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 association between psychosocial characteristics at work and problem drinking: a cross-sectional study of men in three Eastern European urban populations.

BACKGROUND: Psychosocial factors at work are thought to influence health partly through health behaviours. AIMS: To examine the association between effort-reward imbalance and job control and several alcohol related measures in three eastern European populations. METHODS: A cross-sectional study was conducted in Novosibirsk (Russia), Krakow (Poland), and Karvina (Czech Republic). The participants completed a questionnaire that included effort-reward at work, job control, and a number of sociodemographic variables. Annual alcohol intake, annual number of drinking sessions, the mean dose of alcohol per drinking session, and binge drinking (> or =80 g of ethanol in one session at least once a week) were based on graduated frequencies in the questionnaire. Data were also available on problem drinking (> or =2 positive answers on CAGE questionnaire) and negative social consequences of drinking. All male participants in full employment (n = 694) were included in the present analyses. RESULTS: After controlling for age and centre, all indices of alcohol consumption and problem drinking were associated with the effort-reward ratio. Adjustment for material deprivation did not change the results but adjustment for depressive symptoms reduced the estimated effects. Job control was not associated with any of the alcohol related outcomes. CONCLUSIONS: The imbalance of effort-reward at work is associated with increased alcohol intake and problem drinking. The association appears to be partly mediated by depressive symptoms, which might be either an antecedent or a consequence of men's drinking behaviour.

[Use of the results of monitoring in the practice of district public health personnel]. / Vyuzití výsledku monitoringu v praxi okresního hygienika.

The author presents her experience with the introduction and implementation of the system of monitoring of the health status of the population and environmental factors on the territory of the Karviná district after 1989. It provides evidence that the results of monitoring need not be conceived only as systematic collection and analysis of data and evaluation of trends but also as valuable material for supervision by organs of the hygiene service. It provides also information for authorities of the state administration and self-administration, the public, teaching and training of students incl. theses etc. It draws attention to the necessity of organizational changes in the activities of the District hygiene station, to increased demands on the professional standard of workers and the need of close collaboration of field and laboratory departments.

[Detection of HIV antibodies in clients of the AIDS Center of the District Health Service in Karvina 1993-2000]. / Vysetrení HIV protilátek u klientu poradny AIDS Okresní hygienické stanice Karviná v letech 1993-2000.

The authors present the trends of some characteristics recorded in a group of subjects examined for HIV antibodies in the AIDS centre of the District Hygiene Station in Karviná in 1993 to 2000. These characteristics reflect the development of activities of the centre. During the period a total of 3733 HIV tests were made, incl. three positive ones. In two instances men with homosexual relations in the case-history were involved, in one case a male heterosexual. The declining trend of the ratio of anonymous examinations is apparent from 58.8% in 1993 to 7.7% in 2000. Parenteral drug users, prostitutes (in particular women) and homosexuals account on a long-term basis for ca 30% of all examinations. Recently this ratio is even higher. Repeated examinations (check-ups) of the same client account for 16.1% of all implemented HIV tests. At least once 384 parenteral drug users were examined, in prostitutes similarly as in men with homosexual relationships the number of subjects examined at least once is ca 200. Repeated tests were made in ca one quarter of all parenteral drug users, ca one third of the prostitutes and ca one fifth of homosexuals. In none of the repeated tests seroconversion to HIV positivity was recorded. To achieve close contact and monitoring of the HIV statute of groups with a risk behaviour despite their existence at the brink of law and despite their natural tendency to hide is real. Without collaborating organizations, without gaining their confidence and in particular without the confidence of the clients this would not be possible.

[Seroprevalence of viral hepatitis A, B and C in intravenous drug users]. / Séroprevalence virových hepatitid typu A-C u injekcních uzivatelu drog.

Markers of viral hepatitis A-C of 99 intravenous drug users predominantly (in 96%) from the Karviná district were examined from March 1998 to February 1999. Pervitin (methamphetamine) was the basic drug in all subjects. Anti-HAV was detected in 6.4% of VHA non-vaccinated individuals, anti-HAV/IgM was not found in any case, HBsAg was detected in 4.0% (acute VHB was diagnosed in all these cases), anti-HBc in 9.2% and anti-HCV in 25.0% of the investigated cases. Our results confirmed the importance of drug use by injection, esp. needle sharing, for the spread VHB and VHC. In case of VHA the fecal-oral route of transmission in this subpopulation is dominant.

[Endemic incidence of Mycobacterium kansasii infection in Karvina District 1968-1999; overview of the descriptive characteristics]. / Endemický výskyt mykobakteriózy kansasii v okrese Karviná v letech 1968-1999, prehled deskriptivních charakteristik.

The objective of the submitted work was to present a summary of basic epidemiological data in a group of 1034 subjects from whom during the period between 1968-1999 Mycobacterium kansasii was isolated. In the analysis of the group principles of the descriptive epidemiological method were used. In the first years, when diseases were recorded and the number of cases increased, epidemiologists of the District Hygiene Station in Karviná made an investigation. The objective was to describe the clinical aspect and based on epidemiological investigations to analyze data and to find an answer to basic links of the spread of infection, i.e. source, route of transmission to susceptible subjects and based on the assembled findings, to suggest the necessary epidemiological provisions. Interhuman transmission was not proved in any of the patients. The causal agent of the infection is most probably transmitted through water (by the aerogenic route). The Karviná district belongs to the largest investigated endemic areas in the world.

Endemic incidence of infections caused by Mycobacterium kansasii in the Karviná district in 1968-1995 (analysis of epidemiological data--review).

The Karviná district (northwestern part of North Moravia and Silesia) is typical by its industrial character, above all mining of black coal which is coked and which led to the devastation of the countryside. The ratio of light industry is low. In a small area (347 km2) there is a population of 824 inhabitants per km2. The population is concentrated in particular in urban agglomerations of the flat block type. Up to 1990 almost 55% of the population was employed in heavy industry. Due to its industrial activities, incl. metallurgical plants and ironworks in nearby Ostrava and Trinec, the district is one of the areas with a heavily contaminated atmosphere in particular with solid aerosol containing toxic metals (the values of solid aerosol varied on average between 100 and 150 micrograms/ml), the elevated values of Nox due to contamination from traffic and polyaromatic hydrocarbons were not negligible either during the investigation period. Since 1968 an endemic incidence of mycobacteria has been recorded which is due to Mycobacterium kansasii. At first only an occasional incidence was involved, since 1973 there has been a more substantial increase with a maximum in 1983 (64 cases) and thus up to 1995 there are 961 cases on records, incl. 787 (81.8%) in men and 174 (18.2%) in women. From the total number of recorded M. kansasii in 937 instances (97.3%) the lungs were affected (777 men, 160 women). The mean annual incidence was 34.3 cases, i.e. 12.03 per 100,000 population (28.1, i.e. 20/100,000 in men, 6.2, i.e. 4.28/100,000 in women). As to age, 78.8% of cases are recorded in the age bracket from 25 to 64 years (in men 81%, in women 68.9%). The highest specific morbidity in men is in the age group from 45-54 years (on average 73.13 per 100,000 per year), in women in the age group from 75 to 84 years (on average 9.75 per 100,000 per year). As to occupation, the ratio of mine employees at the time of contraction of the disease (incl. retired miners) was 52.2%), other workers 14.6%--all stigmatized by an increased dust concentration in other workplaces in heavy industry. As far as the domicile is concerned, the incidence was by far highest in Havírov (more than 56%), followed by Karviná (26.7%). These towns are inhabited mostly by miners. As to the mode of assessment 68.8% cases were diagnosed on account of pulmonary complaints and during dispensarization (stigmatization by dust) and 24.6% cases during preventive radiodiagnostic examinations of miners lungs. It did not prove possible to reveal the source. Interhuman transmission was not proved in any of the patients. The causal agent of the infection is most probably transmitted through water (by the aerogenic route). M. kansasii was isolated from drinking water (560 samples, in 7% M. kansasii was found), as well as in industrial water. In 1971-1995 a total of 1231 samples of industrial water were examined (scrapings and untreated water). From these M. kansasii was isolated in 43.7% (538 specimens). In soil samples (93) and small mouse-like rodents (187) M. kansasii was not detected. The authors confirm that the development of disease depends in a decisive way on the susceptibility of the individual which in turn depends in particular on exposure to dust with possible lung damage and contamination of the atmosphere. In the district there is a high incidence of recurring acute diseases of the airways in children, incl. allergies affecting the airways. In the towns of Karviná, Havírov, Orlová, Bohumín and Ceský Tesín there is a high ratio of children with reduced immunity. In November 1981 to January 1982 987 first form pupils were examined for postvaccination TB allergy (standard tuberculin and avian tuberculin were used). The reactivity to avian tuberculin was higher than to standard tuberculin (see results). The highest ratio of intense reactions (30%) was recorded in children from Havírov where there is also the highest specific (and simple) incidence in adults.

[A phone survey of prostitute services in homes]. / Telefonický pruzkum bytové prostituce.

BACKGROUND: Home prostitution is the hidden form of commercial sex network. We had done a phone survey of commercial sexual services provided in the private flats. METHODS AND RESULTS: We had used advertisements in the section "Intim services" of local adnewspaper "Avizo" as the primary source of relevant phone numbers. "Avizo" is sold in Northern Moravia--mainly in Ostrava, Karvina and Frydek-Mistek districts. We accomplished the phone interview with 48 subjects (individual persons or groups working in the particular flat) using the set of prepared questions. Three of these subjects were male, providing commercial sex for women. We estimated the number of such private flats, number of persons working there and number of professional contacts of this type in Karvina, Ostrava districts and whole Czech republic. CONCLUSIONS: We constructed an estimate of sexual sex workers for whole Czech republic--10,200 persons, therefrom 5100 persons in 1750 private flats, who accomplish to 1.36 mil sexual contact with customers annually. Regarding the risk behaviour nearly all of interviewed subjects indicated the use of condoms; 80% of subjects reported to be HIV-tested.