Cannabis use and the development of psychosis or schizophrenia, analysis of current legislation and regional mapping: A systematic review

Objective: This systematic review aims to summarize the findings of studies that investigated the risk, precocity and intensity of psychosis in cannabis users, taking into account the status of legalization and/or decriminalization of cannabis use in different countries. Methodology: Articles published up to May 2018 were included, in English, Portuguese and Spanish, all extracted from the PubMed and SciELO databases, respecting the inclusion and exclusion criteria. Results: 19 studies from 18 countries were included. The relationship of cannabis use and the onset of psychotic symptoms was sufficiently substantiated. However, there was no data that supported an increase in the risk, precocity or intensity of psychosis in cannabis users from countries with higher levels of legalization/decriminalization of cannabis use to the date of the present study. Conclusion: The use of cannabis is associated with the development of psychosis. So far, there is no data pointing to an increase in the precocity, risk or intensity of psychosis in cannabis users, due to the legalization or decriminalization of the use of cannabis. However, the absence of data to date does not exclude these possibilities, since none of the studies analyzed in this review specifically assessed the effects of legalization/decriminalization policies on those outcomes. Therefore, prospective studies focused on the effects of legalization or decriminalization policies should be conducted in countries such as Canada, Spain, the United States of America (some states), the Netherlands, and Uruguay.

Objetivo: esta revisión sistemática pretende resumir los hallazgos de los estudios que investigaron el riesgo, la precocidad y la intensidad de la psicosis en los consumidores de cannabis, teniendo en cuenta el estado de legalización y/o despenalización del consumo de cannabis en diferentes países. Metodología: fueron incluidos artículos publicados hasta mayo de 2018, en lengua inglesa, portuguesa y española, todos extraídos de las bases de datos PubMed y SciELO, respetando los criterios de inclusión y exclusión. Resultados: se incluyeron 19 estudios de 18 países. La relación entre el consumo de cannabis y el inicio de síntomas psicóticos estuvo suficientemente fundamentada. Sin embargo, no hubo datos que respaldaran un aumento en el riesgo, la precocidad o la intensidad de la psicosis en los consumidores de cannabis de países con niveles más altos de legalización/despenalización del uso de cannabis hasta la fecha del presente estudio. Conclusión: el consumo de cannabis está asociado con el desarrollo de psicosis. Hasta el momento, no hay datos que indiquen un aumento en la precocidad, el riesgo o la intensidad de la psicosis en usuarios de cannabis, debido a la legalización o despenalización del uso de cannabis. Sin embargo, la ausencia de datos hasta la fecha no excluye estas posibilidades, ya que ninguno de los estudios analizados en esta revisión evaluó específicamente los efectos de las políticas de legalización/despenalización en esos resultados. Por ello, los estudios prospectivos centrados en los efectos de las políticas de legalización o despenalización deben llevarse a cabo en países como Canadá, España, los Estados Unidos de América (algunos estados), los Países Bajos y Uruguay.

Suicide after and during the COVID-19 pandemic in Mexico City

Objectives: Prior research has indicated that no increase in suicides occurred immediately following the declaration of the COVID-19 emergency in Mexico City. Here we examine longer-term overall suicide trends and trends according to basic demographic groups. Methods: We used interrupted time-series analysis to model trends in monthly suicides before COVID-19 (January 1, 2010 to March 31, 2020), comparing the expected number of suicides both overall and according to age and sex with the observed number of suicides for the remainder of 2020 (April 1, 2020 to December 31, 2020). Results: There was an overall increase in suicides during the first 9 months of the pandemic, with a rate ratio of 2.07 (1.86-2.31). The increase began in the early months of the pandemic and remained stable and high after June 2020. Men and women, younger people (< 45) and older people (≥ 45) were affected. The increase was especially high among older women (RR = 3.33; 2.04-5.15). Conclusions: The increase in suicides in Mexico City is worrying and highlights the need to strengthen economic development, mental health, and well-being programs. Suicides among older women should be closely monitored. There is an urgent need to expand primary health care services to include robust suicide prevention and treatment options.

Atención colaborativa para depresión y prevención de suicidio: una intervención viable en el sistema de salud mexicano / Collaborative care for depression and suicide prevention: a feasible intervention within the Mexican health system

Resumen: México enfrenta un enorme desafío para atender los trastornos mentales, con la depresión como uno de los principales contribuyentes a los años de vida ajustados por discapacidad (AVAD) y el aumento de las tasas de suicidio. Estos desafíos se combinan con la escasez de recursos y asignación ineficiente de fondos. Si bien no hay una solución mágica a corto plazo, discutimos experiencias actuales que podrían usarse para brindar una mejor atención primaria en salud mental. Nos centramos en depresión y conducta suicida argumentando que la atención colaborativa es un modelo factible y replicable, enfatizando la capacitación del personal no especializado para que se convierta en administrador de casos y brinde atención primaria en salud mental. México está experimentando un proceso de cambios, incluido el surgimiento de la atención médica universal, por lo que es el momento para que la atención en salud mental sea más transversal, disponible y científicamente probada.

Abstract: Mexico faces an enormous challenge in attending mental health disorders with depression rising as one of the five main contributors to disability adjusted life years (DALYs) and increasing suicide rates. These challenges are coupled with a dearth of resources and an inefficient allocation of the meager funds. While no magical bullet is available to ameliorate this situation in the short term, here we discuss current concepts and experiences that could be used in Mexico to deliver better primary mental health care. We focus on depression and suicidal behavior and argue that collaborative care is a feasible and replicable model, emphasizing the importance of training non-specialized primary care personnel to become case managers and provide primary mental health care. Mexico is currently undergoing a process of changes, including the emergence of universal health care. The time seems right to make mental health care more transversal, widely available and scientifically proven.

Perfil epidemiológico dos acidentes causados por animais peçonhentos no município de Patrocínio, Minas Gerais: retrato de uma década / Epidemiological profile of accidents caused by venomous animals in the municipality of Patrocínio, Minas Gerais: portrait of a decade / Perfil epidemiológico de accidentes causados por animales venenosos en el municipio de Patrocínio, Minas Gerais: retrato de una década

Justificativa e objetivos: apesar dos avanços na área assistencial, os acidentes por animais peçonhentos ainda são um importante problema de saúde pública no Brasil. Entre os anos de 2015 e 2016, a região Sudeste apresentou o maior número de notificações, e Minas Gerais foi o estado com mais ocorrências. O objetivo deste estudo foi descrever as características epidemiológicas dos acidentes por animais peçonhentos notificados entre 2008 e 2017 no município de Patrocínio, Minas Gerais. Métodos: estudo descritivo retrospectivo realizado por meio da análise das informações das fichas de notificação do Sistema de Informação de Agravos de Notificação (SINAN) de vítimas de acidentes por animais peçonhentos ocorridos durante os anos de 2008 a 2017 em Patrocínio. Resultados: foram registrados 1.084 casos, a maioria ocasionada por escorpiões (47,23%), seguida por serpentes (17,07%), aranhas (15,31%) e abelhas (11,07%). Sobre as vítimas, constatou-se o predomínio de homens (63,10%) na faixa etária entre 20 a 39 anos (32,56%). A maior parte dos acidentes foi classificada como leve (89,11%) e a cura ocorreu em 98,80% dos casos; um evoluiu para óbito. Conclusão: embora os acidentes por animais peçonhentos não apresentem altas taxas de letalidade no município estudado, a incidência desse agravo de saúde tem aumentado nos últimos anos. Além disso, informações epidemiológicas atualizadas podem contribuir com ações de políticas públicas e informar a população local sobre os riscos iminentes.(AU)

Background and objectives: despite advances in health care, accidents involving venomous animals are still a major public health problem in Brazil. Between 2015 and 2016, the Southeast region had the highest number of notifications, and Minas Gerais was the state with more occurrences. The objective of this study was to describe the epidemiological characteristics of accidents by venomous animal notified between 2008 and 2017 in the municipality of Patrocínio, Minas Gerais. Methods: this is a retrospective descriptive study conducted by analyzing the information from reporting forms of the Notifiable Diseases Information System for victims of accidents with venomous animals occurred during the years 2008 to 2017 in Patrocínio. Results: in total, 1084 cases were recorded, mostly caused by scorpions (47.23%), followed by snakes (17.07%), spiders (15.31%) and bees (11.07%). There was a predominance of male victims (63.10%), aged between 20-39 years (32.56%). Most accidents were classified as mild (89.11%) and the cure occurred in 98.80% of cases; one evolved to death. Conclusion: although accidents with venomous animals do not have high mortality rates in the municipality studied, the incidence of this health problem has increased in recent years. In addition, this updated epidemiological information may contribute to public policy actions and inform the local population about imminent risks.(AU)

Justificación y objetivos: a pesar de los avances en salud, los accidentes de animales venenosos siguen siendo un importante problema de salud pública en Brasil. Entre 2015 y 2016, la región sudeste tuvo el mayor número de notificaciones y Minas Gerais fue el estado con más casos. El objetivo de este estudio fue describir las características epidemiológicas de los accidentes por animales venenosos notificados entre 2008 y 2017 en el municipio de Patrocínio, Minas Gerais. Métodos: estudio descriptivo retrospectivo llevado a cabo mediante el análisis de la información de los formularios de notificación del Sistema de Información de Enfermedades Notificables de víctimas de accidentes con animales venenosos que ocurrieron durante los años 2008 a 2017 en Patrocínio. Resultados: se registraron 1084 casos, en su mayoría causados por escorpiones (47.23%), seguidos de serpientes (17.07%), arañas (15.31%) y abejas (11.07%). Predominaron las víctimas del sexo masculino (63,10%), con edades entre 20 y 39 años (32,56%). La mayoría de los accidentes se clasificaron como leves (89,11%) y la curación se produjo en el 98,80% de los casos; uno evolucionó hasta la muerte. Conclusiones: aunque los accidentes con animales venenosos no tienen altas tasas de mortalidad en el municipio estudiado, la incidencia de este problema de salud ha aumentado en los últimos años. Además, esta información epidemiológica actualizada puede contribuir a las acciones de política pública e informar a la población local sobre los riesgos inminentes.(AU)

Intervenciones no farmacológicas para reducir síntomas depresivos en mujeres con cáncer de mama / Non-pharmacological interventions to reduce depressive symptoms in women with breast cancer

Resumen: Objetivo: Describir y discutir los resultados de las intervenciones no farmacológicas (INF) adyuvantes en el tratamiento de los síntomas depresivos entre mujeres con cáncer de mama (CaMa). Material y métodos: Se realizó una revisión sistemática sobre INF, aplicadas a pacientes con cáncer y síntomas depresivos en siete bases de datos. La revisión se limitó del 1 de enero de 2006 al 31 de diciembre de 2017 y a los idiomas inglés, español y portugués. Los descriptores médicos empleados fueron "breast neoplasm" y "depression". Resultados: Existen diversas INF que pueden estimular principalmente las dimensiones físicas o psicosociales. En este artículo se propone una clasificación basada en nueve estrategias terapéuticas identificadas, entre las que sobresalen el ejercicio, la psicoterapia y el yoga con meditación. Conclusiones: Con base en la evidencia disponible, se concluye que la psicoterapia y yoga con meditación reducen los síntomas depresivos en pacientes con CaMa. Se requiere mayor investigación para determinar la magnitud de la reducción de los síntomas depresivos, de acuerdo con su gravedad, presencia de comorbilidades y diversidad de INF.

