Diferencias en el consumo de drogas ilegales entre nativos e inmigrantes en una amplia muestra de consumidores de droga por vía parenteral en Cataluña (España)

Programas de reducción de daños; Inyectores de drogas; Inmigrante; HeroínaHarm reduction programs; Injected drug user; Immigrant; Heroin.Programes de reducció de danys; Injectors de drogues; Immigrant; HeroïnaEl objetivo del estudio era describir los patrones de abuso de drogas ilegales en relación con el proceso migratorio y el uso de centros de tratamiento entre los usuarios de drogas por vía inyectada (IDUs) de los programas de reducción de daños, y comparar las características de los IDUs nativos e inmigrantes. Estudio de diseño transversal de 748 IDUs de más de 18 años que fueron atendidos en los centros de reducción de daños entre 2008 y 2009. Se exploraron las diferencias en las condiciones socioeconómicas, de consumo de drogas ilegales, de estado de salud y de uso de los centros de tratamiento de drogas entre los IDUs nativos y los inmigrantes. Además, también se ha descrito si los IDUs inmigrantes empezaron a inyectarse drogas ilegales antes o después de entrar en el país de acogida. Los IDUs inmigrantes tienden a vivir solos más frecuentemente, a empezar la inyección a edad más avanzada, a usar heroína inyectada más frecuentemente y a usar menos los centros de tratamiento de drogas que los nativos. Un 66% de los inmigrantes empezaron a usar drogas ilegales antes de llegar al país de acogida. Los que empezaron en otros países llevaban 5 o menos años residiendo en el país de acogida (63,9%). En general, los IDUs inmigrantes (36,9%) frecuentaban menos los centros de tratamiento de drogas que los nativos (71,8%). En conclusión, la migración podría ser un factor de riesgo para la iniciación en el abuso de las drogas ilegales o el aumento de su consumo, a menudo adoptando los patrones de consumo local y agravándose debido al menor acceso a los centros de tratamiento de drogas.The aims of this study were to describe illegal drug abuse patterns in relation to the migration process and use of drug treatment centers among immigrant injected drug users (IDUs) involved in harm reduction programs, and to compare the characteristics of immigrant and native IDUs. Cross-sectional study of 748 IDUs aged ≥18 years attending harm reduction centers between 2008 and 2009. We explored differences in socio-economic status, illegal drug consumption, health status and use of treatment centers in native versus immigrant IDUs. We also described whether immigrant IDUs started using injected drugs before or after entering the host country. Immigrant IDUs tend to live alone more frequently, start injection at later ages, use heroin and inject it more frequently and use drug treatment centers less frequently than native IDUs. Seventy-six percent of immigrants began using illegal drugs before arriving at the host country. Those who started in other countries were residing in the host country for 5 years or less (63.9%). Overall, immigrant IDUs attended drug treatment centers (36.9%) less frequently than native IDUs (71.8%). In conclusion, migration could be a risk factor for illegal drug abuse initiation or increase in consumption, often with the adoption of local consumption patterns and aggravated due to a lower access to drug treatment centers.The study was supported by the following: Direcció General de Salut Pública, Departament de Salut, Generalitat de Catalunya; Subdirecció General de Drogodependències, Departament de Salut, Generalitat de Catalunya; Agència de Gestió d’Ajuts Universitaris i de Recerca - AGAUR (2005/SGR/00505), Departament d’Universitats, Recerca i Societat de la Informació, de la Generalitat de Catalunya; and Red de Trastornos Adictivos [RD06/0001/1018] & [RD12/0028/0018]

Is systematic training in opioid overdose prevention effective?

The objectives were to analyze the knowledge about overdose prevention, the use of naloxone, and the number of fatal overdoses after the implementation of Systematic Training in Overdose Prevention (STOOP) program. We conducted a quasi-experimental study, and held face-to-face interviews before (n = 725) and after (n = 722) implementation of systematic training in two different samples of people who injected opioids attending harm reduction centers. We asked participants to list the main causes of overdose and the main actions that should be taken when witnessing an overdose. We created two dependent variables, the number of (a) correct and (b) incorrect answers. The main independent variable was Study Group: Intervention Group (IG), Comparison Group (CG), Pre-Intervention Group With Sporadic Training in Overdose Prevention (PREIGS), or Pre-Intervention Group Without Training in Overdose Prevention (PREIGW). The relationship between the dependent and independent variables was assessed using a multivariate Poisson regression analysis. Finally, we conducted an interrupted time series analysis of monthly fatal overdoses before and after the implementation of systematic program during the period 2006-2015. Knowledge of overdose prevention increased after implementing systematic training program. Compared to the PREIGW, the IG gave more correct answers (IRR = 1.40;95%CI:1.33-1.47), and fewer incorrect answers (IRR = 0.33;95%CI:0.25-0.44). Forty percent of people who injected opioids who received a naloxone kit had used the kit in response to an overdose they witnessed. These courses increase knowledge of overdose prevention in people who use opioids, give them the necessary skills to use naloxone, and slightly diminish the number of fatal opioid overdoses in the city of Barcelon

