Bakgrund: Ett narkotikafritt Sverige har under lång tid varit målet för den svenska folkhälsopolitiken. Att använda narkotika är, förutom skadorna för individen, även kostsamt och ett problem för samhället. Anledningarna till varför en individ använder narkotika är ett komplext samband mellan samhälleliga och individuella faktorer. Det förebyggande arbetet fokuserar på att narkotikadebuten hos ungdomar senareläggs alternativt uteblir. Hur ungdomar ställer sig till narkotika är således en angelägen kunskap för att kunna utforma ett förebyggande arbete som ger effekt. Syfte: Syftet med studien var att beskriva inställning till narkotikaanvändning bland ungdomar i en kommun. Metod: En explorativ kvalitativ studie med semistrukturerade intervjuer användes. Genom ändamålsenligt urval rekryterades elva ungdomar i ålder 15-18, både flickor och pojkar, vilka deltog frivilligt. Data analyserades genom tematisk analys. ”Social practice theory” användes som teoretiskt ramverk för att förklara och diskutera inställningens betydelse för narkotikaanvändning. Resultat: Tre teman av inställning till narkotikaanvändning bland ungdomarna identifierades: a) narkotikans förväntade effekt, b) social tillhörighet och c) samhället.  Resultatet visade att det fanns en generell negativ inställning till narkotika, men att inställningen varierade beroende på hur ungdomen värderade narkotikans påverkan på kroppen, vänners inställning, samt samhällets normer. Slutsats: Ungdomarna har en ambivalent inställning till narkotika. Det är främst vänners inställning som påverkar den enskilde individen, följt av normalisering av narkotika i samhället. Det fortsatta arbetet för att minska narkotikaanvändningen bör därför fokusera på att skapa restriktiva värderingar och normer kring narkotika. / Background: A drug-free Sweden has long been the target of Swedish public health policy. Using drugs, besides the damage to the individual, are also costly and a problem for society. The reasons why an individual uses drugs is a complex link between social and individual factors. The preventive work focuses on the postponement of the debut of drug use in young people, alternatively does not occur. Thus, why young people resort to drugs is important knowledge to be able to design effective preventive actions. Purpose: The purpose of the study was to describe the attitude towards drug use among young people in a municipality. Method: An explorative qualitative study with semi-structured interviews was used. A purposeful selection was used and eleven adolescents (15-18 years old), both girls and boys, participated voluntary. Data were analyzed by using thematic analysis. "Social practice theory" was used as a theoretical framework to explain individuals´ attitudes on drug use. Results: Three themes of attitudes towards drug use among young people were identified: a) the expected effect of drugs, b) social affiliation and c) society. The results showed that there were general negative attitudes toward drugs, but that the attitudes varied depending on how the youth assessed the drugs’ impact on the body, friends’ attitudes and norms in the society. Conclusion: Young people have an ambivalent attitude toward drugs. It is primarily friends' attitudes that affect the individual, followed by the normalization of drugs in society. Continued efforts to reduce drug use should therefore focus on creating restrictive values ​​and norms on drugs.

The Health Sector at the state of Kuwait is facing many challenges. One of which is public expectations in health are high, and thus, the Ministry of Health (MOH) in Kuwait has amplified the health expenditure by 86% since 2007. And since the medicine budget represents half of the total MOH budget, it is proposed that the development in health policy might be a suitable tool to control the inflation within the health budget. This thesis examines the opportunities and challenges of introducing an EML in Kuwait and the factors influencing its effectiveness. A mixed-methodology approach has been used to enhance and validate the data, in the form of interviews, comparative studies and questionnaires. One major limitation to the research was the lack of previous data relating to this work, and the information should be gathered in person in the form of hard copies, and later, the data was analysed using qualitative and quantitative approaches. It has been attained that, the EML might be a valuable tool if adopted and implemented appropriately, EML adjustment to country health situation is crucial for successful utilisation and fulfilling the concept objectives. Standard Treatment Guidelines are fundamental part of EM selection process, in Kuwait there were lack in the uniformity of the local STG, but fortunately, there is an eagerness to innovate, and the medicine situation might benefit from a type of organisation, overall, if the EML implemented efficiently in Kuwait, it might help in improving the general health and control the inflation in MOH budget.

Most gamblers never experience addiction and the majority of those who do eventually recover. This thesis investigates how most maintain control over their gambling and how the majority of those who do experience gambling addiction regain control. Findings are based on 25 qualitative semi-structured interviews with participants who fit one of three ideal-type groups: (i) gamblers who have never experienced addiction; (ii) gamblers who have regained control after experience of gambling addiction; and (iii) gamblers experiencing addiction at time of interview. Participants were recruited who had never engaged in formal treatment because existing research suggests most who experience gambling addiction and/or recovery never to do so. This study is underpinned by a synthesis of Bourdieusian theory and Foucauldian-inspired governmentality literature which was used to guide the thesis and help explain gambling behaviour. Taking a Foucauldian genealogical approach, the dominant theory of addiction as a biomedical disorder is critiqued and revealed to be myth. Instead, (gambling) addiction is demonstrated to be a social construction which becomes embodied within individuals and thereby influences gambling behaviour. Consequentially, it is shown that research concerning substance use is applicable to the investigation of gambling behaviours. Given paucity of gambling research, substance-related literature is drawn upon throughout the thesis. Attention is given to research demonstrating regulation over drug use to be influenced by the social settings in which consumption takes place as well as the wider social and cultural milieus in which the lives of actors are embedded. Moreover, particular appreciation is given to literature indicating recovery from addiction to be supported by shifts in socio-cultural milieu. In contrast to most existing addictions/gambling research, the agential capacities of gamblers to shape their own behaviours, albeit in ways heavily constrained by context (or ‘structure’) are emphasised throughout the thesis. Data revealed various gambling-related strategies to help constrain gambling and minimise harm. These are examined and it is recommended that this knowledge could be used to aid development of more effective ‘harm-reduction’ style interventions and policies in ways which support less harmful patterns of gambling behaviour. However, although valuable, those with greater control tended to rely little on such strategies to manage their gambling. Instead, greater control over gambling and recovery from gambling addiction was found to have less to do with how participants gamble (e.g. whether or not they followed harm-reduction strategies) and far more to do with the wider, non-gambling-related, aspects of their lives and the nature of their subjectivities/dispositions. Principally influential were found to be the qualities of interviewees’ socio-cultural milieus. Alongside gambling, those with greater control tended to participate in non-gambling-related communities with attendant ways of thinking and cultural expectations (values/norms) that marginalise (heavier) gambling. Drawing on Bourdieusian and Foucauldian governmentality theory, it is argued that, because of their day-to-day participation in such communities/milieus, those with greater control embody mentalities and expectations which discourage riskier gambling behaviour. This, in turn, results in more ‘prudential’ subjectivities which discourage problematic gambling behaviour. Participants who had experienced recovery and many of those who had never experienced addiction revealed long-term reductions in gambling behaviour. Findings suggested these reductions (as well as recovery) to be supported by social and cultural processes, occurring over the life-course, which encourage increased participation in more ‘conventional’ life/milieus and thereby promote alterations in subjectivities in ways more conducive to control. A dual approach to discouraging problematic gambling behaviour is recommended. Although it is important to promote ‘safer’ ways of gambling (e.g. through promotion of harm-reduction style interventions and by designing gambling environments in ways to support greater constraint), it is also imperative to support the development of lives/milieus and subjectivities more conducive to control (e.g. participation in ‘conventional’ life and access to resources required to do so).

Cirurgiões-dentistas são responsáveis pela prescrição de medicamentos, fazendo-se necessário estudos que investiguem o quanto o paciente conhece seu tratamento. Outro aspecto de destaque na odontologia é a automedicação. OBJETIVOS: Avaliar e caracterizar o nível de conhecimento dos pacientes em relação aos medicamentos prescritos em serviços odontológicos públicos de Porto Alegre; verificar existência de prescrições verbais; identificar a prevalência de automedicação. METODOLOGIA: A pesquisa seguiu o modelo de estudo transversal. O instrumento de coleta de dados foi um questionário preenchido após consulta com o dentista, em dois serviços de urgência odontológica. Para avaliar o nível de conhecimento, utilizou-se um escore cuja pontuação possibilitou a classificação em nível bom, regular ou insuficiente. Para a automedicação, identificou-se a prevalência da prática, classes farmacológicas e medicamentos mais utilizados pelos pacientes, no âmbito odontológico. RESULTADOS: Dos 286 entrevistados, 164 (57%) eram do sexo feminino, com média de idade de 35 anos e renda familiar de 3,5 salários mínimos. Observou-se um índice de aproximadamente 10% de prescrições verbais, e em relação às prescrições escritas (n=258), identificou-se que 86% dos pacientes sabiam o nome do medicamento, 85% a freqüência de doses, 66% a indicação terapêutica e 65% a dose. Apenas 20% e 9% sabiam informar sobre precauções e efeitos adversos, respectivamente. Através do escore utilizado, 55% da amostra apresentou um nível de conhecimento regular, 34% insuficiente e 11% bom. Encontrou-se uma prevalência de 70% de automedicação, sendo as classes mais utilizadas os analgésicos (52%), antiinflamatórios não-esteróides (14%), relaxantes musculares (11%) e antibióticos (9%). Não houve associação entre a prática da automedicação e variáveis sócio-demográficas. CONCLUSÕES: A maioria dos pacientes apresenta um nível de conhecimento suficiente a respeito das informações principais do tratamento, porém é necessária uma melhor comunicação entre dentista e paciente a fim de promover o uso racional de medicamentos. A alta prevalência de automedicação e não associação com características sócio-demográficas pode estar relacionada ao problema que geralmente motiva a busca do atendimento de urgência, a dor dental, que requer solução imediata e pode ser, em um primeiro momento, contornada com medicamentos de venda livre. Porém, deve-se ressaltar o percentual expressivo de medicamentos utilizados equivocadamente para tratar afecções bucais. / Dentists are responsible for drug prescribing, hence the importance of studies that aim to evaluate patients’ knowledge regarding their treatment. Another matter of concern in dentistry is the practice of self-medication. OBJECTIVES: To assess and describe the degree of patients’ knowledge regarding their prescribed medicine in emergency dental services located in Porto Alegre, Brazil; verify the occurence of verbal prescribing practice by dentists; assess prevalence of self-medication. METHODS: A cross-sectional study was carried out in two emergency services, whose data were collected using a structured questionnaire after dental consultation. In order to evaluate the degree of patient’s knowlegde, a scoring system was used, which each variable was graded. The sum of the points produced three different levels: good, regular and insufficient. Regarding self-medication, the aim was to establish its prevalence and identify the most utilized medications before seeking the dentist. RESULTS: Of the 286 outpatients interviewed, 164 (57%) were female, with a 35 year-old average and family mean income of 3.5 minimal salaries. Around 10% of the patients received verbal prescription and of the 258 who were questioned concerning medication knowledge from written prescriptions, 86% identified correctly the drug’s name, 85% could tell the dose schedule, 66% knew the indication and 65% the correct dosage. Only 20% and 9% were able to inform aspects of precautions and adverse reactions, respectively. From scoring system results, 55% of the patients displayed a regular knowledge, 34% insufficient and 11% a good one. The prevalence of self-medication among patients was 70%, being analgesics (52%), nonsteroidal antiinflammatories (14%), muscle relaxants (11%) and antibiotics (9%) the most utilized groups. There was no association between self-medication and independent variables. CONCLUSIONS: The majority of the patients showed a sufficient knowledge level concerning the primary aspects of drug treatment, however a better communication between dentists and pacients is required in order to promote rational drug use. The high prevalence of self-medication and its lack of association with socio-demographic variables might be related to the reason people usually seek the emergency department, that is dental pain, which requires immediate care and may be, on a first attempt, solved with OTC drugs. However, there was an expressive share of medication mistankely used for dental purposes.

