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Abstract Background Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs. Methods This cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure. Results Presence of family conflict (p = 0.002), maltreatment (p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later (p

Objective: We explored hospitalization patterns and the clinical and individual characteristics of a large cohort of patients who underwent involuntary psychiatric hospitalization in Brazil (n=64,685). Methods: Data were collected from the District Attorney's Office of the State of São Paulo (Ministério Público do Estado de São Paulo) on all involuntary psychiatric hospitalizations in the city of São Paulo between January 2003 and February 2020. The annual involuntary psychiatric hospitalization rate was calculated and descriptive statistics of the characteristics were produced. Results: Involuntary psychiatric hospitalizations increased from 5.8 to 25.5 per 100,000 population, with an eight-folder increase in the first 10-year period (2003-2013). The majority of admissions were to public institutions (86.6%), involved a psychotic disorder in the primary diagnosis (26.1%), involved more than one diagnosis (83.7%), and lasted less than 7 days (52.4%). The majority of the patients were aged 18 to 39 years and were single, and readmission was relatively common (13%). Although the reason for admission was missing in many reports (44%), the risk of harm to self or others was the most common (68.5%). Conclusion: This is one of the largest cohorts of involuntary psychiatric hospitalization records ever explored. These findings build upon existing international evidence about involuntary psychiatric hospitalizations and show recent trends in admission rates in the largest city in Brazil.

Objective: To assess the efficacy of cannabidiol (CBD) in the management of crack-cocaine craving and the treatment of frequent withdrawal symptoms. Methods: Thirty-one men with a diagnosis of crack-cocaine dependence were enrolled in a randomized, double-blind, placebo-controlled trial. We applied neuropsychological tests and assessed craving intensity, anxiety and depression symptoms, and substance use patterns at baseline and at the end of the trial. The participants were treated with CBD 300 mg/day or placebo for 10 days. During this period, we used a technique to induce craving and assessed the intensity of symptoms before and after the induction procedure. Results: Craving levels reduced significantly over the 10 days of the trial, although no differences were found between the CBD and placebo groups. Craving induction was successful in both groups, with no significant differences between them. Indicators of anxiety, depression, and sleep alterations before and after treatment also did not differ across groups. Conclusion: Under the conditions of this trial, CBD was unable to interfere with symptoms of crack-cocaine withdrawal. Further studies with larger outpatient samples involving different doses and treatment periods would be desirable and timely to elucidate the potential of CBD to induce reductions in crack-cocaine self-administration.

Introdução: Os trabalhadores da área da saúde (TAS) estão na linha de frente da luta contra covid-19. De acordo com o Ministério da Saúde do Brasil, até 24/07/2021, foram notificados 132.338 casos de síndrome gripal e 589 óbitos causados por covid-19 em TAS. Desde janeiro de 2021, foi iniciado a vacinação para covid-19 em TAS. Objetivos: 1. Avaliar a incidência de covid-19 em TAS de 12 hospitais de atendimento à pacientes com covid-19; 2. Analisar o impacto da vacinação e das medidas de prevenção na transmissão de SARS-CoV-2 para TAS. Casuística e método: Estudo tipo coorte com TAS de 12 hospitais que são gerenciados pela Associação Paulista para o Desenvolvimento da Medicina (SPDM) de 01/03/2020 a 31/07/2021. Todos os TAS das 12 instituições receberam treinamento em prevenção da covid-19 com protocolos de utilização de equipamentos proteção individual e práticas de precauções de contato e aerossol. Os profissionais com sinais ou sintomas de síndrome gripal foram afastados das atividades e colhido exame de RT-PCR para pesquisa de SARS-CoV-2 em secreção de naso/orofaringe. A partir de janeiro de 2021, foi iniciado a vacinação em todos os hospitais para covid-19 de acordo com o protocolo do Ministério da Saúde. Resultados: Durante o período de 01/03/2020 a 31/07/2021, foram internados nos 12 hospitais da SPDM, 38.119 pacientes com diagnóstico de covid-19: 23.165 entre março a dezembro de 2020 e 14.954 entre janeiro a julho de 2021. Os hospitais possuem 13.003 colaboradores e destes, 3.630 (27,90%) tiveram diagnóstico de covid-19. A partir de janeiro de 2021, foi iniciado a vacinação nos TAS: 70,9% vacinados com CoronaVac (Sinovac); 26,9% AstraZeneca; 0,2% Janssen; Pfizer 1,9% e 0,2% Janssen. A taxa de adesão à vacinação foi de 98,34%. Estratificando o período pandêmico em três fases: na fase 1 (março a junho 2020) tivemos 2.048 (Média/mês = 511,5) TAS notificados com covid-19; fase 2 (julho de 2020 a janeiro de 2021), implantação de protocolos e medidas de prevenção, 2.299 (Média/mês = 328,2) notificações; fase 3 (fevereiro a julho de 2021) com o impacto da vacinação, 1.405 notificações (Média/mês = 234,1) (p = 0,0002). A fase 3 foi a de maior número de internações com covid-19. Conclusões: A implantação das medidas de prevenção, incluindo protocolos e treinamentos, tiveram impacto na redução de infecção em TAS, entretanto a vacinação para covid-19 conseguiu reduzir significativamente a transmissão, mesmo na fase de maior número de internações por covid-19.

Objetivo: Descrever as características do serviço e o perfil dos usuários atendidos no Ambulatório Médico de Especialidades de Psiquiatria Dra. Jandira Masur (AME Psiquiatria), na cidade de São Paulo. Métodos: Foi realizado um estudo transversal com amostra de conveniência de todos os pacientes atendidos desde o início do funcionamento do ambulatório, em agosto de 2010, até dezembro de 2019. Resultados: Trata-se do maior estudo ambulatorial já realizado no Brasil, constituído por 30.151 pacientes, em sua maioria mulheres (62%). Os diagnósticos mais prevalentes foram transtornos do humor e de ansiedade (36,5%), seguidos por transtornos neuróticos, relacionados com o estresse e somatoformes (29%). Também identificou-se que o número de novos pacientes foi crescente ao longo do tempo e que o ambulatório disponibilizou em torno de 74 mil aberturas de vagas durante o período do estudo. Conclusão: Este serviço demonstrou ser referência como modelo de gestão no campo da saúde mental no Sistema Único de Saúde na cidade de São Paulo.

Although there is a wide array of evidence showing the beneficial effect of religiosity on violence among adolescents, nationwide studies in the general population are scarce. This study aims to explore whether religiosity is associated or not with diminishing violence in a Brazilian population-based representative sample. This observational cross-sectional study was conducted in 2011-2012 using face-to-face interviews and included 4,608 individuals 14 years and older. The survey included measures of religiosity (religious affiliation and importance of religion), violence (involvement in fights, domestic violence and police detention), depression, social support and alcohol dependence. We used logistic regression models and mediation analyses. In the total sample analyses, after adjustments, having a religious affiliation was inversely associated with lower involvement in fights (OR = 0.60,CI95%:0.37-0.98) and less police detention (OR = 0.37,CI95%:0.20-0.70), whereas the importance of religion was only associated with less fights (OR = 0.60,CI95%:0.36-0.99). Subanalyses revealed different associations depending on the age group evaluated. Mediation tests showed that the association of religious affiliation on violence outcomes was mediated by alcohol use. In conclusion, religiosity seems to be an important factor associated with lower levels of violence in this nationwide representative survey and alcohol dependence seems to mediate this relationship. Health professionals should be aware of these findings in their clinical practice.

BackgroundAlthough many studies suggest that religiosity is a protective factor against drug use, there is little information on its effect on drug consumption patterns of those who do use drugs.AimsWe aimed to examine if there is any relationship between religiosity during childhood and adolescence, and drug consumption in adult crack users.MethodWe performed a cross-sectional study of adults addicted to crack cocaine. Logistic regression analysis was used to estimate the odds ratio for the association between religious history in the age groups 8–11, 12–14 and 15–17 years and outcome variables.ResultsFrom a total of 531 respondents, religious involvement during childhood and adolescence was correlated to less frequent onset of drug consumption before 18 years (odds ratio 0.95, 95% CI 0.92–0.98) and less craving (odds ratio 0.95, 95% CI 0.91–0.99), mainly between the ages of 15 and 17 years.ConclusionsReligiosity provides some protection against drug consumption patterns in crack cocaine addicts.Declaration of interestNone.

Objective: To investigate the association of alcohol and cocaine use with urban violence (both as victim and as perpetrator) in a representative sample of the Brazilian population. Method: The Second Brazilian Alcohol and Drugs Survey (II BNADS) interviewed 4607 individuals aged 14years and older from the Brazilian household population including an oversample of 1157 adolescents (14 to 18years old). The survey gathered information on alcohol, tobacco and illegal substances use as well as on risk factors for abuse and dependence, behaviors associated with the use of substances and the possible consequences, as urban violence indicators. Results: Approximately 9.3% of the Brazilian population has been victim of at least one form of urban violence. This proportion increases to 19.7% among cocaine users and to 18.1% among individuals with alcohol use disorders (AUD). Perpetration of violence was reported by 6.2% of the sample. Cocaine use and AUD increased in almost four times the chances of being an aggressor. Being religious and married decreased the chances of being a victim and/or perpetrador of urban violence. Higher education also decreased the chances of involvement in both victimization or perpetration of violence. Both Parallel Mediation Models considering cocaine use as a predictor of urban violence (victimization or perpetration) were valid and alcohol consumption and depressive symptoms were mediators of this relationship. Conclusions: This study presents relevant data of interest to Brazil as this country is one of the major consumer market of cocaine and also is among the most violent countries worldwide. Keywords: Urban violence, Cocaine, Alcohol use disorder, Household survey, Epidemiology

Objective: The aim of this study was to estimate nationally representative prevalence rates of amphetamine-type stimulant (ATS) use and to identify consumption-associated factors, proposing a conditional model of direct and indirect consumption paths. Method: Using data from the Second Brazilian National Alcohol and Drugs Survey, this cross-sectional study analyzed a subsample of 3,828 participants between 15 and 64 years old, gathering information on the use of psychoactive substances in a probabilistic sample of the Brazilian household population. Results: Rates of lifetime and last-year ATS use were, respectively, 4.1 and 1.6%. Economically privileged individuals and users of other substances were more at risk for using ATS. The results suggest that higher education decreases the chances of ATS consumption. The conditional model showed that higher income increased ATS use, higher education lowered the odds of such an increase, and cocaine use cancelled that associative effect. Conclusion: Brazil presents high rates of ATS use. Prevention and treatment strategies should focus on the protective effect of higher education levels and should target polydrug use. Knowledge of ATS-associated factors and user profiles is the starting point for developing effective treatments and tailored prevention strategies.

Objective: To perform a construct validation of the List of Threatening Events Questionnaire (LTE-Q), as well as convergence validation by identifying its association with drug use in a sample of the Brazilian population. Methods: This is a secondary analysis of the Second Brazilian National Alcohol and Drugs Survey (II BNADS), which used a cross-cultural adaptation of the LTE-Q in a probabilistic sample of 4,607 participants aged 14 years and older. Latent class analysis was used to validate the latent trait adversity (which considered the number of events from the list of 12 item in the LTE experienced by the respondent in the previous year) and logistic regression was performed to find its association with binge drinking and cocaine use. Results: The confirmatory factor analysis returned a chi-square of 108.341, weighted root mean square residual (WRMR) of 1.240, confirmatory fit indices (CFI) of 0.970, Tucker-Lewis index (TLI) of 0.962, and root mean square error approximation (RMSEA) score of 1.000. LTE-Q convergence validation showed that the adversity latent trait increased the chances of binge drinking by 1.31 time and doubled the chances of previous year cocaine use (adjusted by sociodemographic variables). Conclusion: The use of the LTE-Q in Brazil should be encouraged in different research fields, including large epidemiological surveys, as it is also appropriate when time and budget are limited. The LTE-Q can be a useful tool in the development of targeted and more efficient prevention strategies.

Objective: Cocaine use disorders (CUDs) represent a major public health problem in many countries. To better understand the interaction between the environmental modulations and phenotype, the aim of the present study was to investigate the DNA methylation pattern of CUD patients, who had concomitant cocaine and crack dependence, and healthy controls. Methods: We studied DNA methylation profiles in the peripheral blood of 23 CUD patients and 24 healthy control subjects using the Illumina Infinium HumanMethylation450 BeadChip arrays. Results: Comparison between CUD patients and controls revealed 186 differentially methylated positions (DMPs; adjusted p-value [adjP] < 10-5) related to 152 genes, with a subset of CpGs confirmed by pyrosequencing. DNA methylation patterns discriminated CUD patients and control groups. A gene network approach showed that the EHMT1, EHMT2, MAPK1, MAPK3, MAP2K1, and HDAC5 genes, which are involved in transcription and chromatin regulation cellular signaling pathways, were also associated with cocaine dependence. Conclusion: The investigation of DNA methylation patterns may contribute to a better understanding of the biological mechanisms involved in CUD.

Com base na análise dos dados de corte transversal provenientes do Segundo Levantamento Nacional de Álcool e Drogas realizado em 2012, utilizando-se uma amostra probabilística estratificada por conglomerado representativa da população brasileira, este estudo apresenta as prevalências de estupro e analisa a relação deste evento com o consumo de álcool. Foram considerados 1.918 homens e 2.365 mulheres, totalizando uma amostra de 4.283 indivíduos. Nossos resultados estimam a prevalência de estupro na vida em 2,6% da população geral, sendo 1,7% entre os homens e 3,5% entre as mulheres. Para ambos os sexos, as maiores prevalências se concentraram entre indivíduos com idades entre 26 e 59 anos (3,3%), com baixa escolaridade (3,8%), solteiros, divorciados ou viúvos (3,1%). Entre os indivíduos com diagnóstico para transtorno por uso de álcool de acordo com o DSM-5 (Manual Diagnóstico e Estatístico de Transtornos Mentais), 6% relataram ser vítimas de estupro, bem como, 3,3% daqueles que disseram beber pesado episódico (binge). Análises de regressão logística e multifatorial indicaram que tanto para mulheres quanto para homens a idade (aqueles entre 26 e 59 anos), o estado civil (solteiro), o diagnóstico de transtorno por uso de álcool e o beber pesado episódico são fatores associados ao aumento da probabilidade de vitimização por estupro, enquanto maior nível de educação (mais do que 9 anos de estudos) revelou-se um fator capaz de diminuir as chances de ocorrência. A identificação da amplitude desse problema de saúde pública, bem como a avaliação da urgência na implantação de medidas preventivas e assistenciais, partem do conhecimento das prevalências e do perfil sociodemográfico das vítimas.

Objective: To investigate the prevalence rates of suicidal ideation (SI) and suicide attempts (SA) and their association with substance use in a nationally representative sample of Brazilians. Methods: The Second Brazilian National Alcohol and Drug Survey (II BNADS) is a household cross-sectional survey that investigated the consumption of psychotropic drugs and associated risk factors. This national probability sample survey used a multistage cluster design to select 4,607 participants aged 14 or older and had a total response rate of 77%. Illegal drug use, SI and SA were obtained by confidential self-report assessment. Results: SI and SA were reported by 9.9 and 5.4% of the sample, respectively. This prevalence was 20.8 and 12.4% among individuals with alcohol use disorders (AUD), 31.5 and 16.5% among cannabis users and 40.0 and 20.8% among cocaine users. After adjusting for demographic characteristics, tobacco use, family history of suicide and depression, both SI and SA were positively associated with AUD, cannabis and cocaine use. Conclusion: AUD, cannabis and cocaine use were significantly associated with SI and SA, even after the adjustments. Public health initiatives targeting suicide prevention should consider including assessment and management of substance misuse, and therapeutic approaches to substance misuse should include assessment of suicidality.

Objective: To compare intimate partner violence (IPV) prevalence rates in 2006 and 2012 in a nationally representative household sample in Brazil. The associations between IPV and substance use were also investigated. Methods: IPV was assessed using the Conflict Tactic Scale-R in two waves (2006/2012) of the Brazilian Alcohol and Drugs Survey. Weighted prevalence rates and adjusted logistic regression models were calculated. Results: Prevalence rates of IPV victimization decreased significantly, especially among women (8.8 to 6.3%). The rates of IPV perpetration also decreased significantly (10.6 to 8.4% for the overall sample and 9.2 to 6.1% in men), as well as the rates of bidirectional violence (by individuals who were simultaneously victims and perpetrators of violence) (3.2 to 2.4% for the overall sample). Alcohol increased the likelihood of being a victim (odds ratio [OR] = 1.6) and perpetrator (OR = 2.4) of IPV. Use of illicit drugs increased up to 4.5 times the likelihood of being a perpetrator. Conclusions: In spite of the significant reduction in most types of IPV between 2006 and 2012, violence perpetrated by women was not significantly reduced, and the current national rates are still high. Further, this study suggests that use of alcohol and other psychoactive drugs plays a major role in IPV. Prevention initiatives must take drug misuse into consideration.

Objective: This study compared the rates of binge drinking (BD) and alcohol use disorder (AUD) reported for 2006 with those reported for 2012, exploring their associations with unprotected sex, early pregnancy, and abortion in a representative sample of women in Brazilian households. Methods: This was a descriptive analysis of data from a cross-sectional study involving randomized multistage cluster sampling of the population ≥ 14 years of age. Weighted prevalence rates and odds ratios were estimated, and serial mediation analysis was performed. Results: A total of 4,256 women were analyzed. The BD prevalence was 35.1% and 47.1% in 2006 and 2012, respectively, a significant increase, especially among women 40-59 years of age. There was no significant difference in AUD prevalence. BD (without AUD) was found to increase the odds of unprotected sex and abortion. The path analysis showed that early pregnancy was a mediator of the relationship between alcohol consumption and abortion. Conclusion: Among women in Brazil, the harmful use of alcohol is increasing, which has an impact on female reproductive health and exposure to risks. There is a need for specific prevention initiatives focusing on alcohol-related behaviors in women.

Objective:To describe mortality by suicide among physicians in the state of São Paulo, Brazil, between 2000 and 2009.Methods:Secondary analysis of government mortality data. The variable of interest was “underlying cause of death”, specifically deaths classified by the ICD-10 as intentional self-harm (X60 to X84).Results:The analyses examined 2,297 declarations of death, among which suicide accounted for 50 cases, i.e., 1.7% of all causes of death. Women comprised 13.2% of the total sample and represented 24% of the death-by-suicide group, indicating an overrepresentation of women in the latter (p = 0.02). Deaths by suicide occurred on average 20 years earlier than deaths by other causes (46.8±14.2 years and 68.1±15.8 years, respectively; p = 0.001). There was a significant association between single and/or divorced status and suicide (p < 0.001). The average mortality rate during the study period was 4.2 deaths per 100,000 physicians registered with the Regional Board of Medicine of the State of São Paulo.Conclusion:Deaths by suicide occurred 20 years earlier than deaths by other causes. Medical institutions should develop strategies for the prevention and early detection of mental disorders and occupational stressors that elevate the risk of suicide among physicians.

Abstract: Abortion is a very sensitive issue with relevance to public health; however few clinical or population-based studies have examined induced abortion among drug users. The study aims to evaluate the prevalence of induced abortion and sex-related conditions in an inpatient drug user sample. A cross-sectional design study was conducted in an inpatient addiction treatment unit in São Paulo, Brazil, with a sample of 616 patients, aged 18-75. Sociodemographic data, sexual behavior, and dependence severity were evaluated in relation to induced abortion. Approximately 27% of patients reported having a history of abortion (themselves in the case of women or partners in the case of men). The mean age was 34.6±10.9 years old, 34.9% diagnosed with severe alcohol dependence, 33% were diagnosed with severe levels of dependence on other drugs, 69.6% were diagnosed cocaine users (inhaled and smoked), and alcohol was the drug of choice for 30.4%. Chances of having a history of abortion is greater for women than for men with a odds ratio (OR = 2.9; 95%CI: 1.75-4.76), (OR = 1.7; 95%CI: 1.09-2.75) of no condom use; (OR = 2.0; 95%CI: 1.35-3.23) of history of STI and (OR = 3.2; 95%CI: 1.29-5.73) use of morning-after pill. Drug- and alcohol-dependent patients have high-risk behaviours of sporadic use or no-condom use which contribute to unplanned pregnancy and induced abortion, making this vulnerable population a group which deserves special attention in sexual health prevention programmes and health promotion efforts for the reduction of induced abortion.

Objective: The connection between lower alcohol use and religiousness has been extensively examined. Nevertheless, few studies have assessed how religion and religiousness influence public policies. The present study seeks to understand the influence of religious beliefs on attitudes toward alcohol use. Methods: A door-to-door, nationwide, multistage population-based survey was carried out. Self-reported religiousness, religious attendance, and attitudes toward use of alcohol policies (such as approval of public health interventions, attitudes about drinking and driving, and attitudes toward other alcohol problems and their harmful effects) were examined. Multiple logistic regression was used to control for confounders and to assess explanatory variables. Results: The sample was composed of 3,007 participants; 57.3% were female and mean age was 35.7 years. Religiousness was generally associated with more negative attitudes toward alcohol, such as limiting hours of sale (p < 0.01), not having alcohol available in corner shops (p < 0.01), prohibiting alcohol advertisements on TV (p < 0.01), raising the legal drinking age (p < 0.01), and raising taxes on alcohol (p < 0.05). Higher religious attendance was associated with less alcohol problems (OR: 0.61, 95%CI 0.40-0.91, p = 0.017), and self-reported religiousness was associated with less harmful effects of drinking (OR: 0.61, 95%CI 0.43-0.88, p = 0.009). Conclusions: Those with high levels of religiousness support more restrictive alcohol policies. These findings corroborate previous studies showing that religious people consume less alcohol and have fewer alcohol-related problems.

Objective: Depression is a highly prevalent condition and is considered a major public health issue. The aim of the present study was to estimate the prevalence of depressive symptoms in the Brazilian population and establish their sociodemographic correlates. Method: A cross-sectional study was conducted between November 2005 and April 2006. Data were collected in face-to-face interviews using a standardized questionnaire. The sample consisted of 3,007 interviews with individuals aged 14 years and older and followed a probabilistic design covering the Brazilian national territory. Depressive symptoms were assessed according to the Center for Epidemiologic Studies Depression Scale. Results: The observed prevalence of depressive symptoms was 28.3% (13% mild/moderate; 15.3% major/severe; p < 0.01). Increased depressive symptom rates were associated with being a female, being 45 years of age and older, having lower educational attainment, being single, having family income of up to 2.5 times minimum wage, and living in the northern region of Brazil (p < 0.05). Conclusions: The prevalence of depressive symptoms in Brazil is high, with major depressive symptoms being the most frequent form of this symptomatology. Considering the biopsychosocial model of mental disorders, this survey points to the involvement of psychosocial factors in the prevalence of depressive symptoms in Brazil.

OBJECTIVE: To estimate the prevalence of female sexual dysfunction symptoms and the associated risk factors in a sample of patients with substance-related disorders admitted to a specialized in-patient care unit. METHODS: This study used a cross-section design, with eight months of data collection, conducted with substance-dependent women using structured questionnaires to collect socio-demographic data and identify their drug of choice. The Drug Abuse Screening Test, Short Alcohol Dependence Data questionnaire, Fagerstrom Test for Nicotine Dependence, and Arizona Sexual Experience Scale were also administered. RESULTS: The sample consisted of 105 women who had a mean age of 34.8 years (SD = 12.1, range = 18-65) and were predominantly heterosexual (74.3%), single (47.6%), Caucasian (50.5%), catholic (36.2%), and educated only to the level of primary education (40%), with a monthly family income of up to one minimum salary (37.5%). In 42.9% of the patients, crack was the drug of choice; 47.6% of the sample qualified for the Drug Abuse Screening Test (substantial problems related to drugs), 43.8% exhibited Short Alcohol Dependence Data (moderate or severe dependency), 47.6% exhibited Fagerstrom Test for Nicotine Dependence (high or very high nicotine dependence). The prevalence of sexual dysfunction symptoms was 34.2% (95% CI = [25.3, 44.1]), and a high level of nicotine dependence and low income increased the chances of having sexual dysfunction by 2.72-fold and 2.54 fold, respectively. An association was also observed between female sexual dysfunction symptoms and schooling and levels of drug dependence. CONCLUSIONS: Female sexual dysfunction symptoms were common among this sample and primarily associated with high levels of nicotine use.

The aim of this study was to evaluate the potential relationship between self-reported sexual dysfunction, sexual behavior, and severity of addiction of drug users. A cross-sectional design study was conducted at an inpatient addiction treatment unit in Sao Paulo, Brazil, with a sample of 508 male drug users. Sociodemographic data, sexual behavior, and severity of dependence were evaluated.The prevalence of sexual dysfunction was 37.2% and premature ejaculation was 63.8%. Men with sexual dysfunction presented from moderate to severe level of alcohol, tobacco, and other drugs of dependence. The findings from this study are particularly relevant identifying those sociodemographic factors, severity of drug use, and sexual behavior are related to men who experience sexual dysfunction. Health promotion and motivational interventions on sexual health targeted to male drug users can contribute in reducing these at-risk behaviors. More interdisciplinary research is desirable in future in considering men’s sexual health.

OBJECTIVE: To investigate the results of alcohol-related consequences in an underprivileged area of São Paulo. METHOD: One hundred and ninety one adult patients who sought alcohol treatment in 2002 were reassessed in 2007 regarding alcohol use and involvement with crime. The interview consisted of demographic questions and questionnaires assessing alcohol dependence and pattern of alcohol use. Risk and protective factors and involvement with crime were further explored. RESULTS High mortality rate (16.9%, n = 41) was found in this sample and 97.4% were identified as being severe alcohol dependents. The sample consisted of a homogeneous group, average age of 42, 81.9% male, 57.5% black, 52.2% unemployed and 100% of low socioeconomic status. Individuals ageing 35 or younger, not engaged in religious activities and with intense alcohol consumption in the last month had 2.7 times more chance on committing crimes (95% CI = [1.22; 5.93] p = 0.014). Subjects who consumed alcohol in the last month also had a 4.1 greater chance of becoming involved in crime (95% CI = [1.2; 14.24] p = 0.024). CONCLUSION: Alcohol dependence within an underprivileged community was associated with high rates of crime and mortality. Religious affiliation was negatively associated with delinquent behavior.OBJETIVO: Explorar as consequências relacionadas ao uso de álcool na periferia de São Paulo. MÉTODO: Pacientes que procuraram tratamento para alcoolismo em 2002 foram convidados para reavaliação em 2007 para estudo de seguimento retrospectivo. A entrevista consistiu de questões sociodemográficas e questionários que avaliaram a dependência alcoólica e o padrão do consumo. Pesquisa adicional sobre fatores de risco e de proteção e envolvimento com crime foi contemplada neste estudo. RESULTADOS: A alta taxa de mortalidade (16,9% n = 41) e a dependência grave de álcool foi confirmada em 97,4% da amostra. O grupo se mostrou homogêneo, média de idade (42 anos), sexo masculino (81,9%), raça negra (57,5%), desempregados (52,2%), proveniente de classe social E e D (100%). Indivíduos com até 35 anos sem afiliação religiosa e tendo consumido muito álcool no ultimo mês apresentaram 2,7 mais chances de cometer crimes (95% IC = [1,22; 5,93] p = 0,014). Indivíduos que consumiram álcool no ultimo mês também tiveram suas chances 4,1 vezes maiores de estarem envolvidos com o crime (95% IC = [1,2; 14,24] p = 0,024). CONCLUSÃO: O consumo alcoólico na periferia foi associado a altas taxas de criminalidade e mortalidade, e a afiliação religiosa foi associada negativamente com comportamento delinquente.

OBJETIVO: Analisar a evolução do consumo entre usuários de crack com histórico de tratamento. MÉTODOS: Uma coorte de, originalmente, 131 dependentes de crack admitidos em uma enfermaria de desintoxicação em São Paulo, SP, entre 1992 e 1994, foi re-entrevistada em três ocasiões: 1995-1996, 1998-1999 e 2005-2006. As variáveis averiguadas foram: dados demográficos, comportamento sexual de risco, padrões de consumo de crack e outras substâncias, prisões, desaparecimentos e óbitos. Na análise estatística empregou-se o teste de qui-quadrado, a regressão logística multinomial e regressão de Cox. RESULTADOS: Dos pacientes avaliados, 43 estavam abstinentes do crack (12 meses ou mais), 22 eram usuários, 13 estavam presos, dois desaparecidos e 27 estavam mortos. Foram identificados três grupos com trajetórias distintas de consumo pós-alta. Comportamento seguro com uso de preservativo foi identificado como fator relacionado ao grupo de abstinentes estáveis (p = 0,001). Teste HIV positivo na internação (p = 0,046); consumo de cocaína aspirada no último ano (p = 0,001) e tempo de uso de cocaína aspirada na vida (mais de 132 meses) (p = 0,000) foram fatores relacionados a uso de longo termo. Uso pregresso de cocaína endovenosa aumentou em 2,5 vezes as chances de óbito em 12 anos (p = 0,031) (IC95%: 1,08; 5,79). CONCLUSÕES: A recorrência e persistência do consumo nos anos pós-alta de tratamento refletem novas modalidades de uso do crack. Por outro lado, padrões de abstinência estável apontam a viabilidade dos processos de recuperação relativos ao uso de crack.OBJETIVO: Analizar la evolución del consumo entre usuarios de crack con historia de tratamiento. MÉTODOS: Una cohorte de, originalmente, 131 dependientes de crack admitidos en una enfermería de desintoxicación en Sao Paulo, Sureste de Brasil, entre 1992 y 1994, fueron entrevistados nuevamente en tres ocasiones: 1995-1996, 1998-1999 y 2005-2006. Las variables investigadas fueron: datos demográficos, comportamiento sexual de riesgo, patrones de consumo de crack y otras sustancias, prisiones, desaparecimientos y óbitos. En el análisis estadístico se utilizó la prueba de chi-cuadrado, la regresión logística mulinomial y regresión de Cox. RESULTADOS: De los pacientes evaluados, 43 estaban abstinentes del crack (12 meses o más), 22 eran usuarios, 13 estaban presos, dos desaparecidos y 27 estaban muertos. Se identificaron tres grupos con trayectorias distintas de consumo post-alta. Comportamiento seguro con uso de preservativo fue identificado como factor relacionado al grupo de abstinentes estables (p=0,001). Prueba VIH positiva en la internación (p=0,046); consumo de cocaína aspirada en el último año (p=0,001) y tiempo de uso de cocaína aspirada en la vida (más de 132 meses) (p=0,000) fueron factores relacionados al uso por largo tiempo. Uso previo de cocaína endovenosa aumentó en 2,5 veces las chances de óbito en 12 años (p=0,031) (IC95%:1,08;5,79). CONCLUSIONES: La recurrencia y persistencia de consumo en los años post-alta de tratamiento reflejan nuevas modalidades de uso de crack. Por otro lado, patrones de abstinencia estable apuntan la viabilidad de los procesos de recuperación relativos al uso de crack.OBJECTIVE: To analyze the evolution of drug use among treated crack cocaine users. METHODS: A cohort originally comprising 131 crack addicts admitted to a detoxification unit in the city of São Paulo, Southeastern Brazil, between 1992 and 1994 were followed up on three occasions: 1995-96, 1998-99, and 2005-06. Variables investigated included demographical data, risky sexual behaviors, intake patterns for crack and other substances, incarceration, disappearance, and death. Statistical analysis was carried out using chi-square tests, multinomial logistic regression and Cox regression. RESULTS: Among the patients evaluated, 43 were crack-free (12 months or longer), 22 were users, 13 were imprisoned, two were missing, and 27 were deceased. Three groups with distinct post-discharge drug use patterns were identified. Safe sexual behavior (condom use) was correlated with stable abstinence (p=0.001). Positive HIV test upon admission (p=0.046), use of snorted cocaine in the last year (p=0.001), and lifetime use of snorted cocaine (132 months or longer) (p=0.000) were associated with long term use of crack cocaine. History of intravenous cocaine use increased the probability of death at 12 years by 2.5 fold (p=0.031) (95%CI: 1.08; 5.79). CONCLUSIONS: Recurrence and persistence of crack use in the years following discharge reflect new modalities of drug use. On the other hand, stable abstinence patterns provide evidence of the feasibility of recovery from crack addiction.

OBJECTIVE: To describe patterns of alcohol consumption in the adult Brazilian population. METHOD: Multicluster random sample of 2,346 subjects 18 years of age or older, selected nationwide. Interviews were conducted in respondents' homes between November 2005 and April 2006. RESULTS: About 48% of the sample had not drunk alcoholic beverages in the past year, with variations by gender, age, marital status, education, income and region of the country. Among drinkers, 29% reported drinking 5 or more drinks per occasion (men, 38%). Sociodemographic variables are associated with the frequency and amount of drinking, alcohol problems, and alcohol abuse and dependence. Among the whole sample (including drinkers and non drinkers), 28% reported binge drinking, 25% reported at least one kind of alcohol related problem, 3% were alcohol abusers and another 9% were alcohol dependent. DISCUSSION: Abstinence is high in the Brazilian population. However, elevated proportions of those who drink consume alcohol in a high risk pattern (binge-drinking), report a high level of alcohol problems, alcohol abuse and dependence. National public policies must consider these factors, as well as the regional Brazilian differences.OBJETIVO: Apresentar os padrões de consumo de bebidas alcoólicas entre a população adulta brasileira. MÉTODO: Amostra de 2.346 indivíduos, cuidadosamente selecionada da população brasileira com 18 anos ou mais. Amostra selecionada em todo o território brasileiro, por meio de procedimento probabilístico em múltiplos estágios. As entrevistas, realizadas nas residências, ocorreram entre novembro de 2005 e abril de 2006. RESULTADOS: 48% da amostra relataram não haver bebido no último ano e esse índice variou de acordo com sexo, idade, estado civil, nível educacional e de renda e região do país. Entre aqueles que bebiam, 29% consumiam usualmente cinco ou mais doses por ocasião (38% entre os homens). Fatores sociodemográficos foram relevantes em relação a todas as variáveis de consumo estudadas: frequência, quantidade, problemas, abuso e dependência. Na amostra total, incluindo os não-bebedores, 28% beberam em binge, 25% relataram ao menos um tipo de problema relacionado ao consumo, 3% preencheram critério para abuso e 9% para dependência. DISCUSSÃO: O grau de abstinência da população brasileira é alto. No entanto, os bebedores apresentam elevado nível de consumo de risco. A prevalência de problemas relacionados ao consumo, abuso e dependência de álcool também é significativa. Políticas públicas nacionais devem levar em conta esses fatores assim como as diferenças regionais.

OBJECTIVE: To describe patterns of alcohol consumption by adolescents in Brazil. METHOD: From November 2005 to April 2006, a sample composed of 661 subjects aged between 14 to 17 years was rigorously selected in Brazil using a multistage probabilistic method to represent the profile of the adolescent Brazilian population. RESULTS: 34% of Brazilian adolescents drink alcoholic beverages. The mean age of drinking initiation was 14 years of age. Older adolescents, as well as those living in the southern part of Brazil, those who are not attending school and those who are working, and black individuals and those with personal income reported a higher frequency of drinking. Socio-demographic factors such as gender, income bracket, family income and student status do increase the amount of alcohol consumed. Males report a higher frequency of binge drinking than females. Moreover, more than half of the males that had drunk in the previous year reported having engaged in binge drinking on at least one occasion. Beer represents approximately half of all the drinks consumed by adolescents. There was no significant difference between genders in the kind of alcohol consumed. DISCUSSION: Among adolescents who drink, the consumption of several drinks is frequent. Alcohol consumption varies from region to region, social economic status (including self-generated income) and age. These findings are discussed in light of their importance for the development of alcohol prevention policies in Brazil.OBJETIVO: Apresentar um panorama nacional sobre o padrão de consumo de bebidas alcoólicas entre adolescentes no Brasil. MÉTODO: Amostra rigorosamente selecionada em procedimento probabilístico em múltiplos estágios em todo o território brasileiro, de novembro de 2005 a abril de 2006, representando um perfil da população adolescente brasileira, composta por 661 sujeitos entre 14-17 anos. RESULTADOS: 34% dos adolescentes brasileiros bebem. A idade média de início da experimentação de bebidas alcoólicas foi de 14 anos. Adolescentes mais velhos, habitando a região Sul, que não estudam, que trabalham, de cor negra e que têm rendimento próprio apresentaram maior frequência de consumo. A quantidade usual consumida varia de acordo com sexo, classe social, renda familiar e o fato de estudar ou não. Os jovens do sexo masculino se destacam por apresentarem um percentual bem maior do beber em binge quando comparados com as jovens e mais da metade dos adolescentes do sexo masculino que bebem o fizeram em binge em pelo menos em uma ocasião. Aproximadamente metade das doses consumidas por adolescentes é de cerveja ou chope. Com relação aos gêneros, não foi detectada diferença significativa entre tipos de bebida. DISCUSSÃO: O consumo de altas doses é frequente entre os adolescentes. Os padrões de consumo dos adolescentes apresentam variações em relação a região, estrato social, rendimentos próprios e idade. Os achados têm importância para o estabelecimento de políticas nacionais.

OBJETIVO: Realizar uma atualização sobre o abuso de cannabis em pacientes com transtornos psiquiátricos. MÉTODO: Busca de artigos nas bases de dados eletrônicas Medline, The Cochrane Library Database, Lilacs, PubMed e SciELO, utilizando os descritores "marijuana abuse", "cannabis abuse", "psychiatric disorders" AND "mental disorders"; incluindo artigos que avaliaram ambas as exposições para abuso e dependência de cannabis e qualquer outro transtorno psiquiátrico. Foi considerado o período até dezembro de 2009. RESULTADOS: Observou-se que o abuso frequente de cannabis pode aumentar o risco para o desenvolvimento de esquizofrenia e de sintomas psicóticos crônicos, embora estes achados ainda careçam de comprovação. A cannabis parece ser uma das drogas de escolha de portadores de transtorno afetivo bipolar, sendo que é descrito que estados maníacos podem ser induzidos pelo seu consumo. O abuso de maconha também frequentemente co-ocorre em indivíduos com transtornos ansiosos, sendo que a relação de cronicidade destas condições e o consumo de maconha ainda é incerta. Para depressão ainda não existem evidências claras que apontem que o consumo de cannabis ocorre como forma de automedicação. Em indivíduos com transtornos psiquiátricos, há relatos de que o uso da cannabis pode exacerbar sintomas positivos, somar efeitos negativos no curso do transtorno, contribuir para pior adesão ao tratamento e levar a maior número de hospitalizações. CONCLUSÃO: O abuso de cannabis em pacientes com transtornos psiquiátricos como esquizofrenia, transtornos do humor e ansiosos tem impacto negativo tanto na fase aguda quanto em fases mais avançadas destas condições, embora futuros estudos avaliando estas associações ainda sejam necessários.OBJECTIVE: To perform an update on cannabis abuse by patients with psychiatric disorders. METHOD: A search was performed in the electronic databases Medline, The Cochrane Library Database, Lilacs, PubMed, and SciELO, using the keywords 'marijuana abuse', 'cannabis abuse', 'psychiatric disorders', and 'mental disorders'. Articles published until December 2009, dealing with cannabis abuse and dependence in association with other psychiatric disorders were included. RESULTS: Cannabis abuse was found to be associated with increased risk for the onset of schizophrenia and chronic psychotic symptoms, although these findings require confirmation from additional research. Cannabis seems to be one of the drugs of choice of individuals with bipolar disorder, despite evidence that manic states can be induced by its use. Cannabis abuse also occurs frequently in individuals with anxiety disorders, but the relationship between the chronic nature of these conditions and the use of marijuana remains uncertain. In respect to depression, there is no clear evidence to date that depressive patients use cannabis as a form of self-medication. In individuals with psychiatric disorders, the use of cannabis has been associated with increased positive symptoms, additional negative symptoms in the course of illness, impaired treatment compliance, and more hospitalizations. CONCLUSION: The abuse of cannabis by patients with psychiatric disorders such as schizophrenia and mood and anxious disorders has a negative impact both in the acute and advanced stages of these conditions, although further investigation on this association is still necessary.

OBJECTIVE: To investigate the association of cocaine and marijuana use during adolescent pregnancy in São Paulo-SP, Brazil, with psychiatric disorders, social status and sexual history. METHOD: One thousand pregnant adolescents were assessed by using the Composite International Diagnostic Interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo. Hair samples were collected for analysis. RESULTS: The following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 years of age, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disorder, post-traumatic stress disorder, and somatoform disorder. CONCLUSION: In early adolescence pregnancy, having 3 or more sexual partners in life for this population is significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.OBJETIVO: Investigar, numa população de gestantes adolescentes de uma maternidade pública de São Paulo-SP, Brasil, a associação entre o consumo de cocaína e maconha durante a gravidez com distúrbios psiquiátricos, status social e história sexual. MÉTODO: Mil adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico e socioeconômico no centro obstétrico de um hospital público de São Paulo. Destas, foi colhida amostra para análise de fios de cabelo. RESULTADOS: Os seguintes dados foram associados com o uso de cocaína e/ou maconha durante o terceiro trimestre de gravidez: ter menos de 14 anos, ter história de mais do que três parceiros sexuais e ter transtornos psiquiátricos, em especial, transtorno afetivo bipolar, transtorno do estresse pós-traumático e transtorno somatoforme. CONCLUSÃO: Na população de adolescentes grávidas avaliada, ter menos de 14 anos e ter três ou mais parceiros sexuais na vida está significativamente associado ao uso de maconha ou cocaína durante a gestação. Esta associação sugere que programas de intervenção específicos devem ser dirigidos a essas jovens.

OBJETIVO: Estimar a prevalência de violência por parceiros íntimos e o consumo de álcool durante os eventos dessa violência. MÉTODOS: Estudo transversal com amostra probabilística de múltiplos estágios, representativa da população brasileira, composta por amostra de 1.445 homens e mulheres casados ou vivendo em união estável, entrevistados entre novembro de 2005 e abril de 2006. As entrevistas foram realizadas na casa dos entrevistados, usando um questionário fechado padronizado. As taxas de prevalência de violência por parceiros foram estimadas e testes qui-quadrado foram empregados para avaliar as diferenças de gênero nessa prevalência. RESULTADOS: Homens apresentaram uma prevalência geral de 10,7% de episódios de violência por parceiros e as mulheres 14,6%. Homens consumiram álcool em 38,1% dos casos de e as mulheres em 9,2%. Com relação à percepção de consumo de álcool pela companheira, homens informaram que sua parceira consumia em 30,8% dos episódios de violência e mulheres que o seu parceiro fazia ingestão de álcool em 44,6% dos episódios. CONCLUSÕES: As mulheres se envolveram em mais episódios de (perpetração, vitimização ou ambos) leves e graves do que os homens. A freqüência quatro vezes maior de relatos de homens alcoolizados durante os eventos permitem supor que a prevenção à violência por parceiros possa se beneficiar de políticas públicas de redução do consumo de álcool.

OBJECTIVE: The objective of the present study, with focus on gender, was aimed at evaluating alcohol-dependent individual in terms of socio-demographic variables related to alcohol consumption and therapeutic interventions. METHODS: This is a retrospective cross-sectional study of 1,051 patients (833 men and 218 women), with diagnosis of alcohol dependence syndrome, according to ICD-10 criteria, who had sought treatment for the first time at a specialised health centre between 2000 and 2006. RESULTS: The results showed that women, compared to men, are more likely to be unemployed and without partner, in addition to having higher educational level, latter age of alcohol initiation, needing less outpatient alcohol detoxification program, consuming more fermented beverage, presenting less psychiatric comorbidities, and using less coadjutant medications during treatment. CONCLUSION: We can state that some peculiarities exist permeating both gender and alcohol consumption. A further focus on the characteristics of each population is needed to facilitate the adequate use of therapeutic interventions according to gender specificities.OBJETIVO: O objetivo do presente estudo, com foco no gênero, foi avaliar dependentes de álcool em termos de variáveis sociodemográficas, relacionadas ao consumo de álcool e intervenções terapêuticas. MÉTODOS: Este é um estudo retrospectivo transversal com 1.051 pacientes (833 homens e 218 mulheres), com diagnóstico de síndrome de dependência do álcool, de acordo com o CID-10, que procuraram tratamento pela primeira vez em um serviço especializado, entre 2000 e 2006. RESULTADOS: Os resultados mostraram que as mulheres, comparadas aos homens, eram desempregadas e sem companheiro, além de ter melhor nível educacional, iniciarem o consumo alcoólico mais tardiamente, necessitarem menos do programa de desintoxicação alcoólica ambulatorial, consumirem mais bebidas fermentadas, apresentarem menos comorbidades psiquiátricas e usarem menos medicamentos coadjuvantes durante o tratamento. CONCLUSÃO: Pode-se afirmar que existem algumas peculiaridades que permeiam ambos os gêneros e o consumo alcoólico. É necessário ampliar o foco nas características de cada população, a fim de facilitar intervenções terapêuticas mais ajustadas, de acordo com as especificidades.

OBJECTIVE: This paper aims to present and discuss the Transtheoretical Model and its importance for the treatment of substance abuse disorders. METHOD: A literature review was made based on articles from the last 10 years in substance use with human subjects found in PubMed (Medline) and the Scientific Electronic Library Online, as well as on the main books written by the creators of the model. From the initial collection of articles related to the Transtheoretical Model, the University of Rhode Island Assessment and substance abuse, those related to other health conditions were excluded. Although articles related to hospitalization were also excluded, as were those related to the Minnesota Model, treatment proposals were included. RESULTS: Although the TTM has been studied for over 20 years, new concerns regarding the initial idea continue to arise. Such concerns include the cross-sectional design of studies employing the model, as well as the prescriptive versus descriptive point of view. DISCUSSION: The review of the Transtheoretical Model brought intentional behavior change to light, which could broaden the understanding of addictive behaviors. Together with its concepts of processes and stages of change, the Transtheoretical Model provides professionals with the idea that the effectiveness of therapy is dependent upon the capability of the therapist to match the technique to the current motivational stage of the patient in the process of change. This demonstrates the importance of identifying the stage of change of the patient when they present for treatment. Here, we describe the principal elements of the Transtheoretical Model, as well as the instruments currently used to identify the stage of change. Finally, criticisms and limitations of the model are discussed.OBJETIVO: Este artigo tem como objetivos a apresentação e discussão do Modelo Transteórico e sua importância para o tratamento da dependência química. MÉTODO: Foi feita revisão de literatura baseada em artigos dos últimos 10 anos sobre abuso de substâncias com sujeitos humanos encontrados no PubMed (Medline) e a Scientific Electronic Library Online, bem como as principais obras dos idealizadores da Teoria. Dos artigos encontrados inicialmente sobre o Modelo, University of Rhode Island Assessment e dependência química, aqueles relacionados a outras condições de saúde foram excluídos. Propostas de tratamento foram consideradas (exceto Modelo Minnesota e internação). RESULTADOS: Novas diretrizes surgem sobre a idéia inicial da teoria, apesar da mesma já ser estudada há mais de 20 anos: estudos transversais empregando o modelo, bem como a avaliação do potencial prescritivo ou descritivo do mesmo. DISCUSSÃO: Esta teoria enfoca a mudança intencional de comportamento, o que ampliou a compreensão dos comportamentos aditivos. O Modelo Transteórico sugere aos profissionais que a efetividade do tratamento depende da capacidade do mesmo de aplicar a técnica adequada à situação motivacional do paciente no processo de mudança. Isto demonstra porque é tão importante identificar o estágio de mudança do paciente quando este ingressa no tratamento. O artigo descreve os principais elementos da teoria bem como os principais instrumentos usados atualmente para identificar os estágios. Por fim, são discutidas as críticas e as limitações do modelo.

O estudo objetivou avaliar a prevalência de abuso físico e exposição à violência parental na infância, segundo características sócio-demográficas. Um procedimento de amostragem de múltiplos estágios foi usado para selecionar 3.007 indivíduos de 14 anos de idade ou mais, entre 2005/2006, incluindo sujeitos de todas as regiões do país, assim, os resultados são nacionalmente representativos. Foram acessadas experiências de abuso físico (bater, bater com alguma coisa, queimar/escaldar, ameaçar/usar faca ou arma) e exposição à violência parental (testemunhou ameaça e/ou agressão física parental) na infância. Realizaram-se as análises através do teste qui-quadrado de Pearson. A prevalência de história de abuso físico na infância foi de 44,1%, sendo que 33,8% relataram história de abuso físico moderado e 10,3% abuso físico severo. A prevalência de exposição à violência parental foi de 26,1%, sendo que 7,5% testemunharam violência parental moderada e 18,6% testemunharam violência parental severa na infância. Análises combinadas entre estes dois tipos de violência demonstraram significativas associações entre elas. Estes resultados podem ajudar na implementação de estratégias de intervenção alertando profissionais de saúde para alta prevalência deste tipo de violência na população.The aim of this study was to investigate the prevalence of physical abuse and exposure to parental violence during childhood, in relation to socio-demographic characteristics. Multi-stage sampling was used to select 3,007 individuals 14 years or older in 2005-2006, from all regions of the country. The study detected cases of physical abuse (beating, striking with objects, burning or scalding, threatening and/or using knives or firearms) and exposure to parental violence (witnessing parental threats and/or actual physical aggression) during childhood. Analyses were performed with the Pearson chi-square test. Prevalence of history of physical abuse in childhood was 44.1% (33.8% moderate, 10.3% severe). Prevalence of exposure to parental violence was 26.1% (7.5% witnessed moderate parental violence and 18.6% severe). Combined analyses of these two types of violence showed significant associations between them. The findings may help implement intervention strategies to call the attention of health professionals to the high prevalence of this type of violence.

OBJECTIVE: Brazil lacks information about driving under the influence of alcohol (DUI) originated from representative samples obtained from the general population. METHOD: 333 subjects with a valid driver's license and drinking in the last 12 months were drawn from a multistaged sample of 2,346 adults from the first Brazilian Household Survey of Patterns of Alcohol Use. A multivariate analysis was conducted to understand the associations between risk factors and driving after drinking three or more drinks. RESULTS: the overall DUI prevalence reported in the sample was 34.7% - 42.5% among males and 9.2% among females. Being male (OR = 6.0, 95% CI 2.9-12.6), having a previous DUI accident (OR = 7.9, 95% CI 2.5-24.9), binging in the last year (OR = 2.2, 95% CI 1.03-4.5) and having an unfavorable opinion towards policies (OR = 2.9, 95% CI 1.4-6.2) remained associated with heavy drinking and driving after model adjustments. DISCUSSION: This was the first study evaluating driving under the influence of alcohol in a representative sample of the Brazilian population. The prevalence of DUI found is alarming, and possibly underestimated in the sample. Results demonstrate the need for more studies on this association and show directions towards preventive strategies for the specific high-risk group of male drivers with previous problems with alcohol and unfavorable opinions about prevention policies.OBJETIVO: O Brasil carece de informação sobre beber e dirigir a partir de amostras representativas da população. MÉTODO: Uma amostra de 2.346 adultos do I Levantamento Nacional Domiciliar sobre Padrões de Consumo de Álcool forneceu 333 indivíduos com carteira de motorista e que haviam bebido álcool nos últimos 12 meses. Utilizou-se análise multivariada para compreender associações entre fatores de risco e dirigir após três ou mais drinques. RESULTADOS: A prevalência de beber e dirigir na amostra foi 34,7% - 42,5% nos homens e 9,2% nas mulheres. Ser homem (OR = 6,0; IC95% 2,9-12,6), ter tido acidente prévio com beber e dirigir (OR = 7,9; IC95% 2,5-24,9), ter tido "consumo excessivo episódico" no ultimo ano (OR = 2,2; IC95% 1,03-4,5) e ter uma opinião desfavorável sobre políticas públicas (OR = 2,9; IC95% 1,4-6,2) mantiveram-se associados com consumo pesado e dirigir após ajustes no modelo. DISCUSSÃO: Este é o primeiro estudo que avalia beber e dirigir em uma amostra representativa da população brasileira. A prevalência de beber e dirigir encontrada é alarmante e possivelmente subestimada nesta amostra. Os achados demonstram a necessidade de outros estudos sobre esta associação, e dão indicações sobre possíveis estratégias preventivas para este grupo específico de motoristas masculinos com problemas prévios com álcool e opiniões desfavoráveis sobre políticas de prevenção.

OBJECTIVE: Describe suicide attempts assisted in an emergency room (ER) and acute substance consumption or dependence on these individuals. METHODS: Descriptive epidemiologic study was carried out during one year, evaluating suicide attempts assisted at Embu das Artes ER, São Paulo, Brazil. Patients were scheduled to a non structured psychiatric interview. Main outcomes measures were: socio demographic data, suicide attempt method, drugs or alcohol acute use in the six hours prior to attempt, patients with ICD-10 substance dependence diagnosis. The descriptive analyses and chi-square test (p < 0.05) were used to verify associations between the variables studied. RESULTS: sample was formed of 80 patients, mean age of 26.9 years (SD = 8.91), predominantly female (72.5%) and 21.2% adolescents. Most suicide attempts were made through medicine ingestion (62.5%). Approximately 21.2% and 7.5% related to have used alcohol and an illicit drug respectively within 6 hours prior to attempt and 10% were found to be substance dependent. All substance dependents had attempted suicide previously (p-value = 0.4). There was a significant association between suicide attempt through medicine ingestion and psychiatric treatment history (p = 0.02). CONCLUSION: More national studies are necessary to consider the role of alcohol and drug in suicide attempts assisted in ER, especially in chemical dependents whose suicidal behavior is relevant.OBJETIVO: Descrever as tentativas de suicídio atendidas em um pronto-socorro (PS) e o consumo agudo ou dependência de substâncias nestes indivíduos. MÉTODOS: O estudo epidemiológico descritivo foi conduzido durante um ano para avaliação de tentativas de suicídio assistidas em um PS de Embu das Artes, SP. Os pacientes foram agendados para uma entrevista psiquiátrica não estruturada. As principais variáveis de desfecho foram: dados sociodemográficos, métodos da tentativa de suicídio, uso de álcool ou drogas seis horas antes da tentativa, pacientes com diagnóstico de dependência de substância pela CID-10. Utilizaram-se a análise descritiva e o teste qui-quadrado (p < 0,05) para verificar associações entre as diversas variáveis estudadas. RESULTADOS: A amostra constituiu-se de 80 casos, cujos participantes tinham idade média de 26,9 anos (DP = 8,91), predominantemente de mulheres (72,5%), 21,2% de adolescentes. A maioria das tentativas de suicídio foi por ingesta de medicação (62,5%). Aproximadamente 21,2% e 7,5% relataram ter feito uso de álcool e de drogas ilícitas, respectivamente, nas seis horas que antecederam a tentativa e 10% da amostra têm dependência de substâncias. Todos os dependentes de substâncias já tentaram suicídio anteriormente (p-valor = 0,4). Houve associação significativa entre a forma da tentativa de suicídio por ingesta de medicação e histórico de tratamento psiquiátrico (p = 0,02). CONCLUSÃO: Mais estudos nacionais são necessários para considerar o papel do uso de álcool e drogas em tentativas de suicídio assistidas em PS, especialmente em dependentes químicos cujo comportamento suicida é relevante.

OBJETIVO: O objetivo deste estudo é avaliar a eficácia da naltrexona com intervenção breve em pacientes com dependência de álcool. MÉTODO: Este estudo é um ensaio clínico randomizado, duplo-cego, placebo-controlado de 12 semanas. A amostra de 71 pacientes foi dividida randomicamente em dois grupos (um recebendo naltrexona e outro placebo). Sujeitos dependentes de álcool foram tratados com 50 mg de naltrexona ou placebo diariamente por 12 semanas. Ambos os grupos de tratamento receberam intervenção breve. Os desfechos clínicos primários para este estudo foram taxa de recaída e mudança no padrão de consumo de álcool. RESULTADOS: Na intenção de tratar, menor porcentagem de sujeitos tratados com naltrexona recaíram (3% 21%; p = 0,054). Naltrexona com intervenção breve não foi superior ao placebo para diminuir os dias de consumo (6,2 + 10,6 3,05 + 7,3; p = 0,478), os dias de consumo moderado (0 2,2 + 6,9; p = 0,345) e os dias de consumo pesado (0,03 + 0,2 0,3 + 0,9; p = 0,887). Naltrexona foi bem tolerada. Os efeitos adversos mais frequentes na presente amostra foram: cefaleia (25,4%), sonolência (20,9%), náuseas (16,4%), hiperfagia (16,4%), anorexia (14,9%), ansiedade (10,4%), pirose (10,4%) e irritabilidade (10,4%). CONCLUSÕES: Embora o grupo naltrexona tenha demonstrado tendência para reduzir taxa de recaída (> 5 doses/dia), não foi encontrada nenhuma diferença em outras variáveis de consumo de álcool entre os grupos naltrexona e placebo. Estudos futuros devem examinar a eficácia desse tipo de combinação de tratamento nos cuidados primários de saúde.OBJECTIVE: The objective of this study is to evaluate the efficacy of naltrexone with brief intervention among patients with alcohol dependence. METHOD: This study is a 12-week randomized, double blind, placebo-controlled clinical trial. The sample of 71 patients was randomly divided in two groups (one receiving naltrexone and the other placebo). Alcohol-dependent subjects were treated with 50 mg of naltrexone or placebo daily for 12 weeks. Both treatment groups received brief intervention. The primary results for this study were relapse rate and change in drinking behaviors. RESULTS: In the intention-to-treat fewer naltrexone treated subjects relapsed (3% 21%; p = 0.054). Naltrexone with brief intervention was not effective in decreasing drinking days (6.2 + 10.6 3.05 + 7.3; p = 0.478), moderate drinking days (0 2.2 + 6.9; p = 0.345) and heavy drinking days (0.03 + 0.2 0.3 + 0.9; p = 0.887). Naltrexone was well tolerated. The most frequent adverse effects in our sample were: headache (25.4%), drowsiness (20.9%), nausea (16.4%), hyperphagia (16.4%), anorexia (14.9%), anxiety (10.4%), heartburn (10.4%) and irritability (10.4%). CONCLUSIONS: Although the naltrexone group showed a tendency to reduce relapse rate (> 5 drinks/day), no differences were found in other alcohol consumption variables between naltrexone and placebo groups. Further studies should examine the efficacy of this kind of treatment combination in the primary health care.

OBJECTIVE: To evaluate anticraving action and tolerability of topiramate in cocaine user treatment. METHOD: Male users of inhaled cocaine which met criteria for cocaine dependence (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were selected for outpatient 12-week, open label trial with topiramate; individual dosage ranged between 25-300 mg/day. Main clinical variables were abstinence rate, craving intensity, frequency and duration, adherence, dropouts, side effects and impulsivity measure through Barratt Impulsivity Scale. Patients received assertive strategic counseling for abstinence assistance and medication monitoring evaluation every two weeks. Comparative analysis was made with intention to treat, missing values were replaced (last observation carried forward), and significance level was 5%. RESULTS: Adherence to treatment was 57% (at least three evaluations), 32% dropped out (one evaluation). There were no severe side effects. Negative test average was 25.4% (31.2). Significant reduction in craving intensity and duration was observed in 25% of the sample. No statistical significant reduction in craving frequency was observed in 7.1%. Increase in frequency was observed in 10.7% and 82.1% did not present any variation. No significant statistical variations in Barratt Impulsivity Scale or in the total score were found in the final evaluation when compared to baseline. CONCLUSION: More randomized placebo-controlled trials with topiramate for cocaine dependants should be performed to evaluate preliminary evidence.OBJETIVO: Avaliar a ação anticraving e tolerabilidade do topiramato em usuários de cocaína. MÉTODO: Homens usuários de cocaína inalada que preenchiam critérios para dependência de cocaína (Manual Diagnóstico e Estatístico de Desordens Mentais, quarta edição) foram selecionados para 12 semanas de tratamento ambulatorial, em ensaio clínico aberto com topiramato; dosagens escalonadas entre 25-300 mg/dia. As principais variáveis clínicas foram taxa de abstinência, intensidade, freqüência e duração do craving, aderência, perdas, efeitos colaterais e impulsividade medida por meio da Escala de Impulsividade Barratt. Os pacientes receberam estratégias assertivas de aconselhamento para manutenção da abstinência e monitoramento da medicação avaliada a cada duas semanas. Análises comparativas foram feitas com intenção de tratar, valores perdidos foram substituídos (última observação carregada ao final) e o nível de significância de 5%. RESULTADOS: A aderência ao tratamento foi de 57% (pelo menos três avaliações), 32% de perdas (uma avaliação). Não houve efeitos colaterais graves. A média de testes negativos foi 25,4% (31,2). Significante redução na intensidade e duração do craving foi observada em 25% da amostra. Nenhuma redução significativa na freqüência do craving foi observada em 7,1%. Aumento na freqüência foi observado em 10,7% e 82,1% não apresentaram nenhuma variação. Nenhuma variação estatisticamente significativa na Escala de Impulsividade Barratt ou na pontuação total foi encontrada no final da avaliação quando comparado à inicial. CONCLUSÃO: Mais ensaios clínicos placebo-controlados com o topiramato para dependentes de cocaína deveriam ser conduzidos a fim de avaliar a evidência preliminar.

Os problemas decorrentes do consumo de álcool em motoristas são estudados internacionalmente, e estudos epidemiológicos indicam alta prevalência de morbidade e mortalidade relacionadas ao beber e dirigir, entretanto existem escassos dados nacionais a respeito. Neste presente estudo, 913 condutores de veículos foram parados, em vias públicas de tráfego com maiores concentrações de bares, restaurantes e casas noturnas, em Belo Horizonte, Minas Gerais, Brasil e solicitados que respondessem a um questionário e fizessem o teste do bafômetro ativo. Esta pesquisa foi realizada no mês de dezembro de 2005 e dezembro de 2006. Para tanto, adotamos a metodologia do tipo pontos de fiscalização de sobriedade utilizada internacionalmente. Na nossa amostra, 38,0% dos motoristas apresentavam algum traço de álcool no ar expirado e 19,6% estavam com níveis de álcool iguais ou acima dos limites legais (0,6g/l). Esses dados foram cinco vezes maiores do que aqueles encontrados em pesquisas semelhantes, em outros países. Os achados deste estudo sugerem a relevância do problema na cidade de Belo Horizonte (e provavelmente no Brasil), a necessidade de pesquisas permanentes, do desenvolvimento de políticas públicas específicas para o assunto e do eficaz cumprimento da lei existente.Problems resulting from alcohol consumption by drivers have been studied worldwide, and epidemiological research points to high injury and death rates related to drinking-and-driving. However, equivalent data are limited in Brazil. In this study, 913 drivers were stopped on public roads with heavy traffic and high concentrations of bars, restaurants, and nightclubs in Belo Horizonte, Minas Gerais State, and asked to answer a questionnaire and submit to an active breathalyzer test. The study was done in December 2005 and December 2006. The study adopted the internationally accepted sobriety checkpoint method. In the sample, 38.0% of drivers showed some trace of alcohol in their exhaled air, and 19.6% were at or above the legal limit (0.6g/l). These figures were five times those found in similar surveys in other countries. The findings suggest a critical drinking-and-driving problem in Belo Horizonte (and probably elsewhere in Brazil) and the need for on-going research, the development of specific public policies to deal with the problem, and effective enforcement of the existing law.

The purpose of this paper is to supply a narrative review of the concepts, history, functions, methods, development and theoretical bases for the use of halfway houses for patients with mental disorders, and their correlations, for the net construction of chemical dependence model. This theme, in spite of its relevance, is still infrequently explored in the national literature. The authors report international and national uses of this model and discuss its applicability for the continuity of services for alcohol dependents. The results suggest that this area is in need of more attention and interest for future research.

Embora cresça o número de mulheres com abuso ou dependência alcoólica, elas ainda permanecem como alvo não prioritário na tomada de decisão dos gestores de políticas públicas. OBJETIVOS: Caracterizar o perfil sociodemográfico de mulheres com abuso ou dependência do álcool, identificar o consumo alcoólico, as intervenções terapêuticas realizadas e alguns fatores que poderiam estar relacionados ao abandono precoce do tratamento nesta população. METÓDOS: Foram incluídas 192 mulheres que procuraram pela primeira vez tratamento na Unidade de Pesquisa em Álcool e Drogas (UNIAD) da Universidade Federal de São Paulo (UNIFESP), no período de 2000 a 2006. As informações foram coletadas nos prontuários das pacientes, as quais foram separadas em dois grupos, usando-se como critério o abandono de tratamento. RESULTADOS: Não houve diferença significativa nas características sociodemográficas da população estudada. Em ambos os grupos houve predomínio de solteiras, com primeiro grau incompleto e situação de desemprego. O consumo diário de destilados foi significantemente maior no grupo abandono gradual (p < 0,002). O grau de dependência grave foi significantemente maior (p < 0,001) nos dois grupos em relação aos graus leve e moderado. A quantidade de álcool ingerida por semana, o uso de medicação coadjuvante e a necessidade de atendimento psiquiátrico prévio foi significantemente maior no grupo abandono gradual (p < 0,001 e p < 0,002), respectivamente. CONCLUSÃO: Mulheres usuárias de álcool que desistiram do tratamento no primeiro mês quando comparadas às não desistentes fizeram mais uso de fermentados ou a associação deste com destilados, consumiram menos unidades de álcool por semana, usaram menos medicações coadjuvantes e procuraram menos tratamentos prévios.Although the number of women who use, abuse of and become addicted to alcohol is increasing, they are still not the main target of the health care services as their distinctive characteristics regarding psychoactive substances have not been taken into account by the public health policy decision-makers. OBJECTIVE: To characterise those women who use alcohol as well as to identify the pattern of alcohol consumption, clinical interventions, and previous treatments performed in this patient population. METHODS: This retrospective cohort study reviewed medical records of alcohol users who had sought treatments offered by UNIAD and UNIFESP between 2000 - 2006. A total of 192 patients were included in this study according to criteria for treatment dropout. RESULTS: The groups were found to have similar socio-demographic characteristics. Consumption of both fermented and distilled beverages were significantly higher in the dropout group (p = 0.002). Alcohol addiction was found to be significantly more severe in both groups (p < 0.001). Use of auxiliary medication (p < 0.001) and search for psychiatric consultation (p < 0.001) were significantly higher in the non-dropout group. CONCLUSION: Alcoholic women who abandoned the treatment during the first month, compared to those who did not, made more use of both fermented and distilled beverages, had consumed less units per week, used less auxiliary medications, and sought less treatments.

