Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components.

BACKGROUND: Co-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However, existing process evaluation frameworks have been built on practices characterised by top-down developed and implemented interventions and may be limited in capturing essential elements of co-creation. This study aims to provide a review of studies planning and/or conducting a process evaluation of public health interventions adopting a co-creation approach and aims to derive assessed process evaluation components, used frameworks and insights into formative and/or participatory evaluation. METHODS: We searched for studies on Scopus and the Health CASCADE Co-Creation Database. Co-authors performed a concept-mapping exercise to create a set of overarching dimensions for clustering the identified process evaluation components. RESULTS: 54 studies were included. Conceptualisation of process evaluation included in studies concerned intervention implementation, outcome evaluation, mechanisms of impact, context and the co-creation process. 22 studies (40%) referenced ten existing process evaluation or evaluation frameworks and most referenced were the frameworks developed by Moore et al (14%), Saunders et al (5%), Steckler and Linnan (5%) and Nielsen and Randall (5%).38 process evaluation components were identified, with a focus on participation (48%), context (40%), the experience of co-creators (29%), impact (29%), satisfaction (25%) and fidelity (24%).13 studies (24%) conducted formative evaluation, 37 (68%) conducted summative evaluation and 2 studies (3%) conducted participatory evaluation. CONCLUSION: The broad spectrum of process evaluation components addressed in co-creation studies, covering both the evaluation of the co-creation process and the intervention implementation, highlights the need for a process evaluation tailored to co-creation studies. This work provides an overview of process evaluation components, clustered in dimensions and reflections which researchers and practitioners can use to plan a process evaluation of a co-creation process and intervention.

A Case of Vaping-Associated Candida and Herpes Simplex Virus (HSV) Co-infection Causing Esophagitis in an Immunocompetent Patient.

Electronic cigarettes (e-cigarettes) and vaping have gained popularity in the last two to five years as an alternative way of consuming nicotine, as well as tetrahydrocannabinol (THC), particularly in the younger population. Vaping/e-cigarettes heat nicotine/THC and other chemical components to create the vapor to be inhaled, which increases the risk of mucosal infection and esophagitis. Although tobacco smoking has been extensively studied and known to affect the oral cavity and esophagus, the effect of vaping is yet to be well-studied. We report a case of odynophagia secondary to esophageal candidiasis, herpes simplex virus (HSV) esophagitis, and reflux esophagitis associated with vaping.

Atorvastatin-Associated Eosinophilic Spongiosis: A Case Report and a Relevant Literature Review of Dermatological Manifestations.

Atorvastatin, a widely prescribed 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitor (HMG-CoA reductase inhibitor), is associated with various adverse effects, including many dermatologic manifestations. We present the case of a 73-year-old man who developed eosinophilic spongiosis shortly after initiating atorvastatin therapy, an adverse effect which to our knowledge has not yet been reported in association with atorvastatin. Our investigation explores the clinical and histopathologic characteristics of eosinophilic spongiosis induced by atorvastatin, delving into potential mechanisms behind statin-induced eosinophilia. A literature review, focusing on atorvastatin's dermatological side effects, revealed a limited number of relevant studies, emphasizing the scarcity of documented cases. Our aim is to raise awareness of eosinophilic spongiosis as a potential side effect of atorvastatin, emphasizing its impact on patients' quality of life. This case prompts further research into the mechanisms underlying such dermatologic reactions, contributing to a better understanding of atorvastatin's diverse adverse effects.

The effect of bullying and cyberbullying on predicting suicide risk in adolescent females: The mediating role of depression.

This paper analyzed the role of depression as a mediator in the association between bullying, cyberbullying, and suicide risk in adolescent females. A total of 751 Colombian adolescent females (M= 13.71, SD=1.897), who were administered the Plutchik Suicide Risk Scale, the Beck Depression Inventory, the European Bullying Intervention Project Questionnaire and Cyberbullying. Bullying victimization and aggression and cyberbullying victimization were found to contribute statistically significant effects that explaining 22 % of the variance in depression. The variables of victimization in bullying and cyberbullying and depression explained 64 % of the variance in suicidal risk, and depression mediated the association between victim and aggressor roles in bullying and cyberbullying in predicting suicidal risk, whose total direct and indirect effects are statistically significant. The findings support the role of depression as a mediating variable between bullying and cyberbullying and suicidal risk in female adolescents and highlight the importance of focusing prevention and intervention efforts on risk factors for depression and suicidal behavior in cases of bullying and cyberbullying.

A review of implementation and evaluation frameworks for public health interventions to inform co-creation: a Health CASCADE study.

BACKGROUND: By including the needs and perspectives of relevant stakeholders, co-creation is seen as a promising approach for tackling complex public health problems. However, recommendations and guidance on how to plan and implement co-creation are lacking. By identifying and analysing existing implementation and evaluation frameworks for public health, this study aims to offer key recommendations for professional stakeholders and researchers wanting to adopt a co-creation approach to public health interventions. METHODS: Firstly, PubMed and CINAHL databases were screened for articles introducing original implementation and evaluation frameworks for public health interventions. Backwards snowballing techniques were applied to the included papers. Secondly, identified frameworks were classified and relevant data extracted, including steps and constructs present in the frameworks. Lastly, recommendations were derived by conducting thematic analysis on the included frameworks. RESULTS: Thirty frameworks were identified and data related to their nature and scope extracted. The frameworks' prominent steps and constructs were also retrieved. Recommendations related to implementation and evaluation in the context of co-creation were included. CONCLUSION: When engaging in co-creation, we recommend including implementation considerations from an early stage and suggest adopting a systems thinking as a way to explore multiple levels of influence, contextual settings and systems from an early planning stage. We highlight the importance of partnering with stakeholders and suggest applying an evaluation design that is iterative and cyclical, which pays particular attention to the experience of the engaged co-creators.

Conducting co-creation for public health in low and middle-income countries: a systematic review and key informant perspectives on implementation barriers and facilitators.

BACKGROUND: There has been an increase in the use of co-creation for public health because of its claimed potential to increase an intervention's impact, spark change and co-create knowledge. Still, little is reported on its use in low-and-middle-income countries (LMICs). This study offers a comprehensive overview of co-creation used in public-health-related interventions, including the interventions' characteristics, and reported implementation barriers and facilitators. METHODS: We conducted a systematic review within the Scopus and PubMed databases, a Google Scholar search, and a manual search in two grey literature databases related to participatory research. We further conducted eight interviews with first authors, randomly selected from included studies, to validate and enrich the systematic review findings. RESULTS: Through our review, we identified a total of twenty-two studies conducted in twenty-four LMIC countries. Majority of the interventions were designed directly within the LMIC setting. Aside from one, all studies were published between 2019 and 2023. Most studies adopted a co-creation approach, while some reported on the use of co-production, co-design, and co-development, combined either with community-based participatory research, participatory action research or citizen science. Among the most reported implementation barriers, we found the challenge of understanding and accounting for systemic conditions, such as the individual's socioeconomic status and concerns related to funding constraints and length of the process. Several studies described the importance of creating a safe space, relying on local resources, and involving existing stakeholders in the process from the development stage throughout, including future and potential implementors. High relevance was also given to the performance of a contextual and/or needs assessment and careful tailoring of strategies and methods. CONCLUSION: This study provides a systematic overview of previously conducted studies and of reported implementation barriers and facilitators. It identifies implementation barriers such as the setting's systemic conditions, the socioeconomic status and funding constrains along with facilitators such as the involvement of local stakeholders and future implementors throughout, the tailoring of the process to the population of interest and participants and contextual assessment. By incorporating review and interview findings, the study aims to provide practical insights and recommendations for guiding future research and policy.

"Learning to learn" in the Extended Inverted Classroom: An evaluation of the effects of interactive teaching on knowledge and cognitive regulation in medical students.

INTRODUCTION: The evidence regarding the effects of the Inverted Classroom on students' metacognitive skills is limited. This study evaluates these effects on student perceptions about knowledge and cognitive regulation during a surgical course. METHODS: We measured student perceptions before and after a conventional Inverted Classroom in surgery using the Metacognitive Awareness Inventory. We evaluated the mean differences between the scores of the two measurements using Student's t-test (p < 0.05), and the size of the effect on knowledge and cognitive regulation using Cohen's d test (95%CI). RESULTS: A total of 158 students (pre-intervention) and 155 students (post-intervention) were included in the analysis. Significant differences were found (p < 0.05) in, as well as positive effects on, the students' abilities to know their own learning (declarative knowledge) (d = 0.24; 95%CI, 0.02-0.47), to use learning strategies (procedural knowledge) (d = 0.19; 95%CI, -0.02 to 0.41) and to understand when and why to use these strategies (conditional knowledge) (d = 0.20; 95%CI, -0.01 to 0.42), in addition to the abilities to plan (d = 0.31; 95%CI, 0.09-0.53) and to evaluate their learning (d = 0.31; 95%CI, 0.08-0.53). CONCLUSIONS: The Inverted Classroom has positive effects on metacognitive skills according to students' perceptions. Further studies are required that compare these effects with other methodologies for teaching in the classroom and the workplace.

Association of Strict Versus Lenient Cholesterol Lowering with Cardiac Outcomes, Diabetes Progression and Complications, and Mortality in Patients with Diabetes Treated with Statins: Is Less More?

INTRODUCTION: Whereas some guidelines recommend statin use to achieve low-density lipoprotein cholesterol (LDL-C) goal < 70 mg/dL for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients at higher risk, others recommend against a target LDL-C level. Achieving a target level < 70 mg/dL commonly requires the use of high intensity statins, which has been associated with higher risk of diabetes progression. The objective of this study is to assess the association of strict (≤ 70 mg/dL) versus lenient (> 70 to100 mg/dL) LDL-C lowering on major adverse cardiovascular events (MACE), diabetes progression, diabetes microvascular complications, and total mortality in patients with diabetes. METHODS: This was a retrospective propensity score (PS)-matched study from a national cohort of, predominantly male, veterans diagnosed with diabetes without prior cardiovascular disease (from fiscal years 2003-2015), who were initiated on a statin. We created PS to match strict (mean LDL-C during follow-up ≤ 70 mg/dL) versus lenient (mean LDL-C during follow up > 70-100 mg/dL) using 65 baseline characteristics including comorbidities, risk scores, medication classes usage, vital signs, and laboratory data. Outcomes included MACE, diabetes progression, microvascular diabetes complications, and total mortality. RESULTS: From 80,110 eligible patients, we PS-matched 21,294 pairs of statin initiators with strict or lenient LDL-C lowering. The mean (SD) age was 64 (9.5) years and mean (SD) duration of follow-up was 6 (3) years. MACE was similar in the PS-matched groups [6.1% in strict versus 5.8% in lenient; odds ratio (OR): 1.06; 95% confidence interval (95% CI) 0.98-1.15, P = 0.17]. Diabetes progression was higher among the strict vs lenient group (66.7% in strict versus 64.1% in lenient; OR 1.12; 95% CI 1.08-1.17, P < 0.001). There was no difference in microvascular diabetes complications (22.3% in strict versus 21.9% in lenient; OR 1.02; 95% CI 0.98-1.07, P = 0.31) and no difference in total mortality (14.6% in strict versus 15% in lenient; OR 0.97; 95% CI 0.92-1.02, P = 0.20). CONCLUSION: Strict compared with lenient lowering of LDL-C with statins in men with diabetes without preexisting ASCVD did not decrease the risk of MACE but was associated with an increased diabetes progression. Clinicians should monitor their patients for diabetes progression upon escalating statins to achieve LDL-C levels ≤ 70 mg/dL.

Diferencias de género en la agresividad en jóvenes infractores en Medellín, Colombia / Gender differences in aggressiveness between juvenile offenders in Colombia

(analítico) La investigación sobre agresividad en jóvenes delincuentes es insuficiente en Colombia y, en consecuencia, no hay suficiente información sobre las diferencias de género en esta población. No evaluar e intervenir este comportamiento desde un enfoque de diferencias sexuales impacta negativamente la efectividad de las políticas criminales. En esta investigación participaron 1050 jóvenes infractores, seleccionados por conveniencia. Se incluyeron 855 hombres y 195 mujeres de 14 a 19 años de edad residentes en Medellín (Antioquia). Los principales resultados fueron: 1) muy altos niveles de agresividad proactiva, reactiva y total en los adolescentes infractores; 2) la existencia de diferencias en la agresividad proactiva y agresividad total en las mujeres comparadas con los hombres; y 3) la variación de la agresividad de acuerdo con ciertas variables sociodemográficas y asociadas con el delito.

(analytical) Research on aggressiveness among young offenders is insufficient in Colombia and, consequently, there is not enough information on gender differences related to aggression for this population. Failure to evaluate and intervene with this behavior using a gender perspective negatively impacts the effectiveness of criminal policies. A total of 1050 young offenders, selected based on ease of access, participated in this research study. The population consisted of 855 males and 195 females between 14 and 19 years of age living in Medellín. The main results were: 1) there were very high levels of proactive, reactive and total aggressiveness in adolescent offenders; 2) there were differences in proactive aggressiveness and total aggressiveness in females compared to males; and 3) levels of aggressiveness varied depending on certain sociodemographic and crime-associated variables.

(analítico) A pesquisa sobre a agressividade em jovens infratores é insuficiente na Colômbia e, conseqüentemente, não há informações suficientes sobre as diferenças de gênero nesta população. Não avaliar e intervir neste comportamento a partir de uma perspectiva de gênero tem um impacto negativo na eficácia das políticas criminais. Esta pesquisa envolveu 1050 jovens infratores, selecionados por conveniência. Entre eles estavam 855 homens e 195 mulheres entre 14 e 19 anos de idade morando em Medellín. Os principais resultados foram: 1) níveis muito altos de agressividade proativa, reativa e total nos adolescentes infratores; 2) a existência de diferenças na agressividade proativa e total nas mulheres em comparação com os homens, e 3) a variação da agressividade de acordo com certas variáveis sociodemográficas e relacionadas ao crime.

Caracterización de la agresividad en adolescentes con trastorno de la conducta grave: un estudio exploratorio

El trastorno de conducta grave es un notable problema social y de salud mental en población infantil y adolescente. Aquí se presentan los resultados de una investigación cuantitativa de nivel descriptivo, que tuvo como objetivo general realizar una caracterización de la agresividad en un grupo de adolescentes con este tipo de trastorno. El estudio se desarrolló con jóvenes de un centro de internamiento preventivo que se encontraban en proceso de judicialización, aún no sancionados, pero privados de la libertad. Se seleccionaron por conveniencia 115 hombres, a los que se les aplicaron cinco instrumentos de medición: el Inventario de Motivos para la Agresión, el Inventario de Situaciones y Comportamientos Agresivos, el Cuestionario de Agresión de Buss-Perry, el Cuestionario de Agresividad Proactiva y Reactiva, y la Escala de Agresividad Apetitiva. El principal motivo para la agresión era conseguir algo que querían, eran agresivos sin que hubiese algún motivo, expresaban frecuentemente su ira, amenazaban a personas conocidas, se enojaban cuando tenían desacuerdos, creían que los demás se burlaban de ellos a sus espaldas, se sentían bien después de agredir física o verbalmente a alguien, portaban armas para usarlas en peleas y consideraban que pelear era lo único que querían hacer en la vida.

Severe conduct disorder is a notable social and mental health problem in child and adolescent population. Here we present the results of a descriptive quantitative research with the general objective of characterizing aggressiveness in a group of adolescents with this type of disorder. The study was carried out with young people from a preventive detention center who were in the process of judicialization, not yet sanctioned, but deprived of their liberty. A total of 115 males were selected by convenience and five measurement instruments were applied: the Motives for Aggression Inventory, the Aggressive Situations and Behavior Inventory, the Buss-Perry Aggression Questionnaire, the Proactive and Reactive Aggressiveness Questionnaire, and the Appetitive Aggressiveness Scale. The main motive for aggression was to get something they wanted, they were aggressive for no reason, they frequently expressed anger, threatened people they knew, got angry when they had disagreements, believed that others made fun of them behind their backs, felt good after physically or verbally assaulting someone, carried weapons to use in fights, and considered that fighting was the only thing they wanted to do in life.

Academic stress and adaptation to university life: mediation of cognitive-emotionalregulationand social suppor / Estrés académico y adaptación a la vida universitaria: mediación de la regulación cognitivo-emocional y el apoyo social

La vida universitaria implica retos personales, sociales, académicos e institucionales a los que los estudiantes deben adaptarse no sólo para lograr el éxito académico sino también para garantizar una buena salud física y mental durante la carrera. Este periodo puede estar influenciado por situaciones estresantes que pueden afectar a nivel personal y académico. El objetivo del presente estudio fue determinar, mediante un análisis con ecuaciones estructurales, si diversas estrategias de regulación cognitivo-emocional y el apoyo social percibido, actúan como mediadores del efecto del estrés sobre la adaptación a la vida universitaria en 555 estudiantes universitarios colombianos (437 mujeres, 78,7%) con edades comprendidas entre los 16 y los 49 años (M= 22,83; DT = 4,774). Los resultados muestran que las estrategias de regulación cognitivo-emocional positiva (Focus y Reappraisal), negativa (Rumiación, Autoculpabilización y Culpar a otros) y el apoyo social son mediadores del efecto del estrés sobre la adaptación a la vida universitaria.(AU)

University life involve personal, social, academic, and institu-tionalchallenges to which the students must adapt not only to achieve aca-demic successbut also to guarantee a good physical and mental health dur-ing the career. Thisperiod can be influenced by stressful situations that can affect at personal andacademic level. The objective of the present study was to determine, through ananalysis with structural equations, whether various cognitive-emotional regulationstrategies and perceived social sup-port, act as mediators of the effect of stress onadaptation to university life in 555 Colombian university students (437 women,78.7%) with ages from 16 to 49 years (M = 22.83; SD = 4.774). The results showthat the cogni-tive-emotional regulation strategies positive (Focus andReappraisal), nega-tive (Rumination, Self-blame and Blaming others) and socialsupportaremediators oftheeffect ofstresson adaptationto universitylife.(AU)

