Analyzing 14-years of suicide rates in Chile: Impact of alcohol policy, domestic violence, and a suicide prevention program.

Suicide is a major public health problem worldwide with far-reaching effects on families, communities, and societies. Influencing factors range from macro-level interventions like alcohol control policies and suicide prevention programs to individual contributors such as alcohol abuse and domestic violence. This study aimed to examine the relationship between Chile's suicide rate changes from 2002 to 2015 and the Alcohol Act of 2004, a national suicide prevention program implemented in 2007, alcohol abuse, and domestic violence. Assembling a unique longitudinal dataset from Chilean public institutions, the study employed an instrumental variable time-series cross-regional design. Results indicated that the Alcohol Act was not associated with suicide rates, domestic violence exhibited a significant association with increased suicide rates, and the national suicide prevention program was linked to reductions in suicide rates, especially among males. These findings align with research from neighbouring countries, showcasing the efficacy of suicide prevention programs in decreasing suicide rates in Chile. Results highlight the importance of integrating protocols to early-detect domestic violence in suicide prevention programs, as well as the need to further improving alcohol control policies to complement suicide prevention programs.

Treinamento aos agentes comunitários de saúde frente à assistência aos usuários de álcool / Entrenamiento de agentes de salud con respecto a la asistencia a usuarios de alcohol / Community health agent training regarding assistance to alcohol users

Objetivo: avaliar as percepções, conhecimentos e atitudes antes e após a realização de um treinamento aos Agentes Comunitários de Saúde (ACS). Método: estudo quase experimental e quantitativo, realizado no interior do estado de São Paulo. Para a coleta de dados foi utilizado ficha de identificação sociodemográfica, Seaman & Manello e Short Alcohol and Alcohol Problems Perception Questionnaire, aplicados em 31 ACS de serviços de Atenção Primária à Saúde. O estudo foi submetido e aprovado pelo Comitê de Ética. Resultados: as percepções foram positivas, mas ainda existem dificuldades para trabalhar na prática, os conhecimentos apresentaram mudanças em relação aos sinais e sintomas relacionados ao uso de álcool e as atitudes. Não foram observadas mudanças significativas após o treinamento. Conclusão: o treinamento é uma estratégia que possibilita mudanças nas práticas de saúde para a assistência integral e que deve ser incorporada nas rotinas das unidades de Atenção Primária à Saúde (APS).

Objetivo: evaluar percepciones, conocimientos, y actitudes antes y después de un entrenamiento de Agentes Comunitarios de Salud (ACS). Método: estudio cuasiexperimental y cuantitativo, realizado en el interior del estado de São Paulo. Para colectar a los datos se utilizó un formulario de identificación sociodemográfica, el Seaman & Manello y el Short Alcohol and Alcohol Problems Perception Questionnaire, aplicados a 31 ACS en servicios de atención primaria a la salud. El estudio fue aprobado por el comité de ética. Resultados: las percepciones fueran positivas, pero hay dificultades en la práctica del trabajo. Los conocimientos cambiaron con respecto a las señales y síntomas relacionados al uso de alcohol y a las actitudes. No se observó cambios significativos después del entrenamiento. Conclusión: el entrenamiento posibilita cambios en las prácticas de salud para la asistencia integral, y debe ser incorporado en las rutinas de las unidades de atención primaria a la salud (APS).

Objective: To evaluate the perceptions, knowledge, and attitudes, before and after a training session provided to community health workers (CHW). Method: Quasi-experimental, quantitative study, carried out in the countryside of the state of São Paulo. For data collection, we used Seaman and Manello's sociodemographic identification form and the Short Alcohol and Alcohol Problems Perception Questionnaire, applied to 31 CHWs of primary health care services. The study was submitted and approved by the research ethics committee. Results: Perceptions were positive, but there are still practical obstacles regarding the actual work. The knowledge related to signs and symptoms of alcohol use and related attitudes was changed, as were the attitudes. There were no significant changes after training. Conclusion: training is a strategy that enables changes in health practices for integral care. It should be incorporated in the routine of Primary Health Care (PHC) units.

The use of health education strategies and art in rural health prevention focusing on alcohol abuse/addiction and other drugs.

INTRODUCTION: Health education is a relevant strategy to prevent alcohol and other drugs addiction. The objective of this study is to analyze health education strategies used to prevent drug abuse and addiction in rural areas. METHODS: This study is an integrative review. The study included articles indexed in Virtual Health Library, Periodicals Portal bases from CAPES, Brazilian Digital Library of Theses, PubMed, and SciELO. Relationships between health education strategies and art were sought, without obtaining satisfactory results. RESULTS: The selection of studies obtained 1173 articles. After exclusion, 21 publications were included in the sample. The predominant country of origin of articles was the USA, with 14 references. The lack of Latin American articles is highlighted. Overall, among the interventions carried out with a focus on preventing addiction to alcohol and other drugs, those that considered the specific cultural context of the studied community were relevant. Strategies adapted to the rural context must be built according to local values, beliefs, and practices. Motivational Interviewing proved to be an effective intervention for alcohol addiction harm reduction strategies. DISCUSSION: The frequency of harmful use of alcohol and other drugs in the rural population highlights the need to implement public policies focused on local communities. It is essential to adopt actions focused on health promotion. There is a need for further studies on health education strategies, including their relationships with the arts, in the context of preventing drug abuse in the rural population, in order to enable more effective interventions.

Almanac for preventing the use of alcohol and other drugs among adolescents: construction and validity.

OBJECTIVES: to build and validate an almanac to prevent the use of alcohol and other drugs among adolescents. METHODS: a methodological study, based on the adaptation of Echer's stages and on Culture Circles. The Content Validity Index and the Concordance Index were used for validity. RESULTS: problematization in Culture Circles and literature review supported the elaboration of an almanac. In validity with eleven health judges, the material obtained a global Content Validity Index of 0.73 in the first version and 0.84 in the second version, with validation with five judges. In terms of concordance, the 95% value was obtained with four technical judges and 86.2% with nine participants from the target audience. CONCLUSIONS: the constructed and validated almanac has playful, dialogic and problematizing potential.

Effectiveness of a Brief Group Intervention for Harmful Alcohol Use in Men at a Primary Health Care Facility in Brazil: A Randomized Clinical Trial.

To evaluate the effectiveness of a brief group intervention (BGI) in reducing the use of alcohol and increasing the readiness to change in men with risky and harmful alcohol use. A randomized clinical trial with follow-ups at 30 and 90 days that was conducted in a primary health care (PHC) facility in the central region of São Paulo (Brazil). A total of 112 men were randomized to the experimental group (EG) (n = 55) or the control group (CG) (n = 57). To identify the pattern of alcohol use and the readiness to change, the Alcohol Use Disorders Identification Test (AUDIT) and the readiness to change (RTC) rule were used. The EG received a BGI session applied by nurses using the Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy (FRAMES) model. The CG was instructed to continue with the standard service of the unit after an initial interview. Intergroup analyses using the generalized equation estimation (GEE) method were performed. A significant difference in the pattern of use was observed between the EG and CG at follow-up evaluated (EG T1 (7.73 ± 5.14), CG T1 (12, 48 ± 5.62)) and EG T2 (6.65 ± 4.83), CG T2 (11.68 ± 6.65)). When compared the baseline (T0) measures (13.04) with the last time (T2) (6.65) at EG, it was identified a reduction of 6.39 in the AUDIT score. Differences between groups were found for readiness to change at follow-up ((EG T1 (8.50 ± 2.44) and CG T1 (5.67 ± 3.10) and (EG T2 (8.80 ± 1.73) and CG T2 (5.36 ± 3.33)), when contrasting with the baseline. The data suggest that the BGI was effective when compared to the control condition, as there was a reduction in risky and harmful use of alcohol for low-risk use, according to the alcohol use scores, and an increase in the stages of readiness to change.

The alcohol prevention magnitude measure: Application of a Spanish-language version in Santiago, Chile.

BACKGROUND: The Alcohol Prevention Magnitude Measure (APMM) is an instrument to monitor and improve substance use prevention at the community level developed in Sweden. The aim of this study was to produce and apply a Spanish-language version of the APMM. METHOD: We translated and adapted the APMM using an expert panel. We retained 37 indicators in five dimensions, with total scores ranging from 0 to 100 points and 0 to 20 in each dimension. The instrument was administered to the prevention coordinators in six socioeconomically heterogeneous municipalities of Santiago de Chile, during the pilot implementation of a community-based prevention model in 2019 and 2020. We calculated median scores for the instrument and each dimension. We tested for differences between 2019 and 2020 using the Wilcoxon Test and between municipalities with the Friedman Test. RESULTS: The Spanish version of the APMM was acceptable to stakeholders. The median scores were 49.3 (range: 34.0 to 64.0) in 2019 and 67.3 (range 55.5 to 80.5) in 2020. The median scores for Staff and budget were 14.0 in 2019 and 2020, for Prevention policy 5.0 in 2019 and 16.0 in 2020, for Cooperation with key agents 12.0 in both years, for Supervision and alcohol licenses 4.3 in 2019 and 9.0 in 2020, and for Prevention activities 11.0 in 2019 and 15.0 in 2020. The scores in the dimensions Prevention policy and Supervision and alcohol licenses significantly increased in 2020. The differences between the municipalities were not significant. CONCLUSIONS: Improvements of the prevention index between 2019 and 2020 in the dimension Prevention policies may be related to the intervention. Improvements in Supervision and alcohol licenses could be related to curfew policies in the context of the COVID-19 pandemic. The Spanish version of the APMM deserves larger scale testing in Latin America.

Would the Brazilian population support the alcohol policies recommended by the World Health Organization?

OBJECTIVE: To evaluate the support of the Brazilian population to the alcohol-policies proposed by the World Health Organization to decrease alcohol harm (specifically: to decrease alcohol availability and advertising, and to increase pricing). In addition, we evaluated the factors associated with being against those policies. METHODS: Data from 16,273 Brazilians, aged 12-65 years, interviewed in the 3rd Brazilian Household Survey on Substance Use (BHSU-3) were analyzed. The BHSU-3 is a nationwide, probability survey conducted in 2015. Individuals were asked if they would be against, neutral, or in favor of seven alcohol policies grouped as: 1) Strengthen restrictions on alcohol availability; 2) Enforce bans or restrictions on alcohol advertising, sponsorship, and promotion; and 3) Raise prices on alcohol through excise taxes and pricing. Generalized linear models were fitted to evaluate factors associated with being against each one of those policies and against all of policies. RESULTS: Overall, 28% of the Brazilians supported all the above mentioned policies, whereas 16% were against them. The highest rate of approval refers to restricting advertising (53%), the lowest refers to increasing prices (40%). Factors associated with being against all policies were: being male (AOR = 1.1; 95%CI: 1.0-1.3), not having a religion (AOR = 1.4; 95%CI: 1.1-1.8), being catholic (AOR = 1.3; 95%CI: 1.1-1.5), and alcohol dependence (AOR = 1.6; 95%CI: 1.1-2.4). CONCLUSIONS: The Brazilian government could count on the support of most of the population to restrict alcohol advertising. This information is essential to tackle the lobby of the alcohol industry and its clever marketing strategy.

Intervención educativa sobre alcoholismo en pobladores del policlínico Fermín Valdés Domínguez, Baracoa / Educative Intervention about Alcoholism in Residents belonging to Fermín Valdés Domínguez Polyclinic of Baracoa Municipality

Introducción: El alcoholismo es una enfermedad crónica que daña el organismo, el funcionamiento familiar y social, y puede ser causa de violencia, conductas antisociales, desavenencias familiares, accidentes e incluso homicidios. Objetivo: Evaluar la utilidad de la aplicación de un programa de intervención educativa para modificar el nivel de conocimientos sobre alcoholismo en pobladores de la comunidad de Santa Rosa. Métodos: Se realizó un estudio preexperimental de tipo antes-después. El universo del estudio estuvo compuesto por los pacientes mayores de 18 años de edad. Se seleccionó una muestra no probabilística de tipo intencional de 30 pacientes, cuya selección obedeció a los siguientes criterios de inclusión: estar aptos física y mentalmente, tener de 19 a 70 años, no tener ningún proceso mórbido invalidante y tener disposición a participar en el estudio. Resultados: Se evidenció un predominio del sexo masculino y la edad de 18 a 20 años. Antes de la intervención educativa, 76,7 por ciento no tenía conocimientos sobre las consecuencias que provoca el consumo de alcohol; luego de aplicada la intervención mejoraron notablemente estos conocimientos. Del total de encuestados, 76,6 por ciento (23) tenía un conocimiento bajo antes de la intervención educativa y después de aplicada la intervención, 86,7 por ciento se encontraban calificados con conocimiento alto. Solo un adolescente clasificó en nivel bajo. Conclusiones: Se evidenció la efectividad de la intervención educativa al aportar los conocimientos necesarios sobre temas relacionados con el alcoholismo, se propuso extender la estrategia de intervención a todos los pobladores del municipio(AU)

Introduction: Alcoholism is a chronic disease that damages the organism, as well as family and social functioning, apart from being a cause of violence, antisocial behaviors, family disagreements, accidents, and even homicides. Objective: To assess the usefulness of applying an educational intervention program to modify the level of knowledge about alcoholism in residents from the community of Santa Rosa, Baracoa Municipality, Guantánamo Province, Cuba. Methods: A preexperimental before-and-after study was carried out. The study universe was made up of patients over eighteen years of age. A nonprobabilistic purposive sample of thirty patients was selected under the following inclusion criteria: to be physically and mentally fit, to be between nineteen and seventy years old, not to have any disabling morbid process, and to be willing to participate in the study. Results: There was a predominance of the male sex and ages between eighteen and twenty years. Before the educational intervention, 76.7 percent had no knowledge about the consequences of alcohol consumption; after the intervention, this knowledge improved significantly. Of the total number of respondents, 76.6 percent (23) had a low level of knowledge before the educational intervention, while 86.7 percent were classified as having a high level of knowledge after the intervention. Only one adolescent was classified at a low level. Conclusions: The effectiveness of the educational intervention was evidenced, since it provided the necessary knowledge on topics related to alcoholism. The intervention strategy was proposed to be extended to all the inhabitants of the municipality(AU)

Electroencephalographic neurofeedback as a tool for reducing harm and risk associated with alcohol use disorder: A critical review.

ISSUES: Alcohol use disorder (AUD) causes the highest harms around the world. Many people use alcohol to reduce stress and anxiety, considered as risk factors for AUD. Chronic alcohol use leads to changes in the reward system and the high level of stress may exacerbate neuroendocrine responses. Electroencephalographic (EEG) neurofeedback shows reduction of stress, anxiety and alcohol abuse and it could be an important tool for reducing harm and risk associated with AUD. The aim of this paper is to review the studies that investigated the effects of EEG neurofeedback in subjects with AUD and it proposes to discuss this intervention as a tool for reducing harm and risk in AUD. APPROACH: Medline, PsycINFO and LILACS databases were searched and appropriated terms were used. Inclusion criterion was adopted. The year of publication was not limited because of the scarce number of studies. Eighty-two papers returned and eight were included. A critical review was conducted. KEY FINDINGS: Most of the papers analysed used the alpha/theta protocol to reduce the 'hyperexcitation' of the nervous system. This protocol provides relaxation, decreases anxiety or stress, prevents alcohol relapse, maintains abstinence and increases the feeling of well-being. IMPLICATIONS: EEG neurofeedback has important effects on AUD and anxiety or stress. Studies reinforce the use of EEG neurofeedback as an alternative tool for reducing harm and risk in AUD. CONCLUSION: EEG neurofeedback is an intervention to treat AUD, specifically, to reduce harm and risk. However, more randomised studies are necessary to consolidate the effectiveness of the technique.

Reducing women's alcohol use: a brief intervention pilot study at a primary health care service in Brazil.

This study assesses the feasibility of a brief intervention among women with hazardous alcohol use at a primary health care service in Brazil. A two-arm randomized pilot study was carried out from July 2017 to January 2018 with 44 women aged 18 years or older with hazardous alcohol use. The intervention group completed a brief intervention in a single session lasting 20 to 30 minutes. The control group received five minutes of brief advice. Alcohol use was assessed by the Alcohol Use Disorders Identification Test (AUDIT), and the frequency and quantity of alcohol consumed in the previous month were assessed at baseline and the first and third months of follow-up in both groups. The AUDIT score was decreased in both groups at baseline (intervention group 12.89, control group 10.64), the 1st month (intervention group 12.78 p = .9; control group 7.9 p = .01) and the 3rd month (intervention group 10.11 p = .13; control group 7.09 p < .01). The intervention group continued using alcohol after the brief intervention, although the quantity of alcohol consumed was reduced compared with that at baseline (p < .01). Finally, the brief intervention delivered in a primary health care service in Brazil showed the potential to reduce women's pattern of alcohol consumption.

Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial.

INTRODUCTION: Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this. METHODS AND ANALYSIS: Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde).Follow-up6 months.OutcomesThe primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance-assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity-assessed by the International Physical Activity Questionnaire, depression-assessed by the Geriatric Depression Scale and quality of life-assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations. TRIAL REGISTRATION NUMBER: RBR-8rcxkk.

Aplicación Alcoholism: una vía para el desarrollo de conocimientos sobre el alcoholismo / Alcoholism's App: a way for increasing knowledge related to alcoholism / Aplicativo Alcoholism: uma forma de desenvolver o conhecimento sobre alcoolismo

RESUMEN Introducción: El alcoholismo constituye hoy día un problema vigente y en ascenso durante la etapa de la adolescencia. Objetivo: Validar una aplicación para contribuir al conocimiento sobre el alcoholismo en estudiantes del Instituto Politécnico "General Luis A. Milanés Tamayo" de Granma. Método: En marzo de 2019 en la Facultad de Ciencias Médicas de Bayamo, provincia Granma se elaboró una aplicación para contribuir al conocimiento sobre el alcoholismo en estudiantes de dicha institución educativa. Se emplearon las herramientas JClic y Gimpshop 2.8 con licencia GPL/Linux. Para determinar su viabilidad, en el período febrero a marzo de 2019 se encuestaron 40 estudiantes seleccionados por muestreo aleatorio estratificado, de un universo de 397 alumnos. Resultados: Antes del uso de la aplicación el 77,5 % de los estudiantes reflejó un bajo nivel de conocimiento sobre el tema. Después de utilizar el producto informático, el 90,0 % reveló un alto nivel de conocimientos sobre el alcoholismo. Conclusiones: El diseño e implementación de la aplicación Alcoholism contribuye a que los estudiantes se apropien de conocimientos sobre el tema alcoholismo, los que mostraron una adecuada satisfacción con su utilización.

ABSTRACT Introduction: Alcoholism nowadays is a rising problem in adolescent's population. Objective: To certificate an App that contributes to increase knowledge related to alcoholism for the students of the Instituto Politécnico "General Luis A. Milanés Tamayo" in Granma. Method: In March 2019, at the Facultad de Ciencias Médicas in Bayamo, Granma, it was created an App for contributing on the students´ knowledge about alcoholism. Tools used were JClic and Gimpshop 2.8, with GPL/Linux license. To determine its efficacy, from February to March 2019 a cohort of 40 students of the total (397 students) were selected by stratified random sampling to be surveyed out. Results: 77.5% of the students, before the App usage, showed a low level of knowledge about concerning issue and a high level (90.0%) after the App implementation. Conclusion: The design and implementation of the Alcoholism App contributes to the students' appropriation of knowledge on the subject of alcoholism, who showed adequate satisfaction with its use.

RESUMO Introdução: O alcoolismo constitui um problema atual e crescente durante a etapa da adolescência. Objetivo: Validar um aplicativo para contribuir com o conhecimento sobre alcoolismo em alunos do Instituto Politécnico "General Luis A. Milanés Tamayo" de Granma. Método: Em março de 2019, na Faculdade de Ciências Médicas de Bayamo, província do Granma, foi desenvolvido um aplicativo que visa contribuir para o conhecimento sobre o alcoolismo em alunos da referida instituição de ensino. Foram utilizadas as ferramentas JClic e Gimpshop 2.8 com licença GPL/Linux. Para determinar sua viabilidade, no período de fevereiro a março de 2019, foram pesquisados 40 alunos selecionados por amostragem aleatória estratificada, de um universo de 397 alunos. Resultados: Antes de usar o aplicativo, 77,5% dos alunos refletirem baixo nível de conhecimento sobre o assunto. Após usar o produto de informática, 90,0% revelaram alto nível de conhecimento sobre alcoolismo. Conclusões: A concepção e implementação do aplicativo Alcoholism contribuem para a apropriação dos conhecimentos dos alunos sobre a temática do alcoolismo, os quais demonstraram satisfação adequada com o seu uso.

Alcoolismo e envelhecimento nas pesquisas em saúde: um perfil bibliométrico / Alcoholismo y envejecimiento en las investigaciones en salud: un perfil bibliométrico / Alcoholism and aging in health research: a bibliometric profile

Objetivo: avaliar as publicações científicas sobre o alcoolismo e o envelhecimento. Métodos: estudo bibliométrico, realizado por meio da análise de artigos disponíveis na base de dados da LILACS, EBSCOT e MEDLINE, no período de 2010-2016. Resultados: os achados demostram a crescente busca sobre a temática em diversos países, nos últimos anos, aperfeiçoando a importância da contribuição da mesma quando se pensa em saúde pública, bem como os pesquisadores atuam em diversas áreas de conhecimentos; o que possibilita descobertas que podem informar o desenvolvimento e a implementação de ações de prevenção e promoção da saúde, que refletem as necessidades de saúde mental do envelhecimento. Conclusão: é importante que os profissionais de saúde e a população idosa discutam sobre consumo de álcool como componente do manejo da doença crônica. Nos casos de consumo de álcool, os provedores têm a oportunidade de fornecer uma intervenção breve ou oferecer referências, se necessário

Objetivo: Evaluar las publicaciones científicas sobre el alcoholismo y el envejecimiento. Métodos: Estudio bibliométrico, realizado por medio del análisis de artículos disponibles en la base de datos de LILACS, EBSCOT y MEDLINE, en el período 2010-2016. Resultados: Los hallazgos de esta revisión demuestran que la creciente demanda sobre la temática en diversos países, en los últimos años, perfeccionando la importancia de la contribución de la misma cuando se piensa en salud pública, así como los investigadores actúan en diversas áreas de conocimientos; lo que posibilita descubrimientos que pueden informar el desarrollo y la implementación de acciones de prevención y promoción de la salud que reflejan las necesidades de salud mental del envejecimiento. Conclusión: Es importante que los profesionales de salud y la población anciana discutan sobre el consumo de alcohol como componente del manejo de la enfermedad crónica. En los casos de consumo de alcohol, los proveedores tienen la oportunidad de proporcionar una intervención breve o ofrecer referencias. A pesar de la relevancia, todavía son escasos los estudios sobre la temática, en el escenario de investigación nacional, siendo necesario más producción científica

Objective:Tevaluate scientific publications about alcoholism and aging. Methods: It included analysis of items available in the database of the LILACS, EBSCOT and MEDLINE, in the period from 2010 to 2016. Results: The findings of this review show increasing bibliometric search on the subject in several countries, in recent years, enhancing the importance of the contributions on the subject in terms of public health, as well as researchers working in different areas of knowledge. Conclusion: It is important that health professionals and the elderly debate about alcohol consumption as a component of chronic disease management and that the health care network ensures quick intervention or referrals. Despite the relevance, studies on the subject are still scarce in the national research scenario, and more scientific production is needed

Avaliação da implantação da Política de Atenção Integral à Usuários de Álcool e outras Drogas na Estratégia Saúde da Família do Rio de Janeiro-RJ / Evaluation of the implementation of the Comprehensive Care Policy for Users of Alcohol and Other Drugs in the Family Health Strategy of Rio de Janeiro-RJ

Esta pesquisa tem como objetivo, avaliar o grau de implantação da Política de Atenção Integral a usuários de Álcool e Droga, na Estratégia Saúde da Família do município do Rio de Janeiro, RJ, Área de Planejamento 3.1. Trata-se de uma pesquisa avaliativa, do tipo análise de implantação, com corte transversal, abordagem formativa e colaborativa, utilizando estudo de caso único e métodos mistos. Teve como caso, a Estratégia Saúde da Família da Área de Planejamento 3.1, com dez unidades de análise. Participaram gestores da APS e Programa de Saúde Mental, Coordenação da Área de Planejamento referente a Atenção Primária à Saúde, profissionais da equipe mínima da Estratégia Saúde da Família (médicos, enfermeiros, técnicos de enfermagem e agentes comunitários de saúde), e respectivos gerentes, responsáveis técnicos de medicina, responsáveis técnicos de enfermagem, e representante do Conselho Municipal de Saúde. Resultados: a Política de Atenção Integral à Usuários de Álcool e outras Drogas no município do Rio de Janeiro, encontra-se parcialmente implantada, tendo como insumo melhor avaliado o recurso físico, enquanto Protocolos, Diretrizes Terapêuticas, Linhas Guias, Fluxos, Referência e Contra Referência pior avaliação. As atividades relacionadas a diretriz Promoção e Proteção à Saúde obtiveram melhor avaliação, enquanto a diretriz Prevenção de Agravos pior avaliação. Quanto ao contexto Político Organizacional, o Projeto de Governo e a Capacidade de Governo foram os que mais influenciaram no processo de implantação. Conclusão: A ESF apresenta fragilidades em relação a insumos essenciais para prevenção, diagnóstico, avaliação e tratamento dos usuários de álcool e outras drogas, recursos humanos insuficientes ou ausentes, problemas orçamentários, organizativos, restrição de atividades relacionadas as diretrizes Intersetorialidade, Prevenção de agravos e Promoção e Proteção à Saúde de suma importância neste contexto. Somado a isto, o contexto político organizacional influenciou de forma negativa o processo de implantação desta política neste nível de atenção.

This research aims to evaluate the degree of implementation of the Comprehensive Care Policy for Alcohol and Drug users, in the Family Health Strategy of the city of Rio de Janeiro, RJ, Planning Area 3.1. This is an evaluative research, of the implementation analysis type, with a transversal cut, formative and collaborative approach, using a single case study and mixed methods. In the case of the Family Health Strategy of the Planning Area 3.1, with ten units of analysis. Managers of the PHC and Mental Health Program, Coordination of the Planning Area regarding Primary Health Care, professionals from the minimum team of the Family Health Strategy (doctors, nurses, nursing technicians and community health agents) and respective managers, participated in the study. responsible medical technicians, responsible nursing technicians, and representative of the Municipal Health Council. Results: the Comprehensive Care Policy for Users of Alcohol and other Drugs in the city of Rio de Janeiro is partially implemented, having the physical resource as the best evaluated input, while Protocols, Therapeutic Guidelines, Guidelines, Flows, Reference and Contraindications Reference worse evaluation. Activities related to the Health Promotion and Protection guideline had the best evaluation, while the Disease Prevention guideline had the worst evaluation. Regarding the Political Organizational context, the Government Project and the Government Capacity were the ones that most influenced the implementation process. Conclusion: The ESF has weaknesses in relation to essential inputs for the prevention, diagnosis, evaluation and treatment of users of alcohol and other drugs, insufficient or absent human resources, budgetary and organizational problems, restriction of activities related to Intersectoriality, Prevention of diseases and Health Promotion and Protection of paramount importance in this context. Added to this, the organizational political context had a negative influence on the process of implementing this policy at this level of care.

