Vinculação do Adulto e Sistema Comportamental de Prestação de Cuidados em Toxicodependentes integrados em Comunidade Terapêutica e em Programa de Metadona

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

“Adaptação à vida”: A gravidez na toxicodependência e o V.I.H./S.I.D.A.

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Crenças, atitudes e comportamentos de saúde e de risco de adictos em comunidades terapêuticas

Os comportamentos de saúde e de risco são comuns em toxicodependentes. Este trabalho foi conduzido no âmbito da análise descritiva da amostra, nomeadamente, caracterização sócio-demográfica e variáveis cognitivas, seguindo-se um segundo objectivo que consistiu na descrição dos comportamentos, crenças e atitudes face à saúde que os adictos apresentam. A amostra é constituída por 75 sujeitos, do sexo masculino, com uma média de idade de 34,07 anos. A metodologia utilizada caracteriza o estudo de quantitativo-correlacionai, uma vez que se pretende efectuar a descrição das características da amostra e os comportamentos de saúde e de risco que apresentam. Os resultados revelam que os adictos apresentam comportamentos de risco, logo, são menores os comportamentos de saúde adoptados durante os consumos. É necessário intervir nas várias áreas de saúde do adicto, nomeadamente, nas práticas sexuais, na prevenção de doenças, nos cuidados alimentares, na conduta rodoviária e na preocupação com o exercício físico-desportivo. /ABSTRACT: Health behaviors and risk factors are common in drug addicts. This work was conducted under the descriptive analysis, including socio-demographic and cognitive variables, followed by a second objective was to describe the altitudes, beliefs and altitudes towards health that addicts have. The sample consists of 75 subjects were mala, with a mean age of 34.07 years. The methodology characterizes the quantitative and correlational study, since we intend to perform the description of sample characteristics and health behaviors and risk they present. The results show that addicts exhibit risky behavior, so they are smaller health behaviors adopted during the intake. lt is necessary to intervene in several areas of health of the addict, including sexual practices, disease prevention, care food, conduct road and the concern that physical exercise I sports.

Delito y enfermedad mental: consumo de sustancias legales e ilegales

 Resumen  Palabras clave: drogas, psiquiatrización, medicalización, control social.AbstractThe article addresses the connections between medicalization and the prosecution of the consumption of substances called narcotics and their effects on the subject- a subject who, at the same time, is entitled to rights. Through the examination of six judicial warrants for compulsory admissions to a "psychiatric colony", the working of the interconnection between legal and psychiatric practices is analyzed. What is also analysed are the effects such interconnection has on the construction of a broader spectrum of action and intervention, both of the judiciary and the medical practices, beyond the framework of the statutory regulations upon which such admissions are based. From the examined material two main aspects come to light: firstly, the medical and mental-health arguments from which decisions about psychiatric hospital admissions in drug or alcohol abuse cases will be made. Secondly, there is also an indication of the purpose or objective of such hospital admissions. This paper also deals with the processes that Foucault calls "indefinite medicalization « and the real productions that go beyond therapeutic aspects, relating the effects of the former with the workings of the control of subjects through the different diagnoses categories of addicts, be it alcoholics or drug addicts.Keywords: drug, psychiatrization, medicalization, social control. 

Safety and efficacy of drug-eluting stents in women: a patient-level pooled analysis of randomised trials

BACKGROUND The safety and efficacy of drug-eluting stents (DES) in the treatment of coronary artery disease have been assessed in several randomised trials. However, none of these trials were powered to assess the safety and efficacy of DES in women because only a small proportion of recruited participants were women. We therefore investigated the safety and efficacy of DES in female patients during long-term follow-up. METHODS We pooled patient-level data for female participants from 26 randomised trials of DES and analysed outcomes according to stent type (bare-metal stents, early-generation DES, and newer-generation DES). The primary safety endpoint was a composite of death or myocardial infarction. The secondary safety endpoint was definite or probable stent thrombosis. The primary efficacy endpoint was target-lesion revascularisation. Analysis was by intention to treat. FINDINGS Of 43,904 patients recruited in 26 trials of DES, 11,557 (26·3%) were women (mean age 67·1 years [SD 10·6]). 1108 (9·6%) women received bare-metal stents, 4171 (36·1%) early-generation DES, and 6278 (54·3%) newer-generation DES. At 3 years, estimated cumulative incidence of the composite of death or myocardial infarction occurred in 132 (12·8%) women in the bare-metal stent group, 421 (10·9%) in the early-generation DES group, and 496 (9·2%) in the newer-generation DES group (p=0·001). Definite or probable stent thrombosis occurred in 13 (1·3%), 79 (2·1%), and 66 (1·1%) women in the bare-metal stent, early-generation DES, and newer-generation DES groups, respectively (p=0·01). The use of DES was associated with a significant reduction in the 3 year rates of target-lesion revascularisation (197 [18·6%] women in the bare-metal stent group, 294 [7·8%] in the early-generation DES group, and 330 [6·3%] in the newer-generation DES group, p<0·0001). Results did not change after adjustment for baseline characteristics in the multivariable analysis. INTERPRETATION The use of DES in women is more effective and safe than is use of bare-metal stents during long-term follow-up. Newer-generation DES are associated with an improved safety profile compared with early-generation DES, and should therefore be thought of as the standard of care for percutaneous coronary revascularisation in women. FUNDING Women in Innovation Initiative of the Society of Cardiovascular Angiography and Interventions.

Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women.

Safety and Efficacy of New-Generation Drug-Eluting Stents in Women at High Risk for Atherothrombosis: From the Women in Innovation and Drug-Eluting Stents Collaborative Patient-Level Pooled Analysis

BACKGROUND The safety and efficacy of new-generation drug-eluting stents (DES) in women with multiple atherothrombotic risk (ATR) factors is unclear. METHODS AND RESULTS We pooled patient-level data for women enrolled in 26 randomized trials. Study population was categorized based on the presence or absence of high ATR, which was defined as having history of diabetes mellitus, prior percutaneous or surgical coronary revascularization, or prior myocardial infarction. The primary end point was major adverse cardiovascular events defined as a composite of all-cause mortality, myocardial infarction, or target lesion revascularization at 3 years of follow-up. Out of 10 449 women included in the pooled database, 5333 (51%) were at high ATR. Compared with women not at high ATR, those at high ATR had significantly higher risk of major adverse cardiovascular events (15.8% versus 10.6%; adjusted hazard ratio: 1.53; 95% confidence interval: 1.34-1.75; P=0.006) and all-cause mortality. In high-ATR risk women, the use of new-generation DES was associated with significantly lower risk of 3-year major adverse cardiovascular events (adjusted hazard ratio: 0.69; 95% confidence interval: 0.52-0.92) compared with early-generation DES. The benefit of new-generation DES on major adverse cardiovascular events was uniform between high-ATR and non-high-ATR women, without evidence of interaction (Pinteraction=0.14). At landmark analysis, in high-ATR women, stent thrombosis rates were comparable between DES generations in the first year, whereas between 1 and 3 years, stent thrombosis risk was lower with new-generation devices. CONCLUSIONS Use of new-generation DES even in women at high ATR is associated with a benefit consistent over 3 years of follow-up and a substantial improvement in very-late thrombotic safety.

Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments

Objective: To evaluate an experimental heroin maintenance programme.

Women & drug abuse : you and your community can help.

"Printed 1994"--P. [12].

Missing links : coordinating federal drug policy for women, infants, and children : hearing before the Committee on Governmental Affairs, United States Senate, One Hundred First Congress, first session, July 31, 1989.

Shipping list no.: 90-200-P.

Specialized therapeutic community program for female addicts /

Mode of access: Internet.

Advancing the agenda for recovery : specialized alcohol and drug treatment services for women : plan years 2007-2011.

"December 20, 2006."--Cover letter.

Women's treatment services -- reshaping the landscape : specialized alcohol and drug treatment services for women, plan years 2011-2013 /

"1/10."--Colophon.