Fernanda Gonçalves Moreira

Situations related to drug misuse in public schools in the city of São Paulo, Brazil

OBJECTIVE To explore situations, attitudes and behavior of public elementary school education supervisors concerning psychoactive substance misuse. METHODS The study was carried out in the city of São Paulo, Southeastern Brazil, in 2002. Data were collected using a semi-structured questionnaire applied to eight key informants in the administrative area experienced in education supervision. Qualitative content analysis with ethnographic reference was conducted. RESULTS Most discourses show that knowledge transmission is thought as essential for drug use prevention, though supervisors reported being ill-informed on this subject. The most frequent attitudes toward drug users are impotence and inability to act and sometimes a repressive attitude. These are motivated by misinformation and fear due to mistaken association of drug users and criminals. In situations indirectly related to drug abuse (family and behavior problems) more understanding and inclusive attitudes are reported, following the harm reduction paradigm. CONCLUSIONS Theoretical capacity building of educators for preventive attitudes would support their skills developed through dealing with situations (in)directly related to drug abuse in schools. Thus, educators would feel more confident to make interventions for harm or risk reduction among drug users.

Knowledge and attitudes related to drug abuse and prevention displayed by public school educators

OBJECTIVE To investigate the connection between knowledge about and the attitudes towards drug abuse by students displayed by public school educators in Brazil. METHOD Cross-sectional study, with probabilistic sampling encompassing 20% of the municipal elementary schools located in the city of São Paulo from which educators were enrolled to answer three questionnaires: 1) professional and personal data; 2) assessment of their attitudes in drug abuse situations; 3) assessment of their knowledge on drug abuse. RESULTS Considering possible values between -17 and +21, professionals scored 11.5 +/- 3.8 in the Attitudes scale. These values correspond to more empathic attitudes. Scores in the Knowledge on Drugs Scale were 55.2 +/- 12.5 (possible values: 0 to 100). Correlation between the Attitudes Scale and the time spent working as education professionals was -0.288 (p < 0.01). The difference in the means in the Attitude Scale according to professional academic qualifications was statistically significant (-1.93, t = 2.26; gl = 80; p < 0.05). CONCLUSION The level of knowledge about drugs displayed by educators was average and not influenced by the professionals academic qualifications. In contrast, their attitudes were predominantly empathic and directly associated to their academic qualifications and inversely associated to the amount of time they had spent in that position.

Drug-Related Disorders and the Criminal and Clinical Background of the Prison Population of Sao Paulo State, Brazil

Objective To analyze the association between drug (DAD) and alcohol (AAD) abuse and dependency and criminal and clinical background by gender of prisoners in São Paulo, Brazil. Method Cross-sectional study, random sample stratified by administrative district, from which prisons and prisoners were selected via random, multistage sampling. Psychiatric diagnoses were made with the CIDI 2.1. Lifetime prevalence and 95% CI were calculated and adjusted via analysis of complex samples. Multinomial logistic regression analysis was carried out with four categories of dependent variables: presence AAD; presence DAD; presence of another mental disorder; no mental disorders. For female alcohol and drug abuse and dependency (ADAD) were combined into a single category. Results The sample was composed by 1809 interviewed prisoners (1192 men and 617 women). Prevalence of DAD and AAD was 25.2% and 15.6%, respectively, among female prisoners, and 26.5% and 18.5% among males. Male prisoners with DAD were more likely to have a criminal record as an adolescent (OR 2.17), to be a repeat offender (OR 2.85), and to have committed a property crime (OR 2.18). Prisoners with AAD were repeat offenders (OR 2.18). Among female prisoners, ADAD was associated with repeat offenses (OR 3.39), a criminal record as an adolescent (OR 9.24), a clinical or infectious condition (OR 5.09), another health problem (OR 3.04), and violent crime (OR 2.5). Conclusion The study confirmed an association between drug-use disorders and the criminal and clinical background in the study population. Prisoners with such disorders were more likely to be repeat offenders and to have a criminal record as adolescents. Among female prisoners disorders were also associated with violent crime and health problems, while among males they were associated with property crime. These patterns in clinical and criminal backgrounds illustrate the need for social rehabilitation programs and specific medical treatment for prison populations.

Avaliação da evolução da empatia em alunos do quarto ano da graduação em medicina da Unifesp em 2012

OBJECTIVE: This study consisted of reassessing empathy demonstrated by fourth-year medical students at Unifesp after a prior evaluation in 2009 when the students were in the first year of the course, and a consequent comparison of the results obtained. METHOD: A validated instrument known as the Empathy Inventory (Falcone, 2008) was used to measure empathy among 80 fourth-year students at Unifesp Medical School. The inventory features 40 questions in a Likert scale that assess four factors related to the ability to empathize: Adoption of a Perspective, Interpersonal Flexibility, Altruism and Emotional Sensitivity. RESULTS: Empathy among medical students at Unifesp showed no statistically significant change from 2009 to 2012. CONCLUSION: The increased contact that students have with patients at the beginning of the course combined with the high number of curricular subjects focused on the humanities possibly explains the result. Students at the institution are able to develop the technique giving it a more humanist character and learning from the beginning how to treat patients, rather than illnesses.

