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1.
PLoS One ; 16(8): e0255594, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34352012

RESUMEN

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.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Alcohólicos/psicología , Depresión/terapia , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/prevención & control , Intoxicación Alcohólica/psicología , Alcoholismo/diagnóstico , Colombia/epidemiología , Comorbilidad , Atención a la Salud , Depresión/psicología , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , México/epidemiología , Persona de Mediana Edad , Perú/epidemiología , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Derivación y Consulta , Detección de Abuso de Sustancias/métodos
2.
Subst Abus ; : 1-9, 2021 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-33849396

RESUMEN

Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, Mage = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.

3.
J Gen Intern Med ; 36(9): 2663-2671, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33469752

RESUMEN

PURPOSE: We aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured. METHODS: We undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage). RESULTS: The combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5). CONCLUSIONS: Training of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions. TRIAL REGISTRATION: Clinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.


Asunto(s)
Consumo de Bebidas Alcohólicas , Atención Primaria de Salud , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Humanos , América Latina/epidemiología
4.
Prim Health Care Res Dev ; 22: e4, 2021 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-33504413

RESUMEN

BACKGROUND: Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). METHODS: An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal-Wallis non-parametric tests. RESULTS: Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients' normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann-Whitney U = -18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann-Whitney U = -12.82, P = 0.035) and Mexican respondents (Mann-Whitney U = -13.56, P = 0.018). CONCLUSIONS: The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.


Asunto(s)
Atención Primaria de Salud , Adolescente , Adulto , Anciano , Colombia , Intervención en la Crisis (Psiquiatría) , Estudios Transversales , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Perú , Adulto Joven
6.
Psychol Med ; : 1-13, 2020 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-32343221

RESUMEN

BACKGROUND: There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. METHODS: Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. RESULTS: Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. CONCLUSIONS: Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.

9.
An. Fac. Med. (Perú) ; 80(3): 332-336, jul.-set. 2019. ilus, tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1054832

RESUMEN

Introducción: La provincia constitucional del Callao es una de las más afectadas por la epidemia de tuberculosis a nivel nacional. Asimismo, se debe considerar que los establecimientos de salud del primer nivel de atención son usualmente la puerta de entrada para estos pacientes, al sistema sanitario. Objetivos: Describir las características de la oferta de servicios de salud en unidades de tuberculosis en el primer nivel de atención de la Provincia Constitucional del Callao. Métodos: Se realizó un estudio descriptivo, en 45 servicios de salud, en los que se indagó sobre características de infraestructura, recursos humanos y el ingreso de data al sistema de información. Resultados: Los 45 establecimientos contaban con "unidades de atención diferenciadas para tuberculosis", atienden en ellas 19 médicos, 35 enfermeros, 3 nutricionistas, 10 psicólogos, 9 asistentes sociales y 50 técnicos de enfermerías. El 96% del personal realizó otras atenciones, y el 33% tuvo menos de 6 meses laborando en estas unidades. Solo un 40% recibió algún entrenamiento específico. El sistema de información fue manual, utilizando libros y registros físicos. Conclusiones: Los servicios de salud cuentan con infraestructura adecuada, pero existen serias limitaciones de personal y en el sistema de información.


Introduction: The constitutional province of Callao is one of the most affected by the epidemic of tuberculosis nationwide. Likewise, it should be considered that the first level health care services are usually the gateway for these patients to the health system. Objectives: To describe the characteristics of the offer of health services in tuberculosis units from first level of care in the Constitutional Province of Callao. Methods: A descriptive study was carried out in 45 tuberculosis units from primary care health services, which investigated the characteristics of infrastructure, human resources and data entry to the information system. Results: 45 primary care health services have "Differentiated units of TB care"; which have 19 doctors, 35 nurses, 3 nutritionists, 10 psychologists, 9 social workers and 50 nursing technicians. 96% of professionals refers doing non-exclusive activities for caring TB patients. 33% have less than 6 months in this work and only 40% have received specific training. In addition, the program’s information system is manual using paper record books. Conclusions: The health services have adequate infrastructure, but there are serious limitations of professionals and information system.

