O farmacêutico, uma vez inserido na equipe multidisciplinar, tem um papel importante a desempenhar na educação em saúde com o objetivo de melhorar o conhecimento sobre as condições crônicas, refletindo positivamente na adesão ao tratamento e em conseqüência nos resultados clínicos e na qualidade de vida dos indivíduos. O objetivo deste estudo foi elaborar, implementar e avaliar o modelo de intervenções educativas para o uso racional de medicamentos. O estudo clínico longitudinal, prospectivo, randomizado foi conduzido por uma equipe multidisciplinar com 119 pacientes asmáticos (60/grupo controle e 59/grupo intervenção) atendidos no Ambulatório Especializado em Asma do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A elaboração do modelo foi composto de cinco módulos contendo informações básicas sobre a doença, adesão ao tratamento proposto, medicamentos, técnicas de uso de dispositivos e cuidados com os medicamentos, complementado com material impresso e visual. O modelo foi implementado por meio de reuniões de educação dirigidas por profissional farmacêutico e avaliado de acordo com as recomendações da Organização Mundial da Saúde. As intervenções educativas para o uso racional de medicamentos proporcionaram ao grupo intervenção o aumento de 21% no conhecimento sobre a doença e aprimoramento das técnicas de utilização dos dispositivos inalatórios com significância estatística intra e intergrupos (p<.0001). Os resultados também mostraram aumento do número de pacientes classificados como mais aderentes após a intervenção mensurada pelo Teste de Morisky Green com significância estatística (p. 0.0244) e pelo reabastecimento da receita com significância intragrupo (p = 0.0113). Em relação à função pulmonar, a diferença intergrupos de CVF (p=0.0287) e de 8% do valor de VEF1 (p. 0,0461) sugerem relevância clínica. Os resultados mostram aumento das pontuações com significância estatística intragrupo em todos os domínios do questionário de qualidade de vida com significância estatística. Após a finalização do estudo o modelo foi implementado para o grupo controle e a avaliação mostrou aumento do conhecimento em asma e melhoria da qualidade de vida. Este modelo foi eficaz e economicamente viável para ser implantado pelo SUS quando testado para pacientes com a condição clínica asma e poderá ser adaptado e reproduzido para outras condições crônicas. / The pharmacist, once inserted into the multidisciplinary team has an important role to play in health education with the goal of improving the knowledge about the chronic conditions, reflecting positively on treatment adherence and consequently clinical outcomes and quality of life individuals. The aim of this study was to develop, implement and evaluate a model of educational interventions for the rational drug use. The clinical study longitudinal, prospective, randomized study was conducted by a multidisciplinary team with 119 asthmatic patients (60/control group and 59/ intervention group) in the Specializing in Asthma Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto. The development of the model was composed of five modules containing basic information about the disease, treatment compliance, drugs, techniques and drug cares and supplemented with visual and printed material. The model was implemented through educational meetings led by pharmacist professional and evaluated according to the recommendations of the World Health Organization. Educational interventions for the rational drug use provided to the intervention group 21% increase in knowledge about the disease and improvement of inhalers techniques with statistical significance within and between groups (p <.0001). The results also showed an increase patients number classified as more adherent after the intervention measured by test Morisky Green with statistical significance (p. 0.0244) and the replenishment of medical prescription with intragroup significance (p = 0.0113). Regarding lung function, the difference between groups in FVC (p = 0.0287) and 8% of the value of FEV1 (p. 0.0461) suggest clinical relevance. The results show increase in scores statistically significant intragroup in all domains of quality of life questionnaire with statistical significance. After completion of the study, the model was implemented for the control group and the evaluation showed an increase in asthma knowledge and quality of life improvement. This model was effective and economically viable to be implemented by the SUS when tested for patients with asthma and the clinical condition may be reproduced and adapted for other chronic conditions.

Using thematic analysis, this qualitative study investigates desistance from illicit drug use from the perspective of patients within opioid substitution treatment (OST). Wikström's theoretical framework was used to explain this process. From semi-structured reflective interviews with 12 patients admitted to an OST clinic in Sundsvall, three main themes were identified as relevant to the research aim. These main themes were labelled as follows: Motives for desistance, Perspectives on OST and Recipe for successful desistance. The findings were similar to those of previous research. The participants expressed criticism on specific regulations within OST, but were positive to the treatment in general. They felt a lack of emotional support from OST, but still reported an improvement in mental well being. While varied views on diversion of OST medication were expressed, a majority believe dillicitly used opioids to originate from sources other than OST. In conclusion, the participants viewed OST as an essential method for desistance from illicit drug use. Having a sincere will to desist and perceiving the past illicit opioid use as problematic were also deemed necessary for the treatment to be successful. / <p>2017-06-01</p>

In South Africa today, the numbers of drug-dependent adolescents are increasing at alarming rates. These adolescents require rehabilitation. The numbers of institutions that offer drug rehabilitation services are also growing exponentially. However, the programs followed by the institutions are wide ranging in nature and are not controlled by government or a professional body. Although these institutions claim individual successes, their success rates – especially in regard of adolescents – is highly subjective and suspect. The discipline of educational psychology is uniquely capable of setting objective criteria to which all programs for drug-dependent adolescents should comply. Educational psychology emphasizes two important aspects of human development: The educational and the psychological. Moreover, it gives considerable weight to the adolescent’s participation in her own development. The uncontrolled use of dependence-forming substances by adolescents negatively influences every level of their physical, emotional, cognitive, psychological and social development. To facilitate their growth to responsible adulthood, specialized treatment is required to address specific adolescent developmental tasks and needs. It has become imperative that the programs offered to adolescents in South Africa be analysed and examined critically in order to determine whether they comply with the dictates of a responsible educational-psychological approach. It is against this background that a research study was undertaken to investigate the current position of drug rehabilitation programs for adolescents offered by centres and clinics in South Africa. The aim of this study was to determine and describe educational-psychological criteria to evaluate the suitability of current programs that are offered to drug dependent adolescents in this country. A theoretical framework was developed by an extensive literary research. This framework formed the foundation of an empirical study. The initial stage of the empirical study – the identification of drug rehabilitation centres and clinics that offer in-patient treatment for adolescents – was hampered by the lack of government involvement in the registration and monitoring of such centres and clinics and the programs they offer. No database containing information on drug use, drug misuse and drug dependence, as well as places and methods of rehabilitation, exists. Identified institutions were contacted and requested to participate in this research. Several refused. The centres and clinics that were willing to assist and offered unique programs, were visited. In several instances one centre was visited and described as representative of several centres or clinics that offer programs based on a similar approach. Documentation regarding drug rehabilitation programs were perused. Interviews with adolescents – whose parents had given permission for their participation – and with available parents and staff were recorded and transcribed. The transcriptions were qualitatively analysed. Educational-psychological criteria that address the specific development needs of adolescents were identified. This research found that although some programs address some minor educationalpsychological aspects of the adolescent’s substance problem, not one of the in-patient programs addressed the problem holistically by emphasizing the development and needs of these adolescents. The effect of these programs on the educationalpsychological development of adolescents moving towards responsible adulthood, must be questioned. The educational-psychological criteria – as set out in this research study – should be applied to in-patient drug rehabilitation programs for adolescents in South Africa to increase the quality and success of the said programs. Through such an approach, adolescents are valued as individuals who have to complete general developmental tasks successfully to arrive at a responsible and meaningful adulthood. / Prof. J.C. Kok

Recent research into the adolescent substance abuser has been motivated by the recognition that the successful rehabilitation of such persons may depend on the development of a positive self-concept. Literature dealing with the Gestalt Therapy, the Adolescent; Chemical Dependency, Addiction and Substance Abuse have been discussed. The various stages and elements of social development of the adolescent were discussed in order to determine whether there exists a correlation between a dysfunctional family life or “unfinished business” and the cause of substance abuse. The interviews conducted with thirteen (13) respondents, who were referred by the court and/or educational institutions, indicate that there is a definite connection between the poor self-concept of the adolescent substance abuser (based on previous traumatic experiences) and substance abuse. The research indicates that the majority of these adolescents choose to abuse substances for comfort – to compensate for the fragmentation in their lives. In accordance with the Gestalt Therapy which advocates an integration of the various elements of the self – a holistic view - the researcher found that it was possible to treat the addiction successfully if the adolescent could deal with the “unfinished business” in his/her past. Consequently, the final Chapter of this study sets out guidelines of the development of a therapeutic programme founded on principles of the Gestalt Therapy. / Dr. E. Oliphant Dr. W.J.H. Roestenburg

[pt] Na presente Dissertação realiza-se uma análise dos objetivos implícitos nas diferentes ofertas de tratamentos do uso de drogas, administrados pelo poder público no município do Rio de Janeiro - em que uma das práticas, é voltada exclusivamente para crianças e adolescentes em situação de rua. A abordagem do fenômeno, da vivência de crianças e adolescentes em situação de rua, a partir da década de 1980, e do proíbicionismo às drogas tidas como ilícitas, que vinha sendo intensificado também neste período, compõem dois importantes pontos de análise para contextualização da temática discutida. A análise do crescente proíbicionismo e criminalização em torno das drogas consideradas ilícitas (produção, cultivo, consumo e venda), no decorrer do século XX, apontam as raízes econômicas, geoeconômicas e geopolíticas, que compõem a questão. A ocorrência do uso de drogas ilícitas por crianças e adolescentes em situação de rua (e as diversas questões que derivam desta) gera uma situação de crescente responsabilização desses atores sociais, pela situação que vivenciam. Frente à abrangência do discurso que reforça a criminalização das drogas e de todos os atores sociais que, de alguma forma, se relacionam com estas, no município do Rio de Janeiro, coexistem duas práticas de oferta de tratamento, contraditórias entre si. A implementação das práticas das diretrizes do Protocolo Especializado de Abordagem Social, do governo do município do Rio de Janeiro, concomitante a execução das diretrizes de tratamento da Política Nacional de Saúde Mental, se contradizem e expressam a correlação de forças, dos projetos societários em conflito na sociedade. Para compor a análise das concepções duas práticas de tratamento do uso de drogas, e as particularidades destas quando direcionadas para crianças e adolescentes em situação de rua, apresentada nesta Dissertação, foram realizadas entrevistas com profissionais e estudiosos da temática, pela aplicação de questionários semiestruturados. A pesquisa realizada, de abordagem qualitativa, foi aprovada pela Câmara de Ética e Pesquisa da PUC – Rio, e autorização dos entrevistados foi previamente solicitada. / [en] This dissertation focuses on the analysis of the goals implicit in the different offers of treatment for drug users, administered by the government in the city of Rio de Janeiro - where a practice is dedicated exclusively to children and adolescents in street situation. The approach to the phenomenon, that is, the experience of children and adolescents living on the streets, from the 1980s, and the prohibition on drugs regarded as illegal, are also intensified during this period, comprising two important points of analysis for contextualizing the theme discussed. The analysis of the growing prohibition and criminalization of drugs considered illicit (production, cultivation, consumption and sale), in the course of the twentieth century, pointed at economic, geo-economic and geopolitical roots, that make up the question. The occurrence of illicit drug use by children and adolescents living on the streets (and various other issues that derive from this) generates a situation of increasing criminalization and social accountability of these actors. As part of the scope of the discourse that strengthens the criminalization of drugs and all social actors that somehow relate to these, in the municipality of Rio de Janeiro, two contradictory practices of treatment offer coexist. The practical implementation of the Protocol guidelines (Protocolo Especializado de Abordagem Social – Specialized Protocol of Social Approach), issued by the government of the city of Rio de Janeiro, and the concurrent implementation of treatment guidelines of the National Mental Health present contradictions and express the correlation of forces of social projects in conflict in society. Consultations were held with professionals and scholars in order to compose the analysis of the concepts of the two treatment practices of drug use, as well as the particularities of these when directed to children and adolescents in street situation presented in this Dissertation. To compose an analysis of concepts two treatment practices of drug use, and the particularities of these when directed to children and adolescents in street situation presented in this Dissertation, we conducted interviews with practitioners and scholars of the subject, by the application of semi-structured questionnaires. The research, a qualitative approach was approved by the Research Ethics Board of PUC - Rio, and authorization of respondents was previously requested.

