Revista estudiantil de acceso abierto y revisión por pares publicada por la Escuela de Ciencias Conductuales y Neurales – Ponce Health Sciences University Salud y Conducta Humana (SCH) es una revista científica publicada de forma continua desde 2014. Su misión es promover la investigación estudiantil en salud, conducta y cognición humana, fomentando la mentoría académica y la colaboración interdisciplinaria. Acepta manuscritos inéditos en español o inglés y utiliza un sistema de revisión por pares doble ciego para garantizar la calidad científica. Áreas de interés: psicología, salud pública, medicina, neurociencia, trabajo social, enfermería, consejería, entre otras disciplinas relacionadas con la salud y la conducta humana. Equipo editorial Editor en jefe: Caleb Esteban, PhD Subdirectora de edición y coordinación editorial: Lianel Rosario, M.S. Asistente editorial: Angélica M. Caldero Cuevas, B.A. Asistente editorial auxiliar: Aldrick Adorno Adorno, M.S.
Behavioral barriers and facilitators for sexual orientation and gender identity (SOGI) data collection in a community health clinic in southern Puerto Rico: A rapid qualitative analysis
Collecting sexual orientation and gender identity (SOGI) is essential to provide affirming and evidence-based care and to address health inequities, especially among sexual and gender minorities (SGM). Despite the importance of collecting SOGI, there are multilevel barriers that hinder such implementation. However, in the context of Puerto Rico, few studies have examined these barriers and facilitators, and none have explored them through a behavioral lens. Objective: The purpose of this qualitative study is to explore the behavioral barriers and facilitators of SOGI data collection in a Community Health Clinic (CHC) in Southern Puerto Rico. Method: We conducted semi-structured interviews (N=10) among healthcare providers (n=5) and healthcare personnel (n=5). We analyzed the data using the Planning for and Assessing Rigor in Rapid Qualitative Analysis (PARRQA) approach and guided by the Theoretical Domains Framework (TDF). Results: Findings from the analysis indicate that key barriers to SOGI data collection include beliefs about consequences, emotion, social influence, and environmental context and resources. In contrast, behavioral facilitators include knowledge, skills, behavioral regulation, and reinforcement. Conclusions: We discuss pragmatic strategies for behavioral change to improve SOGI data collection in healthcare settings.
Derechos de autor 2025 Salud y Conducta Humana https://creativecommons.org/licenses/by/4.0
Psychosocial impact of recurrent afebrile cellulitis and antibiotic toxicity in an elderly patient
Recurrent hospitalizations in elderly patients not only increase morbidity but also have profound psychosocial and behavioral health implications. The complexity of care, polypharmacy, and caregiver burden contribute to poor outcomes and reduced quality of life. Objective. To explore the behavioral and psychosocial challenges associated with recurrent cellulitis and antibiotic toxicity in an elderly woman, highlighting the role of caregiver stress and healthcare system barriers. Method. We present the case of an 87-year-old Puerto Rican woman with multiple comorbiditieswho was hospitalized four times in six months for recurrent cellulitis. Clinical data and caregiver narrative were analyzed to assess both medical and behavioral health dimensions. Results. Despite multiple hospitalizations, the patient remained afebrile and presented with atypical signs of infection. Repeated courses of antibiotics, including prolonged linezolid, culminated in lactic acidosis. Her son reported increasing emotional distress, exhaustion, and frustration with fragmented healthcare coordination. The recurrent admissions, lack of continuity, and progressive frailty created psychological strain for both patient and caregiver. The patient died shortly after her last discharge, intensifying the emotional burden on her family. Conclusions. This case illustrates how recurrent infections in the elderly extend beyond biomedical complications to include significant behavioral health consequences. Caregiver stress, treatment fatigue, and systemic barriers are critical determinants of outcomes. Integratingbehavioral health support and care coordination into infection management may improve quality of life for patients and families.
Legislaciones y políticas como determinantes de la salud en comunidades género diversas
Las legislaciones y propuestas de políticas públicas que atentan contra las poblaciones género diversas pudieran ser detrímentales para la salud integral al generar experiencias traumáticas y estrés crónico. Objetivo. Examinar las políticas públicas aprobadas y propuestas en Puerto Rico (PR), a través del sistema SUTRA, que pueden incidir en la salud de identidades género diversas. Se pretendió analizar cómo las acciones ejecutivas emitidas por el Gobierno de Estados Unidos (EE. UU.) influyen en el contexto puertorriqueño. Método. Se realizó una revisión de literatura de tipo bibliográfica con enfoque cualitativo narrativo, abarcando el periodo legislativo y ejecutivo 2025. Resultados. Los hallazgos revelan 14 medidas legislativas propuestas en PR que restringen derechos en áreas de salud y reconocimiento de las identidades de género diversas. En contraste, se evidenció una ausencia de medidas protectoras, encontrándose solo dos políticas para estas identidades. A su vez, se identificaron 8 acciones ejecutivas en EE. UU., junto con 21 políticas anti-LGBTQIA+ propuestas en el plan de gobierno Project 2025, que buscan restringir el acceso a la atención de afirmación de género, permitir que instituciones financiadas con fondos federales nieguen dichos servicios y reducir protecciones antidiscriminatorias. Conclusiones. En conjunto, estas dinámicas políticas no solo perpetúan desigualdades estructurales, sino que también pudieran afectar de manera significativa su bienestar, generando riesgos para su salud mental en contextos de discriminación, persecución política y violencia de género. Estos resultados subrayan la urgencia de promover un marco legislativo que deje de ser una fuente de daño y se transforme en mecanismos de reparación y justicia social.
Considering inpatient antibiotic use at the end of life for children with cancer
In adult oncology, high-quality end-of-life care (EOLC) metrics emphasize minimizing aggressive interventions. Although no guidelines specifically address antibiotic use at end-of-life (EOL), the Infectious Diseases Society of America classifies antibiotics as “aggressive therapy”. Nevertheless, 87% of hospitalized adults with cancer at EOL receive antibiotics in the final week of life, though fewer than half have documented infections. Comparable pediatric metrics are lacking; however, anticipatory guidance is critical for high-quality care. Objective. To describe antibiotic use in children with cancer at end-of-life (EOL) and evaluate documentation of discussions regarding antimicrobial management. Method. Retrospective chart review of children with malignancy who died inpatient at a U.S. academic center (2012–2022). Data included antimicrobial use, microbiological testing, documentation of discussions by Palliative Care (PC) or Infectious Disease (ID), and patient demographics and EOLC variables. IRB reviewed and found it exempt. Results. Of the 303 children, 223 (74%) received antibiotics at the time of death, most given without evidence of infection (65.9%). Only 79 patients (26%) had documented PC or ID discussions about antibiotic management, primarily focused on discontinuation or de-escalation. Conclusions. Antibiotics at pediatric EOL are frequently prescribed without clear evidence of infection and are seldom included in goals-of-care discussions. Standardized processes and anticipatory guidance may reduce reflexive prescribing, promote stewardship, and better align care with family priorities, highlighting the need for protocols that ensure goal–concordant care.
#ReachOut: Prevención del suicidio en la Generación Alfa en Puerto Rico utilizando la tecnología
El suicidio es la tercera causa de muerte a nivel mundial en personas de 15 a 29 años. Lo que representa un desafío de gran relevancia en Salud Pública, ya que el suicidio en etapas tempranas del ciclo de vida del individuo genera una carga significativa en términos de Años de Vida Potencial Perdidos (AVPP). En Puerto Rico, la mortalidad de suicidio en adolescentes (15 a 19 años) para el 2023 tuvo una tasa de 3.2 por cada 100,000 habitantes. Objetivo. Desarrollar un audiovisual educativo sobre el comportamiento suicida dirigido a adolescentes puertorriqueños. Método. Se revisó la literatura publicada en los últimos cinco años sobre el suicidio en la población de interés, abarcando estudios de PR, EE.UU. y Latinoamérica. En base a la revisión se elaboró el video educativo con contenido dirigido a la prevención del suicidio. El producto fue validado en su contenido por Contextual Behavioral Research Alliance de PHSU y no se requirió de un comité de revisión institucional, ya que no se interactuó con sujetos. Resultados. El audiovisual de tres minutos incluye el siguiente material adaptado culturalmente a PR: qué es el suicidio, las diferencias entre conducta suicida y muerte por suicidio, las señales de alerta del suicidio, cómo ser un ente de ayuda y recursos de apoyo. Conclusiones. Recomendamos realizar un grupo focal para evaluar el material y facilitar su diseminación entre adolescentes en Puerto Rico.
Posttraumatic stress and impairment indicators in trauma-exposed minors: A comparison by history of sexual abuse
Childhood sexual abuse (CSA) is among the most devastating traumatic experiences, with an alarming global prevalence and long-term health consequences. In Puerto Rico, 8.5% of high school students reported experiencing sexual violence in the past year, highlighting the urgent need for research in this population. Comparative studies of trauma-exposed minors (TEM) with versus without CSA remain limited, particularly in underserved populations. Objective. We examined posttraumatic stress disorder (PTSD) symptom severity and impairment indicators in TEM, comparing those with versus without a CSA history. Method. Participants were 140 minors (51.43% male) between 6–17 years (M = 11.76, SD = 3.25), assessed for eligibility in a trauma treatment project (IRB-approval #2122-014). Youth and one caregiver completed multiple measures. We used chi-square and Student’s t-tests to compare groups in sociodemographic and clinical variables (p ≤ .05), and Cohen’s d to estimate effect sizes. Results. Minors with a CSA history (n = 41) showed significantly higher PTSD symptom severity [t (136) = 2.25, p = .026, d = 0.42] and more traumatic events [t (136) = 4.41, p ≤ .001, d = 0.83]. They were also more likely to present ≥2 areas of impairment (66.7% vs. 48.0%), lifetime suicidal behavior (43.9% vs. 26.3%), and scores above the cutoff for probable PTSD (60.0% vs. 32.7%). Conclusions. CSA survivors exhibited greater symptom severity, multiple impairments, and suicidality compared to peers. These findings highlight the urgent need for differentiated assessments and targeted interventions to address the unique vulnerabilities of TEM with a CSA history.
De la disertación a la publicación: estrategias para transformar la investigación doctoral en artículos científicos
Una disertación doctoral es un proyecto de investigación original que representa la culminación de la formación académica avanzada y busca generar conocimiento nuevo que contribuya al desarrollo de la disciplina, a diferencia de una tesis de maestría, orientada principalmente a la aplicación de conocimientos existentes. Aunque valiosas, muchas disertaciones permanecen confinadas en bibliotecas universitarias o archivos digitales, lo que limita su difusión y reduce su contribución al debate científico. Este editorial ofrece estrategias prácticas y metodológicas para transformar disertaciones en manuscritos publicables, promoviendo la visibilidad, el impacto y la integración del conocimiento generado en el ámbito doctoral. Convertir una disertación en un artículo científico implica una reconfiguración metodológica y narrativa que responda a los estándares editoriales de las revistas académicas. Este proceso requiere delimitar su alcance, enfocándose en una contribución central con hasta tres hallazgos claramente definidos. Se recomienda priorizar la información esencial para garantizar la replicabilidad y eliminar contenido redundante, siguiendo una estructura clara que incluya introducción, métodos, resultados y discusión. Asimismo, es fundamental atender las consideraciones éticas relacionadas con la autoría, la aprobación institucional y el intercambio responsable de datos. Finalmente, aprovechar la mentoría académica y el apoyo institucional puede facilitar el proceso de redacción y publicación, contribuyendo al fortalecimiento de una cultura de divulgación científica ética, estratégica y colaborativa.
Dulce Digital 2.0 - Innovative Diabetes Self-Management in the Digital Age
Healthcare reform is a driving force with the imperative to identify low-cost and clinically effective methods to respond to the increasing healthcare needs. The U.S. has the highest prevalence of diabetes among individuals of minority and low socioeconomic status who are disproportionately affected. This project incorporates the inclusion of Diabetes self-management education (DSME) as an effective method to improve clinical and cost outcome and can be successfully tailored for ethnically diverse populations. The objective of this research is to conduct a direct comparison of live Project Dulce, telehealth Project Dulce, and Dulce Digital programs to explore each delivery modality's feasibility, acceptance, and effectiveness across Hispanic communities living with type 2 diabetes (DM2). Currently, we are in the recruitment and enrollment phase of the study. This includes identifying potential patients to participate in the study, obtaining their informed consent, and randomizing each participant in one of three arms: Dulce Digital, Project Dulce -Telehealth, and Project Dulce Live. The first arm will only receive text messages whereas arms 2 and 3 will be attending five DSME classes. The primary outcome will evaluate the change over time in the glycated hemoglobin test among participants enrolled in text-based Dulce Digital vs. Project Dulce Telehealth and Project Dulce Live. Previous studies of Project Dulce have shown a significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes (Gilmer et al., 2005), but Dulce Digital uses a simple, low-cost text messaging program that has been found to be highly acceptable in high-risk, Hispanic individuals with DM2.
Exploring Sex-Based Differences in Inpatient Mental Health Care Within General Hospital Settings
Mood (78%) and anxiety disorders (16%) represent the most common mental health diagnoses (MHD) within the Latino population in the United States (US). For Puerto Ricans living in the US mood disorders account for 20.7% of MHD, as opposed to 22.5% for island residents. Moreover, while Puerto Rican females (10.5%) exhibit higher rates of MHD compared to males (8.2%), males are less likely to seek mental health services (26.4%) than females (37.5%). Our aim is to analyze sociodemographic characteristics and clinical trends among inpatients in general hospitals in southwestern Puerto Rico based on their assigned sex at birth. We conducted a retrospective exploratory analysis of chart data collected from 1,737 inpatients using databases from the Clinical Psychology Services Programs at Hospital Damas, Ponce and La Concepción Hospital, San Germán, between August 2020 to August 2023. The sociodemographic profile revealed a mean age of 63 ± 18.6 years, with 55.5% females, and 75.1% reporting a monthly income of ≤$1,500. Clinical data indicated a higher prevalence of MHD among males (76.3%) compared to females (63.9%), with depression being the most prevalent (20.7% males; 18.6% females), followed by neurocognitive disorders (18.9% males; 19.5% females). Notably, both sexes demonstrated similar rates of mental health services utilization (30.5% males; 35.4% females). Furthermore, musculoskeletal (29.8% males; 19.5%) and circulatory system (15.7%; 19.5% females) diseases were the most common medical comorbidities. Additional analyses between sex differences will be presented. Future research regarding the role of culture on males’ reluctance to receive mental health care is warranted.
Relationships Among Cognitive Variables in Puerto Rican Children Using the Cognitive Assessment System 2 – Spanish Version
The Cognitive Assessment System 2 – Spanish Version (CAS2: SP) is a comprehensive test that assesses a range of cognitive variables, including planning, attention, simultaneous processing, and successive processing (PASS). Understanding the relationships among these processes can offer valuable insights into their interconnectedness and their impact on overall cognitive functioning in children. However, there is a notable scarcity of research specifically examining these relationships in Puerto Rican children. Therefore, our study aims to fill this gap by exploring patterns, associations, and dependencies among these cognitive processes, how they influence one another, and how they contribute to overall cognitive performance in children. To achieve these aims, we conducted secondary data analysis with a sample of 34 children, ranging from first to fourth grade, representing 11 schools across the metropolitan and southern areas of Puerto Rico (IRB #1314-085). Employing bivariate correlation analysis, we examined the relationships between the PASS processes. The results revealed significant positive correlations between planning and attention (r = 0.523, p < 0.001), attention and successive processing (r = 0.458, p = 0.003), planning and successive processing (r = 0.393, p = 0.011), planning and simultaneous processing (r = 0.387, p = 0.012), and simultaneous processing and successive processing (r = 0.330, p = 0.028). However, no correlation was found between attention and simultaneous processing (r = 0.282, p = 0.053). These results provide a broader insight of the cognitive abilities of Puerto Rican children, contributing to a deeper understanding of their interconnectedness.
Efficacy of an Environmental Enrichment Intervention for Endometriosis: A Pilot Study
Background: Environmental Enrichment (EE) has shown to improve disease presentation, anxiety, and immune-related disturbances in the rat model of endometriosis. However, there is a knowledge gap regarding the effects of EE interventions in patients with this chronic disease. This study aimed to adapt and test the efficacy of an EE intervention on pelvic pain, mental health, perceived stress, quality of life and systemic inflammation in endometriosis patients through a randomized clinical trial (RCT). Methods: A multidisciplinary team adapted and implemented a two-arm RCT comparing an EE intervention with a wait-list control group. Six EE modules administered on alternate weeks were provided to patients in the intervention (N=29); controls received education only. Survey data and biospecimens were collected at baseline, end-of-study, and 3-months post-intervention to assess pain (Brief Pain Inventory-BPI), endometriosis-related quality of life-QoL (Endometriosis Health Profile-30-EHP30), anxiety (Generalized Anxiety Disorder-7- GAD7), depression (Patient Health Questionnaire for Depression-8-PHQ8), pain catastrophizing (Pain Catastrophizing Score-PCS), stress (Perceived Stress Scale-14-PSS14), and saliva cortisol. Results: Compared to the wait-list controls, participants in the EE intervention showed significantly decreased GAD-7 scores at the end of the intervention and 3-month follow-up. Depression, perceived stress and QoL improved at the 3-month follow-up compared to baseline. While pain levels did not improve, they significantly correlated with anxiety, depression, QoL and pain catastrophizing score. Conclusions: This pilot RCT demonstrated significant improvements in anxiety and depressive symptoms, QoL, and perceived stress supporting enriched environments as an integrative psychosocial intervention to be used as adjuvant to standard of care for endometriosis pain.
Understanding the Biological Role of MMP16 in Cisplatin Resistance in Ovarian Cancer
High-Grade Serous Ovarian Cancer (HGSOC) is the most common and lethal of Ovarian Cancer (OC) types. The standard treatment for women with OC includes surgery and platinum/taxenes-combined therapy. However, around 70% of women with HGSOC become resistant to platinum-based chemotherapy. Therefore, new therapeutic strategies with higher specificity and efficacy are needed for women with advanced and drug-resistant OC. Matrix metalloproteases (MMPs) are a group of enzymes involved in the degradation of the extracellular matrix (ECM). Deregulation of MMPs contributes to tumor growth and metastasis in several cancer types. Preliminary gene expression studies of our research team found that the messenger RNA (mRNA) levels of MMP16 are higher in cisplatin-resistant as compared with cisplatin-sensitive OC cells. The aim of this project is to understand the role of MMP16 in the cisplatin resistance of OC cells. We hypothesize that MMP16 increased expression may contribute to cancer progression and drug-resistance. We performed experiments in A2780/A2780CP20 and OVCAR3/OVCAR3CIS human OC cells. To assess the MMP16 protein levels we used western blot analysis. To measure the mRNA levels, we used qRT-PCR. Kaplan-Meier survival curves were generated by interrogation of the KM Plotter patient database. The MMP16 Western blots and qRT-PCR experiments confirmed that the protein and mRNA levels are more abundant in cisplatin-resistant as compared with cisplatin-sensitive cells. Interrogation of the KM plotter database showed that OC patients with higher MMP16 mRNA levels live less as compared with OC patients with lower MMP16 levels. Ongoing experiments are testing the biological effect of small interference RNA (siRNA) targeting MMP16 in cisplatin-resistant OC cells.
Characterizing the Effect of Restraint Stress on the Hippocampal Activity of Breast Tumor-Bearing Mice
Brain-derived neurotrophic factor (BDNF) is a crucial regulator of neuronal plasticity in the brain and signaling throughout the central nervous system. Interestingly, patients with behavioral disorders, such as major depressive disorder, exhibit decreased BDNF expression in the hippocampus (HPC). In addition, chronic stress leads to lower BDNF levels in the HPC and increased microglia. Our group has shown that stress induces systemic inflammation and accelerates disease progression in cancer patients. However, the role of chronic stress on the HPC in breast cancer patients is poorly understood. Our study aimed to understand the effects of restraint stress on the HPC of breast tumor-bearing mice. We hypothesize that restraint stress will increase microglia activation and decrease BDNF in the HPC of breast tumor-bearing mice, which could contribute to depressive-like behaviors. Our experiments were conducted using breast-tumor-bearing NU/NU mice that were restrained for two hours daily for six weeks. Unstressed breast tumor-bearing mice were used as a control group. Mice were sacrificed after six weeks, and their brain, tumors, and blood were collected. Our data demonstrated increased tumor growth and elevated levels of pro-inflammatory factors in the blood of mice subjected to restraint stress. Furthermore, immunohistochemical analyses of the brain suggested a decrease in BDNF levels and increased microglia in the HPC. These data provide a foundation to support further studies that aim to understand how brain function can be altered in cancer patients.
Acceptability of the Electronic Version of the Puerto Rico Biobank Questionnaire by Hispanic Patients: A Pilot Project
The Puerto Rico BioBank (PRBB) gathers tissues and data from oncologic surgery patients in Southern Puerto Rico to support cancer-related health disparities research. The response rate of the PRBB paper questionnaires is low (60%) leading to incomplete annotation of biospecimens impacting on their utility for research. This study aims to assess if an electronic questionnaire (EQ) is well accepted, thereby improving data collection from PRBB donors. We conducted a cross-sectional study among PRBB participants aged 21-89 years, where we offered a choice between EQ or paper questionnaires (PQ). EQ responses were collected via a text-distributed REDcap link. The study was approved by PHSU-IRB; data analysis was done with SPSS 29. During June-August 2023, 52 patients were consented for the PRBB and offered their preference of questionnaire. Acceptability of EQ was 23.1% (n = 12), 58.3% females and 41.6% males. The mean age of those preferring the EQ was 52.3 vs. 62.2 y/o (p = 0.013). Of those who preferred the PQ, 46.1% were >61 y/o. Most subjects answering follow-up questions found the EQ easy to complete (100%) and comfortable to answer (88.9%). Even in those preferring the EQ, 44.4% would still prefer answering PQs. This study suggests that the acceptability of the PRBB EQ is low in oncologic patients from Southern Puerto Rico. Acceptability of the PRBB EQ appears to be influenced by sex and age; possible external influences include the lengthy admission process and proficient use of technology. Alternative approaches need to be considered to address the low acceptability of the PRBB EQ.
Association between Adverse Childhood Experiences and Mental Health Conditions, and Attenuation by Resilience and Social Support among Adults living in Puerto Rico
Adverse childhood experiences (ACE) are associated with risk of mental health conditions (MHC) in adulthood. Resilience and social support (SS) may be protective against MHC. How these factors may impact ACE and MHC, however, is poorly understood. We examined associations between ACE and MHC, and potential attenuation by resilience and SS, in Puerto Rico. Cross-sectional data were analyzed from 1,146 adults (30-75 years) participating in the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT). ACE were assessed using the Behavioral Risk Factor Surveillance System Module. Resilience was captured using the Brief Resilience Scale. SS was assessed using the Interpersonal Support Evaluation List-12. Multivariable-adjusted logistic regressions estimated the odds ratio (95% CI) of having depressive symptoms (Center for Epidemiological Studies-Depression screener), anxiety (Generalized Anxiety Disorder 7-item screener), and post-traumatic stress disorder (PTSD 6-item Checklist-Civilian). Models were further adjusted for resilience and SS. Sixty three percent of participants reported at least one ACE of which35.3% reported depressive symptoms, 25.5% anxiety, and 35.2% PTSD. Participants with ACE (vs. not) had higher odds of depressive symptoms (1.64, [1.21, 2.22]), anxiety (1.59, [1.13, 2.24]) and PTSD (2.71, [1.95, 3.76]), adjusted for sociodemographic and behavioral characteristics. Adjusting for resilience slightly attenuated these results for depressive symptoms (1.44, [1.03, 2.01]), anxiety (1.45, [1.01, 2.09]) and PTSD (2.61, [1.83, 3.71]). When adjusting for SS, only the association between ACE and PTSD remained significant (2.31, [1.64, 3.25]). While further research could clarify how resilience manifests among those with ACE, SS may potentially alleviate MHC.
Retos en la búsqueda de servicios de ayuda en personas sobrevivientes de violencia sexual LGBT+
La violencia sexual es un problema de salud pública que afecta el bienestar de las personas. Debido la vulnerabilización y marginalización de las personas LGBT+, este grupo tiene mayor probabilidad de experimentar violencia sexual que otros grupos. El propósito de este estudio cualitativo fue explorar los retos en la búsqueda de servicios de ayuda entre personas LGBT+ sobrevivientes de violencia sexual en Puerto Rico. Este estudio cualitativo de tipo fenomenológico triangular se basó en el Modelo Ecológico Culturalmente Inclusivo para la Recuperación de una Agresión Sexual y la Teoría de Estrés de Minorías (#2109072035). Se llevaron a cabo entrevistas semiestructuradas a personas LGBT+ sobrevivientes (n = 1), profesionales de ayuda (n = 2), y líderes de la comunidad (n = 2), entre febrero 2022 y junio 2023. Se llevó a cabo una triangulación de datos entre las entrevistas realizadas. Los resultados preliminares reflejaron que la violencia sexual ha sido normalizada e impide el reconocimiento de esta al ser vivenciada. De igual forma, se evidenciaron deficiencias en los sistemas de ayuda. Como recomendaciones, las personas participantes enfatizaron la importancia de la educación sexual y la concienciación comunitaria, el acceso a servicios, la representación de la población LGBT+ en las campañas mediáticas y los adiestramientos sobre el trabajo con sobrevivientes LGBT+. Las personas LGBT+ en la Isla que sobreviven violencia sexual no sienten satisfacción con el sistema de ayuda que se les ofrece. Es importante accionar y continuar investigando sobre este tema para desarrollar herramientas que mejoren el sistema de ayuda.
Insulin Resistance and Childhood Trauma Influence Electroretinographic Function in Early-course Psychosis: A Case-control Study
Background: Electroretinographic dysfunction is observed in schizophrenia, with a-wave and b-wave amplitudes potentially serving as state- and trait-markers respectively. Insulin resistance (IR) and childhood trauma (CT) have also been associated with schizophrenia. Electroretinographic dysfunction in early-course psychosis (EP) lacks exploration. This study aimed to understand the relationships between electroretinographic dysfunction, IR, and CT in EP. Methods: The study involved healthy controls (HC, N=13) and EP individuals (N=14) and included photopic and scotopic flash-electroretinography (fERG), blood collection for IR assessment, and the Childhood Trauma Questionnaire (CTQ). Data were analyzed using SPSS v.29. Group differences across fERG conditions were explored using repeated-measures ANOVA (3 flash conditions X 2 groups) controlled for gender and age. Sub-analyses included Chi-square, Mann-Whitney U-tests, Spearman correlations, linear regressions, and mediation analyses. Results: Compared to HC, EP participants showed (1) lower photopic a-wave and b-wave amplitudes, specifically in the left eye and under the P1 condition, (2) greater odds for IR, and (3) higher CTQ scores. IR was associated with a higher CTQ score and a lower P2b amplitude. A higher CTQ score – with IR acting as a mediator – was associated with lower P2b amplitude, notably in the left eye. Conclusion: These findings suggest that reduced photopic a-wave and b-wave amplitudes, IR, and CT are explanatory markers in EP. CT may dysregulate the hypothalamic-pituitary-adrenal axis, increasing the risk of experiencing IR and later-life psychosis. IR might be a trait marker in psychosis, contributing to electroretinographic dysfunction and neurodegeneration of cone post-synaptic cells. Further investigations are needed.
Characterization of Myeloid-Derived Suppressor Cells in Response to Restraint Stress in Preclinical of Ovarian Cancer
Ovarian cancer (OC) is the fifth-leading cause of cancer death among females in the United States. Myeloid-derived suppressor Cells (MDSCs) are immature and immunosuppressive cells that play a key role in the tumor microenvironment (TME). Tumor-associated MDSCs aid immune evasion and are associated with poor prognosis in cancer patients. Chronic stress has been shown to increase tumor-associated inflammation and promote immune escape. However, the role of chronic stress on MDSCs infiltration and function in OC is poorly understood. This study aims to determine the role of chronic stress on MDSCs infiltration and biology in the TME. We hypothesize that restraint stress results in the upregulation of MDSCs infiltration in TME. To address this, we inoculated 3 to 4-month-old C57BL/6 female mice with ID8 or IG10 ovarian cancer cells and subjected them to restraint stress (2 hours daily) for 6-8 weeks. Unstressed mice were used as controls. Upon sacrifice, tumors were collected for immunofluorescence (IF) and flow cytometry (FC) analyses. IF and FC were used to characterize MDSCs by the expression of cell surface markers (CD11b+ and Gr-1+ (Ly- 6G/Ly-6C)). Our results suggest that chronic restraint stress led to increased infiltration of MDSCs in the TME in ID8 (p=0.0018) and IG10 (p=0.0018) mouse models. Also, FC results show an increased infiltration of MDSCs (CD11b+/Ly-6G) (p=0.04) in IG10 tumors. These data suggest that biobehavioral stressors and neuroendocrine system activation may modulate the OC TME, specifically the regulation and function of MDSCs, which impact the OC progression and TME immunosuppression.
Trazando el camino hacia la neuropsicología puertorriqueña: Qué debemos saber
Pediatric Neuroradiology Clinical Cases for Physicians, Neuropsychologists and Students
Rates and Predictors of Loneliness and Generalized Anxiety among Latinx College Students in Puerto Rico
Loneliness and Generalized Anxiety Disorder (GAD) are among college students' most common mental health problems. In the last years, there has been an increase in the prevalence of these conditions due to COVID-19 social distancing measures. Despite this, few studies have explored the relationship feelings of loneliness had anxiety symptoms in higher education Hispanic institutions. Puerto Rican college students are a unique and vulnerable group at the intersection of socioeconomic and health disparities. Therefore, the present study explored whether loneliness experienced during the Pandemic could predict GAD symptoms of students from the University of Puerto Rico, Rio Piedras campus. Researchers used a cross-sectional study design with an online survey that collected sociodemographic data, anxiety symptoms (GAD-7), and feelings of loneliness (TILS) from a sample of 356 university students between April and December 2022. Researchers performed two simple linear regression models to predict anxiety symptoms. The first model results revealed that loneliness predicted 15% of the variance related to anxiety symptoms (R2 = .15, F (1,340) = 59.17, p < .001). In the second model, researchers controlled for sex; however, no significant changes were observed in the model (r = .08). The results of this study suggest that feelings of loneliness during the Pandemic were significantly related to GAD symptoms experienced by college students. In addition, being female was significantly associated with anxiety symptoms compared to males, although the effect was small. Implications for future research, clinical practice, and academic institutions are discussed.
