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1.
Aten. prim. (Barc., Ed. impr.) ; 52(1): 47-53, ene. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-ET2-3528

RESUMEN

El Proyecto ÉVICT (Evictproject.org), a raíz del aumento de consumo de cannabis en población juvenil española, ha estudiado su asociación con el tabaco, concluyendo que el consumo conjunto de tabaco y cannabis: tiene una influencia en el proceso de aprender a fumar, pues el inicio puede ser conjunto y con influencia bidireccional; tiene una influencia en el desarrollo de dependencia pues su interacción es relevante para el desarrollo de este trastorno, y tiene una influencia en la toxicidad, pues probablemente, el fumar tabaco y cannabis genera mayores problemas que fumar solo una de las 2. Y, por tanto, el equipo EVICT emite unas consideraciones en prevención: diferenciar uso medicinal y recreativo; comunicar que fumar cannabis no es terapéutico ni inocuo, y puede ayudar a generar dependencia de nicotina o, menos frecuentemente, al propio cannabis. Consideraciones en abordaje y tratamiento: en personas que consumen tabaco/cannabis debemos plantear como primera opción el cese de las 2 sustancias. Consideraciones en reducción de daños: a quienes solo consumen productos de tabaco/cannabis, los programas serían más aplicables a aquella cuyo consumo se considere más problemático


EVICT project has noted the increase in cannabis use in the Spanish youth population, and has studied its association with tobacco, concluding that: It has an influence in the learning to smoke process: The beginning can be combined and with bi-directional influence. It has an influence on dependence the development of dependence. Their interaction is relevant in the development of dependence. It has an influence on toxicity: Smoking tobacco and cannabis generates greater problems than smoking tobacco alone. And, therefore, the EVICT team issues some considerations: Prevention considerations. Differentiate between therapeutic and recreational use. Smoking cannabis is not therapeutic nor innocuous, and can affect the development of nicotine dependence, or, less frequently, cannabis dependence. Approach and treatment considerations. In A first option of cessation of both must be proposed in people who consume tobacco and cannabis Harm Reduction. To those that only consume tobacco/cannabis: Harm Reduction programs should be more applicable to those in whom consumption is considered more problematic


Asunto(s)
Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Fumar/epidemiología , Fumadores , Tabaquismo/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Abuso de Marihuana/epidemiología , Codependencia (Psicología) , Tabaquismo/prevención & control , Prevención del Hábito de Fumar/legislación & jurisprudencia
2.
Epidemiol Psychiatr Sci ; 29: e94, 2020 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-31973775

RESUMEN

AIMS: Previous studies analysing blood alcohol concentration (BAC) at the time of suicide have primarily focused on sociodemographic factors. Limited research has focused on psychosocial factors and co-ingestion of other substances to understand the mechanisms of how alcohol contributes to death by suicide. The aim was to examine time trends, psychosocial factors related to acute alcohol use and co-ingestion of alcohol and other substances before suicide. METHODS: The Queensland Suicide Register in 2004-2015 was utilised and analysed in 2019. The cut-off point for positive BAC was set at ⩾0.05 g/dl. Substances were categorised as medicines, illegal drugs and other. Medicines were coded by the Anatomical Therapeutic Chemical (ATC) classification system. Joinpoint regression, univariate odds ratios, age and sex-adjusted odds ratios and Forward Stepwise logistic regression were performed. RESULTS: BAC information was available for 6744 suicides, 92% of all cases in 2004-2015. The final model showed that independent factors distinguishing BAC+ from BAC- were: age group 25-44 years, Australian Indigenous background, being separated or divorced, hanging, diagnosis of substance use, lifetime suicidal ideation, relationship and interpersonal conflict, not having psychotic and other psychiatric disorder, and no nervous system drugs or any other substances in blood at the time of suicide. CONCLUSIONS: Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment.


