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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]

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]

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]

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]

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 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]

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]

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]

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]

Introduction Depression is a public health problem that carries substantial costs for the individual and the society. In order to establish evidence-based priorities for resource allocation in mental health care, it is necessary to integrate the costs and effectiveness of interventions and specify the essential packages for their treatment. The following are pioneering studies of cost-effectiveness for the treatment of depression: 1. compared psychopharmacology options (fluoxetine, imipramine and desipramine) to found no difference between drugs in terms of clinical efficacy, effect on quality of life and costs, and 2. evaluated cost-effectiveness of collaborative program of stepped care in primary care of persistent depression, to demonstrate a substantial increase in the effectiveness and additional moderate cost increase in comparison with usual treatment. Recently, the World Health Organization convened the National Institute of Psychiatry Ramón de la Fuente, as a collaborating center, to participate in the «Selecting interventions that are cost-effective» labeled WHO-CHOICE (CHOosing Interventions that are Cost-Effective). This paper presents the findings of the evaluation of costeffectiveness of different clinical interventions for the treatment of depression in Mexico, considering its implementation in primary care services. Method The cost-effectiveness unit of measure gathered by WHO (and used in this work) are the years of healthy life lost because of disease, named DALYs (Disability Adjusted Life Years). DALYs result from the sum of years lost by premature mortality over the years that are lost through living in disability status. The advantages of using a measure of health at the population level as lost DALYs is that it allows comparing interventions for different diseases and addresses a relevant question from the avoidable burden health policy standpoint. Interventions evaluated included: 1. tricyclic antidepressants, 2. new antidepressants (SSRIs), 3. brief psychotherapy, 4. trycliclic antidepressants + brief psychotherapy, 5. new antidepressants + brief psychotherapy, 6. tricyclic antidepressants + brief psychotherapy + proactive case management, and 7. new antidepressants + brief psychotherapy + proactive case management. DALYs avoided as a result of each intervention or combination were calculated to determine its effectiveness. Both patients and program costs, a 3% discount by the process of converting future values to present ones, as well as an age adjustment giving less weight to year lived by the young were included. Finally, the cost of averted DALYs for each intervention was estimated to determine their cost effectiveness. Results The combined strategies of proactive case management with psychotherapy plus antidepressants can be considered as the most effective one. With the combination with tricyclic antidepressants, the number of DALYs averted was 207,171, and with SSRI of 217,568, corresponding to more than double of DALYs when tricyclic antidepressants are used alone and almost double when using only SSRIs. The most expensive intervention was the combination of SSRIs with brief psychotherapy, with a total of $12,256 million pesos (972 million dollars), the least expensive treatment were tricyclic antidepressants, which involved $4,523 million pesos (359 million dollars). Over 99% of the costs were from patient medications, and less than 1% from program and training costs. It is clear that the greatest cost is for added proactive case management. The use of SSRI was the most cost-effective treatment (no combination) for the management of depression in Mexican primary care. The most cost-effective combination was tryciclic antidepressants plus brief psychotherapy plus proactive case management. Conclusions Although the are some studies on health economics in Mexico, most are directed to consider costs, and few ones have evaluated the cost-effectiveness relationship of diagnostic and therapeutic interventions, lees son in the mental health field. Antecedents of the present study in Mexico included a study that observed that psychiatric patients require more medical consultations, laboratory analysis, hospitalization days, surgeries and medication, in contrast with patients that never needed mental attention. Nevertheless, investigations about cost-effectiveness relationship are rare. Just one study evaluates the costs of positive changes in psychopathology with antipsychotic medication for the treatment of schizophrenic patients. In this direction, the present work is the first effort to evaluate cost-effectiveness of different communitarian interventions to treat depression in Mexico. According with our findings, also in México, the interventions available to treat depression in primary care level prevent a substantial number of DALYs: almost six times when SSRIs plus brief psychotherapy plus proactive case management are administered. The specific effect of proactive case management is preventing relapses and increasing the time free of disease, which results in greater benefit to the patient, his family and the society. Thus, interventions are cost-effective despite the proactive case management significantly increases the cost of care to these patients. In conclusion, the inclusion of psychosocial treatments is advantageous from a cost-effectiveness standpoint. Averted DALYs with these interventions are more «economic». As observed in previous studies, a modest investment in improving depression produces greater gains in resource-limited environments. In Mexico, there is evidence that such interventions in primary care are effective when they are given by medical staff with a brief training, making them a promising tool for a cost-effective and evidence-based public policy. [ABSTRACT FROM AUTHOR]

The Home Observation for the Measurement of the Environment (HOME) Inventory is the most widely used tool in evaluating the environmental stimulation and family potential to provide necessary cognitive, social, and emotional support available to the child development. The HOME uses an observation/interview format to measure specific interactions between the caregiver and the child, various issues and events that might stimulate the child, and a variety of experiences provided at home or by family members that offer opportunity for growth and development. There are several versions to use from birth to age 3 (Infant-Toddler HOME), the most famous data come the late 60's (1968), it is composed by 45 items (HOME-45) clustered into six subscales. It has a back up of 40 years of publications, over 650 papers, associating with the children's language development, intellectual performance, and academic achievement or psychosocial and socioeconomic characteristics of the family. In Mexico, there are only two published version reports of the use of HOME-45. Most reports refer to the version of Cravioto from the late 60's, with 7 subscales and 62 items (HOME-62) from which there's poor information in the literature about the criteria for to interpreter the outcome results. The aim is to show the results of the implementation of both versions of HOME inventory, and provide criteria for interpretation in a sector of the Mexican population of low socioeconomic status. Material and methods We studied 1031 children and their homes from three communities of low socioeconomic status of central Mexico. Explaining the procedures and obtained informed consent, they were visited at home to implement the HOME Inventory and the socio-economic survey, with a 95% interobserver reliability. The procedures performed were approved by the Ethics and Research Committees from National Pediatric Institute. We applied the HOME-45 and HOME-62 in a integrated format to obtain the total score and each subscale from each version. It was also felt cut-off formed three groups with low stimulation (lowest fourth), middle stimulation (middle half) and high stimulation (upper fourth). The HOME-45 applies all the items to children 0 to 3 years; in the HOME-62 before 3 months old are evaluated only 50 items and after 3; 9; 12; 15 and 18 months old apply 54; 55; 57; 59 and 62 items respectively. Depending on the age, 26 to 36 items are common, representing from 58 to 80% of HOME-45 and 52 to 58% of HOME- 62.… [ABSTRACT FROM AUTHOR]

The term «eating behavior» is immediately related to food consumption. However, eating is a complex behavior mediated by external factors. Eating is not exclusively related to satisfying individual's needs or nutritional requirements. Eating behavior alteration has originated disordered eating (DE) and eating disorders (ED), such as anorexia nervosa, bulimia nervosa and binge eating syndrome, where patterns of food ingestion are altered and people forget the importance of maintaining a balance between caloric ingestion and caloric expenditure, with repercussions in the nutritional status and in the individual's health. Recent studies carried out in Mexican population have confirmed the presence of DE, particularly among adolescents and young adults, and predominantly in females. Data from a representative sample of students with a mean age of 14.5 years reported an increase in the proportion of DE between the 1997 and the 2003 assessments (1.3% in males and 3.4% in females) compared to the 3.8% in males and 9.6% in females registered in 2003. More recent data from the National Nutrition and Health Survey 2006, in a representative sample of adolescents 10 to 19 years of age, indicated a prevalence of 0.8% (1% in females and 0.4% in males), with higher scores in the north and center-west areas of the country, followed by the central and south-south-east areas, with almost two-fold percentages in the urban settings compared to the rural ones. The multifactorial origin of ED is well known and among the most studied risk factors are: eating behaviors, high body mass index (BMI) and body thin-ideal internalization. Research findings indicate that overweight and obese adolescents are at more risk for body dissatisfaction, as their physical appearance is farther away from being as the one promoted by society and the media. The sociocultural pressure to be thin has promoted the internalization of the idea that being thin is synonymous to success, greater social acceptance, femininity (among females), self-control, and selfesteem. Based on the above, the main purpose of this paper was to evaluate the prevalence of DE and its relationship to body thin-ideal internalization and BMI in high school and college male and female students from an urban setting. An additional objective was to provide data on reliability and validity of the scales used in a sample of males, as well as additional validity data in females. Data analyzed in this research come from a larger study on risky factors associated to ED carried out in high-school and college students in the city of Pachuca, Hidalgo, during the 2007-2008 school years. After censing the school, a sample of 845 students was selected (381 males, 464 females), 45.1% was from high school, with a range of 15 to 17 years(X=15.82; D.E.=0.78), and 54.9% from college with a range of 18 to 23 years(X=19.81; D.E.=1.41) and that completed the questionnaires adequately.… [ABSTRACT FROM AUTHOR]

