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1.
Artigo em Russo | MEDLINE | ID: mdl-32621471

RESUMO

OBJECTIVE: To determine the spectrum of hormones of the stress-realizing system in the time course of therapy of withdrawal syndrome and post-withdrawal state and analyze their possible relationships with the duration of therapeutic remission in patients with alcohol dependence. MATERIAL AND METHODS: The examination included 74 men admitted in the clinic at Mental Health Research Institute NRMC diagnosed as having «Mental and behavioral disorders due to use of alcohol¼ (dependence syndrome F10.21 and withdrawal state - F10.30) according to ICD-10. The control group included 35 men matched in age with patients. Concentration of cortisol, testosterone, and thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4) were determined by immunoenzyme method (IEM), in patients - at two points: point 1 - by day 3-5 of the admission in the clinic in the withdrawal syndrome state after alcohol detoxification; point 2 - by day 15-17 of the anti-alcohol therapy. RESULTS: In the general group of patients with alcohol dependence the elevation of the level of cortisol in comparison with control was established (pc<0,0001 at both points) and increase of concentration at point 2 (p=0,0253 to point 1). Concentration of testosterone at point 1 exceeded the level of control (pc=0,0203), at point 2 decreased up to control values and in relation to point 1 (p=0,0004). In relation to control the level of TSH in patients was decreased at point 1 (pc=0,0077); the concentration of fT3 and fT4 was reliably decreased at both points; concentration of fT4 decreased further in the process of the therapy of the post-withdrawal state (p=0,0003 to point 1). According to the duration of the last therapeutic remission, two groups of patients were formed: those with unstable remission (up to 6 months) and with the formed stable remission (1 year or more). A comparative analysis of the concentration of cortisol and testosterone in blood serum taken in patients at point 1 revealed a significant excess of testosterone in the group with unstable remission, both in relation to the control (pc=0,0239) and to the indicator in the group of patients with stable remission (p=0,0159). CONCLUSION: Dysfunctions in the spectrum of stress-realizing hormones in patients with alcohol dependence in the time course of the therapy for withdrawal syndrome and post-withdrawal state were revealed, the main of which are high level of cortisol, testosterone, reduction of secretion of free thyroxine and free triiodothyronine. Patients with unstable therapeutic remission are characterized by a high concentration of testosterone after alcohol detoxification, which allows us to consider testosterone as a biological criterion that can increase the accuracy of prediction of the duration of remission after anti-alcohol therapy.


Assuntos
Alcoolismo , Humanos , Masculino , Hormônios Tireóideos , Tireotropina , Tiroxina
2.
MMWR Morb Mortal Wkly Rep ; 69(30): 981-987, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32730240

RESUMO

Excessive alcohol use is a leading cause of preventable death in the United States (1) and costs associated with it, such as those from losses in workplace productivity, health care expenditures, and criminal justice, were $249 billion in 2010 (2). CDC used the Alcohol-Related Disease Impact (ARDI) application* to estimate national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011-2015, including deaths from one's own excessive drinking (e.g., liver disease) and from others' drinking (e.g., passengers killed in alcohol-related motor vehicle crashes). This study found an average of 93,296 alcohol-attributable deaths (255 deaths per day) and 2.7 million YPLL (29 years of life lost per death, on average) in the United States each year. Of all alcohol-attributable deaths, 51,078 (54.7%) were caused by chronic conditions, and 52,361 (56.0%) involved adults aged 35-64 years. Age-adjusted alcohol-attributable deaths per 100,000 population ranged from 20.3 in New Jersey and New York to 52.3 in New Mexico. YPLL per 100,000 population ranged from 613.8 in New York to 1,651.7 in New Mexico. Implementation of effective strategies for preventing excessive drinking, including those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL.†.


