OBJECTIVES: We aimed to develop a Service Capacity Index for Substance Use Disorders (SCI-SUD) that would reflect the capacity of national health systems to provide treatment for alcohol and drug use disorders, in terms of the proportion of available service elements in a given country from a theoretical maximum. METHODS: Data were collected through the WHO Global Survey on Progress with Sustainable Development Goals (SDG) Health Target 3.5, conducted between December 2019 and July 2020 to produce the SCI-SUD, based on 378 variables overall. RESULTS: The SCI-SUD was directly derived for 145 countries. We used multiple imputation to produce comparable SCI-SUD estimates for countries that did not submit data (40 countries) or had very high level of missingness (9 countries). The final SCI-SUD demonstrates considerable consistency and internal stability and is strongly associated with the macro-level economic, healthcare-related and epidemiologic (such as prevalence rates) variables. CONCLUSION: The presented methodology represents a step forward in monitoring the global situation in regard to the development of treatment systems for SU disorders, however, further work is warranted to improve the external validity of the measure (e.g., in-depth data generation in countries) and ensure its feasibility for regular reporting (e.g., reducing the number of variables).

• Klíčová slova
• global estimates, global monitoring, health systems, service capacity, substance use disorders,
• MeSH
• ethanol MeSH
• lidé MeSH
• poruchy spojené s užíváním psychoaktivních látek * epidemiologie   terapie   MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• ethanol MeSH

Ecosystem services (ESs) have received widespread attention worldwide for their potential to solve sustainability issues. However, extensive land use and land cover change (LUCC) driven by human activities has raised concerns regarding its impacts on ESs, especially in coastal zones. More importantly, spatial-temporal changes, their coupling relationships with LUCC, and their underlying drivers have not been thoroughly analyzed. This study focuses on China's coastal zones to investigate the spatial-temporal changes of ecosystem service multifunctionality (ESM) from 2000 to 2018. Coupling coordination degree (CCD) analysis of the relationship between ESM and comprehensive intensity of land use was applied to identify coastal cities with low-level coordination and their main drivers in 2018. The results show that: (1) the proportion with high levels of ESM decreased by 1.01% from 2000 to 2010 and then increased by 3.29% from 2010 to 2018; (2) the ESM of China's coastal zones present significant spatial heterogeneity, and the low levels of ESM are mainly distributed in the north and urban areas, while most areas in the southern coastal zones have high levels of ESM; (3) forest land is the leading land cover type for ESM, and China's forest conservation policies significantly contribute to the increase in ESM; (4) the CCD of most cities in the southern coastal zones, apart from Shanghai and the Pearl River Delta, is at a relatively high level and experiences no significant changes, while most cities in the northern coastal zones display an improving trend; (5) the land use type, landform type, and leaf area index are the determinants of ESM, and the annual average temperature, population density, and surface elevation are the greatest influences on the CCD. The findings of this study can inform ecological conservation and landscape planning and are beneficial to the sustainable development of coastal zones in China.

• Klíčová slova
• Coastal zones, Comprehensive intensity of land use, Coupling coordination analysis, Ecosystem service multifunctionality, Explanatory power,
• MeSH
• ekosystém * MeSH
• lesy MeSH
• lidé MeSH
• velkoměsta MeSH
• zachování přírodních zdrojů * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Čína MeSH
• velkoměsta MeSH

Background We aimed to determine the prevalence and gap in use of mental health services for late-life depression in four European regions (Western Europe, Scandinavia, Southern Europe and Central and Eastern Europe) and explore socio-demographic, social and health-related factors associated with it. Methods We conducted a cross-sectional study based on data from the Survey on Health, Ageing and Retirement in Europe. Participants were a population-based sample of 28 796 persons (53% women, mean age 74 years old) residing in Europe. Mental health service use was estimated using information about the diagnosis or treatment for depression. Results The prevalence of late-life depression was 29% in the whole sample and was highest in Southern Europe (35%), followed by Central and Eastern Europe (32%), Western Europe (26%) and lowest in Scandinavia (17%). Factors that had the strongest association with depression were total number of chronic diseases, pain, limitations in instrumental activities of daily living, grip strength and cognitive impairment. The gap in mental health service use was 79%. Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization.

