Opioides, sobredosis y los desafíos de la reducción de daños como estrategia eficiente en el campo de la salud pública / Opioids, Overdose and Harm Reduction as an Efficient Strategy for Public Healt

Resumen El tráfico y el consumo de drogas es un desafío global que afecta a todas las sociedades en diferentes formas y dimensiones; su carácter multidimensional tiene un alto impacto en la salud de las poblaciones y en la economía de los países. Tan solo en 2021, se estimó que 296 millones de personas q q q consumieron drogas. Durante años, la política mundial de salud en materia de drogas estuvo centrada en la prohibición; sin embargo, en la actualidad se sabe que un enfoque de reducción de riesgos y daños, lejos de rechazar la abstinencia, reduce los efectos negativos del consumo de sustancias legales e ilegales, incluidas las muertes por sobredosis, lo cual trae grandes beneficios a la salud y al funcionamiento social de quienes las consumen. Este artículo brinda una comprensión integral del consumo de opioides, específicamente fentanilo, y recalca la necesidad de abordarlo a través de un enfoque integral que combine estrategias basadas en la evidencia, bajo el reconocimiento de que la salud es un derecho humano fundamental y una condición indispensable para el desarrollo.

Abstract Drug trafficking and use is a global challenge that affects all societies in different forms and dimensions. Its multidimensional nature has a high impact on the health of populations and the economies of countries. In 2021, it was estimated that 296 million people used drugs. For years, global health policy on drugs was focused on prohibition, however, we now know that a harm reduction approach, far from rejecting abstinence, reduces the negative effects of legal and illegal substance use, including overdose-related deaths. Harm reduction brings great health benefits and improves social functioning of those engaged in substance use. This article provides a comprehensive understanding of opioid use, specifically fentanyl, and emphasizes the need to address it through a comprehensive approach that combines evidence-based strategies, recognizing that health is a fundamental human right and an essential condition for development.

Addressing substance abuse among healthcare professionals in a tertiary healthcare facility in Nigeria: a case study of Nnamdi Azikiwe university teaching hospital

Background: The use of psychoactive substances is prevalent worldwide, including among healthcare workers whose well-being, productivity, and effectiveness in addressing substance addiction in patients and the wider community can be significantly impacted. However, the extent of substance misuse among healthcare professionals in Nigeria, with its substantial social and public health implications, remains poorly understood. This research focused on the prevalence, attitudes, substances used, and influencing factors regarding substance misuse among staff at Nnamdi Azikiwe university teaching hospital (NAUTH) in Nnewi. Methods: A descriptive cross-sectional study was conducted involving 194 healthcare workers, using a multi-stage sampling method. Data were collected via a semi-structured self-administered questionnaire and analyzed with SPSS version 20. Results were presented in tables, considering p values less than 0.05 as significant. Results: Of the 197 respondents, 63.5% were female and 36.5% male, spanning various professions including doctors, nurses, and other healthcare specialists. Notably, 66% of participants had used substances in their lifetime. Alcohol was the most commonly abused substance, with significant percentages of moderate and high-risk users. Socialization and peer pressure were identified as the predominant factors influencing substance use, with significant statistical associations found between substance use and variables such as profession, sex, and duration of practice. Conclusions: The study highlighted a considerable prevalence of alcohol use among healthcare workers, who generally held a moderate view towards substance misuse and identified socialization and peer pressure as key factors. These findings underscore the pressing need for targeted training and intervention strategies for substance addiction among healthcare workers in Nigeria.

REGULATORY CHALLENGES AND LANDSCAPES OF MONOCLONAL ANTIBODY REGISTRATION: GLOBAL OUTLOOK

Objective: This review aims to illuminate the unprecedented growth and versatile therapeutic landscape of monoclonal antibody (mAb) products, highlighting their significant impact on diverse medical fields such as oncology, septicemia treatment, infection management, and substance abuse disorder interventions. This review outlines the challenges associated with the development, manufacturing, and regulatory approval of monoclonal antibodies, emphasizing the need for diligent attention to overcome these complexities. The review comprehensively examines the historical evolution and therapeutic applications of monoclonal antibodies, emphasizing their potent and versatile characteristics that have enabled successful interventions in challenging regulatory approvals. It delves into the critical considerations in manufacturing, regulatory navigation, and the strategic integration of expedited approval pathways, providing a holistic understanding of the intricate terrain of innovation, clinical translation, and impactful patient care in the realm of monoclonal antibody products. Monoclonal antibodies have significantly advanced medical treatment in various domains, revolutionizing cancer therapy, offering new avenues for septicemia management, augmenting the arsenal against infections, and opening novel pathways for addressing substance abuse disorders. Their development and regulatory approval are associated with challenges of scientific innovation, manufacturing, and regulatory compliance. Despite the challenges, monoclonal antibodies have demonstrated remarkable potential in addressing complex medical conditions. The review serves as a compass, guiding researchers, clinicians, and regulatory authorities through the intricate terrain of monoclonal antibody innovation and clinical translation. It emphasizes the need for diligent attention to overcome the complexities associated with their development and regulatory approval while highlighting their significant impact on advancing patient care.

