Publications by authors named "Jaroslav Sejvl"

6 Publications

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

BMJ Open 2021 05 19;11(5):e043037. Epub 2021 May 19.

Department of Addictology, Charles University, First Faculty of Medicine, Praha, Czech Republic.

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.
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http://dx.doi.org/10.1136/bmjopen-2020-043037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137204PMC
May 2021

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

Int J Public Health 2020 Nov 6;65(8):1403-1412. Epub 2020 Aug 6.

Department of Addictology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.

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.
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http://dx.doi.org/10.1007/s00038-020-01449-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588359PMC
November 2020

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

Clin Toxicol (Phila) 2020 09 8;58(9):870-880. Epub 2020 Jan 8.

Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.

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. 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. 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;  = .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,  = .004) and mental component summary score (9.5 points; 95%CI 1.9-17.1,  = .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;  = .033), bodily pain (8.7 points; 95%CI 1.6-17.6;  = .018), and social functioning (8.2 points; 95%CI 3.0-17.4;  = .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  > .05). 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.
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http://dx.doi.org/10.1080/15563650.2019.1702994DOI Listing
September 2020

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

Cent Eur J Public Health 2019 12;27 Suppl:S55-S65

Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech 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.
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http://dx.doi.org/10.21101/cejph.a5812DOI Listing
December 2019

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

Cent Eur J Public Health 2019 12;27 Suppl:S29-S39

Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.

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.
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http://dx.doi.org/10.21101/cejph.a5764DOI Listing
December 2019

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

Clin Toxicol (Phila) 2020 04 12;58(4):241-253. Epub 2019 Jul 12.

Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.

The influence of co-morbid conditions on the outcome of acute methanol poisoning in mass poisoning outbreaks is not known. 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. 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. 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;  = .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;  = .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  < .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;  = .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 ( = .027) or moderate ( = .020) scores. For the patients who died during follow-up, cancers of different localizations were responsible for 7/15 (47%) of the deaths. 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.
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http://dx.doi.org/10.1080/15563650.2019.1637525DOI Listing
April 2020
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