Associated factors to non-medical and medical use of psychoactive medication among Mexican adolescents and adults in a national household survey.

BACKGROUND: Non-medical use of psychoactive medication is a public health problem. Studies in other contexts indicate that individual sociodemographic characteristics are associated with non-medical use, but these associations have not been assessed in the Mexican context. OBJECTIVES: To estimate the prevalence non-medical and medical use of psychoactive medication among Mexican adolescents and adults' medication users and to estimate the associations between sociodemographic characteristics and non-medical use of psychoactive medication, using data from a nationally representative sample. METHODS: Secondary analysis of data collected from the National Survey of Drug, Alcohol, and Tobacco Consumption (ENCODAT) 2016 to 2017. The analytical sample included people aged 12 to 65 years. The sample was stratified into two age categories: adolescents (12-17 years) and adults (18-65 years). Sub-analyses were performed to describe prevalence of use and non-medical use of psychoactive medication at the state-level. Descriptive statistics and multinomial logistic regression models were used to estimate associations between sociodemographic characteristics and medical, non-medical, and non-use of psychoactive medication in adolescents and adults. RESULTS: Among Mexican medication users in 2016, the national prevalence of non-medical use of psychoactive drugs was 19.6%; 22.2% among adolescents and 19.4% among adults. States adjacent to the US-Mexico border reported the highest levels of non-medical use of psychoactive medication. Illicit drug consumption was associated with non-medical use. Sociodemographic characteristics associated with non-medical use varied between adolescents and adults. CONCLUSIONS: There is a high proportion of non-medical use of psychoactive drugs among Mexican medication users, especially among young people. Understanding factors associated with the misuse of psychoactive medications in Mexico can inform policy for prevention and treatment.

Intersectionality and depression symptoms in Mexican adults aged ≥50, MHAS 2001 and 2012.

OBJECTIVE: To analyze, from the perspective of intersectionality, the association of social inequality dimensions (occupation, poverty, and educational level) and socio-demographic and health characteristics with the proportion of depressive symptoms among males and females aged 50 years and older who participated in the 2001 and 2012 waves of the Mexican Health and Aging Study (MHAS). MATERIALS AND METHODS: Descriptive analysis and logistic regression models stratified by sex were performed, including interaction terms between poverty, educational level, and employment conditions on the presence of depressive symptoms. RESULTS: The proportion of females with depressive symptoms was significantly higher than that of males in both waves. A high proportion of older females in poverty, with five years or less of education and manual occupational activities, reported depressive symptoms in the MHAS-2001. The interactions evaluated between occupation, poverty, and educational level were not statistically significant under adjusted models; however, disability and comorbidities were associated with depressive symptoms in both sexes. CONCLUSION: A higher proportion of females have depressive symptoms under conditions of inequality; however, the effect of the intersection between employment and socio-demographic characteristics on depressive symptoms was not observed under adjusted models.

The Columbia-suicide severity rating scale: validity and psychometric properties of an online Spanish-language version in a Mexican population sample.

The aim of this study was to evaluate the validity and psychometric properties in a Mexican sample of a Spanish-language online version of the Columbia-Suicide Severity Rating Scale (C-SSRS). Data were collected between May and October 2021 from 3,645 participants aged 18 years and over, who agreed to complete the questionnaire. Reliability analysis, confirmatory factor analysis (CFA), and psychometric properties were calculated using a two-parameter model. The results showed a reasonable level of reliability with a Cronbach's alpha of 0.814, and evidence of unidimensionality, and construct validity for suicide risk at three risk levels: low, medium, and high. Analysis of the items suggests that they are consistent with the proposed theoretical model. Our results also demonstrate that the parameters are stable and able to efficiently discriminate individuals at high risk of suicide. We propose the use of this version of the C-SSRS in the Spanish-speaking population, since it is a multifactorial assessment of suicide risk and the inclusion of other clinical and risk factor assessments for a more comprehensive evaluation.

Research evaluating the effectiveness of dementia interventions in low- and middle-income countries: A systematic mapping of 340 randomised controlled trials.

OBJECTIVES: More people with dementia live in low- and middle-income countries (LMICs) than in high-income countries, but best-practice care recommendations are often based on studies from high-income countries. We aimed to map the available evidence on dementia interventions in LMICs. METHODS: We systematically mapped available evidence on interventions that aimed to improve the lives of people with dementia or mild cognitive impairment (MCI) and/or their carers in LMICs (registered on PROSPERO: CRD42018106206). We included randomised controlled trials (RCTs) published between 2008 and 2018. We searched 11 electronic academic and grey literature databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, World Health Organization Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit) and examined the number and characteristics of RCTs according to intervention type. We used the Cochrane risk of bias 2.0 tool to assess the risk of bias. RESULTS: We included 340 RCTs with 29,882 (median, 68) participants, published 2008-2018. Over two-thirds of the studies were conducted in China (n = 237, 69.7%). Ten LMICs accounted for 95.9% of included RCTs. The largest category of interventions was Traditional Chinese Medicine (n = 149, 43.8%), followed by Western medicine pharmaceuticals (n = 109, 32.1%), supplements (n = 43, 12.6%), and structured therapeutic psychosocial interventions (n = 37, 10.9%). Overall risk of bias was judged to be high for 201 RCTs (59.1%), moderate for 136 (40.0%), and low for 3 (0.9%). CONCLUSIONS: Evidence-generation on interventions for people with dementia or MCI and/or their carers in LMICs is concentrated in just a few countries, with no RCTs reported in the vast majority of LMICs. The body of evidence is skewed towards selected interventions and overall subject to high risk of bias. There is a need for a more coordinated approach to robust evidence-generation for LMICs.

Determinantes sociales asociados con ideación suicida durante la pandemia por Covid-19 en México.

OBJETIVO: Estimar la prevalencia de la ideación suicida (IS) y su asociación con los determinantes sociales (DS) en la pobla-ción mexicana durante la pandemia de Covid-19. Material y métodos. Datos de la encuesta de Atención Psicológica a Distancia para la Salud Mental debido a la Contingencia por Covid-19 obtenidos durante 2020. La muestra fue de 79 665. Se realizaron modelos de regresión logística obteniendo razones de momios (RM) con intervalos de confianza del 95% (IC95%). RESULTADOS: La prevalencia de IS fue de 17.1% (mujeres:18.8% y hombres: 14.4%). Principales DS asociados fueron: ser mujer (RM=1.11; IC95% 1.06,1.13), mujeres jóvenes (RM=1.30; IC95% 1.09,1.54), escolaridad (RM=1.89; IC95% 1.14,3.12), soltera(o) (RM= 1.31; IC95% 1.24,1.38), desempleo (RM= 2.33; IC95% 2.21,2.45), distanciamiento social (RM 1.81; IC95%1.68,1.96), vivir solo (RM 1.18; IC95% 1.10,1.27), pérdida de familiar por Covid-19 (RM= 1.41; IC95%1.30,1.54), tener un diagnóstico de depresión (RM= 5.72; IC95% 5.41,6.05), ser víctima de violencia física (RM=2.71; IC95% 2.49,2.95), consumo excesivo de alcohol (RM=1.68; IC95%1.58,1.79) y drogas (RM= 3.13; IC95% 2.88,3.41), y sospecha o diagnóstico de Covid-19 (RM=1.79; IC95% 1.67,1.89). CONCLUSIONES: La prevalencia de IS durante la pandemia por Covid-19 fue elevada; se discute la relevancia de los DS estructurales e intermedios que influyen en la IS.

Principales sesgos en la investigación epidemiológica en salud ocupacional / Main biases in epidemiological research in occupational health

El objetivo de este documento es mostrar una síntesis de los principales sesgos que pueden aparecer en el estudio de la salud del trabajo, sus orígenes y consecuencias. Para ello, se realizó una revisión documental de libros y artículos publicados en los últimos 10 años en inglés y español. Se dejó fuera aquellos documentos que no estuvieran publicados en revistas con comité editorial y en caso de los libros, que no tuvieran registro ISBN. Se incluyeron 7 libros y 14 artículos. Un sesgo es un error sistemático, que sucede en el proceso de investigación y que pueden darse durante la planeación, recolección y procesamiento de datos. Se revisarán dos tipos principales de sesgos: 1) Selección y 2) Información y/o medición, en cada caso se describe la definición, potencial impacto en los resultados y se plantean una serie de ejemplos que ayudan a su compresión. Uno de los efectos principales de la presencia de sesgos en investigación es que ocasiona un error de clasificación en los participantes, que puede ser diferencial o no, esto impacta los resultados al sobre o subestimarlos, en otras palabras, se encuentran efectos mayores a los reales o peor, no los encontramos cuando si existen. Para ilustrar el impacto de los sesgos, se revisan distintos escenarios que ejemplifican los casos de sobreestimación y subestimación que originan resultados poco confiables(AU)

This document aims to show a synthesis of the main biases that can be present in occupational health studies, their origins and their consequences. For this purpose, a documentary review was conducted of books and articles published in the last 10 years in English and Spanish. Excluding those documents that were not published in journals with an editorial board and, in the case of books, that did not have an ISBN registry. A total of 7 books and 14 articles were included. A bias is a systematic error that occurs in the research process and can occur during the data planning, collection, and processing. Two main types of biases will be reviewed: 1) Selection and 2) Information and/or measurement biases, in each case their definition and, their possible impact on the results are described, a series of examples that may help to understand them are provided. One of the main effects of the presence of biases in research is that they cause an error in the classification of participants, which can be differential or not, and this has an impact on the results by overestimating or underestimating them, i.e., finding stronger effects than the real ones, or worse, not finding them when they exist. To illustrate the impact of biases, different scenarios were reviewed that provide examples of cases of overestimation and underestimation that lead to unreliable results(AU)

Mental Health Symptoms, Binge Drinking, and the Experience of Abuse During the COVID-19 Lockdown in Mexico.

