BackgroundThe association between Adverse Childhood Experiences (ACEs), prosocial behavior, and depression (like other negative mental health outcomes) has not been thoroughly understood. This study aimed at evaluating their simultaneous association while controlling for key confounding variables.MethodsA cross-sectional study was carried-out with 2918 secondary school students from seven charter schools located in low-resourced neighborhoods in Bogota (Colombia), 54.12% were female, and mean age was 13.81 years. The self-report instrument included demographic variables, well-being, mental health, risk behaviors and symptoms of psychopathology. Assessment of ACEs was done by a series of yes/no questions, prosocial behavior was evaluated with the corresponding subscale in the Strengths and Difficulties Questionnaire, and depression was assessed with the Self-Reporting Questionnaire. Associations were tested using the Spearman correlation coefficient, Z tests and Chi-square tests, and all primary outcome analyses were adjusted for potential confounding variables through multivariate logistic regression using depression as outcome.ResultsMean exposure to ACEs was 3.15 events; those exposed to four or more obtained lower scores in well-being, satisfaction with life and family functioning, and higher scores in symptoms of psychopathology. For the prosocial behavior scores, 64.35% were classified as close to the average, 17.51% as slightly lowered, 11.91% as low, and 6.23% as very low; participants with higher levels of prosocial behavior showed lower scores in symptoms of psychopathology. While ACEs had a positive association with depressive symptoms (Odds Ratio [OR] 2.21, 95% confidence interval [CI] 1.67-2.94), prosocial behavior did not have a significant association with either ACEs or depressive symptoms in multivariate regression models.ConclusionsNovel studies should further elucidate the developmental pathways involving positive and negative mental health constructs to better understand the actual effectiveness of interventions that use these constructs in their design.

Abstract Background While resilience has generated a lot of interest in mental health, operationalizing the construct of resilience remains an important challenge. This study aims to evaluate the concordance of two resilience scales that evaluate intrapersonal aspects of resilience in adolescents. Methods Cross-sectional evaluation of internal consistency, concordance, and correlation of the Individual Protective Factors Index Questionnaire (IPFI) and the Adolescent Resilience Scale (ARS) in sixth grade students of three low-income public schools in Colombia. Results 325 adolescents (41.5% female) participated in the study (72.5% response rate). Mean age was 12.1 years (standard deviation [SD]: 1.04). Of a possible score from 1–4, the mean adjusted IPFI score was 3.3 (SD: 0.3; Cronbach’s alpha: 0.87). Of a possible score from 21–105, the total ARS score was 76.4 (SD 13.0; Cronbach’s alpha: 0.82); both distributions were non-normal and left-skewed. The Lin’s concordance correlation coefficient was 0.34 and the Spearman correlation coefficient was 0.52 (p-value < 0.0001 for both). Notably, 10 adolescents (3.1% of the sample) had a score in the lowest quartile in one of the two instruments, and a score in the highest quartile in the other instrument. Conclusions There was low concordance between the scales, with notable lack of overlap in who was identified as having “low” levels of resilience. To better elucidate and operationalize the construct of resilience, studies using resilience scales should consider greater focus in understanding what aspects of the construct are being measured and how they relate to meaningful variables (well-being, risk of illness, etc.).

BackgroundHealth information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties.ObjectiveUsing participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C).MethodsThis study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions.ResultsA total of 2 co-design workshops were held with 18 users—young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions—young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context.ConclusionsThe application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C—a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

Phenomenon:Mental health problems among medical students are a worrisome issue; recent studies have shown that one-third may be suffering major depressive disorder and one out of ten had suicidal ideation. Few studies have evaluated the association of medical students' mental health and their sexual orientation. This study aimed to evaluate differences in mental health indicators among medical students with diverse sexual orientations at a South American medical school.Approach:This study is a secondary analysis of cross-sectional data obtained through an electronic survey. The survey assessed demographics, academic variables, and several mental health scales and indexes, including: World Health Organization Well-being Index, Satisfaction With Life Scale, Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve), Self-Reporting Questionnaire, Athens Insomnia Scale, Eating Attitudes Test, and Alcohol Use Disorders Identification Test. Sexual orientation was assessed using self-identification and responses dichotomized as heterosexual and non-heterosexual.Findings:554 students completed the survey (response rate: 70%). Mean age was 20.6 years, and the sample was 58.7% women. Eighty-two participants (14.8%) self-identified as non-heterosexual; this group comprised mostly males, fewer of whom lived with their family, and more of whom used loans or scholarships to pay university tuition fees. After adjustment for sex and tuition fee payment, non-heterosexual orientation was significantly associated (adjusted Odds Ratios [aOR] above 3.00) with rating mental health as bad, self-perceiving a need for mental health evaluation/treatment, and reporting last-year use of psychiatric medication. Lastly, non-heterosexual respondents reported more frequent psychiatric symptoms (depression/anxiety scores, suicidal ideation, eating disorder symptoms and substance use) with an aOR between 2.17 and 2.51.Insights:This study suggests that self-identified non-heterosexual medical students exhibit worse mental health outcomes evaluated through validated self-report scales and subjective perception of mental health status. This report specifically indicates that non-heterosexual medical students report family dysfunction more often and have less social support, which serve as additional risk factors. Future studies must assess social support, clarify the impact of family and peer support in mental health problems, and explore students' views on their sexual identity and the burden imposed by experiences of discrimination.

