Quality of life in a community sample of young cocaine and/or heroin users: the role of mental disorders.

PURPOSE: Drug addiction and psychiatric disorders are frequently concomitant; however, few studies have investigated the impact of psychiatric disorders other than substance use disorder (SUD) on health-related quality of life (HRQoL) in drug users not in treatment. We studied the association of psychiatric disorders other than SUD with HRQoL in a street-recruited sample of cocaine and/or heroin users. METHODS: It is a cross-sectional study involving 287 young users of cocaine and/or heroin in Barcelona, Spain. HRQoL was assessed with the Nottingham health profile (NHP). Patterns of drug use and mental disorders were assessed using the Spanish version of the psychiatric research interview for substance and mental disorders IV, and degree of dependence through the severity of dependence scale (SDS). The association of mental disorders with HRQoL was assessed through a Tobit regression analysis. RESULTS: The overall NHP score was 23.9 (SD = 20.5, range 0-91.7). Sixty-one percent of the sample had two or more SUDs; 22 % had at least one non-SUD Axis I disorder (anxiety, mood, psychotic, or eating disorder); and 27.2 % had a borderline personality disorder (BPD) and/or antisocial personality disorder. Variables negatively associated with the global NHP score were psychosis [transformed beta coefficient: 15.23; 95 % confidence interval [CI] 4.48-25.97], BPD (9.55; 95 % CI 2.95-16.15), severity of dependence (8.12; 95 % CI 3.37-12.87), having two or more SUDs (for two or three SUDs: 6.83; 95 % CI 2.08-11.59) (>3 SUDs: 7.70; 95 % CI 1.72-13.68) and the intravenous use of some substance (10.20; 95 % CI 6.00-14.40). CONCLUSION: HRQoL among street-recruited illegal substance users was impaired, particularly among those with psychiatric comorbidity, psychosis, and BPD being especially relevant.

Substance use among road traffic casualties admitted to emergency departments.

OBJECTIVE: To describe the prevalence of recent psychoactive substance use and associated factors among road traffic casualties admitted to emergency departments. METHODS: A cross-sectional study was carried out, including adults injured in road traffic crashes admitted to the emergency department (ED) of eight hospitals in Catalonia (Spain), during three cross-sections, each of 4 days duration (2005-2006). Information sources were an interview, an oral fluid specimen and the patient's clinical record. Dependent variables were presence of alcohol, cannabis, cocaine, ecstasy, opiates or benzodiazepines. Independent variables were socioeconomic characteristics and circumstances of the injuries and admission. Prevalence and exact 95% confidence intervals were estimated for men and women. Bivariate analyses and multivariate binomial regression modelling were carried out to study factors associated with substance use in male drivers and pedestrians. RESULTS: The prevalence of substance use was higher in men (n = 226) than in women (n = 161) for any substance (34.4% and 16.2%), any illegal substance (19.3% and 7.6%), alcohol (18.5% and 9.2%) and cannabis (17.0% and 3.8%), respectively. In male drivers and pedestrians, alcohol use was associated with being in the 25-30-year age group, being injured at night and the weekend, and arriving at the ED by ambulance; cannabis use was only associated with being in the 18-30-year age group. CONCLUSIONS: A high prevalence of recent psychoactive substance use, especially alcohol, cannabis and cocaine, was observed in all age groups. The results indicate the need to screen for substance use and to give simple advice to casualties at EDs.

A comparison between the force of infection estimates for blood-borne viruses in injecting drug user populations across the European Union: a modelling study.

A number of studies have been conducted in injecting drug user (IDU) populations in Europe, in which the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) was measured together with demographic and epidemiological information such as age and the age at first injection. A measure of the risk of becoming infected is the force of infection (FOI), defined as the per capita rate at which susceptible individuals acquire infection. The objective of this study was to estimate the FOI and its heterogeneity for HBV, HCV and HIV (where available) for IDU populations in a number of countries in Europe. Data were obtained from five countries: Belgium, the United Kingdom, Spain and Italy, and the Czech Republic, which provided two data sets. The model describes the prevalence of infection as a function of the FOI that may vary over time or duration of IDU. In addition to this, if two or more infections were being considered then a parameter describing the potential heterogeneity of the FOI within the IDU population was also estimated. The results here add to the growing evidence that new initiates to injecting are at an increased risk of blood-borne viral infection compared with more experienced IDUs. In addition, there is evidence of individual heterogeneity of FOI estimates within the overall IDU populations. This suggests that different proportions of individuals in each population are at increased risk of infection compared with the rest of the population. Future interventions should identify and target these individuals. Moreover, changes over time in individual heterogeneity estimates of IDU populations may provide an indicator for measuring intervention impacts.

The impact of harm reduction programs and police interventions on the number of syringes collected from public spaces. A time series analysis in Barcelona, 2004-2014.

BACKGROUND: To estimate the effect of opening two services for people who use drugs and three police interventions on the number of discarded syringes collected from public spaces in Barcelona between 2004 and 2014. METHODS: We conducted an interrupted time-series analysis of the monthly number of syringes collected from public spaces during this period. The dependent variable was the number of syringes collected per month. The main independent variables were month and five dummy variables (the opening of two facilities with safe consumption rooms, and three police interventions). To examine which interventions affected the number of syringes collected, we performed an interrupted time-series analysis using a quasi-Poisson regression model, obtaining relative risks (RR) and 95% confidence intervals (CIs). RESULTS: The number of syringes collected per month in Barcelona decreased from 13,800 in 2004 to 1655 in 2014 after several interventions. For example, following the closure of an open drug scene in District A of the city, we observed a decreasing trend in the number of syringes collected [RR=0.88 (95% CI: 0.82-0.95)], but an increasing trend in the remaining districts [RR=1.11 (95% CI: 1.05-1.17) and 1.08 (95% CI: 0.99-1.18) for districts B and C, respectively]. Following the opening of a harm reduction facility in District C, we observed an initial increase in the number collected in this district [RR=2.72 (95% CI: 1.57-4.71)] and stabilization of the trend thereafter [RR=0.97 (95% CI: 0.91-1.03)]. CONCLUSION: The overall number of discarded syringes collected from public spaces has decreased consistently in parallel with a combination of police interventions and the opening of harm reduction facilities.

Psychiatric comorbidity in young heroin users.

In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.

Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain.

AIMS: To assess the relationship between methadone treatment (MT) and overdose and HIV/AIDS mortality among heroin users resident in Barcelona city. DESIGN: All patients who started treatment in any treatment centre between 1992 and 1997 were included in a cohort the first time they were admitted for heroin addiction treatment. Follow-up controls were carried out every 9 months, on average, until 31 December 1999. Variables, both constant and varying over time, were fitted into Cox regression models. FINDINGS: The study recruited 5049 patients, which provided 23,048.2 person-years. Fifty per cent were in MT during the study period; of the total cohort 1005 patients died: 38.4% due to AIDS, 34.7% to overdose and 27% to other causes. Overall mortality decreased from 5.9 deaths per 100 person-years in 1992 to 1.6 in 1999. Globally, life expectancy at birth was 39 years, 38 years lower than that of the general population. The main factor for overdose mortality was not being in MT at the time of death [relative ratio (RR) = 7.1]; other factors were being a current injector at baseline and being HIV positive. For AIDS mortality, the main factor was the calendar year (RR for 1996 versus 1999 = 4.6), the next major factor was more than 10 years of heroin consumption, followed by not being in MT, being unemployed, then having a prison record. CONCLUSIONS: The observed mortality decline could be linked to the effectiveness of low-threshold MT. The life expectancy of heroin users increased by 21 years during the study period.

Proposing indicators for evaluation of tuberculosis control programmes in large cities based on the experience of Barcelona.

OBJECTIVE: To evaluate the effectiveness of the Barcelona Tuberculosis (TB) Control Programme and to propose evaluation indicators. MATERIALS AND METHODS: Using quantitative indicators, the results and impact of the programme over the period 1987 to 1999 were evaluated. Statistical analysis was based on a description of indicators, including tests for trends, and on the evolution of the incidence. RESULTS: The incidence of tuberculosis rose between 1987 and 1991 (P = 0.10), and fell between 1991 and 1999 (P < 0.001). During the study period statistically significant improvements were observed in the percentage of cases notified by the medical profession, adherence to treatment and the percentage of cases on directly observed treatment (DOT), and meningitis among children aged 0 to 4 years fell notably. However, diagnostic delay in smear-positive cases and the percentage of cases whose contacts were examined did not vary significantly. The evaluation indicated an average annual decline in tuberculosis incidence of 6.7%, and rates of adherence to treatment (94.5% among smear-positive cases) achieved their objectives. The average median diagnostic delay (36 days) and the percentage of cases with contacts examined (mean 59.8%) were rather less optimistic. CONCLUSIONS: The results of the evaluation were in general positive. Decline in incidence, meningitis in children, treatment adherence rates, diagnostic delay and percentage of cases with studied contacts were considered the best indicators for evaluation of TB programmes.

Effectiveness of tuberculosis control programmes in prisons, Barcelona 1987-2000.

SETTING: Different bodies have emphasised the need for prisons to implement and evaluate their own tuberculosis prevention and control programmes (TPCP), with the aims of evaluating TPCP in Barcelona prisons and obtaining conclusions that would allow any necessary modifications to be introduced to improve their effectiveness. METHODS: An assessment was carried out for the period 1987-2000, using the exhaustive retrospective method. The quantitative indicators used were defined in the same way as those employed by the Barcelona TPCP, which were taken as the gold standard. The assessment studied trends in the indicators and evaluated the impact by comparing the results with the gold standard. RESULTS: Statistically significant trends (P < 0.0001) were found for incidence rates, infection prevalence, treatment adherence rates among smear-positive cases and percentage of cases on directly observed treatment (DOT). When impact was assessed, only the decline in the average annual incidence rate (25.2%) and desired rates of adherence among smear-positives (> or = 95% since 1993) achieved the proposed objectives. CONCLUSIONS: The observed decline in incidence shows that when programmes are based on reducing diagnostic delay, controlling adherence using DOT and tracing contacts, tuberculosis control among the prisons is effective.

Factors predicting non-completion of tuberculosis treatment among HIV-infected patients in Barcelona (1987-1996).

OBJECTIVE: To determine the predictive factors of non-completion of tuberculosis (TB) treatment among patients infected with the human immunodeficiency virus (HIV). DESIGN: Between 1987 and 1996, 2201 HIV-infected TB patients were detected by the Barcelona Tuberculosis Prevention and Control Programme. Patients who completed treatment were compared to those who abandoned. Bivariate analysis was made by chi(2) test to compare qualitative variables. Associations were measured by means of odds ratios (OR) with 95% confidence intervals (CI). Variables showing a statistically significant association were analysed at multivariate level by means of a logistic regression model. RESULTS: Treatment was carried to completion by 1065 patients (48.4%), 289 (13.1%) abandoned, 648 (29.5%) died during treatment, and 142 (6.5%) moved out of the city. Final outcome could not be established in 57 (2.5%). Intravenous drug users (IDU) represented 76.2% of patients. The rate of non-completion between 1987 and 1992 was 26.3% and for 1993-1996 it was 15.1%, a decrease of 42.6%. Living in neighbourhoods of a low socio-economic level (OR 1.61; 95% CI 1.222.13), homelessness (OR 3.56; 95% CI 2.01-6.31), history of TB (OR 1.61; 95% CI 1.12-2.33), and having presented with a current TB episode in 1987-1992 (OR 1.42; 95% CI 1.01-2.00), were risk factors for abandoning TB treatment. CONCLUSIONS: Social and health factors together influence non-completion of TB treatment in HIV-infected patients, while health interventions can improve treatment completion.

Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona, 1989-93.

Drug-related deaths have become a major source of premature mortality. This paper presents an analysis of deaths due to acute adverse drug reactions caused by opiates or cocaine in the city of Barcelona over a 5-year period during which figures were stable. Annual mortality rates due to adverse drug reactions of city residents for the 1989-93 period were estimated to be 15.3 per 100,000 people in the 15-49-year age group. Mortality rates for men (25.0) are consistently higher than mortality rates for women (5.8). Mortality rates by age group show different patterns by gender. Males in the 25-29-year group have the highest mortality rate (62.8), almost doubling the rates for the 20-24 (36.1) and 30-34 (33.3)-year groups. The highest differential in age-specific mortality by gender is seen in the 35-39-year age group, where mortality rates for men (21.5) are eight times higher than for women (2.6 per 100,000). The distribution by place of residence, stratifying data across city neighbourhoods and municipal districts displays wide differences between districts in the mean annual rates, ranking between 77.3 and 8.3 per 100,000, a nine-fold magnitude. Differences are even steeper when we break down data by neighbourhood. Although all areas with high adverse drug reactions mortality are areas of low socio-economic level, a more complex association between deprivation and drug use must exist, as other areas with similarly low socio-economic indicators do not suffer from such high mortality. A cross-tabulation of place of residence and district of death shows that for most adverse drug reaction deaths, death takes place in the district of residence but patterns related to districts who attract drug-related deaths and districts who export them may be observed. These results provide new insights into the epidemiology of substance abuse in Barcelona, where it follows patterns that may be similar to those of other major urban areas in Spain, but also in other Southern European countries.

A small area analysis estimating the prevalence of addiction to opioids in Barcelona, 1993.

STUDY OBJECTIVE: To determine the distribution of opioid use prevalence in small areas and its relation with socioeconomic indicators. DESIGN: Capture-recapture was applied using data from the Barcelona Drug Information System for 1993 (treatment demands, hospital emergency room visits, deaths from heroin acute adverse reaction and pre-trial prison admissions). To avoid dependence between sources, a log-linear regression model with interactions was fitted. For small neighbourhoods, where capture-recapture estimates were not obtainable, the Heroin Problem Index (HPI) was used to predict prevalence rates from a regression model. The correlation between estimated opioid use prevalence by neighbourhoods and their socioeconomic level was computed. MAIN RESULTS: The city's estimated prevalence was 12.9 opioid addicts per 1000 inhabitants aged 15 to 44 years (95% CI: 10.1, 17.2), which represents 9176 persons. The highest rate was found in the inner city neighbourhood. Comparing rates obtained for each neighbourhood with their unemployment rates, a high correlation coefficient was obtained (r = 0.80, p < 0.001). CONCLUSION: The main contribution of this study is that of combining capture-recapture with the HPI to produce small area prevalence estimates, which would not have been possible using only one method. Areas with higher socioeconomic status showed proportionally low addiction prevalences, but in depressed areas, prevalences varied widely.

[Change in health-related problems of cocaine consumption in Catalonia, Spain]. / Cambio de los problemas de salud provocados por la cocaína en Cataluña.

BACKGROUND: Our aim was to study the evolution of cocaine-related health problems in Catalonia, Spain. METHODS: Analysis of first treatment admissions, emergency-room episodes, and mortality recorded by information systems on drug abuse in Catalonia and the city of Barcelona (Spain) in 1999. RESULTS: In 1999, cocaine was the illegal drug most frequently reported among drug-related emergency-room episodes (1,093 episodes in the city of Barcelona). In addition, cocaine was the illegal drug most frequently found among fatal drug overdoses (80% of all deaths in the last quarter of 1999) and the one that caused the highest number of treatment admissions (1,547 cases in Catalonia). CONCLUSIONS: There is an increase in cocaine-related health problems which means that it is needed health to improve the diagnosis, health education, treatment and prevention of complications associated with the use of this substance.

[Mortality trends in the young people of the city of Barcelona, 1983-1993]. / Evolución de la mortalidad en los jóvenes de la ciudad de Barcelona: 1983-1993.

BACKGROUND: The aim of this study was to analyze trends in overall and cause specific mortality in young people from 15 to 34 years-old residing in the city of Barcelona (Spain) from 1983 to 1993. METHODS: Data were obtained from death certificates. The overall deaths as well as deaths due to motor vehicle accidents, suicide, AIDS and drug overdose were studied. Annual crude and standardized rates were calculated (direct method) by sex and cause of death. Simple lineal regression analysis was performed to model time trends. RESULTS: Global mortality rates increased from 65.7 per 100,000 inhabitants in 1983 to 114.1 per 100,000 inhabitants in 1993. By causes, AIDS changed from being non existent as a cause of death in 1983 to becoming the main cause of death since 1990 to the present time (standardized rate = 45.6/100,000 inhabitants for men and 18.25 for women in 1993). In addition, this cause has experienced a significant increase among people older than 20 years. Overdose was the only cause with a significant increase in all age groups in men and women. Motor vehicle crashes were the main cause of death in the youngest age group (15-19 years) with significant increases in men. CONCLUSIONS: Since 1990, AIDS and drug overdoses are the principal causes of death in young people in the city of Barcelona. Although this situation has left motor vehicle accidents in the third place, deaths from this cause have also increased.

