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Background: As one of the forms of media and art most consumed in the world, Oscar- nominated movies should have their drug use representation monitored because of possibly influencing but also reflecting society’s behavior. Objective: The present study aims to investigate drug use representation in scenes from movies nominated for the Academy Awards (Oscar) from 2008-2011 through media content analysis. Methods: 437 scenes from Oscar-nominated movies (best film, best actor and best actress categories) showing drug consumption and/or its effects were assessed. Each drug represented and identified in a given scene (i.e., drug use incident) was counted as a unit for the present study (n = 515). Survey settings were used to control for over- or under-estimation of the prevalence of a variable in a given year or movie. Results: All the Oscar-nominated movies portrayed at least one scene of drug use. There was a massive predominance of alcohol and tobacco in movies, with a high use among men who also use drugs, habitually or occasionally, but related to stress/tension, predominantly at home. However, there was a significant progressive increase in the use of drugs other than alcohol and tobacco, multiple drugs, and by women. Conclusion: These findings echo epidemiological studies on substance use in western countries, an overall trend towards greater home drug use representation and gender convergence since 1970, which increased since 2000. Monitoring drug use representation in Oscar-nominated movies may represent an important public health tool.

Background Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) provide a safe environment in which people who inject drugs (PWIDs) can inject under hygienic and supervised conditions. Numerous reviews have documented the benefits of these facilities; however, there is a lack of clarity surrounding their long-term effects. Purpose To conduct, with a systematic approach, a literature review, of published peer-reviewed literature assessing the long-term impacts of DCRs/SIFs. Methods A systematic search of the PubMed and Embase database was performed using the keywords: ("SUPERVISED" OR "SAFE*") AND ("CONSUMPTION" OR "INJECT*" OR "SHOOTING") AND ("FACILITY*" OR "ROOM*" OR "GALLERY*" OR "CENTRE*" OR "CENTER*" OR "SITE*"). Included studies were original articles reporting outcomes for five or more years and addressed at least one of the following client or community outcomes; (i) drug-related harms; (ii) access to substance use treatment and other health services; (iii) impact on local PWID population; (iv) impact on public drug use, drug-related crime and violence; and (v) local community attitudes to DCRs. Results Four publications met our inclusion criteria, addressing four of the five outcomes. Long-term data suggested that while the health of PWID naturally declined over time, DCRs/SIFs helped reduce injecting-related harms. The studies showed that DCRs/SIFs facilitate drug treatment, access to health services and cessation of drug injecting. Local residents and business owners reported less public drug use and public syringe disposal following the opening of a DCR/SIF. Conclusion Long-term evidence on DCRs/SIFs is consistent with established short-term research demonstrating the benefits of these facilities. A relative paucity of studies was identified, with most evidence originating from Sydney and Vancouver. The overall body of evidence would be improved by future studies following outcomes over longer periods and being undertaken in a variety of jurisdictions and models of DCRs/SIFs.

Background Heroin and cocaine are among the most dangerous illicit drugs available and their presence on the market is increasing. These facts have led to the investigation of the quality of heroin and cocaine samples seized in Luxembourg by police and customs but also collected at the national supervised drug consumption facilities. Methods Samples obtained from 2019 to 2020 were analyzed to determine their composition and content using GC–MS, HPLC-UV and LC-Q-ToF. The statistical evaluation of concentration changes depending on the source of collection is based on an ANOVA single factor test and a two-tailed t test. Results Results showed important differences between seizure and collection sources. For both drugs, customs samples had significantly higher concentrations than police samples and the latter had significantly higher concentrations than samples from drug consumption facilities, whereas for heroin two cutting steps were identified, for cocaine samples only one appears to occur on the local market. Indeed, cocaine samples seized by police consisted of a mixture of low and high concentration samples. Conclusion The results show that extensive adulteration with pharmacological active and inactive compounds takes place at local levels, which, however, are different for heroin and cocaine. This knowledge on variability of quality of drugs should be considered in the elaboration of drug and harm prevention strategies.

Substance use disorder (SUD) is a behavioral disorder characterized by volitional drug consumption. Mouse models of SUD allow for the use of molecular, genetic, and circuit-level tools, providing enormous potential for defining the underlying mechanisms of this disorder. However, the relevance of results depends on the validity of the mouse models used. Self-administration models have long been the preferred preclinical model for SUD as they allow for volitional drug consumption, thus providing strong face validity. While previous work has defined the parameters that influence intravenous cocaine self-administration in other species-such as rats and primates-many of these parameters have not been explicitly assessed in mice. In a series of experiments, we showed that commonly used mouse models of self-administration, where behavior is maintained on a fixed-ratio schedule of reinforcement, show similar levels of responding in the presence and absence of drug delivery-demonstrating that it is impossible to determine when drug consumption is and is not volitional. To address these issues, we have developed a novel mouse self-administration procedure where animals do not need to be pretrained on sucrose and behavior is maintained on a variable-ratio schedule of reinforcement. This procedure increases rates of reinforcement behavior, increases levels of drug intake, and results in clearer delineation between drug-reinforced and saline conditions. Together, these data highlight a major issue with fixed-ratio models in mice that complicates subsequent analysis and provide a simple approach to minimize these confounds with variable-ratio schedules of reinforcement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Airborne grass (Poaceae) pollen measurements are used in public warning systems to inform people about the risk of allergic symptoms. However, there is no consensus about which exact thresholds of pollen concentrations provoke the allergic symptoms. The aim of this study was to review the relevant scientific information on the relationship between grass pollen concentrations and the occurrence of emergency department (ED) visits, hospital admissions (HA), drug consumption and allergic symptoms. Literature search was conducted by experts’ consultation and snowball strategy. Studies meeting the criteria for inclusion were assessed regarding their risk of bias (RoB). A high RoB resulted in exclusion of the study from data synthesis. Extensive data were extracted and qualitatively compared. The review is registered in PROSPERO. 32 Studies were eligible while 18 showed a low RoB and were qualitatively synthesised. Emergency department visits and hospital admissions were mostly investigated. Threshold values of 10 grains/m3 and 12 grains/m3 were reported for ED visits and HA. Evidence exists that an increase of 10 grains/m3 of air leads to a significant increase in adverse health outcomes. Especially at a three-day lag, adverse health effects were shown. Variations in exposure and outcome measurement make the definition of pollen thresholds difficult. As a consequence, no defined pollen threshold values could be identified. Studies with uniform exposure measures and statistical methods are necessary to gain a better understanding of the impact of grass pollen on human health. Determining personal thresholds could be beneficial for affected people.

In the pharmacotherapy of depressive disorders, drug consumption was maximal in the group of Slavs, less in the groups of Karachays, Turkmens, Nogais, and minimal in the group of Armenians.

Management of drug is one of the factors which contribute to the quality of hospital services. This study aimed at finding out drug planning in Pharmacy Unit of Adelia Surgical Hospital by using ABC analysis method. This research is qualitative descriptive study involving informants. Primary data were collected by interview with respondents and secondary data report of general drugs purchased period of May 2018 – May 2019. The Result using ABC analysis indicate that there are 23 (17,42%) kindof drugs in group A, 35 (26,52%) in group B and 74 (56,06%) in grup C. Group A if in the event of an excess or deficiency will couse harm to the hospital. ABC analysis method will effectively improve hospital drug consumption plan.

Hypertension is a chronic disease that requires long-term treatment, where it is very prone to non-adherence in taking antihypertensive drugs. This study aims to determine the effect of the number of drugs received by patients on the level of adherence to the consumption of antihypertensive drugs. This research is a cross-sectional observational study that was conducted in 4 community health centers in Surabaya City. The measurement of adherence in this study used the Indonesian version of the MGLS questionnaire. The number of subjects in this study was 143 which fit the inclusion criteria. The majority of the adherence levels of the study subjects were moderate (MGLS questionnaire). Based on statistical analysis, it is known that there is a significant effect (P = 0.035) of the number of drugs received by patients on the level of drug consumption adherence e as measured using the Indonesian version of the MGLS questionnaire.

Social Network Sites (SNS) have become an important tool in our daily lives and many organizations nowadays especially in the west are utilizing it as a business tool especially in the context of employers using these SNS to screen job candidates. This is because recruiting a candidate based on their resume and a 10-15 minutes interview does not paint a complete picture of the candidate’s suitability for the job. This recruiting process is also slowly but surely catching up in local context in Malaysia. Thus, this study examines firstly, the usage of SNS as a possible tool by employers to screen job candidates during the recruitment process and secondly, the awareness of potential job candidates/employees on its impact. Utilizing a mixed-methodology approach using descriptive design and interviews, 70 companies and 120 final year students from universities in the Klang Valley in Malaysia participated in the study. The findings show that 61.5% of Malaysian companies view potential candidates’ SNS profiles in order to gain greater knowledge of the candidates and 89.2% of final year students are aware of employers’ ability to screen candidates based on their SNS profiles. The most common reasons for employers to reject candidates based on their SNS profiles are lying about qualifications, postings related to drug consumption and posting of negative remarks or comments against past employers. Prospective employees need to be aware that their behaviour is being monitored through their SNS profiles and the information extracted has a great influence on their job prospects.

Background : Tuberculosis (TB) is a disease caused by Mycobacterium Tuberculosis generally attacking lungs, and the treatment is a minimum of six months. The recovery of TB clients requires adherence to medication treatment and Drug Consumption Supervisors (PMO). Objective : This study aims to analyze the relationship between drug consumption, supervisors' knowledge and support, and patients' obedience to take tuberculosis drugs. Method : This research employed a quasi-experiment with a total population sampling technique. The study was conducted in May-August 2019 in sector one, East Jambe, Karawang district (4 villages), and it employed 101 respondents of TB patients and 101 respondents of supervisors (family). Analysis in this study is used in the Spearman Rho Test. Result : The supervisor analysis reveals that 71.3% of the supervisors are 25-49 years old, 59.4% of them are female, 80.1% of them are unemployed, 70.3% of them have low education, and 52.5% of them are married couples. TB patient analysis reveals that 59.4% of the patients are 25-49 years old, 63.4% of them are male, and 59.4% of them have new TB The level of supervisors' knowledge is good at 78.2%, and their support is good at 63.4%, while the patients' adherence to taking drugs is good at 93.1%. The relationship analysis reveals there is no relationship between the supervisors' knowledge and patient's medication adherence (p-value 0.13); otherwise, there is a significant relationship between the supervisors' support and drug-taking adherence (p-value 0.04). Conclusion: The supervisors' knowledge does not affect adherence, but their support significantly influences the patients' obedience of taking TB drugs.

The purpose of the study was to analyze the structure of drug consumption in the conditions of inpatient treatment of children with acute respiratory viral infections to optimize treatment standards and reduce material costs. The paper presents the results of a retrospective study of the consumption of drugs in the inpatient treatment of children with acute respiratory viral infections. It is shown that the most vulnerable group for the occurrence and development of acute respiratory viral infections is represented by children aged 1 year to 7 years (60.0% of the total population). Evaluation of drug consumption suggests that the frequency of prescriptions is dominated by J01 category «Antibacterial drugs for systemic use» and R01 «Nasal preparations» (18.58% and 16.56%, respectively). At the same time, the group L03 «Immunostimulants» makes a significant contribution to the consumption structure according to the frequency of appointments, covering 9.31%.

Among the different hemodialysis (HD) strategies, the short daily hemodialysis performed at home (SDHHD) provides clinical benefits to the patient. Expanded hemodialysis (HDx) employs cutoff medium membranes that exhibit greater clearance capacity of uremic toxins of medium-high molecular weight. This case series study reported the results of seven patients who were transferred to expanded hemodialysis at home (HHDx), from December 2017 to March 2019, over a 12-month follow-up period. The AK-98 monitor and Theranova 400 membrane (Baxter International Inc., Deerfield, IL, USA) were used. The main outcome measures were blood analytical values and drug consumption. The blood levels of beta 2-microglobulin were significantly reduced (p = 0.0082), while maintaining albumin levels with less use of phosphorus binders. Regarding the safety profile, technique-related adverse events were not reported. According to the results of the current study, HHDx was a safe technique, which additionally had the ability to provide benefits to patients due to its greater purification capacity. Further studies, especially multicenter ones, with a greater number of patients are needed to confirm these results.

Aims: Patient-controlled analgesia (PCA) is usually considered a better option for pain management compared to conventional analgesia. The beneficial effect of PCA has been assessed in a number of studies; however, the results are inconsistent. The goal of this study was to compare of patient-controlled epidural analgesia (PCEA) to conventional epidural analgesia after total hip replacement (THR). Methods: This prospective study was performed at the Department of Anesthesia and Intensive Care Medicine at a tertiary university hospital. After THR, patients were admitted to the intensive care unit (ICU) and randomized to one of two groups (PCEA and non-PCEA). Postoperative pain in the PCEA group was treated using a standardized protocol, while the analgesia in the non-PCEA group was based on physician prescription according to the patient's clinical condition. The total consumption of analgesics, patients' satisfaction, pain intensity, and analgesia-related complications were recorded for 24 h after surgery. Results: The final sample consisted of 111 patients (PCEA group, n=55 and non-PCEA group, n=56). The PCEA group had significantly lower total consumption of analgesic mixtures (0.9±0.3 and 1.3±0.4 mL/kg per day, P

Municipal wastewaters can generally provide real-time information on drug consumption, the incidence of specific diseases, or establish exposure to certain agents and determine some lifestyle consequences. From this point of view, wastewater-based epidemiology represents a modern diagnostic tool for describing the health status of a certain part of the population in a specific region. Hospital wastewater is a complex mixture of pharmaceuticals, illegal drugs, and their metabolites as well as different susceptible and antibiotic-resistant microorganisms, including viruses. Many studies pointed out that wastewater from healthcare facilities (including hospital wastewater), significantly contributes to higher loads of micropollutants, including bacteria and viruses, in municipal wastewater. In addition, such a mixture can increase the selective pressure on bacteria, thus contributing to the development and dissemination of antimicrobial resistance. Because many pharmaceuticals, drugs, and microorganisms can pass through wastewater treatment plants without any significant change in their structure and toxicity and enter surface waters, treatment technologies need to be improved. This short review summarizes the recent knowledge from studies on micropollutants, pathogens, antibiotic-resistant bacteria, and viruses (including SARS-CoV-2) in wastewater from healthcare facilities. It also proposes several possibilities for improving the wastewater treatment process in terms of efficiency as well as economy.

Aim: To investigate the health care utilization and drug consumption of patients with fibromyalgia (FM). Materials and Methods: This is a cross-sectional study using the Clalit Health Care database. Clalit is the largest HMO in Israel, serving more than 4.4 million enrollees. We identified FM patients and age and sex-matched controls. Indicators of healthcare utilization and drug consumption were extracted and analyzed for both groups. Results: The study included 14,296 FM patients and 71,324 controls. The mean age was 56 years, with a female predominance of 92%. The mean number of visits across of all healthcare services (hospitalizations, emergency department visit, general practitioner clinic visits, rheumatology clinic visits and pain clinic visits) and the mean difference (MD) were significantly higher for FM patients compared to controls (MD 0.66, p

Background: Substance abuse is a common practice among health-care workers across the globe. Aim: To assess prevalence and practices of tobacco, alcohol, and non-medicinal drug consumption practices among MBBS (including intern) and medical laboratory technology (MLT) students. Materials and Methods: A cross-sectional study was conducted and students underwent a face-to-face confidential interview using a predesigned, pretested, semi-structured interview schedule adapted from the Global Health Professional Student Survey. Results: A total of 283 (MBBS = 206 and MLT = 77) students participated in the study giving a response rate of 83.3%. The mean age was 20.92 (±1.75) years; 56.9% were male. Among medical students who had “ever” undertaken such practices were as follows: smoking (cigarette) (83, 40.2%), alcohol (98, 47.5%), and drug (38, 18.4%) intake, respectively; current (past 30 days) smokers were 34 (16.5%), and current (past 30 days) alcohol drinkers were 61 (29.6%). Males had a slightly higher prevalence of consumption of all substances in comparison to females except alcohol (P > 0.05). A statistically higher proportion of medical compared to paramedical (29.9% and 3.9%) students had ever drunk alcohol or consumed drug (P < 0.05). About 40 (14.1%) students had consumed all the three substances. On multiple regression analysis it was found that students staying in hostel (OR: 2.57; 95% CI: 1.3–4.8) had ever tried smoking in comparison to day-scholar (P = 0.003). Similarly, medical students (OR: 2.94; 95% CI: 1.1–7.5; P = 0.02) in comparison to paramedical students were ever alcohol drinker, and finally, drug intake was found to be statistically significant with age (above 20 years in reference to

In 2016 West Java was the fourth-ranked province as the region with the highest prevalence ofhypertension, which was 29.4% in Indonesia. Failure to treat hypertension was found due tolow compliance in the use of hypertension drugs. Non-compliance with the consumption ofantihypertensive drugs will have an impact on the incidence of uncontrolled blood pressure.Long term Uncontrolled blood pressure can cause complications of the disease and even death.The purpose of this study is to identify the overview of hypertensive patients in consuminghypertension drugs.This study uses a qualitative method with a phenomenological approach through in-depthinterviews on 6 people with hypertension, using semi-structured questions about theirexperience in taking hypertension medication.From this study, it was found that taking medication for a long period caused a feeling oflaziness and boredom in taking medicine, resulting in patients with hypertension who stoppedconsuming medication. Fear of side effects from taking medication for a long time makeshypertensive patients decided to stop the consumption of hypertension medicine.It is hoped that this research can be an input to improve health promotion to reduce the failureof hypertension treatment.

This work is a continuation of the article devoted to the spread of drug use among the working population and in various professional groups. The second part of the article, based on the materials of quantitative and qualitative studies conducted by the sector of sociology of deviant behavior (ISRAS – FCTAS RAS), as well as reviews of different studies, discusses the features of substance use in the Armed forces of the Russian Federation. The main latency factors of drug use were identified. It is noted that the structure of drug use among military almost completely reflects the structure of their distribution among population in in the country. It is shown that, despite the steadily decreasing number of people exempted from military service due to drug use and the military involved in drug consumption, the lack of detection of drug users in Russian army remains.

This article describes the rationale for methodology of comprehensive assessment of drug consumption in real clinical practice. The proposed methodology includes three stages: 1) epidemiological monitoring – disease epidemiology assessment; assessment of the role of factors leading to the disease; 2) pharmacoepidemiological monitoring – assessment of pharmacotherapy in real clinical practice; clinical efficacy analysis of drugs; cost-effectiveness analysis; 3) long-term clinical and economical evaluation of various treatment options. Comprehensive assessment of drug consumption should result in optimal pharmacotherapy regimens, decrease of the drug load, increasing of the therapy effectiveness and cost reduction. The scheme of comprehensive assessment of drug consumption is universal and can be used for clinical guidelines development, treatment standards, for the optimal formation of drugs lists at the federal level. Separate stages and sub-steps of an integrated assessment also can be used at the territorial and local levels, medical institution, to optimize pharmacotherapy.

Introducción: El consumo de alcohol y de drogas en ambientes laborales constituye un riesgo para el mismo trabajador, para terceros y compromete la productividad. La OIT recomienda la evaluación médica previa de la salud de los trabajadores. El objetivo de este trabajo fue estimar la prevalencia de consumo de marihuana y cocaína en muestras de orina para aspirantes a empleos de alto riesgo y analizar algunos factores asociados. Métodos: Se tomaron 2.197 muestras de orina para detectar consumo de marihuana y cocaína. La fuente fue secundaria. El análisis toxicológico se realizó con la técnica de inmunoensayo cromatográfico de flujo lateral. Se calcularon medidas de frecuencia absoluta y relativa, y se aplicó la prueba de chi cuadrado de Pearson para el análisis de factores asociados. Resultados: La prevalencia de marihuana fue de 7,3 % y de cocaína de 3,6 %. Hubo asociación estadística entre el resultado positivo de marihuana y sexo, edad, escolaridad y tipo de empresa. Para cocaína se encontró asociación con las mismas variables, excepto en edad. Conclusiones: El uso de pruebas de drogas en orina como exámenes médicos preocupacionales es el primer paso para la prevención del consumo de drogas en ambientes laborales de alto riesgo. Hay evidencia acerca de que los aspirantes a un trabajo que consumen drogas tienen más probabilidad de asumir riesgos en el ambiente laboral.

Purpose To determine the relationship of illnesses and medical drug consumption with the occurrence of traffic accidents among truck and bus drivers. Methods This is a cross-sectional study on truck and bus drivers in Tehran, Iran. The criteria for participating in this study were: married males over 30 years old, driving license in grade one, five years of job experience, mental health and non-addiction license. The criterion for not participating in this study was the lack of cooperation in responding to the questions. Six months was spent to collect the latest five years data of driving accidents from 2011 to 2016. A total of 323 truck and bus drivers in Tehran city and the suburbs, Iran were chosen. Among them, 112 were responsible for accidents (accident group) while 211 were not responsible for any accidents or involved in an accident in the last five years (non-accident group). A specially designed questionnaire was used to investigate the demographic information, medical drug consumption, medical backgrounds and history of accidents. Results The results revealed that compared with healthy subjects, the occurrence of accidents among people with diabetes (OR = 2.3, p = 0.001) and vision weakness (OR = 1.7, p = 0.020) was significantly higher, while that among people with cardiac (OR = 0.5, p = 0.002) and hypertension (OR = 0.9, p = 0.048) problems was remarkably lower. Moreover, consumption of Gemfibrozil (OR = 1.8, p = 0.010) and Glibenclamide (OR = 2.2, p = 0.002) drugs resulted in significantly higher incidence of accidents than those without. Conclusion Frequencies of illnesses like cardiovascular and hypertension were not higher in accident drivers than in non-accident drivers; but diabetes, vision weakness and consumption of Gemfibrozil and Glibenclamide lead to more traffic accidents., Highlights • Vascular-cardinal and blood pressure lead to less traffic accidents. • Diabetes and vision weakness lead to more traffic accidents. • Consumption of Gemfibrozil and Glibenclamide lead to more traffic accidents.

espanolEl chemsex es el uso intencionado de drogas psicoactivas para mantener relaciones sexuales, generalmente entre hombres que tienen sexo con otros hombres , en sesiones que pueden durar desde varias horas hasta dias, con una o multiples parejas sexuales. Objetivos: Conocer la epidemiologia del chemsex, su impacto sobre la salud fisica y mental, y conocer los detalles de su uso. Material y metodos: Para los grupos de estudio Virus de la Inmunodeficiencia Humana positivos y negativos del Hospital Universitario Virgen de las Nieves de Granada se han empleado dos cuestionarios parecidos que incluyen variables sociodemograficas, de consumo de drogas, impacto sobre salud fisica y mental, y practicas sexuales de riesgo que contestaron de forma voluntaria ente los pacientes que acudieron a las consultas de infecciones y de transmision sexual. Resultados: de la muestra total de 141 pacientes, un 14,9% practica chemsex. Del grupo positivos (n=90) lo practica un 11,1% (n=10) y del grupo negativos (n=51) un 21,6% (n=11). Las drogas mas consumidas son los poppers, cocaina , 3,4-metilendioximetanfetamina , speed, farmacos para la disfuncion erectil, mefedrona y metanfetaminas . No se usa el slamming. Desde que practican chemsex, el 60% de positivos ha contraido alguna infeccion de transmision sexual, la mas frecuente VIH; y ha contraido alguna infeccion de transmision sexual el 63,6% de los negativos, la mas frecuentes sifilis. Esta poblacion lleva a cabo practicas sexuales como, barebacking y uso de juguetes sexuales sin proteccion. Conclusiones: En nuestro medio el chemsex lo practica un numero significativo de homosexuales del Hospital Universitario Virgen de las Nieves , consumiendo varias drogas por sesion, principalmente por la via inhalada, y siendo el popper la mas utilizada. Tienen practicas sexuales de riesgo que aumentan el riesgo de transmision de infecciones de transmision sexual. La enfermedad mental es prevalente en ambos grupos. EnglishChemsex is the intentional use of psychoactive drugs to maintain sexual relations, usually between men who have sex with other men, in sessions that can last from several hours to days, with one or multiple sexual partners. Objectives: To know the epidemiology of chemsex, its impact on physical and mental health, and to know the details of its use. Material and methods: For the study groups positive and negative Human Immunodeficiency Virus of the Virgen de las Nieves University Hospital of Granada, two similar questionnaires were used, including sociodemographic variables, drug consumption, impact on physical and mental health, and risky sexual practices that answered voluntarily among the patients who attended the consultations for infections and sexual transmission. Results: of the total sample of 141 patients, 14,9% practiced chemsex. Of the positive group (n = 90) it is practiced by 11,1% (n = 10) and of the group negative (n = 51) by 21,6% (n = 11). The most consumed drugs are poppers, cocaine, 3,4-methylenedioxymethamphetamine, speed, drugs for erectile dysfunction, mephedrone and methamphetamines. Slamming is not used. Since practicing chemsex, 60% of positives have contracted some sexually transmitted infection, the most frequent HIV; and has contracted some sexually transmitted infection (63,6% of the negative, the most frequent syphilis.) This population carries out sexual practices such as barebacking and use of unprotected sex toys Conclusions: chemsex practices it in our environment. a significant number of homosexuals from the Virgen de las Nieves University Hospital, consuming several drugs per session, mainly through the inhaled route, and being the most used popper. They have risky sexual practices that increase the risk of transmission of sexually transmitted infections. Mental illness is prevalent in both groups.

Background/aim: This study was designed to evaluate the relationship between urinary phytate concentration and risk of fracture at 10 years, determined by using the FRAX model, in women who had undergone menopause within 5 years of the time of enrollment. Materials and methods: Of the 212 postmenopausal women evaluated, 69 were excluded because they had urinary phytate concentrations between 0.51 and 0.99 mg/L. Of the remaining 143 women, 91 had low (≤0.50 mg/L) and 52 had high (≥1.0 mg/L) urinary phytate concentrations. The 10-year risk of fracture was calculated by using the FRAX model.Results: The risks of major osteoporotic fracture and hip fracture were higher in women with low urinary phytate levels (P < 0.001 in both cases). Evaluation of the risk of hip fracture in women with and without risk factors for osteoporosis (e.g., tobacco, alcohol, and drug consumption) and according to urinary phytate concentrations indicated that, among women with no risk factors, those with low and high urinary phytate levels had a range of risks of 0%-0.6% and 0%-0.3%, respectively (P = 0.098). Moreover, among women with at least one risk factor, those with low and high urinary phytate had a range of risks of 0.1%-0.8% and 0.1%-0.4%, respectively (P = 0.002). Similar results were observed when the risks of major osteoporotic fracture were analyzed.Conclusion: These results indicate the relationship of phytate with the risks of major osteoporotic fracture and hip fracture, with these differences being more marked in women with risk factors for osteoporosis. From this study follows the importance of the consumption of phytate-rich products (nuts, legumes, whole cereals) to protect against the risk of fracture in 10 years, mainly in women with risk factors for osteoporosis.

Anticoagulants are essential for the treatment of cardiovascular illnesses. With the ageing population in the West countries, and the consequent increase in the frequency of thrombogenic heart diseases oral anticoagulants represent a not insignificant portion of drug consumption. Over the past few years, direct oral anticoagulants (DOACs) have been marketed because they are easier to use than vitamine K antagonists (VKAs). The introduction of these drugs has raised two main issues: (1) progress of the switch from VKAs to DOACs; (2) the comparison of adverse drug reactions (primarily hemorrhagic) on DOACs compared to indirect oral anticoagulants (IOAs). This article is confined to discussing oral anticoagulants, focusing on the two issues outlined above, and the potential answers that may be found in pharmacoepidemiology studies.

Introducción: La automedicación es la principal causa de consumo de medicamentos dentro del uso irracional de fármacos, se ha convertido en un problema de salud, constituyendo un potencial de riesgo para las personas. El objetivo del estudio es, determinar características sobre la automedicación. Metodología: Es descriptivo, transversal y prospectivo. La muestra seleccionada corresponde a 1200 habitantes mayores de 18 años residentes del distrito 3, ciudad de Cochabamba. Resultados: 36 (3%) no consume medicamentos sin receta médica y 1164 (97%) lo hace. Las fuentes de información para la automedicación son; Televisión 48 (4%), internet 252 (21%), familia 396 (33%), prescripción anterior 324 (27%) y Otras fuentes de información 180 (15%). Los síntomas frecuentes para la automedicación son; Cefalea 372 (31%), Mialgia 336 (28%), Fiebre 288 (24%), Diarrea 48 (4%) y otros 156 (13%). Los fármacos frecuentes que consumen por automedicación son; Analgésicos 348 (29%), antibióticos 264 (22%), Antigripales 216 (18%), antinflamatorios 288 (24%), Antiulcerosos 36 (3%) y Vitaminas 48 (4%). Discusión: La automedicación es elevado en relación a otros estudios, los familiares son la principal fuente de información para conocer sobre medicamentos y la cefalea es el síntoma principal para esta práctica con el consumo de analgésicos. Conflictos de InteresesLos autores declaramos no tener conflictos de interés para el presente estudio.

Мігрень належить до захворювань, що мають важливе медико-соціальне значення, пов’язане з періодичними нападами сильного пульсуючого болю, ризиком виникнення ускладнень, зниженням якості життя пацієнтів, з високою загальною вартістю і тривалістю лікування. Мета роботи: аналіз асортименту, оцінка показників соціально-економічної доступності і споживання лікарських засобів для лікування мігрені на українському фармацевтичному ринку впродовж 2014-2016 років. Матеріали та методи. Для аналізу соціально-економічної доступності лікарських засобів для лікування мігрені розрахували показник адекватності платоспроможності (Ca.s.), який показує частку заробітної плати, що витрачається на придбання лікарських засобів на місячний курс лікування мігрені. Для розрахунку об’ємів споживання лікарських засобів для лікування мігрені був використаний показник DDDs/1000 жителів/день або DIDs. Результати. Впродовж 2014–2016 років лікарські засоби для лікування мігрені були представлені на ринку в обмеженому асортименті – 20-33 торгові назви на основі 3-4 МНН. Переважна частка асортименту лікарських засобів на ринку належала суматриптану (42-65 %). Ціни на препарати варіювали в широкому діапазоні, але з кожним роком зростали. Серед препаратів для лікування мігрені переважали середньодоступні (51-74 %) та малодоступні (26-49 %) і лише один препарат ерготаміну у 2016 р. був високодоступним. З агальне споживання всіх лікарських засобів на ринку становило відповідно 0,1998 DІD (2014 р.); 0,1334 DІD (2015 р.); 0,3211 DІD (2016 р.). Найбільші показники споживання встановлені для препаратів суматриптану, що представлений в більшій кількості торгових найменувань та є більш доступним для населення України. Висновки. На українському фармацевтичному ринку представлений обмежений асортимент препаратів для лікування мігрені в Україні. Показники соціально-економічної доступності і обсягів споживання лікарських засобів для лікування мігрені в цілому досить низькі, що може бути пов’язано зі значною вартістю лікування препаратами даної групи.

Elisabetta Caselli,1,2 Luca Arnoldo,3 Carla Rognoni,4 Maria D’Accolti,1,2 Irene Soffritti,1,2 Luca Lanzoni,2 Matteo Bisi,2 Antonella Volta,2 Rosanna Tarricone,4 Silvio Brusaferro,3 Sante Mazzacane2 1Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; 2CIAS Research Interdepartmental Centre, Departments of Architecture and Medical Sciences, University of Ferrara, Ferrara, Italy; 3Department of Medicine, University of Udine, Udine, Italy; 4Centre for Research on Health and Social Care Management (CERGAS), Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy Purpose: Antimicrobial resistance (AMR) is one of the major threats to human health, and the high frequency of resistant pathogens in the hospital environment can contribute to the transmission of difficult-to-treat health care-associated infections (HAIs). We recently reported that, compared with conventional chemical cleaning, the use of a microbial-based sanitation strategy (Probiotic Cleaning Hygiene System [PCHS]) was associated with remodulation of hospital microbiota and reduction of HAI incidence. Here, we aimed to analyze the impact of PCHS on AMR and related effects, such as HAI-associated antimicrobial drug consumption and costs. Patients and methods: Five Italian hospitals, enrolled in a multicenter study where conventional sanitation methods were replaced with PCHS, were included in the analysis. The study period included a 6-month observation for each sanitation type. Surface microbiota AMR was analyzed using microarray, nested PCR, antibiogram, and microdilution tests. Drug consumption data and related costs were obtained from the medical records of all hospitalized patients affected by HAIs. Results: PCHS use was associated with up to 99% decrease of the AMR genes harbored by surface hospital microbiota, independently of the resistance types originally present in each individual setting (Pc

Background Social restrictions set due to COVID-19 decreased pediatric emergency department (ED). The aim is to report epidemiology of intoxicated patients in pediatric ED during the first and second waves of COVID-19. Methods Data for this retrospective hospital discharge register study was gathered from January 2017 to December 2020. Patients aged Results Incidence of ED visit for intoxicated patient was 65 per 10,000 in 2020 and 54 per 10,000 in 2017–2019 (IRR 1.20 CI 0.87–1.68). Incidence was lower during the lockdown compared to reference years (IRR 0.50 CI 0.17–1.44). Peak monthly incidence (12 per 10000) was recorded after lockdown in July 2020 (IRR 2.45 CI 1.01-5.92). Discussion Based on these results, the lockdown and social restrictions did not decrease heavy alcohol or drug consumption among adolescents in Finland.

The discrimination faced by people understood to have alcohol or other drug addictions has been the subject of extensive research, with many studies documenting experiences of stigma within healthcare services. Building on this literature, we examine the role of stigma in shaping the healthcare expectations of people seen as affected by alcohol and other drug addictions. Our analysis draws on recent theorisations of stigma as a process of social production to analyse in-depth, qualitative interviews with 20 people who had recently attended an inpatient withdrawal management service. Participants describe as exceptional forms of care that are often taken for granted by other members of the community. We argue that routinised experiences of discrimination work to constitute basic care as exceptional. This finding is significant for two reasons: (1) people who consume alcohol and other drugs often have complex healthcare needs and already encounter obstacles to accessing the care they need, and (2) by positioning people who consume drugs outside the purview of healthcare, this dynamic obstructs their fundamental right to care. We conclude by reflecting on the implications of these findings for those who are often positioned as not entitled to high quality healthcare.

Background Illicit drug consumption in Mexico has been growing constantly and has begun to be a public health problem. The aim of this study is to identify the principal characteristics and socioeconomic variables associated with consumption of illegal drugs in Mexico. Methods Using information from the 2016 national addictions survey in Mexico, we develop a logistic regression model to determine the variables associated with drug consumption, sometime in lifetime or recently, in the general population of Mexico. Results Analyzing information from 56,877 persons, the prevalence of the use of illicit drugs at least once in lifetime was 15.4% and 3.6% for males and females, respectively. The variables associated with more consumption of illegal drugs was utilization of substances with alcohol (RR 9.3; 95% CI 7.9-10.8) and nicotine products (RR 4.7; 95% CI 4.3-5.1), male gender (RR 2.6; 95% CI 2.4-2.8), and relatives' drug consumption (RR 2.1; 95% CI 1.8-2.4). Conclusions Having more education, being older, and having a partner was associated with lower illicit drug consumption sometime in lifetime; in the case of recent consumption, in addition, having a job or active child-rearing in the house in a positive sense.

This study presents the development of an analytical method for the simultaneous determination of multiclass illicit drugs (cocainoids, opiates, amphetamines, and cannabinoids) and psychoactive pharmaceuticals (anxiolytics, hypnotics, antipsychotics, antidepressants, and antiparkinsonian), in municipal wastewater. The analytical method was validated in terms of specificity, linearity, precision, and accuracy. The recoveries (%) for the majority of the analytes ranged between 70 and 120%, while the method showed good repeatability (2.4–29.2%). The limits of detection (LOD) of the method ranged between 0.8 and 9.4 ng L−1. The method was implemented on influent and effluent samples from Thessaloniki (N. Greece) wastewater treatment plant (WWTP), and it revealed the daily presence of benzoylecgonine (BEG) (84.0–202.2 ng L−1), methadone (12.3–17.5 ng L−1), 11-Nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH) (80.3–171.9 ng L−1), morphine (144.2–264.3 ng L−1), and 6-monoacetylmorphine (6-MAM) (5.8–12.0 ng L−1) in the influent samples of WWTP. Clozapine (101.6–315.5 ng L−1), quetiapine (33.5–109.7 ng L−1), and fluoxetine (20.9–124.4 ng L−1) were pharmaceutical psychotics with the highest concentration in the influents. Back calculation estimated that the daily consumption of cocaine, heroin, cannabis, and methadone was 36–95, 86–164, 2300–5400, and 8–12 mg day−1 per 1000 inhabitants, respectively. The consumption was estimated between 7–16 and 15 mg day−1 per 1000 inhabitants for methyl diethanolamine (MDEA) and 3,4-methylenedioxymethamphetamine (MDMA), respectively.

Illicit drug abuse is a worldwide social and health problem, and monitoring illicit drug use is of paramount importance in the context of public policies. It is already known that relevant epidemiologic information can be obtained from the analysis of urban residual waters. This approach, named wastewater-based epidemiology (WBE), is based on the measurement of specific markers, resulting from human biotransformation of the target drugs, as indicators of the consumption of the compounds by the population served by the wastewater treatment installation under investigation. Drug consumption estimation based on WBE requires sewage sampling strategies that express the concentrations along the whole time period of time. To this end, the most common approach is the use of automatic composite samplers. However, this active sampling procedure is costly, especially for long-term studies and in limited-resources settings. An alternative, cost-effective, sampling strategy is the use of passive samplers, like the polar organic chemical integrative sampler (POCIS). POCIS sampling has already been applied to the estimation of exposure to pharmaceuticals, pesticides, and some drugs of abuse, and some studies evaluated the comparative performances of POCIS and automatic composite samplers. In this context, this manuscript aims to review the most important biomarkers of drugs of abuse consumption in wastewater, the fundamentals of POCIS sampling in WBE, the previous application of POCIS for WBE of drugs of abuse, and to discuss the advantages and disadvantages of POCIS sampling, in comparison with other strategies used in WBE. POCIS sampling is an effective strategy to obtain a representative overview of biomarker concentrations in sewage over time, with a small number of analyzed samples, increased detection limits, with lower costs than active sampling. Just a few studies applied POCIS sampling for WBE of drugs of abuse, but the available data support the use of POCIS as a valuable tool for the long-term monitoring of the consumption of certain drugs within a defined population, particularly in limited-resources settings.

Therapies - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le jeudi 28 janvier 2021

We believe that analysing pooled urine samples for recreational drugs used at mass events can provide useful information about trends in drug use. An opportunity arose with the Ultra Europe music festival, which is attended by more than 150,000 people from over 150 countries every year. We analysed 30 pooled urine samples collected from portable chemical toilets located at or close to the Ultra Europe music festival venue in Split, Croatia in 2016–2018 to detect the presence of classic and new psychoactive substances (NPS). Four urine samples collected in 2016 were from a toilet without added chemicals (otherwise used to kill the smell) while the remaining samples were collected from toilets with added chemicals. Samples were qualitatively analysed with gas chromatography-mass spectrometry (GC/MS) using the fullscan mode. Data were compared with the Wiley mass spectral library of designer drugs and our in-house library containing about 1000 compounds and metabolites. We identified forty-six different substances and metabolites, 26 of which were classic substances/metabolites, mostly from the stimulants group, while 20 were NPS. In the NPS group, most of them were phenethylamines and cathinones. The variety of substances was the highest on the first day of the festival regardless of the year, but 2018 showed a significant drop compared to the previous two years. The results of our study revealed a stable trend of classic drug consumption, while NPS trend changed from one year to another., Analiza uzoraka urina prikupljenih iz prijenosnih kemijskih zahoda korisna je u otkrivanju droga za rekreaciju koje su se koristile tijekom Ultra Europe glazbenoga festivala. Zbog prisutnosti više od 150 000 ljudi iz više od 150 svjetskih zemalja, moguće je dobiti više informacija o svjetskom trendu NPS-a. Analiza uzoraka urina koji su se prikupljali od 2016. do 2018. tijekom glazbenoga festivala Ultra Europe u Splitu provedena je radi otkrivanja prisutnosti novih psihoaktivnih tvari (NPS). Analizirano je trideset uzoraka urina prikupljenih iz prijenosnih kemijskih zahoda smještenih na mjestu festivala ili blizu njega. U 2016. godini prikupljeno je osam uzoraka urina iz dvaju zahoda koji su bili smješteni na dvama različitim mjestima, i to jedan s dodanim kemikalijama, a drugi bez njih. U 2017. godini prikupljeno je deset uzoraka urina iz triju zahoda na trima mjestima, svi iz zahoda s dodanim kemikalijama. U 2018. godini prikupljeno je dvanaest uzoraka urina iz devet prijenosnih kemijskih zahoda na četirima mjestima, svi s dodatkom kemikalija. Uzorci su kvalitativno analizirani tehnikom plinske kromatografije-spektrometrije masa (GC/MS) korištenjem načina ukupnog skeniranja. Podatci su uspoređeni s bazom spektara masa Wiley (DD2015), kao i s vlastitom bibliotekom koja sadržava oko 1000 spojeva i metabolita. U analiziranim uzorcima pronađeno je 46 različitih tvari i metabolita, od kojih 26 klasičnih tvari/metabolita, uglavnom iz skupine stimulansa, te 20 tvari iz skupine novih psihoaktivnih tvari (NPS). U skupini NPS-a najviše ih je bilo iz skupina fenetilamina i katinona. U svakoj promatranoj godini, prvoga festivalskog dana otkriveno je više tvari nego u ostalim danima. Suprotno 2016. i 2017. godini, u 2018. godini broj otkrivenih tvari bio je znatno manji. Rezultati našeg istraživanja pokazali su stabilnost konzumacije klasičnih droga, ali su se trendovi NPS-a mijenjali.

Purpose: The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region. Methods: A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. Results: The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (−9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017). Conclusions: The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypotensive treatment is estimated to have increased with an additional 50% due to a growing number of ageing individuals. This will lead to higher costs, not only for medications but also for diagnosing, monitoring and other aspects of glaucoma care. (Less)

Background: Physical fitness levels and the amount of accumulated adipose tissue (fatness) relate to current and future individuals’ heath status. Nevertheless, the interrelationships of their combined patterns with polypharmacy and the types of medications consumed have not been sufficiently investigated. Methods: This cross-sectional study was carried out in six Spanish regions between 2008 and 2009 with a sample of older community-dwelling adults (≥65 years old) without dementia or cancer. Fitness was measured with one-leg balance and senior fitness tests, as well as by measuring weight and fat mass with a bioelectrical impedance analyzer. Polypharmacy was defined as the use of five or more medications. An analysis of variance was performed for comparisons between the physical fitness and fatness patterns and the medication consumed. Results: A total of 1709 elders were included in the study (72.1 ± 5.2 years). The two unfit patterns were those with the highest drug consumption. The High-Fat–Unfit pattern was the one that had the most significant consumption and had the highest percentage of polymedicated subjects. The Low-Fat–Fit pattern had a significantly lower percentage of people that did not consume any medications. The highest percentages of drug consumption in 7 of the 10 groups that were included were concentrated in the two unfit patterns. Conclusions: This study highlights the importance of fitness in older adults, as it is at least as important as the avoidance of accumulation of excess fat with respect to the consumption of a smaller number of medicines., This research was funded by the Ministerio de Trabajo y Asuntos Sociales—IMSERSO (104/07), University of Zaragoza (UZ 2008-BIO-01), Ministerio de Sanidad, Servicios Sociales e Igualdad—IMSERSO (147/11), Centro Universitario de la Defensa de Zaragoza (UZCUD2016-BIO 01 and UZCUD2017-BIO-01), Ministerio de Educación y Ciencia (Red EXERNET DEP2005-00046), Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Biomedical Research Networking Center on Pathophysiology of Obesity and Nutrition (CIBEROBN), FEDER funds from the European Union (CB16/10/00477), and the 4IE+ project (0499_4IE_PLUS_4_E) funded by the Interreg V-A España-Portugal (POCTEP) 2014–2020 program. In addition, D. N. received a grant from “Gobierno de Aragón” (DGAIIU/1/20).

The lockdown measures implemented to curb the spread of SARS-CoV-2 may affect (illicit) drug consumption patterns. This rapid response study investigated changes in cannabis use in a non-probability sample of cannabis users in the Netherlands during the early lockdown period. We fielded an online cross-sectional survey 4–6 weeks after implementation of lockdown measures in the Netherlands on March 15, 2020. We measured self-reported \motives for changes in use, and assessed cannabis use frequency (use days), number of joints per typical use day, and route of administration in the periods before and after lockdown implementation. 1,563 cannabis users were recruited. Mean age was 32.7 ± 12.0 years; 66.3% were male and 67.9% used cannabis (almost) daily. In total, 41.3% of all respondents indicated that they had increased their cannabis use since the lockdown measures, 49.4% used as often as before, 6.6% used less often, and 2.8% stopped (temporarily). One-third of those who were not daily users before the lockdown became (almost) daily users. Before the lockdown, most respondents (91.4%) used cannabis in a joint mixed with tobacco and 87.6% still did so. Among users of joints, 39.4% reported an increase in the average number consumed per use day; 54.2% stayed the same and 6.4% used fewer joints. This rapid response study found evidence that during the lockdown more users increased rather than decreased cannabis consumption according to both frequency and quantity. These data highlight the need to invest more resources in supporting cessation, harm reduction, and monitoring longer term trends in cannabis use.

Issue Drug consumption rooms (DCR) are in place for more than three decades in Europe and have been proven to be effective as a public health response. However, their implementation remains slow and controversial in many countries. In Portugal, despite being legal since 2001, the first DCR only came into reality in 2019 by the initiative of the City Council of Lisbon. Description of the Problem These Programs are aimed at high risk users with a very fragile social and health situation and for that reason usually they adopt a integrate model of care, offering other services behind supervised consumption: basic healthcare, social support, rapid testing and referral to other services. In context of the first year of implementation of a mobile DCR in Lisbon, we intend to investigate if the program was able to reach those at higher risk. Service data collected between April and December 2019 was used to define the client's profile. Results The data collected by the program indicates that the vast majority of registered users are men, over 40 years old and homeless. Most users have already been tested for HIV and viral hepatitis in their lifetime, however, there are still barriers in accessing and utilizing specialized care. We also observed high risk practices: injecting in public spaces, groin injection and high rates of benzodiazepine injection. Lessons The mobile DCR in Lisbon was able to reach those users at greater risk, both by the pattern of consumption, and by the social and health situation in which they find themselves. Key message DCR combined with other harm reduction responses and health services can contribute to improve the health of a very marginalized group of users.

Objective: To determine the risk factors associated with extensively multidrug-resistant tuberculosis in multidrug-resistant patients in the DIRIS Lima Sur, 2017. Type and design: The type of research was observational and analytical, retrospective case and control. The population consisted of a total of 158 patients who received treatment for MDR-TB between 2016 and 2017. The sample consisted of 24 cases diagnosed with extensively resistant pulmonary tuberculosis (XDR-TB) and 48 controls with MDR-TB. The data collection technique was the survey and the instrument was a questionnaire for both groups (case-controls). Results: 5 internal and external risk factors associated with XDR-TB were identified. Among the internal factors associated at the bivariate level were: drug consumption, having received TB/MDR-TB treatment previously, having received TB/MDR-TB treatment less than one year, having failed to the primary and individualized scheme for TB/MDR-TB (p

Background Iranian government has introduced multiple healthcare system reforms during the last 30 years aiming at improving accessibility and affordability of care. Pharmaceutical products are one of the major sources of financial burden on the healthcare system. The healthcare system and pharmaceutical sector have been balanced out by the partially counteracting effects of the HSEP (Health sector evolution plan) and the imposed sanctions. Methods This research investigates the healthcare system performance as well as the pharmaceutical market trend mostly based on the financial criteria from 2001. The correlation between the two change patterns was studied to understand the underlying driving market forces. Results During 2001 to 2013, total health expenditure has grown 25.6% in average. THE (Total health expenditure) share of the GDP remains between 6-7%, while the out of pocket payment has dropped to 37% in 2015 from 57% in 2001, and most health services been directed to the inpatient facilities. Iranian pharmaceutical market has grown rapidly in recent years and grew 28.38% per year and drug consumption per capita reached 34.43$ from 2.28$. However, the import drove most of the market expansion. Noteworthy, the share of pharmaceuticals from THE has also increased. Conclusions It is concluded that the sanctions and HSEP have enforced partially counteracting forces on the pharmaceutical market to maintain its consistent growing trend.

This article belongs to the Special Issue Application of Immunonutrient in Human Health and Disease., It is widely known that a good balance and healthy function for bacteria groups in the colon are necessary to maintain homeostasis and preserve health. However, the lack of consensus on what defines a healthy gut microbiota and the multitude of factors that influence human gut microbiota composition complicate the development of appropriate dietary recommendations for our gut microbiota. Furthermore, the varied response to the intake of probiotics and prebiotics observed in healthy adults suggests the existence of potential inter- and intra-individual factors, which might account for gut microbiota changes to a greater extent than diet. The changing dietary habits worldwide involving consumption of processed foods containing artificial ingredients, such as sweeteners; the coincident rise in emotional disorders; and the worsening of other lifestyle habits, such as smoking habits, drug consumption, and sleep, can together contribute to gut dysbiosis and health impairment, as well as the development of chronic diseases. This review summarizes the current literature on the effects of specific dietary ingredients (probiotics, prebiotics, alcohol, refined sugars and sweeteners, fats) in the gut microbiota of healthy adults and the potential inter- and intra-individual factors involved, as well as the influence of other potential lifestyle factors that are dramatically increasing nowadays.

A goal in addiction research is to distinguish forms of neuroplasticity that are involved in the transition to addiction from those involved in mere drug taking. Animal models of drug self-administration are essential in this context. Here, we compared in male rats two cocaine self-administration procedures that differ in the extent to which they evoke addiction-like behaviours. We measured both incentive motivation for cocaine using progressive ratio procedures, and cocaine-induced c-fos mRNA expression, a marker of neuronal activity. Rats self-administered intravenous cocaine (0.25 mg/kg/infusion) for seven daily 6-hour sessions. One group had intermittent access (IntA; 6 minutes ON, 26 min OFF × 12) to rapid infusions (delivered over 5 s). This models the temporal kinetics of human cocaine use and produces robust addiction-like behaviour. The other group had Long access (LgA) to slower infusions (90 s). This produces high levels of intake without promoting robust addiction-like behaviour. LgA-90 s rats took twice as much cocaine as IntA-5 s rats did, but IntA-5 s rats showed greater incentive motivation for the drug. Following a final self-administration session, we quantified c-fos mRNA expression in corticostriatal regions. Compared to LgA-90 s rats, IntA-5 s rats had more cocaine-induced c-fos mRNA in the orbitofrontal and prelimbic cortices and the caudate-putamen. Thus, a cocaine self-administration procedure (intermittent intake of rapid infusions) that promotes increased incentive motivation for the drug also enhances cocaine-induced gene regulation in corticostriatal regions. This suggests that increased drug-induced recruitment of these regions could contribute to the neural and behavioural plasticity underlying the transition to addiction.

Background Aiming to reducing overdose mortality, over 40 supervised drug consumption services (SCS) presently operate in Canada. Arguments against SCS include the potential for increased non-fatal overdoses mediated by risk compensation. This study estimates associations between SCS use and recent non-fatal overdose among people who inject drugs (PWID). Methods We analyzed cross-sectional baseline data collected between November 2018 and March 2020 from a cohort of adult PWID in Toronto, Canada. Recent non-fatal overdose was self-reported over the previous six months. The primary exposure was frequency of SCS use, self-reported as the proportion of injections performed at an SCS (all or most [75–100%], some [26–74%], few [≤25%], or none) in the previous six months. The prevalence of recent overdose was compared between all unique pairs of groups based on their frequency of SCS use and expressed as covariate-adjusted prevalence ratios (PR) estimated using modified Poisson regression. Results Among 701 PWID (median [IQR] age, 40 [33 to 49]; 64.3% cisgender men; 56.8% injecting daily), most reported SCS use (all/most, 26.2%; some, 30.9%; few, 29.4%) versus no use (13.5%), with 38.6% reporting a recent overdose. From adjusted regression analyses, more frequent SCS use was not statistically significantly associated with overdose when compared to either no SCS use or less frequent use. Associations between SCS use frequency and overdose were notably smaller among SCS clients compared to associations between SCS clients and non-users (e.g., all/most versus none: PR, 1.43 [95% CI, 0.93 to 2.21]; all/most versus some: PR, 0.94 [95% CI, 0.75 to 1.17]; all/most versus few: PR, 1.15 [95% CI, 0.89 to 1.48]). Conclusion Findings did not indicate statistically significant associations between SCS use frequency and recent non-fatal overdose, particularly among SCS clients who may be more comparable. Nevertheless, overdose was common, underscoring the need to prevent non-fatal overdose and associated morbidity.

This paper selects and analyzes the key trends of current substance abuse that are most widespread in western European countries, the USA, Canada, and Russia, while also reviewing their differences and similarities. Foreign case studies, along with the results of analyzing the most prominent trends of substance abuse, must be accounted for when designing the optimal and most efficient measures for impacting the current drug abuse situation and eliminating its negative consequences. This paper examines the motivations and factors that encourage substance abuse; the phenomenon of substance abuse normalization; and the problems with identifying modern drug addicts that may arise as they try to adapt their behavior. The paper is based on a secondary analysis of several surveys among the working-age population (2013, 2016, 2017), as well as a college youth survey, entitled “The Student Lifestyle: Behavior Risks” (Ivanovo, Krasnodar, Moscow, Rybinsk, Chita, Yaroslavl). All of the above studies were conducted by the deviant behavior sociology sector of the RAS Federal Sociology Research Center. In addition, we considered surveys of college students in the USA and students in higher education in Canada.The analysis shows that: the age of first drug use is shifting upwards, which signifies that people are consciously deciding to consume addictive substances as mature individuals; there is an emerging trend of people aged 50 and over being introduced to addictive substances; the most popular motivation for consuming such substances is hedonism, i.e. the desire for pleasure; the attitude towards substance abuse is growing more and more tolerant, as introduction to recreational psychoactive drugs is becoming a fact of life and drug use is being integrated into society; modern substance abuse patterns still remain largely latent. We also consider foreign researchers’ insights, which warrant attention as we analyze the situation regarding substance abuse in Russian society and work on an effective anti-drug and addiction prevention policy.