Seasonal and weekly fluctuations in alcohol use in the Czech Republic.

Sezónní a týdenní výkyvy v uzívání alkoholu patrí mezi doposud neanalyzované aspekty epidemiologického výzkumu uzívání alkoholu ceskou dospelou populací. Cílem studie je nabídnout deskriptivní a analytický pohled na sezónní a týdenní vzorce uzívání alkoholu u ceské dospelé populace. Výzkum byl realizován na reprezentativním vzorku 809 osob v rámci on-line setrení v prostredí Ceského národního panelu. Sledovanými promennými jsou uzívání alkoholu, sezónní uzívání a uzívání alkoholu v rámci dní v týdnu. Výsledky ukazují, ze nejcastejsí je konzumace v pátek, prípadne v sobotu, s výjimkou lidí v duchodovém veku, kterí alkohol uzívání rovnomerneji v rámci celého týdne. Z hlediska mesícu v roce je nejvyssí spotreba uvádena v léte (cerven, cervenec, srpen) a v prosinci. Respondenti s vyssím skóre dotazníku AUDIT uzívají alkohol více v letních mesících nez v prosinci. Výsledky výzkumu mohou prispet k lepsímu casovému zacílení preventivních i klinických aktivit.

Making the hospital care in the Czech Republic more effective through volunteering.

Volunteering in the health sector contributes to improving the quality of services and has positive benefits for the volunteers themselves and the health service providers, and especially for patients and their families, as well as for society. The aim of this article is to summarize the main findings of the evaluation of the project Efficiency of the hospital care system in the Czech Republic through volunteering (CZ.03 .3.X/0.0/0.0/15_018/0007517), which was implemented between 2019 and 2023 by the Ministry of Health of the Czech Republic. The evaluation of the project was based on a combination of quantitative research (questionnaire surveys focused on the target groups of the project) and qualitative methods (individual and group interviews). The internal and external impact evaluation of the project shows significant changes in the short term for patients and their family members who use volunteering in healthcare, as well as for healthcare professionals and providers. The development of volunteering in healthcare and its effective coordination is a suitable and proven tool to support and improve the psychosocial aspect of care for hospitalized patients and a way to achieve the desired goals of the healthcare system.

Health systems in the mirror of international comparisons.

The international comparison of health systems is a frequently used tool of health policy. It assumes that international experiences are, at least to some extent, transferable from one country to another. The aim of this article is to review selected methods of international comparison of health systems. At the same time, we ask the question of how useful each method is for the evaluation of the Czech health system.

Individual, Social, and Environmental Factors Associated with Different Patterns of Stimulant Use: A Cross-Sectional Study from Five European Countries.

INTRODUCTION: Amphetamine-type stimulants (ATSs) are the second most commonly consumed class of illicit drugs globally, but there is limited understanding of the precise factors associated with problematic versus controlled ATS consumption. This exploratory study aimed to identify which individual, social, and environmental factors are associated with different patterns of ATS use over time. METHODS: Cross-sectional surveys were conducted in Germany, England, The Netherlands, Poland, and the Czech Republic via face-to-face computer-assisted personal interviews to collect data on different user groups. 1,458 adults (18+) reported exposure to but no ATS use (n = 339); former rare/moderate ATS use (n = 242); current rare/moderate ATS use (n = 273); former frequent/dependent ATS use (n = 201); current frequent/dependent ATS use (n = 403). Extent of ATS/other substance use was assessed by number of consumption days (lifetime, past year, past month) and Severity of Dependence Scale. To identify factors associated with group membership, data were also collected on previous injecting drug use (IDU) and consumption setting/rules. Psychological distress was measured using the Brief Symptom Inventory, with additional data collected on self-reported adverse life events and physical/mental health. RESULTS: Currently, using frequent/dependent ATS users experienced more frequent unstable living conditions (27.5%) and psychological distress (59.8%) compared to other groups. A multinomial logistic regression showed that currently abstinent rare/moderate users were more likely to abstain from methamphetamine use {odds ratio (OR) = 2.48 (confidence interval [CI] = 1.32-4.68)} and from IDU (OR = 6.33 [CI = 2.21-18.14]), to avoid ATS use during working hours (OR = 6.67 [CI = 3.85-11.11]), and not to use ATS for coping reasons (OR = 4.55 [CI = 2.50-6.67]) compared to the reference group of currently using frequent/dependent users. CONCLUSIONS: People who use ATS frequently and/or at dependent levels are more likely to have experienced social and economic adversity compared to infrequent ATS users. On the other hand, there is a substantial share of users, which show a controlled use pattern and are able to integrate ATS use into their lives without severe consequences.

