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Uusküla A, Rannap J, Weijler L, Abagiu A, Arendt V, Barrio G, Barros H, Brummer-Korvenkontio H, Casabona J, Croes E, Jarlais DD, Seguin-Devaux C, Dudás M, Eritsyan K, Folch C, Hatzakis A, Heimer R, Heinsbroek E, Hope V, Jipa R, Ķīvīte-Urtāne A, Levina O, Lyubimova A, Malczewski A, Matser A, McAuley A, Meireles P, Mravčík V, Op de Coul E, Ojavee SE, Parés-Badell O, Prins M, Pulido J, Romanyak E, Rosinska M, Seyler T, Stone J, Sypsa V, Talu A, Tarján A, Taylor A, Vickerman P, Vorobjov S, Dolan K, Wiessing L. Incarceration history is associated with HIV infection among community-recruited people who inject drugs in Europe: A propensity-score matched analysis of cross-sectional studies. Addiction 2023; 118:2177-2192. [PMID: 37991429 DOI: 10.1111/add.16283] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 05/22/2023] [Indexed: 11/23/2023]
Abstract
AIMS We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe. DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months). MEASUREMENTS Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID. FINDINGS Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09-1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47-2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33-3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16-1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59-2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18-1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76-0.94), male sex (aOR = 0.77, 95% CI = 0.65-0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59-0.88) were associated with lower odds of HIV positivity. CONCLUSIONS A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.
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Affiliation(s)
- Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Jürgen Rannap
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Lisa Weijler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Adrian Abagiu
- National Institute for Infectious diseases 'Professor Dr Matei Bals', Bucharest, Romania
| | - Vic Arendt
- Service National des Maladies Infectieuses, Centre Hospitalier de Luxembourg, Luxembourg
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | | | - Jordi Casabona
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Don Des Jarlais
- School of Global Public Health, New York University, New York, NY, 10012, USA
| | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
| | - Mária Dudás
- National Public Health Center, Budapest, Hungary
| | - Ksenia Eritsyan
- National Research University Higher School of Economics, St Petersburg, Russia
| | - Cinta Folch
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Robert Heimer
- Department of the Epidemiology of Microbial Diseases, Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Ellen Heinsbroek
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Vivian Hope
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Raluca Jipa
- National Institute for Infectious diseases 'Professor Dr Matei Bals', Bucharest, Romania
| | | | - Olga Levina
- National Research University Higher School of Economics, St Petersburg, Russia
- Acuity Systems, Herndon, VA, USA
| | - Alexandra Lyubimova
- National Research University Higher School of Economics, St Petersburg, Russia
| | - Artur Malczewski
- EMCDDA Polish National Focal Point, National Bureau for Drug Prevention, Warsaw, Poland
| | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection andd Immunity Institute, Amsterdam, the Netherlands
| | - Andrew McAuley
- Public Health Scotland, Meridian Court, Glasgow, Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Paula Meireles
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Společnost Podané ruce, Brno, Czech Republic
- Klinika Podané ruce, Brno, Czech Republic
| | - Eline Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sven E Ojavee
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | | | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection andd Immunity Institute, Amsterdam, the Netherlands
| | - José Pulido
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain
| | | | - Magdalena Rosinska
- Department of Infectious Diseases Epidemiology and Surveillance, National Institute of Public Health NIH, National Research Institute, Warsaw, Poland
| | - Thomas Seyler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ave Talu
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Anna Tarján
- Hungarian Reitox National Focal Point, Budapest, Hungary
| | - Avril Taylor
- Emeritus Professor of Public Health, School of Education and Social Sciences, University of West Scotland, Paisley, Scotland, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sigrid Vorobjov
- Department of Drug and Infectious Diseases Epidemiology, National Institute for Health Development, Tallinn, Estonia
| | - Kate Dolan
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, NSW, Australia
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
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Kňažek F, Horák M, Ocetková T, Somerlíková K, Bláhová B, Plevková M, Mravčík V, Chomynová P, Kočárová R. Typology of Users of Psychedelics and Alike Psychoactive Substances in Czechia: Results of the National Online Survey. J Psychoactive Drugs 2023; 55:601-611. [PMID: 36827494 DOI: 10.1080/02791072.2023.2177908] [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] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 10/29/2022] [Accepted: 12/08/2022] [Indexed: 02/26/2023]
Abstract
The aim of this study was to define the typical groups of users of psychedelics and alike psychoactive substances in Czechia regarding various variables such as demographics, their patterns of use, or motivation for use. Data from 890 Czech respondents were collected through an online questionnaire as a part of The National Psychedelic Research Project. Subjects reported experience with the use of 29 selected substances by answering 133 questions of the questionnaire. Cluster analysis based on answers on last year use was performed, and descriptive statistics was used for 18 questions from the questionnaire. Six groups of users were identified with distinguished users and demographic characteristics, namely, The most experienced; Pure smokers; Highly educated mild users; Past-time users with families; Responsible (party) students and Deep meaning natural substance users. Groups differ mainly in the type of substances used, frequency of use last year, and demographics. Our findings highlight several patterns typical for psychedelics and alike psychoactive substances use in Czechia in each of the groups and the need for targeted drug prevention services, the raise of public awareness regarding this topic, and a possible reevaluation of the legal status of some substances. Results can be useful for health-care providers, social workers, and policy-makers.
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Affiliation(s)
- Filip Kňažek
- Technology transfer centre, National Institute of Mental Health, Klecany, Czech Republic
- Faculty of Pharmacy, Masaryk,University, Brno, Czech Republic
| | - Miroslav Horák
- Faculty of Regional Development and International Studies, Mendel University in Brno, Brno, Czech Republic
| | - Tereza Ocetková
- Faculty of Regional Development and International Studies, Mendel University in Brno, Brno, Czech Republic
| | - Kristína Somerlíková
- Faculty of Regional Development and International Studies, Mendel University in Brno, Brno, Czech Republic
| | - Barbora Bláhová
- Technology transfer centre, National Institute of Mental Health, Klecany, Czech Republic
| | - Michaela Plevková
- Technology transfer centre, National Institute of Mental Health, Klecany, Czech Republic
- Faculty of Arts, Palacký University, Olomouc, Czech Republic
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University
| | - Pavla Chomynová
- National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic
- Department of Addictology, First Faculty of Medicine, Charles University
| | - Rita Kočárová
- Technology transfer centre, National Institute of Mental Health, Klecany, Czech Republic
- Faculty of Arts, Charles University, Prague, Czech Republic
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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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Chomynová P, Kočárová R, Kňažek F, Plevková M, Bláhová B, Valeš K, Mravčík V. Use of psychedelics in the Czech Republic: results of recent population surveys. Cent Eur J Public Health 2022; 30:144-153. [DOI: 10.21101/cejph.a7079] [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] [Received: 08/27/2021] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
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Mravčík V, Kumpanová Valachovičová S, Vobořil J. Declining neutralizing antibody levels after SARS-CoV-2 mRNA vaccination: observational data from community point-of-care testing service in Brno, Czechia. Cent Eur J Public Health 2022; 30:111-118. [PMID: 35876600 DOI: 10.21101/cejph.a7230] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/23/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Understanding immune response is critical for control of COVID-19 pandemic. However, recent studies show that vaccine-induced humoral immunity may not be long-lasting and weaker in SARS-CoV-2 variants of concern. METHODS In May 2021, 253 self-nominated persons were tested for antibodies against SARS-CoV-2 in 1 to 104 days (mean 41, median 28) after two doses of Moderna and Pfizer-BioNTech vaccines in the city of Brno, Czechia. Two point-of-care iCHROMA™ II immunofluorescence assays were used: COVID-19 Ab against mix of SARS-CoV-2 nucleocapsid and spike proteins (IgG Ab); and COVID-19 nAb against S1-RBD protein (nAb). Results were analysed in relation to gender, age, vaccine, and past COVID-19 disease. RESULTS Antibodies nAb were detectable in 92.9% (95% CI: 89.7-96.0) of vaccinees. We observed statistically insignificant decrease of positive results from 93.9% (95% CI: 89.5-98.3) and 97.0% (95% CI: 92.8-100.0) in the first and second month after vaccination, respectively, to 91.7% (95% CI: 83.8-99.5) and 78.3% (95% CI: 61.4-95.1) in the third and fourth month, respectively. Quantitative results showed decreasing level of nAb in both genders, age groups and vaccines. Higher levels of nAb were found in younger age group and in COVID-19 convalescents. IgG Ab showed little dynamics in time. CONCLUSIONS We found robust humoral response after vaccination with mRNA vaccines, however, decreasing nAb levels suggest that vaccine-induced humoral immunity is rapidly waning. This finding is relevant for adjustment of vaccination strategies with regard to inclusion of booster dose(s).
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Affiliation(s)
- Viktor Mravčík
- Spolecnost Podane ruce, Brno, Czech Republic.,Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Mravčík V, Husa P, Kumpanová Valachovičová S, Vobořil J. Decreasing neutralization antibody levels following vaccination against SARS-CoV-2 in the elderly: an observational study in Southern Moravia, Czech Republic. Epidemiol Mikrobiol Imunol 2022; 71:9-20. [PMID: 35477266] [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: 06/14/2023]
Abstract
INTRODUCTION Understanding the immune response after SARS-CoV-2 vaccination is essential to control the COVID-19 pandemic. Recent studies indicate that vaccine-induced humoral immunity may not be long-lasting and is weaker in the elderly. METHODOLOGY AND SAMPLE At the turn of June and July 2021, 653 seniors (426 women and 197 men with a mean age of 74 years) were tested once for antibodies against SARS-Cov-2 in the South Moravian Region between 9 and 161 days after the second dose of vaccine (558 Pfizer -BioNTech, 28 Moderna, 36 AstraZeneca, 1 Johnson & Johnson). Samples of the whole capillary blood were tested in two point-of-care iCHROMA II immunofluorescence assays: (1) COVID-19 Ab against mix of SARS-CoV-2 nucleocapsid and spike proteins (IgM Ab, IgG Ab) and (2) COVID-19 nAb against S1-RBD protein (nAb). Results were analysed in relation to gender, age, vaccine type, and past COVID-19 disease. RESULTS Our results show high variability in the antibody response but indicate an overall relatively weak and decreasing antibody response in the first six months after vaccination. Only 58.4% (95% CI: 54.6-62.3) of subjects had virus neutralizing antibodies (nAb). The level of nAb decreased with time from vaccination - at post-vaccination months 4 and 5, nAb were only detected in 41.1% (95% CI: 30.9-51.3) and 15.4% (95% CI: 1.5-29.3) of subjects, respectively. Vaccinees in older age groups, those vaccinated with AstraZeneca, and naive individuals showed a lower antibody response. CONCLUSION The antibody response to SARS-CoV-2 vaccine in the elderly was relatively weak and decreased in the first six months after vaccination. Although humoral immunity is complex and cellular immune memory is a key element of the humoral response after exposure to the wild virus, our results suggest that vaccine-induced humoral immunity may not be long-lasting. The oldest koncenage groups who have not acquired natural SARS-CoV-2 infection are particularly at risk. This finding is relevant for adjusting vaccination strategies in selected population groups to include a booster dose. More research into the antibody response and the complex immune response after vaccination against SARS-CoV-2 over longer time is needed.
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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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10
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Petruželka B, Mravčík V, Barták M, Babor TF. The identification of artefacts in reporting of drug-induced deaths using structural breaks analysis of time series statistics. Drug Alcohol Rev 2021; 40:1207-1218. [PMID: 33880791 DOI: 10.1111/dar.13296] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Drug-related mortality is a key epidemiological indicator that is collected nationally and internationally. Significant efforts were made in 2006-2007 to improve the quality of data concerning drug-related mortality in the Czech Republic. The aim of this article is to identify the effect of a quality improvement project on the drug-induced mortality data reported in the General Mortality Registry (GMR), and to demonstrate how to identify, quantify and interpret changes in drug-induced mortality based on the example of the Czech Republic. METHODS We extracted data on illicit drug-induced deaths from the Czech Republic GMR and Special Mortality registry (SMR) for the years between 2004 and 2012, and aggregated monthly and quarterly time series. We applied a new procedure to identify structural breakpoints in time series based on dating structural changes in standard linear regression models. RESULTS In the GMR, breakpoints were identified in three time series: (i) opioid-related deaths; (ii) other stimulant-related deaths; and (iii) total drug-induced deaths. In the SMR, the structural breaks were identified for opioids, volatile substances and selection D time series. In each of these time series, the analysis identified a decrease in the intercepts in the different segments. DISCUSSION AND CONCLUSIONS The structural breaks identified and quantified in the GMR time series were plausibly caused by the quality improvement efforts that started in 2006. These results demonstrate that it is critical for the analysis and use of drug mortality data collected in the registries to identify practice changes in the relevant registries, to quantify their influence and to adjust mortality estimates accordingly.
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Affiliation(s)
- Benjamin Petruželka
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - 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 of the Czech Republic, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic
| | - Miroslav Barták
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Thomas F Babor
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, USA
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11
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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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12
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Mravčík V, Chomynová P. Substance use and addictive behaviours during COVID-19 confinement measures increased in intensive users: Results of an online general population survey in the Czech Republic. Epidemiol Mikrobiol Imunol 2021; 70:98-103. [PMID: 34412485] [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: 06/13/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected substance use and other addictive behaviour, however detailed insight is lacking. MATERIAL AND METHODS Online questionnaire survey on the sample of 3,000 respondents aged 15+ randomly selected from the Czech internet panel using socio-demographic quotas was performed shortly after the end of confinement measures in May 2020 (response rate 35.4%). Questions covered current prevalence and patterns of substance use (i.e. in the last 12 months) and other forms of addictive behaviours as well as changes in their behaviour during the confinement measures. Responses were provided on categorical scale; a factor of 0 to 2 was assigned to the categories to quantify the changes where 1 means no change. RESULTS Respondents reporting the highest frequency of current use, especially the use of alcohol, cannabis and sedatives, further increased their intensity of use during the confinement measures by 5-10% on average, while less frequent users reduced it. The reduction of use during confinement measures increased with decreasing frequency of current use. Although the same correlation exists in tobacco smokers, decrease in intensity of use was observed also in daily smokers. On the population level, our results suggest a slight increase in total alcohol and sedatives consumption and a significant increase in the total consumption of gaming and social media. On the contrary, there was a significant reduction in the consumption of tobacco and online gambling (likely due to the ban on sports matches), and a slight reduction in the consumption of cannabis and other illicit drugs. CONCLUSION People with intensive patterns of substance use increased their use during confinement measures. The same concerns gaming and social media. Without this insight the overall picture suggests rather overall reduction of consumption. Addiction treatment system should prepare for the increase of treatment demand following COVID-19 epidemic.
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13
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Thanki D, Mravčík V, Běláčková V, Mačiulytė D, Zábranský T, Širvinskienė A, Subata E, Lorenzo-Ortega R. Prevalence of high-risk drug use and coverage of opioid substitution treatment and needle and syringe programs in Lithuania in 2015-2016: A multi-method estimation study. J Subst Abuse Treat 2020; 122:108229. [PMID: 33509418 DOI: 10.1016/j.jsat.2020.108229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/10/2020] [Revised: 08/03/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES In Lithuania, injecting heroin and other illicit opioids has dominated high-risk drug use since about 2000. More recently, patients have reported a high-risk use of amphetamines. Newly diagnosed HIV cases among people who inject drugs peaked in 2002 and 2009 and drug-related deaths have been on the increase. Yet research has reported a limited number of available harm-reduction programs. This study aimed to estimate the size of high-risk drug using populations in Lithuania and to apply these estimates in assessing the coverage of opioid substitution treatment (OST) and needle and syringe programs (NSP). METHODS We used indirect prevalence estimation methods (HIV and Mortality Multiplier, Capture-Recapture, Truncated Poisson and the Multivariate Indicator Method) to obtain annual prevalence estimates of the population of high-risk opioid users (HROU) and of people who inject drugs (PWID) in Lithuania in 2015/2016. We computed the coverage of OST (the annual percentage of HROU in these programs) and NSP (the number of provided syringes per PWID per year), using the prevalence estimates and the data from drug services. RESULTS There were between 4854 and 12,444 HROU and between 8371 and 10,474 PWID in Lithuania in 2015/2016. In addition, we obtained a preliminary estimate of 4742-7000 high-risk amphetamine users. This constitutes around 2.5-6.5 HROU and 4.4-5.3 PWID per 1000 inhabitants aged 15-64. On average, 9.9-25.5% of HROUs were in OST and an average PWID in Lithuania obtained 19-29 syringes via NSPs during the study period. CONCLUSIONS While the current prevalence of high-risk drug use in Lithuania is comparable to other European countries and for PWID, it is above the average; and the coverage of OST and NSP services in this population is markedly lower than in most countries of the European Union and warrants further investment.
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Affiliation(s)
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic; Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic; AdRes Institut, Prague, Czech Republic.
| | - Vendula Běláčková
- ResAd, Prague, Czech Republic; Social Policy Research Centre, Faculty of Arts and Social Sciences, University of New South Wales, Australia
| | | | | | | | - Emilis Subata
- Republican Centre for Addictive Disorders, Vilnius, Lithuania.
| | - Rocio Lorenzo-Ortega
- Medicine Preventive Unit, Virgen de la Victoria Hospital, Málaga, Spain; Medicine Preventive, Public Health and History of Science Department, Malaga University, Málaga, Spain
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14
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Miovský M, Miklíková S, Mravčík V, Grund JP, Černíková T. Understanding the crisis in harm reduction funding in Central and Eastern Europe. Harm Reduct J 2020; 17:83. [PMID: 33092597 PMCID: PMC7579931 DOI: 10.1186/s12954-020-00428-6] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/12/2020] [Indexed: 12/01/2022] Open
Abstract
Background The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformation had significant consequences for drug policies in the region. A large number of emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable, and closely associated with political decisions and insufficient institution building.
A sharp distinction is made between health and social services, often without regard to client input. The main objective of the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution building which represents a major threat to the future of HR services in the region. Methods Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions. Results The insufficient investments in finalising the process of the institution building of HR services have resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare. Conclusion The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s, which remains present until today, together with all its weak points. The entire situation is responsible for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept.
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Affiliation(s)
- Michal Miovský
- Department of Addictology, First Faculty of Medicine, and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Silvia Miklíková
- Department of Addictology, First Faculty of Medicine, and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, and General University Hospital in Prague, Charles University, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | | | - Tereza Černíková
- Department of Addictology, First Faculty of Medicine, and General University Hospital in Prague, Charles University, Prague, Czech Republic. .,National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic.
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15
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Pitonak M, Chomynová P, Mravčík V. Substance use, mental health, and life satisfaction in Czech straight and sexual-minority population. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Evidence shows that sexual minorities are more vulnerable to substance use and psychological distress as a result of minority stress compared with heterosexuals. So far, research conducted outside North America or Western Europe has been underrepresented. This research compares for the first time the substance use, quality of mental health and life satisfaction between the sexual minority people and heterosexuals using a nationally representative probability sample in the Czech population.
Methods
Sample of the general population aged 15+ years surveyed within the National Survey on Substance Use in 2016 in randomly selected households (N = 3,601, F2F interviews). Prevalence of licit and illicit substance use, psychological distress (MHI-5 scale) and life satisfaction (SWLS scale) were analyzed by respondents' self-reported sexual identity and behaviors. Logistic regressions were applied to evaluate the differences between groups. Adjustment for basic sociodemographic characteristics was performed.
Results
2.8% of adults identified as sexual minorities, including 0.5% lesbians or gays and 2.3% bisexuals. Sexual minorities were more likely to experiment with (illicit) substance use in the last 12 months (OR = 1.74, 95% CI: 1.03-2.94), more often experience psychological distress (OR = 2.56, 95% CI: 1.50-4.38), and were slightly less often satisfied with their lives (OR = 0.79, 95% CI: 0.46-1.37) compared to heterosexuals. Sexual minority status was not found as a significant predictor for daily tobacco smoking nor for frequent excessive/binge alcohol consumption.
Conclusions
In accordance with international evidence, sexual minorities represent a vulnerable group from the perspective of substance use and psychological distress. Factors influencing life satisfaction of sexual minority people living in geographically underrepresented regions need to be further investigated using measures more sensitive to local cultural circumstances.
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Affiliation(s)
- M Pitonak
- National Institute of Mental Health, Klecany, Czechia
| | - P Chomynová
- National Institute of Mental Health, Klecany, Czechia
- National Monitoring Centre for Drugs and Addiction, Prague, Czechia
- Faculty of Medicine, Department of Addictology, Charles University and General University Hospital, Prague, Czechia
| | - V Mravčík
- National Institute of Mental Health, Klecany, Czechia
- National Monitoring Centre for Drugs and Addiction, Prague, Czechia
- Faculty of Medicine, Department of Addictology, Charles University and General University Hospital, Prague, Czechia
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16
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Škařupová K, Vlach T, Mravčík V. Early intervention and identification of gambling disorder: a systematic literature review of strategies implemented by gambling operators. Cent Eur J Public Health 2020; 28:18-23. [PMID: 32228812 DOI: 10.21101/cejph.a5849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/02/2019] [Accepted: 12/05/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent developments in online lotteries and betting and in digitalization of land-based gambling devices bring new opportunities to track behaviour of individual players and to identify and address developing problem in its initial stages. Early identification of gambling disorder allows for timely intervention and increases the likelihood of successful recovery and minimises harms. Our review aims to examine what on-site strategies are available in both online and offline gambling venues to early identify and address the developing gambling problem while also assessing their effectiveness and strength of the evidence. METHODS We searched main academic databases and other internet resources and collected 67 peer-reviewed papers and grey literature documents that describe one or more such strategies. RESULTS Available measures ranged from information provision, gambling behaviour surveillance and associated personalized interventions to setting limits and self-exclusion. CONCLUSIONS Although a number of methods how to address disordered gambling are available to gambling operators, there is still insufficient evidence about the validity and reliability of identification strategies and about effectiveness of the intervention methods.
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Affiliation(s)
- Kateřina Škařupová
- Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Tomáš Vlach
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic.,Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic
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17
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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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18
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Chomynová P, Kozák J, Mravčík V. Substance use in Roma population in contact with social workers in the Czech Republic: A cross-sectional questionnaire survey. J Ethn Subst Abuse 2020; 20:275-294. [PMID: 31990239 DOI: 10.1080/15332640.2020.1717399] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An increasing number of studies have focused on the topic of Roma communities and social exclusion in the Czech Republic, however, substance use has been surveyed only marginally. This paper brings new data on the patterns of substance use among Roma population in contact with social workers (546 respondents). Substance use, including daily smoking and regular excessive alcohol drinking, has been 2-6 times higher among Roma compared to the general population. Current illicit substance use was reported by 1/3 of the respondents (46.7% of males, 17.8% of females) with cannabis (27.1%) and methamphetamine (11.9%) being the most reported substances.
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Affiliation(s)
- Pavla Chomynová
- Czech National Monitoring Centre for Drugs and Addictions, Office of the Government of the Czech Republic, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic.,Department of Addictology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Kozák
- Czech National Monitoring Centre for Drugs and Addictions, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Viktor Mravčík
- Czech National Monitoring Centre for Drugs and Addictions, Office of the Government of the Czech Republic, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic.,Department of Addictology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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19
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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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Mravčík V, Chomynová P, Grohmannová K, Rous Z. Gambling products and their risk potential for gambling disorder. Cas Lek Cesk 2020; 159:196-202. [PMID: 33297707] [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
Gambling brings excitement, which is a part of entertainment, but also a basis of operant conditioning, which, in conjunction with other biological and psychological factors, leads to the loss of control over the player's behaviour. This gambling disorder (problem gambling) is characterized by a high intensity and episodic character of gambling and a high amount of staked money, with negative consequences to players and their close ones. Problem gamblers have a high rate of psychiatric comorbidity, as well as suicide. Various gambling products pose a different risk of problem gambling. The game's risk is determined by the arousal for players, the social nature of the game, or the degree of skill required for gambling. It is an effect of so-called structural and situational characteristics, such as amount and variability of bets, structure and probability of win, jackpot, game speed, near wins, audio and visual effects, etc. The game risk increases also with its accessibility or with substance use while playing. In the Czech Republic, there is a high availability of electronic gaming machines (EGM) compared to the neighbouring countries; the availability of on-line games has increased dramatically in recent years. There is also an observed increase in participation in on-line gambling, not just odds and live betting, but also technical games or casino games as reported in population surveys. Estimated up to 5.7% of the adult population is at risk of problem gambling (approx. 510 thousand persons), of which 1.2-1.4% are at a high risk (approx. 80-120 thousand persons). EGMs represent the highest risk, but also casino or on-line games including odds betting, especially live betting shows high risk of problem gambling. Most of the problem gamblers are men; especially young men are highly vulnerable. Although the new Gambling Act has introduced a number of new preventive measures since 2017 according to basic types of games, the assessment of the risk potential of particular gambling products is not a part of their licensing. This contributes to increasing availability of high-risk games, especially on-line.
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Mravčík V, Kožený J, Nečas V, Tišanská L. Barriers to treatment of infectious and other somatic comorbidity in drug users. Epidemiol Mikrobiol Imunol 2020; 69:73-80. [PMID: 32819106] [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: 06/11/2023]
Abstract
BACKGROUND Intensive use of illicit drugs in general and drug injecting in particular are associated with higher somatic co-morbidity, especially of infectious aetiology. The treatment participation of drug users is complicated by a number of barriers. MATERIAL AND METHODS At the end of 2013, a cross-sectional questionnaire study was conducted on a non-random sample of 240 drug users (188 men and 52 women) recruited in low-threshold drug services in Prague based on their willingness to participate in the study. Drug injecting sometimes in their lifetime was reported by 237 respondents (98.8%), injecting drug use in the last 12 months by 232 (96.7%), and injecting drug use in the last 30 days by 228 (95.0%). The questionnaire included 38 of the 59 original items from the Barriers to Treatment Inventory (BTI). Factor analysis of these items was performed. In addition to the questionnaire survey, two focus groups with a total of 14 clients were carried out. RESULTS The factor analysis resulted in a 5-factor model that was fed with 23 BTI items. The factors identified can be interpreted as: (1) difficulty entering treatment due to additional responsibilities (e.g. children, family, work, etc.), (2) previous poor treatment experience, fear and concerns about the treatment or negative attitudes of staff, (3) financial difficulties and formal barriers (health insurance debts, problems with the law, etc.), (4) concerns that entering treatment will be too complicated and difficult, (5) distrust of the treatment's ability to improve the client's life situation. The results of the focus groups have shown that drug users face stigmatization and discrimination in healthcare facilities. CONCLUSION The access to treatment of infectious and other somatic co-morbidity in drug users is complicated by a number of barriers, which largely arise from the lifestyle and socio-economic situation associated with drug use and from negative experiences with the attitude of medical staff. Healthcare professionals should actively identify and respond to barriers to care among drug users by taking appropriate measures in the context of a multidisciplinary approach and cooperation.
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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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Abstract
BACKGROUND AND AIMS Gambling in adolescence is often related to licit and illicit substance use. Some evidence shows that teenage smokers gamble more than non-smokers. The aim of the study is to analyze the relationship between problem gambling and smoking among Czech adolescents. METHODS Data on 6,082 adolescents (50.1% boys and 49.9% girls) aged 15-19 years were collected as part of the ESPAD study in the Czech Republic in 2015. Logistic regression and linear regression models were used to test the hypothesis that the early onset of daily smoking increases the risk of problem gambling. RESULTS The age of initiation of daily smoking seems to be a more reliable marker of the risk of problem gambling than smoking status or intensity of smoking. More than 20% of smokers who started smoking daily at the age of 12 years or earlier are at risk of problem gambling, which shows a significantly increased probability compared to non-smokers (OR = 2.7). Other factors that increase the chances of becoming a problem gambler include being male, of higher age, and a student of a secondary school. DISCUSSION AND CONCLUSIONS The relationship between adolescent smoking and gambling is complex and is likely to be influenced by other underlying factors. Early daily smokers and at-risk gamblers tend in a similar way to risky behavior as a result of impulsivity. Interventions targeting early smoking and other substance-use behavior should not only aim at quitting smoking but could also include preventing smokers from developing problem gambling.
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Affiliation(s)
- Martin Špolc
- Institute of Economic Studies, Faculty of Social Sciences, Charles University in Prague, Prague, Czech Republic
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic,Epidemiological and Clinical Research of Addictions, National Institute of Mental Health, Klecany, Czech Republic,Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Barbora Drbohlavová
- Epidemiological and Clinical Research of Addictions, National Institute of Mental Health, Klecany, Czech Republic,Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavla Chomynová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic,Corresponding author: Pavla Chomynová; National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Nabrezi E. Benese 4, Prague 1, CZ-11801, Czech Republic; Phone: +420 224 003 822; E-mail:
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25
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Mravčík V, Janíková B, Drbohlavová B, Popov P, Pirona A. The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic. Harm Reduct J 2018; 15:60. [PMID: 30514306 PMCID: PMC6280526 DOI: 10.1186/s12954-018-0268-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022] Open
Abstract
Opioid agonist therapy (OAT) has been available in a standard regime in the Czech Republic since 2000. Buprenorphine is the leading medication, while methadone is available only in a few specialised centres. There is an important leakage of buprenorphine onto the illicit market, and the majority of Czech opioid users are characterised by the misuse (and injecting) of diverted buprenorphine medications. Most prescribed buprenorphine for OAT is not covered by current national health insurance schemes, and patients have to pay considerable prices to afford their treatment. This affordability barrier together with limited accessibility is likely the leading factor of limited coverage of OAT and of recent stagnation in the number of patients in the official treatment programmes in the Czech Republic. It also encourages doctor shopping and the re-selling of parts of their medication at a higher price, which represents the main factor that drives the Czech illicit market for buprenorphine, but at the same time co-finances the medication of clients in official OAT programmes. Improving access to OAT by making it financially affordable is essential to further increase OAT coverage and is one of the factors that can reduce the illicit market with OAT medications.
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Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Barbara Janíková
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Barbora Drbohlavová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Petr Popov
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Alessandro Pirona
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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26
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Stone J, Fraser H, Lim AG, Walker JG, Ward Z, MacGregor L, Trickey A, Abbott S, Strathdee SA, Abramovitz D, Maher L, Iversen J, Bruneau J, Zang G, Garfein RS, Yen YF, Azim T, Mehta SH, Milloy MJ, Hellard ME, Sacks-Davis R, Dietze PM, Aitken C, Aladashvili M, Tsertsvadze T, Mravčík V, Alary M, Roy E, Smyrnov P, Sazonova Y, Young AM, Havens JR, Hope VD, Desai M, Heinsbroek E, Hutchinson SJ, Palmateer NE, McAuley A, Platt L, Martin NK, Altice FL, Hickman M, Vickerman P. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Infect Dis 2018; 18:1397-1409. [PMID: 30385157 PMCID: PMC6280039 DOI: 10.1016/s1473-3099(18)30469-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/30/2018] [Accepted: 07/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity. FINDINGS We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40-2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28-2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94-1·65) and a 21% increase in HCV (1·21, 1·02-1·43) acquisition risk. INTERPRETATION Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID. FUNDING Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sam Abbott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Iversen
- Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Julie Bruneau
- Department of Family Medicine, Université de Montréal, Montréal, QC, Canada; Centre hospitalier de l'Université de Montreal, Montréal, QC, Canada
| | - Geng Zang
- Centre hospitalier de l'Université de Montreal, Montréal, QC, Canada
| | - Richard S Garfein
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Yung-Fen Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
| | - Tasnim Azim
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael-John Milloy
- BC Centre for Excellence in HIV/AIDS and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margaret E Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Malvina Aladashvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Faculty of Medicine, Tbilisi State University, Tbilisi, Georgia
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic; Department of Addictology, The First Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Michel Alary
- University Hospital Centre of Québec Research Centre-Laval University, QC, Canada; National Institute of Public Health of Québec, QC, Canada
| | - Elise Roy
- National Institute of Public Health of Québec, QC, Canada; Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, QC, Canada
| | - Pavlo Smyrnov
- International Charitable Foundation Alliance for Public Health, Kiev, Ukraine
| | - Yana Sazonova
- International Charitable Foundation Alliance for Public Health, Kiev, Ukraine
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, KY, USA; Center on Drug and Alcohol Research, University of Kentucky, KY, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, KY, USA
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK; National Infection Service, Public Health England, London, UK
| | - Monica Desai
- National Infection Service, Public Health England, London, UK
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Natasha K Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Frederick L Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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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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28
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Abstract
Reported incidence of human immunodeficiency virus (HIV) infection in the Czech Republic increased steeply over the past decade from 90 new cases in 2005 to 266 in 2015. This increase is almost exclusively attributed to sexual transmissions between men who have sex with men (MSM). In 2015, there were 79% (n=210) newly diagnosed cases among MSM, 17% (n=45) were attributed to heterosexual transmission and 1% (n=3) to people who inject drugs. Interventions targeted at MSM have not yet been prioritised in the broadly focused national HIV prevention strategy which this is envisaged to change in the programme set out for 2018 to 2022. The national budget for HIV prevention has been reduced, however, and this remains. Availability of voluntary counselling and testing has decreased substantially in the past decade. Post- and pre-exposure prophylaxis for sexual intercourse among MSM are not part of the HIV prevention policy and the concept of treatment as prevention is not fully recognised. Provision of a combined prevention strategy with a focus on MSM, reflecting the above factors including stigmatisation, should contribute to reverse the development of a concentrated HIV epidemic among MSM in the Czech Republic.
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Affiliation(s)
- Viktor Mravčík
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Michal Pitoňák
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Barbara Janíková
- Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Ivo Procházka
- Institute of Sexology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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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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30
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Wiessing L, Ferri M, Běláčková V, Carrieri P, Friedman SR, Folch C, Dolan K, Galvin B, Vickerman P, Lazarus JV, Mravčík V, Kretzschmar M, Sypsa V, Sarasa-Renedo A, Uusküla A, Paraskevis D, Mendão L, Rossi D, van Gelder N, Mitcheson L, Paoli L, Gomez CD, Milhet M, Dascalu N, Knight J, Hay G, Kalamara E, Simon R, Comiskey C, Rossi C, Griffiths P. Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study. Harm Reduct J 2017; 14:19. [PMID: 28431584 PMCID: PMC5401609 DOI: 10.1186/s12954-017-0141-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/04/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND AIMS Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Vendula Běláčková
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- National Institute for Mental Health, Prague, Czech Republic
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Patrizia Carrieri
- Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
- ORS PACA, Marseille, France
| | - Samuel R. Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, New York, USA
| | - Cinta Folch
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, The University of New South Wales (UNSW), Sydney, Australia
| | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jeffrey V. Lazarus
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Barcelona Institute of Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- National Institute for Mental Health, Prague, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic
| | - Mirjam Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Vana Sypsa
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ana Sarasa-Renedo
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Spanish Field Epidemiology Training Program (PEAC), National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Dimitrios Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Luis Mendão
- Group of Activists on Treatments (GAT), Lisbon, Portugal
| | - Diana Rossi
- Intercambios Civil Association and University of Buenos Aires, Buenos Aires, Argentina
| | - Nadine van Gelder
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Luke Mitcheson
- Alcohol, Drug, and Tobacco Division, Health and Wellbeing Directorate, Public Health England, London, UK
| | - Letizia Paoli
- Leuven Institute of Criminology (LINC), Faculty of Law, University of Leuven, Leuven, Belgium
- Centre for Global Governance Studies (GSS), Leuven, Belgium
| | - Cristina Diaz Gomez
- French Monitoring Centre for Drugs and Drug Addiction (OFDT), Saint-Denis, France
| | - Maitena Milhet
- French Monitoring Centre for Drugs and Drug Addiction (OFDT), Saint-Denis, France
| | - Nicoleta Dascalu
- The Romanian Association Against AIDS (ARAS), Bucharest, Romania
| | | | - Gordon Hay
- Public Health Institute, Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - Eleni Kalamara
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Roland Simon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | | | - Carla Rossi
- Centro Studi Statistici e Sociali CE3S, Rome, Italy
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
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Červený J, Chomynová P, Mravčík V, van Ours JC. Cannabis decriminalization and the age of onset of cannabis use. Int J Drug Policy 2017; 43:122-129. [PMID: 28395168 DOI: 10.1016/j.drugpo.2017.02.014] [Citation(s) in RCA: 16] [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: 02/17/2016] [Revised: 01/27/2017] [Accepted: 02/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the Czech Republic in 2010 a law was introduced decriminalizing personal possession of small quantities of several illicit drugs, including cannabis. METHODS We use 2012 survey data to examine the effect of a change in cannabis policy on the age of onset of cannabis use. We estimate the effect of the policy change using a mixed proportional hazards framework that models the transition to first cannabis use. RESULTS The change in cannabis policy did not affect the transition to first cannabis use. CONCLUSION We find no evidence of cannabis decriminalization affecting the age of onset of cannabis use.
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Affiliation(s)
- Jakub Červený
- Department of Economics, CentER, Tilburg University, The Netherlands
| | - Pavla Chomynová
- National Monitoring Center for Drugs and Addiction, The Office of the Government of the Czech Republic, Czech Republic; National Institute of Mental Health, Czech Republic
| | - Viktor Mravčík
- National Monitoring Center for Drugs and Addiction, The Office of the Government of the Czech Republic, Czech Republic; Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Czech Republic; National Institute of Mental Health, Czech Republic
| | - Jan C van Ours
- Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands; Department of Economics, University of Melbourne, Australia; Tinbergen Institute, Amsterdam/Rotterdam, The Netherlands; CEPR, London, United Kingdom.
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Lejčková P, Mravčík V, Radimecký J. Regional Comparison of Drug Use in the Czech Republic in 2002: Situation Analysis in Wider Demographic and Socioeconomic Contexts. Journal of Drug Issues 2016. [DOI: 10.1177/002204260703700107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper describes regional differences in the extent of drug use within the Czech Republic, especially in regard to wider demographic, socioeconomic, and institutional contexts. It documents the relationship that exists between the presence of environmental risk factors and the extent of related risk behaviors (e.g., criminal behavior or problematic use of psychotropic substances). Available sociodemographic and economic indicators collected from 14 regions were assessed in light of the data on the extent of criminality, distribution and funding of services for drug users, and the extent of drug use. Further on, correlation, factor and cluster analyses were made to closely observe the relationship of individual indicators and to assess the similarities within the regions. The analysis reveals that within the Czech Republic (its geographic size is similar to that of the state of South Carolina), substantial differences exist in terms of risk behaviors and drug use. The analysis illustrates that regions exhibiting the highest number of environmental risk factors also experience higher levels of personal risk taking. That is, both high drug use prevalence and negative indicators of drug use consequences are concentrated in regions experiencing extensive social problems. These findings can facilitate better targeting of the scarce resources that are designated every year for drug policy by directing them in the future to the neediest locales experiencing most severe drug-related problems. Existing regional differences should also be considered when formulating and implementing health, social, and drug policies at the national and regional levels.
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Sopko B, Škařupová K, Nečas V, Mravčík V. Estimation of Problem Drug Users in Prague in 2011 from Low-threshold Data: Modified Capture-Recapture Method, Adjusted for Clients Avoiding Any Identification (Non-Coded Clients). Cent Eur J Public Health 2016; 24:39-44. [PMID: 27070968 DOI: 10.21101/cejph.a4096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/09/2014] [Accepted: 12/21/2015] [Indexed: 11/15/2022]
Abstract
AIM Local prevalence estimates of problem drug use (PDU) are crucial in the process of assessment of drug situation and trends and for the planning of evidence-based policy responses. The aims of our study are twofold: to estimate the number of problem drug users (PDUs) in the Czech capital city in 2011, and to examine the usability of the capture-recapture method (CRM) modified for data from low-threshold programmes (LTPs) for drug users. METHOD Six independent LTPs provided data for analysis (SANANIM, Drop-in and Progressive, each of these providing one drop-in centre and one outreach programme). After adjustment of the standard CRM formula for cases without an individual identifier, the overlaps between programmes were calculated and the size of hidden population was estimated. RESULTS In total, it was estimated that there were 10,754 PDUs in Prague in 2011. The current estimate is in line with estimates obtained previously using another indirect standard approach - the multiplier method. CONCLUSION The modified version of CRM thus proved a reliable method for local PDU estimates.
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Affiliation(s)
- Bruno Sopko
- National Monitoring Centre for Drugs and Drug Addiction, Prague, Czech Republic.,Department of Medical Chemistry and Clinical Biochemistry, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Kateřina Škařupová
- Institute for Research on Children, Youth and the Family, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Vlastimil Nečas
- National Monitoring Centre for Drugs and Drug Addiction, Prague, Czech Republic.,National Institute of Mental Health, Prague, Czech Republic
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Drug Addiction, Prague, Czech Republic.,Department of Addictology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.,National Institute of Mental Health, Prague, Czech Republic
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Mravčík V, Florián Z, Nečas V, Štolfa J. [Infectious and other somatic comorbidity in problem drug users - results of a cross-sectional study with medical examination]. Epidemiol Mikrobiol Imunol 2016; 65:56-62. [PMID: 27246646] [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: 06/05/2023]
Abstract
BACKGROUND Problem drug use is associated with excess risk of infectious and other somatic diseases resulting mainly from injecting drug use. MATERIAL AND METHODS At the end of 2013, a complete medical history and physical examination was done in 40 problem drug users (30 males and 10 females), mean age 35.5 years (37.0 and 30.9, respectively), recruited in 4 low-threshold facilities in Prague. Of them, 37 were ex- or active injecting drug users, predominantly of methamphetamine (pervitin) and less often of buprenorphine. RESULTS The study physician rated the health status as -good or satisfactory in 35 participants and as unsatisfactory in five participants (12.5%). The most common pathologies were dental problems (36 participants, i.e. 90.0%) and skin conditions (15.0%). The most prevalent dental pathology was caries while dermatological disorders were mostly trophic skin lesions on the lower legs, including crural ulcers, and injection site infections. Gynaecological pathology was found in 2 of 10 females. The study subjects were most commonly diagnosed with chronic hepatitis C, status post hepatitis A and B, chronic caries, missing teeth, post-thrombotic swelling and trophic skin lesions on the lower legs, purulent skin lesions, and gastroduo-denal ulcer. A vast majority of the study participants were smokers. All were referred to various specialists for further examination or treatment, mostly to stomatology, hepatology, gastroenterology, and internal/general medicine departments. However, in reality the treatment participation rate is low among problem drug users due to the drug use-specific factors and needs that limit access to treatment. CONCLUSION The incidence of diverse somatic comorbidities requiring standard general medical care is significant among problem drug users. Infectious, dermatological, and dental pathologies are predominant. In areas with high prevalence of problem drug use, implementation of a special program should be considered to provide comprehensive medical care taking account of the special needs of this target group.
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Abstract
AIM To provide an overview of gambling and associated problems in the Czech Republic, including an overview of the historical context, legislation, prevalence, treatment and research base and agenda. METHODS A review of literature and relevant sources. RESULTS The trajectory of gambling patterns in the territory of the Czech Republic in the 20th century reflected broad socio-political changes. Those included significant expansion between the wars, strict state control and bans on some gambling activities during the communist regime and finally dynamic development characterized by a boom in electronic gaming machines (EGMs) and increasing accessibility of gambling facilities after 1989, which aggravated gambling-related problems. Many municipalities have banned EGMs, which has created conflict in regulation at state and municipal levels. The draft gambling law prepared in 2014 aims to clarify the regulatory framework. Before 2012 there was only sporadic research interest in gambling, but in 2012 the first complex research on gaming and problem gambling in the Czech population took place. The estimated prevalence of problem gambling is currently 2% in the population aged 15-64 years. Preventive measures, counselling and treatment services for problem gamblers are limited. CONCLUSIONS Weak and ineffective regulation of the gambling market in the Czech Republic during the past 20 years, despite the large growth in gambling, has led to inadequate prevention and response to problem gambling which has become a considerable public health, social and political issue.
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Affiliation(s)
- Zdeněk Szczyrba
- Department of Geography at the Faculty of Science, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, The Office of the Government of the Czech Republic, Prague, Czech Republic.,Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - David Fiedor
- Department of Geography at the Faculty of Science, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Jakub Černý
- National Monitoring Centre for Drugs and Addiction, The Office of the Government of the Czech Republic, Prague, Czech Republic.,Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Irena Smolová
- Department of Geography at the Faculty of Science, Palacký University in Olomouc, Olomouc, Czech Republic
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Mravčík V. (De)criminalisation of possession of drugs for personal use - A view from the Czech Republic. Int J Drug Policy 2015; 26:705-7. [PMID: 25814385 DOI: 10.1016/j.drugpo.2015.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/15/2014] [Accepted: 01/06/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, Czech Republic; Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
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37
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Mravčík V, Běláčková V, Grohmannová K, Zábranský T. [New psychoactive substances and their prevalence in the Czech Republic]. Cas Lek Cesk 2015; 154:216-221. [PMID: 26612328] [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: 06/05/2023]
Abstract
Recently, there is a global growing concern over the new (mainly synthetic) psychoactive substances, known as legal highs, research chemicals or bath salts. They are represented by various chemical groups imitating "old" illicit drugs with stimulant, euphoric, hallucinogenic or sedative effects. In the Czech Republic, the peak of their use and supply was observed at the beginning of 2011, when new psychoactive substances were available in smart shops known locally as Amsterdam shops - in that time mainly synthetic cathinones and also synthetic cannabinoids were present. After legislative change that placed tens of new substances under the control of criminal law in April 2011, new psychoactive substances are available at Internet and their use is (after short and media driven boom in early 2011) rather limited and decreasing. Though, the use of new synthetic stimulants was recently reported locally among problem (injecting) drug users; new very potent synthetic opioids represent potential threat of further expansion in this users subgroup.
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Mravčík V, Strada L, Reimer J, Schulte B. Hepatitis C treatment uptake and adherence among injecting drug users in the Czech Republic. Epidemiol Mikrobiol Imunol 2014; 63:265-269. [PMID: 25523218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Injecting drug users (IDUs) represent a major subpopulation of hepatitis C virus (HCV)-infected people in developed countries. Yet their uptake to treatment is generally low despite well-documented effectiveness of HCV treatment among former and active IDUs. The present study represents the first attempt to describe the HCV treatment coverage among IDUs and identify factors that affect treatment uptake in the Czech Republic. METHODS From January to March 2011, a questionnaire survey was conducted among viral hepatitis treatment centres in the Czech Republic. RESULTS From a total of 76 identified hepatitis treatment centres existing in the country, 39 provided HCV treatment to (mainly former or abstaining) IDUs in 2010. Most clinicians reported being cautious in initiating HCV treatment in IDUs. Abstinence, a screening phase before treatment initiation, opioid substitution treatment and an external evaluation by a specialist were often prerequisites for skrting treatment. However, HCV treatment centres rarely provided drug-use specific services. Financial constraints were also reported, further limiting the inclusion of IDUs into treatment, as non-users are widely preferred to active drug users. Clinicians reported no difference in treatment uptake and adherence between drug users and non-users, nor between opioid and methamphetamine users. CONCLUSION A number of system- and provider-related factors limit HCV treatment in IDUs in the Czech Republic, despite permissive national clinical guidelines. Targeting these factors is crucial to reduce HCV prevalence at population level.
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Mravčík V, Strada L, Štolfa J, Bencko V, Groshkova T, Reimer J, Schulte B. Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: a literature review. Patient Prefer Adherence 2013; 7:1067-75. [PMID: 24204126 PMCID: PMC3804540 DOI: 10.2147/ppa.s49113] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION AND METHODS Hepatitis C virus (HCV) infections are highly prevalent amongst people who inject drugs (PWID). Despite well documented evidence of its effectiveness, suggested cost-effectiveness, and potential to reduce HCV prevalence rates, the uptake of antiviral HCV treatment by PWID is low. This nonsystematic literature review describes factors associated with the uptake, adherence, and efficacy of HCV treatment among PWID and discusses strategies to increase their uptake of treatment. RESULTS Low HCV treatment uptake among PWID is associated with a number of patient-related and provider-related barriers. Beliefs and fears about low efficacy and adverse effects on the patient's part are common. A substantial number of factors are associated with the chaotic lifestyle and altered social functioning of PWID, which are often associated with decompensation or relapsing into drug addiction. This may lead to perceived low adherence with treatment and low efficacy on the provider's part too, where lack of support, inadequate management of addiction, and other drug-related problems and poor treatment of side effects have been described. Practical issues such as the accessibility of treatment and finances also play a role. Strategies to improve the HCV treatment rate among PWID involve pretreatment management and assessment, a multidisciplinary approach, management of side effects, and enhanced education and counseling. CONCLUSION Specific factors are associated with poorer treatment outcomes in PWID on the side of both the patient and the treatment system. However, given that PWID can achieve treatment adherence and sustained virologic response rates comparable with those in nondrug users, drug use per se should not be considered a criterion for exclusion from treatment. Further development of measures leading to higher uptake of treatment and adherence in PWID and appropriate adaptation of HCV treatment guidelines represent important tools in this regard.
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Affiliation(s)
- Viktor Mravčík
- National Monitoring Centre for Drugs and Drug Addiction, Prague, Czech Republic
- Department of Addictology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- Correspondence: Viktor Mravčík, National Monitoring Centre for Drugs and Drug Addiction, Office of the Government of the Czech Republic, Nábřeží E Beneše 4, 118 01 Prague 1, Czech Republic, Tel +420 296 153 354, Fax +420 296 153 264, Email
| | - Lisa Strada
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Josef Štolfa
- Department of General Practice, Institute for Postgraduate Medical Education in Prague, Prague, Czech Republic
- Department of General Practice, Second Faculty of Medicine, Prague, Czech Republic
| | - Vladimir Bencko
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Teodora Groshkova
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
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Mravčík V, Sopko B. [Prevalence estimates of problem drug users in the Czech Republic in 2006 and 2007 using the capture-recapture method]. Epidemiol Mikrobiol Imunol 2013; 62:74-82. [PMID: 23964968] [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: 06/02/2023]
Abstract
BACKGROUND An estimate of problem drug use prevalence is a substantial part of the monitoring of the epidemiological situation in drug use and its consequences and an important indicator for drug policy implementation. The capture-recapture method (CRM) is one of the most commonly used standard methods for this purpose worldwide. METHODS AND MATERIAL The CRM was used to estimate the numbers of problem drug users (PDU) and problem users of opiates/opioids (PUO) in the Czech Republic in 2006 and 2007. The following data sources were used: the General Health Insurance Company records of payments to out- and in-patient psychiatric care providers, records of admissions to psychiatric hospitals, replacement therapy register, and reports of newly diagnosed cases of viral hepatitis. Cases were defined as diagnoses F11, F15, and F19 according to the International Classification of Diseases, Tenth Revision (ICD-10) from the health insurance and admission records, the replacement therapy register covers PUO by definition, and injecting drug users were selected from reported cases of viral hepatitis. Log-linear analysis in Rcapture (R) was performed and the Akaike information criterion was used for model selection. RESULTS Altogether 12,882 and 13,505 individuals entered into analysis of PDUs and 5146 and 5409 individuals entered into analysis of PUO in 2006 and 2007, respectively. The estimates of PDUs were 23,900 (95% CI: 20,700-28,500) in 2006 and 31,000 (25,500-39,400) in 2007. The estimates of PUO were 6,864 (6,641-7,113) in 2006 and 7,096 (6,871-7,346) in 2007. The male/female ratio was 2.2/1. In PDU estimates, 83% were in the age range 15-34 and 17% were aged above 34; in PUO estimates, the respective rates were 80% and 20%. The prevalence rates of PDU in the age range 15-64 were 2.28 and 2.95 per 1,000 population in 2006 and 2007, respectively. The prevalence rates of PUO in the age range 15-64 were 0.65 and 0.67 per 1,000 in 2006 and 2007, respectively. The highest prevalence of both PDUs and PUO was observed in the Usti Region and Prague, followed by the Karlovy Vary, Plzeň, and Central Bohemia Regions. CONCLUSION PDU estimates in the Czech Republic obtained using the CRM are consistent with those derived by other methods. The major drawbacks are the quality of potential data sources and hassles in their acquisition and preparation. The interconnection of the available data sources also limits the validity and representativeness of estimates and therefore, another independent data source(s) should be sought in the future.
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Affiliation(s)
- Viktor Mravčík
- Narodni monitorovaci stredisko pro drogy a drogove zavislosti, Praha.
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Mravčík V, Burešová Z, Popov P, Miovský M. [Sobering-up stations in the Czech Republic in the context of analogous models of care for acute intoxications in Europe]. Cas Lek Cesk 2013; 152:129-134. [PMID: 23822545] [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: 06/02/2023]
Abstract
BACKGROUND To map systems of care for persons with acute intoxications with alcohol and other drugs in European countries, to identify various models of this care and to contribute to discussion on the reform of sobering-up stations in the Czech Republic. METHODS In 2012, a questionnaire survey was performed among national institutions which are focal points to European monitoring centre for drugs and drug addiction. All 27 EU member states, Norway, Croatia and Turkey were addressed, altogether 30 countries. Questionnaire consisted of 4 open questions. RESULTS 16 countries responded. Specific system of supervised recovery, which is close to the system of sobering-up stations in the Czech Republic, exists in 5 countries, i.e. approximately one third of participating countries. In remaining 11 countries, a care of boozers and persons intoxicated with other drugs is provided within acute or intensive medical care or in case of public nuisance by police. Model of sobering-up stations existed in past in countries of the Soviet bloc. Aside from the Czech Republic, sobering-up stations have remained in Poland, where the functions of the service as well as status and rights of clients were reformed. The change has an impact on the increase of prestige of the service and sobering-up stations are regarded as the essential element of medical care for the intoxicated persons. Special sobering-up services can play in different countries similar functions: supervised recovery and care for intoxicated persons, prevention of health harms and injuries, counselling and motivation of clients to reduce the drug consumption and to start treatment, facilitating further special addiction care and prevention of public nuisance and damages to other persons and properties. CONCLUSIONS Special system of care of boozers and persons acutely intoxicated with other drugs exists in several European countries with number of useful public health and public order functions. It diverts uncomplicated intoxications from intensive medical care or police intervention, which is efficient also in economical terms. The reform of the system of sobering-up stations in the Czech Republic should take into account its role within the system of addiction prevention and treatment, status and rights of clients and issues of financing and payments for the service.
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Affiliation(s)
- Viktor Mravčík
- Narodni monitorovaci stredisko pro drogy a drogove zavislosti, Praha
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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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Mravčík V, Škařupová K, Orlíková B, Zábranský T, Karachaliou K, Schulte B. Use of gelatine capsules for application of methamphetamine: A new harm reduction approach. International Journal of Drug Policy 2011; 22:172-3. [DOI: 10.1016/j.drugpo.2010.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 11/27/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
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