Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union.

BACKGROUND: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. METHODS: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. RESULTS: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. CONCLUSIONS: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

[Weight changes of patients in methadone maintenance treatment during four years period]. / Zmeny váhy u pacientov v metadónovej udrziavacej liecbe pocas styroch rokov.

BACKGROUND: Besides significant reduction in heroin consumption, weight gain is an accompanying phenomenon during methadone maintenance treatment. Priority of this on-going study was to find out, if it is stable, or transitory. We were also interested in possible contribution of pharmacological and socio-cultural factors on body weight changes. METHODS AND RESULTS: It was a longitudinal, clinical, observational study. The sample consisted of 42 patients from methadone maintenance treatment program (MMTP) from the Centre for Treatment of Drug Dependencies in Bratislava. Their average age was 28.6 years (SD ± 6.0); 67 % were males. The weight (kg) and body mass index (BMI) were monitored in the series of five measurements during four years period in MMTP: at treatment entry after one year, after two, after three and after four years in the program. Relationship was also explored between daily dose of methadone and BMI. The average weight of the patients and their BMI were: before the entry into MMTP 65.2 kg (SD ± 13.9) and 22.2 (SD ± 3.9); after one year 72.7 kg (SD ± 15.3) and 24.7 (SD ± 4.1); after two 75.2 kg (SD ± 16.7) and 25.6 (SD ± 4.4); after three 74.2 kg (SD ± 17.1) and 25.1 (SD ± 4.5); after four years 75.0 kg (SD ± 16.5) and 25.2 (SD ± 4.2). Significant increase of BMI was detected after one year (t = 5.03; p < 0.001) and less significant between one and two years (t = 2.5; p < 0.05) in MMTP. Significant difference was also found between proportional distributions of the patients according to BMI categories: underweight, norm, overweight, obesity; at the time of entry to MMTP and after one year in it (χ² = 13.6; p < 0.01). No any other statistically significant changes were found later on, after 1 - 4 years from the entry to the treatment. The correlation between daily dose of methadone and BMI (r = 0.273) was not significant after four years in MMTP. CONCLUSIONS: The weight of the patients in MMTP has increased significantly after one year in the treatment, but remained stable from the second year. No substantial correlation was detected between methadone dose and BMI.

Stereoselective determination of methadone and its main metabolite in serum and urine from methadone maintenance patients.

OBJECTIVES: A stereoselective HPLC method was developed to separate and quantify both enantiomers of methadone and its main metabolite EDDP in serum and urine. The method was used to establish that there is a relationship between the dose of methadone prescribed and its serum concentration as well as urine excretion of methadone and its metabolite enantiomers. METHODS: The chiral alpha1-glycoprotein stationary phase was used for enantioseparation of (R)-methadone, (S)-methadone and (R)-EDDP (S)-EDDP. The enantiomers of methadone and EDDP were extracted from urine and serum by a simple solidphase procedure. RESULTS: The validated method was applied to the analysis of 31 serum and urine samples obtained from methadone-maintained outpatients (65% male, age 28.8+/-4; methadone dose 146+/-47 mg). A significant correlation (Pearson) r=0.67 (p<0.001) between methadone dose and serum concentration of (R)-methadone was found. Due to the large variation in results obtained from analysis of the subjects' urine specimens, no statistically significant relationship between methadone dose and urine excretion of methadone and EDDP enantiomers was established. The rate of R/S methadone (1.38 in serum, 2.43 in urine) and R/S EDDP (0.83 in urine) confirmed stereoselectivity in methadone metabolism with high individual variability. CONCLUSIONS: The enantioselective evaluation of serum methadone concentration might be an interesting tool in methadone maintenance programme. On the other hand, the urinary excretion of methadone and EDDP enantiomers is not reliable as marker of methadone compliance but could be useful for monitoring individual metabolism or for studying the stereoselectivity in pharmacokinetics and metabolism of methadone.

Staff regard towards working with substance users: a European multi-centre study.

AIMS: To compare regard for working with different patient groups (including substance users) among different professional groups in different health-care settings in eight European countries. DESIGN: A multi-centre, cross-sectional comparative study. SETTING: Primary care, general psychiatry and specialist addiction services in Bulgaria, Greece, Italy, Poland, Scotland, Slovakia, Slovenia and Spain. PARTICIPANTS: A multi-disciplinary convenience sample of 866 professionals (physicians, psychiatrists, psychologists, nurses and social workers) from 253 services. MEASUREMENTS: The Medical Condition Regard Scale measured regard for working with different patient groups. Multi-factor between-subjects analysis of variance determined the factors associated with regard for each condition by country and all countries. FINDINGS: Regard for working with alcohol (mean score alcohol: 45.35, 95% CI 44.76, 45.95) and drug users (mean score drugs: 43.67, 95% CI 42.98, 44.36) was consistently lower than for other patient groups (mean score diabetes: 50.19, 95% CI 49.71, 50.66; mean score depression: 51.34, 95% CI 50.89, 51.79) across all countries participating in the study, particularly among staff from primary care compared to general psychiatry or specialist addiction services (P<0.001). After controlling for sex of staff, profession and duration of time working in profession, treatment entry point and country remained the only statistically significant variables associated with regard for working with alcohol and drug users. CONCLUSIONS: Health professionals appear to ascribe lower status to working with substance users than helping other patient groups, particularly in primary care; the effect is larger in some countries than others.