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1.
Am J Forensic Med Pathol ; 41(1): 32-34, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000220

RESUMO

Thymus glands from 283 autopsy cases were sampled and evaluated with histochemical and immunohistochemical methods. A subpopulation of 41 intravenous drug addicts were compared with age-matched control cases.It was found that an accelerated involution of the thymus occurred in the 20- to 25-year interval and thereafter with a steady pace of 5% per year. Also the size of Hassall bodies declined successively.In drug addicts, an increased dystrophic calcification of the Hassall bodies and a significant difference in thymus size (atrophy) compared with controls were seen. Moreover, a difference was seen in the relative numbers of CD4 and CD8 lymphocytes where CD4+ cells were reduced in drug addicts.It is hypothesized that signs of hepatitis C virus infection that was found in the majority of drug addicts and the reduced number of functionally intact Hassall corpuscles could explain the reduction of CD4+ lymphocytes and thymic hypotrophy in this population.


Assuntos
Usuários de Drogas , Abuso de Substâncias por Via Intravenosa , Timo/patologia , Adolescente , Adulto , Envelhecimento/patologia , Atrofia/patologia , Linfócitos T CD4-Positivos/patologia , Linfócitos T CD8-Positivos/patologia , Calcinose/patologia , Estudos de Casos e Controles , Feminino , Patologia Legal , Hepatite C Crônica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
BMC Infect Dis ; 19(1): 1019, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791253

RESUMO

BACKGROUND: Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany. METHODS: We used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates. RESULTS: Total number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening). CONCLUSIONS: Screening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.


Assuntos
Erradicação de Doenças , Hepatite C/prevenção & controle , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Adulto , Antivirais/economia , Antivirais/uso terapêutico , Estudos de Coortes , Análise Custo-Benefício , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/estatística & dados numéricos , Erradicação de Doenças/economia , Erradicação de Doenças/métodos , Erradicação de Doenças/estatística & dados numéricos , Usuários de Drogas/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Custos de Cuidados de Saúde , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Hepatite C/economia , Hepatite C/epidemiologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Vigilância da População/métodos , Anos de Vida Ajustados por Qualidade de Vida , Minorias Sexuais e de Gênero/estatística & dados numéricos
3.
BMC Infect Dis ; 19(1): 1022, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791273

RESUMO

BACKGROUND: Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. METHODS: We used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights. RESULTS: We enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV. CONCLUSION: Unsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission.


Assuntos
Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Idoso , Cidades/epidemiologia , Estudos Transversais , Epidemias , Feminino , Infecções por HIV/sangue , Soropositividade para HIV/epidemiologia , Hepatite B/sangue , Antígenos de Superfície da Hepatite B/análise , Antígenos de Superfície da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/imunologia , Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Vigilância da População/métodos , Prevalência , Assunção de Riscos , Estudos Soroepidemiológicos , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto Jovem
4.
J Opioid Manag ; 15(6): 507-520, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850513

RESUMO

OBJECTIVE: To identify key characteristics and habits of recreational opioid users. DESIGN: The data were compiled from volunteers who participated in clinical studies at a contract research organization in Toronto, Ontario, Canada. INTERVENTIONS: Data were collected from 5,018 male and female recreational opioid users via telephone and face-to-face screening interviews. Five recreational opioid users participated in a live interview broadcast on the internet. MAIN OUTCOME MEASURES: Demographic data, recreational drug use history, routes of recreational drug administration, alcohol use, and smoking status. A subset of the demographic information and recreational drug use history was summarized separately using data collected between 2013 and 2016 from 114 recreational opioid users who were not dependent on opioids. Interview excerpts were included from five recreational opioid users who described their real-world experiences with drug abuse, including the impact of abuse-deterrent opioid formulations on their drug abuse behavior. RESULTS: The preferred route of administration of opioids was oral (52 percent), followed by intranasal (36 percent), intravenous (10 percent), and buccal (chewing on a patch; 2 percent). Other substances used included nicotine, alcohol, and non-opioid psychoactive drugs (primarily cannabis). Oxycodone was the most frequently reported opioid of abuse. CONCLUSIONS: Recreational opioid users have distinct drug-related behaviors and preferences. Monitoring current trends and examining these behaviors is an important component to understand the potential safety risks associated with recreational opioid use.


Assuntos
Analgésicos Opioides , Usuários de Drogas/psicologia , Hábitos , Transtornos Relacionados ao Uso de Opioides , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Ontário , Transtornos Relacionados ao Uso de Opioides/psicologia , Oxicodona
5.
Clin Ter ; 170(6): e425-e426, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696904

RESUMO

The practice of drug of abuse adulteration is changing. Currently, the risk of new adulteration practices involves New Psychoactive Substances (NPS), which can also be used as adulterants. In particular, the phenomenon of adulteration concerns fentanyl and its analogs, substances that can be toxic even if taken in very small quantities. The adulteration that involves NPS is creating a serious threat to the health of drug users, not only because of the pharmacological action but because of the increased toxicity of these new cutting agents.


Assuntos
Contaminação de Medicamentos , Psicotrópicos/efeitos adversos , Usuários de Drogas , Fentanila/efeitos adversos , Humanos
6.
Tidsskr Nor Laegeforen ; 139(15)2019 10 22.
Artigo em Norueguês | MEDLINE | ID: mdl-31642627

RESUMO

BACKGROUND: The policy on drug use is currently undergoing significant change. This article examines how the view of addiction to illegal drugs changed in the first 30 years after the advent of 'the drug problem' in Norway. MATERIAL AND METHOD: We performed a search in Oria, bokhylla.no and various databases on the history of illegal drugs in Norway, with an emphasis on the period from 1960-90, with white papers from 1976 and 1986. RESULTS: Until the mid-1960s, Norway had very few opiate abusers. This generally concerned abuse of medically prescribed drugs, and was perceived as an internal problem for the health services. The youth counterculture in the late 1960s brought the recreational use of illegal substances to Norway, leading to major concern on the part of the public authorities. 'The drug problem' was now perceived as a significant societal problem, with social and societal causal explanations, and was therefore the subject of a white paper (1976). The next white paper (1986) put forward the ideal of a 'drug-free society' for the first time, with the purpose of general deterrence and strict sentencing as important instruments. INTERPRETATION: From the early 1960s until the late 1980s, the 'drug problem' was perceived in different ways. At the start of the period, it was formulated primarily as a medical problem. From the late 1960s, it was seen first and foremost as a social problem caused by changes in society, whereas from the late 1970s until the late 1980s, control measures constituted the most important instrument to address the problem.


Assuntos
Transtornos Relacionados ao Uso de Substâncias/história , Direito Penal/história , Usuários de Drogas/história , Política de Saúde/história , História do Século XX , Humanos , Noruega , Transtornos Relacionados ao Uso de Opioides/história , Medicina Social/história
7.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(9): 1134-1138, 2019 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-31594160

RESUMO

Objective: To understand the serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), triiodothyronine (T3), and thyroxine (T4) and identify the related influencing factors of thyroid dysfunction in drug users. Methods: From June to August 2018, a face-to-face questionnaire survey was conducted in 788 male drug users in a drug rehabilitation center in Jiangsu province to collect their socio-demographic information. Then, venous blood sample was collected from each participant for the detection of various hematological indicators, such as thyroid hormones. Results: The abnormal rates of T3, T4, FT3, FT4 and TSH were 4.57%, 1.27%, 0.51%, 0.38% and 0.89%, respectively, in the male drug users. HCV infection was an influencing factor for abnormal T3 level in the male drug users (OR=8.52, 95%CI: 2.36-30.74, P=0.001). And serum T3 (P<0.001) and T4 (P=0.048) levels increased with increasing HCV viral load. Conclusions: HCV infection was an influencing factor for the abnormality of serum T3 level in drug users. Therefore, thyroid-related knowledge should be added in the health education for drug users, and the monitoring of thyroid function should be strengthened for drug users infected with HCV.


Assuntos
Usuários de Drogas , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/sangue , Hormônios Tireóideos/sangue , China , Humanos , Masculino , Tireotropina , Tiroxina , Tri-Iodotironina
8.
Invest. educ. enferm ; 37(3): [E011], 15 Octubre 2019. Tab 1, Tab 2, Tab 3, Fig 1, Fig 2, Fig 3
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1023504

RESUMO

Objective. This research sought to analyze the predictive effect of personal (personality traits), social (social support and social stigma) and community factors (characteristic of the neighborhood and exposure to consumption) on the transition of drug use in young adults. Methods. Case and control study. The cases were 70 individuals from 18 to 34 years of age who had already transitioned into illicit drug use and the controls were 210 legal drug usuers (tobacco or alcohol) in the same age range who had not had the transition. A data file was applied along with seven instruments that measured the transition and consumption variables. Results. Marihuana was the illicit drug of highest transition. It was shown that greater personality traits of neuroticism, extraversion, and openness to the experience meant higher probability of drug use transition; while greater personality traits of agreeableness and conscience meant lower probability for the transition. The characteristics of the neighborhood environment and exposure to the opportunity of consumption increase the probability of the drug use transition. Social support and social stigma influenced negatively upon the drug use transition. Conclusion. Personality traits, neighborhood characteristics, exposure to drug use, social support, and the social stigma of drug use are factors that intervene in the transition from legal to illicit drug use.


