Vulnerability in women primary caregivers of children in palliative care due to intimate partner violence in a pediatric hospital in Mexico / Vulnerabilidad en mujeres cuidadoras primarias de menores en cuidados paliativos debida a violencia de pareja en un hospital de niños en México

Abstract Background: Women are the primary caregivers of children in palliative care. Research has shown that the presence of intimate partner violence at home exacerbates the vulnerability of the caregiver. Current statistics indicate a high prevalence of violence in Mexico present in the intersectionality between intimate partner violence and the role of the primary caregiver. This study aimed to describe the frequency of intimate partner violence among primary palliative caregivers at the Hospital Infantil de México Federico Gómez. Methods: We conducted a cross-sectional and prospective study with convenience sampling; no sample calculation was performed. All female primary caregivers of children in the palliative care unit were invited to participate. The Scale of Violence and Index of Severity of Violence was used as the measuring instrument. Results: One hundred women participated in the study by submitting their survey in a designated mailbox. No sociodemographic data or patient diagnoses were collected. The frequency of intimate partner violence was 28%, of which 16% were considered severe cases. Women reported psychological violence (36%), sexual violence (23%), and physical violence (22%). Conclusions: Almost one-third of female primary caregivers of pediatric patients at the Hospital Infantil de México Federico Gómez have been victims of some form of violence by current partners. This study highlights a previously unreported problem and opens the door for studies to correlate intimate partner violence among primary caregivers and the quality of life of children in palliative care.

Resumen Introducción: Las mujeres son las principales cuidadoras de los niños en cuidados paliativos. Las investigaciones han demostrado que la violencia de pareja en el hogar exacerba la vulnerabilidad del cuidador. Las estadísticas actuales sobre violencia en México indican una alta prevalencia presente en la interseccionalidad entre la violencia de pareja y el rol de cuidador principal. El objetivo de este estudio fue describir la frecuencia de violencia de pareja entre los cuidadores primarios del Hospital Infantil de México Federico Gómez (HIMFG). Métodos: Se llevó a cabo un estudio transversal y prospectivo con muestreo por conveniencia; no se realizó ningún cálculo de muestra. Se invitó a participar a todas las mujeres cuidadoras primarias de niños en la Unidad de Cuidados Paliativos. Se utilizó como instrumento la Escala de Violencia e Índice de Severidad de la Violencia. Resultados: Cien mujeres participaron en el estudio; no se recogieron sus datos sociodemográficos ni diagnósticos. La frecuencia de violencia de pareja fue del 28%: 16% se consideraron casos graves. Las mujeres reportaron violencia psicológica (36%), violencia sexual (23%) y violencia física (22%). Conclusiones: Alrededor de la tercera parte de las mujeres cuidadoras principales de pacientes pediátricos del HIMFG han sido víctimas de algún tipo de violencia por parte de sus parejas actuales. Este estudio destaca un problema no informado previamente y abre la puerta a estudios para correlacionar la violencia de pareja íntima entre los cuidadores primarios y la calidad de vida de los niños en cuidados paliativos.

Vulnerability in women primary caregivers of children in palliative care due to intimate partner violence in a pediatric hospital in Mexico.

BACKGROUND: Women are the primary caregivers of children in palliative care. Research has shown that the presence of intimate partner violence at home exacerbates the vulnerability of the caregiver. Current statistics indicate a high prevalence of violence in Mexico present in the intersectionality between intimate partner violence and the role of the primary caregiver. This study aimed to describe the frequency of intimate partner violence among primary palliative caregivers at the Hospital Infantil de México Federico Gómez. METHODS: We conducted a cross-sectional and prospective study with convenience sampling; no sample calculation was performed. All female primary caregivers of children in the palliative care unit were invited to participate. The Scale of Violence and Index of Severity of Violence was used as the measuring instrument. RESULTS: One hundred women participated in the study by submitting their survey in a designated mailbox. No sociodemographic data or patient diagnoses were collected. The frequency of intimate partner violence was 28%, of which 16% were considered severe cases. Women reported psychological violence (36%), sexual violence (23%), and physical violence (22%). CONCLUSIONS: Almost one-third of female primary caregivers of pediatric patients at the Hospital Infantil de México Federico Gómez have been victims of some form of violence by current partners. This study highlights a previously unreported problem and opens the door for studies to correlate intimate partner violence among primary caregivers and the quality of life of children in palliative care.

INTRODUCCIÓN: Las mujeres son las principales cuidadoras de los niños en cuidados paliativos. Las investigaciones han demostrado que la violencia de pareja en el hogar exacerba la vulnerabilidad del cuidador. Las estadísticas actuales sobre violencia en México indican una alta prevalencia presente en la interseccionalidad entre la violencia de pareja y el rol de cuidador principal. El objetivo de este estudio fue describir la frecuencia de violencia de pareja entre los cuidadores primarios del Hospital Infantil de México Federico Gómez (HIMFG). MÉTODOS: Se llevó a cabo un estudio transversal y prospectivo con muestreo por conveniencia; no se realizó ningún cálculo de muestra. Se invitó a participar a todas las mujeres cuidadoras primarias de niños en la Unidad de Cuidados Paliativos. Se utilizó como instrumento la Escala de Violencia e Índice de Severidad de la Violencia. RESULTADOS: Cien mujeres participaron en el estudio; no se recogieron sus datos sociodemográficos ni diagnósticos. La frecuencia de violencia de pareja fue del 28%: 16% se consideraron casos graves. Las mujeres reportaron violencia psicológica (36%), violencia sexual (23%) y violencia física (22%). CONCLUSIONES: Alrededor de la tercera parte de las mujeres cuidadoras principales de pacientes pediátricos del HIMFG han sido víctimas de algún tipo de violencia por parte de sus parejas actuales. Este estudio destaca un problema no informado previamente y abre la puerta a estudios para correlacionar la violencia de pareja íntima entre los cuidadores primarios y la calidad de vida de los niños en cuidados paliativos.

From harassment to disappearance: Young women's feelings of insecurity in public spaces.

BACKGROUND: There are processes of gender socialization that increase the vulnerability of young women against a continuum of threats in the public space. This study explored the feeling of insecurity in public spaces among young women in a city located near the northern border of Mexico. METHODS AND FINDINGS: This study was based on the tradition of grounded theory. Purposive sampling was used, and 24 group interviews were conducted with junior high school, high school and university students to understand the conditions that favour the emergence of the feeling of insecurity, its psychosocial consequences and management strategies. A computer-assisted qualitative analysis was performed using MAXQDA 18 software. The study showed that street harassment was manifested mainly as sexual harassment but generated a continuous threat of feminicide and disappearance. Young women experienced discomfort and restrictions on mobility, and they had to assume individual responsibility for their safety in the absence of support from the state. CONCLUSIONS: The interaction between gender and age determines the vulnerability to crime in urban spaces. Future studies could analyse the chronic impact of this continuum of threats and develop psychosocial interventions that promote the empowerment of young women.

Structural violence and the need for compassionate use of methadone in Mexico.

BACKGROUND: Epidemiological data from Mexico have documented an increase in heroin use in the last decade. However, there is no comprehensive care strategy for heroin users, especially those who have been accused of a crime. The objective of this study was to describe the heroin and methadone use of intravenous heroin users of both sexes who have been in jail, to offer evidence for the formulation of health policy. METHODS: This study used an ethnographic approach, with open-ended interviews carried out from 2014 to the present. Heroin users of both sexes attending a private methadone clinic in Mexico City were invited to participate. The sample was non-probabilistic. All interviews were audiotaped and transcribed, and narratives were analyzed using thematic analysis. RESULTS: Participants in this study were 33 users of heroin, two of them women, who had been in prison. They ranged in age from 33 to 62 years, had used heroin for a period of 13-30 years, and were from three states: Michoacan, Oaxaca, and Mexico City. Three principal categories of analysis were structured: 1. Pilgrimage for help (dynamics of the drama of suffering, pain, and time through health care spaces); 2) methadone use as self-care; and 3) accessibility to methadone treatment. The impossibility of access to methadone treatment is a condition which motivates users in their journey. The dynamics of methadone use are interpreted as a form of self-care and care to avoid substance use. Reducing the psychological, physical, and harmful effects of the substance allows them to perform daily activities. The inability to access treatment leads to a significant effect on users who experience structural violence. CONCLUSION: Compassionate methadone treatment and holistic attention should be considered as a way to meet patients' needs and mitigate their suffering, based on public health policy that allows for human rights-based care.

"I Didn't See It as a Problem, I Thought It Was Going to Be Taken Away": Narratives From Family Members of Users in Rehab.

There are multiple discourses on addictions that influence the way in which relatives interpret the substance use of a family member. The purpose of this study is to understand the influence of these discourses on the construction of use as a problem by relatives of people in recovery. Narratives were obtained on the path of the illness to identify the phases in the construction of use as a problem and the influence of the discourses on each phase. The process has four successive phases: normalization, impasse, exasperation, and adoption of the treatment ideology. This process goes from the legitimization of use to its moral interpretation and subsequently to the transition to medical discourse. It is concluded that it is important to reduce the influence of the moral discourse in order to facilitate timely detection and early care, as well as to design interventions focused on the reconstruction of use as a problem.

The Invisible Burden of Violence Against Girls and Young Women in Mexico: 1990 to 2015.

The increasing burden of interpersonal violence in women in Mexico is a neglected social and health problem that competes with other leading causes of premature death, disability, and health losses in young women. In this article, we focus on revealing the burden of violence in girls and young women and its implications for public policy. This study presents the subnational analysis of Mexico from the Global Burden of Disease study (1990-2015). The global study harmonized information of 195 countries and 79 risk factors. The study analyzed the deaths, years of life lost to premature death (YLL), years lived with disability (YLD), and the healthy years of life lost or disability-adjusted life year (DALY) related to violence. Nationwide, violence in young women accounts for 7% of all deaths in the 10 to 29 years age group and arises as the second most important cause of death in all age groups, except 10 to 14 years old, where it stands in the seventh position from 1990 to 2015. The health losses and social impact related to violence in young women demands firm actions by the government and society. It is urgent for health institutions to focus on the health of girls and young women because gender inequities have an enormous effect on their lives. Girls and women are nearly universally less powerful, less privileged, and have fewer opportunities than men.

Qualitative Study of the Processes of Transgender-Men Identity Development.

OBJECTIVE: Describe and analyze the mental health service and medical needs of a group of transgender men from the point when they changed their gender identity to male. MATERIAL AND METHOD: Transgender men volunteers who attended a specialized care center in Mexico City answered a qualitative semi-structured interview to explore their needs as well as the adversities they unnecessarily face due to the lack of information and care for their condition. Interviews were audio-recorded and transcribed for thematic analysis. RESULTS: Respondents began to develop their transgender identity in childhood; however, during that time, almost none of them had any helpful contact with a health professional. Those who did receive some form of care received mistreatment rather than positive feedback. It was not until adulthood that they obtained facts about a specialized care center. CONCLUSION: It is necessary for health professionals to have information about sexual diversity and be trained to meet the needs of transgender children, in order to have information on places and professionals who accompany them and advise on available treatments such as hormone blockers or treatments. The study includes a small but important sample. However, the currently hostile, discriminatory environment, significantly exposes transgender people to developing mental health problems.

