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Background. Perinatal depression (PND) is a clinical disease developed in any stage during the pregnancy and postpartum period with serious health and economic implications. Objective. The aim of this work was to analyze via bibliometrics indicators Mexico's production on PND to provide a view of the academic landscape and a comprehensive reference for subsequent research in the country. Method. The Scopus and Web of Science (WoS) databases were used to perform a search for peer reviewed papers related to PND in México. The search was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The extracted data were processed with VOS Viewer to examine link strength and clusters associations of diverse bibliometrics variables. Results. A total of 132 records were retrieved and we included 70 studies in the bibliometric analysis after application of the exclusion criteria. The authors with more papers were Navarrete L., and Asunción Lara M. The institutions with more papers were the National Institute of Perinatology, Ramón de la Fuente National Institute of Psychiatry, and National Institute of Public Health of Mexico. A diminution of the research considered in PND is observed in the last two years. Four keyword clusters were identified related to PND: symptoms, prevalence, pregnancy. Discussion and conclusion. The scarce literature concerning PND in Mexico compared with other countries could be due the limited collaboration between the health institutes. An urgent need to increase research on PND in Mexico is evident to be applicable in the management of resources in the healthcare system. [ABSTRACT FROM AUTHOR]

The importance of biopsychosocial factors in the genesis and maintenance of disease is increasingly being recognized. Most illnesses should be studied from a multifactorial perspective to facilitate understanding and treating them. Many psychopathological processes involve factors such as loneliness, hopelessness, and lack of social cohesion. As early as the nineteenth century, J.M. Charcot defined those illnesses in which no organic lesion was visible as functional disorders. Today, the anthropological view of illness known as the Heidelberg School provides us with a more global and comprehensible assessment of illness. The anthropological approach is complemented by a bioethical one, a bioethics of daily life which, as a practical science, studies and evaluates the living conditions of individuals, seeking practical solutions and contributing its reflections with deliberation and care. In this paper, we aim to highlight the most important factors that have an impact on illness by providing an anthropological view of illness and bringing bioethics closer to everyday life. [ABSTRACT FROM AUTHOR]

Background. Front-of-package food labeling is a public health strategy implemented to reduce the consumption of processed food to decrease the incidence of obesity in Mexico. Although there is an increasing focus among public health officials on implementing policies designed to address obesity, much less attention has been paid to how these policies could impact those with disordered eating, despite the fact that millions suffer from such illnesses. Objective. The aim of this article is to present scientific literature related to front-of-pack-age labeling and its impact on obesity and eating disorders. Method. Papers related to nutrition labels and obesity and eating disorders were reviewed. Results. The papers reviewed found no significant improvement regarding the consumption of processed food. Other measurements, including nutritional education, availability, physical education, and body-image acceptance, have a better impact on nutritional health. Discussion and conclusion. Front-of-package labeling is regarded as an important measure in the attempt to reduce obesity levels. However, there is insufficient scientific evidence to suggest that this type of labeling reduces the consumption of processed foods in patients with obesity. [ABSTRACT FROM AUTHOR]

Introduction. The popular use of marijuana and its components (THC and CBD) for medicinal purposes is often regarded as irresponsible and ignorant. However, in this paper, it is conceptualized and studied as medical knowledge of self-care, in which it is linked to different therapeutic knowledge from conventional and alternative medicine to treat anxiety. Objective. This article reports on a qualitative research project designed to analyze the practices and risks of self-medication with CBD, and its links with medical treatments and self-care measures for dealing with anxiety in adult women in Mexico City. Method. Eleven adult women, mostly professionals, diagnosed with anxiety, participated in the study. In-depth interviews were conducted to learn how women use therapeutic resources to cope with anxiety in their everyday lives. The interviews were transcribed and analyzed using ATLAS ti 7 software. Results. Self-medication is part of a self-care process with several facets: the experience of symptoms, self-diagnosis, the use of various remedies (dosage and administration), and their evaluation. During this process, women use a range of medication, psychological therapies, herbalism, acupuncture, yoga, and sleep hygiene measures, including CBD, either as an alternative or an adjunct to biomedical pharmacology, with or without medical supervision. Certain risks were identified, such as the use of CBD that may be incorrectly labeled or interact dangerously with other self-prescribed substances. Discussion and conclusion. These results coincide with those of various authors who equate self-care with a first level of care, which has risks that could be reduced by controlling misleading marketing and developing professional medical services, which are trained and accessible to users, who could inform them about the medicinal use, scope and risks of CBD or THC for health. [ABSTRACT FROM AUTHOR]

Background. Research is crucial to the development of society. The literature on the challenges for scientific development highlights that chronic stress in researchers can affect their academic production and their physical and mental health. Although some literature reports the consequences of stress in the academic field, most studies are carried out on students, and there is very little knowledge on the characteristics of stress because of simultaneous academic, occupational, and socio-personal demands. Objective. To analyze and contrast the methodological components and main results of stress-related studies on researchers. Method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide was used to analyze current evidence in the literature. Full-text scientific papers from the period 2008-2019 were included in both English and Spanish, on subjects engaged in research and teaching. The databases used were Scopus, Ebsco, Dialnet, and Web of Science. Results. One hundred and eighty records were obtained, but only four met the criteria for the qualitative evaluation. Discussion and conclusion. Stress is present in the 20% of subjects associated with psychological (lack of control, emotional fatigue, overload, multi-tasking) and institutional variables (evaluation system demands, tenure track, lack of scientific recognition). The studies emphasize aspects that predispose and precipitate stress but do not highlight psychological aspects of the stressful experience. [ABSTRACT FROM AUTHOR]

Introduction New therapeutic strategies against cocaine overdose toxicity have been developed. These new approaches are based on the design and synthesis of proteins involved in the destruction of cocaine before it has a chance to penetrate nerve tissue. Objective To review the progress in the effect of the increase in the catalytic activity of BChE and hCE enzymes produced for the treatment of patients in cocaine overdose toxicity conditions in order to determine the advantages and disadvantages of its use. Its potential future use in patients channeled by a cocaine overdose is also explored. Method A bibliographic search was conducted using PubMed; descriptors were "cocaine", "hydrolase", "esterase" and "butyrylcholinesterase". 220 papers were obtained and 126 papers were used for these review. Results The BChE, COCH and Coce bacterial enzymes significantly decrease the levels of cocaine in blood and brain and thereby attenuate the effects of a cocaine overdose. Discussion and conclusion The results obtained in animal models suggest the potential therapeutic use of these enzymes in humans to rapidly inactivate cocaine and develop treatments to stop deaths associated with cocaine overdose intoxication. These enzymatic approaches offer a novel therapeutic application to treat cocaine overdose. [ABSTRACT FROM AUTHOR]

Efforts to identify new cases of HIV, HVC and other STIs, through the application of quick tests, focus on people who inject drugs, without taking into account the fact that the use of alcohol and other drugs of abuse inhibits decision making, increasing the transmission of STIs through risky sexual practices. Accordingly, it is necessary to have detection algorithms that consider people who use multiple drugs to improve the identification of new cases and their subsequent linkage with health services. Objective. This paper describes the development process of the OPB-APR model for the detection, counseling and referral of people with HIV and other STIs at addiction treatment centers. Method. The procedure is divided into three phases: 1. A literature review to identify the basic concepts of HIV and other STIs, substance use, risky sexual behaviors, quick tests, and specialized psychological counseling; 2. A feasibility study in which a health professional is trained to implement the OPB-APR model; 3. Drafting of the final version. Results. The final version of the OPB-APR model was obtained, which describes standardized procedures for detection, counseling and referral to health services. Discussion and conclusions. The OPB-APR model aims to strengthen the public health system by increasing the coverage of services for the detection of HIV, HCV and other STIs. The above through the implementation of standardized procedures among specialized and non-specialized health professionals of addiction care centers [ABSTRACT FROM AUTHOR]

Background The study about the misuse of inhalant solvents started in Mexico during the 1970, although the interest in this subject decreased during some periods, its consumption continued among the young population, thus, it is relevant to update the state of the art on this matter. Objective Identify the state of knowledge on inhalant abuse, its consequences, prevention and the treatment alternatives in Mexico in the last four decades. Method We performed a bibliographical inquiry between August and September 2014 on the papers published between 1970 and 2014 about inhalant solvents consumption in Mexico. It integrated the publications included in the historical archive of the Epidemiological and Psychosocial Research Direction, Mental Health Journal, Medline, Elsevier and Scielo México. Results After revision, 83 out of 1083 papers fulfilled all the criteria that we considered for inclusion in the analysis. This body of work has been performed on different population segments: marginalized groups, juvenile gang members, children in street situation, adults and minors secluded in detention centers, sex workers, people seeking treatment, students, and the general population. Discussion and conclusion The several relevant aspects of the consumer population of inhalant solvents in Mexico were identified. Detection of this ample profile of individuals at risk could serve as the basis for the development of prevention and treatment programs to attend to the specific needs of these groups, since the programs currently in progress are scarce and some of them have not had follow up assessments or have not been evaluated at all. [ABSTRACT FROM AUTHOR]

Around the world, natural and man-provoked disasters cause the migration of big human groups,mental disorders -such as post-traumatic stress disorder-, and economic losses It has been estimated that each year 130 disasters of different nature occur in the Americas and that 67% of the hospitals and clinics are located in high risk areas. For this reason, the World Health Organization considers that disaster prevention, risk reduction, preparations, and recovery are activities which form a continuous cycle. In the light of this, it has developed the “Safe Hospital" program and the “Hospital Safety Index" ,two tools to evaluate the functionality of hospitals and the probability that they continue working in the case of disaster. This paper makes a brief practical review of the general evacuation measures for the mental patients of a psychiatric hospital as this is a highly vulnerable population given to causes which are intrinsic and extrinsic to mental illness. These measures include: the right moment to make the decision to evacuate a psychiatric hospital, the way to carry this out, evaluating patients requiring an immediate evacuation, evaluating pre- and post-sinister treatment, medical drugs supply, who will be responsible for the evacuation, the place where patients will be transferred taking into account the duration of the catastrophe, patients identification, the information which will be provided to relatives, the supervision of life in the shelters, and patients return at the end of the catastrophe. Finally, the paper suggests some elements to be considered for prevention, as well as some actions to evacuate a psychiatric hospital in the face of disaster situations. These are not exclusive for this population for they can be applied to other vulnerable groups, such as children and the elderly. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the most common forms and expressions of structural stigma from the perspective of a group of people who attended four treatment centers as a result of having received a psychiatric or neuropsychiatric diagnosis (n=68) and a group of health service providers engaged in these services in Mexico City (n=95). We adopted an approach, based on the intersectionality approach, which involves the interplay between social determinants, including gender, in the processes of social exclusion in mental health. In this qualitative study, the in-depth interview technique was used, for which specific guidelines were designed for providers and users of psychiatric services. The interviews were audio recorded, transcribed and subsequently encoded through a specialized program (Atlas ti, version 7.0). This paper examines the perceptions and experiences of stigma and discrimination related to psychiatric disorders, and other specific aspects related to the care process. Among the findings are the structural nature of discrimination not only directed at people affected by severe mental illness, but also at health personnel. Moreover, the respondents' accounts reveal certain structural barriers that impact the quality of care, particularly for users who have multiple conditions of social vulnerability that go beyond the scope of these service providers, constituting dilemmas for the provider. Lastly, on the basis of the analysis of the various difficulties expressed by the study population in relation to the care services, the main challenges to improving the quality of services in the field of mental health are described. [ABSTRACT FROM AUTHOR]

This paper reports on a research project designed to identify the uses of the Internet and cellular telephony that could place children at risk of contact with situations associated with sexual exploitation: hooking up on line, consumption of pornography and the production of humiliating, sexualized images. The questionnaires were administered to 147 adolescents with an average age of 13 years and 3 months. Results A total of 66.2% of the boys and 71.4% of the girls reported having Facebook, followed by Hi5 (69%) and My Space (43.3%). Teenagers were observed to provide their real names (64.7% of boys and 78% of girls) and actual ages in social networks. A total of 79.6% of the respondents reported that they liked to talk on Chat or Messenger, while a significant percentage (64.1%) had done so with strangers. A total of 53.1% of the population reported having met a friend with a sexualized image of their person through a cell phone (28.6 of boys and 11.6% of girls). These images were usually shared with friends (reported by 77.1% of boys and 62.8% of girls). But others were up- loaded onto the Internet (34.3% of boys and 37.2% of women) and a minority were sold (8.6% of boys and 2.3% of girls). The paper indicates that true information on the person provided with no restrictions whatsoever by adolescents in social networks and their interaction with strangers in chats are indicators of unsafe Web browsing. Qualitative research results indicate that these acts occur when teenagers are seeking popularity. The paper also discusses teenagers' consumption of pornography as a type of manhood that is "hot" by nature and shows that the production of sexualized images occurs in contexts where amusement is combined with sexual transgression. [ABSTRACT FROM AUTHOR]

The CES-D is a screening instrument to measure depressive symptoms during the last week. It is useful and easy to use because no trained staff is needed to administer and score it. Interest in depression has been consistent in Mexico in recent years, and the CES-D is one of the most used scales. The goal of this paper is to present a bibliometric analysis of scientific papers reporting data obtained with the scale; the papers had to be published in a scientific journal with a reviewing board, a group of peer reviewers and be ISNN registered. Materials were found in EBSCOhost and Google Scholar databases. 80 papers were published between 1986 and 2011. An average of three papers was published every year . Most of the studies were developed in Mexico City and nationwide; there was a bi-national study, a multinational one, and four in several states combined. The journals with the highest number of papers were: SALUD MENTAL, Salud Pública de México, and Revista Mexicana de Psicología. There were 17 institutions involved in coordinating the studies; six of them were international. 41% of the studies were conducted with adolescents, 32% with women, and 90% in urban contexts. There are some areas which need further study to build a more comprehensive understanding about the distribution and characteristics of depressive symptoms and hence new studies must be designed to include understudied groups and populations. [ABSTRACT FROM AUTHOR]

According to studies conducted in different countries, it is estimated that approximately 30% to 50% of people with mental health problems are not recognized by the general practitioner. Given this situation, it has been proposed that the practitioner at the primary care services must play a decisive role in the early detection of cases by establishing a definitive diagnostic and a timely treatment. Several organizations have pointed out that one of the first actions that need to be implemented to fulfill the aims in the care of people with mental disorders is to prepare the first-contact doctors and to have a brief, low cost, self-applied, valid and reliable scale. The studies mention that using screening tests at the primary care level is crucial for the success of the programs. The detection and recognition of psychiatric symptomatology rates vary depending on the type of scale applied. The tools that have been widely used are the Goldberg's General Health Questionnaire (GHQ), Zung Self-Rating Depression Scale, Beck Depression Inventory, the Depression Symptom Checklist (DS 20), the Hopkins Symptom Checklist (SCL), the Hamilton Depression Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), the Montgomery-Asberg Depression Rating Scale, the Geriatric Depression Scale (GDS), the self-administered computerized assessment (PROQSY), the criteria of the 3rd revised edition of the Diagnostical and Statistical Manual of Mental Disorders (DSM-III-R), the Structured Clinical Interview for DSM-IV (SCID), and the criteria of the Symptom Driven Diagnostic System for Primary Care (SDDS-PC), among others. The preliminary results confirm the existence of a high percentage of possible psychiatric cases (46.9%), but only 4% of cases are referral. The low capability of the general practitioner at the primary care level in detecting these pathologies has been confirmed as well. These scales have been applied in different scenarios and to different types of population. Although the dominating criteria for choosing the tool are sensitivity and specificity, some authors mention that strategies for adequately handling cases, such as the confirmation of the diagnosis and followup of the patients, are required once the treatment has started. In this paper, we present the psychometric characteristics of the Kessler (K-10) scale in detecting depression and anxiety disorders in the primary care. Material and methods The study is a methodological process that aims to validate the Kessler Psychological Distress scale (K-10). It was conducted in two health care centers of primary care level in Mexico City. The subjects were 280 individuals who requested attention at the mentioned centers and to whom the K-10 test was applied after giving their informed consent. Later on, the computerized version of the International Neuropsychiatric Interview (MINI), which uses the diagnostic criteria of the DSM-IV, was applied to the subjects in order to confirm the diagnostics for depression and anxiety. The MINI is a version adapted to Latin American Spanish by the National Institute of Psychiatry Ramon de la Fuente Muñiz. The diagnostic accuracy was processed following the MINI diagnoses for depression and anxiety closely, and the scores on the scale K-10 as a predictor. The sensitivity and specificity were calculated for all possible cut points in order to establish the optimal cut off point. The efficiency and maximum likelihood ratios were also calculated. The area under the ROC curve as well as the probability quotients, positive and negative (LR+ and LR-), were also calculated. The K-10 is a brief screening tool that can be easily applied by the primary care personnel which measures the psychological distress of a person during the four weeks prior to the application. It consists of ten questions with Likert-like answers that range from 1 to 5 and are categorized in a five level ordinal scale: Always, Very Often, Sometimes, Rarely, Never; where «Never» has an assigned value of 1, and «Always» has assigned value of 5. It has a minimum score of 10 and a maximum of 50. The ranges of the instrument are four levels: low (10-15), moderate (16-21), high (22-29) and very high (30-50). The instrument showed an internal consistency of 0.90 and it has been used in various population studies promoted by the World Health Organization as well as government organizations in Australia, Spain, Colombia and Peru. Results Out of 280 individuals to whom the tool was applied, 78.9% (221) were female and 21.1% (59) male. These values represent the proportion of patients attending the primary care services (95% confidence interval=±5.4%). The mean age of women was 39 years, and the mean age of men was 41. The 70.6% of the women manifested more psychological distress than men (52.5%)[χ²(1)=6.05,p=0.014. No other sociodemographic variable showed significant differences. The instrument is highly precise, it can detect up to 87% of depression cases, and 82.4% of anxiety cases. The scale was compared with the MINI and it presented a prevalence of 26.8% and 10.6%, respectively. Of the total of depression cases, 26.4% also presented anxiety; these represent a co-morbidity of 5.4%. The construct validity presented one factor alone that explains the 53.4% of the total variance, this is why the scale is considered as onedimensional. In other words, the scale only measures the construct of the psychological distress. The internal consistency was α=0.901. Once the sensitivity and specificity for all cut off points had been determined using the MINI as a golden rule, it was observed that the cut off point for maximum sensitivity and specificity corresponded to 21 for the diagnosis of depression, and 22 for anxiety. Conclusions The K-10 is a good instrument for the detection of depression and anxiety cases at the primary care level which meets the criteria of validity and reliability. However, given that only one diagnosis was considered for all the range of anxiety disorders, the scale must be chosen carefully for all the other disorders that are not included in this paper. The use of the instrument is recommended for the general practitioners at the primary care level, mainly for diagnosing depression. Various studies in which other screening instruments have been used for the detection of depressive disorder at primary care point out that any screening method are useful in making the diagnosis. By using these instruments, the depression diagnosis at primary care level increases from 10% to 47%. The latter supports the fact that the selection of a good instrument turns out to be effective in detection, treatment and clinical outcomes of the entity. Since this recommendation is only one of the activities required in primary care level for good handling of detected cases, it is noteworthy to mention that a comprehensive care model that encompasses both the detection as well as the pharmacological and psychosocial treatments is required. [ABSTRACT FROM AUTHOR]

This article includes the results of a multi-level conceptual approach review, considering four models of analysis, delving into the determinants and the explanatory factors in the process of search and use of health services. Such models are: psychosocial, epidemiological, sociological, and socio-economic. The implications, determinants, and characteristics of utilization of health care services have been subject to scrutiny since the eighties. Research on this matter has not been independent of the process of reform, which has been carried out simultaneously in virtually every country in the world. In fact, establishing adequate health services for patients who need them most has become a generally accepted priority. For the purpose of this study, and as a preamble to understanding the process of search and use of health services, the concept of need, along with its applications in the different models of service use, must be defined. In the literature, there are four types of need: a) normative need, that which is expert-defined as such in a given situation, b) felt need, which corresponds to a perceived lack of something beneficial to the individual, c) expressed need, one not only experienced, but also articulated by the individual, and d) comparative need, i.e. a standard that meets the same characteristics of another receiving certain coverage or service. This paper will refer to the expressed need, which may or may not correspond exactly to the use of health care services. Along the same lines, the concept of demand, applied from an economic perspective, will be utilized as a synonym for use. The implementation of reform processes and the evaluation of the possible implications of such reforms require extensive knowledge regarding the determinants of use of health care services. A main determinant can be identified, for example, when an individual uses such services, sometimes repeatedly, because he is in a situation of need (experienced), understood as the perception of discomfort or illness. There are certain biological differences (i.e. sex and age) that might explain some of the variations observed in the relationship between situations of need and use. However, could there be other reasons that would lead to use? If so, this situation might create unnecessary extra work for professional health care providers preventing them from engaging the real needs of the population served; on the other hand, if there are any other motives (besides the absence of necessity) causing an individual, or group of individuals, not to meet his care needs, he may be at risk. It is widely known that not all health problems are reported to physicians by patients at the time of consultation. Also, there are great numbers of single users who are responsible for the utilization of a large portion of consultations intended for that population, taking advantage and, occasionally, using health services without having, from a medical standpoint, a clear justification to do so. These examples are extremes that can be observed as patterns of use that are determined by the perceived need for health and a long list of factors described from different disciplinary perspectives. Analyzing the search and use of health services implies studying availability and accessibility to them. Although the measurement of these variables is not exact, it is used in most studies. When considering use by socio-economic group accessibility, the fairness of the system in question is also evaluated. This is highly relevant because problems of use of services are related to health equity and accessibility, two challenges currently being addressed by a substantive reform of the health systems in most countries of the world; particularly in Latin America, and more so in Mexico. Thus, this paper intends to address, through a review of different theoretical models, factors affecting the search and use of health services. It assumes that the central premise in the context of health sector reforms in Latin America, especially in Mexico, is that the health service users have come to occupy a leading role in establishing the health needs addressed by care systems. Indeed, the main issues of structural adjustment in health systems are related to setting health needs according to epidemiological changes, changes in perception of diseases, and changes in the variables of equity, efficiency, coverage, and accessibility to health systems for different population groups. From this new perspective, the health systems, in turn, propose relevant changes in the interaction between the two main social actors within this reform process: first, the behavior of suppliers (any institution that provides health services to the population), and second, the behavior and perceptions of consumers (population using health services demanded from a particular institution). The path converges when both social actors represent the process of seeking and obtaining medical care, as determined by a number of variables and constraints addressed in this article through different conceptual approaches, i.e. whenever the explanatory conceptual model is used, the process of medical care is primarily conceived as two chains of activities and events where participants are parallel -the care- giver on the one hand, and the client or user of health services on the other. In an extended approach, use and its determinants have much to do with the study of accessibility, coverage, and equity in health. Some authors claim that, under this approach, the study of accessibility and coverage in health are made identical to the determinants of service utilization. This wider vision includes various aspects, considering use as a schematic sequence of events from the time the need for medical attention arises until it initiates/is followed by the use of medical services. Throughout this process, psychosocial and epidemiological determinants of care are identified, including seeking process aspects such as health-related beliefs, confidence in the health care system, disease frequency, pain tolerance, and presence of disability. This schematic succession of events is precisely what has allowed the study of health service use to exhibit different approaches, which in turn has led to the creation of various psychosocial and epidemiological models that have attempted to explain why the population does not use health services. From an economic perspective, the literature on health service utilization mainly considers two approaches: the traditional approach and the managerial approach. These provide different but complementary explanations regarding demand and investment in health services. The traditional approach to demand for health services is based on consumer theory, where demand for medical services is mainly determined by the patient but conditioned by the health system. Within this emerging model, demand for health services is the result of a problem of inter-temporal utility maximization of the patient, and considered a function in the production of health. The managerial approach, related to human capital theory, considers information asymmetries between doctor and patient regarding the type and quantity of necessary medical treatment. In this context, the decision making process can be divided into two parts: first, patients initially choose whether or not to seek treatment, and then, once the patient begins treatment, the physician determines the number of visits and use of services for tracking, monitoring, and controlling the damage that initially triggered the stages. To specify a model of demand for medical services as a two part process, we should distinguish, at each stage, «who makes the decisions?», and «what is the set of explanatory variables?» Describing the initial demand for medical services should be considered an approach that reflects the patient's decision to visit the doctor. The economic models elucidate this decision as the explanatory variables arise from the need to demand or investment, i.e. the doctor chooses the treatment considering not only medical criteria, but also economic incentives. Both processes can be assumed to have the same set of explanatory variables, but the explanation may differ depending on the stage of the decision-making process being analyzed, the type of coverage, the service availability, and the provider's behavior. In this article, each one of the above phases is examined from different perspectives, describing the conditions and determinants of the process of search and use of health services and making a cross-analysis for each model reviewed in a contingency matrix. Finally, a comprehensive analysis of the models is proposed as a starting point for finding a model that allows, in a trans-disciplinary way, to elucidate a better explanation of the determinants and constraints of the process of search and use of health services. [ABSTRACT FROM AUTHOR]

Edwin S. Shneidman (13-05-1918 - 15-05-2009) is known as the father of contemporary suicidology. His work reflects the intensive study of lives and deaths, especially suicides, and is the mirror to his mind. Few people, like doctor Edwin S. Shneidman, are vouchsafed the rare opportunity to create a new discipline, to name it, to shape it, to contribute to it, and most importantly, to catalyze other competent investigators to invest in it: suicidology. In his reflections, Shneidman does not know whether suicide was looking for him or he was looking for suicide. Part of his motivation on that day in 1949, when he discovered 100's of «genuine suicide notes» in the vaults of the Los Angeles Coroner's Office, was that he was restless and looking for some niche in psychology. He had an autonomic reaction with the feeling and knew that had discovered an unknown way to understanding the suicide behavior, and that suicide notes could be the golden road to the unconscious of suicide, and suicidology began. What Shneidman had tried to do in his career was to explain the word suicide. It is not taxonomy. Disregarding all of biology and genetics, suicide is essentially psychological pain. It is not entirely so, but that is what we can investigate and explicate. Shneidman's main contributions have been conceptual. He had made up words and concepts —suicidology, psychological autopsy, postvention, subintentioned death, psychache— where he felt then to be required to reflect some nuances of his thoughts, and he has given renewed emphasis on well-established words and concepts —perturbation, constriction, lethality— when he felt that they were more accurate than some of the current reductionistic jargon. Shneidman is first and foremost a suicidologist. His work in suicide can be subdivided as follows: Definitional and theoretical, suicide notes, administrative and programmatic, clinical and community, and psychological autopsy and postvention. Shneidman, in his important book, Definition of Suicide in which he asserted a psychologically oriented definition of suicide: «Currently in the Western world, suicide is a conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which suicide is perceived as the best solution». Shneidman was asked to write the paper «Suicide» for the Britannica Encyclopedia. Shneidman decided he would not reproduce the usual tables of statistics of suicide among various countries at various times, but, instead, introduce a potpourri of then current ideas about suicide, a significant paper in the history of suicidology. It shifted the focus to the suicidal mind, away from the statistical. Shneidman through all his clinical and researching work, obtained the famous Ten Suicide Common Characteristics. Although we actually do not know how many commonalities there are, Shneidman's ten of suicide are: 1. The common purpose of suicide is to seek a solution; 2. The common goal of suicide is cessation of consciousness; 3. The common stimulus in suicide is intolerable psychological pain; 4. The common stressor in suicide is frustrated psychological needs; 5. The common emotion in suicide is hopelessness-helplessness; 6. The common cognitive state in suicide is ambivalence; 7. The common perceptual state is constriction; 8. The common action in suicide is egression; 9. The common interpersonal act in suicide is communication of intention; and 10. The common consistency in suicide is with lifelong coping patterns. Also, suicide notes are synonymous with Shneidman's career. Shneidman seeked to illustrate the point that suicide notes -which, after all, are the penultimate act of that person's life- can be very informative when they are placed within the context of the thousand details of that person's life. Using that approach, the suicide notes are illuminated by the life, and many details of the life are tragically illustrated by the content of the notes. Shneidman's work was also programmatic. Perhaps the major pioneering administrative effort in Shneidman's life was his work at the LASPC (Los Angeles Suicide Prevention Center). The LASPC was started in 1955 with Norman Farberow and Robert Litman. It was the first comprehensive center and it became a model for prevention centers that pulled the troika of suicide prevention unto the modern stage. They represent three interwoven aspects of modern suicide work: research, training and clinical service. In 1966, he was called to work at the Institute of Mental Health (NIMH), to draft a proposal for a National Program in Suicide Prevention. When Shneidman went to Washington, there were three suicide prevention centers in the country and three years later (1966- 1969) there were more than 100. The paper «The NIMH Center for Studies of Suicide Prevention» is not only important because it outlines Shneidman's endeavors in suicide prevention, but it is also marked by its publication in The Bulletin of Suicidology. He neologized the word, suicidology, for that publication. In 1969, after three years at NIMH, Shneidman went to Harvard as a Visiting Professor and then to the Center for Advanced Studies of Behavioral Science, Stanford, as a Fellow. Next, Shneidman went to the University of California, Los Angeles (UCLA). He also, with others, created in 1968 the American Association of Suicidology (AAS). The Bulletin, after Shneidman left NIMH, stopped existing within a year or so. Thus, he wanted a journal for suicidology and created one, under the auspices of the AAS, the Suicide and Life Threatening Behavior Journal (SLTB). Shneidman's career in suicidology has not only been intellectual but also practical. The pamphlet, «How to Prevent Suicide» -which sold for $.25- was published in 1967, a year after Shneidman went to NIMH. It was one of the first attempts to meet the responsibility to put out something for the public. It was a prevention effort at the community or public level, something he espoused all his life: Prevention is education. He provided certain rules for treatment of suicidal people and prescriptive advice for the psychotherapist, suggesting a focus on the assessment of the patient's mental lethality. Shneidman's rule: reduce the perturbation, and the lethality will come down with it. Therapy revolves around mollifying pain. Shneidman's key papers on the Psychological Autopsy and Postvention are noted. He outlined his thoughts about what one does after suicide and then labeled what was done with people after the dire event as postvention. His brief paper on the case of the bereaved sets forth the differences that distinguish professional sessions with survivors from ordinary condolence conversation. All his life, Shneidman strongly supported the care of the survivors. He reflected on the life-saving role that others can play in saving a potentially suicidal person's life. But Shneidman also ruefully reflects that, in the final analysis, it is the suicidal individual who must play the vital role of sustaining the drama of living to another day. Stepping back from Shneidman's collected works and his life, one is struck by the generativity, the sheer productiveness of his life. [ABSTRACT FROM AUTHOR]

Introduction Although Spanish adolescents recognize that reiterative alcohol abuse has negative consequences over consumers and society in general, the percentages of teenagers who get drunk during the weekends keep alarming high. Young people are exposed to a wide range of messages about the externalities related to alcohol consumption whose connotation and importance are divergent. Our main goal is to analyze which channels are the most effective to reduce alcohol abuse. To that end, we focus on a theoretical framework which combines the forming of risk perceptions with the decision of consuming alcoholic beverages. We focus on young people because alcohol consumption patterns consolidate in adolescence and adolescents are also highly sensitive to peerpressure, and in general, to social forces. Materials and methods The main contribution of this paper lies in analyzing how the different sources of information (relatives, friends, teachers, official organism, mass media, seminars, hooked people and publications) configure risk perceptions. To address the issue of endogeneity between risk perception and risky behaviors, we consider a simultaneous equation system, and to analyze the robustness of the results, we carry out two more different specifications: a model in which these endogenous variables are included but treated as exogenous and a model in which these variables are excluded. We have drawn sub-populations of 21344, 26530 and 25521 high-school students from the Spanish National Surveys on Drug Use in the School Population 2000, 2002 and 2004. We have also used the Harmonised Consumer Price Indexes (HCPI) as a proxy of the alcoholic beverages' prices. These indexes, provided by the Spanish National Statistical Institute, are statistical measures which summarize the evolution of the acquisition capacity of the resident population in Spain to buy alcoholic drinks across Spanish provinces (n=50). Because these indexes also compute for geographical and temporal differences (for example, some Spanish provinces are important wine producers or some years have been specially good or bad for the agricultural sector given weather or economic conditions), we have introduced time and geographical dummy variables in order to control for these two dimensions. Results Our results validate the theoretical framework. The riskier the students consider the consumption of alcoholic beverages, the lower is their alcohol demand. This empirical evidence is fundamental in justifying the design of public polices oriented to inform young people about the real risks of consuming drugs. This paper also brings to light that the most effective channels to inform young people are official organisms, parents and siblings, mass media, talks and seminars, and teachers. The other way around, friends seem to exert a negative influence. The main conclusion we draw from these results is that alcohol consumption is a social issue. To design effective anti-drug policies, we have to take into account adolescents' social environments: families, friends and schools, among others. It is fundamental to inform parents and teachers, and in general to reach the highest population section as possible. The good piece of news is that people who surround adolescence are getting more and more involved with their education; parents and teachers are sharing the responsibility of informing adolescents about drugs. [ABSTRACT FROM AUTHOR]

Since enkephalins discovery in 1975, several opioid peptides have been included in neuroscience research. Enkephalins have been involved in the homeostasis maintenance of the organism, mostly with cellular and molecular mechanisms implicated in antinociception and narcotic responses. Moreover, enkephalins have been shown to be involved in the control of stress, regulation of cardiovascular functions, modulating primary immune responses, in addition to cellular differentiation processes. As opioid peptides appear to modulate several bioactivities and physiological responses in organisms, this posits that several modifications should occur during their synthesis, cell release, and receptor binding in target cells. At present, it has been demonstrated that the endogenous opioid system (EOS), displays a circadian rhythm, in which its tissue content, presynaptic release, and receptor's number reaches its maximal concentration during the dark phase (24:00h) and the minimal during the early morning (05:00 h). Recently, our group reported that functional pinealectomy disrupts the enkephalin circadian rhythm and significantly reduces the tissue content of opioid peptides in the rat brain. However, the effect was shown to be specific to the hour along the 24h daytime. There were no significant changes during the light period, only during the dark period (01:00h), when the enkephalin tissue content decreased in the experimental group. The effect was reverted when pinealectomized rats were injected with single doses of melatonin (MEL) (150μg/kg i.p.). If the lack of melatonin in the rat brain significantly reduced the enkephalin tissue content, and its exogenous administration re-established the enkephalin tissue levels, it is possible that the hormone is involved in the enkephalin synthesis. In this paper we provide further evidence that supports the relation between melatonin and opioid peptides synthesis and release. In addition, we studied the effect of darkness and melatonin administration in enkephalin tissue levels. Finally, we analyzed the luzindole effect as a melatonin receptor antagonist in the pinealectomized rat brain. Subjects: Male Wistar rats were housed in a light and temperature controlled room. Water and pellet food were available ad libitum. This group was subdivided in: 1. Functional pinealectomy group (FP). Rats were housed individually during 15 days in a room with continuous light (<50lux). 2. FP rats were housed in a dark room during four or six hours. 3. FP rats were injected with melatonin (150, 300, 600μg/kg s.c.). 4. FP rats were injected with Luzindole (187.5, 375, 750μg/kg i.p.). After 30 min, the animals were injected with melatonin (150μg/kg). 5. FP rats were injected with melatonin (800μg/kg) and subjected to the in vitro release processes. The rats were sacrificed by decapitation and the blood collected for melatonin serum determination. The brains were removed and processed for an analytical preparative procedure for the enkephalin determination by radioimmunoassay technique. The in vitro release methodology was performed as follows: tissue samples were homogenized by applying 8 strokes with a Thomas grinder system. The homogenates were centrifuged at 4,000rpm, 4°C during 10 min. Supernatants were recovered and centrifuged at 12,000rpm at 4°C for 20 min. Supernatants were discarded and pellets were resuspended in the homogeneization buffer (1:9 w/v). Samples were placed on top of a Percoll gradient density (23%, 15%, and 10%) and centrifuged at 20,000 rpm at 4°C for 25min. The synaptosomal enriched fraction (15-23%) was obtained and diluted in 1mL of Krebs buffer (mM: NaCl 119, KCl 4.6, CaCl2·2H2O 1.25, KH2PO4 0.85 MgSO4 0.84, NaHCO3 24.8, sucrose 10). Buffer was gasified with a mixture of C02 95% and O2 5%, pH 7.4. 800μL aliquots were placed into plastic chambers. After 20 min of stabilization with Krebs buffer, three different superfusates were collected: 1. basal, 2. potassium [50mM], and 3. post-stimulus (Krebs buffer without potassium). Samples were collected into HCl 0.1N, boiled and subsequently loaded into Amberlite XAD-2 columns (8×0.7cm) for solid-phase peptide extraction. The flow rate was held constant at 0.5 mL min-1 and elution of the whole peptide fraction was carried out using a continuous gradient with absolute methanol. Eluted samples were lyophilized and resuspended in 2mL of distilled water and finally stored at -20°C for further quantification of IR-Enkephalin using standard radioimmunoassay procedures. The results showed that functional pinealectomy reduced the opioid tissue content in the different brain structures assayed. The lack of melatonin significantly decreased the enkephalin tissue content when compared to the control group. However, tissue levels of enkephalin material were completely restored after four and six hours of administration of different doses of exogenous melatonin administration to the rats. As continuous light decreases the melatonin content in the brain, darkness should be able to counteract the aforementioned effect. Our results showed that tissue levels of enkephalin material were increased over 200% and 300%, after exposing animals to a four or six-hour period of darkness, when compared to animals exposed to continuous light. Luzindole was used to abolish any melatonin activity via activation of its membrane brain receptors. Our experiments showed that different doses of the antagonist were not able to obliterate the increased content of opioid peptides induced with melatonin administration in the tested brain tissues. Finally, enkephalin release showed a significant decrease in pinealectomized rats, showing a complete restoration of released peptide levels as shown by control group, after hormone administration. Thus, melatonin appears to counteract the neuronal decrease of the releasable pool of opioid peptide within the nerve terminals, reaching the released rate values detected in the control group. Our results suggest four relevant features: 1. Functional pinealectomy induces a significant decrease in the tissue content of opioid peptide material that seems to correlate with a decrease in the presynaptic release of enkephalins. 2. Darkness and MEL administration counteracted the light induced effects, namely the decreased content of opioid peptide material in tissue and the reduced peptide release from nerve terminals. 3. Nonetheless, the presence of luzindole was not able to inhibit the synthesis of opioid peptides. Melatonin is a hormone that synchronizes cell activity with photoperiod. Beyond this physiological property, MEL has been related to neuropeptide synthesis. Previous reports have shown that surgical or functional pinealectomy reduces the Met-Enkephalin tissue content in the rat brain. Also, it has been demonstrated that MEL stimulates the Proopiomelanocortin (POMC) gene expression in the immune system. In this paper, we showed further evidence that melatonin participates in the biosynthetic regulation of opioid peptides. Dark stimulation after continuous light exposure on rats produced an increase of tissue content of enkephalin above 300%, when compared with tested animals subjected to functional pinealectomy. Similar results were obtained with the exogenous melatonin administration. These evidences support the hypothesis that hormone treatment may be able to interact with protein kinase C (in the active-state of the enzyme). In addition, the hormone could modulate the cellular responses of several transcription factors (c-Fos, c-Jun, AP-1) responsible for the enkephalin gene expression. On the other hand, rats exposed to MEL-receptor antagonist luzindole, injected before MEL administration, showed that the tissue content of opioid peptide was not totally abolished by the melatonin antagonist. It has been proposed that melatonin not only interacts with its membrane receptor, but it is able to cross the cytoplasmic membrane and interact directly with the intracellular signal transduction system via the biomolecules that operate within. In conclusion, the physiology of melatonin appears to control the synthesis and presynaptic release of the endogenous opioid system in the rat brain. [ABSTRACT FROM AUTHOR]

Suicidal behavior, in its different manifestations, represents an international public health problem, being one of the ten main causes of general mortality and one of the three top main causes of death in adolescence and young adulthood. The statistics of suicidal attempts are also very worrying, even more if it is considered that for each case of suicide attempt attended in a health-care center, it is estimated that there are four non-reported and non-attended cases. Several studies report the importance of considering the role of some risk factors such as a family loss, a family history of suicidal behaviors, severe mental health problems in the family, economic problems, personality disorders, non-stable mood state, aggressiveness, impulsiveness and social alienation. When those problems are combined with alcohol or drug abuse, the suicide risk is higher. The presence of suicidal behaviors in Latin-Americans high school and university students has been reported by different papers in which the suicidal ideation indicators range from 8% to 25% and the suicide attempts vary from 8% to 12%. In these papers the difference between women and men is highlighted, given that the first group has a higher propensity of suicidal attempts and men group is in full risk of committed suicide. There are no statistics that confirm the differences between high school and university students. Some studies have confirmed the importance of stressful life events in the suicide phenomenon during adolescents, especially of interpersonal and emotional stressors. Few studies have inquired about the characteristics of suicidal behaviors in student population in Colombia. For this reason, health promotion and suicide prevention actions have not reached the expected effects. The purpose of this study is to know the prevalence and the characteristics of suicidal behavior in high school and college students in the city of San Juan de Pasto. A descriptive study was developed with 463 students belonging to six high schools and two universities, which ensures equal proportions regarding level (high school or university), gender and type of education (public or private). Their ages range from 9 to 30 years old. The Parasuicide Indicators Schedule (CIP- Cédula de Indicadores Parasuicidas) was applied; it was part of a battery of tests of the «Adaptation and validation of psychological instruments in students of San Juan de Pasto» project, which was approved by the ethical committee of the University of Nariño. The stressful life events questionnaire for adolescents (Cuestionario de Eventos Estresantes Vitales para Adolescentes -EEVA-Udenar) was applied to a randomly selected sub-sample. The prevalence of suicidal behavior was of 30%, 18% of the sample analyzed had suicidal thoughts, 4% had suicidal plans and 8% reported previous suicide attempts. The suicidal behavior was more frequent in women than in men and it is unsettling that the proportion of suicide attempts between women and men is 3:1. Suicide behaviors were more frequent in students whose ages ranged from 17 to 20 years old..… [ABSTRACT FROM AUTHOR]

Introduction Studies on developmental psychopathology have shown that several problems and disorders that started during childhood persist into adulthood. Recent epidemiological studies have emphasized the need for the early identification of problems and disorders in childhood and adolescence that may eventually lead to other psychopathologies in adulthood. A previous paper presented the rationale and development of a brief instrument which could be used to early identify clinical risk conditions in children by health professionals: the Brief Screening and Diagnostic Questionnaire, CBTD. The CBTD is a 27-item questionnaire which is answered by the parents of the child exploring symptoms frequently reported as motives for seeking attention at the out-patient mental health services. The instrument showed good reliability, KR-20= 0.81, and construct validity for identifying groups of symptoms that suggest the presence of the most frequent psychiatric syndromes in children and adolescents. As our goal was to identify probable psychiatric disorders, and diagnostic criteria are not equal to clusters of symptoms identified by factor analyses, the next task was to explore the data using a different statistical technique and to develop observational units, syndromes, for further clinical evaluation. The objectives of this paper are: 1. to present the resulting algorithms and 2. their prevalence in children and adolescent population in Mexico City. Method The CBTD was included as part of the instruments used in an epidemiological study on psychiatric morbidity in Mexico City. The study was designed as a household survey on a representative sample of the adult population aged 18-65 years in Mexico City. In addition, information was obtained about all the respondents' children aged 4-16 years living at the same household. The total sample included 1685 children and adolescents with the following distribution by age-groups: 16.3% were 4-5 years old; 25.5%, 6-8 years old; 30.9%, 9-12 years old, and 27.4%, 13-16 years old. Once the independence of the observations was assured, logistic regression analyses were performed between cardinal symptoms for different diagnoses and the rest of the items from the questionnaire. Statistically significant associations were evaluated clinically and compared to psychiatric syndromes as defined by the DSM-IV and ICD-10 classifications. Based on these results, algorithms for probable psychiatric syndromes were created. Results Using the results from logistic regression analyses, algorithms were created considering different levels of severity for probable disorders: attention-deficit and hyperactivity distinguishing three subtypes, depressive with two definitions and two severity degrees, anxiety with two subtypes, oppositional behavior, conduct disorder, specific language disorder, epilepsy, and other clinical conditions such as problems related with eating attitudes, enuresis and impulsivity. Depressive and hyperactive attention-deficit syndromes were the most frequent in the population. Among these groups of syndromes, depression, as defined in terms of the presence of irritability or sadness and three or more associated symptoms, and the combined subtype of hyperactive attention-deficit, were the most prevalent. Oppositional behavior and anxiety syndromes were also frequent, and all of the afore mentioned syndromes appeared predominantly associated at least with another one. Mixed externalizing and internalizing syndromes were found in 5% of the population, while only internalizing syndromes were reported in 4.5% and only externalizing syndromes in 2.4%. Although as a whole no significant differences by sex were found on the number of syndromes presented, in males the frequency increased with age, while in girls more syndromes were reported on the youngest and elder age-groups.… [ABSTRACT FROM AUTHOR]

Introduction. This paper analyses the evolution of antisocial behavior within the context of representative cross-sectional studies in student population from Mexico City. Surveys with students have collected data about substance use and related factors. The latter is associated with antisocial behavior and delinquency, eating disorders, risk sexual behavior, and suicide attempt. Statistics on younger offenders show an increased number of subjects presented before law institutions, meaning that they have been prosecuted somehow (there were 2623 cases in 1999, and 3506 in 2003). At the same time, there is a decrease in the age for committing these faults which are becoming more serious; a larger number of homicides, raping, and carrying weapons have been reported. The objective of this paper is to present tendencies of antisocial behavior through data obtained from three different representative surveys in junior high school and high school students from Mexico City (1997, 2000, and 2003). Surveys were held by the Instituto Nacional de Psiquiatria Ramón de la Fuente and by the Secretaria de Educación Pública. [ABSTRACT FROM AUTHOR]

Introduction Inhalant use among various populations in Mexico occurs within the context of its legality, inadequate health regulation and supervision of its production and sales, high availability and low cost, combined with the pleasurable effects of inhaling, which vary according to the context and users. Objective This paper describes the social practices involved in the co-construction of inhalant use contexts of two groups of Mexican middle school students and their reported effects. Method Photo elicitation methodology was used, with two videotapes produced by students on school sociality practices where inhalants we are used and then analyzed in discussion groups. Results The theoretical categorization of the data was performed using Atlas. ti software. It was found that although the students inhaled toluene, only one of the students experienced dizziness and headaches, while another classmate felt sleepy. The other video was different; students got high, experiencing euphoria, emotional disinhibition and hallucinations. Dizziness, pain and drowsiness seem largely determined by toluene and alcohol use, whereas the different effects appear to be caused by the sociality of the contexts of inhalant use, students' subjectivity and their length of consumption. Discussion and conclusion It is argued that students enjoy inhalant use because getting high reinforces their sociality. The article concludes that inhalant use should be discouraged by incorporating the agency and subjectivity of youth, without neglecting the macro-social factors involved in the production, marketing and regulation of inhalants. [ABSTRACT FROM AUTHOR]

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. 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. [ABSTRACT FROM AUTHOR]

Mental disorders in Latin-America are highly prevalent and represent a significant burden on users and their families. These people most of the times have to deal with the stigma attached to the diagnosis they receive. Stigma towards mental illness causes negative consequences for patients and family members, becoming the main barrier to full social inclusion. Considering the above, the first objective of this paper is to analyze the main characteristics of stigma towards mental illness and the psychological and social variables with which it is associated. Secondly, we describe the main strategies for reducing different types of stigma. Finally, we propose approaches to assess and reduce stigma in the context of Latin-America and the Caribbean. [ABSTRACT FROM AUTHOR]

Sexual violence occurs when an individual obtains sexual interaction through coercion, intimidation, blackmail, lesions or threats of physical harm. It ranges from slight approaches to rape, and involves some kind of persuasion to obtaining unwanted sexual interactions; it happens more often in dating relationships. The aim of this paper is to measure the association of sexual attitudes and the acceptance of rape myths with sexual coercion in a sample of college students, and compare these variables by sex and age. The sample was non-probabilistic and included 630 students (51% had experiences of sexual coercion); 71% of men reported practicing sexual coercion. Women who practiced sexual coercion had a less traditional sexual attitude than men (F= 21.413, p<.001), and women who faced sexual coercion had a more permissive attitude in sexual interactions (F=37.432, p<.001). Men who faced sexual coercion blamed rape victims more than women (F=10.603, p=.001). Younger men also blamed rape victims more than the older ones (F=9.841, p=.002). When women use sexual coercion it seems to have a paradoxical implication regarding their gender role. It also appears to be a problem for negotiating safe sexual encounters; women who reported more sexual permissiveness seem to participate more frequently in unplanned sexual interactions and they may be more vulnerable to coercion. It is necessary to modify beliefs about abusive sexual behaviors being normal in dating relationships. [ABSTRACT FROM AUTHOR]

Depression is one of the most common emotional problems in palliative patients. Due to the advanced nature of the disease, several physical symptoms presented by patients overlap with symptoms of depression, making it difficult to evaluate and diagnose the problem. The aim of this paper was to conduct a narrative review of the main instruments used to assess depression when it is present in palliative patients, with a special consideration of the Mexican context. Based on the available data and the scholarly literature, it is more appropriate to conduct an assessment of depression focused on emotional aspects than somatics aspects in palliative patients. Internationally, a number of depression assessments place greater emphasis on anhedonia and emotions, such as hopelessness, than on somatic aspects of depresssion. In Mexico, a considerable gap remains in the development of instruments to identify depression in the palliative setting. Finally, we describe alternative assessments of depression, which could be evaluated and considered in the future in the palliative care setting. [ABSTRACT FROM AUTHOR]