Objetivo. Analizar el efecto predictivo de factores personales (rasgos de personalidad), sociales (apoyo social y estigma social) y comunitarios (características del barrio y exposición al consumo) sobre la transición del consumo de drogas en jóvenes. Métodos. Estudio de casos y controles. Los casos fueron 70 personas de 18 a 34 años que habían transitado al consumo de drogas ilícitas y los controles fueron 210 personas de la misma edad consumidores de alguna droga lícita (tabaco o alcohol) que no han tenido transición. Se aplicó una cédula de datos y siete instrumentos que midieron las variables de transición y consumo. Resultados. La droga ilegal de mayor transición fue la marihuana. Se mostró que a mayores rasgos de personalidad de neuroticismo, extraversión y apertura a la experiencia fue más alta la probabilidad de la transición del consumo de drogas, por el contrario, a mayores rasgos de personalidad amabilidad y conciencia fue menor fue la probabilidad para la transición. Las características del entorno de barrio y la exposición a la oportunidad de consumo incrementan la probabilidad de la transición del consumo de drogas. El apoyo social y el estigma social influyeron negativamente en la transición del consumo de drogas. Conclusión. Los rasgos de personalidad, las características del barrio, la exposición al consumo de drogas, el apoyo social y el estigma social del consumo de drogas son factores que intervienen en la transición del consumo de drogas legales a ilegales.


Objetivo. Analisar o efeito preditivo de fatores pessoais (características de personalidade), sociais (apoio social e estigma social) e comunitários (características do bairro e exposição ao consumo) sobre a transição do consumo de drogas em jovens. Métodos. Estudo de casos e controles. Os casos foram 70 pessoas de 18 a 34 anos que haviam transitado ao consumo de drogas ilícitas e os controles foram 210 pessoas da mesma idade consumidores de alguma droga lícita (tabaco ou álcool) que não hão tido transição. Se aplicou uma cédula de dados e sete instrumentos que mediram as variáveis de transição e consumo. Resultados. A droga ilegal de maior transição foi a maconha. Se mostrou que as de maiores características de personalidade de neuroticismo, extroversão e apertura à experiência foi mais alta a probabilidade da transição do consumo de drogas; enquanto que a maiores traços de personalidade amabilidade e consciência foi menor foi a probabilidade para a transição. As características do entorno de bairro e a exposição à oportunidade de consumo incrementam a probabilidade da transição do consumo de drogas. O apoio social e a estigma social influenciaram negativamente na transição do consumo de drogas. Conclusão. Os traços de personalidade, as características do bairro, a exposição ao consumo de drogas, o apoio social e a estigma social do consumo de drogas são fatores que intervém na transição do consumo de drogas legais a ilegais.


Assuntos
Humanos , Personalidade , Apoio Social , Drogas Ilícitas , Estudos de Casos e Controles , Características de Residência , Inquéritos e Questionários , Fatores de Risco , Adulto Jovem , Usuários de Drogas , Estigma Social
9.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1272-1277, out.-dez. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022701

RESUMO

Objective: The study's purpose has been to know the viewpoint of women crack users in regards to their motherhood experience. Methods: This qualitative study was carried out with five women who used crack during pregnancy. Data was collected from May to August 2014, through the participant observation, production of field diary and semi-structured interviews. The analysis process followed the Clifford Geertz Interpretivism. Results: The crack use is not a fundamental factor in the maternity process of women who do use it. Some factors may influence the relationship between mother and child, and also the women's experience during this process, such as the desire to be a mother, pregnancy planning and family context. Conclusion: It is imperative to think of intersectoral public health policies aiming to support the crack users in an integral manner, then reducing social inequality and proposing an approach that highlights the user possibilities, as well as the individual specificity and singularity


