Suchergebnisse

Drug users are generally thought to experience higher mortality rates than those found among the general population. This study analyzes mortality rates among different subgroups of drug users in the Czech Republic. For this project, a retrospective cohort mortality study was conducted. A cohort of 12,207 persons aged 15 to 49 who had been hospitalized for drug related behavioral disorders was followed from 1997 to 2002. The study findings indicate that direct standardized mortality for the cohort of drug users was 16.78 per 1000 person-years (PY); 22.38 for men and 11.18 per 1000 PY for women. After reaching a peak in 1998, mortality rates began to decrease and stabilized around 14 per 1,000 PY from 2000 to 2002. When compared to the rates found in the general population, drug user mortality is eight times higher than nonuser rates (SMR = 8.15; 8.13 for men and 8.22 for women). These mortality rates are highest among polyvalent drug and opiate users and lowest among stimulant users. The authors conclude that the overall mortality of opiate users in the Czech Republic is relatively low when compared with those reported in similar European and non-European studies. There were few overdoses found in the cohort, and in sharp contrast to other available studies, no AIDS related cases were observed.

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.

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.

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 ...

<b><i>Background:</i></b> There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy. <b><i>Objectives:</i></b> To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP). <b><i>Method:</i></b> A cohort study using nationwide registries in Czechia (2000–2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (<i>n</i> = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (<i>n</i> = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (<i>n</i> = 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 (<i>b</i>) and odds ratios from multivariable linear and binary logistic regression were estimated. <b><i>Results:</i></b> 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] <i>b</i> = 122.3 g, 95% CI: 26.0–218.5) and length (aMD <i>b</i> = 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 <i>b</i> = −63.0 g, −123.0 to −3.1) and birth length (aMD <i>b</i> = −0.3 cm, −0.6 to 0.0). <b><i>Conclusions:</i></b> 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.

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.