Abstract: Objective: To describe and discuss the results of non-pharmacological interventions (NPI) adjuvants in the treatment of depressive symptoms among women with breast cancer (BC). Materials and methods: A systematic review on NPI was performed, which was applied to patients with cancer and depressive symptoms in seven databases. The review was limited from January 1, 2006 to December 31, 2017 and to English, Spanish and Portuguese languages. The medical descriptors used were "breast neoplasm" and "depression". Results: There are several NPI that are able stimulate the physical or psychosocial dimensions. In this article we propose a classification based on nine identified therapeutic strategies, among which exercise, psychotherapy and yoga with meditation stand out. Conclusions: Based on the available evidence, we concluded that psychotherapy and yoga with meditation reduce depressive symptoms in patients with CaMa. More research is needed to determine the magnitude of the reduction of depressive symptoms, according to their severity, presence of comorbidities and diversity of INF.

Psychopathology and self-harm among incoming first-year students in six Mexican universities / Psicopatología y autolesiones en alumnos de nuevo ingreso en seis universidades mexicanas

Abstract: Objective: To estimate psychopathology and self-harm behavior of incoming first-year college students, socio-demographic correlates, service use and willingness to seek treatment. Materials and methods: 4 189 male and female incoming first-year students of six universities in four different states of Mexico responded to an online survey with a 79.3% response rate. Results: Almost one in three incoming students has experienced some type of psychopathology; however, only one in five has received treatment. Female, students who are older, whose parents are not married or deceased, and who have a non-heterosexual orientation, no religion or a non-Catholic/Christian religion have greater odds (1.18 - 1.99), whereas those who attend a private university and have a parent with some college education have lower odds (0.68 - 0.75) of experiencing any probable disorder. Conclusions: Substantial unmet need for mental health services combined with reported willingness to use university services suggests an opportunity for the detection, referral, and treatment of incoming students to promote a successful transition.

Resumen: Objetivo: Estimar psicopatologías y autolesiones en universitarios de nuevo ingreso, así como los correlatos sociodemográficos, el uso de servicios y la disposición para recibir tratamiento. Material y métodos: 4 189 estudiantes de nuevo ingreso de seis universidades en cuatro estados contestaron una encuesta en línea con una tasa de respuesta de 79.3%. Resultados: 32.5% han padecido psicopatologías en su vida, pero únicamente 19.5% han recibido tratamiento. Mujeres, estudiantes con una orientación no heterosexual, estudiantes de mayor edad, quienes tienen padres fallecidos o no casados, sin religión o con una religión no católica/cristiana tienen mayor probabilidad de presentar psicopatologías (RM= 1.18-1.99), mientras que aquellos de universidades privadas y cuyos padres tienen estudios universitarios tienen menor probabilidad (RM= 0.68-0.75). Conclusiones: La alta tasa de psicopatologías no tratadas combinada con la disposición reportada de recibir servicios a través de su universidad sugiere una oportunidad para la detección, canalización y tratamiento de alumnos de nuevo ingreso para promover una transición exitosa.

Suicide ideation and behavior in Mexico: Encodat 2016 / Ideación e intento de suicidio en México: Encodat 2016

Abstract: Objective: To provide updated information regarding the 12-month prevalence and associated sociodemographic factors for suicide ideation and behavior (plan and attempts) to substantiate preventive programs in Mexico. Materials and methods: Cross-sectional nationally representative survey, conducted during 2016 (n=56 877) among those 12-65 years old living in rural, urban and metropolitan dwellings. Results: The prevalence of suicide ideation in the last 12-months was 2.3%, 0.8% of the sample reported a plan and 0.7% reported a suicide attempt. All three outcomes were about two times more common among females and suicide plan and attempt were less common among the elderly (50-65 years old). Suicide attempts were more common in urban than in rural areas. The state of Tabasco showed an increased prevalence of ideation, plan and attempts when compared to national average rates. Conclusions: Public health measures to diminish and treat suicidal behavior are urgently needed all over the country.

Resumen: Objetivo: Dar información actualizada sobre la prevalencia de 12 meses y los factores sociodemográficos asociados para la ideación y el comportamiento suicida (plan e intentos) para fundamentar programas preventivos en México. Material y métodos: Encuesta transversal representativa a nivel nacional, por sexo y grupos de edad, realizada durante 2016 (n = 56 877) entre personas de entre12 y 65 años de edad en zonas rurales, urbanas y metropolitanas. Resultados: La prevalencia de ideación suicida en los últimos 12 meses fue de 2.3%, 0.8% de la muestra informó un plan y 0.7% informó un intento de suicidio. Los tres resultados fueron aproximadamente dos veces más comunes entre las mujeres y el intento de suicidio fue menos común entre los más viejos (50 a 65 años). Los intentos de suicidio fueron más comunes en las zonas urbanas que en las rurales. El estado de Tabasco mostró una mayor prevalencia de ideas, planes e intentos en comparación con las tasas promedio nacionales. Conclusiones: Es urgente y necesario que existan medidas de salud pública para disminuir y tratar el comportamiento suicida en todo el país.

Biomechanical behavior of overdentures supported by different implant position and angulation using Micro ERA® system: a finite element analysis study

Aim: The aim of this study was to investigate the biomechanical behavior of implant-retained mandibular overdentures using Micro ERA® system with different implant position and angulation by finite element analysis (FEA). Methods: Four 3D finite element models of simplified mandibular overdentures were constructed, using one Bränemark implant with a Micro ERA® attachment. The implant was positioned on the canine or lateral incisor area with an angulation of either 0º (C-0º; LI-0º) or 17º (C-17º, LI-17º) to the vertical axis. A 100 N axial load was applied in one side simultaneously, from first premolar to second molar. In all models it was analyzed the overdenture displacement, compressive/tensile stress in the bone-implant interface, and also the von Mises equivalent stress for the nylon component of the housing. The stresses were obtained (numerically and color-coded) for further comparison among all the groups. Results: The displacement on the overdenture was higher at the posterior surface for all groups, especially in the C-17º group. When comparing the compressive/tensile stress in the bone-implant interface, the lateral-incisor groups (LI-0º and LI-17º) had the highest compressive and lowest tensile stress compared to the canine groups (C-0º and C-17º). The von Mises stress on the nylon component generated higher stress value for the LI-0º among all groups. Conclusions: The inclination and positioning of the implant in mandibular overdenture interferes directly in the stress distribution. The results showed that angulated implants had the highest displacement. While the implants placed in the lateral incisor position presented lower compressive and higher tensile stress respectively. For the attachment the canine groups had the lowest stress

Drug use on both sides of the US-Mexico border / Uso de drogas en ambos lados de la frontera Estados Unidos-México

Abstract Objective To compare drug use for cities along the US-Mexico border. Materials and methods Data are from the US-Mexico Study on Alcohol and Related Conditions (UMSARC, 2011-2013), a survey of 4 796 randomly selected Mexican and of Mexican origin individuals on both sides of the border. Results Higher rates of any past-year drug use and symptoms of drug use disorders were found only in the border city of Laredo, when compared to the non-border city of San Antonio. Nuevo Laredo and Reynosa/Matamoros showed higher rates of drug use than the non-border city of Monterrey. Much higher rates (OR's in the range of 4-11) were found in the US cities when compared to their across-the-border Mexican counterparts. Conclusions Drug use is high on the border for the selected Mexican cities. Misuse of prescription drugs is nevertheless a concern in the south Texas border cities in our study.

Resumen Objetivo Comparar el consumo de drogas para las ciudades a lo largo de la frontera Estados Unidos-México. Material y métodos Los datos provienen del Estudio "US-Mexico study on alcohol and related conditions" (UMSARC, 2011- 2013), una encuesta de 4 796 personas mexicanas y de origen mexicano en ambos lados de la frontera. Resultados Las tasas más altas de cualquier consumo de drogas en el año pasado y los síntomas de trastornos por uso de drogas se encontraron sólo en la ciudad fronteriza de Laredo, en com paración con la ciudad no fronteriza de San Antonio. Tanto Nuevo Laredo como Reynosa/Matamoros mostraron mayo res tasas de consumo de drogas que la ciudad no fronteriza de Monterrey. Tasas mucho más altas (OR en el rango de 4-11) fueron encontradas en las ciudades de los Estados Unidos en comparación con sus contrapartes mexicanas fronterizas. Conclusiones El consumo de drogas en México es alto en la frontera. El uso de medicamentos recetados fuera de prescripción es una preocupación en las ciudades fronterizas del sur de Texas.

The spasticity in the motor and functional disability in adults with post-stroke hemiparetic / A espasticidade no comprometimento motor e funcional de hemiparéticos pós acidente vascular cerebral

Abstract Introduction: Spasticity acts as a limiting factor in motor and functional recovery after Stroke, impairing the performance of daily living activities. Objective: To analyze the influence of spasticity on main muscle groups and to associate it with motor impairment and functional level of chronic hemiparetic patients after stroke. Methods: Twenty-seven chronic hemiparetic patients of both sexes were selected at the Physical Therapy and Occupational Therapy Service of the Unicamp Clinics Hospital. Assessments were carried out in two sessions, in the first one the motor impairment (Fugl-Meyer Assessment - FM) and functional impairment (Barthel Index - BI) were evaluated, and in the second, the degree of spasticity of the main muscle groups (Modified Ashworth Scale - MAS). Results: A negative correlation was detected between upper limb spasticity and motor and functional impairment. No muscle group evaluated in the lower limbs showed correlation between muscle tone and the level of impairment of the lower extremity on FM and the functional level measured by BI. Conclusion: Spasticity has been shown to be a negative influence factor in the level of motor and functional impairment of the upper limbs of chronic hemiparetic patients after stroke.

Resumo Introdução: A espasticidade atua como um fator limitante na recuperação motora e funcional após o Acidente Vascular Cerebral (AVC), prejudicando a realização das atividades de vida diária. Objetivo: Analisar a influência da espasticidade nos principais grupos musculares e associá-la ao comprometimento motor e ao nível funcional de pacientes hemiparéticos crônicos pós-AVC. Métodos: Vinte e sete pacientes hemiparéticos crônicos, de ambos os sexos, foram selecionados no Serviço de Fisioterapia e Terapia Ocupacional do Hospital de Clínicas da Unicamp. As avaliações foram realizadas em duas sessões: na primeira foi avaliado o comprometimento motor (Protocolo de Desempenho Físico de Fugl-Meyer - FM) e funcional (Índice de Barthel - IB), e na segunda, o grau de espasticidade dos principais grupos musculares (Escala Modificada de Ashworth - EMA). Resultados: Foi detectada uma correlação negativa entre a espasticidade dos membros superiores com o comprometimento motor e funcional. Nenhum grupo muscular avaliado nos membros inferiores apresentou correlação entre o tônus muscular e o nível de comprometimento da subseção da extremidade inferior FM e o nível funcional mensurado pelo IB. Conclusão: A espasticidade mostrou ser um fator de influência negativa no nível de comprometimento motor e funcional dos membros superiores de pacientes hemiparéticos crônicos pós-AVC.

Inserção do Conteúdo Fitoterapia em Cursos da Área de Saúde / Inclusion of Phytotherapy Content in Health Training Courses

RESUMO Este trabalho verificou a opinião de acadêmicos da Saúde sobre a inserção do conteúdo fitoterapia nos cursos de graduação. Trata-se de estudo transversal e analítico, realizado com aplicação de questionário a alunos de Enfermagem, Medicina e Odontologia em 2011. Participaram 248 acadêmicos, a maioria do sexo feminino (69,8%), com idade entre 17 e45 anos. Os estudantes (70,8%) mostraram interesse pela inclusão da fitoterapia, sem diferença entre os sexos (p= 0,757), sendo 83,1% da Enfermagem, 68,2% da Medicina e 63,0% da Odontologia (p=0,019). Entre as motivações destacam-se: ampliação do conhecimento (35,7%) e constatação da evidência científica (16,5%). O desconhecimento da Política Nacional de Práticas Integrativas e Complementares foi de 84,7% na Enfermagem, 84,6% na Medicina e 74,7% na Odontologia (p=0,166), sem diferença significativa entre os sexos (p= 0,333). Conclui-se que os estudantes são favoráveis à inserção do conteúdo fitoterápico no currículo, embora desconheçam a Política Nacional de Práticas Integrativas e Complementares, regulamentada para o sistema de saúde brasileiro.

ABSTRACT This study examined the views of health academics about the inclusion of herbal medicine content in undergraduate courses. It is cross-sectional analytical study, with a questionnaire applied tonursing, medical and dentistry students in 2011. The study involved248 students, mostly women (69.8%), aged 17-45 years. The students (70.8%) showedinterest in the inclusion of herbal medicine, with no difference between genders (p = 0.757) and 83.1% of nursing, 68.2% and 63.0% of medical and dentistry students (p = 0.019), respectively. The reasons given for this include: expansion of knowledge (35.7%) and finding scientific evidence (16.5%). 84.7% of the nursing students, 84.6% ofthe medical students and 74.7% of the dentistry students (p = 0.166) did not know about the National Policy on Integrative and Complementary Practices, with no significant difference between genders (p = 0.333). In conclusion, students favor the inclusion of herbal medicine content in the curriculum, despite being unaware of the National Policy on Integrative and Complementary Practices, regulated forthe Brazilian health system.

Cognitive processes affect the gait of subjects with Parkinson’s and Alzheimer’s disease in dual tasks / Processos cognitivos afetam a marcha de sujeitos com doença de Parkinson e de Alzheimer em duplas tarefas

Objective To investigate the relation between gait parameters and cognitive impairments in subjects with Parkinson’s disease (PD) and Alzheimer’s disease (AD) during the performance of dual tasks. Methods This was a cross-sectional study involving 126 subjects divided into three groups: Parkinson group (n = 43), Alzheimer group (n = 38), and control group (n = 45). The subjects were evaluated using the Timed Up and Go test administered with motor and cognitive distracters. Gait analyses consisted of cadence and speed measurements, with cognitive functions being assessed by the Brief Cognitive Screening Battery and the Clock Drawing Test. Statistical procedures included mixed-design analyses of variance to observe the gait patterns between groups and tasks and the linear regression model to investigate the influence of cognitive functions in this process. A 5% significant level was adopted. Results Regarding the subjects’ speed, the data show a significant difference between group vs task interaction (p = 0.009), with worse performance of subjects with PD in motor dual task and of subjects with AD in cognitive dual task. With respect to cadence, no statistical differences was seen between group vs task interaction (p = 0.105), showing low interference of the clinical conditions on such parameter. The linear regression model showed that up to 45.79%, of the variance in gait can be explained by the interference of cognitive processes. Conclusion Dual task activities affect gait pattern in subjects with PD and AD. Differences between groups reflect peculiarities of each disease and show a direct interference of cognitive processes on complex tasks. .

Objetivo Investigar a relação entre parâmetros da marcha e comprometimento cognitivo em sujeitos com doença de Parkinson (DP) e doença de Alzheimer (DA) durante tarefas duplas. Métodos Este estudo consistiu em uma pesquisa transversal envolvendo 126 sujeitos, divididos em três grupos: grupo Parkinson (n = 43), grupo Alzheimer (n = 38) e grupo controle (n = 45). Os sujeitos foram submetidos ao teste Timed Up and Go, administrado com distrator motor e cognitivo. Os parâmetros analisados na marcha foram cadência e velocidade, tendo as funções cognitivas avaliadas por meio da Bateria Breve de Rastreio Cognitivo e do Teste do Desenho do Relógio. Os procedimentos estatísticos incluíram a análise mista de variâncias para observar os padrões da marcha nos grupos e nas tarefas e o modelo de regressão linear para investigar a influência das funções cognitivas nesse processo. O nível de significância foi estipulado em 5%. Resultados Em relação à velocidade, os dados vislumbram diferença significativa na interação grupo vs. tarefa (p = 0,009), com pior rendimento dos sujeitos com DP na dupla tarefa motora e dos com DA na situação de dupla tarefa cognitiva. Sobre a cadência, os resultados não apontaram diferença significativa na interação grupo vs. tarefa (p = 0,105), vislumbrando pouca interferência das condições clínicas sobre esse parâmetro. O modelo de regressão linear demonstrou que até 45.79% da variação nos parâmetros da marcha podem ser explicados por processos cognitivos. Conclusão Atividades de dupla tarefa afetam a marcha de sujeitos com DA e DP. A diferença entre grupos reflete peculiaridades de cada doença e demonstra interferência direta de processos cognitivos em atividades complexas. .

