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1.
Psychiatr Prax ; 46(8): 445-450, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31683335

RESUMO

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.


Assuntos
Consumo de Bebidas Alcoólicas , Redução do Dano , Transtornos Relacionados ao Uso de Substâncias , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Berlim , Alemanha , Humanos , Prevalência , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
2.
N C Med J ; 80(6): 367-371, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685575

RESUMO

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.


Assuntos
Delinquência Juvenil/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Criança , Humanos , North Carolina/epidemiologia
3.
Lancet ; 394(10208): 1580-1590, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31657733

RESUMO

We assess the current and describe possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. First, we describe global patterns of cannabis use and their most probable adverse health effects. Second, we summarise evidence regarding the effectiveness of cannabinoids for medicinal use and describe approaches that have been used to regulate the use of medicinal cannabis and how these approaches might have affected medicinal and recreational use and harms (eg, road crashes). Third, we describe how jurisdictions that have legalised recreational use have regulated production and sale of cannabis. Fourth, we evaluate the effects of cannabis legalisation on cannabis use and harms and on the use of alcohol, tobacco, and other drugs. Fifth, we use alcohol and tobacco policy examples to identify possible long-term public health effects of cannabis legalisation. Finally, we outline policy approaches that could minimise harms to public health arising from the legalisation of a commercial cannabis industry.


Assuntos
Cannabis , Uso da Maconha/epidemiologia , Maconha Medicinal/administração & dosagem , Saúde Pública/legislação & jurisprudência , Comércio/economia , Feminino , Humanos , Legislação de Medicamentos/economia , Masculino , Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Maconha Medicinal/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
4.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190009, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576985

RESUMO

INTRODUCTION: Knowledge about risky sexual behavior among young people has been widely acknowledged as a key tool to controlling the spread of HIV. This article aimed at presenting the risk behavior of Brazilian Army conscripts toward HIV infection according to the country's geographic regions. . METHOD: We collected data from 37,282 conscripts, aged 17 to 22, during enlistment in the Brazilian Army in 2016. The prevalence of HIV infection, both self-reported and measured through laboratory results, and risk behavior factors were estimated by region. RESULTS: 75% of the sample of conscripts reported to have already started sexual activity, and the average age of their sexual initiation was 15. Condom use varied according to the type of sexual relationship, being lower among steady partners and greater among less stable relationships. HIV prevalence assessed by laboratory tests was 0.12% across the country and the highest prevalence was observed in the North region (0.24%). Alcohol and illicit drug usage was higher in the South region. DISCUSSION: The study allowed the observation of risk behavior monitoring for HIV infection among young Brazilians. Lower condom usage among steady partners may be contributing to an increase in the number of HIV-infected individuals. CONCLUSION: Results suggest the need to intensify prevention campaigns to disseminate safe sex practices among young people, in addition to the expansion of testing offer to this population.


Assuntos
Infecções por HIV/etiologia , Comportamentos de Risco à Saúde , Militares/estatística & dados numéricos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Preservativos/estatística & dados numéricos , Estudos Transversais , Geografia , Infecções por HIV/epidemiologia , Humanos , Masculino , Prevalência , Medição de Risco , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
5.
Lancet Psychiatry ; 6(11): 935-950, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31588045

