Filhos de dependentes químicos com fatores de risco bio-psicossociais: necessitam de um olhar especial?

CONTEXTO: A dependência química tende a afetar a família como um todo. Filhos de dependentes químicos têm um risco aumentado para o desenvolvimento da dependência química, bem como para transtornos psiquiátricos, quando comparados com outras crianças. OBJETIVO: Investigar o perfil de crianças, adolescentes e familiares em um serviço de prevenção seletiva para filhos de dependentes químicos e discutir alternativas de intervenção e tratamento para essa população. Tipo de estudo: corte transversal. AMOSTRA: serviço de prevenção seletiva, situado em um bairro da periferia da cidade de São Paulo, com 63 familiares, 54 crianças e 45 adolescentes. INSTRUMENTOS: dados sócio-demográficos; Procedimento de Desenhos de Família com Estórias - DF-E; Drug Use Screening Inventory (DUSI); Critérios de investigação sobre situações de estresse psicossocial vividas pela criança (CID 10, 1993); Self-Report Questionnaire SRQ-20; CAGE familiar. RESULTADOS: com relação ao perfil familiar, 67% pertencem à categoria socioeconômica D; na maioria das famílias o pai é o dependente químico (67%), tendo como substância de escolha o álcool (75%). O SRQ-20 detectou, em 59% dos cônjuges que não eram dependentes químicos, risco de distúrbios em saúde mental. Nas crianças, foi observada timidez e sentimento de inferioridade, depressão, conflito familiar, carência afetiva e bom nível de energia, que é indicativo de equilíbrio emocional e mental. Nos adolescentes, foi observado maior índice de problemas nas seguintes áreas do DUSI: desordens psiquiátricas, sociabilidade, sistema familiar e lazer/recreação. CONCLUSÃO: o artigo concluiu a necessidade de um serviço especializado de prevenção seletiva, dirigido a crianças, adolescentes e familiares afetados pela dependência química, uma vez que filhos de dependentes químicos representam um grupo de risco para o desenvolvimento de problemas bio-psicossociais.CONTEXT: Alcoholism and other drug addictions tend to run in the families. Children of addicted parents are more at risk of addiction and psychiatric disorders than other children. OBJECTIVE: The aim of this study was to investigate the profile of children, adolescents and families in a selective prevention service offered to the children of addicted parents, and to discuss alternatives for the assessment and treatment of this population. DESIGN: cross-sectional study. SETTING: Selective prevention service implemented in downtown district of São Paulo, with 63 parents, 54 children and 45 adolescents. MAIN MEASUREMENTS: Socio-demographic data, Procedimento de Desenhos de Família com Estórias - DF-E; Drug Use Screening Inventory (DUSI); Criteria about psychosocial stress situation in childhood; Self-Report Questionnaire SRQ-20; Family CAGE. RESULTS: Regarding to the family profile, 67% belongs to D level in socio-demographic data, with the majority of families studied having an addicted father (67%); alcohol was the most frequent substance used (75%). The SRQ-20 assessing 59% of mates, who are not addicted, with mental suffering. In children, it was observed shyness, inferiority feelings, depression, family conflict, need for warm-heartness and good level of energy that is level-headed in terms of emotional and mental areas. In adolescents, it was observed higher level of problems in DUSI areas: psychiatric disorder, social competency, family system, and leisure/recreation. CONCLUSIONS: The paper concluded the need of a specialized selective prevention service in children, adolescents and families affected by substance abuse considering that children of addicted parents are at risk of developing bio-psychosocial problems

Filhos de dependentes químicos com fatores de risco bio-psicossociais: necessitam de um olhar especial? Children of addicted parents with bio-psychosocial risk factors: do they need a special care?

