Psychoactive drugs in the Brazilian public health system: Use profile and associated factors

Abstract The purpose of this study is to estimate the prevalence of and characterize the use of psychoactive drugs among drug users in a Brazilian municipality, relating the findings to factors associated with the consumption of these substances. Through a cross-sectional design, 1,355 drug users from the public health systems community pharmacies were interviewed. Sociodemographic and health-related data were collected, as well as any other prescribed drugs. The prevalence of psychoactive drug use within the last month was 31.0%, with antidepressants and benzodiazepines being the most prescribed (53.5% and 24.6% respectively). Most psychoactive drug users were female (81.9%), lived with a partner (52.6%), had private health insurance (69.2%) and a monthly per-capita income up to one minimum wage (54.0%). The adjusted Odds Ratio (OR) confirmed the following factors to be positively associated with the use of psychoactive drugs: female gender (OR=2.06; 95% CI 1.44; 2.95), age ≥60 years old (OR=1.77; 95% CI 1.26; 2.48), follow-up with a psychologist (OR=4.12; 95% CI 1.84; 5.25), absence of regular physical activity (OR=1.59; 95% CI 1.13; 2.23), and smokers (OR=1.94; 95% CI 1.26; 2.97). Approximately one out of three individuals used at least one psychoactive drug. Health managers should focus the planning and actions aimed at their rational use for these groups, leading to increased overall treatment success

Prevalência do uso de substâncias psicoativas em gestantes e puérperas / Prevalencia del consumo de sustancias psicoactivas en mujeres embarazadas y puérperas / Prevalence of psychoactive substance use in pregnant and puerperal women

Objetivo: investigar a prevalência do uso de substâncias psicoativas em gestantes e puérperas atendidas no ambulatório de um Hospital Escola. Método: pesquisa transversal, descritiva, com amostra de 174 gestantes e puérperas. Na coleta de dados, utilizou-se o instrumento padronizado Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) e um questionário sociodemográfico e gineco-obstétrico. A análise de dados foi realizada por meio da estatística descritiva. Resultados: a prevalência de uso de substâncias psicoativas entre as gestantes foi de 28,7 % e 1,1% entre as puérperas, com destaque para o álcool e tabaco. O tabaco constitui a substância com maior frequência de uso; que desencadeia maior desejo/urgência de consumo; maior taxa de tentativas de diminuição. Conclusão: o uso de substâncias psicoativas na gestação e puerpério constitui-se um desafio à saúde pública e para os profissionais de saúde, suscitando o desenvolvimento de ações educativas, bem como a captação precoce dessas mulheres.

Objective: to investigate the prevalence of psychoactive substance use in pregnant and puerperal women attended at an outpatient clinic in a teaching hospital. Method: A descriptive transversal research with a sample of 174 pregnant and puerperal women. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and a sociodemographic and obstetric-gynecologic survey were utilized in data collection. Data analysis was performed through descriptive statistics. Results: the prevalence of psychoactive substance use among pregnant women was of 28.7% and 1.1% among puerperal women, with alcohol and tobacco as highlights. Tobacco constitutes the substance with greater frequency of use, triggering greater desire/urgency of consummation and a higher rate of intake lowering attempts. Conclusion: the use of psychoactive substances among pregnant and puerperal women constitutes a challenge to public health and for health professionals, eliciting the development of educational actions as well as early identification of these women.

Objetivo: investigar la prevalencia del uso de sustancias psicoactivas en mujeres embarazadas y puérperas atendidas en el ambulatorio de un Hospital Escuela. Método: investigación transversal, descriptiva, con una muestra de 174 mujeres embarazadas y puérperas. En la recopilación de datos, se utilizó el instrumento estandarizadoAlcohol, Smoking and Substance Involvement Screening Test (ASSIST) y un cuestionario sociodemográfico y gineco-obstétrico. El análisis de los datos se realizó mediante estadísticas descriptivas. Resultados: la prevalencia del consumo de sustancias psicoactivas entre las embarazadas fue del 28,7%, mientras que entre las puérperas fuel del 1,1%, con destaque para el alcohol y el tabaco. El tabaco constituye la sustancia de mayor frecuencia de uso; que desencadena mayor deseo/urgencia de consumo; mayor tasa de tentativas de disminución. Conclusión: el uso de sustancias psicoactivas en elembarazo y el puerperio constituye un reto para la salud pública y para los profesionales de la salud, suscitando el desarrollo de acciones educativas, así como la captación temprana de estas mujeres.

