Análisis comparativo del marco legal en salud mental y suicidio en México / Comparative analysis of the legal framework on mental health and suicide in Mexico

Resumen: Objetivo: Analizar el marco legislativo y normativo en salud mental y suicidio en México. Material y métodos: Se realizó un análisis secundario de los principales ordenamientos jurídicos en materia de salud mental y suicidio, vigentes hasta septiembre de 2020, de las 32 entidades de México y del nivel federal. Resultados: Se analizaron 51 documentos. Sólo 14 entidades cuentan con una Ley de Salud Mental y dos estados tienen una Ley de Suicidio. A nivel federal, se definen los lineamientos de atención de la conducta suicida en las normas técnicas de la Secretaría de Salud. Sin embargo, en las leyes de salud, nacional o estatales, han existido omisiones al respecto. La prevención no se define a profundidad en la mayoría de los documentos analizados. Conclusiones: Es prioritario impulsar leyes integrales de salud mental y conducta suicida armonizadas en el ámbito nacional.

Abstract: Objective: Analyze the legislative and normative framework on mental health and suicide in Mexico. Materials and methods: A secondary analysis of the main legal systems on mental health and suicide, in force until September 2020, of the 32 entities in Mexico and at the federal level was carried out. Results: 51 documents were analyzed. Only 14 states have a mental health law and two states have a law on suicide. At the federal level, the guidelines for the care of suicidal behavior are defined in the technical standards issued by the health ministry. However, in both state and national health laws, there has been omissions in this regard. Prevention is not defined in depth in most of the documents analyzed. Conclusions: It is a priority to promote comprehensive laws on mental health and suicidal behavior harmonized at the national level.

[Comparative analysis of the legal framework on mental health and suicide in Mexico]. / Análisis comparativo del marco legal en salud mental y suicidio en México.

OBJECTIVE: Analyze the legislative and normative framework on mental health and suicide in Mexico. MATERIALS AND METHODS: A secondary analysis of the main legal systems on mental health and suicide, in force until September 2020, of the 32 entities in Mexico and at the federal level was carried out. RESULTS: 51 documents were analyzed. Only 14 states have a mental health law and two states have a law on suicide. At the federal level, the guidelines for the care of suicidal behavior are defined in the technical standards issued by the Health Ministry. However, in both state and national health laws, there have been omissions in this regard. Prevention is not defined in depth in most of the documents analyzed. CONCLUSIONS: It is a priority to promote comprehensive laws on mental health and suicidal behavior harmonized at the national level.

Obstetric violence criminalised in Mexico: a comparative analysis of hospital complaints filed with the Medical Arbitration Commission.

INTRODUCTION: Disrespect and abuse during childbirth have been reported by numerous countries around the world. One of their principal manifestations is the performance of invasive or surgical procedures without the informed consent of women. Non-dignified treatment is the second most common form of this conduct. Five Mexican states have classified obstetric violence as a crime: Aguascalientes, Chiapas, Guerrero, the State of Mexico and Veracruz. The others have not yet done so although it is provided for in their civil and administrative regulations. OBJECTIVE: To analyse whether criminalising obstetric violence has been conducive to the recognition and observance of the reproductive rights of women, based on the records of poor health care complaints filed by women with the Medical Arbitration Commissions (CAMs by their Spanish initials) in two Mexican states. MATERIALS AND METHODS: We conducted an observational qualitative study using a phenomenological approach. Analysis included two states with similar partner demographic and maternal health indicators but different legal classifications of obstetric violence: the Chiapas has criminalized this form of violence while Oaxaca has not. We reviewed the records of obstetric care complaints filed with CAMs in both states from 2011 to 2015, all of them concluded and including full information. RESULTS: Differences were observed regarding the contents of complaints, specifically in the categories of abuse, discrimination and neglect during childbirth. The narratives in the other complaint categories were similar between states. CONCLUSION: After analysing the records of malpractice complaints in Chiapas and Oaxaca, we conclude that the differentiated legal status of obstetric violence has not influenced recognition or observance of the reproductive rights of women. Criminalising obstetric violence has not improved care provided by health personnel.

Conductas de riesgo y dinámica familiar del adolescente y la de sus padres / Risk behaviors and family dynamics of adolescents and their parents / Condutas de risco e dinâmica familiar do adolescente e a de seus pais

Resumen Objetivo: determinar la relación de los elementos de la dinámica familiar como comunicación y cohesión con las conductas de riesgo del adolescente y la de sus padres. Materiales y métodos: estudio transversal descriptivo correlacional en una muestra no probabilística por conveniencia de 50 adolescentes con sus respectivos padres, pertenecientes a una telesecundaria de la ciudad de Cosoleacaque, Veracruz durante los meses de octubre y noviembre de 2014. Previo consentimiento informado se aplicó una cédula de datos sociodemográficos y el test de la Organización Panamericana de la Salud "Cómo es Tu familia" y "Cómo es Su Familia", que midió la comunicación padre-hijo y las conductas de riesgo, y la Faces III de Olson que valoró la cohesión padre-hijo. El análisis de la prueba Chi-Cuadrada y coeficiente de Spearman se realizó en el Paquete Estadístico para las Ciencias Sociales. Resultados: la media de edad de los adolescentes fue de 13.3 ± 1.23 años. La cohesión y comunicación de los padres no se asocia con la conducta de riesgo del adolescente (p=0.218>0.05 y p=.981>0.05, respectivamente). La conducta de riesgo del padre sí se asocia con la conducta de riesgo de los adolescentes (p=0.002 <0.05). Conclusión: la dinámica familiar no se asocia con las conductas de riesgo del adolescente, pero sí se asocia con la conducta de riesgo del padre, lo que es importante para el profesional de enfermería en el campo de la promoción de la salud al brindar estrategias familiares que impacten en la conducta de los padres y en su bienestar integral.

Abstract Objective: to determine the relationship of the elements of family dynamics, such as communication and cohesion, with risk behaviors of adolescents and their parents. Materials and Methods: Descriptive, correlative, cross-sectional study in a non-probabilistic sample for the convenience of 50 adolescents with their respective parents belonging to a tele-secondary school in the city of Cosoleacaque, Veracruz, during the months of October and November 2014. Prior informed consent, a sociodemographic data card and the Pan American Health Organization Parentadolescent communication scale "How is your family?" were applied, that measured parent-child communication and risk behaviors. Also, Olson's Faces III scale was applied which assessed parent-child cohesion. The analysis of the Chi-square test and the Spearman coefficient was performed in the Statistical Package for the Social Sciences. Results: the mean age of the adolescents was 13.3 ± 1.23 years. Parental cohesion and communication was not associated with adolescent risk behavior (p = 0.218> 0.05 and p = .981> 0.05, respectively). The risk behavior of the parent was associated with the risk behavior of adolescents (p = 0.002 <0.05). Conclusion: family dynamics was not associated with risk behaviors of adolescents, but it was associated with risk behavior of the parent which is important for the nursing professional in the field of health promotion to provide family strategies that impact on the behavior of parents and on their well-being.

Resumo Objetivo: determinar a relação dos elementos da dinâmica familiar como comunicação e coesão com as condutas de risco do adolescente e a de seus pais. Materiais e métodos: estudo transversal descritivo correlacional em uma amostra não probabilística por conveniência de 50 adolescentes com seus respectivos pais, pertencentes a ensino médio da cidade de Cosoleacaque, Veracruz durante os meses de outubro e novembro de 2014. Prévio consentimento informado se aplicou uma tabela de dados sócio demográficos e o teste da Organização Pan-americana da Saúde "Como é Tua família" e "Como é Sua Família", que mediu a comunicação pai-filho e as condutas de risco, e a Faces III de Olson que valorou a coesão pai-filho. O análise da prova Chi-Quadrada e coeficiente de Spearman se realizou no Pacote Estatístico para as Ciências Sociais. Resultados: a média de idade dos adolescentes foi de 13.3 ± 1.23 anos. A coesão e comunicação dos pais não se associa com a conduta de risco do adolescente (p=0.218>0.05 e p=.981>0.05, respectivamente). A conduta de risco do pai si se associa com a conduta de risco dos adolescentes (p=0.002 <0.05). Conclusão: a dinâmica familiar não se associa com as condutas de risco do adolescente, mas si se associa com a conduta de risco do pai, o que é importante para o profissional de enfermagem no campo da promoção da saúde ao brindar estratégias familiares que impactem na conduta dos pais e em seu bem estar integral.

[Sleep disorders and quality of life in refractory partial epilepsy: results of the SLEEP study]. / Alteraciones del sueño y calidad de vida en la epilepsia parcial refractaria: resultados del estudio SLEEP.

INTRODUCTION: Sleep disorders are frequent among patients with epilepsy and are correlated with a poorer quality of life. AIMS: To evaluate the prevalence of sleep disorders in patients with refractory and non-refractory focal epilepsy, and to explore the influence of these alterations on the quality of life of these patients. PATIENTS AND METHODS: An epidemiological, controlled, cross-sectional study was conducted in 150 outpatient neurology services. Patients who had been treated with two antiepileptic drugs since the onset of the disease (18-55 years) were recruited for the study. RESULTS: The sample included 237 patients with non-refractory focal epilepsy and 264 patients with refractory focal epilepsy. Twenty-two per cent of the non-refractory epilepsy group and 45% of the group with refractory epilepsy (p < 0.0001) suffered from some sleep disorder. The patients with refractory epilepsy had a poorer quality of life (p < 0.001) as measured with the quality of life questionnaire QOLIE-10. A positive significant correlation was observed between quality of life and quality of sleep, in both chronic insomnia (r = 0.65; p < 0.0001) and excessive daytime sleepiness (r = 0.43; p < 0.0001). CONCLUSIONS: Sleep disorders are more frequent in refractory than in non-refractory epilepsy, and affect the patients' quality of life.

TITLE: Alteraciones del sueño y calidad de vida en la epilepsia parcial refractaria: resultados del estudio SLEEP.Introduccion. Las alteraciones del sueño son frecuentes en pacientes con epilepsia y se correlacionan con una peor calidad de vida. Objetivos. Evaluar la prevalencia de las alteraciones del sueño en pacientes con epilepsia focal refractaria y no refractaria y explorar la influencia de estas alteraciones en la calidad de vida de los pacientes. Pacientes y metodos. Estudio epidemiologico, controlado, transversal, realizado en 150 consultas ambulatorias de neurologia. Se reclutaron pacientes que habian sido tratados con dos farmacos antiepilepticos desde el inicio de la enfermedad (18-55 años). Resultados. Se incluyeron 237 pacientes con epilepsia focal no refractaria y 264 pacientes con epilepsia focal refractaria. El 22% del grupo con epilepsia no refractaria y el 45% del grupo con epilepsia refractaria (p < 0,0001) padecian alguna altera­cion del sueño. Los pacientes con epilepsia refractaria tenian peor calidad de vida (p < 0,001) medida con el cuestionario de calidad de vida QOLIE-10. Se observo una correlacion positiva y significativa entre la calidad de vida y la calidad del sue­ño, tanto en el insomnio cronico (r = 0,65; p < 0,0001) como en la somnolencia excesiva diurna (r = 0,43; p < 0,0001). Conclusion. Las alteraciones del sueño son mas frecuentes en la epilepsia refractaria que en la no refractaria, y afectan a la calidad de vida de los pacientes.

Alteraciones del sueño y calidad de vida en la epilepsia parcial refractaria: resultados del estudio SLEEP / Sleep disorders and quality of life in refractory partial epilepsy: results of the SLEEP study

Introducción. Las alteraciones del sueño son frecuentes en pacientes con epilepsia y se correlacionan con una peor calidad de vida. Objetivos. Evaluar la prevalencia de las alteraciones del sueño en pacientes con epilepsia focal refractaria y no refractaria y explorar la influencia de estas alteraciones en la calidad de vida de los pacientes. Pacientes y métodos. Estudio epidemiológico, controlado, transversal, realizado en 150 consultas ambulatorias de neurología. Se reclutaron pacientes que habían sido tratados con dos fármacos antiepilépticos desde el inicio de la enfermedad (18-55 años). Resultados. Se incluyeron 237 pacientes con epilepsia focal no refractaria y 264 pacientes con epilepsia local refractaria. El 22% del grupo con epilepsia no refractaria y el 45% del grupo con epilepsia refractaria (p < 0,0001) padecían alguna alteración del sueño. Los pacientes con epilepsia refractaria tenían peor calidad de vida (p < 0,001) medida con el cuestionario de calidad de vida QOLIE-10. Se observó una correlación positiva y significativa entre la calidad de vida y la calidad del sueño, tanto en el insomnio crónico (r = 0,65; p < 0,0001) como en la somnolencia excesiva diurna (r = 0,43; p < 0,0001). Conclusión. Las alteraciones del sueño son más frecuentes en la epilepsia refractaria que en la no refractaria, y afectan a la calidad de vida de los pacientes (AU)

Introduction. Sleep disorders are frequent among patients with epilepsy and are correlated with a poorer quality of life. Aims. To evaluate the prevalence of sleep disorders in patients with refractory and non-refractory focal epilepsy, and to explore the influence of these alterations on the quality of life of these patients. Patients and methods. An epidemiological, controlled, cross-sectional study was conducted in 150 outpatient neurology services. Patients who had been treated with two antiepileptic drugs since the onset of the disease (18-55 years) were recruited for the study. Results. The sample included 237 patients with non-refractory focal epilepsy and 264 patients with refractory focal epilepsy. Twenty-two per cent of the non-refractory epilepsy group and 45% of the group with refractory epilepsy (p < 0.0001) suffered from some sleep disorder. The patients with refractory epilepsy had a poorer quality of life (p < 0.001) as measured with the quality of life questionnaire QOLIE-10. A positive significant correlation was observed between quality of life and quality of sleep, in both chronic insomnia (r = 0.65; p < 0.0001) and excessive daytime sleepiness (r = 0.43; p < 0.0001). Conclusions. Sleep disorders are more frequent in refractory than in non-refractory epilepsy, and affect the patients’ quality of life (AU)

[Lennox-Gastaut syndrome in Spain: a descriptive retrospective epidemiological study]. / Síndrome de Lennox-Gastaut en España: estudio epidemiológico retrospectivo y descriptivo.

INTRODUCTION: Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic syndromes in childhood. It is characterised by the presence of several types of seizures, a characteristic electroencephalographic trace and its frequent association with mental retardation. There are no accurate data on the epidemiology of LGS in Spain. AIM: To describe the epidemiological profile of LGS in Spain. PATIENTS AND METHODS: We conducted a retrospective epidemiological study of a series of 331 patients with LGS from 50 Spanish hospitals. Patients were considered to be cases of LGS if they had at least two of the three types of seizures that characterise LGS (axial tonic seizures, atypical absences and atonic seizures) and displayed slow diffuse intercritical spike-wave activity (lower than 3 Hz) in the electroencephalogram in wakefulness. RESULTS: The mean age of the patients was 18.2 +/- 13.5 years. Of the total sample, 62% were males and 97% had cognitive retardation. And 54% of cases had a symptomatic aetiology. The most frequent types of seizures were axial tonic (89%), followed by the atypical absent type (84%) and atonic seizures (69%). In all, 99% of patients were treated with polytherapy, the most commonly used drugs being valproic acid, lamotrigine and topiramate. CONCLUSIONS: The results of the study are in line with those from previous analyses carried out in populations with similar characteristics. The high percentage of LGS patients with cognitive retardation in this epileptic encephalopathy results in important family and social repercussions.

Síndrome de Lennox-Gastaut en España: estudio epidemiológico retrospectivo y descriptivo / Lennox-Gastaut syndrome in Spain: a descriptive retrospective epidemiological study

Introducción. El síndrome de Lennox-Gastaut (SLG) es uno de los síndromes epilépticos más graves de la infancia. Se aracteriza por la presencia de varios tipos de crisis, un trazado electroencefalográfico característico y la frecuente asociación de retraso mental. No existen datos precisos sobre la epidemiología del SLG en España. Objetivo. Describir el perfil epidemiológico del SLG en España. Pacientes y métodos. Estudio epidemiológico retrospectivo de una serie de 331 pacientes con SLG procedentes de 50 hospitales españoles. Se consideraron casos de SLG aquellos pacientes que tenían al menos dos de los tres tipos de crisis características del SLG (crisis tónicas axiales, ausencias atípicas y crisis atónicas) junto con actividad intercrítica difusa de punta-onda lenta (< 3 Hz) en el electroencefalograma en vigilia. Resultados. La edad media de los pacientes fue de de 18,2 ± 13,5 años. El 62% eran varones y el 97% tenía retraso cognitivo. El 54% de los casos fue de etiología sintomática. Los tipos de crisis más frecuentes fueron las tónicas axiales (89%), seguidas de las ausencias atípicas (84%) y las crisis atónicas (69%). El 99% de los pacientes fue tratado con politerapia, siendo los fármacos más frecuentemente empleados el ácido valproico, la lamotrigina y el topiramato. Conclusiones. Los resultados del estudio son consistentes con los de estudios previos realizados en poblaciones de características similares. El elevado porcentaje de pacientes con SLG con retraso cognitivo condiciona en esta encefalopatía epiléptica una gran repercusión, tanto familiar como social (AU)

Introduction. Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic syndromes in childhood. It is characterised by the presence of several types of seizures, a characteristic electroencephalographic trace and its frequent association with mental retardation. There are no accurate data on the epidemiology of LGS in Spain. Aim. To describe the epidemiological profile of LGS in Spain. Patients and methods. We conducted a retrospective epidemiological study of a series of 331 patients with LGS from 50 Spanish hospitals. Patients were considered to be cases of LGS if they had at least two of the three types of seizures that characterise LGS (axial tonic seizures, atypical absences and atonic seizures) and displayed slow diffuse intercritical spikewave activity (< 3 Hz) in the electroencephalogram in wakefulness. Results. The mean age of the patients was 18.2 ± 13.5 years. Of the total sample, 62% were males and 97% had cognitive retardation. And 54% of cases had a symptomatic aetiology. The most frequent types of seizures were axial tonic (89%), followed by the atypical absent type (84%) and atonic seizures (69%). In all, 99% of patients were treated with polytherapy, the most commonly used drugs being valproic acid, lamotrigine and topiramate. Conclusions. The results of the study are in line with those from previous analyses carried out in populations with similar characteristics. The high percentage of LGS patients with cognitive retardation in this epileptic encephalopathy results in important family and social repercussions (AU)

Síndrome de Lennox-Gastaut en España: estudio epidemiológico retrospectivo y descriptivo / Lennox-Gastaut syndrome in Spain: a descriptive retrospective epidemiological study

Introducción. El síndrome de Lennox-Gastaut (SLG) es uno de los síndromes epilépticos más graves de la infancia. Se caracteriza por la presencia de varios tipos de crisis, un trazado electroencefalográfico característico y la frecuente asociación de retraso mental. No existen datos precisos sobre la epidemiología del SLG en España. Objetivo. Describir el perfil epidemiológico del SLG en España. Pacientes y métodos. Estudio epidemiológico retrospectivo de una serie de 331 pacientes con SLG procedentes de 50 hospitales españoles. Se consideraron casos de SLG aquellos pacientes que tenían al menos dos de los tres tipos de crisis características del SLG (crisis tónicas axiales, ausencias atípicas y crisis atónicas) junto con actividad intercrítica difusa de punta-onda lenta (< 3 Hz) en el electroencefalograma en vigilia. Resultados. La edad media de los pacientes fue de de 18,2 ± 13,5 años. El 62% eran varones y el 97% tenía retraso cognitivo. El 54% de los casos fue de etiología sintomática. Los tipos de crisis más frecuentes fueron las tónicas axiales (89%), seguidas de las ausencias atípicas (84%) y las crisis atónicas (69%). El 99% de los pacientes fue tratado con politerapia, siendo los fármacos más frecuentemente empleados el ácido valproico, la lamotrigina y el topiramato. Conclusiones. Los resultados del estudio son consistentes con los de estudios previos realizados en poblaciones de características similares. El elevado porcentaje de pacientes con SLG con retraso cognitivo condiciona en esta encefalopatía epiléptica una gran repercusión, tanto familiar como social (AU)

Introduction. Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic syndromes in childhood. It is characterised by the presence of several types of seizures, a characteristic electroencephalographic trace and its frequent association with mental retardation. There are no accurate data on the epidemiology of LGS in Spain. Aim. To describe the epidemiological profile of LGS in Spain. Patients and methods. We conducted a retrospective epidemiological study of a series of 331 patients with LGS from 50 Spanish hospitals. Patients were considered to be cases of LGS if they had at least two of the three types of seizures that characterise LGS (axial tonic seizures, atypical absences and atonic seizures) and displayed slow diffuse intercritical spikewave activity (< 3 Hz) in the electroencephalogram in wakefulness. Results. The mean age of the patients was 18.2 ± 13.5 years. Of the total sample, 62% were males and 97% had cognitive retardation. And 54% of cases had a symptomatic aetiology. The most frequent types of seizures were axial tonic (89%), followed by the atypical absent type (84%) and atonic seizures (69%). In all, 99% of patients were treated with polytherapy, the most commonly used drugs being valproic acid, lamotrigine and topiramate. Conclusions. The results of the study are in line with those from previous analyses carried out in populations with similar characteristics. The high percentage of LGS patients with cognitive retardation in this epileptic encephalopathy results in important family and social repercussions (AU)