Executive functions and emotion regulation in substance use disorder / Funções executivas e regulação emocional no transtorno por uso de substâncias

OBJECTIVE: The executive functions (EF) and emotion regulation (ER) and their relationship with the substance use disorder (SUD) were analyzed. METHODS: A cross-sectional design was used. The sample consisted of 130 volunteers divided into three groups: group 01 (n = 60), composed of participants who did not meet the diagnostic criteria for any type of SUD; group 02 (n = 51), with users with alcohol and/ or tobacco use disorder; group 03 (n = 19), with users with multiple substance use disorder, including at least one illicit substance. RESULTS: Group 02 presented worse performance in EF and ER when compared to group 01, and showed a significant correlation between the working memory and the use of maladaptive ER. Group 03 showed great losses in EF and ER when compared to the other groups. CONCLUSION: This study supports the idea that EF, ER and SUD are related. In addition, it was observed that people with SUD had worse performance in EF and ER when compared to people without SUD, greater damage being observed in people with SUD of polysubstances.

OBJETIVO: Analisaram-se as funções executivas (FE) e a regulação emocional (RE) e a sua relação com o transtorno por uso de substâncias (TUS). MÉTODOS: Utilizou-se um delineamento transversal. A amostra foi composta por 130 voluntários, divididos em três grupos: grupo 01 (n = 60), composto pelos participantes que não preenchiam os critérios diagnósticos para nenhum tipo de TUS; grupo 02 (n = 51), com os entrevistados com TUS de álcool e/ou cigarro; grupo 03 (n = 19), com os voluntários com TUS de polissubstâncias, incluindo pelo menos uma substância ilícita. RESULTADOS: O grupo 02 apresentou pior desempenho nas FE e na RE, quando comparado ao grupo 01, e exibiu uma correlação significativa entre a memória de trabalho e o uso de RE desadaptativa. O grupo 03 apresentou maior prejuízo nas FE e na RE, quando comparado aos demais grupos. CONCLUSÃO: Este estudo apoia a ideia de que as FE, a RE e o TUS estão relacionados. Além disso, observou-se que as pessoas com TUS apresentaram pior desempenho nas FE e na RE, quando comparadas com as pessoas sem o TUS, sendo as com TUS de polissubstâncias com maior prejuízo.

Revisão integrativa sobre os efeitos do uso de crack no ciclo reprodutivo, gravídico-puerperal e na infância em longo prazo / Integrative review on the effects of crack use on the reproductive, gravidic-puerperal cycle and long-term childhood

Este estudo buscou analisar obras e publicações latino-americanas e caribenhas sobre os efeitos do consumo de crack no ciclo reprodutivo da mulher, gravídico-puerperal e na infância. Trata-se de uma revisão integrativa norteada pela questão: quais são os efeitos do consumo de crack no ciclo reprodutivo, na fisiologia da gravidez, do parto e do puerpério, no desenvolvimento físico e neurofisiológico do embrião/feto e neurocomportamental do neonato e da criança em longo prazo? A busca foi realizada na base de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde e na Scientific Electronic Library Online por meio da palavra crack isolada e associada a outras palavras em equações de busca. Os critérios de inclusão foram: texto completo, de qualquer natureza, entre janeiro de 2010 e julho de 2020, em inglês, português e espanhol. Duplicatas, na base de dados e na biblioteca e entre a base de dados e a biblioteca, foram rejeitadas, assim como publicações indexadas inadvertidamente à palavra-chave crack. A amostra final constituiu-se por 19 artigos de um total de 825 publicações. A revisão não resultou em uma síntese que apresentasse evidências de alta qualidade sobre os efeitos do uso de crack no ciclo reprodutivo, gravídico-puerperal e na infância em longo prazo e nem sobre as razões desses efeitos e fatores interferentes. À vista disso, permanecem as evidências geradas no período anterior ao estipulado por esta revisão que indicam algum tipo de uso e de abuso de crack por mulheres/gestantes e de piores desfechos maternos, perinatais e neonatais.

This study aimed to analyze Latin American and Caribbean works and publications on the effects of crack use on the reproductive cycle of women, pregnancy, and childbirth. This is an integrative review guided by the question: what are the effects of crack use on the reproductive cycle, physiology of pregnancy, childbirth and puerperium, physical and neurophysiological development of the embryo/fetus, and neurobehavioral development of the newborn and child in the long run? The search was carried out on the database of the Latin American and Caribbean Literature in Health Sciences and in the Scientific Electronic Library Online using the word crack alone and associated with other words in search equations. Inclusion criteria were full text of any nature, between January 2010 and July 2020, in English, Portuguese, and Spanish. Duplicates, in the database and in the library and between the database and the library, were rejected, as t h e y were publications inadvertently indexed to the keyword crack. The final sample consisted of 19 articles from a total of 825 publications. The review did not result in a synthesis that presented high-quality evidence on the long-term effects of crack use on the reproductive, pregnancy-puerperal, and childhood cycles, nor on the reasons for these effects and interfering factors. Thu s, the evidence generated in the period prior to that stipulated by this review remains, indicating some type of use and abuse of crack by women/pregnant women and worse maternal, perinatal, and neonatal outcomes.

O circuito dos afetos na drogadição: uma explicação alternativa para a servidão às drogas / El circuito de los afectos en la drogadicción: una explicación alternativa para la servidumbre a las drogas / The circuit of affects in drug addiction: an alternative explanation for the servitude to drugs

Apresentamos uma explicação alternativa para a noção de drogadição, refletindo sobre os motivos que levam uma pessoa a perseverar no consumo de drogas, mesmo sabendo dos malefícios decorrentes. Referenciado pelas obras de Humberto Maturana e pela teoria dos afetos na Ética de Spinoza, assumimos o pressuposto de que os seres humanos são movidos por paixões e formulamos o circuito dos afetos da drogadição. Identificamos nesse circuito três complexos afetivos: complexo singular pessoal, complexo de alívio/oblívio e complexo psicossocial, que formam uma dinâmica espiral de afetos tristes. Tais afetos compelem o indivíduo a continuar nessa dinâmica, e o papel das drogas passa a ser acessório. Cada complexo afetivo é caracterizado por afetos de origens distintas e a compreensão da particularidade e da especificidade de cada um organiza a ação de cuidado correspondente, a fim de interromper a dinâmica espiral do circuito. (AU)

Presentamos una explicación alternativa para la noción de drogadicción, reflexionando sobre los motivos que llevan a una persona a perseverar en el consumo de drogas, incluso sabiendo de los perjuicios que causan. Referenciado por las obras de Humberto Maturana y por la teoría de los afectos en la Ética de Spinoza, asumimos la presuposición de que los seres humanos son movidos por pasiones y formulamos el circuito de los afectos de la drogadicción. En ese circuito identificamos tres complejos afectivos: complejo singular personal, complejo de alivio/olvido y complejo psicosocial que forman una dinámica espiral de afectos tristes. Tales afectos compelen al individuo a continuar en esa dinámica y el papel de las drogas pasa a ser accesorio. Cada complejo afectivo se caracteriza por afectos de orígenes distintos y la comprensión de la particularidad y de la especificidad de cada uno organiza la acción de cuidado correspondiente, de forma que interrumpa la dinámica espiral del circuito. (AU)

We present an alternative explanation for drug addiction, reflecting on the reasons that lead a person to persevere in drug consumption despite knowing the harm that this consumption brings. Based on the works by Humberto Maturana and on the theory of affects in Spinoza's Ethics, we assume that human beings are moved by passions and formulate the circuit of affects of drug addiction. In this circuit, we have identified three affective complexes: the singular personal complex, the relief/oblivion complex, and the psychosocial complex, which form a spiral dynamics of sad affects. Such affects impel the individual to continue in this dynamics, and drugs play only an accessory role. Affects from different origins characterize each affective complex and understanding their particular and specific features guides the corresponding care action, in order to interrupt the spiral dynamics of the circuit. (AU)

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

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

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

Because of the baby: reduction on drug use during pregnancy / Por causa do bebê: redução do uso de drogas por gestantes

Abstract Objectives: evaluate changes in the use of psychoactive substances (PAS) throughout pregnancy. Methods: longitudinal study, with pregnant women users of PAS at a prenatal follow-up. Results: 76 pregnant women used: tobacco (84.2%, n=64), alcohol (73.7%, n=56), cocaine (27.6%, n=21), marijuana (26.3%, n=20) and crack (13.1%, n=10). Spontaneous interruption had occurred in 60% (n=6) of crack users, 57.1% (n=12) of cocaine and 50% (n=28) of alcohol. After the Brief Intervention, 78.9% (15 of the total of 19) of alcohol users and 70% (7 of the total of 10) of marijuana users discontinued the consumption and there was a reduction in smoking cigarettes. Conclusions: the spontaneous reduction in the consumption of PAS and after the interventions, pregnancy is a window of opportunity to reduce the use of drugs.

Resumo Objetivos: avaliar mudanças no uso de substâncias psicoativas (SPA) durante a gravidez. Métodos: estudo longitudinal, com gestantes usuárias de SPA em seguimento pré-natal. Resultados: 76 gestantes, que utilizavam: tabaco (84,2%, n=64), álcool (73,7%, n=56), cocaína (27,6%, n=21), maconha (26,3%, n=20) e crack (13,1%, n=10). Houve interrupção espontânea em 60% (n=6) das usuárias de crack, 57,1% (n=12) de cocaína e 50% (n=28) de álcool. Após Intervenção Breve, cessaram o consumo 78,9% (15 do total de 19) das usuárias de álcool e 70% (7 do total de 10) de maconha, e as tabagistas diminuíram o número de cigarros. Conclusões: a redução do consumo de SPA espontânea e após intervenções reforçam a gravidez como janela de oportunidade para abordagem do uso de drogas.

Estudio transversal de las características y factores asociados a la evolución clínica de pacientes hospitalizados en una unidad de psiquiatría infanto-juvenil pública en Chile / A cross-sectional study on the characteristics and factors associated with the clinical course of child and adolescent patients hospitalized in a public child and adolescent psychiatric unit of Chile

INTRODUCCIÓN: La Unidad de Corta Estadía Infanto-juvenil del Hospital Psiquiátrico del Salvador (Valparaíso, Chile) y sus pacientes poseen características clínicas y sociales diferentes a las reportadas por la escasa literatura nacional al respecto. OBJETIVOS: Describir el funcionamiento la unidad, las características sociofamiliares y clínicas de sus pacientes y analizar los factores asociados a su evolución clínica. MÉTODOS: Estudio transversal que describió el universo de pacientes hospitalizados durante tres años. Las variables se recogieron desde una base de datos anonimizada. Se evaluó la evolución clínica dentro del año posterior al egreso hospitalario. RESULTADOS: El modelo de atención de la unidad presenta los componentes biomédico, psicodinámico y ecológico. Se analizaron 98 pacientes, 70,4% hombres, con edad promedio de 11,5 ± 2,3 años. Un 82,6% perteneció al nivel socioeconómico bajo y 35,7% estaba desescolarizado; 98,9% presentó disfunción familiar y 91,8% de los padres portaba alguna psicopatología. Los motivos de ingreso más frecuente fueron riesgo de hetero y autoagresión. Los diagnósticos de egreso más frecuente fueron trastornos de conducta, depresivos y del desarrollo de la personalidad. El tiempo de estadía promedio fue de 41,8 ± 31,1 días. Los fármacos más utilizados fueron antipsicóticos y estabilizadores del ánimo. Un 47% tuvo una buena evolución clínica, 27% regular y 26% insatisfactoria. El único factor que se asoció a esta última fue haber tenido prescrito un antidepresivo durante la hospitalización. El factor que consistentemente se vinculó al reingreso a lo largo de un año, fue el haber presentado trastorno por consumo de sustancias. El abandono a tratamiento se relacionó con haber presentado un trastorno de conducta al egreso hospitalario y a tener padres con antecedente de suicidio o suicidio consumado. CONCLUSIONES: El perfil de pacientes de esta unidad corresponde a pacientes de nivel socioeconómico bajo, psicopatología severa, conducta desadaptativa, disfunción familiar y frecuente psicopatología parental. El trastorno por consumo de sustancias es un factor significativamente asociado al reingreso hospitalario.

