Is there interest of Mexican adults in being prepared should they develop Alzheimer's or other dementia? / ¿Existe interés en adultos mexicanos de preparase en caso de llegar a padecer Alzheimer u otra demencia?

Abstract Introduction Alzheimer's disease, as well as other dementias, cause a progressive deterioration of cognitive functions, preventing patients from making decisions and having control over themselves in an advanced stage of the disease. Objective To explore some expectations, wishes and preferences in a sample of mature adults should they develop Alzheimer or other dementia. Method We surveyed 368 mature Mexican adults without dementia using a large survey created by the authors and used in a previous study; data were collected in some public places where mature people were invited to participate. The survey was completed from July 2019 to August 2020. Results Although most participants had considered they might suffer from dementia in the future, less than half had communicated their wishes to their relatives about future medical treatments in case they could no longer decide for themselves; very few had prepared a written advance directive. Most participants agreed that patients should know their initial diagnosis, mainly to be able to prepare themselves. The main reason given by those who would prefer to hide the diagnosis was to avoid suffering. Discussion and conclusion Our results highlight the need for health professionals to promote discussion with people about the possibility of suffering from dementia, as well as the importance of making decisions in advance, and letting their relatives know about them.

Resumen Introducción La enfermedad de Alzheimer, así como las otras demencias, causan un deterioro progresivo de las funciones cognitivas, evitando que en una etapa avanzada de la enfermedad los pacientes puedan tomar decisiones y tener control sobre sí mismos. Objetivo Explorar algunas expectativas, deseos y preferencias en una muestra de adultos maduros en caso de que llegaran a desarrollar Alzheimer u otra demencia. Método Encuestamos a 368 adultos mexicanos maduros sin demencia usando una encuesta creada por los autores y utilizada en un estudio anterior; los datos se recopilaron en algunos lugares públicos donde se invitó a las personas a participar. La encuesta se aplicó de julio de 2019 a agosto de 2020. Resultados Aunque la mayoría de los participantes había considerado que podría sufrir demencia en el futuro, menos de la mitad había comunicado sus deseos a sus familiares sobre futuros tratamientos médicos en caso de que ya no pudieran decidir por sí mismos; muy pocos habían preparado una voluntad anticipada por escrito. La mayoría de los participantes estuvo de acuerdo en que los pacientes deben conocer su diagnóstico inicial, principalmente para poder prepararse. La principal razón aducida por quienes preferirían ocultar el diagnóstico fue el deseo de evitar sufrimiento. Discusión y conclusión Nuestros resultados destacan la necesidad de que el personal de salud promueva la discusión con las personas sobre la posibilidad de padecer demencia, así como la importancia de tomar decisiones por anticipado e informar de ellas a sus familiares.

Dating Violence among Undergraduate Medical Students at a Public University in Mexico City: An Exploratory Study.

Gender-based violence (GBV) and cyber-aggression are growing problems in Mexico, but there is a dearth of information on their associated risks. We aimed to determine the prevalence of dating violence (DV) and cyber-aggression in a public campus and compared students' acceptability of abusive DV based on their sex and sexual orientation. We employed a cross-sectional design to survey 964 first-year medical students attending a public university. We analyzed who found "acceptable" abusive behaviors from a dating partner and carried out descriptive analyses of sample characteristics by sex. We included 633 women and 331 men. Homosexual and bisexual orientation was lower among women (1.5%, 4.8%) vs. men (16.9%, 7.2%). Of women and men, respectively, 64.2% and 35.8% reported having been in a dating relationship. Experiencing abusive behaviors in the year prior to the study was associated with students' level of "acceptability". A total of 43.5% of the students who experienced cyber-aggression did not report any mental health consequences, 32.6% did not seek professional help, and 17.4% reported feeling depressed. Students that accepted emotionally abusive DV behaviors displayed a fourfold risk of experiencing physical abuse. Women and sexual minorities are more at risk of experiencing GBV and DV. More male students reported being victims of cyber-aggression.

