Treinamento aos agentes comunitários de saúde frente à assistência aos usuários de álcool / Entrenamiento de agentes de salud con respecto a la asistencia a usuarios de alcohol / Community health agent training regarding assistance to alcohol users

Objetivo: avaliar as percepções, conhecimentos e atitudes antes e após a realização de um treinamento aos Agentes Comunitários de Saúde (ACS). Método: estudo quase experimental e quantitativo, realizado no interior do estado de São Paulo. Para a coleta de dados foi utilizado ficha de identificação sociodemográfica, Seaman & Manello e Short Alcohol and Alcohol Problems Perception Questionnaire, aplicados em 31 ACS de serviços de Atenção Primária à Saúde. O estudo foi submetido e aprovado pelo Comitê de Ética. Resultados: as percepções foram positivas, mas ainda existem dificuldades para trabalhar na prática, os conhecimentos apresentaram mudanças em relação aos sinais e sintomas relacionados ao uso de álcool e as atitudes. Não foram observadas mudanças significativas após o treinamento. Conclusão: o treinamento é uma estratégia que possibilita mudanças nas práticas de saúde para a assistência integral e que deve ser incorporada nas rotinas das unidades de Atenção Primária à Saúde (APS).

Objetivo: evaluar percepciones, conocimientos, y actitudes antes y después de un entrenamiento de Agentes Comunitarios de Salud (ACS). Método: estudio cuasiexperimental y cuantitativo, realizado en el interior del estado de São Paulo. Para colectar a los datos se utilizó un formulario de identificación sociodemográfica, el Seaman & Manello y el Short Alcohol and Alcohol Problems Perception Questionnaire, aplicados a 31 ACS en servicios de atención primaria a la salud. El estudio fue aprobado por el comité de ética. Resultados: las percepciones fueran positivas, pero hay dificultades en la práctica del trabajo. Los conocimientos cambiaron con respecto a las señales y síntomas relacionados al uso de alcohol y a las actitudes. No se observó cambios significativos después del entrenamiento. Conclusión: el entrenamiento posibilita cambios en las prácticas de salud para la asistencia integral, y debe ser incorporado en las rutinas de las unidades de atención primaria a la salud (APS).

Objective: To evaluate the perceptions, knowledge, and attitudes, before and after a training session provided to community health workers (CHW). Method: Quasi-experimental, quantitative study, carried out in the countryside of the state of São Paulo. For data collection, we used Seaman and Manello's sociodemographic identification form and the Short Alcohol and Alcohol Problems Perception Questionnaire, applied to 31 CHWs of primary health care services. The study was submitted and approved by the research ethics committee. Results: Perceptions were positive, but there are still practical obstacles regarding the actual work. The knowledge related to signs and symptoms of alcohol use and related attitudes was changed, as were the attitudes. There were no significant changes after training. Conclusion: training is a strategy that enables changes in health practices for integral care. It should be incorporated in the routine of Primary Health Care (PHC) units.

Preventing alcohol use post-bariatric surgery: patient perspectives on a technology-based approach.

BACKGROUND: Nearly two-thirds of patients engage in alcohol use after bariatric surgery, while a substantial number meet criteria for alcohol use disorder after their procedure. Given that pre-surgical education may not be sufficient, alternative methods of preventing post-surgical drinking are needed. We sought feedback on a proposed technology-based intervention to reduce alcohol use for individuals who have undergone bariatric surgery. METHODS: Twenty patients who consumed alcohol post-surgery completed qualitative interviews where they provided opinions on sample intervention content, delivery method, timing, and other aspects of a two-session web-based intervention followed by tailored text messaging for 6 months. Interviews were recorded, transcribed, and coded using thematic analysis principles. RESULTS: Participants strongly endorsed using technology to deliver an alcohol intervention, citing the interactivity and personal tailoring available in the proposed software. Education about the effects of post-surgical drinking and learning new coping strategies for social situations were the two most salient themes to emerge from questions about intervention content. Throughout the interviews, participants strongly highlighted the importance of measuring patient readiness to change alcohol use and matching intervention content to such motivation levels. Respondents felt that text messages could extend what they had learned, but also requested additional non-alcohol content (e.g., recipes, exercise tips). Most participants agreed that an online forum consisting of peers and professionals with whom they could ask questions and interact would be useful. CONCLUSION: Web- and text message-based interventions may be an acceptable approach to prevent alcohol use post-bariatric surgery.

Patient perceptions regarding alcohol use after bariatric surgery.

INTRODUCTION: Patients who have undergone bariatric surgery are at increased risk of an alcohol use disorder. Though patients understand this risk, the majority engage in post-surgical alcohol use. This suggests that education alone is not sufficient to reduce post-surgical drinking. To prevent development of post-surgical alcohol use disorders, we need better understanding of the reasons patients use alcohol following surgery. The purpose of this study was to identify factors associated with post-surgical alcohol use. METHOD: Patients (N = 20) who were 1-3 years post-bariatric surgery and were consuming alcohol at least twice monthly participated in a 60-min interview. Participants responded about their knowledge regarding risk of post-surgical alcohol use and reasons why patients may start drinking. Deductive and inductive coding were completed by two independent raters. RESULTS: Although nearly all participants were aware of the risks associated with post-surgical alcohol use, most believed that lifelong abstinence from alcohol was unrealistic. Common reasons identified for using alcohol after bariatric surgery included social gatherings, resuming pre-surgical use, and addiction transfer. Inductive coding identified three themes: participants consumed alcohol in different ways compared to prior to surgery; the effect of alcohol was substantially stronger than pre-surgery; and beliefs about why patients develop problematic alcohol use following surgery. CONCLUSION: Patients consume alcohol after bariatric surgery for a variety of reasons and they do not believe recommending abstinence is useful. Understanding patient perceptions can inform interventions to minimize alcohol use after bariatric surgery. Modifications to traditional alcohol relapse prevention strategies may provide a more robust solution to decreasing negative outcomes experienced by individuals undergoing bariatric surgery.

Practitioner and digitally delivered interventions for reducing hazardous and harmful alcohol consumption in people not seeking alcohol treatment: a systematic review and network meta-analysis.

AIM: To compare the effectiveness of practitioner versus digitally delivered interventions for reducing hazardous and harmful alcohol consumption. DESIGN: Systematic review and network meta-analysis comprising comprehensive search for randomised controlled trials, robust screening and selection methods and appraisal with the Cochrane Risk of Bias tool. Network meta-analyses were conducted in Stata using random effects, frequentist models. The confidence in network meta-analysis (CINeMA) tool was used to assess confidence in effect sizes. SETTING: Online or community or health settings where the intervention was immediately accessible without referral. PARTICIPANTS: Non treatment-seeking hazardous or harmful drinkers. MEASUREMENTS: Primary outcome was mean difference in alcohol consumption (g/wk); secondary outcome was number of single high intensity drinking episodes. Baseline consumption was analysed as a covariate. FINDINGS: Of 201 included trials (94 753 participants), 152 reported a consumption outcome that could be converted to grams/week; 104 reported number of single high intensity drinking episodes. At 1 and 6 months, practitioner delivered interventions reduced consumption more than digitally delivered interventions (1 month: -23 g/wk (95% CI, -43 to -2); 6 months: -14 g/wk [95% CI, -25 to -3]). At 12 months there was no evidence of difference between practitioner and digitally delivered interventions (-6 g/wk [95% CI, -24 to 12]). There was no evidence of a difference in single high intensity drinking episodes between practitioner and digitally delivered interventions at any time point. Effect sizes were small, but could impact across a population with relatively high prevalence of hazardous and harmful drinking. Heterogeneity was a concern. Some inconsistency was indicated at 1 and 6 months, but little evidence was apparent at 12 months. CONCLUSION: Practitioner delivered interventions for reducing hazardous and harmful alcohol consumption are more effective than digitally delivered interventions up to 6 months; at 12 months there is no evidence of a difference.

Prevalence and characteristics of hazardous and harmful drinkers receiving general practitioners' brief advice on and support with alcohol consumption in Germany: results of a population survey.

OBJECTIVE: The German treatment guideline on alcohol-related disorders recommends that general practitioners (GPs) offer brief advice on, and support with, reducing alcohol consumption to hazardous (at risk for health events) and harmful (exhibit health events) drinking patients. We aimed to estimate the implementation of this recommendation using general population data. DESIGN: Cross-sectional analysis of data (2021/2022) of a nationwide, population-based household survey. SETTING: Germany. PARTICIPANTS: Population-based sample of 2247 adult respondents who reported hazardous or harmful drinking according to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; score women: 4-12 and men: 5-12). MAIN OUTCOME MEASURE: Ever receipt of 'brief GP advice on, or support with, reducing alcohol consumption'. Differences in the likelihood of ever receiving advice and/or support (yes/no) relative to respondents' sociodemographic, smoking and alcohol consumption characteristics were estimated using logistic regressions. RESULTS: Ever receipt of GP advice on/support with reducing drinking was reported among 6.3% (95% CI=5.3% to 7.4%), and the offer of support among 1.5% (95% CI=1.1% to 2.1%) of the hazardous and harmful drinking respondents. The likelihood of having ever received advice/support was positively associated with being older (OR=1.03 per year, 95% CI=1.01 to 1.04), a current or former (vs never) smoker (OR=2.36, 95% CI=1.46 to 3.80; OR=2.17, 95% CI=1.23 to 3.81) and with increasing alcohol consumption (OR=1.76 per score, 95% CI=1.59 to 1.95). One in two harmful drinking respondents (AUDIT-C score 10-12) reported appropriate advice/support. The likelihood was negatively associated with being woman (eg, OR=0.32, 95% CI=0.21 to 0.48), having a medium or high (vs low) education and with increasing household income. CONCLUSIONS: A small proportion of hazardous and harmful drinking people in Germany report having ever received GP advice on, or support with, reducing alcohol consumption. The implementation of advice/support seems to be linked to specific socio-demographic characteristics, tobacco smoking and alcohol consumption level. Health policy measures should aim to increase alcohol screening, brief intervention rates and awareness for at-risk populations in primary care. TRIAL REGISTRATION NUMBER: DRKS00011322, DRKS00017157.

Problem drinkers and high risk-taking behaviors under the stay-at-home policy of the COVID-19 emergency declaration.

BACKGROUND: To the best of the authors' knowledge, this is the first study to examine whether problem drinkers have had high risk-taking behaviors during the stay-at-home policy (e.g., dining out at a bar) under the COVID-19 emergency declaration. METHODS: We investigated data from Japan COVID-19 and Society Internet Survey(JACSIS)study-a web-based nationwide survey, conducted from August to September 2020. From a total of 12,076 current drinkers, problem drinkers were detected by Cut, Annoyed, Guilty, and Eye-opener (CAGE) questions. A CAGE score of 4 showed potential alcohol use disorder and scores of 2 to3 showed potential alcohol abuse; individuals with these scores were regarded as problem drinkers compared to light-or-no-risk drinkers, with a CAGE score of 0 to 1. The outcome assessed the presence of 18 behaviors against the stay-at-home policy, such as dining out at a bar, meeting people, or going to crowded places. All these behaviors were limited in Japan during the first declaration of emergency between April and May 2020. RESULTS: Based on the multivariable logistic regression, the participants with potential alcohol use disorder demonstrated 16 out of the 18 risk-taking behaviors, such as dining out at a bar (adjusted odds ratio (aOR): 2.08; 95% confidence interval (CI): 1.56-2.79), dining out at a restaurant (aOR: 1.79; 95% CI:1.37-2.35), visiting friends (aOR: 1.81; 95% CI: 1.34-2.44), going to karaoke (1.97; 95% CI: 1.26-3.10), and riding on a crowded train (aOR: 1.46; 95% CI: 1.07-1.99), compared to light-or-no risk drinkers with a CAGE score of 0 to 1. Additionally, participants with potential alcohol abuse (CAGE score of 2 to 3) had 10 out of 18 behaviors against the stay-at-home policy: the corresponding aORs for the aforementioned behaviors were 1.45 (95% CI: 1.25-1.67), 1.27 (95% CI: 1.12-1.44), 1.17 (95% CI: 1.01-1.36), 1.49 (95% CI: 1.17-1.90), and 1.19 (95% CI: 1.03-1.38), respectively. Problem drinkers had a significant association with being men, a higher income and job position, smoking, sleep deprivation, depression, and other mental diseases. CONCLUSIONS: Overall, problem drinkers were more likely to have higher risk-taking behaviors against the stay-at-home policy, compared to light-or-no-risk drinkers.

Intervención educativa sobre alcoholismo en pobladores del policlínico Fermín Valdés Domínguez, Baracoa / Educative Intervention about Alcoholism in Residents belonging to Fermín Valdés Domínguez Polyclinic of Baracoa Municipality

Introducción: El alcoholismo es una enfermedad crónica que daña el organismo, el funcionamiento familiar y social, y puede ser causa de violencia, conductas antisociales, desavenencias familiares, accidentes e incluso homicidios. Objetivo: Evaluar la utilidad de la aplicación de un programa de intervención educativa para modificar el nivel de conocimientos sobre alcoholismo en pobladores de la comunidad de Santa Rosa. Métodos: Se realizó un estudio preexperimental de tipo antes-después. El universo del estudio estuvo compuesto por los pacientes mayores de 18 años de edad. Se seleccionó una muestra no probabilística de tipo intencional de 30 pacientes, cuya selección obedeció a los siguientes criterios de inclusión: estar aptos física y mentalmente, tener de 19 a 70 años, no tener ningún proceso mórbido invalidante y tener disposición a participar en el estudio. Resultados: Se evidenció un predominio del sexo masculino y la edad de 18 a 20 años. Antes de la intervención educativa, 76,7 por ciento no tenía conocimientos sobre las consecuencias que provoca el consumo de alcohol; luego de aplicada la intervención mejoraron notablemente estos conocimientos. Del total de encuestados, 76,6 por ciento (23) tenía un conocimiento bajo antes de la intervención educativa y después de aplicada la intervención, 86,7 por ciento se encontraban calificados con conocimiento alto. Solo un adolescente clasificó en nivel bajo. Conclusiones: Se evidenció la efectividad de la intervención educativa al aportar los conocimientos necesarios sobre temas relacionados con el alcoholismo, se propuso extender la estrategia de intervención a todos los pobladores del municipio(AU)

