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Dear editorThe impact of COVID-19 on survivors is wide and varied. The experience of COVID-19 infection includes physical isolation, fear of impending death, and stigma-discrimination. The COVID-19...

El objetivo del presente trabajo fue explorar las denominaciones conocidas para trastornos mentales en un grupo de estudiantes de medicina de Santa Marta, Colombia. Se diseñó un estudio cualitativo con estudiantes que iniciaban un curso de psiquiatría listaron palabras o frases escuchadas en la comunidad para denominar a las personas que reúnen criterios para un trastorno mental. Se realizó un análisis basado en teoría fundamentada. Participaron 21 estudiantes, 15 mujeres y 6 hombres entre 18 y 25 años. Se contaron 228 palabras que se reagruparon en 98 connotaciones similares: 40 correspondían términos peyorativos populares: loco o chiflado. Basados en los resultados se concluye que es alto el número de denominaciones para los trastornos mentales conocidas por este grupo estudiantes de medicina. Estas palabras generalmente tienen una connotación peyorativa.

ObjectiveTo establish the Reported and Intended Behavior Scale (RIBS) psychometric performance, a mental disorder-related stigma measurement, among Colombian adolescents.MethodsA validation study was carried out with 350 students aged between 10 and 17, 53.7% of whom were girls. The RIBS has two sub-scales -reported behaviors and intended behaviors, with four items each. Frequencies were estimated for reported behaviors, whereas internal consistency (Cronbach’s alpha and McDonald’s omega) and confirmatory factor analysis (CFA) were measured for intended behaviors.ResultsThe reported behavior sub-scale ranged from 10.0 to 24.9%, whereas the intended behavior sub-scale presented a Cronbach’s alpha of 0.88 (CI95% 0.86-0.90) and a McDonald omega of 0.88. For the CFA, KMO was 0.81; Bartlett chi squared, 771.1 (df=6, p=0.01); and Eigen value, 2.95 that explained 73.9% of the total variance. For the goodness-of-fit tests, chi squared was 21.9 (df=2, p=.001); RMSEA, 0.17 (CI90% 0.11-0.24); CFI, 0.97; TLI, 0.92; and SMSR, 0.03.ConclusionsThe RIBS can measure reported behaviors, and the intended behavior sub-scale shows high internal consistency. However, the dimensionality of the intended behavior sub-scale presents modest goodness-of-fit indexes. These findings need further replications.

espanolLas personas que reunen criterios para trastornos por consumo de sustancias (TCS) con frecuencia son victimas del complejo estigma-discriminacion (CED), no solo por parte de la sociedad general, sino tambien por profesionales de la salud y la presencia de autoestigma. No obstante, la relacion de los TCS con factores biologicos predisponentes y condiciones sociales adversas se considera que estos son ‘autoinducidos’. Asimismo, se conoce que en los TCS se presentan cambios biologicos, psicologicos o del desarrollo que menoscaban la decision de abandono y la persistencia en el consumo, a pesar de las consecuencias negativas fisicas, emocionales y sociales. El CED relacionado con el TCS es un estresor que deteriora aun mas la calidad de vida de las personas consumidoras y, al mismo tiempo, se configura como una barrera de acceso a servicios de salud. Es necesario disenar e investigar la efectividad de estrategias para reducir el CED relacionado con TCS en diferentes poblaciones y contextos. EnglishPeople who meet criteria for substance use disorders (SUD) are often victims of the stigma-discrimination complex (SDC) not only by the general society, but also by health professionals and the presence of self-stigma. However, the relationship of the SUD with predisposing biological factors and adverse social conditions, SUD are considered 'self-induced'. Likewise, it is known that SUD presents biological, psychological or developmental changes that undermine the decision of abandonment and persistence in consumption, despite negative physical, emotional and social consequences. The SDC related to SUD is a stressor that deteriorates the quality of life of consumers and, at the same time, it is configured as a barrier to access to health services. It is necessary to design and investigate the effectiveness of strategies to reduce SDC related to SUD in different populations and settings.

This study aimed to know the psychometric properties of the five-item Francis scale of the attitude towards Christianity (Francis-5) by assessing psychiatric outpatients in Santa Marta, Colombia. A sample of 260 adult patients participated. The exploratory and confirmatory factor analyses revealed an excellent one-dimensional structure with high internal consistency. It was concluded that the Francis-5 exhibited good indicators of validity and reliability in Colombian psychiatric outpatients.

Context: Several investigations have shown that people in an adoption situation have a higher frequency of mental problems or disorders than the general population. However, no known meta-analysis consolidates information about the association between the adoption situation and suicide attempt. Objectives: We aimed to systematically evaluate the primary observational studies that quantified the association between the being adopted and suicide attempt. Methods: A systematic review was designed that used a logical strategy based on specific descriptors in Spanish, English, and Portuguese, in combination with the Boolean operators (AND, OR). The search was performed on the following databases: PubMed, Scopus, Health Virtual Library, ProQuest, EBSCOhost, PsycArticles, BioMed Central, and Sage Journal. Articles were included until December 2018. The quality of the studies was evaluated with a tool based on the STROBE criteria. Results: Six studies met the inclusion criteria. Three studies used case-control designs and the remaining three were cohort studies. Case-control studies computed 69 suicide attempts in 1,216 adopted people compared to 436 attempts amidst 20,555 non-adopted people (OR = 2.30, 95% CI 1.24 - 4.28, I2 = 61%). Cohort studies computed 536 suicide attempts among 36,965 people in adoption compared to 15,112 attempts in 3,118,069 non-adopted people (RR = 2.99, 95% CI 2.54 - 3.53, I2 = 73%). Conclusions: The adoption situation can increase suicide attempts; it predicts at least two times more cases of suicide attempts among adopted people than in the general population.