Doctoring and mothering during the SARS-COV2 pandemic: Characteristics of physicians-mothers during COVID-19 and their impact on mental health / Medicina y maternidad durante la pandemia por SARS-COV2: Características de médicas madres de familia durante la Covid-19 y su impacto en la salud mental

Abstract Introduction During COVID-19, health workers faced increased stress accentuated by gender roles, such as motherhood. Objective This study analyzed the characteristics of a group of physicians-mothers, its impact on mental health, and their experiences during this pandemic. Method Mixed methods study using an online survey to investigate sociodemographic, family, emotional, and professional aspects, in addition to the personal experience of 537 doctors-mothers during the first stage of COVID-19. Results Due to the pandemic, most of the participants changed their daily activities. The hours dedicated to professional work (HM = 5.08, p< .0001), childcare (HM = 3.74, p< .0001), and food planning and preparation (HM = -6.96, p< .0001) were increased, while the hours dedicated to physical exercise (MH = 8.67, p< .0001) and personal care (MH = 9.54, p< .0001) decreased. It has been pointed out that this pandemic has generated a lack of well-defined spaces, resulting in multitasking. Fear and guilt were two common words in the speeches of the participants. Fear of getting sick and dying, or fear of infecting their families. Guilt at feeling that they did not play a good role either as doctors or as mothers. Most common psychological symptoms were insomnia, sadness or discouragement, and constant worry or tension. Discussion and conclusion The pandemic evidenced and exacerbated both the disparities faced by these female doctors in the medical field, as well as the inequity in housework and home-care. The loss of boundaries between the public and the private showed the mothers-doctor struggling to reconcile their personal and professional life with substantial repercussions for their mental health.

Resumen Introducción Durante el COVID-19, los trabajadores de la salud enfrentaron mayor estrés, acentuado por los roles de género, como la maternidad. Objetivo Analizar las características de un grupo de madres médicas, su impacto en la salud mental, y sus experiencias durante esta pandemia. Método Estudio de métodos mixtos mediante una encuesta en línea que indagó aspectos familiares, emocionales, profesionales y la experiencia personal de 537 madres médicas durante la primera etapa del COVID-19. Resultados Por la pandemia, las participantes cambiaron sus actividades diarias. Asimismo, incrementaron el número de horas dedicadas al trabajo profesional (HM = 5.08, p< .0001), el cuidado de niños (HM = 3.74, p< .0001) y la planificación y preparación de alimentos (HM = -6.96, p< .0001). Disminuyeron las horas dedicadas al ejercicio físico (MH = 8.67, p< .0001) y al cuidado personal (MH = 9.54, p< .0001). Señalaron que esta pandemia generó una falta de espacios definidos, lo que favoreció el multitasking. Miedo y culpa fueron dos palabras habituales en los discursos de las participantes. También miedo a enfermarse y morir, o miedo a contagiar a sus familias. Culpabilidad por sentir que no desempeñaron un buen papel ni como médicas ni como madres. Los síntomas psicológicos más comunes fueron insomnio, tristeza y tensión constante. Discusión y conclusión La pandemia evidenció y exacerbó las disparidades que enfrentan estas doctoras en el campo de la medicina y la inequidad en las tareas del hogar. La pérdida de los límites entre lo público y lo privado mostró a las médicas madres conciliando su vida personal y profesional, con repercusiones sustanciales para su salud mental.

Financial Toxicity Among Older Mexican Adults With Cancer and Their Families: A Mixed-Methods Study.

PURPOSE: The financial toxicity (FT) of cancer is common among older adults in high-income countries, but little is known about the financial hardships faced by older patients with cancer living in developing countries. The aim of this study was to explore the financial burden of cancer among older Mexican adults and their relatives, as well as factors that might mitigate such burden. METHODS: This mixed-methods study included patients age 65 years and older with the 10 most common malignancies in Mexico and 3-24 months from diagnosis at two cancer centers in Mexico City and their relatives. For the quantitative component, patients and relatives answered the Spanish version of the Consumer Financial Protection Bureau Financial Well-Being Scale. Patients completed the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale and a 3-month, self-reported cost diary. For the qualitative component, focused interviews were used to explore the individual experiences of patients and their relatives. RESULTS: Ninety-six patients and their relatives were included, of whom 45% had stage IV disease. On the COST-FACIT scale, 9% reported no FT, 52% mild FT, 39% moderate FT, and 0% severe FT. The mean Consumer Financial Protection Bureau Financial Well-Being Scale score was 45.2, with 78% reporting poor financial well-being (score ≤ 50). On cost diaries, most expenses were associated with purchasing medications, including chemotherapy. Focused interviews showed that most patients and relatives had to acquire debt to face costs of cancer care. CONCLUSION: A high proportion of Mexican older adults with cancer reported FT and poor financial well-being. Understanding experiences associated with FT and strategies to mitigate it represents an essential first step to design public policies aimed at protecting older adults with cancer and their families from catastrophic spending.

