La repercusión de la COVID-19 en los servicios para los trastornos mentales, neurológicos y por consumo de sustancias psicoactivas en la Región de las Américas: resultados de una evaluación rápida, noviembre del 2020 / The impact of COVID-19 on mental, neurological and substance use services in the Americas: results of a rapid assessment, November 2020

Los eventos que causan un grado de estrés importante, como la pandemia de COVID-19, constituyen un factor de riesgo para la aparición, agudización o recaída de toda una gama de trastornos mentales, neurológicos y por consumo de sustancias psicoactivas, en especial en los grupos de población más vulnerables. En los estudios de ámbito nacional en la Región de las Américas se describe un aumento del desasosiego, la depresión, la ansiedad y el insomnio, entre otros, como resultado de la pandemia de COVID-19. Además, los casos de COVID-19 dan lugar a varias complicaciones neurológicas y mentales.Los eventos que causan un grado de estrés importante, como la pandemia de COVID-19, constituyen un factor de riesgo para la aparición, agudización o recaída de toda una gama de trastornos mentales, neurológicos y por consumo de sustancias psicoactivas, en especial en los grupos de población más vulnerables. En los estudios de ámbito nacional en la Región de las Américas se describe un aumento del desasosiego, la depresión, la ansiedad y el insomnio, entre otros, como resultado de la pandemia de COVID-19. Además, los casos de COVID-19 dan lugar a varias complicaciones neurológicas y mentales. Para comprender la repercusión de la pandemia en los servicios para los trastornos mentales, neurológicos y por consumo de sustancias psicoactivas, la OMS elaboró una encuesta, que fue realizada por la OMS y la OPS y se envió a los puntos focales de salud mental designados para ello en los ministerios de salud de todos los Estados Miembros de la OMS. Este informe utiliza los datos presentados por los Estados Miembros de la OPS en respuesta a la encuesta para presentar un panorama general de la repercusión de la COVID-19 en tales servicios en la Región de las Américas. Esta información será útil para fundamentar la planificación y las respuestas destinadas a atenuar los efectos de la pandemia por los países de la Región.

Major stressors such as the COVID-19 pandemic represent risk factors for the development, exacerbation and relapse of a range of mental, neurological and substance use (MNS) disorders, particularly in the most vulnerable groups. National studies from the Region of the Americas, demonstrate increases in distress, depression, anxiety, and insomnia, among other conditions, as a result of the COVID-19 pandemic. Furthermore, COVID-19 itself is associated with neurological and mental complications. This report is based on the results of a survey, developed by the World Health Organization (WHO) and implemented by the WHO and the Pan American Health Organization (PAHO), which was sent to designated mental health focal points in ministries of health of all WHO Member States. It uses data submitted by PAHO Member States in response to the survey to provide an overview of the impact of COVID-19 on MNS services in the Region of the Americas. This information will help to inform planning and response to mitigate the effects by countries in the Region.

Calidad de vida y variables psicológicas que afectan la adherencia al tratamiento anti-retroviral en pacientes mexicanos con infección por VIH/SIDA / Quality of life and psychological variables affecting adherence to antiretroviral treatment in Mexican patients with HIV/AIDS

Resumen Introducción: El tratamiento anti-retroviral (TAR) es indispensable en pacientes con infección por VIH/ SIDA; suprimir la carga viral requiere de un estricto apego a éste, por compromiso del paciente. El fracaso del TAR es primordialmente por falta de adherencia, que puede ser debida a una deficiente calidad de vida y/o a variables psicológicas. Objetivo: Determinar la calidad de vida, variables psicológicas y la adherencia al TAR, en pacientes con infección por VIH/SIDA. Material y Método: Se incluyeron 160 pacientes con diagnóstico de infección por VIH/SIDA y con TAR. Se recabaron los instrumentos MOS SF-36 y VPAD-24, una encuesta demográfica, y datos clínicos. Se hicieron asociaciones cuantitativas y cualitativas entre las variables. Resultados: La adherencia al TAR estuvo asociada con evitar comportamiento depresivo y con ausencia de adicciones. El comportamiento depresivo se encontró asociado con las adicciones. Un 87% de pacientes estaba en el rango de mejor calidad de vida. Por debajo del promedio del puntaje de salud general estuvieron masculinos, con orientación sexual HSH, solteros, en la vitalidad a los ≥ 38 años, en dolor corporal y función social a tres esquemas TAR. Conclusión: La buena adherencia al TAR estuvo asociada a evitar comportamiento depresivo y a la ausencia de adicciones y no se asoció a la calidad de vida.

Background: Antiretroviral treatment (ART) is essential in HIV/AIDS patients. Suppressing viral load requires strict adherence to ART in addition to the patient's commitment to treatment. The failure of ART is mainly due to lack of adherence, which may in turn be due to poor quality of life and/or to psychological variables. Aim: To determine the quality of life and psychological variables and adherence to ART, in patients with HIV/AIDS. Material and Method: 160 patients diagnosed with HIV/AIDS and with ART were included. The MOS SF-36 and VPAD-24 instruments, a socio-demographic survey, and clinical data were collected. Quantitative and qualitative associations were made between the variables. Results: The adherence to ART was associated with avoidance of depressive behavior and with the absence of addictions. Depressive behavior associated with addictions. 87% of patients ranked in the best quality of life. Below the average of the general health score were males, with MSM sexual orientation, single, in vitality at ≥ 38 years, in corporal pain and with social function to three ART schemes. Conclusion: Good adherence to ART was associated with avoiding depressive behavior and with non-addictions and not associated with quality of life.

