Perfil de prescripción de levetiracetam en niños menores de cuatro años atendidos en un hospital de alta complejidad de Chile / Levetiracetam prescription profile in children younger than 4 years treated at a tertiary care hospital in Chile

Introducción. El levetiracetam (LEV) es un antiepiléptico aprobado por el Instituto de Salud Pública de Chile como terapia concomitante en crisis epilépticas en niños mayores de cuatro años. Sin embargo, es ampliamente indicado desde el periodo neonatal, lo que hace necesario evaluar su utilización fuera de ficha técnica. Objetivo. Determinar el perfil de prescripción-indicación de LEV en el tratamiento de las crisis epilépticas en menores de cuatro años en un hospital de alta complejidad del sur de Chile. Población y método. Estudio observacional, descriptivo y retrospectivo. Se revisaron las historias clínicas de quienes iniciaron tratamiento con LEV entre 2014 y 2019, y se recopilaron datos sobre variables sociodemográficas, farmacológicas y clínicas. El análisis se basó en la descripción del perfil de los pacientes, prescripción, seguimiento y seguridad. Resultados. Se incluyeron 68 pacientes: 40 (58,8 %) de sexo masculino, 49 (72,1 %) con edad gestacional ≥ 37 semanas. La etiología principal de la epilepsia fue de tipo estructural (35,3 %); el LEV se utilizó principalmente en niños diagnosticados con malformación del sistema nervioso central (17,6 %) y predominó la monoterapia (55,9 %). En el 50 % se usó LEV para crisis focales. Cinco niños (7,3 %) presentaron trastornos de tipo psiquiátrico clasificados como probables reacciones adversas al medicamento. Conclusión. El LEV se utilizó en niños con diferentes diagnósticos con baja frecuencia de eventos adversos. El perfil de utilización varió en los diferentes grupos etarios. Es necesario identificar en futuros estudios la efectividad especialmente en el recién nacido y en epilepsias refractarias.

Introduction. Levetiracetam (LEV) is an antiepileptic drug approved by the Chilean Institute of Public Health as concomitant therapy for epileptic seizures in children older than 4 years of age. However, it is widely prescribed from the neonatal period, which makes it necessary to evaluate its off-label use. Objective. To determine the prescription-indication profile of LEV in the treatment of epileptic seizures in children younger than 4 years in a tertiary care hospital in southern Chile. Population and method. Observational, descriptive, and retrospective study. The medical records of patients who started treatment with LEV between 2014 and 2019 were reviewed, and data on sociodemographic, pharmacological, and clinical variables were collected. The analysis was based on the description of the profile of patients, prescriptions, follow-up, and safety. Results. A total of 68 patients were included: 40 (58.8%) were males, 49 (72.1%) were born at a gestational age ≥ 37 weeks. The main etiology of epilepsy was structural (35.3%); LEV was mostly used in children diagnosed with central nervous system malformation (17.6%), and monotherapy was the prevailing dosage (55.9%). LEV was used for focal seizures in 50% of cases. Five children (7.3%) had psychiatric disorders, classified as probable adverse drug reactions. Conclusion. LEV was used in children with various diagnoses, with a low rate of adverse events. The profile of drug use varied in the different age groups. Future studies are needed to identify effectiveness, especially in newborn infants and patients with refractory epilepsy.

Short-term effects of the strengthening families Program (SFP 10-14) in Brazil: a cluster randomized controlled trial.

