Treatments for people who use anabolic androgenic steroids: a scoping review.

BACKGROUND: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems. METHODS: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible. RESULTS: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided. CONCLUSION: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health- or drug-related journals, will support development of the evidence base

Fisioterapia e saúde coletiva: desafios e novas responsabilidades profissionais Physiotherapy and collective health: challenges and new professional responsibilities

O fisioterapeuta vem destinando sua atenção, quase que exclusivamente, à cura de doentes e à reabilitação de sequelados. No entanto, o novo perfil epidemiológico e a nova lógica de organização do sistema de saúde sugerem a reestruturação das práticas profissionais e a redefinição do campo de atuação do fisioterapeuta. Neste sentido, esse artigo tem por objetivo discutir a reorientação do campo de atuação profissional da fisioterapia e novas possibilidades de atuação no SUS. Inicialmente, realiza-se um debate sobre as transições demográfica, nutricional e epidemiológica e as novas demandas profissionais diante dos novos modelos assistenciais. Tomando como referência o modelo de Vigilância em Saúde e a atenção básica como eixo de reestruturação do sistema de saúde, evidencia-se a necessidade de superação da reabilitação como único nível de atuação profissional e apresenta-se o modelo da fisioterapia coletiva como instrumento para reorientação da atuação do fisioterapeuta. Por fim, apresentam-se algumas possibilidades de atuação do fisioterapeuta na atenção básica e no âmbito coletivo.<br>The physiotherapist is destining its attention almost exclusively on the cure of patients and their rehabilitation. However, the new epidemic profile and the new logic of organization of the health system suggest the restructuring of this professional practices and the re-definition of the field of the physiotherapist's performance. In this sense, this article aims to discuss the reorientation of the field of the physiotherapy professional performance and the new possibilities of acting at the Unified Health System (SUS). The article starts with a debate about the demographic, epidemiological and nutrition transitions and the new professional demands before the new attendance models. Taking as reference the model of health surveillance and the primary attention as a restructuring axis of the health system, it is highlighted the overcome of the rehabilitation as only level of professional performance and showed the collective model of the physiotherapy as an instrument of reorientation of the physiotherapist's performance. Finally, it is presented some possibilities of the physiotherapist's performance in the basic attention and in the collective ambit