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Introduction: Vancomycin is a frequently used antibiotic for treating severe infections caused by multidrug-resistant, Gram-positive pathogens. To ensure its effectiveness and minimize the risk of nephrotoxicity, safe administration and dose monitoring are crucial. Understanding the impact of vancomycin serum levels on clinical outcomes is of paramount importance, necessitating improved knowledge on its use, dose monitoring, nephrotoxicity, and safe administration. Objective: This study aimed to evaluate the incidence of acute kidney injury (AKI) in patients receiving vancomycin before and after the implementation of an institutional protocol for vancomycin administration in a public tertiary hospital in southern Brazil. Materials and methods: A cross-sectional study design was employed, analyzing data from the electronic medical records of 422 patients who received vancomycin. The patient population was divided into two independent cohorts: those treated in 2016 (pre-protocol) and those treated in 2018 (post-protocol), following the implementation of the institutional vancomycin administration protocol. Results: The study included 211 patients in each year of assessment. Patients from both cohorts had a Charlson Comorbidity Index (CCI) score of 4. The post-protocol cohort consisted of older individuals, with a mean age of 62.8 years. In addition, patients in the post-protocol year had higher baseline creatinine levels, higher rates of intensive care unit (ICU) hospitalization, and increased use of vasopressors. In the pre-protocol year, patients received vancomycin therapy for a longer duration. When comparing the incidence of AKI between the two groups, an intervention study revealed rates of 38.4% in group 1 and 20.9% in group 2, indicating a significant reduction (p < 0.001) in the post-protocol group. A logistic regression model was developed to predict AKI, incorporating variables that demonstrated significance (p ≤ 0.250) in bivariate analysis and those recognized in the literature as important factors for AKI, such as the duration of therapy, vancomycin serum level, and ICU hospitalization. The logistic regression classification performance was assessed using a receiver operating characteristic (ROC) curve, yielding an area under the curve of 0.764, signifying acceptable discrimination of the regression model. Conclusion: Implementation of the institutional protocol for vancomycin administration resulted in a significant and cost-effective impact, ensuring appropriate therapeutic dosing, reducing adverse events (e.g., nephrotoxicity), and improving clinical outcomes for patients in the study population.
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Background: The outbreak of coronavirus disease 19 has led to measures of social distancing and quarantine worldwide. This stressful period may lead to psychological problems, including changes in substance use. In addition, sociodemographic factors are linked to changed levels of drug use and abuse observed during the COVID-19 pandemic, which are also associated with increased anxiety, depression, and other disorders. Thus, the aim of the study was to investigate (i) changes in drug use during the COVID-19 pandemic associated with social distancing, and (ii) to verify factors associated with those changes. Methods: A web-based cross-sectional observational survey was completed by a self-selected adult general population in Brazil (N = 2,435) during September/October 2020 (first wave) before and throughout the pandemic. Key outcomes: social distancing, self-reported drug use (ASSIST), and emotional states (DASS-21). Results: High social distancing was associated with fewer chances (prevalence ratio) of increased drug use for alcohol (0.71, CI95%: 0.64-0.80), tobacco (0.72; CI95%: 0.60-0.87), cannabis (0.65; CI95%: 0.55-0.78), and others. Low social distancing presented a higher DASS-21 score for anxiety (P = 0.017). Concerning covariates analysis by a general linear model, men (alcohol: 1. 71; cannabis: 3.86), younger age (alcohol: 0.97), less education (alcohol, tobacco, cannabis and cocaine/crack comparing several lower schooling categories vs. higher education), lower income (alcohol: 0.42; tobacco: 0.47; and cannabis: 0.36), and higher depression DASS-21 score (alcohol: 1.05; tobacco: 1.08; cannabis: 1.07; and cocaine/crack: 1.07) were associated with higher use prevalence of several drugs. Conclusions: Individuals reporting low social distancing increased the use of most drugs during the pandemic, while high social distancing significantly decreased drug use. Anxiety and depressive states and several sociodemographic factors (men; lower income; less education) were associated with higher drug use patterns.
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Abstract Objectives: Programs for parents have been found to have a direct positive impact on reducing the consumption of psychoactive substances by adolescents, as well as having an indirect impact on reducing risk factors and increasing protective factors. The present study aimed to verify if a telehealth prevention program based on a brief motivational intervention helps to reduce parental risk practices and increase parental protective practices for drug use in comparison with psychoeducation. Methods: A pilot randomized controlled trial was performed at the National Service of Guidance and Information on Drug Use (Ligue 132), from September 2014 to December 2015, with the parents of adolescents (n = 26). The outcome measures were parental style, risk, and protective parental practices. Results: The brief motivational intervention was found to be more effective than psychoeducation in reducing the negligent behavior of parents. Furthermore, when comparing pre‐ and post‐intervention data, the brief motivational intervention helped to change parental style and the large majority of parental practices: increasing positive monitoring, as well as decreasing physical abuse, relaxed discipline, inconsistent punishment, and negative monitoring. Conclusions: These results demonstrate that the telehealth intervention is effective in modifying the parental practices known to help in preventing drug use. Studies with more number of subjects are required so that the results can be substantiated and generalized.
Resumo Objetivos: Os programas para pais parecem ter um impacto positivo direto sobre a redução do consumo de substâncias psicoativas por adolescentes, bem como um impacto indireto sobre a redução dos fatores de risco e aumento dos fatores protetores. O presente estudo visou a verificar se um programa telessaúde de prevenção com base em uma intervenção breve motivacional ajuda a reduzir as práticas de risco dos pais e aumentar as práticas protetoras com relação ao uso de drogas, em comparação à psicoeducação. Métodos: Um ensaio piloto controlado randomizado foi feito no Serviço Nacional de Informações e Orientações sobre Drogas (Ligue 132), de setembro de 2014 a dezembro de 2015, com os pais de adolescentes (n = 26). As medições dos resultados foram o estilo dos pais e as práticas de risco e protetoras dos pais. Resultados: A intervenção breve motivacional parece ser mais eficaz do que a psicoeducação na redução dos comportamentos negligentes dos pais. Adicionalmente, quando comparada aos dados pré e pós-intervenção, a intervenção breve motivacional ajudou a mudar o estilo dos pais e a grande maioria das práticas dos pais: aumentou o monitoramento positivo e reduziu o abuso físico, disciplina permissiva, punição não condizente e monitoramento negativo. Conclusões: Esses resultados demonstram que a intervenção telessaúde é eficaz na mudança das práticas dos pais, conhecida por ajudar a prevenir o uso de drogas. Estudos com maior número de indivíduos são necessários para que os resultados possam ser comprovados e generalizados.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Padres/educación , Educación en Salud/métodos , Conducta del Adolescente/psicología , Telemedicina/métodos , Trastornos Relacionados con Sustancias/prevención & control , Padres/psicología , Factores Socioeconómicos , Estudios de Casos y Controles , Proyectos Piloto , Trastornos Relacionados con Sustancias/psicología , Factores Protectores , MotivaciónRESUMEN
Abstract Objective: To describe the users' drug abuse characteristics, problematic behaviors associated with addiction, the motivation of teenagers and young adults to quit cocaine and/or crack abuse, and then compare these characteristics. Methods: A cross-section study was conducted with 2390 cocaine/crack users (teenagers from 14 to 19 years of age, and young adults from 20 to 24 years of age); 1471 were young adults and 919 were teenagers who had called a phone counseling service between January 2006 and December 2013. Semi-structured interviews were performed via phone calls. The questionnaires included sociodemographic information; assessment of the characteristics of cocaine/crack abuse; assessment of the problematic behaviors; also, the Contemplation Ladder was used to evaluate the stages of readiness to cease substance abuse. Results: Participants reported using cocaine (48.2%), crack and other smoking forms (36.7%) and combined consumption of both drugs (15%). Young adults were more prone to using crack or crack associated with cocaine (OR = 1.9; CI 95% = 1.05-1.57) and they were exposed to substance abuse for longer than two years (OR = 3.45; CI 95% = 2.84-4.18), when compared to teenagers. On the other hand, they showed higher readiness to quit. Conclusion: Data shows important differences in drug abuse characteristics, problematic behaviors and motivation to cease substance abuse between teenager and young adult cocaine and/or crack users. Behaviors displayed by young adults involve greater physical, mental and social health damages. These findings reinforce the importance of public policy to act on prevention and promoting health, to increase protection factors among teenagers and lower risks and losses during adult life.
Resumo Objetivo: Descrever as características de consumo, comportamentos problemáticos associados ao uso e motivação para cessar o consumo entre adolescentes e jovens usuários de cocaína e/ou crack e comparar essas características. Métodos: Realizou-se um estudo transversal, com 2.390 usuários de cocaína/crack (adolescentes: 14 - 19 anos e jovens: 20 - 24 24 anos) sendo 1471 jovens e 919 adolescentes, que ligaram para um serviço de aconselhamento telefônico entre janeiro de 2006 e dezembro de 2013. Foram realizadas entrevistas semiestruturadas por telefone. Os questionários incluíram informações sociodemográficas; avaliação das características do consumo de cocaína/crack; avaliação dos comportamentos problemáticos e escala de Contemplação Ladder para avaliar os estágios de motivação. Resultados: Os participantes relataram uso de cocaína (48,2%), crack e outras formas fumadas (36,7%) e uso associado de ambas as formas (15%). Os jovens faziam maior uso de crack ou crack associado à cocaína (OR = 1,19; IC 95% = 1,05-1,57) e estavam expostos ao uso da droga havia mais de 2 anos (OR = 3,45; IC 95% = 2,84-4,18) quando comparados aos adolescentes. Por outro lado, mostraram-se mais motivados para cessar o consumo. Conclusão: Os dados mostraram haver importantes diferenças nas características de consumo, comportamentos problemáticos e motivação para cessar o consumo entre adolescentes e jovens usuários de cocaína e/ou crack. Os jovens apresentaram comportamentos que envolvem maiores prejuízos para a saúde física, mental e aspectos sociais. Esses achados reforçam a importância de ações de políticas públicas de prevenção e promoção de saúde para aumentar os fatores de proteção entre os adolescentes e reduzir riscos e prejuízos para a vida adulta.
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Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Cocaína Crack , Trastornos Relacionados con Cocaína/prevención & control , Consejo Dirigido/métodos , Motivación , Factores Socioeconómicos , Teléfono , Estudios TransversalesRESUMEN
OBJECTIVE: To describe the users' drug abuse characteristics, problematic behaviors associated with addiction, the motivation of teenagers and young adults to quit cocaine and/or crack abuse, and then compare these characteristics. METHODS: A cross-section study was conducted with 2390 cocaine/crack users (teenagers from 14 to 19 years of age, and young adults from 20 to 24 years of age); 1471 were young adults and 919 were teenagers who had called a phone counseling service between January 2006 and December 2013. Semi-structured interviews were performed via phone calls. The questionnaires included sociodemographic information; assessment of the characteristics of cocaine/crack abuse; assessment of the problematic behaviors; also, the Contemplation Ladder was used to evaluate the stages of readiness to cease substance abuse. RESULTS: Participants reported using cocaine (48.2%), crack and other smoking forms (36.7%) and combined consumption of both drugs (15%). Young adults were more prone to using crack or crack associated with cocaine (OR=1.9; CI 95%=1.05-1.57) and they were exposed to substance abuse for longer than two years (OR=3.45; CI 95%=2.84-4.18), when compared to teenagers. On the other hand, they showed higher readiness to quit. CONCLUSION: Data shows important differences in drug abuse characteristics, problematic behaviors and motivation to cease substance abuse between teenager and young adult cocaine and/or crack users. Behaviors displayed by young adults involve greater physical, mental and social health damages. These findings reinforce the importance of public policy to act on prevention and promoting health, to increase protection factors among teenagers and lower risks and losses during adult life.
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Trastornos Relacionados con Cocaína/prevención & control , Cocaína Crack , Consejo Dirigido/métodos , Motivación , Adolescente , Estudios Transversales , Femenino , Humanos , Masculino , Factores Socioeconómicos , Teléfono , Adulto JovenRESUMEN
OBJECTIVES: Programs for parents have been found to have a direct positive impact on reducing the consumption of psychoactive substances by adolescents, as well as having an indirect impact on reducing risk factors and increasing protective factors. The present study aimed to verify if a telehealth prevention program based on a brief motivational intervention helps to reduce parental risk practices and increase parental protective practices for drug use in comparison with psychoeducation. METHODS: A pilot randomized controlled trial was performed at the National Service of Guidance and Information on Drug Use (Ligue 132), from September 2014 to December 2015, with the parents of adolescents (n=26). The outcome measures were parental style, risk, and protective parental practices. RESULTS: The brief motivational intervention was found to be more effective than psychoeducation in reducing the negligent behavior of parents. Furthermore, when comparing pre- and post-intervention data, the brief motivational intervention helped to change parental style and the large majority of parental practices: increasing positive monitoring, as well as decreasing physical abuse, relaxed discipline, inconsistent punishment, and negative monitoring. CONCLUSIONS: These results demonstrate that the telehealth intervention is effective in modifying the parental practices known to help in preventing drug use. Studies with more number of subjects are required so that the results can be substantiated and generalized.
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Conducta del Adolescente/psicología , Educación en Salud/métodos , Padres/educación , Trastornos Relacionados con Sustancias/prevención & control , Telemedicina/métodos , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Motivación , Padres/psicología , Proyectos Piloto , Factores Protectores , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
For any professional, it is of crucial importance to know not only how coping styles and strategies are present in an individual, but to know about its role to the treatment of alcohol abuse. Moreover, new approaches have emerged in this area in terms of relapse prevention and the counseling by phone can be an alternative. The aim of this study is to examine the factor structure of the Coping Behaviors Inventory (CBI) and to test its invariance across groups face-to-face and phone counseling in Brazil. For this purpose, two studies were carried out: study I, the factor structure was revisited in terms of exploratory factor analysis. Study II, face-to-face and phone counseling were examined through confirmatory factor analysis and multigroup analysis. The results confirmed the 4-factor solution with a revised model for the removal of 16 items. Thus presented, a reduced version with better indexes than the previous versions developed over the last 30 years that was ones reformulated from 60 items. The Internal consistency for study I presented α = 0.90 and homogeneity was between 0.17 and 0.5). In addition the KMO = 0.9 = 0.932, X ( df = 630 ) 2 = 6091.94, p < 0.0 < 0.001. In study II, cronbach's alpha = 0.91 and homogeneity 0.23-0.61 (telemedicine treatment) and α = 0.90 0.17 to 0.63 (face-to-face treatment). In the CFA, the examination of the current version has better fit than the that the traditional model. Moreover, the new version showed convergent validity with the IDHEA questionnaire. In the multigroup analysis no significant changes between groups to a metric level. Finally, the Brazilian version of inventory showed no differences between the phone counseling and face-to-face participants in a metric level after a multigroup analysis.
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A relação entre drogas e suicídio é apontada como causal, porém alguns autores defendem a perspectiva que a presença de substância é um fator de risco. Portanto é importante nos serviços voltados aos dependentes químicos explorar o risco de suicídio para medidas preventivas. Pensando nisso foi realizado um estudo transversal no Ligue 132, para descrever as informações disponível relacionadas a situações de suicídio e a disponibilidade de serviços públicos para o atendimento desses casos. Em 2011 foi encontrado 77 casos com menções de suicídio. A substância mais envolvida foi o álcool. Entre os sujeitos que identificaram o município de onde estavam falando 64% possuía algum formato de CAPS. Ha necessidade de mais estudos para investigar o uso de telemedicina para o atendimento de casos de suicídio assim como uma descrição mais detalhada desses casos para compreensão melhor das causas.(AU)
The relationship between drugs and suicide is pointed out as causal, but some authors defend the perspective that the presence of substance is a risk factor. Therefore, it is important in services for the dependents to explore the risk of suicide for preventive measures. With this in mind, a cross-sectional study was carried out in Ligue 132, to describe the available information related to suicide situations and the availability of public services to attend these cases. In 2011, 77 cases of suicide were found. The most involved substance was alcohol. Among the subjects that identified the municipality where they were speaking 64% had some form of CAPS. There is a need for further studies to investigate the use of telemedicine for the treatment of suicide cases as well as a more detailed description of these cases for a better understanding of the causes.(AU)
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Humanos , Telemedicina , Trastornos Relacionados con Sustancias , Ideación Suicida , Suicidio , Consumidores de Drogas , Servicios de Salud MentalRESUMEN
RATIONALE: Alcohol addiction causes severe problems, and its deprivation may potentiate symptoms such as anxiety. Furthermore, ethanol is a neurotoxic agent that induces degeneration and the consequences underlying alcohol-mediated brain damage remain unclear. OBJECTIVES: This study assessed the behavioral changes during acute ethanol withdrawal periods and determined the levels of DNA damage and reactive oxygen species (ROS) in multiple brain areas. METHODS: Male Wistar rats were subjected to an oral ethanol self-administration procedure with a forced diet where they were offered 8% (v/v) ethanol solution for 21 days followed by five repeated 24-h cycles alternating between ethanol withdrawal and re-exposure. Control animals received an isocaloric control diet without ethanol. Behavioral changes were analyzed on ethanol withdrawal days in the open-field (OF) and elevated plus-maze (EPM) tests within the first 6 h of ethanol deprivation. The pre-frontal cortex, hypothalamus, striatum, hippocampus, and cerebellum were dissected for alkaline and neutral comet assays and for dichlorofluorescein ROS testing. RESULTS: The repeated intermittent ethanol access enhanced solution intake and alcohol-seeking behavior. Decreased exploratory activity was observed in the OF test, and the animals stretched less in the EPM test. DNA single-strand breaks and ROS production were significantly higher in all structures evaluated in the ethanol-treated rats compared with controls. CONCLUSIONS: The animal model of repeated intermittent ethanol access induced behavioral changes in rats, and this ethanol exposure model induced an increase in DNA single-strand breaks and ROS production in all brain areas. Our results suggest that these brain damages may influence future behaviors.
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Alcoholismo/metabolismo , Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Daño del ADN/efectos de los fármacos , Etanol/administración & dosificación , Síndrome de Abstinencia a Sustancias/metabolismo , Factores de Edad , Alcoholismo/complicaciones , Animales , Ansiedad/etiología , Ansiedad/metabolismo , Daño del ADN/fisiología , Masculino , Aprendizaje por Laberinto/efectos de los fármacos , Aprendizaje por Laberinto/fisiología , Ratas , Ratas Wistar , Especies Reactivas de Oxígeno/metabolismo , Autoadministración , Síndrome de Abstinencia a Sustancias/etiologíaRESUMEN
OBJETIVOS: investigar a qualidade de vida e voz, além das principais alterações perceptivo-auditivas e as medidas acústicas jitter, shimmer e Glottal Noise Excitation em usuários de substâncias psicoativas lícitas e/ou ilícitas que buscaram um centro de tratamento para dependência química. MÉTODOS: estudo transversal. Os participantes responderam aos questionários de Mensuração de Qualidade de Vida em Voz e World Health Organization Quality of Life Instrument-Bref. Além disso foi realizado, um registro vocal da vogal /a/ e de uma contagem de números de 1 a 20. Os registros vocais foram avaliados por meio da escala GRBAS-I (G - grau global da disfonia, R - rugosidade, B - soprosidade, A - astenia, S - tensão) e a análise acústica (jitter, shimmer, Glottal noise excitation) pelo software VoxMetria. RESULTADOS: avaliaram-se 29 protocolos e registros de voz; na amostra, 19 (65,5%) eram homens; a idade média da amostra foi de 37,8 anos. Os escores de ambos os questionários não apresentaram diferenças entre os usuários de drogas lícitas e os de drogas ilícitas. Na análise perceptiva por meio da GRBAS-I, eles mostraram predominância de alterações discretas e moderadas nos itens grau geral da disfonia, rugosidade e instabilidade para usuárias de drogas ilícitas. A medida acústica jitter e o shimmer estavam alterados para homens e mulheres, e o desvio padrão da frequência fundamental também estava alterado. CONCLUSÃO: alterações de qualidade de vida e voz foram identificadas em ambos os usuários. A maioria dos usuários apresentou alterações nas medidas de jitter e shimmer. Usuários de drogas ilícitas apresentaram mais alterações de Glottal Noise Excitation e desvio padrão da frequência fundamental. .
PURPOSES: to investigate the Quality of Life and Voice in addition to the main perceptual-auditory changes and the acoustic measures jitter, shimmer and Glottal Noise Excitation in users of licit and/or illicit psychoactive substances who sought a treatment center for chemical dependency. METHODS: cross-sectional study in which participants responded the questionnaires Voice-Related Quality of Life survey and World Health Organization Quality of Life Instrument-Bref. Voice recordings of the vowel /a/ and a count from 1 to 20 were performed. The voice recordings were evaluated by GRBAS-I (G - overall degree of dysphonia, R - roughness, B - breathiness, A - asthenia, S - strain) scale and acoustic analysis by the software VoXmetria. RESULTS: 29 protocols and voice recordings were assessed, 19 (65.5%) subjects of the sample were male, and the mean age of the sample evaluated was 37.8 years. The scores of both questionnaires indicate no differences between users of licit or illicit drugs. The perceptual analysis through GRBAS-I revealed the prevalence of mild and moderate changes in the items overal degree of dysphonia, roughness, and instability for licit and illicit drug users. Jitter and shimmer were altered for men and women, as was the standard deviation of the fundamental frequency. CONCLUSION: changes in quality of life and voice were identified in users of both licit and illicit drugs. Most users showed changes in jitter and shimmer. Illicit drug users had more changes in Glottal Noise Excitation and standard deviation of the fundamental frequency. .