Background: Access barriers are all situations or conditions that limit seeking, receiving or enjoying benefits offered by the health system. This set of situations translates into underutilization of the services offered. In Colombia, there is little information about barriers to accessing medical care in general, and even less in the specific field of mental health. Aim: To determine the barriers to accessing psychiatric care in outpatients in Santa Marta, Colombia. Methods: The authors designed a cross-sectional study with a non-probability sample of adult patients who consulted between August and December 2018. The barriers to access were measured with a 20-item version of the Barriers to Access to Care Evaluation (BACE) scale. Results: A total of 247 patients participated; they were between 18 and 82 years (mean ( M) = 47.5, standard deviation ( SD) = 13.9). A total of 69 (27.9%) patients classified as having major attitudinal barriers; 62 (25.1%) patients, major barriers related to stigma-discrimination; and 41 (16.6%) patients, major instrumental barriers. Concerning the associated variables, age less than 45 years was related to major attitudinal barriers (odds ratio (OR) = 2.9, 95% confidence interval (CI) 1.6-5.5), major barriers related to stigma-discrimination (OR = 3.8, 95% CI 2.0-7.2) and major instrumental barriers (OR = 2.7, 95% CI 1.3-5.3). Men reported major instrumental barriers more frequently than women (OR = 2.8, 95% CI 1.3-5.8). Conclusion: The major attitudinal, related to stigma-discrimination and instrumental barriers to access frequently delay a consultation with mental health services. Actions are necessary to reduce barriers to accessing mental health care.

Dear Editor:Throughout history, the stigma-discrimination complex (SDC) has been associated with serious mental disorders such as those on the spectrum of schizophrenia, where symptoms, side effects and impaired social functioning are difficult to conceal. (1) For its part, SDC related to major depressive disorder (MDD) is a growing phenomenon even though its clinical characteristics are easy to hide or are less evident in the social sphere (2,3); in these cases, said association may have more negative effects on people’s lives than the disorder itself. (4,5) Consequently, the Depression Stigma Scale (DSS) was designed to quantify the relationship between SDC and MDD (SDC-MDD). This is a Likert scale consisting of two subscales with nine items each. The first addresses the issue of attitude towards people who meet criteria for MDD, i.e. perceived stigma, and the second, the anticipated attitude for MDD, i.e. personal stigma or self-stigma. (6)

Human behaviours have different meanings according to the historical moment and context. In this article sexual behaviours are taken as a category in order to analyse how psychiatric nosology is structured, as manifested in texts such as the DSM-5. The development of these diagnostic manuals are tools that are far from being free of subjectivities and interference of elements of power, expressed in the way health, illness, mental health, and mental disorders, are assumed; in short, the normal and pathological. Each new diagnosis, or even its elimination, and the recomposing of the different diagnostic criteria, especially in the field of sexual behaviour, present visions of how individual and collective human life is conceived, as well as an expression of accurate attempts to control human sexualities through the medicalisation of behaviour, coupled with moral, religious, and even legal considerations. Categories such as gender dysphoria, paraphilia or paraphilic disorders are examples of how the limits intended to establish a biomedical perspective are also incomplete and imprecise. These violate individual and social construction of sexualities and the conception of mental health, showing persistent difficulties and controversies that are evident in the way psychiatric classifications are made.

Background: The process of evaluating measurement scales is an ongoing procedure that requires revisions and adaptations according to the characteristics of the participants. The Homophobia Scale of seven items (EHF-7) has showed acceptable performance in medical students attending to two universities in Colombia. However, performance of some items was poor and could be removed, with an improvement in the psychometric findings of items retained. Objective: To review the psychometric functioning and refine the content of EHF-7 among medical students from two Colombian universities. Methods: A group of 667 students from the first to tenth semester participated in the research. Theirs ages were between 18 and 34 (mean, 20.9 ±2.7) years-old, and 60.6% were females. Cronbach alpha (α) and omega of McDonald (Ω) were calculated as indicators of reliability and to refine the scale, an exploratory (EFA) and confirmatory factor analysis (CFA) was performed. Results: EHF-7 showed α = .793 and Ω = .796 and a main factor that explained 45.2% of the total variance. EFA and CFA suggested the suppression of three items. The four-item version (EHF-4) reached an α = .770 and Ω = .775, with a single factor that accounted for 59.7% of the total variance. CFA showed better indexes (x2 = 3.622; df = 1; p = 0.057; Root-mean-square error of approximation (RMSEA) = .063, 90% CI, .000-.130; Comparative Fit Indices (CFI) = .998; Tucker-Lewis Index (TLI) = .991). Conclusions: EHF-4 shows high internal consistency and a single dimension that explains more than 50% of the total variance. Further studies are needed to confirm these observa tions, that can be taken as preliminary. RESUMEN Introducción: La evaluación de escalas de medición es un proceso continuo que exige revisiones y adaptaciones según las características de los participantes. La Escala para Homofobia de siete ítems (EHF-7) ha mostrado aceptable desempeño general en estudiantes de Medicina de dos universidades en Colombia. No obstante, el desempeño de algunos ítems fue deficiente y se podría eliminar algunos con el mejoramiento en el comportamiento de los ítems conservados. Objetivo: Revisar el funcionamiento psicométrico y afinar el contenido de EHF-7 en estudiantes de Medicina de dos universidades colombianas. Métodos: Participaron 667 estudiantes de 18-34 (media, 20,9 ± 2,7) anos, de los que el 60,6% eran mujeres. Se calcularon el alfa de Cronbach (α) y el omega de McDonald (Ω) como indi cadores de confiabilidad, y para afinar la escala, se llevaron a cabo análisis de factores exploratorios (AFE) y confirmatorios (AFC). Resultados: EHF-7 mostró α = 0,793 y Ω = ,796, además de un factor principal que explicó el 45,2% de la varianza total. Los AFE y AFC indican eliminar tres ítems. La versión de cuatro ítems (EHF-4) alcanzó α = 0,770 y Ω = 0,775, con un único factor que dio cuenta del 59,7% de la varianza total, con AFC que mostró mejores indicadores (x2 = 3,622; gl = 1; p = 0,057; RMSEA = 0,063; IC90%, 0,000-0,130; CFI = 0,998; TLI = 0,991). Conclusiones: EHF-4 presenta alta consistencia interna y una dimensión que explica más del 50% de la varianza total. Es preciso realizar investigaciones que confirmen estas observa ciones aún preliminares.

In 2016 and 2017, the suicide rate in Colombia went up from 5.20 to 5.72, respectively. The same trend was observed for the State of Magdalena for the same period with an increase in the rates that went from 3.37 in 2016 and 4.27 per one hundred thousand inhabitants in 20171,2. The suicide rate in the State of Magdalena occupies third place among the departments of the Colombian Caribbean region1

RESUMEN El Centro de Estudios Epidemiológicos (CES) de los Estados Unidos introdujo con la escala para depresión (CES-D) y otra escala para cuantificar en forma rápida ideación suicida (CES-IS) durante las dos semanas más recientes; sin embargo, se conoce poco del rendimiento psicométrico de este instrumento. El objetivo fue verificar el desempeño psicométrico de la CES-IS en adolescentes escolarizados de un municipio de Boyacá, Colombia. Se realizó un estudio de validación con la participación de 363 estudiantes de un municipio de características rurales en edades entre 10 y 17 años (media=13; DE=1,8); 55,4% de los estudiantes de sexo femenino y 44,5% de sexo masculino. Los adolescentes diligenciaron los cuatro ítems de la CES-IS, una versión de diez ítems de la (CES-D-10) y la escala de Rosenberg para autoestima (ERA). Se estimó la consistencia interna (alfa de Cronbach y omega de McDonald), la estructura dimensional (análisis factorial confirmatorio, AFC) y la convergencia con la CES-D-10 (correlación de Spearman, rs). Las puntuaciones en la CES-IS se observaron entre 4 y 20 (M=6,1; DE=3,5; Me=4, RIC=4-7) y en la CES-D entre 11 y 44 (M=23,3; DE=6,8; Me=22; RIC=18-27). La CESIS mostró alfa de Cronbach de 0,86 y omega de McDonald de 0,87, una dimensión que explicó el 71,2% de la varianza, los indicadores de ajuste RMSEA=0,00; IC90% 0,00-0,09; CFI=1,00; TLI=1,00; y SRMR=0,01, correlación convergente de rs=0,59 (p=0,001) con la CES-D-10 y correlación divergente de rs=-0,38(p=0,001) con la ERA. Se concluye que la CES-IS en adolescentes de un municipio de Boyacá presenta alta consistencia interna, una estructura unidimensional y alta convergencia con la CES-D-10 y divergencia con la ERA. Se necesita investigar el rendimiento de este instrumento en adolescentes colombianos con otras características distintivas. ABSTRACT The Center for Epidemiological Studies (CES) of the United States introduced, along with the Depression Scale (CES-D) and another scale to rapidly quantify suicidal ideation (CED-IS) during the two most recent weeks. However, little is known about the psychometric performance of this instrument. The objective of this study was to verify the psychometric performance of the CES-IS in school enrolled adolescents from a small town in Boyacá, Colombia. A validation study was carried out with the participation of 363 students between 10 and 17 years of age (mean=13, SD=1.8); 55.4% female students and 44.5% male students. The adolescents completed the four items of the CES-IS, a ten-item version of the CES-D-10 and the Rosenberg Self-esteem Scale (RSS). Internal consistency (Cronbach alpha and McDonald omega), dimensional structure (confirmatory factorial analysis, AFC) and convergence with CES-D-10 (Spearman correlation, rs) were estimated. The CES-IS scores were observed between 4 and 20 (M=6.1, SD=3.5, Me=4, IQR=4-7) and the CES-D between 11 and 44 (M=23.3, SD=6.8, Me=22, IQR=18-27). The CES-IS showed Cronbach alpha of 0.86 and McDonald’s omega of 0.87, a dimension that explained 71.2% of the variance, the adjustment indicators RMSEA=0.00, 90%CI 0.00-0.09; CFI=1.00, TLI=1.00 and SRMR = 0.01, convergent correlation of rs=0.59 (p=0.001) with the CES-D-10 and divergent correlation of rs=-0.38 (p=0.001) with the RSS. It is concluded that the CES-IS among adolescents of a small town in Boyacá, Colombia, has high internal consistency, a onedimensional structure and high convergence with CES-D-10 and divergence with the RSS. It is necessary to investigate the performance of this instrument in Colombian adolescents with other distinctive characteristics.

Background Cultural psychiatry evaluates manifestations, symptoms of emotional distress and mental disorders in diverse cultural contexts; it also addresses social problems such as poverty, violence, inequalities between groups or social classes. Objective To present a narrative review of the most relevant cultural aspects in the context of clinical practice in psychiatry and to suggest some alternatives to improve the cultural competence of health care professionals. Method A narrative review was carried out of the most relevant articles in the area. Results Usually, the cultural argument is used to explain differences in observed prevalences in some mental disorders according to gender and geographical location. Cultural differences modify the expression of emotional distress and this can reduce the accuracy and affect the reliability and validity of the current diagnostic classification used in psychiatry. The American Psychiatric Association, in the most recent classification, revised cultural syndromes but only included a limited number of situations. Consequently, medical education and psychiatry must respond to diverse populations and provide quality care through the development of trans-cultural competence in the curriculum. Conclusions It should be considered that cultural differences modify the expression of distress and thereby undermine the validity and reliability for diagnoses in distinct cultural contexts. In an increasingly globalised world, future classifications may completely omit ‘cultural syndromes’.

Resumen Introduccion Se propone el concepto “complejo estigma-discriminacion asociado a trastorno mental” (CEDATM) para englobar los terminos usados en la teoria de la atribucion: estigma, estereotipo, prejuicio y discriminacion. El CEDATM (el internalizado y el percibido) es un fenomeno frecuente que puede explicar un porcentaje de los casos de suicidio. Objetivo Revisar los factores que pueden explicar la asociacion existente entre CEDATM y suicidio y postular posibles mecanismos implicados subyacentes. Resultados Se identificaron articulos en MEDLINE con los descriptores en ingles para “estigma”, “trastornos mentales” y “suicidio” o “tasa de suicidio”. Se incluyeron articulos publicados entre enero de 2000 y junio de 2014. No se consideraron revisiones del tema y estudios de casos. Los dos estudios incluidos mostraron que el estigma incrementa el riesgo de comportamientos suicidas. Se evidencio que las personas con estigma internalizado realizaron mas intentos de suicidio y que la tasa de suicidio en poblacion general es mas alta en los paises con mayor estigma percibido. Se considero que la relacion entre CEDATM y suicidio se establece por mecanismos interrelacionados: un mecanismo “directo” que incluye el CEDATM percibido y se configura como barreras de acceso a servicios y acciones en salud mental, y un mecanismo “indirecto” que involucra el CEDATM internalizado y que incrementa la vulnerabilidad a episodios depresivos y comportamientos autolesivos repetidos que pueden terminar en suicidio. Conclusiones El CEDATM impacta negativamente en la calidad de vida de las personas que reunen criterios de trastornos mentales y da cuenta de un numero importante de suicidios. Una primera via se relaciona con el estigma percibido, que se configura como barrera de acceso a servicios y acciones en salud mental, y una segunda ruta que incluye comportamientos autolesivos repetidos que reducen la autoestima e incrementan el estres percibido. Se necesitan investigaciones que profundicen en el conocimiento de esta asociacion.

The Spanish version of the five-item Francis scale of attitude toward Christianity is a refinement of the short version of the Francis scale of attitude toward Christianity. The scale is a good measurement for intrinsic religiosity. It has been applied previously among Colombian adolescent students. The internal consistency and construct and nomological validity were tested among a sample of 1349 Colombian college students from Santa Marta, Colombia. Participants were aged between 18- and 30-years-old; 51% were men; and 68% were social science students. Exploratory analysis factor, Cronbach alpha and omega McDonald were computed. The scale showed high internal consistency (both alpha and omega = .96) and excellent construct and nomological validity (one factor which explained for 88% of variance; women scored higher than men; and Protestants scored higher than Catholics and students with other religion filiations). The five-item Francis scale can be used further researches in Hispano-America among college...

The empirical study of negative attitudes toward gay and lesbian people (homonegativity) is a way to understand the reason for its prevalence. The aim of this study was to examine the psychometric properties of a Spanish version of the Attitudes Toward Lesbians and gay men scale (ATLG). A total of 359 undergraduate students were recruited from two different cities in Colombia, South America. Participants' attitudes toward gays and lesbian people were assessed using the ATLG Scale and the Homophobia Scale; anxiety was measured using a short version of the Zung Self-Rating Anxiety Scale. Internal consistency analyses have shown that the ATLG Scale is a reliable measure of homonegativity in a Colombian sample. In addition, principal components analyses, as well as convergent and divergent validity analyses have confirmed that the ATLG Scale is a valid and reliable measure of homonegativity in the Colombian context and support its use as a research instrument.

Resumen: Se desconoce la frecuencia de complejo estigma-discriminación percibido en víctimas del conflicto armado colombiano. El objetivo del estudio fue establecer la frecuencia y variables asociadas al estigma-discriminación percibido en víctimas del conflicto armado, en municipios del Departamento del Magdalena, Colombia. Se realizó un estudio transversal con víctimas registradas en el Programa de Atención Psicosocial y Salud Integral a Víctimas. Los síntomas depresivos se cuantificaron con cuatro ítems dicotómicos (tres o más se clasificaron como alto nivel de síntomas depresivos) y el estigma-discriminación percibido se cuantificó con seis incisos dicotómicos (dos o más afirmaciones se categorizó como alto estigma-discriminación percibido). Participaron 943 adultos (M = 47,9; DE = 14,2); 67,4%, mujeres; 109 (11,6%) informaron alto nivel de síntomas depresivos y 217 (23%) presentaron alto estigma-discriminación percibido. El alto estigma-discriminación percibido se asoció a alto nivel de síntomas depresivos (OR = 6,47; IC95%: 4,23-9,88). Se concluye que un cuarto de las víctimas del conflicto armado en Magdalena informa alto estigma-discriminación percibido; éste se asocia significativamente a alto nivel de síntomas depresivos. Abstract: There is no information on frequency of perceived devaluation-discrimination in victims of the armed conflict in Colombia. The aim of this study was thus to determine the frequency of perceived devaluation-discrimination and associated variables among victims of the armed conflict in municipalities in the Department of Magdalena, Colombia. A cross-sectional study was conducted among victims enrolled in the Program for Psychosocial Care and Comprehensive Healthcare for Victims. Depressive symptoms were quantified with four dichotomous items (three or more were classified as high level of depressive symptoms), and perceived devaluation-discrimination was quantified with six dichotomous items (two or more were classified as high perceived devaluation-discrimination). A total of 943 adults participated (M = 47.9; SD = 14.2); 67.4%, women; 109 (11.6%) reported high level of depressive symptoms and 217 (23%) showed high perceived devaluation-discrimination. High perceived devaluation-discrimination was associated with high level of depressive symptoms (OR = 6.47; 95%CI: 4.23-9.88). In conclusion, one-fourth of the victims of the armed conflict in Magdalena reported high perceived devaluation-discrimination, which was significantly associated with high level of depressive symptoms. Resumo: É desconhecida a frequência do complexo estigma-discriminação percebido em vítimas do conflito armado colombiano. O objetivo do estudo foi estabelecer a frequência e variáveis associadas ao estigma-discriminação percebido em vítimas do conflito armado, em municípios do Departamento de Magdalena, Colômbia. Foi realizado um estudo transversal com vítimas registradas no Programa de Atenção Psicossocial e Saúde Integral às Vítimas. Os sintomas depressivos foram quantificados com quatro itens dicotômicos (três ou mais foram classificados como alto nível de sintomas depressivos), e o estigma-discriminação percebido foi quantificado com seis subsecções dicotômicas (com duas ou mais afirmações foi categorizado como alto estigma-discriminação percebido). Participaram 943 adultos (M = 47,9; DP = 14,2); 67,4%, mulheres; 109 (11,6%) informaram alto nível de sintomas depressivos e 217 (23%) presentaram um alto estigma-discriminação percebido. O alto estigma-discriminação percebido foi associado à alto nível de sintomas depressivos (OR = 6,47; IC95%: 4,23-9,88). Concluiu-se que um quarto das vítimas do conflito armado em Magdalena informa alto estigma-discriminação percebido, que foi associado significativamente à alto nível de sintomas depressivos.

