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Resumen: El daño hepático por medicamentos no es tan raro, su diagnóstico es por exclusión, en algunos casos puede inducir falla hepática aguda. Se realizó una revisión de la bibliografía de los medicamentos más utilizados en los procedimientos anestésicos y el riesgo que existe en estos medicamentos de desarrollar daño hepático por fármacos; los únicos medicamentos que tienen mayor riesgo de hepatotoxicidad son los inhalados halogenados, particularmente el halotano, ahora en desuso, el resto de los medicamentos son seguros.
Abstract: Liver damage by drugs is not so rare, its diagnosis is by exclusion, in some cases can induce acute liver failure. A review of the literature of the drugs most used in anesthetic procedures and the risk that exists of these drugs in the development of liver damage by drugs was carried out; the only drugs that have a higher risk of hepatotoxicity are halogenated inhaled ones, particularly halothane now in disuse, the rest of the drugs are safe.
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Abstract Introduction Research findings about intimate-partner violence (IPV) have focused mostly on women as victims of violence. Recent studies show the importance of violence inflicted by women towards men or between same-sex couples. Objective To estimate the prevalence of intimate-partner violence and its association with alcohol and drug consumption in a representative sample of men and women in Mexico through secondary data analysis. Method The data come from a representative sample who filled out the section on intimate-partner violence in the Mexican 2011 Encuesta Nacional de Adicciones (National Survey on Addictions). Results The prevalence of intimate-partner violence in the last year was 17.6% against women and 13.4% against men. If one of the two partners consumed substances, the risk that men and women would experience violence increased, and that risk was even greater if both consumed. Discussion and conclusion This is the first time violence against men was reported in a Mexican national study. The findings show that gender-based violence should also be considered a result of social and cultural violence.
Resumen Introducción Los hallazgos de investigación sobre la violencia de pareja se han centrado principalmente en las mujeres como víctimas de la violencia. Estudios recientes destacan también la importancia de la violencia infligida por las mujeres hacia los hombres o entre parejas del mismo sexo. Objetivo Estimar la prevalencia de la violencia de pareja y su asociación con el consumo de alcohol y drogas en una muestra representativa de hombres y mujeres en México mediante un análisis secundario de datos. Método Los datos provienen de la Encuesta Nacional de Adicciones de México 2011, específicamente de una muestra representativa que contestó la sección sobre violencia de pareja. Resultados La prevalencia de violencia de pareja en el último año fue de 17.6% hacia las mujeres y de 13.4% hacia los hombres. Si uno de los dos integrantes de la pareja consumía sustancias, aumentaba el riesgo de que hombres o mujeres experimentaran violencia y ese riesgo era aún mayor si ambos consumían. Discusión y conclusión Esta es la primera vez que se reporta la violencia hacia los hombres en un estudio nacional mexicano. Los resultados muestran que la violencia de género también debe considerarse como resultado de la violencia social y cultural.
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Abstract Introduction Almost 5% of the Mexican general population (18-65 years old) has suffered depression once in their lives, and 2% of them more than once without receiving treatment. Objetive To measure the prevalence of depressive disorder and to calculate its relationship with psychosocial indicators. Method Data were collected through two censuses with high school and college students from a university in Mexico City (n = 116 214). Participants completed the CES-D and other scales. Multivariate logistic regression models were used. Results The prevalence of depressive disorder was 16%. Predictors of depressive disorder were: having suffered psychological or sexual violence, having a family member who had been injured during an assault, history of depression in the family, poor quality in family and social relationships, among others. Discussion and conclusion The prevalence of depressive disorder increases with age. As prevention and treatment at an early age are essential, intervention and monitoring strategies must be created and systematized taking gender and other elements into account, such as the relationship with the parents, violence, and a history of depression in the family.
Resumen Introducción Casi el 5% de la población general de México (18-65 años) ha sufrido depresión una vez en su vida y 2% la ha sufrido más de una vez sin haber recibido tratamiento. Objetivo Medir la prevalencia del trastorno depresivo y calcular su relación con algunos indicadores psicosociales. Método Los datos fueron recolectados por medio de dos censos con estudiantes de bachillerato y de licenciatura en la Ciudad de México (n = 116 214). Los participantes completaron el CES-D y otras escalas. Se usaron modelos de regresión logística multivariable. Resultados La prevalencia del trastorno depresivo fue del 16%. Los predictores del trastorno depresivo fueron: haber sufrido violencia psicológica o sexual, tener un miembro de la familia que hubíera sido herido durante un asalto, antecedentes de depresión en la familia, mala calidad en las relaciones familiares y sociales, entre otros. Discusión y conclusión La prevalencia del trastorno depresivo aumenta con la edad. Como la prevención y el tratamiento a una edad temprana son esenciales, se deben crear y sistematizar estrategias de intervención y monitoreo que tomen en cuenta el género y otros elementos, como la relación con los padres, violencia e historia de depresión en la familia.
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Abstract Introduction Parenting practices refer to specific behaviours used by parents and caretakers of children to guide childhood development and socialization goals. These practices are associated with children's health, psychological, and physical development. Objective To determine the psychometric properties of the Parenting Practices Inventory (PPI) among a group of child caregivers in Mexico City. Method The PPI was applied to 443 caregivers of children and adolescents, who attended a general health care centre in Mexico City. For the psychometric evaluation of the instrument, the full distribution and discrimination of the items was analysed first. Then, the validity of the construct was tested through an exploratory factor analysis and a confirmatory analysis with structural equation modelling. Results The internal consistency of the PPI showed α = .867 and 41.25% of variance explained for all four dimensions of interest. The confirmatory factor analysis showed that the model had goodness of fit. It included twenty-four items with adequate consistency and validity indices. Discussion and conclusion The PPI is therefore a potentially useful psychometric measure for evaluating parenting practices among this type of population and could have major implications for the development of interventions and preventive programmes. It provides scientific bases for diagnostic decision-making and primary health care from the moment of initial contact to specialized medical care.
Resumen Introducción Las prácticas de crianza se refieren a comportamientos específicos utilizados por los padres y cuidadores de niños para guiar su desarrollo y metas de socialización infantil. Estas prácticas están asociadas con la salud, el desarrollo psicológico y físico de los niños. Objetivo Determinar las propiedades psicométricas del Inventario de Prácticas de Crianza (IPC) entre un grupo de cuidadores de niños en la Ciudad de México. Método El IPC se aplicó a 443 cuidadores de niños y adolescentes, que asistieron a consulta médica general en un Centro de salud en la Ciudad de México. Para la evaluación psicométrica del instrumento se analizó la distribución total y la discriminación de los reactivos. La validez de constructo se probó a través de análisis factorial exploratorio y análisis confirmatorio con modelos de ecuaciones estructurales. Resultados El IPC mostró α = .867 y 41.25% de la varianza explicada para las cuatro dimensiones de interés. El análisis factorial confirmatorio mostró que el modelo tuvo buena bondad de ajuste. Incluyó veinticuatro ítems con una consistencia e índices de validez adecuados. Discusión y conclusión El IPC es una medida psicométrica potencialmente útil para evaluar las prácticas de crianza en esta población y podría tener implicaciones importantes para el desarrollo de intervenciones y programas preventivos. Esto brinda bases científicas para la toma de decisiones en la atención primaria de la salud desde el momento del contacto inicial hasta la atención médica especializada en caso de ser requerida.
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Abstract Introduction Non-suicidal self-injuries (NSSI) are a worldwide health problem that affects principally young people, and can impact negatively the mental and physical health of those that self-injure. Objective To examine the frequency of NSSI in 564 undergraduate students (132 male, 432 female) from Mexico City and the association of NSSI with depressive symptoms, anxiety, impulsivity, self-efficacy, and emotion regulation. Method A convenience sample of 564 undergraduate students (aged 17-26 years) from eight universities in the Mexico City metropolitan area completed a survey in their classrooms. Results Of the total sample, 30.9% had experimented at some point in their lifetime with NSSI on one to four occasions, while 26.9% had recurrent NSSI (i.e., five or more occasions). Nearly eleven percent self-injured in the prior 12 months. The NSSI most often reported among those who self-injured was cutting oneself (48.0%). Recurrent self-injurers reported higher levels of depression and impulsivity, and less self-efficacy than those who had experimented with such behaviors or without any lifetime NSSI. While 54.4% perceived the need for professional help, only 18.1% sought professional services. Discussion and conclusion NSSI is a hidden problem in the college population in Mexico City which needs to be addressed by university administrators and mental health professionals. Depressive symptomatology, impulsivity, and self-efficacy are factors that should be considered when developing preventive intervention strategies.
Resumen Introducción Las autolesiones no suicidas (ANS) son un problema mundial de salud que afecta principalmente a jóvenes, y puede impactar de manera negativa la salud mental y física de la persona que se autolesiona. Objetivo Examinar la frecuencia de ANS en 564 estudiantes de licenciatura (132 hombres, 432 mujeres) de la Ciudad de México y la asociación de las ANS con síntomas depresivos, ansiedad, impulsividad, autoeficacia y regulación emocional. Método Una muestra de conveniencia de 564 estudiantes universitarios (edades 17-26 años) de ocho universidades del área metropolitana de la Ciudad de México completó una encuesta en sus salones de clases. Resultados Del total de la muestra, 30.9% se habían infligido ANS de manera experimental de una a cuatro ocasiones, mientras que 26.9% presentaron ANS recurrentes (cinco o más ocasiones) en algún momento en su vida. Casi once por ciento reportaron ANS en los 12 meses previos. Las ANS reportadas con mayor frecuencia entre aquellos que se autolesionaron fueron cortarse a sí mismos (48.0%). Las personas con autolesiones recurrentes reportaron mayores niveles de depresión e impulsividad, y menos autoeficacia que aquellas que habían experimentado con estos comportamientos o sin ninguna historia de ANS en su vida. Aunque 54.4% percibían la necesidad de atención, solo 18.1% buscaron servicios profesionales. Discusión y conclusión Las ANS son una problemática oculta en la población universitaria de la Ciudad de México, la cual necesita ser atendida por las autoridades universitarias y los profesionales de la salud. La sintomatología depresiva, impulsividad y autoeficacia son factores que se deben considerar para desarrollar estrategias preventivas.