Objetivo: Conhecer a visão da mulher usuária de crack em relação a experiência da maternidade. Método: estudo qualitativo, com cinco mulheres que utilizaram crack na gestação. Dados coletados entre maio e agosto de 2014, através da observação participante, construção de diário de campo e entrevistas semiestruturadas. A análise seguiu o Interpretativismo, de Clifford Geertz. Resultados: o uso de crack não é fator fundamental no processo de maternidade das mulheres usuárias, alguns fatores podem influenciar na relação entre mãe e filho e na experiência da mulher neste processo, como o desejo de ser mãe, planejamento da gravidez e contexto familiar. Conclusão: deve-se pensar em políticas públicas de saúde intersetoriais, visando atender as usuárias de forma integral, diminuindo a desigualdade social e propondo uma abordagem que destaque as possibilidades, especificidade e singularidade do indivíduo


Objetivo: Conocer la visión de la mujer usuaria de crack en relación a la experiencia de maternidad. Método: estudio cualitativo, con cinco mujeres que utilizaron crack en la gestación. Los datos fueron recolectados entre mayo y agosto de 2014, a través de observación participante, construcción de diario de campo y entrevistas semiestructuradas. El análisis siguió el Interpretativismo de Clifford Geertz. Resultados: uso de crack no es un factor fundamental en el proceso de maternidad de las mujeres usuarias. Algunos factores pueden influenciar en la relación entre madre e hijo y en la experiencia de la mujer en este proceso, como lo deseo de ser madre, planeamiento del embarazo y contexto familiar. Conclusión: se debe pensar en políticas públicas de salud intersectoriales, visando atender a las usuarias de forma integral, reduciendo a la desigualdad social y proponiendo un abordaje que destaque las posibilidades, especificidad y singularidad del individuo


Assuntos
Humanos , Feminino , Gravidez , Exposição Materna , Relações Materno-Fetais/psicologia , Fumar Cocaína/psicologia , Vulnerabilidade Social , Relações Familiares/psicologia , Usuários de Drogas/psicologia
10.
Physiol Rev ; 99(4): 2115-2140, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31507244

RESUMO

Drug consumption is driven by a drug's pharmacological effects, which are experienced as rewarding, and is influenced by genetic, developmental, and psychosocial factors that mediate drug accessibility, norms, and social support systems or lack thereof. The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction. In parallel, changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. Counterintuitively, in the addicted person, the actual drug consumption is associated with an attenuated dopamine increase in brain reward regions, which might contribute to drug-taking behavior to compensate for the difference between the magnitude of the expected reward triggered by the conditioning to drug cues and the actual experience of it. Combined, these effects result in an enhanced motivation to "seek the drug" (energized by dopamine increases triggered by drug cues) and an impaired prefrontal top-down self-regulation that favors compulsive drug-taking against the backdrop of negative emotionality and an enhanced interoceptive awareness of "drug hunger." Treatment interventions intended to reverse these neuroadaptations show promise as therapeutic approaches for addiction.


Assuntos
Comportamento Aditivo , Encéfalo/fisiopatologia , Usuários de Drogas/psicologia , Recompensa , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Animais , Encéfalo/metabolismo , Neurônios Dopaminérgicos/metabolismo , Humanos , Vias Neurais/metabolismo , Vias Neurais/fisiopatologia , Plasticidade Neuronal , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Transtornos Relacionados ao Uso de Substâncias/reabilitação
11.
BMC Infect Dis ; 19(1): 774, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488064

RESUMO

BACKGROUND: HCV (Hepatitis C virus) is a prevalent chronic disease with potentially deadly consequences, especially for drug users. However, there are no special HCV or HIV (human immunodeficiency virus)-related intervention programs that are tailored for drug users in China; to fill this gap, the purpose of this study was to explore HCV and HIV-related knowledge among drug users in MMT (methadone maintenance treatment) sites of China and to investigate the effectiveness of HCV and HIV-related education for improving the knowledge of IDUs (injection drug users) and their awareness of infection. METHODS: The study was a randomized cluster controlled trial that compared a usual care group to a usual care plus HCV/HIV-REP (HCV/HIV-Reduction Education Program) group with a 24-week follow-up. The self-designed questionnaires, the HCV- and HIV-related knowledge questionnaire and the HIV/HCV infection awareness questionnaire, were used to collect the data. Four MMT clinics were selected for this project; two MMT clinics were randomly assigned to the research group, with subjects receiving their usual care plus HCV/HIV-REP, and the remaining two MMT clinics were the control group, with subjects receiving their usual care over 12 weeks. Sixty patients were recruited from each MMT clinic. A total of 240 patients were recruited. Follow-up studies were conducted at the end of the 12th week and the 24th week after the intervention. RESULTS: At baseline, the mean score (out of 20 possible correct answers) for HCV knowledge among the patients in the group receiving the intervention was 6.51 (SD = 3.5), and it was 20.57 (SD = 6.54) for HIV knowledge (out of 45 correct answers) and 8.35 (SD = 2.8) for HIV/HCV infection awareness (out of 20 correct answers). At the 12-week and 24-week follow-up assessments, the research group showed a greater increase in HCV-/HIV-related knowledge (group × time effect, F = 37.444/11.281, P < 0.05) but no difference in their HIV/HCV infection awareness (group × time effect, F = 2.056, P > 0.05). CONCLUSION: An MMT-based HCV/HIV intervention program could be used to improve patient knowledge of HCV and HIV prevention, but more effort should be devoted to HIV/HCV infection awareness. TRIAL REGISTRATION: Protocols for this study were approved by institution review board (IRB) of Shanghai Mental Health Center (IRB:2009036), and registered in U.S national institutes of health (http://www.clinicaltrials.gov, NCT01647191 ). Registered 23 July 2012.


Assuntos
Usuários de Drogas/educação , Infecções por HIV/prevenção & controle , Hepatite C/prevenção & controle , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Educação de Pacientes como Assunto , Adulto , Conscientização , China/epidemiologia , Análise por Conglomerados , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Eficiência Organizacional , Feminino , HIV/fisiologia , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Hepacivirus/fisiologia , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/normas , Prevalência , Inquéritos e Questionários , Resultado do Tratamento
12.
BMC Public Health ; 19(1): 1210, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477063

RESUMO

BACKGROUND: There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria. METHODS: This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis. RESULTS: The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05-0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02-0.21; p < 0.001) were significantly less likely than FSW to have used condom in the last 30 days. A lower proportion of FSW and PWID used condom during anal sex in the last 12 months when compared with MSM (p < 0.001 respectively). The proportion of MSM (23.5%) and FSW (23.4%) who had ever used psychoactive drugs was high. Of those who had ever used psychoactive drugs, 25.0% of FSW and 29.4% of MSM had injected drugs in the last 30 days of the survey. Also, 39.3% of PWID shared needles and syringes. The use of psychoactive substances (AOR: 5.01; 95%CI: 2.59-9.68; p < 0.001) and the ability to negotiate condom use (AOR: 2.04; 95%CI: 1.06-3.93; p = 0.03) were factors associated with condom use in the last 30 days of the survey. CONCLUSION: HIV prevention programs designed for MSM, FSW and PWID need to address inconsistent condom use during sex by addressing condom negotation skills. This sexual risk behavior is common to the three groups.


Assuntos
Usuários de Drogas/psicologia , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Assunção de Riscos , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia , Adolescente , Adulto , Estudos Transversais , Usuários de Drogas/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Nigéria/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
13.
BMC Infect Dis ; 19(1): 702, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395032

RESUMO

BACKGROUND: Hepatitis C infection is a major public health concern globally. In Ireland, like other European countries, people who use drugs (PWUD) and prisoners carry a larger HCV disease burden than the general population. Recent advances in HCV management have made HCV elimination across Europe a realistic goal. Engaging these two marginalised and underserved populations remains a challenge. The aim of this review was to map key findings and identify gaps in the literature (published and unpublished) on HCV infection in Irish PWUD and prisoners. METHODS: A scoping review guided by the methodological framework set out by Levac and colleagues (based on previous work by Arksey & O'Malley). RESULTS: A total of 58 studies were identified and divided into the following categories; Epidemiology, Guidelines and Policy, Treatment Outcomes, HCV-related Health Issues and qualitative research reporting on Patients' and Health Providers' Experiences. This review identified significantly higher rates of HCV infection among Irish prisoners and PWUD than the general population. There are high levels of undiagnosed and untreated HCV infection in both groups. There is poor engagement by Irish PWUD with HCV services and barriers have been identified. Prison hepatology nurse services have a positive impact on treatment uptake and outcomes. Identified gaps in the literature include; lack of accurate epidemiological data on incident infection, untreated chronic HCV infection particularly in PWUD living outside Dublin and those not engaged with OST. CONCLUSION: Ireland like other European countries has high levels of undiagnosed and untreated HCV infection. Collecting, synthesising and identifying gaps in the available literature is timely and will inform national HCV screening, treatment and prevention strategies.


