Malaria outbreak in users of injectable drugs

An outbreak of Plasmodium vivax malaria among drug addicts in Bauru, S. Paulo State, Brazil, is reported. Until July 1989, 12 cases had been confirmed by thick smear examinations and 20 contacts were being investigated. All of them reported frequent use of intravenous cocaine and sharing of needles and syringes but deny having travelled through endemic malarial areas.     

Characterization of the crack cocaine culture in the city of São Paulo: a controlled pattern of use

OBJECTIVE: To characterize the situation regarding crack cocaine use in the city of S?o Paulo, along with the sociodemographic profile of its users. METHODOLOGICAL PROCEDURES: Qualitative ethnographic study carried out with an intentional sample of crack cocaine users (n=45) and former users (n=17). The participants were recruited by means of the chain sampling method and they underwent a semi-structured interview guided by a questionnaire, in 2004 and 2005. The combination of each question and its respective responses gave rise to specific reports that were interpreted individually. ANALYSIS OF THE RESULTS: The predominating profile of the crack cocaine users was that they were single young men of low socioeconomic class and low schooling level, without formal employment ties. The pattern of use most frequently cited was compulsive, characterized by multiple drug use and carrying out illegal activities in exchange for crack cocaine or money. However, controlled use was also identified. This consisted of non-daily use of crack cocaine mediated by individual factors that were developed intuitively by the user. Controlled use was similar in nature to the strategies adopted by former users to achieve a state of abstinence. CONCLUSIONS: The culture of crack cocaine use has undergone changes regarding the pattern of use. Although most users do so compulsively, the existence of controlled use was observed. This deserves to be investigated in more detail, particularly with regard to the strategies adopted to attain this.     

Drug abuse prevalence among secondary school students in São José do Rio Preto, São Paulo State, Brazil

This study investigates the prevalence of drug consumption among secondary school students in S?o José do Rio Preto, S?o Paulo State, Southeast Brazil, and its distribution in relation to gender and grade in school. A cross-sectional survey was carried out in S?o José do Rio Preto. A self-applied questionnaire was answered by a proportional sample of 1,041 teenagers enrolled in 9th, 10th, and 11th grades in public schools. Lifetime consumption of psychoactive substances was: alcohol 77%, tobacco 28.7%, solvents 18.1%, marijuana 12.1%, amphetamines 3.7%, cocaine 3.3%, hallucinogens 3.1%, and crack 1.4%. Weekly use of marijuana was the highest (2.8%), followed by solvents (1.3%). Males consumed more alcohol, marijuana, cocaine, and crack than females. Nighttime use of tobacco, marijuana, cocaine, and hallucinogens was observed. In the present study, prevalence of psychoactive substance use was observed in S?o José do Rio Preto at rates similar to those found in other Brazilian studies.     

Assessment of the promotion of breastfeeding in public and private maternities of S?o Paulo city, Brazil]

OBJECTIVE: The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) carried out a study to compare and evaluate the practices of protecting, promoting and supporting breastfeeding in public and private hospitals using the "ten steps" of the Hospital Initiative (BFHI) as a reference parameter. METHODS: Forty-five hospitals of the municipality of S?o Paulo participated in the study. Data on the practices of infant feeding were collected by interviewing nurseries' supervisors of all public hospitals (26), and from a random sample of private hospitals (19), corresponding to a third of the total, during the years 1996-1997. RESULTS: More than a quarter of the public hospitals and more than one third of the private hospitals did not comply with any of the BFHI steps. Seven of the "ten steps" were observed in only two public hospitals. In general, practices of protection, promotion, and support of breastfeeding were seen at a higher frequency in public hospitals. CONCLUSIONS: The present study shows that practices considered detrimental to the onset and progressing of breastfeeding - unnecessary separation of the mother and her newborn, restrictions regarding the length of time and frequency of breastfeeding, use of pre-lacteal foods and supplements - are still quite frequently observed in public and private hospitals within the city of S?o Paulo. Given the benefits of breastfeeding for both the mother's and their children's health, and the important role maternities play for an early and successful onset of breastfeeding, it is paramount that the BFHI patterns be adopted by hospitals within the municipality of S?o Paulo.     

Characteristics of heroin and cocaine users unknown to treatment agencies. Results from the Swiss Hidden population study

The aim of this study was to compare the characteristics of heroin or cocaine users who are not in contact with drug-treatment agencies in Switzerland to the characteristics of a group who are in treatment. A sample of 917 users of heroin and/or cocaine was recruited outside treatment settings by 31 Privileged Access Interviewers. Respondents were divided into a study group of 512 heroin and/or cocaine users not following any treatment, and a control group of 238 users who were following treatment. Respondents in the no-treatment group use drugs less frequently, are less likely to inject drugs, have a more social pattern of use and more often have the impression of controlling their drug use. They have less contact with the legal system and the police, are in a better social situation and more often perceive themselves to be in good health. In both groups, respondents whose main drug of use is heroin generally have a more problematic pattern of use than those who use mainly cocaine. There are no significant differences between the two groups regarding present HIV-risk behaviour and prevention. The data show no significant association between the duration of use of heroin or cocaine and signs for problem use. These findings support the hypothesis that drug users not in treatment and drug users in treatment are two distinct populations, in terms of profile of drug use and prevalence of social or health problems that are associated to it.     

Crack usage circuits in the downtown area of the city of São Paulo (SP, Brazil)

Although drug usage has been prevalent since the dawn of humankind, drug abuse has currently escalated alarmingly and can be characterized as a public health problem. The spread of "crack," a drug derived from cocaine paste, is worsening the situation by aggravating the social damages and harming the health of users. An ethnographic study was conducted in downtown S?o Paulo, SP (Brazil) in locations where crack is sold and used in order to establish the impact of the spread of this drug in the daily life of users. A field diary was used to record the observations and informal dialogues with the people who circulate in the location under scrutiny. The results of this study show the circuits covered by the users, their dynamics and the complex relationships with other social players, based on permanent tension, involving the practice of violence in which the users are both victims and perpetrators. The study also suggests the importance of other factors such as the history of the region in question, the public policies, economic questions and the lack of social investments and public health. It is suggested that the advanced degree of degradation of the region researched is not only the result of the people and activities practiced in the area, but also mainly of the urban process that led to such a social scenario.     

Cost of schizophrenia: direct costs and use of resources in the State of São Paulo

OBJECTIVE: To estimate the direct costs of schizophrenia for the public sector. METHODS: A study was carried out in the state of S?o Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS: Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US $191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS: Most schizophrenia patients in the state of S?o Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.     

Situations related to drug misuse in public schools in the city of São Paulo, Brazil

OBJECTIVE: To explore situations, attitudes and behavior of public elementary school education supervisors concerning psychoactive substance misuse. METHODS: The study was carried out in the city of S?o Paulo, Southeastern Brazil, in 2002. Data were collected using a semi-structured questionnaire applied to eight key informants in the administrative area experienced in education supervision. Qualitative content analysis with ethnographic reference was conducted. RESULTS: Most discourses show that knowledge transmission is thought as essential for drug use prevention, though supervisors reported being ill-informed on this subject. The most frequent attitudes toward drug users are impotence and inability to act and sometimes a repressive attitude. These are motivated by misinformation and fear due to mistaken association of drug users and criminals. In situations indirectly related to drug abuse (family and behavior problems) more understanding and inclusive attitudes are reported, following the harm reduction paradigm. CONCLUSIONS: Theoretical capacity building of educators for preventive attitudes would support their skills developed through dealing with situations (in)directly related to drug abuse in schools. Thus, educators would feel more confident to make interventions for harm or risk reduction among drug users.     

Forthcoming study says 3 of 4 new HIV infections are drug-related

According to an unpublished study by the Centers for Disease Control and Prevention (CDC), drug use is linked to nearly three-quarters of new HIV infections. Many of the infections are a result of sharing contaminated needles, but an increasing number are linked to crack cocaine addicts and other drug users who contract HIV through unprotected sex and pass the virus on to others the same way. According to researcher Dr. Scott Holmberg, as many as half of the new infections among heterosexuals are a result of crack cocaine use. Holmberg's findings present a different picture of the epidemic from what the CDC's AIDS caseload reports show. CDC statistics show that roughly half of the people diagnosed with AIDS in 1994 were gay or bisexual men, including some who injected drugs. Injection drug use among heterosexuals was the second largest category. However, those figures reflect infections that occurred perhaps eight or ten years ago. Holmberg's data and analyses involve new infections, those that took place in 1994. Researchers and activists speculate that the study could alter government policies on preventing HIV and drug abuse.     

Remission from drug abuse over a 25-year period: patterns of remission and treatment use.

OBJECTIVES: Using an epidemiologically obtained sample, we examined patterns of illicit drug use, abuse, and remission over a 25-year period and recent treatment use. METHODS: The surviving members of the cohort (n = 841), previously surveyed in 1972 and 1974, comprised 3 subsamples of Vietnam War enlisted men and civilian controls. Retrospectively obtained year-to-year measures from the 1996-1997 survey included use and remission of sedatives, stimulants, marijuana, cocaine, and opiates, as well as substance abuse and psychiatric treatment use. RESULTS: Relatively stable patterns of frequent use in adulthood were found, with the mean duration from initiation to the last remission ranging from 9 to 14 years. A majority attempted to quit; however, most did not use traditional drug treatment in their last attempts. Fewer than 9% of the then-current drug users were treated in inpatient or outpatient settings at the time of data collection. CONCLUSIONS: Most drug abusers who had started using drugs by their early 20s appeared to gradually achieve remission. Spontaneous remission was the rule rather than the exception. Nonetheless, considerable unmet needs existed for those who had continued use into middle age.     

