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1.
Adicciones ; 35(2): 135-142, 2023 Jul 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36975063

RESUMO

Lifetime prevalence of cannabis use is estimated 192 million adults worldwide (2017) and has increased by 16% in the last decade. However, data on quantity and frequency of use that can lead to harm is lacking. We have developed a survey to assess patterns of cannabis use and related harms in a sample of cannabis users. This paper focuses on evaluating the feasibility of the survey and the users' satisfaction in a pilot sample. Forty cannabis users were recruited (>18 years old, living in Spain, cannabis use at least once during the last 12 months) between December 2018 and January 2019. Participants answered an online survey (mental health, organic harm and injury) and an ad hoc questionnaire to assess accessibility, feasibility, satisfaction, design and content appropriateness. Of the participants, 93.23% (n = 37.3) were satisfied with the design, 94.92% (n = 38.2) were satisfied with the content, and 94.73% (n = 37.0) were satisfied with the accessibility of the survey; only minor changes were required to improve feasibility and accessibility. Participants used a median of 1.0 Standard Joint Unit per day (Interquartile Range [IQR] 1.0-2.0). Of the sample, 92.5% reported at least one related harm and suffers a median of 4.0 disorders (IQR, 1.25-5.0). The present study allows for designing a feasible online survey to conduct a cross-sectional study with a larger sample.


Globalmente, 192 millones de adultos han consumido cannabis alguna vez en su vida (2017), un consumo que se ha incrementado en un 16% en la última década. Sin embargo, seguimos sin tener información clara sobre qué cantidad y qué frecuencia de consumo va a causar daño. Por tanto, este proyecto desarrolla una encuesta para evaluar los patrones de consumo de cannabis y los daños relacionados en una muestra de consumidores. Este artículo se centra en mostrar la factibilidad de la encuesta y la satisfacción de los usuarios en una muestra piloto. Cuarenta usuarios de cannabis fueron reclutados (>18 años, viviendo en España, consumo de cannabis mínimo una vez en los últimos 12 meses) entre diciembre de 2018 y enero de 2019. Los participantes respondieron una encuesta en línea (consumo cannábico, salud mental, organicidad y lesiones) y un cuestionario ad hoc para evaluar la accesibilidad, factibilidad, satisfacción, diseño y contenido. El 93,23% de participantes estaba satisfecho con el diseño; el 94,92% estaba satisfecho con el contenido y el 94,73% estaba satisfecho con la accesibilidad de la encuesta, y fueron necesarios solo cambios menores para mejorar la factibilidad y la accesibilidad de algunos ítems. Los participantes consumieron una mediana de 1,0 Unidades de Porro Estándar por día (Rango Intercuartílico [RIQ] 1,0-2,0). El 92,5% de la muestra puntuó como mínimo en un daño relacionado y con una mediana de 4,0 patologías (RIQ 1,25-5,0). El presente estudio nos permite diseñar una encuesta en línea con determinada factibilidad que pueda ser usada en un estudio transversal a gran escala.


Assuntos
Cannabis , Adulto , Humanos , Adolescente , Cannabis/efeitos adversos , Estudos Transversais , Saúde Mental , Inquéritos e Questionários , Espanha/epidemiologia
2.
Adicciones ; 33(1): 31-42, 2021 Jan 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31018002

RESUMO

INTRODUCTION: Systematic screening of problematic cannabis use does not include the motivations that lead to consumption, although from a person-centered perspective this is fundamental. The present study explores the motivations for cannabis use in adults and its relationship with cannabis use patterns and problematic use. METHOD: Adult cannabis users (previous 60 days) were recruited in the province of Barcelona (n = 468). Information on their sociodemographic data, cannabis use pattern, Cannabis Abuse Screening Test (CAST) and the main motivation for use were collected. Motivations were categorized a posteriori according to the Marijuana Motives Measures (MMM). A descriptive and inferential analysis was carried out to link the motivations to sociodemographic variables, consumption pattern and probability of suffering problematic cannabis use (CAST). RESULTS: Using cannabis to heighten positive feelings (35%), out of habit (29%) and to cope with negative feelings (25%) were the most frequent motivations. In comparison to other motivations, coping is related to a greater quantity of cannabis used (4 vs 3 joints per day, p = 0.005), higher probability of problematic cannabis use (77% vs 64%, p = 0.05), and greater social vulnerability (unemployment 56% vs 37%, p = 0.001; and low educational level 14% vs 8%, p = 0.042). CONCLUSIONS: Coping as a motivation for cannabis use is present in one out of four users and is a marker of social vulnerability, greater quantity of cannabis used and higher risk of problematic use. Patient-centered care together with preventive (emotional and social education) and clinical strategies (psychotherapy) can be useful for this population at higher risk.


Introducción. El cribado sistemático del consumo problemático de cannabis no incluye las motivaciones que llevan al consumo, aunque desde una perspectiva de atención centrada en la persona, este dato sea fundamental. El presente estudio explora las motivaciones de consumo de cannabis en adultos y su relación con el patrón de consumo y consumo problemático.  Método. Consumidores adultos de cannabis (en los últimos 60 días) fueron reclutados en la provincia de Barcelona (n=468). Se pasó un cuestionario para explorar datos sociodemográficos, patrón de uso, la Cannabis Abuse Screening Test (CAST) y la motivación principal para el consumo. Los motivos de consumo se categorizaron a posteriori según la Marijuana Motives Measures (MMM). Se realizó un análisis descriptivo e inferencial para explorar la relación entre la motivación categorizada y variables sociodemográficas, patrón de consumo y puntuaciones de la CAST.Resultados. Consumir cannabis para mejorar las emociones positivas (35%), por costumbre (29%) y para afrontar emociones negativas (25%) fueron las motivaciones más frecuentes. Respecto a otras motivaciones, el "afrontamiento" se relaciona con mayor cantidad consumida (4 vs 3 porros/día, p = 0,005), mayor probabilidad de tener un consumo problemático (77% vs 64%, p = 0,05), y mayor vulnerabilidad social (desempleo 56% vs 37%, p = 0,001; y bajo nivel de estudios (14% vs 8%, p = 0,042)). Conclusiones. El afrontamiento está presente en uno de cada cuatro usuarios de cannabis, es un marcador de vulnerabilidad social y de mayor cantidad de consumo de cannabis y probabilidad de consumo problemático. Una atención centrada en la persona junto con estrategias preventivas (educación emocional y social) y clínicas (psicoterapia) pueden ser de utilidad en esta población de mayor riesgo.


Assuntos
Adaptação Psicológica , Cannabis/efeitos adversos , Abuso de Maconha/epidemiologia , Motivação , Adolescente , Adulto , Escolaridade , Feminino , Humanos , Masculino , Abuso de Maconha/terapia , Assistência Centrada no Paciente/métodos , Espanha , Inquéritos e Questionários , Desemprego/estatística & dados numéricos , Adulto Jovem
3.
Eur Addict Res ; 24(3): 109-117, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29949807

RESUMO

INTRODUCTION: The Standard Joint Unit (1 SJU = 7 mg of 9-Tetrahydrocannabinol) simplifies the exploration of risky patterns of cannabis use. This study proposes a preliminary quantitative cutoff criterion to screen for cannabis use disorder (CUD). METHODOLOGY: Socio-demographical data and information on cannabis quantities, frequency of use, and risk for CUD (measured with the Cannabis Abuse Screening Test (CAST) of cannabis users recruited in Barcelona (from February 2015 to June 2016) were collected. CAST scores were categorized into low, moderate, and high risk for CUD, based on the SJU consumed and frequency. Receiver operating characteristic (ROC) analysis related daily SJU with CUD. RESULTS: Participants (n = 473) were on average 29 years old (SD = 10), men (77.1%), and single (74.6%). With an average of 4 joints per smoking day, 82.5% consumed cannabis almost every day. Risk for CUD (9.40% low, 23.72% moderate, 66.88% high) increased significantly with more frequency and quantities consumed. The ROC analyses suggest 1.2 SJU per day as a cutoff criterion to screen for at least moderate risk for CUD (sensitivity 69.4%, specificity 63.6%). CONCLUSION: Frequency and quantity should be considered when exploring cannabis risks. A 1 SJU per day is proposed as a preliminary quantitative-based criterion to screen users with at least a moderate risk for CUD.


Assuntos
Abuso de Maconha/diagnóstico , Detecção do Abuso de Substâncias/métodos , Adulto , Feminino , Humanos , Masculino , Valores de Referência , Fatores de Risco , Sensibilidade e Especificidade , Detecção do Abuso de Substâncias/instrumentação , Adulto Jovem
4.
Prog Transplant ; 26(1): 82-91, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27136254

RESUMO

BACKGROUND: Hispanic dialysis patients often encounter barriers to learning about living kidney donation and transplantation. Effective culturally targeted interventions to increase knowledge are lacking. We developed a culturally targeted educational website to enhance informed treatment decision making for end-stage kidney disease. METHODS: A pretest/posttest intervention study was conducted among adult Hispanic patients undergoing dialysis at 5 dialysis centers in Chicago, Illinois. Surveys included a 31-item, multiple-choice pretest/posttest of knowledge about kidney transplantation and living donation, attitudes about the website, Internet use, and demographics. The intervention entailed viewing 3 of 6 website sections for a total of 30 minutes. The pretest/posttest was administered immediately before and after the intervention. Participants completed a second posttest via telephone 3 weeks thereafter to assess knowledge retention, attitudes, and use of the website. RESULTS: Sixty-three patients participated (96% participation rate). Website exposure was associated with a mean 17.1% same day knowledge score increase between pretest and posttest (P < .001). At 3 weeks, participants' knowledge scores remained 11.7% above pretest (P < .001). The greatest knowledge gain from pretest to 3-week follow-up occurred in the Treatment Options (P < .0001) and Cultural Beliefs and Myths (P < .0001) website sections. Most participants (95%) "agreed" or "strongly agreed" that they would recommend the website to other Hispanics. CONCLUSIONS: Web-based education for patients undergoing dialysis can effectively increase Hispanics' knowledge about transplantation and living kidney donation. Study limitations include small sample size and single geographic region study. Dialysis facilities could enable website access as a method of satisfying policy requirements to provide education about kidney transplantation.


Assuntos
Instrução por Computador/métodos , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/educação , Internet , Falência Renal Crônica/terapia , Transplante de Rim , Doadores Vivos , Diálise Renal , Adulto , Estudos Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Prog Transplant ; 24(2): 152-62, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24919732

RESUMO

CONTEXT: Given the shortage of kidneys for transplant, living kidney donation (LKD) is increasingly used to expand the organ donor pool. Although Hispanics/Latinos need disproportionately more kidney transplants, they receive a smaller proportion of living donor kidney transplants than other ethnic/racial groups. OBJECTIVE: To assess Hispanics' awareness, perceptions, misconceptions, cultural beliefs, and values about and barriers to LKD. DESIGN: Nine focus groups were conducted with 76 adult Hispanics in Chicago, Illinois, between January and March 2012. PARTICIPANTS: Focus groups included kidney transplant recipients, living kidney donors, dialysis patients, and the general Hispanic public. RESULTS: Several themes emerged as perceived barriers to LKD. Many participants identified knowledge deficits about LKD, expressing uncertainty about the differences between LKD and deceased donation, and whether kidney disease simultaneously afflicts both kidneys. Many believed that donors experience dramatically shorter life expectancies, are unable to have children, and are more susceptible to kidney disease after donating. Recipients and donors reported that family members were involved in discussions about the donor's decision to donate, with some family members discouraging donation. Financial barriers cited included fear of becoming unable to work, losing one's job, or being unable to pay household bills while recovering. Participants also identified logistic barriers for undocumented immigrants (eg, the inability to obtain government insurance for transplant candidates and uncertainty about their eligibility to donate). Donors desired information about optimizing self-care to promote their remaining kidney's health. Culturally competent interventions are needed to redress Hispanics' knowledge deficits and misconceptions and reduce LKD disparities among Hispanics.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispânico ou Latino/psicologia , Transplante de Rim/psicologia , Doadores Vivos/psicologia , Adolescente , Adulto , Idoso , Chicago , Feminino , Grupos Focais , Hispânico ou Latino/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Front Psychiatry ; 12: 643556, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34434125

RESUMO

Background: Cannabis is the third most consumed drug worldwide. Thus, healthcare providers should be able to identify users who are in need for an intervention. This study aims to explore the relationship of acute, chronic, and early exposure (AE, CE, and EE) to cannabis with cognitive and behavioral harms (CBH), as a first step toward defining risky cannabis use criteria. Methods: Adults living in Spain who used cannabis at least once during the last year answered an online survey about cannabis use and health-related harms. Cannabis use was assessed in five dimensions: quantity on use days during the last 30 days (AE), frequency of use in the last month (AE), years of regular use (YRCU) (CE), age of first use (AOf) (EE), and age of onset of regular use (AOr) (EE). CBH indicators included validated instruments and custom-made items. Pearson correlations were calculated for continuous variables, and Student's t-tests for independent samples were calculated for categorical variables. Effect sizes were calculated for each of the five dimensions of use (Cohen's d or r Pearson correlation) and harm outcome. Classification and Regression Trees (CART) analyses were performed for those dependent variables (harms) significantly associated with at least two dimensions of cannabis use patterns. Lastly, logistic binary analyses were conducted for each harm outcome. Results: The mean age of participants was 26.2 years old [standard deviation (SD) 8.5]. Out of 2,124 respondents, 1,606 (75.6%) reported at least one harm outcome (mean 1.8 and SD 1.5). In our sample, using cannabis on 3 out of 4 days was associated with an 8-fold probability of scoring 4+ on the Severity Dependence Scale (OR 8.33, 95% CI 4.91-14.16, p <0.001), which is indicative of a cannabis use disorder. Also, a start of regular cannabis use before the age of 25 combined with using cannabis at least once per month was associated with a higher probability of risky alcohol use (OR 1.33, 95% CI 1.12-1.57, p = 0.001). Besides, a start of regular cannabis use before the age of 18 combined with a period of regular use of at least 7.5 years was associated with a higher probability of reporting a motor vehicle accident (OR 1.81, 95% CI 1.41-2.32, p < 0.0001). Results were ambiguous regarding the role that age of first use and milligrams of THC per day of use might play regarding cannabis-related harms. Conclusions: The relationship among AE, CE, and EE with CBH indicators is a complex phenomenon that deserves further studies. The pattern of cannabis use should be carefully and widely evaluated-(not just including frequency but also other dimensions of pattern of use)-in research (preferably in longitudinal studies) to assess cannabis-related harms.

9.
Drug Alcohol Depend ; 176: 109-116, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28531767

RESUMO

OBJECTIVE: Reliable data on cannabis quantities is required to improve assessment of cannabis consumption for epidemiological analysis and clinical assessment, consequently a Standard Joint Unit (SJU) based on quantity of 9-Tetrahydrocannabinol (9-THC) has been established. METHODOLOGY: Naturalistic study of a convenience sample recruited from February 2015-June 2016 in universities, leisure spaces, mental health services and cannabis clubs in Barcelona. Adults, reporting cannabis use in the last 60 days, without cognitive impairment or language barriers, answered a questionnaire on cannabis use and were asked to donate a joint to further determine their 9-THC and Cannabidiol (CBD) content. RESULTS: 492 participants donated 315 valid joints. Donators were on average 29 years old, mostly men (77%), single (75%), with at least secondary studies (73%) and in active employment (63%). Marijuana joints (N=232) contained a median of 6.56mg of 9-THC (Interquartile range-IQR=10,22) and 0.02mg of CBD (IQR=0.02); hashish joints (N=83) a median of 7.94mg of 9-THC (IQR=10,61) and 3.24mg of CBD (IQR=3.21). Participants rolled 4 joints per gram of cannabis and paid 5€ per gram (median values). CONCLUSION: Consistent 9-THC-content in joints lead to a SJU of 7mg of 9-THC, the integer number closest to the median values shared by both cannabis types. Independently if marijuana or hashish, 1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC. For CBD, only hashish SJU contained relevant levels. Similarly to the Standard Drink Unit for alcohol, the SJU is useful for clinical, epidemiological and research purposes.


Assuntos
Dronabinol/análise , Dispositivos para Fumar/estatística & dados numéricos , Adulto , Cannabis , Feminino , Humanos , Masculino , Fumar Maconha/epidemiologia , Espanha
10.
Transplantation ; 100(5): 1149-60, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26444846

RESUMO

BACKGROUND: Hispanics/Latinos receive disproportionately fewer living donor kidney transplantations (LDKTs) than non-Hispanic whites. We conducted a multisite, randomized controlled trial to evaluate the efficacy of exposure to a bilingual, culturally targeted website, Infórmate, for increasing Hispanics' knowledge about LDKT. METHODS: Hispanic patients initiating transplant evaluation and their family/friends at 2 transplant centers were randomized to view Infórmate before attending routine transplant education sessions; usual care controls only attended education sessions. All participants completed a pretest; website participants also completed a posttest immediately after viewing Infórmate. All participants completed a 3-week telephone follow-up test. Random effects linear regression of 3-week knowledge scores tested the significance of website exposure after adjusting for clustering within families and controlling for pretest scores and covariates. RESULTS: Two hundred-eighty-two individuals participated (81% patient participation rate). Website exposure was associated with a mean 21.7% same day knowledge score increase between pretest and posttest (P < 0.001). At 3 weeks, website participants' knowledge scores remained 22.6% above the pretest; control scores increased to 11.8% (P = 0.0001). Regression results found that website participants were associated with a 10.0% greater knowledge score at 3-week follow-up (P < 0.0001). Most website participants (92.6%) plan to return to Infórmate in the future. CONCLUSIONS: Our culturally targeted website increased participants' knowledge about LDKT above and beyond transplant education and should supplement transplant center education for Hispanics. When considered at the population level, Infórmate could have a great impact on knowledge gains in this underserved population disproportionately affected by kidney disease.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Internet , Transplante de Rim , Doadores Vivos , Educação de Pacientes como Assunto/métodos , California , América Central , Chicago , Características Culturais , Competência Cultural , Hispânico ou Latino , Humanos , Falência Renal Crônica/cirurgia , Idioma , Modelos Lineares , Área Carente de Assistência Médica , México , Porto Rico , Análise de Regressão , Inquéritos e Questionários , Estados Unidos
11.
JMIR Res Protoc ; 4(2): e42, 2015 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-25896143

RESUMO

BACKGROUND: As the kidney shortage continues to grow, patients on the waitlist are increasingly turning to live kidney donors for transplantation. Despite having a disproportionately higher prevalence of end-stage kidney disease (ESKD), fewer waitlisted Hispanic patients received living donor kidney transplants (LDKTs) than non-Hispanic whites in 2014. Although lack of knowledge has been identified as a barrier to living kidney donation (LKD) among Hispanics, little is known about information needs, and few bilingual educational resources provide transplant-related information addressing Hispanics' specific concerns. OBJECTIVE: This paper describes the process of developing a bilingual website targeted to the Hispanic community. The website was designed to increase knowledge about LKD among Hispanic patients with ESKD, their families, and the public, and was inspired by educational sessions targeted to Hispanic transplant patients provided by Northwestern University's Hispanic Kidney Transplant Program. METHODS: Northwestern faculty partnered with the National Kidney Foundation of Illinois for expertise in ESKD and Hispanic community partners across the Chicago area. We established a Community Advisory Board (CAB) of 10 Chicago-area Hispanic community leaders to provide insight into cultural concerns and community and patients' needs. Website content development was informed by 9 focus groups with 76 adult Hispanic kidney transplant recipients, living kidney donors, dialysis patients, and the general Hispanic public. The website development effort was guided by community input on images, telenovela scripts, and messages. After initial development, formal usability testing was conducted with 18 adult Hispanic kidney transplant recipients, dialysis patients, and living kidney donors to identify ways to improve navigability, design, content, comprehension, and cultural sensitivity. Usability testing revealed consistently high ratings as "easy to navigate", "informative", and "culturally appropriate". Bandura's Social Cognitive Theory and Gagne's Conditions of Learning Theory guided website design to facilitate adult learning. RESULTS: The website, "Infórmate: Living Kidney Donation for Hispanics/Latinos" (Infórmate Acerca de la Donación de Riñón en Vida), includes six sections: Treatment Options, Donation: Step-by-Step, Benefits and Risks, Financial Issues, Immigrant Issues, and Cultural Beliefs and Myths. Sections host 5-10 interactive messages that summarize important points and link to detailed explanations for users interested in learning more about specific issues. The website hosts interactive videos, multimedia testimonials, telenovelas, games, and quizzes. Photographs and videos of Hispanic living donors are shown to promote pride and ownership. CONCLUSIONS: Our success in developing a website was driven by a development team with expertise in transplantation, social science, evaluation, instructional design, and Hispanic perspectives, and by a patient-centered approach toward content and design. Based on feedback from usability testing and our CAB, the website is sensitive to Hispanic cultural sensibilities. We have nearly completed a formal evaluation of the website's impact on increasing Hispanics' knowledge about LKD and will disseminate the website thereafter.

13.
Av. cardiol ; 18(3): 76-83, jun. 1998. graf
Artigo em Espanhol | LILACS | ID: lil-264390

RESUMO

Este estudio intenta determinar la relación entre el estrés psicosocial, detectado a través de la prueba de Hamilton modificada y la presencia de factores de riesgo cardiovascular. De una población total de 2460 trabajadores del área Lagoven-Caracas, fueron seleccionados al azar simple 179 pacientes durante los meses de enero a mayo de 1995. Todos estos pacientes fueron sometidos a la prueba de Halmiton modificada en 1993 y seguidos por un período de dos años. Considerando que el estrés estaba presente cuando la prueba de Halminton mostraba un puntaje mayor de seis. Asimismo los pacientes fueron sometidos a un examen médico que incluía Rx. de tórax, electrocardiograma de superficie, perfil lipídico, glicemia, índice de masa corporal (IMC), investigación sobre hábito tabáquico, hipertensión arterial (HTA) y revisión de historia familiar de enfermedad cardiovascular. El grupo en estudio estaba conformado por 102 pacientes con factores de riesgo cardiovascular (FRC) y el grupo control estaba constituido por 77 pacientes libres de estos factores de riesgo. El análisis estadístico utilizado fue el Chi cuadrado. Del total de 179 pacientes estudiados encontramos que 102 (57 por ciento), presentaban FRC y 77 pacientes (43 por ciento) estaban libres de FRC. Asimismo 48 pacientes (49 por ciento) presentaban estrés y 91 (51 por ciento) estaban libres de estrés. Al analizar los diferentes subgrupos con FRC con o sin estrés, no se encontró diferencia estadísticamente significativa. La presencia de estrés en esta población fue alta, tanto en el grupo con FRC como en el grupo sin factores de riesgo. Cuando el estrés fue considerado en cada subpoblación con FRC no se observó diferencia estadísticamente significativa al compararlo con el grupo control


Assuntos
Humanos , Masculino , Feminino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/psicologia , Isquemia Miocárdica/terapia , Fatores de Risco , Estresse Psicológico
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