Impulsividade, fissura e comportamentos sexuais de risco em usuários de cocaína / Impulsivity, craving and risky sexual behavior in cocaine users

O estudo teve por objetivo avaliar as possíveis relações entre impulsividade, fissura e comportamentos sexuais de risco entre usuários de cocaína. Trata-se de um estudo transversal, de abordagem quantitativa. A amostra foi composta por 80 indivíduos acolhidos em duas Comunidades Terapêuticas (CTs). Os instrumentos utilizados foram: Informações sociodemográficas, Escala de Impulsividade de Barrat (BIS-11); o Crack Craving Questionnaire - Brief (CCQB) e Questionário sobre uso de substâncias e comportamentos sexuais (SUSBS). Da amostra, todos eram do sexo masculino adultos, com baixas condições socioeconômicas, acolhidos há mais de um mês, usuários crônicos de múltiplas drogas, sendo as mais usadas: o álcool, a maconha, a cocaína e o crack. Os participantes foram classificados como altamente impulsivos (33,3%), com nível grave de fissura (67,9%), perda o controle sobre o uso de substância (70,5%), metade usava drogas para melhorar o desempenho sexual, 45% concordaram que o uso era para favorecer a atividade sexual e 43% consideram o sexo indissociável do uso de substâncias. A fissura (CQB-B) foi associada com a impulsividade, mas não com o tipo de substância usada. Os resultados mostram a importância compreender e avaliar os entrelaces entre impulsividade, fissura e comportamentos sexuais entre usuários de substâncias psicoativas, assim como ir além da investigação desses problemas, com intuito de melhorar as práticas preventivas para os comportamentos sexuais de risco nas CTs

The study aimed to evaluate the associations between impulsivity, craving, and risky sexual behaviors among cocaine users. This is a cross-sectional study, with a quantitative approach. The sample consisted of 80 individuals hosted in two Therapeutic Communities in the region of Ribeirão Preto, SP. Sociodemographic information, the Barrat Impulsivity Scale (BIS-11); the Crack Craving Questionnaire - Brief (CCQ-B) and, the Substance Use and Sexual Risk Behavior Questionnaire (SUSBS) were used. Of the sample, all were adult males, with low socioeconomic conditions, housed for more than a month, chronic users of multiple drugs, the most used being: alcohol, marijuana, cocaine and crack. Participants were classified as highly impulsive (33.3%), with a severe level of craving (67.9%), loss of control over substance use (70.5%), half used drugs to improve sexual performance, 45% agreed that use was to promote sexual activity and 43% considered sex to be inseparable from substance use. Craving (CCQBB) was associated with impulsivity, but not with the type of substance used. The results show the importance of understanding and evaluating the links between impulsivity, craving and sexual behaviors among users of psychoactive substances, as well as going beyond investigating these problems, with the aim of improving preventive practices for risky sexual behaviors in TCs

Skeletal muscle mass index and phase angle are decreased in individuals with dependence on alcohol and other substances.

OBJECTIVE: The aim of this study was to evaluate whether low skeletal muscle mass index (SMI) and low phase angle (PhA) are associated with demographic, clinical, lifestyle, and nutritional status in patients dependent on alcohol and other substances. METHODS: We prospectively included 63 individuals dependent on alcohol and other substances and 71 age- and sex-matched healthy controls. Body composition was assessed by bioelectrical impedance analysis. Subjective global assessment was used to evaluate malnutrition. All included participants underwent a psychiatric evaluation, including the administration of the Mini-International Neuropsychiatric Interview. Univariate and multivariate analysis were performed to evaluate associations between low skeletal muscle mass index (SMI) and low phase angle (PhA) and nutritional, lifestyle, and alcohol use and cocaine/crack use variables, controlling for sex and age. RESULTS: Low SMI and low PhA were identified in 11.1% and 44.5% of the substance dependents, respectively. Low midarm muscle circumference (r = 0.58; P < 0.001), low midarm muscle area (r = 051; P < 0.001), and reduced PhA (r = 0.59; P < 0.001) were positively correlated with low SMI. Multivariate analysis showed that heavy alcohol consumption (≥80 g·d· ≥5 y-1; odds ratio [OR], 2.33; 95% confidence interval [CI], 1.12-4.84; P = 0.02) and sedentary lifestyle (OR, 4.39; 95% CI, 1.29-14.89; P = 0.02) were independently associated with reduced SMI. Low PhA was independently associated with heavy alcohol consumption (OR, 3.64; 95% CI, 1.62-8.15; P = 0.002) and cocaine or crack use (OR, 3.97; 95% CI, 1.05-15.11; P = 0.04) in multivariate analysis. CONCLUSIONS: Low SMI and low PhA are independently associated with heavy alcohol consumption. Low PhA is independently associated with cocaine or crack use.

