RESUMO
AIMS: This study aimed to classify alcohol-dependent outpatients on the basis of clinical factors and to verify if the resulting types show different treatment retention. METHODS: The sample comprised 332 alcoholics that were enrolled in three different pharmacological trials carried out at São Paulo University, Brazil. Based on four clinical factors - problem drinking onset age, familial alcoholism, alcohol dependence severity, and depression - K-means cluster analysis was performed by using the average silhouette width to determine the number of clusters. A direct logistic regression was performed to analyze the influence of clusters, medication groups, and Alcoholics Anonymous (AA) attendance in treatment retention. RESULTS: Two clusters were delineated. The cluster characterized by earlier onset age, more familial alcoholism, higher alcoholism severity, and less depression symptoms showed a higher chance of discontinuing the treatment, independently of medications used and AA attendance. Participation in AA was significantly related to treatment retention. DISCUSSION: Health services should broaden the scope of services offered to meet heterogeneous needs of clients, and identify treatment practices and therapists which improve retention. Information about patients' characteristics linked to dropout should be used to make treatment programs more responsive and attractive, combining pharmacological agents with more intensive and diversified psychosocial interventions.
Assuntos
Alcoolismo/reabilitação , Análise por Conglomerados , Usuários de Drogas/classificação , Pacientes Ambulatoriais/classificação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Alcoólicos Anônimos , Alcoolismo/psicologia , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Índice de Gravidade de DoençaRESUMO
Non-injecting drug users are at high-risk for acquiring hepatitis B virus (HBV), although the factors contributing to this increased risk are not known. In the present study, the overall and occult HBV infection prevalence rates were determined in a large population of non-injecting drug users in the Central-West region of Brazil. HBV genotypes and predictors of infection were also identified. A total of 852 individuals in 34 drug treatment centers were interviewed, and their serum samples were tested for the presence of HBV markers by ELISA. HBsAg and anti-HBc-positive samples were tested for HBV DNA by PCR. Samples with HBV DNA were genotyped by restriction fragment length polymorphism (RFLP). The overall prevalence of HBV infection was 14% (95% CI: 11.7-16.5). A multivariate analysis of risk factors showed that age >30 years, non-white race/ethnicity, duration of drug use >10 years, lifetime number of sexual partners >10, non-use of condoms, and HCV and HIV status were associated significantly with HBV infection. Of the 9 (1%) HBsAg-reactive samples, HBV DNA was present in 2/2 of HBeAg-positive and in 5/7 anti-HBe-positive samples. An occult HBV infection rate of 2.7% (3/110) was found among anti-HBc-positive individuals. All HBV DNA-positive samples were genotyped: seven were genotype A, two were genotype D, and one was genotype F. Finally, few individuals (8%) had serological evidence of a previous HBV vaccination. These findings indicate that preventive interventions are needed for both sexual and drug-related high-risk behavior. Additionally, non-injecting drug users should be targeted for HBV vaccination.
Assuntos
Usuários de Drogas , Vírus da Hepatite B/isolamento & purificação , Hepatite B/epidemiologia , Hepatite B/virologia , Adulto , Brasil/epidemiologia , Estudos Transversais , DNA Viral/sangue , Usuários de Drogas/classificação , Feminino , Genótipo , Vírus da Hepatite B/classificação , Vírus da Hepatite B/genética , Humanos , Masculino , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Prevalência , Fatores de Risco , Adulto JovemRESUMO
Objetivamos avaliar a escala DMS (de drogas), comparando-a com o desempenho das escalas MAC e BrTIV (de alcoolismo), numa amostra de 76 pacientes e 91 controles. Verificamos o desempenho das escalas nos pontos de corte originais, avaliando sensibilidade e falsos-positivos, bem como identificamos o melhor ponto de corte, através da Curva ROC. Avaliamos a capacidade discriminatória destas escalas entre controles e cada subgrupo de pacientes (somente álcool; álcool e outra drogas; somente outras drogas) e entre pacientes usuários apenas de álcool e os demais subgrupos de pacientes. Realizamos ainda procedimentos de Análise de Variância (ANOVA), com comparações múltiplas (testes Post Hoc), objetivando discriminar, par a par, qual(is) grupo(s) difere(m) significativamente dos demais. Nossos resultados sugerem que todas as escalas estudadas discriminam adequadamente o grupo de controle dos grupos de pacientes; todavia, nenhuma das escalas foi capaz de distinguir os subgrupos de pacientes entre si. Assim, em nosso país, a escala DMS parece não ser capaz de discriminar alcoolistas e usuários disfuncionais de outras substâncias psicoativas.