Uso de sustancias psicoactivas en estudiantes de escuelas secundarias de Rosario (Argentina) / Psychoactive Drugs Use Among High-School Students In Rosario (Argentina)

Resumen El consumo de Sustancias psicoactivas (SPs) es un problema de salud mundial que afecta particularmente a los adolescentes. Por lo tanto, el conocimiento del contacto que los jóvenes tienen con las SPs, permitirá el desarrollo de políticas de prevención. El objetivo del trabajo fue evaluar el contacto con SPs de estudiantes secundarios de Rosario y alrededores. Entre el 2013 y el 2016, contestaron de forma anónima un cuestionario 1064 estudiantes, observándose un aumento significativo del consumo de SPs en el año 2016. Cuando se excluyen el consumo de tabaco y alcohol (SPs legales) el porcentaje permanece constante. El aumento observado se debe al consumo de SPs tales como alcohol y tabaco. Se observó una disminución de la edad de inicio así como un cambio en los porcentajes y patrones de consumo. La SP más consumida fue el alcohol seguida de tabaco o marihuana. Los cambios observados podrían estar relacionados con las edades y los años de cursado de los estudian tes encuestados.

Abstract. Adolescence is characterized by anxiety, peer-pressure, identity search, etc. All these features contribute to experiment with Psychoactive Drugs (P.D.). P.D. use is a global health problem that has its onset during adolescence. The developing of prevention policies according to a specific population needs the knowledge of the levels and patterns of P.D. use. The goal of the present work was to evaluate P.D.'s level of contact and patterns of use among high school students in Rosario (Argentina). Between 2013 and 2016, a total of 1064 students were surveyed. The results showed that P.D. use (at least once in a lifetime) was significantly higher in 2016 compared to previous years. However, when the use of legal vs illegal P.D. was discriminated we found that such increase was due to higher use of alcohol and tobacco; while the illegal P.D. use remained constant. Moreover, in 2016 we found a decrease in the age of onset as well as a change in the patterns of P.D use. However, all these results must be analyzed taking into account intrinsic differences of the sample.

Internações decorrentes do uso de substâncias psicoativas: estudo em um hospital psiquiátrico / Hospitalizations due to the use of psychoactive substances: study in a psychiatric hospital / Internaciones derivadas del uso de sustancias psicoactivas: estudio en un hospital psiquiátrico

Objetivo: Analisar a ocorrência de internação por transtornos psiquiátricos decorrentes do uso de substâncias psicoativas em um hospital psiquiátrico de referência. Método: Estudo censitário, retrospectivo, analítico e de abordagem quantitativa, realizado a partir de 123 registros de internações. Resultados: Obteve-se que a média de idade dos pacientes internados em 2015 foi de 40,7, a maioria era do sexo masculino (66,7%), provenientes da zona urbana (78%) e com histórico de reinternações (52,8%). As múltiplas drogas e outras substâncias psicoativas (39,8%) constituíram-se como as principais substâncias de abuso pelos pacientes. Além disso, verificou-se que, entre os pacientes internados, houve presença de comorbidades psiquiátricas. Conclusão: Diante disso, evidencia-se a necessidade de estratégias voltadas para a prevenção e o tratamento adequado aos distúrbios ocasionados pelo uso de álcool e outras drogas

Objective: To analyze the occurrence of hospitalization for psychiatric disorders resulting from the use of psychoactive substances in a referral psychiatric hospital. Method: A census, retrospective, analytical and quantitative approach, based on 123 records of hospitalizations. Results: The mean age of hospitalized patients in 2015 was 40.7, the majority were male (66.7%), from the urban area (78%) and had a history of readmissions (52, 8%). Multiple drugs and other psychoactive substances (39.8%) were the main substances of abuse by patients. In addition, it was found that among hospitalized patients, there were psychiatric comorbidities. Conclusion: In view of this, it is evident the need for strategies aimed at prevention and appropriate treatment of disorders caused by the use of alcohol and other drugs

Objetivo: Analizar la ocurrencia de internación por trastornos psiquiátricos derivados del uso de sustancias psicoactivas en un hospital psiquiátrico de referencia. Metodo: Estudio censitario, retrospectivo, analítico y de abordaje cuantitativo, realizado a partir de 123 registros de internaciones. Resultados: Se obtuvo que la media de edad de los pacientes internados en 2015 fue de 40,7, la mayoría era del sexo masculino (66,7%), provenientes de la zona urbana (78%) y con histórico de reinternaciones (52, 8%). Las múltiples drogas y otras sustancias psicoactivas (39,8%) se constituyeron como las principales sustancias de abuso por los pacientes. Además, se verificó que, entre los pacientes internados, hubo presencia de comorbilidades psiquiátricas. Conclusión: Ante ello, se evidencia la necesidad de estrategias dirigidas a la prevención y el tratamiento adecuado a los disturbios ocasionados por el uso de alcohol y otras drogas

Characteristics of HIV-infected persons without long term disease progress and related factors in Guangxi Zhuang Autonomous Region / 中华流行病学杂志

