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Campos RO, Santos DVDD, Diaz AV, Emerich B, Trape T, Gama CAPD, Amaral CEM, Poderoso RE, Ferrer AL, Miranda L, Pereira MB, Surjus LT. Mental Health Studies published in the last 25 years in the Journal Ciência & Saúde Coletiva. CIENCIA & SAUDE COLETIVA 2020; 25:4771-4790. [PMID: 33295500 DOI: 10.1590/1413-812320202512.27932020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022] Open
Abstract
A systematic review of the 25-year Mental Health production of Journal Ciência & Saúde Coletiva was performed to identify whether this production had changed over time. We investigated whether these changes would have any relationship with the implementation of a new regulatory and legal framework for this field and the expansion of public services and the promotion of public funding agencies' investigation on the subject. A total of 278 original papers were analyzed from the following categories: sociocultural transformations related to madness and its approach; legislative changes; implantation, coverage range and operation of the network of substitute services; clinic/care developed in substitute services; the role and possibilities of primary care; drug use-related problems; mental health of children and adolescents; epidemiological studies/psychiatric categories; and others - which included ethnic-racial issues, violence, about the elderly population, suicide, bullying, and migration. A chronological relationship can be observed between the increase in publications and research notices and the expansion of services, not seemingly in the same way concerning care for people with alcohol and other drug problems.
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Affiliation(s)
- Rosana Onocko Campos
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp). R. Tessália Vieira de Camargo 126, Barão Geraldo. 13084-971 Campinas SP Brasil.
| | | | - Alberto Velzi Diaz
- Consejo de Investigadores, Universidad Nacional de Rosario. Rosario Santa Fé Argentina
| | - Bruno Emerich
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp). R. Tessália Vieira de Camargo 126, Barão Geraldo. 13084-971 Campinas SP Brasil.
| | - Thiago Trape
- Faculdade São Leopoldo Mandic. Rio de Janeiro RJ Brasil
| | | | | | - Rosana Evangelista Poderoso
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp). R. Tessália Vieira de Camargo 126, Barão Geraldo. 13084-971 Campinas SP Brasil.
| | | | - Lilian Miranda
- Universidade Federal Rural do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Mariana Barbosa Pereira
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp). R. Tessália Vieira de Camargo 126, Barão Geraldo. 13084-971 Campinas SP Brasil.
| | - Luciana Togni Surjus
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp). R. Tessália Vieira de Camargo 126, Barão Geraldo. 13084-971 Campinas SP Brasil.
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Ford N, Scourse R, Lemoine M, Hutin Y, Bulterys M, Shubber Z, Donchuk D, Wandeler G. Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta-Analysis. Hepatol Commun 2018; 2:1160-1167. [PMID: 30288470 PMCID: PMC6167073 DOI: 10.1002/hep4.1247] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/15/2018] [Indexed: 01/06/2023] Open
Abstract
Successful treatment outcomes for chronic hepatitis B virus (HBV) infection requires high levels of adherence to treatment. We searched three databases and abstracts from two conferences up to January 2018 for studies reporting the proportion of patients who were adherent to HBV antiviral therapy and pooled data using random effects meta-analysis. We included 30 studies, providing data for 23,823 patients. Overall, adherence to treatment was 74.6% (95% confidence interval [CI] 67.1%-82.1%). Adherence was similar in high-income settings (75.1%; 95% CI, 65.4%-85.0%) and in low-income and middle-income settings (72.9%; 95% CI, 57.8%-88.0%). Reported barriers to adherence included forgetting, limited understanding of the importance of adherence, and change to routine. Conclusion : There is a need to reinforce assessment and reporting of adherence as a routine part of HBV care and to assess the extent to which evidence-based interventions to improve adherence to medication for human immunodeficiency virus [HIV] and other chronic diseases are effective for HBV infection.
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Affiliation(s)
- Nathan Ford
- Department of HIV and Global Hepatitis Program World Health Organization Geneva Switzerland
| | - Roz Scourse
- Médecins Sans Frontières Access Campaign Geneva Switzerland
| | - Maud Lemoine
- Department of Surgery and Cancer St Mary's Hospital, Imperial College London London United Kingdom
| | - Yvan Hutin
- Department of HIV and Global Hepatitis Program World Health Organization Geneva Switzerland
| | - Marc Bulterys
- Department of HIV and Global Hepatitis Program World Health Organization Geneva Switzerland
| | - Zara Shubber
- Department of Infectious Disease Epidemiology Imperial College London London United Kingdom
| | | | - Gilles Wandeler
- Department of Infectious Diseases and Institute of Social and Preventive Medicine University of Berne Berne Switzerland
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Toledo L, Góngora A, Bastos FIPM. [On the sidelines of society: crack use, deviation, criminalization and social exclusion - a narrative review]. CIENCIA & SAUDE COLETIVA 2018; 22:31-42. [PMID: 28076527 DOI: 10.1590/1413-81232017221.02852016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022] Open
Abstract
The article comprises a narrative review of the scientific literature, aiming to identify and discuss the contexts of vulnerability and social exclusion faced by users of crack cocaine and other substances who live on the sidelines of society in the Brazilian and international context. The paper summarizes insights from different theoretical frameworks, focusing on an integrated perspective of substance use and abuse, with an emphasis on the use of crack and its inter-relationships with social vulnerability, marginalization, social exclusion and deviation. In a first step, broad aspects of qualitative research on drugs are outlined. The subsequent section highlights issues associated with exclusion and social vulnerability of crack users, followed by an assessment of the main associations mentioned in the literature on drug use and criminal involvement. Finally, the concept of "sidelines of society" is discussed, as exemplified by situations and events experienced by users of crack and other substances, as mentioned in the literature.
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Affiliation(s)
- Lidiane Toledo
- Programa de Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Andrés Góngora
- Programa de Pós-Graduação em Antropologia Social, Museu Nacional, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Francisco Inácio P M Bastos
- Programa de Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil. .,Departamento de Informações em Saúde, Centro de Informação Científica e Tecnológica, Fiocruz. Rio de Janeiro RJ Brasil
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Fischer B, Kuganesan S, Gallassi A, Malcher-Lopes R, van den Brink W, Wood E. Addressing the stimulant treatment gap: A call to investigate the therapeutic benefits potential of cannabinoids for crack-cocaine use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1177-82. [DOI: 10.1016/j.drugpo.2015.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 01/14/2023]
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Krawczyk N, Filho CLV, Bastos FI. The interplay between drug-use behaviors, settings, and access to care: a qualitative study exploring attitudes and experiences of crack cocaine users in Rio de Janeiro and São Paulo, Brazil. Harm Reduct J 2015; 12:24. [PMID: 26245997 PMCID: PMC4527230 DOI: 10.1186/s12954-015-0059-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/29/2015] [Indexed: 12/02/2022] Open
Abstract
Background Despite the growing attention surrounding crack cocaine use in Brazil, little is understood about crack users’ histories, use patterns and the interplay of drug-use behaviors, settings, and access/barriers to care. Qualitative studies seldom cross-compare findings regarding people who use crack from different settings. This study aims to explore the insights of regular crack users in two major Brazilian cities and to examine how social and contextual factors, including stigma and marginalization, influence initial use and a range of health and social issues. Methods In-depth interviews and focus groups were conducted with 38 adult crack cocaine users recruited from impoverished neighborhoods in Rio de Janeiro and São Paulo. Interviews and focus groups were audio recorded and transcribed verbatim. Qualitative analysis was carried out, and content was organized and analyzed by recurrent themes relevant to study interests. Results For study participants from both cities, frequent crack cocaine use plays a central role in daily life and leads to a range of physical, psychological, and social consequences. Common concerns among users include excessive crack use, engagement in risky habits, infrequent health service utilization, marginalization, and difficulty reducing use. Conclusions Disadvantaged conditions in which many crack cocaine users grow up and live may perpetuate risk behaviors and stigma may further marginalize users from necessary health and recovery services. Reducing stigma and moralizing discourse related to drug use, especially among health professionals and law enforcement personnel, may help encourage users to seek necessary care. New harm-reduction-based care and treatment alternatives for marginalized drug users are being developed in parts of Brazil and elsewhere and should be adapted and expanded for other populations in need.
