Comparison of Alcohol Consumption and Alcohol Policies in the Czech Republic and Norway.

OBJECTIVE: The Czech Republic is characterized by high alcohol consumption and is well known as the world's biggest consumer of beer. In contrast, the alcohol consumption in Norway is relatively low. In this article, we describe and discuss alcohol policy development in the Czech Republic since the mid-1980s to the present and its impact on the alcohol consumption and compare our findings, including the dynamics of the total alcohol consumption and the development of drinking patterns among young people, with the situation in Norway. METHODS: The study uses the methodology of "process tracing". Selected national statistics, research outcomes and related policy documents were analyzed to identify possible relations between the alcohol consumption and the alcohol policy in two different environments and institutional/policy settings. RESULTS: There was a clear difference in alcohol consumption trends in both countries in the last three decades. Norway was characterized by low alcohol consumption with tendency to decline in the last years. In contrast, the Czech Republic showed an upward trend. In addition, alcohol consumption among Czech youth has been continuously increasing since 1995, whereas the opposite trend has occurred in Norway since the late 1990s. The results revealed that the alcohol-control policies of the Czech Republic and Norway were significantly different during the study period. Norway had a very restrictive alcohol policy, in contrast to the liberal alcohol policy adopted in the Czech Republic, in particular after political transition in 1990. Liberalization of social life together with considerable decline of alcohol price due to complete privatization of alcohol production and sale contributed to an increase of the alcohol consumption in the Czech Republic. CONCLUSIONS: Persistently high alcohol consumption among general population and its growth among young people in the Czech Republic pose social, economic and health threats. Norway could provide the inspiration to Czech politicians about effective options in combating these threats.

Changes in mortality after first psychiatric admission: a 20-year prospective longitudinal clinical study.

OBJECTIVE: To examine changes in the mortality of patients admitted to a Norwegian psychiatric hospital from 1985 to 2003: this period saw profound changes in structure and organization of the mental healthcare system. METHOD: A 20-year prospective longitudinal, record linkage study of all patients admitted to a psychiatric hospital with sector responsibility from 1985 to 2003. RESULTS: Excess mortality was found for the patient group. Overall standardized mortality ratio (SMR) (95% confidence interval, CI) was 2.85 (2.53-3.07)/2.15 (1.94-2.41) for male/female patients. One third of the patients who died in the study period died within 2 years after first admission, and 45% of the deaths happened within 2 years after last discharge. The median age at death decreased in the study period for patients who were younger than 65 years at their first admission. The median difference of lost years of life for the patients younger than 65 years at first admittance was 26.95/23.96 years for male/female patients. SMR increased for the youngest cohorts during the study period over time. From 1985 to 2003, SMR increased dramatically for both genders. CONCLUSION: Patients admitted to a Norwegian psychiatric hospital for their first stay during 1985-2003 suffered increased excess mortality, whereas mortality in the general population decreased. The mortality was highest in the first 2 years after admission. Despite profound changes in the mental healthcare system, the mortality gap increased in the study period and was highest in the youngest birth cohorts.

A prospective longitudinal study of utilization of a psychiatric hospital in Hordaland County, Norway, from 1985 to 2003.

BACKGROUND: In Norway, as in the rest of the Western world, during the last three decades there has been a reduction of psychiatric hospital beds and expansion of extramural mental services, more based on ideology than empirical research. AIMS: To study the use of a psychiatric hospital before and after expansion of the outpatient psychiatric care in Hordaland County, Norway from 1985 to 2003. METHODS: All patients admitted from a catchment area of 168,000 inhabitants were included in a prospective longitudinal study. RESULTS: During the study period, there was a decrease in psychiatric hospital beds in the county. From 1991 to 2003, the annual number of outpatient consultations in District Psychiatric Centres more than doubled, but none of the four psychiatric hospitals in the county showed any decline in the number of admitted patients. Since 1995, there was a 100% increase in the annual number of stays, number of individual patients and number of first-stay patients admitted to the psychiatric hospital serving the inner-city area of Bergen, the main city in Hordaland, and the surrounding countryside. In this hospital, the annual number of patients with a drug/alcohol problem showed a fivefold increase. The same was the case for patients from the immigrant population. The annual number of first stays and hospital days for patients aged 20-29 years from the rural area increased more than twofold. CONCLUSION: There is still an increased need for specialized inpatient hospital mental healthcare, despite the growth of the extramural mental health services.