High rates of relapse in adolescents crack users after inpatient clinic discharge / Alto índice de recaída em adolescentes usuários de crack após a alta da internação

ABSTRACT Objective The objective of the present study was to evaluate 88 adolescent crack users referred to hospitalization and to follow them up after discharge to investigate relapse and factors associated with treatment. Methods Cohort (30 and 90 days after discharge) from a psychiatric hospital and a rehab clinic for treatment for chemical dependency in Porto Alegre between 2011 and 2012. Instruments: Semi-structured interview, conducted to evaluate the sociodemographic profile of the sample and describe the pattern of psychoactive substance use; Crack Use Relapse Scale/CURS; Questionnaire Tracking Users to Crack/QTUC; K-SADS-PL. Results In the first follow-up period (30 days after discharge), 65.9% of participants had relapsed. In the second follow-up period (90 days after discharge), 86.4% of participants had relapsed. Conclusion This is one of the first studies that show the extremely high prevalence of early relapse in adolescent crack users after discharge, questioning the cost/benefit of inpatient treatment for this population. Moreover, these results corroborate studies which suggested, young psychostimulants users might need tailored intensive outpatient treatment with contingency management and other behavioral strategies, in order to increase compliance and reduce drug or crime relapse, but this specific therapeutic modality is still scarce and must be developed in Brazil.

RESUMO Objetivo O objetivo do presente estudo foi avaliar 88 adolescentes usuários de crack no que se refere à hospitalização e dar-lhes seguimento após a alta, para investigar as recaídas e os fatores associados ao tratamento. Métodos Coorte (30 e 90 dias após a alta) de um hospital psiquiátrico e uma clínica de reabilitação, para o tratamento de dependência química em Porto Alegre, entre 2011 e 2012. Instrumentos: entrevista semiestruturada, realizada para avaliar o perfil sociodemográfico da amostra e descrever o padrão de uso de substâncias psicoativas; Escala de Recaída dos Usuários de Crack/ERUC; Questionário de Seguimento de Usuários de Crack/QSUC; K-SADS-PL. Resultados No primeiro período de seguimento (30 dias após a alta), 65,9% dos participantes recaíram. No segundo período de seguimento (90 dias após a alta), 86,4% dos participantes tiveram recaíram. Conclusão Este é um dos primeiros estudos que mostram a prevalência extremamente alta de recaída precoce em adolescentes usuários de crack após a alta, questionando o custo-benefício do tratamento em regime de internação para essa população. Além disso, esses resultados corroboram estudos que sugerem que usuários de psicoestimulantes jovens podem precisar de um adaptado Tratamento Ambulatorial Intensivo, com manejo de contingências e outras estratégias comportamentais, a fim de aumentar a adesão, reduzir o uso da droga ou recaída ao crime. No entanto, essa modalidade terapêutica específica ainda é escassa e deve ser desenvolvida no Brasil.

Confirmatory factor analysis (CFA) of the Crack Use Relapse Scale (CURS)

Abstract Background When it comes to crack/drug use, relapse is a relatively common event in the first weeks after the end of treatment. However little is known about what happens to patients who relapse after discharge. Objective To report the confirmatory factor analysis (CFA) of the Crack Use Relapse Scale (CURS) in an inpatient population. Methods A five-point Likert scale with 25 items and, initially, 9 theoretical factors was generated and utilized in a cross-sectional study with a sample of 333 hospitalized male crack users. Results CFA indicated a well-fitting model for the CURS. Discussion The CFA shows that the CURS model is appropriate and well-fitting for assessment of latent variables common to psychiatric and psychological constructs – in this case, relapse of crack cocaine use after inpatient treatment.

Following Up Crack Users after Hospital Discharge Using Record Linkage Methodology: An Alternative to Find Hidden Populations.

