Factores laborales y consumo psicotrópico entre trabajadores de la salud de Centros de Atención Psicosocial / Occupational Factors and Psychotropic Drugs Consumption in Health Workers from Psychosocial Care Centers

Introducción: El entorno laboral y sus circunstancias, especialmente en profesiones con alta carga de estrés, son factores de vulnerabilidad de los trabajadores en relación al uso de sustancias psicoactivas. En este sentido, rutinas de trabajo insalubre ponen los profesionales de la salud en situaciones de riesgo cuanto a la estabilidad física y mental. Objetivo: Evaluar la prevalencia de los factores laborales asociados al consumo de psicotrópicos por parte de profesionales de la salud en los Centros de Atención Psicosocial. Métodos: Estudio transversal analítico, realizado en siete unidades de los centros de una capital del noreste de Brasil, de febrero a junio de 2019. Los 161 trabajadores de la salud activos participaron en la investigación; las informaciones fueron recolectadas por el instrumento Alcohol, Smoking and Substance Involvement Screening Test y el cuestionario sobre condiciones sociodemográficas, ocupacionales, de salud y consumo de psicotrópicos. Para el análisis estadístico descriptivo, los datos se ingresaron en el Microsoft Excel 2016, después exportados al programa Statistical Package for the Social Sciences, 23.0. Resultados: En el análisis de las motivaciones para el uso/abuso de psicotrópicos se observó recurrencia de estresores ocupacionales: condiciones de trabajo (5,80 por ciento), insatisfacción laboral (2,90 por ciento), dificultades de relacionarse (1,40 por ciento) y aumento de la productividad (1,60 por ciento). Conclusiones: La prevalencia de condiciones insalubres y estresantes entre los factores que influyen en el consumo de psicotrópicos por parte de los profesionales de la salud destaca la vulnerabilidad de estos trabajadores en relación con las condiciones diarias de trabajo(AU)

Introduction: The work environment and its circumstances, especially in professions with a high stress load, are factors for workers' vulnerability regarding the use of psychoactive substances. In this respect, unhealthy work routines put health professionals at risk in terms of physical and mental stability. Objective: To assess the prevalence of occupational factors associated with the consumption of psychotropic drugs by health professionals in psychosocial care centers. Methods: Analytical and cross-sectional study carried out, from February to June 2019, in seven units at centers of a capital city of northeastern Brazil. The 161 active health workers participated in the research. The information was collected using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the questionnaire on sociodemographic, occupational and health-related conditions, as well as on psychotropic drugs consumption. For the descriptive statistical analysis, the data were entered into Microsoft Excel 2016, and then exported to the Statistical Package for the Social Sciences program (23.0). Results: In the analysis of the motivations for the use and/or overuse of psychotropic drugs, recurrence of occupational stressors was observed: working conditions (5.80 percent), job dissatisfaction (2.90 percent), relationship difficulties (1.40 percent) and increased productivity (1.60 percent). Conclusions: The prevalence of unhealthy and stressing conditions among the factors that influence psychotropic drugs consumption by health professionals highlights the vulnerability of these workers regarding daily working conditions(AU)

Vulnerabilidade, família e o uso de drogas: uma revisão integrativa de literatura / Vulnerability, family and drug use: an integrating literature review / Vulnerabilidad, familia y el uso de drogas: una revisión integral de literatura

Os problemas relacionados ao uso de álcool e outras drogas é uma realidade na sociedade atual e revela a existência de diferentes fatores relacionados. Entre eles, destaca-se a condição de vulnerabilidade como importante elemento contribuinte para o uso abusivo, bem como a família, sendo entendida como fator de risco e/ou proteção e como sistema diretamente afetado pelo problema. Diante disso, este estudo teve como objetivo realizar uma revisão integrativa de literatura sobre a relação entre vulnerabilidade, drogas e contexto familiar. Para tanto, foi realizada uma busca por artigos nas bases de dados Scielo e BVS utilizando os descritores "vulnerabilidade AND drogas AND família" que rastreou um total de 105 artigos. Após a aplicação dos critérios de inclusão, restaram 22 artigos. Desses, sete envolveram adolescentes escolares, cinco pessoas em situação de rua e cinco familiares de usuários, quatro foram realizados com os próprios usuários de drogas e um com profissionais da saúde. Os resultados das análises dos estudos sugerem que a relação entre uso de drogas, família e condição de vulnerabilidade é intrínseca, sendo difícil analisá-los isoladamente. A compreensão do problema das drogas requer uma visão ampliada e sistêmica de todos os fatores envolvidos neste complexo processo para ser possível o planejamento e a qualificação das políticas públicas.

The problems related to the use of alcohol and other drugs are a reality in today's society and reveal the existence of different related factors. Among them, the condition of vulnerability stands out as an important contributing element to abusive use, as well as family context, being understood as a risk and/or protective factor and as a system directly affected by the problem. Therefore, this study aimed to carry out an integrative literature review on the relationship between vulnerability, drugs and family. For this, a search for articles in the Scielo and VHL databases was carried out combining the descriptors "AND drugs AND family vulnerability", which tracked a total of 105 articles. After using the inclusion criteria, there were 22 articles remaining to be analyzed. From the 22 studies, seven involved school adolescents, five with street people, five with family members, four with drug users and one with health professionals. Results have shown that the relationship between drug use, family and vulnerability is intrinsic, making it difficult to analyze them in isolation. Understanding the drug problem requires an expanded and systemic view of all factors involved in this complex process in order to plan and qualify public policies.

Los problemas relacionados con el uso de alcohol y otras drogas es una realidad en la sociedad actual y revela la existencia de diferentes factores constitutivos y activos para determinar el fenómeno. Entre éstos, la condición de vulnerabilidad se destaca como un contribuyente importante al uso abusivo, así como a la familia, que se entiende como un factor de riesgo y / o protección y como un sistema directamente afectado por el problema. Por lo tanto, este estudio tuvo como objetivo realizar una revisión bibliográfica integradora sobre la relación entre vulnerabilidad, drogas y contexto familiar. Para este fin, se realizó una búsqueda de artículos en las bases de datos Scielo y BVS apoyada en la combinación de los descriptores "vulnerabilidad Y drogas Y familia" que rastrearon un total de 105 artículos. Después de aplicar los criterios de inclusión, quedaron 22 artículos, que fueron analizados en su totalidad. De éstos, siete se llevaron a cabo con adolescentes escolares, cinco con personas sin hogar, cinco con familiares de usuarios, cuatro con consumidores de drogas y uno con profesionales de la salud. Los resultados del análisis de los estudios sugieren que la relación entre el consumo de drogas, la familia y la condición de vulnerabilidad es intrínseca, lo que dificulta su análisis de forma aislada. Comprender el problema de las drogas requiere una visión ampliada y sistémica de todos los factores involucrados en este complejo proceso, para que sea posible planificar y calificar las políticas públicas.

Genome-wide association study of psychiatric and substance use comorbidity in Mexican individuals.

The combination of substance use and psychiatric disorders is one of the most common comorbidities. The objective of this study was to perform a genome-wide association study of this comorbidity (Com), substance use alone (Subs), and psychiatric symptomatology alone (Psych) in the Mexican population. The study included 3914 individuals of Mexican descent. Genotyping was carried out using the PsychArray microarray and genome-wide correlations were calculated. Genome-wide associations were analyzed using multiple logistic models, polygenic risk scores (PRSs) were evaluated using multinomial models, and vertical pleiotropy was evaluated by generalized summary-data-based Mendelian randomization. Brain DNA methylation quantitative loci (brain meQTL) were also evaluated in the prefrontal cortex. Genome-wide correlation and vertical pleiotropy were found between all traits. No genome-wide association signals were found, but 64 single-nucleotide polymorphism (SNPs) reached nominal associations (p < 5.00e-05). The SNPs associated with each trait were independent, and the individuals with high PRSs had a higher prevalence of tobacco and alcohol use. In the multinomial models all of the PRSs (Subs-PRS, Com-PRS, and Psych-PRS) were associated with all of the traits. Brain meQTL of the Subs-associated SNPs had an effect on the genes enriched in insulin signaling pathway, and that of the Psych-associated SNPs had an effect on the Fc gamma receptor phagocytosis pathway.

Impact of COVID-19-Related Stress and Lockdown on Mental Health Among People Living With HIV in Argentina.

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina. SETTING: PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. METHODS: Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. RESULTS: A total of 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86, P = 0.003 and loneliness ΔF(1,1326) = 5.77, P = 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76, P = 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. DISCUSSION: The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.

Aspects of protection and social vulnerability of teenagers in public all-day schools.

OBJECTIVE: identify and analyze aspects related to social vulnerability of a group of teenagers of a public all-day school with regard to harmful and abusive use of psychoactive drugs. METHODS: a strategic social study, with a qualitative approach, was carried out with 49 teenagers of a public all-day secondary school. Focus groups were carried out between 2016 and 2017, and the resulting material was transcribed and analyzed by means of thematic content analysis, resulting in the following categories: The family I come from; Birds of a feather; If I'm studying, how can I work?; Drugs: a non-parallel universe. RESULTS: social vulnerability was associated with unequal income distribution, fragile social relations affected by the harmful use of drugs and vulnerability of public all-day schools. Final considerations: all-day schools did not appear as an effective tool to break away with the context of social vulnerability regarding the use of drugs.

Signs of altered psychomotor capacity and use of alcohol and other drugs among nightclub patrons who drive in the city of São Paulo, Brazil.

Objectives: To investigate the occurrence of signs of altered psychomotor capacity (SAPC) associated with the violation of the dry law at the exits of nightclubs in the city of São Paulo, Brazil.Methods: Data from drivers participating in the Balada com Ciência project were used. Alcohol dosages were measured with breathalyzer test. The use of other drugs was obtained by interviewees' self-report. SAPC (speech, walking, glazed eyes, and alcohol odor) were verified by the interviewers at the time of the interview and categorized as "no sign" or "at least one sign". All measurements were evaluated at the exit of the nightclubs. The population description considered the sample weighting. Logistic regression analysis evaluated the association between the occurrence of SAPC, alcohol and other drugs use, controlling for sociodemographic variables.Results: At nightclubs, the SAPC among drivers are about 8 times higher when the breath alcohol concentration is above 0.05 mg/L if compared with those who did not drink alcohol, and about 30 times higher when the alcohol concentration was ≥ 0.34 mg/L in exhaled air. This finding is not generally verified in the literature for those who report the use of drugs inside nightclubs, which is interesting, since 20.4% of the interviewed population reported using drugs in the places surveyed.Conclusion: This study suggests the potential of using the Perham (2007) physical test for alcohol intoxication in sobriety checkpoints at the exit of nightclubs. However, the verification of these signs is not enough for the identification of drug use by drivers.

[Attention-deficit/hyperactivity disorder and substance abuse. Scientific evidence]. / Trastorno por déficit de atención/hiperactividad y uso de sustancias. Evidencias científicas.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental alteration of biological basis that started in childhood may persist during adolescence-youth and, despite what was believed until not many years ago, also in adulthood up to 50-60% of those affected, producing a significant clinical and psychosocial deterioration. In spite of being a syndrome easily identifiable by the triad: inattention, hyperactivity and impulsivity that characterizes it, in clinical practice there are different circumstances that hinder and complicate its diagnosis and treatment. One of the most significant is the presence, both in childhood and adulthood, of other comorbid mental disorders. It is from adolescence-youth when together with ADHD we can detect the presence of personality, mood and anxiety disorders and especially the use of several substances. The evidences existing until now show how the comorbidity of ADHD and substance use disorder influence the evolutionary course of both, complicating the approach, the treatment and, therefore, aggravating the final prognosis. The difficulties in their approach and the scarcity of treatment options make us underline the importance of preventive treatment in the infantile stage, starting from psychoeducation programs focused on the vulnerability of these patients to substances and the consequences associated with consumption.

El trastorno por déficit de atención con hiperactividad (TDAH) es una alteración del neurodesarrollo de base biológica que iniciado en la infancia puede persistir durante la adolescencia-juventud y, a pesar de lo que se pensaba hasta hace no muchos años, también en la edad adulta hasta en un 50-60% de los afectados, produciendo un notable deterioro clínico y psicosocial. A pesar de tratarse de un síndrome fácilmente identificable por la triada: desatención, hiperactividad e impulsividad que le caracteriza, en la práctica clínica existen diferentes circunstancias que dificultan y complican su diagnóstico y tratamiento. Una de las más significativas es la presencia, tanto en la infancia como en la edad adulta, de otros trastornos mentales comórbidos. Es a partir de la adolescencia-juventud cuando junto al TDAH podemos detectar la presencia de trastornos de la personalidad, trastornos del estado de ánimo, trastornos de ansiedad y muy especialmente trastornos por uso de sustancias. Las evidencias existentes hasta el presente muestran como la comorbilidad del TDAH y el trastorno por uso de sustancias influyen en el curso evolutivo de ambos, complicando el abordaje, el tratamiento y consecuentemente agravando el pronóstico final. Las dificultades en su abordaje y la escasez de opciones de tratamiento nos hacen subrayar la importancia del tratamiento preventivo en la etapa infantil a partir de programas de psicoeducación centrados en la vulnerabilidad de estos pacientes a las sustancias y las consecuencias asociadas al consumo.

Trastorno por deficit de atención/hiperactividad y uso de sustancias / Attention-deficit/hyperactivity disorder and substance abuse. Scientific evidence

El trastorno por déficit de atención con hiperactividad (TDAH) es una alteración del neurodesarrollo de base biológica que iniciado en la infancia puede persistir durante la adolescencia-juventud y, a pesar de lo que se pensaba hasta hace no muchos años, también en la edad adulta hasta en un 50-60% de los afectados, produciendo un notable deterioro clínico y psicosocial. A pesar de tratarse de un síndrome fácilmente identificable por la triada: desatención, hiperactividad e impulsividad que le caracteriza, en la práctica clínica existen diferentes circunstancias que dificultan y complican su diagnóstico y tratamiento. Una de las más significativas es la presencia, tanto en la infancia como en la edad adulta, de otros trastornos mentales comórbidos. Es a partir de la adolescencia-juventud cuando junto al TDAH podemos detectar la presencia de trastornos de la personalidad, trastornos del estado de ánimo, trastornos de ansiedad y muy especialmente trastornos por uso de sustancias. Las evidencias existentes hasta el presente muestran como la comorbilidad del TDAH y el trastorno por uso de sustancias influyen en el curso evolutivo de ambos, complicando el abordaje, el tratamiento y consecuentemente agravando el pronóstico final. Las dificultades en su abordaje y la escasez de opciones de tratamiento nos hacen subrayar la importancia del tratamiento preventivo en la etapa infantil a partir de programas de psicoeducación centrados en la vulnerabilidad de estos pacientes a las sustancias y las consecuencias asociadas al consumo.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental alteration of biological basis that started in childhood may persist during adolescence-youth and, despite what was believed until not many years ago, also in adulthood up to 50-60% of those affected, producing a significant clinical and psychosocial deterioration. In spite of being a syndrome easily identifiable by the triad: inattention, hyperactivity and impulsivity that characterizes it, in clinical practice there are different circumstances that hinder and complicate its diagnosis and treatment. One of the most significant is the presence, both in childhood and adulthood, of other comorbid mental disorders. It is from adolescence-youth when together with ADHD we can detect the presence of personality, mood and anxiety disorders and especially the use of several substances. The evidences existing until now show how the comorbidity of ADHD and substance use disorder influence the evolutionary course of both, complicating the approach, the treatment and, therefore, aggravating the final prognosis. The difficulties in their approach and the scarcity of treatment options make us underline the importance of preventive treatment in the infantile stage, starting from psychoeducation programs focused on the vulnerability of these patients to substances and the consequences associated with consumption.

Understanding Opioid Use After Total Hip Arthroplasty: A Comprehensive Analysis of a Mandatory Prescription Drug Monitoring Program.

INTRODUCTION: Opioids remain the most prescribed medication after total hip arthroplasty (THA) despite the potential for abuse and adverse effects. Given the high rates of opioid abuse and potential adverse effects, the reporting of controlled substances is now mandatory in many statewide databases. This study aimed to use a mandatory statewide database to analyze opioid prescription patterns in postoperative THA patients and identify independent risk factors for those patients who need a second prescription and/or require prolonged use (>6 months). METHODS: We retrospectively reviewed a consecutive series of 619 primary THAs. Demographic and comorbidity information were collected for all patients. Narcotic prescription data (converted to morphine milligram equivalents) as well as prescription data for sedatives, benzodiazepines, and stimulants were collected from the State's Controlled Substance Monitoring websites 6 months before and 9 months after the index procedure. Bivariate and multivariate analyses were done for second prescription and continued use. RESULTS: Of the 619 patients who underwent THA, 34.9% (216/619) used preoperative opioids, 36.2% (224/619) filled a second opioid prescription, and 10.5% (65/619) had continued use past 6 months. Patients with preoperative opioids were at an approximately 4-fold increased odds of requiring a second script and 12 times odds of continued opioid use. In the multivariate analysis, independent risk factors for requiring a second prescription, in descending order of magnitude, included the use of any sedative or sleep aid prescription and preoperative narcotic use. Independent risk factors for continued narcotic use longer than 6 months after THA included preoperative narcotic use and increased length of stay. DISCUSSION: Several risk factors and their relative weight have been identified for continued narcotic consumption after THA. It is important for surgeons to consider these predisposing factors preoperatively during the informed consent process and for managing postoperative pain expectations.

Prevalence of depression, anxiety, and substance-related disorders in parents of children with cerebral palsy: a systematic review.

AIM: To estimate the prevalence of mental illness in parents of children with cerebral palsy (CP). METHOD: This is a systematic review that follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols in the search for observational studies determining the prevalence of depression, anxiety, and substance abuse in parents of individuals with CP. The information sources used for this study were: PubMed, SciELO, Cochrane Library, Clinical Trials, and Biblioteca Virtual de Saúde. RESULTS: Fourteen articles were selected and included, investigating 1264 mothers and 105 fathers of children with CP. Data extracted for analysis were divided into three categories: study data, data about participants with CP, and data about parents. All studies included volunteer parents, of whom 95 per cent were female. INTERPRETATION: CP is related to a higher prevalence of symptoms of depression and anxiety in parents. Factors such as a child's degree of functionality and socioeconomic level may influence the frequency of mental disorders in parents. However, these studies have heterogeneous samples and applied different criteria to characterize their populations. WHAT THIS PAPER ADDS: Depression and anxiety are more prevalent for parents of children with cerebral palsy (CP) than parents of typically developing children. The child's illness severity is a risk factor for mental illness in parents of children with CP. The more time spent on child care, the higher the risk of mental illness among mothers of children with CP. There is a lack of reliable data in the literature on substance abuse in parents of children with CP.

PREVALENCIA DE DEPRESIÓN, ANSIEDAD Y TRASTORNOS RELACIONADOS AL USO DE SUSTANCIAS EN PADRES DE NIÑOS CON PARÁLISIS CEREBRAL: REVISIÓN SISTEMÁTICA: OBJETIVO: Calcular la prevalencia de enfermedad mental en padres de niños con parálisis cerebral (PC). METODO: Esta es una revisión sistemática que sigue la metodología para Protocolos de Revisiones Sistemáticas y Metaanálisis en la búsqueda de estudios observacionales que determinan la prevalencia de depresión, ansiedad y abuso de sustancias en padres de individuos con PC. Las fuentes de información utilizadas para este estudio fueron: PubMed, SciELO, LILACS, Biblioteca Cochrane, Clinical Trials, y Biblioteca Virtual de Saúde. RESULTADOS: Se seleccionaron e incluyeron 14 artículos, investigando 1.264 madres y 105 padres de niños con PC. Los datos extraídos para análisis fueron divididos en tres categorías: datos de estudio, datos sobre participantes con PC y datos sobre padres. Todos los estudios incluyeron padres voluntarios, de quienes el 95% fueron del sexo femenino. INTERPRETACIÓN: La PC está relacionada a una mayor prevalencia de síntomas de depresión y ansiedad en los padres. Factores como el grado de funcionalidad del niño y el nivel socioeconómico pueden influir en la frecuencia de trastornos cognitivos en los padres. Sin embargo, estos estudios tienen muestras heterogéneas y utilizaron diferentes criterios para caracterizar a las poblaciones.

PREVALÊNCIA DE DEPRESSÃO, ANSIEDADE, E DESORDENS RELACIONADAS AO USO DE SUBSTÂNCIAS EM PAIS DE CRIANÇAS COM PARALISIA CEREBRAL: UMA REVISÃO SISTEMÁTICA: OBJETIVO: Estimar a prevalência de doença mental em pais de crianças com paralisia cerebral (PC). MÉTODO: Esta é uma revisão sistemática que segue o protocol Itens preferenciais para reportar em revisões sistemáticas e metanálises na busca por estudos observacionais que determinassem a prevalência de depressão, ansiedade, e abuso de substâncias nos pais de indivíduos com PC. As fontes de informação usadas para este estudo foram: PubMed, SciELO, LILACS, Cochrane Library, Clinical Trials, e Biblioteca Virtual de Saúde RESULTADOS: Quatorze artigos foram selecionados e incluídos, investigando 1264 mães e 105 pais de crianças com PC. Os dados extraídos para análise foram divididos em três categorias: dados dos estudos, dados sobre os participantes com PC, e dados sobre os pais. Todos os estudos incluíram pais voluntários, dos quais 95 por cento eram mulheres. INTERPRETAÇÃO: A PC se relaciona com maior prevalência de sintomas de depressão e ansiedade em pais. Fatores como grau de funcionalidade da criança e nível socioeconomico podem infuenciar a frequência de desordens cognitivas nos pais. No entanto, estes estudos têm amostras heterogêneas e aplicaram diferentes critérios para caracterizar suas populações.