Assuntos
Alcoolismo/mortalidade , Expectativa de Vida/tendências , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estados Unidos/epidemiologia , Adulto Jovem
3.
Bone Joint J ; 102-B(7): 881-889, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600138

RESUMO

AIMS: Conservative treatment of moderately displaced proximal humeral head fractures yields good clinical results, but secondary fragment displacement may occur. Identification of those fractures at risk of displacement may influence initial decision-making. METHODS: A total of 163 shoulders in 162 patients with conservatively treated isolated proximal humeral fractures were included. The fractures occurred between January 2015 and May 2018. The mean age of the patients was 69 years (26 to 100) and the mean follow-up was 144 days (42 to 779). The fractures were classified according to Neer. Scores for osteoporosis (Tingart, Deltoid Tuberosity Index (DTI)) and osteoarthritis (OA) of the glenohumeral joint were assessed. Translation of the head on follow-up radiographs of more than 10 mm was defined as displacement. Eccentric head index (EHI) describes the offset of the humeral head centre in relation to the diaphyseal axis. The ratio was estimated on anteroposterior (AP) and Neer views. Medial hinge was considered intact if the medial cortex proximal and distal to the fracture was in line on AP view. RESULTS: Secondary fracture displacement occurred in 41 patients (25.2%). Clinical risk factors were alcohol abuse (odds ratio (OR) 6.8; 95% confidence interval (CI) 1.3 to 36; p = 0.025) and previously diagnosed osteoporosis (OR 4.6; 95% CI 0.6 to 34; p = 0.136). Age (OR 1.1; 95% CI 1.0 to 1.1; p = 0.003) and sex (OR 0.9; 95% CI 0.3 to 2.8; p = 0.867) were not independent factors. Radiological risk factors were OA grade 3 (OR 16.4; 95% CI 0.25 to 37.6; p = 0.107) and osteoporosis with the DTI (OR 10; 95% CI 0.8 to 250; p = 0.031) being more predictive than the Tingart score (OR 2.3; 95% CI 0.8 to 4.7; p = 0.041). A high EHI (AP/Neer > 0.4, OR 18.9; 95% CI 2.1 to 30.9/3.0; 95% CI 1.1 to 8.0; p = 0.002/p = 0.033) and a disrupted medial hinge (OR 3.7; 95% CI 1.1 to 12.6; p = 0.039) increased the risk of secondary displacement significantly. Neer classification had no influence. CONCLUSION: During conservative treatment, a quarter of patients showed secondary fracture displacement of at least 10 mm. Patients with alcohol abuse, severe OA, and osteoporosis are at risk. Newly defined EHI and disrupted medial hinge are relevant predictors for secondary displacement. Cite this article: Bone Joint J 2020;102-B(7):881-889.


Assuntos
Tratamento Conservador , Fraturas do Ombro/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoporose/complicações , Recidiva , Fatores de Risco , Fraturas do Ombro/diagnóstico por imagem
5.
Am J Addict ; 29(4): 268-270, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32500608

RESUMO

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic and control measures may have increased the risk of abusing addictive substances as well as addictive behaviors. METHODS: We present an initial online survey in 6416 Chinese about the relation between the COVID-19 pandemic and addictive behavior in China. RESULTS: During the COVID-19 pandemic, 46.8% of the subjects reported increased dependence on internet use, and 16.6% had longer hours of internet use. The prevalence (4.3%) of severe internet dependence rose up to 23% than that (3.5%) before the COVID-19 pandemic occurred, and their dependence degree rose 20 times more often than being declined (60% vs 3%). Relapses to abuse from alcohol and smoking abstinence were relatively common at 19% and 25%, respectively. Similarly, 32% of regular alcohol drinkers and 20% of regular smokers increased their usage amount during the pandemic. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: These three coping behaviors (internet, alcohol, and smoking) during this COVID-19-related crisis appear to have increased the risk for substance use disorders and internet addiction. (Am J Addict 2020;00:00-00).


Assuntos
Alcoolismo/epidemiologia , Comportamento Aditivo , Infecções por Coronavirus , Internet , Pandemias , Pneumonia Viral , Fumar/epidemiologia , Adulto , Comportamento Aditivo/epidemiologia , Comportamento Aditivo/psicologia , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Feminino , Humanos , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Prevalência , Inquéritos e Questionários
6.
Rev Assoc Med Bras (1992) ; 66(3): 307-313, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32520150