Escopo. Conhecer a estrutura interna e confiabilidade da escada breve de Francis para a religiosidade (Francis-5) em estudantes de medicina de uma universidade de Bucaramanga, Colombia. Metodologia. Foi feita uma analise fatorial exploratoria na que participaram 365 estudantes, entre os 18 e 30 anos de idade (M = 20.12 anos; DE = 1.93). A validez nomologica foi provada ao comparar as pontuacoes segundo o sexo e a filiacâo religiosa dos participantes. A consistencia interna foi avahada com alfa de Cronbach. Resultados. Foi observada uma dimensâo responsavel do 88.4% de variacâo, com pontuacâo maiores em mulheres do que em homens (M = 16.70, DE = 5.03 frente a M = 15.35, DE = 5.51, t = 2.41, p = 0.016) e em cristâos nâo catolicos (M = 18.26, DE = 4.26) que em outras filiacoes (M = 16.68, DE = 4.28), em catolicos em relacâo com (M = 12.86, DE = 7.53) outras filiacoes e (M = 8.00, DE = 7.38) sem filiacâo religiosa (F = 32.84, p < 0.001); com um alpha de 0.97. Conclusao. Francis-5 e um instrumento valido e confiavel para quantificar religiosidade em estudantes de medicina. Futuras pesquisas devem determinar outras medidas de validez e confiabilidade.

Introducción: Las personas con orientación sexual no heterosexual afrontan frecuentemente el complejo estigma-discriminación. Por su parte, las personas que reúnen criterios para trastorno de ansiedad social (TAS) presentan síntomas molestos en situaciones sociales en las que son evaluados o pueden ser víctimas de burlas o rechazo. Sin embargo, no se cuenta con una revisión sistemática que presente la magnitud de esa asociación. Objetivo: Revisar la asociación entre orientación sexual y trastorno de ansiedad social en estudios observacionales durante los últimos veinte años. Método: Se realizó una revisión sistemática en la Biblioteca Virtual en Salud, Medline, PsycArticles y Scopus. Se usaron como palabras claves ‘homosexualidad’, orientación sexual, comportamiento sexual, trastorno de ansiedad social, fobia social, trastornos mentales y salud mental. La búsqueda se limitó a estudios publicados con la participación de adultos entre enero de 1997 y diciembre de 2016. Se realizó un análisis cualitativo de los estudios y se calcularon razones de disparidad (OR) si fueron informadas. Resultados: Se incluyeron cinco investigaciones que mostraron una asociación estadísticamente significativa entre orientaciones no heterosexuales, en particular bisexualidad, y el TAS, OR entre 1,9 y 3,5; IC 95% 1,0-11,4. Conclusiones: Las orientaciones sexuales no heterosexuales se asocian a TAS. Es importante considerar la orientación en personas que reúnan criterios para TAS y el papel que juega el complejo estigma-discriminación por orientación. Se necesitan estudios en América Latina que aborden esta relación desde una perspectiva social y cultural.

Background: The perceived stigma represents a sociocultural barrier to access mental health services and prevents individuals who meet criteria for a mental disorder the possibility of receiving comprehensive and integred care.

Objetivo: Determinar la validez y confiabilidad de la escala para homofobia (EHF) enestudiantes de medicina de una universidad de Bogotá, Colombia, 2010. Método: Serealizó un estudio de validación con la participación de 124 estudiantes de sexto a décimosemestre, en edades entre 19 y 34 años de edad, media de 23,7 años (DE=2,7);y 66,1%, mujeres y 33,9% hombres. Resultados: Se estimó alfa de Cronbach y omegade McDonald como medidas de confiabilidad y análisis factorial exploratorio paraconocer la estructura interna de la escala. El alfa de Cronbach fue 0,81 y la omega deMcDonald, 0,82. La estructura interna dio cuenta de un único factor responsable del49,2% de la varianza. Conclusión: La EHF muestra buena consistencia interna y unfactor en estudiantes de medicina de sexto a décimo semestre de una universidad deBogotá, Colombia. La escala mide con aceptable validez y confiabilidad el prejuiciohacia personas homosexuales en estudiantes de medicina. Este desempeño permiteel uso en nuevas investigaciones.Objective: To determine the validity and reliability of the Homophobia Scale (HS) inmedical students of a university in Bogotá, Colombia, 2010. Method: A validation studywas conducted with the participation of 124 students from sixth to tenth semester,aged between 19 and 34 years old, average 23.7 years (SD=2.7); and 66.1% womenand 33.9% men. Results: It was estimated Cronbach alpha and McDonald omegaas measures of reliability; and exploratory factor analysis to determine the internalstructure of the scale. Cronbach alpha was 0.81; and McDonald omega, 0.82. Theinternal structure showed a single factor responsible for 49.2% of the total variance.Conclusion: HS shows good internal consistency and a single factor in medical studentsfrom sixth to tenth semester at a university in Bogotá, Colombia. HS measureswith acceptable validity and reliability the prejudice toward homosexuals in medicalstudents. This performance allows use in further research.

