Programa de prevención del consumo de drogas Saluda: evaluación de una nueva versión en adolescentes españoles

En la actualidad se han evaluado numerosas intervenciones preventivas de drogodependencias en el medio escolar. Sin embargo, en España son pocos los estudios que analizan la influencia precisa de cada uno de los componentes específicos a los programas con el fin de determinar cuáles se consideran cruciales para el cambio de conducta de consumo. El objetivo del presente estudio fue evaluar los efectos de una nueva versión del programa de prevención del consumo de drogas Saluda en la que se prescinde del componente fomento del ocio saludable y las tareas para casa. Esta versión reducida fue dirigida a una muestra de 106 escolares (44.6 % chicos) entre 14 y 17 años (M = 15.20; DT = 0.92) de un centro de Educación Secundaria. Se trata de un estudio exploratorio de tipo cuasi experimental y un diseño pre-post de un único grupo. Se realizó diferencia de proporciones mediante la prueba Z y diferencia de medias mediante la prueba T para muestras relacionadas. Los resultados muestran una reducción en el porcentaje de episodios de embriaguez, así como un efecto de mejora significativa sobre las variables protectoras del consumo. Se discuten estos hallazgos y se realizan propuestas para la mejora de futuras intervenciones.

NUTRITION AND HEALTH STATUS OF HIV-INFECTED ADULTS ON ARVS AT AMREF CLINIC KIBERA URBAN SLUM, KENYA

The health of people living with HIV and AIDS (PLWHA) is nutritionally challenged in many nations of the world. The scourge has reduced socio-economic progress globally and more so in sub-Saharan Africa (SSA) where its impact has been compounded by poverty and food insecurity. Good nutrition with proper drug use improves the quality of life for those infected but it is not known how PLWHA exposed to chronic malnutrition and food shortages from developing nations adjust their nutrition with use of Anti-Retro-viral Drugs (ARVs). This study assessed nutritional status, dietary practices, and dietary management of common illnesses that hinder daily food intake by the patients and use of ARVs with food recommendations provided by the health care givers. A descriptive case study design was used to sample 120 HIV-infected patients using systematic sampling procedure. These patients sought health care from an urban slum, Kibera AMREF clinic. Data were collected by anthropometric measurements, bio-chemical analysis, semi-structured questionnaire and secondary data. The Statistical Package for Social Sciences (SPSS) and the Nutri-Survey software packages were used to analyze data. Dietary intakes of micro-nutrients were inadequate for >70% of the patients when compared to the Recommended Daily Requirements. When Body Mass Indices (BMI) were used, only 6.7% of the respondents were underweight (BMI<18.5kg/m2) and 9.2% were overweight (BMI> 25kg/m2), serum albumin test results (mean 3.34±0.06g/dl) showed 60.8% of the respondents were protein deficient and this was confirmed by low dietary protein intakes. The BMI was not related to dietary nutrient intakes, serum albumin and CD4 cell counts (p>0.05). It appeared that there was no significant difference in BMI readings at different categories of CD4 cell count (p>0.05) suggesting that the level of immunity did not affect weight gain with ARV as observed in many studies from developed countries. Malnutrition was, therefore, evident among the 60.8% of the cases as identified by serum albumin tests and food intake was not adequate (68%) for the patients as they ate once a day due to lack of food. National food and nutrition policy should incorporate food security boosting guidelines for the poor people infected with HIV and using ARVs.

Sociabilidades e hedonismos: etnografia entre jovens usuários de substâncias psicoativas sintéticas Fortaleza Ceará

This dissertation shows a comparison between practices related to the body, to identities and to the health of young drug takers of synthetic and manipulated psychoactive substances living in Fortaleza. Through ethnographic accompaniment of parties and two social nets of young people I was able to verify the differences and similarities that make these addicted singular and plural in their notion of ethos and world vision. Notions of being hippie/alternative and being punk are present between these nets. Because their use and circulation are developed in environments usually distinct, it is possible to trace singular aspects between the nets and its actions. In parallel, on the attempt to build a triangulated data, I had information related to youth and drugs in local media and in governmental institutions bound to health mental and city security policies. With this junction of data I present a perspective to questions evolving formal and informal important controls to the conduction of their lives and identities. I present this as a sequel to well developed studies in Brasil about youth in interface to drug use, although still not very explored in the state of Ceará.

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

Violência contra as mulheres trabalhadoras do sexo e vulnerabilidade ao HIV/AIDS em 10 cidades brasileiras

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2016.

Behavioral traits predicting cocaine-conditioned place reference in mice: role of anxiety adn the basolateral amygdala

Aims. The individual susceptibility to cocaine addiction, a factor of interest in the understanding and prevention of this disorder, may be predicted by certain behavioral traits. However, these are not usually taken into account in research, making it difficult to identify whether they are a cause or a consequence of drug use. Methods. Male C57BL/6J mice underwent a battery of behavioral tests (elevated plus maze, hole-board, novelty preference in the Y maze, episodic-like object recognition memory and forced swimming test), followed by a cocaine-conditioned place preference (CPP) training to assess the reinforcing effect of the drug. In a second study, we aimed to determine the existence of neurobiological differences between the mice expressing high or low CPP by studying the number of neurons in certain addiction-related structures: the medial prefrontal cortex, the basolateral amygdala and the ventral tegmental area. Results. Anxiety-like behaviors in the elevated plus maze successfully predicted the cocaine-CPP behavior, so that the most anxious mice were also more likely to search for cocaine in a CPP paradigm. In addition, these mice exhibited an increased number of neurons in the basolateral amygdala, a key structure in emotional response including anxiety expression, without differences in the others regions analyzed. Conclusions. Our results suggest a relevant role of anxiety as a psychological risk factor for cocaine vulnerability, with the basolateral amygdala as potential common neural center for both anxiety and addiction.

Relatório de estágio

Este relatório destina-se a descrever as acções desenvolvidas no estágio, do 1º Curso de Mestrado em Enfermagem Comunitária, realizado na Escola Superior de Saúde de Portalegre. A intervenção comunitária, realizou-se na comunidade escolar de Portalegre, tendo tido duas vertentes: Educação sexual na adolescência; Promoção de comportamentos saudáveis nos estilos de vida dos adolescentes. As ações realizadas abordaram a educação sexual na adolescência, com base no diagnóstico de situação e, através da elaboração de um projecto de intervenção, aplicado em metodologia de planeamento em saúde. A intervenção comunitária teve como base a promoção de comportamentos saudáveis nos estilos de vida dos adolescentes, a alunos das escolas de Portalegre do 9º e 12º anos, na área de ciências e tecnologias. Todo este trabalho foi desenvolvido na fase teórica e suportou a nossa intervenção em estágio. Assim, após a conclusão deste diagnóstico, seguiu-se a fase de estabelecimento de prioridades, fixação dos objectivos, selecção de estratégias, preparação da execução e avaliação. Na adolescência, a educação sexual deverá ser orientada para a maturação psicossexual, para os afetos, para a contraceção e planeamento familiar e para a prevenção de doenças. É da responsabilidade dos profissionais de saúde, da escola, mas sobretudo da família, proporcionar um ambiente favorável à aprendizagem e ao diálogo. O realce da educação sexual, deverá ser colocado na igualdade de papéis, na tolerância face ao pluralismo de orientação e de condutas sexuais. Por outro lado, é também na adolescência, que se adquirem hábitos e comportamentos saudáveis. Assim, os profissionais de saúde, conjuntamente com a escola e a família, poderão ter um papel preponderante, capacitando os jovens de competências que lhes permitam optar por comportamentos saudáveis, a nível de alimentação, álcool, uso de drogas, prevenção de infecções sexualmente transmissíveis e cidadania

Malestar en la cultura. Suicidio: aspectos transculturales

La introducción menciona que el suicidio es un epítome del Malestar en la Cultura. Pasa revista por sectores vulnerables, grupos indígenas, intelectuales, la relación con catástrofes económicas. Cita varios de los países propensos, mencionando algunas tasas de suicidio, deteniéndose en casos de suicidios colectivos de la historia. Menciona diversos métodos suicidas, épocas propensas, tanto como la relación eutanasia-suicidio y los cambios ocurridos según edad y género. Numerosas referencias son mencionadas de acuerdo a culturas, pueblos, religiones. Compara el suicidio humano con el mundo animal y alerta sobre criterios de prevención y uso de fármacos. Dada una publicación ofrecida en Ecuador, el artículo realiza una breve referencia sobre el tema. El colofón recuerda que el suicidio es el acontecimiento humano más estremecedor

El consumo de drogas en el contexto de familias con hijos adolescentes

El presente trabajo de investigación titulado “El consumo de drogas en el contexto de familiascon hijos adolescentes”, evidencia una investigación teórica y de prevención a esta realidad que constituye un problema de consideración para la sociedad, en el contexto de familias con hijos adolescentes. La investigación sobre el consumo de drogas en adolescentes ha sido abordada en la modalidad de monografía, dividida en tres temáticas: el consumo de drogas, factores de riesgo-proteccióny prevención. Cada una de estas temáticas tiene como finalidad determinarlas causas y consecuencias del consumo de las sustancias psicotrópicas, tipos dedroga y contribuir a la valoración del ser humano y su capacitación para evitar el consumo de drogas. Se incluye anexos de talleres para padres que debe aplicar el Orientador Familiar y materiales sobre eventos relacionados con la prevención a la sociedad ante el problema suscitado en las familias ante el consumo de drogas en los adolescentes.