Agresividad en delincuentes juveniles colombianos y su relación con la agresividad parental / Aggressiveness in Colombian juvenile delinquents and its relationship with parental aggressiveness

La hostilidad de los padres puede generar en los niños la formación de estilos de pensamiento y acción que los pone en riesgo de desarrollar comportamientos inadaptados socialmente. Se realizó un estudio ex post facto cuantitativo de nivel descriptivo-correlacional para analizar los comportamientos agresivos en delincuentes juveniles colombianos y sus relaciones con los mismos comportamientos en sus padres y madres. Participaron 115 jóvenes (con sus madres y sus padres) de sexo masculino que estaban en internamiento preventivo por diferentes delitos. Se aplicaron cinco autoinformes para medir diferentes formas de agresividad en los jóvenes, sus madres y sus padres. Salvo en la hostilidad, los jóvenes tuvieron puntuaciones mayores que sus madres y/o sus padres en todas las demás formas de agresividad. Respecto a la agresividad apetitiva, los jóvenes y sus padres tuvieron mayores puntuaciones que sus madres. Se encontraron múltiples correlaciones entre las diferentes formas de agresividad de jóvenes, madres y padres. (AU)

Parental hostility can generate in children the formation of thinking and action styles that put them at risk of developing socially maladaptive behaviors. An ex post facto quantitative descriptive-correlational study was carried out to analyze aggressive behaviors in Colombian juvenile delinquents and their relationships with the same behaviors in their fathers and mothers. A total of 115 male juveniles (with their mothers and fathers) who were in pretrial detention for different offenses participated. Five self-reports were applied to measure different forms of aggressiveness in the youths, their mothers and fathers. Except for hostility, the youths had higher scores than their mothers and/or fathers in all other forms of aggression. Regarding appetitive aggression, youths and their fathers had higher scores than their mothers. Multiple correlations were found between the different forms of aggression of youths, mothers and fathers. (AU)

Psychoneuroimmunologic Correlates in a Group of Men who Have Sex with Men with Risky Sexual Behaviors / Os Correlatos Psiconeuroimunológicos em um Grupo de Homens que Fazem Sexo com Homens com Comportamentos Sexuais de Risco

ABSTRACT This work aims to know what correlations can be found among psychological, neuropsychological, neurobiological, and immunological measures in a group of men who have sex with men negative for anti-HIV-1/2 antibodies which have sexual risk behaviors. Statistically significant correlations were found among certain behavioral, emotional, personality, neurobiological, and immunological variables. The circuit of interactions among depression, stress, neuroticism, and conscientiousness stands out, which could indirectly explain risky sexual behavior. In summary, there is a relationship between personality characteristics, mood disorders, risk behaviors, and an activated T cell profile.

RESUMO O objetivo deste trabalho é conhecer as correlações que podem ser encontradas entre as medidas psicológicas, neuropsicológicas, neurobiológicas e imunológicas em um grupo de homens que fazem sexo com homens com HIV-1/2 anti-corpos-negativos que se envolvem em comportamentos sexuais de risco. Foram encontradas correlações estatisticamente significativas entre certas variáveis comportamentais, emocionais, de personalidade, neurobiológicas e imunológicas. Destaca-se o circuito de interações entre depressão, estresse, neuroticismo e responsabilidade, que poderia explicar indiretamente o comportamento sexual de risco. Em resumo, há uma relação entre características de personalidade, distúrbios de humor, comportamentos de risco e um perfil de célula T ativado.

Funciones ejecutivas de niños con trastorno por déficit de atención e hiperactividad con o sin epilepsia rolándica benigna

Introducción: La relación entre el TDAH y la epilepsia, aunque muy frecuente, no es clara. Los estudios clínicos en neuropsicología y neurología (neuropsiquiatría) pueden ofrecer información valiosa para la evaluación, la intervención y el tratamiento. Método: Se realizó un estudio con diseño no experimental, enfoque cuantitativo, nivel descriptivo y corte transversal con el objetivo de comparar el funcionamiento ejecutivo de un grupo de niños con TDAH y un grupo de niños con TDHA y EBPCT. Se conformó una muestra por conveniencia de 40 niños emparejados (todos hombres) agrupados en dos grupos de 20 con edades entre los 7 y los 13 años. Para realizar la evaluación del funcionamiento ejecutivo se aplicaron algunas pruebas de la Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales - BANFE. Resultados: De acuerdo con los valores de la significancia asintótica bilateral, se encontraron diferencias estadísticamente significativas en las variables Stroop A - Aciertos, Stroop B - Aciertos, Señalamiento autodirigido (Aciertos, Planeación y Tiempo), y Memoria de Trabajo Visoespacial (Nivel máximo, Perseveraciones y Errores de orden). Conclusiones: Los resultados del presente estudio coinciden con los fallos en el control inhibitorio y los problemas de atención sostenida reportados en la literatura. Los niños con EBPCT y TDAH tienen un perfil de funcionamiento ejecutivo diferente y más deteriorado que los niños con TDAH solo.

Introduction: The relationship between ADHD and epilepsy, although very frequent, is not clear. Clinical studies in neuropsychology and neurology (neuropsychiatry) can provide valuable information for assessment, intervention and treatment. Method: A non-experimental design, quantitative approach, descriptive level and cross-sectional study was carried out with the aim of comparing the executive functioning of a group of children with ADHD and a group of children with ADHD and CPSDD. A convenience sample of 40 matched children (all males) grouped in two groups of 20 children between 7 and 13 years of age was formed. In order to evaluate executive functioning, some tests of the Neuropsychological Battery of Executive Functions and Frontal Lobes - BANFE were applied. Results: According to the bilateral asymptotic significance values, statistically significant differences were found in the variables Stroop A - Hits, Stroop B - Hits, Self-directed Signaling (Hits, Planning and Time), and Visuospatial Working Memory (Maximum Level, Perseverations and Order Errors). Conclusions: The results of the present study coincide with the failures in inhibitory control and sustained attention problems reported in the literature. Children with EBPCT and ADHD have a different and more impaired executive functioning profile than children with ADHD alone.

Estudio exploratorio sobre la ansiedad por la salud en universitarios colombianos durante el confinamiento por la pandemia del COVID-19 en el segundo semestre del 2020 / Exploratory study on health anxiety in Colombian university students during COVID-19 pandemic confinement in the second semester of 2020

Introducción: La ansiedad por la salud es un estado psicológico caracterizado por cierto tipo de creencias, emociones y actitudes hacia la posibilidad de contraer una enfermedad. La ansiedad por la salud ha sido considerada un mediador de la respuesta psicológica ante la pandemia generada por el COVID-19. Objetivo: Determinar el nivel de ansiedad por la salud de una muestra de estudiantes universitarios colombianos, discriminando y comparando en función de ciertas variables sociodemográficas, y describir sus principales características durante el confinamiento social en el segundo semestre del 2020. Metodología: Se realizó un estudio cuantitativo, no experimental, de nivel descriptivo y corte transversal en una muestra de 1004 estudiantes de pregrado de 3 instituciones de educación superior de la ciudad de Medellín. Se utilizó el Inventario Breve de Ansiedad por la Salud. Resultados: El valor de la media para la ansiedad por la salud estuvo por encima del valor reportado por otros estudios. Se encontraron altos porcentajes de preocupación por la salud (39,64 %), consciencia del malestar/dolor (63,3 %), miedo de tener una enfermedad grave (20,01 %), interés por las sensaciones o cambios corporales (68,92 %), riesgo de padecer una enfermedad grave (30,33 %) y consecuencias sobre la vida (35,75 %). No se encontraron diferencias estadísticamente significativas en ninguna de las comparaciones entre grupos. Conclusiones: La preocupación por la salud y la ansiedad durante las epidemias/pandemias pueden tener un impacto psicológico importante, además de estar relacionadas con un comportamiento preventivo ineficaz y tener consecuencias adversas en el largo plazo.

Introduction: Health anxiety is a psychological state characterized by certain types of beliefs, emotions, and attitudes toward the possibility of contracting a disease. Health anxiety has been considered a mediator of the psychological response to the pandemic generated by COVID-19. Objectives: To determine the level of health anxiety in a sample of Colombian university students, discriminating and comparing according to certain sociodemographic variables, and to describe the main during social confinement between August and November 2020. Methodology: A quantitative, non-experimental, descriptive, cross-sectional study was conducted in a sample of 1004 undergraduate students from three higher education institutions in the city of Medellin. The Short Health Anxiety Inventory - SHAI was used. Results: The mean value for health anxiety was above the value reported by other studies. High percentages of health concern (39.64 %), awareness of discomfort/pain (63.3 %), fear of having a serious illness (20.01 %), interest in bodily sensations or changes (68.92 %), risk of having a serious illness (30.33 %) and consequences on life (35.75 %) were found. No statistically significant differences were found in any of the comparisons between groups. Conclusions: Health concerns and anxiety during with epidemics/pandemics can have a significant psychological impact, as well as being related to ineffective preventive behavior and having adverse long-term consequences.

Ehlers-Danlos: A Literature Review and Case Report in a Colombian Woman with Multiple Comorbidities.

Ehlers-Danlos syndromes (EDS) are a heterogeneous group of genetically transmitted connective tissue disorders that directly affect collagen synthesis, with a broad range of symptoms. Case presentation: This study presents a clinical case of a Colombian woman with myopathic EDS and multiple comorbidities taking 40 years of medical history to make the right diagnosis. This article also presents a review of the current literature on EDS, not only to remind the syndrome but also to help the clinician correctly identify symptoms of this diverse syndrome. Conclusion: A multidisciplinary approach to the diagnosis of the patient, including clinical and molecular analysis, and neuropsychological and psychological assessment, is important to improve the treatment choice and the outcome prediction of the patients.

Learning climate and work engagement in clinical residents: The relationship with human self-determination / Clima de aprendizaje y enganche al trabajo del residente clínico: relación con la autodeterminación humana

Introduction: The learning climate is a factor associated with the clinical resident's engagement in work activities and the improvement of students' well-being in the workplace through their self-determination during clinical rotation. Objective: To determine the relationship between the learning climate measured with the D-RECT 35 scale and residents' self-determination and commitment to work using the UWES 17 scale. Materials and methods: We conducted a cross-sectional correlational study with residents of surgical medical specialties in clinical rotation at the practice site and who completed the measurement questionnaires. Results: We evaluated 188 residents of clinical specialties. The median of the results in the learning climate scale was 3.9/5.0; in the self-determination scale, 4.86/7.0, and in the job engagement scale, 5.0/6.0. The learning climate was considered adequate and a positive relationship was found with self-determination and the residents' attachment to their activities; these correlations were statistically significant. Conclusions: Adequate learning climates are positively related to the ability to engage in work activities and the self-determination of clinical residents as they favor collaborative work and access to supervision generating greater autonomy and more enthusiasm and dedication to assigned activities. This can drive improvements in educational programs in clinical departments and translate into safer patient care.

Introducción. El clima de aprendizaje es un factor que se asocia con el compromiso hacia las actividades laborales del médico residente y el mejoramiento del bienestar estudiantil en el sitio de trabajo por medio de su autodeterminación durante la rotación clínica. Objetivo. Determinar la relación del clima de aprendizaje medido con la escala D-RECT 35, y la autodeterminación del médico residente y su compromiso con el trabajo mediante la escala UWES 17. Material y métodos. Se hizo un estudio correlacional de corte transversal con médicos residentes de especialidades médico-quirúrgicas que hacían la rotación clínica en el sitio de práctica y completaron los cuestionarios de medición. Resultados. Se evaluaron 188 médicos residentes de especialidades clínicas; la mediana de la escala de clima de aprendizaje fue de 3,9/5,0; la de la escala de autodeterminación fue de 4,86/7,0, y la de la escala de compromiso laboral fue de 5,0/6,0. El clima de aprendizaje se consideró como adecuado y se encontró una relación positiva con la autodeterminación y el compromiso del médico residente con sus actividades; dichas correlaciones tuvieron significación estadística. Conclusiones. El clima de aprendizaje adecuado se relaciona positivamente con la capacidad de comprometerse con las actividades laborales y con la autodeterminación del médico residente en entrenamiento; asimismo, favorecen el trabajo colaborativo y el acceso a la supervisión, y generan mayor autonomía, entusiasmo y dedicación a las actividades asignadas, lo cual puede incentivar mejoras en los programas educativos de los departamentos clínicos y reflejarse en una atención más segura a los pacientes.

Teaching Rheumatology in the undergraduate: It is enough? / Educación y reumatología en el pregrado: ¿enseñamos suficiente?

ABSTRACT Introduction: Musculoskeletal disorders (MSD) are the second leading cause of disability worldwide. There are difficulties in the early diagnosis and therapeutic approach to these pathologies, with a negative impact on their outcomes. Access to rheumatology is limited, with a low supply in the face of growing demand, which makes the general practitioner the first contact for care. Objectives: Describe the perception and confidence that general practitioners have regarding the training in rheumatology received at undergraduate level. Materials and methods: Observational cross-sectional study, with a Likert-type survey tool being used. The study included general practitioners graduated from the Colombian Medicine program between 2009 and 2019. The variables studied were those related to the curriculum, acquired knowledge or skills, and proficiency in content in rheumatol ogy compared to practice. Subjects who attended a specialist or who had an employment relationship with a specialist rheumatology centre were excluded. Results and Conclusions: A total of 102 physicians were surveyed, and 86 completed ques tionnaires were included in the final analysis. Of these, 83.4% were graduates of private universities. Over two-thirds (37%9) had a formal subject in rheumatology, 16% received training with specific strategies, 54% expressed security when performing the MS physical examination, and 47% were sure in the diagnostic approach, and prescription of disease-modifying drugs. In order to strengthen the training in rheumatology required by the undergraduate, a joint effort is required with the medical schools in defining the competen cies and skills of the primary care physician, together with the health needs and available educational strategies.

RESUMEN Introducción: Las enfermedades musculoesqueléticas (ME) son la segunda causa de discapa cidad mundial. Se presentan dificultades en el enfoque diagnóstico y terapéutico temprano de estas enfermedades, lo cual tiene un impacto negativo en sus desenlaces. El acceso a Reumatología es limitado, con una baja oferta frente a la creciente demanda, lo que convierte al médico general en el primer contacto de atención. Objetivos: Describir la percepción y la confianza que tienen los médicos generales respecto a la formación en reumatología recibida en el pregrado. Materiales y métodos: Estudio observacional de corte transversal en el cual se indagó a médi cos generales, egresados de programas de medicina colombianos entre el 2009 y 2019, mediante un cuestionario con respuesta tipo Likert, sobre variables relacionadas con el planteamiento curricular, los conocimientos o habilidades adquiridas y la suficiencia en el contenido en reumatología con respecto a la práctica. Se excluyó a los sujetos que cur saran algún programa de especialización o que tuvieran relación laboral con un centro especializado de Reumatología. Resultados y conclusiones: Se encuestó a 102 médicos; 86 encuestas fueron incluidas en el análisis final. El 83,4% de ellos eran egresados de universidades privadas, el 37% contó con una asignatura formal de reumatología, el 16% recibió formación con estrategias específicas, el 54% manifestó seguridad al realizar el examen físico musculoesquelético, el 47% expresó sentirse seguro en el enfoque diagnóstico y la prescripción de medicamentos modificadores de la enfermedad. Es necesario fortalecer la formación en Reumatología en el pregrado; se requiere un trabajo conjunto con las facultades de medicina en la definición de competen cias del médico de Atención Primaria, alineado con las necesidades de salud y las estrategias educacionales disponibles.

Clima de aprendizaje y enganche al trabajo del residente clínico: relación con la autodeterminación humana / Learning climate and work engagement in clinical residents: The relationship with human self-determination

Introducción. El clima de aprendizaje es un factor que se asocia con el compromiso hacia las actividades laborales del médico residente y el mejoramiento del bienestar estudiantil en el sitio de trabajo por medio de su autodeterminación durante la rotación clínica. Objetivo. Determinar la relación del clima de aprendizaje medido con la escala D-RECT 35, y la autodeterminación del médico residente y su compromiso con el trabajo mediante la escala UWES 17. Materiales y métodos. Se hizo un estudio correlacional de corte transversal con médicos residentes de especialidades médico-quirúrgicas que hacían la rotación clínica en el sitio de práctica y completaron los cuestionarios de medición. Resultados. Se evaluaron 188 médicos residentes de especialidades clínicas; la mediana de la escala de clima de aprendizaje fue de 3,9/5,0; la de la escala de autodeterminación fue de 4,86/7,0, y la de la escala de compromiso laboral fue de 5,0/6,0. El clima de aprendizaje se consideró como adecuado y se encontró una relación positiva con la autodeterminación y el compromiso del médico residente con sus actividades; dichas correlaciones tuvieron significación estadística. Conclusiones. El clima de aprendizaje adecuado se relaciona positivamente con la capacidad de comprometerse con las actividades laborales y con la autodeterminación del médico residente en entrenamiento; asimismo, favorecen el trabajo colaborativo y el acceso a la supervisión, y generan mayor autonomía, entusiasmo y dedicación a las actividades asignadas, lo cual puede incentivar mejoras en los programas educativos de los departamentos clínicos y reflejarse en una atención más segura a los pacientes.

Introduction: The learning climate is a factor associated with the clinical resident's engagement in work activities and the improvement of students' well-being in the workplace through their self-determination during clinical rotation. Objective: To determine the relationship between the learning climate measured with the D-RECT 35 scale and residents' self-determination and commitment to work using the UWES 17 scale. Materials and methods: We conducted a cross-sectional correlational study with residents of surgical medical specialties in clinical rotation at the practice site and who completed the measurement questionnaires. Results: We evaluated 188 residents of clinical specialties. The median of the results in the learning climate scale was 3.9/5.0; in the self-determination scale, 4.86/7.0, and in the job engagement scale, 5.0/6.0. The learning climate was considered adequate and a positive relationship was found with self-determination and the residents' attachment to their activities; these correlations were statistically significant. Conclusions: Adequate learning climates are positively related to the ability to engage in work activities and the self-determination of clinical residents as they favor collaborative work and access to supervision generating greater autonomy and more enthusiasm and dedication to assigned activities. This can drive improvements in educational programs in clinical departments and translate into safer patient care.