Dissertation (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2006. / Vita. Bibliography: pp. 113-123.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 160-179).

Thesis (Ph.D.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 172 pages. Includes Vita. Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 102-113).

Thesis (Ph. D.)--University of Washington, 2000. / Includes bibliographical references (leaves 100-121).

A tuberculose à uma doenÃa infecciosa e contagiosa causada por uma bactÃria, o Mycobacterium tuberculosis. O abandono do tratamento da tuberculose pulmonar por pacientes com baciloscopia positiva favorece a manutenÃÃo da cadeia de transmissÃo, assim como o aumento das populaÃÃes bacterianas resistentes à quimioterapia de primeira linha. Iniciar o tratamento, desistir dele, retratar, abandonar novamente... situaÃÃo cada vez mais frequente na populaÃÃo acometida por tuberculose e usuÃria de drogas, lÃcitas ou ilÃcitas. O consumo de substÃncias psicoativas cresceu assustadoramente a partir da segunda metade do sÃculo XX, configurando-se nas Ãltimas dÃcadas como um fenÃmeno de massa e como uma questÃo de saÃde pÃblica. Segundo a OMS, cerca de 10% das populaÃÃes dos centros urbanos de todo o mundo, consomem abusivamente substÃncias psicoativas, independentemente da idade, sexo, nÃvel de instruÃÃo e poder aquisitivo. O presente trabalho tem como objetivo avaliar a influÃncia do uso abusivo de drogas ilÃcitas no abandono do tratamento para tuberculose pulmonar em uma Unidade de AtenÃÃo PrimÃria à SaÃde no municÃpio de Fortaleza. Por meio de estudo epidemiolÃgico observacional, retrospectivo, foram analisamos fatores socio-epidemiolÃgicos e fatores clÃnicos de pacientes em tratamento para tuberculose pulmonar, verificando-se a presenÃa do uso abusivo de drogas nesta populaÃÃo, e a influÃncia destas no abandono do tratamento, utilizando para isso questionÃrios estruturados (questionÃrio geral e ASSIST). Resultados: dos 116 casos de tuberculose investigados, 68,9% sÃo do sexo masculino, com mÃdia de idade de 37,5 anos, de cor parda (72,4%), solteiro (56,9%), com ensino fundamental incompleto (50%). A situaÃÃo de emprego da maioria (37%) era de desemprego. Quanto ao perfil epidemiolÃgico do caso, 84,4% eram de casos novos, 13% de reingresso apÃs abandono e 2,6% de recidiva. O motivo que levou ao encerramento do caso mostrou-nos um dado alarmante: 36% dos pacientes abandonaram o tratamento. Comparando as diferenÃas entre o grupo de cura e o de abandono, nÃo houve diferenÃa significativa entre a mÃdia das idades dos dois grupos (p > 0,75). Em ambos os grupos houve predomÃnio do sexo masculino, porÃm observamos uma diferenÃa significativamente maior no grupo do abandono (p = 0,0001). No grupo abandono o nÃvel de escolaridade foi inferior ao do grupo cura/conclusÃo (p = 0,017). Houve associaÃÃo entre abandono e desemprego (p < 0,0001) e reingresso apÃs abandono. Pelo resultado do questionÃrio ASSIST, a frequÃncia do uso de drogas na vida correspondeu a 95,1% para o Ãlcool, seguido do tabaco.(51,6%). A Cannabis sativa, a cocaÃna e o crack foram citados por 41,9% dos questionados. Inalantes como lolà e cola de sapateiro jà haviam sido provados por 19,3%. O uso de crack necessita de intervenÃÃo com indicaÃÃo para tratamento intensivo na maioria dos usuÃrios (61,9%), o que demonstra a forÃa de dependÃncia quÃmica que essa substÃncia causa. ConclusÃo: O abandono do tratamento da tuberculose se mostra um risco significativo nos pacientes usuÃrios de drogas, em especial as ilÃcitas onde observa-se um consumo abusivo, necessitando-se de intervenÃÃo, seja uma intervenÃÃo breve ou tratamento mais intensivo. / Tuberculosis is an infectious and contagious disease caused by a bacterium, Mycobacterium tuberculosis. Treatment Refusal for pulmonary tuberculosis in patients with smear-positive favors the maintenance of the transmission chain, as well as increased resistance to first-line chemotherapy. Starting treatment, give it up, portray, leave againâ situation increasingly common in the population affected by tuberculosis and uses drugs, licit or illicit. The consumption of psychoactive substances has increased since the second half of the twentieth century, becoming a mass phenomenon in recent decades and a public health problem. According to WHO, about 10% of the populations of urban centers world consume abusively psychoactive substances, regardless of age, sex, education level and purchasing power. This study aims to evaluate the influence of the abusive use of illegal drugs in the abandonment of treatment for pulmonary tuberculosis in a Unit of Primary Health Care in Fortaleza. Through a epidemiologic, observational and retrospective study, socio-demographic factors and clinical factors were analyzed in patients treated for pulmonary tuberculosis, verifying the presence of substance abuse in this population, and the influence of these in abandonment of treatment, using structured questionnaires (general questionnaire and ASSIST). Results: of the 116 TB cases investigated, 68.9% are male, with a mean age of 37.5 years, mulatto (72.4%), single (56.9%), with incomplete primary education (50%). The employment status of the majority (37%) were unemployed. As to the epidemiological profile of the case, 84.4% were new cases, 13% of return after default and 2.6% of recurrence. The cause of the closure of the case was by treatment refusal in 36% of patients. Comparing the differences between the group cure and abandonment, there was no significant difference between the mean ages of the two groups (p> 0.75). In both groups there was a predominance of males, but had a significantly greater difference in the dropout (p = 0.0001). In the group abandoned, the education level was lower than the cure group (p = 0.017). There was an association between dropout and unemployment (p <0.0001) and return after default. The ASSIST questionnaire showed that the frequency of drug use in life corresponded to 95.1% for alcohol, followed by tobacco. (51.6%). Cannabis sativa, cocaine and crack were cited by 41.9% of respondents. Inhalants like lolo and glue had already been tried by 19.3%. The use of crack needs intensive treatment in the majority of users (61.9%), demonstrating the chemical addiction to this substance. Conclusion: The abandonment of tuberculosis treatment shows a significant risk in patients using drugs, especially illicit substances with abuse use, necessitating the intervention, whether a brief intervention or more intensive treatment.

