Dating Violence among Undergraduate Medical Students at a Public University in Mexico City: An Exploratory Study.

Gender-based violence (GBV) and cyber-aggression are growing problems in Mexico, but there is a dearth of information on their associated risks. We aimed to determine the prevalence of dating violence (DV) and cyber-aggression in a public campus and compared students' acceptability of abusive DV based on their sex and sexual orientation. We employed a cross-sectional design to survey 964 first-year medical students attending a public university. We analyzed who found "acceptable" abusive behaviors from a dating partner and carried out descriptive analyses of sample characteristics by sex. We included 633 women and 331 men. Homosexual and bisexual orientation was lower among women (1.5%, 4.8%) vs. men (16.9%, 7.2%). Of women and men, respectively, 64.2% and 35.8% reported having been in a dating relationship. Experiencing abusive behaviors in the year prior to the study was associated with students' level of "acceptability". A total of 43.5% of the students who experienced cyber-aggression did not report any mental health consequences, 32.6% did not seek professional help, and 17.4% reported feeling depressed. Students that accepted emotionally abusive DV behaviors displayed a fourfold risk of experiencing physical abuse. Women and sexual minorities are more at risk of experiencing GBV and DV. More male students reported being victims of cyber-aggression.

El consumo de drogas en estudiantes de México: tendencias y magnitud del problema / Drugs use in Mexican students: trends and Magnitude of the problem

RESUMEN Introducción: El consumo de drogas y sus consecuencias sociales y de salud son del interés de múltiples sectores. Las encuestas en estudiantes son estrategias epidemiológicas para monitorear el problema, las cuales se complementan con encuestas de hogares y en grupos especiales de la población, lo que permite ver anticipadamente fenómenos que posteriormente son evidentes en la población general. Además de las tendencias y del patrón de consumo de drogas, estos estudios muestran la influencia de otros factores que incrementan el uso y sus consecuencias. Objetivo: Conocer las prevalencias de uso de drogas, alcohol y tabaco en estudiantes de primaria (5° y 6°) y secundaría-bachillerato de México y sus Estados. Método: Es una encuesta probabilística en población escolar 5° y 6° de primaria, secundaria y bachillerato con representatividad nacional y de cada Estado del país. La muestra fue de 52 171 alumnos en primaria y 114 364 en secundaria-bachillerato. La información se obtuvo mediante un cuestionario estandarizado y validado en encuestas anteriores. Resultados: El consumo de tabaco alguna vez fue de 30.4% y la edad promedio de inicio de esta sustancia fue 13.4 años. El 53.2% ha bebido alcohol y 14.5% ha bebido en exceso. La prevalencia de consumo de drogas alguna vez fue de 17.2%. Las drogas de preferencia son la mariguana (10.6%), seguida de inhalables (5.8%) y cocaína (3.3%). Discusión y conclusión: El crecimiento del consumo de sustancias, principalmente mariguana y alcohol, resalta la importancia de la creación de nuevas estrategias de prevención para disminuir los índices de consumo entre los estudiantes.

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

Tendencias del uso de drogas en la Ciudad de México: Encuesta de Estudiantes del 2009 / Drug use trends in Mexico City: 2009 students survey

