| 1. |
- Blomé, Marianne Alanko, et al.
(författare)
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Hepatitis C treatment at a Swedish needle exchange program, a successful model of care – the ACTIONNE study
- 2021
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Ingår i: International Journal of Drug Policy. - : Elsevier BV. - 0955-3959. ; 96
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Tidskriftsartikel (refereegranskat)abstract
- Background: To engage people who inject drugs (PWID) in HCV care, innovative models of care are urgently needed. A needle exchange program (NEP) could serve as an ideal platform for comprehensive HCV management including post treatment follow up. Methods: 50 actively injecting patients at the Malmö Needle exchange program (MNEP) were consecutively enrolled between April 2018 and May 2019. All patients received a fixed-dose combination of once-daily glecaprevir/pibrentasvir for 8 or 12 weeks. Patients were monitored weekly during treatment and data on adherence and side effects was recorded. The primary endpoint was SVR12. Adherence to treatment was the secondary endpoint. Results: 47/50 (94%) patients completed treatment. 45/50 were HCV negative at 12 weeks post treatment giving an SVR12 rate per ITT of 90% and an SVR12 rate per protocol of 96%. One patient showed reinfection 12 weeks post treatment and one patient was lost to follow up and did not produce an SVR12 result. The mean adherence per week, according to pill count, was 98%. Conclusion: Our study shows that the NEP can be a useful tool for engaging actively injecting PWID in HCV management and that SVR rates, comparable to those in non-PWID settings, can be achieved.
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| 2. |
- Bråbäck, Martin, et al.
(författare)
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Health related quality of life in individuals transferred from a needle exchange program and starting opioid agonist treatment
- 2018
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Ingår i: Journal of addiction. - : Hindawi Limited. - 2090-7834 .- 2090-7850. ; 2018, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Background. Opioid agonist treatment (OAT), for the treatment of heroin dependence, has been reported to improve overall health and lower mortality. Drug use and retention in treatment have often been used as measures of treatment success. More recently, however, researchers have suggested that measurements of quality of life should be an outcome in substance use treatment evaluations. In a recent randomized controlled trial we demonstrated high rates of successful rapid referral from a needle exchange program (NEP) to OAT. The aim of this study was to see whether an improvement in health related quality of life (HRQoL) could be seen at 3-month follow-up after starting OAT and whether it was associated with any baseline characteristics. We also wanted to compare our sample to a sample from the general population with regard to HRQoL. Methods. This was a 3-month follow-up of 71 patients who started OAT. Measurements of HRQoL with EQ-5D (an instrument developed by the EuroQol group) were made at baseline and at three months. Results. Mean EQ-5D VAS (visual analogue scale) for the study sample at baseline was 47.3, which was lower than a Swedish reference population reporting 83.3. Individuals reporting being prescribed a drug for a psychiatric condition had significantly lower EQ-5D index values. Improvement in EQ-5D index score was significantly less for individuals reporting previous overdoses (-0.10, p=0.025). Individuals reporting previous suicide attempts had significantly lower EQ-5D VAS score at baseline. A significant increase of the EQ-5D VAS difference over time was found with a mean difference of 10.94 (p=0.008) for the total sample. Conclusion. To our knowledge this is the first time HRQoL as an outcome is reported in a population transferred from a NEP to OAT. Our results indicate that OAT can result in increased HRQoL, even with this type of rapid low-threshold referral.
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| 5. |
- Bråbäck, Martin, et al.
(författare)
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Malmö treatment referral and intervention study—high 12-month retention rates in patients referred from syringe exchange to methadone or buprenorphine/ naloxone treatment
- 2017
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 8:AUG
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Tidskriftsartikel (refereegranskat)abstract
- Background: Heroin dependence is associated with high mortality. Opioid agonist treatment (OAT) with methadone or buprenorphine has strong evidence for treatment of this relapsing condition. In our setting, OAT has been associated with strict and demanding intake procedures, often with requirements of social stability, but also high, approximately 80 percent 12-month retention rates. In a recent randomized controlled trial, we demonstrated high rates of successful rapid referral from a syringe exchange programme (SEP) to treatment with methadone or buprenorphine, including actual treatment initiation. The objectives of this study were to assess 12-month retention rates, in order to assess whether a novel referral program of current drug users at a SEP would achieve retention rates comparable to more traditional intake procedures. Methods: The present report is a 12-month follow-up of 71 patients who successfully started treatment with methadone or buprenorphine/naloxone. Patient data from baseline and at 12 months were collected. results: Out of the 71 patients who started treatment, 58 (82%) were still in treatment after 12 months. conclusion: This was a population, referred from a SEP, with a high drug use severity on admission and no pretreatment requirement for social stability, but there were still high retention rates at 12 months comparable to regular opioid agonist clinics in our setting.
