O agente comunit��rio e o usu��rio de ��lcool: discursos sobre a concep����o e a assist��ncia na Aten����o B��sica

Estima-se que 52% da popula����o mundial faz uso de ��lcool, sendo a droga mais consumida no mundo. Ao usu��rio, o ��lcool torna-se prejudicial devido ��s consequ��ncias nos n��veis biol��gicos, sociais e funcionais. Assim, a redu����o do uso abusivo da subst��ncia �� um dos objetivos da Organiza����o Mundial de Sa��de (OMS) e uma das prioridades na agenda de sa��de p��blica mundial. No Brasil, a Pol��tica do Minist��rio da Sa��de para a Aten����o Integral aos Usu��rios de ��lcool e Outras Drogas teve como objetivo a cria����o de uma rede de aten����o integral a eles - a RAPS (Rede de Aten����o Psicossocial). A RAPS �� considerada um grande avan��o da Reforma Psiqui��trica, j�� que integra os diversos pontos de aten����o dispon��veis no Sistema ��nico de Sa��de (SUS). Um dos pontos da RAPS �� a Aten����o B��sica (AB), que atrav��s da atua����o das equipes da Estrat��gia Sa��de da Fam��lia (ESF) tem a possibilidade de monitora����o, preven����o do uso e colabora����o na reinser����o social dos usu��rios de ��lcool e outras drogas devido �� proximidade e cria����o de v��nculo entre o servi��o e usu��rio. Para que o v��nculo seja estabelecido o Agente Comunit��rio de Sa��de (ACS) �� a pe��a fundamental, visto que conhece a comunidade e reconhece suas necessidades, al��m de ser a figura que medeia as rela����es entre a equipe de sa��de e os usu��rios. Assim sendo, o objetivo deste estudo foi descrever e analisar o discurso de ACS sobre o uso de ��lcool e a assist��ncia prestada na AB. Trata-se de um estudo qualitativo de teor descritivo, cuja pesquisa ocorreu em cinco munic��pios da regi��o central do Estado de Santa Catarina. Foram realizadas entrevistas semiestruturadas, analisadas atrav��s do m��todo da An��lise de Conte��do. A an��lise das entrevistas resultou na formula����o de duas categorias e quatro subcategorias emp��ricas. Os resultados evidenciaram que os ACS percebem o consumo de ��lcool como inerente a popula����o em virtude da cultura caracterizada pelo consumo habitual e festivo da droga. Eles percebem que o uso do ��lcool torna-se um problema quanto �� defini����o social atribu��da pela comunidade, ressaltando as consequ��ncias para a fam��lia e outras perdas vivenciadas pelos usu��rios com base nas repercuss��es sociais. Quanto �� assist��ncia prestada por eles aos usu��rios de ��lcool, os resultados indicaram uma pr��tica desprovida de instrumentos ou habilidades para a abordagem adequada do uso, evidenciando uma pr��tica infundada pelos ACS. A pr��tica est�� pautada tamb��m nas cren��as em rela����o aos usu��rios de ��lcool, que est��o muito ligadas aos estigmas relacionados a estes usu��rios em geral e n��o em evid��ncias cient��ficas. Conclui-se que a partir do conhecimento das percep����es e pr��ticas deste profissional, �� poss��vel direcionar a����es que potencialize a pr��tica dos ACS, j�� que s��o profissionais com grandes possibilidades de atua����o diante da preven����o e tratamento do abuso de ��lcool e reabilita����o social do usu��rio

Dually Active HIV/HBV Antiretrovirals Protect Against Incident Hepatitis B Infections: Potential for Prophylaxis.

BACKGROUND ���Hepatitis-B virus (HBV) has a detrimental effect on HIV natural course, and HBV vaccination is less effective in the HIV infected. We examine the protective effect of dually active antiretroviral therapy (DAART) for HIV/HBV (Tenofovir/Lamivudine/Emtricitabine) in a large cohort encompassing heterosexuals, men-who-have-sex-with-men (MSM), and intravenous drug users (IDU), who are HIV-infected yet susceptible to HBV, with comprehensive follow-up data about risky behavior and immunological profile. METHODS ���We defined an incident HBV infection as the presence of any of HBV serological markers (HBsAg/AntiHBc/HBV-DNA) following a negative baseline AntiHBc test. Patients with positive AntiHBs were excluded. Cox proportional hazard models were utilized, with an incident case of HBV infection as the outcome variable. RESULTS ���We analyzed 1,716 eligible patients from the Swiss HIV Cohort Study with 177 incident HBV cases. DAART was negatively associated with incident HBV infection (hazard ratio 0.4, 95%CI 0.2-0.6). This protective association was robust to adjustment (0.3, 0.2-0.5) for condomless sex, ���CD4 count, drug use, and patients' demographics. Condomless sex (1.9,1.4-2.6), belonging to MSM (2.7,1.7-4.2) or IDU (3.8,2.4-6.1) were all associated with higher HBV hazard. CONCLUSIONS ���Our study suggests that DAART, independently of CD4 count and risky behavior, has a potentially strong public health impact including pre-exposure prophylaxis of HBV co-infection.

The contribution of research to Australian policy responses to heroin dependence 1990-2001: a personal retrospection

Periodic public concern about heroin use has been a major driver of Australian drug policy in the four decades since heroin use was first reported. The number of heroin-dependent people in Australia has increased from several hundreds in the late 1960s to around 100000 by the end of the 1990s. In this paper I do the following: (1) describe collaborative research on heroin dependence that was undertaken between 1991 and 2001 by researchers at the National Drug and Alcohol Research Centre: (2) discuss the contribution that this research may have made to the formulation of policies towards the treatment of heroin dependence during a period when the policy debate crystallized around the issue of whether or not Australia should conduct a controlled trial of heroin prescription; and (3) reflect on the relationships between research and policy-making in the addictions field, specifically on the roles of investigator-initiated and commissioned research, the interface between researchers, funders and policymakers: and the need to be realistic about the likely impact of research on policy and practice.

Serious adverse events in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)

Aims The study estimated serious adverse event (SAE) rates among entrants to pharmacotherapies for opioid dependence, during treatment and after leaving treatment. Design A longitudinal study based on data from 12 trials included in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Participants and settings A total of 1.244 heroin users and methadone patients treated in hospital, community and GP settings. Intervention Six trials included detoxification; all included treatment with methadone, buprenorphine, levo-alpha-acetyl-methadol (LAAM) or naltrexone. Findings During 394 person-years of observation, 79 SAEs of 28 types were recorded. Naltrexone participants experienced 39 overdoses per 100 person-years after leaving treatment (44% occurred within 2 weeks after stopping naltrexone). This was eight times the rate recorded among participants who left agonist treatment. Rates of all other SAEs were similar during treatment versus out of treatment, for both naltrexone-treated and agonist-treated participants. Five deaths occurred, all among participants who had left treatment, at a rate of six per 100 person-years. Total SAE rates during naltrexone and agonist treatments were similar (20, 14 per 100 person-years, respectively). Total SAE and death rates observed among participants who had left treatment were three and 19 times the corresponding rates during treatment. Conclusions Individuals who leave pharmacotherapies for opioid dependence experience higher overdose and death rates compared with those in treatment. This may be due partly to a participant self-selection effect rather than entirely to pharmacotherapy being protective. Clinicians should alert naltrexone treatment patients in particular about heroin overdose risks. Duty of care may extend beyond cessation of dosing.

The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia

Background: In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures. Methods: Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15 - 19 years. Results: There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15 - 19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications. Conclusion: A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.

Changes in the initiation of heroin use after a reduction in heroin supply

Increasing heroin use in Australia over the past 30 years has been associated with a decline in the age of initiation to heroin use. The 2001 Australian heroin shortage was used to assess the effects of a reduction in heroin supply on age of initiation into heroin injecting. Data collected from regular injecting drug users (IDU) over the period 1996-2004 as part of the Australian Illicit Drug Reporting System were examined for changes in self- reported age of first heroin use after the onset of the heroin shortage. Estimates were also made of the number of young people who may not have commenced injecting heroin during the heroin shortage. The proportion of IDU interviewed in the IDRS who were aged

Documenting the heroin shortage in New South Wales

Australian heroin markets have recently undergone dramatic change, sparking debate about the nature of such markets. This study aimed to determine the onset, peak and decline of the heroin shortage in New South Wales (NSW), using the most appropriate available methods to detect market level changes. The parameters of the heroin shortage were determined by reviewing: reports of heroin users about availability and price (derived from the existing literature and the Illicit Drug Reporting System); qualitative interviews with injecting drug users, and health and law enforcement professionals working in the illicit drug field; and examining data on heroin seizures over the past decade. There was a marked reduction in heroin supply in NSW in early 2001. An increase in the price of heroin occurred in 2001, whereas it had decreased steadily since 1996. A reduction in purity also occurred, as reported by drug users and heroin seizures. The peak period of the shortage appears to have been January to April 2001. The market appears to have stabilised since that time, although it has not returned to pre- 2001 levels: heroin prices have decreased in NSW for street grams, but not to former levels, and the price of `caps' (street deals) remain elevated. Heroin purity in NSW has remained low, with perhaps a 10% increase above the lowest recorded levels. These data support the notion that the heroin market in NSW underwent significant changes, which appear to have involved a lasting shift in the nature of the market.

Improvement in measures of psychological distress amongst amphetamine misusers treated with brief cognitive-behavioural therapy (CBT)

This trial of cognitive-behavioural therapy (CBT) based amphetamine abstinence program (n = 507) focused on refusal self-efficacy, improved coping, improved problem solving and planning for relapse prevention. Measures included the Severity of Dependence Scale (SDS), the General Health Questionnaire-28 (GHQ-28) and Amphetamine Refusal Self-Efficacy. Psychiatric case identification (caseness) across the four GHQ-28 sub-scales was compared with Australian normative data. Almost 90% were amphetamine-dependent (SDS 8.15 +/- 3.17). Pretreatment, all GHQ-28 sub-scale measures were below reported Australian population values. Caseness was substantially higher than Australian normative values {Somatic Symptoms (52.3%), Anxiety (68%), Social Dysfunction (46.5%) and Depression (33.7%). One hundred and sixty-eight subjects (33%) completed and reported program abstinence. Program completers reported improvement across all GHQ-28 sub-scales Somatic Symptoms (p < 0.001), Anxiety (p < 0.001), Social Dysfunction (p < 0.001) and Depression (p < 0.001)}. They also reported improvement in amphetamine refusal self-efficacy (p < 0.001). Improvement remained significant following intention-to-treat analyses, imputing baseline data for subjects that withdrew from the program. The GHQ-28 sub-scales, Amphetamine Refusal Self-Efficacy Questionnaire and the SDS successfully predicted treatment compliance through a discriminant analysis function (p

Psychosocial variables associated with the co-occurrence of risky sexual behavior with alcohol consumption among university students

This study examined the association of theoretically guided and empirically identified psychosocial variables on the co-occurrence of risky sexual behavior with alcohol consumption among university students. The study utilized event analysis to determine whether risky sex occurred during the same event in which alcohol was consumed. Relevant conceptualizations included alcohol disinhibition, self-efficacy, and social network theories. Predictor variables included negative condom attitudes, general risk taking, drinking motives, mistrust, social group membership, and gender. Factor analysis was employed to identify dimensions of drinking motives. Measured risky sex behaviors were (a) sex without a condom, (b) sex with people not known very well, (c) sex with injecting drug users (IDUs), (d) sex with people without knowing whether they had a STD, and (e) sex with using drugs. A purposive sample was used and included 222 male and female students recruited from a major urban university. Chi-square analysis was used to determine whether participants were more likely to engage in risky sex behavior in different alcohol use contexts. These contexts were only when drinking, only when not drinking, and when drinking or not. The chi-square findings did not support the hypothesis that university students who use alcohol with sex will engage in riskier sex. These results added to the literature by extending other similar findings to a university student sample. For each of the observed risky sex behaviors, discriminant analysis methodology was used to determine whether the predictor variables would differentiate the drinking contexts, or whether the behavior occurred. Results from discriminant analyses indicated that sex with people not known very well was the only behavior for which there were significant discriminant functions. Gender and enhancement drinking motives were important constructs in the classification model. Limitations of the study and implications for future research, social work practice and policy are discussed. ^

Interactive Effects of Morphine on HIV Infection: Role in HIV-Associated Neurocognitive Disorder

HIV epidemic continues to be a severe public health problem and concern within USA and across the globe with about 33 million people infected with HIV. The frequency of drug abuse among HIV infected patients is rapidly increasing and is another major issue since injection drug users are at a greater risk of developing HIV associated neurocognitive dysfunctions compared to non-drug users infected with HIV. Brain is a major target for many of the recreational drugs and HIV. Evidences suggest that opiate drug abuse is a risk factor in HIV infection, neural dysfunction and progression to AIDS. The information available on the role of morphine as a cofactor in the neuropathogenesis of HIV is scanty. This review summarizes the results that help in understanding the role of morphine use in HIV infection and neural dysfunction. Studies show that morphine enhances HIV-1 infection by suppressing IL-8, downregulating chemokines with reciprocal upregulation of HIV coreceptors. Morphine also activates MAPK signaling and downregulates cAMP response element-binding protein (CREB). Better understanding on the role of morphine in HIV infection and mechanisms through which morphine mediates its effects may help in devising novel therapeutic strategies against HIV-1 infection in opiate using HIV-infected population.

Psychosocial variables associated with the co-occurance of risky sexual behavior with alcohol consumption among university students

This study examined the association of theoretically guided and empirically identified psychosocial variables on the co-occurrence of risky sexual behavior with alcohol consumption among university students. The study utilized event analysis to determine whether risky sex occurred during the same event in which alcohol was consumed. Relevant conceptualizations included alcohol disinhibition, self-efficacy, and social network theories. Predictor variables included negative condom attitudes, general risk taking, drinking motives, mistrust, social group membership, and gender. Factor analysis was employed to identify dimensions of drinking motives. Measured risky sex behaviors were (a) sex without a condom, (b) sex with people not known very well, (c) sex with injecting drug users (IDUs), (d) sex with people without knowing whether they had a STD, and (e) sex with using drugs. A purposive sample was used and included 222 male and female students recruited from a major urban university. Chi-square analysis was used to determine whether participants were more likely to engage in risky sex behavior in different alcohol use contexts. These contexts were only when drinking, only when not drinking, and when drinking or not. The chi-square findings did not support the hypothesis that university students who use alcohol with sex will engage in riskier sex. These results added to the literature by extending other similar findings to a university student sample. For each of the observed risky sex behaviors, discriminant analysis methodology was used to determine whether the predictor variables would differentiate the drinking contexts, or whether the behavior occurred. Results from discriminant analyses indicated that sex with people not known very well was the only behavior for which there were significant discriminant functions. Gender and enhancement drinking motives were important constructs in the classification model. Limitations of the study and implications for future research, social work practice and policy are discussed.

Sexual risk behaviors and HIV risk among Americans aged 50 years or older: a review.