Na rua, a droga é destruição e curtição: um estudo em representações sociais / For the homeless, drugs are destruction and fun: a study in social representations

Este estudo objetiva analisar a estrutura das representações sociais de pessoas em situação de rua sobre drogas. Pesquisa qualitativa, com 158 pessoas em situação de rua, que responderam ao Teste de Associação Livre de Palavras, com o estímulo "drogas" de novembro/2017 a janeiro/2018. Os dados foram processados por dois softwares que permitiram análise fundamentada na Teoria das Representações Sociais. Nas representações gráficas geradas pelos softwares, os termos "destruição", "coisa ruim", "tristeza" sinalizam uma conotação negativa sobre as drogas em contraponto ao termo "curtição" que revela o uso como ação que promove prazer, sobrevivência, relacionada ao contexto da rua. Para o grupo investigado, as drogas representam elemento de sobrevivência, que podem potencializar outras vulnerabilidades. Destaca-se a importância da Estratégia de Redução de Danos no cuidado às pessoas em situação de rua, pela possibilidade desta considerar o sujeito, suas representações e especificidades.

This study aimed to analyze the structure of social representations of the homeless regarding drugs. It is a qualitative study, with 158 homeless people, who responded to a Word Association Test, with the stimulus "drugs", from November/2017 to January/2018. The data were processed using two types of software that enabled analysis based on the Social Representations Theory. In the graphic representations generated by the software, the terms "destruction", "bad thing", and "sadness" indicate a negative connotation in relation to drugs, in contrast to the term "fun", which revealed usage as an action to promote pleasure, or survival, related to the context of homelessness. For the investigated group, drugs represent an element of survival, which may enhance other vulnerabilities. The importance of a Damage Reduction Strategy in the care of the homeless stands out, as it considers the subject, their representations and specificities.

An examination of the association between early initiation of substance use and interrelated multilevel risk and protective factors among adolescents.

One of the major goals of drug use prevention programs is to delay the age of onset of substance use. What is called early initiation, usually occurring in adolescents under the age of 15, is a salient predictor of Substance Use Disorders later in adulthood. The causes of early initiation are complex and multifaceted and this has led to the identification of a rich set of risk and protective factors that influence age of onset. Nonetheless, there is little knowledge about the interdependence of these factors in their impact on early initiation. This paper addresses this question by applying Multiple Correspondence Analysis to data on family, community and social risk and protective factors from over 1200 adolescents. We find that community and to a lesser extent social factors are the most clearly associated to early initiation and we compare our results to those obtained from linear regression analyses of the same data that do not incorporate interdependence and find opposite results. We discuss the differences between linear regressions and MCA to evaluate the interplay of risk and protective factors and the implications of our findings for health policy and the design of prevention interventions aimed at delaying age of onset.

Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence

Objective: To investigate the prevalence of early childhood maltreatment and associations with later sexual behavior among adult substance users. Methods: A cross-sectional study enrolled 134 substance dependents who sought outpatient care in São Paulo, Brazil. Childhood trauma prevalence was assessed using the Childhood Trauma Questionnaire (CTQ). The Sexual Addiction Screening Test (SAST), drug of choice (DOC), and sexual behavior were also investigated. Results: The sample was composed predominantly of single adult males (76.1%), with alcohol as the DOC (73.9%). Experiences of emotional neglect (88.1%), emotional abuse (80.6%), physical neglect (78.4%), physical abuse (64.2%), and sexual abuse (31.3%) were prevalent. Women were more likely to have been sexually abused (OR 2.9, 95%CI 1.15-7.61) and physically abused (OR 3.7, 95%CI 1.31-10.6) in childhood. Those who were sexually abused in adulthood were more likely to have suffered physical abuse in childhood (OR 6.9, 95%CI 1.45-11.8). The odds of having been sexually abused in childhood were higher among subjects who reported to have exchanged sexual favors for drugs (OR 5.7, 95%CI 1.35-9.64) and to have been sexually abused in adulthood (OR 6.1, 95%CI 5.2-12.36). Conclusion: Physical and sexual abuse in childhood are highly prevalent in substance-dependent adults, and are associated with sexual revictimization and high-risk sexual behavior in adulthood.

Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence.

OBJECTIVE: To investigate the prevalence of early childhood maltreatment and associations with later sexual behavior among adult substance users. METHODS: A cross-sectional study enrolled 134 substance dependents who sought outpatient care in São Paulo, Brazil. Childhood trauma prevalence was assessed using the Childhood Trauma Questionnaire (CTQ). The Sexual Addiction Screening Test (SAST), drug of choice (DOC), and sexual behavior were also investigated. RESULTS: The sample was composed predominantly of single adult males (76.1%), with alcohol as the DOC (73.9%). Experiences of emotional neglect (88.1%), emotional abuse (80.6%), physical neglect (78.4%), physical abuse (64.2%), and sexual abuse (31.3%) were prevalent. Women were more likely to have been sexually abused (OR 2.9, 95%CI 1.15-7.61) and physically abused (OR 3.7, 95%CI 1.31-10.6) in childhood. Those who were sexually abused in adulthood were more likely to have suffered physical abuse in childhood (OR 6.9, 95%CI 1.45-11.8). The odds of having been sexually abused in childhood were higher among subjects who reported to have exchanged sexual favors for drugs (OR 5.7, 95%CI 1.35-9.64) and to have been sexually abused in adulthood (OR 6.1, 95%CI 5.2-12.36). CONCLUSION: Physical and sexual abuse in childhood are highly prevalent in substance-dependent adults, and are associated with sexual revictimization and high-risk sexual behavior in adulthood.

[Attention deficit hyperactivity disorder beyond adolescence. Time to think different?] / Trastorno por déficit de atención e hiperactividad más allá de la adolescencia ¿Tiempo de pensar diferente?

ADHD is a neurodevelopmental disorder characterized by a pattern of severe inattention-disorganization and/or hyperactivity-impulsivity beyond what is expected for individuals with a comparable development level. These behaviors impair daily life activities of patients in more than one environment and impact their performance and abilities compared with their peers. Extensive reviews have been published about the psychiatric comorbidities associated with ADHD but little attention has been given to the overall impact of ADHD on health. This study reviews some of the most common problems in medical care associated with ADHD like smoking, substance use, accident risk, sleep disorders, obesity, hypertension, diabetes, and early mortality. Today, a close follow-up of patient with ADHD is necessary not only from the psychiatric perspective but also in regard to general medicine issues to prevent the impact on health of those medical co-morbidities. Such conditions can end in severe chronic diseases with consequences and high cost for the individuals, the families and the society far beyond the academic and emotional impact frequently described as associated to ADHD. This condition has serious repercussions on health which need a medical multidisciplinary approach.

Trastorno por déficit de atención e hiperactividad más allá de la adolescencia ¿tiempo de pensar diferente? / Attention deficit hyperactivity disorder beyond adolescence. Time to think different?

El trastorno por déficit de atención e hiperactividad (TDAH) es un desorden del neurodesarrollo caracterizado por un patrón de inatención-desorganización e hiperactividad-impulsividad más grave que lo esperado para el nivel de desarrollo de acuerdo con la edad del individuo. Para el diagnóstico es necesario, además, que este comportamiento produzca alteraciones en las distintas áreas de funcionamiento del afectado en comparación con individuos similares de su entorno. Se han publicado extensas revisiones sobre las comorbilidades psiquiátricas asociadas con el TDAH, pero se ha dedicado poca atención a su efecto en la salud general. En este trabajo se revisan algunos de los problemas de medicina general del adulto más frecuentemente asociados con el diagnóstico de TDAH, tales como tabaquismo, adicción, accidentes, trastornos de sueño, obesidad, hipertensión, diabetes, y muerte temprana. Hoy se requiere un seguimiento más cercano de los afectados con TDAH, no solo desde el punto de vista psiquiátrico sino también en lo referente a la atención médica general, para prevenir su impacto sistémico que en la adultez lleva a enfermedades crónicas graves y costosas para los sistemas de salud, los individuos y la sociedad. Estas consecuencias tienen repercusiones médicas muy serias que exceden lo académico y lo emocional y deben ser consideradas por equipos multidisciplinarios.

