Decreasing neutralization antibody levels following vaccination against SARS-CoV-2 in the elderly: an observational study in Southern Moravia, Czech Republic.

INTRODUCTION: Understanding the immune response after SARS-CoV-2 vaccination is essential to control the COVID-19 pandemic. Recent studies indicate that vaccine-induced humoral immunity may not be long-lasting and is weaker in the elderly. METHODOLOGY AND SAMPLE: At the turn of June and July 2021, 653 seniors (426 women and 197 men with a mean age of 74 years) were tested once for antibodies against SARS-Cov-2 in the South Moravian Region between 9 and 161 days after the second dose of vaccine (558 Pfizer -BioNTech, 28 Moderna, 36 AstraZeneca, 1 Johnson & Johnson). Samples of the whole capillary blood were tested in two point-of-care iCHROMA II immunofluorescence assays: (1) COVID-19 Ab against mix of SARS-CoV-2 nucleocapsid and spike proteins (IgM Ab, IgG Ab) and (2) COVID-19 nAb against S1-RBD protein (nAb). Results were analysed in relation to gender, age, vaccine type, and past COVID-19 disease. RESULTS: Our results show high variability in the antibody response but indicate an overall relatively weak and decreasing antibody response in the first six months after vaccination. Only 58.4% (95% CI: 54.6-62.3) of subjects had virus neutralizing antibodies (nAb). The level of nAb decreased with time from vaccination - at post-vaccination months 4 and 5, nAb were only detected in 41.1% (95% CI: 30.9-51.3) and 15.4% (95% CI: 1.5-29.3) of subjects, respectively. Vaccinees in older age groups, those vaccinated with AstraZeneca, and naive individuals showed a lower antibody response. CONCLUSION: The antibody response to SARS-CoV-2 vaccine in the elderly was relatively weak and decreased in the first six months after vaccination. Although humoral immunity is complex and cellular immune memory is a key element of the humoral response after exposure to the wild virus, our results suggest that vaccine-induced humoral immunity may not be long-lasting. The oldest koncenage groups who have not acquired natural SARS-CoV-2 infection are particularly at risk. This finding is relevant for adjusting vaccination strategies in selected population groups to include a booster dose. More research into the antibody response and the complex immune response after vaccination against SARS-CoV-2 over longer time is needed.

Substance use and addictive behaviours during COVID-19 confinement measures increased in intensive users: Results of an online general population survey in the Czech Republic.

BACKGROUND: The COVID-19 pandemic has affected substance use and other addictive behaviour, however detailed insight is lacking. MATERIAL AND METHODS: Online questionnaire survey on the sample of 3,000 respondents aged 15+ randomly selected from the Czech internet panel using socio-demographic quotas was performed shortly after the end of confinement measures in May 2020 (response rate 35.4%). Questions covered current prevalence and patterns of substance use (i.e. in the last 12 months) and other forms of addictive behaviours as well as changes in their behaviour during the confinement measures. Responses were provided on categorical scale; a factor of 0 to 2 was assigned to the categories to quantify the changes where 1 means no change. RESULTS: Respondents reporting the highest frequency of current use, especially the use of alcohol, cannabis and sedatives, further increased their intensity of use during the confinement measures by 5-10% on average, while less frequent users reduced it. The reduction of use during confinement measures increased with decreasing frequency of current use. Although the same correlation exists in tobacco smokers, decrease in intensity of use was observed also in daily smokers. On the population level, our results suggest a slight increase in total alcohol and sedatives consumption and a significant increase in the total consumption of gaming and social media. On the contrary, there was a significant reduction in the consumption of tobacco and online gambling (likely due to the ban on sports matches), and a slight reduction in the consumption of cannabis and other illicit drugs. CONCLUSION: People with intensive patterns of substance use increased their use during confinement measures. The same concerns gaming and social media. Without this insight the overall picture suggests rather overall reduction of consumption. Addiction treatment system should prepare for the increase of treatment demand following COVID-19 epidemic.

Barriers to treatment of infectious and other somatic comorbidity in drug users.

BACKGROUND: Intensive use of illicit drugs in general and drug injecting in particular are associated with higher somatic co-morbidity, especially of infectious aetiology. The treatment participation of drug users is complicated by a number of barriers. MATERIAL AND METHODS: At the end of 2013, a cross-sectional questionnaire study was conducted on a non-random sample of 240 drug users (188 men and 52 women) recruited in low-threshold drug services in Prague based on their willingness to participate in the study. Drug injecting sometimes in their lifetime was reported by 237 respondents (98.8%), injecting drug use in the last 12 months by 232 (96.7%), and injecting drug use in the last 30 days by 228 (95.0%). The questionnaire included 38 of the 59 original items from the Barriers to Treatment Inventory (BTI). Factor analysis of these items was performed. In addition to the questionnaire survey, two focus groups with a total of 14 clients were carried out. RESULTS: The factor analysis resulted in a 5-factor model that was fed with 23 BTI items. The factors identified can be interpreted as: (1) difficulty entering treatment due to additional responsibilities (e.g. children, family, work, etc.), (2) previous poor treatment experience, fear and concerns about the treatment or negative attitudes of staff, (3) financial difficulties and formal barriers (health insurance debts, problems with the law, etc.), (4) concerns that entering treatment will be too complicated and difficult, (5) distrust of the treatment's ability to improve the client's life situation. The results of the focus groups have shown that drug users face stigmatization and discrimination in healthcare facilities. CONCLUSION: The access to treatment of infectious and other somatic co-morbidity in drug users is complicated by a number of barriers, which largely arise from the lifestyle and socio-economic situation associated with drug use and from negative experiences with the attitude of medical staff. Healthcare professionals should actively identify and respond to barriers to care among drug users by taking appropriate measures in the context of a multidisciplinary approach and cooperation.

[Infectious and other somatic comorbidity in problem drug users - results of a cross-sectional study with medical examination]. / Infekcní a dalsí somatická komorbidita problémových uzivatelu drog - výsledky prurezové studie s lékarským vysetrením.

BACKGROUND: Problem drug use is associated with excess risk of infectious and other somatic diseases resulting mainly from injecting drug use. MATERIAL AND METHODS: At the end of 2013, a complete medical history and physical examination was done in 40 problem drug users (30 males and 10 females), mean age 35.5 years (37.0 and 30.9, respectively), recruited in 4 low-threshold facilities in Prague. Of them, 37 were ex- or active injecting drug users, predominantly of methamphetamine (pervitin) and less often of buprenorphine. RESULTS: The study physician rated the health status as -good or satisfactory in 35 participants and as unsatisfactory in five participants (12.5%). The most common pathologies were dental problems (36 participants, i.e. 90.0%) and skin conditions (15.0%). The most prevalent dental pathology was caries while dermatological disorders were mostly trophic skin lesions on the lower legs, including crural ulcers, and injection site infections. Gynaecological pathology was found in 2 of 10 females. The study subjects were most commonly diagnosed with chronic hepatitis C, status post hepatitis A and B, chronic caries, missing teeth, post-thrombotic swelling and trophic skin lesions on the lower legs, purulent skin lesions, and gastroduo-denal ulcer. A vast majority of the study participants were smokers. All were referred to various specialists for further examination or treatment, mostly to stomatology, hepatology, gastroenterology, and internal/general medicine departments. However, in reality the treatment participation rate is low among problem drug users due to the drug use-specific factors and needs that limit access to treatment. CONCLUSION: The incidence of diverse somatic comorbidities requiring standard general medical care is significant among problem drug users. Infectious, dermatological, and dental pathologies are predominant. In areas with high prevalence of problem drug use, implementation of a special program should be considered to provide comprehensive medical care taking account of the special needs of this target group.

Hepatitis C treatment uptake and adherence among injecting drug users in the Czech Republic.

BACKGROUND: Injecting drug users (IDUs) represent a major subpopulation of hepatitis C virus (HCV)-infected people in developed countries. Yet their uptake to treatment is generally low despite well-documented effectiveness of HCV treatment among former and active IDUs. The present study represents the first attempt to describe the HCV treatment coverage among IDUs and identify factors that affect treatment uptake in the Czech Republic. METHODS: From January to March 2011, a questionnaire survey was conducted among viral hepatitis treatment centres in the Czech Republic. RESULTS: From a total of 76 identified hepatitis treatment centres existing in the country, 39 provided HCV treatment to (mainly former or abstaining) IDUs in 2010. Most clinicians reported being cautious in initiating HCV treatment in IDUs. Abstinence, a screening phase before treatment initiation, opioid substitution treatment and an external evaluation by a specialist were often prerequisites for skrting treatment. However, HCV treatment centres rarely provided drug-use specific services. Financial constraints were also reported, further limiting the inclusion of IDUs into treatment, as non-users are widely preferred to active drug users. Clinicians reported no difference in treatment uptake and adherence between drug users and non-users, nor between opioid and methamphetamine users. CONCLUSION: A number of system- and provider-related factors limit HCV treatment in IDUs in the Czech Republic, despite permissive national clinical guidelines. Targeting these factors is crucial to reduce HCV prevalence at population level.

Hepatitis C prevalence in injecting drug users in Europe, 1990-2007: impact of study recruitment setting.

Monitoring injecting drug users' (IDUs) health is challenging because IDUs form a difficult to reach population. We examined the impact of recruitment setting on hepatitis C prevalence. Individual datasets from 12 studies were merged. Predictors of HCV positivity were sought through a multilevel analysis using a mixed-effects logistic model, with study identifier as random intercept. HCV prevalence ranged from 21% to 86% across the studies. Overall, HCV prevalence was higher in IDUs recruited in drug treatment centres compared to those recruited in low-threshold settings (74% and 42%, respectively, P < 0·001). Recruitment setting remained significantly associated with HCV prevalence after adjustment for duration of injecting and recent injection (adjusted odds ratio 0·7, 95% confidence interval 0·6-0·8, P = 0·05). Recruitment setting may have an impact on HCV prevalence estimates of IDUs in Europe. Assessing the impact of mixed recruitment strategies, including respondent-driven sampling, on HCV prevalence estimates, would be valuable.

[Pregnant women and mothers using alcohol, tobacco and illegal drugs]. / Rodicky uzívající alkohol, tabák a nelegální drogy.

UNLABELLED: This analysis is focused on use of addictive substances among women hospitalised during delivery or puerperium. Analysed data come from National Registry of Mothers at Childbirth and from National Registry of Newborns, which are managed by the Institute of Health Information and Statistics. GOAL: To describe the prevalence of addictive substances use among women during gestation and to study its relation to health complications during pregnancy, delivery or puerperium and to health status of foetus and newborns. METHODS AND MATERIALS: The reporting to registries is provided in the Report on mother at childbirth and in the Report on newborn. Both registers provide basic socio-demographic information about mother, information about previous pregnancies and abortions, about current pregnancy, course of delivery, birth and neonatal treatment and health of newborn during hospitalization of mother during delivery or puerperium. Use of addictive substances is monitored in the National Registry of Mothers at Childbirth since 2000. Addictive substances are divided to tobacco, alcohol and drugs. Descriptive analysis of data was performed and binary logistic regression was used to test association of substance use with education and marital status (adjusted for age), analysis of variance was used to test association of substance use with selected health complications of pregnancy, delivery or puerperium and with health status of foetus/newborns (adjusted for age, education, marital status and interaction between addictive substances). RESULTS: In 2000-2009, 1,008,821 mothers were reported of whom 60,502 women were registered as cigarette smokers, 1,528 used alcohol and 1,836 used other (illegal) drugs. Total of 1,027,200 newborns were reported. The average age of mothers using addictive substances were about 0.5-3 years lower in comparison with nonusers, in average mothers using illegal drugs were the youngest. Mothers using addictive substances were more often unmarried and had lower education than nonusers - almost 2/3 of mothers using addictive substances were unmarried or didn't live in permanent partnership and more than 82% of mothers-users have lower education (primary or secondary school without a diploma). The association between substance use and induced and spontaneous abortions was observed only in smokers. Serious complications of pregnancy were associated with all monitored addictive substances - in mothers-smokers, a probability of serious complications were about 40 %, in users of illicit drugs about 13 % and in alcohol users about 5 % higher as compared to nonusers. Substance use showed almost no association with problems during childbirth. Alcohol and illegal drugs use increased probability of complications in puerperium. Health status of foetus/newborn was negatively significantly altered mainly in those born to mothers-smokers in almost all observed characteristics. Mothers alcohol use during pregnancy was associated primarily with the overall health status of foetus immediately after delivery, congenital anomalies, stillbirth or need for treatment of newborn in the theatre. Infants of mothers using addictive substances had higher probability of consequent hospitalization after discharge from the neonatal department, transfer to infant home and death of infant. CONCLUSION: Association between complications during pregnancy, delivery and puerperium and health status of newborns and substance use of mothers during pregnancy was found mainly in cigarette smoking. Alcohol use was found significant in some (but serious) health problems of mothers and newborns. The association between illegal drugs and monitored indicators wasn't found. Following the results of this work, criteria for reporting of illegal drug use in mothers during pregnancy should be improved.