Asunto(s)
Consumo de Bebidas Alcohólicas/sangre , Nivel de Alcohol en Sangre , Sistema de Registros/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Australia/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología , Suicidio/psicología
3.
Am J Forensic Med Pathol ; 41(1): 5-10, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32000222

RESUMEN

Use of excessive force (UOEF) is an important and controversial topic but little is known about how injury severity is related to allegations of UOEF. We hypothesized that such complaints would be associated with more significant traumatic injuries. Emergency department records were searched for all individuals making UOEF complaints against an urban police department from 2010 to 2012. Demographic, diagnosis, and other medical data, including Injury Severity Score, were obtained. From police records, force used, suspect resistance and threat, and other call data were obtained. The same data were collected for a control group randomly chosen from all use-of-force events identified during the study period. Of the 235 complaints filed, 42 (18%) subjects had medical evaluation. The control group was significantly younger and more likely to be male; there was no significant difference in race or income. Major injuries were infrequent. No significant difference was found in Injury Severity Score or other medical variables between the 2 groups. Among the law enforcement variables, the only significant difference was a higher likelihood of psychiatric-related calls in the control group. The majority of patients alleging UOEF did not require immediate medical attention, and we found no relationship between injury severity and UOEF complaints.


Asunto(s)
Puntaje de Gravedad del Traumatismo , Policia , Heridas y Traumatismos/epidemiología , Adulto , Estudios de Casos y Controles , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/epidemiología , Washingtón/epidemiología
4.
Lancet Psychiatry ; 7(2): 135-147, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31974072

RESUMEN

BACKGROUND: Psychiatric disorders are established risk factors for self-harm. However, variation in the risk of self-harm by specific psychiatric disorder and stratified by gender and age is rarely examined in population-representative samples. This study aimed to investigate the risk of self-harm following diagnosis of different psychiatric disorders in an Asian population, through a review of inpatient records retrieved from the Hong Kong Clinical Data Analysis and Reporting System (CDARS). METHODS: For this nested case-control study, the inpatient data of people admitted for any reason to Hong Kong public hospitals, between Jan 1, 2000, and Dec 31, 2010, were extracted from CDARS. Cases were people aged 10 years or older who had been admitted to inpatient care with a first-listed record of psychiatric disorder during the study period. The seven psychiatric disorders of interest were: depression, alcohol misuse or dependence, personality disorders, bipolar disorders, anxiety disorders, schizophrenia, and substance misuse or dependence. Two control patients were matched per case from a subsample of all individuals with the same gender, age, and admission time (ie, same calendar year and month), who did not have any record of the psychiatric disorders of interest. Any patients with a history of self-harm diagnosis before, or at the same time as, the first diagnosis of psychiatric disorder (cases) or admission (controls), were excluded. For each diagnostic category, a Cox proportional hazard regression model was fitted to estimate the adjusted hazard ratio (HR; plus 95% CIs) of associated self-harm, adjusting for gender, age, control-matched admission time, 20 districts of residence, physical comorbidities established as risk factors for self-harm (diabetes, asthma, migraine, epilepsy, HIV, and cancer), and presence of the six other psychiatric disorders. We repeated this analysis in subgroups stratified by gender (male and female) and by age (adolescent, 10-24 years; young adult, 25-44 years; middle-aged, 45-64 years; and older people, ≥65 years). FINDINGS: Between 2000 and 2010, we followed up a cohort of 86 353 people with a first-recorded diagnosis of a psychiatric disorder of interest, and 134 857 matched controls. The highest risk of self-harm was observed in patients with substance misuse or dependence (adjusted HR vs matched controls, 9·6 [95% CI 8·4-11·0]), followed by those with personality disorders (3·7 [2·8-4·9]) and alcohol misuse or dependence (3·2 [2·9-3·7]). When stratified by gender and age, the highest risk of self-harm behaviour was found in the substance misuse or dependence group for both genders (for female patients: adjusted HR vs matched controls, 7·7 [6·0-9·8]; and for male patients, 10·5 [8·9-12·4]), and for all age groups (adolescent: 9·6 [7·2-12·7]; young adults: 10·2 [8·4-12·3]; middle-aged: 11·2 [8·0-15·6], and older people: 3·2 [1·7-6·1]). INTERPRETATION: First-recorded diagnoses of psychiatric disorders were significantly associated with an elevated risk of subsequent self-harm. The associations varied considerably by diagnostic categories across gender and age subgroups. Our findings highlight the need to develop more efficient and targeted preventive measures in psychiatric care management, with specific attention to demographic characteristics linked to increased risk within the same diagnostic category. FUNDING: None.