In collaboration with a charter schools’ alliance in Bogotá (Colombia), our research group has conducted several research projects on teenagers’ mental health. This presentation intends to compare self-injurious behavior (SIB) data from surveys conducted in 2011 and 2019.

There are not many direct comparisons of anxiety and depression symptoms between medicine students and the general population. This study aimed to determine the type of anxiety and depression symptoms at a medical school in Bogota (Colombia), and to compare the findings with population data. All students enrolled at a medical school were invited to participate in 2017. The Self-Reporting Questionnaire was applied to measure anxious and depressive symptoms. These findings were compared with data from the National Survey of Mental Health 2015 that were obtained with the same instrument in the same age range (18-25 years). A total of 554 students participated in the survey (70% response rate); 477 were between 18 and 25 years old. Anxiety symptoms (>= 5) were reported by 44.9% of the medical students and 6.8% of the general population, and depression symptoms (>= 7) were reported by 33.9% and 2.6%, respectively. The most prevalent symptoms reported by the medical students were fatigue, lack of sleep, and feeling tired all the time. In turn, the general population reported headaches, fear, nervousness, tension, and uneasiness. All comparisons showed p-values < 0.01. As prevalence is higher and symptom profile is different, specific policies are needed to reduce risk throughout medical degree programmes.

The objective of this presentation is to evaluate the efficacy of a school-based intervention to enhance resilience in at-risk youth living in urban low-income neighborhoods with significant community violence.

Background: Health information technologies (HIT) hold enormous promise for improving access to, and better quality, mental health care. However, despite rapid spread of such technologies in high-income countries, they have not yet been commonly adopted in low and middle-income countries. People living in these parts of the world are at risk of experiencing not only physical but also technological and social health inequalities. One possible solution is to utilise already available (and successfully implemented) HITs developed in other counties. Objective: Using participatory design methodologies with Colombian end users (young people, their supportive others, health professionals), this study aimed to: conduct co-design workshops to culturally adapt an online mental health clinic (MHeC) for young people; perform one-on-one user testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC, and adapt it to the Colombian context; and, inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). Methods: Utilisation of a research and development (R&D) cycle including four iterative phases: co-design workshops; knowledge translation; tailoring to language, culture and place (or context); rapid prototyping; and then, one-on-one user testing

The goal of this presentation is to evaluate the mental health of medical students enrolled in the second term of 2017 at a medical school in Bogotá (Colombia). We compared indicators among younger students (ages 16−18 years) to the rest of the sample group.

ResumenLa disforia de género o transexualismo es una condición que comprende a las personas que padecen profundo malestar o rechazo hacia el sexo biológico por cuanto se identifican con el sexo opuesto. Por lo tanto, se asocia a disfunción biopsicosocial y compromiso severo de la calidad de vida. En Colombia se han producido notables avances de índole constitucional y legislativa en las dos últimas décadas, los cuales son discutidos en la presente revisión. En el tratamiento multidisciplinario de los pacientes transexuales, el último paso corresponde a la cirugía de reasignación genital. El propósito de esta revisión es investigar el estado actual de la cirugía de reasignación genital enfocada en el contexto nacional.

The goal of this presentation is to compare the performance of two resilience evaluation measures in a Colombian high-risk adolescent school sample group and their association with mental disorder-screening scores.

Blended courses supported by digital technology (bLearning) and competency-based medical education can be found in different university curricular reform initiatives around the world. Today, it is essential to implement new technologies and teaching methods that are flexible and encourage students to acquire the necessary professional skills. This article describes how using the bLearning format transformed the Social Medicine course for second-year medical students at Universidad de los Andes (Colombia), particularly their ability to achieve target competencies. A qualitative case study was carried out to explore the curriculum structure, training and skills, educational model and learning environments used during the course. We discuss the methods used, the results achieved, and the challenges encountered during the implementation process. Findings show that bLearning both facilitated the transformation of the course design and promoted flexibility and autonomy in students' learning process. Additionally, the new format facilitated the development of various competencies including: cognitive, technical and procedural, integrative and communicative, reflection, and professional ones.

La discapacidad es hoy uno de los principales problemas de salud publica, y las personas en condicion de discapacidad son una de las poblaciones a las que mas se les vulneran sus derechos fundamentales. Existe hoy reconocimiento juridico internacional y nacional para garantizar a todas las personas, y con predileccion a las poblaciones mas vulnerables, la realizacion efectiva y el pleno disfrute de sus derechos fundamentales como son la vida, la integridad, la dignidad, la salud, la educacion, la movilidad y la participacion politica, entre otros. En este sentido, maxime si la salud es un derecho fundamental, los medicos y los profesionales de la salud deben ser defensores y garantes de los derechos fundamentales de sus pacientes, en especial de aquellos mas debiles y necesitados. La formacion medica debe incluir en las competencias profesionales el conocimiento en derechos humanos y la responsabilidad del medico de defenderlos en sus pacientes.