Esta investigación tiene como objetivo evaluar el grado de implementación de la Política de Atención Integral a Usuarios de Alcohol y Drogas, en la Estrategia de Salud de la Familia de la ciudad de Rio de Janeiro, RJ, Área de Planificación 3.1. Se trata de una investigación evaluativa, del tipo análisis de implementación, con un enfoque de corte transversal, formativo y colaborativo, utilizando un estudio de caso único y métodos mixtos. En el caso de la Estrategia de Salud de la Familia del Área de Planificación 3.1, con diez unidades de análisis. Participaron del estudio gestores del Programa de APS y Salud Mental, Coordinación del Área de Planificación de la Atención Primaria de Salud, profesionales del equipo mínimo de la Estrategia Salud de la Familia (médicos, enfermeros, técnicos de enfermería y agentes comunitarios de salud) y los respectivos gestores, técnicos médicos responsables, técnicos de enfermería responsables y representante del Consejo Municipal de Salud. Resultados: la Política de Atención Integral a Usuarios de Alcohol y otras Drogas en la ciudad de Río de Janeiro está parcialmente implementada, teniendo el recurso físico como el insumo mejor evaluado, mientras que Protocolos, Directrices Terapéuticas, Directrices, Flujos, Referencia y Contraindicaciones Referencia peor evaluación . Las actividades relacionadas con la directriz Promoción y Protección de la Salud tuvieron la mejor evaluación, mientras que la directriz Prevención de Enfermedades tuvo la peor evaluación. En cuanto al contexto Político Organizativo, el Proyecto de Gobierno y la Capacidad de Gobierno fueron los que más influyeron en el proceso de implementación. Conclusión: La ESF presenta debilidades en relación a insumos esenciales para la prevención, diagnóstico, evaluación y tratamiento de usuarios de alcohol y otras drogas, recursos humanos insuficientes o ausentes, problemas presupuestarios y organizacionales, restricción de actividades relacionadas con la Intersectorialidad, Prevención de enfermedades y Promoción y Protección de la Salud de suma importancia en este contexto. Sumado a esto, el contexto político organizacional influyó negativamente en el proceso de implementación de esta política en este nivel de atención.

Factores asociados a la hipertensión arterial en adolescentes de San Juan y Martínez, 2018 / Factors associated with high blood pressure in adolescents in San Juan y Martínez, 2018

Introducción: La hipertensión arterial del adulto tiene sus orígenes en la infancia. Los adolescentes copian los mismos estilos de vida del adulto que son desencadenantes potenciales de enfermedades cardiovasculares. Objetivo: Caracterizar los factores asociados a la hipertensión arterial en los adolescentes de San Juan y Martínez en el 2018. Métodos: Se realizó una investigación descriptiva, transversal. El universo estuvo constituido por 522 adolescentes de San Juan y Martínez y la muestra estuvo integrada por 203 adolescentes tomados al azar en los diferentes centros de estudio del Consejo Popular Pueblo. Resultados: El sexo femenino fue el más representativo, predominó el color de la piel negra, los antecedentes patológicos familiares más representativos fueron la hipertensión arterial y la diabetes mellitus, un elevado porcentaje de los adolescentes fuman e ingieren bebidas alcohólicas. Existe un predominio de los hábitos dietéticos malos y regulares, así como una tendencia sedentaria; gran número de ellos presentan obesidad o sobrepeso. Conclusiones: En los adolescentes de San Juan y Martínez se observa un aumento de los factores que predisponen a padecer una hipertensión arterial, lo que posibilita su desarrollo en edades tempranas de la vida. De ahí que los médicos generales integrales deban trabajar en su prevención para evitar el avance de esta enfermedad en este grupo etario(AU)

Introduction: Adult´s high blood pressure has its onset in the childhood. Adolescents copy the same lifestyles that adults have which are potential triggers for cardiovascular diseases. Objective: Characterize the factors associated with high blood pressure in the adolescents of San Juan y Martinez municipality in 2018. Methods: A descriptive, cross-sectional research was conducted. The group sample was formed by 522 teenagers from San Juan y Martínez municipality and the sample by 203 adolescents selected randomly in the different study centers of Pueblo district. Results: The female sex was the most representative; there was predominance of the black skin; the most representative family pathological history were high blood pressure and diabetes mellitus; a high percent of adolescents smoke and consume alcoholic beverages. There is a predominance of bad and regular dietary habits, as well as a sedentary trend; a large number of adolescents are obese or overweight. Conclusions: In the adolescents of San Juan y Martínez there is an increase in the factors that predispose to high blood pressure, which makes it possible to develop at an early stage of life. Hence, comprehensive general doctors must work on its prevention to stop the progression of this disease in this age group(AU)

Factores de riesgo asociados al cáncer de mama / Risk Factors Associated with Breast Cancer