Asunto(s)
Trastornos de Ansiedad/epidemiología , Trastorno Bipolar/epidemiología , Trastorno Depresivo/epidemiología , Trastornos de la Personalidad/epidemiología , Esquizofrenia/epidemiología , Conducta Autodestructiva/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Estudios de Casos y Controles , Niño , Femenino , Estudios de Seguimiento , Hong Kong/epidemiología , Hospitales Públicos/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Sistemas de Registros Médicos Computarizados/estadística & datos numéricos , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Riesgo , Factores Sexuales , Adulto Joven
5.
J Forensic Sci ; 65(1): 97-102, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31386191

RESUMEN

Understanding trends in substance use by gender among jail-based treatment program participants can inform policies and programs tailored to this population. Preprogram assessment data from 3509 individuals entering a jail-based substance use disorder treatment program in Missouri between 1998 and 2016 were analyzed. Primary outcome was program participants' strongly preferred substances. Demographic covariates and drug preferences were compared between males and females. Average yearly trends in preferred substances were calculated. While 25.8% of the sample preferred heroin, it was more strongly preferred by women (36.4%) than men (22.0%, p < 0.0001). Alcohol and marijuana were preferred more by males. Overall, preferences for heroin and methamphetamine increased over time while alcohol, marijuana, and other stimulants decreased. Women being more likely to prefer heroin and the increasing preference for heroin over time are consistent with national trends. Offering evidence-based treatment like pharmacotherapy and gender-sensitive approaches can help address the needs of this vulnerable population.


Asunto(s)
Conducta de Elección , Prisioneros , Factores Sexuales , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Distribución por Edad , Consumo de Bebidas Alcohólicas , Cannabis , Cocaína , Cocaína Crack , Femenino , Heroína , Humanos , Masculino , Metanfetamina , Missouri/epidemiología , Medicamentos bajo Prescripción , Distribución por Sexo , Trastornos Relacionados con Sustancias/rehabilitación , Adulto Joven
6.
J Forensic Sci ; 65(1): 160-165, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31343744

RESUMEN

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.


Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Prisioneros/psicología , Prisiones , Adulto , Coinfección , Femenino , Infecciones por VIH/epidemiología , Hepatitis C Crónica/epidemiología , Humanos , Estudios Longitudinales , Masculino , Polifarmacia , Estudios Prospectivos , Psicotrópicos/uso terapéutico , España/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
7.
Accid Anal Prev ; 134: 105329, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31704642

RESUMEN

Though U.S. motor vehicle crashes as a whole have decreased over the past few years, fatalities among vulnerable road users have increased. Pedestrian deaths rose nationally by 27% between 2007 and 2016 accounting for 16% of all motor vehicle fatalities. This increase continues to burden transportation specialists, public health professionals, and community stakeholders. Potential risk factors include characteristics of the built environment, distractions, and pedestrians' use of alcohol and drugs. Pedestrian deaths in Georgia, United States, increased 40% between 2014 and 2016 while drug overdose deaths have increased by 18% during the same period. Concurrent increases in mortality due to pedestrian fatalities and drug overdoses make Georgia a natural environment in which to describe the proximity of drugs among pedestrian fatalities, a topic largely overlooked by the literature. This study explores the epidemiology of pedestrian fatalities in Georgia over a 10-year period with an emphasis on reported substance use among cases. The study employed 10-year data from the Fatality Analysis Reporting System (FARS) administered by the National Highway Traffic Safety Administration. Descriptive methods were used to explore drug screens by person, place, and time. We also examined trends in total drug screens over the examination period. Between 2007 and 2016, 1781 pedestrian crashes were reported to FARS; the fatality rate for this period was 94.5%. Of these, most were male with Blacks and Whites equally represented. Ages 15-64 accounted for 81.1% of cases with most occurring in the Atlanta Metropolitan area. When adjusted for population, one finds higher rates in more rural areas of the state. Data revealed that testing for the presence of drugs occurred among half of reported cases. Of those testing positive, five drug categories emerged; stimulants (45.8%), cannabinoids (21.5%), narcotics (including opioids) (14.1%), depressants (12.1%), and "Other Drugs" (6.3%). Positive drug screens across all drug classifications increased by 178.1% between 2007 and 2016. These findings suggest the need for state-wide policies designed to promote more consistent screening among pedestrians involved in motor vehicle crashes as well as diligence in understanding the role played by drugs among this population. Additional investigation should be conducted to tease out the presence of category-specific drugs among pedestrians. Understanding the epidemiology of pedestrian fatalities in the state, especially in relation to substance use, serves as a first step toward implementing localized preventive efforts.


