Implications of Impulsivity on Criminal Behavior in Individuals With Substance Use Disorder.

OBJECTIVE: Our aim was to analyze the association between criminal behavior and impulsivity in individuals with drug addiction and investigate whether impulsiveness mediates the relationship between drug use severity and legal problems. METHODS: This cross-sectional study included 773 men diagnosed with addiction (295 alcohol users and 478 users of crack/polysubstance) while undergoing addiction treatment. The BIS-11 and ASI-6 were applied to assess impulsivity, criminal behavior, and drug use. RESULTS: The prevalence of criminal behavior was 41.7% (n = 123) in alcohol users and 64.9% (n = 310) in users of crack/polysubstance. Earlier use of different substances and higher impulsivity scores were observed in individuals with criminal history. Mediation analyses revealed that impulsiveness acts as a mediator factor between substance use and criminal behavior, enhancing the severity of legal problems. CONCLUSION: Our findings can help in deciding on tailored treatment strategies, focusing not only on substance use, but also on the prevention of social problems, criminality, and impulsivity.

A hierarchical analysis of associated factors to lifetime suicide attempts in alcohol use disorder.

BACKGROUND: Substance use is strongly associated with suicide attempts throughout life. We aimed to investigate the prevalence of suicide attempts (SA) and associated factors in life in patients with Alcohol Use Disorder (AUD). METHODS: The sample consisted of 424 men with AUD who underwent treatment at the Addiction Psychiatry Unit of the Hospital de Clínicas de Porto Alegre. The clinical evaluation included the Addiction Severity Index, the Childhood Trauma Questionnaire, the Barratt Impulsiveness Scale, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Variables that showed p-value < 0.05 in the bivariate analyses were included in a hierarchical regression model with robust variance to investigate associations with SA in life via estimation of adjusted Prevalence Ratios (PR). RESULTS: The lifetime prevalence of SA among alcohol users was 36.6%. Patients with childhood maltreatment, borderline personality disorder, and higher impulsivity scores had a higher lifetime prevalence of SA. CONCLUSION: Our findings indicate that male inpatient alcoholics present an important prevalence of SA. The study also corroborates the relationship between maltreatment, impulsivity, and borderline personality disorder with SA among inpatients in treatment for AUD.

Crack users show high rates of antisocial personality disorder, engagement in illegal activities and other psychosocial problems.

The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 ± 8.1 and 32.9 ± 8.8 vs. 42.4 ± 12, respectively; p < .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.

High rates of injured motorcycle drivers in emergency rooms and the association with substance use in Porto Alegre, Brazil.

BACKGROUND: Although the fleet of motorcycles and the number of traffic accidents (TA) is increasing in the world, few studies have evaluated intoxication by alcohol and/or drugs in this group of drivers. This study aims to evaluate the prevalence of motorcycle riders among drivers who are victims of TA, and ascertain factors associated with drug and alcohol use. METHODS: All TA victims admitted on a 24/7 routine between October and November 2008 to two trauma hospitals of Porto Alegre, Brazil were invited to participate, then submitted to an interview, breathalysed and had their saliva collected for drugs. RESULTS: Among the overall sample of drivers, 78.4% were motorcycle riders. Toxicological analysis yielded a 15.3% prevalence of marijuana use, 9.2% of cocaine use, 3.2% benzodiazepine use and 7% of alcohol use. Factors associated with alcohol or drug intoxication were the diagnosis of alcohol abuse or dependence and history of previous TA. CONCLUSIONS: The prevalence of motorcycle riders among drivers who are victims of TA was alarming. The association of alcohol abuse or dependency and intoxication justify the need for therapeutic interventions specifically targeted to the treatment of drug dependency, as well as public policies directed to prevention of injuries-particularly among recidivist motorcycle riders.

Childhood trauma subtypes may influence the pattern of substance use and preferential substance in men with alcohol and/or crack-cocaine addiction.

OBJECTIVE: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. METHODS: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. RESULTS: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. CONCLUSIONS: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies.