Although HIV-related sexual risk behaviors have been studied extensively in adolescents and young adults, there is limited information about these behaviors among older Americans, which make up a growing segment of the US population and an understudied population. This review of the literature dealing with sexual behaviors that increase the risk of becoming HIV-infected found a low prevalence of condom use among older adults, even when not in a long-term relationship with a single partner. A seminal study by Schick et al published in 2010 reported that the prevalence of condom use at last intercourse was highest among those aged 50-59 years (24.3%; 95% confidence interval, 15.6-35.8) and declined with age, with a 17.1% prevalence among those aged 60-69 years (17.1%; 95% confidence interval, 7.3-34.2). Studies have shown that older Americans may underestimate their risk of becoming HIV-infected. Substance use also increases the risk for sexual risk behaviors, and studies have indicated that the prevalence of substance use among older adults has increased in the past decade. As is the case with younger adults, the prevalence of HIV infections is elevated among ethnic minorities, drug users (eg, injection drug users), and men who have sex with men. When infected, older adults are likely to be diagnosed with HIV-related medical disorders later in the course of illness compared with their younger counterparts. Physicians are less likely to discuss sexual risk behaviors with older adults and to test them for HIV compared with younger adults. Thus, it is important to educate clinicians about sexual risk behaviors in the older age group and to design preventive interventions specifically designed for older adults.

The Impact of Marijuana Use on Memory in Patients with HIV/AIDS

<p>The most robust neurocognitive effect of marijuana use is memory impairment. Memory deficits are also high among persons living with HIV/AIDS, and marijuana use among this population is disproportionately common. Yet research examining neurocognitive outcomes resulting from co-occurring marijuana and HIV is virtually non-existent. The primary aim of this case-controlled study was to identify patterns of neurocognitive impairment among HIV patients who used marijuana compared to HIV patients who did not use drugs by comparing the groups on domain T-scores. Participants included 32 current marijuana users and 37 non-drug users. A comprehensive battery assessed substance use and neurocognitive functioning. Among the full sample, marijuana users performed significantly worse on verbal memory tasks compared to non-drug users and significantly better on attention/working memory tasks. A secondary aim of this study was to test whether the effect of marijuana use on memory was moderated by HIV disease progression, but these models were not significant. This study also examined whether the effect of marijuana use was differentially affected by marijuana use characteristics, finding that earlier age of initiation was associated with worse memory performance. These findings have important clinical implications, particularly given increased legalization of this drug to manage HIV infection.</p>

Percep����es de adolescentes usu��rios de drogas acerca da depend��ncia qu��mica

Este estudo objetivou conhecer a percep����o de adolescentes usu��rios de drogas atendidos no CAPS ad no munic��pio do Rio Grande acerca da depend��ncia qu��mica.Tratou-se de uma pesquisa com abordagem qualitativa realizada no primeiro semestre de 2012 no CAPS ad do munic��pio do Rio Grande/ RS, com oito adolescentes usu��rios de drogas. Os dados foram coletados atrav��s de entrevistas semiestruturadas e analisados pelo m��todo de Discurso do Sujeito Coletivo. Os dados do estudo mostraram que as principais causas apontadas pelos adolescentes para o in��cio do uso de drogas foram �� curiosidade, a imaturidade e a ingenuidade; a influ��ncia dos amigos e a vontade de pertencer a um grupo, de n��o ser diferente de seus pares; acharem que se muitos ��s utilizam estas devem ser boas; conviver com usu��rios de drogas no seu ambiente de consumo e a dificuldade de enfrentar perdas e a desestrutura����o familiar. Evidenciou-se que a droga apresenta-se como fonte de al��vio para a tristeza e o desamparo sentido. As principais consequ��ncias do uso de drogas foram desgra��a, tristeza e muitas coisas ruins; alguns se sentem fortes, poderosos e rebeldes, desestrutura����o familiar, interrup����o do processo de escolariza����o e marginaliza����o. Os principais fatores de risco para o uso de drogas na adolesc��ncia s��o a falta de informa����es, o n��o acreditar nos malef��cios das drogas e nas consequ��ncias negativas destas em suas vidas, ver outro usu��rio falando ou consumindo a droga e conviver com usu��rios de drogas no seu ambiente de consumo, ser assediado por traficantes que lhes oferecem a droga e insistem para que a consumam, morar com uma fam��lia em que o uso de drogas est�� naturalizado, perceber a droga como uma coisa boa e fonte de al��vio e vivenciar situa����es de raiva extrema e de perda de controle. Verificou-se como fatores de prote����o a vontade de parar de usar drogas, a busca de ajuda por parte dos familiares, a exist��ncia dos Servi��os de Aten����o aos usu��rios, do Conselho Tutelar e do Juizado da Inf��ncia e da Adolesc��ncia. Verificou-se como Influ��ncia do v��nculo familiar para o uso de drogas na adolesc��ncia a falta de atitude dos pais ao saberem do uso de drogas de seus filhos. Os familiares percebem que o adolescente est�� fazendo uso de drogas por seu aspecto f��sico e diante de suas atitudes agressivas. Muitos adolescentes convivem com o uso de drogas por seus familiares desde a inf��ncia. Possuem como expectativas e projetos de vida: retomar os estudos, arrumar um emprego e ter uma profiss��o, construir uma fam��lia, tornar-se motivo de orgulho para seus pais, mudar sua hist��ria de vida, realizar um tratamento e parar de usar drogas, se desintoxicar e se reinserir na sociedade, reconquistando a confian��a e respeito das pessoas com quem convive, viver pelo menos at�� passar dos 18 anos de idade. concluiu-se que adolesc��ncia �� uma etapa vulner��vel, em que o jovem enfrenta mudan��as pessoais, familiares e sociais. Dessa forma a fam��lia, professores e profissionais da sa��de precisam saber como lidar com os conflitos vividos pelos adolescentes de forma a fornecer suporte com vistas a minimiz��-los. O conhecimento constru��do com este estudo poder�� nos possibilitar um novo olhar para os transtornos relacionados ao uso de drogas na adolesc��ncia, auxiliando na elabora����o de estrat��gias de preven����o e tratamento mais efetivo.

Hepatitis B and C prevalence in Portugal: disparity between the general population and high-risk groups

Background and aims: The prevalence of anti-HCV and HBsAg in Portugal has been shown to be elevated in high-risk groups, such as intravenous drug-users and incarcerated individuals. However, in the general population, prevalence remains largely unknown. The aims of this study were to estimate the prevalence of anti-HCV and HBsAg in the general Portuguese population and identify associated risk factors. Materials and methods: We carried out a nationwide, population-based cross-sectional study of adults resident in mainland Portugal. Serology for HBsAg, anti-HBc, anti-HBs, and anti-HCV was performed. Anti-HCV-positive individuals were tested for HCV RNA by PCR. Results: Of 1685 participants, 50.6% were men, mean age 50.2��18.3 years. In terms of hepatitis C, the prevalence of anti-HCV was 0.54% [95% confidence interval (CI): 0.2���0.9] and 0.12% (95% CI: 0.0���0.3) were viremic, with peak prevalence among individuals 35���64 years of age (0.8%), men (0.8%), and individuals from Lisbon and Tagus Valley region (1.9%). In terms of hepatitis B, the estimated prevalence of HBsAg was 1.45% (95% CI: 0.9���2.0). A higher prevalence was found in individuals who were 35���64 years old (2.2%), in men (2.5%), and in the Northern region (2.6%). The presence of positive serological markers of hepatitis C virus and hepatitis B virus infection did not correlate with elevated aminotransferases, race, place of birth, and alcohol consumption. Conclusion: These results suggest a low endemicity for both hepatitis B and hepatitis C in the general population, in contrast to a very high prevalence in risk groups, thus suggesting that targeted screening to high-risk groups may be more cost-effective than general population screening.