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Resumen: INTRODUCCIÓN: La supervisión parental comprende: cuidado de los hijos, conocimiento de su paradero y actividades y adaptación. Para que ésta se dé es necesario que exista comunicación y apoyo entre padres e hijos, de manera que el ambiente familiar sea agradable. Por otro lado, se ha encontrado que la inconsistencia o ausencia de ésta es un factor de riesgo de la conducta antisocial y, en casos más graves, de delincuencia en los hijos. OBJETIVO: Conocer cuál es la relación que existe entre el ambiente familiar, la supervisión parental y la gravedad de la conducta antisocial en menores infractores. MÉTODO: La población estuvo conformada por menores infractores de un Centro Tutelar del Estado de Morelos. El instrumento se aplicó a 86 hombres. RESULTADOS: La comunicación del hijo fue un predictor de: 1. el manejo de reglas y conocimiento de pares, y 2. el conocimiento de las actividades del hijo. Esto último es lo que predice de manera significativa la gravedad de la conducta antisocial. DISCUSIÓN Y CONCLUSIÓN: De acuerdo con los hallazgos, es importante que exista un ambiente familiar basado en la comunicación y el apoyo, que fomente una comunicación más libre de los adolescentes con sus padres, de manera que la supervisión parental se consiga más fácilmente. Esto ayudará para que los jóvenes no se involucren en comportamientos que los puedan llevar a delinquir.
Abstract: INTRODUCTION: Parental supervision is constituted by a series of correlated parental behaviors involving children care, knowing their where abouts, which activities they are performing, and the situation of their adaptive processes. In order for parental supervision to take place, it is necessary that communication and mutual support exist between mother and father, as well as between parents and children so that the family environment becomes pleasant. Supervision is one of the most studied factors related to anti-social behavior, and it has been observed that its absence or inconsistency allows for the occurrence of anti-social behavior, which in the more serious cases leads to delinquency. OBJECTIVE: To know the relationship between family environment, supervision and the seriousness of anti-social behavior in juvenile offenders confined in a state penitentiary from Morelos. METHOD: A survey was used to collect data from a population of 86 juvenile male offenders from a state penitentiary located in Morelos. RESULTS: Parent-children communication and support are interrelated and form the familiar environment. Thus, children's communication predicts proper supervision and monitoring, specifically in the area of knowing children's activities, which, at the same time, predict less serious anti-social behavior. DISCUSSION AND CONCLUSION: It is important that families have an environment based on communication and support. It is also relevant to encourage adolescents to freely communicate with their parents so supervision and monitoring become common elements that help adolescents to stay away from behaviors that could lead them to crime.
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Resumen La presente investigación evalúa las propiedades psicométricas de la adaptación al español del Inventory of Statements About Self-injury de Klonsky y Glenn (2009). Esta escala evalúa las diferentes motivaciones o funciones que las personas refieren para realizar autolesiones no suicidas. Se aplicó la escala en una muestra (N = 435) de alumnos universitarios de ambos sexos con una historia de autolesiones no suicidas. El análisis factorial confirmatorio detectó 7 factores interpretables (autorregulación, venganza, búsqueda de sensaciones/fortaleza, evitando el suicidio, manifestando angustia, autodeterminación y embotamiento), 5 más que el instrumento original. La confiabilidad de la escala fue aceptable, con un alfa de Cronbach de 0.89 para la escala total y de 0.72 a 0.82 para cada factor. Se presenta la validez convergente a través de correlaciones positivas entre la escala y mediciones de depresión, ansiedad e impulsividad. El instrumento adaptado al español presenta propiedades psicométricas aceptables para la medición de autolesiones no suicidas en población universitaria mexicana.
Abstract This research evaluates the psychometric properties of the Spanish language adaptation of the Inventory of Statements About Self-injury (Klonsky and Glenn, 2009). This scale assesses the motivations or functions that people with non-suicidal self-injuries report for engaging in self-injurious behaviors. The inventory was administered to a sample of 435 male and female university students with a lifetime history of non-suicidal self-injuries. A confirmatory factor analysis detected 7 interpretable factors (self-regulation, revenge, sensation seeking/toughness, avoiding suicide, marking distress, self-determination and numbness), 5 more than the original instrument. The scale had adequate internal consistency with a Cronbach's alpha of 0.89 and Cronbach's alphas of 0.72 to 0.82 for each factor. Positive correlations between the scale and measures of depression, anxiety and impulsivity suggest the convergent validity of the scale. Overall, the scale presents acceptable psychometric properties for the measurement of non-suicidal self-injuries in a Mexican university population.
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ANTECEDENTES: La sintomatología ansiosa y depresiva es parte de los principales problemas de salud mental en pacientes oncológicos, lo cual afecta la calidad de vida y la adhesión al tratamiento, además de que se asocia con mayor número de síntomas y estancia hospitalaria. Mediante instrumentos de tamizaje válidos y confiables, como la Escala hospitalaria de ansiedad y depresión (HADS), ha sido posible detectar posibles casos en pacientes hospitalarios. Sin embargo, hasta ahora no se habían caracterizado las propiedades psicométricas en pacientes oncológicos en población mexicana.OBJETIVO: Determinar las propiedades psicométricas de la HADS en una muestra de pacientes oncológicos.MÉTODO: Participaron 400 pacientes del Instituto Nacional de Cancerología, de los cuales 226 eran mujeres (56.5%) y 174 eran hombres (43.6%); la edad promedio fue de 47.4 ± 14.1 años. Los participantes contestaron, además de la HADS, los siguientes inventarios: depresión de Beck, ansiedad de Beck, termómetro de distrés.RESULTADOS: Un análisis factorial ajustado a dos factores presentó un instrumento con 12 reactivos, similar a la versión original. La consistencia interna de la escala global mostró un índice satisfactorio (a=0.86). Los alfas de Cronbach de cada subescala tuvieron un valor de .79 y .80 que explicaron el 48.04% de la varianza. La validez, por medio de correlación con las medidas concurrentes, mostró resultados significativos (r de Pearson de .51 a .71, p<0.05).DISCUSIÓN Y CONCLUSIÓN: La HADS en pacientes con cáncer en población mexicana presentó adecuadas características psicométricas. La relevancia de los resultados obtenidos radica en que se trata de una población que puede llegar a requerir atención oportuna en salud mental en etapas tempranas de su tratamiento. La detección de sintomatología ansiosa y depresiva por medio de la HADS deriva en beneficios para la población oncológica y en estrategias funcionales de atención adecuada y costo-efectivas.
BACKGROUND: Symptoms of anxiety and depression are among the major mental health problems in cancer patients. These symptoms affect the quality of life and treatment adherence, and are associated with other symptoms and longer hospital stays. Valid and reliable screening instruments such as the Hospital Anxiety and Depression Scale (HADS), have made possible the detection of possible cases of depression and anxiety in medically ill patients. However, the psychometric properties of this instrument have not been documented in different types of cancer diagnoses in the Mexican population.OBJECTIVE: To determine the psychometric properties of the HADS in a sample of patients with cancer from the Mexican population.METHOD: Four hundred patients from the National Cancer Institute participated, of which 226 were women (56.5%) and 174 men (43.6%), with a mean age of 47.4 ±14.1 years. Participants completed concurrently the HADS as well as the following inventories: 1. Beck Depression, 2. Beck Anxiety and 3. Distress Thermometer.RESULTS: A factor analysis adjusted to two factors explained 48.04% of the variance, with 12 items loading on these two factors in a way similar to the original version. The internal consistency of the overall scale was satisfactory (α=0.86). Cronbach's alphas for each subscale were .79 and .80. The concurrent validity assessed by way of correlations with concurrent measures showed significant associations (Pearson r=51-71, p<0.05).DISCUSSION AND CONCLUSION: The HADS has adequate construct validity, internal consistency and concurrent validity for its use in cancer patients from the Mexican population. The relevance of these results is a cost effective tool to provide timely mental health care early in oncological treatment for those in need. Detecting anxiety and depression symptoms through the HADS may benefit cancer patients by ensuring appropriate care that may increase their quality of life and treatment adherence, and reduce their hospital stays.
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Los objetivos de este trabajo fueron explorar: (1) la asociación entre medio ambiente social a niveles municipal y familiar, y conductas alimentarias de riesgo, en mujeres adolescentes; y (2) la interacción entre medio ambiente social y cultural e índice de masa corporal (IMC). La información se obtuvo de una encuesta representativa de las estudiantes de preparatoria en el Estado de México, México (15-19 años). Se aplicó un cuestionario para conductas alimentarias de riesgo y datos sociodemográficos. Se evaluó el medio ambiente social y cultural municipal mediante el índice de marginación del municipio. El análisis se hizo mediante regresión multinivel. La prevalencia de conductas alimentarias de riesgo fue 4,23%. El IMC y el nivel socioeconómico familiar se asociaron directamente con conductas alimentarias de riesgo. El índice de marginación municipal no se asoció con conductas alimentarias de riesgo. Esto puede deberse a que no se midieron los componentes relevantes del medio ambiente social y cultural, o a que el nivel municipal no ejerza un efecto contextual sobre conductas alimentarias de riesgo. El efecto del IMC sobre conductas alimentarias de riesgo fue mayor en municipios más marginados.
