Prevalence of hepatitis C, hepatitis B and HIV and their therapeutic management in a French public psychiatric hospital.

INTRODUCTION: Several studies suggest that the prevalence of hepatitis C, hepatitis B and HIV are higher in psychiatric patients than in the general population; however, few French studies have been published. The aims of this study were to determine the seroprevalence of the three viruses, describe the profile of infected patients and evaluate the initiation of antiviral treatment in a population of patients hospitalized in a psychiatric hospital. METHOD: Between January and October 2020, screening for hepatitis C virus, hepatitis B virus and HIV was systematically offered to all patients admitted to the intersectoral reception and orientation unit of a psychiatric hospital. If serology was positive, viral load was automatically determined from the same blood sample. As direct-acting antivirals (DAAs) are not financed "in addition" to hospital charges, it was decided a priori to start treatment for HCV immediately before discharge. RESULTS: Between January 7 and October 1, 2020, 407 patients accepted screening. Of these patients, 17 (4.2%; 95% CI: 2.2-6.1%) were anti-HCV positive and two were anti-HIV+/anti-HCV- (0.49%). HCV RNA was detectable in 9/17 anti-HCV+ patients, with a prevalence of infection of 2.2% (CI: 0.8-3.6%). Drug use was identified in 16 anti-HCV+ patients (94%), ten with active drug use. Of the nine viraemic patients, only four received a prescription for DAA treatment at the end of hospitalization, and only one was followed up by his general practitioner with the confirmation of virological cure three months after treatment cessation. No patient tested positive for hepatitis B surface antigen, but 3% had serological markers indicating HBV past infection. The anti-HBV vaccination coverage rate was only 39% in the entire population and only 41% for patients with a history of drug use. CONCLUSION: Our study confirms that the prevalence of HCV infection is significantly higher in the psychiatric population than in the general population. By far, the main risk factor for HCV infection is drug use. This justifies the systematic performance of regular screening in this population. The way in which DAAs are financed in psychiatric hospitals seems to be a major obstacle to the initiation of treatment for chronic HCV infection during hospitalization and therefore to the elimination of HCV infection in the psychiatric population.

[Recreative drug use and cardiovascular disease]. / Consommation de drogues récréatives et pathologies cardiovasculaires.

Widely spread, and continuously increasing, recreational drug use in general population has been associated with cardiovascular events, as illustrated by clinical studies and supported by a pathophysiological rationale. Understanding the cardiovascular effects of drugs, screening, and secondary prevention are crucial components in the management of those patients in cardiology.

[Unsafe practices fostering cutaneous abscesses in people who inject substances : Results from the ANRS-OUTSIDER study]. / Des pratiques à risque favorisant la survenue d'abcès cutanés chez les personnes qui injectent des substances : résultats de l'étude ANRS-OUTSIDER.

INTRODUCTION: Cutaneous abscesses are a common complication of intravenous substance use. Although these skin and soft tissue infections represent one of the main causes of emergency room visits and hospitalizations in people who inject drugs (PWID), data on their prevalence and causes are scarce. The present study was part of the larger ANRS-OUTSIDER project and aimed to study the factors associated with skin abscesses in PWID, focusing in particular on the different stages of injection. METHOD: Analyses were based on data of the 164 persons who regularly injected psychoactive substances participating in the French ANRS-OUTSIDER project. A face-to-face questionnaire collected data on sociodemographics, substance use, injection practices, and experience of skin abscesses in the previous six months. Factors associated with skin abscesses were studied using a logistic regression model. RESULTS: Of the 140 participants for whom abscess data were recorded at inclusion, 35% reported having a skin abscess in the previous six months. Factors associated with skin abscesses were: benefiting from universal health coverage (PUMA/CMU/AME) (Odd ratio (OR) = 0.28, confidence interval (CI) à 95%=0.08-0.99), finding the vein to inject by touch (OR=3.44, 95% CI=1.41-8.43) and licking the needle before injection (OR=5.16, 95% CI=1.10-24.30). CONCLUSION: Our results highlight that skin abscesses were very frequent among the complications observed in our sample of French PWID, and that certain injection practices fostered their occurrence. These data will provide stakeholders with useful information to improve prevention and harm reduction messages for PWID.

[Which psychoactives substances are found in used syringes?] / Analyse des seringues usagées : un reflet de la consommation de substances psychoactives par les usagers de drogues par voie intraveineuse ?

OBJECTIVE: The aim of this study is to analyze the residual content of used syringes. METHODS: Used syringes were collected in March 2014 at 9 sites in Marseille (automatic injection kit dispensers, streets, drug-user risk reduction centers [Centres d'accueil et d'accompagnement à la réduction de risques pour usagers de drogues [CAARUD]). Several substances (n=28) were investigated using liquid chromatography and mass spectrometry method. RESULTS: On average, 2±1 substances in each syringe were found among 254 syringes analyzed. The most detected substances were cocaine, buprenorphine, methylphenidate and cathinones (in 57 %, 56 %, 39 % and 19 % of the syringes respectively). Heroin and morphine were found in 10 % of the syringes. DISCUSSION-CONCLUSION: This study helps define the main substances consumed by injection drugs users. It highlighted differencies in used substances according to neighborhood and site of collection and thus help to adjust prevention and harm reduction strategies.

Profiles and health risks (STIs, HCV, HIV) of injecting drug users.

OBJECTIVE: The aim of this article is twofold: to present the sociodemographic profiles of people who inject drugs (PWID) in Togo and to assess the prevalence of health risks (sexually transmitted infections [STIs], the hepatitis C virus, and HIV), the problems linked to drug injection, and the factors characterizing PWIDs. PARTICIPANTS AND METHODS: Using a questionnaire, this cross-sectional descriptive study was conducted on 384 PWIDs in Togo. The questionnaire focused on sociodemographic characteristics, consumption history, and known health problems and risks. Snowball sampling allowed for data collection in all regions of the country. RESULTS: In the sampling, the results revealed prevalence of 17% for STIs and 53% for the hepatitis C virus. The onset of medical problems and STI signs was significantly triggered when the person was female, over 25 years of age, polygamous, not attending school, unemployed, and had been using drugs for more than five years. Moreover, reused injection equipment was shown to be associated with the high STI prevalence. CONCLUSION: Drug injection is dangerous and results in numerous health problems. This study shows that PWID vulnerability of stems from specific characteristics, such as being uneducated, single, unemployed, bereft of parents, and having a low monthly income. Additional research is required to further investigate the health risks associated with drug injection in view of providing PWIDs with comprehensive care.

Possible impact of the COVID-19 pandemic on the recreational use of nitrous oxide in the Paris area, France.

INTRODUCTION: Recreational use of nitrous oxide (N2O) is increasing in Western countries, including France. During the COVID-19 pandemic, some authors warned that recreational N2O use could increase further as the supply of illicit drugs was impacted by various containment measures. METHODS: We retrospectively analyzed N2O exposures reported to the Paris Poison Control Center (France) from 2010/01/01 to 2021/04/15. The Poison Severity Score was used to grade severity. RESULTS: During the study period, 93 cases of N2O recreational exposures were reported (male/female ratio: 1.1; median age: 20.9 years range: [14.8-49.0]). The first case was reported in 2012, 84/93 (90%) and 65/93 (70%) were reported since 2019 and March 17th 2020 (first lockdown in France) respectively. Most of the patients were symptomatic (88/93; 95%) and developed neurological symptoms (78/93; 84%). Among the fourteen patients who developed moderate to severe symptoms, eleven were reported after March 2020. CONCLUSION: Despite a marked increase in recreational N2O exposures during the COVID-19 pandemic, the exact impact of COVID-19 on this increase remains to be determined as it was observed from 2019.

Encontro com a guerra no Brasil: entre psicanálise, Clausewitz e Foucault / Meeting the war in Brazil: between psychoanalysis, Clausewitz and Foucault / La rencontre avec la guerre au Brésil: entre psychanalyse, Clausewitz et Foucault / Encuentro con la guerra en Brasil: entre el psicoanálisis, Clausewitz y Foucault

Resumo A guerra do tráfico de drogas no Brasil tem ganhado destaque nas pesquisas dentro da psicologia pelo significativo número de mortes relacionadas a este fenômeno. Partindo da descrição dos cinco primeiros dias de encontro entre pesquisadores e adolescentes envolvidos com o fenômeno descrito, pretende-se apontar alguns pontos de aproximação e diferença entre ele e o que é chamado pelo significante "guerra" na filosofia de Clawsewitz e Foucault. Para tanto, foi feita uma descrição do campo, seguida pela problematização, retomando três aportes teóricos: a tese da guerra como continuação da política, de Clausewitz; a inversão feita por Foucault que sustenta o Racismo de Estado; e um aprofundamento psicanalítico sobre as diversas modalidades dos conflitos sob o nome de guerra. Concluindo, essa análise resultou na tese de que existe uma guerra no Brasil como consequência do sistema político excludente, denunciada pelos jovens envolvidos com o tráfico de drogas.

Abstract The 'war on drugs' promoted in Brazil has gained prominence in psychology research due to the ensuing significant number of deaths. By describing the five first meetings held with teenagers, the researchers highlight some similarities and differences between the described phenomenon and what Clausewitz and Foucault call 'war.' To this end, after describing the field research, the paper discusses three theoretical points: Clausewitz's thesis that war is the continuation of politics; Foucault's inversion, which sustain state racism; and an in-depth psychoanalysis of the various forms of conflict under the umbrella-term 'war.' In conclusion, this analysis point out the war going on in Brazil as a consequence of the exclusionary political system, denounced by youths involved in drug trafficking.

Résumé La guerre au trafic de drogues promue au Brésil a pris de l'importance dans la recherche en psychologie en raison du nombre important des décès qu'elle a entraîné. En décrivant les cinq premières réunions tenues avec des adolescents, les chercheurs souligne certaines similitudes et différence entre le phénomène décrit et ce que Clausewitz et Foucault appellent la « guerre ¼. Pour cela, après avoir décrit la recherche, l'article discute de trois points théoriques : la thèse de Clausewitz, selon laquelle la guerre est le prolongement de la politique; l'inversion faite par Foucault, qui soutient le racisme d'État ; et une psychanalyse approfondie des différentes formes de conflit sous le terme générique de « guerre ¼. En conclusion, cette analyse met en évidence la guerre qui se déroule au Brésil comme une conséquence du système politique d'exclusion dénoncé par les jeunes impliqués dans le trafic de drogue.

Resumen La guerra en contra del tráfico de drogas en Brasil ha ganado atención en la investigación en psicología debido al número significativo de muertes relacionadas a este fenómeno. Partiendo de la descripción de los cinco primeros días de encuentro entre investigadores y adolescentes envueltos en el fenómeno descrito, se pretende señalar algunos puntos de aproximación y diferencia entre este y lo que es llamado por el significante "guerra" en la filosofía de Clausewitz y Foucault. Para esto, se llevó a cabo una descripción de campo, seguida por la problematización con tres aportes teóricos: la tesis de la guerra como extensión de la política de Clausewitz; la inversión hecha por Foucault que sustenta el Racismo de Estado; y una profundización psicoanalítica sobre las diversas modalidades de los conflictos bajo el nombre de guerra. En conclusión, este análisis constató la tesis de que existe una guerra en Brasil como consecuencia de un sistema político excluyente, denunciada por los jóvenes envueltos con tráfico de drogas.

Different Peoples, Different Inebriations: The Recognition of Different Cultures of Intoxication in Early Modern English Medicine.

In early modern Europe, the global dimensions of the drug trade and the introduction of new substances contributed to the development of new cultures of intoxication. This process was particularly evident in England, where a new intoxication culture emerged from the recognition of how different substances produced similar reactions. Medical travel literature provides a critical source for examining alternative methods of drug consumption in the non-Western world in this period: culturally embedded practices like Turkish opium eating or Native American tobacco smoking became significant benchmarks for comparing with Western habits of alcohol consumption. This article argues that the early modern Western medical community relied on comparisons of intoxication in other contexts in an effort to describe its own culturally embedded practices of alcohol intoxication.

Canvis en les característiques de les intoxicacions en menors de 18 anys. Revisió de casos en un servei d’urgències (2011-2018) / Cambios en las características de las intoxicaciones en menores de 18 años. Revisión de casos en un servicio de urgencias (2011-2018) / Changes in the pattern of poisonings in patients under 18 years. A review of cases in an emergency department (2011–2018)

Fonament. Les intoxicacions han sofert canvis al llarg deltemps en relació amb l’etiologia, el maneig i les complicacions. Conèixer-ne l’epidemiologia ajuda a generar mesurespreventives.Objectiu. Analitzar les característiques epidemiològiques iclíniques, el pronòstic i la mortalitat de les intoxicacions enun servei d’urgències pediàtriques.Mètode. Estudi descriptiu, retrospectiu, observacional. Període: vuit anys. Es van incloure menors de divuit anys ambsospita d’intoxicació atesos a urgències que van requeriringrés hospitalari o observació. Anàlisi feta mitjançant elprograma SPSS.Resultats. Es van incloure cinquanta-dos pacients, delsquals trenta-tres van ser menors de sis anys (63,5%) i dinou majors de dotze anys (36,5%). Tots els successos enels menors de sis anys van ser involuntaris. El 94,7% deles intoxicacions en els majors de dotze anys van ser intencionades, de les quals el 72,2% tenien intenció suïcida.Els tòxics més freqüents van ser els medicaments (63,4%),seguits de les drogues il·lícites (15,4%). El 50% del totald’intoxicacions va presentar alteració del nivell de consciència i el 28,8% va requerir suport respiratori. Enl’11,5% es va fer rentat gàstric i en el 30% es va administrar carbó activat. L’alteració del nivell de consciència vaser l’únic factor significatiu (p<0,05) associat a l’ingrés ala Unitat de Cures Intensives Pediàtriques (UCIP).Conclusions. Les intoxicacions predominaren en els menors de sis anys. Del total d’intoxicacions, la medicamentosa va ser la causa més freqüent, seguida de les drogues il·lícites.El factor clínic més relacionat amb l’ingrés a la UCIP va serl’alteració de la consciència. (AU)

Fundamento. Las intoxicaciones han sufrido cambios a lo largo del tiempo en etiología, manejo y complicaciones. Conocer su epidemiología ayuda a generar medidas preventivas. Objetivo. Analizar las características epidemiológicas y clínicas, el pronóstico y la mortalidad de las intoxicaciones en un servicio de urgencias pediátricas. Método. Estudio descriptivo, retrospectivo, observacional. Periodo:8 años. Se incluyó a los menores de 18 años con sospecha de intoxicación atendidos en urgencias que requirieron ingreso u observación. Análisis realizado mediante el programa SPSS. Resultados. Se incluyeron 52 pacientes, de los cuales 33 fueron menores de 6 años (63,5%) y 19 mayores de 12 años (36,5%).Todos los eventos en los menores de 6 años fueron involuntarios. El 94,7% de las intoxicaciones en los mayores de 12 años fueron intencionadas, de las cuales el 72,2% tenían intención suicida. La causa medicamentosa (63,4%) fue la más frecuente, seguida por las drogas ilícitas (15,4%). El 50% del total de intoxicaciones presentaron alteración del nivel de consciencia y el 28,8% precisó soporte respiratorio. En el 11,5% se realizó lavado gástrico y en el30% se administró carbón activado. La alteración del nivel de consciencia fue el único factor significativo (p<0,05) asociado con el ingreso en la unidad de cuidados intensivos pediátricos (UCIP).Conclusiones. Las intoxicaciones predominaron en los menores de6 años. Del total de intoxicaciones, la medicamentosa fue la causa más frecuente, seguida por las drogas ilícitas. El factor clínico más relacionado con el ingreso a UCIP fue la alteración del nivel de consciencia. (AU)

Background. Poisonings in pediatrics have undergone changes overtime in terms of etiology, management, and complications. It is important to know the epidemiology to generate preventive measures. Objective. To analyze the epidemiology, clinical characteristics,prognosis, and mortality of poisonings in pediatric patients caredfor in the emergency department.Method. This is a descriptive, retrospective and observationalstudy. Period: 8 years. Patients under 18 with suspected poisoningadmitted in the emergency department were included. The statistical analysis was performed using the SPSS program.Results. 52 patients were selected, 33 under 6 years of age (63.5%)and 19 over 12 years (36.5%). All events in children under 6 wereunintentional. 94.7% of poisonings in patients over 12 years of agewere intentional, of which 72.2% had a suicidal intention. Pharmacologic agents (63.4%) were the most frequently identified ingestedsubstance, followed by illicit drugs (15.4%). 50% of all cases hadaltered level of consciousness and 28.8% required respiratory support. Gastric lavage was performed in 11.5% and activated charcoalwas administered in 30%. Altered level of consciousness was theonly significant factor (p<0.05) associated with admission to thepediatric intensive care unit (PICU).Conclusions. Poisoning cases were more frequent in children under6 years. Pharmacologic agents were the most frequently identifiedpoisoning substances, followed by illicit drugs. Decreased consciousness was the most significant clinical factor leading to admission to the PICU. (AU)

[Geriatric Psychiatry in Nursing Homes in the Canton Basel-Stadt - The View of General Practitioners]. / Die hausärztliche gerontopsychiatrische Versorgung in Stadtbasler Alters- und Pflegeheimen.

Geriatric Psychiatry in Nursing Homes in the Canton Basel-Stadt - The View of General Practitioners Abstract. Background: This cross-sectional study intends to examine the potential need for an outpatient geronto-psychiatric service and evaluates GPs' views of the frequency of psychiatric symptoms among residents of nursing homes in the canton of Basel-Stadt, Switzerland. Results: Nine out of ten (89 %) see a need for a geronto-psychiatric service. Two thirds (58,9 %) of them prefer a service available during office hours. GPs estimate that 63 % of their nursing home residents suffer from psychiatric symptoms (dementia in 60 %, depression in 23 %, sleep disorders in 11 %). Antipsychotics are prescribed most often (in 50,6 %). Discussion: GPs in the canton of Basel-Stadt see a need for an outpatient geronto-psychiatric service. Psychiatric symptoms are common among residents of nursing homes.

Effects of Cannabis Use in Youth and Young Adults With Type 1 Diabetes: The Highs, the Lows, the Don't Knows.

Our objective was to address the request by our Diabetes Canada/Canadian Institutes of Health Research-funded Virtual Patient Network (VPN) of youth and young adults with type 1 diabetes for information on the impact of cannabis use on type 1 diabetes. To respond to this patient-initiated request, we conducted a literature search in PubMed, with search terms relevant to the following: cannabis use in youth with type 1 diabetes, effects of cannabis use on glycemic control and diabetic emergencies and immune-modulating properties of cannabis. These were synthesized in a narrative review. The number of studies is limited and is based largely on self-report and cross-sectional assessment. The existing literature indicates that 10% to 30% of youth and young adults with type 1 diabetes report ever using cannabis, similarly to the general population. Use appears to be associated with higher glycated hemoglobin and greater diabetic ketoacidosis incidence. There is some evidence of poorer self-management during episodes of use. Cannabis has been shown to be protective against type 1 diabetes in animal models, but such findings have yet to be replicated in humans. Existing cross-sectional studies suggest adverse effects of cannabis use on glycemic control and self-management. However, it is not clear if the associations identified are due to use itself or other patient or contextual factors. Nonetheless, given high use rates, health-care providers should query use, discuss its potential impact on diabetes management and outcomes, and codevelop an action plan.

Adolescentes usuários de drogas e a desinserção social / Teenage drug users and "social disinsertion" / Adolescentes usuarios de drogas y la exclusión social / Jeunes usagers de drogue et l'exclusion sociale

O texto em questão buscou responder como as dificuldades de adesão ao tratamento, apresentadas por adolescentes usuários de drogas, podem beneficiar o trabalho realizado nos Centros de Atenção Psicossocial Infanto-Juvenill (CAPSi) do estado de Minas Gerais. Nele se destaca, entre outras, a dificuldade que se chamou de desinserção social. O campo teórico/prático da psicanálise orientou o trabalho através do método do caso único, que permite resultados universalizados respeitando as singularidades, isto é, um universal alcançado a partir do singular. Fragmentos das entrevistas semiestruturadas realizadas com os cinco jovens estudados, indicados pelas equipes dos serviços por serem considerados paradigmáticos daqueles que apresentavam dificuldades de adesão, e com os profissionais que os acompanharam são utilizados para subsidiar as considerações apresentadas, considerando a cartografia própria da vida dos sujeitos implicados no processo. Constatou-se que os efeitos das destituições simbólicas do Outro, no contemporâneo, têm favorecido a instauração de modos subjetivos de desconexão social, a exemplo da toxicomania, e que o modo como a desinserção aparece, na singularidade de cada caso, no contexto da adolescência, indica a presença de um sintoma social da época. A descrença dos jovens na relação com o Outro Social aparece em suas relações com o CAPSi, um Outro Institucional. Mas, quando esse Outro se faz exceção e se apresenta como lugar de cuidado, de presença e interesse pelo sujeito, mudanças ocorrem entre a desinserção e a inserção possível, levando o sujeito a encontrar um lugar no Outro, não se apagando no coletivo da política pública.

The text in question sought to answer how the difficulties of adherence to treatment, presented by adolescent drug users, can benefit the work carried out in the Psychosocial Care Centers of Children-Juvenile (CAPSi) of the state of Minas Gerais. It highlights, among others, the difficulty that has been called "social disinsertion." The theoretical/practical field of psychoanalysis guided the work through the unique case method, which allows universalized results respecting the singularities, that is, a universal achieved from the singular. Fragments of the semi-structured interviews conducted with the five youths studied, indicated by the service teams because they are considered paradigmatic of those who had difficulties with adherence, and with the professionals who accompanied them are used to support the considerations presented, considering the cartography of their lives involved in the process. It was found that the effects of symbolic dismissals of the Other, in the contemporary, have favored the establishment of subjective modes of social disconnection, such as drug addiction, and that the way disinsertion appears, in the uniqueness of each case, in the context of adolescence, indicates the presence of a social symptom of the time. Young people's disbelief in their relationship with the Other Social appears in their relationship with CAPSi, an Institutional Other. But when this Other becomes an exception and presents itself as a place of care, presence, and interest for the subject, changes occur between disinsertion and possible insertion, leading the subject to find a place in the Other, not disappearing in the collective of public politics.

El texto buscó contestar como las dificultades de adhesión al tratamiento, presentadas por adolescentes usuarios de drogas, pueden beneficiar el trabajo realizado en el Centro de Atención Psicosocial Infantojuvenil (CAPSi) del estado de Minas Gerais. En él subrayamos, entre otras, la dificultad que llamamos de exclusión social. El campo teórico/practico del psicoanálisis oriento el trabajo por medio del método del caso único, que permite resultados universalizados respetando las singularidades, es decir, un universal logrado a partir del singular. Fragmentos de las entrevistas semiestructuradas realizadas con los cinco jóvenes investigados, indicados por el personal de los servicios porque eran considerados paradigmáticos de aquellos que presentaban dificultades de adhesión, y con los profesionales que les acompañaron son utilizados para subsidiar las consideraciones presentadas, considerando la cartografía propia de la vida de los sujetos involucrados en el proceso. Se observó que los efectos de las destituciones simbólicas del Otro, en el contemporáneo, favorece la implantación de modos subjetivos de desconexión social, a ejemplo de la toxicomanía, y que el modo como la exclusión se presenta, en la singularidad de cada caso, en el contexto de la adolescencia, indica la presencia de un síntoma social de la época. La incredulidad de los jóvenes en la relación con el Otro Social surge en sus relaciones con el CAPSi, un Otro Institucional. Pero, cuando este Otro hace excepción y se presenta como lugar de cuidado, de presencia y interés por el sujeto, cambios ocurren entre la exclusión y la inclusión posible, llevando el sujeto a encontrar un lugar en el Otro, no borrándose en el colectivo de la política pública.

Le texte en question a eu comme objectif d'expliquer comment des difficultés d'adhésion au traitement présentées par des jeunes consommateurs de drogues peuvent bénéficier des travaux menés dans les centres de prise en charge psychosociale des jeunes (CAPSi) chez l'État de Minas Gerais, au Brésil. On fait attention, entre autres, à la difficulté qui s'est appelée d'exclusion sociale. Le champ théorique / pratique de la psychanalyse a guidé le travail à travers la méthode du cas unique, qui permet d'obtenir des résultats universels respectant les singularités, c'est-à-dire un universel obtenu à partir du singulier. Des entretiens semi-structurés ont été menés avec cinq jeunes étudiés, lesquels on été indiqués par les équipes de service à cause de leurs caractéristiques de patients paradigmatiques de difficile observance. Entretiens ou été aussi menés avec les professionnels qui les ont accompagnés. Certains fragments des entretiens ont été utilisés pour soutenir les considérations présentées, en considérant la cartographie de la vie des sujets impliqués dans le processus. Il a été constaté que les effets des destitutions symboliques de l'Autre, dans le monde contemporain, ont favorisé l'établissement de modes subjectifs de déconnexion sociale, tels que la toxicomanie. On a aussi constaté que la manière dont l'exclusion apparaît, dans chaque cas, dans le contexte de l'adolescence. , indique la présence d'un symptôme social du temps. L'incrédulité des jeunes dans leur relation avec l'Autre social apparaît dans leur relation avec CAPSi, un Autre Institutionnel. Mais lorsque cet Autre devient une exception et se présente comme un lieu de soin, de présence et d'intérêt pour le sujet, des changements se produisent entre l'exclusion et l'insertion possible, ce qui amène le sujet à trouver une place dans l'Autre, et ne disparaissant pas dans le collectif de la politique publique.

A developmental origins perspective on the emergence of violent behavior in males with prenatal substance exposure.

Children with prenatal substance exposure are at increased risk for externalizing behavior problems and violence. However, the contribution of early life experiences for placing these individuals at risk is not well understood. Utilizing a sample of 1,388 children with prenatal substance exposure from the Maternal Lifestyle Study, we attempt to shed light on these contributing factors by examining the impact of infant temperament, maternal sensitivity, and early life stress on the expression of violent behavior at ages 12 through 14 years. Males may be more at risk for increases in violent behavior in early adolescence through a number of early life experiences, such as variability in responses to maternal flexibility and engagement related to individual differences in temperament, as well as exposure to early adversity. Comparing two prevailing developmental theoretical frameworks, deficit models and differential susceptibility, we aim to understand the developmental origins of violent behavior in males by identifying children who may be most susceptible to early caregiving experiences.

A abordagem dos termos dependência química, toxicomania e drogadição no campo da Psicologia brasileira / L'approche des termes dépendance chimique, toxicomanie et addiction aux drogues dans le domaine de la psychologie brésilienne / El enfoque de los términos dependencia química, toxicomanía y drogadicción en el campo de la Psicología brasileña / Analysis of how the terms chemical dependency, toxicomania and drug addiction are used in Psychology in Brazil

O consumo de substância psicoativa é um fenômeno abrangente na sociedade brasileira, existindo diversos modos de nomeá-lo, destacando-se: toxicomania, drogadição e dependência química. O objetivo deste estudo é investigar como a Psicologia aborda o fenômeno, bem como a compreensão desses termos. Foi realizada revisão de literatura por meio do portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes); nele foram reunidas e avaliadas publicações de revistas de Psicologia nacionais. Utilizaram-se como descritores os termos: dependência química, toxicomania, e drogadição, inseridos separadamente. Observou-se que eles podem ser utilizados como sinônimos, embora guardem algumas diferenças. O termo "dependência química" é baseado em manuais de classificação de doenças, sendo mais utilizado em relatos de pesquisa; a palavra "toxicomania" é utilizada para abordar uma relação de consumo tóxica, tanto com uma substância psicoativa quanto com outro objeto; já "drogadição" refere-se a uma relação de submissão e exclusividade com a droga.

L'usage de substances psychoactives est un phénomène répandu dans la société brésilienne, et on l'appelle de différentes manières, comme: toxicomanie, addiction aux drogues et dépendance chimique. Cette étude vise à étudier comment la psychologie a abordé ce phénomène, ainsi que la compréhension de ces termes. Un examen de la documentation a été réalisé avec des études sur le thème sur le portail CAPES, publiées dans laquelle revues nationales de psychologie. Les mots-clés suivants ont été utilisés : dépendance chimique, toxicomanie, addiction aux drogues, insérés séparément. Les trois termes sont utilisés comme synonymes, bien que différents les uns des autres. Le terme « dépendance chimique ¼ est basé sur les manuels de classification des maladies et est plus largement utilisé dans les rapports de recherche; le mot « toxicomanie ¼ fait référence à une relation de consommation toxique, pouvant être une substance psychoactive ou avec un autre objet; et « addiction aux drogues ¼ désigne une relation de soumission et d'exclusivité avec la drogue.

El consumo de sustancias psicoactivas es un fenómeno de gran amplitud en la sociedad brasilera, y hay diversas maneras de nombrarlo, las cuales se destacan las siguientes: toxicomanía, drogadicción y dependencia química. Este estudio buscó investigar de qué modo la psicología ha abordado el fenómeno, así como la comprensión de estos tres términos. Se realizó una revisión de literatura en el portal de periódicos Capes (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), en el cual se reunieron y evaluaron publicaciones en revistas de Psicología nacionales. Se utilizaron como descriptores los términos: dependencia química, toxicomanía, drogadicción; colocándolos por separado. Se observó que los tres términos son utilizados como sinónimos, aunque tengan diferencias. El término "dependencia química" se basa en manuales de clasificación de enfermedades, siendo más utilizado en relatos de investigación; la palabra "toxicomanía" es utilizada para describir una relación de consumo tóxica, que puede ser tanto con una sustancia psicoactiva como con otro objeto; ya "drogadicción" se refiere a una relación de sumisión y exclusividad con la droga.

The use of psychoactive substance is a widespread phenomenon in the Brazilian society, so it is named several ways, for instance, toxicomania, drug addiction and chemical dependency. The purpose of this study is to analyze how Psychology has addressed this phenomenon and used these three terms. A scientific literature review was conducted with studies on this theme on the portal of Capes (Coordination for the Improvement of Higher Education Personnel), published in national Psychology journals. The following keywords were inserted separately for the search: chemical dependency, toxicomania, and drug addiction. The three terms are used as synonyms, although presenting minor differences between one another. "Chemical dependency" is commonly found in disease classification manuals and more widely used in research reports; "toxicomania" refers to toxic consumption which could be of a psychoactive or another substance; and 'drug addiction' refers to an exclusive submission relationship with drugs.

El consumo de drogas como sostén narcisista en la adolescencia / The consumption of drugs as a narcissistic support in the adolescence / O consumo de drogas como suporte narcisista na adolescência / La consommation de drogues comme soutien narcissique dans l'adolescence)

La tradición científica ha encontrado, en la transformación endocrina y en las condiciones ambientales, una explicación al consumo de drogas en la adolescencia, abriendo con ello la puerta a un tratamiento donde la subjetividad difícilmente ha sido leída como tal. La siguiente investigación propone comprender el periodo de la adolescencia como un proceso que, iniciándose en la pubertad, reactualiza los conflictos infantiles del sujeto, exigiendo de este, una reorganización psíquica que conduce a su subjetivación; situando desde esta visión al consumo de drogas como una posibilidad de sopesar o no, dicho advenimiento.

A tradição científica encontrou uma explicação para o consumo de drogas na adolescência, na transformação endócrina e nas condições ambientais, abrindo as portas para um tratamento em que a subjetividade dificilmente tem sido lida como tal. A pesquisa a seguir propõe compreender a adolescência como o processo que se inicia na puberdade e reativa os conflitos infantis do sujeito, demandando, dessa forma, uma reorganização psíquica que conduza à sua subjetivação; situando a partir desta visão o consumo de drogas como uma possibilidade de ponderar ou não dito advento.

The scientific tradition has found an explanation for the drug consumption in the adolescence, in the endocrine transformation and in the environmental conditions, opening the door to a treatment where the subjectivity has hardly been read as such. The following research proposes to understand adolescence as the process that begins at puberty, reactivates the infantile conflicts of the subject, thus demanding a psychic reorganization leading to its subjectivation; situating from this viewpoint, the consumption of drugs as a possibility to mourn or not that kind of situation.

La tradition scientifique a trouvé une explication pour la consommation des drogues pendant l'adolescence, dans la transformation endocrine et dans les conditions environnementales, ouvrant les portes à un traitement où la subjectivité difficilement a été lue comme telle. L'étude suivante propose de comprendre l'adolescence comme le processus qui commence à la puberté, déclenche les conflits de l'enfance du sujet, exigeant, ainsi, une réorganisation psychique qui mène à sa subjectivation; situant à partir de cette vision la consommation de drogues comme une possibilité de tristesse ou pas, dit l'avènement.

Die wissenschaftliche Tradition erklärt den Drogenkonsum bei Jugendlichen aufgrund der endokrinen Transformation und den Umweltbedingungen, was zu einer Behandlung führt, in der die Subjektivität kaum als solche gelesen wird. Die folgende Arbeit schlägt vor, die Adoleszenz als einen Prozess zu verstehen, der in der Pubertät beginnt, die kindlichen Konflikte des Subjekts reaktiviert und von diesem eine psychische Reorganisation verlangt, die zu seiner Subjektivierung führt. Aus dieser Sicht kann man den Drogenkonsum als einen Versuch betrachten, mit diesem Phänomen umzugehen.

A motivação para a interrupção ou uso de crack em gestantes e puérperas / The motivation for the interruption or use of crack in pregnant women and puerperas / La motivación para la interrupción o uso de crack en embarazadas y mujeres en post-parto / La motivation pour l'interruption ou l'usage de crack chez les femmes enceintes et accouchées

Este trabalho teve como objetivo investigar os aspectos afetivos presentes na motivação para a interrupção e/ou continuidade do consumo de crack durante o período gestacional. Entendemos a afetividade a partir da perspectiva teórica de Jean Piaget, compreendida como a energética da ação. Sendo assim, levantamos a hipótese de que os afetos atuam como motivadores da ação de interrupção ou de continuidade do consumo de drogas durante o período gestacional e puerperal, e nos questionamos quais são os aspectos afetivos envolvidos nessa conduta. Diante disso, realizamos um estudo de caso com uma gestante e três puérperas, com a faixa etária de 19 a 38 anos, que interromperam e/ou continuaram o uso de crack durante a gestação e o puerpério. Como instrumento de coleta de dados, utilizamos uma entrevista semiestruturada. O tratamento e a análise dos dados foram realizados a partir da análise de conteúdo de Bardin. Os resultados indicam que os aspectos afetivos atuam diretamente na decisão de interromper ou continuar o uso do crack. Na interrupção foram citados os sentimentos de culpa, vontade, amor e medo. Em contrapartida, no que diz respeito à continuidade do consumo da droga, surgiram os sentimentos de tristeza, prazer, raiva, vontade, solidão e ausência de vergonha. Todas as participantes atribuíram representações negativas ao crack e ao seu uso, especialmente durante a gestação. Dessa maneira, faz-se relevante a investigação dos aspectos afetivos envolvidos no consumo do crack a fim de aperfeiçoar as estratégias de cuidado voltadas a esse público.

This study aimed to investigate the emotional aspects present in the motivation for the interruption and/or continuity of crack consumption during the gestational period. We understand affectivity from the theoretical perspective of Jean Piaget, understood as the energy of action. Thus, we hypothesized that affections act as motivators for the interruption or continuity of drug use during the gestational and puerperal period, and we question which emotional aspects involved in this behavior. Therefore, we carried out a case study with a pregnant woman and three puerperal women, with ages ranging from 19 to 38 years, who interrupted and/or continued crack usage during pregnancy and puerperium. As a data collection instrument, we used a semi-structured interview. Data analysis and treatment were performed using the Bardin content analysis. The results indicate that affection aspects act directly in the decision to interrupt or continue the use of crack. In the interruption, they mentioned feelings of guilt, will, love and fear. On the other hand, regarding the continuity of drug use, feelings of sadness, pleasure, anger, will, loneliness and lack of shame arose. All participants attributed some negative representations to crack and its use, especially during pregnancy. In this way, it is relevant to investigate the affective aspects involved in the use of crack in order to improve the care strategies aimed at this public.

Este trabajo tuvo como objetivo investigar los aspectos afectivos presentes en la motivación para la interrupción y/o continuidad del consumo de crack durante el período gestacional. Entendemos la afectividad a partir de la perspectiva teórica de Jean Piaget, comprendida como la energética de la acción. De este modo, presentamos la hipótesis de que los afectos actúan como motivadores de la acción de interrupción o de continuidad del consumo de drogas durante el período gestacional y de post-parto, y nos preguntamos cuales son los aspectos afectivos envueltos en esta conducta. Frente a eso, realizamos un estudio de caso con una embarazada y tres mujeres en post-parto, con edades entre 19 a 38 años, que interrumpieron y/o continuaron el uso del crack durante el embarazo y el post-parto. Como instrumento de colecta de datos, utilizamos una encuesta semi estructurada. El tratamiento y análisis de los datos fueron realizados a partir del análisis de contenido de Bardin. Los resultados indican que los aspectos afectivos actúan directamente en la decisión de interrumpir o continuar el uso del crack. En la interrupción fueron citados los sentimientos de culpa, voluntad, amor y miedo. En cambio, en lo que se refiere a la continuidad del consumo de la droga, surgieron los sentimientos de tristeza, placer, rabia, voluntad, soledad y falta de vergüenza. Todas las participantes atribuyeron representaciones negativas al crack y a su uso, especialmente durante el embarazo. De esa forma, es relevante la investigación de los aspectos afectivos involucrados en el consumo del crack con la finalidad de perfeccionar las estrategias de cuidado relacionadas con este público.

Cette étude a eu l'objectif d'examiner les aspects affectifs présents dans la motivation d'interruption et / ou de continuité de l'usage de crack pendant la période de gestation. On comprend l'affectivité du point de vue théorique de Jean Piaget, c'est-à-dire,l'énergie de l'action. Ainsi, on a eu l'hypothèse que les affections sont des facteurs de motivation de l'action d'interruption ou de la continuité de l'usage de drogues pendant la gestation et dans la période puerpérale. Donc, on a questionné quels sont les aspects affectifs impliqués dans ce comportement. À cet égard, on a conduit une étude de cas sur une femme enceinte et trois accouchées, âgés de 19 à 38 ans, qui ont interrompu et / ou poursuivi l'usage de crack pendant la gestation et la période puerpérale. Comme outil de collecte de données, on a conduit une interview semi-structurée. L'analyse et le traitement des données ont été effectués à l'aide de l'analyse du contenu de Bardin. Les résultats indiquent que les aspects affectifs ont une influence directe dans la décision d'interrompre ou de continuer l'usage du crack. Dans l'interruption ont été mentionnés des sentiments de culpabilité, de volonté, d'amour et de peur. Par contre, en ce qui concerne la continuité de consommation de drogues, des sentiments de tristesse, de plaisir, de colère, de volonté, de solitude et de manque de honte sont apparus. Tous les participantes ont attribué des représentations négatives au crack et à son usage, en particulier pendant la période de gestation. De cette manière, il faut mettre en relief les aspects affectifs liés à l'utilisation de crack, afin d'améliorer les stratégies de soins destinées à ce public.

[Online information system for -phytotherapy in animals]. / Online-Informationssystem für die Phytotherapie bei Tieren.

INTRODUCTION: Phytotherapy becomes increasingly popular in veterinary medicine. To fully exploit the therapeutic potential of medicinal plants and ensure their safe use, knowledge about the effective plant parts and preparations is required. Improper use and overdosage of medicinal plants can be toxic. With www.phytoarznei.ch, we provide an online decision support aid that allows for the retrieval of currently available information on medicinal plants and their use in domestic animals. This decision support system is based on the available literature in the field, which after critical evaluation has been incorporated into a structured database. For each medicinal plant or drug, we have listed therapeutic indications, different application types, organoleptic properties, plant ingredients, pharmacological effects, dosages, duration of treatment, toxicity, legal frame for use in livestock and relevance for doping. A user-friendly access to all data is achieved by means of two search programs, either by entering the plant name or name of the drug in a search field or by selecting the desired animal species and therapeutic application from respective drop-down lists. This database on medicinal plant applications in animals is linked to the poisonous plant database of the University of Zurich and, for marketed preparations, to the Swiss compendium of veterinary medicinal products as well as to an index of related veterinary products.

INTRODUCTION: En médecine vétérinaire aussi, la phytothérapie devient de plus en plus populaire. Exploiter le potentiel thérapeutique des plantes médicinales et assurer leur utilisation en toute sécurité nécessite toutefois une connaissance particulière des parties de plantes ou des préparations efficaces. Une utilisation inappropriée et un surdosage de plantes médicinales peuvent être toxiques. C'est pourquoi nous avons créé un outil de prise de décision en ligne, www.phytoarznei.ch, qui permet un accès rapide aux connaissances actuelles sur les plantes médicinales et leur utilisation sur les animaux. Ce système d'information est basé sur la littérature spécialisée disponible qui a été incorporée, après une évaluation critique, dans une base de données structurée. Les indications thérapeutiques, les modes d'applications, les propriétés organoleptiques, les composants, les effets pharmacologiques, doses, la durée du traitement, la toxicité, les réglementations juridiques chez les animaux de rente ainsi que la pertinence en matière de dopage sont répertoriés pour chaque plante médicinale ou médicament à base de plantes. Deux programmes de recherche fournissent un accès convivial, soit par la saisie du nom de la plante, du nom du médicament ou des ingrédients de la plante dans une zone de recherche, soit en sélectionnant les espèces d'animaux souhaitées ainsi que l'utilisation thérapeutique dans des menus déroulants correspondants. Cette base de données des plantes médicinales est liée avec base de plantes toxiques de l'Université de Zurich et, si des produits finis correspondants sont disponibles, au Compendium des médicaments vétérinaires suisse ainsi qu'à un répertoire de produits vétérinaires.

A vontade em Vygotski: contribuições para a compreensão da "fissura" na dependência de drogas / Le volonté chez Vygotski: contributions à la compréhension d'avidité dans la dépendance des drogues / La voluntad en Vygotski: contribuciones a la comprensión del craving en la drogadicción / The will in Vygotsky: contributions to the understanding of the "craving" in drug addiction

Resumo A fissura (craving) é questão central no cuidado a pessoas com problemas decorrentes do uso de álcool e outras drogas, sendo considerada uma incapacidade de controlar o desejo pelo consumo. Contudo, não há definição unívoca desse fenômeno. Investigou-se o conceito de vontade em Lev S. Vygotski (1896-1934), considerando-se que sua abordagem poderia contribuir para a compreensão da fissura. Realizou-se uma revisão da literatura acerca do craving e uma análise focal do conceito de vontade em textos selecionados de Vygotski. Não obstante as controvérsias sobre a definição do fenômeno da fissura, a proposição de Vygotski acerca da vontade como função psicológica superior mediada por motivos auxiliares possibilita ampliar a compreensão do craving. O manejo da fissura, assim, depende não somente de uma iniciativa individual, mas também de questionamentos sobre a lógica social, política e histórica que preside os significados sobre o uso de drogas.

Resumé L'avidité (craving) est un point central pour le soin des personnes ayant problèmes issus de l'utilisation de l'alcool et d'autres drogues envisagée comme l'incapacité de contrôler le désir de consommation. Cependant, il n'y a pas de définition univoque sur ce phénomène. On a recherché le concept de volonté chez Lev S. Vygotski (1896-1934) en envisageant que son approche pourrait contribuer à la compréhension de l'avidité. On a effectué une révision de littérature autour du craving et une analyse focale du concept de volonté dans des textes sélectionnés de Vygotski. Malgré les controverses sur la définition du phénomène d'avidité, la proposition de Vygotski autour de la volonté comme fonction psychologique supérieure médiate par motifs auxiliaires permet d'enrichir la compréhension du craving. Le maniement de l'avidité ne dépend pas seulement d'une initiative individuelle, mais aussi des interrogations sur la logique sociale, politique et historique qui oriente les sens de l'utilisation des drogues.

Resúmen La fisura (craving) es un tema central en la atención de personas con problemas derivados del uso de drogas, considerada una incapacidad para controlar el deseo de consumo. Sin embargo, no existe una definición única de este fenómeno. Se investigó el concepto de voluntad de Lev S. Vygotsky (1896-1934) teniendo en cuenta que podría contribuir a la comprensión de la fisura. Se realizó una revisión bibliográfica sobre el deseo, y un análisis focal del concepto de voluntad en textos seleccionados de Vygotski. A pesar de las controversias en la definición del fenómeno de la fisura, la proposición de Vygotsky sobre la voluntad como función psicológica superior mediada por motivos auxiliares hace posible ampliar la comprensión del craving. El tratamiento de la fisura no sólo depende de una iniciativa individual, sino también de preguntarnos acerca de la lógica social, política e histórica que preside los significados del consumo de drogas.

Abstract Craving is a central issue in the care of people with problems due to the use of alcohol and other drugs, and is considered an inability to control the desire for consumption. However, there is no clear definition of this phenomenon. We investigated the concept of will in the works of Lev S. Vygotsky (1896-1934), considering that his approach could contribute to understanding the craving. We reviewed the literature on craving and performed a focal analysis of the concept of will in selected texts by Vygotsky. Despite the controversies over the definition of the craving phenomenon, Vygotsky's proposition that the will is a superior psychological function mediated by auxiliary motives makes it possible to deepen the understanding of the craving. Craving management thus depends not only on individual initiative, but also on questions about the social, political, and historical logic that presides over the meanings of drug use.

Pesquisa narrativa com mulheres que usam drogas: uma experiência etnográfica feminista / Recherche narrative avec les femmes utilisatrices de drogues: une expérience féministe ethnographique / La investigación narrativa con mujeres que utilizan drogas: una experiencia etnográfica desde la perspectiva feminista / Narrative research with drug-using women: a feminist ethnographic experience

Resumo Trata-se de pesquisa narrativa inscrita no campo epistemológico feminista, que buscou conhecer a trajetória de vida de mulheres usuárias de crack. Foi realizada uma etnografia multissituada/multilocal, que partiu da escuta de usuárias inseridas num serviço público de saúde mental para, na sequência, seguir duas delas pelos espaços nos quais circulavam, quais sejam, abrigo, escola, equipamentos de saúde, além de suas próprias casas. Como método de coleta de dados foi utilizada a técnica de entrevista narrativa. A escuta das mulheres possibilitou a desarticulação de sentidos fixos e desafiou a inteligibilidade orientadora das práticas de cuidado às pessoas que usam drogas. Foram ressaltados os limites que a condição de usuária de um serviço de saúde mental estabelece à enunciação de um saber válido das mulheres sobre si mesmas, sendo suas narrativas produto do discurso sobre elas elaborado pelo campo da saúde, que institui e prescreve sua própria materialização como usuárias de drogas.

Résumé Ce travail est une recherche narrative inscrite dans le domaine épistémologique féministe, qui a cherché connaître les trajectoires de vie des femmes utilisatrices de crack cocaine. Une ethnographie multi-située à été conduite, en commençant par écouter les utilisatrices insérées dans un service de santé mentale publique, pour à la suíte suivre deux d'entre elles dans les espaces à travers lesquels elles circulent, à savoir l'école et les établissements de santé en plus de leur propres logements. Comme méthode de collecte des données, la technique d'entrevue narrative a été utilisée. L'écoute des femmes a permis le démantèlement des signifiants fixes et remis en cause les intelligibilités dirigeant les pratiques de soins aux personnes qui consomment des drogues. On a mis en évidence les limites que la condition d'utilisateur d'un service de santé mentale imposent sur l'énoncé d'une connaissance valable des femmes sur elles-mêmes, leurs narratifs étant un produit du discours elaboré sur elles par le système de santé, qui établit et prescrit leur matérialisation en tant qu'utilisatrices de drogues.

Resumen Se trata de una investigación narrativa inscrita en el campo epistemológico de perspectiva feminista, no cual buscó conocer las trayectorias de vida de mujeres usuarias de crack. Se realizó una etnografía multisituada / multilocal, que partió de la escucha de usuarias insertadas en un servicio público de salud mental para luego seguir dos dellas por los espacios por los cuales circulaban, cuáles son, la calle, escuela, equipamientos de salud, además de sus propias casas. Como método de recolección de datos se utilizó la técnica de entrevista narrativa. La escucha de las mujeres posibilitó la desarticulación de sentidos fijos y desafió las inteligibilidades orientadoras de las prácticas de cuidado a las personas que usan drogas. Se resalta los límites que la condición de usuaria de un servicio de salud mental establece la enunciación de un saber válido de las mujeres sobre sí mismas, siendo sus narrativas producto del discurso sobre ellas elaborado por el campo de la salud, que instituye y prescribe su propia materialización como usuarias de drogas.

Abstract This is a narrative research, inserted in the feminist epistemological field, that sought to know the life trajectory of women who use crack. A multi-sited ethnographic research was carried out, which started from listening to drug-using women who took part in a public mental health service to, then, following two of them through the spaces in which they lived, namely, shelter, school, health center, in addition to their own homes. The narrative interview technique was used as data collection method. The act of listening to the women allowed us to disarticulate fixed meanings and challenge the guiding intelligibility of care practices to people who use drugs. The limitations that the condition of user of a mental health service establishes to the enunciation of a valid knowledge of the women about themselves stood out, as their narratives are a product of the discourse created about them by the health field, which institutes and prescribes their own materialization as drug users.