Background: The health crisis associated with the COVID-19 pandemic is causally linked to negative mental health symptoms in the same way as other diseases such as Ebola. Objective: The purpose of this paper is to describe the relationship between mental health symptoms, binge drinking, and the experience of abuse during the COVID-19 lockdown. Method: We surveyed 9,361 participants, all Mexican, with an average age of 33 years old (SD = 10.86). In this group of people, we found out that 59% were single (5,523), 71% were women (6,693). Forty-six percentage were complying with lockdown procedures (4,286), 50% were partially complying (4,682), and 4% were not complying at all (393). The invitation to participate was open from April 24th to April 30th during the second stage of the pandemic in Mexico, in 2020, characterized by voluntary complete lockdown staying at home. Thus, we used a cross-sectional online survey design to assess mental health risk factors related to the COVID-19 pandemic. The survey was available on a WebApp designed by Linux®, PHP®, HTML®, CSS®, and JavaScript®. We calculated descriptive and inferential analysis to describe the mental health average distribution as a function of the lockdown, binge drinking, and experience of abuse. To calculate the reliability and validation of the subscales, we used Cronbach's Alpha and Factor Loading. We run the confirmatory factor loading analysis, and we described the relationship between each latent variable and its item factor load, obtained through structural modeling equations, derived from 179 iterations and 207 parameters (t[1,171] = 28,079.418, p < 0.001). We got a CFI of 0.947, a TLC of 0.940, an RMSEA of 0.049 (0.049-0.050), and an SRMR of 0.048. Findings: The results indicated that reported attitudes such as avoidance, sadness, withdrawal, anger, and anxiety were associated with acute stress, which was linked to an anxiety condition caused by uncertainty about achieving or maintaining overall good health. Discussion and Prospects: People in lockdown mentioned a sudden increase in alcohol consumption. They lived episodes of physical and emotional abuse, in contrast with those who stated that they did not go into lockdown or consume alcohol, or experienced abuse. Limitations: Further studies should diagnose mental health conditions as part of the impact of COVID-19, ensure their follow-up, and assess the effect of providing remote psychological care. There is a need to explore methods to curb the increase in the number of people affected by post-traumatic stress disorder.

Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico.

BACKGROUND: Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy. METHODS: A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. RESULTS: A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. CONCLUSIONS: Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

Association between physical disability and incidence of depressive symptoms in older Mexican adults / [Asociación entre la discapacidad física y la incidencia de síntomas depresivos en adultos mayores mexicanos].

Introduction: Functional limitations associated with the aging process can lead to the development of depressive symptoms and increase the vulnerability of older adults. Objective: To estimate the association between physical disability and the incidence of clinically significant depressive symptoms in older Mexican adults. Materials and methods: We conducted a retrospective cohort study with data from the Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM). The analytical sample (n=6,780) included adults over 50 years old with measurements for the main variables and no clinically significant depressive symptoms reported in the first round. These symptoms were evaluated with the CESD-9 scale and disability by means of the report of activities of daily living (ADL) or instrumental activities of daily living (IADL). Descriptive, bivariate, and multivariate analyses were performed using logistic regression models adjusted by sociodemographic variables, health conditions, childhood adversities, social participation, and stressful life events. Results: The incidence of clinically significant depressive symptoms was 25.75% (95% CI: 24,70 - 26,80). Compared to those without IADL limitations, an increased risk of 68% for the development of clinically significant depressive symptoms was found (95% CI: 1.10-2.57; p= 0,015). With the ADL model, the OR for the development of clinically significant depressive symptoms was 1.36 (1.01 -1.81; p= 0.039). Both models were adjusted by confounding variables. Conclusion: Presenting limitations in daily life is an important risk factor for the development of clinically significant depressive symptoms at two years of follow-up.

Introducción. Las limitaciones funcionales asociadas con el proceso de envejecimiento pueden conducir al desarrollo de síntomas depresivos e incrementar la vulnerabilidad de los adultos mayores. Objetivo. Estimar la asociación entre la discapacidad física y la incidencia de síntomas depresivos clínicamente significativos en adultos mayores mexicanos. Materiales y métodos. Se hizo un estudio retrospectivo de cohorte con datos provenientes de la Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM). La muestra analítica (n=6.780) incluyó a adultos mayores de 50 años que contaran con mediciones de las variables principales y que no presentaran síntomas depresivos clínicamente significativos en la ronda cero. Estos síntomas se evaluaron con la escala CESD-9 y, la discapacidad, mediante el reporte de limitaciones para la realización de actividades básicas o instrumentales de la vida diaria. Se hicieron análisis descriptivos, bivariados y multivariados, utilizando el modelo de regresión logística y ajustando según las variables sociodemográficas, las condiciones de salud, las adversidades de la infancia, la participación social y los eventos vitales estresantes. Resultados. La incidencia de síntomas depresivos clínicamente significativos fue de 25,75 % (IC95% 24,70-26,80). Comparados con aquellas personas sin limitaciones para las actividades instrumentales, se encontró un incremento del 68 % en el riesgo para el desarrollo de dichos síntomas (IC95% 1,10-2,57; p=0,015). En el modelo de actividades básicas de la vida diaria, la razón de probabilidad (odds ratio, OR) para su desarrollo fue de 1,36 (1,01-1,81; p=0,039), ambos ajustados por variables de confusión. Conclusión. Las limitaciones en la vida diaria son un factor de riesgo importante para el desarrollo de síntomas depresivos clínicamente significativos en personas con seguimiento de dos años.

Asociación entre la discapacidad física y la incidencia de síntomas depresivos en adultos mayores mexicanos / Association between physical disability and incidence of depressive symptoms in older Mexican adults

Resumen : Introducción. Las limitaciones funcionales asociadas con el proceso de envejecimiento pueden conducir al desarrollo de síntomas depresivos e incrementar la vulnerabilidad de los adultos mayores. Objetivo. Estimar la asociación entre la discapacidad física y la incidencia de síntomas depresivos clínicamente significativos en adultos mayores mexicanos. Materiales y métodos. Se hizo un estudio retrospectivo de cohorte con datos provenientes de la Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM). La muestra analítica (n=6.780) incluyó a adultos mayores de 50 años que contaran con mediciones de las variables principales y que no presentaran síntomas depresivos clínicamente significativos en la ronda cero. Estos síntomas se evaluaron con la escala CESD-9 y, la discapacidad, mediante el reporte de limitaciones para la realización de actividades básicas o instrumentales de la vida diaria. Se hicieron análisis descriptivos, bivariados y multivariados, utilizando el modelo de regresión logística y ajustando según las variables sociodemográficas, las condiciones de salud, las adversidades de la infancia, la participación social y los eventos vitales estresantes. Resultados. La incidencia de síntomas depresivos clínicamente significativos fue de 25,75 % (IC95% 24,70-26,80). Comparados con aquellas personas sin limitaciones para las actividades instrumentales, se encontró un incremento del 68 % en el riesgo para el desarrollo de dichos síntomas (IC95% 1,10-2,57; p=0,015). En el modelo de actividades básicas de la vida diaria, la razón de probabilidad (odds ratio, OR) para su desarrollo fue de 1,36 (1,01-1,81; p=0,039), ambos ajustados por variables de confusión. Conclusión. Las limitaciones en la vida diaria son un factor de riesgo importante para el desarrollo de síntomas depresivos clínicamente significativos en personas con seguimiento de dos años.

Abstract : Introduction: Functional limitations associated with the aging process can lead to the development of depressive symptoms and increase the vulnerability of older adults. Objective: To estimate the association between physical disability and the incidence of clinically significant depressive symptoms in older Mexican adults. Materials and methods: We conducted a retrospective cohort study with data from the Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM). The analytical sample (n=6,780) included adults over 50 years old with measurements for the main variables and no clinically significant depressive symptoms reported in the first round. These symptoms were evaluated with the CESD-9 scale and disability by means of the report of activities of daily living (ADL) or instrumental activities of daily living (IADL). Descriptive, bivariate, and multivariate analyses were performed using logistic regression models adjusted by sociodemographic variables, health conditions, childhood adversities, social participation, and stressful life events. Results: The incidence of clinically significant depressive symptoms was 25.75% (95% CI: 24,70 - 26,80). Compared to those without IADL limitations, an increased risk of 68% for the development of clinically significant depressive symptoms was found (95% CI: 1.10-2.57; p= 0,015). With the ADL model, the OR for the development of clinically significant depressive symptoms was 1.36 (1.01 -1.81; p= 0.039). Both models were adjusted by confounding variables. Conclusion: Presenting limitations in daily life is an important risk factor for the development of clinically significant depressive symptoms at two years of follow-up.

[Open communication between mental health professionals and parents of patients with intellectual disabilities]. / Comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual.

OBJECTIVE: To estimate the factors associated with open communication between mental health professionals and parents of patients with intellectual disabilities and other neurodevelopmental disorders. MATERIALS AND METHODS: Cross-sectional survey in 759 mental health professionals. The association between the pattern of open communication and the attributes of communication was estimated through a logistic, ordinal, multivariate model. RESULTS: The prevalence of the pattern of open communication in mental health professionals was 30.6% (95%CI 27.4-34.0). The associated factors were younger age (RM=2.42, 95% CI 1.57-3.75), specialty (RM= 1.56, 95%CI 1.09-2.23), high value to the truth (RM= 4.95, 95% CI 3.21-7.65), low paternalism (RM= 10.93, 95%CI 7.22-16.52) and courses in bioethics (RM= 1.45, 95%CI 1.01-2.09), adjusted for confusing variables. CONCLUSIONS: Mental health professionals reported low levels of open com-munication with parents of people with neurovelopmental disorders, so prioritizing the value to the truth, promoting less paternalism, and respecting the autonomy of patients, can contribute to changing these patterns of communication in clinical practice in Mexico.

OBJETIVO: Estimar los factores asociados con la comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual y otros trastornos del neurodesarrollo. MATERIAL Y MÉTODOS: Encuesta transversal en 759 profesionales de la salud mental. Se estimó la asociación entre el patrón de comunicación abierto y los atributos de la comunicación a través de un modelo logísti-co, ordinal y multivariado. RESULTADOS: La prevalencia del patrón de comunicación abierta en profesionales de la salud mental fue de 30.6% (IC95% 27.4-34.0). Los factores asocia-dos fueron menor edad (RM=2.42, IC95% 1.57-3.75), espe-cialidad (RM=1.56, IC95% 1.09-2.23), alto valor a la verdad (RM=4.95, IC95% 3.21-7.65), bajo paternalismo (RM=10.93, IC95% 7.22-16.52) y cursos de bioética (RM=1.45, IC95% 1.01-2.09), ajustando por variables confusoras. CONCLUSIONES: Los profesionales de la salud mental reportaron bajos niveles de comunicación abierta con los padres de personas con trastornos del neurodesarrollo, por lo que priorizar el valor a la verdad, promover un menor paternalismo y el respeto a la autonomía de los pacientes puede contribuir a cambiar estos patrones de comunicación en la práctica clínica en México.

[Knowledge about neurodevelopmental disorders associated with the acceptance of the inclusive education model, in basic education teachers] / Conocimiento sobre trastornos del neurodesarrollo asociado con la aceptación del modelo de educación inclusiva en docentes de educación básica

OBJECTIVE: To describe the prevalence of knowledge about neurodevelopment disorders (NDDs) and the level of acceptance of models of inclusive education (IEM) in teachers. MATERIALS AND METHODS: A multicenter cross-sectional study in Mexico and Central America. A self-report instrument to teachers of basic level on knowledge in NDDs and acceptance of the IEM. RESULTS: The response of 511 teachers was obtained. The prevalence of high acceptance of the IEM was 28.6%. Of the 120 teachers who reported having extensive knowledge about intellectual disability, 3.8% were in the lowest percentile of acceptance of the IEM, 19.5% in the average percentile of acceptance and 55.5% of them were in the highest percentile acceptance (p<0.001). Among teachers, a greater knowledge about NDDs was associated with the acceptance of IEM: learning disorders RM 3.76 (95%CI 2.13-6.62); attention deficit disorders with hyperactivity RM 2.24 (95%CI 1.31-3.84) and intellectual disability RM 3.84 (95%CI 2.46-5.99). CONCLUSIONS: The teaching acceptance of IEM can be favored with greater and better training of education professionals on the different NDDs.

OBJETIVO: Describir la prevalencia del conocimiento sobre trastornos del neurodesarrollo (TdN) y el nivel de aceptación de los modelos de educación inclusiva (MEI) en docentes. MATERIAL Y MÉTODOS: Estudio transversal multicéntrico en México y Centroamérica. Aplicación de un instrumento de autorreporte a docentes de nivel básico sobre conocimiento en TdN y aceptación de los MEI. RESULTADOS: Se obtuvo la respuesta de 511 docentes. La prevalencia de alta aceptación de MEI fue de 28.6%. De los 120 docentes que refirieron tener un amplio conocimiento sobre discapacidad intelectual, 3.8% estuvieron en el percentil más bajo de aceptación de MEI, 19.5% en el percentil de aceptación promedio y 55.5% de ellos se encontraron en el percentil de mayor aceptación (p<0.001). Entre los docentes, un mayor conocimiento sobre los TdN se mostró asociado con la aceptación de MEI: trastornos del aprendizaje RM 3.76 (IC95% 2.13-6.62); trastornos por déficit de atención con hiperactividad RM 2.24 (IC95% 1.31-3.84) y discapacidad intelectual RM 3.84 (IC95% 2.46-5.99). CONCLUSIONES: La aceptación docente de MEI puede favorecerse con una mayor y mejor capacitación de los profesionales de la educación sobre los diferentes TdN.

Comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual / Open communication between mental health professionals and parents of patients with intellectual disabilities

Resumen Objetivo: Estimar los factores asociados con la comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual y otros trastornos del neurodesarrollo. Material y métodos: Encuesta transversal en 759 profesionales de la salud mental. Se estimó la asociación entre el patrón de comunicación abierto y los atributos de la comunicación a través de un modelo logístico, ordinal y multivariado. Resultados: La prevalencia del patrón de comunicación abierta en profesionales de la salud mental fue de 30.6% (IC95% 27.4-34.0). Los factores asociados fueron menor edad (RM=2.42, IC95% 1.57-3.75), especialidad (RM=1.56, IC95% 1.09-2.23), alto valor a la verdad (RM=4.95, IC95% 3.21-7.65), bajo paternalismo (RM=10.93, IC95% 7.22-16.52) y cursos de bioética (RM=1.45, IC95% 1.01-2.09), ajustando por variables confusoras. Conclusión: Los profesionales de la salud mental reportaron bajos niveles de comunicación abierta con los padres de personas con trastornos del neurodesarrollo, por lo que priorizar el valor a la verdad, promover un menor paternalismo y el respeto a la autonomía de los pacientes puede contribuir a cambiar estos patrones de comunicación en la práctica clínica en México.

Abstract Objective: To estimate the factors associated with open communication between mental health professionals and parents of patients with intellectual disabilities and other neurodevelopmental disorders. Materials and methods: Cross-sectional survey in 759 mental health professionals. The association between the pattern of open communication and the attributes of communication was estimated through a logistic, ordinal, multivariate model. Results: The prevalence of the pattern of open communication in mental health professionals was 30.6% (95%CI 27.4-34.0). The associated factors were younger age (RM=2.42, 95% CI 1.57-3.75), specialty (RM= 1.56, 95%CI 1.09-2.23), high value to the truth (RM= 4.95, 95% CI 3.21-7.65), low paternalism (RM= 10.93, 95%CI 7.22-16.52) and courses in bioethics (RM= 1.45, 95%CI 1.01-2.09), adjusted for confusing variables. Conclusion: Mental health professionals reported low levels of open communication with parents of people with neurovelopmental disorders, so prioritizing the value to the truth, promoting less paternalism, and respecting the autonomy of patients, can contribute to changing these patterns of communication in clinical practice in Mexico.

Conocimiento sobre trastornos del neurodesarrollo asociado con la aceptación del modelo de educación inclusiva en docentes de educación básica / Knowledge about neurodevelopmental disorders associated with the acceptance of the inclusive education model, in basic education teachers

Resumen Objetivo: Describir la prevalencia del conocimiento sobre trastornos del neurodesarrollo (TdN) y el nivel de aceptación de los modelos de educación inclusiva (MEI) en docentes. Material y métodos: Estudio transversal multicéntrico en México y Centroamérica. Aplicación de un instrumento de autorreporte a docentes de nivel básico sobre conocimiento en TdN y aceptación de los MEI. Resultados: Se obtuvo la respuesta de 511 docentes. La prevalencia de alta aceptación de MEI fue de 28.6%. De los 120 docentes que refirieron tener un amplio conocimiento sobre discapacidad intelectual, 3.8% estuvieron en el percentil más bajo de aceptación de MEI, 19.5% en el percentil de aceptación promedio y 55.5% de ellos se encontraron en el percentil de mayor aceptación (p<0.001). Entre los docentes, un mayor conocimiento sobre los TdN se mostró asociado con la aceptación de MEI: trastornos del aprendizaje RM 3.76 (IC95% 2.13-6.62); trastornos por déficit de atención con hiperactividad RM 2.24 (IC95% 1.31-3.84) y discapacidad intelectual RM 3.84 (IC95% 2.46-5.99). Conclusión: La aceptación docente de MEI puede favorecerse con una mayor y mejor capacitación de los profesionales de la educación sobre los diferentes TdN.

Abstract Objective: To describe the prevalence of knowledge about neurodevelopment disorders (NDDs) and the level of acceptance of models of inclusive education (IEM) in teachers. Materials and methods: A multicenter crosssectional study in Mexico and Central America. A self-report instrument to teachers of basic level on knowledge in NDDs and acceptance of the IEM. Results: The response of 511 teachers was obtained. The prevalence of high acceptance of the IEM was 28.6%. Of the 120 teachers who reported having extensive knowledge about intellectual disability, 3.8% were in the lowest percentile of acceptance of the IEM, 19.5% in the average percentile of acceptance and 55.5% of them were in the highest percentile acceptance (p<0.001). Among teachers, a greater knowledge about NDDs was associated with the acceptance of IEM: learning disorders RM 3.76 (95%CI 2.13-6.62); attention deficit disorders with hyperactivity RM 2.24 (95%CI 1.31-3.84) and intellectual disability RM 3.84 (95%CI 2.46-5.99). Conclusion: The teaching acceptance of IEM can be favored with greater and better training of education professionals on the different NDDs.

Homicides during the Barranquilla Carnival, Colombia: A 10 Year Time-Series Analysis.

Homicides are currently the third leading cause of death among young adults, and an increase has been reported during holidays. The aim of the present study was to explore whether an association exists between Carnival in Barranquilla, Colombia, and an increase in homicides in the city. We used mortality records to identify the number of daily homicides of men and women throughout the week of Carnival, and we compared those with records from all of standard days between 1 January 2005 and 31 December 2015. Conditional fixed-effects models were used, stratified by time and adjusted by weather variables. The average number of homicides on Carnival days was found to be higher than on a standard day, with an OR of 2.34 (CI 95%: 1.19-4.58) for the occurrence of at least one male homicide per day during Carnival, and 1.22 (CI 95%: 1.22-7.36) for female homicides, adjusted by weather variables. The occurrence of homicides during Carnival was observed and was similar to findings for other holidays. Given that violence is a multifactorial phenomenon, the identification of the factors involved serves as a basis for evaluating whether current strategies have a positive effect on controlling it.

Air Pollution and Suicide in Mexico City: A Time Series Analysis, 2000-2016.

The association between air pollution and suicide has recently been under examination, and the findings continue to be contradictory. In order to contribute evidence to this still unresolved question, the objective of the present study was to evaluate the association between air quality and daily suicides registered in Mexico City (MC) between 2000 and 2016. Air quality was measured based on exposure to particulate matter under 2.5 and 10 micrometers (µm) (PM2.5 and PM10, respectively), ozone (O3), nitrogen dioxide (NO2), and sulfur dioxide (SO2), adjusting for weather variables (air temperature and relative humidity), and holidays. To this end, an ecologic time series analysis was performed using a Poisson regression model conditioned by time and stratified by gender and age groups. Models were also generated to explore the lagged and accumulative effects of air pollutants, adjusted by weather variables. The effects of the pollutants were very close to the null value in the majority of the models, and no accumulative effects were identified. We believe these results, in this case, no evidence of a statistical association, contribute to the current debate about whether the association between air pollution and suicide reported in the scientific literature reflects an actual effect or an uncontrolled confounding effect.

Association between the employment status and the presence of depressive symptoms in men and women in Mexico.

This study aims to estimate the relationship between employment status and depressive symptoms among Mexican adults, as well as to explore its differential effect by gender. Cross-sectional study of 36,516 adults between 20 and 59 years of age taken from the 2012 Mexican National Health and Nutrition Survey. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale (CES-D), and the employment status was determined a week before the survey. Logistic regression models were stratified by gender and education level and adjusted by sociodemographic and health-related conditions to estimate the association between depressive symptoms and employment status. The prevalence of clinically depressive symptoms was 7.59% for men and 18.62% for women. In the case of men, those who were unemployed were more likely to present depressive symptoms (OR = 1.66; 95%CI: 1.08-2.55) than those who were working. For women, employment status is not associated with the presence of depressive symptoms, except in students (OR = 1.57; 95%CI: 1.02-2.43) compared with those who were working. In both genders, disability preventing one from working was associated with depressive symptoms. Although being employed has been reported to be associated with lower levels of psychiatric morbidity, the estimated effect is different for men and women. Occupational health policies should consider these conditions.

Effectiveness of augmented Individual Placement and Support interventions for competitive employment in people with schizophrenia: Systematic review and meta-analysis / Revisión sistemática y metaanálisis de la efectividad de intervenciones aumentadas de IPS para la obtención de empleo competitivo en personas con esquizofrenia

Abstract: Background: It has been estimated that over 70% of people living with a diagnosis of schizophrenia wish to work. The Individual Placement and Support (IPS) model has proven to be highly effective in enhancing competitive employment in people with schizophrenia. However, the efficacy of augmented IPS interventions, in other words, those that incorporate a psychosocial intervention into the model, has not been evaluated in this population. Objective: To assess the efficacy of augmented IPS interventions designed to obtain competitive employment in people with schizophrenia. Method: A systematic review of the literature on randomized clinical trials of augmented IPS interventions, published in English between 2007 and 2017, was conducted in the electronic databases of PubMed, Science Direct, and EBSCO. Risk of bias and competitive employment rates were calculated. A meta-analysis was performed using the random effects method to estimate the effect of augmented IPS interventions. Results: Twelve articles were identified in which 10 augmented IPS interventions were compared with other interventions. In eight studies conducted on people with schizophrenia, the intervention was based on IPS + social skills/work skills/cognitive remediation vs. IPS or modified IPS. No general effect favoring augmented interventions (RR = 1.37, 95% CI [.97, 1.95], I2 = 52%) was found. Augmented IPS interventions tend to be more effective when they are implemented during the first psychotic episode. Discussion and conclusion: It is not possible to conclude that augmented IPS interventions have a significant effect over standard IPS interventions in obtaining competitive employment in people with schizophrenia.

Resumen: Antecedentes: Se ha estimado que más del 70% de las personas que viven con diagnóstico de esquizofrenia desean trabajar. El modelo Individual Placement and Support (IPS) ha mostrado efectividad para que las personas con esquizofrenia consigan un empleo competitivo. Sin embargo, en esta población no se ha evaluado la eficacia de las intervenciones aumentadas de IPS -es decir, aquellas que añaden al modelo una intervención psicosocial. Objetivo: Evaluar la eficacia de las intervenciones aumentadas de IPS dirigidas a la obtención de empleo competitivo en personas con esquizofrenia. Método: Se realizó una revisión sistemática de la literatura de ensayos clínicos aleatorizados sobre intervenciones aumentadas de IPS publicados en inglés entre 2007 y 2017, en las bases de datos electrónicas de PubMed, Science Direct y EBSCO. Se calcularon el riesgo de sesgo y las tasas de empleo competitivo. Se realizó un metaanálisis mediante el método de efectos aleatorios para estimar el efecto de las intervenciones aumentadas de IPS. Resultados: Se identificaron 12 artículos en los que se comparaban 10 intervenciones aumentadas de IPS con alguna otra intervención. En ocho estudios realizados en personas con esquizofrenia, la intervención se basó en IPS + habilidades sociales/habilidades laborales/remediación cognitiva vs. IPS o IPS modificadas, sin que se encontrara un efecto general en favor de las intervenciones aumentadas (RR = 1.37, 95% IC [.97, 1.95], I2 = 52%). Las intervenciones aumentadas de IPS tienden a ser más efectivas cuando se llevan a cabo en el primer episodio psicótico. Discusión y conclusión: No se puede concluir que las intervenciones aumentadas de IPS tengan un mayor efecto sobre las intervenciones estándar de IPS para la obtención de empleo competitivo en personas con esquizofrenia.

Weather and Suicide: A Decade Analysis in the Five Largest Capital Cities of Colombia.

Historically, seasonal variations in suicide rates were thought to be associated with changes in weather. Most of this evidence however, is based on studies that were conducted in developed countries that are located outside the tropics. As such, it is necessary to examine this association in developing countries, such as Colombia, which do not experience marked seasons. In addition, it is important to adjust for the effect of holidays when analyzing this association as they have been reported to be a relevant confounding factor. Our objective was to estimate the association between daily suicide incidence among men and women in five major Colombian cities (Bogotá, Medellin, Cali, Barranquilla, and Bucaramanga) and daily temperature and rainfall. For this purpose, we conducted a multi-city, multi-temporal ecological study from 2005 to 2015, using data from the suicide mortality registries (provided by the National Administrative Department of Statistics). Daily measurements of the two weather variables were obtained from the official historical registry of the meteorological station at each city airport. We used these data to estimate conditional Poisson models for daily suicide counts, stratifying by sex and adjusting for holidays. Although we found that none of the weather variable estimators could reject the null hypothesis, we uncovered an association between suicide incidence and long weekends in the total suicide model (Incidence Rate Ratio (IRR): 1.19, 95% confidence interval (CI): 1.04⁻1.23). We found no evidence of association between weather variables and suicide in Colombia. Our study is based on daily observations and it provides evidence of absence of this association in a tropical country that does not experience marked seasons.

Prevalence of depressive symptoms and factorial invariance of the Center for Epidemiologic Studies (CES-D) Depression Scale in a group of Mexican indigenous population

Introduction: The short version of the Center for Epidemiologic Studies (CES-D) Depression Scale is a viable tool for screening depressive symptomatology in the general population, but its factorial invariance for indigenous populations in Latin America has not been reported. Objective: To describe the differences in the prevalence of depressive symptomatology and the factorial invariance of the short version of the CES-D scale for the Mexican indigenous population. Materials and methods: We conducted a cross-sectional study with a representative sample of 37,165 Mexican adults aged 20 to 59 years. Indigenous identity was determined by self-report of being a speaker of an indigenous language. Eight groups of analysis were created according to gender, literacy, and being indigenous. An exploratory factor analysis was used to describe the prevalence of depressive symptoms as measured by the short version of the CES-D, as well as the configuration factorial invariance of the profiles. The variance-covariance matrices of the pairs of profiles were compared using the modified Mantel test. Results: The prevalence of depressive symptoms was 16.8% (95% CI: 13.4-20.3) for indigenous women who could read, 21.3% (95% CI: 15.5% 27.1) for indigenous women who could not read, 8.5% (95% CI: 6.0-11.1) for indigenous men who could read, and 10.4% (95% CI: 5.2-15.6) for indigenous men who could not read. No significant differences in the factorial loads of the profiles were found. Conclusion: The prevalence of depressive symptoms in indigenous people is lower than in the nonindigenous population. The factorial invariance of the CES-D scale was high for the indigenous population.