The Effects of American Sign Language on General Self- Efficacy and Anxiety Among Mothers in a Residential Rehabilitation Facility for Drug Addiction and Substance Abuse

Globally, approximately 208 million people aged 15 and older used illicit drugs at least once in the last 12 months; 2 billion consumed alcohol and tobacco consumption affected 25% (World Drug Report, 2008). In the United States, 20.1 million (8.0%) people aged 12 and older were illicit drug users, 129 million (51.6%) abused alcohol and 70.9 million (28.4%) used tobacco (SAMHSA/OAS, 2008).Usually considered a problem specific to men (Lynch, 2002), 5.2% of pregnant women aged 15 to 44 are also illicit drug and substance abusers (SAMHSA/OAS, 2007). During pregnancy, illicit drugs and substance abuse (ID/SA) can significantly affect a woman and her infant contributing to developmental and communication delays for the infant and influencing parenting abilities (Budden, 1996; March of Dimes, 2006b; Rossetti, 2000). Feelings of guilt and shame and stressful experiences influence approaches to parenting (Ashley, Marsden, & Brady, 2003; Brazelton, & Greenspan, 2000; Ehrmin, 2000; Johnson, & Rosen, 1990; Kelley, 1998; Rossetti, 2000; Velez et al., 2004; Zickler, 1999). Parenthood is an expanded role that can be a trying time for those lacking a sense of self-efficacy and creates a high vulnerability to stress (Bandura, 1994). Residential treatment programs for ID/SA mothers and their children provide an excellent opportunity for effective interventions (Finkelstein, 1994; Social Care Institute for Excellence, 2005). This experimental study evaluated whether teaching American Sign Language (ASL) to mothers living with their infants/children at an ID/SA residential treatment program increased the mothers’ self-efficacy and decreased their anxiety. Quantitative data were collected using the General Self-Efficacy Scale and the State-Trait Anxiety Inventory showing there was both a significant increase in self efficacy and decrease in anxiety for the mothers. This research adds to the knowledge base concerning ID/SA mothers’ caring for their infants/children. By providing a simple low cost program, easily incorporated into existing rehabilitation curricula, the study helps educators and healthcare providers better understand the needs of the ID/SA mothers. This study supports Bandura’s theory that parents who are secure in their efficacy can navigate through the various phases of their child’s development and are less vulnerable to stress (Bandura, 1994).

Território, Criminalidade e tráfico de drogas ilícitas em Montes Claros/MG

Urban violence, manifestly public and free, has changed the standard of sociability of townspeople. The city is an increasingly private space of hopes of reducing the risk of victimization, due to the fear of violence that separates and distances the classes in expectation of concealing this behavior. However, violence has many facets and, in one way or another, will always be present as a product of social friction. It is in the urban context and using drug trafficking as a backdrop that this work raises questions about the territorial violence in Montes Claros - MG. The objective was to analyze the dynamics of illicit drug trafficking from the concepts of territory, observing to what extent the appropriation of space contributes to the use of violence, especially in interpersonal disputes. Methodologically, it seeks from quantitative and qualitative techniques make the spatial distribution of criminal indicators, defining and creating hierarchy territories of violence in urban areas. From the qualitative approach seeks to organize and analyze data together to the Civil and Military Police, Brazilian Institute of Geography and Statistics -IBGE, João Pinheiro Foundation and the System of the Ministry of Health Mortality Information - SIM. The opportunity of miscegenation between the knowledge of the survey respondents and the official data has introduced qualitative part. The city of Montes Claros has been taken as an object of observation due to a set of conditions, which stood its medium size, your importance in the regional context and their socioeconomic disparities. The results point to the existence of multiple territoriality of violence involving the trafficking of illicit drugs in urban space. Territorial disputes by the traffickers have victimized people with socioeconomic characteristics and urban spatial origin similar. The dynamism of the established boundaries from the cohesion and / or rupture of the interests of those involved creates and destroys territories in the power struggle.

Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users

Article

Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users

Article

Militância, organização e mobilização antiproibicionista da maconha: coletivos, eventos e marchas em Natal (RN)

Based on the proposal entitled anti-prohibitionist, contrary to prohibition and illegality of cannabis and its use, the anti-prohibitionist Collectives proposes to discuss the topic of drugs, especially marijuana, aiming decriminalization and legalization of this psychoactive. With this idea was articulated anti-prohibitionist movement in Natal, by organizing collectives that discuss issues related to drug use and conduct activities directed to this issue, such as Marijuana Marches and Cycles of Debates anti-prohibitionist. In this study we sought to understand the positioning in social and cultural terms, the marijuana users participating of the collectives, on the situation of illegality of their actions, in front of social, legal and moral question involved in the illicit psychoactive, through initiatives conferences, events and demonstrations for this purpose

Militância, organização e mobilização antiproibicionista da maconha: coletivos, eventos e marchas em Natal (RN)

Based on the proposal entitled anti-prohibitionist, contrary to prohibition and illegality of cannabis and its use, the anti-prohibitionist Collectives proposes to discuss the topic of drugs, especially marijuana, aiming decriminalization and legalization of this psychoactive. With this idea was articulated anti-prohibitionist movement in Natal, by organizing collectives that discuss issues related to drug use and conduct activities directed to this issue, such as Marijuana Marches and Cycles of Debates anti-prohibitionist. In this study we sought to understand the positioning in social and cultural terms, the marijuana users participating of the collectives, on the situation of illegality of their actions, in front of social, legal and moral question involved in the illicit psychoactive, through initiatives conferences, events and demonstrations for this purpose

Risk Factors and Associations for Hepatitis C Infection among Hispanic/Latino Intravenous Drug Users in Miami-Dade County, Florida

Hepatitis C infection (HCV) continues to disproportionately affect Hispanics/Latinos in the United States. Hispanic/Latino intravenous drug users (IDUs), because of their risky injection and sexual behaviors, are prone to HCV infection and rapid transmission of the virus to others via several routes. With a prevalence rate of approximately 75% among IDUs, it is imperative that transmission of HCV be prevented in this population. This study aims to examine the associations between demographic, injection and sexual risk factors to HCV infection in a group Hispanic/Latino IDUs in Miami-Dade County, Florida. Preliminary unadjusted results in this sample reveal that age (OR=4.592, p=0.004), weekly injection (OR=5.171, p=0.000), daily injection frequency (OR=3.856, p=0.000) and use of a dirty needle (OR=2.320, p= 0.006) were all significantly associated with HCV infection. Being born outside the U.S. was significantly negatively associated with HCV infection (OR=0.349, p=0.004). Additionally, having two or more sex partners in the past three months (OR=0.472, p=0.014) was negatively associated with HCV infection. After adjusting for all other variables, older age (AOR=7.470, p=0.006), weekly injection (AOR=3.238, p=0.007) and daily injection frequency (AOR=2.625, p=0.010) were all significantly associated with HCV infection. Being born outside the U.S. (AOR=0.369, p=0.019) was a significant protective factor for HCV infection, along with having two or more sex partners in the past three months (AOR=0.481, p=0.037). When analyzing the significant variables in a backward regression model, having 2 or more sex partners in the past three months was not significant at the p

Effect of the Supplemental Nutrition Assistance Program (SNAP) and Nutrition Education on Nutrition and Health Outcomes of HIV+ Individuals

