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The increasing burden of interpersonal violence in women in Mexico is a neglected social and health problem that competes with other leading causes of premature death, disability, and health losses in young women. In this article, we focus on revealing the burden of violence in girls and young women and its implications for public policy. This study presents the subnational analysis of Mexico from the Global Burden of Disease study (1990-2015). The global study harmonized information of 195 countries and 79 risk factors. The study analyzed the deaths, years of life lost to premature death (YLL), years lived with disability (YLD), and the healthy years of life lost or disability-adjusted life year (DALY) related to violence. Nationwide, violence in young women accounts for 7% of all deaths in the 10 to 29 years age group and arises as the second most important cause of death in all age groups, except 10 to 14 years old, where it stands in the seventh position from 1990 to 2015. The health losses and social impact related to violence in young women demands firm actions by the government and society. It is urgent for health institutions to focus on the health of girls and young women because gender inequities have an enormous effect on their lives. Girls and women are nearly universally less powerful, less privileged, and have fewer opportunities than men.
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Pessoas com Deficiência , Adolescente , Criança , Feminino , Nível de Saúde , Humanos , Masculino , México/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , ViolênciaRESUMO
Abstract: Introduction: Gambling disorder is characterized by an uncontrollable need to gamble, lack of control over gambling, prioritizing gambling over other activities, and continuing to gamble despite the negative consequences this entails. Worldwide, between .1% and 5% of people show signs of problem gambling and between .1% and 2.2% present a positive result in gambling disorder criteria. Objective: To determine the extent of the problem of gambling disorder in Mexico and to identify and analyze the demographic groups in which it occurs. Method: ENCODAT 2016-2017 is a probabilistic, multi-stage survey with national and state representativeness. The sample comprises 56 877 people who answered a standardized questionnaire that collects information on addictive substance use and other areas such as gambling disorder. Results: A total of 24.5% of the population aged 12 to 65 have played a betting game at lifetime. Men have higher statistically significant prevalences than women in nearly all types of gambling and in six of the nine symptoms of gambling disorder. In Mexico, .3% of the target population meet the criteria for gambling disorder, with adolescents showing the highest percentage (.4%). Discussion and conclusion: It is necessary to reinforce public policies for this issue that include the development of preventive actions targeting the adolescent and youth population in Mexico, and to ensure the adequate monitoring of authorized centers.
Resumen: Introducción: El juego patológico se caracteriza por la necesidad incontrolable de jugar, la falta de control sobre el juego, la prioridad de jugar sobre otras actividades y de continuar jugando a pesar de las consecuencias negativas. A nivel mundial, entre .1% y el 5% de las personas muestra señales de juego problemático y del .1% al 2.2% presenta un resultado positivo en los criterios de juego patológico. Objetivo: Conocer la extensión del problema del juego patológico en México e identificar y analizar los grupos demográficos en los que se presenta. Método: La ENCODAT 2016-2017 es una encuesta probabilística y polietápica con representatividad nacional y estatal. La muestra fue de 56 877 personas, las cuales contestaron un cuestionario estandarizado que recaba información sobre consumo de sustancias adictivas y otras áreas como el juego patológico o ludopatía. Resultados: El 24.5% de la población de 12 a 65 años ha jugado algún juego de azar alguna vez en la vida. Los hombres presentan prevalencias estadísticamente significativas más altas que las mujeres en casi todos los tipos de juegos y en 6 de los 9 síntomas de juego patológico. En el país, el .3% de la población objetivo cumple con los criterios para juego patológico, y los adolescentes muestran el mayor porcentaje (.4%). Discusión y conclusión: Es necesario reforzar políticas públicas sobre el tema que incluyan el desarrollo de acciones preventivas dirigidas a la población adolescente y joven del país, así como incidir en el monitoreo adecuado de los centros autorizados.
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Abstract Introduction Marijuana use among the student population has increased in Mexico and Latin America. There are social, interpersonal and individual factors associated with the onset and continuation of marijuana use. These include the availability of drugs in the community, opportunity for use, low perceived risk of harm from marijuana use and social tolerance by family and close friends. Moreover, these factors increase the probability of experimenting with other drugs, polysubstance use and dependence. Objective To identify the relationship between the level of urbanization, drug availability, exposure to opportunity for use, risk perception and social tolerance of the level of marijuana use among Mexican middle and high school students. Method The results are drawn from various surveys conducted in Mexico City and the National Survey of Drug Use among Students 2014. A total of 114 364 middle and high school students participated (49.8% boys and 50.2% girls). Results Of the respondent 10.6% had used marijuana at least once (12.9% boys and 8.4% girls). The variables that predicted higher marijuana use were drug use approval by family and best friend,, the level of urbanization and low risk perception. Discussion and conclusion Action must be taken on the factors mentioned to decrease the availability and use of drugs in the environment, and raise awareness of their consequences. These elements must be introduced systematically and creatively into preventive programs in this area.
Resumen Introducción El consumo de mariguana en población estudiantil se ha incrementado en México y América Latina. Existen factores sociales, interpersonales e individuales asociados con el inicio y la continuación de su consumo. Entre ellos encontramos la disponibilidad de drogas en la comunidad, la oportunidad de consumo, la baja percepción de riesgo por consumir mariguana, la tolerancia social de la familia y la de los amigos cercanos. Además, estos factores aumentan la probabilidad de experimentar con otras drogas, ser policonsumidor y producir dependencia. Objetivo Conocer la relación entre el nivel de urbanización, la disponibilidad de drogas, la exposición a la oportunidad de consumo, la percepción de riesgo y la tolerancia social con el nivel de consumo de mariguana en los estudiantes mexicanos de secundaria y bachillerato. Método Los resultados parten de diversas encuestas realizadas en la Ciudad de México y de la Encuesta Nacional de Consumo de Drogas en Estudiantes 2014. Participaron 114 364 alumnos de secundaria y bachillerato (49.8% hombres y 50.2% mujeres). Resultados El 10.6% consumieron mariguana alguna vez (12.9% hombres y 8.4% mujeres). Las variables predictoras de un mayor consumo de mariguana fueron la tolerancia ante el consumo de drogas de la familia y del mejor amigo, el nivel de urbanización y una baja percepción de riesgo. Discusión y conclusión Es necesario incidir en los factores señalados con objeto de disminuir la disponibilidad y el consumo de drogas en el entorno, así como en el conocimiento real de sus consecuencias. Estos elementos deben introducirse sistemática y creativamente en los programas preventivos del área.
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Resumen: INTRODUCCIÓN: La supervisión parental comprende: cuidado de los hijos, conocimiento de su paradero y actividades y adaptación. Para que ésta se dé es necesario que exista comunicación y apoyo entre padres e hijos, de manera que el ambiente familiar sea agradable. Por otro lado, se ha encontrado que la inconsistencia o ausencia de ésta es un factor de riesgo de la conducta antisocial y, en casos más graves, de delincuencia en los hijos. OBJETIVO: Conocer cuál es la relación que existe entre el ambiente familiar, la supervisión parental y la gravedad de la conducta antisocial en menores infractores. MÉTODO: La población estuvo conformada por menores infractores de un Centro Tutelar del Estado de Morelos. El instrumento se aplicó a 86 hombres. RESULTADOS: La comunicación del hijo fue un predictor de: 1. el manejo de reglas y conocimiento de pares, y 2. el conocimiento de las actividades del hijo. Esto último es lo que predice de manera significativa la gravedad de la conducta antisocial. DISCUSIÓN Y CONCLUSIÓN: De acuerdo con los hallazgos, es importante que exista un ambiente familiar basado en la comunicación y el apoyo, que fomente una comunicación más libre de los adolescentes con sus padres, de manera que la supervisión parental se consiga más fácilmente. Esto ayudará para que los jóvenes no se involucren en comportamientos que los puedan llevar a delinquir.
Abstract: INTRODUCTION: Parental supervision is constituted by a series of correlated parental behaviors involving children care, knowing their where abouts, which activities they are performing, and the situation of their adaptive processes. In order for parental supervision to take place, it is necessary that communication and mutual support exist between mother and father, as well as between parents and children so that the family environment becomes pleasant. Supervision is one of the most studied factors related to anti-social behavior, and it has been observed that its absence or inconsistency allows for the occurrence of anti-social behavior, which in the more serious cases leads to delinquency. OBJECTIVE: To know the relationship between family environment, supervision and the seriousness of anti-social behavior in juvenile offenders confined in a state penitentiary from Morelos. METHOD: A survey was used to collect data from a population of 86 juvenile male offenders from a state penitentiary located in Morelos. RESULTS: Parent-children communication and support are interrelated and form the familiar environment. Thus, children's communication predicts proper supervision and monitoring, specifically in the area of knowing children's activities, which, at the same time, predict less serious anti-social behavior. DISCUSSION AND CONCLUSION: It is important that families have an environment based on communication and support. It is also relevant to encourage adolescents to freely communicate with their parents so supervision and monitoring become common elements that help adolescents to stay away from behaviors that could lead them to crime.
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Antecedentes: En el alcoholismo, el tema del craving es un asunto controvertido. Sin embargo, se sabe que, si un alcohólico puede hablar del suceso en sus propios términos, aumenta la probabilidad de lograr un afrontamiento exitoso y evitar una recaída. No obstante, se conoce muy poco acerca de dicho afrontamiento y aún menos cuando se alude a él con términos propios del bebedor.Objetivo: Conocer el afrontamiento de la "obsesión mental por beber", expresión que suelen utilizar los miembros de Alcohólicos Anónimos (AA) para hablar de las reacciones características del craving.Método: La muestra incluyó a 192 individuos que habían participado en AA durante 10 años en promedio (DE=7.5 años). Se aplicó un instrumento empírico para medir el afrontamiento (Kr=.86). Se utilizó un conglomerado de dos fases para establecer perfiles.Resultados: El análisis encontró cinco estilos de afrontamiento: 1. evadir situaciones inductoras al tiempo que se busca una solución (evasivo-activo); 2. evadir retrayéndose (evasivo-pasivo); 3. mostrar sentimientos de enojo y no hacer nada (emocional-pasivo); 4. recordar y comparar la vida pasada como alcohólicos activos (revalorativo) y 5. negar cualquier afrontamiento (negador).Discusión y conclusion: Los datos son preliminares, pero ofrecen la oportunidad de ampliar y especificar la forma en que ciertos alcohólicos de nuestro país solucionan un problema tan complejo como es el craving. El agrupamiento de respuestas supone esfuerzos o estilos de afrontar que pueden resultar o no efectivos para lograr una recuperación -por ejemplo, prevenir las recaídas en las personas que asisten a los grupos de AA-, por lo que plantea una importante perspectiva de investigación.
Background: Although craving is a controversial concept in alcoholism research, it is known that if an alcoholic can talk about the event using his own words, the probability of successful coping and prevention of relapse is bigger. However, little is known about such coping, and even less when it is articulated from the drinker's perspective.Objective: To identify the coping mechanism to this event that causes physical and emotional responses similar to those of craving, identified with the own language of Alcoholics Anonymous (AA).Method: The sample consisted of 192 individuals who participated in AA meetings for an average of ten years (SD=7.5). An empirical instrument was developed to measure coping (Kr=.86) and a two-phase conglomerate analysis was used to create categories to develop profiles.Results: The analysis showed five coping profiles suggesting that AA members cope with the event as follow: 1. evading but looking for a direct solution (elusive-active conglomerate), 2. evading but retracting (elusive-liabilities conglomerate), 3. getting upset and doing nothing (emotional-passive conglomerate), 4. remembering and comparing their past life (revalorative conglomerate), and 5. denying (denier conglomerate).Discussion and conclusion: Although the data are preliminary, they offer the opportunity to expand and specify how certain alcoholics solve a complex problem, such as craving. The information concurs with literature in the sense that this grouping of responses assumed those efforts that may be effective or not for the recovery process, for example, to prevent relapses in alcoholics who attend AA groups, so it raises an important research perspective.
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Antecedentes El consumo de alcohol, tabaco y otras drogas tiene repercusiones importantes en la vida diaria de los adultos mayores. Con el objeto de conocer la asociación entre consumo de sustancias psicoactivas y variables de cuidado y salud en adultos mayores. Método Se recopiló información de una muestra aleatoria del padrón de usuarios del IAAM-DF. 2098 personas aceptaron participar y fueron entrevistadas en sus hogares, su tasa de respuesta fue de 83.9%. Resultados y discusión Se encontró que 13.1% requiere de ayuda en actividades básicas e instrumentales de la vida diaria; 81.4% percibe poco apoyo social; 82.2% señala pertenecer a una familia disfuncional, y a 45.5% le ha sido diagnosticada una enfermedad crónico-degenerativa. Mediante razón de momios se determinó que el consumo riesgoso de alcohol y la dependencia de éste por adultos mayores incrementan en ellos el riesgo de padecer enfermedades crónico-degenerativas, infecciosas y trastornos mentales, e influyen en su necesidad de recibir apoyo en actividades básicas e instrumentales de la vida diaria , así como en su percepción de disfunción familiar. El consumo de tabaco aumentó el riesgo de padecer enfermedades crónico-degenerativas e infecciosas, y se asocia con la percepción de salud y apoyo familiar. La ingestión de alguna droga, ilegal o prescrita, no se asoció significativamente con variables de cuidado, pero sí impacta en la aparición de enfermedades crónico-degenerativas y de trastornos mentales. Los resultados muestran que el consumo de alcohol, tabaco y otras drogas influye en la salud y el cuidado de los adultos mayores en la Ciudad de México, por lo cual constituye una tarea urgente atender estas problemáticas para mejorar la calidad de vida de éstos.
Background The use of alcohol, tobacco and other drugs have a significant impact on the daily lives of older adults. In order to study the relationship between substance use, health and care variables in older adults. Method Information was collected in a random sample of the registry users of the DF IAAM program; 2098 people agreed to participate and was interviewed in their homes, the response rate obtained was 83.9%. Results and discussion It was found that 13.1% receive aid in basic and instrumental activities of daily living, 81.4% perceived little social support, 82.2% perceived belonging to a dysfunctional family and 45.5% have been diagnosed with a chronic degenerative disease. Using odds ratios, it was shown that at-risk drinking and alcohol dependence increased the risk of chronic degenerative diseases, infectious and mental disorders and affects the need for support in basic and instrumental activities of daily living and perception of family dysfunction. Smoking increased risk of chronic degenerative and infectious diseases and also was associated with perceived health and family support. The use of any illegal or prescribed drugs was not significantly associated with care variables, but affect chronic degenerative diseases and mental disorders. The results of this study showed that use of alcohol, tobacco and other drugs affect the health and care of older adults in Mexico City, so it is urgent to address these problems in order to improve their quality of life.
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Introducción Los estudios epidemiológicos en nuestro país muestran un incremento en el consumo de drogas ilegales y de alcohol. La edad de inicio también ha disminuido, especialmente en el consumo de alcohol. Por su parte, el consumo de inhalables se ha incrementado en forma importante, especialmente entre las mujeres jóvenes. Son diversos los factores asociados al consumo de drogas, pero de manera importante destacan el desarrollo de estrategias de resistencia, junto con sus habilidades sociales subyacentes, así como los estilos parentales de crianza. Método La presente es una encuesta probabilística en población escolar de secundarias y bachilleratos de la Ciudad de México que se levantó en noviembre del 2012, con representación a nivel de cada Delegación. La muestra fue de 26 503 alumnos. La información se obtuvo mediante un cuestionario estandarizado y validado en encuestas anteriores. Resultados El consumo de tabaco disminuyó significativamente (de 44.3% a 41.0%), el 32.9% de los adolescentes comenzó a utilizar tabaco antes de los 13 años. El 68.2% consumió alcohol alguna vez; en tanto que la edad de inicio promedio de consumo de esta sustancia se mantuvo en los 12.6 años. La prevalencia de consumo de drogas alguna vez aumentó de 21.5% a 24.4%. La mariguana es la droga de preferencia en la población estudiantil (15.9%). También se encontraron incrementos en la presencia de abuso sexual, mientras que el intento suicida disminuyó. Discusión Los resultados muestran el continuo crecimiento que tiene esta problemática, aunque los inhalables se mantuvieron constantes y el tabaco disminuyó de manera importante. Dado estos resultados, es una tarea preponderante dedicar más esfuerzos a la prevención con estudios e intervenciones evaluadas para preescolar y primaria, así como para los padres de familia y los maestros.
Introduction Epidemiological studies in our country show increases in the consumption of illegal drugs and alcohol. The age of onset has decreased, especially regarding alcohol use. Meanwhile, consumption of inhalants has increased significantly, especially among young women. There are several factors associated with drug use, but the development of resistance strategies, along with its underlying social skills and parenting styles, stand out in a significant way. Method Data comes from a probabilistic survey carried out in November 2012, with students from 7th to 12th school grades, in Mexico City, which was representative for each of its districts. The sample was 26 503 students. Information was obtained through a questionnaire standardized and validated in previous surveys. Results Tobacco consumption decreased significantly (44.3% to 41.0%); 32.9% of the adolescents began its use before age 13. Lifetime consumption of alcohol was 68.2%, while the average age of onset of cannabis use remained at 12.6 years. Lifetime prevalence of any drug use increased from 21.5% to 24.4%. Marijuana was the first drug of choice among students (15.9%). Increases were also found in sexual abuse rate, while suicide attempt decreased. Discussion Although inhalants use remained stable and tobacco use decreased significantly, results show the continued growth of drug use. Given this context, concentrating more efforts in prevention with studies and evaluated interventions for pre-school and elementary school students, as well as for parents and teachers, is a preponderant task.
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Introduction Alcohol is an endemic problem in our country. It affects mainly adolescents, and is associated with the availability and individual characteristics and context that favor the likelihood of experiencing, continue to use and move toward the problematic use and dependence. Substance use is also associated with being exposed to them and making decisions about their conduct towards the opportunity, so prevention may be more effective when you understand the mechanisms between the availability and behavior and exposure to opportunity and the temptation to consume. This work addresses these constructs in a group of adolescents using a qualitative approach and explores the perception of the constructs, their association with the use and the strategies used by adolescents to avoid consumption. Methodology The sample was composed by 60 adolescents, 30 experimentalists and 30 alcohol abusers, divided into six groups. Results The results show a clear identification and definition of constructs exposed to the opportunity and temptation to consume. Family parties and invitations are considered situations associated with exposure to the opportunity, and temptation consumption is associated with unpleasant emotions. In the coping strategies to avoid drinking, experimenters think about the consequences of consumption, in saying no, and in respecting the rules and decisions, while the abusers think of the fun and never refuse an invitation from a friend. Discussion Results are proposed for inclusion in models of prevention and care for specific populations.
El consumo de alcohol es un problema endémico en nuestro país. Afecta principalmente a los adolescentes y se asocia con la disponibilidad y con características individuales y del contexto que favorecen la probabilidad de experimentar, continuar usando y avanzar hacia el consumo problemático y la dependencia. El uso de sustancias también se relaciona con estar expuesto a ellas y tomar decisiones sobre su conducta frente a la oportunidad. Así, la prevención puede ser más efectiva cuando se comprenden los mecanismos intermedios entre la disponibilidad y la conducta como la exposición a la oportunidad y la tentación al consumo. Este trabajo aborda estos constructos en un grupo de adolescentes mediante una aproximación cualitativa y explora la percepción de los constructos, su asociación con el consumo y las estrategias que utilizan los adolescentes para evitar el consumo. Método La muestra se integró con 60 adolescentes, 30 experimentadores y 30 abusadores de alcohol, divididos en seis grupos. Los resultados muestran una clara identificación y definición de los constructos exposición a la oportunidad y tentación al consumo. Fiestas familiares e invitaciones son consideradas situaciones asociadas con la exposición a la oportunidad; y la tentación al consumo se asocia con emociones desagradables. En las estrategias de enfrentamiento para evitar el consumo, los experimentadores piensan en las consecuencias del consumo, en decir no y en respetar las reglas y decisiones; en tanto que los abusadores piensan en la diversión y nunca rechazarían la invitación de un amigo. Discusión A partir de los resultados se hacen propuestas para su incorporación en modelos de prevención y atención para poblaciones específicas.
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Los conocimientos que proporciona la psicología deben dar respuesta a diferentes problemáticas, lo que sólo puede lograrse cuando los hallazgos obtenidos por evidencia científica son asequibles a otros grupos científicos, y núcleos sociales, a fin de que éstos logren apropiarse y usarlos para solucionar problemas, mejorar su calidad de vida o prevenir una situación potencial de riesgo. Sin embargo, con frecuencia se observan diferentes barreras para la utilización efectiva de los conocimientos. Además, se tiene la falsa impresión de que la investigación en las ciencias de salud resulta una actividad poco responsiva ante las necesidades de los actores sociales que podrían beneficiarse de su uso. En este contexto, en el presente artículo se presenta una revisión general del concepto de transferencia tecnológica, los modelos que se han desarrollado para llevar a cabo ésta y un ejemplo de cómo se ha iniciado la transferencia de un programa de intervención en el ámbito de las adicciones en México y cuáles son sus retos para el avance de dicho proceso y su posible adopción en centros de atención a las adicciones. Se concluye que, para cumplir con la incorporación de tratamientos en instituciones de atención de adicciones, hace falta evaluar la efectividad del programa de intervención breve en escenarios clínicos, cumplir con todos los indicadores CONSORT de los ensayos clínicos aleatorizados e integrar al proceso de transferencia cuatro aspectos principales: 1. propiciar un mayor acercamiento con los profesionales de la salud; 2. permitir la "reinvención" del programa dentro de un contexto de colaboración entre los actores involucrados y evaluar dicho proceso; 3. considerar limitaciones, recursos, objetivos y prácticas de la institución donde se pretende transferir el programa y 4. ofrecer seguimiento a largo plazo para evaluar el éxito de la adopción de la innovación.
The knowledge provided by psychology should respond to different problems, which can only be achieved when the findings from scientific evidence become available to other scientific groups and social nuclei, in order to achieve them appropriately and use them to solve problems, improve their quality of life, or prevent a potentially hazardous situation. However, various barriers to the effective use of knowledge are often observed. In addition, there exists the false impression that research in the health sciences is an activity that rarely meets the needs of the social actors who might benefit from its use. In this context, this paper presents a general overview of the concept of technology transfer, the models that have been developed to perform this and an example of how the transfer of an intervention program in the field of addictions in Mexico has been started and what the challenges are to advancing this process and its possible adoption in addiction centers. The authors conclude that in order to comply with the incorporation of treatments at addiction treatment institutions, it is essential to evaluate the effectiveness of the brief intervention program in clinical settings, adhere to all the CONSORT indicators for randomized clinical trials and incorporate four main aspects into the transfer process: 1. foster closer relations with health professionals; 2. allow the "reinvention" of the program within a context of collaboration between stakeholders and evaluate this process; 3. consider the constraints, resources, objectives and practices of the institution to which the program is to be transferred, and 4. provide long-term monitoring to assess the success of the adoption of the innovation.
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OBJECTIVE: Evaluate some of the key indicators that characterize the Mexican mental health system using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). METHODS: The strategy for examining the WHO-AIMS indicators included: (i) a review of documentary sources; (ii) application of the questionnaire; and (iii) group work with a team of experts using the consensus technique. To facilitate collection of the data, a questionnaire was prepared in which the indicators were turned into simple questions. The people gathering the data were trained, and the activity was monitored. RESULTS: It was found that, of the total budget for health, only 2% is allocated for mental health, and, of that share, 80% is used in the operation of psychiatric hospitals. The pivotal point for mental health care is in the psychiatric hospital; there are very few psychiatric units in the general hospitals, few residential establishments, and few services targeted specifically to care for children and adolescents. Access is limited because of the centralized health care system, with the majority of establishments located in the large cities. Only 30% of primary care services have protocols for the evaluation and treatment of mental disorders. Finally, in the mental health facilities, the ratios of psychiatrists, other physicians, nurses, and psychologists per 100 000 population are 1.6, 1.3, 3.4, and 1.5, respectively. CONCLUSIONS: More funding will be needed in order to bridge the gap between the mental health burden and the budget allocated for its care, and resources will need to be used more rationally, with the first level of care becoming the pivot. In addition, it will be necessary to increase the number of specialists, offer periodic in-service training for personnel at the first level of care, and enlist greater participation by the rest of society.
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Transtornos Mentais/terapia , Serviços de Saúde Mental/normas , Indicadores de Qualidade em Assistência à Saúde , Política de Saúde , Humanos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/legislação & jurisprudência , MéxicoRESUMO
OBJETIVO: Evaluar algunos indicadores clave del sistema de salud mental mexicano utilizando el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (IESM-OMS). MÉTODOS: La estrategia utilizada para responder a los indicadores del IESM-OMS incluyó: i) Revisión de fuentes documentales, ii) Aplicación de cuestionarios y iii) Trabajo grupal utilizando la técnica de consenso con expertos. Para facilitar la recopilación de la información, se elaboró un cuestionario donde los indicadores fueron transformados en preguntas sencillas. Asimismo, se capacitó a las personas encargadas de recabar los datos y se realizó un seguimiento de dicha actividad. RESULTADOS: Del total del presupuesto asignado a la salud, solo 2% estaba destinado a la salud mental y, de ese porcentaje, 80% se empleaba para el funcionamiento de los hospitales psiquiátricos. El eje de la atención de la salud mental se encontraba en el hospital psiquiátrico y existían muy pocas unidades de hospitalización psiquiátrica en los hospitales generales y establecimientos residenciales, así como servicios específicos para niños y adolescentes. El acceso estaba limitado por la centralización del sistema de atención, ya que la mayoría de los establecimientos se ubicaban en las grandes ciudades. Solamente 30% de los servicios de atención primaria contaban con protocolos de evaluación y tratamiento para trastornos mentales. Finalmente, en los establecimientos de salud mental, la tasa de psiquiatras, médicos, enfermeros y psicólogos por cada 100 000 habitantes registró valores de 1,6, 1,3, 3,4 y 1,5 respectivamente. CONCLUSIONES: Para reducir la brecha entre la carga que representan los trastornos mentales y el presupuesto asignado para su atención, se requiere de un mayor financiamiento y una utilización de los recursos más racional, considerando al primer nivel como el eje de la atención. Asimismo, será necesario ampliar el número de especialistas, capacitar periódicamente al personal en los primeros niveles de atención e incrementar la participación del resto de la sociedad.
OBJECTIVE: Evaluate some of the key indicators that characterize the Mexican mental health system using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). METHODS: The strategy for examining the WHO-AIMS indicators included: (i) a review of documentary sources; (ii) application of the questionnaire; and (iii) group work with a team of experts using the consensus technique. To facilitate collection of the data, a questionnaire was prepared in which the indicators were turned into simple questions. The people gathering the data were trained, and the activity was monitored. RESULTS: It was found that, of the total budget for health, only 2% is allocated for mental health, and, of that share, 80% is used in the operation of psychiatric hospitals. The pivotal point for mental health care is in the psychiatric hospital; there are very few psychiatric units in the general hospitals, few residential establishments, and few services targeted specifically to care for children and adolescents. Access is limited because of the centralized health care system, with the majority of establishments located in the large cities. Only 30% of primary care services have protocols for the evaluation and treatment of mental disorders. Finally, in the mental health facilities, the ratios of psychiatrists, other physicians, nurses, and psychologists per 100 000 population are 1.6, 1.3, 3.4, and 1.5, respectively. CONCLUSIONS: More funding will be needed in order to bridge the gap between the mental health burden and the budget allocated for its care, and resources will need to be used more rationally, with the first level of care becoming the pivot. In addition, it will be necessary to increase the number of specialists, offer periodic in-service training for personnel at the first level of care, and enlist greater participation by the rest of society.
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Humanos , Transtornos Mentais/terapia , Serviços de Saúde Mental/normas , Indicadores de Qualidade em Assistência à Saúde , Política de Saúde , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/legislação & jurisprudência , MéxicoAssuntos
Saúde Mental , Formulação de Políticas , Hospitais Psiquiátricos , Transtornos Mentais , Serviços de Saúde Mental , México , Saúde Mental , Formulação de Políticas , Hospitais Psiquiátricos , Transtornos Mentais , Serviços de Saúde Mental , Transtornos Mentais , Serviços de Saúde Mental , Indicadores de Qualidade em Assistência à Saúde , Política de SaúdeRESUMO
Drugs use at party contexts has increased in recent decades. Drugs dealing facilitates consumer access to substances, whose sales practices vary according to drugs use, places for the consumption and the drug social function. Drug dealing is socially constructed from a set of practices ranging from reasons to dealing and those related to the consolidation as a common practice. The aim of this research was to describe and analyze the drugs users' experience in party contexts, about their dealer's construction process. An interpretative multiple-case study with the snowball technique was carried out to get the participants. The information was obtained by a semi-structured interview and nonparticipant observation at the dealing places. The information obtained points out the group's participation on the selection of the dealer as the initiation of drugs dealing, the extroversion features and communication skills as an important profile to be a dealer; specially, the capability to satisfy the group's emotional request through the drugs. Also, benefits as acceptation, protection and the warmth from the group and the economical earning. The dealer/businessmen consolidation is socially constructed according to the new identity assumed, the group participation and the specific activities as a business.
El uso de drogas en contextos de fiesta se ha incrementado en las últimas décadas. El narcomenudeo facilita el acceso a sustancias de consumo, cuyas prácticas de venta varían conforme a la droga de uso, los espacios de consumo y la función de la droga en los grupos que la consumen. La venta de drogas implica una serie de prácticas que la construyen y que incluyen los motivos del inicio de venta, el proceso de desarrollo y las relacionadas con la consolidación de la venta como práctica habitual. El objetivo de esta investigación fue describir y analizar la experiencia de usuarios de drogas en contextos de fiesta respecto al proceso en que se construyen como dealers. Para lo anterior, se realizó un estudio interpretativo de casos múltiples, empleando la técnica de "bola de nieve" para captar a los participantes. La observación se obtuvo por medio de una entrevista semiestructurada y la observación no participante en escenarios de venta. Se obtuvo información relacionada con los elementos del salto del uso a la venta como la elección del dealer por el grupo, su perfil para ser elegido como la extroversión y habilidades de comunicación; y sobre todo su capacidad para satisfacer la demanda de emociones de los miembros de su grupo por medio de las drogas de venta. Además, de la aceptación, protección y afecto del grupo y las ganancias económicas. La consolidación como dealer/empresario se construye conforme se asumen una nueva identidad, la participación del grupo y las actividades específicas de la empresa.
RESUMO
OBJECTIVE: To study the impact of mental disorders on failure in educational attainment in Mexico. METHODS: Diagnoses and age of onset for each of 16 DSM-IV disorders were assessed through retrospective self-reports with the Composite International Diagnostic Instrument (CIDI) during fieldwork in 2001-2002. Survival analysis was used to examine associations between early onset DSM-IV/CIDI disorders and subsequent school dropout or failure to reach educational milestones. RESULTS: More than one of two Mexicans did not complete secondary education. More than one-third of those who finished secondary education did not enter college, and one of four students who entered college did not graduate. Impulse control disorders and substance use disorders were associated with higher risk for school dropout, secondary school dropout and to a lesser degree failure to enter college. Anxiety disorders were associated with lower risk for school dropout, especially secondary school dropout and, to a lesser degree, primary school dropout. CONCLUSIONS: The heterogeneity of results found in Mexico may be due to the effect of mental disorders being diminished or masked by the much greater effect of economic hardship and low cultural expectations for educational achievement. Future research should inquire deeper into possible reasons for the better performance of students with anxiety disorders in developing countries.
Assuntos
Transtornos Mentais/epidemiologia , Evasão Escolar/psicologia , Adolescente , Idade de Início , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Criança , Maus-Tratos Infantis , Fatores de Confusão Epidemiológicos , Estudos Transversais , Países em Desenvolvimento , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/psicologia , Violência Doméstica , Escolaridade , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , México/epidemiologia , Motivação , Transtornos Fóbicos/epidemiologia , Transtornos Fóbicos/psicologia , Pobreza , Fatores Socioeconômicos , Evasão Escolar/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Alcohol abuse in Mexico has an enormous impact on people's health. This problem has led authorities to undertake actions to combat and reduce both consumption levels and their consequences. The interventions, focusing on handling problem drinkers -people who already show symptoms of dependence and consume more than one drug, including alcohol-, have proved their effectiveness in various scenarios. In the work setting, this problem is no exception and has also been a focus of concern and the implementation of actions to prevent excess alcohol consumption and provide care for persons beginning to display problems. However, implementing programs in the workplace has proved complicated. Other countries have found that many programs are not correctly evaluated or simply not evaluated, making it impossible to determine their effectiveness in solving the problems for which they were designed. Moreover, the personnel that implement them are not properly trained, programs are expensive to implement, and conflicts of interest tend to arise. In Mexico, low-cost, effective actions have been implemented for this population. However, the time available for undertaking preventive activities is limited, while the length of workers' shifts means that they do not have enough time for these activities. One current challenge is the Translation of Research as a tool for the development of efficient, simpler, more practical, and safer interventions, without ignoring the discovery of new information regarding health and disease prevention, as well as creating more efficient treatments and improving existing ones. Within this perspective, researchers worked to produce a brief intervention to reduce harmful alcohol consumption among the working population. It is based on the principles of cognitive social theory put forward by Bandura, in which alcohol consumption is regarded as learned behavior, that causes problems and may be replaced by healthy behaviors, provided dependence has not developed. Another of the components included is motivational theory, according to which the effectiveness of a particular form of treatment is related to individuals' motivation to continue it. The aim of this article is to describe the process of translation of research, derived from the implementation of cognitive social and motivational theories to adapt an intervention program designed in a comic book format that is easy to read and understand to teach workers with excess alcohol consumption to moderate their consumption. Method The work was carried out in two stages: Phase 1. Adaptation of a brief intervention to a comic book format. A comic was produced using the elements of a brief intervention. In order to ensure that the concepts put forward in the base theory were accessible to the target population, they were subjected to a process of cognitive laboratories following the methodology proposed by Beatty. The comic was produced to make the material easier to read and understand. The process began with a scriptwriter who translated the theoretical contents, together with the terms obtained in the cognitive laboratories into a story that would reflect the target population. This version was subjected to an evaluation described in stage 2. Phase 2. Evaluation of language, characters, contents, and format of comic. Participants: Researchers worked with 49 subjects from various firms and states in Mexico, 59.2% of whom were men, mostly between the ages of 24 and 42, and over half of whom were married (61.2%). Half had only completed high school or less. Instrument: The questionnaire contained demographic questions and indicators to evaluate the comic for: format, understanding of contents, characters, language, and perceived usefulness for reducing problem drinking, among other things. Procedure: Participants attended a training course during which they were asked to evaluate the comic. Each one was given a printed copy and a questionnaire. The subjects volunteered to participate and were guaranteed the confidentiality of the information they provided. Results Over 85% said that they were used to reading on a daily to weekly basis. Most of them thought that the illustrations were attractive and felt that the characters reflected the role they played in the story. They did not like the length of the comic or the fact that the drawings were extremely detailed, with too much text. They also disliked the font and the type of language used. Nearly 80% thought that the reading material was neither tedious nor dull. Most rated the story good or very good and thought that the title encouraged people to read it and that they would use it if they had drinking problems. They also identified themselves with the characters and the situations described in the comic. What they liked best was the way the topic was dealt with in a comic, the way the problem was highlighted, the type of language used (colloquial), the message given, the goal setting, the way they became involved in the reading, and the link between users and the family environment. Finally, the evaluations of the comic showed that some drawings were regarded as aggressive, the children's language did not match their parents', and the order of the dialogues was confusing. This moment in the translation of the intervention made it possible to make changes in several aspects included in the final version. The comic was given to a proofreader to correct spelling mistakes while maintaining the colloquial tone. Discussion This activity resulted in a comic in which the characters guide the workers through a series of strategies to reduce consumption. This complies with the principles of translating research by adapting the concepts derived from social and motivational cognitive theory, which have proved their effectiveness in dealing with addictive behaviors. The inclusion of experts from various areas made it possible to adapt knowledge, by incorporating strategies from the latter into a script that included the dialogues and sketched the characters that would form part of the story. The experts continued to participate during the evaluation process until the final version, with the definitive images, and final dialogues and exercises. Having the workers targeted by the intervention try out various aspects of the material made it possible to adjust the language, contents and the story told, the characters' performance and appearance and the way the exercises and dialogues were carried out. This also made it possible to see how useful the workers found it in reducing their own consumption or helping the people around them -family, co-workers and friends- to do so. In order to produce this sort of material, it is essential to use colloquial language that will be understood by the target population, which is the most delicate stage of the process since it involves the correct use of technical assumptions, since otherwise, one would work from a totally different perspective. This material can reach men of productive age, who are those that make less use of health services, meaning that it is a tool that covers this inaccessible sector of the population. However, the workers were also given the possibility of seeking help from specialists if they failed to achieve their objectives, in which case the comic achieves the objective of raising awareness. Lastly, one of the limitations of the material concerns the fact that the subject himself has to follow up his own progress, meaning that the adaptation must be carried out as rigorously as possible. It also implies that the material must be evaluated through an analysis of the changes that take place in workers as a result of using it. The next stage will therefore be to test the intervention through the comic in a controlled test and to evaluate its efficiency in reducing alcohol abuse problems, as well as the subject's possible progression to severe dependence.
El abuso en el consumo de alcohol en México es un problema de salud pública por lo que se han realizado diferentes acciones para reducir los niveles de consumo y las consecuencias derivadas de éste. Entre estas acciones hay intervenciones que han probado su eficacia en diferentes escenarios. En el ambiente laboral, sin embargo, ha sido complicado instrumentarlas, por el rechazo, el poco apoyo y el desinterés de funcionarios e instituciones, porque los empleados no disponen de tiempo en sus jornadas y por la falta de espacios para realizar actividades de prevención. Por esta razón es importante adaptar el conocimiento científico para el desarrollo de intervenciones eficientes, más simples, más prácticas y más seguras. Actualmente el proceso de traducción de la investigación es una vía para lograrlo. El objetivo de este artículo es describir este proceso mediante la adaptación de una intervención basada en las teorías cognitiva social y motivacional, cuyos conceptos se presentan en forma de estrategias guiadas por personajes en una historieta -de fácil lectura y comprensión- con la finalidad de que trabajadores que presentan consumo nocivo de alcohol aprendan a moderarlo. Método El trabajo se realizó en dos fases: Fase 1. Se creó la historieta para lograr que los conceptos planteados en la teoría base fueran accesibles a la población objetivo en un formato fácil de leer y entender. Fase 2. Evaluación de lenguaje, personajes, contenidos y formato de la historieta. Participantes: Cuarenta y nueve sujetos voluntarios de diferentes empresas y Estados de la República Mexicana, 59.2% hombres, la mayoría de entre 24 y 43 años, más de la mitad casados y con escolaridad de preparatoria o menos. Instrumento: Un cuestionario que contenía preguntas demográficas e indicadores para evaluar la historieta. Procedimiento: Los participantes se encontraban en un curso de capacitación, ahí se les dio una historieta y un cuestionario invitándolos a que ayudaran para evaluarla. La participación fue voluntaria y se garantizó la confidencialidad de la información proporcionada. Resultados En su mayoría las ilustraciones les resultaron agradables, consideraron a los personajes acordes con el papel que desempeñan en la historia, que la lectura del material no era tediosa o cansada, mencionaron que la historia era buena o muy buena y que el título motivaba a la lectura, que usarían la guía si tuvieran problemas con su consumo de alcohol, además de sentirse identificados con los personajes y las situaciones descritas. Lo que más les agradó es el modo en que se trató el tema en una historieta, el lenguaje utilizado, el mensaje que se les da, el planteamiento de metas, la forma de involucrarlos en la lectura, la relación del consumidor y la familia, cómo los van motivando, lo que sucede en la recaída y cómo se recupera el usuario. La información recabada fue utilizada para realizar la versión final de la historieta. Discusión El resultado fue un material de fácil lectura que permite su utilización individual, en momentos y lugares que cada persona deseé utilizar. Cumple con los principios de la traducción de la investigación al adaptar conceptos derivados de la teoría. Para lograrlo fue importante el uso de lenguaje coloquial que facilitó su lectura y la apropiación de los conocimientos por la población objetivo, esto implicó incluir cuidadosamente los supuestos teóricos para no distorsionar la perspectiva planteada originalmente. Esta intervención permite además llegar a grupos de difícil acceso como los hombres en edad productiva, que acuden poco a servicios de salud. Es necesario probar la intervención mediante la historieta, por ello la siguiente etapa será hacerlo mediante un ensayo controlado para evaluar su eficiencia para reducir los problemas de abuso de alcohol, así como la eventual progresión a la dependencia grave.
RESUMO
OBJETIVOS: Validar la Prueba de Identificación de Trastornos Derivados del Consumo de Alcohol (AUDIT, por su sigla en inglés) en pacientes con esquizofrenia. MÉTODOS: Se aplicó la Cédula Diagnóstica Internacional Compuesta (CIDI, por su sigla en inglés) versión 1.0 y el AUDIT a 80 sujetos con esquizofrenia, de ambos sexos y mayores de 16 años, de la consulta externa del Instituto Nacional de Psiquiatría de la ciudad de México. RESULTADOS: De los 80 pacientes esquizofrénicos, 57 eran hombres y 23 mujeres con un promedio de edad de 30,5 y 34,3 años, respectivamente; la edad de inicio de la esquizofrenia fue de 22 años para los hombres y 26 años para las mujeres; 35 sujetos (43,7 por ciento) consumían alcohol al momento del estudio. La escala AUDIT mostró alta consistencia interna, con un alfa de Cronbach de 0,812; el punto de corte de la escala completa del AUDIT para esta población fue de 4 puntos o más; se construyeron los puntos de corte de la "prueba rápida" y de los "Problemas psicosociales y probable dependencia al alcohol" del AUDIT utilizando como estándar de comparación el CIDI (DSM-III-R y CIE-10). CONCLUSIONES: La validación del AUDIT mostró que es un instrumento de tamizaje muy útil y sensible para identificar a pacientes con esquizofrenia en riesgo de abuso o dependencia de alcohol, por lo que se recomienda su uso en estudios clínicos y epidemiológicos en Latinoamérica.
OBJECTIVES: To validate the Alcohol Use Disorders Identification Test (AUDIT) in schizophrenic patients. METHODS: The Composite International Diagnostic Interview (CIDI v. 1) and the AUDIT were administered to 80 subjects with schizophrenia, of both sexes, more than 16 years of age, from the outpatient services at the National Institute of Psychiatry in Mexico City. RESULTS: Of the 80 schizophrenic patients, 57 were men and 23 women, with a mean age of 30.5 years and 34.3 years, respectively; the age at schizophrenia onset was 22 years for men, and 26 years for women; 35 subjects (43.7 percent) were consumers of alcohol at the time of the study. The AUDIT scale showed high internal consistency with a Cronbach's alpha of 0.812; for this population, the cutoff point for the full AUDIT scale was 4 points or more; cutoff points for the AUDIT "rapid test" and the "psychosocial issues and probable alcohol dependence" were based on benchmarking against the CIDI (DSM-IIIR and ICD-10). CONCLUSIONS: The AUDIT validation showed it to be a useful and sensitive screening tool for identifying schizophrenic patients at risk for alcohol abuse and dependence; therefore, it is recommended for use in clinical and epidemiological studies in Latin America.
Assuntos
Adulto , Feminino , Humanos , Masculino , Transtornos Induzidos por Álcool/complicações , Transtornos Induzidos por Álcool/epidemiologia , Inquéritos e Questionários , Esquizofrenia/complicaçõesRESUMO
Introduction Since three years from now, in Mexico there has been several surveys and specific research regarding drug use. Over these years the national surveillance systems databases (SISVEA, CIJ) have shown that cocaine use has stabilized and marijuana use is still increasing, although there are some regional differences. Also, the results of the 2003 Mexico City Students' Survey revealed a similar inclination: an increase on marijuana use, a slight diminish on cocaine use and as a new stage: a rebound on inhalant use. However, these changes and trends on drug use are not the same all over the country. The results found in these databases suggest that the northern border behaves differently from the rest of the country, even all along the northern border itself. While drug use in Matamoros is lower than in other border cities, Nuevo Laredo, Reynosa and Ciudad Juarez registered high cocaine and heroin use. On the other hand, even though the border cities of Sonora and Baja California have these same drug use problems, they also show high rates of methamphetamine use. Another important issue on border cities is that Ciudad Juarez has reached Tijuana's use levels, mainly among teens between 12 and 1 7 years old. These two cities have the highest substance use levels in the country, even above Mexico City. On the central region of the country, the drug use rates are halfway between. Even though Mexico City's drug use levels are among the central region and the two border cities mentioned before, in all the states that have been studied, there's been a general significant increase in drug use. In southern states, especially Yucatan (where there's a household and a students' survey), the drug rates are the lowest in the country. However, the women's drug use rates keeps increasing. Specifically the 2003 students' survey showed that in some Mexico City's counties women have higher alcohol and tobacco prevalence, and their illegal drug use trends begin to be alike to men's illegal drug use trends. Objective To present drug use prevalence results from the 2006 Mexico City Students Survey. Material and methods This survey used a 10523 Mexico City students random sample. The sample design was stratified (by county), with two stages (by school) and clustered (by groups). This data is representative by State County and by educational level. The design is comparable with previous student's surveys made by the National Psychiatric Institute (INP) and the Mexican Board of Education (SEP). The marijuana, cocaine and inhalants variation coefficients (VC) were determined according to the 2003 survey. The variable with the highest VC, a non-response rate and a design effect of two were considered as in previous surveys. With all these parameters, it was considered a 15% non-response rate, the same found in previous studies. The sample's accuracy level was 95%, with an absolute error average of 0.004. The questionnaire was made with drug use indicators that the World Health Organization used in their own surveys. Besides, some youth behaviors were explored: suicide attempt, depression, eating risk behaviors, sexual behavior, etc. Results From this sample 49.9% were women and 50.5% male. As for Tobacco <
Introducción Desde hace tres años se han hecho varias encuestas sobre consumo de drogas en nuestro país, además de investigaciones específicas sobre el tema. En estos últimos tres años diversos sistemas de información del país (SISVEA, CIJ) han mostrado que el consumo de cocaína se ha estabilizado y que el consumo de mariguana sigue en aumento, aunque estos aspectos presentan variaciones a nivel regional. Asimismo, en los datos de la encuesta de estudiantes de la Ciudad de México del 2003, se encontró una situación similar, hubo un incremento en el consumo de mariguana, un ligero decremento en el consumo de cocaína y, como nueva situación, un repunte en el consumo de inhalables. Por supuesto que los cambios y comportamientos no son iguales en todo el país. Por otra parte, se ha observado que las mujeres han incrementado su consumo de drogas de manera específica. Por ejemplo, el reporte de la encuesta del 2003 muestra que en los casos del alcohol y del tabaco, en algunas delegaciones de la Ciudad de México hay una mayor prevalencia de mujeres que consumen estas sustancias y hay indicios de que en el consumo de algunas drogas ilegales las prevalencias del consumo son similares a las de los hombres. Objetivo El objetivo de este estudio fue el de presentar los resultados de la Encuesta del 2006 sobre las prevalencias del uso de drogas entre la comunidad escolar en la Ciudad de México. Material y métodos El estudio se realizó con una muestra aleatoria de 10 523 estudiantes de todo el Distrito Federal. Los datos de este estudio son representativos por delegación y por nivel educativo, y el diseño es comparable al de estudios anteriores realizados en escuelas por el Instituto Nacional de Psiquiatría Ramón de la Fuentes Muñiz y la Secretaría de Educación Pública. El cuestionario se conformó con los indicadores de consumo de drogas que se han utilizado en este tipo de estudios que corresponden a los empleados por la OMS. Además, se exploraron diversas conductas de los adolescentes, como el intento suicida, su nivel de depresión y sus conductas alimentarias de riesgo, así como diversos aspectos de su conducta sexual. Resultados Del total de la muestra el 49.5% fueron mujeres y el 50.5% fueron hombres. En los resultados se encontró que el consumo de tabaco alguna vez en la vida ha afectado de modo similar tanto a hombres como a mujeres y fue similar a lo encontrado en el 2003. Por otro lado, se encontró que el 68.8% de los/as adolescentes ha usado alcohol alguna vez en su vida y un 41.3% lo ha consumido en el último mes; resultando igualmente afectados tanto los hombres como las mujeres. La prevalencia total de consumo de drogas fue del 1 7.8%, porcentaje estadísticamente mayor al del 2003 en un 2.6%. Los hombres estuvieron dentro del subgrupo más afectado por el consumo actual en comparación con las mujeres. De acuerdo al nivel educativo de los participantes, el consumo de sustancias fue casi del doble para los/as adolescentes de escuelas de bachillerato, como para los de bachillerato técnico, en comparación con los/as de secundaria. En cuanto a las drogas ilegales, en el consumo durante el último año, una proporción menor de mujeres ha experimentado con drogas -en ellas se ha observado, en los últimos tres años, un incremento importante en el consumo de inhalables y mariguana- en tanto que el consumo de cocaína se ha mantenido estable. Por lo que respecta a cada sustancia, la mariguana ocupa el primer lugar de preferencia entre los/as adolescentes, le sigue el consumo de inhalables, los tranquilizantes en tercer lugar y la cocaína en cuarto. Conclusiones El estudio mostró un incremento importante en el consumo de drogas en los últimos tres años: del 15.2% ha pasado a 17.8%. Además, dentro del uso de cada sustancia se observan situaciones distintas. Por un lado, el incremento del uso de la mariguana y de los inhalables es grande, mientras que en los tranquilizantes el consumo se mantiene estable y el de la cocaína ha disminuido. Al analizar estos resultados según el sexo, se encontró que los niveles de consumo de drogas ilegales (mariguana e inhalables principalmente), en las mujeres, han aumentado y la cocaína se ha mantenido estable: en tanto que en los hombres también se han incrementado las dos primeras sustancias, pero el consumo de cocaína ha disminuido. Por lo que respecta a las drogas legales, la dinámica se mantiene similar. Por un lado, el consumo de alcohol se ha incrementado en tanto que el consumo de tabaco se mantiene similar al del 2003. Las delegaciones más afectadas por el consumo de drogas son Azcapotzalco, Cuauhtémoc, Benito Juárez, Coyoacán y Tlalpan, las cuales han desplazado a Gustavo A. Madero, Venustiano Carranza, Iztacalco y Miguel Hidalgo. En el caso del abuso del alcohol, también han cambiado las delegaciones más afectadas, actualmente son Miguel Hidalgo, Cuauhtémoc, Benito Juárez, Cuajimalpa y Tlalpan. Al analizar la relación del consumo de drogas con otras conductas problemáticas se observa que los y las usuarias de drogas, han presentado de dos a tres veces más sintomatología depresiva, intento suicida, conductas antisociales, así como un posible trastorno por déficit de atención.
RESUMO
The World Health Organization (WHO) estimates that by the year 2020 tobacco addiction will be responsible for 10 million deaths, seventy percent of which will occur in underdeveloped countries. On the other hand, depression affects about 121 million people worldwide, and is projected to reach a second place in the ranking of Disability Adjusted Life Years (DALYs) calculated for all ages and both sexes by the year 2020. In Mexico, 14 million people are current smokers and 9.6 million are former smokers, according to the 2002 National Addictions Survey, and almost four million people are diagnosed with depression. Both disorders are classified among the main causes of mortality and disability in Mexico. By gender, major depression in females is the second most prevalent disorder. Two percent of the Mexican population (two million people) present at least one major depressive episode before reaching the age of 18. Several studies have found an important link between depression and smoking. More recently, it was reported that the manifestation of depressive symptomatology predicts smoking addiction. Although the strong association between affective disorders and drug abuse has been documented, they are generally treated independently. For this reason, the need for integral management of comorbid diseases has been highlighted. Little is known about specific populations of patients that simultaneously manifest both disorders, and more knowledge is needed in order to design precise integral treatments for this kind of patients, taking into consideration the gender, severity of depression and level of nicotine dependence. The aim of this study was to describe the association between depressive symptoms, sociodemographic characteristics, and pattern of tobacco consumption of heavy smokers with minimal-mild depressive symptomatology in order to adjust for these relations in a later longitudinal regression analysis after these subjects have been assigned to different conditions of a new integral treatment to quit smoking. A total of 89 heavy smokers were assessed; 74 of them (83%) had minimal-mild depressive symptomatology; there were 35 females and 39 males, with an average age of 44.3 yrs. Level of tobacco addiction was determined by the Fagerström Test for Nicotine Dependence, and the Beck Depression Inventory was used to assess depressive symptomatology. By means of regression models, we found an increase of the depressive symptomatology related to the severity of tobacco addiction (p= .025). Those with a bachelor's educational level, had less depressive symptomatology (p= .025). The high frequency of depressive symptomatology and the protective factor of schooling concur with findings reported in other studies. The better understanding of the characteristics of smokers with different levels of tobacco consumption and depressive symptomatology is suggested. It is important to gain knowledge on the particular characteristics of specific groups of smokers for the development of new treatments that can simultaneously treat smoking addiction and depression, and can also help to norm criteria for their treatment.
La Organización Mundial de la Salud (OMS) estima que para el año 2020 la adicción al tabaco será responsable de 10 millones de muertes, 70% de las cuales ocurrirá en los países subdesarrollados. La mitad de los fumadores actuales, aproximadamente 650 millones de personas, morirá debido a una causa relacionada con el consumo de tabaco. Por otro lado, actualmente la depresión afecta a cerca de 121 millones de personas en el mundo, y se ha proyectado que para el año 2020 ocupará el segundo lugar en Años de Vida Ajustados por Discapacidad (AVAD) en todos los grupos de edad y en ambos sexos. En México, 14 millones de personas son fumadores actuales y 9.6 millones son ex fumadores, según la Encuesta Nacional de Adicciones (ENA) 2002, y casi cuatro millones de personas padecen depresión. Ambos trastornos se clasifican entre las principales causas de morbimortalidad en nuestro país. En cuanto a las diferencias por sexo, en las mujeres, la depresión es el segundo trastorno más frecuente. El dos por ciento de la población mexicana (dos millones de personas) ha padecido por lo menos un episodio de depresión importante antes de alcanzar la edad de 18 años. Varios estudios han encontrado una asociación importante entre la depresión y el tabaquismo. Recientemente se reportó que la manifestación de la sintomatología depresiva predice la adicción al tabaco. De acuerdo con varios estudios, se sabe que la nicotina reduce la incidencia y la gravedad de los síntomas depresivos y que la abstinencia del tabaco puede desencadenar síntomas depresivos, por lo que se ha sugerido que las personas con depresión fuman a manera de automedicación contra la sintomatología depresiva. A pesar de que ha sido documentada la fuerte asociación entre los trastornos afectivos y las adicciones, estos trastornos se atienden generalmente de manera independiente. Por esta razón, se ha subrayado la necesidad de generar tratamientos integrales para los trastornos comórbidos. Hasta el momento, se sabe poco sobre poblaciones específicas de pacientes que de manera simultánea son adictos al tabaco y padecen sintomatología depresiva, por lo se requiere de mayor entendimiento de sus características para diseñar tratamientos integrales específicos para este tipo de pacientes. Para ello se debe tomar en consideración el sexo, la gravedad de la depresión y el nivel de dependencia de la nicotina. El objetivo del presente estudio fue describir la relación que existe entre los síntomas depresivos, las características sociodemográficas y el patrón de consumo de tabaco en fumadores fuertes con sintomatología depresiva mínima leve para ajustar dichas relaciones mediante un modelo de regresión longitudinal, en un estudio posterior, donde los pacientes serán asignados a diversas condiciones terapéuticas de un nuevo tratamiento integral contra el tabaquismo. Un total de 89 fumadores fuertes fueron evaluados; 74 de ellos (83%) padecían sintomatología depresiva mínima leve; había 35 mujeres y 39 hombres, con una media de edad de 44.3 años. El nivel de adicción al tabaco fue determinado por la prueba de Fagerström para la dependencia a la nicotina, y se usó el Inventario de Depresión de Beck para determinar el nivel de sintomatología depresiva. Mediante un modelo de regresión, encontramos un aumento de la sintomatología depresiva relacionada con la gravedad de la dependencia al tabaco (p = .025). Aquellos con nivel de enseñanza de licenciatura presentaron menos sintomatología depresiva (p = .025). Los principales resultados de este estudio son la asociación significativa entre el nivel de dependencia al tabaco y la sintomatología depresiva en fumadores fuertes. Tanto la alta incidencia de la sintomatología depresiva como el factor protector de la enseñanza concuerdan con los reportes de otros estudios con fumadores. Es importante conocer las características particulares de grupos específicos de fumadores para desarrollar nuevos tratamientos que pueden tratar simultáneamente la adicción al tabaco y la depresión, así como para ayudar a normar criterios para su tratamiento. Se sugiere continuar ahondando en el conocimiento de las características de los fumadores con diversos niveles de consumo de tabaco y sintomatología depresiva.
RESUMO
Drug use in Mexico has been on the rise since the 1970s. Nonetheless, this problem has exhibited important variations in the different regions of Mexico. To document these trends, the National Institute of Psychiatry Ramón de la Fuente (INP) has performed household surveys on addictions in different Mexican cities. In the 1970s and early 1980s surveys were conducted in the following cities: Mexico City, La Paz, Baja California Sur; Mexicali, Baja California Norte; Monterrey, Nuevo León; San Luis Potosí, San Luis Potosí; and Puebla, Puebla, among others. The first national survey in urban population was carried out in 1 988, and was repeated in 1993 and 1998, while the first national survey to included rural population was conducted in 2002, which is being followed by another study currently in the field. The student population has also been extensively studied, and has been included in three national drug surveys and studies performed in different entities. Antecedents Results from these surveys show that drug use has not increased in a uniform fashion throughout the Mexican Republic and both student and household surveys have demonstrated higher rates in the northwestern region of the country comprising the states of Baja California, Sonora and Chihuahua, which have exhibited above-average drug use on comparison with the remaining regions of the country. The most frequently consumed drug by the population is marihuana. The 1988 national household survey registered a rising prevalence in use of 2.9% in Mexican population aged 12-65 years of individuals who had used drugs at some time during their lifetime; in 1993 this prevalence increased to 3.32% and in 1998 to 4.70%; while in 2002 the percentage demonstrated a slight decrease to 3.48%. In 1988, the second place in drug preferences of the population was inhalants with a prevalence of drug use at some time during their lifetime of 0.76%; by 1993, the second place was occupied by cocaine. Prevalence of use of the latter was 0.33% in 1988; by 1993, cocaine increased to 0.56% and to 1.45% in 1998, presenting a slight decrease in use in 2002 (1.23%). From 1988-2002 non-prescribed medical drugs consumed were found in the third place in population preference. Objective This article compared drug use rates observed in three cities on or near Mexico's northern border with the U. S.: Ciudad Juarez, Chihuahua; Tijuana, Baja California Norte, and Monterrey, Nuevo León, were studied as part of the 1 998 national survey on addictions by selecting independent representative samples of these localities and with a new survey of these entities in 2005. Method The 1998 national survey of addictions was carried out in a representative sample of Mexican urban population (in localities of 2500 inhabitants). Independent samples were drawn from inhabitants living in several cities throughout Mexico. In this article we report the drug-use trends for three of these cities (Ciudad Juarez, Monterrey and Tijuana) by comparing the rates observed in 1998 with the results of a new wave of household surveys conducted in 2005 in the same cities using comparable methodology. Samples in both periods included population 12-65 years of age residing in households. Sample design was stratified by means of the following: several stages with localities (Áreas Geoestadísticas Básicas, AGEBS, its acronym in Spanish, census tracts); blocks of houses within the selected localities; segments of houses within sample blocks, and one individual per household as the selection unit in each stage. Sample size in Tijuana was 466 and 553 in 1998 and 2005, respectively, while sample sizes for Ciudad Juarez were 472 in 1998 and 606 in 2005, and for Monterrey this was 637 in 1998 and 675 in 2005, and the non-response rate was 23% in 1 998 and 20.3% in 2005. Instruments for obtaining information employed in both time frames considered were similar. Two types of questionnaires were administered: a household questionnaire that included sociodemographic information on all household inhabitants in the sample and their housing conditions and an standardized individual questionnaire administered in a face-to-face interview that collected information on the following: prevalence and use patterns of tobacco, alcohol, five types of illegal drugs (marihuana, cocaine, heroin, hallucinogens, amphetamine-type stimulants and other drugs); four types of medical pharmaceuticals utilized without a prescription (narcotics, stimulants, tranquilizers and sedatives), determining consequences and services utilization. In this article tobacco and alcohol use is not reported. This questionnaire has been extensively tested and used in previous surveys. Interviewers were persons academically prepared in the Social Sciences and trained in the logistics of the several survey stages and extensively supervised during field work. Results Highest rates of use were observed in Tijuana and Ciudad Juarez in contrast with Monterrey, which had lower rates. When use of any drug was considered, an increase in lifetime use from 1998-2005 was observed in all three cities; when use during the past year was contemplated, an increase was observed from 1998-2005 from 2.8-4.8% in the case of Ciudad Juarez and in Monterrey from 1.3%-2.0%, while these rates for Tijuana decreased from 5.4%-4.01%. Reports of use during the previous month fell in Tijuana from 4.4%-2.81 % and in Monterrey this decreased from 1.1 %-0.71 %, while in Ciudad Juarez drug use rates during the previous month increased from 2.4%-3.24%. It is important to mention that there was no statistical significance in any of the different prevalences types. Lifetime use of medical drugs without prescription increased in Tijuana and in Monterrey, while in Ciudad Juarez this remained stable from 1998-2005. In 2005, use of medical drugs decreased in Ciudad Juarez from 1.2%-0.88% and in Tijuana from 1.3%-1 .28%, while in Monterrey no use was detected in 1998, but 0.48% of interviewees did reported drug use in 2005. Previous-month use increased in Tijuana from 0.7%-1 .28% and in Monterrey this ranged from no use in 1998 to 0.48% by contrast in Ciudad Juarez previous-month drug use fell from 1.2-0.88%. In referring only to use of any illegal drug (excluding medical pharmaceutical), lifetime use increased in all three cities from 1998-2005; lifetime use doubled in Monterrey and Ciudad Juarez, while use during the previous year decreased in Tijuana from 4.4%-3.25% and increased in Ciudad Juarez from 1.6%-3.98% and in Monterrey from 1.3%-1 .52%. Prior-month increased in Ciudad Juarez from 1.2%-2.42%, while this exhibited a decrease in Tijuana from 3.9%-2.05% and in Monterrey from 1.1%-0.23%. Data also indicate that a high proportion of individuals in Monterrey have used only one drug; these percentages rose in the 1998-2005 period from 3.7%-8.96% numbers of the poly-drug users doubled in Tijuana from 4%-8.44% and in Ciudad Juarez from 3.2%-7.43%; in Tijuana this was due to an increase among males, and in Ciudad Juarez the number of poly-drug users increased in both genders.
El consumo de drogas en México ha ido en aumento. En la década de 1970, el Instituto Nacional de Psiquiatría realizó las primeras encuestas de hogares sobre el tema de las adicciones en población de distintas ciudades del país: la Ciudad de México, La Paz, B.C.S.; Mexicali, B.C.; Monterrey, N.L.; San Luis Potosí, S.L.P., y Puebla, Pue, entre otras y ha documentado las tendencias del problema y sus variaciones regionales. A nivel nacional se han realizado en hogares cuatro encuestas en 1988, en 1993, en 1998 y en 2002, denominadas <