Differential impact on suicide mortality during the COVID-19 pandemic in Brazil.

OBJECTIVES: To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome. METHODS: Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling. RESULTS: The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color. CONCLUSIONS: Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.

Prevalence and correlates of gambling problems among a nationally representative sample of Brazilian adolescents.

The objectives of the study are: (a) to provide the first prevalence estimates of pathological gambling among Brazilian adolescents using an age-specific instrument in a nationally representative sample; (b) to investigate the extent to which adolescents participate in gambling activities in a developing country; and (c) to correlate different levels of gambling behavior with demographic variables. Multistage cluster sampling selected 3,007 individuals over 14 years of age from Brazilian household population. A total of 661 participants were between 14 and 17 years old. The Lie/Bet Questionnaire and the DSM-IV-MR-J were used for assessing problem and pathological gambling. 2.8% scored positive on the screening questionnaire, while 1.6% were classified as problem and pathological gamblers. Factors associated with problem and pathological gambling were male sex, not currently studying and considering religion as not important. Less than 4 months elapsed between the age of regular gambling involvement and the first gambling problem. Prevalence rates were quite similar from recent studies which used nationally representative samples. The association of problem and pathological gambling with male sex, school drop-out and low religiosity supports the Problem Behavior Theory. The fast progression to problem gambling adds evidence that adolescents may be more vulnerable to the effects of gambling.

Surgical Site Infection after Cesarean Delivery in Times of COVID-19.

OBJECTIVE: To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. METHODS: A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation as ml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. RESULTS: There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. CONCLUSION: The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.

OBJETIVO: Analisar os efeitos da pandemia de COVID-19 sobre o consumo de equipamentos e produtos de proteção individual (EPPI), assim como a frequência de infecção de sítio cirúrgico (ISC) em pacientes não infectadas por COVID-19 submetidas a cesarianas. MéTODOS: Foi realizado um estudo retrospectivo em uma maternidade de um hospital público de ensino que não fazia parte do serviço de referência para o tratamento do COVID-19. Foram comparados o consumo de EPPI e a ocorrência de ISC após cesárea nos períodos mensais antes e após a ocorrência do primeiro caso de COVID-19 em Porto Alegre, RS, Brasil. O consumo de EPPI foi medido em unidades de máscaras, luvas, aventais e gorros, e o uso de produtos à base de álcool ou de sabonete para higienização das mãos em ml/paciente/dia. O índice SSI foi calculado como a proporção de casos de ISC sobre o número de cesarianas realizadas mensalmente durante o período do estudo. RESULTADOS: Houve aumento em todos os itens medidos do EPPI, com o consumo de máscaras descartáveis apresentando uma mediana de 1.450 no período pré-COVID e de 2550 no período pós-COVID (aumento de 75,9%). Detectou-se também diminuição de ISC, com medianas de 1,74 no período pré-COVID e de 0,89 no período pós-COVID, com redução de 49% no valor da mediana. CONCLUSãO: O aumento do consumo de EPPI pode ser resultado de práticas mais seguras adotadas pelos profissionais de saúde com o advento do COVID-19, do qual a redução na ocorrência de ISC pode ser uma consequência direta. Apesar da gravidade da crise, pode-se afirmar que situações extremas podem gerar reflexões valiosas e oportunidades de melhorias.

Clinical vulnerability for severity and mortality by COVID-19 among users of alcohol and other substances.

The COVID-19 pandemic is a public health emergency. Individuals with substance use disorder have a higher risk of infection and may suffer from more severe forms of the disease. Our goal is to investigate the prevalence of risk factors for COVID-19 severity in individuals with different substance use and explore whether specific types of substance are potentially associated with more clinical risk factors which could increase morbimortality in this population. The sample included 821 men hospitalized at an inpatient Addiction unit (305 alcohol users, 233 cocaine/crack users, and 283 multiusers). Data were collected using the Addiction Severity Index version 6. The most prevalent risk factors for COVID-19 severity observed in our sample were: smoking (82.5%), arterial hypertension (26.6%), respiratory problems (23.4%), and history of homelessness (25.1%). Arterial hypertension and cirrhosis occurred more frequently among alcohol users. Multiusers lived in the streets longer and had a higher prevalence of HIV than alcohol users. Overall, 28% of the sample had three or more risk factors. The frequency of risk factors was high and this scenario suggests that these individuals could be more susceptible to worse COVID-19 prognosis. Therefore, prevention strategies directed at specific characteristics of substance users merit attention during the pandemic.

The next pandemic: impact of COVID-19 in mental healthcare assistance in a nationwide epidemiological study.

BACKGROUND: Studies have reported the worsening of psychiatric symptoms during the COVID-19 pandemic. However, few studies have evaluated the impact on the access to mental health services during COVID-19. Our aim was to analyze temporal trends and prediction of appointments held in Brazil's public health system, to compare the observed and expected number of mental healthcare appointments during the COVID-19 pandemics. METHODS: An ecological time-series study was performed, analyzing mental health appointments before and during the pandemic (from 2016 and 2020) from the Brazilian governmental database. The structural break in the data series was assessed using the Chow test, with the break considered in March 2020. Bayesian structural time-series models were used to estimate current average appointments and the predicted expectation if there was no pandemic. FINDINGS: Compared to the expected, between March and August 2020 about 28% less outpatient appointments in mental health were observed, totaling 471,448 individuals with suspended assistance. Group appointments and psychiatric hospitalizations were also severely impacted by the pandemic (decreased of 68% and 33%, respectively). On the other hand, mental health emergency consultations and home care increased during this period (36% and 52%, respectively). INTERPRETATION: Our findings demonstrate a dramatic change in mental health assistance during the COVID-19 pandemic, which corroborates a recent WHO survey. This phenomenon can aggravate the mental health crisis and generate a parallel pandemic that may last for a longer time than the COVID-19 pandemic. FUNDING: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Risk behaviors for HCV- and HIV-seroprevalence among female crack users in Porto Alegre, Brazil.

Several studies have shown a high prevalence of HIV-seropositive status among crack users, though most refer to North American populations. Few studies evaluate HCV prevalence among female crack users. In addition, there is a particular lack of data about risk behaviors and HIV/HCV prevalence in this population around the world. In order to ascertain the HIV/HCV serostatus and associated risk behaviors for infection of female crack users of Porto Alegre, Brazil. A cross-sectional study of a convenience sample of 73 current female crack users was conducted. Subjects answered NIDA's Risk Behavior Assessment and an AIDS Information Questionnaire. In addition, blood was collected from subjects for HIV/HCV tests. The overall prevalence of HIV was 37.0%; HCV seroprevalence was 27.7%; of 15.1% the sample was co-infected with HIV and HCV. Four years of schooling or fewer (OR 4.72-CI 95%; 1.49-14.99) and having three or more HIV tests in one's lifetime (OR 4.26-CI 95% (1.29-14.04)) were associated with HIV infection (after multivariate logistic regression). The single greatest risk factor for HCV infection was having 4 years of schooling or fewer (OR 4.51-CI 95%; 1.18-17.27). We found a very high prevalence of HIV and HCV infection among female crack users, and low education was the most significant risk factor associated with both infections.

Fatores associados à exposição ao HIV em usuários de álcool / Factors associated with HIV exposure in alcohol users

Introdução: A prevalência de HIV é maior em Porto Alegre comparada ao restante do país. O abuso de álcool afeta o juízo crítico, sendo associado a comportamentos de risco que podem levar à contaminação pelo HIV. Objetiva-se analisar fatores associados à exposição ao HIV em alcoolistas com práticas sexuais de risco comparando com aqueles que se previnem.Métodos: Estudo transversal com 126 homens alcoolistas (HIV negativo), divididos em 2 grupos: Exposto Sexual (n = 42) e Pouco Exposto Sexual (n = 84), considerando uso de preservativo e número de parceiros sexuais.Resultados: A maioria dos sujeitos do grupo Exposto Sexual era solteiro, sem ocupação laboral, com histórico de moradia de rua e de relação com profissional do sexo, apresentavam maior preocupação com infecção por HIV (p < 0,05).Conclusão: Sugere-se o desenvolvimento e monitoramento de intervenções preventivas específicas, considerando as características do abuso de álcool e seu papel na transmissão do HIV.

