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

Percepción de estudiantes de bachillerato sobre contenidos relacionados con el consumo de alcohol y marihuana en las redes sociales

Las redes sociales son espacios virtuales, en los que millones de adolescentes alrededor del mundo se comunican libremente acerca de temas relevantes para su desarrollo y entretenimiento. La literatura internacional indica que, la exposición a contenidos relacionados con el consumo de alcohol y marihuana, contribuye al desarrollo de una menor percepción de riesgo al consumo, y una mayor tolerancia social hacia el uso de estas drogas. La presente investigación tuvo como objetivo ex- plorar la percepción del consumo de alcohol y marihuana, que aparece en las redes sociales, en una muestra de 35 estudiantes de bachillerato. Se realizó un estudio cualitativo exploratorio a través de cuatro grupos focales, integrados por alumnos de bachillerato de la ciudad de Xalapa, Veracruz, de ambos sexos, de entre 15 y 19 años de edad, provenientes de distintos contextos socioeconómicos. El contenido de las entrevistas grupales fue transcrito y analizado, utilizando la metodología de la teoría fundamentada. Los resultados indican que, las redes sociales eran la principal fuente de información de los estudiantes, sobre la disponibilidad y los efectos del alcohol y la marihuana, sobrepasando a la televisión, los padres y los profesores. Los estudiantes percibieron el contenido sobre el consumo de drogas en las redes sociales, como una extensión de la presión de sus pares para iniciarse en el consumo de alcohol y marihuana. Abstract Social networks are virtual spaces in which millions of teenagers around the world communicate freely about themes relevant to their development and entertainment. International literature indicates that constant exposure to social networks’ content related to alcohol and marijuana consumption contributes to the development of a more tolerant perception of drugs and their use. The aim of this qualitative study was to explore the perceptions of high school students regarding the alcohol and marijuana consumption posts on social networks in a sample of 35 high school students. Four focus groups were conducted with a sample of high school students from the city of Xalapa, Veracruz. Participants were both males and females whose ages ranged between 15 and 19 years and had different scio-economic backgrounds. The focus groups verbatim was transcribed and analyzed using a grounded theory approach. Results they indicated that the content posted on social networks was participants’ main source of information about the effects and availability of alcohol and marijuana, surpassing television, teachers and parents. The online content was perceived as an extension of the peer pressure teenagers experienced to start using drugs

Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions.

Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders

How culturally unique are pandemic effects? Evaluating cultural similarities and differences in effects of age, biological sex, and political beliefs on COVID impacts

Despite being bio-epidemiological phenomena, the causes and effects of pandemics are culturally influenced in ways that go beyond national boundaries. However, they are often studied in isolated pockets, and this fact makes it difficult to parse the unique influence of specific cultural psychologies. To help fill in this gap, the present study applies existing cultural theories via linear mixed modeling to test the influence of unique cultural factors in a multi-national sample (that moves beyond Western nations) on the effects of age, biological sex, and political beliefs on pandemic outcomes that include adverse financial impacts, adverse resource impacts, adverse psychological impacts, and the health impacts of COVID. Our study spanned 19 nations (participant N = 14,133) and involved translations into 9 languages. Linear mixed models revealed similarities across cultures, with both young persons and women reporting worse outcomes from COVID across the multi-national sample. However, these effects were generally qualified by culture-specific variance, and overall more evidence emerged for effects unique to each culture than effects similar across cultures. Follow-up analyses suggested this cultural variability was consistent with models of pre-existing inequalities and socioecological stressors exacerbating the effects of the pandemic. Collectively, this evidence highlights the importance of developing culturally flexible models for understanding the cross-cultural nature of pandemic psychology beyond typical WEIRD approaches

Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country

BackgroundWeb-based interventions are at an early stage in non–English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. ObjectiveThe aim of this study is to explore participants’ satisfaction and acceptability for the second version of HDep. MethodsA retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). ResultsIn all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. ConclusionsHDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative–quantitative study from a low- to middle-income, non–English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence

A four-year experience with a Web-based self-help intervention for depressive symptoms in Mexico

OBJECTIVE: To describe a four-year descriptive, naturalistic study monitoring the use of HDep (Help for Depression or Ayuda para depression (ADep)in Spanish), an open-access/free Web-based, psycho-education, cognitive-behavioral intervention program produced in Mexico consisting of seven self-help modules that include feedback-generating assessments of depressive symptoms, vignettes, recorded messages, a relaxation exercise, a personal workbook, blogs, and user discussion forums. METHODS: Data were collected on all individuals who entered the HDep site since the program's launching in 2009. Those who entered the site two or more times and also registered as "users" or "participants." The user data consisted of 1) user profiles; 2) scores for the CES-D (Center for Epidemiological Studies Depression Scale), for users who completed the feedback-generating assessments of depressive symptoms; 3) user evaluations of the usefulness of HDep; and 4) transcripts of HDep discussion forum posts. The raw user data were obtained through Moodle (Modular Object-Oriented Dynamic Learning Environment, a free software e-learning platform) and analyzed quantitatively (using SPSS) and qualitatively (using ATLAS.ti). RESULTS: A total of 28 078 individuals accessed HDep and 17 318 of those (61.6%) qualified as users. Of all users, 84.4% were women, 64.6% used the workbook, and 60.9% entered the discussion forums (of whom 16.3% added a post). Depressive symptoms (CES-D score ≥ 16) were observed in 97.1% of the users who completed the feedback-generating assessment (n = 16 564). User retention dropped across the seven modules (from 12 366 users for Module 1 to 626 for Module 7). However, all seven modules were rated very high for "helpfulness/usefulness," with mean scores all above 4 on a 1 - 5 scale. The HDep discussion forums showed a rich social interaction. Predictors of entering at least one module (based on stepwise logistic regression analysis) included being a woman, being ≥ 30 years old, reporting disability, and having attempted suicide. Of the 72 participants who completed the final user evaluation of HDep, 97.5% said it had an enormous influence on helping them to identify and transform negative thoughts. CONCLUSIONS: Despite the high attrition among users, and the need for further structure adaptation, HDep can be considered a potentially useful mental health tool in Mexico for 1) detecting depression (via the CES-D assessments) and 2) providing a means of social support to those with depression. The high levels of depressive symptoms detected among users suggest that the role of free-access, self-help, Web-based interventions in public mental health programs should be further investigated. The effectiveness of HDep in reducing depressive symptoms and providing a support system has yet to be assessed and should be examined in future research

Estudio transversal de consumo de tabaco en trabajadores de un hospital de tercer nivel

Introduction: tobacco use is the leading cause of preventable deaths and morbidity around the globe. Previous studies in medical hospitals population are seen as positive role in promoting on tobacco abstinence, however, when tobacco use in health personnel, the odds decrease withdrawal. Objectives: 1) determine the prevalence of smoking, 2) compare different workspaces on variables allied to the tobacco use, 3) identify risk factors. Method: a self-report questionnaire containing questions to assess tobacco use and the Fagerström Test of Nicotine Dependence and the Cigarette Dependence Scale to assess nicotine dependence was applied to 1004 workers in the hospital. Results: 23.4% of the sample reported tobacco use in the last year, 60.4% of the smokers are males, 91.2% with a low dependence. Among the risk factors found that the age group 20 to 31 years (OR=2.62, 95% CI [1.77-3.88], p<.001), male (OR=2.91, 95% CI [1.82-4.68], p<.001), age of first use (OR=1.09, 95% CI [.71-1.68], p<.001), civil status (OR=4.51, 95% CI [1.18- 17.18], p=.027), secondary school (OR=3.51, 95% CI [1.66- 7.40], p=.001), high school (OR=3.11, 95% CI [1.61- 6.02], p=.001) increase the probability to be regular smoker. Discussion: the present study provides current information of the tobacco use in a third level hospital workers, finding a low prevalence of physicians who smoking behavior (16.3%) compared to other areas of work, the related implications with the findings discussed in the study.----------------------- Introducción: el consumo de tabaco es la primera causa prevenible de muerte y morbilidad en el mundo; estudios previos en hospitales muestran que la población médica sirve como modelo positivo en la promoción de la abstinencia del tabaco, sin embargo, cuando el personal de salud lo usa, las probabilidades de abstinencia disminuyen. Objetivos: 1) conocer la prevalencia de tabaquismo, 2) comparar las distintas áreas de trabajo en función de variables relacionadas con el consumo de tabaco, 3) identificar los factores de riesgo. Método: a 1,004 trabajadores de un establecimiento hospitalario se les aplicó un cuestionario de autorreporte que contenía preguntas para evaluar el tabaquismo, así como el Fagerström Test of Nicotine Dependence (FTND) y la Cigarette Dependence Scale (CSD-12 y CSD-5) para evaluar dependencia de nicotina. Resultados: 23.4% de los trabajadores consumió tabaco en el último año, 60.4% de los fumadores son del sexo masculino, 91.2% presentó dependencia baja. Entre los factores de riesgo se encontraron los siguientes: grupo de edad de 20 a 31 años (OR=2.62, IC del 95% [1.77-3.88], p<.001), ser hombre (OR=2.91, IC del 95% [1.82-4.68], p<.001), edad de inicio del consumo (OR=1.09, IC del 95% [.71-1.68], p<.001), estado civil (OR=4.51, IC del 95% [1.18-17.18], p=.027), y tener una escolaridad de secundaria (OR=3.51, IC del 95% [1.66-7.40], p=.001) o bachillerato (OR=3.11, IC del 95% [1.61-6.02], p=.001). Discusión y conclusiones: el presente estudio aporta información actual sobre el consumo de tabaco en trabajadores de planta de un hospital de tercer nivel; se encontró una baja prevalencia de médicos que consumen tabaco (16.3%), en comparación con el personal de otra áreas de labor. Las implicaciones relacionadas con los hallazgos se discuten en el estudio