Relationship between optical coherence tomography findings and clinical variables in patients with opiate use disorder / Relação entre os achados da tomografia de coerência óptica e as variáveis clínicas em pacientes com transtorno por uso de opiáceos

ABSTRACT Purpose: This study aimed to examine optical coherence tomography findings in patients with opiate use disorder by comparing them with healthy controls. Methods: The study included 30 opiate use disorder patients and 30 controls. The participants' detailed biomicroscopic examinations, visual acuity, intraocular pressure, and both eye examinations were evaluated. A total of 120 eyes were evaluated using optical coherence tomography, measuring the central macular thickness, mean macular thickness, mean macular volume and retinal nerve fiber layer thickness. Moreover, all participants filled in the demographic data form and Barratt Impulsiveness Scale. Results: Upon examination of the optical coherence tomography findings, central macular thickness, mean macular thickness, and mean macular volume were thinner in both eyes in patients with opiate use disorder (p<0.01 in all measurements in both eyes). Similarly, the total values of the superior quadrant and retinal nerve fiber layer thickness were statistically significant in both eyes compared to that in the control group (p=0.007, p=0.002; p=0.049, p=0.007, in the right and left eyes, respectively). Only the left eye was positively correlated with retinal nerve fiber layer superior quadrant measurement and hospitalization (r=0.380, p=0.039). Conclusion: Our results revealed that the patients' central macular thickness, mean macular thickness, and mean macular volume values were thinner. Increase in the retinal nerve fiber layer thickness superior quadrant thickness and total value was also observed. Further studies with larger sampling groups that evaluate neuroimaging findings should be conducted.

RESUMO Objetivo: O objetivo foi investigar foi, os achados da tomografia de coerência óptica em pacientes com transtorno do uso de opiáceos, comparando-os com controles saudáveis. Métodos: O estudo incluiu 30 pacientes com transtorno do uso de opiáceos e 30 controles. Os exames biomicroscópicos detalhados de todos os participantes, acuidade visual, pressão intraocular e ambos os exames oculares foram avaliados com tomografia de coerência óptica. Um total de 120 olhos foram avaliados usando tomografia de coerência óptica, e a espessura macular central, espessura macular média, volume macular médio e a espessura da camada de fibra nervosa da retina dos participantes foram medidos. Além disso, todos os participantes preencheram o Formulário de Dados Demográficos e a Escala de Impulsividade Barratt (BIS-11). Resultados: Quando os achados de tomografia de coerência óptica foram examinados, espessura macular central, espessura macular média e volume macular médio eram mais finos de acordo com controles saudáveis em ambos os olhos em pacientes com transtorno do uso de opiáceos (p<0,01 em todas as medições em ambos os olhos). Da mesma forma, os valores totais do quadrante superior e espessura da camada de fibra nervosa da retina estavam mais em níveis estatisticamente significativos em ambos os olhos em comparação com o grupo controle (p=0,007, p=0,002; p=0,049, p=0,007, no olho direito e esquerdo, respectivamente). Estar internado em hospital e apenas a medida do quadrante superior da espessura da camada de fibra nervosa da retina do olho esquerdo associou-se positivamente (r=0,380, p=0,039). Conclusão: Em nossos resultados, descobrimos que os valores de espessura macular central, espessura macular média e volume macular médio dos pacientes eram mais finos. Verificamos também espessamento no quadrante superior e valor total da espessura da camada de fibra nervosa da retina. Nosso estudo deve ser apoiado por novos estudos com grupos de amostragem maiores, nos quais os achados de neuroimagem são avaliados.

Inconsistencia científica de los estudios que difunden los efectos paliativos de la marihuana o relativizan sus consecuencias nocivas / Scientific inconsistency of the studies that disseminate the palliative effects of marijuana or downplay its harmful consequences

Los países o territorios que legalizaron la marihuana o consideran hacerlo tienen que prevenir el aumento de las sobredosis por drogas; los resultados que ofrecen las experiencias de Estados Unidos -promocionadas con dudoso respaldo científico- se confirmaron equivocados. Las tendencias de mortalidad por opioides en los Estados Unidos, líder mundial tanto en mortalidad por opioides como en trastorno por consumo de cannabis, no acompaña la hipótesis que propone la disponibilidad de marihuana para reducir la mortalidad por opioides. Durante la última década, las tendencias de mortalidad por opioides del país en las jurisdicciones que legalizan y no legalizan la marihuana, sugieren lo contrario. Las personas de raza negra no hispanas y los hispanos en particular, necesitan ayuda para revertir las tendencias que pudieron facilitarse por la legalización de la marihuana.