Objective: To understand the characteristics of HIV infected persons without long term disease progress [also known as long term non-progressors (LTNPs)], and related factors in Guangxi Zhuang Autonomous Region (Guangxi). Methods: Data of persons living with HIV and receiving no antiretroviral therapy in Guangxi by the end of 2016 were collected from the national HIV/AIDS comprehensive control and prevention information system of China. Results: By the end of 2016, there were 313 LTNPs in Guangxi, accounting for 2.3% of those being reported for more than 10 years, 5.4% of those being reported for more than 10 years and surviving, and 26.6% of those being reported for more than 10 years, surviving and receiving no antiretroviral therapy. Among the LTNPs, 87.2%(273) were men, 94.9% (297) were aged ≤ 40 years, 32.3% (101) were farmers, 55.6% (174) were single, divorced or widowed, 69.3% (217) were of Han ethnic group, 68.1% (213) were injecting drug users, and 52.1% (163) were from custody facilities. Multiple logistic regression analysis indicated that factors associated with delayed disease progression included age ≤40 years (compared with age >40 years, aOR=1.55, 95%CI: 1.31-3.12) and injection drug use (compared with sexual transmission, aOR=1.23, 95%CI: 1.10-1.74). Conclusions: A number of LTNPs existed in HIV-infected individuals in Guangxi. Further research are needed to identify the related factors, and it is necessary to conduct large sample size studies on host immunology, genetics and the virology of HIV to explore the related mechanism.

Prevalence of HCV infection in a prison population of the greater Florianópolis area

Abstract INTRODUCTION The present study aimed to estimate the prevalence of Hepatitis C virus (HCV) infection in a prison population. METHODS: A total of 147 individuals were interviewed and subjected to venipuncture for collection of blood sample. The study population consisted of male individuals who attended the health unit of the state penitentiary of Florianópolis. RESULTS: The prevalence of HCV infection was 5.4%. Regarding behavioral variables, 95 (64.6%, p<0.0507) subjects reported consuming alcohol and 7 (4.8%, p<0.0476) reported having already used injectable drugs. CONCLUSIONS: The prevalence of HCV infection in the studied population was higher than that in the general populations.

New psychoactive substances abuse among patients with access to methadone maintenance treatment in Jiangsu province: a case-control study / 中华流行病学杂志

Objective: To explore the reasons and factors associated with new psychoactive substances abuse among patients with access to methadone maintenance treatment (MMT). Methods: A well-developed questionnaire and urine tests were used to collect information about demographic characteristics, condition of MMT and drug abuse, family and social support of MMT clients. A 1∶1 matched case-control study was conducted, and conditional logistic regression model was used to identify factors associated with new psychoactive substances abuse. Results: A total of 212 (106 pairs) clients receiving MMT were recruited, and most of them were males (78.3%, 166/212), married or cohabitant (48.6%, 103/212) and unemployed (63.2%, 134/212). The average age of the clients was (45.1±7.2) years. The main types of abused new psychoactive substances were benzodiazepine (62.3%, 66/106) and methamphetamine (39.6%, 42/106). The proportion of abusing multi new psychoactive substances was 8.5% (9/106). Results from multivariate conditional logistic regression analysis indicated that using opioid drug during the past 6 months of MMT treatment might increase the risk of abusing new psychoactive substances (OR=3.25, 95%CI: 1.35-7.79), benzodiazepine (OR=3.25, 95%CI: 1.11- 9.47) and methamphetamine (OR=13.31, 95%CI: 1.12-158.01). Moreover, MMT for more than9 years reduced the risk of abuse of new psychoactive substances (OR=0.03, 95%CI: 0.01-0.21), benzodiazepine (OR=0.02, 95%CI: 0.00-0.36) and methamphetamine (OR=0.02, 95%CI: 0.00-0.69). Conclusion: Less new psychoactive substances abuse might be associated with longer duration of MMT treatment. And inappropriate support from family and friends might increase the risk of abusing new psychoactive substances in MMT clients, especially in clients who used opioid.

Study on the prevalence of HIV infection and related risk behaviors among male new-type drug users in Qingdao, Shandong province / 中华流行病学杂志

Objective: To understand the characteristics of new-type drug consumption, sexual behaviors and the prevalence of HIV infection among male new-type drug users in Qingdao, Shandong province. Methods: A cross sectional survey was conducted from 2015 to 2016. Participants were recruited from MSM community-based organizations (CBO) and general community through snowball method, relying on volunteers and male peer educators who were on new-type drugs themselves. Face-to-face interview was carried to collect information on drug use and sexual behaviors. Blood samples were collected to test HIV, syphilis and HCV antibodies. Urine samples were collected to test the evidence of new-type drugs. Qualitative variables and quantitative variables were analyzed using Chi-square test/Fisher's exact test and Student's t-test respectively. Multivariate logistic regression was used to analyze related factors of binary variables. Results: A total of 1 034 newtype drug users were recruited, including 431 (41.7%) MSM population and 603 (58.3%) who were not MSM. Compared with the the group of people who were not MSM, people in the the MSM group were younger, unmarried and with higher level of education. The proportion of methamphetamine users were 49.7% (214/431) and 100.0% (603/603) among the groups of MSM or not MSM, respectively. People in the MSM group, 66.8% (288/431) used 5-Methoxy-N, N-diisopropyltryptamine (5-MeODIPT, "foxy" ) in the last six months. However, none from the not-MSM group ever used 5-MeO-DIPT. In the last six months, proportions of sharing new-type drugs with more than two people in the MSM or not groups were 87.9% (379/431) and 97.7% (588/602), respectively (χ(2)=39.84, P<0.01). Proportions of unprotected sexual behavior among the MSM or not groups were 47.5% (285/600) and 7.4% (32/430) respectively (χ(2)=190.10, P<0.01). The proportions of 'group sex' after using drugs among the two groups were 78.1% (335/429) and 5.5% (33/600) respectively (χ(2)=573.73, P<0.01). The prevalence rates of HIV, syphilis and HCV antibody positive among the MSM or not groups were 2.1% and 0.2%, 3.3% and 6.3%, 0.0% and 0.3%, respectively. Conclusion: The prevalence of sharing new-type drugs with more than two people was high among male new-type drug users in Qingdao city. Male new-type-drug-users who were MSM, presented both high prevalence of group sex and HIV infection, and with less condom use. Intervention measures towards this sub-population should be strengthened.

Consumo de drogas e fatores associados: estudo transversal com adolescentes escolares do ensino fundamental / Drug use and associated factors: a cross-sectional study with elementary school adolescents

Objetivo: estimar a prevalência do consumo de drogas entre adolescentes escolares e a sua associação com variáveis sociodemográficas e sexuais. Método: estudo transversal realizado por meio de entrevista estruturada com 239 estudantes do ensino fundamental de uma escola pública da rede estadual da Bahia, Brasil. Os dados foram processados pelo programa Stata, versão 12, e analisados segundo a estatística descritiva e inferencial. Resultado: a prevalência de adolescentes que haviam consumido drogas no último mês foi de 25,92%. Houve associação estatística entre a variável consumo de drogas e religião (RP = 1,88 e IC95%= 1,03 ­ 3,41), série de estudo (RP = 2,0 e IC95% = 1,03 ­ 3,85) e trabalho (RP = 3,68 e IC95% = 1,08 ­ 12,54). Conclusão: identifi ou-se elevada prevalência de consumo de drogas entre adolescentes escolares e sua associação com a baixa escolaridade, a falta de prática religiosa e a precocidade no trabalho e na relação sexual. (AU)

Aim: to estimate the prevalence of drug use among school adolescents and its association with sociodemographic and sexual variables. Method: a cross-sectional study conducted through a structured interview with 239 elementary school students from a public school in the state of Bahia, Brazil. Data were processed by the Stata program, version 12, and analyzed according to descriptive and inferential statistics. Results: the prevalence of adolescents who had used drugs in the last month was 25.92%. There was a statistical association between variable drug use and religious identification (PR=1.88 and 95%CI=1.03 - 3.41), study series (PR=2.0 and 95%CI =1.03 - 3.85) and work (PR=3.68 and 95%CI =1.08-12.54). Conclusion: high prevalence of drug use among school-age adolescents and its association with low schooling, lack of religious practice, and precocious work and sexual intercourse were identified. (AU)

Mulheres usuárias de crack: conhecendo suas histórias de vida / Women crack users: knowing their life stories / Mujeres usuarias de crack: conociendo sus historias de vida

Objetivo: Conhecer o significado e as repercussões do uso de crack por mulheres, a partir de suas histórias de vida. Métodos: Estudo qualitativo, tipo História de Vida, desenvolvido em uma Unidade de Internação Psiquiátrica de um hospital em Porto Alegre, Rio Grande do Sul, de maio a agosto de 2012, utilizando-se o referencial de Daniel Bertaux como suporte metodológico. Realizaram-se seis entrevistas, com mulheres usuárias de crack. Resultados: O conhecimento do contexto social do uso de crack por mulheres evidencia um universo de significados, em que há uma complexidade quanto ao fenômeno que vai além de entendimentos simplificados e ideias pré-concebidas. Além disso, os depoimentos das mulheres descortinaram realidades sofridas, permeadas por violência, desestrutura familiar, dependência química. Conclusões: Esta investigação pode contribuir para a execução de ações em saúde mental pautadas nas necessidades da usuária de crack, permitindo um cuidado voltado para o social, transformador de realidades.

