Evaluating and comparing success rates for inpatient treatment of alcohol addiction in the Czech Republic.

OBJECTIVES: This systematic review seeks to present and compare data from studies evaluating the success of medium-term inpatient treatment of alcohol-dependent patients in the Czech Republic. Another aim was to identify the problems that make such comparisons difficult. No previous review comparing the efficiency of various therapeutic programmes has been published in the Czech Republic. METHODS: Bibliographia medica Cechoslovaca and PubMed were used to find studies published in professional medical journals since 1970 evaluating the abstinence of patients who voluntarily completed medium-term inpatient treatment of alcohol dependence. RESULTS: Medium-term inpatient treatment of alcohol addiction leads to one year of abstinence in 34% to 76% of patients. Such variance in value is largely caused by selection bias, differences in the definition of abstinence, and differences in data collection methods. CONCLUSION: The comparison of studies presented many challenges. Further steps should be taken to help compare treatment programmes in the future, as the programmes provide different therapeutic interventions of different intensities and lengths to different patients. Adequate demographic and other pretreatment characteristics data collection, detailed descriptions of therapeutic interventions, and identification of effective components of the therapeutic programme could support further research in this area, optimize existing programmes, and increase the overall treatment efficiency.

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity.

BACKGROUND: Most severe substance use disorders (SUDs) are connected with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Therapeutic communities (TCs) provide a suitable option for the treatment of severe SUDs. The relationship between ADHD, the severity of the SUD, and other comorbidities in residential TCs is unknown. OBJECTIVE: To estimate the prevalence of ADHD among clients with an SUD in residential rehab, and to compare the mental health of clients with and without ADHD. METHODS: A cohort study was conducted in 5 residential TCs (N = 180, 76.7% male, 53.9% 25-34 years, 79.2% diagnosed with methamphetamine use disorder). We assessed ADHD symptoms, substance use, mental health problems, and psychiatric symptoms. RESULTS: ADHD was found in 51% of the clients who showed significantly higher scores for their psychiatric status composite score (ASI-PSY) (F = 9.08, p < 0.001; t = 5.05, p < 0.001), the positive psychiatric symptoms total (SCL-PST) (F = 3.36, p < 0.05; t = 3.15, p < 0.01), and the global severity index (SCL-GSI) (F = 3.27, p < 0.05; t = 3.18, p < 0.01). The ASI-PSY and SCL correlated significantly with the symptoms of attention deficit disorder (Pearson's r's = 0.30-0.42, p's < 0.001) and the symptoms of hyperactivity disorder (r's = 0.24-0.30, p's < 0.01). Even when severity of substance use was accounted for, ADHD was confirmed as a significant predictor of ASI-PSY (B= 0.14, p < 0.001 for combined disorder; B = 0.20, p < 0.001 for attention disorder) and partially of SCL-PST (B = 8.12, p < 0.05 for attention disorder). CONCLUSIONS: The ADHD prevalence in TCs was nearly 10-fold compared to the globally recorded values. ADHD diagnostic procedures and interventions should become an integral part of the standard diagnostic and treatment process.

The context and historical correlations of the origin and development of the oldest continually existing residential alcohol treatment model ("Apolinar model") in Central Europe from 1948 to 1960.

Building upon the tradition of the oldest specialized programs, the "Apolinar model" of alcohol treatment influenced the emergence and development of residential treatment programs in what is now the Czech Republic and Slovakia. Similarly to the socialist concept of unitary economy, this approach was applied in all emerging treatment programs until the Velvet Revolution. To identify and describe the key factors determining the origin and development of residential alcohol treatment and what became known as the Apolinar model in the context of the development of the addiction-specific institutional infrastructure. Qualitative content analysis of retrieved historical documents was used to identify and establish the sources and data. The relevant documents were identified and compiled according to their thematic relationship with the focus of the research in terms of their place and time of origin and authorship. The Apolinar model represented a compact and unique treatment approach. This was owed to both foreign and local experience, ideas and inspiration, which the program drew on. The key figure behind the Apolinar model was Jaroslav Skála. In addition to achieving the maximum that was possible at the time and creating a homogeneous, original, and successful residential alcohol treatment model, Skála succeeded in establishing valuable international links and kept his facility and the emerging Czechoslovak addiction professional community in contact with the latest international trends and leading institutions.

Understanding the crisis in harm reduction funding in Central and Eastern Europe.

BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformation had significant consequences for drug policies in the region. A large number of emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable, and closely associated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input. The main objective of the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution building which represents a major threat to the future of HR services in the region. METHODS: Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions. RESULTS: The insufficient investments in finalising the process of the institution building of HR services have resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare. CONCLUSION: The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s, which remains present until today, together with all its weak points. The entire situation is responsible for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept.

Methanol Poisoning as an Acute Toxicological Basal Ganglia Lesion Model: Evidence from Brain Volumetry and Cognition.

BACKGROUND: Acute methanol poisoning leads to optic neuropathy and necrotic lesions of basal ganglia (BG) and subcortical white matter. Survivors of methanol poisoning exhibit long-term executive and memory deficits. Associations between brain volumetry parameters and cognitive sequelae of methanol poisoning are not known. The aim of our study was to identify long-term associations between the cognitive performance of survivors of methanol poisoning and the volume of the brain structures that are selectively vulnerable to methanol. METHODS: We conducted a cross-sectional follow-up study on a sample of patients (n = 33, age 50 ± 14 years, 82% males) who survived acute methanol poisoning during methanol mass poisoning outbreak from September 2012 till January 2013 in the Czech Republic. A battery of neuropsychological tests and brain magnetic resonance imaging were included in the clinical examination protocol. Specific brain structures (putamen, globus pallidus, nucleus caudatus, and frontal white matter) were selected as regions of interest, and their volumes were estimated using the MorphoBox prototype software. RESULTS: In robust multiple regression models, sustained visual attention performance (as assessed by Trail Making Test and Prague Stroop Test) was positively associated with BG structures and frontal white matter volumes (Wald = 9.03 to 85.50, p < 0.01), sensitivity to interference (as assessed by Frontal Battery Assessment) was negatively associated with frontal white matter volume (Wald = 35.44 to 42.25, p < 0.001), and motor performance (as assessed by Finger Tapping Test) was positively associated with globus pallidus and frontal white matter volumes (Wald = 9.66 to 13.29, p < 0.01). CONCLUSIONS: Our results demonstrate that smaller volumes of elements of BG-thalamocortical circuitry, namely the BG and frontal white matter, relate to attention and motor performance in methanol poisoning from a long-term perspective. Disruption of those functional circuits may underlie specific cognitive deficits observed in methanol poisoning.

First alcohol treatment institutions in today's Czech Republic and Slovak Republic.

OBJECTIVE: Drawing on qualitative analysis of selected historical documents, the paper seeks to provide a definition of the general characteristics of the first institutional alcohol treatment facilities in today's Czech Republic and Slovakia, taking into account the historical context of the first half of the 20th century. An additional aim was to point out the importance of archival research and its contribution to understand the determinants of alcohol-related agenda and alcohol treatment. METHODS: The basic data platform was generated by analysis of historical documents pertaining to the subject matter under study and to institutional processes in different periods. The data was processed using the open coding method (as part of the grounded theory approach) and other specific methods based on the matching of data from scientific and professional literature and archives in different periods. Over 1,100 pages of text from relevant archival materials were analysed. This research is original, no such systematic analysis of historical documents on this subject matter has been conducted on such a scale with the intention of identifying the general correlates of the historical development of an alcohol-related agenda and alcohol treatment. RESULTS: The establishment of the first institutional facilities intended to provide treatment for alcohol dependency was based on the notion of addiction as a disease, which needs to be treated in dedicated facilities applying an individualised approach. The circumstances of the establishment of the facilities under analysis were similar. Their existence was made possible by distinguished personalities rather than a general belief and social pressure that the issue of alcohol addiction should be addressed. This also explains the fact that the occupancy of these facilities never reached their full capacity, that they were not self-reliant in economic terms, and that they did not readily resume their operation after 1945. CONCLUSIONS: The analysis of the establishment, operation, and dissolution of these facilities at the time reveals the discontinuity in the approach to alcohol abuse and its treatment in the context of the historical development and perception of alcohol-related problems in Czech and Slovak society in the first half of the 20th century. Significant social changes occurred after 1948. New legislative instruments were used to enforce treatment based on a principle that was different from the previous approaches. The results of our study also make it possible to reveal the intensity of apparent individual and institutional motives in the process of the development of alcohol treatment in historical terms and its projection into different post-war periods. The understanding of these correlates will help in designing additional trajectories of research into the effects of social and political changes on addiction treatment and thus identifying the intensity of the historical development and its influence on the perception of addiction treatment at present. These findings will also be of great importance for a historical comparative analysis, including overlaps with the development of recent theories, and will support the emergence of new areas of study for the social sciences.

National Addiction-specific Institutional Infrastructure - fundamental prerequisite for successful implementation of specialized academic degree study programmes: a case study in historical perspective.

OBJECTIVE: Human resources are crucial for addiction treatment and prevention services, as well as for science and research. The aim of this historical case study is to explain and demonstrate the role of specialized university academic degree study programmes in addictions in the context of a national institutional infrastructure. This specific group of very highly specialized academic programmes represents the highest level of professional development and is producing a totally new generation of addiction specialists with a very distinctive professional identity. METHODS: The study protocol is based on a case study research design and the case is defined as the historical development of addiction specialized institutions closely related to self-help, prevention, and treatment activities on the historical territory of the Czech Republic. We identified relevant historical sources related to establishing and/or running activities or institutions according to the categories specified in our concept of the national institutional infrastructure. All the materials and sources that were collected were sorted according to a timeline and categories of institutions and we systematically determined the first recorded activity/institution in each particular category. For this simple sorting system we used open and selected coding according to Grounded Theory. RESULTS: The public health model developed by Thomas Babor recognizes six different structural mechanisms to support university-based programmes in addiction studies: specialized journals, research centres, professional societies, specialized libraries and documentation centres, training and education programmes and institutions, and funding agencies. We attempted to redefine the concept of addiction studies within the broader context of the addiction field and added three additional mechanisms of support: public interest groups, self-help groups, and service providers. Using a historical case study in the Czech Republic, we demonstrate the potential for a broader context and interaction between these support mechanisms and academic institutions hosting academic programmes in addiction studies. CONCLUSION: The process of establishing integrated addiction studies programmes at Charles University in the Czech Republic had its origins in, and support from, various national institutions and professional organizations. This allowed the university to develop academic programmes at the bachelor's, master's, and Ph.D. levels. The availability of career opportunities for advanced-level addiction professionals in the Czech Republic was also a critically important factor in developing sustainable academic programmes in addiction studies. Our experience is that the creation of successful and sustainable academic programmes for addiction professionals is difficult to achieve without broad infrastructure support, national advocacy efforts, and legislative change at the national level.

Incorporation of Universal Prevention Curriculum into established academic degree study programme: qualitative process evaluation.

OBJECTIVE: Comprehensive bachelor's, master's, and doctorate-level curricula of Addiction Studies (Addictology) were developed and implemented at Charles University (First Faculty of Medicine) between 2003 and 2012. This Prague model combines three evidence-based approaches to addressing substance use - prevention, treatment, and public health - into a balanced professionalised discipline. Graduates from this programme are licensed by the State Authority as addictology, a regulated profession in the Czech Republic. Professionals with these degrees are recognised as healthcare professionals, can perform directly in the field and can be contracted by health insurance companies. In 2016, it was decided to integrate the Universal Prevention Curriculum (UPC) into these programmes of study. The UPC was developed by a group of prevention researchers from the United States. This article describes the technical steps involved when adapting the UPC into an established university degree programme. We describe the requirements needed for successful implementation and reaccreditation. Finally, we examine both barriers and enhancers of the adoption of UPC as a university programme. METHODS: A qualitative process evaluation study was conducted on the activities carried out in 2017-2018, demarcated by a successful university accreditation of the new curricula combining the original Prague model and the UPC curriculum. Field records, observation methods, official documents, curricular documents, syllabuses, content analysis, and thematic analysis were used for this process. RESULTS: We identified three clusters of issues and challenges during the adaptation and implementation process: technical (developing a new credit scheme, adopting new terminology using local and culture-specific examples, and cancelling, establishing, and/or fusing particular courses, identifying some critical issues for any practical implementation of the UPC); teaching staff-related (team work, involving motivated and qualified staff for moving from a national to an international perspective); and content and contextual (the conflict between different theoretical perspectives such as public health vs. mental health and drug use prevention vs. risk behaviour prevention). CONCLUSION: The adaptation of the UPC had a significant impact on study profiles and competencies. Such an implementation necessarily requires a team of staff members with sufficient capacities to be able to coordinate the process, facilitating each step and supervising it. The current adaptation of the UPC involved specific merging procedures to fit in with existing courses and emphasising an international perspective. This process opened a national discussion about the implementation of the UPC in the system of life-long education programmes and training. Beginning in September 2019, when the first group of students will attend this new model of Addictology studies, we will continue our evaluation of the implementation process and the factors that played a role in either hindering or supporting the implementation. The findings from this evaluation will be used to make adjustments to the curriculum.

Public health response to methanol mass poisoning in the Czech Republic in 2012: a case study.

OBJECTIVES: The study focuses on the 2012 methanol outbreak in the Czech Republic. The main goal of the present study was to apply analytical and descriptive tools to selected qualitative and quantitative processes related to the 2012 methanol outbreak in the Czech Republic. The secondary goal was to study and evaluate in detail their potential for creating integrated conceptual national policies aimed at eliminating the risk of methanol poisoning in the future. METHODS: The presented qualitative analysis focused on the content of documents published by Czech public authorities - the Ministry of Health, the Ministry of the Interior, the Czech Agriculture and Food Inspection Authority, and the Regional Public Health Authorities - as well as the content of the relevant legal regulations. Moreover, statistical data concerning the number of hospitalisations and deaths due to the methanol intoxication were used to provide a background to a detailed description of the relevant facts. RESULTS: In procedural terms, most of the analysed measures focused on a strongly restrictive regulation of sales, regular information channels designed to protect consumers on the national as well as international level, and elimination of further health and economic risks stemming from the dangerous alcoholic products that had already entered distribution networks. The health, social and economic consequences of such activities are quantified at a highly aggregated level. The analysed institutional ties are evaluated also in the context of international documents: the European Action Plan to Reduce Harmful Use of Alcohol 2012-2020 and the Global Strategy to Reduce Harmful Use of Alcohol, and their current potential for steering public policies is assessed. CONCLUSION: The analysis and evaluation of procedural activities carried out after the methanol outbreak have laid the foundations for a multidimensional study that can contribute to integrated national policy concepts aimed at preventing these and similar negative health, societal and economic consequences. Six years after the methanol outbreak, national and regional health policies have reflected no findings concerning the experience of patients whose health was impaired due to methanol, and the economic cost of the event has not been calculated. The quality of life of these patients has greatly decreased due to permanent or partial incapacity and serious upheavals of their and their families' economic and social conditions. This opens the question of researching and evaluating multiple aspects of health, social and economic impacts of harmful use of alcohol and setting up processes to mitigate these impacts.

Universality properties of school-based preventive intervention targeted at cannabis use.

This study aims to examine the effect of school-based preventive intervention on cannabis use in Czech adolescents with different levels of risk factors and provide evidence of its universality. A randomized controlled prevention trial with six waves was conducted over a period of 33 months. We used a two-level logistic random-intercept model for panel data; we first looked at the statistical significance of the effect of the intervention on cannabis use, controlling for the characteristics of the children and time dummies. Then we analyzed the effects of the interactions between the intervention and the characteristics of the children on cannabis use and related it to the definition of universal preventive interventions. The setting for the study was in basic schools in the Czech Republic in the years 2007-2010. A total of 1,874 sixth-graders (mean age 11.82 years) who completed the baseline testing. According to our results, the prevention intervention was effective. We found all the selected characteristics of the children to be relevant in relation to cannabis use, except their relationships with their friends. We showed empirically that the intervention is universal in two dimensions for the selected characteristics of the children. First, all adolescents who undergo the intervention are expected to benefit. Second, with respect to the effect of the intervention on cannabis use, the total level of individual risk of cannabis use is superior to the composition of the risk factors in the individual risk profile. We present indicative evidence that the drug prevention intervention may be considered a true universal preventive intervention.

Imaging findings after methanol intoxication (cohort of 46 patients).

OBJECTIVES: Our goal is to demonstrate the variability of imaging findings, primarily in the MRI, in 46 patients who survived acute methanol poisoning. This cohort of patients is the largest such sample group examined by MRI. METHODS: Patients were examined by means of imaging methods (42 patients by MRI and 4 by CT). All had an identical protocol of MR examination (T2WI, FLAIR, T1WI with or without application of contrast medium and T2WI/FFE, DWI in the transversal plane of the scan, and with focus on the optic nerves in the coronal plane of the scan in T2WI-SPIR). RESULTS: Imaging methods revealed a positive finding associated with methanol intoxication in 21 patients (46%). These consisted of symmetrical lesions in the putamen--13 patients (28%), haemorrhage--13 cases (28%), deposits in white matter with localization primarily subcortically--4 cases (9%), lesions in the region of the globus pallidus--7 cases (15%) (in 6 cases without combination with the lesions in the putamen), lesions in the brainstem afflicted 6 patients (13%), and lesion in the cerebellum was found in one case. A pathological finding was found only in the patients examined by MRI. CONCLUSION: Almost half of the patients who survived acute methanol poisoning had pathological findings by MRI. The most common finding concerned an affliction of the putamen, which is a predilection area. An interesting finding was the relatively frequent occurrence of selective lesion of the globus pallidus, which is more usually associated with other types of intoxication.

Condom use in the context of romantic relationships: A study among university students from 12 universities in four Central and Eastern European countries.

OBJECTIVE: To investigate the extent to which romantic relationship status influences condom use during vaginal, oral and anal sex among students from 12 universities in the Czech Republic, Hungary, Lithuania and Slovakia. METHODS: A pilot study of 880 students from the ongoing Student Life Cohort in Europe (SLiCE) study. Multiple logistic regression was conducted to establish the effect of romantic relationship status on condom use during vaginal, anal and oral sex in the previous 30 days, while adjusting for participants' age, gender, use of alcohol and other drugs prior to sex, condom-carrying practices and number of sexual partners. RESULTS: Of the total sample, 73.7% were currently engaged in a romantic relationship and their condom use during vaginal sex (p < 0.001), oral sex (p < 0.001) and anal sex (p = 0.003) was significantly associated with their romantic relationship status. Students who were not in a romantic relationship had the lowest odds of condom use. Use of alcohol or other drugs before sex was detrimental to condom use (odds ratio 0.5; p = 0.045) during vaginal sex. Condom use during vaginal and oral sex was lower among older students. CONCLUSION: The need to target university students with more pragmatic sexual health risk reduction interventions that accommodate the role of romantic relationships on behavioural choices is justified.

[Sobering-up stations in the Czech Republic in the context of analogous models of care for acute intoxications in Europe]. / Záchytné stanice v Ceské republicev kontextu obdobných sluzebo akutne intoxikované v Evrope

BACKGROUND: To map systems of care for persons with acute intoxications with alcohol and other drugs in European countries, to identify various models of this care and to contribute to discussion on the reform of sobering-up stations in the Czech Republic. METHODS: In 2012, a questionnaire survey was performed among national institutions which are focal points to European monitoring centre for drugs and drug addiction. All 27 EU member states, Norway, Croatia and Turkey were addressed, altogether 30 countries. Questionnaire consisted of 4 open questions. RESULTS: 16 countries responded. Specific system of supervised recovery, which is close to the system of sobering-up stations in the Czech Republic, exists in 5 countries, i.e. approximately one third of participating countries. In remaining 11 countries, a care of boozers and persons intoxicated with other drugs is provided within acute or intensive medical care or in case of public nuisance by police. Model of sobering-up stations existed in past in countries of the Soviet bloc. Aside from the Czech Republic, sobering-up stations have remained in Poland, where the functions of the service as well as status and rights of clients were reformed. The change has an impact on the increase of prestige of the service and sobering-up stations are regarded as the essential element of medical care for the intoxicated persons. Special sobering-up services can play in different countries similar functions: supervised recovery and care for intoxicated persons, prevention of health harms and injuries, counselling and motivation of clients to reduce the drug consumption and to start treatment, facilitating further special addiction care and prevention of public nuisance and damages to other persons and properties. CONCLUSIONS: Special system of care of boozers and persons acutely intoxicated with other drugs exists in several European countries with number of useful public health and public order functions. It diverts uncomplicated intoxications from intensive medical care or police intervention, which is efficient also in economical terms. The reform of the system of sobering-up stations in the Czech Republic should take into account its role within the system of addiction prevention and treatment, status and rights of clients and issues of financing and payments for the service.

An evidence-based approach in school prevention means an everyday fight: a case study of the Czech Republic's experience with national quality standards and a national certification system.

The Czech Republic has reached the end of a 15-year-long period of the development of a nationwide preventive system in schools. Reflection on this development can offer an interesting case study that demonstrates the general difficulties involved in creating a national prevention policy and implementing the principles of an evidence-based approach. Through its historical context the up-to-date outputs of the latest projects are presented as "key documents" (quality standards, textbook, explanatory dictionary, examples of good practice etc.) and a national system of assessment of quality called a certification procedure, which has a practical impact on the grant system of the Ministry of Education of the Czech Republic. This context is also used to show how certain European networks (EUSPR, IREFREA, etc.) can be very helpful in generalizing this idea across Europe. All the examples of activities on the national or international level seem to be promising and supportive of the increasingly noticeable trend of using research evidence in real practice and making the whole field more attractive for students and young researchers.

The picture of mental health/illness in the printed media in three Central European countries.

Even in the era of the Internet, printed media are still among the most frequently identified sources of mental health information. Many studies have shown that this information is frequently negative and contributes to stigmatization of people with mental illness. This international comparative study describes the content of media messages about mental health/illness in terms of stigma in three Central European countries. The study sample comprised all articles pertaining to the topic of mental health/illness (N = 450) identified during five week-long periods in 2007 chosen from the six most widely read newspapers and magazines in each country. The authors used content analysis methods to achieve quantitative and qualitative objectives. More than half of all articles contained negative statements reflecting stigma toward persons with mental illness. Substance abuse disorders are the most frequent mental conditions covered in all three countries (22%), and psychotic disorders are the most stigmatized. Countries significantly differ in length of articles, in the association of aggressive behavior with persons with mental illness, and in the use of a sensationalized style of writing. Coverage of mental health/illness issues differs to some extent across countries but is generally of poor quality. On the basis of the authors' findings, practical recommendations for journalists can be tailored specifically for each country.

The effect of the school-based unplugged preventive intervention on tobacco use in the Czech Republic.

Unplugged is a school prevention programme widely implemtend in Europe, with some positive evaluations. This research aims to measure the impact of this program on tobacco use by means of the lifetime and last-30-day tobacco use prevalence indicators and verify the duration of the intervention's measurable effect over time. The study was designed as a randomised controlled prevention trial. The intervention is based on the Comprehensive Social Influence model and consists of 12 lessons delivered to Czech adolescents in the 2007-2008 academic year. The prevalence indicators were calculated to assess the differences between the experimental (N = 914) and control (N = 839) groups on each outcome 1, 3, 12, 15, and 24 months after the end of the intervention. Data were collected using the 2003 version of the ESPAD questionnaire. As regards the 30-day smoking prevalence indicator, the tests performed after the completion of the intervention showed statistically significant differences between both groups in favour of the experimental one. Two years after the completion of the intervention the experimental and control groups showed 30-day prevalence rates of 26.7% and 33.1%, respectively (p = .01). The progression of smoking in the 30-day prevalence among the experimental group was significantly slower than that among the control group over the period of time. The differences in the lifetime prevalence rates were not statistically significant. The implementation of Unplugged resulted in a statistically significant measurable positive effect on tobacco use in Czech adolescents.

Somatic Symptoms, Anxiety, and Depression Among College Students in the Czech Republic and Slovakia: A Cross-Sectional Study.

Studying in college can be a challenging time for many students, which can affect their mental health. In addition to academic pressure and stressful tasks, another aggravating factor in student life is the ongoing coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to examine the prevalence of anxiety, depression, and somatic symptoms in Czech and Slovak college students during the COVID-19 pandemic and to evaluate possible socio-demographic determinants of mental health problems. A total of 3,099 respondents participated in this cross-sectional study (Czech Republic: 1,422, Slovakia: 1,677). The analyzes included the Patient Health Questionnaire for somatic symptoms (PHQ-15), the Generalized Anxiety Disorder instrument (GAD-7), and the Patient Health Questionnaire for depression (PHQ-9). Socio-demographic factors were gender, age, family structure, marital status, form of study, degree of study, year of study, field of study, distance between home and college, residence, and housing during the semester. Among Czech students, prevalence of somatic complaints, anxiety and depression was 72.2, 40.3, and 52%, respectively. Among Slovak students, prevalence of somatic complaints, anxiety and depression was 69.5, 34.6, and 47%, respectively. During the COVID-19 pandemic, the most severe mental health problems were identified in a non-negligible part of the sample (Czech Republic: PHQ-15 = 10.1%, GAD-7 = 4.9%, PHQ-9 = 3.4%; Slovakia: PHQ-15 = 7.4%, GAD-7 = 3.5%, PHQ-9 = 2.7%). Regarding the differences between the analyzed countries, a significantly higher score in somatic symptoms, anxiety, and depression was identified in the Czech Republic. Significant differences in mental disorders were found in most socio-demographic characteristics. The main results of the logistic regression analysis revealed that risk factors for mental health disorders in Czech and Slovak students were female gender, younger age, third degree of study, and study of Informatics, Mathematics, Information and Communication Technologies (ICT). Especially in the case of these high-risk groups of students, public policies should consider a response to impending problems. The findings are an appeal for a proactive approach to improving the mental health of students and for the implementation of effective prevention programs, which are more than necessary in the Czech and Slovak college environment.

Chronic toluene misuse among Roma youth in Eastern Slovakia.

This report presents pilot data on toluene misuse among Roma (Gypsy) youth in eastern Slovakia. Twenty interviews were conducted with field social workers (FSWs) working in seven Roma settlements with a combined population of 17,050 people. An estimated 340 chronic toluene users, mostly males (90%, n = 306), were identified in the researched communities. FSWs reported that children younger than 10 years of age represented about 15% of users (n = 52) and that the majority of users (75%, n = 255) were between 10 and 25 years of age. Consequences of prolonged use on individuals and communities are discussed. The study's limitations are noted.

Estimation of long-term costs of postacute care in survivors of the methanol poisoning outbreak.

OBJECTIVES: To fill the existing research gap related to long-term costs of postacute care in methanol poisoning survivors, healthcare cost for 6 years after the outbreak has been modelled and estimated. DESIGN: In a prospective longitudinal cohort study, data collected from 55 survivors of the Czech methanol mass poisoning outbreak in 2012 were collected in four rounds (5 months, then 2, 4 and 6 years after the discharge) in the General University Hospital in Prague according to the same predefined study protocol. The collected data were used to inform the cost model. SETTING AND PARTICIPANTS: All 83 patients discharged from a hospital poisoning treatment after the 2012 methanol outbreak were informed about the study and invited to participate. Fifty-five patients (66%) gave their written informed consent and were followed until their death or the last follow-up 6 years later. The costs were modelled from the Czech healthcare service (general health insurance) perspective. MAIN OUTCOME MEASURES: Long-term national budget impact of the methanol poisoning outbreak, frequencies of sequelae and their average costs. RESULTS: The postacute cost analysis concentrated on visual and neurological sequelae that were shown to be dominant. Collected data were used to create process maps portraying gradual changes in long-term sequelae over time. Individual process maps were created for the central nervous system, peripheral nervous system, sequelae detected during eye examinations and sequelae concerning the visual evoked potentials. Based on the process maps the costs of the postacute outpatient care were estimated. CONCLUSIONS: In 2013-2019 the highest costs per patient related to postacute care were found in the first year; the average costs decreased afterwards, and remained almost constant for the rest of the studied period of time. These costs per patient ranged from CZK4142 in 2013 to CZK1845 in 2018, when they raised to CZK2519 in 2019 again.