Psychoactive substances use before suicide: detailed analysis of all cases that occurred in the Brazilian Federal District in a 10-years period.

BACKGROUND: Psychoactive substances (PASs) are an important risk factor for suicide. This study investigated the sociodemographic characteristics, data related to the suicidal behavior, the methods employed, the circumstances of the events, and the use of PASs before dying in all suicides that occurred between 2005-2014 in the Brazilian Federal District, comparing cases with positive and negative detection for PASs in the post-mortem analysis to identify groups at greatest risk. METHODS: A population-based, observational, cross-sectional study with an analytical aspect was conducted with suicides cases collected from local police, which toxicological examination was performed (headspace gas chromatographic-mass spectrometry-HS-GC/MS) for detection of ethanol and methanol in blood samples; immunoassay for other substances (cocaine, marijuana, benzodiazepine). RESULTS: The results showed that the increase in the suicide rate was 10 × greater than the population growth, and 44% of the individuals used PASs before suicide. Individuals are more likely to die by suicide at home, be male, have tried before, and change their behavior days before death; they choose to hang as the method and are influenced by alcohol. CONCLUSION: Identifying what sociodemographic characteristics are associated with a fatal suicide attempt among individuals who use PASs and those who do not use and those who have/do not have mental disorders and what methods are employed could be employed as a path to better interventions. Thus, prevention actions could be planned and directed to individuals with greater risk.

Suppression of the postprandial hyperglycemia in patients with type 2 diabetes by a raw medicinal herb powder is weakened when consumed in ordinary hard gelatin capsules: A randomized crossover clinical trial.

INTRODUCTION: Contradictory claims about the efficacy of several medicinal plants to promote glycemic control in patients with type 2 diabetes mellitus (T2DM) have been explained by divergences in the administration form and by extrapolation of data obtained from healthy individuals. It is not known whether the antidiabetic effects of traditional herbal medicines are influenced by gelatin capsules. This randomized crossover trial aimed to evaluate the acute effect of a single dose of raw cinnamon consumed orally either dissolved in water as a beverage or as ordinary hard gelatin capsules on postprandial hyperglycemia (>140 mg/dL; >7.8 mmol/L) in T2DM patients elicited by a nutritionally-balanced meal providing 50 g of complex carbohydrates. METHODS: Fasting T2DM patients (n = 19) randomly ingested a standardized meal in five experimental sessions, one alone (Control) and the other after prior intake of 3 or 6 g of crude cinnamon in the form of hard gelatin capsules or powder dissolved in water. Blood glucose was measured at fasting and at 0.25, 0.5, 0.75, 1, 1.5 and 2 hours postprandially. After each breakfast, its palatability scores for visual appeal, smell and pleasantness of taste were assessed, as well as the taste intensity sweetness, saltiness, bitterness, sourness and creaminess. RESULTS: The intake of raw cinnamon dissolved in water, independently of the dose, decreased the meal-induced large glucose spike (peak-rise of +87 mg/dL and Δ1-hour glycemia of +79 mg/dL) and the hyperglycemic blood glucose peak. When cinnamon was taken as capsules, these anti-hyperglycemic effects were lost or significantly diminished. Raw cinnamon intake did not change time-to-peak or the 2-h post-meal glycaemia, but flattened the glycemic curve (lower iAUC) without changing the shape that is typical of T2DM patients. CONCLUSIONS: This cinnamon's antihyperglycemic action confirms its acarbose-like property to inhibit the activities of the carbohydrate-digesting enzymes α-amylases/α-glucosidases, which is in accordance with its exceptionally high content of raw insoluble fiber. The efficacy of using raw cinnamon as a diabetes treatment strategy seems to require its intake at a specific time before/concomitantly the main hyperglycemic daily meals. Trial registration: Registro Brasileiro de Ensaios Clínicos (ReBEC), number RBR-98tx28b.

Effects of working in vulnerable contexts on the mental health of primary healthcare professionals during the COVID-19 pandemic: a mixed-methods study.

OBJECTIVE: The objective of this study is to analyse the relationship and psychosocial issues between working during the COVID-19 pandemic in primary healthcare (PHC) facilities located in the most vulnerable health region (HR) of the Federal District of Brazil (FDB) compared with a lesser region. DESIGN: Mixed-method study data. The questionnaire was based on the World Health Survey and the Convid Behavioural Survey. Quantitative data were described in absolute and relative frequency. Pearson's χ2 test verified differences according to the region (significance level <5%). A margin of error of 8% with 95% CI defined the sample. The content analysis (by Bardin) analysed the qualitative data. SETTING: A representative sample of PHC professionals working at the Western HR and Central HR of the FDB. PARTICIPANTS: 111 women and 27 male PHC professionals, aged ≥ 18 years. OUTCOME MEASURES: Psychosocial variables-personal emotions towards the clients, social relationships and use of psychoactive substances (PAS). INTERVENTION: An online questionnaire (27 questions) and 1 open-ended question. RESULTS: The sample comprised 138 PHC professionals; 80.40% were female aged between 40 and 49 years old (27.3%); declared themselves as black/pardo (58.7%); were married (53.60%), and worked in family healthcare teams (47.80%). No association between working in the most vulnerable HR compared with the least one and presenting psychosocial issues, except for anger towards clients (p=0.043). 55.10% worked much more than usual, 60.80% reported being depressed, 78.20% anxious, 76.80% stressed, 77.50% had no empathy and 78.30% felt isolated from family/friends. Towards the clients, 59.40% reported empathy and 72.5% no affection/care. The consume of psychotropic medications was reported by 34.80%, and 14.50% increased alcohol/PAS use. Qualitative data leverage quantitative findings: work overload, the indifference of the Federal Government and distance from family/friends. CONCLUSION: Working in the most vulnerable region and in the least one affects the psychosocial aspects of the PHC professionals equally.

Acute Flaxseed Intake Reduces Postprandial Glycemia in Subjects with Type 2 Diabetes: A Randomized Crossover Clinical Trial.