RESUMO

BACKGROUND: Antidepressants, opioids for non-cancer pain, gabapentinoids (gabapentin and pregabalin), benzodiazepines, and Z-drugs (zopiclone, zaleplon, and zolpidem) are commonly prescribed medicine classes associated with a risk of dependence or withdrawal. We aimed to review the evidence for these harms and estimate the prevalence of dispensed prescriptions, their geographical distribution, and duration of continuous receipt using all patient-linked prescription data in England. METHODS: This was a mixed-methods public health review, comprising a rapid evidence assessment of articles (Jan 1, 2008, to Oct 3, 2018; with searches of MEDLINE, Embase, and PsycINFO, and the Cochrane and King's Fund libraries), an open call-for-evidence on patient experience and service evaluations, and a retrospective, patient-linked analysis of the National Health Service (NHS) Business Services Authority prescription database (April 1, 2015, to March 30, 2018) for all adults aged 18 years and over. Indirectly (sex and age) standardised rates (ISRs) were computed for all 195 NHS Clinical Commissioning Groups in England, containing 7821 general practices for the geographical analysis. We used publicly available mid-year (June 30) data on the resident adult population and investigated deprivation using the English Indices of Multiple Deprivation (IMD) quintiles (quintile 1 least deprived, quintile 5 most deprived), with each patient assigned to the IMD quintile score of their general practitioner's practice for each year. Statistical modelling (adjusted incident rate ratios [IRRs]) of the number of patients who had a prescription dispensed for each medicine class, and the number of patients in receipt of a prescription for at least 12 months, was done by sex, age group, and IMD quintile. FINDINGS: 77 articles on the five medicine classes were identified from the literature search and call-for-evidence. 17 randomised placebo-controlled trials (6729 participants) reported antidepressant-associated withdrawal symptoms. Almost all studies were rated of very low, low, or moderate quality. The focus of qualitative and other reports was on patients' experiences of long-term antidepressant use, and typically sudden onset, severe, and protracted withdrawal symptoms when medication was stopped. Between April 1, 2017, and March 31, 2018, 11·53 million individuals (26·3% of residents in England) had a prescription dispensed for at least one medicine class: antidepressants (7·26 million [16·6%]), opioids (5·61 million [12·8%]), gabapentinoids (1·46 million [3·3%]), benzodiazepines (1·35 million [3·1%]), and Z-drugs (0·99 million [2·3%]). For three of these medicine classes, more people had a prescription dispensed in areas of higher deprivation, with adjusted IRRs (referenced to quintile 1) ranging from 1·10 to 1·24 for antidepressants, 1·20 to 1·85 for opioids, and 1·21 to 1·85 for gabapentinoids across quintiles, and higher ISRs generally concentrated in the north and east of England. In contrast, the highest ISRs for benzodiazepines and Z-drugs were generally in the southwest, southeast, and east of England, with low ISRs in the north. Z-drugs were associated with increased deprivation, but only at the highest quintile (adjusted IRR 1·11 [95% CI 1·01-1·22]). For benzodiazepines, prescribing was reduced for people in quintiles 4 (0·90 [0·85-0·96]) and 5 (0·89 [0·82-0·97]). In March, 2018, for each of medicine class, about 50% of patients who had a prescription dispensed had done so continuously for at least 12 months, with the highest ISRs in the north and east. Long-term prescribing was associated with a gradient of increased deprivation. INTERPRETATION: In 1 year over a quarter of the adult population in England had a prescription dispensed for antidepressants, opioids (for non-cancer pain), gabapentinoids, benzodiazepines, or Z-drugs. Long-term (>12 months) prescribing is common, despite being either not recommended by clinical guidelines or of doubtful efficacy in many cases. Enhanced national and local monitoring, better guidance for personalised care, and better doctor-patient decision making are needed. FUNDING: Public Health England.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos/efeitos adversos , Antidepressivos/efeitos adversos , Benzodiazepinas/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Acetamidas/efeitos adversos , Adolescente , Adulto , Idoso , Compostos Azabicíclicos/efeitos adversos , Bases de Dados Factuais/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Gabapentina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Piperazinas/efeitos adversos , Pregabalina/efeitos adversos , Saúde Pública , Pirimidinas/efeitos adversos , Síndrome de Abstinência a Substâncias/epidemiologia , Adulto Jovem , Zolpidem/efeitos adversos
6.
Niger Postgrad Med J ; 26(4): 211-215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621660

RESUMO

Introduction: Recent evidence suggests that rates of drug use and abuse in Nigeria exceed the global average. There is a strong treatment demand for psychoactive drug use disorders in Nigeria; however, it is not known whether available treatment facilities are attending to the array of treatment needs. This audit compares the pattern of presentations at a tertiary facility with a community-based survey. Methods: A review of cases (n = 212) seen at a regional drug treatment facility over a 4-year period, using local data retrieved from the Nigerian Epidemiological Network of Drug Use (NENDU) and comparison with data from the recently published national drug use survey. Results: Nine out of ten clients seen were male (93.4%). About half (49.5%) of the clients used psychoactive substances for the first time between ages 10 and 19 years. Cannabis was the primary drug of use overall and also among males, while females were more likely to present with opiate abuse. Over half had a co-occurring physical or mental disorder, and a minority had received testing for hepatitis C in the past 12 months. Conclusion: Although patterns of drug abuse presentations were consistent with findings from a national community-based survey, there was an under-representation of females in treatment. Implications for policy development and practice are discussed.


Assuntos
Transtornos Mentais/epidemiologia , Pacientes/estatística & dados numéricos , Drogas Ilícitas/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Distribuição por Idade , Alcoolismo/epidemiologia , Alcoolismo/reabilitação , Criança , Comorbidade/tendências , Estudos Transversais , Feminino , Hospitais Psiquiátricos , Humanos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Abuso de Maconha/epidemiologia , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Nigéria/epidemiologia , Pacientes/psicologia , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Adulto Jovem
7.
Afr Health Sci ; 19(2): 1888-1896, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656472

RESUMO

Background: Adolescents experience high rates of depression, initiation of sexual activity, and substance use. Objectives: To better understand the demographics of adolescents presenting to an adolescent clinic in Uganda, and to elucidate which factors are associated with depressive symptoms, sexual initiation, and substance use. Methods: A retrospective review was performed on intake forms obtained during interviews with adolescents presenting to the Makerere/Mulago Columbia Adolescent Health Clinic (MMCAH) in Kampala, Uganda. Results: Depressive symptoms in adolescents were correlated with having a chronic illness (p=.026), and reported poor quality of home life (p<.001). Initiation of sexual activity was also correlated with chronic illness (p=.008) and poor quality of home life (p=.006). Substance use was correlated with maternal death (p=.041), chronic illness (p=.038), and substance use among family members (p<.001) and friends (p<.001). Conclusions: Knowing the aforementioned risk factors can help us better understand the needs of adolescents presenting to MMCAH, and allows us to develop targeted interventions aimed at decreasing health risks in Kampala's adolescent population.


Assuntos
Depressão/epidemiologia , Comportamento Sexual/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Serviços de Saúde do Adolescente , Criança , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Uganda/epidemiologia , Adulto Jovem
8.
Pan Afr Med J ; 33: 135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558934

RESUMO

Introduction: The rate of sexually transmitted infection's, including HIV has increased in recent years in Ethiopia. Many adolescents and young people still do not protect themselves against unintended pregnancies and STIs. Therefore, this study was conducted to assess the predictors of risky sexual behavior among pre-college students in Adama Town, Ethiopia. Methods: School based cross-sectional study was employed. In this study 364 students were recruited from all pre-college schools in Adama town, Ethiopia. Bivariate and multivariate logistic regression analysis were used to examine the relationship between the outcome variables and independent variables. Results: The mean age at sexual debut was 16.1 years (± 2.72SD). Social media usage for sexual activity and having multiple sexual partners were observed among students. About 7% of students used social media for watching pornography. The odds of risky sexual behaviour were higher among social media users compared to the nonusers AOR = 1.23 (95% CI 1.13,3.12). Risky sexual behaviour was almost 4 times more likely among night club goers AOR = 4.294 (95% CI: 2.033, 9.073). Peer pressure and substance abuse were also a significant predictor for risky sexual behavior AOR = 6.97 (95% CI: 4.24, 9.69). Conclusion: Social media use, peer pressure, substance abuse, and night club going were found to be significantly associated with risky sexual behaviour among pre-college students. Thus, schools need to establish and strengthen reproductive health clubs to be able to equip students with required skills and knowledge about sexuality. Parents should be aware of the dynamic behavioral change of their children, listen and attend to their needs.


Assuntos
Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Mídias Sociais/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Estudos Transversais , Literatura Erótica/psicologia , Etiópia , Feminino , Humanos , Modelos Logísticos , Masculino , Infuência dos Pares , Instituições Acadêmicas , Parceiros Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
9.
Metas enferm ; 22(7): 72-79, sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-ET2-2576

RESUMO

El consumo de drogas y sus consecuencias son una importante causa directa de morbimortalidad en España. También está asociado indirectamente con otros problemas sociales y de salud. La arteterapia tiene un largo recorrido en el tratamiento de las adiciones en otros países y en España tiene cada día más presencia, formando parte de los equipos multidisciplinares en los centros de atención a la drogodependencia. La arteterapia ofrece un espacio seguro para la expresión de las emociones difíciles, que las personas en tratamiento para las adicciones experimentan a través del lenguaje visual desde el que se pueden sortear los bloqueos verbales. Además de facilitar el desarrollo de los recursos que pueden favorecer, también hace que el proceso de cambio desde el consumo a la abstinencia sea una realidad. Este artículo, séptimo de la serie Arteterapia, tiene como objetivo mostrar las aportaciones que la arteterapia ofrece a las personas con adicciones, se tratan las conexiones del abordaje arteterapéutico con el modelo transteórico de Prochaska y DiClemente y la entrevista motivacional, los mecanismos de acción por los cuales opera la arteterapia y, finalmente, se describen varias experiencias arteterapéuticas con un grupo de personas en tratamiento de las adicciones en el marco del proyecto Lakoma


Using drugs and its consequences are a major direct cause of morbimortality in Spain. It is also associated indirectly with other Social and health problems. Art Therapy has a long history in addiction treatment in other countries, and it is increasingly present in Spain, as part of the multidisciplinary teams in Care Centers for Drug Addiction. Art Therapy offers a safe space for expressing those difficult emotions experienced by persons on treatment for addiction, through the visual language that can sort out any verbal blocking. As well as facilitating the development of potentially favourable resources, it also turns into a reality the process of change from use to abstinence This is the seventh article in the Art Therapy series, and its objective is to show the contributions that Art Therapy offers to persons with addiction. It deals with the connections of the Art Therapy approach with the transtheoretical model by Prochaska and Diclemente and the motivational interview, the mechanisms of action through which Art Therapy acts and finally, there is a description of various experiences in Art Therapy with a group of persons on treatment for addiction in the setting of the Lakoma


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Terapia pela Arte/instrumentação , Transtornos Relacionados ao Uso de Substâncias/terapia , Terapia pela Arte/métodos , Entrevista Motivacional/métodos , Entrevista Motivacional/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Psicoterapia/métodos
11.
Expert Rev Clin Pharmacol ; 12(9): 901-908, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31422705

RESUMO

Introduction: The current emphasis on combatting the opioid epidemic in the United States and across the globe is well warranted, but rates and variations of other drugs and substances of abuse may be inadvertently increasing as well. These drugs and substances deserve equal attention in the literature to equip healthcare practitioners with the knowledge to provide optimal care in overdose patients. Areas covered: This evaluation includes loperamide, gabapentin, and modafinil and was accomplished through a comprehensive literature review of PubMed, MEDLINE, SCOPUS, ProQuest Central, ProQuest Dissertations, and CINAHL. The results of forty-four pieces of literature are included in this evaluation. The objective of this review is to provide a repository of standard and emerging treatment modalities for loperamide, gabapentin and modafinil for the emergency medicine team. Expert opinion: Loperamide, gabapentin, and modafinil are becoming drugs of abuse, and as such, should be on the radar of healthcare providers. Recognizing their unique toxicity profiles is imperative in providing optimal resuscitative care.


Assuntos
Gabapentina/envenenamento , Loperamida/envenenamento , Modafinila/envenenamento , Overdose de Drogas/terapia , Tratamento de Emergência/métodos , Humanos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
12.
BMC Infect Dis ; 19(1): 712, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31438873

RESUMO

BACKGROUND: Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment uptake and cure in the pre- and post-direct acting antiviral (DAA) era. METHODS: We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age- and sex-standardized rates of comorbidity and comparisons were made by interferon-based and interferon-free, DAA HCV treatments. RESULTS: The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29-3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. CONCLUSION: People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.


Assuntos
Hepatite C/epidemiologia , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Canadá/epidemiologia , Coinfecção/epidemiologia , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Hepatite C/tratamento farmacológico , Humanos , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Multimorbidade , Prevalência , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
13.
Int J Equity Health ; 18(1): 122, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382979

RESUMO

BACKGROUND: Unmet need for mental health services remains high in the United States and is disproportionately concentrated in some groups. The scale and nature of these disparities have not been fully elucidated and bear further scrutiny. As such, in this study, we examine the demographic, socioeconomic, and health correlates of unmet need for mental health treatment as well as the reasons for unmet need. METHODS: We draw upon the National Survey for Drug Use and Health (NSDUH) from 2002 to 16 for adults aged 18 and over in the United States (n = 579,017). Using multivariable logistic regression, we simultaneously model the demographic, socioeconomic, and health correlates of unmet need for mental health treatment from 2002 to 16. We also analyse the reasons for unmet need expressed by these populations, reasons which include cost, perceived stigma, minimisation of symptoms, low perceived effectiveness of treatment, and structural barriers. RESULTS: Major characteristics associated with increased odds of unmet need include past year substance abuse or dependence (other than hallucinogens and sedatives), fair, poor, or very poor health, being female, and an educational attainment of college or higher. With respect to reasons for unmet need, cost was most often cited, followed by perceived stigma, structural barriers, and minimisation. Characteristics associated with increased odds of indicating cost as a reason for unmet need include: being uninsured or aged 26-35. Minimisation and low perceived effectiveness are mentioned by high-income persons as reasons for unmet need. College-educated persons and women had higher odds of citing structural barriers as a reason for unmet need. CONCLUSIONS: The correlates and causes of unmet need highlight the intersectionality of individual health needs with implications on addressing inequities in mental health policy and practice.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/psicologia , Saúde Mental , Pessoa de Meia-Idade , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos , Adulto Jovem
14.
BMC Infect Dis ; 19(1): 686, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382923

RESUMO

BACKGROUND: In Europe, the highest proportion of HIV diagnoses are in gay men and other men who have sex with men (MSM). Globally, HIV prevalence is particularly high among males who report selling sex, but rates among men who buy sex from other men are less clear. This study analyzed the association of transactional sex (TS) and HIV diagnosis, sexually transmitted infection (STI) diagnoses, and various drug use; and examined the variations in TS by payment direction. METHODS: We conducted a cross-sectional, non-randomized, observational study. This European MSM Internet Survey recruited MSM from 38 European countries. For descriptive purposes we stratified according to TS behavior (frequently selling sex, frequently buying sex, neither frequently selling nor buying sex in the previous 12 months), and we constructed separate multivariable logistic regression models to investigate whether engaging in TS accounted for some of the HIV- and STI diagnoses and drug use in this population. RESULTS: Of almost 161,000 sexually active MSM, 12.2% engaged in TS. The multivariable logistic regression results showed that relative to not frequently engaging in TS, frequently selling sex was independently associated with a higher odds of reporting diagnosed HIV (ever, adjusted odds ratio [aOR] 1.60, confidence interval [CI] 95% 1.39 to 1.85), bacterial STIs (past 12 months, aOR 1.75 CI 95% 1.54 to 2.00), using heroin or crack cocaine or injecting drugs (aOR 3.17, CI 95% 2.70 to 3.73), and using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41). Compared to men not engaging in frequent TS, frequently buying sex was associated with a higher odds of using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41). CONCLUSIONS: MSM who frequently sell sex suffer greater sexual- and substance use risks than other MSM, but both men who frequently sell and those who buy sex are more likely to use benzodiazepines. MSM who sell sex to other men constitute an important at-risk population who must be offered targeted health services.


Assuntos
Infecções por HIV/transmissão , Homossexualidade Masculina/estatística & dados numéricos , Trabalho Sexual/estatística & dados numéricos , Adulto , Cocaína Crack , Estudos Transversais , Europa (Continente)/epidemiologia , Infecções por HIV/epidemiologia , Heroína , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Comportamento Sexual , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/transmissão , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
15.
Tijdschr Psychiatr ; 61(7): 477-487, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31372969

RESUMO

BACKGROUND: Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.
AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.
METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.
RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.
CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Comorbidade , Consenso , Humanos , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
17.
Sci Total Environ ; 688: 771-779, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31255815

RESUMO

The abuse of illicit drug addiction is a worldwide public health and social problem. In this paper, we reported on a simple and rapid colorimetric biosensor for duplexed detection of methamphetamine (METH) and cocaine in a single assay. Gold nanoparticles (AuNPs) and Au@Ag NPs were synthesized and functionalized with DNA reporter probes (RPs) for METH and cocaine, respectively. The magnetic beads (MBs) were conjugated with two capture probes (CPs) respective to METH and cocaine. The respective RPs and CPs were designed to hybridize with each illicit drug-binding DNA aptamers through DNA-DNA hybridization, forming a sandwich structure. This MBs-based sandwich structure could be removed with an external magnetic field. However, due to the higher affinity of DNA aptamers with illicit drugs, the sandwich structure was disassembled when illicit drugs are introduced into the solution, leading to the colour changes of the supernatant. Utilizing a non-negative matrix factorization (NMF) algorithm to process the data, we demonstrated the ability of our biosensor for the simultaneous quantification of two illicit drugs. Under the optimal condition, our sensors were able to detect both METH and cocaine at the nM level with a wide dynamic range. This sensing platform provides a huge potential on drug consumption evaluation at the community level for wastewater-based epidemiology.


Assuntos
Drogas Ilícitas/análise , Detecção do Abuso de Substâncias/métodos , Poluentes Químicos da Água/análise , Monitoramento Ambiental/instrumentação , Monitoramento Ambiental/métodos , Ouro/química , Limite de Detecção , Nanopartículas Metálicas/química , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Águas Residuárias/química
18.
J Opioid Manag ; 15(3): 205-212, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343722

