Latin America and the Caribbean Code Against Cancer 1st edition: Building capacity on cancer prevention to primary healthcare professionals.

INTRODUCTION: Every year 1.5 million new cancer cases are diagnosed in Latin America and the Caribbean (LAC). Of these, about 40 % could be prevented. Health illiteracy has been identified as a main barrier for cancer prevention. Primary healthcare professionals (HCP) are key in cancer prevention as they are the first entry point of the population into the healthcare system. The LAC Code Against Cancer 1st edition aims to improve health literacy and awareness of cancer prevention in the LAC population, through building capacity of primary HCP. METHODS: The definition and development of the learning objectives, curriculum, structure, and evaluation of an online learning program for primary HCP was led by a dedicated group of experts from the LAC Code Against Cancer project. A pedagogical guideline and a template to ensure harmonization across topics were produced to guide the program development. Two rounds of internal revisions and an editorial process were performed. RESULTS: An online competency-based microlearning program for primary HCP was produced, taking the LAC Code Against Cancer as a basis. The competences addressed in the curriculum are core knowledge, communication skills, decision-making and applying knowledge to real-world situations. A comprehensive evaluation to assess acquisition of these competences, based on the Miller's Pyramid, was designed with three data collection points: a) immediately before, to assess baseline knowledge and skills; b) immediately after, to determine acquired competences; and c) at 3-6 months follow-up, to assess performance in daily practice. The e-learning will be freely available in the Virtual Campus for Public Health of the Pan American Health Organization in Spanish, English, and Portuguese. CONCLUSION: Primary HCP, perceived as trustworthy sources of information, are key actors to increase the population's awareness and literacy on cancer prevention. Building capacity of these professionals has the potential to increase dissemination and impact of the LAC Code Against Cancer by prompting communication with the public and offering personalized actionable preventive messages through counselling.

Latin America and the Caribbean Code Against Cancer 1st edition: Formative research on the comprehension and persuasiveness of the recommendations by the general population.

BACKGROUND: Cancer prevention is the most efficient and cost-effective strategy in cancer control. One prevention strategy is giving credible, clear, and evidence-based recommendations to the individual; however, it is key that these messages are accepted and understood properly by the public. This study aimed to pilot the draft recommendations developed as part of the Latin America and the Caribbean (LAC) Code Against Cancer 1st edition, in terms of comprehension and persuasion of each message. METHODS: A mixed method two-wave study, in which two versions of the messages were presented to the general population in five LAC countries. We used an ad-hoc questionnaire and interviews that followed the cognitive-pretesting methodology. RESULTS: Findings suggest that the messages were generally well understood, especially in Spanish speaking countries, and that the messages were generally more understandable than persuasive. We adapted and revised the recommendations based on the findings of the first Wave and held a second iteration in the Spanish speaking countries. We observed a better understanding of most messages in Wave 2. CONCLUSION: The LAC Code Against Cancer is a valuable tool of well understood messages for the public, with concrete actions everyone can take to prevent cancer. Further research should assess particularities of the region for further efficient dissemination of these important health messages, identify key messages for certain population groups and future interventions that strengthen health literacy in rural and less educated populations to increase behavior change.

Differences in anxiety sensitivity and experiential avoidance between subtypes of social anxiety disorder.

Both anxiety sensitivity (AS) and experiential avoidance (EA) have been linked to social anxiety disorder (SAD). However, previous studies did not consider their joint variance and the heterogeneity of SAD. In this mixed methods cross-sectional survey, we examined 121 online participants (age range: 16-70 years) who self-reported as socially anxious. We compared AS and EA levels in individuals with a primary fear of noticeable anxiety symptoms vs. behaving ineptly. AS and EA were highly prevalent across the sample. Surprisingly, the noticeable symptoms subtype showed slightly lower AS and EA levels than the inept behavior subtype. The noticeable symptoms subtype scored notably lower on social anxiety measures (mean = 69.8) than the inept behavior subtype (mean = 89.3). EA was uniquely associated with social anxiety in both subtypes, while AS was uniquely associated with social anxiety only in the inept behavior subtype. The joint variance explained substantially more of the noticeable symptoms subtype's social anxiety (32.5%) compared to the inept behavior subtype's (9.4%). Qualitative themes aligned with these findings, indicating a self-reinforcing dynamic between high AS, high EA, and social anxiety symptoms. Potential clinical implications are discussed. Future research should examine causality in the AS-EA-SAD dynamic, considering the heterogeneity of SAD.

