Objetivos: Avaliar a influência da adição de clonidina a sedação e analgesia com morfina e midazolan em infusão contínua em crianças submetidas à ventilação mecânica. Métodos: Estudo randomizado, duplo cego e placebo controlado, realizado na UTI Pediátrica do Hospital Geral de Caxias do Sul. Incluídas crianças submetidas à ventilação mecânica que utilizaram morfina e midazolan em infusão contínua. Foram randomizados a receber clonidina (5 μg/kg/cada 8 horas) ou placebo associados a infusão dos sedativos. Diariamente eram anotadas as doses infundidas nas 24 horas, assim como as doses de sedação intermitente e aplicado o escore de Finnegan para definir e quantificar abstinência. Os grupos foram comparados quanto a doses de sedativos administradas, tempo de uso de infusão contínua, presença e duração da abstinência.Resultados: Foram incluídas 69 crianças (31 no grupo clonidina e 38 no placebo). Completaram o estudo 59 pacientes, 25 no grupo clonidina e 34 no placebo. Os grupos foram semelhantes nas características gerais (peso, idade, sexo, indicação de ventilação mecânica). Não houve diferença nas doses de sedativos utilizadas, tanto em infusão contínua quanto intermitente. A prevalência da abstinência foi semelhante (72 e 75%, respectivamente), da mesma forma que sua duração, além de não haver diferença no tempo de ventilação mecânica. Conclusão: Neste estudo, a adição de clonidina ao esquema de sedação não influiu nas doses diárias e cumulativas de sedativos utilizados e também não alterou a prevalência ou a evolução da abstinência. Atribuímos à ausência de eficácia ao elevado grau de sedação utilizado neste serviço para crianças em ventilação mecânica. / Objective: To evaluate the sedative effect of associating clonidine to the morphine plus midazolan intravenous infusion in children submitted to mechanical ventilation Methods: Randomized, double blind, placebo controlled, carried through clinical assay in the PICU of the Hospital Geral of Caxias do Sul. It has been enclosed children submitted to mechanical ventilation, which had used morphine and midazolan in continuous infusion. It’s had been randomized to received clonidine (5μg/kg/8/8h) and placebo associated to infusion of sedative. Daily it’s written the administered doses in the 24 hours, beyond the doses of intermittent sedation and the Finnegan Score applied to define and to quantify the withdrawal. The groups had been compared to managed doses of sedatives, time of use of continuous infusion, presence and duration of the abstinence. Results: 69 patients had been enclosed to project (31 in clonidine group and 38 in the placebo group). The two groups had been similar in general characteristics (weight, age, gender, indication of mechanical ventilation). It did not have difference in the midazolan and morphine doses used between the groups, in the necessity of extra sedation as well. 59 patients had completed the study, 25 in clonidine group and 34 in placebo group. The prevalence of the abstinence was similar (72% and 75%, respectively), in the same way that its duration. It hasn’t been any difference in the mechanical ventilation time also. Conclusion: The clonidine did not show effectiveness in the evolution of the abstinence in this study, probably for objectives of sedation used in this service.

Made available in DSpace on 2014-06-11T19:29:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2005Bitstream added on 2014-06-13T19:17:13Z : No. of bitstreams: 1 santos_ce_me_assis.pdf: 620057 bytes, checksum: 164e88370deda8a8a6e9d3c48d7573a9 (MD5) / Este estudo teve como objetivo examinar o fenômeno da reincidência na drogadição a partir da visão do adicto. O trabalho foi realizado em equipamento especializado no tratamento da dependência química e problemas relacionados ao uso de álcool e outras drogas, contando com a participação de onze sujeitos. O trabalho, dentro do referencial teórico psicanalítico, partiu da escuta da drogadição, com o enquadre das entrevistas preliminares dentro do referencial da clínica da urgência em psicanálise. Os resultados do trabalho de escuta e de reflexão apontaram a questão da reincidência como um falso problema para os sujeitos, já que estes demonstraram que a desintoxicação, concomitante à abstinência provocada pela internação, é somente um momento de privação do gozo propiciado pela droga, ao qual se segue, via de regra, um novo período de uso. A abstinência não significa que os sujeitos fazem uma renúncia correlata ao desejo da droga, é apenas uma parada provavelmente ligada à menor tolerância ao embate provocado pelo tipo de gozo em ação nos casos apresentados. A abstinência forçada, como estratégia presente nos tratamentos comuns da drogadição, mostrou-se de conseqüências altamente negativas para os efeitos obtidos pelos mesmos. / This survey is aimed at examining the drugaddiction reincidence phenomenon from the addict’s point of view. The survey was held at the Chemical Dependence Attention Center of the Healthcare Service Dr. Cândido Ferreira in the city of Campinas/SP, counting on the participation of eleven subjects. The survey, within the psychoanalytic theoretical allusion, started from listening to the addict, with the focus on the preliminary interviews within the reference on the clinics of urgency in psychoanalysis. The results of listening and consideration activities pinpointed to the reincidence issue as a fake problem to the subjects, whereas these have manifested that the unpoisoning, concomitant to the abstinence triggered by internment, is only a moment of bereavement of delight propitiated by the drug, to which a new period of use commonly follows. The abstinence does not mean that the subjects reciprocally resign the desire of the drug, but it is only a pause probably linked to the minor tolerance to the onset provoked by the type of delight in action on the presented cases. The compelled abstinence, as a current strategy on common drugaddiction treatments, has shown highly negative consequences for the effects obtained from them.

Objetivos: Avaliar a influência da adição de clonidina a sedação e analgesia com morfina e midazolan em infusão contínua em crianças submetidas à ventilação mecânica. Métodos: Estudo randomizado, duplo cego e placebo controlado, realizado na UTI Pediátrica do Hospital Geral de Caxias do Sul. Incluídas crianças submetidas à ventilação mecânica que utilizaram morfina e midazolan em infusão contínua. Foram randomizados a receber clonidina (5 μg/kg/cada 8 horas) ou placebo associados a infusão dos sedativos. Diariamente eram anotadas as doses infundidas nas 24 horas, assim como as doses de sedação intermitente e aplicado o escore de Finnegan para definir e quantificar abstinência. Os grupos foram comparados quanto a doses de sedativos administradas, tempo de uso de infusão contínua, presença e duração da abstinência.Resultados: Foram incluídas 69 crianças (31 no grupo clonidina e 38 no placebo). Completaram o estudo 59 pacientes, 25 no grupo clonidina e 34 no placebo. Os grupos foram semelhantes nas características gerais (peso, idade, sexo, indicação de ventilação mecânica). Não houve diferença nas doses de sedativos utilizadas, tanto em infusão contínua quanto intermitente. A prevalência da abstinência foi semelhante (72 e 75%, respectivamente), da mesma forma que sua duração, além de não haver diferença no tempo de ventilação mecânica. Conclusão: Neste estudo, a adição de clonidina ao esquema de sedação não influiu nas doses diárias e cumulativas de sedativos utilizados e também não alterou a prevalência ou a evolução da abstinência. Atribuímos à ausência de eficácia ao elevado grau de sedação utilizado neste serviço para crianças em ventilação mecânica. / Objective: To evaluate the sedative effect of associating clonidine to the morphine plus midazolan intravenous infusion in children submitted to mechanical ventilation Methods: Randomized, double blind, placebo controlled, carried through clinical assay in the PICU of the Hospital Geral of Caxias do Sul. It has been enclosed children submitted to mechanical ventilation, which had used morphine and midazolan in continuous infusion. It’s had been randomized to received clonidine (5μg/kg/8/8h) and placebo associated to infusion of sedative. Daily it’s written the administered doses in the 24 hours, beyond the doses of intermittent sedation and the Finnegan Score applied to define and to quantify the withdrawal. The groups had been compared to managed doses of sedatives, time of use of continuous infusion, presence and duration of the abstinence. Results: 69 patients had been enclosed to project (31 in clonidine group and 38 in the placebo group). The two groups had been similar in general characteristics (weight, age, gender, indication of mechanical ventilation). It did not have difference in the midazolan and morphine doses used between the groups, in the necessity of extra sedation as well. 59 patients had completed the study, 25 in clonidine group and 34 in placebo group. The prevalence of the abstinence was similar (72% and 75%, respectively), in the same way that its duration. It hasn’t been any difference in the mechanical ventilation time also. Conclusion: The clonidine did not show effectiveness in the evolution of the abstinence in this study, probably for objectives of sedation used in this service.