Background: Postprandial glycemic excursions are associated with impairment control of diabetes mellitus. Long-term consumption of flaxseed can lower blood glucose levels; however, its effects on the postprandial glycemic response remain unknown. Therefore, this study aimed to evaluate the acute effects of raw flaxseed consumption on the 2 h postprandial glycemic curve in men with type 2 diabetes mellitus (T2DM). Methods: This was a randomized crossover clinical trial. Nineteen men with T2DM were randomly assigned a standardized breakfast without (control) or with a previous intake of 15 g of ground raw golden flaxseed (flax). Glycemia was measured at fasting and postprandial at 15, 30, 45, 60, 90, and 120 min. Palatability markers (visual appeal, smell, and pleasantness of taste) and taste intensity (sweetness, saltiness, bitterness, sourness, and creaminess) were evaluated. Results: The peak glucose rise and the 2 h AUC glycemic response reduced in the flax group by 17% (p = 0.001) and 24% (p < 0.001), respectively. The glucose peak time, palatability, and taste parameters did not differ between the two groups. Conclusions: Ingestion of 15 g of ground raw golden flaxseed before breakfast decreases the 2 h postprandial glycemic response in men with T2DM.

The Increased Alcohol and Marijuana Use Associated with the Quality of Life and Psychosocial Aspects: a Study During the Covid-19 Pandemic in a Brazilian University Community.

The primary practice adopted to reduce Covid-19 contamination is social distancing (SD). SD had significant consequences on alcohol/drug use, quality of life, and psychosocial aspects. In the university community specifically, SD produces a collective traumatic event with changes in the work routine by the suspension of presence. This study aims to identify and analyze the associations of increased alcohol and marijuana consumption on the quality of life and psychosocial aspects of the university community (students, professors, and technical and administrative staff) at a Brazilian public university during SD due to Covid-19 pandemic. This descriptive and cross-sectional study used an online questionnaire to obtain information from 2790 university community participants. Data were analyzed using IBM SPSS Statistics version 22. The analysis included descriptive associations performed using Spearman's correlation coefficient and p < 0.05 was taken as statistically significant. The participants' majority was 62% female, 95.4% students, 73% were 17-25 years old, 33.4% had income between 1 and 3 minimum wage, and 48% of the university community "totally adhered to SD." The increased alcohol consumption during SD was associated with a worsening in quality of life (p = 0.001), health satisfaction (p = 0.015), the meaning of life (p = 0.040), ability to concentrate (p = 0.001), satisfaction with yourself (p = 0.029), and frequency of negative feelings (p = 0.001); in contrast, increased alcohol use improved satisfaction with peer support (p = 0.042), as well as increased marijuana use improved satisfaction with sex life (p < 0.001). The increased alcohol use was higher in women (30.5%) than in men (26.7%) and was negatively associated with more quality of life and psychosocial aspects among women than men. Students were the segment that presented the highest frequency of associations with increased alcohol and/or marijuana use in the three domains analyzed. This study innovated by associating increased alcohol and/or marijuana use with worsening quality of life and psychosocial aspects rather than evaluating them apart. Future studies must identify whether this association between increased alcohol use, mainly, and the worsening quality of life and psychosocial aspects during the SD period is maintained or improved with the return to face-to-face activities at the university, with particular attention to women and students. Psychologists and other mental health professionals should be called upon to develop interventions to meet emerging mental health needs.

Evaluation of the potential use of cannabidiol in the treatment of cocaine use disorder: A systematic review.

BACKGROUND: Cannabinoids may have an important therapeutic potential for the treatment of dependence on crack cocaine. Cannabidiol (CBD), in particular, has anxiolytic, antipsychotic and anticonvulsant properties and plays a role in regulating motivation circuitry and controlling sleep disorders. Several studies were performed evaluating CBD in experimental models for cocaine. This systematic review aims evaluate the potential use of CBD in the treatment of cocaine use disorder. METHOD: Five databases (Scielo; Medline/PubMed; PsycINFO; Cochrane Library; Virtual Health Library-VHL) were searched up to January 2020. Full-text reports published in English were included if they were experimental studies that administered CBD to human and/or adult animals in use or with a history of crack/cocaine administration. The risk of bias of each study selected was appraised by two independent reviewers following the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) protocol. MAJOR FINDINGS: Fifty-one studies were analyzed, and 14 were selected. No studies conducted with humans were found; only one clinical trial was ongoing. The results were grouped into the following categories: cocaine self-administration, brain-stimulation reward, conditioned place preference, neuronal proliferation, anxiety, hepatic protection, anticonvulsant effect and locomotor sensitization response Only four studies had a low risk of bias. CBD promotes reduction on cocaine self-administration. Also, it interferes in cocaine induce brain reward stimulation and dopamine release. CBD promotes alteration in contextual memory associated with cocaine and in the neuroadaptations, hepatotoxicity and seizures induced by cocaine. CONCLUSION: The evidence indicates that CBD is a promising adjunct therapy for the treatment of cocaine dependence due to its effect on: cocaine reward effects, cocaine consumption, behavioral responses, anxiety, neuronal proliferation, hepatic protection and safety. Moreover, clinical trials are strongly required to determine whether the findings in animal models occur in humans diagnosed for cocaine or crack cocaine use disorder.

Práticas de articulação de rede na atenção psicossocial: quais desafios enfrentam os profissionais para matriciar, reunir-se e encaminhar? / Prácticas de articulación de red en la atención psicosocial: ¿Cuáles son los desafíos enfrentados por los profesionales para realizar el apoyo matricial, reunirse y derivar? / Network articulation practices in psychosocial care: what challenges do professionals face in matriciar, meeting, and referring?

Este estudo se propôs a explorar as práticas de articulação de rede desenvolvidas pelos profissionais atuantes em dois pontos da Rede de Atenção Psicossocial do Distrito Federal: os Centros de Atenção Psicossocial Álcool e outras Drogas e as Unidades Básicas de Saúde, abrangendo as sete regiões de saúde existentes, evidenciando as estratégias utilizadas, bem como as dificuldades e os desafios que atravessam sua implementação à luz do modelo de Atenção Psicossocial (AP). Trata-se de uma pesquisa com abordagem qualitativa e enfoque exploratório com 36 participantes entrevistados; utilizou-se a triangulação intramétodo e adotou-se a análise de conteúdo de Bardin. Identificaram-se a falta de infraestrutura e de insumos para tecer as práticas de matriciamento, reuniões com a rede e encaminhamentos de forma satisfatória, conforme a perspectiva dos participantes. Contudo, surgiram estratégias interventivas e de promoção de saúde para o fortalecimento da AP.(AU)

La propuesta de este estudio es explorar las prácticas de articulación de red desarrolladas por los profesionales actuantes en dos puntos de la Red de Atención Psicosocial del Distrito Federal: los Centros de Atención Psicosocial Alcohol y otras Drogas y las Unidades Básicas de Salud, incluyendo las siete regiones de salud existentes, poniendo en evidencia las estrategias utilizadas, así como las dificultades y los retos presentes en su implementación a la luz del modelo de Atención Psicosocial (AP). Se trata de una encuesta con abordaje cualitativo y enfoque exploratorio con 36 participantes entrevistados; se utilizó la triangulación intramétodo y se adoptó el análisis de contenido de Bardin. Se identificó la falta de infraestructura y de insumos para tejer las prácticas de apoyo matricial, reuniones con la red y derivaciones de forma satisfactoria, conforme la perspectiva de los participantes; no obstante, surgieron estrategias de intervención y de promoción de la salud para el fortalecimiento de la AP.(AU)

This study aimed to explore the network articulation practices developed by professionals working in two points of the Psychosocial Care Network in the Federal District: The Psychosocial Care Centers for Alcohol and Other Drugs and the Basic Health Units, covering seven existing health regions, highlighting the strategies used, as well as the difficulties and challenges that cross its effective implementation following the Psychosocial Care model. This research uses a qualitative and exploratory approach, using intra-method triangulation with 36 participants and adopting Bardin's content analysis. A lack of infrastructure and inputs was identified to build the matrix support practices, meetings with the network, and referrals satisfactorily according to the participant's perspective. However, intervention and health promotion strategies emerged to strengthen Psychosocial Care.(AU)

Estudiantes que usan drogas: cómo profesores lidian y piensan sobre ellos / Estudantes que usam drogas: como professores lidam e pensam sobre eles / Students who use drugs: what teachers think and how they handle the situation

Descrever e analisar percepções e atitudes de professores quanto ao uso de álcool/drogas (AD) por estudantes do Ensino Médio de escolas públicas de Águas Lindas-GO/Brasil. Estudo misto realizado em 11 escolas, com 91 professores, por meio de questionário sociodemográfico, entrevista semiestruturada sobre a percepção em relação ao uso de AD por estudantes, e questões sobre o julgamento daqueles que fazem uso. A maioria (57%) era do sexo masculino, idade média 37,2 anos; acredita que alunos que fazem uso de AD são moralmente fracos (51%), um perigo para a sociedade (47%) e podem cometer delitos na própria família (98%); em contrapartida os consideram tão importantes quanto qualquer outra pessoa (98%). Afirmam que não se sentem capacitados para abordar o tema AD, tampouco para lidar com alunos que usam. O estudo revela e reforça que a educação em saúde deveria compor a formação dos professores para uma abordagem preventiva e de acolhimento.

Describir y analizar percepciones y actitudes de profesores relacionadas el uso de alcohol/drogas (AD) por estudiantes de la enseñanza secundaria de escuelas públicas de Aguas Lindas-GO/Brasil. Estudio mixto realizado en 11 escuelas, con 91 profesores, por intermedio de cuestionario sociodemográfico, entrevista semiestructurada sobre la percepción con relación al uso de AD por estudiantes, y cuestiones sobre el juzgamiento de aquellos que hacen uso. La mayoría (el 57%) era del sexo masculino, edad media 37,2 años; cree que alumnos que hacen uso de AD son moralmente débiles (el 51%), un peligro para la sociedad (el 47%) y pueden cometer delitos en la propia familia (el 98%); en contrapartida los consideran tan importantes cuanto cualquier otra persona (el 98%). Afirman que no se sienten capacitados para abordar el tema AD, tampoco para lidiar con alumnos que usan. El estudio revela y refuerza que la educación en salud debería componer la formación de los profesores para un abordaje preventiva e de acogimiento.

In order to describe and analyze teachers' perceptions and attitudes regarding the use of alcohol/drugs (AD) by High School students from public schools in Águas Lindas-GO/Brazil, this mixed study was carried out in 11 schools, with 91 teachers, using a sociodemographic questionnaire, a semi-structured interview about the perception of AD use by students, and questions about the judgment of those who use it. Most (57%) were male, average age 37.2 years; most participants believed that students who use AD are morally weak (51%), a danger to society (47%), and may commit crimes in their own families (98%); on the other hand, they consider them as important as anyone else (98%). They claim that they do not feel qualified to address the DA theme, nor to deal with students who use it. The study reveals and reinforces that health education should form part of teacher training for a preventive and welcoming approach.

Substance use disorders and social functioning from an occupational perspective: a pre and post-study / Transtornos pelo uso de substâncias e funcionamento social sob uma perspectiva ocupacional: um pré e pós estudo

Abstract Introduction Improvements in the social functioning (SF) of people experiencing substance use disorders (SUD) can occur even without use discontinuation. Occupational Therapy (OT) performs multifaceted work on it. Objective This study analyzes the SF of people experiencing SUD before and after treatment and the contributions of OT. Method A pre and post-study before and after starting treatment for SUD in a Psychosocial Care Centre - Alcohol and other Drugs (CAPS-AD) in Brasilia, Brazil - was conducted with 35 clients based on an SF questionnaire. A measure of the participant's SF improvement was defined as the difference between the SF before treatment (SFpre) with the SF after treatment (SFafter). The association between SF and sociodemographic variables/drug/previous treatment was verified by linear regression; all analyses considered a significance level <5%. Results Most of the 35 participants were male (83%), 30-49 years old (77%), attended elementary school (57%), unemployed (57%), single (46%), Black (40%), had been treated previously (60%) and had present alcohol use disorder (46%). Overall, people undergoing treatment significantly improved their SF. Multivariate analysis showed that Whites improved their SF more (mean of 18.8± 10.4) than Pardos/Blacks (10.8± 8.7; 14.1± 6.4), and the improvement in SF was lower for participants who were taking treatment for the first time (10.3± 5.7) compared with those who had previous treatment (17.2± 9.4). Conclusion Treatment in CAPS-AD improved the SF of people experiencing SUD, and the OT professional is a key agent in improving SF due to its performance and approach to clients in vulnerable contexts.

Resumo Introdução Melhorias no funcionamento social (FS) de pessoas com transtornos pelo uso de substâncias (TUS) podem ocorrer mesmo sem descontinuar o uso. A terapia ocupacional realiza um trabalho multifacetado sobre isso. Objetivo Este estudo analisa o funcionamento social das pessoas com transtornos pelo uso de substâncias antes e depois do tratamento e contribuições da terapia ocupacional. Método Um pré e pós-estudo - antes e depois do tratamento para TUS em um Centro de Atenção Psicossocial álcool/drogas (CAPS-AD) em Brasília, Brasil - foi realizado com 35 clientes com um questionário sobre FS. A melhora do FS foi definida como a diferença entre o valor do FS antes (FSpre) e depois do tratamento (FSafter). A associação entre o FS e as variáveis sociodemográficas/drogas/tratamento anterior foi verificada por regressão linear; foi considerado um nível de significância <5%. Resultados A maioria era homens (83%), 30-49 anos de idade (77%), com ensino fundamental (57%), desempregados (57%), solteiros (46%), negros (40%), com tratamento anterior (60%), e apresentavam TU de álcool (46%). Em geral, as pessoas submetidas a tratamento melhoraram significativamente seu FS. A análise multivariada mostrou que os brancos melhoraram mais seu FS (média de 18.8± 10.4) que os Pardos/Negros (10.8± 8.7; 14.1± 6.4), e foi menor entre os que estavam fazendo tratamento pela primeira vez (10.3± 5.7) em comparação com os que o fizeram anteriormente (17.2± 9.4). Conclusão O tratamento no CAPS-AD melhorou o FS das pessoas com TUS, o profissional terapeuta ocupacional é um agente chave para melhorar o FS devido a sua atuação e abordagem em contextos vulneráveis.

Espaços on-line de cuidados coletivos: promoção da saúde em tempos de isolamento pela COVID-19 / Online collective care spaces: health promotion in times of isolation due to COVID-19 / Espacios en línea de cuidados colectivos: promoción de la salud en tiempos de aislamiento por COVID-19

Objetivo: Relatar a experiência das ações de cuidado on-line realizadas pelo Grupo de Trabalho Promoção e Prevenção à Saúde da Universidade de Brasília (UnB) no contexto da pandemia da COVID-19. Síntese dos Dados: Trata-se de um relato de experiência das ações de promoção e prevenção da saúde mental para a comunidade acadêmica da UnB, no período de março a julho de 2020. Adotou-se a metodologia da sistematização de experiência utilizando registros das observações em diários de campo das ações de cuidado on-line: terapia comunitária, técnica de relaxamento, bate-papo literário e cartas solidárias. Assim, com base na empatia, solidariedade, cuidado e interatividade, as ações desenvolvidas envolveram vários atores sociais com experiências diversas, visando à cooperação em busca de soluções possíveis para promoção da saúde da comunidade acadêmica, em tempos de pandemia. Conclusão: A descoberta de espaços virtuais como potencialidades terapêuticas revelou ser um caminho possível para o fortalecimento das redes de cuidado, conexões e laços afetivos entre a comunidade acadêmica num momento de restrição social devido à COVID-19, apesar das inúmeras limitações impostas pelo uso da tecnologia.

Objective: To report the experience of online care actions carried out by the Health Promotion and Prevention Working Group of the University of Brasília (Universidade de Brasília ­ UnB) in the context of the COVID-19 pandemic. Data Synthesis: This is an experience report on mental health promotion and disease prevention actions developed for the academic community of UnB from March to July 2020. The methodology of systematization of experience was adopted using records of observations of online care actions in field journals: community therapy, relaxation technique, literary chat and solidarity letters. Thus, based on empathy, solidarity, care and interactivity, the actions developed involved several social actors with different experiences aiming at cooperation in search for possible solutions to promote the health of the academic community in times of pandemic. Conclusion: The discovery of virtual spaces as therapeutic potentialities proved to be a possible way to strengthen care networks, connections and affective bonds among the academic community at a time of social restriction due to COVID-19, despite the numerous limitations imposed by the use of the technology

Objetivo: Informar la experiencia de las acciones de cuidado en línea realizadas por el Grupo de Trabajo, Promoción y prevención a la Salud de la Universidad de Brasilia (UnB) en el contexto de la pandemia de COVID-19. Síntesis de los Datos: Se trata de un informe de experiencia de las acciones de promoción de la salud mental para la comunidad académica de la UnB, en el período de marzo a julio de 2020. Se adoptó la metodología de sistematización de experiencia utilizando registros de las observaciones en diarios de campo de las acciones de cuidado en línea: terapia comunitaria, técnica de relajamiento, charla literaria y cartas solidarias. Así, con base en la empatía, solidaridad, cuidado e interactividad, las acciones desarrolladas envolvieron varios actores sociales con diversas experiencias, buscando la cooperación para encontrar posibles soluciones para promoción de la salud de la comunidad académica, en tiempos de pandemia. Conclusión: El descubrimiento de espacios virtuales como potencialidades terapéuticas reveló ser un camino posible para el fortalecimiento de las redes de cuidado, conexiones y lazos afectivos entre la comunidad académica en un momento de restricción social debido a COVID-19, a pesar de las innúmeras limitaciones impuestas por el uso de la tecnología.

Práticas de cuidado extramuros nos Centros de Atenção Psicossocial Álcool e outras Drogas: a ocupação cidadã / Extramural care practices developed outside Alcohol and drugs Psychosocial Care Centers: citizen occupation / Prácticas de cuidado extramuros en los Centros de Atención Psicosocial Alcohol y Drogas: la ocupación ciudadana

Este artigo tem por objetivo investigar as práticas extramuros realizadas pelos profissionais que atuam nos Centros de Atenção Psicossocial Álcool e outras Drogas (CAPSad) do Distrito Federal (DF). Trata-se de uma pesquisa de abordagem qualitativa de caráter exploratório e descritivo. A coleta de dados ocorreu por meio de entrevista semiestruturada e questionário sociodemográfico e ocupacional com 48 profissionais que atuam nos sete CAPSad do DF. Adotou-se a análise de conteúdo de Bardin e de forma complementar o software NVivo. Constatou-se que os profissionais realizaram práticas extramuros inovadoras e exitosas, como: "Loja de rua", "Jardim comunitário", "Clube de corrida", atividades esportivas, de geração de renda, participações políticas, de arte, lazer e cultura. No entanto, ainda são escassas as ações de cuidado extramuros de forma sistemática, sendo a maioria temporária. É imprescindível que trabalhadores sejam capacitados e tenham condições para atuar extramuros. (AU)

This article investigates the extramural practices developed by health professionals working in Alcohol and Drugs Psychosocial Care Centers (CAPSad) in the Federal District, Brazil. We conducted a qualitative exploratory descriptive study with data collected using semi-structured interviews and sociodemographic and occupational questionnaires administered to 48 professionals working in seven CAPSad located in the Federal District. We adopted the content analysis method proposed by Bardin and NVivo. The findings show that the professionals developed innovative and successful extramural practices, including: "street shops", "community gardens", "running clubs", sports, income generating activities, and political participation through art, leisure and culture. However, systematic extramural care actions remain scarce and tend to be temporary. It is vital that health worker are trained and have the conditions necessary to develop extramural activities. (AU)

El objetivo de este artículo es investigar las prácticas extramuros realizadas por los profesionales que actúan en los Centros de Atención Psicosocial alcohol y otras drogas (CAPSad) del Distrito Federal (DF). Se trata de una investigación de abordaje cualitativo de carácter exploratorio y descriptivo. La colecta de datos se realizó por medio de entrevista semiestructurada y cuestionario sociodemográfico y ocupacional con 48 profesionales que actúan en los siete CAPSad del DF. Se adoptó el análisis de contenido de Bardin y de forma complementaria el software NVivo. Se constató que los profesionales realizaron prácticas extramuros innovadoras y exitosas, como: "Tienda de calle", "Jardín comunitario", "Club de carreras", actividades deportivas, de generación de renta, participaciones políticas de arte, ocio y cultura. Sin embargo, todavía son escasas las acciones de cuidado extramuros de forma sistemática, siendo la mayoría temporales. Es imprescindible que los trabajadores sean capacitados y tengan condiciones para actuar extramuros. (AU)

Análise Crítica Sobre Medicamentos Prescritos para o Uso Problemático de Crack / Critical Analysis of Prescriptions Medicines for Problematic Crack Use

Resumo Estudo de abordagem descritiva, exploratória e retrospectiva que analisou prontuários de pacientes em tratamento pelo uso problemático de crack. Foram levantadas as prescrições, as interações medicamentosas e o perfil sociodemográfico destes pacientes. Foram feitas revisões de literaturas narrativas para verificar quais medicamentos apresentam maiores potenciais terapêuticos e para caracterizar o perfil dos usuários; dados dos prontuários e da literatura foram triangulados. Os resultados sugerem que os medicamentos utilizados no tratamento do uso problemático de crack são limitados, os medicamentos utilizados na prática não possuem evidências de eficácia, há interações relevantes nas prescrições e o perfil sociodemográfico desses usuários é semelhante com a literatura. Estudos adicionais são desejáveis para buscar um tratamento medicamentoso eficaz para o uso problemático de crack.

Abstract A descriptive, exploratory and retrospective study that analyzed medical records of the patients under treatment for crack use; prescriptions and medicines interactions were collected, and the sociodemographic profile of these patients. Revisions of narrative literatures were conducted to verify which medicines have the greatest therapeutic potentials and to characterize the profile of the crack users; data from the medical records and the literature were triangulated. The results suggest: medicines prescribed in the treatment of the crack use are limited, medicines used in practice don't have evidence of efficacy, there are relevant interactions in the prescriptions, and the sociodemographic profile of these users is similar with the literature. Additional studies are desirable to seek effective medicine treatment for crack use.

Characteristics of clients using a community-based drug treatment service ('CAPS-AD') in Brazil: An exploratory study.

BACKGROUND: Substance use is common in Brazil. In order to improve availability of substance misuse care services, over 400 Psycho-Social Care Centres for Alcohol and Drugs (CAPS-AD) - providing community-based care - have been established following mental health care reform (2001). Information on CAPS-AD clients and outcomes is limited. The present study examined select characteristics of local CAPS-AD clients. METHODS: N=143 adult CAPS-AD clients in Ceilândia (suburb of Brasília, Federal District) participated in a 1-week 'snapshot' assessment of service users (February 2015). Following consent, descriptive data were collected by a brief, anonymous interviewer-administered questionnaire that included socio-demographic, drug use, treatment history and needs/barriers information. RESULTS: Participants were predominantly male; middle-aged; unemployed; married; with middle-school education; primary problem drugs indicated were alcohol and cocaine/crack; half had prior treatment histories and indicated that treatment was externally motivated; 60% reported ways to improve treatment and possible reasons for treatment discontinuation; in multi-variate analyses, the latter was associated with employment and education status (both p<.05). CONCLUSION: CAPS-AD services appear to have increased low-barrier substance misuse treatment availability in Brazil, as well as attract individuals new to the treatment system. Various potential barriers to continuing in treatment should be addressed and more research on CAPS-AD clients and outcomes is needed.

Factors associated with recidivism among adolescents girls in conflict with the law in an institution in Brasília, Federal District, Brazil.

Recidivism is a challenge for the Brazilian socio-educational system because it is associated with personal, social and environmental factors, especially among juvenile offenders. This study examined key characteristics and potential association with recidivism in 391 female adolescent offenders from a correctional institution in Brasília, Federal District, Brazil, between 2004 and 2011. Cross-sectional data on socio-demographics, drug use and offense characteristics from institutional information were examined. Associate factors with recidivism were examined using negative binomial regression analyses. 32.5% of offenders were recidivists at present admission and the mean frequency of recidivism among recidivists was 2.16. About half (53.6%) of the sample reported drug use. After the adjustment, recidivism was positively associated with: age; offender's drug use; residence status; offense type; and no family drug use. Factors associated with juvenile offenders' recidivism confirm findings from elsewhere, and should inform targeted interventions in Brazil.

Aspectos do cuidado integral para pessoas em situação de rua acompanhadas por serviço de saúde e de assistência social: um olhar para e pela terapia ocupacional / Aspects of the whole care for people in street followed by health and social assistance services: a look at and for occupational therapy

Resumo Introdução A população que (sobre)vive nas ruas se caracteriza, muitas vezes, pela ruptura dos vínculos sociais e pelo uso de drogas, necessitando de cuidados de saúde e de assistência social. Objetivo Identificar e analisar as percepções dos profissionais terapeutas ocupacionais e dos usuários sobre a atuação e especificidade da terapia ocupacional junto às pessoas em situação de rua atendidas pelo Centro de Atenção Psicossocial álcool e drogas (CAPS-ad III) e pela Unidade de Acolhimento (UA). Método Trata-se de um estudo exploratório, de abordagem qualitativa, realizada a partir de entrevistas semiestruturadas com três terapeutas ocupacionais e cinco usuários de um CAPS-ad III do Distrito Federal e da UA referenciada por este CAPS-ad III; os dados foram analisados a partir do método de Análise de Conteúdo. Resultados Os dados foram organizados em três categorias temáticas: (1) uso de drogas, a situação de morador de rua e o tratamento no CAPS-ad III; (2) o cotidiano de atuação da terapia ocupacional; e (3) terapia ocupacional e reinserção social. Conclusão A terapia ocupacional atua com população em situação de rua com olhar para o cotidiano e desempenho de Atividades de Vida Diária (AVD), trabalhando na perspectiva da Redução de Danos como forma de buscar uma maior qualidade de vida dos usuários. Torna-se necessário levar espaços de saúde e de assistência social para o contexto do usuário, realizar ações extrapolando o espaço físico do CAPS-ad e colocando o usuário como participante ativo desse processo.

Abstract Introduction The population that lives (survive) on the streets is often characterized by the rupture of social ties and the use of drugs, necessitating health care and social assistance. Objective To identify and analyze the perceptions of the occupational therapist professionals and the users about the performance and specificity of the occupational therapy with the street people assisted by the community-based drug treatment service (CAPS-ad III) and the Embracement Unit (EU). Method This is an exploratory and qualitative study based on semi-structured interviews with 3 occupational therapists and 5 users of a CAPS-ad III from the Federal District and the Embracement Unit (EU) referenced by this CAPS-ad III; the data were analyzed using analysis content. Results The data were organized into three thematic categories: (1) drug use, homelessness and treatment in CAPS-ad III; (2) the daily routine of Occupational Therapy; (3) Occupational Therapy and Social Integration. Conclusion The Occupational Therapy acts with the population in a street situation with a look at the daily life and performance of Activity of Daily Living (ADL), working in the perspective of Harm Reduction as a way to seek a higher quality of life of users. It is necessary to take care spaces and social assistance to the user context, to take actions extrapolating the physical space of CAPS-ad and placing the user as an active participant in this process.

Autopercepção dos profissionais do sistema socioeducativo do Distrito Federal/Brasil a partir de um processo de formação sobre drogas e direitos humanos / Self-perception of the professionals of the socio-educational system of the federal district/brazil from a training process on drugs and human rights / Autopercepción de los profesionales del sistema socioeducativo del Distrito Federal/Brasil a partir de un proceso de capacitación sobre drogas y derechos humanos

INTRODUÇÃO: o atendimento de adolescentes em conflito com a lei torna-se mais desafiador quando estes usam drogas. OBJETIVO: descrever a autopercepção dos profissionais do Sistema Socioeducativo sobre capacitações, condições de trabalho, rede de apoio e satisfação pessoal e profissional no acompanhamento de adolescentes em cumprimento de medida socioeducativa que usam drogas MÉTODO: estudo transversal a partir de um curso de formação sobre drogas e direitos humanos para profissionais do Sistema Socioeducativo do Distrito Federal/Brasil. RESULTADOS: a maioria recebeu treinamento sobre drogas (56,7%), realiza atendimentos (86,7%), mas não se sente capacitada (85,4%); desempenho profissional (43,6%) e realização pessoal (48,7%) considerados bons; espaço físico (48,7%), relação entre unidades (44,7%) e satisfação com o trabalho (42,3%) considerados razoáveis; disponibilidade de materiais (42,5%), quantidade de profissionais (38,2%) e relação com a comunidade (29,3%) considerados muito ruins. CONSIDERAÇÕES FINAIS: capacitações são importantes e o método utilizado deve ser capaz de impactar a atuação do profissional no trabalho.

INTRODUCTION: Counseling adolescents in conflict with the law becomes more challenging when they use drugs. OBJECTIVE: to describe the self-perception of professionals in the socio-educational system about skills, working conditions, support network and personal and professional satisfaction. METHOD: a cross-sectional study based on a training course on drugs and human rights for professionals from the socio-educational system of the Federal District/Brazil. RESULTS: the majority received training on drugs (56.7%), performed care (86.7%), but did not feel qualified (85.4%); professional performance (43.6%) and personal performance (48.7%) considered to be good; physical space (48.7%), relation between units (44.7%) and satisfaction with work (42.3%) considered reasonable; availability of materials (42.5%), number of professionals (38.2%) and community relations (29.3%) considered to be very bad. CONCLUSION: training is important and the method used should be capable of impacting the performance of the professional at work.