Percepción de riesgo sobre el consumo de drogas en estudiantes universitarios

Introducción: El consumo de drogas es un problema de salud que se presenta con mayor frecuencia en la población joven, pues su prevalencia aumenta cada día. En la actualidad existe preocupación sobre la percepción de riesgo del consumo de drogas en estudiantes universitarios. Objetivo: Describir la percepción de riesgo sobre el consumo de drogas en estudiantes universitarios de la provincia Manabí en Ecuador. Métodos: Investigación descriptiva y transversal; universo de 787 estudiantes universitarios de la provincia Manabí en Ecuador. La muestra quedó conformada por 259 estudiantes. Se utilizó la encuesta como técnica de recolección de datos. Como instrumento de investigación se utilizaron las encuestas escolares sobre el uso indebido de drogas de la oficina de las Naciones Unidas contra la droga y el delito. Se utilizó la estadística descriptiva para el procesamiento de los datos. Resultados: Se obtuvo una media de edad de 22,37 años, predominio del sexo femenino (65,25 %) y de estudiantes que consumen algún tipo de droga (79,92 %). El 91,30 % refirió consumo de drogas lícitas (tabaco 43,63 % y alcohol 61,39 %); el 31,26 % consumían drogas medicamentosas y el 23,29 % drogas ilícitas; de ellos, el 85,42 % refirió consumo de marihuana. El 32,04 % tenía una percepción baja sobre el riesgo de consumo de drogas. Conclusiones: En el grupo de estudiantes universitarios de la provincia Manabí que son investigados, existe un aumento del consumo de drogas lícitas, medicamentosas e ilícitas debido a una percepción deficiente del riesgo de consumo de estas sustancias.

Introduction: Drug use is a health problem that occurs more frequently in the young population; its prevalence increases every day. Currently, there is concern about the perception of risk of drug use in university students. Objective: Describe the risk perception of drug consumption in university students from the Manabí province in Ecuador. Methods: Descriptive and cross-sectional research; universe of 787 university students from the Manabí province in Ecuador. The sample was made up of 259 students. The survey was used as a data collection technique. The School Surveys on Drug Abuse from the United Nations Office on Drugs and Crime were used as a research instrument. Descriptive statistics were used to process the data. Results: An average age of 22.37 years was obtained, predominance of the female sex (65.25%) and students who consume some type of drug (79.92%). 91.30% reported consumption of legal drugs (tobacco 43.63% and alcohol 61.39%); 31.26% used medicinal drugs and 23.29% used illicit drugs; Of them, 85.42% reported marijuana use. 32.04% had a low perception of the risk of drug use. Conclusions: In the group of university students from the Manabí province who are investigated, there is an increase in the consumption of licit, medicinal and illicit drugs due to a poor perception of the risk of consumption of these substances.

Asociación entre el grado de consumo de alcohol, tabaco, sustancias ilícitas y el desenlace obstétrico adverso / Association between the degree of alcohol, tobacco, illicit of alcohol, tobacco, illicit substances and adverse obstetric outcome

Resumen OBJETIVO: Establecer la relación entre el grado de consumo de alcohol, tabaco y sustancias ilícitas con los desenlaces obstétricos adversos para que el personal encargado de la atención obstétrica evalúe los riesgos que implica el consumo de esas sustancias. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional, analítico y transversal de una serie de casos llevado a cabo en pacientes en el puerperio hospitalizadas en el servicio de Ginecología y Obstetricia del Hospital General de Saltillo entre marzo y junio del 2023 y que refirieron consumo de alcohol, tabaco o drogas durante el embarazo. Posterior al procedimiento obstétrico se aplicó la herramienta ASSIST o prueba de detección de consumo alcohol, tabaco y sustancias. Según el grado de consumo, se utilizó la prueba χ2 de Pearson y la prueba exacta de Fisher para evaluar su asociación con los desenlaces adversos. RESULTADOS: De 863 atenciones obstétricas, 47 pacientes 5.4% refirieron un consumo activo de diferentes sustancias durante el embarazo; de ellas, 22 consumían 2 sustancias, con una tendencia entre el consumo de tabaco y cannabis a un desenlace obstétrico adverso p = 0.16 y 0.17, respectivamente. El desenlace obstétrico adverso más frecuente fue el bajo peso al nacer en 22 de 47 pacientes. CONCLUSIONES: Las sustancias con mayor tendencia a un desenlace obstétrico adverso fueron el tabaco y la cannabis, y la consecuencia desfavorable más frecuente en los neonatos fue el bajo peso al nacer.

Abstract OBJECTIVE: To determine the relationship between the extent of alcohol, tobacco and illicit substance use and adverse obstetric outcomes to enable obstetric care providers to assess the risks of substance use. MATERIALS AND METHODS: Retrospective, observational, analytical and cross-sectional study of a case series of postpartum patients who were admitted to the Gynaecology and Obstetrics Service of the General Hospital of Saltillo between March and June 2023 and who reported alcohol, tobacco or drug use during pregnancy. After the obstetric procedure, the ASSIST tool or screening test for alcohol, tobacco and drug use was applied. Pearson's χ2 test and Fisher´s exact statistic were used to assess their association with adverse outcomes according to the level of use. RESULTS: Of 863 obstetric attendances, 47 patients 5.4% reported active use of different substances during pregnancy; of these, 22 used 2 substances, with a trend between tobacco and cannabis use for adverse obstetric outcomes p = 0.16 and 0.17, respectively. The most common adverse obstetric outcome was low birth weight in 22 of 47 patients. CONCLUSIONS: The substances with the highest tendency for adverse obstetric outcome were tobacco and cannabis, and the most common adverse neonatal outcome was low birthweight.

Singular therapeutic project actions in a psychosocial care center: professionals' and users' perspectives / Acciones del proyecto terapéutico único en un centro de atención psicosocial: perspectivas de profesionales y usuarios / Ações do projeto terapêutico singular em centro de atenção psicossocial: perspectivas de profissionais e usuários

ABSTRACT Objective: to understand Singular Therapeutic Project actions, developed for users of psychoactive substances, in a Psychosocial Care Center, from professionals' and users' perspectives. Method: phenomenological qualitative research in light of Alfred Schütz's Social Phenomenology. It was carried out in a Psychosocial Care Center for Alcohol and Other Drugs in a municipality in the north of southern Brazil. Phenomenological interviews were used with 13 healthcare professionals and 13 service users between April and August 2023. A comprehensive analysis of information was based on the theoretical-methodological framework. Results: the Singular Therapeutic Project actions were identified from two perspectives (users and professionals) and the reciprocity of perspectives among participants, such as reception and return actions, individual care, collective therapeutic activities, pharmacological treatment and network and referral coordination. Conclusion: the actions are limited to Psychiatric Reform principles and medication care and are centered on professionals, pointing out the need to promote leading role, autonomy and co-responsibility for users.

RESUMEN Objetivo: comprender las acciones del Proyecto Terapéutico Singular, desarrollado para usuarios de sustancias psicoactivas, en un Centro de Atención Psicosocial, desde la perspectiva de profesionales y usuarios. Método: investigación cualitativa fenomenológica a la luz de la Fenomenología Social de Alfred Schütz. Se llevó a cabo en un Centro de Atención Psicosocial al Alcohol y Otras Drogas de un municipio de la región norte del sur de Brasil. Se utilizaron entrevistas fenomenológicas a 13 profesionales de la salud y 13 usuarios del servicio entre abril y agosto de 2023. El análisis integral de la información se basó en el marco teórico-metodológico. Resultados: las acciones del Proyecto Terapéutico Singular fueron identificadas desde dos perspectivas (usuarios y profesionales) y la reciprocidad de perspectivas entre los participantes, como acciones de acogida y retorno, atención individual, actividades terapéuticas colectivas, tratamiento farmacológico y coordinación de redes y derivaciones. Conclusión: las acciones se circunscriben a los principios de la Reforma Psiquiátrica y de la atención médica y se centran en los profesionales, señalando la necesidad de promover protagonismo, autonomía y corresponsabilidad del usuario.

RESUMO Objetivo: compreender as ações do Projeto Terapêutico Singular, desenvolvidas aos usuários de substâncias psicoativas, em um Centro de Atenção Psicossocial, nas perspectivas de profissionais e de usuários. Método: pesquisa qualitativa fenomenológica à luz da Fenomenologia Social de Alfred Schütz. Foi realizada em um Centro de Atenção Psicossocial Álcool e Outras Drogas em município da região norte do sul do Brasil. Utilizou-se entrevista fenomenológica com 13 profissionais de saúde e 13 usuários do serviço, entre abril e agosto de 2023. A análise compreensiva das informações foi pautada no referencial teórico-metodológico. Resultados: foram identificadas as ações do Projeto Terapêutico Singular em duas perspectivas (usuários e profissionais) e a reciprocidade de perspectivas entre os participantes, que foram: as ações de acolhimentos e retornos, atendimentos individuais, atividades terapêuticas coletivas, tratamento farmacológico e articulações de rede e de encaminhamentos. Conclusão: as ações se limitam nos princípios da Reforma Psiquiátrica e ao cuidado medicamentoso e estão centralizadas nos profissionais, apontando a necessidade de promover o protagonismo, a autonomia e a corresponsabilização ao usuário.

Capacidad de los Centros de Atención Psicosocial de Alcohol y Drogas para manejar situaciones de crisis / The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises / Capacidade de manejo de situações de crise por Centros de Atenção Psicossocial Álcool e Drogas

Objetivo: evaluar la capacidad de los Centros de Atención Psicosocial de Alcohol y Otras Drogas 24 horas para manejar situaciones de crisis de las personas que consumen AOD en la atención integral. Método: estudio cuantitativo, evaluativo y longitudinal, realizado de febrero a noviembre de 2019. La muestra inicial estuvo compuesta por 121 personas que consumen AOD, que recibieron atención integral en situaciones de crisis en dos Centros de Atención Psicosocial para Alcohol y Otras Drogas 24 horas en el centro de São Paulo. Los mismos fueron reevaluados después de 14 días de atención. La capacidad para manejar la crisis se evaluó mediante un indicador validado. Los datos se analizaron utilizando estadísticas descriptivas y modelos de regresión de efectos mixtos. Resultados: sesenta y siete personas que consumen AOD completaron el follow-up (54,9%). Durante la atención de las situaciones de crisis, nueve personas que consumen AOD (13,4%; p=0,470) fueron derivadas a otros servicios de la red de salud: siete por complicaciones clínicas, una por intento de suicidio y una por hospitalización psiquiátrica. La capacidad de los servicios para manejar situaciones de crisis fue del 86,6%, fue considerada positiva. Conclusión: los dos servicios evaluados fueron capaces de manejar situaciones de crisis en su área de influencia, evitando internaciones y contando con el apoyo de la red cuando fue necesario, logrando así los objetivos de desinstitucionalización.

Objective: to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users' crises in comprehensive care. Method: a quantitative, evaluative, and longitudinal study was conducted from February to November 2019. The initial sample consisted of 121 users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14 days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. Results: 67 users (54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. Conclusion: both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.

Objetivo: avaliar a capacidade dos Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas em manejar situações de crise dos usuários no acolhimento integral. Método: estudo quantitativo, avaliativo e longitudinal, realizado de fevereiro a novembro de 2019. A amostra inicial foi composta por 121 usuários, acolhidos integralmente em situações de crise por dois Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas do centro de São Paulo. Estes foram reavaliados após 14 dias de acolhimento. A capacidade de manejar a crise foi avaliada por um indicador validado. Os dados foram analisados por estatística descritiva e por regressão de modelos de efeitos mistos. Resultados: sessenta e sete usuários concluíram o follow-up (54,9%). Durante o acolhimento às situações de crise, nove usuários (13,4%; p=0,470) foram encaminhados para outros serviços da rede de saúde: sete por complicações clínicas, um por tentativa de suicídio e um para internação psiquiátrica. A capacidade de manejo das situações de crise pelos serviços foi de 86,6%, avaliada como positiva. Conclusão: os dois serviços avaliados foram capazes de manejar situações de crise no próprio território, evitando internações e tendo apoio da rede quando necessário, atingindo assim, os objetivos da desinstitucionalização.

Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review

Abstract Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.

A study to assess the prevalence of substance abuse and its impact among medical students in a medical college

Background: Psychoactive drug is an emerging global problem. This is a disturbing matter, especially in the case of medical students, affecting their health and academic performance, which in turn affects the health outcomes of patients. The objectives of our study were to assess the prevalence and impact of substance abuse among medical students. Methods: This was cross-sectional study conducted in tertiary care center. A pretested semi structured questionnaire was used to collect the data. Medical students who were available during the study period and who were willing to participate were included in the study. A total of 301 students were interviewed. Data was entered and analysed in SPPSS version 22.0. Descriptive statistics and inferential statistics were used for the statistical analysis. Results: We had a total of 301 responders. Among them, only 70(23.3%) have been a subject to substance abuse. Alcohol was the most abused substance (19.3%). The most common reason for starting these substances was out of curiosity (15.6%). 24.6% of the students have either thought of or tried stopping, however majority of them have not. Out of these students, 10 (3.3%) have experienced withdrawal symptoms. Conclusions: The substance abuse among youngsters in medical colleges is a highly alarming situation. Proper counselling with planned policies should be implemented to root out this evil among the future doctors which will help in providing better health care services to the people.

Prevalence and correlates of anxiety and stress in school going adolescents in Delhi national capital region: a cross sectional study

Background: Anxiety and stress are notable health problems plaguing adolescents. Moreover, issues such as poor sleep quality and body image issues, common in adolescence, have also been linked to anxiety and stress previously. Methods: A cross sectional study was conducted across 392 school going adolescents in Delhi NCR, India. Sociodemographic and lifestyle data was collected using a pre-tested semi-structured questionnaire. DASS-21 was used to screen the participants for anxiety and stress, Pittsburgh sleep quality index for sleep quality, and Stunkard figure rating silhouette for body image issues. Data was entered into MS Excel spreadsheets and Statistical Package for Social Sciences version-25 was used for analysis. Results: 47.5% participants suffered from anxiety and 22.2% from stress. Anxiety was significantly associated with father’s education and occupation, stressful occurrences in the family, poor sleep quality and inadequate exercise. Stress was significantly higher in females and those with poor sleep quality. Conclusions: Anxiety and stress in adolescents show significant associations with familial and lifestyle factors. Identifying these risk factors can enable timely diagnosis and intervention.

The Socio-Demographic Factors and Causes of Substance Abuse Relapse: 36 Cases

Background: Relapse is frequent among substance abusers all across the world, and Bangladesh is no exception. Drug-related issues are gradually becoming a hot topic in Bangladesh, from a social, economic, and medical standpoint. The present study aimed to find out sociodemographic factors associated with relapse amongst substance abuser. Material & Methods: This descriptive type of observational study conducted in the Combined Military Hospital and other Government/Private Hospital/Institute especially Central Drug Addict Treatment Center, Dhaka with a total sample size of 36 participants. Detailed information was obtained in each case according to protocol through complete history from patients or their accompanying attendants using a data collection sheet which was read out to them in Bangla. All the information was recorded in the pre fixed protocol. Collected data was classified, edited, coded and entered into the computer for statistical analysis by using SPSS-23. Results: The study found that yaba was the most commonly abused drug among 36 participants, with 27.78% reporting abuse. 27.78% of participants had a psychiatric illness, with the majority being male (97.22%) and Muslim (88.89%). The largest group of participants were aged 31-40 (47.22%) and most were unemployed (83.33%) and married (94.44%). Peer pressure and family problems were the most commonly reported causes of relapse (91.67% and 83.33%, respectively). Other factors such as unemployment, depression, and failure in life also contributed to relapse. Conclusion: Yaba was the most prevalent substance of abuse and the majority of participants were male, had a psychiatric illness, and were unemployed. Peer pressure and family problems were the main causes of relapse.

Perception about substance abuse among the medical students in Visakhapatnam, India: a qualitative research

Background: Substance abuse is an emerging disorder of global concern. In India about 14.6% of the population (between 10 and 75 year of age) uses alcohol. Also, 28.6 percent (266.8 million) of adults in India, aged 15 and above currently use tobacco in some form. Youth period is an important transition period where students may begin to consume alcohol, tobacco, and other substances. Methods: A Qualitative approach using systematic methods i.e., Free listing & Pile sorting, Conducted among third professional year students in a Medical College of North coast Andhra Pradesh. Analysed by Cultural domain analysis using Visual Anthropac Pile sort version1.0.1.36 based on salience scores. Results: A total of 13 medical students were included. Among them 9 (69%) were females and 4(31%) were males. Stress was found to be the major cause for substance abuse with salience score of 0.418, followed by peer pressure (0.402). The solutions for among them parental guidance is the best solution for substance abuse with highest salience score of 0.412, followed by awareness about consequences (0.409). Conclusions: Our study reveals that it is necessary to bring positive behavioural changes through adoption of comprehensive interventions, counselling methods and health education in medical universities.

Assessment of the magnitude of behavioural risk factors among school going adolescents of Kashmir valley: a cross sectional study

Background: Adolescents are one sixth of the world’s population and account for 6% of the global burden of disease and injury. The unique health issues associated with adolescence have been little understood. Adolescence is a period when many behaviours are consolidated which have major effects on future adult health. Methods: A cross sectional study was conducted in a total of 8 schools in order to assess the magnitude of various behavioural risk factors among school going adolescents. 614 students in the age group of 10-19 years were included in the study. Data was collected using modified WHO global school-based health survey questionnaire. Weight and height of the adolescents were also taken to assess their nutritional status. Results: In the present study 45% of the participants resorted to diet restriction. 19.2% of the adolescents felt lonely. 18.2.5% of the participants had disturbed sleep and 8.8% of them reported having had suicidal thoughts. 3.9% of the participants had ever smoked cigarettes, 3.9% had ever consumed alcohol and 1.8% had ever used drugs. 28.3% of the adolescents reported having been physically attacked and 12.5% reported having been bullied. 29.5% had a screen time of 3 hours or more. Conclusions: It was observed that behavioral risk factors like unhealthy eating habits and lack of physical activity and substance abuse were quite prevalent in the adolescents. Health education on all these behavioural risk factors and incorporation of life skills education in the school curriculum will help in improving the overall health of the adolescents.

Atitudes de profissionais sobre o uso de drogas por gestantes / Health professional attitudes towards drug use for pregnant women / Actitudes de profesionales sobre el consumo de drogas en mujeres embarazadas

O uso de drogas é um dos fatores associados a gestações de alto risco. As crenças e atitudes dos profissionais configuram possíveis dificultadores dos cuidados em saúde. O presente estudo buscou verificar as atitudes profissionais em relação a gestantes usuárias de drogas. Realizou-se a busca bibliográfica de publicações entre 2000 e junho de 2022, nas bases de dados Scielo, Lilacs, Medline/Pubmed, Scopus e PsycINFO. Ao final foram analisados 27 artigos, todos de língua inglesa. Foram identificadas atitudes negativas em 33,3% dos artigos, e atitudes positivas em 44,5%; também foram encontradas atitudes ambivalentes (22,2%). Além disso, alguns dos estudos apontaram algumas barreiras quanto às intervenções. Atitudes negativas e moralizantes denotam um cunho individualizante. Em relação às atitudes positivas, essas podem ter um papel fundamental na atuação profissional e na saúde materna e do feto.

Drug use is one of the factors related to high-risk pregnancy. The health professional beliefs and attitudes regarding this issue constitute possible difficulties in the health care. The present study sought to verify the health professional attitudes towards pregnant women who use drugs. A literature review for studies published between 2000 and june 2022 was carried out in the Scielo, Lilacs, Medline/Pubmed, Scopus, and PsycINFO databases. In the end, 27 articles were analyzed, all of them written in English. Negative attitudes were identified in 33,3% of the articles, and positive attitudes in 44,5%; ambivalent attitudes were also found in 22,2% of the studies. Additionally, some studies pointed out barriers to interventions. The negative and moralizing attitudes denote an individualizing nature. Concerning the positive attitudes, they can play a fundamental role on professional performance and, consequently, on the maternal and fetal health.

El uso de drogas es uno de los factores asociados a los embarazos de alto riesgo. Las creencias y actitudes de los profesionales se configuran como posibles obstáculos al cuidado en salud. El presente estudio buscó verificar las actitudes de los profesionales en relación a embarazadas usuarias de drogas. Se realizó una búsqueda bibliográfica de publicaciones entre 2000 y junio de 2022, en las bases de datos Scielo, Lilacs, Medline/Pubmed, Scopus y PsycINFO. Finalmente, fueron analizados 27 artículos, todos en idioma inglés. Se identificaron actitudes negativas en el 33,3% de los artículos, y actitudes positivas en el 44,5%; así también se encontraron actitudes ambivalentes (22,2%). Además, algunos de los estudios señalaron algunas barreras con respecto a las intervenciones. Las actitudes negativas y moralizantes denotan una impronta individualizadora. En relación con las actitudes positivas, estas pueden tener un papel fundamental en la actuación profesional y en la salud materna y del feto.

Study the frequency of substance abuse in patients with perforated peptic ulcer disease

Background: Peptic ulcer perforation is one of the severe complications of peptic ulcer disease (PUD). Patients with perforated peptic ulcers usually are presented by the acute abdomen. In some studies, substance abuse is one of the peptic ulcer risk factors. Our study aimed to evaluate the frequency of substance abuse in patients with perforated peptic ulcers referred to Ardabil city hospital from January 2020 until March 2021.Methods: This descriptive cross-sectional study was done on 60 patients with peptic ulcer perforation in Ardabil city hospital from January 2020 until March 2021. Data collected by a checklist and analyzed by statistical methods in SPSS version 25.Results: Of all patients, 13 patients (19.7%) had substance abuse and all of them were male. Of all 13 patients with substance abuse, 9 (69.2%) had opium use.Conclusions: The results showed that substance abuse among patients with peptic ulcer perforation, can be consider as a possible risk factor for peptic ulcer perforation, but more studies should perform to identify the effective factors and variables that can be main role in peptic ulcer perforation in patients.

Definition and conceptualization of collaboration in drug rehabilitation: Systematic synthesis and comparison using a scoping review approach

Objective@#Although interagency collaboration in drug treatment and rehabilitation has been substantially studied, a lack of consensus on the nomenclature and definition of collaboration remains an unresolved issue in public health policy and practice. To facilitate further consensus, this review analyses previously used definition, conceptualization, and theorization on interagency collaboration in the field of drug rehabilitation.@*Methods@#We conducted evidence synthesis using a scoping review approach. This review is based on searches using the MEDLINE, CINAHL Complete, Embase, and PsychINFO databases and used the protocol proposed by Arksey and O’Malley.@*Results@#A total of 6,259 papers were retrieved from database and citation searches, 33 of which were eligible for inclusion in the analysis after screening and evaluation. Although the definitions varied, the common elements included (a) the presence of at least two entities, which were either services, programs or organizations; (b) these entities collaborated or shared resources; (c) partnership went through a development process; and (d) the intent of collaboration was to achieve a common purpose. There were five means of conceptualizing collaboration: (a) degrees, or level of intensity and formality; (b) elements, or the constitutive structure and activities; (c) stages, or the development of partnership over time; (d) levels, or the focus of the collaborative; and (e) type, or a distinction between collaboration on in policy and practice.@*Conclusion@#Scholarship in this field can benefit from studies that conceptualize collaboration not only crosssectionally through the description of degrees, elements, levels, and type, but also by considering the stages dimension of collaboration (i.e., evolution of collaboration initiative over time). Countries or jurisdictions may need to formalize a term and definition for collaboration as it applies to initiatives within their territories.

The relationship between anxiety and depression mood and substance abuse history in male prisoners / 中华行为医学与脑科学杂志

Objective:To explore the influence of substance abuse history on anxiety and depression of male prisoners during their imprisonment, and its relationship with violent behavior.Methods:A questionnaire survey was conducted among 1 455 prisoners from October to November 2019.Self-administered personal substance abuse history questionnaires were used to collect the information on substance abuse (alcohol, tobacco, and drug use). The generalized anxiety scale (GAD-7) and patient health questionnaire (PHQ-9) were used to investigate anxiety and depression.All subjects were divided into substance abuse group ( n=871) and non substance abuse group ( n=584) according to whether they had a history of substance abuse or not.SPSS 21.0 software was used for statistical analysis.The statistical methods were t-test, chi square test and Logistic regression analysis. Results:(1)The scores of GAD-7 ((4.95±5.88) vs (3.35±5.33), t=-5.407, P<0.01) and PHQ-9 ((6.69±6.50) vs (4.48±5.73), t=-6.821, P<0.01) scales in the substance abuse group were higher than those in the no-substance abuse group.(2)Somatic disease( β=0.700, OR=2.014, 95% CI=1.599-2.538, P<0.05), history of alcohol abuse( β=0.434, OR=1.543, 95% CI=1.176-2.025, P<0.05), history of tobacco abuse( β=0.387, OR=1.473, 95% CI=1.154-1.880, P<0.05), age ≤ 45( β=0.372, OR=1.450, 95% CI=1.118-1.881, P<0.05) were the risk factors of anxiety among prisoners.Somatic disease( β=0.686, OR=1.986, 95% CI=1.581-2.496, P<0.05), history of tobacco abuse( β=0.488, OR=1.629, 95% CI=1.286-2.063, P<0.05), age ≤ 45( β=0.484, OR=1.622, 95% CI=1.260-2.089, P<0.05), history of alcohol abuse( β=0.344, OR=1.410, 95% CI=1.073-1.854, P<0.05) were the risk factors of depression among prisoners.(3) Years of education ≤ 9 years( β=0.900, OR=2.459, 95% CI=1.855-3.261, P<0.05), age ≤ 45( β=0.788, OR=2.199, 95% CI=1.690~2.860, P<0.05), unmarried( β=0.683, OR=1.980, 95% CI=1.421-2.759, P<0.05), history of alcohol abuse( β=0.308, OR=1.361, 95% CI=1.053-1.758, P<0.05), history of drug abuse( β=0.557, OR=1.745, 95% CI=1.055-2.885, P<0.05) were risk factors for violent behavior of prisoners. Conclusion:The history of substance abuse may be a risk factor for anxiety and depression of prisoners during their imprisonment.Alcohol and drug abuse are both factors influencing the occurrence of violent behavior.

Adherence to ART drugs among HIV-positive pregnant women at selected hospitals of East Ethiopia

Background: Substance abuse among Human Immune Deficiency Virus-positive patients causes depression, carelessness, and anxiety, which in common results in a decrease in adherence to antiretroviral treatment. The purpose of the study is to assess the prevalence of substance abuse and its association with adherence to ART drugs. Methods: The current study was conducted at three hospitals (Hiwot Fana Comprehensive University Hospital, Dillchora Hospital, and Jugal Hospital) located in East Ethiopia. Bivariate and multivariate logistic regression analysis was used to identify the association of independent variables with the dependent variables. Results: In this study, 119 HIV-positive pregnant patients were included. While 74.8% of the patients were adherent to their medication, the remaining 25.2% were nonadherent. The major reasons for nonadherence to ART medications prescribed were getting better (73.3%) and finishing medication (16.7%). Moreover, 96 (80.7%) respondents abused alcohol while 36 (30.3%) and 75 (35.6%) abused opioids and cigarette smoking, respectively. Mothers who abused alcohol were 38.1 times more likely to be nonadherent to ART medications for PMTCT [AOR = 38.1% CI: 21.47­56.54] compared to their counterparts. Additionally, mothers who abuse opioids were 19 times more likely to be nonadherent to ART treatment medication [AOR = 19, 95% CI: 2.46­ 19.46] than their counterparts. Furthermore, mothers who smoked cigarettes were 43.1 more likely to be nonadherent [AOR = 43.19, 95% CI: 8.42­187.84] than nonsmokers. Unemployment was also found to be associated with nonadherence to ART medication to PMTCT of HIV [AOR = 5.4, 95% CI: 2.8­5.7]. Smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART [AOR = 0.22, 95% CI: 0.084­0.355]. Conclusion: Abuse of alcohol, cigarette smoking, abuse of opioids, and joblessness were found to be significantly associated with nonadherence to ART medications prescribed to PMCT of HIV. Wheareas, smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART medications.

Adolescents' lived experiences of substance abuse in the Greater Giyani Municipality

Background: Adolescence is a unique and distinct stage of development that involves changes in the physical, psychological and social aspects of adolescents. It is a critical transition into adulthood whereby heightened risk-taking and sensation-seeking takes place, such as substance abuse. In a South African context, this transition sometimes occurs under economic stress, poverty, unemployment, high levels of crime and political instability. This can place adolescents at risk of substance abuse. Objectives: To explore and describe the lived experiences of adolescents abusing substances in the Greater Giyani Municipality in the Limpopo province, South Africa. Method: A qualitative, exploratory, descriptive and contextual research design with a phenomenological approach was used. Data were collected through individual, in-depth, phenomenological interviews and field notes. Thematic coding was utilised to analyse the collected data, and literature was reviewed to support the findings. Moreover, measures to ensure trustworthiness and ethical principles were applied throughout the research process. Results: Five themes were identified: substance abuse behaviour among adolescents, adolescents' motivation for continuing substance abuse, the effects of substance abuse on the lives of adolescents, factors affecting adolescents' discontinuation of substance abuse and a need to discontinue substance abuse. Conclusion: The study concluded that adolescents abusing substances in the Greater Giyani, Limpopo province, experience loss of control, broken relationships, poor academic performance, stigma attached to mental illness and negative emotions. The adolescents foresaw their future as uncertain and without direction. It is recommended that mental healthcare professionals introduce and implement interventions that will assist the adolescents who abuse substances in the Greater Giyani, Limpopo province. Contribution: The findings in this study could add knowledge in developing and implementing of strategies for psychiatric nurses to support adolescents abusing substances in the Greater Giyani, Limpopo province.

Group interventions in psychosocial care centers for alcohol and drugs: challenges of care practice / Intervenciones grupales en centros de atención psicosocial alcohol y drogas: desafíos de la práctica de atención / Intervenções grupais em centros de atenção psicossocial álcool e drogas: desafios da prática assistencial

ABSTRACT Objective: to understand the challenges of care practice with group interventions Psychosocial Care Centers for Alcohol and Drugs. Method: qualitative intervention research developed with 30 professionals from four Alcohol and Psychosocial Drug Care Centers in a municipality in central Brazil from March to April 2019. We used a professional characterization instrument and conversation wheels to collect data that were submitted to the thematic modality of content analysis. Results: some challenges that permeate the practice with group interventions in CAPSad were evidenced, from the professionals' perspective, such as inadequate physical structure and scarcity of material resources; issues related to aspects of users such as difficulty in adhesion and commitment to groups, incompatible work schedules and lack of financial resources for travel to the centers; factors related to the competence of professionals as not having affinity to work with groups, absence of specific training, prioritization of other practices, demotivation, absence of care records and difficulty in performing the patient discharge and; aspects of work processes such as outpatient organizational culture, very high demand, insufficient human resources, lack of external supervision, few offers of therapeutic groups and lack of criteria for the definition of group coordinators. Conclusion: the challenges experienced include issues of inadequate physical structure and deficient material resources, difficulties related to the life contexts of users, competence of professionals and factors of the work processes of the services.

RESUMEN Objetivo comprender los desafíos de la práctica asistencial con intervenciones grupales en Centros de Atención Psicosocial de Alcohol y Drogas. Método investigación de intervención desarrollada con 30 profesionales de cuatro Centros de Atención Psicosocial de Alcohol y Drogas de un municipio del centro de Brasil de marzo a abril de 2019. Utilizamos un instrumento de caracterización profesional y ruedas de conversación para recolectar datos que fueron sometidos a la modalidad temática de análisis de contenido. Resultados: se evidenciaron algunos desafíos que permean la práctica con intervenciones grupales en CAPSad, desde la perspectiva de los profesionales, como estructura física inadecuada y escasez de recursos materiales; cuestiones relacionadas con aspectos de los usuarios como dificultad para incorporar y compromiso de grupos, jornada laboral incompatible y falta de recursos económicos para desplazamiento al servicio; factores d la competencia de los profesionales como no tener afinidad para trabajar con grupos, ausencia de formación específica, priorización de otras prácticas, desmotivación, ausencia de registros de atención y dificultad en la realización del alta de los usuarios y; aspectos de los procesos de trabajo como cultura organizacional ambulatoria, demanda muy grande, recursos humanos insuficientes, falta de supervisión externa, pocas ofertas de grupos terapéuticos y falta de criterio para la definición de coordinadores de grupo. Conclusión: lo vivido incluye cuestiones de estructura física inadecuada y recursos materiales deficientes, desafíos relacionados con los contextos de vida de los usuarios, competencia de los profesionales y factores de los procesos de trabajo de los servicios.

RESUMO Objetivo: compreender os desafios da prática assistencial com intervenções grupais em Centros de Atenção Psicossocial Álcool e Drogas. Método: pesquisa-intervenção de abordagem qualitativa desenvolvida com 30 profissionais de quatro Centros de Atenção Psicossocial Álcool e Drogas de um município da região central do Brasil de março e abril de 2019. Utilizou-se instrumento de caracterização profissiográfica e rodas de conversa para coleta de dados que foram submetidos à análise de conteúdo, modalidade temática. Resultados: evidenciou-se alguns desafios que permeiam a prática com intervenções grupais em CAPSad, sob a ótica dos profissionais, como estrutura física inadequada e escassez de recursos materiais; questões ligadas a aspectos dos usuários como a dificuldade de adesão e comprometimento com os grupos, agenda de trabalho incompatível e falta de recursos financeiros para deslocamento ao serviço; fatores da competência dos profissionais como não ter afinidade de trabalhar com grupos, ausência de formação específica, priorização de outras práticas, desmotivação, ausência de registros dos atendimentos e dificuldade de realizar a alta dos usuários e; aspectos dos processos de trabalho como cultura organizacional ambulatorial, demanda muito grande, recursos humanos insuficientes, falta de supervisão externa, poucas ofertas de grupos terapêuticos e ausência de critérios para a definição de coordenadores de grupos. Conclusão: os desafios vivenciados englobam questões de estrutura física inadequada e recursos materiais deficitários, dificuldades ligadas aos contextos de vida dos usuários, competência dos profissionais e fatores dos processos de trabalho dos serviços.