Gestação e uso de substâncias psicoativas: qual é o cuidado em saúde desejado pelas mulheres? / Pregnancy and drugs: what healthcare do women want?

Resumo Introdução O uso de substâncias psicoativas vem aumentando entre mulheres em virtude de discriminação, frustrações e violação de direitos. Esse tema está na pauta do debate sobre a atual política brasileira de saúde mental e de saúde à mulher, imerso em tensões por causa das novas propostas de financiamento público. Objetivo O objetivo do estudo foi o de descrever, na perspectiva da mulher usuária de substância psicoativa, quais características do cuidado em saúde no pré-natal são desejadas. Método Em atividade extensionista articulada ao programa formativo brasileiro PET-Redes de Atenção, desenvolveu-se este estudo exploratório e qualitativo com 19 mulheres usuárias de substâncias psicoativas por meio de questionário e entrevista semiestruturada. Resultados Os resultados revelaram dissonância entre o cuidado recebido e o desejado. Este último alinha-se à perspectiva dialógica e integral, como previsto no Sistema Único de Saúde. O relato das mulheres mostra a presença do estigma social, que é o desafio a ser enfrentado. Conclusão Avalia-se que o cuidado em saúde para gestantes em uso de substâncias psicoativas precisa assumir uma perspectiva dialógica, integral e multifacetada, assim como se faz premente o combate ao estigma social e a necessidade de novos estudos nessa temática.

Abstract Background The use of psychoactive substances has increased among women, surrounded by discrimination, frustrations, and violations of rights. This theme is on the debate agenda of the current policies on women's mental health in Brazil, immersed in tensions facing new public funding proposals. Objective The aim of this study was to describe, from the perspective of women users of psychoactive substances, the characteristics desired for prenatal care. Method In a university extension activity articulated to a Brazilian formative program called PET-Networks of Care, this exploratory, qualitative, field study was conducted with 19 women users of psychoactive substances through the application of a questionnaire and a semi-structured interview. Results The results revealed dissonance between the health cared received and the one expected. The latter is in line with a dialogical and integral perspective, as planned by the SUS. Women's reports show the presence of social stigma, which is a challenge to be faced. Conclusion The health care for pregnant women users of psychoactive substances needs to assume a dialogic, integral, and multifaceted perspective, and the fight against social stigma becomes urgent. Further studies in this area are suggested.

Estándares de Acreditación "derechos de pacientes": revisión y estado actual en Centros de Tratamiento en Drogadicción en Colombia / Accreditation standards concerning patients' rights: a review of the current state of affairs related to drug-addiction treatment centers in Colombia

Objetivos Caracterizar y referenciar estado actual del grupo estándares de acreditación "derechos de los pacientes" en muestra de instituciones de tratamiento en drogas de Colombia. Métodos Estudio de enfoque mixto, empírico de tipo descriptivo y hermenéutico; muestra piloto de 21 centros de tratamiento en drogas en las cuales se determina estado actual de los estándares de acreditación "derechos de los pacientes"; se evalúa posible relación o independencia de las variables categóricas mediante prueba exacta de Fisher con nivel de significancia de 0,05. En fase paralela se realiza revisión documental de referenciación. Resultados: Los Centros de tratamiento en drogas suministran información en mayor proporción a familiares (95 %) que a los pacientes (90 %) y menores de edad (81 %). Representan posibles barreras de acceso al tratamiento, ser portador o enfermo VIH (29 %), orientación sexual LGTB (14 %) y ser mujer (10 %); religión y raza no son condiciones para discriminación o barreras de atención. Existen estándares coincidentes en el grupo "derechos de los pacientes" en el sistema de acreditación Colombiano con The Joint Commission, pero esta última entidad acreditadora tiene desarrollos importantes en un manual específico aplicable a instituciones de tratamiento de adicción a drogas. Conclusiones Los centros evaluados en Colombia, muestran logros en el grupo de estándares para la acreditación derechos de los pacientes, pero estos estándares requieren revisión para su adaptación a los desarrollos internacionales y a la particularidad de la población adicta y de las instituciones de tratamiento.