Evaluating the psychofortology of adults recovering from a substance-use disorder has been identified as a research priority in South Africa. This is in line with calls from researchers in diverse fields of psychology for more attention to the resilience, strengths, resources and capacities of people. This study therefore aimed to explore and describe the coping resources, sense of coherence, happiness and satisfaction with life of adults recovering from a substance-use disorder within the Nelson Mandela Metropole. The sample consisted of 99 voluntary participants from various managed recovery centres within the Nelson Mandela Metropole. Participants were given a package of questionnaires to complete under the supervision of the researcher. The assessment consisted of a biographical questionnaire and four standardized paper and pencil measures namely; the Coping Resources Inventory (CRI), the Sense of Coherence Scale (SOC-29), the Affectometer 2 (AFM-2) and the Satisfaction with Life Scale (SWLS). A quantitative, non-experimental exploratory-descriptive research method was used. Data was analysed using descriptive statistics and the Pearson product-moment correlation coefficient. Key findings include the following: Results on the CRI revealed low average mean scores on both the Coping Resources Inventory and within all the five subscales. Results of the SOC-29 revealed a high average mean score for sense of coherence. Results of the AFM-2 revealed that more positive affect than negative affect is present, resulting in happiness. Results of the SWLS revealed an average level of satisfaction with life, with most participants’ reporting neutral levels of satisfaction with life. There were significant positive correlations between the coping resources, sense of coherence, happiness and satisfaction with life of the sample. This implies that these constructs can be categorized under the subdiscipline of psychofortology. Overall, these findings emphasized the need for more research into adults recovering from a substance-use disorder.

Infants of mothers who have received narcotics on a continuous basis during pregnancy are born physically dependent. Drug withdrawal, one of many detrimental effects, is initially the most apparent. Neonatal abstinence syndrome (NAS) was originally described as a generalized disorder characterized by signs of central nervous system hyperirritability, gastrointestinal dysfunction, respiratory distress, and a host of vague autonomic manifestations. Recent studies have suggested that these same signs follow withdrawal from other addicting drugs as well. Feeding problems are the most common and important concomitants of neonatal withdrawal, because sucking function is uncoordinated, ineffectual and poorly sustained. Previous studies have shown a natural history of recovery of sucking dysfunction during recovery from NAS. A disposable and practical apparatus for monitoring nutritive sucking behaviour was developed, based on a prototype previously described in the literature. A weighted scoring system which encompasses the full spectrum of withdrawal signs was also designed. No significant difference in sucking rate was observed between normal and NAS babies on day 1 (p=0.8). There was a highly significant difference on day 2 (prO.0001), day 3 (p=0.0005), and day 4 (p=0.006). No significant difference in nutrient consumption was observed between normal and NAS babies on day 1 (p=0.9) and day 2 (p=0.8). A significant difference was observed on day 3 (p=0.006) and day 4 (p=0.03). A significant inverse correlation was demonstrated between both sucking rate and nutrient consumption with the classical clinical signs of withdrawal over the first two months of life (r=-0.57, -0.51, respectively). The periodic monitoring of sucking rate of the passively addicted infant provides an objective gauge of the seventy of withdrawal in NAS, eliminating the subjectivity of evaluating changes in clinical signs. Therefore, it is recommended that sucking rate measurements be instituted as a standard guide to the management of withdrawal in these infants. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate