Regulation and self-regulation of ethical practices in scientific publication / Regulación y autorregulación de las prácticas éticas en la publicación científica

Abstract Introduction The process of publication is influenced by a pressure on researchers to demonstrate their competence and productivity by publishing large numbers of articles in indexed journals. But there is a great deal of ignorance regarding the ethical obligations in scientific publication; worse, ethical considerations are often seen as mere formalities in the process of publishing an article. Objective This article discusses the ethical practices related to the publication of a scientific article. It encompasses those defined by forms of external regulation and those that might be identified as forms of self-regulation, and it argues for the greater effectiveness of the latter in scientific publication. Method We performed a literature review and a critical analysis of the information. Results There are negative factors that range from plagiarism and the duplication of articles to the fabrication and falsification of data. Researchers look for convenient solutions, taking refuge in practices condoned, paradoxically, by the very scientific community that condemns them. Rather than avoiding these forms of misconduct, the scientific community even justifies them at times, which means that the practices continue. Discussion and conclusion Self-regulation in scientific publication is a preferable goal: it allows participants in the process to assume their obligations freely and with a greater sense of responsibility.

Resumen Introducción Resulta necesario reconocer que el proceso de publicación está influenciado por factores como la presión institucional que se ejerce sobre los investigadores para que publiquen mayor cantidad de artículos en revistas indexadas, lo cual se usa como parámetro de productividad y capacidad. Pero existe un desconocimiento amplio en relación con las obligaciones éticas de la publicación o, peor aún, muchas veces la ética es vista como mero requisito para la aceptación y publicación de un artículo. Objetivo Este trabajo expone las prácticas éticas implicadas en el proceso de publicación de un texto científico, tanto las que se consideran actualmente regulación externa como aquellas que podrían ser identificadas como autorregulativas, a fin de que éstas últimas puedan imperar dentro de las publicaciones. Método Se realizó una revisión de la literatura sobre la materia y un análisis crítico sobre la información. Resultados Existen efectos negativos que van desde la duplicación de artículos y el plagio hasta la fabricación o falsificación de datos. Incluso, se ha buscado una solución cómoda ante las reglas impuestas por la ética de la publicación, pero algunos investigadores han encontrado amparo en prácticas consensuadas dentro de la propia comunidad científica que, paradójicamente, las condena, y a pesar de ello no evita las vejaciones, incluso las llega a "justificar", por lo que siguen presentándose. Discusión y conclusión La autorregulación debería ser razón suficiente para asumir las obligaciones libremente y con mayor responsabilidad dentro del ámbito de la publicación científica.

Aplicación de la Escala de Depresión del Center of Epidemiological Studies en adolescentes de la Ciudad de México / Application of the revised version of the Center of Epidemiological Studies Depression Scale in adolescent students from Mexico City

OBJETIVO: Probar la validez de constructo, concurrente y externa, y la consistencia interna de la Escala de Depresión del Center for Epidemiologic Studies (CES-D-R) en adolescentes. MATERIAL Y MÉTODOS: Estudio transversal con dos cohortes de estudiantes de secundaria del DF. El cuestionario incluyó la CES-D-R y otras escalas sobre problemas relacionados con suicidio, violencia, exposición a oportunidades y consumo de drogas. La participación fue voluntaria y anónima. RESULTADOS: Se incluyó a 1 549 estudiantes (edad promedio, 14 años; DE=1.2). La escala mostró una estructura de seis factores (varianza explicada, 55 por ciento), consistencia interna excelente (a=0.93), discriminación significativa entre puntajes extremos (z=-3.695, p<0.001) y correlación positiva y significativa con la escala de ideación suicida de Roberts (r=0.685, p<0.001). CONCLUSIONES: La CES-D-R tiene excelentes características psicométricas en adolescentes mexicanos, por lo que es adecuada para la detección oportuna de depresión. Esto permite utilizarla en las vigilancias sistemáticas y periódicas en la población escolar para detectar necesidades de atención, prevención y promoción de la salud mental.

OBJECTIVE: To assess the internal consistency, as well as the construct, concurrent and external consistency of the Center for Epidemiologic Studies Depression Scale (CES-D-R) in Mexican adolescents. MATERIAL AND METHODS: The data are from two samples of middle-school students from Mexico City. The questionnaire included the CES-D-R and other scales for suicide problems, peer and family violence, and drug use. RESULTS: The sample included 1 549 students (mean age 14 years, SD=1.2). The CES-D-R showed a six-factor structure (explained variance, 55 percent) with an excellent internal consistency (a=0.93), a significant discriminative power for opposite scores (z=-3.695, p<0.001), and a positive significant correlation with the Roberts Suicidal Ideation Scale (r=0.685, p<0.001). CONCLUSIONS: The CES-D-R has excellent psychometric characteristics for Mexican adolescents and therefore is deemed as an adequate tool for the assessment of depressive symptoms in large samples to detect mental health needs and design preventive interventions.