Syphilis in female sex workers: an epidemiological study of the highway system of the state of Pará, northern Brazil

Abstract INTRODUCTION: Female sex workers (FSWs) are considered a bridge for transmission of pathogens from high-risk to general populations. We assessed the epidemiological status of syphilis in FSWs along the Pará highway system. METHODS: Two hundred and twenty-two FSWs were interviewed and samples were analyzed using rapid qualitative tests and real-time polymerase chain reaction. RESULTS: The prevalence of syphilis was high (36.94%). The high rate of prostitution, use of illicit drugs, and search for financial resources increased Treponema pallidum transmission through unprotected sex. CONCLUSIONS: Several characteristics of FSWs were identified, which reinforce the need for measures guaranteeing their health and protection.

Elevated prevalence of high-risk HPV in healthy oral mucosa of users and nonusers of drugs in Northeastern Brazil

Abstract: Variable rates of HPV infection have been reported in healthy oral mucosa worldwide. The main objective of this study was to detect and genotype HPV infection in users and nonusers of drugs with clinically healthy mucosa from the Northeast Brazil. Samples from 105 patients were amplified using the primers MY09/MY11 and GP5+/GP6+, and genotyping was performed by multiplex-PCR for HPV-6/11, 16 and 18. A total of 81.9% samples were positive. Among drug users, 84.5% presented the virus and 20.4% showed multiple infections. Among non-drug users, 78.7% were positive and 13.5% had multiple infections. Limited information is available on oral HPV in Brazilian population, especially for drug users, and our results showed higher HPV infection rates in both users and nonusers of drugs. More studies and researches focused on drug users including factors like sexual behavior, nutrition and cultural habits are necessary to enhance the comprehension of this relationship, and develop preventive strategies.

Mioclonías inducidas por salbutamol / Myoclonus induced by salbutamol: A case report

Resumen El salbutamol es un agonista adrenérgico β2 ampliamente empleado en pacientes con enfermedades pulmonares obstructivas y restrictivas. Sus principales efectos secundarios son la taquicardia y el temblor. Las mioclonías son contracciones musculares involuntarias, irregulares, bruscas, breves y repentinas, y pueden ser generalizadas, focales o multifocales. Se presenta el caso de un paciente de 61 años con mioclonías de difícil manejo que solo presentó mejoría tras la suspensión definitiva del agonista adrenérgico β2. Se describen los hallazgos clínicos, las intervenciones y el resultado en las mioclonías asociadas con el uso de salbutamol y se discuten la posible génesis y la importancia de este efecto adverso. Para documentar el caso, se siguieron las recomendaciones de las guías para el reporte de casos (CAse REport, CARE). Aunque en diversos estudios se han descrito mioclonías secundarias al uso de diferentes fármacos, hasta donde se sabe, este sería el cuarto reporte de un caso asociado específicamente con el uso del salbutamol.

Abstract Salbutamol is a β2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the β2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.

Bio-behavioral survey of syphilis in homeless men in Central Brazil: a cross-sectional study / Um inquérito bio-comportamental sobre sífilis em homens sem-teto no Centro-oeste do Brasil: um estudo transversal / Cuestionario bioconductual sobre la sífilis en hombres sin techo en el Centro-oeste de Brasil: un estudio transversal

The objective of this study was to investigate the prevalence and factors associated with syphilis in homeless men in Central Brazil. It is a cross-sectional study conducted with 481 individuals attending four therapeutic communities between October and December 2015. A structured interview was conducted to collect sociodemographic data and risk factors for syphilis. Rapid/point-of-care and VDRL tests were performed to determine exposure to syphilis and the presence of active syphilis, respectively. Poisson regression analysis was used to verify the risk factors associated with the outcomes investigated. Of the study participants, 10.2% were reactive to the rapid test, and 5.4% had active syphilis. At the multiple regression analysis, schooling (adjusted prevalence ratio - APR: 0.89; p = 0.005), history of genital ulcer (APR: 2.59; p = 0.002), STI history (APR: 1.97; p = 0.042), and sexual intercourse under drug effects (APR: 1.60; p = 0.022) were independent factors associated with lifetime syphilis. Also, history of genital ulcer (APR: 2.19; p = 0.019), STI history (APR: 1.74; p = 0.033) and number of sexual partners in the last year (APR: 1.02; p = 0.044) were associated with active syphilis. The prevalence of syphilis among homeless men was rather high, confirming the vulnerability of this group to this infection. These results emphasize the need for educational intervention, improvement of risk reduction programs, availability of diagnostic tests, especially the rapid test, and treatment.

O estudo teve como objetivo investigar a prevalência da sífilis e fatores associados em homens sem-teto no Centro-oeste do Brasil. A amostra nesse estudo transversal incluiu 481 indivíduos que frequentavam comunidades terapêuticas entre outubro e dezembro de 2015. Uma entrevista estruturada foi usada para coletar dados sociodemográficos e fatores de risco para sífilis. Foram realizados testes rápidos e VDRL para determinar a exposição à sífilis e a presença de sífilis ativa, respectivamente. A análise de regressão de Poisson foi usada para verificar os fatores de risco associados aos desfechos investigados. Entre os participantes, 10,2% foram reativos ao teste rápido e 5,4% tinham sífilis ativa. Na análise de regressão múltipla, a escolaridade (razão de prevalência ajustada - RPA: 0,89; p = 0,005), história de úlcera genital (RPA: 2,59; p = 0,002), história de DST (RPA: 1,97; p = 0,042) e relações sexuais sob o efeito de drogas (RPA: 1,60; p = 0,022) apareceram como fatores independentes associados à história pregressa de sífilis. Além disso, a história de úlcera genital (RPA: 2,19; p = 0,019), história de DST (RPA: 1,74; p = 0,033) e número de parceiros sexuais no último ano (RPA: 1,02; p = 0,044) estiveram associados à sífilis ativa. A prevalência de sífilis em homens sem-teto era bastante elevada, confirmando a vulnerabilidade desse grupo à infecção. Os achados enfatizam a necessidade de intervenções educacionais, melhoria dos programas de redução de risco, disponibilidade de testes diagnósticos (sobretudo o teste rápido) e tratamento adequado.

El objetivo de este estudio fue investigar la prevalencia y los factores asociados con la sífilis en hombres sin techo en el Centro-oeste de Brasil. Se trata de un estudio transversal, llevado a cabo con 481 personas que asistían a cuatro comunidades terapéuticas entre octubre y diciembre de 2015. La entrevista estructurada se realizó con el fin de recabar datos sociodemográficos y factores de riesgo para la sífilis. Se realizaron pruebas de diagnóstico rápido y serológicas para la sífilis (VDRL por sus siglas en inglés) para determinar la exposición a la sífilis y la presencia de sífilis activa, respectivamente. Se usó el análisis por regresión de Poisson para verificar los factores de riesgo asociados con los resultados investigados. Entre los participantes en el estudio, un 10,2% fueron reactivos a las pruebas de diagnóstico rápido, y un 5,4% tenían sífilis activa. En el análisis de regresión múltiple, la escolarización (la razón de prevalencia ajustada - APR: 0,89; p = 0,005), un historial de úlcera genital (APR: 2,59; p = 0,002), un historial de ETS (APR: 1,97; p = 0,042), e intercambios sexuales bajo los efectos de las drogas (APR: 1,60; p = 0,022) fueron factores independientes asociados con la sífilis a lo largo de la vida. Asimismo, un historial de úlcera genital (APR: 2,19; p = 0,019), un historial de ETS (APR: 1,74; p = 0,033) y el número de parejas de índole sexual en el último año (APR: 1,02; p = 0,044) estuvieron asociados con sífilis activa. La prevalencia de sífilis entre los hombres sin techo fue bastante alta, confirmando la vulnerabilidad de este grupo a la infección. Estos resultados enfatizan la necesidad de intervenciones educativas, así como una mejora en los programas de reducción del riesgo, disponibilidad de pruebas de diagnóstico, especialmente pruebas rápidas, y tratamiento.

Prevalencia del virus de la inmunodeficiencia humana, virus de la hepatitis B y Treponema pallidum en reclusos del Centro de Detención Preventiva de Arica, Chile / Prevalence of HIV, hepatitis B virus and Treponema pallidum in inmates in the Preventive Detention Center of Arica, Chile

Resumen Introducción: Los grupos de riesgo para las infecciones de transmisión sexual (ITS) son trabajadores sexuales, drogadictos, la población joven de inicio sexual precoz, así como la población penal. Objetivo: Determinar la prevalencia de infección por virus de inmunodeficiencia humana (VIH), Treponema pallidum y virus de hepatitis B (VHB) en reclusos (hombres) del Centro de Detención Preventiva (CDP) de Arica. Material y Métodos: El estudio se efectuó en 140 reclusos, con consentimiento informado. Se realizó encuesta epidemiológica y toma de muestra sanguínea. Los exámenes positivos se enviaron al Hospital Regional de Arica para confirmación y posteriormente al Instituto de Salud Pública. Resultados: La prevalencia de ITS fue de 13,6%. La mayor frecuencia se observó en VDRL positivos (7,1%), seguido por infección por VIH (5,7%) y VHB (2,9%). Por edad, la mayor frecuencia (57,9%) se presentó en individuos bajo 31 años. El 63,2% se encontraban en situación de hacinamiento, en 42,1% la edad de inicio de la actividad sexual fue antes de los 15 años y 94,7% declaró ser consumidor de drogas. Conclusiones: El estudio reafirma los factores predisponentes a la transmisión de las ITS, como edad, inicio sexual precoz, consumo de drogas y hacinamiento, destacando que las prisiones son ambientes altamente vulnerables, donde la sobrepoblación, condición sexual, inicio sexual precoz, alto consumo de drogas y la carente visita conyugal proporcionan un contexto epidemiológico favorable para el incremento de ITS.

Background: The risk groups for sexual transmitted diseases (STDs) are sex workers, drug addicts, young people in early sexual initiation, and population in prison. Aim: To determine the prevalence of HIV, Treponema pallidum and hepatitis B Virus (HBV) in male inmates at the Preventive Detention Center (CDP) of Arica. Methods: The study was conducted in 140 inmates, with informed consent. Epidemiological survey and blood sampling was conducted. The positive tests were sent to the Hospital Regional of Arica for confirmation and the National Reference Laboratory for confirmation. Results: STD prevalence was 13.6%. The most prevalent was VDRL positive (7.1%) followed by HIV infection (5.7%) and HBV (2.9%). The highest rate (57.9%) occurred in individuals under 31 years old. 63.2% were in an overcrowded situation, 42.1% of cases corresponded to those whose age of sexual activity onset of was before age 15 and 94.7% used drugs. Conclusions: The study reasserts the predisposing factors for the transmission of STDs as age, early sexual debut, drug abuse and overcrowding, noting that prisons are highly vulnerable environments where overcrowding, sexual condition, early sexual initiation, high drug abuse and the lacking spouses visits provide an epidemiological context favorable for increased STD.

Recent illicit drug use among psychiatric patients in Brazil: a national representative study

ABSTRACT OBJECTIVE To estimate factors associated to illicit drug use among patients with mental illness in Brazil according to gender. METHODS A cross-sectional representative sample of psychiatric patients (2,475 individuals) was randomly selected from 11 hospitals and 15 public mental health outpatient clinics. Data on self-reported illicit drug use and sociodemographic, clinical and behavioral characteristics were obtained from face-to-face interviews. Logistic regression was used to estimate associations with recent illicit drug use. RESULTS The prevalence of any recent illicit drug use was 11.4%. Men had higher prevalence than women for all substances (17.5% and 5.6%, respectively). Lower education, history of physical violence, and history of homelessness were associated with drug use among men only; not professing a religion was associated with drug use in women only. For both men and women, younger age, current hospitalization, alcohol and tobacco use, history of incarceration, younger age at sexual debut, and more than one sexual partner were statistically associated with illicit drug use. CONCLUSIONS Recent illicit drug use among psychiatric patients is higher than among the general Brazilian population and it is associated with multiple factors including markers of psychiatric severity. Our data indicate the need for the development of gender-based drug-use interventions among psychiatric patients in Brazil. Integration of substance use treatment strategies with mental health treatment should be a priority.

Robin Williams' suicide: a case study / O suicídio de Robin Williams: estudo de caso

Abstract Introduction: The world renowned comedian and four-time Oscar nominated actor Robin Williams died on August 11, 2014. From the outset, the news indicated that his death was believed to be a suicide and this was later confirmed to be true by the autopsy reports. Williams had been suffering from severe depression, which is believed to be the leading contributor to his suicide. In this case study, I will highlight the event of the actor's suicide and the main risk factors along with depression leading to his tragic death. As of the end of 2015, no other case study seemed to have addressed or explored the links between the cause (or causes) and events leading to Robin Williams' suicide. Case description: Robin Williams was suffering from relationship problems, financial problems, drug addiction, and major depression. All of these factors led to his suicide. Comments: The chances of committing suicide drastically increase in the presence of any of the key risk factors. Unfortunately, the actor Robin Williams was dealing with four of the major risk factors all together, which put him at a high risk of committing suicide and eventually led to his tragic death.

Resumo Introdução: O ator Robin Williams, comediante reconhecido internacionalmente e quatro vezes indicado ao Oscar, faleceu no dia 11 de agosto de 2014. Desde o início, os noticiários indicavam que sua morte provavelmente resultara de suicídio, e isso foi confirmado posteriormente nos relatórios da autópsia. Williams vinha sofrendo de depressão severa, a qual, acredita-se, foi o fator que mais contribuiu para seu suicídio. Neste estudo de caso, vou discorrer sobre o suicídio do ator e sobre os principais fatores de risco, além da depressão, que levaram à sua morte trágica. Do final de 2015 para cá, nenhum outro estudo de caso parece ter abordado ou explorado as associações entre a causa (ou as causas) e os eventos que levaram ao suicídio do ator Robin Williams. Descrição do caso: Robin Williams vinha sofrendo com problemas de relacionamento, problemas financeiros, abuso de drogas e depressão severa. Todos esses fatores levaram ao seu suicídio. Comentários: As chances de cometer suicídio aumentam drasticamente na presença de qualquer fator de risco chaves. Infelizmente, o ator Robin Williams estava exposto a quatro fatores de risco chaves simultaneamente, colocando-o sob um alto risco de cometer suicídio, o que eventualmente culminou com sua trágica morte.

Evaluation of spinal anesthesia blockade time with 0. 5% hyperbaric bupivacaine, with or without sufentanil, in chronic opioid users: a randomized clinical trial / Avaliação do tempo de bloqueio da raquianestesia com bupivacaína a hiperbárica 0, 5%, com ou sem sufentanil, em usuários crônicos de opioides: um estudo clínico randômico

Abstract Objective: The primary outcome of this study was to evaluate the effect of adding sufentanil to hyperbaric bupivacaine on duration of sensory blockade of spinal anesthesia in chronic opioid users in comparison with non-addicts. Methods: Sixty patients scheduled for orthopedic surgery under spinal anesthesia were allocated into four groups: group 1 (no history of opium use who received intrathecal hyperbaric bupivacaine along with 1 mL saline as placebo); group 2 (no history of opium use who received intrathecal bupivacaine along with 1 mL sufentanil [5 µg]); group 3 (positive history of opium use who received intrathecal bupivacaine along with 1 mL saline as placebo) and group 4 (positive history of opium use who received intrathecal bupivacaine along with 1 mL sufentanil [5 µg]). The onset time and duration of sensory and motor blockade were measured. Results: The duration of sensory blockade in group 3 was 120 ± 23.1 min which was significantly less than other groups (G1 = 148 ± 28.7, G2 = 144 ± 26.4, G4 = 139 ± 24.7, p = 0.007). The duration of motor blockade in group 3 was 145 ± 30.0 min which was significantly less than other groups (G1 = 164 ± 36.0, G2 = 174 ± 26.8, G4 = 174 ± 24.9, p = 0.03). Conclusions: Addition of 5 µg intrathecal sufentanil to hyperbaric bupivacaine in chronic opioid users lengthened the sensory and motor duration of blockade to be equivalent to blockade measured in non-addicts.

Resumo Objetivo: Avaliar o efeito da adição de sufentanil à bupivacaína hiperbárica na duração do bloqueio sensorial da raquianestesia em usuários crônicos de opioides em comparação com não adictos. Métodos: Foram distribuídos em quatro grupos 60 pacientes agendados para cirurgia ortopédica sob raquianestesia: Grupo 1 (sem história de uso de ópio, recebeu bupivacaína hiperbárica intratecal juntamente com 1 mL de solução salina como placebo); Grupo 2 (sem história de uso de ópio, recebeu bupivacaína intratecal juntamente com 1 mL de sufentanil [5 µg]); Grupo 3 (com história de uso de ópio, recebeu bupivacaína intratecal juntamente com 1 mL de solução salina como placebo) e Grupo 4 (com história de uso de ópio, recebeu bupivacaína intratecal juntamente com 1 mL de sufentanil [5 µg]). O tempo de início e a duração dos bloqueios sensitivo e motor foram registrados. Resultados: A duração do bloqueio sensorial no Grupo 3 foi de 120 ± 23,1 min, um tempo significativamente menor do que nos outros grupos (G1 = 148 ± 28,7, G2 = 144 ± 26,4, G4 = 139 ± 24,7, p = 0,007). A duração do bloqueio motor no Grupo 3 foi de 145 ± 30,0 min, um tempo significativamente menor do que nos outros grupos (G1 = 164 ± 36.0, G2 = 174 ± 26.8, G4 = 174 ± 24,9; p = 0,03). Conclusões: A adição de 5 µg de sufentanil intratecal à bupivacaína hiperbárica em usuários crônicos de opioides aumenta a duração dos bloqueios sensorial e motor de forma equivalente ao bloqueio avaliado em não adictos.

Factors associated with problematic drug use among psychiatric outpatients / Fatores associados ao consumo problemático de drogas entre pacientes psiquiátricos ambulatoriais / Factores asociados al consumo problemático de drogas entre pacientes siquiátricos en ambulatorios

ABSTRACT Objective: to examine the factors associated with problematic drug use among psychiatric outpatients. Method: a cross-sectional study was carried out in two mental health services. Eligible individuals were patients of these mental health services, who used them within the data collection period. Instruments: standardized questionnaire with sociodemographic, social network, social harm, and clinical information; Alcohol, Smoking and Substance Involvement Screening Test; Barratt Impulsiveness Scale; Holmes and Rahe Stress Scale. Statistical analysis was performed using parametric statistics considering a significance level of p ≤ 0.05. Study participants were 243 patients, with 53.9% of these presenting problematic drug use. Results: the most important independent predictors of problematic drug use were marital status (OR = 0.491), religious practice (OR = 0.449), satisfaction with financial situation (OR = 0.469), having suffered discrimination (OR = 3.821) and practicing sports activities in previous 12 months (OR = 2.25). Conclusion: the variables found to be predictors were those related to the social context of the patient, there, it is recommended that mental health services valorize psychosocial actions, seeking to know the social support network of patients, their modes of socialization, their financial needs, and their experiences of life and suffering.

RESUMO Objetivo: analisar os fatores associados ao consumo problemático de droga entre pacientes psiquiátricos ambulatoriais. Método: estudo transversal em dois serviços de saúde mental. Foram considerados indivíduos elegíveis os usuários desses serviços de saúde mental, que os utilizaram dentro do período de coleta de dados. Instrumentos: Questionário padronizado sobre dados sociodemográficos, redes sociais, prejuízos sociais e informações clínicas; Teste de Triagem do Envolvimento com Álcool, Cigarro e outras Substâncias (ASSIST); Escala de Impulsividade de Barratt; e Escala de Avaliação de Reajustamento Social de Holmes e Rahe. A análise estatística foi realizada utilizando-se estatísticas paramétricas considerando um nível de significância de p ≤ 0,05. Participaram do estudo 243 pacientes, com 53,9% destes apresentando consumo problemático de drogas. Resultados: os preditores independentes mais importantes do consumo problemático de drogas foram o estado civil (OR = 0,491), a prática religiosa (OR = 0,449), a satisfação com a situação financeira (OR = 0,469), ter sofrido discriminação (OR = 3,821) e a prática de atividades esportivas nos últimos 12 meses (OR = 2,25). Conclusão: as variáveis consideradas preditoras foram aquelas relacionadas ao contexto social do paciente, e por isso, recomenda-se que os serviços de saúde mental valorize ações psicossociais, buscando conhecer a rede de suporte social dos pacientes, seus modos de socialização, suas necessidades financeiras e suas experiências de vida e sofrimento.

