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Item Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis(BMJ Publishing Group Ltd, 2012) Salomón, Joshua A.; Carvalho, Natalie; Gutiérrez-Delgado, Cristina; Orozco, Ricardo; Mancuso, Anna; Hogan, Daniel R.; Lee, Diana; Murakami, Yuki; Sridharan, Lakshmi; Medina-Mora, María Elena; González-Pier, Eduardo; Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA; jsalomon@hsph.harvard.eduObjective To inform decision making regarding intervention strategies against non-communicable diseases in Mexico, in the context of health reform. Design Cost effectiveness analysis based on epidemiological modelling. Interventions 101 intervention strategies relating to nine major clusters of non-communicable disease: depression, heavy alcohol use, tobacco use, cataracts, breast cancer, cervical cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes. Data sources Mexican data sources were used for most key input parameters, including administrative registries; disease burden and population estimates; household surveys; and drug price databases. These sources were supplemented as needed with estimates for Mexico from the WHO-CHOICE unit cost database or with estimates extrapolated from the published literature. Main outcome measures Population health outcomes, measured in disability adjusted life years (DALYs); costs in 2005 international dollars ($Int); and costs per DALY. Results Across 101 intervention strategies examined in this study, average yearly costs at the population level would range from around ?$Int1m (such as for cataract surgeries) to >$Int1bn for certain strategies for primary prevention in cardiovascular disease. Wide variation also appeared in total population health benefits, from <1000 DALYs averted a year (for some components of cancer treatments or aspirin for acute ischaemic stroke) to >300 000 averted DALYs (for aggressive combinations of interventions to deal with alcohol use or cardiovascular risks). Interventions in this study spanned a wide range of average cost effectiveness ratios, differing by more than three orders of magnitude between the lowest and highest ratios. Overall, community and public health interventions such as non-personal interventions for alcohol use, tobacco use, and cardiovascular risks tended to have lower cost effectiveness ratios than many clinical interventions (of varying complexity). Even within the community and public health interventions, however, there was a 200-fold difference between the most and least cost effective strategies examined. Likewise, several clinical interventions appeared among the strategies with the lowest average cost effectiveness ratios—for example, cataract surgeries. Conclusions Wide variations in costs and effects exist within and across intervention categories. For every major disease area examined, at least some strategies provided excellent value for money, including both population based and personal interventions.Item A cross-national study on prevalence of mental disorders, service use, and adequacy of treatment among Mexican and Mexican American populations(American Public Health Association, 2013) Orozco, Ricardo; Borges, Guilherme; Medina-Mora, Maria Elena; Aguilar-Gaxiola, SergioItem Mexican migration experiences to the US and risk for anxiety and depressive symptoms(Amsterdam, Elsevier/North-Holland Biomedical Press., 2011) Familiar, Itziar; Borges, Guilherme; Orozco, Ricardo; Medina-Mora, Maria-Elena; Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; ifamilia@jhsph.eduItem Risk of injury after alcohol consumption from case–crossover studies in five countries from the Americas(2013) Borges, Guilherme; Orozco, Ricardo; Monteiro, Maristela; Cherpitel, Cheryl; Pérez Then, Eddy; López Víctor A.; Bassier-Paltoo, Marcia; Weil, Donald A.; De Bradshaw, Aldacira M.; Dirección de Investigaciones Epidemiológicas y Psicosociales and Universidad Autónoma Metropolitana, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, México D.F., México,; guibor@imp.edu.mxItem Síntomas neuropsiquiátricos en adultos mayores con demencia y su relación con la severidad de la enfermed(Instituto Nacional de la Nutrición "Salvador Zubirán", 2012) Acosta-Castillo, Gilberto Isaac; Sosa, Ana Luisa; Orozco, Ricardo; Borges, Guilherme; Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez; ixhuetzca@hotmail.comLos síntomas neuropsiquiátricos constituyen la dimensión psicopatológica de la demencia; conforman un conjunto variado de síntomas, entre ellos, cambios de personalidad, trastornos conductuales y alteraciones en funciones básicas como el apetito o el sueño. Objetivo. Analizar la prevalencia de síntomas neuropsiquiátricos en pacientes mexicanos con demencia en relación con la severidad de la demencia y el nivel de estrés que generan en los cuidadores, así como analizar la asociación de los síntomas entre sí. Material y métodos. Estudio transversal de base poblacional basado en una muestra comunitaria de 2,003 adultos mayores residentes en áreas de ingreso económico medio o bajo; se analizaron 180 casos identificados con diagnóstico de demencia. Resultados. Se evaluaron doce síntomas neuropsiquiátricos incluidos en el Inventario Neuropsiquiátrico, los más frecuentes son depresión (47.8%), trastornos del sueño (37.2%) e irritabilidad (34.4%). Se encontró una asociación entre la severidad de la demencia y la frecuencia de los delirios, alucinaciones, agitación, depresión, euforia, apatía, desinhibición, irritabilidad y la conducta motora aberrante. La ansiedad, la depresión y los trastornos del sueño se relacionaron con nivel de estrés leve/moderado en los cuidadores. Se identificaron tres factores de agrupación mediante el análisis de componentes principales; el primero formado por delirios, desinhibición y la euforia; el segundo factor, por los trastornos de apetito y la apatía; el tercer factor incluyó la ansiedad y la conducta motora aberrante. Conclusiones. Tal como sucede con muestras de otros países, los síntomas neuropsiquiátricos son frecuentes en adultos mayores mexicanos con demencia en población no institucionalizada, pueden ser auxiliares como indicadores de la severidad de la demencia y su agrupación se relaciona con alteraciones conductuales, síntomas vegetativos y apatía, y sintomatología ansiosa.Item Traumatic life events and posttraumatic stress disorder among Mexican adolescents: results from a survey(Dirección General de Evaluación del Desempeño, Secretaría de Salud. Reforma 450, piso 12.col. Juárez. 06600 México DF, México., 2008) Orozco, Ricardo; Borges, Guilherme; Benjet, Corina; Medina-Mora, María Elena; López-Carrillo, Lizbeth; Secretaría de Salud. Dirección General de Evaluación del Desempeño. Reforma 450, piso 12, col. Juárez, 06600 México DF, México.; rorozcoz@salud.gob.mx, ric_oz@imp.edu.mxObjetivo. Estimar la prevalencia y la asociación entre los Eventos Traumáticos (ET) y Trastorno de Estrés Postraumático (TEPT) en la población adolescente del Área Metropolitana de la Ciudad de México (AMCM). Material y métodos. 3 005 adolescentes del AMCM entre 12 y 17 años fueron entrevistados empleando la versión para adolescentes de la Entrevista Diagnóstica Internacional de Salud Mental, en una muestra probabilística, estratificada y multietápica. Resultados. 68.9% de los adolescentes en el AMCM reportaron por lo menos un ET alguna vez en su vida, con diferencias por sexo. La prevalencia de TEPT fue 1.8% (2.4% mujeres y 1.2% hombres), y el abuso sexual se asoció al desarrollo de TEPT [OR=3.9(CI95%=1.8-8.2)], independientemente del sexo, educación o edad. Conclusiones. La exposición a ET es común en los adolescentes. Se debe poner énfasis en los esfuerzos que buscan reducir el abuso sexual en la infancia y la adolescencia, ya que se asocia fuertemente al TEPT.Item Suicide ideation, plan, and attempt in the Mexican Adolescent Mental Health Survey(ELSEVIER SCIENCE BV, PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS, 2008) Borges, Guilherme; Benjet, Corina; Medina-Mora, María Elena; Orozco, Ricardo; Nock, Matthew; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mxNo representative data among adolescents in Mexico exist on the prevalence and risk factors for suicide ideation, plan, and attempt despite a recent increase in suicide deaths. Method: Data are presented from the Mexican Adolescent Mental Health Survey, a representative household survey of 3,005 adolescents ages 12 to 17 in metropolitan Mexico City who were gathered in 2005, regarding lifetime prevalence and age-of-onset distributions of suicide ideation, plan, and attempt and demographic and psychiatric disorders risk factors. Results: Lifetime ideation was reported by 11.5% of respondents, whereas 3.9% reported a lifetime plan and 3.1% a lifetime suicide attempt. Onset of suicidality started around age 10 and at age 15 showed the highest hazards. Suicide ideators were more likely to report a plan and attemptwithin the first year of onset of ideation. Suicidality was more likely to occur among females. The presence of one or more mental disorders was strongly related to suicide ideation, plan, and attempt. Among ideators only dysthymia was consistently related to a plan and attempt. Conclusions: Intervention efforts should focus on assessment and target adolescents with mental disorders, particularly mood disorders, to be effective in prevention.Item Co-occurrence of alcohol, drug use, dsm-5 alcohol use disorder and symptoms of drug use disorder on both sides of the U.S.-Mexico border(Wiley-Blackwell, 2015) Borges, Guilherme; Zemore, Sarah; Orozco, Ricardo; Cherpitel, Cheryl J.; Ye, Yu; Bond, Jason; Carlisle Maxwell, Jane; Wallisch, Lynn; Dirección de Investigaciones Epidemiológicas y Psicosociales and Universidad Autónoma Metropolitana, Instituto Nacional de Psiquiatría Ramón de la Fuente (Mexico City, CP 14370, Mexico); guibor@imp.edu.mxItem A Cross-National Study on Mexico-US Migration, Substance Use and Substance Use Disorders(2011) Borges, Guilherme; Breslau, Joshua; Orozco, Ricardo; Tancredi, Daniel J.; Anderson, Heather; Aguilar-Gaxiola, Sergio; Medina Mora, Maria-Elena; National Institute of Psychiatry, Calzada México Xochimilco No 101- Col. San Lorenzo Huipulco, México D.F., C.P. 14370, Mexico City, Mexico; guibor@imp.edu.mx