Índice de vulnerabilidad CAPE: Compasión, Acción Asertiva, Pragmatismo y Evidencia - Versión para América Latina y el Caribe (CAPE VI - LAC) "Globalización, conflicto, cambio climático, desastres naturales: poner la salud mental en la política exterior" / CAPE Vulnerability Index: Compassion, Assertive Action, Pragmatism and Evidence - Version for Latin America and the Caribbean (CAPE VI - LAC) "Globalisation, conflict, climate change, natural disasters: putting mental health into foreign policy"

Introducción: El índice de vulnerabilidad CAPE es un índice global de política exterior que identifica a los países a los que se dará prioridad para recibir ayuda exterior. Ofrece un enfoque evidenciado, estructurado y razonado para utilizar la ayuda en acuerdos bilaterales con la salud mental como base. La presente versión está diseñada específicamente para la región de América Latina y el Caribe (ALC), que comprende 33 países. Objetivos: Identificar los países a ser priorizados para la ayuda externa, a través de la versión ALC del Índice de Vulnerabilidad CAPE (CAPE VI-LAC). Materiales y métodos: Al igual que con la versión global del Índice de Vulnerabilidad CAPE, consideramos varios índices o medidas a nivel de país que indican el estado de salud o que puede influir en la salud. Para el análisis, calificamos a los 20 peores países. Utilizamos 26 indicadores validados y disponibles internacionalmente para explorar y realizar el análisis. Resultados: Las cifras y el mapa muestran los 32 países que figuraron entre los 20 peores en al menos un indicador y también los 12 peores dentro de la CAPE VI-LAC en su conjunto. De los 33 países de ALC, sólo San Cristóbal y Nieves no figuraba en ninguno de los 20 países peores en ningún momento. Conclusión: Lo que podemos concluir con un alto grado de certeza es que los 12 países con peores puntuaciones son posiblemente estados frágiles; países donde los gobiernos no tienen el control o la autoridad completos, a menudo son represivos y corruptos, participan en graves abusos de los derechos humanos y se caracterizan por la inestabilidad política de diversas formas, la desventaja por los cambios climáticos extremos, la pobreza extrema, la desigualdad social y étnica divisiones, incapaces de proporcionar servicios básicos y sufren focos de insurgencia en forma de terrorismo, que a menudo son violentos y brutales. Los gobiernos, los donantes de ayuda, las organizaciones regionales y los profesionales y las asociaciones de salud mental deben trabajar juntos para abordar estas situaciones.

Introduction: The CAPE Vulnerability Index is a global foreign policy index that identifies the countries to be prioritise for foreign aid. It offers an evidenced, structured and reasoned approach to using aid in bi-lateral agreements with mental health as a foundation. The present version is specifically design for Latin America and Caribbean (LAC) region, which comprises of 33 countries. Objectives: To identify the countries to be prioritized for foreign aid, through the LAC version of the CAPE Vulnerability Index (CAPE VI-LAC). Materials and methods: Like with the CAPE Vulnerability Index global version we consider various indices or measures at country level that indicate health status or what may influence health. For the analysis we score the worst 20 countries. We used 26 internationally available and validated indicators to explore and perform the analysis. Results: The figures and map show the 32 countries that featured in the worst 20 in at least one indicator and also the worst 12 within the CAPE VI-LAC as a whole. Of the 33 LAC countries only St Kitts and Nevis did not feature in any of the worst 20 countries at any time. Conclusion: What we can conclude with a great degree of certainty that the worst 12 scoring countries are possibly fragile states; countries where the Governments do not have complete control or authority, are often repressive and corrupt, participate in serious human rights abuses and are characterised by political instability of various forms, disadvantage by the extremes of climate changes, extreme poverty, inequality, social and ethnic divisions, unable to provide basic services and suffer from pockets of insurgency in the form of terrorism, which are often violent and brutal. Governments, aid donors, regional organizations, and mental health professionals and associations should work together in order to address these situations.

Experimentation with tobacco during adolescence as a factor influencing treatment of smoking in adulthood. A retrospective cohort

ABSTRACT BACKGROUND: There are still few studies on predictors of smoking cessation in Brazilian samples. Experimentation with tobacco during adolescence (ETA) may be one of the important predictors. OBJECTIVE: This study aimed, within the context of a treatment-seeking group of subjects, to test the hypothesis that ETA negatively affects the outcome of smoking cessation during adulthood. DESIGN AND SETTING: Retrospective (historic) cohort study conducted at a psychosocial care center in São Paulo, Brazil, between 2007 and 2010. METHODS: Data on sociodemographics, smoking and medical profiles were obtained through self-report questionnaires that were completed at the baseline and at any follow-up appointment. Logistic regression models were constructed to describe factors associated with the outcome of smoking cessation, measured according to the self-reported four-week success rate among 367 outpatient smokers. RESULTS: ETA was found to be associated with not quitting smoking through the treatment (odds ratio = 0.57; 95% confidence interval = 0.33-0.96; P < 0.05), even after adjustment for dependence level, sociodemographics, nicotine patch use and number of years of smoking. CONCLUSIONS: Early exposure to nicotine may lead to higher risk of continuing smoking after treatment, in adulthood.

Relevance of the Flexner report for medical education in India

Medicine is one of the oldest professions and has certain professional imperatives and rules. Training of medical professionals is prolonged and often intense and also expensive. It is strongly influenced by cultural values and context and social needs. Over one hundred years ago Abe Flexner reviewed the medical school training in the USA and made some clear recommendations. We believe that some of these observations have a key role to play in medical education at the present time in India. In this brief editorial we raise some of the pertinent factors.

Ethical practice in clinical and research settings

Medicine and its practice have a responsibility not to cause harm. Ethical values lie at the heart of clinical practice. Ethical values are even more important in psychiatry –a medical discipline where its practitioners have been handed responsibility for detaining and treating patients against their will. This responsibility needs to be taken seriously and utilised within the context of clinical practice and ethical values. Various organisations have developed codes of ethical practice and it is vital that practitioners are aware of these. These codes include respect for patients and standards of clinical practice. The basis of these codes is reliant on the concepts of principlism which includes respect for autonomy, beneficience, justice and nonmaleficence. These also impact on human rights and influence outcomes. Ethics must form a part of the curricula at all levels.

Integrated skills for parenting the adolescents (ISPA): An intervention to strengthen parent- adolescent relationship / Integración de habilidades para la crianza de adolescentes: Intervención para el reforzamiento de larelación padres-adolescentes

Parenting skills are an important aspect of child development. The training in development of these skills is a recent trend in order to enable parents to manage the child in their culture and community, with culture-specific training. Systematic presentations of evidence-based models in the field of parenting skills development are beginning to emerge in India. In this paper, we describe the development of a parenting skills development program (Integrated skill for parenting the adolescents ISPA) aimed at strengthening the parent-adolescent bond and describe its components. After an initial needs assessment from parents and their adolescent children, 13 parents were systematically given the parenting program for eleven sessions, each session focusing on different themes. The pre- and post- intervention results show statistically significant changes in parents’ attitudes in relating positively with their adolescents. We describe pros and cons of such approaches.

Las destrezas o habilidades parentales son un aspecto importante del desarrollo infantil. El adiestramiento de lospadres en la adquisición y cultivo de estas destrezas es un proceso reciente orientado a su capacitación apropiada en el manejo del niño dentro de su cultura y su comunidad utilizando principios didácticos específicos para tal cultura. En la India han comenzado a emerger una serie de presentaciones sistemáticas de modelos basados en evidencias en el desarrollo de habilidades parentales. El presente artículo describe uno de estos programas (Habilidades Integralespara padres de adolescents, ISPA, sigla en ingles) orientado al reforzamiento del vínculo padre-adolescente y a la descripción de sus componentes. Luego de una evaluación inicial de las necesidades de los padres de niños adolescents, 13 padres siguieron sistemáticamente el programa de once sesiones, cada una de ellas enfocando temas diferentes. Los resultados antes y después de la intervención muestran cambios estadísticamente significativos en las actitudes de los padres respecto a una relación positiva con sus hijos adolescentes. Se describen los “pros y contras” de tales enfoques.

Using selected scenes from Brazilian films to teach about substance use disorders, within medical education / Usando cenas selecionadas de filmes brasileiros para ensino a respeito dos transtornos relacionados ao uso de substâncias, na educação médica

CONTEXT AND OBJECTIVES: Themes like alcohol and drug abuse, relationship difficulties, psychoses, autism and personality dissociation disorders have been widely used in films. Psychiatry and psychiatric conditions in various cultural settings are increasingly taught using films. Many articles on cinema and psychiatry have been published but none have presented any methodology on how to select material. Here, the authors look at the portrayal of abusive use of alcohol and drugs during the Brazilian cinema revival period (1994 to 2008). DESIGN AND SETTING: Qualitative study at two universities in the state of São Paulo. METHODS: Scenes were selected from films available at rental stores and were analyzed using a specifically designed protocol. We assessed how realistic these scenes were and their applicability for teaching. One author selected 70 scenes from 50 films (graded for realism and teaching applicability > 8). These were then rated by another two judges. Rating differences among the three judges were assessed using nonparametric tests (P < 0.001). Scenes with high scores (> 8) were defined as "quality scenes". RESULTS: Thirty-nine scenes from 27 films were identified as "quality scenes". Alcohol, cannabis, cocaine, hallucinogens and inhalants were included in these. Signs and symptoms of intoxication, abusive/harmful use and dependence were shown. CONCLUSIONS: We have produced rich teaching material for discussing psychopathology relating to alcohol and drug use that can be used both at undergraduate and at postgraduate level. Moreover, it could be seen that certain drug use behavioral patterns are deeply rooted in some Brazilian films and groups.

CONTEXTO E OBJETIVOS: Temas como o abuso de álcool e drogas, dificuldades nos relacionamentos, psicoses, autismo e transtornos de personalidade são largamente usados em filmes. Os filmes têm sido cada vez mais utilizados para ensinar psiquiatria e condições psiquiátricas em diferentes ambientes culturais. Existem muitos artigos sobre cinema e psiquiatria. Mas nenhum desses apresenta metodologia sobre como selecionar o material. Os autores se propuseram a buscar representação do uso problemático de álcool e drogas no período de retomada do cinema brasileiro (1994-2008). TIPO DE ESTUDO E LOCAL: Estudo qualitativo em duas universidades do estado de São Paulo. MÉTODOS: As cenas foram retiradas de filmes disponíveis em locadoras, e foram avaliados utilizando um protocolo desenvolvido especificamente. Foi avaliado o realismo e a aplicabilidade didática de cada cena. Um autor selecionou 70 cenas a partir de 50 filmes (notas de realismo e aplicabilidade didática > 8) para posterior avaliação de outros dois autores. Diferenças nas notas dos três juízes foram avaliadas usando testes não-paramétricos (P < 0,001). Cenas com uma nota alta (> 8) foram definidas como "cenas de qualidade". RESULTADOS: Trinta e nove cenas de 27 filmes foram identificadas como "cenas de qualidade". Álcool, maconha, cocaína, alucinógenos e inalantes são mostrados nessas cenas. Sinais e sintomas de intoxicação, uso abusivo/nocivo e dependência foram encontrados. CONCLUSÕES: Foi produzido rico material para ensino, tanto na graduação quanto na pós-graduação, da psicopatologia relacionada ao uso de álcool e drogas. Além disso, foi possível demonstrar como alguns comportamentos relacionados ao uso de drogas estão arraigados em certos filmes e grupos brasileiros.

Psychiatric epidemiology in India.

Epidemiological studies report prevalence rates for psychiatric disorders from 9.5 to 370/1000 populations in India. This review critically evaluates the prevalence rate of mental disorders as reported in Indian epidemiological studies. Extensive search of PubMed, NeuroMed and MEDLARS using search terms "psychiatry" and "epidemiology" was done. Manual search of literature was also done. Retrieved articles were systematically selected using inclusion and exclusion criteria. Only sixteen prevalence studies fulfilled the study criteria. Most of the epidemiological studies done in India neglected anxiety disorders, substance dependence disorders, co-morbidity and dual diagnosis. The use of poor sensitive screening instruments, single informant and systematic underreporting has added to the discrepancy in the prevalence rate. The prevalence of mental disorders reported in epidemiological surveys can be considered lower estimates rather than accurate reflections of the true prevalence in the population. Researchers have focused on broad non-specific, non-modifiable risk factors, such as age, gender and social class. Future research focused on the general population, longitudinal (prospective), multi-centre, co-morbid studies, assessment of disability, functioning, family burden and quality of life studies involving a clinical service providing approach, is required.