Introduction: Alcoholism is a chronic disease that damages the organism, as well as family and social functioning, apart from being a cause of violence, antisocial behaviors, family disagreements, accidents, and even homicides. Objective: To assess the usefulness of applying an educational intervention program to modify the level of knowledge about alcoholism in residents from the community of Santa Rosa, Baracoa Municipality, Guantánamo Province, Cuba. Methods: A preexperimental before-and-after study was carried out. The study universe was made up of patients over eighteen years of age. A nonprobabilistic purposive sample of thirty patients was selected under the following inclusion criteria: to be physically and mentally fit, to be between nineteen and seventy years old, not to have any disabling morbid process, and to be willing to participate in the study. Results: There was a predominance of the male sex and ages between eighteen and twenty years. Before the educational intervention, 76.7 percent had no knowledge about the consequences of alcohol consumption; after the intervention, this knowledge improved significantly. Of the total number of respondents, 76.6 percent (23) had a low level of knowledge before the educational intervention, while 86.7 percent were classified as having a high level of knowledge after the intervention. Only one adolescent was classified at a low level. Conclusions: The effectiveness of the educational intervention was evidenced, since it provided the necessary knowledge on topics related to alcoholism. The intervention strategy was proposed to be extended to all the inhabitants of the municipality(AU)

Applying Geriatric Principles to Hazardous Drinking in Older Adults.

Older adults continue to drink as they age. Aging changes alcohol kinetics just as with any other drug. Older adults have increased sensitivity to acute alcohol intake that accounts for the increased risk of falls, traffic accidents, and other injury. The Annual Medicare Wellness Exam is an excellent opportunity to introduce screening for unsafe drinking along with accumulated risks and deficits of aging. Older adults have responded well to brief interventions for unhealthy drinking. In the presence of alcohol use disorder or serious comorbidity including psychiatric illness, referral to specialized multidisciplinary care can be lifesaving.

"He who pays the piper calls the tune": Researcher experiences of funder suppression of health behaviour intervention trial findings.

BACKGROUND: Governments commonly fund research with specific applications in mind. Such mechanisms may facilitate 'research translation' but funders may employ strategies that can also undermine the integrity of both science and government. We estimated the prevalence and investigated correlates of funder efforts to suppress health behaviour intervention trial findings. METHODS: Our sampling frame was lead or corresponding authors of papers (published 2007-2017) included in a Cochrane review, reporting findings from trials of interventions to improve nutrition, physical activity, sexual health, smoking, and substance use. Suppression events were based on a previous survey of public health academics. Participants answered questions concerning seven suppression events in their efforts to report the trial, e.g., [I was…] "asked to suppress certain findings as they were viewed as being unfavourable." We also examined the association between information on study funder, geographical location, targeted health behaviour, country democracy rating and age of publication with reported suppression. FINDINGS: We received responses from 104 authors (50%) of 208 eligible trials, from North America (34%), Europe (33%), Oceania (17%), and other countries (16%). Eighteen percent reported at least one of the seven suppression events relating to the trial in question. The most commonly reported suppression event was funder(s) expressing reluctance to publish because they considered the results 'unfavourable' (9% reported). We found no strong associations with the subject of research, funding source, democracy, region, or year of publication. CONCLUSIONS: One in five researchers in this global sample reported being pressured to delay, alter, or not publish the findings of health behaviour intervention trials. Regulation of funder and university practices, establishing study registries, and compulsory disclosure of funding conditions in scientific journals, are needed to protect the integrity of public-good research.

Aplicación Alcoholism: una vía para el desarrollo de conocimientos sobre el alcoholismo / Alcoholism's App: a way for increasing knowledge related to alcoholism / Aplicativo Alcoholism: uma forma de desenvolver o conhecimento sobre alcoolismo

RESUMEN Introducción: El alcoholismo constituye hoy día un problema vigente y en ascenso durante la etapa de la adolescencia. Objetivo: Validar una aplicación para contribuir al conocimiento sobre el alcoholismo en estudiantes del Instituto Politécnico "General Luis A. Milanés Tamayo" de Granma. Método: En marzo de 2019 en la Facultad de Ciencias Médicas de Bayamo, provincia Granma se elaboró una aplicación para contribuir al conocimiento sobre el alcoholismo en estudiantes de dicha institución educativa. Se emplearon las herramientas JClic y Gimpshop 2.8 con licencia GPL/Linux. Para determinar su viabilidad, en el período febrero a marzo de 2019 se encuestaron 40 estudiantes seleccionados por muestreo aleatorio estratificado, de un universo de 397 alumnos. Resultados: Antes del uso de la aplicación el 77,5 % de los estudiantes reflejó un bajo nivel de conocimiento sobre el tema. Después de utilizar el producto informático, el 90,0 % reveló un alto nivel de conocimientos sobre el alcoholismo. Conclusiones: El diseño e implementación de la aplicación Alcoholism contribuye a que los estudiantes se apropien de conocimientos sobre el tema alcoholismo, los que mostraron una adecuada satisfacción con su utilización.

ABSTRACT Introduction: Alcoholism nowadays is a rising problem in adolescent's population. Objective: To certificate an App that contributes to increase knowledge related to alcoholism for the students of the Instituto Politécnico "General Luis A. Milanés Tamayo" in Granma. Method: In March 2019, at the Facultad de Ciencias Médicas in Bayamo, Granma, it was created an App for contributing on the students´ knowledge about alcoholism. Tools used were JClic and Gimpshop 2.8, with GPL/Linux license. To determine its efficacy, from February to March 2019 a cohort of 40 students of the total (397 students) were selected by stratified random sampling to be surveyed out. Results: 77.5% of the students, before the App usage, showed a low level of knowledge about concerning issue and a high level (90.0%) after the App implementation. Conclusion: The design and implementation of the Alcoholism App contributes to the students' appropriation of knowledge on the subject of alcoholism, who showed adequate satisfaction with its use.

RESUMO Introdução: O alcoolismo constitui um problema atual e crescente durante a etapa da adolescência. Objetivo: Validar um aplicativo para contribuir com o conhecimento sobre alcoolismo em alunos do Instituto Politécnico "General Luis A. Milanés Tamayo" de Granma. Método: Em março de 2019, na Faculdade de Ciências Médicas de Bayamo, província do Granma, foi desenvolvido um aplicativo que visa contribuir para o conhecimento sobre o alcoolismo em alunos da referida instituição de ensino. Foram utilizadas as ferramentas JClic e Gimpshop 2.8 com licença GPL/Linux. Para determinar sua viabilidade, no período de fevereiro a março de 2019, foram pesquisados 40 alunos selecionados por amostragem aleatória estratificada, de um universo de 397 alunos. Resultados: Antes de usar o aplicativo, 77,5% dos alunos refletirem baixo nível de conhecimento sobre o assunto. Após usar o produto de informática, 90,0% revelaram alto nível de conhecimento sobre alcoolismo. Conclusões: A concepção e implementação do aplicativo Alcoholism contribuem para a apropriação dos conhecimentos dos alunos sobre a temática do alcoolismo, os quais demonstraram satisfação adequada com o seu uso.

Alcoolismo e envelhecimento nas pesquisas em saúde: um perfil bibliométrico / Alcoholismo y envejecimiento en las investigaciones en salud: un perfil bibliométrico / Alcoholism and aging in health research: a bibliometric profile

Objetivo: avaliar as publicações científicas sobre o alcoolismo e o envelhecimento. Métodos: estudo bibliométrico, realizado por meio da análise de artigos disponíveis na base de dados da LILACS, EBSCOT e MEDLINE, no período de 2010-2016. Resultados: os achados demostram a crescente busca sobre a temática em diversos países, nos últimos anos, aperfeiçoando a importância da contribuição da mesma quando se pensa em saúde pública, bem como os pesquisadores atuam em diversas áreas de conhecimentos; o que possibilita descobertas que podem informar o desenvolvimento e a implementação de ações de prevenção e promoção da saúde, que refletem as necessidades de saúde mental do envelhecimento. Conclusão: é importante que os profissionais de saúde e a população idosa discutam sobre consumo de álcool como componente do manejo da doença crônica. Nos casos de consumo de álcool, os provedores têm a oportunidade de fornecer uma intervenção breve ou oferecer referências, se necessário

Objetivo: Evaluar las publicaciones científicas sobre el alcoholismo y el envejecimiento. Métodos: Estudio bibliométrico, realizado por medio del análisis de artículos disponibles en la base de datos de LILACS, EBSCOT y MEDLINE, en el período 2010-2016. Resultados: Los hallazgos de esta revisión demuestran que la creciente demanda sobre la temática en diversos países, en los últimos años, perfeccionando la importancia de la contribución de la misma cuando se piensa en salud pública, así como los investigadores actúan en diversas áreas de conocimientos; lo que posibilita descubrimientos que pueden informar el desarrollo y la implementación de acciones de prevención y promoción de la salud que reflejan las necesidades de salud mental del envejecimiento. Conclusión: Es importante que los profesionales de salud y la población anciana discutan sobre el consumo de alcohol como componente del manejo de la enfermedad crónica. En los casos de consumo de alcohol, los proveedores tienen la oportunidad de proporcionar una intervención breve o ofrecer referencias. A pesar de la relevancia, todavía son escasos los estudios sobre la temática, en el escenario de investigación nacional, siendo necesario más producción científica

Objective:Tevaluate scientific publications about alcoholism and aging. Methods: It included analysis of items available in the database of the LILACS, EBSCOT and MEDLINE, in the period from 2010 to 2016. Results: The findings of this review show increasing bibliometric search on the subject in several countries, in recent years, enhancing the importance of the contributions on the subject in terms of public health, as well as researchers working in different areas of knowledge. Conclusion: It is important that health professionals and the elderly debate about alcohol consumption as a component of chronic disease management and that the health care network ensures quick intervention or referrals. Despite the relevance, studies on the subject are still scarce in the national research scenario, and more scientific production is needed

Avaliação da implantação da Política de Atenção Integral à Usuários de Álcool e outras Drogas na Estratégia Saúde da Família do Rio de Janeiro-RJ / Evaluation of the implementation of the Comprehensive Care Policy for Users of Alcohol and Other Drugs in the Family Health Strategy of Rio de Janeiro-RJ

Esta pesquisa tem como objetivo, avaliar o grau de implantação da Política de Atenção Integral a usuários de Álcool e Droga, na Estratégia Saúde da Família do município do Rio de Janeiro, RJ, Área de Planejamento 3.1. Trata-se de uma pesquisa avaliativa, do tipo análise de implantação, com corte transversal, abordagem formativa e colaborativa, utilizando estudo de caso único e métodos mistos. Teve como caso, a Estratégia Saúde da Família da Área de Planejamento 3.1, com dez unidades de análise. Participaram gestores da APS e Programa de Saúde Mental, Coordenação da Área de Planejamento referente a Atenção Primária à Saúde, profissionais da equipe mínima da Estratégia Saúde da Família (médicos, enfermeiros, técnicos de enfermagem e agentes comunitários de saúde), e respectivos gerentes, responsáveis técnicos de medicina, responsáveis técnicos de enfermagem, e representante do Conselho Municipal de Saúde. Resultados: a Política de Atenção Integral à Usuários de Álcool e outras Drogas no município do Rio de Janeiro, encontra-se parcialmente implantada, tendo como insumo melhor avaliado o recurso físico, enquanto Protocolos, Diretrizes Terapêuticas, Linhas Guias, Fluxos, Referência e Contra Referência pior avaliação. As atividades relacionadas a diretriz Promoção e Proteção à Saúde obtiveram melhor avaliação, enquanto a diretriz Prevenção de Agravos pior avaliação. Quanto ao contexto Político Organizacional, o Projeto de Governo e a Capacidade de Governo foram os que mais influenciaram no processo de implantação. Conclusão: A ESF apresenta fragilidades em relação a insumos essenciais para prevenção, diagnóstico, avaliação e tratamento dos usuários de álcool e outras drogas, recursos humanos insuficientes ou ausentes, problemas orçamentários, organizativos, restrição de atividades relacionadas as diretrizes Intersetorialidade, Prevenção de agravos e Promoção e Proteção à Saúde de suma importância neste contexto. Somado a isto, o contexto político organizacional influenciou de forma negativa o processo de implantação desta política neste nível de atenção.

This research aims to evaluate the degree of implementation of the Comprehensive Care Policy for Alcohol and Drug users, in the Family Health Strategy of the city of Rio de Janeiro, RJ, Planning Area 3.1. This is an evaluative research, of the implementation analysis type, with a transversal cut, formative and collaborative approach, using a single case study and mixed methods. In the case of the Family Health Strategy of the Planning Area 3.1, with ten units of analysis. Managers of the PHC and Mental Health Program, Coordination of the Planning Area regarding Primary Health Care, professionals from the minimum team of the Family Health Strategy (doctors, nurses, nursing technicians and community health agents) and respective managers, participated in the study. responsible medical technicians, responsible nursing technicians, and representative of the Municipal Health Council. Results: the Comprehensive Care Policy for Users of Alcohol and other Drugs in the city of Rio de Janeiro is partially implemented, having the physical resource as the best evaluated input, while Protocols, Therapeutic Guidelines, Guidelines, Flows, Reference and Contraindications Reference worse evaluation. Activities related to the Health Promotion and Protection guideline had the best evaluation, while the Disease Prevention guideline had the worst evaluation. Regarding the Political Organizational context, the Government Project and the Government Capacity were the ones that most influenced the implementation process. Conclusion: The ESF has weaknesses in relation to essential inputs for the prevention, diagnosis, evaluation and treatment of users of alcohol and other drugs, insufficient or absent human resources, budgetary and organizational problems, restriction of activities related to Intersectoriality, Prevention of diseases and Health Promotion and Protection of paramount importance in this context. Added to this, the organizational political context had a negative influence on the process of implementing this policy at this level of care.

Esta investigación tiene como objetivo evaluar el grado de implementación de la Política de Atención Integral a Usuarios de Alcohol y Drogas, en la Estrategia de Salud de la Familia de la ciudad de Rio de Janeiro, RJ, Área de Planificación 3.1. Se trata de una investigación evaluativa, del tipo análisis de implementación, con un enfoque de corte transversal, formativo y colaborativo, utilizando un estudio de caso único y métodos mixtos. En el caso de la Estrategia de Salud de la Familia del Área de Planificación 3.1, con diez unidades de análisis. Participaron del estudio gestores del Programa de APS y Salud Mental, Coordinación del Área de Planificación de la Atención Primaria de Salud, profesionales del equipo mínimo de la Estrategia Salud de la Familia (médicos, enfermeros, técnicos de enfermería y agentes comunitarios de salud) y los respectivos gestores, técnicos médicos responsables, técnicos de enfermería responsables y representante del Consejo Municipal de Salud. Resultados: la Política de Atención Integral a Usuarios de Alcohol y otras Drogas en la ciudad de Río de Janeiro está parcialmente implementada, teniendo el recurso físico como el insumo mejor evaluado, mientras que Protocolos, Directrices Terapéuticas, Directrices, Flujos, Referencia y Contraindicaciones Referencia peor evaluación . Las actividades relacionadas con la directriz Promoción y Protección de la Salud tuvieron la mejor evaluación, mientras que la directriz Prevención de Enfermedades tuvo la peor evaluación. En cuanto al contexto Político Organizativo, el Proyecto de Gobierno y la Capacidad de Gobierno fueron los que más influyeron en el proceso de implementación. Conclusión: La ESF presenta debilidades en relación a insumos esenciales para la prevención, diagnóstico, evaluación y tratamiento de usuarios de alcohol y otras drogas, recursos humanos insuficientes o ausentes, problemas presupuestarios y organizacionales, restricción de actividades relacionadas con la Intersectorialidad, Prevención de enfermedades y Promoción y Protección de la Salud de suma importancia en este contexto. Sumado a esto, el contexto político organizacional influyó negativamente en el proceso de implementación de esta política en este nivel de atención.

Factores asociados a la hipertensión arterial en adolescentes de San Juan y Martínez, 2018 / Factors associated with high blood pressure in adolescents in San Juan y Martínez, 2018

Introducción: La hipertensión arterial del adulto tiene sus orígenes en la infancia. Los adolescentes copian los mismos estilos de vida del adulto que son desencadenantes potenciales de enfermedades cardiovasculares. Objetivo: Caracterizar los factores asociados a la hipertensión arterial en los adolescentes de San Juan y Martínez en el 2018. Métodos: Se realizó una investigación descriptiva, transversal. El universo estuvo constituido por 522 adolescentes de San Juan y Martínez y la muestra estuvo integrada por 203 adolescentes tomados al azar en los diferentes centros de estudio del Consejo Popular Pueblo. Resultados: El sexo femenino fue el más representativo, predominó el color de la piel negra, los antecedentes patológicos familiares más representativos fueron la hipertensión arterial y la diabetes mellitus, un elevado porcentaje de los adolescentes fuman e ingieren bebidas alcohólicas. Existe un predominio de los hábitos dietéticos malos y regulares, así como una tendencia sedentaria; gran número de ellos presentan obesidad o sobrepeso. Conclusiones: En los adolescentes de San Juan y Martínez se observa un aumento de los factores que predisponen a padecer una hipertensión arterial, lo que posibilita su desarrollo en edades tempranas de la vida. De ahí que los médicos generales integrales deban trabajar en su prevención para evitar el avance de esta enfermedad en este grupo etario(AU)

Introduction: Adult´s high blood pressure has its onset in the childhood. Adolescents copy the same lifestyles that adults have which are potential triggers for cardiovascular diseases. Objective: Characterize the factors associated with high blood pressure in the adolescents of San Juan y Martinez municipality in 2018. Methods: A descriptive, cross-sectional research was conducted. The group sample was formed by 522 teenagers from San Juan y Martínez municipality and the sample by 203 adolescents selected randomly in the different study centers of Pueblo district. Results: The female sex was the most representative; there was predominance of the black skin; the most representative family pathological history were high blood pressure and diabetes mellitus; a high percent of adolescents smoke and consume alcoholic beverages. There is a predominance of bad and regular dietary habits, as well as a sedentary trend; a large number of adolescents are obese or overweight. Conclusions: In the adolescents of San Juan y Martínez there is an increase in the factors that predispose to high blood pressure, which makes it possible to develop at an early stage of life. Hence, comprehensive general doctors must work on its prevention to stop the progression of this disease in this age group(AU)

Screening, Counseling, and Shared Decision Making for Alcohol Use with Transgender and Gender-Diverse Populations.

At-risk alcohol use occurs among transgender and gender-diverse (TGD) populations, yet current alcohol use screening tools and guidelines do not distinguish between sex- and gender-related characteristics, having been developed without accounting for natal sex-based physiology, effects of gender-affirming medical care, and gendered drinking behavior among TGD people. More research on how sex- and gender-related factors independently influence alcohol use can help validate gender-inclusive screening protocols and develop evidence-based guidelines meaningful for people of all genders. In the interim, clinicians must be mindful of gender diversity and engage in transparent, collaborative discussions when screening for and counseling about alcohol use.

Does Reducing Drinking in Patients with Unhealthy Alcohol Use Improve Pain Interference, Use of Other Substances, and Psychiatric Symptoms?

BACKGROUND: We aimed to investigate the impact of reducing drinking in patients with unhealthy alcohol use on improvement of chronic pain interference, substance use, and psychiatric symptoms. METHODS: We analyzed longitudinal data from 2003 to 2015 in the Veterans Aging Cohort Study, a prospective, multisite observational study of US veterans, by emulating a hypothetical randomized trial (a target trial). Alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire, and outcome conditions were assessed via validated survey items. Individuals were followed from the first time their AUDIT score was ≥ 8 (baseline), a threshold consistent with unhealthy alcohol use. We compared individuals who reduced drinking (AUDIT < 8) at the next follow-up visit with individuals who did not (AUDIT ≥ 8). We fit separate logistic regression models to estimate odds ratios for improvement of each condition 2 years postbaseline among individuals who had that condition at baseline: moderate or severe pain interference symptoms, tobacco smoking, cannabis use, cocaine use, depressive symptoms, and anxiety symptoms. Inverse probability weighting was used to account for potential selection bias and confounding. RESULTS: Adjusted 2-year odds ratios (95% confidence intervals) for associations between reducing drinking and improvement or resolution of each condition were as follows: 1.49 (0.91, 2.42) for pain interference symptoms, 1.57 (0.93, 2.63) for tobacco smoking, 1.65 (0.92, 2.95) for cannabis use, 1.83 (1.03, 3.27) for cocaine use, 1.11 (0.64, 1.92) for depressive symptoms, and 1.33 (0.80, 2.22) for anxiety symptoms. CONCLUSIONS: We found some evidence for improvement of pain interference symptoms and substance use after reducing drinking among US veterans with unhealthy alcohol use, but confidence intervals were wide.

[At-risk drinking screening by general practitioners: A survey of patients in primary care]. / Repérage de la consommation d'alcool à risque par les médecins généralistes : enquête auprès de patients en soins premiers.

BACKGROUND: The screening of patients who are at-risk drinkers, which means exceeding the thresholds defined by health authorities or associated with a specific situation (taking psychotropic drugs, having an organic pathology, driving a vehicle, drinking during pregnancy), represents a major issue in primary care. Few studies have offered perspective from the patients' standpoint. The main purpose of this study was to describe general practitioners at-risk drinking screening from their patients point of view. The secondary objective was to identify the factors associated with perception of satisfactory general practitioner knowledge about alcohol consumption. METHODS: A quantitative cross-sectional study was launched in 9 general practitioner offices over 6 months. Patients older than 18 were recruited to answer a questionnaire blinded from their general practitioner, indicating the level of their alcohol consumption and their perception regarding their general practitioner's screening methods. Descriptive, univariate and multivariate logistic regression analyses were performed. RESULTS: All in all, 445 patients were analyzed. Sixty-two at-risk drinkers were screened (13.9 %). Most of the patients declared they had not been interviewed about their alcohol consumption by their general practitioner either during initial consultations (86.1 %) or over time (83.3 %). Only 4.2 % of patients had previously initiated discussion about their consumption. Patients were not ashamed to talk about alcohol (99.2 %) and found their general practitioner to be competent on this topic (100 %). In multivariate analysis, independent factors associated with a good general practitioner knowledge about their patients' current consumption were the questions put forward by their general practitioner about alcohol consumption during their first visit (P<0.001) and during subsequent visits (P<0.001). CONCLUSION: This study showed a low general practitioner screening rate of their patients' at-risk drinking. Only a minority of patients, including at-risk drinkers, declared that their general practitioner was aware of their level of alcohol consumption. Screening could be improved by being systematized during initial consultations and regularly scheduled during subsequent visits, especially in at-risk situations.