The Paradoxical Effect of Living Alone on Cognitive Reserve and Mild Cognitive Impairment among Women Aged 60+ in Mexico City.

An elderly person who lives alone must often be autonomous and self-sufficient in daily living activities. We explored if living alone and marital status were associated with mild cognitive impairment and low cognitive reserve in a sample of Mexican women aged 60+ attending continuing education courses using a cross-sectional design. Objective cognitive functions were assessed using the MMSE and Blessed Dementia Scale. We administered the Cognitive Reserve Questionnaire. Independence skills were assessed with the Katz index and Lawton index. Multivariate logistic regression analysis was used. We recruited 269 participants (x¯ = 69.0 ± 5.8 years). Single, widowed, separated, and divorced women comprised 73% of the participants. A third lived alone and 84% had completed high school. Mild cognitive deficit was observed among 24.5-29.0%; the upper range for cognitive reserve was 61.7%. Living alone versus living with someone was associated with cognitive impairment (OR = 0.51, p = 0.04) and with low to medium cognitive reserve (OR = 0.51, p = 0.02) after adjusting for confounding variables. Living alone was an independent factor associated with a lower probability of displaying mild cognitive impairment and a higher probability of displaying high cognitive reserve. Women living alone in this study had a more robust cognitive framework and had built their own support networks.

Suffering Depression: Illness Perception of Informal Primary Caregivers of Medical Students With Major Depressive Disorder.

When a family member has depression at a level that generates disability in various functional spheres, the informal primary caregiver (IPC) is the individual who provides the majority of emotional and basic needs of the patient. This person is usually a relative and is extremely important in the health-disease-care process. This phenomenological qualitative study aimed to analyze the illness perception, in IPCs of undergraduate medical students previously diagnosed with mild depression. It was found that IPCs generate perceptions about depression based on a lack of knowledge of the disorder, which leads to feelings of sorrow, anger, frustration, and fear, that could interfere with the evolution of patients. Psychiatric disorders, such as depression, strongly impact both patients and people around them. For mental health professionals, in order to provide a more complete clinical approach, it is important to understand the illness perceptions not only of patients but of family IPCs as well.

Experience of oncology residents with death: a qualitative study in Mexico.

BACKGROUND: Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents' concepts of death and related aspects, their reactions and actions in situations pertaining to death in their practice, and their perceptions about existing and necessary training conditions. METHODS: A qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents. RESULTS: Participants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it. CONCLUSIONS: Participants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience. TRIAL REGISTRATION: Not applicable.

Development and psychometric properties of the Subtle Gender-Based Violence Among Medical Residents Assessment Scale (SGEVRA) / Desarrollo y propiedades psicométricas de la Escala de Violencia Sutil de Género en Médicos Residentes (SGEVRA)

Abstract Introduction Medical residents (MR) are an important pillar for a future effective health system. As such, it is important to study all the factors throughout their training that may influence their professional development, like gender-based violence (GV). Objetive To design and evaluate the psychometric proprieties of subtle GV among medical residents' assessment scale (SGEVRA). Method The design was carried out in two phases: (1) in the qualitative phase, three focus groups were interviewed to obtain information about GV during medical training; and (2) in the quantitative phase, the information was incorporated into the instrument and the psychometric properties were tested. Results A total of 1,645 medical residents (MRs) completed the instrument. Exploratory factor analysis led to a final two factor model comprised of 31 items that explained 74.9% of the variance. The factors were labelled as gender discrimination (factor 1) and sexual violence (factor 2); both demonstrated high internal consistency using Cronbach's alpha (factor 1: .987; factor 2: .935). Discussion and conclusion The SGEVRA is a brief, valid, and reliable instrument for assessing subtle GV among MR.

Resumen Introducción Los residentes médicos (MR) son un pilar importante para un futuro sistema de salud efectivo. Por ello, es importante estudiar todos los factores a lo largo de su capacitación que puedan influir en su desarrollo profesional, como la violencia de género (GV). Objetivo Diseñar y evaluar las propiedades psicométricas de la Escala de Violencia Sutil de Género en médicos residentes (SGEVRA, por sus siglas en inglés). Método El diseño se realizó en dos fases: (1) cualitativa: se entrevistó a tres grupos focales para obtener información sobre la VG durante la capacitación médica; y (2) cuantitativa, donde la información se incorporó al instrumento y se evaluaron las propiedades psicométricas. Resultados 1,645 residentes médicos (MR) completaron el instrumento. El análisis factorial exploratorio condujo a un modelo final de dos factores compuesto por 31 reactivos que explicaron el 74.9% de la varianza. Los factores fueron etiquetados como discriminación de género (factor 1) y violencia sexual (factor 2); ambos demostraron una alta consistencia interna con el alfa de Cronbach (factor 1: .987; factor 2: .935). Discusión y conclusión SGEVRA es un instrumento breve, válido y confiable para evaluar GV en MR.

A Qualitative Study of the Acceptability of the Proposed ICD-11 Gender Incongruence of Childhood Diagnosis Among Transgender Adults Who Were Labeled Due to Their Gender Identity Since Childhood.

For the forthcoming ICD-11, the ICD-10 category of Gender Identity Disorder of Childhood has been reformulated as Gender Incongruence of Childhood (GIC) and moved out of the mental disorders chapter. Proponents of eliminating the GIC diagnosis altogether claim that it is unnecessary and inherently harmful, although they do not eschew the diagnosis for adolescents and adults. Using a qualitative methodology, this study examined the impact of receiving a diagnosis related to gender identity as a child among transgender people who had had this experience, and evaluated participants' views of the acceptability and usefulness of the ICD-11 GIC proposal. Participants receiving health services at a specialized public clinic for transgender health in Mexico City who had received some form of diagnosis in childhood were referred to participate in a semistructured interview. A sample of 12 transgender people (eight transgender women and four transgender men; ages 18-49) was necessary to reach saturation. Diagnoses received were non-specific rather than formal gender identity diagnoses, were experienced by participants as negative, and were used to justify potentially harmful interventions. However, when participants reviewed the ICD-11 proposals for GIC, all indicated that the category was necessary and important and could have a range of personal, familial, and social benefits. They agreed with its placement in a new chapter on Conditions Related to Sexual Health and endorsed the proposed definition and name of the category. Although this study involved a small and specific sample, the results raise questions about the claim that the diagnosis is inherently harmful and universally deplored by transgender people.

A bittersweet relationship: What does it mean to be the caregiver of a patient with bipolar disorder?

BACKGROUND: As with most of the chronic illnesses, the changes and consequences brought on by bipolar disorder (BD) are not exclusive to the patient and often spread to those around them, especially for direct caregivers of these patients. It is known that there is a significant emotional and physical toll among persons who coexist daily with those who suffer from this disorder. OBJECTIVE: Aware of the importance of the role played by informal caregivers (especially the family) in the stability and evolution of patients with bipolar disorder, this study seeks to explore the perception that family members responsible for bipolar persons have of themselves as caregivers of these patients. METHOD: This is a qualitative study using a phenomenological design, for which the technique of focused or semi-structured interviews was employed. Ten caregivers of people with diagnosis of BD agreed to participate. RESULTS: Within the family, it is a single individual who has the role of caregiver. Experiences and meanings that are generated into the nucleus of the patient-caregiver relationship are full of ambivalence and involve many aspects worthy of analysing, such as the development of identities, the feminization of patient care, the process of therapeutic decision-making and the evolution of the disease. CONCLUSIONS: It is necessary to integrate evaluation and attention for patients' caregivers, recognizing them as individuals and elucidating their constructed meanings and the dynamics established in their relationship with patients. In this way, there would be a more integrative clinical approach of the patient-caregiver relationship, considering not only the necessary pharmacological treatments but also accompanying both patient and family, along the path they travel as they experience BD.

Mental health literacy about bipolar disorder and schizophrenia among medical students: a comparative study of illness recognition, treatment, and attitudes according to perception of aggressiveness-dangerousness / Alfabetización en salud mental sobre el trastorno bipolar y la esquizofrenia en estudiantes de medicina: estudio comparativo del reconocimiento de la enfermedad, tratamiento y actitudes de acuerdo a la percepción de agresión-peligrosidad

Abstract Introduction Lack of information may result in health professionals' negative attitudes toward individuals with mental illness. Objective We sought to determine the association between the perception of aggressiveness-dangerousness and illness recognition, suggested treatment, and attitudes regarding schizophrenia and bipolar disorder in a group of medical students. Method This field study used a non-experimental, cross-sectional comparative design in a purposive sample of medical students. Mental illness recognition, beliefs about adequate treatment, perception of patient's aggressiveness-dangerousness, and attitudes toward severe mentally ill persons were assessed with previously validated instruments. Results Of the 104 participants, 54.8% identified a mental health condition in the schizophrenia vignette compared with only 3.8% in the case of bipolar disorder. Most students believed that both diagnoses could lead to aggressive behaviors. Dangerousness was more frequently perceived in the schizophrenia vignette. Discussion and conclusion It is necessary to sensitize and educate medical students so they have accurate information about symptoms and available treatments for individuals with mental illnesses.

Resumen Introducción La falta de información puede dar como resultado actitudes negativas de los profesionales de la salud hacia los individuos con trastornos mentales. Objetivo Determinar la asociación entre la percepción de agresión-peligrosidad y el reconocimiento de la enfermedad, tratamiento sugerido y actitudes sobre la esquizofrenia y el trastorno bipolar en un grupo de estudiantes de pregrado de medicina. Método El presente es un estudio no experimental, transversal comparativo en una muestra propositiva de estudiantes de medicina. El reconocimiento de la enfermedad, creencias acerca del tratamiento más adecuado, percepción de la agresión-peligrosidad del paciente y las actitudes hacia los trastornos mentales graves fueron evaluados con instrumentos previamente validados. Resultados El 54.8% de un total de 104 participantes identificaron un estado de salud mental en la viñeta de esquizofrenia en contraste con tan sólo el 3.8% para el caso de trastorno bipolar. La mayoría de los estudiantes consideraron que ambos diagnósticos se relacionaban con conductas agresivas. La peligrosidad fue percibida más frecuentemente en la viñeta del caso con esquizofrenia. Discusión y conclusión Es necesario sensibilizar y educar a los estudiantes de medicina para que tengan información clara y precisa sobre los síntomas y tratamientos disponibles para los individuos con trastornos mentales.

Alfabetización en salud mental en el trastorno bipolar: Asociación con la percepción de agresividad y el género en estudiantes de medicina / Mental health literacy in bipolar disorder: Association with perception of aggressiveness and gender of medical students

Introduction Developing mental health literacy in students and health professionals in general implies gaining abilities in recognizing and treating mental illnesses. In bipolar disorder, this is an important issue due that it helps reducing stigma and the treatment gap found in patients with this diagnosis. Objective To determine the associations between some variables of mental health literacy (illness, recognition, attributable causes and suggested treatment) about bipolar disorder with gender and perception of aggressiveness/dangerousness in a group of medical students. Material and methods One-hundred and three medical students from a public university in Mexico City completed the Aggressiveness Public Concept Questionnaire to assess mental health literacy and aggressiveness/dangerous-ness perception. Results 59.6% of students did not recognize the presence of a mental illness. As described symptoms were not considered as a manifestation of a mental disorder, 83.7% considered non-psychiatric interventions as the most adequate alternative for the management of the behaviors exposed in the vignette. 87.7% considered that the person described in the vignette was aggressive and 33.7% perceived the subject as dangerous. Discussion Campaigns of mental health literacy for medical students must be directed to improve recognition of the essential features of bipolar disorder, therapeutic options as well as the real prevalence and methods of prevention of aggressiveness of these patients.

Introducción La alfabetización en salud sental (ASM) por parte de estudiantes y profesionales de la salud implica su capacidad para reconocer la enfermedad mental y su adecuado manejo, y constituye un elemento esencial para reducir el estigma y la brecha de tratamiento de los pacientes con trastorno bipolar (TBP). Objetivo Determinar la asociación entre algunas variables de la ASM (reconocimiento, causas atribuibles y tratamiento sugerido) para el TBP con el género y la percepción de agresividad en un grupo de estudiantes de medicina. Material y métodos Ciento tres estudiantes de pregrado de la carrera de Medicina de una Universidad pública de la Ciudad de México completaron el Cuestionario de Concepto Público de Agresividad (CPA) para valorar la ASM y la percepción de agresividad/peligrosidad. Resultados El 59.6% de los estudiantes no reconocieron la presencia de una enfermedad mental. Al no considerar los síntomas como la manifestación de una enfermedad mental, el 83.7% sugirió intervenciones no psiquiátricas/no restrictivas para el manejo adecuado de las conductas expuestas en la viñeta clínica. El 87.7% de los estudiantes consideró que la persona descrita era agresiva y el 33.7% la percibió como peligrosa. Discusión Las campañas de ASM para estudiantes de medicina deben abocarse a incrementar el conocimiento de las características esenciales del TBP, las opciones de tratamiento así como la prevalencia real y métodos de prevención de la agresividad en estos pacientes.