INTRODUCTION: This study reports the evaluation of the short-term effects of the Strengthening Families Program (SFP 10-14), adapted as Famílias Fortes (Strong Families) in Brazil, on preventing adolescent drug use and improving parenting behaviors. METHODS: A two-arm, parallel cluster randomized controlled trial was conducted in 60 Social Assistance Reference Centers (SARC) from 12 Brazilian municipalities. In each city, the SARC were randomly assigned to the intervention or control group. A total of 805 families participated in the study, each contributing data from one parent or legal guardian and one adolescent totaling 1,610 participants. Data collection occurred before intervention implementation and 6 months after baseline collection. Data were analyzed using multilevel mixed-effects modeling with repeated measures in two different paradigms: Intention to Treat (ITT) and Per protocol (PP). The study was registered in the Brazilian Ministry of Health Register of Clinical Trials (REBEC), under protocol no. RBR-5hz9g6z. RESULTS: Considering the ITT paradigm, the program reduced the chance of parents and legal guardians being classified as negligent by 60% (95%CI 0.21; 0.78), increased the use of nonviolent discipline by caregivers (Coef 0.33, 95%CI 0.01; 0.64) and decreased the chance of adults exposing adolescents to their drunken episodes by 80% (95%CI 0.06; 0.54). No program effects were observed on outcomes related to adolescent drug use. Similar results were found for the PP paradigm. CONCLUSION: The positive effects on family outcomes suggest preventive potential of the program among the Brazilian population. Long-term evaluations are necessary to verify if the program can also achieve the drug use reduction goals not observed in the short term.

Levetiracetam prescription profile in children younger than 4 years treated at a tertiary care hospital in Chile. / Perfil de prescripción de levetiracetam en niños menores de cuatro años atendidos en un hospital de alta complejidad de Chile.

Introduction. Levetiracetam (LEV) is an antiepileptic drug approved by the Chilean Institute of Public Health as concomitant therapy for epileptic seizures in children older than 4 years of age. However, it is widely prescribed from the neonatal period, which makes it necessary to evaluate its off-label use. Objective. To determine the prescription-indication profile of LEV in the treatment of epileptic seizures in children younger than 4 years in a tertiary care hospital in southern Chile. Population and method. Observational, descriptive, and retrospective study. The medical records of patients who started treatment with LEV between 2014 and 2019 were reviewed, and data on sociodemographic, pharmacological, and clinical variables were collected. The analysis was based on the description of the profile of patients, prescriptions, follow-up, and safety. Results. A total of 68 patients were included: 40 (58.8%) were males, 49 (72.1%) were born at a gestational age ≥ 37 weeks. The main etiology of epilepsy was structural (35.3%); LEV was mostly used in children diagnosed with central nervous system malformation (17.6%), and monotherapy was the prevailing dosage (55.9%). LEV was used for focal seizures in 50% of cases. Five children (7.3%) had psychiatric disorders, classified as probable adverse drug reactions. Conclusion. LEV was used in children with various diagnoses, with a low rate of adverse events. The profile of drug use varied in the different age groups. Future studies are needed to identify effectiveness, especially in newborn infants and patients with refractory epilepsy.

Introducción. El levetiracetam (LEV) es un antiepiléptico aprobado por el Instituto de Salud Pública de Chile como terapia concomitante en crisis epilépticas en niños mayores de cuatro años. Sin embargo, es ampliamente indicado desde el periodo neonatal, lo que hace necesario evaluar su utilización fuera de ficha técnica. Objetivo. Determinar el perfil de prescripción-indicación de LEV en el tratamiento de las crisis epilépticas en menores de cuatro años en un hospital de alta complejidad del sur de Chile. Población y método. Estudio observacional, descriptivo y retrospectivo. Se revisaron las historias clínicas de quienes iniciaron tratamiento con LEV entre 2014 y 2019, y se recopilaron datos sobre variables sociodemográficas, farmacológicas y clínicas. El análisis se basó en la descripción del perfil de los pacientes, prescripción, seguimiento y seguridad. Resultados. Se incluyeron 68 pacientes: 40 (58,8 %) de sexo masculino, 49 (72,1 %) con edad gestacional ≥ 37 semanas. La etiología principal de la epilepsia fue de tipo estructural (35,3 %); el LEV se utilizó principalmente en niños diagnosticados con malformación del sistema nervioso central (17,6 %) y predominó la monoterapia (55,9 %). En el 50 % se usó LEV para crisis focales. Cinco niños (7,3 %) presentaron trastornos de tipo psiquiátrico clasificados como probables reacciones adversas al medicamento. Conclusión. El LEV se utilizó en niños con diferentes diagnósticos con baja frecuencia de eventos adversos. El perfil de utilización varió en los diferentes grupos etarios. Es necesario identificar en futuros estudios la efectividad especialmente en el recién nacido y en epilepsias refractarias.

Cuidado em saúde ao adolescente em vulnerabilidade ao uso de drogas / Health care for adolescents who are susceptible to drug use

RESUMO Este artigo trata das adolescências, no plural, como construção histórico-social de um processo dinâmico, e do adolescente perante seus modos de vida e expressão em um contexto histórico-social e singular. Entende-se aqui que ações meramente prescritivas são insuficientes para responder às complexidades dos processos de adoecimento mental na sociedade contemporânea. Objetivou-se compreender o contexto das práticas de cuidado em saúde ao adolescente em vulnerabilidade, diante do uso de drogas, na dimensão das tensões dos campos de práticas do cuidado em saúde. Estudo descritivo exploratório de abordagem qualitativa, que realizou entrevistas com profissionais da área da saúde (Unidade Básica de Saúde e Centro de Atenção Psicossocial Infantojuvenil). Destacam-se as tensões no campo de práticas entre o modelo assistencial biomédico e de guerra às drogas versus o psicossocial/comunitário; redução de estigma; acesso; redução de danos e nos atendimentos individuais, bem como a importância de refletir e fomentar o processo de mudança da mentalidade diante do adoecimento mental, visando atualizar as formas de cuidar. Esse processo tem sido realizado conforme os princípios da Reforma Psiquiátrica Brasileira, com avanços e retrocessos que repercutem na atualização das práticas de cuidado em saúde mais alinhadas às propostas de ações psicossociais e redutoras de vulnerabilidade.

ABSTRACT This article deals with adolescences, in the plural, as a socio-historical construction of a dynamic process and with the experience of adolescents with their lifestyle and self-expression in a unique socio-historical context. It assumes that purely prescriptive measures are insufficient to address the complexity of mental illness processes in contemporary society. This study aims to understand the context of health care practices for vulnerable youth, particularly those involved in substance use, through the lens of tensions in health practice domains. This is an exploratory, descriptive study using a qualitative approach, with interviews conducted with health professionals (in Basic Health Unit and Psychosocial Care Center for Children and Adolescents). The study highlights the tensions within health practice between the biomedical model and the war on drugs and a community-based psychosocial approach; it underlines the need for reducing stigmatization, improving access, harm reduction, and individualized care. It also emphasizes the importance of considering and promoting a shift in mentality towards mental illness in order to develop care strategies. This process was carried out in line with the principles of the Brazilian Mental Health Reform, with advances and setbacks that affect the updating of health practices, which are more oriented towards proposals for psychosocial and vulnerability-reducing actions.

Effect of recreational cannabis use on bone mineral density: a systematic review.

The recreational use of cannabis products has risen considerably worldwide over the past decade. As the cannabis legal market grows, a critical challenge has been to make substantiated claims about the benefits and adverse health problems triggered by cannabis exposure. Despite accumulating evidence from animal studies demonstrating the role of cannabinoids on bone metabolism, there are conflicting results in clinical literature regarding their effects on bone health outcomes.We undertook a systematic review to assess the evidence for the safety of cannabis use on bone health. We searched the databases MEDLINE, EMBASE, Cochrane Library, and Web of Science up to March 2023 for studies evaluating the effect of the recreational use of cannabis on the bone mineral density (BMD) of adults.Among the 2620 studies reviewed, three cross-sectional studies and one randomized controlled trial comprised 4032 participants from 18 to 60 years who met the inclusion criteria. Two studies showed that cannabis exposure decreased BMD, while the other 2 indicated no alteration. Despite the different study designs, the included studies showed a low risk of bias according to the Joanna Briggs Institute tool.Eligible studies present differences in cannabis products, administration routes, and exposure determination. Further longitudinal research is needed to establish multiple clinical predictors associated with potentially negative consequences of cannabis exposure, especially in vulnerable populations such as elderly individuals.

Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Adolescence is characterized by complex and dynamic changes, often involving experimentation, including the use of psychotropic substances. Although it is well-established that recreational psychotropic drugs are associated with suicide ideation in adults, evidence of this association in adolescents remains limited. OBJECTIVE: To investigate the relationship between suicide ideation and psychotropic recreational drug use among adolescents. DESIGN AND SETTING: Systematic review with meta-analysis developed at Universidade Federal de Uberlândia (UFU) and Universidade Estadual de Campinas (UNICAMP), Brazil. METHODS: A search across eight electronic databases for observational studies, without language or publication year restrictions, was conducted. The Joanna Briggs Institute tool was used to assess the risk of bias. Random-effects meta-analyses and odds ratios were used to measure the effects. RESULTS: The search yielded 19,732 studies, of which 78 were included in the qualitative synthesis and 32 in the meta-analysis. The findings indicated that suicidal ideation was 1.96 times more likely (95% confidence interval, CI = 1.47; 2.61) for adolescents who used some drug recurrently and 3.32 times more likely (95%CI = 1.86; 5.93) among those who abused drugs. Additionally, adolescents who used cannabis were 1.57 times more likely (95%CI = 1.34; 1.84) to experience suicide ideation compared with non-users, while cocaine users had 2.57 times higher odds (95%CI = 1.47; 4.50). CONCLUSIONS: Psychotropic recreational drug use is associated with suicidal ideation among adolescents regardless of current or previous use, abuse, or type of substance used. SYSTEMATIC REVIEW REGISTRATION: Registered in the PROSPERO database under the identification number CRD42021232360. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232360.

Consumo de medicamentos para tratamento e prevenção da Covid-19: uma análise nos territórios da Atenção Primária à Saúde / Consumption of medicines for the treatment and prevention of Covid-19: an analysis in Primary Health Care territories

Resumo O objetivo do estudo foi avaliar o uso de medicamentos associados à Covid-19 por usuários da Atenção Primária à Saúde (APS). Trata-se de um estudo transversal com coleta de dados nas unidades de Estratégia Saúde da Família do município de Rondonópolis, MT, Brasil. Os dados foram obtidos com aplicação de um formulário semiestruturado. Dentre os participantes, 36% afirmaram ter consumido fármacos para prevenção da Covid-19, como ivermectina (89,58%), vitamina D (13,88%) e azitromicina (6,94%). Residir em domicílio em que duas ou mais pessoas precisaram sair para trabalhar na pandemia foi associado ao uso de medicamentos preventivos da Covid-19 (OR: 1,7; IC95%: 1,09 - 2,60). Os resultados indicam a necessidade de realizar ações para a promoção do uso racional de medicamentos nos territórios da APS, com vistas a capacitação profissional, educação popular em saúde e combate à desinformação.

Abstract The study aimed to evaluate the use of medications associated with Covid-19 by users of Primary Health Care (PHC). This is a cross-sectional study with data collection in Family Health Strategy units in the city of Rondonopolis, MT, Brazil. Data were obtained using a semi-structured form. Among the participants, 36% said they had consumed drugs to prevent Covid-19, such as ivermectin (89.58%), vitamin D (13.88%) and azithromycin (6.94%). Living in a household where two or more people had to go out to work during the pandemic was associated with the use of Covid-19 preventive medications (OR: 1.7; 95% CI: 1.09 - vccccccc 2.60). The results indicate the need to carry out actions to promote the rational use of medicines in PHC territories, with a view to professional training, popular health education and combating misinformation.

Facilitating Factors and Barriers to the Implementation of the Icelandic Prevention Model of Adolescent Substance Use in Chile: A Focus Group Study.

The use of alcohol and other drugs is a major public health problem in adolescence. The implementation of evidence-based prevention strategies is still scarce in the global south. This study aimed to evaluate facilitators and barriers to the implementation of the Icelandic prevention model of adolescent substance use (IPM) in Chile. We conducted a qualitative study of stakeholders during the implementation process of the IPM in six municipalities of the Metropolitan Region of Santiago, Chile. We convened six focus groups with parents and professionals from schools and municipal prevention teams (38 participants). Recordings were transcribed and submitted to a six-step thematic analysis. The following facilitators emerged: Participants valued the contribution of the IPM to articulate existing programs and teams, its community focus, and the local data obtained through the survey. There were also several barriers: Those included resistance to adopting a foreign model, the tension between generating local strategies and looking for measures to ensure the fidelity of the implementation, socioeconomic differences between and within municipalities, low-risk perception and supervision of parents in Chile, and a culture that generally does not discourage adolescent substance use. Implementation of the IPM was largely accepted by the stakeholders who agreed with the community approach of the model. The main barriers to consider were related to cultural and socioeconomic factors that need to be addressed in further research and may limit the effects of the model in Chile.

Dataset: Repeated and longitudinal measures database from 1994 to 2018 to assess Chile's substance use control policies for the 2000-2010 decade.

We developed a database to assess Chile's substance use control policies implemented in the 2000-10 decade. The database includes the measurement of consumption of substances such as alcohol, tobacco, and drugs (cannabis, cocaine, and "pasta base" (crack)), individual, relationships, and environmental factors related to substance use, and variables that measure the implementation of laws regulating its use. For the construction of the database, we used information from three sources: i) the biannual National Survey of Drug Consumption for the general population of the National Service of Prevention and Rehabilitation for Drug and alcohol consumption (SENDA) from the Chilean government, ii) the cases filed in local police courts by group of offenses from Chile's Ministry of Justice reports, and iii) the regional imprisoned population from Chile's Correctional Services reports. In the case of the first data source, a data curation process was established to construct this unique database from 1994 to 2018, identifying variables measured systematically over time, standardizing variables' operationalization, and adjusting responses to prespecified flows in each year. On the other hand, substance use control laws enacted in 2004 (alcohol), 2005 (drugs), and 2006 (tobacco) were operationalized as categorical and continuous variables as indicators of its implementation.

Changes in mental health problems during the COVID-19 pandemic in Mexican youth: Insights from the Voces-19 study.

BACKGROUND: Previous research suggests that the mental health impacts of the COVID-19 pandemic were stronger during the first months of it. It has also been proposed that those impacts depended on gender and other social determinants. AIMS: We aim to describe the change in prevalence of mental health problems (symptoms of common mental disorders [CMD], alcohol, and drug use) between two time periods during the pandemic, and the association of mental health problems with social determinants, in adolescents and young adults in Mexico. METHODS: We conducted a repeated cross-section analysis of data from VoCes-19, an online survey in November 2020 to February 2021 and November 2021 to March 2022 (combined n = ×224,099). We assessed the change in the prevalence of mental health problems, the differences in prevalence and change in the prevalence by gender, and the association of social determinants and pandemic-related variables with mental health problems, by means of multivariate regression models. RESULTS: The prevalence of CMD decreased (46.0% vs. 42.4%), while the prevalence of alcohol (frequent use 8.4% vs. 10.3%) and drug use (4.6% vs. 7.7%) increased. The three conditions increased more among girls/young women and trans/queer/non-binary participants than among boys/young men. CONCLUSIONS: The results point to the importance of considering the gendered social context of young people. A better understanding of the social circumstances that relate with mental health is required to inform interventions for these age groups.

Interpersonal and Intimate Violence in Mexican Youth: Drug Use, Depression, Anxiety, and Stress during the COVID-19 Pandemic.

The COVID-19 pandemic may have increased interpersonal and intimate violence, harmful use of alcohol and other drugs (AODs), and mental health problems. This study uses a valid path model to describe relationships between these conditions of young Mexicans during the second year of the pandemic. A sample of 7420 Mexicans ages 18 to 24-two-thirds of whom are women-completed the Life Events Checklist, the Alcohol, Smoking, and Substance Involvement Screening Test, the Major Depressive Episode Checklist, the Generalized Anxiety Scale, and the Post-traumatic Stress Disorder (PTSD) Checklist. Young Mexicans reported higher rates of victimization and perpetration of interpersonal and intimate violence and mental health symptomatology than those noted pre- and in the first year of the pandemic. The harmful use of AOD rates were similar to those reported by adolescents before. The findings suggest asymmetric victimization and perpetration of intimate violence by gender (with women at a higher risk). More men than women have engaged in the harmful use of AODs (except for sedatives, which more women abuse). More women than men were at risk of all mental health conditions. The path model indicates that being a victim of intimate violence predicts the harmful use of tobacco, alcohol, cocaine, and sedatives, depression, anxiety, and specific PTSD symptoms (such as re-experimentation and avoidance symptoms). Being a victim of interpersonal violence resulted in severe PTSD symptoms (including avoidance, negative alterations in cognition-mood, and hyperarousal signs). The harmful use of sedatives predicted depressive symptoms. Men's victimizing intimate violence model contrasted with that of women, which included being the victim of interpersonal violence and severe PTSD symptoms. The high school youth model had three paths: victimizing intimate violence, victimizing interpersonal abuse, and sedative use, which predicted depression. Our findings could serve as the basis for future studies exploring the mechanisms that predict violence to develop cost-effective preventive programs and public policies and to address mental health conditions during community emergencies.

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.

Latent polydrug use patterns and the provision of injection initiation assistance among people who inject drugs in three North American settings.

INTRODUCTION: We sought to identify latent profiles of polysubstance use patterns among people who inject drugs in three distinct North American settings, and then determine whether profile membership was associated with providing injection initiation assistance to injection-naïve persons. METHODS: Cross-sectional data from three linked cohorts in Vancouver, Canada; Tijuana, Mexico; and San Diego, USA were used to conduct separate latent profile analyses based on recent (i.e., past 6 months) injection and non-injection drug use frequency. We then assessed the association between polysubstance use patterns and recent injection initiation assistance provision using logistic regression analyses. RESULTS: A 6-class model for Vancouver participants, a 4-class model for Tijuana participants and a 4-class model for San Diego participants were selected based on statistical indices of fit and interpretability. In all settings, at least one profile included high-frequency polysubstance use of crystal methamphetamine and heroin. In Vancouver, several profiles were associated with a greater likelihood of providing recent injection initiation assistance compared to the referent profile (low-frequency use of all drugs) in unadjusted and adjusted analyses, however, the inclusion of latent profile membership in the multivariable model did not significantly improve model fit. DISCUSSION AND CONCLUSIONS: We identified commonalities and differences in polysubstance use patterns among people who inject drugs in three settings disproportionately impacted by injection drug use. Our results also suggest that other factors may be of greater priority when tailoring interventions to reduce the incidence of injection initiation. These findings can aid in efforts to identify and support specific higher-risk subpopulations of people who inject drugs.

Impaired cognitive control moderates the relation between the attribution of incentive salience and severity of consumption in patients with methamphetamine dependence.

BACKGROUND: Cognitive control and the attribution of incentive salience are two key neuropsychological processes proposed to explain substance use disorder (SUD). However, little is known about how they interact to influence the severity of drug use in people with SUD. OBJECTIVE: To determine if cognitive control exerts a moderating effect on the relation between the attribution of salience to drug/reward-related cues and the severity of drug use in SUD cases. METHOD: Sixty-nine SUD cases with methamphetamine as the main drug of consumption were selected and evaluated. Participants performed the Stroop, Go/No-Go, and Flanker tasks to identify a latent cognitive control factor, and the Effort-Expenditure for Reward task, as well as answering the Methamphetamine Incentive Salience Questionnaire to measure the attribution of incentive salience. Severity of drug use was determined by the KMSK scale and an exploratory clinical interview. RESULTS: As expected, higher incentive salience attribution predicted greater severity of methamphetamine use. Unexpectedly, however, we found a moderating effect of impaired cognitive control on the relations between higher incentive salience scores and higher monthly drug use, and between younger age at onset of systematic drug use and higher incentive salience scores. CONCLUSION: Results show the moderating role of cognitive control on the relation between incentive salience attribution and severity of drug use in SUD cases, and help explain the chronic, relapsing nature of addiction, knowledge necessary to develop more precise prevention and treatment strategies.

Substance Use and Risky Sexual Behavior in the PrEP Outpatient Clinic at the University Hospital of Brasília.

(1) Background: To evaluate the epidemiological profile of people who use drugs at the PrEP outpatient clinic of the University Hospital of Brasília; (2) Methods: Cross-sectional study with a review of data from medical records referring to the first medical consultation. The prevalence ratio was calculated using a Poisson regression model with robust variance; (3) Results: A total of 53% of subjects reported drug use in the last 3 months. The unadjusted prevalence ratio of drug use in trans women was PR: 9.0 (95%CI: 1.4-57.5). people who use drugs have a 1.9 times higher prevalence of STI diagnosis, and a 2.4 times higher prevalence of partners compared to non-users; (4) Conclusions: Substance use was associated with a higher STI prevalence ratio and number of sexual partners.