Malestar depresivo en jóvenes universitarios: impacto de un modelo de psicoterapia breve focalizada con orientación psicoanalítica / Depressive symptomatology in young university students: Impact of a brief psychotherapy model focused with psychoanalytic orientation

El estudio tiene como objetivo evaluar los efectos de una psicoterapia breve focal psicoanalíticamente orientada en una muestra de 38 jóvenes universitarios con sintomatología depresiva leve o moderada y malestar emocional general de una Facultad de la UNAM. Se utilizó un diseño cuasiexperimental pretest-postest y seguimientos. Se utilizaron los instrumentos Inventario de Depresión de Beck (BDI), Escala de Malestar Psicológico de Kessler (K-10), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), y se recolectaron datos sociodemográficos, escolares y clínicos de los participantes. Los resultados de Wilcoxon y Friedman confirman mejoras estadísticamente significativas en la sintomatología. Según los resultados de Q de Cochran, también hubo mejoras en la sensación de malestar en los participantes. Concluimos que los resultados son alentadores en cuanto a la modalidad de la psicoterapia realizada, respecto a su utilidad y relevancia clínica en el trabajo con jóvenes universitarios

The study aims to assess the effects of a psychoanalytically oriented brief psychotherapy in a sample of 38 university students with mild or moderate depressive symptoms and general emotional distress at a UNAM School. A quasi-experimental pretest-posttest design and follow-ups were used. Beck Depression Inventory (BDI), Kessler Psychological Discomfort Scale (K-10), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) were used, and sociodemographic, school and clinical data were collected from the participants. The results of Wilcoxon and Friedman confirm statistically significant improvements in the symptomatology. According to the results of Q de Cochran, there were also improvements in the feeling of discomfort in the participants. We conclude that the results are encouraging in terms of the modality of psychotherapy performed, regarding its usefulness and clinical relevance in working with university students

People who inject drugs (PWID) and HIV/aids cases in Mexico City: 1987-2015.

BACKGROUND: The purpose of this study is to describe the characteristics of individuals who inject drugs, to explore use trends in the past 25 years, and to review the profile of users of various drugs, both legal and illegal, that have been used intravenously without medical prescription in Mexico City. METHODS: Information was drawn from the Drug Information Reporting System (SRID, 1987-2015) and data from the National Center for the Prevention and Control of HIV/aids (CENSIDA, 1983-2018). SRID is based on two 30-day cross-sectional evaluations carried out during June and November. It has served as an uninterrupted epidemiological surveillance system for 32 years, operating both in health and justice institutions in Mexico City and the metropolitan area. The timely identification of changes in use patterns is regarded as the most consistent tool to track the trajectory of the phenomenon. CENSIDA cases were analyzed based on the number of HIV and aids positive injectable drug users during the same period of time in Mexico City. RESULTS: Cocaine users represented the highest number of cases, with a total of N = 293. Back in 2000, the use of this substance showed a significant increase of up to 50%. In turn, heroine and opiates user trends by sex increased from being almost non-existent in 1987 to 13% in 1994. Results provide evidence of the changes in the number of users over the years, with the largest increases being recorded in 1996 (16.5%), 1999 (17%), and 2010 (13%). CONCLUSIONS: The increase observed in the results coincides with domestic and world political situations that have caused an upturn in the use of some substances over the years. It is not far-fetched to think that in the coming years there will be an increase in the number of individuals who inject drugs due to the high production and availability of heroin in Mexico and the emergence of fentanyl use as indicated by ethnographic research in Mexico City and the deaths linked to its consumption. The latest reports, published in 2018, documented at least five cases of fentanyl users.

Feelings of insecurity regarding organized crime in Tamaulipas, Mexico.

OBJECTIVE: To understand the meanings, feelings and practices associated with insecurity in a context with the presence of organized crime. MATERIALS AND METHODS: The study was conducted in a municipality of Tamaulipas, México, with high levels of violence. Semi-structured interviews were conducted with a purposive sample of thirty indirect victims. Interview transcriptions underwent computer-assisted qualitative analysis using the MAXQDA program. RESULTS: Threatening situations and perceived causes of insecurity in the local context were identified. Various psychosocial consequences of insecurity and coping strategies are also described. CONCLUSIONS: Although the strategies used attempt to reduce the impact of insecurity on mental health, a transformation of mobility in public space and social relations is observed. Citizens handle insecurity at the individual level, even when it is attributed to structural causes.

Feelings of insecurity regarding organized crime in Tamaulipas, Mexico / Sentimientos de inseguridad en relación con el crimen organizado en Tamaulipas, México

Abstract Objective To understand the meanings, feelings and practices associated with insecurity in a context with the presence of organized crime. Materials and methods The study was conducted in a municipality of Tamaulipas, México, with high levels of violence. Semi-structured interviews were conducted with a purposive sample of thirty indirect victims. Interview transcriptions underwent computer-assisted qualitative analysis using the MAXQDA program. Results Threatening situations and perceived causes of insecurity in the local context were identified. Various psychosocial consequences of insecurity and coping strategies are also described. Conclusions Although the strategies used attempt to reduce the impact of insecurity on mental health, a transformation of mobility in public space and social relations is observed. Citizens handle insecurity at the individual level, even when it is attributed to structural causes.

Resumen: Objetivo Comprender los significados, afectos y prácticas asociadas con la inseguridad en un contexto con presencia del crimen organizado. Material y métodos El estudio se realizó en un municipio de Tamaulipas, México, con altos niveles de violencia. Se llevaron a cabo entrevistas semiestructuradas, con una muestra propositiva de treinta víctimas indirectas. Las transcripciones de las entrevistas fueron sometidas a un análisis cualitativo asistido por computadora mediante el programa MAXQDA. Resultados Se identificaron las situaciones amenazantes y las causas percibidas de la inseguridad en el contexto local. También se describen diversas consecuencias psicosociales de la inseguridad y las estrategias empleadas para su afrontamiento. Conclusiones Aunque las estrategias empleadas buscan disminuir el impacto de la inseguridad en la salud mental, se observa una transformación de la movilidad en el espacio público y las relaciones sociales. Los ciudadanos manejan la inseguridad a nivel individual, aún cuando le atribuyen causas estructurales.

Violence narratives of Mexican women treated in mutual-aid residential centers for addiction treatment.

BACKGROUND: Violence against women is a social and public health issue in Mexico. The aim of this article is to explore violence among an understudied group of women, who attended Mutual-Aid Residential Centers for Addiction Treatment and experienced stigma both as women and addicts. These centers are particular kind of addiction treatment services that stem from 12-step philosophy, but that have been found to manipulate said philosophy and exercise extreme forms of psychological and physical violence. METHODS: Thirteen semi-structured interviews were carried in 2014 and 2015 out with women who resided in at least one of these centers to understand their experiences of violence prior and during their rehabilitation process. The interview guide covered questions regarding substance use initiations, family violence and dynamics, and rehabilitation experiences. Qualitative data was analyzed using interpretative-phenomenological analysis. RESULTS: Two categories emerged: violence and substance use and abuse, and violence against women in recovery. Results show that all participants experienced violence in their family since childhood, particularly sexual and physical violence. As a result, participants experienced guilt, sadness and shame, which led them to contexts of consumption. Violence continued as they explored alcohol and drug use, even though women felt empowered. CONCLUSIONS: Treatment reproduced masculine violence constantly, but women felt that they were in a context that helped them understand their addiction. Even though women felt these centers played a crucial role in their recovery, women's particular needs and experiences are not considered in the treatment program.

Experiences of Power and Violence in Mexican Men Attending Mutual-Aid Residential Centers for Addiction Treatment.

Fundamental elements of hegemonic masculinity such as power and violence are analyzed through characteristics of 12-step programs and philosophy immersed in Mutual-Aid Residential Centers for Addiction Treatment (CRAMAAs). CRAMAAs are a culturally specific form of substance abuse treatment in Mexico that are characterized by control and violence. Fifteen interviews were carried out with men of varied sociodemographic characteristics, and who resided in at least two of these centers. Results identify that power is expressed through drug abuse and leads them to subsequent biopsychosocial degradation. Residency in CRAMAAs is motivated by women, but men do not seek the residency and are usually admitted unwillingly. Power through violence is carried out inside CRAMAAs where men are victims of abuse. From a 12-step philosophy, this violence is believed to lead them to a path of recovery but instead produces feelings of anger and frustration. The implications of these centers on Mexican public health are discussed.

If three of my brothers have ankylosing spondylitis, why does the doctor say it is not necessarily hereditary? The meaning of risk in multiplex case families with ankylosing spondylitis.

OBJECTIVE: To investigate how patients with ankylosing spondylitis and their relatives in multiplex case families understand concepts of familial aggregation, heredity and risk perceptions, and its impact on decision-making. METHODS: This is a multimethod clinical investigation using field research style in 34 individuals from 10 families with ≥2 members with ankylosing spondylitis covering a wide spectrum of disease severity, educational level, and economical status. The narratives of patients and their relatives were obtained using clinical information, unstructured observation, and personal interviews, which were then transcribed verbatim, coded, and analyzed by three investigators. The interpretation of the textual data was based on two analysis styles, immersion/crystallization and interpretative grounded theory. RESULTS: We identified four broad interrelated interpretive units in patient and relatives narratives: (1) familial interpretation of the disease, (2) genetic risk, (3) decision-making based on risk, and (4) patient-family/physician discourse contradiction on the meaning of heredity. CONCLUSIONS: Patient's and their relatives interpretation of familial aggregation, HLAB27, heredity, and risk perception in relation with ankylosing spondylitis involves four broad interpretive units spanning from clinical symptoms to heredity and decisions made accordingly. Their thoughts and consequent decisions are often in contradiction with the medical knowledge on the role of genetic factors in ankylosing spondylitis.

La coerción sexual asociada con los mitos de violación y las actitudes sexuales en estudiantes universitarios / Sexual coercion associated with the myths of rape and sexual attitudes in college students

La violencia sexual es el logro de actos sexuales mediante coerción, intimidación, chantaje, lesiones o amenazas de daño físico y varía desde acercamientos hasta la violación. Involucra algún tipo de persuasión para que se den intercambios sexuales no consensuados y acontece con mayor frecuencia en relaciones de cortejo, noviazgo o románticas. El objetivo de este trabajo es medir la asociación entre las actitudes sexuales y la aceptación de los mitos de violación con la coerción sexual en una muestra de jóvenes universitarios y hacer una comparación por sexo y grupos de edad. La muestra del estudio fue no aleatoria e incluyó a 630 estudiantes universitarios. El 51% de la muestra reportó experiencias de coerción sexual; los hombres la ejercieron casi tres veces más (71.1%) que las mujeres (28.9%). Las mujeres que ejercieron coerción reportaron una actitud sexual menos tradicional que los hombres (F= 21.413, p<.001) y las que la sufrieron aceptaron más la permisividad (F=37.432, p<.001). Los hombres que sufrieron coerción culpabilizaron más a las víctimas de violación que las mujeres (F=10.603, p=.001); esto mismo se observó en el grupo de 17-20 años de edad (F=9.841, p=.002). El ejercicio de coerción por parte de las mujeres tiene un carácter paradójico en cuanto al rol de género. En los sujetos existe una dificultad para negociar un encuentro sexual seguro o consensuado; las mujeres que reportaron mayor permisibilidad sexual mostraron una mayor propensión a involucrarse en relaciones sexuales no planificadas y ser más vulnerables a la coerción. Es importante hacer esfuerzos para erradicar las creencias que sostienen que los comportamientos sexuales abusivos en las relaciones erótico-afectivas son normales o naturales.

Sexual violence occurs when an individual obtains sexual interaction through coercion, intimidation, blackmail, lesions or threats of physical harm. It ranges from slight approaches to rape, and involves some kind of persuasion to obtaining unwanted sexual interactions; it happens more often in dating relationships. The aim of this paper is to measure the association of sexual attitudes and the acceptance of rape myths with sexual coercion in a sample of college students, and compare these variables by sex and age. The sample was non-probabilistic and included 630 students (51% had experiences of sexual coercion); 71% of men reported practicing sexual coercion. Women who practiced sexual coercion had a less traditional sexual attitude than men (F= 21.413, p<.001), and women who faced sexual coercion had a more permissive attitude in sexual interactions (F=37.432, p<.001). Men who faced sexual coercion blamed rape victims more than women (F=10.603, p=.001). Younger men also blamed rape victims more than the older ones (F=9.841, p=.002). When women use sexual coercion it seems to have a paradoxical implication regarding their gender role. It also appears to be a problem for negotiating safe sexual encounters; women who reported more sexual permissiveness seem to participate more frequently in unplanned sexual interactions and they may be more vulnerable to coercion. It is necessary to modify beliefs about abusive sexual behaviors being normal in dating relationships.

"Salir del clóset" en la Ciudad de México / Outing in Mexico City

El objetivo de este artículo es comprender el proceso de construcción de la identidad lésbico-gay en una muestra de dieciséis personas. El artículo concluye que el modelo de Pérez es comprensivo, aunque no exhaustivo, que la identidad lésbico-gay fortalece el autoconcepto individual y puede generar procesos de cambio social a pequeña escala.

This article seeks to understand the process of LGBT identity construction in a sample of sixteen participants. It concludes that the Pérez model is comprehensive but not exhaustive, and that LGBT identity can strengthen individual self-concept and may generate small-scale social changes.

Los nuevos empresarios: Trayectoria del uso a la venta de drogas en contextos de fiesta / The new businessmen: Pathways from drug use to drug dealing in party contexts

Drugs use at party contexts has increased in recent decades. Drugs dealing facilitates consumer access to substances, whose sales practices vary according to drugs use, places for the consumption and the drug social function. Drug dealing is socially constructed from a set of practices ranging from reasons to dealing and those related to the consolidation as a common practice. The aim of this research was to describe and analyze the drugs users' experience in party contexts, about their dealer's construction process. An interpretative multiple-case study with the snowball technique was carried out to get the participants. The information was obtained by a semi-structured interview and nonparticipant observation at the dealing places. The information obtained points out the group's participation on the selection of the dealer as the initiation of drugs dealing, the extroversion features and communication skills as an important profile to be a dealer; specially, the capability to satisfy the group's emotional request through the drugs. Also, benefits as acceptation, protection and the warmth from the group and the economical earning. The dealer/businessmen consolidation is socially constructed according to the new identity assumed, the group participation and the specific activities as a business.

El uso de drogas en contextos de fiesta se ha incrementado en las últimas décadas. El narcomenudeo facilita el acceso a sustancias de consumo, cuyas prácticas de venta varían conforme a la droga de uso, los espacios de consumo y la función de la droga en los grupos que la consumen. La venta de drogas implica una serie de prácticas que la construyen y que incluyen los motivos del inicio de venta, el proceso de desarrollo y las relacionadas con la consolidación de la venta como práctica habitual. El objetivo de esta investigación fue describir y analizar la experiencia de usuarios de drogas en contextos de fiesta respecto al proceso en que se construyen como dealers. Para lo anterior, se realizó un estudio interpretativo de casos múltiples, empleando la técnica de "bola de nieve" para captar a los participantes. La observación se obtuvo por medio de una entrevista semiestructurada y la observación no participante en escenarios de venta. Se obtuvo información relacionada con los elementos del salto del uso a la venta como la elección del dealer por el grupo, su perfil para ser elegido como la extroversión y habilidades de comunicación; y sobre todo su capacidad para satisfacer la demanda de emociones de los miembros de su grupo por medio de las drogas de venta. Además, de la aceptación, protección y afecto del grupo y las ganancias económicas. La consolidación como dealer/empresario se construye conforme se asumen una nueva identidad, la participación del grupo y las actividades específicas de la empresa.

Inequidades de género, abuso de sustancias y barreras al tratamiento en mujeres en prisión / Gender inequities, substance abuse and treatment barriers in women in prison

The vast majority of women in Mexican prisons have several mental health disorders and addictions, as well as problems obtaining access to treatment for this type of problems. These women's personal background and prison conditions reflect the unresolved problems of the country, such as education and illiteracy, access to health and housing and inequity in the justice systems. The literature has shown that substance abuse affects female prisoners to a greater extent than other women, and that their disadvantaged socio-economic status makes them more likely to engage in and continue substance abuse. Other aspects that exacerbate this vulnerability are their low educational attainment, lack of job skills, and exposure to stigmatization and discrimination in addition to the physical and psychological consequences of addictive behavior. One aspect that has been internationally acknowledged is that gender inequities make women's health more vulnerable, particularly that of female prisoners, since they have greater health deficits and more treatment barriers. International literature has shown that female users of psychoactive substances in general face more barriers than men in seeking or continuing treatment. Research has also shown that the most common personal barriers in women are denial, shame and guilt. Likewise, women's anxiety and depressive disorders tend to be more prevalent and severe, which in turn prevents them from seeking help when they have substance abuse problems. The most common family-related barriers are the difficulty of attending treatment due to family, partner or childcare obligations, pregnancy or fear of losing custody of their children. The main barriers faced by women regarding treatment institutions are the insensitivity or inadequate training of the staff that work there, prejudice and negative attitudes towards women, lack of information on available treatment and extremely long waiting lists. As a result of the above, the aim of this study is to document the barriers to the treatment of addictions of female prisoners, a disadvantaged group that has rarely been studied in Mexico, in order to understand certain aspects related to this population's access to treatment and continuation of the latter. The design used for this research is an ex post facto, descriptive, non-experimental, cross-sectional field study. The sample consisted of 213 women, chosen for convenience, who met the following criteria: alcohol and drug users, ages 18 to 65, able to read and write and with no psychiatric disorders or handicaps that would prevent the interview. The women that participated in this study were drawn from two Mexico City prisons: the Centro Preventivo Femenil Oriente, which houses women that have been accused, tried and sentenced, and the Centro de Readaptación Social Femenil Tepepan, where the inmates are women who have been sentenced and also have psychiatric problems. The ethical care observed included informing the interviewees of the objectives of the study, voluntary participation, confidential handling of the information and the use of witnesses, as well as guaranteeing participants the right to abandon the study and not to answer questions they found uncomfortable. The instrument was designed as a semi-structured interview with 242 questions covering various areas including Allen's Questionnaire on Treatment Barriers. It can be self-administered by the respondents, has internal consistency, construct and content validity and was adapted by Romero (2002). Some of the respondents had to have the questionnaire read out to them because of their low educational attainment. This questionnaire consists of 41 items, 30 of which are divided into three categories: 1. characteristics of treatment services, 2. beliefs, feelings or thoughts, and 3. socio-environmental aspects. Each category also includes an open question to discover other types of barriers not included in the three categories. The results yielded the following socio-demographic profile of the interviewees: 45.5% were in the 28 to 40 year age group; and had had 6 or less years' education (41.3%) or completed junior high school (36.2%). The majority were single (48.6%) or common law (21.6%), while 50.7% had children under the age of 18. Certain other characteristics of this sample such as depression, violence and alcohol and drug use have been reported in other studies. Of the total group of women that had received treatment at some time in their lives, 52.6% (n = 112) mentioned some type of barrier to treatment for addictions. A total of 29.1% (n = 62) of these women mentioned some type of barrier to treatment for alcohol use, while 44.1 % (n = 94) cited some type of barrier to treatment for drug use. Lastly, 39.2% (n = 44) mentioned some type of barrier to treatment for both types of consumption. An analysis of the treatment sub-scale by socio-demographic variable showed greater difficulty in obtaining treatment among women ages 28 to 40 and among those with children under 18. Statistically significant differences were observed regarding the type of offense (robbery) and availability of treatment. As for the beliefs, feelings and thoughts sub-scale, statistically significant differences were found among women with children under 18 and those finding it hard to abandon consumption. The sub-scale related to situational aspects, such as rejection from friends, proved to be the main barrier to enter treatment and was statistically significant among single women. The results of this study pose challenges to the health and mental health service sector regarding the timely treatment and rehabilitation of marginalized women. Likewise, acknowledging gender inequities is crucial when it comes to designing health promotion strategies. Without this perspective, their effectiveness could be jeopardized and gender inequalities actually exacerbated.