This convergent parallel mixed methods study based on Social Ecological Model investigated substance abuse among undergraduate university students at one of the universities in Ethiopia. For quantitative strand of study, data was collected from 422 randomly selected undergraduate students. Data were analysed using Statistical Package for Social Sciences version 17. For qualitative strand, face-to-face interviews were conducted with 17 purposefully selected participants directly involved with students abusing substances. The findings revealed that factors at individual, interpersonal, institutional, community and societal levels affect substance abuse among university students. The study also uncovered loopholes in the policies, guidelines, and programme implementations in the prevention, control, and management of substance abuse at the university. Based on the findings, the researcher developed guidelines based on the findings of the study, the critical literature review, and the inputs from the experts who reviewed the guidelines. The researcher assumes that implementation of the guidelines will reduce substance use and substance abuse among university students. / Health Studies / D. Litt. et Phil. (Health Studies)

Made available in DSpace on 2018-06-04T19:14:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-09-27 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Objetivos: o presente estudo teve como objetivo geral caracterizar os programas de prevenção ao uso de álcool e outras drogas implantados em escolas brasileiras públicas e privadas do ensino fundamental e médio que declararam ter ações preventivas. Métodos: trata-se de um estudo qualitativo composto por 41 entrevistas em profundidade. As entrevistas foram realizadas com diretores e coordenadores pedagógicos de escolas brasileiras. Os entrevistados foram selecionados por subamostra de um inquérito epidemiológico nacional que visou avaliar a presença de programas de prevenção em escolas das cinco regiões brasileiras. As entrevistas foram realizadas por meio do software Skype, gravadas em áudio e transcritas na íntegra, tendo sido utilizado um roteiro semiestruturado. Na análise dos dados utilizou-se o software NVIVO, e a interpretação do material coletado foi submetida à análise de conteúdo com o referencial teórico de Bardin. Resultados: foram identificadas duas categorias de ações de prevenção ao uso de álcool e outras drogas nos estabelecimentos de ensino: escolas que possuíam programas de prevenção propriamente ditos e escolas que realizavam atividades pontuais de prevenção. Foram identificadas 29 escolas (71%) que utilizavam programas de prevenção em suas unidades, enquanto as demais se valeram exclusivamente de atividades preventivas. O programa de maior prevalência aplicado nas escolas investigadas foi o Programa Educacional de Resistência às Drogas (Proerd), que foi aplicado em 54% (n=22) das escolas investigadas. Foram encontrados também outros programas de prevenção como o Nepre, Agrinho, Projeto diretor de turma, Protagonismo juvenil, Dignidade: uma conquista diária e o programa da Secretaria Municipal do Rio de Janeiro (SMS). Em 20 escolas, atividades de prevenção foram combinadas com programas e, em outras 12, elas foram ofertadas como única ação preventiva. Foram utilizadas como atividades preventivas palestras, aulas, seminários, atividades lúdicas e visitas técnicas a clínicas de reabilitação. A droga psicotrópica mais mencionada nos programas e atividades foi o crack e a maconha. Nas entrevistas percebeu-se uma desinformação geral quanto às formas de avaliações dos programas. Além disso, os programas aplicados não possuem evidência de eficácia e não se baseiam em boas práticas preventivas. Conclusão: evidenciou-se que no Brasil, os programas de prevenção são confundidos com atividades preventivas. Os programas apresentados não seguiram as boas práticas de prevenção e não são baseados em evidências científicas. O resultado do estudo pode contribuir para apontar a necessidade do desenvolvimento de políticas públicas nacionais que estimulem a implantação de programas baseados em evidências no currículo das escolas, evitando assim potenciais efeitos iatrogênicos da prevenção escolar. / Objective: This study aimed to characterise alcohol and drug prevention programs employed by Brazilian public and private schools at the elementary and middle school levels. Methods: This is a qualitative study based on forty-one in-depth interviews conducted with directors and coordinators of Brazilian schools. Respondents were selected using a subsample of a national epidemiological survey aimed at assessing the presence of prevention programs in schools from five different regions. Interviews were conducted through Skype software, audio-recorded and transcribed, using a semi-structured script. In order to analyse data, NVivo software was used and interpretation of the collected material was subjected to further content analysis via Bardin’s theoretical framework. Results: We identified two categories of actions to prevent the use of alcohol and other drugs in schools: schools that had proper prevention programs and schools that performed specific prevention activities. Twenty-nine schools (or 71% of the total) who used prevention programs in their units were identified, while others made use of preventive activities. The program most frequently implemented in the investigated schools was the Educational Program of Resistance to Drugs (Proerd), which was applied in 54% (n = 22) of the schools. Other prevention programs included Nepre, Agrinho, Projeto Diretor de Turma (Class Principal), Protagonismo Juvenil (Youth Participation), Dignidade (Dignity): a Daily Conquest and of the Municipal Health Secretary of Rio de Janeiro (SMS). In 20 schools, prevention activities were combined with prevention programs and 12 schools offered only prevention acitvities. Prevention activities were less prevalent than programs, appearing in twelve schools, and were combined with programs in twenty of them. Such preventive activities included lectures, classes, seminars, recreational activities and visits to rehabilitation facilities. The most mentioned psychotropic drugs in the programs and activities were crack cocaine and marijuana. In the interviews, a general lack of information on ways to evaluate programs was noted. In addition, the applied programs do not show evidence of being effective and do not rely on good preventative practices. Conclusions: It was demonstrated that in Brazil, prevention programs are confused with preventative activities. The programs analysed do not follow good practices regarding alcohol and drug prevention and are not based on scientific evidence. The results of this study can help point out the need for national public policy development in order to encourage the implementation of evidence-based programs in school curriculums, thus avoiding potential iatrogenic effects from school-based alcohol and drug prevention efforts. / CNPq: 472991/2012-4 / BV UNIFESP: Teses e dissertações

Made available in DSpace on 2018-06-04T19:14:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-04-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivo: Avaliar o processo de implantação do Programa de Prevenção ao Uso de Drogas Unplugged em escolas do ensino fundamental II (6º ao 9º ano) de Florianópolis (SC), São Paulo e São Bernardo do Campo (SP); analisar a fidelidade de implantação do Programa Unplugged de acordo com o registro de professores aplicadores do programa; avaliar a aceitabilidade do Programa Unplugged a partir da ótica dos envolvidos no processo; analisar a percepção de professores, alunos e gestores escolares sobre a implantação do Programa Unplugged para compreensão das dificuldades, facilidades e potencialidades do programa. Métodos: Através de métodos mistos de pesquisa fez-se um estudo de avaliação de processo de implantação do Programa Unplugged de prevenção ao uso de drogas. O programa foi aplicado em 8 escolas públicas de 3 cidades brasileiras e participaram 62 turmas, 36 professores e 1833 estudantes do 6º a 9º ano, no ano de 2013. Na fase quantitativa, os professores preencheram os formulários de fidelidade (aula a aula) e os alunos e professores responderam aos questionários de satisfação global após aplicação do programa em sala de aula. Os dados qualitativos foram coletados através dos grupos focais com roteiro semiestruturado, categorizados em 5 eixos: Experiência anterior com prevenção; Articulações; Implantação; Resultados imediatos e Futuro do Projeto, considerando-se os aspectos de fidelidade, aceitabilidade e viabilidade do programa. Os grupos focais foram realizados ao final do processo de implantação. Foram realizados 14 grupos focais com 100 sujeitos entre professores, gestores políticos, gestores escolares, multiplicadoras e estudantes. Resultados: O programa foi implantado em proporções adequadas nas escolas, tendo sido completado -12 aulas dadas- em 94% das turmas. Os professores avaliaram seu enriquecimento das habilidades de ensino com a aplicação do Unplugged. Identificou-se uma boa interação e relação entre estudantes e professores. A maior parte das dificuldades encontradas no processo de implantação do programa foi descrita pelos professores. Houve grande destaque para a falta de tempo para se dedicar ao programa, desde a preparação das aulas, como a aplicação das mesmas. Os professores e gestores apontaram a importância de incluir o programa no projeto-político pedagógico na escola. A maioria (77,9%) dos estudantes ficou satisfeita ou muito satisfeita com o programa e sugeriu continuidade (76,5%) no ano letivo seguinte. A formação dos professores para trabalhar com a metodologia em sala de aula e a interlocução entre as multiplicadoras, gestão local e a escola apareceu como um aspecto importante implantação do Programa. Conclusões: O Unplugged é um programa viável para expansão de implantação nas escolas brasileiras de acordo com os resultados. No entanto, para garantir continuidade no currículo escolar sem comprometer o conteúdo acadêmico, serão necessárias alterações de logísticas e de processo de trabalho no ambiente escolar. O resultado da pesquisa contribuiu para identificar aspectos operacionais críticos, bem como as potencialidades, dificuldades e facilidades para a sustentação do na prevenção ao uso de drogas como uma política pública. / Objective: To evaluate the implementation process of the Prevention Program Unplugged in middle schools (6th to 9th grade) of Florianópolis (SC), São Paulo and São Bernardo do Campo (SP); to analyze the implementation fidelity of program Unplugged according to teachers that delivered the program; to assess the acceptability of the Unplugged program from the perspective of those involved in the process; to analyze the perception of teachers, students and school administrators about the implantation of the Unplugged program to understand the difficulties, facilities and capabilities of the program. Methods: Mixed methods were used in this process evaluation study. The program was implemented in 8 public schools in three Brazilian cities and delivered in 62 classes by 36 teachers to 1833 students from 6th to 9th grade, in 2013. In the quantitative phase, teachers filled out the fidelity check list (class by class) and students and teachers answered to the global satisfaction questionnaires after classroom program implementation. Qualitative data were collected through focus groups with semi-structured guide, categorized into five areas: Previous experience with prevention; joints; Implantation; Immediate results and future of the project, considering the aspects of fidelity, acceptability and feasibility of the program. The focus groups were conducted at the end of the implantation process. 14 focus groups were conducted with 100 subjects among teachers, stakeholders, school managers, coaches and students. Results: The program was delivered in appropriate proportions in schools and have been completed -12 lessons - in 94% of classes. Teachers realize an enrichment of their teaching skills with the application of Unplugged. We identified a good interaction and relationship between students and teachers. Teachers described most of the difficulties encountered in the process of program implantation. There was great emphasis on the lack of time to devote to the program, from the preparation of lessons to the application of them. Teachers and managers pointed out the importance of including the program in political-pedagogical project of the school. Most of students (77.9%) were satisfied or very satisfied with the program and suggested continuity (76.5%) in the next school year. The training of teachers to work with the methodology in the classroom and the dialogue between the coaches, stakeholders and the school staff appeared as an important aspect of the program implantation. Conclusions: According to the results, Unplugged is a program feasible to be implanted and expanded in Brazilian schools. However, to ensure continuity without compromising the academic curriculum content it will require logistical and process changes in the school environment. The study results helped to identify critical operational aspects, as well as the opportunities, difficulties and facilities to support the prevention of drug use as a public policy. / BV UNIFESP: Teses e dissertações

Submitted by Ana Valéria de Jesus Moura (anavaleria_131@hotmail.com) on 2018-07-05T15:34:52Z No. of bitstreams: 1 RI. Tese_Doutorado_J_Hind JESSICA HIND RIBEIRO COSTA.pdf: 1234914 bytes, checksum: 7d162b9954248b57655740a212523401 (MD5) / Approved for entry into archive by Ana Valéria de Jesus Moura (anavaleria_131@hotmail.com) on 2018-07-05T15:35:02Z (GMT) No. of bitstreams: 1 RI. Tese_Doutorado_J_Hind JESSICA HIND RIBEIRO COSTA.pdf: 1234914 bytes, checksum: 7d162b9954248b57655740a212523401 (MD5) / Made available in DSpace on 2018-07-05T15:35:02Z (GMT). No. of bitstreams: 1 RI. Tese_Doutorado_J_Hind JESSICA HIND RIBEIRO COSTA.pdf: 1234914 bytes, checksum: 7d162b9954248b57655740a212523401 (MD5) / A presente tese se propõe a refletir acerca do tratamento conferido ao indivíduo que faz uso problemático de substâncias psicoativas, dedicando-se a examinar os modelos terapêuticos adotados para tratar os efeitos psicoquímicos associados à dependência química e as implicações