimate associations between the prevalence of past episodes of depression and social stressful life events variables for men and women separately. Gender prevalence ratios of depression (Gender PR) adjusted for age and subsequently adjusted by the social and stressful life events variables. The analyses considered factors such as age, educational level, per-capita household income, work status, role as the head of household, marital status, events of violence, family problems, personal health problems or accidents, and self-reported financial stress. RESULTS: This study finds that doing housework, reporting a serious family problem and having high financial stress were associated with a higher prevalence of depression in both genders. Whereas, health problems were only associated with prevalence in men. The age-adjusted gender PR was 2.84 [confidence interval (CI): 2.0-4.1], and when all selected variables were included attenuated to a PR of 1.86 (CI 1.3-2.7). The variable most strongly associated with depression in the fully-adjusted model was housework (PR: 5.3; CI: 1.3-21.0). CONCLUSION: In conclusion, this study finds that depression in in Chile is associated with social factors such as participation in housework, family problems, and financial stress, all of which are more common in women. To make further progress in the study of this public health problem in Chile, it is essential to incorporate more detailed characterization of gender roles in surveys and other studies. Likewise, social policies and interventions that contribute to reduce gender social inequalities in the exposure to adverse life circumstances can contribute to reduce unnecessary and avoidable gender disparities in health.

The Effects of Job Instability and Financial Strain on C-Reactive Protein in a Sample of Mexican Immigrants.

OBJECTIVE: Mexican immigrants have lower cardiovascular disease risk than US citizens, but risk increases with level of acculturation. Our study investigated whether job stress and financial strain would be related to inflammation (C-reactive protein), lipids, and blood pressure, and if they would play a role in the acculturation process in Mexican immigrants. METHODS: A sample of 310 Mexican immigrants living in the United States were studied on measures of job stress, financial strain, acculturation, and cardiovascular disease risk factors (C-reactive protein, lipids, and blood pressure). RESULTS: Job instability, financial strain, and acculturation, were related to inflammation, but psychological demands and decision latitude were not related. Lipids and blood pressure were not related to the variables of interest. Body mass index (BMI) was related to both increased acculturation and inflammation, and when controlling for BMI, acculturation was no longer a significant predictor of inflammation. Job instability and financial strain remained significant predictors of inflammation after controlling for BMI, sex, and age. Job instability and financial strain were not related to acculturation, suggesting that these factors are significant stressors for both newly arrived and more established immigrants. CONCLUSIONS: Job instability and financial strain predict increased inflammation in Mexican immigrants but they do not play a role in the relationship between acculturation and C-reactive protein. The effects of acculturation on inflammation in this study were mediated by BMI.