Asunto(s)
Accidentes de Tránsito/mortalidad , Peatones/estadística & datos numéricos , Detección de Abuso de Sustancias/métodos , Accidentes de Tránsito/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Georgia/epidemiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores de Riesgo , Análisis Espacial , Detección de Abuso de Sustancias/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adulto Joven
8.
Forensic Sci Int ; 306: 110002, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31864775

RESUMEN

Designer drugs or new psychoactive substances (NPS) are a heterogeneous group of substances obtained through the modification of chemical structure of some natural products or drugs. NPS illegally commercialized in blotter papers mimicking the most common form of LSD consumption, with a great variability of colours and symbols, have largely increased worldwide, including in Brazil, becoming an important emerging public health issue. In this study, we have evaluated the presence and profile of NPS in blotters seized in the State of Santa Catarina, Brazil, over the period of 2011 to 2017. The state government criminal forensics staff has performed gas chromatography-mass spectrometer (GC-MS) analyses in order to determine the chemical composition of the blotters. During the evaluated period, there was a considerable increase in the seizing of blotters events, from 87 in 2011, to 301 in 2016 and reaching 277 in 2017. There was also an increase in the number of blotters seized per event. Interestingly, while in 2011, 100% of blotters contained LSD, this number decreased to 0,1% in 2014, and achieved 17,6% in 2017, when up to 25 different substances were detected in blotters seized. Drugs such as DOx, NBOMe, fentanyl, mescaline derivatives, triptamines, cathinones, and synthetic cannabinoids were detected and became the major substances found in blotters. In some cases, more than one substance was found in the same blotter, characterizing a new mixture scenario. The presence of several new psychoactive substances in blotters is a reality in forensic toxicology. In Brazil, it might be related to the fact that most of these substances were not considered illegal by Brazilian legislation by the time they emerged.


Asunto(s)
Drogas Diseñadas/análisis , Papel , Psicotrópicos/análisis , Brasil/epidemiología , Cromatografía de Gases y Espectrometría de Masas , Humanos , Dietilamida del Ácido Lisérgico/análisis , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/epidemiología
9.
Rev Saude Publica ; 53: 102, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800913

RESUMEN

We analyzed data from the National School-based Health Survey (PeNSE) carried out in Brazil in 2015 (n = 102,072 adolescents) to estimate how much of the individual variance in the prevalence of health behaviors is attributable to the school level. Multilevel logistic regression models were calculated to estimate the variance partitional coefficient (VPC) of the use of drugs, intake of unhealthy food, leisure physical activity and weight-related behaviors. The between-schools variance was significant in all tested models. The highest VPCs were observed when the use of drugs was analyzed (15%-20% of the total variance of smoking and use of illegal drugs). Lower, but still significant, values were observed in the other outcomes. The school context plays an important role in the adolescents' health and should be considered in the design of public policies and actions in public health.


Asunto(s)
Salud del Adolescente/estadística & datos numéricos , Conductas de Riesgo para la Salud , Instituciones Académicas/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Adolescente , Peso Corporal , Brasil/epidemiología , Femenino , Preferencias Alimentarias , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Sector Privado , Sector Público , Factores de Riesgo , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Consumo de Alcohol en Menores/estadística & datos numéricos
10.
MMWR Morb Mortal Wkly Rep ; 68(50): 1153-1157, 2019 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-31856145

