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.

• MeSH
• dítě MeSH
• kohortové studie MeSH
• lidé MeSH
• methamfetamin * škodlivé účinky   MeSH
• morbidita MeSH
• opioidní analgetika terapeutické užití   MeSH
• poruchy spojené s užíváním opiátů * epidemiologie   farmakoterapie   MeSH
• registrace MeSH
• těhotenství MeSH
• zpožděný efekt prenatální expozice * epidemiologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

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.

• MeSH
• buprenorfin * terapeutické užití   MeSH
• lidé MeSH
• methadon škodlivé účinky   MeSH
• opiátová substituční terapie škodlivé účinky   metody   MeSH
• poruchy spojené s užíváním opiátů * farmakoterapie   MeSH
• předávkování léky * epidemiologie   farmakoterapie   etiologie   MeSH
• registrace MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

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.

• MeSH
• kohortové studie MeSH
• lidé MeSH
• poruchy spojené s užíváním opiátů * MeSH
• předávkování léky * MeSH
• příčina smrti MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Toto číslo Zaostřena je věnováno studii Sčítání adiktologických služeb 2020, která se zaměřila na popis sítě adiktologických služeb v České republice a na popis charakteristik služeb, jako je organizační struktura, klientela služeb, nabízené a poskytované intervence, personální a finanční zabezpečení. V úvodu jsou popsány dosud známé informace o síti adiktologických služeb v ČR, dále je představena metodika studie a její výsledky. Souhrn hlavních výsledků je uveden v závěru.

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• Klíčová slova
• adiktologické služby,
• MeSH
• dostupnost zdravotnických služeb statistika a číselné údaje   zákonodárství a právo   MeSH
• lidé MeSH
• poruchy spojené s užíváním psychoaktivních látek * terapie   MeSH
• poskytování zdravotní péče * statistika a číselné údaje   zákonodárství a právo   MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH

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.

• MeSH
• kohortové studie MeSH
• komplikace těhotenství * MeSH
• lidé MeSH
• methamfetamin škodlivé účinky   MeSH
• novorozenec MeSH
• předčasný porod MeSH
• těhotenství MeSH
• výsledek těhotenství * MeSH
• zpožděný efekt prenatální expozice * MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

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.

• MeSH
• lidé MeSH
• opiátová substituční terapie * MeSH
• poruchy spojené s užíváním opiátů * farmakoterapie   epidemiologie   MeSH
• registrace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Dánsko MeSH
• Norsko MeSH

Zpráva shrnuje současnou situaci v oblasti drogové závislosti a nelegálních drog v Česku. Určeno odborné veřejnosti.

• MeSH
• poruchy spojené s užíváním psychoaktivních látek MeSH
• sociální problémy MeSH
• zakázané drogy MeSH
• Publikační typ
• zprávy MeSH
• Geografické názvy
• Česká republika MeSH

• Konspekt
• Hygiena. Lidské zdraví
• NLK Obory
• adiktologie
• veřejné zdravotnictví

Zpráva, která shrnuje současnou situaci v oblasti užívání a zneužívání alkoholu v Česku. Určeno odborné veřejnosti.

• MeSH
• pití alkoholu MeSH
• poruchy způsobené alkoholem MeSH
• sociální problémy MeSH
• Publikační typ
• zprávy MeSH
• Geografické názvy
• Česká republika MeSH

• Konspekt
• Hygiena. Lidské zdraví
• NLK Obory
• adiktologie
• veřejné zdravotnictví

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.

• MeSH
• dítě MeSH
• dospělí MeSH
• hypotrofický novorozenec fyziologie   MeSH
• komplikace těhotenství ekonomika   epidemiologie   MeSH
• lidé MeSH
• novorozenec MeSH
• porodní hmotnost účinky léků   fyziologie   MeSH
• poruchy spojené s užíváním psychoaktivních látek ekonomika   epidemiologie   MeSH
• předčasný porod ekonomika   epidemiologie   MeSH
• prenatální péče ekonomika   MeSH
• registrace * MeSH
• rizikové faktory MeSH
• růstová retardace plodu ekonomika   epidemiologie   MeSH
• socioekonomické faktory * MeSH
• těhotenství MeSH
• výsledek těhotenství ekonomika   epidemiologie   MeSH
• zpožděný efekt prenatální expozice ekonomika   epidemiologie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

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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• MeSH
• lidé MeSH
• pití alkoholu * epidemiologie   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH