Direct health implications of e-cigarette use: a systematic scoping review with evidence assessment.

Background: E-cigarettes are often marketed as a less harmful alternative to traditional tobacco cigarettes. Despite their popularity, the evidence regarding their effects on human health remains unclear and is filled with complexities. Objectives: This systematic review aims to elucidate the direct effects of electronic cigarette use on human health, carefully distinguishing between the specific characteristics of the populations studied. Methodology: Adhering to the PRISMA guidelines, we conducted a comprehensive search in PubMed/Medline, Web of Science, Scopus, and Google Scholar databases without date restrictions, including articles in both Spanish and English. This approach enabled the identification and analysis of primary studies to understand the direct effect of electronic cigarettes on human health. Results: A total of 33 studies were included that evaluated cardiovascular, pulmonary, renal, weight and fertility effects. Only five studies analyzed e-cigarettes in healthy populations and seven studies compared healthy individuals against smokers. The effects evaluated on smokers or former tobacco smokers were apparently positive, however, among healthy individuals, increased heart rate, mean arterial pressure, oxidative stress, alteration of respiratory epithelial cells and increased airflow resistance were found. Conclusion: Smokers or former smokers who switch to e-cigarettes may reduce their exposure to carcinogens and lower their risk of developing severe health issues associated with conventional smoking. However, in healthy individuals who have never smoked traditional cigarettes, the use of e-cigarettes introduces several cardiovascular and respiratory adverse effects. These findings suggest that while e-cigarettes can be a strategic harm reduction tool for smokers, they are not a safe option for non-smokers.

Feasibility, acceptability, and perceived usefulness of a community-evidence-based harm reduction intervention for sexualized stimulant use among Mexican gay, bisexual, and other men who have sex with men.

BACKGROUND: The use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment. METHODS: The in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale ("not useful"-"very useful") for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention. RESULTS: Participants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention. CONCLUSIONS: This intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.

Voices of the unhoused from Santa Fe, New Mexico: A mixed methods study of health status, substance use, and community harm reduction program perspectives.

No published studies have examined the community service priorities and harm reduction perspectives of unhoused people in Santa Fe, New Mexico. We conducted a mixed methods pilot study of 56 unhoused people at community locations in Santa Fe to: (1) assess the current prevalence of chronic medical conditions and substance use; (2) highlight community service priorities; and (3) explore views of innovative community harm reduction programs. Our first hypothesis was there would be high prevalence of chronic medical conditions, for which we found high prevalence of post-traumatic stress disorder, major depression, substance use disorders, chronic pain, and hypertension. Our second hypothesis was that we would find top community service priorities of housing, food, and health care. We found long- and short-term housing and food, but not healthcare, top priorities. Our third hypothesis was that we would find mixed support for community harm reduction initiatives like managed alcohol programs and overdose prevention centers. We found positive, not mixed, support for these community harm reduction programs among Santa Fe's unhoused. Unhoused study participants ranged in age 27-77 years, with lifetime years unhoused from less than one year to 63 years. Study limitations included small sample size, convenience sampling, and descriptive results. Policies and program initiatives supporting additional Housing First options, managed alcohol programs, and overdose prevention centers in the Santa Fe community are clearly indicated to increase engagement with this vulnerable population. Future research should focus on inclusion of the perspectives of the unhoused in the design, conduct, evaluation, and dissemination of community programs to meet the needs of the unhoused, with re-defined outcomes to include changes in quality of life, program engagement, demarginalization, and future goals and plans, beyond currently utilized health and social service program outcome measures.

Correlation between tobacco control policies and tobacco prevention in Mexico: a sub-national analysis.

This study aims to determinate the correlation between tobacco control policies (TCP) and the prevalence of tobacco use in the 32 Mexican states during the 2016-2017 period. This is an ecological study that measured TCP by the Tobacco Control Scale (TCS) which assigns a score (0-100) based on the level of these component's implementation: price, prohibition in public spaces, expenditures of public information campaigns, publicity prohibitions, health warnings, and treatments. We analyzed the associations between the TCS scores and prevalence of tobacco use extracted from the National Survey of Drug, Alcohol and Tobacco Consumption using Spearman correlations. Prevalence of daily smokers is negatively correlated with global TCS scores for adolescents (p = 0.026). Price showed similar negative correlations with daily prevalence in adolescents (p = 0.003), adults (p = 0.040), men (p < 0.006), and women (p = 0.040). Many Mexican states need to improve on tobacco control policies, especially targeting a key population: adolescents.

Systematic review of cognitive and behavioral strategies used in effective harm reduction interventions for people who use cocaine.

OBJECTIVE: The aim of this systematic review is to identify cognitive and behavioral strategies that have been used in effective harm reduction interventions for people who use cocaine. METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the search was performed on February 26, 2023 across databases including PsycInfo, PubMed, Scopus, and Web of Science. Studies were included if they (1) report the use of one cognitive or behavioral strategy, (2) have harm reduction as the objective, (3) involve participants who used cocaine as at least one of their substances, (4) be published within the last 10 years, and (5) have a randomized controlled trial design. The Cochrane RoB 2.0 Tool was used to assess risk of bias. The cognitive and behavioral strategies were extracted and organized based on their frequency of use in the studies and their corresponding outcomes. RESULTS: The final synthesis included k = 10 studies with N = 3,567 participants. Psychoeducation strategies, influence on social norms, personalized feedback, increased self-efficacy and motivational interviewing were the most frequently used promising strategies across studies. CONCLUSIONS: This review underscores the significance of incorporating cognitive and behavioral strategies within harm reduction interventions, as they represent a promising domain that could enhance the effectiveness of addressing cocaine use.

The joy and pain of being a harm reduction worker: a qualitative study of the meanings about harm reduction in Brazil.

BACKGROUND: Although harm reduction is highlighted as an effective intervention for alcohol and drug use, a funding gap for harm reduction interventions has been identified, mainly in low- and middle-income countries. In these countries, tensions between abstinence and harm reduction models have impaired the shift from punitive practices to evidence-based interventions committed to guaranteeing the human rights of people who use drugs. Since 2015, the Brazilian government has adopted a more punitive and abstinence-focused drug policy that jeopardizes the care of people who use alcohol and other drugs and the comprehension of the harm reduction workers' perspective in relation to their practice. Therefore, this study aimed to comprehend the meanings constructed by Brazilian harm reduction workers regarding their practices with vulnerable populations amidst a context of political tension. METHODS: We conducted 15 in-depth semi-structured qualitative interviews with harm reduction workers employed in public health services for at least 6 months. Data were analyzed using thematic analysis. RESULTS: The thematic axis "The joy and pain of being a harm reduction worker in Brazil" was constructed and divided into four major themes: (1) Invisibility of harm reduction work; (2) Black, poor, and people who use drugs: identification with the service users; (3) Between advocacy and profession: harm reduction as a political act; (4) Small achievements matter. Despite the perceived invisibility of harm reduction workers in the public health and alcohol and drug fields, valuing small achievements and advocacy were important resources to deal with political tension and punitive strategies in Brazil. The findings also highlight the important role of harm reduction workers due to their personal characteristics and understanding of drug use behavior, which bring the target audience closer to actions within the public health system. CONCLUSION: There is an urgent need to acknowledge harm reduction based on peer support as a professional category that deserves adequate financial support and workplace benefits. Additionally, expanding evidence-based harm reduction interventions and community-based voluntary drug use treatment centers should be prioritized by public policies to address the human rights violations experienced by people who use drugs.

Contribution of proactive management of healthcare risks to the reduction of adverse events in a maternity hospital.

BACKGROUND: The risks of the childbirth assistance process are still very high, both for mothers and babies. According to the WHO, birth-related asphyxia accounts for 23% of all 3.3 million annual neonatal deaths and an even larger number of survivors with disabilities. On the other hand, maternal mortality is still a global challenge, affecting 17 mothers per 100 000 births in the USA. This is associated with the use of outdated technologies and a lack of well-defined processes in monitoring labour and early recognition of maternal clinical deterioration. METHOD: This study used Lean methodology to map the care flow for pregnant women in a Brazilian maternity hospital (Hospital Israelita Albert Einstein) in order to identify the risks within this process and a set of actions to minimise them. The work team consisted of 29 individuals, including local medical and nursing leaders, as well as healthcare professionals. The What-if tool was used to categorise the levels of risks, and the proportion of severe and catastrophic adverse events was evaluated before and after the implementation of changes. RESULTS: After the implementation of the actions, 100% of the extreme risks (28 risks) and 8% of the high risks (4 risks) were eliminated. This led to a reduction in the interval between severe/catastrophic events from 126 to 284 days, even with an increase in the average monthly number of visits from 367 to 449. Consequently, the weighted value of events decreased from 7.91 to 3.29 per 1000 patients treated, resulting in an annual cost savings of R$693 646.80 (US$139 000.00). DISCUSSION: The construction of a process based on Lean methodology was essential for mapping the involved risks and implementing a set of actions to minimise them. The participation of the healthcare team and leadership seemed to be important in choosing the measures to be adopted and their applicability. The results found can be attributed to both the established changes and the safety culture brought about by this constructive process.