RESUMEN Introducción: El cáncer de mama es el tumor maligno más frecuente entre las mujeres de todo el mundo. Considerando los dos sexos, es el segundo en frecuencia después del cáncer de pulmón. En Cuba, sigue siendo la neoplasia maligna que más se diagnóstica en mujeres. Se estima que una de cada 9 a 12 mujeres con factores de riesgo padecerá la enfermedad a lo largo de su vida en los países del mundo occidental. Objetivo: Profundizar acerca de los factores de riesgo asociados al cáncer de mama. Métodos: Se realizó una revisión bibliográfica temática, observacional y retrospectiva de 25 artículos en el período comprendido desde septiembre 2018 a enero 2019. Se accedió a las bases de datos de Scielo. La búsqueda se hizo en artículos nacionales e internacionales, con textos completos, estos se sometieron a una lectura crítica utilizando métodos teóricos (análisis histórico-lógico y análisis-síntesis) y empíricos (análisis documental). Conclusiones: Se evidenció que el sexo femenino, la edad, el sobrepeso, la obesidad, el tabaquismo, el alcoholismo, el color de la piel, los antecedentes heredofamiliares de cáncer, la edad de la menarquía, la edad de la menopausia, los antecedentes de enfermedades benignas de la mama, el uso de tratamiento de reemplazo hormonal, la cantidad de hijos, el tiempo de lactancia materna y la actividad física, entre otros, constituyen factores de riesgo predisponentes al cáncer de mama, de ahí la importancia del reconocimiento de estos para la prevención y el diagnóstico precoz.

ABSTRACT Introduction: Breast cancer is the most frequent malignant tumor among women worldwide. Considering the two sexes, it is the second in frequency, after lung cancer. In Cuba, it is still the malignant neoplasm that is most diagnosed in women. It is estimated that one in 9 to 12 women with risk factors will suffer the disease throughout their lives in countries of the western world. Objective: To elaborate on the risk factors associated with breast cancer. Methods: A thematic, observational and retrospective bibliographic review of 25 articles was carried out in the period from September 2018 to January 2019. We accessed the Scielo databases. The search was performed in national and international articles, with full texts, which were subjected to critical reading using theoretical (historical-logical analysis and analysis-synthesis) and empirical (documentary analysis) methods. Conclusions: Evidenced showed that the female sex, age, overweight, obesity, smoking, alcoholism, skin color, hereditary family history of cancer, age of menarche, age of menopause, history of benign breast diseases, the use of hormone replacement treatment, the number of children, the time of breastfeeding, physical activity, among others, are risk factors predisposing to breast cancer; hence the importance of recognizing them for prevention and early diagnosis.

Análisis interdisciplinar con perspectiva de género del alcoholismo en mujeres / Interdisciplinary Analysis with a Gender Perspective on Alcoholism in Women

Introducción: El alcoholismo, entendido en el marco del consumo con dependencia, es una problemática que afecta tanto a hombres como mujeres, sin embargo, con una tendencia al alza en estas últimas. Esto reviste una complejidad diferente al momento de ser abordado, asociada a la dimensión social, el género y el clandestinaje. Objetivo: Comprender las maneras en que opera la dimensión cultural y, en específico, el género, en las trayectorias de vida de mujeres alcohólicas. Métodos: Desde un enfoque cualitativo y transversal, la investigación propone el método etnosociológico sobre relatos de vida, basado en estudios de caso. Resultados: La experiencia del consumo de alcohol está marcada por: I- Consumo inicial en la niñez, que facilita el posterior acceso en una etapa adolescente, etapa asociada al consumo reiterado y vinculado a la aceptación social en términos de expectativas de género. II- Consumo adulto, periodo más problemático desde la perspectiva de la dependencia, clandestinaje y experiencias de violencia asociadas. III- Rehabilitación, proceso indefinido cuyo inicio se asocia a la experiencia de género. Todas las etapas del alcoholismo, en las historias de vida analizadas, tienen relación con el género, lo que se expresa principalmente en: el estigma; la vulnerabilidad; la violencia y el consumo clandestino. Conclusiones: los procesos de rehabilitación de alcoholismo en mujeres requieren de una perspectiva interdisciplinaria que integre el enfoque de género(AU)

Introduction: Alcoholism, understood in the s of consumption with dependence, is a concern affecting both men and women, although with is an upward tendency among the latter ones. This is approached with a different complexity, in association with the social dimension, the gender perspective, and concealment. Objective: To analyze the ways in which the cultural dimension affects several aspects, specifically gender, in the life paths of alcoholic women. Methods: A research with a qualitative and cross-sectional approach was carried out. The ethno-sociological method of life stories was used, based on case studies. Results: The experience of alcohol consumption is marked by 1) initial consumption in childhood, which facilitates subsequent access in a teenage stage, a stage associated with repeated consumption and linked to social acceptance in terms of gender expectations; 2) adult consumption, the most problematic period from the perspective of dependency, concealment, and associated experiences of violence; and 3) rehabilitation, an indefinite process whose beginning is associated with the gender experience. All stages of alcoholism, in the life stories analyzed, are related to gender, which is expressed mainly through stigma, vulnerability, violence, and concealed consumption. Conclusions: Alcoholism rehabilitation processes in women require an interdisciplinary perspective integrating the gender approach(AU)