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We evaluated levels of neuronal DNA damage after acute or repeated cocaine treatment in different brain areas of female rats after ovariectomy or sham surgery. Rats in the control and acute groups were given saline i.p., whereas in the repeated group were given 15 mg/kg, i.p., cocaine for 8 days. After a 10 day washout period, the control group was given saline i.p., whereas rats in the acute and repeated groups were given a challenge dose of 15 mg/kg, i.p., cocaine. After behavioural assessment, rats were killed and the cerebellum, hippocampus, hypothalamus, prefrontal cortex and striatum were dissected for the Comet assay. Acute cocaine exposure induced DNA damage in all brain areas. This effect persisted after repeated administration, except in the hypothalamus, where repeated treatment did not cause increased DNA damage. Sexual hormones exhibited a neuroprotective effect, decreasing cocaine-induced DNA damage in cycling rats in all brain areas.
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Encéfalo/citología , Cocaína/toxicidad , Daño del ADN/efectos de los fármacos , Inhibidores de Captación de Dopamina/toxicidad , Estrógenos/metabolismo , Neuronas/efectos de los fármacos , Animales , Encéfalo/efectos de los fármacos , Cocaína/administración & dosificación , Ensayo Cometa , Inhibidores de Captación de Dopamina/administración & dosificación , Femenino , Ovariectomía , RatasRESUMEN
A entrevista motivacional, intervenção colaborativa que estimula as razões à mudança, pode ser utilizada para ajudar os familiares de usuários de drogas a conduzir transformações na sua interação com o usuário. Os familiares podem desenvolver estratégias mal-adaptativas para manejarem esse problema, conhecido como codependência. Assim, os familiares necessitam receber intervenção, pois podem adoecer diante dos conflitos decorrentes dessa interação. Objetivou-se apresentar um modelo de intervenção breve motivacional por telefone para familiar de usuário. Realizou-se um estudo de caso em um serviço de telemedicina. Os instrumentos utilizados foram: protocolo de atendimento ao familiar, escalas Contemplation Ladder e Holyoake Codependency Index. Betânia, 46 anos, ligou para buscar ajuda para o seu marido usuário de álcool e crack. Após 6 meses, Betânia conseguiu perceber suas necessidades pessoais e as consequências de sua mudança na dinâmica da dependência química. A esposa do usuário reduziu a codependência e modificou comportamentos permissivos. Os serviços de telemedicina e as intervenções breves motivacionais podem promover mudanças comportamentais em familiares que necessitam de atenção e cuidados de saúde de uma forma acessível e abrangente(AU)
Motivational interviewing, a collaborative intervention that stimulates the reasons to change, can be used to help family members of drug users to drive transformation in their interaction with the user. Families of drug users may develop maladaptive strategies for managing this problem, which is known as codependency. Thus, family members need to receive intervention, as they may get sick due to the conflicts arising from this interaction. The goal was to present a model of brief motivational intervention by telephone to the user's family. We conducted a case study of a telemedicine service. The instruments used were: family attendance protocol, Contemplation Ladder and Holyoake Codependency Index. Bethany, 46 years, called to get help for her husband, an alcohol and crack user. After 6 months, Bethany was able to realize her personal needs and the consequences of her change in the dynamics of addiction. The user's wife reduced codependency and modified permissive behavior. Telemedicine services and brief motivational interventions can promote behavioral changes in families that need attention and care in an accessible and comprehensive way(AU)
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Alterations in GABA(A) receptor expression have been associated with the allopregnanolone (3α-hydroxy-5α-pregnan-20-one; 3α,5α-THP) antidepressant-like effect in rats. The present study aimed to verify the effect of bilateral, intra-nucleus accumbens core (intra-AcbC) administration of the neurosteroid allopregnanolone on behaviors in the forced swim and grooming microstructure tests and in the δ and γ2 GABA(A) receptor subunit mRNA expression in right and left hippocampus of rats. The results of this study showed that bilateral, intra-AcbC allopregnanolone administration (5µg/rat) presented antidepressant-like activity in the forced swim test concomitant with an increase in climbing. Allopregnanolone at doses of 1.25 and 5µg/rat also decreased the percentage of correct transitions in the grooming microstructure test. Both δ and γ2 GABA(A) subunit expressions increased in the rat hippocampus after allopregnanolone intra-AcbC treatment. Our findings point to asymmetrical GABA(A) receptor expression changes in the hippocampus of animals treated with allopregnanolone. Further investigation should evaluate the antidepressant-like effect of allopregnanolone not only in other directly infused regions but also with respect to changes in other brain areas of the limbic system to understand allopregnanolone's mechanism of action.
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Conducta Animal/efectos de los fármacos , Depresión/tratamiento farmacológico , Hipocampo/efectos de los fármacos , Núcleo Accumbens/efectos de los fármacos , Pregnanolona/administración & dosificación , Receptores de GABA-A/efectos de los fármacos , Animales , Secuencia de Bases , Cartilla de ADN , Hipocampo/metabolismo , Masculino , Pregnanolona/farmacología , Pregnanolona/uso terapéutico , Ratas , Ratas Wistar , Reacción en Cadena en Tiempo Real de la Polimerasa , Receptores de GABA-A/genéticaRESUMEN
Grooming behavior is an adaptation to a stressful environment that can vary in accordance with stress intensity. Direct and indirect GABA(A) receptor agonists decrease duration, frequency, incorrect transitions and uninterrupted bouts of grooming. Hormonal variation during the different phases of the estrous cycle of female rats also changes the grooming behavior. It is known that GABA(A) agonists and endogenous hormones change anxiety-like behaviors observed in the elevated plus maze test, a classical animal model of anxiety. This study was designed to determine the anxiolytic effect of clonazepam in female rats in different estrous phases and to correlate anxiety behaviors in the elevated plus maze and grooming microstructure tests. Our results show that female rats displayed higher anxiety-like behavior scores during the estrus and proestrus phases in the elevated plus maze and that clonazepam (0.25 mg/kg; i.p.) had an anxiolytic effect that was independent of the estrous phase. Grooming behaviors were higher in the proestrus phase but were decreased by clonazepam administration, independent of the estrous phase, demonstrating the anxiolytic effect of this drug in both animal models. Grooming behaviors were moderately associated with anxiolytic-like behaviors in the elevated plus maze test. Here, we describe the anxiolytic effect of clonazepam and the influence of estrous phase on anxiety. Moreover, we show that the grooming microstructure test is a useful tool for detecting anxiolytic-like behaviors in rats.
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Ansiolíticos/farmacología , Clonazepam/farmacología , Aseo Animal/efectos de los fármacos , Aprendizaje por Laberinto/efectos de los fármacos , Animales , Ciclo Estral/efectos de los fármacos , Femenino , Aseo Animal/fisiología , Aprendizaje por Laberinto/fisiología , Ratas , Ratas WistarRESUMEN
Clinical and preclinical studies have shown that diabetic individuals present more depressive behaviors than non-diabetic individuals. Taurine, one of the most abundant free amino acids in the central nervous system, modulates a variety of biological functions and acts as an agonist at GABAA receptors. Our objective was to assess the antidepressant effect of taurine in diabetic rats. Additionally, we studied the effect of taurine on weight gain, water and food intake, and blood glucose levels in diabetic and non-diabetic rats. Male Wistar rats were divided into control (CTR) and streptozotocin-induced diabetic (STZ) groups and were administered daily 0, 25, 50 or 100 mg/kg of taurine (n = 10 per subgroup) intraperitoneally. After 28 days of treatment, the animals were exposed to the forced swimming test, and their behaviors were recorded. Weight gain, water and food intake, and blood glucose levels were measured weekly. Our results showed that STZ rats had a higher immobility duration than CTR rats, and taurine decreased this depressive-like behavior in STZ rats at doses of 25 and 100 mg/kg. Both of these doses of taurine also decreased water intake and improved weight gain in STZ rats. All doses of taurine decreased the water intake in CTR rats. Taurine, at a dose of 100 mg/kg, decreased food intake and blood glucose levels in STZ rats. Because taurine is a GABA agonist and both amino acids are lower in the plasma of diabetic and depressive individuals, we hypothesize that taurine may represent a new adjuvant drug for the treatment of depression in diabetic individuals.
Asunto(s)
Antidepresivos/administración & dosificación , Depresión/tratamiento farmacológico , Diabetes Mellitus Experimental/tratamiento farmacológico , Taurina/administración & dosificación , Animales , Conducta Animal/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Depresión/complicaciones , Depresión/metabolismo , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Experimental/metabolismo , Relación Dosis-Respuesta a Droga , Ingestión de Líquidos/efectos de los fármacos , Ingestión de Alimentos/efectos de los fármacos , Humanos , Inyecciones Intraperitoneales , Masculino , Ratas , Ratas Wistar , Estreptozocina , NataciónRESUMEN
OBJECTIVE: To evaluate the number of immune cells in the peripheral blood of medication-overuse headache (MOH), chronic migraine (CM), and migraine without aura (MWA) patients, as well as from controls. BACKGROUND: Migraine has been linked to immunologic disturbances, but the role of the immune system in chronic forms of headache that evolve from migraine has not been studied. Psychiatric co-morbidity has been related to both headache chronification and immunologic alterations. METHODS: This cross-sectional study comprised 68 subjects divided in 4 groups: MOH, CM, MWA, control. Subjects were gender-matched, had no physical co-morbidity, and were taking only acetaminophen. Clinical and psychological data were recorded in a standardized protocol. Samples of peripheral blood for hematological analysis were obtained in the morning during the ictal (MOH, CM, and MWA groups) and interictal periods (MWA group), as well from control group. RESULTS: A higher lymphocyte count was measured in MOH patients relative to the MWA patients (mean ± standard deviation: 2448.7/mm3 ± 775.8 vs. 1859.7/mm3 ± 564.7; P = .027). The numbers of blood lymphocytes for CM and control subjects were 2086.1/mm3 ± 540.5 and 1961.7/mm3 ± 385.6, respectively. Multiple linear regression analysis demonstrated that only MOH and MWA groups remained associated with lymphocyte count (B = 540.7; CI 95%: 55.2-1026.1; P = .03; R2 = 19.2%). Analysis for linearity of variables in the spectrum control/MWA/CM/MOH resulted positive for body mass index (from 23.5 ± 3.25 in controls to 26.5 ± 4.49 in MOH patients; P = .034), scores on Beck Depression Inventory (from 3.29 ± 3.05 to 14.65 ± 11.21; P < 0.001) and Hamilton Anxiety Scale (from 4.29 ± 3.93 to 23.24 ± 11.01; P < 0.001), hemoglobin (from 13.7 ± 0.79 to 14.6 ± 1.31; P = .022), and lymphocyte count (from 1961.7 ± 385.6 to 2448.7 ± 775.8; P = .01), but negative for CD8+ T lymphocytes (from 34.0 ± 8.82 to 30.0 ± 6.64; P = .046). CONCLUSIONS: A higher lymphocyte count in the MOH group relative to the MWA group may indicate a chronic inflammatory state. Several clinical and laboratorial characteristics have a range along a spectrum extending from healthy subjects to patients suffering from chronic forms of migraine.
Asunto(s)
Cefaleas Secundarias/patología , Trastornos de Cefalalgia/patología , Leucocitos/patología , Trastornos Migrañosos/patología , Acetaminofén/farmacología , Acetaminofén/uso terapéutico , Adulto , Analgésicos no Narcóticos/farmacología , Analgésicos no Narcóticos/uso terapéutico , Antígenos CD/metabolismo , Recuento de Células , Femenino , Trastornos de Cefalalgia/tratamiento farmacológico , Trastornos de Cefalalgia/epidemiología , Cefaleas Secundarias/tratamiento farmacológico , Cefaleas Secundarias/epidemiología , Pruebas Hematológicas , Humanos , Leucocitos/efectos de los fármacos , Leucocitos/metabolismo , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/epidemiología , Escalas de Valoración PsiquiátricaRESUMEN
OBJETIVO: Verificar a associação entre uso de drogas e estilos parentais percebidos pelos filhos adolescentes brasileiros. MÉTODOS: Este estudo transversal foi realizado com adolescentes de 14 a 19 anos que ligaram para o Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas. Participaram do estudo 232 adolescentes. As entrevistas, realizadas por telefone, incluíram: a Escala de Responsividade e Exigência Parental, que classifica os estilos materno e paterno percebidos pelos adolescentes em autoritativo, negligente, indulgente e autoritário; variáveis sociodemográficas; e instrumento para avaliar consumo no mês e abuso de substâncias. RESULTADOS: Os estilos parentais materno e paterno percebidos como negligente, indulgente ou autoritário (não autoritativos) tiveram associação significativa para uso de drogas [odds ratio (OR) = 2,8, intervalo de confiança de 95 por cento (IC95 por cento) 1,3-5,7 para mães, e OR = 2,8, IC95 por cento 1,3-6,3 para pais]. Os estilos não autoritativos também demonstraram relação significativa com uso de tabaco no mês para o estilo materno (OR = 2,7, IC95 por cento 1,2-6,5) e para o paterno (OR = 3,9, IC95 por cento 1,4-10,7), uso de cocaína/crack no mês (OR = 3,9, IC95 por cento 1,1-13,8) e abuso de qualquer droga (OR = 2,2, IC95 por cento 1,0-5,1) somente para o estilo paterno. A análise de regressão logística mostrou que o estilo materno (OR = 3,3, IC95 por cento 1,1-9,8), sexo do adolescente (OR = 3,2, IC95 por cento 1,5-7,2) e idade (OR = 2,8, IC95 por cento 1,3-6,2) tiveram associação com o uso de drogas. CONCLUSÕES: Adolescentes que avaliam suas mães como não autoritativas apresentam maior chance de usar drogas. Os pais não autoritativos têm mais associação com abuso de drogas pelos adolescentes.
OBJECTIVE: To evaluate the association between drug use and parenting styles perceived by Brazilian adolescent children. METHODS: This cross-sectional study enrolled adolescents aged 14 to 19 years that used the Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas (VIVAVOZ). A total of 232 adolescents participated in the study. Phone interviews were conducted using the Parental Responsiveness and Demandingness Scale, which classifies maternal and paternal styles perceived by adolescent children as authoritative, neglectful, indulgent or authoritarian. Sociodemographic variables were collected and an instrument was used to assess monthly drug use and abuse. RESULTS: Maternal and paternal parenting styles perceived as neglectful, indulgent or authoritarian (non-authoritative) were significantly associated with drug use (odds ratio [OR] = 2.8; 95 percent confidence interval [95 percentCI], 1.3-5.7 for mothers and OR = 2.8; 95 percentCI, 1.3-6.3 for fathers). Non-authoritative styles also had a significant association with tobacco use in the previous month in the analysis of maternal (OR = 2.7; 95 percentCI, 1.2-6.5) and paternal (OR = 3.9; 95 percentCI, 1.4-10.7) styles, and use of cocaine/crack in the previous month (OR = 3.9; 95 percentCI, 1.1-13.8) and abuse of any drug (OR = 2.2; 95 percentCI, 1.0-5.1) only for the paternal style. Logistic regression revealed that maternal style (OR = 3.3; 95 percentCI, 1.1-9.8), adolescent sex (OR = 3.2; 95 percentCI, 1.5-7.2) and age (OR = 2.8; 95 percentCI, 1.2-6.2) were associated with drug use. CONCLUSIONS: Adolescents that perceived their mothers as non-authoritative had greater chances of using drugs. There was a strong association between non-authoritative paternal styles and adolescent drug abuse.
Asunto(s)
Adolescente , Femenino , Humanos , Masculino , Adulto Joven , Autoritarismo , Conducta del Adolescente/psicología , Percepción , Responsabilidad Parental/psicología , Trastornos Relacionados con Sustancias/psicología , Estudios Transversales , Madres/psicología , Oportunidad Relativa , Factores SocioeconómicosRESUMEN
OBJECTIVE: To evaluate the association between drug use and parenting styles perceived by Brazilian adolescent children. METHODS: This cross-sectional study enrolled adolescents aged 14 to 19 years that used the Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas (VIVAVOZ). A total of 232 adolescents participated in the study. Phone interviews were conducted using the Parental Responsiveness and Demandingness Scale, which classifies maternal and paternal styles perceived by adolescent children as authoritative, neglectful, indulgent or authoritarian. Sociodemographic variables were collected and an instrument was used to assess monthly drug use and abuse. RESULTS: Maternal and paternal parenting styles perceived as neglectful, indulgent or authoritarian (non-authoritative) were significantly associated with drug use (odds ratio [OR] = 2.8; 95% confidence interval [95%CI], 1.3-5.7 for mothers and OR = 2.8; 95%CI, 1.3-6.3 for fathers). Non-authoritative styles also had a significant association with tobacco use in the previous month in the analysis of maternal (OR = 2.7; 95%CI, 1.2-6.5) and paternal (OR = 3.9; 95%CI, 1.4-10.7) styles, and use of cocaine/crack in the previous month (OR = 3.9; 95%CI, 1.1-13.8) and abuse of any drug (OR = 2.2; 95%CI, 1.0-5.1) only for the paternal style. Logistic regression revealed that maternal style (OR = 3.3; 95%CI, 1.1-9.8), adolescent sex (OR = 3.2; 95%CI, 1.5-7.2) and age (OR = 2.8; 95%CI, 1.2-6.2) were associated with drug use. CONCLUSIONS: Adolescents that perceived their mothers as non-authoritative had greater chances of using drugs. There was a strong association between non-authoritative paternal styles and adolescent drug abuse.
Asunto(s)
Conducta del Adolescente/psicología , Autoritarismo , Responsabilidad Parental/psicología , Percepción , Trastornos Relacionados con Sustancias/psicología , Adolescente , Estudios Transversales , Femenino , Humanos , Masculino , Madres/psicología , Oportunidad Relativa , Factores Socioeconómicos , Adulto JovenRESUMEN
Introdução: A dependência de drogas é um fenômeno que atinge não somente o usuário, mas também o sistema familiar como um todo. Devido à complexidade dessa relação, a família pode desenvolver características conhecidas como codependência, entre elas: autoestima baixa, valorização das opiniões dos outros em detrimento das suas, dificuldade de identificar os sentimentos ou comportamentos que facilitam o uso de drogas. O objetivo deste estudo foi avaliar as crenças codependentes e o estágio de mudança em familiares de usuários de drogas que procuraram um serviço de teleatendimento. Métodos: Realizou-se um estudo transversal no VIVAVOZ Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas no período de junho a julho de 2007. A amostra incluiu 154 familiares de usuários de drogas. Os instrumentos utilizados foram as escalas Ladder, que avalia o estágio de mudança de comportamento frente ao familiar usuário e Holyoake Codependency Index. Esta avalia a codependência em 13 itens, sendo calculados pela soma de 3 elementos denominados: foco no outro, autosacrifício e reatividade. Resultados: 71% dos familiares apresentaram crenças codependentes. Dentre esses, 89% identificaram-se no estágio de contemplação, ou seja, percebiam a necessidade de mudança no seu comportamento em relação aos usuários. Conclusão: Este estudo reforça a importância de abordagens voltadas à família para motivar seus integrantes a diminuírem os comportamentos codependentes
Introduction: Drug addiction is a phenomenon that affects not only the user but also the family system as a whole. Due to the complexity of this relationship, the family can develop characteristics known as codependency, including: low self-esteem, appreciation of others opinions to the detriment of their own, and difficulty identifying feelings or behaviors that facilitate the use of drugs. The aim of this study was to evaluate the codependent beliefs and stage of change in family members of drug users who sought a helpline service. Methods: This was a cross-sectional study in the VIVAVOZ National Guidance and Information on Prevention of Drug Abuse in the period from June to July 2007. The sample included 154 families of drug users. The instruments used were the Ladder scale, which assesses the stages of changing behavior towards family-user, and the Holyoake Codependency Index, which assesses the codependence in 13 items, calculated from the sum of three elements, namely: Focus on the other, self-sacrifice, and reactivity. Results: 71% of relatives showed codependent beliefs. Among these, 89% identified themselves in the contemplation stage, i.e., they perceived the need for change in their behavior in relation to users. Conclusion: This study reinforces the importance of familyoriented approaches to motivate their members to lower co-dependent behaviors
Asunto(s)
Humanos , Masculino , Femenino , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/prevención & control , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
Diabetes mellitus (DM) is a chronic hyperglycemic state. DM may be associated with moderate cognitive deficits and neurophysiologic/structural changes in the brain (diabetic encephalopathy). Psychiatric manifestations seem to accompany this encephalopathy, since the prevalence of depression in diabetic patients is much higher than in the general population, and clonazepam is being used to treat this complication. The excessive production of oxygen free radicals that may occur in diabetes induces a variety of lesions in macromolecules, including DNA. In this work, we analyzed DNA damage in leukocytes from streptozotocin-induced diabetic rats submitted to the forced swimming test. The DNA damage index was significantly elevated (DI=61.00 ± 4.95) in the diabetic group compared to the control group (34.00 ± 1.26). Significant reductions of the damage index were observed in diabetic animals treated with insulin (45.00 ± 1.82), clonazepam (52.00 ± 1.22), or both agents (39.00 ± 5.83, not significantly different from control levels). Insulin plus clonazepam can protect against DNA damage in stressed diabetic rats.