Opportunities and Threats of the Legally Facilitated Performance-Based Managed Entry Agreements in Slovakia: The Early-Adoption Perspective.

Slovakia has adopted an amendment to Act No. 363/2011, regulating, among other things, drug reimbursement and is undergoing a significant change in the availability of innovative treatments for patients. High expectations are associated with arrangements related to performance-based managed entry agreements. Opinions and positions towards this change appear to be inconsistent, and for the further application of the law in practice and when setting up the main implementation processes, it is necessary to understand the positions and opinions of the individual actors who are involved in the PB-MEA process. The interviews were conducted in the period from 20 May to 15 August 2022 around the same time as the finalisation of the amendment to Act No. 363/2011 and its adoption. A roughly one-hour open interview was conducted on a sample of 12 stakeholders in the following groups: representatives of the Ministry of Health, health-care providers, pharmaceutical companies and others, including a health insurance company. The main objective was to qualitatively describe the perception of this topic by key stakeholders in Slovakia. The responses were analysed using MAXQDATA 2022 software to obtain codes associated with key expressions. We identified three main strong top categories of expressions that strongly dominated the pro-management interviews with stakeholders: legislation, opportunities and threats. Ambiguity and insufficient coverage of the new law, improved availability of medicinal products and threats associated with data, IT systems and potentially unfavourable new reimbursement schemes were identified as key topics of each of the said top categories, respectively. Among individual sets of respondents, there is frequent consensus on both opportunities and threats in the area of implementing process changes in PB-MEA. For the successful implementation of the law in practice, some basic threats need to be removed, among which in particular is insufficient data infrastructure.

The Impact of Beehive Proximity, Human Activity and Agricultural Intensity on Diptera Diversity in a Mediterranean Mosaic of Agroecosystems, with a Focus on Pest Species.

Diptera, with their participation in pollination, significantly contribute to the maintenance of plant diversity, and they also have great potential for assessing habitat health and preserving it. A decline in their abundance and diversity has been recorded worldwide as a consequence of biotic, abiotic, and anthropic alterations. In addition to pollinators, these orders include agricultural and forestry pests, which are a threat to both cultivated and wild plants that are very important to the economy. Many pests have escaped from their native areas, and it is important to monitor their spread to implement sustainable means of control. Our study provides baseline information on Diptera and Vespidae diversity in the Mediterranean mosaic of agroecosystems, giving information on the importance of human influence on insect diversity. We carried out an insect inventory in Istria, Croatia, using a set of traps placed in the proximity of beehives. This study was also important in determining the presence of pests and newly introduced species. A total of 94 species from 24 families were recorded-7 important agricultural pests of Diptera and 17 new records for Croatia. The correlation between species diversity and environmental and anthropogenic factors leads to the conclusion that total insect species richness, pest species richness, and the first findings depend on human activities. The number of honeybee colonies negatively correlated with species richness, while anthropic influence positively affected total and pest species richness.

Laboring Alone: Perinatal Outcomes during Childbirth without a Birth Partner or Other Companion during the COVID-19 Pandemic.

During the first wave of the COVID-19 pandemic in the spring of 2020, the government of the Czech Republic issued a nationwide ban on visitors to maternity wards. We studied whether the absence of a close person during labor due to this ban impacted perinatal indicators. This study was performed using an administrative observational questionnaire focused on absolute frequencies of events sent to maternity facilities across the Czech Republic. Completed answers were received from 33 facilities covering 4805 births during the study period in 2019 and 4514 births in 2020. The differences in individual parameters were tested using Pearson's chi-squared homogeneity test. There were no significant differences between the two periods in spontaneous pre-term births (p = 0.522) or in the number of cesarean sections (p = 0.536). No significant changes were seen in either local or systemic analgesia. Data showed a significantly shorter (p = 0.026) first stage of labor in 2020 compared to 2019, while there was no significant difference (p = 0.673) in the second stage of labor. There was no statistically significant difference found for newborn perinatal adaptation. There were also no significant differences in intrapartum maternal injuries. Overall, we found no significant differences in basic perinatal indicators during the first wave of COVID-19 in 2020 compared to 2019. Although the absence of a close person may cause stress for the laboring women, it does not impair objective clinical outcomes.

Unexpected Previously Unknown Diversity of the Genus Microphor Macquart (Diptera: Dolichopodidae: Microphorinae) in the West Palaearctic.

Microphor baechlii sp. nov. (Switzerland, Turkey), M. chvalai sp. nov. (France), M. nevadensis sp. nov. (Spain), M. pallipes sp. nov. (Italy), and M. turcicus sp. nov. (Turkey) are described and illustrated. The neotype of M. anomalus (Meigen, 1824) is designated. Males of all known Palaearctic species of Microphor are keyed, genitalia are illustrated for new species and species previously inadequately illustrated, and main diagnostic characters are discussed. Microphorstrobli Chvála, 1986 is newly recorded from Bulgaria, M. anomalus (Meigen, 1824) is newly recorded from Turkey, and M. holosericeus (Meigen, 1804) is newly recorded from Turkey and Portugal.

Catalogue of the Diptera (Insecta) of Morocco- an annotated checklist, with distributions and a bibliography.

The faunistic knowledge of the Diptera of Morocco recorded from 1787 to 2021 is summarized and updated in this first catalogue of Moroccan Diptera species. A total of 3057 species, classified into 948 genera and 93 families (21 Nematocera and 72 Brachycera), are listed. Taxa (superfamily, family, genus and species) have been updated according to current interpretations, based on reviews in the literature, the expertise of authors and contributors, and recently conducted fieldwork. Data to compile this catalogue were primarily gathered from the literature. In total, 1225 references were consulted and some information was also obtained from online databases. Each family was reviewed and the checklist updated by the respective taxon expert(s), including the number of species that can be expected for that family in Morocco. For each valid species, synonyms known to have been used for published records from Morocco are listed under the currently accepted name. Where available, distribution within Morocco is also included. One new combination is proposed: Assuaniamelanoleuca (Séguy, 1941), comb. nov. (Chloropidae).

Different phases of ATS use call for different interventions: a large qualitative study in Europe.

BACKGROUND: Amphetamine-type stimulants (ATS) are globally widely used. Scientific literature generally defines four phases of substance use (initiation, continuation, increase and decrease); however, there is limited understanding of what influences these different phases of ATS use. The ATTUNE study investigated which factors shape individual phases of use, or ATS use patterns. In this article, we report on these phases into and out of ATS use, and propose a set of recommendations for prevention, harm reduction and treatment of the different phases of ATS use. METHODS: Qualitative, semi-structured interviews (n = 237) were conducted in five different European countries with participants who had used ATS, varying from a few times in a lifetime to daily. RESULTS: Amphetamine and MDMA were the most commonly used ATS. Yet, types of ATS used differed between the countries. We found that people who use ATS have various motives for and dynamic patterns of ATS use with alternating phases of increase, continuation, decrease and sometimes dependence. Cessation was pursued in different ways and for diverse reasons, such as mental health problems and maturing out. Availability seemed not an issue, regardless of the type of ATS, phase or country. CONCLUSIONS: These findings demonstrate that tailor-made interventions are needed for the diverse types of people who use ATS and different phases or patterns of ATS use, to reduce possible harms of use. We recommended a set of interventions for the different ATS phases. These include drug checking services, peer-led information, self-management of ATS use, mental health support to help people cope with stressful life events and prevent uncontrolled use, and follow-up support after treatment.

Revision of the types of the genus Rhamphomyia species (Diptera, Empididae) described by R. Frey from the collection of the Zoological Institute of Russian Academy of Sciences, St. Petersburg.

Type material for 36 species of the genus Rhamphomyia Meigen described by R. Frey from the collection of the Zoological Institute of the Russian Academy of Sciences, St. Petersburg is discussed. Habitus photo, label data, type locality and condition of the primary type specimen are provided for 30 species. Lectotype designations are made for the following 20 species (original combinations): Rhamphomyia antennata Frey, 1915; R. (Ctenempis) chrysodactyla Frey, 1950; R. (C.) gripha Frey, 1935; R. (C.) ussuriensis Frey, 1950; R. (Dasyrhamphomyia) ornithorhampha Frey, 1950; R. (D.) pleciaeformis Frey, 1950; R. (D.) taimyrensis Frey, 1950; R. (Eorhamphomyia) basispinosa Frey, 1950; R. (E.) multisinuosa Frey, 1950; R. (E.) principalis Frey, 1950; R. (E.) setitibia Frey, 1950; R. (Megacyttarus) cymbella Frey, 1950; R. (Pararhamphomyia) barbipalpis Frey, 1950; R. (P.) mendicula Frey, 1950; R. (P.) semipellucida Frey, 1950; R. (P.) stackelbergi Frey, 1950; R. (P.) transversipyga Frey, 1950; R. (Rhamphomyia) filipjefi Frey, 1950; R. (R.) paraleucoptera Frey, 1950; R. (R.) subtibialis Frey, 1950.

Change Management and Digital Innovations in Hospitals of Five European Countries.

The objective of the paper is to evaluate the quality of systemic change management (CHM) and readiness for change in five Central European countries. The secondary goal is to identify trends and upcoming changes in the field of digital innovations in healthcare. The results show that all compared countries (regardless of their historical context) deal with similar CHM challenges with a rather similar degree of success. A questionnaire distributed to hospitals clearly showed that there is still considerable room for improvement in terms of the use of specific CHM tools. A review focused on digital innovations based on the PRISMA statement showed that there are five main directions, namely, data collection and integration, telemedicine, artificial intelligence, electronic medical records, and M-Health. In the hospital environment, there are considerable reservations in applying change management principles, as well as the absence of a systemic approach. The main factors that must be monitored for a successful and sustainable CHM include a clearly defined and widely communicated vision, early engagement of all stakeholders, precisely set rules, adaptation to the local context and culture, provision of a technical base, and a step-by-step implementation with strong feedback.

Changes in Alcohol Consumption during the COVID-19 Pandemic Are Dependent on Initial Consumption Level: Findings from Eight European Countries.

Evidence suggests that changes in alcohol consumption during the first months of the COVID-19 pandemic were unevenly distributed over consumer groups. We investigated possible inter-country differences in how changes in alcohol consumption are contingent on initial consumption (before or at the start of the pandemic), and how changes in consumption translate into possible changes in the prevalence of heavy drinking. We used data from the European Survey on Alcohol use and COVID-19 (ESAC) conducted in Czechia, Denmark, Finland, Germany, Norway, Poland, Spain, and the UK (N = 31921). Past-year alcohol consumption and changes in consumption were measured by AUDIT-C. Drinking habits were compared according to percentiles of pre-pandemic consumption levels, below versus above the 90th percentile. Across countries, drinkers in the highest 10% for pre-pandemic consumption increased their drinking during the pandemic, whereas absolute changes among those initially drinking below this level were modest. The percentage of people reporting >28 alcohol units/week increased significantly in seven of eight countries. During the first months of the COVID-19 pandemic, alcohol consumption in the upper decile of the drinkers increased as did the prevalence of heavy drinkers, in contrast with a declining consumption in other groups in the sample.

Cost analysis of early rehabilitation after stroke in comprehensive cerebrovascular centres in the Czech Republic.

OBJECTIVES: The paper analyses real-world data on cost of treatment in patients after stroke hospitalized in early rehabilitation units within comprehensive stroke centres in the Czech Republic. This is the first study of the kind in the Czech Republic, while such information is extremely rare worldwide. Stroke treatment witnessed a dramatic development in the last years, when the main progress was due to establishment of specialized (comprehensive) stroke units incorporating also early rehabilitation. There is a general agreement among clinicians that early rehabilitation is beneficial for patients after stroke. METHODS: Costs of early rehabilitation after stroke were calculated by the micro-costing method alongside a pragmatic study in three Czech hospitals. Patients were transferred to specialized early rehabilitation units usually on 7th to 14th day after stroke onset and received four hours of interprofessional rehabilitation per day. RESULTS: The analysis of data collected during the prospective observational research of 87 patients proved significant differences between patients. The average costs of hospitalization were determined to be CZK 5,104 (EUR 194) per one day of intensive rehabilitation in seriously affected patients early after stroke. These costs differed significantly between hospitals (p-value < 0.001); the structure of direct costs was quite stable, though. About 60% of these costs were due to nursing and overhead, while no more than 15% were consumed by therapists. CONCLUSIONS: The treatment of patients after stroke in specialized stroke units proved to be beneficial for the patients increasing the number of those re-integrated in family and community life.

Alcohol consumption during the COVID-19 pandemic in Europe: a large-scale cross-sectional study in 21 countries.

AIMS: To investigate changes in alcohol consumption during the first months of the COVID-19 pandemic in Europe as well as its associations with income and experiences of distress related to the pandemic. DESIGN: Cross-sectional on-line survey conducted between 24 April and 22 July 2020. SETTING: Twenty-one European countries. PARTICIPANTS: A total of 31 964 adults reporting past-year drinking. MEASUREMENTS: Changes in alcohol consumption were measured by asking respondents about changes over the previous month in their drinking frequency, the quantity they consumed and incidence of heavy episodic drinking events. Individual indicators were combined into an aggregated consumption-change score and scaled to a possible range of -1 to +1. Using this score as the outcome, multi-level linear regressions tested changes in overall drinking, taking into account sampling weights and baseline alcohol consumption [Alcohol Use Disorder Identification Test (AUDIT-C)] and country of residence serving as random intercept. Similar models were conducted for each single consumption-change indicator. FINDINGS: The aggregated consumption-change score indicated an average decrease in alcohol consumption of -0.14 [95% confidence interval (CI) = -0.18, -0.10]. Statistically significant decreases in consumption were found in all countries, except Ireland (-0.08, 95% CI = -0.17, 0.01) and the United Kingdom (+0.10, 95% CI = 0.03, 0.17). Decreases in drinking were mainly driven by a reduced frequency of heavy episodic drinking events (-0.17, 95% CI = -0.20, -0.14). Declines in consumption were less marked among those with low- or average incomes and those experiencing distress. CONCLUSIONS: On average, alcohol consumption appears to have declined during the first months of the COVID-19 pandemic in Europe. Both reduced availability of alcohol and increased distress may have affected consumption, although the former seems to have had a greater impact in terms of immediate effects.

Conducting a multi-country online alcohol survey in the time of the COVID-19 pandemic: Opportunities and challenges.

OBJECTIVES: This contribution provides insights into the methodology of a pan-European population-based online survey, performed without external funding during the COVID-19 pandemic. We present the impact of different dissemination strategies to collect data from a non-probabilistic convenience sample and outline post-stratification weighting schemes, to provide guidance for future multi-country survey studies. METHODS: Description and comparison of dissemination strategies for five exemplary countries (Czechia, Germany, Lithuania, Norway, Spain) participating in the Alcohol Use and COVID-19 Survey. Comparison of the sample distribution with the country's actual population distribution according to sociodemographics, and development of weighting schemes. RESULTS: The dissemination of online surveys through national newspapers, paid social media adverts and dissemination with the support of national health ministries turned out to be the most effective strategies. Monitoring the responses and adapting dissemination strategies to reach under-represented groups, and the application of sample weights were helpful to achieve an analytic sample matching the respective general population profiles. CONCLUSION: Reaching a large pan-European convenience sample, including most European countries, in a short time was feasible, with the support of a broad scientific network.

