A crise mundial de uso de opióides em dor crônica não oncológica: causas e estratégias de manejo e relação com o Brasil / The world crisis of use of opioids in non-oncological chronic pain: causes and management strategies and relationship with Brazil

Introdução: O aumento no número de prescrições de opioides para tratamento de dor crônica não oncológica (DCNO) dispensadas por farmácias americanas, combinado com maior dosagem e tempo de uso, resultou em desvios, uso indevido, e aumento da mortalidade por overdose, gerando uma crise de consumo com repercussões em todo o mundo. Objetivo:, Avaliar causas e consequências da crise e estratégias de mitigação, opióides mais prescritos e fornecer informações sobre o uso no Brasil e possíveis impactos da crise no país. Metodologia: É um trabalho de revisão bibliografia, construído a partir de artigos já elaborados encontrados em bibliotecas digitais como Pub Med,Google Scholar e Citeseer Library , bem como nos sites governamentais como o World Drug Report. Resultados: Os Estados Unidos vivem uma crise de superprescrição de opioides com alto índice de mortalidade; a Europa e a Oceania ocupam segundo e terceiro lugar, enquanto alguns países em subdesenvolvimento da África, América do Sul e Ásia vivem uma crise oposta, a carência de acesso a opioides para manejo da DCNO. No Brasil houve um aumento de mais de 700% na prescrição de opióides entre 2009 e 2015, com a codeína sendo o opióide mais vendido (9%). Conclusão: A crise de opióide é multifatorial, iniciando com conceitos equivocados sobre não haver alto risco para desenvolvimento de dependência química, a disseminação da importância do tratamento da dor, expansão do seguro para medicamentos para população geriátrica, e promoção da prescrição de opióides pelas indústrias farmacêuticas. A epidemiologia do uso de opióides no Brasil não está bem documentada, com taxas de prescrição bem inferiores às da América do Norte, sendo a codeína o opióide mais prescrito. Políticas públicas adequadas, mais intensivo treinamento dos prescritores sobre uso de opióides e triagem adequada de pacientes podem equilibrar o uso e minimizar as consequências do consumo excessivo e carência de opióides para DCNO

A social and ecological assessment of tropical land uses at multiple scales: the Sustainable Amazon Network

Science has a critical role to play in guiding more sustainable development trajectories. Here, we present the Sustainable Amazon Network (Rede Amazonia Sustentavel, RAS): a multidisciplinary research initiative involving more than 30 partner organizations working to assess both social and ecological dimensions of land-use sustainability in eastern Brazilian Amazonia. The research approach adopted by RAS offers three advantages for addressing land-use sustainability problems: (i) the collection of synchronized and co-located ecological and socioeconomic data across broad gradients of past and present human use; (ii) a nested sampling design to aid comparison of ecological and socioeconomic conditions associated with different land uses across local, landscape and regional scales; and (iii) a strong engagement with a wide variety of actors and non-research institutions. Here, we elaborate on these key features, and identify the ways in which RAS can help in highlighting those problems in most urgent need of attention, and in guiding improvements in land-use sustainability in Amazonia and elsewhere in the tropics. We also discuss some of the practical lessons, limitations and realities faced during the development of the RAS initiative so far.Keywords: Social–ecological systems, Tropical forests, Land use, Interdisciplinary research, Sustainability, Trade-off

Tumor growth activity of duloxetine in Ehrlich carcinoma in mice

Abstract Objective The objective of this study was to analyze whether duloxetine influences tumor growth in Ehrlich carcinoma. The mice were administered 5 or 30 mg/kg of duloxetine or saline solution. All animals were inoculated with tumor cells. The tumor progression was evaluated by body weight, abdominal circumference, ascites volume and tumor cell count. The effect of duloxetine on immune response was evaluated by lymphoid cells, nitric oxide (NO) production, arginase and superoxide dismutase (SOD) activity and the spleen immunophenotyping. Results There was no difference between the groups regarding weight, abdominal circumference, ascites volume and number of tumor cells. Duloxetine increased the cells of the inguinal lymph node. There was no difference in the number of cells in the bone marrow and spleen. Ascites SOD activity was greater in Duloxetine groups. There were no differences in the levels of NO, nitrite, and arginase. The number of antibody for CD3 (CD3+), CD4+, CD8+ and CD28+ cells was lower in the duloxetine groups. In conclusion, duloxetine has no direct effect on tumor growth and does not alter immunity. The drug increased the SOD that fights free radicals and led the migration of lymphocytes, suggesting that duloxetine could be used in tumor-bearing individuals

Tampa Scale for Kinesiophobia in chronic neck pain patients (TSK-neck): structural and construct validity and reliability in a Brazilian population

Abstract Background To date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain. Methods We included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach’s alpha to assess internal consistency, and ceiling and floor effects. Results The study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains (“somatic focus” and “activity avoidance”) and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach’s alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed. Conclusion The TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain