Smoking and loneliness in older adults: a population-based study in Campinas, São Paulo State, Brazil / Tabagismo e solidão em idosos: um estudo de base populacional em Campinas, São Paulo, Brasil / Tabaquismo y soledad en adultos mayores: un estudio basado en población de Campinas, estado de São Paulo, Brasil

This study aims to analyze the relationship between social isolation and loneliness with smoking in older adults. This is a cross-sectional, population-based study performed with 986 individuals aged 60 years or older. Data were collected from the Health Survey of the Municipality of Campinas (ISACamp 2014/2015), state of São Paulo, Brazil. We estimated the prevalence of smoking and smoking cessation according to independent variables and tested the associations using the chi-square test, considering a 5% significance level. Adjusted prevalence ratios were calculated using simple and multiple Poisson regression. Smoking and smoking cessation were not associated with most variables that indicate objective social isolation. "Often or always" loneliness was related to a higher prevalence of smoking (PR = 2.25; 95%CI: 1.38-3.66) whereas loneliness accompanied of self-reported emotional problems or common mental disorders was strongly associated with smoking and with lower smoking cessation (PR = 6.24; 95%CI: 1.37-28.47 and PR = 0.46; 95%CI: 0.28-0.77, respectively). These findings indicate that loneliness is a psychosocial aspect related to tobacco use which hinders smoking cessation in older adults, emphasizing the importance of emotional problems in this association.

O estudo busca analisar a relação entre isolamento social, solidão e tabagismo entre idosos. Trata-se de um estudo transversal de base populacional que incluiu 986 indivíduos com 60 anos ou mais. Os dados foram obtidos do Inquérito de Saúde de Município de Campinas (ISACamp 2014/2015), São Paulo, Brasil. Foram estimadas as taxas de prevalência do tabagismo e da cessação do tabagismo de acordo com as variáveis independentes e testadas as associações através do teste de qui-quadrado, considerando nível de significância de 5%. Foram calculadas as razões de prevalência ajustadas com o uso de regressão de Poisson simples e múltipla. O tabagismo e a cessação do tabagismo não mostraram associação com a maioria das variáveis que indicam isolamento social objetivo, enquanto o relato da solidão muitas vezes ou sempre esteve relacionado a uma maior prevalência de tabagismo (RP = 2,25; IC95%: 1,38-3,66). A solidão, acompanhada pelo autorrelato de problemas emocionais ou a presença de transtornos mentais comuns, esteve fortemente associada com o tabagismo e com menor prevalência de cessação do tabagismo (RP = 6,24; IC95%: 1,37-28,47 e RP = 0,46; IC95%: 0,28-0,77, respectivamente). Os achados sustentam o papel da solidão enquanto aspecto psicossocial relacionado ao uso de tabaco e ao impedimento da cessação do tabagismo em idosos e destacam a importância de problemas emocionais nessa associação.

El objetivo de este estudio fue analizar la relación entre el aislamiento social y la soledad con el hábito de fumar en adultos mayores. Se trata de un estudio transversal basado en población, realizado con 986 individuos con 60 años o mayores. Los datos se recogieron de la Encuesta de Salud de la Ciudad de Campinas (ISACamp 2014/2015), estado de São Paulo, Brasil. Estimamos la prevalencia del hábito de fumar y dejar de fumar según variables independientes y probamos las asociaciones usando el test chi-cuadrado, considerando un nivel de significancia de un 5%. Se calcularon las ratios de prevalencia usando una regresión simple y múltiple de Poisson. Fumar y dejar de fumar no estuvieron asociadas con la mayor parte de variables que indican aislamiento social objetivo, mientras que informar soledad a menudo o siempre estuvo relacionado con una más alta prevalencia de tabaquismo (RP = 2,25; IC95%: 1,38-3,66). Soledad acompañada de problemas emocionales autoinformados o la presencia de desórdenes mentales comunes estuvo fuertemente asociado con el tabaquismo y con una menor prevalencia de dejar de fumar (RP = 6,24; IC95%: 1,37-28,47 y RP = 0,46; IC95%: 0,28-0,77, respectivamente). Estos resultados apoyan el papel de la soledad como un aspecto psicosocial relacionado con el consumo de tabaco y el impedimento de dejar de fumar en adultos mayores, además de subrayar la importancia de problemas emocionales en esta asociación.

Craving for heroin: difference between methadone maintenance therapy patients with and without ADHD / Fissura por heroína: diferença entre pacientes em terapia de manutenção com metadona com e sem TDAH

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder persisting in adulthood in 40-60% of cases. Clinical and neuroimaging studies suggest that patients affected by both drug addiction and ADHD show higher rates of craving for drug than patients without ADHD. We designed a pilot open-label study to investigate the effects of ADHD on craving for heroin in methadone maintenance therapy patients. Method Patients were recruited from outpatient facilities in an addiction treatment unit in the municipality of Alba, Italy. They were assessed using the Structured Clinical Interview for DSM-5 (SCID-5), the SCID-5 for Personality Disorders (SCID-5-PD), the Diagnostic Interview for Adult ADHD, second edition (DIVA 2.0), and the Clinical Opiate Withdrawal Scale (COWS). Categorical variables were examined using the chi-square test, and continuous variables, the t-test and Mann-Whitney's U test for normally and non-normally distributed data, respectively. Data distribution was evaluated using Shapiro-Wilk's test. Significance was set at p=0.05. Bonferroni correction was applied (0.0063) to avoid type I error. Results A total of 104 patients were included in the study: 14 affected by ADHD (13.5%) and 90 were not affected (86.5%). Patients with ADHD showed higher intensity of craving for heroin than patients without ADHD in the absence of withdrawal symptoms. Conclusion Drug addiction and ADHD share various neurobiological mechanisms that mutually influence the evolution of both disorders. In particular, dopamine dysfunction within various brain circuits may influence impulsivity levels, motivation, inhibitory control, executive functions, and behavior and, consequently, the intensity of craving.

Resumo Introdução O transtorno de déficit de atenção e hiperatividade (TDAH) é um transtorno do neurodesenvolvimento que persiste na idade adulta em 40-60% dos casos. Estudos clínicos e de neuroimagem sugerem que pacientes afetados tanto por adição quanto por TDAH apresentam maiores índices de fissura (craving) por droga do que pacientes sem TDAH. Este estudo piloto aberto investigou os efeitos do TDAH sobre fissura por heroína em pacientes em terapia de manutenção com metadona. Método Os pacientes foram recrutados em serviços ambulatoriais em uma unidade de tratamento de adição na cidade de Alba, Itália. Eles foram avaliados usando os seguintes instrumentos: Structured Clinical Interview for DSM-5 (SCID-5), SCID-5 for Personality Disorders (SCID-5-PD), Diagnostic Interview for Adult TDAH, second edition (DIVA 2.0) e Clinical Opiate Withdrawal Scale (COWS). Variáveis categóricas foram examinadas utilizando o teste do qui-quadrado, e variáveis contínuas, o teste t e o teste U de Mann-Whitney para dados com distribuição normal e não normal, respectivamente. A distribuição dos dados foi avaliada usando o teste de Shapiro-Wilk. O nível de significância foi estabelecido em p=0,05. A correção de Bonferroni foi aplicada (0,0063) para evitar erro tipo I. Resultados Um total de 104 pacientes foram incluídos no estudo: 14 com TDAH (13,5%) e 90 sem (86,5%). Pacientes com TDAH mostraram maior intensidade de fissura por heroína do que pacientes sem TDAH na ausência de sintomas de abstinência. Conclusão Adição e TDAH compartilham mecanismos neurobiológicos que influenciam mutuamente a evolução dos dois transtornos. Em particular, a disfunção da dopamina em vários circuitos cerebrais pode influenciar os níveis de impulsividade, motivação, controle inibitório, funções executivas e comportamento, e, portanto, a intensidade da fissura.

Patrones de consumo de heroína en una muestra de consumidores de Medellín - Colombia / Patterns of heroin use in a sample of consumers in Medellín - Colombia

INTRODUCCIÓN: En Colombia no existen estudios específicos de prevalencia de consumo de heroína. Este artículo evalúa los patrones de consumo de esta sustancia en un grupo de consumidores de la ciudad de Medellín y su área metropolitana, evidenciándose que el consumo empieza a ser una amenaza para la salud pública por las particulares formas de consumo, entre las que se incluyen prácticas de riesgo. OBJETIVO: Evaluar el consumo de heroína en la ciudad de Medellín y su área metropolitana. MÉTODOS: La investigación tuvo un enfoque mixto mediante el estudio de casos múltiples hasta saturar cada una de las variables y categorías propuestas. Se accedió a 42 consumidores de heroína de centros de tratamiento de la ciudad de Medellín y área metropolitana mediante la técnica de "bola de nieve", proceso que se realizó entre los meses de julio y septiembre de 2008. La información se recolectó mediante una entrevista estructurada, cara a cara, que consultó el tipo de heroína consumida, vías de administración, frecuencias de consumo, utensilios utilizados, prácticas de consumo y rituales que acompañan estas prácticas. Los datos cuantitativos se analizaron con el paquete estadístico EPI-Info 2.000 y los cualitativos con Atlas ti, versión 5.5, para Windows. RESULTADOS: Los consumidores eran predominantemente hombres, solteros, con edades comprendidas entre los 18 y los 23 años, sin hijos y muchos con estudios universitarios no terminados. Mayoritariamente se ubicaban en un estrato socioeconómico medio, tenían antecedentes familiares de consumo de sustancias psicoactivas y se iniciaron en el consumo de heroína entre los 15 y los 17 años. Tienen formas particulares de nombrar la heroína, los consumidores, y poseen rituales propios para consumir esta sustancia. En el artículo se presentan detalles de la heroína que consumen, la parafernalia y las prácticas asociadas a dicho consumo. CONCLUSIONES: El consumo de heroína es una realidad emergente en Colombia. Es necesario ahondar en estudios cuanti-cualitativos que nos permitan conocer y comprender más este fenómeno con el fin de disminuir su impacto en la salud pública.

INTRODUCTION: In Colombia, there are no specific studies on the prevalence of heroin use. This paper reviews the patterns of substance use in a consumer group in the city of Medellín and its metropolitan area, showing that consumption is becoming a threat to public health due to the particular forms of consumption, among which risk practices are included. OBJECTIVE: To evaluate the use of heroin in the city of Medellín and its metropolitan area. METHODS: The study took a mixed approach using multiple-case study to cover each of the variables and categories proposed; 42 heroin users of treatment centers in the city of Medellín and its metropolitan area were accessed between July and September 2008, using the "snowball", technique. Information was collected by a structured, face to face interview, asking about the type of heroin consumed, routes of administration, frequency of consumption, equipment used, consumption practices and rituals that accompany these practices. Quantitative data were analyzed using the EPI-Info statistical package 2,000 and Atlas ti qualitative, version 5.5, for Windows. RESULTS: Consumers were predominantly male, single, aged between 18 and 23 years, childless and many had not completed college. Most respondents were in the middle socioeconomic stratum, had a family history of psychoactive substance use and had started heroin use between 15 and 17 years. There are special forms to name heroine, consumers, and rituals to consume the substance. The article gives details of the heroin consumed, the paraphernalia and associated practices. CONCLUSIONS: The use of heroin is an emerging reality in Colombia. Qualitative-quantitative studies are necessary to allow us to acknowledge and understand more about this phenomenon in order to decrease the impact on public health.

Gender differences in drug use and sexual risk behaviors among non-injecting heroin users in Puerto Rico

INTRODUCTION: During the 1990s non-injected heroin use (NIHU) increased notably in several countries. However, very few studies have examined the drug-using practices and other problem behaviors of NIHUs. In this study, we compared male and female NIHUs from Puerto Rico across a number of domains. METHODS: Recruitment proceeded through visits to drug-copping areas and the local hangouts in their vicinity. Subjects were eligible if they were 18 to 25 years old, had never injected any drugs, and had recently used heroin or cocaine. Study participants were administered a computer-assisted personal interview. RESULTS: Of the 412 NIHUs recruited at the time of this study, 74 (18.0%) were females. Female NIHUs were more likely to report sexual assaults and more likely to manifest severe symptomatology of post-traumatic stress disorder than male NIHUs (35.1% vs. 3.6%, p<.01, and 40.5% vs. 25.7%, p=.01, respectively). Females were less likely to report a source of emotional support than males (86.5% vs. 95.3%, p<.01). Close to one in four of the females (23.0%) reported a history of sexually transmitted infections, compared to three percent of the males (p<.01). HIV seroprevalence among females was 4.3% compared to 0.6% among males (p=.01). DISCUSSION: Female heroin users seem to present a host of different needs compared to male heroin users. Given the scarcity of existing programs for female drug users in Puerto Rico, designing supportive systems that effectively address the specific needs of drug-using women should become a high-priority public health issue.

Non -injectable use of heroin: patterns and demographic characteristics of addicts in karachi, Pakistan

Current descriptive study on heroin addiction in Karachi, Pakistan is conducted to explore the patterns and socio-demographic characteristics of male addicts who belong to lower socioeconomic status. The sample of 100 heroin addicts was taken from two treatment centers of Karachi who are providing free of cost treatments. Detailed interviews were conducted according to the form developed by examiners and then this information was confirmed from the record of the treatment centers. Means, standard deviations and percentages were calculated by using SPSS [V.I2]. The results indicate that mean age of the sample was 36.41 [range-21-68 yrs.], 42% of addicts initiated drugs during the age of 16-20 years, Majority of data had gotten education till middle [34%] and 41% of addicts were middle born. 54% were married, 77% belonged to Joint family structure. 78% were employed, 92% had monthly income of less than 14000 Rs., 53% depend upon wage or salary. 17% reported the presence of a drug user in the family. Mean of total duration of drug use was 16.90 years [range=1-41 yrs.], Mean duration of Heroin use of our sample was 13.12 years [range=1-23 yrs.], majority [69%] of the sample use Heroin by smoking, reason for initiation of Drug use was found to be the friends and peer groups influences [57%], 80% were admitted in Rehabilitation centres for one to ten treatments in the past and 40% reported criminal history

Patrones de consumo de heroína en una cárcel de la frontera norte de México: barreras de acceso a tratamiento / Heroin consumption patterns in a northern Mexican border prison: obstacles to treatment access

OBJETIVO: Describir la prevalencia del consumo de heroína, los patrones de inicio, el alto consumo y la dependencia a esta sustancia e identificar barreras que impidan a los adictos acudir a tratamiento. MATERIAL Y MÉTODOS: El estudio se realizó en la cárcel de Ciudad Juárez, Chihuahua, México, entre abril y junio de 2000; los participantes se obtuvieron a través de un muestreo aleatorio simple, partiendo del censo del penal. Se identificaron las barreras al tratamiento, estimadas mediante un modelo de regresión logística. RESULTADOS: La prevalencia de consumo de heroína en los últimos seis meses fue de 26.4 por ciento; de 25.3 por ciento para usuarios fuertes; 95 por ciento fueron dependientes. El promedio de la edad de inicio del consumo fue a los 21 años. El modelo multivariado mostró que baja escolaridad, abstinencia, sobredosis, enfermedades crónicas y tiempo de exposición son barreras que impiden solicitar tratamiento. CONCLUSIONES: Las implicaciones de los resultados se discuten en función de aplicarlos para implantar programas de tratamiento en las cárceles

Social support in treatment-seeking heroin-dependent and alcohol dependent patients.

Social support is being recognized as a positive influence on health. It may influence motivation, treatment compliance and outcome in drug dependent patients. On the basis of clinical impression, it was hypothesized that social support in heroin (illicit drug) dependent patients is poorer than in alcohol dependent patients. The current study was undertaken to assess and compare the social support amongst treatment seeking alcohol dependent patients and heroin dependent patients. Despite lesser proportion of patients with any legal source of income in the heroin dependent subject group, the mean social support score across the two study groups was comparable. Overall, the mean social support scores were low in both the groups. The study provides some undestanding about the perceived social support amongst treatment seeking drug dependent individuals from India and also indicates the need to address the issue of social support in substance users.

Profile of heroin addicts in Nagaland, India.

A total of 395 drug addicts from Nagaland, India during 1992-1993 were studied. Of these, 331 (83.8%) were primary abusers of heroin. Mean age of the group was 21.8 years +/- SD 3.84. Of these 5.2% were females. The majority were unmarried (92.1%) and 52% had completed 10 years of schooling. Drug-related school dropout rate was 72.8%. Unemployment was predominant (90.3%) in the group, of which most were never employed. Christianity was the main religion (90.9%) of the group. The mean age at first use of heroin was 17.6 years +/- SD 3.68. The mean duration of dependence on heroin was 4.4 years +/- SD 2.8. Heroin was injected by 80.9% subjects. Friends were the main source of introduction. Concurrent use of tranquilizers and codeine containing cough syrups was prevalent in the event of a short supply of heroin. The involvement of young, unemployed, unmarried persons in heroin addiction; widespread prevalence of the injection route and needle sharing; chronicity of heroin dependence; paucity of specialized treatment avenues and proximity to the Golden Triangle facilitating illicit traffic, have contributed to emergence of heroin addiction as a major public health problem in Nagaland.

Epidemiologia del abuso de drogas en los Estados Unidos de América: Resumen de métodos y observaciones / Epidemiology of drug abuse in the United States: A summary of methods and findings

Epidemiology has recently been used to effectively track and analyze drug abuse patterns. This article generally describes methods used in the United States for estimating and monitoring drug abuse. It outlines the advantages and limitations of such data sources as surveys, indicators, and ethnography, and briefly explores the work and utility of local, national, and international drug surveillance networks. In addition, it describes national and local patterns for heroin, cocaine, and marijuana abuse