AFRIKAANS: Hierdie navorsingstudie het ten doel gehad om 'n nasorgprogram te ontwikkel vir die benutting deur maatskaplike werkers in die hantering en behandeling van substansafhanklike adolessente. Die misbruik van afhanklikheidsvormende middels word erken as een van die grootste gesondheids- en maatskaplike probleme in Suid¬Afrika. Die eskalerende patrone van dwelmmisbruik en die impak daarvan op die individu en ook op die groter samelewing benodig gespesialiseerde vaardighede om die probleem te verstaan en aan te spreek. Met hierdie behoefte in gedagte is daar besluit om hierdie studie te doen en 'n nasorgprogram te ontwikkel om aan die maatskaplike werker in die praktyk 'n hulpmiddel te verskaf om eff'ektiewe nasorgdienste aan die substansafhanklike adolessent te lewer. Die doel van hierdie ondersoek is om verkennende- en beskrywende navorsing uit te voer na substansafhanklikheid by adolessente. Die kwantitatiewe navorsingsproses is gevolg in die navorsing, alhoewel navorsingsmetodes uit beide die kwantitatiewe- en kwalitatiewe benaderings gebruik is. Daar is twee stellings vir die navorsingstudie geformuleer, naamlik: Daar bestaan 'n leemte aan bestaande bruikbare nasorgprogramme vir die benutting deur maatskaplike werkers in die praktyk vir hulpverlening aan die substansafhanklike adolessent; en dwelmmisbruik neem toe onder adolessente en moet dringend aangespreek word. Die stellings was deur middel van die verkennende navorsingsontwerp en met behulp van persoonlike vraelyste (kwantitatiewe data¬insamelingsmetode) en semi-gestruktuurde aangesig-tot-aangesig onderhoudsvoering (kwalitatiewe data-insamelingsmetode) ondersoek. AIle kwalitatiewe- asook kwantitatiewe data het 'n ooreenkomstige bevestiging op die stellings verskaf. Hierdie data het aangedui dat daar 'n groot leemte aan effektiewe nasorgdienste ten opsigte van die substansafhanklike adolessent bestaan en dat substansafhanklike adolessente as gevolg van oneffektiewe hulpverlening telkens 'n terugval beleef. Verdere navorsing deur middel van die benutting van narratiewe terapie met 'n gesin waar 'n adolessent dwelms gebruik is gedoen. 'n Suid-Mrikaans geformuleerde meetinstrument wat substansafhanklikheid binne die adolessente kultuur en leefwyse, asook eietydse eise en probleme kan vervat en meet, word gevolglik aanbeveel. ENGLISH: The purpose of this research study is the development of an aftercare programme for social workers to use in the handling and treatment of substance dependant adolescents. The abuse of dependant substances is recognised as one of the greatest health and social problems in South Africa. The escalating patterns of drug abuse and the impact thereof on the individual as well as the greater community asks for specialised skills to understand and solve these problems. With this need in mind the researcher decided to develop an aftercare programme, which would serve as a practical guideline for social workers in practice in order to supply effective aftercare services to the substance dependant adolescent. The aim of the study was to investigate substance dependency by adolescents through exploratory- and descriptive studies. The quantitative research process was followed although both the qualitative and quantitative methods were used. Two suppositions were formulated for the research study: A huge gap currently exists for aftercare programs for the assistance of social workers in practice to substance dependant adolescents. These suppositions were investigated through the use of exploratory research design and with the assistance of personal questionnaires (quantitative date gathering method) and semi-structured face-to-face interviewing (qualitative data gathering method). Both quantitative and qualitative data confirmed the formulated suppositions. The data clearly indicated the need for effective aftercare services for substance dependant adolescents, which frequently experience a relapse due to the lack of assistance. Further research can be done through the use of narrative therapy within a family in which an adolescent used drugs. A South African formulated measurement scale, which is able to measure substance dependency within the adolescent culture and way of life, are recommended. / Dissertation (MA (SW))--University of Pretoria, 2006. / Social Work and Criminology / unrestricted

