Health belief model for coronavirus infection risk determinants / Modelo de crença em saúde para determinantes de risco para contaminação por coronavírus

ABSTRACT OBJECTIVE To use the advantages of a ratio scale with verbal anchors in order to measure the risk perception in the novel coronavirus infection, which causes covid-19, in a health belief model-based questionnaire, as well as its validity and reproducibility. METHOD We used the health belief model, which explores four dimensions: perceived susceptibility (five questions), perceived severity (five questions), perceived benefits (five questions), and perceived barriers (five questions). Additionally, we included a fifth dimension, called pro-health motivation (four questions). The questions composed an electronic questionnaire disseminated by social networks for an one-week period. Answers were quantitative values of subjective representations, obtained by a psychophysically constructed scale with verbal anchors ratio (CentiMax ® ). Mean time for total filling was 12 minutes (standard deviation = 1.6). RESULTS We obtained 277 complete responses to the form. One was excluded because it belonged to a participant under 18 years old. Reproducibility measures were significant for 22 of the 24 questions in our questionnaire (Cronbach's α = 0.883). Convergent validity was attested by Spearman-Brown's split half reliability coefficient (r = 0.882). Significant differences among groups were more intense in perceived susceptibility and severity dimensions, and less in perceived benefits and barriers. CONCLUSION Our health belief model-based questionnaire using quantitative measures enabled the confirmation of popular beliefs about covid-19 infection risks. The advantage in our approach lays in the possibility of quickly, directly and quantitatively identifying individual belief profiles for each dimension in the questionnaire, serving as a great ally for communication processes and public health education.

RESUMO OBJETIVO Neste estudo buscamos utilizar as vantagens de uma escala de razão por ancoragem verbal para medidas da percepção de risco de contágio pelo novo coronavírus, causador da covid-19, em um questionário baseado no modelo de crença em saúde, assim como avaliar sua validade e reprodutibilidade. MÉTODO Utilizamos o modelo de crença em saúde, o qual explora quatro dimensões: percepção individual de susceptibilidade percebida (cinco questões), severidade percebida (cinco questões), benefícios percebidos (cinco questões) e barreiras percebidas (cinco questões). Adicionalmente, incluímos uma quinta dimensão, a qual denominamos motivação pró-saúde (quatro questões). As questões definiram um questionário eletrônico que foi divulgado por redes sociais pelo período de uma semana. As respostas foram valores quantitativos de representações subjetivas, obtidas por meio de uma escala psicofísica de razão com ancoragem verbal (CentiMax ® ). O tempo médio total de preenchimento foi de 12 minutos (desvio-padrão = 1,6). RESULTADOS Obtivemos 277 respostas completas ao formulário. Uma foi excluída por se tratar de participante com menos de 18 anos de idade. Medidas de reprodutibilidade foram significantes para 22 das 24 questões de nosso questionário (α de Cronbach = 0,883). A validade convergente foi atestada pelo coeficiente de correlação de Spearman-Brown split half (r = 0,882). Diferenças significantes entre grupos foram encontradas mais intensamente nas dimensões susceptibilidade percebida e severidade percebida, e menos intensamente para benefícios percebidos e barreiras percebidas. CONCLUSÃO Nosso questionário baseado no modelo de crença em saúde utilizando medidas quantitativas permitiu evidenciar as crenças populares sobre os riscos de contágio por covid-19. A vantagem de nossa abordagem é a possibilidade de se identificar os perfis de crença individuais para cada dimensão do questionário de forma rápida, direta e quantitativa, podendo ser uma grande aliada em processos de comunicação e educação em saúde pública.

Suicide risk configuration system in a clustered clinical sample: a generalized linear model obtained through the LASSO technique

Objective: To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care. Method: A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster. Results: The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one's own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships. Conclusions: Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.

Estrutura conceptual do envelhecimento em diferentes etnias / Estructuras conceptuales del envejecimiento en diferentes etnias / Conceptual structure of aging in different ethnicities

Resumo OBJETIVO Elaborar uma estrutura conceptual que explique como idosos de diferentes culturas vivenciam o envelhecimento, formulam conceitos e atribuem valores ao processo de envelhecer. MÉTODO Pesquisa de abordagem qualitativa, realizada com 33 idosos, em município da tríplice fronteira. Os dados foram coletados no período entre fevereiro e agosto de 2011, utilizando como estratégia teórico-metodológica o Interacionismo Simbólico e a Grounded Theory. RESULTADOS Identificou-se o tema central "Tendo que envelhecer: as práticas socioculturais direcionando o envelhecimento em diferentes etnias", constituído por subprocessos que caracterizam os conceitos estruturais do estudo: A velhice concebida por multifatores (físicos, biopsíquicos e socioculturais); Vivenciando o envelhecer no processo de adaptação cultural; Vivenciando o envelhecer como a continuidade da vida; Redefinindo os papeis sociais e; A cultura influenciando hábitos e costumes no cuidado à saúde. CONCLUSÕES A experiência de envelhecer revelou-se um processo singular a cada indivíduo e os valores atribuídos ao mesmo são influenciáveis pela cultura.

Resumen OBJETIVO Elaborar una estructura conceptual que explique cómo ancianos de diferentes culturas sienten el envejecimiento, formulan conceptos y atribuyen valores en el proceso de envejecer. MÉTODO Investigación de abordaje cualitativa, realizada con 33 ancianos, en un municipio de la triple frontera. Se recolectaron los datos desde febrero hasta agosto del 2011, utilizando como estrategia teórica-metodológica el Interaccionismo Simbólico y el Grounded Theory. RESULTADO La temática central identificada fue: "Teniendo que envejecer: las prácticas socioculturales direccionando el envejecimiento en diferentes etnias", constituido por subprocesos que caracterizan los conceptos estructurales del estudio: La vejez concebida como multifactorial (físicos, biopsíquicos y socioculturales); Vivenciando el envejecimiento en el proceso de adaptación cultural; Vivenciando el envejecimiento como continuación de la vida; Redefiniendo los papeles sociales; y La cultura influenciando hábitos y costumbres en el cuidado a la salud. CONCLUSIÓN La experiencia de envejecer se mostró como un proceso singular de cada individuo y los valores atribuidos al mismo son influenciados por cada cultura.

Abstract OBJECTIVE To develop a conceptual framework that explains how elderly people from different cultures experience aging, formulate concepts and assign values to the process of aging. METHOD Qualitative research conducted with 33 elderly people in a municipality of the triple border. The data were collected between February and August of 2011, using Symbolic Interactionism and the Grounded Theory as the theoretical and methodological strategy. RESULTS The central theme identified was: "Having to age: sociocultural practices guiding aging in different ethnicities", which was made up of sub processes that characterize the study's structural concepts: aging conceived as multifactorial (physical, biopsychic and sociocultural); Experiencing aging in the process of cultural adaptation; Experiencing aging as the continuation of life; Redefining social roles; and The culture influencing habits and customs in healthcare. CONCLUSION The experience of aging proved to be a unique process for each individual and the values assigned to it are influenced by one's own culture.

Latent class profile of psychiatric symptoms and treatment utilization in a sample of patients with co-occurring disorders

Objective: To identify symptom-based subgroups within a sample of patients with co-occurring disorders (CODs) and to analyze intersubgroup differences in mental health services utilization. Methods: Two hundred and fifteen patients with COD from an addiction clinic completed the Symptom Checklist 90-Revised. Subgroups were determined using latent class profile analysis. Services utilization data were collected from electronic records during a 3-year span. Results: The five-class model obtained the best fit (Bayesian information criteria [BIC] = 3,546.95; adjusted BIC = 3,363.14; bootstrapped likelihood ratio test p < 0.0001). Differences between classes were quantitative, and groups were labeled according to severity: mild (26%), mild-moderate (28.8%), moderate (18.6%), moderate-severe (17.2%), and severe (9.3%). A significant time by class interaction was obtained (chi-square [χ2[15]] = 30.05, p = 0.012); mild (χ2[1] = 243.90, p < 0.05), mild-moderate (χ2[1] = 198.03, p < 0.05), and moderate (χ2[1] = 526.77, p < 0.05) classes displayed significantly higher treatment utilization. Conclusion: The classes with more symptom severity (moderate-severe and severe) displayed lower utilization of services across time when compared to participants belonging to less severe groups. However, as pairwise differences in treatment utilization between classes were not significant between every subgroup, future studies should determine whether subgroup membership predicts other treatment outcomes.

The mental health care model in Brazil: analyses of the funding, governance processes, and mechanisms of assessment / Modelo de atenção à saúde mental do Brasil: análise do financiamento, governança e mecanismos de avaliação

ABSTRACT OBJECTIVE This study aims to analyze the current status of the mental health care model of the Brazilian Unified Health System, according to its funding, governance processes, and mechanisms of assessment. METHODS We have carried out a documentary analysis of the ordinances, technical reports, conference reports, normative resolutions, and decrees from 2009 to 2014. RESULTS This is a time of consolidation of the psychosocial model, with expansion of the health care network and inversion of the funding for community services with a strong emphasis on the area of crack cocaine and other drugs. Mental health is an underfunded area within the chronically underfunded Brazilian Unified Health System. The governance model constrains the progress of essential services, which creates the need for the incorporation of a process of regionalization of the management. The mechanisms of assessment are not incorporated into the health policy in the bureaucratic field. CONCLUSIONS There is a need to expand the global funding of the area of health, specifically mental health, which has been shown to be a successful policy. The current focus of the policy seems to be archaic in relation to the precepts of the psychosocial model. Mechanisms of assessment need to be expanded.

RESUMO OBJETIVO Analisar o estágio atual do modelo de atenção à saúde mental do Sistema Único de Saúde, segundo seu financiamento, processos de governança e mecanismos de avaliação. MÉTODOS Foi realizada uma análise documental de portarias, informes técnicos, relatórios de conferência, resoluções e decretos de 2009 a 2014. RESULTADOS Trata-se de um momento de consolidação do modelo psicossocial, com ampliação da rede assistencial, inversão de financiamento para serviços comunitários com forte ênfase na área de crack e outras drogas. A saúde mental é uma área subfinanciada dentro do subfinanciamento crônico do Sistema Único de Saúde. O modelo de governança constrange o avanço de serviços essenciais, havendo a necessidade da incorporação de um processo de regionalização da gestão. Os mecanismos avaliativos no campo burocrático se mostram pouco incorporados à política de saúde. CONCLUSÕES É necessário ampliar o financiamento global da saúde e específico da saúde mental, que vem se constituindo como uma política exitosa. O foco atual da política se mostra anacrônico aos preceitos do modelo psicossocial. Aponta-se a necessidade de ampliação de mecanismos avaliativos.

Efectos en la adherencia al tratamiento y en el ajuste psicológico luego de la revelación del diagnóstico de VIH/SIDA con el modelo clínico "DIRE" en niños y jóvenes colombianos menores de 17 años / Effects in the adherence treatment and psychological adjustment after the disclosure of HIV/AIDS diagnosis with the "DIRE" clinical model in Colombian children under 17

Background: A study in five Colombian cities in 2006, confirms the findings of other international studies: the majority of HIV-positive children not know their diagnosis, caregivers are reluctant to give this information because they believe that the news will cause emotional distress to the child becoming primary purpose of this study to validate a model of revelation. Materials and Methods: We implemented a clinical model, referred to as: "DIRE" that hypothetically had normalizing effects on psychological adjustment and adherence to antiretroviral treatment of HIV seropositive children, using a quasi-experimental design. Test were administered (questionnaire to assess patterns of disclosure and non-disclosure of the diagnosis of VIH/SIDA on children in health professionals and participants caregivers, Family Apgar, EuroQol EQ- 5D, MOS Social Support Survey Questionnaire Information treatment for VIH/SIDA and child Symptom Checklist CBCL/6-18 adapted to Latinos) before and after implementation of the model to 31 children (n: 31), 30 caregivers (n: 30) and 41 health professionals. Data processing was performed using the Statistical Package for the Social Science version 21 by applying parametric tests (Friedman) and nonparametric (t Student). Results: No significant differences in adherence to treatment (p = 0.392), in the psychological adjustment were found positive significant differences at follow-ups compared to baseline 2 weeks (p: 0.001), 3 months (p: 0.000) and 6 months (p: 0.000). Conclusions: The clinical model demonstrated effectiveness in normalizing of psychological adjustment and maintaining treatment compliance. The process also generated confidence in caregivers and health professionals in this difficult task.

Antecedentes: Un estudio realizado en cinco ciudades colombianas en el 2006 ratificó lo hallado en investigaciones internacionales: los niños con infección por VIH desconocen su diagnóstico; los cuidadores son renuentes a dar esta información porque consideran que la noticia causará estrés emocional al menor, convirtiéndose en propósito principal de este estudio validar un modelo de revelación. Materiales y Métodos: Se implementó un modelo clínico, denominado: "DIRE", el cual, hipotéticamente tendría efectos de normalización del ajuste psicológico y adherencia al tratamiento anti-retroviral de niños con infección por VIH, mediante diseño cuasi-experimental. Se administraron pruebas (cuestionario para evaluar los patrones de revelación y no revelación del diagnóstico de VIH/SIDA a menores en profesionales de la salud y cuidadores participantes, Apgar Familiar, EuroQol EQ -5D, encuesta de apoyo social MOS, cuestionario de información del tratamiento para el VIH/SIDA y la Lista de Síntomas del Niño CBCL/6-18 adaptado a población latina) antes y después de la implementación del modelo a 31 niños (n: 31), 30 cuidadores (n: 30) y 41 profesionales de la salud (n: 41). El procesamiento de datos se realizó con el paquete estadístico para las ciencias sociales SPSS versión 21 mediante la aplicación de pruebas paramétricas (Friedman) y no paramétricas (Prueba T). Resultados: No se encontraron diferencias significativas en la adherencia al tratamiento (p: 0,392), en el ajuste psicológico se encontraron diferencias significativas positivas en los seguimientos comparados con el basal: dos semanas (p: 0,001); tres meses (p: 0,000) y seis meses (p: 0,000). Conclusiones: El modelo "DIRE" demostró eficacia en la normalización del ajuste psicológico y mantenimiento del cumplimiento terapéutico, favoreciendo la confianza de profesionales y cuidadores participantes en este difícil proceso.

ADHD inattentive symptoms mediate the relationship between intelligence and academic performance in children aged 6-14

Objective: Fluid intelligence and the behavioral problems of attention-deficit/hyperactivity disorder (ADHD) are related to academic performance, but how this association occurs is unclear. This study aimed to assess mediation and moderation models that test possible pathways of influence between these factors. Methods: Sixty-two children with ADHD and 33 age-matched, typically developing students were evaluated with Raven's Colored Progressive Matrices and the spelling and arithmetic subtests of the Brazilian School Achievement Test. Dimensional ADHD symptomatology was reported by parents. Results: Our findings suggest that fluid intelligence has a significant impact on academic tests through inattention. The inattentive dimension was the principal behavioral source of influence, also accounting for the association of hyperactive-impulsive manifestations with school achievement. This cognitive-to-behavioral influence path seems to be independent of diagnosis related group, and gender, but lower socioeconomic status might increase its strength. Conclusion: Fluid intelligence is a relevant factor in the influence of ADHD behavioral symptoms on academic performance, but its impact is indirect. Therefore, early identification of both fluid intelligence and inattentive symptoms is of the utmost importance to prevent impaired academic performance and future difficulties in functioning. .

