Eleftheria Kanavou

National Income Inequality and Declining GDP Growth Rates Are Associated with Increases in HIV Diagnoses among People Who Inject Drugs in Europe: A Panel Data Analysis

Background There is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA). Methods We used panel data (2003–2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated. Findings In multivariable analyses, using two-year lagged values, we found that a 1% increase of GDP was associated with approximately 30% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested. Interpretation Given the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups.

Polydrug use by European adolescents in the context of other problem behaviours

Aim Previous studies of the association between polydrug use and other risk behaviours have generally been limited to specific substances and a small number of behaviours. The aim of this study is to obtain better insight into polydrug use (comprising legal and illegal substances: tobacco, alcohol, tranquillisers/sedatives, cannabis, and other illegal drugs) and its association with co-occurring problem behaviours drawn from various broad domains (sexual, aggressive, delinquent, school achievement, relationships) among European adolescents. Methods Data were obtained from 101,401 16-year-old students from 35 European countries participating in the 2011 ESPAD survey. Associations between polydrug use and other problem behaviours were examined by multinomial and binary logistic regression analyses. Results Tranquillisers/sedatives appeared among the commonest combinations in the polydrug use pattern, especially for females. A strong trend was found between levels of involvement with polydrug use and other problem behaviours for both genders. The highest associations with polydrug use were for problems with the police, risky sexual behaviour and skipping school. Gender differences showed higher prevalences among boys than girls of problem behaviours of aggressive, antisocial type, while girls prevailed over boys in relationship problems. Conclusion An incremental relationship exists between the level of involvement with polydrug use and the co-occurrence of problem behaviours. Preventative interventions should consider the misuse of tranquillisers/sedatives within the context of polydrug use by adolescents and expand their target groups towards multiple problem behaviours.

Prevalence and correlates of electronic cigarette use among adolescents in Greece: A preliminary cross-sectional analysis of nationwide survey data

INTRODUCTION This study reports the prevalence of electronic cigarette (e-cigarette) use among adolescents in Greece and explores how dual smokers of e-cigarettes and combustible (conventional) cigarettes differ from smokers of only combustible cigarettes across socio-demographic, familial, psychosomatic health and substance use characteristics. METHODS Self-reports on smoking were collected from a nationally representative sample of 1320 15-year-old Greek students in the 2014 Health Behaviour in School-aged Children study. Bivariate and multivariable logistic regression analyses were carried out with dependent variables a) lifetime smoking conventional cigarettes and b) lifetime e-cigarette use among lifetime smokers. RESULTS About 36.9% of 15-year-olds reported lifetime smoking of conventional cigarettes, and 16.6% lifetime use of e-cigarettes, mostly experimenting (0.5% reported current e-cigarette use). Six in 7 ever e-cigarette smokers had smoked conventional cigarettes. Peers who smoke and lifetime cannabis use were significant correlates of both lifetime conventional cigarette and e-cigarette smoking, but more strongly for smoking conventional cigarettes. Alcohol use and low parental monitoring correlated with tobacco smoking but not e-cigarette use. Girls were more likely than boys to report lifetime use of tobacco, but, among lifetime smokers, boys had almost seven times the odds of girls of e-cigarette use. In lifetime smokers, low life satisfaction in females and current smoking of conventional tobacco were independently associated with the experimentation with e-cigarettes. CONCLUSIONS Experimental use of e-cigarettes is relatively widespread among adolescents in Greece. Targeted interventions should focus on male smokers and the role of peer processes and cannabis use in the risk of experimenting with e-cigarettes.

Factors associated with HCV test uptake in heroin users entering substitution treatment in Greece

People who inject drugs (PWID) represent the main risk group for hepatitis C virus (HCV) infection in most middle and high‐income countries. Testing PWID is considered as an important prevention measure. Identification of PWID characteristics associated with HCV testing may contribute to strategies targeting the containment of the HCV and HIV epidemics in Greece.

Real-World Data on Health-Related Quality of Life Assessment in Patients With Breast Cancer Receiving Subcutaneous Trastuzumab:

Purpose: Trastuzumab, a humanized anti-human epidermal growth factor receptor 2 (anti-HER2) antibody delivered intravenously, has revolutionized the treatment of patients with breast cancer overexpressing HER2 protein. Recently, a newer subcutaneous formulation was shown to have comparable efficacy to the initial intravenous trastuzumab. In this study, we aimed to evaluate the impact of subcutaneous trastuzumab on the health-related quality of life (HRQoL) of patients diagnosed with early or metastatic HER2-overexpressing breast cancer. Methods: Patients were provided with the EORTC QLQ-C30 (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30) and the BR-23 questionnaires. The scoring of questionnaires and patient’s sociodemographic and clinicopathologic characteristics were recorded and analyzed by descriptive and correlation statistics employing t test and 2-way analysis of variance. Results: A total of 163 patients agreed to participate in the study. About 90 of 163 patients (55.21%) received subcutaneous trastuzumab and 21 patients intravenous trastuzumab (12.88%). A control group of 52 HER2+ patients received chemotherapy without trastuzumab (31.90%). Patients receiving subcutaneous trastuzumab were older and of more advanced disease stage compared with those receiving chemotherapy (58.5 vs 51 years, 39.8% vs 28.8% advanced disease). In univariate analysis, subcutaneous trastuzumab was associated with less nausea and vomiting (P = .002) but worse cognitive function (P = .013) and dyspnea (P = .042). Patients who have received >8 cycles of subcutaneous trastuzumab reported less diarrhea (P = .049) and systemic therapy side effects (P = .015). Multivariate analysis showed that patients without comorbidity receiving subcutaneous trastuzumab had less treatment side effects, less upset by hair loss, and higher emotional functioning. Of note, mastectomy and subcutaneous trastuzumab were associated with improved role functioning (P = .021). In metastatic disease, no negative impact of subcutaneous trastuzumab on HRQoL was found. Conclusions: The administration of subcutaneous trastuzumab improved certain symptoms and did not adversely affect most of the assessed functional scales. Particularly, in the metastatic setting, subcutaneous trastuzumab had no negative impact on HRQoL.

Trends in the Association Between Prescribed and Non-Prescribed Use of Tranquillisers or Sedatives Among Adolescents in 22 European Countries

Aims Tranquillisers and sedatives are valuable medicines with high misuse potential, increasingly used by adolescents without a doctors prescription. We examined the changing association between lifetime non-prescribed use of tranquillisers or sedatives and their prescribed use in European adolescents in 2003-2011. Design Cross-sectional data from 199,231 16-year-old students were collected through anonymous questionnaires administered in schools in 22 European countries participating in the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2003, 2007 and 2011. Results Logistic regression analyses showed a modest increase in lifetime non-prescribed use of tranquillisers or sedatives (adjusted OR [AOR] = 1.08, 95% CI: 1.06-1.11, p < 0.001) and a decrease in prescribed use (AOR = 0.89, 95% CI: 0.87-0.91, p < 0.001) between 2003 and 2011. Adjusting for gender and survey year, any versus no prescribed use increased the odds tenfold for non-prescribed use (AOR = 10.15, 99% CI: 9.60-10.74, p < 0.001). Adjusting also for changes in cannabis use did not affect the strength of the association. Interactions of factors with survey year showed that between 2003 and 2011, there was an increase of 38% in the odds that tranquilliser or sedative misusers had not used these drugs also with a doctors prescription (AOR = 1.38, 99% CI: 1.28-1.50, p < 0.001). Conclusion The waning strength of the association between prescribed and non-prescribed use of tranquillisers or sedatives among adolescents may suggest changes both in the patterns of use and the channels of diversion and access to this class of medication in Europe.

Misuse of prescription opioid analgesics among adolescents in Greece: the importance of peer use and past prescriptions

Aims: The study explored the prevalence and correlates of the non-prescribed use (misuse) of prescription opioid analgesics in a nationally representative sample of adolescent students in Greece. Methods: Cross-sectional data were collected through anonymous questionnaires administered to a random stratified sample of 676 high schools involving 23,279 students aged 15–19 in 2011. Findings: About 16.2% reported lifetime misuse, 6.3% repeated misuse at least three times – most of them to alleviate pain. Results of multivariate logistic regression showed that among the strongest correlates of repeated misuse were peer misuse (Odds ratio [OR] = 4.10, 99% Confidence Interval [CI] = 3.11–5.42), past prescription of opioid analgesics (OR = 3.19, 99% CI = 2.28–4.48 in males, OR = 2.38, 99% CI = 1.78–3.19 in females), lifetime misuse of tranquilisers/sedatives (OR = 3.16, 99% CI = 2.22–4.48), and frequent use of over-the-counter analgesics (OR = 2.37, 99% CI = 1.92–2.92). Other correlates included: female gender, daily smoking (by girls), frequent alcohol use, antisocial behaviour, physical or emotional maltreatment, and past prescription of tranquilisers/sedatives. Illicit drug use failed to explain opioid analgesics misuse. Conclusions: Misuse of prescription analgesics is common among adolescents in Greece and seems to emerge within a self-treating rather than a mood-altering context of use.