Marcelo Santos Cruz

Introdução: Expressões informais como “beber socialmente” e “alcoolismo” estão presentes nas consultas da atenção primária à saúde (APS). Buscamos compreender como a percepção cultural destes profissionais interfere no cuidado, incluindo suas normas descritivas e injuntivas que embasam suas atitudes e intervenções. Metodologia: A metodologia utilizada foi a análise de conteúdo. Entrevistamos 33 profissionais de nível superior da APS no município do Rio de Janeiro por questionário semiestruturado com perguntas sobre “beber socialmente” e “alcoolismo”. Resultados: Os entrevistados percebem “beber socialmente” como consumo de baixa frequência/quantidade, com amigos e família, sem perder o controle e “alcoolismo” como uso grave e problemático. A confiança normativa dos profissionais no “beber socialmente” prejudica investigar aprofundadamente o uso de álcool. A gravidade associada ao “alcoolismo” reforça estigma e dificulta intervenções precoces. Conclusão: Estes termos culturais atravessam a prática clínica, porém são imprecisos e prejudiciais. Capacitações para abordagem ao uso de álcool devem incluir aspectos culturais.

Trata-se de um estudo qualitativo, de caráter descritivo, com o objetivo de refletir sobre o atendimento às famílias com relatos de uso de substâncias psicoativas, a partir da experiência obtida em um serviço público de saúde mental, dos registros do diário de campo e das observações dos atendimentos realizados no período de 2023 a 2024. Os resultados indicam que o uso de substâncias se expressa como fenômeno sistêmico atravessado por dinâmicas familiares e relacionais que ora fortalecem o enfrentamento ao sofrimento psíquico, ora o aprofundam. A terapia de família mostrou-se um dispositivo potente para ampliar o cuidado, deslocando o foco exclusivo do indivíduo consumidor. Conclui-se que a inclusão da família no tratamento favorece práticas de cuidado mais integradas no campo da saúde mental.

Resumo Objetivo: Discutir a possível função de insumo das práticas artísticas e culturais no contexto da Redução de Danos (RD). Métodos: Pesquisa etnográfica desenvolvida no Ponto de Cultura do Centro de Convivência "É de Lei”, localizado em São Paulo-SP, em dois momentos: no primeiro, em outubro de 2016, realizou-se observação participante das atividades artísticas e culturais. No segundo, em novembro de 2016, realizaram-se entrevistas semiestruturadas com profissionais e frequentadores. O estudo identificou e descreveu práticas artísticas e culturais, bem como investigou suas possíveis relações com os insumos em RD na produção do laço social. A análise e a discussão dos dados foram embasadas por conceitos na interface entre a Saúde Coletiva e a Psicanálise. Resultados e Discussão: A pesquisa caracterizou o insumo em RD como promotor de vínculo entre o toxicômano e quem o oferta, com potencial para deslocar o sujeito da relação solitária estabelecida com a substância na direção dos laços sociais que possibilitam exercer sua condição de sujeito singular na cultura. Conclusão: O estudo considerou que as práticas artísticas e culturais podem exercer a função de insumos em RD no que concerne ao estabelecimento de laços sociais.

Objective: To discuss the possible input function of artistic and cultural practices in the context of Harm Reduction (HR). Methods: Ethnographic research developed at the Ponto de Cultura of the Centro de Convivência "É de Lei", located in São Paulo-SP, which took place in two moments: in the first, in October 2016, participative observation of artistic and cultural activities was carried out. In the second, in November 2016, semi-structured interviews were carried out with professionals and regulars. The study identified and described artistic and cultural practices, as well as investigated their possible relationships with HR inputs in the production of the social bond. The discussion of the data was based on concepts at the interface between public health and psychoanalysis. Results and Discussion: The research characterized the input in HR as a promoter of a bond between the drug addict and whoever offers it with the potential to divert the subject from the established solitary relationship with the substance towards the creation of social ties that stimulates the exercise of their condition as a singular subject in culture. Conclusion: The study concluded that artistic and cultural practices can play the role of inputs in HR with regard to the establishment of social bonds.

Background: Agile, accessible and cheap diagnosis of hepatitis C virus (HCV) infection is essential to achieve the elimination of this infection, worldwide, as mandated by the World Health Organzation as part of its strategy for 2030. Dried blood spots (DBS) can be an attractive alternative for sample collection among people living in remote areas and vulnerable populations due to the less invasive collection, its biosafety, and storage & transportation of samples at room temperature. Design: This study aims to estimate the usefulness of dried blood spot samples for the diagnosis and the assessment of HCV infection rates in three different settings in Brazil. Cross-sectional analysis of a sample collection from different populations, aiming to assess the performance of the testing algorithms and respective procedures among different populations with diverse background infection rates. Methods: We reported the evaluation of DBS as alternative samples for detecting anti-HCV in different groups in real life conditions: (I) Vulnerable subjects living in remote areas of Southeast, North and Northeast Brazil (n = 1464); (II) Beauticians (n = 288); (III) People who use non-injectable drugs (n = 201); (IV) patients referred to outpatient care (n = 275). Results: General assay accuracy was 99%, with a weighted kappa value of 0.9, showing an excellent performance. Sensitivities ranged from 87.5% to 100.0% between groups and specificities were above 99.2%. A total of 194 individuals had HCV RNA in serum and concordance of anti-HCV detection in DBS was 98.4%. Conclusions: DBS samples could be used for anti-HCV detection in different populations recruited in real life conditions and ambulatory settings, with a high overall sensitivity and specificity.

Objective Evaluate the association between levels of mindfulness and sociodemographic characteristics and pattern of drug use of individuals seeking treatment in a University Service Specialized in Substance Use Disorders. Methods This is a cross-sectional study with 164 individuals over 18 years of age seeking treatment for the use of psychoactive substances in the June 2018-December 2019 period, using a questionnaire for sociodemographic data, the Mindful Attention Awareness Scale (MAAS) self-reporting instrument, and the Alcohol, Smoking, and Substance Involvement Screening Test. Results An association was found between low levels of mindfulness mainly with the individual risk of being a medium/high-risk user of sedative-hypnotic drugs (p = 0.020). A borderline association was also found between MAAS and the risk of the individual being a medium/high risk of alcohol (p = 0.053) and with a more severe pattern of substance use (p = 0.065). Conclusion Individuals seeking treatment for substance use presented impairments in the attentional aspect of mindfulness and levels of mindfulness seem to protect against behaviors related to substance use, especially against the use of high/moderate risk of sedative-hypnotics.

The use of androgenic‐anabolic steroids (AAS) can be associated with psychiatric symptoms such as insomnia, anxiety and increased aggressiveness. Although dose‐dependent effects have been observed in some controlled studies, this association is not always seen in the ecological use of AAS. This study utilized WADA's steroid profile of suspicious use of AAS, urinary detection of AAS metabolites and measurement of sexual hormones to confirm recent use of AAS in a cohort of 103 bodybuilders (75 males, 28 females). The majority of participants (61.2%) presented symptoms of agitation, insomnia, increased aggressiveness or depression in the last 3 months. About one‐third of participants presented scores on the HAM‐A anxiety scale equivalent to moderate to severe symptoms of anxiety. A minority of participants (12.6%) presented high to moderate scores on the BPQ aggressiveness scale. The majority of participants (73.8%) presented hyperthymic temperament in the BRIEF‐TEMPS scale. There was no significant difference in the presence of psychiatric symptoms between males and females and no association between psychiatric symptoms and estimated weekly doses of AAS. A negative association was observed between scores on the BPQ scale (verbal aggression, anger and total score) and the time of AAS use. We discuss differences of AAS use between male and female bodybuilders and the screening of AAS use in the general population. Our findings highlight the importance of mental health awareness among people using AAS.

The COVID-19 pandemic in Brazil has caused a scenario of extreme social vulnerability, with high unemployment rates and severe cuts to social benefits and policies. Aims: analyze the impacts of the pandemic on the mental health and quality of life on people living in contexts of high-levels of armed and lethal violence and social fragility. Methods: A longitudinal cohort study was undertaken with a convenient sample of fifty individuals who live in 16 favelas in Rio de Janeiro (Brazil) before and during the COVID-19 pandemic. The interviews included enquired about the respondent’s capacity to cope with the pandemic and their access to services as well as questions about mental health (Brief Symptoms Inventory), and Quality of Life (Manchester Short Assessment of Quality of Life). Results: The results revealed a decrease in the somatization dimension of the BSI scale and a worsening on the objective index (SIX) of quality of life. Mental health distress increased more in the male group when compared to the female group during the COVID-19 pandemic. It seems likely; therefore, the COVID-19 pandemic presents a major challenge for people living in a context of urban violence and social deprivation. Conclusions: The worsening of mental distress and quality of life during the pandemic impacts both genders and suggests the need for policies directed to health and employment protection.

Objetivo: Identificar e analisar as formas de tratamento direcionadas as mulheres usuárias de crack apresentadas na literatura. Método: Revisão bibliográfica, do tipo revisão integrativa da literatura, com base em produções científicas disponíveis em: BVSpsi, Pepsic, Socindex e Pubmed. Selecionados 36 estudos qualitativos e de campo, com mulheres usuárias de crack como sujeitos do estudo. Resultados: O estigma foi a principal barreira para o tratamento. Indica-se que seja adotada a perspectiva de gênero no tratamento das usuárias de crack e a inclusão da família pode amenizar conflitos e favorecer ações de cuidado. Ressalta-se a menção das salas de uso como um fator de proteção contra as diversas situações de violência presentes no território. Conclusão: É fundamental incluir questões relativas ao feminino na definição das formas de tratamento destinadas as mulheres usuárias de crack. Este artigo pode indicar lacunas nas pesquisas de campo que precisam ser aprofundadas e ampliadas para outras realidades.