Julio Alfonso Piña López

Instrumento para medir variables psicológicas y comportamientos de adhesión al tratamiento en personas seropositivas frente al VIH (VPAD-24)

OBJETIVO: Probar las propiedades psicometricas de un instrumento que mide variables psicologicas y comportamientos de adhesion al tratamiento en personas con VIH/sida. METODOS: Se realizo un estudio transversal que conto con la participacion de 68 personas seropositivas frente al virus de la inmunodeficiencia humana (VIH) que en el momento del estudio recibian atencion en una institucion de salud de la ciudad de Hermosillo, Mexico. Para el analisis de los datos se utilizaron cinco procedimientos estadisticos en orden sucesivo: la prueba de la t de Student de comparacion de medias, para evaluar la comprension de las preguntas; un analisis factorial exploratorio con rotacion varimax, para estudiar la validez conceptual o teorica del instrumento (construct validity); el coeficiente a de Cronbach, para valorar la confiabilidad; el coeficiente de correlacion de Pearson (r), para analizar la validez concurrente, y un analisis de regresion lineal multiple, para estimar la validez predictiva. RESULTADOS: Con la prueba de la t de Student de comparacion de medias se obtuvieron valores de significacion estadistica de P < 0,05, P < 0,005, P < 0,01 y P < 0,001 en 25 de las 30 preguntas. El analisis factorial exploratorio con rotacion varimax arrojo una estructura de cuatro factores: 1) comportamientos de adhesion presentes y tratamiento; 2) motivos que subyacen a los comportamientos de adhesion o falta de adhesion; 3) bienestar psicologico y competencias sociales y 4) comportamientos de adhesion pasados con valores propios superiores a 1 y que en conjunto explican 65,50% de la varianza. En el analisis de confiabilidad se obtuvo un coeficiente a global de 0,852. En el estudio de la validez concurrente se hallaron correlaciones entre los factores 1 y 2 (r = 0,615; P < 0,01), entre el factor 2 y los factores 3 y 4 (r = -0,178; P < 0,05 y r = 0,265; P < 0,05, respectivamente), asi como entre el factor 3 y la variable tiempo de infeccion en meses (r = 0,265; P < 0,05). Por ultimo, el analisis de regresion lineal multiple mostro que los factores psicologicos 2 y 4 -que en conjunto explican el 48,6% de la varianza- predijeron los comportamientos de adhesion en el presente (coeficiente de determinacion [R²] ajustado = 0,486). CONCLUSION: Segun los resultados obtenidos, el instrumento posee una confiabilidad optima y validez en sus tres variantes: conceptual, concurrente y predictiva.OBJECTIVE To test the psychometric properties of an instrument for measuring psychological variables and adherence to treatment behaviors in persons with HIV infection or AIDS. METHODS A cross-sectional study was performed with 68 subjects who were seropositive for the human immunodeficiency virus (HIV) and who were being treated in a health facility in the city of Hermosillo (Sonora), Mexico, at the time the study was carried out. Five consecutive statistical testing procedures were applied for data analysis: the Student t test for comparison of means, for assessing the comprehensibility of the questions; an exploratory factorial analysis with varimax rotation for determining construct validity; Cronbachs alpha coefficient for determining reliability; Pearsons correlation coefficient (r) for assessing concurrent validity; and multiple linear regression for determining predictive value. RESULTS In 25 out of a total of 30 questions, the Student t test for comparison of means gave statistical significance values of P < or = 0.05, P < or = 0.005, P < or = 0.01, and P < or = 0.001. A four-factor structure was found with the factorial analysis with varimax rotation: (1) current adherence behavior and treatment; (2) underlying reasons for adherence or lack of adherence; (3) psychological well-being and social competencies; (4) past adherence behavior with values above 1 that, taken as a whole, explain 65.50% of the variance. An overall alpha coefficient of 0.852 was obtained with the test for reliability. The test for concurrent validity showed correlations between factors 1 and 2 (r = 0.615; P < or = 0.01), between factor 2 and factors 3 and 4 (r = -0.178; P < 0.05 and r = 0.265; P < 0,05, respectively), and between factor 3 and duration of infection in months (r = 0.265; P < 0.05). Finally, multiple linear regression showed that psychological factors 2 and 4, which together explain 48.6% of the variance, predicted current adherence behavior (adjusted determination coefficient [R2] = 0.486). CONCLUSION According to the results obtained, the instrument has optimal reliability as well as construct validity, concurrent validity, and predictive validity.