Assuntos
Usuários de Drogas/estatística & dados numéricos , Hepatite C/epidemiologia , Prisioneiros/estatística & dados numéricos , Humanos , Irlanda/epidemiologia , Prisões/estatística & dados numéricos
14.
Clin J Am Soc Nephrol ; 14(9): 1355-1362, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31416888

RESUMO

BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with AKI. Their association with nephrotic syndrome has not been systematically studied. This study aimed to assess the risk of nephrotic syndrome associated with NSAID use. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A matched case-control study was performed in the UK primary care database. Cases were patients with a first diagnosis of nephrotic syndrome and controls were those without nephrotic syndrome. NSAID exposure (grouped either based on cyclooxygenase enzyme selectivity and chemical groups) was classified as either current (use at the nephrotic syndrome diagnosis date and corresponding date in the control group), recent, or past use. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using unconditional logistic regression analysis. RESULTS: We included 2620 cases and 10,454 controls. Compared with non-use, current use of 15-28 days and >28 days of conventional NSAIDs was associated with a higher relative risk of nephrotic syndrome: adjusted OR, 1.34; 95% CI, 1.06 to 1.70, and OR, 1.42; 95% CI, 0.79 to 2.55, respectively. Also, recent use (discontinuation 1-2 months before nephrotic syndrome diagnosis date; OR, 1.55; 95% CI, 1.11 to 2.15) and past use (discontinuation 2 months-2 years; OR, 1.24; 95% CI, 1.07 to 1.43), but not current use of <15 days (OR, 0.78; 95% CI, 0.46 to 1.31) nor past use (discontinuation >2 years; OR, 0.96; 95% CI, 0.85 to 1.09) were associated with a higher relative risk of nephrotic syndrome as well as past use of selective COX-2 inhibitors (discontinuation 2-24 months; OR, 1.24; 95% CI, 0.98 to 1.58). Categorization based on chemical groups showed that acetic acid and propionic acid derivatives were associated with a higher risk of nephrotic syndrome. CONCLUSIONS: The use of conventional NSAIDs was associated with a higher risk of nephrotic syndrome starting from at least 2 weeks of exposure, as well as for recent and past exposure up to 2 years before the diagnosis of nephrotic syndrome. This higher risk appeared mainly attributable to acetic acid and propionic acid derivatives.


Assuntos
Usuários de Drogas , Síndrome Nefrótica , Anti-Inflamatórios não Esteroides , Estudos de Casos e Controles , Inibidores de Ciclo-Oxigenase 2 , Humanos
15.
S Afr Med J ; 109(8): 592-596, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31456555

RESUMO

BACKGROUND: Little is known about the current clinical profile and outcomes of patients with infective endocarditis (IE) in South Africa (SA). OBJECTIVES: To provide a contemporary and descriptive overview of IE in a representative SA tertiary centre. METHODS: We conducted a retrospective review of the records of patients admitted to Groote Schuur Hospital, Cape Town, between 2009 and 2016 fulfilling universal criteria for definite or possible IE, in search of demographic, clinical, microbiological, echocardiographic, treatment and outcome information. RESULTS: A total of 105 patients fulfilled the modified Duke criteria for IE. The median age of the cohort was 39 years (interquartile range (IQR) 29 - 51), with a male preponderance (61.9%). The majority of the patients (72.4%) had left-sided native valve endocarditis, 14.3% had right-sided disease, and 13.3% had prosthetic valve endocarditis. A third of the cohort had rheumatic heart disease. Although 41.1% of patients with left-sided disease had negative blood cultures, the three most common organisms cultured in this subgroup were Staphylococcus aureus (18.9%), Streptococcus spp. (16.7%) and Enterococcus spp. (6.7%). Participants with right-sided endocarditis were younger (29 years, IQR 27 - 37) and were mainly intravenous drug users (73.3%), and the majority cultured positive for S. aureus (73.3%) with frequent septic pulmonary complications (40.0%). The overall in-hospital mortality was 16.2%, with no deaths in the group with right-sided endocarditis. Predictors of death in our patients were heart failure (odds ratio (OR) 8.16, 95% confidence interval (CI) 1.77 - 37.70; p=0.007) and age >45 years (OR 4.73, 95% CI 1.11 - 20.14; p=0.036). Valve surgery was associated with a reduction in mortality (OR 0.09, 95% CI 0.02 - 0.43; p=0.001). CONCLUSIONS: IE remains an important clinical problem in a typical teaching tertiary care centre in SA. In this setting, it continues to affect mainly young people with post-inflammatory valve disease and congenital heart disease. The in-hospital mortality associated with IE remains high. Intravenous drug-associated endocarditis caused by S. aureus is an important IE subset, comprising ~10% of all cases, which was not reported 15 years ago, and culture-negative endocarditis remains highly prevalent. Heart failure in IE carries a significant risk of death and needs a more intensive level of care in hospital. Finally, cardiac surgery was associated with reduced mortality, with the largest impact in patients with heart failure.