[Outpatient care for substance users and addicts in the Czech Republic in Health Statistics since 1963]. / Ambulantní péce o uzivatele a závislé na návykových látkách v CR ve zdravotnické statistice od roku 1963.

UNLABELLED: Outpatient care for alcohol and other addictive substances users in the Czech Republic has a 100-year-old history, with the last 50 years covered in health statistics. GOAL: To perform descriptive analysis of the historical data gathered, analysed and published by the Institute for Health Information and Statistics on the network of outpatient psychiatric facilities in 1963-2008 (particularly those specialising in the treatment of addictive disorders, e.g. alcohol counselling centres and later AT centres where AT stands for alcoholism and other toxicomanias) as well as on the numbers and characteristics of their patients--users of addictive substances. RESULTS: The number of visits to alcohol counselling and AT centres showed an upward trend in 1963-1991, mainly from 1970 to 1988 when a historical peak of 387 thousand visits was recorded. This trend was primarily due to males who constituted the majority of the reported patients and their proportion gradually decreased from 95% in 1963 to 79% to 1991. The reporting from the specialised AT centres ended in 1992 to be replaced by the reporting of addictive substances users from all psychiatric outpatient centres. In the period 1993-2008, for which the data by group of addictive substances are available, alcohol users constituted 3/4 of the treated addicts and their annual number decreased by half (from 49 to 25 thousand)--this decrease was also influenced primarily by men, with the male to female ratio declining from approx. 4:1 to 2:1. Since 1995 when age-specific data started to be reported, the age of substance users was increasing, with the exception of non-alcohol drugs users where the proportion of 15-19-year-olds rose in 1995-1997. In 2008, the highest proportion (about two thirds) of alcohol users were aged 40 years and more, while most (nearly 70%) users of non-alcohol drugs were from the age-group 20-39. The number of treated non-alcohol drug users increased more than 3 times between 1993 and 2008. Higher proportions of males were noticed among the users of all non-alcohol drugs but sedatives and hypnotics preferred more often by females (58%). An increase in the number of users was reported for all groups of non-alcohol drugs except volatile substances in 1993-2008: the most common were users of opiates (26%), followed by users of stimulants other than cocaine (23%) and poly-drug users (14%). In 1993-2008, the proportion of injecting drug users decreased from 75% to 50% for opiates and from 70% to 60% for stimulants other than cocaine; however, injecting drug use increased in poly-drug users. The trend in the number of clients of sobering-up stations (short-term detoxification from alcohol and other drugs) follows the trend in the number and capacity of these stations, although a downward trend in their capacity coupled with an upward trend in the number of clients have been observed since 2005. CONCLUSION: Information from the outpatient health care psychiatric facilities is relevant to drug use epidemiology in the Czech Republic, despite the fact that the network of specialised AT centres has not been monitored separately any longer since the early 1990s. Data on drug users in outpatient treatment are in line with the inpatient treatment data and both data sources show some congruent trends. Health statistics remains practically the only data source on the outpatient treatment of alcohol users.

[Residential care for substance users and addicts in the Czech Republic according to the health statistics since 1959]. / Luzková péce o uzivatele a závislé na návykových látkách v CR ve zdravotnické statistice od r. 1959.

UNLABELLED: Similarly to the prevalence of disorders related to the use of addictive substance, the system of medical care for patients with addictive disorders, including the residential treatment, has changed dramatically in the Czech Republic in the last 50 years. GOAL: To perform descriptive analysis of historical data gathered, analysed and published by the Institute for Health Information and Statistics since 1959 on the inpatient psychiatric facilities, and numbers and characteristics of patients hospitalised due to addictive disorders in 1959-2008. RESULTS: The number of episodes of hospitalisation due to alcohol-related conditions was increasing throughout the whole monitored period since the end of the 1950s. After a short decrease at the turn of the 1980s and 1990s, the alcohol-related hospitalisations increased again to the historical peak of 11,691 episodes in 2005. As compared to alcohol-related admissions, the number of hospitalisations due to other (non-alcoholic) addictive disorders was 5-10 times lower until 1993 (60-1,000 episodes annually); however, a sharp increase was observed since 1994, to 5,264 episodes in 2008. The proportion of males among hospitalised alcohol users is currently about 70% in comparison with approximately 95 % at the very beginning of the study period, with most hospitalised persons being aged 40-49 years. Users of sedatives and hypnotics are more often females (approximately 65%), with the highest proportion of them being also aged 40-49 years. From 70 to 90% of hospitalised users of other addictive substances, i. e. illicit drugs and volatile substances, the percentage varying with the substance, are males and the highest proportion of cases is reported in the age group 20-29 years. In the last 15 years, the highest relative rates of hospitalisations for alcohol-related conditions were recorded in the Zlin, Olomouc and Moravian-Silesian Regions and for non-alcohol substance abuse in Prague and the Ustí Region. The inpatient psychiatric bed capacity considerably decreased after 1989, which contrasts with the increasing number of alcohol-related and particularly non-alcohol substance-related hospitalisations since the 1990s. CONCLUSION: The data on hospitalised users of addictive substances are a valuable contribution to the body of information about drug use and its consequences in the Czech Republic and are complementary to the description of the epidemiological situation and trends seen in other data sources. They are of crucial relevance to the study of alcohol abuse due to the scarcity of other data sources in the Czech Republic.

A comparison between the force of infection estimates for blood-borne viruses in injecting drug user populations across the European Union: a modelling study.

A number of studies have been conducted in injecting drug user (IDU) populations in Europe, in which the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) was measured together with demographic and epidemiological information such as age and the age at first injection. A measure of the risk of becoming infected is the force of infection (FOI), defined as the per capita rate at which susceptible individuals acquire infection. The objective of this study was to estimate the FOI and its heterogeneity for HBV, HCV and HIV (where available) for IDU populations in a number of countries in Europe. Data were obtained from five countries: Belgium, the United Kingdom, Spain and Italy, and the Czech Republic, which provided two data sets. The model describes the prevalence of infection as a function of the FOI that may vary over time or duration of IDU. In addition to this, if two or more infections were being considered then a parameter describing the potential heterogeneity of the FOI within the IDU population was also estimated. The results here add to the growing evidence that new initiates to injecting are at an increased risk of blood-borne viral infection compared with more experienced IDUs. In addition, there is evidence of individual heterogeneity of FOI estimates within the overall IDU populations. This suggests that different proportions of individuals in each population are at increased risk of infection compared with the rest of the population. Future interventions should identify and target these individuals. Moreover, changes over time in individual heterogeneity estimates of IDU populations may provide an indicator for measuring intervention impacts.

[Drugs and traffic accidents]. / Drogy a dopravní nehody.

BACKGROUND: The aim of the study was to map the prevalence of alcohol and other psychotropic substances in deceased participants of traffic accidents in the Czech Republic. METHODS AND RESULTS: The studied sample included persons autopsied in the departments of forensic medicine and forensic toxicology that died during traffic accidents and were toxicologically tested in 2003. Case definition involved alcohol cases with blood alcohol concentration (BAC) 0,2 g/kg and higher, with cannabis, detections of active THC metabolites only were taken into account; in cases where volatile substances (solvents) were detected we included into the definition only cases with substances not produced post mortem or in some physiological or pathological statuses. We identified 554 cases of whom 440 (79.4%) were males and 114 (20.6%) were females. 35.5% were in the age group 20 - 34 years. The sample has been classified into 4 categories (average age, % of males): pedestrians (45.4, 76.2), bicyclists (51.1, 82.0), drivers (36.3, 91.2) and others (36.1, 66.2). Alcohol was tested in 548 cases, 214 (39.1%) of those were found positive. 380 cases were tested for other psychotropic substances than alcohol; samples taken from 25 bodies (6.6%) were found positive for at least for one of these substances. 8 cases were positive both for alcohol and some other psychotropic substance - i.e. 3.7% out of 214 cases positive for alcohol were positive for other substance and 32.0% out of 25 cases positive at least for any other psychotropic substance were alcohol-positive. When focusing our analysis at the active participants of road traffic accidents only - pedestrians, bicyclists and drivers (altogether 397 cases) - we have found alcohol to be tested in 394 cases, out of which 158 (39.1%) were positive; as for other psychotropic substances, 314 cases were tested and 23 (7.3%) were positive at least for one of them. 7 cases were found positive for alcohol and other psychotropic substance simultaneously; this represents 4.4% out of 158 cases positive for alcohol and 30.4% out of 23 cases positive at least for one psychotropic substance other than alcohol. Average BAC in active participants of road traffic accidents positive for alcohol were 1.81%, (1.98%o in pedestrians, 1.78 %o in bicyclists and 1.64 %o in drivers). Prevalence of either alcohol or any other psychotropic substances is the lowest in the category of drivers - with the exception of active cannabinoid compounds. Alcohol was by far the most prevalent psychotropic substance, also cannabis, benzodiazepines and stimulants have been found in not negligible frequencies. CONCLUSIONS: The study confirms high prevalence of alcohol influence in deceased participants of traffic accidents. Prevalence of other psychotropic substances is lower by order, but it becomes also significant.

