Arthur Guerra de Andrade

Uso de álcool e drogas por estudantes de medicina da Unesp

BACKGROUND: The objective of this paper was to analyse the prevalence of drug use by medical students of Botucatu Medical School, compared to other eight medical schools of Sao Paulo State (at lifetime, last 12 months, and last 30 days). Research was carried out in 1994 and 1995, with 5,227 students, from first to sixth year of graduation. METHOD: Anonymous self-completed questionnaires were used, including the World Health Organization one, for students drug use survey. The completion rate was of 71% (3.725) and 421 were from Botucatu. RESULTS: There were no significant statistical differences among schools, and the last 30 day drug use rate showed the following results, for Botucatu and other schools (drug use range) respectively: alcohol in 50% (42-50%); tobacco in 7% (7-13%); inhalants in 8% (7-12%); cannabis in 6% (6-16%); benzodiazepines (BZD) in 3% (2-9%); cocaine in 0,5% (0,2-4%); amphetamines in 1% (0-1%). Though there was an increased drug use from first to sixth year, especially BZD, most of the students did not approve of it. Risk factors for drug and alcohol use were: a) being men; b) truancy or excess free time on weekends; and c) approval of using alcohol and drugs. Male and female students used equally BZD (contrary to other medical schools). However, women used them earlier and more frequently (female weekly X male monthly). Women used cannabis before entering school (female 30% X male 19%), being the contrary with solvents use (statistically significant result). CONCLUSIONS: Although the research focus was use (not abuse or dependence), the results suggest the necessity of campus drug and alcohol use policy to be developed and carried out for this population, with curricula modifications, and prevention program included.

Comparing topiramate with naltrexone in the treatment of alcohol dependence

AIM To compare the efficacy of topiramate with naltrexone in the treatment of alcohol dependence. DESIGN The investigation was a double-blind, placebo-controlled, 12-week study carried out at the University of São Paulo, Brazil. SAMPLE A total of 155 patients, 18-60 years of age, with an International Classification of Diseases (ICD-10) diagnosis of alcohol dependence. METHODS After a 1-week detoxification period, patients were assigned randomly to receive topiramate (induction to 300 mg/day), naltrexone (50 mg/day) or placebo. MEASUREMENTS Time to first relapse (consumption of >60 g ethyl alcohol), cumulative abstinence duration and weeks of heavy drinking. FINDINGS In intention-to-treat analyses, topiramate was statistically superior to placebo on a number of measures including time to first relapse (7.8 versus 5.0 weeks), cumulative abstinence duration (8.2 versus 5.6 weeks), weeks of heavy drinking (3.4 versus 5.9) and percentage of subjects abstinent at 4 weeks (67.3 versus 42.6) and 8 weeks (61.5 versus 31.5), but not 12 weeks (46.2 versus 27.8). RESULTS remained significant after controlling for Alcoholics Anonymous attendance, which was higher in topiramate than in other groups. There were no significant differences between naltrexone versus placebo or naltrexone versus topiramate groups, but naltrexone showed trends toward inferior outcomes when compared to topiramate. CONCLUSIONS The results of this study support the efficacy of topiramate in the relapse prevention of alcoholism. Suggestive evidence was also obtained for superiority of topiramate versus naltrexone, but this needs to be verified in future research with larger sample sizes.

Comparative study of drug use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and 2001.

OBJECTIVE To compare the rate of drug use prevalence and to investigate opinions regarding such use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and again in 2001. METHODS Both studies followed the same procedures of sampling and data collection. A random sample of undergraduate students, divided into the areas Humanities, Exact Sciences and Biologic Sciences, responded to an anonymous and self-report survey regarding the use of licit and illicit drugs within the last 30 days, within the last 12 months and over the lifetime of the subject. The two surveys were compared through the construction of (95%) confidence intervals for the prevalence differences for each substance by area and by total number of students. The Wald test for homogeneity was applied in order to compare the prevalences. RESULTS High approval of regularly trying and using cocaine, crack, amphetamines and inhalants was observed. The drugs that showed statistic significant increasing were:lifetime use: alcohol, tobacco, marijuana, inhalants, hallucinogens, amphetamines, anti cholines, barbiturics and any illicit drug;last-12-month use: marijuana, inhalants, amphetamines, hallucinogens and any illicit drug;last-30-day use: marijuana, inhalants, amphetamines and any illicit drug. DISCUSSION The observed difference in the use of some drugs between the two surveys appears to be a consequence of the higher rates of favorable opinions regarding trying and regularly using some psychoactive substances, a finding that mirrors global trends in drug use.