Reduction of maternal mortality due to preeclampsia in Colombia - an interrupted time-series analysis / Reducción de la mortalidad materna por preeclampsia en Colombia - un análisis de series de tiempo interrumpido

Abstract Introduction. Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Five years after (2002-2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR= 0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR= 0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). Conclusions: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations.

Resumen Introducción. La preeclampsia es la causa más importante de mortalidad materna en los países en desarrollo. Se desarrolló e introdujo en Colombia y a nivel nacional un programa de cuidado prenatal que incluyó componentes bio-psicosociales. Se muestran las tendencias de las tasas de mortalidad materna y las causas relacionadas antes y después de la implementación del programa. Métodos: Las tasas de mortalidad general y específica fueron monitoreadas durante 9 años (1998-2006). Un análisis de series de tiempo ininterrumpido se realizó con datos mensuales de casos de mortalidad materna y se compararon las tendencias de cambio en las tasas de mortalidad nacional y el impacto de los cambios atribuibles a la introducción del modelo. Se hizo un análisis multivariado para evaluar la asociación entre las intervenciones. Resultados: Cinco años después de la introducción del programa (2002-2006) la tasa de mortalidad maternal se redujo significativamente en 23% (OR= 0.77, CI 95% 0.710.82). La implementación del MBPS redujo la incidencia de la preeclampsia en 22% (OR= 0.78, CI 95% 0.67-0.88 , igual la mortalidad materna por complicación del parto por hemorragias en 25% (OR= 0.75, CI 95% 0.59-0.90). Otras causas de mortalidad materna no mostraron cambios significativos. No se correlacionó la mortalidad materna con intervenciones de cuidado prenatal individuales como las biomédicas, nutricionales y psicosociales (p= 0.112), sin embargo, ellas en conjunto como un modelo (biopsicosocial) si observaron una asociación significativa (p= 0.042). Conclusiones: La mortalidad maternal general se redujo después de la implementación de un programa nacional de cuidado prenatal. Es importante evaluar este programa en otras poblaciones.

A implicação do apoio social no viver de pessoas com hipertensão arterial / Consecuencias de un apoyo social en el vivir personas con hipertensión / The implication of social support in the lives of people with hypertension

Objetivou-se conhecer os tipos de apoio oferecidos pela rede de apoio social aos hipertensos e as implicações no viver. Estudo qualitativo cuja metodologia baseou-se na Teoria Fundamentada nos Dados. Foram entrevistadas 35 pessoas entre outubro de 2008 e agosto de 2010, sendo 22 hipertensas obrigatoriamente cadastradas no HIPERDIA numa Unidade de Saúde em Belém/PA, 5 familiares, 5 profissionais de saúde e 3 representantes de instituições da comunidade referenciados pelos hipertensos como integrantes da rede de apoio. Os dados foram submetidos aos procedimentos de codificação: análise, comparação e categorização. A categoria "Identificando os tipos de apoio social oferecidos às pessoas no seu viver com hipertensão arterial" foi a Condição Interventora da Teoria. Os tipos de apoio emocional, informacional e instrumental originaram-se principalmente das relações familiares e podem significar alternativas no tratamento, caracterizando um cuidado centrado no hipertenso e sua rede de relações, requerendo atenção dos profissionais de saúde, inclusive do enfermeiro.

Objetiva conocer tipos de apoyo oferecidos por la red de apoyo social a los hipertensos y las implicaciones en su vida. Estudio cualitativo basado en la Grounded Theory. 35 personas fueron entrevistadas entre octubre de 2008 y agosto de 2010, 22 hipertensos obligatoriamente inscrito en HIPERDIA en una Unidad de Salud en Belém/PA, 5 miembros de la familia, 5 profesionales de la salud y 3 representantes de instituciones comunitarias, referenciados por los hipertensos como miembros de la red de apoyo. Los datos fueron sometidos a procedimientos de codificación: análisis, comparación y categorización. La categoría "Identificación de tipos de apoyo social ofrecido a las personas en su vida con la hipertensión", fue la Condición Interventora de la Teoría. Los tipos de apoyo emocional, informativo e instrumental, se originaron principalmente de las relaciones familiares y pueden ser tratamiento alternativo, la atención centrada en el hipertenso y su red, requiriendo atención de los profesionales, incluyendo enfermeras.

This study aimed to know the types of support offered by the network of social support and implications on hypertensive life. Qualitative study whose methodology was based on Grounded Theory. 35 people were interviewed between October 2008 and August 2010, 22 hypertensive compulsorily enrolled in HIPERDIA at a Health Unit in Belém / PA, 5 family members, 5 health professionals and 3 representatives of community institutions, referenced by hypertensive patients, as members of the network support. Data were subjected to coding procedures: analysis, comparison and categorization. The category "Identifying the types of social support offered to people in their living with hypertension" was the Intervening Condition of the Theory. The types of emotional, informational and instrumental support originated mainly from family relationships and may mean alternative treatments, featuring a care focused on people with hypertension and their network of relationships which requires attention from healthcare professionals, including nurses.

