RESUMO
BACKGROUND: Point-of-collection testing (POCT) devices for psychoactive substance detection through oral fluid samples are used in several countries for traffic enforcement. However, the reported reliability of such devices is quite heterogeneous among studies, and evaluating and comparing their analytical performance is of paramount importance to guide enforcement policies. AIM: To evaluate the analytical reliability of four POCT devices for the detection of cocaine and cannabinoids using oral fluid samples of Brazilian drivers. METHOD: A total of 168 drivers were recruited during standard roadblockfI procedures in Southern Brazil. Subjects were screened using one of the following POCT devices: the DDS2™, the DOA MultiScreen™, the Dräger Drug Test 5000™ and the Multi-Drug Multi-Line Twist Screen Device™ (MDML). Results of the screening tests were compared with chromatographic analyses in order to obtain the reliability parameters. RESULTS: The prevalence of confirmed positive samples for cocaine and cannabinoids were 9 % and 4.4 %, respectively. For cocaine, three POCT devices (MDML™, Dräger DrugTest 5000™, DOA MultiScreen™) showed good reliability, greater than 80 % of performance measures, using guidelines for research on drugged driving published by Walsh et al. (cutoff 10ng/mL). However, for cannabinoids, the devices had low reliability-only Dräger DrugTest 5000™ had good performance using cut-offs proposed by Walsh et al. (cutoff 2ng/mL). CONCLUSION: We observed a high prevalence of drivers testing positive for cocaine and cannabinoids. Most devices achieved good reliability performance for cocaine detection using cutoffs proposed by Walsh et al. or using the device's own cutoff. Instead, the reliability for cannabinoid detection obtained the desired parameters in just one device using cut-offs proposed by Walsh et al. and its own cutoff. Difficulties in detecting cannabinoids at the roadside should be better evaluated before the implementation of such tests.
Assuntos
Canabinoides/análise , Cocaína/análise , Dirigir sob a Influência , Saliva/química , Detecção do Abuso de Substâncias/métodos , Adolescente , Adulto , Brasil , Feminino , Humanos , Drogas Ilícitas/análise , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto JovemRESUMO
OBJECTIVE: Low and middle-income countries experience an expressive growth in the number of circulating motorcycles, paralleled by an increasing number of traffic accidents. Delivery motorcycles drivers ("motoboys") are generally perceived as accountable for this scenario. Although traffic accidents have a multivariate etiology, mental disorders, such as substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD), are often involved. This paper aims at investigating the prevalence of ADHD, SUD and other mental disorders in a sample of Brazilian motoboys, and additionally, to evaluate the association between psychiatric diagnoses, motorcycle accidents and traffic violation tickets. METHOD: A convenient sample of subjects was invited to participate in a cross-sectional assessment including an inventory of traffic accidents and violations. Psychiatric diagnoses were based on semi-structured and clinical interviews. RESULTS: A sample of 101 motoboys was assessed. Overall, 75% of subjects had a positive lifetime history of at least one psychiatric disorder. SUD was the most frequent diagnosis (43.6% for alcohol, 39.6% for cannabis). ADHD was associated with a higher number of traffic accidents (p=0.002), and antisocial personality disorder (APD) was associated with a greater number of traffic violations (p=0.007). CONCLUSIONS: The prevalence of mental disorders was much higher in our sample than in the general population. ADHD and APD, but not SUD, were associated with negative traffic outcomes. These findings have implications for public mental health planning since mental disorders can be both prevented and treated, improving driving behavior and increasing road safety.
Assuntos
Transtornos Mentais/epidemiologia , Motocicletas , Acidentes de Trânsito/psicologia , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno da Personalidade Antissocial/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Brasil/epidemiologia , Humanos , Entrevistas como Assunto , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/psicologia , Transtornos Mentais/psicologia , Motocicletas/estatística & dados numéricos , Ocupações/estatística & dados numéricos , Prevalência , Escalas de Graduação Psiquiátrica , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto JovemRESUMO
OBJECTIVES: Few studies of comorbidity among cocaine users have been undertaken in Brazil, despite the fact that cocaine is one of the most commonly used illegal drugs in the country. The aim of this paper is to review existing data on psychiatric evaluations of cocaine users, and present data from two studies that have addressed this issue as it pertains to the Brazilian public health system. STUDY DESIGN: Review and results from two studies (cross-sectional and matched control). METHODS: The Brazilian literature on PubMed, Lilacs, Psychinfo and DATASUS was searched using the key words: 'psychiatric symptoms', 'diagnosis', 'evaluation', 'assessment', 'cocaine disorders' and others related to this issue. Intake data from two studies of male and female cocaine users were also analysed with regard to psychiatric symptoms as measured by the Symptom Check List - 90 Revised (SCL-90). RESULTS: The literature review found no specific studies regarding psychiatric evaluation of cocaine users in Brazil. Analyses from the two studies presented showed high levels of psychiatric symptoms in this population. In the first study, psychiatric symptoms were measured at treatment entry and their prevalence was high, ranging from 27.4% to 53.4%. In the second study, SCL-90R scores at programme admission were higher in cocaine users than normal controls, with effect sizes ranging from moderate to high. CONCLUSIONS: To the authors' knowledge, this is the first article to discuss psychiatric evaluations of comorbidity among cocaine users in Brazil. The results indicate a need to: pay more attention to the evaluation of psychiatric symptoms in cocaine users; emphasize the importance of standardized data collection in this area; and evaluate the course of these symptoms, their impact on outcome, and how they are best addressed in treatment.
Assuntos
Cocaína/efeitos adversos , Transtornos Mentais/etiologia , Saúde Pública/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Testes Psicológicos , Psicometria , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto JovemRESUMO
Our objective was to evaluate the effectiveness of a long-acting formulation of methylphenidate (MPH-SODAS) on attention-deficit/hyperactivity disorder (ADHD) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders (SUD). Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS. This was a 6-week, single-blind, placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD. Participants were randomly allocated to either group A (weeks 1-3 on MPH-SODAS, weeks 4-6 on placebo) or group B (reverse order). The primary outcome measures were the Swanson, Nolan and Pelham Scale, version IV (SNAP-IV) and the Clinical Global Impression Scale (CGI). We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study. The sample consisted of marijuana (N = 16; 100%) and cocaine users (N = 7; 43.8%). Subjects had a significantly greater reduction in SNAP-IV and CGI scores (P < 0.001 for all analyses) during MPH-SODAS treatment compared to placebo. No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales. There was no significant effect on drug use. MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo (P < 0.001). MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD. Randomized clinical trials, with larger samples and SUD intervention, are recommended.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Metilfenidato/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Estimulantes do Sistema Nervoso Central/efeitos adversos , Estudos Cross-Over , Humanos , Masculino , Metilfenidato/efeitos adversos , Método Simples-Cego , Transtornos Relacionados ao Uso de Substâncias/complicações , Resultado do TratamentoRESUMO
Our objective was to evaluate the effectiveness of a long-acting formulation of methylphenidate (MPH-SODAS) on attention-deficit/hyperactivity disorder (ADHD) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders (SUD). Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS. This was a 6-week, single-blind, placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD. Participants were randomly allocated to either group A (weeks 1-3 on MPH-SODAS, weeks 4-6 on placebo) or group B (reverse order). The primary outcome measures were the Swanson, Nolan and Pelham Scale, version IV (SNAP-IV) and the Clinical Global Impression Scale (CGI). We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study. The sample consisted of marijuana (N = 16; 100 percent) and cocaine users (N = 7; 43.8 percent). Subjects had a significantly greater reduction in SNAP-IV and CGI scores (P < 0.001 for all analyses) during MPH-SODAS treatment compared to placebo. No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales. There was no significant effect on drug use. MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo (P < 0.001). MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD. Randomized clinical trials, with larger samples and SUD intervention, are recommended.
Assuntos
Adolescente , Adulto , Humanos , Masculino , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Metilfenidato/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Estudos Cross-Over , Estimulantes do Sistema Nervoso Central/efeitos adversos , Metilfenidato/efeitos adversos , Método Simples-Cego , Transtornos Relacionados ao Uso de Substâncias/complicações , Resultado do TratamentoRESUMO
Brazil has the second largest number of reported AIDS cases in the world. Porto Alegre, like most other large urban centres in Brazil, has been greatly impacted by an AIDS epidemic driven by high rates of drug use and risky sexual behaviours. While epidemiologic surveillance of HIV/AIDS and treatment initiatives for HIV-infected individuals are well developed in Brazil, comparatively little attention has focused on developing interventions directed toward high-risk populations. Intervention programmes, particularly those tailored for chronic drug users, are lacking. This pilot project successfully adapted and tailored a cognitive behavioural HIV intervention developed in the US to the cultural setting in Porto Alegre. The project established feasibility and acceptability of the approach for targeting risky drug and sexual behaviours among a group of male Brazilian drug users. A sample of 120 male cocaine users was recruited from a public health clinic serving the target population in the city of Porto Alegre. The average age of the participants was 29; they averaged less than 8 years of formal education; and less than half (41%) were married. Lifetime self-reported drug use was high with 93% reporting cocaine use, 87% reporting crack use, and 100% reporting marijuana use. 43% of the sample reported ever injecting drugs. Reports of risky sexual behaviours were similarly elevated. Almost half (45%) tested positive for HIV. Preliminary evidence suggests that intervention acceptability was high among participants. Given the reported high risk sexual and drug use behaviours among these men, HIV interventions must be evaluated and expanded to include this population as well as their sexual partners.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Brasil , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/terapia , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/terapia , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
OBJECTIVE: To evaluate criterion convergent and discriminant validity of the World Health Organization Instrument (WHOQoL-BREF) in evaluating quality of life and to verify its convergent validity with the Medical Outcomes study Short-forms (SF-36) and the Symptom Check List (SCL-90) instruments in male alcohol dependent patients who seek treatment at two Brazilian treatment centers. METHODS: A cross-sectional study was performed, in which cases were divided in to two groups according to the severity of alcohol dependence, ascertained by the Short Form Alcohol Dependence Data scale (SADD). RESULTS: The sample was comprised of 36 males, and 63.9% had severe dependence. Subjects with low/moderate dependence showed higher scores in all domains of the WHOQoL-BREF and in nearly all domains of the SF-36. Criterion validity and internal consistency in the WHOQoL-BREF were satisfactory. With regard to convergent validity between the WHOQoL-BREF and SF-36, most correlation coefficients were significant. CONCLUSIONS: The WHOQoL instrument proved to be satisfactory for evaluating quality of life in this sample.
Assuntos
Alcoolismo/fisiopatologia , Entrevistas como Assunto , Qualidade de Vida , Adulto , Alcoolismo/psicologia , Brasil , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Organização Mundial da SaúdeRESUMO
The authors describe the development of a preventive program focused on intravenous drug users at risk of HIV infection, using the Social Network Approach as the intervention model. The authors describe the project's steps in a large university hospital in southern Brazil, emphasizing the unique methods and techniques developed by the treatment staff. Problems encountered during the project development are discussed, aimed at identifying the reasons why the program only achieved partial success. The authors identify critical issues, such as the use of a new technique not previously tried in Brazil, difficulties in maintaining IV drug users in treatment, lack of infrastructure for walk-in treatment, and the challenge of motivating staff and patients to continue treatment. The authors conclude by listing suggestions aimed at facilitating the development of new projects based on the same conceptual model.
Assuntos
Redes Comunitárias , Infecções por HIV/prevenção & controle , Implementação de Plano de Saúde/métodos , Desenvolvimento de Programas/métodos , Abuso de Substâncias por Via Intravenosa , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto/métodos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/terapiaRESUMO
A cross-sectional household survey was used to assess patterns of alcohol experimentation and consumption among Brazilian adolescents, stratified by age and sex. Trained interviewers administered a standardized questionnaire to 950 subjects, ages 10 to 18, which examined such things as age of first alcohol use, situational aspects of consumption, amounts ingested and use among peers. Lifetime prevalence of alcohol use was high (71.5%), especially in the older teens (94.4%). The mean age of first use was 10 years, and consumption of all types of alcohol, including hard liquor, was common. Alcohol use typically began in the home, at family celebrations and social occasions, and progressively evolved to street drinking with peers. This pattern was most evident in males, who reported a larger volume of alcohol consumption per episode, when compared to females. The total amount of alcohol consumption reported for all ages is very high and may be due to permissive cultural views of alcohol. Age and gender play an important role in the evolution of drinking, with male adolescents being exposed to higher concentrations of alcohol and at younger ages than females, who seem to have a more conservative attitude toward excessive drinking. Subjects considered these practices normal, with no concern about the illegality of such behaviors.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Adolescente , Fatores Etários , Consumo de Bebidas Alcoólicas/psicologia , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Renda , Masculino , Prevalência , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
This article describes the characteristics and problems of drug abuse treatment settings in Brazil, both for inpatient and outpatient modalities. Examples from the author's own clinical experience as consultant and researcher working in different parts of the country are used to illustrate the numerous disadvantages of the existing care system, with clear detriment to patients and to positive treatment outcome. In addition, the inadequacy and insufficiency of the training system for therapists and counselors is described, with particular emphasis on the distortions of the already existing models.