Public spending for illegal drug and alcohol treatment in hospitals: an EU cross-country comparison

Background: In view of the current economic crisis and the resulting austerity measures being implemented by governments across Europe, public expenditure for substance abuse treatment has increasingly become a subject of discussion. An EU cross-country comparison would allow an estimation of the total amount of public resources spent on substance abuse treatment, compare various substance abuse treatment funding options, and evaluate the division of expenditures between alcohol and illegal drugs. The purpose of this study is to estimate the public spending of EU countries for alcohol and illegal drug abuse treatment in hospitals. Methods: Our study uses a uniform methodology in order to enable valid cross-national comparisons. Our data are drawn from the Eurostat database, which provides anno 2010 data on government spending for the treatment of illegal drug and alcohol abuse in 21 EU member states. The cross-country comparison is restricted to hospitals, since data were unavailable for other types of treatment providers. The systematic registration of in- and outpatient data is essential to monitoring public expenditures on substance abuse treatment using international databases. Results: Total public spending for hospital-based treatment of illegal drug and alcohol abuse in the 21 EU member states studied is estimated to be 7.6 billion euros. Per capita expenditures for treatment of illegal drug abuse vary, ranging from 0.1 euros in Romania to 13 euros in Sweden. For alcohol abuse, that figure varied from 0.9 euros in Bulgaria to 24 euros in Austria. These results confirm other studies indicating that public expenditures for alcohol treatment exceed that for illegal drug treatment. Conclusions: Multiple factors may influence the number of hospital days for alcohol or illegal substance abuse treatment, and expenditures fluctuate accordingly. In this respect, we found a strong correlation between gross domestic product (GDP) per capita and public expenditures per hospital day. The prevalence of problematic ( illegal or legal) drug use in a country did not correlate significantly with the number of hospital days. Other factors must be included in the analysis of public expenditures for the treatment of substance abuse, such as the drug policy in a given country and the social norms regarding alcohol consumption

Structure-function properties of the gastrodigestive and hepatic systems of zebrafish (Danio rerio)

While they lack mammal-specific organs, zebrafish provide a high degree of resemblance in their genetic profile, molecular mechanisms and organ physiology to humans and have been established as an excellent complementary platform to rodents. However, their use in gastroenterology and hepatology is under-utilised, conceivably due to a lack of digestive system ultrastructural details as most anatomical studies were performed by light and fluorescence imaging. This thesis provides detailed insights into the structure and function of the zebrafish digestive system, particularly the liver. Multimodal bio-imaging approaches were developed in order to investigate the hepatic ultrastructure and function. Using a protocol that renders samples compatible with multiple imaging platforms, we produce a detailed map of the zebrafish gastrodigestive system from organ to subcellular levels. Findings were compared with the rodent/human counterparts and while some differences exist between the zebrafish and the rodent/human hepatic parenchymal cells and biliary system organisations, many similarities, at the sub/cellular levels, were also demonstrated. Using advances in genetics and a protocol that retains endogenous fluorescence within zebrafish at the same time as ultrastructure for electron microscopy, we further investigated key hepatic functional properties (e.g. macromolecular transport routes) by performing albumin injections and studying the liver macrophages. While we demonstrated similarities in the albumin uptake pathway and in the morphology of liver macrophages in zebrafish, we reveal that zebrafish liver macrophages lack of phagocytic function (a key aspect in rodents and human), which may limit their use in hepatic-immune diseases studies. Altogether, our studies provide new insights and novel protocols for the analysis of the zebrafish liver and lay a foundation to further evaluate uptake routes for gastro-digestive research and drug delivery in various diseases

The governmental supervision and management of expenditures regarding the realisation and evaluation of drug policy

In Europe, one widely accepted standard is that public resources should be used in the most efficient and effective way, therefore governments needs to supervise the expenditures and evaluate the policy at the same time. This dissertation tries to guide the policy makers with an economic evaluation of the drug policy. It presents an economic evaluation of the Belgian drug policy with a public expenditure study on legal and illegal drugs, and a generalised cost-effectiveness analysis on alcohol. In addition, this dissertation contributes to European policy research with cross-country comparisons on public expenditures (on drug policy and substance abuse treatment in hospitals) and on cost-effectiveness

The health-related social costs of alcohol in Belgium

Background: Alcohol is associated with adverse health effects causing a considerable economic impact to society. A reliable estimate of this economic impact for Belgium is lacking. This is the aim of the study. Methods: A prevalence-based approach estimating the direct, indirect and intangible costs for the year 2012 was used. Attributional fractions for a series of health effects were derived from literature. The human capital approach was used to estimate indirect costs, while the concept of disability-adjusted life years was used to estimate intangible costs. Sensitivity and scenario analyses were conducted to assess the uncertainty around cost estimates and to evaluate the impact of alternative modelling assumptions. Results: In 2012, total alcohol-attributable direct costs were estimated at is an element of 906.1 million, of which the majority were due to hospitalization (is an element of 743.7 million, 82%). The indirect costs amounted to is an element of 642.6 million, of which 62% was caused by premature mortality. Alcohol was responsible for 157,500 disability-adjusted life years representing is an element of 6.3 billion intangible costs. Conclusions: Despite a number of limitations intrinsic to this kind of research, the study can be considered as the most comprehensive analysis thus far of the health-related social costs of alcohol in Belgium