Étude de l’impact de la prise de médicaments dans le traitement de l’arthrite juvénile sur les événements néfastes à l’accouchement chez la mère et son bébé

La plupart des femmes ayant été atteintes d’arthrite juvénile idiopathique (AJI) continuent de souffrir d’arthrite à l’âge adulte. Certains des médicaments utilisés dans le traitement de l’arthrite tels que les corticostéroïdes et les antiinflammatoires non stéroïdiens (AINS) ne sont pas recommandés durant la grossesse. Le but de ce mémoire est d’estimer l’impact de la prise de ces médicaments sur les événements néfastes à l’accouchement chez ces femmes et leur bébé. Des données administratives sur les prescriptions de médicaments et les hospitalisations d’une cohorte de 1756 femmes ayant souffert d’AJI sont utilisées. Elles ont permis de reconstruire l’historique de consommation de médicaments contre l’arthrite chez les femmes durant la grossesse et l’année précédente. Pour ce faire, deux sous-cohortes de femmes ayant souffert d’AJI ont été formées : une pour la période grossesse et une autre pour la grossesse et l’année précédant celle-ci. Les événements d’intérêt étaient : malformations congénitales, complications néonatales, complications maternelles et petit poids pour l’âge gestationnel. Les proportions de cas présentant l’un de ces événements variaient entre 11,52% et 37,08%. Les médicaments ont été modélisés en terme d’utilisation ou de durée totale de consommation durant la période d’étude. Pour chaque événement, des modèles logistiques ont été estimés pour mesurer l’association entre la prise de médicaments et l’événement, en ajustant pour des variables de confusion potentielles : hypertension avant la grossesse, âge à l’accouchement et obtention du diplôme de secondaire. La consommation de corticostéroïdes semble augmenter statistiquement significativement le risque de présenter des malformations congénitales mais n’avoir aucun impact sur les autres événements. Aucun lien statistiquement significatif n’a été observé entre la consommation de AINS et les événements d’intérêt.

An interprofessional approach to improving paediatric medication safety

Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future.An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions.Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p < 0.001), with the greatest increase noted among medical students. Highly significant changes in students' attitudes to shared learning were observed, indicating that safe medication practice is learnt more effectively with students from other healthcare disciplines. Qualitative data revealed that students' participation in the workshop improved communication and teamworking skills, and led to greater awareness of the role of other healthcare professionals.This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

Learning data-driven models of non-verbal behaviors for building rapport using an intelligent virtual agent

There is a growing societal need to address the increasing prevalence of behavioral health issues, such as obesity, alcohol or drug use, and general lack of treatment adherence for a variety of health problems. The statistics, worldwide and in the USA, are daunting. Excessive alcohol use is the third leading preventable cause of death in the United States (with 79,000 deaths annually), and is responsible for a wide range of health and social problems. On the positive side though, these behavioral health issues (and associated possible diseases) can often be prevented with relatively simple lifestyle changes, such as losing weight with a diet and/or physical exercise, or learning how to reduce alcohol consumption. Medicine has therefore started to move toward finding ways of preventively promoting wellness, rather than solely treating already established illness.^ Evidence-based patient-centered Brief Motivational Interviewing (BMI) interventions have been found particularly effective in helping people find intrinsic motivation to change problem behaviors after short counseling sessions, and to maintain healthy lifestyles over the long-term. Lack of locally available personnel well-trained in BMI, however, often limits access to successful interventions for people in need. To fill this accessibility gap, Computer-Based Interventions (CBIs) have started to emerge. Success of the CBIs, however, critically relies on insuring engagement and retention of CBI users so that they remain motivated to use these systems and come back to use them over the long term as necessary.^ Because of their text-only interfaces, current CBIs can therefore only express limited empathy and rapport, which are the most important factors of health interventions. Fortunately, in the last decade, computer science research has progressed in the design of simulated human characters with anthropomorphic communicative abilities. Virtual characters interact using humans’ innate communication modalities, such as facial expressions, body language, speech, and natural language understanding. By advancing research in Artificial Intelligence (AI), we can improve the ability of artificial agents to help us solve CBI problems.^ To facilitate successful communication and social interaction between artificial agents and human partners, it is essential that aspects of human social behavior, especially empathy and rapport, be considered when designing human-computer interfaces. Hence, the goal of the present dissertation is to provide a computational model of rapport to enhance an artificial agent’s social behavior, and to provide an experimental tool for the psychological theories shaping the model. Parts of this thesis were already published in [LYL+12, AYL12, AL13, ALYR13, LAYR13, YALR13, ALY14].^

The Influence of Gender on Perceived Treatment Need among a Community Sample of Substance Users

Purpose: Most individuals do not perceive a need for substance use treatment despite meeting diagnostic criteria for substance use disorders and they are least likely to pursue treatment voluntarily. There are also those who perceive a need for treatment and yet do not pursue it. This study aimed to understand which factors increase the likelihood of perceiving a need for treatment for individuals who meet diagnostic criteria for substance use disorders in the hopes to better assist with more targeted efforts for gender-specific treatment recruitment and retention. Using Andersen and Newman’s (1973/2005) model of individual determinants of healthcare utilization, the central hypothesis of the study was that gender moderates the relationship between substance use problem severity and perceived treatment need, so that women with increasing problems due to their use of substances are more likely than men to perceive a need for treatment. Additional predisposing and enabling factors from Andersen and Newman’s (1973/2005) model were included in the study to understand their impact on perceived need. Method: The study was a secondary data analysis of the 2010 National Survey on Drug Use and Health (NSDUH) using logistic regression. The weighted sample consisted of a total 20,077,235 American household residents (The unweighted sample was 5,484 participants). Results of the logistic regression were verified using Relogit software for rare events logistic regression due to the rare event of perceived treatment need (King & Zeng, 2001a; 2001b). Results: The moderating effect of female gender was not found. Conversely, men were significantly more likely than women to perceive a need for treatment as substance use problem severity increased. The study also found that a number of factors such as race, ethnicity, socioeconomic status, age, marital status, education, co-occurring mental health disorders, and prior treatment history differently impacted the likelihood of perceiving a need for treatment among men and women. Conclusion: Perceived treatment need among individuals who meet criteria for substance use disorders is rare, but identifying factors associated with an increased likelihood of perceiving need for treatment can help the development of gender-appropriate outreach and recruitment for social work treatment, and public health messages.

Étude de l’impact de la prise de médicaments dans le traitement de l’arthrite juvénile sur les événements néfastes à l’accouchement chez la mère et son bébé

L'obtention des données a été subventionnée par CIORA (Canadian Initiative for Outcomes in Rheumatology Care). CIORA a aussi financé l'analyse des données effectuées par Justine Zehr. L'Initiative Canadienne Pour Des Resultats En Soins Rhumatologiques (ICORA) a financé l'obtention des données et une partie de l'analyse statistique présentée dans ce mémoire.

Patterns of psychotropic prescribing and polypharmacy in older hospitalized patients in Ireland: the influence of dementia on prescribing

Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia. All older patients (≥ 70 years old) that had elective or emergency admissions to six Irish study hospitals were eligible for inclusion in a longitudinal observational study. Of 676 eligible patients, 598 patients were recruited and diagnosed as having dementia, or not, by medical experts. These 598 patients were assessed for delirium, medication use, co-morbidity, functional ability, and nutritional status. We conducted a retrospective cross-sectional analysis of medication data on admission for 583/598 patients with complete medication data, and controlled for age, sex, and co-morbidity. Of 149 patients diagnosed with dementia, only 53 had a previous diagnosis. At hospital admission, 458/583 patients experienced polypharmacy (≥ 5 medications). People with dementia (PwD) were significantly more likely to be prescribed at least one psychotropic medication than patients without dementia (99/147 vs. 182/436; p < 0.001). PwD were also more likely to experience psychotropic polypharmacy (≥ two psychotropics) than those without dementia (54/147 vs. 61/436; p < 0.001). There were no significant differences in the prescribing patterns of anti-cholinergics (23/147 vs. 42/436; p = 0.18) or deliriogenics (79/147 vs. 235/436; p = 0.62). Polypharmacy and psychotropic drug use is highly prevalent in older Irish hospitalized patients, especially in PwD. Hospital admission presents an ideal time for medication reviews in PwD.