A inter-relação entre o uso do crack emcenas abertas e envolvimento com a justiça criminal no município do Rio de Janeiro

No Brasil, o consumo de crack em cenas abertas tem sido associado, pelo senso comum e grande mídia à problemas relacionados à violência, desordem urbana e criminalidade nas grandes cidades. Todavia os estudos sobre este tema no Brasil são pouquíssimos. Sendo assim, no primeiro artigo da tese, identificamos variáveis preditoras para detenção e prisão dos usuários de crack e similares no município do Rio de Janeiroe Região Metropolitana, no período de setembro de 2011 a junho de 2013, através de modelos de regressão logística multinível. As variáveis que se mostraram preditoras de detenção e/ou prisão foram: ter utilizado leito de internação clínica, ser do sexo masculino, ser poliusuário, ter de 0 a 7 anos de estudo, raça/cor “preto” e acréscimo de 1ano no tempo de uso de crack e similares. No segundo artigo, buscamos verificar a possível associação entre um conjunto de cenas abertas de uso de crack com a ocorrência de determinados crimes em seu entorno, no município do Rio de Janeiro, no período de janeiro de 2011 a outubro de 2012, através de um modelo de regressão linear múltipla.As análises evidenciam para uma possível associação entre as cenas abertas de uso de crack e crimes contra propriedade, assim como diferença significativa na média de crimes contra propriedade entre as cenas que estavam localizadas em “favelas” em relação àquelas que estavam localizadas no “asfalto”. Os resultados apontam associações de algumas variáveis no nível individual com detenção e prisão e associação espacial das cenas abertas com os crimes no entorno, tornando-se necessárias intervenções multisetoriais, que considerem a promoção da saúde, o acesso dos usuários aos serviços,o manejo do uso de múltiplas drogas, a diminuição da evasão escolar, alternativas não repressoras para lidar com o uso de drogas em espaço públicos dando prioridade aos programas de abordagem de saúde e assistência social.

In Brazil, crack use in open scenes have been linked by common sense andmainstream media on issues related to violence, urban disorder and criminality in largecities. However studies on this topic in Brazil are very few. Thus, in the first article of thethesis, we identified predictors for arrest and detention of crack and similar users in thecity of Rio de Janeiro and the metropolitan area, from September 2011 to June 2013, bylogistic regression models multilevel. The variables that were predictive of detention and/ or imprisonment were: use of clinical hospital bed, being male, being poliusuário, have0-7 years of education, race/color "black" and 1-year increase in time crack and similaruse. In the second article, we seek to verify the possible association between a set ofscenes open crack use with the occurrence of certain crimes in their surroundings, in thecity of Rio de Janeiro, from January 2011 to October 2012, through a multiple linearregression model. The analyzes show for a possible association between the open crackscenes of use and crimes against property, as well as significant difference in mean crimesagainst property between scenes that were located in "favelas" than those who werelocated in the "asphalt”. The results show associations of some variables at the individuallevel with arrest and detention and spatial association of scenes open with the crimes inthe surroundings, making it necessary multisectoral interventions that consider healthpromotion, user access to services, the management of multiple drug use, reduction ofschool supply, not repressive alternatives to deal with the use of public space in drugsgiving priority to health approach to programs and social assistance.

Emerging patterns of crack use in Mexico City.

BACKGROUND: Recent studies in Mexico have documented a significant increase in crack cocaine use, indicating the potential for an emerging drug epidemic. METHODS: Ethnographic observations and interviews were used describe the profiles and patterns of use among street-recruited crack users in Mexico City. The data came from an international research collaboration funded by the National Institutes of Health. RESULTS: A polythetic typology was developed based on five dimensions central to categorizing patterns of crack use behavior: frequency of use, duration of use, context, social networks, and social contracts. Four types of users were discovered applying these dimensions: dabblers, stable users, crack heads, and old heads. Although several similarities were documented between patterns of crack use in Mexico and those in the United States and Western Europe, several key aspects distinguished crack users in this population: (1) self-regulated use; (2) non-linear progression of crack; and (3) the influence of the dimensions pertaining to setting, social networks, and social contract as contributing to understanding of the previous two. Further, we provide a discussion of how specific contextual factors in Mexico may be giving rise to these emerging patterns. CONCLUSION: Compared to the U.S. and Europe, this study finds that the majority of crack users were able to self-regulate their use without major disruption to daily social functioning. As crack use spreads in Mexico and other Latin American countries, we need to recognize the importance of social context in developing more tailored health and social responses that are specific to these developing countries.

Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities.

BACKGROUND: Crack use constitutes a major problem in cities across Brazil. While existing data suggest that crack use is generally concentrated among disenfranchised young people with extensive health problems and crime involvement, extensive data gaps exist. To address this issue, this study aimed to assess key characteristics of young crack users in two Brazilian cities. METHODS: N=160 regular and young adult (ages 18-24) crack users were recruited by community-based methods in the cities of Rio de Janeiro (Southeast) and Salvador (Northeast). Assessments included an interviewer-administered questionnaire on key social, drug use, health and service use characteristics, as well as serological testing of HBV, HCV and HIV status, and were conducted anonymously between November 2010 and June 2011. Participants provided informed consent and received transportation vouchers following assessment completion. The study was approved by institutional ethics review boards. RESULTS: The majority of participants were: male, with less than high school education, unstably housed (Rio only); gained income from legal or illegal work; arrested by police in past year (Salvador only); had numerous daily crack use episodes and shared paraphernalia (Salvador only); co-used alcohol, tobacco, cannabis and cocaine; had no injection history; rated physical and mental health as 'fair' or lower (Salvador only); had unprotected sex; were never HIV tested; were not HIV, HBV or HCV positive; and did not use existing social or health services, but desired access to crack user specific services. CONCLUSION: Crack users in the two Brazilian sites featured extensive socio-economic marginalization, crack and poly-drug use as well as sexual risk behaviours, and compromised health status. Social and health service utilization are low, yet needs are high. There is an urgent need for further research and for targeted interventions for crack use in Brazil.

Can chronic crack-cocaine exposure cause parrot foot necrosis? A possible hypothesis

Background: Parrot foot necrosis is a poorly understood dermatitis with difficult diagnosis and treatment that has been reported in all species of Amazon parrots. Diagnosis is usually achieved by detailed history and ruling out other causes through evaluation of CBC and biochemical profile. Prolonged crack-cocaine misuse could cause digit or nail lesions in humans. In this report similar clinical manifestations in two African gray parrots owned by crack-cocaine addicted users have been reported. Cases: Two African gray parrots were referred with pruritic foot, discoloration of digits, black and brown patching of the scales on the feet and legs associated with soft tissue swelling. Gross necrosis and self mutilation were also observed. According to the history, both birds had been suffering from the lesions for the past few weeks. A detailed history was obtained for each patient, including environmental condition and their main diet was nuts and fruits. Common causes were ruled out through evaluation of CBC and biochemical profile. Based on gross characteristics and distribution of lesions, foot necrosis was diagnosed. Husbandry recommendations were given and antibiotics were prescribed to prevent possible infections. However, no improvements were seen, following the prescribed medication. Also deterioration of the clinical signs and feet lesions were observed. Typical finger tips showed gangrenous necrosis and very severe dark discoloration. After scrutiny in history taking, and visit of the owner's residence, it was evident that the birds have been exposed to the owner's crack-cocaine smoking area for at least two years. One of the owners accepted the recommendation of amputation of the affected digits and changing either the owner or environment. Follow-up showed no further lesion progression. Discussion: This clinical report presents two cases of parrots exposed to long term crack-cocaine smoke released to the environment. Generally speaking pet birds such as African gray parrots, used to share in many social activities with their owners, and such a behavior makes them more vulnerable to develop lesions in polluted environment. The history of both patients did not show any exposure to external or internal irritant of epithelial tissues except that they were continuously in close contact with crack-cocaine smoke. Clinical manifestations of both cases were similar in the first visit and followup clinical examination. So, according to the history and physical examination fi nding and ruling out other possibilities, it is assumed that foot necrosis may occur following long-term exposure of a bird in a crack-heroin-polluted area. Skin lesions such as burns and blackened hyperkeratosis on hands or digits of human associated with the use of crack have been reported before. Vasoconstriction (due to cocaine exposure) would be able to cause persistent hypoxia at the periphery. Another possible reason for these signs is acute peripheral arterial thrombosis associated with cocaine. Cocaine has also been associated with small vessel vasculitis. It is therefore postulated that, prolonged habitual use of crack-cocaine by parrot owners may result in visible digital changes (caused by multiple prolonged episodes of vasoconstriction, peripheral arterial thrombosis, hypoxia and ischemia) in parrots and could be one of the reasons for foot necrosis.

Can chronic crack-cocaine exposure cause parrot foot necrosis? A possible hypothesis / Can chronic crack-cocaine exposure cause parrot foot necrosis? a possible hypothesis

Background: Parrot foot necrosis is a poorly understood dermatitis with diffi cult diagnosis and treatment that has been reported in all species of Amazon parrots. Diagnosis is usually achieved by detailed history and ruling out other causes through evaluation of CBC and biochemical profi le. Prolonged crack-cocaine misuse could cause digit or nail lesions in humans. In this report similar clinical manifestations in two African gray parrots owned by crack-cocaine addicted users have been reported.Cases: Two African gray parrots were referred with pruritic foot, discoloration of digits, black and brown patching of the scales on the feet and legs associated with soft tissue swelling. Gross necrosis and self mutilation were also observed. According to the history, both birds had been suffering from the lesions for the past few weeks. A detailed history was obtained for each patient, including environmental condition and their main diet was nuts and fruits. Common causes were ruled out through evaluation of CBC and biochemical profi le. Based on gross characteristics and distribution of lesions, foot necrosis was diagnosed. Husbandry recommendations were given and antibiotics were prescribed to prevent possible infections. However, no improvements were seen, following the prescribed medication. Also deterioration of the clinical signs and feet lesions were observed. Typical fi nger

Background: Parrot foot necrosis is a poorly understood dermatitis with diffi cult diagnosis and treatment that has been reported in all species of Amazon parrots. Diagnosis is usually achieved by detailed history and ruling out other causes through evaluation of CBC and biochemical profi le. Prolonged crack-cocaine misuse could cause digit or nail lesions in humans. In this report similar clinical manifestations in two African gray parrots owned by crack-cocaine addicted users have been reported.Cases: Two African gray parrots were referred with pruritic foot, discoloration of digits, black and brown patching of the scales on the feet and legs associated with soft tissue swelling. Gross necrosis and self mutilation were also observed. According to the history, both birds had been suffering from the lesions for the past few weeks. A detailed history was obtained for each patient, including environmental condition and their main diet was nuts and fruits. Common causes were ruled out through evaluation of CBC and biochemical profi le. Based on gross characteristics and distribution of lesions, foot necrosis was diagnosed. Husbandry recommendations were given and antibiotics were prescribed to prevent possible infections. However, no improvements were seen, following the prescribed medication. Also deterioration of the clinical signs and feet lesions were observed. Typical fi nger

Can chronic crack-cocaine exposure cause parrot foot necrosis? A possible hypothesis / Can chronic crack-cocaine exposure cause parrot foot necrosis? a possible hypothesis

Background: Parrot foot necrosis is a poorly understood dermatitis with diffi cult diagnosis and treatment that has been reported in all species of Amazon parrots. Diagnosis is usually achieved by detailed history and ruling out other causes through evaluation of CBC and biochemical profi le. Prolonged crack-cocaine misuse could cause digit or nail lesions in humans. In this report similar clinical manifestations in two African gray parrots owned by crack-cocaine addicted users have been reported.Cases: Two African gray parrots were referred with pruritic foot, discoloration of digits, black and brown patching of the scales on the feet and legs associated with soft tissue swelling. Gross necrosis and self mutilation were also observed. According to the history, both birds had been suffering from the lesions for the past few weeks. A detailed history was obtained for each patient, including environmental condition and their main diet was nuts and fruits. Common causes were ruled out through evaluation of CBC and biochemical profi le. Based on gross characteristics and distribution of lesions, foot necrosis was diagnosed. Husbandry recommendations were given and antibiotics were prescribed to prevent possible infections. However, no improvements were seen, following the prescribed medication. Also deterioration of the clinical signs and feet lesions were observed. Typical fi nger

Background: Parrot foot necrosis is a poorly understood dermatitis with diffi cult diagnosis and treatment that has been reported in all species of Amazon parrots. Diagnosis is usually achieved by detailed history and ruling out other causes through evaluation of CBC and biochemical profi le. Prolonged crack-cocaine misuse could cause digit or nail lesions in humans. In this report similar clinical manifestations in two African gray parrots owned by crack-cocaine addicted users have been reported.Cases: Two African gray parrots were referred with pruritic foot, discoloration of digits, black and brown patching of the scales on the feet and legs associated with soft tissue swelling. Gross necrosis and self mutilation were also observed. According to the history, both birds had been suffering from the lesions for the past few weeks. A detailed history was obtained for each patient, including environmental condition and their main diet was nuts and fruits. Common causes were ruled out through evaluation of CBC and biochemical profi le. Based on gross characteristics and distribution of lesions, foot necrosis was diagnosed. Husbandry recommendations were given and antibiotics were prescribed to prevent possible infections. However, no improvements were seen, following the prescribed medication. Also deterioration of the clinical signs and feet lesions were observed. Typical fi nger