The characteristics of depressive symptoms in medical students during medical education and training: a cross-sectional study

BackgroundMedical education and training can contribute to the development of depressive symptoms that might lead to possible academic and professional consequences. We aimed to investigate the characteristics of depressive symptoms among 481 medical students (79.8% of the total who matriculated).MethodsThe Beck Depression Inventory (BDI) and cluster analyses were used in order to better describe the characteristics of depressive symptoms. Medical education and training in Brazil is divided into basic (1st and 2nd years), intermediate (3rd and 4th years), and internship (5th and 6th years) periods. The study organized each item from the BDI into the following three clusters: affective, cognitive, and somatic. Statistical analyses were performed using analysis of variance (ANOVA) with post-hoc Tukey corrected for multiple comparisons.ResultsThere were 184 (38.2%) students with depressive symptoms (BDI > 9). The internship period resulted in the highest BDI scores in comparison to both the basic (p < .001) and intermediate (p < .001) periods. Affective, cognitive, and somatic clusters were significantly higher in the internship period. An exploratory analysis of possible risk factors showed that females (p = .020) not having a parent who practiced medicine (p = .016), and the internship period (p = .001) were factors for the development of depressive symptoms.ConclusionThere is a high prevalence towards depressive symptoms among medical students, particularly females, in the internship level, mainly involving the somatic and affective clusters, and not having a parent who practiced medicine. The active assessment of these students in evaluating their depressive symptoms is important in order to prevent the development of co-morbidities and suicide risk.

Alcohol and drug use among university students: gender differences

OBJECTIVE This study compared the pattern of alcohol, legal and illegal drugs use among students of the Universidade de São Paulo (Brazil) in 1996 and 2001. METHOD Samples of 2.564 (1996) and 2.837 (2001) students answered a questionnaire proposed by the World Health Organization, which characterizes the consumption of alcohol, legal and illegal drugs in lifetime, in the last 12 months and in the last 30 days. RESULTS Men showed a significant increase in lifetime use of tobacco (44.8% to 50.9%), marijuana (33.7% to 39.5%) and hallucinogens (6.6% to 14.1%) between 1996 and 2001. No significant change was observed among women between 1996 and 2001 in tranquilizer use. Concerning the consumption reported in the last 12 months, both genders displayed significant increases in the consumption of marijuana (22.3% to 27.1% for men and 12.9% to 16.9% for women), amphetamines (1.9% to 5.0% for men and 3.4% to 5.6% for women), and inhalants (9.8% to 15.7% for men and 5.4% to 10.6% for women). The greatest gender difference was observed in consumption reported in the last 30 days with significant increases in male use of tobacco (19.6% to 23.5%), marijuana (15.8% to 20.5%), amphetamines (1.1% to 3.2%), and inhalants (4.0% to 7.9%). Substance use reported in the last 30 days remained stable among women between the 2 surveys. CONCLUSION Rates of substance use among university students increased. These gender differences in substance consumption should be taken into account in the development of preventive and treatment strategies for undergraduate university students.

Decision‐Making Deficits Linked to Real‐life Social Dysfunction in Crack Cocaine‐Dependent Individuals

Crack cocaine-dependent individuals (CCDI) present abnormalities in both social adjustment and decision making, but few studies have examined this association. This study investigated cognitive and social performance of 30 subjects (CCDI × controls); CCDI were abstinent for 2 weeks. We used the Social Adjustment Scale (SAS), Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT). Disadvantageous choices on the IGT were associated with higher levels of social dysfunction in CCDI, suggesting the ecological validity of the IGT. Social dysfunction and decision making may be linked to the same underlying prefrontal dysfunction, but the nature of this association should be further investigated. 

The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility

Substance-dependence is highly associated with executive cognitive function (ECF) impairments. However, considering that it is difficult to assess ECF clinically, the aim of the present study was to examine the feasibility of a brief neuropsychological tool (the Frontal Assessment Battery - FAB) to detect specific ECF impairments in a sample of substance-dependent individuals (SDI). Sixty-two subjects participated in this study. Thirty DSM-IV-diagnosed SDI, after 2weeks of abstinence, and 32 healthy individuals (control group) were evaluated with FAB and other ECF-related tasks: digits forward (DF), digits backward (DB), Stroop Color Word Test (SCWT), and Wisconsin Card Sorting Test (WCST). SDI did not differ from the control group on sociodemographic variables or IQ. However, SDI performed below the controls in DF, DB, and FAB. The SDI were cognitively impaired in 3 of the 6 cognitive domains assessed by the FAB: abstract reasoning, motor programming, and cognitive flexibility. The FAB correlated with DF, SCWT, and WCST. In addition, some neuropsychological measures were correlated with the amount of alcohol, cannabis, and cocaine use. In conclusion, SDI performed more poorly than the comparison group on the FAB and the FABs results were associated with other ECF-related tasks. The results suggested a negative impact of alcohol, cannabis, and cocaine use on the ECF. The FAB may be useful in assisting professionals as an instrument to screen for ECF-related deficits in SDI.

Relação entre consumo de drogas e comportamento sexual de estudantes de 2o grau de São Paulo

OBJECTIVE: Investigate the relationship between drug consumption and sexual behavior in a population of high school students attending a public school in the city of Sao Paulo. METHOD: Questionnaires (a total of 689) were gathered from students with ages between 14 and 21 years old who responded to this study. The questionnaires contained questions about the consumption of psychoative substances and sexual behavior. Then, sexual behavior was compared for differences between drug users and non-users. RESULTS: Illicit drug users (n=366) demonstrated a higher prevalence of complete sexual intercourse: 80,8% of users versus 57,6% of non-users (n=305), p<0,0001); earlier initiation of sexual activity (on average 15,2 years in users versus 15,7 in non-users, p<0,005); more payments for sexual acts (31,1% of users versus 15% of non-users, p<0,001); and a trend toward lesser usage of condoms (56,8% of users versus 65,3% of non-users, p<0,10). The results also were similar when we studied each type of drug separately and the associaton of different types of drugs. CONCLUSIONS: Frequency of drug use was not related to sexual behavior. Alcohol and cannabis were the drugs most associated with sexual risk behavior. Crack use was associated with earlier initiation of sexual activity.

Epidemiologia do beber pesado e beber pesado episódico no Brasil: uma revisão sistemática da literatura

CONTEXTO: O beber pesado episodico (BPE) tem sido fortemente associado a danos e a uma carga social consideraveis. OBJETIVOS: Este estudo tem como finalidade avaliar o panorama brasileiro a partir de aspectos sociodemograficos, fatores individuais e sociais relacionados ao beber pesado. METODOS: A busca de artigos cientificos foi realizada com base em um programa de computador nos principais bancos de dados cientificos. RESULTADOS: Os homens beberam pesado mais frequentemente que as mulheres. O beber pesado episodico foi mais prevalente em adolescentes e adultos jovens, e a prevalencia tende a diminuir com o aumento da idade. As condicoes socioeconomicas parecem ter um efeito sobre o beber pesado. O inicio precoce do beber pesado esteve associado com historia de dependencia do alcool na vida adulta. O beber pesado episodico esteve associado ao uso concomitante de outras substâncias psicoativas. Os fatores de risco para BPE incluiram atividades sociais e disponibilidade de dinheiro. A pressao dos pares mostrou influenciar mais do que o suporte parental especialmente no final de adolescencia. O BP tambem variou de acordo com a cultura, com mais episodios de BP no Sul em comparacao com o Norte do Pais. CONCLUSOES: Uma variedade de aspectos sociodemograficos e individuais associados ao beber pesado foi identificada. Porem, o conhecimento nessa area ainda e muito limitado. Mais pesquisas no Brasil sao urgentemente necessarias visto que os resultados provenientes de outras culturas nao podem ser generalizados.

Drogas de abuso e gravidez

CONTEXTO: Embora seja um problema crescente na populacao mundial, existem poucos trabalhos publicados sobre o uso de drogas durante a gravidez. OBJETIVOS: Abordar de maneira objetiva as drogas de abuso (alcool, cocaina, maconha e tabaco) mais comumente utilizadas pelas mulheres em idade reprodutiva. METODOS: Foi realizada revisao bibliografica (MEDLINE, LILACS) dos textos mais recentes abordando o uso de drogas de abuso em mulheres em idade reprodutiva. RESULTADOS: Foram descritas as principais consequencias da utilizacao de drogas de abuso, tanto para a mae quanto para o bebe. CONCLUSOES: Trata-se de um problema de saude publica pouco discutido, devendo envolver uma equipe multidisciplinar em sua abordagem. A publicacao de mais trabalhos se faz necessaria, a fim de se estabelecer a melhor estrategia de intervencao nesta populacao.BACKGROUND: Despite the fact that it has being a growing problem worldwide, very few works and papers have been published on drug use during pregnancy. OBJECTIVES: To objectively address the most commonly abused drugs (alcohol, cocaine, marijuana, and tobacco) by women of a reproductive age. METHODS: A literature review (MEDLINE, LILACS) of the most recent papers on drug abuse by women of reproductive age was carried out. RESULTS: The primary consequences of drug abuse both for the mother and the infant are described. CONCLUSIONS: This is a little discussed major public health issue which requires the involvement of a multidisciplinary team. The publication of a greater number of papers on the problem is necessary in order to establish the best strategy for addressing intervention in this population.