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| 6. |
- Bråbäck, Martin, et al.
(författare)
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Substance Use, Hospitalizations, and Co-Occurring Disorders among Patients Transferred from a Needle Exchange Program to Opioid Maintenance Treatment
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:2
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Tidskriftsartikel (refereegranskat)abstract
- Opioid use disorders (OUD) is a relapsing condition with high mortality. Opioid maintenance treatment (OMT) reduces heroin use, and overall morbidity and mortality. The prevalence of psychiatric and substance use disorders, potential baseline predictors for psychiatric hospitalization, and psychiatric diagnoses at follow-up were investigated and may give hints about possible preventative strategies. The medical records for 71 patients were reviewed 36 months following referral to OMT from a needle exchange program (NEP). Their psychiatric diagnoses and hospitalizations were identified. Their baseline characteristics were assessed for potential differences between hospitalized versus non-hospitalized patients and between patients with and without psychiatric diagnoses in a longitudinal observational study without controls. A regression analysis was performed to identify predictors for hospitalization when controlling for OMT status. Sixty-five percent of the patients were hospitalized at least once with a psychiatric diagnosis. Substance-related reasons were prevalent, and detoxification occurred among 59% of patients, with sedative-hypnotics (benzodiazepines, zopiclone, zolpidem, and pregabalin) being the substance used by 52% of patients. Baseline use of these drugs and/or buprenorphine predicted for hospitalization when controlling for OMT status. During the follow-up period, 72% of patients met the criteria for a psychiatric diagnosis other than OUD. The prevalence of non-substance use disorders overlapping with SUD was 41%, and that overlapping with anxiety disorder was 27% of all participants. Increased attention to psychiatric co-occurring disorders in the treatment of OUD is required and the importance of addressing sedative-hypnotics use when initiating OMT is highlighted.
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| 7. |
- Bråbäck, Martin, et al.
(författare)
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Susceptibilities of Mycobacterium marinum to Gatifloxacin, Gemifloxacin, Levofloxacin, Linezolid, Moxifloxacin, Telithromycin, and Quinupristin-Dalfopristin (Synercid) Compared to Its Susceptibilities to Reference Macrolides and Quinolones.
- 2002
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Ingår i: Antimicrobial Agents and Chemotherapy. - 1098-6596. ; 46:4, s. 1114-1116
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Tidskriftsartikel (refereegranskat)abstract
- The susceptibility pattern of Mycobacterium marinum was determined. Quinupristin-dalfopristin and telithromycin were less active than clarithromycin. Linezolid showed good antimicrobial activity at clinically achievable concentrations. Gatifloxacin, levofloxacin, and moxifloxacin displayed activities similar to those of ciprofloxacin. Gemifloxacin was less active. The Etest method showed variable agreement with the reference method.
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| 8. |
- Dahlman, Disa, et al.
(författare)
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Attitudes towards hepatitis C and treatment willingness in injection drug users: a follow-up interview study.
- 2015
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Ingår i: Journal of Alcoholism & Drug Dependence. - : OMICS Publishing Group. - 2329-6488. ; 3:4, s. 4-4
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Many injection drug users are infected with hepatitis C virus (HCV), yet few are treated. With opiate maintenance treatment, expected life length increases, and the incitement increases to treat HCV in order to avoid long term complications. The aim of the present study was to investigate attitudes towards HCV and HCV treatment willingness among opiate-dependent injection drug users at Malmö needle exchange program, through interviews just before entering opiate maintenance treatment and after 6 months in opiate maintenance treatment. Heroin-dependent injection drug users were recruited from Malmö needle exchange program October 2011 – April 2013. They had a structured baseline interview (N=83), led by social workers. After 6 months, all patients who successfully entered opiate maintenance treatment and were still enrolled (N=56) had a follow-up interview. Correlations with treatment willingness were calculated using Pearson’s Chi-Square test. Change over time was determined by McNemar Test. A majority at both baseline and follow-up wanted more information about HCV, but HCV-positive subjects did not feel affected by their HCV status. No significant change in treatment willingness was found after 6 month in opiate maintenance treatment, neither were any factors significantly associated with treatment willingness found. We conclude that there is need for inclusion of more information about and easy referral to HCV therapy as part of opiate maintenance treatment.