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No. of bitstreams: 1 maylacardosofernandestoffolo.pdf: 2191724 bytes, checksum: 5d5c02367b2d14ff9701709cdcc6fa38 (MD5) Previous issue date: 2012-02-02 / A presente tese está apresentada em três artigos que contemplaram os seguintes objetivos: caracterizar o perfil de tabagistas que procuram tratamento multiprofissional para a cessação tabágica (artigo 1); avaliar as concentrações séricas de citocinas pro e anti-inflamatórias em fumantes na linha de base e após 4 meses de tratamento para cessação do tabagismo (artigo 2); avaliar a relação de componentes da SM com citocinas pró-inflamatórias em indivíduos tabagistas em tratamento (artigo 3).Artigo 1: Foram avaliados dados provenientes de estudo retrospectivo de tabagistas durante a avaliação para admissão no Centro Interdisciplinar de Pesquisa e Intervenção em Tabagismo do Hospital Universitário da Universidade Federal de Juiz de Fora (CIPIT – HU/UFJF). Durante o período de 2011 a 2014, 159 tabagistas procuraram tratamento, entretanto, os dados disponíveis eram de 149 pacientes. A amostra foi caracterizada predominantemente por pacientes adultos, sendo a maioria do sexo feminino (63,1%), pertencentes à raça branca (48,4%), ensino fundamental incompleto (38,3%), apresentavam sobrepeso/obesidade (71,2%) e obesidade abdominal (63,2%). A história tabágica revelou que o uso de cigarro se iniciou na adolescência (16,95±6,16 anos) e apresentavam elevado consumo diário de cigarro (21,95±12,89 cigarros/dia), alto grau de dependência e fissura intensa, principalmente entre as mulheres, 62,7% e 58,5% respectivamente. a maioria dos tabagistas que procuraram o programa de cessação tabágica caracteriza-se por adultos, do sexo feminino, raça branca, baixo grau de escolaridade, média renda familiar mensal. Apresentam sobrepeso/obesidade,com predomínio de adiposidade abdominal e histórico tabágico com início na adolescência com alto consumo de cigarro e elevado grau de dependência e intensa fissura. Artigo 2: Foram avaliadas as concentrações séricas de citocinas pro e anti-inflamatórias em fumantes na linha de base e após 4 meses de tratamento para cessação do tabagismo. A avaliação nutricional foi baseada em medidas de peso corporal, altura e circunferência da cintura (CC), para calcular o Índice de Massa Corporal (IMC), Índice de Adiposidade Corporal (IAC) e Relação Cintura-Altura (RCQ). Os níveis séricos de leptina, adiponectina e grelina foram determinados pelo método de Imunoabsorção Ligado a Enzima (ELISA). A proporção de leptina/adiponectina (L/A) foi determinada. No final do tratamento, os abstinentes apresentaram níveis mais elevados de adiponectina quando comparados àqueles que permaneceram fumantes (p = 0,024). Houve aumento nos níveis de leptina, L/A e redução nos níveis de adiponectina após o tratamento em abstinentes e fumantes. Os valores médios de RCQ e IAC mostraram-se acima do ponto de corte proposto, indicando obesidade abdominal. Este estudo demonstrou que a cessação do tabagismo melhora os níveis de adiponectina em relação aos fumantes e os níveis de leptina e L/A aumentaram ao longo do tratamento em ambos os grupos. Os valores aumentados de leptina e L/A em abstinentes podem indicar o risco de eventos metabólicos