The objectives of the current study were to explore: (1) the association between the social environment at the city and family levels and risky eating behaviors in adolescent females and (2) the interaction between the social and cultural environment and body mass index (BMI). The data were obtained from a representative survey of female high school students in Mexico State , Mexico (15-19 years). A questionnaire was applied on risky eating behaviors and socio-demographic data. The municipal social and cultural environment was evaluated using the municipal marginalization index. Data analysis used multivariate regression. Prevalence of risky eating behaviors was 4.23%. BMI and family socioeconomic status were directly associated with risky eating behaviors. The municipal marginalization index was not associated with risky eating behaviors. Possible explanations for the latter are that the relevant components of the social and cultural environment were not measured, or that the municipal level does not exert a contextual effect on risky eating behaviors. The effect of BMI on risky eating behaviors was greater in more marginalized municipalities.
Os objetivos deste trabalho foram: (1) explorar a associação entre ambiente social, no nível municipal e familiar, e hábitos alimentares de risco em mulheres adolescentes; e (2) explorar a interação entre ambiente social e cultural e o índice de massa corporal (IMC). Os dados foram conseguidos através de uma pesquisa representativa entre estudantes do segundo grau no Estado de México, México (15-19 anos). Foi aplicado um questionário sobre hábitos alimentares de risco e dados sociodemográficos. O ambiente social e cultural municipal foi avaliado pelo índice de marginalização do município. A análise utilizou o modelo de regressão multinível. A prevalência de hábitos alimentares de risco foi de 4,23%. O IMC e o nível socioeconômico familiar foram diretamente associados a hábitos alimentares de risco. O índice de marginalização municipal não foi associado a hábitos alimentares de risco. Isso pode ser devido ao fato que não foram medidos os componentes relevantes do ambiente social e cultural, ou ao fato que o nível municipal não exerce um efeito contextual sobre hábitos alimentares de risco. O efeito do IMC sobre hábitos alimentares de risco foi maior nos municípios mais marginalizados.
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Adolescent , Female , Humans , Young Adult , Feeding and Eating Disorders/epidemiology , Feeding Behavior , Social Environment , Body Image , Body Mass Index , Local Government , Mexico/epidemiology , Prevalence , Risk Factors , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
Depression is an emotional upset that disrupts the psycho-affective sphere and is associated with different risk behaviors, as alcohol and tobacco use, among young people. The aim of this study is to analyze the differences on depression in four groups of high school and college students (1. alcohol users, 2. tobacco users, 3. alcohol and tobacco non-users, and 4. alcohol and tobacco users). A census was conducted with 116 214 students with a mean age of 15 and 19 years. Heavy alcohol and tobacco use was more frequent in men. A factorial ANOVA analysis was used to compare depressive symptoms between heavy drinkers (4 or more drinks per occasion) and heavy smokers (4 or more cigarettes per day) by sex and school level. More depressive symptoms were found in college students (M = 9.7) than in the high school ones (M = 9.5, p<0.05). The group of alcohol and tobacco users showed higher levels of depressive symptoms (M=11.3) than the alcohol only (M=10.5) and tobacco only users (M=10.7). Women showed more depressive symptoms (M=10.3) than men. Results point out the need for early detection and intervention, and for more monitoring strategies to develop actions for reducing alcohol and tobacco use in this population and, eventually, depressive outcomes.
La depresión es un malestar emocional que trastoca la esfera psicoafectiva y se asocia con distintas conductas de riesgo como el consumo de alcohol y de tabaco, particularmente en la población joven. El objetivo de este estudio fue analizar las diferencias que existen respecto a la depresión en cuatro grupos de adolescentes (1. consumidores de alcohol, 2. consumidores de tabaco, 3. no consumidores de alcohol ni de tabaco y 4. consumidores de alcohol y tabaco) estudiantes de Bachillerato o Licenciatura. Se realizó un censo con 116 214 estudiantes, con un promedio de edad, en nivel medio superior, de 15 años y de 19 años en nivel superior. El consumo elevado fue más frecuente en los hombres de ambos niveles educativos. Se hizo un análisis de varianza (ANOVA) factorial para determinar las diferencias en la sintomatologia depresiva entre aquéllos que presentaban consumo elevado de alcohol (cuatro o más copas por ocasión) y de tabaco (cuatro o más cigarrillos al dia) por nivel educativo y sexo. Se encontró sintomatologia depresiva más elevada en los estudiantes de nivel superior (M=9.7), en contraste con los jóvenes de medio superior (M=9.5) (p<0.05). Al comparar la sintomatologia depresiva entre los grupos de consumo, los resultados indicaron mayores puntajes en el grupo de consumidores de alcohol y tabaco (M=11.3), seguidos de usuarios excesivos de tabaco solamente (M=10.7) y de alcohol solamente (M=10.5). Las mujeres de ambos niveles educativos presentaron una mayor sintomatologia depresiva (M=10.3), seguidas de los hombres de nivel superior (M=9) y los hombres de nivel medio superior (M=8.8). Los resultados favorecen el desarrollo de acciones de detección e intervención temprana y el monitoreo de esta población.
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Introduction Depression and its symptoms are becoming one of the most important health problems worldwide. The impact of depression on the productive life of people, and the burden it represents because of its co-morbidity, is growing. Some authors estimate that depression is the second cause for the global loss of years of healthy life and the first one in developed countries. An increasing proportion of teenage population has mental health issues. Depression and its symptoms are among the most common, but they are not an epidemic problem yet, although spread enough as to maintain interest in its current impact and in its negative consequences over individual health. Depression has a prominent place among mood disorders in Mexico (4.5%), and women are who mostly suffer it (5.8%), which has remained consistent over time. Different difficult situations occur during adolescence along with depression, depressive mood, and depressive symptoms. This situation may be related to changes and processes that occur during this period when individuals cope with situations they cannot handle, which in turn become stressful. Therefore, it is necessary to study and to work with adolescents in order to be able to differentiate affective, cognitive, somatic, and behavioral expressions, which are proper to this stage, from those possibly caused by an illness that could have negative consequences. Adolescent depression influences mood and the way individuals live unpleasant or annoying experiences, thus it affects almost every aspect of life and becomes a risk factor for psychiatric and behavioral problems. However, there are some areas that need more research, for example: the specific characteristics and expressions of the problem including gender comparisons and using designs with special groups. Data show that depression is growing in adolescents; therefore it is a priority to work on detection and prevention to reduce its impact on mental health and to develop cost-effective intervention strategies. One way to do this is using valid-reliable screening tools because they are cheap, and methodologically-logistically useful. The Center for Epidemiological Studies Depression Scale (CES-D) has been used in different studies with Mexican adolescents, and has proven to have good psychometric characteristics. The CES-D has never been used with an entire population in a great scale study. The objective of this paper is to measure the validity and reliability of the scale (construct, concurrent, and external validity, as well as internal consistency) in a population of high school and college freshman students from Mexico City. Method Design. The study was a census made with high school and college freshman students during 2009. Data were collected in 22 schools. Population. A sample of 58568 students participated in the census. The mean age was 1 7 years old (±2.7). Most of the students lived in homes with one to four other persons at the moment of the study (55.4%); 86% said that only their father worked at that moment, and 59.4 said that only the mother; 79.7% of the students lived with both parents, and 1 7.9% only with their mother; 57403 students (98.0% of the population) completed the CES-D in the age range of 14-24 years: 27264 (47.5%) men, and 30139 (52.5%) women. Instrument. The Automated Medical Examination (Examen Médico Automatizado-EMA) is a diagnostic questionnaire designed by the General Directorate of Medical Services (Dirección General de Servicios Médicos) of the Universidad Nacional Autónoma de México (UNAM). It is a questionnaire with four self-report forms that collect information about the physical and mental health, the family, and the general context of every student. This information is used to create a diagnosis of vulnerability and a predictive profile for developing prevention programs, as well as research protocols that help in promoting a culture for health care. The CES-D was included for the measurement in 2009. Results Overall internal consistency was adequate (α=.83). Internal consistency was tested by sex; the coefficient was higher for women (α=.84). Factor analysis generated a four-factor solution (explained variance 54.1%); each factor had good internal consistency and theoretical agreement. The scale showed a significant discriminative power for opposite scores (z=-l44.121, p<.001), and a positive significant correlation with the Okasha Suicidality Scale (rΦ=.325, p = .000). A cut-off point of 16 or higher was established to identify students with high depressive symptomatology. 14.7% of the participants in this study had high depressive symptomatology (11.1% men, 1 7.9% women). Conclusions The CES-D is a valid and reliable epidemiological instrument for different populations. Since depression is a complex and dynamic phenomenon, it is important to evaluate the psychometric properties of any instrument used to measure it. The results of this study showed that the CES-D maintains its internal consistency as well as good concurrent-external validity. Coefficients are higher for women and they increase with age; thus, it would be necessary to refine some aspects to measure younger subjects in a more consistent manner. The data proved that CES-D is a useful instrument for distinguishing different levels of depressive symptomatology; this is relevant because the scale is often used in collective contexts, allowing systematic monitoring of depression with good cost-effective results. Monitoring is also important to keep acceptable levels of emotional wellbeing in student population. Development and refinement of instruments such as the CES-D would potentially lead to opportune and reliable detection of adolescents who may be at risk for suffering mental health problems. This would facilitate implementing more stable and continuous prevention and attention programs to reduce the negative impact of depression in the short term.
Introducción La depresión y sus manifestaciones sintomatológicas son parte de los principales problemas de salud entre la población mundial y su impacto en la vida productiva ha aumentado con respecto a otras enfermedades. En México, esta tendencia y sus consecuencias negativas en el desarrollo hacia la adultez justifican la necesidad de atenderla y prevenirla. A través de instrumentos de tamizaje válidos y confiables como la Escala de Depresión del Centro de Estudios Epidemiológicos [Center for Epidemiological Studies of Depression Scale: CES-D) diseñada en 1977 por Radloff, ha sido posible detectar posibles casos clínicos de depresión en diversos estudios con adolescentes escolares. Sin embargo, hasta ahora no se había documentado su comportamiento en una población de estudiantes a gran escala. Método El levantamiento de la información se realizó en agosto de 2009, previo al inicio del ciclo escolar. Se obtuvo información de 57403 alumnos, de los cuales 47.5% fueron hombres y 52.5% mujeres, con una edad promedio de 17 años (±2.7). Instrumento. La CES-D se incorporó en los formatos del Examen Médico Automatizado (EMA) quese utilizaron para realizar el levantamiento censal entre los alumnos de nuevo ingreso a bachillerato o licenciatura. Resultados Consistencia inferna y validez de constructo. La consistencia interna de la escala global mostró un índice satisfactorio (α=0.83). Los índices de contabilidad fueron adecuados para todos los grupos de edad. El análisis factorial con extracción de componentes principales y rotación oblicua arrojó una estructura de cuatro factores con valores Eigen mayores a uno, que explican 54.1% de la varianza; los coeficientes de consistencia interna y concordancia teórica resultaron satisfactorios: Afecto deprimido, Afecto positivo, Somatización e Interpersonal (como un indicador integrado por sólo dos reactivos). Validez concurrente por medio de grupos contrastados. En la prueba de grupos contrastados se compararon los puntajes globales de la CES-D que se situaron por debajo del percent i I 25 versus aquéllos por arriba del percentil 75. Se utilizó una comparación de promedios de Mann-Whitney, que mostró diferencias estadísticamente significativas entre los cuartiles contrastados (z = -144.121, p<.001). Validez externa. Se analizó mediante su asociación con la Escala de Expectativas de Vivir-Morir de Okasha (que también se aplica en el EMA), obteniendo una correlación positiva y significativa entre quienes tuvieron sintomatología depresiva elevada y quienes manifestaron deseos de morir (rΦ, = 0.325, p = .000). Detección de sintomatología depresiva elevada. La definición operacional de la sintomatología depresiva elevada se definió con el punto de corte (PC) de la CES-D con base en la media más una desviación estándar (PC> 1 6) con lo que se detectó una frecuencia de sintomatología depresiva elevada de 14.7% (n = 8,197): 11.1% en varones y 1 7.9% en mujeres. Conclusiones Los resultados muestran que en poblaciones tan grandes como la del presente estudio, la CES-D es una herramienta útil y adecuada, breve y fácil de aplicar y analizar para establecer un monitoreo que dé respuesta a una de las necesidades más apremiantes en la población escolar: la detección de la sintomatología depresiva elevada como un aspecto importante del malestar emocional. Sirve, además, para determinar la magnitud de la problemática y arribar a su prevención y, de ser el caso, instrumentar acciones para su tratamiento. La relevancia de los resultados obtenidos radica en que se trata de población escolar que puede llegar a requerir atención y prevención oportunas en salud mental en etapas tempranas de la enfermedad, incluso antes de la confirmación diagnóstica en los servicios especializados. Esta detección deriva en beneficios para la población escolar y en estrategias funcionales de atención adecuada y costo-efectivas.
ABSTRACT
OBJETIVOS: Validar la Prueba de Identificación de Trastornos Derivados del Consumo de Alcohol (AUDIT, por su sigla en inglés) en pacientes con esquizofrenia. MÉTODOS: Se aplicó la Cédula Diagnóstica Internacional Compuesta (CIDI, por su sigla en inglés) versión 1.0 y el AUDIT a 80 sujetos con esquizofrenia, de ambos sexos y mayores de 16 años, de la consulta externa del Instituto Nacional de Psiquiatría de la ciudad de México. RESULTADOS: De los 80 pacientes esquizofrénicos, 57 eran hombres y 23 mujeres con un promedio de edad de 30,5 y 34,3 años, respectivamente; la edad de inicio de la esquizofrenia fue de 22 años para los hombres y 26 años para las mujeres; 35 sujetos (43,7 por ciento) consumían alcohol al momento del estudio. La escala AUDIT mostró alta consistencia interna, con un alfa de Cronbach de 0,812; el punto de corte de la escala completa del AUDIT para esta población fue de 4 puntos o más; se construyeron los puntos de corte de la "prueba rápida" y de los "Problemas psicosociales y probable dependencia al alcohol" del AUDIT utilizando como estándar de comparación el CIDI (DSM-III-R y CIE-10). CONCLUSIONES: La validación del AUDIT mostró que es un instrumento de tamizaje muy útil y sensible para identificar a pacientes con esquizofrenia en riesgo de abuso o dependencia de alcohol, por lo que se recomienda su uso en estudios clínicos y epidemiológicos en Latinoamérica.
OBJECTIVES: To validate the Alcohol Use Disorders Identification Test (AUDIT) in schizophrenic patients. METHODS: The Composite International Diagnostic Interview (CIDI v. 1) and the AUDIT were administered to 80 subjects with schizophrenia, of both sexes, more than 16 years of age, from the outpatient services at the National Institute of Psychiatry in Mexico City. RESULTS: Of the 80 schizophrenic patients, 57 were men and 23 women, with a mean age of 30.5 years and 34.3 years, respectively; the age at schizophrenia onset was 22 years for men, and 26 years for women; 35 subjects (43.7 percent) were consumers of alcohol at the time of the study. The AUDIT scale showed high internal consistency with a Cronbach's alpha of 0.812; for this population, the cutoff point for the full AUDIT scale was 4 points or more; cutoff points for the AUDIT "rapid test" and the "psychosocial issues and probable alcohol dependence" were based on benchmarking against the CIDI (DSM-IIIR and ICD-10). CONCLUSIONS: The AUDIT validation showed it to be a useful and sensitive screening tool for identifying schizophrenic patients at risk for alcohol abuse and dependence; therefore, it is recommended for use in clinical and epidemiological studies in Latin America.
Subject(s)
Adult , Female , Humans , Male , Alcohol-Induced Disorders/complications , Alcohol-Induced Disorders/epidemiology , Surveys and Questionnaires , Schizophrenia/complicationsABSTRACT
The work of Alcoholics Anonymous (AA) in fighting against alcohol abuse and alcoholism has placed it as an institution of great importance in Mexico and around the world. Although its labor has been subject for controversy, there is a lot of evidence that frequent attendance and affiliation to the groups and sessions can be very helpful for many individuals. Research has been dedicated to the identification of the elements contributing to affiliation, such as involvement, commitment, and participation, or the level of adherence to the program's beliefs and activities. Some studies have used the time of membership and the frequency of attendance to AA as indicators of affiliation, but there are some authors who think that it is difficult to explore it using only these variables. Other authors have mentioned that alcoholics can go to AA for many reasons, but that mere attendance is not enough for reaching or maintaining abstinence. It has been established that when the impact of AA is measured only by the time of membership or the frequency of attendance, it is not possible to comprehend the essence of the subjective and behavioral characteristics involved in the process. Thus, it is important to differentiate between these and the true affiliation. There are only a few researches about the elements forming the affiliation to AA, and the ones available do not bring light over the process of its beginning. Some authors say that it is something more than the time or the frequency of attendance to meetings, and that is possible that it is a complex and heterogeneous phenomenon formed by several behaviors and beliefs about the 12 steps. Some studies have pointed out the interaction of different factors to achieve affiliation, but they have also remarked the need for including more variables in measuring it. One conclusion is that affiliation is a whole dimension that encompasses attendance and the level of participation in the activities. There are different questionnaires to measure the affiliation process, but most of them are difficult to interpret, and little is known about their fitting to AA members' perspective of things. Research in Mexico is complicated because of a lack of instruments developed from the local situation and experience. There are data that about 14 000 alcoholics enter AA every year. Relapse is high during the first three months (near 50%), but almost half of the persons that stay show adherence to the program, and eventually reach abstinence. Yet, the topic of the specific elements of affiliation, as well as their influence to maintain abstinence, has not received enough attention. The objectives of this study were: 1. to analyze the elements that constitute an affiliation profile, 2. to know if such elements are different or if they are part of a single construct, and 3. to find out if the amount of affiliation (the way an alcoholic involves him/herself in the activities of the group) can distinguish between those who have relapsed and those who have not. Method The sample was non-probabilistic; it included 192 AA members (87% men and 13% women). Average age was 42 years old. Two groups were formed: relapsed and non-relapsed (143 who did not consume any amount of alcohol since they entered AA or 10 years or more ago, and 49 who consumed any amount of alcohol within the four years prior to the interview). The questionnaire included scales to measure the service, the practice of the 12 steps, the spiritual awakening, sponsoring, time spent in AA, frequency of attendance, and reading of the materials. The questionnaire was specifically designed for measuring affiliation. Results There were significative differences in the mean participation time (it was higher in the non-relapsed subjects: t = -3.225, df=181, p<.00), in the activities related to <