Factors associated with and barriers to participation in Supplemental Nutrition Assistance Program (SNAP) and the effect participation has on food security, nutrition status, disease status and quality of life was investigated in a cross-sectional study including 175 HIV infected individuals. In addition, the effect of a targeted nutrition education on nutrition knowledge, readiness to dietary behavior change, nutrition status, disease status and quality of life was also investigated among a subset of the population (N = 45) in a randomized clinical control trial. SNAP participation rate was 70.3%, similar to the State of Florida and national participation rates. SNAP participation was positively and independently associated with being born in the US (P < 0.001), having monthly income less than $1000 (P = 0.006), and receiving antiretroviral treatment (P < 0.001). Participation barriers include denial of participation by program, recent incarceration, living in a shelter where participation is not allowed and unawareness of eligibility status. In regression analyses, SNAP participation was not significantly associated with improved food security, nutrition status, disease status and health related quality of life (HRQOL). Over half (56%) of the population experienced food insecurity and had inadequate intakes of half of the nutrients assessed. Illicit drug, alcohol and cigarette use were high in this population (31%, 55% and 63% respectively), and affected food security, nutrients intake, disease status and HRQOL. The nutrition education intervention resulted in a trend towards improvements nutrition knowledge, self-efficacy, and readiness to change without impacting nutrition status, disease state and quality of life. Food insecurity and other nutrition related issues, with implications for treatment, management and cost of HIV disease, continue to plague infected individuals living in poverty. More resources, including food and nutrition programs, specifically targeted towards this population are needed to address these issues.

Manifestações orais associadas ao consumo da droga de abuso MDMA

O uso para fins ou meios festivos de lazer da droga ilícita MDMA, também chamado de Ecstasy ou Moly, tem vindo a aumentar drasticamente em Portugal e no Mundo. Esta situação desafia os profissionais de saúde para vários parâmetros na saúde oral e geral. O objetivo desta dissertação visa avaliar e descrever as lesões e patologias na cavidade oral que estão relacionadas com o consumo da substância ilícita MDMA. As consequências para a cavidade oral podem ser a xerostomia, o bruxismo, as cáries rampantes, a doença periodontal, o desgaste e a erosão dentária, e as lesões dos tecidos moles. Os indivíduos consumidores podem apresentar carências nutricionais e um estímulo aumentado à dor. A gestão do prognóstico e o tratamento realizado aos consumidores de MDMA, pois afeta vários órgãos e sistemas no corpo humano, requer uma abordagem multidisciplinar que inclui educação, prevenção e tratamento integrados. Esta revisão bibliográfica teve com base artigos publicados em revistas científicos e monografias disponíveis em vários motores de busca. As palavras-chave usadas foram: “ecstasy”, “MDMA”, “oral manifestations”, “oral health”, “substance abuse”, ”overdose treatment”, “xerostomia” e “methamenfetamine” e a sua conjugação. As situações orais, perante as mais prevalentes comorbidades patogénicas relacionadas com o MDMA e outras dependências ilícitas, necessitam de mais atenção e reforço em relação à prática clínica e aos serviços de saúde. Uma das dificuldades para o tratamento correto destes indivíduos é a falta de informação sobre o assunto referente à prática na clínica dentária. A omissão sobre o consumo por parte do paciente bem como de uma recaída no uso, apresentam dúvidas sobre o fator em causa ou até mesmo no diagnóstico. São, muitas vezes, os Médicos Dentistas os primeiros a terem a oportunidade de diagnosticar o aparecimento de possíveis alterações surgidas em virtude do consumo de MDMA.

Viral hepatitis in patients infected with human immunodeficiency virus

From 1992 to 1995 we studied 232 (69% male, 87% Caucasian) anti-human immunodeficiency virus (anti-HIV) positive Brazilian patients, through a questionnaire; HIV had been acquired sexually by 50%, from blood by 32%, sexually and/or from blood by 16.4% and by an unknown route by 1.7%. Intravenous drug use was reported by 29%; it was the most important risk factor for HIV transmission. The alanine aminotransferase quotient (qALT) was >1 for 40% of the patients, 93.6% had anti-hepatitis A virus antibody, 5.3% presented hepatitis B surface antigen, 44% were anti-hepatitis B core antigen positive and 53.8% were anti-hepatitis C virus (anti-HCV) positive. The anti-HCV test showed a significant association with qALT>1. Patients for whom the probable HIV transmission route was blood had a 10.8 times greater risk of being anti-HCV positive than patients infected by other routes. Among 30 patients submitted to liver biopsy, 18 presented chronic hepatitis.

Elevated Risk for HIV-1 Infection in Adolescents and Young Adults in São Paulo, Brazil

Background. Recent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. Methodology/Principal Findings Subjects were identified from 2002-2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in <25 and >59 years-old age strata (p<0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis. ) Conclusions/Significance In this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratum

Inquérito de saúde: comparação dos entrevistados segundo posse de linha telefônica residencial

Analisar diferenças quanto a características sociodemográficas e relacionadas à saúde entre indivíduos com e sem linha telefônica residencial. Foram analisados os dados do Inquérito de Saúde (ISA-Capital) 2003, um estudo transversal realizado em São Paulo, SP, no mesmo ano. Os moradores que possuíam linha telefônica residencial foram comparados com os que disseram não possuir linha telefônica, segundo as variáveis sociodemográficas, de estilo de vida, estado de saúde e utilização de serviços de saúde. Foram estimados os vícios associados à não-cobertura por parte da população sem telefone, verificando-se sua diminuição após a utilização de ajustes de pós-estratificação. Dos 1.878 entrevistados acima de 18 anos, 80,1% possuía linha telefônica residencial. Na comparação entre os grupos, as principais diferenças sociodemográficas entre indivíduos que não possuíam linha residencial foram: menor idade, maior proporção de indivíduos de raça/cor negra e parda, menor proporção de entrevistados casada, maior proporção de desempregados e com menor escolaridade. Os moradores sem linha telefônica residencial realizavam menos exames de saúde, fumavam e bebiam mais. Ainda, esse grupo consumiu menos medicamentos, auto-avaliou-se em piores condições de saúde e usou mais o Sistema Único de Saúde. Ao se excluir da análise a população sem telefone, as estimativas de consultas odontológicas, alcoolismo, consumo de medicamentos e utilização do SUS para realização de Papanicolaou foram as que tiveram maior vício. Após o ajuste de pós-estratificação, houve diminuição do vício das estimativas para as variáveis associadas à posse de linha telefônica residencial. ) A exclusão dos moradores sem linha telefônica é uma das principais limitações das pesquisas realizadas por esse meio. No entanto, a utilização de técnicas estatísticas de ajustes de pós-estratificação permite a diminuição dos vícios de não cobertura

Elevated Risk for HIV-1 Infection in Adolescents and Young Adults in Sao Paulo, Brazil

Background. Recent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. Methodology/Principal Findings. Subjects were identified from 2002-2004 at four testing sites in Sao Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in,25 and >59 years-old age strata (p < 0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis. Conclusions/Significance. In this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in Sao Paulo and preventive approaches should, therefore, target this age stratum.

Evaluation of pharmacotherapy on elderly residents of nursing homes in the north-east of Brazil

Data related to medication order and the use of medications was collected from 94 elderly medical records of two nursing homes of Aracaju (SE), The mean age was 83.2 (SD = 10.1), with most belonging to the females (63.8%). The prevalence of the use of drugs was 87.2% and the average of medicines consumed was equal to 2.7 (SD = 1.8), mainly with action in the cardiovascular and nervous systems. In this Study, the elderly population studied presented polypharmacy (18.1%), inappropriate use of drugs (28.7%) and double therapy (11.7%). Data showed the need for improvement and evaluation of the quality of pharmacotherapy to promote rational drug use in the elderly population.

The Swiss heroin trials: testing alternative approaches

Over half a million heroin misusers receive oral methadone maintenance treatment world-wide1 but the maintenance prescription of injectable opioid drugs, like heroin, remains controversial. In 1992 Switzerland began a large scale evaluation of heroin and other injectable opiate prescribing that eventually involved 1035 misusers. 2 3 The results of the evaluation have recently been reported.4 These show that it was feasible to provide heroin by intravenous injection at a clinic, up to three times a day, for seven days a week. This was done while maintaining good drug control, good order, client safety, and staff morale. Patients were stabilised on 500 to 600 mg heroin daily without evidence of increasing tolerance. Retention in treatment was 89% at six months and 69% at 18 months.4 The self reported use of non-prescribed heroin fell signifianctly, but other drug use was minimally affected. The death rate was 1% per year, and there were no deaths from overdose among participants . . . [Full text of this article]