Associations Between Habit and Its Determinants with Medication Adherence in Chilean Patients with Type 2 Diabetes Mellitus.

High rates of medication non-adherence have been reported in Chilean patients with type 2 diabetes mellitus (T2DM). Although habit is relevant to medication adherence, few studies have examined the antecedents of habit strength in taking diabetes medication. The aim of the present study was to assess the mediating role of habit strength in the association between determinants of habit formation and medication adherence in Chilean patients with T2DM. Participants were 245 T2DM patients from Chile. Variables were measured using self-report scales. Hypotheses were tested using a series of mediation models. Results supported the mediating role of habit strength in the relationships of medication adherence with planning, exposure to contextual cues, behavior repetition, perceived benefits, and intrinsic motivation. The theoretical and practical implications of these findings for the treatment of T2DM are discussed.

Cardiometabolic comorbidities in Hispanic/Latino cancer survivors: prevalence and impact on health-related quality of life and supportive care needs.

PURPOSE: The aim of this study was to characterize the prevalence of cardiometabolic comorbidities (i.e., diabetes, peripheral vascular disease, myocardial infarction, congestive heart failure, cerebrovascular disease) among Hispanic/Latino cancer survivors and examine the impact of cardiometabolic comorbidities on health-related quality of life (HRQoL), unmet supportive care needs, patient-provider communication self-efficacy, satisfaction with cancer care, and increases in healthy behaviors. METHODS: Hispanics/Latinos diagnosed with breast, prostate, or colorectal cancer (N = 288) were assessed within 15 months of primary treatment completion. RESULTS: One-quarter (24.7%) of survivors were diagnosed with diabetes and one-fifth (20.8%) were diagnosed with peripheral vascular disease. Survivors with at least one cardiometabolic comoribidity were older (t(278) = -.3.622, p < .001) and more likely to have a household income of less than $25,000 (X2 = 8.369, p = .004). When adjusting for sociodemographic and medical covariates, survivors with cardiometabolic comorbidities demonstrated worse overall HRQoL (B = -4.792, p = .050), emotional (B = -1.479, p = .018) and physical (B = -2.228, p = .005) wellbeing, a higher odds of unmet psychological (OR = 2.095, p = .027) and sexuality (OR = 2.898, p = .004) needs, and greater patient-provider communication self-efficacy (B = .179, p = .045). There were no differences in healthy behavior changes or satisfaction with cancer care. CONCLUSIONS: Cardiometabolic comorbidities may be highly prevalent among Hispanic/Latino cancer survivors and increase the risk of worse HRQoL and unmet supportive care needs. Targeted interventions are needed to optimize health among Hispanic/Latino cancer survivors with cardiometabolic comorbidities.

Weight Stigma, Chronic Stress, Unhealthy Diet, and Obesity in Chilean Adults.

BACKGROUND: Obesity is highly prevalent around the world, including in Chile. Although various psychological factors have been previously associated with obesity, there has been less attention on the role of weight stigma as a determinant of obesity in Chile. Therefore, the primary aim of this study was to examine the direct effect of weight stigma on obesity and determine whether chronic stress and unhealthy diet mediate the relationship between weight stigma and obesity. METHODS: Faculty and staff from a Chilean university enrolled in the Chilean Study of Psychological Predictors of Obesity and Metabolic Syndrome and completed anthropometric measurements and measures of weight stigma, chronic stress, and unhealthy diet. RESULTS: Three-hundred and eighty-three participants (Mage = 45 years old; 58% female) were included in the present analysis. Structural equation model analyses demonstrated a direct effect of weight stigma on obesity, chronic stress, and unhealthy diet. However, chronic stress and unhealthy diet did not mediate the relationship between weight stigma and obesity. CONCLUSIONS: Weight stigma is an important determinant of obesity and is associated with high levels of chronic stress and unhealthy diet in Chilean adults. Our results provide further support for the multifactorial nature of obesity and can inform future interventions aimed promoting weight loss in people with overweight and obesity.

