Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial.

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. OBJECTIVE: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. METHODS: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. RESULTS: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. CONCLUSIONS: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-028017.

Relación del apoyo social, las estrategias de atontamiento y los factores clínicos y sociodemográficos en pacientes oncológicos / Relationship Between Social Support, Coping Strategies, Clinical and Socio Demographic Factors in Cancer Patients / Relação do apoio social, estratégias de afrontamento, fatores clínicos e sócio-demográficos em pacientes oncológicos

Objetivo. Describir las relaciones entre las variables sociodemográficas y clínicas, el apoyo social percibido y las estrategias de afrontamiento en una muestra de pacientes con cáncer. Método. Investigación transversal de enfoque cuantitativo, en la que se evaluaron 82 pacientes con diagnóstico de cáncer, seleccionados mediante muestreo no probabilístico, a conveniencia. Como instrumentos se utilizaron la Escala de Estrategias de Coping Modificada (EEC-M) y el Cuestionario MOS para Apoyo Social. Los datos médicos y sociodemográficos fueron recolectados por medio de un cuestionario diseñado para el estudio. Se llevó a cabo un análisis de correspondencias múltiples. Resultados. Se halló que las variables médicas y sociodemográficas están fuertemente relacionadas con los puntajes de los cuestionarios. En la muestra se observó, como tendencia particular, que los datos se agruparon con algunas características sociodemográficas y clínicas. Conclusión. Las variables sociodemográficas y clínicas están relacionadas con la percepción del apoyo social y las estrategias de afrontamiento en pacientes con cáncer; esta información resulta relevante para el diseño de programas de intervención psicológica en pacientes oncológicos.

Objective. To describe the relationship between socio demographic and clinical variables and perceived social support and coping strategies in a sample of patients with cancer. Method. A transversal research quantitative approach was applied, in which 82 patients were evaluated; subjects were selected by non-probability sampling, as the Scale Strategies Modified Coping and the MOS Questionnaire for Social Support were used, medical and socio demographic data were collected through a questionnaire designed for the study. It conducted an analysis of multiple correspondences. Results. It was found that medical and socio demographic variables are strongly correlated with the scores on the questionnaires, and the same trends were found in the sample evaluated, the data was grouped according to certain socio demographic and clinical characteristics. Conclusion. Clinical and socio demographic variables are correlated with the perception of social support and coping strategies in patients with cancer. The importance of taking into account the socio demographic and clinical variables in their relationship with social support and coping strategies for designing psychological intervention programs in cancer patients is discussed.

Escopo. Descrever as relações entre as variáveis sócio-demográficas e clínicas, o apoio social percebido e as estratégias de afrontamento numa amostra de pacientes com câncer. Metodologia. Pesquisa transversal de enfoque quantitativo, na que foram avaliados 82 pacientes com diagnóstico de câncer, selecionados por amostragem não probabilística, a conveniência. Como instrumentos foram utilizados a Escada de Estratégia de Coping Modificada (EEC-M) e o Questionário M05 para Apoio Social. Os dados médicos e sócio-demográficos foram recoltados com um questionário desenhado para o estudo. Foi feita uma análise de correspondências múltiplas. Resultados. Foram encontrado que as variáveis médicas e sócio-demográficas estão fortemente relacionadas com as pontuações dos questionários. Uma tendência particular na amostra foi que os dados foram agrupados em algumas características sócio-demográficas e clínicas. Conclusão. As variáveis sócio-demográficas e clínicas estão relacionadas com a percepção do apoio social e as estratégias de afrontamento em pacientes com câncer, sendo crítica esta informação para o desenho de programas de intervenção psicológica em pacientes oncológicos.

Bullying, redes de apoyo social y funcionamiento familiar en adolescentes de una institución educativa de Santander, Colombia / Bullying, social support networks and family functioning in adolescents in an educational institution Santander, Colombia

La presente investigación tuvo como objetivo caracterizar el bullying y la relación entre redes de apoyo social y funcionamiento familiar percibido por los adolescentes de una institución educativa. Se propuso un diseño no experimental de tipo descriptivo-correlacional con el que se recogieron datos exclusivamente de Floridablanca, Santander. La población estuvo conformada por 304 estudiantes de los grados sextos, novenos y undécimos de una institución educativa pública; las edades oscilaron entre los 10 a 18 años. Como instrumentos se utilizaron tres cuestionarios: el Cuestionario Paredes Lega y Vernon, (2006) para detección del bullying, el APGAR Familiar para medir el funcionamiento familiar, y el Cuestionario MOS de apoyo social. El análisis de la información se trabajó con el programa estadístico SPSS 17.0. Los resultados evidencian que en la institución educativa se presentan conductas asociadas al fenómeno de bullying (agresión, exclusión, intimidación), el 30,5 % de todos los estudiantes admitió que alguna vez ha agredido de diferentes formas a un compañero o compañera ridiculizándolo, golpeándolo, excluyéndolo o por medio de la amenaza, siendo la más repetitiva la ridiculización con un 44,5 %, los resultados demostraron la presencia de bullying en el 22,8% de los estudiantes evaluados. Finalmente, se concluye en la investigación, la importancia de fortalecer las redes de apoyo dentro del contexto escolar, ya que no está cumpliendo la función de brindar apoyo hacia los jóvenes que presentan estos comportamientos, específicamente los que son agredidos, lo que demuestra la necesidad de hacer más partícipes a los docentes, familiares y pares, en las dinámicas que se gestan al interior de la institución educativa que apunten a la construcción de redes de apoyo sólidas en los estudiantes.

The present study aimed to characterize the relationship between bullying and social support networks and family functioning adolescents perceived by an educational institution. We proposed a nonexperimental descriptive-correlational data which was collected exclusively Floridablanca, Santander. The sample consisted of 304 students in grades sixth, ninth and eleventh in a public school, the ages ranged from 10 to 18. As instruments used three questionnaires: Questionnaire Paredes Lega and Vernon (2006) for detection of bullying, the Family APGAR to measure family functioning, and social support questionnaire MOS. The data analysis was worked with SPSS 17.0. The results show that in school behaviors are associated with the phenomenon of bullying (aggression, exclusion, bullying), 30.5% of all students admitted to have ever attacked in different ways to a partner ridiculing, beating , or by excluding it from the threat, the most repetitive ridicule with 44.5%, the results showed the presence of "bullying" in 22.8% of the students tested. Finally, we conclude in research, the importance of strengthening support networks within the school context, as it is not fulfilling the role of providing support to young people who have these behaviors, specifically those who are bullied, which demonstrates the need for more teachers involved, family and peers, the dynamics that are developing within the educational institution aimed at building strong support networks for students.

Evaluación de conocimientos, actitudes, susceptibilidad y autoeficacia frente al VIH/sida en profesionales de la salud / Evaluation of the health professionals' knowledge, attitudes, susceptibilities and self-effectiveness related to HIV/AIDS

Los profesionales de la salud (médicos, psicólogos, trabajadores sociales, enfermeros) cumplen un rol de gran importancia en el desarrollo de los programas de salud sexual y reproductiva dirigidos a los adolescentes. Estos profesionales asumen constantemente problemáticas asociadas a la temática, y son quienes buscan reforzar las destrezas de los adolescentes y jóvenes para prevenir conductas de riesgo que atenten contra su salud. Objetivos: evaluar los conocimientos, actitudes, susceptibilidad y autoeficacia frente al VIH/sida en los profesionales, teniendo en cuenta que son los principales agentes de cambio a los que acude la comunidad. Metodología: la muestra se conformó por 34 profesionales de la salud, 70,6% mujeres y 17,6% hombres, con edades entre 19 y 69 años (M = 33,71; DT = 11,53), pertenecientes a una entidad de salud pública de Cali (Colombia). Se les aplicó la "Adaptación colombiana de la escala VIH/sida-65", "Escala multicomponente de fobia al sida" y "Escala de autoeficacia generalizada (SEA-27)". Resultados: la mayoría de los profesionales de la salud tienen conocimientos adecuados sobre la infección por VIH, una actitud positiva frente a las personas diagnosticadas con el virus y una mayor autoeficacia frente al VIH/sida. Discusión y conclusiones: aunque los profesionales poseen conocimientos correctos, actitudes positivas y autoeficacia frente a la infección por VIH/sida, es necesario fortalecer estrategias que refuercen algunos conceptos y comportamientos favorables frente al VIH/sida ya que son necesarios para las intervenciones dirigidas a la población que accede a los servicios que prestan los profesionales de salud, con el fin de propiciar actitudes y capacidades en el autocuidado de la comunidad.

Health professionals (doctors, psychologists, social workers, nurses) play a very important role in the development of teenage sexual and reproductive health programs. These professionals constantly face the problems associated with these topics, and they attempt to strengthen young people's abilities to prevent high-risk conducts that threaten their health. Goals: evaluate the knowledge, attitudes, susceptibilities and self-effectiveness related to HIV/AIDS, considering that they are the main agents of change upon which the communities depend. Methodology: the sample was comprised by 34 health professionals, of which 70,6% were women and 17,6% were men, between the ages of 19 and 69 years old (M=33,71; DT 11,53):, that belonged to a public health institution from Cali (Colombia). To this effect, The "Colombian variant of the HIV/ AIDS-65 scale", the "AIDS phobia multicomponent scale" and the "Generalized self-effectiveness scale (SEA-27) were applied. Results: most of the health professionals possess an adequate knowledge about the HIV infection, a positive attitude regarding people diagnosed with the virus and a higher self-effectiveness related to HIV/AIDS. Debate and conclusions: Although these professional possess the right knowledge, it is necessary to reinforce certain concepts and favorable behaviors related to the HIV/AIDS, as they are needed for the interventions aimed at the population that access services provided by the health professionals, with the aim of promoting attitudes and capabilities en the communities self-care.

Os profissionais da saúde (médicos, psicólogos, assistentes sociais, enfermeiros) desempenham um papel muito importante no desenvolvimento dos programas de saúde sexual e reprodutiva voltados para a adolescência. Estes profissionais constantemente assumem a responsabilidade de abordar os problemas associados a esta questão, e também procuram o fortalecimento das habilidades dos adolescentes e jovens para prevenir condutas de risco que atentem contra sua saúde. Objetivos: avaliar os conhecimentos, atitudes, susceptibilidades e auto-eficácia perante o HIV/AIDS dos profissionais, levando em conta que eles são os principais agentes de mudanças aos quais as comunidades acodem. Metodologia: a amostra esteve composta por 34 profissionais da saúde; 70,6% mulheres, 17,6% homens, de 19 a 69 anos (M = 33,71; DT = 11, 53) que fazem parte de uma instituição de saúde pública de Cali (Colômbia). A "Adaptação colombiana da escala HIV/AIDS-65", "Escala de multicomponentes de fobia a AIDS" e a "Escala de auto-eficácia generalizada (SEA-27)" foram utilizadas. Resultados: a maioria dos profissionais da saúde possui suficientes conhecimentos da infecção do HIV, mantém uma atitude positiva perante as pessoas diagnosticadas com o vírus e uma maior auto-eficácia perante o HIV/AIDS. Discussão e conclusões: embora os profissionais possuam conhecimentos suficientes, uma atitude positiva e auto-eficácia perante a infecção de HIV/AIDS, é preciso fortalecer as estratégias para apoiar alguns conceitos e condutas favoráveis perante o HIV/AIDS, devido a que são necessários para as intervenções dirigidas à população que utiliza esses serviços oferecidos pelos profissionais da saúde, para propiciar atitudes e as capacidades de cuidado autônomo da própria comunidade.

Factores de riesgo para la infección por VIH/SIDA en adolescentes y jóvenes colombianos / Risk factors in the infection by HIV/AIDS in Colombian adolescents and young people / Fatores de risco de infecção por VIH/SIDA em adolescentes e jovens colombianos

Aunque las cifras de personas infectadas con el Virus de Inmunodeficiencia Humana (VIH) y Síndrome de Inmunodeficiencia Adquirida (SIDA) se han estabilizado en el último año, la población adolescente sigue siendo foco de atención debido a la vulnerabilidad y frecuencia de conductas de riesgo en salud sexual y reproductiva que presentan. Esta situación también se evidencia en Colombia, por lo cual se da la necesidad de conocer la situación actual de los adolescentes en esta área, con el fin de generar estrategias de promoción y prevención, que disminuyan los riesgos frente a la infección por VIH/Sida, enfocadas a las características propias de la población. El propósito del siguiente estudio fue determinar los conocimientos, actitudes, susceptibilidad y autoeficacia en adolescentes y jóvenes ente los 10 y 23 años de instituciones educativas públicas de diferentes ciudades de Colombia. Se evaluó una muestra de 978 adolescentes de 6 a 11 grados de educación básica secundaria. El estudio es de carácter no experimental descriptivo transversal. Se les aplicó la Escala VIH/Sida-65 y la Escala de Autoeficacia (SEA-27). De los adolescentes encuestados, más del 50% había recibido información sobre transmisión y prevención del VIH/Sida, sin embargo los conocimientos adquiridos no se reflejaban en las prácticas y continuaban presentando ideas erróneas sobre el tema; también se encontró que a medida en que aumenta la edad, disminuyen los conocimientos, actitudes, susceptibilidad y autoeficacia frente al VIH/Sida. Es necesario que en los adolescentes se desarrollen intervenciones orientadas hacia el cambio de comportamiento y que sean específicas de acuerdo con la edad, género, nivel de escolaridad y nivel socioeconómico.

Although the number of people infected by the Human Immunodeficiency Virus (HIV) and the Acquired Immune Deficiency Syndrome (AIDS) has stabilized during the past year, the adolescent population continues to be the focus of attention due to its vulnerability and the frequency of risk behaviors that occur in sexual and reproductive health. There is evidence that this too is happening in Colombia and therefore it is necessary to understand the present situation of adolescents in this area and focus on the characteristics of this population in order to reduce the risk of infection by HIV/AIDS. The purpose of this study was to establish the level of knowledge, attitudes, susceptibility and self-efficiency among adolescents and young people between the ages of 10 and 23 in state schools of different Colombian cities. A sample of 987 high-school adolescents between 6th and 11th grades was assessed. The study was non-experimental, descriptive, and cross sectional. The VIH/Sida-65 and Self-Efficiency (SEA-27) scales were administered. Among the adolescents interviewed, more that 50% had received information about the transmission and prevention of HIV/AIDS. However, the knowledge acquired was not reflected in their sexual practices, and there were still misconceptions on the subject. It was also found that the levels of knowledge, attitudes, susceptibility and self-efficiency related in HIV/AIDS diminished as the age of those interviewed increased. It is necessary to carry out interventions aimed at changes in behavior, specifically addressed to the adolescents according to their age, gender, academic level and socio-economic status.

Embora o número de pessoas infectadas com o vírus da imunodeficiência humana (VIH) e a síndrome da imunodeficiência adquirida (sida) ter-se estabilizado ao longo do ano passado, a população adolescente continua sendo um foco por causa da vulnerabilidade e da freqüência de comportamentos de risco em saúde sexual e reprodutiva. Como esta situação é também evidente na Colômbia, é necessário saber o estado atual de adolescentes nessa área, a fim de gerar estratégias de promoção e de prevenção que reduzam a exposição ao VIH /sida, focalizadas nas características da população. O objetivo deste estudo é determinar os conhecimentos, as atitudes, a sensibilidade e a auto-eficácia em adolescentes e jovens entre 10 e 23 anos, de instituições públicas de ensino de diversas cidades da Colômbia. Este estudo descritivo, não-experimental transversal, avaliou uma amostra de 978 adolescentes de 6 a 11 graus de ensino secundário. Se lhes aplicaram as escalas VIH/sida-65 e Auto-Eficácia (SEA-27). Dos adolescentes entrevistados, 50% receberam informações sobre transmissão e prevenção do VIH/sida, mas o conhecimento adquirido não repercutia nas práticas e apresentava ainda idéias equivocadas sobre o assunto. O estudo revelou também que quando a idade aumenta, se reduzem os conhecimentos, as atitudes, a sensibilidade e a auto-eficácia contra o VIH/sida. É necessário que os adolescentes desenvolver intervenções para a mudança de comportamento, específicas para a idade, o sexo, a escolaridade e o nível socioeconômico.

Intervención psicológica en adultos mayores / Psychological intervention in elderly adults

El objetivo de este artículo es plantear una propuesta de intervención psicológica dirigida a adultos mayores institucionalizados y no institucionalizados; para ello se tomó como referencia la situación actual del adulto, los estudios realizados entorno a esta etapa y específicamente lo relacionado con el diseño de programas de intervención, para finalmente exponer la propuesta de intervención psicológica que pretende no solo mejorar la calidad de vida del adulto mayor, sino abarcarlo desde sus diversas áreas de funcionamiento.

The objective of the present article is to raise a proposal of psychological intervention directed to older adults making a distinction between the institutionalized adults from the noninstitutionalized ones, taking as reference the present situation of the adult, the studies developed at this stage and specifically those related to the design of intervention programs. We expose the proposal of psychological intervention that tries not only to improve the quality of life of the older adult but to include them from their diverse areas.