The impact of cannabis on non-medical opioid use among individuals receiving pharmacotherapies for opioid use disorder: a systematic review and meta-analysis of longitudinal studies.

Background: The relationship between cannabis use and the risk of returning to using opioids non-medically during treatment for opioid use disorder (OUD) remains unclear.Objective: We sought to quantify the impact of cannabis use on the risk of non-medical opioid use among people receiving pharmacotherapies for OUD.Methods: A comprehensive search was performed using multiple databases from March 1 to April 5 of 2023. Eligible studies longitudinally assessed the association between cannabis use and non-medical opioid use among people with OUD receiving treatment with buprenorphine, methadone, or naltrexone. We utilized a random-effects model employing the restricted maximum likelihood method. A sensitivity analysis was conducted to understand potential differences between each OUD treatment modality.Results: A total of 10 studies were included in the final meta-analysis. There were 8,367 participants (38% female). The average follow-up time across these studies was 9.7 months (SD = 3.77), ranging from 4 to 15 months. The pharmacotherapies involved were methadone (76.3%) buprenorphine (21.3%), and naltrexone (2.4%). The pooled odds ratio did not indicate that cannabis use significantly influenced non-medical opioid use (OR: 1.00, 95% CI: 0.97-1.04, p = .98). There is evidence of moderate heterogeneity and publication bias.Conclusion: There was no significant association between cannabis use and non-medical opioid use among patients receiving pharmacotherapies for OUD. These findings neither confirm concerns about cannabis increasing non-medical opioid use during MOUD, nor do they endorse its efficacy in decreasing non-medical opioid use with MOUD. This indicates a need for individualized approaches for cannabis use and challenges the requirement of cannabis abstinence to maintain OUD pharmacotherapies.

Use of psychoactive substances among university students from 2019 to 2020: A systematic review.

Psychoactive substances act on the central nervous system producing changes in mental processes, such as perception, consciousness, cognition or mood and emotions. The present study aims to identify: (i) the most used psychoactive substances, (ii) how psychoactive substances are acquired, (iii) and possible reasons for the use of psychoactive substances amongst university students. A literature search was carried out without language restrictions and included articles published between 2019 and 2020 in journals indexed in the electronic databases of Pubmed and Scielo. The inclusion criteria considered were: (i) original articles, (ii) studies carried out with university students, (iii) providing data on the use of psychoactive substances. 15 studies were included in this review, of which: 4 studies addressed possible reasons that lead to use of psychoactive substances, 10 studies reported usage profile and demographic data, and 1 study addressed how students acquire psychoactive substances. Reasons that led to the consumption of psychoactive substances include: feelings of loneliness after moving away from family; difficulty making new friends; poor academic performance and susceptible environment to acquisition of these substances. In the selected studies, alcohol was identified as the main drug used. In light of the findings reported in this review, new prevention and harm reduction measures can be formulated, based mainly on the reasons that lead to the use of psychoactive drugs, consumption patterns and how the drugs were acquired by university students.

Sofrimento psíquico, uso de drogas e trabalho / Psychic distress, drug use and work

Resumo Introdução: a política de atenção ao uso e abuso de álcool e outras drogas dos últimos anos demonstra suas limitações para responder às necessidades de atenção à saúde do(a) trabalhador(a) que usa essas substâncias para aliviar os efeitos adversos dos mecanismos hostis no contexto do trabalho. Objetivo: articular abordagens que reúnem um conjunto teórico-conceitual suficiente para abordar temas complexos e multicausais, como a relação entre o sofrimento psíquico e o trabalho, tendo como elemento principal o uso e abuso de álcool e outras drogas. Resultados: há evidências que apontam a relação entre mudanças no mercado de trabalho no contexto neoliberal, violência moral e ética no ambiente profissional e efeitos negativos sobre a saúde física-psíquica de trabalhadores. Evidenciou-se a necessidade de se romper com a lógica do funcionalismo subjetivista sobre o tema do uso e abuso de álcool e outras drogas relacionados ao trabalho. Conclusão: as estratégias políticas de atenção ao sofrimento psíquico decorrente do uso de álcool e outras drogas devem ir além das práticas focadas somente na abstinência e se basear na interface entre aportes teóricos integrativos, redução de danos e que considere a relação entre sofrimento e defesas dos sujeitos, o trabalho e o meio.

Abstract Introduction: policies aimed at use and abuse of alcohol and other drugs in recent years have shown their limitations in responding to the healthcare needs of workers who use and/or abuse alcohol and other drugs to alleviate the adverse effects from hostile work-related mechanisms. Objective: to articulate approaches that gather a theoretical-conceptual set that adequately addresses complex and multi-causal topics, such as the relation between psychological distress and work, with the use and abuse of alcohol and other drugs as their main element. Results: scientific evidence points out to the relation between neoliberal labor market changes, moral and ethical violence in the professional environment and negative effects on workers' physical and mental health. Studies argue about the need to break with the logic of subjectivist functionalism on the topic of work-related use and abuse of alcohol and other drugs. Conclusion: political strategies aimed at psychological suffering resulting from the use/abuse of alcohol and other drugs must go beyond practices solely focused on abstinence and include the interface between integrative theoretical contributions and harm reduction while considering the interaction between suffering and subjects' defenses, work and environment.

Insumos, arte e laço social no contexto das práticas contemporâneas em Redução de Danos no Brasil / Contemporary practices of Harm Reduction in Brazil: inputs, art and social bonds

Resumo Objetivo: Discutir a possível função de insumo das práticas artísticas e culturais no contexto da Redução de Danos (RD). Métodos: Pesquisa etnográfica desenvolvida no Ponto de Cultura do Centro de Convivência "É de Lei", localizado em São Paulo-SP, em dois momentos: no primeiro, em outubro de 2016, realizou-se observação participante das atividades artísticas e culturais. No segundo, em novembro de 2016, realizaram-se entrevistas semiestruturadas com profissionais e frequentadores. O estudo identificou e descreveu práticas artísticas e culturais, bem como investigou suas possíveis relações com os insumos em RD na produção do laço social. A análise e a discussão dos dados foram embasadas por conceitos na interface entre a Saúde Coletiva e a Psicanálise. Resultados e Discussão: A pesquisa caracterizou o insumo em RD como promotor de vínculo entre o toxicômano e quem o oferta, com potencial para deslocar o sujeito da relação solitária estabelecida com a substância na direção dos laços sociais que possibilitam exercer sua condição de sujeito singular na cultura. Conclusão: O estudo considerou que as práticas artísticas e culturais podem exercer a função de insumos em RD no que concerne ao estabelecimento de laços sociais.

Abstract Objective: To discuss the possible input function of artistic and cultural practices in the context of Harm Reduction (HR). Methods: Ethnographic research developed at the Ponto de Cultura of the Centro de Convivência "É de Lei", located in São Paulo-SP, which took place in two moments: in the first, in October 2016, participative observation of artistic and cultural activities was carried out. In the second, in November 2016, semi-structured interviews were carried out with professionals and regulars. The study identified and described artistic and cultural practices, as well as investigated their possible relationships with HR inputs in the production of the social bond. The discussion of the data was based on concepts at the interface between public health and psychoanalysis. Results and Discussion: The research characterized the input in HR as a promoter of a bond between the drug addict and whoever offers it with the potential to divert the subject from the established solitary relationship with the substance towards the creation of social ties that stimulates the exercise of their condition as a singular subject in culture. Conclusion: The study concluded that artistic and cultural practices can play the role of inputs in HR with regard to the establishment of social bonds.

Reducing harm and promoting positive media use strategies: new perspectives in understanding the impact of preschooler media use on health and development.

Most children grow up in homes with easy access to multiple screens. Screen use by children between the ages of 0 to 5 has become a worldwide preoccupation. In the present narrative review, we examine child and parent screen use and its contribution to physical, cognitive, and social developmental outcomes. As research has mostly focused on the adverse consequences of screen media, we aim to depict both the negative and the positive influences of screen usage. To provide a more nuanced portrait of the potential benefits and harms of screen use, we examine how consequences of media use vary according to the content of media (ex., educational, violent), context (ex., using screens during mealtimes), and the nature (ex., passive vs active use) of child screen use. Our review supports existing screen time guidelines and recommendations and suggests that media content, the context of use, and the nature of child use, as well as the parent's own screen use, be considered clinically. Future research should seek to clarify how these dimensions jointly contribute to child screen use profiles and associated consequences. Finally, child sex, behavioral/temperamental difficulties, and family adversity appear to contribute to child screen use and its consequences and should be considered in future research. Suggestions for harm-reduction approaches are discussed.

Social and environmental determinants influencing injection drug use and HIV risk among two sister cities on the US-Mexico border: a comparative cross-sectional study, 2016-2018.

The economic, social, cultural and political milieus that influence injection drug-related HIV risk behaviors along the US-Mexico border in the previous decade have been studied comparing cities on an East-West axis. In an effort to inform interventions targeting factors beyond the individual level, we used a cross-sectional study design comparing people who inject drugs during 2016-2018, living on a North-South axis, in two cities-Ciudad Juárez, Chihuahua, Mexico and El Paso, Texas, USA-situated at the midpoint of the 2000 US-Mexico borderland stretch. We conceptualize injection drug use and its antecedents and consequences as influenced by factors operating at various levels of influence. Results of analysis comparing samples recruited from each border city indicated significant differences in demographic, socioeconomic, micro- and macro-level factors that affect risk. Similarities emerged in individual-level risk behaviors and some dynamics of risk at the drug use site most frequented to use drugs. In addition, analyses testing associations across samples indicated that different contextual factors such as characteristics of the drug use sites influenced syringe sharing. In this article, we reflect on the potential tailored interventions needed to target the context of HIV transmission risk among people who use drugs and reside in binational environment.

Realidades intersubjetivas de la reducción de daños en Costa Rica: Voces polifónicas del sinhogarismo / Intersubjective realities of harm reduction in Costa Rica:Polyphonic voices of homelessness and drug consumption

Resumen: Objetivo: Comprender las experiencias de Reducción de Daños en las voces de personas costarricenses en situación de calle, consumidoras de sustancias psicoactivas. Materiales y métodos: Investigación cualitativa con diseño fenomenológico que contó con la participación de 10 personas en situación de calle que visitaban diferentes centros de atención en reducción de daños en tres provincias de Costa Rica durante los años de 2019 y 2020. Resultados: La efectivación del derecho a la salud y el reconocimiento de la ciudadanía y la humanidad de las personas en situación de calle consumidoras de sustancias, estuvieron siempre presentes en las experiencias vividas dentro de las instituciones de Reducción de Daños. Además, se explicitó que, los ejes de derechos humanos, cuidados centrados en la persona y el reconocimiento del fenómeno de las drogas como una dimensión perteneciente al ámbito de la Salud Pública fueron puntos neurálgicos "del ser" dentro de la Reducción de Daños en Costa Rica. Conclusión: Una de las mayores contribuciones de este estudio fue la comprensión del progreso de la Reducción de Daños en un no-lugar como la calle. La comprensión fenomenológica social nos mostró también que el sentido de "ser y estar" en el mundo no es algo pasible de ser determinado por estructuras primitivas y punitivas. Por lo tanto, cualquier tentativa de cuidado a la salud que deslegitime al ser humano en cualquier momento o (no) lugar estará destinada al fracaso.

Abstract: Objective: To understand the experiences of Harm Reduction among the voices of homeless people and drug users in Costa Rica. Materials and Methods: A qualitative research with a phenomenological approach that worked with 10 homeless people in Costa Rica during 2019-2020. Results: The materialization of the right to health and the recognition of the citizenship/humanism of homeless people-drug user were always present in the lived experiences of the participants. In addition, it was explicit that the axes of Humanism, Person-centered Care and the recognition of the Drug Phenomenon as a dimension belonging to the field of Public Health were neuralgic points of being within the Harm Reduction in Costa Rica. Conclusion: One of the major contributions of this study was the understanding of the progress of Harm Reduction in a non-place like the street. The social phenomenological understanding also showed us that the sense of "being" in the world is not something that can be determined by primitive and punitive structures. Therefore, any health care attempt that delegitimizes the human being at any time or (no) place will be doomed to failure.

Consultório de Rua: cuidado no território na interface entre HIV/Aids, drogas e Redução de Danos / 'Street Outreach Teams': care in the territory at the interface between HIV/AIDS, drugs and Harm Reduction

RESUMO Este artigo teve como objetivo apresentar a experiência da implementação dos Consultórios de Rua na cidade do Recife-PE como estratégia de prevenção ao HIV/Aids e Redução de Danos (RD) decorrentes do uso de álcool, crack e outras drogas. Ainda que o resgate da história desse processo apresente tensões, impermanências e alternâncias nos modelos de cuidado implementados pela gestão municipal, sua análise aponta a importância de reafirmar, no contexto atual, a proposição de práticas e experiências nesse campo, ancoradas na RD e na defesa da cidadania e dos direitos humanos. Observa-se que os Consultórios de Rua contribuem para fortalecer a prática de RD no Sistema Único de Saúde (SUS) como estratégia de saúde pública, assim como reduzem as vulnerabilidades às Infecções Sexualmente Transmissíveis (IST) e Aids associadas ao uso de álcool, crack e outras drogas. A experiência do CR ampliou a promoção à linha de cuidado para pessoas que usam álcool, crack, e outras drogas, reduzindo também as vulnerabilidades das IST/Aids associadas a esse consumo. No entanto, vê-se que é preciso investir e manter processos formativos que sejam permanentes, além de estudos e pesquisas epidemiológicas que demonstrem os resultados alcançados nos diferentes contextos.

ABSTRACT This article aims to present the experience of implementing 'Street Outreach Teams' in the city of Recife-PE as a strategy for HIV/AIDS prevention and Harm Reduction (HR) associated with the use of alcohol, crack, and other drugs. Although the review of the history of this process reveals tensions, volatility, and alternations in the care models implemented by the city management, the analysis points out the importance of reaffirming, in the current context, the practices and experiences in that field, anchored in HR and in the defense of civil and human rights. Street outreach teams have been found to help strengthen the practice of HR in the Unified Health System, as a public health strategy to reduce vulnerabilities to Sexually Transmitted Infections (STI) and AIDS associated with the use of alcohol, crack, and other drugs. The experience has expanded the promotion of the line of care for people who use alcohol, crack, and other drugs and reduced the vulnerabilities of STI/AIDS associated with such use. However, it seems that it is necessary to invest and maintain permanent training processes, in addition to epidemiological studies and research demonstrating the results achieved in different contexts.

"The Drug Sellers Were Better Organized than the Government": A Qualitative Study of Participants' Views of Drug Markets during COVID-19 and Other Big Events.

"Big events", such as wars, economic crises, pandemics, or natural disasters, affect the risk environment in which people use drugs. While the impact of big events on injection risk behaviors and access to drug-treatment services is well documented, less is known about the effects of big events on drug markets. Based on self-reporting data on drug availability among people who use drugs (PWUD) in the aftermath of Hurricane Maria in Puerto Rico and during the COVID-19 lockdown in a Midwestern US state, this study aims to document the effects of big events on drug markets. Qualitative data on the effects of Hurricane Maria on drug markets are based on participants' self-reporting (N = 31). Data collection started after the hurricane and ended in 2020. Data on changes to the drug supply during the COVID-19 lockdown were collected based on semi-structured interviews with PWUD (N = 40) in a Midwestern US state. Findings show that while the drug markets might have initially been affected by big events, most effects were temporary. Drug availability, pricing, and quality might have suffered some initial fluctuations but stabilized as the drug markets absorbed the initial shocks caused by the hurricane and the lockdown measures. In preparation for increasingly more frequent and virulent pandemics and natural disasters, health infrastructures should be strengthened to prevent not only overdose episodes and deaths but also drug-related harms.

Arguments used by proponents and opponents in Brazil's regulatory discussions of e-cigarettes and heated tobacco products.

OBJECTIVES: To identify proponents and opponents of the commercialisation and marketing of e-cigarettes and heated tobacco products (HTPs), identify the arguments used on both sides and compare how the arguments have changed over time, we analysed three policy discussions occurring in 2009, 2018 and 2019. METHODS: We conducted a content analysis of one document and six videos from these discussions, provided on the Brazilian Health Regulatory Agency website, or upon request. RESULTS: The arguments most used by tobacco companies were related to claims that the use of e-cigarettes and HTPs is less harmful than conventional tobacco. Unions that support its commercialisation also argued that lifting the ban would prevent smuggling and guarantee their quality. On the other side, universities, medical and anti-tobacco institutions argued that such devices may have health risks, including the risk of inducing cigarette smoking. In 2009, most arguments belonged to the 'health' theme, while in 2018 and 2019 economic arguments and those related to morals and ethics were frequently used. CONCLUSIONS: Those that supported the commercialisation and marketing of e-cigarettes and HTPs first focused on arguments of harm reduction, while 10 years later the right to access and potential economic consequences also became common. Public health agents and academics must gather evidence to effectively respond to these arguments and discuss these policies, and must prepare themselves to use and respond to arguments related to moral and economic themes.

Revisão integrativa: estudos sobre redução de danos voltada para população de mulheres trans e travestis / Integrative review: studies on harm reduction aimed at the population of trans women and transvestites

RESUMO Apresentam-se os achados da pesquisa da dissertação de mestrado com abordagem integrativa que objetivou revisitar as publicações com a temática LGBTQIA+ de periódicos científicos. Ao colocar, como enfoque, a estratégia de Redução de Danos (RD), a presente pesquisa objetivou identificar quais as práticas realizadas para a população trans e contextualizar como a RD pode contribuir para construção de vínculo no cuidado à saúde. Coletaram-se os dados nas bases Lilacs e SciELO. Recuperaram-se 110 artigos publicados, entre 2005 e 2020, em português. Seus resumos foram lidos na íntegra. Identificaramse sete abordagens: RD como estratégia de políticas públicas; violências vivenciadas nas trajetórias de transição percorridas pelas travestis; atendimento à população LGBTQIA+; profissionais de saúde capazes de prestar um cuidado humanizado, verdadeiramente centrado na pessoa, com escuta ativa; o cuidado a saúde e hormonização como processo de construção feminina; movimentos sociais; educação e ações afirmativas para a continuidade do estudo e colocação profissional. Assim, a pesquisa contribui para ampliar o conhecimento e a compreensão sobre a temática LGBTQIA+. As demandas específicas de travestis e transexuais em sua busca por atendimento nos serviços de saúde são explicitadas de modo a compreender como a RD pode ser estratégia de cuidado à saúde da população trans.

ABSTRACT We present the research findings of the master's thesis with an integrative approach, which aimed to revisit publications with an LGBTQIA+ theme in scientific journals. By focusing on the Harm Reduction (HR) strategy, this research aimed to identify the practices conducted for the trans population and contextualize how HR can contribute to building bonds in healthcare. Data were collected in the LILACS and SciELO databases. We retrieved 110 articles published from 2005 to 2020 in Portuguese. Their summaries were read in full. Seven approaches were identified: HR as a public policy strategy; violence experienced in the transition trajectories followed by transvestites; assistance to the LGBTQIA+ population; health professionals can provide truly person-centered, humanized care, with active listening; healthcare and hormonization as a feminine construction process; social movements; education and affirmative actions for continued study and professional placement. Thus, the research contributes to expanding knowledge and understanding about LGBTQIA+ issues. The specific demands of transvestites and transsexuals in their search for care in health services are explained in order to understand how HR can be a health care strategy for the trans population.

Reducing harm and promoting positive media use strategies: new perspectives in understanding the impact of preschooler media use on health and development

Abstract Most children grow up in homes with easy access to multiple screens. Screen use by children between the ages of 0 to 5 has become a worldwide preoccupation. In the present narrative review, we examine child and parent screen use and its contribution to physical, cognitive, and social developmental outcomes. As research has mostly focused on the adverse consequences of screen media, we aim to depict both the negative and the positive influences of screen usage. To provide a more nuanced portrait of the potential benefits and harms of screen use, we examine how consequences of media use vary according to the content of media (ex., educational, violent), context (ex., using screens during mealtimes), and the nature (ex., passive vs active use) of child screen use. Our review supports existing screen time guidelines and recommendations and suggests that media content, the context of use, and the nature of child use, as well as the parent's own screen use, be considered clinically. Future research should seek to clarify how these dimensions jointly contribute to child screen use profiles and associated consequences. Finally, child sex, behavioral/temperamental difficulties, and family adversity appear to contribute to child screen use and its consequences and should be considered in future research. Suggestions for harm-reduction approaches are discussed.