RESUMEN

In the United States, driving while impaired is illegal. Nonetheless, an estimated 10,511 alcohol-impaired driving deaths occurred in 2018.* The contribution of marijuana and other illicit drugs to these and other impaired driving deaths remains unknown. Data from the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health (NSDUH) indicated that in the United States during 2014, 12.4% of all persons aged 16-25 years reported driving under the influence of alcohol, and 3.2% reported driving under the influence of marijuana (1). The impairing effects of alcohol are well established, but less is known about the effects of illicit substances or other psychoactive drugs (e.g., marijuana, cocaine, methamphetamines, and opioids, including heroin). This report provides the most recent national estimates of self-reported driving under the influence of marijuana and illicit drugs among persons aged ≥16 years, using 2018 public-use data from NSDUH. Prevalences of driving under the influence of marijuana and illicit drugs other than marijuana were assessed for persons aged ≥16 years by age group, sex, and race/ethnicity. During 2018, 12 million (4.7%) U.S. residents reported driving under the influence of marijuana in the past 12 months; 2.3 million (0.9%) reported driving under the influence of illicit drugs other than marijuana. Driving under the influence was more prevalent among males and among persons aged 16-34 years. Effective measures that deter driving under the influence of drugs are limited (2). Development, evaluation, and further implementation of strategies to prevent alcohol-impaired,† drug-impaired, and polysubstance-impaired driving, coupled with standardized testing of impaired drivers and drivers involved in fatal crashes, could advance understanding of drug- and polysubstance-impaired driving and support prevention efforts.


Asunto(s)
Conducir bajo la Influencia/estadística & datos numéricos , Abuso de Marihuana/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Femenino , Humanos , Masculino , Estados Unidos/epidemiología , Adulto Joven
11.
PLoS Med ; 16(12): e1002995, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31846461

RESUMEN

BACKGROUND: Intimate partner violence (IPV) against women is associated with a wide range of adverse outcomes. Although mental disorders have been linked to an increased risk of perpetrating IPV against women, the direction and magnitude of the association remain uncertain. In a longitudinal design, we examined the association between mental disorders and IPV perpetrated by men towards women in a population-based sample and used sibling comparisons to control for factors shared by siblings, such as genetic and early family environmental factors. METHODS AND FINDINGS: Using Swedish nationwide registries, we identified men from 9 diagnostic groups over 1998-2013, with sample sizes ranging from 9,529 with autism to 88,182 with depressive disorder. We matched individuals by age and sex to general population controls (ranging from 186,017 to 1,719,318 controls), and calculated the hazard ratios of IPV against women. We also estimated the hazard ratios of IPV against women in unaffected full siblings (ranging from 4,818 to 37,885 individuals) compared with the population controls. Afterwards, we compared the hazard ratios for individuals with psychiatric diagnoses with those for siblings using the ratio of hazard ratios (RHR). In sensitivity analyses, we examined the contribution of previous IPV against women and common psychiatric comorbidities, substance use disorders and personality disorders. The average follow-up time across diagnoses ranged from 3.4 to 4.8 years. In comparison to general population controls, all psychiatric diagnoses studied except autism were associated with an increased risk of IPV against women in men, with hazard ratios ranging from 1.5 (95% CI 1.3-1.7) to 7.7 (7.2-8.3) (p-values < 0.001). In sibling analyses, we found that men with depressive disorder, anxiety disorder, alcohol use disorder, drug use disorder, attention deficit hyperactivity disorder, and personality disorders had a higher risk of IPV against women than their unaffected siblings, with RHR values ranging from 1.7 (1.3-2.1) to 4.4 (3.7-5.2) (p-values < 0.001). Sensitivity analyses showed higher risk of IPV against women in men when comorbid substance use disorders and personality disorders were present, compared to risk when these comorbidities were absent. In addition, increased IPV risk was also found in those without previous IPV against women. The absolute rates of IPV against women ranged from 0.1% to 2.1% across diagnoses over 3.4 to 4.8 years. Individuals with alcohol use disorders (1.7%, 1,406/82,731) and drug use disorders (2.1%, 1,216/57,901) had the highest rates. Our analyses were restricted to IPV leading to arrest, suggesting that the applicability of our results may be limited to more severe forms of IPV perpetration. CONCLUSIONS: Our results indicate that most of the studied mental disorders are associated with an increased risk of perpetrating IPV towards women, and that substance use disorders, as principal or comorbid diagnoses, have the highest absolute and relative risks. The findings support the development of IPV risk identification and prevention services among men with substance use disorders as an approach to reduce the prevalence of IPV.


