Popular education to improve water quality and hygiene in a Mexican indigenous community.

Long-term research has identified significant water contamination and associated poor health outcomes in the indigenous community of Alpuyeca, located in south-central Mexico. We set out to develop a popular education initiative in this community to improve water, sanitation and hygiene (WaSH) knowledge and practices. In order to avoid recreating hierarchical power dynamics in this vulnerable community, a participatory action research (PAR) design was used, wherein the community took leadership and facilitation roles in each stage of the research process. In qualitative interviews and design sessions, community members identified unsatisfied WaSH needs in households and community institutions and articulated a clear worldview of the spiritual role of water, which guided the development of a series of popular education-based workshops and discussions. The popular education initiative process was documented with a mixed methods framework, using before-and-after surveys, semi-structured interviews and participatory observation. Increases in knowledge and practices related to water purification, water consumption and hand hygiene were noted in the community. The community identified locally installed and managed ecotechnologies as a key opportunity for sustainable development, community participation and the adoption of water and sanitation systems, compatible with public imaginaries of the role of water.

Non-Migrant Paid Domestic Workers and Depressive Symptoms: A Mixed-Methods Systematic Review.

Health of non-migrant paid domestic workers (PDWs) has seldom been studied. This review examines the relationship between being a non-migrant paid domestic worker and manifesting depressive symptoms (DS). Following a mixed-methods systematic review protocol, we found 10 relevant cross-sectional studies conducted in African, Asian, and Latin American countries. Depressive symptoms prevalence reported in quantitative studies ranged from 28% (CI: 22-35) to 53% (CI: 46-60). Qualitative evidence points towards structural conditions (poverty and intersectional discrimination) as drivers of female job placement in domestic work. Qualitative and quantitative evidence suggest that DS occurs more frequently in PDWs than other workers in the informal labor market. Psychosocial risks, working conditions, and workplace abuse play an intervening role in the development of DS. Future longitudinal research and adequate sampling methods are needed to examine protective factors, perceptions of working conditions, and work-family conflict in PDWs to better assess the development of DS among them.

Levels of Adherence of an Exercise Referral Scheme in Primary Health Care: Effects on Clinical and Anthropometric Variables and Depressive Symptoms of Hypertensive Patients.

Among the modifiable health behaviors, physical activity (PA) promotion has been one of the challenges in primary care, particularly how to translate the results of proven interventions and implement them in the real world. This study was aimed to compare whether two programs designed for hypertensive patients achieve changes in clinical and anthropometric variables, quality of life, and depressive symptoms; and if higher levels of adherence to one of the interventions using an exercise referral (ER) approach achieved better health outcomes. Pragmatic cluster randomized trials were carried out in four Primary Health Care Units (PHCUs). Physicians in the PHCUs identified hypertensive patients and assessed whether they were eligible to be part of this trial. Each center was randomized to a brief PA counseling (BC, n = 2) or an exercise referral (ER, n = 2) intervention to conducted PA programs among hypertensive patients aged 35-70 years, self-reported as physically inactive. Outcome variables included changes in blood pressure levels, triglycerides, HDL cholesterol, fasting glucose, body mass index, waist/hip ratio, abdominal obesity, and metabolic syndrome risk score, health-related quality of life, and depressive symptoms. Longitudinal multilevel analyses assessed the effects of the BC and ER programs and the level of adherence of the ER on clinical, anthropometric, and mental health variables, models were linear for continuous variables, and logistic for dichotomous variables. Differences were observed in triglycerides, BMI, metabolic risk scores variables, and depressive symptoms among ER and BC programs. In addition, differences in the ER group were observed according to the level of adherence in blood pressure levels, waist circumference and waist/hip ratio, depressive symptoms, and the mental health component of health-related quality of life. An ER program in comparison to a BC intervention is promoting changes in some specific health indicators of hypertensive patients, showing the usefulness of these PA programs in primary health care facilities.