Objective: To know the meaning and the implications of the use of crack by women, from their life stories. Methods: Qualitativestudy, like Life Story, developed in a Psychiatric Unit of a hospital in Porto Alegre, Rio Grande do Sul, from May to August of 2012,using the referential of Daniel Bertaux as methodological support. Six interviews were held with women users of crack. Results:Knowledge of the social context of crack consume by women shows a universe of meanings, in which there is a complexityabout the phenomenon that goes beyond simplified understandings and preconceived ideas. In addition, the testimony of womenunveils suffered realities, permeated by violence, family dysfunction and chemical addiction. Conclusion: This research maycontribute to the implementation of actions in mental health, based on the needs of the users of crack, allowing a care focusedon the social, a tool of transformation of realities.

Objetivo: Conocer el significado y los efectos del uso de crack por mujeres, a partir de sus historias de vida. Métodos: Estudiocualitativo, del tipo Historia de Vida, desarrollado entre Mayo y Agosto de 2012 en una Unidad de Internación Psiquiátrica deun hospital de Porto Alegre (RS), utilizando el referencial de Daniel Bertaux como soporte metodológico. Fueron realizadasentrevistas con seis mujeres. Resultados: El conocimiento del contexto social en el consumo de crack por mujeres revelaun universo de sentidos donde hay una complejidad cuanto al fenómeno que va más allá de interpretaciones simplificadase ideas preconcebidas. Además, los testimonios descortinaran realidades permeadas por la violencia, desorden familiar ydependencia química. Conclusión: Esta investigación puede contribuir para la implementación de acciones en salud mental,reglamentadas por las necesidades de las usuarias de crack, permitiendo una atención direccionada al social, herramienta detransformación de la realidad.

Rede de saúde no atendimento ao usuário de álcool, crack e outras drogas / Health network assisting users of alcohol, crack, and other drugs / Red de salud en la atención a los usuarios de alcohol, crack y otras drogas

Objetivo: Analisar, na perspectiva dos enfermeiros, a articulação de uma rede de saúde para o atendimento aos usuários de álcool, crack e outras drogas. Métodos: Estudo observacional, descritivo, exploratório, com abordagem quantitativa, desenvolvido em um município litorâneo do estado do Piauí, Brasil, com 56 enfermeiros por meio da aplicação de questionários. Resultados: A maioria dos enfermeiros (82,0%) afirmou que os locais de saúde onde trabalham articulam-se com outros serviços da Rede de Saúde na assistência ao usuário de álcool, crack e outras drogas, principalmente por meio do encaminhamento a um serviço de saúde mental (48,8%). A integração entre as equipes (46,3%) e a corresponsabilidade ao usuário e sua família foi considerada razoável (51,2%). A presença de dificuldades no processo de articulação foi informada pelos enfermeiros que afirmaram utilizar estratégias para superá-las. Dentre as dificuldades informadas, 40,5% estiveram relacionadas ao desrespeito ao sistema de referência e contra referência. Conclusão: Ressalta-se a necessidade da realização de debates para tratar do funcionamento e articulação em rede para atenção a esses usuários.

Objective: This study has the goal to analyze the articulation of the health network to assist users of alcohol, crack and otherdrugs from a nurses' perspective. Methods: This is an observational, descriptive, and exploratory study with a quantitativeapproach. It was conducted in the health network in a coastal city in the state of Piaui, Brazil, with 56 nurses who answered aquestionnaire. Results: The majority of nurses (82.0%) reported that the place where they work is articulated with other healthnetwork services for assistance to users of alcohol, crack and other drugs. Mainly, it happens by using the referral to a mentalhealth service (48.8%). The integration among the health staff (46.3%), and the responsibility with the user and his/her family wasconsidered fair (51.2%). In fact, nurses who said that they use strategies to overcome this situation also informed the presenceof difficulties on the integration process. Among the difficulties that were reported, 40.5% of them was related to disrespect forthe reference and counter reference system. Conclusion: Thus, it is necessary to promote debates in order to discuss thefunctioning and coordination of the health network that assist these users.

Objetivo: Analizar, según la perspectiva de los enfermeros, la articulación de la red de salud para atender a los usuarios dealcohol, crack y otras drogas. Métodos: Estudio observacional, descriptivo y exploratorio, con enfoque cuantitativo, desarrollado,en una ciudad costera en el estado de Piauí, Brasil, con 56 enfermeros a través del uso de cuestionarios. Resultados: La mayoríade los enfermeros (82,0%) dijo que los locales de salud donde trabajan son articulados con otros servicios de la Red de Saluden la asistencia a los usuarios de alcohol, crack y otras drogas, principalmente a través de la derivación a un servicio de saludmental (48,8%). La integración de los equipos (46,3%) y la corresponsabilidad al usuario y su familia se consideró razonable(51,2%). La presencia de dificultades en el proceso de integración fue informada por los enfermeros que dijeron que usanestrategias para superarlas. Entre las dificultades señaladas, 40,5% estuvieron relacionadas con la falta de respeto al sistemade referencia y contra referencia. Conclusión: Hacemos hincapié en la necesidad de debates para discutir el funcionamientoy articulación en red para la atención a estos usuarios.

Representações sociais de discentes técnicos de enfermagem sobre drogas / Nursing technician students’ social representations on drugs

Discutir as representações sociais de discentes de um curso técnico de enfermagem acerca da problemática das drogas. Pesquisa qualitativa fundamentada na Teoria das Representações Sociais, envolvendo 98 discentes, para as quais foram aplicadas as técnicas de associação livre de palavras (TALP), grupo focal e entrevista. Os dados do TALP foram processados no software estatístico STATA. A identificação de termos com significância estatística norteou a análise de conteúdo para as demais técnicas, gerando duas categorias temáticas. A droga foi representada como objeto de destruição da pessoa, família e sociedade. A imagem da pessoa usuária de drogas aparece vinculada ao sexo masculino, jovem, de cor preta, morador da periferia e pobre. As representações sociais ressaltam aspectos de experiências e do contexto sociocultural das estudantes acerca das drogas, evidenciando demandas na formação dessas profissionais para integralidade da assistência...

Non-adherence to telemedicine interventions for drug users: systematic review / Não adesão em intervenções por telemedicina para usuários de drogas: revisão sistemática

OBJECTIVE To estimate rates of non-adherence to telemedicine strategies aimed at treating drug addiction. METHODS A systematic review was conducted of randomized controlled trials investigating different telemedicine treatment methods for drug addiction. The following databases were consulted between May 18, 2012 and June 21, 2012: PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library), Embase, Clinical trials and Google Scholar. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the studies. The criteria evaluated were: appropriate sequence of data generation, allocation concealment, blinding, description of losses and exclusions and analysis by intention to treat. There were 274 studies selected, of which 20 were analyzed. RESULTS Non-adherence rates varied between 15.0% and 70.0%. The interventions evaluated were of at least three months duration and, although they all used telemedicine as support, treatment methods differed. Regarding the quality of the studies, the values also varied from very poor to high quality. High quality studies showed better adherence rates, as did those using more than one technique of intervention and a limited treatment time. Mono-user studies showed better adherence rates than poly-user studies. CONCLUSIONS Rates of non-adherence to treatment involving telemedicine on the part of users of psycho-active substances differed considerably, depending on the country, the intervention method, follow-up time and substances used. Using more than one technique of intervention, short duration of treatment and the type of substance used by patients appear to facilitate adherence. .

OBJETIVO Estimar taxas de não adesão em intervenções com estratégias de telemedicina para tratamento de dependência química. MÉTODOS Foi realizada revisão sistemática de ensaios clínicos randomizados com diferentes métodos terapêuticos de dependência química que incluíam telemedicina. Foram consultadas as bases de dados PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library), Embase e Clinical Trials e a plataforma Google Scholar no período de 18/4/2012 a 21/6/2012. Para avaliar a qualidade dos estudos, utilizou-se a escala Grading of Recommendations Assessment, Development and Evaluation . Os critérios avaliados foram: adequada sequência da geração de dados, ocultação da alocação, cegamento, descrição das perdas e exclusões e análises por intenção de tratar. Foram selecionados 274 estudos, dos quais 20 foram analisados. RESULTADOS As taxas de não adesão variaram entre 15,0% e 70,0%. As intervenções avaliadas possuíam no mínimo três meses de intervenção e, embora todos utilizassem a telemedicina como apoio, os métodos de tratamentos foram diferentes. Em relação à qualidade dos estudos, os valores também variaram entre muito baixa qualidade e alta qualidade. Os estudos com qualidade alta demonstraram maiores taxas de adesão, bem como aqueles que utilizaram mais de uma técnica de intervenção e tempo limitado de tratamento. Estudos com monousuários apontaram maiores taxas de adesão que estudos com poliusuários. CONCLUSÕES As taxas de não adesão a tratamentos para usuários de substâncias psicoativas por meio de telemedicina apresentaram consideráveis diferenças, dependendo do país, método da intervenção, tempo de seguimento ...

Correlates of unprotected sex in a sample of young club drug users

OBJECTIVES: To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. METHODS: This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. RESULTS: Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PR = 1.26; 95% confidence interval (CI): 1.044-1.543; p = 0.017) and the use of alcohol/drugs to make sex last longer (PR = 1.430; 95% CI: 1.181-1.732; p<0.001) are associated with unprotected sex. CONCLUSIONS: The implementation of intervention strategies aimed at reducing sexually risky behaviors should take into consideration the specific characteristics of drug users and should include the development of safer sex negotiation skills. .

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence / Agresores y resilientes en Medellín, Colombia: necesidad de un cambio de paradigma para superar la violencia / Agressores e resilientes em Medellín, Colômbia: necessidade de uma mudança de paradigma, a fim de superar a violência

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Los objetivos fueron estimar la proporción de jóvenes resilientes y comparar dicha proporción con la de jóvenes con conductas agresivas y con otras conductas de riesgo. Estudio transversal en una muestra representativa de personas entre los 12 a 60 años, habitantes de Medellín, Colombia, y el área metropolitana (N = 4.654). Muestreo probabilístico polietápico. Se seleccionaron los jóvenes entre 14-26 años para el presente análisis (n = 1.780). La proporción de jóvenes resilientes es de un 22,9%, la de agresores un 11,3%, la de jóvenes con otras conductas de riesgo es de un 65,8%. La alta proporción de jóvenes resilientes obliga a reorientar las políticas públicas de la prevención terciaria y el control de la violencia a la promoción de las conductas resilientes y al desarrollo positivo de los niños y jóvenes en la sociedad.

Os objetivos foram estimar a proporção de jovens resistentes e compará-la com jovens com condutas agressivas, e jovens que também apresentam comportamento sexual de risco e uso de drogas. Estudo transversal de uma amostra representativa de pessoas com idades entre 12 e 60 anos, habitantes de Medellín e sua área metropolitana, na Colômbia (N = 4.654), foi utilizado a partir de amostragem probabilística multiestágio. Jovens entre 14 e 26 anos foram selecionados para a presente análise (n = 1.780). A proporção de jovens resistentes foi de 22,9%, de agressores 11,3%, e de jovens com conduta de risco foi de 65,8%. A alta proporção de jovens resistentes força uma reorientação das políticas públicas para a prevenção e controle da violência, privilegiando a promoção de condutas de resistência ao invés de continuar com ações de prevenção terciária.

Detection of the B"-GWGR variant in the southernmost region of Brazil: unveiling the complexity of the human immunodeficiency virus-1 subtype B epidemic

Typical human immunodeficiency virus-1 subtype B (HIV-1B) sequences present a GPGR signature at the tip of the variable region 3 (V3) loop; however, unusual motifs harbouring a GWGR signature have also been isolated. Although epidemiological studies have detected this variant in approximately 17-50% of the total infections in Brazil, the prevalence of B"-GWGR in the southernmost region of Brazil is not yet clear. This study aimed to investigate the C2-V3 molecular diversity of the HIV-1B epidemic in southernmost Brazil. HIV-1 seropositive patients were ana-lysed at two distinct time points in the state of Rio Grande do Sul (RS98 and RS08) and at one time point in the state of Santa Catarina (SC08). Phylogenetic analysis classified 46 individuals in the RS98 group as HIV-1B and their molecular signatures were as follows: 26% B"-GWGR, 54% B-GPGR and 20% other motifs. In the RS08 group, HIV-1B was present in 32 samples: 22% B"-GWGR, 59% B-GPGR and 19% other motifs. In the SC08 group, 32 HIV-1B samples were found: 28% B"-GWGR, 59% B-GPGR and 13% other motifs. No association could be established between the HIV-1B V3 signatures and exposure categories in the HIV-1B epidemic in RS. However, B-GPGR seemed to be related to heterosexual individuals in the SC08 group. Our results suggest that the established B"-GWGR epidemics in both cities have similar patterns, which is likely due to their geographical proximity and cultural relationship.

Occult hepatitis B virus infection among injecting drug users in the Central-West Region of Brazil

The prevalence of occult hepatitis B virus (HBV) infection was investigated in 149 hepatitis B surface antigen (HBsAg) negative injecting drug users (IDUs) in the Central-West Region of Brazil. Of these individuals, 19 were positive for HBV DNA, resulting in an occult HBV infection prevalence of 12.7% (19/149); six of these 19 individuals had anti-HBV core and/or anti-HBV surface antibodies and 13 were negative for HBV markers. All IDUs with occult hepatitis B reported sexual and/or parenteral risk behaviours. All HBV DNA-positive samples were successfully genotyped. Genotype D was the most common (17/19), followed by genotype A (2/19). These findings reveal a high prevalence of occult HBV infection and the predominance of genotype D among IDUs in Brazil's Central-West Region.