RESUMEN Objetivo: analizar los factores asociados al consumo problemático de droga entre pacientes siquiátricos en ambulatorios. Método: estudio transversal en dos servicios de salud mental. Fueron considerados individuos elegibles los usuarios de esos servicios de salud mental, que utilizaron drogas dentro del período de recolección de datos. Instrumentos: cuestionario estandarizado sobre datos sociodemográficos, redes sociales, perjuicios sociales e informaciones clínicas; Test de Detección del Involucramiento con Alcohol, Cigarro y otras Sustancias (ASSIST); Escala de Impulsividad de Barratt; y Escala de Evaluación de Readecuación Social de Holmes y Rahe. El análisis estadístico fue realizada utilizando estadísticas paramétricas considerando un nivel de significación de p ≤ 0,05. Participaron del estudio 243 pacientes, con 53,9% de estos presentando consumo problemático de drogas. Resultados: los predictores independientes más importantes del consumo problemático de drogas fueron: el estado civil (OR = 0,491), la práctica religiosa (OR = 0,449), la satisfacción con la situación financiera (OR = 0,469), el haber sufrido discriminación (OR = 3,821) y la práctica de actividades deportivas en los últimos 12 meses (OR = 2,25). Conclusión: las variables consideradas predictoras fueron aquellas relacionadas al contexto social del paciente, y por eso, se recomienda que los servicios de salud mental valoricen acciones psicosociales, buscando conocer la red de soporte social de los pacientes, sus modos de socialización, sus necesidades financieras y sus experiencias de vida y sufrimiento.

Efectos de las adicciones en la práctica odontológica: un problema de salud pública / Effects of addictions in dental practice: a public health concern

En la actualidad el consumo de sustancias psicoactivas se vincula al aumento delos accidentes de tránsito y a las situaciones de violencia (robos, asaltos, suicidios, homicidios) y está presente en las causas más frecuentemente de muerte en el grupo de 15-24 años de edad. Los trastornos biológicos, psicológicos y sociales involucrados en el consumo y sus efectos en la salud de la población, nos motivan como profesionales de la salud a comprender y profundizar en esta problemática y aportar las bases suficientes en los programas de prevención y promoción de la salud.

Female sexual dysfunction in patients with sub-stance-related disorders

OBJECTIVE: To estimate the prevalence of female sexual dysfunction symptoms and the associated risk factors in a sample of patients with substance-related disorders admitted to a specialized in-patient care unit. METHODS: This study used a cross-section design, with eight months of data collection, conducted with substance-dependent women using structured questionnaires to collect socio-demographic data and identify their drug of choice. The Drug Abuse Screening Test, Short Alcohol Dependence Data questionnaire, Fagerstrom Test for Nicotine Dependence, and Arizona Sexual Experience Scale were also administered. RESULTS: The sample consisted of 105 women who had a mean age of 34.8 years (SD = 12.1, range = 18-65) and were predominantly heterosexual (74.3%), single (47.6%), Caucasian (50.5%), catholic (36.2%), and educated only to the level of primary education (40%), with a monthly family income of up to one minimum salary (37.5%). In 42.9% of the patients, crack was the drug of choice; 47.6% of the sample qualified for the Drug Abuse Screening Test (substantial problems related to drugs), 43.8% exhibited Short Alcohol Dependence Data (moderate or severe dependency), 47.6% exhibited Fagerstrom Test for Nicotine Dependence (high or very high nicotine dependence). The prevalence of sexual dysfunction symptoms was 34.2% (95% CI = [25.3, 44.1]), and a high level of nicotine dependence and low income increased the chances of having sexual dysfunction by 2.72-fold and 2.54 fold, respectively. An association was also observed between female sexual dysfunction symptoms and schooling and levels of drug dependence. CONCLUSIONS: Female sexual dysfunction symptoms were common among this sample and primarily associated with high levels of nicotine use.

Hepatitis C in hemodialysis: the contribution of injection drug use

BACKGROUND: Hepatitis C virus (HCV) infection is the most common cause of acute or chronic hepatitis in patients on hemodialysis (HD). The purpose of this study was to describe the prevalence of positive HCV RNA and investigate injection drug use as an emerging risk factor in patients with chronic renal disease on HD. METHODS: This was a multicenter cross-sectional study with 325 patients with chronic renal disease on HD in the period between August 1, 2005 to August 30, 2006, receiving care at four institutions in the city of Porto Alegre, Southern Brazil. Epidemiological data were collected by means of a structured questionnaire. The following laboratory tests were performed: alanine aminotransferase (ALT), anti-hepatitis C virus antibodies (anti-HCV), and qualitative polymerase chain reaction (PCR). RESULTS: Of 325 patients, 68 had positive HCV RNA results. The comparison between patients with positive and negative PCR results revealed significant differences in duration of HD (mean = 71 versus 52.4 months; p = 0.02); previous blood transfusion (92 percent versus 72 percent; p < 0.01); injection drug use (13 percent versus 0.7 percent; p < 0.01); anti-HCV positivity at start of HD therapy (60 percent versus 4 percent; p < 0.01); and mean ALT value (39 versus 26.5; p < 0.01). Logistic regression analysis showed a positive HCV RNA independently associated to being on HD for more than five years [OR: 2.1 (95 percent CI 1.2 -3.8)]; previous blood transfusion [OR: 3.7 (95 percent CI 1.4 - 9.5)]; and injection drug use [OR: 22.6 (95 percent CI 4.2 - 119.6)]. CONCLUSION: Injection drug use was an independent risk factor for HCV infection among chronic renal disease patients on HD.

HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: a review of the literature / Prevalência de infecção por HIV, sífilis e hepatite B e C entre portadores de doenças mentais crônicas

A limited number of studies worldwide have investigated the prevalence of HIV, syphilis, and hepatitis B and C infection among psychiatric patients. However, prevalence of these infections in the population with chronic mental illness has not been clearly established. Most of the published papers are from developed countries and have derived from relatively small and non-representative samples. We performed a systematic review of the published literature to identify studies on these infectious diseases within psychiatric populations in Brazil and other developing countries. Overall, prevalence rates varied from 0 percent to 29 percent for HIV; 1.6 percent to 66 percent for HBV; 0.4 percent to 38 percent for HCV; and 1.1 percent to 7.6 percent for syphilis. Several risk factors were identified and discussed, although sampling limitations restrict the generalization of study findings. This review highlights the lack of information on the prevalence of sexually transmitted diseases and their associated factors among persons with chronic mental illness and identifies gaps in the knowledge base in both developing and developed countries.

Os portadores de doenças mentais crônicas encontram-se em risco para a infecção pelo HIV e outras infecções sexualmente transmissíveis. Entretanto, a prevalência dessas infecções entre portadores de doença mental crônica ainda não está claramente estabelecida nesta população. A maioria dos trabalhos sobre o tema foi conduzida em países desenvolvidos, com amostras relativamente pequenas e não representativas. Foi realizada uma revisão sistemática da literatura para identificar estudos sobre a prevalência do HIV, sífilis, hepatite B e C entre pacientes com doença mental crônica no Brasil e no mundo. De um modo geral, as prevalências variaram de 0 por cento a 29 por cento, 3 a 66 por cento, 0,4 a 38 por cento e 3,3 por cento a 7,6 por cento para HIV, hepatite B, hepatite C e sífilis, respectivamente. Vários fatores de risco foram identificados e discutidos, embora a literatura atual não demonstre achados significativos gerados por estudos representativos. Tal revisão destaca a escassez de informação sobre a prevalência de infecções sexualmente transmitidas e seus fatores associados entre portadores de doenças mentais crônicas e identifica lacunas no conhecimento atual em países desenvolvidos bem como nos em desenvolvimento.

Distúrbios da vitamina A e do Ferro em pacientes submetidos à hemodiálise / Disorders of vitamin A and iron in patients undergoing hemodialysis / Trastornos de la vitamina A y hierro en pacientes sometidos a hemodiálisis

Introdução: As concentrações séricas de vitamina A e do ferro se encontram alteradas na insuficiência renal crônica. Objetivo: Discutir os aspectos que envolvem as alterações metabólicas e funcionais da vitamina A e do ferro em pacientes submetidos à hemodiálise. Métodos: Foi realizada uma seleção de estudos relevantes a partir de banco de dados (Medline, Scielo e Lilacs), bem como a partir de livros e teses acadêmicas sobre o tema. Resultados: Segundo a pesquisa bibliográfica, as concentrações séricas de vitamina A se encontram elevadas na insuficiência renal crônica, porém pouco se sabe sobre os possíveis efeitos tóxicos do excesso dessa vitamina no tratamento dialítico. Entre os fatores que ppodem contribuir para esse quadro estão à diminuição da conversão do retinol a ácido retinóico, que é uma função do rim e um acúmulo da proteína carreadora do retinol. A deficiência de ferro afeta mais de 50% dos pacientes em diálise e as perdas desse micronutriente, estimadas para esses pacientes ficam em torno de 1,5 a 3 g por ano. A suplementação com ferro e eritropoietina tem frequentemente restaurado os níveis de hematócrito para valores normais ou próximos aos normais. No entanto, recentemente, tem se levantado à questão de que grandes doses ferro parenteral podem estar associadas com a morbimortalidade, principalmente por infecção e doenças cardiovasculares. Conclusão: Uma melhor compreensão dos aspectos metabólicos da vitamina A e do ferro, em pacientes recebendo hemodiálise, contribuirá para uma abordagem terapêuticas mais racional .

Background: Serum concentrations of vitamin A and iron are altered in chronic renal failure. Objective: To discuss the aspects that involve the metabolic and functional alterations of vitamin A and iron in patients undergoing hemodialysis. Methods: We performed a selection of relevant studies from the database (Medline, Lilacs and Scielo) as well as from books and academic theses on the subject. Results: According to the literature, serum concentrations of vitamin A are elevated in chronic renal failure, but little is known about the possible toxic effects of excess of vitamin A in dialysis. PPOD Among the factors that contribute to this framework are to decrease the conversion of retinol to retinoic acid, which is a function of the kidney and a buildup of retinol binding protein. Iron deficiency affects more than 50% of patients on dialysis and loss of this micronutrient, these patients are estimated to be around 1.5 to 3 g per year. Supplementation with iron and erythropoietin is often restored the levels of hematocrit to normal or near-normal. However, it has recently risen to the point that large doses of parenteral iron may be associated with morbidity and mortality, mainly due to infection and cardiovascular diseases. Conclusion: A better understanding of metabolic aspects of vitamin A and iron in patients receiving hemodialysis, contribute to a more rational therapeutic approach.

Antecedentes: Las concentraciones séricas de vitamina A y hierro son alterados en la insuficiencia renal crónica. Objetivo: Discutir los aspectos que involucran las alteraciones metabólicas y funcionales de la vitamina A y hierro en pacientes sometidos a hemodiálisis. Métodos: Se realizó una selección de los estudios pertinentes de la base de datos (Medline, Lilacs y Scielo), así como de libros y tesis académicas sobre el tema. Resultados: De acuerdo a la literatura, las concentraciones séricas de vitamina A se encuentran elevados en la insuficiencia renal crónica, pero poco se sabe sobre los posibles efectos tóxicos del exceso de vitamina A en diálisis. PPOD Entre los factores que contribuyen a este marco son la reducción de la conversión de retinol a ácido retinoico, que es una función del riñón y una acumulación de la proteína transportadora de retinol. La deficiencia de hierro afecta a más del 50% de los pacientes en diálisis y la pérdida de este micronutriente, estos pacientes se estima en alrededor de 1,5 a 3 g por año. La suplementación con hierro y eritropoyetina suele ser restaurado los niveles de hematocrito a lo normal o casi normal. Sin embargo, recientemente ha aumentado hasta el punto de que grandes dosis de hierro parenteral puede estar asociada con una morbilidad y mortalidad, principalmente debido a la infección y las enfermedades cardiovasculares. Conclusión: Una mejor comprensión de los aspectos metabólicos de la vitamina A y hierro en pacientes sometidos a hemodiálisis, contribuir a un enfoque terapéutico más racional.

Domestic violence, alcohol and substance abuse

Violência doméstica e abuso de substâncias psicoativas são comuns em pacientes atendidos no sistema de saúde de baixa complexidade. Apesar de estes problemas acarretarem graves seqüelas físicas e psicológicas, eles freqüentemente não são diagnosticados. Este artigo oferece uma revisão ampla sobre a prevalência destes problemas e suas conseqüências para a saúde de adultos, crianças e idosos, bem como discute os desafios enfrentados por médicos clínicos para a sua detecção, avaliação e encaminhamento.

Avaliação de riscos ao desenvolvimento neuropsicomotor em crianças: triagem utilizando-se o Teste de Denver II e identificação de fatores maternos de risco / Assessment of risk to neuro-psychomotor development: screening using the Test Denver II and identification of maternal risks

PURPOSE: To identify a positive screening test for developmental delay in children by the Denver Test II and their risk factors. METHODS: A sample of 398 children was studied at 0 the 12 months of age regarding their neurodevelopment. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having neurodevelopment delay. A set of independent variables was: socioeconomic, reproductive and environmental, birth conditions children's care. Analyses were performed using chi-square test and multivariate techinique logistic regression. RESULTS: At of 0 - 12 months of age, 45,73% (182) of the total of 398 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children, gestacional age less than 38 weeks, socioeconomic status family, schooling of the mother, mother's age, use of drug. CONCLUSIONS: This study demonstrates: 1--The Denver Test permited screening the delays development; 2--Maternal risk factors may interfere in the child's neurodevelopmental.

Doença mental e comportamento violento: novas evidências da pesquisa / Mental disease and violent behavior: new evidence from research

Foi efetuada uma revisão crítica da literatura pertinente, distribuindo-se os estudos por suas três vertentes principais: os de prevalência de comportamento violento em doentes mentais, os de prevalência de doenças mentais em populações violentas e estudos baseados na comunidade. Indepentemente da linha de investigação, boa parte dos estudos atuais aponta para a presença de uma associação significativa entre doença mental e comportamento violento. Há, portanto, evidências de uma importante associação entre doença mental e comportamento violento, comparativamente a populações normais, qualquer que seja a vertente estudada. A presença de co-morbidade com uso/abuso de álcool/drogas aumenta o risco de tais comportamentos.

Prevalencia de afección hepática, alcoholismo, hepatitis B, C y HIV en pacientes con antecedentes de consum / Prevalence of hepatic involvement, alcoholism, hepatis B, C and HIV in patients with background history of drug use

Drug addicts frequently have liver diseases for different reasons: alcohol abuse, the drugs themselves, but more often hepatitis B and C infections. AIDS is common in this population as well and could also affect the liver directly or in the form of hepatocellular or biliary damage. We conducted this study to determine the prevalence of liver diseases, alcoholism, hepatitis B and C infections, and HIV positivity in this population. We studied a cohort of 137 persons, all with a history of drug abuse, and investigated the quantity of alcohol intake, the kind of drug used, and he routes of drug administration. RESULTS: We found liver disease in 33.6%. The prevalence of alcoholism was 65.4%, of HCV 67.3%, and of HBV 17.3%. HDV was undetectable, whereas we found HIV at a frequency of 17.3%. HCV RNA was detected in 85.4% of HCV. The drug most often used was cocaine at 90.4%, followed by marihuana at 88.3%; LSD use occurred in 17.5%. We found parenteral drug use in 43.1%. We performed 22 liver biopsies, 21 associated with HCV, and detected histological changes consistent with chronic hepatitis in 17, with cirrhosis in 4, and with hepatocellularcarcinoma in 1.