Understanding adherence of hypertensive patients in Mexico to an exercise-referral scheme for increasing physical activity.

Among the strategies developed thus far for promoting physical activity (PA), exercise-referral schemes (ERs) have gained in popularity as an effective means of preventing secondary health conditions such as hypertension. However, information on the factors affecting adherence to these programs is limited. Using a mixed-methods approach, we undertook the present study to determine the factors associated with adherence to a specific ER aimed at increasing PA among the hypertensive patients in a Social Security institution in Mexico. Data were obtained through semi-structured questionnaires and interviews as well as from the clinical records of participants. For the quantitative component, multinomial regression analysis estimated the factors behind the varying levels of adherence. For the qualitative component, we performed a content analysis based on the health belief model. According to our findings, 80% of participants who began the ER exhibited high levels of adherence. Older age and being female were the key demographic characteristics of those showing increased adherence. Meanwhile, financial issues, the investment of time required, low perception of the benefits of PA, lack of confidence in being able to achieve changes in lifestyle, and a reluctance to acknowledge the seriousness of their health condition were the principal factors among those who did not join the program or exhibited low levels of adherence. Our findings can serve as a basis for designing PA interventions that take into account individual, cultural and administrative elements in their efforts to improve adherence to PA programs for those suffering from chronic conditions such as hypertension.

COVID-19 Response in Latin America.

Effective management of a pandemic due to a respiratory virus requires public health capacity for a coordinated response for mandatory restrictions, large-scale testing to identify infected individuals, capacity to isolate infected cases and track and test contacts, and health services for those infected who require hospitalization. Because of contextual and socioeconomic factors, it has been hard for Latin America to confront this epidemic. In this article, we discuss the context and the initial responses of eight selected Latin American countries, including similarities and differences in public health, economic, and fiscal measures, and provide reflections on what worked and what did not work and what to expect moving forward.

Loss of job-related right to healthcare associated with employment turnover: challenges for the Mexican health system.

BACKGROUND: The Mexican health system segments access and right to healthcare according to worker position in the labour market. In this contribution we analyse how access and continuity of healthcare gets interrupted by employment turnover in the labour market, including its formal and informal sectors, as experienced by affiliates to the Mexican Institute of Social Security (IMSS) at national level, and of workers with type 2 diabetes (T2DM) in Mexico City. METHODS: Using data from the National Employment and Occupation Survey, 2014, and from IMSS electronic medical records for workers in Mexico City, we estimated annual employment turnover rates to measure the loss of healthcare access due to labour market dynamics. We fitted a binary logistic regression model to analyse the association between sociodemographic variables and employment turnover. Lastly we analysed job-related access to health care in relation to employment turnover events. RESULTS: At national level, 38.3% of IMSS affiliates experienced employment turnover at least once, thus losing the right to access to healthcare. The turnover rate for T2DM patients was 22.5%. Employment turnover was more frequent at ages 20-39 (38.6% national level; 28% T2DM) and among the elderly (62.4% national level; 26% T2DM). At the national level, higher educational levels (upper-middle, OR = 0.761; upper, OR = 0.835) and income (5 minimum wages or more, OR = 0.726) were associated with lower turnover. Being single and younger were associated with higher turnover (OR = 1.413). T2DM patients aged 40-59 (OR = 0.655) and with 5 minimum wages or more (OR = 0.401) experienced less turnover. Being a T2DM male patient increased the risk of experiencing turnover (OR = 1.166). Up to 89% of workers losing IMSS affiliation and moving on to other jobs failed to gain job-related access to health services. Only 9% gained access to the federal workers social security institute (ISSSTE). CONCLUSIONS: Turnover across labour market sectors is frequently experienced by the workforce in Mexico, worsening among the elderly and the young, and affecting patients with chronic diseases. This situation needs to be prospectively addressed by health system policies that aim to expand the financial health protection during an employment turnover event.

State of Children Environmental Health Research in Latin America.