associados à história de tabagismo que devem ser investigados. Artigo 3: Foram avaliados aspectos clínicos (medida da massa corporal, estatura, circunferência da cintura (CC) e pressão arterial) e bioquímicos (HDL-colesterol, triglicerídeos, glicemia de jejum, leptina, IL-1β, IL-6, IL-8, IL10, IL-12 e TNF-α) de uma subamostra de tabagistas em tratamento do Centro Interdisciplinar de Pesquisa e Intervenção em Tabagismo do Hospital Universitário da Universidade Federal de Juiz de Fora (CIPIT – HU/UFJF). Participaram do estudo 16 tabagistas. Um total de 43,8% dos tabagistas iniciou o tratamento com síndrome metabólica (SM). Todas as interleucinas e TNF-α mantiveram os mesmos níveis séricos durante todo o tratamento (início e após 4 meses). Os níveis séricos de leptina foram maiores para aqueles que tinha a SM no início do tratamento (Mediana:19,06 ng/mL X 5,45 ng/mL; Z=-2,17, p=0,03). A presença de SM foi associada ao TNF-α (R=0,958,p=0,001), IL-1β (R=0,958,p=0,012), IL-6 (R=0,958, p=0,002) e leptina (R=0,958, p=0,001). Níveis elevados da PAS associaram-se ao TNFα (R=0,923, p=0,016) e IL-1β (R=0,923, p=0,031). A hipertrigliceridemia apresentou associação com TNF-α (R=0,912, p=0,013), IL-1β (R=0,912, p=0,026), IL-10 (R=0,912, p=0,024), IL-12 (R=0,912, p=0,038). A CC foi associada com a leptina (p=0,003R=0,911; R2=0,831). Após 4 meses de tratamento, determinadas citocinas foram associadas aos níveis de HDL e CC. As IL-6, IL-8 e TNFα apresentaram associação com HDL (R=0,922), com significância de p=0,002, p=0,029 e p=0,045, respectivamente. Já a CC, apresentou associação com a leptina (p=0,017; R=0,796). Grande parte das alterações nos parâmetros antropométricos que compõe a SM e a ocorrência da mesma podem ser atribuídas às IL-1β, IL-6, IL-8, Il-12 e TNF-α e leptina. A leptina apresenta-se com um marcador de risco para a SM em tabagistas no início do tratamento para a cessação tabágica. / This thesis is presented in three articles that had the following objectives: characterize the profile of smokers seeking multi-professional treatment for smoking cessation (Article 1); To assess serum pro-and anti-inflammatory cytokine concentrations in smokers at baseline and after 4 months of smoking cessation treatment (Article 2); To evaluate the relationship of SM components with proinflammatory cytokines in smokers undergoing treatment (Article 3).Article 1: The aim of the present study was to characterize the profile of smokers in multi professional treatment for smoking cessation. Retrospective data collected from 149 smokers were evaluated during the evaluation for admission in the Interdisciplinary Center for Research and Intervention in Smoking at the University Hospital of the Federal University of Juiz de Fora (CIPIT-HU/UFJF). The sample was predominantly characterized by adult patients, the majority being female (63.1%), married (45.6%), white (48.4%), incomplete elementary school (38.3%) and were overweight/obese (71.2%). The smoking history showed that cigarette use began in adolescence (16.95±6.16 years) and presented high daily cigarette consumption (21.95±12.89 cigarettes/day), high degree of dependence and intense craving, mainly among women, 62.7% and 58.5%, respectively. The Knowledge of the nicotine user profile of smoking