Asunto(s)
Alcoholismo/epidemiología , Violencia de Pareja/psicología , Trastornos Mentales/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Comorbilidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Suecia , Adulto Joven
12.
J Forensic Nurs ; 15(4): 231-241, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31764527

RESUMEN

INTRODUCTION: Clients on methadone maintenance treatment (MMT) have high attrition rates that are attributed to personal and system-related factors. To develop supportive interventions for these clients, it is imperative to understand social demographic characteristics and challenges that clients in the MMT program face. OBJECTIVES: This article aims to describe (a) the sociodemographic characteristics and clinical profiles of clients in a MMT program, (b) factors that impact their positive clinical outcomes, and (c) the study's implications for practice. METHODS: A retrospective review of 101 randomly selected electronic medical records representing one third of all the records were examined for sociodemographic characteristics, clinical profiles, and outcomes. Descriptive statistics were used to analyze these variables. Interviews with 18 healthcare providers focusing on their experiences of caring for clients in the MMT program were analyzed thematically. RESULTS: The average age of clients on MMT is 35.5 years. Clients had early exposure to alcohol and drugs, and at the time of enrollment to the program, they presented with complex healthcare needs, borne from chronic use, and exposure to adverse traumatic events. Personal and systemic factors impact clients' recovery. These include poverty, homelessness, and inadequate healthcare services. Understanding sociodemographic characteristics, clinical profiles, and clients' challenges is central to the development of supportive interventions that enhance retention to care and recovery.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Centros de Tratamiento de Abuso de Sustancias , Adulto , Distribución por Edad , Canadá/epidemiología , Femenino , Necesidades y Demandas de Servicios de Salud , Personas sin Hogar , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Medio Social , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/rehabilitación , Adulto Joven
13.
BMC Infect Dis ; 19(1): 925, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666015

RESUMEN

BACKGROUND: Ruili is a border city in southwest China along the heroin trafficking route. In recent decades, the city has witnessed increased in HIV transmission. The current study aims to explore the spatiotemporal trends in HIV prevalence identify and map the spatial variation and clustering of factors associated with HIV transmission through drug use and heterosexual contact transmissions at the village level from 1989 through 2016. METHODS: Geographic information system-based spatiotemporal analyses, including global and local spatial autocorrelation analyses and space-time scanning statistics, were applied to detect the location and extent of HIV/AIDS high-risk areas. RESULTS: Drug use and heterosexual contact were identified as the major transmission routes causing infection in Ruili. Results of global spatial analysis showed significant clustering throughout the city caused by transmission via drug use in the early phase of the epidemic and transmission via heterosexual contact in the late phase of the epidemic during the study period. Hotspots of transmission from drug use were randomly distributed throughout the city. However, the hotspots of transmission by heterosexual contact were located in the central area only around the Jiegao China-Myanmar land port. Space-time scanning showed that transmission from drug use clustered in the southwest area between 1989 and 1990, while transmission by heterosexual contact clustered in the central area between 2004 and 2014. CONCLUSIONS: Heterosexual contact has become the dominant mode of transmission. Interventions should focus on highly clustered area where is around the Jiegao land port.


Asunto(s)
Infecciones por VIH/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adulto , China/epidemiología , Ciudades , Análisis por Conglomerados , Epidemias , Femenino , Sistemas de Información Geográfica , Infecciones por VIH/transmisión , Heterosexualidad , Humanos , Masculino , Mianmar , Prevalencia , Conducta Sexual , Análisis Espacio-Temporal , Trastornos Relacionados con Sustancias/virología
14.
Lancet ; 394(10209): 1668-1684, 2019 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-31668410

RESUMEN

The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.


Asunto(s)
Monitoreo de Drogas/métodos , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Psicotrópicos/efectos adversos , Salud Pública/legislación & jurisprudencia , Adolescente , Adulto , Comercio/legislación & jurisprudencia , Recolección de Datos , Control de Medicamentos y Narcóticos/métodos , Femenino , Humanos , /legislación & jurisprudencia , Masculino , Persona de Mediana Edad , Motivación , Psicotrópicos/clasificación , Trastornos Relacionados con Sustancias/epidemiología , Adulto Joven
15.
N C Med J ; 80(6): 367-371, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31685575

RESUMEN

This article will describe the mental health/substance use issues of justice-involved youth, highlight the role that trauma and adverse childhood experiences (ACEs) have in the development of these issues, discuss what services are offered at the highest levels of confinement, identify the service gaps and needs for this vulnerable population, and briefly examine the anticipated effects of the upcoming North Carolina Raise the Age legislation.


Asunto(s)
Delincuencia Juvenil/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Niño , Humanos , North Carolina/epidemiología
16.
Methodist Debakey Cardiovasc J ; 15(3): 228-230, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31687105

RESUMEN

This column is supplied by Amita Jain, MD, and Juan Jose Olivero, MD. Dr. Jain completed an internal medicine residency at Houston Methodist Hospital in Houston, Texas, and recently joined a primary care practice in Delaware. She earned a Bachelor of Medicine and Surgery (MBBS) degree, with a distinction in microbiology, from Terna Medical College at the Maharashtra University of Health Sciences in Navi Mumbai, India. Before coming to Houston, Dr. Jain completed residency training in internal medicine and allied subspecialties at the Dr. Babasaheb Ambedkar Memorial Hospital in Byculla, Mumbai. Dr. Olivero is a nephrologist at Houston Methodist Hospital and a member of the hospital's Nephrology Training Program. He obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.


Asunto(s)
Lesión Renal Aguda/inducido químicamente , Ácidos Aristolóquicos/efectos adversos , Suplementos Dietéticos/efectos adversos , Medicamentos Herbarios Chinos/efectos adversos , Fallo Renal Crónico/inducido químicamente , Riñón/efectos de los fármacos , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/terapia , Progresión de la Enfermedad , Interacciones de Hierba-Droga , Humanos , Riñón/fisiopatología , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Pronóstico , Medición de Riesgo , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología , Factores de Tiempo
17.
Psychiatr Danub ; 31(4): 457-464, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31698402

RESUMEN

AIMS: National mental health policies must be grounded in accurate assessments of diseases. In the current article we used the Global Burden of Disease Study 2016 to examine burden due to mental and substance use disorders in Romania. METHODS: For each mental and substance use disorder included in the GBD 2016 we reported the yearly estimates for YLL (as a measure for non-fatal burden), YLD (fatal burden) and DALY (summing years lived with disability and years of life lost to give a measure of total burden). RESULTS: Mental and substance use disorders were the third leading cause of non-fatal burden in Romania in 2016, explaining 13.53% of total years lived with disability, the ninth leading cause for fatal burden explaining 0.84% of total years of life lost, and were the fifth leading cause of total burden, accounting for 5.52% of total disability-adjusted life years. Among MSDs, depression, anxiety and alcohol use disorders have the highest rate. Starting 1997 there has been a slow decrease of age-standardized disability-adjusted life year rates, with no significant change in the last 5 years. CONCLUSION: Global Burden of Disease Study 2016 found that mental and substance use disorders were the fifth leading contributors to disease burden in Romania, with anxiety and depressive being the most prevalent. Despite national programs and strategies in the area of mental health initiated especially after 1990, the mental health system does not fully meet the needs of the patients. Effective population-level strategic measures are still required in order to reduce the burden of disease.


Asunto(s)
Carga Global de Enfermedades/estadística & datos numéricos , Salud Global/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Personas con Discapacidad , Humanos , Prevalencia , Rumanía/epidemiología
18.
Forensic Sci Int ; 305: 110004, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31707239

RESUMEN

This study aims to investigate the prevalence of alcohol and drugs of abuse in Italian drivers involved in road traffic crashes between 2011 and 2018. Toxicological analyses were performed on the whole blood of 7593 injured drivers. Alcohol and illicit drugs, namely tetrahydrocannabinol (THC; cut-off 2ng/ml), cocaine (cut-off 10ng/ml), illicit opiates (cut-off 10ng/ml) and amphetamines (amphetamine, methamphetamine, MDMA, MDA; cut-off 20ng/ml) were investigated. The age and gender of the driver, the time of the crash (weekend/weekday and day/night), the road crash year and Blood Alcohol Concentration (BAC) were also considered. The 16.2% of samples tested positive for alcohol, 2.5% for cocaine, followed by opiates (2.0%), cannabinoids (1.5%), and amphetamines (0.5%). The overall prevalence of alcohol and drugs was lower than those reported in previous epidemiological studies of the DRUID project. The year 2011 showed the highest prevalence of drug-positive cases (24.1%), while the lowest prevalence was found in 2016 (16.8%), after the update of the Road Traffic Law (RTL) that increased punishments for driving under the influence. A progressive increase in the number of alcohol-positive female drivers was observed from 2011 to 2018, and the highest prevalence was found in the 26-35-year-old age range. Illicit drugs showed the highest overall prevalence in drivers <26 years of age but, if considering single drugs, cocaine and opiates were mostly found in subjects older than 36 years of age. A higher percentage of drug-positive drivers was found on weekend nights for alcohol and on both weekend and weekday nights for drugs. The types of drugs used by drivers did not change during the studied period.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Nivel de Alcohol en Sangre , Conducir bajo la Influencia/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Distribución por Edad , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Detección de Abuso de Sustancias , Trastornos Relacionados con Sustancias/sangre
19.
Psychiatr Prax ; 46(8): 445-450, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31683335

RESUMEN

OBJECTIVE: Substance use patterns and sociodemographic variables of Berlin's party scene were investigated to derive preventive measures and harm reduction services, which meet the needs of the consumers. METHODS: A questionnaire was used online and in the field among Berlin partygoers (N = 877) and structured interviews (N = 20) were conducted with professionals working in this area, including social workers, emergency medical service, police and club owners and users. RESULTS: A risky consumption pattern was found in 67 % of participants, who also stated need for counseling and a wish for reduction of their substance use. Of all preventive measures, drug checking was requested most often. Substances with the highest prevalence were alcohol, cannabis, amphetamine, MDMA, cocaine and ketamine, whereas methamphetamine and new psychoactive substances were barely stated. CONCLUSION: There is an urgent need to expand current preventive measures. There is a willingness of the scene to use according services, especially by those who need it the most.


Asunto(s)
Consumo de Bebidas Alcohólicas , Reducción del Daño , Trastornos Relacionados con Sustancias , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Berlin , Alemania , Humanos , Prevalencia , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología
20.
BMC Public Health ; 19(1): 1345, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640664

RESUMEN

BACKGROUND: Slapping/spanking is related to a number of poor health outcomes. Understanding what factors are related to the increased or decreased use of spanking/slapping is necessary to inform prevention. This study used a population-based sample to determine the prevalence of slapping/spanking reported by youth; the relationship between sociodemographic factors and slapping/spanking; and the extent to which parental exposures to victimization and maltreatment in childhood and current parental mental health, substance use and family circumstances, are associated with youth reports of slapping/spanking. METHODS: Data were from the 2014 Ontario Child Health Study, a provincially representative sample of households with children and youth aged 4-17 years. Self-reported lifetime slapping/spanking prevalence was determined using a sub-sample of youth aged 14-17 years (n = 1883). Parents/primary caregivers (i.e., person most knowledgeable (PMK) of the youth) self-reported their own childhood experiences including bullying victimization, slapping/spanking and child maltreatment, and current mental health, substance use and family circumstances including mental health functioning and emotional well-being, alcohol use, smoking, marital conflict and family functioning. Analyses were conducted in 2018. RESULTS: Living in urban compared to rural residence and family poverty were associated with decreased odds of slapping/spanking. PMK childhood experiences of physical and verbal bullying victimization, spanking, sexual abuse, emotional abuse, and exposure to physical intimate partner violence were associated with increased odds of youth reported slapping/spanking (adjusted odds ratio [AOR] ranged from 1.33-1.77). PMK experiences of physical abuse and exposure to emotional/verbal intimate partner violence in childhood was associated with decreased odds of youth reported slapping/spanking (AOR = 0.72 and 0.88, respectively). PMK's higher levels of marital conflict, languishing to moderate mental health functioning and emotional well-being, and moderate or greater alcohol use were associated with increased odds of youth reported slapping/spanking (AOR ranged from 1.36-1.61). CONCLUSIONS: It may be important to consider parent/primary caregiver's childhood experiences with victimization and maltreatment along with their current parental mental health, substance use and family circumstances when developing and testing strategies to prevent slapping/spanking.


Asunto(s)
Relaciones Padres-Hijo , Padres/psicología , Castigo , Adolescente , Adulto , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Víctimas de Crimen/psicología , Víctimas de Crimen/estadística & datos numéricos , Estudios Transversales , Composición Familiar , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Ontario/epidemiología , Factores de Riesgo , Autoinforme , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología
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