Alexandre Dido Balbinot

Associação entre fissura e perfil antropométrico em dependentes de crack

OBJECTIVE: To verify the variation of the crack addicts during hospitalization and the association with anthropometric profile. METHODS: This is a cross-section quantitative survey (n = 30). The profile of substance use; socio-demographic data; the anthropometric variables (weight, height, body mass index, waist-hip ratio circumferences, skin fold thickness and bone diameter) were evaluated; the craving was assessed using the Cocaine Craving Questionnaire Brief. The collection of data on initial and final 24 hours of treatment was carried out. RESULTS: There was a significant increase in fat percentage of individuals and significant reduction in craving. There was no evidence of association between anthropometric variables and craving, the beginning and the end of hospitalization. CONCLUSION: There was a significant reduction in craving and significant change in body composition, however there was no correlation between variables.

Tratamento de exposição a estímulos e treinamento de habilidades como coadjuvantes no manejo do craving em um dependente de crack

OBJECTIVE An increased prevalence of crack cocaine users has been observed in clinical samples over the past years, underscoring the need for conducting research and developing treatment strategies aimed at this population. The objective of this study was to describe the case of a crack cocaine addict (inpatient) submitted to cue exposure treatment (CET) and coping skills training (CS) as adjuvant approaches to the conventional addiction treatment. CASE DESCRIPTION A male patient, 29 years old, single, with complete high school, was dependent on crack cocaine and marijuana and also had a diagnosis of harmful alcohol use. The patient had been hospitalized for 2 weeks and had undertaken a protocol comprising four motivational interview and relapse prevention sessions. Six sessions of CET and CS were carried out over 2 weeks, including both in vivo and imaginal exposure to stimuli evoking craving for crack cocaine, such as a crack pipe, a lighter, and simulated crack cocaine rocks (in vivo exposure), or remembering places and friends associated with drug use (imaginal exposure). The patient was also trained to use strategies for the management of craving. Three months after hospital discharge, toxicological screening was performed to assess abstinence. CET and CS were considered by the patient to be important techniques for the maintenance of abstinence and of a low level of craving 3 months after discharge. COMMENTS These findings suggest that the two techniques may be useful as adjuvant therapies in the treatment of crack cocaine dependents. CET and CS should be assessed in clinical trials in order to demonstrate their real benefits.

Influência da família no consumo de crack

Objective This paper aims to study the contributions of families of crack users on promoting both consumption and cessation of consumption of this substance. Methods A cross-sectional, mixed study with a quantitative design (descriptive and analytical statistics, by robust Poisson regression) and a qualitative design (thematic content analysis). Results Among 519 crack users interviewed 48.3% reported having shared crack cocaine with some family member. The more expressive occurrence of sharing was for marital relations indicated by 30.6% of respondents. The estimated prevalence rates of the outcome crack usage stopped for more than 12 weeks, by robust Poisson regression controlling for confounding factors, for crack users who reported shared with brothers use was 0.940 (95% CI: 0.885-0.999; p = 0.045). For qualitative dimension, 20 respondents freely exposed the involvement they realize that their families have with their drug use, some indicating opposition to consumption, other stimulus, or offering, besides the interplay between crack usage and family conflicts and a negative environment. In addition, respondents who reported having family members in mental health treatment were 9% more likely to be stopped for 12 weeks or more (PR = 1.09 95% CI: 1.03-1.15; p = 0.005). Conclusion Family groups appear not only as a protective factor, but also as an important risk factor for crack cocaine use and their inclusion treatments is justified on these evidences.

Análise do Perfil de Dependentes de Crack em Internação Hospitalar

Current essay focuses on research with regard to pregnancy. Pregnancy brings about huge physical and psychological transformations in the female with a great variety of emotional oscillations, such as fear, anxiety, insecurity, doubts, happiness and others, which, because of the prevailing imbalance, contribute towards the start of post-partum depression symptoms. Scientific registers focusing on PPD prevention methods already demonstrate the use of psycho-social, psycho-pharmacological and hormonal strategies even though no single isolated intervention is sufficiently efficacious in the development of the disease. A review of the literature, based on on-line access to abstracts from databases, is provided. The psychotherapeutic approach is of fundamental importance in treatment, coupled to family support and follow-up.

Validation of an instrument to evaluate health promotion at schools

ABSTRACT OBJECTIVE To validate an instrument designed to assess health promotion in the school environment. METHODS A questionnaire, based on guidelines from the World Health Organization and in line with the Brazilian school health context, was developed to validate the research instrument. There were 60 items in the instrument that included 40 questions for the school manager and 20 items with direct observations made by the interviewer. The items’ content validation was performed using the Delphi technique, with the instrument being applied in 53 schools from two medium-sized cities in the South region of Brazil. Reliability (Cronbach’s alpha and split-half) and validity (principal component analysis) analyses were performed. RESULTS The final instrument remained composed of 28 items, distributed into three dimensions: pedagogical, structural and relational. The resulting components showed good factorial loads (> 0.4) and acceptable reliability (> 0.6) for most items. The pedagogical dimension identifies educational activities regarding drugs and sexuality, violence and prejudice, auto care and peace and quality of life. The structural dimension is comprised of access, sanitary structure, and conservation and equipment. The relational dimension includes relationships within the school and with the community. CONCLUSIONS The proposed instrument presents satisfactory validity and reliability values, which include aspects relevant to promote health in schools. Its use allows the description of the health promotion conditions to which students from each educational institution are exposed. Because this instrument includes items directly observed by the investigator, it should only be used during periods when there are full and regular activities at the school in question.

Hospitalization due to drug use did not change after a decade of the Psychiatric Reform.

ABSTRACT OBJECTIVE To investigate whether the psychiatric hospitalization rates due to use of psychoactive substances and average time of hospitalization suffered any changes after the first decade of effective implementation of the psychiatric reform in Brazil. METHODS This article examines the evolution of hospitalizations due to disorders arising from the use of alcohol or other substances in the state of Santa Catarina, Southern Brazil, from 2000 to 2012. This is an ecological, time-series study, which uses data from admissions obtained by the Informatics Service of the Brazilian Unified Health System. Hospitalization rates by 100,000 inhabitants and average time of occupancy of beds were estimated. Coefficients of variation of these rates were estimated by Poisson Regression. RESULTS The total and male hospitalization rates did not vary (p = 0.056 and p = 0.244, respectively). We observed an increase of 3.0% for the female sex (p = 0.049). We did not observe any significant variation for occupancy time of beds. CONCLUSIONS The deployment of services triggered by the Brazilian psychiatric reform was not accompanied by a reduction of hospitalization rates or mean occupancy time of hospitalized patients during this first decade of implementation of the reform.

Psychiatric hospitalizations in the Rio Grande do Sul State (Brazil) from 2000 to 2011

OBJECTIVE To examine the variation in the rates of psychiatric hospitalization and the mean hospital stay time in the public health system in the state of Rio Grande do Sul, in the south of Brazil, from 2000 to 2011. METHODS This was an ecological study. Data were collected from DATASUS. The rates were obtained from diagnosis of admissions due to psychoactive substance use and to other causes, stratified by the gender of the patients. The data were analyzed using Poisson regression and Spearman correlation coefficient. RESULTS Increasing hospitalization rates were observed for women with disorders due to substance use (p < 0.001) and other causes (p < 0.001), and among men with disorders due to the use of alcohol or other drugs (p < 0.001). This elevation of the rates remained statistically significant and inversely correlated to the length of hospital stay (p < 0.001). DISCUSSION In a period of expansion of the local care networks for mental health, an increase in the occupancy of psychiatric beds in the state was noticed, with shorter length of stay and greater diversity of gender and causes of hospitalization.

Validação psicométrica do marijuana craving questionnaire -short form – versão Brasil

Introducao: O objetivo deste estudo foi realizar a validacao psicometrica do Marijuana Craving Questionnaire-Short Form - Versao Brasil (MCQ-SF – Versao Brasil). Metodos: Neste estudo transversal, uma amostra nao aleatoria de 120 participantes do sexo masculino foi dividida em dois grupos: Grupo 1, incluindo usuarios de cannabis da populacao geral (n=34) e Grupo 2, incluindo pacientes internados em unidade de dependencia quimica e que preenchiam criterios diagnosticos para dependencia de cannabis pela CID-10 (n=86). Os individuos do Grupo 1, que foram recrutados pelo metodo snow-ball , deviam estar utilizando a cannabis ha pelo menos um ano, te-la utilizado pela ultima vez ha no minimo 24 e no maximo 48 horas, e nao ser dependentes de outras substâncias psicoativas salvo a nicotina. Os individuos do Grupo 2 deviam apenas preencher criterios diagnosticos para dependencia de cannabis , nao sendo necessario que nao fossem dependentes de outras substâncias psicoativas. Alem disso, deviam estar utilizando a cannabis ha pelo menos um ano e te-la utilizado pela ultima vez ha no minimo 24 horas. Os instrumentos utilizados foram: entrevista clinica com dados sociodemograficos, SRQ20, MMSE, MCQ-SF – Versao Brasil, EAV do craving, BDI, BAI, estimulo visual indutor de craving . Resultados: Na analise fatorial, foram encontrados tres fatores: Emocionalidade, Intencionalidade e Compulsividade. Os tres fatores apresentaram variância total de 66,74 %. O alfa de Cronbach do seu total de pontos foi 0,89. O instrumento no total de pontos foi correlacionado com a Escala Analogico-Visual (r=0,644; p<0,01). Conclusoes: Conclui-se que o MCQ-SF – Versao Brasil demonstrou ter propriedades psicometricas satisfatorias.

Padrão de uso e possibilidade de cessação do consumo do crack: estudo transversal

O objetivo desta pesquisa foi analisar a relacao entre o padrao de consumo de crack nos ultimos seis meses de uso ativo e a condicao de abstinencia ou nao no momento das entrevistas. Trata-se de um estudo transversal com amostragem de conveniencia, sendo que foram entrevistadas 495 pessoas entre os 14 e os 54 anos de idade. Foram estimadas razoes de prevalencia por Regressao de Poisson robusta para a condicao abstinente por 12 semanas ou mais, segundo os padroes de consumo referidos, ajustando para sexo, idade, escolaridade, tempo desde o primeiro contato com a droga, uso de medicacao e hospitalizacao em funcao do crack. Identificou-se associacao entre o uso frequente e pesado e a cessacao do consumo (RP 1,06 [IC95%: 1,01 - 1,12] p = 0,019). Esse achado amplia o leque de particularidades em relacao ao crack e reforca os investimentos terapeuticos para todos os padroes de consumo.

Condições associadas à cessação do uso de crack entre usuários em atendimento

This paper presents conditions associated with abstinence from crack in a cross-sectional study with a snowball sampling, in a sample of 495 crack users in treatment at different health services in a metropolitan area in southern Brazil. Data were submitted to a multivariate analysis, by robust Poisson regression in order to estimate the prevalence ratio for the outcome abstinence, defi ned as reference to a period equal or over 12 weeks since the last usage. Remained in association with crack abstinence: lack of partner, relative in mental health treatment, mourning in the last 12 months, sexual diffi culties assigned to crack cocaine and knowledge of therapeutic community as effective resource. Appeared on negative association with abstinence: having smocked crack cocaine with the father, attend the criteria for crack cocaine dependence, poor health self perception and BDI score more than minimum. Despite not establishing causation, this paper contributes to the advancement of the recognition of elements that must be integrated into treatment planning, in order to optimize results.