AIMS: Mental disorders characterized by preoccupation with distressing bodily symptoms and associated functional impairment have been a target of major reconceptualization in the ICD-11, in which a single category of Bodily Distress Disorder (BDD) with different levels of severity replaces most of the Somatoform Disorders in ICD-10. This study compared the accuracy of clinicians' diagnosis of disorders of somatic symptoms using either the ICD-11 or ICD-10 diagnostic guidelines in an online study. METHODS: Clinically active members of the World Health Organization's Global Clinical Practice Network (N = 1065) participating in English, Spanish, or Japanese were randomly assigned to apply ICD-11 or ICD-10 diagnostic guidelines to one of nine pairs of standardized case vignettes. The accuracy of the clinicians' diagnoses as well as their ratings of the guidelines' clinical utility were assessed. RESULTS: Overall, clinicians were more accurate using ICD-11 compared to ICD-10 for every presentation of a vignette characterized primarily by bodily symptoms associated with distress and impairment. Clinicians who made a diagnosis of BDD using ICD-11 were generally correct in applying the severity specifiers for the condition. LIMITATIONS: This sample may represent some self-selection bias and thus may not generalize to all clinicians. Additionally, diagnostic decisions with live patients may lead to different results. CONCLUSIONS: The ICD-11 diagnostic guidelines for BDD represent an improvement over those for Somatoform Disorders in ICD-10 in regard to clinicians' diagnostic accuracy and perceived clinical utility.
International Classification of Diseases , Medically Unexplained Symptoms , Humans , Neurasthenia , Somatoform Disorders/diagnosis , Case-Control Studies
BACKGROUND: Alcohol consumption is one of the main risk factors for death by road injuries, but little is known about the global distribution of the population-attributable risk (PAR) of alcohol use for death by road injuries. METHODS: We used publicly available data from the 2019 Global Burden of Disease Study (GBD) to estimate the PAR of alcohol use for 5 types of road injury, globally and individually for available countries, by socio-demographic index (SDI), and by age, sex, and year from 1990 to 2019. RESULTS: 6.6% of all road injuries in 2019 were attributable to alcohol consumption, with large variations worldwide; the highest burden was in Europe and among countries classified in the high-middle SDI. PAR was higher in men than in women, and among younger individuals. Important variations in PAR of alcohol were also observed by road injury type, with motorcyclist road injuries having the highest PAR. Overall, PAR showed a small increase during 1990-2019; younger (<39 years old) men showed an increasing trend during this period, while older women had a decreasing trend in PAR. CONCLUSIONS: PAR for alcohol and road injuries is not homogenous. Large PAR for alcohol and road deaths was found in Europe, among men, young adults, and motorcyclists. These results could help public health agencies, law enforcement, and the public guide efforts to reduce these deaths.
Accidents, Traffic/statistics & numerical data , Alcohol Drinking/adverse effects , Driving Under the Influence/statistics & numerical data , Wounds and Injuries/epidemiology , Adolescent , Adult , Aged , Child , Driving Under the Influence/trends , Female , Global Health , Humans , Male , Middle Aged , Social Change , Wounds and Injuries/etiology , Young Adult
INTRODUCTION: Mental, neurological, substance use, suicide, and related somatic disorders (TMNS, for the Spanish acronym) have a negative impact on the quality-of-life of people and the Mexican economy, but updated information is lacking. The objective of this work is to analyze the disability adjusted life years (DALYs) of the TMNS in Mexico by sex, age, state, and degree of marginalization between 1990 and 2019. METHODS: The data and methodology of the «Global Burden of Disease Group¼ (GBD) are used. The GBD calculates DALYs as the sum of two components: years of life lost due to premature mortality (YLL) and years lived with disability (YLD). Likewise, the data on the degree of marginalization from the National Population Council in Mexico are used. RESULTS: TMNS represented 16.3% of the disease burden in the Mexican population in 2019. The trend of the age-standardized rates of DALYs of the TMNS has increased little from 1990 to 2019. The highest increase has been for women. Mental (depression) and neurological (headache) disorders contribute the most to the disease burden among TMNS. In the interior of the country, Baja California Sur presented the highest increase in the period. DISCUSSION: The results show a complex panorama of the TMNS and its subtypes by sex, age groups and territory. More resources are needed to improve mental health care.
Antecedentes El consumo de alcohol, tabaco y otras drogas tiene repercusiones importantes en la vida diaria de los adultos mayores. Con el objeto de conocer la asociación entre consumo de sustancias psicoactivas y variables de cuidado y salud en adultos mayores. Método Se recopiló información de una muestra aleatoria del padrón de usuarios del IAAM-DF. 2098 personas aceptaron participar y fueron entrevistadas en sus hogares, su tasa de respuesta fue de 83.9%. Resultados y discusión Se encontró que 13.1% requiere de ayuda en actividades básicas e instrumentales de la vida diaria; 81.4% percibe poco apoyo social; 82.2% señala pertenecer a una familia disfuncional, y a 45.5% le ha sido diagnosticada una enfermedad crónico-degenerativa. Mediante razón de momios se determinó que el consumo riesgoso de alcohol y la dependencia de éste por adultos mayores incrementan en ellos el riesgo de padecer enfermedades crónico-degenerativas, infecciosas y trastornos mentales, e influyen en su necesidad de recibir apoyo en actividades básicas e instrumentales de la vida diaria , así como en su percepción de disfunción familiar. El consumo de tabaco aumentó el riesgo de padecer enfermedades crónico-degenerativas e infecciosas, y se asocia con la percepción de salud y apoyo familiar. La ingestión de alguna droga, ilegal o prescrita, no se asoció significativamente con variables de cuidado, pero sí impacta en la aparición de enfermedades crónico-degenerativas y de trastornos mentales. Los resultados muestran que el consumo de alcohol, tabaco y otras drogas influye en la salud y el cuidado de los adultos mayores en la Ciudad de México, por lo cual constituye una tarea urgente atender estas problemáticas para mejorar la calidad de vida de éstos.
