María del Carmen Gogeascoechea-Trejo

Introduction: dual diagnosis (DD), defined as the co-occurrence of substance use disorders and other mental disorders, represents a significant clinical and public health challenge due to its impact on quality of life and treatment outcomes. Although this phenomenon has been widely documented, limited attention has been paid to the specific role of stimulant use and the developmental stage of adolescence in shaping its clinical presentation. Objective: this study explored differences in sociodemographic characteristics, patterns of stimulant use, and psychopathological behaviors among individuals aged 13 to 25 with a stimulant use disorder—categorized as having either dual diagnosis or a single diagnosis. Method: a cross-sectional study was conducted based on a retrospective review of clinical records (n = 125) from a therapeutic community (TC) in Mexico. Results: eighty-six of 125 residents (68.8%) met the study’s operational definition of dual diagnosis, and methamphetamine was the most frequently recorded primary substance. The most frequently identified mental disorders were depressive disorders, neurodevelopmental disorders, schizophrenia spectrum and other psychotic disorders, and anxiety disorders. Differences were also observed between residents with SD and DD in the documentation of psychopathological behaviors, particularly impulsivity, self-harming behaviors, and suicidal behaviors. Discussion and conclusions: these findings underscore the importance of accurately characterizing DD in clinical settings. They highlight the importance of developing comprehensive intervention strategies that address the structural complexity of dual diagnosis, while also accounting for the neurodevelopmental specificity of adolescence.

Drug use, mental health, and gender identity are complex phenomena influenced by multiple social, psychological, and cultural factors. Previous research indicates that the university stage represents a period of vulnerability for mental health, especially among students whose gender identity differs from the traditional categories of man or woman. This study aimed to examine the association between gender identity, drug use, and symptoms of anxiety and depression among students at a public university in Mexico. A cross-sectional correlational study was conducted through a public invitation survey among undergraduate students enrolled in a public university in Mexico. Data were collected using the Drug Use Questionnaire for University Students administered through the LimeSurvey platform. Variables included sociodemographic characteristics, gender identity (man, woman, and other identity), drug use, and symptoms of anxiety and depression. The results indicate that students who identified with another gender identity showed a higher likelihood of using the substances analyzed compared with those who identified as women, particularly prescription drugs and marijuana. Additionally, they presented higher odds of reporting anxiety and depressive symptoms compared with those who identified as men. These findings highlight the need for targeted prevention and support strategies to improve mental health among students with diverse gender identities.

Health infrastructure is a critical component for the functioning of any health system, as it determines both the quality of care and equitable access to services. In Mexico, these conditions are non-uniform; while urban areas concentrate highly specialized hospitals, rural communities continue to face shortages that restrict access to basic care. This article presents a narrative review that integrates conceptual models such as Donabedian’s model, the social determinants of health, and health system resilience to analyze how infrastructure inequalities impact equity. It also examines international experiences, including the expansion of Brazil’s Unified Health System (SUS) and the use of telemedicine in Canada, which provide valuable insights for the Mexican context. The main contribution of this study lies in linking these global references to national realities and in proposing specific strategies, such as needs-based planning and the construction of resilient infrastructure, as potential pathways to reduce long-standing gaps in access to health care.

Background: While mobile health (mHealth) interventions show promise for type 2 diabetes management, mechanisms linking user experience to clinical outcomes remain poorly understood. We hypothesized that perceived usability may mediate associations between patient characteristics and short-term clinical changes, with implications for health equity in digital interventions. Methods: Secondary analysis of the intervention arm from a randomized controlled trial in urban Mexican primary care (ClinicalTrials.gov NCT05924516). Participants used a diabetes self-management mobile application for 90 days. We assessed usability with the validated Computer System Usability Questionnaire (CSUQ; 16 items, 7-point scale) and measured clinical changes in body mass index (BMI), systolic blood pressure (SBP), and HbA1c. Bayesian mediation analysis (literature-informed priors) examined interface quality as a mediator of age-related clinical effects. Item-level analysis identified educational disparities in specific usability dimensions using independent t-tests adjusted for multiple comparisons. Results: Mean overall usability was 5.20/7 (SD = 0.89, 74th percentile). Interface quality mediated 39% of the age–SBP association. Participants experiencing high usability (≥6) versus low usability showed BMI reduction −0.78 vs. −0.21 kg/m² (Cohen’s d = 0.56) and SBP reduction −7.3 vs. −1.2 mmHg (Cohen’s d = 0.51). No mediation effect was observed for HbA1c change. Users with ≤primary education (41% of sample) scored 1.9 points lower on error messages (3.2 vs. 5.1, p < 0.01) and 1.4 points lower on help documentation (3.6 vs. 5.0, p < 0.03). These disparities persisted after controlling for age and baseline severity. Conclusions: Perceived usability was associated with a potential mechanistic pathway linking user experience to clinical outcomes. Higher usability scores were associated with clinically meaningful improvements in cardiometabolic parameters. Educational disparities in understanding error messages and helping documentation represent modifiable design barriers. Implementing contextual error explanations with visual examples and plain-language help content may enhance both clinical effectiveness and equity in digital diabetes interventions.

Adolescent tobacco use remains a critical public health challenge, requiring innovative early prevention strategies. This study participatively evaluated a medium-fidelity prototype of the No le entres app, designed to prevent tobacco use among adolescents. The prototype was developed based on user-centered design and gamification frameworks, with the aim of ensuring cultural relevance and active user engagement. Qualitative design with content analysis was employed. Four focus groups were conducted in Xalapa, Veracruz: two with health professionals from Medical Specialty Units—Community Mental Health and Addiction Centers (UNEME CECOSAMA), and two with secondary school students. Nineteen professionals and twenty-two adolescents participated. Data were analyzed using MAXQDA 2022, applying both a priori and emergent categories. Professionals valued the app’s innovative approach but recommended improvements in navigation speed, visual design, message clarity, and cultural validation. Adolescents emphasized the need for more engaging features, such as music, rewards, team competitions, and updated graphics. Both groups highlighted the importance of interactivity, personalization, and contextualized content. Findings underscore the value of participatory methods in designing digital health interventions and confirm that involving end users enhances usability and acceptability. The app demonstrates potential for integration into school settings as a preventive tool, with implications for influencing adolescent knowledge, attitudes, and behaviors regarding tobacco use.

Background/Objective: Type 2 Diabetes Mellitus (T2DM) represents a major increasing burden for primary care systems worldwide. Digital health interventions (DHIs) have been proposed as scalable tools to improve glycemic control, yet uncertainty remains regarding which intervention characteristics yield the greatest benefit. To evaluate the effectiveness of DHIs on HbA1c levels in adults with T2DM and to examine whether intervention duration, engagement intensity, glucometer integration, and healthcare provider involvement modify glycemic outcomes. Data Sources: PubMed, Embase, Cochrane Library, and JMIR databases were systematically searched for relevant studies published between January 2020 and May 2025. Study Eligibility Criteria: Randomized controlled trials comparing DHIs plus usual care versus usual care alone in adults with T2DM and reporting HbA1c as the primary outcome. Methods: Data were extracted using the Jadad scale and TIDieR framework. Random-effects meta-analysis estimated pooled mean differences (MD) in HbA1c with 95% CIs. Subgroup analyses examined effects by intervention characteristics. Heterogeneity and sources of variance were assessed through Cochran’s Q, I², meta-regression, and sensitivity analyses (leave-one-out and trim-and-fill). Results: Thirteen RCTs (n ≈ 20,000) met inclusion criteria. DHIs achieved significant HbA1c reductions (range 0.01% to 1.57%; pooled MD −1.08%; 95% CI −1.18 to −0.99; p = 0.001). Short-term (≤6 months), low-intensity interventions showed the largest effect sizes (MD −1.16%, 95% CI 0.94 to 1.39). Glucometer integration and healthcare provider involvement contributed minimally to additional benefit. Meta-regression confirmed substantial heterogeneity, but no single factor explained variance across studies. Limitations: Considerable heterogeneity across interventions and variability in engagement measurement may limit the generalizability of findings. Conclusions: Short-term, low-intensity DHIs significantly improve glycemic control in primary care populations with T2DM. Advanced meta-analytic techniques confirm the robustness of these effects, providing practical guidance for selecting and implementing effective digital interventions in routine diabetes care.

En México, la oferta de suplementos alimenticios con fines terapéuticos o de rehabilitación no está permitida por la ley; no obstante, se observa que estos productos se publicitan para fines distintos a los permitidos legalmente, sobre todo en la Internet y por medio de agentes no regularizados. El objetivo del estudio es identificar la prevalencia de consumo de suplementos alimenticios para el control de peso y su asociación con características sociodemográficas en población adulta, así como aportar elementos de análisis de la regulación sanitaria ejercida sobre dichos productos; Materiales y métodos: Estudio transversal analítico realizado en unidades urbanas del primer nivel de atención. Se encuestó a 154 pacientes adultos diagnosticados con sobrepeso u obesidad que acudieron a consulta externa. Las variables analizadas fueron el consumo de suplementos alimenticios, edad, sexo, escolaridad, ocupación y nivel socioeconómico. En el análisis se utilizó la prueba de chi cuadrado para identificar asociación entre variables; Resultados: La prevalencia de consumo de suplementos alimenticios para el control de peso fue de 24.1%. Las variables edad y escolaridad mostraron asociación con el consumo; Conclusiones: La prevalencia encontrada resalta la necesidad de una regulación sanitaria más eficiente. La educación nutriológica y la colaboración de sociedades y gobiernos para la implementación de políticas públicas adecuadas se identifican como estrategias para la disminución en la oferta y consumo de estos productos. Palabras clave: obesidad, prevalencia, regulación sanitaria, sobrepeso, suplementos alimenticios

Introducción: La falta de continuidad del cuidado puede ocasionar omisiones o duplicaciones en las acciones dirigidas al cuidado de usuarios con Enfermedades Crónicas No Transmisibles (ECNT), generando un posible deterioro de su salud. Particularmente, en México y Colombia no existe un instrumento que evalúe la continuidad del cuidado que incluya sus tres elementos esenciales. Objetivos: Diseñar un instrumento que evalúe la continuidad del cuidado entre niveles asistenciales en usuarios con ECNT en México y Colombia; y validar el contenido del cuestionario por medio de un juicio de expertos en versiones adaptadas al contexto mexicano y colombiano. Materiales y Métodos: Se diseñó el cuestionario Continuidad del Cuidado entre Niveles Asistenciales. Se realizó el proceso de validación de contenido por expertos usando el método Delphi. Se seleccionaron 16 jueces expertos (8 por país). Los ítems del cuestionario fueron evaluados bajo cuatro categorías: suficiencia, claridad, coherencia y relevancia. Se realizaron dos rondas de evaluación para determinar el grado de concordancia entre jueces. Resultados: El cuestionario obtuvo un Coeficiente de Validez de Contenido General “Excelente” para ambos países (0,97). La versión final quedó conformada por 85 ítems divididos en tres secciones. Discusión: Este instrumento, a diferencia de otros, evalúa desde la experiencia de los usuarios con ECNT la continuidad del cuidado de forma multidisciplinaria en los tres niveles de atención. Conclusión: El cuestionario alcanzó una validez de contenido esperada usando el método Delphi, para evaluar la continuidad del cuidado entre niveles asistenciales en usuarios con ECNT según el contexto mexicano y colombiano.

Introducción. Entre los jóvenes universitarios se ha observado una tolerancia creciente hacia el consumo de drogas debido a una reducción en la percepción de riesgo, que se considera como aquellos juicios o intuiciones que se tienen sobre la peligrosidad de una situación que puede contribuir a la normalización del consumo. El objetivo fue analizar la percepción de los estudiantes sobre: consumo, venta y gravedad del consumo de drogas en su facultad; conductas de docentes y estudiantes que facilitan el consumo de alcohol y la postura de las autoridades universitarias ante estudiantes consumidores. Material y Método. Se analizó la base de datos derivada del proyecto Consumo de drogas en estudiantes universitarios, en el que participaron 19,815 estudiantes de una universidad pública mexicana; se realizaron comparaciones según sexo y área académica utilizando pruebas de chi-cuadrada y el análisis post hoc de Bonferroni. Resultados. Las mujeres reportaron una menor percepción que los hombres sobre las variables analizadas. Las áreas académicas que se distinguieron por mostrar diferencias con respecto a las otras fueron: Económico-Administrativa en el consumo de drogas ilegales dentro de las facultades y la venta de drogas legales cerca de sus facultades y Biológico-Agropecuaria en la venta cercana de drogas ilegales cerca de sus facultades y en la percepción de la gravedad del consumo de drogas legales. Conclusión. El conocimiento de la percepción de los jóvenes universitarios acerca de las variables estudiadas de acuerdo al sexo y el área académica marca la pauta para implementar estrategias específicas de intervención