A comparison of physical activity among women based upon sexual orientation

Purpose: This cross-sectional study examined potential differences in reported past-year leisure time, occupational, total (leisure plus occupational), vigorous and usual household physical activity among 737 women who self-identified as lesbian (n = 405) or heterosexual (n = 332), were 35-55 years of age (Mean = 45.2 ± 5.5), reported their race as either Black (n = 80, 11%) or White (n = 657, 89%), and were recruited for participation in the Epidemiologic STudy of HEalth Risk in women (ESTHER) project at the University of Pittsburgh, PA. Potential differences in predictors of past-year leisure time physical activity between the groups were also examined. Methods: Physical activity was assessed through verbal interview using the Modifiable Activity Questionnaire (MAQ) and a composite questionnaire for usual household physical activity. Physical activity, sociodemographic, behavioral and lifestyle variables were compared by sexual orientation using median, Chi-Square and independent t-tests. Predictors of past-year leisure time physical activity were determined using multivariate step-wise logistic regression. Results: The groups did not differ by age, race, education, income, employment, or marital or partner status. More heterosexuals (49%) reported children age <18 yrs living in the household compared to lesbians (15%) (p <.001). Body mass index (BMI), cigarette smoking and alcohol use were higher among lesbians (p <.05). There were no differences in reported time (hrs/wk) spent in past-year leisure time, occupational, total, or vigorous physical activity. Usual household physical activity (hrs/wk) was higher among heterosexuals than among lesbians (20.8 vs. 15.7 hrs/wk)(p< .001). Predictors of past-year leisure time physical activity included BMI for both groups. Additional predictors for lesbians were smoking status, educational attainment, and current committed marital or partner relationship status. Conclusions: Although time (hrs/wk) spent in past-year leisure time, occupational, vigorous and total physical activity were not different between lesbians and heterosexual women, time spent in usual household physical activity was higher among heterosexuals. Lesbians had four predictors of past-year leisure time physical activity while heterosexuals had only one. Therefore, although many aspects of physical activity are similar between lesbians and heterosexuals, some differences in physical activity exist among women based upon sexual orientation

Methodological considerations in social cost studies of addictive substances : a systematic literature review

Background: Alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals' use is associated with a higher likelihood of developing several diseases and injuries and, as a consequence, considerable health-care expenditures. There is yet a lack of consistent methodologies to estimate the economic impact of addictive substances to society. The aim was to assess the methodological approaches applied in social cost studies estimating the economic impact of alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals. Methods: A systematic literature review through the electronic databases, Medline (PubMed) and Web of Science, was performed. Studies in English published from 1997 examining the social costs of the addictive substances alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals were eligible for inclusion. Results: Twelve social cost studies met the inclusion criteria. In all studies, the direct and indirect costs were measured, but the intangible costs were seldom taken into account. A wide variety in cost items included across studies was observed. Sensitivity analyses to address the uncertainty around certain cost estimates were conducted in eight studies considered in the review. Conclusion: Differences in cost items included in cost-of-illness studies limit the comparison across studies. It is clear that it is difficult to deal with all consequences of substance use in cost-of-illness studies. Future social cost studies should be based on sound methodological principles in order to result in more reliable cost estimates of the economic burden of substance use

Adverse Childhood Experiences, Personality, and Crime: Distinct Associations among a High-Risk Sample of Institutionalized Youth

Despite high rates of adverse childhood experiences (ACEs) and personality-related disturbances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowledge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention. We examined a heterogeneous high-risk sample of 342 adolescents (35.1% females, 64.9% males) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or juvenile justice institutions regarding cumulative ACEs, psychopathic traits, temperament, and clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment. We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based on dimensional measures of psychopathy, temperament, and personality disorders derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective. Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime

Adverse Childhood Experiences, Personality, and Crime: Distinct Associations among a High-Risk Sample of Institutionalized Youth

Despite high rates of adverse childhood experiences (ACEs) and personality-related distur bances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowl edge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention. We examined a heterogeneous high-risk sample of 342 adolescents (35.1% females, 64.9% males) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or ju venile justice institutions regarding cumulative ACEs, psychopathic traits, temperament, and clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment. We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based on dimensional measures of psychopathy, temperament, and personality disorders derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective. Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime