Guillermina Natera Rey

Population study of depressive symptoms and risk factors in pregnant and parenting Mexican adolescents

OBJECTIVE To study the prevalence of, severity of, and risk factors for depressive symptoms in a probabilistic sample of Mexican adolescent mothers. METHODS A sample of adolescents aged 13-19 years, drawn from a national survey, was interviewed in relation to severity of depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) 16-23 and CES-D > 24] and pregnancy or parenting status. RESULTS Depressive symptoms (CES-D 16-23) ranged from 2.3% in the first postpartum semester to 32.5% in the second trimester of pregnancy; high depressive symptoms (CES-D > 24) ranged from 3.0% in the second postpartum semester to 24.7% in mothers of an infant more than 1 year old. Significant differences between groups were in mothers in the second gestation trimester, who had significantly more symptoms than those who had never been pregnant and those in the first postpartum semester. In those with high symptomatology, no significant differences were observed between groups. A multinomial logistic regression model used to estimate the likelihood of depression found increased risk of depressive symptoms (CES-D 16-23) in those without a partner in the first, second, or third trimester of pregnancy; in the second postpartum semester; and with a child over the age of 1 year. Increased risk of high symptomatology (CES-D > 24) was found in those not in school or with a child over the age of 1 year. CONCLUSIONS Depressive symptoms entail an enormous burden of disease for the mother and mental health risks to the infant; mothers should therefore be targeted in prevention and intervention actions.

An international perspective: Constructing intervention strategies for families in Mexico

In this article, the authors comment on the contribution of the Alcohol, Drugs and the Family research group to draw public and scientific attention to the suffering and needs of families coping with addiction problems. The article also describes the impact of the stress-strain-coping-support model and the 5-Step Method on the research, intervention and education domains in Mexico. Some of the limitations to positively influence public policy are underscored; these include the nature of the sociocultural context which favors the view of addictions as private problems that must be solved within the family. The experience of delivering the 5-Step Method to Mexican urban population and its adaptation to indigenous communities and web-based format are discussed as well. Overall, the development and implementation of the 5-Step Method in Mexico has been positive, as demonstrated particularly by a cost-effectiveness study carried out with indigenous communities. Based on this review, the scope and challenges for family intervention in Mexico are outlined considering: (1) the dissemination of the 5-Step Method in both the rural and urban contexts; (2) extensive training of family counsellors; and finally (3) policy making to fulfil the needs of families facing addictive problems.

Prevalence of Substance Use Among Patients of Community Health Centers in East Los Angeles and Tijuana

ABSTRACT Background: Given the increased use of psychoactive substances on the United States–Mexico border, a binational study (Tijuana, Mexico–Los Angeles, USA) was conducted to identify the prevalence of substance use in primary care settings. Objectives: To compare the prevalence and characteristics of patients at risk for substance use disorders in Tijuana and East Los Angeles (LA) community clinics with special attention paid to drug use. Methods: This was an observational, cross-sectional, analytical study, comparing substance use screening results from patients in Tijuana and LA. The settings were 2 community clinics in LA and 6 in Tijuana. Participants were 2,507 adult patients in LA and 2,890 in Tijuana eligible for WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) screening during March–October 2013. Patients anonymously self-administered the WHO ASSIST on a tablet PC in the clinic waiting rooms. Results: Of eligible patients, 96.4% completed the ASSIST in Tijuana and 88.7% in LA (mean 1.34 minutes and 4.20 minutes, respectively). The prevalence of patients with moderate-to-high substance use was higher in LA than Tijuana for each substance: drugs 19.4% vs. 5.7%, alcohol 15.2% vs. 6.5%, tobacco 20.4% vs. 16.2%. LA patients born in Mexico had 2x the odds and LA patients born in the United States had 6x the odds of being a moderate-to-high drug user compared to Tijuana patients born in Mexico. Conclusions: Moderate-to-high drug use is higher in LA than in Tijuana but rates are sufficiently high in both to suggest that screening for drug use (along with alcohol and tobacco use) should be integrated into routine primary care of community clinics in both cities.

Validez y confiabilidad de la prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST) en estudiantes universitarios

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization (WHO), has been used successfully in many countries, but there are few studies of its validity and reliability for the Mexican population. The objective of this study was to determine the psychometric properties of the self-administered ASSIST test in university students in Mexico. This was an ex post facto non-experimental study with 1,176 undergraduate students, the majority women (70.1%) aged 18-23 years (89.5%) and single (87.5%). To estimate concurrent validity, factor analysis and tests of reliability and correlation were carried out between the subscale for alcohol and AUDIT, those for tobacco and the Fagerström Test, and those for marijuana and DAST-20. Adequate reliability coefficients were obtained for ASSIST subscales for tobacco (alpha = 0.83), alcohol (alpha = 0.76), and marijuana (alpha = 0.73). Significant correlations were found only with the AUDIT (r = 0.71) and the alcohol subscale. The best balance of sensitivity and specificity of the alcohol subscale (83.8% and 80%, respectively) and the largest area under the ROC curve (81.9%) was found with a cutoff score of 8. The self-administered version of ASSIST is a valid screening instrument to identify at-risk cases due to substance use in this population.

Las necesidades de salud y la respuesta social en una localidad rural: Metáforas y dilemas frente al consumo de alcohol

Background. Harmful alcohol use is identified as a public health problem and the success of the health system response to needs will depend on the programs, the actors who implement them and their degree of acceptability among the recipient population. Objective. To determine the perception of how political, civil, commercial and health system actors meet the health needs derived from harmful alcohol use in a rural area, with the aim of providing information for decision-making in health policies to cope with this problem. Method. Case study with a qualitative approach, conducted in a rural town of Morelos, in which its inhabitants identified the fact that alcohol posed a health problem. Results. Discourse is analyzed by identifying the metaphors used to make sense of this phenomenon and the dilemmas faced. Discussion and conclusion. The authors discuss the differences in the way it is perceived and how they prevent the implementation of actions to prevent and deal with alcohol abuse and sales regulations. They conclude that designing public policies that respond to the health needs in this area requires taking into account the dilemmatic nature of the social thinking of the individuals involved in this response, which goes beyond health service provision, and incorporating social determinants (economic, political and cultural).

Estilos de afrontamiento a la "obsesión mental por beber" (craving) en bebedores en proceso de recuperación

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. span> 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.

¡Ya no sé ni qué hacer!: barreras para la búsqueda de atención de las necesidades derivadas del consumo de alcohol

Backgroudn This paper analyzes the main barriers to seeking health care and the regulation of alcohol abusers and their relatives in a rural community. Objective Was to analyze the metaphors and dilemmas of alcohol consumers and their families regarding their health needs, seeking care, the implementation of regulation and the obstacles they face in a rural community in Mexico.Background. This paper analyzes the main barriers to seeking health care and the regulation of alcohol abusers and their relatives in a rural community. Objective. Was to analyze the metaphors and dilemmas of alcohol consumers and their families regarding their health needs, seeking care, the implementation of regulation and the obstacles they face in a rural community in Mexico. Method. This is a qualitative case study, involving ethnography, focus groups and semi-structured interviews. Results. How that people view alcohol abuse as a problem until an addiction occurs and are torn between regarding it as a “vice” or a disease. Seeking care is hampered by tolerance towards consumption, ignorance of how to proceed, fear of “gossip” in a context of weak regulation and treatment options, where consumption is socio-culturally encouraged. Discussion and conclusion. That the meanings and dilemmas faced by actors in the search for health care and the regulation of alcohol sales constitute barriers to which the health system must respond in an integral fashion.

I just don't know what to do! Barriers to seeking treatment for needs arising from alcohol consumption

Backgroudn This paper analyzes the main barriers to seeking health care and the regulation of alcohol abusers and their relatives in a rural community. Objective Was to analyze the metaphors and dilemmas of alcohol consumers and their families regarding their health needs, seeking care, the implementation of regulation and the obstacles they face in a rural community in Mexico.Background. This paper analyzes the main barriers to seeking health care and the regulation of alcohol abusers and their relatives in a rural community. Objective. Was to analyze the metaphors and dilemmas of alcohol consumers and their families regarding their health needs, seeking care, the implementation of regulation and the obstacles they face in a rural community in Mexico. Method. This is a qualitative case study, involving ethnography, focus groups and semi-structured interviews. Results. How that people view alcohol abuse as a problem until an addiction occurs and are torn between regarding it as a “vice” or a disease. Seeking care is hampered by tolerance towards consumption, ignorance of how to proceed, fear of “gossip” in a context of weak regulation and treatment options, where consumption is socio-culturally encouraged. Discussion and conclusion. That the meanings and dilemmas faced by actors in the search for health care and the regulation of alcohol sales constitute barriers to which the health system must respond in an integral fashion.

I do not know what to do! Barriers to seeking care for needs arising from alcohol consumption

Backgroudn This paper analyzes the main barriers to seeking health care and the regulation of alcohol abusers and their relatives in a rural community. Objective Was to analyze the metaphors and dilemmas of alcohol consumers and their families regarding their health needs, seeking care, the implementation of regulation and the obstacles they face in a rural community in Mexico.Background. This paper analyzes the main barriers to seeking health care and the regulation of alcohol abusers and their relatives in a rural community. Objective. Was to analyze the metaphors and dilemmas of alcohol consumers and their families regarding their health needs, seeking care, the implementation of regulation and the obstacles they face in a rural community in Mexico. Method. This is a qualitative case study, involving ethnography, focus groups and semi-structured interviews. Results. How that people view alcohol abuse as a problem until an addiction occurs and are torn between regarding it as a “vice” or a disease. Seeking care is hampered by tolerance towards consumption, ignorance of how to proceed, fear of “gossip” in a context of weak regulation and treatment options, where consumption is socio-culturally encouraged. Discussion and conclusion. That the meanings and dilemmas faced by actors in the search for health care and the regulation of alcohol sales constitute barriers to which the health system must respond in an integral fashion.