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.

Use of alcohol, tobacco, cannabis, and other substances during the first wave of the SARS-CoV-2 pandemic in Europe: a survey on 36,000 European substance users.

BACKGROUND: SARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe. METHODS: Data were obtained from a cross-sectional online survey of 36,538 adult substance users from 21 European countries conducted between April 24 and July 22 of 2020. Self-perceived changes in substance use were measured by asking respondents whether their use had decreased (slightly or substantially), increased (slightly or substantially), or not changed during the past month. The survey covered alcohol (frequency, quantity, and heavy episodic drinking occasions), tobacco, cannabis, and other illicit drug use. Sample weighted data were descriptively analysed and compared across substances. RESULTS: Across all countries, use of all substances remained unchanged for around half of the respondents, while the remainder reported either a decrease or increase in their substance use. For alcohol use, overall, a larger proportion of respondents indicated a decrease than those reporting an increase. In contrast, more respondents reported increases in their tobacco and cannabis use during the previous month compared to those reporting decreased use. No distinct direction of change was reported for other substance use. CONCLUSIONS: Our findings suggest changes in use of alcohol, tobacco and cannabis during the initial months of the pandemic in several European countries. This study offers initial insights into changes in substance use. Other data sources, such as sales statistics, should be used to corroborate these preliminary findings.

The identification of artefacts in reporting of drug-induced deaths using structural breaks analysis of time series statistics.

INTRODUCTION: Drug-related mortality is a key epidemiological indicator that is collected nationally and internationally. Significant efforts were made in 2006-2007 to improve the quality of data concerning drug-related mortality in the Czech Republic. The aim of this article is to identify the effect of a quality improvement project on the drug-induced mortality data reported in the General Mortality Registry (GMR), and to demonstrate how to identify, quantify and interpret changes in drug-induced mortality based on the example of the Czech Republic. METHODS: We extracted data on illicit drug-induced deaths from the Czech Republic GMR and Special Mortality registry (SMR) for the years between 2004 and 2012, and aggregated monthly and quarterly time series. We applied a new procedure to identify structural breakpoints in time series based on dating structural changes in standard linear regression models. RESULTS: In the GMR, breakpoints were identified in three time series: (i) opioid-related deaths; (ii) other stimulant-related deaths; and (iii) total drug-induced deaths. In the SMR, the structural breaks were identified for opioids, volatile substances and selection D time series. In each of these time series, the analysis identified a decrease in the intercepts in the different segments. DISCUSSION AND CONCLUSIONS: The structural breaks identified and quantified in the GMR time series were plausibly caused by the quality improvement efforts that started in 2006. These results demonstrate that it is critical for the analysis and use of drug mortality data collected in the registries to identify practice changes in the relevant registries, to quantify their influence and to adjust mortality estimates accordingly.

Four new West Palaearctic species and new distributional records of Hybotidae (Diptera).

Megagrapha starki Barták & Grootaert, sp. nov. (Poland, Russia, Slovakia), Oedalea portugalica Barták & Grootaert, sp. nov. (Portugal), Hybos conicus Grootaert & Barták, sp. nov. (Greece, Turkey), and Platypalpus obscuroides Barták & Grootaert, sp. nov. (Slovakia) are described and illustrated. Diagnostic characters are discussed. The female of Syndyas merzi Shamshev & Grootaert, 2012 is described for the first time. New distributional records are presented: Megagrapha europaea Papp & Földvári, 2001 is first reported from Slovakia and Syndyas merzi Shamshev & Grootaert, 2012 is first reported from Turkey.