abstinence program allows a better reception of this population as well as the development of efficient and dynamic health strategies. Such strategies allow the increase of the participation and adherence of smokers, contributing to the permanent increase of abstinence rates. Article 2: It was evaluated the serum concentrations of pro and antiinflammatory cytokines in smokers at baseline and after 4 months of treatment for smoking cessation. Nutritional assessment was based on measurements of body weight, height, and waist circumference (WC), to calculate the Body Mass Index (BMI), Body Adiposity Index (BAI) and Waist-to-height ratio (WHtR). The serum levels of leptin, adiponectin and ghrelin was determined by Enzyme-Linked Immunosorbent Assay (ELISA). The leptin/adiponectin ratio (L/A) was calculated. At the end of treatment, the abstinent had higher levels of adiponectin when compared those who remained smoker (p = 0.024). There was an increase in leptin levels, L/A and reduction in adiponectin levels after the treatment in abstinent and smokers. The medium values of WHtR and BAI showed above of the proposed cutoff point, indicating abdominal obesity .This study has demonstrated that smoking cessation improves adiponectin levels when compared with smokers and the leptin and L/A levels increased throughout the treatment in both groups. The increased values of leptin and L / A in abstinents may indicate risk of metabolic events associated with smoking history that should be investigated.Article 3: Clinical aspects were evaluted (body mass, height, waist circumference, and blood pressure) and biochemical parameters (HDL-cholesterol, triglycerides, fasting glycemia, leptin, IL-1β, IL-6, IL-8 , IL10, IL-12 and TNF-α) from a subsample of smokers undergoing treatment at the Interdisciplinary Center for Research and Intervention in Smoking at the University Hospital of the Federal University of Juiz de Fora (CIPIT-HU / UFJF). Sixteen smokers participated in the study. A total of 43.8% of smokers started treatment with MS. All interleukins and TNF-α maintained the same serum levels throughout the treatment (beginning and after 4 months). Serum leptin levels were higher for those with MS at the start of treatment (Median: 19.06 ng / mL X 5.45 ng / mL, Z = -2.17, p = 0.03). The presence of SM was associated with TNF-α (R = 0.958, p = 0.001), IL-1β (R = 0.958, p = 0.012), IL- 0.958, p = 0.001). Elevated SBP levels were associated with TNFα (R = 0.923, p = 0.016) and IL-1β (R = 0.923, p = 0.031). Hypertriglyceridemia was associated with TNF-α (R = 0.912, p = 0.013), IL-1β (R = 0.912, p = 0.026), IL-10 (R = 0.912, p = 0.024) 0.912, p = 0.038). CD was associated with leptin (p = 0.003R = 0.911, R2 = 0.831). After 4 months of treatment, certain cytokines were associated with HDL and CC levels. IL-6, IL-8 and TNFα were associated with HDL (R = 0.922), with significance of p = 0.002, p = 0.029 and p = 0.045, respectively. On the other hand, CC was associated with leptin (p = 0.017, R = 0.796). Most of the changes in the anthropometric parameters that make up SM and its occurrence can be attributed to IL-1β, IL-6, IL-8, IL-12 and TNF-α and leptin. Leptin is a risk marker for MS in smokers at the start of treatment for smoking cessation.

L'addiction aux drogues est une pathologie psychiatrique chronique qui représente un problème de santé publique majeur. Malgré des avancées importantes permettant de mieux comprendre les modifications cérébrales induites par les drogues d'abus, les thérapies restent encore limitées. Ainsi, l'étude des processus cérébraux qui sous-tendent les risques de rechute à long terme semble être centrale à l'élaboration de nouvelles stratégies thérapeutiques. Une partie de cette thèse vise à déterminer les modifications cérébrales induites à long terme lors du sevrage, suite à une prise chronique de cocaïne. Notre première étude a révélé une réduction de la densité vasculaire cérébrale lors du sevrage précoce, exclusivement localisée dans le cortex cingulaire. Dans la seconde étude, nous avons mis en évidence des modifications du métabolisme cérébral et étudié leur évolution lors du sevrage. Après un mois de sevrage, période où l'on trouve le phénomène d'incubation du « craving », nous avons mis en évidence une réduction du métabolisme cortical et striatal alors que l'amygdale se voit hyperactivée témoignant d'une dérégulation des fonctions cérébrales. Enfin, nous avons caractérisé le mécanisme sous-jacent à l'effet « anti-craving » de l'environnement enrichi (EE). Nous avons émis l'hypothèse que l'EE agirait comme une récompense alternative pour diminuer la recherche de cocaïne, ainsi nous avons testé les effets de l'exposition au sucrose et à l'exercice physique sur le comportement de recherche de drogue. Nous avons montré que l'accès à une récompense alternative pendant le sevrage ne permet pas de réduire la recherche de cocaïne suggérant que l’EE n'agit pas exclusivement comme une récompense alternative. / Drugs addiction is a chronic brain disorder representing a major public health problem. Although important advances allowed a better understanding of the cerebral modifications induced by chronic exposure to drugs, the therapies still nowadays limited. Therefore the investigation of cerebral processes that underlie the persistent risks of relapse, seem to be crucial to offer new therapeutic strategies. A part of this thesis aims at investigating the cerebral modifications induced in a long term during the withdrawal, due to a chronic voluntary intake of cocaine. In our first study we found a reduction of the density of cerebral vessels during the early withdrawal selectively localized in the cingular cortex. In our second study we found that cocaine intake leads to modifications of cerebral metabolism that evolve during the withdrawal. After one month of withdrawal, at a time when the phenomenon of incubation of craving is found, we found a decrease in cortical and striatal metabolism and a hyperactivation of the amygdala which demonstrates a persistent disregulation of brain functioning. Finally, in our third study, we tried to dissect the mechanism underlying the anti-craving effect of the enriched environment (EE). We hypothesized that the EE acts as an alternative reward to decrease the cocaine seeking behavior. Thus we tested the effects of exposure to sucrose or the physical exercise on relapse to cocaine. We demonstrated that the access to an alternative reward during the withdrawal does not allow reducing cocaine seeking which suggests that the EE does not act exclusively as an alternative reward.

Coping with relapse in the drug addiction treatment is a frequent problem. To accept and admit a possibility of a relapse in an individual, which has already a took part, and duly finished his residential treatment, is important for his future life in abstinence. Relapses must be seen as a natural part of the therapeutic process and its needed to prepare clients and their families to them, during the treatment. Relapses might lead client to a deeper self-knowledge and also to gain the ability to recognize and manage risk situations. Research work was aimed on clients, who underwent at least one or more attempts to addiction treatment, which, although they completed it in due time, they are unable to remain in longer abstinence of drugs, and are reaching back to fall into previous level of drug dosage. Aim of this work was to map into more detaile the factors stading in the backround of relapse in an individual client after each treatment, to examine the circumstances, motivation for abstinence, decisions, and mental states, which clients were aware before starting the relapse, by using semi - structured interviews and anamnestic data. The basic findings of this research include the changing causes which trigger relapses in the majority of clients who had repeated treatments. There was a lack of...

Background: Abstinent woman, former alcohol user, who is in marriage with active alcohol user. Concept co-dependency (Kudrle, 2003, Whitfield, 1991). Determination, agreement and the will of the married couple for participation in this case study concerning alcohol use and its effects on their coexistence. Objectives and research questions: The main objective of this thesis was to investigate the coexistence of an alcohol-dependent husband with abstinent wife. The main research question was: How is the coexistence of dependent partner with abstinent wife? Additional research questions were: 1) Does, the coexistence look as harmonic in the eyes of the couple and does it fulfil the image of the ideal partnership? 2) What is the role of the respondents in the partnership - is there a sign of co-dependency? 3) Which are the relaps prevention techniques the wife use for maintaining the abstinence? 4) What circumstance or situations may motivate the husband to quit alcohol use? Methodology: The gathering of data for this case study was done by qualitative approach. The main collection methods were the semi-structures in-depth interviews (Miovský, 2006). As the additional methods the study of the medical records of respondents, Quality of Life questionnaire (WHOQOL-BREF) (WHO, 1996), Alcohol Use Disorders...

In order to establish the way in which the Grade 10 Muslim learners perceived HIV/Aids, the research was designed to expose the direction (if any) provided by the values and cultural symbols within the dominant culture of the family and the school. The enquiry was motivated by the fact that the 15-24 year age-group (of which the Muslim adolescents were a part) is still considered a most vulnerable group in terms of HIV/Aids. Although the South African Department of Education has prescribed that HIV/Aids be taught during the Life Orientation periods at schools, this has been affected by operational problems. Learners do not always have the benefit of accurate information and confident role models who are able to guide them towards responsible behavior. Anecdotal evidence pointed to the possibility that HIV/Aids were low amongst Muslims who form a comparatively high percentage in the Western Cape Province of South Africa where the study was conducted. Since the Social Cognitive Theory and the Eight Gateways or “entry points” of school culture highlight social interventions, the theoretical framework facilitated data collection and reinforced the findings. Analysis revealed that a collaborative and trustworthy relationship within the school culture that embraced parents, learners and teachers. Responses of the teachers indicated that they made use of the guidelines from the South African Department of Education and teachings of their religion. The Muslim family and school culture emphasized abstinence instead of safe sexual behavior in their teaching of HIV/Aids because of their Islamic religious background. Although the Muslim learners were aware of the dangers of irrational behavior they conceded that there were some who ignored the guidance of their parents and teachers thus succumbing to other social pressures. However, they generally appreciated the knowledge provided by their family and school culture that supported them to adapt their attitudes and behavior especially in terms of HIV/Aids. The main recommendation of this study is that HIV/Aids education may be productive if an integrative approach is implemented where communities work collectively to promote strict moral adherence that will enable learners to avoid unsafe sexual behavior and HIV-infection. / Thesis (PhD)--University of Pretoria, 2010. / Early Childhood Education / unrestricted

The prevalence of opioid use has increased in many populations including pregnant women, which has led to a substantial rise in infants born dependent on opioids due to in utero exposure. Many women use multiple substances aside from opioids during pregnancy, and their infants therefore present with a variety of symptoms. With increasing legalization and changing perception of marijuana, it has become one of the most commonly used substances during pregnancy. Few studies have evaluated concomitant use of marijuana and opioids in pregnancy despite both being implicated in adverse newborn outcomes. The primary aim of this study was to determine the association between marijuana use and pregnancy outcomes in opioid-exposed pregnancies. The secondary aim was to identify, in a sample of women already using opioids, maternal characteristics associated with marijuana use during pregnancy. A retrospective chart review was conducted from July 2011 to June 2016 of all births from 6 delivery hospitals in South-Central Appalachia to determine pregnancy and neonatal outcomes of pregnancies exposed to any form of opioid and positive urine drug screen for marijuana at the time of delivery. 2375 pregnancies met the inclusion criteria with 108 pregnancies positive for marijuana. Student t-test and Chi-Square test were used for group comparison for presence and absence of marijuana. Logistic regression was done for significant confounding variables to find aOR for marijuana exposure for neonatal abstinence syndrome diagnosis, premature birth, and low birth weight. Among opioid using women, marijuana positive women were more likely to be unmarried, nulliparous, and use tobacco and benzodiazepines. Infants born to the marijuana users were likely to be of earlier gestational age (3 days), lower birth weight, and preterm; with preterm birth and low birth weight (mean difference = 265 gms) increased two fold even after controlling for parity, marital status, tobacco and benzodiazepine use with aOR of 2.35 (1.30-4.23) and 2.02 (1.18-3.47) respectively. Ultimately, prenatal use of marijuana in opioid-exposed pregnancies carries significant risk of prematurity and low birth weight. For pregnant women continuing their American College of Obstetricians and Gynecologists recommended medical assisted treatment for opioid use disorder, providers should counsel women to abstain from marijuana during pregnancy.

The presenter will discuss challenges and implications of Neonatal Abstinence Syndrome (NAS) to classroom environment, behavior management and special education. The presenter will then open discussion on experiences with NAS in classrooms, schools, and communities.