Problemática suicida en adolescentes y el contexto escolar: Vinculación autogestiva con los servicios de salud mental / Suicidal phenomenon in adolescents and school context: link between self-management and health services

Deliberately Self-Inflicted Injuries (DSII) can include different behaviors with lethal consequences. Suicide threat, suicide attempt and suicide itself can be grouped within these conducts. Though suicide in school contexts is more frequent in women, it has been observed that DSII has similar frequencies in both genders according to age, recurrence, motives, methods, and lethality. Official sources provide an epidemiological overview of the suicide phenomenon and concur in pointing out that: a) adolescent and young population has the highest suicide attempt and suicide prevalences; b) men commit more suicide than women but these attempt it more than men; and c) there are some areas in Mexico where suicide prevalences are higher. There is a lot of information about the suicide problem, but there are still some questions unanswered. For example, what are the most subtle characteristics of the different adolescent and young populations affected by the phenomenon? Do the context and the type of population represent a specific peculiarity? How does suicide behave in juvenile offenders? How does it behave in people who live and work in the streets? And how does it behave in groups of migrant and indigenous people? From the present situation of the suicide phenomenon in the school context, emerges the importance of intervention strategies for preventing its occurrence. Thus, one of the proposals under development underlines the need for creating self-management and binding mechanisms within schools. Self-management implies an ascending transformation process, which seeks that the individuals of certain group or community identify their own needs and change their perception of such needs to ignite the development of the inherent potentials in their community. The suicidal problem is growing in school population, that is why it is important to treat it adequately from prevention, having in mind the characteristics of socio-educational institutions. These institutions have particular resources and needs that shape them and could make them ideal setting for prevention and mental health promotion among adolescents. Since the suicide phenomenon has a multifactorial nature, complex and dynamic, an interdisciplinary approach seems to be one the most adequate options to work. This assumption represents a starting point to promote self-management actions that facilitate links between schools and mental health services. Nevertheless, within educational institutions coexist a series of complex circumstances that, at the same time, found and affect the possibility to begin self-management. For example, the academic and bureaucratic demands have an impact on keeping the links with health services or diminish the role of the school as a potential facilitator. Another element opposing the development of self-management strategies in schools is the context where facilities are located. Many schools are in areas where drug traffic is usual, where weapon trading is evident, and where informal commerce and insecurity are normal. Thus, if self-management process is to be initiated, the proposal should be founded on a well-defined basis, which should address these elements: 1. A clear definition of the situations to be attended. 2. Specific strategies to achieve goals, to create interest, and to motivate the school staff. 3. To acknowledge real chances to fulfill perceived needs and the possible obstacles. 4. To consider all the people involved in achieving objectives, their roles, and the commitments they would attend. 5. To work constantly and consistently to ignite self-management. 6. To make use of every convenient option available. 7. To conduct meetings to establish specific needs, to remark objectives, to communicate achievements, and to structure or re-structure plans.

Dentro de las Lesiones Autoinfligidas Deliberadamente (LAD) hay una serie variada de conductas que pueden tener consecuencias fatales; entre ellas se incluyen comportamientos autodestructivos como el gesto suicida, el intento o tentativa de suicidio y el suicidio consumado. Las fuentes oficiales muestran un panorama epidemiológico de la problemática suicida y coinciden en señalar que la población de adolescentes y jóvenes tiene la mayor prevalencia de tentativas de suicidio y suicidio consumado; los varones se suicidan más y la tasa de intentos es más alta en las mujeres, y hay zonas geográficas del país con prevalencias mayores. A partir del estado actual del fenómeno en el contexto escolar, es importante desarrollar estrategias de intervención para prevenir su ocurrencia. En este sentido, una de las propuestas es la generación de mecanismos de autogestión y vinculación en el ámbito de las escuelas. La autogestión implica un proceso de transformación ascendente en que los individuos de un grupo identifican sus necesidades y cambian su percepción de las mismas para conseguir generar un desarrollo del potencial de su comunidad. La problemática suicida es multifactorial, compleja y dinámica, por lo que la interdisciplinariedad pareciera una opción de trabajo adecuada. Entonces, se parte de este supuesto para promover acciones autogestivas que faciliten la vinculación entre las escuelas y los servicios de salud mental. Para que se inicie el proceso autogestivo, la propuesta debiera sustentarse en una base bien definida, la cual tendría que tomar en consideración los siguientes elementos: 1. Definir claramente las situaciones que se busca atender. 2. Establecer rutas críticas para conseguir objetivos y contar con el interés y la disposición del personal escolar. 3. Distinguir las posibilidades reales para responder a las necesidades percibidas y los obstáculos que se puedan presentar. 4. Considerar a todas las personas involucradas en el logro de objetivos, su papel y los compromisos a los que responderían, así como la capacitación constante para el desarrollo, fortalecimiento y aplicación de habilidades profesionales requeridas y adecuadas. 5. Trabajar de manera constante y consistente para iniciar la autogestión. 6. Recurrir a de todas las opciones pertinentes de las que se disponga. 7. Realizar reuniones en que se resalte la importancia de plantear necesidades claras, se reiteren los objetivos, se comuniquen los logros y se elaboren planes.

Trastorno por estrés postraumático en pacientes con lesiones no intencionales producidas en accidentes de tránsito

Resumen: En México los accidentes son un grave problema de salud pública. Estos eventos de tipo traumático tienen una probabilidad potencial de ocurrir de forma fortuita en cualquier momento de la vida de los individuos. Actualmente ocupan la tercera causa de mortalidad general y la primera en adultos jóvenes. Los accidentes producidos por vehículos de motor ocupan el primer puesto dentro del rango de los accidentes en general, esto de acuerdo a las tasas de mortalidad en adultos jóvenes que publican la OMS, la OPS y la SSA en México. Una de las consecuencias de los accidentes de tránsito por vehículo de motor es la secuela psicológica que dejan en los individuos en edad productiva. Estas secuelas se conocen como Trastorno por Estrés Postraumático (TEPT) y a pesar de que en nuestro país existen cifras alarmantes de ausentismo laboral y baja en la productividad como consecuencia de ello, no ha sido estudiado a profundidad. El Estrés Postraumático es un trastorno de ansiedad causante de disfunción psicosocial y aparece en condiciones de exposición a un estresor traumático. La etiología del TEPT es multifactorial y en ella intervienen factores genéticos, psicológicos, educativos y ambientales. El propósito del presente estudio fue determinar la frecuencia del TEPT en pacientes que hubiesen tenido lesiones físicas por accidentes de tránsito (accidentes automovilísticos producidos por vehículos de motor) y que fueron atendidos en el Servicio de Ortopedia y Trauma, del Hospital Regional "Lic. Adolfo López Mateos" del ISSSTE. Para ello se diseño un estudio transversal descriptivo con muestreo no probabilístico seleccionando una muestra mediante los criterios de inclusión siguientes: ser mayor de 18 años, haber sufrido accidente por vehículo de motor, haber sido atendido al menos por un mes en el Servicio de Trauma y Ortopedia de ese centro hospitalario, y encontrarse en condiciones físicas y mentales para contestar un cuestionario. El instrumento fue un formato autoaplicable conformado por la Escala de Mississippi para el TEPT para tamizaje, selección de casos y medición de la severidad de los síntomas. También se incluyó la Cédula de Evaluación Clínica en Neuropsiquiatría de la OMS (Schedules for Clinical Assessment in Neuropsychiatry-SCAN), un instrumento que establece el perfil de afecto (PANAS), y por último una cédula de identificación para datos sociodemográficos. En el estudio participaron 37 sujetos que cumplieron con los criterios de inclusión. De éstos, 57% fueron hombres y 43% mujeres, con un promedio de edad de 35 años (DE=12.44); 40.5% eran solteros, 51.4% casados; 43.2% de los sujetos tenía nivel de educación básica y 56.8% media superior y superior. Para la calificación de TEPT, se determinó como casos a los sujetos que puntuaron por arriba de 5 en la Escala de Mississippi y posteriormente eran confirmados con la cédula SCAN. La mayoría de los sujetos que sufrieron accidentes fueron hombres (57%), los eventos ocurrieron en día sábado, cuando éstos se dirigían a su casa, en su automóvil y sin compañía. La mayoría de los sujetos estuvieron involucrados en choques vehiculares. De todos los casos, 62.2% cumplieron con los criterios para ser corroborados con TEPT, lo cual representa un porcentaje mayor al reportado en población mexicana. Se encontraron diferencias estadísticamente significativas en la proporción de sujetos que reportaron TEPT y el tipo de vehículo en que se encontraban al ocurrir el accidente (X2=9.868, p=.007), así como en el tiempo que había trascurrido desde el momento del mismo (X2=8.651, p=.013). De las pruebas de asociación con el perfil de afecto, el afecto negativo durante la última semana anterior al estudio tuvo una correlación positiva y significativa con el TEPT, es decir que a mayor afecto negativo hay más síntomas de estrés.

Summary: We have carried out this research because accidents are a serious public health problem in Mexico. They are the third overall mortality cause and the first among young adults. In addition, in our country, the study of posttraumatic stress disorder (PTSD) has not been focused sufficiently on accidents, not to speak of motor vehicles accidents. Among the different types of accidents, traffic accidents are placed at the top of the list. Aside from causing injuries and the loss of man hours at work, these accidents bring about emotional distress to affected individuals. Stress is a factor that triggers short-and medium-term consequences which are in turn reflected in the quality of life of the patient and his/her family. PTSD is an anxiety disorder that causes psychosocial disfunctioning and appears due to the exposure to a stressor or traumatic event. It may come about in two ways: when the subject is a victim of a serious threat to his/her life or integrity and when the subject witnesses an event seriously affecting a third party. The main stressors may be natural phenomena, such as hurricanes and earthquakes, intentional attacks, such as rape or any form of criminal violence, and, as is the case here, from traumatic events caused by motor vehicles. The etiology of PTSD is multi-factorial and involves genetic, psychological, educational, and environmental aspects. It has three forms: severe, where the disorder appears immediately after the occurrence of the event or until a month later; chronic, lasting between one and three months; and delayed, where symptoms appear six months after the event. Our objective was to establish PTSD frequency in patients with physical injuries caused by motor vehicles accidents who were attended at the Regional Orthopaedics and Trauma Hospital "Adolfo López Mateos". Together with the application of the scales, we were interested in making a description of the socio-demographical side of accidents, comparing the affect profile, and somehow defining the wide range of factors involved in the occurrence of this problem. For this, we devised a transversal and descriptive study with a non-probabilistic sampling. The sample was chosen using the following inclusion criteria: a) Being older than 18 years. b) Having suffered a motor vehicle accident. c) Having received attention for a month at least at the Orthopaedics and Trauma Hospital "Adolfo López Mateos". d) Having the physical and mental conditions to answer a self-report questionnaire or at least to be interviewed instead. The instrument used was a self-report questionnaire consisting of different scales: 1. The Mississippi PTSD Scale for screening, case selection and symptoms severity measurement. This scale has been translated and validated in Mexico. 2. The WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN). 3. An instrument to establish the affect profile (PANAS). 4. A socio-demographical data identification schedule. Results from this study show some interesting characteristics from subjects involved in traffic accidents such as the fact that victims are mostly men driving alone at weekends. As has been pointed out, this supports the importance of putting into practice actions to educate drivers involved in such circumstances more often. In addition, policies which allow for the modification of traffic environments as to their adequateness to social contexts should be established. Likewise, data from this work agree with those from other studies as to the existence of an association between the presence of PTSD and the involvement in car accidents. Although the prevalence of the sample of this study is much higher than previous Mexican reports, it shows some interesting figures regarding the fact that most subjects who reported PTSD were women who had an elementary education level and a partner by the time of the accident. Falls from vehicles, people run over by cars and individuals driving alone at the time of accidents were other relevant high-impact findings. While it is true, on the one hand, that the aforementioned results are non-significant, they do give an idea of some aspects which would be useful to bear in mind in providing clinical attention to affected individuals. On the other hand, aspects which did have a statistical significance on the data from this sample should be taken into account. One of these was the fact that the higher rate of PTSD was reported in individuals who suffered an accident while being inside a vehicle, in individuals involved in an accident which had occurred between one and three months before and who in addition tended to present a negative affect profile. These are important findings because they give us the opportunity to consider more specific aspects at the time of developing attention strategies which could alleviate the temporal impact and scale of the problem.

Panorama del trabajo de investigación en epidemiología psiquiátrica en México: últimos 30 años

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Abstract: Mental health frames and policies to enforce them cannot be excluded from the social context, neither the population's health conditions or the international tendencies. Their strategic place depends on the role they play in the global milieu, and on the benefits derived from what is done in terms of prevention and attention within the field. Psychiatric epidemiology serves as a tool for knowing mental disorders distribution, the risk factors implied in their etiology and evolution, as well as the elements influencing their detection and treatment. But psychiatric epidemiology has remained behind other branches of epidemiology given the problems for conceptualizing and measuring mental disorders. Thus, most of the work has been basically descriptive. Nevertheless it has been possible to move forward through historical series, analyses of community diagnosis, health services evaluation, risk measurement, description of clinical frames, identification of new syndromes and its related causes, and in carrying out national and international representative surveys in general population. This paper has four objectives: 1. to present an overview of the work done in epidemiologic psychiatry in Mexico for the last 30 years; 2. to analyze the main areas explored; 3. to identify the most used designs; and 4. to enumerate the populations studied. Method. Articles about different aspects related to study and analysis of psychiatric epidemiology in Mexico were collected, including those reporting empirical results. The search was performed in a bibliographic database consulted in the Centro de Información en Salud Mental y Adicciones (CISMAD), located at the Instituto Nacional de Psiquiatría Ramón de la Fuente. Approximately 158 papers published in national and international journals were reviewed. Results. In the 1970's, work was aimed towards historical analysis seeking to provide an epidemiologic view of psychiatric disorders in Mexico. Interest was set on aspects related to attention of mental patients, the teaching of psychiatry, and in the advance of psychiatric knowledge. Some studies were done to have a look at the frequency and characteristics ofcertain diseases in unexplored populations. During the 1980's there was a renewed interest in dissecting the status of epidemiologic psychiatry and mental health, together with an intention to state its role in the future. Cross sectional studies were performed to know the prevalence ofdifferent mental illnesses in medical care. Validity and reliability of several detection and diagnosis instruments were evaluated, and some essays about the importance of having a clear view of attention needs and demands were carried out. At the beginning of the 1990's there were descriptive studies in rural and urban populations to describe the main elements determining the use of health services and the quest patterns for different attention options. New diagnosis instruments were used in subjects attending the first and second levels of care. Research on schizophrenia began with reviews and dissertations about its status in Mexico and other countries. Results of the Mental Health National Survey showing prevalence in general population were made public. Home base surveys made possible to know the scope of mental illness in children, adolescents, and adults. The use of epidemiology in child psychiatry allowed the inclusion of developmental psychopathology in the analysis of the interaction and interdependence of biological, psychological, and social variables. The 21st century set the emergence of the first longitudinal reports on suicide. Work continues on the prevalence of mental illness and new approaches on risk factors are added. Research on the frequency of disorders from well-defined diagnosis criteria is signed. Use and abuse of substances, and violence against women are studied to know their effects on mental health. The Survey on Psychiatric Morbidity was planned and conducted with great methodological rigor, and thus it was included in the first generation of ICPE studies, which has enabled data comparison on an international basis. Results have shown that depressive disorders are the most recurrent, whereas disorders related to substance abuse and dependence affect basically men, and that anxiety disorders are the most chronic. In 2000, the World Health Organization launched an initiative to make national epidemiologic studies in different countries, and Mexico was the first Latin American country to participate. The National Psychiatric Epidemiology Survey initial results have confirmed that the prevalence of disorders along life is 28.6%, and that annual prevalence is 14%. Discussion. It is important to underline the need to pay attention to mental health problems from a preventive approach. In this respect, Mexico is a little behind and it is urgent to grow according to the advances, instruments, and techniques used in other countries. It is also important to acknowledge the work done so far; in this sense, the development of national surveys accounts for it. General population studies allow for the generation of an overview of the needs and the basic issues to create preventive interventions. Mexican epidemiologic psychiatry is in a developmental stage, stressed by the use of standardized diagnosis criteria to get comparable data (both from Mexico and other countries in the world). However, the study designs employed until now do not allow for the exploration of the temporary evolution of disorders and related factors to be more exhaustive. Besides, there are limitations in evaluating health services, which could be overcome through cost-effectiveness analyses. In the national context it is notorious the lack of inquiring about the diagnosis boundaries, which should be one of the main directions of psychiatric epidemiology in the next years. This would be highly relevant taking into account that Mexico is a transition country that accepts and uses both European and American criteria. It should be mentioned also that, although Mexico has the same kind of problems than other countries, research has shown they are smaller, which makes studies on protective and risk factors a priority for the future. There are still certain aspects of epidemiology which remain practically untouched in research. For instance, it is important to focus on rural areas, on migrant populations, and on native groups to overcome the existing backwardness. Another important topic in the prevention area is the work to do carried out with mental problems during childhood and adolescence. Longitudinal studies would mark the path to evaluate different types of factors: genetic, biologic, familiar, psychodyna-mic, social, and economic. It is also important to analyze the interaction among them to know its impact on etiology and on the development of psychopathology during life.