[Association between cardiometabolic risk and cognitive impairment]. / Factores de riesgo cardiometabólico y funcionamiento cognitivo: el rol de la reserva cognitiva.

BACKGROUND: Several risk factors are associated with cognitive impairment in older people, but little attention has been paid to cardiometabolic variables, as well as how cognitive reserve can mediate this association. AIM: To determine the association of cardiometabolic risk factors with cognitive functioning and whether the cognitive reserve mediates this association. MATERIAL AND METHODS: A cross-sectional study with 300 participants with a median age of 56 years (53% male) was conducted. Participants had a cognitive functioning assessment. Fasting glucose, HDL-cholesterol, and blood pressure were measured. RESULTS: A Structural Equation Modeling, revealed a direct effect of cardiometabolic latent risk factors on both a cognitive functioning (ß = -.204; p = .056), and cognitive reserve factors (ß = -.236, p = .04). Cognitive reserve was directly associated with cognitive functioning (ß = .327, p = .01), but did not mediate the association between the cardiometabolic risk factors and cognitive functioning (ß = .077, p = .07). The overall goodness of fitness was excellent χ2 (50) = 58.357, p = .195, comparative fit index = .980, Tucker-Lewis Index = .974, root mean square error of approximation = .023 and Standardized Root Mean Square Residual = .041. CONCLUSIONS: A direct effect of cardiometabolic risk factors on cognitive functioning was observed.

[Association between weight-based stigmatization psychological stress and calorie intake]. / Estigma de obesidad, cortisol e ingesta alimentaria: un estudio experimental con mujeres.

BACKGROUND: Weight-based stigmatization is frequent among overweight and obese people. AIM: To determine the association between weight-based stigmatization, psychological stress, cortisol, negative emotions, and eating behavior in a sample of middle-aged women. MATERIAL AND METHODS: Eighty-two women aged 45 ± 8 years, 55% with overweight or obesity, were randomly allocated to watch a video called "Stigma: the human cost of obesity" or a control video about planet earth. The effect of watching either video on calorie consumption, psychological stress and cortisol reactivity was assessed. Cortisol was measured on four salivary samples. Psychological stress and negative emotions were self-reported. RESULTS: Among women who watched the stigmatizing video, there was a direct association between psychological stress and calorie intake, but negative emotions did not mediate this association. Moreover, psychological stress moderated the association between watching the stigmatizing video and the cortisol output (ß = 0.32; p = 0.005). CONCLUSIONS: Women with high psychological stress have a greater intake of calories. After watching the stigmatizing video, a greater psychological stress is associated with greater cortisol output.

[Health care effects of cultural beliefs about physicians and perceived discrimination]. / Creencias culturales sobre los médicos y percepción de discriminación: El impacto en la continuidad de la atención.

BACKGROUND: Healthcare inequities may hamper physical and mental health. AIM: To examine perceived discrimination in healthcare services in relation to socio-structural and cultural antecedents as well as their effect on psychological processes and health. MATERIAL AND METHODS: Questionnaires on beliefs about physicians, perceived discrimination, emotions and affective states and avoidance consequences in health were answered by 337 child caregivers (85% women) attending preventive health care appointments at primary health care centers. RESULTS: Negative beliefs about healthcare professionals are directly associated with avoidance behaviors in health and perceived discrimination. The latter perception has no direct effects on avoidance behaviors, but it has an indirect effect through negative emotions associated with discrimination. CONCLUSIONS: There is an association between cultural, psychological and structural factors in health care. These results contribute to understand the phenomenon of discrimination and its negative consequences.

[Longitudinal association between chronic psychological stress and metabolic syndrome]. / Estrés psicológico y síndrome metabólico.