Objective The aim of this paper is to explore in women sex workers the violence they experience in the exercise of their activity, and if it is associated with alcohol use and the consumption of other substances such as cocaine, mariguana and tobacco. Method This is a descriptive, non-experimental study, developed with a nonrandom sample of 103 sex workers selected for convenience type field. The selection criteria were being between 18 and 65 years of age, being a sex worker, and literate. An expressly designed instrument consisting of a semi-structured interview was used. Results Regarding the workplace, 50.8% of them worked in bars, 39.0% on the streets, and 10.2% in cabarets. More than a half reported having suffered violent experiences in the workplace; of these, 95.8% experienced physical violence, 26.0%, sexual violence, and 24.0%, emotional violence. Regarding the actors involved in violent episodes, they were other sex workers (97%), customers (77.2%), owners or employees of bars (30.2%), and police (25.0%). Regarding substance use, 98% of the sex workers reported having consumed alcohol in the past month; 23.3%, cocaine; and 11.7%, marijuana. Likewise, 40% smoked tobacco. Seventy-five percent of the sex workers reported being a high drinker. Most of the women reported that customers generally pressed them in to drinking alcohol and a high percentage reported that they consumed it because of the demands of bar or cabaret managers. The experiences of workplace violence were associated with cocaine use (χ2 = 6.417 [100, 1] df p <.05) and tobacco (χ2 = 7.486 [100.1] gl p <.01). This association remained if violence had occurred in the last month. Alcohol consumption was associated with experiences of physical violence (χ2 = 5.180 [100.1] gl p <.05), and emotional abuse (χ2 = 4.514 [100.1] gl p <.05). Discussion The results show that violence is a common experience in the work environment of these women, and that this is carried out by multiple actors. Findings highlight that sex workers point out to other sex workers as those who exercise more violence. High alcohol use and the use of other drugs are associated with this violence, requiring future studies to explore in-depth this link. The findings are discussed, with recommendations for the care of these problems in female sex workers. [ABSTRACT FROM AUTHOR]

Emotional distress is the subjective sensation of diminishment in wellbeing which manifests itself in a number of unspecific symptoms. It might be a risk factor for the development of mental illness, especially among individuals with psychosocial or biological vulnerability. Recent studies show that primary health care services receive a growing number of patients who suffer distress, but do not fulfill the diagnostic criteria of a mental or physical illness. This phenomenon is more frequent among women. The objective of this paper is to analyze the emotional distress experienced by a group of women who attended primary health care institutions in Mexico City, as well as their perceptions and experiences around the attention received, in order to identify their treatment needs. Data was gathered through techniques and instruments pertaining qualitative methodology. The information was coded and analyzed according to the meaning categorization method developed by Kvale. The results show that the main triggers of emotional distress are associated to daily life worries (lack of money, problems with children, domestic violence, among others). In some cases, it is associated as well with traumatic events, such as violence and sexual abuse in the past or at present. Data also suggest that women do not talk about emotional distress directly during medical consultations and that health care professionals do not identify distress or minimize its importance. These aspects are related to the current characteristics of the service, which lacks a comprehensive approach and a psychosocial point of view. [ABSTRACT FROM AUTHOR]

In the present paper, the multidisciplinary research on Salvia divinorum and its chemical principles is analyzed regarding whether the ethnobotany, phytochemistry, psychopharmacology, and neuropharmacology of this sacred psychoactive plant and main principle clarify its experienced effects and divinatory uses. The scientific endeavor traverses from the recorded traditional ceremonies and beliefs, continues with the botanical identification, the isolation of active molecules, the characterization of mental and neural effects, the possible therapeutic applications, and impinges upon the mind-body problem. The departure point of this search is ethnopharmacology, and therefore the traditional beliefs, ritual uses, and mental effects of this Mazatec sacred mint recorded during a 1973-1983 field research project are described. A water potion of crushed leaves produced short-lasting light-headedness, dysphoria, tactile and proprioceptive sensations, a sense of depersonalization, amplified sound perception, and increased visual and auditory imagery, but no actual hallucinations. Similar effects were described using questionnaires and are attributable to the diteprene salvinorin A, but cannot be explained solely by its specific and potent brain kappa-opioid receptor agonist activity. Some requirements for a feasible classification and mechanism of action of consciousness-altering products are proposed and include the activation of neural networks comprising several neurochemical systems. Top-down analyses should be undertaken in order to characterize such neural networks and eventually allowing to explore the differential ethnic effects. As is the case for other consciousness-altering preparations, a careful and encompassing research on this plant and principle can be consequential to academic undertakings ranging from the mind-body problem and a better understanding of shamanic ecstasy, to the potential generation of analgesic, antidepressant, and drug-abuse attenuating products. [ABSTRACT FROM AUTHOR]

The growing number of publications on the subject of burnout syndrome suggests this is the most widely researched psychological work-related outcome in the last decades. It is important to review the state of art in this phenomenon and to examine the challenging dimension that it has reached. The general objective of this paper was to carry out a systematic review of the published literature in order to characterize burnout research in Mexico. Methods A manual search was carried out in 1 2 databases including Spanish or Latin American journals. All the existent articles up to July 2012 were taken into account and five criteria were defined so as to assure the comparability among the studies. Meta-analyses were estimated with the averages of the burnout dimensions and the Cronbach alpha coefficients reported. Results Sixty-four studies were selected (n=1 3 801 employees); most of them were from health professionals and more than half were collected in Jalisco and Distrito Federal. The methodological analyses revealed that more than 90% of the studies were observational/cross-sectional designs, and most with data analyses that are vulnerable to the effect of confounding variables. A remarkable finding was the huge heterogeneity in the criteria used to determine the prevalence of burnout. The meta-analyses in 14 selected studies showed average burnout symptoms values of "once a month or less" within the frequency scale. Discussion The general balance of this review shows that the research on burnout in Mexico still has areas of opportunity. It is necessary to broaden the range of occupations and regions to improve the methodological designs and the information analyses, and to ensure the used scales have good psychometric properties. Some recommendations for future research are offered. [ABSTRACT FROM AUTHOR]

Although pharmacotherapy is the essential treatment for bipolar I disorder depression, a significant percentage of patients continue experiencing emotional episodes. Cognitive behavioral therapy (CBT), interpersonal psychotherapy and social rhythm and focused family therapy, as well as psychoeducation, share the emphasis on the empowerment of the patient so she/he becomes an active participant in treatment, becomes aware of the nature of the disorder who suffers, and learns to recognize early symptoms of depressive episodes in order to prevent its recurrence. The addition of the CBT aims to alleviate depressive symptoms, restore the psychosocial functioning and prevent the appearance of new affective episodes. Objectives This paper aimed to demonstrate the importance and usefulness of the CBT as an adjuvant of the pharmacological management of depression in bipolar disorder type I in those areas which cannot be resolved by pharmacological treatment (residual symptoms, adherence and compliance with treatment, awareness and understanding of bipolar disorder, identification of prodromal symptoms and developing coping skills). Method Controlled clinical trials about the usefulness of CBT as an adjunctive treatment of patient with depression due to bipolar disorder type I are reviewed. Results CBT increases adherence to drug therapy, decreases the frequency of relapses, diminishes residual symptoms, the need for hospitalization, and the duration time of depressive episodes; it also improves psychosocial functioning. However, these effects diminish over time and its results are lower in patients with more affective episodes and greater comorbidity. Conclusions There is evidence of the utility of the CBT as a useful tool to improve the evolution of the condition in depressed patients due to bipolar I disorder and of the need to extend the time of this and other psychosocial interventions, since this disorder is a condition that lasts a lifetime and causes significant impact on psychosocial functioning of the person. [ABSTRACT FROM AUTHOR]

Epidemiologic research plays a very relevant role to know the prevalence of schizophrenia. However, sometimes data from different studies are compared without taking into account some methodological questions that influence the results. This paper reviews different methodological factors that influence variability of rates in schizophrenia prevalence. Also, we provide some generic recommendations for measuring prevalence. We have revised 52 studies which offer prevalence rates of schizophrenia. A big difference appears in the prevalence rates of schizophrenia which range between 1 to 45 per 1000 inhabitants. The factors founded can be summarized as follows: 1. type of prevalence; 2. denominator population; 3. place of selection of cases; 4. classification issue; 5. diagnoses categories and 6. methods of diagnoses. In conclusion, in the epidemiological studies about schizophrenia prevalence we have to take into account the methodological factors involved in order to interprete and compare results from different studies. [ABSTRACT FROM AUTHOR]

The paper describes and analyzes the concepts related to social networks in Internet addiction psychological and behavioral disorders from a psychological perspective in order to understand the phenomenon of persistent use of ISN and its possible implications. Due to the above, some recommendations are made that will support professional human behavior to identify and avoid or minimize potential abuse problem involving activity belonging to such networks. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction Attachment theory has recently been postulated as a useful framework for enhancing our understanding of the role of psychosocial and environmental factors in relation to the vulnerability, expression, and course of psychosis. In this paper we present the Spanish adaptation and psychometric properties of the Psychosis Attachment Measure (PAM), a 16-item self-report scale specifically designed to measure adult attachment in people with psychosis. Method In study 1, the PAM was adapted into Spanish following the translation/back-translation procedure and was administered to 24 early psychosis patients to evaluate its intelligibility. In study 2, the psychometric properties of the scale were assessed in a sample of 235 university students. The students completed the PAM and the Relationship Questionnaire (RQ) via an Internet website. Results Results from study 1 demonstrated that the Spanish version of the scale is semantically and conceptually equivalent to the original English version and that it is appropriate for use with people experiencing psychotic symptoms. Paralleling the findings from the English version of the instrument, results from study 2 indicated that two factors, conceptually representing anxiety and avoidance, underlie the Spanish version of the PAM. The anxiety and avoidance subscales were found to have adequate levels of internal reliability and to be associated in a theoretically predicted fashion with the four prototypes of adult attachment measured with the RQ. Discussion The good psychometric properties exhibited by the instrument support its use for the assessment of adult attachment styles in the Spanish cultural context and allow for the comparability of findings across cultures. Having a Spanish instrument for assessing attachment in psychosis populations is a relevant contribution that opens up new avenues for research and clinical applications. [ABSTRACT FROM AUTHOR]

At the National Institute of Perinatology, a line of clinical psychological research is the study and treatment of patients with couple problems to generate strategies of intervention based on clinical research. Objective To identify risk indicators in a psychotherapy institutional group process. Material and method The qualitative-interpretative method was used. The sessions, in an open group form, were once a week during two hours. Attendance ranged between eight and 12 participants. 35 sessions were analyzed with the content analysis method. Results The mean age was 32.3 years for women and 35.1 for men. The information was systematized with the most significant stories. The indicators found in women were: impotence and trapping feelings, affective distancing from their couple, confusion of the origin of the relationship conflicts between external and/or internal origins, violent or confused communication, submissive or explosive character, resentment due to a perceived indifference from their couple, history of sexual abuse which difficults a satisfactory development of couple relationships, guilt, and resentment or anger feelings at their parents. The indicators in men were: trapping and impotence feelings due to the control exercised by their couples, violent behaviors on domestic environments, over-exigent and persecutory conducts, difficulty on the individuation process and unsolved conflicts with their primary figures which prevent a satisfactory relationship. Conclusions Marital problems deeply disturb the affective life of people and have familiar and social consequences. This paper is an incursion to un-derstand a small part of the important facts regarding this universe, aiming to be more specific in the treatment plans for people suffering marital conflicts. [ABSTRACT FROM AUTHOR]

Introduction Anorexia nervosa is a suffering entity from eating disorders and family has a relevant role in this disorders; a severe family dysfunction is a risk factor and an important maintainer factor. On the other hand, the family's participation in treatment increases the possibility of success. The aim of this paper is to contribute with the analysis of the form on which the subjects, who suffer from anorexia nervosa and their parents, coexist with their suffering, and share their story. Materials and methods It is a qualitative research study that pretends to know about the family's experiences. The informants where selected according to a theoretical non probabilistic sample. Depth interviews were used and the material was analyzed through a narrative analysis by thematic axis according to Kolher Riessman model. Results The presented family is formed by three members, mother, father and daughter, with anorexia nervosa. Presenting excessively restrictive behaviors oscillating between control and impulsivity. The mother turns her into her confident and the father is too strict and demanding. Concerning the treatment, it lasted approximately three years on impasse, the patient did not show any evolution. Discussion The four evolution moments of the suffering had several points of view according to each of the informants, in literature, the mother and daughter's symbiotic relationship and the peripheral relationship established with the father are mentioned, change was achieved in the family alliances and the change in the nature of their bonds was facilitated. Conclusions These findings are an initial step to know the experiences of each of the family members during the treatment and the expectations they have towards the remission of the suffering. [ABSTRACT FROM AUTHOR]

The subject of this paper focuses on the clinical role of the gaze. The study, based on clinical and theoretical postulates of fundamental psychopathology, discusses mental suffering caused by the destruction of skin. We analyze elements for the clinical management of children hospitalized for burns in order to show the importance of a (visual) device that functions as: 1. a suture for the invasive opening that physical and psychological injuries generated due to the violent and unexpected destruction of skin, 2. protection and symbolic restitution of tissues related to resignifications of mental suffering in a body with burns. [ABSTRACT FROM AUTHOR]

Traditionally, medicine has had an intercommunicating language for use amongs doctors all over the world. Psychiatry has not been an exception, and after a period in which Latin was the "lingua franca", this position was consequently occupied by French, German, and, to a smaller degree, English. Starting with the Second World War, and for obvius reasons, this latter language dominated this position in an absolute manner in a way never before achieved, except perhaps for Latin. There is, however, a huge difference, in that, while Latin was no one's mother tongue, and everyone, including psychiatrists from Romance languages countries, had to learn it, English is the mother tongue for more than four hundred millions persons in the so called First World, many of whom are responsible for the inmense majority of the research carried out in our discipline. An imposition has been placed in the Academic Media, obliging the writing of articles for high impact Journals if one aspires promotion, and the ten Journals of greatest impact in Psychiatry are written in English without exception. Should our reseachers write in another language rather than their owns? What true possibility do they have of having their articles published in those Journals? How many of their tongue peers will have access to that information? These are the questions we will try to answer in this paper. [ABSTRACT FROM AUTHOR]

Chemical substances play an important role in life quality; they are present in household items and consumer products like furniture, cloths, toys, etc. However some of these substances could be dangerous for health and environment. Among the best known are the organohalogens pollutants like the polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs). These substances persist in the environment, they bioaccumulate and may cause adverse effects in humans health. There is increasing evidence that organohalogens cause neurotoxicity in rats and human brains during development. We have been studying the neurotoxicity of Aroclor 1254 (PCB mixture) and DE-71 (PBDE mixture) in collaboration with Currás-Collazo team (UC-MEXUS/CONACYT grants). We show in this paper the principal results of our research related with molecules that participate in the osmoregulatory system, learning and memory as vasopressin, PACAP and nitric oxide synthase. We exposed pregnant rats to this organohalogens perinatally; the pups were allowed to grow until three months old for an osmotic challenge. Brains were processed for immunflourescence, other group was used to evaluate memory with the passive inhibitory avoidance test and Western-blot was done for presynaptic proteins Synapsin I and Synaptophysin. We found a disruption in the content of VP, PACAP and nNOS suggesting that the PCB and PBDE exposure alter the function of hypothalamic neurons that regulates osmosis and water balance. We demonstrated also that PBDE treatment modifies systolic pressure and plasmatic osmolality compared with controls suggesting a cardiovascular alteration caused by PBDEs. We found an alteration in the nNOS activity in Aroclor-1254 treated rats. Memory test and presynaptic proteins expression showed an important reduction in males, suggesting that PCBs alters the expression and activity of nitric oxide and learning and memory. Therefore, due to the neurotoxicity of the organohalogens and its constant contact with humans there is a big concern about the lack of adequate legislation in Mexico and monitoring programs to evaluate the degree of contamination in the population, especially in infants as well as the regions most affected by such contamination. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to review the definitions of psychiatry and the epistemological structure of the discipline as a branch of medical science. Reflection makes sense, because in order to navigate the flood of information provided in the journals and scientific conferences today, the psychiatrist requires a body of doctrine to guide, regulate and structure its practice. Critical study and hermeneutic rigour allow us to specify the three largest circulation definitions on the Spanish-speaking world, and also add some new challenges that social organization is asking the mental health professionals, which must be incorporated into their responsibilities and functions. It also discusses the relationship of psychiatry and the so-called human sciences, neurology and neuroscience, as well as their adherence to the general field of medical sciences. Given the diversity of interests, sources of knowledge and research methods that incorporates within it, psychiatry has been considered as an heterogeneous and heterological science. It is closer to the approach of trans-disciplinarity complexity than the structure of the formal disciplines. This places it in an awkward position within the set of medical sciences. Hence, the transit route passes along the edge of epistemological suspicion. [ABSTRACT FROM AUTHOR]

It is widely accepted that psychiatric comorbidity can increase the severity, chronicity, and treatment resistance of psychiatric disorders. In various studies worldwide, it has been estimated that the prevalence of alcohol use disorders in women with disordered eating behaviors (DEB) is situated at between 2.9 and 48.6%. It is worth noting that previous studies have not considered the analysis of the variables that could explain the comorbidity between DEB and alcohol use in adolescents, such as impulsivity, which is the key variable for explaining this comorbidity. On the other hand, most studies have addressed the adult population in psychiatric hospitals or people with eating disorders (ED) or alcohol use disorders. It is considered that those subjects have already developed psychiatric comorbid disorders. Impulsivity could be an unspecific trait that aggravates the psychiatric condition of a determined person and it is therefore more likely for that person to seek specialized care. According to the above, the role of impulsivity in the comorbidity of ED and alcohol use might not be similar to that of the general population, mostly among those who have not yet developed a whole clinical syndrome. Therefore, we consider that it is important to clarify the involvement of impulsivity in the comorbidity between disordered eating behaviors (DEB) and binge drinking (BD) in high school students. It is also crucial to analyze the association between impulsivity and the coexistence of DEB and binge drinking (BD) in female students aged between 15 and 19 years at public high schools in the State of Mexico. Methods Data for this study were drawn from the Project entitled "Prevalence and Factors Associated with Disordered Eating Behaviors in Adolescent Women with Different Levels of Urbanization and Migration Intensity" (CONACyT-SEP-2004-46560). The design for this study is cross-sectional and analytical. A sample of 2357 female students at 11 public high schools in the State of Mexico was randomly selected during the 2006-2007 school year. For data collection for this project, a questionnaire was used that included socio-demographic variables, the Plutchik Impulsivity Scale (PIS),the Brief Questionnaire to Measure Risky Eating Behaviors (BQREB) and the questions on alcohol use included in the Questionnaire of Surveys on Substance Use in Students in Mexico (2003 version). Data were analyzed with the STATA version 10 survey function. Results Impulsivity was associated with the coexistence of DEB and BD (U=224427; p<0.01). The 3.5% of female students with impulsivity presented DEB and BD together vs. 0.6% who did not; 19.6% of female students with impulsivity presented one of the two behaviors vs. 7.8% without this trait. Impulsivity was associated positively and significantly with the coexistence of DEB and BD (t=3.8; p<0.01), regardless of socioeconomic variables, such as the father's educational attainment, the mother's educational attainment, and the number of services in the household. Conclusion The results of this paper indicate a statistically significant association between impulsivity and the coexistence of DEB and BD. This means that there is a greater percentage of coexistence of DEB and BD in female high school students considered to be impulsive in comparison with adolescents without this trait. This occurs regardless of socioeconomic variables, such as the father's educational attainment, the mother's educational attainment, and the number of services in the household. Future research should establish the role of other variables such as depression and examine the association of impulsivity with socioeconomic variables. [ABSTRACT FROM AUTHOR]

The recently modified General Law on Health (Ley General de Salud) establishes in article 74b, section VII, that any individual with mental or behavioral disorders will have «The right to be treated and cared for within his community or as closely as possible to his family's or friends' place of residence»; this leads us to the questions titling this article. In Mexico, according to the National Psychiatric Epidemiology Survey, 28.6% of the population has presented one of the 23 IDC disorders at some point in their lives. Only one out of 10 patients with a mental disorder had access to specialized care. One of the most important limiting factors explaining the difference between subjects requiring services and those being provided for is the insufficient number of available psychiatrists. The worldwide mean number of psychiatrists per 100000 individuals is 3.96 (SD 5.94) and their distribution varies from one region to another; they average 0.06 in low-income countries and 9.0 in those with high incomes. As a medical specialty, psychiatry is relatively new. Not until the XIXth Century did the treatment of mental disorder become part of the medical realm. In Mexico, the teaching of psychiatry as a specialty begins in 1950. In 2010, 137 positions for Psychiatry residency were made available throughout the country: Campeche, Coahuila, Jalisco, Mexico City, Nuevo León, Puebla, Sonora, San Luis Potosí, Tabasco, Tamaulipas and Yucatán. Most openings (and educational venues) providing specialization in Psychiatry are in Mexico City. Regardless, the number of psychiatrists remains scarce and the scope of their activity does not fulfill the World Health Organization's recommendations. The purpose of this paper was to determine the number and distribution of psychiatrists in Mexico and propose new fields for their activities. Methods A descriptive, cross-sectional, heterodemic study was conducted. The following data sources were reviewed: the 2008 Directory of the Mexican Psychiatric Association (MPA), the 2008 Directory of the Mexican Council of Psychiatry (MCP) and the II Assessment of Population and Housing (2005). Results In the Directory of the Mexican Psychiatric Association, 1397 active members were reported. In the Directory of the Mexican Council of Psychiatry, 1430 certified psychiatrists are tallied. We noticed that in total, there are more certified psychiatrists than members of the MPA. In terms of the second objective, we established that except for Mexico City, the number of psychiatrists vis-à-vis the number of inhabitants is notably inferior to the worldwide mean of 3.96/ 100 000, throughout the rest of the country. In 22 states, there is less than one psychiatrist per 100 000 inhabitants. Discussion In Mexico, the number of psychiatrists is insufficient to attend the population's needs; hence, as proposed in 2001 by the WHO, the option is to restructure the management of mental disorders via specific actions. In the model proposed for mental health, a continuum is established whereby care is provided directly in the community and progresses into that offered in the so-called «highly specialized» centers, psychiatric hospitals. This continuum follows a pyramidal pattern whereby the base, where most actions are concentrated, includes self-care and the apex represents specialized care. Where should psychiatrists be in this pyramidal context? At first glance, it would appear that the psychiatrist's expected activity realm would be within psychiatric services per se, such as in general or specialized hospitals. However, following the described pyramidal structure, most interventions take place at the base: self-care, informal care within the community and mental health care at the primary care level. It is interesting to mention that in another state, among all certified psychiatrists not one was assigned to primary care and only 18% were active in a general hospital. In the context of pyramidal care, who will provide the necessary information required for the encouragement of self-care? Informal care in the community refers to that provided by individuals without formal training and that should be trained in order to become the first contact point for patients with mental health issues. Mental health care at the primary care level has been broadly reviewed but the identification of a successful model depends not only on a particular country's circumstances but also on specific regions within that country. Until now, training primary care physicians has not proven to be an effective strategy in increasing mental health care coverage unless they are directly integrated within formal mental health services. An effective strategy is supervision and support of primary care physicians by psychiatrists. A possible schema could include the programming of case reviews and constant feedback to the primary care personnel such as physicians and psychologists. The community should be at the forefront in terms of the practice of psychiatry. From said position, the psychiatrist can: 1. support selfcare and informal care programs, 2. supervise and offer support to primary care providers, 3. provide direct attention to mental health issues requiring specialized attention and 4. act as a link between the different care levels. A psychiatrist's activities within a general hospital allow: 1. integration with medicine, 2. the appropriate management of nonpsychiatric co-morbidities due to more available resources and 3. blunting of stigmatization. Other forms of care for patients with mental health disorders deserve a paragraph; although their usefulness has been proven they have not been evaluated in our country and their application has not become commonplace. We are referring to daytime hospitalization and homecare provided by a team specialized in the management of crises. These models also require a psychiatrist as part of the team. The purpose of this study was to provide an overview of the activity of psychiatrists in Mexico without intending to exhaustively review the current situation. Its limitations are obvious since only certified and/or MPA members were included. Although we included all psychiatrists that at some point were certified and not only those with active current certification, it is evident that there are colleagues that belong to neither professional organization although these two include the greatest number of the country's psychiatrists. [ABSTRACT FROM AUTHOR]

International interest has grown over the past 15 years in the prognostic potential of early identification and intervention in the prodromal and first-episode phases of psychosis. This focus is associated with increasing optimism about the benefits of implementing treatment as early as possible in the course of psychosis, at least to help improve the course of illness, reducing its long-term impact. A clearer framework for guiding, designing, and evaluating preventive interventions in mental disorders has been developed. As a consequence, a series of research projects and real-world services systems are currently emerging. Additionally, several influential international figures and research groups have developed and cooperated in disseminating a more optimistic set of ideas concerning early intervention in psychosis. The early psychosis programs developed worldwide have a number of common elements and goals: a) early detection of new cases, b) reducing the duration of untreated psychosis (DUP), and c) providing better and continued treatment during the «critical period» of the early years of the disorder. Moreover, family interventions usually offer psychoeducation and/or individual and group family therapy, in conjunction with communication and problem solving training, which can help to develop coping strategies and reduce distress and burden. Intervention programs in early psychosis are usually composed by interdisciplinary teams, providing a wide range of integrated services that typically include psychoeducation, clinical case management, and group interventions. Specific interventions generally include pharmacotherapy, stress management, relapse prevention, social and employment rehabilitation support, and cognitive and family therapy. The current challenges in the implementation of psychological interventions in the early stages of psychosis are: 1. to adapt treatment modalities that have been proven effective in stable and residual stages of the disease to its early stages; 2. to develop new forms of therapy tailored to the specific characteristics of these early stages of psychosis; and 3. treatment packages need to be individually tailored to specific needs rather than applied homogenously across early psychosis patients. One example of the integration of all these aspects is the «needadapted integrated treatment» developed by Alanen et al. in Finland, which combines different forms of treatment in a flexible, individually designed intervention in order to take into account the needs of both patients and families. Following the experience and work of Alanen et al., an Early Psychosis Program (EPP) currently is being developed in the Mental Health Services of Sant Pere Claver in Barcelona, addressed to young people between 14 and 35 years with at risk mental states (ARMS), first episode psychosis (FEP), and post-crisis stages of psychosis. All cases included in the program are derived from various community resources (primary health care, schools, emergency services, and inpatient units for acute patients) and assessed exhaustively by the team to define the treatment plan for each case. The treatment modalities offered by the EPP are: individual and group therapy, unifamiliar and multifamiliar psychotherapy, psychoeducation and pharmacotherapy in those cases where necessary. Furthermore, there is an intensive community support for those patients who have difficulties engaging with mental health services. During the EPP all patients are monitored through weekly visits with their psychiatrist, psychologist, social worker and/or nursing staff. The aim of this paper is to present and describe the integrated need-adapted treatment approach of the early psychosis program currently being developed in a specialized center in Barcelona (Spain). [ABSTRACT FROM AUTHOR]

The purpose of this study is to identify and describe the actions designed to combat the commercial sexual exploitation of children (CSEC) which jeopardizes or affects the victims of exploitation. To this end, the paper analyzes the paradoxical results obtained in the research and actions to combat CSEC, implemented under the auspices of the institutions to promote research on CSEC and the prevention, protection and care of child victims of the phenomenon. These results were obtained by the research team when it systematized 16 CSEC diagnoses undertaken in various parts of the country and from the information derived from the fieldwork carried out between 2000 and 2005 by the Inter-Institutional Committees to combat CSEC and at the institutions for the protection and care of child victims of sexual exploitation. The fieldwork involved participant observation during the working meetings of the Inter-Institutional Committees and at the «closed door» shelters inhabited by children and teenage victims of sexual exploitation. Individual interviews were conducted with the population of the shelter. Individual interviews were carried with the population at the shelter, with a good rapport being established with the various informants. They were asked to give their informed consent and assured of the confidentiality and anonymity of their identity. Participants were also given information on their health and referred to medical and psychological services when required. The systematization of the 16 diagnoses basically describes the parts of the country where the studies were carried out; the type of institution responsible for the diagnosis; the objectives pursued; the type of techniques used to obtain information and whether or not the study complied with the basic ethical standards for the care and benefit of the informants participating in the diagnoses. The researchers stressed the ethical handling of the information and the implications of this for the child victims identified. The main results show that the research was carried out in 48 municipalities, with 68.75% being carried out by institutions and organizations specializing in social assistance and/or private consultancy. Only a third of the studies (31.25%) were conducted by institutions specializing in social research. A total of 62.5% of the studies utilized quantitative techniques, while 43.75% employed qualitative techniques and 6.25% of the research combined the use of both techniques. Moreover, most of the research failed to pay sufficient attention to the ethical aspects of protecting the informants; 75% of the informants reported not having been asked to give their informed consent, adding that no benefits were provided for the victims interviewed during the research. The results of the fieldwork in the various shelters revealed various institutional practices regarding the care of child victims that paradoxically ended up jeopardizing the child population they were supposedly trying to benefit. Although the various shelters had protocols for permanent, comprehensive care (medical, psychological, social/familial) for the resident child population, the institutions' programs and installations frequently lacked sufficient personnel and resources to guarantee proper care, particularly as regards physical and mental health. At the same time, there was a tendency to implement discriminatory measures in the case of girls who had been sexually exploited. They were asked to meet health requirements, placed in isolation, and subjected to diagnoses of their sexual practices and orientation that were not required of other children and teenagers admitted without having had a background of engagement in sexual commerce. At the same time, the institutions did not always meet the recommendations of the care protocols, since they ended up prioritizing moral mandates on the behavior and lives of the girls affected by CSEC over the well-being and health the children required and/or wanted. In short, we found that the actions for researching and caring for child victims tended to violate the basic general principles of the Convention on the Rights of the Child, such as non-discrimination, emphasizing the child's higher interest, her voice and points of view and guaranteeing his or her right to life, survival and development. The article concludes that in the experience of Mexican state institutions' and civil society's efforts to combat CSEC, there has been a rush to organize and carry out actions without having the resources to achieve this. This includes a lack of ethical research committees, specialized medical care and necessary healthcare networks, but above all, the fact that they have yet to fully assimilate the rights approach. This means that within CSEC, there is tendency towards a highly formalized, normative implementation of the rights approach while there is a prevalence of practices and conceptualizations based on a view of the children's «irregular situation» and the risks and problems they face. Similar results have also been observed in most of the Latin American countries that ratified the Convention on the Rights of the Child. As in Mexico, many of the countries implemented the rights approach in a formalistic manner. They assumed that simply citing the articles in the CRC in the laws, trials, inter-institutional committees, research, programs to benefit children, leaflets for tourists, radio and TV programs, etc., would suffice to change the cultural beliefs and practices that for many years have enabled adults to interact with children as «minors», subordinates, property or even merchandise. After a decade of formalist applications in Latin America, the results suggest that no state has managed to ensure that all children will effectively enjoy, without discrimination, the human rights to survival, development, participation and protection in special situations in which their rights are violated. Contrary to expectations, the paradigm of irregular situations has not been replaced by a rights approach and the two situations have coincided instead. As in Mexico, there has been a process of progress and regression, resulting from the unequal permeation of the various institutional and cultural spheres by the principles of the Convention. This has been determined by various factors: the CRC's degree of penetration of normative regulations; the sociocultural diversity of the populations which the authorities are attempting to benefit; the role of the state, the market and civil society in the provision of services for children; the availability and accessibility of resources; corporate resistance to change and the influence of political parties, among others. According to Pilloti, the formalistic implementation of the Convention on the Rights of the Child in Latin America is implemented from rigid, exclusive conceptions that ignore the moment and the historical, social and cultural context and fail to contribute to the analysis of the problems affecting children and/or the drawing up of strategies to discourage this. The formalistic application of the CRC tends to overestimate the role of laws and judicial procedures as instruments of social change, by separating the discourse on children's rights from the socio-economic and cultural reality in which the injustices affecting children are expressed. [ABSTRACT FROM AUTHOR]

It has been suggested that anhedonia is a core symptom of the disorder that precedes and possibly plays a causal role during the subsequent development of schizophrenia. Several works confirmed high levels of anhedonia and lower levels of intrinsic motivation and positive affect in schizophrenic patients when compared to control subjects. On this paper we are dealing with the term gaudiebility, which is defined as a construct that includes all the set of modulators which regulate the enjoyment. The aim of this study was to evaluate if people suffering from schizophrenia show levels of gaudiebility significantly lower when compared to the average population. Data were obtained from two different adult samples. One sample (n=30) made up by schizophrenic patients of Hospital del Mar de Barcelona (Spain), the other one (n=37) made up by the general population was obtained by the use of snowball technique. All participants agreed to reply in writing to the gaudiebility scale (Padrós and Fernández, 2008). The results show that people diagnosed with schizophrenia (mean=48.27 and SD=11.22) showed lower scores in the level of gaudiebility [F (3)=4.303, p=.008] than control group (mean=56.73 and SD=9.80). The results came out as expected and were also consistent with the high levels of anhedonia, as well as with the low positive affective and intrinsic motivation levels found in different research. Further studies controlling the schizophrenia subtypes and the sociodemographic variables are required. Our pilot study suggests that the low gaudiebility levels found in schizophrenic patients should motivate the design of specific intervention programs to raise gaudiebility levels. [ABSTRACT FROM AUTHOR]

The consumption of substances with addictive potential is a relevant health problem. In Mexico, the abuse is spreading and the use of services is unfrequent. To extend the offer and accessibility to treatment means to increase the coverage and to guarantee that efficient and effective models are used to treat the patients. The aim of the paper was to learn what has been investigated in this respect; a systematic review of the studies was undertaken to evaluate the treatment research through clinical trials. Methods A review of the published literature from 1980 to 2010 in databases and specialized documentation centers was undertaken. Reports of clinical trials to evaluate interventions for the consumption of alcohol, tobacco and drugs were included. The criteria proposed by CONSORT were used as indicators. Results Two hundred and twenty publications were located on treatment in Mexico, of which only 26 (11.8 %) corresponded to clinical trials to evaluate the impact of different interventions. The most used type of treatment was the cognitive-behavioral brief one, followed by its combination with therapy of replacement, pharmacological therapy and individual psychotherapy or group therapy. Trials also included evaluation of motivational brief therapy, the program «La familia enseñante» (teaching family) and psychotherapy, as well as the therapy centered on solutions. Discussion Most of the clinical trials localized do not comply with the criteria or do it partially. Additionally they have short scopes due to the limited size of the samples. The results reveal that the reports published of investigations are very scanty to evaluate programs of treatment. There is a need to implement programs of treatment directed to specific populations and to the use of different types of drugs, and to evaluate the interventions. [ABSTRACT FROM AUTHOR]

Schizophrenia-spectrum disorders have a chronic and episodic course that results in impairment of all life domains. Pharmacological and psychosocial treatments provide symptom relief, but there is not a cure for schizophrenia and many patients suffer chronic impairment. In addition, it is expensive both in economical terms and also in terms of personal costs for both patients and their families. International interest has grown over the past 15 years in the prognostic potential of early identification and intervention in the prodromal and first-episode phases of psychotic illness. This focus is associated with increasing optimism about the benefits of implementing treatment as early as possible in the course of psychosis at least to help improve the course of illness, reducing its long-term impact. The most recent epidemiological studies have shown that patients with longer duration of untreated psychosis (DUP) have worse short-term outcomes in terms of treatment response, positive symptoms, negative symptoms, and global functioning. Neuroimaging studies have also indicated that prolonged untreated illness is associated with more pronounced structural brain abnormalities, while this is less prominent earlier in the course of the disorder. Therefore, early detection aims to reduce treatment delay in the hope of improving prognosis and reducing illness severity. Early intervention in psychotic disorders has gained momentum in the last decades, and there is now an estimated 200 centers worldwide offering specialized services for young people experiencing their first episode of psychosis. Each of these programs has unique characteristics and distinctive features in terms of treatment modalities and assessment tools, but most have a number of common elements and goals: a) early detection of new cases, b) reducing DUP, and c) providing better and continued treatment during the «critical period» of the early years of the disease. Moreover, the role of family work in early psychosis can be crucial given that relatives are the main informal caretakers of persons with mental health problems. Family interventions in early psychosis usually offer psychoeducation and/or individual and group family therapy, communication and problem solving training, which can help to develop coping strategies and reduce distress and burden. Intervention programs in early psychosis are usually composed by interdisciplinary teams, providing a wide range of integrated services that typically include psychoeducation, clinical case management, and group interventions. Specific interventions generally include pharmacotherapy, stress management, relapse prevention, social and employment rehabilitation support, and cognitive and family therapy. Given the complex etiology and clinical manifestation of psychosis, treatment packages for people experiencing early psychosis need to be individually tailored to specific needs rather than applied homogenously across early psychosis patients. The current challenge in the implementation of psychological interventions in the early stages of psychosis are: 1. to adapt treatment modalities that have been proven effective in stable and residual stages of the disease to its early stages; 2. to develop new forms of therapy tailored to the specific characteristics of these early stages of psychosis (prodromal and ultra high-risk phase, onset and first episode psychosis, and «critical period» or post-crisis psychosis); and 3. treatment packages need to be individually tailored to their specific needs rather than applied homogenously across a group of patients. The aims of this paper are: 1. to present the basic concepts, rationale and state of the art of the early detection and intervention paradigm; 2. to review and present the main detection and intervention programs in early psychosis and 3. to provide an overview of the current psychotherapeutic approaches in early psychosis. [ABSTRACT FROM AUTHOR]