[The epidemiology of the acute adverse drug reaction in Barcelona in 1983-1992: a mortality analysis]. / Epidemiología de la reacción aguda adversa a drogas en Barcelona, 1983-1992: análisis de la mortalidad.

BACKGROUND: Mortality caused by acute adverse drug reactions (AADR) increased in Spain over the eighties and has become one of the major causes of death for youth. This paper presents the results of a study in the city of Barcelona during the 1983-92 decade; based in the city drug information system. METHODS: The study includes all deaths caused by AADR autopsied in the Forensic Institute between 1983 and 1992. Mortality of city residents is analyzed by cohort, grouping data in two-years and adjusting Poisson regression to mortality rates by age group, birth cohort and period of study. RESULTS: During this period a sharp increase in AADR mortality is seen, as there were 19 deaths in the city in 1983 and 160 in 1992. The increase concentrates in the years 1987-89. Although previously the increasing mortality of drug users was related by some observers with the progressive deterioration of their health status, linked to their increasing age and to the cumulative effects of years of substance dependence, the mortality analysis points to a clear period effect, resulting in an increased mortality across all age groups, for cohorts born after 1960. CONCLUSIONS: These results point to changes in the illegal drug market in the city or in the patterns of abuse as most likely causes for the increase. The results also suggest that since 1989 there is a stabilization in mortality due to AADR, which deserves further study.

[The evolution of AIDS mortality and survival in Barcelona (1981-1997)]. / Evolución de la mortalidad y supervivencia del SIDA en Barcelona (1981-1997).

BACKGROUND: To analyze the evolution of AIDS mortality and survival in Barcelona, Spain. PATIENTS AND METHODS: AIDS-cases registered in Barcelona (Spain) between 1981-1997. Study of mortality and survival probability. RESULTS: Mortality decreased by 55% between 1996-1997. Survival probability at 547 days was of 80.3% in 1997 compared with 48.6% before 1988. Being older than 36 years old, IVDU, having other AIDS-defining disease than tuberculosis, and year of diagnostic before 1997 were associated with poor survival. CONCLUSIONS: AIDS mortality in Barcelona has enormously decreased. The best survival in 1997 is probably attributable to the new antiretroviral therapies.

[Methadone maintenance programs with supplementary services: a cost-effectiveness study]. / Programas de mantenimiento de metadona con servicios auxiliares: un estudio de coste-efectividad.

OBJECTIVE: Methadone maintenance programs (MMP) currently offer the best treatment for opioid-addicted patients. The aim of this study was to examine the cost-effectiveness of three MMPs that offered varying levels of supplementary services. Health-related quality of life was used as a measure of effectiveness. METHODS: A 12-month follow-up study of 586 patients beginning methadone treatment in Drug Care Centers in Barcelona was performed. The Nottingham Health Profile was used to measure quality of life. Standard unit costs and total cost per patient were calculated from activity registries. Sociodemographic, health-related and toxicological data were collected through a semi-structured interview. A cost-effectiveness analysis was performed through two multiple linear regressions with the same adjusting variables. RESULTS: The greater the number of supplementary services involved, the higher the costs. The adjusted models revealed a significant increase in health-related quality of life (an increase of 8% in the Nottingham Health Profile) and in costs (17%) between low- and medium-intensity programs. CONCLUSION: The medium-intensity program showed the best cost-effectiveness ratio. However, the study's limitations preclude categoric generalization of the data.

[Discrepancies in the number of deaths from an acute reaction to psychoactive substances recorded in Spain]. / Discrepancias en el número de muertes por reacción aguda a sustancias psicoactivas registradas en España.

OBJECTIVE: The National Mortality Register (NMR) is used to monitor and prioritize health problems, but it may underestimate deaths from external causes, among which are deaths from acute reaction to psychoactive substances (ARPS). To evaluate the discrepancies between death from ARPS collected in the NMR and those collected in the specific register of the State Information System for Drug Addiction (SEIT). METHODS: We evaluated the discrepancy between ARPS deaths in 15-49 years olds registered in the NMR (code E850-858) and deaths from acute reaction to opium and cocaine in the SEIT, in Barcelona, Bilbao, Madrid, Sevilla, Valencia and Zaragoza, between 1984-93. RESULTS: 3,491 ARPS deaths were registered in SEIT, 1,285 in NMR. Varying degrees of discrepancies appeared between the two registers in all six cities. The NMR in Madrid showed 92% fewer deaths than the SEIT, while in Barcelona the NMR figure was 23% lower. Between 1984 and 1993 the differences between registers in all cities, except Madrid and Seville, narrowed (p < 0.01). CONCLUSIONS: Even though detection of ARPS deaths in the NMR has been improving, it still underestimates the real situation, and is therefore not a useful tool in the evaluation of temporal-spatial variations. To improve detection of ARPS deaths (and those from other external causes) a systematic linkage with data from the coroners' registers must be done.

[Influence of social inequality, social unrest and extreme poverty on tuberculosis morbidity in the City of Barcelona]. / Influencia de las desigualdades sociales, la conflictividad social y la pobreza extrema sobre la morbilidad por tuberculosis en la ciudad de Barcelona.

BACKGROUND: The main purpose of this study was to analyse inequalities between tuberculosis/intravenous drug user and tuberculosis/not intravenous drug user among the different neighbourhoods of Barcelona and the relationship to socioeconomic indicators and social/material deprivation indicators throughout the 1990-1995 period. METHODS: An ecological study which included all cases of tuberculosis among residents of Barcelona, the analysis unit being the neighbourhood. Intravenous drug users within the 15-49 age range and non-intravenous drug users over age 14 were included. The mean annual incidence rate standardized by age was used. The social indicators considered were the inner city areas, unemployment, less than primary education, overcrowding, social unrest and extreme poverty. In the bivariate analysis, the relationship between tuberculosis incidence and the social indicators was studied by means of the Spearman correlation coefficient, and the multivariate analysis by means of the Poisson regression. RESULTS: The incidence rates were higher in the inner city neighbourhoods, followed by the newer outlying working class neighbourhoods in both groups studied, and in other older outlying districts for the non-users of intravenous drugs. Among the intravenous drug user group, the variables related to a greater risk of tuberculosis were: man (RR = 7.42, confidence interval at 95% ICI95%-: 6.16-8.93), age (RR = 61.51, CI95%: 34.64-109.20), unemployment (RR = 1.68, CI95%: 1.51-1.88), social unrest (RR = 1.29, CI 95%: 1.04-1.58), overcrowding (RR = 1.36, CI 95%: 1.19-1.55) and inner city areas (RR = 1.92, CI 95% 1.48-2.50). Among the male non-users of intravenous drugs, no interaction between unemployment and age was found. Neighbourhoods with extreme poverty and inner city neighbourhoods showed a higher risk of tuberculosis (RR = 1.11, CI 95% 1.08-1.135 and RR = 1.80, CI95%: 1.51-2.14). Among the female non-users of intravenous drugs, a relationship was found in those of lesser age (RR = 1.29, CI 95%: 1.05-1.57), unemployment (RR = 1.18, CI 95%: 1.09-1.26), extreme poverty (RR = 1.95, CI 95%: 1.56-2.45) and inner city areas (RR = 1.72, CI 95%: 1.35-2.19). CONCLUSION: Inequalities in tuberculosis are related to different social indicators such as unemployment and inner city areas. A difference exists between the two groups studied. Tuberculosis is related with social unrest and overcrowding among intravenous drug users and with extreme poverty among non-users of intravenous drugs.

Depression among regular heroin users: the influence of gender.

The aim of this study was to determine the prevalence of recent (last 12 months) depression in regular young heroin users and to ascertain factors associated with depression in this population, broken down by gender. A sample of 561 participants completed a cross-sectional survey. Eligibility criteria were: age 30 years or younger, and having used heroin for at least 12 days in the last 12 months and at least one day in the last 3 months. Participants were recruited outside of health-care facilities in the cities of Barcelona, Madrid and Seville by targeted sampling and chain referral methods. Depression was assessed using the World Mental Health Composite International Diagnostic Interview. The prevalence of recent depression was 22.3% (35.2% among women and 17.3% among men, p<0.001). In the multivariate analysis, the factors positively associated with recent depression in the whole sample were female gender, age 25 or less, inability to work due to health problems and high risk consumption of alcohol. Among woman, the related variables were age 25 or less, cocaine dependence in the last 12 months, and alcohol consumption in that period. Among men, employment status was the only related variable. Analysis of an overall sample without the gender breakdown may hide important differences in the factors associated with depression in men and women. Both prevention and treatment of depression should rely on specific gender analysis.