Factores de riesgo psicosociales y ambientales asociados a trastornos mentales / Psychosocial and environmental risk factors associated with mental disorders

En Colombia, son escasos los estudios sobre la asociación de los factores psicosociales y medioambientales con trastornos mentales de mayor prevalencia; tales estudios son necesarios debido al contexto de violencia, inseguridad social e inestabilidad laboral y económica del país. El objetivo de este estudio fue identificar los factores de riesgo psicosociales y ambientales de los trastornos mentales, en los usuarios de servicios de psicología de Colombia. Para ello, se aplicaron el Mini International Neuropsychiatric Interview y un cuestionario de evaluación del Eje IV del DSM-IV-TR, a 490 participantes. Se utilizaron análisis descriptivos y de factores de riesgo. Como factor de riesgo para la depresión, se identificaron los problemas de vivienda, acceso a los servicios de asistencia sanitaria, los relativos al grupo primario, los económicos, del ambiente social y los problemas laborales. Para la ansiedad generalizada se identificaron los problemas económicos y los relativos a la enseñanza. Para los trastornos de pánico, fueron relevantes los problemas relacionados con el ambiente social, y para la fobia social, los problemas de enseñanza, los laborales y el ambiente social.

In Colombia, there are few studies on the association of psychosocial and environmental factors with the most prevalent mental disorders; such studies are important due to the context of violence, social insecurity, and job and economic instability in the country. The objective of this study was to identify the psychosocial and environmental risk factors for mental disorders, in users of psychologicalservices in Colombia. The Mini International Neuropsychiatric Interview and a Questionnaire to evaluate the Axis-IV of the DSM-IV-TR were applied to 490 participants.The analysis comprised descriptive statistics and risk factors. As riskfactors for depression, there were identified housing problems, access to health care services, problems related to the primary group, economics, problems of the social environment, and labor. For generalized anxiety, there were identified economic and education issues. For panic disorders, the risk factors were related to social environment, and for social phobia, the risk factors were problems in education,work and social environment.

Estilos de liderazgo, clima organizacional y riesgos psicosociales en entidades del sector salud: un estudio comparativo / Leadership styles, organizational climate and psychosocial risks in the health sector agencies. A comparative study / Estilos de liderança, ambiente organizacional e riscos psicossociais nas entidades do sector da saúde. Um estudo comparativo

El propósito de este estudio fue describir el clima organizacional, los factores de riesgo psicosocial y los estilos de liderazgo que perciben un grupo de 400 trabajadores del sector salud en cuatro ciudades colombianas, y observar si existen diferencias significativas entre ellas. Para ello se aplicó el ECO, el CFP y el PAT. De acuerdo con los resultados, los participantes presentaron riesgos psicosociales de diversa índole, siendo más relevantes los referidos a las relaciones interpersonales El clima organizacional, aunque no es óptimo, tampoco es adverso. Los dos estilos de liderazgo resultantes en el estudio fueron evidenciados solamente en Bogotá. Se encontraron diferencias significativas en la mayoría de las variables estudiadas, lo cual podría deberse al efecto de aspectos culturales. Se discuten estos hallazgos.

The purpose of this study was to describe the organizational climate, psychosocial risk factors and leadership styles perceived by a group of 400 workers of the health sector in four Colombian cities and to observe whether there are significant differences between them. In order to achieve this objective, the instruments entitled ECO, CFP and PAT_were administered. According to the results, the participants showed psychosocial risks factors of diverse nature and the most relevant ones were those related to interpersonal relationships. Although the organizational climate found was not optimal, it was not adverse either. The two resulting leadership styles were evidenced only in Bogota. Significant differences were found in most variables studied which could be attributed to cultural aspects. These findings are discussed.

A fim de provar e avaliar o impacto de um programa motivacional de terapia breve para controlar o consumo de álcool em bebedores prejudiciais levou-se a cabo um estudo empírico-analítico com desenho quase experimental. O programa de intervenção constituiu a variável independente, baseado em princípios de entrevista motivacional e de autocontrole cognitivo. A variável dependente foram os indicadores de consumo (intensidade, freqüência e risco), etapa motivacional ante a mudança, estado dos processos da mudança e expectações acerca do consumo. As variáveis foram medidas em três momentos com instrumentos validados previamente: 1. pré-intervenção, 2. ao finalizar a intervenção e 3. cinco semanas depois de acabado o tratamento. No estudo participaram 180 estudantes universitários detectados previamente como bebedores prejudiciais, designados aleatoriamente a uno de três grupos: 1. terapia motivacional individual, 2. terapia motivacional grupal e 3. ausência de terapia. Ambas as terapias motivacionais (individual e grupal) levaram à redução importante dos indicadores de consumo e a melhorar o uso dos processos de mudança responsáveis do consumo. No entanto, a intervenção grupal conduziu a um impacto maior do que a intervenção individual em aspetos como freqüência de consumo, auto-eficácia em situações de alto risco de consumo, percepção de vulnerabilidade e dano, e uso de processos comportamentais associados à mudança e à conservação desta.