Given the multiple ways of regulations and market situations for new psychoactive substances (NPS), it is of interest how NPS users procure their drugs in different countries as well as in different user groups. Data comes from a face-to-face and online survey conducted in six EU countries, covering three groups of current (12-month) adult NPS users: (1) socially marginalized, (2) users in night life, and (3) users in online communities. While the supply situation differed considerably between countries, friends were the most prevalent source for buying, followed by online shops and private dealers. Marginalized users were more likely to buy from dealers, while online respondents showed the highest rates for buying online. While buying NPS from online or offline shops was relatively prevalent, we also found high rates for social supply and buying from dealers. A considerable part of this market may be classified as "social online supply," with private suppliers procuring their drugs online. The market features among marginalized users resemble more those of illicit drug markets than those for other NPS users. ; info:eu-repo/semantics/acceptedVersion
International audience ; Despite their ecological importance and diversity, spiders (Arachnida: Araneae) are underrepresented in conservation policies in comparison to other groups. We review all extant conservation tools focusing on spiders in Europe, highlighting general patterns, limitations, gaps, and future directions. We assembled a comprehensive online database reporting all available information concerning the legal protection and conservation status of 4,154 spider species. Existing international legislation has limited coverage, with only one species listed in the Bern Convention and EU Habitats Directive. At the national and subnational levels, 178 species are formally mentioned in the legislation of 19 European countries. Moreover, the International Union for Conservation of Nature (IUCN) includes assessments for 301 species worldwide, 164 of these threatened and eight native to Europe. In addition, spiders are mentioned in Regional Red Lists and Red Books in 28 out of 42 European countries considered in this review. Northern and Central European countries have the highest percentage of species assessed at the regional level in Red Lists and Red Books. The Mediterranean basin has the highest spider diversities in Europe but conservation efforts are lacking, both in terms of assessments and national or subnational legislation. Among European species, Dolomedes plantarius, Argyroneta aquatica and Eresus kollari are the most frequently mentioned in European conservation measures, possibly due to their ecological traits and their strict association with declining habitats. Considering the current threats to spiders in Europe, the protection of large areas of suitable habitat should be considered as the most effective approach to spider conservation.
International audience ; Despite their ecological importance and diversity, spiders (Arachnida: Araneae) are underrepresented in conservation policies in comparison to other groups. We review all extant conservation tools focusing on spiders in Europe, highlighting general patterns, limitations, gaps, and future directions. We assembled a comprehensive online database reporting all available information concerning the legal protection and conservation status of 4,154 spider species. Existing international legislation has limited coverage, with only one species listed in the Bern Convention and EU Habitats Directive. At the national and subnational levels, 178 species are formally mentioned in the legislation of 19 European countries. Moreover, the International Union for Conservation of Nature (IUCN) includes assessments for 301 species worldwide, 164 of these threatened and eight native to Europe. In addition, spiders are mentioned in Regional Red Lists and Red Books in 28 out of 42 European countries considered in this review. Northern and Central European countries have the highest percentage of species assessed at the regional level in Red Lists and Red Books. The Mediterranean basin has the highest spider diversities in Europe but conservation efforts are lacking, both in terms of assessments and national or subnational legislation. Among European species, Dolomedes plantarius, Argyroneta aquatica and Eresus kollari are the most frequently mentioned in European conservation measures, possibly due to their ecological traits and their strict association with declining habitats. Considering the current threats to spiders in Europe, the protection of large areas of suitable habitat should be considered as the most effective approach to spider conservation.
International audience ; Despite their ecological importance and diversity, spiders (Arachnida: Araneae) are underrepresented in conservation policies in comparison to other groups. We review all extant conservation tools focusing on spiders in Europe, highlighting general patterns, limitations, gaps, and future directions. We assembled a comprehensive online database reporting all available information concerning the legal protection and conservation status of 4,154 spider species. Existing international legislation has limited coverage, with only one species listed in the Bern Convention and EU Habitats Directive. At the national and subnational levels, 178 species are formally mentioned in the legislation of 19 European countries. Moreover, the International Union for Conservation of Nature (IUCN) includes assessments for 301 species worldwide, 164 of these threatened and eight native to Europe. In addition, spiders are mentioned in Regional Red Lists and Red Books in 28 out of 42 European countries considered in this review. Northern and Central European countries have the highest percentage of species assessed at the regional level in Red Lists and Red Books. The Mediterranean basin has the highest spider diversities in Europe but conservation efforts are lacking, both in terms of assessments and national or subnational legislation. Among European species, Dolomedes plantarius, Argyroneta aquatica and Eresus kollari are the most frequently mentioned in European conservation measures, possibly due to their ecological traits and their strict association with declining habitats. Considering the current threats to spiders in Europe, the protection of large areas of suitable habitat should be considered as the most effective approach to spider conservation.
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