10.
BMC Med ; 17(1): 101, 2019 05 24.
Artículo en Inglés | MEDLINE | ID: mdl-31122269

RESUMEN

BACKGROUND: Specific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders. METHODS: We conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (< 13 years) SP. RESULTS: Among 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR = 2.4, 95% CI 2.3-2.5, p < 0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR = 1.4, 95% CI 1.4-1.5, p < 0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5 days out of role in the past month) than those without childhood SP (1.1 days) or with only 1 subtype (1.8 days) (B = 0.56, SE 0.06, p < 0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR = 1.7, 95% CI 1.7-1.8, p < 0.001). CONCLUSIONS: This large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.


Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Fóbicos/diagnóstico , Trastornos Fóbicos/epidemiología , Adolescente , Adulto , Edad de Inicio , Anciano , Envejecimiento/psicología , Biomarcadores/análisis , Niño , Estudios Transversales , Diagnóstico Precoz , Femenino , Salud Global/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Longevidad , Masculino , Trastornos Mentales/diagnóstico , Salud Mental , Persona de Mediana Edad , Prevalencia , Psicopatología , Estudios Retrospectivos , Adulto Joven
11.
Addiction ; 114(8): 1446-1459, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30835879

RESUMEN

AIMS: To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. DESIGN: Cross-sectional, representative household surveys. SETTING: Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. PARTICIPANTS: A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). MEASUREMENTS: Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. FINDINGS: Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. CONCLUSIONS: Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.


Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Comorbilidad , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Salud Global , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Nivel de Atención , Organización Mundial de la Salud
12.
JAMA Psychiatry ; 76(7): 708-720, 2019 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-30865282

RESUMEN

Importance: Limited empirical research has examined the extent to which cohort-level prevalence of substance use is associated with the onset of drug use and transitioning into greater involvement with drug use. Objective: To use cross-national data to examine time-space variation in cohort-level drug use to assess its associations with onset and transitions across stages of drug use, abuse, dependence, and remission. Design, Setting, and Participants: The World Health Organization World Mental Health Surveys carried out cross-sectional general population surveys in 25 countries using a consistent research protocol and assessment instrument. Adults from representative household samples were interviewed face-to-face in the community in relation to drug use disorders. The surveys were conducted between 2001 and 2015. Data analysis was performed from July 2017 to July 2018. Main Outcomes and Measures: Data on timing of onset of lifetime drug use, DSM-IV drug use disorders, and remission from these disorders was assessed using the Composite International Diagnostic Interview. Associations of cohort-level alcohol prevalence and drug use prevalence were examined as factors associated with these transitions. Results: Among the 90 027 respondents (48.1% [SE, 0.2%] men; mean [SE] age, 42.1 [0.1] years), 1 in 4 (24.8% [SE, 0.2%]) reported either illicit drug use or extramedical use of prescription drugs at some point in their lifetime, but with substantial time-space variation in this prevalence. Among users, 9.1% (SE, 0.2%) met lifetime criteria for abuse, and 5.0% (SE, 0.2%) met criteria for dependence. Individuals who used 2 or more drugs had an increased risk of both abuse (odds ratio, 5.17 [95% CI, 4.66-5.73]; P < .001) and dependence (odds ratio, 5.99 [95% CI, 5.02-7.16]; P < .001) and reduced probability of remission from abuse (odds ratio, 0.86 [95% CI, 0.76-0.98]; P = .02). Birth cohort prevalence of drug use was also significantly associated with both initiation and illicit drug use transitions; for example, after controlling for individuals' experience of substance use and demographics, for each additional 10% of an individual's cohort using alcohol, a person's odds of initiating drug use increased by 28% (odds ratio, 1.28 [95% CI, 1.26-1.31]). Each 10% increase in a cohort's use of drug increased individual risk by 12% (1.12 [95% CI, 1.11-1.14]). Conclusions and Relevance: Birth cohort substance use is associated with drug use involvement beyond the outcomes of individual histories of alcohol and other drug use. This has important implications for understanding pathways into and out of problematic drug use.


Asunto(s)
Consumidores de Drogas/psicología , Fumar Marihuana/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Fumar Marihuana/psicología , Salud Mental , Persona de Mediana Edad , Prevalencia , Riesgo , Trastornos Relacionados con Sustancias/psicología , Organización Mundial de la Salud , Adulto Joven
13.
Depress Anxiety ; 36(6): 499-510, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30726581

RESUMEN

BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) definition of agoraphobia (AG) as an independent diagnostic entity makes it timely to re-examine the epidemiology of AG. Study objective was to present representative data on the characteristics of individuals who meet DSM-IV criteria for AG (AG without a history of panic disorder [PD] and PD with AG) but not DSM-5 criteria, DSM-5 but not DSM-IV criteria, or both sets of criteria. METHODS: Population-based surveys from the World Mental Health Survey Initiative including adult respondents (n = 136,357) from 27 countries across the world. The Composite International Diagnostic Interview was used to assess AG and other disorders. RESULTS: Lifetime and 12-month prevalence estimates of DSM-5 AG (1.5% and 1.0%) were comparable to DSM-IV (1.4% and 0.9%). Of respondents meeting criteria in either system, 57.1% met criteria in both, while 24.2% met criteria for DSM-5 only and 18.8% for DSM-IV only. Severe role impairment due to AG was reported by a lower proportion of respondents who met criteria only for DSM-IV AG (30.4%) than those with both DSM-5 and DSM-IV AG (44.0%; χ 2 1 = 4.7; P = 0.031). The proportion of cases with any comorbidity was lower among respondents who met criteria only for DSM-IV AG (78.7%) than those who met both sets (92.9%; χ 2 1 = 14.5; P < 0.001). CONCLUSIONS: This first large survey shows that, compared to the DSM-IV, the DSM-5 identifies a substantial group of new cases with AG, while the prevalence rate remains stable at 1.5%. Severity and comorbidity are higher in individuals meeting DSM-5 AG criteria compared with individuals meeting DSM-IV AG criteria only.


Asunto(s)
Agorafobia/diagnóstico , Agorafobia/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Salud Global/estadística & datos numéricos , Encuestas Epidemiológicas , Salud Mental/estadística & datos numéricos , Adolescente , Adulto , Anciano , Comorbilidad , Femenino , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Trastorno de Pánico/epidemiología , Prevalencia , Adulto Joven
14.
Rev. bras. med. fam. comunidade ; 14(41): e1788, fev. 2019. ilus
Artículo en Portugués | LILACS, Coleciona SUS | ID: biblio-981944

RESUMEN

Objetivo: Relatar a experiência da implementação de oficinas de saúde e sexualidade por residentes de saúde da família com adolescentes do 8º ano de uma escola pública em Florianópolis. Relato de experiência: As oficinas foram organizadas sob a forma de encontros mensais, com turmas do 8º ano dos períodos matutino e vespertino, da Escola de Ensino Básico Hilda Teodoro, situada no bairro da Trindade, em Florianópolis, entre os meses de março a dezembro de 2017. Os encontros eram realizados em pequenos grupos, com 16 alunos por turma, dispostos em roda de maneira a permitir a interação e participação de todos os membros, tendo duração de 45 a 90 minutos. Durante os encontros, eram realizadas palestras, dinâmicas e rodas de conversa, estimulando a reflexão, debate e conscientização dos adolescentes acerca da importância de temas como: gravidez na adolescência, doenças sexualmente transmissíveis, orientação sexual e identidade de gênero, machismo, métodos anticoncepcionais e anatomia dos órgãos reprodutivos. Discussão: Por meio da experiência, notou-se participação ativa e ricas contribuições por parte dos adolescentes, principalmente das meninas, evidenciando interesse considerável sobre a temática da sexualidade, principalmente a gravidez na adolescência e os métodos contraceptivos. Os discursos e pontos de vista ressaltaram as mudanças em curso na sociedade brasileira, em direção à igualdade de gênero e empoderamento feminino. Conclusão: As oficinas de saúde e sexualidade desenvolvidas pelos residentes de medicina de família e comunidade e saúde da família representaram uma oportunidade ímpar de interação entre os programas de residência, as equipes de Estratégia de Saúde da Família e a comunidade, utilizando o cenário escolar como ferramenta para a promoção de saúde e empoderamento social.


