Erikson Felipe Furtado

Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil

This study reports on the views of Primary Health Care (PHC) providers in Southeast Brazil on the use of alcohol and other drugs which reflect stigma, moralization, or negative judgment. Six hundred nine PHC professionals from the Brazilian states of São Paulo and Minas Gerais took part in the study. The majority (86.5%) of these professionals were female. Attitudes toward the use of alcohol and other drugs were evaluated in comparison to Hansens disease, obesity, depression, schizophrenia, HIV/AIDS, and tobacco use. The use of tobacco, marijuana/cocaine, and alcohol were the most negatively judged behaviors (p < 0.05). Nursing assistants and community health care workers demonstrated the severest judgment of alcohol use. In addition, marijuana/cocaine addicts and alcoholics suffered the highest rate of rejection by professionals. The hypothesis that the use of alcohol and other drugs is a behavior stigmatized by health professionals being confirmed, it is important to develop strategies for changing provider attitudes in order to provide a higher quality of service to these patients. This study is important as a first study among PHC professionals about social stigma of alcohol and other drugs users.

Morbidade psiquiátrica e uso de álcool em gestantes usuárias do Sistema Único de Saúde

OBJETIVO: Investigar a relacao entre consumo de alcool e problemas emocionais em gestantes, verificando se as gestantes com consumo problematico de alcool (uso nocivo ou dependencia) tiveram mais problemas emocionais quando comparadas aquelas cujo consumo nao era problematico. METODOS: Estudo transversal, observacional, sobre uma amostra clinica de um servico obstetrico publico de Ribeirao Preto, SP. A amostra foi nao probabilistica, de conveniencia, do tipo consecutiva, composta por 450 gestantes. Foram aplicados tres questionarios: para dados sociodemograficos, o Questionario de Morbidade Psiquiatrica (QMPA) e um questionario padronizado como parte da anamnese para avaliacao de problemas relacionados ao uso de alcool (uso nocivo ou sindrome de dependencia) de acordo com os criterios da CID-10. Foram utilizados testes univariados (ANOVA) para o exame comparativo entre grupos utilizando medidas de distribuicao central e intervalo de confianca de 95%. RESULTADOS: Foram encontradas 172 gestantes (38,2%) problematicas (escore >7) pelo QMPA. Detectaram-se conforme criterios da CID-10, 41 (9,1%) gestantes com consumo problematico de alcool, sendo 27 (6,0%) com diagnostico de uso nocivo e 14 (3,1%) com dependencia ao alcool. A presenca de diagnostico de uso nocivo ou sindrome de dependencia ao alcool relacionou-se a maior intensidade de sofrimento emocional das gestantes, ou seja, maior media de pontuacao nas subescalas ansiedade, depressao e alcool do QMPA. CONCLUSOES: Considerando a prevalencia de problemas emocionais, o consumo de alcool durante a gestacao e os riscos de problemas a saude materno-infantil sugere-se que sejam realizadas avaliacoes mais criteriosas pelos profissionais de saude.

Efficacy of brief alcohol screening intervention for college students (basics): a meta-analysis of randomized controlled trials

BackgroundMany studies reported that brief interventions are effective in reducing excessive drinking. This study aimed to assess the efficacy of a protocol of brief intervention for college students (BASICS), delivered face-to-face, to reduce risky alcohol consumption and negative consequences.MethodsA systematic review with meta-analysis was performed by searching for randomized controlled trials (RCTs) in Medline, PsycInfo, Web of Science and Cochrane Library databases. A quality assessment of RCTs was made by using a validated scale. Combined mean effect sizes, using meta-analysis random-effects models, were calculated.Results18 studies were included in the review. The sample sizes ranged from 54 to 1275 (median = 212). All studies presented a good evaluation of methodological quality and four were found to have excellent quality. After approximately 12 months of follow-up, students receiving BASICS showed a significant reduction in alcohol consumption (difference between means = −1.50 drinks per week, 95% CI: -3.24 to −0.29) and alcohol-related problems (difference between means = −0.87, 95% CI: -1.58 to −0.20) compared to controls.ConclusionsOverall, BASICS lowered both alcohol consumption and negative consequences in college students. Gender and peer factors seem to play an important role as moderators of behavior change in college drinking. Characteristics of BASICS procedure have been evaluated as more favorable and acceptable by students in comparison with others interventions or control conditions. Considerations for future researches were discussed.

Estigma social sobre o uso de álcool

O uso de alcool e outras drogas e um importante problema de saude publica em todo o mundo, com relativa complexidade no entendimento do tema e nas acoes de prevencao e tratamento. O objetivo do presente estudo e apresentar uma revisao bibliografica sobre estigma social e uso de alcool. Estudos que investigam o estigma social associado ao usuario de alcool e de outras drogas sugerem que tal associacao apresenta um importante impacto tanto para a definicao de politicas publicas quanto para acoes de prevencao e tratamento. A moralizacao e os estereotipos associados aos usuarios podem influenciar direta ou indiretamente nos resultados e na qualidade da prevencao e tratamento do uso. Dessa forma, estudos e acoes que visem diminuir o impacto do estigma na qualidade de assistencia de usuarios tornam-se relevantes.

Consumo de álcool na gestação: desempenho da versão brasileira do questionário T-ACE

OBJETIVO: Avaliar as caracteristicas de desempenho da versao brasileira do questionario Tolerance, Annoyed, Cut down e Eye-opener (T-ACE), para rastreamento do consumo de alcool na gestacao. METODOS: Estudo observacional, transversal, em amostra sequencial de 450 mulheres no terceiro trimestre de gestacao, assistidas em maternidade no municipio de Ribeirao Preto, estado de Sao Paulo, em 2001. Foram aplicados: questionario para coleta de dados sociodemograficos, T-ACE, questionario para levantamento da historia de consumo de alcool ao longo da gestacao e entrevista clinica para identificacao de uso nocivo e dependencia ao alcool, segundo criterios diagnosticos da CID-10. Foram feitos testes de concordância entre diferentes entrevistadores e de confiabilidade teste/re-teste. RESULTADOS: Do total, 100 gestantes (22,1%) foram consideradas positivas pelo T-ACE. Os indices kappa para concordância e confiabilidade foram 0,95, com 97% de respostas concordantes. Quando comparado aos parâmetros da CID-10 e ao padrao de consumo, o T-ACE com ponto de corte igual ou acima de dois pontos, apresentou coeficientes de sensibilidade e especificidade de 100% e 85% e de 97,9% e 86,6% respectivamente. CONCLUSOES: A versao brasileira do T-ACE mostrou preencher adequadamente os criterios de desempenho que a qualificam ao papel de instrumento basico para o rastreamento do consumo de alcool durante a gravidez. Sua utilizacao e recomendavel nas rotinas e praticas dos servicos obstetricos devido a tendencia de aumento do consumo alcoolico feminino, dificuldades para identificacao do abuso de alcool pela gestante e riscos de problemas de desenvolvimento nos filhos.

Gender-related pathways for behavior problems in the offspring of alcoholic fathers

The objective of the present study was to examine gender differences in the influence of paternal alcoholism on childrens social-emotional development and to determine whether paternal alcoholism is associated with a greater number of externalizing symptoms in the male offspring. From the Mannheim Study of Risk Children, an ongoing longitudinal study of a high-risk population, the developmental data of 219 children [193 (95 boys and 98 girls) of non-alcoholic fathers, non-COAs, and 26 (14 boys, 12 girls) of alcoholic fathers, COAs] were analyzed from birth to the age of 11 years. Paternal alcoholism was defined according to the ICD-10 categories of alcohol dependence and harmful use. Socio-demographic data, cognitive development, number and severity of behavior problems, and gender-related differences in the rates of externalizing and internalizing symptoms were assessed using standardized instruments (IQ tests, Child Behavior Checklist questionnaire and diagnostic interviews). The general linear model analysis revealed a significant overall effect of paternal alcoholism on the number of child psychiatric problems (F = 21.872, d.f. = 1.217, P < 0.001). Beginning at age 2, significantly higher numbers of externalizing symptoms were observed among COAs. In female COAs, a pattern similar to that of the male COAs emerged, with the predominance of delinquent and aggressive behavior. Unlike male COAs, females showed an increase of internalizing symptoms up to age 11 years. Of these, somatic complaints revealed the strongest discriminating effect in 11-year-old females. Children of alcoholic fathers are at high risk for psychopathology. Gender-related differences seem to exist and may contribute to different phenotypes during development from early childhood to adolescence.

Relação entre prática religiosa, uso de álcool e transtornos psiquiátricos em gestantes

CONTEXTO: A saude mental de gestantes e bastante discutida na literatura cientifica. Nesse periodo, a mulher passa por alteracoes fisicas, hormonais, psicologicas e sociais e torna-se mais suscetivel a problemas psiquicos. Ha carencia de estudos abordando a relacao entre saude mental e religiosidade nessa populacao. OBJETIVO: Investigar a relacao entre pratica religiosa, prevalencia de diagnosticos psiquiatricos e consumo alcoolico em gestantes de Juiz de Fora. MATERIAL E METODOS: Estudo transversal envolvendo 260 gestantes acompanhadas em Centros de Atendimentos a gestantes de Juiz de Fora, utilizando-se um questionario sociodemografico (incluindo filiacao e pratica religiosa), o Mini International Neuropsychiatric Interview e o Alcohol Use Disorders Identification Test (AUDIT). RESULTADOS: A maioria das gestantes era praticante de religiao (60,8%). As gestantes praticantes apresentavam menor frequencia (p < 0,05) de Episodio Depressivo Maior com caracteristicas Melancolicas, Episodio Hipomaniaco, Transtorno de Pânico com Agorafobia Atual, Fobia Social Atual e Transtorno do Estresse Pos-traumatico. Em relacao ao diagnostico de Abuso de uma ou mais substâncias psicoativas, houve uma tendencia a menor prevalencia nos grupos de gestantes religiosas praticantes (p = 0,057). CONCLUSOES: Observou-se que as praticantes tendem a apresentar menores taxas de transtornos de humor e transtornos ansiosos que as gestantes nao praticantes de religiosidade.

Association of DRD4 exon III polymorphism with auditory P300 amplitude in 8-year-old children

Summary.Objectives: The present study was designed to investigate the association between the DRD4 genotype and auditory P300 amplitudes in a high-risk community sample. Methods: ERPs were elicited in 197 eight-year-olds (98 boys, 99 girls) using a passive and an active oddball task. Auditory stimuli of 60 dB HL were presented binaurally at 1000 (standard stimulus) and 2000 Hz (target stimulus), at a relative frequency ratio of 80:20. Two trial blocks of 250 stimuli each were collected. P300 amplitudes were analyzed from Fz, Cz and Pz. DNA was genotyped for the DRD4 exon III polymorphism. Results: A pattern of significant interactions of the DRD4 genotype with gender and experimental conditions was obtained. In both the active and the passive task, boys with at least one copy of the DRD4 7-repeat allele displayed significantly lower P300 amplitudes during the second trial block than boys carrying other alleles. Conclusions: This finding provides further evidence supporting a role of P300 amplitude reduction as an endophenotype for disinhibited psychopathology.

Psychische Auffälligkeiten von Kindern alkoholkranker Väter

Objectives In spite of a growing interest in recent years in epidemiological research on behavior problems of children of alcoholics (COAs), few prospective longitudinal child psychiatric studies have been conducted up to now. Methods In the Mannheim Study of Risk Children, an ongoing prospective study of high risks, the data of 219 children (26 COAs and 193 non-COAs) were analyzed from birth to the age of 11 years. Sociodemographic data, organic and psychosocial risk factors, the number and severity of behavior problems, and the rate of expansive and introversive disorders have been investigated. Results The family status of the COAs was characterized by the fathers lower level of education as well as by socioeconomic difficulties and more numerous adverse life events. Other psychosocial problems such as marital conflict and a lack of coping mechanisms were also more frequent in COA families. A significantly higher rate of expansive symptoms and disorders was found in children of alcoholic fathers from the age of two years on. Conclusions Children of alcoholic fathers represent a group at risk for the early onset of psychiatric problems and are deserving of more attention in prevention and early intervention programs.

Avaliação do desempenho do CAGE com pacientes psiquiátricos ambulatoriais

Descriptive and transversal study to evaluate the performance of CAGE among psychiatric outpatients at a tertiary-level university hospital. Convenience sample composed of patients from HCFMRP-USP (n=127). The instruments used were CAGE and the diagnostic interview based on ICD-10 criteria for harmful use and alcohol dependence. The performance of CAGE scores was evaluated through the analysis of ROC curve, using the ICD-10 clinical diagnostic as a gold standard. The sensitivity and specificity in accordance with the cut-off points are: > or =0, Sens=100%, Spec=0%; > or =1, Sens=100%, Spec=73.7%; > or =2, Sens=53.8%, Spec=87.7%; > or =3, Sens=53.8%, Spec=94.7%; > or =4, Sens=0%; Spec=100%. Score 1 showed to be the ideal critical point for sensibility/specificity. > or =1 was the best cut-off point for CAGE among psychiatric outpatients from a tertiary-level university hospital. To increase the diagnostic power of the test and the reliability of its results, its performance in the study population should be assessed.Descriptive and transversal study to evaluate the performance of CAGE among psychiatric outpatients at a tertiary-level university hospital. Convenience sample composed of patients from HCFMRP-USP (n=127). The instruments used were CAGE and the diagnostic interview based on ICD-10 criteria for harmful use and alcohol dependence. The performance of CAGE scores was evaluated through the analysis of ROC curve, using the ICD-10 clinical diagnostic as a gold standard. The sensitivity and specificity in accordance with the cut-off points are: ³0, Sens=100%, Spec=0%; ³1, Sens=100%, Spec=73.7%; ³2, Sens=53.8%, Spec=87.7%; ³3, Sens=53.8%, Spec=94.7%; ³4, Sens=0%; Spec=100%. Score 1 showed to be the ideal critical point for sensibility/ specificity. ³1 was the best cut-off point for CAGE among psychiatric outpatients from a tertiary-level university hospital. To increase the diagnostic power of the test and the reliability of its results, its performance in the study population should be assessed.