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study.

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

Role of RhoA/ROCK-dependent actin contractility in the induction of tenascin-C by cyclic tensile strain

In chick embryo fibroblasts, the mRNA for extracellular matrix protein tenascin-C is induced 2-fold by cyclic strain (10%, 0.3 Hz, 6 h). This response is attenuated by inhibiting Rho-dependent kinase (ROCK). The RhoA/ROCK signaling pathway is primarily involved in actin dynamics. Here, we demonstrate its crucial importance in regulating tenascin-C expression. Cyclic strain stimulated RhoA activation and induced fibroblast contraction. Chemical activators of RhoA synergistically enhanced the effects of cyclic strain on cell contractility. Interestingly, tenascin-C mRNA levels perfectly matched the extent of RhoA/ROCK-mediated actin contraction. First, RhoA activation by thrombin, lysophosphatidic acid, or colchicine induced tenascin-C mRNA to a similar extent as strain. Second, RhoA activating drugs in combination with cyclic strain caused a super-induction (4- to 5-fold) of tenascin-C mRNA, which was again suppressed by ROCK inhibition. Third, disruption of the actin cytoskeleton with latrunculin A abolished induction of tenascin-C mRNA by chemical RhoA activators in combination with cyclic strain. Lastly, we found that myosin II activity is required for tenascin-C induction by cyclic strain. We conclude that RhoA/ROCK-controlled actin contractility has a mechanosensory function in fibroblasts that correlates directly with tenascin-C gene expression. Previous RhoA/ROCK activation, either by chemical or mechanical signals, might render fibroblasts more sensitive to external tensile stress, e.g., during wound healing

Induction of tenascin-C by cyclic tensile strain versus growth factors: distinct contributions by Rho/ROCK and MAPK signaling pathways

Expression of the extracellular matrix (ECM) protein tenascin-C is induced in fibroblasts by growth factors as well as by tensile strain. Mechanical stress can act on gene regulation directly, or indirectly via the paracrine release of soluble factors by the stimulated cells. To distinguish between these possibilities for tenascin-C, we asked whether cyclic tensile strain and soluble factors, respectively, induced its mRNA via related or separate mechanisms. When cyclic strain was applied to chick embryo fibroblasts cultured on silicone membranes, tenascin-C mRNA and protein levels were increased twofold within 6 h compared to the resting control. Medium conditioned by strained cells did not stimulate tenascin-C mRNA in resting cells. Tenascin-C mRNA in resting cells was increased by serum; however, cyclic strain still caused an additional induction. Likewise, the effect of TGF-beta1 or PDGF-BB was additive to that of cyclic strain, whereas IL-4 or H2O2 (a reactive oxygen species, ROS) did not change tenascin-C mRNA levels. Antagonists for distinct mitogen-activated protein kinases (MAPK) inhibited tenascin-C induction by TGF-beta1 and PDGF-BB, but not by cyclic strain. Conversely, a specific inhibitor of Rho-dependent kinase strongly attenuated the response of tenascin-C mRNA to cyclic strain, but had limited effect on induction by growth factors. The data suggest that regulation of tenascin-C in fibroblasts by cyclic strain occurs independently from soluble mediators and MAPK pathways; however, it requires Rho/ROCK signaling

How do fibroblasts translate mechanical signals into changes in extracellular matrix production?

Mechanical forces are important regulators of connective tissue homeostasis. Our recent experiments in vivo indicate that externally applied mechanical load can lead to the rapid and sequential induction of distinct extracellular matrix (ECM) components in fibroblasts, rather than to a generalized hypertrophic response. Thus, ECM composition seems to be adapted specifically to changes in load. Mechanical stress can regulate the production of ECM proteins indirectly, by stimulating the release of a paracrine growth factor, or directly, by triggering an intracellular signalling pathway that activates the gene. We have evidence that tenascin-C is an ECM component directly regulated by mechanical stress: induction of its mRNA in stretched fibroblasts is rapid both in vivo and in vitro, does not depend on prior protein synthesis, and is not mediated by factors released into the medium. Fibroblasts sense force-induced deformations (strains) in their ECM. Findings by other researchers indicate that integrins within cell–matrix adhesions can act as ‘strain gauges’, triggering MAPK and NF-κB pathways in response to changes in mechanical stress. Our results indicate that cytoskeletal ‘pre-stress’ is important for mechanotransduction to work: relaxation of the cytoskeleton (e.g. by inhibiting Rho-dependent kinase) suppresses induction of the tenascin-C gene by cyclic stretch, and hence desensitizes the fibroblasts to mechanical signals. On the level of the ECM genes, we identified related enhancer sequences that respond to static stretch in both the tenascin-C and the collagen XII promoter. In the case of the tenascin-C gene, different promoter elements might be involved in induction by cyclic stretch. Thus, different mechanical signals seem to regulate distinct ECM genes in complex ways

Estimating trends in injecting drug use in Europe using national data on drug treatment admissions.

The report describes trends in drug injection in the EU Member States, Norway and Turkey between 2000 and 2011, through an analysis of data on those admitted to drug treatment. Results indicate that current drug injection, including its incidence, has declined in recent years in Europe. While heroin remains the drug most frequently involved in drug injection, data show how drug injectors are now more likely to be using stimulants than in the past

Marketing of food, non-alcoholic, and alcoholic beverages. A toolkit to support the development and update of codes of conduct.

Public health policy makers have identified the restriction of marketing of foods, non-alcoholic, and/or alcoholic beverages that promote unhealthy diets and practices to children and adolescents as an area of urgent action. This is backed by international reference organisations such as the World Health Organization, the Organisation for Economic Co-operation and Development, and UNICEF. Marketing codes of conduct, either generic marketing codes or specific to foods, non-alcoholic, and/or alcoholic beverages, are normally used to address such practices. At EU level, the Audiovisual Media Services Directive (AVMSD) has recently been revised; the Directive applies to all services with audiovisual content and it governs EU-wide coordination of national legislation on several areas, including commercial communications and protection of minors. The AVMSD calls for effectively reducing the exposure of children to audiovisual commercial communications of foods and beverages that are high in salt, sugars, fat, saturated fats or trans-fatty acids or that otherwise do not fit national or international nutritional guidelines. Similarly, it calls for effectively reducing the exposure of children and minors to audiovisual commercial communications of alcoholic beverages. EU Member States should attain such reductions, using tools that work, including codes of conduct. Furthermore, the AVMSD protects consumers and especially minors regarding the processing of their personal data, stating that such personal data should not be used for commercial purposes. For both these major reasons, its transposition at national level is seen as an opportunity to expand, re-inforce or introduce effective measures to reduce food, non-alcoholic, and alcoholic beverages marketing pressure to children and adolescents. This toolkit aims to contribute to strengthening the expertise of EU Member States in this area. It is based on a thorough analysis of statutory, co- and self-regulatory marketing codes that are in place in the EU and beyond. The following aspects were examined: general characteristics, scope, target audience, addressed marketing techniques, included measures, as well as information on implementation, monitoring and evaluation. The development of the toolkit has benefited from valuable comments of national experts from EU Member States on nutrition and physical activity and on alcohol, as well as thoughtful discussion and feedback from a group of top international experts in the area of marketing consulted during a dedicated workshop organised by the JRC in May 2018. The toolkit comprises a checklist of the main aspects that a marketing code should include. This will be useful both when initiating the policy-making process and when updating existing codes. Practical guidance is then provided for each of the aspects incorporated in the checklist. This guidance is given in the form of an inventory of specific actions extracted and adapted from existing marketing codes for food and beverages, including alcoholic beverages, and that can inspire future codes. The toolkit also addresses current challenges with regard to digital marketing and offers some insights on potential solutions. The EU Member States can use the checklist and the practical guidance to update their codes for restricting marketing of food, non-alcoholic, and alcoholic beverages or introduce new ones. This toolkit ultimately aims to protect consumers, especially children and minors, in the EU from the effects of the marketing of such products.JRC.F.1-Health in Societ