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Gabrhelík R, Hesse M, Nechanská B, Handal M, Mravčík V, Tjagvad C, Thylstrup B, Seid AK, Bukten A, Clausen T, Skurtveit S. Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study. Front Public Health 2023; 11:1179763. [PMID: 37809010 PMCID: PMC10558053 DOI: 10.3389/fpubh.2023.1179763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Opioid maintenance treatment (OMT) has the potential to reduce mortality rates substantially. We aimed to compare all-cause and overdose mortality among OMT patients while in or out of OMT in two different countries with different approaches to OMT. Methods Two nation-wide, registry-based cohorts were linked by using similar analytical strategies. These included 3,637 male and 1,580 female patients enrolled in OMT in Czechia (years 2000-2019), and 6,387 male and 2,078 female patients enrolled in OMT in Denmark (years 2007-2018). The direct standardization method using the European (EU-27 plus EFTA 2011-2030) Standard was employed to calculate age-standardized rate to weight for age. All-cause and overdose crude mortality rates (CMR) as number of deaths per 1,000 person years (PY) in and out of OMT were calculated for all patients. CMRs were stratified by sex and OMT medication modality (methadone, buprenorphine, and buprenorphine with naloxone). Results Age-standardized rate for OMT patients in Czechia and Denmark was 9.7/1,000 PY and 29.8/1,000 PY, respectively. In Czechia, the all-cause CMR was 4.3/1,000 PY in treatment and 10.8/1,000 PY out of treatment. The overdose CMR was 0.5/1,000 PY in treatment and 1.2/1,000 PY out of treatment. In Denmark, the all-cause CMR was 26.6/1,000 PY in treatment and 28.2/1,000 PY out of treatment and the overdose CMR was 7.3/1,000 PY in treatment and 7.0/1,000 PY out of treatment. Conclusion Country-specific differences in mortality while in and out of OMT in Czechia and Denmark may be partly explained by different patient characteristics and treatment systems in the two countries. The findings contribute to the public health debate about OMT management and may be of interest to practitioners, policy and decision makers when balancing the safety and accessibility of OMT.
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Affiliation(s)
- Roman Gabrhelík
- First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czechia
- Department of Addictology, General University Hospital in Prague, Prague, Czechia
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Blanka Nechanská
- First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czechia
- Department of Addictology, General University Hospital in Prague, Prague, Czechia
| | - Marte Handal
- Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Viktor Mravčík
- First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czechia
- Department of Addictology, General University Hospital in Prague, Prague, Czechia
| | - Christian Tjagvad
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Abdu Kedir Seid
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Anne Bukten
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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Eide D, Skurtveit S, Clausen T, Hesse M, Mravčík V, Nechanská B, Rolová G, Thylstrup B, Tjagvad C, Seid AK, Odsbu I, Gabrhelík R. Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study. Eur Addict Res 2023; 29:272-284. [PMID: 37385232 PMCID: PMC10614278 DOI: 10.1159/000530822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/18/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender. METHODS This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000-2019), Denmark (2000-2018), and Norway (2010-2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality. RESULTS In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark). CONCLUSION This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.
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Affiliation(s)
- Desiree Eide
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Gabriela Rolová
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Christian Tjagvad
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Abdu Kedir Seid
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Ingvild Odsbu
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
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Gabrhelík R, Skurtveit S, Nechanská B, Mravčík V, Handal M. Morbidity through 3 Years of Age in Children of Women Using Methamphetamine during Pregnancy: A National Registry Study. Eur Addict Res 2023; 29:19-29. [PMID: 36423599 PMCID: PMC9932820 DOI: 10.1159/000527238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of studies on methamphetamine (MA) exposure and morbidity in children beyond the perinatal period. OBJECTIVES We compared morbidity in children (0-3 years) with prenatal MA exposure to opioid-exposed and to non-exposed children. METHODS We used data from a Czech nationwide, registry-based cohort study (2000-2014). Children, who reached 3 years of age, of mothers hospitalized with (i) MA use disorder during pregnancy (MA; n = 194), (ii) opioid use disorder during pregnancy (opioids; n = 166), and (iii) general population (GP; n = 1,294,349) with no recorded history of substance use disorder (SUD). Information on inpatient contacts, length of stay, and diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10]) were assessed. Crude and adjusted odds ratios (aOR), 95% confidence interval (CI) for the risk of hospitalization, and for getting diagnosis from the ICD-10 diagnosis chapters were calculated using binary logistic regression. A stratified analysis on hospitalizations with SUD of mothers was performed. RESULTS No significant differences were found in the measures of hospitalization between the MA and opioid groups. Children prenatally exposed to MA and opioids had higher numbers of hospitalizations and diagnoses and longer stays in hospital than children in the GP. Increased risks of certain infectious and parasitic diseases were found in both MA (aOR = 1.6; CI: 1.1-2.3) and opioid (aOR = 1.9; 1.3-2.8) groups as compared to the GP group. The most pronounced difference in stratified analysis on maternal hospitalizations related to SUD after birth was observed for injury, poisoning, and certain other consequences of external causes in the strata of the MA group who had hospitalized mothers (aOR 6.3, 1.6-24.6) compared to the strata without maternal hospitalizations (aOR 1.4, 0.9-2.3). CONCLUSION This study suggests that children born to mothers using MA during pregnancy have similar morbidity during the first 3 years of life but higher than the GP. The excess of risk was primarily due to infections and injuries in the MA group.
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Affiliation(s)
- Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia,Department of Addictology, General University Hospital in Prague, Prague, Czechia,*Roman Gabrhelík,
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway,Norwegian Centre for Addiction Research at the University of Oslo, Oslo, Norway
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Marte Handal
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia,Norwegian Institute of Public Health, Oslo, Norway
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Gabrhelík R, Handal M, Mravčík V, Nechanská B, Tjagvad C, Thylstrup B, Hesse M, Minařík J, Jarkovský J, Bukten A, Clausen T, Skurtveit S. Opioid maintenance treatment in the Czech Republic, Norway and Denmark: a study protocol of a comparative registry linkage study. BMJ Open 2021; 11:e047028. [PMID: 33972343 PMCID: PMC8112418 DOI: 10.1136/bmjopen-2020-047028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Opioid maintenance treatment (OMT) varies across settings and between countries. We plan to use data from several nationwide health and population registers to further improve the knowledge base established from earlier studies. Our aim is to study OMT adherence trajectories and to identify factors associated with improved outcomes for OMT patients across the Czech Republic, Norway and Denmark, in order to further improve OMT and our understanding of the key elements of treatment success. METHODS AND ANALYSIS The registry-based cohort approach across the three countries allows us to link data from a range of registers on the individual level, by using personal identifiers in nationwide cohorts of OMT and non-OMT patients and the general non-using populations. A total of ~21 500 OMT patients over the last two decades in all three countries will be included in the study. The following outcome variables (based on the International Classification of Diseases, 10th Revision codes) will be obtained from relevant registers: treatment adherence to OMT, comorbidity (somatic and mental health), and all-cause and cause-specific mortality. Outcomes of the country-specific analyses will be pooled. ETHICS AND DISSEMINATION The national OMT cohorts have been approved by the ethics committees in the respective countries. Data will be stored according to national and local guidelines and treated confidentially, and all data will be analysed separately for each country and compared across countries. Findings will be disseminated in peer-reviewed scientific journals, national and international conferences, and in briefings to inform clinical decision-making.
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Affiliation(s)
- Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Marte Handal
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Norwegian Institute of Public Health, Oslo, Norway
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Christian Tjagvad
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Birgitte Thylstrup
- Centre For Alcohol And Drug Research, Aarhus University, Aarhus, Denmark
| | - Morten Hesse
- Centre For Alcohol And Drug Research, Aarhus University, Aarhus, Denmark
| | - Jakub Minařík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Jarkovský
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anne Bukten
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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Gabrhelík R, Skurtveit S, Nechanská B, Handal M, Mahic M, Mravčík V. Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study. Eur Addict Res 2021; 27:97-106. [PMID: 32702698 DOI: 10.1159/000509048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy. OBJECTIVES To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP). METHOD A cohort study using nationwide registries in Czechia (2000-2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (n = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (n = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (n = 1,511,310) with no substance use disorder diagnosis (GP). The neonatal outcomes studied were growth parameters, gestational age, preterm birth, and Apgar score. To explore the associations between MA exposure and neonatal outcomes, regression coefficients (b) and odds ratios from multivariable linear and binary logistic regression were estimated. RESULTS MA-exposed women had similar socio-economic characteristics to opioid-exposed, both of which were worse than in the GP. After adjustment, MA exposure was associated with a more favourable birthweight when compared to the opioid-exposed (adjusted mean differences [aMD] b = 122.3 g, 95% CI: 26.0-218.5) and length (aMD b = 0.6 cm, 0.0-1.1). Unadjusted results from the comparison with the GP showed that the MA group had poorer neonatal outcomes, especially in the growth parameters. Adjustment for background characteristics had a profound effect on the comparison with the GP. After adjustment, MA exposure was associated only with a slightly reduced birthweight (aMD b = -63.0 g, -123.0 to -3.1) and birth length (aMD b = -0.3 cm, -0.6 to 0.0). CONCLUSIONS Although the observed negative outcomes were large in the MA-exposed newborns, the adjustment had a profound effect on the comparison with the GP, indicating the large influence of lifestyle and socio-economic factors in these high-risk pregnancies. MA-exposed newborns had better neonatal outcomes compared to opioids-exposed.
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Affiliation(s)
- Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia, .,Department of Addictology, General University Hospital in Prague, Prague, Czechia,
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Centre for Addiction Research at the University of Oslo, Oslo, Norway
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Marte Handal
- Norwegian Institute of Public Health, Oslo, Norway
| | - Milada Mahic
- Norwegian Institute of Public Health, Oslo, Norway
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia.,National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czechia
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Mravčík V, Nechanská B, Gabrhelík R, Handal M, Mahic M, Skurtveit S. Socioeconomic characteristics of women with substance use disorder during pregnancy and neonatal outcomes in their newborns: A national registry study from the Czech Republic. Drug Alcohol Depend 2020; 209:107933. [PMID: 32109712 DOI: 10.1016/j.drugalcdep.2020.107933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal substance use can pose a risk to the fetal health. We studied the background characteristics of women with substance use disorders (SUDs) and selected neonatal outcomes in their children. MATERIAL AND METHODS A database-linkage study was performed. The sample consisted of pregnant women with a SUD during pregnancy (ICD-10 diagnosis F10-F19 except F17, n = 1710), women not diagnosed with a SUD (n = 1,511,310) in Czechia in 2000-2014, and their children. The monitored neonatal outcomes were gestational age, birth weight, preterm birth, and small-for-gestational age (SGA). Binary logistic regression adjusted for age, marital status, education, concurrent substance use, and prenatal care was performed. RESULTS Women with illicit SUDs were younger, more often unmarried, with a lower level of education, a higher abortion rate, a higher smoking rate, and lower compliance to prenatal care than women with a SUD related to alcohol, or sedatives and hypnotics (SH). Women with a SUD had worse socioeconomic situations, poorer pregnancy care, and worse neonatal outcomes than women without a SUD. After adjustment, we found no difference in SGA between the illicit SUD groups and the alcohol and the SH groups. The newborns from all SUD groups had a higher risk of SGA when compared to women without a SUD. However after adjustment, the difference remained significant just in the alcohol group (OR = 1.9, 95 % CI = 1.4-2.6). CONCLUSION Mother's SUD during pregnancy increased risk of fetal growth restriction as measured by SGA. The role of maternal socioeconomic and lifestyle factors for the risk of SGA was substantial.
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Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic.
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Marte Handal
- Norwegian Institute of Public Health, Oslo, Norway
| | - Milada Mahic
- Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway; Norwegian Centre for Addiction Research at the University of Oslo, Norway
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Mravčík V, Chomynová P, Nechanská B, Černíková T, Csémy L. Alcohol use and its consequences in the Czech Republic. Cent Eur J Public Health 2020; 27 Suppl:S15-S28. [PMID: 31901189 DOI: 10.21101/cejph.a5728] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/10/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Alcohol consumption is associated with substantial public health burden. This article summarises available information on the patterns and prevalence of alcohol use in the Czech Republic with a focus on the heavy alcohol use and its health and social consequences. METHODS A non-systematic literature review was conducted. The data sources included primarily 3 series of surveys in the adult population, 2 series of surveys in the school population, routine monitoring system of per capita alcohol consumption, routine statistics on alcohol-related morbidity and mortality, and alcohol-related crime. RESULTS In recent years the registered alcohol consumption in the Czech Republic has been very high; 9.8 litres of pure alcohol were consumed per capita in 2017. Recently, the prevalence of hazardous alcohol consumption in the adult population has reached 16.8-17.6% and harmful alcohol consumption 9.0-9.3%. From 12% to 17% of adult population and 12% of adolescent population were heavy episodic drinkers. Alcohol-related disorders are disproportionately higher (2-3 times) among men. Mortality for alcohol-related causes fully attributable to alcohol (AAF = 100%) and their proportion in overall mortality is on increase. CONCLUSIONS Alcohol consumption as well as the prevalence of heavy episodic drinking in the Czech Republic belongs among the highest globally. On the other hand, declines in alcohol use have been recently observed among children and adolescents. Available data on alcohol-related morbidity indicate stable situation, though alcohol-related mortality is increasing. Alcohol-related burden is rather underestimated and evidence-based alcohol policy should be increasingly implemented.
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Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic.,Centre for Epidemiological and Clinical Research on Addictions, National Institute of Mental Health, Klecany, Czech Republic
| | - Pavla Chomynová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic.,Centre for Epidemiological and Clinical Research on Addictions, National Institute of Mental Health, Klecany, Czech Republic
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Centre for Epidemiological and Clinical Research on Addictions, National Institute of Mental Health, Klecany, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Tereza Černíková
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic
| | - Ladislav Csémy
- Centre for Epidemiological and Clinical Research on Addictions, National Institute of Mental Health, Klecany, Czech Republic.,National Institute of Public Health, Prague, Czech Republic
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Shaikh H, Nechanská B. Wunderlichs syndrome in patient with sporadic bilateral angiomyolipomas - case report. Rozhl Chir 2020; 99:548-551. [PMID: 33445926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We present the case report of bilateral renal angiomyolipomas in a 70-year-old patient. Spontaneous bleeding into the retroperitoneum and hemodynamic instability required an acute surgical revision with a left-sided nephrectomy. The contralateral angiomyolipoma was selectively embolized in the second period and subsequently resected.
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Handal M, Nechanská B, Skurtveit S, Lund IO, Gabrhelík R, Engeland A, Mravčík V. Prenatal exposure to opioid maintenance treatment and neonatal outcomes: Nationwide registry studies from the Czech Republic and Norway. Pharmacol Res Perspect 2019; 7:e00501. [PMID: 31428431 PMCID: PMC6694203 DOI: 10.1002/prp2.501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 12/03/2022] Open
Abstract
There is lack of knowledge about the safety of treatment with methadone and buprenorphine as part of opioid maintenance treatment (OMT) during pregnancy. The purpose of this study was to examine neonatal outcomes concerning the use of OMT during pregnancy. We used nationwide registry linkages from the Czech Republic (2000-2014) and Norway (2004-2013). We compared prenatally OMT-exposed newborns with (a) newborns of women hospitalized with opioid use disorder during pregnancy in the Czech sample and (b) newborns with neonatal abstinence syndrome (NAS) in Norway. We performed multivariate linear and binary logistic regression exploring the associations between OMT and neonatal outcomes (growth parameters, gestational age, fetal death, small for gestational age, Apgar score, and NAS). Regression coefficients (b) and odds ratios (ORs) were estimated. The cohorts consisted of 333 Czech, and 235 Norwegian OMT-exposed newborns, and 106 and 294 newborns in the comparison groups, respectively. In both countries, the neonatal growth parameters were similar in the OMT and the comparison groups. In Norway, OMT exposure prolonged gestational age (adjusted b = 0.96 weeks, 95% confidence interval [CI] =0.39-1.53) while the odds of preterm birth and Apgar score at 5 minutes were lower than in the comparison group (adjusted OR = 0.35, 0.16-0.75 and aOR = 0.21, 0.06-0.78, respectively). Newborns of women in OMT had similar growth parameters as newborns of women with opioid use disorders who were not in OMT during pregnancy. Overall, our findings do not suggest that OMT results in worse neonatal outcomes.
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Affiliation(s)
- Marte Handal
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
| | - Blanka Nechanská
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
- Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
| | - Svetlana Skurtveit
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
- Norwegian Centre for Addiction Research at the University of OsloOsloNorway
| | - Ingunn Olea Lund
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Anders Engeland
- Department of Chronic Diseases and AgeingNorwegian Institute of Public HealthOsloNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Viktor Mravčík
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
- National Monitoring Centre for Drugs and AddictionOffice of the Government of the Czech RepublicPragueCzech Republic
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Skurtveit S, Nechanská B, Handal M, Mahic M, Mravčík V, Gabrhelík R. Hospitalization of children after prenatal exposure to opioid maintenance therapy during pregnancy: a national registry study from the Czech Republic. Addiction 2019; 114:1225-1235. [PMID: 30725515 PMCID: PMC6899595 DOI: 10.1111/add.14576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/17/2018] [Accepted: 01/25/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Our understanding of the long-term safety of prenatal exposure to opioid maintenance treatment (OMT) is insufficient. We compared childhood morbidity (0-3 years) between OMT-exposed and relevant comparison groups. DESIGN Nation-wide, registry-based cohort study. Registries on reproductive health, addiction treatment, hospitalization and death were linked using identification numbers. SETTING The Czech Republic (2000-14). PARTICIPANTS Children with different prenatal exposure: (i) mother in OMT during pregnancy (OMT; n = 218), (ii) mother discontinued OMT before pregnancy (OMT-D; n = 55), (iii) mother with opioid use disorder, but not in OMT during pregnancy (OUD; n = 85) and (iv) mother in the general population (GP) (n = 1 238 452) MEASUREMENTS: Episodes of hospitalization were observed as outcomes. Information on in-patient contacts, length of stay and diagnoses (International Classification of Diseases version 10) were assessed. Binary logistic regressions were conducted to estimate the associations between OMT exposure and the outcomes, crude and adjusted for the socio-economic status and smoking. FINDINGS No significant differences were found in the overall proportion of hospitalization among OMT-exposed children, children of OMT-D and children of women with OUD [54.1%, 95% confidence interval (CI) = 47.3-60.1%; 47.3%, 95% CI = 33.9-61.1%; 51.8%, 95% CI = 40.7%-62.6%], while the proportion was significantly lower (35.8%, 95% CI = 35.7-35.8%) in the GP. There were no significant differences in risk of specific diagnoses between OMT-exposed children, children of OMT-D and children of women with OUD. In the adjusted analyses, differences between OMT-exposed and children in the GP were still present for infections and parasitic diseases (OR = 2.0, 95% CI = 1.4-2.7), diseases of the digestive system (OR = 1.7, 95% CI = 1.2-2.6) and diseases of the skin and subcutaneous tissue (OR = 1.9, 95% CI = 1.2-3.2). CONCLUSION This study did not find clear evidence for an increase in risk of morbidity during the first 3 years of life in children with prenatal opioid maintenance treatment exposure compared with children of women who discontinued such treatment before pregnancy or suffered from opioid use disorder without this treatment. Compared the general population, there appears to be an increased risk of hospitalizations for infectious, gastrointestinal and skin diseases.
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Affiliation(s)
- Svetlana Skurtveit
- Norwegian institute of Public HealthOsloNorway,Norwegian Centre for Addiction Research at the University of OsloNorway
| | - Blanka Nechanská
- Department of Addictology, First Faculty of MedicineCharles UniversityCzech Republic,Institute of Health Information and Statistics of theCzech Republic
| | | | | | - Viktor Mravčík
- Department of Addictology, First Faculty of MedicineCharles UniversityCzech Republic,National Monitoring Centre for Drugs and AddictionPragueCzech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of MedicineCharles UniversityCzech Republic
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Nechanská B, Mravčík V, Skurtveit S, Lund IO, Gabrhelík R, Engeland A, Handal M. Neonatal outcomes after fetal exposure to methadone and buprenorphine: national registry studies from the Czech Republic and Norway. Addiction 2018; 113:1286-1294. [PMID: 29443414 PMCID: PMC6221017 DOI: 10.1111/add.14192] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/07/2017] [Accepted: 02/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Opioid maintenance treatment (OMT) is recommended to opioid-dependent females during pregnancy. However, it is not clear which medication should be preferred. We aimed to compare neonatal outcomes after prenatal exposure to methadone (M) and buprenorphine (B) in two European countries. DESIGN Nation-wide register-based cohort study using personalized IDs assigned to all citizens for data linkage. SETTING The Czech Republic (2000-14) and Norway (2004-13). [Correction added after online publication on 26 April 2018: The Czech Republic (2000-04) corrected to (2000-14).] PARTICIPANTS: Opioid-dependent pregnant Czech (n = 333) and Norwegian (n = 235) women in OMT who received either B or M during pregnancy and their newborns. MEASUREMENTS We linked data from health registries to identify the neonatal outcomes: gestational age, preterm birth, birth weight, length and head circumference, small for gestational age, miscarriages and stillbirth, neonatal abstinence syndrome (NAS) and Apgar score. We performed multivariate linear regression and binary logistic regression to explore the associations between M and B exposure and outcomes. Regression coefficient (β) and odds ratio (OR) were computed. FINDINGS Most neonatal outcomes were more favourable after exposure to B compared with M, but none of the differences was statistically significant. For instance, in the multivariate analysis, birth weight was β = 111.6 g [95% confidence interval (CI) = -10.5 to 233.6 and β = 83.1 g, 95% CI = -100.8 to 267.0] higher after B exposure in the Czech Republic and Norway, respectively. Adjusted OR of NAS for B compared with M was 0.94 (95% CI = 0.46-1.92) in the Norwegian cohort. CONCLUSIONS Two national cohorts of women receiving opioid maintenance treatment during pregnancy showed small but not statistically significant differences in neonatal outcomes in favour of buprenorphine compared with methadone.
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Affiliation(s)
- Blanka Nechanská
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Viktor Mravčík
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic,National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech RepublicPragueCzech Republic
| | - Svetlana Skurtveit
- Norwegian institute of Public HealthOsloNorway,Norwegian Centre for Addiction Research at the University of OsloOsloNorway
| | | | - Roman Gabrhelík
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Anders Engeland
- Norwegian institute of Public HealthOsloNorway,Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
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12
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Nordt C, Wiessing L, Kuijpers W, Wisselink J, Espelt A, Brugal MT, Mravčik V, Nechanská B, Seifritz E, Herdener M. Long-Term Opioid Agonist Treatment Participation after First Treatment Entry is Similar across 4 European Regions but Lower in Non-Nationals. Eur Addict Res 2018; 24:173-183. [PMID: 30016806 DOI: 10.1159/000490529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/30/2018] [Indexed: 11/19/2022]
Abstract
Heroin users in opioid agonist treatment (OAT) show markedly reduced heroin consumption, less crime and a lower mortality rate. However, the extent of long-term OAT participation over subsequent treatment episodes remains unclear. We analysed the annual proportion of patients in treatment (at least 1 day) since the start of first OAT in 4 European regions: Barcelona (BA) 1996-2012: 8,602 patients; Czech -Republic (CZ) 2000-2014: 4,377 patients; Netherlands (NL) 1994-2014: 33,235 patients, Zurich (ZU) 1992-2015: 11,795. We estimated the long-term decline of treatment need due to mortality or abstinence and also a "nuisance" short-term decline until the equilibrium level of cycling in and out of OAT is reached to obtain the adjusted treatment participation value. The adjusted treatment participation was around 50% (BA: 47.4-51.4%; CZ: 49.8-53.9%; NL: 52.3-54.0%; ZU: 46.4-49.3%), and the annual decline of treatment need was close to 4%. Non-nationals (NL patients with a migrant background) showed substantial lower adjusted treatment participation (rate ratio BA: 0.059-0.343; NL: 0.710-0.751; ZU: 0.681-0.797; CZ: n.a.). Our method may provide a policy-relevant indicator of long-term provision, quality and access to OAT following first treatment.
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Affiliation(s)
- Carlos Nordt
- Center for Addictive Disorders, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Wil Kuijpers
- Stichting Informatievoorziening Zorg, Houten, the Netherlands
| | | | - Albert Espelt
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Manresa, Spain.,CIBER de Epidemiologia y Salud Pública, Madrid, Spain
| | | | - Viktor Mravčik
- Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital in Prague, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, The Office of the Government of the Czech Republic, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital in Prague, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Erich Seifritz
- Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Marcus Herdener
- Center for Addictive Disorders, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
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Gabrhelík R, Nechanská B, Mravčík V, Skurtveit S, Lund IO, Handal M. A Unique Opportunity to Study Short and Long Term Consequences in Children Prenatally Exposed to Illicit Drugs and Opioid Maintenance Treatment Using Czech and Scandinavian Registers. Cent Eur J Public Health 2017; 24:248-251. [PMID: 27743517 DOI: 10.21101/cejph.a4474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 05/19/2016] [Indexed: 11/15/2022]
Abstract
Licit and illicit drug use in pregnant women constitutes a long lasting and serious problem worldwide. Information on long-term effects of maternal drug use on the child is limited. Nationwide registers provide a great potential to study short and long-term consequences for children exposed to licit and illicit drugs during pregnancy. We discuss this potential, with a special emphasis on exposure to methamphetamine, heroin and prescription drugs used for opioid maintenance treatment (OMT). We also discuss the advantages of register data and of merging such data from different regions. The Czech and Scandinavian registers are largely comparable and provide great opportunities to conduct innovative research. For instance, using Czech and Scandinavian cohorts we can compare groups with similar characteristics, such as mothers in OMT and mothers addicted to other drugs while also controlling for important confounding factors such as health and socio-economic status.
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Affiliation(s)
- Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic
| | - Svetlana Skurtveit
- Norwegian institute of Public Health, Oslo, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | | | - Marte Handal
- Norwegian institute of Public Health, Oslo, Norway
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14
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Winkler P, Mladá K, Csémy L, Nechanská B, Höschl C. Suicides following inpatient psychiatric hospitalization: A nationwide case control study. J Affect Disord 2015; 184:164-9. [PMID: 26093829 DOI: 10.1016/j.jad.2015.05.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research shows the elevated risk of suicide associated with current or recent inpatient psychiatric hospitalization. However, it is unclear whether this applies in the area of post-communist Central and Eastern Europe where mental health care has not been deinstitutionalized yet. The present study aims to examine the rates of suicides among psychiatric patients during and shortly after discharge from inpatient hospitalization in the Czech Republic. METHODS All inpatient psychiatric hospitalizations and all suicides committed between 2008 and 2012 have been merged on an individual data basis. The time horizon between the admission and two months after the discharge from inpatient psychiatric facility was utilized and multiple logistic regression was performed to calculate the odds of committing suicide. RESULTS A total of 137,290 inpatients were hospitalized in Czech psychiatric facilities between 2008 and 2012, and 402 of the inpatients committed suicide during the hospitalization or within the 2 months after the discharge. Highly elevated risks of suicides were found to be associated with being a male, having a history of multiple hospitalizations, and having a diagnosis of affective, anxiety, or personality disorder. LIMITATIONS Limitations are related to the design of the study, and its reliance on routinely collected data. Also, it was not possible to assess the odds of suicide associated with inpatient psychiatric hospitalization against the odds of suicide in general population. CONCLUSIONS During psychiatric treatment and recovery, suicial behavior and idealiation is increased. In psychiatry, hospitalization may be a risky period for suicide behavior. Suicide rates during and soon after the psychiatric hospitalization identified in this study from Central and Eastern Europe are similar to the findings from Western Europe. Preventive strategies should be tailored accordingly.
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Affiliation(s)
- Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Karolína Mladá
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
| | - Ladislav Csémy
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
| | - Blanka Nechanská
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; Institute of Health Information and Statistics, Palackého nám. 4 , P.O. BOX 60, Praha 2 - Nové Město 128 01, Czech Republic
| | - Cyril Höschl
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
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15
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Ivanová K, Juríčková L, Šnevajsová E, Mistríková L, Nechanská B, Ondra P. Development of health status of inhabitants of the Czech Republic and Slovakia in relation to social determinants of health after split-up of former Czechoslovakia. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku162.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Nechanská B, Mravčík V, Sopko B, Velebil P. [Pregnant women and mothers using alcohol, tobacco and illegal drugs]. Ceska Gynekol 2012; 77:457-469. [PMID: 23116352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED This analysis is focused on use of addictive substances among women hospitalised during delivery or puerperium. Analysed data come from National Registry of Mothers at Childbirth and from National Registry of Newborns, which are managed by the Institute of Health Information and Statistics. GOAL To describe the prevalence of addictive substances use among women during gestation and to study its relation to health complications during pregnancy, delivery or puerperium and to health status of foetus and newborns. METHODS AND MATERIALS The reporting to registries is provided in the Report on mother at childbirth and in the Report on newborn. Both registers provide basic socio-demographic information about mother, information about previous pregnancies and abortions, about current pregnancy, course of delivery, birth and neonatal treatment and health of newborn during hospitalization of mother during delivery or puerperium. Use of addictive substances is monitored in the National Registry of Mothers at Childbirth since 2000. Addictive substances are divided to tobacco, alcohol and drugs. Descriptive analysis of data was performed and binary logistic regression was used to test association of substance use with education and marital status (adjusted for age), analysis of variance was used to test association of substance use with selected health complications of pregnancy, delivery or puerperium and with health status of foetus/newborns (adjusted for age, education, marital status and interaction between addictive substances). RESULTS In 2000-2009, 1,008,821 mothers were reported of whom 60,502 women were registered as cigarette smokers, 1,528 used alcohol and 1,836 used other (illegal) drugs. Total of 1,027,200 newborns were reported. The average age of mothers using addictive substances were about 0.5-3 years lower in comparison with nonusers, in average mothers using illegal drugs were the youngest. Mothers using addictive substances were more often unmarried and had lower education than nonusers - almost 2/3 of mothers using addictive substances were unmarried or didn't live in permanent partnership and more than 82% of mothers-users have lower education (primary or secondary school without a diploma). The association between substance use and induced and spontaneous abortions was observed only in smokers. Serious complications of pregnancy were associated with all monitored addictive substances - in mothers-smokers, a probability of serious complications were about 40 %, in users of illicit drugs about 13 % and in alcohol users about 5 % higher as compared to nonusers. Substance use showed almost no association with problems during childbirth. Alcohol and illegal drugs use increased probability of complications in puerperium. Health status of foetus/newborn was negatively significantly altered mainly in those born to mothers-smokers in almost all observed characteristics. Mothers alcohol use during pregnancy was associated primarily with the overall health status of foetus immediately after delivery, congenital anomalies, stillbirth or need for treatment of newborn in the theatre. Infants of mothers using addictive substances had higher probability of consequent hospitalization after discharge from the neonatal department, transfer to infant home and death of infant. CONCLUSION Association between complications during pregnancy, delivery and puerperium and health status of newborns and substance use of mothers during pregnancy was found mainly in cigarette smoking. Alcohol use was found significant in some (but serious) health problems of mothers and newborns. The association between illegal drugs and monitored indicators wasn't found. Following the results of this work, criteria for reporting of illegal drug use in mothers during pregnancy should be improved.
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Affiliation(s)
- B Nechanská
- Ustav zdravotnických informací a statistiky CR, Praha, reditel.
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17
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Zvolský M, Nechanská B, Králíková E. [The use of diagnoses related to tobacco use in the Czech Republic]. Cas Lek Cesk 2012; 151:573-578. [PMID: 23387815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND According to the International Statistical Classification of Diseases and Related Health Problems 10th Revision, tobacco dependence is coded by group F17 - Mental and behavioral disorders due to use of tobacco. There are other codes for diagnoses and conditions associated with tobacco use. The aim of our analysis was to determine how often these codes are reported in clinical practice. METHODS AND RESULTS We observed the incidence of diagnoses F17, P04.2, Z72.0 or T65.2 in years 2002-2011 in hospitalized patients and the F17 diagnosis in patients of psychiatric health facilities. According to data from the Institute of Health Information and Statistics of the Czech Republic diagnoses indicating smoking patients were reported in 1.5% of hospitalized patients in 2011, although the prevalence of smoking in the population is around 30% in last 15 years. Smoking-related diagnoses were reported in 2.1% of cases in Internal medicine departments. Codes F17, T65.2 and Z72.0 occurred as an accessory diagnose in vascular brain disease in 1.8% of hospitalizations and for respiratory tract neoplasms (dg. C32-C34) it was 7.1% of hospitalizations. CONCLUSIONS These results demonstrate the underestimation of the importance of smoking and its relationship to clinical disciplines. Although it is one of the most common diseases in the population with a direct relation to fatal diseases of civilization, the information on its incidence is not used in clinical practice.
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Affiliation(s)
- Miroslav Zvolský
- Ustav zdravotnických informací a statistiky Ceské republiky, Praha.
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18
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Mravcík V, Nechanská B, St'astná L. [Outpatient care for substance users and addicts in the Czech Republic in Health Statistics since 1963]. Epidemiol Mikrobiol Imunol 2011; 60:64-73. [PMID: 21838174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Outpatient care for alcohol and other addictive substances users in the Czech Republic has a 100-year-old history, with the last 50 years covered in health statistics. GOAL To perform descriptive analysis of the historical data gathered, analysed and published by the Institute for Health Information and Statistics on the network of outpatient psychiatric facilities in 1963-2008 (particularly those specialising in the treatment of addictive disorders, e.g. alcohol counselling centres and later AT centres where AT stands for alcoholism and other toxicomanias) as well as on the numbers and characteristics of their patients--users of addictive substances. RESULTS The number of visits to alcohol counselling and AT centres showed an upward trend in 1963-1991, mainly from 1970 to 1988 when a historical peak of 387 thousand visits was recorded. This trend was primarily due to males who constituted the majority of the reported patients and their proportion gradually decreased from 95% in 1963 to 79% to 1991. The reporting from the specialised AT centres ended in 1992 to be replaced by the reporting of addictive substances users from all psychiatric outpatient centres. In the period 1993-2008, for which the data by group of addictive substances are available, alcohol users constituted 3/4 of the treated addicts and their annual number decreased by half (from 49 to 25 thousand)--this decrease was also influenced primarily by men, with the male to female ratio declining from approx. 4:1 to 2:1. Since 1995 when age-specific data started to be reported, the age of substance users was increasing, with the exception of non-alcohol drugs users where the proportion of 15-19-year-olds rose in 1995-1997. In 2008, the highest proportion (about two thirds) of alcohol users were aged 40 years and more, while most (nearly 70%) users of non-alcohol drugs were from the age-group 20-39. The number of treated non-alcohol drug users increased more than 3 times between 1993 and 2008. Higher proportions of males were noticed among the users of all non-alcohol drugs but sedatives and hypnotics preferred more often by females (58%). An increase in the number of users was reported for all groups of non-alcohol drugs except volatile substances in 1993-2008: the most common were users of opiates (26%), followed by users of stimulants other than cocaine (23%) and poly-drug users (14%). In 1993-2008, the proportion of injecting drug users decreased from 75% to 50% for opiates and from 70% to 60% for stimulants other than cocaine; however, injecting drug use increased in poly-drug users. The trend in the number of clients of sobering-up stations (short-term detoxification from alcohol and other drugs) follows the trend in the number and capacity of these stations, although a downward trend in their capacity coupled with an upward trend in the number of clients have been observed since 2005. CONCLUSION Information from the outpatient health care psychiatric facilities is relevant to drug use epidemiology in the Czech Republic, despite the fact that the network of specialised AT centres has not been monitored separately any longer since the early 1990s. Data on drug users in outpatient treatment are in line with the inpatient treatment data and both data sources show some congruent trends. Health statistics remains practically the only data source on the outpatient treatment of alcohol users.
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Affiliation(s)
- V Mravcík
- Národní monitorovací stredisko pro drogy a drogové závislosti Urad vlády Ceské republiky, Praha.
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19
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Mravcík V, Nechanská B, St'astná L. [Residential care for substance users and addicts in the Czech Republic according to the health statistics since 1959]. Epidemiol Mikrobiol Imunol 2011; 60:21-31. [PMID: 21542232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED Similarly to the prevalence of disorders related to the use of addictive substance, the system of medical care for patients with addictive disorders, including the residential treatment, has changed dramatically in the Czech Republic in the last 50 years. GOAL To perform descriptive analysis of historical data gathered, analysed and published by the Institute for Health Information and Statistics since 1959 on the inpatient psychiatric facilities, and numbers and characteristics of patients hospitalised due to addictive disorders in 1959-2008. RESULTS The number of episodes of hospitalisation due to alcohol-related conditions was increasing throughout the whole monitored period since the end of the 1950s. After a short decrease at the turn of the 1980s and 1990s, the alcohol-related hospitalisations increased again to the historical peak of 11,691 episodes in 2005. As compared to alcohol-related admissions, the number of hospitalisations due to other (non-alcoholic) addictive disorders was 5-10 times lower until 1993 (60-1,000 episodes annually); however, a sharp increase was observed since 1994, to 5,264 episodes in 2008. The proportion of males among hospitalised alcohol users is currently about 70% in comparison with approximately 95 % at the very beginning of the study period, with most hospitalised persons being aged 40-49 years. Users of sedatives and hypnotics are more often females (approximately 65%), with the highest proportion of them being also aged 40-49 years. From 70 to 90% of hospitalised users of other addictive substances, i. e. illicit drugs and volatile substances, the percentage varying with the substance, are males and the highest proportion of cases is reported in the age group 20-29 years. In the last 15 years, the highest relative rates of hospitalisations for alcohol-related conditions were recorded in the Zlin, Olomouc and Moravian-Silesian Regions and for non-alcohol substance abuse in Prague and the Ustí Region. The inpatient psychiatric bed capacity considerably decreased after 1989, which contrasts with the increasing number of alcohol-related and particularly non-alcohol substance-related hospitalisations since the 1990s. CONCLUSION The data on hospitalised users of addictive substances are a valuable contribution to the body of information about drug use and its consequences in the Czech Republic and are complementary to the description of the epidemiological situation and trends seen in other data sources. They are of crucial relevance to the study of alcohol abuse due to the scarcity of other data sources in the Czech Republic.
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Affiliation(s)
- V Mravcík
- Národní monitorovací stredisko pro drogy a drogové závislosti, Praha.
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