María Elena Medina-Mora Icaza

Consumo de alcohol y drogas en estudiantes de Pachuca, Hidalgo

Resumen es: Objetivo. Determinar la prevalencia del consumo de drogas y bebidas alcoholicas entre estudiantes, asi como la relacion de este consumo con variables s...

Evaluación del sistema de salud mental en México: ¿hacia dónde encaminar la atención?

OBJECTIVE: Evaluate some of the key indicators that characterize the Mexican mental health system using the World Health Organizations 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.

El consumo de drogas en estudiantes de México: tendencias y magnitud del problema

Introduction. Drug use and its social and health consequences are subject of interest. Students’ surveys are epidemiological strategies to monitor this problem, and they are complemented with household and specific population surveys. All this can show in advance some phenomenon that later is visible in general population. Besides drug use trends and patterns, these studies show the influence of other factors that may increase the drugs use and their consequences. Objective. To know the drugs, alcohol and tobacco use prevalences in elementary (5th and 6th grade), middle and high school students (7th-12th grades) of Mexico and its States. Material and methods. This survey is a probabilistic elementary-high school students’ survey with national and statal representativity. The study sample had 52 171 elementary students and 114 364 middle and high school students. The information was obtained with a previously standardized and validated questionnaire. Results. The lifetime tobacco use was 30.4% and the average onset age was 13.4 years old. 53.2% has drunk alcohol and 14.5% has binge drinking. Any drug use lifetime prevalence is 17.2%. The preferred drugs are marihuana (10.6%), followed by inhalants (5.8%) and cocaine (3.3%). Discussion and conclusion. The increase in drugs use, specially of marihuana and alcohol, highlights the importance of creating new prevention strategies focused to decrease their use rate among students.

La percepción de los adolescentes sobre el consumo de alcohol y su relación con la exposición a la oportunidad y la tentación al consumo de alcohol

El consumo de alcohol es un problema endemico en nuestro pais. Afecta principalmente a los adolescentes y se asocia con la disponibilidad y con caracteristicas individuales y del contexto que favorecen la probabilidad de experimentar, continuar usando y avanzar hacia el consumo problematico y la dependencia. El uso de sustancias tambien se relaciona con estar expuesto a ellas y tomar decisiones sobre su conducta frente a la oportunidad. Asi, la prevencion puede ser mas efectiva cuando se comprenden los mecanismos intermedios entre la disponibilidad y la conducta como la exposicion a la oportunidad y la tentacion al consumo. Este trabajo aborda estos constructos en un grupo de adolescentes mediante una aproximacion cualitativa y explora la percepcion de los constructos, su asociacion con el consumo y las estrategias que utilizan los adolescentes para evitar el consumo. Metodo. La muestra se integro con 60 adolescentes, 30 experimentadores y 30 abusadores de alcohol, divididos en seis grupos. Los resultados muestran una clara identificacion y definicion de los constructos exposicion a la oportunidad y tentacion al consumo. Fiestas familiares e invitaciones son consideradas situaciones asociadas con la exposicion a la oportunidad; y la tentacion 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 diversion y nunca rechazarian la invitacion de un amigo. Discusion. A partir de los resultados se hacen propuestas para su incorporacion en modelos de prevencion y atencion para poblaciones especificas.

Magnitude and extent of gambling disorder in the Mexican population

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.

The Invisible Burden of Violence Against Girls and Young Women in Mexico: 1990 to 2015:

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.

Contextual factors associated with marijuana use in school population

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.

Relación entre supervisión parental y conducta antisocial en menores infractores del Estado de Morelos

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.

Traducir la evidencia en salud: ¿Qué hacemos con el alcohol?

The first five articles in this issue of SALUD MENTAL tackle the important issue of alcohol abuse; in these articles, readers will be given a tour of neurodegeneration due to chronic exposure to alcohol, cravings or the intense desire to drink, and how to confront it; the obstacle-strewn path to help for those who become sick, and the search for opportunities to help Alcoholics Anonymous groups. All of these papers tell of the vicissitudes that must be overcome in order to rehabilitate those who have become dependent; they tell of the paths to recovery from a disorder that is responsible for an important proportion of the global burden of illness.

Asociación del consumo de sustancias psicoactivas con el cuidado y la salud del adulto mayor

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.