Compassion and Self-Compassion: Counterfactors of Burnout in Medical Students and Physicians.

OBJECTIVE: To examine the relationship between self-compassion, compassion for others and Burnout in medical students and physicians. METHODS: A cross-sectional study was conducted. Medicine students and general physicians from two Colombian cities participated (n = 359). The Compassion Scales and the Maslach Inventory were administered. An Exploratory Structural Equation approach was used for validating new measures and testing for relationships between latent variables. RESULTS: Most participants were students (85.9%), mean age was 22 years (SD = 7), 55.2% were female, 62,6% dedicated more than 48 weekly hours to study or practice, while physicians had worked a mean of 10.34 years (SD = 8.67). Self-compassion and Compassion for others action subscales were validated, but engagement subscales of were not. Participant´s compassion actions for others and self-compassion actions are negatively related to depersonalization and emotional exhaustion, respectively. Additionally, compassion dimensions were positively associated with professional accomplishment. CONCLUSION: Our findings indicate that compassion and self-compassion actions inversely relate to different components of Burnout and could constitute protective factors against the stress of healthcare. Compassion and self-compassion training programs for medical students and physicians might be an alternative to avoid Burnout, diminishing physicians' depersonalization and emotional exhaustion while enhancing their professional accomplishment.

HPV-Vaccine Hesitancy in Colombia: A Mixed-Methods Study.

In Colombia, the uptake rate of the HPV vaccine dropped from 96.7% after its introduction in 2013 to 9% in 2020. To identify the behavioural components of HPV-vaccine hesitancy in females aged 15 and under and their families, we conducted a convergent mixed-methods study in which 196 parents/caregivers responded to an online questionnaire and 10 focus groups were held with 13 of these parents/caregivers, and 50 age-eligible girls. The study is novel as it is the first to explore the factors influencing HPV-vaccine hesitancy alongside the COVID vaccine within an integrative model of behaviour change, the capability-opportunity-motivation-behaviour (COM-B) model. We found that COVID-19 has had an impact on the awareness of HPV and HPV vaccination. Lack of information about the vaccination programs, concerns about vaccine safety and the relationship between HPV and sexuality could be related to vaccine hesitancy. Trust in medical recommendations and campaigns focused on the idea that vaccination is a way of protecting daughters from cervical cancer could improve HPV vaccine uptake.

Interactions Between Intensive Care and Palliative Care Are Influenced by Training, Professionals' Perceptions and Institutional Barriers.

Background: There is growing interest in the use of a Palliative care approach in Intensive care. However, it tends to remain inconsistent, infrequent or non-existent, as does its acceptance by intensive care physicians. This study sought to explore the perceptions, level of knowledge, perceived barriers, and practices of physicians regarding palliative care practices (PC) in Intensive Care Units (ICU). Methods: Descriptive-correlational study. Participating physicians working in ICU in Colombia (n = 101) completed an ad hoc questionnaire that included subscales of perceptions, knowledge, perceived barriers, and PC practices in ICU. A Structural Equation Model (PLS-SEM) was used to examine the reciprocal relationships between the measured variables and those that could predict interaction practices between the 2 specialties. Results: First, results from the measurement model to examine the validity and reliability of the latent variables found (PC training, favorable perceptions about PC, institutional barriers, and ICU-PC interaction practices) and their indicators were obtained. Second, the structural model found that, a greater number of hours of PC training, a favorable perception of PC and a lower perception of institutional barriers are related to greater interaction between PC and ICU, particularly when emotional or family problems are detected. Conclusions: PC-ICU interactions are influenced by training, a positive perception of PC and less perceived institutional barriers. An integrated ICU-PC model that strengthens the PC training of those who work in ICU and provides clearer guidelines for interaction practices, may help overcome perceived barriers and improve the perception of the potential impact of PC.

Prevalence and characteristics of patients with heart failure needing palliative care.