Use of Marijuana to Promote Well-Being: Effects of Use and Prohibition in the Daily Lives of Brazilian Adults.

Background: Marijuana is the most widely used illicit drug worldwide. From an occupational perspective, its use is paradoxical in that although it can be harmful to health and has criminal consequences, it can also promote well-being. This study examined predictors of well-being to determine the effects of marijuana use and its prohibition on the daily lives of Brazilian adults. Methods: This cross-sectional study used an anonymous online questionnaire with a final sample of 2637 respondents. Utilizing logistic regression, variables were selected pertaining to use and prohibition risks, benefits of use, and harm reduction associated with the socioeconomic characteristics of the respondents. Results: Using marijuana for fun was most likely among those self-identified as male, trans/non-binary people, college graduates, and those with higher incomes. Living with family members and using less frequently proved to be protective against the adverse effect of "getting high." Indigenous peoples and youth were more likely to report trouble with the police due to marijuana use; individuals with higher education and longer use of marijuana reported more frequent use of harm reduction strategies; people who identified their color as yellow were more likely to report daily use compared to people who identified their color as white; women and people with higher income were less likely to report daily use. Conclusions: Social class, race, gender, and generation were predictors of well-being associated with marijuana use and its prohibition, indicating an interaction between different dimensions involving the use of illicit substances. Identifying the effects of the use and prohibition of marijuana in promoting well-being, from the conception of drug use as a non-sanctioned occupation, can broaden the understanding of this complex human phenomenon, with health and criminal repercussions, subsidizing the development of approaches more equitable and adequate into occupational therapy to reduce personal and social harm.

Naltrexona em baixa dose (LDN): tendência de consumo nas capitais brasileiras e Distrito Federal, 2014-2020 / Low-dose naltrexone (LDN): consumption trend in Brazilian capitals and the Federal District, 2014-2020

Resumo Estudo ecológico com objetivo de determinar o consumo de naltrexona em baixa dose (LDN) nas 26 capitais brasileiras e Distrito Federal e acompanhar a tendência entre os anos de 2014 e 2020. A coleta de dados da dispensação de naltrexona manipulada, se deu por meio do Sistema Nacional de Gerenciamento de Produtos Controlados, publicizado em 2020, considerando-se baixa dose prescrições de até 5 mg. O cálculo dos coeficientes de dispensação utilizou as estimativas populacionais do Instituto Brasileiro de Pesquisa Geografia e Estatística. Utilizou-se análise estatística descritiva e de regressão generalizada de Prais-Winsten para a série temporal. As tendências observadas foram classificadas em crescentes, estáveis ou decrescentes, com intervalo de confiança de 95% e nível de significância de 5%. Os resultados demonstraram maiores coeficientes de consumo de LDN nas regiões Centro-Oeste, Sul e Sudeste e menores nas Norte e Nordeste. Observou-se dispensação de LDN crescente em 55,6% das capitais, estacionária em 44,4% e ausência de coeficientes decrescentes. Apesar das evidências limitadas quanto à farmacoterapia de LDN e da sua prescrição off-label, os dados demonstram que a prescrição, dispensação e consumo vem crescendo no Brasil, com ênfase nas regiões centro-sul do país.

Abstract The scope of this paper is an ecological study to determine the consumption of low-dose naltrexone (LDN) in the 26 Brazilian capitals and the Federal District and monitor the trend between the years 2014 to 2020. Data collection on the dispensation of manipulated naltrexone was done through the National Management System of Controlled Products, published in 2020, considering low-dose prescriptions of up to 5 mg. The calculation of the dispensation coefficients used the population estimates of the Brazilian Institute of Geography and Statistics. Descriptive statistical analysis and generalized Prais-Winsten regression analysis were used for the time series analysis. The trends observed were classified as increasing, stable, or decreasing, with a 95% confidence interval and 5% significance level. The results showed higher LDN consumption coefficients in the Mid-West, South and Southeast regions and lower coefficients in the North and Northeast. Increasing dispensation of LDN was observed in 55.6% of the capitals, being stationary in 44.4%, with no decreasing coefficients. Despite the limited evidence regarding LDN pharmacotherapy and its off-label prescription, the data show that prescription, dispensing, and consumption have been on the increase in Brazil, with emphasis on the central-south regions of the country.