RESUMO

OBJECTIVE: To identify or use alcohol abuse and abuse in the IAMSPE elderly, through the application of AUDIT, socioeconomic characterization of the elderly, and problems associated with drinking and weight, if there is a relationship between depression and alcohol abuse. METHODS: This is a cross-sectional, exploratory, and descriptive study with a quantitative approach. One hundred elderly patients were interviewed to apply a socioeconomic form and to assess alcohol consumption from AUDIT. RESULTS: correlation between alcohol consumption and female gender (p = 0.021). Most of the participants were between 60 and 79 years old, were female, had a partner, had completed elementary school, had income and selected house, were retired and unemployed. CONCLUSION: In the present study, we found no correlation between alcohol abuse and depression; Only one correlation was found between male gender and higher alcohol abuse. However, a significant prevalence of moderate use of high alcohol was found (3.9% in women and 21.7% in men), i.e., it poses a risk to the health of the elderly.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Alcoolismo/epidemiologia , Fatores Etários , Idoso , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Alcoolismo/diagnóstico , Estudos Transversais , Transtorno Depressivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários
7.
Acta Cir Bras ; 35(3): e202000305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520081

RESUMO

PURPOSE: To evaluate the effect of chronic alcoholism on morphometry and apoptosis mechanism and correlate with miRNA-21 expression in the corpus cavernosum of rats. METHODS: Twenty-four rats were divided into two experimental groups: Control (C) and Alcoholic group (A). After two weeks of an adaptive phase, rats from group A received only ethanol solution (20%) during 7 weeks. The morphometric and caspase-3 immunohistochemistry analysis were performed in the corpus cavernosum. The miRNA-21 expression was analyzed in blood and cavernous tissue. RESULTS: Chronic ethanol consumption decreased cavernosal smooth muscle area of alcoholic rats. The protein expression of caspase 3 in the corpus cavernosum was higher in A compared to the C group. There was no difference in the expression of miRNA-21 in serum and cavernous tissue between the groups. CONCLUSION: Chronic ethanol consumption reduced smooth muscle area and increased caspase 3 in the corpus cavernosum of rats, without altered serum and cavernosal miR-21 gene expression.


Assuntos
Alcoolismo/complicações , Apoptose/efeitos dos fármacos , Pênis/efeitos dos fármacos , Pênis/patologia , Animais , Caspase 3/análise , Modelos Animais de Doenças , Disfunção Erétil/induzido quimicamente , Disfunção Erétil/patologia , Expressão Gênica , Imuno-Histoquímica , Masculino , MicroRNAs/análise , Músculo Liso/efeitos dos fármacos , Ratos Wistar , Valores de Referência
8.
Aust N Z J Public Health ; 44(3): 186-192, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32459387

RESUMO

OBJECTIVE: To examine whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers. METHODS: We analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012-October 2013) and the 759 who completed a follow-up survey a year later (August 2013-August 2014). RESULTS: More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow-up surveys. In contrast, of these smokers who had made quit attempts between surveys, more who reported higher stress were able to sustain abstinence for at least one month; other associations were inconclusive. Conclusions and implications for public health: Health staff and Aboriginal and Torres Strait Islander smokers need not see being more stressed as an obstacle to quitting among Aboriginal and Torres Strait Islander people. Health staff should emphasise the benefits to mental health that come with successfully quitting smoking.


Assuntos
Alcoolismo/psicologia , Depressão/psicologia , Satisfação Pessoal , Fumantes/psicologia , Fumar/efeitos adversos , Estresse Psicológico/psicologia , Adulto , Alcoolismo/etnologia , Austrália/epidemiologia , Pesquisa Participativa Baseada na Comunidade , Depressão/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Fumar/epidemiologia , Fumar/etnologia , Abandono do Hábito de Fumar/etnologia , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Estresse Psicológico/etnologia
9.
PLoS One ; 15(5): e0232740, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396577

