Inés V. Bustamante

Improving mental and neurological health research in Latin America: a qualitative study

BackgroundResearch evidence is essential to inform policies, interventions and programs, and yet research activities in mental and neurological (MN) health have been largely neglected, particularly in low- and middle-income countries. Many challenges have been identified in the production and utilization of research evidence in Latin American countries, and more work is needed to overcome this disadvantageous situation. This study aims to address the situation by identifying initiatives that could improve MN health research activities and implementation of their results in the Latin American region.MethodsThirty-four MN health actors from 13 Latin American countries were interviewed as part of an initiative by the Global Forum for Health Research and the World Health Organization to explore the status of MN health research in low- and middle-income countries in Africa, Asia and Latin-America.ResultsA variety of recommendations to increase MN health research activities and implementation of their results emerged in the interviews. These included increasing skilled human resources in MN health interventions and research, fostering greater participation of stakeholders in the generation of research topics and projects, and engendering the interest of national and international institutions in important MN health issues and research methodologies. In the view of most participants, government agencies should strive to have research results inform the decision-making process in which they are involved. Thus these agencies would play a key role in facilitating and funding research. Participants also pointed to the importance of academic recognition and financial rewards in attracting professionals to primary and translational research in MN health. In addition, they suggested that institutions should create intramural resources to provide researchers with technical support in designing, carrying out and disseminating research, including resources to improve scientific writing skills.ConclusionFulfillment of these recommendations would increase research production in MN health in Latin American countries. This, in turn, will raise the profile of these health problems, and consequently will underscore the need of continued high-quality and relevant research, thus fostering a virtuous cycle in the decision-making process to improve MN health care.

University students' perceived norms of peers and drug use: a multicentric study in five Latin American countries

Este estudo transversal comparou a percepcao dos companheiros de usuarios de drogas em uma amostra de estudantes universitarios da America Latina. Os estudantes de nove universidades, localizadas em cinco paises (Brasil, Chile, Colombia, Honduras e Peru) responderam questionario que abordou questoes sobre o tagagismo, alcool, maconha e cocaina. A analise foi focalizada na comparacao da percepcao e da realidade dos atuais usuarios de drogas. Os resultados confirmaram, de forma geral, a ideia de que os estudantes superestimam o uso de drogas. Resultados inesperados foram identificados em relacao ao uso de alcool. Enquanto os estudantes geralmente superestimam o uso de tabaco, maconha e cocaina, entre seus pares, estimaram com bastante precisao ou subestimaram o uso de alcool entre seus pares. Apesar desse resultado inesperado, este estudo mostra que a percepcao do uso de drogas entre estudantes universitarios da America Latina se comporta de maneira similar ao uso de drogas em outras localidades. Os resultados tambem apoiam a sugestao de que intervencoes, usando retroalimentacao normativa, seriam uteis para fortalecer os programas de prevencao ao uso de drogas, dirigidos aos jovens da America Latina.This cross-sectional study compared perceived peer drug use and actual drug use in a sample of Latin American university students. Students from nine universities in five countries (Brazil, Chile, Colombia, Honduras and Peru) completed a questionnaire that addressed the use of tobacco, alcohol, marijuana and cocaine. Analysis focused on comparing perceptions to actual drug use. The findings largely, but not completely, confirmed the idea that students overestimate peer drug use. The unexpected findings were those relating to alcohol. While students generally overestimated peer use of tobacco, marijuana and cocaine, they accurately estimated or underestimated peer use of alcohol. Apart from the anomalous findings with regard to alcohol, this study shows that perceived drug use relates to actual drug use in Latin America as it does elsewhere. The results also support the suggestion that interventions using normative feedback would be useful to strengthen drug use prevention programs aimed at youth in Latin America.

Factores predictores de uso problemático de alcohol en personas atendidas en una sala de emergencia

RESUMEN Objetivos. Valorar el efecto predictivo de caracteristicas claves de pacientes atendidos en salas de emergencia para detectar casos de uso problematico de alcohol. Materiales y Metodos. La muestra de estudio estuvo constituida por 371 personas atendidas en el lapso de siete dias completos de enero de 2005 en el servicio de emergencia de un hospital publico de Lima, Peru. Se aplico un cuestionario demografico, el SIDUC/CICAD para uso reciente de sustancias psicoactivas en salas de emergencias (i.e., uso dentro de las seis horas previas a la atencion) y el AUDIT para uso problematico de alcohol en el ultimo ano. El analisis de regresion logistica simple y multivariada permitio valorar el efecto predictor de la edad, sexo, especialidad del servicio de atencion, presencia de dano fisico y el uso reciente de alcohol para detectar casos problematicos de su uso. Resultados. El odds de tener uso problematico de alcohol en los varones es 26 veces el odds de tener dicho problema entre las mujeres (p<0,001). El analisis estratificado por sexo y ajustado por edad y especialidad del servicio de emergencia, mostro que para los varones el uso reciente de alcohol estuvo fuertemente asociado con presentar uso problematico (OR=5,2; IC al 95%: 2,4-11,5; p<0,001), mientras que para las mujeres no se encontro dicha asociacion. Conclusiones. Se debe tamizar uso problematico de alcohol en aquellos varones con uso reciente de alcohol atendidos en salas de emergencia, para poder identificarlos y darles la oportunidad de recibir consejeria o un manejo medico adecuado.

Perceived norms among peruvian students for drug use among peers

El objetivo de este estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por sus pares y el uso real de drogas entre universitarios, entre 18 y 24 anos, de las areas de salud. Se trata de un estudio transversal, basado en un censo y en un cuestionario anonimo y autoaplicado. Participaron 306 estudiantes (82%). La proporcion del consumo, en el ultimo ano, fue de 51,3% para el tabaco, 90,8% para el alcohol, 5,9% para la marihuana y 0,7% para la cocaina. Se observo una diferencia entre la norma percibida de consumo y la proporcion de uso real informado para el tabaco (70% vs. 51.3%), marihuana (10% vs. 5.9%) y cocaina (8.3% vs. 0.7%). Se concluye que los universitarios sobrestiman el consumo de tabaco, marihuana y cocaina de sus pares.O objetivo deste estudo foi avaliar a diferenca entre as normas percebidas pelos estudantes universitarios, com idade entre 18 e 24 anos, sobre o uso de drogas pelos seus pares e o uso de drogas relatado pelos proprios estudantes em cursos da area da saude. Foi usado o metodo transversal, baseado em censo realizado atraves de questionario, preenchido pelos proprios estudantes, sem identificacao. O numero de participantes foi de 306 (82%). Como resultados obteve-se: a proporcao de estudantes que utilizou drogas no ultimo ano foi de 51,3% para o tabaco, 90,8% para o alcool, 5,9% para a maconha e 0,7% para a cocaina. Diferenca entre as normas percebidas e o uso de drogas foi observada para o tabaco (70% vs 51,3%), maconha (10% vs 5.9%) e cocaina (8,3% vs 0,7%). Conclui-se que os estudantes universitarios apresentaram estimativa aumentada sobre o consumo de tabaco, maconha e cocaina entre seus pares.OBJECTIVE to evaluate the difference between perceived norms about drug use among peer and actual drug use as reported by the same university students. The students were between 18 and 24 years old and attended health courses. METHOD cross-sectional study based on a survey, using an anonymous questionnaire filled out by the students. RESULTS There were 306 participants. Senior students used drugs as follows: 51.3% used tobacco, 90.8% used alcohol, 5.9% used marijuana, and 0.7% used cocaine. Differences were observed between perceived norms and actual drug use for tobacco (70% vs. 51.3%), marijuana (10% vs. 5.9%) and cocaine (8.3% vs. 0.7%). CONCLUSIONS university students presented an overestimated rate for the use of tobacco, marijuana and cocaine among their peers.

Normas percibidas por estudiantes peruanos acerca de sus pares y el uso de drogas

El objetivo de este estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por sus pares y el uso real de drogas entre universitarios, entre 18 y 24 anos, de las areas de salud. Se trata de un estudio transversal, basado en un censo y en un cuestionario anonimo y autoaplicado. Participaron 306 estudiantes (82%). La proporcion del consumo, en el ultimo ano, fue de 51,3% para el tabaco, 90,8% para el alcohol, 5,9% para la marihuana y 0,7% para la cocaina. Se observo una diferencia entre la norma percibida de consumo y la proporcion de uso real informado para el tabaco (70% vs. 51.3%), marihuana (10% vs. 5.9%) y cocaina (8.3% vs. 0.7%). Se concluye que los universitarios sobrestiman el consumo de tabaco, marihuana y cocaina de sus pares.O objetivo deste estudo foi avaliar a diferenca entre as normas percebidas pelos estudantes universitarios, com idade entre 18 e 24 anos, sobre o uso de drogas pelos seus pares e o uso de drogas relatado pelos proprios estudantes em cursos da area da saude. Foi usado o metodo transversal, baseado em censo realizado atraves de questionario, preenchido pelos proprios estudantes, sem identificacao. O numero de participantes foi de 306 (82%). Como resultados obteve-se: a proporcao de estudantes que utilizou drogas no ultimo ano foi de 51,3% para o tabaco, 90,8% para o alcool, 5,9% para a maconha e 0,7% para a cocaina. Diferenca entre as normas percebidas e o uso de drogas foi observada para o tabaco (70% vs 51,3%), maconha (10% vs 5.9%) e cocaina (8,3% vs 0,7%). Conclui-se que os estudantes universitarios apresentaram estimativa aumentada sobre o consumo de tabaco, maconha e cocaina entre seus pares.OBJECTIVE to evaluate the difference between perceived norms about drug use among peer and actual drug use as reported by the same university students. The students were between 18 and 24 years old and attended health courses. METHOD cross-sectional study based on a survey, using an anonymous questionnaire filled out by the students. RESULTS There were 306 participants. Senior students used drugs as follows: 51.3% used tobacco, 90.8% used alcohol, 5.9% used marijuana, and 0.7% used cocaine. Differences were observed between perceived norms and actual drug use for tobacco (70% vs. 51.3%), marijuana (10% vs. 5.9%) and cocaine (8.3% vs. 0.7%). CONCLUSIONS university students presented an overestimated rate for the use of tobacco, marijuana and cocaine among their peers.

Stigma towards mental illness and substance use issues in primary health care: Challenges and opportunities for Latin America

ABSTRACT Stigma towards mental illness and addictive disorders is a global problem and one of the main obstacles in tackling this issue remains the effective integration of mental health services into primary health care (PHC). In Latin America, information has significantly increased on the existence of stigma; however, little is known about effective interventions to prevent stigma and promote recovery-oriented practices in PHC. The aim of this study is to understand the existing evidence regarding mental health stigma in PHC with a special focus on the Latin American region. A scoping review of the literature related to mental health stigma in PHC was conducted. Two hundred and seventeen articles were evaluated; 74 met inclusion criteria and 14 additional articles were selected from references of search results. Results were subdivided into five different perspectives: users, family members and significant others, health professionals, contextual factors, and potential effective interventions. Only nine studies were based in Latin America, and only one described an intervention to reduce stigma in mental health services, not specifically in PHC. We found an urgent need to develop interventions to understand and reduce stigma in PHC settings, especially in Latin America.

Family Factors and Adolescent Problem Drinking in a High-Risk Urban Peruvian Neighborhood

ABSTRACT Background: Family relationships are widely recognized as playing a role in adolescent alcohol use. Although family relationships and parenting vary by culture, limited research has explored these relationships in Latin America. Objectives: We sought to determine which family factors are associated with adolescent alcohol use in Callao, Peru. Methods: Data come from a cross-sectional survey conducted in a public secondary school in Callao, Peru in 2007. A total of 180 11th grade students are included in the analysis. Our main outcome measure was problem drinking, defined as self-report of having ever consumed beer, wine, spirits, or hard alcohol to a point of drunkenness. Logistic regression was used to determine if odds of problem drinking varied by level of parental monitoring (knowledge of activities and whereabouts), positive family relationships, or family conflict, while controlling for demographic and peer variables. Results: Low levels of parental monitoring and low levels of positive family relationships were each associated with significantly higher odds of lifetime problem drinking in analyses adjusted for deviant peer affiliation along with sociodemographic variables (odds ratio (OR) = 4.2; 95% confidence interval (CI): 1.3–13.5; OR = 4.4; 95% CI: 1.5–13.0, respectively). Although family conflict was associated with elevated odds of lifetime problem drinking, this did not reach significance (adjusted OR = 2.01; 95% CI: 0.8–5.1). Conclusions/Importance: Interventions designed to prevent adolescent alcohol use in urban Peru may benefit from promoting positive family interactions and parental monitoring skills.

Normas percibidas por estudiantes universitarios respecto a sus pares y el uso de drogas: estudio multicéntrico en cinco países de América Latina

Este estudo transversal comparou a percepcao dos companheiros de usuarios de drogas em uma amostra de estudantes universitarios da America Latina. Os estudantes de nove universidades, localizadas em cinco paises (Brasil, Chile, Colombia, Honduras e Peru) responderam questionario que abordou questoes sobre o tagagismo, alcool, maconha e cocaina. A analise foi focalizada na comparacao da percepcao e da realidade dos atuais usuarios de drogas. Os resultados confirmaram, de forma geral, a ideia de que os estudantes superestimam o uso de drogas. Resultados inesperados foram identificados em relacao ao uso de alcool. Enquanto os estudantes geralmente superestimam o uso de tabaco, maconha e cocaina, entre seus pares, estimaram com bastante precisao ou subestimaram o uso de alcool entre seus pares. Apesar desse resultado inesperado, este estudo mostra que a percepcao do uso de drogas entre estudantes universitarios da America Latina se comporta de maneira similar ao uso de drogas em outras localidades. Os resultados tambem apoiam a sugestao de que intervencoes, usando retroalimentacao normativa, seriam uteis para fortalecer os programas de prevencao ao uso de drogas, dirigidos aos jovens da America Latina.This cross-sectional study compared perceived peer drug use and actual drug use in a sample of Latin American university students. Students from nine universities in five countries (Brazil, Chile, Colombia, Honduras and Peru) completed a questionnaire that addressed the use of tobacco, alcohol, marijuana and cocaine. Analysis focused on comparing perceptions to actual drug use. The findings largely, but not completely, confirmed the idea that students overestimate peer drug use. The unexpected findings were those relating to alcohol. While students generally overestimated peer use of tobacco, marijuana and cocaine, they accurately estimated or underestimated peer use of alcohol. Apart from the anomalous findings with regard to alcohol, this study shows that perceived drug use relates to actual drug use in Latin America as it does elsewhere. The results also support the suggestion that interventions using normative feedback would be useful to strengthen drug use prevention programs aimed at youth in Latin America.

Normas percebidas por estudantes universitários sobre seus companheiros e uso de drogas: um estudo multicêntrico em cinco países da América Latina

Este estudo transversal comparou a percepcao dos companheiros de usuarios de drogas em uma amostra de estudantes universitarios da America Latina. Os estudantes de nove universidades, localizadas em cinco paises (Brasil, Chile, Colombia, Honduras e Peru) responderam questionario que abordou questoes sobre o tagagismo, alcool, maconha e cocaina. A analise foi focalizada na comparacao da percepcao e da realidade dos atuais usuarios de drogas. Os resultados confirmaram, de forma geral, a ideia de que os estudantes superestimam o uso de drogas. Resultados inesperados foram identificados em relacao ao uso de alcool. Enquanto os estudantes geralmente superestimam o uso de tabaco, maconha e cocaina, entre seus pares, estimaram com bastante precisao ou subestimaram o uso de alcool entre seus pares. Apesar desse resultado inesperado, este estudo mostra que a percepcao do uso de drogas entre estudantes universitarios da America Latina se comporta de maneira similar ao uso de drogas em outras localidades. Os resultados tambem apoiam a sugestao de que intervencoes, usando retroalimentacao normativa, seriam uteis para fortalecer os programas de prevencao ao uso de drogas, dirigidos aos jovens da America Latina.This cross-sectional study compared perceived peer drug use and actual drug use in a sample of Latin American university students. Students from nine universities in five countries (Brazil, Chile, Colombia, Honduras and Peru) completed a questionnaire that addressed the use of tobacco, alcohol, marijuana and cocaine. Analysis focused on comparing perceptions to actual drug use. The findings largely, but not completely, confirmed the idea that students overestimate peer drug use. The unexpected findings were those relating to alcohol. While students generally overestimated peer use of tobacco, marijuana and cocaine, they accurately estimated or underestimated peer use of alcohol. Apart from the anomalous findings with regard to alcohol, this study shows that perceived drug use relates to actual drug use in Latin America as it does elsewhere. The results also support the suggestion that interventions using normative feedback would be useful to strengthen drug use prevention programs aimed at youth in Latin America.

Normas percebidas por estudantes peruanos sobre uso de drogas entre seus pares

El objetivo de este estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por sus pares y el uso real de drogas entre universitarios, entre 18 y 24 anos, de las areas de salud. Se trata de un estudio transversal, basado en un censo y en un cuestionario anonimo y autoaplicado. Participaron 306 estudiantes (82%). La proporcion del consumo, en el ultimo ano, fue de 51,3% para el tabaco, 90,8% para el alcohol, 5,9% para la marihuana y 0,7% para la cocaina. Se observo una diferencia entre la norma percibida de consumo y la proporcion de uso real informado para el tabaco (70% vs. 51.3%), marihuana (10% vs. 5.9%) y cocaina (8.3% vs. 0.7%). Se concluye que los universitarios sobrestiman el consumo de tabaco, marihuana y cocaina de sus pares.O objetivo deste estudo foi avaliar a diferenca entre as normas percebidas pelos estudantes universitarios, com idade entre 18 e 24 anos, sobre o uso de drogas pelos seus pares e o uso de drogas relatado pelos proprios estudantes em cursos da area da saude. Foi usado o metodo transversal, baseado em censo realizado atraves de questionario, preenchido pelos proprios estudantes, sem identificacao. O numero de participantes foi de 306 (82%). Como resultados obteve-se: a proporcao de estudantes que utilizou drogas no ultimo ano foi de 51,3% para o tabaco, 90,8% para o alcool, 5,9% para a maconha e 0,7% para a cocaina. Diferenca entre as normas percebidas e o uso de drogas foi observada para o tabaco (70% vs 51,3%), maconha (10% vs 5.9%) e cocaina (8,3% vs 0,7%). Conclui-se que os estudantes universitarios apresentaram estimativa aumentada sobre o consumo de tabaco, maconha e cocaina entre seus pares.OBJECTIVE to evaluate the difference between perceived norms about drug use among peer and actual drug use as reported by the same university students. The students were between 18 and 24 years old and attended health courses. METHOD cross-sectional study based on a survey, using an anonymous questionnaire filled out by the students. RESULTS There were 306 participants. Senior students used drugs as follows: 51.3% used tobacco, 90.8% used alcohol, 5.9% used marijuana, and 0.7% used cocaine. Differences were observed between perceived norms and actual drug use for tobacco (70% vs. 51.3%), marijuana (10% vs. 5.9%) and cocaine (8.3% vs. 0.7%). CONCLUSIONS university students presented an overestimated rate for the use of tobacco, marijuana and cocaine among their peers.