Alcohol harm reduction in Europe.

This chapter provides an overview of harm reduction approaches to alcohol in Europe. First, definitions ascribed to alcohol harm reduction are outlined. Then, evaluated alcohol harm reduction interventions in European countries are described and the evidence for their effectiveness examined. These include multi-component programmes, improvements to the drinking environment, and initiatives to reduce the harms associated with drink-driving. Third, harm reduction activities that have been recorded and described but not yet evaluated are briefly outlined. These include ‘grassroots’ initiatives and more formal local initiatives. To conclude, the chapter raises questions about how alcohol harm reduction is defined and put into practice, the evidence-base that is available for policymakers, and how information is shared. It highlights the need to develop systems to facilitate knowledge transfer on alcohol harm reduction between researchers, policymakers and practitioners in Europe but stresses the importance of respecting local and cultural diversity in the development and implementation of harm reduction initiatives

Unintended consequences of drug policies experienced by young drug users in contact with the criminal justice systems

The aim of this paper is to assess to what extent prohibitive drug policies hamper the management of drug problems from the perspective of young people who have experience with the criminal justice systems (CJS). Qualitative, in-depth interviews were carried out in six European countries (Austria, Denmark, Germany, Italy, Poland, and the UK) following a common interview guide to obtain comparative data on the life trajectories of drug experienced youth. Altogether 198 interviews with people aged 14–25 years were collected and analysed by national teams following a common coding book. Unintended consequences of drug policies for the individual and society were identified. Individual consequences included health consequences and traumatic experiences with law enforcement. Social consequences included those affecting social relations such as stigmatisation and those impacting on institutions, for example, focusing on drug use and neglecting other problems. This paper confirmed earlier research indicating unintended consequences of prohibitive drug policies but also added to the literature its cross-national perspective and use of young people narratives as a source of analyses. There are, however, policy measures available that may reduce the volume and range of unintended effects. Their implementation is crucial to reduce the array of unintended consequences of prohibitive drug policies

Stakeholder ownership: a theoretical framework for cross national understanding and analyses of stakeholder involvement in issues of substance use, problem use and addiction

This project contributes to understanding of the role of different stakeholder groups in the formulation and implementation of policy in the addictions field in Austria, Denmark, Finland, Italy, Poland and the UK. It comprises a number of case studies which draw on a range of theoretical frameworks to examine stakeholder dynamics at international, national and local levels. Mainly qualitative methods were used: interviews, policy and documentation analyses, webcrawler network analysis, and simple surveys; one case study was based on a survey only. The case studies fall into four main categories: three focus on controversial issues in drug treatment policy and practice – opioid substitution treatment, drug consumption rooms, and heroin assisted treatment; three look at stakeholder activity in alcohol control and public health; one pilot case study considers the potential role of researchers in the development of a scientific network around gambling; and one looks at the role of nurses in implementing brief interventions. In addition, themes explored across case studies included the role of evidence and stakeholder activity, drug users as stakeholders, and the role of external stakeholders on national policy. Professional stakeholders at implementation level and families and drug users as stakeholders are also considered. The case studies revealed that, in many instances, the addictions field is characterised by tensions between groups, by entrenched relationships between some addiction-specific stakeholder groups and powerful political stakeholders, and by the dominance of some forms of evidence over other forms of knowledge. Science and scientists are only influential in policy terms if their scientific findings ‘fit’ with the wider political context. Nevertheless, at least within the European context, there are opportunities for new stakeholder groups to emerge and gain policy salience and there are opportunities for stakeholders to challenge prevailing frames of understanding the addictions and prevailing modes of responding to problems of substance misuse and addiction

Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys

Funding: The WMH surveys were supported by the United States National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, Bristol-Myers Squibb and Shire. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/ 00204-3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The WMHI was funded by WHO (India) and helped by Dr R Chandrasekaran, JIPMER. Implementation of the Iraq Mental Health Survey (IMHS) and data entry were carried out by the staff of the Iraqi MOH and MOP with direct support from the Iraqi IMHS team with funding from both the Japanese and European Funds through United Nations Development Group Iraq Trust Fund (UNDG ITF). The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14- TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese National Mental Health Survey (LEBANON) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), Fogarty International, Act for Lebanon, anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from Janssen Cilag, Eli Lilly, GlaxoSmithKline, Roche, and Novartis. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the PanAmerican Health Organization (PAHO). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The Romania WMH study projects ‘Policies in Mental Health Area’ and ‘National Study regarding Mental Health and Services Use’ were carried out by National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, SC. Cheyenne Services SRL, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The EZOP – Poland (Epidemiology of Mental Disorders and Access to Care) survey was supported by the grant from the EAA/Norwegian Financial Mechanisms as well as by the Polish Ministry of Health). The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01- MH059575) and National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust.Background. To examine cross-national patterns and correlates of lifetime and 12-month comorbid DSM-IV anxiety disorders among people with lifetime and 12-month DSM-IV major depressive disorder (MDD). Method. Nationally or regionally representative epidemiological interviews were administered to 74 045 adults in 27 surveys across 24 countries in the WHO World Mental Health (WMH) Surveys. DSM-IV MDD, a wide range of comorbid DSM-IV anxiety disorders, and a number of correlates were assessed with the WHO Composite International Diagnostic Interview (CIDI). Results. 45.7% of respondents with lifetime MDD (32.0-46.5% inter-quartile range (IQR) across surveys) had one of more lifetime anxiety disorders. A slightly higher proportion of respondents with 12-month MDD had lifetime anxiety disorders (51.7%, 37.8-54.0% IQR) and only slightly lower proportions of respondents with 12-month MDD had 12-month anxiety disorders (41.6%, 29.9-47.2% IQR). Two-thirds (68%) of respondents with lifetime comorbid anxiety disorders and MDD reported an earlier age-of-onset (AOO) of their first anxiety disorder than their MDD, while 13.5% reported an earlier AOO of MDD and the remaining 18.5% reported the same AOO of both disorders. Women and previously married people had consistently elevated rates of lifetime and 12-month MDD as well as comorbid anxiety disorders. Consistently higher proportions of respondents with 12-month anxious than non-anxious MDD reported severe role impairment (64.4 v. 46.0%; χ 2 1 = 187.0, p < 0.001) and suicide ideation (19.5 v. 8.9%; χ 2 1 = 71.6, p < 0.001). Significantly more respondents with 12-month anxious than non-anxious MDD received treatment for their depression in the 12 months before interview, but this difference was more pronounced in high-income countries (68.8 v. 45.4%; χ 2 1 = 108.8, p < 0.001) than low/middle-income countries (30.3 v. 20.6%; χ 2 1 = 11.7, p < 0.001). Conclusions. Patterns and correlates of comorbid DSM-IV anxiety disorders among people with DSM-IV MDD are similar across WMH countries. The narrow IQR of the proportion of respondents with temporally prior AOO of anxiety disorders than comorbid MDD (69.6-74.7%) is especially noteworthy. However, the fact that these proportions are not higher among respondents with 12-month than lifetime comorbidity means that temporal priority between lifetime anxiety disorders and MDD is not related to MDD persistence among people with anxious MDD. This, in turn, raises complex questions about the relative importance of temporally primary anxiety disorders as risk markers v. causal risk factors for subsequent MDD onset and persistence, including the possibility that anxiety disorders might primarily be risk markers for MDD onset and causal risk factors for MDD persistence.publishersversionpublishe

Variations in experience of social support and physical health among adult residents of Poland in urban versus rural areas

Background. A study reveals – against to common beliefs–less support between rural area residents in comparison to town-dwellers and significantly higher support for healthy, not for poor health research participants. Objectives. The aim of our paper was comparing support from spouse/partner, relatives, friends and strangers among people with good and ill physical health. A next purpose was to find differences of social support and experience of social undermining in urban and rural residential settings. Material and methods. The study “Epidemiology of Mental Disorders and Access to Mental Health Care, EZOP – Poland” was carried out on random sample of 24 000 of Poland residents and a 50,4% response rate, 10 081 computer-assisted personal interviews. Of those respondents, 4 000 constituted a sub-sample asked to complete the social networks and support section of the questionnaire. Data were analyzed by age, gender, residential setting and marital status for statistically significant differences in the percentage of functional and structural social support being reported, using the chi-squared test with a significance level of 0.05 used to reject the null hypothesis (H₀= lack of relationship between variables). Results. A majority of respondents maintain that in difficult life situations, family and a close network of friends and acquaintances make it possible to openly discuss problems and obtain help. However, respondents who rate their health as “poor” or “very poor” significantly less often than healthy individuals experience support coming from their relatives, friends, or strangers. In comparison to urban areas, the extent of social support in rural areas is significantly limited. The rural setting offers less support and even less opportunities for interaction with relatives, friends, acquaintances and strangers. Negative social factors– low levels of trust, isolation from friends and family, lack of a social life, lack of a helpful neighborhood – are conditions significantly more often found in the countryside than in urban areas. Conclusions. Results obtained from the EZOP study shows that amount of social support received is higher in urban areas and among those who enjoy better physical health.Wprowadzenie. Praca odkrywa niezgodną z powszechnymi przekonaniami prawdę, że wieś jest mniej przyjaznym środowiskiem dla swoich mieszkańców niż miasto, a chorzy ludzie, najbardziej potrzebujący wsparcia, otrzymują go znacząco mniej niż zdrowi. Cel. Celem niniejszej pracy jest porównanie wsparcia, jakie uzyskują osoby w dobrym i złym stanie zdrowia ze strony współmałżonka (partnera), rodziny, przyjaciół i obcych. Kolejnym celem jest ocena różnicy w uzyskiwanym wsparciu, a także przejawach zaprzeczenia wsparcia przez mieszkańców miast i wsi. Materiał i metody. Badanie „Epidemiologia zaburzeń psychiatrycznych i dostęp do psychiatrycznej opieki zdrowotnej – EZOP Polska” zostało zrealizowane na próbie losowej 24 tysięcy mieszkańców Polski. Przy 50,4% poziomie realizacji wywiadów przeprowadzono 10 081 wywiadów indywidualnych wspomaganych komputerowo. Następnie wyodrębniono 4 000 respondentów, którzy odpowiedzieli na pytania o relacje społeczne i wsparcie społeczne. W analizie uwzględniono podział według wieku, płci, środowiska zamieszkania i stanu cywilnego. Ustalono istotne statystycznie różnice w uzyskiwanym wsparciu strukturalnym i funkcjonalnym przy zastosowaniu testu chi-kwadrat, zakładając poziom ufności 0,05 do odrzucenia hipotezy zerowej (H0 = brak związku między zmiennymi). Wyniki. Większość respondentów utrzymuje, że rodzina oraz krąg bliskich przyjaciół i znajomych - w trudnych sytuacjach życiowych - stwarza warunki do otwartego omówienia problemu i otrzymania pomocy. Niemniej respondenci, którzy oceniają swoje zdrowie jako „złe” i „bardzo złe” istotnie rzadziej doświadczają wsparcia, niż osoby zdrowe. Zakres wsparcia społecznego na terenach wiejskich jest znacząco ograniczony w porównaniu ze wsparciem wśród mieszkańców miast. W środowisku wiejskim stwierdzamy mniej wsparcia, a nawet mniej możliwości spotkania z członkami rodziny, przyjaciółmi, znajomymi lub obcymi. Również na wsi istotnie częściej niż na terenach zurbanizowanych obserwujemy działanie takich negatywnych czynników jak niski poziom zaufania społecznego, izolację wobec rodziny i przyjaciół, brak życia towarzyskiego, oraz brak pomocnego sąsiedztwa. Wnioski. Wyniki badania EZOP wskazują, że zakres otrzymywanego wsparcia społecznego jest istotnie wyższy w środowiskach miejskich, oraz wśród osób cieszących się lepszym zdrowiem fizycznym

Analiza właściwości tribologicznych nanokompozytowej powłoki TiN/Si3N4 w styku ślizgowym z przeciwelementem ceramicznym, stalowym i polimerowym

In this work, the friction and wear of a hard TiN/Si3N4&enspnanocomposite coating in sliding contact with Al2O3&enspceramic, 100Cr6 steel, and PTFE polymer balls were analysed. The coating was deposited on Vanadis 23 high-speed steel by a new gas pulsed magnetron sputtering technique. Studies of micromechanical properties indicate very high hardness of the coating equal to 49 GPa with simultaneous very good adhesion to the substrate confirmed in the scratch test. Based on the tribological studies in an unlubricated ball-on-disk contact, the coefficient of friction and specific wear index of the coating and balls were determined. In the friction cooperation, the most advantageous pair of coating and counterpart was an association of TiN/Si3N4&enspcoating with a ceramic Al2O3&enspball. In this combination, the wear index of the coating was 5.3·0.04·10-6 mm3/Nm, whereas the value of the wear index of the ball was 0.04·0.04·10-6 mm3/Nm. According to our investigation, this is the best pair among the tested materials that can be used in friction nodes under a high load. The analysis of the wear mechanism for individual pairs was based on microscopic examination of wear tracks.W niniejszej pracy dokonano analizy tarcia i zużycia twardej powłoki nanokompozytowej TiN/Si3N4&ensppodczas współpracy z kulami ceramicznymi Al2O3, stalowymi 100Cr6 i polimerowymi PTFE. Powłoka została osadzona na próbkach z ulepszonej stali szybkotnącej Vanadis 23 metodą rozpylania magnetronowego sterowanego impulsami ciśnienia gazu. Badania właściwości mikromechanicznych wykazały bardzo dużą twardość powłoki wynoszącą 49 GPa i jednocześnie bardzo dobrą adhezję do podłoża potwierdzoną w próbie zarysowania. Na podstawie badań tribologicznych w niesmarowanym styku ślizgowym typu kula/tarcza wyznaczono współczynnik tarcia oraz wskaźnik zużycia objętościowego powłoki i kul. Najkorzystniejsze pod względem odporności na zużycie zarówno powłoki, jak i przeciwelementu było skojarzenie powłoki TiN/Si3N4&enspz kulą Al2O3. W tym skojarzeniu wskaźnik zużycia powłoki był równy 5,3·0.04·10-6 mm3/Nm, a kuli 0,04·0.04·10-6 mm3/Nm. Skojarzenie to jest najlepsze spośród badanych par i może znaleźć zastosowanie do wysoko obciążonych węzłów tarcia. Analizę mechanizmu zużycia dla poszczególnych skojarzeń wykonano w oparciu o badania mikroskopowe śladów zużycia

Analysis of diabetic patients hospitalizations in Poland by gender, age and place of residence

Background. There are few updated data on rates of hospital mortality of diabetic patients and length of their hospital stay on a country level. To determine such rates we provided analysis using claims data from a Nationwide General Hospital Morbidity Study carried out by the National Institute of Public Health – National Institute of Hygiene (NIPH- NIH) in Warsaw from 2010 to 2018. Objective. The aim of the study was to analyze the nine years changes of in-hospital morbidity and mortality in diabetic patients and length of hospital stay using a comparative approach by gender, age and place of residence. Material and methods. The data on all patients from general hospitals in Poland treated because of diabetes were taken from a nationwide database, kept since 1979 by the Department for Monitoring and Analyses of Population Health of NIPH-NIH. This database contains information gathered under the Statistical Research Program of Public Statistics. Hospitalization rates were used to evaluate the ‘hospitalized’ incidence of diabetes (number of hospitalization cases due to diabetes per year by the analyzed unit of population). In-hospital mortality was calculated as the percentage of deceased patients out of all patients hospitalized due to diabetes. Results. The number of cases and hospitalization rates of diabetic patients was rapidly declining by 18.8% for type 2 (E11) and 23.7% for type 1 (E10) diabetes. The downward tendency in the scope of hospitalization affected mainly older women and rural residents. Hospital mortality due to diabetes rose up dangerously to 3.77% exceeding the rates recorded eight years earlier. Conclusions. The recent reduction in hospitalization rates of people with diabetes in Poland may be associated with an unexpected increase in hospital mortality