Treatment demand for cannabis use problems: analyses of routine data from 30 European countries.

Cannabis use and treatment demand has risen in the past decade. Previous analyses of treatment demand are limited by methodological constraints or are outdated. Cross-country differences and trends in cannabis treatment demand are described using data from the European Monitoring Centre for Drugs and Drug Addiction. Two novel indicators are employed: firstly, the cannabis-attributable treatment fraction (CATF) is obtained by dividing the number of treatment entrants for cannabis use problems by the number of treatment entrants for any substance use problem, accounting for possible changes in the reporting system. Secondly, comparing the number of treatment entrants for cannabis use problems to the number of people who use cannabis (near) daily yields the treated-user-ratio (TUR), which considers a proxy for treatment need (frequent use). Across 30 countries with available data, the importance of cannabis in European treatment facilities varies greatly (CATF: min = 3%; max = 65%), with lower estimates in Eastern European countries. Across 20 countries with complete data, the CATF has risen from 29.4% in 2013 to 37.1% in 2020. The TUR calculated on 26 countries suggests that about 3 in 100 frequent users have sought treatment for their cannabis use problems. Over time, treatment demand has increased at a slower pace than treatment need in most countries. One in three treatment entrants for substance use problems in Europe are due to cannabis, with large variations between countries. There are indications for a widening treatment gap for cannabis use problems. In countries liberalising cannabis laws, monitoring changes in treatment access and demand is warranted.

Cannabis use, health problems, and criminal offences in Germany: national and state-level trends between 2009 and 2021.

The German federal government plans to decriminalise cannabis. The impact of this policy on use prevalence, cannabis-related health and legal problems cannot be fully anticipated and should be viewed in context with current trends. We used routine data on (a) cannabis use (population-based surveys), (b) cannabis-related diagnoses (ICD-10 code F12) in outpatient medical settings and (c) minor law offences (registered violations against the narcotics law for possessing small amounts) to analyse age and sex-specific trends by federal state between 2009 and 2021. To enable comparisons across time and federal state besides crude prevalence rates, age-standardised rates were calculated. Between 2009 and 2021, the age-standardised prevalence of cannabis use (5.7-10.6%), rate of diagnoses (1.1-3.7 per 1,000), and legal offences (1.8-3.1 per 1,000) increased, with the largest increase noted for cannabis-related diagnoses. Relatively, increases were most pronounced for older users (40-to-59-year-olds: use and offences; 35-to-44-year-olds: cannabis-related diagnoses) and rather stagnant for minors. Cannabis use and health problems appear to be more pronounced in Northern and city states, while no clear geographic trend was observed for law offences. Cannabis-related outpatient treatment demand has risen more steeply than use prevalence suggesting an increasing challenge for the health care system. Despite rising rates for documented offences, the long-term implications of law violations on social and occupational life are poorly understood but may be considered for evaluations of the proposed law changes.

Orthodontic treatment demand for fixed treatment and aligners among young adults in middle Europe and South America - a questionnaire study.

BACKGROUND: Patients experiencing any malocclusion, may desire for treatment. However, there is no scientific information orthodontic treatment demand and the knowledge of young adults about orthodontic treatment. The aim of the study was to assess orthodontic treatment demand in young adults from Poland and Chile, their previous orthodontic experience and their knowledge on fixed and aligner orthodontic treatment. METHODS: The target group comprised people aged 18-30. The sample size was estimated as above 400 for each country. The survey was carried out in Polish and Spanish within 3 months and consisted of 25 questions delivered via social media. Comparisons were made between countries, age subgroups and gender. RESULTS: The response rate was 1,99%, what stands for 1092 responses, 670 from Chile and 422 from Poland, respectively. The percentage of young adults who were already treated was 42,9% in Poland and 25,0% in Chile. The ones planning to have orthodontic treatment within a year counted for 11,8% in Poland and 5,3% in Chile. Most young adults who want to be treated (20,6%) rely on doctor's recommendation on type of appliance while 14,7% of all respondents are interested solely in aligners. Most respondents have heard about aligners (58%). Direct provider-to-customer service without a doctor is not acceptable, neither in Poland (85,1%) nor in Chile (64,8%). Most young adults provided incorrect answers referring various aspects of aligner treatment. CONCLUSIONS: In both countries, patients demand to be treated and monitored by the orthodontist. A high percentage of patients want to be treated exclusively with aligners. Direct-to-consumer orthodontics does not seem attractive to patients. Young adults do not have adequate knowledge referring to aligner treatment. Many people want to be treated despite a previous orthodontic treatment.

The Need for Treatment of Neovascular Age-Related Macular Degeneration: A Study Based on the Polish National Registry.

INTRODUCTION: The Polish National AMD Therapeutic Program offered us a unique opportunity to determine the need for treatment of neovascular age-related macular degeneration (nAMD). METHODS: A search, extraction, and analysis of data from the monitoring system of the Therapeutic Program of the National Health Fund was performed. Demographic data from the Central Statistical Office were also obtained and analyzed. All national data, and from the Silesian Voivodeship specifically, from patients who had received treatment prior to January 14, 2022 (57,876 eyes) were analyzed. RESULTS: Approximately 0.1% of the Polish population requires treatment for nAMD when the best-corrected visual acuity (BCVA) criteria exclude irreversible severe changes in the fovea (0.2-0.8 by Snellen). There were 30,771 eyes in the therapeutic program in January 2022, and 4898 (15.9%) of them were in Silesia, which contains 11.7% of the total population and 12.4% of the elderly population (65 years of age and older). However, as a result of the COVID-19 pandemic, the average number of monthly enrollments in the therapeutic program decreased from 717 in the first quarter of 2020 to 505 in the second quarter (with a low of 407 in April). Moreover, in 2020, a negative balance was recorded between included and excluded patients. CONCLUSION: The need for nAMD treatment in the elderly community (65 years of age and older) is estimated to be 0.55-0.66%.

Problematic Use of Nitrous Oxide by Young Moroccan-Dutch Adults.

The recreational use of nitrous oxide (N2O; laughing gas) has largely expanded in recent years. Although incidental use of nitrous oxide hardly causes any health damage, problematic or heavy use of nitrous oxide can lead to serious adverse effects. Amsterdam care centres noticed that Moroccan-Dutch young adults reported neurological symptoms, including severe paralysis, as a result of problematic nitrous oxide use. In this qualitative exploratory study, thirteen young adult Moroccan-Dutch excessive nitrous oxide users were interviewed. The determinants of problematic nitrous oxide use in this ethnic group are discussed, including their low treatment demand with respect to nitrous oxide abuse related medical-psychological problems. Motives for using nitrous oxide are to relieve boredom, to seek out relaxation with friends and to suppress psychosocial stress and negative thoughts. Other motives are depression, discrimination and conflict with friends or parents. The taboo culture surrounding substance use-mistrust, shame and macho culture-frustrates timely medical/psychological treatment of Moroccan-Dutch problematic nitrous oxide users. It is recommended to use influencers in media campaigns with the aim to decrease the risks of heavy nitrous oxide use and improve treatment access. Outreach youth workers can also play an important role in motivating socially isolated users to seek medical and or psychological help.

Machine Learning Can Predict Anti-VEGF Treatment Demand in a Treat-and-Extend Regimen for Patients with Neovascular AMD, DME, and RVO Associated Macular Edema.

PURPOSE: To assess the potential of machine learning to predict low and high treatment demand in real life in patients with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME) treated according to a treat-and-extend regimen (TER). DESIGN: Retrospective cohort study. PARTICIPANTS: Three hundred seventy-seven eyes (340 patients) with nAMD and 333 eyes (285 patients) with RVO or DME treated with anti-vascular endothelial growth factor agents (VEGF) according to a predefined TER from 2014 through 2018. METHODS: Eyes were grouped by disease into low, moderate, and high treatment demands, defined by the average treatment interval (low, ≥10 weeks; high, ≤5 weeks; moderate, remaining eyes). Two random forest models were trained to predict the probability of the long-term treatment demand of a new patient. Both models use morphological features automatically extracted from the OCT volumes at baseline and after 2 consecutive visits, as well as patient demographic information. Evaluation of the models included a 10-fold cross-validation ensuring that no patient was present in both the training set (nAMD, approximately 339; RVO and DME, approximately 300) and test set (nAMD, approximately 38; RVO and DME, approximately 33). MAIN OUTCOME MEASURES: Mean area under the receiver operating characteristic curve (AUC) of both models; contribution to the prediction and statistical significance of the input features. RESULTS: Based on the first 3 visits, it was possible to predict low and high treatment demand in nAMD eyes and in RVO and DME eyes with similar accuracy. The distribution of low, high, and moderate demanders was 127, 42, and 208, respectively, for nAMD and 61, 50, and 222, respectively, for RVO and DME. The nAMD-trained models yielded mean AUCs of 0.79 and 0.79 over the 10-fold crossovers for low and high demand, respectively. Models for RVO and DME showed similar results, with a mean AUC of 0.76 and 0.78 for low and high demand, respectively. Even more importantly, this study revealed that it is possible to predict low demand reasonably well at the first visit, before the first injection. CONCLUSIONS: Machine learning classifiers can predict treatment demand and may assist in establishing patient-specific treatment plans in the near future.

Cocaine treatment demands in 10 western European countries: observed trends between 2011 and 2018.

AIMS: To describe cocaine treatment demand in 10 western European countries and to examine the size, direction and temporality of recent trends in the proportion of cocaine users among all clients entering treatment. DESIGN: Aggregated data collected through the European Union standardized treatment demand monitoring system (TDI) between 2011 and 2018 were used. SETTING: Belgium, England, France, Germany, Ireland, Italy, Luxembourg, Spain, Switzerland and the Netherlands. PARTICIPANTS: In total, more than 700 000 cocaine treatment records were analysed. Clients in treatment for cocaine as primary drug were predominantly male (85%), with an average age of 35 years. MEASUREMENTS: Number of treatment episodes for substance use and for cocaine as primary or secondary drug were collected year- and country-wise. When available, powder cocaine and crack and patients with and without previous treatment were differentiated. FINDINGS: Among the participating countries the share of cocaine as primary drug in treatment demand ranged between 4.7% [95% confidence interval (CI) = 4.6-4.9%] in Germany and 43.1% in Spain (95% CI = 42.6-43.5%). The general trend analysis showed a decreasing proportion of cocaine-related treatment entrants between 2011 and 2014 among all subgroups followed by a strong increase in 2015. The increase appeared stronger than for powder cocaine. Seven of 10 countries observed a recent significant increase in the proportion of treatment entrants reporting cocaine as the primary substance: Belgium [annual percentage change (APC) = 9.6%, P < 0.01], England (APC = 14.9%, P < 0.05), France (APC = 21.8%, P < 0.01), Ireland (APC = 28.2%, P < 0.01), Italy (APC = 7.8%, P < 0.01), Spain (APC = 7.0%, P < 0.05) and Switzerland (APC = 12.0%, P < 0.05). Trends were similar when looking at cocaine reported as primary or adjunctive substance. CONCLUSIONS: Despite substantial country-specific variation regarding cocaine prevalence and treatment demand, there has been an overall significant increase since 2015 in the share of cocaine-related treatment demand in western Europe.

Cost-effectiveness of expanding the capacity of opioid agonist treatment in Ukraine: dynamic modeling analysis.

BACKGROUND AND AIMS: Although opioid agonist treatment (OAT) for opioid use disorder (OUD) is cost-effective in settings where the HIV epidemic is concentrated among people who inject drugs, OAT coverage in Ukraine remains far below internationally recommended targets. Scale-up is limited by both OAT availability and demand. This study aimed to evaluate the cost-effectiveness of a range of plausible OAT scale-up strategies in Ukraine incorporating the potential impact of treatment spillover and the real-world demand for addiction treatment. DESIGN, SETTING AND PARTICIPANTS: Ten-year horizon (2016-25) modeling study of opioid addiction epidemic and treatment that accommodated potential peer effects in opioid use initiation and supply-induced treatment demand in three Ukrainian cities: Kyiv, Mykolaiv and Lviv, comprising a simulated population of people at risk of and with OUD. MEASUREMENTS: Incremental cost per quality-adjusted life-year gained in the simulated population. FINDINGS: An estimated 12.2-, 2.4- and 13.4-fold OAT capacity increase over 2016 baseline capacity in Kyiv, Mykolaiv and Lviv, respectively, would be cost-effective at a willingness-to-pay of one per-capita gross domestic product (GDP) per quality-adjusted life-year gained. This result is robust to parametric and structural uncertainty. Even under the most ambitious capacity increase, OAT coverage (i.e. the proportion of people with OUD receiving OAT) over a 10-year modeling horizon would be 20, 11 and 17% in Kyiv, Mykolaiv and Lviv, respectively, owing to limited demand. CONCLUSIONS: It is estimated that a substantial increase in opioid agonist treatment (OAT) capacity in three Ukrainian cities would be cost-effective for a wide range of willingness-to-pay thresholds. Even a very ambitious capacity increase, however, is unlikely to reach internationally recommended coverage levels. Further increases in coverage may be limited by demand and would require addressing existing structural barriers to OAT access.

Cost-Effectiveness of Proton Versus Photon Therapy in Pediatric Medulloblastoma Treatment: A Patient Volume-Based Analysis.

BACKGROUND: Proton radiation therapy offers advantages over photon therapy, assisting with severe side effect avoidance. Pediatric patients with medulloblastoma have demonstrated benefit from this technology in recently published cohort studies. OBJECTIVES: To compare the costs and benefits between proton and photon therapy in treating pediatric medulloblastoma. METHODS: The model was built with a lifetime horizon from the Brazilian health system perspective using a 3% discount rate. A microsimulation model was developed after a literature search, comparing scenarios of equipment life span and number of patients treated per year (50, 100, and 150 patients with 10, 25, and 20 years of equipment life span). The baseline parameters were 50 patients treated annually and 20 years of equipment life span. RESULTS: The quality-adjusted life-year gain was 2.71, and the average incremental cost-effectiveness ratio was $34 590.54 per quality-adjusted life-year. For the willingness-to-pay threshold of 1 gross domestic product per capita, it was observed that the incorporation of the technology would be cost-effective if more than 150 patients were treated per year. The weight of the equipment life span and other variables was limited when it varied in the sensitivity analysis, without significant changes to the model results. CONCLUSIONS: Proton therapy is not cost-effective for pediatric medulloblastoma treatment from the Brazilian health system perspective. The investment is not worth when considering the number of potential patients and the country dimensions.

An Examination of Who Is Eligible and Who Is Receiving Bariatric Surgery in England: Secondary Analysis of the Health Survey for England Dataset.

BACKGROUND: Over 2 million people in England were estimated to be eligible for bariatric surgery in 2006. In 2014, clinical guidelines were updated, widening potential eligibility, meanwhile, obesity prevalence rose. However, numbers receiving surgery decreased, and concerns exist of inequalities in access between population groups. This study is aimed at estimating the number of adults eligible for surgery in England and to compare demographics with those that receive surgery. METHODS: BMI and comorbidity status were used to determine eligibility for bariatric surgery within participants of the 2014 Health Survey for England dataset (6938 adults), based on the National Institute of Health and Care Excellence guidelines. Results were scaled up using national population estimates. The demographics of eligible participants were compared against 2014/2015 hospital episode statistics for sex and age group using a chi-squared analysis. RESULTS: Of the total population of England, 7.78% (95% CI 7.1-8.6%), or 3,623,505 people, could have been eligible for bariatric surgery in 2014; nearly a million more than if previous guidelines applied. Eligibility peaked at ages 45-54, with most in the 35-64 age group (58.9%). 58.4% of those eligible were women. Patients receiving surgery were far more likely to be female than male (76.1%) and the distribution skewed towards younger ages when compared with those eligible. CONCLUSION: Bariatric surgery may benefit many people in England; significant investment is required so that service provision is adequate for demand. Differences between demographics of those eligible and receiving surgery may be explainable; however, the potential health inequality should be investigated.

Comparison of clinical features and survival between young and old chronic lymphocytic leukemia patients: a single center study from Turkey.

We aimed to investigate whether the clinical characteristics, the rate of treatment demand and survival differ between chronic lymphocytic leukemia (CLL) patients <65 years (y) and ≥65 y. Sixty three (46%) patients were <65 y and 74 (54%) were ≥65 y. 28.6% (18/63) of the patients <65 required treatment, while this rate was 44.6% (33/74) for patients ≥65 y (p > .05). The probability of overall survival (OS) was 90 vs. 51% in patients <65 y and ≥65 y (p = .016). In univariate analysis, the age affected OS (p = .04, HR: 0.212, CI: 0.047-0.946). In subgroup analysis, in treated patients, the probability of OS was 73 vs. 49% in patients <65 y and ≥65 y (p = .389). The survival difference between the young and old patients is too high to be ignored and age seems to affect the outcome of CLL patients.

Rising incidence of ageing opioid users within the EU wide treatment demand indicator; The Irish opioid epidemic from 1996 to 2014.

BACKGROUND: Literature identifies older people who use opioids as a neglected population. Little is known about temporal changes, or about treatment demand among this population. METHODS: The EU Treatment Demand Indicator (TDI) for Ireland (1996-2014) was analyzed for trends in new opioid treatment admissions, ageing and drug using behaviors. A Joinpoint analysis was conducted. RESULTS: Data from 18,692 individuals entering treatment for the first time showed that while the trend of age-adjusted incidence declined between 1996 and 2014, incidence among older age groups increased, with a rising incidence not previously observed among those aged 50 years and older. Subgroups of early and late treatment entries, and early and late opioid onset were observed. The median age commencing opioid use increased by three years from 18 to 21 years (U = 326141.5, p < 0.001). The median age entering treatment increased by 11 years (from age 20 to age 31) (U = 145465.5, p < 0.001). The median opioid-using duration prior to treatment increased by 5 years (from 2 to 7 years) (U = 170807.5, p < 0.001). Half of the individuals started injecting within one year of first using opioids. The median time between first injecting and commencing treatment increased by 6 years for men and 2 years for women. CONCLUSIONS: The study utilizes European TDI data and finds that those entering treatment in Ireland is older, are injecting longer and are taking longer to enter treatment. These findings highlight how TDI data can be used to identify hidden groups at risk of chronic harm which may require prioritizing in policy and practice.

Psicoterapia de casal: ambiguidade na demanda de tratamento e manejo clínico / Couple's psychotherapy: ambiguity in treatment and clinical management / Psicoterapia de pareja: ambigüedad en la demanda del tratamento y manejo clínico

O presente trabalho tem como objetivo investigar a demanda de tratamento em psicoterapia de casal, buscando compreender as repercussões das contradições entre a queixa inicial e as questões latentes na condução do encaminhamento, bem como o manejo clínico necessário diante da ambiguidade do pedido de ajuda. Desenvolvemos uma investigação clínico-qualitativa, a partir de um estudo de caso. O atendimento ocorreu em uma clínica-escola de uma universidade privada da cidade do Rio de Janeiro. A psicoterapia de casal transcorreu em coterapia, durante três meses, com frequência de uma vez por semana, estando em supervisão semanalmente. Verificamos que, muitas vezes, a demanda do casal por tratamento é fortemente ambígua, podendo desencadear impasses para o psicoterapeuta, como intensas inquietações na condução das intervenções terapêuticas e dúvidas na indicação adequada de tratamento.

This study aims to investigate the demand for treatment in couples psychotherapy. It seeks to understand the repercussions of contradicting initial complaints and latent issues in the conduct requiring referral, as well as the necessary clinical management due to the ambiguity in the request for help. We developed a clinical-qualitative investigation, based on a case study. The treatment took place at a private university school-clinic in the city of Rio de Janeiro. The couples psychotherapy occurred in co-therapy, once a week for three months with weekly supervisions. We verified that the couples' demand for treatment is often very ambiguous, which can lead to deadlocks for the psychotherapist, such as intense concerns about the conduct of therapeutic interventions and doubts regarding the recommendations for the adequate treatment.

El presente trabajo tiene como objetivo investigar la demanda de tratamiento en psicoterapia de parejas. Busca comprender las repercusiones de las contradicciones entre la queja inicial y las cuestiones latentes en la orientación del tratamiento, como el manejo clínico necesario ante la ambigüedad de la solicitud de ayuda. Desarrollamos una investigación clínico-cualitativa, basada en un estudio de caso. El caso tuvo lugar en una clínica-escuela de una universidad privada en la ciudad de Rio de Janeiro. La psicoterapia de pareja transcurrió en coterapia, una vez por semana durante tres meses con supervisión semanal. Verificamos que, a menudo, la demanda de la pareja por el tratamiento es fuertemente ambigua, pudiendo desencadenar dificultad al psicoterapeuta, como las preocupaciones intensas sobre la realización de intervenciones terapéuticas y las dudas con respecto a las recomendaciones de tratamiento adecuadas.

Inclusion of gaming disorder criteria in ICD-11: A clinical perspective in favor.

Data from a specialist treatment facility for Internet addiction (IA) in Japan showed that (a) the vast majority of treatment seekers are addicted to online games, (b) their symptoms are often quite severe, and (c) there is a significant demand for IA treatment. In addition, systemic obstacles to the delivery of medical services in Japan exist due to the exclusion of IA criteria from ICD-10. Consequently, the inclusion of GD criteria in ICD-11 will almost certainly increase the capacity and quality of treatment through advances in research and possible changes in national medical systems to meet treatment demand.

A study on orthodontic recognition and treatment demand among undergraduates / 预防医学

Objective Toinvestigatetheorthodonticrecognition,treatmentdemandanditsinfluencingfactorsamong undergraduates.Methods Usingstratifiedrandomsamplingmethod,600undergraduateswereselectedaccordingtotheir departmentsandgradesandthenaquestionnairesurveywasconducted.Results Therateofstudentswhohavethe demand of orthodontic treatment was 33.6%.The score of the recognition of orthodontic treatment was 2.94 ±1.543 (total score is 6).The grade,dental self-confidence,being laughed at their teeth by others,the influence from their friends who had taken orthodontic treatment,avoiding showing their teeth when smiling,the score of recognition were influencing factors of the demand of orthodontic treatment by Chi square test (all P<0.05 )while the latter four factors were related factorsbylogisticregression(allP<0.05)withtheORof2.14,2.78,2.18and1.20respectively.Conclusion The recognition of orthodontic treatment among undergraduates is limited.Psychosocial factors and recognition play an important role in the demand of orthodontic treatment.