• Klíčová slova
• Depression, Epidemiology, Europe, Old age,
• MeSH
• činnosti denního života MeSH
• deprese epidemiologie   terapie   MeSH
• důchod statistika a číselné údaje   MeSH
• kvalita života * MeSH
• lidé MeSH
• prevalence MeSH
• průřezové studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• služby péče o duševní zdraví statistika a číselné údaje   MeSH
• stereotypizace MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

Background: Timely information about trends in psychoactive substance use could yield tailored interventions and reduce potential harms. However, conventional epidemiological tools might have limited capacity to detect trends emerging on a local level. Objectives: The aim of this study was to explore best practice in the identification of new drug trends at the local level. Methods: A total of 33 key informants from seven European municipalities/regions were interviewed to describe trends in substance use in their locality and to provide expert insights on how these were identified. Semi-structured interviews were analyzed with open coding method. Results: Four case studies that described local trends and responses were compiled: onset of problematic GHB use in the Dutch municipality of Breda (1); emerging retail shops selling new psychoactive substances (NPS) across the regions of Czech Republic (2) and in the Portuguese Agueda and Coimbra (3); and use of drugs with unknown content in the Italian region of Emilia Romagna, and its city Bologna (4). "Early identifiers" in the four case studies were organizations that work directly with people who use drugs (PWUD), emergency departments, and local police. Efficient methods of horizontal and vertical information sharing, sometimes facilitated by communication platforms, were in place, such that included early warning systems on local, national, and supra-local level. Local-level identification systems appeared as best suited to provide locally relevant information. Conclusions: Best practice in identifying emerging trends should involve all relevant "early identifiers", should consist of supra-local exchange platforms, integrate the qualities of local-level identification, and be facilitated by local-level coordinators.

• Klíčová slova
• New psychoactive substances, key informant interviews, open coding, trend identification and response, trends in substance use,
• MeSH
• hodnocení rizik metody   trendy   MeSH
• lidé MeSH
• policie MeSH
• poruchy spojené s užíváním psychoaktivních látek epidemiologie   MeSH
• psychotropní léky aplikace a dávkování   MeSH
• samoléčba statistika a číselné údaje   MeSH
• šíření informací MeSH
• urgentní služby nemocnice MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Názvy látek
• psychotropní léky MeSH

BACKGROUND: Evidence regarding the efficacy or effectiveness of the disease-modifying drugs (DMDs) in the older multiple sclerosis (MS) population is scarce. This has contributed to a lack of evidence-based treatment recommendations for the ageing MS population in practice guidelines. We examined the relationship between age (<55 and ≥55 years), DMD exposure and health service use in the MS population. METHODS: We conducted a population-based observational study using linked administrative health data from British Columbia, Canada. We selected all persons with MS and followed from the most recent of their first MS or demyelinating event, 18th birthday or 01-January-1996 (index date) until the earliest of emigration, death or 31-December-2017 (study end). We assessed DMD exposure status over time, initially as any versus no DMD, then by generation (first or second) and finally by each individual DMD. Age-specific analyses were conducted with all-cause hospitalizations and number of physician visits assessed using proportional means model and negative binomial regression with generalized estimating equations. RESULTS: We included 19,360 persons with MS (72% were women); 10,741/19,360 (56%) had ever reached their 55th birthday. Person-years of follow-up whilst aged <55 was 132,283, and 93,594 whilst aged ≥55. Any DMD, versus no DMD in the <55-year-olds was associated with a 23% lower hazard of hospitalization (adjusted hazard ratio, aHR0.77; 95%CI 0.72-0.82), but not in the ≥55-year-olds (aHR0.95; 95%CI 0.87-1.04). Similar patterns were observed for the first and second generation DMDs. Exposure to any (versus no) DMD was not associated with rates of physician visits in either age group (<55 years: adjusted rate ratio, aRR1.02; 95%CI 1.00-1.04 and ≥55 years: aRR1.00; 95%CI 0.96-1.03), but variation in aRR was observed across the individual DMDs. CONCLUSION: Our study showed beneficial effects of the DMDs used to treat MS on hospitalizations for those aged <55 at the time of exposure. In contrast, for individuals ≥55 years of age exposed to a DMD, the hazard of hospitalization was not significantly lowered. Our study contributes to the broader understanding of the potential benefits and risks of DMD use in the ageing MS population.