INTRODUCTION: Patients of the Short-stay Child and Adolescent Unit of the Del Salvador Psychiatric Hospital (Valparaíso, Chile) exhibit different clinical and social characteristics compared to literature reports of other national centers, although published data are scarce. OBJECTIVES: To describe the operation of the Unit, the socio-familial and clinical characteristics of its patients and analyze factors associated with their clinical evolution. METHODS: We performed a cross-sectional study to describe the patients hospitalized over a three-year period. Variables were registered in an anonymized database. Clinical evolution was evaluated over the year following hospital discharge. RESULTS: The Unit's model of care can be described as involving biomedical, psychodynamic, and ecological components. We included 98 patients, of which 70.4% were male, and the average age was 11.5 ± 2.3 years. 82.6% were of low socioeconomic status, and 35.7% did not attend school; 98.9% presented family dysfunction, and 91.8% of parents had a history of psychopathology. The most frequent reason for admission was the risk of harm to self or others. The most frequent discharge diagnoses were behavioral, depressive, and personality development disorders. The average length of stay was 41.8 ± 31.1 days. The most commonly used pharmacological agents were antipsychotics and mood stabilizers. Regarding clinical evolution in the first year post-discharge, 47% were evaluated as positive, 27% regular, and 26% unsatisfactory. The factor associated with an unsatisfactory clinical course was having had in-patient antidepressants. Re-admission during the first year post-discharge was associated with comorbid substance use disorder. Treatment noncompliance was associated with a history of behavioral disorder at hospital discharge and having parents with a history of suicide or consummated suicide. CONCLUSIONS: The patient profile is one of low socioeconomic status, severe psychopathology, maladaptive behavior, family dysfunction, and parental psychopathology. Substance use disorder is also associated with readmission.

Productos intermedios de la cocaína: la pasta base o "paco" / Intermediate products of cocaine: the base paste or "paco"

El uso indebido de drogas se ha convertido en un grave problema a nivel mundial. En los últimos años, en nuestro país se ha incrementado en más del 200% el consumo de pasta base de cocaína (paco). A pesar de que el paco es un producto intermedio en la obtención de cocaína, y que muchos de sus efectos son atribuibles al contenido de esa droga, su consumo produce un cuadro clínico claramente distinto al observado en los consumidores de clorhidrato de cocaína, lo cual puede estar relacionado con su impureza. Sin perjuicio del gran impacto social producido por el consumo de paco, poco se sabe sobre su composición química y menos aún sobre sus efectos crónicos en los distintos órganos ni sobre su fisiopatología. Si bien existe material de autopsia de adictos al paco, los hallazgos están contaminados por la coexistencia en un mismo paciente de múltiples tóxicos. Urge la formación de grupos multidisciplinarios, con moderna tecnología para enfrentar este gravísimo flagelo. (AU)

Drug abuse has become a serious problem worldwide. In recent years, in our country the consumption of cocaine base paste (Paco) has increased by more than 200%. Despite of the fact that Paco is an intermediate product in the manufacture of cocaine, and that many of its effects are attributable to its content, its consumption produces a clearly different clinical picture than that observed in cocaine hydrochloride users, which It may be related to the impurity of this drug. Without prejudice to the great social impact produced by the consumption of this drug, little is known about its chemical composition and even less about its chronic effects on the different organs or its pathophysiology. Although there is an autopsy material for drug addicts, the findings are contaminated by the coexistence of multiple toxins in the same patient. The formation of multidisciplinary groups is urgent, with modern technology to face this very serious scourge. (AU)

Drug use influence on mindfulness among nursing students / Influencia del consumo de drogas en la atención plena entre los estudiantes de enfermería / Influência do uso de drogas na atenção plena entre estudantes de enfermagem

ABSTRACT Objective: To assess the association between the presence of drug use and the dimensions of mindfulness in a population of students of technical education in nursing. Method: Correlational study conducted in a teaching institution in the inlands of the state of São Paulo, in 2017. Participants were 135 students for which the ASSIST questionnaire with personal characterization data and the Mindfulness Five-facet Questionnaire were applied. Data were analyzed with use of descriptive and analytical statistics. Results: The most used drugs were alcohol, tobacco and cannabis. The lowest score for mindfulness was 49 and the maximum was 171 points. There was a positive association between the presence of drugs in the three previous months and the "non-reactivity to internal experience" facet (p=0.004). Conclusion: Although the association seems to be in line with the precepts of mindfulness, this fact cannot be considered positive if analyzed separately from the other concepts of mindfulness. Descriptors: Mindfulness; Substance Use Disorders; Nursing Students; Technical Education in Nursing; Mental Health.

RESUMEN Objetivo: Verificar la asociación entre la presencia del consumo de drogas y las dimensiones de la atención plena en una población de estudiantes de educación técnica de enfermería. Método : Investigación correlacional realizada en una institución de enseñanza en el interior de São Paulo, en 2017. Participación de 135 estudiantes para quienes se aplicó el cuestionario ASSIST con datos de caracterización personal y el cuestionario de cinco facetas de Mindfulness. Los datos se sometieron a estadísticas descriptivas y analíticas. Resultados: Las drogas más utilizadas fueron el alcohol, el tabaco y el cannabis. La puntuación más baja para mindfulness fue 49 y la máxima fue de 171 puntos. Hubo una asociación positiva entre la presencia de drogas en los últimos tres meses y la faceta "no reaccionar a la experiencia interna" (p=0.004). Conclusión: Aunque la asociación parezca estar en línea con los preceptos de mindfulness, este hecho no puede considerarse positivo si se analiza por separado de otros conceptos de la atención plena. Descriptores: Atención Plena; Trastornos por Uso de Sustancias; Estudiantes de Enfermería; Educación Técnica en Enfermería; Salud Mental.

RESUMO Objetivo: Verificar a associação da presença do uso de drogas com as dimensões da atenção plena em uma população de estudantes do ensino técnico em enfermagem. Método: Estudo correlacional, realizado em uma instituição de ensino do interior paulista, em 2017. Participaram 135 alunos para os quais foi aplicado o questionário ASSIST com dados de caracterização pessoal e o Questionário das Cinco Facetas do Mindfulness. Os dados foram submetidos à estatística descritiva e analítica. Resultados: As drogas mais utilizadas foram álcool, tabaco e maconha. O menor escore obtido para a atenção plena foi de 49 e o máximo de 171 pontos. Houve associação positiva entre a presença de drogas nos últimos três meses e a faceta "não reagir à experiência interna" (p=0,004). Conclusão: Embora a associação pareça consonante com os preceitos do mindfulness, este dado não pode ser considerado positivo se analisado separadamente dos outros conceitos da atenção plena.

Assessment of components of crack users' attention network / Evaluación de componentes de la red para atención de los usuarios de crack / Avaliação de componentes da rede para o atendimento a usuários de crack

ABSTRACT Objective: Assess components of the Psychosocial Attention Network (RAPS) in crack user care in a Rio Grande do Sul municipality. Method: Qualitative study based on Fourth Generation Evaluation. Data collection occurred in 2014, through participating observation and interviews based on the Hermeneutic-Dialectic Circle. Ten uses, eleven family members, seven managers and eight workers at a Psychosocial Attention Center participated. The Constant Comparative Method was used for data analysis. Results: Difficulties were observed in the network articulation with the general hospital, due to prejudice and the lack of structure of the team. SAMU's (Mobile Emergency Care Service) dependence on the Military Brigade for the service indicates a frailty of the network. The need to re-think the way therapeutic farms operate in the network is a consensus. Conclusion: RAPS is being implemented and its concretization depends on the involvement of professionals, managers and social control of users and family members.

RESUMEN Objetivo: Evaluar los componentes de la Red de Atención Psicosocial (RAPS) en la atención de los usuarios de crack en una ciudad de Rio Grande do Sul. Método: Investigación cualitativa basada en la evaluación de cuarta generación. La recolección de datos se produjo en 2014, a través de la observación participante y entrevistas, basadas en el Círculo Hermenéutico-Dialéctico. Participaron diez usuarios, once familiares, siete gerentes y ocho trabajadores de un Centro de Atención Psicosocial. El Método Comparativo Constante fue adoptado para el análisis de datos. Resultados: Se identificaron dificultades en la articulación de la red con el hospital general debido a los prejuicios y la falta de estructura del equipo. La dependencia del Servicio Móvil de Atención de Emergencia (SAMU) en la Brigada Militar para proporcionar servicio demuestra una debilidad de la red. Existe consenso sobre la necesidad de repensar la forma en que operan las granjas terapéuticas en la red. Conclusión: La Red de Atención Psicosocial se está implementando y su implementación depende de la participación de profesionales y gerentes, y del control social de los usuarios y sus familias.

RESUMO Objetivo: Avaliar componentes da Rede de Atenção Psicossocial (RAPS) no cuidado ao usuário de crack em um município do Rio Grande do Sul. Método: Estudo qualitativo, baseado na Avaliação de Quarta Geração. A coleta de dados ocorreu em 2014, através de observação participante e entrevistas, com base no Círculo Hermenêutico-Dialético. Participaram dez usuários, onze familiares, sete gestores e oito trabalhadores de um Centro de Atenção Psicossocial. O Método Comparativo Constante foi adotado para a análise dos dados. Resultados: Foram identificadas dificuldades na articulação em rede com o hospital geral devido ao preconceito e falta de estrutura da equipe. A dependência do SAMU na Brigada Militar para realizar atendimentos aponta uma fragilidade da rede. Há consenso sobre a necessidade de repensar o modo como as fazendas terapêuticas operam na rede. Conclusão: A RAPS está em implementação e sua efetivação depende do envolvimento dos profissionais e gestores, e do controle social de usuários e familiares.