Introduction: The HIV prevalence is higher in Porto Alegre compared to other capitals in Brazil. Alcohol abuse affects critical judgment, being associated with risky behaviors that can lead to HIV infection. Aim:To analyze factors associated with exposure to HIV in alcohol users, comparing those with risky sexual practices and those who use prevention methods.Methods: Cross-sectional study with 126 male alcohol users (HIV negative), divided into 2 groups: Sexually Exposed (n = 42) and Less Sexually Exposed (n = 84), considering condom use and number of sexual partners.Results: Most subjects in the Sexually Exposed group were single, without a job, with a history of homelessness and a relationship with a sexual worker, and were more concerned about HIV infection (p < 0.05).Conclusion: The development and monitoring of specific preventive interventions is suggested, considering the characteristics of alcohol abuse and its role in HIV transmission.

Childhood trauma subtypes may influence the pattern of substance use and preferential substance in men with alcohol and/or crack-cocaine addiction

Objective: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. Methods: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. Results: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. Conclusions: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies.

Crack-cocaine users have less family cohesion than alcohol users.

OBJECTIVE: Many studies correlate characteristics of family functioning and the development of drug addiction. This study sought to evaluate and compare the family environment styles of two groups of psychoactive substance users: 1) alcohol-only users and 2) crack-cocaine users. METHODS: Three hundred and sixty-four users of alcohol, crack-cocaine, and other drugs, recruited from research centers in four Brazilian capitals participated in this study. Subjects were evaluated through the Family Environment Scale and the Addiction Severity Index, 6th version (ASI-6). ASI-6 t-scores were compared by analysis of variance (ANOVA) and post-hoc tests. A final model was obtained using a logistic regression analysis. All analyses were adjusted for partner, age, and psychiatric t-score. RESULTS: We found a significant difference between groups in the cohesion subscale (p = 0.044). The post-hoc test revealed a difference of 1.06 points (95%CI 0.11-2.01) between groups 1 (6.45±0.28) and 2 (5.38±0.20). No significant between-group differences were observed in the other subscales. However, categorical analyses of variables regarding family dynamic showed that crack users more often reported that sometimes people in their family hit each other (30.4% vs. 13.2%, p = 0.007) and that people in their family frequently compared each other regarding work and/or school achievement (57.2% vs. 42.6%, p = 0.041). CONCLUSION: These results suggest that families of crack-cocaine users are less cohesive than families of alcohol users. This type of family environment may affect treatment outcome, and should thus be adequately approached.

Differential impact on suicide mortality during the COVID-19 pandemic in Brazil

Objectives: To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome. Methods: Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling. Results: The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color. Conclusions: Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.

EFFECT OF SIZE OF INTESTINAL DIVERSIONS IN OBESE PATIENTS WITH METABOLIC SYNDROME SUBMITTED TO GASTRIC BYPASS.

Background: There is no consensus on the ideal size of intestinal loops in gastric bypass of bariatric surgeries. Aim: To evaluate the metabolic outcome of patients submitted to gastric bypass with alimentary and biliopancreatic loops of different sizes. Methods: Was conducted a retrospective cohort study in diabetic obese patients (BMI≥35 kg/m2) with metabolic syndrome submitted to gastric bypass. The patients were divided into three groups according to the size of the intestinal loop: group 1, biliopancreatic limb 50 cm length and alimentary limb 100 cm length; group 2 , biliopancreatic limb 50 cm length and alimentary limb 150 cm length; and group 3, biliopancreatic limb 100 cm length and alimentary limb 150 cm length. The effect of gastric bypass with different sizes of intestinal loops in relation to the parameters that define metabolic syndrome was determined. Results: Sixty-three patients were evaluated, and they had a mean age of 44.7±9.4 years. All were diabetics, with 62 (98.4%) being hypertensive and 51 (82.2%) dyslipidemic. The three groups were homogeneous in relation to the variables. In 24 months, there was a remission of systemic arterial hypertension in 65% of patients in group 1, 62.5% in group 2 and 68.4% in group 3. Remission of diabetes occurred in 85% of patients in group 1, 83% in group 2 and 84% in group 3. There was no statistical difference in %LEW between the groups, and waist measurements decreased in a homogeneous way in all groups. The size of loops also had no influence on the improvement in dyslipidemia. Conclusion: Variation in size of intestinal loops does not appear to influence improvement in metabolic syndrome in this group of patients.

Racional: Não há consenso sobre o tamanho ideal das alças intestinais no bypass gástrico em Y-de-Roux em cirurgias bariátricas. Objetivos: Avaliar os desfechos metabólicos de pacientes submetidos ao bypass gástrico com alça intestinal alimentar e biliopancreática de tamanhos diferentes. Métodos: Realizou-se coorte retrospectiva em pacientes obesos (IMC≥35 kg/m2) diabéticos com síndrome metabólica submetidos ao bypass gástrico em Y-de-Roux. Foram divididos em três grupos conforme a dimensão das alças intestinais: grupo 1, alça biliopancreática de 50 cm e alça alimentar de 100 cm; grupo 2, alça biliopancreática de 50 cm e alça alimentar de 150 cm e grupo 3, alça biliopancreática de 100 cm e alça alimentar de 150 cm. Foram avaliados os parâmetros que compõem a síndrome metabólica. Resultados: Incluíram-se 63 pacientes, com média de idade de 44.7±9.4 anos. Todos eram diabéticos, 62 (98.4%) hipertensos e 51 (82.2%) dislipidêmicos. Os três grupos eram homogêneos em relação às variáveis estudadas. Em 24 meses houve remissão da hipertensão arterial sistêmica em 65% do grupo 1, 62.5% no grupo 2 e 68.4% no grupo 3. A remissão do diabete melito tipo 2 ocorreu em 85% dos pacientes do grupo 1, 83% no grupo 2, e 84% no grupo 3. Não houve diferença estatística na porcentagem de perda do excesso de peso entre os grupos e as medidas da cintura abdominal reduziram de forma homogênea em todos os grupos. A dimensão das alças também não influenciou na melhora da dislipidemia. Conclusão: A variação da dimensão das alças intestinais não influenciou na melhora da síndrome metabólica neste grupo de pacientes.

Surgical Site Infection after Cesarean Delivery in Times of COVID-19 / Infecção de sítio cirúrgico após cesariana em tempos de COVID-19

Abstract Objective To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. Methods A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation asml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. Results There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. Conclusion The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.

Resumo Objetivo Analisar os efeitos da pandemia de COVID-19 sobre o consumo de equipamentos e produtos de proteção individual (EPPI), assim como a frequência de infecção de sítio cirúrgico (ISC) em pacientes não infectadas por COVID-19 submetidas a cesarianas. Métodos Foi realizado umestudo retrospectivo em umamaternidade de um hospital público de ensino que não fazia parte do serviço de referência para o tratamento do COVID-19. Foram comparados o consumo de EPPI e a ocorrência de ISC após cesárea nos períodos mensais antes e após a ocorrência do primeiro caso de COVID-19 em Porto Alegre, RS, Brasil. O consumo de EPPI foimedido emunidades demáscaras, luvas, aventais e gorros, e o uso de produtos à base de álcool ou de sabonete para higienização das mãos em ml/paciente/dia. O índice SSI foi calculado como a proporção de casos de ISC sobre o número de cesarianas realizadas mensalmente durante o período do estudo. Resultados Houve aumento em todos os itens medidos do EPPI, com o consumo de máscaras descartáveis apresentando uma mediana de 1.450 no período pré-COVID e de 2550 no período pós-COVID (aumento de 75,9%). Detectou-se também diminuição de ISC, com medianas de 1,74 no período pré-COVID e de 0,89 no período pós-COVID, com redução de 49% no valor da mediana. Conclusão O aumento do consumo de EPPI pode ser resultado de práticas mais seguras adotadas pelos profissionais de saúde com o advento do COVID-19, do qual a redução na ocorrência de ISC pode ser uma consequência direta. Apesar da gravidade da crise, pode-se afirmar que situações extremas podem gerar reflexões valiosas e oportunidades de melhorias.

Prediction of early mortality after acute stroke.

The purpose of this trial was to identify clinical factors and evaluation studies with significant value as mortality predictors in patients suffering an acute stroke. One hundred forty-eight consecutive patients hospitalized at the Hospital de Clínicas, Montevideo, with a clinical diagnosis of stroke were studied: 85 had ischemic strokes and 63 presented with intracerebral hemorrhages. The potentially predictive variables (past medical history, clinical assessment, neuroimaging, biochemical analysis) were evaluated within the first 24 hours of admission; patient follow-up was performed until they left the hospital or died. The modified National Institutes of Health Stoke Scale (NIHSS) was used to assess neurologic impairment. Three variables were identified as early mortality predictors in this population: (1) Glasgow Coma Scale score < or = 11 on admission (R = 0.19); (2) severe mass effect, defined as the presence of ventricular shift across the midline and/or enlargement of contralateral ventricle in early computed tomography (CT) scan (R = 0.26); and (3) modified NIHSS quotient score > or = 0.26 on admission (R = 0.27). We conclude that modified NIHSS was the most consistent instrument for an early identification of patients at high mortality risk, even before confirmatory evidence of the stroke's nature was obtained. A cutoff of 0.26 on NIHSS quotient score on admission was identified as the most significant predictive value.

Crack/cocaine users show more family problems than other substance users.

OBJECTIVES: To evaluate family problems among crack/cocaine users compared with alcohol and other substance users. METHODS: A cross-sectional multi-center study selected 741 current adult substance users from outpatient and inpatient Brazilian specialized clinics. Subjects were evaluated with the sixth version of the Addiction Severity Index, and 293 crack users were compared with 126 cocaine snorters and 322 alcohol and other drug users. RESULTS: Cocaine users showed more family problems when compared with other drug users, with no significant difference between routes of administration. These problems included arguing (crack 66.5%, powder cocaine 63.3%, other drugs 50.3%, p=0.004), having trouble getting along with partners (61.5%× 64.6%× 48.7%, p=0.013), and the need for additional childcare services in order to attend treatment (13.3%×10.3%×5.1%, p=0.002). Additionally, the majority of crack/cocaine users had spent time with relatives in the last month (84.6%×86.5%×76.6%, p=0.011). CONCLUSIONS: Brazilian treatment programs should enhance family treatment strategies, and childcare services need to be included.

Differences between attendance in emergency care of male and female victims of traffic accidents in Porto Alegre, Rio Grande do Sul state, Brazil.

Driving under the influence of alcohol/ drugs (DUI) is a well-established risk factor for traffic accidents, and men and women have different consumption patterns. The scope of this paper is to analyze differences in alcohol and drug consumption, as well as on behavior associated with traffic accidents among men and women. A cross-sectional study was conducted with 609 sequential traffic accident victims attended in emergency care from Porto Alegre. Subjects gave a structured interview, were breathalyzed and had a saliva test for alcohol/drug screening. Results showed that women were mainly passengers or pedestrians (p < 0.001). There was no significant difference in positive blood alcohol concentration. However, men reported more binge drinking and THC use, while women had more benzodiazepine in their saliva (p<0.05). This is the first Brazilian study to compare alcohol and drug use among men and women who were the victims of traffic accidents. Results point to differences in the pattern of substance abuse, as well on risk behavior. Data may be useful for specific prevention strategies that take gender differences into consideration.