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1.
Cancer Cytopathol ; 128(10): 679-680, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33006815
2.
Cien Saude Colet ; 25(9): 3475-3480, 2020 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32876252

RESUMO

The study aims to identify marital violence precipitating/intensifying elements during the COVID-19 pandemic. This is a narrative review of the literature, and the search was carried out in May 2020. We employed the PubCovid-19 platform, which is indexed in the United States National Library of Medicine (PubMed) and the Excerpta Medica (EMBASE) database. English descriptors "Domestic violence", "COVID-19", and "Intimate Partner Violence" were used in the search, and nine papers were selected for full-text reading. Three empirical categories were elaborated from the exploration of the selected material: Economic instability, Alcohol and other drugs use/abuse, and Weaker women's support network. Support networks for women in situations of marital violence should be expanded in this pandemic context, with emphasis on the use of digital technologies as possible tools for screening pandemic-related violence cases.


Assuntos
Infecções por Coronavirus/epidemiologia , Programas de Rastreamento/métodos , Pneumonia Viral/epidemiologia , Maus-Tratos Conjugais/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
3.
Rev Saude Publica ; 54: 82, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876301

RESUMO

OBJECTIVE To characterize recent HIV infections among newly diagnosed men who have sex with men and transgender women in Tijuana. METHODS Limiting Antigen (LAg)-Avidity testing was performed to detect recent HIV infection within a cohort of newly-diagnosed men who have sex with men and transgender women in Tijuana. Logistic regression was used to determine characteristics associated with recent infection. A partial transmission network was inferred using HIV-1 pol sequences. Tamura-Nei 93 genetic distances were measured between all pairs of sequences, and the network was constructed by inferring putative transmission links (genetic distances ≤ 1.5%). We assessed whether recent infection was associated with clustering within the inferred network. RESULTS Recent infection was detected in 11% (22/194) of newly-diagnosed participants. Out of the participants with sequence data, 60% (9/15) with recent infection clustered compared with 31% (43/139) with chronic infection. Two recent infections belonged to the same cluster. In adjusted analyses, recent infection was associated with years of residence in Tijuana (OR = 1.5; 95%CI 1.01-1.09), cocaine use (past month) (OR = 8.50; 95%CI 1.99-28.17), and ever experiencing sexual abuse (OR = 2.85; 95%CI 1.03-7.85). DISCUSSION A total of 11% of men newly diagnosed with HIV who have sex with men and transgender women in Tijuana were recently infected. The general lack of clustering between participants with recent infection suggests continued onward HIV transmission rather than an outbreak within a particular cluster.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Pessoas Transgênero , Brasil/epidemiologia , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
4.
J Subst Abuse Treat ; 118: 108103, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32972644

RESUMO

In response to the novel coronavirus 2019 (Covid-19) pandemic, many people experiencing homelessness and substance use disorders entered respite and recuperation facilities for care and to isolate and prevent subsequent SARS-CoV-2 transmission. However, because drug use was officially prohibited in these facilities, we observed people who use substances leaving isolation temporarily or prematurely. The initial Covid-19 surge magnified the need for harm reduction access for those who use substances to ensure their safety and well-being and that of their local communities. In this commentary, we argue that expanding harm reduction access is crucial for subsequent waves of SARS-CoV-2 infection and also for patients who use substances and are hospitalized for other reasons.


Assuntos
Infecções por Coronavirus/epidemiologia , Pessoas em Situação de Rua , Pneumonia Viral/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Infecções por Coronavirus/prevenção & controle , Redução do Dano , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/terapia
5.
Medicine (Baltimore) ; 99(39): e22344, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991449

RESUMO

BACKGROUND: Depression is a disease with a high incidence and easy to relapse. It not only affects the work and life of patients, but also brings a heavy economic burden. University is the peak of depression, and the prevalence of depression among college students is much higher than that of ordinary people. The purpose of this research is to evaluate depression symptoms, life satisfaction, self-confidence, substance use, social adjustment, and dropout rates of the use of psychological intervention for college students. METHODS: We will identify relevant trials from systematic searches in the following electronic databases: PubMed, Embase, Web of Science and The Cochrane Library. We will also search Clinical Trials.gov, the WHO International Clinical Trials Registry Platform for unpublished data. Additional relevant studies will be searched through search engines (such as Google), and references included in the literature will be tracked. All relevant randomized controlled trials (RCTs) will be included. There are no date restrictions. Use Cochrane Collaboration's Risk of bias tool to conduct risk of bias analysis. Use the Grades of Recommendation, Assessment, Development, and Evaluation to assess the quality of evidence. All statistical analysis will be performed using Stata (V.15.0.) and Review Manager (V.5.2.0). RESULTS: A total of 6238 records were obtained by searching the database and 27 records were obtained by other sources. After removing duplicate records, there are 4225 records remaining. We excluded 3945 records through abstract and title, leaving 280 full-text articles. CONCLUSION: This will be the first study to compare the effects of different psychological treatments on depression in college students. We hope that this study will guide clinical decision-making of psychotherapy to better treat depression in college students. PROTOCOL REGISTRATION: INPLASY202070134.


Assuntos
Depressão/terapia , Psicoterapia/métodos , Estudantes/psicologia , Adolescente , Adulto , Depressão/epidemiologia , Depressão/psicologia , Feminino , Carga Global da Doença/economia , Humanos , Incidência , Masculino , Metanálise em Rede , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Satisfação Pessoal , Prevalência , Psicoterapia/tendências , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoimagem , Ajustamento Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Universidades , Adulto Jovem
6.
West J Emerg Med ; 21(5): 1102-1104, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32970561

RESUMO

The isolation that comes from social distancing during the COVID-19 pandemic can be particularly detrimental to the United States' population of people who use drugs. People with substance use disorders may be at risk for return to use, exacerbation of existing mental health disorders, and risky drug practices. In this commentary, we review the risk to people who use drugs and how emergency department providers can best support these individuals during the unprecedented time of social distancing.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Serviço Hospitalar de Emergência , Pneumonia Viral/psicologia , Isolamento Social/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos/epidemiologia
7.
Medicine (Baltimore) ; 99(35): e21360, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871863

RESUMO

HIV prevalence is higher among Men who have Sex with Men (MSM), owing to their unsafe sexual behavior. Further, MSM indulge in behaviors such as consumption of alcohol/oral drugs and/or injecting during/before sex that poses the risk of unsafe behaviors, thereby increasing their vulnerability to HIV. The study aims to analyze the factors associated with HIV infection among the multi-risk MSM using any substances with those MSM who do not use substances.Community-based cross-sectional survey design using probability-based sampling between October 2014 and November 2015.For the nation-wide Integrated Biological and Behavioral Surveillance (IBBS), 23,081 MSM were recruited from 4067 hotspots in 108 districts across India. Information on demographics, sexual behaviors, substance use, sexual partners, and awareness on HIV and its management was collected from the consented respondents using computer-assisted personal interview (CAPI) by trained personnel. Blood samples were tested for HIV. Statistical analyses were done, to study the associations between substance use and its influence on high-risk sexual behaviors and HIV infection.One in 3 MSM (33.88%) in India were substance users, thus exhibiting "multi-risk" (MR) behaviors. Significantly higher HIV prevalence (3.8%, P < .05) was reported among MR-MSM, despite 97.2% of them being aware of HIV. Higher HIV prevalence among MSM exhibiting homosexual behavior for ≤1 year is of specific concern, as this accounts to recent infections and indicates the increased vulnerability of the infection among the new entrants.Substance-use resulting in high-risk sexual behavior was significantly associated with higher HIV prevalence among MR-MSM. Integrated targeted interventions focusing on safe sex and safe-IDU practices among MR-MSM are required to end the disease transmission.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Homossexualidade Masculina/estatística & dados numéricos , Comportamento Sexual/etnologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Conscientização , Estudos Transversais , Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/psicologia , Homossexualidade Masculina/etnologia , Humanos , Índia/epidemiologia , Masculino , Prevalência , Assunção de Riscos , Comportamento Sexual/psicologia , Parceiros Sexuais/classificação , Adulto Jovem
9.
BMC Med ; 18(1): 241, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32731868

RESUMO

BACKGROUND: Citizens affected by substance use disorders are high-risk populations for both SARS-CoV-2 infection and COVID-19-related mortality. Relevant vulnerabilities to COVID-19 in people who suffer substance use disorders are described in previous communications. The COVID-19 pandemic offers a unique opportunity to reshape and update addiction treatment networks. MAIN BODY: Renewed treatment systems should be based on these seven pillars: (1) telemedicine and digital solutions, (2) hospitalization at home, (3) consultation-liaison psychiatric and addiction services, (4) harm-reduction facilities, (5) person-centered care, (6) promote paid work to improve quality of life in people with substance use disorders, and (7) integrated addiction care. The three "best buys" of the World Health Organization (reduce availability, increase prices, and a ban on advertising) are still valid. Additionally, new strategies must be implemented to systematically deal with (a) fake news concerning legal and illegal drugs and (b) controversial scientific information. CONCLUSION: The heroin pandemic four decades ago was the last time that addiction treatment systems were updated in many western countries. A revised and modernized addiction treatment network must include improved access to care, facilitated where appropriate by technology; more integrated care with addiction specialists supporting non-specialists; and reducing the stigma experienced by people with SUDs.


Assuntos
Betacoronavirus , Infecções por Coronavirus/reabilitação , Pneumonia Viral/reabilitação , Síndrome Respiratória Aguda Grave/reabilitação , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Qualidade de Vida , Síndrome Respiratória Aguda Grave/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Telemedicina/organização & administração
10.
MMWR Morb Mortal Wkly Rep ; 69(32): 1049-1057, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32790653

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health challenges related to the morbidity and mortality caused by the disease and to mitigation activities, including the impact of physical distancing and stay-at-home orders.* Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April-June of 2020, compared with the same period in 2019 (1,2). To assess mental health, substance use, and suicidal ideation during the pandemic, representative panel surveys were conducted among adults aged ≥18 years across the United States during June 24-30, 2020. Overall, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic† (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%). The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18-24 years (25.5%), minority racial/ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid caregivers for adults§ (30.7%), and essential workers¶ (21.7%). Community-level intervention and prevention efforts, including health communication strategies, designed to reach these groups could help address various mental health conditions associated with the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Transtornos Mentais/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Ideação Suicida , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
13.
Epidemiol Psychiatr Sci ; 29: e148, 2020 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-32746958

RESUMO

AIM: Drug use disorders are an important issue worldwide. Systematic attempts to estimate the global incidence of drug use disorders are rare. We aimed to determine the incidence of drug use disorders and their trends. METHODS: We obtained the annual incident cases and age-standardised incidence rate (ASR) of drug use disorders from 1990 to 2017 using the Global Health Data Exchange query tool. The estimated annual percentage changes of the ASR were used to quantify and evaluate the trends in the incidence rate. Gaussian process regression and the Pearson's correlation coefficient were used to assess the relationship between the ASR and socio-demographic index (SDI). RESULTS: The number of drug use disorders' cases increased by 33.5% from 1990 to 2017 globally, whereas the ASR exhibited a stable trend. The ASR was higher in men than in women. Most cases (53.1%) of drug use disorders involved opioid. A positive association (ρ=0.35, p < 0.001) was found between ASR and SDI. Teenagers aged 15-19 years had the highest incidence rate. CONCLUSIONS: The incident cases of drug use disorders were increasing, but the incidence rate did not change significantly from 1990 to 2017. Current preventive measures and policies for drug use disorders might have little effect. The present results suggest that future strategies should focus on men, teenagers and high-risk regions in order to improve the current status of drug use disorders.


Assuntos
Carga Global da Doença/tendências , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Saúde Global , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
14.
Stroke ; 51(9): 2664-2673, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755347

RESUMO

BACKGROUND: Anecdotal reports suggest fewer patients with stroke symptoms are presenting to hospitals during the coronavirus disease 2019 (COVID-19) pandemic. We quantify trends in stroke code calls and treatments at 3 Connecticut hospitals during the local emergence of COVID-19 and examine patient characteristics and stroke process measures at a Comprehensive Stroke Center (CSC) before and during the pandemic. METHODS: Stroke code activity was analyzed from January 1 to April 28, 2020, and corresponding dates in 2019. Piecewise linear regression and spline models identified when stroke codes in 2020 began to decline and when they fell below 2019 levels. Patient-level data were analyzed in February versus March and April 2020 at the CSC to identify differences in patient characteristics during the pandemic. RESULTS: A total of 822 stroke codes were activated at 3 hospitals from January 1 to April 28, 2020. The number of stroke codes/wk decreased by 12.8/wk from February 18 to March 16 (P=0.0360) with nadir of 39.6% of expected stroke codes called from March 10 to 16 (30% decrease in total stroke codes during the pandemic weeks in 2020 versus 2019). There was no commensurate increase in within-network telestroke utilization. Compared with before the pandemic (n=167), pandemic-epoch stroke code patients at the CSC (n=211) were more likely to have histories of hypertension, dyslipidemia, coronary artery disease, and substance abuse; no or public health insurance; lower median household income; and to live in the CSC city (P<0.05). There was no difference in age, sex, race/ethnicity, stroke severity, time to presentation, door-to-needle/door-to-reperfusion times, or discharge modified Rankin Scale. CONCLUSIONS: Hospital presentation for stroke-like symptoms decreased during the COVID-19 pandemic, without differences in stroke severity or early outcomes. Individuals living outside of the CSC city were less likely to present for stroke codes at the CSC during the pandemic. Public health initiatives to increase awareness of presenting for non-COVID-19 medical emergencies such as stroke during the pandemic are critical.


Assuntos
Isquemia Encefálica/epidemiologia , Hemorragias Intracranianas/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Estudos de Coortes , Comorbidade , Connecticut/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Infecções por Coronavirus/epidemiologia , Dislipidemias/epidemiologia , Serviços Médicos de Emergência , Grupos Étnicos , Feminino , Humanos , Hipertensão/epidemiologia , Renda , Seguro Saúde , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/fisiopatologia , Hemorragias Intracranianas/terapia , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Telemedicina , Trombectomia , Terapia Trombolítica
15.
J Med Internet Res ; 22(9): e21490, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32841152

RESUMO

BACKGROUND: Evidence from past pandemics suggests that fear, uncertainty, and loss of control during large-scale public health crises may lead to increased pandemic-related information seeking, particularly among persons predisposed to high anxiety. In such groups, a greater consumption of information pertaining to the COVID-19 pandemic may increase anxiety. OBJECTIVE: In this study, we examine the association between online activity and Generalized Anxiety Disorder 7 (GAD-7) scores in the United States. METHODS: We recruited participants for an online survey through advertisements on various platforms such as Google, Facebook, and Reddit. A total of 406 adult US participants with moderate to severe (≥10) GAD-7 scores met the inclusion criteria and completed the survey. Anxiety levels measured using the GAD-7 scale formed our primary outcome. Our key independent variables were average daily time spent online and average daily time spent online searching about COVID-19 within the past 14 days. We used as controls potential confounders of the relation between our key independent variables and GAD-7 scores, namely, sleep quality, the COVID-19 Fear Inventory scale, binge drinking, substance use, prescription drug abuse, and sociodemographic attributes. RESULTS: Linear multivariate regression analyses showed that GAD-7 scores were higher among those who spent >4 hours online (per day) searching for information about COVID-19 (coefficient 1.29, P=.002), controlling for all other covariates. The total time spent online was not statistically associated with GAD-7 scores. CONCLUSIONS: Results from this study indicate that limiting pandemic-related online information seeking may aid anxiety management in our study population.


Assuntos
Transtornos de Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/psicologia , Internet/estatística & dados numéricos , Pandemias , Pneumonia Viral/psicologia , Adulto , Transtornos de Ansiedade/etiologia , Bebedeira/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
16.
J Subst Abuse Treat ; 118: 108102, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32854983

RESUMO

The current coronavirus disease (COVID-19) pandemic has rapidly spread across the world. Individuals with stimulant use disorder are a vulnerable population, who are particularly at risk of negative outcomes during this pandemic due to several risk factors, including mental and physical comorbidities, weakened immune responses, high-risk behaviors, and barriers to healthcare access. Engaging patients with stimulant use disorder in regular treatment has become even more difficult during this pandemic, which has resulted in many cuts to addiction treatment programs. The most effective treatment options for stimulant use disorder are psychosocial interventions, which rely heavily on in-person interactions, posing an added challenge during physical distancing. In particular, contingency management (CM) is a behavioral therapy that utilizes tangible reinforcements to incentivize targeted behavior changes, and is an effective treatment intervention used for stimulant use disorder. This paper highlights the treatment challenges for individuals with stimulant use disorder and the importance of adapting CM programs during COVID-19. We present strategies for how CM can be adapted and its role expanded in a safe way during the COVID-19 pandemic to help prevent infection spread, stimulant use relapse, and worsened psychosocial consequences.


Assuntos
Terapia Comportamental/métodos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Populações Vulneráveis
17.
PLoS One ; 15(8): e0238170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857791

RESUMO

OBJECTIVE: Increase in alcohol and substance use among college students is a global public health concern. It is associated with the risk of alcohol and substance use disorders to the individual concerned and public health problems to their family and society. Among students there is also the risk of poor academic performance, taking longer to complete their studies or dropping out of university. This study determined the prevalence and patterns of alcohol and substance use of students at the entry to the university. METHOD: A total of 406 (50.7% male) students were interviewed using the Assessment of Smoking and Substance Involvement Test (ASSIST) and the Alcohol Use Disorder Identification Tool (AUDIT). Bivariate logistic regression analyses were used to examine associations between substance use and students' socio-demographic characteristics. Multivariate logistic regression analysis was conducted to examine the predictors of the lifetime and current alcohol and substance use. RESULTS: Lifetime and current alcohol and substance use prevalence were 103 (25%) and 83 (20%) respectively. Currently frequently used substances were alcohol 69 (22%), cannabis 33 (8%) and tobacco 28 (7%). Poly-substance use was reported by 48 (13%) respondents, the main combinations being cannabis, tobacco, and alcohol. Students living in private hostels were four times more likely to be current substance users compared with those living on campus (OR = 4.7, 95% CI: 2.0, 10.9). CONCLUSION: A quarter of the study respondents consumed alcohol and/or substances at the entry to university pushing the case for early intervention strategies to delay initiation of alcohol and substance use and to reduce the associated harmful consequences.


Assuntos
Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estudos Transversais , Feminino , Humanos , Quênia , Masculino , Prevalência , Estudantes , Universidades , Adulto Jovem
18.
PLoS One ; 15(8): e0237905, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817717

RESUMO

Homelessness is poorly captured in most administrative data sets making it difficult to understand how, when, and where this population can be better served. This study sought to develop and validate a classification model of homelessness. Our sample included 5,050,639 individuals aged 11 years and older who were included in a linked dataset of administrative records from multiple state-maintained databases in Massachusetts for the period from 2011-2015. We used logistic regression to develop a classification model with 94 predictors and subsequently tested its performance. The model had high specificity (95.4%), moderate sensitivity (77.8%) for predicting known cases of homelessness, and excellent classification properties (area under the receiver operating curve 0.94; balanced accuracy 86.4%). To demonstrate the potential opportunity that exists for using such a modeling approach to target interventions to mitigate the risk of an adverse health outcome, we also estimated the association between model predicted homeless status and fatal opioid overdoses, finding that model predicted homeless status was associated with a nearly 23-fold increase in the risk of fatal opioid overdose. This study provides a novel approach for identifying homelessness using integrated administrative data. The strong performance of our model underscores the potential value of linking data from multiple service systems to improve the identification of housing instability and to assist government in developing programs that seek to improve health and other outcomes for homeless individuals.


Assuntos
Pessoas em Situação de Rua/classificação , Habitação/normas , Problemas Sociais/prevenção & controle , Adolescente , Adulto , Idoso , Criança , Gerenciamento de Dados , Feminino , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Massachusetts , Pessoa de Meia-Idade , Problemas Sociais/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Populações Vulneráveis , Adulto Jovem
20.
PLoS Med ; 17(8): e1003131, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810147

RESUMO

BACKGROUND: Intimate partner violence (IPV) is linked to substance use by male perpetrators and is associated with an increased risk of depression for women who experience violence. Unite for a Better Life (UBL) is a gender-transformative intervention delivered to men, women, and couples in Ethiopia; previous evidence demonstrated the intervention significantly reduced experience of and perpetration of IPV when delivered to men and led to more equitable household task-sharing when delivered to men and couples. The aim of this analysis is to assess engagement in the UBL intervention and to examine the relationship between random assignment to the intervention and men's past-year substance use and women's reported depressive symptoms as measured at the individual level. METHODS AND FINDINGS: A sample of 64 villages in Gurague zone, Ethiopia, was randomly allocated to 4 arms (men's UBL, women's UBL, couples' UBL, or control). In each village, 106 households were randomly sampled, and households in the intervention arms were invited to participate in UBL, consisting of 14 sessions delivered by trained facilitators. Households in the control arm were offered a short educational session on IPV. Descriptive data on participant engagement in the intervention are reported, and outcomes assessed in an intention-to-treat (ITT) analysis include male use of substances (alcohol and khat) and women's depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9). Results from both adjusted and unadjusted specifications are reported, the latter adjusting for baseline covariates including age, education level, marriage length, polygamy, socioeconomic status, months between intervention and endline, and the baseline level of the outcome variable. The baseline sample includes 6,770 respondents surveyed in 2014-2015, and follow-up data were available from 88% of baseline respondents surveyed in 2017-2018; the majority of respondents report no education, and 61% are Muslim. Respondents reported high attendance rates and engagement in the intervention. In addition, there was evidence of a significant reduction in frequent past-year alcohol intoxication self-reported by men (adjusted odds ratio [AOR] = 0.56, 95% CI 0.36-0.85, p = 0.007), and a significant increase in the probability of frequent khat use self-reported by men (AOR = 3.09, 95% CI 1.37-6.96, p = 0.007), both observed in the couples' UBL arm at 24 months' follow-up relative to the control arm. There was a significant increase in symptoms of moderate depression among women in the women's UBL arm only (AOR = 1.65, 95% CI 1.13-2.41, p = 0.010), again relative to the control arm. There was no evidence of shifts in symptoms of mild or severe depression. The primary limitation of this study is the reliance on self-reported data around sensitive behaviors. CONCLUSIONS: The findings suggest that the UBL intervention was associated with a reduction in men's use of alcohol when delivered to couples, but there was no evidence of a decrease in reported symptoms of depression among women in any experimental arm, and some evidence of an increase in symptoms of moderate depression in the women's UBL arm. Further research should explore how to optimize IPV prevention interventions to target related risks of mental health and substance use. TRIAL REGISTRATION: Clinicaltrials.gov NCT02311699; Socialscienceregistry.org AEARCTR-0000211.


Assuntos
Depressão/psicologia , Depressão/terapia , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Análise por Conglomerados , Depressão/epidemiologia , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Autorrelato , Parceiros Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Adulto Jovem
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