El objetivo de este estudio fue determinar la correlación entre homofobia y racismo en estudiantes de medicina de Bucaramanga (Colombia). Se realizó un estudio transversal que incluyó a estudiantes mayores de 18 años. La actitud hacia homosexuales (homofobia o prejuicio sexual) se midió con la Escala de Homofobia (EHF) y la actitud hacia afrocolombianos (el racismo o la discriminación racial), con una versión en español de la Escala de Racismo Moderno (MRS). La asociación entre homofobia y racismo se calculó con los coeficientes de Pearson (r) y Spearman (rs). Un grupo de 334 estudiantes aceptó participar. La media para la edad fue 20,1 años (DE=1,9), 59,0 % eran mujeres. El alfa de Cronbach fue 0,78 para la EHF y 0,62 para la MRS. Las puntuaciones en la EHF fueron entre 7 y 34 (media=17,8; SD=5,4) y en la MRS, entre 0 y 34 (media=13,8; SD=5,2). El coeficiente r fue 0,35 (p

El objetivo de este estudio fue determinar la correlación entre homofobia y racismo en estudiantes de medicina de Bucaramanga (Colombia). Se realizó un estudio transversal que incluyó a estudiantes mayores de 18 años. La actitud hacia homosexuales (homofobia o prejuicio sexual) se midió con la Escala de Homofobia (EHF) y la actitud hacia afrocolombianos (el racismo o la discriminación racial), con una versión en español de la Escala de Racismo Moderno (MRS). La asociación entre homofobia y racismo se calculó con los coeficientes de Pearson (r) y Spearman (rs). Un grupo de 334 estudiantes aceptó participar. La media para la edad fue 20,1 años (DE=1,9), 59,0 % eran mujeres. El alfa de Cronbach fue 0,78 para la EHF y 0,62 para la MRS. Las puntuaciones en la EHF fueron entre 7 y 34 (media=17,8; SD=5,4) y en la MRS, entre 0 y 34 (media=13,8; SD=5,2). El coeficiente r fue 0,35 (p

El objetivo fue conocer la confiablidad y la dimensionalidad del AUDIT (Cuestionario de Identificación de los Trastornos debidos al Consumo de Alcohol) (Saunders, Aasland, Babor, de la Fuente & Grant, 1993) en estudiantes de medicina de Bogotá, Colombia. Se diseñó un estudio cuantitativo con una muestra no probabilística de 256 estudiantes mayores de 18 años (media=21,8; DE=2,8) y 60,5% mujeres. Se calculó el coeficiente alfa, el coeficiente omega y la dimensionalidad (análisis factorial confirmatorio). Se observó que el alfa fue 0,792 y la omega, 0,878. Se observaron dos dimensiones que explicaron el 49,4% de la varianza. Se concluye que el cuestionario AUDIT muestra alta confiabilidad, con dos dimensiones y es válido para la identificación de trastornos relacionados con el consumo de alcohol. Se necesitan investigaciones que exploren el desempeño frente a un criterio de referencia.

Objetivo Conocer la consistencia interna de la Escala para Racismo Moderno (EMR) en estudiantes de medicina de Bucaramanga, Colombia.Métodos Un total de 352 de estudiantes, media para la edad de 20,0 años (DE=1,9), informó la actitud hacia los afrocolombianos; el 59,4 % de los participantes eran mujeres. Los estudiantes completaron la versión de 10 incisos de EMR. Se calcularon alfa de Cronbach y omega de McDonald como coeficiente de consistencia interna. Análisis de factores exploratorios se realizaron para proponer una versión breve.Resultados La versión de 10 puntos mostró alfa de Cronbach 0,48 y omega de McDonald de 0,15. Una versión breve (incisos 1, 4, 5, 7 y 8) presentó alfa de Cronbach de 0,64 y omega de McDonald de 0,65. Esta versión presentó un factor principal responsable del 41,6 % de la varianza total.Conclusiones Una versión corta en español del MRS muestra un mejor desempeño psicométrico que la versión original. Se necesitan más investigaciones para corroborar estos hallazgos o hacer los ajustes según las regiones culturales colombianas.

Background The process of evaluating measurement scales is an ongoing procedure that requires revisions and adaptations according to the characteristics of the participants. The Homophobia Scale of seven items (EHF-7) has showed acceptable performance in medical students attending to two universities in Colombia. However, performance of some items was poor and could be removed, with an improvement in the psychometric findings of items retained. Objective To review the psychometric functioning and refine the content of EHF-7 among medical students from two Colombian universities. Methods A group of 667 students from the first to tenth semester participated in the research. Theirs ages were between 18 and 34 (mean, 20.9 ± 2.7) years-old, and 60.6% were females. Cronbach alpha ( α ) and omega of McDonald ( Ω ) were calculated as indicators of reliability and to refine the scale, an exploratory (EFA) and confirmatory factor analysis (CFA) was performed. Results EHF-7 showed α = .793 and Ω = .796 and a main factor that explained 45.2% of the total variance. EFA and CFA suggested the suppression of three items. The four-item version (EHF-4) reached an α = .770 and Ω = .775, with a single factor that accounted for 59.7% of the total variance. CFA showed better indexes ( χ 2 = 3.622; df = 1; p = 0.057; Root-mean-square error of approximation (RMSEA) = .063, 90% CI , .000–.130; Comparative Fit Indices (CFI) = .998; Tucker-Lewis Index (TLI) = .991). Conclusions EHF-4 shows high internal consistency and a single dimension that explains more than 50% of the total variance. Further studies are needed to confirm these observations, that can be taken as preliminary.

The validation of a measurement tool in mental health is a complex process that usually starts by estimating reliability, to later approach its validity. Factor analysis is a way to know the number of dimensions, domains or factors of a measuring tool, generally related to the construct validity of the scale. The analysis could be exploratory or confirmatory, and helps in the selection of the items with better performance. For an acceptable factor analysis, it is necessary to follow some steps and recommendations, conduct some statistical tests, and rely on a proper sample of participants.

Introduction: Mental capacity is understood as a multidimensional construct that alludes to the capacity of individuals of making autonomous decisions. Mental competency is the ability to perform a task and the ability of a person to act or behave appropriately in certain circumstances, with a clear reference to legal aspects. However, there is a tendency to assimilate both concepts. Objective: To show how mental capacity can be evaluated in a structured way avoiding inadequate assessments, violations of patients’ human rights, and the generation of a bioethical dilemma when the principle of beneficence is given more relevance than the principle of autonomy. Method: Various instruments that allow a valid and trustworthy evaluation of mental capacity are reviewed. It is convenient that physicians train in their application and interpretation of results. Conclusion: More studies on the subject are required in Latin America.

The aim of this study was to establish test-retest reliability of a Spanish version of the Francis Scale of Attitude toward Christianity (Campo-Arias, Oviedo, & Cogollo, 2009) among adolescent students in Cartagena, Colombia. A group of ninth grade students from two public schools in Colombia ( N =157) completed the five-item scale. Cronbach's alphas were .74 and .76 in the first and second administrations, respectively. Both Pearson's ρ and intra-class correlation coefficient were .69. A Spanish translation of the 5-item scale had consistent stability over four weeks.

La homofobia es una actitud negativa hacia personas homosexuales, frecuente en profesionales de la salud y con implicaciones en la salud pública. Este fenómeno había sido poco estudiado en estudiantes de enfermería. El objetivo fue conocer la prevalencia y las variables asociadas a la homofobia en estudiantes de enfermería. La revisión sistemática fue realizada de los artículos de investigación formal en EBSCO, Imbiomed, LILACS, MEDLINE, Ovid y ProQuest. Fueron incluidos los artículos publicados entre 1998 y 2008, escritos en español, inglés o portugués. Fueron utilizadas las palabras llave homophobia, homosexuality y nursing students. Se realizó un análisis descriptivo. Se revisaron ocho investigaciones. Entre el 7 y el 16% de los estudiantes presenta algún grado de homofobia. La homofobia es más común en varones y en los religiosos más conservadores. La homofobia es frecuente en estudiantes de enfermería y puede tener implicancias negativas para el ejercicio de la enfermería. A homofobia é uma atitude negativa em relação a pessoas homossexuais, frequente em profissionais da saúde, e com implicações na saúde pública. Este fenômeno havia sido pouco estudado em estudantes de enfermagem. O objetivo foi conhecer a prevalência e variáveis associadas à homofobia em estudantes de enfermagem. A revisão sistemática foi realizada nos artigos de pesquisa formal em EBSCO, Imbiomed, LILACS, MEDLINE, Ovid e ProQuest. Foram incluídos os artigos publicados entre 1998 e 2008, escritos em espanhol, inglês ou português. Foram utilizadas as palavras-chave homophobia, homosexuality e nursing students. Uma análise descritiva foi realizada. Oito pesquisas foram revisadas. Entre 7% e 16% dos estudantes apresenta algum grau de homofobia. A homofobia é mais comum em homens e nos religiosos mais conservadores. A homofobia é frequente em estudantes de enfermagem, e pode ter implicações negativas para o exercício da enfermagem. Homophobia is defined as a general negative attitude towards homosexual persons, with implications on public health. This fact has been less investigated among nursing students. The objective of this review was to learn about the prevalence of homophobia and its associated variables among nursing students. A systematic review was performed on original articles published in EBSCO, Imbiomed, LILACS, MEDLINE, Ovid, and ProQuest, including articles published between 1998 and 2008 in English, Portuguese and Spanish. Key words used were homophobia, homosexuality, and nursing students. Descriptive analysis was performed. Eight studies were analyzed. The incidence of homophobia in nursing students is between 7% and 16%. Homophobia is more common among males and religious conservatism people. Homophobia is quite frequent in nursing students. This negative attitude toward homosexuality may affect services and care giving by nursing professions and could have negative implications in nursing practice.

Introduction: Intra- and inter-rater concordance studies are important in order to measure the reliability or the reproducibility of evaluations (interviews or scales applied by a rater) in psychiatry. Objective: To present some principles regarding the validation process of diagnostic interviews or scales applied by a rater, and regarding the handling and comprehension of more useful statistical tests. Method: Review of literature. Results: Concordance is understood as the grade of agreement or disagreement among evaluations made to the same subject successively by an evaluator or among two or more interviewers. This process is part of the

RESUMENObjetivo: determinar las variables asociadas a haber tenido relaciones sexuales en mujeres y hombres, estudiantes de secundaria en Santa Marta, Colombia.Materiales y métodos: se diseñó un estudio transversal para conocer las variables relacionadas con haber tenido relaciones sexuales. Mediante regresión logística se ajustaron las variables asociadas en forma separada para mujeres y para hombres.Resultados: un grupo de 2.039 mujeres y otro de 1.536 hombres participaron en el estudio. La prevalencia general de relaciones sexuales fue 22,5%; en hombres 41,0%; y en mujeres 8,6%. En mujeres, haber tenido relaciones sexuales se relacionó con no haber recibido información sobre VIH-SIDA (OR=9,4; IC95% 1,3-71,4), consumo de alcohol (OR=8,3; IC95% 4,4-15,6), edad mayor de 15 años (OR=4,2; IC95% 3,0-6,0), consumo de cigarrillo durante el último mes (OR=3,0; IC95% 2,0-4,6) y consumo de marihuana (OR=2,8; IC95% 1,1-7,1). En hombres, se asoció a consumo de marihuana (OR=10,9; IC95% 2,5-47,4), consumo de alcohol (OR=5,2; IC95% 3,7-7,2), consumo de cigarrillo el último mes (OR=3,4; IC95% 2,3-5,1), edad mayor de 15 años (OR=3,0; IC95% 2,2-4,0) y orientación heterosexual (OR=1,7; IC95% 1,2-2,5).Conclusiones: la prevalencia de relaciones sexuales es mayor en hombres que en mujeres. Exclusivamente en mujeres se relaciona con no haber recibido información sobre VIH-SIDA; y en hombres con orientación heterosexual. Es necesario considerar los aspectos culturales propios de América del Sur en la investigación del comportamiento sexual adolescente.

The Menopause Rating Scale (MRS) measures quality of life in menopausal women. It compounds of three dimensions that assess somatic, psychological and urogenital menopausal-related symptoms. However, the validity of the scales may vary according to population characteristics, and there are no validations to date of MRS in American indigenous population. To assess the validity of MRS in Indigenous Colombian women during menopause. A research was done a sample of 914 indigenous women, 507 postmenopausal women and 407 premenopausal. They were between 40-49 years-old, with a mean age of 59.3 ± 5.9years. MRS was applied to all enrolled women. Cronbach's alpha was applied for the original proposed dimensions, and the dimensions from the results of factor analysis and maximum likelihood methods. A Promax rotation was applied to analysis. MRS showed a Cronbach's alpha: 0.86. The somatic dimension: 0.63, the psychological dimension: 0.75, and urogenital: 0.84. Score was greater in postmenopausal compared to premenopausal, 14.4 (±SD, 6.4) versus 8.4 (±SD, 5.9) (P

There is little evidence about linguistic expressions used that show internalized homophobia by homosexual individuals. The objective of this research was to explore suggestive internalized homophobic language used by web page users for homosocialization purposes among homosexual men living in Bogota and Cartagena, Colombia. A qualitative study was designed with the purpose of analyzing content of 40 profiles, 20 from Bogota, and in the same proportion in Cartagena. This was based on account profiles from a website which contained contact inquiries between people who were not heterosexual and described homophobic characteristics when referring to their ideal partner. It was observed that in 19 out of 20 profiles in Bogota and the same proportion in Cartagena people used suggestive and direct qualifiers that showed internalized explicit homophobia and implicit language, for instance, “I am looking for serious people”. The internalized homophobia is expressed by looking for that “macho” man who is professional and lives a heterosexual lifestyle. Authors conclude that homosexual men who requested contact with other men by Internet often expressed internalized homophobia in explicit and implicit ways, which suggests accepting hegemonic model of masculine men. Quantitative studies are needed in Colombian non-heterosexual populations.

Title: Performance of the genetically based racism instrument in medical studentsResumenEl concepto de discriminación racial se depura con el tiempo. En la actualidad se distinguen diferentes formas, entre otras, genético, moderno, simbólico o sutil. En consecuencia, se proponen instrumentos para la cuantificación de estos constructos. El objetivo del estudio fue conocer el desempeño de la Escala de Racismo Basado en la Genética (ERBG) en estudiantes de medicina de una universidad de Bucaramanga, Colombia. Se diseñó un estudio de validación en el que participaron 341 estudiantes en edades entre 18 y 30 años, 59,2 % mujeres, completaron una versión de nueve incisos de la ERBG. La consistencia interna se estimó con los coeficientes de alfa de Cronbach y omega de McDonald y la estructura interna mediante análisis factorial exploratorio. Se observó que ERBG presentó alfa de Cronbach de 0,81 y omega de McDonald de 0,82. La estructura interna de la ERBG se limitó a una sola dimensión responsable del 40,6 % de la varianza de total. Se concluye que ERBG presenta alta consistencia interna y una estructura unidimensional en los estudiantes participantes. Futuras investigaciones deben explorar el desempeño de este instrumento en estudiantes de otras carreras y ciudades colombianas.AbstractThe concept of racial discrimination changes over the time; and today different forms are distinguished, among others, genetic, modern, symbolic and subtle. Accordingly, scales for quantifying these are proposed. The objective of the research was to determine the psychometric performance of the Genetically Based Racism Instrument (GBRI) among medical students of a university in Bucaramanga, Colombia. A validation study was done which participation of 341 students aged between 18 and 30 years, 59.2% females, completed a nine-item version of the GBRI. Cronbach alpha and McDonald omega were estimated. Internal structure was computed with exploratory factor analysis. RBGS presented Cronbach alpha of 0.81; and McDonald omega, 0.82. Internal structure was represented by one dimension responsible for 40.6 % of variance. As conclusion, GBRI has high internal consistency and one-dimension structure in the participating students. Future research should explore the performance of this instrument in students of other academic programs and Colombian cities.Keywords: Racism; medical students; reproducibility of results; factor analysis; validation studies. (Fuente: Decs Bireme).