The Mental Itineraries of the Everyday Lives of Indigenous Women Linked to their Partners’ Excessive Alcohol Consumption

Some time ago, a psychosocial research project was launched (1999) in an Otomí community in the state of Hidalgo to determine the dynamics of alcohol consumption. It was found, as in many places in Mexico, that alcohol consumption is deeply rooted in culture and that it is a tradition, but also the cause of many social problems, which involve various spheres of everyday life. One of these is women’s everyday lives due to the violence and economic negligence inflicted on them, which produces emotional states of anguish, anxiety, physical and psychological malaise, which increases when they see how their partners’ health is affected as a result of alcohol consumption. Can anything be done for them? Do they want help? Although women are not the only ones to suffer from this, since some children and parents are also affected, they are the main ones to feel the effects. As a means of supporting the family group, a brief intervention model was adapted as an alternative for providing support for the family. The results of the participation in the intervention program and the analysis of the narrations of this process expressed by women are presented in this paper. By mental itineraries, we understand the processes of psychological and cognitive changes undergone by these women in the search for an answer to a situation they could no longer tolerate, which plunged them into a state of crisis. This is analyzed from the theory of experience (Turner, 1994; Mier, 2001) and the Ritual Process (Turner, 1969) understood as, a process of awareness different from previous ones, which makes it different from other similar events. It also drives them to seek help, even though this may involve dealing with cultural norms and patriarchal dominance. What changes an everyday experience for a woman who has tolerated a situation for a long time, suddenly turning it into a social drama that drives her to seek help? The anthropology of experience is based on how individuals experience their culture, in other words, how events are perceived by awareness. To document this experience, we not only recorded data but also cognition, feelings and expectations. Studying this long-established, everyday situation that suddenly becomes a social drama requires examining all the stages in order to be able to reconstruct it. The social drama comprises four stages: rupture, crisis, readjustment and reintegration. Lastly, the study proved the usefulness of the intervention for indigenous communities, despite the fact that the model is counter-cultural, since it runs counter to the cultural habits of alcohol consumption and obedience in a highly patriarchal society that looks for victims and culprits as a means of dealing with situations that cannot be solved or understood

The Mental Itineraries of the Everyday Lives of Indigenous Women Linked to their Partners’ Excessive Alcohol Consumption

Some time ago, a psychosocial research project was launched (1999) in an Otomí community in the state of Hidalgo to determine the dynamics of alcohol consumption. It was found, as in many places in Mexico, that alcohol consumption is deeply rooted in culture and that it is a tradition, but also the cause of many social problems, which involve various spheres of everyday life. One of these is women’s everyday lives due to the violence and economic negligence inflicted on them, which produces emotional states of anguish, anxiety, physical and psychological malaise, which increases when they see how their partners’ health is affected as a result of alcohol consumption. Can anything be done for them? Do they want help? Although women are not the only ones to suffer from this, since some children and parents are also affected, they are the main ones to feel the effects. As a means of supporting the family group, a brief intervention model was adapted as an alternative for providing support for the family. The results of the participation in the intervention program and the analysis of the narrations of this process expressed by women are presented in this paper. By mental itineraries, we understand the processes of psychological and cognitive changes undergone by these women in the search for an answer to a situation they could no longer tolerate, which plunged them into a state of crisis. This is analyzed from the theory of experience (Turner, 1994; Mier, 2001) and the Ritual Process (Turner, 1969) understood as, a process of awareness different from previous ones, which makes it different from other similar events. It also drives them to seek help, even though this may involve dealing with cultural norms and patriarchal dominance. What changes an everyday experience for a woman who has tolerated a situation for a long time, suddenly turning it into a social drama that drives her to seek help? The anthropology of experience is based on how individuals experience their culture, in other words, how events are perceived by awareness. To document this experience, we not only recorded data but also cognition, feelings and expectations. Studying this long-established, everyday situation that suddenly becomes a social drama requires examining all the stages in order to be able to reconstruct it. The social drama comprises four stages: rupture, crisis, readjustment and reintegration. Lastly, the study proved the usefulness of the intervention for indigenous communities, despite the fact that the model is counter-cultural, since it runs counter to the cultural habits of alcohol consumption and obedience in a highly patriarchal society that looks for victims and culprits as a means of dealing with situations that cannot be solved or understood

La cohesión y el conflicto en familias que enfrentan el consumo de alcohol y otras drogas una comparación transcultural México-Gran Bretaña

This paper presents a comparison of the results obtaines through the Interpersonal Relations subscale of the Family Environment Scale (Moos & Moos, 1981) in Mexico and England. The main objective is to demonstrate that there are differences between both countries regarding how families perceive cohesion and conflict in the light of the colectivism-individualism construct. The sample studied was integrated by 107 individuals from separate families from Mexico City and 100 individuals from South West England; all of them had lived with an alcohol or drug user. Through exploratory factor analysis two factors were found, one of them related to positive aspects of the family environment (cohesion) and a second factor which denotes conflict. The confirmatory factor analysis demonstrated that both factors are inversely related. Other correlations indicate higher risk for alcohol consumption in families with high cohesion and high risk for drug use in families with a large number of members. Later, variance analysis corroborates that relatives of alcohol users perceive higher cohesion than relatives of drug users. Furthermore, it was observed that English relatives report higher scores in some items of the cohesion subscale while Mexican relatives scored higher on 2 items of the conflict subscale. These results might reflect different situations occurring within the family depending on the number or members and the extent of their agreements to cope with substance use.En este artículo se comparan los resultados obtenidos en México e Inglaterra empleando la subescala de Relaciones Interpersonales de la Escala de Ambiente Familiar (Family Environment Scale [FES], Moos & Moos, 1981). El objetivo principal es demostrar que existen diferencias entre ambos países en cuanto a la forma en que las familias perciben la cohesión y el conflicto a la luz del constructo colectivismo-individualismo. La muestra estuvo integrada por ciento siete familiares en la Ciudad de México y cien en el Sur de Inglaterra, todos ellos habían vivido con un familiar consumidor de alcohol o drogas. A través de un análisis factorial exploratorio se encontraron dos factores, uno de ellos relacionado con aspectos positivos del ambiente familiar (cohesión) y el segundo factor que denota aspectos de conflicto. El análisis factorial confirmatorio demostró que ambos factores están inversamente relacionados. Otras correlaciones indican niveles de asociación entre las familias con alta cohesión y consumo de alcohol, así como asociaciones entre familias con un número de integrantes mayor y consumo de drogas. (Posteriormente se realizó un análisis de varianza en el que se corroboró que los familiares de usuarios de alcohol perciben mayor cohesión que los familiares de usuarios de drogas). Por otra parte, se observó que los familiares ingleses reportan mayores puntajes en algunos reactivos de la sub-escala de cohesión en tanto que los mexicanos tuvieron mayor puntaje en 2 reactivos de la subescala de conflicto. Estos resultados pueden estar reflejando diferentes situaciones que ocurren en el interior de las familias dependiendo del número de integrantes y el grado de acuerdo entre ellos para hacer frente al problema de consumo

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study.

Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1 st December 2017

Adverse effects of antipsychotics on sleep in patients with schizophrenia. Systematic review and meta-analysis

IntroductionOur objective was to conduct a systematic review and meta-analysis of adverse effects on sleep in patients with schizophrenia receiving antipsychotic treatment.MethodsA systematic search was performed in PubMed, Cochrane Central, Embase, Toxline, Ebsco, Virtual Health Library, Web of Science, SpringerLink, and in Database of abstracts of Reviews of Effects of Randomized Clinical Trials to identify eligible studies published from January 1990 to October 2021. The methodological quality of the studies was evaluated using the CONSORT list, and the Cochrane bias tool. Network meta-analysis was performed using the Bayesian random-effects model, with multivariate meta-regression to assess the association of interest.Results87 randomized clinical trials were identified that met the inclusion criteria, and 70 articles were included in the network meta-analysis. Regarding the methodological quality of the studies, 47 had a low or moderate bias risk. The most common adverse effects on sleep reported in the studies were insomnia, somnolence, and sedation. The results of the network meta-analysis showed that ziprasidone was associated with an increased risk of insomnia (OR, 1.56; 95% credible interval CrI, 1.18–2.06). Several of the included antipsychotics were associated with a significantly increased risk of somnolence; haloperidol (OR, 1.90; 95% CrI, 1.12–3.22), lurasidone (OR, 2.25; 95% CrI, 1.28–3.97) and ziprasidone (OR, 1.79; 95% CrI, 1.06–3.02) had the narrowest confidence intervals. In addition, perphenazine (OR, 5.33; 95% CrI, 1.92–14.83), haloperidol (OR, 2.61; 95% CrI, 1.14–5.99), and risperidone (OR, 2.41; 95% CrI, 1.21–4.80) were associated with an increased risk of sedation compared with placebo, and other antipsychotics did not differ. According to the SUCRAs for insomnia, chlorpromazine was ranked as the lowest risk of insomnia (57%), followed by clozapine (20%), while flupentixol (26 %) and perospirone (22.5%) were associated with a lower risk of somnolence. On the other hand, amisulpride (89.9%) was the safest option to reduce the risk of sedation.DiscussionInsomnia, sedation, and somnolence were the most frequent adverse effects on sleep among the different antipsychotics administered. The evidence shows that chlorpromazine, clozapine, flupentixol, perospirone, and amisulpride had favorable safety profiles. In contrast, ziprasidone, perphenazine, haloperidol, and risperidone were the least safe for sleep.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017078052, identifier: PROSPERO 2017 CRD42017078052

La difícil identificación del consumo de alcohol en jóvenes en comunidades indígenas

En este trabajo se presentan algunas de las dificultades para abordar, en las comunidades indígenas, el consumo de alcohol y sus consecuencias; además se describen características del consumo del alcohol por género, y el papel de los jóvenes frente a las tradiciones de consumo en dos comunidades indígenas

Expectativas, consumo de alcohol y problemas asociados en estudiantes universitarios de la ciudad de México Alcohol use expectancy, intake, and related problems among college students in Mexico City?

OBJETIVO: Establecer la relación entre las expectativas hacia el consumo de alcohol, los patrones de su uso y los problemas asociados a su consumo en una muestra de estudiantes universitarios de la ciudad de México. MATERIAL Y MÉTODOS: Estudio transversal realizado en octubre de 1998, en el que participaron 678 estudiantes, hombres y mujeres entre los 17 y 25 años de edad, provenientes de universidades públicas y privadas. En él se midieron las expectativas a partir de un cuestionario de autorreporte, el Alcohol Expectancy Questionnaire (AEQ), que fue adaptado a esta población obteniendo una consistencia interna global elevada (alpha=0.93). RESULTADOS: Del total de los estudiantes, 31% presentó un consumo alto (mayor a cinco copas por ocasión de consumo en el último año), principalmente en los varones, mientras que 17% fueron no consumidores. Mediante un modelo estructural de ecuaciones se estudió la relación entre las subescalas de expectativas, el patrón de consumo y problemas asociados. El análisis de varianza mostró una relación estadísticamente significativa entre seis subescalas de expectativas (el alcohol como facilitador de la interacción grupal, expresividad verbal, desinhibición, incremento de la sexualidad, reducción de la tensión psicológica e incremento de la agresividad) y las variables sexo, consumo de alcohol y problemas asociados (F=5.23, gl=1, p< 0.05). CONCLUSIONES: De manera consistente con lo informado en otros países, se encontró que los efectos que las personas atribuyen al consumo de alcohol, anticipándose a la experiencia de estar bebiendo (expectativas), están estrechamente relacionadas con su consumo. Los resultados de este estudio indican que los estudiantes con un consumo alto de alcohol tuvieron mayores puntuaciones en seis de las subescalas de expectativas, además de que éstas fueron más elevadas entre quienes informaron que tuvieron problemas relacionados con el consumo en el último año. Las expectativas del alcohol como facilitador de la interacción grupal, como reductor de la tensión psicológica y como agente que incrementa la conducta agresiva se relacionaron con un consumo de alcohol más alto. El texto completo en inglés de este artículo está disponible en: <A HREF="file:///C:/maria/spm/v43n2/a02v43n2.htm">http://www.insp.mx/salud/index.html</A><br>OBJECTIVE: To assess the relationship between alcohol use expectancies, drinking patterns, and alcohol-related problems, among college students in Mexico City. MATERIAL AND METHODS: This cross-sectional study was conducted in October 1998. Study subjects were 678 male and female college students aged between 17 and 25 years, from private and public schools. Alcohol expectancies were measured through the self-reported "Alcohol Expectancy Questionnaire" (AEQ), adapted for this population, with a high overall internal reliability coefficient (alpha=0.93). RESULTS: Thirty-one per cent of study subjects, mainly males, reported heavy drinking (5 drinks or more per drinking occasion in the previous year), while 17% were non-consumers. Relationships for each of the AEQ scales, drinking patterns, and alcohol-related problems, were analyzed through a structural equations model. Analysis of variance showed a statistically significant association between six AEQ subscales -alcohol as a facilitator of a group interaction, verbal expression, disinhibition, sexual enhancement, reduction of psychological tension and arousal agression- (F=5.23, df=1, p<0.05). CONCLUSIONS: Study findings from other countries show that effects attributed to alcohol, in anticipation of the drinking episode (expectancies), are closely related to alcohol intake. Our results showed that heavy drinkers had higher scores in six AEQ subscales, particularly those who reported having alcohol-related problems in the previous year. Alcohol expectancies related to higher alcohol intake were: facilitation of social interaction, decreasing psychological tension, and increasing arousal/aggression. The English version of this paper is available at: <A HREF="file:///C:/maria/spm/v43n2/a02v43n2.htm">http://www.insp.mx/salud/index.html</A

Las drogas y la salud pública: ¿hacia dónde vamos? Drugs and public health: where are we heading to?

El artículo presenta una propuesta para la atención del problema de las adicciones desde un enfoque de salud pública, define sus alcances y limitaciones frente a los retos del fenómeno, especialmente para la formulación de políticas; se suma a las propuestas que buscan integrar los temas sociales en la evaluación del resultado de las acciones y que proponen como meta última el bien de la persona y de las comunidades con una perspectiva de bienestar para la población. Describe el reto que enfrenta México en su papel como país productor, de tránsito y de consumo, analiza brevemente la evidencia sobre las políticas públicas y hace una serie de recomendaciones al respecto.This paper describes a plan for the attention of addictions from a public health perspective; it defines strengths of this perspective and its limitations to face the special challenges that the problem represents for social policies; adopts a wider perspective that includes the integration of health and social issues in measuring policy results having as a main aim the benefit of the person and of the communities with a perspective of the populations well being. It describes the challenge the country faces as producer, route of traffic and rates of consumption, analyzes briefly the evidence of public policies and makes a series of recommendations

Psychometric properties of the Mexican version of the opening minds stigma scale for health care providers (OMS-HC)

Background Healthcare providers are one of the main groups that contribute to the stigmatization of people with mental disorders. Apathy, accusation, fatalism, and morbid curiosity are the most common forms of stigmatization encountered, and these are associated with inadequate treatment, reduced treatment adherence, decreased help-seeking behavior, an increased risk of relapse, and complications with other medical conditions. The aim of this study was to examine the psychometric properties of an adapted Spanish version of the Opening Minds Stigma Scale (OMS-HC) for healthcare providers in Mexico and identify certain stigmatizing attitudes within this group. Methods An ex-post facto cross-sectional observational study was conducted with 556 healthcare providers in Mexico, with an average age of 29.7 years, who were mostly women (80.4%). Validity was examined through confirmatory factor analysis. Differences according to gender, discipline, occupation, and educational level were analyzed using multivariate methods. Results The factor structure of the OMS-HC, consisting of three subscales identified by the original authors of the instrument (attitudes of healthcare providers towards people with mental illness, secrecy/help-seeking, and social distance), was confirmed. The model demonstrated good fit (x2/df = 2.36, RMSEA = 0.050, CFI = 0.970, TLI = 0.962, SRMR = 0.054, NFI = 0.950, PNFI = 0.742). Internal consistency was found to be adequate (α = 0.73, ω = 0.76) for the scale itself and slightly lower than acceptable for the subscales. Significant differences were found by discipline, educational level, and, for student providers, by academic semester. Higher scores were observed on the OMS-HC scale among nursing and medical professionals, undergraduate students, and those in early semesters. Conclusions The Spanish version of the OMS-HC has demonstrated adequate psychometric properties and could be a useful tool to facilitate research on this topic in Mexico, and to carry out comparative studies with healthcare personnel in other Spanish-speaking countries