La labor realizada por los grupos de Alcohólicos Anónimos (AA) para combatir el problema del alcoholismo los ha convertido en una de las opciones importantes. La adherencia o afiliación a estos grupos puede ser benéfica para ciertos alcohólicos, por lo que la investigación ha buscado identificar los aspectos que contribuyen a su establecimiento. Aunque la investigación aún no aclara el proceso mediante el que se logra, la ha destacado como un constructo que entrelaza la asistencia a las reuniones y el nivel de participación en los grupos, y se menciona que, cuanto mayor es el involucramiento, tiende a mejorar el pronóstico del alcohólico. A pesar de este panorama, en nuestro contexto, el tema de los componentes específicos de la afiliación a AA, así como su relevancia para mantener la abstinencia en comparación con la recaída, no ha recibido atención suficiente por parte de los investigadores en alcoholismo. Este trabajo tiene como objetivos: explorar elementos que pueden constituir un perfil de afiliación a AA, conocer si esos elementos son diferentes o forman parte de un mismo constructo y si la graduación de afiliación (clasificación de la forma en que el alcohólico se involucra en las diferentes actividades de los grupos) puede diferenciar entre quienes han recaído o no en el consumo de alcohol. Método La muestra fue no probabilística intencional; incluyó a 192 miembros de AA (87% hombres y 1 3% mujeres). Se formaron dos grupos: no recaídos y recaídos (143 no consumieron ninguna cantidad de alcohol y 49 consumieron cualquier cantidad de alcohol después de por lo menos tres meses de abstinencia). Se diseñó un cuestionario para evaluar la afiliación a AA; en éste se indaga el servicio, el apadrinamiento, la práctica de los 12 pasos, el <
ABSTRACT
Introduction Tobacco use is considered a worldwide public health problem because of the amount of death and disease it causes. The WHO reports that 30% of the adult population in the world are cigarette smokers, and that nearly five million of these will die within one year. Prospective studies performed by the WHO show that if current tobacco use continues, in 2020 there will be 8.4 million deaths due to tobacco-related diseases every year; seven out of 10 of these deaths will occur in emergent countries, like Mexico. More than 53000 tobacco users die every year in Mexico because of tobacco-related diseases, and at least 147 of these die daily. Data from the National Addictions Survey (NAS) 2002 showed that 26.4% of the people between 12 and 65 years old were active tobacco consumers; this amounted to nearly 14 million individuals. Of these, 7.1% were under 18 years old. The number of tobacco consumers in Mexico has increased from nine million in 1988 to 14 million in 2002. According to the NAS, 52% of the users smoke on a daily basis, and 61.4% of them began smoking when they were minors. To know the actual consumption levels, it is important to consider some factors: the number of cigarettes a person smokes, the different situations where a person smokes, and the social and physical consequences of smoking. Thus, it would be possible to develop a consumer classification (i. e. soft consumers, mild consumers, and hard consumers). There may be numerous causes for a person to be ill. When speaking about the harmful effects of tobacco use, the literature is clear in stating that these begin with the first cigarette smoked. However, it can take up to 30 years for a consumer to notice the damage on his health after his/her consumption began; but within the first ten years there are problems in lung function and in physical endurance. When a person starts smoking there are acute and unpleasant side effects that are rarely associated with smoked tobacco use. Consumption creates a tolerance which makes unpleasant effects to stop or fade away, giving place to pleasant sensations produced by nicotine; concentration improves and psychomotor skills, alert, and activation get better and there is a reduction in anxiety and stress. The relationship between tobacco use and mental health is evident at the level of the emotional outcomes of suffering a chronic illness, such as lung cancer. On the other hand, nicotine use has been related to a reduction in the severity of depression. Chemical alternatives for reducing consumption, based on the substance physical effects that promote addiction, have not proven to be effective so far. There is also evidence that consumers that fail in quitting smoking or people that have dependence problems with nicotine show a high prevalence of mayor depression when compared to non-dependent consumers. This association was direct with the severity of nicotine dependence. It also has been observed that smoking interferes often with psychological learning tools, mainly when consumption starts at very early ages. Emotional distress can produce low self-esteem and a lack of self-confidence. Therefore, the chances to begin tobacco consumption increase when it is used as a crutch to cope with social pressure and acceptance. Since tobacco use is a conduct that has shown to have serious repercussions on physical health and an important relationship with mental health in human beings, and is therefore a growing public health problem, the objective of this study is to explore a possible link among smoked tobacco consumption, mental health and physical problems in male workers from a textile factory. Method A non-probabilistic convenience sample was used in the study. Subjects voluntarily agreed to complete the questionnaire: 279 male workers were interviewed; 54% were between 18 and 27 years old and 23% were between 28 and 37. Most of them had studied junior high school or higher (74%) and 65% were in a serious relationship (married or living with a couple). Data about tobacco use were collected using a questionnaire with questions from the NAS 2002. To explore mental health the five-item Mental Health Inventory was used (MHI-5). As it is a self-answered screening test, it does not give a diagnosis, but it does allow establishing if subjects have symptoms of a probable mental health problem. Information about physical distress was collected through an 11-item somatization sub-scale from the Symptoms Check List-90 (SCL-90). The number of physical troubles that subjects reported during the last month was considered. All instruments have good levels of reliability and validity. Finally, several socio-demographic questions were included. The questionnaire was answered in groups inside a training room. Trained interviewers participated in the process of collecting information. Subjects' participation was voluntary and their verbal acceptation was obtained before answering the questionnaires. Anonymity and confidentiality were guaranteed. Workers were told that no information would be given to the union or business authorities, and those who asked for their results received them personally. Neither invasive procedures nor intervention techniques were used. The union authorities received a global report so they could acknowledge the importance of smoked tobacco and mental health-related problems among their workers. Statistical analyses were performed using SPSS 11.
Introducción El consumo de tabaco es considerado un problema de salud pública en todo el mundo debido a la cantidad de enfermedades y muertes relacionadas con su uso. La Organización Mundial de la Salud (OMS) reporta que 30% de los adultos son fumadores y, de éstos, aproximadamente cinco millones de personas morirán en un año. También se estima que para 2020 habrá 8.4 millones de muertes anuales por enfermedades relacionadas con el consumo de tabaco, de las cuales siete de cada 10 ocurrirán en países en vías de desarrollo, como México, donde más de 53 mil personas fumadoras mueren al año por enfermedades asociadas al tabaquismo y al menos 147 personas mueren diariamente. Por otro lado, en la bibliografía se ha encontrado que el daño en el organismo por fumar comienza desde el primer cigarro, que a los 10 años se presentan síntomas sutiles en la función pulmonar y disminución de la tolerancia al ejercicio, y que es entre 20 y 30 años después cuando los síntomas hacen a un fumador tomar conciencia del daño a su salud. En cuanto a la relación entre el uso de tabaco y la salud mental, ésta se evidencia por las consecuencias emocionales que conlleva padecer una enfermedad crónica. En este contexto, el objetivo del presente trabajo fue conocer la relación de problemas emocionales y malestares físicos con el consumo de tabaco en hombres trabajadores de una empresa textil mexicana. Método La muestra estuvo conformada por 279 sujetos que laboraban en una empresa textil, en su mayoría jóvenes entre 18 y 27 años (54.5%), con escolaridad de secundaria (59.3%) y casados o en unión libre (65.6%). El instrumento utilizado incluyó las escalas de salud mental (MHI-5), malestares físicos (SCL-90) y consumo de tabaco. La aplicación del instrumento se realizó de manera grupal dentro de la empresa textil en que laboraban los sujetos. Resultados No se encontraron diferencias significativas en cuanto a problemas de salud mental y síntomas físicos entre fumadores y no fumadores. Mediante un modelo de análisis de trayectorias, se analizó la relación existente entre síntomas físicos, problemas de salud mental e indicadores de consumo de tabaco. Se encontró así que el principal predictor de los síntomas físicos en fumadores es el tiempo que llevan consumiendo y que los síntomas físicos son un importante predictor de problemas de salud mental. Discusión Sin importar la cantidad de cigarrillos consumidos, la frecuencia de consumo ni otros indicadores de consumo elevado, el tiempo que se lleva consumiendo es un predictor importante del número de síntomas físicos que se manifiestan, lo que puede deberse a los efectos dañinos que tiene el consumo prolongado del tabaco. De este modo se confirma lo mencionado en otras investigaciones de que, después de los primeros 10 años de consumo, se presentan malestares físicos sutiles y que a lo largo de 20 o 30 años se presentaran malestares importantes. Si bien no se encontró una relación directa entre consumo de tabaco y salud mental, se puede sugerir una relación indirecta derivada de la influencia que tiene el consumo sobre el plano del bienestar físico. En este sentido es de esperarse que, a medida que se continúe consumiendo tabaco y los malestares físicos aumenten, también se incrementen los problemas de salud mental. Por otro lado, el modelo aquí presentado requiere ser completado incluyendo otras áreas que puedan influir sobre el bienestar físico y mental. Sin embargo, se logró evidenciar la importancia que tiene el consumo de tabaco sobre el malestar físico, a la vez que aumenta la probabilidad de que se presenten más problemas en la salud mental de la población consumidora.
ABSTRACT
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Summary: Antisocial behavior emerges as the result of different factors such as scholar problems, drug consumption, alcoholism, antisocial peer relationships, emotional problems, etc., which may in turn predispose to the individual to develop a pattern of antisocial behavior. The present work aims to determine the association of antisocial behavior between the factors of a bad family environment and mistreatment, and to determine if they can predict the presence of antisocial behaviors in adolescents. Family plays a primary role in the development of a person, especially in adolescent. In recent times, several problems of family disintegration and inadequate parent-child relationships are observed, and it has been described that antisocial personalities may arise from environments with child abuse, economical problems, humiliation, physical punishment and family disintegration. The experience of such emotions during childhood may lead to a severe impairment in the conformation of an emotionally-adapted personality, and may promote a tendency for the commitment of delictive behaviors in the future. It is necessary to close the vicious cycle where mistreated parents mistreat their own children and avoid that the parents who lived unpleasant experiences of hostility, rejection, lack of communication, inestability, etc., repeat these patterns with their children. It is important to revalorize the role of family, its functions and characteristics and the most important, its determinant influence on young people that have behavior problems as antisocial behavior. It is vital to create conscience about the harm that some children, adolescents and even adults have from their negative familial experiences of hostility, aggression, and mistreatment, because these experiences increase the possibilities of delictive behavior in these individuals. Objective. In this context, the present research has its main interest in showing the relationship between past experiences of mistreatment or inadequate familial environments and the presence of antisocial behaviors in adolescents. Method. The present research is supported on results of the Mexico City Survey on drug consumption in 7 th to 12 th grade population carried on October 2003. The total sample of the survey comprised 10659 students. For this research we used 3603 students, that corresponds to the number of students that completed the Form A of the questionnaire, that contained the areas of interest of the study. The questionnaire was previously validated an its main indicators have shown adequate stability in different surveys. This instrument was applied in three different times due to its extension. Total time for its application was of 75 minutes. Raters were trained for the application of the questionnaire. The course lasted 12 hours and included all the theoretical aspects related to addictions, objectives of the study, management of the questionnaire and the instructions for its application in the groups. Results. First of all, a comparative analysis by gender was performed. It was observed that antisocial behaviors were more frequent in men than in women. It is important to mention that men committed this acts in a double frequency than women, specially in terms of severe acts, where 10% of men committed them in contrast to the 3.3% observed in women. Additionally, two factor ANOVA was performed (gender and antisocial behaviors) with the variables of this study, mistreatment and family environment, to determine if there were differences between groups (p<0.05) and significant differences were observed in all the areas of family environment. The interaction analysis of the two factors: gender, act-non acts with family environment showed that for the area of hostility and rejection there were significant differences where women that committed antisocial acts were the ones that reported higher levels of hostility and rejection. In terms of communication of the son/daughter, women that committed antisocial acts were also the ones that reported a lower level of communication. In the area of parent support, women that committed antisocial acts were also the ones that reported the lower levels. In the areas of parent communication and support to the son/daughter, men and women that committed antisocial acts reported less communication and support, respectively. For the area of mistreatment, women reported higher levels of prosocial discipline and negative discipline when compared to men. No significant differences emerged between men an women in the area of severe negative discipline. Also, no significant differences emerged between adolescents that committed antisocial acts and adolescents than do not committed these acts, in terms of prosocial discipline. Nevertheless, adolescents that committed antisocial acts reported higher levels of severe negative discipline. For the analysis of the interaction of the factors gender, acts-non acts in the area of mistreatment, no differences emerged in the area of negative discipline. Significant differences emerge for prosocial discipline, where men that do not committed antisocial acts reported the lowest levels of prosocial discipline. For severe negative discipline, both men and women that committed antisocial acts reported the highest levels. Finally, using logistic regression, we find that the main predictors of antisocial behavior were the presence of high hostility, low level of communication from the children, less child support and the presence of higher negative discipline and negative severe discipline. Communication, parent support and prosocial discipline were not predictive variables for antisocial behavior. Our results support what is described in other studies where family is the main agent of socialization as family teaches the ways of social interaction, values, habit, etc. Furthermore, several studies that evaluated the relationship of the family and antisocial behavior were performed by analyzing the role of the family as a mediator of behavior and society, on the basis that family teaches children rules, abilities and motivations that in some way constitute their cultural and social patterns. We conclude that family environment and mistreatment are factors associated to the presence of antisocial behavior. We must prevent this problem by improving familial relationships and providing a positive family environment to adolescents. In this way, our adolescents may have an adequate development throughout their lives. If an adequate and positive environment is provided during childhood and is maintained through adolescence, with positive affective family relationships, the adolescent may see his/her parents as a guide; a reasonable not arbitrary discipline allows the adolescent to develop a social behavior that leads to an adequate self-control and self-directedness. On the contrary, if the relationships between parents and children are not favorable, the social behavior of the adolescent may be easily impaired and it is very common that these adolescents exhibit severe difficulties for social adaptation.
ABSTRACT
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Summary: In alcoholism research, the exploration of the spirituality have a great importance. Some authors keep distance from this concept and it has been commonly criticized. However, other researchers (Gorsuch, Connors, Tonigan, and Miller) have agreed in pointing out to this and other variables, like religion for example, as important elements that protect individuals from addiction, also as factors that favor treatment and mediate in long abstinence periods. According to Morjaria and Orford, the assumption of a link between spirituality and alcoholism exist because is one of the principles of Alcoholics Anonymous (AA) foundation. In the present, the work of AA is one of the most popular approaches in recovering from alcoholism, within Mexico and in other countries as well, and although its effectiveness over alcohol consumption is still debatable, not well documented and inconclusive. There is evidence suggesting that a regular participation in the group meetings could benefit a lot of individuals; especially those whose participation in all the activities is more enthusiastic and those who develop more beliefs inside the groups. A key element in AA's philosophy is the acceptance of a spiritual strength that comes from a bigger power than themselves (Higher Power: can be understood as a "whole" or the power represented by God), which helps in the recovery process. AA acknowledge the importance of religious thoughts, and the relevance of spiritual tradition in the recovery of each alcoholic, however, the core of the treatment is not placed on these aspects, but it is on spirituality. According to AA, every individual may have his own definition of spirituality and it is outlined by his personal orientation. In that respect, Forcehimes, Kurtz, and Ketchman said that spirituality is a transformation breakthrough marked by a personal experience of "spiritual awakening", all resulting from regular participation to the meetings and from the daily practice of the twelve-step program. The twelve-step program represents one of the most important components in the recovery strategy of AA and reflects the spiritual nature of the program. DiClemente and Gabhainn have noted that the practice of the steps has fundamental implications in reaching and maintaining abstinence, especially for those who practice them on a regular way. However, available evidence about the benefits that each step brings to the alcoholics is still limited and sometimes controversial. There are very few investigations in Mexico about the role of spirituality in the alcoholic recovery process. AA have not been sufficiently studied and there is a lot unknown about their treatment strategies. The objective of this study is to know if the effectiveness of the practice of the 12 steps, the frequency of their practice, and the experience of the "spiritual awakening" (that AA consider as a consequence of practicing the steps) influence on the maintenance of abstinence in members of AA. The sample was non probabilistic and included 192 AA members from traditional groups (or "an hour and a half" groups, named after the time meetings last) from southern Mexico City area. Individuals were divided in two groups: relapsed and not relapsed. The first group included 49 alcoholics (90 percent of males, 10 percent of females) who relapsed after an abstinence period of three or more months within AA (abstinence mean = 2.4 years). The second group included 143 subjects (86 percent of males, 14 percent of females) who have not relapsed since they entered AA or for a ten year period or longer. To determine the influence of the spiritual principles of the 12 steps program, a question was designed to measure the practice of each one of them, as well as a scale to explore the frequency of such practice. Also, since AA considers the "spiritual awakening" as a result of working with the steps, a question about its occurrence was included. Results showed that not relapsed individuals have practiced significantly more steps (mean=9, SD=4.1) than the relapsed ones (mean=7, SD=4.4) (t=2.304, df=190, p=.02). Results also showed that frequency in the practice of: thinking about events that led to alcoholism (steps 4 and 5), humbleness to accept help from a Higher Power (steps 6, 7, and 11), acceptance of responsibility to reduce the consequences of addiction (steps 8, and 9), and helping other alcoholics (step 12), is significantly different between both groups; not relapsed individuals had a more frequent practice of these steps. Since AA assumes that working the steps leads to experience a spiritual conversion or "spiritual awakening" (it implies a change in the self-concept, in the view of the world, and stop being self-centered), a regression analysis was performed to test this assumption. Results suggested that a greater involvement in steps 4 to 12 -usually considered as steps for action and maintenance- increases 10 percent the probability for experiencing the "spiritual awakening" (p=.000). Besides this experience increases two times the probability for staying sober in not relapsed subjects (Exp[B]=2.095, CI=1.032-4.253, p=.04). No statistical differences were found in the practice of steps 13, but this does not mean that they are not important, for these are the most practiced steps in both groups. However, the fact that relapsed alcoholics put great value upon these steps, points out their willingness to stop consuming (apparently they have accepted being powerless before alcohol, and to surrender their will and life to a Higher Power), but it also underlines their difficulty in attaching to some of the beliefs and activities that AA consider as base to complete the practice the steps and to develop spirituality. Several of these activities are related to elements in the program that mean more action and certain degree of confusion and discouragement for those who focus in staying sober only based on a vague idea of what constitutes the Higher Power. AA recognizes the first three steps as the facilitators of abstinence and as the beginning of the path to "spiritual awakening" through an aid that transcends the individual (Higher Power), but they also emphasize that many times this is not enough for the recovery. Paradoxically, they state that this condition could lead to a feeling of false security that could invite the alcoholic to flirt with the idea of having "just one drink". Therefore, it is not casual that relapsed individuals in the sample of this study focus on practicing the first three steps, though more research is needed to further confirmation. These results allow concluding that spacing out the practice of the 12 steps or not practicing them at all, produces low levels of spirituality, which could be the cause of a relapse. Results also showed that a higher level of spirituality (linked to the practice of more steps) has an important influence on the recovery of alcoholics, particularly for those whose practice of the steps is more regular. The sample of this study showed that its particular way to develop spirituality (spiritual awakening) and therefore maintain abstinence requires of a process that involves cognitive, emotional, and behavioral activity (steps 4-12), and not only to embrace the conviction of alcoholism as a disease susceptible of being cured (steps 1-3). Finally it is important to indicate that the 12 steps program represent a particular way of expressing spirituality, and that they are limited to specific cognitions and practices; thus, more research is required to replicate these results with other measures of spirituality.
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Abstract: There are different factors within work environment that could créate both wellbeing and distress in workers. The climate perception employees have, as well as their evaluation of some, could have positive and negative consequences at personal and organizational levels. Work stress is another element that has meaningful repercussions on the health of people and on the quality of their performance; it has been related to alcohol and psychoactive substances abuse, besides of an increase in different social and work problems. The main objective of this paper is to determine the relationship between organizational factors (such as work stress, organization climate, and work satisfaction) and alcohol use, and the occurrence of industrial problems and accidents in Mexican workers in a textile organization. Method In order to interfere as less as possible with the production process, this study was carried out at the facilities of the organization, during work hours and during weekends. Thus, only employees who attended to work these days were interviewed. The sample included 277 workers who basically performed as operative staff. No more organization characteristics are described on behalf of an agreement, and of the anonymity of the answers given by the subjects. All the interviewees were men, their ages fluctuated between 16 and 65 years, 85% of them had attained junior high school, and 72% were married or living with a partner. A self rated questionnaire was used, along with the AUDIT (alcohol use disorder identification test) alcohol test, a work stress scale, another scale for organization climate, one more for work satisfaction, and some general questions. All the scales had good internal consistency. The procedure consisted in gathering 20 workers in a well-ventilated and illuminated room. The interviewer, who was previously trained, read the instructions aloud, emphasizing anonymity and confidentiality of any information the workers give, and stating that no one from the company would have access to the data. Analyses were performed with statistical software SPSS 11.5. EQS 6.0 was used to test the structural equation model with the relationship between organizational factors, alcohol use and negative consequences at work. Results Organizational climate. Most of the workers (92%) perceived a good level of communication with the work group, 87.2% mentioned to receive help from the boss when they have to do an activity they are not familiar with, 78% said they have enough support to solve the problems related to work. There were differences between the workers according to education level; the ones with the higher level perceived a more adverse climate. There were differences also between shifts (morning, evening, and mixed); the workers from the first one perceived a less favorable climate. Work satisfaction. Most of the workers think of their job as something useful (95%), 93% said they liked it, and 88.3% mentioned their families are satisfied. There are statistical differences be-tween satisfaction and education levels; subjects who had only basic education were more satisfied than those with a higher level. The stress sources are related to the effort implied in the struggle to move forward (87.6%), to have too much work to do (60.5%), and to the possibility of an accident when subjects are careless (51.6%). The total scale scores indicated that 14.2% of the workers had high levels of work stress. Alcohol use: 61.7% of the workers consumed alcohol during the previous year. According to the AUDIT (using eight or more as a cutoff score) 25.8% were classified as cases for alcohol related problems; 26.5% of the subjects had risk consumption, and 5.3% were consuming in a dangerous way because of the frequency and the amount they drink. Work problems: 24.1% of the subjects mentioned they have invested more time than usual in some activity related to work, 21% have been told off because of their performance, 18% felt they could not achieve quality outcomes. The incidents that workers mentioned were: hand injuries (17.5%), finger injuries (15.7%), being close to suffer an accident (13.5%), and suffering damage or injuries when working (10%). A structural equation model allowed to observe that organizational factors, climate, satisfaction, and work stress are meaningful predictors of work accidents and problems. Of all the variables included in this analysis, work stress also was the one that best predicted alcohol use at the work place. A direct effect of the individual level of alcohol use and of the use at the work place on problems and accidents, was observed. This effect was not initially considered in the model of individual consumption, neither were the frequency, the amount consumed, nor the excessive use; it was necessary to add this direct path to adjust the model so they were observed as important elements. Discussion Interviewees perceived communication as an important climate issue, mainly when established with the work group. Another element mentioned as important was perceived, that is support from the boss or supervisor to solve problems. Education level has a relevant role in the way workers live their work climate; those with a lower level experience it as more favorable. This could be the consequence of higher work expectations related to a higher education level. There are differences among shifts; workers from the first shift experienced a more favorable climate. The model included climate as a meaningful element for the presence of consequences at work place; this had a direct effect over the existence of problems and the occurrence of accidents, it was opposite to the results observed in other studios were there was not a direct relationship. Work satisfaction has to do with job usefulness, the joy for the task done, and family satisfaction with the position. The education at level affects perception of work climate. This evaluation of the worker climate has been identified as a significant factor for the reduction of negative effects at work. It is necessary to mention that employees with a higher stress level are the married ones, which may be caused by the responsibilities implied in being a family supplier. This concurs with the result of a study on burnout, which found that being married is a risk factor to develop high stress. Work stress was the most predictive component of accidents and problems at the work place, which had a direct relation (0.50). It also directly predicted alcohol use at the work place (0.22), and had a negative statistical difference with climate (-.29). Thus, it is important to consider that when workers perceive a better climate, stress level goes down, and it is necessary to consider this organizational factor to improve work conditions besides employees' physical and mental health. According to the model tested in this study, alcohol use has a direct and meaningful effect on performance and on the frequency of problems and accidents, inside and outside the organization. It is important to consider that prevention in work places must be done globally, taking into account organizational factors such as climate, stress, and worker satisfaction. It also should include educative and practical elements that allow reducing excessive alcohol use and its negative consequences (poor performance, bad interpersonal relationships, and bad outcome quality) at work, besides reducing also industrial accidents. The most frequent work problems were as follows: to invest more time than necessary in an activity, to be told-off because of mistakes, and to have problems with the boss or supervisor. These events have an impact on productivity and represent money loss for the company. The most frequent accidents were as follows: hand injuries, which are related to heavy machinery operation, basic in the production process of this industry. This reflects the need to consider the physical aspects of the place where activities are performed, as well as the psychosocial factors affecting individuals, all of which will result in benefit of any organization.
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Abstract: In facilitating the presence of risk behaviors for health, some conditions inherent to the gastronomical and hotel industry may significantly affect the people working in this market. Among them are non-regular working days, temporary employment, law salaries, problems at work, low professional prestige, minimum development opportunities, bad relationships with managers, and unsafe conditions in the job environment. In comparison with other work areas, this is one of the sectors with higher risk of problems related to alcohol use, mainly due to the availability of the substance in the work place, to the social pressure, to the working schedules, and to the way people cope with stress at work. Due to movements, rhythm, and techniques used in the activities performed in this kind of job, it is possible to develop bones and muscles alterations, and because of constant changes in labor shifts circadian cycles suffer disruptions that lead to different somatic symptomatologies. Studies in workers have shown that problematic alcohol consumption is present in 33-44% of this population. Other studies have found prevalences up to 24% of mental disorders in workers. The Department of Labor has reported that, as part of work diseases, mental and behavioral disorders increased its prevalence of 0.3% in 1999 to 1.9% in 2003. On the other hand, some studies report an association between mental disorders, somatization, and alcohol use in general population. People spend a considerable portion of their lives at their work places and working in gastronomic and hotel industry implies high risk for health. The objective of this paper is to know the association among alcohol use, the number of symptoms regarding mental health problems, and the level of discomfort caused by somatic symptoms in a sample of gastronomic and hotel industry workers from Mexico City. Material and method Population and sample Sampling was non-random, on convenience, and by quota. The sample included 194 men, over 18 years old, who were working at companies from the gastronomic and hotel industry in Mexico City. Most of the subjects were under 45 years old, over half of them studied until junior high school. The most frequent position among the subjects was waiter. Working days vary, depending on the day and time banquets and receptions are programmed. Over two thirds of the subjects mentioned having three or less years working in this kind of job. Questionnaire The short version of the AUDIT (first three questions) was used to establish the level of alcohol use. This version allows to rate subjects in three levels, according to the amount and frequency of consumption: low risk use, risk use, and dangerous use. The five-item Mental Health Inventory (MHI-5) was used to determine the presence of mental health problems. The MHI-5 is a screening test that measures non-psychotic affective disorders, according to DSM-IV criteria, with no reference to specific disorders. The Symptoms Check List-90 (SCL-90) was used to identify psychological stress derived from somatic symptoms. The three scales have good levels of reliability and validity. The field team talked to the managers of the training department at the union, because all the subjects in the sample were affiliated, to get permission to collect the information. No invasive techniques were used nor any other type of intervention. Subjects responded to the questionnaire gathered in groups inside a training room. The fieldwork involved trained interviewers, whose training was voluntary. All the workers accepted to participate and to respond the questionnaire through a verbal agreement. Participation was anonymous and neither the union representatives nor the managers had access to individual questionnaires, which granted confidentiality. The union representatives acknowledged a global report that intended to make them aware of the magnitude of the alcohol use and mental health problems among their affiliates. SPSS 10 software was used to analyze data. Results A total of 44.2% of the subjects reported drinking four or more drinks per occasion; 60.9% of them mentioned they had drunk six or more drinks per occasion during the last year; 55.5% of the workers were located in a low risk consumption level; 43.1% had a risky consumption level, and 10.4% consumed at a dangerous level. Results regarding mental health showed that a quarter of the subjects «have felt uneasy¼ (26.1%), 16.7% «have felt happy¼, 9.7% «have felt sad and melancholic¼, 8.4% «have felt down or as if nothing could cheer them up¼, and 4.3% «have been very nervous¼. A cut-off score of 16 or higher allowed identifying 11% of cases with symptoms of a possible mental health problem. Most of the subjects (69.6%) mentioned having experienced at least one somatic symptom during the last month. The ones that caused more discomfort were muscular pain (17.6%), backaches (12%), headaches (9.7%), weakness in some part of the body (7.1%), and nausea (6.7%). A cut-off score of eight or higher allowed to identify 14.7% of cases with somatic symptomatology that caused psychological distress. A Pearson correlation analysis was performed and the results showed a significant association between the level of alcohol consumption and the discomfort due to somatic symptoms (pr=.404^><.01). Significant associations were also found between the mental health state and the discomfort due to somatic symptoms (pr=.339 ^><.01), and between the level of alcohol consumption and the mental health state (pr=.260 ^><.01). Discussion and conclusions The percentage of alcohol consumers, the amount of alcohol consumed, the frequency of consumption, and the prevalence of problematic consumption were higher in this group of workers when compared to employees from other occupations. This can be the result of a mayor substance availability within gastronomic and hotel work environments. The association between alcohol use and the number of symptoms of mental health problems may be an indicator of co-morbidity between both conditions. It is also possible that the association is related to excessive alcohol use as a way to cope with emotional problems. The somatic symptoms with the highest prevalence were part of the somatization scale, but there is a possibility that they are indicators of an illness or disease derived from the labor activity instead of indicators of somatic symptoms. On the other hand, whether alcohol use increases frequency of mental and physical troubles or that consumption is present as a reaction to these troubles, more research is necessary to know more about these variables co-morbidity because these relate to the presence of accidents, problems at work, social and family problems, as well as economic burden. The use of screening scales in working settings is important because it reduces costs and helps to identify related problems. In addition, they are easy to use at factories and businesses without interfering with the manufacturing processes. Nevertheless, it is important to use more specific instruments with identified cases. This would permit a more precise diagnosis and, if necessary, to refer subjects to institutions that provide specialized health care. To have such a structure would reinforce protective factors for subjects to cope with the risks inherent to their professional activity. Limitations and suggestions Conclusions are valid only for the workers in this sample because of the sampling method and they cannot be applied to all the workers of the gastronomic and hotel industry. So far, studies about substance use in working settings have focused on men population; however, women are an important segment that researchers should consider investigating to collect information that can sustain proper and necessary actions.
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Abstract: Introduction. This paper analyses the evolution of antisocial behavior within the context of representative cross-sectional studies in student population from Mexico City. Surveys with students have collected data about substance use and related factors. The latter is associated with antisocial behavior and delinquency eating disorders, risk sexual behavior, and suicide attempt. Statistics on younger offenders show an increased number of subjects presented before law institutions, meaning that they have been prosecuted somehow (there were 2623 cases in 1999, and 3506 in 2003). At the same time, there is a decrease in the age for committing these faults which are becoming more serious; a larger number of homicides, raping, and carrying weapons have been reported. The objective of this paper is to present tendencies of antisocial behavior through data obtained from three different representative surveys in junior high school and high school students from Mexico City (1997, 2000, and 2003). Surveys were held by the Instituto Nacional de Psiquiatría Ramón de la Fuente and by the Secretaría de Educación Pública. Method. The analysis unit considered for this study was the student himself coming from state and private schools. Three levels were studied: junior high school, high school, and technical schools. Sample design was planned based on the evaluation of drug use tendencies in the students from this population, determining the level of contribution of each district in the city. Schools were randomly selected in each of the 16 districts. Sample design was stratified, two-staged, and in clusters. Stratification variable was the level of the school. First selection unit was the school, and second was the school group. Sample was self-weighted using the city district as the weigh variable. Three probabilistic samples were obtained, representing each one of the districts and education level: 1997 sample, N=10173; 2000 sample, N = 10578; 2003 sample, N=10659. Outcome rate in each measure was 97% in 1997, 95% in 2000, and 98% in 2003. Age mean in the three samples was 14.6 years old, and equivalence men-women was similar in the three studies. Questionnaire used has been validated before, and its basic indicators have maintained consistency through different researches. Socioeconomic and antisocial behavior data were used for this study. Two factors previously obtained were used. The first one was called Violence and Thieving Behaviors, this one includes picking things worth 50 pesos or less, taking things from a store without paying for them, damaging other people's property, punching or hurting someone, being involved in fights, and using firing objects. The second factor was called Serious Antisocial Behaviors, and it included: picking things worth 500 pesos ormore, breaking locks, attacking someone using an object or weapon, selling drugs, and using a knife or gun to rob someone. These factors have been already used and have shown good consistency. The survey operative design included a main coordinator, supervisors, and pollsters who were trained on conceptual issues about addiction, project background and objectives, instrument use, instructions for interviewing, and group selection. Emphasis was made on proper instructions for subjects, as well as remarks for anonymity and confidentiality in handling information. Inconsistent questionnaires were corrected or eliminated. Intelligent software was used for registering data, which verified that the answers were coherent. Results. There was a 2% increase in antisocial behaviors among students between 1997 and 2000; the most notorious raise was observed in behaviors from factor Violence and Thieving, which fluctuated between .57% and 1.8%. From 2000 to 2003 there was a raise of 6.7% for any antisocial behavior, and the increase was again more notorious in Violence and Thieving (6.5%). There were minor increases in the second factor, though these were important. For instance, picking things worth 500 pesos or more, and attacking someone had a bigger raise in 2000 and 2003, while breaking locks had its bigger raise between 1997 and 2000. No changes were observed for selling drugs and using a knife or gun to rob someone. There was a 2.47% increase for any antisocial behavior in men between 1997 and 2000, basically in the factor Violence and Thieving. From 2000 to 2003 this increase raised to 7.36%, observed again in the Violence and Thieving factor. In the case of women, there was only an increase in two behaviors between 1997 and 2000: picking things for 50 pesos or less and breaking locks. From 2000 to 2003 there was an important increase in behaviors pertaining to Violence and Thieving (5.71%), to be involved in fights had the highest increase. Between 2000 and 2003, women participated in more serious acts. The proportion of students behaving antisocially was calculated considering the districts. The district of Tlalpan had the only increase observed between 1997 and 2000. Significant raise was observed in almost every district (except for Cuajimalpa and Gustavo A. Madero) from 2000 to 2003. Venustiano Carranza, Benito Juarez, Iztacalco, and Alvaro Obregon had the biggest increase. Variations are the same for both factors. Discussion. This study allows to see the changes in antisocial behavior rates in Mexico City students from 1997 to 2003. Slight variations were found in some behaviors between 1997 and 2000, there were no modifications in others. However, there was an important raise from 2000 to 2003, which is bigger if compared to 1997. Increase in antisocial behavior is similar for men and women, although proportion is unequal yet; almost two men for every woman. When considering district as a control variable, Benito Juarez and Tlalpan show the higher prevalences on any antisocial behavior. This situation is similar for Violence and Thieving. In the case of Serious Antisocial Behaviors, Venustiano Carranza and Azcapotzalco had the higher prevalences. It is important to fully understand the reasons of adolescents for behaving antisocially. Apparently the conditions facilitating this type of behaviors are not only related to marginalization and social disadvantage, but to others, such as new interaction ways, which favor the search for exciting sensations and hiding from supervision. This includes involvement in risk behaviors, such as unsafe sexual intercourse, drug use, violence, and burgling. It is necessary to go deeper into these new forms of antisocial behavior and to work more in prevention as an attempt to counteract present tendencies of this issue.
ABSTRACT
Actualmente, la mayoría de los estudios en México sobre el consumo de drogas se han enfocado al estudio del consumo. Adicionalmente, no se cuenta actualmente con cifras epidemiológicas que indiquen la magnitud del problema de la dependencia. En este sentido, el presente trabajo muestra las prevalencias de los usuarios con síndrome de dependencia y con problemas asociados al consumo de drogas, así como los predictores sociodemográficos y de hábitos de consumo, que llevan a que el usuario desarrolle la dependencia. La investigación forma parte de la Encuesta Nacional de Adicciones (ENA), realizada por el Instituto Mexicano de Psiquiatría (IMP) y la Dirección General de Epidemiología (DGP), que se llevó a cabo en población urbana de 12 a 65 años con lugar fijo de residencia en todo el país. Además de las secciones generales de datos y patrones de consumo, se utilizó la Escala para Evaluar los Problemas Asociados al Consumo de Dogras (EPACD), que consistió en 18 reactivos que impidieron el área psicológica, la de dependencia y la sociofamiliar. Esta escala se aplicó únicamente a los usuarios de drogas, sin incluir alchohol y tabaco, de un total de 590 cuestionarios fueron contestados solamente 522 con lo cual se conformó la muestra final de este estudio. La validación de esta escala ya ha sido reportada en otro lugar (17,18). En general, los resultados de la investigación indican que los usuarios reportan con más frecuencia tener problemas psicológicos (33.8 por ciento) asociados al consumo, seguidos por los problemas sociofamiliares (25.9 por ciento). En tanto, la dependencia al consumo de drogas afecta al 8.3 por ciento de los usuarios (0.34 por ciento de la población urbana total del país). Con repecto a los predictores del síndrome de dependencia a las drogas, donde se empleó la técnica estadística de regresión logística se encontró que aun cuando existen diferencias importantes en la distribución sociodemográfica de estos sujetos (hombre de menos de 35 años y con estudios de preparatoria, son los que se presentan más el síndrome de dependencia), el consumir más de una droga y consumirlas con mayor frecuencia, son los principales predictores. Finalmente, el hallazgo más relevante es que el consumo problemático (problemas asociados y dependencia al consumo de drogas), no es una dimensión separada del uso de drogas, aspecto que traducido en aplicaciones prácticas...