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| 9. |
- Forsberg, Bertil, et al.
(författare)
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An expert assessment on climate change and health : with a European focus on lungs and allergies
- 2012
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Ingår i: Environmental Health. - 1476-069X. ; 11:Supplement 1, s. S4-
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFor almost 20 years, the Intergovernmental Panel on Climate Change has been assessing the potential health risks associated with climate change; with increasingly convincing evidence that climate change presents existing impacts on human health. In industrialized countries climate change may further affect public health and in particular respiratory health, through existing health stressors, including, anticipated increased number of deaths and acute morbidity due to heat waves; increased frequency of cardiopulmonary events due to higher concentrations of air pollutants; and altered spatial and temporal distribution of allergens and some infectious disease vectors. Additionally exposure to moulds and contaminants from water damaged buildings may increase.MethodsWe undertook an expert elicitation amongst European researchers engaged in environmental medicine or respiratory health. All experts were actively publishing researchers on lung disease and air pollution, climate and health or a closely related research. We conducted an online questionnaire on proposed causal diagrams and determined levels of confidence that climate change will have an impact on a series of stressors. In a workshop following the online questionnaire, half of the experts further discussed the results and reasons for differences in assessments of the state of knowledge on exposures and health effects.ResultsOut of 16 experts, 100% expressed high to very high confidence that climate change would increase the frequency of heat waves. At least half expressed high or very high confidence that climate change would increase levels of pollen (50%), particulate matter (PM2.5) (55%), and ozone (70%). While clarity is needed around the impacts of increased exposures to health impacts of some stressors, including ozone and particulate matter levels, it was noted that definitive knowledge is not a prerequisite for policy action. Information to the public, preventive measures, monitoring and warning systems were among the most commonly mentioned preventative actions.ConclusionsThis group of experts identifies clear health risks associated with climate change, and express opinions about these risks even while they do not necessarily regard themselves as covering all areas of expertise. Since some changes in exposure have already been observed, the consensus is that there is already a scientific basis for preventative action, and that the associated adaptation and mitigation policies should also be evidence based.
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| 10. |
- Troberg, Katja, et al.
(författare)
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Malmö Treatment Referral and Intervention Study (MATRIS)-36-month follow-up on retention and substance use among patients referred from needle exchange to opioid agonist treatment-The role of stimulant use at baseline
- 2023
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Ingår i: Journal of Substance Use and Addiction Treatment. - 2949-8759. ; 151
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Opioid use disorder (OUD) is the leading cause of overdose morbidity and mortality globally. Retention in opioid agonist treatment (OAT) is crucial as it effectively reduces overdose mortality among individuals suffering from OUD. Previous research on treatment retention among heroin-dependent individuals referred from needle exchange programs (NEP) to OAT is scarce, and with predictors for retention in OAT being somewhat inconclusive, further investigations into this subject is of great interest. The aim of our study was to assess 36-month treatment outcomes-defined as retention and illicit drug abstinence-and predictors of OAT discontinuation.METHODS: This is a longitudinal cohort study of 71 study subjects successfully referred from a NEP to OAT. Participants were included between October 2011 and April 2013 and followed for 36 months. The study collected data from a structured baseline interview and from patient records, including laboratory data.RESULTS: At the 36-month follow-up, retention was 51 % (n = 36), with mean days in treatment of 422 for those who discontinued treatment. Amphetamine use during the 30 days before inclusion was positively correlated with treatment discontinuation (AOR 1.22 [95 % CI 1.02-1.46]). No statistically significant association with retention was seen for gender, age, suicide attempt prior to treatment, or benzodiazepine use during 30 days prior to treatment. Opiate use and use of other substances were reduced over time, with major reductions occurring during the first 6 months.CONCLUSIONS: Hitherto, baseline factors predicting retention in OAT have been insufficiently demonstrated. Active referral from NEP to OAT is effective when it comes to long-term retention and reduction of substance use while in treatment. Except from use of amphetamine, the use of other substances prior to OAT was not associated with treatment discontinuation. Further and in-depth analyses of baseline predictors are of importance for OAT retention.
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