INTRODUCCIÓN: la atención de adolescentes en conflicto con la ley se vuelve más desafiante cuando éstos usan drogas. OBJETIVO: describir la autopercepción de los profesionales del Sistema Socioeducativo sobre capacitaciones, condiciones de trabajo, red de apoyo y satisfacción personal y profesional. MÉTODO: estudio transversal a partir de un curso de formación sobre drogas y derechos humanos para profesionales del sistema socioeducativo del Distrito Federal/Brasil. RESULTADOS: la mayoría recibió entrenamiento sobre drogas (56,7%), realiza atendimientos (86,7%), pero no se siente capacitada (85,4%); desempeño profesional (43,6%) y realización personal (48,7%) considerados buenos; espacio físico (48,7%), relación entre unidades (44,7%) y satisfacción con el trabajo (42,3%) considerados razonables; la disponibilidad de materiales (42,5%), cantidad de profesionales (38,2%) y relación con la comunidad (29,3%) considerados muy malos. CONCLUSIÓN: Capacitaciones son importantes y el método utilizado debe ser capaz de impactar la actuación del profesional en el trabajo.

O debate sobre álcool, crack e outras drogas na formação universitária e o papel dos profissionais da rede intersetorial em uma ação de educação em saúde / The debate on alcohol, crack and other drugs in the education and the role of the professionals of the intersectoral network in a health education action / El debate sobre alcohol, crack y otras drogas en la educación y el papel de los profesionales de la red intersectorial en una acción de educación para la salud

INTRODUÇÃO: O processo histórico das políticas públicas em saúde promoveu um avanço na forma de produzir o cuidado e como consequência a necessidade de associação entre ensino, pesquisa e extensão, requerendo novos investimentos formativos em temas contemporâneos, como a educação permanente sobre drogas e suas vulnerabilidades associadas. OBJETIVO: Apresentar o projeto de extensão Roda de Debate sobre Drogas e Vulnerabilidades Associadas como uma ação de educação permanente para o fortalecimento da interação de atores intersetoriais e a comunidade acadêmica. MÉTODO: Estudo do tipo misto sequencial utilizando dados quantitativos e qualitativos, realizado por meio da aplicação de questionários e entrevistas. Os dados quantitativos foram analisados utilizando o software SPSS e os dados qualitativos a análise de conteúdo categorial. Resultados e Discussão: Os resultados mostraram um espaço relevante de educação permanente aos profissionais e mudanças importantes na percepção dos participantes sobre o tema drogas. Observa-se a necessidade de ampliar e qualificar a extensão universitária oferecendo alternativas de aprendizado, especialmente sobre temas permeados por mitos e pouco abordados nos currículos dos cursos de graduação.

INTRODUCTION: The historical process in public policies promoted a breakthrough in the form of care delivery in health and, as a consequence, the need for associating teaching, research and extension, resulting in the necessity for new training investments, such as continuing education on current issues as the problem of drugs and the associated vulnerabilities. OBJECTIVE: Present the extension project Debate Round on Drugs and Associated Vulnerabilities as a continuing education action to strengthen the interaction between intersectoral actors and academic community. METHOD: Study of sequential mixed type using quantitative and qualitative data, conducted through questionnaires and interviews. Quantitative data were analyzed using the SPSS software and qualitative datausing the categorical content analysis. Results and discussion: The results showed the significant opportunity of continuing education to professionals and major changes in the perception of the participants on the drugs topic.It is necessary to expand and qualify the university extension programs offering learning alternatives especially on issues permeated by myths and little addressed in the curricula of undergraduate courses.

INTRODUCCIÓN: El proceso histórico en las políticas públicas promovió un gran avance en la forma de prestación de la atención en salud y como resultado la importancia de la asociación entre la enseñanza, la investigación y la extensión, dando como resultado la necesidad de nuevas inversiones en formación, como la formación continua sobre temas de actualidad, como el problema de las drogas y las vulnerabilidades asociadas. OBJETIVO: Presentar el proyecto Rueda de Debate sobre Drogas y Vulnerabilidades Asociadas como una acción de educación continuada para fortalecer la interacción de los actores intersectoriales y la comunidad académica. MÉTODO: Estudio de tipo mixto secuencial a partir de datos cuantitativos y cualitativos, llevado a cabo con cuestionarios y entrevistas. Los datos cuantitativos se analizaron utilizando SPSS y los cualitativos usando el análisis de contenido categorial. Resultados y Discusión: Los resultados mostraron una importante oportunidad de educación continua de los profesionales y grandes cambios en la percepción de los participantes sobre el tema de las drogas. Se señala la necesidad de ampliar las alternativas que ofrece la extensión universitaria sobre temas permeados por mitos y poco abordados en la formación universitaria.

Centro Regional de Referência sobre Drogas e Vulnerabilidades Associadas da Faculdade de Ceilândia/Universidade de Brasília / Regional Reference Center on Drugs and Associated Vulnerabilities - Ceilândia College/University of Brasília

Introdução: A proposta da criação do Centro Regional de Referência sobre Drogas e Vulnerabilidades Associadas da Faculdade de Ceilândia/Universidade de Brasília nasce a partir do reconhecimento do abuso de drogas como importante problema de saúde pública no Brasil. Reforça-se essa importância quando se focam regiões específicas do Brasil, como a região Centro-Oeste, onde esta e outras vulnerabilidades se tornam ainda mais evidentes e, consequentemente, com maior necessidade de ações que visem enfrentar tais dificuldades. Objetivos: Capacitar os trabalhadores da rede integral de atenção aos usuários de drogas dos municípios de Águas Lindas de Goiás, Valparaíso de Goiás, Luziânia e Brazlândia. Métodos: Mapeamento dos territórios, criação e consolidação de rede de pactuações com lideranças e serviços. Os cursos foram organizados no modelo crash course, role-play e supervisões e discussões in loco. A avaliação foi dividida em duas fases, antes e depois do curso por meio dos instrumentos de ficha de inscrição, teste de múltipla escolha e questionário pós-curso. Resultados: Pode-se perceber que as estratégias utilizadas puderam se adequar à demanda dos diversos grupos e a metodologia tem sido extremamente favorável, pois tem permitido que o grupo apresente uma participação ativa, aproximando os debates da realidade dos serviços. A equipe que integra o projeto tem se fortalecido e se constituído como um grupo permanente, gerando diversos desdobramentos do CRR-UnB/FCE. Conclusão: Essa experiência tem demonstrado a fundamental importância do mapeamento do território, da formação de rede de pactuações, da intersetorialidade e do diálogo constante para eficácia de uma proposta de educação permanente.

Factors associated with recidivism among adolescents girls in conflict with the law in an institution in Brasília, Federal District, Brazil / Fatores associados à reincidência entre adolescentes femininas em conflito com a lei de uma instituição de Brasília, Distrito Federal, Brasil / Factores asociados a la reincidencia entre adolescentes mujeres en conflicto con la ley de una institución de Brasília, Distrito Federal, Brasil

Abstract Recidivism is a challenge for the Brazilian socio-educational system because it is associated with personal, social and environmental factors, especially among juvenile offenders. This study examined key characteristics and potential association with recidivism in 391 female adolescent offenders from a correctional institution in Brasília, Federal District, Brazil, between 2004 and 2011. Cross-sectional data on socio-demographics, drug use and offense characteristics from institutional information were examined. Associate factors with recidivism were examined using negative binomial regression analyses. 32.5% of offenders were recidivists at present admission and the mean frequency of recidivism among recidivists was 2.16. About half (53.6%) of the sample reported drug use. After the adjustment, recidivism was positively associated with: age; offender’s drug use; residence status; offense type; and no family drug use. Factors associated with juvenile offenders’ recidivism confirm findings from elsewhere, and should inform targeted interventions in Brazil.

Resumo A reincidência constitui um desafio para o sistema socioeducativo brasileiro por estar associada a fatores pessoais, sociais e ambientais, especialmente entre adolescentes em conflito com a lei. Este estudo verificou as principais características associadas à reincidência em uma amostra de 391 mulheres adolescentes em conflito com a lei em uma unidade de internação de Brasília, Distrito Federal, Brasil, entre 2004-2011. Dados transversais sociodemográficos acerca do uso de drogas e sobre as características do ato infracional foram analisados. Fatores associados à reincidência foram analisados por regressão binomial negativa. Trinta e dois vírgula cinco por cento das adolescentes pesquisadas eram reincidentes e a frequência média de reincidências foi de 2,16. Cinquenta e três vírgula seis por cento da amostra relataram uso de drogas. Após ajuste, reincidir foi positivamente associado à idade, uso de drogas, residência, tipo de ato infracional e não uso de drogas pela família. Nossos achados corroboram com outros contextos mundiais, demonstrando a necessidade de orientação nas intervenções adotadas pelo sistema socioeducativo brasileiro.

Resumen La reincidencia es un reto para el sistema socio-educativo brasileño. Este estudio examinó características claves y su posible asociación con la reincidencia de 391 adolescentes mujeres infractoras en una institución correccional en Brasília, Distrito Federal, Brasil, entre 2004 a 2011. Se examinaron datos transversales socio-demográficos, uso de drogas y las características del delito cometido a partir de la información institucional. Los factores asociados con la reincidencia se obtuvieron por análisis de regresión negativa-binomial. 32,5% de las internas eran reincidentes y la frecuencia media de reincidencia entre las reincidentes era de 2,16. Un 53,6% de la muestra informó consumo de drogas. Después del ajuste, la reincidencia se asoció positivamente con: edad; uso de drogas de la delincuente; estatus de residencia; tipo de delito; el no uso de drogas por parte de la familia. Los factores asociados con la reincidencia de las delincuentes confirman hallazgos de otros estudios, y deberían informar intervenciones específicas sobre esta población en Brasil.

Desenvolvendo e articulando a rede intersetorial para cuidado integral de usuários de drogas em contextos de vulnerabilidade / Developing and articulating intersectorial networks for integral care of drug users in vulnerable contexts

Este manuscrito apresenta um relato de experiência com algumas atividades do Centro de Referência sobre Drogas e Vulnerabilidades Associadas da Universidade de Brasília ­ Faculdade Ceilândia (CRR/FCE/UnB) implementadas e desenvolvidas durante o ano de 2013. Este relato permite a reflexão sobre o processo de construção de parcerias baseadas na rede social e na noção de território para cuidado daqueles com problemas relacionados ao uso de drogas e as vulnerabilidades associadas. Esta experiência segue o atual marco da prática e da política nacional (p. ex., lei 10.216/2001), nas quais se estabelecem as mudanças no modelo de cuidado integral de pessoas com transtornos mentais, inclusive aquelas em sofrimento pelo uso de álcool e outras drogas. Inicialmente, a equipe do CRR/FCE/UnB mapeou a rede social local (instituições públicas de diferentes setores) de quatro municípios, sendo uma delas no Distrito Federal (Brazlândia) e três no estado de Goiás (Valparaíso, Luziânia e Águas Lindas). Após o mapeamento, a equipe do CRR buscou articular e estabelecer uma agenda de discussão sobre os problemas relacionados ao uso de álcool e outras drogas e suas vulnerabilidades associadas entre as diferentes instituições, setores e profissionais (p. ex., enfermeiros, médicos, terapeutas ocupacionais, assistentes sociais, policiais). Essa estratégia possibilitou a capacitação de diversos atores para o desenvolvimento e qualificação da sua rede intersetorial que, consequentemente, qualifica as ações de cuidado integral, conforme recomendado por inúmeras políticas nacionais

This manuscript presents an experience report with some activities that the Reference Center on Drugs and Associated Vulnerabilities - CRR, 'Faculdade Ceilândia'/University of Brasilia - UNB implemented and developed in 2013. This account allows us to reflect on the process of building partnerships based on social networks and the notion of territory for people with problems related to drugs and their associated vulnerability. The experience follows the current national framework, in which the social network has become a central paradigm of public practices and policies (e.g. Law 10.216/2001). These changes occur in the model of care for people with mental disorders, including the integral health policy for users and dependents of alcohol and other drugs. The CRR team mapped local social networks, i.e. several public institutions in different sectors, in four municipalities: one in the Federal District (Brazlândia) and three in the state of Goiás (Valparaiso, Luziânia, Águas Lindas). After the mapping, the CRR team sought to articulate and establish an agenda to discuss alcohol and drug use and its associated vulnerabilities among these different institutions, sectors and professionals, e.g. nurses, physicians, occupational therapists, social workers, and police officers. This strategy enabled several actors to develop and qualify their local intersectorial network, which consequently qualifies the integral care actions, as recommended by several national policies