Tramadol misuse in the Niger Delta; A review of cases presenting within a year

Objective: Tramadol is an opioid agent used for pain management with huge potentials of misuse. The misuse of Tramadol is associated with increased morbidity and mortality; and this is common among young adults in low-income settings. The aim of this study is to highlight cases of Tramadol misuse managed in a rural teaching hospital in the Niger Delta region of Nigeria.

Method: We used the case report design to highlight five cases of Tramadol misuse in our setting over a year period.

Results: Majority of the cases were males and young adults using Tramadol for non-medical purposes. They all presented with various clinical features including altered levels of consciousness.

Conclusion: Tramadol misuse among young male adults is common in our region. Further research and intervention programs are essential to understand the true burden and also prevent further misuse in the community.     

Ask them all: Self-report universal prenatal substance use screening in the United States

Background: Increasing rates of opioid use in the United States have created a national public health crisis. Substance use in pregnancy increases risk for poor birth outcomes. National advisory groups recommend screening all women for prenatal substance use. However, there is no single approach or tool recommended for universal prenatal substance use screening.

Objective: This study seeks to evaluate the effectiveness of universal screening using a direct approach self-report of substance use in pregnancy.

Method: A retrospective review of de-identified data to evaluate women’s willingness to self-report substance use through direct screening. Data obtained from 24 months of maternal self-report were analyzed to assess the overall effectiveness of a direct screening method during the prenatal period.

Results: Findings revealed maternal substance use disclosure rates of 9.7%, higher than the 5.4% United States national average.

Conclusion: Increasing awareness of maternal prenatal substance use offers opportunity for education and support early in pregnancy. Findings suggest the direct method may support maternal self-report of substance use in universal prenatal screening. Additional study with diverse populations and clinical settings is needed.     

The link between childhood trauma and dissociation in frequent users of classic psychedelics and dissociatives

Background: Childhood trauma severity is associated with the level of subsequent substance use as well as with the self-reported severity of dissociation. Classic psychedelics and dissociatives target neurotransmitter systems thought to be involved in the onset of dissociative symptoms and may evoke severe and long-lasting symptoms of depersonalization in some users. However, it is currently unclear whether drug use puts people with a history of childhood trauma at higher risk of developing dissociative symptoms.

Objectives: The current study investigates whether the one-year prevalence of substance use significantly moderates the link between childhood trauma and the severity of depersonalization.

Methods: Participants (n = 297, of which 80.2% were active users) filled out an online self-report questionnaire including the Childhood Trauma Questionnaire (CTQ), the Cambridge Depersonalisation Scale (CDS), and information about their substance use.

Results: Results indicate that childhood trauma and substance use are significant individual predictors of dissociation scores in this sample, but no moderation of substance use on the link between childhood trauma and depersonalization was established.

Conclusions: It is hypothesized that the quality (particularly the context) of the experience of substance use rather than the sheer quantity may be responsible for the manifestation of depersonalization.     

Treatment needs of drug users: The perspective of Iranian women

Background: Treatment needs and health-care issues in women are completely different from those of men. In order to develop and apply successful treatment programs for substance-dependent women, gender-based differences should be considered to provide them with effective health care and treatment services.

The present study was conducted to investigate the views of substance dependent women about their health care and treatment needs.

Methods: In-depth and semi-structured interviews were conducted among 20 opiate using women who were chosen through purposeful sampling from camps, methadone maintenance treatment (MMT) centers and women’s prison in Sanandaj, Iran in 2015. Data were analyzed using content analysis (a conventional approach).

Findings: Three main factors were recognized through data analysis: individual factors, structural factors, and social factors.

Conclusions: The results of the study suggests the need for structural changes such as improving comprehensive services and enhancing referral system regarding gender-based differences to provide the substance-dependent women with more effective treatment and medical care.     

Prevalence of psychoactive substance use among male adolescents in Southwest Nigeria

Introduction: Substance use in the adolescent period is recognized as a growing problem in Nigeria. The problem is even more significant among male adolescents in southwest Nigeria with consequent legal and academic problems.

Objectives: The study aimed to describe the pattern of substance use among male secondary-school adolescents and identify sociodemographic correlates of substance use.

Methods:. A total sampling of male students in senior classes of secondary schools selected randomly from urban and semi-urban areas of Ibadan a city in Nigeria were approached for the study.

Results: The mean age of the respondents was 16.49 years (SD ±1.31). Lifetime use of any psychoactive substance was 54%. The most common substance ever used by respondents were non-amphetamine stimulants (39%) followed by alcohol (31%) while hallucinogens (1.0%) and cocaine (1.0%) were the least ever used. None of the respondents had never used an amphetamine-type stimulant. Seven of the respondents (2.9%) reported ever using a psychoactive substance though injection in the last 3 months.

Conclusion: This study reports a high prevalence of psychoactive substance use among male secondary-school adolescents in Ibadan southwest Nigeria. It showed that being in a higher class and engaging in paid work after school were factors significantly associated with substance use. The findings of this study have implications for adolescent mental health intervention in the field of addiction.     

Recommendations to improve opioid use disorder outcomes in countries of the Middle East

Background: Progress has been made in treatment of opioid use disorder (OUD) in the Middle East; current clinical practice often differs from standards of care elsewhere.

Aim: describe treatment approaches in selected countries to inform recommendations for improving care.

Methods: Evidence describing approaches to OUD care was collected and analyzed in a structured, comparative manner. Recommendations were developed based on experts’ clinical experience in the region.

Results: Care differs across countries assessed: Egypt, KSA, UAE, Oman, Kuwait, and Bahrain. Detoxification programs are the common treatment approach in Egypt, KSA, Oman, and Bahrain; integrated programs with opioid agonist therapy (OAT): UAE, Kuwait. Fear of misuse and diversion risk commonly limits access to OAT. Problems with sourcing medicines may limit treatment options. There is limited data on treatment needs or provision. Recommendations: develop effective policy and expert-led consensus on best practice for OUD in the region including integrated treatment programs, provide support for specialists and centers, include innovative medication choices with low diversion risk, promote collaborative work, coordinate data collection, and sharing.

Conclusions: There is important unmet need for OUD in the region and opportunity to improve services through collaboration to support change. Therapy options with reduced diversion risk may address barriers to care.     

“I used to be an addict. I’m still an addict. I’m always going to be a recovering addict”: Understanding the challenges of individuals seeking recovery

Background and Objective: Although preventable, substance addiction has become one of the most prominent public health problems facing the nation. As a result, treatment programs and centers have focused resources and efforts on aiding individuals on their path to long-term recovery. However, the constant threat, reinforced by high incidence, of relapse presents a major obstacle to long-term recovery. Relapse prevention programs are designed to target social and psychological factors contributing to lapses in sobriety. Yet, the exact factors that can impact long-term recovery and prevent or lower the instances of relapse are not always clear. The current study explores the major contributors to relapse as experienced in a male residential treatment center.

Methods: The data were gathered through 31 in-depth interviews in a residential halfway house treatment facility for substance use recovery.

Results: The results of the study underscored social support and interpersonal relationships as major factors impacting long-term recovery. More specifically, lack of efficacy in managing interpersonal relationships and building new support networks were identified as essential barriers to long-term recovery.

Conclusions: The management of interpersonal relationships seems to be a key to long-term recovery, which emphasizes the need for strategies that underscore the development of positive relationships that will strengthen resistance to relapse and long-term recovery.     

The clinical toxicology of sodium hypochlorite

Introduction: Sodium hypochlorite is used as a bleaching and disinfecting agent and is commonly found in household bleach.

Objective: The objective is to review critically the epidemiology, mechanisms of toxicity, clinical features, diagnosis, and management of hypochlorite poisoning.

Methods: PubMed was searched from January 1950 to June 2018 using the terms “Hypochlorite”, “Sodium Hypochlorite”, “Sodium Oxychloride”, “Hypochlorous Acid”, “Bleach”, “Chlorine Bleach”, in combination with the keywords “poisoning”, “poison”, “toxicity”, “ingestion”, “adverse effects”, “overdose”, and “intoxication”. In addition, bibliographies of identified articles were screened for additional relevant studies including non-indexed reports. Non-peer-reviewed sources were also included. These searches produced 110 citations which were considered relevant.

Epidemiology: There is limited information regarding statistical trends on world-wide poisoning from sodium hypochlorite. In the United States of America, poison control center data have shown that enquiries regarding hypochlorite bleaches have ranged from 43,000 to 46,000 per year over the period 2012–2016.

Mechanisms of toxicity: Hypochlorite’s potential to cause toxicity is related to its oxidizing capacity and the pH of the solution. Toxicity arises from its corrosive activity upon contact with mucous membranes and skin.

Features following ingestion: While small accidental ingestions are very unlikely to cause clinically significant toxicity, large ingestions may cause corrosive gastrointestinal injury and systemic effects, including metabolic acidosis, hypernatremia, and hyperchloremia.

Features following dental exposure: Hypochlorite is used extensively by dentists for cleaning root canals and is safe if the solution remains within the root canal. Extrusions into the periapical area can result in severe pain with localized large and diffuse swelling and hemorrhage.

Features following skin exposure: Prolonged or extensive exposure may cause skin irritation and damage to the skin or dermal hypersensitivity. Such exposures can result in either immediate or delayed-type skin reactions. High concentration solutions have caused severe chemical skin burns.

Features following inhalation: Although there are only limited data, inhalation of hypochlorite alone is likely to lead to no more than mild irritation of the upper airways.

Features following ocular exposure: Corneal injuries from ocular exposure are generally mild with burning discomfort and superficial disturbance of the corneal epithelium with recovery within 1 or 2 days. With higher concentration solutions, severe eye irritation can occur.

Diagnosis: The diagnosis can typically be made on the basis of a careful history, including details of the specific product used, its hypochlorite concentration, and the amount involved. As hypochlorite bleach produces a characteristic smell of chlorine, this may provide a diagnostic clue. In severe cases, corrosive injury is suggested on presentation because of hypersalivation, difficulty swallowing, retrosternal pain or hematemesis.

Management: Symptom-directed supportive care is the mainstay of management. Gastrointestinal decontamination is not beneficial. Local corrosive injury is the major focus of treatment in severe cases. Fiberoptic endoscopy and CT thorax/abdomen are complimentary and have been shown to be useful in corrosive injuries in assessing the severity of injury, risk of mortality and risk of subsequent stricture formation and should be performed as soon as possible after ingestion. Dental periapical extrusion injuries should be left open for some minutes to allow bleeding through the tooth and to limit hematoma development in tissue spaces. Once the bleeding has ceased, the canal can be dressed with non-setting calcium hydroxide and sealed coronally.

Conclusions: Accidental ingestion of household bleach is not normally of clinical significance. However, those who ingest a large amount of a dilute formulation or a high concentration preparation can develop severe, and rarely fatal, corrosive injury so prompt supportive care is essential as there is no specific antidote. Treatment primarily consists of symptom-directed supportive care.     

The frequency of hospitalizations and length of stay differences between schizophrenic and schizoaffective disorder inpatients who use cannabis

Background: The literature on the effects of cannabis use by patients with schizophrenia is variable.

Aims: To determine whether there are differences among urine-screened cannabis-only users, polysubstance users using cannabis, and nonusers on the number of inpatient hospitalizations and length of stay for patients with schizophrenia or schizoaffective disorder.

Method: This study (N = 116) included patients who tested positive for only cannabis (n = 20, Group 1); tested positive for cannabis and had a history of other substance use (n = 43, Group 2); and had negative drug screens (n = 53, Group 3).

Results: Groups 1 and 2 had significantly lower numbers of hospitalizations than Group 3 without controlling for any other factors, and non-significantly lower lengths of stay than Group 3.

Conclusions: Our results do not support the hypothesis that cannabis exacerbates psychotic symptoms in patients with schizophrenia or schizoaffective disorder. Our study is unique in that it utilized objective urine drug screens.     

Exploring the associations between substance use and online risk-taking among college students

Background: The rise of the Internet has provided another context in which college students can engage in normative risk-taking behavior. However, little is known about online risk-taking or the extent to which it is associated with substance use.

Methods: Heterogeneity in self-reported online risk-taking was explored among 246 U.S. college students (17–23 year old; 60% male; 65% White) using a finite number of discrete online risk-taking profiles. The relationship between different profiles of online risk-taking and substance use was then assessed using multinomial logistic regression.

Results: Three unique classes of online risk-taking emerged. Individuals in the high online risk-taking class had significantly higher odds of engaging in lifetime alcohol use, lifetime marijuana use, and lifetime illegal drug use compared to individuals in the low risk-taking class. Substance use was not associated with the probability of membership in the sexual online risk-taking class relative to the low risk-taking class.

Conclusions: Results suggest a need for a more nuanced understanding of which students are engaging in online risks and how online risk-taking is associated with substance use.     

The availability of raw data in substance abuse scientific journals

Objective: The availability of research data sets is an important milestone since it can enhance the dynamics of research. This study aims to analyse the PubMed Central repository to determine the availability and type of raw data sets in Substance Abuse journals indexed in the Journal Citation Reports.

