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OBJECTIVES: To determine cannabis use patterns, the predictive sociodemographic correlates of driving under the influence of cannabis (DUIC) and the association between risk perception and cannabis dependence among vehicle drivers in Jamaica. DESIGN: Secondary data analysis. SETTING: Used the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS: 1060 vehicle drivers extracted from the population sample of 4623. PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis used Pearson's χ2 test and logistic regression. ORs and 95% CIs were recorded. A p<0.05 was considered statistically significant. RESULTS: More than 10% of Jamaican drivers admitted to DUIC in the past year. Approximately 43.3% of drivers who currently use cannabis reported DUIC only. Evidently, 86.8% of drivers who DUIC were heavy cannabis users. Approximately 30% of drivers with moderate to high-risk perception of smoking cannabis sometimes or often were dependent on cannabis. Notwithstanding, drivers with no to low-risk perception of smoking cannabis sometimes or often were significantly likelier to be dependent (p<0.001 and p<0.001, respectively). Logistic regression highlighted male drivers (OR 4.14, 95% CI 1.59 to 14.20, p=0.009) that were 34 years and under (OR 2.97, 95% CI 1.71 to 5.29, p<0.001) and were the head of the household (OR 2.22, 95% CI 1.10 to 4.75, p=0.031) and operated a machine as part of their job (OR 1.87, 95% CI 1.09 to 3.24, p=0.023) were more likely to DUIC, while those who were married (OR 0.42, 95% CI 0.22 to 0.74, p=0.004) and had achieved a tertiary-level education (OR 0.26, 95% CI 0.06 to 0.76, p=0.031) were less likely. CONCLUSIONS: Two in five Jamaican drivers, who currently smoke cannabis, drive under its influence, with over 85% engaging in heavy use. Public health implications necessitate policy-makers consider mobile roadside drug testing and amending drug-driving laws to meet international standards.
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Cannabis , Dirigir sob a Influência , Abuso de Maconha , Fumar Maconha , Masculino , Humanos , Jamaica , Agonistas de Receptores de CanabinoidesRESUMO
OBJECTIVES: This study aimed to examine concurrent polysubstance use of alcohol, tobacco and marijuana and determine correlations with access to marijuana, friend and familial drug use habits, risk perception and the age of initiation associated with the singular use of these substances. DESIGN: A secondary data analysis. SETTING: Used the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS: Involved the entire dataset comprising 4623 randomly selected respondents between 12 and 65 years old. OUTCOME MEASURES: Primary outcome: concurrent polysubstance use recorded as using two or more of alcohol, tobacco and marijuana. Predictor variables include risk perception and age of initiation of singular alcohol, tobacco and marijuana use, ease of marijuana access and family and friend alcohol and illegal drug use. RESULTS: Approximately 58%-66% of respondents commenced singular alcohol, tobacco or marijuana use under 17. Participants commencing marijuana use at 11 years and under and between 12 and 17 were 3.346 and 4.560 times more likely to report past month concurrent polysubstance use (p=0.030 and p<0.001). Respondents who did not believe that smoking tobacco sometimes (p=0.049), and smoking marijuana sometimes and often was harmful, had increased odds of concurrent polysubstance use (p=0.047 and p<0.001, respectively). Respondents who indicated access to marijuana as easy were significantly more likely to report past month concurrent polysubstance use compared with those who reported access as difficult (p=0.002). Participants who indicated that friends or family members get drunk and take illegal drugs were associated with 1.722 and 1.864 increased odds of reporting past month concurrent polysubstance use (p=0.004 and p=0.017, respectively). CONCLUSIONS: Decreased perceived risk, childhood and adolescent age of initiation and easy access to marijuana were significantly associated with polysubstance use among Jamaicans. The influence of friends and family members' drug and alcohol use behaviours on individuals developing polysubstance use habits further endorses the need for interventions.
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Cannabis , Fumar Maconha , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Humanos , Criança , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Jamaica/epidemiologia , Fumar Maconha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , EtanolRESUMO
OBJECTIVES: To determine the prevalence of alcohol use patterns, sociodemographic factors and risk of alcohol dependence among vehicle drivers in Jamaica. DESIGN: A secondary data analysis. SETTING: This study was conducted using the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS: This included 1060 vehicle drivers derived from the population sample of 4623. The participants from each household were randomly selected as the respondent for the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Alcohol use and dependence were measured using the Alcohol Use Disorders Identification Test questionnaire. Driving under the influence of alcohol (DUIA) was assessed by questions regarding its use in the past 12 months. The analysis involved the use of Pearson's χ2 test and logistic regression. RESULTS: 75% of Jamaicans reported lifetime alcohol use. Approximately 65% of drivers indicated that they currently drink alcohol. 18% of drivers who currently drink alcohol admitted to DUIA. Reportedly, 54.5% of these drivers were alcohol binge drinkers, with 41.5% also driving under the influence of cannabis. The bivariate analysis demonstrated that DUIA was higher among Christian participants and those who worked in non-machine operator jobs (p=0.002 and p=0.008, respectively). Vehicle drivers altogether and drivers who drive under the influence of alcohol had significant associations with hazardous drinking (p=0.011 and p<0.001, respectively). Logistic regressions highlighted drivers 34 years and under (p=0.012), male drivers (p=0.002) and the head of the household (p=0.050) were 1.82, 3.30 and 1.86 times more likely, respectively, to report driving under the influence of alcohol in the past year. CONCLUSIONS: The prevalence of alcohol use among Jamaica's population and vehicle drivers is high. That one in five drivers, who currently consume alcohol, also admits to driving under the influence suggests the urgent need for mitigation strategies and legislative action as part of a preventative effort to reduce drunk driving.
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Alcoolismo , Dirigir sob a Influência , Masculino , Humanos , Jamaica/epidemiologia , Etanol , Consumo de Bebidas Alcoólicas/epidemiologiaRESUMO
BACKGROUND: Attention-deficit and hyperactivity disorder (ADHD) is frequently diagnosed in patients with substance use disorders (SUDs), including opioids. There remains concern about the safety and efficacy of prescription amphetamines (PAs) and their impact on effectiveness of opioid use disorder (OUD) treatment with buprenorphine. OBJECTIVES: To assess the effect of PAs on OUD buprenorphine treatment retention and/or SUD-related emergency admission or drug-related poisonings. METHODS: We used a retrospective cohort design with a secondary analysis of data from Merative MarketScan Commercial and Multi-State Medicaid Databases from 1 January 2006 to 31 December 2016. Individuals included were aged 12-64 years, had an OUD diagnosis and were prescribed buprenorphine. Our analysis used multivariable Cox regression to evaluate the relationship between PA receipt and time to buprenorphine discontinuation. The second part focused on subsamples of buprenorphine initiators who had either (1) any SUD-related emergency admissions or (2) drug-related poisoning. These outcomes were modelled as a function of PA exposure using conditional logistic regression models as part of a within-person, case-crossover design. FINDINGS: Our sample had 90 269 patients with OUD (mean age 34.2 years (SD=11.3)) who initiated buprenorphine. Being prescribed a PA was associated with improved buprenorphine retention among individuals both with (adjusted HR (aHR) 0.91 (95% CI 0.86 to 0.97)) and without a concurrent psychostimulant use disorder (PSUD) (aHR 0.92 (95% CI 0.90 to 0.93)). CONCLUSIONS: PA use was associated with improved buprenorphine retention in people with OUD with and without co-occurring PSUD. The risks of acute SUD-related events and drug-related poisonings associated with PA use did not differ when comparing PA-using days with days without PA use. CLINICAL IMPLICATIONS: Patients with OUD on buprenorphine should receive treatment with a PA when indicated.
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Buprenorfina , Overdose de Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Transtornos Relacionados ao Uso de Opioides , Adulto , Humanos , Anfetaminas/uso terapêutico , Buprenorfina/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estudos Retrospectivos , Estudos Cross-OverRESUMO
PURPOSE: Substance misuse has long been recognized as a major predisposing risk factor for traumatic injury. However, there still exists no clear scientific consensus regarding the impact of drug use on patient outcomes. Therefore, this study aims to evaluate the demographic profile, hospital-course factors, and outcomes of trauma patients based on their toxicology. METHODS: This is a non-concurrent cohort study of 3709 patients treated at the Puerto Rico Trauma Hospital during 2002-2018. The sample was divided into four groups according to their toxicology status. Statistical techniques used included Pearson's chi-square test, Spearman correlation, and negative binomial and logistic regressions. RESULTS: Admission rates for marijuana (rho = 0.87) and marijuana and cocaine positive (rho = 0.68) patients increased. Positive toxicology patients underwent surgery more often than negative testing patients (marijuana: 68.7%, cocaine: 65.6%, marijuana & cocaine: 69.8%, negative: 57.0%). Among patients with non-penetrating injuries, a positive toxicology for cocaine or marijuana was linked to a 48% and 42% increased adjusted risk of complications, 37% and 27% longer TICU LOS, and 32% and 18% longer hospital LOS, respectively. CONCLUSION: Our results show an association between positive toxicology for either marijuana, cocaine, or both with higher need for surgery. Additionally, our results show an increase in complications, TICU LOS, and hospital LOS among non-penetrating trauma patients testing positive for marijuana or cocaine. Therefore, this study provides valuable information on the clinical profile of patients with positive toxicology, suggesting they might benefit from more aggressive management.
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Cannabis , Cocaína , Ferimentos e Lesões , Humanos , Cannabis/efeitos adversos , Cocaína/efeitos adversos , Estudos de Coortes , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologiaRESUMO
INTRODUCTION: Obsessive-compulsive and related disorders (OCRDs) and disorders due to addictive behaviours (DABs) are prevalent conditions that share behavioural and neurobiological characteristics. The Research Domain Criteria lists a series of constructs whose dysfunctions may be present in both groups of disorders. The present study will describe the research protocol of a scoping review of the literature on self-report scales and questionnaires that tap dysfunctional constructs that underlie OCRDs and DABs. METHODS AND ANALYSIS: This protocol outlines a scoping review on self-report tools and questionnaires that assess OCRDs and DABs-related constructs. The scoping review will select sources in MEDLINE, EMBASE, PsychINFO and Web of Science databases. Inclusion and exclusion criteria will be designed according to the Population, Concept, Context, Types of source framework. Two reviewers will screen independently titles, abstracts and full texts to determine the eligibility of articles. A methodological framework including six stages steps ((1) identifying a research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarising and reporting the result) will be used, and the findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Information extracted will be collated, and quantitative results will be presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. ETHICS AND DISSEMINATION: Ethical approval for conducting this scoping review is not required, as this study will involve secondary analysis of existing literature. The researchers will disseminate the study results via conference presentations and publication in a peer-reviewed journal. SCOPING REVIEW PROTOCOL REGISTRATION: DOI 10.17605/OSF.IO/UJ7G5.
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Comportamento Aditivo , Projetos de Pesquisa , Transtorno da Personalidade Compulsiva , Humanos , Revisão por Pares , Revisões Sistemáticas como AssuntoRESUMO
The inadequate and abusive usage of psychoactive substances is something real that affects Brazil's elderly population, and it is a huge challenge for the public health system and its professionals. Aware of the social impact involving the use of illegal drugs, in 2002, the Ministry of Health instituted a network of psychosocial assistance as a strategy to deal with the problem. This study carried out an analysis of the profile of use of legal and illegal drugs by the elderly who are assisted by the network of psychosocial assistance in the Federal District. A quantitative and analytical study with secondary data collection, using patient records held in the CAPS-AD in the Federal District. The inclusion criteria were people of 60 and over who were users of alcohol and other drugs and who sought assistance at CAPS-AD between 2000 and 2017. A total of 408 medical records were analyzed concerning social demographic variations, types of rehabilitation services sought, types of substances consumed, associations between drugs consumed, time of consumption, and adherence to the treatment. Most of the elderly users were male (85.3%), on average 64 ± 4.42 years old. Regarding the drugs consumed, the highest quantity was for illegal substances (76%), compared to the legal ones (23%). No significant difference was found between males (OR = 1.1) and females (OR = 0.74) regarding the use or abuse of multiple drugs. The elderly used both legal and illegal drugs for a long period of time, with low adherence to the treatment, and alcohol consumption among the elderly prevailed above the other psychoactive substances.
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OBJECTIVES: This study aimed to explore the impact of a new set of six pictorial warnings introduced in 2018. DESIGN AND SETTING: Using a cross-sectional design, we examined awareness of the new warnings among Colombian smokers across two time points of data collection. PARTICIPANTS: Adult smokers (≥18 years of age), defined as having smoked at least 100 cigarettes in their lifetime and currently smoking at least one cigarette per week participated at time 1, prior to the introduction of the new health warnings in Colombia in 2018 (n=1985, 72% male), and at time 2, 12 months post introduction (n=1572, 69% male). PRIMARY OUTCOMES: At each time, we examined smokers' responses to warnings on packs (negative affect, thinking about warning messages and cognitive elaboration), attitudes toward smoking (perceived likelihood and severity of harm, self-efficacy, response efficacy and quit intentions), knowledge of the health risks of smoking and responses to the new warnings (negative affect, believability, thinking about the harms, reactance and perceived message effectiveness). RESULTS: Awareness of the warnings was low, with only 59% of smokers reporting having seen them at time 2. Between times, we observed a reduction in negative affect toward current warnings (p<0.001), reduced thinking about (p<0.001) and cognitive elaboration of the warning message (p<0.001), and an increase in perceived severity of warnings (p<0.001). When asked about the six new health warnings, we found a reduction in negative affect (p<0.07), cognitions related to harm (p<0.01), believability (p<0.03), reactance (p<0.01) and perceived message effectiveness (p<0.02) between times. CONCLUSIONS: Our data indicate that effectiveness was low prior to the introduction of the new health warnings and at 12 months post introduction. Tobacco control policy should seek to improve exposure to and noticeability of tobacco health warnings in Colombia.
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Abandono do Hábito de Fumar , Produtos do Tabaco , Adulto , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Rotulagem de Produtos , Abandono do Hábito de Fumar/psicologia , Prevenção do Hábito de Fumar , NicotianaRESUMO
Objectives: The effects of smoking on color vision have been scarcely studied. To bridge such gap, this study examined if there were differences in chromatic discrimination between heavy and light smokers. Methods: The psychophysical Trivector test was used to evaluate chromatic discrimination in healthy controls (n = 36), heavy smokers (n = 29), and light smokers (n = 32). The subject's task was to identify the orientation of the Landolt C ring gap - presented and randomized in one of the four positions (e.g., up, down, right, and left). Results: The thresholds for Protan (red), Deutan (green) and Tritan (blue) were higher in heavy smokers compared to nonsmokers but not to light smokers. Conclusions: The results confirm that heavy smoking and chronic exposure to its harmful compounds affect color discrimination when compared to light smoking; and this is more pronounced in heavy smokers than light smokers. This is particularly important to understand the differences among smokers on visual and multisensory processing.
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Testes de Percepção de Cores , Percepção de Cores , Testes de Percepção de Cores/métodos , Humanos , Fumantes , Fumar/epidemiologiaRESUMO
OBJECTIVES: People who inject drugs (PWID) play an integral role in facilitating the entry of others into injection drug use (IDU). We sought to assess factors influencing PWID in providing IDU initiation assistance across three distinct North American settings and to generate pooled measures of risk. DESIGN: We employed data from three PWID cohort studies participating in PReventing Injecting by Modifying Existing Responses (PRIMER), for this cross-sectional analysis. SETTING: Tijuana, Mexico; San Diego, USA; Vancouver, Canada. PARTICIPANTS: A total of 2944 participants were included in this study (Tijuana: n=766, San Diego: n=353, Vancouver: n=1825). MEASUREMENTS: The outcome was defined as recently (ie, past 6 months) assisting in an IDU initiation event. Independent variables of interest were identified from previous PRIMER analyses. Site-specific multiple modified Poisson regressions were fit. Pooled relative risks (pRR) were calculated and heterogeneity across sites was assessed via linear random effects models. RESULTS: Evidence across all three sites indicated that having a history of providing IDU initiation assistance (pRR: 4.83, 95% CI: 3.49 to 6.66) and recently being stopped by law enforcement (pRR: 1.49, 95% CI: 1.07 to 2.07) were associated with a higher risk of providing assistance with IDU initiation; while recent opioid agonist treatment (OAT) enrolment (pRR: 0.64, 95% CI: 0.43 to 0.96) and no recent IDU (pRR: 0.21, 95% CI: 0.07 to 0.64) were associated with a lower risk. We identified substantial differences across site in the association of age (I2: 52%), recent housing insecurity (I2: 39%) and recent non-injection heroin use (I2: 78%). CONCLUSION: We identified common and site-specific factors related to PWID's risk of assisting in IDU initiation events. Individuals reporting a history of assisting IDU initiations, being recently stopped by law enforcement, and recently injecting methamphetamine/speedball were more likely to have recently assisted an IDU initiation. Whereas those who reported not recently engaging in IDU and those recently enrolled in OAT were less likely to have done so. Interventions and harm reduction strategies aimed at reducing the harms of IDU should incorporate context-specific approaches to reduce the initiation of IDU.
