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1.  Factors associated with help-seeking behaviors in Mexican elderly individuals with depressive symptoms: a cross-sectional study 
International journal of geriatric psychiatry  2013;28(12):10.1002/gps.3953.
Objective
Depression in the elderly is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help seeking process, which usually starts with the feeling “that something is wrong” and ends with appropriate medical care, is influenced by several factors.
The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms.
Methods
A cross-sectional study of 60-year or older of community dwelling elderly belonging to the largest health and social security system in Mexico was done. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition and specialized mental health.
Results
A total of 2,322 individuals were studied; from these, 67.14% (n=1,559) were women, and the mean age was 73.18 years (SD=7.02) 57.9% had symptoms of depression, 337 (25.1%) participants sought help, and 271 (80.4%) received help and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ2=81.66, p<0.0001), significant variables were female gender (OR=0.07 95% CI 0.511–0.958 p=0.026), health care use (OR 3.26 CI 95% 1.64–6.488, p=0.001). Number of years in school, difficulty in activities, SAST score and depression as a disease belief were also significant.
Conclusions
Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of elderly with depressive symptoms.
doi:10.1002/gps.3953
PMCID: PMC3797168  PMID: 23585359
Mental health services; late life depressive symptoms; help-seeking; late life depression care
2.  Late-life Depressive Symptoms: Prediction Models of Change 
Journal of affective disorders  2013;150(3):886-894.
Background
Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms.
Methods
Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item Geriatric Depression Scale, and a score of 11 was used as cutoff point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms.
Results
7,882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR .971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR .581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations.
Conclusions
New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms.
Limitations
The study has not included clinical evaluations and nutritional assessments
doi:10.1016/j.jad.2013.05.007
PMCID: PMC3759587  PMID: 23731940
late-life depression; depression trajectories; depressive symptoms; geriatric syndromes; geriatric depression scale
3.  Race/ethnicity and sex differences in progression from drinking initiation to the development of alcohol dependence 
Drug and alcohol dependence  2011;118(2-3):375-382.
Background
Prior studies on the course of alcohol use disorders have reported a “telescoping” effect with women progressing from drinking initiation to alcohol dependence faster than men. However, there is a paucity of population-based analyses that have examined progression to alcohol dependence comparing race/ethnicity subgroups, and little is known about whether the telescoping effect for women varies by race/ethnicity. We examined whether a telescoping effect is present in the general population comparing race/ethnicity subgroups and comparing men and women stratified by race.
Methods
This study uses data from Wave I of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to compare a nationally representative sample of White, Black and Hispanic adults 18–44 years of age (n = 21,106). Time to event analyses compare the risk of alcohol initiation, onset of alcohol dependence, and the transition from initial use to onset of alcohol dependence in the three race/ethnicity groups and for males and females in each race/ethnicity group.
Results
Whites were younger than Blacks and Hispanics of the same sex at drinking onset and progressed to alcohol dependence at a faster rate than both Blacks and Hispanics. In addition, we found no evidence of a telescoping effect in women for any race/ethnicity group.
Conclusions
The present study illustrates differences in the course of transition from alcohol initiation to the development of dependence by race/ethnicity but not sex. Our findings highlight the need for additional study of factors resulting in race/ethnicity differences in order to inform culturally relevant prevention and intervention initiatives.
doi:10.1016/j.drugalcdep.2011.04.024
PMCID: PMC3190032  PMID: 21652154
4.  Depressed mood and the effect of two universal first grade preventive interventions on survival to the first tobacco cigarette smoked among urban youth 
Drug and alcohol dependence  2008;100(3):194-203.
Introduction
As part of an evaluation of two first-grade, universal preventive interventions whose proximal targets were early learning and behavior, we investigated the influence of depressed mood, the interventions, and their interaction on survival to the first tobacco cigarette smoked through age 19. One intervention focused on improving teacher behavior management and instructional skills (Classroom-Centered, CC) as a means of improving student behavior and learning and the other on the family–school partnership (FSP). Variation in the relationship between depressed mood and first cigarette smoked by gender and grade was also examined.
Methods
Self-reports of smoking behavior and depressed mood were collected on an annual basis from grade 6 through age 19. The present analyses were restricted to the 563 youth who had never smoked by grade 6, or 83% of the original sample of first grade participants. Discrete-time survival analysis was used to examine the effects of depressed mood and the interventions on survival to the first tobacco cigarette smoked.
Results
Depressed mood was associated with reduced survival time to the first cigarette smoked (adjusted hazard ratio, aHR: 1.4; 95% CI: 1.1–1.9), whereas the CC intervention prolonged survival time (aHR: 0.8; 95% CI: 0.7–0.9). No significant variation in the effect of depressed mood on survival was found by gender or grade, nor was the effect of the CC intervention moderated by depressed mood.