Objective: To describe an experience of implementing a health and sexuality workshop by family health residents with students from 8th grade classes from a public school in Florianópolis. Experience report: Workshops were organized in the form of monthly meetings, with 8th grade classes of morning and afternoon shifts, from the Hilda Teodoro Elementary School, located in the Trindade neighborhood, Florianópolis, from March to December, 2017. The meetings were performed in small groups, with 16 students per class, organized in circle allowing the interaction and participation of all members, lasting from 45 to 90 minutes. During the workshops, lectures, dynamics and conversation were developed, stimulating adolescents to wonder, discuss and reflect about the importance of topics such as teenage pregnancy, sexually transmitted diseases, sexual orientation and gender identity, machismo, contraceptive methods and anatomy of the reproductive organs. Discussion: Through the experience, it was noticed active participation and rich contributions by the adolescents, mainly of the girls, evidencing considerable interest on the subject of sexuality, especially teenage pregnancy and contraceptive methods. The speeches and points of view highlighted the changes taking place in Brazilian society, towards gender equality and women's empowerment. Conclusion: Health and sexuality workshops organized by family medicine and family health residents represented a relevant opportunity to interaction amongst Family Health Strategy Residence Programs, Family Health Strategy teams and communities, using the school scenario as a tool for health promotion and social empowerment.


Objetivo: Informar la experiencia de la implementación de talleres de salud y sexualidad por residentes de salud de la familia con adolescentes del 8º año de una escuela pública en Florianópolis. Relato de experiencia: Los talleres fueron organizados en forma de encuentros mensuales, con clases del 8º año, períodos matutino y vespertino, de la Escuela de Educación Básica Hilda Teodoro, ubicada en el barrio de la Trinidad en Florianópolis, entre los meses de marzo a diciembre de 2017. Los encuentros se realizaban en pequeños grupos, con 16 alumnos por clase, dispuestos en de manera que permita la interacción y participación de todos los miembros, teniendo una duración de 45 a 90 minutos. Durante los encuentros se realizaron charlas, dinámicas y ruedas de conversación, estimulando la reflexión, debate y concientización de los adolescentes acerca de la importancia de temas como embarazo en la adolescencia, enfermedades sexualmente transmisibles, orientación sexual e identidad de género, machismo, métodos anticonceptivos y anatomía de los adolescentes órganos reproductivos. Discusión: Por medio de la experiencia, se notó participación activa y ricas contribuciones por parte de los adolescentes, principalmente de las niñas, evidenciando un interés considerable sobre la temática de la sexualidad, principalmente el embarazo en la adolescencia y los métodos anticonceptivos. Los discursos y puntos de vista resaltaron los cambios en curso en la sociedad brasileña, en dirección a la igualdad de género y empoderamiento femenino. Conclusión: Los talleres de salud y sexualidad desarrollados por los residentes de medicina de la familia y salud de la familia representaron una oportunidad relevante de interacción entre los Programas de Residencia en Salud de la Familia, los equipos de Estrategia de Salud de la Familia y la comunidad, utilizando el escenario escolar como herramienta para la promoción de la salud y el empoderamiento social.


Asunto(s)
Especialización , Adolescente , Sexualidad , Internado y Residencia
15.
Soc Psychiatry Psychiatr Epidemiol ; 54(2): 157-170, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30173317

RESUMEN

PURPOSE: Our understanding of community-level predictors of individual mental disorders in large urban areas of lower income countries is limited. In particular, the proportion of migrant, unemployed, and poorly educated residents in neighborhoods of these urban areas may characterize group contexts and shape residents' health. METHODS: Cross-sectional household interviews of 7251 adults were completed across 83 neighborhoods of Buenos Aires, Argentina; Medellín, Colombia; São Paulo, Brazil; Lima, Peru; and Mexico City, Mexico as part of the World Mental Health Survey Initiative. Past-year internalizing and externalizing mental disorders were assessed, and multilevel models were used. RESULTS: Living in neighborhoods with either an above-average or below-average proportion of migrants and highly educated residents was associated with lower odds of any internalizing disorder (for proportion migrants: OR 0.75, 95% CI 0.62-0.91 for the bottom tertile and OR 0.79, 95% CI 0.67-0.94 for the top tertile compared to the middle tertile; for proportion highly educated: OR 0.76, 95% CI 0.64-0.90 for the bottom tertile and OR 0.58, 95% CI 0.37-0.90 for the top tertile compared to the middle tertile). Living in neighborhoods with an above-average proportion of unemployed individuals was associated with higher odds of having any internalizing disorder (OR 1.49, 95% CI 1.14-1.95 for the top tertile compared to the middle tertile). The proportion of highly educated residents was associated with lower odds of externalizing disorder (OR 0.54, 95% CI 0.31-0.93 for the top tertile compared to the middle tertile). CONCLUSIONS: The associations of neighborhood-level migration, unemployment, and education with individual-level odds of mental disorders highlight the importance of community context for understanding the burden of mental disorders among residents of rapidly urbanizing global settings.