decorrentes do uso nocivo, notadamente quando este se apresenta coligado à complicações sociais e sofrimentos psíquicos. Tem destaque, entre os modelos propostos no Brasil, a perspectiva de Redução de Danos, a qual apresenta estratégias mais realistas de lidar com o sujeito a partir da compreensão da sua autonomia e vulnerabilidade. O objetivo central proposto é o de construir uma possível alternativa de intervenção voltada para a compreensão, o diálogo e o acolhimento do sujeito, tendo como paradigma fundante a alteridade. A partir de uma relação humanizada e dialógica com o profissional de saúde o sujeito deve ser respeitado em sua totalidade, tornando-se ativo na escolha das etapas do tratamento e na compreensão dos riscos e danos associados ao uso. Assim, finalmente, são sugeridas algumas mudanças na formação do profissional de saúde, bem como na aplicação do tratamento voltado à abstinência, com o intuito de que o plano terapêutico construído em conjunto com o paciente atenda aos seus interesses e proteja os direitos decorrentes da sua identidade, enfrentando os riscos e danos demandados pelo indivíduo. / The present thesis aims to develop a reflection about the way individuals with problematic use of psychoactive substances are treated. For this purpose, the thesis examines the different therapeutical models adopted in the treatment of the psychochemical effects related to chemical addiction and the consequences of the abuse of those substances, specially when it envolves social and psychic implications. Among those models, the Harm Reduction Approach deserves a special attention. This approach presents more realistic strategies to deal with the individual as it parts from the understanding of the subject’s autonomy and vulnerability. The main goal of this thesis is to part from an alterity paradigm to build an alternative intervention based on the understanding, the dialogue and the shelter of the individual. From a humanized and dialogical relationship with the health professionals, the individuals must be respected in their totality, participating actively in the treatment’s choices and comprehending the risks and harms derived from the use of substances. By the end, the thesis suggests some changes in the health professionals’ training, as well as in the treatment related to abstinence, in order to make it possible to develop along with the patient a therapeutical plan to approach the risks and harms while still being capable of addressing her/his interests and of protecting her/his identity related rights.

Este trabalho de pesquisa teve como objetivo geral compreender a experiência da maternidade em usuárias de crack. Como objetivos específicos a descrição de como se deu a experiência nessas mulheres sobre o saber/sentir grávida e a compreensão de como se apresentou o cuidado dos filhos e o cuidado de si. Os sujeitos participantes foram mulheres mães usuárias de crack. A metodologia empregada foi a qualitativa embasada na fenomenológica existencial. Para tanto, foram colhidas as narrativas dos sujeitos participantes, bem como, a narrativa da pesquisadora, frente ao seu afetar-se no encontro com essas mulheres, no seu campo-ação. Foram entrevistadas cinco mulheres. O marco teórico tomou autores como Heidegger, Foucault e Benjamin. A análise dos resultados considerou a hermenêutica filosófica de Gadamer. Como resultado apresentou o desvelamento do universo singular das mulheres nas suas experiências com a maternidade. Pudemos apreender o fenômeno de não sentir-se mãe nas suas narrativas. Assim como, o fenômeno do abandono, da rejeição, do estigma, da violência e a relação estabelecida com a substância onde possibilitou refletir sobre a forma ôntica do viver na atualidade. / This research had as main objective to understand the experience of motherhood in crack smokers. Specific description of how was the experience of these women know / feel pregnant and understanding how it presented the child care and self-care goals. The subjects were mothers of women crack users. The methodology was qualitative grounded in existential phenomenology. Thus, we collected narratives of research subjects, as well as the narrative of the researcher, is facing its affect on the meeting with these women, through their action. Five women were interviewed. The theoretical framework authors took as Heidegger, Foucault and Benjamin. The analysis considered the philosophical hermeneutics of Gadamer. As a result presented the unveiling of the unique universe of women in their experiences with motherhood. Could not grasp the phenomenon of mother feel in their narratives. As the phenomenon of abandonment, rejection, stigma, violence and the relationship established with the substance where possible to reflect on the ontic way of living today.

Cirurgiões-dentistas são responsáveis pela prescrição de medicamentos, fazendo-se necessário estudos que investiguem o quanto o paciente conhece seu tratamento. Outro aspecto de destaque na odontologia é a automedicação. OBJETIVOS: Avaliar e caracterizar o nível de conhecimento dos pacientes em relação aos medicamentos prescritos em serviços odontológicos públicos de Porto Alegre; verificar existência de prescrições verbais; identificar a prevalência de automedicação. METODOLOGIA: A pesquisa seguiu o modelo de estudo transversal. O instrumento de coleta de dados foi um questionário preenchido após consulta com o dentista, em dois serviços de urgência odontológica. Para avaliar o nível de conhecimento, utilizou-se um escore cuja pontuação possibilitou a classificação em nível bom, regular ou insuficiente. Para a automedicação, identificou-se a prevalência da prática, classes farmacológicas e medicamentos mais utilizados pelos pacientes, no âmbito odontológico. RESULTADOS: Dos 286 entrevistados, 164 (57%) eram do sexo feminino, com média de idade de 35 anos e renda familiar de 3,5 salários mínimos. Observou-se um índice de aproximadamente 10% de prescrições verbais, e em relação às prescrições escritas (n=258), identificou-se que 86% dos pacientes sabiam o nome do medicamento, 85% a freqüência de doses, 66% a indicação terapêutica e 65% a dose. Apenas 20% e 9% sabiam informar sobre precauções e efeitos adversos, respectivamente. Através do escore utilizado, 55% da amostra apresentou um nível de conhecimento regular, 34% insuficiente e 11% bom. Encontrou-se uma prevalência de 70% de automedicação, sendo as classes mais utilizadas os analgésicos (52%), antiinflamatórios não-esteróides (14%), relaxantes musculares (11%) e antibióticos (9%). Não houve associação entre a prática da automedicação e variáveis sócio-demográficas. CONCLUSÕES: A maioria dos pacientes apresenta um nível de conhecimento suficiente a respeito das informações principais do tratamento, porém é necessária uma melhor comunicação entre dentista e paciente a fim de promover o uso racional de medicamentos. A alta prevalência de automedicação e não associação com características sócio-demográficas pode estar relacionada ao problema que geralmente motiva a busca do atendimento de urgência, a dor dental, que requer solução imediata e pode ser, em um primeiro momento, contornada com medicamentos de venda livre. Porém, deve-se ressaltar o percentual expressivo de medicamentos utilizados equivocadamente para tratar afecções bucais. / Dentists are responsible for drug prescribing, hence the importance of studies that aim to evaluate patients’ knowledge regarding their treatment. Another matter of concern in dentistry is the practice of self-medication. OBJECTIVES: To assess and describe the degree of patients’ knowledge regarding their prescribed medicine in emergency dental services located in Porto Alegre, Brazil; verify the occurence of verbal prescribing practice by dentists; assess prevalence of self-medication. METHODS: A cross-sectional study was carried out in two emergency services, whose data were collected using a structured questionnaire after dental consultation. In order to evaluate the degree of patient’s knowlegde, a scoring system was used, which each variable was graded. The sum of the points produced three different levels: good, regular and insufficient. Regarding self-medication, the aim was to establish its prevalence and identify the most utilized medications before seeking the dentist. RESULTS: Of the 286 outpatients interviewed, 164 (57%) were female, with a 35 year-old average and family mean income of 3.5 minimal salaries. Around 10% of the patients received verbal prescription and of the 258 who were questioned concerning medication knowledge from written prescriptions, 86% identified correctly the drug’s name, 85% could tell the dose schedule, 66% knew the indication and 65% the correct dosage. Only 20% and 9% were able to inform aspects of precautions and adverse reactions, respectively. From scoring system results, 55% of the patients displayed a regular knowledge, 34% insufficient and 11% a good one. The prevalence of self-medication among patients was 70%, being analgesics (52%), nonsteroidal antiinflammatories (14%), muscle relaxants (11%) and antibiotics (9%) the most utilized groups. There was no association between self-medication and independent variables. CONCLUSIONS: The majority of the patients showed a sufficient knowledge level concerning the primary aspects of drug treatment, however a better communication between dentists and pacients is required in order to promote rational drug use. The high prevalence of self-medication and its lack of association with socio-demographic variables might be related to the reason people usually seek the emergency department, that is dental pain, which requires immediate care and may be, on a first attempt, solved with OTC drugs. However, there was an expressive share of medication mistankely used for dental purposes.