The study and analysis of different factors related to the academic performance of medical students remains a topic of interest, either for selection processes or for the establishment of strategies and interventions to support students who may need it. It is said that there are two groups of features associated with academic performance: the academic (high school grades, scores on entrance exams) and non-academic (personality traits, presence or absence of psychopathology, sociodemographic aspects) characteristics. The purpose of this study was to identify the influence that different features of a group of medical students from the High Academic Performance Program (HAPP) at Universidad Nacional Autonoma de Mexico (UNAM) had on their school performance. Materials and methods This paper presents the one year follow up of a cohort of students initially studied during the selection process to entry the HAPP of Medicine School at UNAM. We evaluated all first-year medical students of UNAM who, during 2009-2010, continued to be part of the HAPP and who agreed to participate in this research. At the end we studied 94 students (48 men, 46 women) with a mean age of 18.3 years. The analyzed variables were: academic performance, demographic factors, academic background, personality, abstract thinking, creative thinking, mental disorder. For the initial evaluation at the entrance to University we used the Minnesota Multiphasic Personality Inventory -2 (MMPI-2), the subscale of abstract reasoning from the Differential Aptitude Test (DAT), a semi-structured interview to investigate demographic and academic characteristics, and the figural test from the Torrance Test of Creative Thinking. In a second assessment (at the end of the first year), we applied the MMPI-2 (for a second time with the intention to avoid the pressure that students could have during the selection process to enter the HAPP) and Mini-International Neuropsychiatric Interview (MINI) to assess the presence of psychopathology. Also, final grades were collected from the academic file of each student. For statistical analysis we used ANOVA, multiple linear regression models, bivariate correlations and cluster analysis. Results The general knowledge test was presented as the only significant predictor for both the final average for all subjects separately, and for the final general average. Results: The general knowledge test was the only significant predictor for both the final average and the final grades for each subject. Characteristics of creative thinking (e.g fluency) or personality traits (such as MMPI-2 Mania scale) were significant predictors for the final average for most of the subjects, however they were not consistent at all. Anatomy (r= 859), developmental biology (r=852), biochemistry (r=.893) and cell biology and tissue (r=.889) were subjects whose average had a high correlation with the global final average, while public health (r=.696) and medical psychology (r=.670) showed a moderate correlation. The score of abstract thinking (r=.029) had not any correlation with the final average that these students got at the end of the year. A comparison between the two measurements (one at the entrance to Medicine School and the other one year later) of the MMPI-2 was made and we found that there was a pattern of consistency between measurements and all correlations among the different scales that shape the inventory were significant (p<.001). Hypochondriasis, Depression, Hysteria and Psychasthenia scales, tended to rise significantly. In order to evaluate the presence of psychopathology in these students at the end of the first year of Medicine School, the MINI it was used. Of the 96 students, it was found that 77 (80.20%) had no psychopathology, and that 19 (19.79%) had one or more mental disorders at the moment of the interview. The disorders that presented the participants were: major depressive disorder (n=15), generalized anxiety disorder (n=7), bipolar disorder (n=1) and anorexia nervosa (n=1). To determine the influence of the presence of psychopathology on the students final grades, we analyzed the differences between the group of students without any mental disorder and the group with psychopathology. There was no statistically significant difference in the general final average (U=678 500, Z0-.503, p=0.615), and it was a characteristic that only made a difference for the final grades of Anatomy (U=475, Z=-2.50, p=0.012) and Public Health (U=544, Z=-2.007, p=0.045). None of the socioeconomic aspects influenced the students' academic performance. Discussion For the group of the evaluated students, we only found that the general test scores of knowledge is a significant and consistent predictor for average subjects in the first year and the final general average. Conclusions The general knowledge test was a useful predictor for final grades because it seems to summarize many of the skills and habits related to student academic success. [ABSTRACT FROM AUTHOR]

Introduction Depression and its symptoms are becoming one of the most important health problems worldwide. The impact of depression on the productive life of people, and the burden it represents because of its co-morbidity, is growing. Some authors estimate that depression is the second cause for the global loss of years of healthy life and the first one in developed countries. An increasing proportion of teenage population has mental health issues. Depression and its symptoms are among the most common, but they are not an epidemic problem yet, although spread enough as to maintain interest in its current impact and in its negative consequences over individual health. Depression has a prominent place among mood disorders in Mexico (4.5%), and women are who mostly suffer it (5.8%), which has remained consistent over time. Different difficult situations occur during adolescence along with depression, depressive mood, and depressive symptoms. This situation may be related to changes and processes that occur during this period when individuals cope with situations they cannot handle, which in turn become stressful. Therefore, it is necessary to study and to work with adolescents in order to be able to differentiate affective, cognitive, somatic, and behavioral expressions, which are proper to this stage, from those possibly caused by an illness that could have negative consequences. Adolescent depression influences mood and the way individuals live unpleasant or annoying experiences, thus it affects almost every aspect of life and becomes a risk factor for psychiatric and behavioral problems. However, there are some areas that need more research, for example: the specific characteristics and expressions of the problem including gender comparisons and using designs with special groups. Data show that depression is growing in adolescents; therefore it is a priority to work on detection and prevention to reduce its impact on mental health and to develop cost-effective intervention strategies. One way to do this is using valid-reliable screening tools because they are cheap, and methodologically-logistically useful. The Center for Epidemiological Studies Depression Scale (CESD) has been used in different studies with Mexican adolescents, and has proven to have good psychometric characteristics. The CES-D has never been used with an entire population in a great scale study. The objective of this paper is to measure the validity and reliability of the scale (construct, concurrent, and external validity, as well as internal consistency) in a population of high school and college freshman students from Mexico City. Method Design. The study was a census made with high school and college freshman students during 2009. Data were collected in 22 schools. Population. A sample of 58568 students participated in the census. The mean age was 17 years old (±2.7). Most of the students lived in homes with one to four other persons at the moment of the study (55.4%); 86% said that only their father worked at that moment, and 59.4 said that only the mother; 79.7% of the students lived with both parents, and 17.9% only with their mother; 57403 students (98.0% of the population) completed the CES-D in the age range of 14-24 years: 27264 (47.5%) men, and 30139 (52.5%) women. Instrument. The Automated Medical Examination (Examen Médico Automatizado-EMA) is a diagnostic questionnaire designed by the General Directorate of Medical Services (Dirección General de Servicios Médicos) of the Universidad Nacional Autónoma de México (UNAM). It is a questionnaire with four self-report forms that collect information about the physical and mental health, the family, and the general context of every student. This information is used to create a diagnosis of vulnerability and a predictive profile for developing prevention programs, as well as research protocols that help in promoting a culture for health care. The CES-D was included for the measurement in 2009. Results Overall internal consistency was adequate (α=.83). Internal consistency was tested by sex; the coefficient was higher for women (α=.84). Factor analysis generated a four-factor solution (explained variance 54.1%); each factor had good internal consistency and theoretical agreement. The scale showed a significant discriminative power for opposite scores (z=-144.121, p<.001), and a positive significant correlation with the Okasha Suicidality Scale (rΦ=.325, p=.000). A cut-off point of 16 or higher was established to identify students with high depressive symptomatology. 14.7% of the participants in this study had high depressive symptomatology (11.1% men, 17.9% women). Conclusions The CES-D is a valid and reliable epidemiological instrument for different populations. Since depression is a complex and dynamic phenomenon, it is important to evaluate the psychometric properties of any instrument used to measure it. The results of this study showed that the CES-D maintains its internal consistency as well as good concurrent-external validity. Coefficients are higher for women and they increase with age; thus, it would be necessary to refine some aspects to measure younger subjects in a more consistent manner. The data proved that CES-D is a useful instrument for distinguishing different levels of depressive symptomatology; this is relevant because the scale is often used in collective contexts, allowing systematic monitoring of depression with good cost-effective results. Monitoring is also important to keep acceptable levels of emotional wellbeing in student population. Development and refinement of instruments such as the CES-D would potentially lead to opportune and reliable detection of adolescents who may be at risk for suffering mental health problems. This would facilitate implementing more stable and continuous prevention and attention programs to reduce the negative impact of depression in the short term. [ABSTRACT FROM AUTHOR]

This paper shows the evaluation of the effectiveness of a selective prevention on drug use in adolescents, based on the Theory of Planned Behavior by Azjen. To develop this program, different theoretical models were evaluated considering their suitability to the institutional context in which it will be implemented. The criteria used to select a model that could be useful as a basis to design and evaluate a preventive intervention for drug use included: a) incorporation of protective and risk factors that could be malleable; b) consistency, parsimony and theoretical economy; c) a demonstrated explanatory and predictive capacity; d) empirical effectiveness; e) practical applicability. One of the models that complies with these requirements is the Model of Planned Behavior by Azjen, which proposes that the most immediate causes for drug use are the intentions of the subject to consume them or not. These intentions are determinated by the «attitudes» toward drug use, by the normative beliefs or «subjective norm» and by the Perceived Behavior Control. Attitudes toward the behavior are a person's overall evaluation of the behavior (i.e drug use) and the corresponding positive or negative judgments about it. The normative beliefs or subjective norms are a person's own estimate of social pressure to use or not to use drugs. Subjective norms have two interacting components: beliefs about how other people, who may be significant to the person, would like them to behave (normative beliefs), and the positive or negative judgments about each belief (outcome evaluations). Perceived behavioral control is the magnitude to which a person feels able to carry out the behavior. It includes two aspects: how much control a person has over the behavior; and how confident a person feels about being able to perform or not the behavior. It is determined by control beliefs about the power of both situational and internal factors to inhibit or facilitate the performance of the behavior. Perceived behavioral control, the last element introduced in the theory, along with the attitude to conduct, and the subjective norm, contribute, all of them, to predict the behavior intention. Generally speaking, there is important empirical evidence concerning the predictive and explicative capacity of this model in different populations. Once the theoretical model was chosen, indicators related to constructs of the Theory of Planned Behavior were elaborated adapting these constructs to the features of middle education Mexican population by means of a series of interviews with focal groups. Based on these indicators, a scale was constructed to prove the explanatory capacity of the theoretical model in Mexican population. The reliability and validity of this self-applied questionnaire was proved. Once this was done, based on these antecedents, the model was adapted in a practical sense. This means that the content, objectives and techniques for a preventive intervention were developed. This preventive intervention was piloted and then evaluated through the aforementioned scale. The program included attitudinal and normative components, conformed by informative strategies and persuasive messages directed to an attitudinal change, as well as the development of strategies of behavioral control focused on social abilities that included components derived from social learning theory, and a series of cognitive behavioral techniques accorded to the Planned Behavioral Theory. It was expected a reduction in the drugs use intention by means of a change of drug use favorable beliefs as well as reinforcing unfavorable beliefs of drug use. It was also tried to change the perception about the magnitude of drug users in the subject's immediate surroundings and on its perception about social acceptance or tolerance for drugs. Also it was tried to increase the perception of self control, in order to the develop behavioral control skills to refuse the offer of drugs. The first sessions (devoted to work on subjective norm) were directed to create an interest in the participants regarding to their relation with favorable situations to drug consumption, and to modify their perception about the real magnitude of drug use and about approval and social tolerance to them, both topics frequently overestimated for some adolescents. These sessions were also devoted to identifying beliefs associated with drug use and the value that participants give to these beliefs, in order to question those that are established upon false premises. The next sessions (devoted to perceived behavioral control) had as an objective to learn appropriated behavioral responses to confront risk situations, in order to increase the perception of self-control in those circumstances. This was achieved by means of modeling, essay and reinforcing techniques. This model was designed to be applied in groups no greater than 15 persons, twice a week in five sessions of 50 minutes each. The program was applied by professional personnel such as psychologists or social workers with previous experience in drugs use prevention. The program was implemented in three groups (one for each grade) of five high schools in Mexico City and was applied to three groups of school, randomly chosen; other three groups, in the same grades, were used as control groups. The groups were randomly chosen. Other three groups, in the same grades, were used as comparison groups. Then, the final sample was composed by 250 participants (96 from intervened groups and 154 from comparison groups) from 12 to 15 years old, and with slightly more men than women, but equivalent for cases and control. The results showed that the intervened group had a statistical significant reduction in the intention of drugs use. On the contrary, the comparative group showed an increasing intention to use them. With respect to the set of variables that predicted the behavioral intention, the perceived behavioral control stands out as the variable that had the greatest change. There were no significant differences in pre-post measures in the control group. Differences between pre-post measurements were also contrasted between both groups using a Student's t test that showed significant differences in perceived behavioral control and behavioral intention variables. Finally, in order to get a greater control on the test scores, an ANCOVA analysis was applied using the post-test scores as dependent variable and the pre-test scores as covariables. This analysis was useful to corroborate the significance of the drug use intention in the future, mainly in situations that require an amount of self-control, while attitude and normative variables did not show significative changes. Outcomes confirmed the pertinence to give greater resources (time, quantity, and complexity of activities, didactic materials, etc.) to the sessions devoted to developing behavioral control skills. These results can be considered satisfactory, because the main objective of the program was to reduce the intention to use drugs; however, it is also necessary to strengthen the attitudinal and normative components. It is necessary to consider that the variable «subjective norm» obtained the lowest levels in confidence, possibly because of the use of self-reported answers in a variable so sensitive to the influence of social elements. For this reason, it is necessary to develop questions that diminish this element that, according to Doll and Azjen, can explain, even a 5% of variance in «behavioral intention». Finally, it must be considered that this evaluation shows the effectiveness of the program to achieve the expected changes in behavioral intention variable only in controlled situations. It is necessary to investigate if it is possible to obtain similar results in more usual conditions and with other populations. This means that as well as to grant the internal validity of the evaluation it is also necessary to establish its external validity. [ABSTRACT FROM AUTHOR]