RESUMO

BACKGROUND: Colorectal cancer (CRC) is regarded as a multifactorial disease and shares many risk factors with alcoholism. However, the association between alcoholism and CRC remains controversial. OBJECTIVES: In this study, we aimed to evaluate the association between alcoholism and risk of CRC. METHODS: We performed a large-scale, population-based nested case-control study using the Longitudinal Health Insurance Database 2013, derived from Taiwan's National Health Insurance Research Database, and collected data from 2000 to 2013. There were 49,095 diagnosed cases of CRC defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Each case was matched with three controls by sex, age, index date of CRC, and annual medical visits; a total of 147,285 controls were identified. Multiple risk factors of CRC in alcoholism cases were investigated using unconditional multiple logistic regression analysis. RESULTS: Among 49,095 cases of CRC, alcoholism was associated with a significantly higher risk of CRC (adjusted odds ratio (OR), 1.631; 95% CI, 1.565-1.699) in multivariate logistic regression, after adjusting other CRC risk factors, and in stratified analysis with multivariate logistic regression. In addition, there was a time-dependent relationship between alcoholism duration and CRC risk in >1 year, > 2 years, >5 years, and > 11 years groups (adjusted ORs, 1.875, 2.050, 2.662 and 2.670; 95% CI, 1.788-1.967, 1.948-2.158, 2.498-2.835, and 2.511-2.989 respectively). CONCLUSION: An association between alcoholism and risk of CRC was found in this study. Furthermore, patients with longer alcoholism history showed higher likelihood of developing CRC, which indicates a time-dependent relationship between alcoholism exposure and CRC. Further research on colorectal tumorigenesis is needed.


Assuntos
Alcoolismo/complicações , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
11.
BMC Infect Dis ; 20(1): 357, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429864

RESUMO

BACKGROUND: We report a case of subdural empyema in a homeless patient caused by Bartonella quintana. B. quintana is a facultative intracellular bacteria for which bacterial growth is fastidious. The molecular biology approach has been a real help in establishing the diagnosis. CASE REPORT: A 59-years old homeless patient, with a history of chronic alcohol abuse, was brought to the emergency department with a massive subdural empyema. Extensive microbiological evaluation didn't reveal any pathogen in the pus collected before antibiotic treatment. B. quintana was detected in the pus from the empyema using a 16S rRNA-based PCR. Histology of intraoperative samples was consistent with the diagnosis and a serological assay was positive. The patient responded well to a treatment that included craniectomy with drainage of the loculated pus, total removal of the infected capsule and a combination of antibiotics. CONCLUSION: This unique case of B. quintana-related empyema illustrates the risk of secondary infection of subdural hematoma with B. quintana since such infections have recently reemerged, predominantly among the homeless populations. Patients with subdural empyema in at-risk populations should be systematically evaluated for B. quintana with an appropriate diagnostic approach involving molecular biology.


Assuntos
Bartonella quintana/genética , Empiema Subdural/diagnóstico , Pessoas em Situação de Rua , Febre das Trincheiras/diagnóstico , Alcoolismo/complicações , Antibacterianos/uso terapêutico , Bartonella quintana/imunologia , Craniotomia , Drenagem , Empiema Subdural/tratamento farmacológico , Empiema Subdural/microbiologia , Empiema Subdural/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , Fatores de Risco , Resultado do Tratamento , Febre das Trincheiras/tratamento farmacológico , Febre das Trincheiras/microbiologia , Febre das Trincheiras/cirurgia
12.
Aust N Z J Public Health ; 44(3): 201-207, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32364653

RESUMO

OBJECTIVE: To investigate factors associated with alcohol use in adolescents, with the focus on analysing the comorbidities between single-occasion harmful-drinking episodes with mental health issues and risk behaviours. METHODS: This study used data from the Young Minds Matter survey, designed to inform on the prevalence of the seven most common mental health disorders of children and adolescents. Logistic regression modelling was used to assess the odds of harmful drinking behaviour in young people aged 13-17 years in Australia. RESULTS: We found a strong association between single-occasion harmful drinking and mental health issues, which hold after controlling for sociodemographic characteristics. Young people with severe mental health issues within the past year were four times more likely to have been drinking at harmful levels in the past 30 days. CONCLUSIONS: Alcohol use can have adverse health effects among children and adolescents. Research has found a bidirectional association between alcohol use and mental health conditions where the presence of one issue almost doubles the risk of having the other issue. Implications for public health: The comorbidity between these issues suggests the need for strategies to integrate policies addressing mental health and alcohol use disorders in young people.


Assuntos
Comportamento do Adolescente/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/psicologia , Assunção de Riscos , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Austrália/epidemiologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental , Prevalência , Inquéritos e Questionários
13.
Drug Alcohol Rev ; 39(5): 441-446, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32395850

RESUMO

INTRODUCTION AND AIMS: The Australian Treatment Outcomes Profile (ATOP) is a brief clinical tool measuring recent substance use, health and wellbeing among clients attending alcohol and other drug (AOD) treatment services. It has previously been assessed for concurrent validity and inter-rater reliability. In this study we examine whether it is suitable for administration over the telephone. DESIGN AND METHODS: We recruited a sample of 107 AOD clients across public sector specialist AOD treatment services in New South Wales, Australia between 2016 and 2018. Participants had a mean age of 47 years and 46% were female. Participants completed a face-to-face ATOP and a phone ATOP with a researcher within 5 days. Comparisons between the two administration modes were undertaken using Spearman's rank correlation coefficient for continuous or ordinal variables, and Cohen's Kappa for nominal variables. RESULTS: Among 107 participants, 59% were attending for alcohol treatment and 41% for opioid treatment. Most ATOP items (76%) reached above 0.7 (good) or 0.9 (excellent) agreement between face-to-face and telephone use. DISCUSSION AND CONCLUSIONS: Our findings suggest that the ATOP is a suitable instrument for telephone monitoring of recent substance use, health and social functioning among AOD clients. Its validation for remote use over the telephone will support staff to monitor clients' risks and outcomes-of particular relevance in response to the COVID-19 pandemic in which services are increasingly relying on telework approaches to client monitoring.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Tratamento de Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Telefone , Adulto , Alcoolismo/reabilitação , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Pandemias , Reprodutibilidade dos Testes , Inquéritos e Questionários , Resultado do Tratamento
14.
Indian J Med Ethics ; V(2): 105-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32393446

RESUMO

The lockdown declared to prevent the spread of Covid 19 in India created unforeseen problems, including severe alcohol withdrawal symptoms and the need to manage them. The state of Kerala in India saw suicide deaths by six affected individuals, prompting the state government to instruct government doctors to prescribe alcohol to addicts. The local medical association approached the courts against this. These events raise interesting ethical issues discussed here. Keywords: alcohol withdrawal, prescribing alcohol, Covid 19, ethics of alcohol prescription.


Assuntos
Alcoolismo , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Síndrome de Abstinência a Substâncias , Alcoolismo/terapia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/ética , Humanos , Índia , Pneumonia Viral/epidemiologia , Síndrome de Abstinência a Substâncias/terapia
15.
Rev Esp Salud Publica ; 942020 May 28.
Artigo em Espanhol | MEDLINE | ID: mdl-32463027

RESUMO

OBJECTIVE: The diseases' declaration is a fundamental tool in public health. It's essential to know the magnitude of the problem and decide properly how to solve it. The active finding of cases allows us to know cases that weren't registered by means of the passive declaration. In this study, we intend to analyze whether tuberculosis (TB) cases detected by Tuberculosis Units (TBU) by active finding are different to those reported passively by health professionals. METHODS: Data from the Galician Registry of Tuberculosis (SITUB) were collected analyzing the 2,753 TB cases detected between 2014 and 2018. Confidence intervals were compared and the data were analyzed with Chi square or T-Student tests as required. RESULTS: 44.67% of TB cases of were detected by TBU by active finding. A higher proportion was detected by active finding in bacilliferous, patients with positive culture, pulmonary location and alcoholism. It was lower in HIV (-) and in pediatric cases (under 15 years). Although the proportion of the type of declaration varied depending on the TBU or age, no changes were detected when segregating by TBU or in people over 15 years old. CONCLUSIONS: If active finding wasn't perform, almost half of the cases would be lost. We observed differences in the characteristics of the patients according to the way they have been detected, although we don't know their possible cause. Therefore, the detection of cases by active finding it's an important public health tool.


Assuntos
Tuberculose/diagnóstico , Adolescente , Alcoolismo , Criança , Pessoal de Saúde , Humanos , Saúde Pública , Sistema de Registros , Espanha , Estudantes
16.
An Bras Dermatol ; 95(3): 376-378, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32276796

RESUMO

A 44-year-old male patient presented with nodules that evolved with inflammation, following drainage of seropurulent secretion and ulceration. The patient had a 6 year-history of alcohol addiction and reported contact with cats. At the physical examination, the patient had skin-colored and erythematous nodules, and ulcers covered with thick, blackened crusts on the face, trunk and limbs. A culture of a nodule fluid revealed growth of Sporotrix sp. He also had pulmonary involvement and therefore the disease was classified as systemic sporotrichosis, a rare form that usually affect patients infected with HIV. Chronic alcohol abuse was considered the factor of immunosuppression for the patient.


Assuntos
Alcoolismo/complicações , Alcoolismo/imunologia , Imunocompetência , Hospedeiro Imunocomprometido , Esporotricose/imunologia , Esporotricose/patologia , Adulto , Eritema/imunologia , Eritema/patologia , Humanos , Masculino , Sporothrix/isolamento & purificação , Esporotricose/induzido quimicamente
17.
PLoS One ; 15(4): e0231647, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302340

RESUMO

Help-seeking prior to a suicide attempt is poorly understood. Participants were recruited from a previous research trial who reported a history of suicidal behaviours upon follow-up. Qualitative interviews were conducted with six adults to understand their lived experience of a suicide attempt and the issues affecting help-seeking prior to that attempt. Participants described being aware of personal and professional supports available; however, were ambivalent about accessing them for multiple reasons. This paper employs an ecological systems framework to better understand the complex and multi-layered interpersonal, societal and cultural challenges to help-seeking that people with suicidal ideation can experience.


Assuntos
Alcoolismo/psicologia , Depressão/psicologia , Comportamento de Busca de Ajuda , Relações Interpessoais , Suicídio/psicologia , Adulto , Alcoolismo/epidemiologia , Comorbidade , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Autorrelato/estatística & dados numéricos , Suicídio/prevenção & controle
18.
PLoS One ; 15(4): e0231022, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32255781

RESUMO

This study identifies how to screen for harmful alcohol use among gender minority (e.g., transgender and gender-expansive) people using brief screening methods and identifies which screening methods perform best among gender-expansive, transfeminine, and transmasculine subgroups, as screening recommendations are not currently available. Using 2018 Annual Questionnaire data from The PRIDE Study, area under the curve (AUC) values were compared to identify which screening methods ("4 or more" or "5 or more" drinks on one occasion in the past year, or one or more items from the Alcohol Use Disorders Identification Test [AUDIT]) best predicted (i) harmful alcohol use and (ii) one or more past year alcohol dependence symptoms or consequences. Among 1892 participants, "5 or more" drinks on one occasion (AUC ranges: 0.82-0.86) performed better than "4 or more" drinks (AUC ranges: 0.78-0.81) in predicting harmful drinking. The screening methods "4 or more" drinks, "5 or more" drinks, and the consumption items of the AUDIT (AUDIT-C) using a cutoff score of 3 all maximized sensitivity and specificity to predict alcohol dependence symptoms or consequences in gender minority people overall (AUC: 0.77-0.78). Screening for "5 or more" drinks on one occasion within the past year performed as well as or better than other screening methods to detect both harmful drinking and alcohol dependence-related symptoms or consequences. This single-item screening method can identify if more extensive alcohol use assessment is warranted with gender minority people.


Assuntos
Alcoolismo/diagnóstico , Programas de Rastreamento/métodos , Minorias Sexuais e de Gênero/psicologia , Adulto , Área Sob a Curva , Feminino , Humanos , Masculino , Sensibilidade e Especificidade , Minorias Sexuais e de Gênero/estatística & dados numéricos , Inquéritos e Questionários
19.
PLoS Med ; 17(4): e1003056, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32302308