Assuntos
Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Adulto , Fatores Etários , Usuários de Drogas , Endocardite Bacteriana/terapia , Feminino , Insuficiência Cardíaca/mortalidade , Doenças das Valvas Cardíacas/epidemiologia , Próteses Valvulares Cardíacas/efeitos adversos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Estudos Retrospectivos , Cardiopatia Reumática/epidemiologia , África do Sul/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia
16.
Rev Saude Publica ; 53: 54, 2019 Aug 15.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432911

RESUMO

Guidelines emphasize the importance of approaching substance use by adolescents, particularly in primary health care. However, there are problems with its incorporation. The objective of this study was to present the training stages on the theme for professionals in primary health care. Researchers conducted logistic structuring, content elaboration and evaluation of difficulties before and after training. Sixty percent of professionals involved in the care of adolescents in a medium-sized city participated in the study. More than half of them stated having difficulties in the approach, mainly theoretical limitations and short consultations. After the training, the professionals informed whether they felt more prepared, but practical difficulties remained.


Assuntos
Educação Continuada , Atenção Primária à Saúde/organização & administração , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente , Adulto , Brasil , Usuários de Drogas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Prevenção Primária/métodos
17.
Artigo em Inglês | MEDLINE | ID: mdl-31443148

RESUMO

The prevalence of illicit drug misuse, including cannabis, in Croatian touristic regions is alarming. This study aimed to identify the prevalence of cannabis consumption (CC), to identify associations between sociodemographic and sport factors and CC, and to evaluate the predictors of CC initiation in adolescents residing in touristic regions. This study enrolled 644 adolescents from two touristic regions in Croatia (Split-Dalmatia and Dubrovnik-Neretva County) who were tested at baseline (16 years of age) and follow-up (18 years of age). The study instrument consisted of questions focused on predictors (age, gender (male, female), place of residence (urban or rural environment), familial social status, and different sport-related factors) and CC outcome. The results indicated a high prevalence of cannabis consumption (>30% of adolescents consumed cannabis), with a higher prevalence in males, and adolescents from rural communities. The prevalence of CC increased by 10% during the study period, with no significant differences between genders in trajectories of changes. Quitting sports was a risk factor for CC at baseline and follow-up. Better sport competitive results (odds ratio (OR): 0.80, 95% confidence interval (CI): 0.65-0.96) and familial social status (socioeconomic status: OR: 0.66, 95% CI: 0.39-0.91; maternal education: OR: 0.65, 95% CI: 0.48-0.88) were associated with lower likelihood of CC at baseline. The adolescents who reported better sport competitive results were at increased risk for initiation of CC during the course of the study (OR: 1.40, 95% CI: 1.03-2.01). The protective effects of sports at baseline were most likely related to various factors that prevent the consumption of substances in youth athletes (i.e., commitment to results, adult supervision); with the end of active participation, adolescent athletes are at high risk for CC initiation.


