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Carrasco-Garrido P, Hernández-Barrera V, Jiménez-Trujillo I, Lima Florencio L, Gallardo Pino C, Yeamans S, Palacios-Ceña D. Trends in the nonmedical misuse of benzodiazepines and Z-hypnotics among school-aged adolescents (2016-2021): gender differences and related factors. Child Adolesc Ment Health 2024. [PMID: 38778447 DOI: 10.1111/camh.12716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The misuse of psychotropic medication has increased during the past decade, especially among adolescents. The aim of our study was to describe the prevalence and patterns of the nonmedical use of benzodiazepines (BDZ) and Z-hypnotics among school-aged adolescents through the lens of sex. In addition, we sought to analyze the temporal evolution of the nonmedical use of these drugs during the period 2016-2021. METHODS The temporal evolution of the nonmedical use of these drugs was analyzed based on survey data collected in 2016, 2018 and 2021, which includes the first years of the COVID-19 pandemic. To assess the possible effect of the COVID-19 pandemic, the year at survey was conducted was introduced as a categorical variable. We used data from the Spanish State Survey on Drug Use in Secondary Education, which covers drug use among students aged 14-18 years. Using multivariate logistic regression models, we estimated the independent effect of different variables (sociodemographic data, use of other psychoactive substances, risk perception and availability) on the nonmedical use of BDZ and Z-hypnotics. RESULTS In total, survey data from 95,700 adolescents were included in our analysis. The nonmedical use of BDZ and Z-hypnotics increased among adolescents during the study period. The adjusted odds ratio (AOR) from 2016 to 2018 was 1.11 (95% CI 0.94-1.31) and from 2018 to 2021 the AOR was 1.26 (95% CI 1.08-1.46), using 2016 and 2018, respectively, as reference years. The nonmedical use of BDZ and Z-hypnotics was more likely in adolescent girls than boys (AOR = 2.11). The nonmedical use of prescription opioids (AOR = 3.44), novel psychoactive substances and other illicit psychoactive drugs (AOR = 4.10) were risk factors for the nonmedical use of BDZ and Z-hypnotics in both sexes. Use of cannabis (AOR = 1.38) was a predictor of nonmedical use in female adolescents only. CONCLUSIONS This study shows that the trend of the nonmedical use of BDZ and Z-hypnotics among school-aged adolescents in Spain increased between 2016 and 2021. Among adolescents aged 14 to 18, the probability of nonmedical use of these psychoactive substances was twice as high for female adolescents as for male adolescents.
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Affiliation(s)
- Pilar Carrasco-Garrido
- Department of Medical Specialties and Public Health, Health Sciences Faculty Universidad Rey Juan Carlos, Madrid, Spain
- Research Group in Epidemiology of Medicines (RESEPMED), Rey Juan Carlos University, Alcorcón, Spain
| | - Valentín Hernández-Barrera
- Department of Medical Specialties and Public Health, Health Sciences Faculty Universidad Rey Juan Carlos, Madrid, Spain
- Research Group in Epidemiology of Medicines (RESEPMED), Rey Juan Carlos University, Alcorcón, Spain
| | - Isabel Jiménez-Trujillo
- Department of Medical Specialties and Public Health, Health Sciences Faculty Universidad Rey Juan Carlos, Madrid, Spain
- Research Group in Epidemiology of Medicines (RESEPMED), Rey Juan Carlos University, Alcorcón, Spain
| | - Lidiane Lima Florencio
- Research Group in Epidemiology of Medicines (RESEPMED), Rey Juan Carlos University, Alcorcón, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Carmen Gallardo Pino
- Department of Medical Specialties and Public Health, Health Sciences Faculty Universidad Rey Juan Carlos, Madrid, Spain
- Research Group in Epidemiology of Medicines (RESEPMED), Rey Juan Carlos University, Alcorcón, Spain
| | - Spencer Yeamans
- Department of Medical Specialties and Public Health, Health Sciences Faculty Universidad Rey Juan Carlos, Madrid, Spain
- Research Group in Epidemiology of Medicines (RESEPMED), Rey Juan Carlos University, Alcorcón, Spain
| | - Domingo Palacios-Ceña
- Research Group in Epidemiology of Medicines (RESEPMED), Rey Juan Carlos University, Alcorcón, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
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Mazza M, De Berardis D, Marano G. Keep in mind sex differences when prescribing psychotropic drugs. World J Psychiatry 2024; 14:194-198. [PMID: 38464773 PMCID: PMC10921286 DOI: 10.5498/wjp.v14.i2.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/02/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Women represent the majority of patients with psychiatric diagnoses and also the largest users of psychotropic drugs. There are inevitable differences in efficacy, side effects and long-term treatment response between men and women. Psychopharmacological research needs to develop adequately powered animal and human trials aimed to consider pharmacokinetics and pharmacodynamics of central nervous system drugs in both male and female subjects. Healthcare professionals have the responsibility to prescribe sex-specific psychopharmacotherapies with a priority to differentiate between men and women in order to minimize adverse drugs reactions, to maximize therapeutic effectiveness and to provide personalized management of care.
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Affiliation(s)
- Marianna Mazza
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Giuseppe Marano
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Tiguman GMB, Hoefler R, Silva MT, Lima VG, Ribeiro-Vaz I, Galvão TF. Prevalence of antidepressant use in Brazil: a systematic review with meta-analysis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 46:e20233095. [PMID: 37718462 PMCID: PMC11189131 DOI: 10.47626/1516-4446-2023-3095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To estimate the prevalence of antidepressant use in Brazil. METHODS We conducted a systematic review with searches in MEDLINE, Embase, Scopus, LILACS, and SciELO up to May 2023. Two researchers independently selected studies, extracted data, and assessed the methodological quality. We pooled the prevalence of antidepressant use using meta-analyses of proportions (Freeman-Tukey transformation) and estimated heterogeneity by the I2 statistic. OR meta-analyses of antidepressant use by sex were calculated (men as reference) and between-study variation was explored by meta-regressions. RESULTS Out of 3,299 records retrieved, 23 studies published in 28 reports were included, with a total of 75,061 participants. The overall prevalence of antidepressant use was 4.0% (95%CI 2.7-5.6%; /² = 98.5%). Use of antidepressants in the previous 3 days was higher in women (12.0%; 95%CI 9.5-15.1%; /² = 0%) than men (4.6%; 95%CI 3.1-6.8%; /² = 0%) (p < 0.001; OR = 2.82; 95%CI 1.72-4.62). Gender differences were particularly higher for antidepressant use in the previous year (women: 2.3%; 95%CI 1.6-3.1; /² = 37.6% vs. men: 0.5%; 95%CI 0.2-1.0%; /² = 0%, p < 0.001; OR = 4.18; 95%CI 2.10-8.30). Between-study variation in the overall prevalence of antidepressant use significantly increased with mean participant age (p = 0.035; residual /² = 0%; regression coefficient = 0.003). CONCLUSION Four out of every 100 Brazilians used antidepressants in this 3-decade assessment. Use increased with age and was more prevalent in women compared to men. REGISTRATION NUMBER PROSPERO CRD42022345332.
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Affiliation(s)
| | - Rogério Hoefler
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Marcus Tolentino Silva
- Departamento de Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil
| | - Vanessa Gomes Lima
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Inês Ribeiro-Vaz
- Unidade de Farmacovigilância do Porto, Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Taís Freire Galvão
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Terra e Souza LH, Diaz-Quijano FA, de Azevedo Barros MB, Lima MG. Race (black-white) and sex inequalities in tooth loss: A population-based study. PLoS One 2022; 17:e0276103. [PMID: 36228031 PMCID: PMC9560604 DOI: 10.1371/journal.pone.0276103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
The effect of health inequalities is determined by different socioeconomic, sex, and race conditions. This study aimed to analyze the association of tooth loss with race (defined by self-reported skin color) and sex. Based on the hypothesis that the association between tooth loss and race may be modified by sex, we also aimed to evaluate possible interactions between race and sex in association with this event, in a population-based study in the city of Campinas, Brazil. A directed acyclic graph was used to select covariates. The prevalence, of tooth loss was 19% higher in black women compared to white men (Prevalence ratio [PR]: 1.19; 95%CI: 1.05–1.34). Moreover, the prevalence of tooth loss in black women was 26% higher than in white women (PR: 1.26; 95%CI: 1.13–1.42); and, within the strata of black people, black women had 14% higher dental loss (PR: 1.14; 95%CI: 1.02–1.27) compared to black men. This study found a significant interaction between race and sex in tooth loss, with a disadvantage for black women. In addition, this work contributes to the discussion of health inequities and can support policies for the provision of universal dental care.
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Affiliation(s)
- Lívia Helena Terra e Souza
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
- * E-mail:
| | - Fredi Alexander Diaz-Quijano
- Department of Epidemiology, Laboratory of Causal Inference in Epidemiology [Laboratório de Inferência Causal em Epidemiologia], School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Marilisa Berti de Azevedo Barros
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
| | - Margareth Guimarães Lima
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
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Carrasco-Garrido P, Fernández-de-Las-Peñas C, Hernández-Barrera V, Palacios-Ceña D, Jiménez-Trujillo I, Gallardo-Pino C. Benzodiazepines and Z-hypnotics consumption in long-COVID-19 patients: Gender differences and associated factors. Front Med (Lausanne) 2022; 9:975930. [PMID: 36160133 PMCID: PMC9493021 DOI: 10.3389/fmed.2022.975930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPsychotropic drug consumption has increased during the COVID-19 pandemic. We describe here the prevalence and identifying factors associated with Benzodiazepine (BZD) and Z-hypnotics use among a sample of Spanish adults suffering from long-COVID-19 syndrome, from a gender perspective.Materials and methodsData were anonymously collected between 15th December 2021 and 15th March 2022. The collection form consisted of several questions gathering sociodemographic information, post-COVID symptom, health profile, and pharmacological drug intake. Using logistic multivariate regression models, we estimated the independent effect of each of these variables on self-medicated consumption. Three models were generated (female, male, and both gender).ResultsPrevalence of BZD and Z-hypnotics use was 44.9% (46.5% for women; 37.8% for men). Zolpidem was the most consumed drug among male (20.7%), and lorazepam in female (31.1%). Patterns of drug consumption among female were related with number of post-COVID symptoms and smoking habit (AOR 2.76, 95%CI 1.16–6.52). Males under 40 years of age are more likely to consume BZD and Z-hypnotics (AOR 5.52, 95%CI 1.08–28.27).ConclusionThe prevalence of consumption of BZD and Z-hypnotics in those subjects with long-COVID-19 in our study reaches values of 44.9%. Women with long-COVID-19 declare a higher prevalence of consumption than men. Predictors of BZD and Z-hypnotic in men were, age and number of medication use. Smoking habit and the number of post-COVID symptoms were predictive variables in women.
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Affiliation(s)
- Pilar Carrasco-Garrido
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
- *Correspondence: Pilar Carrasco-Garrido,
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Valentín Hernández-Barrera
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Carmen Gallardo-Pino
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
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Schmidt MG, Franken DL, Olinto MTA, da Costa JSD, Paniz VMV. Impact of multimorbidity on the use of sleep medications among women: a population-based study in Southern Brazil. Sleep Breath 2022; 27:1135-1142. [DOI: 10.1007/s11325-022-02672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
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Amaral CMM, Carvalho RC, Vieira MEB, Aguiar PM. Factors Associated With Use of Medications for Anxiety and Depression in Pharmacy Students in Brazil. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2021; 85:8285. [PMID: 34315701 PMCID: PMC8341240 DOI: 10.5688/ajpe8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
Objective. To map undergraduate pharmacy students' use of medications for anxiety and depression and associated factors at one university in Brazil.Methods. A cross-sectional study was conducted from May to July 2019 among undergraduate pharmacy students at one university. Data regarding sociodemographic issues and the use of psychotropics were collected using an online questionnaire. Exploratory descriptive analysis of data, the chi-square test, and multivariate binary logistic regression were performed to identify factors associated with the use of medications for anxiety and depression.Results. Of 900 students enrolled, usable survey responses were received from 198. Most respondents were female with a mean age of 22.3 years. Among these, 17.7% of pharmacy students used medications to treat anxiety and 13.1% used medications for depression. The most common psychotropics were escitalopram and fluoxetine. There were two peak usage times: the initial and final year of pharmacy school. Dissatisfaction with the pharmacy program and psychological care were significantly associated with the use of medications for anxiety. In contrast, monthly income from three to 15 times the minimum wage, religiosity/spirituality, and psychological care were associated with students' use of medications for depression.Conclusion. There was a high prevalence of medication use to treat anxiety and depression among undergraduate pharmacy students, and this use was associated with psychological care, monthly income, and religiosity/spirituality.
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Affiliation(s)
| | - Renata Cunha Carvalho
- University Hospital of University of São Paulo, Psychiatric Outpatient Clinic, São Paulo, Brazil
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Seifert J, Führmann F, Reinhard MA, Engel RR, Bernegger X, Bleich S, Stübner S, Rüther E, Toto S, Grohmann R, Sieberer M, Greil W. Sex differences in pharmacological treatment of major depressive disorder: results from the AMSP pharmacovigilance program from 2001 to 2017. J Neural Transm (Vienna) 2021; 128:827-843. [PMID: 33977402 PMCID: PMC8205885 DOI: 10.1007/s00702-021-02349-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/02/2021] [Indexed: 12/25/2022]
Abstract
Data on drug prescription for outpatients with major depressive disorder (MDD) suggest women are more likely to be treated with psychotropic drugs, while data on sex differences regarding pharmacological treatment of psychiatric inpatients are currently not available. Drug utilization data from the program "Drug Safety in Psychiatry" (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) of 44,418 psychiatric inpatients with MDD were analyzed for sex differences between 2001 and 2017. Sex differences were analyzed using relative risks (RR) and 95% confidence intervals (95% CI). Time trends were analyzed by comparing the first (2001-2003) with the last time period (2015-2017). In general, men and women were equally likely to use psychotropic drugs. Monotherapy was more common in men. Women were more likely to utilize ≥ 4 psychotropic drugs. Antidepressant drugs (ADDs) were the most prescribed drug class. Men had a higher utilization of noradrenergic and specific serotonergic antidepressants (RR 1.15; 95% CI 1.12-1.19), especially mirtazapine (RR 1.16; 95% CI 1.12-1.19), but also of other ADDs such as bupropion (RR 1.50; 95% CI 1.35-1.68). Males had a slightly higher utilization of second-generation antipsychotic drugs (RR 1.06; 95% CI 1.03-1.09) and were less often treated with low-potency first-generation antipsychotic drugs (RR 0.86; 95% CI 0.83-0.90). Tranquilizing (e.g., benzodiazepines; RR 0.89; 95% CI 0.86-0.92) and hypnotic drugs (e.g., Z-drugs; RR 0.85; 95% CI 0.81-0.89) were less utilized in the treatment of male patients. Not all sex differences were stable over time. More sex differences were detectable in 2015-2017 than in 2001-2003. Findings suggest that certain psychotropic drugs are preferred in the treatment of men vs. women, however, sex differences found in this study are not as large as in ambulatory settings. To make evidence-based sex-specific recommendations in the treatment of MDD, differences in drug response and tolerability need to be further researched.
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Affiliation(s)
- Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Fabienne Führmann
- Department of Psychiatry and Psychotherapy, KRH Psychiatrie GmbH, Wunstorf, Germany
| | - Matthias A Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Xueqiong Bernegger
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Prosomno, Clinic for Sleep Medicine, Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Marcel Sieberer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, St. Marien-Hospital Hamm gGmbH, Hamm, Germany.,Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg, Switzerland
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Carrasco-Garrido P, Jiménez-Trujillo I, Hernández-Barrera V, Lima Florencio L, Palacios-Ceña D. Patterns of non-medical use of benzodiazepines and Z-Drugs among adolescents and young adults: gender differences and related factors. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2020.1800846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Pilar Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Madrid, Spain
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
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Maia LO, Daldegan-Bueno D, Fischer B. Opioid use, regulation, and harms in Brazil: a comprehensive narrative overview of available data and indicators. Subst Abuse Treat Prev Policy 2021; 16:12. [PMID: 33499891 PMCID: PMC7836143 DOI: 10.1186/s13011-021-00348-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Global opioid consumption increased multifold post-2000, disproportionately in high-income countries, with severe mortality/morbidity consequences. Latin America features comparatively low opioid availability; Brazil, the region's most populous country, makes an interesting case study concerning opioid use/harms. In this comprehensive overview, we aimed to identify and summarize medical and non-medical data and indicators of opioid availability and use, regulation/control, and harm outcomes in Brazil since 2000. METHODS We searched multiple scientific databases to identify relevant publications and conducted additional 'grey' literature searches to identify other pertinent information. RESULTS Despite some essential indicators, opioid-related data are limited for Brazil. Data indicate that population-level availability of prescription opioids represents only a small fraction of use in comparison to high-income countries. However, within Latin America, Brazil ranks mid-level for opioid consumption, indicating relatively moderate consumption compared to neighboring jurisdictions. Brazil has implemented restrictive regulations to opioid prescribing and is considered 'highly restricted' for opioid access. Codeine remains the major opioid analgesic utilized, but stronger opioids such as oxycodone are becoming more common. Professional knowledge regarding medical opioid use and effects appears limited. National surveys indicate increases in non-medical use of prescription opioids, albeit lower than observed in North America, while illicit opioids (e.g., heroin) are highly uncommon. CONCLUSIONS Overall population-level opioid availability and corresponding levels of opioid-related harms in Brazil remain substantially lower than rates reported for North America. However, the available surveillance and analytical data on opioid use, policy/practice, and harms in Brazil are limited and insufficient. Since existing and acute (e.g., pain-related) needs for improved opioid utilization and practice appear to be substantiated, improved indicators for and understanding of opioid use, practice, and harms in Brazil are required.
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Affiliation(s)
- Lucas O. Maia
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, V6B 5K3 Vancouver, BC Canada
| | - Dimitri Daldegan-Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, 1023 Grafton, Auckland New Zealand
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, V6B 5K3 Vancouver, BC Canada
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, 1023 Grafton, Auckland New Zealand
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8 Toronto, ON Canada
- Department of Psychiatry, Federal University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 05403-903 São Paulo, Brazil
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Ruiz AMP, Lima MG, Medina LDPB, Pinto RL, Barros MBDA, Filho ADAB. Can Meals Outside Homes Impact Sodium Intake? Curr Dev Nutr 2020; 4:nzaa091. [PMID: 32582874 PMCID: PMC7302511 DOI: 10.1093/cdn/nzaa091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The WHO currently recommends a daily sodium intake of 2 g and has established the goal of a 30% reduction in mean salt intake by 2025. OBJECTIVE We sought to estimate sodium intake in study participants according to the locations of where they consumed meals and their demographic and socioeconomic characteristics and practices related to salt consumption. METHODS A population-based, cross-sectional study was conducted with a sample of 2574 individuals aged ≥10 y who answered the 2015 Campinas-Brazil Nutrition Survey. Mean sodium intake was estimated using a 24-h recall log and associations with the independent variables were tested using generalized regression analysis stratified by age group. RESULTS Sodium intake was higher in male participants as well as adolescents and adults who reported eating ≥1 meal outside the home (6.07% and 7.06% increase, respectively). Per meal, sodium was consumed more outside the home at breakfast, during an afternoon snack, and at dinner among adolescents. No significant differences were found in the analysis by type of meal among the adults and seniors. CONCLUSIONS Sodium intake exceeded the WHO recommendation in all age groups analyzed. Having ≥1 meal outside the home was associated with greater sodium intake among adolescents and adults. Measures to regulate the food industry and dietary/nutritional education strategies targeting consumers are important to reducing the sodium intake of the population.
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Affiliation(s)
- Ana Maria Pita Ruiz
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas 13083-970, SP, Brazil
| | - Margareth Guimarães Lima
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas 13083-970, SP, Brazil
| | | | - Renata Luz Pinto
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas 13083-970, SP, Brazil
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Reisman Y. Are There Any Sex/Gender Differences in Post-Selective Serotonin Reuptake Inhibitors (SSRI) Sexual Dysfunction (PSDD)? CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00222-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Krawczyk N, Silva PLDN, De Boni RB, Mota J, Vascncellos M, Bertoni N, Coutinho C, Bastos FI. Non-medical use of opioid analgesics in contemporary Brazil: Findings from the 2015 Brazilian National Household Survey on Substance Use. Glob Public Health 2019; 15:299-306. [PMID: 31190616 DOI: 10.1080/17441692.2019.1629610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Prior studies on substance use in Brazil have not focused on opioid misuse, previously thought to be nearly non-existent. This paper presents new findings on heroin and non-medical use of opioid analgesics. Data come from the 2015 Brazilian Household Survey on Substance Use (BHSU-3), a nationally representative survey estimating epidemiological parameters related to substance use by residents across Brazil. BHSU-3 used stratified multi-stage probability sampling across multiple geographic domains of interest, resulting in 16,273 interviews with household residents. Lifetime heroin use among Brazilians was 0.3 (95% C.I:0.2-0.4). Lifetime, past-year, and past-month non-medical use of opioid analgesics were respectively 2.9 (95%C.I.:2.3-3.4), 1.4 (95%C.I.:1.1-1.7) and 0.6 (95%C.I.:0.4-0.8). Past-year prevalence of non-medical opioid analgesics use was lower among males [Prevalence Ratio (PR): 0.54 (95% C.I.:0.36-0.78)], those aged 12-24 [0.56 (95% C.I.:0.34-0.92)], persons with monthly family incomes between R$1,501-3,000 [0.59 (95% C.I.:0.38-0.92)] or greater than R$3,000 [0.64 (95% C.I.:0.42-0.98)], and persons who were unemployed [0.65 (95% C.I.:0.46-0.92)]. Non-medical use of opioids in Brazil may be more prevalent than previously recognised. Proper measurement and evaluation of opioid misuse across Brazil and other Latin American countries is critical to understand and prevent opioid-related harms.
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Affiliation(s)
- Noa Krawczyk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Jurema Mota
- Fundação Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
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Montero-Marin J, Perez-Yus MC, Cebolla A, Soler J, Demarzo M, Garcia-Campayo J. Religiosity and Meditation Practice: Exploring Their Explanatory Power on Psychological Adjustment. Front Psychol 2019; 10:630. [PMID: 30971982 PMCID: PMC6445895 DOI: 10.3389/fpsyg.2019.00630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/06/2019] [Indexed: 01/11/2023] Open
Abstract
There has been increased interest in the relationships between religiosity, meditation practice and well-being, but there is lack of understanding as to how specific religious components and distinct meditation practices could influence different positive and negative psychological adjustment outcomes. The aim of this study was to assess the explanatory power of religious beliefs and the practice of prayer, focused attention (FA), open monitoring (OM), and compassion meditation (CM) on psychological adjustment, taking into consideration a number of practice-related variables such as session length, frequency of practice and lifetime practice. Psychological adjustment was assessed by means of happiness, positive affect, depression, negative affect, and emotional overproduction. A cross-sectional design was used, with a final sample comprising 210 Spanish participants who completed an online assessment protocol. Hierarchical regressions were performed, including age, sex and psychotropic medication use in the first step as possible confounders, with the addition of religious beliefs and the practice of prayer, FA, OM, and CM in the second step. FA session length was related to all psychological adjustment outcomes: happiness (ΔR 2 = 0.09, p = 0.002; β = 0.25, p = 0.001), positive affect (ΔR 2 = 0.09, p = 0.002; β = 0.18, p = 0.014), depression (ΔR2 = 0.07, p = 0.004; β = -0.27, p < 0.001), negative affect (ΔR 2 = 0.08, p = 0.007; β = -0.27, p < 0.001) and emotional overproduction (ΔR 2 = 0.07, p = 0.013; β = -0.23, p = 0.001). CM session length was related to positive affect (β = 0.18, p = 0.011). CM practice frequency was associated with happiness (ΔR 2 = 0.06, p = 0.038; β = 0.16, p = 0.041). Lifetime practice of FA was related to happiness (ΔR 2 = 0.08, p = 0.007; β = 0.21, p = 0.030) and OM to emotional overproduction (ΔR 2 = 0.08, p = 0.037; β = -0.19, p = 0.047). Religious beliefs and prayer seemed to be less relevant than meditation practices such as FA, OM, and CM in explaining psychological adjustment. The distinct meditation practices might be differentially related to distinct psychological adjustment outcomes through different practice-related variables. However, research into other forms of institutional religiosity integrating social aspects of religion is required.
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Affiliation(s)
- Jesus Montero-Marin
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Maria C. Perez-Yus
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Ausias Cebolla
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBERObn Ciber Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Joaquim Soler
- Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau–IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Marcelo Demarzo
- Mente Aberta – Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Javier Garcia-Campayo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Miguel Servet Hospital and University of Zaragoza, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
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