Hablemos de la bulimia: El impacto del lenguaje y los medios de comunicación en la concepción de la bulimia
En este escrito se desarrolla una síntesis cualitativa en formato de revisión de literatura para explorar el impacto del lenguaje y los medios de comunicación en la conceptualización social de la bulimia. Objetivos: identificar las limitaciones que presenta la categoría “bulimia nerviosa”, según publicada en el Manual Diagnóstico y Estadístico de Desórdenes Mentales (DSM 5-TR) de la Asociación Psiquiátrica de Estados Unidos, como producto de un sistema clasificatorio (APA, 2022). Explorar la forma en que el lenguaje utilizado para referirse a la bulimia propulsa los discursos dominantes que patologizan al individuo y le responsabilizan por su condición. Vincular el desarrollo de un discurso que tergiversa la percepción de la bulimia en la cultura popular al uso de los medios de comunicación para perpetuar estándares sociales de belleza. Metodología: Esta revisión literaria se realiza mediante búsquedas en bases de datos electrónicas de artículos originales, investigaciones, tesis y revisiones (Google Scholar, EbscoHost, SciELO, Redalyc). Se aplicaron los operadores booleanos AND, OR y NOT y la búsqueda avanzada para la selección de los artículos. Resultados: Habiendo analizado la información obtenida de los artículos utilizados en esta revisión, se sostiene el impacto del lenguaje y los medios de comunicación en la conceptualización social de la bulimia. Conclusión: Se propone la aproximación a la bulimia como una categoría emergente de demandas sociales, en miras de acabar con la percepción de la bulimia como una condición puramente biológica y alterar como es concebida socialmente.
COVID-19 y privación de contacto físico: Efectos en sintomatología de ansiedad y depresión
El distanciamiento físico y social como medida de reducir el contagio por COVID-19 ha tenido efectos psicológicos en la salud mental de las personas a nivel mundial. Sin embargo, el impacto de estas medidas de distanciamiento no se ha investigado en Puerto Rico con la población universitaria que se ha visto afectada por el cambio de enseñanza a nivel virtual. El objetivo de este estudio fue explorar la relación entre el contacto físico y social con la sintomatología depresiva y ansiedad en la población estudiantil universitaria. Este fue un estudio cuantitativo de encuesta transversal en línea. La muestra consistió en 246 estudiantes universitarios. Los resultados reflejaron que existe una relación estadísticamente significativa, leve y e inversa entre el contacto físico y social con síntomas de depresión y ansiedad; y una relación estadísticamente significativa entre contacto físico y anhelo de abrazar. Mientras menos las personas participantes compartían con sus familiares y amistades física y socialmente; mayor sintomatología de ansiedad y depresión presentaron. También, mientras menos contacto físico y social más extrañaban abrazar a sus seres queridos. Nuestros hallazgos nos convocan a considerar nuevas formas de interacción y cercanía dentro de las medidas de salubridad para mitigar los efectos de la pandemia.
Fortaleciendo el legado de la revista Salud y Conducta Humana: Un espacio de estudiantes para estudiantes
Este editorial conmemora el 10mo aniversario de la revista Salud y Conducta Humana con un análisis de su evolución temática y cambios estructurales, como la reorganización editorial y la adopción de la licencia CC BY 4.0. Además, se presenta el Vol. 10 Núm. 1 (2023), que incluye tres artículos regulares, dos reseñas de libros, y trabajos premiados en el octavo y noveno simposio estudiantil, destacando la colaboración entre estudiantes, docentes y mentores en la producción científica.
10mo Aniversario: Evolución temática en la revista Salud y Conducta Humana
A lo largo de sus 10 años de trayectoria, la revista Salud y Conducta Humana ha servido como un espacio formativo para el desarrollo de destrezas investigativas estudiantiles en los campos de la salud y la conducta humana. Desde su fundación en 2014, ha promovido una cultura de publicación y reflexión académica, integrando procesos de mentoría, revisión por pares y colaboración interdisciplinaria. Su evolución editorial refleja los cambios temáticos y estructurales que han marcado una década de compromiso con la formación y divulgación científica estudiantil.
Innovación en la difusión del conocimiento científico: Metodología de publicación continua
Tras una década dedicada a la divulgación del conocimiento científico, Salud y Conducta Humana ha dado un paso significativo en su evolución editorial al adoptar, desde enero de 2024, la metodología de publicación continua. Esta transformación responde al compromiso de la revista con la agilidad, accesibilidad y difusión oportuna de los avances científicos en el ámbito de la salud y la conducta humana. Desde su fundación en 2014, la revista se ha distinguido por promover la publicación de trabajos inéditos realizados por estudiantes, centrados en debates contemporáneos relevantes al campo. Publica artículos regulares y reportes breves de diversas disciplinas como psicología, neurociencias, salud pública, psiquiatría, medicina, enfermería, trabajo social y consejería, lo que la posiciona como un recurso clave para la comunidad investigadora. La implementación de la publicación continua tiene como objetivo seguir fomentando el intercambio científico, potenciar la investigación estudiantil y garantizar la disponibilidad inmediata del conocimiento validado por pares. Este editorial ofrece una guía sobre este nuevo modelo editorial, detallando su naturaleza, ventajas y aplicación en el contexto de la revista.
Adverse Life Experiences and Psychological Distress in Preschoolers and Their Caregivers
Puerto Rican (PR) families have experienced multiple adversities in recent years, potentially impacting health outcomes. However, a research gap remains in understanding the adversities faced by PR families with preschoolers and its association with psychological distress. Childhood is a critical period of vulnerability for the developing brain and adverse experiences can have lifelong consequences on the children’s health and development. This cross-sectional study aims to describe adverse life experiences of PR preschool children and their caregivers and determine the extent of their associations with psychological distress. Caregivers (n=102) anonymously completed the Kessler Psychological Distress Scale, the Strengths and Difficulties Questionnaire (SDQ), and the adult and child versions of the Adverse Life Experiences Scale (ALES). Descriptive statistics and Pearson correlation analyses at a 0.05 significance were performed. Among caregivers, 32.4% reported at least five adversities. The most common adversities reported were family death (56.9%), natural disasters (39.2%), and poverty (38.2%). Caregiver reports on their children (ages 3-5) identified 10.2% as having experienced at least three adversities, with natural disasters (22.6%) and family death (15.7%) being the most prevalent. Significant positive correlations were found between caregivers’ ALES scores and psychological distress scores (r=0.46, p<0.001), and between caregivers’ reports on children’s ALES scores and behavioral problems scores (SDQ) (r=0.24, p<0.014). While the study cannot establish causality, these findings suggest that adversities impact participants’ emotional health and well-being. It also highlights the need to elucidate awareness from health professionals about the short- and long-term impact of adversities on the health development of children and families.
Exploring the Relationship Between Chronic Stress, Ovarian Cancer, and Bone Marrow Remodeling via Hypothalamic Inputs
Ovarian cancer (OC) is one of the deadliest gynecologic malignancies, primarily due to a lack of early detection and prevention services. Studies show that prolonged exposure to stress leads to dysregulation of the immune response. It is suggested that the hypothalamus, a brain region involved in stress and immune responses, plays a role in this process via disruption of the Hypothalamic-Pituitary-Adrenal (HPA) axis. We hypothesize that chronic stress increases neuronal activity in the hypothalamus, causing disruptions in the HPA axis and promoting the accumulation of myeloid-derived suppressor cells (MDSCs) in the bone marrow, resulting in an immunosuppressive environment and ovarian tumor progression. Bone marrow samples from C57BL/6 mice injected with IG10Luc ovarian cancer cells and subjected to chronic restraint stress were evaluated by immunofluorescence staining assays (IFs) to determine the accumulation of MDSCs (CD11b+/Gr-1+) and synaptic terminals (synaptophysin and tyrosine hydroxylase [TH+]). Additionally, we analyzed hypothalamus samples to evaluate changes in neuronal activity (cFos+). Our studies show a significant decrease in the number of MDSCs in the bone marrow of tumor-bearing mice subjected to chronic stress. Additionally, confocal microscopy confirmed the presence of synaptic terminals in the bone marrow, although further studies are needed to assess the effect of chronic stress on this process. There was no significant difference in the levels of cFos expression in the hypothalamus between groups. Our data provides the foundation for exploring the role of the hypothalamus in modulating immune responses and bone marrow remodeling and identifying neuroimmunological markers to improve ovarian cancer outcomes.
Unusual Presentation of Baraitser-Winter Cerebrofrontofacial Syndrome: A Case Report and Review of Clinical Features
Baraitser-Winter cerebrofrontofacial syndrome (BWCFF) is an autosomal dominant disorder identified in less than 100 cases. It results from a missense mutation in the ACTB or ACTG1 genes. These genes encode for the beta (β)-actin and gamma (γ)-actin proteins, major constituents of the non-muscle cytoskeletal actin. BWCFF is strongly characterized by intellectual disability with facial and eye anomalies. However, different clinical expressions of this mutation have been documented. We present the case of a 23-year-old male with refractory epilepsy since the age of 15, mild intellectual disabilities, and facial characteristics such as a wide nasal bridge, wide spaced eyes, high arched eyebrows, and orbital hypertelorism. The patient also suffered an intussusception caused by inversion of Meckel's diverticulum, which has not been previously described in BWCFF patients. Sequence analysis and deletion/duplication testing showed a c.589G>A (p.Gly197Ser) variant in the ACTB gene, compatible with Baraister-Winter Syndrome. The increasing availability and affordability of modern genetic testing can aid in our understanding and potential development of treatment of complex neurologic disorders. This report highlights the importance of clinical suspicion and awareness of the classical features of this condition for the early diagnosis and proper management of these patients.
The Relationship Between Psychological Well-Being and Academic Achievement Among University of Puerto Rico Students
Students from the University of Puerto Rico (UPR) have overcome adversities, including hurricanes, earthquakes, the pandemic, and fiscal crises. These difficulties have caused feelings of uncertainty, helplessness, and depression, severely impacting student mental health and academic performance. The objective was to explore if there was significant correlation between college student psychological well-being and academic achievements. Researchers employed a cross-sectional design with convenience sampling of 1,065 students from the UPR, Río Piedras campus. The data were collected via an online survey administered through SurveyMonkey. The instrument used was the Survey for Psychological Wellbeing (EBP, Spanish). The database for the sample was created using SPSS v. 27, and data analysis was performed in Intellectus Statisticsled. The results of the Spearman correlation analysis revealed that student GPA was positively correlated with several subscales of psychological well-being, including positive relations (p = .015, 95% CI = [.01, .13]), self-acceptance (p < .001, 95% CI = [.16, .27]), personal growth (p < .001, 95% CI = [.08, .19]), autonomy (p = .001, 95% CI = [.04, .16]), domain of the environment (p < .001, 95% CI = [.13, .25]), and life purpose (p < .001, 95% CI = [.15, .27]). The result demonstrated a significant positive relationship between psychological well-being and academic achievement among UPR students. Therefore, when students’ psychological needs are being met, they will be more likely to succeed academically. Researchers suggest that universities address various social, educational, and environmental factors impacting student well-being and recommend implementing strategies that promote mental health and academic performance.