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OBJECTIVE: To evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. METHODS: This is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. RESULTS: Relapse was associated with low family income (P=.006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P=0.683) in terms of relapses. CONCLUSIONS: In this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.
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Internação Compulsória de Doente Mental , Internação Involuntária , Transtornos Relacionados ao Uso de Substâncias/terapia , Comunidade Terapêutica , Adolescente , Adulto , Brasil , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Testes Psicológicos , Recidiva , Serviços de Saúde Rural , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento , Adulto JovemRESUMO
Objective: To evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. Methods: This is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. Results: Relapse was associated with low family income (P = .006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P = 0.683) in terms of relapses. Conclusions: In this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.
Objetivo: Evaluar las asociaciones entre recaída y admisiones (voluntarias e involuntarias) en una muestra de dependientes de sustancias. Métodos: Este es un estudio transversal realizado en una comunidad médica terapéutica privada, especializada en el tratamiento de la adicción, ubicada en una zona rural de São Paulo, Brasil. Se utilizaron las características sociodemográficas, la Escala de Evaluación de Cambios de la Universidad de Rhode Island (URICA), la Escala de Evaluación de la Etapa de Preparación y Tratamiento (SOCRATES), el Inventario de Ansiedad de Beck (BAI), el Inventario de Depresión de Beck (BDI) y la Entrevista Clínica Estructurada para DSM-IV-SCID. Resultados: La recaída se asoció con bajos ingresos familiares (p = 0,006) y contemplación de la etapa motivacional (p < 0,05). Sin embargo, no se observaron diferencias significativas entre los individuos que ingresaron involuntariamente (64%) y los voluntarios (54%) (p = 0,683) en términos de recaídas. Conclusiones: En esta muestra, el resultado de la recaída en admisiones involuntarias no fue diferente que en los voluntarios.
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PURPOSE: The heterogenic characteristics of affected family members (AFMs) of substance misusing relative (SMR) remain understudied. This study examined the occurrence and correlates of AFMs having more than one relative with substance use problems. MATERIAL AND METHODS: A secondary analysis of a cross-sectional study on the characteristics of affected family members in Brazil was performed (N= 3157). Levels of AFM stress, strain, coping and hopefulness were assessed. Factors associated with AFMs having other substance misusing relatives (other-SMRs) were explored using univariate logistic regressions. RESULTS: The occurrence of having other-SMR was reported by 61.6% of the sample (1945/3157). Of this, 47% (904/1945) reported that the other-SMR was a member of the SMR's immediate family (spouse/partner/children/siblings). The likelihood of having other-SMRs was related to the AFM being female, from a low socioeconomic background, between the age of 35-44 years older, being SMR's mother or wife/girlfriend/fiancée, scoring higher on family member impact, psychological and physical symptoms, withdrawal coping and to have an older SMR. CONCLUSION: Information about the characteristics of AFMs is key to understanding how the experience of harm associated with the relative's problem might manifest. Our findings offer information that could be used when developing interventions aimed at reducing the harm experienced by AFMs.
Objetivo: Las características heterogéneas de familiares afectados (FA) de familiares con abuso de sustancias (FAS) han sido objeto de pocos estudios. Este estudio revisó la ocurrencia y los correlatos de FA con uno o más familiares con problemas de abuso de sustancias. Materiales y Métodos: Análisis secundario de un estudio transversal sobre las características de FA en Brasil (N = 3157). Valoramos los niveles de los FA de estrés, presión, afrontamiento y esperanza. Exploramos los factores asociados con los FA que tenían otros familiares con abuso de sustancias (otros-FAS) mediante regresiones logísticas ordinales. Resultados: El 61,6% de la muestra (1945/3157) informó de la ocurrencia de otros-FAS. De estos, el 47% (904/1945) informó que los otros-FAS eran familiares directos del FAS (cónyuge/pareja/hijos/hermanos). La probabilidad de ocurrencia de otros-FAS estaba relacionada con que el FAS fuese mujer, de bajo nivel socioeconómico (NSE), con una edad entre los 35-44 años, fuese la madre o esposa/novia/prometida del FAS, obtuviese una puntuación más alta en impacto familiar, síntomas psicológicos y físicos, evitamiento como mecanismo de afrontamiento, y que tuviese un FAS mayor. Conclusión: Información sobre las características de los FA es clave para entender cómo puede manifestarse la experiencia de daños asociados con el problema del familiar. Nuestros hallazgos aportan datos que pueden ser útiles para desarrollar intervenciones con el objetivo de reducir los daños sufridos por los FA.
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Adaptação Psicológica , Família/psicologia , Estresse Psicológico/psicologia , Transtornos Relacionados ao Uso de Substâncias , Adulto , Brasil , Estudos Transversais , Relações Familiares/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Apoio Social , Adulto JovemRESUMO
As in many other health disorders, people who misuse substances tend to be assisted by female caregivers. Despite this, little is known about the characteristics of women affected by a substance misusing relative (SMR). Data from 2541 Brazilian female affected family members (AFM) were analyzed. The majority of participants were mothers, age 45 or above, in a relationship, responsible for the substance use treatment of the SMR, and were related to a male SMR. High levels of physical and psychological symptoms were associated with socioeconomic status, mothers, responsibility for the SMR's treatment, cocaine and crack-cocaine as substance of the preference of the SMR, and financial contraints as reasons for the delay to seeking help. Findings demonstrate the complex social systems associated with female AFMs and the need of gender sensitive approaches to address the AFM's coping responses to the substance misuse problem in the family.
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OBJECTIVE: To compare intimate partner violence (IPV) prevalence rates in 2006 and 2012 in a nationally representative household sample in Brazil. The associations between IPV and substance use were also investigated. METHODS: IPV was assessed using the Conflict Tactic Scale-R in two waves (2006/2012) of the Brazilian Alcohol and Drugs Survey. Weighted prevalence rates and adjusted logistic regression models were calculated. RESULTS: Prevalence rates of IPV victimization decreased significantly, especially among women (8.8 to 6.3%). The rates of IPV perpetration also decreased significantly (10.6 to 8.4% for the overall sample and 9.2 to 6.1% in men), as well as the rates of bidirectional violence (by individuals who were simultaneously victims and perpetrators of violence) (3.2 to 2.4% for the overall sample). Alcohol increased the likelihood of being a victim (odds ratio [OR] = 1.6) and perpetrator (OR = 2.4) of IPV. Use of illicit drugs increased up to 4.5 times the likelihood of being a perpetrator. CONCLUSIONS: In spite of the significant reduction in most types of IPV between 2006 and 2012, violence perpetrated by women was not significantly reduced, and the current national rates are still high. Further, this study suggests that use of alcohol and other psychoactive drugs plays a major role in IPV. Prevention initiatives must take drug misuse into consideration.
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Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Vítimas de Crime/estatística & dados numéricos , Violência por Parceiro Íntimo/tendências , Fatores Socioeconômicos , Inquéritos e Questionários , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Violência por Parceiro Íntimo/legislação & jurisprudência , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Uso de Tabaco/epidemiologia , Adulto JovemRESUMO
Objective: To compare intimate partner violence (IPV) prevalence rates in 2006 and 2012 in a nationally representative household sample in Brazil. The associations between IPV and substance use were also investigated. Methods: IPV was assessed using the Conflict Tactic Scale-R in two waves (2006/2012) of the Brazilian Alcohol and Drugs Survey. Weighted prevalence rates and adjusted logistic regression models were calculated. Results: Prevalence rates of IPV victimization decreased significantly, especially among women (8.8 to 6.3%). The rates of IPV perpetration also decreased significantly (10.6 to 8.4% for the overall sample and 9.2 to 6.1% in men), as well as the rates of bidirectional violence (by individuals who were simultaneously victims and perpetrators of violence) (3.2 to 2.4% for the overall sample). Alcohol increased the likelihood of being a victim (odds ratio [OR] = 1.6) and perpetrator (OR = 2.4) of IPV. Use of illicit drugs increased up to 4.5 times the likelihood of being a perpetrator. Conclusions: In spite of the significant reduction in most types of IPV between 2006 and 2012, violence perpetrated by women was not significantly reduced, and the current national rates are still high. Further, this study suggests that use of alcohol and other psychoactive drugs plays a major role in IPV. Prevention initiatives must take drug misuse into consideration.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Fatores Socioeconômicos , Inquéritos e Questionários , Vítimas de Crime/estatística & dados numéricos , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Violência por Parceiro Íntimo/tendências , Brasil/epidemiologia , Prevalência , Estudos Transversais , Uso de Tabaco/epidemiologia , Violência por Parceiro Íntimo/legislação & jurisprudência , Violência por Parceiro Íntimo/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: This study proposes to describe family members in the city of Sao Paulo who are seeking support in mutual self-help groups to deal with a substance misusing relative. METHOD: Five hundred participants (one participant per family) completed a structured questionnaire collecting socio-demographic information, length of time taken to seek help, and where they sought help. Participants were recruited from the mutual self-help group 'Amor Exigente' in the city of Sao Paulo, Brazil. RESULTS: Parents of substance misusers counted as the largest group of family members. It took an average time of 3.7 years for the family members to discover their relatives' substance misuse. 42% had then sought help immediately; it took an average of 2.6 years for the remaining 58% of the sample to seek some form of support. A belief that the substance misuse of their relatives was just a transient problem or that they could cope with the situation by themselves were among the most indicated reasons for delay in seeking help. DISCUSSION: Findings stress the importance of implementing services that take into account the difficulties families have in finding help to deal with the substance misusing relative.
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Família/psicologia , Acessibilidade aos Serviços de Saúde , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adaptação Psicológica , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos de Autoajuda , Fatores de TempoRESUMO
This article aims to describe the record type for first-time hospital admissions of 761 women at a single institution between 1997 and 2010 according to International Classification of Diseases, 10(th) revision, criteria, for mental and behavioral disorders due to psychoactive substance use (F10-F19). This cross-sectional study included a convenience sample of 4,736 patients in the Brazilian public health system, among whom 761 were women. Overall, the rate of alcohol-related hospitalizations decreased from 93.6% in 1997 to 50.9% in 2010. In contrast, the rate of crack cocaine-related hospitalizations increased in women from 2.8% in 1997 to 67.8% in 2010. The linear regression was R(2) = 0.8472. These data indicate a new trend in the pattern of psychoactive substance use in women.
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Consumo de Bebidas Alcoólicas/epidemiologia , Cocaína Crack , Hospitalização/tendências , Mudança Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Saúde da Mulher/tendências , Adolescente , Adulto , Idade de Início , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Classificação Internacional de Doenças , Modelos Lineares , Masculino , Distribuição por Sexo , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
Objective: To compare the neurobehavior of neonates born to adolescent mothers with and without depression during gestation. Methods: This prospective cross-sectional study included healthy term neonates born to adolescent mothers with untreated depression during gestation, without exposure to legal or illicit drugs, and compared them with infants born to adolescent mothers without psychiatric disorders. Maternal psychiatric diagnoses were assessed by the Composite International Diagnostic Interview (CIDI 2.1) and neonatal neurobehavior by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) at 24 to 72 hours of life. Neurobehavioral outcomes were analyzed by ANOVA adjusted for confounders. Results: 37 infants born to mothers with depression during gestation were compared to 332 infants born to mothers without psychiatric disorders. Infants of mothers with depression had smaller head circumferences. Significant interactions of maternal depression and male gender, gestational age > 40 weeks, regional anesthesia during delivery, vaginal delivery, and infant head circumference ≥ 34 cm were found. Worse performance was noted in the following neonatal neurobehavioral parameters: arousal, excitability, lethargy, hypotonicity, and signs of stress and abstinence. Conclusion: Infants born to adolescent mothers with depression exhibit some behavioral changes in the first days of life. These changes are associated with infant sex, gestational age, type of anesthesia, mode of delivery, and head circumference. .
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Adolescente , Criança , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Adulto Jovem , Transtorno Depressivo/complicações , Comportamento do Lactente , Complicações na Gravidez , Gravidez na Adolescência , Brasil , Estudos Transversais , Transtorno Depressivo/diagnóstico , Unidades de Terapia Intensiva Neonatal , Exame Neurológico , Estudos Prospectivos , Fatores Socioeconômicos , População UrbanaRESUMO
OBJECTIVE: To compare the neurobehavior of neonates born to adolescent mothers with and without depression during gestation. METHODS: This prospective cross-sectional study included healthy term neonates born to adolescent mothers with untreated depression during gestation, without exposure to legal or illicit drugs, and compared them with infants born to adolescent mothers without psychiatric disorders. Maternal psychiatric diagnoses were assessed by the Composite International Diagnostic Interview (CIDI 2.1) and neonatal neurobehavior by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) at 24 to 72 hours of life. Neurobehavioral outcomes were analyzed by ANOVA adjusted for confounders. RESULTS: 37 infants born to mothers with depression during gestation were compared to 332 infants born to mothers without psychiatric disorders. Infants of mothers with depression had smaller head circumferences. Significant interactions of maternal depression and male gender, gestational age > 40 weeks, regional anesthesia during delivery, vaginal delivery, and infant head circumference ≥ 34 cm were found. Worse performance was noted in the following neonatal neurobehavioral parameters: arousal, excitability, lethargy, hypotonicity, and signs of stress and abstinence. CONCLUSION: Infants born to adolescent mothers with depression exhibit some behavioral changes in the first days of life. These changes are associated with infant sex, gestational age, type of anesthesia, mode of delivery, and head circumference.
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Transtorno Depressivo/complicações , Comportamento do Lactente , Complicações na Gravidez , Gravidez na Adolescência , Adolescente , Brasil , Criança , Estudos Transversais , Transtorno Depressivo/diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Exame Neurológico , Gravidez , Estudos Prospectivos , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
PURPOSE: This study estimates the prevalence of common mental disorders and the proportion and potential determinants of detection among adolescents attending prenatal care. METHODS: We recruited 930 consecutive adolescents admitted for obstetric care, of which 457 participants had attended the hospital's prenatal care unit. Common mental disorders were assessed using the Composite International Diagnostic Interview (version 2.1). A detailed review of prenatal care records was used to identify detection of psychiatric disorders by prenatal healthcare professionals. RESULTS: A total of 103 adolescents (22.5%) had some mental disorder but only one-fifth of them had had their psychiatric disorder detected during prenatal care. The most frequent diagnosis using the Composite International Diagnostic Interview (version 2.1) was depression (13.5% or 62), but only 21% had been detected. Alcohol and drug dependence were the least common mental disorders (2.4%), but they were the most commonly detected (45.5%). Physical chronic condition increased the likelihood of detecting psychiatric disorder. CONCLUSION: Mental health is not yet recognized as an integral component of practice in prenatal care. Given the potential effect of antenatal psychiatric morbidity on maternal and child outcomes, especially among adolescents, practice needs to be changed and prenatal care professionals trained in the recognition and basic treatment of common mental disorders.
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Erros de Diagnóstico , Transtornos Mentais/diagnóstico , Complicações na Gravidez/psicologia , Gravidez na Adolescência/psicologia , Cuidado Pré-Natal , Adolescente , Brasil/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Entrevista Psicológica , Transtornos Mentais/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologiaRESUMO
The National Institute of Public Policy for Alcohol and Other Drugs (INPAD) is based at the Federal University of São Paulo, Brazil, and was created to collect scientific evidence regarding epidemiology, develop new therapeutic approaches, study health economics and provide education to subsidize the proper measures to change the Brazilian scenario of alcohol and drug consumption. Policies directed towards the control of alcohol and drugs in Brazil are fragmented, poorly enforced and therefore ineffective. The unregulated market of alcohol in Brazil has contributed to the worsening health of the Brazilian population. Since 1994, INPAD has participated actively in academic debates and discussions about alcohol and drug policies and their effects on the political welfare of the country. Many scientific papers and books have been published on this subject, and the internet and other media have provided excellent opportunities for the dissemination of specialized information to the general population.
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Academias e Institutos/organização & administração , Pesquisa/organização & administração , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Brasil , Serviços Comunitários de Saúde Mental , Criatividade , Projetos de Pesquisa Epidemiológica , Pessoal de Saúde/educação , Política de Saúde/legislação & jurisprudência , Humanos , Relações Interprofissionais , Objetivos Organizacionais , Política Pública/legislação & jurisprudência , Desenvolvimento de Pessoal , TelemedicinaRESUMO
This study estimetes the prevalecence of common mental disorders and the proportion and potential determinants of detection among adolescents attending prenatal care. Methods: We recruited 930 consecutive adolescens admitted for obstetric care, of which 457 participants had attended the hospital's prenatal care unit. Common mental disorders were assessed using the Composite International Diagnostic INterview (version 2.1). A detailed review od prenatal care records was used to identify detection of psychiatric disorders by orenatal healthcare professionals. Results: A total of 103 adolescents(22.5%) had some mental disorder but only one-fifth of them had had their psychiatric disorder detected during prenatal care. The most frequent diagnosis using the Compsite Internaional Diagnostic Interview (version2.1). was depression (13.5%), but only 21% had been detected. Alcohol and drug dependence were the least common mental disorders (2.4%), but they were the most commoly detected (45.5%), Physical chronic condition increased the likelihood of detecting psychiatric disorder. Conclusion: Mental health is not yet recognized as an integral component of practice in prenatal care, Given the potential effect of antenatal psychiatric morbidity on maternal and child outcomesm especially among aodlescents, practice needs to be changed and prenatal care professionals trained in the recognition and basic treatment of common mental disorders...
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Adolescente , Psiquiatria do Adolescente , Cuidado Pré-Natal/psicologiaRESUMO
Purpose: This study estimetes the prevalecence of common mental disorders and the proportion and potential determinants of detection among adolescents attending prenatal care. Methods: We recruited 930 consecutive adolescens admitted for obstetric care, of which 457 participants had attended the hospital's prenatal care unit. Common mental disorders were assessed using the Composite International Diagnostic INterview (version 2.1). A detailed review od prenatal care records was used to identify detection of psychiatric disorders by orenatal healthcare professionals. Results: A total of 103 adolescents(22.5%) had some mental disorder but only one-fifth of them had had their psychiatric disorder detected during prenatal care. The most frequent diagnosis using the Compsite Internaional Diagnostic Interview (version2.1). was depression (13.5%), but only 21% had been detected. Alcohol and drug dependence were the least common mental disorders (2.4%), but they were the most commoly detected (45.5%), Physical chronic condition increased the likelihood of detecting psychiatric disorder. Conclusion: Mental health is not yet recognized as an integral component of practice in prenatal care, Given the potential effect of antenatal psychiatric morbidity on maternal and child outcomesm especially among aodlescents, practice needs to be changed and prenatal care professionals trained in the recognition and basic treatment of common mental disorders.(AU)
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Adolescente , Psiquiatria do Adolescente , Adolescente , Gravidez , Cuidado Pré-Natal/psicologiaRESUMO
INTRODUCTION: Prenatal tobacco exposure interferes with neonatal outcomes. OBJECTIVE: To determine the neonatal neurobehavioral effects of in utero tobacco exposure. METHODS: This prospective cross-sectional study included healthy, term, with birth weight appropriate for gestacional age neonates without exposure to alcohol, drugs, or infections, born to adolescent mothers without psychiatric disorders or post-traumatic stress. Infants were classified according to in utero tobacco exposure, as identified by the Composite International Diagnostic Interview administered to mothers. Neurobehavior was assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Both tools were administered between 24 and 72 hours after birth. Neurobehavioral outcomes were compared between exposed and nonexposed infants by ANOVA. The associations between neurobehavioral scores and number of cigarettes smoked were studied by linear correlation. RESULTS: During the study, 928 newborns of adolescent mothers were born, and 388 were included in the study. Of these, 23 were exposed to tobacco, and 365 neonates were not exposed. There were no differences between the groups in gestational age, birth weight, post-natal age at the exam, or time between last feeding and exam. Exposed neonates showed higher scores on arousal (p = 0.004), excitability (p = 0.003), and stress/abstinence signals (p = 0.019) and a lower score on regulation (p = 0.025). After adjusting for the type of anesthesia, mode of delivery, gender, age at neurologic exam, exam duration and time between last feeding and exam, differences in arousal and excitability remained significant. The mean number of cigarettes consumed daily was positively correlated with lethargy (p = 0.013) and inversely with attention (p = 0.043). CONCLUSIONS: Neonates exposed in utero to tobacco showed worse neurobehavioral performance between 24 and 48 hours of life.
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Atenção/fisiologia , Comportamento do Lactente/psicologia , Letargia/epidemiologia , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Fumar/efeitos adversos , Adolescente , Criança , Métodos Epidemiológicos , Feminino , Humanos , Recém-Nascido , Masculino , Exposição Materna/estatística & dados numéricos , Testes Neuropsicológicos , Gravidez , Adulto JovemRESUMO
BACKGROUND: Late preterm infants have higher morbidity in the neonatal period and difficulties at school age. There are few data about neonatal neurobehavior performance that may interfere in their development. OBJECTIVES: To compare the neurobehavior of healthy late preterm and full-term neonates born to adolescent mothers. METHODS: This prospective cross-sectional study included infants with a gestational age of 40(0/7)-40(6/7) weeks (full term) and 34(0/7)-36(6/7) weeks (late preterm) aged 24-72 h without exposure to alcohol, tobacco, drugs or infections and free of clinical problems during the first 3 days of life. Infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Outcomes were analyzed by ANOVA. RESULTS: From July 2001 to November 2002, 3,685 infants were born, 928 of adolescent mothers. After exclusion, 36 late preterm and 96 term infants were enrolled. Adjusted for anesthesia type, delivery mode, gender, age at NNNS examination, time between last feeding and examination, and examination duration, late preterm, compared to term neonates, presented lower scores for attention (p = 0.041), arousal (p = 0.011), regulation (p < 0.001), quality of movements (p < 0.001) and higher scores for non-optimal reflexes (p < 0.001) and hypotonicity (p = 0.029). CONCLUSION: Late preterm infants of adolescent mothers have a more immature neurobehavioral performance at 24-72 h of life in multiple areas compared to term neonates suggesting a need for careful follow-up.
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Comportamento do Lactente , Recém-Nascido Prematuro , Gravidez na Adolescência , Adolescente , Distribuição de Qui-Quadrado , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Exame Neurológico , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
INTRODUCTION: Prenatal tobacco exposure interferes with neonatal outcomes. OBJECTIVE: To determine the neonatal neurobehavioral effects of in utero tobacco exposure. METHODS: This prospective cross-sectional study included healthy, term, with birth weight appropriate for gestacional age neonates without exposure to alcohol, drugs, or infections, born to adolescent mothers without psychiatric disorders or post-traumatic stress. Infants were classified according to in utero tobacco exposure, as identified by the Composite International Diagnostic Interview administered to mothers. Neurobehavior was assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Both tools were administered between 24 and 72 hours after birth. Neurobehavioral outcomes were compared between exposed and nonexposed infants by ANOVA. The associations between neurobehavioral scores and number of cigarettes smoked were studied by linear correlation. RESULTS: During the study, 928 newborns of adolescent mothers were born, and 388 were included in the study. Of these, 23 were exposed to tobacco, and 365 neonates were not exposed. There were no differences between the groups in gestational age, birth weight, post-natal age at the exam, or time between last feeding and exam. Exposed neonates showed higher scores on arousal (p = 0.004), excitability (p = 0.003), and stress/abstinence signals (p = 0.019) and a lower score on regulation (p = 0.025). After adjusting for the type of anesthesia, mode of delivery, gender, age at neurologic exam, exam duration and time between last feeding and exam, differences in arousal and excitability remained significant. The mean number of cigarettes consumed daily was positively correlated with lethargy (p = 0.013) and inversely with attention (p = 0.043). CONCLUSIONS: Neonates exposed in utero to tobacco showed worse neurobehavioral performance between 24 and 48 hours of life.