Um olhar sensível às tribos pós-modernas: cuidando da saúde dos adolescentes no cotidiano / Una mirada sensible a las tribus postmodernas: el cuidado de la salud de los adolescentes en la vida cotidiana / A careful look to postmodern tribes: caring for adolescent health in the context of their everyday lives

Trata-se de uma reflexão teórica, fundamentada na Sociologia Compreensiva de Michel Maffesoli. Tem como objetivo refletir sobre o cuidado com a saúde dos adolescentes no cotidiano contemporâneo, considerando um olhar sensível para o fenômeno das tribos urbanas. As tribos são compreendidas como estruturação de grupos de pessoas que se reúnem afetivamente, construindo um vínculo de socialidade com um objetivo comum. Esta reflexão enfoca a importância de se considerar a maneira de viver dos adolescentes e visa ampliar os horizontes dos profissionais da saúde, em busca de estratégias de atuação, sintonizadas com a realidade e as necessidades de cuidados para promover a saúde, delineando, assim, maneiras de cuidar afetivas e, portanto, mais efetivas, contribuindo para repensar as políticas de atenção à saúde dos adolescentes na contemporaneidade.

Se trata de una reflexión teórica, basada en la Sociología Comprensiva de Michel Maffesoli. Tuvo como objetivo reflexionar sobre el cuidado de la salud de los adolescentes en la vida cotidiana contemporánea, teniendo en cuenta un aspecto sensible en el fenómeno de las tribus urbanas. Estas son entendidas como la estructuración de grupos de personas que se reúnen afectivamente para la construcción de un vínculo de sociabilidad hacia una meta común. Esta reflexión, centrándose en la importancia de considerar el modo de vida de los adolescentes tiene como objetivo ampliar los horizontes de los profesionales de la salud en la búsqueda de estrategias de acción en sintonía con la realidad y necesidades de atención para promover la salud, delineando así formas de cuidar, contribuyendo a repensar las políticas de atención de la salud de los adolescentes en la sociedad contemporánea.

This is a theoretical reflection, based on Michel Maffesoli's Comprehensive Sociology, which is concerned with the health care of adolescents in contemporary everyday life, and particularly with the phenomenon of urban tribes. These are understood as groups of people who have emotional ties, building a bond of sociality towards a common goal. This study focuses on the importance to take into account the lifestyle of adolescents and aims to raise awareness among health professionals about such issues, seeking for strategies tuned with reality and care needs in order to promote health, devising ways to improve caring, rethinking health policies for adolescents in contemporary society.

Asociación de la posición socioeconómica y la percepción del ambiente con la autopercepción del estado de salud en mujeres de Bogotá, Colombia / Socioeconomic status, perception of environment, and their association with self-rated health status among women in Bogotá, Colombia

OBJETIVO: Evaluar un modelo conceptual que sugiere una asociación entre la posición socioeconómica (PSE), la percepción del entorno del barrio y la realización de actividad física, con la autopercepción del estado de salud (APES) por parte de mujeres residentes en barrios de bajo nivel socioeconómico de Bogotá, Colombia. MÉTODOS: Se describe un análisis de fuente secundaria de la primera medición de un ensayo grupal comunitario que evaluó un programa dirigido a promover el consumo de frutas y verduras y la actividad física en cuidadoras de hogar residentes en Bogotá. Se realizaron análisis multivariados logísticos de multinivel, con el fin de identificar asociaciones y verificar las mediaciones propuestas en el modelo conceptual. RESULTADOS: En los modelos ajustados se encontró que la PSE medida a nivel individual y la percepción del barrio estuvieron inversa y significativamente asociados a una APES no óptima, mientras que la asociación entre la actividad física y la APES no fue significativa. CONCLUSIONES: Los hallazgos del estudio resaltan la importancia de la PSE de las personas en la valoración de su estado de salud, y extienden la evidencia sobre el papel independiente de la percepción del entorno del barrio en la APES en mujeres.

OBJECTIVE: Evaluate a conceptual model that suggests an association between socioeconomic status (SES), perception of neighborhood environment, physical activity behavior, and self-rated health status (SRHS) among women living in low-resource neighborhoods of Bogotá, Colombia. METHODS: A secondary source analysis of the first measurement of a community cluster trial was used to evaluate a program to encourage a higher consumption of fruits and vegetables and increase physical activity levels among homemakers in Bogotá. Analyses were done using a multivariate multilevel logistic model to identify associations and confirm the mediations proposed in the conceptual model. RESULTS: The adjusted models revealed that individual-level SES and neighborhood perception are inversely and significantly associated with suboptimal SRHS, while the association between physical activity and SRHS was not significant. CONCLUSIONS: The study findings underscore the importance of individual SES in assessment of health status and strengthen the evidence on the independent role of perception of neighborhood environment in the SRHS of women.

Inoculation message treatments for curbing noncommunicable disease development / Tratamientos mediante mensajes de inoculación para contener la aparición de enfermedades no transmisibles

OBJECTIVE: To study the effect of various types of inoculation message treatments on resistance to persuasive and potentially deceptive health- and nutrition-related (HNR) content claims of commercial food advertisers. METHODS: A three-phase experiment was conducted among 145 students from a Midwestern U.S. university. Quantitative statistical analyses were used to interpret the results. Results: Results provide clear evidence that integrating regulatory focus/fit considerations enhances the treatment effectiveness of inoculation messages. Inoculation messages that employed a preventative, outcome focus with concrete language were most effective at countering HNR advertising claims. The findings indicate that inoculation fosters resistance equally across the most common types of commercially advertised HNR product claims (e.g., absolute, general, and structure/function claims). CONCLUSIONS: As the drive to refine the inoculation process model continues, further testing and application of this strategy in a public health context is needed to counter ongoing efforts by commercial food advertisers to avoid government regulations against deceptive practices such as dubious health/nutrition claims. This research advances inoculation theory by providing evidence that 1) good regulatory fit strengthens the effect of refutational preemption and 2) an inoculation approach is highly effective at fostering resistance to commercial advertisers' HNR content claims. This macro approach appears far superior to education or information-based promotional health campaigns targeted solely at specific populations demonstrating rising rates of noncommunicable disease.

OBJETIVO: Estudiar el efecto de diversos tipos de tratamientos basados en mensajes de inoculación sobre la resistencia a los reclamos de los anunciantes de alimentos comerciales con contenidos persuasivos y potencialmente engañosos relacionados con la salud y la nutrición (RSN). MÉTODOS: Se llevó a cabo un experimento en tres fases en el que participaron 145 estudiantes de una universidad del centro oeste de los Estados Unidos. Para interpretar los resultados, se utilizaron análisis estadísticos cuantitativos. RESULTADOS: Se obtuvieron datos probatorios claros de que la integración de las consideraciones de la teoría del enfoque/ajuste regulador mejoran la eficacia de los tratamientos basados en mensajes de inoculación. Los mensajes de inoculación que adoptaron un enfoque de prevención de resultados y utilizaron un lenguaje concreto fueron más eficaces en contrarrestar los reclamos publicitarios RSN. Se observó que la inoculación fomenta la resistencia por igual frente a los tipos más frecuentes de reclamos RSN de los productos anunciados comercialmente (reclamos absolutos, generales, y de estructura y función). CONCLUSIONES: Mientras se mantienen los intentos de perfeccionar el modelo del proceso de inoculación, es preciso seguir poniendo a prueba y aplicando esta estrategia en un contexto de salud pública con objeto de contrarrestar las iniciativas regulares de los anunciantes de alimentos comerciales para evitar las reglamentaciones gubernamentales contra prácticas engañosas tales como los reclamos equívocos en materia de salud y nutrición. Esta investigación promueve la teoría de la inoculación al proporcionar datos probatorios de que 1) un buen ajuste regulador fortalece el efecto de la prevención refutadora; y 2) un método de inoculación resulta ser muy eficaz en fomentar la resistencia a los reclamos con contenidos RSN de los anunciantes comerciales. Este enfoque macro se muestra muy superior a las campañas de promoción de la salud educativas o basadas en la información dirigidas exclusivamente a poblaciones específicas que presentan tasas ascendentes de enfermedades no transmisibles.

Tendências e diversidade na utilização empírica do Modelo Demanda-Controle de Karasek (estresse no trabalho): uma revisão sistemática / Trends and diversity in the empirical use of Karasek's demand-control model (job strain): a systematic review

INTRODUÇÃO: O modelo demanda-controle de Karasek tem sido utilizado para investigar associação entre estresse no trabalho e desfechos de saúde. Entretanto, diferentes instrumentos e definições têm sido adotados para aferir a exposição "alta exigência no trabalho", o que dificulta a comparação de resultados entre estudos. OBJETIVO: Descrever os instrumentos e as definições adotadas para a variável de exposição "estresse no trabalho", avaliada segundo o modelo demanda-controle, nos estudos observacionais publicados até 2010. MÉTODOS: Revisão sistemática de estudos observacionais publicados até dezembro de 2010, que avaliaram a exposição "estresse no trabalho", aferido segundo o modelo demanda-controle de Karasek e utilizaram o JCQ ou seus derivados, desde que explicitado nos textos. RESULTADOS: Entre 877 resumos selecionados, 496 (57%) preencheram os critérios de inclusão. Identificou-se tendência à produção bibliográfica crescente no tema. A maioria dos estudos foi de natureza seccional; não encontramos diferenças relevantes entre as populações de estudo masculinas e femininas. Suécia, EUA, Japão e Canadá concentraram 57% das publicações, em sua maioria incluindo mais de 1.000 participantes e ocupações diversificadas. Desfechos cardiovasculares e seus fatores de risco foram os mais estudados (45%), seguidos por aqueles relacionados à saúde mental (25%). Em 71% dos estudos foi utilizado o Job Content Questionnaire (com 2 a 49 itens) e, em 19% do total, a versão sueca (Demand Control Swedish Questionnaire). Quadrantes de exposição demanda-controle foram utilizados em 51% dos trabalhos, mas com variados pontos de corte; escores das duas dimensões foram analisados em separado em 27%, e sua razão em 14% do total. Apoio social no trabalho foi avaliado em 44% dos estudos. CONCLUSÃO: O modelo Karasek deverá continuar a suscitar pesquisas epidemiológicas e esperamos que os pesquisadores enfrentem essas questões teóricas e metodológicas ainda pendentes.

INTRODUCTION: Karasek's demand-control model has been used to investigate association between job strain and health outcomes. However, different instruments and definitions have been utilized to assess the exposure 'high strain at work', which makes difficult the comparison of results across studies. OBJECTIVE: To describe the measurement instruments and the definitions adopted for the exposure variable 'job strain', according to the demand-control model, by observational studies published until 2010. METHODS: Systematic review of observational studies published until December 2010, addressing the exposure 'job strain', measured according to the demand-control model and used the JCQ or its derivatives, since explicit. RESULTS: Among 877 selected abstracts, 496 (57%) met the inclusion criteria. It identified a trend towards the increasing production literature on the subject. Most studies were sectional; found no relevant differences among study populations of men and women. Sweden, USA, Japan and Canada accounted for 57% of publications, mostly including more than 1000 participants and diverse occupations. Cardiovascular outcomes and their risk factors were the most studied (45%), followed by those related to mental health (25%). In 71% of the studies used the Job Content Questionnaire (from 2 to 49 items) and 19% of the total, the Swedish version (Demand-Control Questionnaire Swedish). Quadrants of the demand-control exposure were used in 51% of the work, but with different cutoff points; scores of the two dimensions were analyzed separately in 27%, and its ratio in 14% of the total. Social support at work was assessed in 44% of the studies. CONCLUSION: Karasek's model should continue to raise epidemiological studies and we hope that researchers face these theoretical and methodological issues outstanding.

Assistência em saúde mental sustentada no modelo psicossocial: narrativas de familiares e pessoas com transtorno mental / Mental health care based on the psychosocial model: reports of relatives and persons with mental disorders / Atención en salud mental basada en el modelo psicosocial: testimonios de familiares y personas con transtorno mental

Esta pesquisa foi realizada com o método da história oral temática e desenvolvida no ano de 2009, em Curitiba, com oito colaboradores pertencentes a três famílias que tinham um integrante com transtorno mental. O objetivo do estudo foi descrever a percepção de familiares e de portadores de transtorno mental sobre a assistência em saúde mental sustentada no modelo psicossocial. Os dados foram obtidos por meio de entrevista semiestruturada, analisados e apresentados de maneira descritiva. Os colaboradores consideraram os serviços extra-hospitalares, como o Centro de Atenção Psicossocial e os ambulatórios de saúde mental, estratégias inovadoras, e mencionaram o atendimento por equipe multiprofissional, a mediação de conflitos familiares e o princípio de territorialidade. Destacaram o acompanhamento do portador de transtorno mental pela Unidade Básica de Saúde e ressaltaram a importância das associações na rede de saúde mental. Atribuíram à inclusão da família no tratamento a melhora na relação familiar e a aceitação da doença.

This study was performed in 2009 in Curitiba, using the thematic oral history technique. The participants were eight individuals from three different families who had one relative suffering from a mental disorder. The objective of the study was to describe the perception of relatives and persons with mental disorders regarding mental healthcare based on the psychosocial model. The data were obtained through semi-structured interviews, which were then analyzed and organized descriptively. The participants opined that extra-hospital services such as the Psychosocial Care Center and mental health outpatient clinics are innovative strategies. They described receiving assistance from a multidisciplinary team, the mediation of family conflicts, and the principle of territoriality. They highlighted that the individual with a mental disorder is followed by the Basic Health Unit and emphasized the importance of mental health network connections. They believe that including the family in the treatment regime improves family relationships and their acceptance of the disease.

Investigación según metodología de historia oral temática, desarrollada durante 2009 en Curitiba, con ocho colaboradores pertenecientes a tres familias con un miembro padeciendo transtorno mental. Se objetivó describir la percepción de familiares y portadores de transtorno mental sobre la atención de salud mental basada en el modelo psicosocial. Datos recabados mediante entrevista semiestructurada, analizados y presentados de modo descriptivo. Los colaboradores consideraron estrategias innovadoras a los servicios extrahospitalarios como el Centro de Atención Psicosocial y ambulatorios de salud mental, mencionaron la atención por parte de equipo multidisciplinario, la mediación de conflictos familiares y el principio de territorialidad. Destacaron el seguimiento del portador de transtorno mental por la Unidad Básica de Salud y resaltaron la importancia de las asociaciones en la red de salud mental. Atribuyeron la mejora de las relaciones familiares y la aceptación del padecimiento a la inclusión de la familia en el tratamiento.

Teoría del comportamiento planificado y conducta sexual de riesgo en hombres homosexuales / Theory of planned behavior and risky sexual behavior in homosexual men

OBJETIVO: Explorar la adecuación de modelo de la teoría del comportamiento planificado (TCP) para el análisis de la conducta sexual de riesgo en el colectivo "hombres que tienen sexo con hombres" (HSH) con el objetivo de proponer un modelo alternativo que mejore su comprensión. MÉTODOS: Análisis cualitativo de entrevistas semiestructuradas individuales y de grupos nominales realizadas con 45 HSH que durante los últimos 12 meses mantuvieron relaciones sexuales de riesgo (penetración anal insertiva o receptiva sin utilizar preservativo). Para el manejo de los datos se realizó un análisis del discurso mediante el "método comparativo constante" realizado en dos fases: a) identificación de variables de la TCP y de inadecuaciones entre esta teoría y las declaraciones de los informadores, y b) propuesta de un modelo psicosocial alternativo coherente con los resultados. RESULTADOS: Se confirmó una adecuación general de la TCP, su modificación en aspectos puntuales y la incorporación de nuevas variables que, en posteriores investigaciones, podrían ser incluidas para verificar cuantitativamente su potencial incremento de la capacidad predictiva y/o explicativa del modelo para la conducta sexual de riesgo en HSH. CONCLUSIONES: Los resultados obtenidos parecen indicar la importancia de poner a prueba los postulados matemáticos del modelo TCP. Se estableció un equilibrio estable entre la validación de la TCP, sugiriéndose posibles modificaciones en aspectos puntuales que, en posteriores investigaciones, podrían ser incluidas para verificar su potencial incremento de la capacidad explicativa del modelo para la conducta sexual de riesgo en HSH.

OBJECTIVE: Explore the appropriateness of the theory of planned behavior (TPB) model for analyzing risky sexual behavior in men who have sex with other men (MSM), with the object of proposing an alternative model that improves understanding. METHODS: Qualitative analysis of semi-structured individual and nominal group interviews conducted with 45 MSM who engaged in risky sexual behavior (insertive or receptive anal penetration without use of a condom) during the past 12 months. In order to manage the data, a discourse analysis using the constant comparative method was performed in two phases: a) identification of TPB variables and incongruities between this theory and the statements made by the informants, and b) proposal of an alternative psychosocial model that is consistent with the results. RESULTS: The overall appropriateness of the TPB was confirmed, with changes in specific aspects and the introduction of new variables that could be included in subsequent research in order to quantitatively verify the potential increase in the predictive and/or explanatory capacity of the model for risky sexual behavior in MSM. CONCLUSIONS: The results obtained appear to indicate the importance of testing the mathematical assumptions of the TPB model. A stable balance was established between validation of the TPB and suggesting possible changes in specific aspects that could be included in subsequent research to confirm the potential increase in the explanatory capacity of the model for risky sexual behavior in MSM.

Factores presentes en la deserción universitaria en la Facultad de Psicología de la Universidad De San Buenaventura, sede Bogotá en el periodo comprendido entre 1998-2009 / Factors related to the college dropout in the Faculty of Psychology at San Buenaventura University Bogotá in the period 1998-2009

El objetivo del presente estudio fue describir los factores socio demográficos y las categorías del modelo psicológico de Ethington, presentes en la deserción universitaria, evaluados por medio de una encuesta telefónica diseñada con base en estas categorías y validada por jueces. Los participantes tenían entre 16 y 32 años, solteros, de estratos 3 y 4. Los resultados descriptivos permiten concluir que existen diversas causas para que se presente la deserción en la Facultad de Psicología de la Universidad San Buenaventura, sede Bogotá. Dificultades tales como incompatibilidad del horario de estudio con el horario de trabajo, escasa información respecto al programa elegido al ingresar a la Universidad y dificultades de salud. Es importante destacar que la categoría que presentó el porcentaje más alto fue la de apoyo económico familiar con un 95%.

The purpose of this study was to describe the categories as well as the socio-demographic aspects of Ethington's psychological model, present in the university dropout. In order to do that, those aspects were assessed using a telephone survey validated by judges. Participants were between 16 and 32 years, single, from 3 and 4 social stratum. The results show that there are various reasons for dropout in the Faculty of Psychology at the University of San Buenaventura, such as: incompatibility between study and work schedules, unsuitable or insufficient information when going to University and finally, health difficulties.

Dimensionality of the premenstrual syndrome: confirmatory factor analysis of premenstrual dysphoric symptoms among college students

Premenstrual syndrome and premenstrual dysphoric disorder (PMDD) seem to form a severity continuum with no clear-cut boundary. However, since the American Psychiatric Association proposed the research criteria for PMDD in 1994, there has been no agreement about the symptomatic constellation that constitutes this syndrome. The objective of the present study was to establish the core latent structure of PMDD symptoms in a non-clinical sample. Data concerning PMDD symptoms were obtained from 632 regularly menstruating college students (mean age 24.4 years, SD 5.9, range 17 to 49). For the first random half (N = 316), we performed principal component analysis (PCA) and for the remaining half (N = 316), we tested three theory-derived competing models of PMDD by confirmatory factor analysis. PCA allowed us to extract two correlated factors, i.e., dysphoric-somatic and behavioral-impairment factors. The two-dimensional latent model derived from PCA showed the best overall fit among three models tested by confirmatory factor analysis (c²53 = 64.39, P = 0.13; goodness-of-fit indices = 0.96; adjusted goodness-of-fit indices = 0.95; root mean square residual = 0.05; root mean square error of approximation = 0.03; 90 percentCI = 0.00 to 0.05; Akaike's information criterion = -41.61). The items "out of control" and "physical symptoms" loaded conspicuously on the first factor and "interpersonal impairment" loaded higher on the second factor. The construct validity for PMDD was accounted for by two highly correlated dimensions. These results support the argument for focusing on the core psychopathological dimension of PMDD in future studies.