Emotional distress is the subjective sensation of diminishment in well-being which manifests itself in a number of unspecific symptoms. It might be a risk factor for the development of mental illness, especially among individuals with psychosocial or biological vulnerability. Recent studies show that primary health care services receive a growing number of patients who suffer distress, but do not fulfill the diagnostic criteria of a mental or physical illness. This phenomenon is more frequent among women. The objective of this paper is to analyze the emotional distress experienced by a group of women who attended primary health care institutions in Mexico City, as well as their perceptions and experiences around the attention received, in order to identify their treatment needs. Data was gathered through techniques and instruments pertaining qualitative methodology. The information was coded and analyzed according to the meaning categorization method developed by Kvale. The results show that the main triggers of emotional distress are associated to daily life worries (lack of money, problems with children, domestic violence, among others). In some cases, it is associated as well with traumatic events, such as violence and sexual abuse in the past or at present. Data also suggest that women do not talk about emotional distress directly during medical consultations and that health care professionals do not identify distress or minimize its importance. These aspects are related to the current characteristics of the service, which lacks a comprehensive approach and a psychosocial point of view.

La presencia de malestar emocional -que se define como el conjunto de sensaciones subjetivas que percibe una persona de que su bienestar sufre una merma y que se manifiesta por síntomas inespecíficos- puede constituir un factor de riesgo para la aparición de enfermedades mentales, sobre todo en personas con vulnerabilidades biológicas y psicosociales. Estudios recientes señalan que los servicios de atención primaria reciben un número, cada vez mayor, de personas con malestares que no cubren los criterios diagnósticos de una enfermedad, ya sea mental o física, fenómeno que es más frecuente en las mujeres. El objetivo de este trabajo es analizar los malestares emocionales de un grupo de mujeres que acude a instituciones de atención primaria de la Ciudad de México, así como sus percepciones y vivencias sobre la atención recibida, con el propósito de identificar necesidades de atención. Para recopilar la información se utilizaron técnicas e instrumentos propios de la metodología cualitativa. La información se codificó y analizó conforme al método de "categorización de significados" propuesto por Kvale. Los resultados mostraron que los principales detonantes de los malestares emocionales en las participantes se asocian con las preocupaciones que enfrentan cotidianamente (como falta de dinero, problemas con los hijos y violencia intrafamiliar) y, en otros casos, con la vivencia de experiencias traumáticas de violencia y abuso sexual, pasadas y presentes. Los datos demuestran también que las mujeres no hablan directamente de su malestar emocional, pero que tampoco lo detecta el personal de salud o que, cuando lo hace, le resta importancia. Lo anterior se relaciona con las condiciones actuales del servicio, que no ofrece una atención integral y adolece de una visión psicosocial.

OBJECTIVE: Evaluate some of the key indicators that characterize the Mexican mental health system using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). METHODS: The strategy for examining the WHO-AIMS indicators included: (i) a review of documentary sources; (ii) application of the questionnaire; and (iii) group work with a team of experts using the consensus technique. To facilitate collection of the data, a questionnaire was prepared in which the indicators were turned into simple questions. The people gathering the data were trained, and the activity was monitored. RESULTS: It was found that, of the total budget for health, only 2% is allocated for mental health, and, of that share, 80% is used in the operation of psychiatric hospitals. The pivotal point for mental health care is in the psychiatric hospital; there are very few psychiatric units in the general hospitals, few residential establishments, and few services targeted specifically to care for children and adolescents. Access is limited because of the centralized health care system, with the majority of establishments located in the large cities. Only 30% of primary care services have protocols for the evaluation and treatment of mental disorders. Finally, in the mental health facilities, the ratios of psychiatrists, other physicians, nurses, and psychologists per 100 000 population are 1.6, 1.3, 3.4, and 1.5, respectively. CONCLUSIONS: More funding will be needed in order to bridge the gap between the mental health burden and the budget allocated for its care, and resources will need to be used more rationally, with the first level of care becoming the pivot. In addition, it will be necessary to increase the number of specialists, offer periodic in-service training for personnel at the first level of care, and enlist greater participation by the rest of society.