Lifshitz has documented that conceptualization of old age is influenced by stereotypes. Milligan, Powell, Harley and Furchtgott, made evident that elderly people with poor health have a tendency to see themselves as the stereotype of an "old person", whereas those with better health tend to see themselves as younger people. Lasher and Faulkender have stressed the importance of anxiety in the process of getting old as an important factor adjusting to themselves. Lack of adjustment may manifest in four main dimensions: physical, psychological and social, and transpersonal or spiritual. These four dimensions are synthesized in three specific fears: 1. Fear of the process of aging, 2. fear of the state of being old, and 3. fear or anxiety facing old people. Based on this theoretical frame, the authors developed the Anxiety about Aging Scale, and Watkins, Coates and Ferroni pointed out the need to adapt it in order to apply it on elderly people. The objective of this paper is to evaluate the psychometric properties of the original Lasher and Faulkender scale, as well as presenting an adapted version for Mexican elderly people. Method Two independent samples of elder adults were used (n=234 and n=151) selected by availability within a government health clinic; on average, they were 63 years old. The original Lasher and Faulkender scale was translated into Spanish following a double blind procedure, using Likert type answer options with four alternatives. Two questionnaires were used, which included the original scale (EAE-O), in one, and the adapted scale (EAE-A) in the other, as well as the sub-scale of attitude facing one's own aging of the Philadelphia Geriatric Center Morale Scale, APE (2), and the Suicidal Ideational Scale (EIS), designed by Roberts (3). Additionally, interviewees were asked: «If you should have to set an age, forgetting a little about what doctors and people say, at what age would you consider that you really start to be "Old"?» and at what age do you think one would get "very old"? The scales were applied to subjects who agreed voluntarily to participate in an anonymous and informed way. Resulting data were analyzed with the system SPSS, v. 11.0. Factorial structure. A factorial analysis with varimax rotation and eigen values greater than 1 produced the following results: EAEO: The structure obtained was compounded by three factors that explained 53.1% of the variance with Cronbach's alpha of .74 (Fear facing one's own aging, Positive attitude towards old people and Optimism facing one's own aging). EAE-A: The analysis shed a factorial structure compounded by four factors that explained 60.8% of the variance with a general internal alpha consistency of .76 (Positive attitude towards old people, Fear of physical changes, Age and satisfaction with the self and life, and Age and dissatisfaction with the self and life). Concurrent validity. EAE-O. The correlation among the total punctuations of the EAE-O and APE was moderate and significant (r=.481, p<.000). The factors Fear facing one's own aging and Optimism facing one's own aging of the EAE-O, calculated here, obtained a moderate association with the total punctuation of the APE (r=.423, p<.000; r=.333, p<.000, respectively), and the factor of Positive attitude facing old people reported a very low association and no significant (r=.075, p=.252). As expected, the two factors of the APE that seem to evaluate positive and negative attitudes facing aging obtained moderate associations and significant with the two scales of the EAE-O that seem to evaluate the same attitudes (Optimism facing one's own aging, r=.415, p<.000; and Fear facing one's own aging, r=.424, p<.000, respectively). Consequently, a very low association was obtained when relating it with the opposite factor (v.gr. negative vs. positive). EAE-A.… [ABSTRACT FROM AUTHOR]

Psychometric tests are effective to measure psychological characteristics, including personality, motivation, intellectual abilities and psychopathological traits. The Psychopathological diagnostic could be supported on some of these psychometric tests, which ideally should be of simple and fast application. Two of the most common tests are the Symptom Check List 90 (SCL 90) and the Temperament and Character Inventory (TCI). SCL 90, developed by Derogatis, Lipman and Covi in 1973, is a 90-item self-report inventory that assesses the level of distress experienced by the subject. Items are comprised in nine dimensions: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. The SCL 90 has been translated into several languages and has been successfully applied in Argentina and Spain. In Mexico, Cruz- Fuentes et al. and Lara et al. considered that this test can be well used as a psychometric instrument in clinical research. Due to its efficiency and brief time to response (12-15 min.), the SCL 90 has been administered to support psicopathological diagnostics and to complement the research of epilepsy, social-behavior disorders, physical disorders, pharmacological treatment and for the comparison of psychological features in crosscultural studies. The TCI is a self-applied test that describes personality according to Clonninger's psychobiological model. In this model temperament is described as highly heritable and stable during lifetime, and it is divided in four dimensions: novelty seeking, harm avoidance, reward dependence, and persistence. Character is described as being determined by the individual's experience and is modifiable during life-time. It is divided in to three dimensions self-directedness, cooperativeness and self-transcendence. The TCI has been used to correlate personality features to genetics variability and to complement clinical studies that involves psychiatric disorder, such as, obsessive-compulsive disorder, anxiety and depression. This test has been translated and administered in American, French, German, Korean and Spanish populations. In Mexico, Sánchez-Carmona, Páez, López and Nicolini considered that the TCI constitute a psychometric test that can be used to develop the clinical research in Mexican populations. In recent years, research and clinical evaluation in several countries, such as United States and France, have successfully designed and applied computerized versions of the SCL 90 and TCI. These versions provide a quicker rate of testing and a permanent storage of data. In this work, we analyze the validity of viability to apply a computerized version of the SCL 90 and the TCI in Spanish. This computerized version was previously developed at the Instituto de Neurobiología de la Universidad Nacional Autónoma de México. This version involves a computer program in Java language, which give an easy access to the users and is compatible with any computational environment. The sequence to answer the computerized version involves five steps: a) accessing the main control program, b) writing the user's identification data, c) answering SCL 90 test, d) answering TCI test, e) forming the database. The formats employed in these computerized versions are similar to those in paper-and-pencil original versions. Its rate sequences were formed according to the SCL 90 and the TCI's application manuals.… [ABSTRACT FROM AUTHOR]

The present paper is a part of a broader research project aimed at adapting a brief intervention model to help families cope with substance abuse for its application to an indigenous population. Due to cultural differences between urban and indigenous contexts, the adaptation of psychological instruments to assess the intervention outcomes is a major need. Poortinga and Van de Vijver point out that transferring an instrument from the cultural group where it has been designed to another group is a common and economic practice; however, it can lead to invalid conclusions. For this reason, the adaptation must be pursued according to a thorough systematic process in order to develop reliable, understandable, and culture-sensitive instruments. Cognitive laboratories are among the different methods to evaluate instruments previous to its final application. Its main utility is to generate information about the quality of an instrument and about the way a single question is interpreted, accepted or rejected in different cultural groups. The objective of this article is to adapt the Coping Questionnaire (CQ), the Symptom Rating Test (SRT) and the Center for Epidemiologic Studies Depression Scale (CES-D) for its use in indigenous population through the cognitive laboratories method. The main interest is to develop instruments to assess psychological distress and how people cope with excessive drinking in the Mezquital Valley. To accomplish this objective, a two-phase study was carried out. Language adaptation for all three instruments was completed in phase 1, while the validation and identification of the psychometric properties of the new version took place during phase 2. The study was carried out in a community located in Municipio del Cardonal, Hidalgo, where around 60% of the population aged 5 or older speak an indigenous language, mainly Otomi also known as Ñahñu. The participants in phase 1 were 43 bilingual (Spanish-Ñahñu) women aged between 16 and 60 years, whose main activity was housekeeping. Women were contacted at community meetings, and they agreed to participate voluntarily once the objectives of the study were explained. They were also asked to authorize the recording of the interviews. The language adaptation was performed through the concurrent probing method of cognitive laboratory in its individual modality. Each one of the original items and answer options were read aloud as many times as needed. Immediately following the response, every participant was asked: What does this question mean?, Could you rephrase it?, How would you explain this question to another person in your community?. All comments were taken into account to rewrite each item. The instructions of all three questionnaires were also simplified to facilitate understanding. As a result of this procedure, the phrasing of 26 out of the 30 items of the CQ changed. The way the SRT questions were written was adjusted so that they could be used in an interview, which is why nearly all the items were modified. As for the CES-D, 9 items were modified, while 11 remained as in the original. Through this method, versions that were easier to understand were achieved, since commonly used terms among the population being studied were incorporated, which in turn reduced the time required to apply the three questionnaires. During the second phase, the researchers proceeded to validate the final version of the three instruments with a non-probabilistic study of 191 women who were contacted in the health center of the municipal head town; these were inhabitants of 30 of the 92 communities comprising the Municipio del Cardonal. All of them spoke Spanish, 65.8% were aged between 26 and 45 (X=35.2, SD=10.05), 29.5% had completed their primary school studies, while 26% had finished junior high school.… [ABSTRACT FROM AUTHOR]

Bipolar spectrum disorder which includes bipolar I, bipolar II, ciclothymia and bipolar disorder, not otherwise specified often goes unidentified, underdiagnosed, or confounded with major depressive disorder. There are several considerations that try to explain this frequent omission. One crucial aspect is that, the first mood episode at onset is often a depressive one, and some bipolar patients present multiple depressive episodes prior to their first episode of mania. Additionally, long-term evaluation of patients with bipolar I or II disorders, reveal that depressive symptoms occur more common than manic or hypomanic symptoms. Another plausible explanation is that bipolar patients frequently underreport symptoms of mania. Thus it is not surprising to find that in many patients, may elapse about 10 years from the first time for they seek treatment until a clinician finally makes the correct diagnosis. As a consequence, such patients may suffer poorer outcomes, subsyndromal symptoms and a course of illness marked by more sever symptoms, chronic mood episodes, increased recurrence and more impaired psychosocial functioning. The correct diagnosis of bipolar disorder becomes an important and crucial issue, if it is considered that there is a current trend to understand better this affective illness as a spectral disorder. This concept helps to identify different subtle subtypes of bipolarity which often are unrecognized, by means of the actual diagnostic criteria. This diagnostic reformulation is based on the phenomenological manifestations of the entities, as well as in other specific clinical aspects, such as comorbidity, predominant episodes, genetic information and treatment response to among others. Thus, correct recognition of bipolar disorder will bring an important benefit to patients and may reduce erratic treatments and improve outcome. Several epidemiological studies report that the global prevalence of bipolar I disorder is around 1%, in the general population, but when considering all subtypes included in the bipolar spectrum, this lifetime prevalence increases up to 5%. As a consequence of an incorrect diagnosis, patients are often undertreated or receive an erroneous pharmacological treatment, mainly with antidepressants, which complicate outcome by promoting manic or hypomanic reactions and may have devastating consequences in the further clinical intents to stabilize the disorder. In order to increase the recognition of an illness, the correct utilization of a clinical screening procedure is mandatory. Several screening instruments exist for a variety of psychiatric disorders. However, only until recently, some of them have been developed specifically to identify bipolar disorders. The Mood Disorder Questionnaire, was the first screening instrument specifically developed to detect bipolar cases in clinical settings. It is a self-report, single-page, paper and pencil inventory than can be quickly and easily scored by a physician, a nurse or by trained medical staff assistance. It is composed of 13 questions which are answered with a positive or negative fashion, elaborated from the bipolar diagnostic criteria and clinical experience and inquires about possible manic symptoms. In the original report of its development and validation, it was concluded that it is a useful screening instrument for bipolar spectrum disorders, with a good sensitivity (0.73) and a very good specificity (0.90). Method The questionnaire has been translated to other languages and has been used in non-clinical settings, with very good standards of performance.… [ABSTRACT FROM AUTHOR]

Violence is recognized as a Public Health problem around the world. In the specific case of intimate Partner Abuse, which occurs at home, women are particularly vulnerable to be abused by their partners. In Mexico, as in other countries in Latin America, the systematic study of violence towards women is incipient. However, it is a highly predominant problem, which has a big impact on women's health, and represents a significant challenge to the Health System demanding health care due to intentional injuries. This paper analyzed information generated by the first National Survey of violence against women in 2003 (ENVIM, by his name in Spanish). The main objective is to identify the factors associated with the health services utilization by women, because of partner abuse. [ABSTRACT FROM AUTHOR]

This paper has four objectives: 1. to present an overview of the work done in epidemiologic psychiatry in Mexico for the last 30 years; 2. to analyze the main areas explored; 3. to identify the most used designs; and 4. to enumerate the populations studied. [ABSTRACT FROM AUTHOR]

In Mexico, addictions among the middle- and high-school student population have been widely studied, which has shed light on certain risks associated with alcohol abuse, including a higher probability of experiencing with other drugs particularly in the case of males-, engaging in risky sexual practices and attempting suicide, a situation that is twice as common among those who drink and drive. Nevertheless, research on alcohol abuse among the university population has been less explored, particularly as regards the identification of the variables that predict excessive alcohol consumption. A review of the international literature on factors associated with alcohol abuse in this type of population indicates that it is among university students that high or explosive consumption tends to be largest, even among young people who do not attend school, and that the period of higher consumption is between 17 and 21 years of age. Other factors that have been identified include exposure to negative life events, inappropriate coping styles, personality variables, resorting to alcohol to reduce tension, and environmental and socio—cognitive variables, foremost among which arc expectations of the positive effects of alcohol. These expectations not only predict alcohol consumption but also differentiate between problem and non-problem drinking. For example, while social drinkers tend to harbor more social expectations when drinking alcohol, excessive drinkers expect alcohol to increase their aggressive and social behavior, while reducing stress or tension. This paper seeks to evaluate the impact of expectations regarding alcohol, in predicting alcohol abuse among students at public and private universities in Mexico City. Indicators of alcohol abuse include consumption of five or more drinks on each occasion, drunkenness during the past month and year as well as associated problems. The study also seeks to determine the way in which sub-scales of expectations interact with each other. [ABSTRACT FROM AUTHOR]