RESUMO

BACKGROUND: Both intimate partner violence (IPV) and alcohol misuse are highly prevalent, and partner alcohol misuse is a significant contributor to women's risk for IPV. There are few evidence-based interventions to address these problems in low- and middle-income countries (LMICs). We evaluated the effectiveness of an evidence-based, multi-problem, flexible, transdiagnostic intervention, the Common Elements Treatment Approach (CETA) in reducing (a) women's experience of IPV and (b) their male partner's alcohol misuse among couples in urban Zambia. METHODS AND FINDINGS: This was a single-blind, parallel-assignment randomized controlled trial in Lusaka, Zambia. Women who reported moderate or higher levels of IPV and their male partners with hazardous alcohol use were enrolled as a couple and randomized to CETA or treatment as usual plus safety checks (TAU-Plus). The primary outcome, IPV, was assessed by the Severity of Violence Against Women Scale (SVAWS) physical/sexual violence subscale, and the secondary outcome, male alcohol misuse, by the Alcohol Use Disorders Identification Test (AUDIT). Assessors were blinded. Analyses were intent-to-treat. Primary outcome assessments were planned at post-treatment, 12 months post-baseline, and 24 months post-baseline. Enrollment was conducted between May 23, 2016, and December 17, 2016. In total, 123 couples were randomized to CETA, 125 to TAU-Plus. The majority of female (66%) and a plurality of male (48%) participants were between 18 and 35 years of age. Mean reduction in IPV (via SVAWS subscale score) at 12 months post-baseline was statistically significantly greater among women who received CETA compared to women who received TAU-Plus (-8.2, 95% CI -14.9 to -1.5, p = 0.02, Cohen's d effect size = 0.49). Similarly, mean reduction in AUDIT score at 12 months post-baseline was statistically significantly greater among men who received CETA compared to men who received TAU (-4.5, 95% CI -6.9 to -2.2, p < 0.001, Cohen's d effect size = 0.43). The Data and Safety Monitoring Board recommended the trial be stopped early due to treatment effectiveness following the 12-month post-baseline assessment, and CETA was offered to control participants. Limitations of the trial included the lack of a true control condition (i.e., that received no intervention), self-reported outcomes that may be subject to social desirability bias, and low statistical power for secondary IPV outcomes. CONCLUSIONS: Results showed that CETA was more effective than TAU-Plus in reducing IPV and hazardous alcohol use among high-risk couples in Zambia. Future research and programming should include tertiary prevention approaches to IPV, such as CETA, rather than offering only community mobilization and primary prevention. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov (NCT02790827).


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Consumo de Bebidas Alcoólicas/terapia , Terapia Cognitivo-Comportamental/métodos , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Alcoolismo/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem , Zâmbia/epidemiologia
20.
PLoS One ; 15(4): e0231766, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298383

RESUMO

INTRODUCTION: Risk reduction towards safer behaviour is promoted after enrolment in HIV prevention trials. We evaluated sexual behaviour, changes in sexual behaviour and factors associated with risky behaviour after one-year of follow-up among women enrolled in HIV prevention trials in Northern Tanzania. METHODS: Self-reported information from 1378 HIV-negative women aged 18-44 enrolled in microbicide and vaccine feasibility studies between 2008-2010,was used to assess changes in behaviour during a 12-month follow-up period. Logistic regression with random intercepts was used to estimate odds ratios for trends in each behaviour over time. A behavioural risk score was derived from coefficients of three behavioural variables in a Poisson regression model for HIV incidence and thereafter, dichotomized to risky vs less-risky behaviour. Logistic regression was then used to identify factors associated with risky behaviour at 12 months. RESULTS: At baseline, 22% reported multiple partners, 28% were involved in transactional sex and only 22% consistently used condoms with non-regular partners. The proportion of women reporting multiple partners, transactional sex and high-risk sex practices reduced at each 3-monthly visit (33%, 43% and 47% reduction in odds per visit respectively, p for linear trend <0.001 for all), however, there was no evidence of a change in the proportion of women consistently using condoms with non-regular partners (p = 0.22). Having riskier behaviours at baseline, being younger than 16 years at sexual debut, having multiple partners, selling sex and excessive alcohol intake at baseline were strongly associated with increased odds of risky sexual behaviour after 12 months (p<0.005 for all). CONCLUSION: An overall reduction in risky behaviours over time was observed in HIV prevention cohorts. Risk reduction counselling was associated with decreased risk behaviour but was insufficient to change behaviours of all those at highest risk. Biological HIV prevention interventions such as PrEP for individuals at highest risk, should complement risk reduction counselling so as to minimize HIV acquisition risk.


Assuntos
Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Sexo sem Proteção/prevenção & controle , Adolescente , Adulto , Alcoolismo , Estudos de Coortes , Preservativos , Aconselhamento , Demografia , Estudos de Viabilidade , Feminino , Seguimentos , Infecções por HIV/prevenção & controle , Humanos , Modelos Logísticos , Razão de Chances , Fatores de Risco , Comportamento de Redução do Risco , Assunção de Riscos , Parceiros Sexuais , Fatores Sociológicos , Tanzânia/epidemiologia , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
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