OBJETIVO: Evaluar algunos indicadores clave del sistema de salud mental mexicano utilizando el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (IESM-OMS). MÉTODOS: La estrategia utilizada para responder a los indicadores del IESM-OMS incluyó: i) Revisión de fuentes documentales, ii) Aplicación de cuestionarios y iii) Trabajo grupal utilizando la técnica de consenso con expertos. Para facilitar la recopilación de la información, se elaboró un cuestionario donde los indicadores fueron transformados en preguntas sencillas. Asimismo, se capacitó a las personas encargadas de recabar los datos y se realizó un seguimiento de dicha actividad. RESULTADOS: Del total del presupuesto asignado a la salud, solo 2% estaba destinado a la salud mental y, de ese porcentaje, 80% se empleaba para el funcionamiento de los hospitales psiquiátricos. El eje de la atención de la salud mental se encontraba en el hospital psiquiátrico y existían muy pocas unidades de hospitalización psiquiátrica en los hospitales generales y establecimientos residenciales, así como servicios específicos para niños y adolescentes. El acceso estaba limitado por la centralización del sistema de atención, ya que la mayoría de los establecimientos se ubicaban en las grandes ciudades. Solamente 30% de los servicios de atención primaria contaban con protocolos de evaluación y tratamiento para trastornos mentales. Finalmente, en los establecimientos de salud mental, la tasa de psiquiatras, médicos, enfermeros y psicólogos por cada 100 000 habitantes registró valores de 1,6, 1,3, 3,4 y 1,5 respectivamente. CONCLUSIONES: Para reducir la brecha entre la carga que representan los trastornos mentales y el presupuesto asignado para su atención, se requiere de un mayor financiamiento y una utilización de los recursos más racional, considerando al primer nivel como el eje de la atención. Asimismo, será necesario ampliar el número de especialistas, capacitar periódicamente al personal en los primeros niveles de atención e incrementar la participación del resto de la sociedad.

Abstract: Introduction: Currently, there are a number of methodological alternatives to find out the dynamics, the extension and the levels of drug use in the general population. The trends on drug use in our country llave registered important variations in the last 25 years. Among the most outstanding of these trends are: the high and stable use of marijuana, the increase in cocaine use and a decrease in the use of inhalants. Recently an increase in the use of these stimulants has been registered. The different studies show that these trends present some variations, since different group populations with different characteristics have been studied. This is the case of the data obtained by the Drug Information Reporting System -IRSD-which detects users with specific characteristics (regular drug users and advanced cases of addiction). Based on the facts mentioned above, the intention of this article is to present the main trends on drug use in Mexico City within the period between 1986 and 2003, according to the drug Information reporting System -DIRS- and to analyze these trends compared to other studies with different types of population. Background: The Information Reporting System on Drugs IRSD is a mechanism used to obtain data coming from diverse agencies that are related to the problem of the use of drugs; such agencies belong to the health sector or to the agencies of law enforcement. The main advantages of this type of systems are a low cost of operation -since it works with the infrastructure of the institutions that mainly conform the system- its easy application and that it provides current and fast information on the phenomenon. The continuous operation of the IRSD allows the accumulation of data with a sequence which makes possible the analysis of the trends on drug use, the identification of new groups at high risk and new drugs in the market. It also allows to identify the design of the preventive actions derived from the continuous analysis of information coming from its data bases. Mexico City has its own Drug Information Reporting System -IRSD- since 1986 coordinated by the National Institute of Psychiatry Ramon de la Fuente. Its objective is to count on a periodic and homogenous source of information which can be used as a diagnosis tool to design suitable programs of prevention appropriate to the Mexican population from a health perspective. The IRSD carries out semester evaluations of the phenomenon and has done now a total of 34. Method: Sample description: IRSD information between 1986 and June 2003 was used. This data base is conformed by 16,377 studied cases. It is a considered as «case» any person who recognizes to have consumed at least once in life some drug with the deliberate purpose of being intoxicated. The cases are also excluded from accidental or occupational exhibition and when only alcohol and tobacco have been consumed. Instrument: The Information is obtained from an individual scale applied twice a year, in health and justice agencies. This schedule collects information on the following aspects: socio-demographic profiles of the users, the reason for entering the institution, problems associated with the drug use and patterns of consumption of 12 drugs. For this article, only the information corresponding to the pattern of consumption was used to identify the trends. The analysis includes the information compiled by the IRSD during the period of 1986 and the first semester of 2003. Procedure: The instrument is applied twice a year, in periods of 30 days, during the months of June and November to any one who uses drugs and has entered the health and justice agencies for such reason. Once the period of information gathering is over, the applied instruments are sent by all the participant institutions to the National Institute of Psychiatry for their processing and analysis. Finally, the results are reintegrated into a report which is distributed among the participant institutions and people interested in this problem. Results: The analysis of the trends on drug use observed by the IRSD during the period 1986-2003 shows the following: Marijuana and inhalants reach the level of higher consumption for all drugs until the second semester of 1997. In the following years there is a decrease for these substances, particularly for inhalants. The trend of cocaine use shows significant changes. The first important increase in the levels of use was observed between the years of 1993 and 1997. At the end of this period the use of cocaine was reported by every 40 of 100 users. The following year this proportion went up to 63, which represents an increase of more than 50 per cent. From this year and up to date the trend shows a stable behavior with similar levels of use. In regard to hallucinogens low levels of consumption have been observed, during the 15 years of evaluation by the IRSD. Approximately five of 100 cases report their use by semester. Sedatives and tranquilizers show the highest increase during the first semester of 1993, with 28 users for every 100 cases; since then a decrease in consumption has been observed. The consumption of stimulants has presented a very irregular trend through the evaluations. For heroin use a very low percentage of consumption is observed with one out of every 100 cases. There was a slight increase only in two evaluations during the first semester of 1992 and 1993. Conclusions: The most outstanding results regarding the tendencies of consumption of addictive substances is the increase of cocaine use at the beginning of the nineties and has always showed a tendency do increase. In the last evaluation certain stability in its consumption, is observed, at least in the last two years. It is important to emphasize that the increase in the consumption of cocaine may probably be associated to its availability in Mexico as well as that for its derivatives. Equally significant within this period of evaluation is the decrease of inhalant consumption, specially during 1999. Some studies show a possible substitution of these substances by cocaine and or its derivatives. The trends of drug use provided by the IRSD must be interpreted taking into account that the drug user population included in the evaluations belongs to a sector that does not represent the whole universe of users in the general population. However the trends of drug use reported by the IRSD are in agreement with those reported by the surveys in general and school population, where marijuana, cocaine and inhalants were reported as the drugs of greater use among the Mexican population. It is important to note that when the lack of financial and or human resources become real obstacles to carry out sophisticated, extensive periodic studies to evaluate drug use, a system of this type is a valuable alternative for the developing countries.

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In the last 20 years, research on the determinants of the HIV epidemic among drug users has focused mainly on studies of risk behaviour for drug injection. Studies involving human behaviour present special methodological problems. This paper presents a review of 1) the most important features that make this field different from the study of blood-borne diseases in other populations, and 2) the basic variables used in epidemiology to analyse injecting risk behaviour. Alternatives to improve research planning and results are proposed based on collaborating with other disciplines and improving the methodological resources of epidemiology.

El estudio de las conductas de riesgo de inyección de drogas ha sido uno de los ejes en los que se ha centrado la investigación de los determinantes de la epidemia de infección por VIH en los últimos 20 años. El estudio de estas conductas presenta dificultades metodológicas especiales. Se revisan: 1) los aspectos más relevantes que hacen de ésta un área de trabajo diferenciada del estudio de las enfermedades de transmisión sanguínea en otras poblaciones y 2) las variables básicas utilizadas por la epidemiología para operativizar los comportamientos de riesgo de inyección. Se proponen alternativas para enriquecer los planteamientos y los resultados de investigación en este área mediante la colaboración con otras disciplinas y la optimización de los recursos metodológicos de la epidemiología.

In the last 20 years, research on the determinants of the HIV epidemic among drug users has focused mainly on studies of risk behaviour for drug injection. Studies involving human behaviour present special methodological problems. This paper presents a review of 1) the most important features that make this field different from the study of blood-borne diseases in other populations, and 2) the basic variables used in epidemiology to analyse injecting risk behaviour. Alternatives to improve research planning and results are proposed based on collaborating with other disciplines and improving the methodological resources of epidemiology.

El estudio de las conductas de riesgo de inyección de drogas ha sido uno de los ejes en los que se ha centrado la investigación de los determinantes de la epidemia de infección por VIH en los últimos 20 años. El estudio de estas conductas presenta dificultades metodológicas especiales. Se revisan: 1) los aspectos más relevantes que hacen de ésta un área de trabajo diferenciada del estudio de las enfermedades de transmisión sanguínea en otras poblaciones y 2) las variables básicas utilizadas por la epidemiología para operativizar los comportamientos de riesgo de inyección. Se proponen alternativas para enriquecer los planteamientos y los resultados de investigación en este área mediante la colaboración con otras disciplinas y la optimización de los recursos metodológicos de la epidemiología.

The aim of this work is to inform of the usefulness of the Drug Information Registry System as an important diagnostic source to evaluate pharmacodependence in Mexico City. A short description of the methodological frame of the system is included, some results are presented synthetically and the importance of these data as supporting material to define research and preventive program policies is discussed. The advantages of these systems are commented, especially in countries, such as Mexico, where notification of drug use is not obligatory.

El presente trabajo tiene como objetivo dar a conocer la utilidad del Sistema de Registro de Información sobre Drogas como fuente diagnóstica importante para la evaluación del fenómeno de la farmacodependencia en la Ciudad de México. Incluye una breve descripción del soporte metodológico de este sistema, se presentan de manera sintetizada algunos de sus resultados y se discute la importancia de sus datos como material de apoyo para el establecimiento de políticas en materia de investigación y prevención del problema. Se comentan las ventajas de contar con un sistema de este tipo sobre todo porque en nuestro país no existe un sistema de notificación obligatoria de uso de drogas.