This paper presents the probabilistic record linkage (PRL) methodology as an alternative way to find or follow up hard-to-reach population as crack users. PRL was based on secondary data from public health information systems and the strategy used from standardization; phonetic encoding and the rounds of matching data were described. A total of 293 patient records from medical database and two administrative datasets obtained from Ministry of Health Information Systems were used. Patient information from the medical database was the identifiers to the administrative datasets containing data on outpatient treatment and hospital admissions. 40% of patient records were found in the hospital database and 12% were found in the outpatient database; 95% of the patients were hospitalized up to 5 times, and only 10 out of them had outpatient information. The record linkage methodology by linking government databases may help to address research questions about the path of patients in the care network without spending time and financial resources with primary data collection.

Factors associated with recurrence of alcohol-related traffic violations in southern Brazil

Objective: To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil. Method: This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level. Results: A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for ≥ 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08). Conclusions: In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated. .

Factors associated with recurrence of alcohol-related traffic violations in southern Brazil.

OBJECTIVE: To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil. METHOD: This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level. RESULTS: A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for ≥ 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08). CONCLUSIONS: In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated.

Challenges associated with drunk driving measurement: combining police and self-reported data to estimate an accurate prevalence in Brazil.

BACKGROUND: Drunk driving is an important risk factor for road traffic crashes, injuries and deaths. After June 2008, all drivers in Brazil were subject to a "Zero Tolerance Law" with a set breath alcohol concentration of 0.1 mg/L of air. However, a loophole in this law enabled drivers to refuse breath or blood alcohol testing as it may self-incriminate. The reported prevalence of drunk driving is therefore likely a gross underestimate in many cities. OBJECTIVE: To compare the prevalence of drunk driving gathered from police reports to the prevalence gathered from self-reported questionnaires administered at police sobriety roadblocks in two Brazilian capital cities, and to estimate a more accurate prevalence of drunk driving utilizing three correction techniques based upon information from those questionnaires. METHODS: In August 2011 and January-February 2012, researchers from the Centre for Drug and Alcohol Research at the Universidade Federal do Rio Grande do Sul administered a roadside interview on drunk driving practices to 805 voluntary participants in the Brazilian capital cities of Palmas and Teresina. Three techniques which include measures such as the number of persons reporting alcohol consumption in the last six hours but who had refused breath testing were used to estimate the prevalence of drunk driving. RESULTS: The prevalence of persons testing positive for alcohol on their breath was 8.8% and 5.0% in Palmas and Teresina respectively. Utilizing a correction technique we calculated that a more accurate prevalence in these sites may be as high as 28.2% and 28.7%. In both cities, about 60% of drivers who self-reported having drank within six hours of being stopped by the police either refused to perform breathalyser testing; fled the sobriety roadblock; or were not offered the test, compared to about 30% of drivers that said they had not been drinking. DISCUSSION: Despite the reduction of the legal limit for drunk driving stipulated by the "Zero Tolerance Law," loopholes in the legislation permit many drivers under the influence of alcohol to act with impunity. In this context the police/traffic officers are often powerless to enforce the law and thus drunk driving continues to go unchecked. CONCLUSION: Strong legislation and effective enforcement are necessary to reduce the prevalence of this dangerous behaviour. Correction techniques allow calculation of a truer prevalence of drunk driving, which can assist police and policymakers alike to redirect resources and align strategies.

[Food and Nutritional Surveillance System (SISVAN) in children from Rio Grande do Sul State, Brazil: coverage, nutritional status, and data reliability]. / Sistema de Vigilância Alimentar e Nutricional (SISVAN) em crianças do Rio Grande do Sul, Brasil: cobertura, estado nutricional e confiabilidade dos dados.

This study aimed to evaluate: the coverage of the Food and Nutritional Surveillance System (SISVAN) in the State of Rio Grande do Sul, Brazil, and it Regional Health Offices in 2006; the nutritional status of children 0-10 years of age; and the reliability of data on nutritional status recorded in the system. A cross-sectional descriptive study was conducted with secondary data on 63,320 children. Coverage was defined as the proportion of children younger than 10 years covered by the Family Health Strategy in the State's various municipalities (counties). Height-for-age (H/A) and body mass index for age (BMI/A) were classified according to World Health Organization (WHO) criteria. Agreement between the nutritional classifications recorded in the system and those calculated in this study was evaluated with the weighted kappa coefficient (at 5%). The system's coverage in the State of Rio Grande do Sul was 10.5%. Low height-for-age was found in 7.1% of children and overweight in 8.4%. Agreement between the classifications showed a kappa coefficient of 0.43. The system's coverage and agreement between classifications were both low, and the study showed the coexistence of high overweight and stunting rates in this age group.

Sistema de Vigilância Alimentar e Nutricional (SISVAN) em crianças do Rio Grande do Sul, Brasil: cobertura, estado nutricional e confiabilidade dos dados / Food and Nutritional Surveillance System (SISVAN) in children from Rio Grande do Sul State, Brazil: coverage, nutritional status, and data reliability

Este estudo objetivou avaliar: cobertura do Sistema de Vigilância Alimentar e Nutricional (SISVAN) no Rio Grande do Sul e suas Coordenadorias Regionais de Saúde em 2006; estado nutricional das crianças de 0-10 anos e a confiabilidade dos dados sobre estado nutricional registradas no sistema. Realizou-se estudo transversal descritivo de base secundária com 63.320 crianças. A cobertura baseou-se no número de menores de 10 anos cobertos pela Estratégia Saúde da Família nos municípios. Os índices estatura/idade (E/I) e de massa corporal/idade (IMC/I) foram classificados com base na Organização Mundial da Saúde (OMS). A concordância entre classificações nutricionais registradas no sistema e as geradas neste estudo foi avaliada pelo teste kappa ponderado (nível de 5 por cento). No Rio Grande Sul, a cobertura do sistema foi de 10,5 por cento e encontraram-se frequências de déficit de E/I de 7,1 por cento e de excesso de peso de 8,4 por cento. A concordância entre classificações teve kappa = 0,43. Apontaram-se baixas cobertura do sistema e concordâncias de classificações e a coexistência de excesso de peso e déficit estatural entre os acompanhados.

This study aimed to evaluate: the coverage of the Food and Nutritional Surveillance System (SISVAN) in the State of Rio Grande do Sul, Brazil, and it Regional Health Offices in 2006; the nutritional status of children 0-10 years of age; and the reliability of data on nutritional status recorded in the system. A cross-sectional descriptive study was conducted with secondary data on 63,320 children. Coverage was defined as the proportion of children younger than 10 years covered by the Family Health Strategy in the State's various municipalities (counties). Height-for-age (H/A) and body mass index for age (BMI/A) were classified according to World Health Organization (WHO) criteria. Agreement between the nutritional classifications recorded in the system and those calculated in this study was evaluated with the weighted kappa coefficient (at 5 percent). The system's coverage in the State of Rio Grande do Sul was 10.5 percent. Low height-for-age was found in 7.1 percent of children and overweight in 8.4 percent. Agreement between the classifications showed a kappa coefficient of 0.43. The system's coverage and agreement between classifications were both low, and the study showed the coexistence of high overweight and stunting rates in this age group.

Shortage and underutilization of psychiatric beds in southern Brazil: independent data of Brazilian mental health reform.

BACKGROUND: Mental health policies throughout the world are being subjected to several changes due to increased pressure from the public and from health administrators. Mental health policies in the developing world experienced changes following advice and consultation from the World Health Organization (WHO). This was the case with Brazil, which enacted several laws and policies affecting community care and the closure of beds in psychiatric hospitals (the deinstitutionalization movement). Rio Grande do Sul, the southeast state in Brazil, adopted this policy in 1992, but still suffers from a shortage of psychiatric beds in both general hospitals (GHs) and psychiatric hospitals (PHs), despite advances in the provision of community care. As a result, Rio Grande do Sul (RS) can be studied as an example of "what actually happens" in mental health care in the developing world. METHODS: The study analyzed online administrative data from 2000 to 2007 for three main parameters of mental health care (i.e. hospital use rate, length of stay, and hospital bed capacity). These were used to evaluate differences in psychiatric care among GHs and PHs. The number of existing and required psychiatric beds in RS was also calculated. RESULTS: GHs had very low hospital use rates, while PHs had a very high length of stay (200% higher than GH). The number of admissions to GHs grew by 170% over the 8 year period, and psychiatric bed availability was 1.5 per 10,000 inhabitants. CONCLUSIONS: The study provided evidence for the need of 30-50% more psychiatric beds in GHs. Also, additional staff training is needed to increase use rates in GHs and decrease the length of stay in PHs. Additional studies covering national data must be carried out to assess the extent of these problem in other Brazilian mental health care services.

A falácia da adequação da cobertura dos Centros de Atenção Psicossocial no estado do Rio Grande do Sul / The fallacy of adequate coverage offered by Psychosocial Care Centers in the state of Rio Grande do Sul

Introdução: A análise dos resultados da expansão da rede de atenção à saúde mental para a população brasileira tem utilizado como medida de desfecho o indicador de cobertura dos Centros de Atenção Psicossocial (CAPS), que considera adequada a existência de um CAPS para cada 100 mil habitantes. O Rio Grande do Sul encontra-se classificado em terceiro lugar no ranking nacional, com índice de 0,7 CAPS/100.000 habitantes. Este estudo objetivou testar a variabilidade de cobertura de cada região para verificar se esse índice global representava as realidades regionais. Método: Foram utilizados dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e dados populacionais do ano de 2009 disponibilizados pelo site do Departamento de Informática do Sistema Único de Saúde do Ministério da Saúde. Foram calculados os indicadores de cobertura para as 19 regionais de saúde, sendo gerado índice de cobertura resultante da razão entre o indicador observado e o esperado de acordo com a população de cada região geográfica analisada. Resultados: Analisada a variabilidade de cobertura de cada região, foi evidenciada a ocorrência de sete regiões com cobertura insuficiente, representando 49 por cento da população do estado com cobertura inadequada. Conclusão: O estudo demonstrou que o uso do índice global é falacioso, pois não representa as realidades regionais, sendo que cerca de metade das regiões com excesso de cobertura mascaram as regiões deficientes. Isso sugere que as análises de cobertura devem ser realizadas por áreas geográficas para identificar carências regionais e fornecer subsídios para a extensão da rede de forma igualitária para usuários de diferentes regiões do estado.

Introduction: Analysis of the results of the ongoing expansion of the Brazilian public mental health care network has used the indicator of coverage offered by Psychosocial Care Centers (Centros de Atenção Psicossocial, CAPS), which considers the rate of one CAPS per 100,000 inhabitants to be adequate, as its outcome measure. The state of Rio Grande do Sul ranks third in nationwide CAPS coverage standings, with 0.7 centers per 100,000 inhabitants. The present study sought to assess the variability of coverage in different regions in order to verify the representativeness of the overall coverage rate. Method: We used data collected from the National Database of Health Facilities (Cadastro Nacional de Estabelecimentos de Saúde, CNES) and 2009 population data made available at the website of the Ministry of Health Department of Information Technology. We calculated 19 coverage indicators, one for each health region, and computed a coverage rate based on the ratio between the actual indicator and the expected indicator according to the population of each region. Results: Analysis of the variability of coverage for each region showed that seven regions had inadequate coverage, with 49 percent of the state population receiving inadequate coverage. Conclusion: This study showed that the use of an overall rate for mental health care coverage can be considered a fallacy, as it fails to represent regional realities; roughly half of the regions with excessive coverage masked the regions with poor coverage. This finding suggests that analysis of care coverage must be broken down into geographic areas, in order to identify regional needs and provide support for equal expansion of the community mental health care network for users living in different geographic areas.