The results of this study show the favorable epidemiological trend because of the decreasing number of new opiate patients in treatment. The retention of opiate patients in substitution therapy indicates the effectiveness of methadone maintenance programs. Our research did not determine any influence of methadone substitution therapy on an increasing risk of specific (overdose) mortality.
AimTo assess the effect of liver damage on methadone metabolism in opiate addicts undergoing methadone maintenance treatment (MMT).MethodsThis cross-sectional study recruited 74 patients treated at the outpatient clinic of Public Health Institute of Split-Dalmatia County from 2013-2016. Concentrations of methadone and its main inactive metabolite were measured in participants’ biological samples on regular check-ups. Urine samples obtained before oral methadone intake, and blood and urine samples obtained 90 minutes after methadone intake were analyzed using gas chromatography/mass spectrometry. Participants were divided into groups according to liver damage criteria: hepatitis C virus status (positive, negative, or clinical remission); aspartate aminotransferase to platelet ratio (APRI) index (<0.7 and ≥0.7); and fibrosis-4 score (<1.45, 1.45-3.25, >3.25).ResultsMetabolic ratio and methadone metabolite concentration in plasma decreased linearly with HCV infection status by the factor of 1.67 (P = 0.001) and 2.2 (P = 0.043), respectively. Metabolic ratio in plasma decreased in patients with APRI index ≥0.7 by the average factor of 2.12 (P = 0.01) and methadone metabolite concentration in plasma decreased by the factor of 6.16 (P = 0.009). Metabolic ratio in urine decreased with the severity of fibrosis-4 score by the average factor of 1.63 (P = 0.008), whereas methadone metabolite concentration decreased by the factor of 3.53 (P = 0.007).ConclusionLiver damage decreases methadone metabolism. Indices of liver function should be calculated regularly during MMT for methadone dose titration.
U ovom radu prikazuje se korištenje art-terapije u svrhu očuvanja i unapređenja mentalnog zdravlja djece i mladih s teškoćama. Stigmatizacija s kojom se često susreću narušava njihovo mentalno zdravlje dok uspješna socijalna integracija djeluje kao zaštitni faktor u očuvanju i unapređenju mentalnog zdravlja. S tim ciljem proveden je projekt “Poveži se bojom, približi se slikom” u kojem su sudjelovala djeca i mladi s teškoćama, kao i njihovi vršnjaci tipičnog razvoja. U sklopu projekta provedeno je istraživanje čiji je cilj bio ispitati uspješnost metode art-terapije kao načina senzibilizacije djece i mladih, učenika osnovnih i srednjih škola, za potrebe i mogućnosti osoba s teškoćama te poticanja inkluzivnog promišljanja i djelovanja. U istraživanju je sudjelovalo 359 učenika/učenica s područja Splitsko-dalmatinske županije, ujedno i sudionika/-ica projekta. Korišten je anketni upitnik koji se sastojao od pitanja otvorenog i zatvorenog tipa te su prikupljeni i analizirani kvalitativni i kvantitativni podaci. Rezultati su pokazali da art-terapija korištena kao alat za socijalnu interakciju pridonosi povećanju stupnja senzibilizacije i prihvaćanja djece s teškoćama od strane njihovih vršnjaka bez teškoća. Naposljetku dvosmjerna socijalizacija u poticajnom okruženju posljedično pridonosi zaštiti i unapređenju mentalnog zdravlja djece s teškoćama.
Summary: The comic book art technique is rarely analysed as an illustrative and projective technique within the field of mental health and prevention of behavioural problems of children and young people. That is why the aim of this study is directed towards analysing the potentials of comic book art as a projective technique. The evaluation results of the Mostly Sunny project were used, and qualitative research methods were applied. The data were obtained through focus groups and thematic framework analysis was conducted. Through thematic framework analysis 21 dimensions were recognized. Adolescents are known for their difficulties in verbalizing their thoughts and emotions. Various approaches have been used in dealing with mental health problems of adolescents. A visual approach to the issue of mental health, such as the use of comic books, has shown positive results. The evaluation of young peoples answers has proven that this method was a way for them to get in touch with their own feelings and to talk about them without having to be afraid of what others might think. This may also be a good approach for young people in the future because it provides a safe environment, which is something different in the context/ field of working with a specific and vulnerable population. By analysing these dimensions, it is possible to conclude that the comic created through this project is easy to use because it is short and eventful, it allows the participants of the program to work together on their experiences which initiates developmental processes such as emotional literacy or the integration of other people's messages about themselves. Key words: comic book art; prevention of emotional and behavioural problems; thematic analysis.
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