Prevention of alcohol exposed pregnancies in Europe: the FAR SEAS guidelines.

INTRODUCTION: Drinking during pregnancy is the leading cause of birth defects and child developmental disorders in Europe. The adverse effects of drinking during pregnancy may include physical, behavioural and cognitive problems, known collectively as fetal alcohol spectrum disorders (FASD). Evidence-based comprehensive recommendations at the European level on how to implement preventive and treatment policies to reduce alcohol-exposed pregnancies are needed. FAR SEAS, a tendered service contract (number 20,187,106) awarded by the European Commission, aimed at developing guidelines to respond to this knowledge gap. METHODS: FAR SEAS recommendations were built on (1) a two-phase review of interventions, (2) an international expert consultation, and (3) a pilot study on prevention of FASD conducted in the Mazovia region of Poland. The review of interventions included nineteen electronic open access databases, several repositories of grey literature and a key informant consultation covering most European Union (EU) countries and an additional guidelines search. After triangulating sources, 94 records were collected. Experts contributed in the design of the research questions, addressing the gaps in the literature and reviewing the recommendations formulated. The Polish pilot added nuances from real world practice to the formulated recommendations, resulting in the final set of guidelines for dissemination. RESULTS: The FAR SEAS Guidelines comprise 23 recommendations grouped into different topics areas of policies, communication strategies, screening, brief intervention and referral to treatment, treatment and social services. The recommendations highlight the need to respect women's autonomy and avoid discrimination and stigmatization; using universal screening for women of childbearing age, including detection of other psychosocial risks (such as domestic violence); and individualized, comprehensive and multidisciplinary supportive interventions for those who require it, such as those with alcohol use disorders, including women's partners. Policies to prevent FASD should be multicomponent, and public health communication should combine information about the risks together with self-efficacy messages to promote changes. CONCLUSIONS: The FAR SEAS guidelines are a tool to support policy-makers and service managers in implementing effective programmes to reduce prenatal alcohol exposure among general and at-risk population groups. FASD prevention has to involve comprehensive and multi-level evidence-based policies and practice, with services and activities tailored to the needs of women at differing levels of risk, and with due attention to reducing stigma.

High-Risk Cannabis Use: A Proposal of an Operational Definition through Delphi Methodology for Scientific Consensus.

INTRODUCTION: Cannabis ranks as one of the most widely used psychoactive substances worldwide. Its usage has been reported as a risk factor for developing a variety of physical and mental health issues, alongside social and economic problems. According to the World Health Organization (WHO), hazardous (or high-risk) substance use is defined as "a pattern of substance use that increases the risk of harmful consequences for the user." The primary objective of this study was to achieve a consensus on an operational definition of high-risk cannabis use suitable for a European jurisdiction (Spain). METHODS: A three round Delphi study was conducted. The Delphi technique entails group decision-making and iterative forecasting by consulting a panel of experts and conducting systematic feedback rounds. An online survey was distributed among a diverse expert panel comprising professionals from Spain working on fields related to cannabis use (research, policy planning, and clinical professionals). One-hundred ninety-nine invitations were sent to experts, of which forty-five (22.6%) accepted to participate. All participants were provided the option to revise a background document with the latest compiled scientific evidence and guidelines related to health and social conditions associated to cannabis usage. This background document also proposed the quantification of dose using a standardized unit established for the population of Spain (the Standard Joint Unit or SJU) based on quantity of cannabis main psychoactive constituent, 9-tetrahydrocannabinol (9-THC) (1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC). Three rounds of Likert scale and open-ended questions were administered until consensus, defined as ≥75% agreement, was attained. RESULTS: Consensus was reached on defining high-risk cannabis use as the usage of more than 4 SJU (>28 mg THC) per week or any use of cannabis with potency >10% THC. Concurrent use of cannabis with other drugs was also considered high risk, while the smoked route was considered the riskiest administration route. It was also agreed that vulnerable groups for high-risk cannabis use (for whom any pattern of cannabis use represents high risk of harm) include individuals under the age of 21, pregnant or breastfeeding women, individuals with psychiatric history, those with medical health issues related to cannabis use, professional drivers and heavy machine operators. CONCLUSION: This operational definition of high-risk cannabis use for Spain elucidates usage patterns and individual vulnerability factors predictive of heightened harm. Its adoption holds potential to inform decision-making among individuals, professionals, and policy-makers, facilitating evidence-based interventions aimed at prevention and risk reduction.

Usefulness of dried blood spot samples for monitoring hepatitis C treatment outcome and reinfection among people who inject drugs in a test-and-treat program.

Dried blood spots (DBS) are a reliable tool to diagnose viremic hepatitis C virus (HCV) infection. We evaluated the clinical performance of a DBS-based molecular assay for the assessment of cure and reinfection after on-site treatment at a harm reduction center (HRC). Genotyping from DBS samples was also assessed to discriminate reinfection from treatment failure. People who inject drugs (PWID) from an ongoing test-and-treat pilot at the largest HRC in Barcelona were included in the study. HCV-RNA detection from DBS collected after treatment (with follow-up at 12, 36, and 60 weeks) was compared with a molecular point-of-care test using finger-stick blood (GeneXpert). Baseline and follow-up DBS samples were genotyped by NS5B sequencing or commercial real-time PCR. Among treated patients, 193 follow-up DBS samples were tested. The DBS-based assay showed 100% specificity (129/129), and sensitivity ranged from 84.4% to 96.1% according to different viral load cut-offs (from detectable to 3000 IU/mL). Sensitivity as test of cure (follow-up 12) ranged from 85.1% to 97.4%. Among the 64 patients with recurrent viremia, 10.9% had low viral loads (≤1000 IU/mL); HCV genotyping allowed us to classify 73.5% of viremic cases either as reinfection or as treatment failure. DBS samples are useful to assess cure and differentiate reinfection from relapse after HCV antiviral treatment in the real world, facilitating decentralization of treatment and posttreatment follow-up in PWID. However, a fraction of patients presented with low viral loads, limiting viremia detection and genotyping in DBS and, therefore, repeat testing is recommended.

Low risk of viral hepatitis amongst patients with severe mental disorders.

BACKGROUND AND AIMS: Patients with severe mental disorders (SMD) have been classically considered as a particularly high-risk population for bloodborne virus infections. We performed a systematic screening of hepatitis B and C virus among the population with SMD in the area of influence of Hospital Clínic (Barcelona) in order to evaluate the real prevalence of these infections and achieve HCV microelimination in this subpopulation. METHODS: We screened two cohorts for anti-HCV and HBsAg: Cohort A (hospitalized patients with SMD, done systematically) and Cohort B (outpatients, mental health centre-CSMA, done voluntarily). Risk factors and socio-demographic variables were collected. In positive cases, telematic review was activated by Hepatology, calculation of FIB-4 and prescription of direct-acting agents (DAA) in HCV or follow-up in HBV. RESULTS: In Cohort A, 404 patients were screened. 3 HBV patients were detected (0.7%). In all of them, there was a history of drug use. 12 anti-HCV positive patients were detected (3%); 8 of them had a history of drug use. Among the HCV positive, only 2 patients were viraemic (received DAA, both achieving SVR) as most of them (n = 6) had already been cured with DAA. In cohort B, 305 patients were screened, after 542 (64% of the target population) declined to participate. No cases of HCV or HBV were detected. CONCLUSIONS: HCV/HBV prevalence among SMD population with no history of drug use does not seem to be different from the general population. These data may be of interest for defining health policies.

Association between Cannabis Use Disorder and Mental Health Disorders in the Adolescent Population: A Cohort Study.

INTRODUCTION: According to the literature, early initiation to cannabis use and a dependent pattern of use are important risk factors for the development of mental health disorders. However, there are few cohort studies which look at the development of mental health disorders associated with cannabis use among young people with cannabis use disorder (CUD). The aim of the study was to determine the cumulative incidence of mental health disorders and the risk of developing mental health disorders among minors who commenced treatment for CUD in Catalonia during 2015-2019. METHODS: This was a retrospective fixed cohort study, matched for confounding variables, based on data from the Catalan Health Surveillance System. The exposed cohort comprised young people who entered treatment for CUD during 2015-2019 (n = 948) and who were minors on the date of commencing treatment. Matching was done with a paired cohort (n = 4,737), according to confounding variables. Individuals with a diagnosis of a mental health disorder prior to the study period were excluded. The cumulative incidence was calculated for mental health disorders for the exposed and the paired cohorts and stratified by type of mental disorder. Incidence rate ratios were estimated using the conditional Poisson model with robust variance, stratified by sex. RESULTS: The cumulative incidence for development of a mental health disorder was 19.6% in the exposed cohort and 3.1% in the paired cohort; with higher incidence among females (females 32.7%; males 15.8%). The exposed cohort had an 8.7 times increased risk of developing a mental health disorder than the paired cohort. The most frequent diagnoses were reaction to severe stress, adjustment disorder, and personality disorders. CONCLUSION: This study confirmed that the exposed cohort was at increased risk of developing mental health disorders compared to the paired cohort. To date, few studies have analyzed the association between cannabis use and the development of mental health disorders, considering cannabis dependence. Further studies should be undertaken considering CUD. In addition, more studies are needed to understand the factors that determine the development of CUD. Further research in these areas would contribute to the design of prevention strategies aimed at those young individuals with a higher risk of developing cannabis dependence and suffering its consequences.

Incidence and Determinants of COVID-19 in Patients Seeking Treatment for Substance Use Disorder: A Patient-Based Linkage Study.

INTRODUCTION: People with substance use disorder (SUD) may be at increased risk of COVID-19 infection. However, there is little evidence regarding the incidence of and determinants associated with infection in this group. The aims of the study were to determine the cumulative incidence of COVID-19 among people who sought treatment for heroin, cocaine, cannabis, and alcohol use disorder in Catalonia; to identify sociodemographic, substance, and clinical determinants associated with COVID-19 infection among SUD patients; and to compare the cumulative incidence of COVID-19 infection in the population with SUD with that of the general population. METHODS: A patient-based retrospective observational study was conducted. The study population comprised people who sought treatment for heroin, cocaine, cannabis, or alcohol use disorder in Catalonia in 2018 and 2019. We analysed cumulative incidence of COVID-19 (confirmed by PCR test) from 25 February to 31 December 2020. Additionally, we used a log-link binomial generalized linear model for COVID-19 infection, using the substance as the exposition, adjusting for sociodemographic and clinical variables. RESULTS: Of the 23,092 individuals who sought treatment for SUD, 38.15% were considered suspected cases of COVID-19, and 2.60% (95% CI = 2.41-2.82) were confirmed positive for COVID-19 by PCR test during the study period. Those who sought treatment for alcohol use (cumulative incidence of COVID-19 of 3% [95% CI = 2.70-3.34]) had a higher risk ratio than, those who sought treatment for heroin use (cumulative incidence of 1.94% [95% CI = 1.47-2.56]). Being born outside of Spain, living in an institutionalized residence, having HIV, and being in a high morbidity group were associated with higher risk of COVID-19 infection. Meanwhile, the cumulative incidence of COVID-19 in the general population, according to public COVID-19 test data, was 3.86% (95% CI = 3.85-3.87). CONCLUSION: This study did not find higher cumulative incidence of COVID-19 infection among people with SUD in Catalonia in 2020, despite the clinical vulnerability of this population and their social disadvantage. However, differences were seen in the cumulative incidence of COVID-19 according to the substance for which treatment was sought. For example, those with alcohol dependence had a higher rate than those dependent on heroin. Further studies are needed to determine the factors contributing to these differences.

Point-of-care hepatitis C testing and treatment strategy for people attending harm reduction and addiction centres for hepatitis C elimination.

According to WHO goals, the elimination of Hepatitis C Virus (HCV) by 2030 requires enhancing and simplifying HCV testing. Our aim was to create a model to assess and compare different strategies for HCV testing, linkage to care and treatment among people who access harm reduction centres (HRC) and Addiction Centres in Catalonia. A decision tree model was designed to evaluate two strategies: Hepatitis C Point-of-care (POC) "test and treat", at the community versus standard-of-care (SOC), in which HCV testing was performed at community and therapy at the hospital. Both strategies were assessed separately in HRCs (6,878 users) and Addiction Centres (13,778 users). with a time horizon of 18 months. Healthcare outcomes were HCV testing, linkage to care, treatment outcomes and reinfection rate. HCV testing was performed in 3,178 (46%) of the HRC users. Compared with SOC, POC increased access to treatment by 57% (63% vs. 6%). SVR rates were 64% in POC vs. 23% in SOC. Reinfection rates were 21% with POC compared to 24% with SOC. With POC, losses to follow-up were reduced by 41%. In the Addiction Centres, 12,566 users (91%) were screened using the two strategies. Compared to the SOC, POC increased access to treatment and linkage to care by 19% along with SVR at the same rate. Reinfection rates decreased by 6%. Thus, the implementation of a POC "test and treat" strategy at HRCs and Addiction Centres has shown to be an effective public health strategy to help eliminating HCV in accordance with WHO goal.

Characterization of Acute HCV Infection and Transmission Networks in People Who Currently Inject Drugs in Catalonia: Usefulness of Dried Blood Spots.

BACKGROUND AND AIMS: Accurate identification of recent HCV infections is critical for tracing the extent and mechanisms of ongoing transmission. We aimed to validate dried blood spot (DBS) samples for the assessment of Hepatitis C virus (HCV) genetic diversity and to determine epidemiological parameters including incidence, determinants of acute infection, and phylogenetic clustering in people who inject drugs (PWID). APPROACH AND RESULTS: HCV nonstructural protein 5B next-generation sequencing was performed from plasma and/or DBS in 220 viremic PWID from the HepCdetect II study. No significant differences were found in consensus sequences or Shannon entropy (SE) intrahost diversity estimate between paired plasma/DBS specimens. SE values were used to identify acute infections with 93.3% sensitivity (95% CI, 0.81-1.06) and 95.0% specificity (95% CI, 0.88-1.02) in a set of well-defined controls. An acute HCV infection (either primary infection or reinfection) was detected in 13.5% of viremic participants and was associated with age ≤30 years (OR, 8.09), injecting less than daily (OR, 4.35), ≤5 years of injected drug use (OR, 3.43), sharing cocaine snorting straws (OR, 2.89), and being unaware of their HCV status (OR, 3.62). Annualized HCV incidence was estimated between 31 and 59/100 person-years. On phylogenetic analysis, 46.8% of viremic cases were part of a transmission pair or cluster; age ≤30 years (OR, 6.16), acute infection (OR, 5.73), and infection with subtype 1a (OR, 4.78) were independently associated with this condition. CONCLUSIONS: The results obtained from plasma and DBS characterize PWID with acute infection and those involved in ongoing HCV transmission and allow estimating incidence from cross-sectional data. This information is critical for the design and assessment of targeted harm reduction programs and test-and-treat interventions and to facilitate monitoring of HCV elimination in this key population.

Pilot hepatitis C micro-elimination strategy in Pakistani migrants in Catalonia through a community intervention.

BACKGROUND AND AIMS: Pakistani migrants in Catalonia, Spain, could have high hepatitis C virus (HCV) prevalence. The aims of the HepClink study were (i) to implement and assess the quality of a micro-elimination strategy based on a community intervention and (ii) to obtain data from primary care (PC) registries as a baseline comparator. METHODS: The community intervention targeted Pakistani adults and consisted of education, screening and simplified access to treatment. Quality indicators were calculated (effectiveness, impact and acceptability). The testing rate, the prevalence of HCV antibodies and HCV-RNA were compared with those observed in the Pakistani population accessing PC in the previous year. RESULTS: A total of 505 participants were recruited through the community intervention (64.6% men, median 37 years) vs those accessing PC (N = 25 455, 70.9% men, median 38 years). Among study participants, 35.1% did not know about HCV and 9.7% had been previously tested. The testing rate in the community intervention was 99.4% vs 50.7% in PC. Prevalence was 4.6% vs 7.1% (p = .008) for HCV antibodies and 1.4% (3/6 new diagnoses) vs 2.4% (p = .183) for HCV-RNA. Among the six viremic patients, three began treatment within the intervention and two through the usual circuit and all completed the full course. CONCLUSIONS: This novel community intervention was well accepted and effective at reaching a Pakistani migrant population with a low-level knowledge of HCV and largely not tested before. The observed prevalence and the high unawareness of their HCV status justify a targeted screening in this group both in the community and in PC.

COVID-19 Lockdown and Consumption Patterns among Substance Use Disorder Outpatients: A Multicentre Study.

INTRODUCTION: COVID-19 has had a great impact on mental health in the general population. However, few studies have focused on patients with substance use disorders (SUDs). This research aimed to compare the clinical status and substance use patterns of SUD outpatients, before and during confinement due to the COVID-19 pandemic. METHODS: This multicentre study recruited 588 patients (29.2% women; M age = 47.4 ± 11.7 years) in thirteen centres for addiction treatment in Catalonia, Spain. All subjects were evaluated with validated instruments and ad hoc questionnaires. The sample was divided into 3 groups according to how the substance consumption pattern changed during lockdown (maintained pattern, worsened pattern, and improved pattern). RESULTS: More than 62% of the patients maintained or worsened their consumption pattern during confinement, and about 38% improved throughout this time. Diverse factors were associated with the changes in pattern like age, addiction severity, psychological distress during lockdown, social and familial issues, and therapeutic variables. CONCLUSION: The home lockdown during the COVID-19 pandemic was associated with major implications for substance consumption and psychiatric distress among SUD outpatients. Considering this, the need to plan appropriate interventions in cases of similar health crises is highlighted.

The impact of the COVID-19 pandemic on harm reduction services in Catalonia: the experience of people who use drugs and harm reduction professionals.

BACKGROUND: Harm reduction services and professionals have had to reorganise and adapt to COVID-19 prevention measures while still ensuring health and social services for people who use drugs (PUD). OBJECTIVE: To assess the impact of the COVID-19 pandemic on PUD and on the professionals who provide harm reduction services. METHODS: A qualitative, exploratory, multicentre design was used. Two focus groups were held with harm reduction professionals, and 40 individual semi-structured interviews were undertaken with PUD in various harm reduction services in Catalonia. Interviews and focus group discussions were transcribed and analysed using thematic content analysis. RESULTS: Harm reduction services adapted to the pandemic situation by employing methods such as reducing opening hours and closing drop in areas, along with health protection measures such as access control, which in turn led to stress among both professionals and service users. Despite the changes implemented, PUD continued to have access to sterile drug use equipment and methadone treatment. In addition, those who were not in treatment were able to access it rapidly. Regarding their emotional state, the PUD reported that it was worse during the pandemic than before the lockdown, with women affected to a greater extent than men. The harm reduction professionals reported difficulties in managing service users' compliance with the security measures at the beginning of the lockdown and having had to focus primarily on providing food and shelter for the PUD. CONCLUSIONS: It is important to keep PUD in mind and maintain a harm reduction perspective when implementing confinement measures in situations such as those experienced during the COVID pandemic. Guaranteeing that PUD have their basic needs such as food, hygiene and shelter covered is key.

A Multicenter Study on the Impact of Gender, Age, and Dual Diagnosis on Substance Consumption and Mental Health Status in Outpatients Treated for Substance Use Disorders During COVID-19 Lockdown.

Objective COVID-19 and lockdown measures impacted mental health globally and had a particular impact on patients with substance use disorders (SUD). However, the impact of gender, age, and dual diagnosis on consumption patterns and mental health during COVID-19 lockdown among patients with SUD has not been analyzed in depth. Therefore, this study aimed to examine substance use and mental health status during COVID-19 lockdown considering gender, age, and previous dual diagnosis in patients with SUD treated in different outpatient addiction clinics in Catalonia. Methods: Thirteen clinics participated and 588 patients were enrolled in the study, of whom 70.7% were men and 29.3% were women. The mean age was 48 ± 11.3 years, and 63.2% had dual diagnoses. Results: Men reported significantly more frequent alcohol and cocaine consumption during lockdown, while women experienced more anxiety and depressive symptoms. Younger patients more frequently reported consuming cocaine and cannabis, breaking the lockdown rule, worsened family relationships, and reduced incomes. Older patients more frequently reported maintaining abstinence. Previous dual diagnosis was more often associated with benzodiazepine use disorder, less active working during lockdown, and more anxiety and depressive symptoms than not having previous dual diagnosis. Conclusions: Both new psychiatric symptoms and general worsening of existing symptoms were frequent during the lockdown. Differences based on the gender, age, and dual diagnosis of outpatients treated for substance use disorders should be considered in the planning of protection measures such as home confinement.

An estimation of the social cost of illicit drug consumption in Catalonia. / Estimación del coste social del consumo de drogas ilegales en Catalunya.

Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non-healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.

Mundialmente, así como en España, el consumo de drogas ilegales es uno los principales contribuyentes a la carga mundial de morbilidad. Cuantificar los costes que las drogas ilegales imponen a la sociedad es clave para la toma de decisiones. El objetivo de este trabajo es estimar el coste social del consumo de drogas ilegales en Cataluña para un año específico y establecer una metodología para poder replicar dichas estimaciones regularmente y monitorear el impacto de los planes nacionales. Se ha realizado un estudio de coste de la enfermedad. Para la estimación de los costes de mortalidad y morbilidad se ha utilizado el enfoque de la fracción atribuible. Solo se incluyeron los costes del sector público, sanitarios y no sanitarios. El coste del consumo de drogas ilegales en Cataluña en 2011 se estimó en 326,39 millones de € (0,16% del PIB catalán en 2011; 0,15% en 2018). El 82% del coste total correspondió a costes directos; de estos, el 30,32% correspondió al sistema penal, 15,99% a hospitalizaciones, 13,48% a la policía, 17,19% a farmacia, 8,34% a tratamiento en centros especializados y 5,74% a comunidades terapéuticas, entre otros. Los costes indirectos representaron el 18% de los costes totales, principalmente pérdidas de productividad debidas a muertes por el consumo de drogas. Este estudio ha sido una oportunidad para recopilar datos de forma sistemática y pensar en los posibles rendimientos económicos que podrían obtenerse de políticas y programas efectivos destinados a reducir el consumo de drogas ilegales.

Polydrug use of tobacco and cannabis: Relationship with self-perceived health and mood state in adolescents in Central Catalonia- DESKcohort Project. / Policonsumo de tabaco y cannabis: Relación con la salud autopercibida y el estado de ánimo en adolescentes de la Catalunya Central-Proyecto DESKcohort.

The objective was to estimate the prevalence of polydrug use of tobacco and cannabis and to see its relationship with self-perceived health and mood state in adolescents from Central Catalonia in the 2019-2020 academic year. A cross-sectional study was carried out with a sample of 7,319 students, who answered a self-administered questionnaire. The dependent variables were the polydrug use of tobacco and cannabis and polydrug use of tobacco and high-risk cannabis. The main independent variables were self-perceived health status and mood state. Frequencies and percentages were analyzed for the prevalence analysis, and the Chi-square test was used. Poisson regression models were adjusted with robust variance, obtaining Prevalence Ratios. The prevalence of polydrug use of tobacco and cannabis was 3.5% and polydrug use of tobacco and high-risk cannabis was 2.5%. In boys, attending higher academic courses (4th of ESO (aPR: 3.88; 95% CI: 2.14-7.05) vs. CFGM (aPR: 8.67; CI95%: 4.51-16.67), having worse self-perceived health (aPR: 4.79; CI95%: 3.24-7.08) and worse mood state (aPR: 1.47; CI95%: 1.05-2.08) act as factors associated with polydrug use of tobacco and cannabis. The results for girls, and risky use of cannabis follow a similar pattern. Among the main conclusions we observe is that there are no differences in self-perceived health and mood state when comparing polydrug use of tobacco and cannabis and polydrug use of tobacco and high-risk cannabis, so risk reduction strategies must be applied whether the use of cannabis is occasional or problematic.

El objetivo fue estimar la prevalencia del policonsumo de tabaco y cannabis y ver su relación con la salud autopercibida y el estado de ánimo en los adolescentes escolarizados de la Catalunya Central en el curso 2019-2020. Estudio transversal con una muestra de 7.319 estudiantes, que contestaron un cuestionario auto administrado. Las variables dependientes fueron el policonsumo de tabaco y cannabis y policonsumo de tabaco y cannabis de riesgo. Las variables independientes principales fueron la salud autopercibida y el estado de ánimo. Para el análisis de prevalencia se analizaron frecuencias y porcentajes, y se usó la prueba de Chi-cuadrado. Se ajustaron modelos de regresión de Poisson con varianza robusta, obteniendo Razones de Prevalencia. La prevalencia del policonsumo de tabaco y cannabis fue de 3,5% y del policonsumo de tabaco y cannabis de riesgo 2,5%. En los chicos, cursar un curso académico superior (4º de ESO (RPa: 3,88; IC95%:2,14-7,05) vs. CFGM (RPa: 8,67; IC95%:4,51-16,67), tener peor salud autopercibida (RPa: 4,79; IC95%:3,24-7,08) y un peor estado de ánimo (RPa: 1,47; IC95%:1,05-2,08) actúan como factores asociados con el policonsumo de tabaco y cannabis. En chicas y por consumo de riesgo de cannabis siguen un patrón similar. Entre las principales conclusiones observamos que no hay diferencias en la salud autopercibida y el estado de ánimo en el policonsumo de tabaco con cannabis y con cannabis de riesgo, por lo que deben existir estrategias de reducción de riesgos tanto si el consumo de cannabis es puntual como si el consumo de cannabis es problemático.

Certification program of Addiction Centres for hepatitis C virus elimination in Spain. HepCelentes Project. / Programa de certificación de Centros de Adicciones para la eliminación del virus de la hepatitis C en España. Proyecto HepCelentes.

Microelimination strategies for the hepatitis C virus (HCV) in vulnerable populations, such as users of Addiction Centres (AC), are key for the elimination of hepatitis C. The aim of the HepCelentes project was to design a certification program for AC from the generation of a guide with the criteria to favour the prevention, diagnosis, control, and treatment of HCV in Spain. The project was structured in 4 phases: normalisation, implementation, certification, and communication. In the first phase, developed between July and December 2020, a Steering Committee was created (formed by representatives of scientific societies, healthcare professionals from AC, primary care centres and hospital units, and patient associations) that, from of an exhaustive bibliographic review, generated by consensus an accreditation guide for AC. The guide consists of 22 criteria (15 mandatory and 7 recommended) structured based on the requirements to be met by AC, justification for the selection, level of action (management, prevention, diagnosis and treatment/follow-up), measurement of the indicator, objective level to be achieved, evidence of compliance, clarifications to improve understanding, and mandatory / recommendation (depending on their relevance to achieve HCV elimination and its feasibility for implementation in real practice). The development of a certification system for the AC, based on consensus and coordination of multidisciplinary teams, is intended to favour the management of hepatitis C and its elimination in AC users, supporting the international, national, and regional elimination strategies.

Las estrategias de microeliminación del virus de la hepatitis C (VHC) en poblaciones vulnerables, como los usuarios de los centros de adicciones (CA), son fundamentales para lograr la eliminación de la hepatitis C. El objetivo del proyecto HepCelentes fue diseñar un programa de certificación para los CA, a partir de la generación de una guía con los criterios para favorecer la prevención, diagnóstico, control y tratamiento del VHC en España. El proyecto se estructuró en 4 fases: normalización, implementación, certificación y comunicación. En la primera fase, desarrollada entre julio y diciembre de 2020, se creó un Comité de Normalización (formado por representantes de sociedades científicas, profesionales sanitarios de CA, centros de atención primaria, unidades hospitalarias, y asociaciones de pacientes) que, a partir de una revisión bibliográfica exhaustiva, generó por consenso una guía de certificación de los CA. La guía consta de 22 criterios (15 obligatorios y 7 recomendados) estructurados en base a la definición del criterio, justificación de su selección, nivel de actuación (gestión, prevención, diagnóstico y tratamiento/seguimiento), fórmula de medición, nivel objetivo a alcanzar, evidencias de su cumplimiento, aclaraciones para mejorar su comprensión y obligatoriedad/recomendación (en función de la relevancia en la eliminación y capacidad de implementación). El desarrollo de un sistema de certificación para los CA, a partir del consenso y la coordinación de equipos multidisciplinares, pretende favorecer el manejo de la hepatitis C y su eliminación en los usuarios de los CA, apoyando las estrategias de eliminación internacionales, nacionales y autonómicas.

Hepatitis C virus: Testing rate and attrition at linkage to specialized care, Catalonia, Spain 2011-2016.

Hepatitis C virus (HCV) screening through primary care providers (PCP) might increase linkage to specialized care. This study aimed to calculate HCV testing rate and prevalence of anti-HCV according to socio-demographic factors in primary care in Catalonia, Spain, from 2011 to 2016, and to identify the rate and determinants of attrition at linkage to specialized care. Patient data from 274 primary care centres (3414 PCP) were analysed, including socio-demographic information, morbidity, laboratory tests and treatments (1-Jan-2011 to 31-Dec-2016). Both descriptive and inferential statistics were used to examine HCV testing rate, HCV seroprevalence and rate of attrition at linkage to specialized care. In the study period, there were 839 072 people tested for HCV infection and 21 156 with first-time positive anti-HCV test results. Rate of HCV testing was 143.54/103 pop (95% CI: 143.26-143.83). Women had higher HCV testing rate (158.65/103 women [95% CI: 158.24-159.07]), compared to men (128.10/103 men [95% CI: 127.72-128.49]). The highest HCV testing rate was among people aged 25-34 (284.11/103 pop [CIs: 283.10-285.12]). The anti-HCV seroprevalence was 3.62/103 pop (CIs: 3.57-3.67). The highest prevalence was found among men (4.20/103 men [CIs: 4.12-4.27]), people aged 45-54 (7.19/103 pop [CIs: 7.01-7.37]), people aged 75-84 (7.26/103 pop [CIs: 6.99-7.53]), Spanish (3.68/103 [CIs: 3.61-3.75]), European and Northern Americans (5.64/103 [CIs: 5.33-5.96]) and Asians (9.78/103 [CIs: 9.21-10.35]). From those who had a positive anti-HCV result, 49.8% (N = 10 528) were not linked to specialized care. Appropriate clinical care pathways and referral systems need to be established to ensure optimal linkage to specialized care for people newly diagnosed with HCV in primary care.

Mental well-being of the general population: direct and indirect effects of socioeconomic, relational and health factors.

PURPOSE: The aim of this study was to analyse the association between individual mental well-being and social, economic, lifestyle and health factors. METHODS: Cross-sectional study on a representative sample of 13,632 participants (> 15y/o) from the Catalan Health Interview Survey 2013-2016 editions. Mental well-being was assessed with the Warwick-Edinburg Mental Well-being Scale (WEMWBS). Linear regressions were fitted to associate well-being and sociodemographic, relational, lifestyle and health variables according to minimally sufficient adjustment sets identified using directed acyclic graphs. Predictors entered the model in blocks of variable types and analysed individually. Direct and total effects were estimated. RESULTS: Health factors significantly contributed to mental well-being variance. Presence of a mental disorder and self-reported health had the largest effect size (eta2 = 13.4% and 16.3%). The higher individual impact from a variable came from social support (ß = - 12.8, SE = 0.48, eta2 = 6.3%). A noticeable effect gradient (eta2 = 4.2%) from low to high mental well-being emerged according to economic difficulties (from ß = 1.59, SE = 0.33 for moderate difficulties to ß = 6.02 SE = 0.55 for no difficulties). Younger age (ß = 5.21, SE = 0.26, eta2 = 3.4%) and being men (ß = 1.32, SE = 0.15, eta2 = 0.6%) were associated with better mental well-being. Direct gender effects were negligible. CONCLUSIONS: This study highlights health and social support as the most associated factors with individual mental well-being over socioeconomic factors. Interventions and policies aimed to these factors for health promotion would improve population mental well-being.

Mental ill-health during COVID-19 confinement.

BACKGROUND: Confinement due to COVID-19 has increased mental ill-health. Few studies unpack the risk and protective factors associated with mental ill-health and addictions that might inform future preparedness. METHODS: Cross-sectional on-line survey with 37,810 Catalan residents aged 16+ years from 21 April to 20 May 2020 reporting prevalence of mental ill-health and substance use and associated coping strategies and behaviours. RESULTS: Weighted prevalence of reported depression, anxiety and lack of mental well-being was, respectively, 23, 26, and 75%, each three-fold higher than before confinement. The use of prescribed hypnosedatives was two-fold and of non-prescribed hypnosedatives ten-fold higher than in 2018. Women, younger adults and students were considerably more likely, and older and retired people considerably less likely to report mental ill-health. High levels of social support, dedicating time to oneself, following a routine, and undertaking relaxing activities were associated with half the likelihood of reported mental ill-health. Worrying about problems living at home, the uncertainty of when normality would return, and job loss were associated with more than one and a half times the likelihood of mental ill-health. With the possible exception of moderately severe and severe depression, length of confinement had no association with reported mental ill-health. CONCLUSIONS: The trebling of psychiatric symptomatology might lead to either to under-identification of cases and treatment gap, or a saturation of mental health services if these are not matched with prevalence increases. Special attention is needed for the younger adult population. In the presence of potential new confinement, improved mental health literacy of evidence-based coping strategies and resilience building are urgently needed to mitigate mental ill-health.

The relationship between motivations for cannabis consumption and problematic use. / Relación entre las motivaciones para consumir y el consumo problemático de cannabis.

INTRODUCTION: Systematic screening of problematic cannabis use does not include the motivations that lead to consumption, although from a person-centered perspective this is fundamental. The present study explores the motivations for cannabis use in adults and its relationship with cannabis use patterns and problematic use. METHOD: Adult cannabis users (previous 60 days) were recruited in the province of Barcelona (n = 468). Information on their sociodemographic data, cannabis use pattern, Cannabis Abuse Screening Test (CAST) and the main motivation for use were collected. Motivations were categorized a posteriori according to the Marijuana Motives Measures (MMM). A descriptive and inferential analysis was carried out to link the motivations to sociodemographic variables, consumption pattern and probability of suffering problematic cannabis use (CAST). RESULTS: Using cannabis to heighten positive feelings (35%), out of habit (29%) and to cope with negative feelings (25%) were the most frequent motivations. In comparison to other motivations, coping is related to a greater quantity of cannabis used (4 vs 3 joints per day, p = 0.005), higher probability of problematic cannabis use (77% vs 64%, p = 0.05), and greater social vulnerability (unemployment 56% vs 37%, p = 0.001; and low educational level 14% vs 8%, p = 0.042). CONCLUSIONS: Coping as a motivation for cannabis use is present in one out of four users and is a marker of social vulnerability, greater quantity of cannabis used and higher risk of problematic use. Patient-centered care together with preventive (emotional and social education) and clinical strategies (psychotherapy) can be useful for this population at higher risk.

Introducción. El cribado sistemático del consumo problemático de cannabis no incluye las motivaciones que llevan al consumo, aunque desde una perspectiva de atención centrada en la persona, este dato sea fundamental. El presente estudio explora las motivaciones de consumo de cannabis en adultos y su relación con el patrón de consumo y consumo problemático.  Método. Consumidores adultos de cannabis (en los últimos 60 días) fueron reclutados en la provincia de Barcelona (n=468). Se pasó un cuestionario para explorar datos sociodemográficos, patrón de uso, la Cannabis Abuse Screening Test (CAST) y la motivación principal para el consumo. Los motivos de consumo se categorizaron a posteriori según la Marijuana Motives Measures (MMM). Se realizó un análisis descriptivo e inferencial para explorar la relación entre la motivación categorizada y variables sociodemográficas, patrón de consumo y puntuaciones de la CAST.Resultados. Consumir cannabis para mejorar las emociones positivas (35%), por costumbre (29%) y para afrontar emociones negativas (25%) fueron las motivaciones más frecuentes. Respecto a otras motivaciones, el "afrontamiento" se relaciona con mayor cantidad consumida (4 vs 3 porros/día, p = 0,005), mayor probabilidad de tener un consumo problemático (77% vs 64%, p = 0,05), y mayor vulnerabilidad social (desempleo 56% vs 37%, p = 0,001; y bajo nivel de estudios (14% vs 8%, p = 0,042)). Conclusiones. El afrontamiento está presente en uno de cada cuatro usuarios de cannabis, es un marcador de vulnerabilidad social y de mayor cantidad de consumo de cannabis y probabilidad de consumo problemático. Una atención centrada en la persona junto con estrategias preventivas (educación emocional y social) y clínicas (psicoterapia) pueden ser de utilidad en esta población de mayor riesgo.

Women who inject drugs and violence: Need for an integrated response. / Mujeres que usan drogas inyectadas y violencia: Necesidad de una respuesta integrada.

The aim of this study was to describe the prevalence of physical and/or sexual violence experienced by women who inject drugs (WWID) and identify associated factors. A cross-sectional study was conducted among 120 WWID in a network of harm reduction centres using an anonymous questionnaire. Oral fluid samples were also collected to estimate the prevalence of HIV and hepatitis C. Univariate and multivariate Poisson regression models with robust variance were performed to identify the factors associated with experiencing violence, obtaining prevalence ratios (PR) and their 95% confidence intervals. The results showed that the prevalence of violence reported by WWID in the last 12 months was 45.8% (42.2% physical and 11.9% sexual aggression). In multivariate analysis, variables associated with experiencing violence were homelessness (PR = 1.59; CI: 1.07-2.38), reporting exchanges of sex for money or drugs (PR = 1.65; CI: 1.19-2.29), reporting a previous sexually transmitted infection (PR = 1.49; CI: 1.04-2.15) and/or injecting drugs less frequently than daily (RP = 2.29; CI: 1.49-3.54). This study highlights the importance of establishing detection protocols and systems of referral to the network of attention to women suffering violence, within the centres of the drug addiction care network, as well as the development of multilevel strategies that take into account not only individual factors but also other social and/or structural aspects that may be playing a relevant role in addressing this problem.

El objetivo de este estudio fue describir la prevalencia de violencia física y/o sexual experimentada por mujeres que usan drogas por vía inyectada (MUDVI) e identificar factores asociados. Se realizó un estudio transversal en 120 MUDVI usuarias de centros de reducción de daños mediante un cuestionario anónimo y recogida de muestras de fluido oral para estimar la prevalencia del VIH y de la hepatitis C. Los factores asociados a la presencia de violencia se analizaron mediante un modelo de regresión de Poisson con varianza robusta univariante y multivariante, obteniendo razones de prevalencia (RP) y sus intervalos de confianza al 95%. Los resultados muestran que la prevalencia de  agresiones en los últimos 12 meses fue del 45,8% (42,2% agresiones físicas y 11,9% agresiones sexuales). A nivel multivariante, las variables asociadas a la presencia de violencia fueron estar sin domicilio fijo (RP=1,59; IC: 1,07-2,38), ejercer el trabajo sexual (RP=1,65; IC: 1,19-2,29), haber sufrido alguna infección de transmisión sexual (RP=1,49; IC: 1,04-2,15) y/o inyectarse drogas no de forma diaria (RP=2,29; IC: 1,49-3,54). Este estudio pone de manifiesto la importancia de establecer protocolos de detección, y derivación a la red de atención a la violencia de género, dentro de los centros de la red de atención a las drogodependencias, así como el desarrollo de estrategias multinivel que tengan en cuenta no solamente factores individuales sino también otros aspectos sociales y/o estructurales que pueden estar jugando un papel relevante a la hora de abordar este problema.