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Preparações Farmacêuticas , Abuso de Substâncias por Via Intravenosa , Estudos de Coortes , Estudos Transversais , Humanos , México/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
INTRODUCTION: Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this. METHODS AND ANALYSIS: Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde).Follow-up6 months.OutcomesThe primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance-assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity-assessed by the International Physical Activity Questionnaire, depression-assessed by the Geriatric Depression Scale and quality of life-assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations. TRIAL REGISTRATION NUMBER: RBR-8rcxkk.
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Alcoolismo , Intervenção em Crise , Idoso , Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/prevenção & controle , Brasil , Agentes Comunitários de Saúde , Análise Custo-Benefício , Humanos , Atenção Primária à Saúde , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: Cancer care providers' (CCPs) attitudes towards smoking cessation are influenced by many factors, including their smoking status and knowledge. Our objective was to assess CCPs' characteristics, tobacco use and smoking cessation practices in two Latin American cancer centres. DESIGN: Cross-sectional survey. SETTINGS: Two urban cancer centres located in Colombia and Mexico. PARTICIPANTS: A total of 238 CCPs. MEASURES: Online survey consisted of 28 close-ended questions adapted from the 2012 International Association for the Study of Lung Cancer survey and the Global Adult Tobacco Survey developed by the WHO. Means, frequencies and proportions were reported for each country. Factors associated to providing of smoking cessation treatment or referral at initial visit were evaluated using logistic regression. RESULTS: Current smoking prevalence was 10.5% and 12.3% among Colombian and Mexican CCPs, respectively. Around three quarters of the Colombian (86.4%) and Mexican CCPs (66.1%) considered to have inadequate training in smoking cessation. Approximately two-thirds of Colombian (67.5%) and Mexican CCPs (63.9%) reported always or most of the time asking patients about tobacco use during the initial visit. In Colombia and Mexico, the most relevant barriers for providing cessation services were (1) difficulties for motivating patients with cancer, (2) patient resistance in quitting smoking, (3) lack of local resources or referral centres for smoking cessation and (4) lack of training in smoking cessation. CCPs appointed at Instituto Nacional de Cancerología were less likely to provide cessation treatment or referral to their patients if they had less than 50% of their time devoted to patient care and were former or current smokers. The regression model for Instituto de Cancerología did not retain statistically significant variables. CONCLUSION: Our findings highlight an urgent need for assisting Latin American CCPs in their quitting efforts as well as expanding formal smoking cessation training specifically tailored to these professionals for improving patients' cancer prognosis and quality of life.
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Neoplasias , Abandono do Hábito de Fumar , Adulto , Atitude , Colômbia/epidemiologia , Estudos Transversais , Humanos , México/epidemiologia , Neoplasias/epidemiologia , Neoplasias/terapia , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
Nicaragua is one of the countries in Latin America with lowest levels of development. In Nicaragua, people in a homeless situation are one of the most socially excluded groups, and there is a lack of data regarding their characteristics, circumstances, and needs. This study examines the state of health, disability, and substance use among people living homeless (n = 68) in the city of León (Nicaragua). Sixty percent of the homeless people contacted responded to a questionnaire which was administered with the respondents by means of an interview. The findings showed that people living homeless in León had very negative states of health and disability, worse than those observed in other socially excluded groups in the same city and homeless people in more developed countries. The interviewees also presented a high level of substance abuse - mainly of alcohol and inhaled glue.
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Pessoas com Deficiência/estatística & dados numéricos , Nível de Saúde , Pessoas Mal Alojadas/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: Assessing the knowledge, attitudes and perceptions (KAP) of tobacco-associated diseases, and how it is influenced by tobacco products' advertisement, promotion and sponsorship (TAPS) while enforcing a strong and comprehensive ban. DESIGN: The Panamanian implementation of the Global Adult Tobacco Survey: an international standardised cross-sectional survey study. SETTING: National Panamanian population aged between 15 years and 29 years old. PARTICIPANTS: There were 4796 responding participants (n=905 830 in the expanded sample). PRIMARY AND SECONDARY OUTCOMES: An index was developed using factorial analysis using TAPS and KAP variables. The primary outcomes were: (1) The national median index value. (2) The index value stratified by sex, age, occupation, income quintile and geographical areas. (3) The first and second factor loadings (FFL and SFL, respectively) for variables included in the KAP index. RESULTS: Fifteen out of the 16 variables comprising the index were variables related to KAP and one variable was related to TAPS. The top three variables according to their FFL were 'KAP that cigarette is associated to ': (1) ' bladder cancer'. (2) ' breast cancer'. (3) ' stomach cancer'. The top three variables according to the SFL were 'KAP that cigarette is associated to ': (1)' chronic bronchitis'. (2) ' myocardial infarction'. (3) ' lung cancer'. Illegal tobacco advertisement in posters was the only TAPS variable included in the index. The national KAP index value was 0.26. Our results show that current smokers, teens, men, people with the lowest income quintile, and those living in Guna Yala Indigenous Territory (health region with the highest smoking prevalence) had a lower median value than the national median. CONCLUSIONS: Men, young adults and deprived youth had the lowest median KAP index. Illegal TAPS had no influence on the KAP of tobacco-associated diseases when a strong and comprehensive ban is enforced.
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Publicidade , Conhecimentos, Atitudes e Prática em Saúde , Produtos do Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia , Adolescente , Adulto , Publicidade/legislação & jurisprudência , Publicidade/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Panamá/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
PURPOSE: To investigate the association between mental disorders and substance misuse at 30 years of age with gender, socioeconomic position at birth, and family income trajectories. METHODS: The 1982 Pelotas Birth Cohort was used; all 5914 children born alive at hospital were originally enrolled (99.2% of all city births). In 2012, 3701 subjects were located and interviewed (68% retention rate). Mental disorders and substance misuse were assessed, and their prevalence analysed according to gender, socioeconomic status at birth, and four different income trajectories: always poor, never poor, poor at birth/non-poor at age 30, and non-poor at birth/poor at age 30. RESULTS: While women presented higher prevalence of mental disorders, substance misuse was much more frequent among men. Individuals in the lowest income quintile at birth presented 2-5 times more mental disorders and substance misuse than those in the highest quintile. Young adults who were always poor or were not poor at birth but were poor at 30 years of age had a higher prevalence of mental disorders than the other groups. CONCLUSIONS: The high rates of mental disorders and lifetime suicide attempts in young adults, especially those who were always poor or became poor after childhood, suggest that recent socioeconomic-related stressful situations may have a higher impact on the current mental health than events earlier in life. However, we could not identify at what specific ages socioeconomic changes were more important.
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Disparidades nos Níveis de Saúde , Transtornos Mentais/epidemiologia , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Transtornos Mentais/etiologia , Pobreza/psicologia , Classe Social , Transtornos Relacionados ao Uso de Substâncias/etiologia , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricosRESUMO
This self-administered mail survey study, conducted along the USA-Mexico border, examines Roman Catholic Priests' involvement in aiding Hispanic individuals with substance abuse problems. The Priests were found to be highly involved or willing to be involved in: (1) participating in juramentos (pledge usually to Virgin of Guadalupe, with Priest as witness, to temporarily abstain from substance use), (2) providing referrals, and (3) working with family and/or treatment resources in the community in order to help the person seeking their help. Fluency in Spanish, regardless of Hispanic ethnicity, was found to positively impact involvement in juramentos, providing referrals, and willingness to work with community resources.
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Catolicismo , Clero , Hispânico ou Latino , Transtornos Relacionados ao Uso de Substâncias/terapia , Humanos , México , Encaminhamento e Consulta , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
OBJECTIVES: The rapid growth of urban areas in China in the past few decades has introduced profound changes in family structure and income distribution that could plausibly affect mental health. Although multilevel studies of the influence of area-level socioeconomic factors on mental health have become more common in other parts of the world, a study of this sort has not been carried out in Chinese cities. Our objectives were to examine the associations of two key neighbourhood-level variables-median income and percentage of married individuals living in the neighbourhood-with mental disorders net of individual-level income and marital status in three Chinese cities. SETTING: Household interviews in Beijing, Shanghai and Shenzhen, PRC, as part of the cross-sectional World Mental Health Surveys. PARTICIPANTS: 4072 men and women aged 18-88 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Lifetime and past-year internalising and externalising mental disorders. RESULTS: Each one-point increase in neighbourhood-level percentage of married residents was associated with a 1% lower odds of lifetime (p=0.024) and 2% lower odds of past-year (p=0.008) individual-level externalising disorder, net of individual-level marital status. When split into tertiles, individuals living in neighbourhoods in the top tertile of percentage of married residents had 54% lower odds of a past-year externalising disorder (OR=0.46, 95% CI: 0.24 to 0.87) compared with those in the bottom tertile. Neighbourhood-level marital status was not statistically associated with either lifetime or past-year internalising disorders. Neighbourhood-level income was not statistically associated with odds of either internalising or externalising disorders. CONCLUSIONS: The proportion of married residents in respondents' neighbourhoods was significantly inversely associated with having externalising mental disorders in this sample of Chinese cities. Possible mechanisms for this finding are discussed and related to social causation, social selection and social control theories. Future work should examine these relationships longitudinally.
Assuntos
Transtornos Mentais/epidemiologia , Características de Residência/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Cidades/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto JovemRESUMO
The Caribbean and Central America represent a formidable challenge for researchers and policy makers in the HIV field, due to their pronounced heterogeneity in terms of social, economic, and cultural contexts and the different courses the HIV epidemic has followed in the region. Such contrasting contexts and epidemics can be exemplified by 2 countries that share the island of Hispaniola, the French Creole-speaking Haiti, and the Spanish-speaking Dominican Republic. Haiti has experienced the worst epidemics outside of sub-Saharan Africa. Following a protracted economic and social crisis, recently aggravated by a devastating earthquake, the local HIV epidemic could experience resurgence. The region, strategically located on the way between coca-producing countries and the profitable North American markets, has been a transshipment area for years. Notwithstanding, the impact of such routes on local drug scenes has been very heterogeneous and dynamic, depending on a combination of local mores, drug enforcement activities, and the broad social and political context. Injecting drug use remains rare in the region, but local drug scenes are dynamic under the influence of increasing mobility of people and goods to and from North and South America, growing tourism and commerce, and prostitution. The multiple impacts of the recent economic and social crisis, as well as the influence of drug-trafficking routes across the Caribbean and other Latin American countries require a sustained effort to track changes in the HIV risk environment to inform sound drug policies and initiatives to minimize drug-related harms in the region.
Assuntos
Infecções por HIV , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Região do Caribe/epidemiologia , Tráfico de Drogas , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trabalho Sexual , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Viagem , Adulto JovemRESUMO
The ventilatory response of infants of mothers who smoke and misuse substances and controls to carbon dioxide was assessed at 6-12 weeks and the perinatal period. Infants of mothers who smoke and misuse substances had a dampened response at the peak age of sudden infant death syndrome, greater than in the perinatal period.
Assuntos
Dióxido de Carbono/fisiologia , Comportamento Materno , Complicações na Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Respiração , Fumar , Transtornos Relacionados ao Uso de Substâncias , Feminino , Seguimentos , Humanos , Hipercapnia/fisiopatologia , Lactente , Recém-Nascido , Masculino , Gravidez , Testes de Função Respiratória , Fatores de Risco , Morte Súbita do Lactente/etiologia , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
BACKGROUND: Substance use is common in Brazil. In order to improve availability of substance misuse care services, over 400 Psycho-Social Care Centres for Alcohol and Drugs (CAPS-AD) - providing community-based care - have been established following mental health care reform (2001). Information on CAPS-AD clients and outcomes is limited. The present study examined select characteristics of local CAPS-AD clients. METHODS: N=143 adult CAPS-AD clients in Ceilândia (suburb of Brasília, Federal District) participated in a 1-week 'snapshot' assessment of service users (February 2015). Following consent, descriptive data were collected by a brief, anonymous interviewer-administered questionnaire that included socio-demographic, drug use, treatment history and needs/barriers information. RESULTS: Participants were predominantly male; middle-aged; unemployed; married; with middle-school education; primary problem drugs indicated were alcohol and cocaine/crack; half had prior treatment histories and indicated that treatment was externally motivated; 60% reported ways to improve treatment and possible reasons for treatment discontinuation; in multi-variate analyses, the latter was associated with employment and education status (both p<.05). CONCLUSION: CAPS-AD services appear to have increased low-barrier substance misuse treatment availability in Brazil, as well as attract individuals new to the treatment system. Various potential barriers to continuing in treatment should be addressed and more research on CAPS-AD clients and outcomes is needed.