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Affiliation(s)
- Noa Krawczyk
- FIOCRUZ-Oswaldo Cruz Foundation, Av. Brasil, 4365, Biblioteca de Manguinhos #229, Rio de Janeiro, 21045-900, Brazil.
| | - Carlos Linhares Veloso Filho
- Psychiatry Institute, Federal University of Rio de Janeiro, Avenida Venceslau Brás, 71 - Fundos - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil.
| | - Francisco I Bastos
- FIOCRUZ-Oswaldo Cruz Foundation, Av. Brasil, 4365, Biblioteca de Manguinhos #229, Rio de Janeiro, 21045-900, Brazil.
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Bertoni N, Burnett C, Cruz MS, Andrade T, Bastos FI, Leal E, Fischer B. Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil. Int J Equity Health 2014; 13:70. [PMID: 25181954 PMCID: PMC4243730 DOI: 10.1186/s12939-014-0070-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/25/2014] [Indexed: 12/12/2022] Open
Abstract
Introduction Studies have shown important gender differences among drug (including crack) users related to: drug use patterns; health risks and consequences; criminal involvement; and service needs/use. Crack use is prevalent in Brazil; however, few comparative data by sex exist. We examined and compared by sex key drug use, health, socio-economic indicators and service use in a bi-city sample of young (18–24 years), regular and marginalized crack users in Brazil. Methods Study participants (total n = 159; n = 124 males and n = 35 females) were recruited by community-based methods from impoverished neighborhoods in Rio de Janeiro and Salvador. Assessments occurred by an anonymous interviewer-administered questionnaire and serum collection for blood-borne virus testing between November 2010 and June 2011. Descriptive statistics and differences for key variables by sex were computed; in addition, a ‘chi-squared automatic interaction detector’ (‘CHAID’) analysis explored potential primary factors differentiating male and female participants. Results Most participants were non-white, and had low education and multiple income sources. More women had unstable housing and income from sex work and/or panhandling/begging, whereas more men were employed. Both groups indicated multi-year histories of and frequent daily crack use, but virtually no drug injection histories. Men reported more co-use of other drugs. More women were: involved in sex-for-drug exchanges; Blood-Borne Virus (BBV) tested and HIV+. Both groups reported similar physical and mental health patterns; however women more commonly utilized social or health services. The CHAID analysis identified sex work; paid work; begging/panhandling; as well as physical and mental health status (all at p < 0.05) as primary differentiating factors by sex. Conclusions Crack users in our study showed notable differences by sex, including socio-economic indicators, drug co-use patterns, sex risks/work, BBV testing and status, and service utilization. Results emphasize the need for targeted special interventions and services for males and female crack users in Brazil.