Discourse of psychoactive substance dependents on their discursively constructed image / Discurso de los dependientes de sustancias psicoactivas sobre su imagen construida discursivamente / Discursos de dependentes de substâncias psicoativas sobre sua imagem discursivamente construída

ABSTRACT Objective: to analyze the discourse of psychoactive substance users undergoing treatment regarding their image of themselves as drug dependent subjects, of other dependents and the social position assumed by them. Method: qualitative study conducted between March and September of 2016 through a semi-structured interview and drawings, based on the theoretical-methodological reference of French Discourse Analysis. Participation of 12 drug dependent subjects undergoing treatment in the service that substitutes the asylum. Results: The images that psychoactive substance dependents have of themselves and of chemically dependent subjects are associated with the image of a negative, diabolical, transgressive, sick and socially excluded individual. Final considerations: The ideological effects of meanings produced by users' discourses reproduce the biological and moral model. Health professionals, including nurses, need to invest in discourses that address the psychosocial model to demythologize this stigmatizing image and modify their work practice.

RESUMEN Objetivo: analizar el discurso del consumidor de sustancias psicoactivas en tratamiento sobre la imagen que tiene de sí mismo como un sujeto dependiente de las drogas, sobre otros dependientes y sobre la posición social asumida por él. Método: investigación cualitativa realizada entre marzo y septiembre de 2016 a través de una entrevista semiestructurada y dibujos basados en la referencia teórico-metodológica de la escuela francesa del Análisis del Discurso. Doce adictos a las drogas fueron tratados en el servicio de sustitución del manicomio. Resultados: las imágenes que los dependientes de sustancias psicoactivas tienen de sí mismos y de los dependientes químicos se asocian con la imagen negativa, diabólica, transgresora, enferma y de una persona socialmente excluida. Consideraciones finales: los efectos de significado producidos ideológicamente por los discursos de los dependientes reproducen el modelo biológico y moral. Los profesionales de la salud, incluidos los enfermeros, deben invertir en discursos que aborden el modelo psicosocial, para desmitificar esta imagen estigmatizante y modificar su práctica en el trabajo.

RESUMO Objetivo: analisar o discurso do usuário de substâncias psicoativas em tratamento sobre a imagem que ele tem de si mesmo enquanto sujeito dependente de drogas, dos outros dependentes e da posição-social assumida por ele. Método: estudo qualitativo, realizado em março e setembro de 2016, por meio de entrevista semiestruturada e desenhos, baseado no referencial teórico-metodológico da Análise de Discurso de linha francesa. Participaram 12 dependentes de drogas em tratamento no serviço substitutivo ao manicômio. Resultados: As imagens que o dependente de substâncias psicoativas tem de si e do dependente químico estão associadas com a imagem negativa, diabólica, transgressora, de doente e socialmente excluído.Considerações finais: Os efeitos de sentido ideologicamente produzidos pelos discursos dos usuários reproduzem o modelo biológico e moral. Os profissionais de saúde, inclusive o enfermeiro, necessitam investir em discursos que abordem o modelo psicossocial, para desmitificar esta imagem estigmatizante e modificar sua prática no âmbito de seu trabalho.

Prevalence and factors associated to the use of illicit drugs and psychotropic medications among brazilian undergraduates

The aim of this study was to verify the prevalence of use of psychoactive substances (PS) and its associated factors in undergraduate students of a university in southern Brazil. The study was carried out with 830 undergraduate students in the year 2016. The individuals answered a self-administered questionnaire about the PS and its prevalence of daily use, in the last 30 days or at any time of their lives, as well as socioeconomic conditions and academic variables. Caffeine-based energy drinks was the most consumed psychoactive substance (96.3%) among undergraduates in the last 30 days, followed by alcohol (64.0%). Among the illicit drugs most consumed in the last 30 days was marijuana (17.3%), while anxiolytics and amphetamines were the most prevalent psychoactive medicaments in the last 30 days. The prevalence of lifetime illicit drugs used by these students was 41.5%, where we highlight besides marijuana (38.6%) the high consumption of cocaine (7.8%), ecstasy (9.3%) and solvents. Socioeconomic and demographic factors such as gender, have children, religion, and financial background as well as academic variables were associated to recent consumption of these substances. This study concluded there is a high prevalence of use of PS among the undergraduate students, including illicit drugs.

Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España / Male sex workers: between safe sex and risk. Ethnography in a gay sauna in Barcelona, Spain

Resumen Esta etnografía se realizó en Barcelona, ciudad que ofrece diferentes recursos de ocio homosexual, como las saunas gay. El objetivo fue analizar desde los estudios sobre género y masculinidades, cómo se articula la sexualidad, la percepción sobre la infección por VIH y otras infecciones de transmisión sexual (ITS), y las medidas preventivas en trabajadores sexuales masculinos (TSM) usuarios de saunas gay. Se realizaron 10 entrevistas en profundidad y observación entre 2012 y 2016. Las prácticas de sexo seguro son más frecuentes con clientes, mientras que las de riesgo se realizan más con parejas no comerciales. La orientación sexual juega un rol relevante, los homosexuales asumen más prácticas de riesgo en el trabajo sexual que los heterosexuales. Consumo de drogas o la escasez de redes de apoyo se relacionaron con mayor vulnerabilidad social y conductas de riesgo. Contraer el VIH aún genera miedo, mientras que tener otras ITS se percibe como parte de la vida sexual de un hombre. El TSM afianza una masculinidad con múltiples parejas sexuales, breadwinner y por otra parte, cuestiona un modelo heteronormativo. Las intervenciones para la prevención del VIH e ITS en este colectivo, deberían considerar los determinantes sociales como las precarias alternativas laborales y el ofrecer mayor soporte social.

Abstract This ethnography was conducted in Barcelona, a city that provides different gay leisure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth interviews and observation were conducted between 2012 and 2016. Safe sex practices are more frequent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than heterosexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man's sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronormative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social support.

Consumption of alcohol and drugs and school absenteeism among high school students of public schools / El consumo de alcohol y de drogas y el absentismo escolar en estudiantes de enseñanza media pública / Consumo de álcool e drogas e absenteísmo escolar em estudantes do ensino médio público

ABSTRACT Objective: To evaluate the relation between the consumption of alcohol and other drugs and school absenteeism in high school students of public schools in the 30 days prior to data collection. Method: Cross-sectional study of quantitative character conducted from May to September 2017, with 282 high school students of public schools of Mossoró-RN. We used a closed questionnaire with questions about drug consumption as our instrument of analysis. We performed hierarchical binary logistic regression by using the SPSS 20.0. Results: In bivariate analysis, the relation between absenteeism and drug consumption patterns proved to be significant to those who engage in heavy episodic drinking of alcohol and in the use of tobacco, inhalants and marijuana. The adjusted regression model only included the variables tobacco and heavy episodic drinking of alcohol. Conclusion: The hierarchical binary logistic regression analysis corroborated with absenteeism outcomes, explaining it in 12.3% of cases.

RESUMEN Objetivo: Evaluar la relación entre el consumo de alcohol y de otras drogas y el absentismo escolar en estudiantes de la enseñanza media pública durante 30 días anteriores a la recolección de datos. Método: Estudio transversal, cuantitativo, realizado entre mayo y septiembre de 2017, en el cual participaron 282 adolescentes, estudiantes de escuelas públicas de enseñanza media de la ciudad de Mossoró (RN, Brasil). Se utilizó un cuestionario cerrado con preguntas sobre el consumo de drogas. Se realizó una regresión logística binaria jerarquizada con el auxilio del SPSS 20.0. Resultados: En el análisis bivariado, la relación entre el absentismo escolar y los patrones de consumo de drogas se mostró significativa para quienes tenían un consumo excesivo episódico de alcohol y un consumo de tabaco, de inhalantes y de marihuana. El modelo de regresión ajustado incluyó solamente las variables consumo excesivo episódico de alcohol y consumo de tabaco. Conclusión: El análisis de la regresión logística binaria jerarquizada se mostró ajustada para el resultado del absentismo escolar, lo que explica el 12,3% de los casos.

RESUMO Objetivo: Avaliar a relação do consumo de álcool e outras drogas com o absenteísmo escolar em estudantes do ensino médio público nos 30 dias anteriores à coleta. Método: Estudo transversal, quantitativo, realizado de maio a setembro de 2017, com 282 adolescentes, estudantes de escolas públicas de ensino médio de Mossoró-RN. Utilizou-se um questionário fechado com questões sobre o uso de drogas. Realizou-se regressão logística binária hierarquizada com o apoio do SPSS 20.0. Resultados: Na análise bivariada, a relação entre o absenteísmo escolar e os padrões de consumo de drogas se mostrou significativa para aqueles com prática de beber pesado episódico de álcool e uso de tabaco, inalantes e maconha. O modelo de regressão ajustado incluiu apenas as variáveis beber pesado episódico de álcool e tabaco. Conclusão: A análise da regressão logística binária hierarquizada se mostrou ajustada para o desfecho do absenteísmo escolar, explicando-o em 12,3% dos casos.

Perception of oral health status of adolescents and young adults undergoing substance abuse treatment / Percepción del estado de salud bucal de adolescentes y adultos jóvenes en tratamiento por drogodependencia

Objective: to determine the oral health status perception of adolescents and young adults in drug dependence treatment. Material and Method: a qualitative research model was proposed. The theoretical sample by saturation consisted of adolescent population and young adults hospitalized in the Portal Amarillo center (the National Drug Information and Reference Center, Montevideo, Uruguay). Inclusion criteria: a) being between 15 and 24 years old. b) being in treatment for drug abuse. Exclusion criteria: a) non-lucid patients. b) non-collaborating patients. Results: participants considered oral health as having clean, white and aligned teeth; and oral disease as the presence of caries, bleeding gums and communicable diseases; chewing, aesthetics and taste were seen as altered functions. Before becoming drug consumers, oral hygiene was regular, after meals and as instructed; once addiction began, hygiene was very irregular at best (if they remember to do it), and without reinforcement of the instruction. Prior to drug consumption, participants were students or held a job; they had a good family life, with a partner or in search of one. After consumption, they report self-marginalization, loss of contact with partners and children, isolation from the family and social discrimination. Addiction makes it difficult for them to access dental care, except in urgent situations. Conclusions: Young people in treatment for drug dependence are aware that addiction damages oral health, deteriorating aesthetics, affecting oral functions, self-esteem and quality of life.

Objetivo: conocer la percepción de adolescentes y adultos jóvenes vinculados al consumo abusivo de drogas a partir de la situación de dependencia. Materiales y Métodos: se planteó un modelo de investigación cualitativo. La muestra teórica por saturación fue población adolescente y adulta joven que se asistió en régimen de internación en el Portal Amarillo. Criterios de inclusión: a) tener entre 15 y 24 años. b) estar en tratamiento por consumo de drogas. Criterios de exclusión: a) pacientes no lúcidos. b) pacientes no colaboradores. Resultados: los participantes refieren como salud bucal tener los dientes limpios, blancos y alineados; como enfermedad caries, sangrado de encías y enfermedades transmisibles; y como funciones alteradas la masticación, la estética y el gusto. Antes de la situación de dependencia la higiene bucal era regular, después de las comidas y con instrucción recibida, a partir de la dependencia la higiene fue muy irregular, si se acordaban y sin refuerzo de la instrucción. Previo al consumo eran individuos integrados al estudio o al trabajo, con vida familiar ordenada, con pareja o en procura de tenerla; posteriormente al consumo relatan automarginación con pérdida de contacto con la pareja e hijos, aislamiento de la familia y discriminación social. El consumo dificulta el acceso a la atención odontológica, excepto en situaciones de urgencia. Conclusion: Las personas jóvenes en tratamiento por dependencia a las drogas perciben el deterioro de su salud bucal a partir de la situación de consumo, alterando la estética, las funciones orales, la autoestima y la calidad de vida.

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

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

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

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

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

Rotura simultanea bilateral de tendon cuadricipital asociada a anabolizantes esteroideos / Bilateral simultaneous rupture of quadriceps tendon associated to anabolic steroids administration

La rotura bilateral y simultánea del tendón cuadricipital es una lesión rara con pocos reportes en la literatura, que suele ocurrir en mayores de 50 años con enfermedades sistémicas crónicas subyacentes. Presentamos el caso de un paciente masculino sano de 32 años con rotura bilateral de tendón cuadricipital durante la práctica de musculación asociada a la administración de anabolizantes esteroideos y el tratamiento realizado

Bilateral and simultaneous rupture of the quadriceps tendon is a rare injury with a few reports in record that usually occurs in people older than 50 years with underlying chronic systemic diseases. We present the case of a healthy 32-year-old male patient with bilateral quadriceps tendon rupture during weight training practice associated to anabolic steroids administration and the treatment provided