CONTEXTO: A dependência química tende a afetar a família como um todo. Filhos de dependentes químicos têm um risco aumentado para o desenvolvimento da dependência química, bem como para transtornos psiquiátricos, quando comparados com outras crianças. OBJETIVO: Investigar o perfil de crianças, adolescentes e familiares em um serviço de prevenção seletiva para filhos de dependentes químicos e discutir alternativas de intervenção e tratamento para essa população. Tipo de estudo: corte transversal. AMOSTRA: serviço de prevenção seletiva, situado em um bairro da periferia da cidade de São Paulo, com 63 familiares, 54 crianças e 45 adolescentes. INSTRUMENTOS: dados sócio-demográficos; Procedimento de Desenhos de Família com Estórias - DF-E; Drug Use Screening Inventory (DUSI); Critérios de investigação sobre situações de estresse psicossocial vividas pela criança (CID 10, 1993); Self-Report Questionnaire SRQ-20; CAGE familiar. RESULTADOS: com relação ao perfil familiar, 67% pertencem à categoria socioeconômica D; na maioria das famílias o pai é o dependente químico (67%), tendo como substância de escolha o álcool (75%). O SRQ-20 detectou, em 59% dos cônjuges que não eram dependentes químicos, risco de distúrbios em saúde mental. Nas crianças, foi observada timidez e sentimento de inferioridade, depressão, conflito familiar, carência afetiva e bom nível de energia, que é indicativo de equilíbrio emocional e mental. Nos adolescentes, foi observado maior índice de problemas nas seguintes áreas do DUSI: desordens psiquiátricas, sociabilidade, sistema familiar e lazer/recreação. CONCLUSÃO: o artigo concluiu a necessidade de um serviço especializado de prevenção seletiva, dirigido a crianças, adolescentes e familiares afetados pela dependência química, uma vez que filhos de dependentes químicos representam um grupo de risco para o desenvolvimento de problemas bio-psicossociais.<br>CONTEXT: Alcoholism and other drug addictions tend to run in the families. Children of addicted parents are more at risk of addiction and psychiatric disorders than other children. OBJECTIVE: The aim of this study was to investigate the profile of children, adolescents and families in a selective prevention service offered to the children of addicted parents, and to discuss alternatives for the assessment and treatment of this population. DESIGN: cross-sectional study. SETTING: Selective prevention service implemented in downtown district of São Paulo, with 63 parents, 54 children and 45 adolescents. MAIN MEASUREMENTS: Socio-demographic data, Procedimento de Desenhos de Família com Estórias - DF-E; Drug Use Screening Inventory (DUSI); Criteria about psychosocial stress situation in childhood; Self-Report Questionnaire SRQ-20; Family CAGE. RESULTS: Regarding to the family profile, 67% belongs to D level in socio-demographic data, with the majority of families studied having an addicted father (67%); alcohol was the most frequent substance used (75%). The SRQ-20 assessing 59% of mates, who are not addicted, with mental suffering. In children, it was observed shyness, inferiority feelings, depression, family conflict, need for warm-heartness and good level of energy that is level-headed in terms of emotional and mental areas. In adolescents, it was observed higher level of problems in DUSI areas: psychiatric disorder, social competency, family system, and leisure/recreation. CONCLUSIONS: The paper concluded the need of a specialized selective prevention service in children, adolescents and families affected by substance abuse considering that children of addicted parents are at risk of developing bio-psychosocial problems

Motivação para a mudança do comportamento de beber: diferenças entre pacientes usuários de álcool do ambulatório de gastroenterologia e do serviço especializado no tratamento do alcoolismo

CONTEXT AND OBJECTIVE: For some patients who have developed significant alcohol-related physical disease, total abstinence from alcohol may offer the best chance of survival. The aim of this study was to investigate motivation for treatment in two groups of alcohol users: outpatients from the gastroenterology clinic and outpatients from the specialist alcohol treatment service. DESIGN AND SETTING: Cross-sectional study, at a federally funded public teaching hospital. METHODS: The sample studied was 151 outpatients from the gastroenterology clinic and 175 from the specialist alcohol treatment service. The interview was conducted in the outpatient clinics at the first appointment, and consisted of demographic questions and scales for measuring quality of life, alcohol dependence, pattern of alcohol, motivation for treatment and consequences of alcohol consumption. RESULTS: The results suggested that outpatients from the gastroenterology clinic were less dependent on alcohol, had suffered fewer consequences from alcohol and had fewer emotional and mental health problems than did the outpatients from the alcohol treatment service. In relation to their stages of change, the gastroenterology outpatients presented high precontemplation scores at the beginning of treatment while outpatients of alcohol treatment service showed higher scores in contemplation, action and maintenance. CONCLUSION: The medical treatment may be a reason for the temporary alcohol abstinence behavior among the gastroenterology outpatients.CONTEXTO E OBJETIVO: Para alguns pacientes que desenvolveram doenças físicas relacionadas ao consumo de álcool, a abstinência pode oferecer a melhor chance de sobrevivência. O objetivo deste estudo foi de investigar a motivação para tratamento em dois grupos de consumidores de álcool: pacientes do ambulatório de gastroenterologia e do ambulatório especializado no tratamento para alcoolismo. TIPO DO ESTUDO E LOCAL: Corte transversal, no hospital-escola do serviço público federal. MÉTODOS: A amostragem estudada foi de 151 pacientes do ambulatório de gastroenterologia e 175 do ambulatório especializado. A entrevista foi conduzida nos ambulatórios na primeira consulta ao serviço e consistiu em uma seção com dados demográficos e escalas que avaliaram qualidade de vida, dependência de álcool, padrão de consumo alcoólico, motivação para tratamento e conseqüências decorrentes do beber. RESULTADOS: Os resultados sugeriram que os pacientes do ambulatório de gastroenterologia eram menos dependentes do álcool, sofriam menos as conseqüências relacionadas ao consumo de bebidas alcoólicas e possuíam menos problemas mentais e emocionais quando comprados com os pacientes do ambulatório para tratamento do alcoolismo. Em relação aos estágios de mudança, os pacientes da gastroenterologia apresentaram maiores escores na precontemplação no início do tratamento e os pacientes do ambulatório especializado apresentaram escores maiores em contemplação, ação e manutenção. CONCLUSÃO: O tratamento médico pode ser uma razão para a abstinência temporária de álcool para os pacientes do ambulatório de gastroenterologia.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Motivation to change drinking behavior: the differences between alcohol users from an outpatient gastroenterology clinic and a specialist alcohol treatment service

CONTEXT AND OBJECTIVE: For some patients who have developed significant alcohol-related physical disease, total abstinence from alcohol may offer the best chance of survival. The aim of this study was to investigate motivation for treatment in two groups of alcohol users: outpatients from the gastroenterology clinic and outpatients from the specialist alcohol treatment service. DESIGN AND SETTING: Cross-sectional study, at a federally funded public teaching hospital. METHODS: The sample studied was 151 outpatients from the gastroenterology clinic and 175 from the specialist alcohol treatment service. The interview was conducted in the outpatient clinics at the first appointment, and consisted of demographic questions and scales for measuring quality of life, alcohol dependence, pattern of alcohol, motivation for treatment and consequences of alcohol consumption. RESULTS: The results suggested that outpatients from the gastroenterology clinic were less dependent on alcohol, had suffered fewer consequences from alcohol and had fewer emotional and mental health problems than did the outpatients from the alcohol treatment service. In relation to their stages of change, the gastroenterology outpatients presented high precontemplation scores at the beginning of treatment while outpatients of alcohol treatment service showed higher scores in contemplation, action and maintenance. CONCLUSION: The medical treatment may be a reason for the temporary alcohol abstinence behavior among the gastroenterology outpatients

LAAO-<i>Bl</i> induces necrosis and apoptosis in renal epithelial cell lines.

<p>(A) MDCK (a) and HK-2 (b) cells were treated with LAAO-<i>Bl</i> (1.56–50/100 μg/mL) for 12 h. After treatment, cell viability was determined by MTT. (B) Percentage release of the lactate dehydrogenase enzyme of MDCK (a) and HK-2 (b) cells treated with the indicated concentrations of LAAO-<i>Bl</i>. Triton (7%) was used as positive control. (C) Annexin V⁺/PI^-, Annexin V⁺/PI⁺ and AnnexinV^-/PI⁺-populations were analyzed by flow cytometry in MDCK (a) and HK-2 (b) cells for 12 h after treatment with LAAO-<i>Bl</i>. Staurosporine (1 μg/mL) and doxorubicin (10 μM) for 12h were used as positive controls. All data are representative of three independent experiments in triplicate and are expressed as mean ± S.E.M. *Significantly different from control group (p<0.05, one way ANOVA, Dunnett post-test).</p

L-Aminoacid oxidase from bothrops leucurus venom Induces nephrotoxicity via apoptosis and necrosis

Acute renal failure is a common complication caused by Bothrops viper envenomation. In this study, the nefrotoxicity of a main component of B. leucurus venom called L-aminoacid oxidase (LAAO-Bl) was evaluated by using tubular epithelial cell lines MDCK and HK-2 and perfused kidney from rats. LAAO-Bl exhibited cytotoxicity, inducing apoptosis and necrosis in MDCK and HK-2 cell lines in a concentration-dependent manner. MDCK apoptosis induction was accompanied by Ca2+ release from the endoplasmic reticulum, reactive oxygen species (ROS) generation and mitochondrial dysfunction with enhanced expression of Bax protein levels. LAAO-Bl induced caspase-3 and caspase-7 activation in both cell lines. LAAO-Bl (10 μg/mL) exerts significant effects on the isolated kidney perfusion increasing perfusion pressure and urinary flow and decreasing the glomerular filtration rate and sodium, potassium and chloride tubular transport. Taken together our results suggest that LAAO-Bl is responsible for the nephrotoxicity observed in the envenomation by snakebites. Moreover, the cytotoxic of LAAO-Bl to renal epithelial cells might be responsible, at least in part, for the nephrotoxicity observed in isolated kidney.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

LAAO-<i>Bl</i> exposure induces mitochondrial hyperpolarization, intracellular Ca²⁺ mobilization and ROS generation in MDCK cells.

<p>(A) Changes on ΔΨm after LAAO-<i>Bl</i> (50 μg/mL) stimulation were measured by TMRE fluorescence (25 nM, 15 min at 37°C) and detected by confocal microscopy or flow cytometry. (a) Confocal images from cells TMRE loaded were collected at baseline and seconds after exposure with LAAO-<i>Bl</i> showing the increase of ΔΨm in MDCK cells in relation to basal levels. (b) Representative histograms obtained from MDCK cells TMRE loaded and exposed with LAAO-<i>Bl</i> (50 μg/mL). The uncoupler FCCP (5 μM) was used as positive control (b). (B) Intracellular LAAO-<i>Bl</i> (50 μg/mL) induced ROS generation in MDCK cells. After treatment for 12 h, cells were incubated with DCFH-DA (5 μM, 30 min at 37°C) then examined by flow cytometer. ROS generation was expressed as a ratio of relative fluorescent intensity compared to the control group. <i>t</i>-BHP (5 μM) was used as positive control. (C) (a) Cytosolic Ca²⁺ increase (%) induced by LAAO-<i>Bl</i> (50 μg/mL) was monitored in a real-time fluorescence microscope. Relative increase in maximum cytosolic Ca²⁺ response (%) evoked by LAAO-<i>Bl</i> (50 μg/mL) or after pre-incubation with TG (2 μM, 20 min) (TG + LAAO-<i>Bl</i>) or 2-APB (100 μM, 10 min) (2-APB + LAAO-<i>Bl</i>) or with Ryanodine (Ryd., 20 μM, 20 min) (Ryd. + LAAO-<i>Bl</i>). (b) The summary data quantifies the flow cytometry analysis of cells loaded with propidium iodide (PI, 50 μg/mL) under treatment with LAAO-<i>Bl</i> (50 μg/mL) for 12 hrs, in the presence or absence of catalase (100 μg/mL) or BAPTA-AM (20 μM). The data represent the mean ± S.E.M of at least three independent experiments. *Significantly different from control group (p<0.05, one way ANOVA, Dunnett post-test).</p

LAAO-<i>Bl</i> activates Bax, caspases 3 and 7 in epithelial kidney cells.

<p>(A) Caspase-3/7 activity was determined in the presence of the fluorogenic Ac-DEVD-afc substrate after treatment with LAAO-<i>Bl</i> (12 h) in the presence or absence of zVAD (10 μM) in MDCK (a) and HK-2 cells (b). (B-C) Western blot analyses were performed to detect the effects of LAAO-<i>Bl</i> on changes in Caspase-3 (a), -7 (b) and Bax (c) expressions from total protein of MDCK (B) and Caspase-3 (a), -7 (b) HK-2 (C) cell extracts. Percentage of Caspase-3 (a), -7 (b) and Bax (c) expression in MDCK (B) and caspase-3 (a) and caspase-7 (b) HK2 (C) treated with LAAO-<i>Bl</i> for 12 h. Data normalized in relation to Control group. Protein bands were analyzed and normalized to the densitometric values of α-tubulin. Doxorubicin was used as positive control (10 μM). Data are representative results of three independent experiments.</p