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Cruz M, Bertoni N, Bastos FI, Burnett C, Gooch J, Fischer B. Comparing key characteristics of young adult crack users in and out-of-treatment in Rio de Janeiro, Brazil. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:2. [PMID: 24406052 PMCID: PMC3896734 DOI: 10.1186/1747-597x-9-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/18/2013] [Indexed: 11/10/2022]
Abstract
Background Crack use is prevalent among street drug users in Brazilian cities, yet despite recent help system reforms and investments, treatment utilization is low. Other studies have identified a variety of – often inconsistent – factors associated with treatment status among crack or other drug users. This study compared socio-economic, drug use, health and service use characteristics between samples of young adult crack users in- and out-of-treatment in Rio de Janeiro, Brazil. Findings Street-involved crack users (n = 81) were recruited by community-based methods, and privately assessed by way of an anonymous interviewer-administered questionnaire as well as biological methods, following informed consent. In-treatment users (n = 30) were recruited from a public service in-patient treatment facility and assessed based on the same protocol. Key indicators of interest were statistically cross-compared. Not-in-treatment users were less likely to: be white, educated, stably housed, to be involved in drug dealing, to report lifetime marijuana and current alcohol use, to report low mental health status and general health or addiction/mental health care; they were more likely to: be involved in begging and utilize social services, compared to the in-treatment sample (statistical significance for differences set at p < .05). Conclusions In-treatment and not-in-treatment crack users differed on several key characteristics. Overall, in-treatment users appeared to be more socio-economically integrated and connected to the health system, yet not acutely needier in terms of health or drug problems. Given overall low treatment utilization but high need, efforts are required to facilitate improved treatment access and use for marginalized crack users in Brazil.
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Affiliation(s)
| | | | | | | | | | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, 2400-515 West Hastings St,, Vancouver V6B 5 K3, Canada.
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Inglez-Dias A, Ribeiro JM, Bastos FI, Page K. Políticas de redução de danos no Brasil. CIENCIA & SAUDE COLETIVA 2014; 19:147-57. [DOI: 10.1590/1413-81232014191.1778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 04/09/2013] [Indexed: 01/05/2023] Open
Abstract
Considerando a disseminação da epidemia de HIV e o controle de sua transmissão entre usuários de drogas injetáveis (UDI), estratégias de redução de danos foram incorporadas em diversos países, incluindo o Brasil. Considerando a emergência das drogas como tema central na agenda governamental, especialmente o crack, o presente artigo registra e discute as práticas observadas em um programa de pesquisa e atenção aos UDI: o UFO. Foram considerados aspectos tais como acesso e adesão do usuário, dificuldades de financiamento, sustentabilidade e avaliação de resultados. As etapas do estudo envolveram pesquisa documental, observação sistemática e entrevistas com informantes-chave. Destacamos características do UFO que poderiam contribuir para políticas de redução de danos no cenário brasileiro. O programa estudado se apresenta como um exemplo exitoso de iniciativas de redução de danos, obtendo sucesso no acesso e adesão desse grupo, favorecendo seu acesso aos serviços de saúde e prevenção de riscos associados ao uso de drogas.
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Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Lipman L, Burnett C, Fischer B. Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil. BMC Health Serv Res 2013; 13:536. [PMID: 24373346 PMCID: PMC3893546 DOI: 10.1186/1472-6963-13-536] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 12/17/2013] [Indexed: 11/11/2022] Open
Abstract
Background Crack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a two-city sample of young (18–24 years), marginalized crack users in Brazil. Methods N = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants’ drug use, health, and social and health service utilization characteristics were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011. Results The majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important. Conclusions The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users’ social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also.
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Affiliation(s)
| | | | | | | | | | | | | | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 2400 - 515 W Hasting St, Vancouver, BC V6B 5K3, Canada.
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Bastos FI. Structural violence in the context of drug policy and initiatives aiming to reduce drug-related harm in contemporary Brazil: a review. Subst Use Misuse 2012. [PMID: 23186486 DOI: 10.3109/10826084.2012.705678] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Brazil, the 6th largest world economy, has experienced rapid economic, demographic, and social structural changes during the last decade. Notwithstanding, Brazil being one of the most unequal societies worldwide, 40 million of 200 million Brazilians have moved from poverty to middle-class standards during this period. This review analyzes the success of different Brazilian initiatives aiming to reduce drug consumption-related harms, as well as the failed attempts to curb structural violence, despite some very recent initiatives have yet to be fully implemented and evaluated.
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