Described as the ‘invisible epidemic’, non-communicable diseases (NCDs) are the world’s leading cause of death. Most are caused by preventable factors, including poor diet, tobacco use, harmful use of alcohol and physical inactivity. Diabetes, cancer and cardiovascular and chronic lung diseases were responsible for 38 million (68%) of global deaths in 2012. Since 1990, proportionate NCD mortality has increased substantially as populations have aged and communicable diseases decline. The majority of NCD deaths, especially premature NCD deaths (<70 years, 82%), occur in low-income and middle-income countries, and among poor communities within them. Addressing NCDs is recognised as central to the post-2015 agenda; accordingly, NCDs have a specific objective and target in the Sustainable Development Goals. While deaths from NCDs occur mainly in adulthood, many have their origins in early life, including through epigenetic mechanisms operating before conception. Good nutrition before conception and interventions aimed at preventing NCDs during the first 1000 days (from conception to age 2 years), childhood and adolescence may be more cost-effective than managing established NCDs in later life with costly tests and drugs. Following a life-course approach, maternal and child health interventions, before delivery and during childhood and adolescence, can prevent NCDs and should influence global health and socioeconomic development. This paper describes how such an approach may be pursued, including through the engagement of non-health sectors. It also emphasises evaluating and documenting related initiatives to underwrite systematic and evidence-based cross-sectoral engagement on NCD prevention in the future.
Objective: Several studies have shown evidence of executive function impairment associated with substance abuse. This suggests the potential usefulness of a baseline assessment measure to screen for dysexecutive impairments in individuals beginning treatment. The Dysexecutive Questionnaire (DEX) is a test widely used to estimate executive dysfunction. The main objective of this work is to study the psychometric properties of the Spanish version of the Dysexecutive Questionnaire (DEX-Sp). A complementary goal is to study its potential utility for initial screening in addicted individuals seeking treatment. Method: A sample of 131 non-clinical and 127 clinical individuals meeting the DSM-IV-TR substance abuse or dependence criteria were recruited. Results: Internal consistency of the questionnaire was assessed (Cronbach's α =0.91), as well as other reliability indicators. Exploratory and confirmatory factor analysis offers four-and five-factor solutions. Also tested were the dimensionality and structural model and its convergent and discriminant validity with other instruments. Differences between clinical and non-clinical individuals and total scores were also analyzed. Conclusions: The data suggest that the Spanish version of the DEX is a useful measure for assessing general symptoms of dysexecutive syndrome, and a valid, reliable and adequate screening test for estimating cognitive impairment associated with substance abuse.Key words: Executive functions, dysexecutive syndrome, frontal lobe, addictive behaviour, questionnaires, psychometrics, factor analysis, treatment. RESUMEN ABSTRACTObjetivo: Diversos estudios han evidenciado el deterioro de las funciones ejecutivas asociado al abuso de sustancias. Este hecho sugiere la conveniencia de contar con algún instrumento de cribado que sirva para establecer una línea base sobre los déficits que presentan los sujetos que inician tratamiento. El Cuestionario Disejecutivo (DEX) es un test ampliamente utilizado para estimar disfunción ejecutiva. El principal objetivo del presente trabajo se centra en estudiar las propiedades de la versión española del Cuestionario Disejecutivo (DEX-Sp). Complementariamente se pretende estudiar su potencial utilidad como instrumento de cribado en adictos en tratamiento. Método: 131 sujetos de población no clínica y 127 adictos (con criterios DSM-IV-TR para abuso o dependencia). Resultados: Se estudia la consistencia interna (α de Cronbach = 0,91) entre otros indicadores de fiabilidad. El análisis factorial exploratorio y confirmatorio ofrece soluciones de 4 y 5 factores. Se estudió la dimensionalidad y el modelo estructural de base, así como la validez convergente y discriminante. Se estudiaron las diferencias apreciadas entre adictos y población no clínica. Conclusiones: Los datos sugieren que la versión española del DEX es un instrumento útil para evaluar síntomas disejecutivos generales, con la suficiente fiabilidad y validez para explorar deterioro cognitivo asociado al abuso de sustancias.
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