Remote crisis intervention and suicide risk management in COVID-19 frontline healthcare workers.

Introduction: Despite the propagation of virtual mental health services for vulnerable groups during COVID-19 pandemic, the implementation and evaluation of remote evidence-based practices (EBP) to manage them in low- and middle-income countries remains scarce. In the current study, we describe and evaluate the implementation process and clinical impact of brief, remote, manualized EBP for crisis intervention and suicide risk management among healthcare workers attending patients with COVID-19 (COVID-19-HCWs) in Mexico. Methods: The implementation process comprised community engagement of volunteer mental health specialists, creation of new clinical teams with different disciplines and skills, intervention systematization through manuals and education through 4-h remote training as main strategies. Mexican COVID-19-HCWs who had used a free 24-h helpline rated their pre- and post-intervention emotional distress. Therapists recorded patients' pre-intervention diagnosis, severity, and suicide risk, the techniques used in each case, and their post-treatment perception of COVID-19-HCWs' improvement at the end of the intervention. Results: All techniques included in the intervention manual were employed at least in one case (n = 51). At the beginning of the intervention, 65.9% of the COVID-19-HCWs were considered moderately ill or worse according to Clinical Global Impression-Severity (CGI-S) scores, whereas at the end, 79.4% of them were perceived as much or very much improved according to CGI-Improvement scores (CGI-I), and their emotional distress had been significantly reduced (p < 0.001). Discussion: This prospective study provides evidence that implementation of remote EBP is feasible and useful to reduce emotional distress and suicide risk among COVID-19-HCWs from a middle-income country. However, this study was limited by lack of a control group, improvement ratings provided by therapists and non-anonymous satisfaction ratings.

Developing an App to Screen for Dual Disorders: A Tool for Improving Treatment Services in Mexico.

Background: Previous studies in Mexico undertaken at residential facilities for treating substance use disorders (SUDs) reported that the prevalence of Dual Disorders (DDs) is over 65%. DDs pose a major challenge for the Mexican health system, particularly for community-based residential care facilities for SUDs, due to the shortage of certified professionals to diagnose and treat these patients. Moreover, the lack of standardized algorithms for screening for and evaluating DDs to refer patients to specialized services (whether private or public) hinders timely care, delaying the start of integrated treatment. The use of new technologies provides a strategic opportunity for the timely detection of DDs through the development of standardized digital applications for the timely detection of DDs. Objective: To develop an app to screen for DDs, which will contribute to referral to specialized services in keeping with the level of severity of psychiatric and addictive symptomatology, and be suitable for use by community-based residential care facilities for SUDs. Method: The research project was implemented in two stages. Stage 1 involved obtaining the psychometric properties of the Dual Diagnosis Screening Interview (DDSI). Stage 2 consisted of two steps to test the Beta version of the app and the quality of version 1.0. Results: The DDS obtained sensitivity and specificity scores above 85%. The app and its algorithm to screen for and refer DDs proved to be efficient and easy to apply with satisfactory community acceptance. Conclusion: The app promises to be a useful screening tool at residential addiction treatment centers.

Collaborative care for depression and suicide prevention: a feasible intervention within the Mexican health system.

Mexico faces an enormous challenge in attending mental health disorders with depression rising as one of the five main contributors to disability adjusted life years (DALYs) and increasing suicide rates. These challenges are coupled with a dearth of resources and an inefficient allocation of the meager funds. While no magical bullet is available to ameliorate this situation in the short term, here we discuss current concepts and experiences that could be used in Mexico to deliver better primary mental health care. We focus on depression and suicidal behavior and argue that collaborative care is a feasible and replicable model, emphasizing the importance of training non-specialized primary care personnel to become case managers and provide primary mental health care. Mexi-co is currently undergoing a process of changes, including the emergence of universal health care. The time seems right to make mental health care more transversal, widely available and scientifically proven.

Characterization of dual disorders in addiction treatment-seekers at mexican outpatient centers.

In Mexico, very few studies have been published on dual disorders (DD) at specialized treatment centers describing actual treatment needs and even fewer have been undertaken at addiction treatment centers in the public system. The objective of this study was therefore to analyze DD and other clinical characteristics in people seeking treatment at outpatient addiction centers in the public system.

Caracterización de la patología dual en personas que buscan tratamiento de adicciones en centros ambulatorios mexicanos / Characterization of dual disorders in addiction treatment-seekers at mexican outpatient centers

INTRODUCCIÓN: En México son pocos los estudios publicados sobre la patología dual (PD) en centros de tratamiento espe­cializados que describan las necesidades reales de tratamiento y menos aún que se hayan realizado en centros de tratamiento de adicciones del sistema público. Por esto, el objetivo de pre­sente estudio fue analizar la PD y otras características clínicas en personas que buscan tratamiento en centros ambulatorios de adicciones del sistema público. MÉTODO: Estudio transversal multisede. Se analizó una muestra de 148 pacientes de cen­tros de tratamiento. Se evaluaron trastornos psiquiátricos con la Mini Entrevista Neuropsiquiátrica Internacional, conductas sexuales de riesgo con la Escala de Comportamiento de Riesgo de VIH, consumo de drogas inyectables, y la calidad de vida con el Cuestionario de Calidad de Vida. Se realizaron análisis univariados mediante chi cuadrado para determinar diferen­cias estadísticas entre personas con y sin PD, así como regre­sión lineal para calidad de vida y regresión logística binomial para determinar el riesgo para presentar consumo de drogas inyectables, uso de condón y conducta suicida. RESULTADOS: La cocaína fue la droga de impacto con mayor prevalencia (33.8%). El grupo de personas con trastorno por consumo de alcohol + trastorno por consumo de drogas presentó mayor comorbilidad con el trastorno depresivo mayor (25.7%), tras­torno antisocial (27.7%), déficit de atención (11.5%) e intento suicida (17.6%). El grupo con PD presentó mayor consumo de drogas inyectables (OR= 1.67), no uso de condón con pareja primaria (OR= 3.66), más intentos de suicidio (OR= 4.2) y una menor calidad de vida en comparación con aquellos sin PD. CONCLUSIÓN: Caracterizar a los pacientes con PD, permite iden­tificar con precisión sus necesidades de tratamiento y desarro­llar programas de mejora continua para optimizar los recursos y mejorar el éxito de la atención

INTRODUCTION: In Mexico, very few studies have been published on dual disorders (DD) at specialized treatment centers describing actual treatment needs and even few­er have been undertaken at addiction treatment centers in the public system. The objective of this study was therefore to analyze DD and other clinical characteristics in people seeking treatment at outpatient addiction centers in the public system. Method. Cross-sectional multi-site study. A sample of 148 patients from treatment centers was analyzed. Psychi­atric disorders were evaluated with the Mini International Neuropsychiatric Interview, risky sexual behaviors with the HIV Risk Behavior Scale, injection drug use, and quality of life with the Quality of Life Questionnaire. Univariate chi-square analyses were performed to determine statistical dif­ferences between subjects with and without DD, while linear regression was used to calculate quality of life and binomial logistic regression to determine the risk of injection drug use, condom use, and suicidal behavior. RESULTS: Cocaine was the impact drug with the highest prevalence (33.8%). The group of subjects with alcohol use disorder + drug use disorder presented greater comorbidi­ty with major depressive disorder (25.7%), antisocial disor­der (27.7%), attention deficit (11.5%) and suicide attempt (17.6%). The group with DD presented higher injection drug use (OR = 1.67), non-use of condoms with a primary part­ner (OR = 3.66), more suicide attempts (OR = 4.2) and lower quality of life than those without DD. CONCLUSION: Characterizing patients with DD enables the accurate identification of their treatment needs and the development of continuous improvement programs to opti­mize resources and improve the success of care

Community mental health care in Mexico: a regional perspective from a mid-income country.

BACKGROUND: Access to mental health care is a worldwide public health challenge. In Mexico, an unacceptably high percentage of the population with mental disorders does not receive the necessary treatment, which is mainly due to the lack of access to mental health care. The community mental health care model was created and has been implemented to improve this situation. In order to properly plan and implement this model a precise situational diagnosis of the mental health care network is required, thus this is a first approach to evaluate the community mental health networks in the state of Jalisco. METHODS: Two components from the EvaRedCom-TMS instrument were used including a general description and accessibility of the community mental health care network. A geographic and economic accessibility evaluation was carried out for the different regions of the state ranging from scattered rural to urban communities using information gathered from health institutions, telephone interviews and computer applications. RESULTS: Jalisco's community mental health network includes a total of 31 centers and 0.64 mental health workers for every 10,000 inhabitants > 15 years of age. The mean transportation cost required to access mental health care was 16.25 USD per visit. The time needed to reach the closest mental health center in 7 of the 13 analyzed regions was more than 30 min and the mean time required to reach a prolonged stay center was 172.7 min with transportation cost (taxi, private and public transport) of 22.3 USD. Some marginalized regions in the state have a mean 114 min required to reach the closest mental health care center and 386 min to reach a prolonged stay center. CONCLUSIONS: This first approach to evaluate the mental health networks in Mexico showed that there are multiple barriers to access its care including an unfavorable number of human resources, long distances, and high costs. The identification of Jalisco's mental health network deficiencies is the first step towards establishing a properly planned community mental health care model within the country.

Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other Country-Level Epidemics: The Case of Mexico.

COVID-19 frontline healthcare workers (FHCW) are struggling to cope with challenges that threaten their wellbeing. We examine the frequency and predictors of the most frequent mental health problems (MHP) among FHCW during the first COVID-19 peak in Mexico, one of the most severely affected countries in terms of FHCW's COVID-19 mortality. A cross-sectional survey was conducted between May 8 and August 18, 2020. A total of 47.5% of the sample (n = 2218) were FHCW. The most frequent MHP were insomnia, depression, posttraumatic stress symptoms, and health anxiety/somatization (whole sample: 45.7, 37.4, 33.9, and 21.3%; FHCW: 52.4, 43.4, 40.3 and 26.1, respectively). As compared to during the initial COVID-19 phase, depression and health anxiety/somatization symptoms as well as experiences of grieving due to COVID-19, personal COVID-19 status, and having relatives and close friends with COVID-19 were more frequent during the COVID-19 peak. Obesity, domestic violence, personal COVID-19 status, and grieving because of COVID-19 were included in regression models for main FHCW's MHP during the COVID-19 peak. In conclusion, measures to decrease other country-level epidemics contributing to the likelihood of COVID-19 complications (obesity) and MHP (domestic violence) as well as FHCW´s probability of COVID-19 infection could safeguard not only their physical but also mental health.

Atención colaborativa para depresión y prevención de suicidio: una intervención viable en el sistema de salud mexicano / Collaborative care for depression and suicide prevention: a feasible intervention within the Mexican health system

Resumen: México enfrenta un enorme desafío para atender los trastornos mentales, con la depresión como uno de los principales contribuyentes a los años de vida ajustados por discapacidad (AVAD) y el aumento de las tasas de suicidio. Estos desafíos se combinan con la escasez de recursos y asignación ineficiente de fondos. Si bien no hay una solución mágica a corto plazo, discutimos experiencias actuales que podrían usarse para brindar una mejor atención primaria en salud mental. Nos centramos en depresión y conducta suicida argumentando que la atención colaborativa es un modelo factible y replicable, enfatizando la capacitación del personal no especializado para que se convierta en administrador de casos y brinde atención primaria en salud mental. México está experimentando un proceso de cambios, incluido el surgimiento de la atención médica universal, por lo que es el momento para que la atención en salud mental sea más transversal, disponible y científicamente probada.

Abstract: Mexico faces an enormous challenge in attending mental health disorders with depression rising as one of the five main contributors to disability adjusted life years (DALYs) and increasing suicide rates. These challenges are coupled with a dearth of resources and an inefficient allocation of the meager funds. While no magical bullet is available to ameliorate this situation in the short term, here we discuss current concepts and experiences that could be used in Mexico to deliver better primary mental health care. We focus on depression and suicidal behavior and argue that collaborative care is a feasible and replicable model, emphasizing the importance of training non-specialized primary care personnel to become case managers and provide primary mental health care. Mexico is currently undergoing a process of changes, including the emergence of universal health care. The time seems right to make mental health care more transversal, widely available and scientifically proven.

Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico.

BACKGROUND: Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy. METHODS: A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. RESULTS: A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. CONCLUSIONS: Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

[Open communication between mental health professionals and parents of patients with intellectual disabilities]. / Comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual.

OBJECTIVE: To estimate the factors associated with open communication between mental health professionals and parents of patients with intellectual disabilities and other neurodevelopmental disorders. MATERIALS AND METHODS: Cross-sectional survey in 759 mental health professionals. The association between the pattern of open communication and the attributes of communication was estimated through a logistic, ordinal, multivariate model. RESULTS: The prevalence of the pattern of open communication in mental health professionals was 30.6% (95%CI 27.4-34.0). The associated factors were younger age (RM=2.42, 95% CI 1.57-3.75), specialty (RM= 1.56, 95%CI 1.09-2.23), high value to the truth (RM= 4.95, 95% CI 3.21-7.65), low paternalism (RM= 10.93, 95%CI 7.22-16.52) and courses in bioethics (RM= 1.45, 95%CI 1.01-2.09), adjusted for confusing variables. CONCLUSIONS: Mental health professionals reported low levels of open com-munication with parents of people with neurovelopmental disorders, so prioritizing the value to the truth, promoting less paternalism, and respecting the autonomy of patients, can contribute to changing these patterns of communication in clinical practice in Mexico.

OBJETIVO: Estimar los factores asociados con la comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual y otros trastornos del neurodesarrollo. MATERIAL Y MÉTODOS: Encuesta transversal en 759 profesionales de la salud mental. Se estimó la asociación entre el patrón de comunicación abierto y los atributos de la comunicación a través de un modelo logísti-co, ordinal y multivariado. RESULTADOS: La prevalencia del patrón de comunicación abierta en profesionales de la salud mental fue de 30.6% (IC95% 27.4-34.0). Los factores asocia-dos fueron menor edad (RM=2.42, IC95% 1.57-3.75), espe-cialidad (RM=1.56, IC95% 1.09-2.23), alto valor a la verdad (RM=4.95, IC95% 3.21-7.65), bajo paternalismo (RM=10.93, IC95% 7.22-16.52) y cursos de bioética (RM=1.45, IC95% 1.01-2.09), ajustando por variables confusoras. CONCLUSIONES: Los profesionales de la salud mental reportaron bajos niveles de comunicación abierta con los padres de personas con trastornos del neurodesarrollo, por lo que priorizar el valor a la verdad, promover un menor paternalismo y el respeto a la autonomía de los pacientes puede contribuir a cambiar estos patrones de comunicación en la práctica clínica en México.

[Knowledge about neurodevelopmental disorders associated with the acceptance of the inclusive education model, in basic education teachers] / Conocimiento sobre trastornos del neurodesarrollo asociado con la aceptación del modelo de educación inclusiva en docentes de educación básica

OBJECTIVE: To describe the prevalence of knowledge about neurodevelopment disorders (NDDs) and the level of acceptance of models of inclusive education (IEM) in teachers. MATERIALS AND METHODS: A multicenter cross-sectional study in Mexico and Central America. A self-report instrument to teachers of basic level on knowledge in NDDs and acceptance of the IEM. RESULTS: The response of 511 teachers was obtained. The prevalence of high acceptance of the IEM was 28.6%. Of the 120 teachers who reported having extensive knowledge about intellectual disability, 3.8% were in the lowest percentile of acceptance of the IEM, 19.5% in the average percentile of acceptance and 55.5% of them were in the highest percentile acceptance (p<0.001). Among teachers, a greater knowledge about NDDs was associated with the acceptance of IEM: learning disorders RM 3.76 (95%CI 2.13-6.62); attention deficit disorders with hyperactivity RM 2.24 (95%CI 1.31-3.84) and intellectual disability RM 3.84 (95%CI 2.46-5.99). CONCLUSIONS: The teaching acceptance of IEM can be favored with greater and better training of education professionals on the different NDDs.