[Questionnaire study of general practitioners regarding experience and attitude to opioid substitution therapy]. / Dotazníková studie mezi praktickými lékari zamerená na zkusenosti a postoje k substituci opioidy.

UNLABELLED: General practitioners (GPs) in their surgeries and substitution treatment centres are the major providers of opioid maintenance treatment in a number of European countries. Although in the Czech Republic any GP has been allowed to prescribe buprenorphine (Subutex) since 2001, the opioid substitution treatment provided by primary care professionals has not been the subject of research to date. OBJECTIVE: To collect and analyze data on GPs' experience gained with opioid maintenance treatment in the Czech Reupblic, their attitudes and needs. METHOD: A structured questionnaire was distributed via the Bulletin of the Association of General Practitioners and district Association representatives. The validity of study results may be affected by a low respondence rate (10%) with 398 questionnaires only returned by mail. RESULTS: Twenty-eight (7%) GPs reported to have gained experience with buprenorphine which was most frequently prescribed in the regions with the highest prevalence of heroin users, i.e. in Prague and the Ustí nad Labem region (27% and 12%, respectively). Other regions, including wes- tern and southern Bohemia with relatively high prevalence of heroin users, showed lower buprenorphine prescription rates (0-6%). Most buprenorphine prescribers (78%) rated their experience as positive or highly positive. Availability and effectiveness were seen as the main pros of the substitution treatment. One third of the GPs who have not prescribed opioid maintenance treatment yet are considering doing so in the future. Greater awareness of drug abuse issues and availability of methodical guidance and consulting in opioid substitution treatment are going to become the most relevant factors in the future. Possible reportability of data on opioid maintenance treatment to a central registry does not seem to be a major obstacle to implementing the substitution treatment in the GPs' surgeries. Decision makers should take advantage of the GPs' potential to promote the opioid maintenance treatment in the Czech Republic.

[Mortality of drug users. Summary of cohort study results]. / Umrtnost uzivatelu drog v CR Souhrn výsledku kohortové studie.

AIMS: The cohort study aimed to find the level of mortality among different groups (cohorts) of drug users and compare it with the mortality rate of the general population. At the same time, the study focused on differences in mortality levels according to gender and type of drug used. METHODS: A retrospective cohort mortality study was conducted. In 1997-2002, 4 defined groups of drug users were followed. These included two cohorts of hospitalized persons for drug-related behavioral disorders (12,207 and 2,824 persons), cohort of injecting drug users with reported viral hepatitis (3,037 persons) and substitution treatment clients (704 persons). FINDINGS: Direct standardized mortality rate reached 16-33 per 1000 person-years of follow-up, depending on the cohort. In all cohorts, mortality was higher among men than women. In the follow-up period, mortality observed a consecutive decrease. The level of mortality among drug users was 8-11 times higher compared to general population. The highest mortality was observed for polyvalent and opiate users, relatively lowest for stimulants users. CONCLUSIONS: The level of mortality of drug users in the Czech Republic is comparable to mortality in other European countries; compared to other cohorts, the mortality level in CR is relatively lower. The study proved differences in mortality levels by cohorts; further research should focus on the impact of treatment on the mortality levels.

[Summary of illegal drug use in the Czech Republic]. / Aktuální prehled stavu uzívání nelegálních drog v Ceské republice.