From self-care to hospitalization: bipolar patients' health care practices in Mexico.

BACKGROUND: New research is continually improving the comprehension of bipolar disorder (BD). However, many challenges remain to be addressed, such as understanding the health care practices (HCPs) chosen by bipolar patients and the determinants of seeking treatment. MATERIAL: Using a qualitative approach, we studied the HCPs of six patients with BD through focused interviews. DISCUSSION: Even patients who report using primarily allopathic care usually test out and combine different HCPs. CONCLUSION: Pathways to care in BD are composed of a combination of HCPs because patients need to develop a stock of potential treatment alternatives to deal with the suffering involved in living with BD.

Preferencias de especialidad médica entre los estudiantes de pregrado de la Facultad de Medicina de la UNAM: ¿En qué lugar se ubica la Psiquiatría? / Medical specialty preferences among undergraduate students of the Faculty of Medicine at UNAM: where is psychiatry?

Introduction In several countries, the number of candidates to enter Psychiatry is diminishing. In Mexico, the kind of factors that influence the preference for a medical specialty and the way the selection tendencies change across the years of the medical career is not well known. In this study we analyzed the specialty preferences in a representative sample of students from different years of Medicine School at the National Autonomous University of Mexico (UNAM). Material and methods Descriptive cross-sectional study. Specialty preferences were assessed in students enrolled in the 2009-2010 school year of the Medicine School through a questionnaire designed expressly for this research. Data were analyzed quantitatively and qualitatively. Results A total of 2737 students participated. Most of the students (n = 2634) had already considered a specialty. Preferred specialties were General surgery (n=403, 14.72%), followed by Internal medicine (n=382, 13.96%) and Pediatrics (n=261, 9.54%). On the other hand, Radiology (n=314, 11.47%), Pediatrics (n=280, 10.23%) and Family medicine (n=263, 9.61%) were all specialties that students would not choose. For Psychiatry, there was a greater tendency only among first year students to see it as a choice of specialty. Compared with men (n=114, 11.53%), the percentage of women (n=259, 14.81%) who considered Psychiatry as an option of medical residency was higher. Discussion We could see that Psychiatry is neither the most preferred nor the most rejected specialty among medical students. Unfortunately, misconceptions still prevail around it and they do not favor its selection as a potential option of residency. It would be necessary to strengthen the knowledge about mental health and psychiatry, and to have the teachers promoting it in order to change the trends of selection.

Introducción En diversos países el número de candidatos para ingresar a la especialidad de Psiquiatría es cada vez menor. En México desconocemos a detalle los factores que inciden en la preferencia por una especialidad médica y la forma en que esa tendencia se va modificando a través de los años de la carrera de Medicina. En este estudio analizamos las preferencias de especialidad en una muestra representativa de estudiantes de los diferentes años de la carrera de Medicina en la Universidad Nacional Autónoma de México (UNAM). Material y métodos Estudio transversal descriptivo. Por medio de un cuestionario diseñado ex profeso para la indagación de las preferencias de especialidad, se evaluaron a los alumnos inscritos en el ciclo escolar 2009-2010 de la carrera de Medicina que aceptaron participar. Los datos se analizaron cuanti y cualitativamente. Resultados Participaron 2737 estudiantes. La mayor parte de los alumnos (n=2634) ya tenía considerada una opción de especialidad. Con una p<0.001, las especialidades preferidas fueron: Cirugía general (n=403, 14.72%), seguida de Medicina interna (n=382, 13.96%) y Pediatría (n=261, 9.54%). Mientras que Radiología (n=314, 11.47%), Pediatría (n=280, 10.23%) y Medicina familiar (n=263, 9.61%) se mencionaron como las especialidades que no elegirían. En cuanto a la Psiquiatría, sólo entre los alumnos de primer año se observó una mayor tendencia a considerarla como una opción de especialidad. En comparación con los hombres (n=114, 11.53%), fueron más las mujeres (n=259, 14.81%) que la consideraron como una alternativa para cursar una residencia. Discusión Si bien la Psiquiatría no se encuentra entre las especialidades más rechazadas por los alumnos participantes, tampoco figura dentro de las preferidas. Desafortunadamente siguen prevaleciendo concepciones erróneas a su alrededor que no favorecen su selección como una potencial especialidad a cursar. Sería necesario reforzar el conocimiento sobre la salud mental y la psiquiatría y su promoción por parte de los docentes en la búsqueda de un cambio en las tendencias.

Alfabetización sobre esquizofrenia para estudiantes de medicina / Literacy among medical students on schizophrenia

Introducción: La alfabetización en salud mental (ASM) por parte de estudiantes y profesionales de la salud implica su capacidad para reconocer la enfermedad mental y su adecuado manejo, lo que constituye un elemento esencial para reducir el estigma y la brecha de tratamiento de los pacientes con esquizofrenia. Objetivo: Determinar la asociación entre el reconocimiento, causas atribuibles y tratamiento sugerido de la esquizofrenia, con el género y la percepción de agresividad (PA) en un grupo de estudiantes de medicina. Método: Noventa y ocho estudiantes de una universidad pública de la Ciudad de México completaron el Cuestionario de Concepto Público de Agresividad (CPA) para valorar la ASM y la PA. Resultados: El 94.9% de los estudiantes reconocieron la presencia de una enfermedad mental. Menos de la mitad (44.9%) consideraron las intervenciones psiquiátricas como las más adecuadas para el control de los síntomas. El reconocimiento de la enfermedad mental se asoció con el nivel de restricción del tratamiento sugerido por los hombres. Las etiologías psicológica y biopsicosocial de los síntomas fueron las más frecuentemente referidas. El 82.7% de los estudiantes consideraron que la persona descrita era agresiva. Conclusiones: La atribución biopsicosocial de los síntomas y la PA podrían estar relacionados con la sugerencia de tratamientos coercitivos. Las campañas de ASM para estudiantes de medicina deben abocarse a incrementar el conocimiento de opciones terapéuticas y de la prevalencia real y métodos de prevención de la agresividad de los pacientes con esquizofrenia.

Alfabetización sobre esquizofrenia para estudiantes de medicina / Literacy among medical students on schizophrenia

Introducción: La alfabetización en salud mental (ASM) por parte de estudiantes y profesionales de la salud implica su capacidad para reconocer la enfermedad mental y su adecuado manejo, lo que constituye un elemento esencial para reducir el estigma y la brecha de tratamiento de los pacientes con esquizofrenia. Objetivo: Determinar la asociación entre el reconocimiento, causas atribuibles y tratamiento sugerido de la esquizofrenia, con el género y la percepción de agresividad (PA) en un grupo de estudiantes de medicina. Método: Noventa y ocho estudiantes de una universidad pública de la Ciudad de México completaron el Cuestionario de Concepto Público de Agresividad (CPA) para valorar la ASM y la PA. Resultados: El 94.9% de los estudiantes reconocieron la presencia de una enfermedad mental. Menos de la mitad (44.9%) consideraron las intervenciones psiquiátricas como las más adecuadas para el control de los síntomas. El reconocimiento de la enfermedad mental se asoció con el nivel de restricción del tratamiento sugerido por los hombres. Las etiologías psicológica y biopsicosocial de los síntomas fueron las más frecuentemente referidas. El 82.7% de los estudiantes consideraron que la persona descrita era agresiva. Conclusiones: La atribución biopsicosocial de los síntomas y la PA podrían estar relacionados con la sugerencia de tratamientos coercitivos. Las campañas de ASM para estudiantes de medicina deben abocarse a incrementar el conocimiento de opciones terapéuticas y de la prevalencia real y métodos de prevención de la agresividad de los pacientes con esquizofrenia. (AU)

Mental health care reforms in Latin America: child and adolescent mental health services in Mexico.

This column provides an overview of child and adolescent mental health services in Mexico, where prevalence rates of mental disorders among young people are up to twice as high as U.S. and Canadian rates. The mental health care system in Mexico is underdeveloped and underfunded, and for the approximately 40% of the population with no insurance, access to and quality of care are particularly poor. This column offers policy recommendations aimed at better meeting the needs of this vulnerable population.