Prevalence of tobacco use in individuals with severe mental illnesses, São Paulo, Brazil

OBJECTIVE: To analyze the prevalence of cigarette smoking in individuals with severe mental illnesses in a large urban centre of a middle income country. METHODS: Cross-sectional study carried out in S?o Paulo. The sample (N=192) comprised individuals diagnosed with severe mental illnesses who had contact with public psychiatric care services from September to November 1997 and were aged between 18 and 65 years. Prevalence of daily tobacco smoking in the 12 months previous to the interview and characteristics associated were studied. RESULTS: Out of 192 subjects with severe mental illnesses interviewed, 115 (59.9%; 95% CI: 52.6%; 66.9%) reported smoking cigarettes on a daily basis. Male gender, marital status separated or widowed, irregular use of neuroleptic drugs and history of ten or more psychiatric admissions were independently associated with cigarette smoking. CONCLUSIONS: The prevalence of cigarette smoking in the present sample was higher than that found in the general Brazilian population. Mental care services should implement non-smoking policies and mental health providers need to help patients with severe mental illness who want to quit smoking.     

Concurrent use of alcohol and cocaine: differences in patterns of use and problems among users of crack cocaine and cocaine powder

AIM: To investigate differences in alcohol and drug consumption behaviours and related problems among users of cocaine powder versus crack cocaine. METHODS: The sample of concurrent users of alcohol and cocaine (n = 102) was recruited from clinical and community (non-clinical) settings in London. Those recruited in the community were contacted by means of snowball sampling methods. Data were collected by means of face-to-face structured interviews. RESULTS: Heavy drinking was common. There were differences in alcohol consumption between users of cocaine powder and crack cocaine. Cocaine powder users reported more frequent heavy drinking than crack users. Heavy drinking often involved drinking excessive amounts over prolonged periods. Crack cocaine users reported more serious problems associated with cocaine, other illicit drugs, psychological and physical health problems, and acquisitive crime. CONCLUSIONS: Frequent heavy drinking represents a serious risk to the health of many cocaine users. The differences in alcohol consumption patterns confirm the importance of distinguishing between use of cocaine powder and crack cocaine. Few of the sample had received treatment for cocaine or alcohol problems. Healthcare professionals working in primary care or accident and emergency settings may need to be trained to detect, assess, and respond to concurrent alcohol and cocaine problems.     

Sexual risk for hepatitis B virus infection among hepatitis C virus-negative heroin and cocaine users

Hepatitis C virus (HCV) and hepatitis B virus (HBV) are highly prevalent, often co-occurring infections among drug users. We examined HBV prevalence and risk behaviour patterns among a group of HCV-negative heroin and/or cocaine users in order to understand HBV risk and prevention opportunities among this unique group. Of 164 people enrolled, 44% had injected drugs. Overall, 24% of participants tested positive for exposure to HBV; drug injectors (28%) were only slightly and not significantly (P=0.287) more likely to test positive than those who had never injected drugs (21%). HBV exposure was significantly associated with multiple indicators of greater sex risk. HBV status was not associated with any demographic characteristic, but participants who reported longer duration of cocaine use were significantly less likely to test positive to exposure for HBV. It appears that HBV risk among HCV-negative drug users in this cohort is primarily due to sexual behaviour.     

Capture-recapture estimates of problem drug use and the use of simulation based confidence intervals in a stratified analysis

STUDY OBJECTIVE: To establish the prevalence of problem drug use in the 10 local authorities within the Metropolitan County of Greater Manchester between April 2000 and March 2001. SETTING AND PARTICIPANTS: Problem drug users aged 16-54 resident within Greater Manchester who attended community based statutory drug treatment agencies, were in contact with general practitioners, were assessed by arrest referral workers, were in contact with the probation service, or arrested under the Misuse of Drugs Act for offences involving possession of opioids, cocaine, or benzodiazepines. DESIGN: Multi-sample stratified capture-recapture analysis. Patterns of overlaps between data sources were modelled in a log-linear regression to estimate the hidden number of drug users within each of 60 area, age group, and gender strata. Simulation methods were used to generate 95% confidence intervals for the sums of the stratified estimates. MAIN RESULTS: The total number of problem drug users in Greater Manchester was estimated to be 19 255 giving a prevalence of problem drug use of 13.7 (95% CI 13.4 to 15.7) per 1000 population aged 16-54. The ratio of men to women was 3.5:1. The distribution of problem drug users varied across three age groups (16-24, 25-34, and 35-54) and varied between the 10 areas. CONCLUSIONS: Areas in close geographical proximity display different patterns of drug use in terms of prevalence rates and age and gender patterns. This has important implications, both for future planning of service provision and for the way in which the impact of drug misuse interventions are evaluated.     

Do Supervised Injecting Facilities Attract Higher-Risk Injection Drug Users?

BACKGROUND: In Western Europe and elsewhere, medically supervised safer injection facilities (SIFs) are increasingly being implemented for the prevention of health- and community-related harms among injection drug users (IDUs), although few evaluations have been conducted, and there have been questions regarding SIFs' ability to attract high-risk IDUs. We examined whether North America's first SIF was attracting IDUs who were at greatest risk of overdose and blood-borne disease infection. METHODS: We examined data from a community-recruited cohort study of IDUs. The prevalence of SIF use was determined based on questionnaire data obtained after the SIF's opening, and we determined predictors of initiating future SIF use based on behavioral information obtained from questionnaire data obtained before the SIF's opening. Pearson's chi-square test was used to compare characteristics of IDUs who did and did not subsequently initiate SIF use. RESULTS: Overall, 400 active injection drug users returned for follow-up between December 1, 2003 and May 1, 2004, among whom 178 (45%) reported ever using the SIF. When we examined behavioral data collected before the SIF's opening, those who initiated SIF use were more likely to be aged <30 years (odds ratio [OR]=1.6, 95% confidence interval [CI]=1.0-2.7], p=0.04); public injection drug users (OR=2.6, 95% CI=1.7-3.9, p<0.001); homeless or residing in unstable housing (OR=1.7, 95% CI=1.2-2.7, p=0.008); daily heroin users (OR=2.1, 95% CI=1.3-3.2, p=0.001); daily cocaine users (OR=1.6, 95% CI=1.1-2.5, p=0.025); and those who had recently had a nonfatal overdose (OR=2.7, 95% CI=1.2-6.1, p=0.016). CONCLUSIONS: This study indicated that the SIF attracted IDUs who have been shown to be at elevated risk of blood-borne disease infection and overdose, and IDUs who were contributing to the public drug use problem and unsafe syringe disposal problems stemming from public injection drug use.     

Philanthropic general hospitals: a new setting for psychiatric admissions

OBJECTIVE: To understand the process that led Brazilian philanthropic general hospitals to implement psychiatric units and to describe the main characteristics and therapeutic approaches of these services. METHODS: Ten institutions in three Brazilian states (Minas Gerais, S?o Paulo e Santa Catarina) were assessed in 2002. Forty-three semi-structured interviews were carried out with health professionals who worked at the hospitals to collect data on service implementation process, therapeutic approaches and current situation. The interviews were audio-recorded and their content was analyzed. RESULTS: There was no mental hospital in the cities where the institutions were located. In five hospitals, psychiatric patients were admitted to general medical wards because there was no psychiatric unit. The therapeutic approach in six hospitals was based on psychopharmacological treatment. Due to lack of resources and more appropriate therapeutic planning, the admission of patients presenting psychomotor agitation increases resistance against psychiatric patients in general hospitals. Financial constraints regarding laboratory testing is still a challenge. There is no exchange between local authorities and hospital administrators of these institutions that are compelled to exceed the allowed number of admissions to meet the demand of neighboring cities. CONCLUSIONS: The need for mental health care to local populations combined with individual requests of local authorities and psychiatrists made possible the implementation of psychiatric units in these localities. In spite of the efforts and flexibility of health professional working in these institutions, there are some obstacles to be overcome: resistance of hospital community against psychiatric admissions, financial constraints, limited professional training in mental health and the lack of a therapeutic approach that goes beyond psychopharmacological treatment alone.     

Needle sharing and participation in the Amsterdam Syringe Exchange program among HIV-seronegative injecting drug users.

To enhance the prevention of human immunodeficiency virus infection, factors related to regular participation in the Amsterdam Syringe Exchange and the borrowing of syringes were studied in 131 HIV-seronegative injecting drug users in a 1989-90 survey. A total of 29 percent of the users reported borrowing syringes, that is injecting drugs at least once in the past 4-6 months with a needle or syringe previously used by someone else. Users at increased risk of borrowing are previous borrowers, long term moderate-to-heavy alcohol users, current cocaine injectors, and drug users without permanent housing. Regular clients of the syringe exchange, when compared with other injecting drug users, were found more often to be frequent, long term injectors. They borrowed slightly less often than other users, but this was not statistically significant, even after controlling for frequency of injecting or other potential confounders. The results suggest that, 5 years after the start of the Amsterdam Syringe Exchange, drug use characteristics govern an individual injecting drug user's choice of exchanging or not exchanging syringes. The conclusion is that it seems more important to direct additional preventive measures at injecting drug users with an increased risk of borrowing rather than at users who do not participate in the syringe exchange or who do so irregularly.