Asunto(s)
Trastornos Mentales/epidemiología , Pobreza/psicología , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos , Adulto , Argentina/epidemiología , Brasil/epidemiología , Ciudades/epidemiología , Colombia/epidemiología , Estudios Transversales , Escolaridad , Femenino , Encuestas Epidemiológicas , Humanos , América Latina/epidemiología , Masculino , Trastornos Mentales/psicología , México/epidemiología , Persona de Mediana Edad , Análisis Multinivel , Perú/epidemiología , Migrantes/psicología , Desempleo/psicología , Urbanización
16.
Drug Alcohol Rev ; 37 Suppl 2: S63-S71, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29707842

RESUMEN

INTRODUCTION AND AIMS: To investigate if socio-economic disadvantage, at the individual- and country-level, is associated with heavier drinking in some middle- and high-income countries. DESIGN AND METHODS: Surveys of drinkers were undertaken in some high- and middle-income countries. Participating countries were Australia, England, New Zealand, Scotland (high-income) and Peru, Thailand and Vietnam (middle-income). Disadvantage at the country-level was defined as per World Bank (categorised as middle-or high-income); individual-level measures were (i) years of education and (ii) whether and individual was under or over the poverty line in each country. Measures of heavier drinking were (i) proportion of drinkers that consumed 8+ drinks and (ii) three drinking risk groups (lower, increasing and higher). Multi-level logistic regression models were used. RESULTS: Individual-level measures of disadvantage, lower education and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle-income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high-income countries. Interactions between country-level income and individual-level disadvantage were undertaken: disadvantaged drinkers in the middle-income countries were less likely to be heavier drinkers relative to those with less disadvantage in the high-income countries. DISCUSSION AND CONCLUSIONS: Associations between socio-economic disadvantage and heavier drinking vary depending on country-level income. These findings highlight the value of exploring cross-country differences in heavier drinking and disadvantage and the importance of including country-level measurements to better elucidate relationships.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Intoxicación Alcohólica/epidemiología , Renta , Pobreza , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/economía , Intoxicación Alcohólica/economía , Comparación Transcultural , Escolaridad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
17.
Drug Alcohol Rev ; 37 Suppl 2: S36-S44, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29582496

RESUMEN

INTRODUCTION AND AIMS: Cross-country studies on alcohol purchasing and access are rare. We examined where and when people access alcohol to understand patterns of availability across a range of middle- and high-income countries. DESIGN AND METHODS: Surveys of drinkers in the International Alcohol Control study in high-income countries (Australia, England, Scotland, New Zealand and St Kitts and Nevis) and middle-income countries (Mongolia, South Africa, Peru, Thailand and Vietnam) were analysed. Measures were: location of purchase from on-premise and take-away outlets, proportion of alcohol consumed on-premise versus take-away outlets, hours of purchase, access among underage drinkers and time to access alcohol. RESULTS: On-premise purchasing was prevalent in the high-income countries. However, the vast majority of alcohol consumed in all countries, except St Kitts and Nevis (high-income), was take-away. Percentages of drinkers purchasing from different types of on-premise and take-away outlets varied between countries. Late purchasing was common in Peru and less common in Thailand and Vietnam. Alcohol was easily accessed by drinkers in all countries, including underage drinkers in the middle-income countries. DISCUSSION AND CONCLUSIONS: In nine out of 10 countries the vast majority of alcohol consumed was take-away. Alcohol was readily available and relatively easy for underage drinkers to access, particularly in the middle-income countries. Research is needed to assess the harms associated with take-away consumption including late at night. Attention is needed to address the easy access by underage drinkers in the middle-income countries which has been less of a focus than in high-income countries.


Asunto(s)
Consumo de Bebidas Alcohólicas/economía , Bebidas Alcohólicas/provisión & distribución , Comercio/estadística & datos numéricos , Bebidas Alcohólicas/economía , Humanos , Renta , Encuestas y Cuestionarios , Factores de Tiempo
18.
Drug Alcohol Rev ; 37 Suppl 2: S45-S52, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29441632

RESUMEN

INTRODUCTION AND AIMS: This study examines the proportion of alcohol markets consumed in harmful drinking occasions in a range of high-, middle-income countries and assesses the implications of these findings for conflict of interest between alcohol producers and public health and the appropriate role of the alcohol industry in alcohol policy space. DESIGN AND METHODS: Cross-sectional surveys were conducted in 10 countries as part of the International Alcohol Control study. Alcohol consumption was measured using location- and beverage-specific measures. A level of consumption defined as harmful use of alcohol was chosen and the proportion of the total market consumed in these drinking occasions was calculated for both commercial and informal alcohol. RESULTS: In all countries, sizeable proportions of the alcohol market were consumed during harmful drinking occasions. In general, a higher proportion of alcohol was consumed in harmful drinking occasions by respondents in the middle-income countries than respondents in the high-income countries. The proportion of informal alcohol consumed in harmful drinking occasions was lower than commercial alcohol. DISCUSSION AND CONCLUSIONS: Informal alcohol is less likely to be consumed in harmful drinking occasions compared with commercial alcohol. The proportion of commercial alcohol consumed in harmful drinking occasions in a range of alcohol markets shows the reliance of the transnational alcohol corporations on harmful alcohol use. This reliance underpins industry lobbying against effective policy and support for ineffective approaches. The conflict of interest between the alcohol industry and public health requires their exclusion from the alcohol policy space.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Política de Salud , Salud Pública , Bebidas Alcohólicas/economía , Bebidas Alcohólicas/provisión & distribución , Comparación Transcultural , Estudios Transversales , Humanos , Industrias/organización & administración , Encuestas y Cuestionarios
19.
Drug Alcohol Rev ; 37 Suppl 2: S86-S95, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29464804

RESUMEN

INTRODUCTION AND AIMS: To investigate behaviours related to four alcohol policy variables (policy-relevant behaviours) and demographic variables in relation to typical quantities of alcohol consumed on-premise in six International Alcohol Control study countries. DESIGN AND METHODS: General population surveys with drinkers using a comparable survey instrument and data analysed using path analysis in an overall model and for each country. MEASURES: typical quantities per occasion consumed on-premise; gender, age; years of education, prices paid, time of purchase, time to access alcohol and liking for alcohol advertisements. RESULTS: In the overall model younger people, males and those with fewer years of education consumed larger typical quantities. Overall lower prices paid, later time of purchase and liking for alcohol ads predicted consuming larger typical quantities; this was found in the high-income countries, less consistently in the high-middle-income countries and not in the low middle-income country. Three policy-relevant behaviours (prices paid, time of purchase, liking for alcohol ads) mediated the relationships between age, gender, education and consumption in high-income countries. DISCUSSION AND CONCLUSIONS: International Alcohol Control survey data showed a relationship between policy-relevant behaviours and typical quantities consumed and support the likely effect of policy change (trading hours, price and restrictions on marketing) on heavier drinking. The path analysis also revealed policy-relevant behaviours were significant mediating variables between the effect of age, gender and educational status on consumption. However, this relationship is clearest in high-income countries. Further research is required to understand better how circumstances in low-middle-income countries impact effects of policies.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Bebidas Alcohólicas/economía , Comercio/economía , Política de Salud , Adolescente , Adulto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/economía , Comparación Transcultural , Escolaridad , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Factores Sexuales , Encuestas y Cuestionarios , Adulto Joven
20.
Psychol Med ; 48(16): 2730-2739, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29478433

RESUMEN

BACKGROUND: Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders. METHODS: In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments. RESULTS: After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1-1.5] to 1.9 (95% CI 1.4-2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2-1.9) to 1.7 (95% CI 1.2-2.4). CONCLUSIONS: PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.


Asunto(s)
Enfermedad Crónica/epidemiología , Dolor Crónico/epidemiología , Salud Global/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Organización Mundial de la Salud , Adulto Joven
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