High dose cocaine use in São Paulo: a comparison of treatment and community samples.

This cross-sectional study investigates patterns of drug use and associated problems among 332 cocaine users from treatment and community samples in São Paulo, Brazil. Data were collected using a structured questionnaire and the Severity of Dependence Scale (SDS). The majority were regular users of high doses of smoked cocaine. After controlling for severity of cocaine use, users in the community were found to be more involved in illegal activities, more likely to report adverse effects of cocaine, to be involved in prostitution, and to have lived on the streets. Better methods are required to provide interventions to tackle the problems and risk behaviors of these cocaine users.

HIV-risk behaviour among non-heroin using cocaine injectors and non-injectors in São Paulo, Brazil.

The aim of this study was to investigate HIV-risk behaviour among cocaine users in relation to preferred route of administration and to relate this to reported HIV serostatus. Two hundred and ninety-four patients were interviewed in 15 different services that offer treatment, assistance or counselling to drug users and/or HIV-positive patients using a structured questionnaire that had been developed and piloted in Brazil. At the time of interview, lifetime use of snorted cocaine was 94%, of smoked crack 82% and of injected cocaine 32%. Twenty-eight per cent described themselves as HIV-positive, 32% as negative and 40% were unaware of their status. Non-injectors tended to be younger, had used fewer substances, had spent less time using cocaine, were less likely to have had sex with other drug users or to have been tested for HIV. Non-injectors had high levels of contact with injectors. Those reporting a positive HIV result were older, had used more classes of drugs, had used cocaine for longer and were more likely to have injected and participated in at-risk behaviours. The findings are discussed in terms of policy changes that may be necessary to reduce the high level of risk behaviour among Brazilian cocaine users.

[Smoking prevalence at the Federal University of São Paulo, 1996--preliminary data of an institutional program]. / Prevalência de tabagismo na Universidade Federal de São Paulo, 1996--dados preliminares de um programa institucional.

PURPOSE: To evaluate the prevalence of tobacco smoking among health workers, professores, nurses and students of Federal University of São Paulo and the acceptance of an institutional program for quitting smoking. METHODS: We analized the answers of a questionnairy with 51 questions, distributed to people from different categories. RESULTS: The total percentage of answered questionnaires was 48.6% (2613). The answers obtained from health workers were 37.3%, professors 49.0%, nurses 52.7% and students 76.5% The total percentage of smokers at UNIFESP was 15.5%:23.7% for health workers, 18% for professors, 16% for nurses and 8.6% for students. There was no significant statistical difference between the prevalence of smoking among females (17.3%) and males (16.3%). The age of major prevalence of smoking was between 31 to 40 years (26.6%). For all ages, people who have university level smoked less, independent of sex. Eighty three percent (83%) of the UNIFESP workers and students are worried of being passive smokers. Between the smokers, 55% were thinking of quiting and 42% declared that need some help to quit. CONCLUSION: We concluded that educational programs and help for cessation at institutional level are necessary and well accepted at UNIFESP, and the completion of these programs will contribute to the obeying of the prohibitive laws of no smoking within the community.

Prevalência de tabagismo na Universidade Federal de Säo Paulo, 1996: dados preliminares de um programa institucional / Smoking prevalence at Universidade Federal de Säo Paulo, 1996: preliminary data of an institutional program

Objetivo. O conhecimento da prevalência do tabagismo é necessário para a realizaçao de programas institucionais adequados que visem a diminuiçao do número de fumantes. O objetivo do trabalho foi verificar a prevalência do tabagismo entre funcionários, docentes, enfermeiros e alunos da Universidade Federal de Sao Paulo e a aceitabilidade de um programa antifumo. Pacientes e Métodos. Foram analisadas as respostas obtidas a partir de um questionário contendo 51 questoes, distribuídos para as diferentes categorias. Resultados. A porcentagem total de questionários respondidos foi de 48,6 por cento (2.613) sendo 37,3 por cento para funcionários, 49,0 por cento para docentes, 52,7 por cento para enfermeiras e 76,5 por cento para alunos. Verificou-se que a porcentagem total de fumantes na UNIFESP foi de 15,5 por cento, sendo 23,7 por cento entre funcionários, 18 por cento entre docentes, 16 por cento entre enfermeiros e 8,6 por cento entre alunos. A faixa etária de maior prevalência de fumantes foi a de 31 a 40 anos (26,6 por cento). Nao houve diferença estatística entre a prevalência de fumantes entre homens e mulheres. Em ambos os sexos, para todas as faixas etárias, os indivíduos com maior nível de instruçao fumavam menos. Das pessoas que responderam o questionário, 82,5 por cento estavam preocupadas em serem fumantes passivas. Dos fumantes, 55 por cento estao pensando em largar de fumar e 42 por cento julgam precisar de algum tipo de ajuda. Conclusao. Programas educacionais e de cessaçao do tabagismo em nível institucional sao necessários e bem aceitos na UNIFESP, devendo ser realizados para que as leis de restriçao do fumo dentro da instituiçao sejam efetivamente cumpridas.

