Prevalence of opioid dependence and practice of opioid agonist treatment in the Berlin custodial setting

Hintergrund: Abhängigkeit von Opioiden ist eine häufige Gesundheitsstörung von Menschen in Haft. Obwohl die Substitutionstherapie national und international als Standardtherapie bei Opioidabhängigkeit angesehen wird, gibt es Hinweise darauf, dass diese Behandlungsmethode in deutschen Haftanstalten nicht systematisch angeboten wird. Es fehlen systematische Untersuchungen zur Praxis der Substitutionsbehandlung in Haft. Methoden: Es wurde zum Stichtag eine Vollerhebung als Querschnittsuntersuchung aus den im Dokumentationssystem erfassten Routinedaten in allen Berliner Haftanstalten durchgeführt. Für alle opioidabhängigen Menschen wurden soziodemographische Merkmale, Daten zur Substitutionsbehandlung, zu den Komorbiditäten HIV, HCV und Schizophrenie sowie zum Haftaufenthalt erhoben. Die Daten wurden vorerst deskriptiv ausgewertet, um die Prävalenz der Opioidabhängigkeit und der Durchführung von Substitutionsbehandlungen zu ermitteln. Zusätzlich wurde anhand logistischer Regressionen der Einfluss bestimmter Faktoren auf den Zugang zu einer Substitutionsbehandlung in Haft analysiert. Ergebnisse: 16% (n=652/4038) der zum Stichtag in Berlin inhaftierten waren opioidabhängig. Von ihnen erhielten 42% (n=274/652) eine Substitutionsbehandlung. Es zeigten sich deutliche Schwankungen der Substitutionsraten zwischen den einzelnen Haftanstalten. Nicht-deutsche, opioidabhängige Männer mit kurzer Haftdauer, die vor Haft nicht substituiert wurden, scheinen während des Haftaufenthalts weniger häufig eine Substitutionsbehandlung zu erhalten. Zur Substitution wurden Methadon (33%, n=85/274), Levomethadon (55%, n=151/274) und Buprenorphin (14%, n=38/274) genutzt, wobei auch hier deutliche Unterschiede zwischen den Haftanstalten sichtbar wurden. Das Geschlecht, deutsche Nationalität, die Durchführung einer Substitutionsbehandlung zu Haftbeginn, die voraussichtliche Haftlänge, sowie Inhaftierung in bestimmten Haftanstalten waren unabhängige Einflussfaktoren auf den Zugang zu einer Substitutionsbehandlung während der Haftzeit. Die Prävalenz von HIV konnte auf 4%-8% und die von HCV auf 31%-42% geschätzt werden, wenngleich nur bei 56% der Menschen ein anamnestischer oder schriftlicher Befund über den Infektionsstatus für beide Erkrankungen vorlag. Schlussfolgerungen: Opioidabhängigkeit ist ein bedeutendes Gesundheitsproblem in Haft und Substitutionsbehandlungen werden in unterschiedlicher Häufigkeit durchgeführt. Insti-tutionelle Handlungsanweisungen und die suchtmedizinische Weiterbildung könnten die Qualität der Versorgung verbessern und die Versorgungslücke bestimmter Personengruppen, sowie die Unterschiede der Durchführung zwischen den Haftanstalten mindern. Sys-tematische Screeningangebote auf Infektionserkrankungen und weitere schadensminimie-rende Präventionsangebote sollten angesichts der hohen Prävalenz von HIV und HCV ein-geführt werden.Background: Dependence on opioids is a common health disorder among people in prison. Although nationally and internationally opioid agonist treatment is considered standard treatment for opioid dependence, it seems that treatment is not systematically offered in German prisons. Systematic surveys on the practice of agonist treatment in prison are lacking. Methods: A full census from the routine data recorded in the documentation system was conducted as a cross-sectional study on a reference date in all Berlin prisons. Data on sociodemographic characteristics, opioid agonist treatment, comorbidities HIV, HCV, and schizophrenia, as well as information on incarceration were collected for all opioid-dependent individuals. The data were first analyzed descriptively to determine the preva-lence of opioid dependence and the implementation of agonist treatment. In addition, lo-gistic regressions were conducted in order to analyze the statistical influence of certain factors on the provision of opioid agonist treatment in prison. Results: 16% (n=652/4038) of those detained in the Berlin custodial setting at the re-porting date were opioid dependent. Of these, 42% (n=274/652) received agonist treat-ment. The treatment rates varied widely between the prisons. Non-German, opioid-dependent men with a short duration of imprisonment who had not received agonist treat-ment before incarceration less often got agonist treatment during detention. Methadone (33%, n=85/274), levomethadone (55%, n=151/274), and buprenorphine (14%, n=38/274) were used for agonist treatment, again showing differences in prescription practice be-tween prisons. Gender, German nationality, initial receipt of agonist treatment, anticipated imprisonment duration, and imprisonment in specific prisons were independent factors in-fluencing the access to agonist treatment during imprisonment. The prevalence of HIV was at 4%-8% and that of HCV at 31%-42%, although only from 56% of the people in detention there could be found an anamnestic or written report of infection status for both diseases. Conclusions: Opioid dependence is a significant health problem in the custodial setting and the implementation of agonist treatment varies between the different prisons. Treat-ment guidelines within local prison’s standard operating procedures and training in addic-tion medicine could improve the quality of care, improve the treatment of certain groups and reduce disparities of implementation among correctional facilities. Systematic screen-ing for infectious diseases and other measures of harm reduction should be introduced to address the high prevalence of HIV and HCV in prison

From Marvels of Nature to Inmates of Asylums: Imaginations of Natural Folly

In medieval and Renaissance times European courts kept fools, who were placed into one of two categories: artificial fools (or jesters) and natural fools. The present study examines natural fools. Extant studies generally treat natural fools as both mentally and physically ill and/or disabled. This study contributes to the discussion of natural folly by examining two sources about the Ernestinian Saxon court fool Claus Narr. According to the documents natural fools were seen as permanently mentally changed people and classified as so-called "wonder men." Therefore they were kept and collected at courts. When permanent mental difference and psychiatric disease amalgamated at the beginning of the 18th century, however, the natural fool became an object of education and medicine. This paper argues that the changing meaning of the natural fool nevertheless retained components of its initial medieval conception

Systemic inflammatory response to cardiac surgery: does female sex really protect?

Sex hormones have important interactions with the immune system and modulate the inflammatory response. In this regard, oestrogen inhibits the transcription of proinflammatory cytokines and confers tissue protection in experimental models. On the basis of this evidence, Trotter et al. in this issue of Critical Care addressed the question of whether, in children, female sex would protect against the deleterious effects of cardiac operations with cardiopulmonary bypass by providing a favourable anti-inflammatory cytokine balance. The observations made in that study suggest sex-related immunomodulation and organ protection during cardiac surgery in the paediatric population. Prospective trials conducted in large series, including sex hormone determination in neonates, infants and children with congenital cardiac defects, are necessary to test this hypothesis. The verification of sex-related intraoperative organ protection would provide new opportunities for preventing the uncontrolled systemic inflammatory response that may occur during cardiac surgery

Hemolytic anemia following intravenous immunoglobulins in children with PIMS-TS: Two case reports

This is the first case report on two children presenting with immediate and severe hemolytic anemia following the administration of high-dose intravenous immunoglobulins (IVIGs) in the context of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Hemolytic anemia was described as a significant decrease in hemoglobin and an increase in lactate dehydrogenase after the second administration of high-dose IVIGs was performed. Both patients were found to have AB blood group. One of our patients showed massive pallor, weakness, and inability to walk in association with hemolysis. However, in both cases, the anemia was self-limiting and transfusion of red blood cells was not required: both patients recovered without persistent impact. Nonetheless, we aim to draw attention to this widely unknown adverse effect of IVIG, especially in the context of PIMS-TS. We suggest determining the patient's blood group prior to high-dose IVIG infusion and replacing the second IVIG through high-dose steroids or anticytokine therapy. Using IVIGs containing lower titers of specifically anti-A or anti-B antibodies to avoid isoagglutinin-caused hemolytic anemia is desirable; however, the information is not routinely available

Unstructured mathematical model for biomass, lactic acid and bacteriocin productions by lactic acid bacteria in batch fermentation

6 páginas, 3 figuras, 2 tablasBACKGROUND: A simple macroscopical model was proposed to describe the fermentation kinetics of growth, bacteriocins and lactic acid production by Lactococcus lactis and Pediococcus acidilactici in a batch system. The equations used were: the logistic reparametrized for growth, the Luedeking–Piret model for bacteriocin production, the maintenance energy model for glucose consumption; and the homofermentative balance equation for lactic acid formation. RESULTS: In all the cultures, the mathematical models, consistents and robusts, adjusted, perfectly, the experimental kinetic profiles. Also, the corresponding kinetic parameters were significant, so much biological as statistically. CONCLUSIONS: The group of integrated equations used, besides showing high accuracy in predicting the studied bioproductions, established a useful tool for the control of lactic acid bacteria kinetics in bioreactors in terms of its statistical consistency. Copyright © 2007 Society of Chemical IndustryPeer reviewe

Three study decades on irrigation performance and salt concentrations and loads in the irrigation return flows of La Violada irrigation district (Spain)

30 Pags., 3 Tabls., 9 Figs. The definitive version is available at: http://www.sciencedirect.com/science/journal/01678809Irrigation district salt balances identify the main sources and sinks of salts and quantify salt loads in irrigation return flows. Salt balances were performed in La Violada Irrigation District during the 80s (1982–1984), 90s (1995–1998) and 00s (2006–2008) decades. Total Dissolved Solids (TDS) and loads in irrigation return flows were related with changes in irrigation performance and infrastructures during these decades. TDS increased linearly to increases in Irrigation Consumptive Use Coefficient (ICUC) (P 66%, and decreased exponentially for values above and below these thresholds, respectively. Therefore, the key management strategy to reduce salt discharge to downstream areas is to decrease drainage volumes by improving irrigation management.This work was sponsored by the Spanish Ministry of Science and Education project AGL2006-11860/AGR, the European Regional Development Fund (FEDER) and the European Union project INCO CT-2005-015031.Peer reviewe

Моделирование процессов в оборудовании при обработке тонкостенных деталей

Для тонкостенных деталей актуальна задача минимизации характерных технологических деформаций. Из-за особенностей процесса фрезерования тонкостенные детали представляют особую сложность в механической обработке. При обработке неизбежно возникают вибрации, обусловленные высокими силами резания при недостаточной жёсткости детали или инструмента. В следствии таких вибраций снижается точность обработанной детали и качество поверхности, вызванная недостаточной жёсткостью технологической системы.В работе рассматривается альтернативный способ снижения технологических деформаций посредством использования математического моделирования процесса фрезерования с учетом времени.Due to the characteristics of the milling process, modeling workpiece dynamics during the machining of freeform surfaces is a challenge: The relative movement between the milling tool and the workpiece leads to a variation of the excitation position, and the material removal process results in changing modal parameters of the workpiece. In this work is discussed dealing with modeling techniques for the prediction of workpiece deflections

Developing a Medical Institution Management System through Promoting Social Accountability

The paper regards the implementation of social accountability principles into the system of medical institution management as the target of research. The process of personnel management is viewed as its research subject. The paper aims to develop the system of incentives for medical institution personnel based on the principles of social accountability. The research methods and tools applied in the study are analysis of content and internal enterprise documentation, staff member interviews and statistical methods of data processing. The expected research outcome is the implementation phase of the social accountability management system resulted in the development of the Code of corporate conduct. The article advocates the view, that the Code of Conduct should be based on the diagnosis of the state of corporate culture and motivate employees of the organization. The management team of medical institution can set their own social and reasonable quality management system, which will enable it to promote and involve staff in the process of improvement

Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany

INTRODUCTION: In 2015, 4062 unaccompanied minor refugees were registered in Berlin, Germany. According to national policies, basic clinical examination and tuberculosis (TB) screening is a prerequisite to admission to permanent accommodation and schooling for every refugee. This article evaluates the use of an interferon-γ-release-assay (IGRA) during the initial examination and TB screening of 970 unaccompanied minor refugees. RESULTS: IGRA test were obtained during TB screening for 301 (31.0%) of 970 adolescents not previously screened for TB. Positive IGRA results were obtained in 13.9% (42/301). Most of the 42 IGRA-positive refugees originated from Afghanistan or Syria (n?20 and 10 respectively). Two IGRA-positive adolescents were lost to follow-up, 2 were diagnosed with TB and the remaining 38 diagnosed with latent TB infection (LTBI). Demographic features of the 40 patients with positive IGRA result were as follows: 39 male, median age 16.8 years (IQR 16.0-17.2y), none meeting underweight criteria (median BMI 21.3kg/m2). On initial chest X-ray 2/40 participants had signs of active TB, while in 38 active disease was excluded and the diagnosis of latent TB infection (LTBI) made. Active hepatitis B-co-infection was diagnosed in 3/38 patients. All patients with LTBI received Isoniazid and Rifampicin for 3 months without occurrence of severe adverse events. The most frequently observed side effect was transient upper abdominal pain (n = 5). Asymptomatic elevation of liver transaminases was seen in 2 patients. 29 patients completed treatment with no signs of TB disease at the end of chemoprevention and 9 were lost to follow up. CONCLUSION: Screening for TB infection in minor refugees was feasible in our setting with a relatively high rate of TB infection detected. Chemopreventive treatment was tolerated well regardless of underlying hepatitis-B-status. Minor refugees migrating to Germany should be screened for TB infection, instead of TB disease only, regardless of the background TB incidence

Does cardiac surgery in newborn infants compromise blood cell reactivity to endotoxin?

INTRODUCTION: Neonatal cardiac surgery is associated with a systemic inflammatory reaction that might compromise the reactivity of blood cells against an inflammatory stimulus. Our prospective study was aimed at testing this hypothesis. METHODS: We investigated 17 newborn infants with transposition of the great arteries undergoing arterial switch operation. Ex vivo production of the pro-inflammatory cytokine tumor necrosis factor-α (TNF-α), of the regulator of the acute-phase response IL-6, and of the natural anti-inflammatory cytokine IL-10 were measured by enzyme-linked immunosorbent assay in the cell culture supernatant after whole blood stimulation by the endotoxin lipopolysaccharide before, 5 and 10 days after the operation. Results were analyzed with respect to postoperative morbidity. RESULTS: The ex vivo production of TNF-α and IL-6 was significantly decreased (P < 0.001 and P < 0.002, respectively), whereas ex vivo production of IL-10 tended to be lower 5 days after the operation in comparison with preoperative values (P < 0.1). Ex vivo production of all cytokines reached preoperative values 10 days after cardiac surgery. Preoperative ex vivo production of IL-6 was inversely correlated with the postoperative oxygenation index 4 hours and 24 hours after the operation (P < 0.02). In contrast, postoperative ex vivo production of cytokines did not correlate with postoperative morbidity. CONCLUSION: Our results show that cardiac surgery in newborn infants is associated with a transient but significant decrease in the ex vivo production of the pro-inflammatory cytokines TNF-α and IL-6 together with a less pronounced decrease in IL-10 production. This might indicate a transient postoperative anti-inflammatory shift of the cytokine balance in this age group. Our results suggest that higher preoperative ex vivo production of IL-6 is associated with a higher risk for postoperative pulmonary dysfunction