RESUMO

OBJECTIVE: This study describes the incidence of neonatal abstinence syndrome (NAS) in Ontario, Canada by year and health region from 2003 to 2016. DESIGN: The incidence of NAS diagnoses per 1,000 live births was calculated for the 36 local public health agency regions in Ontario from 2003 to 2016 using retrospective hospital admissions data. Infants with a diagnosis of NAS were identified using ICD-10 code P961. Local public health agency level data were aggregated and analyzed by geographic region and by Statistics Canada 2015 Peer Groups. RESULTS: The incidence of NAS in Ontario increased from 0.99 per 1,000 live births in 2003 to 5.94 per 1,000 live births in 2016. There were major differences in NAS incidence by geography, North Western Ontario had the greatest incidence across all years. Health regions with a rural and population center mix or mostly rural population had greater incidence rate of NAS compared to health regions with high density population centers. CONCLUSIONS: The incidence of NAS has dramatically increased across Ontario in the last decade. Actions should be taken to combat the continued increase in NAS rates, especially in health regions with disproportionately high incidence of NAS.


Assuntos
Analgésicos Opioides/efeitos adversos , Síndrome de Abstinência Neonatal , Transtornos Relacionados ao Uso de Substâncias/complicações , Humanos , Incidência , Lactente , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia , Ontário/epidemiologia , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
19.
BMC Public Health ; 19(1): 1006, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31351454

RESUMO

BACKGROUND: Cannabis has been identified as a possible risk factor in some tuberculosis (TB) outbreaks. As the most widely used (largely) illegal substance in Western countries this may be an important public health concern. We aim to systematically review the evidence on the association between cannabis use and TB (latent infection and active disease) to inform ongoing and future TB prevention and control strategies. METHODS: We conducted a systematic review. We searched Ovid Medline, Embase and PsycInfo, together with the World Health Organization website and Google Scholar, for all years to January 2018. Reference lists and conference abstracts were hand-searched, a forward citation search was conducted on the Web of Science, and experts were contacted. Two authors independently screened studies for inclusion, extracted data and assessed risk of bias using an adapted version of ROBINS-I ("Risk of Bias in Non-randomised Studies - of Interventions"). Data were narratively synthesised. RESULTS: Of 377 records identified, 11 studies were eligible. Study designs were heterogeneous. Six studies utilised a relevant comparator group. Four of these investigated the association between cannabis use and latent TB infection; all provided some evidence of an association, although only two of these had adjusted for confounders. The remaining two comparator studies investigated the association between cannabis use and active TB disease; neither found evidence of an association after adjusting for confounding. All six studies were at "Serious" risk of bias. The five studies which did not utilise a relevant comparator group were all indicative of TB outbreaks occurring among cannabis users, but the quality of the evidence was very weak. CONCLUSIONS: Evidence for an association between cannabis use and TB acquisition is weak. The topic warrants further robust primary research including the collection of consistent and accurate exposure information, including cannabis use practices, dose and frequency, and adjustment for confounders.


Assuntos
Fumar Maconha/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tuberculose/epidemiologia , Humanos , Medição de Risco
20.
Forensic Sci Med Pathol ; 15(3): 382-391, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31359307

RESUMO

In order to better understand risk factors associated with drug-facilitated sexual assault (DFSA), this study examined complainant-specific and contextual factors, as well as the toxicological profile of DFSA in Victoria, Australia. Clinical files and toxicological analysis results collected by the Victorian Institute of Forensic Medicine (VIFM) for all cases of alleged DFSA in Victoria that occurred between 1st January 2011 - 31st December 2013 were reviewed. Two hundred and four cases of alleged DFSA were identified; complainants were predominately female (93%), and their median age was 26 years (range = 18-54). Self-reported premorbid depression (21.1%) and drug and alcohol abuse (9.8%) were four and two times higher than 12-month prevalence rates in Australia, respectively. All assailants were male, half were known to the complainant and half of alleged assaults occurred in private residences. Most (93.6%) complainants reported voluntary consumption of psychoactive substances prior to the alleged DFSA. Alcohol was the most commonly self-reported substance consumed (n = 164; 64%) and concomitant use of alcohol, prescription and illicit drugs was also commonly self-reported (24%). There were 14 cases that produced a positive toxicology result where the complainant did not report voluntary consumption, which suggests these drugs may have been used covertly to facilitate sexual assault. The results of this study indicate that Females in their mid-20's who exhibit higher rates of mental health concerns represent a sub-group of the Australian population with increased vulnerability to DFSA, which typically occurs in a familiar setting in the context of voluntary alcohol and other substance use.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Vítimas de Crime/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Delitos Sexuais/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Austrália/epidemiologia , Criminosos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Drogas Ilícitas , Detecção do Abuso de Substâncias , Adulto Jovem
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