OBJETIVO: Describir la prevalencia del conocimiento sobre trastornos del neurodesarrollo (TdN) y el nivel de aceptación de los modelos de educación inclusiva (MEI) en docentes. MATERIAL Y MÉTODOS: Estudio transversal multicéntrico en México y Centroamérica. Aplicación de un instrumento de autorreporte a docentes de nivel básico sobre conocimiento en TdN y aceptación de los MEI. RESULTADOS: Se obtuvo la respuesta de 511 docentes. La prevalencia de alta aceptación de MEI fue de 28.6%. De los 120 docentes que refirieron tener un amplio conocimiento sobre discapacidad intelectual, 3.8% estuvieron en el percentil más bajo de aceptación de MEI, 19.5% en el percentil de aceptación promedio y 55.5% de ellos se encontraron en el percentil de mayor aceptación (p<0.001). Entre los docentes, un mayor conocimiento sobre los TdN se mostró asociado con la aceptación de MEI: trastornos del aprendizaje RM 3.76 (IC95% 2.13-6.62); trastornos por déficit de atención con hiperactividad RM 2.24 (IC95% 1.31-3.84) y discapacidad intelectual RM 3.84 (IC95% 2.46-5.99). CONCLUSIONES: La aceptación docente de MEI puede favorecerse con una mayor y mejor capacitación de los profesionales de la educación sobre los diferentes TdN.

Necesidades de atención en salud mental y uso de servicios en población mexicana con trastornos mentales graves / Mental health care needs and use of services in Mexican population with serious mental disorders

Resumen: Objetivo: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. Material y métodos: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. Resultados: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (β=1.062; p=.000), ingreso familiar (β=1.000, p=.000) y no tener ocupación (β=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (β=4.158; p=.000). Conclusiones: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

Abstract: Objective: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. Materials and methods: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychiatric hospital. Results: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (β=1.062, p=.000), family income (β=1.000, p=.000) and no laboral occupation (β=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (β=4.158, p=.000). Conclusions: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

[Mental health care needs and use of services in Mexican population with serious mental disorders]. / Necesidades de atención en salud mental y uso de servicios en población mexicana con trastornos mentales graves.

OBJECTIVE: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. MATERIALS AND METHODS: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychi- atric hospital. RESULTS: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (ß=1.062, p=.000), family income (ß=1.000, p=.000) and no laboral occupation (ß=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (ß=4.158, p=.000). CONCLUSIONS: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

OBJETIVO: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. RESULTADOS: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (ß=1.062; p=.000), ingreso familiar (ß=1.000, p=.000) y no tener ocupación (ß=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (ß=4.158; p=.000). CONCLUSIONES: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

Effectiveness of augmented Individual Placement and Support interventions for competitive employment in people with schizophrenia: Systematic review and meta-analysis / Revisión sistemática y metaanálisis de la efectividad de intervenciones aumentadas de IPS para la obtención de empleo competitivo en personas con esquizofrenia

Abstract: Background: It has been estimated that over 70% of people living with a diagnosis of schizophrenia wish to work. The Individual Placement and Support (IPS) model has proven to be highly effective in enhancing competitive employment in people with schizophrenia. However, the efficacy of augmented IPS interventions, in other words, those that incorporate a psychosocial intervention into the model, has not been evaluated in this population. Objective: To assess the efficacy of augmented IPS interventions designed to obtain competitive employment in people with schizophrenia. Method: A systematic review of the literature on randomized clinical trials of augmented IPS interventions, published in English between 2007 and 2017, was conducted in the electronic databases of PubMed, Science Direct, and EBSCO. Risk of bias and competitive employment rates were calculated. A meta-analysis was performed using the random effects method to estimate the effect of augmented IPS interventions. Results: Twelve articles were identified in which 10 augmented IPS interventions were compared with other interventions. In eight studies conducted on people with schizophrenia, the intervention was based on IPS + social skills/work skills/cognitive remediation vs. IPS or modified IPS. No general effect favoring augmented interventions (RR = 1.37, 95% CI [.97, 1.95], I2 = 52%) was found. Augmented IPS interventions tend to be more effective when they are implemented during the first psychotic episode. Discussion and conclusion: It is not possible to conclude that augmented IPS interventions have a significant effect over standard IPS interventions in obtaining competitive employment in people with schizophrenia.

Resumen: Antecedentes: Se ha estimado que más del 70% de las personas que viven con diagnóstico de esquizofrenia desean trabajar. El modelo Individual Placement and Support (IPS) ha mostrado efectividad para que las personas con esquizofrenia consigan un empleo competitivo. Sin embargo, en esta población no se ha evaluado la eficacia de las intervenciones aumentadas de IPS -es decir, aquellas que añaden al modelo una intervención psicosocial. Objetivo: Evaluar la eficacia de las intervenciones aumentadas de IPS dirigidas a la obtención de empleo competitivo en personas con esquizofrenia. Método: Se realizó una revisión sistemática de la literatura de ensayos clínicos aleatorizados sobre intervenciones aumentadas de IPS publicados en inglés entre 2007 y 2017, en las bases de datos electrónicas de PubMed, Science Direct y EBSCO. Se calcularon el riesgo de sesgo y las tasas de empleo competitivo. Se realizó un metaanálisis mediante el método de efectos aleatorios para estimar el efecto de las intervenciones aumentadas de IPS. Resultados: Se identificaron 12 artículos en los que se comparaban 10 intervenciones aumentadas de IPS con alguna otra intervención. En ocho estudios realizados en personas con esquizofrenia, la intervención se basó en IPS + habilidades sociales/habilidades laborales/remediación cognitiva vs. IPS o IPS modificadas, sin que se encontrara un efecto general en favor de las intervenciones aumentadas (RR = 1.37, 95% IC [.97, 1.95], I2 = 52%). Las intervenciones aumentadas de IPS tienden a ser más efectivas cuando se llevan a cabo en el primer episodio psicótico. Discusión y conclusión: No se puede concluir que las intervenciones aumentadas de IPS tengan un mayor efecto sobre las intervenciones estándar de IPS para la obtención de empleo competitivo en personas con esquizofrenia.

Factores Psicológicos y Relaciónales Asociados a Episodios de Embriaguez en Adolescentes Escolares de Guadalajara, México / Psychological and Related Factors Associated with Drunkenness Episodes in Adolescent Students in Guadalajara, Mexico / Fatores Psicológicos e Relações Associados a Episódios de Embriaguez em Adolescentes Escolares de Guadalajara, México

Resumen El objetivo de este estudio fue asociar factores psicológicos y relaciónales vinculados a episodios de embriaguez en 1134 adolescentes escolares de Guadalajara, México. Se evaluaron diez factores psicológicos y relacionales. La variable de desenlace fue episodios de embriaguez durante el último mes. Se encontró una prevalencia de embriaguez de 26.5% con mayor consumo en hombres. Después del análisis de regresión logística los factores asociados a embriaguez fueron tabaquismo, alta autoestima, alta impulsividad, bajo locus de control interno, la presencia de estrés cotidiano y relación distante con el padre. La investigación concluye que los factores psicológicos y relacionales asociados a episodios de embriaguez hicieron referencia a un perfil de omnipotencia altamente influenciable, y al desapego emocional, por lo que el consumo excesivo de alcohol parece perfilarse como una estrategia de seguridad.

Abstract The aim of this study was to identify psychological and related factors linked with drunkenness episodes in 1134 adolescent students in Guadalajara, Mexico. The study evaluated ten psychological and related factors. The outcome variable was the number of episodes of drunkenness in the last month. We found 26.5% more episodes of drunkenness in men. A logistic regression analysis indicated that factors associated with drunkenness were smoking, high self-esteem, high impulsiveness, low self-control, presence of daily stress and distant relationship with father. The study concluded that the psychological and related factors associated with drunkenness episodes were related to a highly impressionable omnipotence profile and emotional indifference, with excessive consumption of alcohol as a safety strategy.

Resumo O objetivo deste estudo foi associar fatores psicológico e relações vinculados a episódios de embriaguez em 1134 adolescentes escolares de Guadalajara, México. Avaliaram-se dez fatores psicológicos e relacionais. A variável de desenlace foi episódios de embriaguez de 26.5 % com maior consumo em homens. Depois da análise de regressão logística, os fatores associados à embriaguez foram tabaquismo, alta autoestima, alta impulsividade, baixo lócus de controle interno, presença de estresse cotidiano e relação distante com o pai. A pesquisa conclui que os fatores psicológicos e relacionais associados a episódios de embriaguez fizeram referência a um perfil de onipotência altamente influenciável e ao desapego emocional; nesse sentido, o consumo excessivo de álcool parece perfilar-se como uma estratégia de segurança.

[Strategies of adolescents according to gender to quit their smoking habit]. / Estrategias de adolescentes según género para cesar su hábito tabáquico.

Objective: to explore and analyze tobacco smoking cessation strategies and identify differences by gender in adolescents. Methods: exploratory study with 62 regular tobacco smoking students from a public high school University of Guadalajara. Free lists were used for data collection. Results: seventy-nine percent of the students had tried to quit tobacco-smoking. Strategies used were focused on volition (53.5 %), substitution (16.3 %), avoiding hanging with smokers (12.8 %), reflexive thinking (10.5 %) and a progressive reducing tobacco smoking (7 %). Differences were found in strategies used by men and women: while the women used a higher rate of reflexive thinking and substituted tobacco smoking by ingesting calories, men avoided hanging out with smokers and substituted tobacco smoking with burning energy strategy. Tobacco smoking reduction was reported as the most efficient strategy. Conclusions: tobacco smoking cessation strategies derived from a cultural notion of tobacco as a vice where the most important issue was making the decision and using one's own resources. To stop smoking tobacco came out as a health need which should be attended by health care services.

[Changes in risk behaviors according to gender in a cohort of high school students]. / Cambios de comportamientos de riesgo según género en una cohorte de estudiantes de preparatoria.

Objective: to analyze changes on risk behavior (RB) by gender in an adolescent student's cohort. Methods: online questionnaire based on YRBSS of CDC with 36 RB was applied in two periods (2003, 2005) to 115 students aged 15 to 19 from High School. Statistics: McNemar and binomial. Results: significant decrease in relation to RB frequency about suicide (general), carry weapons (general and men) and friends fights (general and women), significant increase of RB frequency about alcohol consumption (general and both genders), not quitting (men), non vegetable consumption (general), not condom use (general and women) not using contraceptives (general and women) and alcohol and drugs consumption in car (general). With inadequate exercise and there were contrary trends; with drugs use and sexual violence there was no change. Conclusions: adolescents from both genders start High School with similar profile of wide frequency of RB in both genders, there were only nine significant changes, and six did not have. Few changes by gender were observed, there was an increase in unsafe sex practices and alcohol consumption in women.

Objetivo: analizar el cambio de comportamientos de riesgo y género en estudiantes de 15 a 19 años de edad de una escuela preparatoria. Métodos: en 2003 y 2005 se aplicó un cuestionario en línea, voluntario y confidencial, a 115 estudiantes, basado en Youth risk behavior surveillance system del Center for Disease Control and Prevention con 36 indicadores. El análisis estadístico se llevó a cabo con pruebas de McNemar y binomial. Resultados: disminución significativa de comportamientos de riesgo en suicidio (muestra total), portación de armas (total y hombres) e involucramiento en peleas (total y mujeres), y aumento significativo en necesidad y consumo de alcohol (total y ambos sexos), no dejar de fumar (hombres), no consumir verduras (total), no usar condón (total y mujeres), no usar anticonceptivos (total y mujeres), y consumir alcohol o drogas en vehículos (total). En ejercicio inadecuado hubo tendencias contrarias; en consumo de drogas y violencia sexual no hubo cambios. Conclusiones: se ingresó con amplio rango de frecuencia de comportamientos de riesgo en ambos sexos; hubo nueve cambios significativos (25 %), dos tercios negativos. Preocupa el incremento de los comportamientos de riesgo en sexo inseguro y consumo de alcohol en mujeres.

[Factors associated to tobacco-smoking pattern in school teenagers]. / Factores asociados a los patrones de consumo de tabaco en adolescentes escolares.

OBJECTIVE: to evaluate the association between tobacco-smoking patterns and family and school variables in school teenagers from Guadalajara, Mexico. METHODS: 556 high school students at the Universidad de Guadalajara participated in the study. The analysis included the following risk factors: parental, siblings and friends smoking habits, being employed while studying, being an irregular student, school shift (morning/evening), and history of rejection in their first application to enter high-school. RESULTS: 48.3 % of students smoked occasionally and 9.7 % smoked regularly. The logistic regression analysis showed that the covariate smoking peers was associated to occasional and regular consumption when compared to non-consumption. The covariates: smoking father, being an irregular student and history of rejection to the first application, were associated to regular consumption. Unexpectedly, smoking peers was a protective factor for progression from occasional to regular consumption. CONCLUSIONS: smoking peers was a risk factor associated to progress from non-smoking to occasional and to regular tobacco consumption. Parental smoking, being an irregular student, and being previously rejected to enter to the high school were identified as risk factors for progression from non-smoking to regular consumption.