BACKGROUND: Promotion of biomedical research along with the development of evidence-based prevention policies have been suggested as an effective way to reduce environmental risks for children's health in Latin America. However, there is little information on the current state of childhood environmental health research, which might help identify its strengths and limitations, as well as to design a strategy to improve the future of child environmental health research in the region. OBJECTIVE: To describe the current state of environmental health research on children exposed to environmental pollutants in Latin America. METHODOLOGY: We performed a comprehensive search of published peer-reviewed environmental health articles (1994-2014), dealing with the exposure of Latin American children to chemical compounds. We described the type of studies and their research topics, and identified networks of co-authors. We also analyzed the relationship between research funding sources and the impact factor (IF) of the journal where research was published. RESULTS: The average number of publications was about 20 per year. Mexico and Brazil produced almost 70% of the 409 identified papers. The most studied contaminant was lead, but research on this element has declined since 2005. Retrospective studies were the most frequent, and also showed a decreasing trend. Most studies did not assess health effects. Four groups of leading investigators and two collaboration models for scientific production were identified. Except for Mexico, there was very little collaboration with North American and European countries. Compared to articles that did not report financial support, those that received international funding had on average an IF around 7, and those with national funding reached a mean IF near 3. CONCLUSION: There is a limited number of publications and insufficient collaboration between Latin-American scientists. It is necessary to identify strategies to stimulate South-South-North alliances and strengthen the scarce research on the environmental health of children in the region.

Brief Counseling and Exercise Referral Scheme: A Pragmatic Trial in Mexico.

INTRODUCTION: The effectiveness of clinical-community linkages for promotion of physical activity (PA) has not been explored in low- and middle-income countries. This study assessed the effectiveness of a primary care-based, 16-week intervention rooted in behavioral theory approaches to increase compliance with aerobic PA recommendations. STUDY DESIGN: Pragmatic cluster randomized trial. SETTING/PARTICIPANTS: Patients had diagnosed (<5 years) hypertension, were aged 35-70 years, self-reported as physically inactive, had a stated intention to engage in PA, and attended Primary Healthcare Centers in the Social Security health system in Cuernavaca, Mexico. Of 23 Primary Healthcare Centers, four were selected based on proximity (5 km radius) to a center. INTERVENTION: Each center was randomized to a brief PA counseling (BC, n=2) or an exercise referral (ER, n=2) intervention. The study was conducted between 2011 and 2012. MAIN OUTCOME MEASURES: Change in objectively measured PA levels (ActiGraph GT3X accelerometers) at baseline, 16, and 24 weeks. Intention-to-treat analyses were used to assess the effectiveness of the intervention overall and according to ER intervention attendance. Longitudinal multilevel mixed-effects analyses considering the interaction (time by intervention) were conducted. Each model was also adjusted by baseline value of the outcome measure, demographic and health variables, social support, PA self-efficacy, and barriers. RESULTS: Minutes/week of objectively measured moderate to vigorous PA increased by 40 and 53 minutes in the ER and BC groups, respectively (p=0.59). Participants attending >50% of ER program sessions increased their moderate to vigorous PA by 104 minutes/week and compliance with aerobic PA recommendations by 23.8%, versus the BC group (both p<0.05). CONCLUSIONS: Both BC and ER led to modest improvements in PA levels, with no significant differences between groups. Adequate adherence with the ER program sessions led to significant improvements in compliance with aerobic PA recommendations versus BC. These results can help guide development and implementation of programs integrating standardized PA assessment, counseling, and referrals via clinical-community linkages in Mexico and other low- and middle-income countries in the region.

Capacidades de investigación sobre determinantes sociales de la salud en Brasil, Colombia y México / Research capacities on social determinants of health in Brazil, Colombia and Mexico / Capacidades de investigação sobre determinantes sociais da saúde no Brasil, Colômbia e México

RESUMEN Objetivo: analizar las capacidades de investigación sobre determinantes sociales y determinación social de los procesos saludenfermedad (DSS) en Brasil, Colombia y México con base en los sistemas nacionales de ciencia, tecnología e innovación (SNCTI) y la producción científica sobre DSS (2005-2012) de cada país. Metodología: se realiza un estudio exploratorio a partir de revisión de literatura, consulta de plataformas nacionales de cada SNCTI, entrevistas y foros de consulta, contemplando las siguientes categorías de estudio para analizar las capacidades de: 1. Producción científica, formación de investigadores y políticas relativas a capacidades de investigación; 2. Redes de colaboración; 3. Infraestructura para la investigación y 4. Producción y apropiación social del conocimiento. Resultados y Discusión: la investigación sobre DSS se divulga principalmente en revistas científicas de circulación nacional, en Brasil y Colombia, mientras que en México se publica principalmente en revistas extranjeras. Los tres países cuentan con SNCTI consolidados, sin embargo, son escasos los montos de financiamiento para investigación sobre DSS. Conclusiones: es necesario articular acciones de fortalecimiento de capacidades de investigación, fortaleciendo redes y posicionando los DSS en agendas estratégicas.

ABSTRACT Objective: to analyze the research capacities on social determinants and social determination of the health-disease process (SDH) in Brazil, Colombia and Mexico based on the characteristics of the National Systems of Science, Technology and Innovation (SNCTI) and the scientific production on SDH between 2005 and 2012. Methodology: an exploratory study was conducted. Data were obtained from literature reviews, the national platforms for each SNCTI, interviews and forums. The following categories of study were taken into account when analyzing capabilities: 1. Scientific production, training of researchers and policies concerning research capabilities. 2. Collaborative networks; 3. Infrastructure for research and 4. Production and social appropriation of knowledge. Results and discussion: research on SDH is primarily published in scientific journals. In Brazil and Colombia, findings are primarily published in national journals, while the majority of research on SDH from Mexico is published in international journals. All three countries have solid SNCTI. However, funding for research on SDH is scarce. Conclusion: it is necessary to coordinate actions to strengthen the capacities for research on SDH in order to strengthen networks and position SDH on strategic agendas.

RESUMO Objetivo: analisar as capacidades de investigação sobre determinantes sociais e determinação social dos processos saúdedoença (DSS) no Brasil, Colômbia e México com base nos sistemas nacionais de ciência, tecnologia e inovação (SNCTI) e a produção científica sobre DSS (2005-2012) de cada país. Metodologia: Se realiza um estudo exploratório a partir da revisão de literatura, consulta de plataformas nacionais de cada SNCTI, entrevistas e foros de consulta, contemplando as seguintes categorias de estudo para analisar as capacidades: 1. Produção científica, formação de investigadores e políticas relativas a capacidades de investigação; 2. Redes de colaboração; 3. Infraestrutura para a investigação e 4. Produção e apropriação social do conhecimento. Resultados e discussão: A investigação sobre DSS se divulga principalmente em revistas científicas de circulação nacional, em Brasil e Colômbia, entanto que no México se publica principalmente em revistas estrangeiras. Os três países contam com SNCTI consolidados, mas, são escassos os montantes de financiamento para investigação sobre DSS. Conclusão: È necessário articular ações de fortalecimento de capacidades de investigação, fortalecendo redes e posicionando os DSS em agendas estratégicas.

Frailty and Social Vulnerability in Mexican Deprived and Rural Settings.

OBJECTIVE: To estimate the prevalence of frailty in a sample of rural elderly living in socially vulnerable circumstances as well as to determine its correlates. METHOD: Cross-sectional study of 558 rural elderly participating in a prospective study conducted in Mexico. Frailty was defined using the Fried criteria. Ordinal logistic regression model was used to identify the correlates of frailty levels. RESULTS: Prevalence of frailty was 8.6%. Disability in basic activities of daily living and illiteracy increase the probability of being pre-frail and/or frail (odds ratio [OR] = 2.72, p < .01; OR = 1.45, p = .05, respectively), while living in households with higher socioeconomic status reduces this probability (OR = 0.85, p < .01). DISCUSSION: A high prevalence of frailty was found among these young elderly, who did not yet fully show adverse health events. Also the social vulnerability of rural elderly is associated with frailty status. These findings highlight the health needs of socially and economically vulnerable elderly population.

