Background: Intravenous way of drug application is the most common between problem drug users at Prague. Due Mravčík et al. (2015), the estimate is, that there was a 15 700 intravenous drug users at Prague in 2014 (7 500 pervitin users, 2 500 heroin users and 5 700 buprenorphine users). And that they spend about 15,5 millions of syringes every year (Švůgerová, 2015). But the data in Annual report on drug situation 2014 says, there was only 2, 6 millions of syringes distributed (Mravčík et al., 2015). This means, that Prague intravenous drug users spend many more syringes, that are distributed by low-treshold services and pharmacies. That is a reason of charting of the behaviour of drug users in connection with application of addictive substance, especially how the consuption of injecting material is connected with single type of drug user. Aims: The main aim of the thesis is to find out the frequency of drug application in intravenous drug users and to estimate the total consumption of injecting materialial depended on single of users typology (used drugs, frequncy of contact with harm reduction services…) Research sample: The sample consists of 155 clients of harm reduction services at Prague (3 contact centers and 3 streetwork programs). All of the respondents stated the intravenous drug using in...

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Introduction Substance use in adolescents with disabilities is rising, containing the prevalence of substance-related disorders (SRD) such as addiction, mental or health disorders, cancer, accidents and mortality. Yet little is known about the existing substance use prevention programs among adolescents with dosabilities or physical impairments. The aim of this systematic review was to investigate the effects of school-based interventions or prevention programs directed at the reduction of alcohol, tobacco and drug use in young adolescents with disabilities or physical impairments. Method Five scientific databases were explored mainly for school-based randomized controlled trials (RCTs) and prevention programs examining the effects of substance use interventions and prevention programs on adolescents with disabilities or physical impairments. Guided by the NICE guidelines, eligible articles were detected from which data were collected. A systematic literature review was performed for many diverse outcomes such as, substance use knowledge, substance use, modelling social environment, intention to quit smoking, peer pressure, etc. Results The primary literature search resulted in 821 articles. Five studies were incuded in the systematic literature review. Most of the collected studies were about adolescents with intellectual disabilities (MBID or MMID). The review's sample group ranged from 12-to 18-year-old adolescents. Included studies had a total sample of 981 out of which 13 were teachers. Studies measured both primary and secondary outcomes like modelling smoking, substance use and frequency of alcohol use. Conclusion This review summarized evidence about interventions and prevention programs aimed at decreasing or preventing substance use in adolescents with various types of disabilities or physical impairments. Substance use education increases knowledge about alcohol, tobacco and drug use and the health-related harms in teenagers with disabilities. Additional research is required especially among teenagers with intellectual disabilities and other types of disabilities.

INTRODUÇÃO: Infecções pelo HIV, HBV, HCV e Treponema pallidum encontram no sistema prisional um ambiente favorável para suas propagações e representam grave problema de saúde pública. Neste estudo buscamos conhecer o perfil epidemiológico dos reeducandos de uma unidade prisional e a dinâmica do seu comportamento associado às infecções estudadas. Foram medidas as prevalências dessas infecções e suas coinfecções, investigados os potenciais fatores de risco, assim como medido o padrão de uso de drogas no presídio com ênfase no crack. MÉTODOS: Estudo epidemiológico transversal realizado de fevereiro a dezembro de 2007, na Penitenciária I de São Vicente. Realizada uma análise descritiva utilizando medidas de frequência, médias e desvio padrão. Foram considerados apenas os diagnósticos sorológicos para definição das infecções. Utilizado o OR (odds ratio) como medida de associação com nível de significância de 5% (?). Utilizada a regressão logística para estimar OR ajustado por algumas variáveis. RESULTADOS: Participaram das entrevistas 546 (84,1%) reeducandos e 514 (94,1%) realizaram as sorologias. Apresentaram um perfil jovem com idade média de 29,8 anos. 52,0% (283) referiram relacionamento conjugal com média de dois filhos. Declararam ser de cor parda 51,5% (280). O tempo médio de prisão foi de 10,5 anos. As prevalências identificadas foram: HIV 1,8% [IC95% = 0,1- 3,3], HBV 21,0% [IC95% = 17,8-25,1], HCV 5,3% [IC95% = 3,5-7,6], e 5,3% [IC95% =3,5-7,6] para a infecção pelo Treponema pallidum. Os fatores de risco associados com a infecção pelo HIV foram: uso de droga injetável (OR=15,38), > 30 anos (OR=13,3), uso de cocaína na vida (OR= 5,36) e uso de crack na vida (OR= 5,21). Nas análises multivariadas as variáveis que se mantiveram associadas com o HBV foram: uso de droga injetável (OR=3,36), ter referido DST (OR= 2,28), > de 30 anos (OR=1,86) e mais de cinco anos de prisão (OR= 2,17); com o HCV foram: uso de droga injetável (OR=9,65), uso de maconha na prisão (OR=2,91) e idade >30 anos (OR=8,41); com o Treponema pallidum foram: relação homossexual (OR=11,92) e ter referido sífilis (OR=10,88). As prevalências das coinfecções foram: 0,8% [IC95%= 0,2-2,0] para HIV/HBV, 1,4% [IC95%=0,5-2,8], para HBV/Treponema pallidum, 1,8% [IC95%= 0,8-3,3] para HBV/HCV, e para a tripla infecção 0,4% [IC95%= 0,5-1,4]. Confirmaram o uso de crack na vida 25,0% (136) dos entrevistados. Idade média de início de uso de drogas ilícitas foi de 15,4 anos. Na prisão, o uso de álcool foi relatado por 8,4% (45), tabaco por 62,0% (318), maconha por 36,5 % (194), cocaína por 9,0% (48), e crack por 11,7% (15), sendo seu uso diário referido por 2,3% (3). Uso de drogas injetáveis na vida foi referido por 5,9% (32) e nenhum uso nos últimos seis meses. As situações de violência relacionadas com drogas para 14,3% (28) foram de ameaças de morte, 16,7% (57) agressões físicas e 27,3% (3) sofreram agressão sexual. Para 15,8% (30) o crack esteve relacionado com estas situações. O seu uso com outras drogas foi referido por 41,5% (54). CONCLUSÃO: As prevalências encontradas na população confinada continuam maiores que as observadas na população geral. O consumo de drogas e praticas sexuais desprotegidas foram mantidas no período de confinamento. O tempo de confinamento mostrou-se fator importante na análise de risco. Os fatores de riscos identificados aparecem como importantes indicadores para a estruturação de estratégias de controle dessas infecções junto à população confinada. / INTRODUCTION: Infection by HIV, HBV, HCV and Treponema pallidum are common in the prison system due to an environment favorable to their propagation and represent a serious public health problem. This study aims to understand the epidemiological profile of the inmates in a prison unit and the behaviors associated with the infectious diseases studied. We estimated the prevalence of these infections and their co-infections, investigated potential risk factors, as well as identified the pattern of drug use in prison, especially crack use. METHODS: A cross-sectional epidemiological study conducted from February to December 2007 at the São Vicente Penitentiary . A descriptive analysis using frequency measures, means and standard deviations was conducted. We considered only the setting for serological diagnosis of infections. Odds ratio (OR) with a significance level of 5% (?) was used as a measure of association and a logistic regression was applied to estimate adjusted OR for some variables. RESULTS: A total of 546 prisoners were interviewed (84.1%). Of these, 514 (94.1%) underwent serological analysis. Results showed a profile of young men with an average age of 29.8 years. Fifty-two percent (283) reported marital relationship with an average of two children, and 51.5% (280) reported being of mixed ethnicity. The average time of arrest was 10.5 years. The prevalences were identified: HIV 1.8% [95% CI = 0.1 - 3.3], HBV 21.0% [95% CI 17.8 to 25.1], HCV 5.3% [95% CI = 3.5 to 7.6] and 5.3% [95% CI = 3.5 to 7.6] for infection with Treponema pallidum. The risk factors associated with HIV infection were injected-drug use (OR = 15.38), > 30 years (OR = 13.3), cocaine use (OR = 5.36) and use of crack during lifetime (OR = 5.21). According to multivariate analyzes, variables associated with HBV were: injected-drug use (OR = 3.36), reported any STD (OR = 2.28), > 30 years (OR = 1.86) and more than five years in prison (OR = 2.17); the variables associated with HCV were: injected-drug use (OR = 9.65), marijuana use in prison (OR = 2.91) and age> 30 years (OR = 8.41); the variables associated with Treponema pallidum were: homosexual intercourse (OR = 11.92) and have referred syphilis (OR = 10.88). The prevalence of co-infections were 0.8% [95% CI = 0.2 to 2.0] for HIV / HBV, 1.4% [95% CI = 0.5 to 2.8] for HBV / Treponema pallidum, 1.8% [95% CI = 0.8 to 3.3] for HBV / HCV infection and for the triple infection 0.4% [95% CI = 0.5 to 1.4]. Average age of onset of illicit drug use was 15.4 years. The use of crack during lifetime was reported by 25.0% (136) of respondents. In prison, alcohol use was reported by 8.4% (45), tobacco by 62.0% (318), marijuana by 36.5% (194), 9.0% for cocaine (48), and crack by 11.7% (15), with the daily use of crack reported by 2.3% (3). Injected-drug use during lifetime was reported by 5.9% (32), but no use in the last six months was reported. Drug-related violence episodes reported were death threats 14.3% (28), 16.7% (57) assaults and 27.3% (3) suffered sexual assault. To 15.8% (30) of the respondents, crack use was associated with violence episodes. The use of crack-cocaine in association with other drugs was reported by 41.5% (54). CONCLUSION: The prevalence found in the confined population is still larger than those observed in the general population. Drug use and unprotected sexual practices were maintained during the period of confinement. The confinement time proved to be an important factor in the analysis of risk of infection. The identified risk factors appear to be important indicators for developing strategies to control these infections in the prison environment.

Introdução. A doença isquêmica coronariana (DIC) ainda é a principal causa de morte no mundo. A sua prevenção secundária é essencial, uma vez que reduz novos eventos cardiovasculares e mortalidade, e pode ser influenciada por diversos fatores, incluindo sociodemográficos. Objetivo. Avaliar a prevenção secundária da doença isquêmica coronariana na linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) (2008-2010). Métodos. Os dados foram analisados pelos testes: Kolmogorov-Smirnov, qui-quadrado, análise de variância (ANOVA), Mann-Whitney e regressão logística, conforme necessário. Resultados. Dos 15.094 participantes, 2,7% reportaram diagnóstico prévio de DIC. Destes, 16,3% não utilizavam qualquer medicamento recomendado pelas diretrizes, 22,7% relataram utilizar a combinação de antiplaquetário, betabloqueador, antagonista do sistema renina-angiotensina e hipolipemiante, e 12,1% a combinação de antiplaquetário, betabloqueador e hipolipemiante. Os principais fatores associados ao uso de medicamento foram renda [Razão de Chances (RC) = 2,041 Intervalo de Confiança de 95% (IC95%)1,07 a 3,89] e sexo (RC = 0,517 IC95% 0,31 a 0,85). A frequência de uso dos medicamentos se manteve semelhante conforme o tempo desde o evento isquêmico coronariano, exceto para o uso de apenas um medicamento, que foi aumentando conforme o tempo. Conclusão. A prevenção secundária foi menor do que o recomendado pelas diretrizes, principalmente em mulheres e participantes com menor renda, indicando uma necessidade de melhores políticas públicas que visam a prevenção secundária de DIC / Introduction. Coronary heart disease (CHD) remains the main cause of mortality worldwide. Secondary prevention of CHD is necessary and avoids new cardiovascular events and mortality. Several factors, including sociodemographic characteristics, contribute positively or negatively to secondary prevention. Objective. To evaluate secondary prevention of CHD in the baseline examination of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods. Kolmogorov-Smirnov test, chi-squared test, one-way analysis of variance (ANOVA), Mann-Whitney test and logistic regression models were performed, as necessary. Results. Of the 15,094 participants included, 2.7% reported previous diagnosis of CHD. Not using any drug was reported by 16.3% of participants with CHD and the use of recommended drugs were reported by 22.7% for the combination of four classes and 12.1% for the combination of antiplatelet medication, beta-blocker and lipid lowering. The main characteristics associated with medication use was income [Odds Ratio (OR) = 2.041; 95% Confidence Interval (95%CI) 1.07 to 3.89] and sex (OR = 0.517; CI95% 0.31 to 0.85). Frequency of medication use was similar among time since CHD event, except for the use of just one drug that increased over time. Conclusion. Use of secondary prevention for CHD was below the recommended guidelines, especially in women and participants with lower income, suggesting the need of public health policies addressing secondary prevention of CHD, especially in these high-risk groups

OBJETIVOS: O presente estudo visou estimar a prevalência da comorbidade entre transtornos mentais graves e o abuso de substâncias psicoativas, e estudar os fatores associados a essa comorbidade, em pacientes com transtornos mentais graves residentes em São Paulo. MÉTODO: O estudo teve desenho de corte transversal. Vinte serviços de saúde mental (emergências, hospitais psiquiátricos e ambulatórios) foram pesquisados, a fim de identificar todos os pacientes com idade entre 18 e 65 anos, com diagnóstico clínico de transtorno mental grave, que fossem residentes em um dos 7 distritos administrativos escolhidos para o estudo e que tiveram ao menos um contato com o serviço de saúde no período entre 1/9/1997 e 30/11/1997. Os pacientes incluídos foram avaliados quanto a sintomas psiquiátricos, ajustamento social, uso de álcool e uso de substâncias psicoativas, utilizando-se instrumentos padronizados. RESULTADOS: Dos 620 pacientes identificados, 404 foram aleatoriamente selecionados para serem entrevistados. Foi possível entrevistar diretamente 192 (47,9%) indivíduos. A prevalência de comorbidade nos últimos 12 meses foi de 10,4% (I.C. 95%: 6.5 a 15.6), sendo 7,3% para abuso de álcool e 4,7% para abuso de drogas ilícitas, e mostrou-se maior entre homens, entre migrantes, entre indivíduos separados/divorciados, em indivíduos com 12 ou mais anos de escolaridade, e em indivíduos com o diagnóstico de transtornos do espectro da esquizofrenia. A presença de sintomas negativos de esquizofrenia foi significativamente menor entre os indivíduos que receberam o diagnóstico de abuso de substâncias psicoativas. CONCLUSÃO: Os resultados deste estudo sugerem que na população estudada a prevalência de transtornos decorrentes do uso de álcool e outras drogas é mais baixa do que as prevalências encontradas em outros estudos, realizados nos EUA e Europa. Essa discrepância de resultados pode ser devida a diversos fatores, incluindo o consumo de substâncias pela população geral na qual estão os sujeitos investigados, o ambiente social onde esses sujeito vivem e aspectos culturais relacionados ao consumo de substâncias. / OBJECTIVES: To investigate the prevalence of substance use disorders among patients with severe mental illnesses in São Paulo, Brazil, and to study factors associated with such comorbidity. METHOD: The study had a cross-sectional design. Twenty mental health services (emergency, inpatient and outpatient services) were scrutinized to identify all patients aged 18 to 65 years old, with a clinical diagnosis of severe mental illness, who were resident in one of 7 administrative districts chosen for the study, and had had at least one contact with such services between 1stSeptember and 30th November 1997. Assessments included psychiatric symptoms, social adjustment, and patterns of alcohol and drug use, using standardized instruments. RESULTS: Out of 620 patients identified, 404 were randomly selected to be interviewed. One hundred and ninety two patients (47.9%) were directly interviewed. The prevalence of comorbidity was 10,4% (95%CI: 6.5 to 15.6), being 7,3% for alcohol abuse and 4,7% for drug abuse, and was higher among male subjects migrants, single or separated individuals, those with 12 or more years of education, and among those with schizophrenia-like disorders. Presence of negative symptoms was associated with lower prevalence of comorbidity. CONCLUSIONS: Results of the present study suggest that the prevalence of dual diagnosis in São Paulo is lower than those found in previous studies, carried out in the USA and Europe. Such discrepancy may be due to several factors, including population patterns of substance use, the social environment where patients live, and cultural issues related to the use of alcohol.

Drug trade is a part of non-observed economy in the system of national accounts. Estimations of drug trade were made from demand side based on estimation of drug consumption. This needs estimations of drug users, which was possible to estimate from drug use prevalence in last year. Several surveys done in society were the data source. Other information from the surveys was information about frequency of drug use. Several research studies gave information about consumed drug quantity by one opportunity. Police and customs have a common database about drug seizures. The database is source for information about import and export of drugs, drug purities by production or import and by consumption or export. Police reports drug prices also. The physical indicators of the drug trade are recalculated by wholesale and retail prices into financial indicators, which are possible to record into system of national accounts.

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Introduction Child sexual abuse is a common problem. Psychological and behavioural problems in children and adults who have experienced child sexual abuse have been associated with the abuse. Little research has been conducted which has been long-term, prospective, involved substantiated sexual abuse, included a control group, took into account mediating factors, utilised multiple data sources, relied on standardised measures and had a high follow-up rate. Aim The aims of this study were to compare a cohort of sexually abused young people with a group of nonabused peers and to establish predictors of psychological and behavioural outcome. Method This study was a follow-up which was long-term, prospective, involved a sample of children with substantiated sexual abuse, included a control group, took into account mediating factors, utilised multiple data sources, relied on standardised measures and had a high follow-up rate. Eighty-four sexually abused young people were followed up five years after presenting to Children�s Hospitals� Child Protection Units for sexual abuse and were compared to a group of 84 nonabused young people of similar age and sex. The two groups were compared on the basis of demographic variables, family functioning, mother�s mental health and life events; the outcome measures of depression, self-esteem, anxiety, behaviour, criminal activity, alcohol and other drug use, eating problems, running away, suicide attempts, self-injury, hopefulness, despair and attributional style; and potential mediating factors such as further notifications to the Department of Community Services, receipt of psychological treatment, legal action against offenders and victims compensation. Potential predictors of outcome were (1) demographic variables, (2) sexual abuse characteristcs, (3) intake data and (4) five year follow-up variables. Main findings Follow-up rates were 81percent (n equals 68) for cases and 89percent (n equals 75) for controls. Five years after presenting for the sexual abuse, the sexually abused young people were performing more poorly than their nonabused peers on various measures of psychological state and behaviour. Although the abused children had experienced more negative life events (p<.001), were from lower socio-economic groups (p<.0001), had more changes in parent figures (p<.001) and had mothers who were more psychologically distressed (p equals .03), multiple regression analysis showed that after allowing for these and other demographic and family factors, there were still significant differences between the groups after the 5 years. The abused children displayed more disturbed behavior (p equals .002), had lower self-esteem (p<.001), were more depressed or unhappy (p<.001) and were more anxious (p equals .03) than controls. Sexually abused children had significantly higher levels of bingeing (p equals .02), self-injury (p equals.009) and suicide attempts (p equals .03). Significant predictors of psychological and behavioural outcome were significantly related to family and parent functioning variables. Abuse status was not a significant predictor when offered to each of the predictive models. Significant predictors of outcome included the following intake variables: family functioning, mother�s mental health, whether parents were employed or not, behaviour scores, prior notifications for neglect, history of parental discord and whether there were caregiver changes or not prior to intake. The classification of the index sexual abuse event as indecent assault and whether there were notifications for sexual abuse prior to the index event also significantly predicted outcome. Five year follow-up variables which were significant predictors of outcome were the young person�s age, number of negative life events, attributional style, self-esteem, depression, number of parent changes, anxiety, despair, whether there were notifications for abuse/neglect after intake and having a parent with a history of drug/alcohol problems. Conclusions Difficulties associated with child sexual abuse continue for some years after the abuse event. Child sexual abuse needs to be considered as a possible antecedent of behaviour and psychological difficulties in young people. Treatment and monitoring should continue for some years after the abuse. Treatment may need to be directed more towards young people�s psychological states rather than focusing specifically on the sexual abuse. Family and parent functioning may need to be addressed early in order to prevent some of the behavioural and psychological difficulties associated with the long-term outcome of child sexual abuse.

The aim of this thesis is to describe the users visiting the syringe exchange clinic in Malmö with respect to what characterises the group, how they utilize the services of the clinic and how their patterns of participation relate to risk behaviour, physical and mental health and social development. The heterogeneity of the group has been captured by the use of Stimsons dimensions “integration in majority society” and “involvement in sub-culture”, yielding four different groups of syringe exchangers: “stables”, “loners”, “two-worlders” and “junkies”. The study rests on two sources of data: a register from the clinic including all syringe exchangers that have visited the clinic between 1989 and 2003, altogether 3660 individuals, and an interview of visitors at the clinic during 1995, including 496 persons. The results show that syringe exchangers, compared to other persons with severe addiction in Malmö, to a larger extent use amphetamine as their drug-of-choice, are older and inject more irregularly. The population visiting the clinic is heterogeneous with respect to integration in society and involvement in sub-cultures. The group classified as junkies do, as expected, display the highest inclination to share syringes and needles with other and hence have the most advanced risk behaviours. As to utilization of the programme, the results show that the longer the syringe exchangers stay in the programme, the more frequent they visit it. Also with respect to utilization-patterns, we find substantial variations within the studied group. Five categories are discernible: drop-in visitors with only one or two visits, sporadic visitors who in spite of contacts over a number of years never really establish a regular contact, intermittent visitors who have had contact over several years but display a very irregular visiting pattern, regular visitors who relatively fast establish a consistent contact with visits between uniform time intervals and frequent visitors who tend to stay longer than others and visit the clinic more often. Another aspect of utilization is to what extent the distribution of needles and syringes cover the needs of the visitors. With a strict definition of need, only a minority manages to cover their needs, but if we accept a more extensive individual re-use, around 90 percent of the average need is covered. Data also reveals that a very high proportion of the users on at least one occasion have visited the programme without syringe exchange taking place or any complementary service delivered. Basically these visits seem to be of a more social nature, reinforcing the contacts between the staff and the visitors. Data do not give any clear support for the basic assumption that syringe exchange reduce the incidence of HIV or hepatitis. Recent sharing of utensils or low coverage of syringe need through the programme do not predict a higher infection risk. Instead we find that the social contacts with the staff (without syringe exchange) function as a predictor of lower incidence. This indicates that the mechanisms may be more complex than just related to the provision of clean needles and syringes. The result shows that integration increase over time while sub-cultural involvement decreases. However, the patterns for different groups are very diverse and we find no evidence that more frequent contacts as such are related to increased integration. There is however, some evidence that social visits are positively related to increased integration. No support could be found for the assumption that the programme increases the number of severe addicts.