Evolução Funcional de Pacientes com Hemorragia Subaracnóide Aneurismática não Traumática / Functional Outcome of Patients With Non-Traumatic Aneurysmal Subarachnoid Hemorrhage

Descrever a evolução funcional de pacientessubmetidos ao tratamento cirúrgico de clipagem aneurismáticaadmitidos no Hospital das Clínicas da Universidade Estadualde Campinas (Unicamp). Material e métodos: Foi realizada aavaliação de Hunt-Hess e Fisher na internação do paciente.A Medida de Independência Funcional (MIF) foi realizada nopós-operatório e na alta do paciente, e a avaliação da escalade prognóstico de Glasgow (GOS) foi feita na alta hospitalardo paciente. Foram computados os dias de internação dospacientes, a identificação das artérias comprometidas. Otratamento fisioterapêutico, baseado na cinesioterapiaconvencional, foi realizado 2 vezes ao dia. Resultados: Foramavaliados 13 pacientes, com predomínio de aneurismas naartéria cerebral média (53,85%). A média de idade foi de51,62 (±13,04) anos, e a variação da MIF entre a admissão ealta hospitalar obteve a média de 34,85 (±20,85) pontos (p<0,001). A comparação da MIF com as escalas de Hunt-Hess,Fisher e GOS não obteve estatística significante. Conclusão:A Hemorragia Subaracnóide (HSA) é um evento grave queresulta no comprometimento motor e cognitivo do paciente. AMIF pode ter um importante papel preditivo para oacompanhamento da neuroreabilitação intrahospitalar na fasesubaguda da HSA aneurismática não traumática...

To describe the functional outcome of patientsundergoing surgical treatment of intracranial aneurysmclipping admitted to the University of Campinas (Unicamp)hospital. Material and methods: Hunt-Hess and Fisherevaluation was performed with patients at admission. TheFunctional Independence Measure (FIM) test was performedpost-operatively and at discharge, and the Glasgow OutcomeScale (GOS) assessment was carried out at patientdischarge. Data on the length of hospital stay as well asaffected arteries were obtained. Physical therapy, based onconventional kinesiotherapy, was performed twice a day.Results: A total of 13 patients were studied, with a prevalenceof aneurysms in the middle cerebral artery (53.85%). Theaverage age was 51.62 (±13.04) years, and the change inFIM between admission and discharge averaged 34.85 (±20.85) points (p <0.001). Comparison of FIM with the Hunt-Hess, Fisher and GOS scales demonstrated no significantcorrelations. Conclusion: ASH is a serious event that resultsin cognitive and motor impairment of the patient. FIM could bean important predictive tool for monitoring in-hospitalneurorehabilitation in the subacute phase of non-traumaticaneurysm...

Prevalencia y factores asociados al consumo de tabaco, alcohol y drogas en una muestra poblacional de adultos mayores del Distrito Federal / Prevalence and associated factors of use of tobacco, alcohol and drugs in elderly from Distrito Federal

There are no studies in Mexico estimating the use of psychoactive substances in the elderly (+69 yrs) and there is a lack of information about the risk factors determining the burden of disease for this age group. The goal of this study is to present prevalences of use of alcohol, tobacco, illicit drugs and nonmedical prescription drugs in beneficiaries of a cash supplement program sponsored by the Institute for the Care of Elderly from Federal District (Instituto para la Atención del Adulto Mayor del Distrito Federal, IAAM-DF). Furthermore, significant sociodemographic factors associated with substance use are reported. From a random sample of the 2 501 users registries of a cash supplement program of IAAM-DF, a total of 2 098 agreed to participate and were interviewed in their homes. The response rate was of 83.9%. We found that 63.5% of all participants ever used alcohol, 45.4% ever used tobacco and 3.5% ever used any drugs. Near one out of every two men and one out of every four women used alcohol during the previous 12 months, one out of every 10 older adults used tobacco and just one out of every 100 used any kind of drug in the last 12 months. Overall prevalence of substance use is higher in men, with the exception of medical drugs. Outstanding associated factors in substance use were sex and higher socioeconomic levels. This is the first study in the country on substance use in dwelling elderly, not living in institutions. Alcohol use, even risky drinking, is not uncommon, smoking tobacco habits do not disappear with age, and medical drug use can be of concern for its effects on other diseases. Therefore, it becomes necessary to establish definitions of risky use for this population and develop appropriate intervention programs for this population group.

No existen investigaciones en el país sobre uso de sustancias psico-activas en poblaciones de adultos mayores (+69 años) y se carece de información sobre los factores de riesgos que son determinantes para la carga de la enfermedad en este grupo. Este estudio tuvo como objetivo presentar las prevalencias de consumo de alcohol, tabaco, drogas ilícitas y drogas médicas usadas sin prescripción en los beneficiarios del programa de pensión alimentaria del Instituto para la Atención del Adulto Mayor del Distrito Federal (IAAM-DF). Adicionalmente, se reportaron factores sociodemográficos asociados al consumo de estas sustancias. De una muestra aleatoria del padrón de usuarios del programa del IAAM-DF de 2501 personas, un total de 2098 aceptaron participar y fueron entrevistadas en sus hogares, obteniéndose una tasa de respuesta de 83.9%. Se encontró que 65.3% de la población consumió alcohol, 45.4% tabaco y 3.5% alguna droga alguna vez en la vida. En los últimos 12 meses, casi uno de cada dos varones y una de cada cuatro mujeres consumió alcohol; uno de cada 10 adultos mayores consumió tabaco; y sólo uno de cada 100 consumió alguna droga. La prevalencia de consumo de sustancias es mayor en hombres, con excepción de las drogas médicas. Los factores asociados que destacaron fueron el sexo y los mejores niveles económicos. Éste es el primer estudio realizado en el país sobre uso de sustancias en población de adultos mayores con domicilio fijo, no institucionalizado. El consumo de alcohol, incluso el consumo riesgoso, no es infrecuente; el hábito tabáquico no ha desaparecido con la edad, y el uso de drogas médicas puede ser un motivo de preocupación por su efecto en otras patologías. Se hace necesario establecer definiciones de uso riesgoso para esta población y desarrollar programas de intervención adecuados para este grupo.

La carga de enfermedad, lesiones, factores de riesgo y desafíos para el sistema de salud en México / Burden of disease, injuries, risk factors and challenges for the health system in Mexico

Objetivo. Presentar los resultados de la carga de enfermedad en México de 1990 a 2010 para las principales enfermedades, lesiones y factores de riesgo, por sexo. Materiales y métodos. Se realizó un análisis secundario del estudio de la carga mundial de la enfermedad 2010. Resultados. En 2010 se perdieron 26.2 millones de años de vida saludable (AVISA), 56% en hombres y 44% en mujeres. Las principales causas de AVISA en hombres fueron violencia, cardiopatía isquémica y los accidentes de tránsito. En las mujeres fueron la diabetes, la enfermedad renal crónica y la cardiopatía isquémica. Los trastornos mentales y musculoesqueléticos concentran 18% de la carga. Los factores de riesgo que más afectan a los hombres son sobrepeso/obesidad; niveles de glucosa en sangre y de presión arterial elevados; y el consumo de alcohol y tabaco (35.6% de AVISA perdidos). En las mujeres, el sobrepeso y la obesidad; glucosa elevada; hipertensión arterial; baja actividad física; y el consumo de alcohol y tabaco fueron responsables de 40% de los AVISA perdidos; en ambos sexos, la dieta contribuye con 12% de la carga. Conclusiones. El panorama epidemiológico en México demanda una urgente adecuación y modernización del sistema de salud.

Objective. To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. Materials and methods. A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. Results. In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. Conclusions. The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.

Comorbilidad de los trastornos por consumo de sustancias con otros trastornos psiquiátricos en Centros Residenciales de Ayuda-Mutua para la Atención de las Adicciones / Comorbidity of substance abuse disorders with other psychiatric disorders in Mutual-Aid Residential Treatment Centers

La comorbilidad de los trastornos por consumo de sustancias con otros trastornos mentales presenta una importante prevalencia; se ha reportado que ésta es mayor en los centros de tratamiento psiquiátrico (2050%) y para las adicciones (50-75%) en comparación con la población abierta. Una modalidad de Ayuda-Mutua para la atención de las adicciones común en México es la de los Centros Residenciales y Casas de Recuperación para las adicciones, también llamados "anexos". El objetivo del estudio fue estimar la prevalencia de comorbilidad de los trastornos por consumo de sustancias con otros trastornos psiquiátricos en una muestra de participantes de sexo masculino adscritos a los Centros Residenciales de Ayuda-Mutua para la Atención de las Adicciones (CRAMAA). Se captó a un total de 535 participantes, de los cuales 346 cumplieron los criterios de inclusión y fueron evaluados. La evaluación diagnóstica de los trastornos por uso de sustancias y los 17 trastornos psiquiátricos comórbidos se realizó con la Entrevista Internacional Diagnóstica Compuesta (WMH-CIDI). Los resultados mostraron que 75.72% cumplía con criterios diagnósticos para algún trastorno psiquiátrico comórbido, siendo los más prevalentes los trastornos por déficit de atención y comportamiento perturbador, seguidos por los trastornos de ansiedad, la ansiedad por separación, los trastornos afectivos, los trastornos por control de impulsos y con menor frecuencia los trastornos de la conducta alimentaria. En la mayoría de los casos (83.59%), los trastornos psiquiátricos comórbidos precedieron a los trastornos adictivos. Este estudio constituye una aportación que puede considerarse para futuras propuestas en políticas públicas, que se traduzcan en acciones para ofertar servicios que atiendan las adicciones y los trastornos psiquiátricos de manera integral.

Substance use disorders have a high degree of comorbidity with other psychiatric disorders; it has been reported that the prevalence of comorbidity is higher in psychiatric (20-50%) and addiction (50-75%) treatment settings than in household or student populations. Because of limited treatment alternatives and greater treatment needs, Mutual-Aid groups have become relevant in the last decades. A modality of Mutual-Aid for addiction treatment that has proliferated in Mexico has taken the form of residential Mutual-Aid centers called "anexos" in Spanish. The objective of this study was to estimate the prevalence of lifetime comorbidity between substance use disorders and psychiatric disorders in those who attended these residential Mutual-Aid centers. The initial sample consisted of 535 male participants diagnosed with a substance use disorder, but only 346 fulfilled the inclusion criteria to continue with the evaluation. Only males were included as the participating centers only admit males. Psychiatric diagnosis was evaluated with the Composite International Diagnostic Interview (WMH-CIDI) using DSM-IV criteria. The results showed that 75.72% met criteria for any comorbid psychiatric disorder, the most frequent being attention deficit and conduct disorders, followed by anxiety disorders, separation anxiety disorders, mood disorders, impulse control disorders and least frequently eating disorders. While the study is limited by its non-representative sample, the findings provide valuable information for a hidden population for which there is a dearth of information and points to the need for integrative services which address both addiction and comorbid psychiatric disorders simultaneously.

Impacto de los trastornos psiquiátricos comunes y las condiciones crónicas físicas en el individuo y la sociedade / The impact of common mental and physical health conditions on days out of role: costs for the individual and society

OBJETIVO: Estimar los costos individuales y poblacionales de condiciones crónicas físicas y mentales comunes en la población mexicana, en función del número de días perdidos por problemas en el funcionamiento. MATERIAL Y MÉTODOS: 5 826 adultos fueron evaluados entre 2001-2002 con la Entrevista Internacional Psiquiátrica Compuesta y el Cuestionario para la Evaluación de Discapacidades. Se realizaron modelos generales lineales y se estimó la proporción de riesgo atribuible a la población, tomando en cuenta la prevalencia de la condición y la comorbilidad. RESULTADOS: Las condiciones de mayor impacto para el individuo son la depresión, el estrés postraumático y el trastorno bipolar. Las de mayor impacto a nivel poblacional son la depresión, el dolor, el insomnio y las enfermedades cardiovasculares. CONCLUSIÓN: Los hallazgos señalan la importancia de aumentar el gasto en salud mental para asignar una proporción más equitativa para su atención en cuanto al costo que representan para la sociedad.

OBJECTIVE: To estimate the individual and societal costs of common mental and physical health conditions in the Mexican population with regards to the number of days out of role. MATERIALS AND METHODS: 5 826 adults were evaluated in 2001-2002 with the Composite International Diagnostic Interview and the WHO Disability Assessment Schedule. General linear models were used to estimate individual-level effects. Societal-level effects were estimated with the population attributable risk proportion which takes into account prevalence and comorbidity of disorders. RESULTS: The conditions with the strongest individual -level effects were major depression, post-traumatic stress disorder and bipolar disorder. The strongest societal-level effects were associated with major depression, pain, insomnia and cardiovascular conditions. CONCLUSION: The findings suggest the importance of investing in mental health expenditure to a level commensurate with the costs to society of mental health disorders.

Mexican immigration to the U.S., the occurrence of violence and the impact of mental disorders

Objective: To study immigration, U.S. nativity, and return migration as risk factors for violence among people of Mexican origin in the U.S. and Mexico. Methods: Cross-sectional surveys in the United States (2001-2003; n=1,213) and Mexico (2001-2002; n=2,362). Discrete time survival models were used. The reference group was Mexicans living in Mexico without migrant experience or a migrant relative. Results: Mexican immigrants in the U.S. have lower risk for any violence (hazard ratio [HR] = 0.5, 95% confidence interval [95%CI] 0.4-0.7). U.S.-born Mexican-Americans were at higher risk for violence victimization of a sexual nature (for sexual assault, HR = 2.5, 95%CI 1.7-3.7). Return migrants were at increased risk for being kidnapped or held hostage (HR = 2.8, 95%CI 1.1-7.1). Compared to those without a mental disorder, those with a mental disorder were more likely to suffer any violence (HR = 2.3, 95%CI 1.9-2.7), regardless of the migrant experience. Conclusions: The impact of immigration on the occurrence of violence is more complex than usually believed. Return migrants are more likely to suffer violence such as being held hostage or beaten by someone other than a partner. .

Índice de riesgo para el intento suicida en México / Risk index for attempted suicide in Mexico

OBJETIVO: Desarrollar un índice de riesgo de los intentos de suicidio en los últimos 12 meses dentro de un grupo de personas con ideación suicida. MATERIAL Y MÉTODOS: Estudio de prevalencia. Se analizaron los datos de la Encuesta Nacional de Adicciones de 2008. El índice de riesgo estuvo conformado por la edad, estado civil, religión, ocupación, tipo de población, migración a Estados Unidos, consumo de alcohol y drogas, síntomas de depresión, conducta problemática y abuso sexual. RESULTADOS: Se observó un incremento monotónico con el aumento de los factores de riesgo y la ausencia o presencia de un plan y el riesgo, con razones de momios desde 2.07 hasta 152.19. El área bajo la curva fue elevada, con un valor de 0.844, cercano a 1. CONCLUSIÓN: El uso de este índice puede ayudar a prevenir que los pacientes sigan desarrollando ideación suicida e intento suicida de consecuencias inciertas, incluyendo la muerte.

OBJECTIVE: To develop a risk index of suicide attempts in the last 12 months among people with suicide ideation. MATERIALS AND METHODS: Cross-sectional study. Data came from the National Addictions Survey 2008. The risk index was made up by age, marital status, religion, occupation, area of the country in which they live, immigrant to the United States, alcohol and drug consumption, depression symptoms, behavioral problems and a history of sexual abuse. RESULTS: We found a monotonic relationship between the increase in risk factors and the existence of a plan and the risk, with an odds ratio over 2.07 up to 152.19. The area under the curve is quite high, with a value of 0.844, very close to 1. CONCLUSION: The use of this index may help prevent patients from further developing their suicide ideation process and may prevent a suicide attempt of uncertain consequences, including death.