Illegal drugs represent substantial health, social, legal and economical risks both for individuals and the whole society. Since 1989 the Czech drug scene has changed rapidly; these changes have resulted in an establishment of new market-based drug scene similar to other western European countries. Authors summarise basic data on the whole spectrum of drug users groups and emphasise that the concept of drug users as patients in treatment or as criminal offenders only was wrong. So-called recreational drug users are the most prevalent and from the research point of view the least studied group of users mostly without any contact with treatment services or criminal justice system. Drug information system introduced in the Czech Republic four years ago is presented; this system allows comparison with other European countries. It covers surveys on drug use among general and school population, studies on prevalence estimates of problem drug use, treatment demands, drug related infectious diseases and drug related deaths. Data on drug related crime, drug consumption and drug seizing are briefly presented.

[Detection of HIV antibodies in clients of the AIDS Center of the District Health Service in Karvina 1993-2000]. / Vysetrení HIV protilátek u klientu poradny AIDS Okresní hygienické stanice Karviná v letech 1993-2000.

The authors present the trends of some characteristics recorded in a group of subjects examined for HIV antibodies in the AIDS centre of the District Hygiene Station in Karviná in 1993 to 2000. These characteristics reflect the development of activities of the centre. During the period a total of 3733 HIV tests were made, incl. three positive ones. In two instances men with homosexual relations in the case-history were involved, in one case a male heterosexual. The declining trend of the ratio of anonymous examinations is apparent from 58.8% in 1993 to 7.7% in 2000. Parenteral drug users, prostitutes (in particular women) and homosexuals account on a long-term basis for ca 30% of all examinations. Recently this ratio is even higher. Repeated examinations (check-ups) of the same client account for 16.1% of all implemented HIV tests. At least once 384 parenteral drug users were examined, in prostitutes similarly as in men with homosexual relationships the number of subjects examined at least once is ca 200. Repeated tests were made in ca one quarter of all parenteral drug users, ca one third of the prostitutes and ca one fifth of homosexuals. In none of the repeated tests seroconversion to HIV positivity was recorded. To achieve close contact and monitoring of the HIV statute of groups with a risk behaviour despite their existence at the brink of law and despite their natural tendency to hide is real. Without collaborating organizations, without gaining their confidence and in particular without the confidence of the clients this would not be possible.

[A phone survey of prostitute services in homes]. / Telefonický pruzkum bytové prostituce.

BACKGROUND: Home prostitution is the hidden form of commercial sex network. We had done a phone survey of commercial sexual services provided in the private flats. METHODS AND RESULTS: We had used advertisements in the section "Intim services" of local adnewspaper "Avizo" as the primary source of relevant phone numbers. "Avizo" is sold in Northern Moravia--mainly in Ostrava, Karvina and Frydek-Mistek districts. We accomplished the phone interview with 48 subjects (individual persons or groups working in the particular flat) using the set of prepared questions. Three of these subjects were male, providing commercial sex for women. We estimated the number of such private flats, number of persons working there and number of professional contacts of this type in Karvina, Ostrava districts and whole Czech republic. CONCLUSIONS: We constructed an estimate of sexual sex workers for whole Czech republic--10,200 persons, therefrom 5100 persons in 1750 private flats, who accomplish to 1.36 mil sexual contact with customers annually. Regarding the risk behaviour nearly all of interviewed subjects indicated the use of condoms; 80% of subjects reported to be HIV-tested.

[Seroprevalence of viral hepatitis A, B and C in intravenous drug users]. / Séroprevalence virových hepatitid typu A-C u injekcních uzivatelu drog.

Markers of viral hepatitis A-C of 99 intravenous drug users predominantly (in 96%) from the Karviná district were examined from March 1998 to February 1999. Pervitin (methamphetamine) was the basic drug in all subjects. Anti-HAV was detected in 6.4% of VHA non-vaccinated individuals, anti-HAV/IgM was not found in any case, HBsAg was detected in 4.0% (acute VHB was diagnosed in all these cases), anti-HBc in 9.2% and anti-HCV in 25.0% of the investigated cases. Our results confirmed the importance of drug use by injection, esp. needle sharing, for the spread VHB and VHC. In case of VHA the fecal-oral route of transmission in this subpopulation is dominant.