Evaluating and comparing success rates for inpatient treatment of alcohol addiction in the Czech Republic.

OBJECTIVES: This systematic review seeks to present and compare data from studies evaluating the success of medium-term inpatient treatment of alcohol-dependent patients in the Czech Republic. Another aim was to identify the problems that make such comparisons difficult. No previous review comparing the efficiency of various therapeutic programmes has been published in the Czech Republic. METHODS: Bibliographia medica Cechoslovaca and PubMed were used to find studies published in professional medical journals since 1970 evaluating the abstinence of patients who voluntarily completed medium-term inpatient treatment of alcohol dependence. RESULTS: Medium-term inpatient treatment of alcohol addiction leads to one year of abstinence in 34% to 76% of patients. Such variance in value is largely caused by selection bias, differences in the definition of abstinence, and differences in data collection methods. CONCLUSION: The comparison of studies presented many challenges. Further steps should be taken to help compare treatment programmes in the future, as the programmes provide different therapeutic interventions of different intensities and lengths to different patients. Adequate demographic and other pretreatment characteristics data collection, detailed descriptions of therapeutic interventions, and identification of effective components of the therapeutic programme could support further research in this area, optimize existing programmes, and increase the overall treatment efficiency.

Somatic Symptoms, Anxiety, and Depression Among College Students in the Czech Republic and Slovakia: A Cross-Sectional Study.

Studying in college can be a challenging time for many students, which can affect their mental health. In addition to academic pressure and stressful tasks, another aggravating factor in student life is the ongoing coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to examine the prevalence of anxiety, depression, and somatic symptoms in Czech and Slovak college students during the COVID-19 pandemic and to evaluate possible socio-demographic determinants of mental health problems. A total of 3,099 respondents participated in this cross-sectional study (Czech Republic: 1,422, Slovakia: 1,677). The analyzes included the Patient Health Questionnaire for somatic symptoms (PHQ-15), the Generalized Anxiety Disorder instrument (GAD-7), and the Patient Health Questionnaire for depression (PHQ-9). Socio-demographic factors were gender, age, family structure, marital status, form of study, degree of study, year of study, field of study, distance between home and college, residence, and housing during the semester. Among Czech students, prevalence of somatic complaints, anxiety and depression was 72.2, 40.3, and 52%, respectively. Among Slovak students, prevalence of somatic complaints, anxiety and depression was 69.5, 34.6, and 47%, respectively. During the COVID-19 pandemic, the most severe mental health problems were identified in a non-negligible part of the sample (Czech Republic: PHQ-15 = 10.1%, GAD-7 = 4.9%, PHQ-9 = 3.4%; Slovakia: PHQ-15 = 7.4%, GAD-7 = 3.5%, PHQ-9 = 2.7%). Regarding the differences between the analyzed countries, a significantly higher score in somatic symptoms, anxiety, and depression was identified in the Czech Republic. Significant differences in mental disorders were found in most socio-demographic characteristics. The main results of the logistic regression analysis revealed that risk factors for mental health disorders in Czech and Slovak students were female gender, younger age, third degree of study, and study of Informatics, Mathematics, Information and Communication Technologies (ICT). Especially in the case of these high-risk groups of students, public policies should consider a response to impending problems. The findings are an appeal for a proactive approach to improving the mental health of students and for the implementation of effective prevention programs, which are more than necessary in the Czech and Slovak college environment.

The context and historical correlations of the origin and development of the oldest continually existing residential alcohol treatment model ("Apolinar model") in Central Europe from 1948 to 1960.

Building upon the tradition of the oldest specialized programs, the "Apolinar model" of alcohol treatment influenced the emergence and development of residential treatment programs in what is now the Czech Republic and Slovakia. Similarly to the socialist concept of unitary economy, this approach was applied in all emerging treatment programs until the Velvet Revolution. To identify and describe the key factors determining the origin and development of residential alcohol treatment and what became known as the Apolinar model in the context of the development of the addiction-specific institutional infrastructure. Qualitative content analysis of retrieved historical documents was used to identify and establish the sources and data. The relevant documents were identified and compiled according to their thematic relationship with the focus of the research in terms of their place and time of origin and authorship. The Apolinar model represented a compact and unique treatment approach. This was owed to both foreign and local experience, ideas and inspiration, which the program drew on. The key figure behind the Apolinar model was Jaroslav Skála. In addition to achieving the maximum that was possible at the time and creating a homogeneous, original, and successful residential alcohol treatment model, Skála succeeded in establishing valuable international links and kept his facility and the emerging Czechoslovak addiction professional community in contact with the latest international trends and leading institutions.

Estimation of long-term costs of postacute care in survivors of the methanol poisoning outbreak.

OBJECTIVES: To fill the existing research gap related to long-term costs of postacute care in methanol poisoning survivors, healthcare cost for 6 years after the outbreak has been modelled and estimated. DESIGN: In a prospective longitudinal cohort study, data collected from 55 survivors of the Czech methanol mass poisoning outbreak in 2012 were collected in four rounds (5 months, then 2, 4 and 6 years after the discharge) in the General University Hospital in Prague according to the same predefined study protocol. The collected data were used to inform the cost model. SETTING AND PARTICIPANTS: All 83 patients discharged from a hospital poisoning treatment after the 2012 methanol outbreak were informed about the study and invited to participate. Fifty-five patients (66%) gave their written informed consent and were followed until their death or the last follow-up 6 years later. The costs were modelled from the Czech healthcare service (general health insurance) perspective. MAIN OUTCOME MEASURES: Long-term national budget impact of the methanol poisoning outbreak, frequencies of sequelae and their average costs. RESULTS: The postacute cost analysis concentrated on visual and neurological sequelae that were shown to be dominant. Collected data were used to create process maps portraying gradual changes in long-term sequelae over time. Individual process maps were created for the central nervous system, peripheral nervous system, sequelae detected during eye examinations and sequelae concerning the visual evoked potentials. Based on the process maps the costs of the postacute outpatient care were estimated. CONCLUSIONS: In 2013-2019 the highest costs per patient related to postacute care were found in the first year; the average costs decreased afterwards, and remained almost constant for the rest of the studied period of time. These costs per patient ranged from CZK4142 in 2013 to CZK1845 in 2018, when they raised to CZK2519 in 2019 again.

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity.

BACKGROUND: Most severe substance use disorders (SUDs) are connected with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Therapeutic communities (TCs) provide a suitable option for the treatment of severe SUDs. The relationship between ADHD, the severity of the SUD, and other comorbidities in residential TCs is unknown. OBJECTIVE: To estimate the prevalence of ADHD among clients with an SUD in residential rehab, and to compare the mental health of clients with and without ADHD. METHODS: A cohort study was conducted in 5 residential TCs (N = 180, 76.7% male, 53.9% 25-34 years, 79.2% diagnosed with methamphetamine use disorder). We assessed ADHD symptoms, substance use, mental health problems, and psychiatric symptoms. RESULTS: ADHD was found in 51% of the clients who showed significantly higher scores for their psychiatric status composite score (ASI-PSY) (F = 9.08, p < 0.001; t = 5.05, p < 0.001), the positive psychiatric symptoms total (SCL-PST) (F = 3.36, p < 0.05; t = 3.15, p < 0.01), and the global severity index (SCL-GSI) (F = 3.27, p < 0.05; t = 3.18, p < 0.01). The ASI-PSY and SCL correlated significantly with the symptoms of attention deficit disorder (Pearson's r's = 0.30-0.42, p's < 0.001) and the symptoms of hyperactivity disorder (r's = 0.24-0.30, p's < 0.01). Even when severity of substance use was accounted for, ADHD was confirmed as a significant predictor of ASI-PSY (B= 0.14, p < 0.001 for combined disorder; B = 0.20, p < 0.001 for attention disorder) and partially of SCL-PST (B = 8.12, p < 0.05 for attention disorder). CONCLUSIONS: The ADHD prevalence in TCs was nearly 10-fold compared to the globally recorded values. ADHD diagnostic procedures and interventions should become an integral part of the standard diagnostic and treatment process.

Understanding the crisis in harm reduction funding in Central and Eastern Europe.

BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformation had significant consequences for drug policies in the region. A large number of emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable, and closely associated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input. The main objective of the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution building which represents a major threat to the future of HR services in the region. METHODS: Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions. RESULTS: The insufficient investments in finalising the process of the institution building of HR services have resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare. CONCLUSION: The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s, which remains present until today, together with all its weak points. The entire situation is responsible for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept.

Fatal injuries and economic development in the population sample of Central and Eastern European Countries: the perspective of adolescents.

OBJECTIVES: Researches consider the young generation (adolescents) to be the population group whose mortality from injury has the lowest effect on economic growth. The objective was to evaluate the relations between economic indicators and preventable injury mortality in Central and Eastern European Countries (CEECs), with a primary focus on adolescents. METHODS: The analyses included health indicators of preventable injury mortality and economic indicators that represent human development and economic growth in the CEECs from 1990 to 2016. The analytical process involved a population group divided by age (0-14 years: children, 15-24 years: adolescents, 25-74 years: adults) and gender. Descriptive analysis, cluster analysis and primarily panel regression analysis were used. RESULTS: Significant effects of economic indicators on drowning were found in all analysed relations. In the group of adolescents, significant effects of fatal falls were found. Overall, it can be concluded that the effects of fatal injuries are not homogenous between age and gender groups. CONCLUSIONS: The effects of years and individual countries should be taken into account in the cross-sectional analyses. In terms of economic growth, public policies should focus on drowning in children, on falls in adolescents and on transport accidents, fire injuries and poisoning in adults.

Health-related quality of life determinants in survivors of a mass methanol poisoning outbreak: six-year prospective cohort study.

Purpose: The effect of acute methanol poisoning on the follow-up quality of life of survivors in mass poisoning outbreaks is not known. The objective of this is to study the impact of visual and central nervous system (CNS) sequelae of methanol poisoning on long-term health-related quality of life (QoL) of survivors, its clinical determinants, and dynamics.Materials and methods: A total of 54 patients with confirmed methanol poisoning (mean age 46.7 ± 13.4 years, 9 females) were examined consequently three times within six-year prospective cohort study and compared to 23 controls with the history of chronic alcohol abuse. The following tests were performed: SF-36 QoL questionnaire, visual evoked potentials (VEP) of optic nerve, ocular examination with retinal nerve fiber layer (RNFL) thickness measurement, brain magnetic resonance imaging (MRI), and biochemical and toxicological tests.Results: Acute methanol poisoning led to significant decrease in physical component summary (PCS) compared to PCS of age-adjusted controls (mean score with SD 46.8 ± 11.0 versus 52.3 ± 9.4 points; p = .003). In 17/40 (42.5%) patients with three rounds of examination, signs of severe disability (≤30 points in at least one score) were present six years after discharge, with negative dynamics of PCS score during the observation period. The patients with abnormal RNFL thickness had lower PCS (mean difference 10.5 points; 95%CI 3.5-17.5, p = .004) and mental component summary score (9.5 points; 95%CI 1.9-17.1, p = .015) compared to the patients with normal RNFL. Signs of physical and mental adaptation to long-term visual sequelae were registered with gradual reduction of difference in most of physical and mental components scores compared to the patients with normal RNFL during six years of observation. Signs of hemorrhagic brain lesions were associated with permanent decrease of PCS score (mean difference 7.4 points; 95%CI 0.6-14.0; p = .033), bodily pain (8.7 points; 95%CI 1.6-17.6; p = .018), and social functioning (8.2 points; 95%CI 3.0-17.4; p = .005) six years after discharge. No effect of type of antidote (fomepizole versus ethanol) and extracorporeal enhanced elimination modality (intermittent hemodialysis versus continuous renal replacement therapy) applied in hospital on long-term QoL was found (all p > .05).Conclusion: Acute methanol poisoning was associated with a significant decrease of health-related quality of life of survivors persisting for at least six years after discharge. The more pronounced decrease in QoL scores was observed in the patients with hemorrhagic brain lesions and visual sequelae of poisoning with abnormal RNFL thickness.

The impact of co-morbidities on a 6-year survival after methanol mass poisoning outbreak: possible role of metabolic formaldehyde.