BACKGROUND: Few hospitals and heart failure (HF) clinics offer concurrent palliative care (PC) together with life-prolonging therapies. To know the prevalence of patients in HF clinics needing PC and useful tools to recognize them are the first steps to extending PC in those settings. However, it is still unknown whether tools commonly used to identify patients with HF needing PC can correctly distinguish them. Two systematic reviews found that the NECesidades PALiativas (NECPAL) tool was one of the two most commonly used tools to asses PC needs in HF patients. Therefore, we assessed 1) the prevalence of PC needs in HF clinics according to the NECPAL tool, and 2) the characteristics of the patients identified as having PC; mainly, their quality of life (QoL), symptom burden, and psychosocial problems. METHODS: This cross-sectional study was conducted at two HF clinics in Colombia. We assessed the prevalence of PC in the overall sample and in subgroups according to clinical and demographic variables. We assessed QoL, symptom burden, and psychosocial problems using the 12-Item Short-Form Health Survey (SF-12), the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Edmonton Symptom Assessment System (ESAS). We compared the results of these tools between patients identified as having PC needs (+NECPAL) and patients identified as not having PC needs (-NECPAL). RESULTS: Among the 178 patients, 78 (44%) had PC needs. The prevalence of PC needs was twice as nigh in patients NYHA III/IV as in patients NYHA I/II and almost twice as high in patients older than 70 years as in patients younger than 70 years. Compared to -NECPAL patients, +NECPAL patients had worse QoL, more severe shortness of breath, tiredness, drowsiness, and pain, and more psychosocial problems. CONCLUSION: The prevalence of PC needs in outpatient HF clinics is high and is even higher in older patients and in patients at more advanced NYHA stages. Compared to patients identified as not having PC needs, patients identified as having PC needs have worse QoL, more severe symptoms, and greater psychosocial problems. Including a PC provider in the multidisciplinary team of HF clinics may help to assess and cover these needs.

Addressing psychosocial work-related stress interventions: A systematic review.

BACKGROUND: Work-related stress can be defined as an individual's reactions to work characteristics and indicates a poor relationship between coping abilities and work environment. If unmanaged, stress can impact mental and physical health (e.g., causing depression and cardiovascular disease). Many individuals use maladaptive stress-coping strategies, such as sedentary activities, unhealthy eating behaviors, and alcohol consumption, which do not contribute to long-term stress management. In contrast, stress reduction programs can help people manage and effectively reduce stress in the long term. OBJECTIVE: To gather the state of the art of work-related stress interventions, their efficacy and applications. METHOD: The PsycINFO and EBSCOHost databases were used. The search was carried out between January 28 and March 30, 2019. Inclusion criteria were full text available, text in English or Spanish and a study population comprising workers. RESULTS: Twenty-nine articles that included interventions involving aromatherapy, bibliotherapy, cognitive-behavioral therapy, exercise, alternative medicine, mindfulness, technology, stress management and sensory intervention were analyzed. The interventions showed significant reductions in stress, anxiety, depression and burnout; however, most of the studies were not based on specific stress models, and control groups often received no intervention whatsoever. As a result, it is challenging to draw conclusions regarding the success of the interventions, especially if they are novel. CONCLUSION: The results suggest that there is a broad portfolio of successful interventions regarding work-related stress. Most of the successful interventions were based on mindfulness; however, aerobic exercise and bibliotherapy may also be successful. The structure and level of evidence appear to be very relevant to the development of a successful intervention.

Cognitive behavioral therapy reduces illness perceptions and anxiety symptoms in patients with unruptured intracranial aneurysm.

The main purpose of this study was to assess the relation between cognitive behavioral therapy and possible changes in illness perceptions and anxiety in patients diagnosed with unruptured intracranial aneurysm. An observational study of an intervention with 67 patients with an unruptured intracranial aneurysm from two medical centers in a Colombian city (n = 35 on the intervention group) was carried out. To assess changes, measurements were taken at baseline and at one-year follow-up with the Beck Anxiety Inventory and the Illness Perception Questionnaire, brief version, taking into account the importance of perceptions in the process of adjusting to illness and acquiring healthy life habits. Hypotheses were tested by a structural model. The results obtained from this study showed that illness perceptions were related to anxiety levels at both time points; however, the relations were stronger before cognitive behavioral therapy (ßt0 = 0.61, p < 0.01; ßt1 = 0.37, p < 0.01). Cognitive behavioral therapy was found to be a moderator of changes in both illness perceptions and anxiety at the time of follow-up (ß = -0.31, p < 0.01; ß = -0.26, p < 0.01). The structural model suggests that cognitive behavioral therapy is associated with less anxiety (ß = -0.17, p < 0.05) and better illness perceptions (ß = -0.35, p < 0.01) in patients diagnosed with unruptured intracranial aneurysms.