Conclusions
Strategies to prevent tobacco cigarette smoking should include both a focus on depressed mood in adolescence as well as on early success in elementary school.
doi:10.1016/j.drugalcdep.2008.08.020
PMCID: PMC3425943  PMID: 19059736
Tobacco smoking; Depressive symptoms; Gender; Intervention studies; Adolescent
5.  Childhood predictors of first chance to use and use of cannabis by young adulthood 
Drug and alcohol dependence  2011;117(1):7-15.
Aims
To prospectively examine the linkage between childhood antecedents and progression to early cannabis involvement as manifest in first chance to try it and then first onset of cannabis use.
Methods
Two consecutive cohorts of children entering first grade of a public school system of a large mid-Atlantic city in the mid 1980s (n=2311) were assessed (mean age 6.5 years) and then followed into young adulthood (15 years later, mean age 21) when first chance to try and first use were assessed for 75% (n=1698) of the original sample. Assessments obtained at school included standardized readiness scores (reading; math) and teacher ratings of behavioral problems. Regression and time to event models included covariates for sex, race, and family disadvantage.
Results
Early classroom misconduct, better reading readiness, and better math readiness predicted either occurrence or timing of first chance to try cannabis, first use, or both. Higher levels of childhood concentration problems and lower social connectedness were not predictive.
Conclusions
Childhood school readiness and behavioral problems may influence the risk for cannabis smoking indirectly via an increased likelihood of first chance to use. Prevention efforts that seek to shield youths from having a chance to try cannabis might benefit from attention to early predictive behavioral and school readiness characteristics. When a youth’s chance to try cannabis is discovered, there are new windows of opportunity for prevention and intervention.
doi:10.1016/j.drugalcdep.2010.12.023
PMCID: PMC3128694  PMID: 21288658
marijuana abuse/epidemiology; sex factors; child behavior; academic readiness
6.  Depressive Symptoms Among Older Adults in Mexico City 
Journal of General Internal Medicine  2008;23(12):1973-1980.
ABSTRACT
BACKGROUND
Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries.
OBJECTIVE
To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider.
DESIGN
Cross-sectional, multistage community survey.
PARTICIPANTS
A total of 7,449 persons aged 60 years and older.
MEASUREMENTS
Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire.
MAIN RESULTS
The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = −20.2, 95% CI = −21.3, −19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2).
CONCLUSIONS
According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.
doi:10.1007/s11606-008-0799-2
PMCID: PMC2596501  PMID: 18818976
aged; depression; comorbidity; primary healthcare
7.  MAPSAR Image Simulation Based on L-band Polarimetric Data from the SAR-R99B Airborne Sensor (SIVAM System) 
Sensors (Basel, Switzerland)  2009;9(1):102-117.
This paper describes the methodology applied to generate simulated multipolarized L-band SAR images of the MAPSAR (Multi-Application Purpose SAR) satellite from the airborne SAR R99B sensor (SIVAM System). MAPSAR is a feasibility study conducted by INPE (National Institute for Space Research) and DLR (German Aerospace Center) targeting a satellite L-band SAR innovative mission for assessment, management and monitoring of natural resources. Examples of simulated products and their applications are briefly discussed.
doi:10.3390/s90100102
PMCID: PMC3280736  PMID: 22389590
SAR; MAPSAR simulation; SIVAM system; L-band radar; Amazon Region
8.  Examining racial and ethnic disparities in site of usual source of care. 
Little is known about why minorities have a lower propensity to use private doctors' offices for their usual source of care than non-Hispanic whites. This study used the 2001 Commonwealth Fund's Health Care Quality Survey of adults to determine if this disparity is due to racial and ethnic differences in attitudes about health and healthcare, and perceptions of racial and ethnic discrimination in healthcare. We found that race and ethnic disparities at the site of the usual source of care persisted even after controlling for individuals' attitudes about health and healthcare, and their perceptions about racial and ethnic discrimination in healthcare. We found that the impact of attitudes and perceptions did vary by subgroups. These factors were important for Asians' site of usual source of care but had little impact on African Americans' site of usual of care. However, despite their differential impact by race and ethnicity, attitudes and perceptions were not the source of observed disparities in site of care. Therefore, in addition to focusing on provider-patient relationships, perhaps future research and policymakers should focus on system-level factors to explain and increase minority use of care in private physicians' offices.
PMCID: PMC2569590  PMID: 17304965

Results 1-8 (8)