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Objective: To measure the impact of the COVID-19 pandemic on the implementation of a program for timely detection, brief intervention, and referral for treatment of alcohol consumption in health centers at the first level of care in Mexico City. Methods: The data were collected at 18 health centers in Mexico City between 2019 and 2021, as part of a larger study. A total of 287 participating health professionals measured their patients' alcohol consumption using the AUDIT-C test. The patients' demographic aspects and consumption patterns were analyzed, as well as care actions (detection, brief intervention, provision of leaflets, monitoring, and referral) at three points in time: before the COVID-19 pandemic, during confinement, and after confinement. Parametric and nonparametric tests were performed to identify the relationship and differences between the variables at the three points. Results: A total of 9090 people who consumed alcohol were identified; detection of consumption fluctuated in the three periods studied (26%, 53%, and 37%, respectively). Medium- and high-risk consumption was more frequent among young men with higher schooling during and after confinement. In the post-confinement period, monitoring and referral actions increased. Conclusions: Measuring the impact of the pandemic on the implementation of a program for timely detection of alcohol consumption, brief intervention, and referral for treatment in health centers helps to develop health policies by age, gender, schooling, and type of consumption at the first level of care.
Objetivo: Medir o efeito da pandemia de COVID-19 na implementação de um programa de detecção oportuna, intervenção breve e encaminhamento para tratamento pelo consumo de álcool em centros de saúde no nível da atenção primária na Cidade do México. Métodos: Foram coletados dados em 18 centros de saúde na Cidade do México entre 2019 e 2021, como parte de um estudo mais amplo. Participaram 287 profissionais de saúde, que mediram o consumo de álcool de seus pacientes com o teste AUDIT-C. Foram analisados aspectos demográficos e o padrão de consumo dos pacientes, bem como as medidas em termos de atendimento (triagem, intervenção breve, entrega de folhetos, monitoramento e encaminhamento) em três momentos: antes da pandemia de COVID-19, durante o confinamento e após o confinamento. Foram feitos testes paramétricos e não paramétricos para identificar a relação e as diferenças entre as variáveis nos três períodos. Resultados: Foram identificadas 9.090 pessoas com consumo de álcool, sendo que a porcentagem de consumo detectada flutuou nos três períodos estudados (26%, 53% e 37%, respectivamente). O consumo de médio e alto risco foi mais prevalente entre homens jovens e com nível maior de escolaridade durante e após o confinamento. No período posterior ao confinamento, as medidas de monitoramento e encaminhamento aumentaram. Conclusões: Medir o impacto da pandemia na implementação de um programa de detecção oportuna, intervenção breve e encaminhamento para tratamento do consumo de álcool em centros de saúde ajuda na formulação de políticas de saúde por idade, gênero, escolaridade e tipo de consumo para o primeiro nível de atenção.
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Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.
Assuntos
COVID-19 , Pandemias , Humanos , México/epidemiologia , Colômbia/epidemiologia , Peru/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Políticas , Atenção Primária à SaúdeRESUMO
RESUMEN Objetivo. Medir el efecto de la pandemia de COVID-19 en la implementación de un programa de detección oportuna, intervención breve y referencia para tratamiento por consumo de alcohol en centros de salud del primer nivel de atención de la Ciudad de México. Métodos. Se recopilaron los datos en 18 centros de salud de la Ciudad de México entre 2019 y 2021, como parte de un estudio más amplio. Participaron 287 profesionales de la salud, quienes midieron el consumo de alcohol de sus pacientes con la prueba AUDIT-C. Se analizaron aspectos demográficos y patrones de consumo de los pacientes, así como las acciones de atención (detección, intervención breve, entrega de folletos, monitoreo y referencia) en tres momentos: antes de la pandemia de COVID-19, durante el confinamiento y luego del confinamiento. Se realizaron pruebas paramétricas y no paramétricas para identificar la relación y las diferencias entre las variables en los tres períodos. Resultados. Se identificaron 9 090 personas con consumo de alcohol; el porcentaje de detección del consumo tuvo fluctuaciones en los tres períodos estudiados (26%, 53% y 37%, respectivamente). El consumo de riesgo medio y alto fue más frecuente entre hombres jóvenes y con mayor escolaridad durante y después del confinamiento. En el período posconfinamiento aumentaron las acciones de monitoreo y referencia. Conclusiones. La medición del impacto de la pandemia en la implementación de un programa de detección oportuna, asesoramiento breve y referencia para el tratamiento del consumo de alcohol en centros de salud ayuda a elaborar políticas en salud por edad, género, escolaridad y tipo de consumo para el primer nivel de atención.
ABSTRACT Objective. To measure the impact of the COVID-19 pandemic on the implementation of a program for timely detection, brief intervention, and referral for treatment of alcohol consumption in health centers at the first level of care in Mexico City. Methods. The data were collected at 18 health centers in Mexico City between 2019 and 2021, as part of a larger study. A total of 287 participating health professionals measured their patients' alcohol consumption using the AUDIT-C test. The patients' demographic aspects and consumption patterns were analyzed, as well as care actions (detection, brief intervention, provision of leaflets, monitoring, and referral) at three points in time: before the COVID-19 pandemic, during confinement, and after confinement. Parametric and nonparametric tests were performed to identify the relationship and differences between the variables at the three points. Results. A total of 9090 people who consumed alcohol were identified; detection of consumption fluctuated in the three periods studied (26%, 53%, and 37%, respectively). Medium- and high-risk consumption was more frequent among young men with higher schooling during and after confinement. In the post-confinement period, monitoring and referral actions increased. Conclusions. Measuring the impact of the pandemic on the implementation of a program for timely detection of alcohol consumption, brief intervention, and referral for treatment in health centers helps to develop health policies by age, gender, schooling, and type of consumption at the first level of care.
RESUMO Objetivo. Medir o efeito da pandemia de COVID-19 na implementação de um programa de detecção oportuna, intervenção breve e encaminhamento para tratamento pelo consumo de álcool em centros de saúde no nível da atenção primária na Cidade do México. Métodos. Foram coletados dados em 18 centros de saúde na Cidade do México entre 2019 e 2021, como parte de um estudo mais amplo. Participaram 287 profissionais de saúde, que mediram o consumo de álcool de seus pacientes com o teste AUDIT-C. Foram analisados aspectos demográficos e o padrão de consumo dos pacientes, bem como as medidas em termos de atendimento (triagem, intervenção breve, entrega de folhetos, monitoramento e encaminhamento) em três momentos: antes da pandemia de COVID-19, durante o confinamento e após o confinamento. Foram feitos testes paramétricos e não paramétricos para identificar a relação e as diferenças entre as variáveis nos três períodos. Resultados. Foram identificadas 9.090 pessoas com consumo de álcool, sendo que a porcentagem de consumo detectada flutuou nos três períodos estudados (26%, 53% e 37%, respectivamente). O consumo de médio e alto risco foi mais prevalente entre homens jovens e com nível maior de escolaridade durante e após o confinamento. No período posterior ao confinamento, as medidas de monitoramento e encaminhamento aumentaram. Conclusões. Medir o impacto da pandemia na implementação de um programa de detecção oportuna, intervenção breve e encaminhamento para tratamento do consumo de álcool em centros de saúde ajuda na formulação de políticas de saúde por idade, gênero, escolaridade e tipo de consumo para o primeiro nível de atenção.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Atenção Primária à Saúde , Consumo de Bebidas Alcoólicas/prevenção & controle , COVID-19 , Fatores Sexuais , Programas de Rastreamento , Fatores Etários , Fatores SociodemográficosRESUMO
Introduction: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. Materials and methods: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. Results: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. Conclusions: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19. (AU)
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Humanos , Masculino , Feminino , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Depressão/terapia , Alcoólicos/psicologia , Peru/epidemiologia , Atenção Primária à Saúde/métodos , Detecção do Abuso de Substâncias/métodos , México/epidemiologiaRESUMO
Abstract Introduction The COVID-19 outbreak has involved a permanent and significant increase of fear and worries related to the virus and the measures taken to avoid contagion, such as confinement. Objective To explore the relationship between emotional responses and coping strategies used to face the first confinement among the Mexican adult population and inquire about differences by sex. Method An exploratory study was conducted through a self-administered online survey. It included questions about sociodemographic characteristics, emotions about pandemic information, and coping strategies. An informed consent form was presented prior to data collection. Chi square and Kruskal-Wallis were performed for bivariate analyses. Results A total of 2,650 participants completed the survey (21.6% were men). Significantly more men than women reported feeling calm (p < .001), hopeful (p = .011), and indifferent (p = .002). In contrast, more women, compared to men significantly reported feeling worried (p < .001), fearful (p < 0.001), and sad (p < .001). More women reported being emotionally close to other people (p = .027), seeking help from friends and family to share emotions and concerns (p < .001), and they frequently prayed as a coping strategy regardless of their emotions (p = .005). Discussion and conclusion While women are the least affected by the contagion and their symptoms are milder than in men, they present the most negative emotions, particularly of worry, but they also used more caring and helpful behaviors in comparison with men. These results can serve as a basis for developing research with a gender perspective that delves into the differences by sex found in this study.
Resumen Introducción El brote de COVID-19 ha implicado un aumento significativo y permanente en el miedo y las preocupaciones relacionadas con el virus y las medidas de mitigación, como el confinamiento. Objetivo Explorar la relación entre emociones y estrategias de afrontamiento utilizadas durante el primer confinamiento en población adulta mexicana e indagar sus diferencias por sexo. Método Estudio exploratorio mediante una encuesta en línea autoadministrada. Se obtuvo el consentimiento informado antes de recopilar la información. Se utilizó estadística no paramétrica para los análisis bivariados. Las respuestas de estrategias de afrontamiento se analizaron como variables cuantitativas y se reportaron las medias. Resultados Un total de 2,650 participantes completaron la encuesta (21.6% fueron hombres). Significativamente, más hombres que mujeres informaron sentirse calmados (p < .001), esperanzados (p = .011) e indiferentes (p = .002). Más mujeres, en comparación con los hombres, informaron sentirse significativamente preocupadas (p < .001), temerosas (p < .001) y tristes (p < .001). Más mujeres informaron estar emocionalmente cercanas a otras personas (p = .027), buscar ayuda de amigos y familiares para compartir emociones y preocupaciones (p < .001) y utilizar frecuentemente la oración como una estrategia de afrontamiento (p = .005). Discusión y conclusión Aunque las mujeres son las menos afectadas por el contagio en comparación con los hombres, son las que presentan las emociones más negativas, particularmente de preocupación. Sin embargo, también han utilizado más comportamientos de cuidado y ayuda. Estos resultados pueden servir como base para desarrollar investigación con perspectiva de género que profundice en las diferencias por sexo encontradas en este estudio.
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This article forms part of a collaborative study in which research teams from Canada and Mexico participated. The general objective is to describe the cultural adaptation and semantic validation of three instruments for measuring stigma and mental illness in Mexico City. The criteria of understanding, acceptance, relevance and semantic integrity were used to adapt the following instruments: The Internalized Stigma Inventory (ISMI), the Opinions on Mental Illness Survey (OMI) and the Devaluation and Discrimination Scale (DDS). Four Individual interviews and four group interviews were carried out with 37 informants from different groups (health personnel, persons with diagnostic of mental disorders, relatives and the general population). Lastly, an analysis was carried out on the contents of the information obtained. The instruments proved to be culturally appropriate for the population in Mexico in the various groups studied. The adapted versions would be useful for establishing comparative analyses with other countries. The scope and limitations of the process of semantic equivalence were analyzed in the transcultural research.
Este trabajo forma parte de un estudio colaborativo en el que participan equipos de investigación en Canadá y México. El objetivo general consiste en describir el proceso de adaptación cultural y validación semántica de tres instrumentos de medición sobre el estigma y la enfermedad mental en la Ciudad de México. A partir de los criterios de comprensión, aceptación, relevancia e integridad semántica se adaptaron los siguientes instrumentos: el Inventario de Estigma Internalizado (ISMI), el Cuestionario de Opiniones hacia la Enfermedad Mental (OMI) y la Escala de Percepción de la Devaluación y Discriminación hacia la Enfermedad Mental (DDS). Para ello se llevaron a cabo cuatro entrevistas individuales y cuatro grupales con 37 informantes de diversos sectores (personal de salud, personas con diagnóstico de trastorno mental grave, familiares y población general). Finalmente se efectuó un análisis de contenido de la información obtenida. Los instrumentos adaptados fueron culturalmente apropiados para la población de los diferentes grupos estudiados en México. Las versiones adaptadas serán de utilidad para establecer análisis comparativos con otras regiones. Se analizan los alcances y limitaciones del proceso de equivalencia semántica en la investigación transcultural.