BACKGROUND: Psychological stress and depressive symptoms are variables associated with metabolic syndrome (MetS). AIM: To determine the longitudinal association between psychological stress, depressive symptoms and MetS, and whether these variables predict MetS and its component trajectories. MATERIAL AND METHODS: Four hundred and twenty-three participants aged 44 ± 9 years (59% women), free of cardiovascular disease at baseline were enrolled into the Chilean study of psychological stress, obesity and MetS. Participants were followed-up for three years (three waves). Each year, they completed psychological questionnaires, anthropometric variables were measured, and blood samples were obtained. RESULTS: Hierarchical linear regression showed that chronic psychological stress at baseline predicted the total number of MetS components (MetS score) during the third assessment wave (ß = 0.147; p < 0.01). Growth curve modeling allowed to determine that participants who scored +1 standard deviation (SD) at baseline over the mean in psychological stress (ßchronic stress = 0.903; 95% confidence intervals (CI) = 0.065; 1.741), and depressive symptoms (ßdepressive symptoms = 2.482; 95% CI = 0.040; 4.923) had a higher waist circumference trajectory, as compared to those scoring -1 SD above the mean. CONCLUSIONS: Chronic psychological stress is longitudinally associated with the MetS score. Further, psychological stress and depressive symptoms at baseline predicted elevated MetS score trajectories, and a highest waist circumference.

[Cognitive reserve, depression and social support. Analysis of 206 older adults]. / Funcionamiento cognitivo en adultos mayores: rol de la reserva cognitiva, apoyo social y depresión.

BACKGROUND: Cognitive reserve (CR) is a protective factor in aging. Depression and perceived social support are associated with cognitive performance in older adults. However, their role in the relationship between CR and cognitive functioning is less clear. AIM: To determine the relationship between CR and cognitive functioning and whether this relationship is mediated by depression and moderated by social support. MATERIAL AND METHODS: CR, depression, perceived social support, and cognitive functioning scales were applied to a convenience sample of 206 older adults, aged 69 ± 1 years (77% women). Structural equation analysis and moderate mediation analysis were performed. RESULTS: There was a direct effect of CR in cognitive functioning (ß = 0.223, p = 0.005), which was not mediated by depression (ß = 0.040, p = 0.096). High CR scores were associated with lower depression scores (ß = -0.203, p = 0.002). Higher depression scores were associated with worse cognitive functioning (ß = -0.168, p = 0.040). The effect of CR on depression was moderated by social support (ß = -0.161, p = 0.032) controlling for income and age. CONCLUSIONS: The relationship between CR and cognition in older adults allows an early assessment of cognitive dysfunction risk. Depression is an independent risk factor for cognitive functioning. Social support protects individuals with high CR from developing depression.

[Development of an instrument to assess cultural beliefs about physicians]. / Identificación y medición de creencias culturales sobre los médicos: construcción y validación de un instrumento.

BACKGROUND: Beliefs about professionals' healthcare may influence healthcare behaviors. Such beliefs are in part the result of the interactions that professionals have with their patients. Recent studies highlight the importance of beliefs about physicians, their effect on health-care behaviors, and the requirement of culturally appropriate tools to measure such beliefs. AIM: To develop and validate a culturally appropriate instrument to measure beliefs about physicians. MATERIAL AND METHODS: Based on a "bottom-up" methodology, a culturally pertinent scale of beliefs about physicians was developed and then validated by expert judges. The resulting scale, with 26 items, was applied to 337 participants aged 31 ± 7 years (85% women). RESULTS: Two factors, grouping 24 items, emerged from the exploratory factor analysis. The first was called negative beliefs about doctors (Cronbach's α = 0.96) and the second was called positive beliefs about doctors (Cronbach's α = 0.95). Both factors explain 70 % of the scale variance. CONCLUSIONS: The devised instrument has adequate psychometric properties and is also culturally relevant. It allows the assessment of cultural beliefs about physicians.

[Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care]. / Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche.

BACKGROUND: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. AIM: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. MATERIAL AND METHODS: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. RESULTS: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. CONCLUSIONS: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

[Association between psychological stress and metabolic control in patients with type 1 diabetes mellitus]. / Control metabólico en pacientes diabéticos tipo 1 chilenos: rol del estrés psicológico.

BACKGROUND: An association between psychological stress and metabolic control can occur in patients with diabetes. AIM: To determine the longitudinal association between different psychological stress domains (emotional burden, physician-related distress, regimen-related distress, diabetes-related interpersonal distress) and metabolic control of adolescents with Type 1 diabetes. MATERIAL AND METHODS: An intentional sample of 20 Type 1 diabetic adolescents aged 15 ± 4 years was followed-up for one year. Three HbA1c determinations were performed and a stress self-report was obtained with the Polonsky' Diabetes Distress Scale. RESULTS: Several analyses were conducted using growth curve modeling. The first model included the HbA1c measures, the time term (coded as 0, 1, 2) and several covariates (age, years living with type 1 diabetes mellitus, sex, and physical activity). An overall negative linear trend was found for HbA1c. Subsequent models added the stress domains finding that high levels of emotional burden and regimen related-distress were associated with higher HbA1c levels across all exams. A marginal association was found between diabetes-related interpersonal distress and HbA1c. CONCLUSIONS: Stress levels in type 1 diabetic adolescents deserve attention. Different psychological stress factors predicting metabolic control trajectories in type 1 diabetic adolescents were found.

[How stress gets under the skin]. / How stress gets under the skin o cómo el estrés psicológico se introduce bajo la piel.

How psychological stress gets under the skin and contributes to increase the odds for the onset and progression of chronic diseases has been object of abundant research. In this literature review, evidence about the role that both acute (natural phenomenon, marital conflict, a social evaluative task) and chronic stress (stress at work, and the perception of being discriminated) as well as interpersonal stress have on physical health, is examined. Behavioral (lack of physical activity, smoking, lack of adherence) and physiological (dysregulation of the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, immune system and inflammatory response) mechanisms through which psychological stress may contribute to the onset and progression of cardiovascular disease (altering blood pressure, heart rate reactivity, hemoconcentration and pro-coagulation function), and two key processes involved in cancer progression (angiogenesis and metastasis) are discussed. Finally, how social support may moderate the association among psychological stress and physical health is described.

Perceived social support and treatment adherence in Chileans with Type 2 diabetes.

This study aimed to determine if greater perceived social support was directly associated with better Type 2 diabetes (T2D) treatment adherence and if better T2D treatment adherence was related to lower HbA1c levels in Chilean adults with T2D. For this purpose, 200 adults were recruited from the Chilean Diabetic Association. Participants were asked to complete self-report instruments and provide a capillary blood sample to measure HbA1c. Structural equation model analyses were performed to determine direct associations. The study's results indicate that greater perceived social support was associated with healthier dietary habits, regular foot care, more frequent physical activity, and lower medication intake. Likewise, blood sugar testing and physical activity were related to HbA1c. These findings provide evidence of how perceived social support relates to T2D treatment adherence behaviors in Latino patients from South America and could be used for interventions to enhance social support from patients' families, partners, and friends.

Disentangling between-person and within-person associations of physical symptoms of depression with self-perceived health and life satisfaction: A longitudinal study in Chilean adults.

Depression is a major health problem in Chile. Evidence suggests that physical symptoms of depression (PSD) negatively impact self-perceived health and life satisfaction. The aim of this study was to determine the between-person and within-person associations of PSD with self-perceived health and life satisfaction in Chilean adults. The sample consisted of 1424 participants (64.54% female; Mage = 46.77, SD = 14.88) with data in five waves of the Social Longitudinal Study of Chile. Variables were measured through self-report questionnaires. Hypotheses were tested using multilevel analysis. At the within-person level, physical slowing, fatigue, and sleep problems were associated with poorer self-perceived health and lower life satisfaction. At the between-person level, physical slowing and fatigue were associated with poorer perceived health and lower life satisfaction. PSD are associated with self-perceived health and life satisfaction in Chilean adults longitudinally. The study highlights the importance of monitoring PSD changes in Chilean adults.

[Health-related quality of life in Chileans from vulnerable communes]. / Calidad de vida relacionada con la salud en chilenos de comunas vulnerables.

OBJECTIVE: The COVID-19 pandemic and the resulting social and health crisis impacted the well-being of the population. Health-related quality of life (HRQoL) could be affected, mainly in conditions of social vulnerability. The objective was to analyze the HRQoL and the psychometric properties of the EQ-5D instrument in adult Chilean population from vulnerable communes of the Metropolitan Region. METHOD: Cross-sectional study carried out during quarantine period April to June 2021. Five hundred adults residing in Chilean communes were selected and completed a structured questionnaire by video-call, including the EQ-5D instrument. Descriptive analyzes and confirmatory factor analyzes of the traditional reflective model were performed. RESULTS: The age of the sample was 36.36±12.41 years, the majority reported having a secondary education level and being employed. Regarding the EQ-5D instrument, the most affected dimensions were pain/discomfort and anxiety/depression. The global health status was 73.0±19.71 points. The model showed an adequate fit: χ2=6.992, p=0.221, CFI=0.996, TLI=0.993, RMSEA=0.028 (90% CI: 0.000-0.073) and SRMR=0.067. In addition, the items of the scale were good indicators of the construct of interest. CONCLUSIONS: In a pandemic context, the population was mostly affected by pain/discomfort and anxiety/depression. The EQ-5D instrument is a useful tool to estimate CRSV in the Chilean population in the context of pandemic. In addition, the psychometric evidence supports the dimensionality of the construct and the potential utility of decomposing its analysis.

[Relation between weight stigma and emotional eating: an approach from structural equation modeling]. / Relación entre estigma de peso y alimentación emocional: una aproximación desde el modelo de ecuaciones estructurales.

Introduction: Introduction: dietary intake has been shown to be one of the main factors influencing weight gain, and weight stigma contributes to increased emotional eating. However, the factors that mediate this relationship have been less studied. Objective: the aim of this study was to identify the relationship between weight stigma and emotional eating, and whether this relationship is mediated by internalizing weight bias and psychological distress. Methods: a non-probabilistic sample of 332 people from the general population (192 women and 140 men) answered self-report psychological instruments and provided anthropometric measurements. Results: through structural equation analysis (SEM), direct relationships were identified, among which the relationship between weight stigma and emotional eating stands out (ß = 0.422, p < 0.001), in addition to the indirect relationship between these variables mediated by internalized weight bias and psychological distress (ßindirect = 0.016, p = < 0.05). The model had good indicators of goodness of fit and explained 85 % of the variance. Conclusion: the results show the importance of including psychological and behavioral variables in the treatment of emotional eating in people with overweight and obesity, as well as addressing these issues from public policies to reduce the associated stigma that still prevails in society.

Introducción: Introducción: se ha demostrado que la ingesta alimentaria es uno de los principales factores que influyen en el incremento del peso y que el estigma de peso contribuye a una mayor alimentación emocional. Sin embargo, los factores que median esta relación han sido menos estudiados. Objetivo: el objetivo de este estudio fue identificar la relación que existe entre estigma de peso y alimentación emocional, y si esta relación está mediada por la internalización del sesgo de peso y el malestar psicológico. Métodos: una muestra no probabilística de 332 personas de población general (192 mujeres y 140 hombres) respondió instrumentos psicológicos de autorreporte y proporcionó medidas antropométricas. Resultados: por medio de un análisis de ecuaciones estructurales (SEM), se identificaron relaciones directas, entre las que destaca la relación del estigma de peso y alimentación emocional (ß = 0,422, p < 0,001), además de la relación indirecta entre estas variables mediante la internalización del sesgo de peso y malestar psicológico (ßindirecto = 0,016, p = < 0,05). El modelo tuvo buenos indicadores de bondad de ajuste y explicó un 85 % de la varianza. Conclusión: los resultados muestran la importancia de incluir variables psicológicas y conductuales en el tratamiento de la alimentación emocional en personas con sobrepeso y obesidad, así como de abordar estos temas desde políticas públicas para disminuir el estigma asociado que aún impera en la sociedad.