Cascade of Care for Hepatitis C Virus Infection Among Young Adults Who Inject Drugs in a Rural County in New Mexico.

OBJECTIVE: Treatment for hepatitis C virus (HCV) infection is highly effective; however, people who inject drugs (PWID), the population most affected by HCV, may encounter barriers to treatment. We examined the cascade of care for HCV infection among young adult PWID in northern New Mexico, to help identify gaps and opportunities for HCV treatment intervention. METHODS: Young adults (aged 18-29 y) who self-reported injection drug use in the past 90 days were tested for HCV antibodies (anti-HCV) and HCV RNA. We asked participants with detectable RNA to participate in an HCV education session, prior to a referral to a local health care provider for treatment follow-up, and to return for follow-up HCV testing quarterly for 1 year. We measured the cascade of care milestones ranging from the start of screening to achievement of sustained virologic response (SVR). RESULTS: Among 238 participants, the median age was 26 years and 133 (55.9%) were men. Most (90.3%) identified as Hispanic. Of 109 RNA-positive participants included in the cascade of care assessment, 84 (77.1%) received their results, 82 (75.2%) participated in the HCV education session, 61 (56.0%) were linked to care through a medical appointment, 27 (24.8%) attended the HCV treatment appointment, 13 (11.9%) attended their follow-up appointment, 6 (5.5%) initiated treatment, 3 (2.8%) completed treatment, and 1 (0.9%) achieved SVR. CONCLUSIONS: We observed a steeply declining level of engagement at each milestone step of the cascade of care after detection of HCV infection, resulting in a suboptimal level of HCV treatment and cure. Programs that can streamline testing and expand access to treatment from trusted health care providers are needed to improve the engagement of PWID in HCV treatment.

The impact of a parent-based prevention intervention on Mexican-descent youths' perceptions of harm associated with drug use: Differential intervention effects for male and female youths.

Parent training (PT) interventions reduce the likelihood of youth problematic behaviors, including drug use. However, the dissemination of culturally adapted PT interventions in low-income Latina/o immigrant communities remains scarce. In this selective prevention study, we examined the extent to which exposure to CAPAS-Youth, a culturally adapted version of the PT intervention known as GenerationPMTO© , resulted in increased adolescent perception of harm associated with use of alcohol and other drugs. In a randomized controlled trial with 71 Latina/o immigrant families (95% of parents self-identified as Mexican origin, n = 98), 37 families were allocated to the CAPAS-Youth intervention condition versus wait-list control (n = 34 families). According to adolescents' reports at intervention completion, significant increased levels of perceived harm associated with drug use were found for female youths, but not for males. Differential results indicate the importance of tailoring PT prevention interventions according to youths' sex differences (i.e., males vs. females).

Street and drug use experiences among sheltered children and adolescents in the Federal District of Brazil.

PROBLEM: The use of drugs by street children and adolescents is a problem found in most large cities around the world. METHODS: This is a cross-sectional study of street children and adolescents living in shelters in the Federal District, Brazil. An objective questionnaire was applied to 84 individuals from September 2016 to October 2017; 14 of them participated in the qualitative study. FINDINGS: Most participants were adolescents (84.5%) and males (64.3%), with a history of abandonment, domestic violence, and family drug abuse. All spent some time on the street; boys had a higher chance of being behind the school level and using drugs than girls. Over 60% had used drugs in the previous year, mainly alcohol and marijuana. Over 70% understand the health consequences of this behavior, but most have never tried or failed to stop. About 40% consider themselves dependent on drugs. CONCLUSIONS: The results showed that street-life experience, peer pressure, and exposure to drugs within the family had an important impact on respondent's drug use behavior, reinforcing the importance of education programs that focus on the family.