• Klíčová slova
• ageing, cohort studies, disease-modifying drugs, health services, hospitalization, multiple sclerosis, physician services,
• MeSH
• ambulantní péče MeSH
• antirevmatika terapeutické užití   MeSH
• geriatrické hodnocení MeSH
• hospitalizace statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• ochrana veřejného zdraví MeSH
• pacientův souhlas se zdravotní péčí statistika a číselné údaje   MeSH
• roztroušená skleróza farmakoterapie   epidemiologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spotřeba léčiv statistika a číselné údaje   MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antirevmatika MeSH

BACKGROUND: There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). METHODS: We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model. RESULTS: Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors. CONCLUSION: In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. TRIAL REGISTRATION: PROSPERO registration number: 42016046551 .

• Klíčová slova
• Andersen behavioural model, Anxiety, Barriers to care, Common mental disorders, Depression, Health service utilisation, Healthcare access, Systematic review, Treatment seeking,
• MeSH
• chudoba MeSH
• dospělí MeSH
• duševní poruchy terapie   MeSH
• duševní zdraví statistika a číselné údaje   MeSH
• etnicita statistika a číselné údaje   MeSH
• komorbidita MeSH
• lidé MeSH
• senioři MeSH
• služby péče o duševní zdraví organizace a řízení   MeSH
• sociální opora MeSH
• zaměstnanost statistika a číselné údaje   MeSH
• zdravotní stav * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH

Latency is one of the key parameters of Internet services. However, it is difficult to correctly assess a service by its latency. Many latency measurements are blocked en route by routers and firewalls. For this reason, the service latency is not fully known. This work proposes a method to assess Internet services including the blocked latency measurements. Survival theory is applied to process latency values. The results show that the omission of blocked latencies from statistical processing severely underestimates the service latency. Two Internet service providers were compared as an example. Their latency difference was 9 ms using the traditional approach. The survival latency resulted in a difference of 17 ms. The method of survival latency can be used to increase revenues in e-commerce and to improve the experience of online gaming.

• Klíčová slova
• CDN, E-commerce, IP address, ISP, Internet, Latency, Measurement, Service,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Substance use disorders constitute a major global public health problem, attributable largely to their subsequent comorbidity with other health conditions. This study aimed to investigate the risk of all-cause death and life-years lost following hospitalisation for 28 subsequent physical comorbid conditions in people with a previous hospitalisation for substance use disorder, compared with matched counterparts without substance use disorder. METHODS: We did a retrospective cohort study on data from Czech nationwide registers of all-cause hospitalisations and deaths during the period from Jan 1, 1994, to Dec 31, 2017. The cohorts consisted of individuals who had initially been hospitalised between 15 and 70 years of age (index hospitalisation) and who were subsequently hospitalised with one or more of 28 comorbid physical health conditions. We included individuals with an index hospitalisation for substance use disorders and up to three counterparts without substance use disorders with a subsequent hospitalisation for the same physical health condition, with matching on sex, age (±3 years), work status, and discharge year at first hospitalisation for the subsequent condition. Data on ethnicity were not available. Risk of death due to any cause following the first hospitalisation for each physical health condition until Dec 31, 2017, and life-years lost after disease onset at ages 30, 45, and 60 years, and before 81 years of age, were examined. FINDINGS: From a total 56 229 563 records of hospitalisations identified, we included 121 153 people with hospitalisation for substance use disorders and 6 742 134 people without hospitalisation for substance use disorders in the study. The 28 condition-specific cohorts comprised a median of 6444 individuals (IQR 2033-12 358), ranging from 444 for multiple sclerosis to 36 356 for diseases of the circulatory system. Across the cohorts, the proportion of males ranged from 31·4% for thyroid disorder to 100·0% for prostate disorders. The mean baseline age ranged from 30·0 years (SD 9·1) for chronic viral hepatitis in people with pre-existing substance use disorders to 62·2 years (9·7) for Parkinson's disease in people without pre-existing substance use disorders. After adjusting for potential confounders using stratified Cox proportional hazards models, individuals with a pre-existing substance use disorder had an increased risk of death due to any cause after the onset of 26 out of 28 physical health conditions, relative to their counterparts without substance use disorders, with adjusted hazard ratios ranging from 1·15 (1·09-1·21) for chronic liver disease to 3·86 (2·62-5·67) for thyroid disorder. For seven subsequent health conditions, the risk of death was more than doubled in the group with pre-existing substance use disorders. When compared with the general population via mortality tables, people with pre-existing substance use disorders had substantial losses in life-years after the onset of most of the subsequent physical health conditions regardless of age of onset, and, for the majority of comorbidities, lost considerably more life-years than their counterparts without substance use disorders. INTERPRETATION: A history of hospitalisation for substance use disorders appears to have a significant negative effect on prognosis following the development of various subsequent physical health conditions. These findings strongly suggest that clinical vigilance and high-quality integrated treatment for people with substance use disorders could be life-saving and should be given higher priority on the public health agenda. FUNDING: National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust.

• MeSH
• dospělí MeSH
• komorbidita MeSH
• lidé MeSH
• poruchy spojené s užíváním psychoaktivních látek * epidemiologie   MeSH
• registrace MeSH
• retrospektivní studie MeSH
• státní lékařství * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

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.

• Klíčová slova
• Best practice, Coverage, Drug services, Epidemiology, Evidence-based, HCV, HIV, Harm reduction, Indicators, Injecting drug users/IDU, Interventions, Knowledge exchange, Monitoring, People who inject drugs/PWID, People who use drugs/PWUD, Substance abuse,
• MeSH
• konsensus MeSH
• kvalita zdravotní péče * MeSH
• lidé MeSH
• poruchy spojené s užíváním psychoaktivních látek terapie   MeSH
• snížení rizika poškození * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Early Intervention in Psychosis (EIP) services have been youth-focused since their inception. In England, recent National Institute for Health and Care Excellence (NICE) guidelines and new National Health Service (NHS) Standards for EIP recommend the expansion of the age acceptability criterion from 14-35 to 14-65. In the Cambridgeshire and Peterborough EIP service (CAMEO), we ran a service evaluation to assess the initial impact of this policy change. It aimed to elicit EIP treatment components utilization by patients with first-episode psychosis (FEP) aged over 35, in comparison with those under 35. We found that the over-35s required more contacts from EIP healthcare professionals, especially from care coordinators (coefficient = .239; Robust SE = .102; Z = 6.42; p = 0.019) and social workers (coefficient = 18.462; Robust SE = .692; Z = .016; p < 0.001). These findings indicate that FEP patients aged over 35 may present with more complex and sustained clinical/social needs. This may have implications for EIP service development and commissioning.

• Klíčová slova
• Age inclusivity, Early intervention, Over-35s, Psychosis, Service use,
• MeSH
• časná lékařská intervence MeSH
• lidé MeSH
• mladiství MeSH
• psychotické poruchy * terapie   MeSH
• senioři MeSH
• služby péče o duševní zdraví * MeSH
• státní lékařství MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Anglie MeSH