Background The use of alcohol, tobacco and other drugs have a significant impact on the daily lives of older adults. In order to study the relationship between substance use, health and care variables in older adults. Method Information was collected in a random sample of the registry users of the DF IAAM program; 2098 people agreed to participate and was interviewed in their homes, the response rate obtained was 83.9%. Results and discussion It was found that 13.1% receive aid in basic and instrumental activities of daily living, 81.4% perceived little social support, 82.2% perceived belonging to a dysfunctional family and 45.5% have been diagnosed with a chronic degenerative disease. Using odds ratios, it was shown that at-risk drinking and alcohol dependence increased the risk of chronic degenerative diseases, infectious and mental disorders and affects the need for support in basic and instrumental activities of daily living and perception of family dysfunction. Smoking increased risk of chronic degenerative and infectious diseases and also was associated with perceived health and family support. The use of any illegal or prescribed drugs was not significantly associated with care variables, but affect chronic degenerative diseases and mental disorders. The results of this study showed that use of alcohol, tobacco and other drugs affect the health and care of older adults in Mexico City, so it is urgent to address these problems in order to improve their quality of life.
There are no studies in Mexico estimating the use of psychoactive substances in the elderly (+69 yrs) and there is a lack of information about the risk factors determining the burden of disease for this age group. The goal of this study is to present prevalences of use of alcohol, tobacco, illicit drugs and nonmedical prescription drugs in beneficiaries of a cash supplement program sponsored by the Institute for the Care of Elderly from Federal District (Instituto para la Atención del Adulto Mayor del Distrito Federal, IAAM-DF). Furthermore, significant sociodemographic factors associated with substance use are reported. From a random sample of the 2 501 users registries of a cash supplement program of IAAM-DF, a total of 2 098 agreed to participate and were interviewed in their homes. The response rate was of 83.9%. We found that 63.5% of all participants ever used alcohol, 45.4% ever used tobacco and 3.5% ever used any drugs. Near one out of every two men and one out of every four women used alcohol during the previous 12 months, one out of every 10 older adults used tobacco and just one out of every 100 used any kind of drug in the last 12 months. Overall prevalence of substance use is higher in men, with the exception of medical drugs. Outstanding associated factors in substance use were sex and higher socioeconomic levels. This is the first study in the country on substance use in dwelling elderly, not living in institutions. Alcohol use, even risky drinking, is not uncommon, smoking tobacco habits do not disappear with age, and medical drug use can be of concern for its effects on other diseases. Therefore, it becomes necessary to establish definitions of risky use for this population and develop appropriate intervention programs for this population group.
No existen investigaciones en el país sobre uso de sustancias psico-activas en poblaciones de adultos mayores (+69 años) y se carece de información sobre los factores de riesgos que son determinantes para la carga de la enfermedad en este grupo. Este estudio tuvo como objetivo presentar las prevalencias de consumo de alcohol, tabaco, drogas ilícitas y drogas médicas usadas sin prescripción en los beneficiarios del programa de pensión alimentaria del Instituto para la Atención del Adulto Mayor del Distrito Federal (IAAM-DF). Adicionalmente, se reportaron factores sociodemográficos asociados al consumo de estas sustancias. De una muestra aleatoria del padrón de usuarios del programa del IAAM-DF de 2501 personas, un total de 2098 aceptaron participar y fueron entrevistadas en sus hogares, obteniéndose una tasa de respuesta de 83.9%. Se encontró que 65.3% de la población consumió alcohol, 45.4% tabaco y 3.5% alguna droga alguna vez en la vida. En los últimos 12 meses, casi uno de cada dos varones y una de cada cuatro mujeres consumió alcohol; uno de cada 10 adultos mayores consumió tabaco; y sólo uno de cada 100 consumió alguna droga. La prevalencia de consumo de sustancias es mayor en hombres, con excepción de las drogas médicas. Los factores asociados que destacaron fueron el sexo y los mejores niveles económicos. Éste es el primer estudio realizado en el país sobre uso de sustancias en población de adultos mayores con domicilio fijo, no institucionalizado. El consumo de alcohol, incluso el consumo riesgoso, no es infrecuente; el hábito tabáquico no ha desaparecido con la edad, y el uso de drogas médicas puede ser un motivo de preocupación por su efecto en otras patologías. Se hace necesario establecer definiciones de uso riesgoso para esta población y desarrollar programas de intervención adecuados para este grupo.