INTRODUCTION: Drug consumption rooms (DCR) are places for the hygienic consumption of preobtained drugs in a non-judgemental environment and under the supervision of trained staff. Since 1986, the DCR have been established in 10 countries around the world. Despite the fact that Czech Republic offers wide range of services aimed to minimize the risks connected to problematic drug users, intravenous aplication still prevails. While, effectivity of DCR has already been proven, there are none in the Czech Republic. AIMS: The work aims to provide systematic and comprehensive summary of current state of knowledge regarding establishment and runing of DCR from international experiences. Additionally, the target of this work is to describe what conditions, necessary for legal establishment of DCR, were set in these countries and whether these conditions can be set in Czech Republic. Finally, the thesis analyzes whether the DCR are visited and used by clients and describes what the profile of a typical client is. METHODS: For the first part which deals with establishment of DCR, method of written text analysis based on international scientific databases was used. Second part considering the running of DCR was prepared by analyzing the webpages of individual institutions in order to find out organizational...

Migrant workers are one of the most rapidly growing populations in the United States (U.S.) and have been significantly affected by HIV/AIDS. More than 9 million people in the U.S., primarily concentrated in Texas, Florida, Washington, California, Oregon, and North Carolina, are migrant farm workers. High prevalence rates are also suspected among migrant worker communities where risky health behaviors appear to be common. Constant mobility, isolation, limited education, substandard housing, and poverty are some of the factors that migrant workers experience and in many cases increases their HIV risk. Recent studies have suggested that ethnic identity or the level of attachment with one’s ethnic group may influence engagement in HIV risk behaviors, a fact that may be important in the development of interventions among ethnic minorities. This study assesses the relationship between ethnic identity and HIV risk behaviors in two different samples; one assesses this relationship at baseline with a total of 431 African American migrant and seasonal workers in Immokalee, Florida. The second analyzes changes in ethnic identity and HIV behaviors in a sample of 270 Hispanic and African American migrant and seasonal workers in Immokalee, Florida. Data from baseline and 6-month follow-up were used in the analyses presented. The results suggest that individuals with higher levels of ethnic identity report lower levels of engagement in some, but not all, of the risky behaviors examined. These findings point to a potentially protective role for ethnic identity among this sample.

The current opioid crisis has, among other things, resulted in soaring rates of fatal overdose across Canada, prompting officials to turn to harm reduction in hopes of combatting the epidemic. The Coroners Service of British Columbia issued a statement in March 2017 reporting an 80% increase in the number of deaths resulting from illicit drug use in 2016 from 2015 (Coroners Service of British Columbia, 2017). Despite the abundance of evidence demonstrating the effectiveness of supervised injection services (SIS) in Canada and worldwide, the implementation of this intervention has remained highly controversial, particularly in Ottawa. Guided by Michel Foucault’s theory of governmentality, this thesis explores the obstacles hindering the implementation of supervised injection services in Ottawa, Ontario. Through eight qualitative semi-structured interviews with front-line workers of harm reduction programs, this thesis identifies and explores several obstacles to the implementation of SIS, primarily bureaucratic obstacles stemming from the enactment of the Respect for Communities Act (2015).

Sharing and inappropriate discarding of syringes and drug use equipment can lead to transmission of bloodborne pathogens and decreased sense of community safety. To reduce these risks, interventions such as syringe drop boxes, are implemented. However, little consideration has been made of the social and spatial networks of the injection drug use (IDU) populations in the placement of these drop boxes. A sample of IDU was obtained through respondent driven sampling in Winnipeg, Canada in 2009. Characteristics of the sample and distribution of these characteristics through the social network were assessed. A spatial network was constructed which focused on the connections between IDU and specific geographic locations. Measures of centrality were calculated using Pajek and the geographic network was mapped using ArcGIS. Analysis of the social network revealed variation among network components in demographic and drug use characteristics. Spatial analysis revealed geographic clustering, quantified through network centrality measures. There was congruence between locations of high degree and current drop box placement in Winnipeg. This research illustrates the benefit of combining IDU social network and spatial data to inform evidence-based municipal policies and programs.