La gran mayoría de las mujeres recluidas en las prisiones de México presentan una gran cantidad de trastornos de salud mental y adicciones, así como dificultades para acceder al tratamiento para este tipo de problemas. Los antecedentes personales y las condiciones de reclusión de estas mujeres reflejan los problemas no resueltos del país como son educación y analfabetismo, acceso a la salud, vivienda e inequidad en los sistemas de procuración de justicia. En la bibliografía se ha señalado que el abuso de sustancias afecta a las mujeres presas en mayor medida que a otras mujeres y que su situación socioeconómica desfavorable las hace más susceptibles de incidir y prevalecer en la conducta de abuso de sustancias. Otros aspectos que acentúan esta vulnerabilidad son el bajo nivel educativo, las pocas habilidades para el trabajo, la exposición a la estigmatización y la discriminación, además de las consecuencias físicas y psicológicas de la conducta adictiva. Un aspecto reconocido internacionalmente es que las inequidades de género vulneran de manera particular la salud de las mujeres, lo cual es aún más evidente en las mujeres presas, pues presentan mayores déficits en su salud y mayor número de barreras al tratamiento. Se ha documentado en la bibliografía internacional que las usuarias de sustancias psicoactivas en general se enfrentan a un mayor número de barreras que los hombres para buscar o seguir un tratamiento. Por lo anterior, el objetivo del estudio es documentar las barreras al tratamiento de adicciones de mujeres en prisión, una población desfavorecida poco estudiada en México a fin de entender algunos aspectos relacionados con el acceso a tratamientos de esta población y su permanencia en ellos. El diseño utilizado para esta investigación corresponde a un estudio de campo transversal no experimental, descriptivo, ex post facto. La muestra se conformó de 213 mujeres, seleccionadas por conveniencia, con los siguientes criterios: usuarias de alcohol y drogas, edad de 1 8 a 65 años, que supieran leer y escribir, sin trastorno psiquiátrico o discapacidad que impidiera la entrevista. Las mujeres que participaron en este estudio se seleccionaron de dos prisiones de la Ciudad de México: el Centro Preventivo Femenil Oriente, donde se encuentran mujeres indiciadas, procesadas y sentenciadas, y el Centro de Readaptación Social Femenil Tepepan, donde se encuentran mujeres sentenciadas y con problemas psiquiátricos. Los cuidados éticos observados en el estudio fueron: información de los objetivos a las entrevistadas, participación voluntaria, confidencialidad de la información, empleo de testigos, así como el derecho de abandonar el estudio y de no responder aquellas preguntas que les resultasen incómodas. El instrumento empleado tuvo un formato de entrevista semiestructurada con 242 preguntas que abarcan diversas áreas, entre ellas, el <

Reconocimiento y uso de tácticas de coerción sexual en hombres y mujeres en el contexto de relaciones heterosexuales: Un estudio en estudiantes universitarios / Recognition and use of sexual coercion tactics in men and women in the context of heterosexual relations a study of university students

Violence is a problem gone through by people in one way or another because of the great amount of manifestations in which it is presented. Sexual violence constitutes one of those ways. At the present time, sexual violence is considered a high-priority problem of public health and of human rights; this type of violence is presented in a continuum that goes from groping to forced sexual relationships. Most of the people associate sexual violence with its extreme form which is rape, but, what does it happen with that type of violence where subtlety or persuasions are involved in order to obtain a sexual relationship? This kind of violence is denominated sexual coercion, and it is defined as the use of any type of physical or emotional pressure used by a person to impose on another one acts of sexual order in the context of a heterosexual encounter of mutual agreement to go out together, to get to know themselves, or to have a romantic or erotic relationship, or a more formal relationship such as the courtship. Sexual coercion is a phenomenon mainly studied in heterosexual and student populations and by means of the theory of sexual scripts is one of the forms adopted by it that have been theoretically tackled with. Sexual scripts are all those structural blocks of knowledge information processing where concepts, categories and relationships based on social experience are gathered and which indicate how heterosexual sexual relationships are to be. The vast majority of the studies on sexual coercion have provided enough evidence on the fact that men are the main perpetrators and women are mostly the injured victims. In developing countries, such as Mexico, several studies show that young men frequently feel with the right, precisely for the fact of being men, to have sexual relationships with young women. For this reason, it is understandable that young women's sexual activity is mostly stigmatized, what can contribute to the acceptance of sexual coercion within the intimate couple relationships as a more <> behavior and socially accepted. For this reason, although men can in some moment be sexually constrained and women can exert coercion, the meaning of the fact can be different and, besides, behaviors that are carried out to obtain the wanted sexual behavior themselves also differ between men and women. Tactics constitutes a clear example on the difference between men and women in the act of coercion. Some international studies have identified, in general terms, two types of sexual coercion tactics: indirect and the direct ones. The indirect tactics are strategies in which the person hides his/her sexual purpose. The direct tactics are strategies where the person openly uses physical or psychological force to compel the other one to get involved in certain sexual activity. In Mexico there are not studies about sexual coercion in non formal relationships of heterosexual couples. Because of the above-mentioned, the present work objectives were to know the frequency and type of sexual coercion tactics in men and women university students. Methods and material Three hundred and twenty students were interviewed, 49.7% of them were men and 50.3% women, and the average individual age was of 21 years. The sample was a non random one and the study was of exploratory type. A questionnaire ad hoc of open questions was elaborated, which made inquiries on the tactics used by men and women to press people of another sex to have a sexual relationship. Personal experiences of sexual coercion were also investigated. The application of the instrument was carried out in a group way and its length was around 45 minutes. Open questions were analyzed through the search of thematic units and categories. The contents analysis was used and later transformed into cases count in order to make the corresponding statistical analysis. Result About the experience of sexual coercion, 33.4% of the total sample mentioned that he/she had been victim of sexual coercion. Women (56.1 %) reported being mainly victims of sexual coercion contrary to the men (43.9%), when carrying out an X² statistics there were not significant differences, in statistical terms, between men and women. Nine point four percent of the total sample mentioned that he/she had exerted sexual coercion toward his/her couple. Men (83.3%) reported to have mainly exerted sexual coercion toward their couple contrary to women (16.7%). When carrying out an X² statistics a significant difference, in statistical terms, between men and women was found [X²=16.21, (gl =320/1) p = .000]. Regarding the frequency of the different tactics used by men, men and women reported that the indirect tactics are the most used by men to press women to have sexual relationships. Among the indirect tactics there were found the blackmail, the <>, the verbal deceits, etc. On the other hand, the direct tactics such as threats of physical violence, use of physical violence, insistent petting, etc., were less used by men. Regarding sexual coercion tactics used by women, men and women who participated in the sample, mentioned that direct tactics are more used by women to press a man to have sexual relationships. Within this kind of tactics there were found sexual advances using the body, use of physical violence, use of verbal violence, etc. With respect to the indirect tactics, there were verbal deceits, blackmail, psychological threats, among others. Discussion This research is barely an exploratory study, non representative, but we consider that it makes a contribution of descriptive type to the understanding of sexual coercion in heterosexual relationships when considering both men as women. As it is observed in the results about the experience of sexual coercion, in general terms, such as it is shown in other studies, women were the main victims of sexual coercion, although some men reported being victims, there were no significant difference. Besides, as in other studies, men were those who mostly reported to exert sexual coercion contrary to women, being differences significant in statistical terms. Regarding the tactics used by men in order to coerce their couple, men and women who participated in the sample recognized the indirect tactics as the most used ones, which is in agreement with the outcomes found in other studies. What makes these results interesting is the fact that women recognize in a more open and significant way, that the way a man exerts coercion to a woman is by means of an indirect tactics. These results are much related with the sexual scripts where the man has to gain a sexual access to the woman. With regard to sexual coercion tactics used by women, the direct ones are outstanding, that is to say, those in which woman openly uses the physical, psychological or economic force to press a man to have sexual relationships. The studies about domestic violence state, on the whole, that violence is more exerted by men toward women than the opposite case. Nevertheless, there are also studies about domestic violence which state that women are as aggressive as men. These studies have been questioned and at the moment the debate persists about the findings, because although women use physical violence, it is important to wonder about the intensity of the blow or if the physical violence is rather a defensive answer. The results of this study show the relevance of knowing more about this phenomenon, since many of the subjects in this study are not able to identify any event of sexual coercion in their relationship, reason for which it will be necessary to search what is happening in Mexico on this matter and to even go into the topic of youth's relationships, in particular, the heterosexual ones and the scripts that regulate this relationship, in order to be able of creating better prevention programs guided to eliminate domestic violence to obtain a better mental, sexual and reproductive health.

La violencia es un problema que nos afecta a todas las personas de una u otra manera por la gran cantidad de manifestaciones en las que se presenta. Una de esas formas es la violencia sexual. En la actualidad ésta es considerada un problema prioritario de salud pública y de derechos humanos y se presenta en un continuo que va desde el manoseo hasta las relaciones sexuales forzadas. Una de las formas de este tipo de violencia es la coerción sexual que se define como el uso de cualquier tipo de presión física o emocional que es utilizada por una persona para imponer actos de orden sexual sobre otra en el contexto de un encuentro heterosexual de mutuo acuerdo para salir juntas, para conocerse o sostener una relación romántica o erótica, o en una relación más formal como el noviazgo. La coerción sexual ha sido abordada teóricamente a través de la teoría de los guiones sexuales o scripts. Aunque hombres y mujeres pueden sufrir este tipo de violencia, la gran mayoría de los estudios sobre coerción sexual han evidenciado que los hombres son los principales perpetradores y las mujeres, las víctimas. Un claro ejemplo sobre la diferencia entre hombres y mujeres en la forma de coercionar son las tácticas. Por lo anterior, el presente trabajo tiene como objetivos conocer la frecuencia y tipo de tácticas de coerción sexual en hombres y mujeres universitarios. Material y métodos Se entrevistaron a 320 estudiantes, un 49.7% de los sujetos fueron hombres y 50.3% mujeres, la media de edad fue de 21 años. La muestra fue no probabilística y el estudio fue de tipo exploratorio. Se elaboró un cuestionario ad hoc de preguntas abiertas, las cuales indagan sobre las tácticas utilizadas por hombres y mujeres para presionar a personas de otro sexo a tener una relación sexual; también se indagó sobre las experiencias personales de coerción sexual. La aplicación del instrumento se realizó de manera grupal con una duración aproximada de 45 minutos. Las preguntas abiertas fueron analizadas a través de la búsqueda de unidades temáticas y categorías. Se utilizó el análisis de contenido y después se transformó en conteo de casos para hacer el análisis estadístico correspondiente. Resultados Sobre la experiencia de coerción sexual, un 33.4% de la muestra total menciona que ha sido víctima de ella. Un 9.4% de la muestra total menciona que ha ejercido coerción sexual hacia su pareja; al realizar una X² se encontró una diferencia estadísticamente significativa entre hombres y mujeres [X² =16.21, (gl = 320/1) p = .000]. En cuanto a la frecuencia de las diferentes tácticas utilizadas por los hombres, los y las participantes reportan que las tácticas indirectas son más utilizadas por éstos, mientras que las mujeres utilizan más las tácticas directas. Discusión: Como se observa en los resultados, en general, al igual que en otros estudios, las mujeres son las principales víctimas de coerción sexual y los hombres quienes la ejercen. Los resultados de este estudio evidencian la importancia de conocer más sobre este fenómeno ya que muchos de los sujetos en este estudio no fueron capaces de identificar algún evento de coerción sexual en su relación, por lo que habrá que profundizar mucho más en el tema de las relaciones de pareja de los jóvenes, en particular en la heterosexualidad, y los guiones que la norman, para poder crear cada vez mejores programas de prevención encaminados a eliminar la violencia en las relaciones de pareja y para obtener una mejor salud mental, sexual y reproductiva.

Riesgo y letalidad suicida en pacientes con trastorno límite de la personalidad (TLP), en un hospital de psiquiatría / Suicidal risk and lethality in patients with borderline personality disorder (BPD), at a psychiatry hospital

Suicide attempt in patients diagnosed with Borderline Personality Disorder (BPD) is the most frequent cause of hospitalization in this clinical category and suicidal risks are usually the first manifestation of such disorder. Patients frequently relapse, thus generating high personal and family costs, including: treatments, hospitalization, medication, work disability in economically active people and even death. The American Psychiatric Association, through the DSM-IV, defines the Borderline Personality Disorder as <>. More specifically, criterion five of the disorder mentions self-mutilating behavior, threats, and recurrent suicidal behavior. DSM-IV reports that 8-10% of borderline patients commit suicide. In our country, however, there are no specific data about people diagnosed with BPD who actually have commited suicide. Prevalence of BPD among the general population ranks from 1 to 2%, from 11 to 20% of the psychiatric population; representing 20% of hospitalized patients. The gender distribution is 3:1, being more frequent among women than men. The objective of this study is the assessment of suicidal risk and lethality of 15 patients diagnosed with Borderline Personality Disorder. This research was conducted at the doctors' offices of the host institution, where 1.39% of a total of 1151 hospitalized patients in 2007 were diagnosed with BPD. The comorbidity of DSM-IV Axis I and BPD is frequent and can be found together with mood disorders (depression, dysthymia), substance-related disorders, eating disorders (bulimia nervosa), post-traumatic stress disorder, anxiety disorder and/or attention-deficit hyperactivity disorder. A research conducted in the USA with 504 patients diagnosed with BPD showed that 93% (n = 379) of the patients showed comorbidity of DSM-IV Axis I and mood disorders. Similar results were reported by other researchers. This study was designed to be a descriptive and transversal study. We went through the records of all the adult patients who had been hospitalized due to suicide ideation or attempt, diagnosed by psychiatrists as Borderline Personality Disorder, and confirmed by the SCID-II, and medicated by a psychiatrist. Selection criteria: 18 year-old patients or older, hospitalized due to suicide attempt or ideation, and diagnosed with BPD. The research was conducted in compliance with the regulations governing human research ethics set forth in the Declaration of Helsinki (1975). The instruments used were: the medical history of the patients, the ID file for clinical and epidemiological studies, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID -II), the Hopelessness Scale, the Depressive Syndrome Questionnaire, the Suicidal Ideation Scale, the Risk-Rescue Scale and some risk factors such as: sexual abuse, separation from partner, parental divorce, the suicide of a close relative, and alcohol and substance abuse. The results on the lethality of suicide attempts are similar to the results of other studies: women show a higher number of less lethal suicide attempts, and the methods used are also similar (medication intoxication and mutilation). The comorbidity with depressive disorders was of 86.6%, thus our results concur with those of other studies. Regarding risk factors, 86.6% (n = 13) mentioned they have experienced some type of sexual abuse, 46.6% (n = 7) separated from their partner, 40% (n = 6) had divorced parents, and 6.6% (n = 1) had a close relative who had committed suicide. During their last suicide attempt, one of the subjects had consumed alcohol and none of them had taken drugs; however, these behaviors did not appear to potentiate the suicidal risk. According to the scales applied, 46% of the subjects (n = 7) showed severe hopelessness, while 54% (n = 8) ranged between mild or moderate hopelessness; 13% (n = 2) had severe depression according to Calderon's scale. According to the Suicidal Ideation Scale, 93.3% (n=14) had a >10 score, which means patients show risk of attempting suicide again. The Risk-Rescue Scale suggests that most patients (n = 13) exhibited deliberate self-harming behavior (e.g. cutting superficially the skin around the wrist, taking prescription drugs or intoxicating near key people who could rescue them or provide help and rescue), which are not considered true parasuicidal behavior. The literature shows that BPD is the most prevalent of all personality disorders, both in the general and clinical population, the one with the highest number of suicide attempts in the DSM-IV Axis II, and the one with the highest comorbidity with Axis I mood disorders and Axis II personality disorders. The 15 patients in this sample carried out a total of 128 suicide attempts throughout their lives, which coincides with other research results, which describe that a history of multiple suicide attempts is a predictor of future suicidal behavior and increase the suicidal risk. As shown above, there were no cases obtaining high scores in all the scales applied (hopelessness, depression, suicidal ideation, high risk and low rescue), even in the result integration per subject, thus showing very few, high-lethality suicidal cases. It would be a mistake, however, to think that suicide attempts will always be less lethal, since there is always the risk of someone attempting a more lethal suicide that translates into the death of the patient. Suicide attempt assessment in dealing with Borderline Personality Disorder becomes a necessary condition to design better therapeutic strategies, since it allows health professionals to know the degree of lethality and timely treatment. The assessment of suicide attempts enables a more realistic prognosis, which backs up and guides clinical decisions.