ADHD is a neurodevelopmental disorder characterized by a pattern of severe inattention-disorganization and/or hyperactivity-impulsivity beyond what is expected for individuals with a comparable development level. These behaviors impair daily life activities of patients in more than one environment and impact their performance and abilities compared with their peers. Extensive reviews have been published about the psychiatric comorbidities associated with ADHD but little attention has been given to the overall impact of ADHD on health. This study reviews some of the most common problems in medical care associated with ADHD like smoking, substance use, accident risk, sleep disorders, obesity, hypertension, diabetes, and early mortality. Today, a close follow-up of patient with ADHD is necessary not only from the psychiatric perspective but also in regard to general medicine issues to prevent the impact on health of those medical co-morbidities. Such conditions can end in severe chronic diseases with consequences and high cost for the individuals, the families and the society far beyond the academic and emotional impact frequently described as associated to ADHD. This condition has serious repercussions on health which need a medical multidisciplinary approach.

Gender-related patterns of psychiatric disorder clustering among bariatric surgery candidates: A latent class analysis.

BACKGROUND: Psychiatric disorders tend to distribute unevenly in women and men with severe obesity. The current research aimed to identify homogeneous clusters of concurrent psychiatric disorders among patients seeking bariatric surgery, by gender. METHODS: We recruited a consecutive sample of 393 candidates with obesity (311 women and 82 men) in a university-based bariatric center. Trained clinicians assessed psychiatric disorders through the Structured Clinical Interview for DSM-IV (SCID). Latent class analysis categorized pre-surgical patients into uniform clusters of co-occurring psychiatric disorders. RESULTS: For both genders, the 3-class psychopathological clustering was the best-fitting solution. Among women, the latent classes were: (1) "oligosymptomatic", wherein 42% of patients showed low probability of psychiatric disorders; (2) "bipolar with comorbidities", in 33%; and (3) "anxiety/depression", in 25%. Among men, (1) "bipolar with comorbidities" was found in 47% of patients; (2) "oligosymptomatic", in 40%; and (3) "anxiety/depression", in 13%. For both genders, the probability of presenting eating disorders was higher in both "bipolar" and "anxiety/depression" classes. Substance use disorders was prominent among "bipolar" men. In comparison with "oligosymptomatic" class, the likelihood of higher BMI was observed among "bipolar" men and poorer work attainment among men with "anxiety/depression". LIMITATION: Participants was cross-sectionally drawn from a single bariatric center. CONCLUSIONS: Pre-surgical men and women with severe obesity were distributed in three comorbidity profiles and revealed analogous psychopathological patterns. The class of "bipolar disorders" most likely presented comorbidity with eating and substance use disorder. This natural clustering of psychiatric disorders among bariatric patients suggests gender-related therapeutic approaches and surgical outcomes.

Psychosocial Characteristics of Women with a Delayed Diagnosis of Turner Syndrome.

OBJECTIVES: To characterize the psychosocial profiles of adult women diagnosed with Turner syndrome before (early diagnosis) and at or after (late diagnosis) 13 years of age. STUDY DESIGN: Women with Turner syndrome ages 22 and older at evaluation (n = 110) participated in a cross-sectional study at the National Institutes of Health. Researchers performed nonparametric and logistic regression analyses to assess early and late diagnosis cohorts on measures of depression, substance use, and perceptions of competence and identity. RESULTS: Of study participants, 47% received a Turner syndrome diagnosis at or after age 13 years. Median age at diagnosis was 12.0 years (range, 0-43). Covariate-adjusted models revealed that women with late diagnoses had an increased likelihood of developing mild to severe depressive symptoms (OR, 7.36) and a decreased likelihood of being perceived as competent (OR, 0.26). Women with a late diagnosis also exhibited more frequent substance use compared with women with early diagnoses. CONCLUSIONS: These data suggest that Turner syndrome diagnoses received at or after age 13 years may contribute to adverse outcomes related to depression, substance use, and perceptions of competence. Delayed Turner syndrome diagnoses may place women and girls at risk for negative psychosocial development extending into adulthood. These findings indicate it is important for pediatricians to evaluate psychosocial domains in girls with Turner syndrome regularly, particularly among those diagnosed at age 13 years or older. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00006334.