Personality and anxiety are related to health-related quality of life in unruptured intracranial aneurysm patients selected for non-intervention: A cross sectional study.

BACKGROUND: Personality traits and mental health problems have been previously reported in unruptured intracranial aneurysm (UIA) patients; however, few studies have clarified the relations between these variables and health-related quality of life (HRQoL). This study was designed to characterize the personality traits, HRQoL and mental health of patients with UIA and to evaluate whether personality has an influence on HRQoL and whether this is mediated by the patients' emotional symptoms. METHODS: Sixty-three patients with UIAs (mean age 62.6 years, 83.9% women) answered questionnaires for depression, anxiety, HRQoL and personality traits between June 2016 and May 2019. RESULTS: Eight percent of the sample had depression, and 27.4% had anxiety. Participants showed high levels of responsibility, kindness and neuroticism and low levels of extraversion and openness. HRQoL scores were normal compared with the Colombian population. Structural equation analysis showed that patients' HRQoL was negatively affected by anxiety levels and that the latter are associated with the patient's personality, where neuroticism is directly associated with symptomatology and inversely associated with extraversion. CONCLUSIONS: The results of this study showed the importance of personality and emotional symptoms in the HRQoL of UIA patients. These results are important for developing strategies for psychological counseling in patients with UIAs.

Salud mental y calidad de vida en habitantes del barrio La Cruz, Medellín-Colombia / Mental health and quality of life in habitants of la cruz neighborhood, Medellín-Colombia

Este estudio realiza una caracterización en salud mental y calidad de vida de habitantes del barrio La Cruz de Medellín, entendiendo la salud como concepto íntegro que abarca niveles psicológicos, físicos y sociales. Se tuvo una muestra de 83 personas del sector, 59% mujeres y 41% hombres, a quienes se les aplicaron los siguientes instrumentos: Cuestionario de salud PHQ-9, Cuestionario de ansiedad GAD-7, Escala GENCAT de calidad de vida para adultos, Cuestionario para niños y adolescentes Kiddo-KINDL y la Escala de valoración del barrio para adolescentes. Se encontraron altos niveles de depresión y ansiedad en niños, adolescentes y adultos; así como también relaciones inversas entre la ansiedad con: el desarrollo personal (en adultos), el bienestar emocional (en niños y adolescentes) y el bienestar físico (en adolescentes). Se concluye la pertinencia de una contextualización sobre un barrio con índices de calidad de vida bajos, según antecedentes; además se conocen particularidades del sector y se obtienen resultados significativos con miras a desarrollar programas de promoción y prevención en salud que abarquen factores de riesgo y protección de la comunidad.

This study characterizes the mental health and quality of life of the inhabitants of La Cruz neighborhood of Medellín, understanding health as an integral concept that encompasses psychological, physical, and social levels. There was a sample of 83 people from the sector, 59% women and 41% men. The following instruments were applied: PHQ-9 health questionnaire, GAD-7 anxiety questionnaire, GENCAT scale of quality of life for adults, Kiddo-KINDL Questionnaire for Children and Adolescents, and the Neighborhood Assessment Scale for Adolescents. High levels of depression and anxiety were found in children, adolescents, and adults, as well as inverse relationships between anxiety and personal development (in adults), emotional well-being (in children and adolescents), and physical well-being (in adolescents). The relevance of contextualization on a neighborhood with low quality of life indices is concluded, according to antecedents; In this way, particularities of the sector are known, and significant results are obtained to develop health promotion and prevention programs that include risk factors and protection of the community.