Revictimization of violence suffered by those diagnosed with alcohol dependence in the general population.

Objective. To verify the association between violence and alcohol dependence syndrome in sample populations. Method. Population-wide survey with multistage probabilistic sample. 3,744 individuals of both genders, aged from 15 to 75 years, were interviewed from the cities of São Paulo and Rio de Janeiro using the Composite International Diagnostic Interview (CIDI 2.1). Results. In both cities, alcohol dependence was associated with the male gender, having suffered violence related to criminality, and having suffered familial violence. In both cities, urban violence, in more than 50% of cases, and familial violence, in more than 90% of cases, preceded alcohol dependence. The reoccurrence of traumatic events occurred in more than half of individuals dependent on alcohol. In São Paulo, having been diagnosed with PTSD is associated with violence revictimization (P = 0.014; Odds = 3.33). Conclusion. Alcohol dependence syndrome is complexly related to urban and familial violence in the general population. Violence frequently precedes alcoholism, but this relationship is dependent on residence and traumatic events. This vicious cycle contributes to perpetuating the high rates of alcoholism and violence in the cities. Politicians ordering the reduction of violence in the large metropolises can, potentially, reduce alcoholism and contribute to the break of this cycle.

Efetividade do atendimento psicossocial na continuidade escolar de adolescentes em vulnerabilidade social

OBJECTIVE to study the effectiveness of a psychosocial care program in school continuity of adolescents in social vulnerability. METHODS this was a retrospective cohort study involving 200 adolescents assisted in a multidisciplinary intervention program with harm reduction approach, from 2007 to 2012; the intervention effect was assessed using Poisson regression models. RESULTS 200 adolescents were included in the program; 116 of them continued and 84 dropped it; 74.5% were attending school after six month, with a higher proportion among those who adhered to the intervention (RR=1.12 - 95%CI 1.01;1.27); and those who were studying when they joined the program (RR=8.52 - 95%CI 3.71;19.57). CONCLUSION the evaluated program has a positive effect on rehabilitation and school continuity of adolescents in social vulnerability, but individual characteristics, such as being studying already, play a dominant role in the adherence to the program.Resumo OBJETIVO: estudar a efetividade do programa de atendimento psicossocial (PAS) na continuidade escolar de adolescentes em vulnerabilidade social. METODOS: estudo de coorte retrospectivo de adolescentes atendidos de 2007 a 2012, em programa de intervencao multidisciplinar com pressupostos da abordagem de reducao de danos; o efeito da intervencao foi avaliado por meio de modelos de regressao de Poisson. RESULTADOS: foram incluidos 200 adolescentes, dos quais 116 permaneceram e 84 abandonaram o programa; 74,5% estavam estudando apos seguimento de seis meses, com maior proporcao entre os aderentes a intervencao (RR=1,12 - IC95% 1,01;1,27) e aqueles que estavam estudando no inicio da intervencao (RR=8,52 - IC95% 3,71;19,57). CONCLUSAO: o programa avaliado tem efeito positivo na reinsercao e continuidade escolar do adolescente em vulnerabilidade social; porem, caracteristicas do individuo, como ja estar estudando, desempenharam papel predominante na adesao ao PAS.

P-624 - Psychotropic use and mental health treatment gap in two urban centers: são paulo and rio de janeiro

Objective Estimate the prevalence of use of psychotropic medications in the cities of Sao Paulo (SP) and Rio de Janeiro (RJ); Method Random sample of 3744 individuals, 15–75 years; CIDI 2.1 (depression and anxiety) and direct questions about use of psychotropic medications in the past year; prevalence estimation was performed by weighting oversampling in SP and standardization between cities by age; psychotropic consumption association with socio-demographic variables and diagnosis was performed by logistic regression. Results The prevalence of psychotropic use was 8.95% in SP (CI:7.93–9 .97) and 9:54% in RJ (CI:8.49–10 .59). Antidepressants (4.72% and 4.33%) and tranquilizers (4.20% and 1.73%) respectively in SP and RJ where more common used. Psychiatrists in SP most often prescribed psychotropic (39%), in RJ general practitioners (48.8%) where more cited. Most antipsychotics (52%) and antidepressants (39%) in SP were donated by the government in RJ this figure falls to 8% and 7%. Female individuals with increasing age, separated or divorced with a psychiatric diagnosis in the past year, family history of mental illness and higher income were more likely to use psychotropic drugs. About 70% to 82% of individuals diagnosed with major depressive disorder or phobic disorder, did not use any psychotropic drug. Conclusion There was a decrease in the consumption of psychotropic drugs in Brazil in recent decades, with a change in the consumption of tranquilizers and antidepressants. There is a need for a better training and education of doctors and family assistance programs in recognizing symptoms of common mental health disorders.