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Adolescente , Criança , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Adulto Jovem , Atenção/fisiologia , Comportamento do Lactente/psicologia , Letargia/epidemiologia , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Fumar/efeitos adversos , Métodos Epidemiológicos , Exposição Materna/estatística & dados numéricos , Testes NeuropsicológicosRESUMO
OBJECTIVE: To investigate the association of cocaine and marijuana use during adolescent pregnancy in São Paulo-SP, Brazil, with psychiatric disorders, social status and sexual history. METHOD: One thousand pregnant adolescents were assessed by using the Composite International Diagnostic Interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo. Hair samples were collected for analysis. RESULTS: The following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 years of age, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disorder, post-traumatic stress disorder, and somatoform disorder. CONCLUSION: In early adolescence pregnancy, having 3 or more sexual partners in life for this population is significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.
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Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Abuso de Maconha/epidemiologia , Complicações na Gravidez/epidemiologia , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Fatores Etários , Transtorno Bipolar/diagnóstico , Brasil/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/psicologia , Feminino , Cabelo/química , Humanos , Entrevista Psicológica/métodos , Abuso de Maconha/psicologia , Gravidez , Complicações na Gravidez/psicologia , Terceiro Trimestre da Gravidez , Gravidez na Adolescência/psicologia , Comportamento Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Transtornos Somatoformes/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnósticoRESUMO
OBJECTIVE: To investigate the association of cocaine and marijuana use during adolescent pregnancy in São Paulo-SP, Brazil, with psychiatric disorders, social status and sexual history. METHOD: One thousand pregnant adolescents were assessed by using the Composite International Diagnostic Interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo. Hair samples were collected for analysis. RESULTS: The following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 years of age, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disorder, post-traumatic stress disorder, and somatoform disorder. CONCLUSION: In early adolescence pregnancy, having 3 or more sexual partners in life for this population is significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.
OBJETIVO: Investigar, numa população de gestantes adolescentes de uma maternidade pública de São Paulo-SP, Brasil, a associação entre o consumo de cocaína e maconha durante a gravidez com distúrbios psiquiátricos, status social e história sexual. MÉTODO: Mil adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico e socioeconômico no centro obstétrico de um hospital público de São Paulo. Destas, foi colhida amostra para análise de fios de cabelo. RESULTADOS: Os seguintes dados foram associados com o uso de cocaína e/ou maconha durante o terceiro trimestre de gravidez: ter menos de 14 anos, ter história de mais do que três parceiros sexuais e ter transtornos psiquiátricos, em especial, transtorno afetivo bipolar, transtorno do estresse pós-traumático e transtorno somatoforme. CONCLUSÃO: Na população de adolescentes grávidas avaliada, ter menos de 14 anos e ter três ou mais parceiros sexuais na vida está significativamente associado ao uso de maconha ou cocaína durante a gestação. Esta associação sugere que programas de intervenção específicos devem ser dirigidos a essas jovens.
Assuntos
Adolescente , Feminino , Humanos , Gravidez , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Abuso de Maconha/epidemiologia , Complicações na Gravidez/epidemiologia , Gravidez na Adolescência/estatística & dados numéricos , Fatores Etários , Transtorno Bipolar/diagnóstico , Brasil/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/psicologia , Cabelo/química , Entrevista Psicológica/métodos , Abuso de Maconha/psicologia , Complicações na Gravidez/psicologia , Terceiro Trimestre da Gravidez , Gravidez na Adolescência/psicologia , Comportamento Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Transtornos Somatoformes/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnósticoRESUMO
OBJECTIVE: The aim of this study is to check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair. RESULTS: Hair analysis detected the use of cocaine and/or marijuana in the third trimester of pregnancy in 60 (6%) patients. 40 (4%) patients used only marijuana, 17 (1.7%) used only cocaine, and 3 (0.3%) used both drugs. None of the patients had reported the use of these substances in their interviews with healthcare professionals. CONCLUSION: Although the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drug use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions can be implemented for the mothers as well as for their children.