In the course of the last three years, a wide range of epidemiological studies related to drug use has been conducted, both at a national and international level. Talking about national studies in the field of school population, surveys have been conducted in the states of Colima, Nuevo León and Jalisco, as well as surveys in university population, among others. Regarding tobacco use, several studies were made and they covered many cities of the country. About household surveys, the fifth National Addictions Survey (ENA) was carried out in 2008 and it provided data at a national and state level. The Global Survey of Smoking in Adults (GATS) was also made having nationwide coverage. In relation to tobacco use, the trend shows a decrease in the prevalence of consumption. This is shown in ENA 2008 and GATS, as well as school population studies in different states. For alcohol consumption, the situation is different; both for the prevalence and for the proportion of people who start its early consumption, significant increases have been reported throughout the country. Alcohol abuse remains constant and is similar between men and women. When considering the use of illegal drugs, there is an overall increase. As for marijuana, data indicates that its consumption has increased and that it remains as the primary drug of use. However, the main increase is for inhalants, particularly among school population and especially in women. For cocaine, data from United Nations shows a significant decrease in the supply of this substance due to the increase of seizures. Data from ENA 2008 shows that the use of this drug has doubled between 2002 and 2008. The United Nations report indicates that the increase in our country is apparent until 2005 and since then it has been decreasing. Methamphetamine use remains low and it does not increase. Only in the case of the population that goes to service centers for drug users, a high rate of consumption is found. Finally, the consumption of heroin and hallucinogens is low. Chihuahua remains as the state with the most problems in the use of heroine. Most recent surveys have allowed us to see, in general, some of the trajectories in adolescent mental health, where sexual abuse is presented first in women, followed by ADDH, then the consumption of legal drugs, antisocial behavior, use of inhalants and suicide attempt. Then drug consumption, marijuana and cocaine. In men, the sequence is similar, although they face ADDH first and then sexual abuse. In this context, the objective of this study is to assess the prevalence of drug, alcohol and tobacco use, as well as consumption trends in school population from 7th to 12th grade from Mexico City and its political delegations. Method To ensure the comparability with similar studies carried out in Mexico in school population, the methodology used in this study maintains the basic aspects of the previous measurements that have been made in students from 7th to 1 2th grade from Mexico City and other states. The project had the approval of the ethics committee from the National Institute of Psychiatry Ramón de la Fuente Muñiz, and was approved by the educational authorities of Mexico City to be applied in school population. The unit of analysis from which the information was obtained were the students enrolled in 7th to 12th grade in 2008-2009 from public and private schools in Mexico City. The sampling frame was developed based on the official records of the 2008-2009 school year. A non-response rate of 20%, a confidence level of 95% and an average absolute error of 0.004 were considered. The sample design was stratified by level of education (7th to 9th grades and 10th to 12th grades) and political delegations, which gave 32 different strata. It was also clustered by scholar group which was the primary unit of selection. The sample of groups and students were weighted considering the group, educational level and the delegation. A final sample of 22 980 subjects was obtained: 49.8% were female and 50.2% were men. 56.3% of the sample attended to 7th to 9th grades and 43.7% attended to 10th to 12th grades. In addition, most of the male and female adolescents were full-time students during the year prior to the study and only 7% of men and 5.1% of women were not students. 23.3% of men and 11.9% of women worked part or full time, and additionally, most of them had both parents. The information was obtained through a standardized questionnaire, which has been applied in previous surveys and has been previously validated. Due to the extension of the instrument, four forms were used to include various sections, the main part of questionnaire was administered to all subjects and the last two pages corresponded to forms, so each form was applied to one quarter of the sample. Alcohol consumption indicators used are comparable with WHO indicators, international observatories from Europe and the ones used in <

Introducción En los últimos tres años, se ha realizado una amplia gama de estudios epidemiológicos, a nivel nacional e internacional, sobre el consumo de drogas. En cuanto a tabaco, la Encuesta Nacional de Adicciones 2008, la encuesta de GATS y los estudios estatales en población escolar muestran una tendencia importante a la disminución del consumo de la sustancia. Para el consumo de alcohol, tanto en la prevalencia como en la proporción de personas que inicia su consumo temprano, se han reportado incrementos. El abuso de alcohol se mantiene constante y similar entre hombres y mujeres. Al considerar el uso de drogas ilegales hay incrementos importantes. El incremento más pronunciado es el de los inhalables, especialmente en mujeres. En cuanto a la cocaína, la ENA 2008 señala que se ha duplicado el consumo y el informe de la ONU indica que al parecer el incremento se da hasta 2005 y a partir de ahí ha disminuido. Las metanfetaminas mantienen una prevalencia baja. Sólo entre quienes acuden a los centros de servicio para usuarios de drogas se encuentra un alto consumo. En este contexto, el objetivo de este trabajo es evaluar las prevalencias del uso de drogas, alcohol y tabaco, así como las tendencias de consumo en la población de estudiantes de enseñanza media y media superior de la Ciudad de México. Método El marco muestral se elaboró con base en los registros oficiales del ciclo escolar 2008-2009 de la Secretaría de Educación Pública (SEP). Se consideró una tasa de no respuesta de 20%, un nivel de confianza de 95%, con un error absoluto promedio de 0.004. El diseño de la muestra fue estratificado y por conglomerados; la unidad de selección fue el grupo escolar. Se obtuvo una muestra final de 22 980 sujetos y quedó conformada por 49.8% de mujeres y 50.2% de hombres. La información se obtuvo mediante un cuestionario estandarizado, que ha sido aplicado y validado en las anteriores encuestas. Los indicadores de consumo de alcohol, drogas y tabaco empleados son comparables con los indicadores de la OMS, de los observatorios internacionales de Europa y de los usados en <

Los malestares masculinos: Narraciones de un grupo de varones adultos de la Ciudad de México / Male uneasiness: narratives from a male adult group from Mexico City

Introduction Distresses related to depressive conditions in men have not been sufficiently acknowledged, and yet less studied. The difference between distress and its attention is originated in factors such as a rigid and dual classification of the problem, a false conception that it is a <>, and the social stigma that leads men to accept and face negative emotional states that affect their life quality. This article shows the results of a qualitative study which sought to uncover the social construction of distress from a gender approach and to deepen the understanding about the way men live it and exteriorize it. The concept of loss was taken as a methodological strategy throughout the study to access the male distress experiences, considering that, before an emotionally meaningful loss or an unfavorable event, individuals may react using those experiences. Method Four adult men participated in the study; they were selected using an intensive intentional sampling strategy. We carefully selected only a few cases, seeking to characterize the object of study and to obtain profound information based on reality; they were males who had suffered an important loss. They received a detailed explanation of the study and its objectives, voluntarily accepted to participate and allowed the recording of the interviews. Confidentiality and anonymity were guaranteed. The information was gathered by means of in depth interviews and a thematic guide. We developed categories of analysis from the guide and the study objectives to classify data. Categories were grouped according to their meanings and they generated subcategories that allowed a deeper and more precise analysis. Results The analysis focused on the experiences of four men: Manuel (30 years old), Oscar (36), José (40), and Rodrigo (40). They lived in Mexico City. Manuel and Rodrigo completed high school education, while Oscar and José obtained a college degree. They had different marital status: Oscar is single, Rodrigo is a widower, José is separated from his wife, and Manuel lived together with his girlfriend. Their most important and emotionally meaningful losses, which had caused distress, are described as well as the relationship these had with other aspects of their masculine subjectivity, such as sexuality, the body, violence, sports and work. Loss of couple. Losing the couple was one of the most important experiences the four men lived. This had common causes: psychological and physical violence, cheating, and sexual dissatisfaction. Manuel and Rodrigo spoke about extremely violent episodes where they were beaten-up by their fathers and schoolmates during childhood, followed by brawls during youth as a way of gaining respect. They also said they later reproduced this violence in their relationships with women. Both were jealous and controlling men, but they used different ways to intimidate their couples. Manuel did not use physical, but psychological violence. Instead of psychologically controlling his couple, Rodrigo used to act violently against her. Different elements can be identified from the experience of these men, which entwine in the distress-gender-violence relationship: <> jealousy that triggers violence and using physical or psychological violence as a means for controlling and subordinating the couple. Once they committed and act of violence, they experienced guilt and fear of neglecting that lead them to the rarely kept promise of never doing it again. These events are usually minimized, naturalized, and hardly acknowledged. In the case of cheating, it is important to consider the context where breaking-up takes place, since it is necessary to incorporate other relevant elements of masculine subjectivity: the relationship with the body, the practice of sexuality, the forced heterosexuality, and the continuous evaluation of manhood through social pressure from other men (father, brothers, uncles, and friends). Manuel's experience represents an example of this, because his link with sports and the fitness world allowed him to model his body in order to keep an appealing figure for women and a vehicle for socializing with other men that had similar interests. Being a part of this fellowship allowed Manuel to become a personal trainer and to have several affairs while he was living together with his couple. He said his interest in women and the constant cheating had four basic reasons: the context where fitness takes place, living together for a long time with the same person, feeling sexually unsatisfied, and the realization that her partner showed little interest at home and in doing housework. Thus, in the relationship distress-gender-cheating, when she finds out about him cheating and decides to break-up with him and she leaves him, become the causes on Manuel's distress. José told that problems in his sexual life caused the end of his relationship. He lost his interest in sex and ceased contact with his wife for five or six years because on a genital infection. He also had diabetes since his youth, which also contributed to his lack of interest in sex. José was reluctant to seek medical or psychological help, so his wife decided not to stay with him anymore. Then he reacted with sorrow, impotence, and anger, feelings he considered as a depressive phase. Loss of health. The loss of health could be the result of a chronic illness or a severe injury. It was a distress generating experience for two of them, which had an important impact on their masculine identity in two basic axes: the body and the sexual life. The experiences of José and Manuel allow recognizing the difficulty that men face when they try to accept and admit their own illness and vulnerability, as well as their reticence for taking care of their bodies and health. José said his first painful event was when he was diagnosed with the diabetes at age 25; it was a total self-image change. <> who had to take medication for life. The most traumatic situation Manual had lived was when one of his girlfriends stabbed him in his heart during a fight. This changed the meaning of his life and body; he was downhearted for seven years, affecting his work and his social and sexual life. The origin of distress is beyond losing a couple or health in these cases, because, deep down this distress-health-gender relationship, the problem is in losing the ability to fight or in stopping being sexually active, and therefore in not being able to sustain the gender based commands. Loss of job. Oscar talked about one of this distress generating experiences. Even though he considered himself a competent architect, he had not reached a position where he could get enough social success and economic balance. His story offers the possibility of understanding the meaning of a well-paid job in the life of men: the notion of value as a self-reference, the illusion of self-nomination as someone different and unique, the possibility of recognition and appreciation from others, and the money and power. These elements interact to structure what seams to be one of the most important axes for masculine identity. Because when men cannot enter into the working world, they face crisis and distress periods, which in turn have negative repercussions on their gender identity. Male expressions before losses. There were some fundamental physical expressions of distress: muscular pain, difficult in sleeping, laziness, and untidy appearance. The most frequent emotional expressions included sadness, anger, rage, and vindictive impulses. Other manifestations were more related to the way they have learned to <> by repressing their feelings: not to cry, not to be vulnerable before others, not to show any feelings, and to endure pain.

Consideraciones éticas en intervenciones comunitarias: la pertinencia del consentimiento informado / Ethical considerations in community interventions: the pertinence of informed consent

Ethics, understood as the study of moral norms in terms of its assumptions, origins, and changes over time, systematizes similarities and differences between various moral codes. It therefore serves as a meeting point between different perspectives, through dialogue, a fundamental characteristic of this discipline. One of its derivations, as applied ethics, is bioethics, defined by Van Rensselaer Potter as "New knowledge that provides knowledge on how to use knowledge for the good of society". Although bioethics emerged in the 1970s under the imperative of medical discourse, its development as a discipline reflecting human behavior surrounding health has permitted the combination of various types of knowledge, including the contribution of social sciences in this field. Thus bioethics deals with the dilemmas that may arise in social studies on health (such as addictions, violence and migrations). The aims of this manuscript are to systematize and explain some of the implications of the pertinence and adaptation of informed consent (IC) in a bi-national Mexico-United States study on mental health and migration. It also provides elements of analysis for the detection of ethical dilemmas in these community interventions in mental health in Mexico. It therefore attempts to answer the following questions: Within the context of bi-national research, how does one deal with the principle of autonomy and the notion of "voluntariness" included in the requirement of informed consent, in public mental health interventions in Mexican rural communities? Is it possible to respect the way participants in the host country make decisions while at the same time, meeting the demands of the ethics committee of the sponsor country? In order to arrive at the elements of analysis, the authors briefly explain the conceptualization of the terms ethics and bioethics, and explore some of the postulates put forward in both North American (principalism and casuism) ...

A pesar de que la bioética surge en la década de 1970, bajo el imperativo del discurso biomédico, su desarrollo como disciplina que reflexiona sobre el comportamiento humano en torno a la salud ha permitido la reunión de varios saberes, entre ellos, la aportación de las ciencias sociales en dicho campo. De esta forma, la bioética se ocupa de los dilemas que pueden presentarse en los estudios sociales sobre salud (adicciones, violencia, migraciones), incluso en aquellos que, por cuestiones de interés común, son de tipo binacional o multicéntrico. Los objetivos de este artículo son sistematizar y exponer algunas implicaciones de la pertinencia y adecuación del consentimiento informado (CI) en un estudio binacional México-Estados Unidos sobre salud mental y migración. Además, se aportan elementos de análisis para la detección de dilemas éticos en estas intervenciones comunitarias en salud mental en México. De esta forma, se intenta responder a las siguientes preguntas: En el contexto de una investigación binacional, ¿cómo encarar el principio de autonomía y la noción de "voluntariedad", insertos en el requerimiento de un consentimiento informado, en intervenciones de salud mental pública en comunidades rurales mexicanas? ¿Es posible respetar la manera en que los participantes del país anfitrión toman decisiones y cubrir, al mismo tiempo, las exigencias del comité de ética del país patrocinador? Para allegarse los elementos de análisis, se expone someramente la conceptualización de los vocablos ética y bioética, y se abordan algunos postulados planteados tanto de la bioética norteamericana como de la europea, además de aproximarnos a otras posturas bioéticas. Por otro lado, se revisan los principales aportes de los diversos códigos, declaraciones e informes internacionales, incluidas las recomendaciones de la Comisión Nacional de Bioética de México, que norman el proceso del consentimiento informado (CI) en investigación social. El CI es un "proceso social que, a través de un intercambio activo y respetuoso, brinda información sobre la investigación en forma comprensible para el sujeto, permite cerciorarse de que la entienda y tenga opción de preguntar y recibir respuestas a sus dudas, brinde oportunidad para negarse a participar o manifestar voluntad de colaborar y pueda expresarla oralmente o firmar un formulario, sin haber sido sometido a coerción, intimidación ni a influencias o incentivos indebidos". En este sentido, el proceso de consentimiento informado (PCI) protege la libertad de elección del individuo y el respeto de su autonomía. Por ello, también se debe considerar el contexto de desarrollo de grupos culturales diversos al del investigador, sus tradiciones en cuanto a comunicación y decisión, y se deben respetar estos procedimientos. En la investigación social, como en ninguna otra, la puesta en práctica de la normatividad del PCI es muy variada, debido a que se trabaja con sectores dispuestos a participar (prostitutas, usuarios de drogas, primo-delincuentes, etc.) a condición de no firmar ningún consentimiento escrito, lo que otorga prioridad a la calidad de la relación establecida y no sólo al formato. Este documento expone la reflexión sobre algunos dilemas éticos que se presentaron durante una investigación social cuyo objetivo fue identificar los malestares emocionales asociados a la migración internacional México-EUA y la utilización de servicios de salud mental. Específicamente, el análisis ético se centra en la información recabada en el trabajo de campo por medio de la técnica observación participante, en una comunidad rural en el estado de Michoacán.

Desarrollo de un Modelo Cognitivo-Conductual Motivacional de Atención Escalonada para Estudiantes Universitarios con Problemas de Alcohol / Development of a stepped-care cognitive behavioral motivational model for colege students with alcohol problems

Outcome deta research from international surveys on college students report that alcohol problems in colleges are an emergent health concern. This paper describes the development and evaluation of a stepped-care cognitive-behavioral motivational model for college students with alcohol problems, that includes three specific treatment programs, "BASICS", "GSC", and "SRP", which are part of the state-of-the-art cognitive-behavioral motivational treatments to address a broad spectrum of drinking problems available in centers for alcohol problems at the National Autonomous University of México. A modified version of the stepped-care approach and strategies of treatment-client matching were used to select patients for the treatment programs. This article describes the model and its programs and the initial outcome data from a study designed to evaluate its efficacy on a group of college students that address a broad spectrum of alcohol problems and its future perspectives.

Resultados de encuestas internacionales en estudiantes universitarios documentan que los problemas de alcohol constituyen un problema emergente de salud pública. Se describe el desarrollo y evaluación de un modelo cognitivo-conductual motivacional de atención escalonada para estudiantes universitarios con problemas de alcohol, que incluye tres programas de tratamiento, "BASICS", "GSC" y "SRP", que forman parte del estado del arte de los tratamientos cognitivo-conductuales y motivacionales para el abordaje de un amplio espectro de problemas de alcohol, disponibles en centros y programas de la UNAM. Se empleó una versión modificada del enfoque de atención escalonada y una combinación de estrategias de igualación "cliente-tratamiento", para la asignación de participantes a tratamientos específicos. Se describe el modelo y los resultados obtenidos en un estudio diseñado para evaluar su eficacia con un grupo de estudiantes universitarios que cubren un amplio espectro de problemas de alcohol.

Riesgos asociados al consumo de alcohol durante el embarazo en mujeres alcohólicas de la Ciudad de México

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Summary: Alcoholism is among the main worldwide public health problems and it affects men and women differentially. Several studies show that, when compared to men, women develop more severe dependence, more family and social consequences and experience more difficulties to stop drinking. Differences on the impact that substance abuse has on women's life and health are related to the roles, functions and social expectancies placed on them concerning the continuity and care for the rest of the family. For this reason, alcohol intake constitutes a special problem since it affects the health of both the mother and her offspring. Alcoholic women have a higher risk of suffering obstetric complications during pregnancy, such as placenta insufficiency, intrauterine development retardation, early placenta detachment, spontaneous abortion, stillbirth and pre-term delivery. Alcohol abuse during pregnancy is also associated with low weight offspring, congenital abnormalities and further behavioral and learning difficulties. In some countries, drinking during pregnancy is considered an offense which requires legal action. In some cases, women may be put in jail until delivery and lactation. In other regions, children welfare authorities view drinking during pregnancy as a form of aggression or neglect. Such measures prevent women from searching prenatal attention which in its case might lead to severe health consequences for the mother, the embryo and the society. Estimates of alcohol consumption during pregnancy around the world vary considerably and figures range from 4.1% to 83%. However, the variation might be related to the amount of alcohol units and the period of time considered in each measurement. A case-control study in Naucalpan, Mexico, found that 11% of the women interviewees admitted having drank during pregnancy, 5% of the mothers in the control group and 2% of the case group stopped drinking during lactation. Still, any of the considered variables was found to predict postnatal mortality through logistic regression analyses. Another study performed with data from the 1988 National Survey on Addictions documents that alcohol intake during pregnancy is a risk factor for congenital abnormalities (OR=3.4). The available data about the risks associated with drinking during pregnancy in Mexico comes from research in general population, while little is known about clinical population. For this reason, the objectives of this article are: 1. to analyze the characteristics of alcohol consumption in a group of women who sought help to stop drinking, 2. to identify family history of alcohol abuse in this group and 3. to explore the consequences of drinking on their offspring. In this case study, interviews were held with 200 women who attended two treatment agencies in Mexico City due to alcohol consumption problems. The questionnaire used includes the Spanish version of the CIDI-SAM and other sections to explore drinking during pregnancy and lactation, as well as family history of alcoholism. Selection criteria were: 1. aged 18 or older, 2. seeking help for the first time, 3. physical and mental conditions that would allow to answer the questionnaire, 4. having drank during the previous year. Women agreed to participate voluntarily once the objectives of the study were explained and confidentiality assured. Personnel of both treatment agencies administered the questionnaire and interviews lasted 60 minutes average. The diagnostics of alcohol dependence were obtained according to DSM-IV criteria. Data were analyzed with the statistical program SPSS v. 10, for Windows. A total of 134 women reported having been pregnant at least once, and 57.5% of them admitted having drank alcoholic beverages during pregnancy. Age ranged from 18 to 61 years (mean=40), 50% were married or living with a partner, 18% were divorced or separated and 13% had never married. The number of children ranged from 1 to 12 with a mean of 3. High percentages of family history of alcohol abuse were found among this group (93.5%): mostly the father (72.7%), siblings (63.6%) and the partner (48.1%). Significant differences in family history of alcohol use were found between women who drank during pregnancy and those who did not drink. Around 66% reduced alcohol intake after the confirmation of pregnancy; however, 26% continued drinking as usual and 6.5% started drinking at this period. The mean number of drinks consumed per drinking occasion during pregnancy was 3.5, being the traditional beverage pulque (48.8%) and beer (34.9%) the preferred beverages. In addition, 9.2% also took medical drugs. At least three out of the seven criteria proposed in DSM-IV for alcohol dependency were met by 70.3% of the women who drank during pregnancy. More severe dependence was found among the women who drank during pregnancy than among the group of women who abstained. As to the consequences of drinking, 12% of the women reported spontaneous abortion, 13.7% pre-term deliveries, 5.5% stillbirth, 6.8% congenital abnormalities and 13.7% low birth weight. When comparing women who drank and those who did not during pregnancy, significant differences were found in the percentage of pre-term deliveries (X2=5.63; p=0.01) and congenital abnormalities (X2=4.22; p=0.05). A number of logistic regression models was assessed using three independent variables: drinking during pregnancy, frequency of alcohol consumption and severity of dependence. Dependent variables, on the other hand, were spontaneous abortion, pre-term delivery, stillbirth, congenital abnormalities, low birth weight, alcohol use by the offspring and drinking problems in the offspring. The analysis shows that alcohol consumption during pregnancy is related to pre-term deliveries (OR=7.9), and alcohol use by the offspring (OR=2.1). Severity of dependence is related as well to low birth weight (OR=3.7) and further drinking problems in the offspring (OR=2.7). Likewise, drinking every day or almost every day is also related to later drinking problems in their children (OR=2.9). Finally, having siblings who drink (OR=2.11) and meeting alcohol dependency (OR=2.21) criteria are factors that predict alcohol consumption during pregnancy. These results are consistent with other studies that report positive family history of alcohol abuse among alcoholic women. The proportion of women who stopped drinking during pregnancy (42.5%) is higher than the one reported by other authors. Prevalence of spontaneous abortion, stillbirth and congenital abnormalities are higher than the prevalence reported among general population. These findings suggest that women with severe dependence face more difficulties to stop drinking during pregnancy in spite of the social stigma imposed to future mothers who drink. The results provide some elements that support an association of alcohol abuse during pregnancy with adverse pregnancy outcomes. Nevertheless, the impact of fetal alcohol exposure responds to a complex model where a number of interacting factors, longitudinal reaserch is needed to determine the weight of each participating variable and the underlying relationship between them.

Variables demográficas asociadas con la depresión: diferencias entre hombres y mujeres que habitan en zonas urbanas de bajos ingresos

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Summary This paper is aimed at exploring the relationship of some socio-demographic variables with the presence of depressive disorders among a low-income urban sample. Different variables have consistently been associated with such disorders, for instance, marital status, sex, and socio-economic status. As to marital status, some studies show that married people have better health conditions and feel more satisfied with their lives than their unmarried counterparts. Similarly, it has been found that widowed or divorced people present a number of psychological problems. Low-income population is also at high risk of suffering depressive symptoms, in this sense, some researchers have stated that the lack of resources is associated with sadness, high stress levels, isolation, uncertainty, and low access to health care and/or other sources of support. According to the Mexican National Survey on Mental Health conducted with urban population over 18, the prevalence of depressive disorders is higher among widowers and divorced individuals -both males and females- than among their married counterparts. In addition, an association was found between depression, low schooling and unemployment. A survey undertaken in Mexico City yielded similar results though gender differences were not explored; higher prevalences of depression were found for those who reported having lost their couple or marital break up than for those who were married or single. Other groups that had high depression prevalence were lower income individuals, and those with less schooling. Couple relationships and other socio-demographic variables play a key role in the presence of depressive disorders. Thus, the present study is aimed at: a) analysing how marital status affects the presence of depressive disorders in men and women; b) exploring the role of low socio-economic level in the presence of depressive symptoms; c) exploring which combination of socio-demographic variables better predict the presence of depressive disorder in males and females Method: This research was carried out in four low-income communities located in southern Mexico City. The selected communities include Topilejo, Isidro Fabela and San Pedro Mártir within the Tlalpan district, and the fourth community was constituted by the neighbourhoods of San Marcos and San Juan, in the Xochimilco district. The research design was multistage; blocks were selected at the first stage, dwelling segments, at second stage, and finally, in the third stage the interviewed individual was selected. After this procedure, the final sample consisted of 1156 interviewees, 49% were males and 51% females. The information was gathered through a household questionnaire that explores the general characteristics of the people living in the same dwelling listed on the questionnaire, such as relationship to the family head, age, sex, schooling and income. Some other aspects related to the dwelling characteristics were also explored. Diagnosis of depressive disorder was obtained through the diagnostic interview CIDI version 1.1, which assesses the presence of mental disorders according to the criteria of the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. The selected interviewees participated voluntarily after the research objectives were explained; in addition, the terms of confidentiality were particularly emphasized. Each interview lasted 90 minutes on average. Data analysis were performed with the statistical program SPSS v. 10 for Windows. Results: The findings showed higher prevalence of depressive disorders among females, among people that experienced loss or family rupture and among those with lower economic resources. Similarly, prevalence of depression was higher for men (6.1%) and women (18.3%) who had lost their spouse than for their married counterpart. As to differences between married and single people, the prevalence of depressive disorders in the group of men that had ever married was lower (4.9%) than the prevalence found in the group of married men (5.8%). The opposite was observed among females, since single women present more depressive problems (13.2%) than married women (5.3%). Results also showed how economic difficulties have an effect on the presence of depressive disorders. However, differencesbetween married and single men with the lowest income were minimal. Two logistic regression models show that, particularly among women, the presence of depressive disorder is related to the lack of a couple, economic disadvantages; for instance, low family income, belonging to a large extended family, and playing the social role of family head, which implies responsibility to a large extent. Discussion: The findings of the present study are consistent with previous research that report higher prevalence of depression among females, people without a couple and those with less economic resources. Different authors have confirmed that problems of economic nature are consistently associated with depression problems. Lack of resources leads to high stress levels, sadness, isolation, among other troubles. This situation is more severe for females. Women play a number of social roles that put them at higher risk of suffering mental disorders. Nowadays, women still bear the responsibility of being wives, mothers, educators and care providers for many people, and have become an important part of the work force at the same time. The deficiencies that female family heads must face in different areas not only increase the risk of suffering disorders such as depression and poor quality of life, but also jeopardize their children's opportunities in the future. Dejarlais and colleagues suggest that in order to improve these women's mental health it is necessary to take actions in two ways. On the one hand, it is essential to deal with the factors related to the presence of female distress; on the other, it is crucial to provide attention to reduce the negative consequences. In this way, any prevention or intervention program must include, among other elements, tools to expand women's capabilities to have an income, reinforce social support networks, and to stimulate social and community participation in order to improve their cognitive and relational resources as well as self-esteem. In addition, women must have information about the pathological process they undergo and attention options at their disposal, but to make these programs effective it is above all necessary to tailor them according to women's concerns and needs. This can only be possible if women act as active collaborators. Finally, to work on intervention and prevention programs for female family heads encloses the possibility of breaking the cycle that reproduces distress among their children.

La Encuesta de Estudiantes de Nivel Medio y Medio Superior de la Ciudad de México: noviembre 2003. Prevalencias y evolución del consumo de drogas

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Abstract: Introduction: Research focused on drug consumption in schools has been developed in México since 1976 and has allowed for a constant monitoring of this behavior in the population. The National Institute of Psychiatry Ramón de la Fuente (INP) and the Public Education Administration (SEP) have been the pionering institutions in these efforts, where other interested institutions and states add their contributions to the assessment of the problem in this social sector. Due to the need of developing local preventive programs to reduce drug consumption, several regions of the country have carried out, in a first stage, situational diagnoses of drug consumption. These data, in addition to other community information sources, have helped to enhance efforts in terms of prevention. To date, the main investigations related to students are the Fourth National Survey on Addictions, the National Survey from the National System for the Integral Family Development, regional surveys with young students from 7th to 91 grades (Queretaro; Ríoverde, San Luis Potosí; Sinaloa; Tamaulipas and Ciudad Guzmán, Jalisco.), from 101 to 12th grade (same states, except for Ciudad Guzman and the study done in Guanajuato whose results have not been published yet) and college (Ríoverde). The main findings for adolescents and youths obtained from these studies show an increase in drug consumption, specially for alcohol, cannabis and metamphetamines, although the general index of consumption remains steady since 2001, specially in the case of cocaine. There have also been changes in men and female contributions to the consumption index, giving similar prevalences for alcohol and tobacco in both. Regional variations have been observed, where drug consumption is higher in more urbanized cities. However, new generations are more affected by this phenomenon regardless of the level of urbanization of the place where they live. Also, as it has been previously established, being in a scholastic environment is a protective factor against drug consumption, beacause consumption is higher among adolescents who do not study, and it is a differential factor that protects men more than women. As a consequence, these sources and different students' surveys point out that the probability of drug consumption increases when a minor is working. Additionally, studies report that an early consumption onset for tobacco and alcohol, mainly before 13 years old, increases the possibility of consuming other drugs. This fact is important because several reports on the literature show that age of onset for consuming these drugs is becoming earlier. It is relevant to consider that drug consumption is not an isolated factor. It is known that some precursors for drug consumption are the same for other behaviors, such as sexual intercourses without protection, antisocial, delinquent behaviors or suicide attempt. In behalf of this, prevention programs must be designed in an integral way considering the global environment of adolescents, and not just focused on drug consumption. From this point of view, results from the survey on drug use carried out among students in Mexico City in autumn, 2003, are presented. This survey is the most recent diagnosis about this problem in Mexican adolescents, and keeps the methodological standards of previous surveys. Objective: The aim of the present work is to give a recent and complete view about this problem and prevention opportunities for adolescents of Mexico City and the whole country. Materials and method: The study comprised a randomized sample of 10,659 students from Mexico City, with a two-stage design (school-group), and stratified (from 71 to 9 grades, and from 10 to 123 grades, technical and normal), where the last selection unit was the scholar group. Data is representative for delegation and educational level, and the design is similar to those previously applied in schools by the INP and SEP. The reviewed sample frame was obtained from the registrations to the 2001-2002 school period of SEP A randomized sample was obtained for each county and educational level. Regarding estimations precision, calculated non-response index was 15%, with an absolute error average of 0.004, and a design effect equaling 2. The confidence intervals obtained were generated by the STATA program, version 7.0. The mean-age of the subjects was 14.6 years (12-22 years), 50.5% of the sample were men and 49.5% were women. The indicators of drug consumption included in the questionnaire are the same used in similar studies and are the same used by the WHO. In addition to drug consumption and related problems, several behaviors were assessed among adolescents, such as suicide attempt, level of depression, eating risk behaviors and some features of their sexual behavior. Interviewers were trained to obtain the most reliable information from the adolescents and to keep confidentiality. A total of 23 interviewers and five supervisors participated in the study. Results: First of all, a slightly increase in drug consumption was found in the last three years, from 14.7% to 15.2%, which is not significative. Nevertheless, there are significant changes in the consumption of specific drugs. There is a significant increase in cannabis consumption, while inhalants and tranquilizers remain steady and cocaine use showed a slightly decrease. By sex, it was observed that drug consumption in women has increased, while in men it remains steady or has even decreased a little. In this context, drug preferences remain very similar to those reported three years ago, where cannabis occupied the first place, followed by inhalants, tranquilizers and cocaine (with similar levels of consumption between the last three ones). The drugs of preference among women are tranquilizers. With respect to legal drugs, alcohol consumption has increased, while tobacco consumption remains similar to the reported in the survey of 2000. A significant change in these drugs, as mentioned above, is that their consumption is almost the same among men and women. Talking about alcohol abuse, a 2% increase was observed, which indicates 23.8% of the adolescents had consumed at least five drinks per occasion during the month previous to the study. In regional terms, there were also changes. The most affected delegations are Azcapotzalco, Venustiano Carranza, Miguel Hidalgo and Cuauhtemoc. In the last survey, the most affected delegations were Gustavo A. Madero and Coyoacan. This is very important information, because the SEP implemented several prevention strategies in these two delegations in order to reduce drug consumption. Considering the results of the present study, it can be concluded these efforts were successful. Even though results will be presented in a specific publication, according to the adolescents' evaluation of the brochure given to each student at the end of the application, we can say they were very positive, as 15% of the adolescents indicated they had quitted smoking and a similar percentage reported a decrease in their tobacco consumption. Another 15% mentioned they had used help telephone lines, and more than 60% shared the content of the brochure with their families. Most of them have kept the brochure for future occasions and have also lent it to friends. Discussion: The data about drug consumption is similar to the data of other national studies reporting that consumption of medical and illegal drugs and tobacco, is steadier on the whole, although there are changes in specific drugs consumption and by sex. Meanwhile, the prevalence of alcohol consumption has been increasing, even when its abuse remains stable. For prevention, it is important to consider the new location of the problem (most affected delegations), and to use crime indicators and other delinquent behaviors, to share prevention efforts in the most affected areas of the city. Another interesting result is the low level of risk perception for tobacco and alcohol consumption, which are important precursors for the consumption of other drugs, especially if there is an early consumption onset for these substances. In the context of drug consumption associated with other adolescents' problems, suicide attempt is the most frequent situation reported by the participants (16%) and it is even more frequent than drug consumption. Although this situation seems to be quite problematic, adolescent population in scholastic environments is the least affected in comparison to those that quit or stop studying. On the other hand, the information obtained about the brochure "What's up with your life?" is encouraging for prevention practices, and the presence and growth of these problems makes it important to consider that the process of obtaining information as an integral part of the diagnosis may also be used as an opportunity to reach adolescents with information or materials created for them. Finally, it is important to point out that prevention must be applied during childhood and not only during adolescence. To reach this goal, it is important to include all possible human resources. The point is simple: the possibilities to obtain better results under this conception are greater, because the interaction with children and their complete integration at home facilitate this prevention task. During childhood, the human being is more receptive to this kind of interventions and it is simpler to work with the families. So, when children grow up, it will be easier to communicate with them as adolescents and to give them all the support they require in their identity formation. Even when the work is focused on the longer term, the results will be better and we will be able to offer better options to the new generations from the construction of an adequate prevention culture.