Problemas decorrentes do consumo de álcool em motoristas têm sido amplamente estudados no mundo e indicam elevadas taxas de morbidade e mortalidade relacionadas à bebida e direção. Existem poucos estudos nacionais a respeito. Assim, realizou-se estudo com o objetivo de estimar a prevalência do uso de álcool por motoristas conduzindo veículos e testar a aceitabilidade dos bafômetros ativos e passivos. Foram avaliados 908 motoristas nas principais vias de trânsito de Diadema, estado de São Paulo, de fevereiro de 2005 a março de 2006. A metodologia adotada foi do tipo pontos de fiscalização de sobriedade. Em 23,7% dos motoristas foi encontrado algum traço de álcool no ar expirado; 19,4% estavam com níveis de álcool iguais ou acima dos limites permitidos pela legislação. O bafômetro passivo mostrou-se confiável e com resultados comparáveis aos do ativo. Esses achados foram seis vezes superiores aos encontrados internacionalmente, sugerindo a relevância desse problema. São necessárias políticas específicas para combater esse problema, além de outras pesquisas em âmbito nacional.Problems due to alcohol use among drivers have been assessed worldwide and studies indicate high morbidity and mortality rates related to drinking and driving. There are few national studies about this subject. Thus, this study was conducted aiming at estimating the prevalence of drinking and driving and testing the acceptability of passive and active breathalyzers. A total of 908 drivers were tested in the main streets of a city in the state of São Paulo, from February 2005 to March 2006. The methodology adopted was sobriety checkpoints. In 23.7% of the drivers some level of alcohol was found in the exhaled air; in 19.4% alcohol level was equal to or higher than the legal limit. The passive breathalyzer was reliable and presented results comparable to the active one. These findings were six times higher than those found in similar surveys carried out in other countries, indicating the relevance of this problem. Specific public policies to fight the problem and more national studies are needed.

OBJECTIVE: In this study, we conducted a survey of all the institutions that provide treatment for psychoactive substances in the state of Espirito Santo, Brazil during the period 2004-2005. METHOD: We used a snowball sampling technique to include all the treatment facilities in our State in which we employed a semi-structured interview instrument for key informants at each institution. We present descriptive results and test differences between groups using the Chi-square test. RESULTS: In Espirito Santo, 250 institutions provide treatment for psychoactive substances and are distributed as follows: governmental (17.6%), nongovernmental (22.8%), and self-help groups (59.6%). Of these 250 institutions, 85 provide direct care, with the majority found in the Central region (70.6%) and followed by the Northern (15.3%) and Southern (14.1%) regions. The majority of those that provide direct care are private nonprofit centers (16.8%) institutions with ties to religious organizations make up nearly one-third (30.6%) of direct care providers. The drugs most consumed by those seeking care are alcohol (82.4%), tobacco (81.2%) and marijuana (68.2%). The institutions generally give assistance to people in the 26-45 years age group (89.4%); with regard to gender, the institutions take care of: men (31.8%), women (5.9%), and both sexes (56.5%). The treatment models most used are psychosocial (58.8%), therapeutic community (47.1%) and biomedical (43.5%) and the work is evaluated through the team technique (72.9 %). CONCLUSIONS: In the state of Espirito Santo, indirect care services are many times greater than those that offer direct care and the majority of all services are in the Central region. The populations in the mainland have a comparative disadvantage when it comes to treatment options for psychoactive substance use. We observed that a significant number of institutions that provide drug abuse treatment have financial support from religious organizations. The Espirito Santo State survey demonstrates the necessity of a decentralized provision of specialized care for psychoactive substance users, with substantially more services directed to the Northern and Southern regions of the state. Moreover, the emphasis of these new institutions should be on outpatient care.OBJETIVO: Foi realizado um levantamento de todas as instituiçõesque proporcionam tratamento para dependência de substâncias psicoativas no Estado do Espírito Santo, Brasil, durante o período de 2004-2005. MÉTODO: Foi utilizado o método de amostragem bola-de-neve para incluir todos os estabelecimentos de tratamento no Estado e empregada uma entrevista semi-estruturada para informantes-chave em cada instituição. Os resultados descritivos foram apresentados e as diferenças testadas entre os grupos, utilizando o teste de qui-quadrado. RESULTADOS: No Espírito Santo, 250 instituições proporcionam tratamento para dependência de substâncias psicoativas e se distribuem da seguinte forma: governamentais (17,6%), não-governamentais (22,8%) e grupos de auto-ajuda (59,6%). Destas 250 instituições, 85 proporcionam assistência direta e a maioria se encontra na região Central (70,6%), seguido pela região Norte (15,3%) e Sul (14,1%). A maioria daquelas que fazem o atendimento direto são instituições privadas e sem fins lucrativos (16,8%); as que possuem vínculos com organizações religiosas compõem quase um terço do total (30,6%) de prestadores de serviços diretos. As drogas mais consumidas pelos que buscaram atendimento são álcool (82,4%), tabaco (81,2%) e maconha (68,2%). As instituições geralmente atendem pessoas na faixa etária entre 26 e 45 anos (89,4%); com relação ao sexo, as instituições que atendem somente homens perfazem 31,8%; as que só atendem mulheres, 5,9%; e ambos os sexos, 56,5%. Os modelos de tratamento mais utilizados são o psicossocial (58,8%), a comunidade terapêutica (47,1%) e o biomédico (43,5%), sendo o trabalho avaliado por meio da técnica de grupo (72,9%). CONCLUSÕES: No Estado do Espírito Santo, os serviços de atendimento indireto são muito maiores do que os que oferecem atendimento direto; a maioria dos serviços está na região central do Estado. As populações do interior do Estado estão em desvantagem quanto às opções de tratamento para o uso de substâncias psicoativas. Foi observado que um número significativo de instituições que provêem tratamento para o abuso de drogas tem apoio financeiro de organizações religiosas. A pesquisa no Estado do Espírito Santo demonstra a necessidade da descentralização do atendimento especializado para os usuários de substâncias e de consideravelmente mais serviços direcionados às regiões Norte e Sul do Estado. Além disso, a ênfase dessas novas instituições deve ser o tratamento ambulatorial.

O artigo apresenta uma revisão sobre estudos dos problemas relacionados ao consumo de bebidas alcoólicas e as estratégias para minimizá-los, abordando recentes evidências científicas. Para tanto, realizou-se pesquisa na literatura científica sobre políticas públicas relacionadas ao álcool, por meio das buscas nas bases MEDLINE, SciELO e LILACS. Políticas que visam a diminuir o consumo de álcool têm sido implementadas pelos países para minimizar os efeitos dessa substância na saúde e segurança da população, mas só recentemente tais estratégias e intervenções foram avaliadas cientificamente. Discutem-se as políticas de melhor custo-efetividade, capazes de promover redução dos danos e dos custos socioeconômicos relacionados ao uso de bebidas alcoólicas, por meio de estratégias conducentes à mudança de comportamentos e contextos de consumo prejudiciais aplicáveis em diferentes comunidades.The article is a review of studies on alcohol-related problems and public policies for consumption reduction addressing recent national and international scientific evidences. In this way, literature review was carried out on alcohol-related public policies through searches in MEDLINE, SCiELO and LILACS databases. Policies for alcohol consumption reduction have been implemented in different countries to minimize its effects on people's health and safety but only recently such strategies and interventions have been scientifically evaluated. It is discussed better cost-effectiveness policies for reducing harmful effects and socioeconomic costs associated with alcohol use through the development of strategies favoring changes in behavior and harmful consumption contexts that can be applicable to different communities.

OBJECTIVE: The objectives of this study are to present the creation and operation of a support network to help physicians in Brazil, describe the socio-demographic profile, and investigate the prevalence of mental disorders and chemical dependence among physicians seeking treatment. METHOD: Semi-structured interviews using ICD-10 criteria were conducted to obtain data regarding alcohol/drug dependence, and psychiatric comorbidity. Socio-demographic and occupational characteristics were obtained. RESULTS: 247 patients made contact and 192 attended the first evaluation visit. Of those, 158 were male, and most (55%) were married. The mean age was 42.4 ± 11.1 years. The reasons for seeking treatment were: comorbidity between mental disorders and chemical dependence (67.7%); chemical dependence (20.8%); mental disorders (7.8%); and burnout (4.2%). The mean interval between the detection of the problem and seeking treatment was 7.5 years. Factors associated with the severity of the problem included unemployment (21.6%), difficulties of practicing professional activities (63.5%), problems with the Regional Council of Medicine (13%), psychiatric hospital admission (31.2%), and self-medication (71.8%). In our sample, 9.3% of the physicians had changed their area of specialization. CONCLUSIONS: A high prevalence of psychiatric disorders was found in this sample as well as psychosocial and professional problems. Treatment networks focusing on the physicians' mental health could catalyze cultural changes in treatment-seeking behavior, thereby improving early detection and treatment.OBJETIVO: Pretendemos apresentar a criação e o funcionamento de serviço específico para médicos no Brasil, descrever o perfil sociodemográfico, prevalência de transtornos mentais e dependência química entre médicos que buscaram o serviço. MÉTODO: Foram realizadas entrevistas clínicas semi-estruturadas baseadas no CID-10 para diagnóstico de dependência de álcool/drogas e comorbidade psiquiátrica. Um perfil sociodemográfico e ocupacional foi obtido. RESULTADOS: 247 contatos foram feitos e 192 pacientes compareceram ao primeiro atendimento. Destes, 158 eram homens, a maioria casados (55%), idade média de 42,4 ± 11,1 anos. As causas de procura por atendimento foram: comorbidade entre transtorno mental e dependência química (67,7%), dependência química (20,8%), transtornos mentais (7,8%), burnout (4,2%). O intervalo médio entre a identificação do problema e a busca de tratamento foi de 7,5 anos. Desemprego (21,6%), problemas no exercício profissional (63,5%), problemas no Conselho Regional de Medicina (13%), internação psiquiátrica pregressa (31,2%) e auto-medicação (71,8%) associaram-se à gravidade dos problemas. Mudança de especialidade ocorreu em 9,3% da amostra. CONCLUSÕES: Observamos uma prevalência alta de transtornos psiquiátricos bem como problemas psicossociais e profissionais nesta amostra. Serviços específicos de atenção à saúde mental dos médicos podem ter efeito catalisador nas mudanças culturais quanto à procura de ajuda, favorecendo a detecção precoce e tratamento.

OBJECTIVES: To investigate the relationship between age of onset, alcohol consumption patterns and related problems. METHOD: In 2004, one self-administered questionnaire was completed by 1,990 students from the 5th to 11th grades of schools in Paulínia-SP. Data collection was conducted at the classroom without the presence of the teacher. The participation in the study was voluntary and anonymous. RESULTS: Prevalence of lifetime alcohol use was 62.2%. The mean age of first use of alcohol was 12.35 (sd = 2.72) and ranged between 5 and 19 years of age. In 78% of the cases, the first use occurred before the age of 15, and more than 22% of the students reported having tried alcohol before 10 years of age. There were significant differences regarding current pattern of use: those who started earlier consumed more drinks per occasion (p = 0.013) and had more drunkenness episodes in the last 30 days (p = 0.05). A relationship between the age of first alcohol use and the use of tobacco (p = 0.017) and other drugs (p = 0.047) was observed. CONCLUSIONS: Adolescents first use alcohol in early ages, what impacts the current consumption patterns. This study emphasizes the need of actions regarding public alcohol policies in Brazil in order to prevent or delay the initiation of alcohol use and its related problems.OBJETIVOS: Investigar a relação entre idade de início de uso de álcool, padrão de consumo e problemas relacionados. MÉTODO: Em 2004, um questionário de autopreenchimento foi respondido por 1.990 alunos de 5ª série do ensino fundamental a 3ª série do ensino médio do município de Paulínia-SP. A coleta de dados foi realizada em sala de aula, sem a presença do professor. A participação no estudo era voluntária e anônima. RESULTADOS: A prevalência de uso de álcool na vida foi de 62,2%. A média de idade de primeiro uso de álcool foi de 12,35 (sd = 2,72), variando entre 5 e 19 anos. Em 78% dos casos, o primeiro uso de álcool ocorreu antes dos 15 anos, sendo que mais de 22% dos adolescentes relataram que experimentaram bebida alcoólica antes dos 10 anos. Houve diferenças significantes para padrão de consumo atual: aqueles que começaram mais cedo consumiram mais doses por ocasião (p = 0,013) e tiveram mais episódios de embriaguez nos últimos 30 dias (p = 0,05). Houve associação entre a idade de experimentação do álcool e o uso de tabaco (p = 0,017) e outras drogas (p = 0,047). CONCLUSÕES: Jovens experimentam álcool em idade precoce e isto tem impacto no padrão de consumo atual. Esse artigo enfatiza a necessidade de ações imediatas em relação às políticas públicas do álcool no Brasil para prevenir ou adiar o início do consumo de álcool e problemas relacionados.

Este artigo tem como objetivo apresentar os princípios gerais, conceitos e principais elementos da intervenção breve, com uma revisão da literatura sobre sua aplicação em pacientes alcoolizados atendidos na emergência. Aborda a aplicabilidade da triagem como primeiro passo para o processo da intervenção breve e a utilização de instrumentos padronizados e validados que proporcionam informações úteis para um feedback consistente. Finalmente, destaca os desafios associados com a triagem nas salas de emergência como falta de tempo, formação inadequada dos profissionais, medo de incomodar o paciente e crença de que os alcoolistas não respondem às intervenções. Enfatiza-se, contudo, a importância da Intervenção Breve na emergência, que é viável e eficaz e a necessidade de pesquisas para determinar os ajustamentos dos profissionais e dos serviços de saúde.The purpose of this article was to present the general principles, concepts, and main elements of brief intervention, with a literature review on its use for alcoholic patients treated at emergency rooms. It also presents the applicability of screening as a first step to the brief intervention process and the use of validated standard instruments that allow useful information for consistent feedback. Finally, it highlights the challenges associated with screening in emergency rooms due to insufficient time, inadequate professional training, fear of annoying the patient, and common beliefs that alcoholics do not respond to such interventions. Meanwhile, it emphasizes the relevancy of brief emergency intervention, which is both feasible and efficient, and the need for research to define the relevant adjustments by professionals and the health care system.

OBJETIVO: O consumo de álcool é um problema de saúde pública. A disponibilidade comercial é um importante fator no estímulo ao consumo de álcool por adolescentes. O objetivo do estudo foi verificar com que freqüência menores de 18 anos conseguem comprar bebidas alcoólicas em estabelecimentos comerciais. MÉTODOS: Adolescentes com idades entre 13 e 17 anos tentaram comprar bebidas alcoólicas em uma amostra aleatória de estabelecimentos comerciais em Paulínia (N=108) e Diadema (N=426), no Estado de São Paulo. O estudo foi realizado em novembro e dezembro de 2003 em Paulínia e de julho de 2004 a agosto de 2005 em Diadema. Eles foram orientados a não mentir sobre sua idade quando questionados e a dizer que a bebida era para consumo próprio. Os testes estatísticos realizados foram bi-caudais e o nível de significância considerado foi de pOBJECTIVE: Alcohol use is a public health problem. Commercial availability is an important factor that encourages the use of alcohol by young people. The aim of the study was to assess how often young people under 18 could buy alcohol in shops METHODS: Adolescents from 13 to 17 attempted to purchase alcoholic beverages at a random sample of shops in the cities of Paulinia (n=108) and Diadema (n=426), Southeastern Brazil. The study was conducted from November to December 2003 in Paulínia, and July 2004 to August 2005 in Diadema. They were told not to lie about their ages when asked and to say that the beverage was for themselves. Statistical tests performed were two-tailed and the significance level considered was p

Com objetivo de identificar o perfil sócio-demográfico e comportamental de gestantes adolescentes, foram entrevistadas mil adolescentes, admitidas entre 24 de julho de 2001 e 27 de novembro de 2002, em um hospital municipal de São Paulo, Brasil, correspondendo a 24,3% das internações para resolução da gestação. Setenta (7%) adolescentes foram admitidas para curetagem pós-abortamento e 930 (93%), para parturição, com idade média de 17 ± 1,5 anos. A maioria (72,4%) residia próximo ao hospital e 93% pertenciam às classes econômicas C, D e E. Na época da parturição, 627 (67,3%) adolescentes não estudavam. Apenas 23,7% das adolescentes faziam uso de método contraceptivo, 81,2% não tinham planejado a gestação e 80,1% eram primigestas. Dos partos, 67,4% foram vaginais. Dos bebês, 13,3% foram pré-termo e 15, 9%, baixo peso. Durante a gestação, o consumo referido de tabaco, de álcool e de drogas ilícitas foi, respectivamente de 17,3%, 2,8% e 1,7%. Conclui-se que gravidez na adolescência é um fenômeno complexo, associado a fatores econômicos, educacionais e comportamentais, precipitando problemas decorrentes da maternidade precoce. O presente estudo fornece subsídios para políticas públicas de saúde, visando a prevenir a gravidez na adolescência.To identify the socio-demographic behavioral profile of low-income pregnant teenagers, 1,000 adolescents admitted to a Brazilian public maternity hospital from July 24, 2001, to November 27, 2002, were interviewed. Socio-demographic and behavioral variables were assessed through a questionnaire. Over the 492 days of the study, 24.3% of admissions were adolescents (930 for childbirth and 70 for miscarriage). Mean maternal age was 17 years. Most teenagers (72.9%) lived near the hospital. 930 (93%) belonged to socioeconomic classes C, D, and E. School dropout was identified in 67.3% of the total. 80.1% of the subjects were giving birth for the first time. 81.2% had not planned the pregnancy, and 23.8% had been using some contraceptive method. 67.4% had vaginal deliveries. Some 13.3% of the newborns were premature and 15.9% had low birth weight. 17.3% of these adolescent mothers reported smoking during pregnancy, with 2.8% reporting alcohol and 1.7% illicit drugs. Teenage pregnancy is a complex phenomenon associated with various economic, educational, and behavioral factors. The study provides importance references for public policies to prevent teenage pregnancy.

OBJECTIVE: The study accompanied 131 crack-cocaine users over a 5-year period, and examined mortality patterns, as well as the causes of death among them. METHOD: All patients admitted to a detoxification unit in Sao Paulo between 1992 and 1994 were interviewed during two follow-up periods: 1995-1996 and 1998-1999. RESULTS: After 5 years, 124 patients were localized (95%). By the study endpoint (1999), 23 patients (17.6%) had died. Homicide was the most prevalent cause of death (n = 13). Almost one third of the deaths were due to the HIV infection, especially among those with a history of intravenous drug use. Less than 10% died from overdose. CONCLUSIONS: The study suggests that the mortality risk among crack cocaine users is greater than that seen in the general population, being homicide and AIDS the most common causes of death among such individuals.

OBJECTIVE: To determine the prevalence of psychiatric disorders during pregnancy, the prevalence of cocaine and marijuana use during the third trimester of gestation and the socio-demographic characteristics of a population of low-income teenagers. METHOD: One thousand pregnant teenagers were evaluated using the Composite International Diagnostic Interview, and a socio-demographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo, Brazil. Hair sample was collected for analysis. RESULTS: Of the 1000 pregnant teenagers interviewed, 53.6% were poor, 90.4% were unemployed, 92.5% were financially dependant and 60.2% dropped out of school. Those using drugs during the third trimester of pregnancy were equal to 6% (marijuana: 4%, cocaine: 1.7%, both: 0.3%). Those having at least one psychiatric disorder equaled 27.6%. The most frequent diagnoses were depression (12.9%), posttraumatic stress disorder (10.0%) and anxiety disorders (5.6%). DISCUSSION: Unstructured families, dropping out of school, unemployment and a low level of professional training are all contributing factors to the maintenance of an unfavorable socio-economic environment in which there is a high prevalence of cocaine and marijuana use during the third trimester of pregnancy and an abnormally high incidence of psychiatric disorders.OBJETIVO: Determinar, em adolescentes de baixa renda, a prevalência de transtornos psiquiátricos durante a gravidez, a prevalência de uso de cocaína e maconha no terceiro trimestre de gestação e descrever suas características sociodemográficas. MÉTODO: Mil adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico e socioeconômico no centro obstétrico de um hospital público de São Paulo. Dessas, foi colhida amostra para análise de fios de cabelo. RESULTADOS: Das mil pacientes entrevistadas, 53,6% têm baixa renda, 60,2% abandonaram a escola, 90,4% estão desempregadas e 92,5% são financeiramente dependentes, 6% usaram drogas durante o terceiro trimestre da gravidez (maconha: 4%, cocaína: 1,7%, ambos: 0,3%) e 27,6% tiveram ao menos um transtorno psiquiátrico. Os diagnósticos mais freqüentes foram: depressão (12,9%), transtorno de estresse pós-traumático (10,0%) e ansiedade (5,6%). DISCUSSÃO: Famílias desestruturadas, evasão escolar, desemprego e baixa capacitação profissional são fatores que contribuem para a manutenção desta situação socioeconômica desfavorável, cenário no qual são elementos importantes a alta prevalência de uso de cocaína e maconha no 3º trimestre da gravidez e de transtornos psiquiátricos.

Este estudo buscou analisar, em uma amostra representativa da população brasileira, as prevalências de aceitação de políticas relacionadas ao acesso, promoção, prevenção e tratamento dos problemas relacionados ao uso do álcool, bem como sua anuência para possíveis mudanças. Investigou, ainda, o perfil dos indivíduos não favoráveis às políticas por meio de avaliação da associação com variáveis sociodemográficas, consumo de outras substâncias psicotrópicas, acesso a campanhas de prevenção e exposição a propagandas de bebidas. Trata-se de estudo com desenho transversal usando dados do I levantamento Nacional de Álcool e Drogas. Uma amostra de 3.007 participantes responderam escalas sobre 16 políticas restritivas. Uma escala de aceitação foi criada, e o grupo dos 5% que menos aderiam às políticas foi analisado. As associações foram realizadas através de modelos ajustados de regressão logística (StataSE10). Observou-se que a maioria da população investigada apoia as políticas vigentes, assim como a implementação de novas leis de restrição ao consumo de álcool. Os fatores preditores de não aceitação das políticas foram: ser homem, jovem, sem relacionamento estável, com maior escolaridade, não religioso e tabagista. O uso substâncias ilícitas e abuso e/ou dependência de álcool também foram associados a não adesão às políticas de restrição avaliadas. As políticas referindo tratamento para o alcoolismo e restrição de propagandas foram as mais aceitas.Incentiva-se iniciativas de esclarecimento da importância das políticas de saúde pública direcionadas ao perfil do público menos adepto.