Ciência para Redução de Danos

Abstract

Context: Regular alcohol use is a predominant risk factor for disease, injury, and social harm. While robust evidence is advocating for implementing interventions to reduce the harms of illegal substance use, less literature is dedicated to identifying and understanding interventions aiming at reducing the various harms associated with alcohol.

Objectives: This review describes how alcohol harm reduction (AHR) interventions are currently conducted and analyzes the facilitators and barriers identified by the studies on their efficacy.

Method: This scoping review with evidence appraisal included articles published between 2011 and 2022, addressing one or more AHR interventions for population of at least 18 years (including alcohol user who have an addiction but also alcohol user with harmful drinking), conducted in North industrialized countries (Europe, Nort America, Australia).

Results: Among the 61 articles selected, we identified several forms of support (face-to-face or remote, support in residential settings, structural interventions, and interventions created upon spontaneous initiatives), and strategies of intervention were also analyzed (the ones based upon learning and skill development, the ones based upon psychological support, the ones focusing upon socio-economic conditions, strategies focusing on the coordination and adaptation of the care system, and those strategies based on peer support). The facilitators linked to fundamental characteristics of the interventions were the promotion of empowerment and autonomy of beneficiaries, setting objectives tailored to individual needs, professionals harmonizing their values, evidence-based interventions taking into account cultural contexts, and comprehensive and holistic support. Practical facilitators from the intervention process consist of increasing the number of sessions, involvement, and formation of members of staff, disposing of the necessary resources, and using technological tools.

Discussion: The sheer variety of AHR interventions demonstrates that this is a fertile field in terms of intervention design and innovation. This work illustrates the importance of designing effective, adapted harm reduction interventions, prioritizing interventions that make support more accessible to more people. This also prompts us to consider the potential benefits of invoking proportionate universalism in the design of AHR interventions in order to operationalize alcohol harm reduction philosophy. accessible to more people.

Keywords: Addiction; Alcohol; Alcohol harm reduction; Harm reduction; Interventions; Public health; Scoping review.

Abstract

Introdução: São consideradas drogas psicoativas as substâncias capazes de modificar as funções do sistema nervoso central produzindo euforia ou alterando estados de consciência e vigília. Metodologia: levantamento bibliográfico e por uma abordagem de cunho qualitativo, pois a opção por tal baseia-se na utilização de fontes estabelecidas por material já elaborado, construído basicamente por revistas científicas, artigos e livros. Resultados e Discussão: No Brasil, a história de criação das políticas públicas direcionadas aos usuários de drogas e à prevenção de seu uso é relativamente recente. As discussões a respeito da proibição e liberação das drogas não deve ser pautada na defesa de posições extremista de liberação ou proibição. Foi somente depois da Lei Federal nº 10.216/2001, que legitimou o movimento da reforma psiquiátrica na área da saúde mental, e trouxe os usuários de álcool e drogas para o contexto de discussão da saúde mental na Atenção Básica da Saúde (ABS). Considerações Finais: A literatura mostra que existe uma lacuna sobre às problemáticas relacionadas ao uso das drogas, sendo então necessário buscar um foco diferente de discussão a esta questão e realizar estudos que investiguem e aprofundem esta realidade, visto a importância e urgência que ela demanda.

Keywords: redução de danos, saúde pública, saúde mental

Abstract

There continues to be a high prevalence of smoking in many European countries. In Germany, for example, there are over 20 million smokers, most of whom exhibit little desire to quit. In other countries, the adoption of smoke-free products (SFPs), including e-cigarettes (ECs), heated tobacco products (HTPs), and oral nicotine pouches (NPs), is helping smokers to transition away from cigarettes. In Germany, debate about SFPs primarily focuses on their potential harms to non-smokers, particularly the underage population. This debate seems one-sided: raising concerns alone does not sufficiently inform the 20 million smokers about the comparative health risks of cigarettes and SFPs, an issue increasingly echoed by practitioners and researchers. Instead, the current discourse is dominated by misconceptions, as evidenced by surveys on smokers’ perceptions of the relative health risks of cigarettes and SFPs. Considering the gravity of the topic, it is essential to revisit the scientific facts. The growing evidence shows that SFPs, including ECs, HTPs, and NPs, expose users to significantly fewer numbers and lower concentrations of toxicants relative to combustible cigarettes. In vitro studies and biomarkers of harm in SFP users suggest that these lower emissions translate to reduced risks of harm. It is the nature of science that the evidence will never be complete, but the totality of data should be considered when discussing the correct handling of SFPs. At present, these data suggest that SFPs can play a useful role in curbing the individual and societal risks associated with smoking.

Abstract

This first paper in a three-part Lancet Series combines narrative and systematic reviews with original analyses and meta-analyses to assess three hypotheses concerning a dietary pattern based on ultra-processed foods. The first hypothesis—that this pattern is globally displacing long-established diets centred on whole foods and their culinary preparation as dishes and meals—is supported by decades of national food intake and purchase surveys, and recent global sales data. The second—that this pattern results in deterioration of diet quality, especially in relation to chronic disease prevention—is confirmed by national food intake surveys, large cohorts, and interventional studies showing gross nutrient imbalances; overeating driven by high energy density, hyper-palatability, soft texture, and disrupted food matrices; reduced intake of health-protective phytochemicals; and increased intake of toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives. The third and final hypothesis—that this pattern increases the risk of multiple diet-related chronic diseases through various mechanisms—is substantiated by more than 100 prospective studies, meta-analyses, randomised controlled trials, and mechanistic studies, covering adverse outcomes across nearly all organ systems. The totality of the evidence supports the thesis that displacement of long-established dietary patterns by ultra-processed foods is a key driver of the escalating global burden of multiple diet-related chronic diseases. Two companion papers in this Series specify policy actions and wider public health strategies to promote, protect, and support diets based on fresh and minimally processed foods and prevent their displacement by ultra-processed foods.

This is the first in a Series of three papers about ultra-processed foods and human health. All papers in the Series are available at thelancet.com/series/ultra-processed-food

Abstract

Purpose: This narrative review addresses post-2020, specific, complex challenges for use of and adherence to pre-exposure prophylaxis (PrEP) for HIV prevention among out-of-treatment people who use drugs (PWUD) at syringe services programs (SSPs).

Recent findings: The COVID-19 pandemic and its associated changes to the provision of healthcare have significantly impacted HIV prevention, especially for PWUD. Through a synthesis of literature and clinical experience, we (1) characterize the operational changes imposed by the pandemic on SSPs that shaped the current HIV prevention landscape; (2) describe three levels of current challenges for PWUD, including consumer attitudes, non-medical and medical provider attitudes, and structural and scalability barriers; (3) characterize current models for PrEP in SSPs; and (4) offer practical recommendations for HIV prevention in harm reduction programs. PrEP is a highly effective prevention tool if taken as prescribed. It has been enthusiastically promoted by members of the research, public health and provider communities. Despite its efficacy, PWUD struggle to engage with the PrEP care continuum. We highlight opportunities to advance HIV prevention for PWUD by enhancing tailored, whole-person approaches that may set aside PrEP in favor of other risk reduction routes. For most PWUD who receive services at SSPs, PrEP is a single tool and not realistic until other social and structural determinants of health are addressed.

Keywords: HIV pre-exposure prophylaxis (PrEP); HIV prevention; Harm reduction; People who inject drugs; People who use drugs; Syringe services programs.