Instrumento para la evaluación de variables psicológicas y comportamientos sexuales de riesgo en jóvenes de dos centros universitarios de México

OBJETIVO: Probar las propiedades psicometricas de un instrumento de encuesta destinado a evaluar algunas variables historicas y de contexto que facilitan el comportamiento sexual de riesgo en una muestra de estudiantes de dos centros universitarios de Mexico. METODOS: Estudio transversal con una muestra compuesta por 1 346 estudiantes universitarios de Mexico: 784 del Centro de Estudios Superiores del Estado de Sonora, Hermosillo, Sonora, (33,2% del total de la matricula de ese centro) y 562 de la Universidad Nacional Autonoma de Mexico, campus Tlalnepantla, Estado de Mexico (23,5% del total de estudiantes de ese centro). El trabajo se realizo en octubre de 2006 en Hermosillo y entre los meses de enero y marzo de 2006 en Tlalnepantla. La encuesta contenia 11 preguntas sobre datos sociodemograficos, 7 sobre comportamientos sexuales de riesgo, 22 sobre motivos subyacentes, 8 sobre las situaciones sociales y 6 sobre el estado biologico previo a la relacion. Se evaluo la capacidad de comprension de las preguntas, la validez conceptual y la confiabilidad del instrumento. RESULTADOS: La version definitiva del instrumento quedo constituida por 44 preguntas. En el analisis de confiabilidad se obtuvo un valor a de Cronbach global de 0,821, considerando todas las variables en su conjunto y agrupadas por factores. Se encontraron tres factores (motivos para no usar preservativos en la primera relacion sexual y a lo largo de la vida, motivos del uso inconsistente de preservativos con parejas ocasionales y disposicion hacia la primera relacion sexual y hacia la relacion con parejas ocasionales) que en su conjunto explicaron 38,36% de la varianza total. CONCLUSION: Las propiedades psicometricas del instrumento de encuesta evaluado fueron satisfactorias. Los interesados en aplicar este instrumento deben familiarizarse con el modelo teorico que lo sustenta, ya que la interpretacion de los resultados se basa en las definiciones de las diferentes variables historicas y de contexto contempladas y en su interaccion.

Asociación entre los niveles de estrés y depresión y la adhesión al tratamiento en personas seropositivas al VIH en Hermosillo, México

OBJECTIVES To evaluate the association between variables related to stress, reasons, and depression, and adherence to treatment in HIV-positive individuals, and to analyze the robustness according to a theoretical psychology model. METHODS This was a cross-sectional study of 25 female and 39 male HIV-positive participants receiving services at the Outpatient Center for Prevention and Treatment of HIV/AIDS and Sexually-transmitted Diseases (Centro Ambulatorio para la Prevención y Atención del VIH/Sida e Infecciones de Transmisión Sexual) in Hermosillo, Sonora, Mexico. The psychological variables, the degree of treatment adherence, stress-related circumstances, and the severity of depression were examined. Rates were calculated for the key variables associated with stress, reasons, and depression. The associations among variables were determined by multiple regression. RESULTS During the month preceding the study, 65.6% of the 64 participants reported having faithfully followed the prescribed treatment, while 34.4% had failed, in some way, to follow the treatment (chi(2) = 6.250; P = 0.012). Regression analysis found that there was only one combination, an intermediate level of stress linked to tolerance of uncertainty and low levels of depression, that was significantly associated (F [3.58] = 3.298; P = 0.027) with adherence to treatment; the combination of these two variables explained 38.2% of the total variance found. CONCLUSIONS The combination of stress levels with tolerance of uncertainty and depression could be used as a predictor for true compliance with prescribed treatment plans. These results should be taken into account when designing intervention and treatment-adherence campaigns in HIV-positive individuals.

Chronic myeloid leukemia with expression of ALL-type BCR/ABL transcript: a case-report and review of the literature.

CML with exclusive expression of ALL-type bcr/abl has only been rarely described. In some cases, the presence of this fusion gene has been associated to a differentiated subtype of CML that share some features with CMML, while in another case this molecular hallmark has been associated to a bad prognosis of the disease with a blast phase as clinical presentation or an early transformation to blast phase. We report a case of a 30-year-old woman who was diagnosed of CML in chronic phase in May 1989. She received treatment first with busulfan, achieving hematological remission and afterwards with interferon and Hydroxiurea. In February 1998, she was admitted at our hospital for an ABSCT. Then, molecular studies were performed. Multiplex PCR revealed the presence of a 481 bp product identified as the ela2 bcr/abl transcript and confirmed by sequencing. After 9 years from diagnosis, the patient remains in hematological remission and in good clinical condition.

Psychological, interpersonal, and clinical factors predicting time spent on physical activity among Mexican patients with hypertension

Background It is widely known that physical activity is the key to the optimal management and clinical control of hypertension. Purpose This research was conducted to identify factors that can predict the time spent on physical activity among Mexican adults with hypertension. Methods This cross-sectional study was conducted among 182 Mexican patients with hypertension, who completed a set of self-administered questionnaires related to personality, social support, and medical adherence and health care behaviors, body mass index, and time since the disease diagnosis. Several path analyses were performed in order to test the predictors of the study behavior. Results Lower tolerance to frustration, more tolerance to ambiguity, more effective social support, and less time since the disease diagnosis predicted more time spent on physical activity, accounting for 13.3% of the total variance. The final model shows a good fit to the sample data (pBS =0.235, χ2/gl =1.519, Joreskog and Sorboms Goodness of Fit Index =0.987, adjusted modality =0.962, Bollens Incremental Fit Index =0.981, Bentler-Bonett Normed Fit Index =0.946, standardized root mean square residual =0.053). Conclusion The performance of physical activity in patients with hypertension depends on a complex set of interactions between personal, interpersonal, and clinical variables. Understanding how these factors interact might enhance the design of interdisciplinary intervention programs so that quality of life of patients with hypertension improves and they might be able to manage and control their disease well.Background It is widely known that physical activity is the key to the optimal management and clinical control of hypertension. Purpose This research was conducted to identify factors that can predict the time spent on physical activity among Mexican adults with hypertension. Methods This cross-sectional study was conducted among 182 Mexican patients with hypertension, who completed a set of self-administered questionnaires related to personality, social support, and medical adherence and health care behaviors, body mass index, and time since the disease diagnosis. Several path analyses were performed in order to test the predictors of the study behavior. Results Lower tolerance to frustration, more tolerance to ambiguity, more effective social support, and less time since the disease diagnosis predicted more time spent on physical activity, accounting for 13.3% of the total variance. The final model shows a good fit to the sample data (pBS =0.235, χ2/gl =1.519, Jöreskog and Sörbom’s Goodness of Fit Index =0.987, adjusted modality =0.962, Bollen’s Incremental Fit Index =0.981, Bentler-Bonett Normed Fit Index =0.946, standardized root mean square residual =0.053). Conclusion The performance of physical activity in patients with hypertension depends on a complex set of interactions between personal, interpersonal, and clinical variables. Understanding how these factors interact might enhance the design of interdisciplinary intervention programs so that quality of life of patients with hypertension improves and they might be able to manage and control their disease well.