Transitions in the route of cocaine administration--characteristics, direction and associated variables.

AIMS: To examine transitions in the route of administration of cocaine and the variables associated with them. DESIGN: A cross-sectional study undertaken between January 1996 and October 1997. SETTING: Fifteen different services that offer treatment, counselling or assistance to drug users or HIV-positive patients in the State of São Paulo, Brazil. PARTICIPANTS: Two hundred and ninety-four current or ex-cocaine and crack cocaine users. MEASUREMENTS: A structured interview schedule was developed consisting of 246 questions covering socio-demographic details, drug history, cocaine transitions and HIV-risk behaviours. FINDINGS: Eighty-seven per cent of patients began using cocaine by snorting and 74% subsequently underwent a transition of route--68% towards smoking and 20% to injecting. Half of all transitions occurred in the first 3 years following initiation into cocaine use. Factors associated with transitions were: younger age at cocaine initiation, more frequent use at peak usage, initial use of cocaine by snorting or injecting, a lower level of scholastic attainment and experience with a wider range of drug classes. A cohort effect was apparent with younger cocaine users and those who had begun using after 1990 being more likely to undergo a transition to smoking crack and less likely to start injecting. CONCLUSIONS: Cocaine transitions are very common and are usually towards routes associated with a higher dependency potential and increased HIV-risk behaviour. Further research is needed to see if transitions can be prevented by early identification of potential cases.

Aumento da procura de tratamento por usuários de crack em dois ambulatórios na cidade de Säo Paulo, nos anos de 1990 a 1993 / Increase in the search for treatment by crack users in two outpatient clinics at the city of Säo Paulo in the years from 1990 to 1993

Nos últimos anos tem sido observado aumento do uso de crack (uma forma de cocaína fumada) em pesquisas epidemiológicas e em apreensoes policiais. Até o presente, nao havia dados brasileiros relacionando a procura de tratamento para a dependência de cocaína com as vias habituais de administraçao. Objetivo. Analisar as modificaçoes das vias de administraçao da cocaína em uma populaçao de 245 pacientes atendidos em dois serviços ambulatoriais especializados (PROAD e UDED), na cidade de Sao Paulo, entre os anos de 1990 e 1993. Métodos. Dados de entrevistas padronizadas realizadas na admissao dos pacientes aos serviços foram estudados e determinada a prevalência de uso das diferentes vias de administraçao de cocaína. Resultados. A percentagem de pacientes que relataram uso de cocaína fumada (crack) aumentou de 17 por cento, em 1990, para 64 por cento em 1993 (p<0,01). O uso de cocaína aspirada nao variou durante esse período, permanecendo a via mais freqüentemente relatada (80 por cento), enquanto a via endovenosa variou de 40 por cento, em 1990, para 18 por cento, em 1992, e para 28 por cento, em 1993. Conclusoes. As implicaçoes do aumento de usuários de crack que procuram tratamento sao discutidas em funçao do planejamento de tratamento e de programas de prevençao, com ênfase no risco de transmissao do vírus HIV.

[Increase in the search for treatment by crack users in 2 outpatient clinics at the city of Sao Paulo from 1990 to 1993]. / Aumento da procura de tratamento por usuários de crack em dois ambulatórios na cidade de São Paulo, nos anos de 1990 a 1993.

UNLABELLED: An increase in crack use epidemiological research and police data. Currently, in Brazil, no data are available linking the route of administration and attendance to treatment for cocaine dependence. OBJECTIVE: The purpose of this paper was to analyze the changes in cocaine routes of administration in a cocaine dependent population treatment in two outpatient public services (PROAD and UDED). METHOD: Standardized interview data, collected at admission to treatment were compared from 1990 to 1993. The prevalence rates of smoked ("crack"), injected and snorted cocaine were compared. RESULTS: The percentage of patients who reported "crack" cocaine use increased from 17% in 1990 to 64% in 1993 (p < 0.01) The prevalence of snorted cocaine remained stable in the period of time analyzed, being the most frequent route reported. The intravenous route tended to decrease from 40% in 1990 to 28% in 1993. CONCLUSION: The implications of the increase of "crack" cocaine users who sought treatment are discussed. These data are important in planning prevention and treatment strategies, mainly in AIDS prevention.

Crack cocaine: an increase in use among patients attending clinics in São Paulo: 1990-1993.

Unsubstantiated reports suggest that the availability and use of crack are increasing in São Paulo. To investigate this claim we used the databases from two outpatient clinics for drug users at a public hospital and examined the changes in the reported routes of administration of cocaine among 245 patients who had attended between 1990 and 1993. The proportion reporting crack use increased from 17% in 1990 to 64% in 1993 (p < .01). It does not seem that this increase was simply due to changes in demographic variables. Treatment policies need to be reviewed and HIV harm-reduction programs should focus more on the risks of sexual transmission.

At risk drinking in primary care: report from a survey in Sao Paulo, Brazil.

This article describes the prevalence of at risk drinking among patients attending the primary health care sector in the city of Sao Paulo, Brazil. Five percent of the screened population answered positively to two or more questions on the CAGE questionnaire; 12% of male and 3% of female subjects were considered to be at risk drinking. Patients socio-demographic characteristics were analysed by means of logistic models. Variables sex, age, employment status and years living in Sao Paulo had significant effects on the risk of being a CAGE high-scorer.

Reversal of abnormal dexamethasone suppression test in alcoholics abstinent for four weeks.

Fourteen of 64 alcoholic inpatients (22%) showed a nonsuppression postdexamethasone response when tested between the second and fifth days of admission. No association with alterations of hepatic enzymes (GGT, SGOT, SGPT) was observed. At retest (in the fourth week of abstinence), no abnormal response to the Dexamethasone Suppression Test (DST) was detected. The nonsuppressor alcoholics did not meet the criteria for major depression according to the Research Diagnostic Criteria (RDC). The data indicate a lack of specificity of the DST for the diagnosis of depression in alcoholics during the first days of withdrawal.

Lack of effect of intravenous hypertonic glucose on the intensity of alcohol intoxication induced experimentally and observed in patients of an emergency room.

In the present paper, two experiments are performed to test the efficacy of the intravenous administration of hypertonic glucose (25 or 50%) in alcoholic intoxication. In a first experiment, 10 healthy, nonstarved volunteers, received 15 min after the ingestion of 1.0 g/kg alcohol, 40 ml of 25% glucose i.v., the same volume of 0.9% NaCl or no injection. According to evaluations performed at several time intervals up to 2 h after alcohol ingestion, no difference among the 3 conditions was observed either in the intensity of alcohol intoxication or on blood alcohol levels. In a second experiment, blood glucose and alcohol levels were evaluated in 80 alcoholized patients in an emergency room. The mean glycemic value was 94 mg/100 ml. No difference was found by comparing this value with that presented by nonalcoholized patients. The 80 patients were distributed in two groups of 40 each: one of them was intravenously administered 40 ml of glucose 50% while the other was injected with saline. About 20-30 min later the patients of both groups were clinically evaluated by the physician on duty, being considered equally improved regardless of the injection. The self-evaluation by the patients provided similar results.

A administracao de glicose na intoxicacao alcoolica aguda. Um estudo duplo-cego em voluntarios. / Glucose administration in acute alcoholic intoxication. A double-blind study in volunteers

No presente trabalho, foi avaliada a eficacia da administracao endovenosa de glicose na intoxicacao alcoolica aguda, em voluntarios com boa condicao nutricional, atraves de um procedimento duplo-cego. A administracao de glicose ou soro fisiologico apos a ingestao de 1,0g/kg de alcool nao alterou a sintomatologia apresentada, nem os niveis de alcoolemia

Alcohol consumption during pregnancy and newborn outcome: a study in Brazil.

Neonates born to mothers of low socioeconomic status were examined to assess the intrauterine effects of alcohol. Mothers' alcohol use during pregnancy ranged from abstention to heavy drinking. The newborns were randomly selected and examined without knowledge of the drinking history of the mothers. Likewise, the mothers' interviewers had no information about the clinical condition of the infants. Anthropometric measures showed the nutritional states of the mothers to be uniformly distributed among those mothers graded from abstainers (grade 0) to heavy drinkers (grade IV). Six of the neonates born to 26 heavy drinkers, four born to 103 mothers graded as I, II and III drinkers and 3 born to 50 abstainers were considered to show signs of prenatal effects of alcohol, characterized by small size (weight and/or height) for gestational age, microcephaly and short palpebral fissures. The number of such infants was significantly greater among the neonates born to heavy drinking mothers.