Semelhanças e contrastes nos padrões de uso de crack em Santa Catarina, Brasil: capital vs Meio Oeste

An anxiety management intervention for people with substance use disorders (ITASUD): An intervention mapping approach based on Peplau's theory

Background

The comorbidity of anxiety and drug use disorders complicates treatment prognosis, and one of the greatest challenges is to address the environmental and behavioral factors involved. The aim of this study was to describe the uses of intervention mapping in the design of a theory and evidence-based complex intervention to develop skills around the management of anxiety for cocaine users in outpatient addiction treatment.

Methods

The six steps of the intervention mapping approach, which are needs assessment, creation of matrices of performance objectives, selection of methods and practical strategies, program development, adoption and implementation, and evaluation were applied to develop the Interpersonal Theory of nursing to Anxiety management in people with Substance Use Disorders (ITASUD) intervention. The theory used for the conceptual model was interpersonal relations theory. All theory-based methods and practical applications were developed at the individual level, acting in behavioral, interpersonal, organizational and community environments.

Results

The intervention mapping provided a broad overview of the problem and outcome expectations. The ITASUD intervention consists of five consecutive sessions of 110-min targeting individual determinants of anxiety (knowledge, triggers, relief behaviors, self-efficacy and relations), delivered by a trained nurse using Peplau's concepts of interpersonal relations. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change.

Conclusions

The intervention mapping approach increases the effectiveness of the intervention since the matrices provide a broad view of all factors that affect the problem and facilitate replication through transparency of the determinants, methods, and applications used. ITASUD addresses all factors that play an important role in substance use disorders based on a theoretical basis, which provides the translation of evidence from research into effective practice, policy, and public health improvements.

Housing characteristics of crack cocaine users in Northeast Brazil, 2011-2013

We compared sociodemographic characteristics, substance use patterns, sexual behavior, use of health services, and criminal records of homeless vs. domiciled users. Data are from the Brazilian National Survey on Crack Use. A discriminant model and correspondence analysis cross-compared characteristics of users according to their housing status. The logistic model revealed associations between "living in the streets" and female gender and intermittent work. "Homelessness" was also associated with the use of tobacco and "oxi" in the previous 30 days, reliance on soup kitchens, low access to public mental health services, and arrests in the previous year. Correspondence analysis highlighted the spatial proximity of the variables as follows: "having traded sex for drugs", "informal work", "age 31 years or older", "access to public mental health services", "problems with law enforcement", and female gender with homeless crack users. People who smoke crack cocaine in Northeast Brazil are seldom studied. Their profiles, stratified according to their housing conditions, show subgroups with specific characteristics. While domiciled users have access to specialized clinics, homeless users basically reported access to free food and harm reduction services.

Limites e falência do corpo: o acesso ao tratamento de mulheres usuárias de crack em um CAPSad do Rio de Janeiro

Resumo O abuso de crack evidencia um problema de saúde pública complexo a ser enfrentado. Neste contexto, o consumo pelas mulheres as coloca em situação de maior vulnerabilidade. O artigo tem como objetivos identificar e descrever as motivações para o acesso ao tratamento de mulheres usuárias de crack em um Centro de Atenção Psicossocial (CAPSad), voltado ao atendimento de pessoas com problemas com o álcool e outras drogas. Trata-se de um estudo qualitativo, feito através de observação participante e realização de nove entrevistas em profundidade com mulheres usuárias de crack, submetidos à análise temática. Os resultados indicam a presença do corpo como o argumento usado pelas mulheres para justificar a procura pelo atendimento no CAPSad. As questões ligadas ao corpo, tais como, as vivências de cansaço físico, dor, sono, emagrecimento, esgotamento, medo de morrer e da violência das ruas, direcionaram as usuárias para o tratamento. Muitas delas sentiam essa necessidade em decorrência do abuso do crack e precisavam de ajuda dos profissionais de saúde, por meio do pedido de medicação e acolhimento noturno. Assim, é fundamental reconhecer o uso do corpo como ferramenta de acesso ao tratamento por parte das mulheres usuárias de crack.

Argyrophilic nucleolar organizer regions in oral mucosa cells of crack and cocaine users: a cross-sectional study

The objective of this study was to analyze and compare the presence of argyrophilic nucleolar organizer regions (AgNORs) in exfoliated cells obtained from the buccal mucosa among crack and cocaine users and non-users by the AgNOR staining technique. Seventy-three males ≥ 18 years were categorized into two groups: 38 crack and/or cocaine users and 35 non-user volunteers. They were interviewed and responded a questionnaire regarding general health and drug addiction. Exfoliative cytology specimens were collected from the clinically intact buccal mucosa, and cytological preparations were fixed and stained by AgNOR technique. The mean number of AgNORs (p = 0.02) and the percentage of epithelial cells with more than 3 (p = 0.01) and 4 (p = 0.04) AgNORs/nucleus were significantly higher in the non-user group. In conclusion, the frequency and diversity of substances present in the drugs-cocaine, crack, and alcohol-consumed by the volunteers of this study may have influenced the number of AgNORs and the response to damage and consequent effect on protein synthesis.

O acesso ao tratamento de usuárias de crack sob a perspectiva dos profissionais de saúde

RESUMO O consumo de crack é um problema de saúde pública no Brasil. Nesse grupo, as mulheres se encontram em situação de maior vulnerabilidade, em especial, por acessarem menos os serviços de saúde. Por esse motivo, o objetivo deste estudo foi analisar os sentidos do acesso ao tratamento de mulheres usuárias de crack na perspectiva dos profissionais de saúde de um Centro de Atenção Psicossocial – Álcool e Outras Drogas (Caps AD). Trata-se de uma pesquisa de campo, qualitativa, por meio da observação participante (54 visitas) e de 13 entrevistas semiestruturadas com profissionais, realizada durante oito meses de imersão em um Caps AD do Rio de Janeiro. Um software de gerenciamento de dados – o NVivo – foi utilizado para a análise temática. Trabalho aprovado pelo Comitê de Ética e Pesquisa. Para os profissionais, as mulheres vão buscar ajuda porque possuem laços familiares rompidos, precisam de ajuda social devido ao seu contexto de vulnerabilidade e procuram um tratamento direcionado ao seu corpo em falência. Conclui-se como de fundamental importância que o Caps AD ofereça um trabalho desburocratizado e que amplie suas ações no território.

Urban violence and risk factors for femicide in the Brazilian Amazon

Femicide has received relatively little research attention, despite its severity. Estimates of femicide depend on the strategies used to define it within the sociocultural and political context. This study aimed to assess intentional homicides of women, focusing on femicides, highlighting the characteristics and risk factors. This was a cross-sectional study based on daily surveillance of homicides in the press and mortality records. The study considered fatal victims of assault in women over 11 years of age in Manaus, Amazonas State, Brazil, in 2016-2017. Classification of femicide was based on Brazil's Law n. 13,104/2015. Relative risk was estimated by Poisson regression, and a hierarchical model was used to include variables in the models. Analyses were performed in the R statistical package. Of 138 fatal victims of assault, 52 were cases of femicide, or 37.7% (CI: 29.4-45.5). Each unit addition of age reduced the risk of femicide by 3% (CI: 0.95-0.99). Risk of femicide was 40% lower (CI: 0.40-0.90) in women with up to seven years of schooling, when compared to those with eight years or more. Women killed by bodily force showed 5.5 times higher risk (CI: 2.6-11.3) of femicide, compared to those killed with firearms. Relative risk of femicide was 1.4 (CI: 1.1-2.7) in women killed in daytime, compared to those killed at night. The proportion of femicide in this study was lower than in previous estimates in Brazil, and the local burden of urban crime appears to explain part of this discrepancy. This study showed that age, schooling, use of bodily force, and time of day when the assault occurred are associated with femicide.

Impacts of sexual abuse in childhood and adolescence: an integrative review

This article identifies the impacts of sexual abuse in childhood and adolescence. We conducted an integrative literature review in September 2018 using the Virtual Health Library. A search was conducted using the following descriptors: Sexual Abuse of Children and Adolescents and Sexual Abuse or Child Development. The inclusion criteria were open access full-text original articles published between 2013 and September 2018 in Portuguese, English or Spanish. Sixteen eligible articles were selected after reading the titles and abstracts. The full texts of these articles were read and organized into a table. The studies show that sexual abuse in childhood and adolescence has lifelong psychological, physical, sexual and social impacts. The findings of this study can help alert health care professionals to the importance of investigating the signs and symptoms of sexual abuse given the multiple impacts of abuse on victims' lives.