Context: The influence of co-morbid conditions on the outcome of acute methanol poisoning in mass poisoning outbreaks is not known.Objective: The objective of this is to study the impact of burden of co-morbidities, complications, and methanol-induced brain lesions on hospital, follow-up, and total mortality.Methods: All patients hospitalized with methanol poisoning during a mass poisoning outbreak were followed in a prospective cohort study until death or final follow-up after 6 years. The age-adjusted Charlson co-morbidity index (ACCI) score was calculated for each patient. A multivariate Cox regression model was used to calculate the adjusted hazards ratio (HR) for death. The survival was modeled using the Kaplan-Meier method.Results: Of 108 patients (mean age with SD 50.9 ± 2.6 years), 24 (54.4 ± 5.9 years) died during hospitalization (mean survival with SD 8 ± 4 days) and 84 (49.9 ± 3.0 years; p = .159) were discharged, including 27 with methanol-induced brain lesions. Of the discharged patients, 15 (56.3 ± 6.8 years) died during the follow-up (mean survival 37 ± 11 months) and 69 (48.5 ± 3.3 years; p = .044) survived. The hospital mortality was 22%, the follow-up mortality was 18%; the total mortality was 36%. Cardiac/respiratory arrest, acute respiratory failure, multiorgan failure syndrome, and arterial hypotension increased the HR for hospital and total (but not follow-up) mortality after adjustment for age, sex, and arterial pH (all p < .05). All patients who died in the hospital had at least one complication. A higher ACCI score was associated with greater total mortality (HR 1.22; 1.00-1.48 95% CI; p = .046). Of those who died, 35 (90%) had a moderate-to-high ACCI. The Kaplan-Meier curve demonstrated that patients with a high ACCI had greater follow-up mortality compared to ones with low (p = .027) or moderate (p = .020) scores. For the patients who died during follow-up, cancers of different localizations were responsible for 7/15 (47%) of the deaths.Conclusions: The character and number of complications affected hospital but not follow-up mortality, while the burden of co-morbidities affected follow-up mortality. Methanol-induced brain lesions did not affect follow-up mortality. Relatively high cancer mortality rate may be associated with acute exposure to metabolic formaldehyde produced by methanol oxidation.

Methanol Poisoning as an Acute Toxicological Basal Ganglia Lesion Model: Evidence from Brain Volumetry and Cognition.

BACKGROUND: Acute methanol poisoning leads to optic neuropathy and necrotic lesions of basal ganglia (BG) and subcortical white matter. Survivors of methanol poisoning exhibit long-term executive and memory deficits. Associations between brain volumetry parameters and cognitive sequelae of methanol poisoning are not known. The aim of our study was to identify long-term associations between the cognitive performance of survivors of methanol poisoning and the volume of the brain structures that are selectively vulnerable to methanol. METHODS: We conducted a cross-sectional follow-up study on a sample of patients (n = 33, age 50 ± 14 years, 82% males) who survived acute methanol poisoning during methanol mass poisoning outbreak from September 2012 till January 2013 in the Czech Republic. A battery of neuropsychological tests and brain magnetic resonance imaging were included in the clinical examination protocol. Specific brain structures (putamen, globus pallidus, nucleus caudatus, and frontal white matter) were selected as regions of interest, and their volumes were estimated using the MorphoBox prototype software. RESULTS: In robust multiple regression models, sustained visual attention performance (as assessed by Trail Making Test and Prague Stroop Test) was positively associated with BG structures and frontal white matter volumes (Wald = 9.03 to 85.50, p < 0.01), sensitivity to interference (as assessed by Frontal Battery Assessment) was negatively associated with frontal white matter volume (Wald = 35.44 to 42.25, p < 0.001), and motor performance (as assessed by Finger Tapping Test) was positively associated with globus pallidus and frontal white matter volumes (Wald = 9.66 to 13.29, p < 0.01). CONCLUSIONS: Our results demonstrate that smaller volumes of elements of BG-thalamocortical circuitry, namely the BG and frontal white matter, relate to attention and motor performance in methanol poisoning from a long-term perspective. Disruption of those functional circuits may underlie specific cognitive deficits observed in methanol poisoning.

Public health response to methanol mass poisoning in the Czech Republic in 2012: a case study.

OBJECTIVES: The study focuses on the 2012 methanol outbreak in the Czech Republic. The main goal of the present study was to apply analytical and descriptive tools to selected qualitative and quantitative processes related to the 2012 methanol outbreak in the Czech Republic. The secondary goal was to study and evaluate in detail their potential for creating integrated conceptual national policies aimed at eliminating the risk of methanol poisoning in the future. METHODS: The presented qualitative analysis focused on the content of documents published by Czech public authorities - the Ministry of Health, the Ministry of the Interior, the Czech Agriculture and Food Inspection Authority, and the Regional Public Health Authorities - as well as the content of the relevant legal regulations. Moreover, statistical data concerning the number of hospitalisations and deaths due to the methanol intoxication were used to provide a background to a detailed description of the relevant facts. RESULTS: In procedural terms, most of the analysed measures focused on a strongly restrictive regulation of sales, regular information channels designed to protect consumers on the national as well as international level, and elimination of further health and economic risks stemming from the dangerous alcoholic products that had already entered distribution networks. The health, social and economic consequences of such activities are quantified at a highly aggregated level. The analysed institutional ties are evaluated also in the context of international documents: the European Action Plan to Reduce Harmful Use of Alcohol 2012-2020 and the Global Strategy to Reduce Harmful Use of Alcohol, and their current potential for steering public policies is assessed. CONCLUSION: The analysis and evaluation of procedural activities carried out after the methanol outbreak have laid the foundations for a multidimensional study that can contribute to integrated national policy concepts aimed at preventing these and similar negative health, societal and economic consequences. Six years after the methanol outbreak, national and regional health policies have reflected no findings concerning the experience of patients whose health was impaired due to methanol, and the economic cost of the event has not been calculated. The quality of life of these patients has greatly decreased due to permanent or partial incapacity and serious upheavals of their and their families' economic and social conditions. This opens the question of researching and evaluating multiple aspects of health, social and economic impacts of harmful use of alcohol and setting up processes to mitigate these impacts.

First alcohol treatment institutions in today's Czech Republic and Slovak Republic.

OBJECTIVE: Drawing on qualitative analysis of selected historical documents, the paper seeks to provide a definition of the general characteristics of the first institutional alcohol treatment facilities in today's Czech Republic and Slovakia, taking into account the historical context of the first half of the 20th century. An additional aim was to point out the importance of archival research and its contribution to understand the determinants of alcohol-related agenda and alcohol treatment. METHODS: The basic data platform was generated by analysis of historical documents pertaining to the subject matter under study and to institutional processes in different periods. The data was processed using the open coding method (as part of the grounded theory approach) and other specific methods based on the matching of data from scientific and professional literature and archives in different periods. Over 1,100 pages of text from relevant archival materials were analysed. This research is original, no such systematic analysis of historical documents on this subject matter has been conducted on such a scale with the intention of identifying the general correlates of the historical development of an alcohol-related agenda and alcohol treatment. RESULTS: The establishment of the first institutional facilities intended to provide treatment for alcohol dependency was based on the notion of addiction as a disease, which needs to be treated in dedicated facilities applying an individualised approach. The circumstances of the establishment of the facilities under analysis were similar. Their existence was made possible by distinguished personalities rather than a general belief and social pressure that the issue of alcohol addiction should be addressed. This also explains the fact that the occupancy of these facilities never reached their full capacity, that they were not self-reliant in economic terms, and that they did not readily resume their operation after 1945. CONCLUSIONS: The analysis of the establishment, operation, and dissolution of these facilities at the time reveals the discontinuity in the approach to alcohol abuse and its treatment in the context of the historical development and perception of alcohol-related problems in Czech and Slovak society in the first half of the 20th century. Significant social changes occurred after 1948. New legislative instruments were used to enforce treatment based on a principle that was different from the previous approaches. The results of our study also make it possible to reveal the intensity of apparent individual and institutional motives in the process of the development of alcohol treatment in historical terms and its projection into different post-war periods. The understanding of these correlates will help in designing additional trajectories of research into the effects of social and political changes on addiction treatment and thus identifying the intensity of the historical development and its influence on the perception of addiction treatment at present. These findings will also be of great importance for a historical comparative analysis, including overlaps with the development of recent theories, and will support the emergence of new areas of study for the social sciences.

Incorporation of Universal Prevention Curriculum into established academic degree study programme: qualitative process evaluation.

OBJECTIVE: Comprehensive bachelor's, master's, and doctorate-level curricula of Addiction Studies (Addictology) were developed and implemented at Charles University (First Faculty of Medicine) between 2003 and 2012. This Prague model combines three evidence-based approaches to addressing substance use - prevention, treatment, and public health - into a balanced professionalised discipline. Graduates from this programme are licensed by the State Authority as addictology, a regulated profession in the Czech Republic. Professionals with these degrees are recognised as healthcare professionals, can perform directly in the field and can be contracted by health insurance companies. In 2016, it was decided to integrate the Universal Prevention Curriculum (UPC) into these programmes of study. The UPC was developed by a group of prevention researchers from the United States. This article describes the technical steps involved when adapting the UPC into an established university degree programme. We describe the requirements needed for successful implementation and reaccreditation. Finally, we examine both barriers and enhancers of the adoption of UPC as a university programme. METHODS: A qualitative process evaluation study was conducted on the activities carried out in 2017-2018, demarcated by a successful university accreditation of the new curricula combining the original Prague model and the UPC curriculum. Field records, observation methods, official documents, curricular documents, syllabuses, content analysis, and thematic analysis were used for this process. RESULTS: We identified three clusters of issues and challenges during the adaptation and implementation process: technical (developing a new credit scheme, adopting new terminology using local and culture-specific examples, and cancelling, establishing, and/or fusing particular courses, identifying some critical issues for any practical implementation of the UPC); teaching staff-related (team work, involving motivated and qualified staff for moving from a national to an international perspective); and content and contextual (the conflict between different theoretical perspectives such as public health vs. mental health and drug use prevention vs. risk behaviour prevention). CONCLUSION: The adaptation of the UPC had a significant impact on study profiles and competencies. Such an implementation necessarily requires a team of staff members with sufficient capacities to be able to coordinate the process, facilitating each step and supervising it. The current adaptation of the UPC involved specific merging procedures to fit in with existing courses and emphasising an international perspective. This process opened a national discussion about the implementation of the UPC in the system of life-long education programmes and training. Beginning in September 2019, when the first group of students will attend this new model of Addictology studies, we will continue our evaluation of the implementation process and the factors that played a role in either hindering or supporting the implementation. The findings from this evaluation will be used to make adjustments to the curriculum.

National Addiction-specific Institutional Infrastructure - fundamental prerequisite for successful implementation of specialized academic degree study programmes: a case study in historical perspective.

OBJECTIVE: Human resources are crucial for addiction treatment and prevention services, as well as for science and research. The aim of this historical case study is to explain and demonstrate the role of specialized university academic degree study programmes in addictions in the context of a national institutional infrastructure. This specific group of very highly specialized academic programmes represents the highest level of professional development and is producing a totally new generation of addiction specialists with a very distinctive professional identity. METHODS: The study protocol is based on a case study research design and the case is defined as the historical development of addiction specialized institutions closely related to self-help, prevention, and treatment activities on the historical territory of the Czech Republic. We identified relevant historical sources related to establishing and/or running activities or institutions according to the categories specified in our concept of the national institutional infrastructure. All the materials and sources that were collected were sorted according to a timeline and categories of institutions and we systematically determined the first recorded activity/institution in each particular category. For this simple sorting system we used open and selected coding according to Grounded Theory. RESULTS: The public health model developed by Thomas Babor recognizes six different structural mechanisms to support university-based programmes in addiction studies: specialized journals, research centres, professional societies, specialized libraries and documentation centres, training and education programmes and institutions, and funding agencies. We attempted to redefine the concept of addiction studies within the broader context of the addiction field and added three additional mechanisms of support: public interest groups, self-help groups, and service providers. Using a historical case study in the Czech Republic, we demonstrate the potential for a broader context and interaction between these support mechanisms and academic institutions hosting academic programmes in addiction studies. CONCLUSION: The process of establishing integrated addiction studies programmes at Charles University in the Czech Republic had its origins in, and support from, various national institutions and professional organizations. This allowed the university to develop academic programmes at the bachelor's, master's, and Ph.D. levels. The availability of career opportunities for advanced-level addiction professionals in the Czech Republic was also a critically important factor in developing sustainable academic programmes in addiction studies. Our experience is that the creation of successful and sustainable academic programmes for addiction professionals is difficult to achieve without broad infrastructure support, national advocacy efforts, and legislative change at the national level.

Ten-Item Internet Gaming Disorder Test (IGDT-10): Measurement invariance and cross-cultural validation across seven language-based samples.

The Ten-Item Internet Gaming Disorder Test (IGDT-10) is a short screening instrument developed to assess Internet gaming disorder (IGD) as proposed in the Diagnostic and Statistical Manual of MentalDisorders, fifth edition (DSM-5), adopting a concise, clear, and consistent item-wording. According to initial studies conducted in 2014, the instrument showed promising psychometric characteristics. The present study tested the psychometric properties, including language and gender invariance, in a large international sample of online gamers. In this study, data were collected from 7,193 participants comprising Hungarian (n = 3,924), Iranian (n = 791), English-speaking (n = 754), French-speaking (n = 421), Norwegian (n = 195), Czech (n = 496), and Peruvian (n = 612) online gamers via gaming-related websites and gaming-related social-networking-site groups. A unidimensional factor structure provided a good fit to the data in all language-based samples. In addition, results indicated both language and gender invariance on the level of scalar invariance. Criterion and construct validity of the IGDT-10 was supported by its strong association with the Problematic Online Gaming Questionnaire and moderate association with weekly gaming time, psychopathological symptoms, and impulsivity. The proportions of each sample that met the cut-off score on the IGDT-10 varied between 1.61% and 4.48% in the individual samples, except for the Peruvian sample (13.44%). The IGDT-10 shows robust psychometric properties and appears suitable for conducting cross-cultural and gender comparisons across seven languages. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Gait and Balance Impairment after Acute Methanol Poisoning.

Neurological sequelae including gait impairment were reported in survivors after methanol intoxication; however, no systematic study has been published so far. We aimed to analyse gait and balance impairment in a group of Czech methanol poisoning survivors. We examined 43 patients (age 46 ± 13 years) 2-8 months after methanol poisoning and 43 healthy controls. Investigations contained a shortened version of Falls Efficacy Scale (FES), clinical tests of gait and balance including Timed Up and Go test (TUG) and gait analysis using GaitRite® system, neurological and neuropsychological examination, brain imaging, EMG and tests of alcohol consumption. Nineteen patients admitted balance and gait impairment according to FES. Mild to moderate parkinsonian signs showed seven patients. Patients were slower (8.8 versus 5.7 s, p < 0.001) and performed more steps (11.1 versus 7.9, p < 0.001) in TUG compared with the controls. Gait analysis revealed shorter step length (76.5 versus 88.7 cm, p < 0.001), increased double support phase (18.8 versus 15.5%, p < 0.001) and wider base of support (11.3 versus 9.6 cm, p = 0.006) in patients. Eleven patients had deficit of executive function and performed higher cadence compared to the patients with normal execution (122.7 versus 115.0 step/min., p = 0.025). Lower limb polyneuropathy was verified in nine patients, without relation with gait or balance parameters. Neuroimaging revealed lesions mainly in the basal ganglia. Methanol poisoning survivors presented slower wide-based gait with shortened steps corresponding with frontal gait disorder. Higher stepping cadence associated with executive deficit supported the evidence of frontal lobe dysfunction related to impairment of basal ganglia and connections in frontal cortico-basal ganglia loops.

"It can't happen to me": Alcohol drinkers on the 2012 outbreak of methanol poisonings and the subsequent prohibition in the Czech Republic.

BACKGROUND: In September 2012, a series of methanol poisonings occurred in the Czech Republic as a result of an influx of illicit alcohol into (predominantly) cheap alcoholic beverages on the retail market. The public authorities decided to prevent public health risks by prohibiting sales of liquors that contained more than 20% alcohol (> 20% liquor). The "partial" prohibition lasted for almost two weeks, but the poisonings still continued. This article assesses the impact of the methanol poisoning risks and the (partial) prohibition on alcohol drinking patterns, and describes the understanding of risks and their mitigation in vulnerable groups. METHODS: The rapid assessment and response method (RAR) was used during the (partial) alcohol prohibition. Semi-structured interviews were conducted with respondents recruited for the study in alcohol-intake settings (e.g., bars and restaurants, street alcohol outlets) in six regions. In total, 107 alcohol users were interviewed, mostly with risky drinking patterns (69% scored ≥ 1 on the CAGE scale), and 53 alcohol retailers/staff members serving alcohol. RESULTS: About one third of the alcohol users in the study (35%) drank > 20% liquors during the prohibition; a higher score on the CAGE scale was associated with a lower probability of drinking > 20% liquors during the period of the prohibition, probably because of the perception of being at high risk of poisoning. There was some increase in drinking liquors with an alcohol content less than 20%. Those who continued drinking > 20% liquors typically did so in the belief that some sources of these were safe. CONCLUSIONS: Public policies aimed at reducing the risk of methanol poisonings in emergency situations should adopt broader measures than those focusing on market control. These measures include increased access to brief interventions, addressing the strategies that alcohol consumers adopt to prevent risk, and, in general, helping consumers make informed choices to prevent further fatalities.

Long-term visual damage after acute methanol poisonings: Longitudinal cross-sectional study in 50 patients.

CONTEXT: Visual disturbances due to the toxic effect of formic acid in acute methanol poisonings are generally transient. The subjective symptoms of visual toxicity may resolve within few weeks and fundoscopic signs of acute optic neuropathy subside within 1-2 months; therefore, the prevalence of long-term visual sequelae in the population of survivors of poisonings may be underestimated. OBJECTIVE: To study the prevalence and character of long-term visual sequelae of acute methanol poisonings based on the data from the Czech mass methanol outbreak in 2012. PATIENTS AND METHODS: A total of 50 patients with confirmed methanol poisoning were included in this longitudinal cross-sectional study, median age: 48 (range, 23-73) years. The following tests were performed: optical coherence tomography or OCT with evaluation of the retinal nerve fibers layer (RNFL), visual evoked potentials (VEP), magnetic resonance imaging (MRI) of brain, complete ocular examination (visual acuity/field, color vision, contrast sensitivity, and fundus), neurological examinations, and biochemical tests. RESULTS: Of 50 patients, 7/50 (14%) were discharged with diagnosed visual sequelae and 6/50 (12%) were discharged with both visual and central nervous system sequelae of poisoning. On the follow-up examination, 20/50 (40%) of the patients had long-term visual sequelae, with 8% of blindness. A total of 38% of the patients had abnormal (28% borderline) findings on RNFL, and 40% had abnormal (18% borderline) VEP. Among the patients discharged without detected visual sequelae, 8/37 (22%) had abnormal RNFL and VEP. Patients with visual sequelae had brain lesions more often (70% vs. 27%, p < 0.01). MRI identified optic nerve lesions in 2/20 cases with abnormal VEP only. The groups with and without visual sequelae differed in serum methanol, ethanol, HCO3-, formate, pH, anion gap, and base deficit (all p < 0.01). Visual disturbances on admission and coma were more prevalent in the patients with visual sequelae (p < 0.05). Patients with positive serum ethanol on admission were 93% less likely to have optical axonal damage (OR: 0.07 (95% CI: 0.01-0.8); p < 0.05). No association was found between visual sequelae and type of antidote administered, mode of hemodialysis, or folate substitution. Pre-hospital administration of ethanol seemed beneficial: these patients were 90% less likely to have abnormal RNFL findings (OR: 0.10 (95% CI: 0.02-0.52); p < 0.01). CONCLUSIONS: The long-term visual sequelae were clearly underestimated on discharge, suggesting a significantly higher amount of patients with long-term sequelae than earlier reported. Thorough examinations before discharge and during follow-up will likely uncover a higher morbidity also after methanol poisonings in general.

Cannabis use in children with individualized risk profiles: Predicting the effect of universal prevention intervention.

AIM: To study the effect of a universal prevention intervention targeting cannabis use in individual children with different risk profiles. METHODS: A school-based randomized controlled prevention trial was conducted over a period of 33 months (n=1874 sixth-graders, baseline mean age 11.82). We used a two-level random intercept logistic model for panel data to predict the probabilities of cannabis use for each child. Specifically, we used eight risk/protective factors to characterize each child and then predicted two probabilities of cannabis use for each child if the child had the intervention or not. Using the two probabilities, we calculated the absolute and relative effect of the intervention for each child. According to the two probabilities, we also divided the sample into a low-risk group (the quarter of the children with the lowest probabilities), a moderate-risk group, and a high-risk group (the quarter of the children with the highest probabilities) and showed the average effect of the intervention on these groups. RESULTS: The differences between the intervention group and the control group were statistically significant in each risk group. The average predicted probabilities of cannabis use for a child from the low-risk group were 4.3% if the child had the intervention and 6.53% if no intervention was provided. The corresponding probabilities for a child from the moderate-risk group were 10.91% and 15.34% and for a child from the high-risk group 25.51% and 32.61%. School grades, thoughts of hurting oneself, and breaking the rules were the three most important factors distinguishing high-risk and low-risk children. CONCLUSIONS: We predicted the effect of the intervention on individual children, characterized by their risk/protective factors. The predicted absolute effect and relative effect of any intervention for any selected risk/protective profile of a given child may be utilized in both prevention practice and research.