Percepciones de la enfermedad y hábitos de vida saludable en personas con enfermedades crónicas / Illness perceptions and healthy life habits in people with chronic disease

Resumen Objetivo: Evaluar las percepciones de la enfermedad que se asocian con hábitos de vida saludable en pacientes con enfermedades crónicas en Medellín y municipios aledaños. Método: Estudio prospectivo correlacional basado en la aplicación del cuestionario breve de percepciones de la enfermedad (BIPQ), cuestionario de la salud del paciente (PHQ-9), cuestionario de ansiedad generalizada (GAD-7) y un cuestionario de hábitos de vida saludable. Participaron 51 pacientes con diferentes enfermedades crónicas: migraña, cáncer de seno, diabetes, artritis reumatoide, enfermedad cardiovascular e hipertensión arterial primaria. La evaluación de los hábitos de vida saludable se llevó a cabo tres meses después. Resultados: Se encontró que en promedio los participantes comprenden su enfermedad (M = 8,09, D.T. = 2,48), perciben que sus acciones (M = 7,06, D.T. = 2,79) y el tratamiento (M = 7,89, D.T. = 2,69) la controlan y que esta tiene un carácter crónico (M = 7,49, D.T. = 3,16); que hay correlaciones entre los hábitos de vida saludables (HVS) con la percepción de consecuencias de forma negativa, y la identidad y preocupación emocional de manera positiva (p < 0,05). Además, que una relación lineal entre las consecuencias (Beta = 0,391) y la preocupación emocional por la enfermedad (Beta = 0,311) con los HVS, F (5, 45) = 2,707, p < 0,05. Las proporciones de depresión y ansiedad en la muestra fueron similares a las de la población general. Conclusiones: La percepción de que una enfermedad tiene consecuencias negativas y la preocupación por esta lleva a la implementación de comportamientos saludables.

Abstract Objective: This paper aims to assess illness perceptions associated with healthy lifestyle habits in patients with chronic diseases in Medellin and surrounding municipalities. Method: A prospective correlational study was conducted using a brief illness perceptions questionnaire (BIPQ), a patient's health questionnaire (PHQ-9), a generalized anxiety questionnaire (GAD-7) and a healthy habits questionnaire. 51 patients with different chronic diseases were sampled, illness such as: migraine, breast cancer, diabetes, rheumatoid arthritis, cardiovascular disease and primary arterial hypertension. The assessment of healthy lifestyle habits (HLH) was done three months later. Results: It was found, as a result, that people with chronic diseases understand their illness (M = 8.09, S.D. = 2.48); some of them perceive that their actions (M = 7.06, S.D. = 2.79) and others perceive that their treatment (M = 7.89, S.D. = 2.69) control their diseases and that they have a chronic nature (M = 7.49, S.D. = 3.16). Significant correlations were found between HLH and the perception of consequences in a negative way, and the emotional identity and concern in a positive way (p < 0.05). A linear relationship was found between consequences (Beta = 0.391) and the emotional concern (Beta = 0.311) for the disease with HLH, F (5. 45) = 2.707, p < 0.05. The proportion of depression and anxiety in the sample was similar to general population. Conclusions: The perception that a disease has negative consequences and the concern for it leads to the implementation of healthy behaviors.

Factores psicosociales asociados al estrés en profesores universitarios colombianos

Resumen Objetivo: evaluar los factores psicosociales asociados al estrés en una muestra de profesores de una universidad privada colombiana. Método: Estudio descriptivo correlacional de una muestra intencional de 61 profesores (rango de edad 25 a 63 años; 65,6 % hombres). Se utilizaron el cuestionario de salud del paciente PHQ-9, Cuestionario de Ansiedad generalizada GAD-7, Escala de estrés percibido PSS-14 y un cuestionario sobre factores psicosociales laborales. Adicionalmente se midió la presión arterial. Resultados: El 21,3 % de los profesores presentan niveles significativos de estrés. Hay mayor necesidad de trabajar en casa, interferencia familia-trabajo y trabajo-familia en profesores con estrés, mientras que el control es menor. Cabe anotar que estos profesores también presentan mayor sintomatología emocional. El modelo final mostró que la necesidad de trabajar en casa y la interferencia familia - trabajo explican el 45,6 % de la varianza en el estrés laboral de los profesores.

Abstract Objective: to evaluate the psychosocial factors associated with stress in a sample of professors from a private Colombian university. Method: Correlational descriptive study of an intentional sample of 61 professors (age range 25 to 63 years, 65,6 % men). The patient's health questionnaire PHQ-9, Generalized Anxiety Questionnaire GAD-7, Perceived Stress Scale PSS-14 and a questionnaire of psychosocial work factors were used. In addition, blood pressure measurements were taken. Results: 21,3 % of professors had significant levels of stress. There are more need to work at home, family-work and work-family interference in professors with stress, while control is lower. It should be noted that these teachers also have greater emotional symptoms. The final model showed that the need to work at home and the family - work interference explain 45,6 % of the variance in teachers' work stress.

Potential Therapeutic Targets in People with Emotional Dependency.

OBJECTIVE: To examine the relationship between the components of emotional dependency (ED) with anxious, depressive, and impulsive symptomatology. METHOD: 98 university students (68% women, age M = 20.2 years, ED = 2.19) responded to the ED Questionnaire (EDQ) (Lemos & Londoño, 2006), the Beck Depression Inventory II (Beck, Steer, & Brown, 2011), the Beck Anxiety Inventory (Beck & Steer, 2011), and the short version of the Barratt Impulsiveness Scale BIS-15S (Spinella, 2007). RESULTS: The structural model indicated that a fear of being alone is associated with separation anxiety, which in turn gives rise to plan modification (PM), search for emotional expression (SEE) and attention-seeking (AS). We found that PM was associated with depression, SEE with anxiety, and that impulsivity could lead to AS. CONCLUSION: These results identify potential therapeutic targets in people with ED.

OBJETIVO: Examinar la relación entre los componentes de la dependencia emocional (DE) con sintomatología ansiosa, depresiva e impulsividad. MÉTODO: 98 estudiantes universitarios (68% mujeres, edad M = 20.2 años, DE = 2,19) respondieron el Cuestionario de DE (CDE) (Lemos & Londoño, 2006), el inventario de depresión de Beck II (Beck, Steer, & Brown, 2011) y el de ansiedad (Beck & Steer, 2011) y la escala de impulsividad de Barratt en su versión reducida BIS-15S (Spinella, 2007). RESULTADOS: el modelo estructural señaló que el miedo a la soledad se asocia con la ansiedad de separación, de la que se despliegan las estrategias de modificación de planes (MP), búsqueda de expresión afectiva (BEA) y búsqueda de atención (BA). Se observó asociación de MP con depresión, de BEA con ansiedad, y que la impulsividad podría llevar a la BA. CONCLUSIÓN: Estos resultados señalan blancos terapéuticos en personas con DE.

Depression Levels Following Discharge Predict Quality of Life in Heart Disease Patients / Depressão após Alta Prediz Qualidade de Vida Prévia em Pacientes Cardíacos

Abstract Depression and stress have been related with poor Health Related Quality of Life (HRQoL) prognosis. However, it is not clear when these depressive symptoms should be measured. A sample of 177 Coronary Heart Disease patients were followed for 15 months aimed to compare the effect of depression and stress measure at time of hospitalization and three months later on the physical HRQoL trajectory. Linear growth models' results showed that depression and stress after discharge are negatively correlated with the physical HRQoL and depressive symptoms negatively affect the prognosis of these patients.

Resumo Depressão e estresse têm sido associados ao prognóstico da Qualidade de Vida Relacionada à Saúde (QVRS). Contudo, não há clareza sobre quando os sintomas de depressão devem ser mensurados. Uma amostra de 177 pacientes com cardiopatia isquêmica foi acompanhada por 15 meses, para comparar o efeito do estresse e a depressão durante a internação e, três meses depois, avaliou-se a trajetória do componente físico da QVRS. Os resultados da comparação de duas curvas de crescimento latente mostraram que a depressão e o estresse pós-alta estão negativamente correlacionados com o componente físico da QVRS, e que os sintomas depressivos afetam negativamente o prognóstico desses pacientes.

Percepciones y conocimientos de pacientes y cuidadores sobre cuidados paliativos, de la ciudad de Medellín (Colombia) / Perceptions and kwoledge about palliative care of patients and carers in Medellin, Colombia

Los cuidados paliativos (CP) mejoran la calidad de vida de pacientes y familias que se enfrentan a problemas asociados con enfermedades amenazantes para la vida, mediante la prevención y alivio del sufrimiento. Sin embargo, diversos estudios muestran bajo conocimiento y percepciones contradictorias frente a los efectos de estos cuidados. Esta investigación indagó sobre la percepción y el nivel de conocimiento sobre los CP de pacientes y cuidadores, en la ciudad de Medellín, mediante una metodología mixta con 19 personas (63.2% cuidadores). No se encontraron diferencias respecto a los conocimientos y percepciones entre ambos grupos (p >.05). Se encontró un nivel de conocimientos general aceptable, exceptuando el conocimiento referente a los síntomas que desde los CP se abarcan y los profesionales encargados de brindar estos cuidados. Así mismo, se encontró que según la percepción que tuvieron cui-dadores y pacientes, los CP mejoran la calidad de vida, ayudan a resignificar la muerte y disminuyen la carga asociada a la enfermedad

Palliative care improve the quality of life of patients and families that face problems associated with life-threatening diseases, through prevention and suffering relief. However, many studies show low knowledge and contradictory perceptions regarding the effects of this type of care. This study examined the perception and level of knowledge about palliative care of patients and carers in the city of Medellin, using mixed methods with 19 participants (63% are carers). There were no differences found between both groups regarding knowledge and perceptions (p >.05). It was found an acceptable level of knowledge, except for knowledge concerning the symptoms that palliative care covers and the professionals in charge of providing this. Likewise, it was found that, according to the perception that patients and carers had, palliative care improves the quality of life, it helps to reconsider the meaning of death, and reduces the load associated with the disease

El afecto negativo como factor emocional de orden superior en pacientes cardiovasculares / O afeto negativo como fator emocional de ordem superior em pacientes cardiovasculares / Negative affect as a high order emotional factor in cardiovascular patients

Resumen La depresión, la ansiedad y la ira rasgo han evidenciado ser factores asociados a un peor pronóstico de los pacientes con enfermedad cardiovascular. En el presente estudio se evaluó una muestra de 168 pacientes con cardiopatía isquémica que habían tenido un evento cardíaco en el último mes (edad media = 64 años, DT = 11; 66.7 % hombres) para contrastar la existencia del afecto negativo como factor común entre la depresión, la ansiedad y la ira rasgo. Los instrumentos utilizados fueron las escalas rasgo de los cuestionarios de depresión, ansiedad e ira de Spielberger. Como resultado, los análisis factoriales exploratorios realizados confirmaron la estructura factorial de todas escalas, y el análisis factorial confirmatorio corroboró la existencia del afecto negativo como factor de orden superior (X2 = 3.42, p > .05; CFI > .95, TLI > .95, SRMS < .05). Los resultados de este estudio señalan la importancia de considerar modelos dimensionales para el abordaje de la emoción en esta población.

Resumo A depressão-traço, a ansiedade-traço e a ira-traço mostraram evidências de que são fatores associados a um prognóstico pior dos pacientes com doença cardiovascular. No presente estudo, avaliou-se uma amostra de 168 pacientes com cardiopatia isquêmica que tinham sofrido um evento cardíaco no último mês (idade média = 64 anos, DP = 11; 66.7 % homens) para contrastar a existência do efeito negativo como fator comum entre a depressão, a ansiedade e a ira-traço. Os instrumentos utilizados foram as escalas traço dos questionários de depressão, ansiedade e ira de Spielberger. Como resultado, as análises fatoriais exploratórias realizadas confirmaram a estrutura fatorial de todas as escalas, e a análise fatorial confirmatória corroborou a existência o efeito negativo como fator de ordem superior (X2 = 3.42, p > .05; CFI > .95, TLI > .95, SRMS < .05 ). Os resultados deste estudo assinalam a importância de considerar modelos dimensionais para a abordagem da emoção nessa população.

Abstract Depression, anxiety and anger trait have been shown to be factors related to poor prognosis in patients with cardiovascular disease. A sample of 168 patients with ischemic heart disease that have had a cardiac event in the last month (age: Mean = 64 years, SD = 11; 66.7 % men) was evaluated to verify the existence of negative affect as a common factor among the previous emotions in these patients. Patients answered the Spielberger depression, anxiety and anger trait questionnaires. Exploratory factorial analyses were carried out to confirm the factorial structure of the scales. Confirmatory factor analysis confirmed the existence of negative affect as a higher order factor (X 2 = 3.42, p > .05; CFI > .95, TLI > .95, SRMS < .05). These results suggest that it is important to consider dimensional models for the treatment of emotions in this population.

The Techniques for Overcoming Depression Questionnaire: Mokken Scale Analysis, Reliability, and Concurrent Validity in Depressed Cardiac Patients.

OBJECTIVES: The Techniques for Overcoming Depression (TOD) questionnaire assesses the frequency with which patients being treated for depression use cognitive-behavioral techniques in daily life. This study examined its latent structure, reliability and concurrent validity in depressed cardiac patients. METHOD: The TOD was administered at the initial and final treatment sessions in three trials of cognitive behavior therapy (CBT) (n = 260) for depression in cardiac patients. Mokken scaling was used to determine its dimensionality. RESULTS: The TOD is unidimensional in depressed cardiac patients, both at the initial evaluation (H = .46) and the end of treatment (H = .47). It is sensitive to change and the total score correlates with therapist ratings of the patient's socialization to CBT (r=.40, p<.05), homework adherence (r=0.36, p<0.05), and use of cognitive-behavioral techniques (r=.51, p<.01). TOD scores were associated with post-treatment depression scores in two of the trials (p<.01 in both analyses). CONCLUSIONS: The TOD is a unidimensional, reliable, valid, and clinically informative measure of self-reported use of cognitive-behavioral techniques for overcoming depression in cardiac patients. Studies of the TOD in other depressed patient populations are needed.

Consideraciones sobre la depresión como factor de riesgo en pacientes cardiovasculares / Considerations of depression as risk factor in cardiovascular patients

Numerosos estudios han encontrado una asociación robusta entre los síntomas depresivos o la depresión mayor y un incremento en la morbilidad y la mortalidad cardiaca posterior a un síndrome coronario agudo (SCA); sin embargo, también se ha reportado evidencia en contra. Debido a esta divergencia, la depresión aún no ha sido aceptada por la Asociación Americana del Corazón como un factor de riesgo para un mal pronóstico en pacientes con enfermedades cardiovasculares. En este artículo se aborda el tema de la depresión en pacientes que han tenido un SCA y los factores que pueden influir en la divergencia de los resultados mencionada. Se concluye que la depresión se relaciona con un peor pronóstico en estos pacientes, específicamente cuando su presencia es posterior al evento o se trata de un cuadro resistente al tratamiento. Los síntomas cognitivos y somáticos son indicadores de mal pronóstico, así como la presencia de ansiedad comórbida.

Studies have found a strong association between depressive symptoms and major depression and cardiac morbidity and mortality increased after acute coronary syndrome (ACS); however it has also been reported evidence against this association. This difference in results may explain why depression has not yet been accepted by the American Heart Association as a risk factor for poor prognosis in patients with CVD. In this article depression is discussed as a risk factor of poor prognosis in patients who have had ACS and the factors that may influence the divergence of results in the studies. Our conclusions show that depression is related with a worse prognosis in ACS patients specifically when the symptomatology occurred after the event or when it is a treatment-resistant disorder. Cognitive and somatic symptoms and also comorbid anxiety are bad prognosis indicators.

Health-related quality of life in caregivers of individuals with dementia from Colombia.

The purpose of this study was to compare the health-related quality of life (HRQoL) of 99 caregivers of individuals with dementia and 95 healthy individuals from the general population in Colombia. The 36-item short-form (SF-36), a self-report measure composed of 8 component areas (physical function, role-physical, bodily pain, general health, energy/vitality, social function, role-emotional, and mental health), was used to measure HRQoL. Results indicated that the healthy control group had a higher level of education, socioeconomic status (SES), and number of male participants. After adjusting for education, SES, and gender, the caregivers of individuals with dementia scored significantly lower on all of the SF-36 subscales than the healthy controls. These findings suggest the need for rehabilitation health professionals to develop and implement culturally appropriate interventions to improve the HRQoL of caregivers of individuals with dementia in Colombia.