Objective Characterizing and contrasting the current state of affairs concerning patients' rights-associated accreditation standards in a sample of drug-addiction treatment centers in Colombia. Methods This was mixed methodology research (i.e. descriptive and hermeneutic); a pilot sample of 21 drug-addiction treatment centers in Colombia was used for determining the current state of patients' rights accreditation standards. The possible relationship or independence between categorical variables was evaluated by using Fisher's exact test (0.05 significance level). A contrasting documentary review was made at the same time. Results Drug-addiction treatment centers provided more information for families (95 %) than patients (90 %) or minors (81 %). Possible barriers to gaining access for treatment were being HIV positive (29 %), being part of the LGTB population (14 %) and being female (10 %); religion and ethnicity were not seen as grounds for discrimination or treatment barriers. The patients' rights standards group coincided with Colombia´s accreditation system and Joint Commission standards; however, the latter accreditation entity has made significant progress regarding a specific manual for drug-addiction treatment centers. Conclusions The centers assessed in Colombia had made advances regarding accrediting patients' rights, but such standards require revision for being adapted to international developments and specific matters involved in treating addicts and the specific conditions for institutions dealing with such treatment.

Sífilis Congénita en el Instituto Materno Infantil-Hospital la Victoria, Bogotá / The congenital syphilis protocol used at the Instituto Materno Infantil-Hospital la Victoria, Bogotá

Objetivos Analizar la cohorte de gestantes con VDRL reactivo en el parto y sus neonatos para describir la adherencia al protocolo nacional de tratamiento paraprevenir sífilis congénita e identificar desenlaces clínicos adversos. Metodología Estudio descriptivo, en 73 gestantes y sus neonatos durante el año 2008 en el Instituto Materno Infantil-Hospital La Victoria. Resultados La infección se detectó durante la gestación en 50 casos y en 23 en el parto, en 34 % hubo reinfección; 29 % eran drogadictas, 19 % indigentes y 23 % tenía antecedente de sífilis, 7 casos se consideraron éxito en tratamiento in útero. La frecuencia de sífilis congénita fue de 1 caso por 46 nacimientos, hubo 8 muertes fetales (12 %) y 58 casos de sífilis congénita en neonatos vivos: 27 sintomáticos y 31 asintomáticos; 7 tuvieron neurosífilis, 17 retardo del crecimiento, 6 prematurez. Asistencia a control prenatal, detección de la infección en la gestación y administración de algún tratamiento, se asociaron con menor mortalidad, menor número de neonatos sintomáticos y menor número de neonatos con retardo del crecimiento. Las gestantes con drogadicción mostraron ausencia de control prenatal y mayor número de neonatos sintomáticos, con retardo del crecimiento y prematuros. Conclusiones Es necesario fomentar: en la gestante la asistencia al control prenatal, en el personal de salud la búsqueda de la infección, la verificación del tratamiento en la pareja y la capacitación en la atención materna y neonatal de la entidad.(AU)

Objectives Examining a cohort of women having a reactive venereal disease research laboratory (VDRL) test on delivery (and their newborn) to describe adherence to the Colombian treatment regime to prevent congenital syphilis and identify adverse clinical outcomes. Methodology A descriptive study of 73 pregnant women and their new born was carried out at the Instituto Materno Infantil-Hospital La Victoria during 2008. Results Syphilis was detected in 50 women during their pregnancy and 23 when giving birth; 34 % became re-infected. 29 % were drug addicts, 19 % indigent and 23% had a history of syphilis. 7 cases were considered successful regarding antenatal treatment. Congenital syphilis frequency at the institution was 1 case per 46 births; there were 8 fetal deaths (12 %) and 58 cases of congenital syphilis in the newborn (27 symptomatic and 31 asymptomatic). 7 newborn had neurosyphilis, 17 suffered growth restriction and 6 were premature. Attending antenatal care, detecting syphilis during pregnancy and providing some type of treatment were related to decreased mortality, fewer symptomatic newborn and fewer infants having IUGR. Pregnant female drug addicts did not attend or lacked prenatal care and had a greater number of symptomatic newborn, involving growth restriction and being premature. Conclusions It is recommended that pregnant women be encouraged to attend prenatal care and that health personnel should become involved in detecting the disease, verifying treatment in couples (i.e. including the sexual partner)and training in the institution's maternal and neonatal care programs.(AU)

Validación para Colombia de la escala CRAFFT para tamización de consumo de sustancias psicoactivas en adolescentes / Validation for Colombia of the CRAFFT substance abuse screening test in adolescents

Objetivos Evaluar las propiedades de la escala CRAFFT para el cribado de consumo de sustancias psicoactivas en adolescentes entre los 14 y 18 años y validar el criterio estándar de la escala. Métodos La validez de criterio se realizó comparando la escala CRAFFT contra el gold standard para la identificación del consumo: la entrevista clínica. Mediante el modelo de pruebas diagnósticas se calculó la sensibilidad, la especificidad y los valores predictivos. Resultados Se encontró una sensibilidad de 0,95, una especificidad de 0,83, un VPP de 0,85 y un VPN de 0,94 (χ²=187,87 y p<0,0005) para identificación de consumo disfuncional (uso frecuente, abuso y dependencia) con un puntaje >2. Conclusiones La escala presenta una alta utilidad para el cribado de consumo de sustancias psicoactivas. Con un puntaje igual o mayor a 2 se puede diferenciar el consumo funcional del consumo disfuncional.

Objectives Evaluate the properties of CRAFFT scale for substance abuse screening in adolescent population aged 14 to18. Methods The criteria was validated by comparing the CRAFFT scale to the gold standard for substance use identification (i.e. the clinical interview). The diagnostic test model was used for calculating the sensitivity, specificity and predictive values of the scale. Results The test revealed 0.95 sensitivity, 0.83 specificity, 0.85 PPV and 0.94 NPV (χ²=187.87 and p<0.0005) for identifying dysfunctional use (frequent use, abuse and dependence) with a score >2. Conclusions The scale was seen to have great usefulness for psychoactive substance use screening. A cut-off point of 2 differentiated functional from dysfunctional use.

Transtorno de estresse pós-traumático e uso de drogas ilícitas em mulheres encarceradas no Rio de Janeiro / Posttraumatic stress disorder and illicit drug use among incarcerated women in Rio de Janeiro

CONTEXTO: O risco para o desenvolvimento de transtorno de estresse pós-traumático (TEPT) entre mulheres encarceradas pode estar associado ao consumo de drogas. OBJETIVOS: Determinar a frequência de TEPT entre mulheres encarceradas e sua relação com o uso de drogas na prisão. As voluntárias foram também avaliadas para a determinação de ansiedade-traço, depressão, eventos estressores e características sociodemográficas e comparadas quanto à presença ou não do transtorno. MÉTODOS: Estudo transversal com mulheres encarceradas em que foram utilizados para a avaliação de TEPT os critérios determinados pelo DSM-IV, o Inventário Christo para descrição de uso de drogas, o Inventário de Ansiedade Traço-Estado e o Inventário Beck para avaliação de sintomas de ansiedade e depressão, respectivamente. RESULTADOS: Das 134 mulheres avaliadas, 40,3% apresentaram TEPT. Houve maior uso diário de cocaína entre as positivas para o transtorno (p < 0,01). O uso diário de drogas ilícitas na prisão foi descrito por 53% das entrevistadas. Todas as participantes TEPT-positivas apresentavam algum grau de depressão em comparação às TEPT-negativas (p < 0,05). CONCLUSÃO: A alta prevalência de TEPT encontrada é comparável à de populações de risco. Apesar de estarem em regime prisional, é alto o uso de drogas ilícitas. O maior uso de cocaína entre as detentas que apresentaram TEPT indica preferência por drogas estimulantes em mulheres com o transtorno.

BACKGROUND: The risk of developing posttraumatic stress disorder (PTSD) among incarcerated women may be associated with drug use. OBJECTIVES: To establish the frequency of PTSD in a sample of incarcerated women and its relationship with drug use inside prison. Anxiety and depression, nature of stressors and sociodemographic data were evaluated and the sample of PTSD-positive women was compared with the one of PTSD-negative women. METHODS: The study had a cross-sectional design. The PTSD was evaluated according to the DSM-IV criteria. Drug consumption was assessed with the Christo Inventory for drug consumption. Anxiety was evaluated with the Spielberger Inventory and depression with the Beck Inventory. RESULTS: Among the 134 examined women, 40.3% showed PTSD. There was a significantly higher daily use of cocaine among women with a positive PTSD diagnosis (p < 0.01). Daily consumption of illicit drugs was reported by 53% of the assessed women in prison. Compared to PTSD-negative women, all participants diagnosed as PTSD-positive showed some degree of depression (p < 0.05). DISCUSSION: The high prevalence of PTSD among incarcerated women is comparable to the prevalence of high-risk populations described in other studies. In spite of being in prison, consumption of illicit drugs was high. The association of PTSD with an increased cocaine use suggests a preference to consume stimulant drugs among incarcerated women with PTSD.

Morbilidad atendida y conductas de riesgo de la niñez y adolescencia en situación de calle de Medellín, 2008 / Morbidity and risk behavior regarding street-children in Medellin, Colombia, 2008

Objetivos Describir características, morbilidad atendida y conductas de riesgo para la salud de la niñez y adolescencia en situación de calle de Medellín. Metodología Estudio observacional descriptivo y retrospectivo. Se revisaron historias clínicas de niños, niñas y adolescentes que recibieron atención médica en cinco instituciones de protección entre enero y diciembre del 2008. El análisis incluyo análisis uni y bivariado con las variables de interés. La edad fue agrupada en: niños y niñas (0-12 años) y adolescentes (13-17 años). Resultados Se incluyeron 483 historias clínicas. El 73,1 por ciento de los registros del sexo masculino, 73,1 por ciento adolescentes y 44,7 por ciento residían en la calle. Los principales diagnósticos fueron: Ciertas enfermedades infecciosas y parasitarias (18,3 por ciento), factores que influyen con el estado de salud y contacto con servicios de salud (13,7 por ciento), enfermedades del sistema respiratorio (11,8 por ciento). El 81,0 por ciento consumían sustancias sicoactivas, la más consumida fue la marihuana (80,0 por ciento). El 84,0 por ciento reporta actividad sexual. Conclusión La morbilidad atendida, su actividad sexual y consumo de sicoactivos evidencian una alta vulnerabilidad en salud en este grupo poblacional. Esto exige a instancias de planificación y dirección de políticas públicas en salud la garantía de su derecho constitucional a la salud a través de la ejecución de programas de promoción de la salud y la salud sexual y reproductiva y de estrategias para la prevención de enfermedades y del consumo de sicoactivos.

Objectives Describing the characteristics, morbidity and risk behaviour of street children from Medellin. Methodology This was a descriptive, retrospective study. The medical charts of children aged less than 17 who sought medical attention in five protection institutions in Medellin during 2008 were reviewed. The analysis included descriptive statistics and bivariate analysis. Age was categorised into two groups: boys/girls (0- 12 years) and adolescents (13-17 years). Results The following characteristicswere found after reviewing 483 medical charts: being male (73.1 percent), adolescent (73.1 percent) and living in the streets (44.7 percent). The most common diagnoses were for infectious and parasite illnesses (21.8 percent), factors that affected health status and contact with health services (13.7 percent), respiratory diseases (11.8 percent). A total of 81.0 percent of all children were engaged in psychoactive substance abuse,smoking marijuana being the most common (80.0 percent);84.0 percent reported engaging in sexual activity. Conclusion Infectious diseases, sexual activity and usingpsychoactive substances placed this population in a high vulnerability category. This situation demands that local health-policy makers guarantee thispopulation's constitutional right to health, through health-promotion programmes and sexual and reproductive health strategies to prevent disease and psychoactive substance abuse.

Construction of the Structural Equation Model on Substance Use in Adolescents

PURPOSE: The aim of this study was to construct a structural equation model that would further explain the continuously increasing substance use disorder in Korean adolescents. METHODS: Survey visits using a structured questionnaire were conducted with 3,885 students in 2 middle schools and 2 high schools in Busan. A total of 13 instruments were used in this model. The analysis of data was done with both SPSS 14.0 for descriptive statistics and AMOS 5.0 for covariance structure analysis. RESULTS: Based on the constructed model, belief on substance use was found to have a significantly direct effect in influencing adolescent substance use. In addition, other factors such as family environment, satisfaction with school life, self-concept, social support, and personality vulnerability indirectly affected substance use. The final modified model yielded Chi-square=2,987 (p<.001), df=121, 2/df=22.1, GFI=.96, AGFI=.93, NFI=.91, PNFI=.72, PGFI=.72, RMSEA=.07 and exhibited fit indices. CONCLUSION: This study constructed a model that addresses the factors related to adolescent substance use and explains the relationship of these factors in influencing substance use among Korean adolescents. Findings from this study can contribute to designing appropriate prevention strategies to reduce substance related disorders in adolescents.

A Study on the Risk of Drug Use by Male Adolescents / 기본간호학회지

PURPOSE: The purpose was to identify the risk of drug use by adolescents. METHOD: The participants were 933 male students in the first grade of a high school in D city. The data were collected from Aug. 5th to Oct. 30th, 2004. The instrument was the High Risk Group Adolescent Drug User Screening Test (HIRIGADUST) developed by the Korea Adolescent Society (1996). The data were analyzed using SPSS. RESULTS: For substance use, 64.5% of the students answered that they had drunk, 40.3% that they had smoked, and 2.0% that they had tried drug use. For scores on HIRIGADUST regarding socio-demographic characteristics, there were significant differences depending on school type, personality, academic performance, economic status, and ability to talk with parents. For scores on HIRIGADUST regarding drug using-related characteristics, there were significant differences depending on drinking experience, frequency of drinking, amount of alcohol intake, smoking experience and number of cigarettes smoked. Of the students 27.2% students were in the high risk group. CONCLUSION: In schools, systematic and intensive assessment of drug use should be done, and if needed, a service system connected to clinics specializing in drug addiction should be established. Prevention education should be carried out continuously.

Effects of a Drug Misuse and Abuse Prevention Program on Knowledge, Attitude, and Preventive Behaviors Related to Drug Misuse and Abuse, and Depression in Low-income Elderly Women / 간호학회지

PURPOSE: This study was conducted to determine the effects of a drug misuse and abuse prevention programon knowledge, attitude, and preventive behaviorsrelated to drug misuse and abuse, and depression in low-income elderly women in the urban area. METHOD: The design of this study was a nonequivalent control group pretest-posttest design. The subjects consisted of 26 in the experimental group and 23 in the control group. The program was performed for about 1hour, once a week for 5 weeks. Data was analyzed by the SAS(ver.8.02) computer program, and it included descriptive statistics, Fisher's exact test, Mann-Whitney U test, Wilcoxon signed ranks test, and ANCOVA. RESULT: There were statistically significant differences in knowledge, attitude, and preventive behaviors related to drug misuse and abuse, and depression between the experimental group and the control group. CONCLUSION: This study showed that this prevention program of drug misuse and abuse is appropriate for low-income elderly women, Therefore this program is recommended as a nursing intervention strategy for the elderly.