Desafio do ensino e das competências em saúde no modelo psicossocial nos centros de atenção psicossocial álcool e drogas / Challenge of teaching and health skills in the psychosocial model in psychosocial care centers for alcohol and drugs

O objetivo deste artigo é apresentar a análise documental sobre a formação e a educação continuada e permanente de profissionais de saúde que atuam em Centros de Atenção Psicossocial - Álcool e Drogas. Trata-se de uma pesquisa com estratégias metodológicas mistas: a) análise de documentos governamentais sobre o ensino superior e a aprendizagem em serviço; b) entrevistas semiestruturadas com os profissionais; análise de conteúdos e triangulação dos dados. Entre os resultados identificaram-se alguns avanços no ensino superior em saúde e na educação permanente como as políticas setoriais. Concluiu-se que ainda é baixo o incentivo à educação continuada e permanente nos serviços e na efetividade do cuidado, causados pelas fragilidades da formação e ao reduzido investimento econômico nos serviços, dificultando a inclusão de tecnologias inovadoras necessárias ao implemento da política de saúde mental.

The objective of this study is to reflect on the higher education in health of the psychosocial model and the competences of professionals in the Psychosocial Care Centers for Alcohol and Drugs. The method was qualitative, through the theoretical study of government documents on higher education and in-service learning and empirical with interviews with professionals. Analyzed the contents and triangulated the results. Results show advances in higher education in health and permanent education through sectoral policies. However, the incentive in the reality of services and consequences in the effectiveness of care is still low. Weaknesses in training and service scenario make it difficult to include innovative technologies corresponding to mental health policy.

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Background: The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane's Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response. Aim: To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal.Setting: Three community-based COSUP sites in Mamelodi (Tshwane, South Africa). Methods: A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data. Results: Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants' median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol. Conclusion: Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists.

Psychosocially-Assisted Pharmacological Treatment of Opioid Dependent Adults: A Systematic Review

Background: Opioid dependence is a conundrum that significantly contributes to global mortality, crimes, and transmission of diseases such as hepatitis (B and C), human immunodeficiency virus and perhaps, coronavirus disease 2019 (COVID-19). There are contradictory findings on the efficacy of psychosocially-assisted pharmacological treatment of opioid dependence in adults. Objective: The overall objective of this research is to investigate if psychosocially-assisted pharmacological therapy has significantly better effect than pharmacological therapy with regards treatment outcomes of opioid dependent adults. Methods: All methods employed in this study are in conformity with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) framework for systematic review which involve identification, screening, eligibility and inclusion. This systematic review involved PubMed literature search on randomized controlled trials published between 1st January 2015 to 1st October 2021. Results: PubMed search yielded 5,216 articles which were screened using inclusion and exclusion criteria resulting in 19 articled being retained for data extraction. Of the 19 articles used in this study, 13 (68.4%) articles having a combined sample size of 1,928 (60.6%) showed that addition of psychosocial intervention to pharmacotherapy significantly improved abstinence from opioid abuse. Conclusion: The outcome of evaluation of the overall evidences presented in the 19 articles used in this study is that psychosocially-assisted pharmacological therapy is significantly better than pharmacological treatment with respect to enhancement of abstinence from opioid abuse among opioid-dependent adults. Additionally, this study has provided specific combinations of psychosocial and pharmacological treatment that can produce significant beneficial effect on opioid abstinence. The huge downturn in randomized controlled trials on treatment of opioid dependence among adults has been highlighted in this study.

Saúde mental, transtorno por uso de substâncias e transtorno por uso de opioides: atualizações e estratégias de tratamento / Mental health, substance use disorder, and opioid uses disorder: updates and strategies for treatment / Salud mental, trastorno por uso de sustancias y trastorno por uso de opioides: actualizaciones y estrategias de tratamiento

OBJETIVO: descrever as principais estratégias para abordar lacunas na identificação, tratamento e treinamento sobre saúde mental, transtorno do uso de substâncias (TUS) e transtorno do uso de opioides (TUO). MÉTODO: trata-se de uma revisão narrativa, a partir de artigos recentes e de publicações de instituições que abordam a temática da saúde mental e da dependência química reconhecidas internacionalmente. RESULTADOS: a prevalência de uso concomitante de substâncias e transtornos psiquiátricos/de saúde mental tem sido elevada e continua crescente, compondo problemas complexos que implicam em desafios de tratamento multifacetados, incluindo condições médicas, deficiências, falta de moradia, abandono de medicamentos e altas taxas de recaída. O tratamento de TUS's e TUO's são questões individualmente complexas. A combinação dos dois transtornos requer uma abordagem de diagnóstico e tratamento dedicada e multifacetada. CONCLUSÃO: como a prevalência de TUO's, TUS's e COD's continua a aumentar, enfermeiros e profissionais de saúde devem estar preparados para diagnosticar, tratar e/ou encaminhar os usuários para garantir o cuidado adequado e a recuperação a longo prazo dos indivíduos acometidos.

OBJECTIVE: to describe the main strategies to deal with gaps in the identification, treatment and training regarding substance use disorder (SUD), and opioid uses disorder (OUD). METHOD: this is a narrative review, based on recent articles and publications on mental health and substance use recognized internationally. RESULTS: a prevalence of co-occurring substance use and mental health/psychiatric disorders continue to rise and are considered complex problems, with multifaceted treatment challenges including medical conditions, disabilities, homelessness, medication noncompliance, and high relapse rates. The treatment for SUD and OUD are complex. The co-occurrence of these two disorders require a multifaceted approach for the diagnosis and treatment. CONCLUSION: the prevalence of SUD, OUD and their co-occurrence continue to rise and nurses and other health professionals should be prepared to diagnose, treat and/or refer users to assure their adequate care and long term recovery.

OBJETIVO: describir las principales estrategias para abordar las brechas en la identificación, tratamiento y capacitación en salud mental, trastorno por uso de sustancias (TUS) y trastorno por uso de opioides (TUO). MÉTODO: se trata de una revisión narrativa, basada en artículos y publicaciones recientes de instituciones reconocidas internacionalmente que abordan el tema de la salud mental y la dependencia química. RESULTADOS: la prevalencia del uso concomitante de sustancias y trastornos psiquiátricos/de salud mental ha sido alta y continúa creciente, lo que agrava problemas complejos que implican desafíos de tratamiento multifacéticos, que incluyen afecciones médicas, discapacidades, falta de vivienda, abandono del uso de medicaciones y elevadas tasas de recaída. El tratamiento de los TUS y TUO son problemas individualmente complejo. Una combinación de los dos requiere un enfoque de diagnóstico y tratamiento dedicado y multifacético. CONCLUSIÓN: como la prevalencia de TUO, TUS y COD sigue aumentando, las enfermeras y los profesionales de la salud deben estar preparados para diagnosticar, tratar y / o encaminar para garantizar la atención adecuada y la recuperación a largo plazo de las personas afectadas.

The future of precision medicine in opioid use disorder: inclusion of patient-important outcomes in clinical trials

Opioid use has reached an epidemic proportion in Canada and the United States that is mostly attributed to excess availability of prescribed opioids for pain. This excess in opioid use led to an increase in the prevalence of opioid use disorder (OUD) requiring treatment. The most common treatment recommendations include medication-assisted treatment (MAT) combined with psychosocial interventions. Clinical trials investigating the effectiveness of MAT, however, have a limited focus on effectiveness measures that overlook patient-important outcomes. Despite MAT, patients with OUD continue to suffer negative consequences of opioid use. Patient goals and personalized medicine are overlooked in clinical trials and guidelines, thus missing an opportunity to improve prognosis of OUD by considering precision medicine in addiction trials. In this mixed-methods study, patients with OUD receiving MAT (n=2,031, mean age 39.1 years [SD 10.7], 44% female) were interviewed to identify patient goals for MAT. The most frequently reported patient-important outcomes were to stop treatment (39%) and to avoid all drugs (25%). These results are inconsistent with treatment recommendations and trial outcome measures. We discuss theses inconsistencies and make recommendations to incorporate these outcomes to achieve patient-centered and personalized treatment strategies.

Opioid-induced immunosuppression and carcinogenesis promotion theories create the newest trend in acute and chronic pain pharmacotherapy

Opioids are the main group of pharmacological agents used during the perioperative period and provide a sedative and analgesic component. The observations of opioid consumption in West Europe indicate that this group of drugs is widely used in chronic noncancer pain therapy. Nearly 20 years ago, the first publications indicating that opioids, as an element of perioperative pharmacotherapy in oncologic patients, increase the risk of tumor recurrence and affect further prognosis were presented. The actual publications suggest that there are multifactorial, complex mechanisms underlying the immunological impact and carcinogenesis promotion of opioids and that the intensity varies depending on the type of opioid. There are also questions about the immunosuppressive effects among patients receiving opioids in the treatment of chronic noncancer pain. The aim of the review article is to present information about the action of opioids on the immune system in carcinogenic settings and to define the clinical usefulness of this pharmacological phenomenon.

Intra-nucleus accumbens shell injection of baclofen blocks the reconsolidation of conditioned place preference in morphine-addicted mice / 生理学报

Preclinical studies suggest that the GABA receptor is a potential target for treatment of substance use disorders. Baclofen (BLF), a prototypical GABA receptor agonist, is the only specific GABA receptor agonist available for application in clinical addiction treatment. The nucleus accumbens shell (AcbSh) is a key node in the circuit that controls reward-directed behavior. However, the relationship between GABA receptors in the AcbSh and memory reconsolidation was unclear. The aim of this study was to investigate the effect of intra-AcbSh injection of BLF on the reconsolidation of morphine reward memory. Male C57BL/6J mice were used to establish morphine conditioned place preference (CPP) model and carry out morphine reward memory retrieval and activation experiment. The effects of intra-AcbSh injection of BLF on morphine-induced CPP, reinstatement of CPP and locomotor activity were observed after environmental cues activating morphine reward memory. The results showed that intra-AcbSh injection of BLF (0.06 nmol/0.2 μL/side or 0.12 nmol/0.2 μL/side), rather than vehicle or BLF (0.01 nmol/0.2 μL/side), following morphine reward memory retrieval abolished morphine-induced CPP by disrupting its reconsolidation in mice. Moreover, this effect persisted for more than 14 days, which was not reversed by a morphine priming injection. Furthermore, intra-AcbSh injection of BLF without morphine reward memory retrieval had no effect on morphine-associated reward memory. Interestingly, administration of BLF into the AcbSh had no effect on the locomotor activity of mice during testing phase. Based on these results, we concluded that intra-AcbSh injection of BLF following morphine reward memory could erase morphine-induced CPP by disrupting its reconsolidation. Activating GABA receptor in AcbSh during drug memory reconsolidation may be a potential approach to prevent drug relapse.

Effect of opium addiction on postoperative arrhythmia among patients undergoing cabg operation on cardiopulmonary bypass

Abstract Objectives: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.

MicroRNA-132 in the Adult Dentate Gyrus is Involved in Opioid Addiction Via Modifying the Differentiation of Neural Stem Cells / 神经科学通报·英文版

MicroRNA-132 (miR-132), a small RNA that regulates gene expression, is known to promote neurogenesis in the embryonic nervous system and adult brain. Although exposure to psychoactive substances can increase miR-132 expression in cultured neural stem cells (NSCs) and the adult brain of rodents, little is known about its role in opioid addiction. So, we set out to determine the effect of miR-132 on differentiation of the NSCs and whether this effect is involved in opioid addiction using the rat morphine self-administration (MSA) model. We found that miR-132 overexpression enhanced the differentiation of NSCs in vivo and in vitro. Similarly, specific overexpression of miR-132 in NSCs of the adult hippocampal dentate gyrus (DG) during the acquisition stage of MSA potentiated morphine-seeking behavior. These findings indicate that miR-132 is involved in opioid addiction, probably by promoting the differentiation of NSCs in the adult DG.

Visual and Auditory Reaction Times of Patients with Opioid Use Disorder

OBJECTIVE: Reaction time is defined as the time from the start of a stimulus to the start of the voluntary movement. Time plays an important role in undertaking daily living activities. Reaction time is an important factor in respect of both quality of life and of capabilities demonstrated in the work environment. Alcohol and some addictive substances have effect on RT. The aim of this study was to compare the visual and auditory reaction times of patients with opioid use disorder with healthy control subjects. METHODS: The study was applied to two groups as the opioid use disorder group and the control group. A Sociodemographic and Clinical Data Form was prepared for each patient including age, gender, marital status and education level. Using a computer program the response to visual screen color change (red/blue) and to an auditory ‘beep’ sound of the computer system were recorded. The Student’s t-test was applied as a statistical method. RESULTS: The results showed longer reaction times in the patients with opioid use disorder. CONCLUSION: To add improving reaction time approaches in opioid use disorder treatment may contribute to treatment by increasing quality of life and work performance.

Successful Treatment with Transdermal Buprenorphine Patch in Opioid-Dependent Cancer Patients: Case Series / 한국호스피스완화의료학회지

Opioid aberrant behavior is an emerging problem as strong opioid is increasingly used to alleviate cancer pain in patients with cancer. Although the treatment of opioid addiction and physical dependence for non-cancer pain is well known, few studies have been conducted with cancer patients, particularly in the Korean population. Presented here are ten cases of cancer patients who were physically dependent on strong opioid and successfully treated with a partial mu-opioid receptor agonist, buprenorphine. This is the first report showing the efficacy of transdermal buprenorphine as a treatment for physical dependence on opioid medication in cancer patients.

Cuidado de mulheres usuárias de crack na gestação: revisão bibliográfica / Healthcare of women crack users during pregnancy: bibliographic review / Cuidado de mujeres usuarias de crack en la gestación: revisión bibliográfica

OBJETIVO: levantar e analisar as contribuições da literatura relacionadas à temática. MÉTODO: foi realizada uma revisão integrativa, nas bases de dados Lilacs e Pubmed, considerando estudos publicados entre 2006 e 2017, nos idiomas português, inglês e espanhol, a partir do cruzamento dos descritores: Redução de Danos; Cocaína; Crack; Gestação. RESULTADOS: as bases de dados exibiram baixa quantidade de estudos, sendo encontradas somente 30 publicações. CONCLUSÃO: a literatura levantada prioriza a análise epidemiológica do fenômeno e as consequências do uso de drogas no concepto, porém pouco explora estratégias de cuidado clínico e psicossocial.

OBJECTIVE: to raise and analyze the literature contributions related to this theme. METHOD: an integrative review was performed in the Lilacs and Pubmed databases, considering studies published between 2006 and 2017, in Portuguese, English and Spanish languages, from the intersection of the descriptors: harm reduction, Cocaine, Crack and Gestation. CONCLUSION: the scientific literature prioritizes the epidemiological analysis of the phenomenon and the consequences of drug use in the concept, but little explores strategies of clinical and psychosocial care.

OBJETIVO: levantar y analizar las contribuciones de la literatura relacionadas con la temática. MÉTODO: se realizó una revisión integrativa, en las bases de datos Lilacs y Pubmed, considerando estudios publicados entre 2006 y 2017, en los idiomas portugués, inglés y español, a partir del cruce de los descriptores: reducción de daños, Cocaína, Crack y Gestación. CONCLUSIÓN: la literatura científica prioriza el análisis epidemiológico del fenómeno y las consecuencias del uso de drogas en el concepto, pero poco explora las estrategias de atención clínica y psicosocial.

Acupuncture and the Opioid Epidemic in America / 中国结合医学杂志

The opioid epidemic has become a signifificant public health crisis in the United States of America. This crisis has elicited a response at high levels of governmental and health care organizations including the American College of Physicians, the Food and Drug Administration, the Joint Commission, the National Academies of Science, Engineering and Medicine, the National Association of Attorneys General, and the White House. In various ways, these organizations have recognized that acupuncture can play an important role in dealing with the opioid epidemic. This paper presents and analyzes the scientifific evidence supporting the effificacy of acupuncture in regard to opioid addiction.

Consumo de drogas: reporte por tarjeta de enfermedad de declaración obligatoria. Municipio Plaza de la Revolución / Drugs consumption: Report on compulsory disease declaration card

Introducción:El consumo de sustancias psicoactivas es considerado un serio problema por su impacto negativo sobre la salud, la economía, la convivencia familiar y social. Objetivo: Identificar las características comportamentales relacionadas con el consumo de sustancias psicoactivas en pacientes del municipio Plaza de la Revolución. Material y Métodos: Investigación descriptiva de corte transversal en los 71 pacientes residentes en el municipio, reportados por tarjeta EDO durante el período 2013- 2015 por trastornos relacionados con el consumo de sustancias psicoactivas. Se aplicó una encuesta y una entrevista semiestructurada, previo consentimiento informado de los pacientes. Resultados: El 87.4 por ciento de los encuestados pertenecía al sexo masculino donde primaron personas en edades entre 20 y 29 años. La mayoría de las féminas eran adolescentes contando con una menor de solo 13 años. Primó el diagnóstico de abuso a múltiples sustancias siendo la marihuana, el alcohol y los fármacos los más usados. Los cuadros de intoxicación aguda fueron en su mayoría provocados por psicofármacos. Los monoconsumidores menores de 21 años prefirieron los cannabinoides sintéticos, los de mayor edad el crack. Elevada prevalencia de tabaquismo en los pacientes con incremento del consumo de cigarrillos cuando ingerían bebidas alcohólicas. Los encuestados tenían escasa percepción de riesgo del uso de la marihuana. El mayor número de reportes fue realizado por el Departamento de salud mental del municipio. Conclusiones: Teniendo en cuenta el consumo de múltiples sustancias encabezadas por la marihuana así como el uso de nuevas drogas de síntesis fundamentalmente en adolescentes y adultos jóvenes se trazaron estrategias por el equipo de salud mental(AU)

Introduction: The consumption of psychoactive substances is considered a serious problem because of its negative impact on health, economy, and family and social coexistence. Objective: To identify the behavioral characteristics related to the consumption of psychoactive substances in patients of Plaza de la Revolución Municipality. Material and methods: A descriptive cross-sectional investigation was conducted in 71 patients who live in the municipality, and were reported by compulsory disease declaration cards presenting disorders related to the consumption of psychoactive substances during the 2013-2015 period. A survey and a semi-structured interview were both applied, with a previous informed consent given by the patients. Results: the 87 percent of the inquired people were male, most of them aged 20 - 29 years. Most women were adolescents, including an underage who was only 13 years old. The aspect of great importance was the diagnosis of multiple substance abuse, being Marijuana, alcohol, and medications the most used ones. The cases of acute intoxication were mainly caused by psychopharmaceutical drugs. Monoconsumers younger than 21 years of age preferred the synthetic cannabinoids, and the older ones preferred the crack. There was a high prevalence of smoking in patients with increased cigarette consumption when they were drinking alcohol. The inquired people had a little risk perception of using Marijuana. The greatest number of reports was carried out by the Department of Mental Health of the municipality. Conclusions: Some strategies were developed by the mental health team, considering the consumption of multiple substances headed by Marijuana, as well as the use of new synthetic drugs which were mainly consumed by adolescents and young adults(AU)

Prevenção começa em casa: contribuições da neurociência / Preventions starts at home: contributions from neuroscience / La prevención comienza en casa: aportaciones de la neurociencia

O aumento do uso de drogas e de outros comportamentos que também provocam dependência é evidente no mundo contemporâneo, assim como a dificuldade no tratamento das dependências. Os achados da neurociência podem contribuir, dando subsídios para a prevenção dessa patologia. O presente trabalho aborda a importância do processo de tomada de decisão nas dependências, enfocando o cérebro do adolescente, e enfatiza o papel da intersubjetividade no desenvolvimento. Estudos recentes que descrevem alterações epigenéticas relacionadas a adversidades sofridas na vida precoce são apresentados, assim como dados que mostram que algumas alterações podem ser revertidas por meio da qualidade do vínculo com o cuidador. A prevenção é discutida como ação que começa com a humanização dos arquétipos da grande mãe e do pai, e continua vida afora, uma vez que as adversidades podem contribuir para gerar sintomas ou resiliência, dependendo da intensidade do agente estressor, da maturidade do sistema nervoso e da relação entre criança e cuidador, quer sejam eles pais, parentes, professores, amigos, analistas, enfim, pessoas com as quais seja possível estabelecer uma relação significativa.

The increase of drug abuse and of other behaviors that can lead to addiction are evident in contemporary world, as well as the difficulties related to addiction treatment. Neuroscience data can contribute to the prevention of this pathology. The present paper shows the importance of the decision-making process in addiction, focusing in the adolescent brain and emphasizing the role of intersubjectivity in the development. Recent studies describing epigenetic alterations related to early life adversities are presented, including data revealing that some alterations can be reverted by the quality of the bond with the caregiver. Prevention is discussed as an action that begins at home with the humanization of the great mother and the father archetypes and continues throughout life, once adversities can contribute to generate symptoms or resilience, depending on the stress intensity, the maturity level of the nervous system and the relationship between the child and the caregiver, being them parents, educators, friends, analysts or whoever the child can establish a significant relationship with.

El aumento del uso de drogas y otras conductas que causan dependencia es evidente en el mundo contemporáneo, así como las dificultades relacionadas con el tratamiento de las adicciones. Los datos de la neurociencia pueden contribuir a dar subsidios para prevenir esta patologia. El presente trabajo muestra la importancia del proceso de intersubjetividad en el desarrollo. Se presentan estudios recientes que describen alteraciones epigenéticas relacionadas con las adversidades sufridas en la vida temprana y se incluyen datos que revelan que algunas alteraciones pueden ser revertidas por la calidad de vínculo con el cuidador. La prevención se discute como una acción que comienza en casa con la humanización de los arquetipos de la grande madre y del padre y continúa a lo largo de la vida, ya que las adversidades pueden contribuir a generar síntomas o resiliencia, dependiendo de la intensidad del estresor, la madurez del sistema nervioso y la relación entre el niño y su cuidador, sean padres, educadores, amigos, analistas o cualquier otra persona con la que el niño pueda establecer una relación significativa.

Profissionais de enfermagem e a internação psiquiátrica em hospital geral: percepções e capacitação profissional / Nursing professionals and psychiatric admission in general hospital: perceptions and professional training / Profesionales de enfermería y la internación psiquiátrica en hospital general: percepciones y capacitación profesional

Objetivando verificar como a equipe de enfermagem percebe a internação psiquiátrica no hospital geral e identificar sua capacitação profissional para lidar com a pessoa com transtorno mental e/ou que fazem uso prejudicial de álcool e outras drogas, desenvolveu-se este estudo qualitativo. A coleta de dados ocorreu nos meses de maio a julho de 2016, em hospital geral do estado de Minas Gerais e participaram 31 profissionais de enfermagem. Utilizou-se a entrevista semiestruturada para a obtenção dos dados que foram submetidos à análise de conteúdo e análise temática. Verificou-se que os participantes têm dificuldades em aceitar a internação psiquiátrica no hospital geral, o que se relaciona à possível inaptidão para oferecer cuidados direcionados à pessoa com transtorno mental. Sendo assim, faz-se necessário o desenvolvimento de planejamento educativo, sobretudo para os técnicos de enfermagem, com vistas a qualificá-los para cuidar dessas pessoas (AU).

Qualitative study aimed to investigate how the nursing staff perceives psychiatric care beds in a general hospital and assess whether they are capable toassist people with mental disorders. Data was collected from May to July 2016, in a general hospital in the state of Minas Gerais and 31 nurses participated in the study. Semi-structured interviews were used to collect information, and the data obtained was subsequently submitted to content and thematic analysis. It was found that the participants felt uncomfortable withpsychiatric beds in the general hospital, which may be related to their lack of skills to provide care for people with mental disorders. Therefore, it is necessary to develop educational planning, especially for nursing technicians, in order to make them able to assist these patients (AU).

Se objetivó verificar como es percibida la internación psiquiátrica en hospital general por parte del equipo de enfermería, y verificar su capacitación para encargarse de personas con trastorno mental y/o que hacen uso perjudicial de alcohol y otras drogas. Estudio cualitativo cuyos datos fueron recolectados de mayo a julio de 2016, en hospital general de Minas Gerais, participaron 31 profesionales de enfermería. Se aplicó entrevista semiestructurada para obtención de los datos, sometidos a análisis de contenido y análisis temático. Se verificó que los participantes tenían dificultades para aceptar la internación psiquiátrica en el hospital general, lo cual está relacionado con la posible ineptitud para brindar cuidados dirigidos a personas con trastorno mental. Siendo así, resulta necesario el desarrollo de planificación educativa, particularmente para los técnicos de enfermería, a fin de calificarlos para brindar cuidados a estas personas (AU).