Drug consumption rooms in Catalonia: A comprehensive evaluation of social, health and harm reduction benefits.

BACKGROUND AND AIMS: Despite the availability of several drug consumption rooms (DCR) in different European countries few epidemiological studies have evaluated their benefits. A network of DCR for people who inject drugs (PWID) has existed in Catalonia since 2000. We aimed to study the impact of frequently attending DCR on injecting in public, infectious risk (disposal of used syringes in safe places, sharing needles and/or injecting equipment), accessing drug dependence services and non-fatal overdoses. METHODS: In 2014-2015, we performed the cross-sectional study REDAN in Catalonia's network of harm reduction centres (needle exchange programs, outreach programs, and DCR). A sample of current PWID were recruited. Self-reported data about risky and other behaviours and about access to care were collected through anonymous face-to-face structured interviews. Oral fluid samples were also collected to test for HIV and HCV antibodies. Multiple logistic regressions were used to assess the impact of frequently attending DCR on the different outcomes. RESULTS: Among the 730 PWID recruited, 510 reported attending DCR in the previous 6 months, of whom 21·2% were 'frequent' attenders. After multiple adjustment, frequent attenders had a 61% lower risk of injecting in public (AOR [95%CI]:0·39[0·18-0·85]) and sharing needles or other injecting equipment (0·39[0·18-0·85]) than 'medium' and 'low' attenders. They were six times more likely to place used syringes in a safe place (6·08[3·62-10·23]) and were twice as likely to access drug dependence services (2·56[1·44-4·55]). No significant effect was found for non-fatal overdoses, perhaps because of survival bias. CONCLUSION: The multiple benefits found strongly advocate for the maintenance of current DCR and the promotion of new DCR, in conjunction with other harm reduction strategies, in European countries where they are not yet available.

[Utility of an information system for primary care]. / Utilidad de un sistema de información para la atención primaria.

OBJECTIVE: To know the usefulness and applicability of an information system for basic health areas put into operation 16 years ago. DESIGN: Descriptive study of selected indicators registered in 1994 and 2004. SETTING: Basic health areas of Barcelona, Spain. PARTICIPANTS: Population living in Barcelona, Spain, during 1994 and 2004. MEASUREMENTS: The following indicators were described, and standardized taking the Barcelona 2004 population as reference: proportion of foreign population, proportion of unemployment, number of mothers less than 20 years old, AIDS incidence rate, tuberculosis incidence rate, and traffic accident, ischaemic disease, lung cancer (for men), breast cancer (for women), and total mortality rates. Results were presented for one basic health area, its corresponding district, and Barcelona. Moreover, users of the information system were interviewed about their level of knowledge, and the adequacy, usefulness, and limitations of the system. RESULTS: Disaggregated annual information allows comparing indicators between different fields and years. The information system was found useful to users to describe the level of health of the community and to design preventive interventions. CONCLUSIONS: Although some of the indicators did not show the desired level of accuracy, the information system for basic health areas showed to be useful to know the level of health of the population assigned to primary healthcare teams.

Utilidad de un sistema de información para la atención primaria / Utility of an Information System for Primary Care

Objetivo. Mostrar la utilidad y la aplicabilidad de un sistema de información por zona básica de salud instaurado hace 16 años. Diseño. Estudio descriptivo de una selección de indicadores registrados en los años 1994 y 2004. Emplazamiento. Zonas básicas de salud de Barcelona. Participantes. Población residente en Barcelona en los años 1994 y 2004. Mediciones. Se incluyeron indicadores estandarizados por la población de Barcelona del año 2004. Se calculó la proporción de extranjeros, desempleados y número de madres menores de 20 años; la tasa de incidencia de sida y tuberculosis, y de mortalidad total, por accidente de tráfico, por cardiopatía isquémica y por cáncer de pulmón en varones y cáncer de mama en mujeres. Los resultados se presentaron para un zona básica de salud seleccionada, su distrito y la ciudad de Barcelona. Adicionalmente, se preguntó a personas usuarias del sistema de información sobre el grado de conocimiento, adecuación, utilidad y limitaciones del sistema de información. Resultados. La información anual desagregada permite comparar indicadores entre diferentes ámbitos y entre años. Los usuarios encontraban útil el sistema de información para describir la salud de la comunidad y el diseño de planes preventivos. Conclusiones. El sistema de información por zona básica de salud, a pesar de que algunos indicadores no alcanzaban la precisión deseada, mostró su utilidad para el conocimiento de la salud de la comunidad asignada a un equipo de atención primaria

Objective. To know the usefulness and applicability of an information system for basic health areas put into operation 16 years ago. Design. Descriptive study of selected indicators registered in 1994 and 2004. Setting. Basic health areas of Barcelona, Spain. Participants. Population living in Barcelona, Spain, during 1994 and 2004. Measurements. The following indicators were described, and standardized taking the Barcelona 2004 population as reference: proportion of foreign population, proportion of unemployment, number of mothers less than 20 years old, AIDS incidence rate, tuberculosis incidence rate, and traffic accident, ischaemic disease, lung cancer (for men), breast cancer (for women), and total mortality rates. Results were presented for one basic health area, its corresponding district, and Barcelona. Moreover, users of the information system were interviewed about their level of knowledge, and the adequacy, usefulness, and limitations of the system. Results. Disaggregated annual information allows comparing indicators between different fields and years. The information system was found useful to users to describe the level of health of the community and to design preventive interventions. Conclusions. Although some of the indicators did not show the desired level of accuracy, the information system for basic health areas showed to be useful to know the level of health of the population assigned to primary healthcare teams

Drug-related mortality and its impact on adult mortality in eight European countries.

OBJECTIVE: To estimate the mortality rates from drug-related deaths and other causes among problem drug users and population attributable risk of death due to opiate use in eight study sites in Europe. METHODS: Opiate users were recruited from drug treatment centres during the period 1990-1998 and deaths followed up through national or local mortality registries. Gender-specific overall mortality rate, proportion of deaths by cause (drug-related, HIV, other), standardized mortality ratios (SMRs), and the attributable risk fraction (ARF) were estimated. RESULTS: Crude mortality rates varied from 1 per 100 person-years in the Dublin and London cohorts to 3.8 per 100 person-years in Barcelona. The highest drug-related mortality rate was 10 per 1,000 person-years in Barcelona; the rates were approximately 7 per 1,000 person-years in Denmark, London, Rome, and Vienna, and <3.5 per 1,000 person-years for the others cohorts. The mortality rate for AIDS was <2 per 1,000 person-years in all the cohorts except Lisbon, Rome, and Barcelona, for which it was approximately 6 per 1,000 person-years. The highest SMR among males was 21.1 in Barcelona, and among females the highest SMRs were 53.7 and 37.7 in Barcelona and Rome, respectively. In Denmark the ARF was 5%, whereas it was >10% in all other study sites and 24% in Barcelona. CONCLUSION: Cohort mortality studies, especially in combination with estimates of prevalence, provide useful insights into the impact of opiate use on mortality across European countries and emphasize how preventing overall and drug-related deaths among opiate users can significantly improve the health of the population.