Methods: A search of the 39 journals from the Substance Abuse category of both editions (Sciences and Social Sciences) of the 2014 Journal Citation Reports was conducted. A study of the supplementary material of the original articles was performed through a search in the PubMed Central repository. The number and types of files were registered.

Results: The search in PubMed Central showed that only 4.7% of original articles contained supplementary material uploaded, being text and .pdf files the most frequent materials whereas spreadsheets and raw data represent less than 10%.

Conclusion: The main finding of this study is that the exchange of data in the substance abuse field is not a common practice since researchers are still reticent.     

Psychometric evaluation of the Drug Avoidance Self-Efficacy Scale

Purpose: The aim of this study was to adapt the Drug Avoidance Efficacy Scale, and to assess the validity and reliability of the scale in Turkish adolescents.

Methods: This is a psychometric study. The number of students who were recruited was twenty times the number of scale items. A convenience sample of 320 undergraduate students was recruited from a university in Turkey.

Result: Principal component analysis identified one factor. The factor loadings of the items were ranged 0.41–0.91. The internal reliability coefficient was 0.70 for the scale. It was also found that the scale explained 73.1% of the total variance.

Conclusion: According to the results of this study, it may be statedthat this study provides evidence for the Drug Avoidance Self-Efficacy Scale’s validity and reliability.     

Behavioral misperceptions,attitudinal discrepancies,and adolescent alcohol and marijuana use

Background: Adolescents’ risk of substance use is shaped by perceptions of peers’ use and peers’ approval, and also by attitudes, values, and behaviors of broader, peer-based, school-level climates. Yet misperceiving peer behavior and/or possessing beliefs/values discrepant from peers may also increase substance use.

Methods: Using school-based survey data, we examined (a) associations between individual- and school-level norms and adolescents’ risk of alcohol and marijuana use, (b) accuracy of adolescents’ perception of peer behavior and consistency between individual and peer attitudes, and (c) consequences of behavioral misperceptions and attitudinal discrepancies.

Results: Both individual- and school-level perceptions and attitudes were associated with adolescent substance use, and students aligned behaviors with their perceptions of the broader normative climate.

Conclusions: Peers are key correlates of adolescents’ use, and their influence is nuanced and complex. Substance use prevention and intervention efforts should thus attend to the prevailing norms within certain developmental contexts, and also adolescents’ deviation from such norms.     

A cross-sectional study evaluating the knowledge and beliefs about,and the use of antibiotics amongst Malaysian university students

Background: The introduction of antibiotics into modern medicine has changed clinical care by saving millions of lives. However, misuse of antibiotics has led to their benefits being overshadowed by the development of antimicrobial resistance.

Aims of Study: This study aimed to assess university students’ knowledge and beliefs about and their use of antibiotics.

Methods: This cross-sectional study was conducted among 674 medical and non-medical students of the National Defence University of Malaysia, using universal and convenience sampling methods. The data was collected using a validated questionnaire and analyzed using IBM SPSS 24, and the MANOVA test and Logistic Regression were used to explore the associated factors.

Results: More than half of the respondents’ knowledge was low and their health beliefs outdated. Age, race and program were significantly associated with up-to-date knowledge and beliefs about antibiotic use, factors associated with finishing a course of antibiotics were studying medicine, personal health, and ethnicity. The significant factors associated with antibiotic self-prescribing were beliefs having been prescribed antibiotics during the last one year, and trusting the doctors who did not prescribe antibiotics.

Conclusion: This study has identified a concerning low knowledge about antibiotics amongst some Malaysian university students, reflected in use of un-prescribed antibiotics and a lack of adherence to treatment. There is a need for educational interventions for students regarding antibiotic usage and resistance issues.     

Mechanisms of toxic cardiomyopathy

Background: Dilated cardiomyopathy is a frequent disease responsible for 40–50% of cases of heart failure. Idiopathic cardiomyopathy is a primary disorder often related to familial/genetic predisposition. Before the diagnosis of idiopathic cardiomyopathy is made, clinicians must not only rule out viral and immune causes, but also toxic causes such as drugs, environmental agents, illicit substances and natural toxins.

Objective: The objective of this review is to present recent data on the mechanisms underlying toxic cardiomyopathy.

Methods: The US National Library of Medicine Pubmed database was searched from 1980 to December 2017 utilizing the combinations of the search terms “toxic cardiomyopathy”, “drugs”, “anticancer drugs”, “azidothymidine”, “rosiglitazone”, “carbon monoxide”, “alcohol”, “illicit drugs”, “cocaine”, “metamfetamine”, “metals”, “venom”. A total of 339 articles were screened and papers that dealt with the pathophysiology of toxic cardiomyopathy, either in animal models or in clinical practice were selected, with preference being given to more recently published papers, which left 92 articles.

Anticancer drugs: The mechanisms of anthracycline-induced cardiotoxicity are primarily related to their mechanisms of action as anticancer drugs, mainly the inhibition of topoisomerase II β and DNA cleavage. Additional metabolic or oxidative stress factors may play a part, together with interference with iron metabolism. The more recent drugs, trastuzumab and imatinib, also influence stress pathways.

Antiretroviral agents: Azidothymidine is cardiotoxic as a result of mitochondrial toxicity. In addition to energy depletion, azidothymidine also increases the production of mitochondrial reactive oxygen species (ROS).

Antidiabetic drugs: The cardiotoxicity of thiazolidinedione antidiabetic drugs is still under investigation, though interference with mitochondrial respiration or oxidative stress is suspected.

Cocaine: Among the multiple mechanisms involved in cocaine-related cardiotoxicity, excessive sympathetic stimulation with increased myocardial oxygen consumption is well documented in the acute form of left ventricular dysfunction. As for cocaine-related cardiomyopathy, the role of apoptosis and ROS is under investigation.

Ethanol: The aetiology of ethanol-related cardiotoxicity is multifactorial, with individual susceptibility being important. It involves apoptosis, alterations of the excitation–contraction coupling in cardiac myocytes, structural and functional alterations of the mitochondria and sarcoplasmic reticulum, changes in cytosolic calcium flows, changes in calcium sensitivity of myofilaments, alterations of mitochondrial oxidation, deregulation of protein synthesis, decrease of contractile proteins and disproportion between the different types of myofibrils, changes in the regulation of myosin ATPase, up-regulation of the L-type calcium channels, increase of oxidative stress, and induction of ANP and p21 mRNA expression in ventricular myocardium.

Metamfetamines: Catecholamine-mediated toxicity is the probable cause, with a possible role for genetic susceptibility.

Carbon monoxide: In addition to hypoxic injury, carbon monoxide is also directly toxic to the mitochondria, with impairment of mitochondrial respiratory chain at the cytochrome c oxidase level, decrease of glutathione concentrations and of ATP production. There is no evidence for a delayed dilated cardiomyopathy in survivors of an acute exposure.

Metals: Cobalt-related cardiomyopathy probably results from interference with energy production and contractile mechanisms, but additional factors (nutrition, hypothyroidism) are often required. Antimony may cause lethal oxidative stress and cell death mediated by elevation in intra-cellular calcium. Proposed mechanisms for mercury toxicity include glutathione depletion, production of ROS, and interruption in selenium-dependent endogenous enzymatic reactions. The existence of a lithium-induced cardiomyopathy is still debated.

Scorpion venom: Catecholamine release is the probable cause of acute cardiomyopathy following scorpion envenomation.

Conclusions: The mechanisms behind toxic cardiomyopathy are complex and multifactorial but include interference with myocardial cell bioenergetics and intracellular calcium handling, the generation of ROS, neurohormonal stress, and induction of apoptosis.     

Substance use among municipal solid waste workers in Mumbai: a cross-sectional comparative study

Background: Smoking, alcohol consumption and chewing of tobacco affect the health of people as well as the socioeconomic structure of families, communities and eventually the nation. This study assesses the prevalence of substance use among municipal solid waste workers of Mumbai.

Methods: To conduct the study, information was collected from 540 municipal workers of Mumbai with regard to substance use as well as their socioeconomic and occupational characteristics. To draw inferential statistics, the data was processed through multivariate logistic regression (MLR) and ordered logistics regression (OLR).

Results: Multivariate regression suggests that waste loaders and street sweepers are significantly more likely to smoke, consume alcohol and chew tobacco with reference to the comparison group. Workers with more working years and morbid health status are significantly more likely to get involved with substance use. The results of OLR reveal that municipal waste workers are significantly more likely to consume alcohol on a daily basis (β = 0.220, p < 0.001).

Conclusion: Socioeconomic characteristics significantly contribute in increasing the risk of substance use among workers. Workers defend their habit of substance use by considering it as a mechanism for coping with the filthy nature of their occupation. Evidence-based preventive measures need to be developed in order to reduce substance use among municipal solid waste workers.     

Need of structural interventions for linking people who inject drugs with antiretroviral treatment: A qualitative study

Objective: People who inject drugs (PWIDs) are highly vulnerable to acquiring HIV infection. Existing interventions have not succeeded in linking PWIDs to antiretroviral treatment (ART). Structural interventions (SIs) or public health interventions that alter the structural context need investigation for a suitable linking to care (LIC) strategy.

Methods: We conducted in-depth interviews with 31 HIV-infected PWIDs. Using a thematic approach, interviews were stopped on reaching saturation of themes.

Results: Personal barriers like denial of HIV status, fatalistic attitude, inability to find time because of earning livelihood, or money for their drugs, transportation difficulties and hospital level barriers like time required for registration, crowd at the hospital, and difficulty traversing departments dissuaded LTC. Using social networks, drug peddlers or provision through mobile health units were accepted as feasible alternatives.

Conclusion: PWIDs face various barriers to LTC. SIs are required for LTC of PWIDs. Storytelling for educational campaign, mobile health units at hot spots to provide HIV test and ART, and using social networks and drug peddlers to assist with education and LTC are suggested.

Practice implications: Existing interventions have not succeeded in reducing HIV prevalence as well as linking to ART care. New SI interventions need to be experimented for LTC.

Abbreviations: AIDS: autoimmune deficiency syndrome; ART: antiretroviral treatment; HIV: human immunodeficiency virus; LTC: linking to care; PWID: people who inject drugs; SI: structural Interventions; TB: htuberculosis Bacillus infection     

Substance use and strategies to avoid relapses following treatment: A narrative approach with clients undertaking a twelve-step program in Sweden

Introduction: There is a need for a better understanding of clients who undergo treatment for substance use, especially to avoid relapse.

Aims: To identify our clients’ discourses which led to their substance problems and to determine those discursive strategies which have kept them sober.

Method: A total of 14 participants at a Swedish municipally-operated treatment program were interviewed about their childhood, teenage years, early experiences with substance, how they recognized they had substance problems, found out about treatment, adopted strategies to maintain sober and whether they noticed identity changes during treatment.

Results: Participants saw themselves as the main actors in their life stories even although professional support was one of the important factors in the change to a sober life style. The group mentioned different causes of substance problems such as adverse childhood experiences and loss of stable life patterns; a variety of reasons for seeking treatment, here “turning points” as keeping job and support from others; and different strategies to avoid relapses such as avoiding places where there was alcohol, being frank about their alcohol problems, focusing on one day at a time, attending AA meetings, avoiding romanticizing about alcohol, and participating in new activities and in a government-controlled personal savings program.     

Sex,drugs, & rurality: A brief qualitative analysis of rural gay and bisexual men’s substance use sex expectancies

Background: One well documented reason that individuals use alcohol and drugs is the belief that these substances will increase satisfaction of a sexual experience or somehow otherwise enhance the sexual experience. However, the unique experiences of MSM residing in rural areas are not well represented in the scientific literature.

Methods: We conducted 40 interviews with individuals who identified as a man who has sex with men and lived in rural areas in Oklahoma, a primarily rural and socio-politically conservative state in the United States. Data collection continued until thematic saturation was reached.

Results: Three main substances (and themes) were identified by participants: 1) marijuana (focus on the experience/person), alcohol (more open/playful and reduces anxiety), and methamphetamines (stamina and arousal).

Conclusions: While the themes for alcohol and methamphetamines were in line with previous research, this is one of the first studies to identify the sex expectancies of marijuana of increasing the ability to focus on the sexual experience and/or the partner. Taken together, participants endorsed some type of positive substance use sex expectancies. These results highlight the importance of accounting for substance use sex expectancies when developing interventions to reduce substance use and risky sexual behaviors.     

Nursing Consultation in a Public Bathhouse: A Community Resource for the Vulnerable Population in a European Capital

Background: In Portugal’s capital, Lisbon, there are 19 public showers (PS) attended by a vulnerable population.

Aim: To describe the assessment and interventions performed during nursing consultations.

Method: This is a quantitative, observational, and cross-sectional study.

Findings: In a convenience sample of 77 users, 52% are females, 43% are single, 52% do not possess any economic resources, 87% have mental health issues, and 32% are homeless. The main nursing focuses found were: arterial hypertension, disease management skills, and emotional suffering. The most used nursing intervention is listening, followed by the expression of feelings, valuing the individual and his/her story, analyzing causes, providing support, and comforting.

Conclusions: This study shows that the main focus of the nursing care in these facilities is the human being. The respect for individuality and dignity was the primary concern, in an attempt to empower the individual to better manage his/her health and illness processes.