Below: Probabilities of reporting reasons for not seeking treatment, predicted by alcohol use disorder severity. Severity of alcohol use disorders in the past 12 months ranged from sub threshold (reference) to severe as defined by DSM-5. Predictions are based on multinomial logistic regression. Reasons are grouped by Saunders' theoretical framework. 95 % confidence intervals are indicated
Below: Theoretical framework of the treatment seeking process as suggested by (Saunders et al. [17]). Each step in the process of seeking treatment for an alcohol use disorder is related to specific reasons for not seeking treatment. Reprinted from Journal of Substance Abuse Treatment, 30 (3), Saunders, Zygowicz, & D'Angelo, Person-related and treatment-related barriers to alcohol treatment, p. 261–270, © 2006, with permission from ELSEVIER
Of 1,008 patients diagnosed with an alcohol use disorder (via general practitioner or patient interview) in the past 12 months, the majority (N = 810) did not receive treatment and 251 of those gave a reason for not seeking treatment. The most frequent reason was ‘lack of problem awareness’ (55.3 % of those who responded), the second most common response was ‘stigma or shame’ (28.6 %), followed by ‘encounter barriers’ (22.8 %) and ‘cope alone’ (20.9 %). The results indicated lower probabilities of reporting ‘denial’ and higher probabilities to report ‘encounter barriers’ as alcohol use disorders severity increases. However, both trends were discontinued for patients with severe alcohol use disorders.
Particularly at lower levels of alcohol use disorder severity, a lack of problem awareness prevents patients from seeking treatment. Routinely alcohol consumption monitoring in primary care practices could help primary and secondary prevention of alcohol use disorders and increase treatment coverage.
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Below: Main causes of death among the pooled cohort, where the cause of death is reported
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Below: TBNET study sites in the Pan European network for study and clinical management of drug-resistant tuberculosis (TBPAN-NET) project. Stratification is based on the incidence of tuberculosis (TB) reported during 2010–2011, which matched the inclusion period of the study. Data for 2011 were obtained from the European Centre for Disease Control and Prevention (10). Low TB incidence, <20 cases/100,000 persons; intermediate TB incidence, 20–100 cases/100,000 persons; high TB incidence, >100 cases/100,000 persons.
Drug-resistant Mycobacterium tuberculosis is challenging elimination of tuberculosis (TB). We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. A total of 380 patients with MDR TB and 376 patients with non–MDR TB were enrolled at 23 centers in 16 countries in Europe during 2010–2011. A total of 52.4% of MDR TB patients had never been treated for TB, which suggests primary transmission of MDR M. tuberculosis. At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant. Previous treatment for TB was the strongest risk factor for MDR TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe.
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