Assuntos
Comportamento do Adolescente/efeitos dos fármacos , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Abuso de Maconha/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Croácia/epidemiologia , Feminino , Humanos , Masculino , Razão de Chances , Prevalência , Estudos Prospectivos , Fatores de Risco , Classe Social
18.
Forensic Sci Int ; 303: 109924, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31450173

RESUMO

BACKGROUND: The opioid overdose crisis is especially pronounced in Maine. The Diversion Alert Program (DAP) was developed to combat illicit drug use and prescription drug diversion by facilitating communication between law enforcement and health care providers with the goal of limiting drug-related harms and criminal behaviors. Our objectives in this report were to analyze 2014-2017 DAP for: (1) trends in drug arrests and, (2) differences in arrests by offense, demographics (sex and age) and by region. METHODS: Drug arrests (N=8193, 31.3% female, age=33.1±9.9) reported to the DAP were examined by year, demographics, and location. RESULTS: The most common substances of the 10,064 unique charges reported were heroin (N=2203, 21.9%), crack/cocaine (N=945, 16.8%), buprenorphine (N=812, 8.1%), and oxycodone (N=747, 7.4%). While the overall number of arrests reported to the DAP declined in 2017, the proportion of arrests involving opioids (heroin, buprenorphine, or fentanyl) and stimulants (cocaine/crack cocaine, or methamphetamine), increased (p<.05). Women had significantly increased involvement in arrests involving sedatives and miscellaneous pharmaceuticals (e.g. gabapentin) while men had an elevation in stimulant arrests. Heroin accounted for a lower percentage of arrests among individuals age >60 (6.6%) relative to young-adults (18-29, 22.3%, p<.0001). Older-adults had significantly more arrests than younger-adults for oxycodone, hydrocodone, and marijuana. CONCLUSION: Heroin had the most arrests from 2014 to 2017. Buprenorphine, fentanyl and crack/cocaine arrests increased appreciably suggesting that improved treatment is needed to prevent further nonmedical use and overdoses. The Diversion Alert Program provided a unique data source for research, a harm-reduction tool for health care providers, and an informational resource for law enforcement.


Assuntos
Usuários de Drogas/legislação & jurisprudência , Saúde Pública , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Buprenorfina , Cocaína , Feminino , Fentanila , Redução do Dano , Heroína , Humanos , Hidrocodona , Hipnóticos e Sedativos , Maine/epidemiologia , Masculino , Pessoa de Meia-Idade , Oxicodona , Distribuição por Sexo , Adulto Jovem
19.
BMC Public Health ; 19(1): 1024, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366349

RESUMO

BACKGROUND: Since there is a paucity of research on support for people using Anabolic Androgenic Steroids (AAS), we aimed to identify and synthesise the available evidence in this field. Gaining an understanding of the support both accessed and wanted by recreational AAS users will be of use to professionals who provide services to intravenous substance users and also to those working in the fields of public health and social care, with the aim to increase engagement of those using AAS. METHODS: A systematic scoping review of the literature to explore and identify the nature and scope of information and support both accessed and wanted by non-prescribed AAS users. Any support services or information designed to help people who use AAS were considered. RESULTS: We identified 23 papers and one report for review, which indicated that AAS users access a range of sources of information on: how to inject, substance effectiveness, dosages and side effects, suggesting this is the type of information users want. AAS users sought support from a range of sources including medical professionals, needle and syringe programmes, friends, dealers, and via the internet, suggesting that, different sources were used dependent on the information or support sought. DISCUSSION: AAS users tended to prefer peer advice and support over that of professionals, and access information online via specialist forums, reflecting the stigma that is experienced by AAS users. These tendencies can act as barriers to accessing services provided by professionals. CONCLUSIONS: Support needs to be specific and targeted towards AAS users. Sensitivity to their perceptions of their drug-use and the associated stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement.


Assuntos
Anabolizantes/administração & dosagem , Usuários de Drogas/psicologia , Relações Profissional-Paciente , Congêneres da Testosterona/administração & dosagem , Humanos
20.
Rev Soc Bras Med Trop ; 52: e20190143, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340375

RESUMO

INTRODUCTION: The present study aimed to estimate the prevalence of Hepatitis C virus (HCV) infection in a prison population. METHODS: A total of 147 individuals were interviewed and subjected to venipuncture for collection of blood sample. The study population consisted of male individuals who attended the health unit of the state penitentiary of Florianópolis. RESULTS: The prevalence of HCV infection was 5.4%. Regarding behavioral variables, 95 (64.6%, p<0.0507) subjects reported consuming alcohol and 7 (4.8%, p<0.0476) reported having already used injectable drugs. CONCLUSIONS: The prevalence of HCV infection in the studied population was higher than that in the general populations.


Assuntos
Hepatite C/epidemiologia , Prisioneiros , Adolescente , Adulto , Consumo de Bebidas Alcoólicas , Brasil , Usuários de Drogas/estatística & dados numéricos , Hepacivirus/isolamento & purificação , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Pesquisa Qualitativa , Adulto Jovem
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