2023
Medische sociologie
UNIVERSITEIT ANTWERPEN – GENEESKUNDE BACHELOR 1 – ARTS EN MAATSCHAPPIJ 1
,Inhoud
1. Rilatinegebruik bij studenten..............................................................................................................6
Gebruik van medicatie........................................................................................................................6
Bij studenten..................................................................................................................................6
Overzicht............................................................................................................................................6
Literatuur............................................................................................................................................6
Medische informatie..........................................................................................................................7
Effectiviteit.....................................................................................................................................7
Waarvoor wordt Rilatine ingenomen.............................................................................................7
Ander gebruik van methylfenidaat: narcolepsie.............................................................................7
Hoe werkt Rilatine?........................................................................................................................7
Waarschuwingen............................................................................................................................8
Bijwerkingen...................................................................................................................................8
Opiumwet Nederland.....................................................................................................................8
Medicalisering: ADHD als voorbeeld..................................................................................................8
Voorbeelden...................................................................................................................................9
Medicalisering................................................................................................................................9
DSM as a categorical touchstone....................................................................................................9
Evolutie van ADHD in DSM.............................................................................................................9
Biomedische verbetering als vorm van medicalisering.................................................................10
3 soorten biomedische/cognitieve verbetering............................................................................10
Resultaten doctoraatsonderzoek......................................................................................................11
Situering onderzoek......................................................................................................................11
Problematisch?.............................................................................................................................11
Nieuwe aandacht..........................................................................................................................11
Definities.......................................................................................................................................11
Kwantitatief onderzoek................................................................................................................12
Kwalitatief onderzoek – interviews...............................................................................................16
Conclusie en aanbevelingen.............................................................................................................19
Onbedoelde effecten....................................................................................................................19
Artsen...........................................................................................................................................19
2.(G)Een vies klusje: Rioolwater als informatiebron over druggebruik.................................................20
Indeling presentatie..........................................................................................................................20
Achtergrond......................................................................................................................................20
Waste water-based epidemiology....................................................................................................21
1
, Overzicht uitgevoerd onderzoek......................................................................................................22
Staalafname..................................................................................................................................22
Analyse.........................................................................................................................................23
Terugrekening...............................................................................................................................23
COWAT-project (cocaïne in afvalwater)........................................................................................24
Resultaten.....................................................................................................................................24
Europese vergelijking....................................................................................................................26
Onderzoek in Lier (SEWPROF => SEWage PROFiling)....................................................................27
Wat kan er nog meer gedaan worden met afvalwater?...............................................................30
3.Gecontroleerd gebruik van roesmiddelen (‘drugs’)...........................................................................31
Drugs en zelfcontrole...........................................................................................................................31
1.Drugsepidemiologie in België........................................................................................................31
Drugsepidemiologie in België =....................................................................................................31
Norman Zinberg............................................................................................................................32
2.Studies naar gecontroleerd gebruik...............................................................................................32
Gecontroleerd gebruik van legale drugs: onderzoeksresultaten..................................................32
Gecontroleerd gebruik van heroïne..............................................................................................32
Gecontroleerd gebruik van cocaïne: wat wordt verondersteld?..................................................33
Gecontroleerd gebruik van drugs: wat stelde men vast?.............................................................33
Spontaan stoppen met drugs.......................................................................................................33
Veranderingen in drugscarrières na 20 jaar..................................................................................33
Craving..........................................................................................................................................34
3.Cocaïne-onderzoek in Antwerpen (1996-1999).............................................................................34
Heersend paradigma....................................................................................................................34
‘Worst case scenario’....................................................................................................................34
Niet-problematische gebruikers in kaart brengen........................................................................34
Processen van zelfregulering bij illegale druggebruikers..............................................................35
4.Implicaties voor het drugbeleid in België......................................................................................36
Hulpverlening en preventie als formele controle.........................................................................36
Soorten controlemechanismen....................................................................................................37
Gecontroleerd omgaan met illegale drugs...................................................................................37
Beleid en ontwikkeling en overdracht van normen......................................................................37
4.Verslaving..........................................................................................................................................38
Slavernij (of lijfeigenschap)...............................................................................................................38
Basisbegrippen en definities.............................................................................................................38
Leerdoelen....................................................................................................................................38
2
, DSM..............................................................................................................................................38
“Werkaholisme”...........................................................................................................................42
Jongeren gokken massaal.............................................................................................................43
Gokverslaving...............................................................................................................................43
5.Drugs: Het verhaal van Adam en Eva?...............................................................................................44
I. Intoxicatie/ vergiftiging?................................................................................................................44
Welke producten?........................................................................................................................44
Definities.......................................................................................................................................44
Achtergrond..................................................................................................................................44
Tekens..........................................................................................................................................45
Mydriase, grote pupil (alles wat opwindt)....................................................................................45
II. HIGH, OF TOCH NIET...?................................................................................................................45
1a) Amfetamines..........................................................................................................................45
1b) Cocaïne...................................................................................................................................47
1c) Planten: hallucinaties (waanbeelden) ….................................................................................48
1d) LSD..........................................................................................................................................50
2a) Cannabis.................................................................................................................................50
2b) Heroïne...................................................................................................................................51
2c) GHB.........................................................................................................................................53
2d) Ketamine................................................................................................................................53
2e) Lach gas..................................................................................................................................53
2f) Andere (onderdrukkend…)......................................................................................................54
III. Hoe detecteren?.........................................................................................................................55
Achtergrond..................................................................................................................................55
Staalname.....................................................................................................................................55
Terugrekening...............................................................................................................................55
Geen combinaties maken!!!.........................................................................................................56
Quiz...............................................................................................................................................56
6.Jongeren en alcohol...........................................................................................................................58
Onderzoek van leerstoel Reinier de Graaf jongeren en alcohol.......................................................58
1.Leerstoel Reinier de Graaf Jongeren en alcohol........................................................................58
2. Cijfers jongeren en alcohol België.............................................................................................58
4.Wat leren we uit deze resultaten?.............................................................................................60
5. Toekomstplannen & aanbevelingen: alcoholcampagne studenten + alcoholpolikliniek
jongeren.......................................................................................................................................61
5.Take Home Messages................................................................................................................62
3
, Jongeren en alcohol..........................................................................................................................63
Jongeren met alcoholintoxicatie, een groeiend probleem...........................................................63
Poliklinieken jeugd en alcohol kindergeneeskunde......................................................................63
Schadelijke effecten alcohol.........................................................................................................64
Metabolisme.................................................................................................................................65
Voorlichting..................................................................................................................................68
Onderwijsplan...............................................................................................................................71
Samenvattend...............................................................................................................................73
7.Tabak.................................................................................................................................................75
Resultaten gezondheidsenquête 2018: België..................................................................................75
In Vlaanderen...............................................................................................................................75
Interventies..................................................................................................................................77
Resultaten.....................................................................................................................................77
Tabaksbeleid.....................................................................................................................................78
Hoe was het?................................................................................................................................78
Nu.................................................................................................................................................78
Voor nu en de toekomst...............................................................................................................79
WHO en roken..................................................................................................................................80
Financiële consequenties.................................................................................................................80
Enquête stichting tegen kanker........................................................................................................81
Preventie..........................................................................................................................................81
De e-sigaret......................................................................................................................................82
De reglementering Europa 2014...................................................................................................82
E-sigaret niet zonder gevaren.......................................................................................................83
Voornaamste kernboodschappen: advies van hoge gezondheidsraad.........................................83
Ondertussen … COVID-19.................................................................................................................84
Quod erat demonstrandum..........................................................................................................84
In de VS.........................................................................................................................................84
Preventie..........................................................................................................................................85
Rol van de overheid......................................................................................................................85
Alliantie voor een rookvrije samenleving......................................................................................85
Gidsland Australië.........................................................................................................................86
In België........................................................................................................................................86
‘Derde’ interventie?......................................................................................................................87
Een volksgezondheidsbeleid tegen de inmening van de big tobacco...........................................87
8.Gezondheidspromotie.......................................................................................................................90
4
, Duurzaam werken aan preventie => vaak niet snel resultaten.........................................................90
Inleiding........................................................................................................................................90
Memorandum VIGeZ....................................................................................................................90
Gezondheidspromotie..................................................................................................................90
Het begrip gezondheid volgens WHO...........................................................................................91
Gezondheidspromotie en ziektepreventie in Vlaanderen................................................................92
Plaatsbepaling van GVO in Vlaanderen.........................................................................................92
Het Vlaams preventiedecreet.......................................................................................................92
Logo’s............................................................................................................................................92
Modellen en theorieën.................................................................................................................93
Evaluatie van preventieactiviteiten in Vlaanderen...........................................................................93
Effectiviteit van preventie.............................................................................................................93
Borstkankeropsporing..................................................................................................................95
Relatie ‘gezond gedrag’ – gezondheid..........................................................................................97
Kosteneffectiviteit van preventie..................................................................................................97
Blijvende vragen...........................................................................................................................98
5
Medische sociologie
UNIVERSITEIT ANTWERPEN – GENEESKUNDE BACHELOR 1 – ARTS EN MAATSCHAPPIJ 1
,Inhoud
1. Rilatinegebruik bij studenten..............................................................................................................6
Gebruik van medicatie........................................................................................................................6
Bij studenten..................................................................................................................................6
Overzicht............................................................................................................................................6
Literatuur............................................................................................................................................6
Medische informatie..........................................................................................................................7
Effectiviteit.....................................................................................................................................7
Waarvoor wordt Rilatine ingenomen.............................................................................................7
Ander gebruik van methylfenidaat: narcolepsie.............................................................................7
Hoe werkt Rilatine?........................................................................................................................7
Waarschuwingen............................................................................................................................8
Bijwerkingen...................................................................................................................................8
Opiumwet Nederland.....................................................................................................................8
Medicalisering: ADHD als voorbeeld..................................................................................................8
Voorbeelden...................................................................................................................................9
Medicalisering................................................................................................................................9
DSM as a categorical touchstone....................................................................................................9
Evolutie van ADHD in DSM.............................................................................................................9
Biomedische verbetering als vorm van medicalisering.................................................................10
3 soorten biomedische/cognitieve verbetering............................................................................10
Resultaten doctoraatsonderzoek......................................................................................................11
Situering onderzoek......................................................................................................................11
Problematisch?.............................................................................................................................11
Nieuwe aandacht..........................................................................................................................11
Definities.......................................................................................................................................11
Kwantitatief onderzoek................................................................................................................12
Kwalitatief onderzoek – interviews...............................................................................................16
Conclusie en aanbevelingen.............................................................................................................19
Onbedoelde effecten....................................................................................................................19
Artsen...........................................................................................................................................19
2.(G)Een vies klusje: Rioolwater als informatiebron over druggebruik.................................................20
Indeling presentatie..........................................................................................................................20
Achtergrond......................................................................................................................................20
Waste water-based epidemiology....................................................................................................21
1
, Overzicht uitgevoerd onderzoek......................................................................................................22
Staalafname..................................................................................................................................22
Analyse.........................................................................................................................................23
Terugrekening...............................................................................................................................23
COWAT-project (cocaïne in afvalwater)........................................................................................24
Resultaten.....................................................................................................................................24
Europese vergelijking....................................................................................................................26
Onderzoek in Lier (SEWPROF => SEWage PROFiling)....................................................................27
Wat kan er nog meer gedaan worden met afvalwater?...............................................................30
3.Gecontroleerd gebruik van roesmiddelen (‘drugs’)...........................................................................31
Drugs en zelfcontrole...........................................................................................................................31
1.Drugsepidemiologie in België........................................................................................................31
Drugsepidemiologie in België =....................................................................................................31
Norman Zinberg............................................................................................................................32
2.Studies naar gecontroleerd gebruik...............................................................................................32
Gecontroleerd gebruik van legale drugs: onderzoeksresultaten..................................................32
Gecontroleerd gebruik van heroïne..............................................................................................32
Gecontroleerd gebruik van cocaïne: wat wordt verondersteld?..................................................33
Gecontroleerd gebruik van drugs: wat stelde men vast?.............................................................33
Spontaan stoppen met drugs.......................................................................................................33
Veranderingen in drugscarrières na 20 jaar..................................................................................33
Craving..........................................................................................................................................34
3.Cocaïne-onderzoek in Antwerpen (1996-1999).............................................................................34
Heersend paradigma....................................................................................................................34
‘Worst case scenario’....................................................................................................................34
Niet-problematische gebruikers in kaart brengen........................................................................34
Processen van zelfregulering bij illegale druggebruikers..............................................................35
4.Implicaties voor het drugbeleid in België......................................................................................36
Hulpverlening en preventie als formele controle.........................................................................36
Soorten controlemechanismen....................................................................................................37
Gecontroleerd omgaan met illegale drugs...................................................................................37
Beleid en ontwikkeling en overdracht van normen......................................................................37
4.Verslaving..........................................................................................................................................38
Slavernij (of lijfeigenschap)...............................................................................................................38
Basisbegrippen en definities.............................................................................................................38
Leerdoelen....................................................................................................................................38
2
, DSM..............................................................................................................................................38
“Werkaholisme”...........................................................................................................................42
Jongeren gokken massaal.............................................................................................................43
Gokverslaving...............................................................................................................................43
5.Drugs: Het verhaal van Adam en Eva?...............................................................................................44
I. Intoxicatie/ vergiftiging?................................................................................................................44
Welke producten?........................................................................................................................44
Definities.......................................................................................................................................44
Achtergrond..................................................................................................................................44
Tekens..........................................................................................................................................45
Mydriase, grote pupil (alles wat opwindt)....................................................................................45
II. HIGH, OF TOCH NIET...?................................................................................................................45
1a) Amfetamines..........................................................................................................................45
1b) Cocaïne...................................................................................................................................47
1c) Planten: hallucinaties (waanbeelden) ….................................................................................48
1d) LSD..........................................................................................................................................50
2a) Cannabis.................................................................................................................................50
2b) Heroïne...................................................................................................................................51
2c) GHB.........................................................................................................................................53
2d) Ketamine................................................................................................................................53
2e) Lach gas..................................................................................................................................53
2f) Andere (onderdrukkend…)......................................................................................................54
III. Hoe detecteren?.........................................................................................................................55
Achtergrond..................................................................................................................................55
Staalname.....................................................................................................................................55
Terugrekening...............................................................................................................................55
Geen combinaties maken!!!.........................................................................................................56
Quiz...............................................................................................................................................56
6.Jongeren en alcohol...........................................................................................................................58
Onderzoek van leerstoel Reinier de Graaf jongeren en alcohol.......................................................58
1.Leerstoel Reinier de Graaf Jongeren en alcohol........................................................................58
2. Cijfers jongeren en alcohol België.............................................................................................58
4.Wat leren we uit deze resultaten?.............................................................................................60
5. Toekomstplannen & aanbevelingen: alcoholcampagne studenten + alcoholpolikliniek
jongeren.......................................................................................................................................61
5.Take Home Messages................................................................................................................62
3
, Jongeren en alcohol..........................................................................................................................63
Jongeren met alcoholintoxicatie, een groeiend probleem...........................................................63
Poliklinieken jeugd en alcohol kindergeneeskunde......................................................................63
Schadelijke effecten alcohol.........................................................................................................64
Metabolisme.................................................................................................................................65
Voorlichting..................................................................................................................................68
Onderwijsplan...............................................................................................................................71
Samenvattend...............................................................................................................................73
7.Tabak.................................................................................................................................................75
Resultaten gezondheidsenquête 2018: België..................................................................................75
In Vlaanderen...............................................................................................................................75
Interventies..................................................................................................................................77
Resultaten.....................................................................................................................................77
Tabaksbeleid.....................................................................................................................................78
Hoe was het?................................................................................................................................78
Nu.................................................................................................................................................78
Voor nu en de toekomst...............................................................................................................79
WHO en roken..................................................................................................................................80
Financiële consequenties.................................................................................................................80
Enquête stichting tegen kanker........................................................................................................81
Preventie..........................................................................................................................................81
De e-sigaret......................................................................................................................................82
De reglementering Europa 2014...................................................................................................82
E-sigaret niet zonder gevaren.......................................................................................................83
Voornaamste kernboodschappen: advies van hoge gezondheidsraad.........................................83
Ondertussen … COVID-19.................................................................................................................84
Quod erat demonstrandum..........................................................................................................84
In de VS.........................................................................................................................................84
Preventie..........................................................................................................................................85
Rol van de overheid......................................................................................................................85
Alliantie voor een rookvrije samenleving......................................................................................85
Gidsland Australië.........................................................................................................................86
In België........................................................................................................................................86
‘Derde’ interventie?......................................................................................................................87
Een volksgezondheidsbeleid tegen de inmening van de big tobacco...........................................87
8.Gezondheidspromotie.......................................................................................................................90
4
, Duurzaam werken aan preventie => vaak niet snel resultaten.........................................................90
Inleiding........................................................................................................................................90
Memorandum VIGeZ....................................................................................................................90
Gezondheidspromotie..................................................................................................................90
Het begrip gezondheid volgens WHO...........................................................................................91
Gezondheidspromotie en ziektepreventie in Vlaanderen................................................................92
Plaatsbepaling van GVO in Vlaanderen.........................................................................................92
Het Vlaams preventiedecreet.......................................................................................................92
Logo’s............................................................................................................................................92
Modellen en theorieën.................................................................................................................93
Evaluatie van preventieactiviteiten in Vlaanderen...........................................................................93
Effectiviteit van preventie.............................................................................................................93
Borstkankeropsporing..................................................................................................................95
Relatie ‘gezond gedrag’ – gezondheid..........................................................................................97
Kosteneffectiviteit van preventie..................................................................................................97
Blijvende vragen...........................................................................................................................98
5