Condiciones personales y ambientales de los conductores de buses de Medellín relacionadas con el consumo de sustancias psicoactivas / Personal and environmental conditions of bus drivers in Medellín related to the consumption of psychoactive substances

El escrito es producto de un estudio realizado en la Fundación Universitaria Luis Amigo, Facultad de Psicología, por el Grupo de investigación en farmacodependencia en el año 2012, denominado: Consumo de sustancias psicoactivas en conductores de buses del sector de trasporte público de Medellín. En él, además de describir las drogas más consumidas, se presentan las prevalencias de consumo y los posibles factores de riesgo. Es un estudio descriptivo, con muestreo probabilístico de los conductores de la ciudad de Medellín. Con aplicación de encuesta y análisis estadístico mediante el programa SPSS. Entre los resultados se destaca un consumo alto de cigarrillo, alcohol y marihuana, lo que puede estar relacionado con sus largas jornadas, pocas horas de sueño, situación de estrés, condiciones de peligro en los viajes y delincuencia en sus terminales y en las rutas.

The writing is the product of a study carried out at the Luis Amigo University Foundation, Faculty of Psychology, by the Drug Dependence Research Group in 2012, called: Consumption of psychoactive substances in bus drivers in the public transport sector of Medellín. In it, in addition to describing the most consumed drugs, the prevalences of consumption and possible risk factors are presented. It is a descriptive study, with probabilistic sampling of drivers in the city of Medellín. With application of survey and statistical analysis through the SPSS program. Among the results, a high consumption of cigarettes, alcohol and marijuana stands out, which may be related to their long hours, few hours of sleep, stress situation, dangerous conditions in travel and crime in their terminals and on the routes.

Adolescentes e o uso de drogas ilícitas: um estudo transversal / Adolescents and the use of illegal drugs: a cross-sectional study / Adolescentes y el uso de drogas ilegales: un estudio transversal

Objetivou-se estimar a prevalência do uso de drogas ilícitas por adolescentes. Estudo de delineamento transversal desenvolvido por meio de inquérito epidemiológico, realizado em escolas públicas de Teresina-Piauí, aleatoriamente sorteadas, as quais estão inseridas na área norte do município. A amostra foi composta por 196 adolescentes. Os dados foram coletados em outubro e novembro de 2010, posteriormente digitados e processados com a utilização do software Epi-Info versão 6.04b. Foi obtida uma prevalência do consumo de drogas ilícitas de 17,9%. Os fatores relacionados ao uso de drogas pelos adolescentes estão relacionados aos locais que frequentam, tais como: casa de amigos (42,9%), boates e bares (34,3%). As drogas consumidas pelos adolescentes foram maconha (60%), crack (20%), solventes (11,4%) e outras (17,6%). Conhecer a realidade que permeia o consumo de drogas a partir da estimativa dessa prevalência corrobora o redirecionamento de políticas e ações em saúde voltadas para a redução deste consumo e das comorbidades associadas a esta prática.

This study aimed at estimating the prevalence of illicit drug use among adolescents. Cross-sectional study developed through epidemiological survey. Held in randomly drawn state-owned schools north of Teresina, Piauí, Brazil. The sample consisted of 196 (one-hundred ninety-six) adolescents. Data were collected from October to November, 2010, and were subsequently entered and processed on the basis of Epi-Info version 6.04b. Prevalence of illicit drug use was 17.9%. Factors related to drug use by adolescents are associated to the places they usually hang around at, such as friends’ homes (42.9%), nightclubs, and bars (34.3%). Drugs used were marijuana (60%), crack (20%), solvents (11.4%), and others (17.6%). Assessing the reality of drug consumption from the estimate of prevalence helps the redirection of health policies and actions aimed at reducing consumption and comorbidity levels associated with that practice.

El objetivo fue estimar la prevalencia del consumo de drogas ilícitas por adolescentes. Estudio transversal desarrollado a través de encuesta epidemiológica, realizado en escuelas públicas de Teresina-Piauí-Brasil, elegidas al azar, que se insertan en el norteño municipio. La muestra consistió de 196 adolescentes. Los datos fueron recolectados entre octubre y noviembre de 2010, posteriormente ellos fueron digitados y procesados en la versión 6.04b del Epi-Info. Se obtuvo una prevalencia del consumo de drogas ilícitas de 17,9%. Factores relacionados con el consumo de drogas por los adolescentes se relacionan con los lugares que frecuentan, tales como casa de amigos (42,9%), discotecas y bares (34,3%). Los fármacos utilizados por los adolescentes fueron la marihuana (60%), crack (20%) y solventes (11,4%), y otros (17,6%). Conocer la realidad que impregna el consumo de drogas a partir de la estimativa de esa prevalencia apoya la reorientación de políticas y acciones en salud destinadas a reducir este consumo y las comorbilidades asociadas a esta práctica.