[Health inequality among vulnerable groups in Mexico: older adults, indigenous people, and migrants]. / La desigualdad en salud de grupos vulnerables de México: adultos mayores, indígenas y migrantes.

Health vulnerability refers to a lack of protection for specific population groups with specific health problems, as well as the disadvantages they face in solving them in comparison with other population groups. This major public health problem has multiple and diverse causes, including a shortage of trained health care personnel and the lack of family, social, economic, and institutional support in obtaining care and minimizing health risks. Health vulnerability is a dynamic condition arising from the confluence of multiple social determinants. This article attempts to describe the health situation of three vulnerable groups in Mexico-older adults, indigenous people, and migrants-and, after defining the needs of each, explore measures that could contribute to the design and implementation of public health policies better tailored to their respective needs.

La desigualdad en salud de grupos vulnerables de México: adultos mayores, indígenas y migrantes / Health inequality among vulnerable groups in Mexico: older adults, indigenous people, and migrants

La vulnerabilidad en salud se refiere a la falta de protección de grupos poblacionales específicos que presentan problemas de salud particulares, así como a las desventajas que enfrentan para resolverlos, en comparación con otros grupos de población. Las causas de este importante problema de salud pública son muchas y de diversa índole, incluidas la insuficiencia de personal de salud capacitado y la falta de apoyo familiar, social, económico e institucional para obtener atención y minimizar los riesgos de salud. La vulnerabilidad en salud es una condición dinámica que resulta de la conjunción de varios determinantes sociales. En el presente trabajo se busca describir la situación de salud de tres grupos vulnerables (GV) de México -adultos mayores, indígenas y migrantes- y analizar las medidas que podrían contribuir al diseño e implementación de políticas públicas de salud más acordes a sus necesidades, partiendo de reconocer e identificar las necesidades propias de cada GV.

Health vulnerability refers to a lack of protection for specific population groups with specific health problems, as well as the disadvantages they face in solving them in comparison with other population groups. This major public health problem has multiple and diverse causes, including a shortage of trained health care personnel and the lack of family, social, economic, and institutional support in obtaining care and minimizing health risks. Health vulnerability is a dynamic condition arising from the confluence of multiple social determinants. This article attempts to describe the health situation of three vulnerable groups in Mexico-older adults, indigenous people, and migrants-and, after defining the needs of each, explore measures that could contribute to the design and implementation of public health policies better tailored to their respective needs.

[Health services in the Mixteca: use and conditions of affiliation in US-migrant and non-migrant households]. / Servicios de salud en la Mixteca: utilización y condición de afiliación en hogares de migrantes y no-migrantes a EU.

OBJECTIVE: To describe the socioeconomic and demographic characteristics of households in the Mixteca Baja and analyze differences in affiliation with health care programs and utilization, among members of households with migrants (HogMig) and without migrants (HogNoMig) to the United States. MATERIAL AND METHODS: A cross-sectional, descriptive survey was used with heads of households in a representative sample from the Mixteca Baja of 702 homes with and without migrants to the US. RESULTS: Members of HogMig had more personal and economic resources than those of HogNoMig; they also regularly received remittances. The majority of members of both HogMig and HogNoMig did not receive benefits from the Oportunidades program or health coverage through Seguro Popular, IMSS or ISSSTE. In general, while they used the local health clinic, they often preferred to pay for private practitioners. A small proportion of those covered by IMSS or ISSSTE reported very low utilization of the health services offered by those institutions.

Servicios de salud en la Mixteca: utilización y condición de afiliación en hogares de migrantes y no-migrantes a EU / Health services in the Mixteca: use and conditions of affiliation in US-migrant and non-migrant households

Objetivo. Caracterizar a los hogares de la Mixteca baja en términos socioeconómicos y demográficos y analizar las diferencias entre miembros de hogares de migrantes (HogMig) y no migrantes (HogNoMig) a Estados Unidos en torno a su afiliación y utilización de servicios de salud. Material y métodos. Estudio transversal y descriptivo en el que se realizaron encuestas a jefes de familia de una muestra representativa de 702 hogares de la Mixteca baja con (HogMig) y sin miembros migrantes (HogNoMig) a EU. Resultados. Los integrantes de los HogMig tenían más recursos personales y económicos que los HogNoMig; además recibían remesas regularmente. La mayoría de los miembros de ambos tipos de hogares no recibía beneficios del Programa Oportunidades, ni contaba con afiliación al Seguro Popular, IMSS o ISSSTE. Generalmente utilizaban el centro de salud local, aunque frecuentemente preferían pagar médicos privados. La minoría derechohabiente (IMSS/ ISSSTE) reportó una muy baja utilización de esos servicios.

Objective. To describe the socioeconomic and demographic characteristics of households in the Mixteca Baja and analyze differences in affiliation with health care programs and utilization, among members of households with migrants (HogMig) and without migrants (HogNoMig) to the United States. Material and Methods. A cross-sectional, descriptive survey was used with heads of households in a representative sample from the Mixteca Baja of 702 homes with and without migrants to the US. Results. Members of HogMig had more personal and economic resources than those of HogNoMig; they also regularly received remittances. The majority of members of both HogMig and HogNoMig did not receive benefits from the Oportunidades program or health coverage through Seguro Popular, IMSS or ISSSTE. In general, while they used the local health clinic, they often preferred to pay for private practitioners. A small proportion of those covered by IMSS or ISSSTE reported very low utilization of the health services offered by those institutions.

Características psicométricas de la Escala Center for Epidemiological Studies-depression (CES-D), versiones de 20 y 10 reactivos, en mujeres de una zona rural mexicana / Psychometric characteristics of the Center for Epidemiological Studies-depression Scale (CES-D), 20-and 10-item versions, in women from a Mexican rural area

Depressive symptoms constitute a common mental health problem, with a relevant social and personal impact. These symptoms are present not only among the urban population in more economically developed countries, but also in rural areas in poor and middle development countries. In order to obtain reliable information on the frequency of depressive symptoms, their risk factors or the impact of preventive and clinical measures, valid measurement instruments are needed. Radloff's Center for Epidemiological Studies - Depression scale (CES-D) was originally developed for the study of depressive symptoms in an open population. While the CES-D is not useful for the evaluation of depressive disorders according to psychiatric criteria, it can still yield useful information about the presence of depressed mood, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor retardation, and somatic complaints, which constitute dimensions of depression. The instrument has been shown to be valid in culturally diverse groups. It has also been shown to correlate with the clinical diagnosis of depression, with sensibility as high as 100%, while its specificity has been reported as 57-88%. Shorter versions of the CES-D have been developed. Their advantages include a more easy inclusion in ample questionnaires, and their being less tiresome for respondents. The main objective of this study was to evaluate the psychometric properties of CES-D, both the original, 20- item version, and the 10-item version by Andresen et al., in women living in the Mixteca, a poor rural area which includes part of the states of Guerrero, Oaxaca and Puebla, in southern Mexico. The instrument was applied as part of a comprehensive survey on health and migration in three rural municipalities in the Mixteca. The sampling design included cluster, proportional to size sampling of localities, and systematic selection of households. At each household, one woman of between 15 and 49 years of age responded a questionnaire which included the CES-D. A total of 468 women were included in the sample (median 35 years, interquartile range 28, 42). Of these, 89% were married or had a stable partner, 5% were single, 13% separated, and 12% widowed. The majority (65%) had only six years of schooling, while 1 6% had no formal education. The statistical analysis was conducted on the 343 questionnaires with complete answers to the CES-D (73% of the sample). The mean score in CES-D-20 was 11.3 (standard deviation 8.8). The mean score in CES-D-10 was 6.3 (standard deviation 5.0). According to the respective cut-off points, prevalence of depressive symptoms was 24.5% for the CES-D-20 and 22.3% for CES-D-1 0. A descriptive statistical analysis of the scores in each item and in the complete scales was conducted. In order to evaluate the internal consistency of CES-D, both 1 0- and 20- item versions, inter-item and item-total correlations were calculated. Cronbach's alpha coefficient was also obtained. Factor analysis was employed to determine if the actual aggregation of the items was coherent with the theoretical dimensions they were intended to measure. Another way to prove validity was through the analysis of the association between the score in the CES-D and the answers to questions about <>, an ethnical syndrome well recognized in the region and sharing characteristics with depression. Also, the association of scores with other variables known to be related to depressive symptoms, such as being chronically ill or the educational level, was investigated. In order to evaluate CES-D-10 capacity to identify depressive symptoms, taking the CES-D-20 as reference, Spearman's correlation coefficient between the scores in both scales was calculated. The kappa statistic was employed to evaluate the concordance between scales in the classification of individuals according to their respective cut-off points. For CES-D-20, Cronbach's alpha value was 0.84 and for CES-D-10 it was 0.74. For CES-D-20, four factors with eigen values over 1 were extracted, accounting for 50.6% of variance. The first one included items which, according to Radloff's original solution, are part of the dimensions depressed affect, retarded activity, and positive affect. The second one included items from the depressed affect, retarded activity, and interpersonal dimensions. The fourth factor included only two items, both from the positive affect dimension. A scree plot showed that a two factor solution could also be adequate. For CES-D-10, two factors were extracted, accounting for 46.5% of variance. As for convergent validity, women who reported having <> had a median CES-D-20 score of 13.5 (IQR 8.8, 22), while those who did not report the illness had a median score of 9 (IQR 4, 14). Women without a formal education had a median CES-D-20 score of 1 2 (IQR 8, 20), those who had completed elementary school had a median score of 10 (IQR 5, 15), and those with junior high or over had a median of 8 (IQR 3, 15). Those who reported having a chronic illness had a median score of 12 (IQR 8, 18), while those without a chronic illness had a median of 8 (IQR 4, 13). Similar results were observed for the CES-D-10. Spearman's correlation coefficient between CES-D-20 and CES-D-10 was 0.94 (p<.0001). Kappa value for concordance between both versions of the scale was of 0.80. In comparison to the longer version, CES-D-10 had a sensibility of 79.8% and a specificity of 97.3% for the detection of those over cut-off point. The results show that both scales had good reliability and validity in relation to measures of other variables related to depressive symptoms. The factorial grouping of the items was different from the original, as has been observed by other authors. A similar, unimodal distribution centered in 0 and with a positive skew was observed for the answers to all items, except for two items with a bimodal distribution. Those two items were also different to the rest in their presence (having the symptom at least on day during the past week) and persistence (having the symptom everyday during the past week). These differences suggest that items 4 and 8 of the CES-D could have validity problems in this population. In conclusion, both versions of the CES-D were found to have good psychometric properties in this sample, with the shorter one having the advantage of being easier to include in questionnaires for more comprehensive studies. However, further studies with the use of qualitative methods should clarify the true cross-cultural validity of the CES-D in rural areas in Mexico.

Los síntomas depresivos son un problema de salud mental frecuente e importante en cuanto a sus consecuencias personales y sociales, que afecta no solamente a la población urbana de los países más desarrollados, sino también a los habitantes de zonas rurales en los países pobres. Para obtener información confiable acerca de la frecuencia de síntomas depresivos, así como de sus factores de riesgo o el éxito de las medidas preventivas y de atención, es necesario contar con instrumentos de medición confiables y válidos. El instrumento Center for Epidemiological Studies - Depression (CES- D), de Radloff, fue desarrollado originalmente para el estudio de síntomas depresivos en población abierta. Si bien no es útil para evaluar la presencia de trastornos depresivos del estado de ánimo tal como son definidos en la nosología psiquiátrica, este instrumento permite estudiar la de un rango de manifestaciones basadas en dimensiones de la depresión consideradas en la bibliografía clínica. El objetivo principal de este estudio fue evaluar las propiedades psicométricas del CESD en mujeres de una zona rural de alta marginación, tanto en su versión original como en la versión de 1 0 reactivos de Andresen et al. La información para este estudio se recabó en la zona mixteca, en tres municipios rurales en los cuales se llevó a cabo un muestreo por conglomerados de localidades y sistemático de hogares. Se aplicó el CES-D a 468 mujeres de entre 1 5 y 49 años en los hogares seleccionados. Se hizo un análisis descriptivo de los resultados de puntuación en cada reactivo, así como de los de la escala completa. Para evaluar la consistencia interna del CES-D en sus versiones de 10 y 20 preguntas, se calcularon las correlaciones entre reactivos, y de cada reactivo con la puntuación en la escala completa, así como el coeficiente de alfa de Cronbach. Se llevó a cabo un análisis factorial con el fin de determinar si la agrupación de los reactivos correspondía a sus dimensiones teóricas. Otra medida de la validez de constructo consistió en analizar la relación entre la puntuación en el CES-D y los resultados en preguntas acerca de los <>, un padecimiento reconocido en la tradición étnica de la región. Se observó también la asociación con la presencia de enfermedades crónicas y con el nivel educativo, dos variables que han mostrado estar asociadas a los síntomas depresivos. Para evaluar la capacidad del CES-D-10 de medir los síntomas depresivos, en comparación con la versión de 20 reactivos, se calculó el coeficiente de correlación de Spearman entre las puntuaciones en ambas escalas. Se calculó también el estadístico kappa para evaluar la concordancia entre las versiones larga y corta en la clasificación de individuos por encima del punto de corte. El valor de alfa de Cronbach del CES-D-20 fue de 0.84 y el del CES-D-1 0 de 0.74. Para el CES-D-20, se extrajeron cuatro factores con valores propios mayores a 1, que explicaron en conjunto 50.6% de la varianza. El gráfico de sedimentación mostró que una solución en dos factores también hubiera sido adecuada. Para el CES-D-1 0, se extrajeron dos factores que explicaron en conjunto 46.5% de la varianza. La correlación de Spearman entre el CES-D-20 y el CES-D-10 fue de 0.94 (p<.0001). El valor del estadístico kappa para la concordancia entre ambas formas de la escala fue de 0.80. Se observó un comportamiento similar en la distribución de las respuestas a todos los reactivos, a excepción de dos, los cuales difirieron también en su presencia y persistencia en comparación con el resto, por lo que se sugiere que estos dos reactivos podrían estar presentando problemas de validez.

International migration of partner, autonomy and depressive symptoms among women from a mexican rural area.

BACKGROUND: The emigration of Mexicans to the USA has increased in the last decades, and little is known about the effect of this on the mental health of those who stay behind. AIMS: To evaluate the association of emigration of husband and depressive symptoms (DS) among women who stay in Mexico. We also tested the hypothesis that the husband's migration would increase the woman's autonomy, which in turn would decrease DS. METHODS: A survey was conducted in a rural area in Mexico. Participants (n = 418) were selected through probabilistic sampling in three stages: localities, households and individuals. DS were evaluated using the Centre for Epidemiological Studies-Depression (CES-D) scale. RESULTS: Having a partner in the USA was associated with higher odds of scoring above the cut-off point in CES-D (OR 3.77, 95% CI 1.92-7.43). Economic autonomy was also associated with DS (OR 1.45, 95% CI 1.04-2.02). CONCLUSION: Migration of husband was associated with DS among women. The construct of autonomy and its operational definition should be further explored.